scholarly journals High von Willebrand factor concentration compensates a relative adhesion defect in uremic blood

Blood ◽  
1990 ◽  
Vol 75 (7) ◽  
pp. 1498-1508
Author(s):  
JJ Zwaginga ◽  
MJ Ijsseldijk ◽  
N Beeser-Visser ◽  
PG de Groot ◽  
J Vos ◽  
...  

Uremia is associated with a bleeding diathesis. We investigated platelet adhesion as a cause for the impaired primary hemostasis and the role of von Willebrand factor (vWF) in this process in uremic patients. Perfusions with blood with standardized hematocrit, platelet count, and free Ca2+ ions were performed over inverted and deendothelialized artery segments from human umbilical cords in a modified Baumgartner perfusion chamber. Platelet adhesion in patient perfusates was comparable with control adhesion. However, the high vWF levels present in uremic whole blood did not increase adhesion above the adhesion in control blood with lower vWF levels. These results suggested that a relative adhesion defect was present in patient blood. Control blood in which vWF levels were raised to uremic levels showed the high adhesion that uremic whole blood failed to show. Additionally, in perfusions with uremic plasma in which the initially high vWF level was normalized by dilution with vWF-depleted uremic plasma, adhesion was clearly lower than in normal plasma. Washed patient platelets did not differ from normal platelets in their association with purified vWF, via their adhesion receptors glycoprotein Ib and IIb-IIIa. Patient platelets present in patient plasma showed a similar adhesion defect as control platelets, which were resuspended in the uremic plasma. Therefore, primary defects of uremic platelets were of minor importance for the observed adhesion defect in uremic whole blood. The adhesion defect was not dependent on the presence of uremic vWF; plasma of uremic patients depleted of vWF also inhibited adhesion, and the defect remained present when purified control vWF was added to vWF-depleted uremic plasma. The binding of uremic vWF to the vessel wall and its support of subsequent adhesion were not impaired. These results indicate that the observed adhesion defect was not due to abnormal vWF. Our current results suggest an unknown component present in uremic plasma that directly inhibits platelet interaction with artery segments; however, it has no effect on vWF binding to the vessel wall. High vWF levels in uremic plasma are able to compensate for the defect.

Blood ◽  
1990 ◽  
Vol 75 (7) ◽  
pp. 1498-1508 ◽  
Author(s):  
JJ Zwaginga ◽  
MJ Ijsseldijk ◽  
N Beeser-Visser ◽  
PG de Groot ◽  
J Vos ◽  
...  

Abstract Uremia is associated with a bleeding diathesis. We investigated platelet adhesion as a cause for the impaired primary hemostasis and the role of von Willebrand factor (vWF) in this process in uremic patients. Perfusions with blood with standardized hematocrit, platelet count, and free Ca2+ ions were performed over inverted and deendothelialized artery segments from human umbilical cords in a modified Baumgartner perfusion chamber. Platelet adhesion in patient perfusates was comparable with control adhesion. However, the high vWF levels present in uremic whole blood did not increase adhesion above the adhesion in control blood with lower vWF levels. These results suggested that a relative adhesion defect was present in patient blood. Control blood in which vWF levels were raised to uremic levels showed the high adhesion that uremic whole blood failed to show. Additionally, in perfusions with uremic plasma in which the initially high vWF level was normalized by dilution with vWF-depleted uremic plasma, adhesion was clearly lower than in normal plasma. Washed patient platelets did not differ from normal platelets in their association with purified vWF, via their adhesion receptors glycoprotein Ib and IIb-IIIa. Patient platelets present in patient plasma showed a similar adhesion defect as control platelets, which were resuspended in the uremic plasma. Therefore, primary defects of uremic platelets were of minor importance for the observed adhesion defect in uremic whole blood. The adhesion defect was not dependent on the presence of uremic vWF; plasma of uremic patients depleted of vWF also inhibited adhesion, and the defect remained present when purified control vWF was added to vWF-depleted uremic plasma. The binding of uremic vWF to the vessel wall and its support of subsequent adhesion were not impaired. These results indicate that the observed adhesion defect was not due to abnormal vWF. Our current results suggest an unknown component present in uremic plasma that directly inhibits platelet interaction with artery segments; however, it has no effect on vWF binding to the vessel wall. High vWF levels in uremic plasma are able to compensate for the defect.


Blood ◽  
1985 ◽  
Vol 65 (4) ◽  
pp. 823-831 ◽  
Author(s):  
VT Turitto ◽  
HJ Weiss ◽  
TS Zimmerman ◽  
II Sussman

The present studies were undertaken to determine whether factor VIII/von Willebrand factor (vWF) present in the vessel wall (in addition to that in plasma) may mediate the attachment of platelets to subendothelium. Subendothelium from everted rabbit aorta was exposed to human citrated blood flowing through an annular perfusion chamber at 40 mL/min (wall shear rate of 2,600 s-1 for five minutes). The vessel segments were incubated at 37 degrees C for one hour with various dilutions of either goat-anti-rabbit factor VIII/vWF serum or an IgG fraction prepared from the serum. Control segments were incubated with serum or IgG from a nonimmunized goat. Values of platelet contact (C), platelet adhesion (C + S), and thrombus formation (T) on the subendothelium were evaluated by a morphometric technique. Compared with vessels incubated with fractions prepared from a normal goat, a significant decrease in platelet adhesion (C + S), ranging from 45% to 65%, was observed on vessels incubated with various dilutions (1:5 to 1:50) of either serum or IgG fractions of goat-anti-rabbit factor VIII/vWF. A similar decrease in platelet adhesion was observed with vessels incubated with an F(ab')2 fragment against rabbit factor VIII/vWF prepared in the goat. When goat-anti-rabbit factor VIII/vWF IgG was added to rabbit blood (1:75 dilution), platelet adhesion was reduced to the same extent (65%) on normal rabbit vessels and on vessels pre-incubated with goat-anti-rabbit factor VIII/vWF. Immunofluorescence studies revealed the presence of rabbit factor VIII/vWF in the subendothelium of rabbit aorta and the continued binding of the goat-anti-factor VIII/vWF antibodies on subendothelium during the perfusion studies. No uptake of human factor VIII/vWF on the rabbit subendothelium was observed by this immunologic technique; human factor VIII/vWF was found to be entirely associated with the attached human platelets. Thus, factor VIII/vWF in the vessel wall may mediate platelet attachment to subendothelium in a manner similar to that of plasma factor VIII/vWF.


Blood ◽  
1990 ◽  
Vol 76 (7) ◽  
pp. 1336-1340 ◽  
Author(s):  
G Escolar ◽  
A Cases ◽  
E Bastida ◽  
M Garrido ◽  
J Lopez ◽  
...  

Abstract Uremic patients have an impaired platelet function that has been related to membrane glycoprotein (GP) abnormalities. Using a perfusion system, we have studied the interaction of normal and uremic platelets with vessel subendothelium (SE) under flow conditions. Reconstituted blood containing washed platelets, purified von Willebrand factor (vWF) (1 U/mL), and normal washed red blood cells was exposed to de- endothelialized rabbit segments for 10 minutes at two different shear rates (800 and 1,600 seconds-1). In some experiments a monoclonal antibody to the GPIIb-IIIa complex (EDU3) was added to the perfusates. With normal platelets, the percentage of the vessel covered by platelets (%CS) was 23.1% +/- 3.7% at 800 seconds-1 and 30% +/- 4.3% at 1,600 seconds-1. Platelets were observed in contact or forming monolayers on vessel SE. EDU3 inhibited the spreading of normal platelets. The %CS (11.1% +/- 3.3%) was statistically decreased (P less than .01) and most of the platelets were observed in contact with the vessel surface. These data indicate that, under flow conditions, the interaction of vWF with GPIIb-IIIa can support the spreading of normal platelets in the absence of exogenous fibrinogen. Under the same experimental conditions, the interaction of uremic platelets with SE was markedly impaired at both shear rates studied (P less than .01 v normal platelets). The presence of EDU3 did not modify the interaction of uremic platelets. These results confirm the impairment of the platelet adhesion observed in uremic patients. Furthermore, they indicate the presence of a functional defect in the interaction of vWF with GPIIb-IIIa. The fact that perfusions with normal and uremic platelets in the presence of an antibody to the GPIIb-IIIa complex did not show any differences gives indirect evidence on a functionally normal interaction vWF/GPIb in uremic patients.


Blood ◽  
1987 ◽  
Vol 70 (4) ◽  
pp. 1084-1089 ◽  
Author(s):  
JB Lawrence ◽  
HR Gralnick

Abstract Platelet adherence at high wall shear rates requires plasma von Willebrand factor (vWF). Clinically, the ristocetin cofactor (RCof) activity is the only widely available assay for vWF function. When purified vWF is treated with neuraminidase to yield asialo-vWF (AS- vWF), its RCof activity is increased by 20% to 40%. AS-vWF binds to normal human platelets independently of ristocetin and induces platelet aggregation in the presence of fibrinogen. To determine whether AS-vWF also shows an enhanced capacity to support platelet adherence to subendothelium, we used the Baumgartner technique. Intact vWF, AS-vWF, or AS-vWF treated with beta-galactosidase (asialo, agalacto-vWF; AS,AG- vWF) was added to normal citrated whole blood before perfusion over human umbilical artery segments (wall shear rate, 2,600 sec-1). Four micrograms per milliliter AS-vWF caused a 69% reduction in total platelet adherence compared with citrated whole blood (P less than .001), and 4 micrograms/mL AS,AG-vWF led to a 48% reduction (P less than .005). With 4 micrograms/mL intact vWF, the platelet adherence values were not significantly different from the controls. No significant differences in subendothelial platelet thrombi or postperfusion platelet counts were evident among any of the groups. In reconstituted afibrinogenemic perfusates, 4 micrograms/mL AS-vWF caused a 42% reduction in platelet adherence (P less than .05). Thus, AS-vWF is a potent inhibitor of platelet adherence, despite its enhanced RCof specific activity. Abnormalities in vWF carbohydrate may play a role in impaired primary hemostasis in some patients with von Willebrand's disease.


Blood ◽  
1990 ◽  
Vol 76 (2) ◽  
pp. 345-353 ◽  
Author(s):  
RR Hantgan ◽  
G Hindriks ◽  
RG Taylor ◽  
JJ Sixma ◽  
PG de Groot

We have investigated the molecular basis of thrombus formation by measuring the extent of platelet deposition from flowing whole blood onto fibrin-coated glass coverslips under well-defined shear conditions in a rectangular perfusion chamber. Platelets readily and specifically adhered to fibrin-coated coverslips in 5 minute perfusion experiments done at either low (300 s-1) or high (1,300 s-1) wall shear rates. Scanning electron microscopic examination of fibrin-coated coverslips after perfusions showed surface coverage by a monolayer of adherent, partly spread platelets. Platelet adhesion to fibrin was effectively inhibited by a monoclonal antibody (MoAb) specific for glycoprotein (GP) IIb:IIIa. The dose-response curve for inhibition of adhesion by anti-GPIIb:IIIa at both shear rates paralleled that for inhibition of platelet aggregation. Platelet aggregation and adhesion to fibrin were also blocked by low concentrations of prostacyclin. In contrast, anti- GPIb reduced adhesion by 40% at 300 s-1 and by 70% at 1,300 s-1. A similar pattern of shear rate-dependent, incomplete inhibition resulted with a MoAb specific for the GPIb-recognition region of von Willebrand factor (vWF). Platelets from an individual with severe von Willebrand's disease, whose plasma and platelets contained essentially no vWF, exhibited defective adhesion to fibrin, especially at the higher shear rate. Addition of purified vWF restored adhesion to normal values. These results are consistent with a two-site model for platelet adhesion to fibrin, in which the GPIIb:IIIa complex is the primary receptor, with GPIb:vWF providing a secondary adhesion pathway that is especially important at high wall shear rates.


Blood ◽  
1985 ◽  
Vol 65 (4) ◽  
pp. 823-831 ◽  
Author(s):  
VT Turitto ◽  
HJ Weiss ◽  
TS Zimmerman ◽  
II Sussman

Abstract The present studies were undertaken to determine whether factor VIII/von Willebrand factor (vWF) present in the vessel wall (in addition to that in plasma) may mediate the attachment of platelets to subendothelium. Subendothelium from everted rabbit aorta was exposed to human citrated blood flowing through an annular perfusion chamber at 40 mL/min (wall shear rate of 2,600 s-1 for five minutes). The vessel segments were incubated at 37 degrees C for one hour with various dilutions of either goat-anti-rabbit factor VIII/vWF serum or an IgG fraction prepared from the serum. Control segments were incubated with serum or IgG from a nonimmunized goat. Values of platelet contact (C), platelet adhesion (C + S), and thrombus formation (T) on the subendothelium were evaluated by a morphometric technique. Compared with vessels incubated with fractions prepared from a normal goat, a significant decrease in platelet adhesion (C + S), ranging from 45% to 65%, was observed on vessels incubated with various dilutions (1:5 to 1:50) of either serum or IgG fractions of goat-anti-rabbit factor VIII/vWF. A similar decrease in platelet adhesion was observed with vessels incubated with an F(ab')2 fragment against rabbit factor VIII/vWF prepared in the goat. When goat-anti-rabbit factor VIII/vWF IgG was added to rabbit blood (1:75 dilution), platelet adhesion was reduced to the same extent (65%) on normal rabbit vessels and on vessels pre-incubated with goat-anti-rabbit factor VIII/vWF. Immunofluorescence studies revealed the presence of rabbit factor VIII/vWF in the subendothelium of rabbit aorta and the continued binding of the goat-anti-factor VIII/vWF antibodies on subendothelium during the perfusion studies. No uptake of human factor VIII/vWF on the rabbit subendothelium was observed by this immunologic technique; human factor VIII/vWF was found to be entirely associated with the attached human platelets. Thus, factor VIII/vWF in the vessel wall may mediate platelet attachment to subendothelium in a manner similar to that of plasma factor VIII/vWF.


Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3722-3722
Author(s):  
Jenny K. McDaniel ◽  
Khalil Bdeir ◽  
Douglas B. Cines ◽  
X. Long Zheng

Abstract Background: Human neutrophil peptides (HNPs) are small cationic proteins primarily released from activated and degranulated neutrophils. HNPs have antimicrobial activity against diverse bacteria, viruses, fungi, and parasites. Additionally, HNPs exhibit prothrombotic properties by enhancing platelet aggregation and fibrin formation and by inhibiting proteolytic cleavage of von Willebrand factor (VWF) by ADAMTS13. However, the role of HNPs in thrombus formation under more physiological conditions (i.e. under flow) has not been determined. Objective: To investigate the effects of HNPs on platelet adhesion/aggregation on VWF/collagen surfaces under arterial shears. Design/Method: Whole blood was obtained from C57/BL6 wild type and Adamts13-/-mice, anticoagulated with a potent thrombin inhibitor D-phenylalanyl-L-prolyl-L-arginine chloromethyl ketone (PPACK) and prostaglandin-E1 (PGE1), and platelets were labeled with FITC anti-mouse CD41 IgG. After incubation with varying concentrations of native HNPs and synthetic partially reduced HNP1 (sHNP1) for 30 minutes, the whole blood samples were perfused through a fibrillar collagen-coated surface in a microfluidic system at 100 dyne/cm² for 180 seconds. The rate and extent of accumulation of fluorescein-labeled platelets were determined under an inverted fluorescent microscope at 4-second intervals. The images were analyzed off-line with Montage to evaluate the area of platelet coverage over time. This process was repeated with the addition of N-ethylmaleimide (NEM) alone or NEM-treated sHNP1 to the samples to probe the effect of free cysteine residues. In addition, samples of native HNPs and sHNP1 incubated with NEM were analyzed via LC-mass spectrometry for NEM incorporation. Results: Purified native HNPs at final concentrations of 15 μM and 30 μM exhibited no or little effect on the adhesion and aggregation of murine platelets on VWF/collagen surfaces under arterial shears (100 dyne/cm2). Surprisingly, sHNP1 at the same concentrations (15 and 30 μM) dramatically reduced the rate and surface coverage of platelets from WT (Fig. 1A) and, more profoundly, from Adamts13-/- mice (Fig. 1B) on VWF/collagen surfaces under the same conditions. This inhibitory activity of sHNP1 was abolished upon pretreatment with NEM, which reacts with free thiols (-SH) (not shown). Aliphatic HNP1 with all 6 cysteine residues chemically modified also did not inhibit the adhesion and aggregation of murine platelets on VWF/collagen surfaces under shear (not shown). Analysis of samples by LC-mass spectrometry confirmed the NEM-labeling of free thiols present in sHNP1, but not in native HNPs. Conclusion: These results suggest that high concentrations of locally released native HNPs may be required to inhibit ADAMTS13 activity in vivo. However, the findings from this study indicate that HNPs differentially affect thrombus formation depending on how its redox state is modified by its biological milieu. Somewhat unexpectedly, synthetic and partially reduced HNP1 may be a potent antithrombotic agent by reducing platelet interactions with VWF under arterial shear via a disulfide bond reduction mechanism. Disclosures Zheng: Alexion: Research Funding; Ablynx: Consultancy.


Blood ◽  
1990 ◽  
Vol 76 (2) ◽  
pp. 345-353 ◽  
Author(s):  
RR Hantgan ◽  
G Hindriks ◽  
RG Taylor ◽  
JJ Sixma ◽  
PG de Groot

Abstract We have investigated the molecular basis of thrombus formation by measuring the extent of platelet deposition from flowing whole blood onto fibrin-coated glass coverslips under well-defined shear conditions in a rectangular perfusion chamber. Platelets readily and specifically adhered to fibrin-coated coverslips in 5 minute perfusion experiments done at either low (300 s-1) or high (1,300 s-1) wall shear rates. Scanning electron microscopic examination of fibrin-coated coverslips after perfusions showed surface coverage by a monolayer of adherent, partly spread platelets. Platelet adhesion to fibrin was effectively inhibited by a monoclonal antibody (MoAb) specific for glycoprotein (GP) IIb:IIIa. The dose-response curve for inhibition of adhesion by anti-GPIIb:IIIa at both shear rates paralleled that for inhibition of platelet aggregation. Platelet aggregation and adhesion to fibrin were also blocked by low concentrations of prostacyclin. In contrast, anti- GPIb reduced adhesion by 40% at 300 s-1 and by 70% at 1,300 s-1. A similar pattern of shear rate-dependent, incomplete inhibition resulted with a MoAb specific for the GPIb-recognition region of von Willebrand factor (vWF). Platelets from an individual with severe von Willebrand's disease, whose plasma and platelets contained essentially no vWF, exhibited defective adhesion to fibrin, especially at the higher shear rate. Addition of purified vWF restored adhesion to normal values. These results are consistent with a two-site model for platelet adhesion to fibrin, in which the GPIIb:IIIa complex is the primary receptor, with GPIb:vWF providing a secondary adhesion pathway that is especially important at high wall shear rates.


Blood ◽  
1987 ◽  
Vol 70 (4) ◽  
pp. 1084-1089
Author(s):  
JB Lawrence ◽  
HR Gralnick

Platelet adherence at high wall shear rates requires plasma von Willebrand factor (vWF). Clinically, the ristocetin cofactor (RCof) activity is the only widely available assay for vWF function. When purified vWF is treated with neuraminidase to yield asialo-vWF (AS- vWF), its RCof activity is increased by 20% to 40%. AS-vWF binds to normal human platelets independently of ristocetin and induces platelet aggregation in the presence of fibrinogen. To determine whether AS-vWF also shows an enhanced capacity to support platelet adherence to subendothelium, we used the Baumgartner technique. Intact vWF, AS-vWF, or AS-vWF treated with beta-galactosidase (asialo, agalacto-vWF; AS,AG- vWF) was added to normal citrated whole blood before perfusion over human umbilical artery segments (wall shear rate, 2,600 sec-1). Four micrograms per milliliter AS-vWF caused a 69% reduction in total platelet adherence compared with citrated whole blood (P less than .001), and 4 micrograms/mL AS,AG-vWF led to a 48% reduction (P less than .005). With 4 micrograms/mL intact vWF, the platelet adherence values were not significantly different from the controls. No significant differences in subendothelial platelet thrombi or postperfusion platelet counts were evident among any of the groups. In reconstituted afibrinogenemic perfusates, 4 micrograms/mL AS-vWF caused a 42% reduction in platelet adherence (P less than .05). Thus, AS-vWF is a potent inhibitor of platelet adherence, despite its enhanced RCof specific activity. Abnormalities in vWF carbohydrate may play a role in impaired primary hemostasis in some patients with von Willebrand's disease.


Blood ◽  
1988 ◽  
Vol 71 (5) ◽  
pp. 1253-1259 ◽  
Author(s):  
JN George ◽  
MM Torres

Thrombin is a physiological agonist that promotes platelet aggregation and secretion. In this study we observed that thrombin can also inhibit a function of platelets related to primary hemostasis. Platelet stimulation by thrombin decreased the binding of von Willebrand factor (vWF) to glycoprotein (GP) Ib and decreased ristocetin-induced agglutination, in vitro reactions that correlate with initial platelet adhesion to the vessel wall. Binding of the monoclonal antibody API to GP Ib was also decreased. Cytoskeletal participation in the change of GP Ib was suggested because pretreatment of platelets with cytochalasin to prevent actin filament formation prevented the thrombin-induced decreases in vWF binding. API binding, and ristocetin-induced agglutination. Measurement of GP Ib in detergent extracts by electroimmunoassay demonstrated no loss after thrombin stimulation. Electroimmunoassay also demonstrated that the API epitope of GP Ib on intact thrombin-treated platelets was accessible for complete digestion by chymotrypsin. Therefore GP Ib was neither released from the platelet surface nor internalized by thrombin treatment. A previously recognized effect of thrombin is its induction of receptor sites on platelet surface GP IIb-IIIa for contact-promoting proteins, including vWF that are involved in the platelet spreading and aggregation that follow adhesion. Therefore the action on GP Ib may combine with the effect on GP IIb-IIIa to shift platelet reactivity from GP Ib-vWF-mediated initial contact with the vessel wall to GP IIb-IIIa-mediated spreading and aggregation.


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