Methods: The distribution of HLA-antigens in 289 children with CGN and NS and immune status was studied in 50 patients to identify predictors of progression and steroid sensitivity/resistance. HLA antigens were defined by identification of lymphocytes with the help of a standard microlymphocytotoxic test on the Terasakiґs planchette with special panels of anti-HLA serums (20 antigens of locus A, 31-B and 9-DR) in children with CGN and NS and 350 healthy donors. Serum cytokine levels in steroid sensitive (22 patients – Group 1) and steroid resistant (28 patients – Group 2) children were assessed by ELISA.
Results: HLA-В21, HLA-B27, HLA-B41, HLA-DR4, HLA-DR5 have associations with CGN and NS with the relative risk (RR) ≥2. Steroid sensitivity was associated with HLA-А10, HLA-DR4, the attributive risk for steroid resistance being associated with HLA-А24; HLA-В14, HLA-21, HLA-41; HLA-DR7; А2В14 (s>0.1). The usage of standard scheme of steroid therapy immune modulators including prednisolone, cyclophosphamide, cyclosporine and mycophenolate mofetil led to decreased levels of pro- (TNF-α) and anti- (TGF-β) inflammatory cytokines in corticosteroid sensitive patients, and IFN-γ and VEGF in all patients. After therapy no statistically significant change occurred in IL-4 level, but in steroid resistant children levels were significantly greater (р<0.05).
Conclusions: Assessment of HLA antigens and serum cytokine profiles may be useful in forecasting disease progression and optimization treatment in children with CGN and NS.