Autologous stem cell transplantation for paediatric‐onset polyarteritis nodosa: changes in autoimmune phenotype in the context of reduced diversity of the T‐ and B‐cell repertoires, and evidence for reversion from the CD45RO+ to RA+ phenotype

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Abstract
We have studied immune reconstitution in a patient with paediatric‐onset polyarteritis nodosa treated with high‐dose immunosuppressive agents followed by stem cell rescue. The patient developed several new autoimmune phenomena over the 18 months after immunosuppression and stem cell rescue. Flow cytometry, reverse transcription–polymerase chain reaction (RT‐PCR) heteroduplex and isotype‐specific RT‐PCR analysis of immunoglobulin expression showed that the T‐ and B‐cell repertoires were highly restricted in the first few months after treatment. The dominant T‐cell clones seen after reconstitution were persistently expanded, were different from those which could be demonstrated before autologous stem cell transplantation, and were in the CD8+ population. Our data also show that 12 months after treatment these expanded T‐cell clones were within the CD45RA+ population, suggesting that reversion from the CD45RO+ to the CD45RA+ phenotype had occurred in vivo.

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