Effects of thrombocytopenia and shear rate on neutrophil and platelet deposition on endothelial and medial arterial surfaces

Original article: low regulatory volume decrease rate in platelets from ischemic patients: a possible role for hepoxilin a(3) in thrombogenicity

Hepoxilin-A(3) (Hx-A(3)) is produced by platelets in response to shear-stress. It has an antithrombotic effect on platelets. A low Hx-A(3) level may contribute to the high thrombogenic state that exists in patients with acute coronary syndromes. Since we have previously demonstrated that the regulatory volume decrease (RVD) of human platelets exposed to hypotonic solutions is controlled by Hx-A(3) it is possible that the RVD rate reflects Hx-A(3) activity. In this study, the RVD rate of platelets taken from a healthy control group (n=21) was compared to that of patients with chronic ischemic heart disease (n=23), acute ischemic heart disease (n = 24) and acute myocardial infarction (MI, n = 29). The RVD rate of the control group was significantly higher than the other three groups (P < 0.001). The addition of 100 nM of Hx-A, to the platelets of eight patients with MI increased their RVD rate to that of the controls. Patients with diabetes mellitus or hypertension have the lowest RVD rates. Medications such as aspirin, heparin, and streptokinase did not affect the Hx-A(3) activity of platelets obtained from patients with ischemic heart disease. The results of the present study indicate that patients with acute ischemia may have a low level of platelet Hx-A(3) activity. This possible low level of Hx-A, activity may be associated with a failure to develop an antithrombotic reaction to the shear-stress forces generated during acute ischemia.

Safety and antithrombotic efficacy of moderate platelet count reduction by thrombopoietin inhibition in primates

Most heart attacks and strokes are caused by blood clots (thrombi) that block the vasculature. Because disease-causing arterial thrombosis depends on blood platelets, platelet inhibitors such as aspirin and clopidogrel effectively decrease the risk of thrombosis; however, they also impair platelet-dependent hemostasis that staunches bleeding from wounds and can therefore produce excessive bleeding. Experimental studies show that a reduction in the number of platelets also inhibits thrombosis, but these treatments also interfere with platelet function. Because normal hemostasis requires that the platelet concentration remain within a physiological range in the circulation, we evaluated whether lowering the number of circulating platelets--but only to a value still within the normal range--by inhibiting platelet formation in the bone marrow inhibits acute thrombogenesis in baboons. We reduced the platelet count with an inhibitor against the megakaryocyte-promoting hormone thrombopoietin and then showed that experimental occlusive thrombogenesis on collagen-coated vascular grafts was reduced, without impairment of primary hemostasis. These results suggest that suppressing platelet production without interfering with the hemostatic function of platelets may offer a safe alternative to current therapies for prevention of stroke and heart attack triggered by blood clotting.

Short-term induction of thrombocytopenia delays periodontal healing in rats with periodontal disease: participation of endostatin and vascular endothelial growth factor

BACKGROUND AND OBJECTIVE

Platelets contain factors, including VEGF and endostatin, that can modulate the healing process. We evaluated the effects of severe thrombocytopenia on periodontal healing in rats and determined the contribution of VEGF and endostatin to the healing process.

MATERIAL AND METHODS

Rats were distributed into three test groups and two control groups. Cotton ligatures were placed at the gingival margin level of the lower first molar in the test groups. Sham-operated rats and rats in one of the periodontitis groups were killed 15 days later. Rats in the remaining two periodontitis groups had the ligatures removed in order to study the spontaneous recovery from the periodontal disease 15 days later, and these rats were treated with rabbit antiplatelet serum, in order to induce thrombocytopenia, or normal rabbit serum. An additional group without ligatures received antiplatet serum in the same period.

RESULTS

After ligature removal, rats treated with normal rabbit serum showed reduced myeloperoxidase activity, decreased alveolar bone loss and increased numbers of blood vessels. Thrombocytopenia caused a delay in alveolar bone regeneration, a decrease in the number of vessels and a modest decrease in myeloperoxidase activity. In the rats with periodontitis, serum endostatin concentrations were slightly decreased and serum VEGF remained unchanged compared with sham-operated animals. After ligature removal, a significant VEGF increase and endostatin decrease were observed in the rats treated with normal rabbit serum. Thrombocytopenia led to a dramatic fall in both VEGF and endostatin concentrations.

CONCLUSION

Thrombocytopenia leads to a delay of periodontal healing in the situation of experimental periodontitis, which might be mediated in part by a decrease in the serum concentration of VEGF and endostatin derived from the platelets. However, other factors derived from the platelets may also have contributed to a delay of periodontal healing in the rats with thrombocytopenia.

A rapid, quantitative method for measuring leukocyte adhesion to normal and balloon-injured arteries in vitro

Many of the currently available techniques for quantifying leukocyte adhesion require monolayers of cells and are therefore unsuitable for use in ex vivo arterial tissue. Here we describe a rapid method to measure adhesion of leukocytes to intact artery strips and to determine the effect of artery injury on adhesiveness of leukocytes with and without activation. Leukocytes were isolated from rabbit blood, labelled with 51Cr, and added to the luminal face of the left and right subclavian arteries derived from the same animal. In some experiments the endothelium was removed before addition of leukocytes and in another series of experiments the artery was injured by inflating a balloon catheter within the lumen in vitro before leukocyte addition. After washing, the adhesion of labelled leukocytes was quantified by gamma counting. To determine localization of the leukocytes, some arteries were fixed in situ and examined microscopically, with confirmation of leukocyte identification by enzyme cytochemistry. The adhesion of leukocytes increased progressively during 60 min and was inhibited by reducing the temperature to 4 degrees C. Adhesion was increased by the nitric oxide synthase inhibitor L-NAME. Stretching the artery wall in vitro using a balloon catheter increased leukocyte adhesion within 1 h after injury. In contrast, this did not occur following simple arterial denudation. Histological examination of stained en face preparations and transverse sections of the subclavian arteries revealed loosely adherent granulocytic leukocytes on the endothelial surface. This technique is straightforward and allows accurate and rapid measurement of autologous leukocyte adhesion to normal and pathologically altered arteries ex vivo.

Inhibition of platelet-neutrophil interactions by Fucoidan reduces adhesion and vasoconstriction after acute arterial injury by angioplasty in pigs

The selectin family of cell-adhesion molecules contributes to the interactions of leukocytes and platelets at the site of vascular injury. Such interactions enhance inflammatory reactions and thrombus formation during the arterial response to injury. In this study, we investigated the effects of a selectin inhibitor (Fucoidan) on platelet and neutrophil interactions after arterial injury produced by angioplasty in pigs. [51Cr]-platelet deposition and [111In]-neutrophil adhesion were quantified on intact, mildly, and deeply injured carotid arterial segments, produced by balloon dilation in control (saline, n = 7) and Fucoidan-treated (i.v.; 1 mg/kg, n = 6; 5 mg/kg, n = 5) pigs. In the control group, platelet deposition (x10(6)/cm2) was influenced by the severity of injury and increased significantly (p < 0.05) from 0.06+/-0.06 on intact endothelium to 3.8+/-0.6 and 33.6+/-4.9 on mildly and deeply injured segments, respectively. Fucoidan, 1 mg/kg, had no significant effect, although doses of 5 mg/kg reduced platelet deposition by 73% on deeply injured segments. The level of neutrophil adhesion (x10(3)/cm2) was also influenced by the severity of injury: it increased in the control group from 8.8+/-2.5 on intact endothelium to 226.6+/-45.5 and 397.4+/-61.3 on mildly and deeply injured arterial segments, respectively (p < 0.05). Again, 1 mg/kg Fucoidan had no effect, although doses of 5 mg/kg reduced neutrophil adhesion by 92% and by 84% on mildly and deeply injured segments, respectively. The effects of Fucoidan were associated with a 51% decrease in the vasoconstrictive response at the site of arterial injury. However, Fucoidan had no significant effect on either platelet aggregation or activated clotting time (ACT). In the in vitro perfusion experiments, Fucoidan inhibited both isolated platelet, and neutrophil, adhesion to damaged arterial surfaces. This inhibition was more pronounced in experiments using mixed cell preparations, indicating that Fucoidan interferes with platelet and neutrophil interactions. These results highlight the importance of selectins in the acute physiopathologic reactions related to platelet-neutrophil interactions after arterial injury.

Platelets, neutrophils, and vasoconstriction after arterial injury by angioplasty in pigs: effects of MK-886, a leukotriene biosynthesis inhibitor

1 Leukotrienes constitute a class of potent bioactive mediators known to play a pivotal role in inflammation. Since their biosynthesis has been shown to be enhanced by platelet-neutrophil interactions, leukotrienes may be involved in these interactions and the arterial response to injury. Therefore, we investigated the effects of the selective leukotriene biosynthesis inhibitor 3-[1-(4-chlorobenzyl)-3-t-butyl-thio-5-isopropylindol-2-yl]-2,2- dimethylpropanoic acid (MK-886) on the acute thrombotic and vasomotor responses after arterial injury by angioplasty. 2 Carotid arterial injury was produced by balloon dilatation in control (molecusol vehicle; n=10) and treated (MK-886, 10 mg kg(-1), i.v.; n=9) pigs. The acute thrombotic reaction following deep arterial wall injury was quantified with 51Cr labelled platelets and 111In labelled neutrophils, and the vasomotor response was determined angiographically. 3 Platelet deposition at the site of deep arterial wall injury averaged 56.4+/-11.0x10(6) platelets cm(-2) in the control group, and was significantly reduced to 18.2+/-3.8x10(6) platelets cm(-2) (P<0.005) by treatment with MK-886. Neutrophil deposition was also decreased by MK-886, from 242.8+/-36.8 to 120.9+/-20.3x10(3) neutrophils cm(-2) (P<0.01). MK-886-treated animals had a significant decrease in the postangioplasty vasoconstrictive response at the site of endothelial injury distally, from 37.5+/-3.1% in the control group to 13.5+/-2.5% (P<0.001). 4 The effects of MK-886 were associated with a profound inhibition of ex vivo leukotriene B4 (LTB4) synthesis in blood stimulated by the calcium ionophore A23187 and a significant reduction of neutrophil aggregation in whole blood (P<0.01), whereas neutrophil superoxide anion production, serum thromboxane B2 and platelet aggregation in whole blood were not influenced. 5 The relevant effects of MK-886 are primarily related to inhibition of neutrophil function and suggest an important modulatory role for leukotrienes in the pathophysiological response associated with platelet and neutrophil interactions following arterial injury in vivo.

Host tissue damage by phagocytes

Evidence continues to accumulate on the importance of neutrophils (PMNs) and phagocytes in the causation of tissue and endothelial injury that frequently accompanies the inflammatory response. Increased production of superoxide anions in combination with decreased endothelial antioxidant activity may contribute to the development of vascular disease including atherosclerosis, vasospasm, diabetic vascular complications, tissue damage in ischemia-reperfusion, and hypotension. Free radicals generated in the vascular wall may act directly on smooth muscle or interact with each other thus producing biologically active endogenous mediators. Derangement of macrophage function may occur in conditions characterized by protein malnutrition, thus leading to failure to develop a specific immunoresponse and to an increase in the production of oxygen intermediate radicals, which may cause tissue damage. A local inflammatory response followed by endothelial cell activation could also facilitate migration of immunocompetent cells into the parenchyma of grafted organs and stimulate dendritic cells in the graft. There is now convincing evidence that excessive and prolonged production of NO contributes to tissue damage in septicemia, ischemia/reperfusion injury, and other inflammatory conditions. There is also increasing evidence that the complement system plays an important role in tissue damage in association with phagocytes, e.g., in ischemia/reperfusion injury, carcinogenesis, and aging. It can therefore be surmised that phagocytic cells may act both as "friends" and as "foes" and that they are important mediators of tissue damage in a variety of conditions.

Acute thrombogenicity of intact and injured natural blood conduits versus synthetic conduits: neutrophil, platelet, and fibrin(ogen) adsorption under various shear-rate conditions

We investigated the acute thrombogenicity of synthetic arterial prostheses compared to biological arterial surfaces in contact with flowing nonanticoagulated blood. The acute events following blood/surface interactions were quantified using 51Cr-platelet deposition, 111In-neutrophil adhesion, and 125I-fibrin(ogen) adsorption on expanded polytetrafluoroethylene (ePTFE) synthetic arterial surfaces (Goretex and Impra) and on intact and injured biological arterial surfaces in ex vivo superfusion flow chambers at low (424/sec) and high (3397/sec) shear rates for 5 min at 37 degrees C. The hematological parameters were determined, and surface analysis was assessed by scanning electron microscopy. At low shear rate, the retention on intact arterial surfaces averaged 3.7 +/- 0.7 x 10(6) platelets/cm2, 26.5 +/- 4.2 x 10(3) neutrophils/cm2, and 10.7 +/- 2.2 cpm of fibrin(ogen)/cm2; retention remained statistically similar at the high shear rate on both Goretex and Impra ePTFE surfaces. In contrast, the deposition of platelets and neutrophils on injured arterial surfaces was significantly higher and increased with shear rate, although the significant increase in fibrin(ogen) adsorption was not influenced by the shear rate. At shear rates characterized by patent and stenosed arteries, ePTFE arterial prostheses demonstrated a low level of thrombogenicity compared to injured arteries. This favorable comparison can be considered as the first requirement for their successful use in arterial substitution.

Endogenous nitric oxide release modulates mural platelet thrombosis and neutrophil-endothelium interactions under low and high shear conditions

Nitric oxide (NO) plays an important role in the maintenance of a constant vasodilator tone in the vasculature and confers anti-adhesive properties to the normal functioning endothelium. Whether endogenous NO release influences platelet thrombus formation and neutrophil-endothelium interactions under arterial blood flow conditions was investigated in ex vivo bioassay experiments using superfusion flow chambers. Surfaces of intact or deeply injured porcine arterial segments were exposed to flowing porcine arterial blood under shear conditions typical to patent (424 sec-1) and stenosed (3397 sec-1) arteries, at baseline and after administration of the specific inhibitor of NO synthesis N omega-nitro-L-arginine methyl ester (L-NAME, 3 mg/kg + 3 mg/kg/h; i.v.). L-NAME induced a rapid and significant rise in arterial blood pressure, with a moderate reduction in heart rate. 51Cr platelet deposition on the exposed arterial media, which averaged 15.9 +/- 2.9 x 10(6)/cm2 at a shear rate of 424 sec-1, was increased by L-NAME, to 20.4 +/- 2.8 x 10(6)/cm2 (p < 0.05). At 3397 sec-1 of shear rate, platelet deposition was higher (71.4 +/- 11.9 x 10(6)/cm2) (p < 0.001), and was enhanced by 34%, to 95.8 +/- 12.5 x 10(6)/cm2 (p < 0.05), after L-NAME treatment. 111In neutrophil adhesion to the vascular endothelium was also increased by L-NAME by 83%, from 10.6 +/- 2.5 to 19.4 +/- 5.7 x 10(3)/cm2 (p < 0.05) at 424 sec-1, and by 110%, from 14.1 +/- 4.3 to 29.7 +/- 10.0 x 10(3)/cm2 (p < 0.05) at 3397 sec-1 of shear rate. These results suggest that endogenous NO may be an important modulator of thrombotic and inflammatory processes in patent as well as in stenosed arteries.

Altered erythrocyte membrane band 3 profile as a marker in patients at risk for cardiovascular disease

The aim of this study is to evaluate the correlation between a rise in blood neutrophil concentration and cellular and molecular changes of erythrocytes, among populations presenting an increased risk of cardiovascular disease (CVD). A population of men aged 20-65 years was used which included 22 post-myocardial infarction individuals (< 48 h), 24 survivors of myocardial infarction (> 3 months), 12 hypertensive individuals and 29 individuals presenting normal haematological values and normal lipid profile. The lipid profile parameters used to ascertain increased risk of CVD included triglycerides (TG), total cholesterol (Chol), high-density lipoprotein cholesterol (HDLc), low-density lipoproteins cholesterol (LDLc) and apolipoproteins A1 (Apo A1) and B (Apo B). The hematological parameters measured were concentration of total white blood cells (WBC) and of the several leukocyte types; concentration of red blood cells (RBC); hematocrit (Ht); hemoglobin concentration (Hb); mean cell volume (MCV); activity of erythrocyte glucose-6-phosphate dehydrogenase (G6PD); band 3, its aggregates and fragments in erythrocyte membranes, the percentage of membrane-bound hemoglobin (MBH), and the linkage of immunoglobulin G (IgG) to erythrocyte membrane. We found that the MBH and the band 3 profile is different in control as compared to pathological groups and that, as expected, the aggregation of band 3 promotes the linkage of IgG to the erythrocyte membrane. A negative correlation was shown between total neutrophils and both total RBCs and erythrocyte G6PD activity. We suggest that the erythrocyte, a cell that undergoes and accumulates oxidative and proteolytic damage along its life span, may provide a useful model of oxidative and proteolytic stress in CVD and that band 3 may represent a useful marker of that stress.

Increase of neutrophil adhesion and vasoconstriction with platelet deposition after deep arterial injury by angioplasty

Physiopathologic events after arterial injury are largely influenced by blood element reactions with the injured surface. To determine acute arterial reactivity to injury, simultaneous chromium 51-labeled platelet deposition and indium 111-labeled neutrophil adhesion were quantified at the site of different degrees of carotid arterial injury by balloon dilatation in 21 normal pigs. The degree of vasoconstriction distally to the dilated areas was also quantified angiographically. Arteries were classified histologically as (1) uninjured with intact endothelium; (2) mildly injured with endothelial desquamation; or (3) deeply injured with lesions extending beyond internal elastic lamina, exposing the media. We found that, compared to mild injury, deep injury was associated with greater platelet deposition (38.2 +/- 5.7 x 10(6)/cm2 vs 7.8 +/- 0.9 x 10(6)/cm2; p < 0.05), neutrophil adhesion (30.6 +/- 4.1 x 10(4)/cm2 vs 10.2 +/- 2.9 x 10(4)/cm2; p < 0.05), and vasoconstrictive response (45.5% +/- 3.2% vs 26.7% +/- 2.8%; p < 0.05). Although distally to both types of injuries, noninjured arterial segments with intact endothelium were thromboresistant to platelet deposition, neutrophil adhesion to intact endothelium was much higher after deep injury (2.2 +/- 0.4 x 10(4)/cm2) compared to mild injury (0.36 +/- 0.1 x 10(4)/cm2; p < 0.05). Like platelet deposition, neutrophil adhesion is influenced by the severity of arterial injury; both may therefore be implicated in thrombogenesis and vascular responsiveness after arterial injury in vivo.

Endothelial dysfunction in cerebral vessels following carotid artery infusion of phorbol ester in rabbits: the role of polymorphonuclear leukocytes

The effect of 4 beta-phorbol-12 beta-myristate-13 alpha-acetate (PMA) on endothelium-dependent and endothelium-independent vasoconstriction and vasodilation was studied in isolated segments of rabbit middle cerebral artery (MCA). Concentration-dependent responses of the left and right MCA to the constrictors KCl, noradrenaline, uridine 5'-triphosphate, serotonin, and histamine, as well as to the dilators acetylcholine, bradykinin, sodium nitroprusside, and calcium ionophore (A23187), were compared in control animals and after PMA injection into the left common carotid artery. In the control animals there was no significant difference in the responses of the left and right MCA to either the constrictors or the dilators studied. After PMA injection the endothelium-dependent relaxation in response to acetylcholine, bradykinin, and A23187 was reduced in the left MCA (PMA-injected side), whereas the effect of the endothelium-independent dilator sodium nitroprusside remained unchanged. Simultaneously greater contractile responses of the left MCA to serotonin and histamine were obtained. Neither infusion of L-arginine in vivo before the PMA injection nor incubation of the isolated MCA segments with L-arginine affected this difference in MCA reactivity. Platelet depletion did not change the PMA-induced reduction in the endothelium-dependent relaxation, whereas after leukocyte depletion this reduction practically disappeared. These results suggest that the PMA-induced brain microembolia causes acute endothelial dysfunction, which is possibly mediated by intravascular activation of leukocytes and is independent of nitric oxide synthesis from L-arginine. This phenomenon might play an important role in cerebral angiospastic disorders after intravascular activation of leukocytes in cerebral ischemia and reperfusion.