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Blood, 1 August 2006, Vol. 108, No. 3, pp. 922-927. Prepublished online as a Blood First Edition Paper on April 11, 2006; DOI 10.1182/blood-2006-01-009803. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2006-01-009803v1 108/3/922    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Bougie, D. W. Articles by Aster, R. H. Search for Related Content PubMed PubMed Citation Articles by Bougie, D. W. Articles by Aster, R. H. Related Collections Hemostasis, Thrombosis, and Vascular Biology Immunobiology Cell Adhesion and Motility Free Research Articles Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY Patients with quinine-induced immune thrombocytopenia have both "drug-dependent" and "drug-specific" antibodies Daniel W. Bougie, Peter R. Wilker, and Richard H. Aster From the Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI; Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO; and Departments of Medicine and Pathology, Medical College of Wisconsin, Milwaukee, WI. Immune thrombocytopenia induced by quinine and many other drugs is caused by antibodies that bind to platelet membrane glycoproteins (GPs) only when the sensitizing drug is present in soluble form. In this disorder, drug promotes antibody binding to its target without linking covalently to either of the reacting macro-molecules by a mechanism that has not yet been defined. How drug provides the stimulus for production of such antibodies is also unknown. We studied 7 patients who experienced severe thrombocytopenia after ingestion of quinine. As expected, drug-dependent, platelet-reactive antibodies specific for GPIIb/IIIa or GPIb/IX were identified in each case. Unexpectedly, each of 6 patients with GPIIb/IIIa-specific antibodies was found to have a second antibody specific for drug alone that was not platelet reactive. Despite recognizing different targets, the 2 types of antibody were identical in requiring quinine or desmethoxy-quinine (cinchonidine) for reactivity and in failing to react with other structural analogues of quinine. On the basis of these findings and previous observations, a model is proposed to explain drug-dependent binding of antibodies to cellular targets. In addition to having implications for pathogenesis, drug-specific antibodies may provide a surrogate measure of drug sensitivity in patients with drug-induced immune cytopenia. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: J. A. Peterson, T. N. Nelson, A. J. Kanack, and R. H. Aster Fine specificity of drug-dependent antibodies reactive with a restricted domain of platelet GPIIIA Blood, February 1, 2008; 111(3): 1234 - 1239. [Abstract] [Full Text] [PDF] R. H. Aster and D. W. Bougie Drug-Induced Immune Thrombocytopenia N. Engl. J. Med., August 9, 2007; 357(6): 580 - 587. [Full Text] [PDF] A. Von Drygalski, B. R. Curtis, D. W. Bougie, J. G. McFarland, S. Ahl, I. Limbu, K. R. Baker, and R. H. Aster Vancomycin-Induced Immune Thrombocytopenia N. Engl. J. Med., March 1, 2007; 356(9): 904 - 910. [Abstract] [Full Text] [PDF]

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