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Zahran AM, El-Badawy OH, Mahran H, Gad E, Saad K, Morsy SG, Makboul A, Zahran ZAM, Elhoufey A, Dailah HG, Elsayh KI. Detection and characterization of autoreactive memory stem T-cells in children with acute immune thrombocytopenia. Clin Exp Med 2024; 24:158. [PMID: 39004660 PMCID: PMC11247050 DOI: 10.1007/s10238-024-01386-0] [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: 04/11/2024] [Accepted: 05/28/2024] [Indexed: 07/16/2024]
Abstract
Primary immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by an isolated decrease in platelets below 100 × 109/l after the exclusion of other conditions associated with thrombocytopenia. We investigated the role of different memory T-cell subsets, including T stem cell memory (TSCM), in children diagnosed with primary ITP and its association with therapeutic duration. This case-control study included 39 pediatric patients with acute ITP admitted to the Children's Hospital at Assiut University. Using a FACSCanto flow cytometer, CD8 + and CD4 + T-lymphocytes were gated. Five different subsets were characterized in each of these cells according to CD45RO and CD45RA expression. Afterward, gating was performed based on CCR7, CD95, and CD27. Examination of the CD8 + T cells subpopulation showed that Central memory T (TCM) and CD8+ Naïve T (TN) cells were significantly lower in ITP patients than in healthy children (p < 0.0001) and (p = 0.01), respectively. In addition, CD8 + TEMRA was significantly higher in ITP children than in controls (p = 0.001). CD4 + TCM cells were significantly lower in the ITP patient group (p = 0.04). However, CD4 + TEM was significantly higher in patients than controls (p = 0.04). Our research found that ITP patients had an imbalance in the ratio of CD4+ to CD8+ T cells in the peripheral blood and that TCM cells may be involved in the pathogenetic mechanism of ITP. TCMs could help in prediction of patients with higher risk of developing ITP.
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Affiliation(s)
- Asmaa M Zahran
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Omnia H El-Badawy
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
| | - Hayam Mahran
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Eman Gad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Khaled Saad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Salma G Morsy
- Department of Cancer Biology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Ahmed Makboul
- Department of Clinical Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | | | - Amira Elhoufey
- Department of Community Health Nursing, Alddrab University College, Jazan University, 45142, Jazan, Saudi Arabia
| | - Hamad Ghaleb Dailah
- Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan, Saudi Arabia
| | - Khalid I Elsayh
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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Saki N, Hadi H, Keikhaei B, Mirzaei A, Purrahman D. Gut microbiome composition and dysbiosis in immune thrombocytopenia: A review of literature. Blood Rev 2024:101219. [PMID: 38862311 DOI: 10.1016/j.blre.2024.101219] [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: 02/16/2024] [Revised: 04/14/2024] [Accepted: 06/05/2024] [Indexed: 06/13/2024]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder characterized by excessive reticuloendothelial platelet destruction and inadequate compensatory platelet production. However, the pathogenesis of ITP is relatively complex, and its exact mechanisms and etiology have not been definitively established. The gut microbiome, namely a diverse community of symbiotic microorganisms residing in the gastrointestinal system, affects health through involvement in human metabolism, immune modulation, and maintaining physiological balance. Emerging evidence reveals that the gut microbiome composition differs in patients with ITP compared to healthy individuals, which is related with platelet count, disease duration, and response to treatment. These findings suggest that the microbiome and metabolome profiles of individuals could unveil a new pathway for aiding diagnosis, predicting prognosis, assessing treatment response, and formulating personalized therapeutic approaches for ITP. However, due to controversial reports, definitive conclusions cannot be drawn, and further investigations are needed.
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Affiliation(s)
- Najmaldin Saki
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hakimeh Hadi
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bijan Keikhaei
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Arezoo Mirzaei
- Department of Bacteriology and Virology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Daryush Purrahman
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Mehmandar-Oskuie A, Jahankhani K, Rostamlou A, Mardafkan N, Karamali N, Razavi ZS, Mardi A. Molecular mechanism of lncRNAs in pathogenesis and diagnosis of auto-immune diseases, with a special focus on lncRNA-based therapeutic approaches. Life Sci 2024; 336:122322. [PMID: 38042283 DOI: 10.1016/j.lfs.2023.122322] [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: 10/05/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/04/2023]
Abstract
Autoimmune diseases are a diverse set of conditions defined by organ damage due to abnormal innate and acquired immune system responses. The pathophysiology of autoimmune disorders is exceedingly intricate and has yet to be fully understood. The study of long non-coding RNAs (lncRNAs), non-protein-coding RNAs with at least 200 nucleotides in length, has gained significant attention due to the completion of the human genome project and the advancement of high-throughput genomic approaches. Recent research has demonstrated how lncRNA alters disease development to different degrees. Although lncRNA research has made significant progress in cancer and generative disorders, autoimmune illnesses are a relatively new research area. Moreover, lncRNAs play crucial functions in differentiating various immune cells, and their potential relationships with autoimmune diseases have received growing attention. Because of the importance of Th17/Treg axis in auto-immune disease development, in this review, we discuss various molecular mechanisms by which lncRNAs regulate the differentiation of Th17/Treg cells. Also, we reviewed recent findings regarding the several approaches in the application of lncRNAs in the diagnosis and treatment of human autoimmune diseases, as well as current challenges in lncRNA-based therapeutic approaches to auto-immune diseases.
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Affiliation(s)
- Amirreza Mehmandar-Oskuie
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kasra Jahankhani
- Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Rostamlou
- Department of Medical Biology, Faculty of Medicine, University of EGE, Izmir, Turkey
| | - Nasibeh Mardafkan
- Department of Laboratory Science, Faculty of Paramedicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Negin Karamali
- Student Research Committee, Tabriz University of Medical Science, Tabriz, Iran; Immunology Research Center, Tabriz University of Medical Science, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Zahra Sadat Razavi
- Department of Immunology, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Amirhossein Mardi
- Student Research Committee, Tabriz University of Medical Science, Tabriz, Iran; Immunology Research Center, Tabriz University of Medical Science, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran.
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Hamdy SM, Ali MS, Abd El-Hmid RG, Abdelghaffar NK, Abdelaleem OO. Role of Long non Coding RNAs, NEAT1 and Lnc-DC Expression in Pediatric Immune Thrombocytopenic Purpura. Rep Biochem Mol Biol 2023; 11:635-643. [PMID: 37131890 PMCID: PMC10149135 DOI: 10.52547/rbmb.11.4.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/10/2022] [Indexed: 05/04/2023]
Abstract
Background Pediatric immune thrombocytopenic purpura (ITP) is an autoimmune disease; whose etiology is unknown. lncRNAs are regulators of numerous actions, which participate in the development of autoimmune diseases. We evaluated the expression ofNEAT1 and Lnc-RNA in dendritic cell (Lnc-DC) in pediatric ITP. Methods Sixty ITP patients and 60 healthy subjects were enrolled in the present study; Real-time PCR was performed to assess the expression levels of NEAT1 and Lnc-DC in sera of children with ITP as well as healthy children. Results Both lncRNAs, NEAT1 and Lnc-DC were significantly upregulated in ITP patients in comparison to controls (p <0.0001 and P= 0.001 respectively). Furthermore, significant upregulation of the expression levels of NEAT1 and Lnc-DC were observed in the non-chronic compared with chronic ITP patients. Also, there was significant negative correlation between each of NEAT1 and Lnc-DC and platelet counts before treatment (r= -0.38; P= 0.003 and r= -0.461; P< 0.0001, respectively). Conclusions serum lncRNAs, NEAT1 and Lnc-DC could be used as potential biomarkers in differentiating childhood ITP patients and healthy controls in addition to differentiating non-chronic from chronic ITP which may provide a theoretical basis for the mechanism and treatment of immune thrombocytopenia.
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Affiliation(s)
- Soha Mohamed Hamdy
- Departments of Chemistry, Faculty of Science, Fayoum University, Fayoum, Egypt.
| | - Marwa Saad Ali
- Departments of Chemistry, Faculty of Science, Fayoum University, Fayoum, Egypt.
| | | | | | - Omayma Owees Abdelaleem
- Departments of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University, Egypt.
- Corresponding author: Omayma Owees Abdelaleem; Tel: +01 049491030; E-mail:
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The short-term predictive value of CD4 + cells for combination therapy with high-dose dexamethasone and immunoglobulin in newly diagnosed primary immune thrombocytopenia patients. Thromb Res 2022; 218:157-168. [PMID: 36054980 DOI: 10.1016/j.thromres.2022.08.014] [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: 05/08/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Dexamethasone (DXM) or immunoglobulin (IVIg) are first-line therapies for primary immune thrombocytopenia (ITP), with an effective rate of 80 %. Some patients with both severe bleeding symptoms and platelet counts of <30 × 109/L received a combination of DXM and IVIg. Autoimmune disorders, especially involving CD4+ T-cells, play a key role in the pathogenesis of ITP. We assumed that variations in the immune status of CD4+ T-cells will lead to different treatment responses. Until now, there have been few relevant clinical studies on CD4+ T-cells and the outcome of first-line therapies. METHODS A prospective study enrolling 42 newly diagnosed ITP patients and 30 normal control volunteers was performed. The profiles of major CD4+ T-cells, including T helper (Th)1, Th2, Th17, and regulatory T (Treg) cells, and the related levels of interleukin (IL)-2, IL-17, and IL-23 were examined. The platelet number was recorded at the time point of day 0, day 14, and day 30. RESULTS Greater concentrations of Th1 and Th17 cells and lower relative numbers of Treg cells were found in the ITP group. As for the treatment outcome on day 14, the profiles of Th2 and IL-2 were significantly greater in the NR group, while the expression of IL-17 was elevated in the CR group. As for the treatment outcome on day 30, higher levels of Th2 cells were observed in those patients who needed 2× pulses of HD DXM compared to those who needed only 1× pulse of HD DXM and IVIg, and receiver operating characteristic curve analysis showed that lower Treg cell may predict favorable values. Meanwhile, the higher IL-23 value may predict a poor early response. CONCLUSIONS Our results indicate that Th1, Th17, and Treg cells and IL-2 and IL-23 participate in the onset of ITP. Higher profiles of Th2, IL-2 and IL-23 may predict poor treatment outcomes. Higher levels of IL-17 and lower profile of Treg may predict sensitivity to HD DXM and IVIg combination therapy.
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Liu SY, Qu HT, Sun RJ, Yuan D, Sui XH, Shan NN. High-throughput DNA methylation analysis in ITP confirms NOTCH1 hypermethylation through the Th1 and Th2 cell differentiation pathways. Int Immunopharmacol 2022; 111:109105. [PMID: 35930913 DOI: 10.1016/j.intimp.2022.109105] [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: 05/15/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is a prevalent autoimmune disease with a complex aetiology where DNA methylation changes are becoming triggers. METHOD To investigate novel abnormally methylated genes in the pathogenesis of ITP, we performed a high-throughput methylation analysis on 21 ITP patients and 9 normal control samples. We analysed the extent of key methylated genes and their downstream cytokines through Luminex assay or qRT-PCR. Then, bone marrow mononuclear cells were extracted from ITP patients, and decitabine (demethylation drug) was added to the culture medium of cultured cells. qRT-PCR and ELISA were used to detect whether decitabine could effectively affect target genes and related cytokines. RESULTS Through the STRING and Metascape databases, hypermethylated NOTCH1 can be identified and can influence ITP by regulating many downstream cytokines through Th1 and Th2 cell differentiation pathways. Compared with those in the normal control group, the expression levels of NOTCH1 and its downstream Th2 cytokines (IL-4, IL-10, and GATA3) were significantly decreased and those of Th1 cytokines (IFN-γ, IL-12, and TNF-α) were significantly increased in the ITP group. Decitabine exerts its demethylation effect, so the expression of NOTCH1 and its related cytokines in the ITP group treated with 100 nM decitabine were significantly reversed. CONCLUSIONS Our results suggest that the pathogenesis of ITP may exert its influence on epigenetics through alteration of DNA methylation at regulatory regions of the target NOTCH1 gene in the Th1 and Th2 cell differentiation pathways. At the same time, decitabine may achieve a therapeutic effect on ITP by demethylation.
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Affiliation(s)
- Shu-Yan Liu
- Department of Haematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China
| | - Hui-Ting Qu
- Department of Haematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China; Department of Haematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Rui-Jie Sun
- Department of Rheumatology, Peking Union Medical College Hospital, Clinical Immunology Center, Beijing, China
| | - Dai Yuan
- Department of Haematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China; Department of Haematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Xiao-Hui Sui
- Department of Haematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China; Department of Haematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
| | - Ning-Ning Shan
- Department of Haematology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021, China; Department of Haematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China.
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Tarantini F, Cumbo C, Anelli L, Zagaria A, Conserva MR, Redavid I, Specchia G, Musto P, Albano F. Exploring the Potential of Eltrombopag: Room for More? Front Pharmacol 2022; 13:906036. [PMID: 35677428 PMCID: PMC9168361 DOI: 10.3389/fphar.2022.906036] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
Abstract
Since its introduction in clinical practice, eltrombopag (ELT) has demonstrated efficacy in heterogeneous clinical contexts, encompassing both benign and malignant diseases, thus leading researchers to make a more in-depth study of its mechanism of action. As a result, a growing body of evidence demonstrates that ELT displays many effects ranging from native thrombopoietin agonism to immunomodulation, anti-inflammatory, and metabolic properties. These features collectively explain ELT effectiveness in a broad spectrum of indications; moreover, they suggest that ELT could be effective in different, challenging clinical scenarios. We reviewed the extended ELT mechanism of action in various diseases, with the aim of further exploring its full potential and hypothesize new, fascinating indications.
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Affiliation(s)
- Francesco Tarantini
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem Cell Transplantation Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Cosimo Cumbo
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem Cell Transplantation Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Luisa Anelli
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem Cell Transplantation Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Antonella Zagaria
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem Cell Transplantation Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Maria Rosa Conserva
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem Cell Transplantation Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Immacolata Redavid
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem Cell Transplantation Unit, University of Bari “Aldo Moro”, Bari, Italy
| | | | - Pellegrino Musto
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem Cell Transplantation Unit, University of Bari “Aldo Moro”, Bari, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology and Stem Cell Transplantation Unit, University of Bari “Aldo Moro”, Bari, Italy
- *Correspondence: Francesco Albano,
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Ding B, Liu L, Dai Y, Li M, Xia A, Song X, Liu J, Wang X, Song Y, Zhou H. Identification and verification of differentially expressed key genes in peripheral blood-derived T cells between chronic immune thrombocytopenia patients and healthy controls. Bioengineered 2022; 13:13587-13595. [PMID: 35796625 PMCID: PMC9450975 DOI: 10.1080/21655979.2022.2080422] [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] [Indexed: 11/23/2022] Open
Abstract
Immune thrombocytopenia (ITP), characterized by decreased platelet counts, is a complex immune-mediated disorder with unelucidated pathogenesis. Accumulating evidence shows that T cell-mediated platelet destruction is one crucial process during the progression of ITP. Here, we attempted to identify core genes in peripheral blood-derived T-cells of chronic ITP through the analysis of microarray data (GSE43179) and clinical verification, with the aim to further understand the pathogenesis and progression of ITP. Compared with healthy controls, 97 differentially expressed genes (DEGs), including 63 up-regulated and 34 down-regulated were identified in ITP patients. Functional enrichment analysis showed that the DEGs were mainly enriched in innate immune response, inflammatory response, and IL-17 signaling pathway. Among the DEGs, top 15 hub genes ranked by degree score were identified via protein-protein interaction (PPI) network and were further confirmed by quantitative reverse transcription PCR (qRT-PCR). Among top 15 hub genes, the expression levels of 14 DEGs like TLR4, S100A8, S100A9, and S100A12 were significantly up-regulated, while one DEG IFNG was down-regulated in ITP patients. Noticeably, TLR4 exhibited the highest degree score, and S100A8 had the largest fold change in qRT-PCR analysis. Altogether, our results suggested that the pathogenesis and progression of ITP are related with multiple immune-related pathways, and that TLR4 and S100A8 are likely to play crucial roles.
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Affiliation(s)
- Bingjie Ding
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, Henan, China
| | - Liu Liu
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yingtong Dai
- Department of Blood Component Preparation, Henan Province Red Cross Blood Center, Zhengzhou, Henan, China
| | - Mengjuan Li
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, Henan, China
| | - Ao Xia
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, Henan, China
| | - Xuewen Song
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, Henan, China
| | - Jianping Liu
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, Henan, China
| | - Xiaoran Wang
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, Henan, China
| | - Yongping Song
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, Henan, China
| | - Hu Zhou
- Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Hemostasis and Thrombosis Diagnostic Engineering Research Center of Henan Province, Zhengzhou, Henan, China
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Zhang G, Yang P, Liu X, Liu H, Wang J, Wang J, Xiao J, Nie D, Ma L. HMGB1 is increased in patients with immune thrombocytopenia and negatively associates with Tregs. Thromb Res 2022; 213:128-136. [DOI: 10.1016/j.thromres.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022]
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Tărniceriu CC, Hurjui LL, Florea ID, Hurjui I, Gradinaru I, Tanase DM, Delianu C, Haisan A, Lozneanu L. Immune Thrombocytopenic Purpura as a Hemorrhagic Versus Thrombotic Disease: An Updated Insight into Pathophysiological Mechanisms. Medicina (B Aires) 2022; 58:medicina58020211. [PMID: 35208534 PMCID: PMC8875804 DOI: 10.3390/medicina58020211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 11/16/2022] Open
Abstract
Immune thrombocytopenic purpura (ITP) is a blood disorder characterized by a low platelet count of (less than 100 × 109/L). ITP is an organ-specific autoimmune disease in which the platelets and their precursors become targets of a dysfunctional immune system. This interaction leads to a decrease in platelet number and, subsequently, to a bleeding disorder that can become clinically significant with hemorrhages in skin, on the mucous membrane, or even intracranial hemorrhagic events. If ITP was initially considered a hemorrhagic disease, more recent studies suggest that ITP has an increased risk of thrombosis. In this review, we provide current insights into the primary ITP physiopathology and their consequences, with special consideration on hemorrhagic and thrombotic events. The autoimmune response in ITP involves both the innate and adaptive immune systems, comprising both humoral and cell-mediated immune responses. Thrombosis in ITP is related to the pathophysiology of the disease (young hyperactive platelets, platelets microparticles, rebalanced hemostasis, complement activation, endothelial activation, antiphospholipid antibodies, and inhibition of natural anticoagulants), ITP treatment, and other comorbidities that altogether contribute to the occurrence of thrombosis. Physicians need to be vigilant in the early diagnosis of thrombotic events and then institute proper treatment (antiaggregant, anticoagulant) along with ITP-targeted therapy. In this review, we provide current insights into the primary ITP physiopathology and their consequences, with special consideration on hemorrhagic and thrombotic events. The accumulated evidence has identified multiple pathophysiological mechanisms with specific genetic predispositions, particularly associated with environmental conditions.
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Affiliation(s)
- Claudia Cristina Tărniceriu
- Department of Morpho-Functional Sciences I, Discipline of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, Universității str 16, 700115 Iasi, Romania;
- Hematology Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Loredana Liliana Hurjui
- Department of Morpho-Functional Sciences II, Discipline of Physiology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- Central Clinical Laboratory-Hematology Department, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania;
- Correspondence: authors: (L.L.H.); (I.D.F.)
| | - Irina Daniela Florea
- Department of Morpho-Functional Sciences I, Discipline of Imunology, “Grigore T. Popa” University of Medicine and Pharmacy, Universității str 16, 700115 Iasi, Romania
- Correspondence: authors: (L.L.H.); (I.D.F.)
| | - Ion Hurjui
- Department of Morpho-Functional Sciences II, Discipline of Biophysics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Irina Gradinaru
- Department of Implantology Removable Dentures Technology, “Grigore T. Popa” University of Medicine and Pharmacy, Universității str 16, 700115 Iasi, Romania;
| | - Daniela Maria Tanase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700111 Iasi, Romania;
| | - Carmen Delianu
- Central Clinical Laboratory-Hematology Department, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania;
- Department of Biochemistry, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anca Haisan
- Surgery Department, “Grigore T. Popa” University of Medicine and Pharmacy, Universității str 16, 700115 Iasi, Romania;
- Emergency Department, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
| | - Ludmila Lozneanu
- Department of Morpho-Functional Sciences I, Discipline of Histology, “Grigore T. Popa” University of Medicine and Pharmacy, Universității str 16, 700115 Iasi, Romania;
- Department of Pathology, “Sf. Spiridon” Emergency County Hospital, 700111 Iasi, Romania
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Li J, Xia Y, Fan X, Wu X, Yang F, Hu S, Wang Z. HUWE1 Causes an Immune Imbalance in Immune Thrombocytopenic Purpura by Reducing the Number and Function of Treg Cells Through the Ubiquitination Degradation of Ets-1. Front Cell Dev Biol 2021; 9:708562. [PMID: 34900980 PMCID: PMC8660631 DOI: 10.3389/fcell.2021.708562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Immune thrombocytopenic purpura (ITP) is an autoimmune bleeding disorder and the decreased number and immunosuppressive dysfunction of Treg cells are key promoters of ITP. However, their mechanisms in ITP development have not been fully clarified. Methods: HUWE1 mRNA and protein levels in CD4+ T cells in peripheral blood from ITP patients were assessed by quantitative real-time PCR and Western blot. HUWE1 function in ITP was estimated using flow cytometry, enzyme-linked immunosorbent assay and immunosuppression assay. Besides, the HUWE1 mechanism in reducing the number and function of Treg cells in ITP was investigated by immunoprecipitation, cycloheximide-chase assay, ubiquitin experiment and immunofluorescence assay. Results: HUWE1 expression was elevated in CD4+ T cells in peripheral blood from ITP patients and HUWE1 mRNA level was negatively correlated with platelet counts and Treg cell percentage. Moreover, the interference with HUWE1 increased the number of Treg cells and enhanced its immunosuppressive function, and the HUWE1 overexpression produced the opposite results. For the exploration of mechanism, HUWE1 interacted with E26 transformation-specific-1 (Ets-1) and this binding was dependent on the negative regulation of the phosphorylation level of Ets-1 (Thr38) and HUWE1 facilitated the ubiquitin degradation of Ets-1 protein to restrain Treg cell differentiation and weaken their immunosuppressive functions. The in vivo assay confirmed that the HUWE1 inhibitor alleviated ITP in mice. Conclusion: HUWE1 induced the immune imbalance in ITP by decreasing the number and weakening the function of Treg cells through the ubiquitination degradation of Ets-1.
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Affiliation(s)
- Jianqin Li
- Department of Hematology, The Children's Hospital of Soochow University, Suzhou, China
| | - Yalin Xia
- Department of Hematology, The Children's Hospital of Soochow University, Suzhou, China
| | - Xiaoru Fan
- Department of Hematology, The Children's Hospital of Soochow University, Suzhou, China
| | - Xiaofang Wu
- Department of Hematology, The Children's Hospital of Soochow University, Suzhou, China
| | - Feiyun Yang
- Department of Hematology, The Children's Hospital of Soochow University, Suzhou, China
| | - Shaoyan Hu
- Department of Hematology, The Children's Hospital of Soochow University, Suzhou, China
| | - Zhaoyue Wang
- Department of Hematology, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
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12
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Lozano ML, Segú-Vergés C, Coma M, Álvarez-Roman MT, González-Porras JR, Gutiérrez L, Valcárcel D, Butta N. Elucidating the Mechanism of Action of the Attributed Immunomodulatory Role of Eltrombopag in Primary Immune Thrombocytopenia: An In Silico Approach. Int J Mol Sci 2021; 22:ijms22136907. [PMID: 34199099 PMCID: PMC8269123 DOI: 10.3390/ijms22136907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 12/13/2022] Open
Abstract
Eltrombopag is a thrombopoietin receptor (MPL) agonist approved for the treatment of primary immune thrombocytopenia (ITP). Recent evidence shows that some patients may sustain platelet counts following eltrombopag discontinuation. The systemic immunomodulatory response that resolves ITP in some patients could result from an increase in platelet mass, caused either by the direct action of eltrombopag on megakaryocytes through MPL stimulation, or potential MPL-independent actions on other cell types. To uncover the possible mechanisms of action of eltrombopag, in silico analyses were performed, including a systems biology-based approach, a therapeutic performance mapping system, and structural analyses. Through manual curation of the available bibliography, 56 key proteins were identified and integrated into the ITP interactome analysis. Mathematical models (94.92% mean accuracy) were obtained to elucidate potential MPL-dependent pathways in non-megakaryocytic cell subtypes. In addition to the effects on megakaryocytes and platelet numbers, the results were consistent with MPL-mediated effects on other cells, which could involve interferon-gamma, transforming growth factor-beta, peroxisome proliferator-activated receptor-gamma, and forkhead box protein P3 pathways. Structural analyses indicated that effects on three apoptosis-related proteins (BCL2L1, BCL2, BAX) from the Bcl-2 family may be off-target effects of eltrombopag. In conclusion, this study proposes new hypotheses regarding the immunomodulatory functions of eltrombopag in patients with ITP.
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MESH Headings
- Benzoates/chemistry
- Benzoates/pharmacology
- Benzoates/therapeutic use
- Biomarkers
- Disease Management
- Disease Susceptibility
- Humans
- Hydrazines/chemistry
- Hydrazines/pharmacology
- Hydrazines/therapeutic use
- Immunomodulation/drug effects
- Models, Biological
- Models, Molecular
- Molecular Targeted Therapy/methods
- Protein Interaction Mapping
- Protein Interaction Maps
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Purpura, Thrombocytopenic, Idiopathic/etiology
- Purpura, Thrombocytopenic, Idiopathic/metabolism
- Pyrazoles/chemistry
- Pyrazoles/pharmacology
- Pyrazoles/therapeutic use
- Receptors, Thrombopoietin/antagonists & inhibitors
- Receptors, Thrombopoietin/chemistry
- Receptors, Thrombopoietin/metabolism
- Signal Transduction/drug effects
- Structure-Activity Relationship
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Treatment Outcome
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Affiliation(s)
- Maria L. Lozano
- Hospital General Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, CB15/00055-CIBERER, 30007 Murcia, Spain
- Correspondence: (M.L.L.); (N.B.)
| | - Cristina Segú-Vergés
- Anaxomics Biotech S.L., Diputació 237, 1°, 1, 08007 Barcelona, Spain; (C.S.-V.); (M.C.)
| | - Mireia Coma
- Anaxomics Biotech S.L., Diputació 237, 1°, 1, 08007 Barcelona, Spain; (C.S.-V.); (M.C.)
| | - María T. Álvarez-Roman
- Unidad de Trombosis y Hemostasia, Servicio de Hematología, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Paseo de la Castellana 261, 28046 Madrid, Spain;
| | - José R. González-Porras
- Unidad de Hemostasia y Trombosis, Servicio de Hematología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain;
| | - Laura Gutiérrez
- Grupo de Investigación en Plaquetas, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Departamento de Medicina, Universidad de Oviedo, 33071 Oviedo, Spain;
| | - David Valcárcel
- Servicio Hematología, Vall d´Hebron Insitute of Oncology (VHIO), Hospital Univesitario Vall d’Hebron, Universitat Autònoma de Barcelona, Centro Cellex, Natzaret, 115-117, 08035 Barcelona, Spain;
| | - Nora Butta
- Instituto de Investigación HospitaUniversitario La Paz (IdiPAZ), Paseo de la Castellana 261, 28046 Madrid, Spain
- Correspondence: (M.L.L.); (N.B.)
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13
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Wang M, Liu W, Xu Y, Wang H, Guo X, Ding X, Quan R, Chen H, Zhu S, Fan T, Li Y, Zhang X, Sun Y, Hu X. Predicting bleeding risk in a Chinese immune thrombocytopenia (ITP) population: development and assessment of a new predictive nomogram. Sci Rep 2020; 10:15337. [PMID: 32948823 PMCID: PMC7501260 DOI: 10.1038/s41598-020-72275-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 08/26/2020] [Indexed: 01/19/2023] Open
Abstract
The aim of this study was to develop a model that could be used to forecast the bleeding risk of ITP based on proinflammatory and anti-inflammatory factors. One hundred ITP patients were recruited to build a new predictive nomogram, another eighty-eight ITP patients were enrolled as validation cohort, and data were collected from January 2016 to January 2019. Four demographic characteristics and fifteen clinical characteristics were taken into account. Eleven cytokines (IFN-γ, IL-1, IL-4, IL-6, IL-8, IL-10, IL-17A, IL-22, IL-23, TNF-α and TGF-β) were used to study and the levels of them were detected by using a cytometric bead array (CBA) human inflammation kit. The least absolute shrinkage and selection operator regression model was used to optimize feature selection. Multivariate logistic regression analysis was applied to build a new predictive nomogram based on the results of the least absolute shrinkage and selection operator regress ion model. The application of C-index, ROC curve, calibration plot, and decision curve analyses were used to assess the discrimination, calibration, and clinical practicability of the predictive model. Bootstrapping validation was used for testing and verifying the predictive model. After feature selection, cytokines IL-1, IL-6, IL-8, IL-23 and TGF-β were excluded, cytokines IFN-γ, IL-4, IL-10, IL-17A, IL-22, TGF-β, the count of PLT and the length of time of ITP were used as predictive factors in the predictive nomogram. The model showed good discrimination with a C-index of 0.82 (95% confidence interval 0.73376-0.90 624) in training cohortn and 0.89 (95% CI 0.868, 0.902) in validation cohort, an AUC of 0.795 in training cohort, 0.94 in validation cohort and good calibration. A high C-index value of 0.66 was reached in the interval validation assessment. Decision curve analysis showed that the bleeding risk nomogram was clinically useful when intervention was decided at the possibility threshold of 16-84%. The bleeding risk model based on IFN-γ, IL-4, IL-10, IL-17A, IL-22, TGF-β, the count of PLT and the length of time of ITP could be conveniently used to predict the bleeding risk of ITP.
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Affiliation(s)
- Mingjing Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
- Graduate School, China Academy of Chinese Medical Sciences, No. 16 Nanxiao Street, Dongzhimen, Dongcheng District, Beijing, 100700, China
| | - Weiyi Liu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
| | - Yonggang Xu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
| | - Hongzhi Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
| | - Xiaoqing Guo
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
| | - Xiaoqing Ding
- Dongfang Hospital, Beijing University of Chinese Medicine, No. 6 FangXingYuan 1st Block, Fengtai District, Beijing, 100078, China
| | - Richeng Quan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
| | - Haiyan Chen
- Dongfang Hospital, Beijing University of Chinese Medicine, No. 6 FangXingYuan 1st Block, Fengtai District, Beijing, 100078, China
| | - Shirong Zhu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
- Graduate School, Beijing University of Chinese Medicine, No. 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Teng Fan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
- Graduate School, China Academy of Chinese Medical Sciences, No. 16 Nanxiao Street, Dongzhimen, Dongcheng District, Beijing, 100700, China
| | - Yujin Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
- Graduate School, China Academy of Chinese Medical Sciences, No. 16 Nanxiao Street, Dongzhimen, Dongcheng District, Beijing, 100700, China
| | - Xuebin Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
- Graduate School, China Academy of Chinese Medical Sciences, No. 16 Nanxiao Street, Dongzhimen, Dongcheng District, Beijing, 100700, China
| | - Yan Sun
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China
- Graduate School, Beijing University of Chinese Medicine, No. 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China
| | - Xiaomei Hu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, No.1 Xiyuan Caochang, Haidian District, Beijing, 100091, China.
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Dexamethasone suppresses the Th17/1 cell polarization in the CD4 + T cells from patients with primary immune thrombocytopenia. Thromb Res 2020; 190:26-34. [PMID: 32278222 DOI: 10.1016/j.thromres.2020.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 02/14/2020] [Accepted: 04/03/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease with increased Th17 cells in peripheral blood. Th17/1 cells, which were recently characterized as a new differentiated Th17 lineage secreting IL-17 and IFN-γ, play an important role in the pathogenesis of multiple autoimmune diseases. In this study, we investigated whether Th17/1 cells are involved in the pathogenesis of ITP. MATERIALS AND METHODS Peripheral blood was obtained from 44 ITP patients and 50 healthy controls. The percentages of T cell subsets were evaluated. We also detected molecular signature of Th17/1 cells in CD4+ T cells. Besides, CD4+ T cells from ITP patients were treated with dexamethasone, the inhibitor of NF-κB, or rapamycin to evaluate the impact and mechanism of dexamethasone treatment on Th17/1 cells. RESULTS We found an elevated percentage and an enhanced specific molecular signature of Th17/1 cells in CD4+ T cells in ITP patients. The percentage of Th17/1 cells was correlated positively with Th17 cells in ITP patients and healthy controls. The percentage of Th17/1 cells was correlated with corticosteroid resistance. Dexamethasone reversed the molecular signature of Th17/1 cells and decreased the percentage of Th17/1 cells in vitro. Treatment of dexamethasone and the inhibitor of NF-κB suppressed the phosphorylation of STAT3, while dexamethasone treatment also inhibited the phosphorylation of NF-κB p65. CONCLUSIONS Our data suggested Th17/1 cells may contribute to the pathogenesis of ITP and dexamethasone could inhibit Th17/1 cells through NF-κB/STAT3 pathway. These results may provide a potential therapeutic strategy of correcting the Th17/1 cell deviation in ITP.
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15
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Kim TO, Flanagan JM, Habibi A, Arulselvan A, Lambert MP, Grace RF, Despotovic JM. Genetic variants in toll-like receptor 4 are associated with lack of steroid-responsiveness in pediatric ITP patients. Am J Hematol 2020; 95:395-400. [PMID: 31903617 DOI: 10.1002/ajh.25716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 01/19/2023]
Abstract
Although the most common front-line therapies for immune thrombocytopenia (ITP) have been in use for decades, it is still not possible to predict an individual patient's clinical course and response to therapy. Patients are managed with a trial-and-error approach and often suffer side effects of therapies which could have been avoided if response prediction were possible. Corticosteroids are the most frequently used upfront therapy for adults and children with ITP. Our group performed whole exome sequencing on a cohort of pediatric ITP patients, and identified two missense single nucleotide variants (SNV) in Toll-like receptor 4 (TLR4). These coding variants in TLR4 had an increased frequency in Caucasian patients with poor response to upfront steroid therapy. Both TLR4 (D299G; rs4986790) and TLR4 (T399I; rs4986791) had a minor allele frequency (MAF) of 20.7% in those patients unresponsive to steroids, but were present at lower allele frequencies of 2.3% and 3.4% in responders respectively (P < .001). These findings were consistent with the trend identified in an independent cohort of pediatric ITP patients treated with corticosteroids who underwent direct genotyping for both SNVs. This study identified two candidate genetic variants in two unique cohorts of ITP patients which may contribute to steroid response and have prognostic implications for treatment response in ITP.
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Affiliation(s)
- Taylor Olmsted Kim
- Baylor College of Medicine, Department of Pediatrics Division of Hematology/Oncology Houston Texas
- Texas Children's Hematology Centers Houston Texas
| | - Jonathan M. Flanagan
- Baylor College of Medicine, Department of Pediatrics Division of Hematology/Oncology Houston Texas
- Texas Children's Hematology Centers Houston Texas
| | - Ali Habibi
- Baylor College of Medicine, Department of Pediatrics Division of Hematology/Oncology Houston Texas
| | - Abinaya Arulselvan
- Children's Hospital of Philadelphia, Division of Hematology Philadelphia Pennsylvania
| | - Michele P. Lambert
- Children's Hospital of Philadelphia, Division of Hematology Philadelphia Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Department of Pediatrics Philadelphia Pennsylvania
| | - Rachael F. Grace
- Harvard Medical School Boston Massachusetts
- Boston Children's Hospital Dana Farber/Boston Children's Cancer and Blood Disorders Center Boston Massachusetts
| | - Jenny M. Despotovic
- Baylor College of Medicine, Department of Pediatrics Division of Hematology/Oncology Houston Texas
- Texas Children's Hematology Centers Houston Texas
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16
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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.
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17
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Sheng Z, Li J, Wang Y, Li S, Hou M, Peng J, Feng Q. A CARD9 single-nucleotide polymorphism rs4077515 is associated with reduced susceptibility to and severity of primary immune thrombocytopenia. Ann Hematol 2019; 98:2497-2506. [PMID: 31595308 DOI: 10.1007/s00277-019-03796-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 09/08/2019] [Indexed: 12/29/2022]
Abstract
Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by a low platelet count and consequent increased risk of bleeding. The etiology underlying this condition remains poorly understood. The aim of this study is to evaluate the association of a single nucleotide polymorphism (SNP) rs4077515 in the caspase recruitment domain-containing protein 9 (CARD9) gene with the pathogenesis and therapy of ITP. Two hundred ninety-four patients with ITP and 324 age-matched healthy participants were recruited in this case-control study. Genotyping of CARD9 rs4077515 polymorphism was performed by Sanger sequencing. Our results revealed that a polymorphism rs4077515 in CARD9 gene is associated with decreased risk of susceptibility to and severity of ITP (susceptibility: codominant, AA vs. GG, OR = 0.175, 95% CI = 0.054-0.776, p = 0.001; recessive, GG + AG vs. AA, OR = 6.183, 95% CI = 2.287-16.715, p < 0.001; severity: allele, A vs. G, OR = 0.685, 95% CI = 0.476-0.985, p = 0.041; codominant, AG vs. GG, OR = 0.571, 95% CI = 0.350-0.931, p = 0.025; dominant, AA + AG vs. GG, OR = 0.558, 95% CI = 0.343-0.907, p = 0.019). The existence of the allele A, the mutant AA genotype and the heterozygous AG genotype of CARD9 rs4077515, plays a protective role in ITP. However, CARD9 rs4077515 polymorphism had no effect on corticosteroid sensitivity or refractoriness of ITP.
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Affiliation(s)
- Zi Sheng
- Department of Haematology, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Ju Li
- Department of Haematology, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Yuanjian Wang
- Department of Clinical Medicine, West China School of Medicine, Sichuan University, Chengdu, China
| | - Song Li
- Department of Oncology, Qilu Hospital, Shandong University, Jinan, China
| | - Ming Hou
- Key Laboratory of Cardiovascular Remodelling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, China.,Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital, Shandong University, Jinan, China
| | - Jun Peng
- Department of Haematology, Qilu Hospital, Shandong University, Jinan, 250012, China
| | - Qi Feng
- Department of Haematology, Qilu Hospital, Shandong University, Jinan, 250012, China.
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18
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Goubran H, Hart C, Othman I, Seghatchian J. Flow cytometry and immune thrombocytopenic purpura. Transfus Apher Sci 2018; 57:800-803. [PMID: 30473467 DOI: 10.1016/j.transci.2018.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although Immune thrombocytopenic purpura is a common disorder that family physicians, internists and hematologists face in their everyday practice, its diagnosis rests only on "exclusion" and its therapy is based on algorithms where "trial and error" is the rule. Flow cytometry, if simplified and standardized, could provide a quicker and better diagnostic accuracy. Studies of the lymphocyte subset using flow cytometry and more elaborate immune studies are paving the way for a better understanding of the disease and in identification of prognostic markers. Such studies may even help stratify the first-line therapy responder and assist in the use of the arsenal of immune suppressive therapy with better precision.
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Affiliation(s)
- Hadi Goubran
- Saskatoon Cancer Centre, College of Medicine, University of Saskatchewan, Canada.
| | - Caroline Hart
- Saskatoon Cancer Centre, College of Medicine, University of Saskatchewan, Canada
| | - Ibraheem Othman
- Alain Blair Cancer Centre, College of Medicine, University of Saskatchewan, Canada
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety, Audit/Injection and DDR Strategies, London, UK.
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Low mucosal-associated invariant T-cell number in peripheral blood of patients with immune thrombocytopenia and their response to prednisolone. PLoS One 2018; 13:e0207149. [PMID: 30408105 PMCID: PMC6224073 DOI: 10.1371/journal.pone.0207149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/25/2018] [Indexed: 12/23/2022] Open
Abstract
Mucosal-associated invariant T (MAIT) cells help protect against certain infections and are related to some autoimmune diseases. Immune thrombocytopenia (ITP) is a relatively rare hematological autoimmune disease associated with low platelet count. We designed a cross-sectional study wherein we examined peripheral blood samples of patients with ITP for the number of MAIT cells (CD3+TCR-Vα7.2+CD161+IL-18Rα+ lymphocytes) and their CD4/8 subsets (by flow cytometry) and levels of cytokines (by multiplex assays). The study cohort included 18 patients with ITP and 20 healthy controls (HCs). We first compared the number of MAIT cells between HCs and patients with ITP and then performed subgroup analysis in patients with ITP. The number of total MAIT cells in patients with ITP was significantly lower than that in HCs (p < 0.0001), and the CD4-CD8+ subset of MAIT cells showed the same trend. Moreover, patients with ITP refractory to prednisolone exhibited a significantly lower number of total MAIT and CD4-CD8+ MAIT cells than patients sensitive to prednisolone. The number of total MAIT and CD4-CD8+ MAIT cells was not correlated with the response to thrombopoietin receptor agonist treatment or with Helicobacter pylori infection. We found no relation between cytokine levels and response to prednisolone treatment, although the levels of IP-10 and RANTES showed a correlation with the number of total MAIT and CD4-CD8+ MAIT cells. In conclusion, total MAIT and CD4-CD8+ MAIT cells in peripheral blood were decreased in patients with ITP, correlating with their response to prednisolone.
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20
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Soliman MA, Helwa MA, Fath-Allah SK, El-Hawy MA, Badr HS, Barseem NF. IL-10 polymorphisms and T-cell subsets could affect the clinical presentation and outcome of childhood immune thrombocytopenia in Egyptian population. APMIS 2018; 126:380-388. [DOI: 10.1111/apm.12823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 01/26/2018] [Indexed: 01/16/2023]
Affiliation(s)
- Mohamed A. Soliman
- Department of Clinical Pathology; Faculty of Medicine; Menoufia University; Menoufia Egypt
| | - Mohamed A. Helwa
- Department of Clinical Pathology; Faculty of Medicine; Menoufia University; Menoufia Egypt
| | - Samar K. Fath-Allah
- Department of Clinical Pathology; Faculty of Medicine; Menoufia University; Menoufia Egypt
| | - Mahmoud A. El-Hawy
- Department of Pediatrics; Faculty of Medicine; Menoufia University; Menoufia Egypt
| | - Hassan S. Badr
- Department of Pediatrics; Faculty of Medicine; Menoufia University; Menoufia Egypt
| | - Naglaa Fathy Barseem
- Department of Pediatrics; Faculty of Medicine; Menoufia University; Menoufia Egypt
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21
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Zhang Y, Ma T, Zhou X, Chen J, Li J. Circulating level of Th17 cells is associated with sensitivity to glucocorticoids in patients with immune thrombocytopenia. Int J Hematol 2018; 107:442-450. [PMID: 29327325 DOI: 10.1007/s12185-017-2392-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/08/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
Glucocorticoids are a widely recognized first-line therapy for immune thrombocytopenia (ITP). However, some patients are unresponsive to glucocorticoid therapy for reasons that remain unclear. Accumulating evidence suggests that CD4+ T-cell abnormalities play a crucial role in the development of ITP. In the present study, we investigated peripheral blood CD4+ T cells, Th17-associated cytokines, and the mRNA expression level of Th17 transcription factor-RORγt-in patients with newly-diagnosed ITP before glucocorticoid therapy. The study involved 27 newly-diagnosed patients. Th17-cell levels in the peripheral blood of newly-diagnosed ITP patients were associated with responsiveness to glucocorticoid therapy. Newly-diagnosed ITP patients who were not sensitive to glucocorticoid treatment were found to have lower levels of Th17 cells. Quantifying Th17 cells may allow physicians to predict prognosis of glucocorticoid treatment and stratify therapy for those with ITP. This strategy may provide a new approach to the treatment of glucocorticoid-insensitive patients.
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Affiliation(s)
- YiChan Zhang
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - TingTing Ma
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Xuan Zhou
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - JunHao Chen
- Department of Laboratory, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Juan Li
- Phase I Clinical Trials Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
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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
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Zhang G, Zhang P, Liu H, Liu X, Xie S, Wang X, Wu Y, Chang J, Ma L. Assessment of Th17/Treg cells and Th cytokines in an improved immune thrombocytopenia mouse model. Hematology 2017; 22:493-500. [PMID: 28300523 DOI: 10.1080/10245332.2017.1301040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES The improved passive immune thrombocytopenia (ITP) mouse model has been extensively utilized for the study of ITP. However, how closely this model matches the human inflammation state and immune background is unclear. Our study aimed to explore the profile of Th cytokines and Th17/Treg cells in the model. METHODS We induced the ITP mouse model by dose-escalation injection of MWReg30. The serum levels of cytokines (IFN-γ, IL-2, IL-4, IL-10, IL-17A, and TGF-β1) were measured by enzyme-linked immunosorbent assay and the frequency of Th17 and Treg cells was measured by flow cytometry. The mRNA expression of Foxp3 and RORrt was measured by real-time PCR. RESULTS The serum levels of cytokines IFN-γ, TGF-β1, IL-4, and IL-10 were significantly lower in ITP mice. The secretion of serum proinflammatory cytokines IL-2 and IL-17A and the percentage of Th17 cells showed no statistically significant increase. In ITP mice the frequency of Treg cells and mRNA expression of Foxp3 was significantly lower in splenocytes. CONCLUSION Our data suggest that the improved passive ITP mouse model does not mimic the autoimmune inflammatory process of human ITP. Compared with human ITP, this model has a similar change in frequency of Treg cells, which may directly or indirectly result from antibody-mediated platelet destruction due to attenuated release of TGF-β.
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Affiliation(s)
- Guoyang Zhang
- a Department of Hematology , Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , China
| | - Ping Zhang
- c Department of Hematology , Henan Provincial People's Hospital , Zhengzhou , China
| | - Hongyun Liu
- a Department of Hematology , Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , China
| | - Xiaoyan Liu
- a Department of Hematology , Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , China
| | - Shuangfeng Xie
- a Department of Hematology , Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , China
| | - Xiuju Wang
- a Department of Hematology , Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , China
| | - Yudan Wu
- a Department of Hematology , Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , China
| | - Jianxing Chang
- b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , China.,d Department of General Surgery , Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , China
| | - Liping Ma
- a Department of Hematology , Sun Yat-sen Memorial Hospital, Sun Yat-sen University , Guangzhou , China.,b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation , Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University , Guangzhou , China
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El-Rashedi FH, El-Hawy MA, Helwa MA, Abd-Allah SS. Study of CD4 + , CD8 + , and natural killer cells (CD16 + , CD56 + ) in children with immune thrombocytopenic purpura. Hematol Oncol Stem Cell Ther 2017; 10:8-14. [DOI: 10.1016/j.hemonc.2017.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/17/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022] Open
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Abstract
OBJECTIVES Classically, immune thrombocytopenia (ITP) was thought to be caused by the destruction and insufficient production of platelets, as mediated by autoantibodies. More recently other immune mechanisms that contribute to the disease have been discovered. This review attempts to address the main unresolved questions in ITP. METHODS We review the most current knowledge of the pathophysiology of ITP. Immunological effects of available therapies are also described. DISCUSSION The trigger may be a loss of tolerance due to molecular mimicry with cross-reaction of antibodies arising from infectious agents or drugs, genetic factors, and/or platelet Toll receptors. This loss of tolerance activates autoreactive effector B and T lymphocytes, which in turn initiates platelet destruction, mediated by cytotoxic T lymphocytes and the release of pro-inflammatory cytokines (IL-2/IL-17) by T helper (Th) cells (Th1/Th17). Th2 (anti-inflammatory) and regulatory B (Breg) and Treg cells are also inhibited (with decrease in IL-10/TGF-β), which leads to the disease becoming chronic. Some isotypes of autoantibodies may increase the bleeding risk. Corticosteroids, rituximab, and thrombopoietin receptor agonists (A-TPOs) all increase levels of Tregs and TGF-β. The A-TPOs also increase Breg levels, which could explain why complete remission has been seen in some cases. CONCLUSION A better understanding of the immunomodulatory effects of each ITP therapy is needed to best manage the disease.
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Affiliation(s)
- María Perera
- a Haematology Service , University Hospital Doctor Negrín , Las Palmas de Gran Canaria, Spain
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Hua F, Li Y, Zhao X, Zhang D, Zhan Y, Ji L, Gao S, Meng Y, Li F, Zou S, Cheng Y. The expression profile of toll-like receptor signaling molecules in CD19(+) B cells from patients with primary immune thrombocytopenia. Immunol Lett 2016; 176:28-35. [PMID: 27210424 DOI: 10.1016/j.imlet.2016.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 05/12/2016] [Accepted: 05/15/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND B cells play a critical role in the pathogenesis of immune thrombocytopenia (ITP), and toll-like receptor (TLR) signaling is essential for the activation of autoreactive B cells. The objective of this study was to investigate the expression profile of TLR signaling molecules in circulating and splenic CD19(+) B cells isolated from ITP patients. METHODS CD19(+) B cells were magnetically isolated from peripheral blood and splenocytes. Human Toll-Like Receptor Signaling Pathway RT(2) Profiler™ PCR Array was used to determine the differences in mRNA expression of 84 TLR signaling pathway genes between ITP patients and controls. Flow cytometry was used to investigate intracellular expression of cytokines (IL-1β and IL-10). RESULTS A total of 31 genes involving TLR signaling pathways were differentially transcribed in circulating CD19(+) B cells, among which 27 were up-regulated in ITP. By comparison, differentially transcribed genes amounted to 39 in splenic B cells in ITP, among which only two were down-regulated. Up to 18 TLR signaling molecules exhibited up-regulated transcriptional levels both in splenic B cells and in circulating B cells in ITP. However, Only IL-10 and IL-1β were significantly upregulated in both the circulating and splenic B cells of patients with ITP. Intracellular staining of IL-10 and IL-1β confirmed the results of PCR Array. CONCLUSIONS The expression of TLRs and downstream cytokines, including IL-10 and IL-1β, is up-regulated in circulating and splenic B cells in ITP patients, suggesting that activated TLR signaling pathways in B cells may play dual roles in the pathophysiology of primary ITP.
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Affiliation(s)
- Fanli Hua
- Department of Haematology, Jinshan Hospital, Fudan University, Shanghai, China; Department of Haematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ying Li
- Department of Haematology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Xin Zhao
- Department of Haematology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Dawei Zhang
- Department of Surgery, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yanxia Zhan
- Department of Haematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lili Ji
- Department of Haematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Song Gao
- Department of Haematology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Yuesheng Meng
- Department of Haematology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Feng Li
- Department of Haematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanhua Zou
- Department of Haematology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunfeng Cheng
- Department of Haematology, Zhongshan Hospital, Fudan University, Shanghai, China; Biomedical Research Centre, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Haematology, Qingpu Branch, Zhongshan Hospital, Fudan University, Shanghai, China.
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Yu L, Zhang C, Zhang L, Shi Y, Ji X. Biomarkers for immune thrombocytopenia. Biomark Res 2015; 3:19. [PMID: 26185681 PMCID: PMC4504091 DOI: 10.1186/s40364-015-0045-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/06/2015] [Indexed: 11/13/2022] Open
Abstract
Immune thrombocytopenia is an autoimmune disease with abnormal biomarkers. Immune thrombocytopenia pathogenesis is a complicated process in which the patient’s immune system is activated by platelet autoantigens resulting in immune mediated platelet destruction or suppression of platelet production. The autoantibodies produced by autoreactive B cells against self antigens are considered to play a crucial role. In addition, biomarkers such as transforming growth factor-beta1,Toll-like receptors,T helper 1 andT helper 2 cytokine bias, Notch signaling and abnormal biomarker in megakaryocyte maturation are involved in the pathogenesis of this disease. With the genomewide association study on immune thrombocytopenia, more biomarkers will be founded in the future. They may provides a theoretical basis for the mechanism and treatment of immune thrombocytopenia.
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Affiliation(s)
- Lingjia Yu
- Department of Hematology, Qilu Hospital, Shandong University, 107 West Wenhua Rd, Jinan, Shandong 250012 PR China
| | - Chunmei Zhang
- Department of Hematology, the central Hospital of TaiAn, TaiAn, PR China
| | | | - Yongyu Shi
- Institute of Immunology, School of Medicine, Shandong University, Jinan, PR China
| | - Xuebin Ji
- Department of Hematology, Qilu Hospital, Shandong University, 107 West Wenhua Rd, Jinan, Shandong 250012 PR China
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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.
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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)
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Li Q, Zhang L, Xia R, Zeng Q, Wang Y, Xia L, Xia L, Yang M. Plasma Levels of Interleukin 12 Family Cytokines and Their Relevant Cytokines in Adult Patients with Chronic Immune Thrombocytopenia before and after High-Dose Dexamethasome Treatment. Med Princ Pract 2015; 24:458-64. [PMID: 26111958 PMCID: PMC5588267 DOI: 10.1159/000433472] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 05/20/2015] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE We aimed to investigate the expression of interleukin 12 (IL-12) family cytokines (IL-12, IL-23, IL-27 and IL-35) and their relevant cytokines (IFN-γ, IL-4, IL-17A and IL-10) in patients with chronic immune thrombocytopenia (cITP) as well as the effect of high-dose dexamethasone (HD-DXM) treatment on this expression. MATERIALS AND METHODS DXM was administered orally at a dose of 40 mg per day for 4 consecutive days to 38 patients with cITP. We measured the plasma levels of IL-12p70, IL-23, IL-27, IFN-γ, IL-4 and IL-17A before and after treatment and also in 36 matched healthy controls, by means of FlowCytomix™ technology. The plasma levels of IL-10 and IL-35 were measured by enzyme-linked immunosorbent assay. RESULTS Significantly higher plasma levels of IL-12p70, IL-23, IL-27, IFN-γ and IL-17A were observed in cITP patients than in controls (p < 0.01), and after HD-DXM treatment, these levels decreased significantly (p < 0.01). However, significantly lower plasma levels of IL-4, IL-10 and IL-35 were observed in cITP patients than in controls (p < 0.01); after the HD-DXM treatment, these levels had increased significantly in the cITP patients (p < 0.01). Moreover, the cytokine levels of patients who attained a complete response returned to the levels of normal controls (p > 0.05) but were not corrected in the patients who had no response (p < 0.01). CONCLUSIONS The patients with cITP had abnormal expression of the IL-12 family cytokines and their relevant cytokines levels, and HD-DXM treatment corrected the derangement of plasma cytokines. Measuring cytokine levels may help in the clinical assessment of cITP.
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Affiliation(s)
- Qingsheng Li
- Department of Hematology, The First Affiliated Hospital, Hefei, PR China
| | - Linjie Zhang
- Department of Immunology, Anhui Medical University, Hefei, PR China
| | - Ruixiang Xia
- Department of Hematology, The First Affiliated Hospital, Hefei, PR China
| | - Qingshu Zeng
- Department of Hematology, The First Affiliated Hospital, Hefei, PR China
| | - Yongqing Wang
- Department of Hematology, The First Affiliated Hospital, Hefei, PR China
| | - Liang Xia
- Department of Hematology, The First Affiliated Hospital, Hefei, PR China
| | - Leiming Xia
- Department of Hematology, The First Affiliated Hospital, Hefei, PR China
| | - Mingzhen Yang
- Department of Hematology, The First Affiliated Hospital, Hefei, PR China
- *Mingzhen Yang, Department of Hematology, The First Affiliated Hospital, Anhui Medical University, 218 Jixi Road, Shushan District, Hefei 230022 (PR China), E-Mail
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Leontyev D, Neschadim A, Branch DR. Cytokine profiles in mouse models of experimental immune thrombocytopenia reveal a lack of inflammation and differences in response to intravenous immunoglobulin depending on the mouse strain. Transfusion 2014; 54:2871-9. [DOI: 10.1111/trf.12680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 02/09/2014] [Accepted: 02/25/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Danila Leontyev
- Centre for Innovation; Canadian Blood Services; Toronto Ontario Canada
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Division of Advanced Diagnostics; Infection and Immunity Group; Toronto General Research Institute; Toronto Ontario Canada
| | - Anton Neschadim
- Centre for Innovation; Canadian Blood Services; Toronto Ontario Canada
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Division of Advanced Diagnostics; Infection and Immunity Group; Toronto General Research Institute; Toronto Ontario Canada
| | - Donald R. Branch
- Centre for Innovation; Canadian Blood Services; Toronto Ontario Canada
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- Division of Advanced Diagnostics; Infection and Immunity Group; Toronto General Research Institute; Toronto Ontario Canada
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