*Corresponding author:JianBin Zhang, Department of Nephrological Diseases, Affiliated Yong Chuan Hospital of ChongQing Medical University, China
Received: July 30, 2018; Published: August 13, 2018
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Objective: To investigate the variation and effect of peripheral Th17 and regulatory T (Treg) cells upon the clinical prognosis of idiopathic membranous nephropathy (IMN) patients after cyclosporin A (CsA) treatment.
Methods: Twenty-four IMN patients with 24-hour urinary protein level ≧ 4g were recruited. According to 24-hour urinary protein levels, all patients were assigned into the high-and middle-risk groups. All enrolled patients received standardized treatment of prednisolone acetate in combination with CsA. The Treg and Th17 frequencies were measured by flow cytometry. Serum cytokines were detected by enzyme-linked immunosorbent assay. Serum albumin and 24-hour urinary protein were measured by fully automatic biochemical analyzer.
Results: Compared with the healthy controls, Th17%, levels of IL-17 and TNF-α were up-regulated, whereas Treg% and TGF-β level were down-regulated in the peripheral blood of IMN patients. This imbalance was more pronounced in the high-risk group compared with middle-risk groups. The 24-hour urinary protein level was positively correlated with Th17% and Th17/Treg ratio, whereas negatively correlated with Treg%. After 6-month treatment, Peripheral Th17 frequency, IL-17 and TNF-α level decreased, whereas Treg frequency and TGF-β level increased in the effective group (all P<0.05). No significant changes were found in the ineffective group. Conclusion: IMN patients present with peripheral Th17/Treg imbalance, which is correlated with the severity of IMN. CsA treatment is an effective approach to improve peripheral Th17/Treg imbalance in IMN patients, which is associated with the clinical efficacy of CsA treatment. Monitoring the variations in peripheral frequency of Treg and Th17 is of significance for evaluation of the severity of IMN and clinical efficacy.
Keywords: Th17; Treg; Idiopathic membranous nephropathy; Cyclosporin A; Efficacy evaluation