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Žibřidová K, Souček O, Krčmová LK, Jankovičová K, Gančarčíková M, Pejková MA, Drugda J, Nováková D, Košťál M. Lymphocyte subpopulations: a potential predictor of a response in patients with immune thrombocytopenia. Hematology 2024; 29:2304486. [PMID: 38251842 DOI: 10.1080/16078454.2024.2304486] [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: 09/25/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder caused by increased platelet destruction and altered production. Despite the well-described pathophysiological background of immune dysregulation, current treatment guidelines consist of monotherapy with different drugs, with no tool to predict which patient is more suitable for each therapeutic modality. METHODS In our study, we attempted to determine differences in the immune setting, comparing the patients' responses to administered therapy. During 12-month follow-up, we assessed blood count, antiplatelet autoantibodies, and T lymphocyte subsets in peripheral blood in 35 patients with ITP (newly diagnosed or relapsed disease). RESULTS Our data show that the value of antiplatelet autoantibodies, the percentage of cytotoxic T lymphocytes, and the immunoregulatory index (IRI, CD4+ / CD8+ T cell ratio) differ significantly by treatment response. Responders have a higher IRI (median 2.1 vs. 1.5 in non-responders, P = 0.04), higher antiplatelet autoantibodies (median 58 vs. 20% in non-responders, P = 0.01) and lower relative CD8+ T cells count (P = 0.02) before treatment. DISCUSSION The results suggest that immunological parameters (antiplatelet autoantibodies, relative CD8+ T cell count and IRI) could be used as prognostic tools for a worse clinical outcome in patients with ITP. CONCLUSION These biomarkers could be utilized for stratification and eventually selection of treatment preferring combination therapy.
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Affiliation(s)
- Kateřina Žibřidová
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Ondřej Souček
- Department of Clinical Immunology and Allergology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Lenka Kujovská Krčmová
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Karolína Jankovičová
- Department of Clinical Immunology and Allergology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Markéta Gančarčíková
- Department of Clinical Biochemistry and Diagnostics, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Mária Anna Pejková
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Jan Drugda
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Denisa Nováková
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Milan Košťál
- 4th Department of Internal Medicine - Hematology, University Hospital Hradec Králové, Hradec Králové, Czech Republic
- Academic Department of Internal Medicine, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
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Allegra A, Cicero N, Mirabile G, Giorgianni CM, Gangemi S. Novel Biomarkers for Diagnosis and Monitoring of Immune Thrombocytopenia. Int J Mol Sci 2023; 24:ijms24054438. [PMID: 36901864 PMCID: PMC10003036 DOI: 10.3390/ijms24054438] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
Lower-than-normal platelet counts are a hallmark of the acquired autoimmune illness known as immune thrombocytopenia, which can affect both adults and children. Immune thrombocytopenia patients' care has evolved significantly in recent years, but the disease's diagnosis has not, and it is still only clinically achievable with the elimination of other causes of thrombocytopenia. The lack of a valid biomarker or gold-standard diagnostic test, despite ongoing efforts to find one, adds to the high rate of disease misdiagnosis. However, in recent years, several studies have helped to elucidate a number of features of the disease's etiology, highlighting how the platelet loss is not only caused by an increase in peripheral platelet destruction but also involves a number of humoral and cellular immune system effectors. This made it possible to identify the role of immune-activating substances such cytokines and chemokines, complement, non-coding genetic material, the microbiome, and gene mutations. Furthermore, platelet and megakaryocyte immaturity indices have been emphasized as new disease markers, and prognostic signs and responses to particular types of therapy have been suggested. Our review's goal was to compile information from the literature on novel immune thrombocytopenia biomarkers, markers that will help us improve the management of these patients.
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Affiliation(s)
- Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98100 Messina, Italy
- Correspondence:
| | - Nicola Cicero
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences (BIOMORF), University of Messina, 98100 Messina, Italy
| | - Giuseppe Mirabile
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, 98100 Messina, Italy
| | - Concetto Mario Giorgianni
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences (BIOMORF), University of Messina, 98100 Messina, Italy
| | - Sebastiano Gangemi
- Allergy and Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
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Hassan T, Abdel Rahman D, Raafat N, Fathy M, Shehab M, Hosny A, Fawzy R, Zakaria M. Contribution of interleukin 27 serum level to pathogenesis and prognosis in children with immune thrombocytopenia. Medicine (Baltimore) 2022; 101:e29504. [PMID: 35758390 PMCID: PMC9276440 DOI: 10.1097/md.0000000000029504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
Concepts surrounding the mechanisms of thrombocytopenia in ITP have shifted from the traditional view of autoantibody mediated platelet destruction to more complex mechanisms in which impaired platelet production, T-cell-mediated effects, and disturbed cytokine profiles play a role. Interleukin 27 (IL-27) plays pleiotropic roles in immunomodulation and autoimmune diseases.We aimed to determine the level of IL-27 in patients with ITP and its relationship to patient and disease characteristics as well as disease chronicity and response to treatment.Sixty childrens with primary immune thrombocytopenia were consequetively enrolled in this study as well as 20 age and sex matched healthy controls.ITP patients had significantly higher levels of IL-27 than controls (770.6 and 373.8 pg/ml, respectively). Patients with acute ITP had the highest levels of IL-27 among patient groups, while patients in remission had the lowest IL-27 levels (860.1and 622.9 pg/ml, respectively). Patients who received IVIG and combined steroids plus IVIG had significantly higher IL-27 levels than others. Patients who received Eltrombopag had significantly lower IL-27 levels than others.IL-27 seems to play a role in pathogenesis of childhood ITP. IL-27 can be used as a predictor for disease occurrence as well as responsiveness to treatment.
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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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Zhao Y, Li J. A new NOTCH3 damaging variant in a thrombocytopenia family of Miao ethnic group. J Gene Med 2019; 21:e3130. [PMID: 31729093 DOI: 10.1002/jgm.3130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/15/2019] [Accepted: 10/01/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pediatric inherited thrombocytopenia, also known as a deficiency of platelets in children, is caused by genetic factors and it is hard to obtain an effective treatment. Thus, it is necessary to identify the possible genetic variants that are responsible for thrombocytopenia. METHODS Whole exome sequencing was used to detect genetic variants in two members of a thrombocytopenia family of Miao ethnic group. Multiple in silico analyses were performed to evaluate the effects of the novel missense variants. RESULTS Finally, a novel variant (chr19: g.15170364G>A) in the NOTCH3 gene was found, as confirmed with Sanger sequencing, which could result in a R1694Q substitution in the protein. This variant was consistently suggested to be damaging by sift (Sorting Tolerant From Intolerant; http://sift.jcvi.org), polyphen (Polymorphism Phenotyping, version 2.0; http://genetics.bwh.harvard.edu/pph2) and mutationtaster (http://www.mutationtaster.org) software. By building the 3D model of the key region of NOTCH3 protein and performing the structure simulation, we found that (i) this variant affected the 3D structure model with a root-mean-square deviation = 0.46 between wild-type and mutant type; (ii) this variant caused the protein to reduce the solvent accessible surface area by 421 Å2 ; and (iii) compared to the wild-type protein, the mutant protein had two less amino acids to maintain protein stability. CONCLUSIONS A novel damaging variant in the NOTCH3 gene was identified in a thrombocytopenia family with respect to decreasing the stability of NOTCH3, which may help with the prognosis and therapy of inherited thrombocytopenia.
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Affiliation(s)
- Yingling Zhao
- Department of Hematology, Longgang District Central Hospital of Shenzhen, Guangdong Province, China
| | - Juheng Li
- Department of Hematology, People's Hospital of Longgang District of Shenzhen, Guangdong Province, China
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Takahashi N, Saitoh T, Gotoh N, Nitta Y, Alkebsi L, Kasamatsu T, Minato Y, Yokohama A, Tsukamoto N, Handa H, Murakami H. The cytokine polymorphisms affecting Th1/Th2 increase the susceptibility to, and severity of, chronic ITP. BMC Immunol 2017; 18:26. [PMID: 28511637 PMCID: PMC5434613 DOI: 10.1186/s12865-017-0210-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND T-helper cell type 1 (Th1) polarization in chronic immune thrombocytopenia (cITP) has been reported at the protein and mRNA levels. We evaluated the impact of Th1/Th2 cytokine and cytokine receptor functional polymorphisms on both susceptibility to, and severity of, cITP. We analysed IFN-γ + 874 T/A, IFN-γR -611G/A, IL-4 -590C/T, and IL-4Rα Q576R polymorphisms in 126 cITP patients (male/female: 34/92; median age: 47.7 years) and 202 healthy control donors. Genotyping was determined by PCR and direct sequencing. The Th1/Th2 ratio was detected in peripheral blood mononuclear cells via flow cytometry. RESULTS cITP patients had a higher frequency of the IL-4Rα 576 non-QQ genotype compared to healthy subjects (P = 0.04). cITP patients with the IFN-γ +874 non-AA genotype (high expression type) showed more severe thrombocytopenia than those with the AA genotype (P < 0.05). cITP patients had a significantly higher Th1/Th2 ratio than control patients (P < 0.01); this ratio was inversely correlated with platelet counts. Furthermore, patients with both IFN-γ +874 non-AA genotype (high expression type) and IFN-γR -611 non-AA genotype (high-function type) had a significantly higher Th1/Th2 ratio (P < 0.05). CONCLUSIONS The cytokine polymorphisms affecting Th1/Th2 increase the susceptibility to, and severity of, chronic ITP.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Cells, Cultured
- Child
- Child, Preschool
- Chronic Disease
- Female
- Genetic Predisposition to Disease
- Genotype
- Humans
- Interferon-gamma/genetics
- Interferon-gamma/metabolism
- Interleukin-4/genetics
- Interleukin-4/metabolism
- Interleukin-4 Receptor alpha Subunit/genetics
- Interleukin-4 Receptor alpha Subunit/metabolism
- Male
- Middle Aged
- Polymorphism, Single Nucleotide
- Purpura, Thrombocytopenic, Idiopathic/genetics
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Receptors, Interferon/genetics
- Receptors, Interferon/metabolism
- Th1 Cells/immunology
- Th1-Th2 Balance/genetics
- Th2 Cells/immunology
- Young Adult
- Interferon gamma Receptor
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Affiliation(s)
- Noriyuki Takahashi
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514 Japan
| | - Takayuki Saitoh
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514 Japan
| | - Nanami Gotoh
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514 Japan
| | - Yasuhiro Nitta
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514 Japan
| | - Lobna Alkebsi
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514 Japan
| | - Tetsuhiro Kasamatsu
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514 Japan
| | - Yusuke Minato
- Department of Virology and Preventive Medicine, Gunma University, Gunma, Japan
| | - Akihiko Yokohama
- Division of Blood Transfusion Service, Gunma University Hospital, Gunma, Japan
| | | | - Hiroshi Handa
- Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hirokazu Murakami
- Graduate School of Health Sciences, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514 Japan
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Kundra A, Wang JC. Interferon induced thrombotic microangiopathy (TMA): Analysis and concise review. Crit Rev Oncol Hematol 2017; 112:103-112. [PMID: 28325251 DOI: 10.1016/j.critrevonc.2017.02.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/31/2016] [Accepted: 02/14/2017] [Indexed: 12/17/2022] Open
Abstract
Interferon (IFN) has been associated with development of thrombotic microangiopathy including thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). We reviewed literature from the earliest reported association in 1993, to July 2016 and found 68 cases. Analysis of this data shows: (1) Mean age at diagnosis was 47 years (95% CI, 44-50). (2) Majority of cases were seen where IFN was used for the treatment of chronic myelogenous leukemia (CML), multiple sclerosis (MS), chronic hepatitis C virus infection (HCV) and one case each for hairy cell leukemia (HCL) and Sezary syndrome. (3) There were no cases reported for polycythemia vera (PV) or lymphoma. (4) Sex distribution was nearly equivalent with the exception in patients with multiple sclerosis where there was female predominance (12 of 16 with reported data). (5) For pooled analysis, the average duration of treatment with IFN before TMA was diagnosed was 40.4 months. (6) Comparative analysis showed that patients with MS required the highest cumulative dose exposure before developing TMA (MS 68.6 months, CML 35.5 months, HCV 30.4 months). (7) Cases of confirmed TTP (where A disintegrin and Metalloprotease with thrombospondin type 1 motif 13: ADAMTS 13 level was measured) showed presence of an inhibitor. (8) In all cases of confirmed TTP, moderate to severe thrombocytopenia was a striking clinical feature at presentation while this was not a consistent finding in all other cases of TMA. (9) Outcome analysis revealed complete remission in 27 (40%), persistent chronic kidney disease (CKD) in 28 (42%) and fatality in 12 patients (18%). (10) Treatment with corticosteroids, plasma exchange and rituximab resulted in durable responses.
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Affiliation(s)
- Ajay Kundra
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Jen Chin Wang
- Division of Hematology/Oncology, Brookdale University Hospital Medical Center, Brooklyn, NY, USA.
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Narurkar R, Mamorska-Dyga A, Agarwal A, Nelson JC, Liu D. Babesiosis-associated immune thrombocytopenia. Stem Cell Investig 2017; 4:1. [PMID: 28217703 DOI: 10.21037/sci.2017.01.02] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/04/2017] [Indexed: 11/06/2022]
Abstract
Thrombocytopenia is a common feature of babesiosis. The mechanism for thrombocytopenia in babesiosis remains elusive. We report a case of babesiosis with severe new onset immune thrombocytopenia (ITP). In addition to antibiotics treatment for babesiosis, ITP therapy was administered. ITP in the present case was most likely triggered by the babesia infection. The severity of ITP in this case was not proportional to the severity of parasitemia. The neoantigen triggering the autoimmune response in babesiosis requires further characterization.
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Affiliation(s)
- Roshni Narurkar
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Aleksandra Mamorska-Dyga
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Anup Agarwal
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - John C Nelson
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
| | - Delong Liu
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, NY 10595, USA
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Zhong J, Chen S, Xu L, Lai J, Liao Z, Zhang T, Yu Z, Lu Y, Yang L, Wu X, Li B, Li Y. Lower expression of PD-1 and PD-L1 in peripheral blood from patients with chronic ITP. ACTA ACUST UNITED AC 2016; 21:552-7. [PMID: 27077771 DOI: 10.1080/10245332.2016.1155347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND T-cell dysregulation is a major event involved in immune thrombocytopenic purpura (ITP). Increasing data have indicated that abnormal expression of T-cell immunosuppressive receptors, such as programmed death (PD) 1 and cytotoxic T lymphocyte antigen-4 (CTLA-4), may be related to autoimmune disease pathogenesis. METHODS We analyzed the expression levels of PD-1, its ligand PD-L1, and CTLA-4 in peripheral blood mononuclear cells from 18 patients with chronic ITP by real-time polymerase chain reaction, and samples from 20 healthy individuals served as control. RESULTS The results demonstrated significantly lower expression of PD-1 (median: 0.0015) and PD-L1 (median: 0.0572) in chronic ITP patients compared with healthy individuals (PD-1: median: 0.0117, P < 0.0001; PD-L1: median: 0.5428, P < 0.0001), while there was no significant difference in the CTLA-4 expression level between the chronic ITP patients (median: 0.0818) and healthy individuals (median: 0.1667) (P = 0.219). Moreover, a positive correlation between the expression levels of PD-1 and PD-L1 (rs = 0.486, P = 0.041) and CTLA-4 and PD-1 (rs = 0.643, P = 0.004) in the chronic ITP patients was found. CONCLUSION Consistently lower expression of T-cell immunosuppressive receptors is a common characteristic of chronic ITP, which may be associated with its pathogenesis.
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Affiliation(s)
- Jun Zhong
- a Department of Hematology , First Affiliated Hospital, Jinan University , Guangzhou 510632 , China
| | - Shaohua Chen
- b Institute of Hematology, Medical College, Jinan University , Guangzhou 510632 , China
| | - Ling Xu
- b Institute of Hematology, Medical College, Jinan University , Guangzhou 510632 , China
| | - Jing Lai
- a Department of Hematology , First Affiliated Hospital, Jinan University , Guangzhou 510632 , China
| | - Ziwei Liao
- b Institute of Hematology, Medical College, Jinan University , Guangzhou 510632 , China
| | - Tao Zhang
- a Department of Hematology , First Affiliated Hospital, Jinan University , Guangzhou 510632 , China
| | - Zhi Yu
- a Department of Hematology , First Affiliated Hospital, Jinan University , Guangzhou 510632 , China
| | - Yuhong Lu
- a Department of Hematology , First Affiliated Hospital, Jinan University , Guangzhou 510632 , China
| | - Lijian Yang
- b Institute of Hematology, Medical College, Jinan University , Guangzhou 510632 , China
| | - Xiuli Wu
- b Institute of Hematology, Medical College, Jinan University , Guangzhou 510632 , China
| | - Bo Li
- b Institute of Hematology, Medical College, Jinan University , Guangzhou 510632 , China
| | - Yangqiu Li
- a Department of Hematology , First Affiliated Hospital, Jinan University , Guangzhou 510632 , China.,b Institute of Hematology, Medical College, Jinan University , Guangzhou 510632 , China.,c Key Laboratory for Regenerative Medicine of Ministry of Education , Jinan University , Guangzhou 510632 , China
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