title: The influence of therapy on CD4+CD25(high)FOXP3+ regulatory T cells in systemic lupus erythematosus patients: a prospective study.
abstract: OBJECTIVE
  Regulatory T cells (Tregs) are inversely correlated to disease activity in systemic lupus erythematosus (SLE). However, little is known concerning the influence of immunosuppressive agents on Tregs, which was the objective of this study.
  
  
  METHODS
  Thirty-five patients with SLE (29 females, six males, mean age 42.4 ± 12.8 years) were included. CD4+CD25(high)FOXP3+ Tregs were prospectively assessed by flow cytometry every month for intravenous (iv) and quarterly for oral regimens. Clinical assessment was made with the SLE Disease Activity Index (SLEDAI). Statistical analysis was performed with a Student's t-test; p < 0.05 was considered significant.
  
  
  RESULTS
  In total, 44 cases of SLE relapse were treated with iv cyclophosphamide (CYP, n = 10), iv methylprednisolone (MP, n = 7), iv immunoglobulins (IVIGs, n = 5), oral MP (n = 8), oral MP + azathioprine (AZA, n = 8), and hydroxychloroquine (HCQ, n = 6). CYP, iv MP, and IVIGs resulted in a significant increase in Tregs (4.2 ± 1.6 vs. 10.1 ± 5.7, 2.9 ± 1.3 vs. 10.6 ± 4.8, and 5.6 ± 2.7 vs. 15.2 ± 6.3 cells/mm(3), respectively, p < 0.05). Oral MP, alone or combined with AZA, led to a significant increase in Tregs (7.4 ± 2.5 vs. 11.8 ± 3.8 and 5.1 ± 2.4 vs. 9.4 ± 3.6 cells/mm(3), respectively, p < 0.05), as did HCQ (8.2 ± 2.4 vs. 12.8 ± 2.7 cells/mm(3), p < 0.05). Time to Tregs recovery was significantly shorter with iv MP and IVIGs compared to CYP (1.4 ± 0.5, 1.6 ± 0.9, and 4.0 ± 1.5 months, respectively, p < 0.05).
  
  
  CONCLUSIONS
  Increase in Tregs during SLE remission is independent of the therapeutic regimen used and probably represents an epiphenomenon of disease remission. Time to Tregs restoration was significantly shorter in patients treated with iv MP and IVIGs compared to CYP pulse therapy.
authors.affiliation: Clinical Immunology Unit, 2nd Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki , Greece.
authors.forename: K
authors.initials: K
authors.lastname: Tselios
authors.forename: A
authors.initials: A
authors.lastname: Sarantopoulos
authors.forename: I
authors.initials: I
authors.lastname: Gkougkourelas
authors.forename: P
authors.initials: P
authors.lastname: Boura
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000627:therapeutic use; D015704:CD4 Antigens / Q000378:metabolism; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D005434:Flow Cytometry; D051858:Forkhead Transcription Factors / Q000378:metabolism; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053645:Interleukin-2 Receptor alpha Subunit / Q000378:metabolism; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011446:Prospective Studies; D020551:Pulse Therapy, Drug; D012074:Remission Induction; D050378:T-Lymphocytes, Regulatory / Q000187:drug effects* / Q000276:immunology* / Q000378:metabolism
chemical_list: D015704:CD4 Antigens; C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors; C508017:IL2RA protein, human; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D053645:Interleukin-2 Receptor alpha Subunit; D006886:Hydroxychloroquine; D003520:Cyclophosphamide; D001379:Azathioprine; D008775:Methylprednisolone