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Kikili Cİ, Kivanç D, Ortaboz D, Şentürk Çiftçi H, Özbalak MM, Yenerel MN, Nalçaci M, Ar MC, Oğuz FS, Beşişik SK. Identification of HLA alleles involved in immune thrombotic thrombocytopenic purpura patients from Turkey. Blood Coagul Fibrinolysis 2024; 35:307-315. [PMID: 39083057 DOI: 10.1097/mbc.0000000000001318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is one of the rare group disorders classified as thrombotic microangiopathies (TMAs). Approximately 90% of TTP developed immune-mediation by the formation of antibodies against the enzyme ADAMTS-13. The exact cause is unknown. To establish an association between human leukocyte antigen (HLA) and autoimmune basis, as susceptibility or protection against the disease, we contributed a study aiming to evaluate the role of HLA in immune-mediated TTP (iTTP). Considering epidemiological factors such as age, sex, ethnicity, and geographical origins, we contributed the study in our country, Turkey, which consist of a very heterogeneous population. Patients' data collection was retrospectively from electronic database on two University hospitals having big therapeutic apheresis service. Control arm was healthy people registered as stem cell donors matched in terms of age and sex. The frequency of HLA-DRB1 and HLA-DQB1 alleles between acquired TTP and the control group was compared using the chi-square method. Yates correction and logistic regression were performed on these results. A total of 75 iTTP patients and 150 healthy individuals enrolled to the study. HLA-DRB1∗11, HLA-DQB1∗03, HLA-DRB1∗11:01, HLA-DRB1∗14:01, HLA-DRB1∗13:05, HLA-DRB1∗11 + HLA-DQB1∗03 allele pair and HLA-DRB1∗15 + HLA- DQB1∗06 were proved to be susceptibility allele pairs for iTTP. HLA-DRB1∗15, HLA-DRB1∗01:01, HLA-DRB1∗07:01, HLA-DRB1∗13:01, HLA-DRB1∗14:54, HLA-DQB1∗05:01, HLA-DQB1∗02:02 and HLA-DRB1∗07 + HLA-DQB1∗02 allele pair were found to be protective against iTTP. Our findings support an association with iTTP across very heterogenous populations in Turkey.
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Affiliation(s)
| | - Demet Kivanç
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University
| | - Damla Ortaboz
- Department of Adult Hematology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa
| | | | - Mustafa Murat Özbalak
- Department of Adult Hematology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Nuri Yenerel
- Department of Adult Hematology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Meliha Nalçaci
- Department of Adult Hematology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muhlis Cem Ar
- Department of Adult Hematology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa
| | - Fatma Savran Oğuz
- Department of Medical Biology, Istanbul Faculty of Medicine, Istanbul University
| | - Sevgi Kalayoğlu Beşişik
- Department of Adult Hematology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Wang X, Hao XJ, Dai CG, Ding YJ, Xiong L, Deng J, Jiang JJ. Identification of 8 Rare Deleterious Variants in ADAMTS13 by Next-generation Sequencing in a Chinese Population with Thrombotic Thrombocytopenic Purpura. Curr Med Sci 2023; 43:1043-1050. [PMID: 37815743 DOI: 10.1007/s11596-023-2793-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/30/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Thrombotic thrombocytopenic purpura (TTP) is a rare and fatal disease caused by a severe deficiency in the metalloprotease ADAMTS13 and is characterized by thrombotic microangiopathy. The present study aimed to investigate the genes and variants associated with TTP in a Chinese population. METHODS Target sequencing was performed on 220 genes related to complements, coagulation factors, platelets, fibrinolytic, endothelial, inflammatory, and anticoagulation systems in 207 TTP patients and 574 controls. Subsequently, logistic regression analysis was carried out to identify the TTP-associated genes based on the counts of rare deleterious variants in the region of a certain gene. Moreover, the associations between common variants and TTP were also investigated. RESULTS ADAMTS13 was the only TTP-associated gene (OR = 3.77; 95% CI: 1.82-7.81; P=3.6×10ȡ4) containing rare deleterious variants in TTP patients. Among these 8 variants, 5 novel rare variants that might contribute to TTP were identified, including rs200594025, rs782492477, c.T1928G (p.I643S), c.3336_3361del (p.Q1114Afs*20), and c.3469_3470del (p.A1158Sfs*17). No common variants associated with TTP were identified under the stringent criteria of correction for multiple testing. CONCLUSION ADAMTS13 is the primary gene related to TTP. The genetic variants associated with the occurrence of TTP were slightly different between the Chinese and European populations.
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Affiliation(s)
- Xiao Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xing-Jie Hao
- Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Cheng-Guqiu Dai
- Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ya-Jie Ding
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lv Xiong
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jun Deng
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Jing-Jing Jiang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Stubbs MJ, Coppo P, Cheshire C, Veyradier A, Dufek S, Levine AP, Thomas M, Patel V, Connolly JO, Hubank M, Benhamou Y, Galicier L, Poullin P, Kleta R, Gale DP, Stanescu H, Scully MA. Identification of a novel genetic locus associated with immune mediated thrombotic thrombocytopenic purpura. Haematologica 2021; 107:574-582. [PMID: 33596643 PMCID: PMC8883548 DOI: 10.3324/haematol.2020.274639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
Immune thrombotic thrombocytopenic purpura (iTTP) is an ultra-rare, life-threatening disorder, mediated through severe ADAMTS13 deficiency causing multi-system micro-thrombi formation, and has specific human leukocyte antigen associations. We undertook a large genome-wide association study to investigate additional genetically distinct associations in iTTP. We compared two iTTP patient cohorts with controls, following standardized genome-wide quality control procedures for single-nucleotide polymorphisms and imputed HLA types. Associations were functionally investigated using expression quantitative trait loci (eQTL), and motif binding prediction software. Independent associations consistent with previous findings in iTTP were detected at the HLA locus and in addition a novel association was detected on chromosome 3 (rs9884090, P=5.22x10-10, odds ratio 0.40) in the UK discovery cohort. Meta-analysis, including the French replication cohort, strengthened the associations. The haploblock containing rs9884090 is associated with reduced protein O-glycosyltransferase 1 (POGLUT1) expression (eQTL P<0.05), and functional annotation suggested a potential causative variant (rs71767581). This work implicates POGLUT1 in iTTP pathophysiology and suggests altered post-translational modification of its targets may influence disease susceptibility.
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Affiliation(s)
- Matthew J Stubbs
- Haemostasis Research Unit, UCL (London, UK); Department of Renal Medicine.
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine (Paris, France)
| | | | - Agnès Veyradier
- Department d'Hematologie, Centre de Référence des Microangiopathies Thrombotiques, Hôpital Lariboisière (Paris, France)
| | | | | | - Mari Thomas
- Haemostasis Research Unit, UCL (London, UK); National Institute for Health Research Cardiometabolic Programme, UCLH/UCL Cardiovascular BRC (London, UK)
| | | | | | | | - Ygal Benhamou
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine (Paris, France)
| | - Lionel Galicier
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine (Paris, France)
| | - Pascale Poullin
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine (Paris, France)
| | | | | | | | - Marie A Scully
- Haemostasis Research Unit, UCL (London, UK); National Institute for Health Research Cardiometabolic Programme, UCLH/UCL Cardiovascular BRC (London, UK)
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Mancini I, Giacomini E, Pontiggia S, Artoni A, Ferrari B, Pappalardo E, Gualtierotti R, Trisolini SM, Capria S, Facchini L, Codeluppi K, Rinaldi E, Pastore D, Campus S, Caria C, Caddori A, Nicolosi D, Giuffrida G, Agostini V, Roncarati U, Mannarella C, Fragasso A, Podda GM, Birocchi S, Cerbone AM, Tufano A, Menna G, Pizzuti M, Ronchi M, De Fanti A, Amarri S, Defina M, Bocchia M, Cerù S, Gattillo S, Rosendaal FR, Peyvandi F. The HLA Variant rs6903608 Is Associated with Disease Onset and Relapse of Immune-Mediated Thrombotic Thrombocytopenic Purpura in Caucasians. J Clin Med 2020; 9:jcm9103379. [PMID: 33096882 PMCID: PMC7589625 DOI: 10.3390/jcm9103379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/11/2020] [Accepted: 10/15/2020] [Indexed: 12/26/2022] Open
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy caused by severe ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin motifs 13) deficiency, recurring in 30–50% of patients. The common human leukocyte antigen (HLA) variant rs6903608 was found to be associated with prevalent iTTP, but whether this variant is associated with disease relapse is unknown. To estimate the impact of rs6903608 on iTTP onset and relapse, we performed a case-control and cohort study in 161 Italian patients with a first iTTP episode between 2002 and 2018, and in 456 Italian controls. Variation in rs6903608 was strongly associated with iTTP onset (homozygotes odds ratio (OR) 4.68 (95% confidence interval (CI) 2.67 to 8.23); heterozygotes OR 1.64 (95%CI 0.95 to 2.83)), which occurred over three years earlier for each extra risk allele (β −3.34, 95%CI −6.69 to 0.02). Of 153 survivors (median follow-up 4.9 years (95%CI 3.7 to 6.1)), 44 (29%) relapsed. The risk allele homozygotes had a 46% (95%CI 36 to 57%) absolute risk of relapse by year 6, which was significantly higher than both heterozygotes (22% (95%CI 16 to 29%)) and reference allele homozygotes (30% (95%CI 23 to 39%)). In conclusion, HLA variant rs6903608 is a risk factor for both iTTP onset and relapse. This newly identified biomarker may help with recognizing patients at high risk of relapse, who would benefit from close monitoring or intensified immunosuppressive therapy.
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Affiliation(s)
- Ilaria Mancini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
| | - Elisa Giacomini
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
| | - Silvia Pontiggia
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Andrea Artoni
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Barbara Ferrari
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Emanuela Pappalardo
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
| | - Roberta Gualtierotti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
| | - Silvia Maria Trisolini
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (S.M.T.); (S.C.)
| | - Saveria Capria
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (S.M.T.); (S.C.)
| | - Luca Facchini
- Hematology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.F.); (K.C.)
| | - Katia Codeluppi
- Hematology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (L.F.); (K.C.)
| | - Erminia Rinaldi
- Hematology Unit, A. Perrino Hospital, 72100 Brindisi, Italy; (E.R.); (D.P.)
| | - Domenico Pastore
- Hematology Unit, A. Perrino Hospital, 72100 Brindisi, Italy; (E.R.); (D.P.)
| | - Simona Campus
- Pediatric Unit, Ospedale Microcitemico, 09121 Cagliari, Italy;
| | - Cinzia Caria
- Internal Medicine Unit, S.S. Trinità Hospital, 09121 Cagliari, Italy; (C.C.); (A.C.)
| | - Aldo Caddori
- Internal Medicine Unit, S.S. Trinità Hospital, 09121 Cagliari, Italy; (C.C.); (A.C.)
| | - Daniela Nicolosi
- Hematology Division, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy; (D.N.); (G.G.)
| | - Gaetano Giuffrida
- Hematology Division, Department of Clinical and Molecular Biomedicine, University of Catania, 95123 Catania, Italy; (D.N.); (G.G.)
| | - Vanessa Agostini
- U.O. Medicina Trasfusionale, IRCCS—Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Umberto Roncarati
- U.O. Immunoematologia e Medicina Trasfusionale/Officina Trasfusionale, Cesena e Forlì, 47521 Cesena, Italy;
| | - Clara Mannarella
- Hematology Unit, Madonna delle Grazie Hospital, 75100 Matera, Italy; (C.M.); (A.F.)
| | - Alberto Fragasso
- Hematology Unit, Madonna delle Grazie Hospital, 75100 Matera, Italy; (C.M.); (A.F.)
| | - Gian Marco Podda
- U.O. Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy; (G.M.P.); (S.B.)
| | - Simone Birocchi
- U.O. Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy; (G.M.P.); (S.B.)
| | - Anna Maria Cerbone
- Department of Clinical Medicine and Surgery, AOU Federico II, 80131 Naples, Italy; (A.M.C.); (A.T.)
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, AOU Federico II, 80131 Naples, Italy; (A.M.C.); (A.T.)
| | - Giuseppe Menna
- Department of Oncology, AORN Santobono-Pausilipon, 80122 Naples, Italy;
| | | | - Michela Ronchi
- Internal Medicine Unit, Department of Medicine, Lugo Hospital, Lugo, 48022 Ravenna, Italy;
| | - Alessandro De Fanti
- Departmental Simple Unit of Pediatric Rheumatology, AUSL-IRCSS Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Sergio Amarri
- Paediatrics Unit, AUSL-IRCSS Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Marzia Defina
- Department of Medical, Surgery and Neuroscience, Hematology Unit, Azienda Ospedaliera Universitaria Senese, Università degli Studi di Siena, 53100 Siena, Italy; (M.D.); (M.B.)
| | - Monica Bocchia
- Department of Medical, Surgery and Neuroscience, Hematology Unit, Azienda Ospedaliera Universitaria Senese, Università degli Studi di Siena, 53100 Siena, Italy; (M.D.); (M.B.)
| | - Silvia Cerù
- Hematology Unit, Santa Chiara Hospital, 38122 Trento, Italy;
| | - Salvatore Gattillo
- Immuno-Hematology and Transfusion Medicine Unit, San Raffaele Hospital, 20132 Milan, Italy;
| | - Frits R. Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Flora Peyvandi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, and Fondazione Luigi Villa, 20122 Milan, Italy; (I.M.); (E.G.); (E.P.); (R.G.)
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, 20122 Milan, Italy; (S.P.); (A.A.); (B.F.)
- Correspondence: ; Tel.: +39-02-5503-5414
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5
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Joly BS, Loiseau P, Darmon M, Leblanc T, Chambost H, Fouyssac F, Guigonis V, Harambat J, Stepanian A, Coppo P, Veyradier A. HLA-DRB1*11 is a strong risk factor for acquired thrombotic thrombocytopenic purpura in children. Haematologica 2020; 105:e531. [PMID: 33054098 PMCID: PMC7556652 DOI: 10.3324/haematol.2019.241968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Bérangère S. Joly
- Service d’Hématologie Biologique, Hôpital Lariboisière and EA3518, Institut de Recherche Saint Louis, Hôpital Saint-Louis, AP-HP. Nord, Université de Paris, Paris
- French Reference Center for Thrombotic Microangiopathies, Hôpital Saint Antoine, AP-HP.Sorbonne Université, Paris
| | - Pascale Loiseau
- Laboratoire d'Immunologie et d'Histocompatibilité, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris
| | - Michael Darmon
- Service de Réanimation Médicale, Hôpital Saint-Louis, AP-HP Nord, Université de Paris, Paris
| | - Thierry Leblanc
- Service d’Hématologie Pédiatrique, Hôpital Robert Debré, AP-HP.Nord, Université de Paris, Paris
| | - Hervé Chambost
- APHM, Service d’Hématologie, Immunologie, Oncologie et Pédiatrique, Hôpital de la Timone Enfants & Aix Marseille Université, INSERM, INRA, C2VN, Marseille
| | - Fanny Fouyssac
- Service d’Hémato-Oncologie Pédiatrique, Hôpital de Brabois, CHU de Nancy, Vandoeuvre-les- Nancy
| | - Vincent Guigonis
- Service de Pédiatrie, Hôpital de la Mère et de l’Enfant, CHU de Limoges, Limoges
| | - Jérôme Harambat
- Service de Pédiatrie, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Université de Bordeaux, Bordeaux
| | - Alain Stepanian
- Service d’Hématologie Biologique, Hôpital Lariboisière and EA3518, Institut de Recherche Saint Louis, Hôpital Saint-Louis, AP-HP. Nord, Université de Paris, Paris
- French Reference Center for Thrombotic Microangiopathies, Hôpital Saint Antoine, AP-HP.Sorbonne Université, Paris
| | - Paul Coppo
- French Reference Center for Thrombotic Microangiopathies, Hôpital Saint Antoine, AP-HP.Sorbonne Université, Paris
- Service d’Hématologie, Hôpital Saint Antoine, AP-HP Sorbonne Université, Paris, France
| | - Agnès Veyradier
- Service d’Hématologie Biologique, Hôpital Lariboisière and EA3518, Institut de Recherche Saint Louis, Hôpital Saint-Louis, AP-HP. Nord, Université de Paris, Paris
- French Reference Center for Thrombotic Microangiopathies, Hôpital Saint Antoine, AP-HP.Sorbonne Université, Paris
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HLA loci predisposing to immune TTP in Japanese: potential role of the shared ADAMTS13 peptide bound to different HLA-DR. Blood 2020; 135:2413-2419. [DOI: 10.1182/blood.2020005395] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022] Open
Abstract
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare autoimmune disorder caused by neutralizing anti-ADAMTS13 autoantibodies. In white individuals, HLA allele DRB1*11 is a predisposing factor for iTTP, whereas DRB1*04 is a protective factor. However, the role of HLA in Asians is unclear. In this study, we analyzed 10 HLA loci using next-generation sequencing in 52 Japanese patients with iTTP, and the allele frequency in the iTTP group was compared with that in a Japanese control group. We identified the following HLA alleles as predisposing factors for iTTP in the Japanese population: DRB1*08:03 (odds ratio [OR], 3.06; corrected P [Pc] = .005), DRB3/4/5*blank (OR, 2.3; Pc = .007), DQA1*01:03 (OR, 2.25; Pc = .006), and DQB1*06:01 (OR,: 2.41; Pc = .003). The estimated haplotype consisting of these 4 alleles was significantly more frequent in the iTTP group than in the control group (30.8% vs 6.0%; Pc < .001). DRB1*15:01 and DRB5*01:01 were weak protective factors for iTTP (OR, 0.23; Pc = .076; and OR, 0.23, Pc = .034, respectively). On the other hand, DRB1*11 and DRB1*04 were not associated with iTTP in the Japanese. These findings indicated that predisposing and protective factors for iTTP differ between Japanese and white individuals. HLA-DR molecules encoded by DRB1*08:03 and DRB1*11:01 have different peptide-binding motifs, but interestingly, bound to the shared ADAMTS13 peptide in an in silico prediction model.
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7
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Coppo P. Immune TTP pathogenesis: the rising sun on HLA. Blood 2020; 135:2335-2336. [PMID: 32585027 DOI: 10.1182/blood.2020006078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paul Coppo
- French Reference Center for Thrombotic Microangiopathies
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8
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Hrdinová J, D'Angelo S, Graça NAG, Ercig B, Vanhoorelbeke K, Veyradier A, Voorberg J, Coppo P. Dissecting the pathophysiology of immune thrombotic thrombocytopenic purpura: interplay between genes and environmental triggers. Haematologica 2018; 103:1099-1109. [PMID: 29674502 PMCID: PMC6029525 DOI: 10.3324/haematol.2016.151407] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/13/2018] [Indexed: 01/04/2023] Open
Abstract
Although outstanding progress has been made in understanding the pathophysiology of thrombotic thrombocytopenic purpura (TTP), knowledge of the immunopathogenesis of the disease is only at an early stage. Anti-ADAMTS13 auto-antibodies were shown to block proteolysis of von Willebrand factor and/or induce ADAMTS13 clearance from the circulation. However, it still remains to identify which immune cells are involved in the production of anti-ADAMTS13 autoantibodies, and therefore account for the remarkable efficacy of the B-cell depleting agents in this disease. The mechanisms leading to the loss of tolerance of the immune system towards ADAMTS13 involve the predisposing genetic factors of the human leukocyte antigen class II locus DRB1*11 and DQB1*03 alleles as well as the protective allele DRB1*04, and modifying factors such as ethnicity, sex and obesity. Future studies have to identify why these identified genetic risk factors are also frequently to be found in the healthy population although the incidence of immune-mediated thrombotic thrombocytopenic purpura (iTTP) is extremely low. Moreover, the development of recombinant ADAMTS13 opens a new therapeutic era in the field. Interactions of recombinant ADAMTS13 with the immune system of iTTP patients will require intensive investigation, especially for its potential immunogenicity. Better understanding of iTTP immunopathogenesis should, therefore, provide a basis for the development of novel therapeutic approaches to restore immune tolerance towards ADAMTS13 and thereby better prevent refractoriness and relapses in patients with iTTP. In this review, we address these issues and the related challenges in this field.
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Affiliation(s)
- Johana Hrdinová
- Department of Plasma Proteins, Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, the Netherlands.,PharmaTarget B.V., Maastricht, the Netherlands.,Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Silvia D'Angelo
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Belgium.,Protobios LLC, Tallinn, Estonia
| | - Nuno A G Graça
- Department of Plasma Proteins, Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, the Netherlands.,Icosagen Cell Factory OÜ, Ülenurme Vald, Tartumaa, Estonia
| | - Bogac Ercig
- Department of Plasma Proteins, Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, the Netherlands.,PharmaTarget B.V., Maastricht, the Netherlands.,Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Belgium
| | - Agnès Veyradier
- Service d'Hématologie Biologique and EA3518, Groupe Hospitalier Saint Louis-Lariboisière, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot, France.,Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Jan Voorberg
- Department of Plasma Proteins, Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Paul Coppo
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP, Paris, France .,Service d'Hématologie, Assistance Publique - Hôpitaux de Paris, France.,Sorbonne Université, UPMC Univ Paris 06, France
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9
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Kremer Hovinga JA, Heeb SR, Skowronska M, Schaller M. Pathophysiology of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. J Thromb Haemost 2018; 16:618-629. [PMID: 29356300 DOI: 10.1111/jth.13956] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Thrombotic microangiopathies are rare disorders characterized by the concomitant occurrence of severe thrombocytopenia, microangiopathic hemolytic anemia, and a variable degree of ischemic end-organ damage. The latter particularly affects the brain, the heart, and the kidneys. The primary forms, thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), although their clinical presentations often overlap, have distinctive pathophysiologies. TTP is the consequence of a severe ADAMTS-13 deficiency, either immune-mediated as a result of circulating autoantibodies, or caused by mutations in ADAMTS-13. HUS develops following an infection with Shiga-toxin producing bacteria, or as the result of excessive activation of the alternative pathway of the complement system because of mutations in genes encoding complement system proteins.
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Affiliation(s)
- J A Kremer Hovinga
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - S R Heeb
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - M Skowronska
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - M Schaller
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, Bern, Switzerland
- Department for BioMedical Research, University of Bern, Bern, Switzerland
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10
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Hrdinová J, Verbij FC, Kaijen PHP, Hartholt RB, van Alphen F, Lardy N, Ten Brinke A, Vanhoorelbeke K, Hindocha PJ, De Groot AS, Meijer AB, Voorberg J, Peyron I. Mass spectrometry-assisted identification of ADAMTS13-derived peptides presented on HLA-DR and HLA-DQ. Haematologica 2018; 103:1083-1092. [PMID: 29567779 PMCID: PMC6058777 DOI: 10.3324/haematol.2017.179119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 03/14/2018] [Indexed: 12/21/2022] Open
Abstract
Formation of microthrombi is a hallmark of acquired thrombotic thrombocytopenic purpura. These microthrombi originate from insufficient processing of ultra large von Willebrand factor multimers by ADAMTS13 due to the development of anti-ADAMTS13 autoantibodies. Several studies have identified the major histocompatibility complex class II alleles HLA-DRB1*11, HLA-DQB1*03 and HLA-DQB1*02:02 as risk factors for acquired thrombotic thrombocytopenic purpura development. Previous research in our department indicated that ADAMTS13 CUB2 domain-derived peptides FINVAPHAR and LIRDTHSLR are presented on HLA-DRB1*11 and HLA-DRB1*03, respectively. Here, we describe the repertoire of ADAMTS13 peptides presented on HLA-DQ. In parallel, the repertoire of ADAMTS13-derived peptides presented on HLA-DR was monitored. Using HLA-DR- and HLA-DQ-specific antibodies, we purified HLA/peptide complexes from ADAMTS13-pulsed monocyte-derived dendritic cells. Using this approach, we identified ADAMTS13-derived peptides presented on HLA-DR for all 9 samples analyzed; ADAMTS13-derived peptides presented on HLA-DQ were identified in 4 out of 9 samples. We were able to confirm the presentation of the CUB2 domain-derived peptides FINVAPHAR and LIRDTHSLR on HLA-DR. In total, 12 different core-peptide sequences were identified on HLA-DR and 8 on HLA-DQ. For HLA-DR11, several potential new core-peptides were found; 4 novel core-peptides were exclusively identified on HLA-DQ. Furthermore, an in silico analysis was performed using the EpiMatrix and JanusMatrix tools to evaluate the eluted peptides, in the context of HLA-DR, for putative effector or regulatory T-cell responses at the population level. The results from this study provide a basis for the identification of immuno-dominant epitopes on ADAMTS13 involved in the onset of acquired thrombotic thrombocytopenic purpura.
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Affiliation(s)
- Johana Hrdinová
- Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Fabian C Verbij
- Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Paul H P Kaijen
- Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Robin B Hartholt
- Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Floris van Alphen
- Department of Research Facilities, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Neubury Lardy
- Department of Immunogenetics, Sanquin, Amsterdam, the Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Belgium
| | | | - Anne S De Groot
- EpiVax Inc., Providence, RI, USA.,Institute for Immunology and Informatics, University of Rhode Island, Providence, RI, USA
| | - Alexander B Meijer
- Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, the Netherlands.,Department of Research Facilities, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, the Netherlands.,Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands
| | - Jan Voorberg
- Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, the Netherlands .,Department of Experimental Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Ivan Peyron
- Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, the Netherlands
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