Platelet Membranes/Drug Combination as Antigenic Stimulus for Lymphocytes of Patients with Autoimmune Quinine- or Quinidine-Dependent Purpura
Quinine- or quinidine-induced thrombocytopaenia appears due to synthesis of an IgG antibody which causes platelet damage. We have studied the nature of the antigenic stimulus in this disorder by measuring the incorporation of 3H-thymidine into DNA of normal or patients’ lymphocytes cultured in the presence of the drugs in comparison to known mitogens (phytohaemagglutin-P or pokeweed mitogen).’ Patients’ lymphocytes responded normally to mitogens but not to the drugs, heterologous or autologous platelets alone. However, significant thymidine uptake occurred when patients’ lymphocytes were cultured with autologous or heterologous platelets in the presence of therapeutic concentrations of the drugs (2.4 x 10-4 . 2.4 x 10-8M). Lymphocyte transformation was maximal after 7 days (up to 93% of phytohaemagglutinin-induced response), suggesting B cell involvement. Supernatants from platelets which had undergone the release reaction could not replace platelets while membranes were more effective than platelets on-a protein basis. Control lymphocytes from 20 normals and 8 patients with non-drug-induced thrombocytopaenia did not demonstrate transformation by the drugs and platelets. Thus the drug in combination with a platelet membrane component act as an antigenic stimulus only for sensitised lymphocytes.