Patients with acute coronary syndrome show oligoclonal T-cell recruitment within unstable plaque: evidence for a local, intracoronary immunologic mechanism.
BACKGROUND
Recent studies indicate that T-cell activation may play an important role in the pathophysiology of acute coronary syndromes (ACS). However, although those studies detected T-cell expansion in peripheral blood cells, demonstration of specific T-cell expansion within the plaque of patients with ACS is lacking. The present study aims to address whether a specific, immune-driven T-lymphocyte recruitment occurs within the unstable plaque of patients with ACS.


RESULTS
We simultaneously examined the T-cell repertoire using CDR3 size analysis both in coronary plaques (obtained by directional atherectomy) and in peripheral blood of patients with either ACS (n=11) or chronic stable angina (n=10). Unstable plaques showed a 10-fold increase in T-cell content by quantitative PCR. Using spectratyping analysis, we found several specific T-cell clonotype expansions only in unstable plaque from each patient with ACS, indicating a specific, antigen-driven recruitment of T cells within unstable lesions.


CONCLUSIONS
For the first time, T-cell repertoire was investigated directly into coronary plaques; using this approach, we demonstrate that coronary plaque instability in the setting of ACS is associated with immune-driven T-cell recruitment, specifically within the plaque.
De Palma
Raffaele
R
Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy.
Del Galdo
Francesco
F
Abbate
Gianfranco
G
Chiariello
Massimo
M
Calabró
Raffaele
R
Forte
Lavinia
L
Cimmino
Giovanni
G
Papa
Maria Francesca
MF
Russo
Maria Giovanna
MG
Ambrosio
Giuseppe
G
Giombolini
Claudio
C
Tritto
Isabella
I
Notaristefano
Salvatore
S
Berrino
Liberato
L
Rossi
Francesco
F
Golino
Paolo
P
D000208:Acute Disease; D000368:Aged; D050197:Atherosclerosis / Q000276:immunology / Q000473:pathology; D049109:Cell Proliferation; D002634:Chemotaxis, Leukocyte; D002999:Clone Cells; D022801:Complementarity Determining Regions; D003327:Coronary Disease / Q000276:immunology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D037182:T-Cell Antigen Receptor Specificity; D013601:T-Lymphocytes / Q000502:physiology*
D022801:Complementarity Determining Regions