CD4+ CD25+ FOXP3+ T cell frequency in the peripheral blood is a biomarker that distinguishes intestinal tuberculosis from Crohn's disease

Background Distinguishing between Crohn's Disease (CD) and Intestinal Tuberculosis (ITB) has been a challenging task for clinicians due to their similar presentation. CD4(+)FOXP3(+) T regulatory cells (Tregs) have been reported to be increased in patients with pulmonary tuberculosis. However, there is no such data available in ITB. The aim of this study was to investigate the differential expression of FOXP3(+) T cells in patients with ITB and CD and its utility as a biomarker. Methods The study prospectively recruited 124 patients with CD, ITB and controls: ulcerative colitis (UC) and patients with only haemorrhoidal bleed. Frequency of CD4(+)CD25(+)FOXP3(+) Tregs in peripheral blood (flow cytometry), FOXP3 mRNA expression in blood and colonic mucosa (qPCR) and FOXP3(+) T cells in colonic mucosa (immunohistochemistry) were compared between controls, CD and ITB patients. Results Frequency of CD4(+)CD25(+)FOXP3(+) Treg cells in peripheral blood was significantly increased in ITB as compared to CD. Similarly, significant increase in FOXP3(+) T cells and FOXP3 mRNA expression was observed in colonic mucosa of ITB as compared to CD. ROC curve showed that a value of >32.5% for FOXP3(+) cells in peripheral blood could differentiate between CD and ITB with a sensitivity of 75% and a specificity of 90.6%. Conclusion Phenotypic enumeration of peripheral CD4(+)CD25(+)FOXP3(+) Treg cells can be used as a non-invasive biomarker in clinics with a high diagnostic accuracy to differentiate between ITB and CD in regions where TB is endemic.