Assessment of Peripheral Blood Regulatory T Cells And T Helper 17 Cells in Patients with Systemic Scleroderma

Öz

Regulatory T-cells (T-reg) may play an inhibitory role in the development of autoimmune diseases by suppressing the immune response to autoantigens. Impaired or decreased T-reg and/or increased T helper (h)-17 cells may be responsible for the development of autoimmune diseases. However, studies about the association of T-reg and systemic scleroderma are limited and conflicting. Our aim is to determine whether T-reg and Th-17 levels differed between healthy controls and in patients with systemic scleroderma and whether there is a relationship with disease activation. 17 patients with systemic scleroderma were included in the study. Clinical and laboratory parameters, modified Rodnan skin scores, Valentini disease activity index were evaluated in detail. Concurrent peripheral blood T-reg’s (CD4+CD25+T-reg, CD4+FOXP3+T-reg, CD4+CD25+FOXP3+T-reg) and Th-17 (IL-17 producing T cells) cells levels were studied. Age and sex matched 11 subjects were included as healthy control in this study. Fifteen of seventeen patients were female, median age was 52.8±9.36 years, median disease duration was 5.41±4.51 years. While skin involvement and Raynaud’s phenomenon were determined in all of the patients, esophageal involvement was determined in 13 of the patients (76.5%), and lung involvement in 14 (94.1%) patients. Median Valentini disease activity index was 3.23±1.53. In comparison of systemic scleroderma and healthy control, all the T-reg’s cell levels were significantly higher in systemic scleroderma group than healthy control (p=<0.0001, p=<0.0001 and p=<0.0001, respectively). The levels of CD4+IL-17 cells in systemic scleroderma group were higher when compared to healthy control, but it was not statistically significantly (p=0.100). In a cross-sectional study, it is rather difficult to explained the meaning of increased T-reg cell in systemic scleroderma patients. These results may be due to modification of the cells by immunosuppressive treatment. It might be more meaningful to evaluate T-reg cell before and after the treatment.

Anahtar Kelimeler

• scleroderma,T-regulatory cells,T-helper 17 cells

Sistemik Skleroderma Hastalarında Periferik Kan T Regulatuvar Hücreleri Ve T Helper 17 Hücrelerinin Değerlendirilmesi

Öz

Düzenleyici T hücreleri (T-reg), otoantijenlere karşı immun yanıtı baskılayarak otoimmün hastalıkların gelişiminde önleyici rol oynayabilir. Fonksiyonu bozulmuş veya azalmış T-reg ve / veya artmış T-helper (h)17 hücreler otoimmün hastalıkların oluşumundan sorumlu olabilir. T-reg ve sistemik skleroderma arasındaki ilişkiyi araştıran çalışmalar sınırlıdır ve çelişkilidir. Amacımız, sistemik sklerodermalı hastalarda T-reg ve Th-17 düzeylerinin sağlıklı kontrol grubundan farklı olup olmadığını belirlemek ve hastalık aktivasyonu ile aralarında bir ilişki olup olmadığını ortaya koymaktı. 17 sistemik skleroderma hastası çalışmaya alındı. Klinik ve laboratuvar bulguları, modifiye Rodnan deri skorları, Valentini hastalık aktivasyon indeksleri ayrıntılı bir şekilde değerlendirildi. Eş zamanlı periferik kandan T-reg (CD4+CD25+T-reg, CD4+FOXP3+T-reg, CD4+CD25+FOXP3+T-reg) ve Th-17 (IL-17 üreten T hücreleri) hücre düzeyleri çalışıldı. Cinsiyet ve yaş uyumlu sağlıklı 11 kişi kontrol grubu olarak alındı. 17 hastanın 15’i kadın, yaş ortalaması 52.8±9.36 yıl, hastalık süresi ortalama 5.41±4.51 yıl idi. Hastaların hepsinde cilt tutulumu ve Raynaud fenomeni varken özefagus tutulumu 13 (%76.5) hastada akciğer tutulumu ise 14 (%94.1) hastada vardı.Valentini hastalık aktivite indeksi ortalama 3.23±1.53 idi. Sklerodermalı hasta grubu ile sağlıklı kontrol grubu karşılaştırıldığında tüm T-reg hücrelerin düzeyleri istatistiksel olarak anlamlı olacak şekilde hasta grubunda daha yüksek saptandı. CD4+IL-17 hücre düzeyleri sağlıklı kontrol grubu ile kıyaslandığında hasta grubunda daha yüksek olsa da bu fark istatistiksel anlamlılığa ulaşmadı (sırasıyla p=<0.0001, p=<0.0001, p=<0.0001 ve p=0.100). Kesitsel bir çalışmada, sistemik skleroderma hastalarında artmış T-reg hücrelerinin anlamını açıklamak zordur. Bu durum immünsupresif tedavi ile hücrelerin modifikasyonuna bağlı olabilir. Tedaviden önce ve sonra T-reg hücrelerini değerlendirmek daha anlamlı olabilir.

Anahtar Kelimeler

• Skleroderma,T-regulatuvar hücreler,T-helper 17 hücreler

Kaynakça

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