Immune thrombocytopenia (ITP) is the most common acquired primary hemostatic disorder in dogs. Immune thrombocytopenia less commonly affects cats but is an important cause of mortality and treatment-associated morbidity in both species. Immune thrombocytopenia remains a diagnosis of exclusion for which diagnostic guidelines are lacking. Primary, or non-associative, ITP refers to autoimmune platelet destruction. Secondary, or associative, ITP arises in response to an underlying disease trigger. However, evidence for which comorbidities serve as ITP triggers has not been systematically evaluated. To identify key diagnostic steps for ITP and important comorbidities associated with secondary ITP, we developed 12 Population Evaluation/Exposure Comparison Outcome (PECO) format questions. These questions were addressed by evidence evaluators utilizing a literature pool of 287 articles identified by the panelists using a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations that then were integrated by diagnosis and comorbidity domain chairs. The revised PECO responses underwent a Delphi survey process to reach consensus on final guidelines. A combination of panel expertise and PECO responses were employed to develop algorithms for diagnosis of ITP in dogs and cats, which also underwent 4 iterations of Delphi review. Comorbidity evidence evaluators employed an integrated measure of evidence (IME) tool to determine evidence quality for each comorbidity; IME values combined with evidence summaries for each comorbidity were integrated to develop ITP screening recommendations, which also were subjected to Delphi review. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The final consensus statement provides clinical guidelines for the diagnosis of, and underlying disease screening for, ITP in dogs and cats. The systematic consensus process identified numerous knowledge gaps that should guide future studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Treatment of Immune Thrombocytopenia.

Extracellular vesicles (EVs) derived from mesenchymal stromal cells (MSC-EVs) have been proposed as a novel therapeutic tool with numerous clinically related advantages. However, their characteristics and functionality are dependent on the source of MSCs and their cell culture conditions. Fetal bovine serum (FBS) provides a source of nutrients and growth factors to the cultured cells. However, certain pitfalls are associated with its supplementation to the culture media, including introduction of exogenous FBS-derived EVs to the cultured cells. Thus, recent practices recommend utilization of serum-free (SF) media or EV-depleted FBS. On the contrary, evidence suggests that the immunomodulatory ability of MSC-EVs can be improved by exposing MSCs to an inflammatory (IF) environment. The objective of this study was to (1) compare EVs isolated from two tissue sources of MSCs that were exposed to various cell culture conditions and (2) to evaluate their anti-inflammatory effects. Bone marrow-derived mesenchymal stromal cells (BM-MSCs) and umbilical cord-derived mesenchymal stromal cells (UC-MSCs) were exposed to either a SF media environment, an IF environment, or media supplemented with 5% EV-depleted FBS. Following isolation of MSC-EVs, the isolates were quantified and evaluated for particle size, phenotypic changes, and their immunomodulatory potential. A statistically significant difference was not identified on the yield and protein concentration of different isolates of EVs from BM-MSCs and UC-MSCs, and all isolates had a circular appearance as evaluated via electron microscopy. A significant difference was identified on the phenotype of different EVs isolates; however, all isolates expressed classical markers such as CD9, CD63, and CD81. The addition of BM-derived MSC-EVs from FBS environment or UC-derived MSC-EVs from IF environment resulted in statistically significant downregulation of IL-6 messenger RNA (mRNA) in stimulated leukocytes. This study confirms that EVs produced by different MSC sources and cell culture conditions affect their phenotype and their immunomodulatory capacities.

The extracellular vesicles (EVs) secreted by mesenchymal stromal cells (MSC-EVs) exhibit immunoregulatory functions dependent on their parent cells. MSC-EVs are promising candidates for treating neuroinflammation in neurological diseases due to their acellular nature and their ability to reach the central nervous system. However, the conditions of MSCs for producing EVs with the highest anti-inflammatory efficacy are still unknown. Therefore, the first objective was to study the characteristics of the EVs produced by MSCs cultured in different conditions. The second objective was to evaluate the in vitro anti-inflammatory properties of those EVs in feline stimulated mixed glia. Umbilical cord-derived MSCs were treated with serum-free (SF) media, inflammatory (IF) media, or media supplemented with 5% EV-depleted fetal bovine serum (FBS). The isolated MSC-EVs were characterized by particle size and yield, and their anti-inflammatory ability was evaluated in lipopolysaccharide (LPS) stimulated feline mixed glia. All EV isolates were <160 nm, and the primary mixed glia consisted of microglia, astrocytes, neurons, and endothelial cells. Our results indicate that IF-EVs statistically significantly decreased the production of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α) and downregulated the transcription of the, nuclear factor kappa B p65 subunit in inflammatory mixed glia after 48 hours. In addition, SF- and FBS-EVs significantly reduced in vitro the secretion of IL-6 after 48 hours , but only SF-EVs achieved a significant effect on inhibiting the expression of p65 at 48 hours. Moreover, messenger RNA (mRNA) levels of inducible nitric oxide synthase (iNOS) were significantly decreased following treatment with SF-EV for 24 hours. This study demonstrates that MSC culture conditions affect the therapeutic potential of the secreted EVs in feline mixed glia.