Henoch-Schönlein purpura pathophysiology
|
Henoch-Schönlein purpura Microchapters |
|
Differentiating Henoch-Schönlein purpura from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Henoch-Schönlein purpura pathophysiology On the Web |
|
American Roentgen Ray Society Images of Henoch-Schönlein purpura pathophysiology |
|
Risk calculators and risk factors for Henoch-Schönlein purpura pathophysiology |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
- Although it is known that HSP is a small vessel leukocytoclastic vasculitis, its pathogenetic mechanisms are not yet fully identified. *Researchers have found elevations in the serum levels of immunoglobulin (Ig) A, IgA-containing circulating immune complexes and IgA rheumatoid factors in patients with HSP.
- Therefore, it generally believed that HSP is an immune complex-mediated disease, because HSP is frequently reported to follow respiratory tract infections, a variety of viral and bacterial pathogens have been implicated as triggers of the disease.
- It has been reported that all patients with HSP have small molecular mass IgA1-containing circulating immune complexes, but only those with HSPN have additional large molecular mass IgA1-IgG-containing circulating immune complexes.
- The IgA1 molecule has a hinge region containing up to six O-linked glycan chains[16,17] consisting of N-acetylgalactosamine, usually
with an attached β1,3-linked galactose.
- It has been reported that in patients with HSPN, the activity of β1,3-galactosyltransferase in peripheral B cells is reduced, leading to a lack of terminal β1,3-galactosyl residues in the hinge region of IgA1.
- The primary defect leading to the production of such abnormally glycosylated IgA1 is probably heritable.
- These aberrantly glycosylated IgA1 molecules have been shown to form immune complexes with IgG antibodies specific for galactose-deficient IgA1, thereby inhibiting the binding of the IgA molecules to hepatic receptors and avoiding their internalization and degradation by hepatic cells.
- This formation results in an increased amount of IgA immune complexes in circulation.
- The complexes may then deposit in renal mesangial areas and activate the complement system by the alternative or lectin pathways, which play a major role in the pathophysiology of this disease.
- Further, after depositing in the mesangium, the galactose-deficient IgA1 immune complexes activate mesangial cells.
- This results in the proliferation of cells such as macrophages and lymphocytes and the production of inflammatory and profibrogenic cytokines and
chemokines, which play a pivotal role in mesangial cell proliferation, matrix expansion, and inflammatory cell recruitment.
- There are also other possible pathogenetic mechanisms of HSPN, because throat cultures positive for group A beta-hemolytic streptococcus have been
found in 20%-30% of patients with HSPN, it is thought that nephritis-associated plasmin receptor, a group A streptococcal antigen, may also be responsible for some of the cases of HSPN.
- In addition, eosinophil activation and renal expression of alpha-smooth muscle actin have been reported to play a role in the
pathogenesis of HSPN.