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Background  The main consequence of chronic  Trypanosoma cruzi  infection is the development of myocarditis in approximately 20–30% of infected individuals but not until 10–20 years after the initial infection. We have previously shown that circulating interferon-γ-secreting T cells responsive to  Trypanosoma cruzi  antigens in chronic Chagas disease patients display a low grade of differentiation and the frequency of these T lymphocytes decreases along with the severity of heart disease. This study thought to explore the expression of inhibitory receptors, transcription factors of type 1 or regulatory T cells, and markers of T cell differentiation, immunosenescence or active cell cycle in cardiac explants from patients with advanced Chagas disease myocarditis.    Methodology/Principal Findings  The expression of different markers for T and B cells as well as for macrophages was evaluated by immunohistochemistry and immunofluorescence techniques in cardiac explants from patients with advanced chronic Chagas disease submitted to heart transplantation. Most infiltrating cells displayed markers of antigen-experienced T cells (CD3 + , CD4 + , CD8 + , CD45RO + ) with a low grade of differentiation (CD27 + , CD57 − , CD45RA − , PD-1 − ). A skewed T helper1/T cytotoxic 1 profile was supported by the expression of T-bet; whereas FOXP3 +  cells were scarce and located only in areas of severe myocarditis. In addition, a significant proliferative capacity of CD3 +  T cells, assessed by Ki67 staining, was found.    Conclusions/Significance  The quality of T cell responses and immunoregulatory mechanisms might determine the pattern of the cellular response and the severity of disease in chronic  Trypanosoma cruzi  infection.

Presence of Antigen-Experienced T Cells with Low Grade of Differentiation and Proliferative Potential in Chronic Chagas Disease Myocarditis