title: Enhanced T-helper-1 lymphocyte activation patterns in acute coronary syndromes.
abstract: OBJECTIVE
  We sought to determine whether different stages of coronary artery disease (CAD) are associated with distinct differentiation patterns of activated T cells.
  
  
  BACKGROUND
  Atherosclerosis is an inflammatory disease. However, little is known about specific inflammatory cell activation in atherosclerosis, for example, the T-helper (Th)1/Th2-balance.
  
  
  METHODS
  We studied 18 patients with stable angina (SA), 28 patients with acute coronary syndrome (ACS) (16 with unstable angina pectoris and 12 with ST-segment elevation myocardial infarction), 19 patients with unheralded myocardial infarction (UH), and 16 control patients. Cytokine patterns and transcription factor signaling pathways of circulating T cells were characterized using reverse transcription polymerase chain reaction and flow cytometry.
  
  
  RESULTS
  Although interferon (IFN)-gamma(+)/CD3(+) T cells were approximately 2-fold greater in patients with SA or UH than in control subjects, there was a massive expansion of Th1 cells in patients with ACS (p < 0.001). This increase was paralleled by significantly increased mRNA transcript levels for signal-transducer-and-activator-4 (ACS 1.17 +/- 0.14 relative units [RU]; control patients 0.44 +/- 0.09 RU; SA 0.67 +/- 0.12 RU; UH 0.61 +/- 0.17 RU), interleukin-2 (ACS 1.55 +/- 0.51 RU; control patients 0.21 +/- 0.09 RU; SA 0.54 +/- 0.18 RU; UH 0.45 +/- 0.16 RU), and IFN-gamma in ACS (1.27 +/- 0.39 RU; control patients 0.35 +/- 0.09 RU; SA 0.58 +/- 0.11 RU; UH 0.53 +/- 0.24 RU; p < 0.002). Th2 and Th0 cells were not different across patient subsets. The burden of CAD was identical between SA (1.4 +/- 0.2 diseased vessels, 68 +/- 13% diameter stenosis) and ACS (1.4 +/- 0.2 diseased vessels, 64 +/- 17% diameter stenosis) but significantly greater in patients with UH (2.5 +/- 0.5 diseased vessels, 95 +/- 7% diameter stenosis; p < 0.05).
  
  
  CONCLUSIONS
  Patients with UH have a greater burden of obstructive CAD than SA but no greater T-cell activation. Patients with ACS have the same extent of CAD than SA but significantly greater activation of Th1 cells that may contribute to the increasing instability. Differences in circulating Th1 cells might indicate different pathogenic components, leading to ACS and UH.
authors.affiliation: Department of Cardiology, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany. hmethe@mit.edu
authors.forename: Heiko
authors.initials: H
authors.lastname: Methe
authors.forename: Stefan
authors.initials: S
authors.lastname: Brunner
authors.forename: Daniela
authors.initials: D
authors.lastname: Wiegand
authors.forename: Michael
authors.initials: M
authors.lastname: Nabauer
authors.forename: Joerg
authors.initials: J
authors.lastname: Koglin
authors.forename: Elazer R
authors.initials: ER
authors.lastname: Edelman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000276:immunology* / Q000378:metabolism*; D016022:Case-Control Studies; D004268:DNA-Binding Proteins / Q000235:genetics / Q000378:metabolism; D005260:Female; D005987:Glyceraldehyde-3-Phosphate Dehydrogenases / Q000378:metabolism; D006801:Humans; D007371:Interferon-gamma / Q000235:genetics / Q000378:metabolism; D007378:Interleukins / Q000235:genetics / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000276:immunology* / Q000378:metabolism*; D012333:RNA, Messenger / Q000378:metabolism; D050797:STAT4 Transcription Factor; D050800:STAT6 Transcription Factor; D013577:Syndrome; D006377:T-Lymphocytes, Helper-Inducer / Q000502:physiology*; D015534:Trans-Activators / Q000235:genetics / Q000378:metabolism
chemical_list: D004268:DNA-Binding Proteins; D007378:Interleukins; D012333:RNA, Messenger; D050797:STAT4 Transcription Factor; C494090:STAT4 protein, human; D050800:STAT6 Transcription Factor; C494101:STAT6 protein, human; D015534:Trans-Activators; D007371:Interferon-gamma; D005987:Glyceraldehyde-3-Phosphate Dehydrogenases