Counter-regulation of regulatory T cells by autoreactive CD8+ T cells in rheumatoid arthritis

Ilenia Cammarata, Carmela Martire, Alessandra Citro, Domenico Raimondo, Doriana Fruci, Ombretta Melaiu, Valentina D'Oria, Chiara Carone, Giovanna Peruzzi, Cristina Cerboni, Angela Santoni, John Sidney, Alessandro Sette, Marino Paroli, Rosalba Caccavale, Edoardo Milanetti, Mara Riminucci, Eleonora Timperi, Silvia Piconese, Antonio ManzoCarlomaurizio Montecucco, Rossana Scrivo, Guido Valesini, Elisabetta Cariani, Vincenzo Barnaba

Research output: Contribution to journalArticlepeer-review


The mechanisms whereby autoreactive T cells escape peripheral tolerance establishing thus autoimmune diseases in humans remain an unresolved question. Here, we demonstrate that autoreactive polyfunctional CD8+ T cells recognizing self-antigens (i.e., vimentin, actin cytoplasmic 1, or non-muscle myosin heavy chain 9 epitopes) with high avidity, counter-regulate Tregs by killing them, in a consistent percentage of rheumatoid arthritis (RA) patients. Indeed, these CD8+ T cells express a phenotype and gene profile of effector (eff) cells and, upon antigen-specific activation, kill Tregs indirectly in an NKG2D-dependent bystander fashion in vitro. This data provides a mechanistic basis for the finding showing that AE-specific (CD107a+) CD8+ T killer cells correlate, directly with the disease activity score, and inversely with the percentage of activated Tregs, in both steady state and follow-up studies in vivo. In addition, multiplex immunofluorescence imaging analyses of inflamed synovial tissues in vivo show that a remarkable number of CD8+ T cells express granzyme-B and selectively contact FOXP3+ Tregs, some of which are in an apoptotic state, validating hence the possibility that CD8+ Teff cells can counteract neighboring Tregs within inflamed tissues, by killing them. Alternatively, the disease activity score of a different subset of patients is correlated with the expansion of a peculiar subpopulation of autoreactive low avidity, partially-activated (pa)CD8+ T cells that, despite they conserve the conventional naïve (N) phenotype, produce high levels of tumor necrosis factor (TNF)-α and exhibit a gene expression signature of a progressive activation state. Tregs directly correlate with the expansion of this autoreactive (low avidity) paCD8+ TN cell subset in vivo, and efficiently control their differentiation rather their proliferation in vitro. Interestingly, autoreactive high avidity CD8+ Teff cells or low avidity paCD8+ TN cells are significantly expanded in RA patients who would become non-responders or patients who would become responders to TNF-α inhibitor therapy, respectively. These data provide evidence of a previously undescribed role of such mechanisms in the progression and therapy of RA.

Original languageEnglish
Pages (from-to)81-97
Number of pages17
JournalJournal of Autoimmunity
Publication statusPublished - May 2019


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