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Cavalcanti NV, Palmeira P, Jatene MB, de Barros Dorna M, Carneiro-Sampaio M. Early Thymectomy Is Associated With Long-Term Impairment of the Immune System: A Systematic Review. Front Immunol 2021; 12:774780. [PMID: 34899730 PMCID: PMC8656688 DOI: 10.3389/fimmu.2021.774780] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aims Congenital heart diseases (CHDs) are diagnosed in approximately 9 in 1,000 newborns, and early cardiac corrective surgery often requires partial or complete thymectomy. As the long-term effect of early thymectomy on the subsequent development of the immune system in humans has not been completely elucidated, the present study aimed to evaluate the effects of thymus removal on the functional capacity of the immune system after different periods. Methods A systematic review of the literature was performed using MEDLINE, EMBASE, LILACS and Scopus. The inclusion criteria were original studies that analyzed any component of the immune system in patients with CHD who had undergone thymectomy during cardiac surgery in the first years of life. The results were evaluated for the quality of evidence. Results Twenty-three studies were selected and showed that patients who underwent a thymectomy in the first years of life tended to exhibit important alterations in the T cell compartment, such as fewer total T cells, CD4+, CD8+, naïve and CD31+ T cells, lower TRECs, decreased diversity of the TCR repertoire and higher peripheral proliferation (increased Ki-67 expression) than controls. However, the numbers of memory T cells and Treg cells differed across the selected studies. Conclusions Early thymectomy, either partial or complete, may be associated with a reduction in many T cell subpopulations and TCR diversity, and these alterations may persist during long-term follow-up. Alternative solutions should be studied, either in the operative technique with partial preservation of the thymus or through the autograft of fragments of the gland. Systematic Review Registration Prospero [157188].
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Affiliation(s)
- Nara Vasconcelos Cavalcanti
- Children's Hospital, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Patrícia Palmeira
- Laboratory of Clinical Investigation LIM-36, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Marcelo Biscegli Jatene
- Pediatric Cardiovascular Surgery Department, Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Mayra de Barros Dorna
- Children's Hospital, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Children's Hospital, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil.,Laboratory of Clinical Investigation LIM-36, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, Brazil
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Mengrelis K, Kucera F, Shahid N, Watt E, Ross S, Lau CI, Adams S, Gilmour K, Pils D, Crompton T, Burch M, Davies EG. T cell phenotype in paediatric heart transplant recipients. Pediatr Transplant 2021; 25:e13930. [PMID: 33326675 DOI: 10.1111/petr.13930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 11/01/2020] [Accepted: 11/03/2020] [Indexed: 01/31/2023]
Abstract
Paediatric heart transplantation recipients suffer an increased incidence of infectious, autoimmune and allergic problems. The relative roles of thymus excision and immunosuppressive treatments in contributing to these sequelae are not clear. We compared the immunological phenotypes of 25 heart transplant recipients (Tx), 10 children who underwent thymus excision during non-transplantation cardiac surgery (TE) and 25 age range-matched controls, in two age bands: 1-9 and 10-16 years. Significant differences from controls were seen mainly in the younger age band with Tx showing lower CD3 and CD4 cell counts whilst TE showed lower CD8 cell counts. Naïve T cell and recent thymic emigrant proportions and counts were significantly lower than controls in both groups in the lower age band. T cell recombination excision circle (TREC) levels were lower than controls in both groups in both age bands. There were no differences in regulatory T cells, but in those undergoing thymus excision in infancy, their proportions were higher in TE than Tx, a possible direct effect of immunosuppression. T cell receptor V beta spectratyping showed fewer peaks in both groups than in controls (predominantly in the older age band). Thymus excision in infancy was associated with lower CD8 cell counts and higher proportions of Tregs in TE compared to Tx. These data are consistent with thymus excision, particularly in infancy, being the most important influence on immunological phenotype after heart transplantation.
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Affiliation(s)
- Konstantinos Mengrelis
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Filip Kucera
- Department of Cardiology, Great Ormond Street Hospital, London, UK
| | - Nadia Shahid
- Department of Immunology, Great Ormond Street Hospital, London, UK
| | - Eleanor Watt
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Susan Ross
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Ching-In Lau
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Stuart Adams
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Kimberly Gilmour
- Department of Immunology, Great Ormond Street Hospital, London, UK
| | - Dietmar Pils
- Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Tessa Crompton
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Michael Burch
- Department of Cardiology, Great Ormond Street Hospital, London, UK
| | - E Graham Davies
- UCL Great Ormond Street Institute of Child Health, London, UK.,Department of Immunology, Great Ormond Street Hospital, London, UK
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Yuki K, Koutsogiannaki S. Neutrophil and T Cell Functions in Patients with Congenital Heart Diseases: A Review. Pediatr Cardiol 2021; 42:1478-1482. [PMID: 34282478 PMCID: PMC8289712 DOI: 10.1007/s00246-021-02681-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/14/2021] [Indexed: 01/02/2023]
Abstract
With a significant improvement of survival in patients with congenital heart disease, we expect to encounter these patients more frequently for various medical issues. Clinical studies indicate that infection can pose higher risk in this cohort than general population. Here, with the hypothesis that more severe infection-related complications in CHD cohort may be linked to their inadequate immune response, we reviewed the current literature regarding neutrophil and T cell functions in patients with congenital heart diseases.
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Affiliation(s)
- Koichi Yuki
- Department of Anesthesiology, Critical Care and Pain Medicine, Cardiac Anesthesia Division, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Department of Anaesthesia and Immunology, Harvard Medical School, Boston, MA, USA.
| | - Sophia Koutsogiannaki
- grid.2515.30000 0004 0378 8438Department of Anesthesiology, Critical Care and Pain Medicine, Cardiac Anesthesia Division, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA ,grid.38142.3c000000041936754XDepartment of Anaesthesia and Immunology, Harvard Medical School, Boston, MA USA
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Silva SL, Albuquerque AS, Matoso P, Charmeteau-de-Muylder B, Cheynier R, Ligeiro D, Abecasis M, Anjos R, Barata JT, Victorino RMM, Sousa AE. IL-7-Induced Proliferation of Human Naive CD4 T-Cells Relies on Continued Thymic Activity. Front Immunol 2017; 8:20. [PMID: 28154568 PMCID: PMC5243809 DOI: 10.3389/fimmu.2017.00020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/05/2017] [Indexed: 01/06/2023] Open
Abstract
Naive CD4 T-cell maintenance is critical for immune competence. We investigated here the fine-tuning of homeostatic mechanisms of the naive compartment to counteract the loss of de novo CD4 T-cell generation. Adults thymectomized in early childhood during corrective cardiac surgery were grouped based on presence or absence of thymopoiesis and compared with age-matched controls. We found that the preservation of the CD31- subset was independent of the thymus and that its size is tightly controlled by peripheral mechanisms, including prolonged cell survival as attested by Bcl-2 levels. Conversely, a significant contraction of the CD31+ naive subset was observed in the absence of thymic activity. This was associated with impaired responses of purified naive CD4 T-cells to IL-7, namely, in vitro proliferation and upregulation of CD31 expression, which likely potentiated the decline in recent thymic emigrants. Additionally, we found no apparent constraint in the differentiation of naive cells into the memory compartment in individuals completely lacking thymic activity despite upregulation of DUSP6, a phosphatase associated with increased TCR threshold. Of note, thymectomized individuals featuring some degree of thymopoiesis were able to preserve the size and diversity of the naive CD4 compartment, further arguing against complete thymectomy in infancy. Overall, our data suggest that robust peripheral mechanisms ensure the homeostasis of CD31- naive CD4 pool and point to the requirement of continuous thymic activity to the maintenance of IL-7-driven homeostatic proliferation of CD31+ naive CD4 T-cells, which is essential to secure T-cell diversity throughout life.
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Affiliation(s)
- Susana L Silva
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal; Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Adriana S Albuquerque
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa , Lisboa , Portugal
| | - Paula Matoso
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa , Lisboa , Portugal
| | - Bénédicte Charmeteau-de-Muylder
- Cytokines and Viral Infections, Immunology Infection and Inflammation Department, Institut Cochin, INSERM, U1016, Paris, France; CNRS, UMR8104, Paris, France; Université Paris Descartes, Paris, France
| | - Rémi Cheynier
- Cytokines and Viral Infections, Immunology Infection and Inflammation Department, Institut Cochin, INSERM, U1016, Paris, France; CNRS, UMR8104, Paris, France; Université Paris Descartes, Paris, France
| | - Dário Ligeiro
- Centro de Sangue e Tranplantação de Lisboa, Instituto Português de Sangue e Transplantação, IP , Lisboa , Portugal
| | - Miguel Abecasis
- Departamento do Coração, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental , Carnaxide , Portugal
| | - Rui Anjos
- Departamento do Coração, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental , Carnaxide , Portugal
| | - João T Barata
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa , Lisboa , Portugal
| | - Rui M M Victorino
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisboa, Portugal; Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisboa, Portugal
| | - Ana E Sousa
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa , Lisboa , Portugal
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Roosen J, Oosterlinck W, Meyns B. Routine thymectomy in congenital cardiac surgery changes adaptive immunity without clinical relevance. Interact Cardiovasc Thorac Surg 2014; 20:101-6. [PMID: 25320142 DOI: 10.1093/icvts/ivu343] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The actual importance of the thymus in both children and adults is largely unclear. In congenital cardiac surgery, a partial or total thymectomy is frequently performed to improve access to the heart and great vessels. We performed a literature search to evaluate the effect on the adaptive immune system of the removal of thymus tissue in patients with congenital heart disease. A PubMed search according to Dunning's standard provided 149 articles, of which 13 addressed our search question. Each study has been tabulated with author, cases, controls, follow-up, methods, results and limitations. A first group of articles repeatedly showed the effect on the T-cell compartment, including the impact on subgroups of this compartment. More recent studies, usually with a longer follow-up, confirm that the earlier changes in T-cell population appear to be permanent. Only one author found a normalization of T-cell population five years after thymectomy. In contrast to these clear changes in T-cell population, there is currently no clear clinical relevance. A literature search on thymectomy in congenital cardiac surgery revealed clear changes in T-cell-related immunity; however, there is a lack of clinical relevance. Further investigation of the adaptive immune system is required to explain this discrepancy.
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Affiliation(s)
- Jorg Roosen
- Department of Cardiovascular Sciences, Research Unit of Experimental Cardiac Surgery, KU Leuven, Leuven, Belgium
| | - Wouter Oosterlinck
- Department of Cardiovascular Sciences, Research Unit of Experimental Cardiac Surgery, KU Leuven, Leuven, Belgium
| | - Bart Meyns
- Department of Cardiovascular Sciences, Research Unit of Experimental Cardiac Surgery, KU Leuven, Leuven, Belgium
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