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Emerging Therapies in Immune Thrombocytopenia

by 1,2,* and 1,2
1
Service de Médecine Interne et Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes de l’adulte, Centre Hospitalo-Universitaire Dijon Bourgogne, 21000 Dijon, France
2
Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, LabEx LipSTIC, INSERM, EFS BFC, UMR1098, Université de Bourgogne Franche-Comté, 21000 Dijon, France
*
Author to whom correspondence should be addressed.
Academic Editor: Marie Scully
J. Clin. Med. 2021, 10(5), 1004; https://doi.org/10.3390/jcm10051004
Received: 26 January 2021 / Revised: 17 February 2021 / Accepted: 18 February 2021 / Published: 2 March 2021
(This article belongs to the Special Issue Diagnosis and Management of Thrombocytopenia)
Immune thrombocytopenia (ITP) is a rare autoimmune disorder caused by peripheral platelet destruction and inappropriate bone marrow production. The management of ITP is based on the utilization of steroids, intravenous immunoglobulins, rituximab, thrombopoietin receptor agonists (TPO-RAs), immunosuppressants and splenectomy. Recent advances in the understanding of its pathogenesis have opened new fields of therapeutic interventions. The phagocytosis of platelets by splenic macrophages could be inhibited by spleen tyrosine kinase (Syk) or Bruton tyrosine kinase (BTK) inhibitors. The clearance of antiplatelet antibodies could be accelerated by blocking the neonatal Fc receptor (FcRn), while new strategies targeting B cells and/or plasma cells could improve the reduction of pathogenic autoantibodies. The inhibition of the classical complement pathway that participates in platelet destruction also represents a new target. Platelet desialylation has emerged as a new mechanism of platelet destruction in ITP, and the inhibition of neuraminidase could dampen this phenomenon. T cells that support the autoimmune B cell response also represent an interesting target. Beyond the inhibition of the autoimmune response, new TPO-RAs that stimulate platelet production have been developed. The upcoming challenges will be the determination of predictive factors of response to treatments at a patient scale to optimize their management. View Full-Text
Keywords: immune thrombocytopenia; Syk inhibitor; BTK inhibitor; FcRn; desialylation; TPO-RA immune thrombocytopenia; Syk inhibitor; BTK inhibitor; FcRn; desialylation; TPO-RA
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MDPI and ACS Style

Audia, S.; Bonnotte, B. Emerging Therapies in Immune Thrombocytopenia. J. Clin. Med. 2021, 10, 1004. https://doi.org/10.3390/jcm10051004

AMA Style

Audia S, Bonnotte B. Emerging Therapies in Immune Thrombocytopenia. Journal of Clinical Medicine. 2021; 10(5):1004. https://doi.org/10.3390/jcm10051004

Chicago/Turabian Style

Audia, Sylvain, and Bernard Bonnotte. 2021. "Emerging Therapies in Immune Thrombocytopenia" Journal of Clinical Medicine 10, no. 5: 1004. https://doi.org/10.3390/jcm10051004

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