Inhibition of macrophage neuraminidase 1 protects against immune thrombocytopenia by limiting platelet clearance

Immune thrombocytopenia purpura (ITP) is an autoimmune disorder characterized by a reduction in circulating platelet levels, primarily due to generation of autoantibodies to platelet surface antigens followed by their spleen macrophage-mediated clearance. Emerging evidence implicates neuraminidase (sialidase) enzymes including neuraminidase 1 (NEU1) in platelet clearance and ITP severity; however, the underlying cellular mechanisms remain unknown. Using tissue-specific NEU1 knockout mouse models, we studied the contribution of platelet and macrophage NEU1 to ITP pathogenesis and evaluated whether pharmacological inhibition of NEU1 could preserve platelet counts in a murine ITP model. Constitutive and macrophage-specific, but not platelet-specific, NEU1 knockout mice showed a protection against reduction of platelet counts in the passive ITP model suggesting that macrophage, but not platelet, NEU1 promotes platelet clearance. Genetic deletion or pharmacological blockade of macrophage NEU1 also reduced platelet phagocytosis by cultured macrophages in vitro. The selective NEU1 inhibitor CG33301 protected mice against anti-CD41a antibody-induced thrombocytopenia and showed a higher efficacy compared to pan neuraminidase inhibitor oseltamivir phosphate. Our results demonstrate that the macrophage pool of NEU1 plays a central role in platelet clearance by splenocytes during ITP by activating their phagocytosis and suggest that selective NEU1 inhibition may be a promising therapeutic strategy for this disease.