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Exhausted natural killer cells in adult IgA vasculitis
Get PDFIntroduction. IgA vasculitis nephritis (IgAVN) manifests in up to 84% of adult patients with IgA vasculitis (IgAV) and is associated with an elevated risk of progression to chronic kidney failure. The underlying pathogenic mechanism of adult IgAVN in leukocytes remain largely uncharacterised. Although natural killer (NK) cells were investigated in paediatric IgAV, their specific role in the pathogenesis of adult IgAV has yet to be elucidated. Methods. RNA sequencing of leukocytes from adult IgAV patients and healthy controls (HC) was performed. NK cells’ cytotoxicity was assessed using calcein-AM stained K562 cells, and exocytosis was measured by LAMP-1/CD107a expression. Intracellular perforin and granzyme B were analyzed via flow cytometry, and cytokine secretion was measured by Luminex xMAP. Interferon-induced genes were validated with qPCR. Results. Principal component analysis (PCA) of leukocyte gene expression profiles distinguished IgAV patients from HC. Pathway enrichment analysis showed differences in patients’ subsets - Interferon signalling Reactome pathway was observed only in sample from patients with skin-limited IgAV (sl-IgAV) and was confirmed by increased expression of interferon-induced genes using qPCR. Only in samples from IgAVN patients enrichment of NK cell-mediated cytotoxicity KEGG pathway was found. NK cells from IgAVN patients showed significantly decreased cytotoxicity compared to samples from sl-IgAV patients (p = 2.53 × 10− 2). The % of CD107a+-NK cells significantly increased after stimulation in HC (p = 9.7 × 10− 3) and in sl-IgAV patient samples (p = 2.21 × 10− 2) while only a minor increase was observed in samples of IgAVN patients. IgAVN patients exhibited a decreased % of perforin+ NK cells compared to HC. Following phytohemagglutinin (PHA)/interleukin (IL)-2 stimulation, a significant reduction in intracellular perforin level was observed in HC (p = 2.53 × 10− 2), but not in IgAVN patients NK cells. Interferon (IFN)-ϒ and macrophage inflammatory protein (MIP)-1β were significantly decreased in NK cell culture supernatants from IgAVN patients (p = 2.64 × 10− 2 and p = 2.65 × 10− 2 respectively). Conclusion. Patients with IgAVN exhibited impaired cytotoxic and immunomodulatory functions of NK cells, along with a marked absence of interferon signaling in PBMCs. Further studies are needed to confirm if discrimination of patient subsets based on leukocyte samples might be of clinical use and if deregulated NK function might contribute to the pathogenesis of nephritis in adult IgAV
Intestinal involvement in graft versus host disease in children
Get PDFGraft versus host disease (GVHD) is a complication that frequently occurs afterhaematopoietic stem cell transplantation and concerns many children in paediatrichaematology‐oncology and bone marrow transplantation departments. It can affectvarious organs, with the skin, gastrointestinal tract and liver being the most com-monly involved. To confirm intestinal GVHD and to rule out differential diagnosesendoscopy is frequently needed. Currently, there are no specific consensus rec-ommendations concerning the best method for endoscopic exploration and medicalmanagement of this disease in children, with limited studies available, including alow number of patients. Sigmoidoscopy could be initially proposed under sedation. Ifsigmoidoscopy is normal or if a general anaesthesia is required, colonoscopy andupper endoscopy should be planned, avoiding duodenal biopsy because of the riskof duodenal haematoma. Regarding therapeutic options, corticosteroids are thefirst‐line treatment for GVHD. Ruxolitinib, a Janus kinase inhibitor, is indicated forchildren aged 12 years and older with acute or chronic GVHD who have aninadequate response to corticosteroids or other systemic therapies. Nutritionalsupport has a key role in the management of intestinal GVHD and should beconsidered to guarantee the best possible evolution of intestinal GVHD
