Characterization of the circulating T-cell landscape in cutaneous lichen planus patients 2266750

Abstract Introduction Cutaneous lichen planus (cLP) is a T cell—mediated skin disease in which cytotoxic CD8+ T cells attack basal keratinocytes at the dermo-epidermal junction. While studies have characterized T cell subsets in lesional tissue, circulating immune signatures in cLP are incompletely defined. We performed deep immunophenotyping of circulating T-cell subsets to map systemic alterations in cLP patients vs healthy controls. Methods We included 12 treatment-refractory cLP patients (mean age 63.6 ± 13.6 years) and 2 healthy controls (37.5 ± 10.6 years). Whole blood was profiled for 27 markers by flow cytometry. Sequential gating: singlets → live → CD3+ T cells → CD4+/CD8+/γδ; FOXP3+ Tregs were defined within CD4+. Frequencies were expressed as % of the immediate parent population. Group comparisons used two-tailed exact Mann—Whitney tests with Hodges—Lehmann median differences. Results Across frozen specimens, cLP patients exhibited broad T-cell activation. Proliferation increased in CD4 (Ki67+, p < 0.05), CD8 (6.785% vs 0.885%; Δ=5.90; p < 0.05), and Tregs (83.0% vs 46.8%; Δ=34.1; p < 0.05). Intracellular CTLA-4 was higher on CD4 (11.07% vs 2.615%; Δ=8.45; p < 0.05), CD8 (21.05% vs 9.30%; Δ=11.6; p < 0.05), and γδ T cells (47.20% vs 24.45%; Δ=22.75; p < 0.05). CXCL13+ cells expanded in CD4 (28.20% vs 12.45%; Δ=15.5; p < 0.05), CD8 (18.05% vs 3.595%; Δ=14.46; p < 0.05), γδ (2.805% vs 0.465%; Δ=2.285; p < 0.05), and Tregs (7.56% vs 1.17%; Δ=6.39; p < 0.05). Tregs were TBET-high (78.75% vs 61.55%; Δ=17.3; p < 0.05); GITR+ Tregs trended up (p = 0.1978). Conclusion cLP blood displays a CXCL13+, proliferative T-cell signature with increased intracellular CTLA-4 across CD4, CD8, γδ, and Treg compartments. CXCL13 elevation aligns with lesion-level literature implicating CXCL13+ CD8+ T cells that are suppressed in JAK-STAT therapy responders. Tregs exhibit a GITR upregulated, Th1-like phenotype that suggests loss of suppressive capacity, warranting further investigation on whether Treg dysfunction plays a causative role in cLP. Funding Source N/A Topic Categories Immune Mechanisms of Human Disease (HUM)