Short-range interactions between fibrocytes and CD8⁺ T cells in COPD bronchial inflammatory response

Reviewer #1 (Public Review):

The present study combines quantitative histomorphometry, live cell imaging and tracking, functional analyses, and computational modeling to define potentially pathologic interactions between lung CD8 T cells and fibrocytes in human COPD. The authors use multiple technical approaches to establish the close proximity of CD8 T cells with fibrocytes in peri-bronchial tissue in COPD subjects that notably correlate with functional disease parameters (FEV1/FEV). Their follow-on studies identify specific chemokine pathways and inflammatory consequences of these interactions. Collectively, these seminal data acquired in a unified experimental context, provide support for pathogenic interactions between lung CD8 T cells and fibrocytes and now offer the consideration of mediators and pathways that may be amenable to therapeutic targeting. The strength of the study is the integration of the multi-modality approach, the quality of the quantitative data, and the creation of a tenable model for the interaction role in COPD of CD8 T cells and fibrocytes. While both have been previously implicated in COPD, this new study is more definitive by using this integrated approach.

Reviewer #2 (Public Review):

The authors use a series of elegant methods to describe the nature of the interrelationship among CD8+ T cells and fibrocytes in the airways of COPD patients. They find an increased presence of these interactions in COPD and show that CXCL8-CXCR2 interactions are crucial for this interaction, leading to increased CD8+ T cell proliferation.

Major strengths of the work include the detailed functional experiments used to describe the nature of the CD8+ T cell - fibrocyte interaction. Another key strength is the translational approach of the work, building on clinical data and connecting back to these same clinical data. The conclusions of the authors are supported by the data. The impact of the work is significant and key to our understanding of the interrelationship between inflammation and tissue remodeling in COPD. Understanding this relationship holds strong potential for the identification of new drug targets and for the identification of patients at risk.

The derivation of the CXCL8/CXCR2 dependency is based on a limited number of COPD patients, which could be strengthened. Also, the impact of the interrelationship between CD8 cells and the fibrocytes is not fully described.

Reviewer #3 (Public Review):

Eyraud and colleagues examine how fibrocytes and CD8 cells can interact with each other to promote COPD. The key findings include that CD8 cells and fibrocytes are found to exist in close proximity to each other in COPD lungs using histopathological analysis of patient samples. The authors leverage pre-existing transcriptomic data on CD8 cells to focus on chemokine release by CD8 cells as a potential pathogenic mechanism by which they could affect fibrocyte migration. In vitro studies using peripheral blood-derived CD8 cells and fibrocytes confirm increased fibrocyte migration in the presence of CD8 cells. as drivers of COPD progression. Conversely, in vitro studies show that fibrocytes exert a pro-proliferative effect on CD8 cells. The authors also use a computational model to assess how these interactions could promote the development of fibrocyte-CD8 clusters as COPD progresses over the course of 20 years.

The strengths of the study include:

1. The multi-faceted research approach that integrates histopathology from clinical COPD lung sections, in vitro co-culture studies, and computational modeling.

2. Applying computational modeling to determine how cell-cell interactions of migration and proliferation can result in distribution patterns within the lung that approximate what is found in actual clinical samples

3. Propose a feedback loop of CD8 cells and fibrocytes that could become a potential therapeutic target to interrupt a vicious cycle that promotes COPD.

However, there are also some weaknesses:

1. Specificity of the role of CD8 cells: While much of the focus is on the proximity of and interactions between CD8 cells and fibrocytes, it is not clear whether other cells similarly interact with fibrocytes. For example, CD4 cells, dendritic cells, or interstitial macrophages may similarly interact with fibrocytes as several of these also release chemokines. In the absence of a more comprehensive assessment, it becomes difficult to parse out how specific and relevant the fibrocyte-CD8 cell interactions are for COPD progression when compared to other putative interactions.

2. The transcriptomic analysis which in many ways sets the stage for the chemokine studies uses a pre-existing dataset of COPD and non-COPD samples with only n=2. The robustness of such a sample size is limited and the narrow focus on chemokines or adhesion receptors of CD8 cells in this limited sample size does not provide a more comprehensive analysis that would require larger samples sizes, studying the transcriptomes of other cell types and a broader analysis of which pathways are the most likely to be dysregulated in the cells that surround fibrocytes.

3. Specificity of the findings for COPD: The in vitro studies use circulating cells which are different from lung cells and this is appropriately acknowledged by the authors. However, it appears from the description that the cells are all from COPD patients. It is therefore not clear whether these interactions between fibrocytes and CD8 cells are unique to COPD, whether they also occur between control CD8 and fibrocytes, or only in cells obtained from patients with inflammatory/pulmonary diseases.