A novel flow-based assay reveals discrepancies in ADAMTS-13 inhibitor assessment as compared with a conventional clinical static assay

作者：Grillberger R; Gruber B; Skalicky S; Schrenk G; Knoebl P; Plaimauer B; Turecek P L; Scheiflinger F^*; Rottensteiner H

来源：Journal of Thrombosis and Haemostasis, 2014, 12(9): 1523-1532.

DOI：10.1111/jth.12653

• ADAMTS13 protein
• human
• autoantibodies
• mechanical stress
• thrombotic thrombocytopenic purpura
• von Willebrand factor

BackgroundSeveral static Bethesda-type assays are routinely used to determine ADAMTS-13-neutralizing autoantibodies in acquired thrombotic thrombocytopenic purpura (TTP), but the inhibitory activity of these antibodies has not been thoroughly evaluated under the more physiologic condition of flow. %26lt;br%26gt;ObjectivesWe investigated whether ADAMTS-13 inhibitor assessment with the FRETS-VWF73 assay is predictive for evaluation under flow. %26lt;br%26gt;MethodsAnti-ADAMTS-13 autoantibodies were purified from patients with acquired TTP by chromatography involving an ADAMTS-13 affinity matrix and/or proteinG. ADAMTS-13 activity was measured with the FRETS-VWF73 assay and a novel flow assay determining the ADAMTS-13-mediated decrease in platelet aggregate surface coverage, caused by perfusion of a suspension containing platelets, erythrocytes and von Willebrand factor (VWF) over a surface coated with extracellular matrix components. The neutralizing activities of ADAMTS-13 inhibitors were compared under static conditions and under flow by use of the two assays. %26lt;br%26gt;ResultsThe suitability of the flow-based ADAMTS-13 activity assay for quantification of ADAMTS-13 inhibitors could be demonstrated by reversibility of the ADAMTS-13-dependent decrease in surface coverage upon addition of goat ADAMTS-13 antiserum. Testing the neutralizing activity of purified autoantibodies from six patients in the flow assay according to their FRETS-VWF73-based inhibitor titers gave rise to vastly different inhibitory effects, indicating a discrepancy in inhibitor assessment between static and flow conditions. %26lt;br%26gt;ConclusionsAnti-ADAMTS-13 autoantibodies may show inhibitory properties invivo that are not consistent with the ADAMTS-13 inhibitor levels determined in routine static assays, possibly because certain epitopes are selectively exposed under shear. Consequently, the course of disease and treatment efficacy may vary among TTP patients, despite common inhibitor titers.

• 出版日期2014-9