Abstract
Chronic primary immune thrombocytopenia (CITP) is the most common acquired autoimmune disease that seriously threaten the physical and mental health of patients. Compared with Western medicine treatment, the intervention and treatment of Chinese medicine (CM) has shown certain therapeutic advantages. This paper reviewed the new pathogenesis progress on T cell immune abnormality in CITP, and CM studies on interferes effects of cellular immune regulation of CITP in recent years. Qi deficiency failing to control blood and internal obstruction of blood stasis are the two common types of CM syndromes in CITP patients, the corresponding treatments include invigorating Pi (Spleen), supplementing qi, activating blood, as well as tonifying qi and activating yang, regulating Gan (Liver) to invigorate Pi. The authors also mentioned the problems in the research field of CM for CTIP treatment, and put forward new ideas for the research in the future.
Similar content being viewed by others
References
Liu XG, Bai XC, Chen FP, et al. Chinese guidelines for treatment of adult primary immune thrombocytopenia. Int J Hematol 2018;107:615–623.
Matzdorff A, Meyer O, Ostermann H, et al. Immune thrombocytopenia-current diagnostics and therapy: recommendations of a joint working group of DGHO, ÖGHO, SGH, GPOH, and DGTI. Oncol Res Tret 2018;41(Suppl 5):1–50.
Audia S, Mahevas M, Samson M, et al. Pathogenesis of immune thrombocytopenia. Autoimmun Rev 2017;16:620–632.
Miyakawa Y, Katsutani S, Yano T, et al. Efficacy and safety of rituximab in Japanese patients with relapsed chronic immune thrombocytopenia refractory to conventional therapy. Int J Hematol 2015;102:654–661.
Wang SX, Nie YB, Ju MK, et al. The value of platelet count in predicting the efficacy of rituximab treatment in adult patients with chronic primary immune thrombocytopenia. Chin J Hematol (Chin) 2018;39:573–578.
Wu XY, Chen GL, Wang YL, et al. Research progress on the relationship between cell and pathogenesis of immune thrombocytopenia. Shandong Med J (Chin) 2017;57:101–104.
Raphael I, Nalawade S, Eagar TN, et al. T cell subsets and their signature cytokines in autoimmune and inflammatory diseases. Cytokine 2015;74:5–17.
Ge F, Zhang Z, Hou J, et al. Granulocyte colony-stimulating factor decreases the Th1/Th2 ratio in peripheral blood mononuclear cells from patients with chronic immune thrombocytopenic purpura in vitro. Thromb Res 2016;148:76–84.
Vanikar AV, Trivedi HL. T-regulatory cells: the recently recognized players of immunomodulation. J Stem Cell Res Ther 2014;4:241–246.
Nishimoto T, Kuwana M. CD4+CD25+Foxp3+ regulatory T cells in the pathophysiology of immune thrombocytopenia. Semin Hematol 2013;50(Suppl):S43–S49.
Li Q, Zhang L, Yang M, et al. Increased interleukin-27 promotes Th1 differentiation in patients with chronic immune thrombocytopenia. Scand J Immunol 2014;80:276–282.
Wang X, Zhou YH, Chen XH, et al. Role and significance of T help cells 17 in pathogenesis of idiopathic thrombocytopenic purpura. J Exp Hemat (Chin) 2016;24:1833–1836.
Li J, Wang Z, Hu S, et al. Correction of abnormal T cell subsets by high-dose dexamethasone in patients with chronic idiopathic thrombocytopenic purpura. Immunol Lett 2013;154:42–48.
Rocha AM, Souza C, Rocha GA, et al. The levels of IL-17A and of the cytokines involved in Th17 cell commitment are increased in patients with chronic immune thrombocytopenia. Haematologica 2011;96:1560–1564.
Zhou L, Xu F, Chang C, et al. Interleukin-17-producing CD4+ T lymphocytes are increased in patients with primary immune thrombocytopenia. Blood Coagul Fibrin 2016;27:301–307.
Zhang G, Zhang P, Liu H, et al. Assessment of Th17/Treg cells and Th cytokines in an improved immune thrombocytopenia mouse model. Hematology 2017;22:493–500.
Wang MJ, Xu YG, Ding XQ, et al. Cellular immune function in patients with immune thrombocytopenia. Chin J Clin (Electronic Ed, Chin) 2018;12:65–69.
Hu Y, Wang X, Yu S, et al. Neutralizations of IL-17A and IL-21 regulatory T cell/ T helper17 in imbalance via T hepler17 associated signaling pathway in immune thrombocytopenia. Expert Opin Ther Targ 2015;19:723–732.
Sun T, Zhang D, Yang Y, et al. Interleukin-35 may contribute to the loss of immunological self-tolerance in patients with primay immune thrombocytopenia. Br J Haematol 2015;169:278–285.
Baumjohann D, Preite S, Reboldi A, et al. Persistent antigen and germinal center B cells sustain T follicular helper cell responses and phenotype. Immunity 2013;38:596–605.
Gan C. Advances in the effects of Th17 cell and follicular helper T cells and their cytokines on common autoimmune diseases. Inter J Ped (Chin) 2013;40:183–186.
Dai L, He L, Wang Z, et al. Altered circulating T follicular helper cells in patients with chronic immune thrombocytopenia. Exp Ther Med 2018;16:2471–2477.
Audia S, Rossato M, Santegoets K, et al. Splenic TFH expansion participates in B-cell differentiation and antiplatelet antibody production during immune thrombocytopenia. Blood 2014;124:2858–2866.
Audia S, Rossato M, Trad M, et al. B cell depleting therapy regulates splenic and circulating T follicular helper cells in immune thrombocytopenia. J Autoimmun 2016;77:89–95.
Wu CL, Wang Q, Zhang L, et al. Correlation of Breg with CD4(+)T cells of peripheral blood in patients with CITP and its clinical significance. J Exp Hematol (Chin) 2013;21:1517–1521.
Audia S, Mahévas M, Samson M, et al. Pathogenesis of immune thrombocytopenia. Autoimmun Rev 2017;16:620–632.
Zheng XQ, Zhou SH, Tu RF, et al. Correlation between Treg/Th17 and traditonal Chinese medicine syndrome differentiation classification in patients with immune thrombocytopenia. Acad J Second Milit Med Univ (Chin) 2015;36:1254–1258.
Zheng CM, Ma R. Summary of experience in the treatment of immune thrombocytopenia with MaRou. Chin J Clin (Chin) 2015;9:89–91.
Gong L, Zhang GD, Zhou YM. Idiopathic thrombocytopenia research progress from the kidney treatment. Jilin J Tradit Chin Med (Chin) 2014;34:640–642.
Wang MJ, Deng ZY, Hu XM. General situation of immune thrombocytopenia treated by the method of benefiting qi and controlling blood. Henan Tradit Chin Med (Chin) 2017;37:928–930.
Wen WW, Sun X, Zhuang HF, et al. Effects of panaxadiolsaponins component as a new Chinese patent medicine on proliferation, differentiation and corresponding gene expression profile of megakaryocytes. Chin J Integr Med 2016;22:28–35.
Sun X, Gao RL, Lin XJ, et al. Panaxnotoginsengsaponins induced up-regulation, phosphorylation and binding activity of MEK, ERK, AKT, PI-3K protein kinases and GATA transcription factors in hematopoietic cells. Chin J Integr Med 2013;19:112–118.
Lin XJ, Yin LM, Gao RL, et al. The effects of panaxadiolsaponins on megakaryocytic maturation and immune function in a mouse model of immune thrombocytopenia. Exp Hematol 2015;43:364–373.
Kuang YM, Zhu Y, Gao RL, et al. Clinical study of Pai-nengda Capsule in the treatment of chronic aplastic anemia. Chin J Integr Med 2016;22:124–129.
Gao RL, Chong BH. Research and development of the effective components of panaxdiol asponin as new Chinese patent medicine for treating hemocytopenia. Chin J Integr Med 2012;18:897–902.
Li Q. Clinical observation on the treatment of immune thrombocytopenia with Pai-neng-da Capsule [Dissertation]. Hanzhou: Zhejiang Chinese Medical University, 2014.
Zhang XL. Guipi Decoction treatment of idiopathic thrombocytopenic purpura: a randomized parallel control study. J Pract Tradit Chin Med (Chin) 2016;30:46–48.
Zhao L, Qiu ZC, Chen P, et al. Flavored spleen-invigorating mixture in patients with chronic immune thrombocytopenia T lymphocyte immune function. J Sichuan Tradit Chin Med (Chin) 2014;32:77–79.
Zhang JN, Yang WH. Experience of Professor YANG Wenhua in treating immune thrombocytopenia. J Tradit Chin Med Univ Hunan (Chin) 2014;34:27–33.
Zhou MY, Hu H, Yang JM, et al. Clinical study on idiopathic thrombocytopenic purpura treated with Shengxueling Granule. J Chin Integr Med 2004;6:421–425.
Guo JR, Bao JZ, Zhou YM. The effect of Sheng-xue-ling on the protein expression of steroid-resistant ITP patients. Shanxi J Tradit Chin Med (Chin) 2013;29:40–42.
Bao JZ, Zhou YM, Zhao XH, et al. Clinical observation on Shengxueling formulations combined with Western medicine in treating 30 cases of steroid resistant idiopathic thrombocytopenic purpura. J Tradit Chin Med (Chin) 2017;58:502–505.
Gao C, Wang J, Zhu CL, et al. The establishment of the model of spleen failing to control the blood syndrome in zebrafish and the research on the hemostasis effect of spleen-invigorating, qi-replenishing and blood-containing formula. Comb Tradit Chin West Med Magaz World (Chin) 2018;13:1185–1189.
Chu YT, Zhu XY, Zhang YY, et al. Hemostatic effect of spleen-invigorating, qi-replenishing and blood-containing formula on simvastatin-induced zebrafish hemorrhage model. J Exp Hematol (Chin) 2017;25:853–859.
Li TT, He H, Hou L, et al. Regulation of non-classical immune parameters in immune thrombocytopenic purpura mice by a spleen-invigorating, qi-replenishing and blood-containing formula. J Tradit Chin Med (Chin) 2015;2:91–98.
Zhu CL, He H, Xu Y, et al. Effect of Jianpi Shexue Prescription on the vital signs and organ index of ITP mice models. Acta Chin Med Pharm (Chin) 2017;45:10–14.
Liu Q. Clinical study of Pi invigorating, qi replenishing and blood containing formula in the treatment of immune thrombocytopenia with Pi deficiency type [Dissertation]. Beijing: Beijing University of Chinese Medicine, 2014.
Wu YX, Huang ZH, Yuan Z, et al. Effect of Jianpi Yiqi Shexue Granule on the lymphocyte subpopulation of chronic immune thrombocytopenia patients with Pi deficiency syndrome. J Tradit Chin Med Univ Hunan (Chin) 2016;36:65–68.
Wang JH, Du FQ, Sun AT, et al. Professor SUN Weizheng’s clinical experience in treating chronic primary immune thrombocytopenia. Heilongjiang J Tradit Chin Med (Chin) 2016;45:34–35.
Wang P. Study on the therapeutic effect of compound Rubia extract on ITP mice [Dissertation]. Shanghai: Shanghai University of Traditional Chinese Medicine, 2015.
Sun F, Ni H, Hao J. Effective observation of Ziqian Mixture in the treatment of chronic idiopathic thrombocytopenic disease. Shandong J Tradit Chin Med (Chin) 2016;35:212–214.
Yang XP, Ma R, Su GY, et al. The comparative study of therapeutic effects of Yiqi Tongyang Decoction prepared by three different extraction processes on immune thrombocytopenia model mice. Tradit Chin Drug Res Clin Pharm (Chin) 2018;1:32–35.
Zhu H, Dai LF, Xu YG. Clinical observation on modified Yiqi Tongyang Decoction for 31 cases of chronic idiopathic thrombocytopenic purpura. J Tradit Chin Med (Chin) 2014;55:1022–1024.
Yang XP, Ma R, Yang XH, et al. Effect of Yiqi Tongyang Decoction on blood T cell subsets in patients with chronic immune thrombocytopenia. Chin J Integr Med 2017;23:709–713.
Fang S, Wang Y, Song MM. Prescription characteristic of HU Xiao-mei in the treatment of blood disease with strengthening and warming yang. Chin J Tradit Chin Med Pharm (Chin) 2015;30:457–461.
Li D, Hu YZ. Discussion on the treatment of immune thrombocytopenia by regulating Gan and invigorating Pi. Chin J Integr Trad West Med (Chin) 2011;8:1035–1037.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by the National Natural Science Foundation of China (No. 81774068), National Major Project for the Innovative New Drugs of “the 13th Five-year Plan” (No. 2016ZX09101071)
Rights and permissions
About this article
Cite this article
Liu, Wb., Li, S., Yu, Xl. et al. Research Progress on Chinese Medicine Immunomodulatory Intervention for Chronic Primary Immune Thrombocytopenia: Targeting Cellular Immunity. Chin. J. Integr. Med. 25, 483–489 (2019). https://doi.org/10.1007/s11655-019-3031-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11655-019-3031-9