title: Restoring the Treg cell to Th17 cell ratio may alleviate HBV-related acute-on-chronic liver failure.
abstract: OBJECTIVE
  To investigate the role of T helper 17 cells (Th17) and regulatory T cells (Treg) in hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF).
  
  
  METHODS
  We enrolled 79 patients with HBV infection into the study, 50 patients with HBV-related ACLF and 29 patients with chronic hepatitis B (CHB), from the First Affiliated Hospital of Medical College from January 2009 to June 2012. The ACLF patients were diagnosed according to the criteria recommended by The 19(th) Conference of the Asian Pacific Association for the Study of the Liver in 2009. Twenty healthy individuals with a similar gender and age structures to the two patient groups were also included as the normal controls (NC). Of the 50 ACLF patients, 28 were subsequently classified as non-survivors: 19 patients died from multi-organ failure, 3 underwent liver transplantation, and 6 discontinued therapy during follow-up because of financial reasons. The remaining 22 ACLF patients whose liver and anticoagulation function recovered to nearly normal levels within the next 6 mo were classified as survivors. The number of circulating Treg and Th17 cells was determined upon diagnosis and during the 8th week of follow-up through flow cytometry.
  
  
  RESULTS
  The percentage of circulating Treg cells in the ACLF group was significantly higher than that in the CHB group (5.50% ± 1.15% vs 3.30% ± 1.13%, P < 0.01). The percentages of circulating Th17 cells in the ACLF and the CHB groups were significantly higher than that in the NC group (6.32% ± 2.22% vs 1.56% ± 0.44%, P < 0.01; 3.53% ± 1.65% vs 1.56% ± 0.44%, P < 0.01). No significant difference in Treg cell to Th17 cell ratio was observed between the ACLF group and the CHB group (0.98 ± 0.44 vs 1.12 ± 0.64, P = 0.991), whereas those in the two HBV infection groups were significantly lower than that in the NC group (1.85 ± 1.22; both P < 0.01). The percentage of Treg cells in the survivors during the 8(th) week of follow-up was significantly lower than that during peak ACLF severity [total bilirubin (TBIL) peak] (3.45% ± 0.97% vs 5.18% ± 1.02%, P < 0.01). The percentage of Th17 cells in survivors during the 8(th) week of follow-up was significantly lower than that during the peak TBIL (2.89% ± 0.60% vs 5.24% ± 1.46%; P < 0.01). The Treg cell to Th17 cell ratio during the 8(th) week of follow-up was significantly higher than that during the TBIL peak (1.22 ± 0.36 vs 1.10 ± 0.54; P < 0.05).
  
  
  CONCLUSIONS
  Restoring the Treg cell to Th17 cell ratio during the follow-up phase of ACLF could maintain the immune system at a steady state, which favours good prognosis.
authors.affiliation: Department of Infectious Diseases, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Ying-Hua
authors.initials: YH
authors.lastname: Niu
authors.forename: Dong-Lin
authors.initials: DL
authors.lastname: Yin
authors.forename: Hong-Li
authors.initials: HL
authors.lastname: Liu
authors.forename: Rui-Tian
authors.initials: RT
authors.lastname: Yi
authors.forename: Yu-Cong
authors.initials: YC
authors.lastname: Yang
authors.forename: Hong-An
authors.initials: HA
authors.lastname: Xue
authors.forename: Tian-Yan
authors.initials: TY
authors.lastname: Chen
authors.forename: Shu-Lin
authors.initials: SL
authors.lastname: Zhang
authors.forename: Shu-Mei
authors.initials: SM
authors.lastname: Lin
authors.forename: Ying-Ren
authors.initials: YR
authors.lastname: Zhao
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D002478:Cells, Cultured; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000628:therapy / Q000821:virology; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000276:immunology* / Q000401:mortality / Q000628:therapy / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000276:immunology / Q000401:mortality / Q000821:virology; D050378:T-Lymphocytes, Regulatory / Q000276:immunology* / Q000821:virology; D058504:Th17 Cells / Q000276:immunology* / Q000821:virology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: Acute-on-chronic liver failure; Hepatitis B virus; Regulatory T cells; T helper 17 cells; Treg cell to Th17 cell ratio