PDSA E-News: August 28, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.

Contents:

ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine

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ITP and Platelet Disorders Research and Treatments

 

MORE NEWS ON BLOOD CLOTS AND ITP

Some people in the clinical trials for the new TPO treatments developed blood clots. This finding prompted a number of studies to determine if the TPO agents are causing the problems or if people with ITP are just more susceptible to blood clots because of something inherent in the disease. In one study of people who took TPO agents, researchers in New York used a D-dimer test to determine if their subjects' veins were showing signs of blood-clotting activity. They found that the D-dimer levels of more than half of the ITP patients were above the upper range even before they took the TPO drugs and showed little change, usually downward, when on a TPO treatment.

A Danish study examining years of hospital medical records found that people with chronic ITP had more blood clots in their arteries than the general population. Women with chronic ITP were twice more likely to get blood clots in their arteries as women without the disease. For men the rate was about the same.

Ghanima W et al. "Venous thromboembolism and coagulation activity in patients with immune thrombocytopenia treated with thrombopoietin receptor agonists." Br J Haematol. 2012 Jul 23.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2012.09227.x/full

Nørgaard M et al. "Risk of arterial thrombosis in patients with primary chronic immune thrombocytopenia: a Danish population-based cohort study." Br J Haematol. 2012 Jul 23.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2012.09231.x/full

For more information on the TPO treatments see:
http://www.pdsa.org/treatments/conventional/platelet-growth-factors.html

ITP – IS YOUR THYMUS AT FAULT?

People with ITP don't have as many T-regulatory cells (a type of white blood cell) as others without the disease. Now researchers in Canada know why. According to Dr. John Semple, lead author of a new study and PDSA medical advisor, "instead of being released into the body where [the T-regulatory cells] are needed to prevent us from becoming autoimmune, they are being held up in the thymus." Perhaps a new way to treat ITP is to target the thymus (a small organ located in front of the heart and behind the breast bone) and find something that releases the T-regulatory cells.

"Research Sheds New Light on Common Bleeding Disorder." Insciences OrganisationPress Release. July 24, 2012.
http://insciences.org/article.php?article_id=10892

Aslam R et al. "Thymic retention of CD4+CD25+FoxP3+ T regulatory cells is associated with their peripheral deficiency and thrombocytopenia in a murine model of immune thrombocytopenia (ITP)." Blood. 2012 Jul 3.
http://www.ncbi.nlm.nih.gov/pubmed/22760780

BUT YOU CAN'T BLAME IT ALL ON THE T-CELLS

In addition to T-cell problems, the regulatory B-cells (another type of white blood cell) in people with ITP are also impaired. Researchers in New York found the regulatory B-cells in non-splenectomized people with chronic ITP are not performing their normal task of halting cell destruction very well. However, some of the regulatory B-cell functionality was restored in those patients when they were given a TPO agent.

Li X et al. "Defective regulatory B cell compartment in patients with immune thrombocytopenia (ITP)." Blood. 2012 Aug 2.
http://www.ncbi.nlm.nih.gov/pubmed/22859611

GENETICS MAY PREDICT TREATMENT RESPONSE

Researchers are making some progress if figuring out which people have a better chance of responding to particular treatments for ITP. This is welcome news to those who are tired of trying many treatments that ultimately fail. The bottom line is that the subtle differences in our genes and the proteins they trigger can influence how we respond to treatments and to the course of the disease. Here are two examples of the ways researchers are using genetics to help predict treatment outcomes.

The genes of children who respond to corticosteroids or develop chronic ITP are slightly different from those who respond to IVIg or recover more quickly. Researchers in Taiwan compared the detailed makeup of the human leukocyte antigen (HLA) collection of genes (genes important in controlling the immune system) in ITP patients to healthy controls. Specifically, "patients with HLA-DRB1*11 or -DRB1*15 were more likely to respond poorly to corticosteroids than IVIG." Children with HLA-DRB1*08 were less likely to develop chronic ITP.

In a study examining the characteristics of people responding (or not) to rituximab (Rituxan ®) people with the FCGR3A V/V genetic type were more likely to respond to rituximab. Those who had very high levels of CD8 (proteins that work with T-cells) didn't respond despite a drop in anti-platelet antibodies.

Ho WL et al. "Clinical features and major histocompatibility complex genes as potential susceptibility factors in pediatric immune thrombocytopenia." J Formos Med Assoc. 2012 Jul;111(7):370-9.
http://www.ncbi.nlm.nih.gov/pubmed/22817814

Cooper, N. et al. (2012), "Platelet-associated antibodies, cellular immunity and FCGR3a genotype influence the response to rituximab in immune thrombocytopenia." Br J Haematol. 2012 Aug;158(4):539-47.
http://www.ncbi.nlm.nih.gov/pubmed/22775462

 

Hospitals, Insurance, and Medical Care

HOSPITAL FOOD – HOW BAD IS IT?

Very….if you are tracking the sodium levels. Researchers found about twice the amount of sodium (salt) in patient-selected menus than the recommended 1,500 mg/day when they analyzed both the regular and diabetic meals at three hospitals in Canada. All of the standard menus exceeded the recommended level of sodium and about half of the patient-selected menus for those on a sodium-restricted diet exceeded their limits. Limiting sodium levels is an important public health priority since a number of chronic diseases are linked to excess sodium consumption.

Arcand J et al. "Evaluation of Sodium Levels in Hospital Patient Menus." Arch Intern Med. 2012 Jul 16:1-2.
http://archinte.jamanetwork.com/article.aspx?articleid=1217203

UNDIAGNOSED DISEASE PROGRAM GETS A BOOST

The National Institutes of Health will spend $145 million over the next seven years to help patients with undiagnosed diseases. About 6% of the US population has a rare disorder and many remain a mystery or are very difficult to diagnose. The Undiagnosed Diseases Program (UDP) will set up a new network of medical research centers that will use recent advances in genomics to help diagnose and identify the underlying mechanisms of these cases. This will increase the understanding of these diseases and, hopefully, speed the development of therapies.

"NIH Common Fund announces new programs." National Institutes of Health Press Release, July 2, 2012.
http://www.nih.gov/news/health/jul2012/od-02.htm

Note: PDSA has heard from people whose low platelets seem to be due to unknown factors.

 

General Health and Medicine

BEWARE OF PAXIL®

Paxil, one of the brand names for paroxetine, a type of selective serotonin re-uptake inhibitor (SSRI), was responsible for prolonging a patient's ITP according to a recent case study. In that study the person's platelets went up after discontinuing the drug. This is just one person's experience but it reminds us that prescription drugs, as well as other substances, can affect platelet count and function. For more information on this subject see PDSA's "warnings page" at:
http://www.pdsa.org/about-itp/warnings.html

Ono S et al. "Prolongation of idiopathic thrombocytopenic purpura associated with paroxetine administration." Gen Hosp Psychiatry. 2012 Jul 23.
http://www.ncbi.nlm.nih.gov/pubmed/22832136

CARING FOR THE IMMUNE SYSTEM IN YOUR GUT

The mix of bacteria in your intestinal tract is important for a healthy immune response. The wrong combination of gut microbes could possibly shift the balance of the immune system and cause an autoimmune reaction for susceptible individuals. Overuse of antibiotics, disinfectant soaps, and processed food can alter the mix of gut bacteria.

"Host-Specific Microbiota Appears To Be Critical For A Healthy Immune System" Medical News Today, June 25, 2012.
http://www.medicalnewstoday.com/releases/246932.php

 

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This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web: http://www.pdsa.org, e-mail: pdsa@pdsa.org

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