الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion 163
Summary and Conclusion
The host immune response have been suggested to play a role in
liver injury occurring in patients with chronic hepatitis C. Several studies
suggest that HCY by itself may not be cytopathic, and by comparison
with the hepatitis B virus, the pathogenesis of HCY - induced liver
damage might be mediated by the immune system itself (Liaw et al.,
1995).
The aim of this study was to gain further insight into the relationship
between the host immune response and HCY inpatients with chronic
hepatitis C in Egypt, and to asses if there is particular lymphocyte subsets
in both the liver and peripheral blood of these patients.
We also aimed to find a correlation between tile proportion of these
lymphocyte subsets and each of the level of serum Alanine amino
transaminase level (ALT) and the histopathological activity index
(Knodell’s Score).
This study carried out on twenty-one patients with chronic hepatitis
C (patients group) and twenty individuals who are non reactive to anti-
HCY antibodies (control group). The following investigations were
carried out to both groups; liver function tests, complete blood picture,
serological tests for HCY including anti- HCY antibodies and PCR. Flow
cytometry was used to analyze both the intrahepatic and peripheral blood
lymphocytes using monoclonal antibodies for CD3, CD4, CDS, CDI9,
and CD56.
The results of the present study showed that although there was no
difference in the intrahepatic CD3+lymphocytes between the patients and
control group, there was a significant difference in the T lymphocyte
Summary and Conclusion 164
subsets distribution between both groups. The CDS+ (cytotoxicT)
lymphocytes were the predominant cells at the intrahepatic compartment
in patients group.
Although CD4+lymphocytes proportion was smaller than the CDS+
at the intrahepatic compartment in the patients group, they still
significantly higher in patients than the III CD4+lymphocyte proportion
in the control group. This resulted in significantly higher CD4+/CDS+IHL
ratio in patients than in control group.
There was also a significant difference between the intrahepatic NK
cells between the patients and the control groups.
There was no significant difference between III CD19 (B
lymphocytes) between the patients and control group. No significant
difference was found between the intrahepatic and peripheral blood B
lymphocytes in patient group.
We found a positive correlation between the proportion of
intrahepatic CD4+ lymphocytes and the histopathological activity index
(Knodell’ s Score), while there was no significant correlation between the
lymphocyte subsets and the serum level of alanine aminotransferase
(ALT).
In conclusion, after infection with HCV, multiple factors influence
the virus-host interaction, resulting in a unique, individual disease pattern.
Our data showed that compared to control group, although CDS+ IHL
remained higher than the PBL, patients with chronic hepatitis C had
increased proportions of CD4+ IHL. This revealed that the specific
response ofCD4+ T lymphocytes directed against certain viral proteins are
an essential part of the antiviral effectors mechanism, and the significant
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summary and Conclusion
165
increase in the CD4+ cells observed in the un.. of patients group
compared to control group might reflect the important role played by the
cytokin
es
they produce. Also the positive correlation between the
proportion of CD4+ cells & Knodell’ score reflects the pivotal position of
these cells in the immune system. Our data also lends a further suggestion
that the cytotxic T-cells and NK cells compartalize in liver and are
involved in the local host response to hepatitis C virus and play an
important role in pathogeneses of chronic hepatitis C.
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Summary and Conclusion
166
Recommendations
The significant positive correlation between the proportion of
intrahepatic and peripheral blood CD4+&CD3 and the histological
lesions leads us to propose that evaluation of the accessible peripheral
blood population could be used as an indicator test for the severity of
histological lesions in chronic hepatitis C.
Further studies are recommended on larger groupS of patients,
I including functional studies of the various lymphocyte subsets and their
proliferation and activation to different epitomes of the HCV - virus. Also
we recommend studies of these cell subsets in response to - interferon
treatment.