Bavikar Purva, Dighe Tushar, Wakhare Pavan, Shinde Nilesh, Bale Charan, Sajgure Atul
Nephrology, Dr D Y Patil Hospital, Medical College and Research Institute, Pune, IND.
Cureus. 2021 Oct 30;13(10):e19153. doi: 10.7759/cureus.19153. eCollection 2021 Oct.
Background The role of T-regulatory cells (Tregs) in inflammatory renal disease is not yet established. We attempted to study peripherally circulating T-cells expressing RORtFoxp3 dynamics in acute kidney injury (AKI) and chronic kidney disease (CKD). Aim To determine the role of T-regulatory cells in AKI and CKD. Research methodology This is a cross-sectional study conducted between January 2019 to January 2021 at a single tertiary care centre in Pune, India. Candidates enrolled in the study were either patients with CKD not on maintenance hemodialysis or newly diagnosed cases of AKI. Kidney transplant recipients, patients with autoimmune diseases like systemic lupus erythematosus (SLE), IgA nephropathy, or those receiving immuno-suppressants were excluded. T-lymphocytes were analyzed using a flow cytometer. Results We studied 80 patients with kidney injury, 40 each belonging to the AKI and CKD study groups and 10 healthy volunteers as controls. The rationale behind having a small control group was to merely get an idea of T helper 17 (Th17):Treg ratio and different immune cell-phenotype profiles in healthy volunteers without kidney injury, diabetes, hypertension or any other risk factors. The ratio of RORt:Foxp3 was ≤ 1 in these individuals (control group) while this ratio was significantly altered (MFI RORt:Foxp3 ≥1) in the AKI/CKD study arm. We examined peripherally circulating T-lymphocytes in acute kidney injury and chronic kidney disease, comparing their activity to healthy volunteers. Biopsy-proven kidney injury patients (29/80) were also included in this study. We found that the ratio of RORγt:Foxp3 was altered in patients with kidney injury (acute and chronic) and was statistically significant compared to controls, indicating that injury may be attributed to T-cell dysfunction. Conclusion Our study provides some evidence of T-cell dysfunction in the pathology of kidney injury in acute and chronic kidney disease via activity of Foxp3 and RORγt. We found that there is evidence of altered Th17/Treg activity in kidney injury, more prevalent in acute than chronic, when compared to healthy volunteers.
背景 调节性T细胞（Tregs）在炎症性肾脏疾病中的作用尚未明确。我们试图研究急性肾损伤（AKI）和慢性肾脏病（CKD）中表达RORtFoxp3的外周循环T细胞动态变化。目的 确定调节性T细胞在AKI和CKD中的作用。研究方法 这是一项于2019年1月至2021年1月在印度浦那的一家三级医疗中心进行的横断面研究。纳入研究的对象为非维持性血液透析的CKD患者或新诊断的AKI病例。排除肾移植受者、患有自身免疫性疾病（如系统性红斑狼疮（SLE）、IgA肾病）的患者或接受免疫抑制剂治疗的患者。使用流式细胞仪分析T淋巴细胞。结果 我们研究了80例肾损伤患者，其中40例属于AKI研究组，40例属于CKD研究组，另有10名健康志愿者作为对照。设立小对照组的目的仅仅是为了了解无肾损伤、糖尿病、高血压或任何其他危险因素的健康志愿者中辅助性T细胞17（Th17）与调节性T细胞的比例以及不同免疫细胞表型特征。在这些个体（对照组）中，RORt:Foxp3的比例≤1，而在AKI/CKD研究组中该比例发生了显著变化（平均荧光强度RORt:Foxp3≥1）。我们检测了急性肾损伤和慢性肾脏病中外周循环T淋巴细胞，并将其活性与健康志愿者进行比较。经活检证实的肾损伤患者（29/80）也纳入了本研究。我们发现，肾损伤（急性和慢性）患者的RORγt:Foxp3比例发生了改变，与对照组相比具有统计学意义，这表明损伤可能归因于T细胞功能障碍。结论 我们的研究通过Foxp3和RORγt的活性，为急性和慢性肾脏病肾损伤病理过程中的T细胞功能障碍提供了一些证据。我们发现，与健康志愿者相比，肾损伤中存在Th17/Treg活性改变的证据，急性肾损伤中比慢性肾损伤中更普遍。
