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• W4380927714 abstract "Immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder characterized by an isolated thrombocytopenia (platelet count, <100 × 109/L) [ [1] Rodeghiero F. Stasi R. Gernsheimer T. Michel M. Provan D. Arnold D.M. Bussel J.B. Cines D.B. Chong B.H. Cooper N. Godeau B. Lechner K. Mazzucconi M.G. McMillan R. Sanz M.A. Imbach P. Blanchette V. Kuhne T. Ruggeri M. George J.N. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009; 113: 2386-2393 Crossref PubMed Scopus (1873) Google Scholar ]. Clinically, ITP may present with petechiae, purpura, and mucosal bleedings, and rarely with intracranial hemorrhages [ [2] Zufferey A. Kapur R. Semple J.W. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia (ITP). J Clin Med. 2017; 6: 16 Crossref PubMed Scopus (274) Google Scholar ]. Reduced health-related quality of life, with fatigue, is also frequently experienced by patients with ITP [ [2] Zufferey A. Kapur R. Semple J.W. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia (ITP). J Clin Med. 2017; 6: 16 Crossref PubMed Scopus (274) Google Scholar ]. Therapeutic management may initially consist of corticosteroids, intravenous immunoglobulins, or anti-D, and subsequent approaches may include rituximab, thrombopoietin receptor agonists, or splenectomy [ [3] Provan D. Arnold D.M. Bussel J.B. Chong B.H. Cooper N. Gernsheimer T. Ghanima W. Godeau B. González-López T.J. Grainger J. Hou M. Kruse C. McDonald V. Michel M. Newland A.C. Pavord S. Rodeghiero F. Scully M. Tomiyama Y. Wong R.S. et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019; 3: 3780-3817 Crossref PubMed Scopus (410) Google Scholar , [4] Neunert C. Terrell D.R. Arnold D.M. Buchanan G. Cines D.B. Cooper N. Cuker A. Despotovic J.M. George J.N. Grace R.F. Kühne T. Kuter D.J. Lim W. McCrae K.R. Pruitt B. Shimanek H. Vesely S.K. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019; 3: 3829-3866 Crossref PubMed Scopus (469) Google Scholar ]. Clinical management can be challenging due to the large degree of heterogeneity due to individual patient factors, differing disease stages (newly diagnosed, persistent, chronic, or treatment-refractory ITP), and the complex, multifactorial and not fully elucidated pathophysiology. Underlying the pathophysiology of ITP is the loss of immune tolerance provoked by a decrease in the number and/or function of CD4+ T regulatory cells (Tregs) accompanied by an increase in T helper (Th)1 and Th17 cells, which together initiates and fuels the autoimmune response in ITP [ [2] Zufferey A. Kapur R. Semple J.W. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia (ITP). J Clin Med. 2017; 6: 16 Crossref PubMed Scopus (274) Google Scholar , [5] Semple J.W. Rebetz J. Maouia A. Kapur R. An update on the pathophysiology of immune thrombocytopenia. Curr Opin Hematol. 2020; 27: 423-429 Crossref PubMed Scopus (59) Google Scholar ]. This culminates in increased destruction and impaired production of platelets due to targeting of platelets in the spleen/liver and of bone marrow-megakaryocytes by platelet autoantibodies and/or cytotoxic CD8+ T cells [ [2] Zufferey A. Kapur R. Semple J.W. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia (ITP). J Clin Med. 2017; 6: 16 Crossref PubMed Scopus (274) Google Scholar , [5] Semple J.W. Rebetz J. Maouia A. Kapur R. An update on the pathophysiology of immune thrombocytopenia. Curr Opin Hematol. 2020; 27: 423-429 Crossref PubMed Scopus (59) Google Scholar ]. A principle mechanism in ITP is the destruction of antiplatelet glycoprotein-opsonized platelets via Fcγ receptor–mediated phagocytosis by macrophages in the spleen [ [2] Zufferey A. Kapur R. Semple J.W. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia (ITP). J Clin Med. 2017; 6: 16 Crossref PubMed Scopus (274) Google Scholar , [5] Semple J.W. Rebetz J. Maouia A. Kapur R. An update on the pathophysiology of immune thrombocytopenia. Curr Opin Hematol. 2020; 27: 423-429 Crossref PubMed Scopus (59) Google Scholar ]. The spleen (and potentially the accessory spleen [ [6] Kapur R, Audia S. Secondary spleen in immune thrombocytopenia: not so accessory after all. Br J Haematol. Published online March 27, 2023. https://doi.org/10.1111/bjh.18776 Google Scholar , [7] Pizzi M, Vianello F, Lorenzi L, Binotto G, Sbaraglia M, Scarmozzino F, De Crescenzo A, Guzzardo V, Zoletto S, d’Amore F, Friziero A, D’Adda M, Facchetti F, Dei Tos AP. Accessory spleens recapitulate the immune microenvironment of the main spleen in immune thrombocytopenia. Br J Haematol. Published online March 14, 2023. https://doi.org/10.1111/bjh.18749 Google Scholar ]) is an important regulatory organ in ITP, as the spleen directs platelet destruction, platelet-antibody production, and lymphocyte distribution patterns, as shown in a clinically-relevant murine model of active ITP [ [8] Aslam R. Kapur R. Segel G.B. Guo L. Zufferey A. Ni H. Semple J.W. The spleen dictates platelet destruction, anti-platelet antibody production, and lymphocyte distribution patterns in a murine model of immune thrombocytopenia. Exp Hematol. 2016; 44: 924-930.e1 Abstract Full Text Full Text PDF PubMed Google Scholar ]. Of interest, a significant decrease in the density of sympathetic nerve fibers, in relation to an impaired megakaryocyte distribution, has been observed in the bone marrow of ITP mice [ [9] Wang M. Feng R. Zhang J.M. Xu L.L. Feng F.E. Wang C.C. Wang Q.M. Zhu X.L. He Y. Xue J. Fu H.X. Lv M. Kong Y. Chang Y.J. Xu L.P. Liu K.Y. Huang X.J. Zhang X.H. Dysregulated megakaryocyte distribution associated with nestin+ mesenchymal stem cells in immune thrombocytopenia. Blood Adv. 2019; 3: 1416-1428 Crossref PubMed Scopus (11) Google Scholar ]. The specific contribution of the sympathetic nervous system to the pathophysiology of ITP, including its relation to the aberrant T-cell immunity, has previously not been investigated." @default.
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• W4380927714 date "2023-07-01" @default.
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• W4380927714 title "When immune thrombocytopenia gets on your nerves: β2-adrenergic receptor agonists as a potential treatment?" @default.
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• W4380927714 doi "https://doi.org/10.1016/j.jtha.2023.04.024" @default.
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