Cytokines in systemic lupus erythematosus: far beyond Th1/Th2 dualism lupus: cytokine profiles

The aims of this study were to delineate cytokine profiles of systemic lupus erythematosus (SLE), construct prediction models for diagnosis and disease activity using those profiles, and to examine the associations between TNFB Ncol polymorphism, body mass index (BMI) and vitamin D levels with cytokine levels. Two hundred SLE patients and 196 healthy controls participated in this case–control study. Plasma cytokines levels of tumor necrosis factor (TNF)‐α, interferon (IFN)‐γ, interleukin (IL)‐1β, IL‐ 4, IL‐6, IL‐10, IL‐12 and IL‐17 were measured and cytokines profiles were computed. IL‐6, IL‐12, IL‐17, IFN‐γ and IL‐10 levels were significantly higher in SLE, while IL‐4 was lower in SLE. The Th1/Th2 and Th1+Th17/Th2 profiles were significantly higher in SLE than in healthy controls, whereas there were no significant differences in the proinflammatory cytokine profile (TNFα+IL‐6+IL‐1β). In total, 90.4% of all subjects were correctly classified using Th1+Th17 profile and IL‐10 (positively associated) and IL‐4 (negatively associated) as predictor variables (sensitivity=66.7% and specificity=96.9%). In all, 20.9% of the variance in the SLE Disease Activity Index was predicted by the Th1+Th17/Th2 ratio, IL‐10 and BMI (all positively) and proinflammatory profile (inversely associated). B1/B1 genotype is accompanied by increased IL‐17 and Th17/Th2 ratio, while B1/B2 genotype is accompanied by higher IL‐4 and IFNγ values. 25‐OH vitamin D was inversely associated with IFN‐γ levels. SLE is accompanied by Th1, Th17 and Treg profile and lowered IL‐4 production. Lowered vitamin D levels and B1/B1 genotype, but not BMI, contribute to changes in cytokines profiles. Future treatments should target Th1, Th2 and Th17 profiles rather than inflammatory cytokines.