Decrease in CD4⁺CD25⁺FoxP3⁺ T_reg cells after pulmonary resection in the treatment of cavity multidrug-resistant tuberculosis

Computed tomography (CT) scan of a 53-year-old man with multidrug-resistant tuberculosis. Preoperative CT scan of the chest in October 2008 (A1, A2): right upper lung cavity shows concurrent aspergilloma. Postoperative CT scan of the chest in April 2009 (postoperative month 6: A3, A4): focus of infection was removed and residual intrapulmonary air-containing space with thick wall.

Computed tomography (CT) scan of a 51-year-old female with multidrug-resistant tuberculosis. Preoperative CT scan of the chest in September 2006 (B1, B2, B3): right lung destroyed and collapsed, the left lung showing scale-up complications. Postoperative CT scan of the chest in May 2007 (postoperative month 6: B4, B5): focus of infection was removed and residual intrapulmonary air-containing space with thick wall.

Flow cytometry analyses of CD25^+high expression by CD4⁺ T cells. The lymphocyte gate was generated by use of forward and side-angle scattered light window (FSC/SSC) dot plots (A1). Representative flow cytometry results of surface CD4 and CD25 expression on peripheral blood lymphocytes from a patient with active TB preoperatively (B1), at postoperative month 1 (POM1; C1), and at postoperative month 6 (POM6; D1). L1: CD4⁻CD25⁺ cells; L2: CD4⁺CD25⁺ cells; L3: CD4⁻CD25⁻ cells; L4: CD4⁻CD25⁺ cells; M1: CD4⁻CD25^+high cells; M2: CD4⁺CD25^+high cells; M3: CD4⁻CD25^−high cells; M4: CD4⁻CD25⁺ cells.

Flow cytometry analysis of intracellular FoxP3 and surface CD25 expression on CD4⁺ T cells in patients with tuberculosis (TB). The CD4⁺ T cells are shown gated (A2). Representative flow cytometry results of intracellular FoxP3 and surface CD25 expression on peripheral blood lymphocytes from a patient with active TB preoperatively (B2), at postoperative month 1 (POM1; C2), and at postoperative month 6 (POM6; D2). G1:CD4⁺CD25⁺FoxP3⁻ cells; G2:CD4⁺CD25⁺FoxP3⁺ cells; G3:CD4⁺CD25⁻ FoxP3⁻ cells; G4:CD4⁺CD25⁻ FoxP3⁺ cells.

Percentage of CD4⁺ cells, CD4⁺CD25⁺ cells, and CD4⁺CD25⁻ cells in non-infected control subjects (CTRL; n=10), and in patients with cavity MDR-TB (n=13) pre- and postoperatively: preoperative, postoperative month 1 (POM1), and postoperative month 6 (POM6).

The proportion of CD4⁺CD25⁺ cells that are CD25^high in non-infected controls (CTRL; n=10) and patients with cavity MDR-TB before and after surgery (n=13): preoperative, postoperative month 1 (POM1), and postoperative month 6 (POM6). Horizontal bars indicate median values.

The proportion of CD4⁺CD25⁺FoxP3⁺ T_reg cells among the CD4⁺ cells measured by flow cytometry in 10 non-infected control subjects (CTRL) and 13 patients with cavity MDR-TB pre- and postoperatively: preoperative, postoperative month 1 (POM1), and postoperative month 6 (POM6). Horizontal bars indicate median values.

The proportion of the CD4⁺CD25⁺ cells that are CD25^high in patients with cavity MDR-TB pre- and postoperatively (n=13): preoperative, postoperative month 1 (POM1), and postoperative month 6 (POM6).

The proportion of the CD4⁺CD25⁺FoxP3⁺cells in patients with cavity MDR-TB pre- and postoperatively (n=13): preoperative, postoperative month 1 (POM1), and postoperative month 6 (POM6).

Correlation between the proportion of CD4⁺CD25^+high cells and CD4⁺CD25⁺FoxP3⁺ cells (r=0.878, p<0.001).