Human neutrophil peptides and complement factor Bb in pathogenesis of acquired thrombotic thrombocytopenic purpura

Acquired thrombotic thrombocytopenic purpura is primarily caused by deficiency of plasma ADAMTS13 activity resulting from autoantibodies against ADAMTS13. However, ADAMTS13 deficiency alone is often not sufficient to cause acute thrombotic thrombocytopenic purpura. Infections or systemic inflammation may precede acute bursts of the disease but the underlying mechanisms are not fully understood. Here, 52 patients with acquired idiopathic thrombotic thrombocytopenic purpura and 30 blood donor controls were recruited for the study. Plasma levels of human neutrophil peptides 1-3 and complement activation fragments (i.e. Bb, iC3b, C4d, and sC5b-9) were determined by enzyme-linked immunosorbent assays. Univariate analyses were performed to determine the correlation between each biomarker and clinical outcomes. We found that plasma levels of human neutrophil peptides 1-3 and Bb in patients with acute thrombotic thrombocytopenic purpura were significantly higher than those in the control (p<0.0001). Plasma levels of HNP1-3 correlated with the levels of plasma complement fragment Bb (rho=0.48, p=0.0004) and serum lactate dehydrogenase (rho=0.28, p=0.04); in addition, plasma levels of Bb correlated with iC3b (rho=0.55, p<0.0001), sC5b-9 (rho=0.63, p<0.0001), serum creatinine (rho=0.42, p=0.0011), and lactate dehydrogenase (rho=0.40, p=0.0034), respectively. Moreover, plasma levels of iC3b and sC5b-9 were correlated (rho=0.72, p<0.0001) despite no statistically significant difference of two markers between thrombotic thrombocytopenic purpura patients and the control. We conclude that innate immunity i.e. neutrophil and complement activation via the alternative pathway may play a role in the pathogenesis of acute autoimmune thrombotic thrombocytopenic purpura and a targeted therapy at these pathways may be considered in a subset of these patients.