title: Value of Foxp3 expressing T-regulatory cells in renal tissue in lupus nephritis; an immunohistochemical study.
abstract: BACKGROUND
  Forkhead box P3 (Foxp3) functions as a master regulator in the development and function of T-regulatory (Treg) cells. Recent studies have shown that autoimmune diseases including systemic lupus erythematosus (SLE) are associated with an imbalance with the Treg cells and T helper (Th) subtypes.
  
  
  OBJECTIVE
  To evaluate immunohistochemical expression of Foxp3 positive Treg cells in lupus nephritis (LN) and analyze its association with clinicopathologic parameters.
  
  
  METHODS
  Renal biopsy specimens of 50 patients with LN were studied. Specimens were divided into; group A; 25 LN cases without proliferative activity (Class II and V) and group B: 25 cases with proliferative activity (Class III and IV). Immunohistochemical staining for anti-human Foxp3 antibody and grading from grade 0 to grade 3 was done.
  
  
  RESULTS
  Foxp3 expression in group A was (grade 0 in 14 [56.0%], grade +1 in 11 [44.0 %]) in comparison to group B (grade +1 in 6 [24.0%], grade +2 in 11 [44.0%] and grade +3 in 8 [32.0%]) (P < 0.001). Foxp3 expression was significantly correlated to National Institutes of Health (NIH) activity and chronicity indices (P < 0.05), as well as serum creatinine (P < 0.01) in both groups A and B and there was a highly significant correlation with proteinuria (P < 0.01) in group B with proliferative LN.
  
  
  CONCLUSIONS
  Immunohistochemical Foxp3 expression in renal tissue was higher in proliferative versus non-proliferative LN and is associated with activity and severity of LN. Further studies are needed to determine its prognostic value in LN.
authors.affiliation: Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Marwa M
authors.initials: MM
authors.lastname: Shakweer
authors.affiliation: Internal Medicine and Nephrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Maha
authors.initials: M
authors.lastname: Behairy
authors.affiliation: Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Nadia G
authors.initials: NG
authors.lastname: Elhefnawy
authors.affiliation: Internal Medicine and Nephrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Tamer W
authors.initials: TW
authors.lastname: Elsaid
keywords: Activity index; Chronicity index; Foxp3; Lupus nephritis; Proteinuria; T regulatory cells