High prevalence of hereditary thrombotic thrombocytopenic purpura in central Norway: from clinical observation to evidence.

UNLABELLED: Essentials The population prevalence of hereditary thrombotic thrombocytopenic purpura (TTP) is unknown. We studied the prevalence of hereditary TTP and population frequencies of two ADAMTS-13 mutations. A high frequency of hereditary TTP related to ADAMTS-13 mutation c.4143_4144dupA was found. Vicinity of ABO blood group and ADAMTS-13 loci may facilitate screening of ADAMTS-13 mutations. SUMMARY: Background Hereditary thrombotic thrombocytopenic purpura (TTP) caused by ADAMTS-13 mutations is a rare, but serious condition. The prevalence is unknown, but it seems to be high in Norway. Objectives To identify all patients with hereditary TTP in central Norway and to investigate the prevalence of hereditary TTP and the population frequencies of two common ADAMTS-13 mutations. Patients/Methods Patients were identified in a cross-sectional study within the Central Norway Health Region by means of three different search strategies. Frequencies of ADAMTS-13 mutations, c.4143_4144dupA and c.3178 C>T (p.R1060W), were investigated in a population-based cohort (500 alleles) and in healthy blood donors (2104 alleles) by taking advantage of the close neighborhood of the ADAMTS-13 and ABO blood group gene loci. The observed prevalence of hereditary TTP was compared with the rates of ADAMTS-13 mutation carriers in different geographical regions. Results We identified 11 families with hereditary TTP in central Norway during the 10-year study period. The prevalence of hereditary TTP in central Norway was 16.7 × 10(-6) persons. The most prevalent mutation was c.4143_4144dupA, accounting for two-thirds of disease causing alleles among patients and having an allelic frequency of 0.33% in the central, 0.10% in the western, and 0.04% in the southeastern Norwegian population. The allelic frequency of c.3178 C>T (p.R1060W) in the population was even higher (0.3-1%), but this mutation was infrequent among patients, with no homozygous cases. Conclusions We found a high prevalence of hereditary TTP in central Norway and an apparently different penetrance of ADAMTS-13 mutations.

Hereditary thrombotic thrombocytopenic purpura and the hereditary TTP registry.

Hereditary thrombotic thrombocytopenic purpura, Upshaw-Schulman syndrome, ADAMTS13 Hereditary thrombotic thrombocytopenic purpura (TTP), also known as Upshaw-Schulman syndrome, is a rare recessively inherited disease. Underlying is a severe constitutional deficiency of the von Willebrand factor-cleaving protease, ADAMTS13, due to compound heterozygous or homozygous mutations in the ADAMTS13 gene. The clinical picture is variable and more and more patients with an adult-onset are diagnosed. In the majority of countries the only available treatment is plasma, which when administered regularly can efficiently prevent acute disease bouts. The decision to initiate regular prophylaxis is often not easy, as evidence based guidelines and long term outcome data are lacking. Through the hereditary TTP registry (www.ttpregistry.net, ClinicalTrials.gov identifier: NCT01257269), which was initiated in 2006 and is open to all patients diagnosed with Upshaw-Schulman syndrome and their family members, we aim to gain further information and insights into this rare disease, which eventually will help to improve clinical management of affected patients.

Nephrotoxicity in goats caused by dosing with a water extract from the stems of Narthecium ossifragum plants.

Seven goats were given a single dose of an aqueous extract derived from 30 g (wet weight) of Narthecium ossifragum per kg liveweight. Their serum creatinine and urea concentrations increased to day 5 but then fell to normal by day 10. Serum magnesium increased to day 4 and decreased to normal by day 9. Their serum calcium concentration was lower than normal on days 4, 5 and 6. Histopathological examination of the kidneys of goats killed or found dead 2, 4, 6, 8, 11 or 16 days after dosing revealed tubular epithelial cell degeneration and necrosis. Regeneration of the tubular epithelium and signs of interstitial fibroplast proliferation and fibrosis could be seen in animals killed on days 8, 11, 16 and 42. No signs of liver damage were observed in 3 goats dosed with the insoluble plant material from 40 g (wet weight) Narthecium ossifragum per kg liveweight. The total dose was divided into three doses, which were given intraruminally within 7 h. The activities of aspartate aminotransferase, gamma-glutamyltransferase and glutamate dehydrogenase remained within the normal range in all 10 goats after dosing.

Further studies on the presence, qualities and effects of the toxic principles from Narthecium ossifragum plants.

One calf was dosed during one day with an aqueous extract from 3.0 kg (wet weight) of Narthecium ossifragum and another was dosed on the same day with the insoluble plant residue. The concentrations of serum creatinine and magnesium increased only in the calf dosed with the aqueous extract, while the activity of glutamate dehydrogenase increased only in the serum of the calf dosed with the plant residue, so differentiating the nephrotoxic and hepatotoxic principles as water-soluble and water-insoluble compounds, respectively. One calf was dosed with 30 g (wet weight) N. ossifragum flower stems per kg live weight during one day and another was dosed with 30 g (wet weight) N. ossifragum leaves per kg live weight on the same day. The serum creatinine and urea concentrations and also the activities of glutamate dehydrogenase, aspartate aminotransferase and gamma-glutamyltransferase in the serum increased in the calf dosed with the flower stems, whereas there was only a slight temporary increase in the creatinine concentration in serum from the calf dosed with the leaves. However, histopathological examination of the kidneys of the calf dosed with the flower stems revealed severe tubular necrosis and degeneration. It therefore appears that both the toxic principles are present in the flower stems of N. ossifragum rather than in its leaves. The serum creatinine concentration was significantly increased in a non-ruminating calf dosed with an aqueous extract from 32 g (wet weight) N. ossifragum per kg liveweight during one day, showing the intrinsic nephrotoxicity of the plant.