Effects of eltrombopag on platelet count and platelet activation in Wiskott-Aldrich syndrome/X-linked thrombocytopenia

Anja J. Gerrits, Emily A. Leven, Andrew L. Frelinger, Sophie L. Brigstocke, Michelle A. Berny-Lang, W. Beau Mitchell, Shoshana Revel-Vilk, Hannah Tamary, Sabrina L. Carmichael, Marc R. Barnard, Alan D. Michelson, James B. Bussel

Research output: Contribution to journalArticle

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Abstract

Because Wiskott-Aldrich syndrome (WAS) and X-linked thrombocytopenia (XLT) patients have microthrombocytopenia, hemorrhage is a major problem. We asked whether eltrombopag, a thrombopoietic agent, would increase platelet counts, improve platelet activation, and/or reduce bleeding in WAS/XLT patients. In 9 WAS/XLT patients and 8 age-matched healthy controls, platelet activation was assessed by whole blood flow cytometry. Agonist-induced platelet surface activated glycoprotein (GP) IIb-IIIa and P-selectin in WAS/XLT patients were proportional to platelet size and therefore decreased compared with controls. In contrast, annexin V binding showed no differences between WAS/XLT and controls. Eltrombopag treatment resulted in an increased platelet count in 5 out of 8 patients. Among responders to eltrombopag, immature platelet fraction in 3 WAS/XLT patients was significantly less increased compared with 7 pediatric chronic immune thrombocytopenia (ITP) patients. Platelet activation did not improve in 3 WAS/XLT patients whose platelet count improved on eltrombopag. In conclusion: (1) the reduced platelet activation observed in WAS/XLT is primarily due to the microthrombocytopenia; and (2) although the eltrombopag-induced increase in platelet production in WAS/XLT is less than in ITP, eltrombopag has beneficial effects on platelet count but not platelet activation in the majority of WAS/XLT patients. This trial was registered at www.clinicaltrials.gov as #NCT00909363.

Original languageEnglish (US)
Pages (from-to)1367-1378
Number of pages12
JournalBlood
Volume126
Issue number11
DOIs
StatePublished - Sep 10 2015
Externally publishedYes

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Wiskott-Aldrich Syndrome
Platelet Activation
Platelets
Platelet Count
Chemical activation
Idiopathic Thrombocytopenic Purpura
Blood Platelets
eltrombopag
Thrombocytopenia 1
Hemorrhage
Platelet Membrane Glycoproteins
Platelet Glycoprotein GPIIb-IIIa Complex
P-Selectin
Annexin A5
Membrane Glycoproteins
Pediatrics
Flow cytometry
Flow Cytometry

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Gerrits, A. J., Leven, E. A., Frelinger, A. L., Brigstocke, S. L., Berny-Lang, M. A., Mitchell, W. B., ... Bussel, J. B. (2015). Effects of eltrombopag on platelet count and platelet activation in Wiskott-Aldrich syndrome/X-linked thrombocytopenia. Blood, 126(11), 1367-1378. https://doi.org/10.1182/blood-2014-09-602573

Effects of eltrombopag on platelet count and platelet activation in Wiskott-Aldrich syndrome/X-linked thrombocytopenia. / Gerrits, Anja J.; Leven, Emily A.; Frelinger, Andrew L.; Brigstocke, Sophie L.; Berny-Lang, Michelle A.; Mitchell, W. Beau; Revel-Vilk, Shoshana; Tamary, Hannah; Carmichael, Sabrina L.; Barnard, Marc R.; Michelson, Alan D.; Bussel, James B.

In: Blood, Vol. 126, No. 11, 10.09.2015, p. 1367-1378.

Research output: Contribution to journalArticle

Gerrits, AJ, Leven, EA, Frelinger, AL, Brigstocke, SL, Berny-Lang, MA, Mitchell, WB, Revel-Vilk, S, Tamary, H, Carmichael, SL, Barnard, MR, Michelson, AD & Bussel, JB 2015, 'Effects of eltrombopag on platelet count and platelet activation in Wiskott-Aldrich syndrome/X-linked thrombocytopenia', Blood, vol. 126, no. 11, pp. 1367-1378. https://doi.org/10.1182/blood-2014-09-602573
Gerrits, Anja J. ; Leven, Emily A. ; Frelinger, Andrew L. ; Brigstocke, Sophie L. ; Berny-Lang, Michelle A. ; Mitchell, W. Beau ; Revel-Vilk, Shoshana ; Tamary, Hannah ; Carmichael, Sabrina L. ; Barnard, Marc R. ; Michelson, Alan D. ; Bussel, James B. / Effects of eltrombopag on platelet count and platelet activation in Wiskott-Aldrich syndrome/X-linked thrombocytopenia. In: Blood. 2015 ; Vol. 126, No. 11. pp. 1367-1378.
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AU - Brigstocke, Sophie L.

AU - Berny-Lang, Michelle A.

AU - Mitchell, W. Beau

AU - Revel-Vilk, Shoshana

AU - Tamary, Hannah

AU - Carmichael, Sabrina L.

AU - Barnard, Marc R.

AU - Michelson, Alan D.

AU - Bussel, James B.

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AB - Because Wiskott-Aldrich syndrome (WAS) and X-linked thrombocytopenia (XLT) patients have microthrombocytopenia, hemorrhage is a major problem. We asked whether eltrombopag, a thrombopoietic agent, would increase platelet counts, improve platelet activation, and/or reduce bleeding in WAS/XLT patients. In 9 WAS/XLT patients and 8 age-matched healthy controls, platelet activation was assessed by whole blood flow cytometry. Agonist-induced platelet surface activated glycoprotein (GP) IIb-IIIa and P-selectin in WAS/XLT patients were proportional to platelet size and therefore decreased compared with controls. In contrast, annexin V binding showed no differences between WAS/XLT and controls. Eltrombopag treatment resulted in an increased platelet count in 5 out of 8 patients. Among responders to eltrombopag, immature platelet fraction in 3 WAS/XLT patients was significantly less increased compared with 7 pediatric chronic immune thrombocytopenia (ITP) patients. Platelet activation did not improve in 3 WAS/XLT patients whose platelet count improved on eltrombopag. In conclusion: (1) the reduced platelet activation observed in WAS/XLT is primarily due to the microthrombocytopenia; and (2) although the eltrombopag-induced increase in platelet production in WAS/XLT is less than in ITP, eltrombopag has beneficial effects on platelet count but not platelet activation in the majority of WAS/XLT patients. This trial was registered at www.clinicaltrials.gov as #NCT00909363.

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