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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 917-930
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.917
CD4+CD25+ regulatory T cells decreased future liver remnant after associating liver partition and portal vein ligation for staged hepatectomy
Wei Wang, Chun-Hui Ye, Zhen-Feng Deng, Ji-Long Wang, Ling Zhang, Li Bao, Bang-Hao Xu, Hai Zhu, Ya Guo, Zhang Wen
Wei Wang, Chun-Hui Ye, Zhen-Feng Deng, Ji-Long Wang, Bang-Hao Xu, Hai Zhu, Ya Guo, Zhang Wen, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Wei Wang, Chun-Hui Ye, Zhen-Feng Deng, Ji-Long Wang, Bang-Hao Xu, Hai Zhu, Ya Guo, Zhang Wen, Guangxi Key Laboratory of Enhanced Recovery after Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Ling Zhang, Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Li Bao, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300000, China
Author contributions: Wang W and Ye CH are equal coauthors of this article; Wang W, Ye CH, Deng ZF, Wang JL, Bao L, and Zhang L contributed to the study design; Wen Z and Guo Y provided administrative support; Wang W, Ye CH, and Wen Z provided study materials and/or patients; Wang W, Ye CH, Xu BH, Zhu H, Guo Y, and Wen Z contributed to data collection and assembly; Wang W and Ye CH contributed to data analysis and interpretation; and all authors contributed to manuscript writing and final approval.
Supported by the National Natural Science Foundation of China, No. 8190111624; Guangxi Natural Science Foundation of China, No. 2018JJB140382; and Guangxi University Young and Middle-Aged Teachers’ Basic Scientific Research Ability Improvement Project, No. 2019KY0123.
Institutional review board statement: The studies involving human participants were reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data presented in this study are available upon request to the corresponding author.
STROBE statement: The authors have read the STROBE Statement checklist of items, and the manuscript was prepared and revised according to the STROBE Statement checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Zhang Wen, MD, PhD, Chief Doctor, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. wenzgxmu@163.com
Received: October 9, 2022
Peer-review started: October 9, 2022
First decision: December 12, 2022
Revised: December 22, 2022
Accepted: April 4, 2023
Article in press: April 4, 2023
Published online: May 27, 2023
ARTICLE HIGHLIGHTS
Research background
The mechanism of regeneration of the future liver remnant (FLR) after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a hot research topic in the field of hepatobiliary surgery, but the definitive mechanism of regeneration has not yet been fully elucidated.
Research motivation
Regulatory T cells (Tregs) are closely associated with tissue and organ regeneration in a number of studies, but no studies have been reported on their association with liver regeneration.
Research objectives
This study explored the correlation between CD4+CD25+ Tregs and FLR regeneration after ALPPS from the perspectives of FLR regeneration volume, FLR regeneration rate, kinetic growth rate (KGR), and liver fibrosis score.
Research methods
Collection of clinical data and peripheral blood samples from hepatocellular carcinoma (HCC) patients treated with ALPPS. Flow cytometry was performed to detect changes in the proportion of CD4+CD25+ Tregs to CD4+ T cells in peripheral blood before and after ALPPS. To analyze the relationship between peripheral blood CD4+CD25+ Treg proportion and clinicopathological information and FLR.
Research results
The postoperative CD4+CD25+ Treg proportion in stage 1 ALPPS was negatively correlated with the amount of proliferation volume, proliferation rate, and KGR of the FLR after stage 1 ALPPS. Patients with a high Treg proportion had a lower postoperative KGR as well as a more severe degree of fibrosis. Also, Treg proportion was a good predictor of in postoperative proliferation volume, proliferation rate and KGR.
Research conclusions
CD4+CD25+ Tregs in the peripheral blood of patients with HCC at stage 1 ALPPS were negatively correlated with indicators of FLR regeneration after stage 1 ALPPS and may influence the degree of fibrosis in patients’ livers. Treg percentage was highly accurate in predicting the FLR regeneration after stage 1 ALPPS.
Research perspectives
Research on the mechanism of FLR regeneration after ALPPS is still being explored. In future studies, this report provides certain strong evidence to explore the regeneration mechanism, which will provide positive reference value to further improve the regeneration rate of FLR after ALPPS, reduce the waiting time of patients for ALPPS surgery and improve the survival rate of HCC patients.
