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Gu H, Wang Z, Xie X, Chen H, Ouyang J, Wu R, Chen Z. HIF-1α induced by hypoxic condition regulates Treg/Th17 axis polarization in chronic immune thrombocytopenia. Int Immunopharmacol 2024; 131:111810. [PMID: 38492341 DOI: 10.1016/j.intimp.2024.111810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
Immune thrombocytopenia (ITP) is an acquired immune disorder characterized by increased platelet destruction and reduced platelet (Plt) production. Hypoxia-inducible factor-1α (HIF-1α) have regulatory effects on Treg/Th17 axis balance and may represent relevant factors in the pathogenesis of ITP. Treg/Th17 ratio, serum levels and gene expression were investigated in new diagnosed ITP (NITP) and chronic ITP (CITP). The Treg/Th17 ratio obviously decreased in CITP (P = 0.001). The ratio of Treg/Th17 was correlated with the level of HIF-1α level both in mRNA (r = 0.49, P < 0.0001) and serum level (r = 0.50, P < 0.0001). However, none statistical upregulation of HIF-1α was observed in CITP. In vitro, There was significant polarization difference of Treg/Th17 axis (P = 0.042) and Foxp3-MFI/IL17-MFI (P = 0.0003) in hypoxic condition between NITP and CITP. These findings suggest that HIF-1α induced by hypoxia plays a crucial role in the chronicity of ITP by mediating the imbalance of the Treg/Th17 axis.
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Affiliation(s)
- Hao Gu
- Hematologic Disease Laboratory, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China 100045; Department of Immunology, Ministry of Education Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China 100045
| | - Zhifa Wang
- Hematologic Disease Laboratory, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China 100045; Department of Hematology, Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China 100045
| | - Xingjuan Xie
- Hematologic Disease Laboratory, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China 100045
| | - Hui Chen
- Hematologic Disease Laboratory, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China 100045
| | - Juntao Ouyang
- Hematologic Disease Laboratory, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China 100045
| | - Runhui Wu
- Department of Hematology, Beijing Key Laboratory of Pediatric Hematology-Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China 100045.
| | - Zhenping Chen
- Hematologic Disease Laboratory, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China 100045.
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Mititelu A, Onisâi MC, Roșca A, Vlădăreanu AM. Current Understanding of Immune Thrombocytopenia: A Review of Pathogenesis and Treatment Options. Int J Mol Sci 2024; 25:2163. [PMID: 38396839 PMCID: PMC10889445 DOI: 10.3390/ijms25042163] [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: 12/21/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
The management of immune thrombocytopenia (ITP) and the prediction of patient response to therapy still represent a significant and constant challenge in hematology. ITP is a heterogeneous disease with an unpredictable evolution. Although the pathogenesis of ITP is currently better known and its etiology has been extensively studied, up to 75% of adult patients with ITP may develop chronicity, which represents a significant burden on patients' quality of life. A major risk of ITP is bleeding, but knowledge on the exact relationship between the degree of thrombocytopenia and bleeding symptoms, especially at a lower platelet count, is lacking. The actual management of ITP is based on immune suppression (corticosteroids and intravenous immunoglobulins), or the use of thrombopoietin receptor agonists (TPO-RAs), rituximab, or spleen tyrosine kinase (Syk) inhibitors. A better understanding of the underlying pathology has facilitated the development of a number of new targeted therapies (Bruton's tyrosine kinase inhibitors, neonatal Fc receptors, strategies targeting B and plasma cells, strategies targeting T cells, complement inhibitors, and newer TPO-RAs for improving megakaryopoiesis), which seem to be highly effective and well tolerated and result in a significant improvement in patients' quality of life. The disadvantage is that there is a lack of knowledge of the predictive factors of response to treatments, which would help in the development of an optimized treatment algorithm for selected patients.
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Affiliation(s)
- Alina Mititelu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania; (M.-C.O.); (A.M.V.)
| | - Minodora-Cezarina Onisâi
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania; (M.-C.O.); (A.M.V.)
| | - Adrian Roșca
- Department of Physiology, Carol Davila University of Medicine and Pharmacy, 050471 Bucharest, Romania;
| | - Ana Maria Vlădăreanu
- Department of Hematology, Carol Davila University of Medicine and Pharmacy, Emergency University Hospital of Bucharest, 050098 Bucharest, Romania; (M.-C.O.); (A.M.V.)
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Saleh VM, Auda IG, Ali EN. The C/A functional polymorphism of TGF-β2 gene (rs991967) in primary open angle glaucoma patients. Mol Biol Rep 2023; 50:7197-7203. [PMID: 37418083 DOI: 10.1007/s11033-023-08503-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/04/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Primary Open-angle Glaucoma (POAG) is a functional disease that.leads to blindness globally. The aims of this study are estimation the importance.of transforming growth factor-beta 2 (TGF-β2) in the pathogenicity of POAG and.to evaluate the effect of the C/A SNP of the TGF-β2 gene (rs991967) on POAG development. METHODS Blood samples and some topographic data were collected from POAG.patients and the controls. The serum level of TGF-β2 was estimated by ELISA.and the C/A SNP of the TGF-β2 gene (rs991967) was determined by RFLP-PCR. RESULTS The males are more susceptible to having POAG (p = 0.0201). The serum.TGF-β2 is higher in POAG patients as compared with the control (p < 0.0001). The.AA (reference) genotype was the most common in the patients (61.7%). While..CC genotype (45.0%, OR: 0.136, 95%CI: 0.05-0.36, P < 0.0001) and AC..genotypes (41.7%, OR: 0.051, 95%CI: 0.01-0.16, P < 0.001) were most common..in the control group. Moreover, the TGF-β2 C allele is protective (OR: 0.25,..95%, CI: 0.15-0.44, P < 0.0001). Patients with AA, CC, and AC genotypes have..significantly high levels of TGF-β2 (P < 0.001) than the control. CONCLUSIONS The males were more susceptible to acquiring POAG than females,.. especially the elderly. The TGF-β2 plays important role in the pathogenesis of POAG. The CC and AC genotypes are common in the control and the C allele is a protective factor.
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Affiliation(s)
- Vian Mohammed Saleh
- Department of Biology -College of Science-Mustansiriyah University, Baghdad, Iraq.
| | - Ibtesam Ghadban Auda
- Department of Biology -College of Science-Mustansiriyah University, Baghdad, Iraq
| | - Ekhlass N Ali
- Department of Biology -College of Science-Mustansiriyah University, Baghdad, Iraq
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El-Ghamrawy M, El-Gharbawi N, Shahin G, Abdelhady A, Sayed R, Diaa N, Bishai I. Combined tumor necrosis factor-α (-308 G/A) and tumor necrosis factor-β (+ 252 A/G) nucleotide polymorphisms and chronicity in Egyptian children with immune thrombocytopenia. Int J Hematol 2023; 117:856-862. [PMID: 36802017 DOI: 10.1007/s12185-023-03551-9] [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: 11/21/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Primary immune thrombocytopenia (ITP) is a common autoimmune disorder. Secretion of TNF-α, TNF-β and IFN-γ plays a major role in the pathogenesis of ITP. OBJECTIVE This cross-sectional study aimed to detect TNF-α (-308 G/A) and TNF-β (+ 252 A/G) gene polymorphism in a cohort of Egyptian children with chronic ITP (cITP) to clarify their possible association with progression to chronic disease. METHODS The study included 80 Egyptian cITP patients and 100 unrelated age- and sex-matched controls. Genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS Patients with TNF-α homozygous (A/A) genotype had significantly higher mean age, longer disease duration and lower platelet counts (p values 0.005, 0.024 and 0.008, respectively). TNF-α wild (G/G) genotype was significantly more frequent among responders (p = 0.049). Complete response was more frequent among wild (A/A) TNF-β genotype patients (p = 0.011), and platelet count was significantly lower among homozygous (G/G) genotype (p = 0.018) patients. Combined polymorphisms were strongly associated with susceptibility to chronic ITP. CONCLUSION Homozygosity in either gene might contribute to a worse course of disease, increased severity and poor response to therapy. Patients expressing combined polymorphisms are more prone to progression to chronic disease, severe thrombocytopenia and longer disease duration.
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Affiliation(s)
- Mona El-Ghamrawy
- Pediatric Hematology & BMT Unit, Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Nesrine El-Gharbawi
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gehan Shahin
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Alaa Abdelhady
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rasha Sayed
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nehal Diaa
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Irene Bishai
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Akyol Ş, Tüfekçi Ö, Yilmaz Ş, Ören H. Evaluation of paediatric immune thrombocytopenia patients with clinical and laboratory findings: emphasizing the role of monocytosis. Blood Coagul Fibrinolysis 2022; 33:315-321. [PMID: 35834725 DOI: 10.1097/mbc.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We aimed to investigate the relationship between demographics, clinical features, laboratory findings including monocytosis and clinical course in children with immune thrombocytopenia (ITP). Data of 100 ITP patients were analysed. Complete blood count findings of the patients at certain time points were evaluated to classify the disease as acute, persistent and chronic. An effect of sex on chronicity was not observed ( P = 0.166). Of the patients enrolled in the study, 38% ( n = 38) had chronic course. The mean age of patients with the chronic course was 7 ± 4.1 years, which was significantly higher than the other groups ( P = 0.007). Sixty-five percent ( n = 13) of the patients presenting with mucosal bleeding and 27.4% ( n = 20) of the patients presenting with skin bleeding became chronic ( P = 0.008). MPV was found to be significantly high in chronic ITP patients ( P = 0.049). Monocytosis was noted in 80% of the patients at diagnosis. Intravenous immunoglobulin was used in 84% of the patients with acute ITP; 33% of them developed chronic ITP. The age at diagnosis, presence of mucosal bleeding and increased MPV on admission were high-risk factors for the development of the chronic course. Monocytosis was detected in 80% of the patients on admission, and it may play a role in the pathogenesis of ITP.
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Affiliation(s)
- Şefika Akyol
- Dokuz Eylul University, Department of Pediatric Hematology, Izmir, Turkey
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Yu L, Zhang L, Jiang Z, Yu B. Decreasing lncRNA PVT1 causes Treg/Th17 imbalance via NOTCH signaling in immune thrombocytopenia. ACTA ACUST UNITED AC 2021; 26:734-740. [PMID: 34555308 DOI: 10.1080/16078454.2021.1974200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: Immune thrombocytopenia (ITP) is an autoimmune disease. T helper cell 17 (Th17) cells are increased in peripheral blood of ITP patients. NOTCH signaling is involved in Th17 cell differentiation and function. Besides, lncRNA Plasmacytoma variant translocation 1 (PVT1) was decreased in experimental autoimmune encephalomyelitis, and overexpressing PVT1 inhibited Th17 cell differentiation. Here, we aimed to investigate the effect of lncRNA PVT1 on ITP and its related mechanism.Methods: The number of Th17 cells and Treg cells was carried out using flow cytometry. PVT1 levels were detected by quantitative real-time PCR. Interleukin-17 (IL-17) levels and transforming growth factor-β (TGF-β) levels were detected by enzyme-linked immunosorbent assay. Protein levels of retinoid acid-related orphan receptor γ t (RORγt), forkhead box P3 (Foxp3), and NOTCH1 were carried out by western blot. NOTCH1 ubiquitylation was detected by ubiquitination assay.Results: PVT1 was down-regulated and Th17 cells were up-regulated in ITP patients. Overexpression of PVT1 decreased the number of Th17 cells, and also decreased the levels of IL-17, RORγt, and NOTCH1. Besides, PVT1 could bind to NOTCH1 and mediated NOTCH1 degradation by increasing its ubiquitination. Additionally, excessive expression of PVT1 could increase the levels of PVT1, reduce the amount of Th17 cells, as well as the levels of IL-17, RORγt, and NOTCH1, while co-overexpressing NOTCH1 reversed the results.Conclusion: PVT1 was down-regulated in ITP patients. Overexpressing PVT1 might reduce Th17 cell differentiation by down-regulating NOTCH1, and further alleviated the development of ITP.
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Affiliation(s)
- Ling Yu
- Department of Blood Transfusion, Jinhua People's Hospital, Jinhua, People's Republic of China
| | - Liqin Zhang
- Department of Laboratory, Jinhua People's Hospital, Jinhua, People's Republic of China
| | - Zhiyong Jiang
- Department of hematopathology, Jinhua People's Hospital, Jinhua, People's Republic of China
| | - Beiwei Yu
- Department of Laboratory, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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7
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Tong H, Ding Y, Gui X, Sun Z, Wang G, Zhang S, Xu Z, Wang X, Xu X, Ju W, Li Y, Li Z, Zeng L, Xu K, Qiao J. Dimethyl fumarate inhibits antibody-induced platelet destruction in immune thrombocytopenia mouse. Thromb J 2021; 19:61. [PMID: 34454532 PMCID: PMC8403390 DOI: 10.1186/s12959-021-00314-6] [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: 04/16/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is an autoimmune disease characterized as a low platelet count resulting from immune-mediated platelet destruction. Dimethyl fumarate (DMF) is widely applied for the treatment of several autoimmune diseases with immunosuppressive effect. However, whether it ameliorates ITP is unclear. This study aims to evaluate whether DMF has a preventive effect on ITP in mice. METHODS DMF (30, 60 or 90 mg/kg body weight) was intraperitoneally injected into mice followed by injection of rat anti-mouse integrin GPIIb/CD41antibody to induce ITP. Peripheral blood was isolated to measure platelet count and spleen mononuclear cells were extracted to measure Th1 and Treg cells along with detecting the levels of IFN-γ, and TGFβ-1 in plasma and CD68 expression in spleen by immuohistochemical staining. Additionally, macrophage cell line RAW264.7 was cultured and treated with DMF followed by analysis of cell apoptosis and cycle, and the expression of FcγRI, FcγRIIb and FcγRIV mRNA. RESULTS DMF significantly inhibited antiplatelet antibody-induced platelet destruction, decreased Th1 cells and the expression of T-bet and IFN-γ, upregulated Treg cells and the expression of Foxp3 and TGF-β1 as well as reduced CD68 expression in the spleen of ITP mouse. DMF-treated RAW264.7 cells showed S-phase arrest, increased apoptosis and downregulated expression of FcγRI and FcγRIV. Meanwhile, in vitro treatment of DMF also decreased the expression of cyclin D1 and E2, reduced Bcl-2 level and increased Bax expression and caspase-3 activation. CONCLUSIONS In conclusion, DMF prevents antibody-mediated platelet destruction in ITP mice possibly through promoting apoptosis, indicating that it might be used as a new approach for the treatment of ITP.
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Affiliation(s)
- Huan Tong
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Yangyang Ding
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Xiang Gui
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Zengtian Sun
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Guozhang Wang
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Sixuan Zhang
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Zhengqing Xu
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Xiamin Wang
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Xiaoqi Xu
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Wen Ju
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Yue Li
- School of Medical Technology, Xuzhou Medical University, Xuzhou, 221002, China
| | - Zhenyu Li
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China.,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China.,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China
| | - Lingyu Zeng
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China. .,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. .,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China. .,School of Medical Technology, Xuzhou Medical University, Xuzhou, 221002, China.
| | - Kailin Xu
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China. .,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. .,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China.
| | - Jianlin Qiao
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Road, Quanshan District, Xuzhou, 221002, Jiangsu, China. .,Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China. .,Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou, 221002, China.
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Potential Diagnostic Approaches for Prediction of Therapeutic Responses in Immune Thrombocytopenia. J Clin Med 2021; 10:jcm10153403. [PMID: 34362187 PMCID: PMC8347743 DOI: 10.3390/jcm10153403] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder in which, via unresolved mechanisms, platelets and megakaryocytes (MKs) are targeted by autoantibodies and/or T cells resulting in increased platelet destruction and impairment of MK function. Over the years, several therapeutic modalities have become available for ITP, however, therapeutic management has proven to be very challenging in several cases. Patients refractory to treatment can develop a clinically worsening disease course, treatment-induced toxicities and are predisposed to development of potentially life-endangering bleedings. It is therefore of critical importance to timely identify potential refractory patients, for which novel diagnostic approaches are urgently needed in order to monitor and predict specific therapeutic responses. In this paper, we propose promising diagnostic investigations into immune functions and characteristics in ITP, which may potentially be exploited to help predict platelet count responses and thereby distinguish therapeutic responders from non-responders. This importantly includes analysis of T cell homeostasis, which generally appears to be disturbed in ITP due to decreased and/or dysfunctional T regulatory cells (Tregs) leading to loss of immune tolerance and initiation/perpetuation of ITP, and this may be normalized by several therapeutic modalities. Additional avenues to explore in possible prediction of therapeutic responses include examination of platelet surface sialic acids, platelet apoptosis, monocyte surface markers, B regulatory cells and platelet microparticles. Initial studies have started evaluating these markers in relation to response to various treatments including glucocorticosteroids (GCs), intravenous immunoglobulins (IVIg) and/or thrombopoietin receptor agonists (TPO-RA), however, further studies are highly warranted. The systematic molecular analysis of a broad panel of immune functions may ultimately help guide and improve personalized therapeutic management in ITP.
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Thomas I, Panagoulias I, Aggeletopoulou I, Varvarigou A, Spiliotis BE, Mouzaki A. The Role of Leptin in Childhood Immune Thrombocytopenia (ITP): An Anti-Inflammatory Agent? Int J Mol Sci 2021; 22:ijms22147636. [PMID: 34299256 PMCID: PMC8306583 DOI: 10.3390/ijms22147636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/07/2021] [Accepted: 07/14/2021] [Indexed: 12/21/2022] Open
Abstract
To investigate the effect of leptin in childhood ITP, we measured plasma leptin in 39 children with acute ITP, after treatment and in remission, and in 33 healthy age/BMI-matched controls. We also cultured ITP and control peripheral blood mononuclear cells (PBMCs) with recombinant leptin to assess its direct effect on pro/anti-inflammatory cytokine gene expression. A significant increase in leptin was observed in children with active disease compared to controls. A significant inverse correlation of leptin with platelet count was also observed in children with acute ITP. Leptin remained high after treatment with IVIg, whereas steroid treatment lowered leptin below control levels. In remission, leptin was in the control range. Cytokine gene expression was significantly increased in children with acute ITP compared with controls, with highest expression for IFN-γ and IL-10. IVIg/steroid treatment significantly decreased IFN-γ and IL-10 expression. In remission, IFN-γ and IL-10 expression remained low. Addition of leptin to PBMCs isolated from patients in remission resulted in a significant increase in IL-10 gene expression compared to controls. Further experiments with purified T-cells and monocytes identified monocytes as the source of leptin-induced IL-10. We suggest that leptin acts as an active anti-inflammatory agent in childhood ITP by promoting IL-10 secretion by monocytes.
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Affiliation(s)
- Iason Thomas
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, GR-26500 Patras, Greece; (I.T.); (I.P.); (I.A.)
- Allergy Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | - Ioannis Panagoulias
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, GR-26500 Patras, Greece; (I.T.); (I.P.); (I.A.)
| | - Ioanna Aggeletopoulou
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, GR-26500 Patras, Greece; (I.T.); (I.P.); (I.A.)
| | - Anastasia Varvarigou
- Department of Paediatrics, Medical School, Patras University Hospital, University of Patras, GR-26500 Patras, Greece; (A.V.); (B.E.S.)
| | - Bessie E. Spiliotis
- Department of Paediatrics, Medical School, Patras University Hospital, University of Patras, GR-26500 Patras, Greece; (A.V.); (B.E.S.)
| | - Athanasia Mouzaki
- Laboratory of Immunohematology, Division of Hematology, Department of Internal Medicine, Medical School, University of Patras, GR-26500 Patras, Greece; (I.T.); (I.P.); (I.A.)
- Correspondence: ; Tel.: +30-2610-969123
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Wang X, Lu J, Wei G, Tong H, Zhou J, Ding Y, Zhang S, Xu X, Lai R, Luo Q, Ju W, Yan Z, Zeng L, Xu K, Qiao J. Tacrolimus ameliorates thrombocytopenia in an ITP mouse model. Ann Hematol 2020; 99:2315-2322. [PMID: 32728937 DOI: 10.1007/s00277-020-04203-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/27/2020] [Indexed: 02/06/2023]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease characterized by lower platelet count resulting from immune cells-mediated platelet clearance. Tacrolimus is an immunosuppressive agent which selectively inhibits T cell activation. Whether tacrolimus plays a role in ITP remains unclear. This study aimed to investigate the effect of tacrolimus on ITP in mice. An ITP mouse model was established by injection of rat anti-mouse integrin GPIIb/CD41 immunoglobulin and treated with tacrolimus followed by isolation of peripheral blood mononuclear cells and plasma. The mRNA expression of T-bet, GATA3, and Foxp3 was measured by RT-PCR, and level of IFN-γ, IL-12p70, IL-4, IL-13, and TGF-β in plasma was measured by ELISA. Tacrolimus inhibited antiplatelet antibody-mediated platelet clearance in ITP mouse model. Meanwhile, tacrolimus-treated ITP mice displayed a significant decrease in the mRNA expression of T-bet and plasma level of IFN-γ and IL-12p70 compared with ITP mice but without differences when compared with normal mice. Furthermore, the expression of GATA3, Foxp3, and plasma level of IL-4 and TGF-β were upregulated in tacrolimus-treated ITP mice without significant differences to normal mice (except TGF-β). Tacrolimus prevents antiplatelet antibody-mediated thrombocytopenia in ITP mice possibly through regulating T cell differentiations, suggesting it might be a novel approach for preventing ITP.
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MESH Headings
- Animals
- Blood Platelets/immunology
- Cytokines/biosynthesis
- Cytokines/genetics
- Disease Models, Animal
- Gene Expression Regulation/drug effects
- Humans
- Immunosuppressive Agents/therapeutic use
- Isoantibodies/blood
- Mice
- Mice, Inbred C57BL
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- Purpura, Thrombocytopenic, Idiopathic/genetics
- Purpura, Thrombocytopenic, Idiopathic/metabolism
- RNA, Messenger/biosynthesis
- RNA, Messenger/genetics
- Specific Pathogen-Free Organisms
- T-Lymphocyte Subsets/drug effects
- T-Lymphocyte Subsets/immunology
- Tacrolimus/therapeutic use
- Transcription Factors/biosynthesis
- Transcription Factors/genetics
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Affiliation(s)
- Xiamin Wang
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Key Laboratory of Bone Marrow Stem Cell, Xuzhou, 221002, Jiangsu Province, China
| | - Jun Lu
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Guangyu Wei
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Key Laboratory of Bone Marrow Stem Cell, Xuzhou, 221002, Jiangsu Province, China
| | - Huan Tong
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Key Laboratory of Bone Marrow Stem Cell, Xuzhou, 221002, Jiangsu Province, China
| | - Jingxin Zhou
- Department of Hematology, The First People's Hospital of Suqian City, Suqian, 223899, China
| | - Yangyang Ding
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Key Laboratory of Bone Marrow Stem Cell, Xuzhou, 221002, Jiangsu Province, China
| | - Sixuan Zhang
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Key Laboratory of Bone Marrow Stem Cell, Xuzhou, 221002, Jiangsu Province, China
| | - Xiaoqi Xu
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Key Laboratory of Bone Marrow Stem Cell, Xuzhou, 221002, Jiangsu Province, China
| | - Ran Lai
- Department of Pharmacy, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221002, China
| | - Qi Luo
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Key Laboratory of Bone Marrow Stem Cell, Xuzhou, 221002, Jiangsu Province, China
| | - Wen Ju
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
- Key Laboratory of Bone Marrow Stem Cell, Xuzhou, 221002, Jiangsu Province, China
| | - Zhiling Yan
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China
| | - Lingyu Zeng
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China.
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China.
- Key Laboratory of Bone Marrow Stem Cell, Xuzhou, 221002, Jiangsu Province, China.
| | - Kailin Xu
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China.
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China.
| | - Jianlin Qiao
- Blood Diseases Institute, Xuzhou Medical University, 84 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China.
- Department of Hematology, The Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Rd, Quanshan District, Xuzhou, 221002, Jiangsu, China.
- Key Laboratory of Bone Marrow Stem Cell, Xuzhou, 221002, Jiangsu Province, China.
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11
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Jeon MJ, Yu ES, Kang KW, Lee BH, Park Y, Lee SR, Sung HJ, Yoon SY, Choi CW, Kim BS, Kim DS. Immature platelet fraction based diagnostic predictive scoring model for immune thrombocytopenia. Korean J Intern Med 2020; 35:970-978. [PMID: 32264655 PMCID: PMC7373978 DOI: 10.3904/kjim.2019.093] [Citation(s) in RCA: 3] [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: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/AIMS The diagnosis of immune thrombocytopenia (ITP) is based on clinical manifestations and there is no gold standard. Thus, even hematologic malignancy is sometimes misdiagnosed as ITP and adequate treatment is delayed. Therefore, novel diagnostic parameters are needed to distinguish ITP from other causes of thrombocytopenia. Immature platelet fraction (IPF) has been proposed as one of new parameters. In this study, we assessed the usefulness of IPF and developed a diagnostic predictive scoring model for ITP. METHODS We retrospectively studied 568 patients with thrombocytopenia. Blood samples were collected and IPF quantified using a fully-automated hematology analyzer. We also estimated other variables that could affect thrombocytopenia by logistic regression analysis. RESULTS The median IPF was significantly higher in the ITP group than in the non-ITP group (8.7% vs. 5.1%). The optimal cut-off value of IPF for differentiating ITP was 7.0%. We evaluated other laboratory variables via logistic regression analysis. IPF, hemoglobin, lactate dehydrogenase (LDH), and ferritin were statistically significant and comprised a diagnostic predictive scoring model. Our model gave points to each of variables: 1 to high hemoglobin (> 12 g/dL), low ferritin (≤ 177 ng/ mL), normal LDH (≤ upper limit of normal) and IPF ≥ 7 and < 10, 2 to IPF ≥ 10. The final score was obtained by summing the points. We defined that ITP could be predicted in patients with more than 3 points. CONCLUSION IPF could be a useful parameter to distinguish ITP from other causes of thrombocytopenia. We developed the predictive scoring model. This model could predict ITP with high probability.
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Affiliation(s)
- Min Ji Jeon
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Eun Sang Yu
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Ka-Won Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Byung-Hyun Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Yong Park
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Se Ryeon Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Hwa Jung Sung
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Soo Yong Yoon
- Department of Laboratory Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Chul Won Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Byung Soo Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Dae Sik Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
- Correspondence to Dae Sik Kim, M.D. Division of Hematology-Oncology, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea Tel: +82-2-2626-3062 Fax: +82-2-2626-2208 E-mail:
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12
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Systematic Identification of lncRNA-Associated ceRNA Networks in Immune Thrombocytopenia. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:6193593. [PMID: 32670393 PMCID: PMC7345964 DOI: 10.1155/2020/6193593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022]
Abstract
Primary immune thrombocytopenia (ITP) is an autoimmune disease. However, the molecular mechanisms underlying ITP remained to be further investigated. In the present study, we analyzed a series of public datasets (including GSE43177 and GSE43178) and identified 468 upregulated mRNAs, 272 downregulated mRNAs, 134 upregulated lncRNAs, 23 downregulated lncRNAs, 29 upregulated miRNAs, and 39 downregulated miRNAs in ITP patients. Then, we constructed protein-protein interaction networks, miRNA-mRNA and lncRNA coexpression networks in ITP. Bioinformatics analysis showed these genes regulated multiple biological processes in ITP, such as mRNA nonsense-mediated decay, translation, cell-cell adhesion, proteasome-mediated ubiquitin, and mRNA splicing. We thought the present study could broaden our insights into the mechanism underlying the progression of ITP and provide a potential biomarker for the prognosis of ITP.
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13
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Shabeeb Z, Faraj Y, Mahmood M, Mtashar B. Interplaying of regulatory T-cells and related chemokines in immune thrombocytopenic purpura patients. IRAQI JOURNAL OF HEMATOLOGY 2020. [DOI: 10.4103/ijh.ijh_40_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Upasani V, Vo HTM, Ung S, Heng S, Laurent D, Choeung R, Duong V, Sorn S, Ly S, Rodenhuis-Zybert IA, Dussart P, Cantaert T. Impaired Antibody-Independent Immune Response of B Cells in Patients With Acute Dengue Infection. Front Immunol 2019; 10:2500. [PMID: 31736948 PMCID: PMC6834554 DOI: 10.3389/fimmu.2019.02500] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/07/2019] [Indexed: 12/14/2022] Open
Abstract
Dengue is a mosquito-borne viral disease caused by dengue virus (DENV). The disease is endemic to more than 100 countries with 390 million dengue infections per year. Humoral immune responses during primary and secondary DENV infections are well-investigated. However, the impact of DENV infection on B cell subsets and their antibody-independent functions are not well-documented. Through this study, we aimed to define the distribution of B cell subsets in the acute phase of DENV infection and characterize the effect of DENV infection on B cell functions such as differentiation into memory and plasma cells and cytokine production. In our cohort of Cambodian children, we observed decreased percentages of CD24hiCD38hi B cells and CD27− naïve B cells within the CD19 population and increased percentages of CD27+CD38hiCD138+ plasma cells as early as 4 days post appearance of fever in patients with severe dengue compared to patients with mild disease. Lower percentages of CD19+CD24hiCD38hi B cells in DENV-infected patients were associated with decreased concentrations of soluble CD40L in patient plasma and decreased platelet counts in these patients. In addition, CD19+CD24hiCD38hi and CD19+CD27− B cells from DENV-infected patients did not produce IL-10 or TNF-α upon stimulation in vitro, suggesting their contribution to an altered immune response during DENV infection. In addition, CD19+CD27− naïve B cells isolated from dengue patients were refractory to TLR/anti-IgM stimulation in vitro, which correlated to the increased expression of inhibitory Fcγ receptors (FcγR) CD32 and LILRB1 on CD19+CD27− naïve B cells from DENV-infected patients. Collectively, our results indicate that a defective B cell response in dengue patients may contribute to the pathogenesis of dengue during the early phase of infection.
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Affiliation(s)
- Vinit Upasani
- Immunology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia.,Department of Medical Microbiology and Infection Prevention, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Hoa Thi My Vo
- Immunology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Sivlin Ung
- Immunology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Sothy Heng
- Kantha Bopha Children Hospital, Phnom Penh, Cambodia
| | - Denis Laurent
- Kantha Bopha Children Hospital, Phnom Penh, Cambodia
| | - Rithy Choeung
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Sopheak Sorn
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Sowath Ly
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Izabela A Rodenhuis-Zybert
- Department of Medical Microbiology and Infection Prevention, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Philippe Dussart
- Virology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
| | - Tineke Cantaert
- Immunology Unit, Institut Pasteur du Cambodge, Institut Pasteur International Network, Phnom Penh, Cambodia
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15
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Xu M, Wang X, Xu X, Wei G, Lu W, Luo Q, Li X, Liu Y, Ju W, Li Z, Xu K, Zeng L, Qiao J. Thalidomide prevents antibody-mediated immune thrombocytopenia in mice. Thromb Res 2019; 183:69-75. [PMID: 31670229 DOI: 10.1016/j.thromres.2019.09.035] [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: 05/15/2019] [Revised: 08/06/2019] [Accepted: 09/18/2019] [Indexed: 11/28/2022]
Abstract
Immune thrombocytopenia (ITP) is a heterogeneous autoimmune disorder characterized by immune-mediated platelet destruction, leading to lower platelet count. Thalidomide is considered as a novel immunomodulatory drug for treating several autoimmune diseases. Whether thalidomide can ameliorate ITP remains unclear. This study aims to evaluate the effect of thalidomide on ITP mouse model. ITP mouse model was established through intraperitoneal injection of rat anti-mouse integrin GPIIb/CD41 immunoglobulin. Thalidomide (10, 20 or 50 mg/kg body weight) was intraperitoneally injected into mice followed by antibody injection. Then, peripheral blood and plasma was isolated for analysis of platelet count and the level of IFN-γ and IL-17 in plasma. Meanwhile, spleen was extracted to measure the expression of CD68, a macrophage marker. In addition, macrophage cell line RAW264.7 was cultured and treated with thalidomide followed by analysis of cell viability, apoptosis as well as cell cycle. Thalidomide prevented antiplatelet antibody-mediated platelet destruction in ITP mouse model. Compared with vehicle (phosphate-buffered saline), thalidomide significantly inhibited the secretion of IFN-γ and IL-17 in ITP mouse and reduced the expression of CD68 in spleen. After thalidomide treatment, the cell viability of RAW264.7 cell was significantly reduced and the cell number in S phase was also significantly decreased. In addition, the expression of cyclin E2 was significantly reduced. In conclusion, thalidomide prevents antiplatelet antibody-mediated platelet destruction in ITP mouse possibly through reducing the number of macrophages, suggesting that it might be a novel approach for treating ITP.
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Affiliation(s)
- Mengdi Xu
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China
| | - Xiamin Wang
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China
| | - Xiaoqi Xu
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China
| | - Guangyu Wei
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China
| | - Wenyi Lu
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China
| | - Qi Luo
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China
| | - Xiaoqian Li
- Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Yun Liu
- Department of Clinical Laboratory, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wen Ju
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China
| | - Zhenyu Li
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China
| | - Kailin Xu
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China
| | - Lingyu Zeng
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China.
| | - Jianlin Qiao
- Blood Diseases Institute, Xuzhou Medical University, Xuzhou 221002, China; Department of Hematology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China; Key Laboratory of Bone Marrow Stem Cell, Jiangsu Province, Xuzhou 221002, China.
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16
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Zhang X, Zhang D, Li H, Yang R. IP-10 and MCP-1 gene polymorphisms in Chinese patients with chronic immune thrombocytopenia. Autoimmunity 2019; 52:235-241. [PMID: 31530029 DOI: 10.1080/08916934.2019.1666370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aberrant Th1/Th2 polarization is considered to play a crucial role in the abnormal immune state of primary immune thrombocytopenia (ITP). IFN-γ-inducible protein of 10 kilodaltons (IP-10) and Monocyte chemoattractant protein-1 (MCP-1) gene are involved in enhancing the Th1 and Th2 immune response, respectively. In this study we investigated the distributions of IP-10 (-201 G/A) and MCP-1 (-2518 A/G) polymorphisms in 323 patients with chronic ITP and 255 healthy controls by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP). The IP-10 and MCP-1 levels of blood serum from 79 adult ITP patients and 43 healthy controls were detected with ELISA. The frequency of AG + AA genotype in IP-10 (-201 G/A) was significantly higher in ITP patients than in controls, especially in female and adult patients. ITP patients showed higher IP-10 levels than normal controls. Moreover, both IP-10 (-201 G/A) heterozygote (GA) and homozygote minor allele (AA) patients had significantly increased IP-10 levels compared to homozygote genotype (GG) patients at diagnosis. No significant differences were revealed in genotypes and allele distributions of MCP-1 (-2518 A/G) between ITP patients and normal controls, as well as the MCP-1 levels. In conclusion, the -201 G/A polymorphism of IP-10 gene may be associated with the susceptibility of ITP in Chinese population.
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Affiliation(s)
- Xian Zhang
- The Hematology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Donglei Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China.,Tianjin Sino-US Diagnostics Co., Ltd, Tianjin, China
| | - Huiyuan Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
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17
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Zhang P, Zhang G, Liu X, Liu H, Yang P, Ma L. Mesenchymal stem cells improve platelet counts in mice with immune thrombocytopenia. J Cell Biochem 2019; 120:11274-11283. [PMID: 30775797 DOI: 10.1002/jcb.28405] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/27/2018] [Accepted: 12/06/2018] [Indexed: 01/24/2023]
Abstract
Immune thrombocytopenia (ITP) is a common autoimmune bleeding disorder. The breakdown of immune tolerance (regulatory T [Treg] cells and suppressor cytokines) plays an important role in ITP pathophysiology, especially in refractory ITP. Bone marrow-derived mesenchymal stem cells (BM-MSCs) show immunomodulatory properties and have been extensively utilized for autoimmune diseases. However, it has not been fully elucidated how BM-MSCs affect ITP. In this study, we explore the therapeutic mechanism of BM-MSCs on ITP in mice. Dose-escalation passive ITP mice were inducted by injection of MWReg30. BALB/c mice were randomly divided into two groups: ITP with BM-MSC transplantation and ITP controls. The serum levels of cytokines (interleukin 10 [IL-10] and transforming growth factor-β1 [TGF-β1]) were examined by enzyme-linked immunosorbent assays. The frequency of Treg cells in both peripheral blood and spleen mononuclear cells was analyzed by flow cytometry, and the forkhead box P3 (Foxp3) messenger RNA (mRNA) level was measured by real-time polymerase chain reaction. After BM-MSC treatment, the platelet (PLT) counts were significantly elevated. Meanwhile, cytokines (TGF-β1 and IL-10), the ratios of Treg cells, and the Foxp3 mRNA expression level were significantly higher in the BM-MSC group. Our results show that BM-MSCs can improve PLT counts mainly by secreting suppressive cytokines and upregulating Tregs, which may provide new therapeutic potential for human ITP.
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Affiliation(s)
- Ping Zhang
- Department of Hematology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, China.,Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Guoyang Zhang
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Liu
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hongyun Liu
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Pengfeng Yang
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Liping Ma
- Department of Hematology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,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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18
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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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19
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Oved JH, Lee CSY, Bussel JB. Treatment of Children with Persistent and Chronic Idiopathic Thrombocytopenic Purpura: 4 Infusions of Rituximab and Three 4-Day Cycles of Dexamethasone. J Pediatr 2017; 191:225-231. [PMID: 29173312 PMCID: PMC6020036 DOI: 10.1016/j.jpeds.2017.08.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/18/2017] [Accepted: 08/15/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To assess initial and long-term outcome of children with persistent/chronic idiopathic thrombocytopenic purpura (ITP) treated with 4 infusions of rituximab and three 4-day cycles of dexamethasone (4R+3Dex) including cohorts with most benefit and/or treatment associated toxicity. STUDY DESIGN All pediatric patients with ITP at Weill-Cornell who received 4R+3Dex were included in this retrospective study. Duration was median time from first rituximab infusion to treatment failure. Patient cohort included 33 children ages 1-18 years with persistent/chronic ITP; 19 were female, 10 of whom were adolescents. Every patient had failed more than 1 and usually several ITP treatments. RESULTS Children were treated with rituximab, 375 mg/m2 weekly for 4 weeks and three 4-day courses of dexamethasone 28 mg/m2 (40 mg max). Average age of nonresponders was 7.75 years, and initial responders averaged 12.7 years (P = .0073); 30% maintained continuing response at 60 months or last check-up. Eight of the 10 patients who underwent remission were female with ITP <24 months prior to initiating 4R+3Dex. All responding male patients except 2 relapsed. CONCLUSIONS Durable unmaintained ITP remission after 4R+3Dex was seen almost exclusively in female adolescents with <24 months duration of ITP. This provides a new therapeutic paradigm for a subpopulation with hard-to-treat chronic ITP. The pathophysiology of ITP underlying this distinction requires further elucidation.
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Affiliation(s)
- Joseph H. Oved
- Division of Pediatric Hematology, Weill Cornell Medicine, New York, NY,Division of Pediatric Hematology and Oncology, The Children’s Hospital of Philadelphia, PA,Division of Pediatric Oncology, Weill Cornell Medicine, New York, NY
| | | | - James B. Bussel
- Division of Pediatric Hematology, Weill Cornell Medicine, New York, NY
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20
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Xu LL, Fu HX, Zhang JM, Feng FE, Wang QM, Zhu XL, Xue J, Wang CC, Chen Q, Liu X, Wang YZ, Qin YZ, Kong Y, Chang YJ, Xu LP, Liu KY, Huang XJ, Zhang XH. Impaired Function of Bone Marrow Mesenchymal Stem Cells from Immune Thrombocytopenia Patients in Inducing Regulatory Dendritic Cell Differentiation Through the Notch-1/Jagged-1 Signaling Pathway. Stem Cells Dev 2017; 26:1648-1661. [PMID: 28946811 DOI: 10.1089/scd.2017.0078] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease in which dendritic cells (DCs) play a crucial role in the breakdown of self-tolerance. Studies have identified the function of mesenchymal stem cells (MSCs) in promoting the development of regulatory DCs (regDCs). Our previous work revealed that MSCs in ITP exerted senescence, apoptosis, and impaired immunosuppressive effects on T and B cells. However, it is unclear whether the effects of MSCs on regDC induction are altered in ITP. Our data demonstrated that MSCs in ITP were impaired in inhibiting CD1a+ DC and CD14+ DC differentiation from CD34+ hematopoietic progenitor cells (CD34+ HPCs). DCs differentiated with MSCs in ITP exhibited an increased expression of costimulatory molecules CD80/CD86 and secretion of proinflammatory interleukin-12 (IL-12). Accordingly, the tolerogenic characteristics were deficient in DCs induced by MSCs in ITP. DCs differentiated with MSCs in ITP exhibited an impaired ability to inhibit CD3+ T cell proliferation, to suppress T helper (Th)1 cell differentiation, and to induce anergic and regulatory T cells (Tregs). The expression of Notch signaling components was measured in MSCs in ITP. Reduced expression of the ligand Jagged-1, the receptor Notch-1 intracellular domain (NICD-1), and the target gene Hes-1 was identified in MSCs in ITP. The addition of biologically active Jagged-1 to CD34+ HPCs was observed to promote regDC differentiation. When cultured on Jagged-1-coated plates, MSCs in ITP showed an enhancement of the Notch-1 pathway activation, Jagged-1 expression, and the function in inducing regDCs. Pretreatment with all-trans retinoic acid (ATRA) was found to partially restore the capacity of MSCs in both ITP patients and healthy controls in inducing CD34+-derived regDCs. Our data elucidated that MSCs in ITP were impaired in inducing CD34+-regDCs, associated with the Notch-1/Jagged-1 signaling pathway. ATRA could partially correct the impairment of MSCs, suggesting that ATRA could serve as a potential therapeutic alternative for ITP.
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Affiliation(s)
- Lin-Lin Xu
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Hai-Xia Fu
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Jia-Min Zhang
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Fei-Er Feng
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Qian-Ming Wang
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Xiao-Lu Zhu
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Jing Xue
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Chen-Cong Wang
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Qi Chen
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Xiao Liu
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Ya-Zhe Wang
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Ya-Zhen Qin
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Yuan Kong
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Ying-Jun Chang
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Lan-Ping Xu
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Kai-Yan Liu
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Xiao-Jun Huang
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
| | - Xiao-Hui Zhang
- 1 Peking University People's Hospital, Peking University Institute of Hematology , Beijing, China .,2 Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation , Beijing, China .,3 Collaborative Innovation Center of Hematology, Peking University , Beijing, China
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21
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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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22
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La Manna MP, Orlando V, Dieli F, Di Carlo P, Cascio A, Cuzzi G, Palmieri F, Goletti D, Caccamo N. Quantitative and qualitative profiles of circulating monocytes may help identifying tuberculosis infection and disease stages. PLoS One 2017; 12:e0171358. [PMID: 28208160 PMCID: PMC5313257 DOI: 10.1371/journal.pone.0171358] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/19/2017] [Indexed: 01/31/2023] Open
Abstract
Tuberculosis (TB) is one of the most important cause of morbidity and death among infectious diseases, and continuous efforts are needed to improve diagnostic tools and therapy. Previous published studies showed that the absolute cells number of monocytes or lymphocytes in peripheral blood or yet the ratio of monocytes to lymphocytes displayed the ability to predict the risk of active TB. In the present study we evaluated the ratio of monocytes to lymphocytes variation and we also analyzed the ex-vivo expression of CD64 on monocytes as tools to identify biomarkers for discriminating TB stages. Significant differences were found when the average ratio of monocytes to lymphocytes of active TB patients was compared with latent TB infection (LTBI) subjects, cured TB and healthy donors (HD). By the receiver operator characteristics (ROC) curve analysis the cut-off value of 0.285, allowed the discrimination of active TB from HD, with a sensitivity of 91.04% and a specificity of 93.55% (95% of confidence interval: 0.92-0.99). The ROC curve analysis comparing TB patients and LTBI groups, led to a sensitivity and the specificity of the assay of 85.07% and 85.71%, respectively (95% of confidence interval: 0.85 to 0.96). The upregulation of CD64 expression on circulating monocytes in active TB patients could represent an additional biomarker for diagnosis of active TB. In conclusion, we found that the ML ratio or monocyte absolute count or phenotypic measures show predictive value for active TB.
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Affiliation(s)
- Marco Pio La Manna
- Central Laboratory of Advanced Diagnosis and Biomedical Research(CLADIBIOR), Azienda Universitaria Ospedaliera Policlinico P. Giaccone, Palermo, Italy
| | - Valentina Orlando
- Central Laboratory of Advanced Diagnosis and Biomedical Research(CLADIBIOR), Azienda Universitaria Ospedaliera Policlinico P. Giaccone, Palermo, Italy
| | - Francesco Dieli
- Central Laboratory of Advanced Diagnosis and Biomedical Research(CLADIBIOR), Azienda Universitaria Ospedaliera Policlinico P. Giaccone, Palermo, Italy
- Dipartimento di Biopatologia e Biotecnologie Mediche, Università di Palermo, Palermo, Italy
| | - Paola Di Carlo
- Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Antonio Cascio
- Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Gilda Cuzzi
- Translational Research Unit, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Fabrizio Palmieri
- Translational Research Unit, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Delia Goletti
- Translational Research Unit, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy
| | - Nadia Caccamo
- Central Laboratory of Advanced Diagnosis and Biomedical Research(CLADIBIOR), Azienda Universitaria Ospedaliera Policlinico P. Giaccone, Palermo, Italy
- Dipartimento di Biopatologia e Biotecnologie Mediche, Università di Palermo, Palermo, Italy
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23
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Helbig G, Wichary R, Torba K, Kyrcz-Krzemień S. Resolution of thrombocytopenia, but not polycythemia after ruxolitinib for polycythemia vera with detectable mutation in the exon 12 of the JAK2 gene. Med Oncol 2017; 34:31. [PMID: 28120162 PMCID: PMC5263189 DOI: 10.1007/s12032-017-0891-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/16/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, Dąbrowski Street 25, 40-032, Katowice, Poland.
| | - Ryszard Wichary
- Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, Dąbrowski Street 25, 40-032, Katowice, Poland
| | - Karolina Torba
- Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, Dąbrowski Street 25, 40-032, Katowice, Poland
| | - Sławomira Kyrcz-Krzemień
- Department of Hematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, Dąbrowski Street 25, 40-032, Katowice, Poland
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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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25
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Aref S, El-Ghonemy MS, El-Aziz SA, Abouzeid T, Talaab M, El-Sabbagh A. Impact of serum immunoglobulins level and IL-18 promoter gene polymorphism among Egyptian patients with idiopathic thrombocytopenic purpura. Hematology 2016; 22:99-104. [DOI: 10.1080/10245332.2016.1221213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Salah Aref
- Hematology Unit, Clinical Pathology Department, Mansoura Oncology Center, Mansoura Faculty of Medicine, Egypt
| | - Mohamed Sabry El-Ghonemy
- Hematology Unit, Clinical Pathology Department, Mansoura Oncology Center, Mansoura Faculty of Medicine, Egypt
| | - Sherin Abd El-Aziz
- Hematology Unit, Clinical Pathology Department, Mansoura Oncology Center, Mansoura Faculty of Medicine, Egypt
| | - Tarek Abouzeid
- Clinical Hematology Unit, Mansoura Oncology Center, Mansoura Faculty of Medicine, Egypt
| | - Mona Talaab
- Clinical Hematology Unit, Mansoura Oncology Center, Mansoura Faculty of Medicine, Egypt
| | - Amr El-Sabbagh
- Medical Microbiology and Immunology, Mansoura Faculty of Medicine, Egypt
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Xu XR, Zhang D, Oswald BE, Carrim N, Wang X, Hou Y, Zhang Q, Lavalle C, McKeown T, Marshall AH, Ni H. Platelets are versatile cells: New discoveries in hemostasis, thrombosis, immune responses, tumor metastasis and beyond. Crit Rev Clin Lab Sci 2016; 53:409-30. [PMID: 27282765 DOI: 10.1080/10408363.2016.1200008] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Platelets are small anucleate blood cells generated from megakaryocytes in the bone marrow and cleared in the reticuloendothelial system. At the site of vascular injury, platelet adhesion, activation and aggregation constitute the first wave of hemostasis. Blood coagulation, which is initiated by the intrinsic or extrinsic coagulation cascades, is the second wave of hemostasis. Activated platelets can also provide negatively-charged surfaces that harbor coagulation factors and markedly potentiate cell-based thrombin generation. Recently, deposition of plasma fibronectin, and likely other plasma proteins, onto the injured vessel wall has been identified as a new "protein wave of hemostasis" that may occur even earlier than the first wave of hemostasis, platelet accumulation. Although no experimental evidence currently exists, it is conceivable that platelets may also contribute to this protein wave of hemostasis by releasing their granule fibronectin and other proteins that may facilitate fibronectin self- and non-self-assembly on the vessel wall. Thus, platelets may contribute to all three waves of hemostasis and are central players in this critical physiological process to prevent bleeding. Low platelet counts in blood caused by enhanced platelet clearance and/or impaired platelet production are usually associated with hemorrhage. Auto- and allo-immune thrombocytopenias such as idiopathic thrombocytopenic purpura and fetal and neonatal alloimmune thrombocytopenia may cause life-threatening bleeding such as intracranial hemorrhage. When triggered under pathological conditions such as rupture of an atherosclerotic plaque, excessive platelet activation and aggregation may result in thrombosis and vessel occlusion. This may lead to myocardial infarction or ischemic stroke, the major causes of mortality and morbidity worldwide. Platelets are also involved in deep vein thrombosis and thromboembolism, another leading cause of mortality. Although fibrinogen has been documented for more than half a century as essential for platelet aggregation, recent studies demonstrated that fibrinogen-independent platelet aggregation occurs in both gene deficient animals and human patients under physiological and pathological conditions (non-anti-coagulated blood). This indicates that other unidentified platelet ligands may play important roles in thrombosis and might be novel antithrombotic targets. In addition to their critical roles in hemostasis and thrombosis, emerging evidence indicates that platelets are versatile cells involved in many other pathophysiological processes such as innate and adaptive immune responses, atherosclerosis, angiogenesis, lymphatic vessel development, liver regeneration and tumor metastasis. This review summarizes the current knowledge of platelet biology, highlights recent advances in the understanding of platelet production and clearance, molecular and cellular events of thrombosis and hemostasis, and introduces the emerging roles of platelets in the immune system, vascular biology and tumorigenesis. The clinical implications of these basic science and translational research findings will also be discussed.
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Affiliation(s)
- Xiaohong Ruby Xu
- a Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , ON , Canada .,b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada .,c Department of Medicine , Guangzhou University of Chinese Medicine , Guangzhou , Guangdong , P.R. China
| | - Dan Zhang
- b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada .,c Department of Medicine , Guangzhou University of Chinese Medicine , Guangzhou , Guangdong , P.R. China
| | - Brigitta Elaine Oswald
- b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada .,d Canadian Blood Services , Toronto , ON , Canada .,e Department of Physiology , University of Toronto , Toronto , ON , Canada
| | - Naadiya Carrim
- a Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , ON , Canada .,b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada .,d Canadian Blood Services , Toronto , ON , Canada
| | - Xiaozhong Wang
- b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada .,f The Second Affiliated Hospital of Nanchang University , Nanchang , Jiangxi , P.R. China
| | - Yan Hou
- b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada .,g Jilin Provincial Center for Disease Prevention and Control , Changchun , Jilin , P.R. China
| | - Qing Zhang
- b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada .,h State Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-Sen University , Guangzhou , Guangdong , P.R. China , and
| | - Christopher Lavalle
- b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada .,e Department of Physiology , University of Toronto , Toronto , ON , Canada
| | - Thomas McKeown
- b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada
| | - Alexandra H Marshall
- b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada
| | - Heyu Ni
- a Department of Laboratory Medicine and Pathobiology , University of Toronto , Toronto , ON , Canada .,b Department of Laboratory Medicine , Keenan Research Centre for Biomedical Science, St. Michael's Hospital, and Toronto Platelet Immunobiology Group, Li Ka Shing Knowledge Institute , Toronto , ON , Canada .,d Canadian Blood Services , Toronto , ON , Canada .,e Department of Physiology , University of Toronto , Toronto , ON , Canada .,i Department of Medicine , University of Toronto , Toronto , ON , Canada
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Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is an alloimmune disorder resulting from platelet opsonization by maternal antibodies that destroy fetal platelets. The major risk of FNAIT is severe bleeding, particularly intracranial hemorrhage. Miscarriage has also been reported but the incidence requires further study. Analogous to adult autoimmune thrombocytopenia (ITP), the major target antigen in FNAIT is the platelet membrane glycoprotein (GP)IIbIIIa. FNAIT caused by antibodies against platelet GPIbα or other antigens has also been reported, but the reported incidence of the anti-GPIbα-mediated FNAIT is far lower than in ITP. To date, the maternal immune response to fetal platelet antigens is still not well understood and it is unclear why bleeding is more severe in FNAIT than in ITP. In this review, we introduce the pathogenesis of FNAIT, particularly those new discoveries from animal models, and discuss possible improvements for the diagnosis, therapy, and prevention of this devastating disease.
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Qian C, Cui Q, Deng A, Qin Q, Chen H, Shen H, Wang Z, Ren C, Wu T. [Abnormal expression of IL- 23/IL- 17 axis in peripheral blood of 45 patients with primary immune thrombocytopenia]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:1035-8. [PMID: 26759108 PMCID: PMC7342327 DOI: 10.3760/cma.j.issn.0253-2727.2015.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the expression of IL- 23/IL- 17 axis in peripheral blood of patients with primary immune thrombocytopenia (ITP) and its clinical significance. METHODS The real-time quantitative reverse transcription-polymerase chain reaction(RT-PCR)was used to determine the expression of IL-23p19, p40, p35, IL-23R, IL-12Rβ1, IL-12Rβ2, IL-17A, IL-17F mRNA in the peripheral blood of 45 ITP patients and 30 healthy controls. The correlations between the expression of IL-23 and IL- 17, platelet counts, serum cytokine concentrations of ITP patients were analyzed. Furthermore, nine newly diagnosed ITP patients were followed up during treatment. RESULTS The gene expressions of IL-23p19, p40, IL-23R, IL-12Rβ1, IL-17A, IL-17F in ITP patients were significantly higher than those in healthy controls, the relative expression levels of ITP were 5.58, 2.13, 4.20, 2.45, 4.29, 2.50 times as much as that of healthy controls. And elevated serum IL-23[(198.70±94.56)ng/L vs(50.72±22.97)ng/L, t= 10.06, P<0.001], IL-17[(85.25±21.97)ng/L vs(11.39±4.27)ng/L, t=21.94,P<0.001]levels were also observed in these ITP patients. In addition, the serum IL-23 level in ITP patients was positively correlated with IL-17(r=0.496, P<0.01), but negatively correlated with the platelet counts(r=-0.408, P<0.01), and IL-17 level was negatively correlated with platelet counts(r=-0.464, P<0.01). CONCLUSION The IL-23/IL- 17 expression in ITP patients was significantly elevated, indicating IL-23/IL-17 play an important role in the pathogenesis of ITP.
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Affiliation(s)
| | - Qingya Cui
- Department of Hematology, 100th Hospital of PLA, Suzhou 215007, China
| | | | | | - Haifei Chen
- Department of Hematology, 100th Hospital of PLA, Suzhou 215007, China
| | - Hongshi Shen
- Department of Hematology, 100th Hospital of PLA, Suzhou 215007, China
| | | | | | - Tianqin Wu
- Department of Hematology, 100th Hospital of PLA, Suzhou 215007, China
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CD8+ T cells are predominantly protective and required for effective steroid therapy in murine models of immune thrombocytopenia. Blood 2015; 126:247-56. [PMID: 26036802 DOI: 10.1182/blood-2015-03-635417] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/28/2015] [Indexed: 12/11/2022] Open
Abstract
Immune thrombocytopenia (ITP) is a common autoimmune bleeding disorder characterized by autoantibodies targeting platelet surface proteins, most commonly GPIIbIIIa (αIIbβ3 integrin), leading to platelet destruction. Recently, CD8(+) cytotoxic T-lymphocytes (CTLs) targeting platelets and megakaryocytes have also been implicated in thrombocytopenia. Because steroids are the most commonly administered therapy for ITP worldwide, we established both active (immunized splenocyte engraftment) and passive (antibody injection) murine models of steroid treatment. Surprisingly, we found that, in both models, CD8(+) T cells limited the severity of the thrombocytopenia and were required for an efficacious response to steroid therapy. Conversely, CD8(+) T-cell depletion led to more severe thrombocytopenia, whereas CD8(+) T-cell transfusion ameliorated thrombocytopenia. CD8(+) T-regulatory cell (Treg) subsets were detected, and interestingly, dexamethasone (DEX) treatment selectively expanded CD8(+) Tregs while decreasing CTLs. In vitro coculture studies revealed CD8(+) Tregs suppressed CD4(+) and CD19(+) proliferation, platelet-associated immunoglobulin G generation, CTL cytotoxicity, platelet apoptosis, and clearance. Furthermore, we found increased production of anti-inflammatory interleukin-10 in coculture studies and in vivo after steroid treatment. Thus, we uncovered subsets of CD8(+) Tregs and demonstrated their potent immunosuppressive and protective roles in experimentally induced thrombocytopenia. The data further elucidate mechanisms of steroid treatment and suggest therapeutic potential for CD8(+) Tregs in immune thrombocytopenia.
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Son BR, Kim JY. Association of CD4(+)CD25(+)FoxP3(+) regulatory T cells with natural course of childhood chronic immune thrombocytopenic purpura. KOREAN JOURNAL OF PEDIATRICS 2015; 58:178-82. [PMID: 26124848 PMCID: PMC4481038 DOI: 10.3345/kjp.2015.58.5.178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 04/29/2015] [Accepted: 05/07/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to determine the frequency of CD4(+)CD25(+)FoxP3(+) regulatory T cells (Treg) in the peripheral blood of patients with childhood chronic immune thrombocytopenic purpura (ITP) exhibiting thrombocytopenia and spontaneous remission. The findings of this study indicate the possibility of predicting spontaneous recovery and pathogenesis of childhood chronic ITP. METHODS Eleven children with chronic ITP (seven thrombocytopenic and four spontaneous remission cases; mean age, 8.8 years; range, 1.7-14.9 years) were enrolled in this study. Five healthy children and eight healthy adults were included as controls. The frequency of Treg was evaluated by flow cytometry in the peripheral blood. RESULTS In this study, four patients (36%) achieved spontaneous remission within 2.8 years (mean year; range, 1.0-4.4 years). The frequency of Treg was significantly lower in patients with persisting thrombocytopenia (0.13%±0.09%, P<0.05), than that in the patients with spontaneous remission (0.30%±0.02%), healthy adults controls (0.55%±0.44%), and healthy children controls (0.46%±0.26%). A significantly positive correlation was found between the frequency of Treg and the platelet count in children. CONCLUSION These data suggest that a lower frequency of Treg contributes to the breakdown of self-tolerance, and may form the basis for future development of specific immunomodulatory therapies. Furthermore, Treg frequency has prognostic implication toward the natural course and long-term outcomes of childhood chronic ITP.
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Affiliation(s)
- Bo Ra Son
- Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ji Yoon Kim
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea. ; Department of Pediatric Hematology-Oncology, Kyungpook National University Children's Hospital, Kyungpook National University Medical Center, Daegu, Korea
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Zhao Z, Yang L, Yang G, Zhuang Y, Qian X, Zhou X, Xiao D, Shen Y. Contributions of T lymphocyte abnormalities to therapeutic outcomes in newly diagnosed patients with immune thrombocytopenia. PLoS One 2015; 10:e0126601. [PMID: 25978334 PMCID: PMC4433177 DOI: 10.1371/journal.pone.0126601] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 04/03/2015] [Indexed: 12/14/2022] Open
Abstract
T cell abnormalities have been reported to play an important role in pathogenesis of immune thrombocytopenia (ITP) besides specific autoantibodies towards platelet. The aim of this study was to explore the clinical importance of T lymphocyte subsets in adult patients with newly diagnosed ITP before and after first-line treatment. Elderly ITP patients were also studied and we tried to analyze the relationships between these items and therapeutic outcomes. The patients were treated with intravenous immunoglobulin (IVIG) plus corticosteroids and therapeutic responses were evaluated. As a result, compared with the controls, absolute lymphocyte counts in ITP patients decreased significantly before treatment. After treatment, lymphocyte counts restored to control level regardless of their treatment outcomes. In addition, we observed increased IgG and CD19+ cell expression and decreased CD4+/CD8+ cell ratio in both whole ITP group and elderly group before treatment. After treatment, the increased IgG and CD19+ cell expression could be reduced in both respond and non-respond group regardless of patient age, while CD4+/CD8+ cell ratio could not be corrected in non-respond ITP patients. In non-respond ITP patients, increased CD8+ cell expression was noticed and could not be corrected by first-line treatment. Furthermore, even lower NK cell expression was found in non-respond elderly patients after treatment when compared with that in controls. Our findings suggest that ITP patients usually had less numbers of peripheral lymphocytes and patients with higher levels of CD8+ cells or lower levels of CD4+/CD8+ cell ratio were less likely to respond to first-line treatment. Lower levels of NK cells made therapies in elderly ITP patients even more difficult.
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Affiliation(s)
- Zhenhua Zhao
- Department of Otolaryngology, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi, Jiangsu, 214002, People's Republic of China
| | - Lei Yang
- Department of Hematology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214023, People's Republic of China
| | - Guohua Yang
- Department of Hematology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214023, People's Republic of China
| | - Yun Zhuang
- Department of Hematology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214023, People's Republic of China
| | - Xifeng Qian
- Department of Hematology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214023, People's Republic of China
| | - Xin Zhou
- Department of Hematology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214023, People's Republic of China
| | - Dajiang Xiao
- Department of Otolaryngology, Nanjing Medical University Affiliated Wuxi Second Hospital, Wuxi, Jiangsu, 214002, People's Republic of China
- * E-mail: (YFS); (DJX)
| | - Yunfeng Shen
- Department of Hematology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214023, People's Republic of China
- * E-mail: (YFS); (DJX)
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Zhong H, Bussel J, Yazdanbakhsh K. In vitro TNF blockade enhances ex vivo expansion of regulatory T cells in patients with immune thrombocytopenia. Br J Haematol 2014; 168:274-83. [PMID: 25252160 DOI: 10.1111/bjh.13126] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/29/2014] [Indexed: 01/09/2023]
Abstract
Tumour necrosis factor-α (TNF) is an inflammatory cytokine that is elevated in a number of autoimmune diseases including immune thrombocytopenia (ITP), a bleeding disorder characterized by low platelet counts. In vitro TNF blockade increases expansion of the regulatory T cell (Treg) IKZF2 (also termed Helios) subset in T cell-monocyte cocultures from healthy donors, but its role on proliferative responses of Tregs in ITP patients, who have altered immunoregulatory compartment, remains unclear. TNF in CD4+ T cells from patients with chronic ITP were elevated and negatively correlated with peripheral Treg frequencies, suggesting a possible inhibitory effect of TNF on ITP Tregs. In vitro antibody neutralization with anti-TNF in T cell-monocyte cocultures resulted in a robust expansion of pre-existing ITP Tregs, higher than in healthy controls. Similar to the effects of anti-TNF antibodies, TNF blockade with antibodies against TNFRSF1B (anti-TNFRSF1B, previously termed anti-TNFRII) almost doubled ITP Treg expansion whereas neutralization with anti-TNFRSF1A (anti-TNFRI) antibodies had no effect on proliferative responses of Tregs. In addition, TNFRSF1B levels on ITP Tregs were significantly elevated, which may explain the increased susceptibility of patient Tregs to the actions of TNF blockade. Altogether, these data raise the possibility that TNF blockers, through their ability to increase Treg proliferation, may be efficacious in ITP patients.
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Affiliation(s)
- Hui Zhong
- Laboratory of Complement Biology, New York Blood Center, New York, NY, USA
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Zhang XM, Shan NN. The role of T cell immunoglobulin and mucin domain-3 in immune thrombocytopenia. Scand J Immunol 2014; 79:231-6. [PMID: 24383985 DOI: 10.1111/sji.12153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/09/2013] [Indexed: 12/16/2022]
Abstract
T cell immunoglobulin and mucin domain-3 (TIM-3), originally identified as a T helper (Th) 1-specific type I membrane protein, plays a vital role in Th1 immunity and tolerance induction through interaction with its ligand, galectin-9. The binding of TIM-3 by galectin-9 serves to downregulate Th1 responses. Moreover, the regulatory function of TIM-3 has been extended to other cells, such as Th17 cells, CD4(+) CD25(+) regulatory T cells (Tregs), CD8(+) T cells and certain innate immune cells. Previous studies have acknowledged that the TIM-3 pathway is involved in the pathogenesis of several human autoimmune diseases, such as systemic lupus erythematous, rheumatoid arthritis and aplastic anaemia. Moreover, genetic data suggest a role for TIM-3 in human autoimmune diseases. However, in immune thrombocytopenia (ITP), a common Th1- and possibly Th17-biased autoimmune disorder, the role of TIM-3 has not been explored. Recently, our data have demonstrated that TIM-3 expression is reduced in ITP patients, and we have found a potential link between ITP and the TIM-3 pathway. In this article, we discuss and speculate on the role of the TIM-3 pathway in ITP.
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Affiliation(s)
- X-M Zhang
- Department of Hematology, Shandong provincial Hospital affiliated to Shandong University, Jinan, China
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Lazarus AH, Semple JW, Cines DB. Innate and adaptive immunity in immune thrombocytopenia. Semin Hematol 2014; 50 Suppl 1:S68-70. [PMID: 23664521 DOI: 10.1053/j.seminhematol.2013.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by both accelerated clearance of autoantibody-sensitized platelets and suboptimal platelet production. A number of studies have provided evidence of disturbed innate and adaptive immune responses in patients with ITP. This brief review will highlight some of the more recent work in this field and highlight other findings that provide a potential link between ITP, systemic lupus erythematosus (SLE), and autoimmune hemolytic anemia (AHA).
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Abstract
The diagnosis and management of children with autoimmune cytopenias can be challenging. Children can present with immune-mediated destruction of a single-cell lineage or multiple cell lineages, including platelets (immune thrombocytopenia [ITP]), erythrocytes (autoimmune hemolytic anemia), and neutrophils (autoimmune neutropenia). Immune-mediated destruction can be primary or secondary to a comorbid immunodeficiency, malignancy, rheumatologic condition, or lymphoproliferative disorder. Treatment options generally consist of nonspecific immune suppression or modulation. This nonspecific approach is changing as recent insights into disease biology have led to targeted therapies, including the use of thrombopoietin mimetics in ITP and sirolimus for cytopenias associated with autoimmune lymphoproliferative syndrome.
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Zhang D, Zhang X, Ge M, Xuan M, Li H, Yang Y, Fu R, Zhou F, Zheng Y, Yang R. The polymorphisms of T cell-specific TBX21 gene may contribute to the susceptibility of chronic immune thrombocytopenia in Chinese population. Hum Immunol 2013; 75:129-33. [PMID: 24262372 DOI: 10.1016/j.humimm.2013.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 11/05/2013] [Accepted: 11/11/2013] [Indexed: 02/07/2023]
Abstract
Chronic primary immune thrombocytopenia (ITP) is an acquired autoimmune hemorrhagic disease characterized by both reduced platelet counts and suppression of megakaryocyte and platelet development. T cell-specific T-box transcription factor gene (TBX21) plays a critical role in the development and maintenance of T helper 1 (Th1) cells. Recently, several studies have confirmed that the T-1554C and T-1993C polymorphisms of this gene can influence its expression level and are associated with autoimmune diseases. Therefore, we speculated that TBX21 polymorphisms might be associated with the susceptibility of chronic ITP in Chinese population. We investigated the distributions of TBX21 (T-1514C and T-1993C) polymorphisms in 275 patients with chronic ITP and 261 healthy controls by polymerase chain reaction-restriction fragment length polymorphism. We observed significant overrepresentation of T allele and T/T genotype at T-1993C (but not T-1514C) in patients compared with controls. Stratified analysis by gender and age of disease onset revealed comparable observations in both female and childhood ITP cohorts. In conclusion, the T-1993C polymorphisms of TBX21 gene may be associated with the susceptibility of chronic primary ITP in Chinese population.
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Affiliation(s)
- Donglei Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Tianjin 300020, China
| | - Xian Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Tianjin 300020, China
| | - Meili Ge
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Tianjin 300020, China
| | - Min Xuan
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Tianjin 300020, China
| | - Huiyuan Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Tianjin 300020, China
| | - Yanhui Yang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Tianjin 300020, China
| | - Rongfeng Fu
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Tianjin 300020, China
| | - Fangfang Zhou
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Tianjin 300020, China
| | - Yizhou Zheng
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Tianjin 300020, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 288 Nanjing Road, Tianjin 300020, China.
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