Study the relationship between vitamin A deficiency, T helper 17, regulatory T cells, and disease activity in patients with systemic lupus erythematosus

Background Systemic lupus erythematosus (SLE) is a complex autoimmune disease with activation of the innate and adaptive immune systems. Vitamin A deficiency causes imbalance of T helper 17 (Th17) and regulatory T cell (Treg), deteriorating the progression of SLE. Aim To determine the relationship between vitamin A levels and Th17 and Treg level in patients with SLE and its relation to disease activity. Patients and methods A total of 45 female patients with SLE diagnosed according to the American College of Rheumatology criteria and 45 healthy age-matched and sex-matched patients as control group were included. Full assessment was done including medications, clinical examination (pain evaluation by visual analogue scale and assessment of disease activity by SLE disease activity index), laboratory investigations, and albumin–creatinine ratio. Serum levels of vitamin A were measured by a human KAMIYA kits, and flow cytometry was used for measuring Th17 and Treg percentages. Results There was a significant deficiency of vitamin A level in patients with SLE compared with controls (P=0.001). There was a significant negative correlation between vitamin A and Th17 (P=0.001) and positive correlation between vitamin A and Treg percentages (P=0.001). There was a negative correlation between vitamin A levels and albumin–creatinine ratio in patients with SLE (R=−0.255). A positive correlation between serum levels of vitamin A and C3 and C4 was found (P=0.001). Conclusion Vitamin A deficiency is a bad prognostic factor in patients with SLE, affecting Th17/Treg balance. Routine use of retinoic acid may be a promising supplementary agent in patients with SLE, improving its prognosis.