AB0470 IMMUNOREGULATORY THERAPY EFFECTIVELY PROMOTES THE BALANCE BETWEEN TREG CELLS AND PRO-INFLAMMATORY LYMPHOCYTES IN SYSTEMIC LUPUS ERYTHEMATOSUS
Authors: Xiaoqing Liu, Nalin Lai, Ting Cheng, Xiaojuan Mao, LI Xiaofeng
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Recent studies have reported that some drugs such as low-dose interleukin-2, rapamycin, metformin, retinoic acid and coenzyme Q10 could promote the proliferation and functional recovery of regulatory T cells (Treg) in patients with autoimmune diseases. However, the effects on the balance of Treg cells and pro-inflammatory lymphocytes and long-term efficacy have rarely been reported. <h3>Objectives</h3> To evaluate the changes of peripheral lymphocyte subsets, conventional drugs and remission rate in patients with systemic lupus erythematosus (SLE) after immunomodulatory therapy. <h3>Methods</h3> A total of 89 patients with SLE from the Second Affiliated Hospital of Shanxi Medical University from January 2016 to April 2018 were enrolled, who were divided into well-controlled group and untargeted control group taking a full consideration of the patient's symptoms, signs and related laboratory findings. We measured the absolute counts of B, NK, CD8+T and helper T 1 (Th1), helper T 2 (Th2), helper T 17 (Th17) and Treg cells in peripheral blood of patients before immunomodulatory therapy and during the 3 months and 6 months of follow-up and 93 sex- and age- matched control individuals using flow cytometry. Moreover, the ratios of various cells to Treg cells were calculated. <h3>Results</h3> Compared with healthy controls, Treg cells in SLE patients were significantly lower before the treatment with immunomodulator, while the ratios of various pro-inflammatory lymphocytes to Treg cells (such as Th2/Treg, Th17/Treg, CD8+T/Treg, etc.) were higher. After 3 months and 6 months with immunomodulatory therapy, the absolute number of Treg cells in peripheral blood of SLE patients increased obviously reaching to normal level. Accordingly, the ratios of various pro-inflammatory lymphocytes to Treg cells recovered. At the same time, the dose of glucocorticoid and disease-modifying antirheumatic drugs (DMARDs) decreased distinctly. Additionally, the well-controlled group was able to maintain a high remission rate, and the untargeted control group could achieve a higher response rate after immunomodulatory treatment. <h3>Conclusion</h3> The imbalance between pro-inflammatory lymphocytes and Treg cells caused by the significant decrease of Treg cells may be the main cause of SLE. And immunomodulatory therapy we came up with may reverse the imbalance of proinflammatory lymphocytes and Treg cells, which is an potential and effective treatment for SLE. <h3>References</h3> [1] Chen YJ, Chang YT, Wang CB, et al. Malignancy in systemic lupus erythematosus: a nationwide cohort study in Taiwan[J]. Am J Med, 2010 Dec;123(12):1150. [2] Noack M, Miossec P. Th17 and regulatory T cell balance in autoimmune and inflammatory disease[J]. Autoimmun Rev, 2014, 13(6): 668-677. [3] Yu A, Snowhite I, Vendrame F, et al. Selective IL-2 responsiveness of regulatory T cells through multiple intrinsic mechanisms supports the use of low-dose IL-2 therapy in type 1 diabetes. Diabetes. 2015;64: 2172–2183. [4] Zeiser R, Leveson-Gower DB, Zambricki EA, et al. Differential impact of mammalian target of rapamycin inhibition on CD4 + CD25 + Foxp3+ regulatory T cells compared with conventional CD4+ T cells. Blood. 2008; 111:453–462. [5] Schuiveling M, Vazirpanah N, Radstake TRDJ, Zimmermann M, Broen JCA. Metformin, A New Era for an Old Drug in the Treatment of Immune Mediated Disease?[J]. Curr Drug Targets, 2017;18:1-15. <h3>Disclosure of Interests</h3> None declared