Introduction and Aim: With the growing number of autoantibodies that target brain antigens, such as the dopamine-2 receptor (D2R), an autoimmune aetiology has been proposed in a subgroup of movement and psychiatric disorders. As anti-D2R antibodies in paediatric patients are immunoglobulin G, it is postulated that autoantibody-producing B cells have undergone isotype switching via interactions with D2R-autoreactive T cells. However, these T cells remain unexplored. Hence, we aim to identify and characterise D2R-autoreactive T cells in children with movement and psychiatric disorders.
Methods: A highly sensitive whole blood flow cytometry assay was used to detect rare antigen-specific T cells. Co-expression of CD25 and CD134 on CD4+ T cells was assessed in patients (n=18) and controls (n=16) following stimulation with a library of 67 synthetic human D2R 15-mer peptides and positive controls, PHA, SEB and tetanus toxoid (TT). Patients with a frequency of activated CD4+ T cells greater than 4 standard deviations above the control mean was considered D2R-reactive.
Results: The percentage of activated CD4+CD25+CD134+ T cells was higher in some patients in response to D2R peptides encompassing aa51-75 (1/18), aa121-155 (2/18), aa156-195 (2/18), aa206-265 (1/18), and aa381-443 (1/18). The remaining peptides did not elicit a notable activation in patients nor controls. When stimulated by PHA, SEB and TT, percentage of CD4+CD25+CD134+ T cells were similar in both cohorts.
Conclusion: A subgroup of paediatric patients with movement and psychiatric disorders exhibit an amplified activation of D2R-specific CD4+ T cells. Characterising autoreactive T cells in autoimmune-associated disorders can offer wider options for immunotherapies.