Assessment of HLA Antigens and Serum Cytokine Levels to Predict Disease Progression and Treatment Responses in Children with Chronic Glomerulonephritis
Sunday, March 6, 2016
South Exhibit Hall H (Convention Center)
G.N. Drannik, V. Driianska, Lawrence M. DuBuske, MD, FAAAAI
Rationale: The value of HLA assessment and cytokine assays in assessment of the development and progression of chronic glomerulonephritis and nephrotic syndrome (CGN, NS) in children was studied in Kiev, Ukraine.

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.