Contributions of T lymphocyte abnormalities to therapeutic outcomes in newly diagnosed patients with immune thrombocytopenia.

Zhenhua Zhao,Xifeng Qian,Dajiang Xiao,Yunfeng Shen,Yun Zhuang,Lei Yang,Guohua Yang,Xin Zhou,Jagadeesh Bayry

doi:10.1371/journal.pone.0126601

Zhenhua Zhao, Xifeng Qian + Show 7 more

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https://doi.org/10.1371/journal.pone.0126601

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Journal: PloS one	Publication Date: May 15, 2015
Citations: 17	License type: CC BY 4.0

Affiliation: Nanjing Medical University, Wuxi People's Hospital

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.

Highlights

Immune thrombocytopenia (ITP) is an immune-mediated bleeding disorder in which platelets are opsonized by autoantibodies and destroyed by macrophages in the spleen[1,2,3]
We analyzed absolute lymphocyte counts, IgG levels and T lymphocyte subsets in peripheral blood of 61 adult patients with newly diagnosed ITP before and after treatment in our department. We studied these items in elderly patients who accounted for a large population and tried to analyze the relationship between these immune parameters and therapeutic outcomes
This might be helpful for clinicians to choose alternative treatments for ITP patients, especially the increasing elderly ones

Summary

Introduction

Immune thrombocytopenia (ITP) is an immune-mediated bleeding disorder in which platelets are opsonized by autoantibodies and destroyed by macrophages in the spleen[1,2,3]. Autoantibodies mediated platelet destruction is considered to play a crucial role, increasing evidence suggests that the mechanism of ITP is complicated. T-cellmediated immune abnormalities have been considered important in the pathogenesis of ITP. T cell abnormalities include a significant shift towards T helper (Th) 1 cells and Th17 pro-inflammatory immune responses[6,7], the decreased number or defective function of regulatory T cells (Treg)[8,9], and the platelet destruction by cytotoxic T lymphocytes (CTLs) [10,11,12,13]. There are several reports of different amounts of natural killer (NK) cells that are functionally defective in peripheral blood from ITP patients[14,15,16]

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