1
|
Muller R, Cauchois R, Lagarde M, Roffino S, Genovesio C, Fernandez S, Hache G, Guillet B, Kara Y, Marlinge M, Lenting P, Poullin P, Dignat-George F, Tellier E, Kaplanski G. Reduction of mortality, cardiac damage, and cerebral damage by IL-1 inhibition in a murine model of TTP. Blood 2024; 143:2791-2803. [PMID: 38598839 DOI: 10.1182/blood.2023021974] [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: 07/27/2023] [Revised: 02/09/2024] [Accepted: 03/09/2024] [Indexed: 04/12/2024] Open
Abstract
ABSTRACT Thrombotic thrombocytopenic purpura (TTP), a rare but fatal disease if untreated, is due to alteration in von Willebrand factor cleavage resulting in capillary microthrombus formation and ischemic organ damage. Interleukin-1 (IL-1) has been shown to drive sterile inflammation after ischemia and could play an essential contribution to postischemic organ damage in TTP. Our objectives were to evaluate IL-1 involvement during TTP and to test the efficacy of the recombinant IL-1 receptor antagonist, anakinra, in a murine TTP model. We retrospectively measured plasma IL-1 concentrations in patients with TTP and controls. Patients with TTP exhibited elevated plasma IL-1α and -1β concentrations, which correlated with disease course and survival. In a mouse model of TTP, we administered anakinra (IL-1 inhibitor) or placebo for 5 days and evaluated the efficacy of this treatment. Anakinra significantly reduced mortality of mice (P < .001). Anakinra significantly decreased TTP-induced cardiac damage as assessed by blood troponin concentrations, evaluation of left ventricular function by echocardiography, [18F]fluorodeoxyglucose positron emission tomography of myocardial glucose metabolism, and cardiac histology. Anakinra also significantly reduced brain TTP-induced damage evaluated through blood PS100b concentrations, nuclear imaging, and histology. We finally showed that IL-1α and -1β trigger endothelial degranulation in vitro, leading to the release of von Willebrand factor. In conclusion, anakinra significantly reduced TTP mortality in a preclinical model of the disease by inhibiting both endothelial degranulation and postischemic inflammation, supporting further evaluations in humans.
Collapse
Affiliation(s)
- Romain Muller
- INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Aix Marseille University, Marseille, France
- Assistance Publique des Hôpitaux de Marseille, Department of Clinical Immunology and Internal Medicine, CHU Conception, Marseille, France
| | - Raphaël Cauchois
- INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Aix Marseille University, Marseille, France
- Assistance Publique des Hôpitaux de Marseille, Department of Clinical Immunology and Internal Medicine, CHU Conception, Marseille, France
- French Reference Center for Thrombotic Microangiopathies, Paris, France
| | - Marie Lagarde
- INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Aix Marseille University, Marseille, France
- French Reference Center for Thrombotic Microangiopathies, Paris, France
| | - Sandrine Roffino
- Centre National de la Recherche Scientifique, Institut des Sciences du Mouvement, Aix-Marseille University, Marseille, France
| | - Cécile Genovesio
- Faculté de Pharmacie, Aix-Marseille University, Marseille, France
| | - Samantha Fernandez
- Assistance Publique des Hôpitaux de Marseille, INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Centre Européen de Recherche en Imagerie Médicale, CHU Timone, Aix-Marseille University, Marseille, France
| | - Guillaume Hache
- INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Aix Marseille University, Marseille, France
- Biology Department, Assistance Publique des Hôpitaux de Marseille, INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Centre Européen de Recherche en Imagerie Médicale, CHU Timone, Aix-Marseille University, Marseille, France
| | - Benjamin Guillet
- Biology Department, Assistance Publique des Hôpitaux de Marseille, INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Centre Européen de Recherche en Imagerie Médicale, CHU Timone, Aix-Marseille University, Marseille, France
| | - Yéter Kara
- INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Aix Marseille University, Marseille, France
| | - Marion Marlinge
- Biology Department, Assistance Publique des Hôpitaux de Marseille, INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Centre Européen de Recherche en Imagerie Médicale, CHU Timone, Aix-Marseille University, Marseille, France
| | - Peter Lenting
- INSERM, Hémostase Inflammation Thrombose HITh U1176, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Pascale Poullin
- French Reference Center for Thrombotic Microangiopathies, Paris, France
- Assistance Publique des Hôpitaux de Marseille, Service d'Hémaphérése, CHU Conception, Marseille, France
| | - Françoise Dignat-George
- INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Aix Marseille University, Marseille, France
- Department of Hematology and Vascular Biology, Assistance Publique des Hôpitaux de Marseille, INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, CHU Conception, Aix-Marseille University, Marseille, France
| | - Edwige Tellier
- INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Aix Marseille University, Marseille, France
- French Reference Center for Thrombotic Microangiopathies, Paris, France
| | - Gilles Kaplanski
- INSERM, Institut National de Recherche pour l'agriculture, l'alimentation et l'environnement, Centre de Recherche en CardioVasculaire et Nutrition, Aix Marseille University, Marseille, France
- Assistance Publique des Hôpitaux de Marseille, Department of Clinical Immunology and Internal Medicine, CHU Conception, Marseille, France
| |
Collapse
|
2
|
Hannan F, Hamilton J, Patriquin CJ, Pavenski K, Jurkiewicz MT, Tristao L, Owen AM, Kosalka PK, Deoni SCL, Théberge J, Mandzia J, Huang SHS, Thiessen JD. Cognitive decline in thrombotic thrombocytopenic purpura survivors: The role of white matter health as assessed by MRI. Br J Haematol 2024; 204:1005-1016. [PMID: 38083818 DOI: 10.1111/bjh.19246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/18/2023] [Accepted: 11/24/2023] [Indexed: 03/14/2024]
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare condition caused by severe ADAMTS13 deficiency, leading to platelet aggregation and thrombosis. Despite treatment, patients are prone to cognitive impairment and depression. We investigated brain changes in iTTP patients during remission using advanced magnetic resonance imaging (MRI) techniques, correlating these changes with mood and neurocognitive tests. Twenty iTTP patients in remission (30 days post-haematological remission) were compared with six healthy controls. MRI scans, including standard and specialized sequences, were conducted to assess white matter health. Increased T1 relaxation times were found in the cingulate cortex (p < 0.05), and elevated T2 relaxation times were observed in the cingulate cortex, frontal, parietal and temporal lobes (p < 0.05). Pathological changes in these areas are correlated with impaired cognitive and depressive scores in concentration, short-term memory and verbal memory. This study highlights persistent white matter damage in iTTP patients, potentially contributing to depression and cognitive impairment. Key regions affected include the frontal lobe and cingulate cortex. These findings have significant implications for the acute and long-term management of iTTP, suggesting a need for re-evaluation of treatment approaches during both active phases and remission. Further research is warranted to enhance our understanding of these complexities.
Collapse
Affiliation(s)
- F Hannan
- Department of Medical Biophysics, Western University, London, Canada
| | - J Hamilton
- Department of Medical Biophysics, Western University, London, Canada
| | - C J Patriquin
- Department of Hematology, University Health Network, Toronto, Canada
| | - K Pavenski
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Canada
| | - M T Jurkiewicz
- Department of Medical Imaging, Western University, London, Canada
| | - L Tristao
- Department of Medical Imaging, Western University, London, Canada
| | - A M Owen
- Department of Clinical Neurological Sciences, Western University, London, Canada
- Department of Physiology and Pharmacology and Department of Psychology, Western University, London, Canada
| | - P K Kosalka
- Department of Medicine, Division of Nephrology, Western University, London, Canada
| | - S C L Deoni
- Advanced Baby Imaging Lab, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Diagnostic Radiology, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
- Lawson Health Research Institute, London, Canada
| | - J Théberge
- Department of Medical Biophysics, Western University, London, Canada
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
| | - J Mandzia
- Department of Clinical Neurological Sciences, Western University, London, Canada
| | - S H S Huang
- Department of Medical Biophysics, Western University, London, Canada
- Department of Medicine, Division of Nephrology, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
| | - J D Thiessen
- Department of Medical Biophysics, Western University, London, Canada
- Department of Medical Imaging, Western University, London, Canada
- Lawson Health Research Institute, London, Canada
| |
Collapse
|
3
|
Oliver M, Patriquin CJ, Pavenski K. Predictors of relapse and prophylactic management of immune thrombotic thrombocytopenic purpura. Transfus Apher Sci 2023; 62:103749. [PMID: 37344323 DOI: 10.1016/j.transci.2023.103749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Affiliation(s)
- Monika Oliver
- Department of Medicine, University of Alberta, Canada; Division of Hematology, University of Alberta Hospital, Canada
| | - Christopher J Patriquin
- Department of Medicine, University of Toronto, Canada; Division of Medical Oncology & Hematology, University Health Network, Toronto, Canada
| | - Katerina Pavenski
- Department of Medicine, University of Toronto, Canada; Department of Laboratory Medicine & Pathobiology, University of Toronto, Canada; Departments of Medicine and Laboratory Medicine, St. Michael's Hospital-Unity Health Toronto, Canada.
| |
Collapse
|
4
|
Pavenski K, Huang SHS, Patriquin CJ. Predictors of relapse and preventative strategies in immune thrombotic thrombocytopenic purpura. Expert Rev Hematol 2021; 14:1027-1040. [PMID: 34747320 DOI: 10.1080/17474086.2021.2003703] [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] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare autoimmune blood disorder, which presents with microangiopathic hemolytic anemia, thrombocytopenia, and microvascular thrombosis and is caused by severe deficiency of ADAMTS13. iTTP may result in both acute and chronic complications and is rapidly fatal without expedient treatment. Life-time risk of relapse is approximately 40%. AREAS COVERED A number of predictors of relapse has been described in the literature. The most well-studied predictor of relapse is persistent ADAMTS13 deficiency; however, it is not a perfect marker. Relapse can be prevented by treatment with immunosuppressive medications, with rituximab being the most studied. EXPERT OPINION Patients who recover from iTTP should be regularly assessed, including with ADAMTS13 activity testing. The optimal frequency of assessments has not been established, but every 3 months is recommended. Considering the potential for significant organ damage and mortality associated with iTTP relapse, patients in remission and with persistent ADAMTS13 activity of 10-20% should be prophylactically treated with immunosuppression. Additional markers to precisely identify patients at higher risk of relapse are needed.
Collapse
Affiliation(s)
- Katerina Pavenski
- Departments of Medicine and Laboratory Medicine, St. Michael's Hospital, Toronto, Canada.,Departments of Medicine and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Shih-Han Susan Huang
- Department of Medicine, Division of Nephrology, Western University, London, Canada
| | - Christopher J Patriquin
- Department of Medicine, Division of Medical Oncology & Hematology, University Health Network, Toronto, Canada
| |
Collapse
|