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IgG4-related disease (IgG4-RD) is a fibro-inflammatory disorder involving virtually every organ with a risk of organ dysfunction. Despite recent studies regarding B cell and T cell compartments, the disease’s pathophysiology remains poorly understood. We examined and characterized subsets of circulating lymphocytes in untreated patients with active IgG4-RD. Twenty-eight consecutive patients with biopsy-proven IgG4-RD were included in a prospective, multicentric study. Lymphocytes’ subsets were analyzed by flow cytometry, with analysis of T H 1/T H 2/T H 17, T FH  cells, and cytokine release by peripheral blood mononuclear cells. Results were compared to healthy controls and to patients with primary Sjögren’s syndrome. Patients with IgG4-RD showed an increase of circulating T regulatory, T H 2, T H 17, and CD4 + CXCR5 + PD1 +  T FH  cell subsets. Accordingly, increased levels of IL-10 and IL-4 were measured in IgG-RD patients. T FH  increase was characterized by the specific expansion of T FH 2 (CCR6 − CXCR3 − ), and to a lesser extent of T FH 17 (CCR6 + CXCR3 − ) cells. Interestingly, CD4 + CXCR5 + PD1 +  T FH  cells normalized under treatment. IgG4-RD is characterized by a shift of circulating T cells toward a T H 2/T FH 2 and T H 17/T FH 17 polarization. This immunological imbalance might be implicated in the disease’s pathophysiology. Treatment regimens targeting such T cells warrant further evaluation.

T Cell Polarization toward TH2/TFH2 and TH17/TFH17 in Patients with IgG4-Related Disease