The Relationship Between IgA Vasculitis and Antioxidant Activity In Children

Dicle Tıp Dergisi / Dicle Med J (2021) 48 (2) : 212-219 Original Article / Özgün Araştırma The Relationship Between IgA Vasculitis and Antioxidant Activity In Children Hayrettin Temel 1, Cihangir Akgün 2, Mesut Okur 1 1 Department of Pediatrics, Istanbul Medipol University, Medical Faculty, Istanbul, Turkey 2 Department of Pediatric Nephrology, Istanbul Medipol University, Medical Faculty, Istanbul, Turkey Received: 15.12.2020; Revised: 20.02.2021; Accepted: 16.03.2021 Abstract Objective: Immunoglobulin A vasculitis (IgAV) is the most common systemic vasculitis seen in children. The aim of this study is to investigate the relationship between malondialdehyde-induced oxidative stress, antioxidant system and organ involvement in IgAV patients. Method: 32 patients and 28 healthy children were included in the study. Serum malondialdehyde, reduced glutathione, vitamin E, vitamin C, retinol, and beta-carotene levels were measured in patients (separately in both the active and remission phases) and healthy children. Results: MDA levels were significantly higher in patients with active phase while reduced glutathione and vitamin C levels were markedly lower in both the active and the remission phases. Retinol and beta-carotene levels were lower in the active phase. It was found that retinol levels were significantly lower in patients with gastrointestinal system involvement compared to those without. Vitamin C levels were significantly lower in those with kidney involvement compared to those without. Also, a negative correlation was observed between retinol levels and the number of organs involved. Conclusion: We consider that especially vitamin C and vitamin A may be used in the treatment of IgAV. However, whether the derangements of the oxidant/antioxidant balance in the direction of increased oxidative stress are consequences or causes of the events occurring in the active phase of IgAV are open to further investigation. Keywords: IgA vasculitis, malondialdehyde, vitamin E, vitamin C, vitamin A DOI: 10.5798/dicletip.944308 Correspondence / Yazışma Adresi: Hayrettin Temel, Istanbul Medipol University Medical Faculty, Department of Pediatrics Istanbul, Turkey. e-mail: 212 Temel H., Akgün C.,, Okur M. Çocuklarda IgA Vasküliti ile Antioksidan Aktivite Arasındaki İlişki Öz Amaç: İmmünoglobulin A vaskülit (IgAV) çocuklarda en sık görülen sistemik vaskülittir. Bu çalışmanın amacı, IgAV hastalarında malondialdehit kaynaklı oksidatif stres, antioksidan sistem ve organ tutulumu arasındaki ilişkiyi araştırmaktır. Yöntemler: Çalışmaya 32 hasta ve 28 sağlıklı çocuk dahil edildi. Hastalarda (hem aktif hem de remisyon fazlarında ayrı ayrı) ve sağlıklı çocuklarda serum malondialdehit, redükte glutatyon, E vitamini, C vitamini, retinol ve beta-karoten seviyeleri ölçüldü. Bulgular: Aktif fazı olan hastalarda MDA seviyeleri önemli ölçüde daha yüksekken, redükte glutatyon ve C vitamini seviyeleri hem aktif hem de remisyon fazlarında belirgin şekilde daha düşüktü. Retinol ve beta-karoten seviyeleri aktif fazda daha düşüktü. Gastrointestinal sistem tutulumu olan hastalarda retinol düzeylerinin olmayanlara göre anlamlı derecede düşük olduğu bulundu. Böbrek tutulumu olanlarda, olmayanlara göre C vitamini seviyeleri önemli ölçüde daha düşüktü. Ayrıca, retinol seviyeleri ile ilgili tutulan organ sayısı arasında negatif bir korelasyon gözlendi. Sonuç: IgAV tedavisinde özellikle C vitamini ve A vitamininin kullanılabileceğini düşünüyoruz. Bununla birlikte, oksidan / antioksidan dengesindeki artmış oksidatif stres yönündeki düzensizliklerin, IgAV'nin aktif fazında meydana gelen olayların sonuçları mı yoksa nedenleri mi olduğu daha fazla araştırmaya açıktır. Anahtar kelimeler: IgA vasküliti, malondialdehit, vitamin E, vitamin C, vitamin A. INTRODUCTION Immunoglobulin A vasculitis [IgA vasculitis (IgAV), formerly known as Henoch Schönlein purpura] is the most common form of systemic vasculitis of childhood with a reported incidence of 3-26.7 cases per 100 0001,2. IgAV, characterized by the presence of immunoglobulin A, deposits in the small vessels of skin, gastrointestinal system (GIS), joints and kidneys. Although a variety of infectious and chemical triggers are recognized, the underlying cause of IgAV remains unknown3. Oxidative injury is initiated by free radicals and reactive oxygen metabolites (ROMs) that are generated by activated neutrophils, monocytes, macrophages, endothelial cells and mesangial cells during metabolic processes. When there is an increase in the generation of ROMs or when antioxidant defense mechanisms decrease, the shift in the oxidant/antioxidant balance cause oxidative injury that may produce derangements of cell metabolism including peroxidation of lipids resulting in cell injury and death4. Malondialdehyde (MDA), the final product of lipid peroxidation induced by ROMs, leads to crosslinking in lipids, proteins and nucleic acids, and is considered an important marker of oxidative stress4,5. Antioxidants reduce oxidative damage by inhibiting the activity or expression of free radical-producing enzymes either directly or indirectly by reacting with free radicals or by increasing the activity or expression of intracellular antioxidant enzymes6. Reduced glutathione (GSH) is the predominant intracellular antioxidant in many organisms. GSH protects cells against a wide variety of free radicals such as reactive oxygen species, lipid peroxides, xenobiotic toxins, and heavy metals7. Vitamin E (alpha-tocopherol), a natural antioxidant, neutralizes free radicals and protects the cell membrane against free oxygen radicals. It also improves the functions of other antioxidants by preventing lipid peroxidation8. Vitamin C is a powerful antioxidant that protects cell membranes from damage by eliminating the effects of radicals that initiate lipid peroxidation9. Vitamin A, which is stored mainly in the liver as retinol, is the name given to a group of fat-soluble retinoids and carotenoids10. Beta-Carotene is a strong antioxidant that serves as a scavenger of singlet oxygen. It is also a provitamin A as it can be 213 Dicle Tıp Dergisi / Dicle Med J (2021) 48 (2) : 212-219 converted into retinol11. Because of the close metabolic relationship between beta-carotene and retinol, it is important to evaluate their physiological effects together12. Oxidative injury is implicated in the pathogenesis of various inflammatory, metabolic and toxic insults and ischemic reperfusion injury4. Several experimental studies on oxidative injury in glomerular diseases and vasculitis have been carried out, but few clinical studies have been performed13,14. In this study, the role of oxidative stress in the pathogenesis of IgAV and its relationship with organ and oxidant/antioxidant involvement were investigated on the basis of clinical and laboratory parameters. METHODS This study was conducted prospectively with the approval of the local ethics committee (Date: 24/11/2009 Decisio (...truncated)