Assessment of Serum IL-6 and TNF-α in Egyptian Children with ITP: Relation to Serum Immunoglobulins Level

Abstract

I TP is a complex disorder of immune dysregulation however; the final pathway is loss of tolerance of the immune system to self-antigens located on the surface of the platelets and megakaryocytes. The mechanisms of ITP include auto-antibodies, cytokines, antigen-presenting cells, co-stimulatory molecules, T- lymphocytes and B-lymphocytes. While auto-reactive B-lymphocytes produce anti-platelet auto- antibodies, T-lymphocytes cytokines as (TNF-α and IL-6) were found to have also an important role in the pathogenesis of ITP. ITP is usually a benign, self-limiting disease in children. However, about 10% of childhood newly diagnosed ITP progress to a chronic form. Determinations of the risk factors for developing chronic ITP and the prognosis for chronic ITP are issues for discussion among investigators. The present study aimed to focus on evaluating serum levels of immunoglobulins (IgM, IgG and IgA), TNF-α and IL-6 in acute and chronic primary ITP and to assess their possible roles as predictors of the course of the disease. It also aimed to determine the possible correlation between the studied parameters. This study was conducted at hematology/oncology department, pediatric hospital, Ain-shams University on 20 ITP patients and 10 healthy children serving as controls. The patient group included 10 patients with acute ITP and 10 patients with chronic ITP. All patients and controls were subjected to full detailed history, thorough clinical examination and laboratory investigations including: • Complete blood count using Sysemax XT-1800i (Sysmex Corporation. German). • Serum levels of immunoglobulins (IgM, IgG and IgA) by nephlometric method (MININEPH). • Serum levels of TNF-α and IL-6 using ELISA. Statistical studies were done to detect significant difference, relation and correlation between various parameters in different groups. Patients with acute ITP were followed up over the study period. The present study demonstrated a statistically significant difference between acute ITP and chronic ITP patients regarding age at time of examination (P<0.05). Patients with acute ITP are statistically younger than patients with chronic ITP. Regarding platelet count, there was statistically highly significant difference between patients and controls (P<0.001). Platelet count was statistically lower in patients than controls, while no difference observed between acute and chronic ITP patients. Regarding serum Igs; mean serum level of IgM was statistically lower in acute ITP than controls; the values were also decreased in chronic ITP but the decrease did not reach significance compared to control group. IgG serum levels were statistically lower in acute ITP compared to chronic patients and controls (p<0.05). There was no significant difference in serum IgA levels among the studied groups. Furthermore, there were significant positive correlations between IgM and IgG compared to platelet count in patient groups. On the other hand, there was a significant negative correlation between IgA and platelet count in acute ITP.