The relation of CD4 + CD25+Foxp3+ regulatory T cells concentration with disease activity and damage index in systemic lupus erythematosus

Abstract

Introduction

Regulatory T cells (Treg) deficits, both quantitative and qualitative, are known to be possible triggers for the development of autoimmune disorders by causing T and B cells dysfunction. The contribution of Treg deficiency in the etiology of systemic lupus erythematosus (SLE) is still being debated. The aim of the present study is to evaluate the percentage of circulating CD4⁺CD25⁺Foxp3⁺ Treg cells in a cohort of Egyptian SLE patients and to correlate this value with the activity and damage index of these patients.

Methods

50 female patients with SLE together with an equal number of age- and sex-matched healthy controls were enrolled in the study. Flow cytometric determination of peripheral Treg cells was carried out for all participants by detecting the percentage of CD4⁺CD25+Foxp3+ cells to compare cases with the control group. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), while disease damage was assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI). Both indices were correlated with the percentage of CD4⁺CD25⁺Foxp3 T regulatory cells.

Results

CD4⁺CD25⁺Foxp3⁺ Treg cells percentage was significantly decreased in patients with SLE as compared to healthy controls. On correlating CD4⁺CD25⁺Foxp3⁺ Treg percentage with SLEDAI-2K, a significantly negative correlation was found. Also, there was a negative significant correlation between CD4⁺CD25⁺Foxp3⁺ Treg cells percentage and SLICC/ACR DI. On correlating SLEDAI-2K with damage index (SLICC/ACR DI), we found highly significant positive correlation.

Conclusion

Our study showed impaired production of CD4⁺CD25⁺Foxp3⁺ Tregs in SLE patients, which can play a reciprocal role with some cytokines to affect the activity of the disease and organ damage. CD4⁺CD25⁺Foxp3⁺ Tregs cells should be the target to determine the clinical effectiveness of new therapy to modulate Tregs besides the traditional treatments.