Wolfgang Miesbach: Why B-Cell Depletion Is Not Always Enough in Immune Thrombocytopenia
Wolfgang Miesbach, Professor of Medicine at Frankfurt University Hospital, shared on LinkedIn about a recent article by John Semple, published in JTH, adding:
”How platelets are lost — autoantibodies, cytotoxic CD8⁺ T cells (granzyme/perforin), complement, Fc-independent desialylation via the Ashwell-Morell receptor and impaired megakaryopoiesis (explaining normal TPO levels – TPO-RA success).
- When tolerance breaks down — Th1/Th17 skewing, Treg defects, dysfunctional Bregs and MDSCs – systemic immunoregulatory failure, conceptually akin to SLE.
- Why it starts — genetics, infections (H. pylori), microbiome and environment.
- What this means — durable remission may require restoring immune balance, not just suppressing effector pathways. B-cell depletion alone may fall short where T-cell cytotoxicity dominates.
A clear move toward precision care, with biomarkers, complement signatures and glycosylation patterns guiding therapy.
In Journal of Thrombosis and Haemostasis (JTH), John Semple reflects on the new review by Kerry Hillier, et al. — reframing immune thrombocytopenia (ITP) from a purely antibody-mediated cytopenia into a multifaceted syndrome of immune dysregulation.”
Title: Understanding immune thrombocytopenia pathophysiology has come a long way
Authors: John Semple
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