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Open Access Highly Accessed Research article

Dysregulated balance of Th17 and Th1 cells in systemic lupus erythematosus

Kamini Shah1, Won-Woo Lee12, Seung-Hyun Lee13, Sang Hyun Kim14, Seong Wook Kang15, Joe Craft16 and Insoo Kang1*

Author Affiliations

1 Department of Internal Medicine, Yale University School of Medicine, S525C TAC, 300 Cedar Street, New Haven, Connecticut 06520, USA

2 Department of Microbiology, College of Medicine, Seoul National University, 28 Yongon-dong, Chongno-gu, 110-799, Seoul, Republic of Korea

3 Department of Microbiology, Konkuk University School of Medicine, 322 Danwol-Dong, Chungju, Chungchungbuk-Do 380-701, Republic of Korea

4 Department of Microbiology, College of Medicine, Kangwon National University, 192-1 Hyoja-Dong, Chunchon, Kangwon-Do 200-701, Republic of Korea

5 Department of Internal Medicine, College of Medicine, Chungnam National University, 640 Daesa-Dong, Daejeon 301-131, Republic of Korea

6 Department of Immunobiology, Yale University School of Medicine, 300 Cedar Street, New Haven, Connecticut 06520, USA

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Arthritis Research & Therapy 2010, 12:R53  doi:10.1186/ar2964

Published: 24 March 2010

Abstract

Introduction

Interleukin (IL)-17 is a proinflammatory cytokine that is produced largely by a unique CD4+ T-helper (Th) subset called Th17 cells. The development of Th17 cells is suppressed by interferon (IFN)-γ produced by Th1 cells, suggesting cross-regulation between Th17 and Th1 cells. Thus, this study analyzed the balance of CD4+ Th17 and Th1 cell responses in peripheral blood from patients with systemic lupus erythematosus (SLE) and healthy subjects.

Methods

Twenty-five adult patients with SLE and 26 healthy subjects matched for gender and age (± 2 years) were recruited. Peripheral blood mononuclear cells (PBMCs) from patients and healthy subjects were stimulated for 4 h ex vivo with phorbol myristate acetate (PMA) and ionomycin. The frequency of CD4+ T cells producing IL-17 and/or IFN-γ was measured by using flow cytometry. Expression of Th17-associated chemokine receptors CCR4 and CCR6 on CD4+ T cells as well as plasma levels of Th17-polarizing cytokines were assessed. Disease activity was evaluated by the SLE disease activity index score (SLEDAI). Unpaired t test and Pearson correlation were used for statistical analyses.

Results

Patients with SLE had an increased frequency of CD4+IL-17+ T cells compared with healthy subjects. However, the frequency of CD4+IFN-γ+ T cells was similar between the two groups, indicating an altered balance of Th17 and Th1 cell responses in SLE. Patients with SLE also had an increased frequency of CD4+CCR4+CCR6+ T cells that are known to produce IL-17. The frequency of CD4+IL-17+ T cells and CD4+CCR4+CCR6+ T cells correlated with disease activity. In measuring plasma levels of the Th17-polarizing cytokines, levels of IL-6 were higher in patients with SLE than in healthy subjects, although levels of IL-1β, IL-21, IL-23, and transforming growth factor (TGF)-β were not different between the two groups.

Conclusions

We demonstrate an enhanced Th17 cell response that correlates with disease activity in patients with SLE, suggesting a role for IL-17 in the pathogenesis of lupus. Our data indicate that the mechanisms involved in balancing Th1 and Th17 regulation, as well as in producing IL-6, are aberrant in SLE, leading to an increased Th17 response. We suggest that CCR4 and CCR6 expression on CD4+ T cells should be considered as markers of disease activity, and that IL-17 blocking may offer a therapeutic target in SLE.