Preoperative Th1/Th2 and related cytokines: Prediction value in postoperative febrile UTI after ureteroscopy in patients with ureteral calculi

Abstract

Background. The topic of whether preoperative Th1/Th2 cells and their related factors have a predictive value for postoperative febrile urinary tract infection (UTI) in patients with ureteral calculi has not been explored. Objectives. The objective of this study was to investigate the role of preoperative Th1/Th2 cells and related cytokines in the prediction of postoperative febrile UTI after ureteroscopy in patients with ureteral calculi. Material and methods. One hundred sixty patients who underwent ureteroscopic pneumatic lithotripsy in the Affiliated Hospital of Hangzhou Normal University (China) were recruited and divided into febrile UTI group (n = 78) and non-UTI group (n = 82). Flow cytometry was used to detect the proportions of Th1 and Th2 cells (Th1% and Th2%). Detection of Th1/Th2 cell-related cytokines was conducted using enzyme-linked immunosorbent assay (ELISA). Quantitative real-time polymerase chain reaction (qRT-PCR) was applied to measure the expression of T-bet and GATA3. Results. Compared with patients in non-UTI group, those in febrile UTI group had significantly increased proportions of Th2 cells, levels of Th2 cytokines (interleukin (IL)-4, IL-10 and IL-5), and mRNA expression of Th2-associated transcription factor GATA3 (all p < 0.05). In addition, the Th1/Th2 ratio of febrile UTI group was significantly lower than that of non-UTI group (p < 0.001). Receiver operating characteristic (ROC) curve analysis showed that the accuracy rate of Th2%, Th1/Th2 ratio, and IL-4, IL-10 and IL-5 levels for the diagnosis of postoperative febrile UTI in patients with ureteral calculi was 90.63%, 85.00%, 72.50%, 87.50%, and 91.88%, respectively, and their combined diagnostic sensitivity was 97.4% with specificity as high as 100%. Conclusions. Perioperative Th2 dominance was correlated with the risk of postoperative febrile UTI after ureterscopy in patients with ureteral calculi, which can provide clinical guidance for the development of individualized treatment.

Local induction of bladder Th1 responses to combat urinary tract infections

“…Th1 Responses Promoting Bacterial Clearance. In view of the finding that the bladder's natural adaptive immune response to infection is Th2-biased, which inhibits Th1-mediated bacterial clearance capacity (7,27), we reasoned we could modify this response through vaccination. We hypothesized that bacteriaspecific immune responses with enhanced bacteria-clearing capacity could be evoked by immunizing mice with bacterial antigens accompanied by a known Th1-polarizing adjuvant.…”

“…Mice Heavily Programmed to Evoke a Strong Th2 Response. Recent studies have revealed that mice subjected to multiple UTIs are heavily programmed to evoke a powerful Th2 response with limited capacity to clear infections (7,27). This condition is closely reminiscent of subjects prone to recurrent UTIs, in whom each infectious bout predisposes to another infection (1-6).…”

“…For example, following infection, the bladder's immune response was observed to evoke only a limited T helper type 1 (Th1) response, which is essential for bacterial clearance. Instead, the immune response was heavily skewed toward Th2 immune responses, which are largely directed at bladder tissue repair (7,27). This could explain the bacterial persistence following bladder infection and the enhanced chances for recurrence (7).…”