In order to control for the effect of infection on the T cell subpopulations, disease controls were recruited from the immunodeficiency clinic. These were immune-competent patients who had an increased infection burden, in whom no clinical or laboratory evidence for immunodeficiency was found. Results from this group were included only once a period of 1 year had elapsed since discharge from the clinic, to rule out an evolving immunodeficiency.
The immune tests undertaken were guided by clinical and family histories. The typical panel of tests performed included: IgG, IgA and IgM, and serum and urine electrophoresis with immunofixation if indicated. Specific antibody responses to the vaccines tetanus, pneumococcal and Haemophilius influenza B were performed, and if absent/low responses were noted the patient XL765 mouse was vaccinated and these retested after 1 month. Lymphocyte subsets, both percentage and absolute count, GDC-0068 research buy were also performed, including measurement of B cells, CD4 and CD8 T cells and natural killer (NK) cells [3,27]. At the time of analysis, all XLA and 55 of 58 CVID patients were on immunoglobulin
replacement, but not on immunosuppressive therapy. Those with autoimmune cytopenia or lymphoid interstitial pneumonia had not received corticosteroid therapy within 6 months, and only at prior doses <25 mg/kg. No patient had an affected parent, sibling or child. CVID patients
were categorized into the following clinical phenotypes, as described in Chapel et al. [2,3]: infection only (IO), enteropathy, lymphoid malignancy, polyclonal lymphoproliferation (PL), organ-specific autoimmune disease (OSAI) or autoimmune cytopenias (AC) which included immune thrombocytopenia (ITP). ITP is defined as platelets <100 × 109/l, persistent L-NAME HCl (>6 months), one episode treated with steroids . The autoimmune diseases in patients in the OSAI group included: autoimmune thyroid disease (n = 5), psoriasis (n = 6), uveitis (n = 2), vitiligo (n = 2), pernicious anaemia (n = 3), ulcerative colitis (n = 4) and type 1 diabetes (n = 2). Only one patient had a subsequent lymphoid malignancy and only three had an enteropathy, so these categories were not utilized in the analysis; these patients were included in the CVID total group. Figure 1 demonstrates the distribution of clinical phenotypes of the CVID patient group. The number of patients stated in each group in Table 1 is the maximum number of patients analysed for a T cell subpopulation. However, for some of the T cell subpopulations smaller numbers were analysed due to either technical difficulties with a particular tube or limited sample availability. All flow cytometric analysis was performed on ethylenediamine tetraacetic acid (EDTA) blood samples within 48 h of venepuncture.