Blood Res 2017; 52(4):
Published online December 31, 2017
https://doi.org/10.5045/br.2017.52.4.264
© The Korean Society of Hematology
1Department of Clinical Hematology, King George's Medical University, Lucknow, India.
2Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
3Department of Pathology, King George's Medical University, Lucknow, India.
4Department of Microbiology, King George's Medical University, Lucknow, India.
5Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Correspondence to : Anil Kumar Tripathi, M.D. Department of Clinical Hematology, King George's Medical University, Lucknow - 226003, India. aktkgmu@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Immune thrombocytopenia (ITP) is an immune-mediated disease caused by autoantibodies against platelets membrane glycoproteins GPIIb/IIIa and GPIb/IX. The etiology of ITP remains unclear. This study evaluated the association of polymorphisms in interleukin (
Genotyping of
Genotype differences in
Keywords Primary immune thrombocytopenia,
Immune thrombocytopenia (ITP) is an immune-mediated disease caused by autoantibodies against glycoproteins (GP) IIb/IIIa and GPIb/IX found in the platelet membrane [1]. According to recent guidelines from the International Working Group, ITP is clinically classified into three types, newly diagnosed (for all cases at diagnosis), persistent (for cases with ITP lasting between 3–12 mo from diagnosis, spontaneous remission not achieved after the removal of treatment in between 3–12 mo from diagnosis), and chronic ITP (lasting for more than 12 mo) [2]. The etiology of ITP remains unclear, but both environmental and genetic factors appear to play an important role in its pathogenesis [3]. The development of autoantibodies by B cells, multi-dysfunction in cellular immunity, and cytokine dysregulation are thought to play central roles in the pathophysiology of ITP [4].
A high Th1/Th2 ratio and inflammatory cytokine gene polymorphisms were shown to be associated with ITP [5,6,7]. T cell activity and cytokine abnormalities were found to play a major role in the pathophysiology of autoimmune diseases, including ITP [8,9]. Cytokines are key players known to maintain the balance between Th1 and Th2 cells. An Th1/Th2 imbalance leads to autoreactive B cell differentiation in ITP, and glucocorticoid treatment helps to restore the levels of Th1 and Th2 in ITP patients [10]. Activation of CD4+ T cells leads to a proinflammatory response with the production of autoreactive antibodies and increased expression of interleukin-2 (IL-2) and interferon-γ [11,12,13].
Among genetic factors, polymorphisms in inflammatory cytokine genes, human leukocyte antigen, Fcγ receptors, and tumor necrosis factor are related to ITP [14,15,16]. In addition, Wu et al. [17,18] found that IL-4, IL-10, and IL-1Ra polymorphisms contribute to childhood chronic ITP, while an IL-1β exon 5 polymorphism is associated with childhood ITP. In ITP, IL-1 family members are involved in the stimulation of megakaryocytopoiesis, regulation of platelet production, and generation of autoantibodies [19]. The
However, few studies have examined polymorphisms in ITP and most have evaluated children and adult from only two Eastern populations, Japan and China. No studies have been conducted on Indian subjects; therefore, our aim was to evaluate the correlation of polymorphisms in
The study protocol was approved by the Institutional Ethical Committee. Diagnosis, classification (severe ITP and non-severe ITP), and response assessment were conducted according to the International Working Group Classification 2009. Briefly, ITP was diagnosed as isolated thrombocytopenia (platelet counts <100×109/L) in the absence of other causes or disorders that may be associated with thrombocytopenia. Cases of ITP associated with secondary causes such as human immune deficiency virus, systematic lupus erythematous, and
Five milliliters of peripheral venous blood were collected in EDTA vials from all participants and stored at −80℃. Genomic DNA was extracted using a commercially available genomic DNA extraction kit, the QIAamp DNA extraction Kit (Blood DNA Mini Kit, Qiagen, Hilden, Germany) according to the blood and body fluid spin protocol. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. The reaction mixture of genotypes consisted of 10X buffer containing MgCl2 (2.5 µL), Taq 1 U/µL (1.5 µL), dNTPs 10 mmol (1 µL), forward primer 10 pmol (1 µL), reverse primer 10 pmol (1 µL), DNA (1.5–50 ng/µL), and 16.5 µL high-performance liquid chromatography-grade water in a 25-µL reaction mixture. Primer sequences of
Allele and genotype frequencies were estimated by the allele counting method. Hardy-Weinberg estimates (HWE) for genotype frequencies were calculated using Haploview software. HWE was tested using the χ2 test with a degree of freedom of 1. A
In this study, a total of 218 individuals (Patients=118 and healthy controls=100) were recruited. ITP is found to be more prevalent in women than in men. The proportion of women in ITP patient and healthy control groups was 62.71% and 58% respectively. Severe & non-severe ITP cases were 62 (52.54%) and 56 (47.46%) respectively. Eighty patients (67.80%) showed complete response to corticosteroid therapy. All the demographic details of patients and healthy controls are given in (Table 1).
The present study revealed that genotypes of both homozygous and heterozygous variants of
To determine the association between these polymorphisms and disease severity, we analyzed the data between severe, non-severe, and healthy controls. Notably, a significant association was observed between homozygous variant genotypes of
The genotypic and allelic frequencies of
ITP is an autoimmune disorder characterized by the presence of platelet antibodies that accelerate platelet destruction and inhibit their production [22]. Although the etiology of ITP remains unclear, it is generally accepted that both environmental and genetic factors play an important role in development of the disease [6,15,23,24]. Many recent studies have focused on the association between cytokine gene polymorphism ITP susceptibility [16,17,18]. Alternations in cytokine levels may contribute to disease status [19,23]. Few studies have examined cytokine gene polymorphisms in patients with ITP in India. Therefore, in the present study, we evaluated polymorphisms in various cytokine genes (
The data from the present study demonstrate an association between polymorphisms in both homozygous and heterozygous variants of
We found that the presence of allele-II in
In conclusion,
a)Statistically significant susceptible genotype.
Abbreviations: CI, confidence interval; OR, odds ratio.
a)Statistically significant susceptible genotype.
Abbreviations: CI; confidence Interval; OR, odds ratio.
a)Statistically significant susceptible genotype.
Abbreviations: CI, confidence interval; OR, odds ratio.
Blood Res 2017; 52(4): 264-269
Published online December 31, 2017 https://doi.org/10.5045/br.2017.52.4.264
Copyright © The Korean Society of Hematology.
Deependra Kumar Yadav1, Anil Kumar Tripathi1*, Divya Gupta2, Saurabh Shukla1, Aloukick Kumar Singh5, Ashutosh Kumar3, Jyotsna Agarwal4, and K. N. Prasad5
1Department of Clinical Hematology, King George's Medical University, Lucknow, India.
2Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
3Department of Pathology, King George's Medical University, Lucknow, India.
4Department of Microbiology, King George's Medical University, Lucknow, India.
5Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Correspondence to:Anil Kumar Tripathi, M.D. Department of Clinical Hematology, King George's Medical University, Lucknow - 226003, India. aktkgmu@gmail.com
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Immune thrombocytopenia (ITP) is an immune-mediated disease caused by autoantibodies against platelets membrane glycoproteins GPIIb/IIIa and GPIb/IX. The etiology of ITP remains unclear. This study evaluated the association of polymorphisms in interleukin (
Genotyping of
Genotype differences in
Keywords: Primary immune thrombocytopenia,
Immune thrombocytopenia (ITP) is an immune-mediated disease caused by autoantibodies against glycoproteins (GP) IIb/IIIa and GPIb/IX found in the platelet membrane [1]. According to recent guidelines from the International Working Group, ITP is clinically classified into three types, newly diagnosed (for all cases at diagnosis), persistent (for cases with ITP lasting between 3–12 mo from diagnosis, spontaneous remission not achieved after the removal of treatment in between 3–12 mo from diagnosis), and chronic ITP (lasting for more than 12 mo) [2]. The etiology of ITP remains unclear, but both environmental and genetic factors appear to play an important role in its pathogenesis [3]. The development of autoantibodies by B cells, multi-dysfunction in cellular immunity, and cytokine dysregulation are thought to play central roles in the pathophysiology of ITP [4].
A high Th1/Th2 ratio and inflammatory cytokine gene polymorphisms were shown to be associated with ITP [5,6,7]. T cell activity and cytokine abnormalities were found to play a major role in the pathophysiology of autoimmune diseases, including ITP [8,9]. Cytokines are key players known to maintain the balance between Th1 and Th2 cells. An Th1/Th2 imbalance leads to autoreactive B cell differentiation in ITP, and glucocorticoid treatment helps to restore the levels of Th1 and Th2 in ITP patients [10]. Activation of CD4+ T cells leads to a proinflammatory response with the production of autoreactive antibodies and increased expression of interleukin-2 (IL-2) and interferon-γ [11,12,13].
Among genetic factors, polymorphisms in inflammatory cytokine genes, human leukocyte antigen, Fcγ receptors, and tumor necrosis factor are related to ITP [14,15,16]. In addition, Wu et al. [17,18] found that IL-4, IL-10, and IL-1Ra polymorphisms contribute to childhood chronic ITP, while an IL-1β exon 5 polymorphism is associated with childhood ITP. In ITP, IL-1 family members are involved in the stimulation of megakaryocytopoiesis, regulation of platelet production, and generation of autoantibodies [19]. The
However, few studies have examined polymorphisms in ITP and most have evaluated children and adult from only two Eastern populations, Japan and China. No studies have been conducted on Indian subjects; therefore, our aim was to evaluate the correlation of polymorphisms in
The study protocol was approved by the Institutional Ethical Committee. Diagnosis, classification (severe ITP and non-severe ITP), and response assessment were conducted according to the International Working Group Classification 2009. Briefly, ITP was diagnosed as isolated thrombocytopenia (platelet counts <100×109/L) in the absence of other causes or disorders that may be associated with thrombocytopenia. Cases of ITP associated with secondary causes such as human immune deficiency virus, systematic lupus erythematous, and
Five milliliters of peripheral venous blood were collected in EDTA vials from all participants and stored at −80℃. Genomic DNA was extracted using a commercially available genomic DNA extraction kit, the QIAamp DNA extraction Kit (Blood DNA Mini Kit, Qiagen, Hilden, Germany) according to the blood and body fluid spin protocol. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism. The reaction mixture of genotypes consisted of 10X buffer containing MgCl2 (2.5 µL), Taq 1 U/µL (1.5 µL), dNTPs 10 mmol (1 µL), forward primer 10 pmol (1 µL), reverse primer 10 pmol (1 µL), DNA (1.5–50 ng/µL), and 16.5 µL high-performance liquid chromatography-grade water in a 25-µL reaction mixture. Primer sequences of
Allele and genotype frequencies were estimated by the allele counting method. Hardy-Weinberg estimates (HWE) for genotype frequencies were calculated using Haploview software. HWE was tested using the χ2 test with a degree of freedom of 1. A
In this study, a total of 218 individuals (Patients=118 and healthy controls=100) were recruited. ITP is found to be more prevalent in women than in men. The proportion of women in ITP patient and healthy control groups was 62.71% and 58% respectively. Severe & non-severe ITP cases were 62 (52.54%) and 56 (47.46%) respectively. Eighty patients (67.80%) showed complete response to corticosteroid therapy. All the demographic details of patients and healthy controls are given in (Table 1).
The present study revealed that genotypes of both homozygous and heterozygous variants of
To determine the association between these polymorphisms and disease severity, we analyzed the data between severe, non-severe, and healthy controls. Notably, a significant association was observed between homozygous variant genotypes of
The genotypic and allelic frequencies of
ITP is an autoimmune disorder characterized by the presence of platelet antibodies that accelerate platelet destruction and inhibit their production [22]. Although the etiology of ITP remains unclear, it is generally accepted that both environmental and genetic factors play an important role in development of the disease [6,15,23,24]. Many recent studies have focused on the association between cytokine gene polymorphism ITP susceptibility [16,17,18]. Alternations in cytokine levels may contribute to disease status [19,23]. Few studies have examined cytokine gene polymorphisms in patients with ITP in India. Therefore, in the present study, we evaluated polymorphisms in various cytokine genes (
The data from the present study demonstrate an association between polymorphisms in both homozygous and heterozygous variants of
We found that the presence of allele-II in
In conclusion,
a)Statistically significant susceptible genotype..
Abbreviations: CI, confidence interval; OR, odds ratio..
a)Statistically significant susceptible genotype..
Abbreviations: CI; confidence Interval; OR, odds ratio..
a)Statistically significant susceptible genotype..
Abbreviations: CI, confidence interval; OR, odds ratio..
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