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Clinical and Vaccine Immunology, July 2008, p. 1141-1143, Vol. 15, No. 7
1071-412X/08/$08.00+0 doi:10.1128/CVI.00430-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.
Effects of Delays in Peripheral Blood Processing, Including Cryopreservation, on Detection of CD31 Expression on Naïve CD4 T Cells
Jeanette Higgins,1
Julia A. Metcalf,2
Randy A. Stevens,1
Michael Baseler,1
Michael Proschan,2
H. Clifford Lane,2 and
Irini Sereti2*
AIDS Monitoring Laboratory, Clinical Services Program, SAIC-Frederick, Inc., NCI—Frederick, Frederick, Maryland 21702,1
Clinical and Molecular Retroviral Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 208922
Received 31 October 2007/
Returned for modification 25 December 2007/
Accepted 21 April 2008

ABSTRACT
Delayed processing of peripheral blood or peripheral blood mononuclear
cell isolation and cryopreservation can lead to the detection
of somewhat higher levels of CD31 expression on naïve CD4
T cells by flow cytometry. These observations should be considered
in the planning of multicenter clinical trials and in the interpretation
of the results of functional studies.

TEXT
Antibodies to CD31 (anti-PECAM-1) recognize the platelet/endothelial
cell adhesion molecule-1 (PECAM-1) (
2). Six extracellular immunoglobulin-like
domains of the C2 group compose the CD31 antigen. The CD31 antigen
is a vascular cell adhesion molecule involved in leukocyte migration
through the intercellular junctions of vascular endothelial
cells (
1). The expression of CD31 changes during the T-cell
maturation of CD4 T cells and is lost after triggering of the
T-cell receptor and T-cell activation even before conversion
to a memory phenotype (
3). The loss of CD31 on naïve CD4
+ T cells can thus allow recognition of those naïve cells
that have undergone homeostatic proliferation and have diluted
their receptor excision circle (TREC) content. It has been shown
in humans that naïve CD4 T cells express higher levels
of CD31 than memory CD4
+ T cells and that naïve T cells
expressing CD31 are enriched in their TREC contents (
5). The
study of CD31 expression may be of particular interest in settings
with high rates of CD4 T-cell turnover, the loss of naïve
T cells, and/or functional abnormalities in naïve CD4 T
cells, such as human immunodeficiency virus (HIV) infection
or T-cell recovery after stem cell transplantation or chemotherapy
(
7,
8).
In this study, the timing of processing of peripheral blood or the timing of lymphocyte separation and cryopreservation procedures was evaluated with blood from both HIV-negative (HIV–) and HIV-positive (HIV+) participants to determine what effect there might be on the flow cytometric measurement of the percentage of CD4+ CD45RO– CD27+ (naïve) T cells expressing CD31. Centers for Disease Control and Prevention (CDC) guidelines for CD4+ T-cell determinations with CD45 gating for HIV-infected persons state that peripheral blood can be held for up to 72 h, a practice that can allow testing of the blood at a centralized laboratory in multicenter trials (9). Previous studies have also shown that density gradient separation and cryopreservation do not lead to the loss of either CD4+ or CD8+ T cells but that measurable losses in specific T-cell subsets can be observed (4, 10-12). A cohort of 54 participants, 17 of whom were HIV– and 37 of whom were HIV+, was recruited after informed consent for participation in institutional review board-approved protocols was obtained.
The 17 HIV– study participants had a median age of 50 years (range, 37 to 60 years). The median CD4 T-cell count for the HIV– cohort was 753 cells/µl (range, 352 to 1,225 cells/µl). The 37 HIV+ participants had a median age of 45 years (range, 23 to 64 years). The median CD4 T-cell count of the HIV+ cohort was 679 cells/µl (range, 212 to 1,289 cells/µl). Twenty-two patients (61%) had viral loads of <50 copies/ml. The median viral load of the remaining patients was 13,304 copies/ml (range, 144 to 35,763 copies/ml). One patient was not receiving antiretroviral therapy at the time of the study.
Immunophenotyping of peripheral blood drawn into tubes containing EDTA was done at 4, 24, 48, and 72 h after the blood was drawn, according to the manufacturer's instructions, by using a modification of the CDC guidelines in a Clinical Laboratory Improvement Act-certified laboratory (6, 9, 13). The cells were lysed after they were stained with Optilyse C (Beckman Coulter, Hialeah, FL), washed twice, and resuspended in 500 µl of phosphate-buffered saline (Cambrex, Walkersville, MD). The samples were immediately analyzed on a Becton Dickinson FacsCanto flow cytometer (BD Biosciences). The antibodies used were CD27-fluorescein isothiocyanate (FITC) (clone M-T271), CD31-phycoerythrin (PE) (clone L133.1), CD4-peridinin chlorophyll protein (clones SK3 and SK4), CD41-FITC (clone HIP8) (which was used to exclude the potential effect of platelets on CD31 binding), and CD45RO-allophycocyanin (APC) (clone UCHL1), all from BD/Pharmingen (San Jose, CA). Gating on CD4+ CD27+ CD45RO– (naïve) T cells was used to determine the level of expression of CD31 (Fig. 1). The CD31+ population was defined by the use of an isotype control (mouse immunoglobulin G1 PE, clone X40). In addition, peripheral blood was collected in a heparinized syringe, and peripheral blood mononuclear cells (PBMCs) were isolated by Ficoll-Hypaque separation (13). An aliquot from the heparinized blood was stained to assess the effect of different anticoagulants (EDTA and acid-citrate-dextrose), and no significant differences were observed (data not shown). A fraction of the PBMCs was processed immediately after separation for immunophenotyping, and the remaining PBMCs were cryopreserved. After 1 week, the cryopreserved PBMCs were thawed in a 37°C water bath, washed once in complete medium, counted, and assessed for viability with propidium iodide before they were immunophenotyped. The intra-assay and interassay variabilities were found to be low, with a coefficient of variation of <5%.
The effects of the delayed processing are summarized in Table
1, which reports the mean values and interquartile ranges (IQRs)
for the HIV
– and the HIV
+ cohorts separately. A small
but statistically significant overestimation of the percentage
of CD31 expression on naïve CD4
+ T cells was observed with
delayed processing in both the HIV
– study participants
(+1.8 [
P = 0.08] at 24 h compared to the level at 4 h, +3.3
[
P = 0.003] at 48 h compared to the level at 4 h and +6.2 [
P < 0.0001] at 72 h compared to the level at 4 h) and the HIV
+ study participants (+1.6 [
P = 0.03] at 24 h compared to the
level at 4 h, +3.1 [
P = 0.0002] at 48 h compared to the level
at 4 h and +5.4 [
P < 0.0001] at 72 h compared to the level
at 4 h). Virtually all participants had an increased reading
at 72 h compared to that at 4 h. From these data, it appears
that samples could be held for 24 h or for up to 48 h for centralized
processing in multisite trials with minimal overestimation of
the level of CD31 expression on naïve CD4 T cells. Similar
results were obtained when we compared the percent changes from
the baseline (data not shown).
The effects of the PBMC isolation and cryopreservation are shown
in Table
2, with the mean values and the IQR ranges reported
for the HIV
– and the HIV
+ participants. There was no significant
difference between the measurements for PBMCs in EDTA (peripheral
blood stored for <4 h) and freshly isolated PBMCs, but the
measurements for cryopreserved PBMCs were significantly greater
than those for both peripheral blood in EDTA and freshly isolated
PBMCs for the HIV
+ participants. The effects of PBMC isolation
and cryopreservation varied significantly from person to person
(data not shown). One plausible explanation may be that when
the cells are separated and cryopreserved, there is an enrichment
of the pool of naïve T cells (CD4
+ CD27
+ CD45RO
–),
with higher levels of expression of CD31. The results were the
same for all 54 participants, including the HIV
+ and the HIV
– participants.
View this table:
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TABLE 2. Percentage of naïve CD4+ T cells expressing CD31 in peripheral blood, freshly isolated PBMCs, and cryopreserved PBMCs and absolute differences in percentages in PBMCs or cryopreserved PBMCs from that in peripheral blooda
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These data suggest that cryopreservation can result in small
but systematic overestimations of the proportion of naïve
T cells expressing CD31 in both HIV
+ and HIV
– persons.
Since many functional T-cell assays and TREC measurements are
performed with separated and/or cryopreserved PBMCs, this should
be taken into consideration, particularly when freshly isolated
cells are being compared with cryopreserved cells. Finally,
although optimal results were obtained with immediate processing
after the blood was drawn, the overestimation of CD31 expression
on naïve CD4
+ T cells would be acceptable for most laboratories
for up to 48 h, which would allow off-site flow cytometry to
be performed for multicenter clinical trials.

ACKNOWLEDGMENTS
This project has been funded in whole or in part with federal
funds from the National Cancer Institute, National Institutes
of Health, under contract NO1-CO-12400.
The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

FOOTNOTES
* Corresponding author. Mailing address: Clinical and Molecular Retrovirology Section, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bldg. 10, Room 11B-04, 10 Center Drive MSC 1876, Bethesda, MD 20892. Phone: (301) 496-5533. Fax: (301) 402-0070. E-mail:
isereti{at}niaid.nih.gov 
Published ahead of print on 30 April 2008. 

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Clinical and Vaccine Immunology, July 2008, p. 1141-1143, Vol. 15, No. 7
1071-412X/08/$08.00+0 doi:10.1128/CVI.00430-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.