T cells in the myenteric plexus of achalasia patients show a skewed TCR repertoire and react to HSV-1 antigens.
OBJECTIVE
The loss of myenteric neurons in the lower esophageal sphincter (LES) characterizes achalasia, an esophageal motor disorder. Because the presence of lymphocytic infiltrates suggests an immuno-mediated mechanism ongoing at the sites of disease, we investigated the T-cell receptor (TCR) repertoire and the ability to recognize human herpes virus type 1 (HSV-1) antigens of LES-infiltrating T lymphocytes in achalasia patients.


METHODS
Fifty-nine patients with idiopathic achalasia and 38 heart-beating cadaveric multiorgan donors (controls) were studied. By flow cytometry evaluation and CDR3 length spectratyping analysis, the lymphocytes of 18 patients and 15 controls were analyzed, whereas 41 patients and 23 controls were employed for functional assays.


RESULTS
Achalasia patients were characterized by a significantly higher esophagus lymphocytic infiltrate than controls (24.71%+/- 3.11 and 9.54%+/- 1.34, respectively; P < 0.05), mainly represented by CD3+CD8+ T cells. The characterization of TCR beta chain repertoire of CD3+ cells showed the expression of a limited number of TCR beta variable (BV) gene families (from two to five out of 26), with highly restricted spectratypes, suggesting a disease-associated oligoclonal selection of T cells. Furthermore, lymphocytes from achalasia LES specifically responded to exposure to HSV-1 antigens in vitro as showed by increased proliferation and Th-1 type cytokines release.


CONCLUSIONS
These data suggest that the oligoclonal lymphocytic infiltrate within the LES of achalasia patients may represent the trace of an immune-inflammatory reaction triggered by HSV-1 antigens and that the Th1-type cytokines released by the activated lymphocytes may contribute to establish the neuronal damage accounting for the clinical features of idiopathic achalasia.
Department of Clinical and Experimental Medicine, Hematology and Clinical Immunology Branch, Padua University School of Medicine, Padova, Italy.
Monica
M
Facco
Paola
P
Brun
Ilenia
I
Baesso
Mario
M
Costantini
Christian
C
Rizzetto
Alessandro
A
Berto
Nicola
N
Baldan
Giorgio
G
Palù
Gianpietro
G
Semenzato
Ignazio
I
Castagliuolo
Giovanni
G
Zaninotto
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000956:Antigens, Viral / Q000276:immunology*; D002102:Cadaver; D004931:Esophageal Achalasia / Q000276:immunology*; D049630:Esophageal Sphincter, Lower / Q000294:innervation; D005260:Female; D005434:Flow Cytometry; D018259:Herpesvirus 1, Human / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009197:Myenteric Plexus / Q000276:immunology*; D016133:Polymerase Chain Reaction; D011948:Receptors, Antigen, T-Cell / Q000032:analysis*; D013601:T-Lymphocytes / Q000276:immunology*
D000956:Antigens, Viral; D011948:Receptors, Antigen, T-Cell