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An update on the pathophysiology of immune thrombocytopenia

Semple, John W. LU ; Rebetz, Johan LU orcid ; Maouia, Amal LU and Kapur, Rick LU (2020) In Current Opinion in Hematology 27(6). p.423-429
Abstract

 Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder mediated by antiplatelet autoantibodies and antigen-specific T cells that either destroy platelets peripherally in the spleen or impair platelet production in the bone marrow. There have been a plethora of publications relating to the pathophysiology of ITP and since January of 2019, at least 50 papers have been published on ITP pathophysiology. PURPOSE OF REVIEW: To summarize the literature relating to the pathophysiology of ITP including the working mechanisms of therapies, T-cell and B-cell physiology, protein/RNA/DNA biochemistry, and animal models in an attempt to unify the perceived abnormal immune processes. RECENT FINDINGS: The most recent pathophysiologic... (More)

 Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder mediated by antiplatelet autoantibodies and antigen-specific T cells that either destroy platelets peripherally in the spleen or impair platelet production in the bone marrow. There have been a plethora of publications relating to the pathophysiology of ITP and since January of 2019, at least 50 papers have been published on ITP pathophysiology. PURPOSE OF REVIEW: To summarize the literature relating to the pathophysiology of ITP including the working mechanisms of therapies, T-cell and B-cell physiology, protein/RNA/DNA biochemistry, and animal models in an attempt to unify the perceived abnormal immune processes. RECENT FINDINGS: The most recent pathophysiologic irregularities associated with ITP relate to abnormal T-cell responses, particularly, defective T regulatory cell activity and how therapeutics can restore these responses. The robust literature on T cells in ITP points to the notion that ITP is a disease initiated by faulty self-tolerance mechanisms very much like that of other organ-specific autoimmune diseases. There is also a large literature on new and existing animal models of ITP and these will be discussed. It appears that understanding how to specifically modulate T cells in patients with ITP will undoubtedly lead to effective antigen-specific therapeutics. CONCLUSIONS: ITP is predominately a T cell disorder which leads to a breakdown in self tolerance mechanisms and allows for the generation of anti-platelet autoantibodies and T cells. Novel therapeutics that target T cells may be the most effective way to perhaps cure this disorder.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Current Opinion in Hematology
volume
27
issue
6
pages
7 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85092681428
  • pmid:32868673
ISSN
1531-7048
DOI
10.1097/MOH.0000000000000612
language
English
LU publication?
yes
id
6ebf19b2-8a47-41ad-9274-d27f614fce78
date added to LUP
2020-11-05 13:37:19
date last changed
2024-07-25 03:35:03
@article{6ebf19b2-8a47-41ad-9274-d27f614fce78,
  abstract     = {{<p> Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder mediated by antiplatelet autoantibodies and antigen-specific T cells that either destroy platelets peripherally in the spleen or impair platelet production in the bone marrow. There have been a plethora of publications relating to the pathophysiology of ITP and since January of 2019, at least 50 papers have been published on ITP pathophysiology. PURPOSE OF REVIEW: To summarize the literature relating to the pathophysiology of ITP including the working mechanisms of therapies, T-cell and B-cell physiology, protein/RNA/DNA biochemistry, and animal models in an attempt to unify the perceived abnormal immune processes. RECENT FINDINGS: The most recent pathophysiologic irregularities associated with ITP relate to abnormal T-cell responses, particularly, defective T regulatory cell activity and how therapeutics can restore these responses. The robust literature on T cells in ITP points to the notion that ITP is a disease initiated by faulty self-tolerance mechanisms very much like that of other organ-specific autoimmune diseases. There is also a large literature on new and existing animal models of ITP and these will be discussed. It appears that understanding how to specifically modulate T cells in patients with ITP will undoubtedly lead to effective antigen-specific therapeutics. CONCLUSIONS: ITP is predominately a T cell disorder which leads to a breakdown in self tolerance mechanisms and allows for the generation of anti-platelet autoantibodies and T cells. Novel therapeutics that target T cells may be the most effective way to perhaps cure this disorder.</p>}},
  author       = {{Semple, John W. and Rebetz, Johan and Maouia, Amal and Kapur, Rick}},
  issn         = {{1531-7048}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{423--429}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Current Opinion in Hematology}},
  title        = {{An update on the pathophysiology of immune thrombocytopenia}},
  url          = {{http://dx.doi.org/10.1097/MOH.0000000000000612}},
  doi          = {{10.1097/MOH.0000000000000612}},
  volume       = {{27}},
  year         = {{2020}},
}