The aim of the study was to investigate differences in the proportions of immune cells in dogs at different stages of myxomatous mitral valve degeneration (MMVD) and in comparison with healthy dogs, and to determine whether selected inflammatory and immune parameters have predictive value. In the first part of the study, using Cox regression analysis in 62 dogs with MMVD, we found that neutrophil granulocytes, monocytes, and lymphocytes had no predictive value. Higher concentrations of cytotoxic T cells were negatively associated with survival, while the proportion of T helper cells was positively associated with survival in the group of dogs with unstable congestive heart failure (CHF) and in the group of all dogs with MMVD. In the prospective part of the study, we used flow cytometry to determine the proportions of T lymphocyte subtypes, natural killer cells, and monocytes in 64 dogs with MMVD and 17 healthy dogs, and measured the concentrations of cytokines and chemokines (interleukin (IL) 1β, IL-2, IL-6, IL-10, tumor necrosis factor α (TNF-α), keratinocyte chemotactic-like, monocyte chemoattractant protein-1 (MCP-1)). The proportion of activated T helper cells was significantly lower in the stable CHF group compared to the other groups, while there were no differences in the proportion of cytotoxic T cells and regulatory T cells between the groups. The proportion of monocytes was significantly higher in the stable and unstable CHF groups compared to the preclinical group, while there were no differences in the representation of individual monocyte subtypes between the groups studied. There were also no differences in the population of natural killer cells. To assess the interrelationships, we calculated Spearman's correlation coefficients in the group of all dogs with MMVD and found a negative correlation between the monocyte subtype CD14⁻MHC II⁺and MCP-1 and a positive correlation between monocytes and MCP-1. The proportion of T helper cells was negatively correlated with IL-6 and TNF-α concentrations, while the proportion of cytotoxic T cells was positively correlated with TNF-α concentration. These findings indicate the involvement of monocytes and cytotoxic T cells in the inflammatory process of MMVD and the positive role of T cells in the pathogenesis of MMVD. The results of our study confirm the important role of the immune system in the pathophysiology of MMVD.
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