Levels of Th2, Th1, and Th17 cytokines in patients with asthma of varying severity and disease control

   Introduction. Researchers are increasingly focused on the balance of cytokines that regulate the types of immune-inflammatory responses predominant in patients with asthma.

   Aim. To assess the levels of Th2, Th1, and Th17 cytokines in blood and their interrelationships in asthma patients according to disease severity and level of asthma control.

   Materials and methods. Serum concentrations of interleukin (IL)-4, IL-13, interferon (IFN)γ, IL-2, IL-6, IL-17A, IL-17F, and IL-22 were measured in 144 asthma patients of varying severity. Lung function was evaluated by spirometry and bodyplethysmography.

   Results. Patients with intermittent asthma (Group 1) exhibited elevated serum levels of both Th2 (IL-4, IL-13) and Th1/Th17 cytokines (IFNγ, IL-2, IL-17F, IL-6). In patients with mild persistent asthma (Group 2), IL-4 levels were low, while IFNγ was elevated. In patients with moderate-to-severe uncontrolled asthma during exacerbation (Group 3), Th17 cytokines – IL-17F and IL-22 – were significantly increased. In Group 1, FEV1/FVC ratio positively correlated with IL-6 (Rs = 0.44; p = 0.037), and bronchodilator response (ΔFEV1) negatively correlated with IL-17A (Rs = – 0.76; p = 0.009). In Group 2, IL-17A showed a strong inverse correlation with residual volume/total lung capacity ratio (RV/TLC) (Rs = –0.66; p = 0.0015). In Group 3, expiratory airway resistance (Raw ex) correlated positively with IL-17A (Rs = 0.50; p = 0.031); IL-17F correlated negatively with TLC (Rs = –0.52; p = 0.008) and FVC (Rs = –0.56; p = 0.003). Among uncontrolled moderate-to-severe asthma patients (Group 3), IL-17F negatively correlated with Asthma Control Test (ACT) score (Rs = –0.70; p = 0.014), indicating worse asthma control; IL-17A negatively correlated with FEV1/FVC (Rs = –0.64; p = 0.011); and IL-2 negatively correlated with both FEV1/FVC (Rs = –0.54; p = 0.026) and forced expiratory flow at 50% FVC (FEF50) (Rs = –0.43; p = 0.043).

   Conclusion. Disease progression in asthma is associated with a shift in endotype, driven by regulatory cytokines that orchestrate airway inflammation. This shift correlates with declining bronchial patency, poor asthma control, and the emergence of distinct phenotypic features of endogenous inflammation.

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