Platelet rescue by macrophage depletion in obese ADAMTS‐13‐deficient mice at risk of thrombotic thrombocytopenic purpura

Unlabelled BoxEssentials•Obesity is a potential risk factor for development of thrombotic thrombocytopenic purpura (TTP).•Obese ADAMTS‐13‐deficient mice were triggered with von Willebrand factor (VWF).•Depletion of hepatic and splenic macrophages protects against thrombocytopenia in this model.•VWF enhances phagocytosis of platelets by macrophages, dose‐dependently. Thrombotic thrombocytopenic purpura (TTP) is caused by the absence of ADAMTS‐13 activity. Thrombocytopenia is presumably related to the formation of microthrombi rich in von Willebrand factor (VWF) and platelets. Obesity may be a risk factor for TTP; it is associated with abundance of macrophages that may phagocytose platelets. To evaluate the role of obesity and ADAMTS‐13 deficiency in TTP, and to establish whether macrophages contribute to thrombocytopenia. Lean or obese ADAMTS‐13‐deficient ( Adamts‐13 −/− ) and wild‐type (WT) mice were injected with 250 U kg −1 of recombinant human VWF (rVWF), and TTP characteristics were evaluated 24 h later. In separate experiments, macrophages were depleted in the liver and spleen of lean and obese WT or Adamts‐13 −/− mice by injection of clodronate‐liposomes, 48 h before injection of rVWF. Obese Adamts‐13 −/− mice had a lower platelet count than their lean counterparts, suggesting that they might be more susceptible to TTP development. Lean Adamts‐13 −/− mice triggered with a threshold dose of rVWF did not develop TTP, whereas typical TTP symptoms developed in obese Adamts‐13 −/− mice, including severe thrombocytopenia and higher lactate dehydrogenase (LDH) levels. Removal of hepatic and splenic macrophages by clodronate injection in obese Adamts‐13 −/− mice before treatment with rVWF preserved the platelet counts measured 24 h after the trigger. In vitro experiments with cultured macrophages confirmed a VWF dose‐dependent increase of platelet phagocytosis. Obese Adamts‐13 −/− mice are more susceptible to the induction of TTP‐related thrombocytopenia than lean mice. Phagocytosis of platelets by macrophages contributes to thrombocytopenia after rVWF injection in this model.