title: Circulating activated and effector memory T cells are associated with calcification and clonal expansions in bicuspid and tricuspid valves of calcific aortic stenosis.
abstract: We sought to delineate further the immunological significance of T lymphocytes infiltrating the valve leaflets in calcific aortic stenosis (CAS) and determine whether there were associated alterations in circulating T cells. Using clonotypic TCR β-chain length and sequence analysis we confirmed that the repertoire of tricuspid CAS valves contains numerous expanded T cell clones with varying degrees of additional polyclonality, which was greatest in cases with severe calcification. We now report a similar proportion of clonal expansions in the much younger bicuspid valve CAS cases. Peripheral blood flow cytometry revealed elevations in HLA-DR(+) activated CD8 cells and in the CD8(+)CD28(null)CD57(+) memory-effector subset that were significantly greater in both bicuspid and tricuspid CAS cases with more severe valve calcification. Lesser increases of CD4(+)CD28(null) T cells were identified, principally in cases with concurrent atherosclerotic disease. Upon immunostaining the CD8 T cells in all valves were mainly CD28(null), and CD8 T cell percentages were greatest in valves with oligoclonal repertoires. T cell clones identified by their clonotypic sequence as expanded in the valve were also found expanded in the circulating blood CD28(null)CD8(+) T cells and to a lesser degree in the CD8(+)CD28(+) subset, directly supporting the relationship between immunologic events in the blood and the valve. The results suggest that an ongoing systemic adaptive immune response is occurring in cases with bicuspid and tricuspid CAS, involving circulating CD8 T cell activation, clonal expansion, and differentiation to a memory-effector phenotype, with trafficking of T cells in expanded clones between blood and the valve.
authors.affiliation: Division of Rheumatology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. rjw8@columbia.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Winchester
authors.forename: Margrit
authors.initials: M
authors.lastname: Wiesendanger
authors.forename: Will
authors.initials: W
authors.lastname: O'Brien
authors.forename: Hui-Zhu
authors.initials: HZ
authors.lastname: Zhang
authors.forename: Mathew S
authors.initials: MS
authors.lastname: Maurer
authors.forename: Linda D
authors.initials: LD
authors.lastname: Gillam
authors.forename: Allan
authors.initials: A
authors.lastname: Schwartz
authors.forename: Charles
authors.initials: C
authors.lastname: Marboe
authors.forename: Allan S
authors.initials: AS
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000276:immunology; D001024:Aortic Valve Stenosis / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology / Q000473:pathology; D002114:Calcinosis / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D002454:Cell Differentiation / Q000235:genetics / Q000276:immunology*; D002465:Cell Movement / Q000235:genetics / Q000276:immunology; D002999:Clone Cells; D019674:Genes, T-Cell Receptor beta / Q000276:immunology; D006801:Humans; D007156:Immunologic Memory / Q000235:genetics; D016130:Immunophenotyping; D008213:Lymphocyte Activation / Q000235:genetics / Q000276:immunology*; D008875:Middle Aged; D008943:Mitral Valve / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D008969:Molecular Sequence Data; D016176:T-Lymphocyte Subsets / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D014261:Tricuspid Valve / Q000276:immunology* / Q000378:metabolism / Q000473:pathology