ORIGINAL ARTICLE

Alterations of mononuclear inflammatory cells, CD4/CD8+ T cells, interleukin 1ß, and tumour necrosis factor in the bronchoalveolar lavage fluid, peripheral blood, and skin of patients with systemic sclerosis

M R Hussein¹, H I Hassan¹, E R M Hofny³, M Elkholy², N A Fatehy⁴, A E A Abd Elmoniem⁵, A M Ezz El-Din⁶, O A Afifi⁶ and H G Rashed⁶

¹ Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
² Department of Respiratory Medicine, Faculty of Medicine, Assiut University
³ Department of Dermatology and Venereology, Assiut University
⁴ Department of Rheumatology and Rehabilitation, Assiut University
⁵ Department of Internal Medicine, Faculty of Medicine, Assiut University
⁶ Department of Clinical Pathology, Assiut University

Correspondence to:
Correspondence to:
Dr M R Hussein
Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt; mrh17{at}swissinfo.org

Background: Systemic sclerosis (SSc) is a multisystem disease with underlying immune mechanisms.

Aims: To investigate the clinicopathological characteristics of the lesions; immunological alterations in the bronchoalveolar lavage fluid (BALF), peripheral blood, and skin; and correlations between the clinicopathological characteristics and immunological alterations in SSc.

Materials/Methods: Skin biopsies, BALF, and peripheral blood samples were obtained from 19 patients (18 women, one man) with SSc and six age and sex matched healthy controls (HCs). Mononuclear inflammatory cells (MICs), CD4/CD8 cells, tumour necrosis factor (TNF), and interleukin 1ß (IL1-1ß) concentrations were examined in all samples using histological methods, enzyme linked immunosorbent assay, and immunoperoxidase staining.

Results: The mean (SD) age of the patients with SSc was 34.8 (2.6) years. Proteinuria, positive rheumatoid factor, and C reactive protein were seen in 15.8%, 26.3%, and 26.3% of patients, respectively. Compared with HCs, there were significantly higher: total MICs (macrophages, lymphocytes), neutrophils, and eosinophils in BALF, blood, and skin (all p<0.05); cytokine concentrations in BALF (TNF, p<0.001; IL-1, p<0.01) and peripheral blood (p<0.01 and p<0.05); and CD8/CD4+ T cells in peripheral blood (p<0.05). Compared with HCs, lesional skin had significantly higher histiocyte cell counts (p<0.05), lower lymphocyte counts (p<0.05), and higher CD4/CD8 ratios (p<0.001). There were significant correlations between cytokine concentrations and CD8+ T cells and forced vital capacity (p<0.001 and p<0.01, respectively).

Conclusions: MICs, CD4/CD8+ cells, and cytokines are altered in SSc. These alterations correlated with the underlying disease process and therefore may have pathogenic, modulatory, and potential prognostic roles in SSc.

Abbreviations: BAL, bronchoalveolar lavage; BALF, bronchoalveolar lavage fluid; CRP, C reactive protein; dSSc, diffuse systemic sclerosis; ECG, electrocardiogram; FVC, forced vital capacity HC, healthy control; HRCT, high resolution computerised tomography; IL, interleukin; lSSc, limited systemic sclerosis; MIC, mononuclear inflammatory cell; PBS, phosphate buffer saline; SSc, systemic sclerosis; TGFß, transforming growth factor ß; TNF, tumour necrosis factor

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