Expression of CD4+ CD28null T lymphocytes in children and adolescents with type 1 diabetes mellitus: Relation to microvascular complications, aortic elastic properties, and carotid intima media thickness

Mona H El-Samahy; Azza A G Tantawy; Amira A M Adly; Nevin M Habeeb; Eman A R Ismail; Gehan M Hamed; Rasha Eladawy

doi:10.1111/pedi.12484

Expression of CD4⁺ CD28^null T lymphocytes in children and adolescents with type 1 diabetes mellitus: Relation to microvascular complications, aortic elastic properties, and carotid intima media thickness

Pediatr Diabetes. 2017 Dec;18(8):785-793. doi: 10.1111/pedi.12484. Epub 2017 Jan 19.

Authors

Mona H El-Samahy¹, Azza A G Tantawy¹, Amira A M Adly¹, Nevin M Habeeb¹, Eman A R Ismail², Gehan M Hamed², Rasha Eladawy¹

Affiliations

¹ Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
² Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

PMID: 28102614
DOI: 10.1111/pedi.12484

Abstract

Background: Cardiovascular risk in type 1 diabetes mellitus (T1DM) is associated with endothelial dysfunction, inflammation, and altered immunity. CD4⁺ CD28^null T-cells are a subset of long-lived cytotoxic CD4⁺ T-lymphocytes with proatherogenic and plaque-destabilizing properties. We hypothesized that the frequency of CD4⁺ CD28^null T-cells may be altered in T1DM and related to vascular complications.

Aim: To assess the percentage of CD4⁺ CD28^null T-lymphocytes in children and adolescents with T1DM and their relation to vascular structure and glycemic control.

Methods: Totally 100 patients with T1DM were divided into 2 groups according to the presence of microvascular complications and compared with 50 healthy controls. CD4⁺ CD28^null T-lymphocytes were analyzed using flow cytometry. Aortic elastic properties and carotid intima media thickness (CIMT) were assessed.

Results: Aortic stiffness index and CIMT were significantly higher among patients compared with healthy controls while aortic strain and distensibility were decreased. The percentage of CD4⁺ CD28^null T-cells was significantly higher in patients with and without microvascular complications compared with controls. High frequency of CD4⁺ CD28^null T-cells was found among patients with microalbuminuria or peripheral neuropathy. Patients with CD4⁺ CD28^null T-cells ≥10% had higher HbA1c, urinary albumin creatinine ratio, aortic stiffness, and CIMT. CD4⁺ CD28^null T-cells were positively correlated to HbA1c, aortic stiffness index, and CIMT.

Conclusions: Changes in aortic elastic properties and increased CIMT among young patients with T1DM may enable the recognition of preclinical cardiac impairment. The correlation between CD4⁺ CD28^null T-cells and assessed parameters of vascular structure highlights the role of altered immune response in the occurrence of diabetic vascular complications.

Keywords: CD4+CD28null T lymphocytes; aortic stiffness; carotid intima media thickness; microvascular complications; type 1 diabetes.

MeSH terms

Adolescent
Aorta / diagnostic imaging
CD28 Antigens / metabolism*
CD4-Positive T-Lymphocytes / metabolism*
Carotid Intima-Media Thickness
Case-Control Studies
Child
Cross-Sectional Studies
Diabetes Mellitus, Type 1 / complications
Diabetes Mellitus, Type 1 / diagnostic imaging
Diabetes Mellitus, Type 1 / immunology*
Diabetic Angiopathies / immunology*
Elasticity
Female
Humans
Male

Substances

CD28 Antigens