Abstract
Objective and designT helper 17 (Th17) and regulatory T (Treg) lymphocytes might play important roles in patients with severe sepsis. The association of Th17 or Treg lymphocytes with survival is also unclear.MethodsEighty-seven patients with severe sepsis were enrolled from our intensive care units between August 2008 and July 2010. Leukocyte antigens and clinical data were determined on day 1 in all patients and on day 7 in first-year patients.ResultsThe percentages in peripheral blood mononuclear cells (PBMCs) and circulatory counts of CD4+ and CD8+ lymphocytes in survivors were higher than those in non-survivors. Th1/CD4+ ratios and circulatory Th1 lymphocyte counts in survivors were higher than in non-survivors. Absolute counts of Th17 and Treg lymphocytes in survivors were higher than in non-survivors. The percentages of CD4+ and CD8+ in survivors’ PBMCs were increased after 6 days. Th17/CD4+ ratios and circulatory Th17 lymphocyte counts in survivors were increased after 6 days.ConclusionsHigher Th1 differentiation and total CD4+ T lymphocyte counts were associated with higher survival. The association of circulatory Th17 and Treg lymphocytes with mortality in severe sepsis may be due to the change in total CD4+ T lymphocytes. In survivors, Th17 differentiation and counts were restored.
Highlights
The majority of clinical and basic studies on sepsis have focused on the balance between the function of T helper 1 (Th1) and Th2 cells
We found that the circulatory Treg lymphocyte counts on day 1 in survivors with severe sepsis were higher than those in non-survivors
This result is similar to the study of Hein et al [17], who found that survivors with septic shock had consistently higher Treg lymphocyte counts than nonsurvivors
Summary
The majority of clinical and basic studies on sepsis have focused on the balance between the function of T helper 1 (Th1) and Th2 cells. The presence of interleukin (IL)-12 with signaling through signal transduction and activator of transcription (STAT)-4 skews towards Th1, whereas the presence of IL-4 with signaling through STAT-6 skews towards Th2. The median Th1/Th2 ratio was lower [1]. This suggests that activated T helper cells evolve from the Th1 phenotype to the Th2 phenotype in patients with severe sepsis or that patients with low Th1/Th2 ratios develop sepsis more . T helper cells can be induced to differentiate towards Th1, Th2, Th17 and regulatory T (Treg) phenotypes according to the local cytokine milieu [2] Naıve CD4? T helper cells can be induced to differentiate towards Th1, Th2, Th17 and regulatory T (Treg) phenotypes according to the local cytokine milieu [2]
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