Intravenous immunoglobulin (IVIg) is an effective treatment against immune thrombocytopenia (ITP). Previous studies suggested that IVIg exerts this ame
IntroductionImmune thrombocytopenia (ITP) is a disorder manifested by immune-mediated low platelet (PLT) counts. 1-3 Treatment with high-dose intravenous immunoglobulin (IVIg), a human IgG fraction prepared from pools of plasma of thousands of donors, can rapidly relieve the symptoms of thrombocytopenia. 2,4 The PLT clearance is mainly mediated through IgG Fc receptors (Fc␥R) bearing macrophages in the mononuclear phagocytic system (MPS). 5 In mice, both inhibitory and activating Fc␥Rs, the Fc␥RIIB and Fc␥RIII (encoded by Fcgr2b and Fcgr3, respectively) are important for IVIg-mediated amelioration. [6][7][8] IVIg treatment was shown to induce macrophages expressing Fc␥RIIB, by which it reduced the phagocytic activity of the macrophages. 5,7,8 In addition, Fc␥RIII on CD11c ϩ dendritic cells (DCs) is important for IVIg-mediated amelioration of ITP in a 2-step priming model, in which IVIg could modulate effector leukocytes indirectly through initiator DCs. 5,9 The modulation of PLTs, however, is less characterized. The splenic MPS plays important roles in the phagocytic clearance of PLT during ITP, 1,10,11 suggesting that the severity of ITP is associated with PLT-phagocyte engagements. Thus, we established a flow cytometry-based PLT-splenic CD14 ϩ leukocyte (PLT-CD14 ϩ LC) engagement analysis to investigate the roles of PLTs and phagocytes in IVIg-primed DCs (IVIg-DCs)-mediated modulations. The involvements of P-selectin, Fc␥RIIB, and Fc␥RIII in the amelioration of ITP are discussed.
Methods
IVIg and miceIVIg was purchased from Bayer (Gamimune N) and CSL Limited Inc. The C57BL/6J mice (males, 7-10 weeks old) were purchased from the National Laboratory Animal Center (NLAC). C57BL/6J mice deficient in Fc␥RIII (B6;129P2-Fcgr3 tm1Sjv /J), Fc␥RIIB (B6;129S4-Fcgr2b tm1Rav /J), and Pselectin (B6;129S2-Selp tm1Hyn /J), were purchased from The Jackson Laboratory. Mice were housed in the Laboratory Animal Center of Tzu Chi University. The research methods were approved by the Animal Care and Use Committee of Tzu-Chi University.
Induction and reversal of murine ITPITP was induced and treated as previously described. 7 Mice were intravenously injected with 0.1 mg/kg body weight of anti-PLT monoclonal antibody (mAb, rat anti-mouse integrin ␣ IIb /CD41 Ig, clone MWReg30; BD Biosciences) to induce ITP in all experiments, except for the low-dose treatments of MWReg30 (0.03 mg/kg) described in supplemental Figure 1 (available on the Blood web site; see the Supplemental Materials link at the top of the online article). To analyze PLT counts, whole blood samples (50-100 L) of mice were collected from the retro-orbital venous plexus and mixed with anticoagulant ACD solution (38mM citric acid, 75mM sodium citrate, 100mM dextrose) in Eppendorf tubes. PLT counts were then measured with a hematology analyzer (KX-21N; Sysmex) at various time intervals (0, 2, 4, and 24 hours after anti-CD41...