Study Of The Role Of Regulatory T Cells In The Conversion Of Acute And Chronic Gouty Arthritis

Background : Gout is an inflammatory disease,which is characterized by hyperuricemia and recurrent arthritis.Under a certain inducing factor,the urate crystal deposits,and then,triggers a series of inflammatory cytokine storm,neutrophils aggregation and immune system activation.It is the process above that result in acute gout.But even without treatment,some patients with the first attack of gout will naturally relieve itself within hours,days or weeks,while others are characterized by recurrent attack and eventually cause chronic gout.At present,the pathogenesis of neutrophils,monocytes / macrophages only emphasizes the mechanism of local remission of arthritis,however,the alleviation mechanism of systemic inflammatory response is ignored.What's more,the pathogenesis above can't explain why part of the gout patients will eventually develop chronic gout.It is the regulatory T cells(Regulatory T,Treg)that can inhibit the production of inflammatory cytokines and antibodies,as well as the proliferation of effector of T cells.Also,it plays an important role in maintaining the homeostasis of autoimmunity and inflammation.Treg is involved in the regulation of inflammatory immune system,and has been studied in some other rheumatic diseases,such as systemic lupus erythematosus(SLE)and dermatomyositis.However,as a kind of inflammatory disease,whether Treg cells play an important role in the pathogenesis and progression of gout is still unknown,and so far,there are no relevant reports at home and abroad.Therefore,the article mainly discusses the expression level of Treg of gout patients in different periods,to further analyze the possible pathogenesis associated with Treg and provide new methods for treatment.Objective:To investigate the percentage of CD4~+CD25~+Foxp3~+ regulatory T cell in peripheral blood lymphocytes of patients with gout at different stages(acute and chronic),as well as the difference of expression level of Foxp3 m RNA in CD4~+ T cells.And we use the data obtained above to explore its role in the pathogenesis of gouty arthritis.Methods:The case was selected from male patients who visited outpatient and inpatient Department of Rheumatology and Immunology of Anhui Provincial Hospital during August 2015 to March 2016.The age of all male patients was more than 18 years old,of which there were gout in acute exacerbation in 14 cases with chronic gout in 28 cases,healthy comparisons in 20 cases.(1)Flow cytometry was used to detect the percentage of Treg cells in peripheral blood of acute and chronic gout patients and healthy comparisons.(2)We sort CD4~+ T cells with magnetic beads separation system,extract RNA,and detect the expression level of Foxp3 m RNA in CD4~+ T cells with RT-PCR.The data were analyzed by software SPSS 16.0.Results:(1)The percentage of Treg in peripheral blood of patients with acute gout group(1.659�0.335)% was higher than that in chronic gout group(0.435�0.240)% and healthy control group(1.232�0.290)%;the percentage of Treg in peripheral blood of healthy control group was higher than that of chronic gout group.The difference was statistically significant(P=0.000).(2)The expression level of Foxp3 m RNA in peripheral blood CD4~+ T cells in acute gout group[4.54(2.853,17.663 ] was higher than that in normal control group[0.921(0.591,1.769)],and the difference was statistically significant(Z=-3.232,P=0.001);the expression level of Foxp3 m RNA in peripheral blood CD4~+ T cells in acute gout group was higher than that in chronic gout group[2.913(1.605,12.233)],and the difference was not statistically significant(Z=-1.049,P=0.294);(3)Spearman rank correlation analysis showed that there was no significant correlation between the percentage of Tregs cells in the normal control group,the acute gout group and the chronic gout group and the Foxp3 m RNA expression level(P> 0.05).Conclusions:The increase of Treg cells in patients with acute gout may be related to the self-limitation of the disease itself;the decrease of Treg cells in patients with chronic gout may be the main reason for the recurrent arthritis.The changes of Treg cells were not synchronized with the expression of Foxp3 m RNA in the patients with chronic gout,suggesting that the increase of Fox P3 degradation may inhibit the proliferation and differentiation of Treg cells.