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Antibodies in sulfonamide-induced immune thrombocytopenia recognize
calcium-dependent epitopes on the glycoprotein IIb/IIIa complex
BR Curtis, JG McFarland, GG Wu, GP Visentin and RH Aster
Blood Research Institute, Blood Center of Southeastern Wisconsin, Milwaukee
53233-2194.
Drug-dependent IgG antibodies (DDAb) induced by sulfamethoxazole (SMX) and
sulfisoxazole (SIX) were identified by flow cytometry in 15 patients who
developed thrombocytopenia while taking one of these medications. Fourteen
of the 15 DDAb were specific solely for the glycoprotein (GP)IIb/IIIa
complex, and 13 of these reacted wholly or in part with epitopes present
only on the intact GPIIb/IIIa heterodimer. None of 12 SMX-induced DDAb
cross-reacted with SIX, but one of three SIX-induced antibodies reacted
with SMX. Each of 10 SMX-induced DDAb tested reacted with the N1-acetyl
metabolite of SMX, but only one reacted fully with the N4-acetyl
derivative. Detection of the SMX- and SIX-dependent antibodies was
facilitated by using bovine serum albumin (BSA) to achieve suspension of
these weakly soluble drugs in an aqueous medium. Our findings indicate that
DDAb induced by SMX and SIX, in contrast to those induced by quinidine and
quinine, are mainly specific for GPIIb/IIIa and react preferentially with
calcium-dependent epitopes present only on the intact GPIIb/IIIa
heterodimer.
Volume 84,
Issue 1,
pp. 176-183,
07/01/1994
Copyright © 1994 by The American Society of Hematology
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