Serum Vitamin D Levels in Children with Immune Thrombocytopenia

Author(s): Giuseppe Lassandro, Francesco Carriero, Viviana Palmieri, Valentina Palladino, Anna Amoruso, Maria Filomena Gallone, Giovanni C. Del Vecchio, Silvio Tafuri, Giovanna Russo, Federica Valente, Paola Giordano*.

Journal Name: Endocrine, Metabolic & Immune Disorders - Drug Targets
(Formerly Current Drug Targets - Immune, Endocrine & Metabolic Disorders)

Volume 20 , Issue 2 , 2020

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Objective: Immune thrombocytopenia (ITP) is an acquired immuno-mediated disorder characterized by thrombocytopenia with an increased risk of bleeding. In recent years 1,25[OH]2D3 has been rediscovered as an immune modulator. We decided to evaluate serum Vitamin D levels in a cohort of children with immune thrombocytopenia in order to discover if Vitamin D concentrations may predict ITP duration.

Methods: Thirty children were enrolled in this study (sixteen with chronic ITP and fourteen with newly diagnosed ITP) to assess serum Vitamin D levels.

Results: The results showed that 80% of the enrolled children presented a D hypovitaminosis status. Children with newly diagnosis ITP showed no statistically significantly higher median values of Vitamin D compared to chronic ITP.

Conclusion: This study may suggest that Vitamin D deficiency does not represent a chronicity factor for ITP. However, further studies are needed to understand the role of Vitamin D in ITP pathogenesis.

Keywords: Autoimmunity, children, D vitamin, immune thrombocytopenia, platelets, chronicity.

[1]
Rodeghiero, F.; Stasi, R.; Gernsheimer, T.; Michel, M.; Provan, D.; Arnold, D.M.; Bussel, J.B.; Cines, D.B.; Chong, B.H.; Cooper, N.; Godeau, B.; Lechner, K.; Mazzucconi, M.G.; McMillan, R.; Sanz, M.A.; Imbach, P.; Blanchette, V.; Kühne, T.; Ruggeri, M.; George, J.N. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood, 2009, 113(11), 2386-2393.
[http://dx.doi.org/10.1182/blood-2008-07-162503] [PMID: 19005182]
[2]
De Mattia, D.; Del Vecchio, G.C.; Russo, G.; De Santis, A.; Ramenghi, U.; Notarangelo, L.; Jankovic, M.; Molinari, A.C.; Zecca, M.; Nobili, B.; Giordano, P. Management of chronic childhood immune thrombocytopenic purpura: AIEOP consensus guidelines. Acta Haematol., 2010, 123(2), 96-109.
[http://dx.doi.org/10.1159/000268855] [PMID: 20029174]
[3]
Cines, D.B.; Cuker, A.; Semple, J.W. Pathogenesis of immune thrombocytopenia. Presse Med., 2014, 43(4 Pt 2), e49-e59.
[http://dx.doi.org/10.1016/j.lpm.2014.01.010] [PMID: 24630266]
[4]
Giordano, P.; Urbano, F.; Lassandro, G.; Bianchi, F.P.; Tolva, A.; Saracco, P.; Russo, G.; Notarangelo, L.D.; Gabelli, M.; Cesaro, S.; Wasniewska, M.; Faienza, M.F. Role of antithyroid autoimmunity as a predictive biomarker of chronic immune thrombocytopenia. Pediatr. Blood Cancer, 2019, 66(1)e27452
[http://dx.doi.org/10.1002/pbc.27452] [PMID: 30270575]
[5]
McCrae, K. Immune thrombocytopenia: no longer ‘idiopathic’. Cleve. Clin. J. Med., 2011, 78(6), 358-373.
[http://dx.doi.org/10.3949/ccjm.78gr.10005] [PMID: 21632906]
[6]
Stasi, R.; Evangelista, M.L.; Stipa, E.; Buccisano, F.; Venditti, A.; Amadori, S. Idiopathic thrombocytopenic purpura: current concepts in pathophysiology and management. Thromb. Haemost., 2008, 99(1), 4-13.
[http://dx.doi.org/10.1160/TH07-08-0513] [PMID: 18217129]
[7]
Olsson, B.; Andersson, P.O.; Jernås, M.; Jacobsson, S.; Carlsson, B.; Carlsson, L.M.; Wadenvik, H. T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat. Med., 2003, 9(9), 1123-1124.
[http://dx.doi.org/10.1038/nm921] [PMID: 12937414]
[8]
Zhang, X.L.; Peng, J.; Sun, J.Z.; Liu, J.J.; Guo, C.S.; Wang, Z.G.; Yu, Y.; Shi, Y.; Qin, P.; Li, S.G.; Zhang, L.N.; Hou, M. De novo induction of platelet-specific CD4(+)CD25(+) regulatory T cells from CD4(+)CD25(-) cells in patients with idiopathic thrombocytopenic purpura. Blood, 2009, 113(11), 2568-2577.
[http://dx.doi.org/10.1182/blood-2008-03-148288] [PMID: 19056692]
[9]
Sakakura, M.; Wada, H.; Tawara, I.; Nobori, T.; Sugiyama, T.; Sagawa, N.; Shiku, H. Reduced Cd4+Cd25+ T cells in patients with idiopathic thrombocytopenic purpura. Thromb. Res., 2007, 120(2), 187-193.
[http://dx.doi.org/10.1016/j.thromres.2006.09.008] [PMID: 17067661]
[10]
Audia, S.; Mahévas, M.; Samson, M.; Godeau, B.; Bonnotte, B. Pathogenesis of immune thrombocytopenia. Autoimmun. Rev., 2017, 16(6), 620-632.
[http://dx.doi.org/10.1016/j.autrev.2017.04.012] [PMID: 28428120]
[11]
Siegal, D.; Crowther, M.; Cuker, A. Thrombopoietin Receptor Agonists in Primary ITP. Semin. Hematol., 50(6), 18-21. 2013.
[12]
Pinette, K.V.; Yee, Y.K.; Amegadzie, B.Y.; Nagpal, S. Vitamin D receptor as a drug discovery target. Mini Rev. Med. Chem., 2003, 3(3), 193-204.
[http://dx.doi.org/10.2174/1389557033488204] [PMID: 12570835]
[13]
Pelajo, C.F.; Lopez-Benitez, J.M.; Miller, L.C. Vitamin D and autoimmune rheumatologic disorders. Autoimmun. Rev., 2010, 9(7), 507-510.
[http://dx.doi.org/10.1016/j.autrev.2010.02.011] [PMID: 20146942]
[14]
Marques, C.D.; Dantas, A.T.; Fragoso, T.S.; Duarte, A.L. The importance of vitamin D levels in autoimmune diseases. Rev. Bras. Reumatol., 2010, 50(1), 67-80.
[http://dx.doi.org/10.1590/S0482-50042010000100007] [PMID: 21125142]
[15]
Boonstra, A.; Barrat, F.J.; Crain, C.; Heath, V.L.; Savelkoul, H.F.; O’Garra, A. 1alpha,25-Dihydroxyvitamin d3 has a direct effect on naive CD4(+) T cells to enhance the development of Th2 cells. J. Immunol., 2001, 167(9), 4974-4980.
[http://dx.doi.org/10.4049/jimmunol.167.9.4974] [PMID: 11673504]
[16]
Zhang, H.; Shih, D.Q.; Zhang, X. Mechanisms underlying effects of 1,25-Dihydroxyvitamin D3 on the Th17 cells. Eur. J. Microbiol. Immunol. (Bp.), 2013, 3(4), 237-240.
[http://dx.doi.org/10.1556/EuJMI.3.2013.4.1] [PMID: 24294492]
[17]
Fattizzo, B.; Zaninoni, A.; Giannotta, J.A.; Binda, F.; Cortelezzi, A.; Barcellini, W. Reduced 25-OH vitamin D in patients with autoimmune cytopenias, clinical correlations and literature review. Autoimmun. Rev., 2016, 15(7), 770-775.
[http://dx.doi.org/10.1016/j.autrev.2016.03.015] [PMID: 26988993]
[18]
Mu, W.; Wang, W.; Cui, Z.G.; Sui, A.H. [Expression and significance of vitamin D and its receptor mRNA in the peripheral blood of initial immune thrombocytopenic patients Zhongguo Shi Yan Xue Ye Xue Za Zhi, 2013, 21(3), 684-687.
[PMID: 23815922]
[19]
Liu, W.; Li, H.; Hao, Y.; Li, Y.; Lv, M.; Xue, F.; Liu, X.; Zhang, L.; Yang, R. Decreased immunosuppressive actions of 1α, 25-dihydroxyvitamin D3 in patients with immune thrombocytopenia. Mol. Immunol., 2016, 78, 89-97.
[http://dx.doi.org/10.1016/j.molimm.2016.08.014] [PMID: 27614264]
[20]
Čulić, S.; Markić, J.; Petrović, D.; Konjevoda, P.; Pavelić, J. Serum vitamin D levels in children with newly diagnosed and chronic immune thrombocytopenia. Semin. Hematol., 1(53), 67-69. 2016.
[21]
Grant, W.B. A Review of the Evidence Supporting the Vitamin D-Cancer Prevention Hypothesis in 2017. Anticancer Res., 2018, 38(2), 1121-1136.
[PMID: 29374749]
[22]
Mohammadabadia, M.R.; Mozafar, M.R. Enhanced efficacy and bioavailability of thymoquinone using nanoliposomal dosage form. J. Drug Deliv. Sci. Technol., 2018, 47, 445-453.
[http://dx.doi.org/10.1016/j.jddst.2018.08.019]
[23]
Heidarpour, F.; Mohammadabadi, M.R.; Zaidul, I.S.M.; Maherani, B.; Saari, N.; Hamid, A.A.; Abas, F.; Manap, M.Y.A.; Mozafari, M.R. Use of prebiotics in oral delivery of bioactive compounds: a nanotechnology perspective. Pharmazie, 2011, 66(5), 319-324.
[PMID: 21699064]
[24]
Consensus on vitamin D in pediatric age, https://www.sipps.it/pdf/rivista/anno10/2_3ss_2015.pdf2015.
[25]
Miller, F.; Zohar, S.; Stallard, N.; Madan, J.; Posch, M.; Hee, S.W.; Pearce, M.; Vågerö, M.; Day, S. Approaches to sample size calculation for clinical trials in rare diseases. Pharm. Stat., 2018, 17(3), 214-230.
[http://dx.doi.org/10.1002/pst.1848] [PMID: 29322632]
[26]
Bikle, D.D. Vitamin D and immune function: understanding common pathways. Curr. Osteoporos. Rep., 2009, 7(2), 58-63.
[http://dx.doi.org/10.1007/s11914-009-0011-6] [PMID: 19631030]
[27]
Bizzaro, G.; Antico, A.; Fortunato, A.; Bizzaro, N. Vitamin D and Autoimmune Diseases: Is Vitamin D Receptor (VDR) Polymorphism the Culprit? Isr. Med. Assoc. J., 2017, 19(7), 438-443.
[PMID: 28786260]
[28]
Antico, A.; Tampoia, M.; Tozzoli, R.; Bizzaro, N. Can supplementation with vitamin D reduce the risk or modify the course of autoimmune diseases? A systematic review of the literature. Autoimmun. Rev., 2012, 12(2), 127-136.
[http://dx.doi.org/10.1016/j.autrev.2012.07.007] [PMID: 22776787]
[29]
Yesil, S.; Tanyildiz, H.G.; Tekgunduz, S.A.; Toprak, S.; Fettah, A.; Dikmen, A.U.; Sahin, G. Vitamin D receptor polymorphisms in immune thrombocytopenic purpura. Pediatr. Int. (Roma), 2017, 59(6), 682-685.
[http://dx.doi.org/10.1111/ped.13273] [PMID: 28258612]
[30]
Bockow, B.; Kaplan, T.B. Refractory immune thrombocytopenia successfully treated with high-dose vitamin D supplementation and hydroxychloroquine: two case reports. J. Med. Case Reports, 2013, 7, 91.
[http://dx.doi.org/10.1186/1752-1947-7-91] [PMID: 23556539]
[31]
Huckins, D.; Felson, D.T.; Holick, M. Treatment of psoriatic arthritis with oral 1,25-dihydroxyvitamin D3: a pilot study. Arthritis Rheum., 1990, 33(11), 1723-1727.
[http://dx.doi.org/10.1002/art.1780331117] [PMID: 2242069]
[32]
Tantawy, A.A.; El Bostany, E.A.; Matter, R.M.; El Ghoroury, E.A.; Ragab, S.; El Sherif, N.H. Bone mass and biochemical markers of bone turnover in children and adolescents with chronic immune thrombocytopenia: relation to corticosteroid therapy and vitamin D receptor gene polymorphisms. Platelets, 2013, 24(4), 282-287.
[http://dx.doi.org/10.3109/09537104.2012.690544] [PMID: 22671537]
[33]
Giordano, P.; Lassandro, G.; Giona, F.; Jankovic, M.; Nardi, M.; Nobili, B.; Notarangelo, L.D.; Russo, G.; Mackensen, Sv. ITP-QoL questionnaire for children with immune thrombocytopenia: Italian version validation’s. Pediatr. Hematol. Oncol., 2014, 31(6), 534-547.
[http://dx.doi.org/10.3109/08880018.2014.915443] [PMID: 24852656]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 20
ISSUE: 2
Year: 2020
Page: [221 - 226]
Pages: 6
DOI: 10.2174/1871530319666190614152709
Price: $65

Article Metrics

PDF: 20
HTML: 3