title: T-helper type 1/T-helper type 2 balance in malignant pleural effusions compared to tuberculous pleural effusions.
abstract: OBJECTIVE
  Malignant and tuberculous pleurisies are two major causes of lymphocyte-dominant pleurisy. Several studies have already reported that tuberculous pleurisy is a T-helper type 1(Th1)-dominant disease. In this study, we sought to examine the Th1/T-helper type 2 (Th2) balance, especially focusing on the polarizing status of T-cells to Th1/Th2 in malignant pleural effusions by measuring cytokines in pleural effusions and by evaluating the polarizing status of T-cells on the point of stimulation with interleukin (IL)-12 and/or IL-18. Furthermore, we evaluated inhibitors of interferon (IFN)-gamma production in effusions to rule out the possibility of direct inhibition of T-cell polarization.
  
  
  METHODS
  Effusion samples were collected from 19 patients with malignant pleurisy caused by lung cancer and from 7 patients with tuberculous pleurisy.
  
  
  METHODS
  Concentrations of pleural fluid IFN-gamma, IL-12, and IL-4 were measured. IFN-gamma production of T-cells enriched from malignant pleural effusions in the presence of IL-12 and/or IL-18 was also examined. We further compared the inhibitory activity of malignant pleural effusions against IFN-gamma production and analyzed the expression of T-cell immunoglobulin mucin, mucin domain (Tim-3), a Th1-specific molecule in pleural fluid T-cells.
  
  
  RESULTS
  Although malignant pleural effusions showed low levels of Th1 and Th2 cytokines and ratios of IFN-gamma and IL-12 to IL-4 were low, isolated T-cells produced a significant level of IFN-gamma in the presence of IL-12 and IL-18. Soluble factors were not found to inhibit IFN-gamma production in malignant pleural effusions. In tuberculous pleural effusion, ratios of IFN-gamma and IL-12 to IL-4 were significantly higher, and T-cells showed the expression of Tim-3 messenger RNA.
  
  
  CONCLUSIONS
  We confirmed that T-cells in the malignant pleural effusions are mainly naïve or not definitely polarized to Th1. Moreover, malignant tumor does not actively distort the cytokine condition through production of soluble inhibitors within effusions. The present study indicates that antitumor immunity may be enhanced by restored IFN-gamma activity through combination of IL-12 and IL-18, and that it will lead to new therapies for malignant effusion.
authors.affiliation: Division of Respiratory Medicine, Nagoya University Graduate School of Health Science, 1-1-20 Daikou-minami, Higashi-ku, Nagoya 461-8673, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Okamoto
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Hasegawa
authors.forename: Toru
authors.initials: T
authors.lastname: Hara
authors.forename: Naozumi
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Imaizumi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Shimokata
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kawabe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001483:Base Sequence; D015415:Biomarkers / Q000032:analysis; D015331:Cohort Studies; D016207:Cytokines / Q000032:analysis / Q000276:immunology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D016066:Pleural Effusion, Malignant / Q000276:immunology* / Q000473:pathology; D011379:Prognosis; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018417:Th1 Cells / Q000276:immunology* / Q000378:metabolism; D018418:Th2 Cells / Q000276:immunology* / Q000378:metabolism; D014396:Tuberculosis, Pleural / Q000276:immunology* / Q000473:pathology
chemical_list: D015415:Biomarkers; D016207:Cytokines