Pediatr Blood Cancer. 2025 Dec 17:e70067. doi: 10.1002/1545-5017.70067. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aimed to explore the dynamic alterations of T helper 17 (Th17) cells, regulatory T (Treg) cells and regulatory B (Breg) cells in children with persistent immune thrombocytopenia (ITP).
METHODS: A prospective cohort study was conducted involving 34 children with persistent ITP and 30 age- and sex-matched healthy controls. Peripheral blood samples were collected at baseline and 3 months post-treatment. T helper 17 and Treg cells were quantified as percentages of CD3⁺CD4⁺ T lymphocytes, and Breg cells as a percentage of CD19⁺ B lymphocytes using BD FACSDx Flex flow cytometry. All patients received standard first-line treatment with intravenous immunoglobulin and prednisone, and response was evaluated after 3 months.
RESULTS: At baseline, children diagnosed with ITP exhibited a pronounced imbalance in immune cell subsets compared with age- and sex-matched healthy controls. Specifically, Th17 cell levels and the Th17/Treg ratio were significantly elevated (7.81% ± 3.13% vs. 3.30% ± 1.51% and 1.23 ± 0.72 vs. 0.44 ± 0.23, respectively; both p < 0.001), indicating a proinflammatory immune profile. In contrast, the frequencies of immunosuppressive Treg and Breg cells were notably decreased (6.80% ± 1.75% vs. 8.03% ± 1.14%, p = 0.026; 3.10% ± 2.00% vs. 6.61% ± 1.69%, p < 0.001). After 3 months of standardised treatment, no statistically significant changes were observed in the levels of these immune cell subsets or the Th17/Treg ratio compared with pre-treatment values. Clinically, 73.5% achieved a complete response, 20.6% achieved a partial response, and 5.9% showed no response.
CONCLUSION: Both Th17/Treg cell imbalance and Breg cell deficiency contribute to the pathogenesis of persistent ITP in children. Concurrent monitoring of these immune subsets may aid in immunophenotyping, and their potential role as biomarkers for treatment outcomes warrants further investigation.
PMID:41404740 | DOI:10.1002/1545-5017.70067
