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Chai D, Kong X, Lu S, Zhang J. CD4+/CD8+ ratio positively correlates with coronary plaque instability in unstable angina pectoris patients but fails to predict major adverse cardiovascular events. Ther Adv Chronic Dis 2020; 11:2040622320922020. [PMID: 32489573 PMCID: PMC7238310 DOI: 10.1177/2040622320922020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/30/2020] [Indexed: 01/28/2023] Open
Abstract
Background: The association between CD4+/CD8+ ratio and coronary plaque instability in
patients with unstable angina pectoris (UAP) has not been investigated. We
sought to elucidate the correlation between CD4+/CD8+ ratio and plaque
instability in this patient population. Methods: We enrolled 266 UAP patients who underwent pre-intervention optical coherence
tomography (OCT) examination and percutaneous coronary intervention in our
center from January 2016 to January 2018. Features of coronary plaques in
the culprit arteries were classified as unstable plaque and stable plaque.
Primary endpoint was occurrence of a major adverse cardiovascular event
(MACE). Receiver operating characteristic (ROC) analyses were used to
determine the predictive efficacy of the CD4+/CD8+ ratio for a group of
unstable plaque patients, and binary logistic regression analysis was
performed to evaluate potential independent predictors of plaque
instability. All-cause mortality and MACE between the two groups were
analyzed. Results: UAP patients with unstable plaque had a higher CD4/CD8 ratio compared with
stable plaque patients (p < 0.05). Results of binary
logistic regression analyses showed that CD4+/CD8+ ratio ⩾1.725 and prior
stroke were predictors and risk factors of plaque instability
(p < 0.05). ROC analyses showed that CD4+/CD8+ ratio
⩾1.725 was predictive of plaque instability in UAP patients. However, the
Kaplan–Meier estimate for MACE and all-cause mortality showed no statistical
significance. Conclusions: Higher CD4+/CD8+ ratio is associated with higher risk of plaque instability
in our cohort of UAP patients. However, CD4+/CD8+ ratio was not an
independent predictor of 1-year MACE or all-cause mortality.
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Affiliation(s)
- Dayang Chai
- Department of Cardiology, The First People's Hospital of Taicang, The Affiliated Taicang Hospital of Soochow University, Taicang, China
| | - Xiangquan Kong
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Shu Lu
- Department of Cardiology, The First People's Hospital of Taicang, The Affiliated Taicang Hospital of Soochow University, No. 58 Changsheng Road, Taicang, 215400, China
| | - Junjie Zhang
- Department of Cardiology, Nanjing First Hospital, No. 68 Changle Road, Nanjing, 210006, China
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van Dijk RA, Duinisveld AJF, Schaapherder AF, Mulder-Stapel A, Hamming JF, Kuiper J, de Boer OJ, van der Wal AC, Kolodgie FD, Virmani R, Lindeman JHN. A change in inflammatory footprint precedes plaque instability: a systematic evaluation of cellular aspects of the adaptive immune response in human atherosclerosis. J Am Heart Assoc 2015; 4:jah3876. [PMID: 25814626 PMCID: PMC4579929 DOI: 10.1161/jaha.114.001403] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Experimental studies characterize adaptive immune response as a critical factor in the progression and complications of atherosclerosis. Yet, it is unclear whether these observations translate to the human situation. This study systematically evaluates cellular components of the adaptive immune response in a biobank of human aortas covering the full spectrum of atherosclerotic disease. Methods and Results A systematic analysis was performed on 114 well‐characterized perirenal aortic specimens with immunostaining for T‐cell subsets (CD3/4/8/45RA/45RO/FoxP3) and the Th1/non‐Th1/Th17 ratio (CD4+T‐bet+/CD4+T‐bet−/CD4+/interleukin‐17+ double staining). CD20 and CD138 were used to identify B cells and plasma cells, while B‐cell maturation was evaluated by AID/CD21 staining and expression of lymphoid homeostatic CXCL13. Scattered CD4 and CD8 cells with a T memory subtype were found in normal aorta and early, nonprogressive lesions. The total number of T cells increases in progressive atherosclerotic lesions (≈1:5 CD4/CD8 T‐cell ratio). A further increase in medial and adventitial T cells is found upon progression to vulnerable lesions. This critical stage is further hallmarked by de novo formation of adventitial lymphoidlike structures containing B cells and plasma cells, a process accompanied by transient expression of CXCL13. A dramatic reduction of T‐cell subsets, disappearance of lymphoid structures, and loss of CXCL13 expression characterize postruptured lesions. FoxP3 and Th17 T cells were minimally present throughout the atherosclerotic process. Conclusions Transient CXCL13 expression, restricted presence of B cells in human atherosclerosis, along with formation of nonfunctional extranodal lymphoid structures in the phase preceding plaque rupture, indicates a “critical” change in the inflammatory footprint before and during plaque destabilization.
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Affiliation(s)
- R A van Dijk
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (D., D., M.S., H., L.)
| | - A J F Duinisveld
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (D., D., M.S., H., L.)
| | - A F Schaapherder
- Department of Transplantation Surgery, Leiden University Medical Center, Leiden, The Netherlands (S.)
| | - A Mulder-Stapel
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (D., D., M.S., H., L.)
| | - J F Hamming
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (D., D., M.S., H., L.)
| | - J Kuiper
- Gorlaeus Laboratories, Division of Biopharmaceutics, Leiden Academic Centre for Drug Research, Leiden, The Netherlands (K.)
| | - O J de Boer
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (B., W.)
| | - A C van der Wal
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (B., W.)
| | - F D Kolodgie
- CVPath Institute Inc., Gaithersburg, MD (K., V.)
| | - R Virmani
- CVPath Institute Inc., Gaithersburg, MD (K., V.)
| | - J H N Lindeman
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands (D., D., M.S., H., L.)
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Olloquequi J, Ferrer J, Montes JF, Rodríguez E, Montero MA, García-Valero J. Differential lymphocyte infiltration in small airways and lung parenchyma in COPD patients. Respir Med 2010; 104:1310-8. [PMID: 20359875 DOI: 10.1016/j.rmed.2010.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND In COPD, although histological lesions at both the small airways (wall thickening and tissue remodeling) and lung parenchyma (emphysematous destruction) are definitely different, the inflammatory cells involved in both processes are the same. Our study aims to determine if these histopathological phenotypes are related to two different lymphocyte profiles. METHODS Distribution and cell density of CD3(+), CD4(+), CD8(+) and B lymphocytes were compared in small airways and parenchymal interstitium of 9 non-smokers, 18 smokers without COPD, 16 smokers with moderate COPD and 16 patients with very severe COPD undergoing lung transplantation. Spatial distribution of lymphocytes in periemphysematous parenchyma was also assessed. RESULTS CD3(+) and B cell densities were significantly higher in small airways than parenchyma interstitium of very severe COPD patients. Furthermore, CD8(+) cells were increased in the epithelium of airways of moderate COPD patients compared to non-smokers. Although CD8(+) cell density was increased in parenchyma of COPD patients, CD8(+) and B cell densities were similar when comparing periemphysematous and non-emphysematous alveolar interstitium. CONCLUSIONS In COPD, it is true that the small airways' wall shows a clear inflammatory pattern, with a high mononuclear infiltration and tissue remodeling. However, parenchymal interstitium shows a milder CD8(+) infiltration which, moreover, is not spatially related to emphysematous destroyed areas.
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Affiliation(s)
- Jordi Olloquequi
- Departament de Biologia Cel-lular, Universitat de Barcelona, Barcelona, Spain.
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The aging immune system and its relationship to the development of chronic obstructive pulmonary disease. Ann Am Thorac Soc 2010; 6:573-80. [PMID: 19934352 DOI: 10.1513/pats.200904-022rm] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease of the lungs that usually manifests late in life. Physiologic and immunologic changes that occur in COPD often mimic changes seen in the aging lung. This has led some to characterize COPD as an "accelerated aging phenotype." At the molecular level, COPD and aging share common mechanisms and are associated with significant dysregulation of the immune systems. Aging and COPD are characterized by increases in proinflammatory cytokines such as interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha, which are implicated in aging-related inflammatory diseases and correlate with degree of obstruction in COPD. There is an age-dependent decline in naïve T cells with oligoclonal expansion of CD8(+) CD28(null) T cells from chronic antigenic stimulation. The increase in CD8(+) CD28 (null) T regulatory cells inhibits antigen-specific CD4(+) T cell responses, leading to a decline in adaptive immune response. To compensate for the decline in the adaptive immune function there is a paradoxical up-regulation of innate immune system resulting in a proinflammatory state. The dysregulated adaptive immune system with activated innate immune responses seen with aging results in recruitment and retention of neutrophils, macrophages, and CD4(+) and CD8(+) T cells in the lungs of smokers with COPD. Once the inflammation is triggered, there is a self-perpetuating cascade of inflammation and lung parenchymal damage. This review will focus on how the aging immune system may contribute to COPD development later in life in susceptible individuals.
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Hogg JC, Timens W. The Pathology of Chronic Obstructive Pulmonary Disease. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2009; 4:435-59. [DOI: 10.1146/annurev.pathol.4.110807.092145] [Citation(s) in RCA: 465] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- James C. Hogg
- Department of Pathology and Laboratory Medicine, University of British Columbia and iCapture Center, St. Paul's Hospital, Vancouver, British Columbia V6Z 1Y6, Canada;
| | - Wim Timens
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen 9700 RB, The Netherlands;
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Mikko M, Fredriksson K, Wahlström J, Eriksson P, Grunewald J, Sköld CM. Human T cells stimulate fibroblast-mediated degradation of extracellular matrix in vitro. Clin Exp Immunol 2007; 151:317-25. [PMID: 18062794 DOI: 10.1111/j.1365-2249.2007.03565.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Several chronic diseases are characterized by inflammation, T cell recruitment and tissue remodelling. We hypothesized that activated T cells may stimulate remodelling of extracellular matrix (ECM) in vitro. Total T cells (CD3+) as well as CD4+ and CD8+ subsets were isolated from peripheral blood and stimulated, after which conditioned media (CM) were obtained. CM was added to human lung fibroblasts in three-dimensional collagen gels and the area of gels was measured daily. Hydroxyproline was determined as a measure of collagen degradation in the gels. Matrix metalloproteinase (MMP) activity in the culture media was analysed by gelatine zymography. Cytokine secretion of stimulated CD4+ and CD8+ T cells was analysed. CD3+ CM augmented collagen gel contraction in a time- and dose-dependent manner (P < 0.0001). CD4+ T cell CM was more potent than CD8+ T cell CM (P < 0.001). CD3+ CM and CD4+ T cell CM, but not CD8+ T cell CM, stimulated fibroblast-mediated collagen degradation and MMP-9 activity. A broad-spectrum MMP-inhibitor added to the culture system inhibited both gel contraction and MMP activity. Activated CD4+ T cells secreted significantly more tumour necrosis factor (TNF) and interleukin (IL)-6 compared to CD8+ T cells. CD3+ CM from patients with chronic obstructive pulmonary disease stimulated fibroblast-mediated collagen gel contraction to the same magnitude as CD3+ CM from healthy controls. In conclusion, activated CD4+ T cells can stimulate fibroblast-mediated degradation of ECM in vitro. This could be a mechanism by which activated T cells stimulate degradation of lung tissue leading to pulmonary emphysema.
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Affiliation(s)
- M Mikko
- Karolinska Institutet, Department of Medicine, Unit of Respiratory Medicine, Karolinska University Hospital Solna, Stockholm, Sweden.
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Kanazawa H, Yoshikawa J. Alterations in T-lymphocyte subsets in the airways of asthmatic patients with active hepatitis C virus infection. Respiration 2005; 73:318-23. [PMID: 16179822 DOI: 10.1159/000088357] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 04/12/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The interaction between hepatitis C virus (HCV) infection and certain pulmonary disorders is of considerable interest. We have previously found that active HCV infection in asthmatic patients is associated with impaired responses to inhaled corticosteroid therapy. OBJECTIVES To examine differences in T-lymphocyte subsets in asthmatic airways with or without HCV infection. METHODS 12 HCV-negative and 29-HCV positive asthmatics were included in this study. All HCV-positive asthmatics received interferon (IFN) therapy (11 IFN responders and 18 IFN non-responders). T-lymphocyte subsets in induced sputum were analyzed before and 1 year after IFN therapy. RESULTS Before IFN therapy, percentages of lymphocytes and CD8+ T lymphocytes in induced sputum were higher in HCV-positive asthmatics than in HCV-negative asthmatics. After IFN therapy, there was no significant change in percentages of lymphocytes and T-lymphocyte subsets in IFN non-responders. However, percentage of lymphocytes and CD8+ T lymphocytes in IFN responders significantly decreased, while CD4+ T lymphocytes increased. Therefore, the CD4/CD8 ratio significantly increased following IFN therapy in IFN responders. In IFN responders, forced expiratory volume in 1 s (FEV(1)) after salbutamol administration significantly increased following IFN therapy, while it did not change in non-responders. In addition, in IFN responders, the change in the CD4/CD8 ratio after IFN therapy was significantly correlated with the increase in FEV(1) after salbutamol administration. CONCLUSIONS The number of CD8+ T lymphocytes increases in the airways of asthmatic patients with active HCV infection, and this may be associated with airway dysfunction in these patients.
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Affiliation(s)
- Hiroshi Kanazawa
- Department of Respiratory Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan.
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Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000175939.68435.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000162314.10050.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Aoshiba K, Nagai A. Differences in airway remodeling between asthma and chronic obstructive pulmonary disease. Clin Rev Allergy Immunol 2005; 27:35-43. [PMID: 15347849 DOI: 10.1385/criai:27:1:035] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The functional consequence of asthma and chronic obstructive pulmonary disease (COPD)is airflow limitation, which is mostly reversible in asthma and not fully reversible in COPD. In both diseases, inflammatory conditions are associated with cellular and structural changes,referred to as remodeling, and these structural changes may lead to thickening of the airway wall, thereby promoting airway narrowing and airflow limitation. However, the pattern of infiltrated cells and the pattern of structural changes occur differently in the two diseases. In asthma, CD4+, T lymphocytes, eosinophils, and mast cells are the predominant cells involved,whereas in COPD, CD8+, T lymphocytes, and macrophages are predominantly involved. In severe cases of asthma and COPD, neutrophil infiltration becomes evident. Regarding structural changes, epithelial injury and early thickening of reticular basement membrane are highly characteristic of the airway wall of asthmatics. Increases in airway smooth muscle mass occur in large airways of severe asthmatics and in small airways of patients with COPD. Thickening of the airway wall, goblet cell hyperplasia, mucous gland hypertrophy, and the luminal obstruction caused by inflammatory exudates and mucous are features of both asthma and COPD. Squamous epithelial metaplasia and airway wall fibrosis are commonly observed characteristics of COPD. Destruction and fibrosis of the alveolar wall occur in COPD but not in asthma. The remodeling processes accompanied by chronic inflammatory infiltrates interact in a complex fashion and contribute to the development of airflow limitation in both asthma and COPD.
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Affiliation(s)
- Kazutetsu Aoshiba
- First Department of Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Taraseviciene-Stewart L, Scerbavicius R, Choe KH, Moore M, Sullivan A, Nicolls MR, Fontenot AP, Tuder RM, Voelkel NF. An animal model of autoimmune emphysema. Am J Respir Crit Care Med 2004; 171:734-42. [PMID: 15563631 DOI: 10.1164/rccm.200409-1275oc] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Although cigarette smoking is implicated in the pathogenesis of emphysema, the precise mechanisms of chronic progressive alveolar septal destruction are not well understood. We show, in a novel animal model, that immunocompetent, but not athymic, nude rats injected intraperitoneally with xenogeneic endothelial cells (ECs) produce antibodies against ECs and develop emphysema. Immunization with ECs also leads to alveolar septal cell apoptosis and activation of matrix metalloproteases MMP-9 and MMP-2. Anti-EC antibodies cause EC apoptosis in vitro and emphysema in passively immunized mice. Moreover, immunization also causes accumulation of CD4+ T cells in the lung. Adoptive transfer of pathogenic, spleen-derived CD4+ cells into naive immunocompetent animal also results in emphysema. This study shows for the first time that humoral- and CD4+ cell-dependent mechanisms are sufficient to trigger the development of emphysema, suggesting that alveolar septal cell destruction might result from immune mechanisms.
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