Efficacy Of Qingluo Tongbi Formula On Rheumatoid Arthritis And Its Influence On Th17/Treg Imbalance

Objective To observe the effects of Qingluo Tongbi Formula on Th17/Treg cell imbalance in the peripheral blood of patients with yin deficiency and collateral-heat type rheumatoid arthritis(RA),and to explore its possible mechanisms of effects.Methods Sixty RA patients are randomly divided into two groups:Qingluo Tongbi Formula(treatment)group and methotrexate(control)group.Changes are observed in symptoms,signs,patient pain assessment score(VAS),before and after treatment.ESR,CRP,rheumatoid factor(RF)and anti-cyclic citrullinated peptide antibody(anti-CCP)are detected.The percentage of Th17 and Treg cells in the peripheral blood are detected by flow cytometry.Changes in RoRyT and Foxp3 mRNA expression before and after treatment are detected by real-time quantitative PCR.The levels of IL-6,IL-23,IL-17,TGF-?,IL-10 and IL-35 in peripheral blood are detected by ELISA.Results The joint pain index,tenderness index,swelling index Morning stiffness time,HAQ,VAS,erythrocyte sedimentation rate,CRP,in the two groups decrease significantly compared to those before treatment(P<0.05),and the treatment group show remarkable effects compared with the control group(P<0.05).After treatment,intra-group comparison show that the percentage of Th17 is significantly lower than that before treatment in both groups(P<0.05),but there is no significant difference between groups(P>0.05).The percentage of Treg cells in the two groups is significantly higher(P<0.05)than that before treatment.RORyT mRNA relative expression decrease significantly after treatment in the two groups(P<0.05),but there is no significant difference between groups(P>0.05).Compared to that before treatment,Foxp3mRNA relative expression increase significantly in the control groups(P<0.05),but treatment group do not change significantly.After treatment,the serum levels of IL-6 and IL-17 in the two groups are significantly lower than that before(P<0.05),and the levels of TGF-?,IL-10 and IL-35 are significantly higher than that before treatment(P<0.05),the levels of IL-23 has significantly changed in the control group(P<0.05),but not in the treatment group.Conclusion:Qingluo Tongbi Formula is more effective and safer against yin deficiency and collateral-heat type RA than methotrexate.The mechanism may be as follows:1.Decrease the percentage of pro-inflammatory Th17 cells and increase the percentage of Treg cells,regulate Th 17/Treg cells imbalance.2.The expression of RORyT,a transcription factor associated with Th17 cells,is inhibited.3.The levels of Th17 cell-related pro-inflammatory cytokines IL-6 and IL-17 have decreased,while the levels of Treg-related anti-inflammatory cytokines TGF-?,IL-10 and IL-3 5 have increased.