In proof-of-concept experiments, researchers have highlighted a potential therapy for a rare but potentially deadly blood-clotting disorder, TTP. The researchers deliver this therapeutic enzyme via the cellular equivalent of a Trojan Horse, using tiny blood cell platelets as their protective delivery vehicle, with a key enzyme hidden inside.

TTP, or thrombotic thrombocytopenic purpura, appears as blood clots in small arterioles throughout the body, particularly in the brain, heart, pancreas, and kidneys, resulting in organ damage. The onset of symptoms can be sudden and nonspecific, and the in-hospital death rate remains as high as 20 percent.

TTP is caused by lack of enzyme ADAMTS13 in the blood, most often because of autoantibodies against this enzyme. ADAMTS13normallyacts to cleave a large protein called von Wille brand factor, which is involved in blood clotting. Loss of the enzyme allows destructive microvascular clots to form in important organ tissues.

UAB, led by X. Long Zheng, MD, Robert B. Adams Professor and Division Director of Laboratory Medicine in the Department of Pathology at UAB's School of Medicine, have reported that platelets can spontaneously take up ADAMTS13. The enzyme stays stable in those cells, and the platelets can effectively deliver the enzyme where it is needed.

"Our results for the first time demonstrate that transfusion of rADAMTS13-loaded platelets may be a novel and potentially effective therapeutic approach for arterial thrombosis, associated with congenital and immune-mediated TTP," Zheng said. "This novel approach could be translated to patient care once rADAMTS13 receives an approval from the US Food and Drug Administration for therapy of congenital TTP."

Arterial thrombosis

In previous work published in Blood in 2015, the UAB researchers created transgenic mice, where human rADAMTS13 was expressed exclusively in the platelets. In a background of mice lacking their own ADAMTS13 enzyme, the rADAMTS13-loaded platelets blocked arterial thrombosis and prevented TTP in the mouse model.

Four key experiments – described in a study published in the American Heart Association journal  Arteriosclerosis, Thrombosis and Vascular Biology, or  ATVB  – answered those questions.

First, the researchers incubated isolated human platelets – which are one-fifth the diameter of red blood cells and have a normal function to stop bleeding from blood vessels – for up to two hours in varying concentrations of rADAMTS13 at varying temperatures.

At the cold temperature of 4 C, the platelets did not take up rADAMTS13. But at both 25 and 37 C, the platelets took up rADAMTS13, apparently through endocytosis, in a concentration-dependent manner.

Second, they showed that the rADAMTS13 taken up by the human platelets remained intact and enzymatically active against von Wille brand factor, a key ingredient for platelet adhesion and aggregation. Also, the rADAMTS13 was releasable under arterial shear conditions that cause platelet aggregates to break, as simulated with microfluidic channels.

Third, using microfluidic channels coated with to fibrillar collagen that simulates the flow in arterioles and presents a surface for clot formation, they showed that addition of rADAMTS13-loaded platelets to normal, TTP-patient and reconstituted-TTP blood dramatically inhibited in vitro thrombus formation under arterial flow.

Finally, they showed that transfusion of the rADAMTS13-loaded mouse platelets into genetically engineered mice lacking ADAMTS13 dramatically inhibited thrombus formation in abdominal arterioles after injury.