MicroRNA-cytokine interplay and treg dysregulation in pediatric immune thrombocytopenia: implications for disease chronicity

This study aimed to investigate the immune-epigenetic profile of pediatric immune thrombocytopenic purpura (ITP) and its association with disease chronicity. This case-control study included 93 participants: 33 children with newly diagnosed ITP, 28 with chronic ITP (> 12 months), and 32 age- and sex-matched healthy controls. We assessed platelet count, serum transforming growth factor-β (TGF-β), interleukin-10 (IL-10) levels, circulating CD4⁺CD25⁺FoxP3⁺ Treg frequency, and relative expression of miR-106b-5p and miR-146a-5p. ITP patients demonstrated significantly lower platelet counts, Treg frequency, and TGF-β levels, with elevated IL-10 levels compared to controls. miR-106b-5p expression was significantly upregulated in ITP, particularly in chronic cases, and negatively correlated with platelet count, Treg frequency, and TGF-β. Conversely, miR-146a-5p was significantly downregulated and positively correlated with platelet count and Treg frequency. Chronic ITP exhibited more pronounced miRNA dysregulation and Treg depletion. ROC analysis revealed high diagnostic accuracy of both miRNAs for chronic ITP, with miR-146a-5p demonstrating superior sensitivity.