Key result
High aortic valve PD-L1 expression and immune infiltration are linked to calcification and AS severity.
Why the study?
The relationships among PD-L1 expression, clinicopathologic characteristics, infiltrating immune cells, and disease severity in aortic stenosis were not well elucidated.
Cross-Sectional (n=53)
Immune cell infiltration and PD-L1 expression in aortic valves are associated with calcification and severity of aortic stenosis, highlighting an active inflammatory component in the disease process.
Supports inflammatory mechanisms in aortic stenosis progression; hypothesis-generating for immunomodulatory targets in prospective studies.
Objective: Aortic stenosis (AS) is a disease characterized by narrowing of the aortic valve (AV) orifice. In relation to this disease, the purpose of this study was to elucidate the relationships among factors such as expression of programmed cell death-1 ligand (PD-L1, which is the ligand of PD-1 protein; together, they play a central role in the inhibition of T lymphocyte function), clinicopathologic characteristics, infiltrating immune cells, and disease severity. Methods: We performed immunohistochemical analysis on the surgically-resected AVs of 53 patients with AS. We used the resultant data to identify relationships among PD-L1 expression, disease severity, and the infiltration of immune cells including cluster of differentiation (CD8)-positive T lymphocytes, cluster of differentiation 163 (CD163)-positive macrophages, and forkhead box protein 3 (FOXP3)-positive regulatory T lymphocytes (Tregs). Results: PD-L1 expression in resected AVs was significantly associated with being nonsmoker, valve calcification, and the infiltration of CD8-positive T cells and CD163-positive macrophages. Disease severity and valve calcification were significantly associated with low infiltration of FOXP3-positive Tregs and high infiltration of CD8-positive T cells and CD163-positive macrophages. Moreover, calcified AVs with high PD-L1 expression showed active inflammation without FOXP3-positive Tregs but with high levels of CD8-positive T lymphocytes and CD163-positive macrophages. Conclusions: Immune cell infiltration in the AVs and expression of the immune checkpoint protein PD-L1 were associated with the calcification of AS and disease severity.
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Erkhem‐Ochir et al. (2020) conducted a cross-sectional in Aortic stenosis (n=53). PD-L1 expression and immune cell infiltration was evaluated on Association among PD-L1 expression, disease severity, and infiltration of immune cells. High PD-L1 expression and immune cell infiltration in resected aortic valves were significantly associated with valve calcification and disease severity in patients with aortic stenosis.
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