title: Efficacy of immunomodulatory therapy with all-trans retinoid acid in adult patients with chronic immune thrombocytopenia.
abstract: BACKGROUND
  Immune thrombocytopenia (ITP) is a common hematologic disorder characterized by isolated thrombocytopenia. In adults, ITP is more likely to be chronic, requiring individualised treatment and management. Corticosteroids and splenectomy are the most common therapy for ITP. However, these routine approaches failed in these patients with chronic ITP. The aim of this study was to evaluate the efficacy of immunomodulatory therapy with all-trans retinoid acid (ATRA) in adult patients with chronic ITP.
  
  
  METHODS
  ATRA therapy was applied in a total of 35 patients with chronic ITP who failed with standard dose corticosteroids and/or splenectomy. The response ratio and the change of the T cell subsets including Th1, Th2, Th17 and Treg, were evaluated.
  
  
  RESULTS
  Complete response and overall response were observed in 10 (28.6%) and 19 patients (54.3%), respectively. Compared with the control group, a significant decreased level of Treg cells, IL-10 and Foxp3 expression were found in ITP patients. ATRA therapy could significantly increase the percentage of Treg cell, IL-10 level and Foxp3 expression.
  
  
  CONCLUSIONS
  Our findings indicate that ATRA therapy could induce significant changes of Treg cells to induce response in patients with chronic ITP.
authors.affiliation: MOH Key Lab of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; Collaborative Innovation Center of Hematology, Soochow University, 1 Shizi Street, Suzhou 215006, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Dai
authors.affiliation: MOH Key Lab of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; Collaborative Innovation Center of Hematology, Soochow University, 1 Shizi Street, Suzhou 215006, China.
authors.forename: Ri
authors.initials: R
authors.lastname: Zhang
authors.affiliation: MOH Key Lab of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; Collaborative Innovation Center of Hematology, Soochow University, 1 Shizi Street, Suzhou 215006, China. Electronic address: zwang11@sina.com.
authors.forename: Zhaoyue
authors.initials: Z
authors.lastname: Wang
authors.affiliation: MOH Key Lab of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; Collaborative Innovation Center of Hematology, Soochow University, 1 Shizi Street, Suzhou 215006, China. Electronic address: heyang1963@163.com.
authors.forename: Yang
authors.initials: Y
authors.lastname: He
authors.affiliation: MOH Key Lab of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; Collaborative Innovation Center of Hematology, Soochow University, 1 Shizi Street, Suzhou 215006, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Bai
authors.affiliation: MOH Key Lab of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; Collaborative Innovation Center of Hematology, Soochow University, 1 Shizi Street, Suzhou 215006, China.
authors.forename: Mingqing
authors.initials: M
authors.lastname: Zhu
authors.affiliation: MOH Key Lab of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; Collaborative Innovation Center of Hematology, Soochow University, 1 Shizi Street, Suzhou 215006, China.
authors.forename: Ziqiang
authors.initials: Z
authors.lastname: Yu
authors.affiliation: MOH Key Lab of Thrombosis and Hemostasis, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, China; Collaborative Innovation Center of Hematology, Soochow University, 1 Shizi Street, Suzhou 215006, China.
authors.forename: Chang-Geng
authors.initials: CG
authors.lastname: Ruan
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016753:Interleukin-10 / Q000097:blood; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D006377:T-Lymphocytes, Helper-Inducer / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D050378:T-Lymphocytes, Regulatory / Q000187:drug effects* / Q000276:immunology / Q000473:pathology; D016212:Transforming Growth Factor beta / Q000097:blood; D014212:Tretinoin / Q000627:therapeutic use*
chemical_list: C508609:IL10 protein, human; D007155:Immunologic Factors; D016212:Transforming Growth Factor beta; D016753:Interleukin-10; D014212:Tretinoin
keywords: All-trans retinoid acid; Chronic immune thrombocytopenia; Immunomodulatory therapy; Regulatory T cells