Moschcowitz, Multimers, and Metalloprotease

In 1924, Dr. Eli Moschcowitz described the abrupt onset of petechiae and pallor, followed rapidly by paralysis, coma, and death, in a 16-year-old girl. 1 Terminal arterioles and capillaries in the doomed teenager were occluded by hyaline thrombi, later determined to consist mostly of platelets without perivascular inflammation or endothelial desquamation. Moschcowitz suspected a “powerful poison which had both agglutinative and hemolytic properties” 1 as the cause of this frightening new disease, now known as thrombotic thrombocytopenic purpura. In 1982, unusually large multimers of von Willebrand factor found in the plasma of patients with chronic relapsing thrombotic thrombocytopenic purpura were proposed as . . .