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Maritati F, Canzian A, Fenaroli P, Vaglio A. Adult-onset IgA vasculitis (Henoch-Schönlein): Update on therapy. Presse Med 2020; 49:104035. [PMID: 32645417 DOI: 10.1016/j.lpm.2020.104035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/05/2019] [Indexed: 12/22/2022] Open
Abstract
Immunoglobulin A vasculitis (IgAV, formerly Henoch-Schönlein purpura) is a systemic inflammatory disease affecting small vessels. While it is common and usually benign in childhood, in adults it is rarer has a more severe course. Its main manifestations are cutaneous purpura, arthralgias or arthritis, acute enteritis and glomerulonephritis. Renal involvement is associated with a poor prognosis in adults. The treatment of adult-onset IgAV is still a matter of debate: although in patients with a non-severe phenotype remission can occur spontaneously, more severe cases may need immunosuppressive therapy. There are some areas of uncertainty with respect to the efficacy of immunosuppressive regimens: almost all data come from studies performed in children or from patients with IgA nephropathy and/or IgA-crescentic glomerulonephritis. The only randomised study performed in adults with IgAV and renal involvement showed that immunosuppressive therapy with cyclophosphamide did not improve renal outcome nor did it affect patient survival. The possible efficacy of other drugs is reported only in small case series. Recent evidences show that rituximab could be an effective therapeutic option for adult-onset IgAV, but this also needs to be confirmed in controlled trials. In this review, we focus on therapeutic options for adult-onset IgAV treatment, and discuss the main results of the studies performed so far.
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Affiliation(s)
| | - Alice Canzian
- Nephrology Unit, Parma University Hospital, Parma, Italy
| | | | - Augusto Vaglio
- Department of Biochemical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, and Meyer Children's Hospital, Firenze, Italy.
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Lei WT, Tsai PL, Chu SH, Kao YH, Lin CY, Fang LC, Shyur SD, Lin YW, Wu SI. Incidence and risk factors for recurrent Henoch-Schönlein purpura in children from a 16-year nationwide database. Pediatr Rheumatol Online J 2018; 16:25. [PMID: 29661187 PMCID: PMC5902957 DOI: 10.1186/s12969-018-0247-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/11/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The recurrence rate of Henoch-Schönlein purpura (HSP) is 2.7%-30%, with varied average intervals between the first and second episodes. Few studies have explored the incidence and risk factors for recurrent HSP. METHODS We used a 16-year nationwide database to analyze the incidence of recurrent HSP. Patients with HSP were identified, and risk factors for recurrent HSP were explored. Kaplan-Meier and Cox regression model analyses were performed, and covariates were adjusted in the multivariate model. RESULTS From January 1, 1997 to December 31, 2012, among 2,886,836 individuals in the National Health Insurance Research Database, 1002 HSP patients aged < 18 years were identified. Among them, 164 had ≥2 HSP episodes (recurrence rate, 16.4%; incidence of recurrent HSP, 7.05 per 100 person-years); 83.6% patients with one HSP episode remained free of secondary HSP. The average time intervals between the first and second and second and third HSP episodes were 9.2 and 6.4 months, respectively. After adjusting for demographic parameters, comorbidities, and socioeconomic status, recurrent HSP was found to occur more frequently in patients who had renal involvement (adjusted hazard ratio, 2.41; 95% confidence interval [CI], 1.64-3.54; p < 0.001), were receiving steroid therapy for > 10 days (adjusted hazard ratio, 8.13; 95%CI, 2.51-26.36; p < 0.001), and had allergic rhinitis (adjusted hazard ratio, 1.63; 95%CI, 1.06-2.50; p = 0.026). CONCLUSIONS The annual incidence of recurrent HSP was low. However, children who had underlying allergic rhinitis, presented with renal involvement, and received steroid treatment for > 10 days should be notified regarding the possibility of recurrence.
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Affiliation(s)
- Wei-Te Lei
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Po-Li Tsai
- Division of Colorectal Surgery, Department of Surgery, Mackey Memorial Hospital, Taipei, Taiwan
| | - Szu-Hung Chu
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Hsuan Kao
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- 0000 0004 0573 007Xgrid.413593.9Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Li-Ching Fang
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Shyh-Dar Shyur
- 0000 0004 0573 007Xgrid.413593.9Division of Allergy, Immunology, Rheumatology Disease, Department of Pediatrics, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Wen Lin
- 0000 0004 0573 007Xgrid.413593.9Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, No.45, Minsheng Rd., Tamsui Dist., New Taipei City, 25160, Taiwan. .,Audiology and Speech Language Pathology, Mackay Medical College, No.45, Minsheng Rd., Tamsui Dist., New Taipei City, 25160, Taiwan. .,Department of Psychiatry, Mackay Memorial Hospital, No.45, Minsheng Rd., Tamsui Dist., New Taipei City, 25160, Taiwan.
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Chen AC, Lin CL, Shen TC, Li TC, Sung FC, Wei CC. Association between allergic diseases and risks of HSP and HSP nephritis: a population-based study. Pediatr Res 2016; 79:559-64. [PMID: 26690714 DOI: 10.1038/pr.2015.271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/30/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Some allergic inflammation-associated mediators have been reported in acute stage of Henoch-Schönlein purpura (HSP). However, the association of children with allergic diseases and their subsequent risks of HSP and HSP nephritis remain unknown. METHODS In this study, we included 2,240 children with HSP diagnosed between 2000 and 2008 as well as 8,960 non-HSP controls matched for age, sex, and level of urbanization. The odds ratios (ORs) of HSP were calculated with respect to associations with pre-existing allergic diseases. RESULTS Children with allergic diseases had an increased subsequent risk of HSP; the lowest adjusted OR (aOR) was 1.33 for allergic conjunctivitis (95% confidence interval (CI): 1.17-1.52) and the highest was 1.68 for asthma (95% CI: 1.48-1.91). The aOR increased to 2.03 (95% CI: 1.80-2.31) in children with at least two allergic diseases. Children who visited medical institutes more often per year for associated allergic diseases had an increased risk of HSP. Of the 2,240 children with HSP, 249 (11%) had HSP nephritis and 45.8% of those with nephritis had history of any allergic disease. CONCLUSION Atopic children had an increased subsequent risk of HSP but not an increased risk of HSP nephritis.
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Affiliation(s)
- An-Chyi Chen
- Department of Pediatric Medicine, Children's Hospital of China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan
| | - Te-Chun Shen
- School of Medicine, China Medical University, Taichung, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chang-Ching Wei
- Department of Pediatric Medicine, Children's Hospital of China Medical University Hospital, Taichung, Taiwan.,School of Medicine, China Medical University, Taichung, Taiwan
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Wei CC, Lin CL, Shen TC, Li TC, Chen AC. Atopic Dermatitis and Association of Risk for Henoch-Schönlein Purpura (IgA Vasculitis) and Renal Involvement Among Children: Results From a Population-Based Cohort Study in Taiwan. Medicine (Baltimore) 2016; 95:e2586. [PMID: 26817917 PMCID: PMC4998291 DOI: 10.1097/md.0000000000002586] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Elevation of Th2 cytokine-driven inflammatory mediators has been reported in acute stage of Henoch-Schönlein purpura (HSP). However, the temporal interaction between Th2-mediated allergic diseases and HSP with renal involvement remains unknown. Herein, we conducted a population-based cohort analysis to investigate the risk of HSP and renal involvement in children with atopic dermatitis (AD) as 1 of the first steps in the atopic march.From 2000 to 2007, 95,208 children with newly diagnosed AD and 190,416 randomly selected non-AD controls were included in the study. By the end of 2008, incidences of HSP in both cohorts and the AD cohort to non-AD cohort hazard ratios (HRs) and confidence intervals (CIs) were measured. Comparison of renal involvement in HSP between children with and without AD was analyzed.The incidence of HSP during the study period was 1.75-fold greater (95% CI: 1.27-2.42) in the AD cohort than in the non-AD cohort (14.2 vs 8.11 per 100,000 person-years). The AD to non-AD HR of HSP was greater for girls (1.92, 95% CI: 1.18-3.13), children older than 6 years (2.54, 95% CI: 1.15-5.59), and those living in less urbanized area (2.74, 95% CI: 1.10-6.82). Concurrent allergic rhinitis or asthma did not increase the HR of HSP further. The HR for HSP in AD children increased from 0.67 (95% CI: 0.41-1.11) for those with ≤2 AD-related visits to 9.77 (95% CI: 6.44-14.8) for those with >4 visits (P < 0.0001, by the trend test). The risk of developing HSP in the AD cohort was highest within first year after AD diagnosis (HR: 3.99; 95% CI: 1.61-9.89). AD cohort with HSP had higher occurrence rate of renal involvement, particular hematuria, than non-AD cohort with HSP.AD children had a greater risk of developing HSP and HSP with renal involvement. Further research is needed to clarify the role of allergy in the pathogenesis of HSP and renal involvement.
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Affiliation(s)
- Chang-Ching Wei
- From the Children's Hospital (C-CW, A-CC), Management Office for Health Data (C-LL), and Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (T-CS), China Medical University Hospital, Taichung, Taiwan; and School of Medicine (C-CW, T-CS, A-CC) and Department of Public Health (C-LL, T-CL), China Medical University, Taichung, Taiwan
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Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B. IgA vasculitis (Henoch-Shönlein purpura) in adults: Diagnostic and therapeutic aspects. Autoimmun Rev 2015; 14:579-85. [PMID: 25688001 DOI: 10.1016/j.autrev.2015.02.003] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/05/2015] [Indexed: 12/20/2022]
Abstract
Immunoglobulin A (IgA) vasculitis, formerly called Henoch-Schönlein purpura, is an immune complex vasculitis affecting small vessels with dominant IgA deposits. Clinical manifestations mainly involve cutaneous purpura, arthralgias and/or arthritis, acute enteritis and glomerulonephritis. IgA vasculitis is more common among children than adults, with more severe disease in adults. Gastrointestinal and renal involvements represent the principal causes of morbidity and mortality in adults. Factors associated with long-term end-stage renal disease (ESRD) include baseline renal function impairment and baseline proteinuria >1 or 1.5 g/day, and on renal biopsy degree of interstitial fibrosis, sclerotic glomeruli and fibrinoid necrosis. Management of IgA vasculitis in adults is rendered difficult for clinicians because of the absence of correlation between initial presentation and long-term renal outcome, and the possible occurrence of spontaneous remission in patients with severe presentation or, in contrast, possible evolution to ESRD in patients with mild symptoms. Treatment is often symptomatic because disease course is usually benign. Treatment of severe involvement, including severe gastrointestinal complications or proliferative glomerulonephritis, remains controversial, with no evidence that corticosteroids or immunosuppressive agents improved long-term outcome. Prospective, randomized, controlled trials are thus needed to analyze the benefit-risk ratio of such treatments.
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Affiliation(s)
- Alexandra Audemard-Verger
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France.
| | - Evangeline Pillebout
- Department of Nephrology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
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Wu SH, Liao PY, Chen XQ, Yin PL, Dong L. Add-on therapy with montelukast in the treatment of Henoch-Schönlein purpura. Pediatr Int 2014; 56:315-22. [PMID: 24299021 DOI: 10.1111/ped.12271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 10/08/2013] [Accepted: 11/25/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Previous studies suggested that leukotrienes (LT) were involved in the pathogenesis of Henoch-Schönlein purpura (HSP). This study investigated the efficacy of an add-on therapy with montelukast in the treatment of HSP. METHODS In this four-center, double-blind, placebo-controlled, parallel paired comparative study, 130 children with HSP were divided into two large groups: 84 patients without nephritis and 46 patients with nephritis. For each pair of patients with the same severity of disease, one subject was randomly allocated to one subgroup and the other allocated to the other subbroup; one subgroup received routine treatment plus placebo treatment, while the other subgroup received routine treatment plus montelukast treatment for 3 months. The efficacy was determined using Severity Scale Score (SSS). Blood eosinophil count, eosinophil cationic protein (ECP), IgE, interleukin (IL)-4, IL-5, IL-6, IL-8, IL-17, LTB4 , and urinary LTE4 were measured. RESULTS Add-on therapy with montelukast alleviated the symptoms of HSP including purpura, abdominal pain, stool occult blood, arthritis, proteinuria and hematuria, and, accordingly, shortened the length of hospital stay, and lowered blood eosinophil count, ECP, IgE, IL-4, IL-5, IL-6, IL-8, IL-17, LTB4 , and urinary LTE4 production, and also lowered the HSP relapse rate during the 3 months of treatment, but did not alter the outcome of nephritis at the end of follow up. CONCLUSIONS Add-on therapy with montelukast alleviated the symptoms of HSP. HSP may be improved by add-on therapy with a leukotriene receptor antagonist.
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Affiliation(s)
- Sheng-Hua Wu
- Department of Pediatrics, First Affiliated Hospital with Nanjing Medical University, Nanjing, Jiangsu, China
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Yang Y, Chang C, Chuang Y, Hsu H, Yu H, Lee J, Wang L, Lin Y, Chiang B. Identification and characterization of IgA antibodies against β2-glycoprotein I in childhood Henoch-Schönlein purpura. Br J Dermatol 2012; 167:874-81. [DOI: 10.1111/j.1365-2133.2012.11068.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wu SH, Liao PY, Yin PL, Zhang YM, Dong L. Inverse temporal changes of lipoxin A4 and leukotrienes in children with Henoch-Schönlein purpura. Prostaglandins Leukot Essent Fatty Acids 2009; 80:177-83. [PMID: 19264468 DOI: 10.1016/j.plefa.2009.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 01/16/2009] [Accepted: 01/22/2009] [Indexed: 11/22/2022]
Abstract
The pathogenesis of Henoch-Schönlein purpura (HSP) is not clearly understood. It remains unclear how changes of lipoxin A(4) (LXA(4)) that acts as a "braking signal" in inflammatory process occur in patients with HSP. In this study, we determined the temporal changes of blood and urinary LXA(4), Leukotriene (LT)B(4) and urinary LTE(4) in 49 children with HSP. Inverse temporal changes between gradually increased blood and urinary LXA(4) and gradually decreased blood and urinary LTB(4) and urinary LTE(4) were found in patients with HSP. Furthermore, both 15-S-hydroxyeicosatetraenoic acid and LXA(4) inhibited the LTB(4)-induced chemotaxis of leukocytes and release of LTB(4) from leukocytes obtained from the patients in the active phase of HSP. In 22 children with HSP nephritis, concordant with the gradually increased severity of mesangial proliferation and proteinuria, the glomerular expressions of 15-lipoxygenase and the levels of urinary LXA(4) gradually decreased and the glomerular expressions of LTC(4) synthase and the urinary LTE(4) and LTB(4) gradually increased. The levels of blood and urinary LXA(4) in patients with HSP nephritis were lower than those in patients with purpura alone in early resolution of HSP. The levels of blood and urinary LTB(4) and urinary LTE(4) in the patients with HSP nephritis were higher than those in patients with purpura alone in early resolution of HSP. There was positive correlation between blood LTB(4) and serum C-reactive protein in 49 children with HSP. These data suggest that LTs may play a proinflammatory and profibrotic role in the pathogenesis of HSP, and insufficiency of LXA(4) may be responsible for the patients with HSP whose illness become more serious.
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Affiliation(s)
- Sheng-Hua Wu
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu 210029, People's Republic of China.
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Yang YH, Chuang YH, Wang LC, Huang HY, Gershwin ME, Chiang BL. The immunobiology of Henoch–Schönlein purpura. Autoimmun Rev 2008; 7:179-84. [DOI: 10.1016/j.autrev.2007.11.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Tahan F, Dursun I, Poyrazoglu H, Gurgoze M, Dusunsel R. The role of chemokines in Henoch Schonlein Purpura. Rheumatol Int 2007; 27:955-60. [PMID: 17387476 DOI: 10.1007/s00296-007-0332-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 02/24/2007] [Indexed: 11/27/2022]
Abstract
BACKGROUND The pathogenesis of Henoch Schonlein Purpura is incompletely understood and the role of chemokines is unknown. OBJECTIVE To investigate the levels of CC chemokines, eotaxin, TARC, and CXC chemokine IP-10 in Henoch Schonlein Purpura. METHODS Three groups of children were enrolled in the study: Henoch Schonlein Purpura in active stage (n = 26), Henoch Schonlein Purpura in remission phase (n = 26) and healthy children (n = 18). Levels of eotaxin, TARC, and IP-10 were determined in plasma using ELISA. RESULTS No significant difference was observed in the plasma level of eotaxin and TARC levels between the HSP and healthy children (>0.05). We could not find any significant difference between acute phase of the disease and convalescent phase in eotaxin and TARC levels (P > 0.05). We have suggested significant decreases in plasma IP-10 in the acute phase of the disease compared with the convalescent phase (P < 0.05). There was a significant difference in IP-10 levels between active stage and healthy controls, too (<0.05). We could not find any significant correlation between chemokine levels and system involvement (>0.05). CONCLUSION Our study shows that plasma level of eotaxin and TARC levels do not differ between the HSP and healthy children. But, decreasing the release of the Th1 chemokine IP-10 in HSP active stage may show that in HSP, there is no shift to Th1 lymphocytes in children with HSP. Further investigations are warranted to more fully explore and understand the production of and potential role of these chemokines in HSP.
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Affiliation(s)
- Fulya Tahan
- Department of Pediatric Allergy, Erciyes University School of Medicine, Kayseri, Turkey.
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Yang YH, Huang YH, Lin YL, Wang LC, Chuang YH, Yu HH, Lin YT, Chiang BL. Circulating IgA from acute stage of childhood Henoch-Schönlein purpura can enhance endothelial interleukin (IL)-8 production through MEK/ERK signalling pathway. Clin Exp Immunol 2006; 144:247-53. [PMID: 16634798 PMCID: PMC1809646 DOI: 10.1111/j.1365-2249.2006.03076.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Recently, sera from children with active Henoch-Schönlein purpura (HSP) have been found to enhance interleukin (IL)-8 production by human umbilical venous endothelial cells (HUVEC). To further determine the possible factor with the ability to enhance endothelial IL-8 production in sera from acute stage of HSP, 10 children with HSP at the acute stage and 10 healthy controls were enrolled. IgA antiendothelial cell antibodies (AECA) were detected by cell-based ELISA. Active sera with or without pretreatment with anti-human IgA antibody, sera of controls, and immunoglobulin A (IgA) derived from sera were used to stimulate the HUVEC. The ability of these factors to enhance endothelial IL-8 production was evaluated. Furthermore, signalling pathways were also assayed by different inhibitors, and confirmed by immunoblotting. Serum levels of IgA AECA in HPS patients at the acute stage were significantly higher than in controls (P < 0.001). The active sera could enhance endothelial IL-8 production (P = 0.004, compared with control sera), and the ability of these sera was mostly abolished when pretreated with fixed anti-human IgA antibody. The supernatant IL-8 levels of endothelial cells stimulated by IgA derived from acute stage of HSP were statistically higher than controls (P < 0.001). PD98059, an inhibitor of ERK phosphorylation, significantly reduced IgA AECA-stimulated endothelial IL-8. IgA AECA also enhanced the phosphorylation of ERK1 with a time-dependent manner. Together with these findings, it is concluded that IgA AECA derived from acute stage of HSP may bind to endothelial and enhance endothelial cells to produce IL-8 via MEK/REK signalling pathway.
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Affiliation(s)
- Y-H Yang
- Department of Paediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei, Taiwan
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