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In Vitro Lymphocyte Functions in Undernourished Children With Sickle Cell Anemia
Solo R Kuvibidila1, Renée Gardner1, Maria C Velez1
1Department of Pediatrics, Division of Hematology/Oncology, Louisiana State University Health Sciences Center, New Orleans, LA.
Insights
Undernutrition impairs lymphocyte function in children with sickle cell disease (SCD) genotypes HbSS/HbSβ°. Dietary supplements may help improve these altered immune functions in affected children.
Area of Science:
- Pediatric Hematology
- Immunology
- Nutritional Science
Background:
- Children with sickle cell disease (SCD) often experience growth deficits and compromised immunity.
- The impact of mild to moderate malnutrition on lymphocyte function in SCD is not well understood.
- This study investigates the relationship between undernutrition and lymphocyte function in pediatric SCD patients.
Purpose of the Study:
- To examine the effects of undernutrition on in vitro lymphocyte proliferation and Interleukin-2 (IL-2) activity in children with SCD.
- To differentiate the impact of undernutrition on lymphocyte function based on SCD genotypes (HbSS/HbSβ° vs. HbSC).
- To identify specific nutritional markers associated with altered immune responses in children with SCD.
Main Methods:
- Measured anthropometric data (weight, height) and plasma protein levels (albumin, prealbumin, transferrin, RBP, AGP, CRP, ceruloplasmin) in 90 children with SCD.
- Assessed in vitro lymphocyte proliferation and IL-2 activity in response to phytohemagglutinin stimulation.
- Analyzed data based on SCD genotypes (HbSS, HbSβ°, SC) and nutritional/inflammatory status.
Main Results:
- Children with HbSS/HbSβ° genotypes showed significantly lower anthropometric measurements, hemoglobin, and hematocrit compared to HbSC.
- Lymphocyte proliferation was reduced in HbSS/HbSβ° children with undernutrition, particularly when combined with inflammation.
- Undernutrition, defined by low prealbumin or albumin plus RBP, significantly reduced lymphocyte proliferation in HbSS/HbSβ° patients; IL-2 activity was reduced by low prealbumin in both genotypes.
- Prealbumin, RBP, and hemoglobin levels positively correlated with in vitro lymphocyte functions.
Conclusions:
- Undernutrition significantly alters in vitro lymphocyte function in children with HbSS/HbSβ° SCD genotypes.
- The findings suggest that nutritional interventions, such as dietary supplements, could potentially improve immune function in these children.
- Immune function in children with HbSC genotype was not adversely affected by undernutrition or inflammation in this study.
Abstract:
Background: Children with sickle cell disease (SCD) often suffer from growth deficits and impaired immunity. However, the association between mild to moderate malnutrition and in vitro lymphocyte function has not been well studied. The goal of this study was to investigate the effects of undernutrition on lymphocyte functions in children with SCD. Methods: Weight; height; plasma concentrations of albumin (Alb), prealbumin (PA), transferrin (Tf), retinol-binding protein (RBP), α1-acid glycoprotein (AGP), C-reactive protein (CRP), and ceruloplasmin (Cp); and lymphocyte proliferation and interleukin (IL)-2 in phytohemagglutinin-treated blood lymphocytes were measured in 90 children with SCD (59 SS, 4 Sβ°, 27 SC hemoglobin genotypes). Results: The mean age of the children included in the analysis was 7.65 years. Four of the 90 children had weight and height below the fifth percentile. A higher percentage of children with HbSS/HbSβ° (61.4%) than of those with HbSC (44%) had ≥2 plasma protein concentrations below normal (Alb <35 g/L, PA <160 mg/L, Tf <2.0 g/L, and RBP ≤20 mg/L). Mean anthropometric measurements, hemoglobin, and hematocrit were lower in children with HbSS/HbSβ° than in those with HbSC (P<0.05). Lymphocyte proliferation was reduced by 20% to 27% in children with HbSS/HbSβ° with undernutrition plus inflammation (AGP >1 g/L, CRP >5 mg/L, Cp >600 mg/L) compared to children with neither. Regardless of inflammatory status, lymphocyte proliferation was reduced by 29% to 49% in children with HbSS/HbSβ° and undernutrition defined by PA or Alb plus RBP (P<0.05) compared to those with RBP within normal range. Neither undernutrition nor inflammation reduced lymphocyte proliferation in children with HbSC. Mean IL-2 activity was reduced by undernutrition, defined as PA <160 mg/L, in both groups. PA, RBP, and hemoglobin concentrations positively correlated with in vitro lymphocyte functions (P<0.05). Conclusion: Undernutrition altered in vitro lymphocyte function in children with the HbSS/HbSβ° genotypes. Dietary supplements may improve the altered functions in these children.
