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Kosmidou A, Gavriilaki E, Tragiannidis A. The Challenge for a Correct Diagnosis of Refractory Thrombocytopenia: ITP or MDS with Isolated Thrombocytopenia? Cancers (Basel) 2024; 16:1462. [PMID: 38672544 PMCID: PMC11048195 DOI: 10.3390/cancers16081462] [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: 02/29/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Immune thrombocytopenia (ITP) is an autoimmune disease characterized by isolated thrombocytopenia. It is diagnosed in patients with a platelet count below 100,000 per cubic millimeter in whom other causes of thrombocytopenia have been ruled out, and its diagnosis is generally one of exclusion. Clinical manifestations of patients may vary from asymptomatic disease to mild mucocutaneous or life-threatening bleeding. Glucocorticoids are used as first-line treatment for ITP, while other second-line medications, mainly thrombopoietin-receptor agonists (TPO-RA) and rituximab, are given to patients in whom ITP does not remit, or relapses soon after glucocorticoid treatment. Refractoriness of ITP strongly questions its diagnosis and necessitates a thorough clinical and laboratory work-up to decide whether that is the case of refractory ITP or a misdiagnosis. The aim of this review is to summarize the conditions associated with isolated thrombocytopenia and highlight the characteristics of confusing cases. Even though the case of a myelodysplastic syndrome presented with isolated thrombocytopenia (MDS-IT) is relatively rare and not well-established in the literature, it constitutes one of the most predominant misdiagnoses of refractory ITP. MDS-IT patients are thought to present with multilineage dysplasia, normal karyotype and low risk prognostic score, based on IPSS-R. It has been shown that a significant proportion of MDS-IT patients are misdiagnosed as having the more common ITP. Therefore, it is crucial that in confusing cases of persistent thrombocytopenia a detailed diagnostic work-up is applied-including evaluation of peripheral-blood smear, bone marrow examination and cytogenetic testing-to avoid unnecessary therapy delay.
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Affiliation(s)
- Aikaterini Kosmidou
- 2nd Department of Internal Medicine, General Hospital of Kavala, 65500 Kavala, Greece
| | - Eleni Gavriilaki
- 2nd Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Athanasios Tragiannidis
- 2nd Department of Pediatrics, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
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Norris PAA, Tawhidi Z, Sachs UJ, Cserti-Gazdewich CM, Lin Y, Callum J, Gil Gonzalez L, Shan Y, Branch DR, Lazarus AH. Serum from half of patients with immune thrombocytopenia trigger macrophage phagocytosis of platelets. Blood Adv 2023; 7:3561-3572. [PMID: 37042934 PMCID: PMC10368862 DOI: 10.1182/bloodadvances.2022009423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/21/2023] [Accepted: 04/05/2023] [Indexed: 04/13/2023] Open
Abstract
Humoral antiplatelet factors, such as autoantibodies, are thought to primarily clear platelets by triggering macrophage phagocytosis in immune thrombocytopenia (ITP). However, there are few studies characterizing the capacity and mechanisms of humoral factor-triggered macrophage phagocytosis of platelets using specimens from patients with ITP. Here, we assessed sera from a cohort of 24 patients with ITP for the capacity to trigger macrophage phagocytosis of normal donor platelets and characterized the contribution of humoral factors to phagocytosis. Sera that produced a phagocytosis magnitude greater than a normal human serum mean + 2 standard deviations were considered phagocytosis-positive. Overall, 42% (8/19) of MHC I alloantibody-negative ITP sera were phagocytosis-positive. The indirect monoclonal antibody immobilization of platelet antigens assay was used to detect immunoglobulin G (IgG) autoantibodies to glycoproteins (GP)IIb/IIIa, GPIb/IX, and GPIa/IIa. Autoantibody-positive sera triggered a higher mean magnitude of phagocytosis than autoantibody-negative sera. Phagocytosis correlated inversely with platelet counts among autoantibody-positive patients but not among autoantibody-negative patients. Select phagocytosis-positive sera were separated into IgG-purified and -depleted fractions via protein G and reassessed for phagocytosis. Phagocytosis was largely retained in the purified IgG fractions. In addition, we assessed serum concentrations of C-reactive protein, serum amyloid P, and pentraxin 3 as potential phagocytosis modulators. Pentraxin 3 concentrations correlated inversely with platelet counts among patients positive for autoantibodies. Taken together, sera from approximately half of the patients with ITP studied triggered macrophage phagocytosis of platelets beyond a normal level. An important role for antiplatelet autoantibodies in phagocytosis is supported; a role for pentraxins such as pentraxin 3 may be suggested.
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Affiliation(s)
- Peter A. A. Norris
- Innovation and Portfolio Management, Canadian Blood Services, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada
| | - Zoya Tawhidi
- Innovation and Portfolio Management, Canadian Blood Services, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada
| | - Ulrich J. Sachs
- Institute for Clinical Immunology, Transfusion Medicine, and Haemostasis, Justus Liebig University, Giessen, Germany
- Department of Thrombosis and Haemostasis, Giessen University Hospital, Giessen, Germany
| | - Christine M. Cserti-Gazdewich
- Innovation and Portfolio Management, Canadian Blood Services, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, ON, Canada
| | - Yulia Lin
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, ON, Canada
- Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jeannie Callum
- Innovation and Portfolio Management, Canadian Blood Services, Toronto, ON, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, ON, Canada
- Department of Pathology and Molecular Medicine, Kingston Health Sciences Centre and Queen’s University, Kingston, ON, Canada
| | - Lazaro Gil Gonzalez
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada
| | - Yuexin Shan
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada
| | - Donald R. Branch
- Innovation and Portfolio Management, Canadian Blood Services, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Alan H. Lazarus
- Innovation and Portfolio Management, Canadian Blood Services, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON, Canada
- Toronto Platelet Immunobiology Group, Toronto, ON, Canada
- University of Toronto Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
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Anti-Glycoprotein Antibodies and Sequestration Pattern of Indium Labeled Platelets in Immune Thrombocytopenia. Blood Adv 2021; 6:1797-1803. [PMID: 34654052 PMCID: PMC8941471 DOI: 10.1182/bloodadvances.2021004822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/08/2021] [Indexed: 11/20/2022] Open
Abstract
Anti-GPV antibodies are associated with a splenic sequestration pattern in this cohort. In the presence of antibodies, platelet clearance rate was associated with splenic sequestration.
Antiglycoprotein (anti-GP) antibodies play an important role in the pathophysiology of immune thrombocytopenia (ITP). The sequestration pattern of platelets in the spleen and liver can be studied with 111In-labeled autologous platelet scans. No studies have investigated the role of anti-GP antibodies in sequestration patterns in ITP patients. In this study, we examined the association between antibodies and (1) platelet sequestration site and (2) clearance rate of platelets. All ITP patients receiving an 111In-labeled autologous platelet study between 2014 and 2018 were included. Antibodies were measured using the direct MAIPA method to determine the presence and titer of anti-GPIIb/IIIa, anti-GPIb/IX, and anti-GPV antibodies. Multivariate regression models were used to study the association between anti-GP antibodies, sequestration site, and clearance rate. Seventy-four patients were included, with a mean age of 36 years. Forty-seven percent of the patients showed a predominantly splenic sequestration pattern, 29% mixed, and 25% a hepatic pattern. In 53% of the patients, anti-GP antibodies were detected. Regression models showed a significant association between splenic sequestration and GPV autoantibodies. Furthermore, in patients where antibodies were present, the clearance rate was higher in patients with a splenic sequestration. Anti-GPV antibodies are associated with a splenic sequestration pattern in ITP patients. These associations provide insight into the possible pathophysiological mechanisms of ITP, which may lead to better detection and treatment of this partly idiopathic and prevalent disease.
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Tahiat A, Yagoubi A, Ladj MS, Belbouab R, Aggoune S, Atek L, Bouziane D, Melzi S, Boubidi C, Drali W, Bendahmane C, Iguerguesdaoune H, Taguemount S, Soufane A, Oukil A, Ketfi A, Messaoudi H, Boukhenfouf N, Ifri MA, Bencharif Madani T, Belhadj H, Benhala KN, Khiari M, Cherif N, Smati L, Arada Z, Zeroual Z, Bouzerar Z, Ibsaine O, Maouche H, Boukari R, Djenouhat K. Diagnostic and Predictive Contribution of Autoantibodies Screening in a Large Series of Patients With Primary Immunodeficiencies. Front Immunol 2021; 12:665322. [PMID: 33868317 PMCID: PMC8047634 DOI: 10.3389/fimmu.2021.665322] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate the diagnostic and predictive contribution of autoantibodies screening in patients with primary immunodeficiencies (PIDs). Methods In the present study, PID patients and healthy controls have been screened for 54 different autoantibodies. The results of autoantibodies screening in PID patients were correlated to the presence of autoimmune diseases. Results A total of 299 PID patients were included in this study with a predominance of antibody deficiencies (27.8%) followed by immunodeficiencies affecting cellular and humoral immunity (26.1%) and complement deficiencies (22.7%). Autoimmune manifestations were present in 82 (27.4%) patients. Autoimmune cytopenia (10.4%) was the most common autoimmune disease followed by gastrointestinal disorders (10.0%), rheumatologic diseases (3.7%), and endocrine disorders (3.3%). Autoantibodies were found in 32.4% of PID patients and 15.8% of healthy controls (P < 0.0005). Anti-nuclear antibodies (ANA) (10.0%), transglutaminase antibody (TGA) (8.4%), RBC antibodies (6.7%), anti-smooth muscle antibody (ASMA) (5.4%), and ASCA (5.0%) were the most common autoantibodies in our series. Sixty-seven out of the 82 patients with autoimmune manifestations (81.7%) were positive for one or more autoantibodies. Eleven out of the 14 patients (78.6%) with immune thrombocytopenia had positive platelet-bound IgM. The frequencies of ASCA and ANCA among patients with IBD were 47.4% and 21.0% respectively. All patients with celiac disease had TGA-IgA, while six out of the 11 patients with rheumatologic diseases had ANA (54.5%). Almost one third of patients (30/97) with positive autoantibodies had no autoimmune manifestations. ANA, rheumatoid factor, ASMA, anti-phospholipid antibodies and ANCA were often detected while specific AID was absent. Despite the low positive predictive value of TGA-IgA and ASCA for celiac disease and inflammatory bowel disease respectively, screening for these antibodies identified undiagnosed disease in four patients with positive TGA-IgA and two others with positive ASCA. Conclusion The present study provides valuable information about the frequency and the diagnostic/predictive value of a large panel of autoantibodies in PIDs. Given the frequent association of some AIDs with certain PIDs, screening for corresponding autoantibodies would be recommended. However, positivity for autoantibodies should be interpreted with caution in patients with PIDs due to their low positive predictive value.
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Affiliation(s)
- Azzeddine Tahiat
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Abdelghani Yagoubi
- Pediatric Gastroenterology, Centre Algérois de Pédiatrie, Algiers, Algeria
| | - Mohamed Samir Ladj
- Department of Pediatrics, Mustapha University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Reda Belbouab
- Department of Pediatrics, Mustapha University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Samira Aggoune
- Department of Pediatrics, El-Harrach Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Laziz Atek
- Department of Pediatrics, El-Harrach Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Djamila Bouziane
- Department of Pediatrics, Ain Taya Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Souhila Melzi
- Department of Pediatrics, Bab El-Oued University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Chahinez Boubidi
- Department of Pediatrics A, Hussein Dey University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Warda Drali
- Department of Pediatrics B, Hussein Dey University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | | | - Hamza Iguerguesdaoune
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Sihem Taguemount
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Asma Soufane
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Asma Oukil
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Abdalbasset Ketfi
- Department of Pneumology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Hassen Messaoudi
- Department of Internal Medicine, Mustapha University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | | | | | | | - Hayet Belhadj
- Department of Pediatrics, Central Hospital of the Army, Algiers, Algeria
| | - Keltoum Nafissa Benhala
- Department of Pediatrics A, Beni Messous University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Mokhtar Khiari
- Department of Pediatrics A, Beni Messous University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Nacera Cherif
- Department of Pediatrics B, Beni Messous University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Leila Smati
- Department of Pediatrics, Bologhine Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Zakia Arada
- Department of Pediatrics B, Hussein Dey University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Zoulikha Zeroual
- Department of Pediatrics A, Hussein Dey University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Zair Bouzerar
- Department of Pediatrics, Bab El-Oued University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Ouardia Ibsaine
- Department of Pediatrics, Ain Taya Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Hachemi Maouche
- Department of Pediatrics, El-Harrach Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Rachida Boukari
- Department of Pediatrics, Mustapha University Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
| | - Kamel Djenouhat
- Department of Medical Biology, Rouiba Hospital, Algiers Faculty of Medicine, University of Algiers 1, Algiers, Algeria
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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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Abstract
OBJECTIVES Classically, immune thrombocytopenia (ITP) was thought to be caused by the destruction and insufficient production of platelets, as mediated by autoantibodies. More recently other immune mechanisms that contribute to the disease have been discovered. This review attempts to address the main unresolved questions in ITP. METHODS We review the most current knowledge of the pathophysiology of ITP. Immunological effects of available therapies are also described. DISCUSSION The trigger may be a loss of tolerance due to molecular mimicry with cross-reaction of antibodies arising from infectious agents or drugs, genetic factors, and/or platelet Toll receptors. This loss of tolerance activates autoreactive effector B and T lymphocytes, which in turn initiates platelet destruction, mediated by cytotoxic T lymphocytes and the release of pro-inflammatory cytokines (IL-2/IL-17) by T helper (Th) cells (Th1/Th17). Th2 (anti-inflammatory) and regulatory B (Breg) and Treg cells are also inhibited (with decrease in IL-10/TGF-β), which leads to the disease becoming chronic. Some isotypes of autoantibodies may increase the bleeding risk. Corticosteroids, rituximab, and thrombopoietin receptor agonists (A-TPOs) all increase levels of Tregs and TGF-β. The A-TPOs also increase Breg levels, which could explain why complete remission has been seen in some cases. CONCLUSION A better understanding of the immunomodulatory effects of each ITP therapy is needed to best manage the disease.
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Affiliation(s)
- María Perera
- a Haematology Service , University Hospital Doctor Negrín , Las Palmas de Gran Canaria, Spain
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Xu J, Zhao L, Zhang Y, Guo Q, Chen H. CD16 and CD32 Gene Polymorphisms May Contribute to Risk of Idiopathic Thrombocytopenic Purpura. Med Sci Monit 2016; 22:2086-96. [PMID: 27315784 PMCID: PMC4915321 DOI: 10.12659/msm.895390] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Epidemiological studies have evaluated the associations of CD16 158F>V and CD32 131H>R gene polymorphisms with the risk of idiopathic thrombocytopenic purpura (ITP). MATERIAL AND METHODS Published studies on CD16 158F>V and CD32 131H>R polymorphisms with susceptibility to ITP were systematically reviewed until April 1, 2014. The Cochrane Library Database, Medline, CINAHL, EMBASE, Web of Science, and Chinese Biomedical Database (CBM) were used to search for relevant studies and then a meta-analysis was conducted by using Stata 12.0 software in order to produce consistent statistical results. RESULTS In total, 10 clinical case-control studies with 741 ITP patients and 1092 healthy controls were enrolled for quantitative data analysis. Results of this meta-analysis suggest that CD16 158F>V polymorphism had strong correlations with the susceptibility to ITP under 5 genetic models (all P<0.05). However, no similar associations were found between CD32 131H>R polymorphism and the susceptibility to ITP (all P>0.05). Subgroup analysis by ethnicity revealed that CD16 158F>V polymorphism was associated with the increased risk of ITP among both Caucasian and non-Caucasian populations. Nevertheless, no statistically significant correlations between CD32 131H>R polymorphism and the risk of ITP were observed among Caucasians and non-Caucasians (all P>0.05). CONCLUSIONS Our findings indicate that CD16 158F>V polymorphism may contribute to the increased risk of ITP, whereas CD32 131H>R polymorphism may not be an important risk factor for ITP.
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Affiliation(s)
- Jiannan Xu
- Department of Cardiology, Yanjiao People's Hospital, Sanhe, Hebei, China (mainland)
| | - Liyun Zhao
- Department of Hematology, Xingtai People's Hospital, Xingtai, Hebei, China (mainland)
| | - Yan Zhang
- Department of Ophthalmology, The Military General Hospital of Beijing PLA, Beijing, China (mainland)
| | - Qingxu Guo
- Department of Vascular Surgery, The Military General Hospital of Beijing PLA, Beijing, China (mainland)
| | - Hui Chen
- Department of Hematology, The Military General Hospital of Beijing PLA, Beijing, China (mainland)
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Legrain S, Su D, Breukel C, Detalle L, Claassens JW, van der Kaa J, Izui S, Verbeek JS, Coutelier JP. Involvement of Fcα/μ Receptor in IgM Anti-Platelet, but Not Anti-Red Blood Cell Autoantibody Pathogenicity in Mice. THE JOURNAL OF IMMUNOLOGY 2015; 195:4171-5. [PMID: 26385523 DOI: 10.4049/jimmunol.1500798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 08/24/2015] [Indexed: 11/19/2022]
Abstract
IgM anti-mouse platelet autoantibodies cause thrombocytopenia by mediating uptake of opsonized thrombocytes, whereas IgM anti-erythrocyte autoantibodies induce anemia through a phagocytosis-independent cell destruction. In this article, we show that infection with lactate dehydrogenase-elevating virus, a benign mouse arterivirus, exacerbates the pathogenicity of IgM anti-platelet, but not anti-erythrocyte autoantibodies. To define the role of Fcα/μ receptor (Fcα/μR) in IgM-mediated thrombocytopenia and anemia, we generated mice deficient for this receptor. These animals were resistant to IgM autoantibody-mediated thrombocytopenia, but not anemia. However, the lactate dehydrogenase-elevating virus-induced exacerbation of thrombocytopenia was not associated with enhanced Fcα/μR expression on macrophages. These results indicate that Fcα/μR is required for the pathogenicity of IgM anti-platelet autoantibodies but is not sufficient to explain the full extent of the disease in virally infected animals.
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Affiliation(s)
- Sarah Legrain
- Unité de Médecine Experimentale, Institut de Pathologie Cellulaire, Université Catholique de Louvain, 1200 Bruxelles, Belgium
| | - Dan Su
- Unité de Médecine Experimentale, Institut de Pathologie Cellulaire, Université Catholique de Louvain, 1200 Bruxelles, Belgium
| | - Cor Breukel
- Department of Human Genetics, Leiden University Medical Center, 2333 Leiden, the Netherlands; and
| | - Laurent Detalle
- Unité de Médecine Experimentale, Institut de Pathologie Cellulaire, Université Catholique de Louvain, 1200 Bruxelles, Belgium
| | - Jill W Claassens
- Department of Human Genetics, Leiden University Medical Center, 2333 Leiden, the Netherlands; and
| | - Jos van der Kaa
- Department of Human Genetics, Leiden University Medical Center, 2333 Leiden, the Netherlands; and
| | - Shozo Izui
- Department of Pathology and Immunology, University Medical Center, University of Geneva, 1211 Geneva 4, Switzerland
| | - J Sjef Verbeek
- Department of Human Genetics, Leiden University Medical Center, 2333 Leiden, the Netherlands; and
| | - Jean-Paul Coutelier
- Unité de Médecine Experimentale, Institut de Pathologie Cellulaire, Université Catholique de Louvain, 1200 Bruxelles, Belgium;
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Zhang XM, Shan NN. The role of T cell immunoglobulin and mucin domain-3 in immune thrombocytopenia. Scand J Immunol 2014; 79:231-6. [PMID: 24383985 DOI: 10.1111/sji.12153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/09/2013] [Indexed: 12/16/2022]
Abstract
T cell immunoglobulin and mucin domain-3 (TIM-3), originally identified as a T helper (Th) 1-specific type I membrane protein, plays a vital role in Th1 immunity and tolerance induction through interaction with its ligand, galectin-9. The binding of TIM-3 by galectin-9 serves to downregulate Th1 responses. Moreover, the regulatory function of TIM-3 has been extended to other cells, such as Th17 cells, CD4(+) CD25(+) regulatory T cells (Tregs), CD8(+) T cells and certain innate immune cells. Previous studies have acknowledged that the TIM-3 pathway is involved in the pathogenesis of several human autoimmune diseases, such as systemic lupus erythematous, rheumatoid arthritis and aplastic anaemia. Moreover, genetic data suggest a role for TIM-3 in human autoimmune diseases. However, in immune thrombocytopenia (ITP), a common Th1- and possibly Th17-biased autoimmune disorder, the role of TIM-3 has not been explored. Recently, our data have demonstrated that TIM-3 expression is reduced in ITP patients, and we have found a potential link between ITP and the TIM-3 pathway. In this article, we discuss and speculate on the role of the TIM-3 pathway in ITP.
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Affiliation(s)
- X-M Zhang
- Department of Hematology, Shandong provincial Hospital affiliated to Shandong University, Jinan, China
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10
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Abstract
Primary immune thrombocytopenia (ITP) is one of the most common bleeding disorders of childhood. In most cases, it presents with sudden widespread bruising and petechiae in an otherwise well child. Thought to be mainly a disorder of antibody-mediated platelet destruction, ITP can be self-limited or develop into a chronic condition. In this review, we discuss current concepts of the pathophysiology and treatment approaches to pediatric ITP.
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