Effect of short-term, high-dose methylprednisolone on oxidative stress in children with acute immune thrombocytopenia

Abstract

BackgroundImmune thrombocytopenia (ITP) is the most common cause of acquired childhood thrombocytopenia and is characterized by increased immune-mediated destruction of circulating thrombocytes. Oxidative damage may be involved in ITP pathogenesis; paraoxonase (PON) and arylesterase (ARE) enzymes are closely associated with the cellular antioxidant system. We investigated the effect of short-term high-dose methylprednisolone (HDMP) treatment on the total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), and PON and ARE enzymatic activity in children with acute ITP.MethodsThirty children with acute ITP constituted the study group and 30 healthy children constituted the control group. Children with acute ITP were treated with HDMP: 30 mg/kg for 3 days, then 20 mg/kg for 4 days. The TOS, TAC, OSI, PON, and ARE levels were determined before and after 7 days of HDMP treatment.ResultsThe TAC level (P<0.001), and PON (P<0.001) and ARE (P=0.001) activities were lower and the TOS (P=0.003) and OSI (P<0.001) levels were higher in children with acute ITP than those in healthy children in the control group. We also observed statistically significant increases in the TAC (P<0.01), PON (P<0.001) and ARE levels (P=0.001) and decreases in the TOS (P<0.05) and OSI levels (P<0.05) with 7 days of HDMP treatment compared to their values before treatment.ConclusionOur study demonstrated increased oxidative stress (OSI and TOC) and decreased antioxidant capacity (TAC), PON, and ARE in ITP patients and that steroid treatment could be effective in reducing the oxidative stress.

Oxidative Stress and Antioxidant Status in Immune Thrombocytopenia

“…Meanwhile, for children and adolescents who were diagnosed with ITP, Akbayram et al [43] did not find significant differences in the oxidative stress and antioxidant capacity following steroid treatment. While Cura et al [44] demonstrated an increase in the mean total antioxidant status level, and a decrease in the mean total oxidant status and oxidative stress index levels following one week of high-dose methylprednisolone treatment in children ITP. In addition, it has been proved an inhibitory effect of dexamethasone and prednisolone on the generation of reactive oxygen species from platelets, and this effect of both drugs was dose-dependent.…”

Thiol / disulfide balance and oxidative stress parameters in pediatric patients diagnosed with acute and chronic idiopathic thrombocytopenic purpura

“…19 The results of our study show that TOS and OSI levels are higher in acute and chronic ITP patients compared to the control group, and that TAS level in acute ITP patients is lower compared to the chronic ITP and control groups. Cura et al 7 found that TAS level was lower and TOS and OSI levels were significantly higher in acute ITP patients compared to the control group. Akbayram et al 8 reported that they could not detect a significant difference in TAS levels between acute and chronic ITP patients, and that TAS level decreased in both acute ITP and chronic ITP groups compared to healthy controls.…”

“…17 Free radicals, which normally occur as a product of physiological events in our body, are in a certain balance with antioxidants.6 There are studies suggesting that oxidative stress triggers autoimmunity in both acute and chronic ITP, leading to impairment in platelet structure and platelet dysfunction. 4,7,8,16,18,19 It has also been reported that oxidative stress plays a role in acute ITP becoming chronic. 19 The results of our study show that TOS and OSI levels are higher in acute and chronic ITP patients compared to the control group, and that TAS level in acute ITP patients is lower compared to the chronic ITP and control groups.…”

“…6 Studies have reported that total oxidant level (TOS) and oxidative stress index (OSI) values are higher and total antioxidant level (TAS) is lower in both acute ITP and chronic ITP patients compared to healthy control groups. 7,8 Thiols are organic compounds consisting of a sulfur atom and a hydrogen atom attached to a carbon atom and containing a sulfhydryl group (-SH). While thiols in plasma are primarily composed of albumin and proteins, a few are composed of thiols with low molecular weight such as cysteine, cysteinylglycine, glutathione, homocysteine and γ-glutamyl cysteine.…”

Jianpi Yiqi Shexue ameliorates immune thrombocytopenia related fatigue by regulating mitochondrial function

“…Moreover, antioxidant therapy was shown to ameliorate the bleeding tendency in patients with ITP (29). Importantly, the firstline therapy, methylprednisolone, can effectively reduce the oxidative stress in patients with ITP (30). Thus, oxidative activity might play a pivotal role in the process of ITP.…”