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Fengyong Z, Zhixiang F, Jiajia P, Qin L, Min Q, Guoliang W, Ziyan Z. Increased CD8+ T cells in patients with Henoch-Schonlein purpura nephritis exhibit suppressive immune activity. Immunol Lett 2022; 250:23-28. [PMID: 36174770 DOI: 10.1016/j.imlet.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/29/2019] [Accepted: 09/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND About 40% to 50% of children with Henoch-Schonlein purpura often suffer from nephritis, which can cause irreversible renal damage. Significantly increased peripheral T lymphocytes and reduced B lymphocytes have been widely reported as hallmarks of Henoch-Schonlein purpura nephritis (HSPN) differing from Henoch-Schonlein purpura without nephritis (HSP). While the role of peripheral immune cells, especially CD8+ T cells, in the development of nephritis of Henoch-Schonlein purpura is not clear. OBJECTIVES To explore the changes of peripheral CD8+ T cells and the association of CD8+ T cell markers with indicators of renal function in HSP and HSPN patients. PATIENTS AND METHODS A total of 27 HSP and 16 HSPN patients were included in this study. The serum urea, serum creatinine, 24-hour urinary protein and peripheral white blood cell counts were collected from hospital registry systems. The T cell surface markers (CD28, CD107a and CD69) and cytokine (TNFα and IFNγ) secretion capacity were measured by flow cytometry. RESULTS Compared with HSP patients, The number of CD8+ T cells in HSPN patients increased significantly (p=0.0003) and demonstrated with decreased CD69 expression (p<0.0001) and decreased cytokine secretion. The expression level of CD69 in CD3+, CD4+ and CD8+ T cells all significantly correlated negatively with serum creatinine and 24-hour urinary protein in HSP and HSPN children. CONCLUSIONS The inhibition of CD8+ T cell activity was significantly related to the decline of renal function in HSP and HSPN patients. It is possible to monitor renal function by detecting the expression of CD69 on CD8+ T cells in HSP and HSPN patients.
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Affiliation(s)
- Zhao Fengyong
- School of Life Science, East China Normal University, NO.500 Dongchuan Rd. Minhang, Shanghai, 200241, P.R. China; Shanghai Blood Center, NO.1191,Hongqiao Rd. Changnin, Shanghai, 200051, P.R. China
| | - Fu Zhixiang
- School of Life Science, East China Normal University, NO.500 Dongchuan Rd. Minhang, Shanghai, 200241, P.R. China
| | - Pan Jiajia
- School of Life Science, East China Normal University, NO.500 Dongchuan Rd. Minhang, Shanghai, 200241, P.R. China
| | - Li Qin
- Shanghai Blood Center, NO.1191,Hongqiao Rd. Changnin, Shanghai, 200051, P.R. China
| | - Qian Min
- School of Life Science, East China Normal University, NO.500 Dongchuan Rd. Minhang, Shanghai, 200241, P.R. China.
| | - Wang Guoliang
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, P.R. China.
| | - Zhu Ziyan
- Shanghai Blood Center, NO.1191,Hongqiao Rd. Changnin, Shanghai, 200051, P.R. China.
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Farisogullari B, Cuceoglu MK, Oral H, Yardimci GK, Bilginer Y, Ozen S, Karadag O. Biologics for immunoglobulin A vasculitis: targeting vasculitis or comorbid disease? Intern Emerg Med 2022; 17:1599-1608. [PMID: 35347546 DOI: 10.1007/s11739-022-02968-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/01/2022] [Indexed: 11/05/2022]
Abstract
In this study, we aimed to evaluate the clinical features and treatments, including the use of biological disease-modifying anti-rheumatic drugs (bDMARDs) in a large cohort of pediatric and adult immunoglobulin A vasculitis (IgAV). Since data on the use of bDMARDs in IgAV are very limited, we collated the reasons for use of bDMARDs during the disease course. Patients who were enrolled in the Hacettepe University Vasculitis Research Centre (HUVAC) registry were included. In this prospective database dating from 2014, there were 436 IgAV patients classified as IgAV according to Ankara 2008 and/or American College of Rheumatology 1990 criteria. 88 adults and 330 pediatric IgAV patients were included as the main study group. Concomitant spondyloarthritis (SpA) was observed only in adult patients (10% vs 0% in children, p < 0.001). IgAV relapse was more common in adults than in children (p: 0.017). Adult patients were mostly treated with corticosteroid (p < 0.001) and conventional synthetic disease-modifying anti-rheumatic drug treatment (< 0.001), while more than half of the pediatric patients were followed up without immunosuppressive treatment. Ten (11%) adult patients used biologics. Among them, two patients used rituximab due to IgAV disease activity, three used infliximab due to SpA, three used etanercept due to SpA (one patient had a pediatric onset enthesitis-related arthritis), and two used anakinra due to recurrent familial Mediterranean fever attacks. This is the first study evaluating the use of all bDMARDs for any reason in the IgAV cohorts in the literature. None of the pediatric patients used biologics. Our data suggest biologics are mainly used for comorbid inflammatory diseases over refractory vasculitis in adult IgAV.
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Affiliation(s)
- Bayram Farisogullari
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey
| | - Muserref Kasap Cuceoglu
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Hakan Oral
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gozde Kubra Yardimci
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey
| | - Yelda Bilginer
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Ankara, Turkey
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Hacettepe University Vasculitis Research Center, Sihhiye, 06100, Ankara, Turkey.
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Robert M, Miossec P, Hot A. The Th17 Pathway in Vascular Inflammation: Culprit or Consort? Front Immunol 2022; 13:888763. [PMID: 35479069 PMCID: PMC9035791 DOI: 10.3389/fimmu.2022.888763] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
The involvement of IL-17A in autoimmune and inflammatory diseases has prompted the development of therapeutic strategies to block the Th17 pathway. Promising results came from their use in psoriasis and in ankylosing spondylitis. IL-17A acts on various cell types and has both local and systemic effects. Considering the premature mortality observed during chronic inflammatory diseases, IL-17A action on vascular cells was studied. Both in vitro and in vivo results suggest that this cytokine favors inflammation, coagulation and thrombosis and promotes the occurrence of cardiovascular events. These observations led to study the role of IL-17A in diseases characterized by vascular inflammation, namely allograft rejection and vasculitis. Increased circulating levels of IL-17A and histological staining reveal that the Th17 pathway is involved in the pathogenesis of these diseases. Vasculitis treatment faces challenges while the use of steroids has many side effects. Regarding results obtained in giant cell arteritis with IL-6 inhibitors, a cytokine involved in Th17 differentiation, the use of anti-IL-17 is a promising strategy. However, lessons from rheumatoid arthritis and multiple sclerosis must be learnt before targeting IL-17 in vasculitis, which may be culprit, consort or both of them.
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Affiliation(s)
- Marie Robert
- Department of Clinical Immunology and Rheumatology, and Immunogenomics and Inflammation Research Unit, University of Lyon, Hôpital Edouard Herriot, Lyon, France
- Department of Internal Medicine, University of Lyon, Hôpital Edouard Herriot, Lyon, France
- *Correspondence: Marie Robert,
| | - Pierre Miossec
- Department of Clinical Immunology and Rheumatology, and Immunogenomics and Inflammation Research Unit, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Arnaud Hot
- Department of Internal Medicine, University of Lyon, Hôpital Edouard Herriot, Lyon, France
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Jin K, Parreau S, Warrington KJ, Koster MJ, Berry GJ, Goronzy JJ, Weyand CM. Regulatory T Cells in Autoimmune Vasculitis. Front Immunol 2022; 13:844300. [PMID: 35296082 PMCID: PMC8918523 DOI: 10.3389/fimmu.2022.844300] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 01/28/2022] [Indexed: 12/14/2022] Open
Abstract
Blood vessels are indispensable for host survival and are protected from inappropriate inflammation by immune privilege. This protection is lost in patients with autoimmune vasculitides, a heterogeneous group of diseases causing damage to arteries, arterioles, and capillaries. Vasculitis leads to vascular wall destruction and/or luminal occlusion, resulting in hemorrhage and tissue ischemia. Failure in the quantity and quality of immunosuppressive regulatory T cells (Treg) has been implicated in the breakdown of the vascular immune privilege. Emerging data suggest that Treg deficiencies are disease-specific, affecting distinct pathways in distinct vasculitides. Mechanistic studies have identified faulty CD8+ Tregs in Giant Cell Arteritis (GCA), a vasculitis of the aorta and the large aortic branch vessels. Specifically, aberrant signaling through the NOTCH4 receptor expressed on CD8+ Treg cells leads to rerouting of intracellular vesicle trafficking and failure in the release of immunosuppressive exosomes, ultimately boosting inflammatory attack to medium and large arteries. In Kawasaki’s disease, a medium vessel vasculitis targeting the coronary arteries, aberrant expression of miR-155 and dysregulated STAT5 signaling have been implicated in undermining CD4+ Treg function. Explorations of mechanisms leading to insufficient immunosuppression and uncontrolled vascular inflammation hold the promise to discover novel therapeutic interventions that could potentially restore the immune privilege of blood vessels and pave the way for urgently needed innovations in vasculitis management.
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Affiliation(s)
- Ke Jin
- Department of Medicine, Mayo College of Medicine and Science, Rochester, MN, United States
| | - Simon Parreau
- Department of Medicine, Mayo College of Medicine and Science, Rochester, MN, United States
| | - Kenneth J. Warrington
- Department of Medicine, Mayo College of Medicine and Science, Rochester, MN, United States
| | - Matthew J. Koster
- Department of Medicine, Mayo College of Medicine and Science, Rochester, MN, United States
| | - Gerald J. Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - Jörg J. Goronzy
- Department of Medicine, Mayo College of Medicine and Science, Rochester, MN, United States
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Cornelia M. Weyand
- Department of Medicine, Mayo College of Medicine and Science, Rochester, MN, United States
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- *Correspondence: Cornelia M. Weyand,
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Abstract
Results of immunotherapy in childhood solid cancer have been so far, with the exception of neuroblastoma, quite disappointing. Lack of knowledge of the immune contexture of these tumors may have contributed to the failure of immunotherapies so far. Here, we systematically reviewed the literature regarding the immunology of Wilms tumor (WT), one of the most frequent pediatric solid tumors of the abdomen. In Wilms tumor patients the high cure rate of >90%, achieved by the combination of surgery and radio-chemotherapy, is at the expense of a high early and late toxicity. Moreover, treatment-resistant entities, such as diffuse anaplastic tumors or recurrent disease, still pose unsolved clinical problems. Successful immunotherapy could represent a novel and possibly less-toxic treatment option. Employing the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) method of literature search, we analyzed the current knowledge of the immunological landscape of Wilms tumors in terms of tumor microenvironment, prognostic implications of single biomarkers, and immunotherapy response.
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Meihua M, Xiaozhong L, Qin W, Yunfen Z, Yanyan C, Xunjun S. Association between Tfh and PGA in children with Henoch-Schönlein purpura. Open Med (Wars) 2021; 16:986-991. [PMID: 34250253 PMCID: PMC8254571 DOI: 10.1515/med-2021-0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study was to investigate the roles of follicular helper CD4+ T cells (Tfh) and serum anti-α-1,4-d-polygalacturonic acid (PGA) antibody in the pathogenesis of Henoch-Schönlein purpura (HSP). Methods ELISA was performed to determine serum PGA-IgA and PGA-IgG. Flow cytometry was utilized to determine the peripheral CD4+ CXCR5+ and CD4+ CXCR5+ ICOS+ Tfh cells. Real-time PCR was conducted to determine the expression of Bcl-6 gene. Then the change of Tfh cells was analyzed, together with the association with the anti-PGA antibody as well as the roles in the pathogenesis of HSP. Results Compared with the cases with acute respiratory infection and elective surgery, the proportion of CD4+ CXCR5+ and CD4+ CXCR5+ ICOS+ Tfh cells in the HSP group showed significant elevation (P < 0.001). A significant correlation was noticed between PGA-IgA and CD4+ CXCR5+ Tfh cells (r = 0.380 and P = 0.042) and CD4+ CXCR5+ ICOS+ Tfh cells (r = 0.906 and P < 0.001). The expression of Bcl-6 in the HSP group showed no statistical difference compared with that in the acute respiratory infection and the surgery control (P < 0.05). Conclusion Increased activity of Tfh cells, which is closely related to mucosal immunity, may be a major contributor in the elevation of PGA-IgA, and Tfh cells and PGA-IgA are closely related to the occurrence of HSP.
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Affiliation(s)
- Miao Meihua
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou 215025, China
| | - Li Xiaozhong
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou 215025, China
| | - Wang Qin
- Department of Immunology, School of Biology & Basic Medical Science, Soochow University, Suzhou 215021, China
| | - Zhu Yunfen
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou 215025, China
| | - Cui Yanyan
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou 215025, China
| | - Shao Xunjun
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou 215025, China
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Kisaoglu H, Misir S, Aliyazicioglu Y, Kalyoncu M. Interleukin -17 and oxidative stress in children with immunoglobulin A vasculitis. Scand J Rheumatol 2021; 51:309-314. [PMID: 34169806 DOI: 10.1080/03009742.2021.1926319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: We aimed to investigate levels of interleukin-17 (IL-17) and oxidative stress in the active phase of immunoglobulin A vasculitis (IgAV) and determine whether a relationship exists among IL-17, oxidative stress, and system involvement.Method: Patients diagnosed with IgAV, who were not given non-steroidal anti-inflammatory or steroidal drugs within a month, were enrolled. Blood samples were taken in the active and remission phases of the disease. Malondialdehyde (lipid peroxidation marker), 8-hydroxydeoxyguanosine (DNA oxidation marker), total oxidant status (TOS) and total antioxidant status (TAS) levels for oxidative stress, and IL-17 levels were measured.Results: Forty-four patients aged 1.91-15.41 years were enrolled. IL-17 and TAS levels were significantly higher in the active phase of the disease than in the remission phase. 8-Hydroxydeoxyguanosine levels were higher in patients with gastrointestinal involvement than in patients without involvement in the active phase of the disease. A moderate positive correlation was observed between IL-17 and TAS in both active and remission phases.Conclusion: Our results showed increased DNA oxidation in patients with gastrointestinal involvement in the active phase of IgAV, for the first time. Higher IL-17 and TAS levels in the active phase of the disease and positive correlations of TAS and IL-17 in both active and remission phases suggest that IL-17 and oxidative stress may be related.
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Affiliation(s)
- H Kisaoglu
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - S Misir
- Department of Medical Biochemistry, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Y Aliyazicioglu
- Department of Medical Biochemistry, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - M Kalyoncu
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
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Tian X, Cui Z, Wang S, Pan Y, Lata A, Chen X, Wang X, Qiu X, Deng Z, Wang Y. Low serum IgG4 level: a potential diagnostic biomarker for IgA nephropathy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:781. [PMID: 34268394 PMCID: PMC8246212 DOI: 10.21037/atm-20-7007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
Background In contrast to intense investigations of galactose-deficient immunoglobulin A (IgA)1 specific immunoglobulin G (IgG), little is known about the IgG subclasses in IgA nephropathy (IgAN). Low IgG4 levels in IgAN were noticed in our preliminary experiment. We aimed to verify the low IgG4 levels and investigate the related immune mechanism in IgAN. Methods A total of 112 healthy controls (HC) and 112 newly diagnosed IgAN patients were enrolled in this study. Patients with idiopathic membranous nephropathy (IMN), minimal change disease (MCD), or lupus nephritis (LN) were selected as disease controls (DC) (n=122). Serum IgG4 and IgG levels were detected by enzyme-linked immunosorbent assay (ELISA). The IgG4+ B, T helper 1 (Th1), and Th2 cells were measured by flow cytometry. Receiver operating characteristic curves (ROC) were performed to evaluate the diagnostic value of IgG4. Results Both IgG4 levels and IgG4/IgG in IgAN were lower than HC and DC (all P<0.001). Severe IgAN displayed lower IgG4 levels than mild IgAN (P=0.039). Patients with higher risk of renal progression (>50%) demonstrated lower IgG4 levels than lower-risk (≤15%) patients (P=0.019). The cutoff value of IgG4 in differentiating IgAN from HC and DC was 0.26 mg/mL [sensitivity 98.2%, specificity 82.4%, area under the curve (AUC): 0.941, P<0.0001] and 0.17 mg/mL (sensitivity 90.2%, specificity 85.2%, AUC: 0.937, P<0.0001), respectively. IgG4/IgG displayed similar diagnostic and differential ability. The IgG4+ B/B cells (P<0.0001) and Th2/Th (P=0.042) of IgAN were lower than HC. Conclusions Serum IgG4 levels were low in IgAN. Lower IgG4 levels indicated more severe disease conditions and higher risk of renal progression. Low serum IgG4 seemed to be a potential diagnostic biomarker for IgAN. Decreased IgG4+ B cells and Th2 cells may contribute to the low IgG4 levels in IgAN.
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Affiliation(s)
- Xinyu Tian
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Zhuan Cui
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Song Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Yuejuan Pan
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - A Lata
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Xinxin Chen
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Xiaoyan Qiu
- Department of Immunology, Peking University Health Science Center, Beijing, China
| | - Zhenling Deng
- Department of Nephrology, Peking University Third Hospital, Beijing, China
| | - Yue Wang
- Department of Nephrology, Peking University Third Hospital, Beijing, China
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Chai W, Wang X, Wang W, Wang H, Mou W, Gui J. Decreased glycolysis induced dysfunction of NK cells in Henoch-Schonlein purpura patients. BMC Immunol 2020; 21:53. [PMID: 33036556 PMCID: PMC7547466 DOI: 10.1186/s12865-020-00382-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Henoch-Schonlein purpura (HSP) is the most common systemic vasculitis of the childhood. However, its mechanisms and pathogenesis still need more exploration. Natural killer (NK) cells are innate lymphocytes, and there is a growing appreciation that cellular metabolism is important in determining the immune responsiveness of lymphocytes. Thus, we aimed to analyze the NK cells phenotype and explore the association between glucose metabolism and NK cells function in HSP patients. RESULTS A total number of 64 HSP patients and 34 healthy children were included. The HSP patients were divided into two groups according to whether accompanied with nephritis or not. NK cells in HSP patients without nephritis showed a reduced frequency in peripheral blood, a down-regulated expression of activating receptors both NKp30 and NKp46, and an attenuated cytotoxic function against tumor cells. In addition, the function impairment of NK cells was shown to exacerbate in HSPN. Our data further revealed an aberrant metabolic reprogramming of NK cells in HSP patients. Upon stimulation with cytokines (IL-15, IL-12 and IL-2), NK cells from healthy controls switched to an elevated glycolysis rate to support their effector function. By contrast, the glycolysis rate of activated NK cells in HSP group was not significantly up-regulated from the resting level possibly owing to the inhibition of mTORC1. CONCLUSIONS Our study found that HSP patients were accompanied with dysfunction of NK cells. We concluded that the dysfunction of NK cells in HSP patients was induced with a decreased glycolysis rate and suggested that metabolic reprogramming of NK cells might be a player in the pathogenesis of HSP.
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Affiliation(s)
- Wenjia Chai
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiaolin Wang
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wei Wang
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hui Wang
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wenjun Mou
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jingang Gui
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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Lan LC, Yang MX, Tang Q, Lu ZL, Yun X, Huang L, Chen XQ, Shan QW. Changes of IL-17 and related cytokines in peripheral blood and intestinal mucosa of children with abdominal Henoch-Schonlein purpura. Shijie Huaren Xiaohua Zazhi 2019; 27:694-702. [DOI: 10.11569/wcjd.v27.i11.694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intestinal mucosal barrier injury and immune system disorder may be important in the pathogenesis of abdominal Henoch-Schonlein purpura (HSP). However, the relationship between immune factors and intestinal mucosal barrier injury remains unclear.
AIM To investigate the role of changes of interleukin-17 (IL-17) and its related cytokines in peripheral blood and intestinal mucosa in the pathogenesis of abdominal HSP, and to analyze the relationship between intestinal dysbacteriosis and the pathogenesis of abdominal HSP.
METHODS Twenty-six children with acute abdominal HSP were included into an observation group and 16 healthy children were included into a healthy control group. Peripheral blood and fecal samples were collected from subjects of the two groups. Twenty children with acute abdominal HSP who underwent gastroscopy were selected as a case group, and eight children without obvious mucosal lesions were selected as a control group. The duodenal mucosal tissues of the two groups were collected. Flow cytometry was used to detect the percentages of Th17 cells and Tc17 cells in peripheral blood mononuclear cells (PBMCs). ELISA was used to detect the contents of IL-17, IL-6, IL-23, and IFN-γ in plasma. HE staining was used to observe the pathological changes in the duodenal mucosa. RT-qPCR and immunohistochemistry were used to detect the mRNA and protein expression levels of IL-17, IL-6, IL-23, and IFN-γ in the duodenal mucosa, respectively. Bacterial 16S rDNA was used to detect the number of Bifidobacterium and Escherichia coli in feces.
RESULTS The percentages of Th17 and Tc17 cells in the observation group were significantly higher than those in the control group (P < 0. 05). Plasma concentrations of IL-17, IL-6, and IL-23 in the observation group were significantly higher than those in the healthy control group (P < 0. 05). The pathological changes in the duodenal mucosa in the case group were non-specific chronic inflammation, with vascular inflammatory lesions observed in some cases. The expression of IL-17, IL-6, and IFN-γ mRNAs and proteins in the duodenal mucosa in the case group were significantly higher than those in the control group (P < 0. 05). The quantity of Bifidobacterium and Bifidobacterium/Escherichia coli ratio in the observation group were significantly lower than those in the healthy control group (P < 0.05).
CONCLUSION IL-17 and its related cytokines are involved in systemic and intestinal mucosal inflammation in children with abdominal HSP. Intestinal dysbacteriosis may promote the IL-17-mediated inflammatory reaction, which is related to the pathogenesis of abdominal HSP and intestinal mucosal barrier injury.
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Affiliation(s)
- Lian-Cheng Lan
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Mei-Xiong Yang
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Qing Tang
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zi-Li Lu
- Department of Pathology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xiang Yun
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Li Huang
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xiu-Qi Chen
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Qing-Wen Shan
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Demir S, Sönmez HE, Özen S. Vasculitis: Decade in Review. Curr Rheumatol Rev 2019; 15:14-22. [PMID: 30047330 DOI: 10.2174/1573397114666180726093731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/26/2018] [Accepted: 07/23/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the last decade, we have come to better understand and manage the vasculitides. The classification of vasculitides has been revised. Genome- wide association studies and linkage analyses have been undertaken in hope of better understanding the pathogenesis of vasculitides. Comprehensive genetic studies have highlighted new pathways that may guide us in more targeted therapies. Description of the monogenic forms of vasculitis, such as deficiency of adenosine deaminase type 2 (DADA2), Haploinsufficiency of A20 (HA20), have introduced a new perspective to vasculopathies, and introduced alternative treatments for these diseases. CONCLUSION In this review, the important discoveries in pathogenesis and consensus treatment recommendations from the past decade will be summarized.
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Affiliation(s)
- Selcan Demir
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Özen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Jelusic M, Sestan M, Cimaz R, Ozen S. Different histological classifications for Henoch-Schönlein purpura nephritis: which one should be used? Pediatr Rheumatol Online J 2019; 17:10. [PMID: 30819179 PMCID: PMC6393980 DOI: 10.1186/s12969-019-0311-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/21/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Nephritis is the most important chronic complication of IgA Vasculitis (IgAV)/Henoch-Schönlein purpura (IGAV/HSP) and thus the main prognostic factor of this most common childhood vasculitis. Since the prognosis and treatment selection depends on the mode of interpretation of biopsy material, in this manuscript we have presented several issues related to the uneven application of different histological classifications in IgAV/Henoch-Schönlein purpura nephritis (HSPN). The nephritis of IgAV/IGAV/HSP will be abbreviated as HSPN for this paper. MAIN BODY In clinical practice we use different histological classifications for HSPN. It is not known which of these classifications best correlates with severity of renal disease and renal outcome in IgAV/IGAV/HSP. One of the major problem with existing histological classifications is that there is no consensus on the implementation of biopsy in the treatment of HSPN. There is a histologic classification system conventionally used in HSPN, of the International Study of Kidney Disease in Children (ISKDC). On the other hand there is the new classification system suggested for IgA nephropathy, the Oxford classification. The latter has been validated only in IgA nephropathy. There are also two further histologic classifications of Haas and Koskela that have been developed. Current treatment strategies in HSPN are not standardised nor predominantly based on histological classification. CONCLUSION One of the possible solutions to problems related to the application of different histological classification in HSPN is the implementation of multicenter multinational prospective studies with joint collaboration between pediatric rheumatologists, nephrologists and nephropathologists to correlate the clinical features and outcome with the classification systems as well among the classifications. This classification should be the basis for the construction of guidelines for the treatment of patients with HSPN.
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Affiliation(s)
- Marija Jelusic
- Department of Paediatrics, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
| | - Mario Sestan
- 0000 0004 0397 9648grid.412688.1Department of Paediatrics, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Rolando Cimaz
- 0000 0004 1757 2304grid.8404.8Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Seza Ozen
- 0000 0001 2342 7339grid.14442.37Department of Pediatrics, Hacettepe University, Ankara, Turkey
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Liu YT, Lu SG. [Research advances in immunological pathogenesis of immunoglobulin A vasculitis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:837-840. [PMID: 28697842 PMCID: PMC7389925 DOI: 10.7499/j.issn.1008-8830.2017.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/16/2017] [Indexed: 06/07/2023]
Abstract
Immunoglobulin A (IgA) vasculitis is the most common leukocytoclastic small-vessel vasculitis in children and mainly involves the small vessels in the skin, joints, digestive tract, and kidneys. Its pathogenesis is still unclear. Currently, it is believed that environmental factors can cause autoimmune dysfunction and lead to the deposition of IgA-containing immune complexes on the wall of arterioles on the basis of genetic factors. This article reviews the research advances in the role of immune factors in the pathogenesis of IgA vasculitis.
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Affiliation(s)
- Ya-Ting Liu
- Department of Pediatrics, Lianyungang Hospital Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu 222000, China.
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Su Z, Lv X, Liu Y, Zhang J, Guan J, Gai Z. Circulating midkine in children with Henoch-Schönlein purpura: Clinical implications. Int Immunopharmacol 2016; 39:246-250. [PMID: 27497193 DOI: 10.1016/j.intimp.2016.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/30/2016] [Accepted: 07/28/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Midkine (MK) is a heparin-binding growth factor, which behaves like a cytokine, involved in various cellular processes such as cellular proliferation, differentiation, survival, adhesion, and migration. Studies provided evidence for a role of MK in acute and chronic inflammatory processes. The association between midkine and Henoch-Schönlein purpura (HSP) has not yet been explored. The aim of our study was to investigate the potential role of midkine in children with HSP. METHODS A total of 152 cases consisting of 92 children with HSP and 60 age- and sex-matched healthy control children were enrolled in this prospective study. Circulating midkine, IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, and IL-17A was measured in all of the 92 patients and 60 healthy controls. Midkine diagnostic value was evaluated by receiver operating characteristic (ROC) analysis. RESULTS Renal involvement occurred in 36 of the 92 patients. Circulating midkine level was elevated in children with HSPN than those of patients without renal involvement and of the controls (326.58 (266.58-459.25) pg/ml versus 280.72 (233.67-384.36) pg/ml and 217.3 (198.98-243.65) pg/ml, respectively; P<0.05). Midkine positively correlated with IL-4, IL-6, IL17A, IgA and IgE. The threshold MK concentration of HSPN was 295.58pg/ml, with the sensitivity and specificity of 80.6% and 88.3%, respectively. The area under the receiver operating characteristic (ROC) curve (AUCROC) of MK was 0.902. CONCLUSIONS MK seems to be involved in the development of HSP. Measurement of serum levels of MK is helpful in confirming the diagnosis of HSP and predicting HSPN.
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Affiliation(s)
- Zhantao Su
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Ji'nan 250022, China; Department of Pediatric, Shandong Police Hospital, Ji'nan 250002, China
| | - Xin Lv
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Ji'nan 250022, China
| | - Yi Liu
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Ji'nan 250022, China
| | - Jinhang Zhang
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Ji'nan 250022, China
| | - Jingyun Guan
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Ji'nan 250022, China
| | - Zhongtao Gai
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, Ji'nan 250022, China.
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Expansion of Circulating T Follicular Helper Cells in Children with Acute Henoch-Schönlein Purpura. J Immunol Res 2015; 2015:742535. [PMID: 26491701 PMCID: PMC4600875 DOI: 10.1155/2015/742535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/02/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023] Open
Abstract
Henoch-Schönlein purpura (HSP) is a common systemic small vessel vasculitis in children with disorder autoimmune responses. T follicular helper (TFH) cells play crucial roles in regulating immune responses. The aim of our study was to investigate the probable role of TFH cells in the pathogenesis of children with HSP. In this study, the frequency of circulating CXCR5+CD4+TFH cells with inducible costimulator (ICOS) expression in the children with acute HSP was significantly higher than that in healthy controls (HCs) but not CXCR5+CD4+TFH cells with programmed death-1 (PD-1) expression. Moreover, serum levels of IL-21 and IL-6 cytokines, IgA, and C3 in HSP children were also significantly higher than those in HCs. A positive correlation was observed between the frequencies of circulating ICOS+CXCR5+CD4+TFH cells and the serum IL-21 or IgA levels of acute HSP children, respectively. Additionally, the mRNA expression levels of interleukin- (IL-) 21, IL-6, and transcriptional factors (B-cell lymphoma-6, Bcl-6) were also significantly increased in peripheral blood from acute HSP children compared to HCs. Taken together, these findings suggest that TFH cells and associated molecules might play critical roles in the pathogenesis of HSP, which are possible therapeutic targets in HSP children.
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