CD4 and CXCR5 in Patients with Diabetic Nephropathy

Background: Diabetes is a metabolic condition characterized by hyperglycemia caused by defects in insulin secretion, insulin activity, or both. Diabetic nephropathy (DN) is one of the most common complications of diabetes mellitus especially type 2 diabetes. Blood CXCR5+CD4+ T cells represent three subsets: T follicular helper 1 (Tfh1), Tfh2 and Tfh17 cells. Increasing the numbers of circulating Tfh cells and also stimulation of Tfh cells have been linked with autoimmune diseases and may have a role in pathogenesis of diabetic nephropathy. Aim of the Work: Was to investigate CD4 and CXCR5 in diabetic nephropathy patients and assess their role in the pathogenesis of diabetic nephropathy. Subject and Methods: This study was conducted on 20 diabetic patients without nephropathy (Group I), 20 diabetic nephropathy patients (Group II) and 20 apparently healthy control subjects (Group III). Complete history taking and full clinical examination were done. Assessments of CD4 and CXCR5 were done by flowcytometry (FACS caliber, BD, CA, USA). Results: The present study revealed a statistically significant difference between diabetic patients (Group I), diabetic nephropathy patients (Group II) and healthy control (Group III) regarding CD4+CXCR5+T follicular helper cells level. CD4+CXCR5+T follicular helper cells levels were significantly higher in diabetic nephropathy patients than in diabetic patients without nephropathy and control subjects. CD4+CXCR5+T follicular helper cells level positively correlated significantly with fasting blood glucose, postprandial blood glucose, hemoglobin A1c, creatinine, urea and urinary protein level, and negatively correlated with estimated GFR in diabetic nephropathy patients. Conclusions: This study showed that CD4+CXCR5+T follicular helper cells level might be a useful marker for prediction and diagnosis of diabetic nephropathy patients.