| Evaluation of Bak and Bcl-Xl gene expression among pediatric patients with acute primary immune thrombocytopenia |
Amira Zaki Badawy1, Samia Hassan Kandel1, Iman Aly Ahmedy1, Mahmoud Ahmed Elhawy2, Sally Mohamed El-Hefnawy3, Dina Fouad Sief El-Nasr Zidan1, Hanan Hassan El-sheity1 
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1Clinical Pathology Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
2Pediatrics Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Egypt
33Biochemistry Department, Faculty of Medicine, Menoufia University Shebin Elkom, Egypt |
Correspondence:
Hanan Hassan El-sheity, Email: hanan_elsheity66@yahoo.com
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Received: 1 May 2025 • Revised: 9 June 2025 • Accepted: 11 June 2025 |
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| Abstract |
Background
Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by a low platelet counts and an increased risk of bleeding. Moreover, the apoptotic mechanisms of platelets may influence their production and lifespan.
Purpose
To assess the involvement of apoptotic markers—specifically the B-cell lymphoma protein 2 family proteins Bak and Bcl-Xl in the pathogenesis of acute primary ITP in pediatric patients, and to evaluate the impact of intravenous immunoglobulin (IVIG) therapy on their expression.
Methods
This study included 24 children with acute primary ITP and 30 healthy controls. Patients were enrolled from the Hematology and Oncology Unit of Menoufia University Hospitals, Egypt. Two peripheral blood samples were obtained from each participant: one prior to receiving IVIG therapy and the other after treatment. Platelet-rich plasma was isolated, and Bak and Bcl-Xl gene expression levels were assessed using reverse transcription quantitative polymerase chain reaction.
Results
Before treatment, Bak gene expression and Bak/Bcl-Xl expression ratio were significantly higher in patients versus controls (P=0.001 and P<0.001, respectively), whereas Bcl-Xl gene expression was significantly lower (P= 0.029). After treatment, Bak gene expression and the Bak/Bcl-Xl expression ratio decreased significantly (P<0.001 and P=0.001, respectively), whereas Bcl-Xl gene expression increased significantly (P<0.001).
Conclusion
Pediatric patients with acute primary ITP exhibited a heightened proapoptotic state, as indicated by an increased Bak expression and Bak/Bcl-Xl expression ratio, as well as a reduced Bcl-Xl expression. IVIG therapy appears to mitigate this pro-apoptotic effect, suggesting its ability to restore platelet homeostasis. |
| Key Words:
Platelet BCL2 family proteins, Pediatric patients, Primary immune thrombocytopenia, Reverse transcriptase polymerase chain reaction |
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