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

Year 2018, Volume: 40 Issue: 1, 28 - 33, 21.02.2018

Döndü Üsküdar Cansu Hava Üsküdar Teke Cengiz Korkmaz

https://doi.org/10.20515/otd.395894

Abstract

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.

Keywords

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

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

Abstract

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.

Keywords

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

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