The Detection And Clinical Significance Of Circulating TFH And B Cells In Patients With Henoch-sch(?)nlein Purpura Nephritis

Objective: To detect the expression of the levels of different subsets of circulating TFH and B cells,serum IL-2,IL-4,IL-17 A,IL-21 and IFN-?,and evaluate their potential association with the levels of clinic measures such as values of e GFR in new-onset Henoch-Sch(?)nlein purpura nephritis(HSPN)patients as well as further investigate the their role in the HSPN patients.Methods: The numbers of circulating CD4~+CXCR5~+,CD4~+CXCR5~+ICOS+,CD4~+CXCR5~+PD-1+ TFH cells,CD86~+CD19~+,CD38~+CD19+ B cells,and serum IL-2,IL-4,IL-17 A,IL-21 and IFN-? were detected in a total of 25 patients with newly diagnosed HSPN before and after treatment,and in 14 healthy controls(HC)by flow cytometry analysis,Enzyme-linked immunosorbent assay(ELISA)and Cytometric bead array(CBA).The concentrations of Ig A,Ig G and Ig M were detected by the scattering turbidimetry using on a Siemens special protein analysis instrument(Siemens Healthcare Diagnostics Products,Gmb H,Germany).The effect of prednisone on TFH cells were study in vitro culture.Results: 1.The numbers of circulating CD4~+CXCR5~+,CD4~+CXCR5~+ICOS+,CD4~+CXCR5~+PD-1+ TFH cells,CD86~+CD19~+,CD38~+CD19+ B cells and serum IL-2,IL-4,IL-17 A,IL-21 and IFN-? were significantly higher in HSPN patients(all p<0.05)than in HC.2.Before and after treatment the numbers of CD4~+CXCR5~+ TFH cells were negatively correlated with the values of e GFR,respectively.Similarly the pretreatment and posttreatment numbers of CD4~+CXCR5~+PD-1+ TFH cells were negatively correlated with 24-h urinary proteins,respectively.3.The pretreatment numbers of CD4~+CXCR5~+ICOS+ TFH cells were positively correlated with the levels of 24-h urinary protein and serum IL-21,respectively.The posttreatment numbers of CD4~+CXCR5~+ICOS+ TFH cells were positively correlated with the levels of 24-h urinary protein and serum IL-21,respectively.4.The number of CD4~+CXCR5~+ICOS+ TFH cells was positively correlated with serum Ig A before treatment and not correlated with serum Ig A after treatment.5.The post-treatment numbers of circulating CD4~+CXCR5~+,CD4~+CXCR5~+ICOS+,CD4~+CXCR5~+PD-1+ TFH cells,CD86~+CD19~+,CD38~+CD19+ B cells,serum IL-21 and Ig A reduced significantly compared to pretreatment levels.But the post-treatment levels of serum IL-4 were significantly higher than the pretreatment levels.6.The post-PDN treatment numbers of CD4~+CXCR5~+TFH cells were significantly less than the pre-PDN treatment levels during in vitro culture.Conclusions: 1.The circulating CD4~+CXCR5~+,CD4~+CXCR5~+ICOS+,and CD4~+CXCR5~+PD-1+ TFH cells,as well as CD86~+CD19~+ activated B cells and CD38~+CD19+ plasma may participate in the pathogenesis of HSPN.2.The circulating IL-2,IL-4,IL-17 A,IL-21 and IFN-?may participate in the development of HSPN.