Corticosteroids restore the balance between locally produced Th1 and Th2 cytokines and immunoglobulin isotypes to normal in sarcoid lung

Abstract

SUMMARYIn this study, we have investigated the balance between Th1-and Th2-like activity in the lungs in sarcoidosis and have determined the effect of corticosteroid treatment on this. Twenty-one patients with acute untreated sarcoidosis were investigated by bronchoalveolar lavage (BAL) and compared with 11 normal volunteers. Sixteen of the sarcoid patients required corticosteroid therapy and seven of these were reinvestigated after 2-3 months' treatment. In order to assess Th1-and Th2-like activity in the lungs, IgG subclasses and IgE were measured in BAL fluid and serum, and IL-2, IL-4 and interferongamma (IFN-g) in BAL. In patients with untreated sarcoidosis, albumin-corrected BAL/serum ratios for IgG4 and IgE were significantly reduced (IgG4, 1 . 04 Ϯ 0 . 18 (mean Ϯ s:e:m:); IgE 9 . 58 Ϯ 3 . 11) compared with those in normal controls (IgG4 5 . 3 Ϯ 0 . 72, P < 0 . 001; IgE 67 . 7 Ϯ 28 . 9, P < 0 . 01). Estimates of actual levels of immunoglobulins produced in the lungs were also made and showed extremely high levels of total IgG in sarcoid patients (39 . 56 Ϯ 8 . 2 mg/l ) compared with controls (1 . 17 Ϯ 0 . 5 mg/l, P < 0 . 001). Although there was no difference between the groups in amount of IgG4 locally produced, the proportion of total IgG which was IgG4 was greatly reduced in those with sarcoidosis (1 . 6 Ϯ 0 . 4% compared with 38 . 5 Ϯ 3 . 2%; P < 0 . 001). Lavage levels of IL-4 were also reduced in sarcoid patients (IL-4 2 . 103 Ϯ 0 . 21 pg/ml) compared with those in normals (IL-4 6 . 8 Ϯ 1 . 05; P < 0 . 001). Levels of IL-2 were lower (7 . 63 Ϯ 0 . 51 pg/ml compared with 9 . 4 Ϯ 0 . 95 pg/ml), but this difference was not significant. IFN-g, however, could not be detected above 0 . 4 pg/ml in any of the normal lavage fluid, but was detectable in 12/21 patients with sarcoidosis (x 2 ¼ 7 . 74; P < 0 . 001). These changes reverted towards normal on treatment with oral corticosteroids. The mean albumin-corrected BAL/serum ratio for IgG4 before treatment was 0 . 88 Ϯ 0 . 33 compared with 5 . 5 Ϯ 2 . 1 (P < 0 . 05) on treatment, and for IgE before treatment 9 . 52 Ϯ 2 . 15 compared with 50 . 8 Ϯ 17 . 9 (P < 0 . 05) on treatment. Total IgG produced in the lung fell from 26 . 16 Ϯ 7 . 9 to 6 . 12 Ϯ 2 . 4 mg/l (P < 0 . 001) on treatment, and the proportion of IgG4 locally produced rose from 2 . 3 Ϯ 0 . 8% to 23 . 9 Ϯ 6 . 1% (P < 0 . 01). The mean level of IL-4 in lavage before treatment was 2 . 53 Ϯ 0 . 34 pg/ml compared with 4 . 7 Ϯ 0 . 34 (P < 0 . 001) on treatment. Levels of IL-2 also rose significantly on treatment from 8 . 74 Ϯ 0 . 95 pg/ml before to 14 . 44 Ϯ 1 . 38 pg/ml (P < 0 . 001) on treatment. Levels of IFN-g fell from 1 . 65 Ϯ 0 . 43 pg/ml before treatment to undetectable levels in all patients (P < 0 . 001) on treatment. These results demonstrate an imbalance between Th1-and Th2-like activity in the lungs in sarcoidosis, with suppression of Th2 and increase in Th1. Corticosteroid therapy restores the normal balance between Th1 and Th2 cytokines and immunoglobulins in the lungs, suggesting an effec...

IL‐4 fails to regulatein vitroberyllium-induced cytokines in berylliosis

“…Although not statistically significant, a decrease in the blood cytokine levels (except IL-10) was noted in the individuals treated with steroids. Similar results have been found from sarcoidosis BAL cells for TNF-a [5] and IFN-c [38], indicating that corticosteroids are able to modify the immune response in these disease processes. Furthermore, these findings substantiate the use of blood cells to evaluate future immunotherapeutics.…”

Hepatic Sarcoidosis with an Increased Serum Level of Immunoglobulin G4

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Cytokines and Chemokines in Uveitis - Is there a Correlation with Clinical Phenotype?

“…125 With successful corticosteroid treatment, the balance between Th1 and Th2 has been restored. 128 Different polymorphisms of cytotoxic T-lymphocyte antigen 4 which affect T cell activation and cytokine secretion have, however, been associated with different end organ manifestations in sarcoidosis including those with ocular sarcoidosis predominance. 129 Although a polymorphism has been found in the TNFA2 allele to be significantly associated with Lofgren's syndrome, the acute pulmonary form of the disease with frequent spontaneous remission, the suggestion that the gene for TNF-α was etiologically associated with sarcoidosis has been largely discounted and explained by linkage disequilibrium.…”