慢性乙型肝炎肝纤维化患者Th1／Th2细胞及其细胞因子的变化

目的探讨Th1／Th2细胞及其分泌的细胞因子在慢性乙型肝炎（CHB）肝纤维化患者发生发展中的作用。方法选取2011年3—10月在河北医科大学第三医院感染科接受肝组织病理活检的CHB肝纤维化患者46例,根据纤维化分期分为S0～1期15例,S2～3期20例,S4期11例三组,另取同期健康志愿者10名作为健康对照组。用流式细胞术和实时荧光定量PCR检测外周血Th1、Th2细胞频率和单个核细胞（PBMCs）中干扰素γ（IFN-γ）、白细胞介素4（IL-4）基因表达;用ELISA法检测血清IFN-γ和IL-4水平;用免疫组织化学染色检测肝组织IFN-γ和IL4表达。应用Spearman相关分析、Kruskal—WallisH检验、Logistic逐步回归方法分析Th1／Th2细胞及其细胞因子在CHB肝纤维化患者外周血和肝组织中的变化。结果不同肝纤维化分期的CHB患者外周血Th1／Th2细胞频率的比值、PBMCs中IFN-γ／IL-4mRNA、血清中IFN-γ／IL-4及肝内IFN-γ／IL-4差异均有统计学意义,并随肝纤维化程度加重逐渐下降（χ2=36．259、40．822、26．321和31．852,P〈0．05）。血清及肝组织中IFN-γ,／IL-4比值与肝纤维分期均呈负相关（r=-0．616和-0．531,P〈0．01）。Logistic回归分析显示：AST、凝血酶原时间（PT）和血清IFN-γ／IL4比值是发生显著肝纤维化（S2-4）的三个独立危险因素（OR=5．933,95％CI：1．324～26．586,P=0．02;OR=12．866,95％CI：1．746～94．788,P=0．01;OR=4．755,95％CI：1．034～21．862,P：0．04）。结论CHB患者体内存在Th1／Th2失衡,随着肝纤维化进展,外周血及肝脏内均呈现Th2应答的极化现象,这可能是CHB肝纤维化发生发展的一种机制。     

308nm准分子激光治疗对白癜风患者外周血Th1/Th2细胞因子的影响

目的：研究308nm准分子激光治疗前后白癜风患者外周血Th1型细胞因子（IFN-γ）和Th2型细胞因子（IL-10）水平,探讨308nm准分子激光治疗白癜风的免疫机制。方法：采用ELISA方法检测25例白癜风患者治疗前后和20例正常对照组外周血IFN-γ和IL-10的水平。结果：IFN-γ水平在各组之间均无统计学差异（P〉0.05）。治疗前白癜风患者外周血IL-10水平与正常对照组相比明显增加,差异有统计学意义（P〈0.05）,治疗后白癜风患者外周血IL-10水平与正常对照组相比明显增加,但是差异无统计学意义（P〉0.05）。结论：白癜风患者体内Th2型细胞因子占优势,308nm准分子激光可恢复白癜风患者Th1/Th2的平衡状态。     

Recombinant human growth hormone modulates Th1 and Th2 cytokine response in burned mice.

OBJECTIVE: To determine whether growth hormone (GH) influences the production of type 1 T-helper (Th1) and type 2 T-helper (Th2) cytokine responses after burn. SUMMARY BACKGROUND DATA: GH has been shown to influence immunoregulation. The authors previously reported improved mortality in burned mice treated with GH after infection with herpesvirus. Other work has shown that impaired immunity after burn was characterized by conversion of Th cell populations from Th1 cells to Th2 cells, suggesting an increased susceptibility of patients with burns to infection. METHODS: The production of Th1 and Th2 cytokine from isolated splenic lymphocytes taken from GH-treated burned mice was measured. RESULTS: At 1 and 11 days after burn, Th1 cytokine production by splenic lymphocytes from burned mice treated with GH was greater than in mice receiving saline. In fact, Th1 cytokine production was greater than that of nonburned mice. In addition, the production of Th2 cytokines was decreased. CONCLUSIONS: Results suggest that the Th1/Th2 response is altered after burn, and this can be reversed with GH. GH, therefore, may improve resistance to infection in patients with burns.     

Eosinophilia and cellular cytokine responsiveness in hemodialysis patients.

Eosinophilia in hemodialysis (HD) patients has been associated with allergy to dialyzers and exaggerated activation of complement during HD. Its etiology, however, remains unknown. Complement activation can lead to cytokine production, and interleukin-2 (IL-2) administration has been shown to cause eosinophilia. Because abnormalities in cellular cytokine production in renal patients were previously demonstrated, the relationship between dialysis-associated eosinophilia and IL production in this HD population was studied. Twelve patients on chronic HD therapy with normal eosinophil counts (mean, 0.23 +/- 0.03 cells/nL) were compared with nine patients with eosinophilia (mean, 0.85 +/- 0.17 cells/nL). Measurements of cellular IL-1 and IL-2 production were performed before (pre) and after (post) HD with cuprammonium dialyzers. In patients with eosinophilia, stimulated cellular IL-1 production increased by 117 +/- 40% (P < 0.01) when post-HD measurements were compared with pre-HD values and IL-2 production increased by 127 +/- 65% (P < 0.05). In contrast, there was no difference in stimulated cellular cytokine production when values before and after HD were compared in patients without eosinophilia. Individual responses were reproducible during subsequent dialysis. It was concluded that cellular cytokine production in response to HD is not uniform. Eosinophilia is a clinically useful marker of exaggerated HD-associated cytokine production. Cytokine production depends on individual responsiveness and is probably related to atopy.(ABSTRACT TRUNCATED AT 250 WORDS)     

Th1-Th2 cytokine correlates (INF-gamma and IL-4) in splenectomized patients

This paper attempts to explain if immunodepression in patients who had undergone a splenectomy may be due to altered balance between Th1-Th2 lymphocyte subpopulations, as shown in several studies on phagocyte and lymphocyte cells. This was achieved by dosing serum levels of IFNg, produced by Th1 lymphocytes and IL-4, produced by Th2 lymphocytes. Final analysis showed immunodepression in splenectomized patients but also emphasized that in 70% of all cases, there is functional damage of T-lymphocytes that continues for several years after the surgery involving both cellular and humoral immunity. Immunoglobulin dosage allows the increase of IgE to be seen in 50% of the splenectomized patients studied, all with allergic symptoms that appeared after the operation. The production of IgE is stimulated by Th2 lymphocytes. This leaves one to believe that splenectomy may favour the persistence of allergens in the blood, the appearance of allergic symptoms and the increase of IgE serum levels in patients with normal Th2 functioning and consequently, with normal or increased IL-4 serum levels.     

凝血酶对狼疮肾炎末梢血单个核细胞分泌Th1/Th2细胞因子的影响

目的探讨狼疮肾炎(LN)患者凝血活性对其Th1/Th2平衡的影响。方法LN患者20例,按红斑狼疮病情活动指数(SLEDAI)分为稳定组11例(SLEDAI<9分),活动组9例(SLEDAI≥9分)。健康对照组8例。采集末梢血单个核细胞(PBMC),进行高、低浓度凝血酶刺激下体外培养。ELISA法检测培养液上清IL-10、IFN-γ水平。RT-PCR检测IL-10和IFN-γmRNA表达。结果凝血酶呈浓度依赖性上调LN患者PBMCIL-10表达,但不影响IFN-γ表达,故增加IL-10/IFN-γ比值。结论凝血酶加重狼疮肾炎患者PBMC分泌Th1/Th2细胞因子的平衡紊乱。     

Evaluation of airway inflammation by quantitative Th1/Th2 cytokine mRNA measurement in sputum of asthma patients

BACKGROUND: Asthma is a chronic inflammatory disorder of the airways driven by T cell activation. Th2 cells and their cytokines are thought to play a role in the pathophysiology of allergic as well as non-allergic asthma. METHODS: Airway cells were obtained by sputum induction from 15 healthy and 39 asthmatic individuals and the airway T cell cytokine profiles (interleukin (IL)-4, IL-5, IL-13, IL-10 and interferon (IFN)-gamma) at the mRNA level were studied by real time RT-PCR. RESULTS: Asthma patients had increased expression of IL-5 (p = 0.001) and IL-13 (p = 0.03) mRNA in sputum compared with non-asthmatic controls. IL-4 mRNA and IFN-gamma mRNA were detectable in the sputum of 44% and 21% of patients, respectively, but not in controls. Sputum IL-10 mRNA levels did not differ significantly between patients and controls. Sputum mRNA expression levels of IL-4, IL-5, and IL-13 were significantly correlated with the percentage of eosinophils and were higher in subjects with allergic asthma than in those with non-allergic asthma (p = 0.03, p = 0.02 and p = 0.0002, respectively); they did not differ between mild asthmatic subjects and those with moderate to severe asthma. In contrast, IFN-gamma mRNA expression was higher in non-allergic than in allergic patients (p = 0.04) and higher in patients with moderate to severe asthma than in those with mild asthma (p<0.01). Sputum IL-5 mRNA levels (but not the other cytokine mRNA levels) were also correlated with exhaled nitric oxide (eNO) and with bronchial hyperreactivity expressed as the histamine concentration resulting in a 20% decrease in forced expiratory volume in 1 second. CONCLUSION: Real time RT-PCR analysis of mRNA in induced sputum confirms a predominance of Th2 cytokines in both allergic and non-allergic asthma. IL-5 levels reflect eosinophil infiltration as well as eNO levels and hyperreactivity, and levels of the Th1 cytokine IFN-gamma indicate asthma severity. The technique is a promising tool for use in further studies of asthma severity and disease activity.     

Th1/Th2 cytokine levels: A potential diagnostic tool for patients with necrotizing fasciitis

IntroductionNecrotizing fasciitis (NF) has emerged as rare but rapidly progressive, life-threatening severe skin and soft tissue infection. We conducted a study to investigate whether Th1/Th2 cytokines could serve as biomarkers to distinguish NF from class III skin and soft tissue infections (SSTIs).MethodsA retrospective review was performed for 155 patients suffering from serious skin and soft tissue infections from October 2020 to February 2022. Th1/Th2 cytokines were obtained from peripheral blood and wound drainage fluid samples. Data on demographic characteristics, causative microbiological organisms, Th1/Th2 cytokines, c-reactive protein, procalcitonin and white blood cell (WBC) were extracted for analysis. Factors with statistical difference(p < 0.1) were included in the multivariate logistic regression model. The clinical differential diagnostic values of interleukin-2(IL-2), IL-6, IL-10, tumor necrosis factor-α (TNF-α) and interferon-r (IFN-r) were analyzed by receiver operating characteristic (ROC) curve.ResultsAmong the 155 patients, 66(43%) patients were diagnosed as NF. We found no significant difference for sex, age, location of infection, coexisting condition, predisposition, duration of symptoms before admission and micro-organisms, WBC, procalcitonin and c-reactive protein in NF and class III SSTIs group. NF had higher levels of IL-6 in serum (50.46 [24.89, 108.89] vs. 11.87 [5.20, 25.32] pg/ml; p＜0.01), IL-10 in serum (3.45 [2.03, 5.12] vs. 2.51 [1.79, 3.29] pg/ml; p＜0.01), IL-2 in wound drainage fluid (0.89 [0.49, 1.33] vs. 0.63 [0.14, 1.14] pg/ml; p = 0.02), IL-6 in wound drainage fluid (5000.84 [1392.30, 13287.19] vs. 1927.82 (336.65, 6759.27) pg/ml; p＜0.01), TNF-a in wound drainage fluid (5.20 [1.49, 22.97] vs. 0.96 [0.12, 3.21] pg/ml; p＜0.01) and IFN-r in wound drainage fluid (1.32 [0.47, 4.62] vs. 0.68 [0.10, 1.88] pg/ml; p = 0.02) as compared to the class III SSTIs. Multivariate logistic regression analyses showed that IL-6 in serum, IL-10 in serum and TNF-a in wound drainage fluid exhibited independently significant associations with diagnosis of NF(p＜0.05). In ROC curve analysis of IL-2, IL-6, IL-10, TNF-a and IFN-r for diagnosis of NF, the area under the curve (AUC) of IL-6 in serum could reach to 0.80 (p＜0.001). Using 27.62 pg/ml as the cut off value, the sensitivity was 74% and the specificity was 79% in IL-6 in serum.ConclusionsTh1/Th2 cytokines, IL-6 in serum in particular, are potential biomarkers for the diagnosis of NF in the early stage. However, larger patient populations with multiple centers and prospective studies are necessary to ensure the prognostic role of Th1/Th2 cytokines.     

结直肠癌患者外周血Th1和Th2细胞的检测与临床意义

目的 研究结直肠癌患者外周血CD4+T细胞亚群Th1和Th2细胞的比例以及相关特异性转录因子与细胞因子的表达水平,并观察其与临床分期之间的关系.方法 43名结直肠癌患者(肠癌组)与30名健康体检志愿者(对照组)作为研究对象.结直肠癌患者外周血Th1和Th2细胞占CD4+T细胞的比例运用流式细胞技术进行检测.采用实时荧光定量聚合酶链反应(quantitative Real-time PCR),检测外周血Th1/Th2细胞亚群特异性转录因子的相对基因表达量.血浆细胞因子的表达水平使用液相芯片技术方法定量检测.结果 肠癌组外周血Th2细胞占CD4+T细胞的比例和Th2细胞特异性转录因子GATA-3的mRNA表达量均显著高于对照组(P<0.05).肠癌组外周血Th1细胞特异性转录因子T-bet的mRNA表达量显著低于对照组(P<0.05),但Th1细胞占外周血CD4+T细胞的比例与对照组差异无统计学意义(P>0.05).血浆TNF-α、IL-1β和IL-15表达水平组间无显著差异(P>0.05).结直肠癌患者血浆IFN-γ、IL-4和IL-6的表达水平与病程分期有关(P<0.05).结论 结直肠癌患者外周血中Th1细胞比例变化不明显而Th2细胞比例明显升高.结直肠癌患者血浆细胞因子的不平衡表达可作为机体免疫状态转换与病情判断的指标.     

慢性重型乙型肝炎Th1／Th2平衡状态与预后关系的研究

目的研究慢性重型乙型肝炎Th1／Th2类细胞因子的水平及其对预后的影响。方法采集112例慢性重型乙型肝炎患者外周血,以30例慢性乙型肝炎（CHB）患者和30名健康体检者作为对照,应用ELISA法检测IL-4和IFN-γ水平,荧光PCR法检测HBVDNA载量,分析重型肝炎患者不同分期细胞因子水平以及与HBVDNA载量及短期预后的关系。结果慢性重型乙型肝炎患者外周血IL-4、IFN-γ水平和Th1／Th2比值明显高于CHB患者和健康体检者（z值分别为8．968,10．004和26．067,P值分别为0．009,0．007和0．000）;晚期重型肝炎患者的IL-4水平明显高于早、中期患者（z值分别为3．672和3．158,P值分别为0．000和0．002）,但Th1／Th2比值低于早、中期患者（Z值分别为3．161和2．166,P值分别为0．002和0．030）;不同HBVDNA复制水平的重型肝炎患者IL4、IFN-γ及Th1／Th2比值差异无统计学意义（z值分别为4．431,2．626和0．140,P值分别为0．219,0．403和0．987）;但患者外周血IL4浓度越高,12周的病死率越高。结论Th1／Th2失衡导致重型肝炎的发生,随着病情加重,Th1／Th2比值下降,提示短期预后不良。     

共刺激后淋巴细胞产生Th1/Th2细胞因子的变化及免疫抑制剂的影响

目的 探讨CD28、CD40通路共刺激后淋巴细胞产生Th1(IL-2、IFN-γ、IL-12)及Th2细胞因子(IL-4、IL-10)的变化及免疫抑制剂环孢素(CsA)、雷帕霉素(RPM)及霉酚酸(MPA)对共刺激通路激活后淋巴细胞产生Th1及Th2细胞因子的影响.方法采用单克隆抗体(mAb)与淋巴细胞表面CD3、CD28及CD40L分子结合产生相应刺激信号,单刺激及共刺激组分为:a组,CD3 mAb单刺激;b组,CD3 mAb加CD28 mAb共刺激;c组,CD3 mAb加CD28 mAb加CD40 L mAb共刺激;d组,CD3 mAb加CD28 mAb加CTLA4 mAb共刺激.各mAb的终浓度均为100 ng/ml.干预组分别将终浓度为300 ng/ml的CsA、RPM、MPA加入上述4组.ELISA法测定上述细胞培养上清中的细胞因子值.结果 a、b、c 3组IFN-γ分别为(248.91±11.20)、(555.08±24.42)、(548.19±33.06)ng/ml,IL-2分别为(29.48±8.61)、(1100.82±99.29)、(842.23±29.31)ng/ml,IL-4分别为(32.29±6.76)、(116.02±15.03)、(147.28±18.07)ng/ml,IL-10分别为(147.01±10.47)、(291.79±12.47)、(302.52±35.18)ng/ml.b、c组与a组比较,差异均有统计学意义(P＜0.01);b、c组IL-2、IL-12、IL-4比较,差异均有统计学意义(P＜0.05).d组IFN-γ、IL-2及IL-10分别为(497.42±29.03)、(739.77±18.58)及(120.33±13.21)ng/ml,与b组相比,差异均有统计学意义(P＜0.05).CsA、RPM及MPA对共刺激后Th1/Th2细胞因子的产生均有抑制作用,CsA对4种细胞因子产生的抑制作用强于RPM和MPA,其中对IL-2及IL-4的抑制作用更为明显.CsA与CTLA4 mAb有协同作用.共刺激后IL-12产生升高,MPA可抑制单刺激和共刺激后IL-12的产生,CsA和RPM对IL-12的产生无明显抑制作用.结论 CD28、CD40共刺激通路在淋巴细胞活化中起关键作用.CsA、RPM、MPA及CTLA4 mAb对共刺激后Th1/Th2细胞因子的产生均有抑制作用,CsA的抑制作用更为明显.CD40 L mAb使Th1细胞因子及IL-12水平下降,又促进Th2细胞因子(以IL-4为主)产生,该作用可能是抗CD40 L抗体诱导移植物存活期延长的机制之一.     

C-reactive-protein and cytokine plasma levels in hemodialysis patients

BACKGROUND: Markers of an acute phase reaction, such as C-reactive protein (CRP) or interleukin-6 (IL-6), are predictive for cardiovascular morbidity and mortality in normal subjects and in hemodialysis (HD) patients. Le-vels of acute phase proteins (APP) may vary with time even in the absence of an acute illness and this may weaken the relationship between APP and clinical outcome. We investigated the intra- and inter-individual patterns of several inflammatory markers in HD patients. METHODS: Plasma levels of CRP, IL-10, RANTES, TNF-RI, leptin, ferritin and albumin were measured weekly for 12 weeks after the long inter-dialytic interval by ELISA in ten stable HD patients with no clinical signs of infection. RESULTS: Considerable variability was observed. Intra-individual differences were largest for RANTES (coefficient of variation - CV - 80%, followed by CRP (51%), and low for albumin (11%) and ferritin (12%). Inter-individual variability was highest for IL-10 (135%) followed by CRP (88%). CONCLUSIONS: The present data suggest that single point measurements of APP, particularly CRP, may not be sufficient to assess the cardiovascular risk in HD patients. Even in patients with no apparent signs of infection, there is considerable variability in plasma levels of APP and repeated measurements are recommended to identify patients at high cardiovascular risk.     

Modulation of Th1 and Th2 cytokine profiles and their association with advanced head and neck squamous cell carcinoma.

OBJECTIVE: Plasma cytokine concentrations from patients with head and neck squamous cell carcinoma (HNSCC) were measured to determine whether the potential modulation of host Th1 vs Th2 immune responses are associated with advanced clinical disease. STUDY DESIGN AND SETTING: The concentrations of IL-4, IL-6, IL-10, and IL-12 were measured in the plasma of 58 patients with histologically proven HNSCC. These data were examined with respect to the histologic size (T-stage) of the primary tumor, and presence of nodal metastasis. RESULTS: The concentrations of IL-12 were greater from patients without nodal metastasis, and with T(1)/T(2)-stage tumors. IL-10 levels were greater from patients with nodal metastasis, and with T(3)/T(4)-stage tumors. The concentrations of IL-6 were greater from patients with T(3)/T(4)-stage tumors. CONCLUSIONS: Using parameters of primary tumor size and presence of nodal metastasis, patients with advanced HNSCC have significantly less plasma IL-12 levels, and greater plasma IL-10 and IL-6 levels. SIGNIFICANCE: Patients with advanced HNSCC have a potentially diminished Th1 immune response, and a stronger potential Th2 immune response when compared to that of patients with less advanced disease. EBM rating: D-5.     

T-cell activation follows Th1 rather than Th2 pattern in haemodialysis patients.

BACKGROUND: Patients on chronic intermittent haemodialysis (HD) show an impaired cellular and humoral immune response that clinically appears with frequent infectious complications and low vaccination responses. This immune defect strongly correlates with reduced in vitro proliferative responses of T cells. The defect is localized in antigen presenting cells, which show a decreased co-stimulatory activity. Furthermore, the impaired immune response correlates with an increased production of pro-inflammatory cytokines. In response to primary activation, CD4 positive T helper (Th) cells mainly differentiate into either Th1 or Th2 cells. Th1 cells support cell mediated immunity whereas Th2 cells enhance humoral immune responses. Since both types of responses mutually inhibit each other, the impaired humoral immune response seen in HD patients could either be due to a reduced number of Th2 cells or to a predominant Th1 response. METHODS: We analysed the Th cell profile in HD patients using flow cytometry. Monocytic cytokine expression was analysed using both flow cytometry and enzyme linked immunoadsorbant assays. RESULTS: Our data demonstrate that the cytokine differentiation profile in circulating T cells from HD patients is dysregulated and characterized by an increase in Th1 cells, but a normal amount of Th2 cells. Moreover, the skewed helper cell responses correlate with a higher percentage of monocytes capable of secreting the Th1 promoting cytokine interleukin 12 (IL-12). CONCLUSIONS: Our findings contribute to a better understanding of the pathogenesis of impaired cellular immune functions in dialysis patients and, in particular, the decreased antibody production after vaccination. They provide a link between overproduction of pro-inflammatory cytokines (IL-12) and imbalanced T-cell activation.     

成骨肉瘤患者TH1/TH2亚群漂移研究

观察成骨肉瘤患者辅助性Ｔ淋巴亚群中Ｔｈ１／Ｔｈ２亚群的变化,为细胞因子免疫治疗提供依据。方法应用放射免疫法以及酶联免疫吸附法检测成骨肉瘤患者血清中ＩＬ－２、ＩＬ－４、ＩＬ－６、ＴＮＦ－α的含量,检测外周血单个核细胞培养上清中ＩＬ－２、ＩＬ－４含量。结果成骨肉瘤血清中及培养上清中ＩＬ－２减少,而ＩＬ－４、ＩＬ－６、ＴＮＦ－α含量增加。结论成骨肉瘤患者中存在有Ｔｈ１／Ｔｈ２平衡失调,其中Ｔｈ１亚群功能抑制,Ｔｈ２亚群功能亢进,它们与肿瘤在宿主体内生长密切相关。     

红细胞对血液透析患者单个核细胞分泌功能的影响

目的　探讨红细胞 (RBC)与尿毒症病人单个核细胞分泌功能之间的关系。方法　采用细胞培养技术 ,观察正常人RBC、病人自体RBC、绵羊RBC、红细胞膜碎片、鼠抗人淋巴细胞CD2单克隆抗体 (CD2McAb)对血液透析 (血透 )病人单个核细胞 (PBMNC)分泌白细胞介素 2 (IL 2 )、单核细胞(PBMC)分泌肿瘤坏死因子 (TNF)的影响。结果　自体RBC、同种异体RBC以及绵羊RBC、CD2McAb对病人PBMNC、PBMC分泌IL 2、TNF均有增强作用。自体RBC与CD2McAb共同对PBMNC、PBMC分泌IL 2、TNF有促进作用 ,但与单独加入自体RBC或CD2McAb时相比无显著差异。各种红细胞膜碎片、CD4McAb、CD8McAb、小鼠IgG对PBMNC、PBMC分泌IL 2、TNF无影响。结论　RBC对PBMNC、PBMC分泌IL 2、TNF有直接促进作用 ,其机制认为是通过红细胞表面LFA 3与单个核细胞表面CD2受体之间的相互作用所致。     

Pre-transplant Th1 and post-transplant Th2 cytokine patterns are associated with early acute rejection in renal transplant recipients

In this retrospective study, we tried to define pre- and post-transplant immunological parameters that identify patients at risk for early acute rejection. Lymphocyte subpopulations and plasma levels of cytokines and neopterin were determined pre- and post-transplant in 32 renal transplant recipients with biopsy-proven early acute graft rejection. Recipients without early acute rejection served as controls. High pre-transplant interferon-gamma (IFN-gamma) plasma levels (p = 0.006), consistently high levels of neopterin early post-transplant (p = 0.008), a post-transplant switch from a Th1 to a Th2 cytokine pattern with decreasing IFN-gamma (p = 0.02), low CD8+ lymphocyte counts (p = 0.006) and consistently high CD19+ B lymphocyte counts were associated with acute rejection. Our data suggest that patients with a pre-transplant Th1 and an early post-transplant Th2 cytokine pattern are pre-disposed for early acute rejection.