Complement activation profile in adult primary immune thrombocytopenia

Complement activation has been reported in primary immune thrombocytopenia (ITP); however, its clinical relevance remains poorly understood. This study aimed to clarify the association between complement activation and various biomarkers and the clinical characteristics of patients with ITP. Forty patients with ITP were enrolled in this study. Platelet-bound C1q, C3d, and C4d were elevated in a substantial population of patients with ITP compared with healthy controls with highly variable titers, Hierarchical clustering analysis showed that patients with ITP could be classified into three groups according to their levels: all negative (Cluster 1), elevated C1q with negative to low C3d and C4d (Cluster 2), and high C3d and C4d (Cluster 3). Platelet-associated (PA) IgM was detected mostly in Cluster 3, and PA-IgG was detected in Clusters 2 and 3. The number of cases refractory to first-line therapy increased in Clusters 2 and 3. Complement deposition on the platelet surface correlated with an increased percentage of immature platelets. There was no significant association between complement activation and PA-GPIIb/IIIa or -GPIb/IX antibodies, C1s ratio in the plasma, and fatigue score. Our results suggest that PA-IgG and PA-IgM contribute differentially to the complement activation profile on the platelet surface, and are associated with increase in platelet turnover, characterizing a distinct subset of ITP patients with complement activation. Our findings also may provide a rationale for stratifying patients in future clinical trials of complement-targeted therapies.