High Levels of Costimulatory Receptors OX40 and 4-1BB Characterize CD4+CD28null T Cells in Patients With Acute Coronary Syndrome

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Patients with acute coronary syndrome (ACS) predisposed to recurrent coronary events have an expansion of a distinctive T-cell subset, the CD4+CD28null T cells. These cells are highly inflammatory and cytotoxic in spite of lacking the costimulatory receptor CD28, which is crucial for optimal T cell function. The mechanisms that govern CD4+CD28null T cell function are unknown.


Our aim was to investigate the expression and role of alternative costimulatory receptors in CD4+CD28null T cells in ACS.

Methods and Results:

Expression of alternative costimulatory receptors (inducible costimulator, OX40, 4–1BB, cytotoxic T lymphocyte associated antigen-4, programmed death-1) was quantified in CD4+CD28null T cells from circulation of ACS and stable angina patients. Strikingly, in ACS, levels of OX40 and 4-1BB were significantly higher in circulating CD4+CD28null T cells compared to classical CD4+CD28+ T lymphocytes. This was not observed in stable angina patients. Furthermore, CD4+CD28null T cells constituted an important proportion of CD4+ T lymphocytes in human atherosclerotic plaques and exhibited high levels of OX40 and 4-1BB. In addition, the ligands for OX40 and 4-1BB were present in plaques and also expressed on monocytes in circulation. Importantly, blockade of OX40 and 4-1BB reduced the ability of CD4+CD28null T cells to produce interferon-γ and tumor necrosis factor-α and release perforin.


Costimulatory pathways are altered in CD4+CD28null T cells in ACS. We show that the inflammatory and cytotoxic function of CD4+CD28null T cells can be inhibited by blocking OX40 and 4-1BB costimulatory receptors. Modulation of costimulatory receptors may allow specific targeting of this cell subset and may improve the survival of ACS patients.

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