CHARACTERIZATION OF SERUM PROSTACYCLIN BINDING DEFECTS IN THROMBOTIC THROMBOCYTOPENIC PURPURA (TTP)
To understand further the pathophysiologic significance of PGI2 binding defects in TTP, we measured serum PGI2 binding activity in 12 TTP patients and matched controls. Serum binding of PGI2 was measured by Sephadex G-25 gel filtration. The mean binding activity in 33 healthy subjects ages 20-40 years was 39.9 ± S.D 4.4%. The mean value of TTP (n=12) was significantly lower (26.2 ± 4.1, P <0.01). Serum from 5 severe ITP, 5 DIC and 5 thrombocythemia exhibited normal binding ctivity. To determine the binding kinetics we utilized 3H-iloprost in a gel filtration method described by Hirose and Kano (Biochim. Biophys. Acta. 751:376, 1971). To 50 mg of Sephadex G-50, 0.435 ml of 50mM Tris buffer (pH 7.4) was added. After swelling of the gel was completed 0.195 ml of the buffer solution containing serum and 3H-iloprost was added. The sample was mixed and the protein and ligand concentration was determined. The computer fitting of the binding isotherm according to the originally proposed equation yielded a binding curve consistent with a single class of binding sites. The Kd value of normal serum was 70 μM and the B 48 nmol/ml. Acute TTP serum exhibited a reduced bindingXaffinity (Kd 236 μM) and a slightly elevated capacity (Bmax 85 nmols/ml). The binding parameters improved following successful treatment but the Kd remained subnormal (120 μM). These data indicate that reduced PGI2 binding activity is due to lower affinity of the PGI2 binding proteins. The relationship between defective PGI2 binding activity and PGI2 production was then evaluated. Serial serum and 24 hour urine were collected. Urinary samples were extracted and their 6-Keto-PGF1α (6KP) and thromboxane TXB2 levels were measured by RIA. TTP patients in remission had normal levels of urinary 6KP and TXB2 while urinary 6KP and TXB2 were elevated in relapsing TTP. Defective binding was noted when relapse began to occur while elevated 6KP and TXB2 were noted 48 hrs later. Both 6KP and TXB2 were normalized when the disease was controlled. Our findings indicate that defective PGI2 binding plays an important role in causing excessive platelet activation and platelet-vessel wall interaction in TTP.