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Summary Helicobacter pylori eradication induces platelet recovery in a subgroup of patients with chronic immune thrombocytopenia (cITP), but the mechanisms involved are still not understood. We aimed to evaluate the effect of H. pylori eradication on platelet response and to identify the associated serum cytokine profile in 95 patients with cITP. Serum cytokine concentrations were determined by enzyme-linked immunosorbent assay prior to and 6 months after H. pylori eradication. Remission of cITP was observed in 17 (288%) of 59 patients in whom the bacterium was eradicated. Six months after treatment, a significant reduction in the concentrations of T-helper (Th) 1 and Th17 cells and an increase in T regulatory (Treg) and Th2-cell commitment cytokines were observed in patients who recovered, but not in those whose platelet count did not recover. Patients who had a platelet response to eradication of the bacteria had higher pre-treatment serum levels of c-interferon (IFNG, IFN-c), transforming growth factor-b (TGFB1, TGF-b) and interleukin 17 (IL17A, IL-17) than patients who did not respond, but only higher pre-treatment TGFB1 levels was independently associated with platelet response. In conclusion, amelioration of cITP after eradication of H. pylori was linked to a more efficient suppression of Th1 and Th17 response and a more pronounced Treg cell response.

Th17 cells have been associated with immune-mediated diseases in humans but it has still not been determined whether they play a role in immune thrombocytopenia. We evaluated representative cytokines of the Th17, Th1, Th2 and Treg cell commitment in the serum of patients with chronic immune thrombocytopenia, as well as the cell source of IL-17A. Higher levels of IL-17A and Th17-related cytokines, and an increased percentage of IL-17A producing CD4+ and neutrophils were observed in patients. The levels of cytokines involved in Th1 cell commitment IFN-γ, IL-2, IL12-p70 and the percentages of Th1 cells were also increased, but IL-4 was not detected. Although the concentrations of IL-10 were higher, the levels of TGF-β were similar in both groups. In conclusion, our results point to a putative role for Th-17 cells/IL-17A cytokine in the pathogenesis of chronic immune thrombocytopenia.

Summary Chronic Immune Thrombocytopenia (cITP)isan acquired immune-mediated disease associated with a T-helper cell type 1 (Th1) immune polarization, whose genetic risk factors, however, are largely unknown. We investigated polymorphisms in promoter regions of genes that code molecules involved in proinflammatory immune response [IL1B )31T/C, IL1RN variable number tandem repeats (VNTR), IL2 )330T/G, and TNF )307G/A] as well as in genes that code Toll like receptors (TLR) (TLR2 Arg753Gln, TLR4 Asp299Gly and TLR5 Arg 392stop ) in 122 patients with cITP and 541 blood donors. The frequencies of the IL1RN polymorphic allele 2 (P =0 AE001) and of the IL2 )330 polymorphic allele G (P =0 AE004) were significantly higher in cITP patients than in blood donors. In logistic analysis adjusting for age and gender, the polymorphisms remained independently associated with cITP. Enhanced serum concentrations of interleukin (IL)-1a and IL-1b were observed in cITP (P

Background: Helicobacter pylori gastritis may lead to impairment of the production of pepsinogen and acid, which are essential to cobalamin absorption. In turn, cobalamin deficiency leads to hyperhomocysteinaemia, a risk factor for cardio and cerebrovascular diseases. Aim: To evaluate the effect of H pylori eradication on plasma homocysteine levels in elderly patients. Patients: Sixty-two H pylori -positive elderly patients with cobalamin deficiency were prospectively studied. Methods: Homocysteine and cobalamin concentrations were determined before, 6 and 12 months after H pylori eradication. Results: Corpus atrophy was observed in a few patients; otherwise, in most of them, the degree of corpus gastritis was moderate to severe. The initial homocysteine mean (SD) levels decreased from 41.0 (27.1) to 21.6 (10.1) μmol/l at the 6 month follow-up (p H pylori eradication (p Conclusions: The results of the current study demonstrated that the eradication of H pylori in elderly patients with cobalamin deficiency is followed by increasing of cobalamin and decreasing of homocysteine blood levels.

Chronic Immune Thrombocytopenia (cITP) is an acquired immune-mediated disease associated with a T-helper cell type 1 (Th1) immune polarization, whose genetic risk factors, however, are largely unknown. We investigated polymorphisms in promoter regions of genes that code molecules involved in proinflammatory immune response [IL1B-31T/C, IL1RN variable number tandem repeats (VNTR), IL2-330T/G, and TNF-307G/A] as well as in genes that code Toll like receptors (TLR) (TLR2 Arg753Gln, TLR4 Asp299Gly and TLR5 Arg(392stop)) in 122 patients with cITP and 541 blood donors. The frequencies of the IL1RN polymorphic allele 2 (P = 0·001) and of the IL2-330 polymorphic allele G (P =0·004) were significantly higher in cITP patients than in blood donors. In logistic analysis adjusting for age and gender, the polymorphisms remained independently associated with cITP. Enhanced serum concentrations of interleukin (IL)-1α and IL-1β were observed in cITP (P10(-3) ) and blood donor (P = 0·04) carriers of the IL1RN*2. Also, the serum levels of IL-2 and γ-interferon (IFN-γ) were increased in cITP patients (P10(-3) and P = 0·04 respectively) and blood donors (P10(-3) and P = 0·03 respectively) harbouring the IL2-330G allele. Here we demonstrated that IL2-330G and IL1RN*2 are independently associated with cITP and are functional in vivo, which strongly suggests that they contribute to the pathogenesis of cITP.

OBJETIVOS: Analisar o padrão topográfico da gastrite por H. pylori em relação ao status cagA e associação com úlcera duodenal (UD) e carcinoma gástrico precoce (CaGp). MATERIAL E MÉTODO: Estudamos prospectivamente 160 biopsias endoscópicas e 40 peças de gastrectomia por CaGp. Amostras do antro e do corpo na pequena e grande curvaturas, da incisura e do tumor, foram processadas rotineiramente para histologia com histoquímica para caracterização da metaplasia intestinal (MI). O Helicobacter pylori foi avaliado por histologia, imuno-histoquímica, cultura e reação em cadeia de polimerase (PCR) e o status cagA por PCR. A gastrite crônica (GC) foi classificada segundo o sistema Sydney. Realizou-se estudo topográfico em 130 pacientes, analisando os parâmetros de gastrite comparativamente entre as áreas e em relação ao status cagA. RESULTADOS: Cento e vinte e um pacientes apresentaram GC, 24 UD e 14 eram normais. Detectaram-se amostras cagA-positivas em 59 pacientes com GC, 17 com UD e 24 com CaGp. Todos os parâmetros de GC foram significativamente mais intensos nos pacientes infectados por amostras cagA-positivas, que se associavam ainda à presença de atrofia e MI. A MI foi significativamente mais intensa na porção média da pequena curvatura antral do que nas demais regiões. Nos pacientes com GC e CaGp, infectados por amostras cagA-positivas, inflamação e atividade acometiam igualmente o antro e corpo distal, enquanto a atrofia e a MI predominavam no antro, particularmente na pequena curvatura do antro médio. Nos pacientes cagA-negativos a GC era predominantemente antral, e na UD a GC apresentava predominância antral, independentemente do status cagA. CONCLUSÕES: Nossos dados sugerem que o padrão de gastrite por H. pylori se relaciona com fatores de virulência da bactéria. As lesões pré-neoplásicas são significativamente mais intensas na pequena curvatura do antro médio, onde surge a maioria dos carcinomas gástricos (CaG).

The definition of immune Thrombocytopenia (ITP) as a peripheral blood platelet count less than 100 × 109/L instead of the historical criteria of 150 × 109/L renders subjects with platelets between 100 and 150 × 109/L without a diagnosis. Here, we demonstrated that these subjects have enhanced levels of proinflammatory cytokines linked to Th1 and Th17 cell response, and are more frequently carriers of polymorphisms in genes that code cytokines involved in the commitment of Th1 and Th17 immune response, when compared with controls, similarly to that observed in patients with ITP.