Thrombotic thrombocytopenic purpura (TTP) is a multi-system disorder characterized by micro angiopathic hemolytic anemia, thrombocytopenia, neurologic abnormalities, and less commonly, fever and renal abnormalities. When associated with acute renal failure in adults, the term """"""""hemolytic uremic syndrome"""""""" (HUS) is often used. TTP/HUS is a poorly understood disease that despite recent major therapeutic advances, still has significant morbidity and mortality associated with it. A number of mechanisms have been proposed to explain the pathogenesis of this disease process, but despite a great deal of effort devoted to this, the pathogenesis for the most part remains unclear and the etiology unknown. This proposal will attempt to explore mechanisms of disease in patients with TTP/HUS. The basic premise is that the unifying feature of the various forms of TTP/HUS is perturbation of the endothelial cell with secondary activation of platelets and thrombin, leading to microvascular thrombosis.
The specific aims are: 1. To study patients with primary and secondary TTP/HUS for the presence of immunoglobulin and non-immunoglobulin factors that affect platelets and endothelial cells and characterize the mechanisms of action of these factors in mediating microvascular thrombosis. 2. To develop an in vitro model to assess endothelial cell injury and/or activation in response to immunoglobulin activity identified in aim 1. 3. To define the clinical course, laboratory findings, response to therapy, and clinical outcome of classical TTP and compare it with HIV- associated TTP. The long-term goal of this research is to improve the understanding of the pathogenesis of TTP/HUS in some or all of its various forms. In the process, the study will attempt to determine if there are differences in the pathogenesis of HIV-associated TTP vs. more typical TTP/HUS.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL055556-04
Application #
2735292
Study Section
Special Emphasis Panel (ZHL1-CSR-K (M1))
Project Start
1995-07-01
Project End
2000-06-30
Budget Start
1998-07-01
Budget End
1999-06-30
Support Year
4
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Bloodcenter of Wisconsin, Inc.
Department
Type
DUNS #
City
Milwaukee
State
WI
Country
United States
Zip Code
53233
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Raife, Thomas; Friedman, Kenneth D; Fenwick, Brad (2004) Lepirudin prevents lethal effects of Shiga toxin in a canine model. Thromb Haemost 92:387-93
Raife, Thomas; Atkinson, Bonnie; Montgomery, Robert et al. (2004) Severe deficiency of VWF-cleaving protease (ADAMTS13) activity defines a distinct population of thrombotic microangiopathy patients. Transfusion 44:146-50
Mauro, Michael; Zlatopolskiy, Andrey; Raife, Thomas J et al. (2004) Thienopyridine-linked thrombotic microangiopathy: association with endothelial cell apoptosis and activation of MAP kinase signalling cascades. Br J Haematol 124:200-10
Raife, Thomas J; Lentz, Steven R; Atkinson, Bonnie S et al. (2002) Factor V Leiden: a genetic risk factor for thrombotic microangiopathy in patients with normal von Willebrand factor-cleaving protease activity. Blood 99:437-42
Raife, T; Montgomery, R (2001) New aspects in the pathogenesis and treatment of thrombotic thrombocytopenic purpura and hemolytic uremic syndrome. Rev Clin Exp Hematol 5:236-61; discussion 311-2
Raife, T J; Montgomery, R R (2000) von Willebrand factor and thrombotic thrombocytopenic purpura. Curr Opin Hematol 7:278-83

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