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Prepublished online as a Blood First Edition Paper on April 3, 2003; DOI 10.1182/blood-2002-05-1475.

Submitted May 20, 2002
Accepted March 27, 2003
Inhibition of megakaryocytopoiesis in vitro by immune thrombocytopenic purpura (ITP) plasma and purified ITP monoclonal autoantibodies
Mei Chang*, Peggy A Nakagawa, Shirley A Williams, Michael R Schwartz, Karen L Imfeld, Jeffrey S Buzby, and Diane J Nugent
Children's Hospital of Orange County, Orange, CA, USA
* Corresponding author; email: mchang{at}choc.org.
To determine if megakaryocytes are targeted by ITP autoantibodies, as are platelets, we have studied the effects of ITP plasma on in vitro megakaryocytopoiesis. Umbilical cord blood mononuclear cells were incubated in the presence of thrombopoietin and 10% plasma from either ITP patients (n=53) or healthy donors. The yield of megakaryocytic cells, as determined by flow cytometry, was significantly reduced in the presence of ITP plasma containing anti-platelet glycoprotein (GP) Ib autoantibodies (p<0.001) as compared to both the control and patient plasma with no detectable anti-GP-IIb/IIIa or -Ib autoantibodies. Platelet absorbtion of anti-GP-Ib autoantibodies in ITP plasmas resulted in double the megakaryocyte production of the same plasmas without absorption, whereas platelet absorption of normal control plasma had no effect on megakaryocyte yield. Furthermore, two human monoclonal autoantibodies isolated from ITP patients, 2E7, specific for human platelet glycoprotein IIb heavy chain and 5E5, specific for a neoantigen on glycoprotein IIIa expressed on activated platelets, had significant inhibitory effects on in vitro megakaryocytopoiesis (p<0.001). Taken together, these data indicate that autoantibodies against either platelet GP-Ib or GP-IIb/IIIa in ITP plasma are not only involved in platelet destruction, but may also contribute to the inhibition of platelet production.

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