1
|
Åkesson A, Bussel JB, Martin M, Blom AM, Klintman J, Ghanima W, Zetterberg E, Garabet L. Complement activation negatively affects the platelet response to thrombopoietin receptor agonists in patients with immune thrombocytopenia: a prospective cohort study. Platelets 2023; 34:2159019. [PMID: 36636835 DOI: 10.1080/09537104.2022.2159019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Increased platelet destruction is central in the pathogenesis of immune thrombocytopenia. However, impaired platelet production is also relevant and its significance underlies the rationale for treatment with thrombopoietin receptor agonists (TPO-RAs). Previous studies have associated enhanced complement activation with increased disease severity. Additionally, treatment refractoriness has been demonstrated to resolve by the administration of complement-targeted therapeutics in a subset of patients. The association between complement activation and the platelet response to TPO-RA therapy has previously not been investigated. In this study, blood samples from patients with immune thrombocytopenia (n = 15) were prospectively collected before and two, six and 12 weeks after the initiation of TPO-RA therapy. Plasma levels of complement degradation product C4d and soluble terminal complement complexes were assessed. Patients with significantly elevated baseline levels of terminal complement complexes exhibited more often an inadequate platelet response (p = .04), were exclusively subjected to rescue therapy with intravenous immunoglobulin (p = .02), and did not respond with a significant platelet count increase during the study period. C4d showed a significant (p = .01) ability to distinguish samples with significant terminal complement activation, implying engagement of the classical complement pathway. In conclusion, elevated levels of complement biomarkers were associated with a worse TPO-RA treatment response. Larger studies are needed to confirm these results. Biomarkers of complement activation may prove valuable as a prognostic tool to predict which patients that potentially could benefit from complement-inhibiting therapy in the future.
Collapse
Affiliation(s)
- Alexander Åkesson
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - James B Bussel
- New York Presbyterian Hospital, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Myriam Martin
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Anna M Blom
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jenny Klintman
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Waleed Ghanima
- Center for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway
| | - Eva Zetterberg
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Lamya Garabet
- Center for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway.,Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
2
|
Bussel JB, Soff G, Balduzzi A, Cooper N, Lawrence T, Semple JW. A Review of Romiplostim Mechanism of Action and Clinical Applicability. Drug Des Devel Ther 2021; 15:2243-2268. [PMID: 34079225 PMCID: PMC8165097 DOI: 10.2147/dddt.s299591] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
Thrombocytopenia results from a variety of conditions, including radiation, chemotherapy, autoimmune disease, bone marrow disorders, pathologic conditions associated with surgical procedures, hematopoietic stem cell transplant (HSCT), and hematologic disorders associated with severe aplastic anemia. Immune thrombocytopenia (ITP) is caused by immune reactions that accelerate destruction and reduce production of platelets. Thrombopoietin (TPO) is a critical component of platelet production pathways, and TPO receptor agonists (TPO-RAs) are important for the management of ITP by increasing platelet production and reducing the need for other treatments. Romiplostim is a TPO-RA approved for use in patients with ITP in the United States, European Union, Australia, and several countries in Africa and Asia, as well as for use in patients with refractory aplastic anemia in Japan and Korea. Romiplostim binds to and activates the TPO receptor on megakaryocyte precursors, thus promoting cell proliferation and viability, resulting in increased platelet production. Through this mechanism, romiplostim reduces the need for other treatments and decreases bleeding events in patients with thrombocytopenia. In addition to its efficacy in ITP, studies have shown that romiplostim is effective in improving platelet counts in various settings, thereby highlighting the versatility of romiplostim. The efficacy of romiplostim in such disorders is currently under investigation. Here, we review the structure, mechanism, pharmacokinetics, and pharmacodynamics of romiplostim. We also summarize the clinical evidence supporting its use in ITP and other disorders that involve thrombocytopenia, including chemotherapy-induced thrombocytopenia, aplastic anemia, acute radiation syndrome, perisurgical thrombocytopenia, post-HSCT thrombocytopenia, and liver disease.
Collapse
Affiliation(s)
- James B Bussel
- Department of Pediatrics, Division of Hematology, Weill Cornell Medicine, New York, NY, USA
| | - Gerald Soff
- Department of Medicine, Hematology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Adriana Balduzzi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Ospedale San Gerardo, Monza, Italy
| | | | | | - John W Semple
- Division of Hematology and Transfusion Medicine, Lund University, Lund, Sweden
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Indirect detection of anti-platelet antibodies in immune thrombocytopenia. Pathology 2021; 53:759-762. [PMID: 33838923 DOI: 10.1016/j.pathol.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/12/2020] [Accepted: 12/23/2020] [Indexed: 01/03/2023]
Abstract
Despite recent advances in the understanding and treatment of immune thrombocytopenia (ITP), its diagnosis remains clinical due to the lack of sensitive laboratory tests. The detection of anti-platelet antibodies (APA) in plasma, although highly specific, is notoriously insensitive. Specialised clinical platelet laboratories routinely perform a screening test of only one dilution for indirect APA testing by flow cytometry. We evaluated the presence of APA using several dilutions of plasma from 61 ITP patients. Herein, we report that serial dilutions can improve the diagnostic value of indirect APA assay for ITP. We show that performing just two dilutions (1:2 and 1:25) would capture over 90% of patients with detectable plasma APA. This method enables indirect testing to become a valuable tool to be incorporated into the management algorithm for ITP.
Collapse
|
4
|
He C, Zhao L, Nie Y, Yan R, Zhou K, Li X, Zhou B, Dai K. A novel method to detect autoantibodies against platelets in patients with immune thrombocytopenia. Clin Chim Acta 2020; 511:90-93. [PMID: 33031805 DOI: 10.1016/j.cca.2020.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES To examine anti-platelet autoantibodies in patients with immune thrombocytopenia (ITP) not only provides solid evidence for diagnosis, and also helps to select an individualized strategy for the treatment. The aim of this study is to develop a novel cell-based assay to detect autoantibodies in ITP patients. METHODS/PATIENTS The DNA sequences of human platelet membrane protein GPIbα, GPIbβ, GP IX, GPIIb and GPIIIa subunits were obtained from NCBI database and synthesized. The synthetic fragments were ligated into pcDNA 3.3 and constructed the recombinant plasmids and transfected into Chinese hamster ovary (CHO) cells to establish cell lines stable expressing GPIb-IX and/or GPIIb/IIIa complexes. One hundred and two ITP patients with different anti-platelet autoantibodies, 57 patients with other kinds of autoimmune diseases and 104 healthy control were selected to examine sensitivity, specificity and accuracy of this method. RESULTS CHO cells stable expressing GPIb-IX and/or GPIIb/IIIa proteins were established. The cells were fixed with 4% paraformaldehyde and stored at -80 ℃, more than 80% of the cells were still expressed target proteins after 180 days of storage. The concentrations of target antibody from 0.1 to 100 μg/ml were detectable by this method, and 10-50 μg/ml antibody binding to the CHO cells yielded higher distinguishable fluorescent intensities. Inter-assay and intra-assay coefficients of variation and receiver operating characteristic curve analysis showed that this method had relatively higher reproducibility and specificity. Compared with Flow Cytometric Immunobead Array, this method has relatively higher specificity (95.2%) and accuracy (90.8%) in detection of 102 ITP patients. CONCLUSION A novel cell-based assay to detect autoantibodies in ITP patients is established, which appears to be a promising method to diagnose ITP.
Collapse
Affiliation(s)
- Chunyan He
- Jiangsu Institute of Hematology, Cyrus Tang Medical Institute, The First Affiliated Hospital and Collaborative Innovation Center of Hematology, Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, China; Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lian Zhao
- Jiangsu Institute of Hematology, Cyrus Tang Medical Institute, The First Affiliated Hospital and Collaborative Innovation Center of Hematology, Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, China
| | - Yumei Nie
- Jiangsu Institute of Hematology, Cyrus Tang Medical Institute, The First Affiliated Hospital and Collaborative Innovation Center of Hematology, Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, China
| | - Rong Yan
- Jiangsu Institute of Hematology, Cyrus Tang Medical Institute, The First Affiliated Hospital and Collaborative Innovation Center of Hematology, Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, China
| | - Kangxi Zhou
- Jiangsu Institute of Hematology, Cyrus Tang Medical Institute, The First Affiliated Hospital and Collaborative Innovation Center of Hematology, Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, China
| | - Xiaodong Li
- Jiangsu Institute of Hematology, Cyrus Tang Medical Institute, The First Affiliated Hospital and Collaborative Innovation Center of Hematology, Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, China
| | - Birong Zhou
- Jiangsu Institute of Hematology, Cyrus Tang Medical Institute, The First Affiliated Hospital and Collaborative Innovation Center of Hematology, Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, China
| | - Kesheng Dai
- Jiangsu Institute of Hematology, Cyrus Tang Medical Institute, The First Affiliated Hospital and Collaborative Innovation Center of Hematology, Soochow University, Key Laboratory of Thrombosis and Hemostasis, Ministry of Health, Suzhou 215006, China.
| |
Collapse
|
5
|
Duan S, Wang M, Ding S, Chen Y, Wei S, Chen W, Zhang C, Li Y, Wang H. Application of lyophilised human platelets for antibody detection in solid phase red cell adherence assay. J Immunol Methods 2020; 487:112868. [PMID: 32941887 DOI: 10.1016/j.jim.2020.112868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/27/2020] [Accepted: 09/10/2020] [Indexed: 11/27/2022]
Abstract
Antibodies against human platelets cause a variety of thrombocytopenic disorders, which lead to potentially fatal haemorrhage. Therefore, their prompt detection is mandatory for successful patient treatment. Solid phase red cell adherence (SPRCA) assay allows for platelet antibody detection widely. However, preparation of fresh platelets with HLA-I and human platelet antigens (HPA)1-5,15 genotyped as target cells is inconvenient and fresh platelets have a short shelf life. In this study, the lyophilised human platelets for antibody detection in SPRCA were prepared. Firstly, platelets were resuspended in lyophilisation buffer and freeze-dried. Then the characteristics of lyophilised platelet were analysed. Rehydrated platelets were recovered with a mean rate of 80.91% ± 2.87%, and still retained spherical morphology. Indirect flow cytometry showed that glycoproteins IIb/IIIa, Ia/IIa, Ib/IX, IV, CD109, and HLA class I were present on the surface of the lyophilised platelets at a comparable level to that of fresh platelets. The consistent results obtained with WHO reference reagents containing anti-HPA-1a, anti-HPA-3a, and anti-HPA-5b, as well as clinical samples from the same donors containing anti-HLA antibodies when reacting with lyophilised versus fresh platelets confirmed good antigenicity preservation of platelets after freeze-drying. Further investigation showed that the lyophilised platelets could be stored at 2-8 °C for up to 14 months and the reconstituted suspension was stable for 48 h. Therefore, lyophilised platelets can be a convenient alternative to fresh platelets to use for anti-platelet antibody detection in SPRCA tests.
Collapse
Affiliation(s)
- Shengbao Duan
- Suzhou Institute of Biomedical Engineering and Technology (SIBET), Chinese Academy of Sciences (CAS), Suzhou, PR China; University of Chinese Academy of Sciences, Beijing, PR China
| | | | - Shaohua Ding
- Suzhou Institute of Biomedical Engineering and Technology (SIBET), Chinese Academy of Sciences (CAS), Suzhou, PR China
| | - Yezhou Chen
- Suzhou Institute of Biomedical Engineering and Technology (SIBET), Chinese Academy of Sciences (CAS), Suzhou, PR China
| | - Shuangshi Wei
- Suzhou Institute of Biomedical Engineering and Technology (SIBET), Chinese Academy of Sciences (CAS), Suzhou, PR China
| | - Wei Chen
- Suzhou Blood Center, Suzhou, PR China
| | - Chun Zhang
- Suzhou Institute of Biomedical Engineering and Technology (SIBET), Chinese Academy of Sciences (CAS), Suzhou, PR China
| | - Yong Li
- Suzhou Institute of Biomedical Engineering and Technology (SIBET), Chinese Academy of Sciences (CAS), Suzhou, PR China
| | - Hongmei Wang
- Suzhou Institute of Biomedical Engineering and Technology (SIBET), Chinese Academy of Sciences (CAS), Suzhou, PR China.
| |
Collapse
|