title: The effect of single course high dose dexamethasone on CD28/CTLA-4 balance in the treatment of patients with newly diagnosed primary immune thrombocytopenia.
abstract: To evaluate the effect of a single course of high dose dexamethasone (HD-DXM) on CD28 and CTLA-4 expression in patients with newly-diagnosed primary immune thrombocytopenia (ITP). Twenty-8 ITP patients (18 females and 10 males, age range 18-65 years, median age 38.5 years) enrolled in this study and 26 healthy volunteers (19 women and 7 men, age range 16-66 years, median age 37 years) served as a control group. The patients were treated with HD-DXM (40 mg/day) for 4 consecutive days. CD28 and CTLA-4 expression was assessed by flow cytometry once-monthly for 6 months. Plasma levels of the cytokines IFN-γ and IL-10 were determined by enzyme-linked immunosorbent assay. One month after treatment, a platelet response was observed in 23 (82%) of the patients. The response rates over the next 5 months were 71%, 57%, 53%, 46%, and 39%, chronologically. We observed a significant decrease in CD28 expression after the first month (34.7 ± 4.8% vs. 44.5 ± 4.4% before treatment), after which the CD28 levels gradually increased. In contrast, CTLA-4 expression increased after the first month (3.2 ± 0.5% vs. 0.8 ± 0.4 before treatment), after which the CTLA-4 levels gradually decreased. Similar dynamic changes were seen in the levels of IFN-γ and IL-10. The dynamic changes of CD28 and CTLA-4 were consistent with those of IFN-γ and IL-10 and with the effectiveness of HD-DXM in the treatment of ITP. Our results suggest that a disturbed CD28/CTLA-4 balance may contribute to the immunopathogenesis of ITP.
authors.affiliation: a State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890294); Xinjiang Key Laboratory of Echinococcosis; First Affiliated Hospital of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.
authors.forename: Xinhong
authors.initials: X
authors.lastname: Guo
authors.affiliation: a State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890294); Xinjiang Key Laboratory of Echinococcosis; First Affiliated Hospital of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.
authors.forename: Halida
authors.initials: H
authors.lastname: Yasen
authors.affiliation: a State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890294); Xinjiang Key Laboratory of Echinococcosis; First Affiliated Hospital of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhao
authors.affiliation: a State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890294); Xinjiang Key Laboratory of Echinococcosis; First Affiliated Hospital of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: a State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890294); Xinjiang Key Laboratory of Echinococcosis; First Affiliated Hospital of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.
authors.forename: Mingling
authors.initials: M
authors.lastname: Sun
authors.affiliation: a State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890294); Xinjiang Key Laboratory of Echinococcosis; First Affiliated Hospital of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.
authors.forename: Nannan
authors.initials: N
authors.lastname: Pang
authors.affiliation: a State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890294); Xinjiang Key Laboratory of Echinococcosis; First Affiliated Hospital of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.
authors.forename: Xiujuan
authors.initials: X
authors.lastname: Wang
authors.affiliation: a State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890294); Xinjiang Key Laboratory of Echinococcosis; First Affiliated Hospital of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: a State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890294); Xinjiang Key Laboratory of Echinococcosis; First Affiliated Hospital of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.|b College of Basic Medicine of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.
authors.forename: Jianbing
authors.initials: J
authors.lastname: Ding
authors.affiliation: a State Key Laboratory Incubation Base of Xinjiang Major Diseases Research (2010DS890294); Xinjiang Key Laboratory of Echinococcosis; First Affiliated Hospital of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.|b College of Basic Medicine of Xinjiang Medical University ; Urumqi, Xinjiang , PR China.
authors.forename: Xiumin
authors.initials: X
authors.lastname: Ma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018106:CD28 Antigens / Q000032:analysis*; D060908:CTLA-4 Antigen / Q000032:analysis*; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D007371:Interferon-gamma / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018106:CD28 Antigens; D060908:CTLA-4 Antigen; D007155:Immunologic Factors; D016753:Interleukin-10; D003907:Dexamethasone; D007371:Interferon-gamma