BackgroundRecent studies have shown that increased number of Th17 cells and decreased number of Treg cells in the peripheral blood contribute to ankylosing spondylitis (AS). However, current therapy for AS, including biological agents, immunosuppressant and glucocorticoid, can not correct the imbalance of Th17 and Regulatory T (Treg) cells in AS patients effectively. It has been reported that low dose IL-2 can selectively expand Treg cells and had a critical effect on homeostatic balance between the Th17 and Treg cells.ObjectivesThe study is to explore the effect of low dose IL-2 therapy on the balance of Treg and Th17 cells in patients with AS and observe the efficiency and side effects of the therapy.MethodsSeventeen patients, who met the 1984 modified New York criteria and had evidence of active inflammatory spondylitis (defined as Bath AS Disease Activity Index (BASDAI) score >4) despite of receiving standard therapy including glucocorticoid, immune-suppressants, biological agents or combination of them, were enrolled. These patients were not only given traditional treatment, but also injected subcutaneously low-dose IL-2 (50 WIU/day for 5 days). Clinical and laboratory indicators were compared before and after IL-2 treatment. The side effects were observed in the course of therapy.ResultsThe number of Treg cells significantly increased after the treatment by 1 week (22.58±12.80 vs. 73.46±33.79, p<0.001). At the same time, there was a significantly decrease in the ratio of Th17/Treg cells (0.67±0.70 vs. 0.32±0.33, p=0.068). Besides, Th17 cells were also increased (12.83±9.24 vs. 19.26±13.24, p=0.054). Clinical manifestations were improved after the combination treatment of IL-2 and traditional drugs, especially BASDAI was decreased (4.57±0.61 vs. 1.98±0.83, P<0.001). No obvious adverse reactions were observed.ConclusionsLow dose IL-2 therapy can restore and maintain the balance of Th17 and Treg cells in the active patients with AS. Manifestation improved after the combination therapy. The therapy is safe. Further research is needed to investigate long term benefits of low-dose IL-2 therapy.References Wright P, Utriainen L, Milling S. Dendritic cells and regulatory T cells in spondyloarthritis. Curr Opin Rheumatol. 2013; 25(4):440–7.Zambrano-Zaragoza JF, Agraz-Cibrian JM, González-Reyes C, et al. Ankylosing spondylitis: from cells to genes. Int J Inflam. 2013; 2013:501653.Klatzmann D, Abbas AK. The promise of low-dose interleukin-2 therapy for autoimmune and inflammatory diseases. Nat Rev Immunol. 2015;15(5):283–94.He J, Zhang X, Wei Y, et al. Low-dose interleukin-2 treatment selectively modulates CD4(+) T cell subsets in patients with systemic lupus erythematosus. Nat Med. 2016;22(9):991–3. Disclosure of InterestNone declared
BackgroundPsoriasis arthritis is one of chronic, relapsing, inflammatory autoimmune disorders with skin lesions and joint damage. A therapeutic revolution of psoriatic arthritis (PsA) is still a considerable unmet need in the past decades. It has been well known that the imbalance of Th17 cells and regulatory T cells (Tregs) may be a pivotal cause of PsA. Correction of this dysfunction can be a potential therapy of PsA.ObjectivesIn this study, we measured and compared both absolute numbers and proportions of CD4+CD17+ Th17 cells and CD4+CD25+Foxp3+ Treg cells in peripheral blood of PsA patients and healthy controls to explore the immunopathogenesis of PsA; on the other hand, the effects of low-dose recombinant human IL-2 (rhIL-2) on Th17 and Treg cells were investigated in patients with PsA.MethodsBoth absolute numbers and proportions of Treg and Th17 cells in peripheral blood, defined as the CD4+CD25+Foxp3+T or CD4+IL-17+ T cell populations, were examined by flow cytometry in 40 healthy controls and 77 patients with PsA, including 39 patients who had never received disease-modifying antirheumatic drugs (DMARDs) and 38 patients who were receiving or had received DMARDs. Among these patients, 20 patients consented at enrollment to receive rhIL-2 treatment. Before and after treatment (50WIU/d for 5 days, IH), Th17 and Treg cells in peripheral blood were analyzed by flow cytometry.ResultsThe absolute count of Th17 cells in patients with PsA was very significantly higher than that of healthy controls (P<0.01), but the proportions of Th17 cell were not seen difference between PsA and healthy controls (P>0.05). In contrast with treated-PsA patients, the absolute count of Th17 cells was significant higher in untreated-PsA patients (P<0.05). After the course of rhIL-2 treatment, there was a significant increase in the absolute count of Treg cells (P<0.05), but no diference in the absolute count of Th17 cells, Th17/Treg was significantly lower and went back to nomal.ConclusionsThe results suggest that, not the proportion, but the decrease in the absolute count of Th17 cells, defined as the CD4+CD17+ populations, contributes to the pathogenesis of PsA. After the treatment of rhIL-2, there was a more significant increase in the absolute count of Treg cells than that of Th17, and consequently the balance of Th17/Treg was restored to normal, leading to the development of new therapies.References Karczewski J, Dobrowolska A, Rychlewskahańczewska A, et al. New insights into the role of T cells in pathogenesis of psoriasis and psoriatic arthritis[J]. Autoimmunity, 2016:1.DOI:10.3109/08916934.2016.1166214.Yoo I S, Lee J H, Song S T, et al. T-helper 17 cells: the driving force of psoriasis and psoriatic arthritis.[J]. International Journal of Rheumatic Diseases, 2012, 15(6):531–537. DOI:10.1111/j.1756–185X.2012.01813.x.Szodoray P, Nakken B, Barath S, et al. Altered Th17 cells and Th17/regulatory T-cell ratios indicate the subsequent conversion from undifferentiated connective tissue disease to definitive systemic autoimmune disorde...
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