Alterations in immune cell subsets and their cytokine secretion profile in childhood idiopathic thrombocytopenic purpura (ITP)

Talaat, Roba M.; Elmaghraby, Abeer; Barakat, Shahira; El-Shahat, Mohamed

doi:10.1111/cei.12279

Cited by 91 publications

(79 citation statements)

References 63 publications

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“…Rituximab, an anti-CD20 monoclonal antibody that depletes B cells, has been used to treat ITP for about a decade and has shown its efficacy in a subpopulation of ITP patients [25,26]. Our result, in agreement with previous studies [27][28][29], reported an increased frequency of B cells in ITP patients.…”

Section: Discussionsupporting

confidence: 92%

Regulatory and Memory B Lymphocytes in Children With Newly Diagnosed Immune Thrombocytopenia

Zahran¹,

Aly²,

Elabd³

et al. 2017

J Hematol

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Background: Immune (idiopathic) thrombocytopenic purpura (ITP) is a primary autoimmune disease. It is characterized by a diminished peripheral platelet count (< 100 × 10 9 /L) caused by platelet destruction with an increased risk of mucocutaneous bleeding. The diagnosis of ITP depends on clinical characteristics and the laboratory examinations conducted, as well as the ability to exclude other diseases associated with thrombocytopenia. Antiplatelet autoantibodies are responsible for platelet destruction and probably for inhibition of megakaryopoiesis. B lymphocytes participate in immune responses through production of antibodies, antigen presentation to T cells, and cytokine secretion. The aims of this study were to investigate the levels of Bregs and memory B lymphocytes in newly diagnosed pediatric ITP patients and to correlate their levels with the course of the disease.

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Section: Discussionsupporting

confidence: 92%

Regulatory and Memory B Lymphocytes in Children With Newly Diagnosed Immune Thrombocytopenia

Zahran¹,

Aly²,

Elabd³

et al. 2017

J Hematol

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“…72 Several studies have shown lower frequencies and/or impaired function of Tregs in adults as well as in children with ITP. [73][74][75][76][77] Although the exact mode of action remains For personal use only. on May 7, 2018. by guest www.bloodjournal.org From unclear, IVIg treatment might restore the immunologic balance by inducing Tregs and so might influence the clinical course of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…72 Several studies have shown lower frequencies and/or impaired function of Tregs in adults as well as in children with ITP. [73][74][75][76][77] Although the exact mode of action remains unclear, IVIg treatment might restore the immunologic balance by inducing Tregs and so might influence the clinical course of the disease. In children with lower platelet counts and higher bleeding tendency, both associated with a lower rate of chronic disease, treatment will be instituted more often than in children with higher platelet counts or a low bleeding tendency.…”

Section: Org Frommentioning

confidence: 99%

Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis

Heitink‐Pollé

Nijsten

Boonacker

et al. 2014

Blood

127

124

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Key Points• Older age, insidious onset, no preceding infection, mild bleeding, and higher platelet count are the strongest risk factors for chronic ITP.• Intravenous immunoglobulin treatment seems to protect against development of chronic ITP.Childhood immune thrombocytopenia (ITP) is a rare autoimmune bleeding disorder. Most children recover within 6 to 12 months, but individual course is difficult to predict. We performed a systematic review and meta-analysis to identify predictors of chronic ITP. We found 1399 articles; after critical appraisal, 54 studies were included. The following predictors of chronic ITP in children, assessed in at least 3 studies, have been identified: female gender (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.04-1.31), older age at presentation (age ‡11 years; OR 2.47, 95% CI 1.94-3.15), no preceding infection or vaccination (OR 3.08,, insidious onset (OR 11.27,), higher platelet counts at presentation ( ‡20 3 10 9 /L: OR 2.15, 95% CI 1.63-2.83), presence of antinuclear antibodies (OR 2.87, 95% 1.57-5.24), and treatment with a combination of methylprednisolone and intravenous immunoglobulin (OR 2.67, 95% CI 1. 44-4.96). Children with mucosal bleeding at diagnosis or treatment with intravenous immunoglobulin alone developed chronic ITP less often (OR 0.39, 95% CI 0.28-0.54 and OR 0.71, 95% CI 0.52-0.97, respectively). The protective effect of intravenous immunoglobulin is remarkable and needs confirmation in prospective randomized trials as well as future laboratory studies to elucidate the mechanism of this effect. (Blood. 2014;124(22):3295-3307) IntroductionChildhood immune thrombocytopenia (ITP) is a rare autoimmune disorder characterized by isolated thrombocytopenia (peripheral blood platelet count ,100 3 10 9 /L) in the absence of other causes that may be associated with thrombocytopenia.1 Most children present with a typical history of acute development of purpura and bruising, often after a mild viral infection. Management of newly diagnosed ITP consists of careful observation, regardless of platelet count. Severe bleeding, occurring in only 3% to 5% of children, 2 requires treatment with corticosteroids, intravenous immunoglobulin (IVIg), or anti-Rhesus-D immunoglobulin, either alone or in combination and, if life threatening, also with platelet and red blood cell transfusions. 3,4 Chronic ITP is currently defined as thrombocytopenia ,100 3 10 9 /L lasting for .12 months.1 About 20% to 25% of children with newly diagnosed ITP will develop chronic disease. Because of the high impact of ITP on a child's everyday life and activities, as well as to decide whether treatment has to be instituted to influence the clinical course of ITP, it is of clinical significance if the course of the disease could be predicted at time of diagnosis.Several clinical, therapeutic, laboratory, and genetic predictors of chronic ITP have been evaluated in children.5-7 A systematic review or meta-analysis, however, has not yet been performed. In this study, we systematically analyzed all...

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“…Monoclonal antibodies against FcγRIIIa have been shown to be effective in improving thrombocytopenia in ITP (22,23). Third, elevated Th2 cytokines (IL-4, IL-10) have been observed in patients with ITP (24). Fourth, decreased regulatory T (Treg) cells exhibiting impaired function have been observed in ITP patients (25)(26)(27)(28)(29)(30)(31).…”

Section: Discussionmentioning

confidence: 99%

Association of primary immune thrombocytopenia and common allergic diseases among children

et al. 2015

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Background:Growing evidence has revealed a link between autoimmune and allergic diseases. However, few studies have assessed the relationship between allergic diseases and primary immune thrombocytopenia (ITP), an autoimmune disease frequently occurring in children. This population-based case-control study investigated the association between common allergic diseases and the subsequent risk of developing ITP during childhood. Methods: This study investigated 1,203 children younger than 18 y of age who were diagnosed with ITP between 1998 and 2008, as well as 4,812 frequency-matched controls. The odds ratios of the association between ITP and preexisting allergic diseases were calculated. results: Children with every type of allergic disease examined in this study (except asthma) exhibited an increased risk of developing ITP; the lowest adjusted odds ratio (aOR) was 1.39 for allergic conjunctivitis (95% confidence interval (CI) = 1.09-1.79), whereas the greatest aOR was 1.84 for allergic rhinitis (95% CI = 1.49-2.27). The aORs increased with the number of concurrent allergic diseases to 2.89 (95% CI = 1.98-4.22) for children with at least three allergic diseases. conclusion: Children with atopic diathesis have a greater risk of subsequently developing ITP. The fundamental determinants of this relationship warrant further study.

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Alterations in immune cell subsets and their cytokine secretion profile in childhood idiopathic thrombocytopenic purpura (ITP)

Cited by 91 publications

References 63 publications

Regulatory and Memory B Lymphocytes in Children With Newly Diagnosed Immune Thrombocytopenia

Regulatory and Memory B Lymphocytes in Children With Newly Diagnosed Immune Thrombocytopenia

Clinical and laboratory predictors of chronic immune thrombocytopenia in children: a systematic review and meta-analysis

Association of primary immune thrombocytopenia and common allergic diseases among children

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