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Recombinant ADAMTS-13 for congenital and immune thrombotic thrombocytopenic purpura in pregnancy

Lara Howells1, Maxine Lissack2, Clare Wykes3

  • 1Department of Haematology, University College London Hospitals, London, United Kingdom.

Blood Vessels, Thrombosis & Hemostasis
|October 23, 2025
PubMed

Insights

Recombinant ADAMTS-13 (rADAMTS-13) offers a novel treatment for thrombotic thrombocytopenic purpura (TTP) during pregnancy. This approach achieved excellent outcomes in congenital and immune-mediated TTP cases, improving fetomaternal health.

Area of Science:

  • Hematology
  • Reproductive Medicine
  • Genetics

Background:

  • Thrombotic thrombocytopenic purpura (TTP) is a critical condition.
  • Congenital TTP (cTTP) and immune-mediated TTP (iTTP) stem from ADAMTS-13 enzyme issues.
  • Pregnancy can exacerbate both cTTP and iTTP.

Purpose of the Study:

  • To evaluate recombinant ADAMTS-13 (rADAMTS-13) in managing TTP during pregnancy.
  • To present case studies of TTP treatment in pregnant individuals using rADAMTS-13.

Main Methods:

  • Case series involving three pregnant women with TTP.
  • Treatment with rADAMTS-13 for congenital TTP throughout pregnancy.
  • rADAMTS-13 used as an alternative to plasma exchange for refractory immune-mediated TTP.

Main Results:

  • Two pregnancies with cTTP successfully managed with rADAMTS-13.
  • One case of refractory iTTP treated effectively with rADAMTS-13, replacing plasma exchange.
  • All three pregnancies achieved excellent fetomaternal outcomes.

Conclusions:

  • Recombinant ADAMTS-13 (rADAMTS-13) is a viable and effective therapeutic option for TTP in pregnancy.
  • rADAMTS-13 demonstrates promise in improving outcomes for both congenital and immune-mediated TTP during gestation.
  • This study highlights a significant advancement in managing TTP during pregnancy, ensuring positive maternal and fetal health.

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