Restoring T-helper 17 cell/regulatory T-cell balance and decreasing disease activity by rapamycin and all-trans retinoic acid in patients with systemic lupus erythematosus
Restoring T-helper 17 cell/regulatory T-cell balance and decreasing disease activity by rapamycin and all-trans retinoic acid in patients with systemic lupus erythematosus
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DOI：
10.1177/0961203319877239
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发表时间：
2019-10-01
期刊：
影响因子：
2.6
通讯作者：
Chen, J.
中科院分区：
文献类型：
--
作者：
Chu, Y.;Zhao, C.;Chen, J.
目的 探讨雷帕霉素（RAPA）单用或联合全反式维A酸（ATRA）对系统性红斑狼疮（SLE）患者辅助性T细胞17（Th17）细胞/调节性T细胞（Treg）平衡的影响并评价临床疗效。方法 纳入 70 例 SLE 患者。将他们随机均分为RAPA组和RAPA+ATRA组。治疗6周、12周和24周后，通过流式细胞术测量Th17和Treg细胞的数量。采用系统性红斑狼疮疾病活动指数（SLEDAI）评分和治疗前后泼尼松剂量评价两组疗效。结果 两组患者治疗后不同时间点，Th17细胞数量（p = 0.003）和Th17/Treg比值（p = 0.044）均减少，而Treg细胞数量（p = 0.574）呈增加趋势。 SLEDAI 评分和泼尼松剂量显着下降 (p < 0.001)。两组间Th17细胞数量（p = 0.089）、Treg细胞数量（p = 0.059）、Th17/Treg比值（p = 0.580）、SLEDAI评分（p = 0.127）和泼尼松剂量（p = 0.329）无显着差异。结论 RAPA 单独使用或与 ATRA 联合使用可降低 SLE 患者的疾病活动度，从而减少糖皮质激素的需求。其作用机制之一可能是调节Th17/Treg细胞平衡，这为SLE的发病机制和潜在治疗提供了新模型。
Objective This study aimed to investigate the effect of rapamycin (RAPA) alone or in combination with all-trans retinoic acid (ATRA) on the T-helper 17 (Th17) cell/regulatory T-cell (Treg) balance in patients with systemic lupus erythematosus (SLE) and to evaluate the clinical efficacy. Methods Seventy patients with SLE were enrolled. They were randomly and equally divided into RAPA and RAPA + ATRA groups. The number of Th17 and Treg cells was measured by flow cytometry before and after treatment for 6, 12 and 24 weeks. The SLE Disease Activity Index (SLEDAI) score and the prednisone dose before and after treatment were used to evaluate the efficacy between the two groups. Results In both groups, at different time points after treatment, the number of Th17 cells (p = 0.003) and Th17/Treg ratio (p = 0.044) reduced, while the number of Treg cells (p = 0.574) tended to increase. The SLEDAI score and the dose of prednisone decreased significantly (p < 0.001). There was no significant difference in the number of Th17 cells (p = 0.089), Treg cells (p = 0.059), Th17/Treg ratio (p = 0.580), SLEDAI score (p = 0.127) and the dose of prednisone (p = 0.329) between the two groups. Conclusion Disease activity in SLE patients reduced with RAPA alone or in conjunction with ATRA, reducing glucocorticoid requirement. One of its mechanisms of action may be regulating the Th17/Treg cell balance, which provides a new model for the pathogenesis and potential treatment of SLE.