Background/Purpose: Infection is common and is one of the leading causes of morbidity and mortality in Systemic Lupus Erythematosus (SLE) patients . Excessive using glucocorticoid and DMARDs lead to decrease immune function, which increasing opportunistic infection, such as EBV or CMV. Recent study show that the imbalance between T help cell 17 (Th17) and regulatory T cell (Treg cell) is a pivotal cause of autoimmune disease. However, the relationship between imbalance of Th17/ Treg and SLE combined EBV or CMV viremia is unknown. We will investigate the characteriatic of lymphocytes cell subsets ,especially the CD4+ T subsets in patients with SLE combined EBV / CMV viremia.

Methods: Clinical records of SLE patients combined EBV and CMV viremia (Group infection), 36 SLE patients combines EBV or CMV Viremia, hospitalized in ShanXi medical university the second Hospital, were analyzed. As control, we selected 20 health persons (Group health) whose age matched with group infection, 30 SLE patients without any infection. The absolute numbers of Treg cell and effector lymphocytes cell subsets in peripheral blood were examined by flow cytometry.

Results: (1)Compared with SLE patients without infection,36 SLE patients combined EBV or CMV viremia, including 29 patients with EBV, 13 patients with CMV, 6 patients combined EBV and CMV, the absolute number of total T cell (P=0.001), NK cell (P=0.021), CD4+T cell (P=0.000), CD8+T cell (P=0.002), Th1 cell (P=0.002), Th17 (P=0.022) lower than it the non-infection group.The absolute number of and(CD4+CD25+FOXP3+)Treg (P=0.195), Th2 cell (P=0.290) has no obvious difference between them. (2) And the absolute value of total T lymph cell (P=0.000), total B lymph cell (P=0.015), NK cell (P=0.000), CD4+T cell (P=0.000), CD8+T cell (P=0.000), Th1 cell (P=0.000), Th2 cell (P=0.000), Th17(P=0.003) and Treg (P=0.000) in infection group significantly lower than healthy control. (3)Compared with the healthy control, the absolute number of Total T cell (P=0.011), NK cell (P=0.000), CD4+T cell (P=0.002), Th1 (P=0.005), Th2 cell (P=0.000) and Treg (P=0.000) in non-infection group evidently lower, but there is no siginificant difference in absolute number of Th17 (P=0.325), total B lymph cell (P=0.431), CD8+T cell (P=0.680).

Conclusion: Distortion of the Th17/Treg balance favoring the pro-inflammatory Th17 side is hence believed to contribute to exacerbation of autoimmune disorders.In our study, compared with non-infection group, the absolute count of pro-inflammatory Th17 cells in infection group obviously decreased, this suggests that Th17 might be leading factor of Th17/Treg imbalance in patients with combined SLE  EBV or CMVviremia.  Appropriate immunodulatory therapy for CD4+ T subsets on the basis of antiviral therapy for SLE patients with EBV or CMV may be beneficial .

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/imbalance-between-th17-and-regulatory-t-cells-in-patients-with-systemic-lupus-erythematosus-combined-ebv-cmv-viremia/