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Possible Role of Regulatory B Cells in Different Behçet’s Disease Phenotypes and Therapies: First Report from Egypt

Authors Hetta HF, Mohamed AAA, Zahran AM, Mahran SA, Sayed MM, Saleh MGA, Abdelazeem K, Batiha GES, Al-Rejaie S, Waheed Y, Muhammad K, Hassanien MM

Received 8 September 2020

Accepted for publication 28 January 2021

Published 8 March 2021 Volume 2021:14 Pages 737—744


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Ning Quan

Helal F Hetta,1,2,* Alaa AA Mohamed,3,* Asmaa M Zahran,4,* Safaa A Mahran,3 Marwa MY Sayed,5 Mohamed GA Saleh,6 Khaled Abdelazeem,6 Gaber El-Saber Batiha,7 Salim Al-Rejaie,8 Yasir Waheed,9 Khalid Muhammad,10 Manal M Hassanien3

1Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt; 2Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 3Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt; 4Clinical Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt; 5Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt; 6Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt; 7Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicines, Damanhour University, Damanhur, 22511, Egypt; 8Department of Pharmacology & Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia; 9Foundation University Medical College, Foundation University Islamabad, Islamabad, 44000, Pakistan; 10Department of Biology, College of Science, United Arab Emirates University, Al Ain, 15551, United Arab Emirates

*These authors contributed equally to this work

Correspondence: Helal F Hetta
Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
Email [email protected]

Background and Aim: The data about the role of regulatory B cells (Breg) in Behcet Disease (BD) are scarce. We aimed to evaluate the frequency of total B lymphocytes and Breg cells in different BD phenotypes and therapies attempting to unravel their function.
Methods: This cross-sectional study included 35 BD patients and 39 healthy controls (HCs). The demographic data of the study subjects were collected including age and gender. Current medications including disease-modifying anti-rheumatic drugs (DMARDs) were recorded. All patients underwent testing for baseline laboratory investigations including full blood count, liver and kidney function tests, erythrocyte sedimentation rate (ESR) by Westergren blot and C-reactive protein (CRP). Measurement of the total B lymphocytes and their subtypes B regulatory lymphocytes by flow cytometric assay. Assessment of BD activity was done using the revised Behçet’s Disease Current Activity Form (BDCAF) 2006 and Behçet’s Syndrome Activity Score (BSAS) 1111111111. All participants were assessed for the presence of erectile dysfunction using the International Index of Erectile Function (IIEF-5 score), and for depression using the Beck Depression Inventory.
Results: A dramatic drop in the number of B cells, total and regulatory, was observed in the patients compared to the HCs. Regulatory cells (Bregs) tend to be upregulated with genital ulcers or vascular disease. Bregs but not B lymphocytes were associated with BSAS and ESR. Neither the total B lymphocytes nor the Bregs correlated with CRP or the sexual function or depression scores. Of all the used medications, low-dose aspirin was seen with markedly high Bregs proportions.
Conclusion: This study supports the role of B cells in BD pathogenesis and strongly suggests a possible role for Bregs in the resolution of different BD manifestations.

Keywords: Behcet’s disease, B lymphocytes, Breg

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