Unravelling the complexity of T cell abnormalities in common variable immunodeficiency

We investigated several phenotypic and functional parameters of T cell-mediated immunity in a large series of common variable immunodeficiency (CVID) patients. We demonstrated that the vast majority of CVID patients presented multiple T cell abnormalities intimately related among them, the severity of which was reflected in a parallel loss of CD4⁺ naive T cells. A strong correlation between the number of CD4⁺ naive T cells and clinical features was observed, supporting the subgrouping of patients according to their number of naive CD4⁺ T lymphocytes. A reduced thymic output and disrupted CD4⁺ and CD8⁺ TCR repertoires paralleled the contraction of CD4⁺ naive T cell pools. The evaluation of activation markers and cytokine production indicated a strong T cell activation that was significantly related to the increased levels of T cell turnover and apoptosis. Finally, discrete genetic profiles could be demonstrated in groups of patients showing extremely diverse T cell subset composition and function. Naive CD4⁺ T cell levels were significantly associated with the switched memory B cell-based classification, although the concordance between the respective subgroups did not exceed 58.8%. In conclusion, our data highlight the key role played by the T cell compartment in the pathogenesis of CVID, pointing to the need to consider this aspect for classification of this disease.