Association of immune thrombocytopenia and the expression of OX40 gene and OX40 ligand in Egyptian patients with illustrating the clinical significance

Context Several members of the tumour necrosis factor (TNF) superfamily play an important role in the generation of an optimal memory response; among these are OX40, which is also known as tumour necrosis factor receptor superfamily member 4 (TNFRSF4), and its ligand OX40L. Aims To identify OX40 and OX40 Ligand gene relation to clinical features and laboratory findings at diagnosis, and its correlation with disease progression and patient's outcome. Settings and design In attempt to increase our understanding of the relation between OX40 and OX40 Ligand genes and immune thrombocytopenia (ITP); we studied OX40 and OX40 Ligand genes expression in ITP patients. Methods and patient In the current investigation which included 50 ITP patients and 50 age and sex matched healthy controls, the OX40 and OX40L mRNA gene expression levels were analyzed using the real-time quantitative PCR (RT-QPCR) technique. Statistical analysis used IBM SPSS Advanced Statistics version 22 (SPSS Inc., Chicago, IL) was used to analyze the data. When applicable, the mean and standard deviation or the median and range were used to express numerical data. Frequency and percentage were used to express qualitative data. The Mann-Whitney test (a nonparametric t-test) was used to compare two groups of quantitative data that was not normally distributed. Comparison between three groups was done using Kruskal-Wallis test (nonparametric analysis of variance). Spearman-rho method was used to test the correlation between numerical variables. All tests were two-tailed. A P value less than 0.05 was considered significant. Results OX40 and OX40L gene expression levels were higher in ITP patients compared with the control group, and the difference was highly statistically significant (P<0.001) for both genes. There were a highly significant negative correlation between OX40 gene and duration of illness in days as r value =-0.54 and P value less than 0.001 but no correlation with age, hemoglobin level, platelets count, and total leukocytic count. We found a positive association between OX40 Ligand gene expression level and bleeding per gum, the difference was statistically significant (P<0.05). We also found a positive association between OX40L gene and fever at presentation, the difference was statistically significant (P=0.043). Conclusion According to our research, the expression of the OX40 and OX40L genes may be linked to ITP. Higher levels of OX40L were found in patients who presented with bleeding per gums and who presented with fever. The highest level of OX40 gene expression is associated with the acute type. So OX40 and OX40L genes might be a valuable new markers in the diagnosis and pathogenesis of ITP patients. Egypt J Haematol2024 49:318-324 (c) 2024 The Egyptian Journal of Haematology