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Increased proportion of Th17/Treg cells at the new diagnosed stage of chronic immune thrombocytopenia in pediatrics: the pilot study from a multi-center

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European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Chronic immune thrombocytopenia (CITP) is an autoimmune disease with many immune dysfunctions, including T helper type 17 cell (Th17)/regulatory T cells (Tregs) imbalance. Low quality of life and side effects of drugs are severe, especially in pediatrics. This study aimed to determine Th17/Treg polarization in pediatric CITP when first diagnosing ITP and evaluate its use as a predictive marker for pediatric CITP. This was a pilot study from a multi-center. Setting the effective data size to 100 patients, data entry ended in the 142nd patient who had completed a 1-year follow-up. The percentages of Treg cells and Th17 cells were quantified by flow cytometry when new diagnosed ITP patients first arrived. The association between the Th17/Treg ratio and CITP was analyzed statistically. The percentages of Treg cells and Th17 cells were lower (P = 0.0008) and higher (P = 0.0001), respectively, in the CITP-outcome group compared with the remission group. The receiver operating characteristic analysis showed that the area under the curve (AUC) of Treg and Th17 cells was 0.811 and 0.834, respectively. The ratio of Th17/Treg exhibited the largest AUC of 0.897 (cutoff value 0.076).

Conclusions: Thus, the percentage of Th17 /Treg ratio of pediatric CITP is elevated at new diagnosed ITP stage. It is a promising predictive marker for the development of CITP to some extent.

Trial registration: ChiCTR1900022419 (10th April 2019)

What is Known:

• The percentage of Th17 /Treg ratio of pediatric CITP is elevated.

What is New:

• This study shows that the percentage of Th17 /Treg ratio of pediatric CITP is elevated at new diagnosed ITP stage. This work may provide a new point for pediatric CITP’s prediction. The imbalanced ratio of Th17/Treg was obvious when first diagnose ITP in pediatric CITP patients, rendering them as potential predictive tools for discriminating CITP to facilitate with the management of pediatric patient care. In addition, the combination of them may serve as a predictive marker in pediatric CITP.

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Fig. 1
Fig. 2

Availability of data and material

The data that support the findings of this study are available on request from the corresponding author.

Code availability

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Abbreviations

CITP:

Chronic immune thrombocytopenia

Th17:

T helper type 17 cell

Tregs:

Regulatory T cells

AUC:

Area under the curve

IVIG:

Intravenous immunoglobin

ANA:

Anti-nuclear antibody

PerCP:

Peridinin chlorophyll protein

FITC:

Fluorescein isothiocyanate

APC:

Allophycocyanine

PE:

Phycoerythrin

SEM:

Standard error of the mean

CI:

Confidence interval

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Funding

This work was supported in part by grants from the National Natural Science Foundation of China (No. 81970111), Beijing Natural Science Foundation of China (No. 7192064), the Pediatric Medical Coordinated Development Center of Beijing Municipal Administration of Hospitals (No.XTZD20180205), and National Science and Technology Key Projects (No. 2017ZX09304029001).

Author information

Author notes

  1. Hao Gu and Zhenping Chen contributed equally to this work.

Authors and Affiliations

  1. Hematology & Oncology Center, Beijing Children’s Hospital, Capital Medical University, Beijing, People’s Republic of China

    Hao Gu, Jingyao Ma, Lingling Fu, Jie Ma, Tianyou Wang & Runhui Wu

  2. Hematology and Oncology Laboratory, Beijing Pediatric Research Institute, Beijing Children’s Hospital, National Center for Children’s Health, Beijing, People’s Republic of China

    Zhenping Chen & Runhui Wu

  3. Children’s Hospital, Capital Institute of Pediatrics, Beijing, People’s Republic of China

    Xiaodong Shi

  4. Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China

    Hong Cui

  5. Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China

    Xuanguang Qin

  6. Beijing TongRen Hospital, Capital Medical University, Beijing, People’s Republic of China

    Huimin Hu

Authors
  1. Hao Gu
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hao Gu, Zhenping Chen, and Jingyao Ma; Xiaodong Shi, Xuanguang Qin, and Hong Cui recruited all the subjects and collected the written informed consents; the first draft of the manuscript was written by Hao Gu, and Lingling Fu, Jie Ma, Tianyou Wang commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Tianyou Wang or Runhui Wu.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Capital Medical University (28th August, 2018 /No.IEC-C-008-A08-V.05.1).

Consent to participate

We invite you to participate in the establishment and application of a standardized diagnosis and treatment system for childhood immune thrombocytopenia approved by the Capital Medical University. This study complies with the Declaration of Helsinki and the principles of clinical trial quality management practices and has passed the review of the ethics committee of Beijing Children’s Hospital affiliated to Capital Medical University.

Before deciding whether to participate in this study, please read the following as carefully as possible for you and your parents. He can help you understand the research and why you want to conduct the research, the procedures and duration of the research, the benefits, risks, and discomforts that may be brought to you after participating in the research; you may not fully understand the content described in this consent form; please consult the researcher or doctor for a detailed explanation. If you wish, you can also discuss with your relatives and friends to help you make a decision.

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All authors have read and approved the final manuscript. All parents signed informed consent forms and approved the final manuscript.

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The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this manuscript.

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Patients (or their parent or legal guardian in the case of children under 16) signed informed consent regarding publishing their data and photographs.

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Communicated by Peter de Winter

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Cite this article

Gu, H., Chen, Z., Shi, X. et al. Increased proportion of Th17/Treg cells at the new diagnosed stage of chronic immune thrombocytopenia in pediatrics: the pilot study from a multi-center. Eur J Pediatr 180, 3411–3417 (2021). https://doi.org/10.1007/s00431-021-04121-z

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  • DOI: https://doi.org/10.1007/s00431-021-04121-z

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