The Balance of CD8-Positive T Cells and PD-L1 Expression in the Myocardium Predicts Prognosis in Lymphocytic Fulminant Myocarditis.

IF 1.9 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiology Pub Date : 2024-01-01 Epub Date: 2023-10-12 DOI:10.1159/000534518

Hiroaki Hiraiwa, Ryota Morimoto, Yuta Tsuyuki, Kaori Ushida, Ryota Ito, Shingo Kazama, Yuki Kimura, Takashi Araki, Takashi Mizutani, Hideo Oishi, Tasuku Kuwayama, Toru Kondo, Takahiro Okumura, Toyoaki Murohara

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引用次数: 0

Abstract

Introduction: The clinical significance and prognostic value of T cell involvement and programmed cell death-1 (PD-1)/programmed cell death ligand-1 (PD-L1) have not been established in lymphocytic fulminant myocarditis (FM). We investigated the prognostic impact of the number of CD4+, CD8+, FoxP3+, and PD-1+ T cells, as well as PD-L1 expression, in cardiomyocytes in lymphocytic FM.

Methods: This is a single-center observational cohort study. Myocardial tissue was obtained from 16 consecutive patients at lymphocytic FM onset. The median follow-up was 140 days. Cardiac events were defined as a composite of cardiac death and left ventricular-assist device implantation. CD4, CD8, FoxP3, PD-1, and PD-L1 immunostaining were performed on myocardial specimens.

Results: The median age of the patients was 52 years (seven men and nine women). There was no significant difference in the number of CD4+ cells. The number of CD8+ cells and the CD8+/CD4+ T cell ratio were higher in the cardiac event group (Event+) than in the group without cardiac events (Event-) (p = 0.048 and p = 0.022, respectively). The number of FoxP3+ T cells was higher in the Event+ group (p = 0.049). Although there was no difference in the number of PD-1+ cells, cardiomyocyte PD-L1 expression was higher in the Event+ group (p = 0.112). Event-free survival was worse in the group with a high CD8+ cell count (p = 0.012) and high PD-L1 expression (p = 0.049). When divided into three groups based on the number of CD8+ cells and PD-L1 expression (CD8highPD-L1high [n = 8], CD8lowPD-L1high [n = 1], and CD8lowPD-L1low [n = 7]), the CD8highPD-L1high group demonstrated the worst event-free survival, while the CD8lowPD-L1high group had a favorable prognosis without cardiac events (p = 0.041).

Conclusion: High myocardial expression of CD8+ T cells and PD-L1 may predict a poor prognosis in lymphocytic FM.

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心肌中CD8阳性T细胞和PD-L1表达的平衡可预测淋巴细胞性暴发性心肌炎的预后。

引言：T细胞浸润和程序性细胞死亡-1（PD-1）/程序性细胞坏死配体-1（PD-L1）在淋巴细胞性暴发性心肌炎（FM）中的临床意义和预后价值尚未确定。我们研究了淋巴细胞性FM心肌细胞中CD4+、CD8+、FoxP3+和PD-1+T细胞的数量以及PD-L1表达对预后的影响。方法：这是一项单中心观察性队列研究。从16名连续的淋巴细胞性FM发作患者身上获取心肌组织。中位随访时间为140天。心脏事件被定义为心脏死亡和左心室辅助装置植入的复合事件。对心肌标本进行CD4、CD8、FoxP3、PD-1和PD-L1免疫染色。结果：患者的中位年龄为52岁（7名男性和9名女性）。CD4+细胞的数量没有显著差异。心脏事件组（事件+）中的CD8+细胞数量和CD8+/CD4+T细胞比率高于无心脏事件的组（事件-）（分别为P=0.048和P=0.022）。Event+组FoxP3+T细胞数较多（P=0.049），Event+组心肌细胞PD-L1表达较高（P=0.112）。高CD8+细胞计数（P=0.012）和高PD-L1表达（P=0.049）的组无事件生存率较差。根据CD8+细胞数量和PD-L1表达分为三组（CD8highPD-L1 high[n=8]、CD8lowPD-L1 high[n=1]和CD8lowPD-L1low[n=7]），CD8高PD-L1组无事件生存率最差，而CD8低PD-L1高组无心脏事件预后良好（P=0.041）。结论：CD8+T细胞和PD-L1的高心肌表达可能预示淋巴细胞性FM的不良预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiology 医学-心血管系统

CiteScore

3.40

自引率

5.30%

发文量

审稿时长

1.5 months

期刊介绍： ''Cardiology'' features first reports on original clinical, preclinical and fundamental research as well as ''Novel Insights from Clinical Experience'' and topical comprehensive reviews in selected areas of cardiovascular disease. ''Editorial Comments'' provide a critical but positive evaluation of a recent article. Papers not only describe but offer critical appraisals of new developments in non-invasive and invasive diagnostic methods and in pharmacologic, nutritional and mechanical/surgical therapies. Readers are thus kept informed of current strategies in the prevention, recognition and treatment of heart disease. Special sections in a variety of subspecialty areas reinforce the journal''s value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons, clinical physiologists, pharmacologists and professionals in other areas of medicine interested in current activity in cardiovascular diseases.