101
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Lozier JN, Noel P. Immunohematological Disorders. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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102
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Liu Y, Wang R, Han P, Zhao Y, Li G, Li G, Nie M, Wang L, Chen J, Liu X, Hou M. Effect of recombinant human thrombopoietin on immune thrombocytopenia in pregnancy in a murine model. Int Immunopharmacol 2018; 67:287-293. [PMID: 30572253 DOI: 10.1016/j.intimp.2018.12.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/04/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
Abstract
Primary immune thrombocytopenia (ITP) is a serious medical disorder that has the potential for maternal and fetal mortality. Corticosteroids, intravenous immunoglobulin, or both are the first-line treatments for ITP in pregnancy, but choices are limited if patients fail to respond. Recombinant human thrombopoietin (rhTPO) has been proved effective and safe in management of chronic ITP. However, the efficacy and safety of rhTPO for pregnant ITP patients still need to be explored. Here we developed an ideal murine model that simulated human ITP in pregnancy and evaluated the efficacy and safety of rhTPO in management of ITP in pregnancy. Model mice were subcutaneously administered with 0, 150, 1,500 and 15,000 U/kg rhTPO for 14 days. Significant higher platelet counts were noted in rhTPO-treated groups on Day 7, 10 and 14. On Day 20, half the maternal mice were sacrificed. Frequencies of Tregs in CD4+ T cells in rhTPO-treated groups were statistically higher than control. Significant higher plasma levels of TGF-β1 were observed in rhTPO-treated groups than control. There was no significant abnormality in gross or visceral examination of fetuses. The remaining half maternal mice and their pups were observed for at least three weeks to assess vital signs. No abnormal signs were noted. Furthermore, we investigated the underlying mechanisms. Results showed that Tregs were negative for c-Mpl and rhTPO had no direct effect on Tregs. Additionally, the Treg frequency in splenic CD4+ T cells in LY2109761-treated model mice was statistically lower than control. Thus, rhTPO may be a safe and effective option for treatment of pregnant ITP patients.
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Affiliation(s)
- Yang Liu
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Rui Wang
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Panpan Han
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Yajing Zhao
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Guijie Li
- Department of Interventional Diagnosis and Treatment, Shandong Provincial Qianfoshan Hospital Affiliated to Shandong University, Jinan, China
| | - Guosheng Li
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Mu Nie
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Lingjun Wang
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Jian Chen
- Department of Hematology, Jining No. 1 People's Hospital, Jining, China
| | - Xuena Liu
- Department of Rheumatology, Qilu Hospital, Shandong University, Jinan, China.
| | - Ming Hou
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China; Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital, Shandong University, Jinan, China; Leading Research Group of Scientific Innovation, Department of Science and Technology of Shandong Province, Qilu Hospital, Shandong University, Jinan, China.
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103
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Zhan FX, Li J, Fang M, Ding J, Wang Q. Importance of Th22 Cell Disequilibrium in Immune Thrombocytopenic Purpura. Med Sci Monit 2018; 24:8767-8772. [PMID: 30510151 PMCID: PMC6289030 DOI: 10.12659/msm.912528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The disequilibrium of T helper (Th) cells play an important role in the occurrence and development of immune thrombocytopenic purpura (ITP). Th22 cells, as a newly discovered subset of T lymphocytes, plays an important role in autoimmune disorders and inflammatory diseases. MATERIAL AND METHODS This study explored the role of different lymphocyte subsets in chronic ITP. To explore the value of Th22 cells in the diagnosis of ITP, the numbers of Th1, Th17, and Th22 cells were detected by a 4-color flow cytometric in 32 chronic ITP patients and 30 healthy controls. RESULTS Our data showed that, compared with healthy controls, the numbers of circulating Th1, Th17, and Th22 (p<0.05) cells increased significantly in ITP patients, and Th22 cells were correlated positively with Th1 cells (r=0.4041, p<0.01) and Th17 cells (r=0.4637, p<0.05). Moreover, a positive relationship was found between Th1/Th22 cells and Th1 cells (r=0.7696, p<0.001). CONCLUSIONS A disequilibrium expression profile of Th22 cells in peripheral blood was associated with pathogenesis of ITP, possibly through cooperatively working with Th17 and Th1, which may provide a novel approach for diagnosis of ITP.
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Affiliation(s)
- Feng-Xia Zhan
- Department of Clinical Laboratory, Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Juan Li
- Department of Clinical Laboratory, Qilu Hospital (Qingdao), Shandong University, Qingdao, Shandong, China (mainland)
| | - Min Fang
- Department of Clinical Laboratory, Qingdao Women's and Children's Hospital, Qingdao, Shandong, China (mainland)
| | - Juan Ding
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, Shandong, China (mainland)
| | - Qian Wang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, Shandong, China (mainland)
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104
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Al-Samkari H, Kuter DJ. Thrombopoietin level predicts response to treatment with eltrombopag and romiplostim in immune thrombocytopenia. Am J Hematol 2018; 93:1501-1508. [PMID: 30187942 DOI: 10.1002/ajh.25275] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 11/07/2022]
Abstract
Thrombopoietin receptor agonists (TPO-RAs) are used to treat immune thrombocytopenia (ITP), but predicting clinical response to TPO-RAs before initiation is not possible. To determine whether endogenous TPO levels predict treatment response to TPO-RAs we performed a retrospective analysis of ITP patients with known baseline TPO levels who received TPO-RAs. Data was collected for ITP patients with a baseline TPO level treated with eltrombopag or romiplostim. Multiple logistic regression was used to model the probability of 3 classes of treatment response (overall, moderate, and superior) based on TPO level; receiver operating characteristic (ROC) analysis was performed to identify optimal TPO thresholds for response; correlations between TPO level and various response characteristics were analyzed. A total of 67 patients (37 receiving eltrombopag and 46 receiving romiplostim) were included. Logistic regression models demonstrated a significant predictive relation between TPO level and probability of all classes of response; per 10 pg/mL TPO increase, odds ratio for overall response to eltrombopag was 0.524 (95% CI 0.327, 0.837) and romiplostim was 0.905 (95% CI, 0.844, 0.970). TPO level was inversely correlated with all classes of response; for overall response, r = -0.719 (P < .001) for eltrombopag and r = -0.584 (P < .001) for romiplostim. ROC analysis identified TPO thresholds of ≤136 pg/mL (eltrombopag) and ≤209 pg/mL (romiplostim) as optimally discriminating between responders and nonresponders. Most non-responders had high TPO levels but did respond after addition of low-dose prednisone. In conclusion, TPO levels predict response to eltrombopag and romiplostim in ITP patients, with lower levels predicting improved probability and magnitude of response.
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Affiliation(s)
- Hanny Al-Samkari
- Division of Hematology; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | - David J. Kuter
- Division of Hematology; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
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105
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Rooprai JK, Khamisa K. Is There a Role for Biweekly Romiplostim in the Management of Chronic Immune Thrombocytopenia (ITP)? A Report of Three Cases. Case Rep Hematol 2018; 2018:6037494. [PMID: 30524761 PMCID: PMC6247720 DOI: 10.1155/2018/6037494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 09/30/2018] [Indexed: 11/30/2022] Open
Abstract
Romiplostim is a peptibody, which stimulates platelet production by a mechanism similar to that of endogenous thrombopoietin. It has an established indication as second-line therapy in patients with chronic immune thrombocytopenia (ITP). The agent is typically administered weekly; however, there are instances where a biweekly (i.e., alternate week) dosing may be feasible in a select group of patients. We conducted a retrospective case review to evaluate the efficacy and safety of biweekly administration of romiplostim in maintaining a platelet count of >30 × 109/L in three patients with chronic ITP. Treatment was started with a weekly injection (1 µg/kg) with a dose escalation to achieve a platelet count >30 × 109/L. Once stable on weekly romiplostim, these patients received biweekly administration. No bleeding complications were noted during biweekly dosing for these patients. The current findings suggest that lengthening the dose interval of romiplostim is feasible in select patients with chronic ITP to maintain stable platelet counts. Additional studies are therefore warranted to further evaluate biweekly dosing for romiplostim to increase convenience and decrease costs for patients with chronic ITP.
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Affiliation(s)
| | - Karima Khamisa
- Division of Hematology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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106
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Zeng DF, Chen F, Wang S, Chen SL, Xu Y, Shen MQ, Du CH, Wang C, Kong PY, Cheng TM, Su YP, Wang JP. Autoantibody against integrin α v β 3 contributes to thrombocytopenia by blocking the migration and adhesion of megakaryocytes. J Thromb Haemost 2018; 16:1843-1856. [PMID: 29953749 DOI: 10.1111/jth.14214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 01/04/2023]
Abstract
Essentials The pathogenesis of immune thrombocytopenia (ITP) has not been fully clarified. We analyzed the role of anti-αvβ3 autoantibody in the pathogenesis of ITP in patients. Anti-αvβ3 autoantibody impeded megakaryocyte migration and adhesion to the vascular niche. Anti-αv β3 autoantibody potentially contributes to the pathogenesis of refractory ITP. SUMMARY Background The pathogenesis of immune thrombocytopenia (ITP) has not been fully clarified. Anti-αvβ3 integrin autoantibody is detected in chronic ITP patients, but its contribution to ITP is still unclear. Objectives To clarify the potential role of anti-αvβ3 integrin autoantibody in chronic ITP and the related mechanism. Methods Relationship between levels of anti-αvβ3 autoantibody and platelets in chronic ITP patients was evaluated. The influence of anti-αvβ3 antibody on megakaryocyte (MK) survival, differentiation, migration and adhesion was assessed, and the associated signal pathways were investigated. Platelet recovery and MKs' distribution were observed in an ITP mouse model pretreated with different antibodies. Result In this study, we showed that the anti-αvβ3 autoantibody usually coexists with anti-αIIbβ3 autoantibody in chronic ITP patients, and patients with both autoantibodies have lower platelets. In in vitro studies, we showed that the anti-αvβ3 antibody had no significant effect on the survival and proliferation of MKs, whereas it decreased formations of proplatelet significantly. Anti-αvβ3 antibody impeded stromal cell derived facor-1 alpha (SDF-1α)- mediated migration and inhibited the phosphorylation of protein kinase B. Anti-αvβ3 antibody significantly inhibited MKs' adhesion to endothelial cells and Fibrogen. The phosphorylation of focal adhesion kinase and proto-oncogene tyrosine-protein kinase Src induced by adhesion was inhibited when MKs were pretreated with anti-αvβ3 antibody. In in vivo studies, we showed that injection with anti-αv antibody delayed platelet recovery in a mouse model of ITP. Conclusions These findings demonstrate that the autoantibody against integrin αv β3 may aggravate thrombocytopenia in ITP patients by impeding MK migration and adhesion to the vascular niche, which provides new insights into the pathogenesis of ITP.
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Affiliation(s)
- D F Zeng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - F Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - S Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - S L Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Y Xu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - M Q Shen
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - C H Du
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - C Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - P Y Kong
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - T M Cheng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - Y P Su
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
| | - J P Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Combined Injury, Chongqing Engineering Research Center for Nanomedicine, College of Preventive Medicine, Third Military Medical University, Chongqing, China
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107
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Role of TNF −308 G/A, TNFβ +252 A/G and IL10 −592 C/A and −1082 G/A SNPs in pathogenesis of Immune Thrombocytopenia Purpura in population of Gujarat, India. GENE REPORTS 2018. [DOI: 10.1016/j.genrep.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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108
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Guo L, Kapur R, Aslam R, Hunt K, Hou Y, Zufferey A, Speck ER, Rondina MT, Lazarus AH, Ni H, Semple JW. Antiplatelet antibody-induced thrombocytopenia does not correlate with megakaryocyte abnormalities in murine immune thrombocytopenia. Scand J Immunol 2018; 88:e12678. [DOI: 10.1111/sji.12678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Affiliation(s)
- L. Guo
- The Toronto Platelet Immunobiology Group; Toronto ON Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Toronto ON Canada
- Institute of Medical Science; University of Toronto; Toronto ON Canada
- University of Utah; Salt Lake City UT USA
| | - R. Kapur
- The Toronto Platelet Immunobiology Group; Toronto ON Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Toronto ON Canada
- Institute of Medical Science; University of Toronto; Toronto ON Canada
- Canadian Blood Services; Lund University; Canadian Blood Services; Toronto ON Canada
- Division of Hematology and Transfusion Medicine; Lund University; Lund Sweden
| | - R. Aslam
- The Toronto Platelet Immunobiology Group; Toronto ON Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Toronto ON Canada
| | - K. Hunt
- The Toronto Platelet Immunobiology Group; Toronto ON Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Toronto ON Canada
| | - Y. Hou
- The Toronto Platelet Immunobiology Group; Toronto ON Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Toronto ON Canada
| | - A. Zufferey
- The Toronto Platelet Immunobiology Group; Toronto ON Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Toronto ON Canada
| | - E. R. Speck
- The Toronto Platelet Immunobiology Group; Toronto ON Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Toronto ON Canada
| | | | - A. H. Lazarus
- The Toronto Platelet Immunobiology Group; Toronto ON Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Toronto ON Canada
- Institute of Medical Science; University of Toronto; Toronto ON Canada
- Department of Medicine; University of Toronto; Toronto ON Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto ON Canada
| | - H. Ni
- The Toronto Platelet Immunobiology Group; Toronto ON Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Toronto ON Canada
- Institute of Medical Science; University of Toronto; Toronto ON Canada
- Department of Medicine; University of Toronto; Toronto ON Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto ON Canada
| | - J. W. Semple
- The Toronto Platelet Immunobiology Group; Toronto ON Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital; Toronto ON Canada
- Institute of Medical Science; University of Toronto; Toronto ON Canada
- Canadian Blood Services; Lund University; Canadian Blood Services; Toronto ON Canada
- Division of Hematology and Transfusion Medicine; Lund University; Lund Sweden. Department of Medicine; University of Toronto; Toronto ON Canada. Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto ON Canada. Department of Pharmacology; University of Toronto; Toronto ON Canada
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109
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GPIbα is required for platelet-mediated hepatic thrombopoietin generation. Blood 2018; 132:622-634. [PMID: 29794068 DOI: 10.1182/blood-2017-12-820779] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/18/2018] [Indexed: 12/17/2022] Open
Abstract
Thrombopoietin (TPO), a hematopoietic growth factor produced predominantly by the liver, is essential for thrombopoiesis. Prevailing theory posits that circulating TPO levels are maintained through its clearance by platelets and megakaryocytes via surface c-Mpl receptor internalization. Interestingly, we found a two- to threefold decrease in circulating TPO in GPIbα-/- mice compared with wild-type (WT) controls, which was consistent in GPIbα-deficient human Bernard-Soulier syndrome (BSS) patients. We showed that lower TPO levels in GPIbα-deficient conditions were not due to increased TPO clearance by GPIbα-/- platelets but rather to decreased hepatic TPO mRNA transcription and production. We found that WT, but not GPIbα-/-, platelet transfusions rescued hepatic TPO mRNA and circulating TPO levels in GPIbα-/- mice. In vitro hepatocyte cocultures with platelets or GPIbα-coupled beads further confirm the disruption of platelet-mediated hepatic TPO generation in the absence of GPIbα. Treatment of GPIbα-/- platelets with neuraminidase caused significant desialylation; however, strikingly, desialylated GPIbα-/- platelets could not rescue impaired hepatic TPO production in vivo or in vitro, suggesting that GPIbα, independent of platelet desialylation, is a prerequisite for hepatic TPO generation. Additionally, impaired hepatic TPO production was recapitulated in interleukin-4/GPIbα-transgenic mice, as well as with antibodies targeting the extracellular portion of GPIbα, demonstrating that the N terminus of GPIbα is required for platelet-mediated hepatic TPO generation. These findings reveal a novel nonredundant regulatory role for platelets in hepatic TPO homeostasis, which improves our understanding of constitutive TPO regulation and has important implications in diseases related to GPIbα, such as BSS and auto- and alloimmune-mediated thrombocytopenias.
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110
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Swinkels M, Rijkers M, Voorberg J, Vidarsson G, Leebeek FWG, Jansen AJG. Emerging Concepts in Immune Thrombocytopenia. Front Immunol 2018; 9:880. [PMID: 29760702 PMCID: PMC5937051 DOI: 10.3389/fimmu.2018.00880] [Citation(s) in RCA: 146] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/09/2018] [Indexed: 01/19/2023] Open
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease defined by low platelet counts which presents with an increased bleeding risk. Several genetic risk factors (e.g., polymorphisms in immunity-related genes) predispose to ITP. Autoantibodies and cytotoxic CD8+ T cells (Tc) mediate the anti-platelet response leading to thrombocytopenia. Both effector arms enhance platelet clearance through phagocytosis by splenic macrophages or dendritic cells and by induction of apoptosis. Meanwhile, platelet production is inhibited by CD8+ Tc targeting megakaryocytes in the bone marrow. CD4+ T helper cells are important for B cell differentiation into autoantibody secreting plasma cells. Regulatory Tc are essential to secure immune tolerance, and reduced levels have been implicated in the development of ITP. Both Fcγ-receptor-dependent and -independent pathways are involved in the etiology of ITP. In this review, we present a simplified model for the pathogenesis of ITP, in which exposure of platelet surface antigens and a loss of tolerance are required for development of chronic anti-platelet responses. We also suggest that infections may comprise an important trigger for the development of auto-immunity against platelets in ITP. Post-translational modification of autoantigens has been firmly implicated in the development of autoimmune disorders like rheumatoid arthritis and type 1 diabetes. Based on these findings, we propose that post-translational modifications of platelet antigens may also contribute to the pathogenesis of ITP.
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Affiliation(s)
- Maurice Swinkels
- Department of Hematology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Maaike Rijkers
- Department of Plasma Proteins, AMC-Sanquin Landsteiner Laboratory, Amsterdam, Netherlands
| | - Jan Voorberg
- Department of Plasma Proteins, AMC-Sanquin Landsteiner Laboratory, Amsterdam, Netherlands
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, AMC-Sanquin Landsteiner Laboratory, Amsterdam, Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - A J Gerard Jansen
- Department of Hematology, Erasmus University Medical Centre, Rotterdam, Netherlands.,Department of Plasma Proteins, AMC-Sanquin Landsteiner Laboratory, Amsterdam, Netherlands
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111
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Novotný JP, Köhler B, Max R, Egerer G. Acquired Amegakaryocytic Thrombocytopenic Purpura Progressing into Aplastic Anemia. Prague Med Rep 2018; 118:147-155. [PMID: 29324222 DOI: 10.14712/23362936.2017.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Acquired amegakaryocytic thrombocytopenic purpura (AATP) is a rare hematological disorder characterized by severe thrombocytopenia and a complete or near-to complete absence of megakaryocytes in the bone marrow, while granulopoiesis, as well as erythropoiesis are usually preserved. Although autoimmune mechanisms are believed to be causative, the exact underlying pathogenesis is not known. To date, only few cases have been reported and management of this disease remains controversial with immunosuppression being the treatment modality of choice in the majority of patients. In this article, we report a case of newly acquired AATP without an associated autoimmune disease, refractory to corticoids, intravenous immunoglobulin (IVIG) and second-generation TPO (thrombopoietin) agonists, which have recently been approved for the treatment of thrombocytopenia. Finally, in accordance with other reports, disease progression into aplastic anemia has occurred.
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Affiliation(s)
| | - Birgit Köhler
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Regina Max
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Gerlinde Egerer
- Department of Medicine V, University of Heidelberg, Heidelberg, Germany
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112
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Severe Thrombocytopenia in Patient with Dermatomyositis. CURRENT HEALTH SCIENCES JOURNAL 2018; 44:192-196. [PMID: 30687531 PMCID: PMC6320470 DOI: 10.12865/chsj.44.02.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/27/2018] [Indexed: 11/18/2022]
Abstract
Dermatomyositis (DM) is part of a heterogeneous group of systemic diseases called idiopathic inflammatory myopathies. As in other autoimmune connective tissue diseases (CTD), abnormalities of hematopoietic tissue and/or peripheral blood cells may develop and represent an important prognostic factor. Most common CTD associated with thrombocytopenia (TP) are systemic lupus erythematosus and antiphospholipid syndrome. DM-related TP is less frequent and may develop in the context of an underlying malignancy. Severe TP related to myositis is a very rare occurrence. We report a case of a male patient diagnosed with acute DM, debilitating muscle weakness and rapid development of severe TP.
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113
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Atorvastatin enhances bone marrow endothelial cell function in corticosteroid-resistant immune thrombocytopenia patients. Blood 2018; 131:1219-1233. [PMID: 29288170 DOI: 10.1182/blood-2017-09-807248] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022] Open
Abstract
Key Points
Impaired BM EPCs were found in corticosteroid-resistant ITP patients. Atorvastatin improved BM EPC quantity and function, representing a novel therapy approach for corticosteroid-resistant ITP patients.
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114
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McDonnell A, Bride KL, Lim D, Paessler M, Witmer CM, Lambert MP. Utility of the immature platelet fraction in pediatric immune thrombocytopenia: Differentiating from bone marrow failure and predicting bleeding risk. Pediatr Blood Cancer 2018; 65. [PMID: 28921855 DOI: 10.1002/pbc.26812] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Differentiating childhood immune thrombocytopenia (ITP) from other cause of thrombocytopenia remains a diagnosis of exclusion. Additionally factors that predict bleeding risk for those patients with ITP are currently not well understood. Previous small studies have suggested that immature platelet fraction (IPF) may differentiate ITP from other causes of thrombocytopenia and in combination with other factors may predict bleeding risk. METHODS We performed a retrospective chart review of thrombocytopenic patients with an IPF measured between November 1, 2013 and July 1, 2015. Patients were between 2 months and 21 years of age with a platelet count <50 × 109 /l. Each patient chart was reviewed for final diagnosis and bleeding symptoms. A bleeding severity score was retrospectively assigned. RESULTS Two hundred seventy two patients met inclusion criteria, 97 with ITP, 11 with bone marrow failure (BMF), 126 with malignancy, and 38 with other causes of thrombocytopenia. An IPF > 5.2% differentiated ITP from BMF with 93% sensitivity and 91% specificity. Absolute immature platelet number (AIPN) was significantly lower in ITP patients with severe to life-threatening hemorrhage than those without, despite similar platelet counts. On multivariate analysis, an IPF < 10.4% was confirmed as an independent predictor of bleeding risk at platelet counts <10 × 109 /l in patients with ITP. CONCLUSIONS IPF measurement alone has utility in both the diagnosis of ITP and identifying patients at increased risk of hemorrhage. Further study is required to understand the pathophysiological differences of ITP patients with lower IPF/AIPN.
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Affiliation(s)
- Alicia McDonnell
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karen L Bride
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Derick Lim
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michele Paessler
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Char M Witmer
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michele P Lambert
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Agnelli Giacchello J, Valeri F, Boccadoro M, Borchiellini A. Thrombopoietin receptor agonists in patients with persistent or chronic immune thrombocytopenia. Eur J Haematol 2018; 100:304-307. [DOI: 10.1111/ejh.13014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Jacopo Agnelli Giacchello
- Regional Center for Hemorrhagic and Thrombotic Diseases; Haematology Unit; City of Health and Science University Hospital of Molinette; Turin Italy
| | - Federica Valeri
- Regional Center for Hemorrhagic and Thrombotic Diseases; Haematology Unit; City of Health and Science University Hospital of Molinette; Turin Italy
| | - Mario Boccadoro
- Regional Center for Hemorrhagic and Thrombotic Diseases; Haematology Unit; City of Health and Science University Hospital of Molinette; Turin Italy
| | - Alessandra Borchiellini
- Regional Center for Hemorrhagic and Thrombotic Diseases; Haematology Unit; City of Health and Science University Hospital of Molinette; Turin Italy
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Barbosa AMDC, Ribeiro RA, Silva CÍSM, Cruz FWS, Azevedo OGRD, Pitombeira MHDS, Braga LLC. Platelet count response to Helicobacter pylori eradication for idiopathic thrombocytopenic purpura in northeastern Brazil. Hematol Transfus Cell Ther 2018; 40:12-17. [PMID: 29519366 PMCID: PMC6003102 DOI: 10.1016/j.bjhh.2017.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 08/08/2017] [Accepted: 09/11/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Several studies have demonstrated that platelet counts in Helicobacter pylori-positive patients with chronic idiopathic thrombocytopenic purpura improved significantly after successful eradication of the infection. However, depending of the geographical region of the study the results have been highly divergent. OBJECTIVE The purpose of this study was to evaluate the effect of H. pylori eradication therapy on platelet count in a cohort of chronic idiopathic thrombocytopenic purpura patients from northeastern Brazil. METHOD H. pylori status was determined in 28 chronic idiopathic thrombocytopenic purpura patients using the rapid urease test and histology. H. pylori-positive patients received standard triple therapy for one week. The effect of the eradication therapy was evaluated using the 13C-urea breath test two to three months after treatment. RESULTS The prevalence of H. pylori infection was similar to that found in the general population. Twenty-two patients (78.5%) were H. pylori-positive. Fifteen were treated, 13 (86%) of whom successfully. At six months, 4/13 (30%) displayed increased platelet counts, which remained throughout follow-up (12 months). Platelet response was not associated to mean baseline platelet count, duration of chronic idiopathic thrombocytopenic purpura, gender, age, previous use of medication, or splenectomy. CONCLUSIONS H. pylori eradication therapy showed relatively low platelet recovery rates, comparable with previous studies from southeastern Brazil. The effect of H. pylori eradication on platelet counts remained after one year of follow-up suggesting that treating H. pylori infection might be worthwhile in a subset of chronic idiopathic thrombocytopenic purpura patients.
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117
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Cantoni S, Carpenedo M, Mazzucconi MG, De Stefano V, Carrai V, Ruggeri M, Specchia G, Vianelli N, Pane F, Consoli U, Artoni A, Zaja F, D'adda M, Visentin A, Ferrara F, Barcellini W, Caramazza D, Baldacci E, Rossi E, Ricco A, Ciminello A, Rodeghiero F, Nichelatti M, Cairoli R. Alternate use of thrombopoietin receptor agonists in adult primary immune thrombocytopenia patients: A retrospective collaborative survey from Italian hematology centers. Am J Hematol 2018; 93:58-64. [PMID: 28983953 DOI: 10.1002/ajh.24935] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 01/09/2023]
Abstract
Sequential use of the TPO-RAs romiplostim and eltrombopag in ITP patients failing either agent was retrospectively evaluated to assess efficacy and impact of clinical characteristics on outcome. Patients were grouped into 5 categories: efficacy issues: 1st TPO-RA failure; loss of response; non-efficacy issues: platelet fluctuations; patient's preference; adverse event development. Either one TPO-RA sequence was analyzed at 3 month and at last follow-up. 106/546 patients on TPO-RA underwent switch and 65% achieved, regained or maintained a short- term response independent of switch sequence, gender or age; lower response rates were associated with lines of previous therapy; disease duration lowers probability to respond. Clinically, patients switched for efficacy issue did not differ from those switched for non-efficacy issues. Response was achieved/regained in 57.8% of patients switched for efficacy issues, the lowest response rates were observed in non-responders to 1st TPO-RA; 80% of patients switched for non-efficacy issues maintained a response. Platelet fluctuation resolved in 44.4%. Of the 49 patients evaluable for long-term outcome, 27 were in response on therapy; 16 discontinued the TPO-RA for reasons other than efficacy, while only 6 were non responders. We confirm the efficacy of TPO-RA switch; once achieved, response to the 2nd TPO-RA seems durable.
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Affiliation(s)
- Silvia Cantoni
- Hematology and Oncology Department; Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda; Milan
| | - Monica Carpenedo
- Hematology and Transplant Unit, ASST San Gerardo Hospital; Monza
| | | | | | | | - Marco Ruggeri
- Hematology Department; San Bortolo Hospital; Vicenza
| | | | - Nicola Vianelli
- “L. e A. Seragnoli” Hematology and Oncology Institute, Sant'Orsola Hospital; Bologna
| | - Fabrizio Pane
- Hematology and Transplant Department; Federico II University; Naples
| | - Ugo Consoli
- Hematology Department; G.Garibaldi Hospital; Catania
| | - Andrea Artoni
- “Angelo Bianchi Bonomi” Haemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan
| | - Francesco Zaja
- Hematology Department; DISM, S. M. Misericordia University Hospital; Udine
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Department; University Hospital; Padua
| | | | - Wilma Barcellini
- Oncohematology Department; Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico; Milan
| | | | - Erminia Baldacci
- Hematology and Cell Biology Department; La Sapienza University; Rome
| | - Elena Rossi
- Hematology Department; Catholic University; Rome
| | - Alessandra Ricco
- Hematology and Transplant Department; Policlinico Consorziale; Bari
| | | | | | - Michele Nichelatti
- Biostatistics, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda; Milan
| | - Roberto Cairoli
- Hematology and Oncology Department; Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda; Milan
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Nookaew I, Wadenvik H, Olsson B, Jernås M. Differential expression of T-cell genes in blood and bone marrow between ITP patients and controls. Thromb Haemost 2017; 109:112-7. [DOI: 10.1160/th12-07-0468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/25/2012] [Indexed: 11/05/2022]
Abstract
SummaryPrimary immune thrombocytopenia (ITP) is an autoimmune disease characterised by premature platelet destruction in spleen, liver and bone marrow and a diminished production of platelets. T-cells are important in all forms of autoimmunity including ITP; however, very little is known about T-cells in organs where platelets are destroyed. Our aim was to investigate differences in gene expression in peripheral blood-derived T-cells and bone marrow-derived T-cells between ITP patients and controls. T-cells and subsequent RNA were isolated from blood and bone marrow from chronic ITP patients and healthy controls followed by DNA microarray analysis. There were 1554 differentially expressed genes in peripheral blood-derived T-cells and 976 in bone marrow-derived T-cells between ITP patients and controls and three genes were verified with real-time PCR. Using Gene Ontology functional enrichment analysis we found that genes involved in growth, development, migration, chemotaxis, adhesion and apoptosis were enriched in bone marrow-derived T-cells in ITP. Immune-related genes involved in T-helper cell differentiation, T-cell chemotaxis, migration, immunoglobulin-mediated immune response and classical and alternative pathway complement activation were also enriched in bone marrow-derived T-cells in ITP. Only 213 T-cell genes were differentially expressed in both blood and bone marrow between ITP patients and controls. In conclusion, our findings show that genes involved in major pathophysiologic pathways in ITP such as T-helper cell differentiation, autoantibody response and complement activation are altered in bone marrow-derived T-cells in ITP patients compared with controls. This further supports the concept that bone marrow is an important compartment in ITP.
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Liu CC, Wang SC, Kao CW, Hsieh RK, Chang MC, Chang YF, Lim KH, Chen CG. B cells facilitate platelet production mediated by cytokines in patients with essential thrombocythaemia. Thromb Haemost 2017; 112:537-50. [DOI: 10.1160/th13-11-0949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 03/22/2014] [Indexed: 12/11/2022]
Abstract
SummaryWe investigated the role of activated B cells in thrombopoiesis through the production of interleukin (IL)-1beta and IL-6 in patients with essential thrombocythaemia. The number of B cells did not differ between essential thrombocythaemia patients, irrespective of the presence of Janus activated kinase-2 V617F mutation or wild type, and age-matched healthy adults. However, the number of IL-1beta/IL- 6-producing B cells was significantly higher in essential thrombocythaemia patients than that in healthy controls. The relatively high level of IL-1beta/IL-6 production by B cells was associated with serum B cell-activating factor and expression of Toll-like receptor 4 on B cells. A high level of B cell-activating factor was present in essential thrombocythaemia patients with both Janus activated kinase-2 genotypes. Incubation with B cell-activating factor enhanced the expression of Toll-like receptor 4 on B cells. IL-1beta and IL-6 production was not stimulated by B cell-activating factor alone; Toll-like receptor 4 was activated by lipopolysaccharide or patients’ sera to produce IL-1beta and IL-6 in B cells. Moreover, essential thrombocythaemia patient B cells facilitated megakaryocyte differentiation when co-cultured with CD34+ haematopoietic stem cells. Antibody neutralisation of IL-1beta and IL-6 attenuated megakaryocyte differentiation. These data suggest that B cells play a crucial role in thrombopoiesis in essential thrombocythaemia patients.
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120
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Pan T, Wang Q, Zhu L, Qi J, You T, Han Y. Downregulation of hypoxia-inducible factor-1α contributes to impaired megakaryopoiesis in immune thrombocytopenia. Thromb Haemost 2017; 117:1875-1886. [DOI: 10.1160/th17-03-0155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/23/2017] [Indexed: 01/15/2023]
Abstract
SummaryImpaired megakaryocyte maturation and exaggerated platelet destruction play a pivotal role in the pathogenesis of immune thrombocytopenia (ITP). Previous studies have shown that HIF-1α promotes the homing and engraftment of haematopoietic stem cells (HSCs), thereby stimulating HSC differentiation. However, whether HIF-1α plays a role in megakaryocytic maturation and platelet destruction in ITP remains elusive. Using enzyme-linked immunosorbent assays (ELISAs), we demonstrated that there were lower HIF-1α levels in the bone marrow (BM) of ITP patients than in that of healthy donors and patients with chemotherapy-related thrombocytopenia. Subjects with lower megakaryocyte (<100/slide) and platelet (<30 × 109/L) counts exhibited significantly decreased BM HIF-1α levels, compared to those with higher megakaryocyte (≥100/slide) and platelet (≥30 × 109/L) counts. To test whether HIF-1α regulates megakaryopoiesis and platelet production, megakaryocytes derived from mouse BM cells were treated with an HIF-1α activator (IOX-2; 50 µM) or inhibitor (PX-478; 50 µM). PX-478 significantly decreased HIF-1α expression, cell size, and the populations of CD41-positive and high-ploidy cells. Importantly, to evaluate the role of HIF-1α as a potential therapeutic target in ITP, mouse BM cells were incubated with plasma from ITP patients in the presence or absence of IOX-2. IOX-2 significantly attenuated the ITP plasma-induced decrease in cell size as well as the proportions of CD41-positive and high-ploidy cells. In addition, IOX-2 increased the number of megakaryocytes from mouse BM cells treated with ITP plasma. Our findings indicate that decreased HIF-1α may contribute to impaired megakaryopoiesis in ITP, and HIF-1α may provide a potential therapy for ITP patients.Supplementary Material to this article is available online at www.thrombosis-online.com.
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Peng HL, Zhang Y, Sun NN, Yin YF, Wang YW, Cheng Z, Yan WZ, Liu SF, Xu YX, Xiao X, Zhang GS. A gain-of-function mutation in TNFRSF13B is a candidate for predisposition to familial or sporadic immune thrombocytopenia. J Thromb Haemost 2017; 15:2259-2269. [PMID: 28834165 DOI: 10.1111/jth.13806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Indexed: 01/27/2023]
Abstract
Essentials Positive family histories suggest the existence of hereditary immune thrombocytopenia (ITP). The predisposing gene for familial ITP was screened in two familial ITP patients. The G76S mutation on TNFRSF13B led to immune dysfunction and induced megakaryocyte apoptosis. The G76S mutation on TNFRSF13B is a gain-of-function mutation and a predisposing variant for ITP. SUMMARY Background Most immune thrombocytopenia (ITP) is sporadic but a positive family history of ITP in some patients suggests that hereditary forms exist. Because of the rarity of familial ITP families available for study and the heterogeneity of sporadic ITP, family linkage analysis or genome-wide association studies are limited. Objectives Based on one ITP pedigree, we try to identify the predisposing gene in familial or sporadic ITP and reveal the way in which it causes thrombocytopenia. Methods Gene expression profiling analysis and whole-exome sequencing were performed on samples from family members with ITP, sporadic ITP cases and healthy individuals. We also evaluated the influence of potential pathogenic mutation on immune function and megakaryocyte apoptosis. Results Whole-exome sequencing identified a potential pathologic p.G76S heterozygous mutation on the TNFRSF13B gene in familial ITP patients. ITP patients harboring the G76S mutation displayed an upregulated 'cytokine-cytokine receptor interaction' signal, increased serum TNFα, IL-17α, IFNγ and BAFF levels, and enhanced binding capacity of APRIL ligand to B cells. Additionally, Epstein-Barr virus (EBV)-transformed B cells with the G76S mutation could induce human megakaryocyte line (Meg-01) apoptosis significantly. Conclusion p.G76S mutation on the TNFRSF13B gene is responsible for ITP, and is a genetic predisposing factor for familial or sporadic ITP.
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Affiliation(s)
- H-L Peng
- Department of Hematology, Institute of Molecular Hematology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
| | - Y Zhang
- Department of Oncology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
| | - N-N Sun
- Department of Hematology, Institute of Molecular Hematology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
| | - Y-F Yin
- Department of Hematology, Institute of Molecular Hematology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
| | - Y-W Wang
- Department of Hematology, Institute of Molecular Hematology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
| | - Z Cheng
- Department of Hematology, Institute of Molecular Hematology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
| | - W-Z Yan
- Department of Hematology, Institute of Molecular Hematology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
| | - S-F Liu
- Department of Hematology, Institute of Molecular Hematology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
| | - Y-X Xu
- Department of Hematology, Institute of Molecular Hematology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
| | - X Xiao
- Department of Hematology, Institute of Molecular Hematology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
| | - G-S Zhang
- Department of Hematology, Institute of Molecular Hematology, The Second Xiang-Ya Hospital, Central South University, ChangSha, Hunan, China
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Grodzielski M, Di Buduo CA, Goette NP, Lev PR, Soprano PM, Heller PG, Balduini A, Marta RF. Autoantibodies in immune thrombocytopenia affect the physiological interaction between megakaryocytes and bone marrow extracellular matrix proteins. Br J Haematol 2017; 183:319-323. [DOI: 10.1111/bjh.14977] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Matías Grodzielski
- Institute of Medical Research A Lanari; University of Buenos Aires; Buenos Aires Argentina
- Department of Experimental Haematology; Institute of Medical Research (IDIM); National Scientific and Technical Research Council (CONICET); University of Buenos Aires; Buenos Aires Argentina
| | - Christian A. Di Buduo
- Department of Molecular Medicine; University of Pavia; Pavia Italy
- Biotechnology Research Laboratories; IRCCS San Matteo Foundation; Pavia Italy
| | - Nora P. Goette
- Institute of Medical Research A Lanari; University of Buenos Aires; Buenos Aires Argentina
| | - Paola R. Lev
- Institute of Medical Research A Lanari; University of Buenos Aires; Buenos Aires Argentina
- Department of Experimental Haematology; Institute of Medical Research (IDIM); National Scientific and Technical Research Council (CONICET); University of Buenos Aires; Buenos Aires Argentina
| | - Paolo M. Soprano
- Department of Molecular Medicine; University of Pavia; Pavia Italy
- Biotechnology Research Laboratories; IRCCS San Matteo Foundation; Pavia Italy
| | - Paula G. Heller
- Institute of Medical Research A Lanari; University of Buenos Aires; Buenos Aires Argentina
- Department of Experimental Haematology; Institute of Medical Research (IDIM); National Scientific and Technical Research Council (CONICET); University of Buenos Aires; Buenos Aires Argentina
| | - Alessandra Balduini
- Department of Molecular Medicine; University of Pavia; Pavia Italy
- Biotechnology Research Laboratories; IRCCS San Matteo Foundation; Pavia Italy
- Department of Biomedical Engineering; Tufts University; Medford MA USA
| | - Rosana F. Marta
- Institute of Medical Research A Lanari; University of Buenos Aires; Buenos Aires Argentina
- Department of Experimental Haematology; Institute of Medical Research (IDIM); National Scientific and Technical Research Council (CONICET); University of Buenos Aires; Buenos Aires Argentina
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Safety and efficacy of long-term treatment of chronic/persistent ITP with eltrombopag: final results of the EXTEND study. Blood 2017; 130:2527-2536. [PMID: 29042367 DOI: 10.1182/blood-2017-04-748707] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 10/04/2017] [Indexed: 01/19/2023] Open
Abstract
In phase 2/3 trials, eltrombopag treatment of 6 months or less in patients with chronic/persistent immune thrombocytopenia (ITP) increased platelet counts and reduced bleeding. The open-label EXTEND study evaluated long-term safety and efficacy of eltrombopag in adults with ITP who had completed a previous eltrombopag study. For the 302 patients enrolled, median duration of eltrombopag treatment was 2.37 years (2 days-8.76 years). Median platelet counts increased to 50 × 109/L or more by week 2 and were sustained throughout the treatment period. Overall, 259 patients (85.8%) achieved a response (platelet count ≥50 × 109/L at least once in the absence of rescue), and 133 (52%) of 257 patients achieved a continuous response of 25 weeks or longer. Responses in patients with platelet counts lower than 15 × 109/L, more previous therapies, and/or splenectomy were somewhat lower. Thirty-four (34%) of 101 patients receiving concomitant ITP medication discontinued 1 or more medication. In patients with assessments, bleeding symptoms (World Health Organization grades 1-4) decreased from 57% at baseline to 16% at 1 year. Forty-one patients (14%) withdrew because of adverse events. Hepatobiliary adverse events (n = 7), cataracts (n = 4), deep vein thrombosis (n = 3), cerebral infarction (n = 2), headache (n = 2), and myelofibrosis (n = 2) occurred in more than 1 patient; the remaining adverse events occurred only once. Rates of thromboembolic events (6%) and hepatobiliary adverse events (15%) did not increase with treatment duration past 1 year. EXTEND demonstrated that long-term use of eltrombopag was effective in maintaining platelet counts of 50 × 109/L or more and reducing bleeding in most patients with ITP of more than 6 months' duration. Important adverse events (eg, thrombosis, hepatobiliary, and bone marrow fibrosis) were infrequent. (ClinicalTrials.gov:NCT00351468).
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Newland A, Lee EJ, McDonald V, Bussel JB. Fostamatinib for persistent/chronic adult immune thrombocytopenia. Immunotherapy 2017; 10:9-25. [PMID: 28967793 DOI: 10.2217/imt-2017-0097] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by phagocytosis and destruction of autoantibody-coated platelets via spleen tyrosine kinase (Syk)-mediated signal transduction in macrophages. Effectiveness of existing therapies varies, and even leading treatments (e.g., IVIg, splenectomy, rituximab, thrombopoietic agents) do not provide optimal management for a substantial number of patients with chronic ITP. Fostamatinib disodium is an orally-bioavailable investigational agent being developed for treatment of primary persistent/chronic adult ITP. Fostamatinib inhibits FcR-triggered, Syk-dependent cytoskeletal rearrangement during phagocytosis. Promising findings have been described in several autoimmune diseases, including rheumatoid arthritis, and sustained responses with manageable adverse events observed with ongoing treatment in patients with heavily treated chronic ITP. Fostamatinib represents an active therapy targeting a previously unexplored mechanism of ITP pathogenesis.
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Affiliation(s)
- Adrian Newland
- Academic Haematology Unit, Blizard Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Eun-Ju Lee
- Division of Hematology/Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Vickie McDonald
- Department of Haematology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - James B Bussel
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
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Tada K, Ohta M, Saga K, Takayama H, Hirashita T, Endo Y, Uchida H, Iwashita Y, Inomata M. Long-term outcomes of laparoscopic versus open splenectomy for immune thrombocytopenia. Surg Today 2017; 48:180-185. [PMID: 28726165 DOI: 10.1007/s00595-017-1570-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/27/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Splenectomy is the standard therapy for medically refractory immune thrombocytopenia (ITP). Laparoscopic splenectomy (LS) has gained wide acceptance; however, the long-term outcomes of LS versus open splenectomy (OS) for patients with ITP remain unclear. METHODS We analyzed, retrospectively, 32 patients who underwent splenectomy, as LS in 22 and OS in 10, for refractory ITP at our institute. Data were evaluated based on the American Society of Hematology 2011 evidence-based practice guidelines for ITP. RESULTS Although the operation time was significantly longer in the LS group (p < 0.01), LS was associated with less blood loss (p < 0.01), infrequent blood transfusion during surgery (p < 0.01), quicker resumption of oral intake (p < 0.01), and shorter hospital stay (p < 0.01) than OS. Positive responses, including complete and partial remission, were achieved in 90% of the OS group patients and 77% of the LS group patients. The mean follow-up periods were 183 and 92 months, respectively. Relapse-free survival rates, 15 years after the operation were 63% in the OS group and 94% in the LS group. CONCLUSIONS LS can provide better short-term results and comparable long-term results to those of OS for ITP.
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Affiliation(s)
- Kazuhiro Tada
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan.
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Kunihiro Saga
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Hiroomi Takayama
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Hiroki Uchida
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
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Li J, Ma S, Shao L, Ma C, Gao C, Zhang XH, Hou M, Peng J. Inflammation-Related Gene Polymorphisms Associated With Primary Immune Thrombocytopenia. Front Immunol 2017; 8:744. [PMID: 28702029 PMCID: PMC5487479 DOI: 10.3389/fimmu.2017.00744] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/12/2017] [Indexed: 12/13/2022] Open
Abstract
Primary immune thrombocytopenia (ITP) is an acquired autoimmune disease characterized by a reduced platelet count and an increased risk of bleeding. Although immense research has improved our understanding of ITP, the pathogenesis remains unclear. Here, we investigated the involvement of 25 single-nucleotide polymorphisms (SNPs) of the inflammation-related genes, including CD24, CD226, FCRL3, IL2, IRF5, ITGAM, NLRP3, CARD8, PTPN22, SH2B2, STAT4, TNFAIP3, and TRAF1, in the pathogenesis and treatment response of ITP. We recruited 312 ITP inpatients and 154 healthy participants in this case–control study. Inflammation-related SNP genotyping was performed on the Sequenom MassARRAY iPLEX platform. The expression of TNFAIP3 mRNA was determined by quantitative real-time RT-PCR. All SNPs in healthy controls were consistent with Hardy–Weinberg equilibrium. Statistical analysis revealed that rs10499194 in TNFAIP3 was significantly associated with a decreased risk of ITP after Bonferroni multiple correction (codominant, CT vs. CC, OR = 0.431, 95% CI = 0.262–0.711, p = 0.001; dominant, TT/CT vs. CC, OR = 0.249, 95% CI = 0.141–0.440, p = 0.000). Besides, TNFAIP3 expression was significantly higher in patients with CT and pooled CT/TT genotypes compared with CC genotype (p = 0.001; p = 0.001). Interestingly, rs10499194 was also associated with corticosteroid-sensitivity (codominant, CT vs. CC, OR = 0.092, 95% CI = 0.021–0.398, p = 0.001; dominant, TT/CT vs. CC, OR = 0.086, 95% CI = 0.020–0.369, p = 0.001; allelic, T vs. C, OR = 0.088, 95% CI = 0.021–0.372, p = 0.001). Furthermore, no significant association was found between inflammation-related SNPs and the severity or refractoriness of ITP after Bonferroni multiple correction. Our findings suggest that rs10499194 may be a protective factor for susceptibility and corticosteroid sensitivity in ITP patients.
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Affiliation(s)
- Ju Li
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Sai Ma
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Linlin Shao
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
| | - Chunhong Ma
- Department of Immunology, Shandong University School of Medicine, Jinan, China
| | - Chengjiang Gao
- Department of Immunology, Shandong University School of Medicine, Jinan, China
| | - Xiao-Hui Zhang
- Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University Institute of Hematology, Peking University People's Hospital, Beijing, China
| | - Ming Hou
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China.,Shandong Provincial Key Laboratory of Immunohematology, Qilu Hospital, Shandong University, Jinan, China
| | - Jun Peng
- Department of Hematology, Qilu Hospital, Shandong University, Jinan, China
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127
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Lee JY, Lee JO, Jung JY, Bang SM. Dapsone therapy for refractory immune thrombocytopenia patients: a case series. Blood Res 2017; 52:95-99. [PMID: 28698844 PMCID: PMC5503904 DOI: 10.5045/br.2017.52.2.95] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/01/2017] [Accepted: 04/11/2017] [Indexed: 12/20/2022] Open
Abstract
Background Dapsone has been recommended as a second-line immunosuppressive agent for patients with immune thrombocytopenia (ITP). Methods We retrospectively analyzed the efficacy and safety of dapsone therapy in patients with ITP. Results Nine ITP patients were treated with dapsone at a dose of 50–100 mg/day between May 2013 and March 2016. All patients were refractory to multiple previous treatments, with a median of 7 agents (range, 4–8), and 3 patients had undergone a previous splenectomy. The median pre-treatment platelet count was 4×109/L (range, 3–27×109/L). Only 1 patient (11.1%) responded to dapsone therapy. No severe adverse events were observed, except for 1 case of dapsone hypersensitivity syndrome. Conclusion Although dapsone is still useful for some patients, it may be ineffective in heavily pretreated patients with profound thrombocytopenia.
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Affiliation(s)
- Ji Yun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Young Jung
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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128
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A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy. Blood 2017. [PMID: 28630121 DOI: 10.1182/blood-2017-01-761262] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to determine the safety and efficacy of recombinant human thrombopoietin (rhTPO) for the management of immune thrombocytopenia (ITP) during pregnancy. Pregnant patients with ITP were enrolled in the study if they had a platelet count less than 30 × 109/L, were experiencing bleeding manifestations, had failed to respond to corticosteroids and/or intravenous immunoglobulin (IVIG), and had developed refractoriness to platelet transfusion. Thirty-one patients received rhTPO at an initial dose of 300 U/kg once daily for 14 days. Twenty-three patients responded (74.2%), including 10 complete responders (>100 × 109/L) and 13 responders (30-100 × 109/L). It appears that rhTPO ameliorated the bleeding symptoms remarkably, even in the nonresponders. rhTPO was well tolerated. Dizziness, fatigue, and pain at an injection site were reported in 1 patient each. No congenital disease or developmental delays were observed in the infants in a median follow-up of 53 (range, 39-68) weeks. In conclusion, rhTPO is a potentially safe and effective treatment choice for patients with ITP during pregnancy. Our work has paved the way for further study on the clinical application of rhTPO and other thrombopoietic agents for the management of ITP during pregnancy. This study is registered at www.clinicaltrials.gov as NCT02391272.
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129
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Audia S, Mahévas M, Samson M, Godeau B, Bonnotte B. Pathogenesis of immune thrombocytopenia. Autoimmun Rev 2017; 16:620-632. [DOI: 10.1016/j.autrev.2017.04.012] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 03/17/2017] [Indexed: 01/19/2023]
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130
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Zhou KX, Yan R, Chen MX, Liu J, Cui QY, Hu RP, Liu YC, Zhang Y, Ruan CG, Dai KS. [A Study on the establishment of immune thrombocytopenia model induced by anti-platelet GPⅠbα antibodies]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:390-393. [PMID: 28565737 PMCID: PMC7354184 DOI: 10.3760/cma.j.issn.0253-2727.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Indexed: 11/05/2022]
Abstract
Objective: To establish primary immune thrombocytopenia (ITP) animal model induced by anti-platelet membrane glycoprotein GPⅠbα antibodies AN51 and R300. Methods: Twenty guinea pigs (6-8 week) were divided into 4 groups. Five guinea pigs in each group were intravenously injected with different doses of AN51 (0.05, 0.1, 0.2 μg/g) and 0.2 μg/g IgG as control. The whole blood was collected from inner angular venous plexus. Platelets number was determined by an automated cell counter and Swiss-Jim method. Then, the similar protocol was used to establish ITP nude mice model by intraperitoneal injection of different concentrations of anti-platelet GPⅠbα antibody R300, respectively. Results: ①Five minutes after intravenous injection of AN51 at 0.05, 0.1 and 0.2 μg/g, the platelet counts of guinea pigs reduced about 0-5%, 50%-60% and 70%-80% compared to the control group, respectively. The difference was statistically significant (P<0.01) . ②Six hours after intraperitoneal injection of R300 at 0.05, 0.1, 0.2 μg/g, the platelet counts of nude mice decreased about 20%-30%, 60%-70% and 80%-90% compared to the control group, respectively. The difference was statistically significant (P<0.01) . The nude mice, injected 0.2 μg/g R300 once a day for 2 weeks, showed typical ITP clinical manifestations including large number of petechiaes or ecchymoses on limbs, head and abdomen. Conclusion: AN51 at 0.2 μg/g and R300 at 0.2 μg/g could establish stable ITP model in guinea pigs and nude mice respectively.
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Affiliation(s)
- K X Zhou
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University; Key Laboratory of Thrombosis and Hemostasis, Ministry of Health; Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215006, China
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131
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Sys J, Provan D, Schauwvlieghe A, Vanderschueren S, Dierickx D. The role of splenectomy in autoimmune hematological disorders: Outdated or still worth considering? Blood Rev 2017; 31:159-172. [DOI: 10.1016/j.blre.2017.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 01/26/2023]
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132
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Palau J, Sancho E, Herrera M, Sánchez S, Mingot ME, Upegui RI, Rodríguez Salazar MJ, de la Cruz F, Fernández MC, González López TJ, Hernández JJ, Ríos E, López-Fernández MF, García M, Hernández JÁ, Sanz MA. Characteristics and management of primary and other immune thrombocytopenias: Spanish registry study. Hematology 2017; 22:484-492. [PMID: 28415913 DOI: 10.1080/10245332.2017.1311442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The natural history and its modulation by treatments administered for immune thrombocytopenia (ITP) in the clinical practice remains unknown. In addition, little information is available on the characteristics and management of ITP in Spain. METHODS We conducted an observational, multicenter, registry in 70 Hematology Services from Spain between 2009 and 2011, which included children from 2 months of age and adults with primary ITP or another ITP diagnosed within the last 6 months (platelet count [PC] < 100 × 109/l). Patients were followed-up at 6 and 12 months. RESULTS 484 patients were included (median [Q1, Q3] age 52 [29,74] years, 87.6% adults), 56% women, 10.5% with secondary ITP. Median (Q1, Q3) PC at diagnosis was 12 × 109/l (4, 32); 72% of patients had bleeding symptoms (62% cutaneous bleeding, 29% oral cavity bleeding, 18% epistaxis). 81% of patients with primary ITP received first-line treatment, mainly with corticosteroids (>6 weeks in 59% of cases), either alone (41%) or associated with intravenous immunoglobulin (33%). The response (≥30 × 109/L) to first-line treatment was 92%. A total of 19% of patients received second-line treatment and 6% additional treatments. At 12 months, 74% of primary ITP patients maintained a PC ≥ 100 × 109/L in absence of treatment (10% still had hemorrhagic manifestations). CONCLUSIONS Characteristics of Spanish ITP patients are comparable to those from other countries. Although a high response rate to first-line treatments is observed, at 1 year, the disease persists in around one quarter of patients. Overall therapeutic management in Spain conforms to current recommendations, except for an excessive duration of corticosteroids therapy.
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Affiliation(s)
- Javier Palau
- a Hospital Universitario y Politécnico la Fe , Valencia , Spain
| | | | | | | | | | | | | | | | | | | | | | - Eduardo Ríos
- l Hospital Universitario Virgen de Valme , Sevilla , Spain
| | | | - Marta García
- n Hospital Consorci Sanitari de Terrassa , Terrassa , Spain
| | | | - Miguel A Sanz
- a Hospital Universitario y Politécnico la Fe , Valencia , Spain.,p Departamento de Medicina , Universidad de Valencia , Spain
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133
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Cybulska A, Meintker L, Ringwald J, Krause SW. Measurements of immature platelets with haematology analysers are of limited value to separate immune thrombocytopenia from bone marrow failure. Br J Haematol 2017; 177:612-619. [DOI: 10.1111/bjh.14628] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/31/2016] [Indexed: 01/19/2023]
Affiliation(s)
| | - Lisa Meintker
- Department of Medicine 5 - Haematology and Oncology; Universitätsklinikum Erlangen; Erlangen Germany
| | - Jürgen Ringwald
- Department of Transfusion Medicine and Haemostaseology; Universitätsklinikum Erlangen; Erlangen Germany
| | - Stefan W. Krause
- Department of Medicine 5 - Haematology and Oncology; Universitätsklinikum Erlangen; Erlangen Germany
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134
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Zufferey A, Kapur R, Semple JW. Pathogenesis and Therapeutic Mechanisms in Immune Thrombocytopenia (ITP). J Clin Med 2017; 6:jcm6020016. [PMID: 28208757 PMCID: PMC5332920 DOI: 10.3390/jcm6020016] [Citation(s) in RCA: 295] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/04/2017] [Indexed: 01/19/2023] Open
Abstract
Immune thrombocytopenia (ITP) is a complex autoimmune disease characterized by low platelet counts. The pathogenesis of ITP remains unclear although both antibody-mediated and/or T cell-mediated platelet destruction are key processes. In addition, impairment of T cells, cytokine imbalances, and the contribution of the bone marrow niche have now been recognized to be important. Treatment strategies are aimed at the restoration of platelet counts compatible with adequate hemostasis rather than achieving physiological platelet counts. The first line treatments focus on the inhibition of autoantibody production and platelet degradation, whereas second-line treatments include immunosuppressive drugs, such as Rituximab, and splenectomy. Finally, third-line treatments aim to stimulate platelet production by megakaryocytes. This review discusses the pathophysiology of ITP and how the different treatment modalities affect the pathogenic mechanisms.
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Affiliation(s)
- Anne Zufferey
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
- The Toronto Platelet Immunobiology Group, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
| | - Rick Kapur
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
- The Toronto Platelet Immunobiology Group, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
- Canadian Blood Services, Toronto, ON M5B 1W8, Canada.
| | - John W Semple
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
- The Toronto Platelet Immunobiology Group, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.
- Canadian Blood Services, Toronto, ON M5B 1W8, Canada.
- Department of Pharmacology, Medicine, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5B 1W8, Canada.
- Division of Hematology and Transfusion Medicine, Lund University, 221 84 Lund, Sweden.
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135
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Impact of Immunoglobulin Therapy in Pediatric Disease: a Review of Immune Mechanisms. Clin Rev Allergy Immunol 2017; 51:303-314. [PMID: 26142065 DOI: 10.1007/s12016-015-8499-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intravenous immunoglobulin (IVIG) provides replacement therapy in immunodeficiency and immunomodulatory therapy in inflammatory and autoimmune diseases. This paper describes the immune mechanisms underlying six major non-primary immunodeficiency pediatric diseases and the diverse immunomodulatory functions of IVIG therapy. In Kawasaki disease, IVIG plays a major, proven, and effective role in decreasing aneurysm formation, which represents an aberrant inflammatory response to an infectious trigger in a genetically predisposed individual. In immune thrombocytopenia, IVIG targets the underlying increased platelet destruction and decreased platelet production. Although theoretically promising, IVIG shows no clear clinical benefit in the prophylaxis and treatment of neonatal sepsis. Limitations in research design combined with the unique neonatal immunologic environment offer explanations for this finding. Inflammation from aberrant immune activation underlies the myelinotoxic effects of Guillain-Barré syndrome. HIV-1 exerts a broad range of immunologic effects and was found to decrease serious bacterial infections in the pre-highly active anti-retroviral therapy (HAART) era, although its practical relevance in the post-HAART era has waned. Clinical and experimental data support the role of immune mechanisms in the pathogenesis of childhood epilepsy. IVIG exerts anti-epileptic effects through targeting upregulated cytokine pathways and antibodies thought to contribute to epilepsy. Applications in six additional pediatric diseases including pediatric asthma, atopic dermatitis, cystic fibrosis, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS), autism, and transplantation will also be briefly reviewed. From autoimmunity to immunodeficiency, a dynamic immunologic basis underlies major pediatric diseases and highlights the broad potential of IVIG therapy.
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136
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Gill H, Wong RSM, Kwong YL. From chronic immune thrombocytopenia to severe aplastic anemia: recent insights into the evolution of eltrombopag. Ther Adv Hematol 2017; 8:159-174. [PMID: 28473904 DOI: 10.1177/2040620717693573] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Thrombopoietin (TPO) is the most potent cytokine stimulating thrombopoiesis. Therapy with exogenous TPO is limited by the formation of antibodies cross-reacting with endogenous TPO. Mimetics of TPO are compounds with no antigenic similarity to TPO. Eltrombopag is an orally-active nonpeptide small molecule that binds to the transmembrane portion of the TPO receptor MPL. Initial trials of eltrombopag have centered on immune thrombocytopenia (ITP), which is due to both increased destruction and decreased production of platelets. Eltrombopag at 25-75 mg/day has been shown to be highly effective in raising the platelet count in ITP with suboptimal response to immunosuppression and splenectomy. These successful results led to the exploration of eltrombopag in other thrombocytopenic disorders. In hepatitis C viral infection, eltrombopag raises the platelet count sufficiently enough to allow treatment with ribavirin and pegylated interferon. Because MPL is expressed on hematopoietic cells, eltrombopag use in myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) might enhance leukemic proliferation. Clinical trials of eltrombopag in MDS and AML, however, have shown amelioration of thrombocytopenia without promoting disease progression. In severe aplastic anemia (SAA) not responding to immunosuppression with anti-thymocyte globulin (ATG) and cyclosporine, eltrombopag as a single agent at 150-300 mg/day results in an overall response rate of 40-70%. At high doses, adverse effects including pigmentation, gastrointestinal upset and hepatic derangement have become evident. Current studies have examined the first-line use of eltrombopag in combination with ATG in SAA. In a recent study, eltrombopag used at 150 mg/day with horse ATG resulted in an overall response rate of 90% in newly diagnosed SAA patients, with a complete response rate of about 50%. Clonal karyotypic aberrations are, however, found in 10-20% of SAA patients treated with eltrombopag. The safety and efficacy of eltrombopag in SAA require further evaluation, particularly when it is used with less intensive immunosuppression.
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Affiliation(s)
- Harinder Gill
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Raymond S M Wong
- Sir Y.K. Pao Centre for Cancer and Department of Medicine and Therapeutics, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Yok-Lam Kwong
- Department of Medicine, Queen Mary Hospital, Pokfulam Road, Hong Kong, China
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137
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Brynes RK, Wong RSM, Thein MM, Bakshi KK, Burgess P, Theodore D, Orazi A. A 2-Year, Longitudinal, Prospective Study of the Effects of Eltrombopag on Bone Marrow in Patients with Chronic Immune Thrombocytopenia. Acta Haematol 2016; 137:66-72. [PMID: 28006767 DOI: 10.1159/000452992] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND The long-term effects of eltrombopag on bone marrow (BM) reticulin and/or collagen deposition in previously treated adults with chronic immune thrombocytopenia (ITP) were assessed. METHODS Three BM biopsies were collected at baseline and after 1 and 2 years of eltrombopag treatment. Specimens were centrally processed, stained for reticulin and collagen, independently reviewed by 2 hematopathologists, and rated according to the European Consensus 0-3 scale of marrow fibrosis (MF). RESULTS Of 162 patients enrolled, 93 completed all 3 protocol-specified BM biopsies. All patients with a baseline assessment were negative for collagen. Of 159 patients assessed at baseline, 150 (94%) had normal reticulin (MF-0) and 9 (6%) had minimally increased reticulin (MF-1). After 2 years, 83/93 patients (89%) with BM biopsies had MF-0, 10 (11%) had MF-1, and none had MF-2 or MF-3. Five out of 127 patients (4%) at 1 year and 1 out of 93 (1%) at 2 years had collagen deposition. None of the patients had clinical symptoms typical of BM dysfunction or abnormalities of clinical concern based on white blood cell count or peripheral blood smear. CONCLUSION For most patients with chronic ITP, eltrombopag is not associated with clinically relevant increases in BM reticulin or collagen formation.
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Affiliation(s)
- Russell K Brynes
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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138
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Wang L, Gao Z, Chen XP, Zhang HY, Yang N, Wang FY, Guan LX, Gu ZY, Zhao SS, Luo L, Wei HP, Gao CJ. Efficacy and safety of thrombopoietin receptor agonists in patients with primary immune thrombocytopenia: A systematic review and meta-analysis. Sci Rep 2016; 6:39003. [PMID: 27991534 PMCID: PMC5171907 DOI: 10.1038/srep39003] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/16/2016] [Indexed: 12/25/2022] Open
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease characterized by increased platelet destruction and impaired platelet production. In this study, we conducted a systematic review and meta-analysis to determine the efficacy and safety of thrombopoietin receptor agonists (TPO-RAs) in primary ITP patients. Thirteen randomized controlled trials were included in this study, the pooled results of which demonstrated that TPO-RAs significantly increased platelet response (R) and durable response (DR) rates [risk ratio (RR): 2.77, 95% confidence interval (CI): 2.01-3.82, P = 5.9 × 10-10; RR: 7.52, 95% CI: 3.94-14.35, P = 9.2 × 10-10; respectively] and that TPO-RAs significantly reduced the incidences of any or severe bleeding events (RR: 0.80, 95% CI: 0.67-0.95, P = 0.013; RR: 0.52, 95% CI: 0.27-0.99, P = 0.048; respectively). Moreover, our results indicated that there was a significant reduction in the proportion of patients needing rescue medications in the TPO-RA groups compared with the control groups (RR: 0.50, 95% CI: 0.42-0.59, P = 2.0 × 10-15) and that the rates of any or severe adverse events were similar between the TPO-RA and control regimens (RR: 1.01, 95% CI: 0.92-1.10; RR: 0.74, 95% CI: 0.54-1.01; respectively). These findings demonstrate that TPO-RAs are an effective and safe second-line treatment option for primary ITP patients.
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Affiliation(s)
- Li Wang
- Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Department of Hematology, Laoshan Branch, No. 401 Hospital of Chinese PLA, Qingdao, China
| | - Zhe Gao
- Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- Department of Hematology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-ping Chen
- Department of Hematology, Navy General Hospital of Chinese PLA, Beijing, China
| | - Hai-yan Zhang
- Department of Hematology, Linyi People’s Hospital, Linyi, China
| | - Nan Yang
- Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Fei-yan Wang
- Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Li-xun Guan
- Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Zhen-yang Gu
- Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Sha-sha Zhao
- Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Lan Luo
- Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Hua-ping Wei
- Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Chun-ji Gao
- Department of Hematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
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139
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Low-level light treatment ameliorates immune thrombocytopenia. Sci Rep 2016; 6:38238. [PMID: 27901126 PMCID: PMC5128784 DOI: 10.1038/srep38238] [Citation(s) in RCA: 251] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/07/2016] [Indexed: 11/08/2022] Open
Abstract
Immune thrombocytopenia (ITP) is an immune-mediated acquired bleeding disorder characterized by abnormally low platelet counts. We reported here the ability of low-level light treatment (LLLT) to alleviate ITP in mice. The treatment is based on noninvasive whole body illumination 30 min a day for a few consecutive days by near infrared light (830 nm) transmitted by an array of light-emitting diodes (LEDs). LLLT significantly lifted the nadir of platelet counts and restored tail bleeding time when applied to two passive ITP models induced by anti-CD41 antibody. The anti-platelet antibody hindered megakaryocyte differentiation from the progenitors, impaired proplatelet and platelet formation, and induced apoptosis of platelets. These adverse effects of anti-CD41 antibody were all mitigated by LLLT to varying degrees, owing to its ability to enhance mitochondrial biogenesis and activity in megakaryocytes and preserve mitochondrial functions in platelets in the presence of the antibody. The observations argue not only for contribution of mitochondrial stress to the pathology of ITP, but also clinical potentials of LLLT as a safe, simple, and cost-effective modality of ITP.
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140
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Deng G, Yu S, Li Q, He Y, Liang W, Yu L, Xu D, Sun T, Zhang R, Li Q. Investigation of platelet apoptosis in adult patients with chronic immune thrombocytopenia. ACTA ACUST UNITED AC 2016; 22:155-161. [PMID: 27734765 DOI: 10.1080/10245332.2016.1237004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Immune thrombocytopenia (ITP) is an acquired and heterogeneous autoimmune-mediated hematological disease typically characterized by a low platelet count. Emerging evidence over the past several years suggests that platelet biogenesis and ageing are regulated, at least in part, by apoptotic mechanisms. However, the association between decreased platelets and apoptosis in ITP patients is poorly understood. To better understand the role of platelet apoptosis in ITP pathophysiology, we investigated apoptotic markers in platelets acquired from 40 chronic ITP patients. Furthermore, the results of ITP patients were compared to those from 40 healthy individuals. METHODS Markers of apoptosis, including phosphatidylserine (PS) exposure and mitochondrial inner membrane potentials (ΔΨm), were examined using flow cytometry. The expression of pro-apoptotic molecules such as Bak and Bax and anti-apoptotic molecules such as Bcl-xL were determined using quantitative real-time PCR (qRT-PCR) and Western blotting. RESULTS Our study demonstrated that the platelet mitochondrial membrane depolarization in chronic ITP patients tended to be higher than in healthy controls. Additionally, the proportion of platelets with surface-exposed PS in chronic ITP was significantly higher than that of controls. The results showed that the expression levels of Bak and Bax were significantly higher in chronic ITP patients than in healthy controls; Bcl-xL expression levels were significantly decreased in the platelets of chronic ITP patients compared to healthy controls. DISCUSSION AND CONCLUSION study indicates that the enhancement of platelet apoptosis observed in patients with chronic ITP may be one of the pathogenic mechanisms of chronic ITP.
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Affiliation(s)
- Gang Deng
- a The Ningbo Central Blood Station , Ningbo , China.,b The First Affiliated Hospital of Soochow University , Soochow , China
| | - Shifang Yu
- c The Department of Transfusion Medicine , The Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou , China
| | - Qiming Li
- d The Department of Cardiology , The Fourth Affiliated Hospital of Zhejiang University School of Medicine , Yiwu , China
| | - Yunlei He
- a The Ningbo Central Blood Station , Ningbo , China
| | - Wei Liang
- a The Ningbo Central Blood Station , Ningbo , China
| | - Lu Yu
- a The Ningbo Central Blood Station , Ningbo , China
| | - Deyi Xu
- a The Ningbo Central Blood Station , Ningbo , China
| | - Tao Sun
- c The Department of Transfusion Medicine , The Second Affiliated Hospital of Zhejiang University School of Medicine , Hangzhou , China
| | - Ri Zhang
- b The First Affiliated Hospital of Soochow University , Soochow , China
| | - Qiang Li
- e The Department of Laboratory Medicine , The First Affiliated Hospital of Zhejiang Chinese Medical University , Hangzhou , China
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141
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Zheng D, Huang CS, Huang SB, Zheng CX. Laparoscopic splenectomy for primary immune thrombocytopenia: Current status and challenges. World J Gastrointest Endosc 2016; 8:610-615. [PMID: 27668071 PMCID: PMC5027031 DOI: 10.4253/wjge.v8.i17.610] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 06/02/2016] [Accepted: 06/29/2016] [Indexed: 02/05/2023] Open
Abstract
Primary immune thrombocytopenia (ITP) is an immune-mediated disorder affecting both adults and children, characterised by bleeding complications and low platelet counts. Corticosteroids are the first-line therapy for ITP, but only 20%-40% of cases achieve a stable response. Splenectomy is the main therapy for patients failing to respond to corticosteroids for decades, and about two-thirds of patients achieve a long-lasting response. Although some new drugs are developed to treat ITP as second-line therapies in recent years, splenectomy is still the better choice with less cost and more efficiency. Laparoscopic splenectomy (LS) for ITP proves to be a safe technique associated with lower morbidity and faster recovery and similar hematological response when compared to traditional open splenectomy. Based on the unified hematological outcome criteria by current international consensus, the response rate of splenectomy should be reassessed. So far, there are not widely accepted preoperative clinical indicators predicting favorable response to LS. Since the patients undergoing surgery take the risk of complications and poor hematological outcome, the great challenge facing the doctors is to identify a reliable biomarker for predicting long-term outcome of splenectomy which can help make the decision of operation.
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142
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Goette NP, Glembotsky AC, Lev PR, Grodzielski M, Contrufo G, Pierdominici MS, Espasandin YR, Riveros D, García AJ, Molinas FC, Heller PG, Marta RF. Platelet Apoptosis in Adult Immune Thrombocytopenia: Insights into the Mechanism of Damage Triggered by Auto-Antibodies. PLoS One 2016; 11:e0160563. [PMID: 27494140 PMCID: PMC4975454 DOI: 10.1371/journal.pone.0160563] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/21/2016] [Indexed: 11/26/2022] Open
Abstract
Mechanisms leading to decreased platelet count in immune thrombocytopenia (ITP) are heterogeneous. This study describes increased platelet apoptosis involving loss of mitochondrial membrane potential (ΔΨm), caspase 3 activation (aCasp3) and phosphatidylserine (PS) externalization in a cohort of adult ITP patients. Apoptosis was not related to platelet activation, as PAC-1 binding, P-selectin exposure and GPIb-IX internalization were not increased. Besides, ITP platelets were more sensitive to apoptotic stimulus in terms of aCasp3. Incubation of normal platelets with ITP plasma induced loss of ΔΨm, while PS exposure and aCasp3 remained unaltered. The increase in PS exposure observed in ITP platelets could be reproduced in normal platelets incubated with ITP plasma by adding normal CD3+ lymphocytes to the system as effector cells. Addition of leupeptin -a cathepsin B inhibitor- to this system protected platelets from apoptosis. Increased PS exposure was also observed when normal platelets and CD3+ lymphocytes were incubated with purified IgG from ITP patients and was absent when ITP plasma was depleted of auto-antibodies, pointing to the latter as responsible for platelet damage. Apoptosis was present in platelets from all patients carrying anti-GPIIb-IIIa and anti-GPIb auto-antibodies but was absent in the patient with anti-GPIa-IIa auto-antibodies. Platelet damage inversely correlated with platelet count and decreased during treatment with a thrombopoietin receptor agonist. These results point to a key role for auto-antibodies in platelet apoptosis and suggest that antibody-dependent cell cytotoxicity is the mechanism underlying this phenomenon.
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Affiliation(s)
- Nora P. Goette
- Departamento de Hematología Investigación. Instituto de Investigaciones Médicas A. Lanari-IDIM, Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Ana C. Glembotsky
- Departamento de Hematología Investigación. Instituto de Investigaciones Médicas A. Lanari-IDIM, Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Paola R. Lev
- Departamento de Hematología Investigación. Instituto de Investigaciones Médicas A. Lanari-IDIM, Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Matías Grodzielski
- Departamento de Hematología Investigación. Instituto de Investigaciones Médicas A. Lanari-IDIM, Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Geraldine Contrufo
- Departamento de Hematología Investigación. Instituto de Investigaciones Médicas A. Lanari-IDIM, Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | | | - Yesica R. Espasandin
- Departamento de Hematología Investigación. Instituto de Investigaciones Médicas A. Lanari-IDIM, Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Dardo Riveros
- Departamento de Hematología, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Buenos Aires, Argentina
| | - Alejandro J. García
- Laboratorio de Citometría de Flujo, Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC), Buenos Aires, Argentina
| | - Felisa C. Molinas
- Departamento de Hematología Investigación. Instituto de Investigaciones Médicas A. Lanari-IDIM, Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Paula G. Heller
- Departamento de Hematología Investigación. Instituto de Investigaciones Médicas A. Lanari-IDIM, Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
| | - Rosana F. Marta
- Departamento de Hematología Investigación. Instituto de Investigaciones Médicas A. Lanari-IDIM, Universidad de Buenos Aires (UBA), Consejo Nacional de Investigaciones Cientificas y Tecnicas (CONICET), Buenos Aires, Argentina
- * E-mail:
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Miano M, Ramenghi U, Russo G, Rubert L, Barone A, Tucci F, Farruggia P, Petrone A, Mondino A, Lo Valvo L, Crescenzio N, Bellia F, Olivieri I, Palmisani E, Caviglia I, Dufour C, Fioredda F. Mycophenolate mofetil for the treatment of children with immune thrombocytopenia and Evans syndrome. A retrospective data review from the Italian association of paediatric haematology/oncology. Br J Haematol 2016; 175:490-495. [PMID: 27447678 DOI: 10.1111/bjh.14261] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
Abstract
Mycophenolate mofetil (MMF) has been shown to be effective in children with immune thrombocytopenia (ITP) and Evans syndrome (ES), but data from larger series and details on the timing of the response are lacking. We evaluated 56 children treated with MMF for ITP (n = 40) or ES (n = 16), which was primary or secondary to autoimmune lymphoproliferative syndrome -related syndrome (ARS). Thirty-five of the 54 evaluable patients (65%) achieved a partial (18%) or complete (46%) response after a median (range) of 20 (7-137) and 37 (7-192) d, respectively. ITP and ES patients responded in 58% and 81% of cases (P = not significant, ns), with complete response in 32% and 81% (P = 0·01), respectively. 60% and 73% of children with primary disease and ARS responded (P = ns) with complete response in 34% and 68% of cases (P = 0·01), respectively. Six of 35 (17%) children relapsed after a median of 283 d (range 189-1036). Limited toxicity was observed in four patients. The median durations of treatment and follow-up were seven and 12·7 months, respectively. This is the largest reported cohort of patients treated with MMF for ITP/ES. The results show that MMF is effective and safe and provides a relatively quick response, suggesting that it has a potential role as an alternative to more aggressive and expensive second/further-line treatments.
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Affiliation(s)
- Maurizio Miano
- Haematology Unit, I.R.C.C.S. Istituto Giannina Gaslini, Genoa, Italy.
| | - Ugo Ramenghi
- Haematology Unit, Paediatric Department, University of Turin, Turin, Italy
| | - Giovanna Russo
- Department of Paediatrics, Unit of Paediatric Haematology and Oncology, University of Catania, Catania, Italy
| | - Laura Rubert
- Haematology-Oncology Unit, I.R.C.C.S. Policlinico Fondazione San Matteo Pavia, Pavia, Italy
| | - Angelica Barone
- Paediatric and Onco-Haematology Unit, University Hospital of Parma, Parma, Italy
| | - Fabio Tucci
- Paediatric Haematology-Oncology Unit, Ospedale Pediatrico Meyer, Florence, Italy
| | - Piero Farruggia
- Paediatric Haematology and Oncology Unit, "G. Di Cristina" Children's Hospital, Palermo, Italy
| | | | - Anna Mondino
- Haematology Unit, Paediatric Department, University of Turin, Turin, Italy
| | - Laura Lo Valvo
- Department of Paediatrics, Unit of Paediatric Haematology and Oncology, University of Catania, Catania, Italy
| | | | - Francesco Bellia
- Department of Paediatrics, Unit of Paediatric Haematology and Oncology, University of Catania, Catania, Italy
| | - Irene Olivieri
- Haematology Unit, I.R.C.C.S. Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Palmisani
- Haematology Unit, I.R.C.C.S. Istituto Giannina Gaslini, Genoa, Italy
| | - Ilaria Caviglia
- Infectious Diseases Unit, I.R.C.C.S. Istituto Giannina Gaslini, Genoa, Italy
| | - Carlo Dufour
- Haematology Unit, I.R.C.C.S. Istituto Giannina Gaslini, Genoa, Italy
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144
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Aslam R, Kapur R, Segel GB, Guo L, Zufferey A, Ni H, Semple JW. The spleen dictates platelet destruction, anti-platelet antibody production, and lymphocyte distribution patterns in a murine model of immune thrombocytopenia. Exp Hematol 2016; 44:924-930.e1. [PMID: 27417974 DOI: 10.1016/j.exphem.2016.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/24/2016] [Accepted: 07/02/2016] [Indexed: 12/25/2022]
Abstract
For many years, splenectomy has been used to treat immune thrombocytopenia (ITP), and this procedure benefits approximately two-thirds of the treated patients. Although splenectomy may raise platelet counts, antibody-coated platelets and cytotoxic T lymphocytes appear to persist or can change over time. To better understand how the spleen may affect anti-platelet immune responses, we used a murine model of ITP demonstrating both antibody-mediated and T lymphocyte-mediated thrombocytopenia. Mice with severe combined immunodeficiency (SCID) were either splenectomized or not and transfused with splenocytes from CD61 (GPIIIa) knockout mice immunized against CD61(+) platelets. Platelet counts and anti-platelet antibody levels were performed weekly. After 4 weeks, the mice were sacrificed, and lymphoid organs were harvested and examined by flow cytometry to quantify CD4(+)CD25(+)FoxP3(+) Tregs and conventional cross-presenting XCR1(+) and tolerizing SIRPα+ dendritic cells. The results indicate that compared with control non-splenectomized mice, thrombocytopenia was improved and anti-platelet antibody production was significantly diminished in all splenectomized mice that received immune splenocytes. Splenectomized SCID mice also had a marked reduction in Tregs in the thymus together with an increased proportion of both thymic dendritic cell subsets that correlated with increased platelet counts. Of interest, although splenectomy diminished anti-platelet antibody production and raised platelet counts, marrow megakaryocyte densities were still significantly reduced in mice that received immune splenocytes. These results suggest that the spleen in murine ITP not only is the primary site responsible for platelet destruction, but it also controls, to a significant extent, the antibody response against platelets and the migration patterns of lymphocyte subsets.
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MESH Headings
- Animals
- Autoantibodies/immunology
- Biomarkers
- Blood Platelets/immunology
- Bone Marrow/pathology
- Dendritic Cells/immunology
- Dendritic Cells/metabolism
- Disease Models, Animal
- Female
- Histocompatibility Antigens Class I/immunology
- Integrin beta3/genetics
- Integrin beta3/immunology
- Leukocyte Count
- Lymphocytes/immunology
- Lymphocytes/metabolism
- Lymphocytes/pathology
- Megakaryocytes/metabolism
- Mice
- Mice, Knockout
- Phenotype
- Platelet Count
- Purpura, Thrombocytopenic, Idiopathic/immunology
- Purpura, Thrombocytopenic, Idiopathic/metabolism
- Purpura, Thrombocytopenic, Idiopathic/pathology
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Spleen/immunology
- Spleen/pathology
- Splenectomy
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- T-Lymphocytes, Regulatory/pathology
- Thymocytes/immunology
- Thymocytes/metabolism
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Affiliation(s)
- Rukhsana Aslam
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada
| | - Rick Kapur
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada; Canadian Blood Services, Toronto, ON, Canada
| | - George B Segel
- Division of Hematology and Department of Medicine, University of Rochester, Rochester, NY
| | - Li Guo
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada
| | - Anne Zufferey
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada
| | - Heyu Ni
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada; Canadian Blood Services, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada
| | - John W Semple
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, ON, Canada; Canadian Blood Services, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Departments of Medicine and Pharmacology, University of Toronto, Toronto, ON, Canada.
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145
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Negash M, Tsegaye A, G/Medhin A. Diagnostic predictive value of platelet indices for discriminating hypo productive versus immune thrombocytopenia purpura in patients attending a tertiary care teaching hospital in Addis Ababa, Ethiopia. BMC HEMATOLOGY 2016; 16:18. [PMID: 27375850 PMCID: PMC4930598 DOI: 10.1186/s12878-016-0057-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 06/11/2016] [Indexed: 11/18/2022]
Abstract
Background Bone marrow examination may be required to discriminate causes of thrombocytopenia as hypoproductive or hyperdestructive. However, this procedure is invasive and time consuming. This study assessed the diagnostic value of Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and Platelet Large Cell-Ratio (P-LCR) in discriminating causes of thrombocytopenia as hypoproductive or hyperdestructive (Immune thrombocytopenia purpura). Method A prospective cross-sectional study was conducted on 83 thrombocytopenic patients (Plt < 150 × 109/L). From these, 50 patients had hypoproductive and the rest 33 Immune Thrombocytopenia Purpura (ITP). Age and sex matched 42 healthy controls were included as a comparative group. Hematological analysis was carried out using Sysmex XT 2000i 5 part diff analyzer. SPSS Version16 was used for data analysis. A two by two table and receiver operating characteristic (ROC) curve was used to calculate sensitivity, specificity, positive and negative predictive values, for a given platelet indices (MPV, PDW and P-LCR). Student t test and Mann Whitney U test were used to compare means and medians, respectively. Correlation test was used to determine associations between continuous variables. Results All Platelet indices were significantly higher in ITP patients (n = 33) than in hypoproductive thrombocytopenic patients (n = 50) (p < 0.0001). In particular MPV and P-LCR have larger area under ROC curve (0.876 and 0.816, respectively), indicating a better predictive capacity, sensitivity and specificity in discriminating the two causes of thrombocytopenia. The indices were still significantly higher in ITP patients compared to 42 healthy controls (p < 0.0001). A significant negative correlation was observed between platelet count and platelet indices in ITP patients, (p < 0.001). Conclusion MPV, PDW and P-LCR help in predicting thrombocytopenic patients as having ITP or hypoproductive thrombocytopenia. If these indices are used in line with other laboratory and clinical information, they may help in delaying/ avoiding unnecessary bone marrow aspiration in ITP patients or supplement a request for bone morrow aspiration or biopsy in hypoproductive thrombocytopenic patients.
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Affiliation(s)
- Mikias Negash
- College of Health Science, Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aster Tsegaye
- College of Health Science, Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Amha G/Medhin
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
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146
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Neschadim A, Kotra LP, Branch DR. Small molecule phagocytosis inhibitors for immune cytopenias. Autoimmun Rev 2016; 15:843-7. [PMID: 27296447 DOI: 10.1016/j.autrev.2016.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/07/2016] [Indexed: 01/19/2023]
Abstract
Immune cytopenias are conditions characterized by low blood cell counts, such as platelets in immune thrombocytopenia (ITP) and red blood cells in autoimmune hemolytic anemia (AIHA). Chronic ITP affects approximately 4 in 100,000 adults annually while AIHA is much less common. Extravascular phagocytosis and massive destruction of autoantibody-opsonized blood cells by macrophages in the spleen and liver are the hallmark of these conditions. Current treatment modalities for ITP and AIHA include the first-line use of corticosteroids; whereas, IVIg shows efficacy in ITP but not AIHA. One main mechanism of action by which IVIg treatment leads to the reduction in platelet destruction rates in ITP is thought to involve Fcγ receptor (FcγR) blockade, ultimately leading to the inhibition of extravascular platelet phagocytosis. IVIg, which is manufactured from the human plasma of thousands of donors, is a limited resource, and alternative treatments, particularly those based on bioavailable small molecules, are needed. In this review, we overview the pathophysiology of ITP, the role of Fcγ receptors, and the mechanisms of action of IVIg in treating ITP, and outline the efforts and progress towards developing novel, first-in-class inhibitors of phagocytosis as synthetic, small molecule substitutes for IVIg in ITP and other conditions where the pathobiology of the disease involves phagocytosis.
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Affiliation(s)
- Anton Neschadim
- Centre for Innovation, Canadian Blood Services, Toronto, ON, Canada
| | - Lakshmi P Kotra
- Center for Molecular Design and Preformulations, University Health Network, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; McLaughlin Center for Molecular Medicine, University of Toronto, Toronto, ON, Canada; Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Donald R Branch
- Centre for Innovation, Canadian Blood Services, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Division of Advanced Diagnostics, Infection and Immunity Group, Toronto General Hospital Research Institute, Toronto, ON, Canada.
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147
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Are micromegakaryocytes specific for refractory cytopenia of childhood (RCC)? A study of 38 pediatric patients with thrombocytopenia unrelated to RCC. Leuk Res 2016; 47:84-7. [PMID: 27285854 DOI: 10.1016/j.leukres.2016.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 04/25/2016] [Accepted: 05/21/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Micromegakaryocytes (microMKs) are considered the most reliable dysplastic feature for myelodysplastic syndrome (MDS), particularly refractory cytopenia of childhood (RCC); there is no minimal threshold for the diagnosis of RCC. Since most RCC patients present with thrombocytopenia, the presence of microMKs should raise concern for MDS/RCC. This study attempted to investigate the prevalence of microMKs and associated marrow fibrosis in patients with thrombocytopenia unrelated to MDS/RCC and the need for establishing a threshold for microMKs for the diagnosis of MDS/RCC. DESIGN Bone marrow biopsies of pediatric patients with thrombocytopenia unrelated to RCC were examined for microMKs and fibrosis by CD61 immunohistochemical and reticulin stains respectively. RESULT Thirty eight patients (1-18 years old) were included: 33 immune thrombocytopenia (ITP), 3 chronic thrombocytopenia, and 2 inherited macrothrombocytopenia. Fourteen cases (37%) had microMKs; four cases showed increased marrow fibrosis associated with microMKs (two had ITP and two had macrothrombocytopenia). All patients are alive and none developed MDS (follow up: 3months to 4 years). CONCLUSION MicroMKs can be seen in pediatric patients with thrombocytopenia unrelated to RCC. Hence the mere presence of microMKs is insufficient for the diagnosis of RCC in the pediatric population, and a quantitative threshold needs to be established.
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148
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Neschadim A, Branch DR. Mouse Models for Immune-Mediated Platelet Destruction or Immune Thrombocytopenia (ITP). ACTA ACUST UNITED AC 2016; 113:15.30.1-15.30.13. [PMID: 27038460 DOI: 10.1002/0471142735.im1530s113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenia (ITP) is a debilitating, life-threatening autoimmune disorder affecting more than 4 in every 100,000 adults annually, stemming from the production of antiplatelet antibody resulting in accelerated platelet destruction and thrombocytopenia. Numerous animal models of ITP have been developed that contributed to the basic understanding of the underlying mechanisms of ITP onset, progression, and maintenance. Rodent models that develop ITP spontaneously, or by passive transfer of an antiplatelet sera or antibody, play an instrumental role in the investigation of ITP mechanisms responsible for the breakdown of tolerance in human ITP, in studies of the immunopathology underlying the progression of platelet destruction, and in elucidation of the mechanisms of therapeutic amelioration of ITP by existing and new therapeutic modalities. This unit captures the protocols for the implementation and readout of passive antibody transfer mouse models of ITP, established by the infusion of a commercially-available monoclonal rat anti-mouse CD41 platelet antibody.
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Affiliation(s)
- Anton Neschadim
- Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada
| | - Donald R Branch
- Centre for Innovation, Canadian Blood Services, Toronto, Ontario, Canada.,Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Division of Advanced Diagnostics, Infection and Immunity Group, Toronto General Research Institute, Toronto, Ontario, Canada
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149
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Lebreton L, Tuffigo M, Pillois X, Fiore M. [New perspectives on the role of αIIbβ3 integrin in defective megakaryopoiesis]. Med Sci (Paris) 2016; 32:290-6. [PMID: 27011248 DOI: 10.1051/medsci/20163203014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In recent years, the understanding of the molecular mechanisms involved in platelet production (megakaryopoiesis) has extremely increased, thanks to the study of genetic diseases causing inherited thrombocytopenia. Among the wide variety of transmembrane receptors covering the platelet membrane, αIIbβ3 integrin is the major one, allowing platelets to aggregate upon the occurrence of vascular breach. Platelet counts are usually normal in patients with αIIbβ3 deficiency, suggesting that its role for normal platelet production and morphology is very limited. However, recently, new clinical observations of genetic diseases provided evidence against this hypothesis, bringing new data on the role of αIIbβ3 integrin in defective megakaryopoiesis.
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Affiliation(s)
- Louis Lebreton
- Université Victor Segalen, 146, rue Léo Saignat, 33000, Bordeaux, France
| | - Marie Tuffigo
- Université Victor Segalen, 146, rue Léo Saignat, 33000, Bordeaux, France - Laboratoire d'hématologie, CHU de Bordeaux, avenue Magellan, 33604, Pessac, France
| | - Xavier Pillois
- Centre de référence des pathologies plaquettaires, avenue Magellan, 33604, Pessac, France
| | - Mathieu Fiore
- Laboratoire d'hématologie, CHU de Bordeaux, avenue Magellan, 33604, Pessac, France - Centre de référence des pathologies plaquettaires, avenue Magellan, 33604, Pessac, France
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Min YN, Wang CY, Li XX, Hou Y, Qiu JH, Ma J, Shao LL, Zhang X, Wang YW, Peng J, Hou M, Shi Y. Participation of B-cell-activating factor receptors in the pathogenesis of immune thrombocytopenia. J Thromb Haemost 2016; 14:559-71. [PMID: 26749059 DOI: 10.1111/jth.13246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/20/2015] [Indexed: 12/19/2022]
Abstract
UNLABELLED ESSENTIALS: Dysfunctional B-cell-activating factor (BAFF) system is related to many autoimmune diseases. The regulatory functions of BAFF/BAFF receptors were investigated in an in vitro coculture system. Different regulatory roles of BAFF were investigated via different receptors in immune thrombocytopenia. The upregulated BAFF receptors on autoreactive lymphocytes lead to their hypersensitivity to BAFF. SUMMARY BACKGROUND The pathogenesis of immune thrombocytopenia (ITP) remains enigmatic. B-cell-activating factor (BAFF) and its receptors (BAFF receptor [BAFF-R], transmembrane activator and calcium modulator and cyclophilin ligand interactor [TACI], and B-cell maturation antigen) play central roles in the integrated homeostatic regulation of lymphocytes. OBJECTIVES To investigate the pathologic roles of BAFF receptors in regulating the bioactivities of lymphocytes in ITP. METHODS An in vitro culture system was established by stimulating CD14(-) peripheral lymphocytes with platelet-preloaded dendritic cells in the presence of recombinant human BAFF (rhBAFF; 20 ng mL(-1)). The functions of BAFF receptors were specifically blocked with blocking antibodies. RESULTS BAFF-R, besides prolonging the survival of B cells in both patients and healthy controls, prominently promoted the survival of CD8(+) T cells and the proliferation of B cells in patients with ITP. TACI, as a positive regulator, not only promoted the proliferation of CD4(+) and CD8(+) T cells, but also significantly enhanced the secretion of interleukin-4 in patients with ITP, but not in controls. Besides revealing the pathologic roles of BAFF receptors, these results also indicate that lymphocytes of patients with ITP have enhanced antiapoptotic or proliferative capacity as compared with those from healthy controls when exposed under similar stimulation of rhBAFF. Further study demonstrated that activated autoreactive B cells and CD4(+) T cells from patients with ITP showed significantly higher expression of BAFF-R or TACI than those from healthy controls. CONCLUSIONS Both BAFF-R and TACI are pathogenic participants in ITP. Their dysregulated expression in patients with ITP may lead to hyperreactivity of activated autoreactive lymphocytes in response to rhBAFF, and thus is highly significant in the pathogenesis of ITP.
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Affiliation(s)
- Y-N Min
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - C-Y Wang
- Department of General Medicine, Second Hospital of Shandong University, Jinan, Shandong, China
| | - X-X Li
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Y Hou
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - J-H Qiu
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - J Ma
- Department of General Medicine, Medical Research Institute for Tumor Prevention and Cure, Shandong University, Jinan, Shandong, China
| | - L-L Shao
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - X Zhang
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Y-W Wang
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - J Peng
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, Shandong, China
| | - M Hou
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, Shandong, China
| | - Y Shi
- Hematology Oncology Center, Qilu Hospital, Shandong University, Jinan, Shandong, China
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