We observed by flow cytometry that the frequency of both gastric infiltrating Tregs and PD-1-positive CD4 T cells is correlated with the density of Helicobacter pylori, suggesting that cellular immunity against this pathogen is inhibited.Helicobacter pylori, a common human pathogen, infects about 50% of the world's population (9, 10). Many studies have confirmed that the pathogenesis of H. pylori infection is probably due largely to the host immune system, particularly the cellular immune response. However, the mechanism by which H. pylori negatively regulates the immune response against the bacteria is not completely understood.In recent years, regulatory T cells (Tregs) and related negative regulatory molecules have been a focus of research on the immune mechanisms of diseases. Evidence indicates that removal or reduction of Tregs can enhance immune responses against infectious microbes (1,2,5,6,8,(11)(12)(13)16). Expression of programmed cell death 1 (PD-1, also called CD279), a negative regulatory molecule in the CD28/B7 family, is induced on CD4 ϩ T cells, CD8 ϩ T cells, natural killer T cells, B cells, and activated monocytes during the course of many diseases. B and T lymphocyte attenuator (BTLA), a newly discovered member of the CD28 family of costimulatory molecules, may have inhibitory function similar to that of PD-1.The PD-1 signaling pathway is involved in chronic bacterial infection and may be a potential therapeutic target. However, the role of BTLA in H. pylori infection has not been investigated. In this study, we analyzed the frequency of gastric infiltrating CD4 ϩ CD25 high Tregs in patients with H. pylori infection, as well as the expression of PD-1 and BTLA on gastric infiltrating CD4 ϩ T cells, and their relationships with H. pylorirelated clinical markers.Biopsy specimens of the gastric antrum were obtained from patients undergoing gastric endoscopy for dyspepsia at China Medical University Hospital. There were 38 H. pylori-infected subjects enrolled in this study. Peripheral blood samples from the same patients served as the control. The presence of H. pylori infection was determined by histopathologic examination (including Giemsa staining) and/or by a positive result for a rapid urease test performed on at least one additional biopsy sample. The density of H. pylori was analyzed as suggested by the updated Sydney system (4): 0, absent; 1, mild; 2, moderate; and 3, marked. The degree of inflammation present in the histological specimens was also classified according to the updated Sydney system. Biopsy specimens of the gastric antrum were collected into sterile collection medium (calcium-and magnesium-free Hanks' balanced salt solution [HBSS] with 5% fetal calf serum and penicillin plus streptomycin). The collected tissues were immediately placed in ice-cold RPMI 1640 complete medium (Gibco BRL, Gaithersburg, MD) which contained 10% fetal calf serum supplemented with penicillin (50 IU/ml), streptomycin (50 g/ml), L-glutamine (2 mM), and sodium pyruvate (1 mM). Gastric infiltrating lymph...