The Balance of CD8-Positive T Cells and PD-L1 Expression in the Myocardium Predicts Prognosis in Lymphocytic Fulminant Myocarditis
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Published:2023-10-12
Issue:1
Volume:149
Page:28-39
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ISSN:0008-6312
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Container-title:Cardiology
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language:en
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Short-container-title:Cardiology
Author:
Hiraiwa Hiroaki,Morimoto Ryota,Tsuyuki Yuta,Ushida Kaori,Ito Ryota,Kazama Shingo,Kimura Yuki,Araki Takashi,Mizutani Takashi,Oishi Hideo,Kuwayama Tasuku,Kondo Toru,Okumura Takahiro,Murohara Toyoaki
Abstract
<b><i>Introduction:</i></b> 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<sup>+</sup>, CD8<sup>+</sup>, FoxP3<sup>+</sup>, and PD-1<sup>+</sup> T cells, as well as PD-L1 expression, in cardiomyocytes in lymphocytic FM. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> The median age of the patients was 52 years (seven men and nine women). There was no significant difference in the number of CD4<sup>+</sup> cells. The number of CD8<sup>+</sup> cells and the CD8<sup>+</sup>/CD4<sup>+</sup> T cell ratio were higher in the cardiac event group (Event+) than in the group without cardiac events (Event−) (<i>p</i> = 0.048 and <i>p</i> = 0.022, respectively). The number of FoxP3<sup>+</sup> T cells was higher in the Event+ group (<i>p</i> = 0.049). Although there was no difference in the number of PD-1<sup>+</sup> cells, cardiomyocyte PD-L1 expression was higher in the Event+ group (<i>p</i> = 0.112). Event-free survival was worse in the group with a high CD8<sup>+</sup> cell count (<i>p</i> = 0.012) and high PD-L1 expression (<i>p</i> = 0.049). When divided into three groups based on the number of CD8<sup>+</sup> cells and PD-L1 expression (CD8<sup>high</sup>PD-L1<sup>high</sup> [<i>n</i> = 8], CD8<sup>low</sup>PD-L1<sup>high</sup> [<i>n</i> = 1], and CD8<sup>low</sup>PD-L1<sup>low</sup> [<i>n</i> = 7]), the CD8<sup>high</sup>PD-L1<sup>high</sup> group demonstrated the worst event-free survival, while the CD8<sup>low</sup>PD-L1<sup>high</sup> group had a favorable prognosis without cardiac events (<i>p</i> = 0.041). <b><i>Conclusion:</i></b> High myocardial expression of CD8<sup>+</sup> T cells and PD-L1 may predict a poor prognosis in lymphocytic FM.
Subject
Pharmacology (medical),Cardiology and Cardiovascular Medicine