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Increased production of soluble CTLA-4 in patients with spondylarthropathies correlates with disease activity

Éric Toussirot123*, Philippe Saas4, Marina Deschamps4, Fabienne Pouthier5, Lucille Perrot34, Sylvain Perruche4, Jacqueline Chabod5, Pierre Tiberghien45 and Daniel Wendling12

Author Affiliations

1 Department of Rheumatology, University Hospital Jean Minjoz, Bd Fleming 25030 Besançon cedex, France

2 EA 3186 «Agents Pathogènes et Inflammation» University of Franche-Comté, IFR133, Place St Jacques, Besançon, France

3 CIC-Biotherapy 506, University Hospital St-Jacques, Place St Jacques, 25030 Besançon cedex, France

4 INSERM UMR645, University of Franche-Comté, EFS Bourgogne Franche-Comté, Plateforme de Biomonitoring, CIC-Biotherapy 506, IFR133, Bd Fleming, 25020 Besançon cedex, France

5 EFS Bourgogne Franche-Comté, Bd Fleming, 25020 Besançon cedex, France

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Arthritis Research & Therapy 2009, 11:R101  doi:10.1186/ar2747

Published: 1 July 2009



Spondylarthropathies (SpA) are characterized by abnormal immune responses including T cell activation. Cytotoxic T lymphocyte associated molecule-4 (CTLA-4) is involved in down-regulating immune responses. A soluble form of CTLA-4 (sCTLA-4), resulting from an alternative splicing, has been identified and was found increased in several autoimmune diseases. Here, we evaluated circulating levels of sCTLA-4 as a marker of immune dysregulation in SpA. Intracellular CTLA-4 and levels of CTLA-4 transcript expression in peripheral blood lymphocytes (PBL) were also studied.


Sera from 165 patients with SpA were evaluated for sCTLA-4 measurements. Results were compared with those from 71 patients with rheumatoid arthritis (RA) and 88 healthy subjects. In 32 patients with SpA, 22 patients with RA and 15 healthy controls, we analyzed the intracellular CTLA-4 expression in CD4+ T cells, CD8+ T cells, activated (HLA-DR+Foxp3-) CD4+ T cells, CD4+ regulatory (CD25+Foxp3+) T cells and in CD3 negative cells by flow cytometry. Expression of the full length (coding for membrane CTLA-4) and spliced form (coding for sCTLA-4) of CTLA-4 transcripts in PBL were analyzed by quantitative real-time polymerase chain reaction (QRT-PCR).


High levels of sCTLA-4 were found in the SpA group compared to the RA group and healthy controls (P < 0.0001). Soluble CTLA-4 serum levels strongly correlated with clinical index of disease activity BASDAI (r = 0.42, P < 0.0001) and C-reactive protein (CRP) levels (r = 0.17, P = 0.037). In contrast to RA patients, SpA patients did not exhibit changes in intracellular CTLA-4 expression in the different PBL subsets tested. Finally, the SpA group showed a preferential expression of the spliced CTLA-4 mRNA (P = 0.0014) in PBL.


SpA patients exhibit high levels of circulating sCTLA-4 that may result from an alternative splicing of CTLA-4 transcripts. This may influence immune activation and regulation in SpA.