Evaluation of intrahepatic regulatory T cells to understand their roles in the progression of liver damage in patient with hepatitis

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Infection with hepatitis viruses, especially HBV and HCV is a global health problem. Inadequacy and inefficiency of immune responses contribute to the chronicity of the diseases and play an important role in the progress of liver injury. This paper aimed to evaluate the frequency of immune cells in the liver of patients infected with HBV and HVC and analysed the correlation between pathological findings and clinical course of the diseases. The currently on going study recruited participants who were 18 years old or older and presented to a tertiary hospital in Surakarta, Indonesia since August 2017. Clinical and laboratory data were extracted from the patients’ medical records. The biopsy procedure was performed on patients’ liver as referred by the doctors who treat them. Samples were sent to the Pathology Anatomy Laboratory for assessment of the disease progression and the evaluation of immune cells in the area of portal triad. An immunohistochemistry staining was conducted to enumerate the frequency of immune cells expressing CD4+, CD8+, CD25+ and Foxp3+ which were associated with the presence of T lymphocytes within the subgroups of T helper, T cytotoxic, and T regulatory cells, respectively. From six liver biopsy samples, we detected one unknown hepatitis case, one case of acute viral hepatitis B, three cases of chronic viral hepatitis B without fibrosis, and one case of chronic viral hepatitis C METAVIR score 1. The frequency of cells expressing CD4+ and CD8+ were predominant (>50%), followed by Foxp3+ expression (26-50%); whereas cells expressing CD25+ were being rarely detected (0-5%). These findings suggest that when the liver injury is minimal, the T helper and cytotoxic lymphocytes are proliferated and activated, which may promote the differentiation of regulatory T cells expressing CD25+ and Foxp3+ to minimize immune-mediated liver damage.