Possible mechanism of aggregation of blood platelets by adenosine diphosphate

Blood cells: an historical account of the roles of purinergic signalling

The involvement of purinergic signalling in the physiology of erythrocytes, platelets and leukocytes was recognised early. The release of ATP and the expression of purinoceptors and ectonucleotidases on erythrocytes in health and disease are reviewed. The release of ATP and ADP from platelets and the expression and roles of P1, P2Y(1), P2Y(12) and P2X1 receptors on platelets are described. P2Y(1) and P2X(1) receptors mediate changes in platelet shape, while P2Y(12) receptors mediate platelet aggregation. The changes in the role of purinergic signalling in a variety of disease conditions are considered. The successful use of P2Y(12) receptor antagonists, such as clopidogrel and ticagrelor, for the treatment of thrombosis, myocardial infarction and stroke is discussed.

Cellular Distribution and Functions of P2 Receptor Subtypes in Different Systems

This review is aimed at providing readers with a comprehensive reference article about the distribution and function of P2 receptors in all the organs, tissues, and cells in the body. Each section provides an account of the early history of purinergic signaling in the organ?cell up to 1994, then summarizes subsequent evidence for the presence of P2X and P2Y receptor subtype mRNA and proteins as well as functional data, all fully referenced. A section is included describing the plasticity of expression of P2 receptors during development and aging as well as in various pathophysiological conditions. Finally, there is some discussion of possible future developments in the purinergic signaling field.

Role of catalytic function in the antiplatelet activity of phospholipase A2 cobra (Naja naja naja) venom

Three acidic phospholipases A2 from Indian cobra (Naja naja naja) venom inhibited platelet aggregation in platelet rich plasma induced separately by ADP, collagen and epinephrine with different potencies. The order of inhibition was epinephrine > collagen > ADP. They did not inhibit platelet aggregation induced by arachidonic acid (10 microM). The inhibition was dependent on concentration of the protein and the time of incubation of the phospholipases A2 with platelet rich plasma. Parabromophenacyl bromide modified PLA2 enzymes lost their enzymatic activity as well as platelet aggregation inhibition activity suggesting the involvement of catalytic function in platelet aggregation inhibitory activity.

Ecto-ATPases: identities and functions

Ecto-ATPases are ubiquitous in eukaryotic cells. They hydrolyze extracellular nucleoside tri- and/or diphosphates, and, when isolated, they exhibit E-type ATPase activity, (that is, the activity is dependent on Ca2+ or Mg2+, and it is insensitive to specific inhibitors of P-type, F-type, and V-type ATPases; in addition, several nucleotide tri- and/or diphosphates are hydrolysed, but nucleoside monophosphates and nonnucleoside phosphates are not substrates). Ecto-ATPases are glycoproteins; they do not form a phosphorylated intermediate during the catalytic cycle; they seem to have an extremely high turnover number; and they present specific experimental problems during solubilization and purification. The T-tubule Mg2+-ATPase belongs to this group of enzymes, which may serve at least two major roles: they terminate ATP/ADP-induced signal transduction and participate in adenosine recycling. Several other functions have been discussed and identity to certain cell adhesion molecules and the bile acid transport protein was suggested on the basis of cDNA clone isolation and immunological work.

Functional and biochemical evidence of a specific adenosine A2/Ra receptor on human platelets

5'-N-ethylcarboxamideadenosine (NECA) greater than 2-chloroadenosine greater than adenosine greater than (-)-N6-(R-phenyl-isopropyl)-adenosine [(-)-R-PIA] greater than (+)-N6-(S-phenyl-isopropyl)-adenosine [(+)-S-PIA] inhibited in vitro human platelet aggregation in a dose-dependent fashion. 6-nitrobenzylthioinosine and dipyridamole, which inhibit adenosine uptake, and erythro-9-(2-hydroxy-3-nonyl)-adenine, which blocks adenosine metabolism, did not impair the inhibition induced by NECA and adenosine. 8-phenyltheophylline and theophylline, two competitive antagonists of adenosine receptors, blocked the inhibition of platelet aggregation caused by NECA and adenosine. NECA greater than 2-chloroadenosine greater than adenosine greater than (-)-R-PIA greater than (+)-S-PIA increased platelet cyclic adenosine monophosphate (cAMP) levels in a dose-dependent fashion. A significant linear correlation (r = 0.70, p less than 0.001) was found between the increase of platelet cAMP and the inhibition of platelet aggregation induced by adenosine and its analogs. 8-phenyltheophylline, which is a competitive antagonist of adenosine in platelets, also blocked the cAMP accumulation caused by NECA. These data suggest that NECA and other adenosine analogs activate a specific cell surface adenylate cyclase-linked adenosine receptor whose properties are similar to those of an adenosine A2/Ra receptor.

[Primary shape change of platelets in vitro (author's transl)]

Studies with interference contrast microscopy reveal that platelets undergo a typical shape change within 30--60' after venepuncture, i.e. swelling, formation of large tentacles, tiny protrusions and vesicles at the platelet surface. This "shape change" can be observed in citrated blood and PRP, heparinized blood and EDTA-blood as well. It is enhanced by low incubation temperatures (4 degrees C, 10 degrees C) and delayed at 37 degrees C as compared with room temperature. An increased number of primarily shape changed platelets is found if platelets are strongly mechanically irritated at blood sampling. The shape change is partly reversible in vitro, it is completely or almost completely reversible in vivo. Some antiaggregating agents inhibit the in vitro shape change at varying degrees (Bencyclan, SH 869 greater than ASA greater than D-Propranolol). The shape change is partly inhibited after oral or i.v. administration of ASA. A typical transformation of platelets into "spheric" forms can be observed following the addition of Bencyclan, SH 869 and D-Propranolol to PRP in vitro. The spontaneous "primary shape change" which occurs in PRP or blood after blood sampling is probably different from the secondary ADP-induced shape change. The primary shape change may influence the results of different platelet function and aggregating tests. The shape change kinetics of "healthy" subjects and patients with Hodgkin's disease differ significantly. The described method may gain more clinical interest in the future.

Thrombus formation and endothelial alterations in microarterial anastomoses

The sequential hematological and endothelial responses in the postoperative period after end-to-side arterial anastomosis in 1- to 1.3-mm vessels were assessed by scanning electron microscopy. Two minutes after restoration of flow, an amorphous coating covered the vessel lumen around the suture line, and oozing of blood from the suture line ceased. Within 15 minutes, a partially occluding thrombus was present, which was maximal at the anastomotic bifurcation point. The thrombus underwent partial lysis or embolization within 30 minutes, and gross intraluminal thrombi did not recur. The initial thrombi that formed within 2 minutes were composed of platelets and erythrocytes in a loose reticular fibrin network, but the intraluminal thrombi present at the branch point 15 minutes after flow restoration appeared to be composed solely of platelets. Thrombi that did not undergo complete dissolution had a loss of distinct cellular elements at later time intervals. The fibrin-platelet matrix coating the lumen remained unchanged during the initial 24 hours. When examined at 9 days, normal endothelium was present throughout the vessel with the exception of the suture line, which remained covered by a smooth coagulum. This sequence of events suggest that if surgical manipulation is to result in complete occlusion of the anastomosis, it will likely occur in the initial 30 minutes after resumption of blood flow. Anticoagulant regimens were evaluated. Pretreatment with aspirin and intraoperative heparin irrigation of the vessel lumen were not beneficial in altering the quantity of thrombus. All systemic heparin regimes tested resulted in a quantitative decrease of thrombotic material. Five minutes of intravenous heparin therapy after resumption of blood flow was as effective as long-term heparin in decreasing the transient intraluminal thrombotic response.

[The influence of insulin, glucose and other monosaccharides on the platelet functions (author's transl)]

In vitro investigations were carried out on the action of insulin, glucose, xylose, galactose, fructose and sorbitol on the platelet aggregation test according to Breddin, on the ADP- and collagen-inducced aggregation and the release of platelet factor 4 as well as on the retraction. When incubating platelet-rich plasma with insulin and glucose simultaneously, a marked inhibition of the ADP- or collagen-induced platelet aggregation and release reaction results. Insulin as well as glucose impaired the platelet function only at high concentrations, this inhibition however did not reach that of a combination of both. Fructose, xylose and sorbitol exerted no significant inhibitory effects. In contrast to the prevented aggregation, the retraction was enhanced. As the causal mechanism for the inhibition of the platelet function the Crabtree effect is discussed.

A clinical and experimental study of platelet function in chronic renal failure

Coagulation and platelet function studies were performed on 24 normal subjects and 29 patients with chronic renal failure due to various causes. Thrombocytopenia was uncommon in the uraemic patients but there was reduced platelet retention in glass bead columns and platelet aggregation with adenosine diphosphate (ADP) and thrombin was slower and less complete than normal. The rate of platelet disaggregation in uraemic patients was significantly reduced. The abnormalities tended to be more severe in more uraemic subjects. In normal subjects no inter-relationships were observed between the various measurements of platelet activity. In patients there were significant interrelationships between the measurements of platelet aggregation with ADP and thrombin and between the measurements of aggregation and retention in glass bead columns. It is suggested that if a common pathway is involved in these reactions it is adversely affected in uraemia. Plasma coagulation defects were uncommon and present in only five of the uraemic subjects. Impaired prothrombin consumption apparently due to defective platelet function was present in half the patients but was not detected by a kaolin activation method. Although platelet coagulation function was activated during ADP aggregation and disaggregation in normal and uraemic subjects, it did not correlate in the latter with impairment of aggregation. It is suggested that aggregation and activation of platelet coagulant activity are not necessarily related aspects of platelet function. An effect of uraemic plasma on normal platelets was demonstrated by mixing experiments consistent with a humoral cause for the uraemic platelet defects.

Relationships between platelet function tests in normal and uraemic subjects

IN TESTS OF PLATELET FUNCTION IN NORMAL SUBJECTS, THE FOLLOWING RELATIONSHIPS WERE FOUND: the greater the platelet adhesiveness the less the ability to disaggregate after challenge with adenosine diphosphate (ADP), and the greater the disaggregation after ADP, the longer the clotting time in the test for platelet factor 3 availability. Such correlations were disturbed in uraemic patients.