IntroductionT-cell development is an ordered process thought to take place exclusively in the thymus where CD4 ϩ CD8 ϩ T cells develop into CD4 ϩ and CD8 ϩ T cells with mutually exclusive expression of these 2 receptors. Mature CD4 ϩ and CD8 ϩ T cells then leave the thymus and enter secondary lymphoid organs where they recognize their cognate antigen in the context of major histocompatibility complex (MHC) class II and class I molecules on antigenpresenting cells. Antigenic stimulation induces proliferation and differentiation into armed effector cells with the ability to home to infected organs and to participate in immune responses against intracellular pathogens.Contrary to this conventional dichotomy, circulating CD4 ϩ CD8 ϩ T cells have sporadically been reported in humans as well as in animals such as mice, chicken, swine, and monkeys. [1][2][3][4][5][6] The existence of this unconventional and rare (Ͻ 5%) lymphocyte population in the peripheral blood was explained as a premature release of CD4 ϩ CD8 ϩ T cells from the thymus into the periphery, 7,8 where their maturation into functionally competent single-positive cells continues. 7 There is, however, considerable evidence of an increased frequency of peripheral CD4 ϩ CD8 ϩ T cells during viral infections. [9][10][11][12] In human immunodeficiency virus (HIV) or EpsteinBarr virus (EBV) infections, for example, the percentage of CD4 ϩ CD8 ϩ T cells can increase to 20% of all circulating lymphocytes. 9,10 Yet, in humans, very little is known about their phenotype, antigen specificity, and function. This is particularly striking since in animal models CD4 ϩ CD8 ϩ T cells have been described as antigen-specific memory cells that can be induced by vaccination. 3,4,6 Thus, it is crucial to determine the role and biologic significance of peripheral CD4 ϩ CD8 ϩ T cells in humans, as they could potentially contribute to the adaptive immune response against pathogens.In this study, we addressed this issue with an extensive analysis of peripheral CD4 ϩ CD8 ϩ T cells in both healthy individuals and patients with past or present viral infections. We determined the frequency and ex vivo phenotype of CD4 ϩ CD8 ϩ T cells in regards to memory, activation, homing, differentiation, and maturation markers. Furthermore, we provide data on antigen specificity, proliferation, cytokine production, and cytotoxic potential of CD4 ϩ CD8 ϩ T cells in response to tetanus toxoid and to a large variety of antigens (lysates of infected cells, overlapping viral peptides, minimal optimal viral epitopes) from past (influenza A virus [IV]
Materials and methods
Blood samplesPeripheral blood mononuclear cells (PBMCs) were isolated from anticoagulant citrate dextrose (ACD)-anticoagulated blood of 10 healthy blood donors and 15 HCV-infected patients as described. 13
Viral lysates, peptides, proteins, and antibodiesLysates from CMV-or EBV-infected cells and the corresponding uninfected cells were purchased from Virion (Marristown, NJ). Lysates from HSV-1-, MV-, and VZV-infected cells and the c...