Quantitative changes in T-cell populations after left ventricular assist device implantation: Relationship to T-cell apoptosis and soluble CD95

Hendrik Jan Ankersmit, Niloo M. Edwards, Michael Schuster, Ranjit John, Alfred Kocher, Eric A. Rose, Mehmet Oz, Silviu Itescu

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

Background - Left ventricular assist devices (LVADs) are currently being evaluated as permanent therapy for end-stage heart failure. Because life- threatening infections limit successful long-term device implantation, we investigated the relationship between quantitative T-cell defects in LVAD recipients and CD95-mediated T-cell apoptosis. Methods and Results - Immunological studies were performed in NYHA class IV patients awaiting cardiac transplantation who received either a TCI Heartmate left ventricular assist device (LVAD) or medical management. Fluorochrome-labeled Mabs were used in T-cell phenotypic analyses. T-cell apoptosis was measured by annexin V binding of T cells cultured in medium for 24 hours. Circulating serum levels of soluble CD95 were measured by ELISA. LVAD recipients had a relative lymphopenia and reduction in CD4 T-cell levels compared with NYHA class IV heart failure controls. These observations were confirmed in a longitudinal study in LVAD recipients, which showed that device implantation was accompanied by progressive and sustained reductions in circulating CD4 T-cell levels. These abnormalities in LVAD recipients were accompanied by increased levels of circulating soluble CD95 and by excessive CD4 and CD8 T-cell apoptosis. Susceptibility to induction of apoptosis was >2-fold greater for CD4 T cells than for CD8 T cells. Conclusions - These results suggest that the reduction in CD4 T-cell levels accompanying LVAD implantation is a consequence of an augmented pathway of CD95-mediated apoptosis. The clinical consequences of these abnormalities may include increased prevalence of systemic infections.

Original languageEnglish (US)
Pages (from-to)II211-II215
JournalCirculation
Volume100
Issue number19 SUPPL.
StatePublished - Nov 9 1999

Keywords

  • Apoptosis
  • Assist devices, left ventricular
  • Heart failure
  • Transplantation

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