Th1/Th2 Cytokine Ratio (CKR)

T cells are cells of the immune system that mature in the Thymus organ in the chest. T-helper cells (Th cells) are a type of T cell that do not directly destroy tumour or pathogenic cells, but instead help the immune system by activating and directing other immune cells.

There are a number of different subtypes of Th cells including including Th1, Th2, Th3, Th9, Th17,TR1, TFH and Treg cells. The different types of Th cells are distinguished by the cytokine messengers they produce. Cytokine messengers are regulatory proteins that tell other immune cells how to react when the body is under threat.

Th1 cells produce cytokines which include: IFN-γ (Interferon gamma), IL-2 and TNF-α (Tumour necrosis factor alpha ). Both IFN-γ and TNF-α can be measured in peripheral blood, to determine the concentration of Th1 cells.

Th1 cells are involved in a pro-inflammatory response. Some chronic inflammatory diseases are associated with Th1 cell dominance including multiple sclerosis, diabetes, and rheumatoid arthritis. Th1 cells are also involved in most cases of graft or transplant rejection. A Th1 cell mediated pro-inflammatory response to an embryo will result in implantation failure or recurrent miscarriage (Kwak-Kim, J.Y., et al., 2003; Raghupathy, R., et al., 2000; Daher, S., et al., 2004).

Th2 cells are involved in allergic reactions and antibody production, but also counteract the Th1 pro-inflammatory response, which benefits an embryo.
Th2 cells produce a number of different cytokines: IL-4, IL-5, IL-6, IL-10, and IL-13, but IL-10 is typically used to determine Th2 concentrations in the blood.

The balance or ratio between the Th1 and Th2 cells is important for a healthy immune response, controlling inflammation and maintaining a healthy pregnancy.
Scientists have shown over the past 10 years that a Th1 predominance is associated with pregnancy loss while a Th2 predominance is associated with successful pregnancy outcomes. Clinicians now try to rebalance the Th1/Th2 ratio in patients with a Th1 predominance using immune based therapies (Winger, E.E., et al., 2009; Winger, E.E., et al., 2011).

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