Background: Silibinin has been shown to have anti-HCV activity and immune-modulating properties by regulating\ndendritic cell (DC) function. DCs are antigen-presenting cells that, together with regulatory T cells (Treg), play a\npivotal role in controlling alloimmune, as well as anti-HCV immune responses.\nMethods: Twelve liver transplant patients with HCV recurrence received iv infusion of Silibinin (iv-SIL) for 14\nconsecutive days. Using flow cytometry, before and at the end of treatment, we determined the frequencies of\ncirculating myeloid (m) and plasmacytoid (p) DC and Treg and the expression of costimulatory/coregulatory molecules\nby the DC subsets and Treg. Statistical analysis was performed using the paired Student�s t test and Pearson\ncorrelation test.\nResults: After iv-SIL treatment, we observed an elevated plasmacytoid dendritic cell (pDC)/myeloid dendritic\ncell (mDC) ratio, while pDC displayed lower HLA-DR and higher immunoglobulin-like transcript 4 (ILT4), CD39,\nand HLA-G expression compared to the pretreatment baseline. In addition, after iv-SIL, mDC showed increased\ninducible costimulator ligand (ICOSL) expression. No changes were detected in Treg frequency or programed\ndeath (PD)-1 expression by these cells. Moreover, several correlations between DC/Treg markers and clinical\nparameters were detected.\nConclusions: This descriptive study, in liver transplant patients with HCV recurrence, reveals the impact of iv-SIL on\nDC and Treg. The changes observed in circulating pDC and mDC that have previously been associated with\ntolerogenic conditions shed new light on how iv-SIL may regulate anti-viral and alloimmunity. We have also\nobserved multiple clinical correlations that could improve the clinical management of liver transplant patients\nand that deserve further analysis.
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