1
|
Wang X, Zhou Q, Yang W, Bi H, Wang H, Wang Y, Du Y, Liu L, Liu Y, Yin L, Yao J, Yu J, Tao W, Zhou Y, Zhou Z. The role of CD83 in the pathogenesis of immune thrombocytopenia. Hematology 2024; 29:2372482. [PMID: 38994874 DOI: 10.1080/16078454.2024.2372482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/19/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND CD83 are closely related to the pathogenesis of immune thrombocytopenia (ITP), but the exact mechanism remains unclear. AIM To explore the relationship between CD83 and CD4+ T cell subsets and clarify the role of CD83 in the pathogenesis of ITP. METHODS RT-qPCR and Flow cytometry were used to illustrate CD83 expression. The downregulation and overexpression of DC-CD83 were co-cultured with CD4+ T cells to detect cell proliferation, co-cultured supernatant cytokines and Tregs expression. RESULTS The results indicate that the ITP patients showed higher expression of CD83 than the healthy controls. The proliferation of CD4+ T cells was inhibited by downregulation of DCs-CD83 but promoted by overexpression of DCs-CD83. siRNA-CD83 inhibited proinflammatory IFN-γ and IL-17 secretion while raising TGF-β, IL-10 concentrations. Overexpression of DCs-CD83 promoted Tregs expression. CONCLUSION The Th1/Th2 and Th17/Tregs polarization were reversed via interfering DCs with siRNA-CD83. CD83 plays an important role in ITP pathogenesis, suggesting novel treatment for ITP patients.
Collapse
Affiliation(s)
- Xiuli Wang
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Qiyuan Zhou
- Department of Molecular and Cellular Biology, University of California, Davis, USA
| | - Wen Yang
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Hui Bi
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Honghui Wang
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Yacan Wang
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Yadong Du
- Department of Hematology, The First Affiliated Hospital of Henan University of Science and Technology, Henan, People's Republic of China
| | - Lin Liu
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Yuebo Liu
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Liefen Yin
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Jin Yao
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Jingxing Yu
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Wei Tao
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| | - Yongchun Zhou
- Department of Molecular Diagnostic Center, Kunming Medical University, School of Clinical Oncology: Yunnan Cancer Hospital, Kunming, People's Republic of China
| | - Zeping Zhou
- Department of Hematology, The Second Affiliated Hospital of Kunming Medical University, Kunming, People's Republic of China
| |
Collapse
|
2
|
Zakaria M, Beshir M, Hassan T, Esh A, Abdelaziz E, Tayib R, Nafea A. Role of interleukin 4 (IL4) and interleukin 6 (IL6) in the pathogenesis and prognosis of childhood primary immune thrombocytopenia. Eur J Pediatr 2023:10.1007/s00431-023-04945-x. [PMID: 37097445 DOI: 10.1007/s00431-023-04945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 04/26/2023]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the breakdown of immune tolerance. Impairment of the cellular immunity is primarily evaluated by the levels of the cytokines which can help in predicting the course of ITP. We aimed to assess the levels of IL4 and IL6 in children with ITP and evaluate their role in the pathogenesis and prognosis of this disease. A prospective cohort study was carried on 60 children (15 patients with newly diagnosed ITP, 15 patients with persistent ITP, 15 patients with chronic ITP and 15 healthy children as a control group). Serum IL-4 and serum IL-6 were measured using Human IL-4 and IL-6 ELISA kit in patients and controls. Patients with newly diagnosed and persistent ITP had significantly higher levels of IL4 and IL6 compared to patients with chronic ITP and healthy controls (p < 0.001). The mean serum level of IL4 was 762.0, 741.0, 364.6 and 436.8 pg/ml, and the mean serum level of IL6 was 178.5, 164.4, 57.9 and 88.4 pg/ml for patients with newly diagnosed, persistent, chronic ITP and healthy controls respectively. Serum IL-4 was significantly higher in patients who achieved remission than those who did not improve on first line therapy. CONCLUSION Serum IL-4 and IL-6 may have a role in the pathogenesis of primary ITP. IL-4 seems to be a good predictor to treatment response. WHAT IS KNOWN • There is a delicate balance of specific cytokine levels in immune thrombocytopenia, which has an important role in the immune system and is known to be deregulated in autoimmune diseases. changes in IL-4 and IL-6 might be involved in the pathogenesis of newly diagnosed ITP in both paediatric and adult patients. • We conducted this research study to measure the serum level of IL-4 and IL-6, in newly diagnosed, persistent and chronic ITP patients and study their relation to disease pathogenesis as well as patient's outcome. WHAT IS NEW • We found that IL4 seems to be a good predictor to treatment response and it was a very interesting observation in our study, and to the best of our knowledge, there is no published data about this finding.
Collapse
Affiliation(s)
- Marwa Zakaria
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
| | - Mohamed Beshir
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Tamer Hassan
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Asmaa Esh
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Eman Abdelaziz
- Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ridha Tayib
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - Alaa Nafea
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt
| |
Collapse
|
3
|
Kargar M, Torabizadeh M, Purrahman D, Zayeri ZD, Saki N. Regulatory factors involved in Th17/Treg cell balance of immune thrombocytopenia. Curr Res Transl Med 2023; 71:103389. [PMID: 37062251 DOI: 10.1016/j.retram.2023.103389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/10/2023] [Accepted: 04/04/2023] [Indexed: 04/08/2023]
Abstract
Immune thrombocytopenia is a common heterogeneous autoimmune disease that is characterized by decreasing peripheral blood platelet counts and increasing risk of bleeding. Studies have shown that an imbalance between T helper 17 (Th17) and Regulatory T (Treg) cells differentiated from CD4+T-cells is a key factor influencing the development and pathogenesis of immune thrombocytopenia. Th17 cells promote the development of chronic inflammatory disorders and induce autoimmune diseases, whereas Treg cells regulate immune homeostasis and prevent autoimmune diseases. Several regulators affecting the production and maintenance of these cells are also essential for proper regulation of Th17/Treg balance; these regulatory factors include cell surface proteins, miRNAs, and cytokine signaling. In this review, we focus on the function and role of balance between Th17 and Treg cells in immune thrombocytopenia, the regulatory factors, and therapeutic goals of this balance in immune thrombocytopenia.
Collapse
Affiliation(s)
- Masoud Kargar
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mehdi Torabizadeh
- Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Daryush Purrahman
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zeinab Deris Zayeri
- Golestan Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmaldin Saki
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| |
Collapse
|
4
|
Provan D, Semple JW. Recent advances in the mechanisms and treatment of immune thrombocytopenia. EBioMedicine 2022; 76:103820. [PMID: 35074629 PMCID: PMC8792416 DOI: 10.1016/j.ebiom.2022.103820] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/30/2021] [Accepted: 01/07/2022] [Indexed: 01/09/2023] Open
Abstract
Primary immune thrombocytopenia is an autoimmune disease associated with a reduced peripheral blood platelet count. The phenotype is variable with some patients suffering no bleeding whilst others have severe bleeding which may be fatal. Variability in clinical behaviour and treatment responses reflects its complex underlying pathophysiology. Historically the management has relied heavily on immune suppression. Recent studies have shown that the older empirical immune suppressants fail to alter the natural history of the disease and are associated with a poor quality of life for patients. Newer treatments, such as the thrombopoietin receptor agonists, have transformed ITP care. They have high efficacy, are well tolerated and improve patients’ quality of life. A greater understanding of the underlying pathophysiology of this disorder has helped develop a number of new targeted therapies. These include inhibitors of the neonatal Fc receptor inhibitors, Bruton tyrosine kinase and complement pathway. Here we discuss the mechanisms underlying ITP and the new approach to ITP care.
Collapse
Affiliation(s)
- Drew Provan
- Centre for Immunology, Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London UK.
| | - John W Semple
- Division of Hematology and Transfusion Medicine, Lund University, Lund, Sweden; Clinical Immunology and Transfusion Medicine, Office of Medical Services, Region Skåne, Lund, Sweden; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
5
|
Lin X, Xu A, Zhou L, Zhao N, Zhang X, Xu J, Feng S, Zheng C. Imbalance of T Lymphocyte Subsets in Adult Immune Thrombocytopenia. Int J Gen Med 2021; 14:937-947. [PMID: 33776472 PMCID: PMC7989055 DOI: 10.2147/ijgm.s298888] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/08/2021] [Indexed: 12/26/2022] Open
Abstract
Background Primary immune thrombocytopenia (ITP) is defined as an acquired autoimmune disease characterized by isolated thrombocytopenia. This work is to further clarify the relationship between T cell immune dysfunction and the pathogenesis of ITP. Methods 37 adult patients with ITP were selected and were classified into newly diagnosed ITP (nITP, n = 13), persistent ITP (pITP, n = 6) and chronic ITP (cITP n = 18). The frequency of cytotoxic T lymphocytes (Tc1, Tc2, and Tc17) and helper T cells (Th1, Th2, and Th17), Tregs, and the expression of chemokine receptors and PD-1 on CD4+ T cells were investigated by flow cytometry. Plasma levels of T cell-related cytokines (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, IL-17) were measured by cytometric beads array (CBA). Results The percentage of Tc1 in cITP was greatly higher than nITP and healthy controls (p < 0.05, p < 0.01). The percentage of Treg in nITP and cITP groups was remarkably lower than those in healthy control group (p < 0.05, p < 0.001); and according to platelet count analysis (PLT<50x109/L or PLT>50x109/L), Treg cells in ITP group were significantly lower than those in healthy control group (p < 0.001, p < 0.05). The percentage of CD4+CXCR3+ of cITP was significantly higher than healthy controls and nITP (p < 0.01, p < 0.05). The percentage of CD4+CCR6+ in cITP was significantly higher than healthy controls and nITP (p < 0.001, p < 0.05). The expression of PD-1 in cITP patients was higher than healthy control (p < 0.05), but there was no significant difference among nITP, pITP and cITP (p = 0.25). The levels of IL-2, IFN-γ and TNFα in nITP group and cITP group were significantly higher than those in healthy control group (p < 0.01, p < 0.05; p < 0.01, p < 0.05; p < 0.05, p < 0.05), and the level of IL-10 in nITP group was significantly higher than that in pITP group (p < 0.05). Conclusion Our results suggest that T lymphocyte immune dysfunction does exist in adult ITP patients and plays an important role in the pathogenesis of ITP.
Collapse
Affiliation(s)
- Xiuxiu Lin
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Anhui Xu
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Li Zhou
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Na Zhao
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| | - Xinhui Zhang
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, People's Republic of China
| | - Jin Xu
- Wannan Medical College, Wuhu, People's Republic of China
| | - Shanglong Feng
- Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, People's Republic of China
| | - Changcheng Zheng
- Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China
| |
Collapse
|
6
|
Kurabekova R, Tsirulnikova O, Pashkova I, Gichkun O, Mozheyko N, Gautier S, Shevchenko O. Transforming growth factor beta 1 levels in the blood of pediatric liver recipients: Clinical and biochemical correlations. Pediatr Transplant 2020; 24:e13693. [PMID: 32196884 DOI: 10.1111/petr.13693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 11/18/2019] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
Abstract
TGF-β1 is a cytokine with profibrogenic and immunosuppressive activities, which suggest the clinical significance of TGF-β1 for the assessment of graft function after LT. We analyzed the dynamics of TGF-β1 levels in the blood after LDLT in 135 pediatric liver recipients and examined the relationship between the cytokine levels and the laboratory and clinical variables. We found that TGF-β1 levels in the blood of patients with ESLD were lower than that in healthy children of the same age, P = .001. Moreover, blood levels of TGF-β1 were associated with liver disease etiology (r = .23) and hepatic fibrosis severity (r = .33). Before LDLT, TGF-β1 levels were significantly higher in children with good outcomes than in recipients who developed graft dysfunction early in the post-transplant period, P = .047. One month after LDLT, TGF-β1 levels in blood plasma increased in pediatric recipients, P = .002. Cytokine levels were significantly correlated with gender (r = .21) and HLA (r = -.24) mismatches, as well as with TAC dosage (r = -.32) later in the post-transplant period. One year after LDLT, TGF-β1 plasma levels were higher (P = .01) than those before LDLT and did not correlate with most of the investigated biochemical and clinical variables. Conclusion: Blood levels of TGF-β1 are associated with hepatic fibrosis severity, graft dysfunction development, and TAC dosage and can be regarded as a potential prognostic biomarker for the assessment of graft function and the optimization of immunosuppressant dosage in pediatric recipients after LDLT.
Collapse
Affiliation(s)
- Rivada Kurabekova
- V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Olga Tsirulnikova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Irina Pashkova
- V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Olga Gichkun
- V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Natalia Mozheyko
- V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Sergey Gautier
- V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Olga Shevchenko
- V.I. Shumakov National Medical Research Center of Transplantology and Artificial Organs of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| |
Collapse
|
7
|
CD4 + T cell phenotypes in the pathogenesis of immune thrombocytopenia. Cell Immunol 2020; 351:104096. [PMID: 32199587 DOI: 10.1016/j.cellimm.2020.104096] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/03/2020] [Accepted: 03/12/2020] [Indexed: 12/14/2022]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by low platelet counts due to enhanced platelet clearance and compromised production. Traditionally, ITP was regarded a B cell mediated disorder as anti-platelet antibodies are detected in most patients. The very nature of self-antigens, evident processes of isotype switching and the affinity maturation of anti-platelet antibodies indicate that B cells in order to mount anti-platelet immune response require assistance of auto-reactive CD4+ T cells. For a long time, ITP pathogenesis has been exclusively reviewed through the prism of the disturbed balance between Th1 and Th2 subsets of CD4+ T cells, however, more recently new subsets of these cells have been described including Th17, Th9, Th22, T follicular helper and regulatory T cells. In this paper, we review the current understanding of the role and immunological mechanisms by which CD4+ T cells contribute to the pathogenesis of ITP.
Collapse
|
8
|
Ghanavat M, Ebrahimi M, Rafieemehr H, Maniati M, Behzad MM, Shahrabi S. Thrombocytopenia in solid tumors: Prognostic significance. Oncol Rev 2019; 13:413. [PMID: 31205603 PMCID: PMC6542370 DOI: 10.4081/oncol.2019.413] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/18/2019] [Indexed: 01/01/2023] Open
Abstract
Solid tumors are a heterogeneous group of malignancies that result from out-of-control proliferation of cells. Thrombocytopenia is a common complication among patients with solid tumors that predispose them to bleeding disorders. The aim of this review article is to investigate the underlying mechanisms of the risk and incidence of thrombocytopenia in solid tumors. It can be argued that thrombocytopenia is a poor prognostic factor in solid tumors that can result from several factors such as polymorphism and mutation in some transcription factors and cytokines involved in megakaryocytic maturation or from the adverse effects of treatment. Therefore, an understanding of the exact mechanism of thrombocytopenia pathogenesis in each stage of solid tumors can help in developing therapeutic strategies to decrease bleeding complications in these malignancies.
Collapse
Affiliation(s)
- Majid Ghanavat
- Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan
| | - Mina Ebrahimi
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
| | - Hassan Rafieemehr
- Department of Medical Laboratory Sciences, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan
| | - Mahmood Maniati
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
| | - Masumeh Maleki Behzad
- Thalassemia and Hemoglobinopathy Research Center, Research Institute of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz
| | - Saeid Shahrabi
- Department of Biochemistry and Hematology, Faculty of Medicine, Semnan University Of Medical Sciences, Semnan, Iran
| |
Collapse
|
9
|
Hao Y, Li H, Li Y, Lyu M, Zhang D, Fu R, Guan Y, Wang S, Sun B, Dou X, Yang R. Decreased TLR4 expression on monocytes may cause regulatory T cells abnormality in patients with primary immune thrombocytopenia. Autoimmunity 2017; 50:283-292. [PMID: 28412855 DOI: 10.1080/08916934.2017.1309034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Yating Hao
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| | - Huiyuan Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| | - Yang Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| | - Mingen Lyu
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| | - Donglei Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| | - Rongfeng Fu
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| | - Yue Guan
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| | - Shixuan Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| | - Boyang Sun
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| | - Xueqing Dou
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, PR China
| |
Collapse
|
10
|
Ye QD, Jiang H, Liao XL, Chen K, Li SS. Identification and Validation of Gene Expression Pattern and Signature in Patients with Immune Thrombocytopenia. SLAS DISCOVERY 2016; 22:187-195. [DOI: 10.1177/1087057116664029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In the present study, we sought to define genes associated with immune thrombocytopenia (ITP). Microarray analysis revealed that of 1002 genes associated with ITP, 309 genes had downregulated expression and 693 genes had upregulated expression in patients with ITP. Gene set enrichment analysis revealed that 11 pathways were positively correlated to ITP, such as type I diabetes mellitus, intestinal immune network for IgA production, and oxidative phosphorylation. The messenger RNA expression levels of the indicated genes, including HLA-DRB5, IGHV3-66, IFI27, FAM212A, PLD5, tumor necrosis factor (TNF)–α, interferon-γ, interleukin (IL)–1β, and IL-4, were significantly increased in patients with ITP compared with healthy humans, while MMP8, SLC1A3, CRISP3, THBS1, FMN1, and IL-10 were decreased. In conclusion, the gene expression profile of patients with ITP has established a foundation to study the gene mechanism of ITP progression.
Collapse
Affiliation(s)
- Qi-dong Ye
- Department of Hematology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Jiang
- Department of Hematology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xue-lian Liao
- Department of Hematology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Kai Chen
- Department of Hematology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shan-shan Li
- Department of Hematology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
11
|
Nomura S. Advances in Diagnosis and Treatments for Immune Thrombocytopenia. Clin Med Insights Blood Disord 2016; 9:15-22. [PMID: 27441004 PMCID: PMC4948655 DOI: 10.4137/cmbd.s39643] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/22/2016] [Accepted: 05/24/2016] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia (ITP) is an acquired hemorrhagic condition characterized by the accelerated clearance of platelets caused by antiplatelet autoantibodies. A platelet count in peripheral blood <100 × 109/L is the most important criterion for the diagnosis of ITP. However, the platelet count is not the sole diagnostic criterion, and the diagnosis of ITP is dependent on additional findings. ITP can be classified into three types, namely, acute, subchronic, and persistent, based on disease duration. Conventional therapy includes corticosteroids, intravenous immunoglobulin, splenectomy, and watch-and-wait. Second-line treatments for ITP include immunosuppressive therapy [eg, anti-CD20 (rituximab)], with international guidelines, including rituximab as a second-line option. The most recently licensed drugs for ITP are the thrombopoietin receptor agonists (TRAs), such as romiplostim and eltrombopag. TRAs are associated with increased platelet counts and reductions in the number of bleeding events. TRAs are usually considered safe, effective treatments for patients with chronic ITP at risk of bleeding after failure of first-line therapies. Due to the high costs of TRAs, however, it is unclear if patients prefer these agents. In addition, some new agents are under development now. This manuscript summarizes the pathophysiology, diagnosis, and treatment of ITP. The goal of all treatment strategies for ITP is to achieve a platelet count that is associated with adequate hemostasis, rather than a normal platelet count. The decision to treat should be based on the bleeding severity, bleeding risk, activity level, likely side effects of treatment, and patient preferences.
Collapse
Affiliation(s)
- Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| |
Collapse
|
12
|
Jernås M, Strömberg Célind F, Nookaew I, Mellgren K, Wadenvik H, Olsson B. Normalised immune expression in remission of paediatric ITP. Thromb Haemost 2016; 115:1229-30. [PMID: 26843317 DOI: 10.1160/th15-12-0976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/25/2016] [Indexed: 01/19/2023]
Affiliation(s)
| | | | | | | | | | - Bob Olsson
- Bob Olsson, PhD, Department of Psychiatry and Neurochemistry, University of Gothenburg, V-house, Sahlgrenska University Hospital, SE-431 80 Mölndal, Sweden, E-mail:
| |
Collapse
|
13
|
Abstract
Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder resulting from low platelet counts caused by inadequate production as well as increased destruction by autoimmune mechanisms. As with other autoimmune disorders, chronic ITP is characterized by perturbations of immune homeostasis with hyperactivated effector cells as well as defective regulatory arm of the adaptive immune system, which will be reviewed here. Interestingly, some ITP treatments are associated with restoring the regulatory imbalance, although it remains unclear whether the immune system is redirected to a state of tolerance once treatment is discontinued. Understanding the mechanisms that result in breakdown of immune homeostasis in ITP will help to identify novel pathways for restoring tolerance and inhibiting effector cell responses. This information can then be translated into developing therapies for averting autoimmunity not only in ITP but also many autoimmune disorders.
Collapse
|
14
|
Interleukin-17-producing CD4+ T lymphocytes are increased in patients with primary immune thrombocytopenia. Blood Coagul Fibrinolysis 2016; 27:301-7. [DOI: 10.1097/mbc.0000000000000423] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Consolini R, Legitimo A, Caparello MC. The Centenary of Immune Thrombocytopenia - Part 1: Revising Nomenclature and Pathogenesis. Front Pediatr 2016; 4:102. [PMID: 27807534 PMCID: PMC5069646 DOI: 10.3389/fped.2016.00102] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/07/2016] [Indexed: 12/24/2022] Open
Abstract
The natural history of the immune thrombocytopenia (ITP) is interesting and intriguing because it traces different steps underlying autoimmune diseases. The review points out the main steps that have accompanied the stages of its history and the consequential changes related to its terminology. ITP is an autoimmune disease resulting from platelet antibody-mediated destruction and impaired megakaryocyte and platelet production. However, research advances highlight that a complex dysregulation of the immune system is involved in the pathogenesis of this condition. The review examines the role of the multiple immune components involved in the autoimmunity process, focusing on the more recent mechanisms, which could be new promising therapeutic targets for ITP patients.
Collapse
Affiliation(s)
- Rita Consolini
- Laboratory of Immunology, Department of Clinical and Experimental Medicine, Division of Pediatrics, University of Pisa , Pisa , Italy
| | - Annalisa Legitimo
- Laboratory of Immunology, Department of Clinical and Experimental Medicine, Division of Pediatrics, University of Pisa , Pisa , Italy
| | - Maria Costanza Caparello
- Laboratory of Immunology, Department of Clinical and Experimental Medicine, Division of Pediatrics, University of Pisa , Pisa , Italy
| |
Collapse
|
16
|
Nomura S. Chronic immune thrombocytopenia and semaphorin 5A. Thromb Res 2015; 136:843-4. [PMID: 26381436 DOI: 10.1016/j.thromres.2015.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka 573-1191, Japan.
| |
Collapse
|
17
|
Jernås M, Hou Y, Strömberg Célind F, Shao L, Wang Q, Ju X, Mellgren K, Wadenvik H, Hou M, Olsson B. Altered cytokine levels in pediatric ITP. Platelets 2015; 26:589-92. [PMID: 25806433 DOI: 10.3109/09537104.2014.974526] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease where platelets are destroyed prematurely. In the majority of children, the disease resolves, but in some, it becomes chronic. Cytokines are important mediators of the immune response and are known to be dysregulated in autoimmune diseases. Therefore, our aim was to investigate differences in plasma levels of cytokines between children with ITP and healthy controls. We had two cohorts of children: one Swedish with 18 children with ITP and seven healthy children and a second Chinese one with 58 children with ITP and 30 healthy children. Plasma levels of chemokine (C-X3-C motif) ligand 1 (CX3CL1), transforming growth factor β1 (TGF-β1), and interleukin 22 (IL-22) were analyzed in both cohorts using enzyme-linked immunosorbent assays (ELISAs). We found lower plasma levels of TGF-β1 and elevated levels of CX3CL1 and IL-22 in children with ITP compared with controls in both the Swedish and the Chinese cohort. In conclusion, all three cytokines differ between pediatric ITP and healthy controls and may, therefore, be potential biomarkers for the disease.
Collapse
Affiliation(s)
- Margareta Jernås
- Department of Internal Medicine, University of Gothenburg , Gothenburg , Sweden
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Ye X, Zhang L, Wang H, Chen Y, Zhang W, Zhu R, Fang C, Deng A, Qian B. The role of IL-23/Th17 pathway in patients with primary immune thrombocytopenia. PLoS One 2015; 10:e0117704. [PMID: 25621490 PMCID: PMC4306550 DOI: 10.1371/journal.pone.0117704] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/30/2014] [Indexed: 02/07/2023] Open
Abstract
Background Primary immune thrombocytopenia (ITP) is an autoimmune bleeding disorder with an unclear etiology. This study aims to investigate the role of IL-23/Th17 pathway in patients with ITP. Method The gene expressions of IL-17, IL-23 and their receptors in ITP patients and healthy controls were analyzed by quantitative real-time PCR. ELISA was used to test the IL-17 and IL-23 levels in plasma. Flow cytometry was used to detect the frequency of Th17 cells. The correlation between plasma IL-23 and IL-17 levels, Th17 cells, platelets were analyzed. The level of Th17-related cytokines was measured by ELISA following stimulation with IL-23. Subsequently, the IL-23 and IL-17 levels were measured in patients post-treatment. Results The PBMCs of ITP patients showed increased mRNA expression levels in each of the following: IL-23p19, IL-12p40, IL-23R, IL-12Rβ1, IL-17A, IL-17F, and RORC. In addition, elevated Th17 cells and plasma IL-17, IL-23 levels were also observed in these ITP patients. Furthermore, it was found that IL-23 levels in plasma are positively correlated with IL-17 levels and Th17 cells, yet negatively correlated with platelet count. Following IL-23 stimulation in vitro, IL-17 levels showed significant elevation. Furthermore, both IL-23 and IL-17 levels decreased after effective treatment. Conclusion The IL-23/Th17 pathway may be involved in the pathogenesis of ITP through enhancement of the Th17 response. Moreover, our results suggest that the IL-23/Th17 pathway is a potential therapeutic target in future attempts of ITP treatment.
Collapse
Affiliation(s)
- Xin Ye
- Department of Transfusion Medicine, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Lei Zhang
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Hui Wang
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Yan Chen
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Weiwei Zhang
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Rongrong Zhu
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Chaoping Fang
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Anmei Deng
- Department of Laboratory Diagnosis, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
- * E-mail: (AMD); (BHQ)
| | - Baohua Qian
- Department of Transfusion Medicine, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
- * E-mail: (AMD); (BHQ)
| |
Collapse
|
19
|
Li Q, Yang M, Xia R, Xia L, Zhang L. Elevated expression of IL-12 and IL-23 in patients with primary immune thrombocytopenia. Platelets 2014; 26:453-8. [PMID: 25025295 DOI: 10.3109/09537104.2014.934217] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Immune thrombocytopenia (ITP) is an acquired autoimmune disorder. Both impaired platelet production and T-cell-mediated effects play a role in ITP. A T-helper1 (Th1) polarization of the immune response and up-regulation of Th17 cells have been demonstrated in ITP patients. Interleukin (IL)-12 and IL-23 produced by antigen presenting cells are essential for inducing and sustaining Th1 and Th17 effector cells via different pathways. However, less is known with regard to the levels of expression and synthesis of these two cytokines in patients with ITP. This was determined in this study in 46 patients with ITP as well as in 22 healthy controls. Our results showed that an increased expression of IL-12 p40, IL-12 p35, and IL-23 p19 mRNA was observed in bone marrow mononuclear cells and peripheral blood mononuclear cells of patients with ITP compared with controls. Consequently, higher levels of IL-12 and IL-23 were also found in bone marrow plasma and peripheral blood plasma in patients with ITP than in controls. Afterwards, a markedly higher level of IL-12 and IL-23 in bone marrow plasma or peripheral blood plasma was found in patients with chronic ITP than in patients with acute ITP. Furthermore, the peripheral blood plasma levels of IL-12 and IL-23 were negative correlated with platelet counts in ITP patients. Therefore, the augmented expression of IL-12 and IL-23 in patients with ITP may play an important role in the pathogenesis of this disease.
Collapse
Affiliation(s)
- Qingsheng Li
- Department of Hematology, The First Affiliated Hospital, Anhui Medical University , Hefei , PR China and
| | | | | | | | | |
Collapse
|
20
|
Abstract
Immune thrombocytopenia (ITP) is a bleeding disorder characterized by low platelet counts due to decreased platelet production as well as increased platelet destruction by autoimmune mechanisms. A shift toward Th1 and possibly Th17 cells together with impaired regulatory compartment, including T-regulatory (Tregs) and B-regulatory (Bregs) cells, have been reported, suggesting a generalized immune dysregulation in ITP. Interestingly, several treatments including the use of thrombopoietic agents appear to be associated with improvement in the regulatory compartment. Understanding how Th1/Th17/Treg differentiation and expansion are controlled is central to uncovering how autoimmunity may be sustained in chronic ITP and reversed following response to therapy. In this review, we will summarize the recent findings on the state of the Breg and Treg compartments in ITP, the role of monocyte subsets in the control of Th/Treg expansion, and our working model of how the regulatory compartment may impact response to treatment and the means by which this information may guide therapy in ITP patients in the future.
Collapse
Affiliation(s)
- Karina Yazdanbakhsh
- Laboratory of Complement Biology, New York Blood Center, New York, NY 10065, USA.
| | | | | |
Collapse
|
21
|
Sehgal K, Guo X, Koduru S, Shah A, Lin A, Yan X, Dhodapkar KM. Plasmacytoid dendritic cells, interferon signaling, and FcγR contribute to pathogenesis and therapeutic response in childhood immune thrombocytopenia. Sci Transl Med 2014; 5:193ra89. [PMID: 23843450 DOI: 10.1126/scitranslmed.3006277] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disorder of childhood characterized by immune-mediated destruction of platelets. The mechanisms underlying the pathogenesis of ITP and the therapeutic efficacy of intravenous immunoglobulins (IVIG) in this disorder remain unclear. We show that monocytes from patients with ITP have a distinct gene expression profile, with increased expression of type I interferon response (IR) genes. Plasma from ITP patients had increased levels of several cytokines indicative of immune activation, including an increase in interferon-α. ITP patients also had an increase in plasmacytoid dendritic cells (pDCs) compared to healthy donors. Therapy-induced remission of ITP was associated with abrogation of the IR gene signature in monocytes without reduction in the levels of circulating interferon-α itself. IVIG altered the ratio of activating/inhibitory Fcγ receptors (FcγRs) in vivo primarily by reducing FcγRIII (CD16). The engagement of activating FcγRs was required for IVIG-mediated abrogation of monocyte response to exogenous interferon-α in culture. Moreover, plasma from ITP patients led to activation of monocytes and myeloid DCs in culture with an increase in T cell stimulatory capacity; this activation depended on the engagement of activating FcγRs and interferon-α receptor (IFNAR) and was inhibited by antibody-mediated blockade of these pathways. These data point to a central role of type I interferon in the pathogenesis of ITP and suggest targeting pDCs and blockade of IR as potential therapeutic approaches in this disorder. They also provide evidence for the capacity of IVIG to extinguish IR in vivo, which may contribute to its effects in autoimmunity.
Collapse
Affiliation(s)
- Kartik Sehgal
- Yale Cancer Center, Yale University, New Haven, CT 06519, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Zhao H, Li H, Du W, Zhang D, Ge J, Xue F, Zhou Z, Yang R. ReducedMIR130Ais involved in primary immune thrombocytopenia via targetingTGFB1andIL18. Br J Haematol 2014; 166:767-73. [PMID: 24801815 DOI: 10.1111/bjh.12934] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/01/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Haifeng Zhao
- State Key Laboratory of Experimental Haematology; Institute of Haematology & Blood Diseases Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin China
- Department of Haematology and Oncology; Key Laboratory of Cancer Prevention and Therapy; Tianjin Medical University Cancer Institute and Hospital; Tianjin China
| | - Huiyuan Li
- State Key Laboratory of Experimental Haematology; Institute of Haematology & Blood Diseases Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin China
| | - Weiting Du
- State Key Laboratory of Experimental Haematology; Institute of Haematology & Blood Diseases Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin China
- Department of Immunology, Diabetes and Metabolic Disease Research; The Beckman Research Institute of the City of Hope; Duarte CA USA
| | - Donglei Zhang
- State Key Laboratory of Experimental Haematology; Institute of Haematology & Blood Diseases Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin China
| | - Jing Ge
- State Key Laboratory of Experimental Haematology; Institute of Haematology & Blood Diseases Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin China
| | - Feng Xue
- State Key Laboratory of Experimental Haematology; Institute of Haematology & Blood Diseases Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin China
| | - Zeping Zhou
- State Key Laboratory of Experimental Haematology; Institute of Haematology & Blood Diseases Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin China
- Department of Haematology; The Second Affiliated Hospital of Kunming Medical University; Kunming China
| | - Renchi Yang
- State Key Laboratory of Experimental Haematology; Institute of Haematology & Blood Diseases Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; Tianjin China
| |
Collapse
|
23
|
Talaat RM, Elmaghraby AM, Barakat SS, EL-Shahat M. Alterations in immune cell subsets and their cytokine secretion profile in childhood idiopathic thrombocytopenic purpura (ITP). Clin Exp Immunol 2014; 176:291-300. [PMID: 24460857 PMCID: PMC3992042 DOI: 10.1111/cei.12279] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 12/22/2022] Open
Abstract
Immune thrombocytopenic purpura (ITP) is acquired autoimmune disease in children characterized by the breakdown of immune tolerance. This work is designed to explore the contribution of different lymphocyte subsets in acute and chronic ITP children. Imbalance in the T helper type 1 (Th1)/Th2 cytokine secretion profile was investigated. The frequency of T (CD3(+), CD4(+), CD8(+)) and B (CD19(+)) lymphocytes, natural killer (NK) (CD16(+) 56(+)) and regulatory T (T(reg)) [CD4(+) CD25(+high) forkhead box protein 3 (FoxP3)(+) ] cells was investigated by flow cytometry in 35 ITP children (15 acute and 20 chronic) and 10 healthy controls. Plasma levels of Th1 cytokines [interferon (IFN-γ) and tumour necrosis factor (TNF-α)] and Th2 [interleukin (IL)-4, IL-6 and IL-10)] cytokines were measured using enzyme-linked immunosorbent assay (ELISA). The percentage of Treg (P < 0·001) and natural killer (NK) (P < 0·001) cells were significantly decreased in ITP patients compared to healthy controls. A negative correlation was reported between the percentage of T(reg) cells and development of acute (r = -0·737; P < 0·01) and chronic (r = -0·515; P < 0·01) disease. All evaluated cytokines (IFN-γ, TNF-α, IL-4, IL-6 and IL-10) were elevated significantly in ITP patients (P < 0·001, P < 0·05, P < 0·05, P < 0·05 and P < 0·001, respectively) compared to controls. In conclusion, our data shed some light on the fundamental role of immune cells and their related cytokines in ITP patients. The loss of tolerance in ITP may contribute to the dysfunction of T(regs). Understanding the role of T cell subsets will permit a better control of autoimmunity through manipulation of their cytokine network.
Collapse
Affiliation(s)
- R M Talaat
- Molecular Biology Department, Genetic Engineering and Biotechnology Research Institute (GEBRI), University of Sadat CitySadat City, Egypt
| | - A M Elmaghraby
- Molecular Biology Department, Genetic Engineering and Biotechnology Research Institute (GEBRI), University of Sadat CitySadat City, Egypt
| | - S S Barakat
- Pediatrics Department, Faculty of Medicine, Alexandria UniversityAlexandria, Egypt
| | - M EL-Shahat
- Molecular Biology Department, Genetic Engineering and Biotechnology Research Institute (GEBRI), University of Sadat CitySadat City, Egypt
| |
Collapse
|
24
|
Cines DB, Cuker A, Semple JW. Pathogenesis of immune thrombocytopenia. Presse Med 2014; 43:e49-59. [DOI: 10.1016/j.lpm.2014.01.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/29/2014] [Indexed: 12/30/2022] Open
|
25
|
Involvement of levels of Toll like receptor-4 in monocytes, CD4+ T-lymphocyte subsets, and cytokines in patients with immune thrombocytopenic purpura. Thromb Res 2013; 132:196-201. [PMID: 23830211 DOI: 10.1016/j.thromres.2013.04.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 03/25/2013] [Accepted: 04/30/2013] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Toll-like receptors have been found to be associated with immune-mediated diseases but it is still not clear whether they play a role in immune thrombocytopenic purpura (ITP), especially TLR4. CD4+ T-lymphocyte abnormalities, including Th17, Th1, Th2, and regulator T cell (Treg), are considered important in ITP. There have been few studies regarding the expression of TLR4 and the relationships between TLR4 and Th17 levels in ITP. MATERIALS AND METHODS In this study, we evaluated the expression of TLR4 in monocytes, the plasma concentrations of IL-23, IL-17 and the profiles of Th17, Th1, Th2 cells in 70 patients with ITP and 31 healthy controls. In addition, we evaluated IL-2 and Treg cells in 46 cases of 70 patients with ITP and the same 31 controls. RESULTS Higher levels of TLR4 expression, higher relative numbers of Th17 and Th1 cells and lower levels of Treg cells were observed in patients when compared with controls (p=0.001 for TLR4; p<0.001 for Th17; p=0.014 for Th1; p=0.001 for Treg). The levels of IL-23 and IL-2 were increased (p=0.022 for IL-23; p=0.025 for IL-2), the relative levels of Th2 and concentrations of IL-17 were similar across both groups (p=0.446 for Th2; p=0.316 for IL-17). A significant negative correlation was observed between levels of TLR4 and Treg(r=-0.544, p<0.001), but a significantly positive correlation was observed between IL-2 and IL-23 concentration in patients (r=0.441, p=0.004). Neither the correlation between TLR4 and the other CD4(+) T cells and cytokines nor the correlation between the three cytokines and CD4+ T cells was found to be statistically significant. CONCLUSIONS Our data showed that TLR4, CD4+ T cells (Th1, Th17 and Treg cells) and related cytokines (IL-23, IL-2) may take part in the pathogenesis of ITP. TLR4 may play a role through the TLR4-cytokine-CD4+ T lymphocyte cell pathway.
Collapse
|
26
|
Zhang A, Fu J, Ning B, Li D, Sun N, Wei W, Wei J, Ju X. Tolerogenic dendritic cells generated with IL-10/TGFβ1 relieve immune thrombocytopenia in mice. Thromb Res 2013; 132:63-8. [DOI: 10.1016/j.thromres.2013.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/02/2013] [Accepted: 04/01/2013] [Indexed: 01/22/2023]
|
27
|
|
28
|
Abstract
Immune thrombocytopenia (ITP) results from decreased platelet production and accelerated platelet destruction. Impaired CD4(+) regulatory T-cell (Treg) compartment and skewed Th1 and possibly Th17 responses have been described in ITP patients. The trigger for aberrant T-cell polarization remains unknown. Because monocytes have a critical role in development and polarization of T-cell subsets, we explored the contribution of monocyte subsets in control of Treg and Th development in patients with ITP. Unlike circulating classic CD14(hi)CD16(-) subpopulation, the CD16(+) monocyte subset was expanded in ITP patients with low platelet counts on thrombopoietic agents and positively correlated with T-cell CD4(+)IFN-γ(+) levels, but negatively with circulating CD4(+)CD25(hi)Foxp3(+) and IL-17(+) Th cells. Using a coculture model, we found that CD16(+) ITP monocytes promoted the expansion of IFN-γ(+)CD4(+) cells and concomitantly inhibited the proliferation of Tregs and IL-17(+) Th cells. Th-1-polarizing cytokine IL-12, secreted after direct contact of patient T-cell and CD16(+) monocytes, was responsible for the inhibitory effect on Treg and IL-17(+)CD4(+) cell proliferation. Our findings are consistent with ITP CD16(+) monocytes promoting Th1 development, which in turn negatively regulates IL-17 and Treg induction. This underscores the critical role of CD16(+) monocytes in the generation of potentially pathogenic Th responses in ITP.
Collapse
|
29
|
Trkova M, Becvarova V, Hynek M, Hnykova L, Hlavova E, Kreckova G, Kulovany E, Cutka D, Zatloukalova J, Markova K, Sukova M, Horacek J, Stejskal D. SNP array and phenotype correlation shows that FLI1 deletion per se is not responsible for thrombocytopenia development in Jacobsen syndrome. Am J Med Genet A 2012; 158A:2545-50. [PMID: 22887642 DOI: 10.1002/ajmg.a.35537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/30/2012] [Indexed: 11/07/2022]
Abstract
Jacobsen syndrome (JBS) is a rare chromosomal disorder caused by terminal deletion of the long arm of chromosome 11. We report on four prenatally diagnosed patients with JBS with variable prenatal and postnatal phenotypes and 11q deletions of varying sizes. Precise characterization of the deleted region in three patients was performed by SNP arrays. The severity of both the prenatal and postnatal phenotypes did not correlate with the size of the haploinsufficient region. Despite the large difference in the deletion size (nearly 6 Mb), both of the live-born patients had similar phenotypes corresponding to JBS. However, one of the most prominent features of JBS, thrombocytopenia, was only present in the live-born boy. The girl, who had a significantly longer deletion spanning all four genes suspected of being causative of JBS-related thrombocytopenia (FLI1, ETS1, NFRKB, and JAM3), did not manifest a platelet phenotype. Therefore, our findings do not support the traditional view of deletion size correlation in JBS or the causative role of FLI1, ETS1, NFRKB, and JAM3 deletion per se for the development of disease-related thrombocytopenia.
Collapse
Affiliation(s)
- Marie Trkova
- Gennet, Centre for Fetal Medicine, Praha, Czech Republic.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Fujita S, Nakanishi T, Yoshimura H, Hotta M, Nakamichi N, Tamaki T, Ishii K, Ito T, Nomura S. TGFβ(1) and sCTLA-4 levels are increased in eltrombopag-exposed patients with ITP. Thromb Res 2012; 130:415-9. [PMID: 22789125 DOI: 10.1016/j.thromres.2012.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 05/27/2012] [Accepted: 06/04/2012] [Indexed: 10/28/2022]
Abstract
Some thrombopoietin receptor-agonists (TPR-As) have been developed and shown to be highly effective in the treatment of immune thrombocytopenic purpura (ITP). Soluble cytotoxic T-lymphocyte-associated antigen 4 (sCTLA-4) can modulate and terminate the immune response. Several reports have shown that sCTLA-4 levels are elevated in patients with some autoimmune disorders. However, sCTLA-4 levels have not previously been investigated in TPR-A exposed patients with ITP. We investigated the levels of transforming growth factor (TGF) β(1) and sCTLA-4 in ITP patients to determine the clinical association with TGFβ(1) and sCTLA-4 in TPR-A-exposed patients with ITP. Thirty-seven ITP patients were divided into 2 groups (TPR-A-exposed: 13 patients; unexposed: 24 patients). Doses of eltrombopag ranging from 12.5mg to 50mg were administered daily, and biochemical data obtained before and after eltrombopag administration were compared. Eltrombopag therapy significantly increased sCTLA-4 and TGFβ(1) levels relative to baseline in patients with ITP. In addition, plasma TGFβ(1) was positively correlated with platelet counts and sCTLA-4 in patients with ITP in the eltrombopag-exposed group. However, no significant change in the detection rate for anti-glycoprotein antibody was observed before and 24 weeks after eltrombopag treatment. These results suggest that eltrombopag can partially modulate some immune responses by TGFβ(1) and sCTLA-4, but it does not induce immune tolerance by 24 weeks after treatment.
Collapse
Affiliation(s)
- Shinya Fujita
- First Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Li RD, Han GX, Tao KX. Role of interaction between Th17 cells and commensal microbiota in the pathogenesis of inflammatory bowel disease. Shijie Huaren Xiaohua Zazhi 2011; 19:2907-2912. [DOI: 10.11569/wcjd.v19.i28.2907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is an autoimmune disease whose etiology and pathogenesis remain incompletely understood. Th17 cells can secrete cytokines interleukin-17A and interleukin-17F, which play an important role in the pathogenesis of IBD. Some studies have proved that reduction of IL-17A and IL-17F can attenuate intestinal mucosal inflammation. Additionally, many studies reveal that the occurrence of IBD is correlated with commensal microbiota. Commensal microbiota can alter the number of Th17 cells in intestinal mucosa and cause abnormal intestinal mucosal immune responses. Elucidation of relationship between Th17 cells and commensal microbiota in intestinal mucosa is important for understanding the pathogenesis of IBD.
Collapse
|