Antithrombin–Heparin Complexes

SummaryProtamine (PRT) is the standard drug to neutralise heparin. PRT/heparin complexes induce an immune response similar to that observed in heparin-induced thrombocytopenia (HIT). Partially desulfated heparin (ODSH) was shown to interfere with anti-platelet factor 4/heparin antibodies (Abs), which are responsible for HIT. In this study, we analyse the impact of ODSH on the interaction between anti-PRT/heparin Abs and platelets. The ability of ODSH to prevent anti-PRT/heparin Ab-induced platelet destruction in vivo was investigated using the NOD/ SCID mouse model. ODSH improved platelet survival in the presence of PRT, heparin and anti-PRT/heparin Abs (median platelet survival after 300 minutes (min) with 20 μg/ml ODSH: 75 %, range 70–81 % vs without ODSH: 49%, range 44–59%, p=0.006). Furthermore, when ODSH was applied 60 min after Ab injection platelet survival was improved (median platelet survival after 300 min with ODSH: 83 %, range 77–93 % vs without ODSH: 59 %, range 29–61 %, p=0.02). In in vitro experiments ODSH inhibited platelet activation at concentrations > 16 μg/mL (p< 0.001), as well as PRT/heparin complex binding to platelets (mean fluorescence intensity [MFI] without ODSH: 85 ± 14 vs with ODSH: 15 ± 0.6, p=0.013). ODSH also displaced pre-bound complexes from the platelet surface (MFI without ODSH: 324 ± 43 vs with 32 μg/ml ODSH: 53 ± 9, p< 0.001). While interfering with platelet activation by anti-PRT/heparin Abs, up to a concentration of 16 μg/ml, ODSH had only minimal impact on neutralisation of heparin by PRT. In conclusion, our study shows that ODSH is able to inhibit platelet activation and destruction suggesting a potential clinical use to reduce anti-PRT/heparin Ab-mediated adverse effects.

Download Full-text

Fibronectin modulates formation of PF4/heparin complexes and is a potential factor for reducing risk of developing HIT

Blood ◽

10.1182/blood-2018-05-850370 ◽

2019 ◽

Vol 133 (9) ◽

pp. 978-989 ◽

Cited By ~ 4

Author(s):

Krystin Krauel ◽

Patricia Preuße ◽

Theodore E. Warkentin ◽

Catja Trabhardt ◽

Sven Brandt ◽

...

Keyword(s):

Platelet Activation ◽

Platelet Rich Plasma ◽

Enzyme Linked Immunosorbent Assay ◽

Heparin Binding ◽

Plasma Fibronectin ◽

Platelet Factor ◽

Washed Platelet ◽

Plasma Factor ◽

Heparin Complexes ◽

Patient Groups

Abstract Heparin-induced thrombocytopenia (HIT) is caused by platelet-activating anti–platelet factor 4 (PF4)/heparin antibodies. Platelet activation assays that use “washed” platelets are more sensitive for detecting HIT antibodies than platelet-rich plasma (PRP)–based assays. Moreover, heparin-exposed patients vary considerably with respect to the risk of PF4/heparin immunization and, among antibody-positive patients, the risk of subsequent “breakthrough” of clinical HIT with manifestation of thrombocytopenia. We used washed platelets and PRP, standard laboratory HIT tests, and physicochemical methods to identify a plasma factor interfering with PF4/heparin complexes and anti-PF4/heparin antibody–platelet interaction, thus explaining differences in functional assays. To investigate a modulating risk for PF4/heparin immunization and breakthrough of HIT, we also tested 89 plasmas from 2 serosurveillance trials. Fibronectin levels were measured in 4 patient groups exhibiting different degrees of heparin-dependent immunization and expression of HIT. The heat-labile plasma protein, fibronectin, inhibited PF4 binding to platelets in a dose-dependent fashion, particularly in washed (vs PRP) systems. Fibronectin also inhibited PF4/heparin binding to platelets, anti-PF4/heparin antibody binding to PF4/heparin complexes, and anti-PF4/heparin antibody–induced platelet activation as a result of PF4/heparin complex disruption. In addition, plasma fibronectin levels increased progressively among the following 4 patient groups: enzyme-linked immunosorbent assay (ELISA)+/serotonin-release assay (SRA)+/HIT+ < ELISA+/SRA+/HIT− ∼ ELISA+/SRA−/HIT− < ELISA−/SRA−/HIT−. Altogether, these findings suggest that fibronectin interferes with PF4/heparin complex formation and anti-PF4/heparin antibody–induced platelet activation. Reduced fibronectin levels in washed platelet assays help to explain the greater sensitivity of washed platelet (vs PRP) assays for HIT. More importantly, lower plasma fibronectin levels could represent a risk factor for PF4/heparin immunization and clinical breakthrough of HIT.

Download Full-text

Micropatterned array to assess the interaction of single platelets with platelet factor 4-heparin-IgG complexes

Thrombosis and Haemostasis ◽

10.1160/th13-09-0752 ◽

2014 ◽

Vol 111 (05) ◽

pp. 862-872 ◽

Cited By ~ 11

Author(s):

Krystin Krauel ◽

Nikolay Medvedev ◽

Raghavendra Palankar ◽

Andreas Greinacher ◽

Mihaela Delcea

Keyword(s):

Calcium Imaging ◽

Cell Function ◽

Platelet Factor 4 ◽

Water Soluble ◽

Cell Level ◽

Platelet Factor ◽

Ligand Density ◽

Heparin Complexes ◽

Novel Method ◽

Platelet Aggregates

SummaryWe report a strategy to generate by electron beam lithography high fidelity micropatterned arrays to assess the interaction of single platelets with immobilised ligands. As a proof-of-principle we functionalised the microarrays with platelet factor 4 (PF4)-heparin-IgG complexes. We embedded biotinylated water-soluble quantum dots into polyethylene glycol (PEG)-coated micropatterned arrays and functionalised them via streptavidin to bind biotinylated ligands, here biotinylated-PF4/heparin complexes. The integrity of the PF4/heparin-complexes was shown by binding of anti-PF4/heparin antibodies. Ligand density was quantified by immunofluorescence and immunogold antibody labelling. Real-time calcium imaging was employed for read-out of single platelets activated on micropatterned surfaces functionalised with PF4/heparin-IgG complexes. With the smallest micropatterns (0.5x0.5 µm) we show that single platelets become strongly activated by binding to surface-immobilised PF4/heparin-IgG, while on larger micropatterns (10x10 µm), platelet aggregates formed. These findings that HIT antibodies can cause platelet activation on microarrays illustrate how this novel method opens new avenues to study platelet function at single cell level. Generating functionalized microarray surfaces to which highly complex ligands can be bound and quantified has the potential for platelet and other cell function assays integrated into high-throughput microfluidic microdevices.

Download Full-text

Heparin-induced thrombocytopenia: in vitro studies on the interaction of dabigatran, rivaroxaban, and low-sulfated heparin, with platelet factor 4 and anti-PF4/heparin antibodies

Blood ◽

10.1182/blood-2011-05-353391 ◽

2012 ◽

Vol 119 (5) ◽

pp. 1248-1255 ◽

Cited By ~ 69

Author(s):

Krystin Krauel ◽

Christine Hackbarth ◽

Birgitt Fürll ◽

Andreas Greinacher

Keyword(s):

Factor Xa ◽

Platelet Factor 4 ◽

Thrombin Inhibitors ◽

Direct Thrombin Inhibitors ◽

Platelet Factor ◽

Heparin Induced Thrombocytopenia ◽

Alternative Anticoagulation ◽

Heparin Complexes ◽

History Of

Abstract Heparin is a widely used anticoagulant. Because of its negative charge, it forms complexes with positively charged platelet factor 4 (PF4). This can induce anti-PF4/heparin IgG Abs. Resulting immune complexes activate platelets, leading to the prothrombotic adverse drug reaction heparin-induced thrombocytopenia (HIT). HIT requires treatment with alternative anticoagulants. Approved for HIT are 2 direct thrombin inhibitors (DTI; lepirudin, argatroban) and danaparoid. They are niche products with limitations. We assessed the effects of the DTI dabigatran, the direct factor Xa-inhibitor rivaroxaban, and of 2-O, 3-O desulfated heparin (ODSH; a partially desulfated heparin with minimal anticoagulant effects) on PF4/heparin complexes and the interaction of anti-PF4/heparin Abs with platelets. Neither dabigatran nor rivaroxaban had any effect on the interaction of PF4 or anti-PF4/heparin Abs with platelets. In contrast, ODSH inhibited PF4 binding to gel-filtered platelets, displaced PF4 from a PF4-transfected cell line, displaced PF4/heparin complexes from platelet surfaces, and inhibited anti-PF4/heparin Ab binding to PF4/heparin complexes and subsequent platelet activation. Dabigatran and rivaroxaban seem to be options for alternative anticoagulation in patients with a history of HIT. ODSH prevents formation of immunogenic PF4/heparin complexes, and, when given together with heparin, may have the potential to reduce the risk for HIT during treatment with heparin.

Download Full-text

Antiheparin Antibody: Preparation And Use As A Functional Probe

10.1055/s-0038-1652531 ◽

1981 ◽

Author(s):

S N Gitel ◽

V M Medina ◽

S Wessler

Keyword(s):

Aqueous Solution ◽

Binding Sites ◽

Anticoagulant Activity ◽

Red Cells ◽

Heparin Binding ◽

Antibody Preparation ◽

Specific Antibodies ◽

Coagulation Proteins ◽

Heparin Complexes ◽

Presence And Absence

Antiheparin antibodies were raised in 5 of 6 rabbits immunized sequentially with covalent complexes of ovalbumin-heparin and bovine IgG-heparin. Confirmation of the presence of heparin-specific antibodies in the antisera was based on: (1) antisera precipitation of BSA-heparin but not BSA alone, (2) antisera inhibition of heparin anticoagulant activity without precipitating heparin, (3) antisera precipitation of heparin-heparin complexes, and (4) antibody removal from the antisera by heparin- Sepharose. The antisera had hemagglutination titers between 1:10,000 and 1:50,000 when tested against tanned red cells labeled with BSA-heparin complex; whereas no hemagglutination occurred with tanned erythrocytes tagged with BSA. Heparin-heparin oligomers, prepared by carbo- diimide coupling in aqueous solution and retaining anticoagulant activity, precipitated in the presence of the antiheparin antibodies. Data indicating that heparin has separate binding sites for antithrombin 111 and thrombin were obtained by quantitating the heparin oligomer- antibody precipitate in the presence and absence of these two purified, heparin-binding, coagulation proteins.

Download Full-text

Comparison of recombinant and plasma-derived antithrombin biodistribution in a rabbit model

Thrombosis and Haemostasis ◽

10.1160/th09-01-0062 ◽

2009 ◽

Vol 102 (08) ◽

pp. 302-308 ◽

Cited By ~ 6

Author(s):

Leslie Berry ◽

Bruce Thong ◽

Anthony Chan

Keyword(s):

Vessel Wall ◽

Degradation Products ◽

Rabbit Model ◽

Coagulation Cascade ◽

Blood Levels ◽

Vascular Thrombosis ◽

Time Points ◽

Heparin Complexes ◽

Time Periods ◽

Native Plasma

SummaryAntithrombin (AT) is a native plasma protein that acts as the main inhibitor of enzymes generated by the coagulation cascade. In extreme thrombotic conditions, consumption of plasma AT can make treatment with AT-associated heparin therapies less effective. Supplementation with recombinant human AT (rhAT) has shown promise but altered pharmacokinetics were observed when comparing stable heparin complexes of the plasma-derived AT (pAT) and rhAT proteins. To understand the differential clearance mechanisms,biodistribution of rhAT and pAT was determined. 125I-labelled ATryn (rhAT) or Kybernin P (pAT) was intravenously injected into rabbits. At various time points, animals were sacrificed and organs analysed for bound radioactivity. 131I-albumin, injected shortly before termination, was used as a marker for trapped blood. Levels of circulating protein + metabolites were significantly less for rhAT than pAT (p < 0.001) and removal of acid soluble fragments confirmed that differences were due to more rapid rhAT clearance. More rhAT (28% dose) than pAT (3% dose) was liver-associated by the earliest time points, corresponding to elevated rhAT degradation products in urine/feces. However, at intermediate times (4 hours), rhAT showed significantly increased arterial and venous uptake over pAT (p ≤0.001).These vessel wall interactions accounted for the primary differences between clearance of rhAT and pAT during these time periods. Overall, circulating rhAT is more rapidly lost to the liver and vessels than pAT. Increased vessel wall binding may facilitate rhAT treatment of vascular thrombosis.

Download Full-text