Impaired Intestinal Barrier Function in Immune Thrombocytopenic Purpura Patients Measured by Serum Zonulin

Abstract

Abstract Background Besides its involvement in the digestion and resorption of nutrients, one task of the intestine is to act as a barrier regulating the passage of antigens and macromolecules from the environment into the organism. This barrier is to a major extent formed by the intestinal epithelia and its lateral tight junctions whichclose off the paracellular interstices. The tight junctions consist of transmembrane barrier proteins such as occludin and claudins, which are bound via proteins of the intracellular cytoskeleton with actin and microtubular structures. The function of the intestinal barrier (IB) can be modulated by a variety of stimuli. These include nutrients such as gluten, toxins or bacteria or their respective metabolic products ab- sorbed with the nutrition which induce a raised secretion of zonulin through the cells of the lamina propria. Objective To evaluate serum Zonulin level, as a marker of increased intestinal permeability, in ITP patient compared to healthy subjects. Methods This Study was conducted between October 2022 and June 2023 on 60 patients diagnosed with ITP divided in to 2 sub-groups 30 patients on steroid therapy for a duration longer than 3 months and 30 steroid naïve patients togetherwith 30 apparently healthy individuals as a control group. Patients were recruitedfrom Hematology department and outpatient clinic, Ain Shams University Hospitals. Results There was highly statistically significant difference between chronic patients and newly diagnosed patients regarding PLT and Serum Zonulin p < 0.001. There was highly statistically significant difference between recently diagnosed patients and healthy controls regarding PLT p < 0.001, there was statistically significant difference regarding ALT and Serum Zonulin, (p value were 0.03 and 0.01) respectively. There was a statistically significant correlation among all study participants between Serum Zonulin and Creatinine, p value = .004. There was no statistically significant correlation among all study participants between Serum Zonulin and TLC, HB, PLT and ALT, (p value were 0.736, 0.227, 070 and 0.619) respectively. There was highly statistically significant correlation between serum zonulin level and PLT in chronic patients, p value <0.001. Conclusion There was highly statistically significant difference between three study groups regarding PLT and Serum Zonulin. There was a statistically significant correlation among all study participants between Serum Zonulin and Creatinine. There was highly statistically significant correlation between serum zonulin level and PLT in chronic patients.