Inhibition by ethanol of thrombus formation induced by indwelling aortic catheters in rabbits.
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Biomedical subjects
Publications and source records attributed to H M Groves.
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Platelet aggregation and secretion of granule contents in response to specific agonists are inhibited by acute ethanol (1 to 4 mg/ml in vitro or 4 to 5 mg/ml ex vivo). However, acute administration of ethanol, giving blood levels of 4 to 5 mg/ml, does not affect platelet adherence to de-endothelialized rabbit aortae in vivo, which is the initial step in thrombus formation. Whether ethanol inhibits subsequent reactions in thrombus formation induced by indwelling catheters in rabbit aortae was investigated. Before insertion of the catheters, the rabbits received injections of 51Cr-labeled platelets (and, in some experiments, [125I]fibrinogen), and were given ethanol by stomach tube, to achieve blood levels of approximately 4 mg/ml. Thrombus formation after 3 hours was assessed by determining the number of platelets and the amount of radiolabeled fibrin(ogen) associated with the aortae, and by determining the thrombus weights; all three measurements indicated a 64 to 84% reduction in thrombosis. Thus, experimentally induced thrombus formation in the aorta is significantly reduced by ethanol.
In order to further elucidate the pathogenesis of intimal proliferation and increased thrombogenesis following repeated arterial injuries we studied the sequence of the cellular changes following two injuries of rabbit aortas with a balloon catheter. Following the first injury, the de-endothelialized surface was covered by a platelet monolayer. Polymorphonuclear leucocytes adhered to the inner surface of this monolayer and did not appear to penetrate the vessel wall. By 4 to 7 days, areas of neointima had formed. Within seconds after the reinjury at 7 days after the de-endothelialization small platelet aggregates formed on injured neointimal smooth muscle cells. Within I min platelet thrombi and fibrin strands formed. At 30 min most of the platelet thrombi had become fibrin-rich. Polymorphonuclear leucocytes had accumulated and many had begun to penetrate into the neointimal tissue. The number and extent of penetration of leucocytes into the inner parts of the arterial wall increased with time. Four days after the injury the neointimal cushions were restored and thickened. Both following the first and second injury the formation of neointimal cushions was accompanied by a change in the polarity of the inner layers of medial smooth muscle cells, some of which appeared to have migrated into the neointima.
To investigate the mechanisms involved in the cellular reactions to arterial injuries, we studied the distribution of the deposits on the injured intima and the pattern of neointimal thickening following single and double injuries of rabbit aortae with a balloon catheter. Thirty minutes after the first injury most, but not all, of the inner surface of the aortae was covered by adherent, spread platelets. Seven days following the first injury areas of neointima, mainly proliferating smooth muscle cells, had formed around and opposite the orifices of branch vessels. The rest of the inner aortic surface consisted of acellular subendothelial matrix. Thirty minutes after the second injury, 7 days after the first, single platelets adhered once more to parts of the reinjured subendothelium, mostly between the orifices. Numerous fibrin-rich, platelet thrombi were present mainly on the surface of the injured neointima. Thirty minutes after both the first and second injury polymorphonuclear leucocytes adhered to the inner surface downstream from the orifices of branch vessels and in longitudinally oriented zones opposite the orifices. Four days following the second injury, the neointima was restored with the same distribution as before the second injury, and few thrombi, adherent platelets, or leucocytes remained.
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Ticlopidine (100 mg/kg/day or 400 mg/kg/day) was administered to rats and rabbits for 48 hr before and during the experiments. Aggregation studies of twice-washed platelets resuspended in Tyrode solution containing apyrase and 0.35% albumin showed that inhibition by ticlopidine of aggregation induced by ADP, collagen, sodium arachidonate or thrombin persisted after resuspension, as did inhibition of the release of 14C-serotonin from prelabeled platelets. Thus the inhibitory effect of ticlopidine or its metabolite is not readily reversed. In both species, ticlopidine prolonged platelet survival when it had been shortened by the insertion of an indwelling aortic catheter, although only the higher dose was effective in rabbits. In this species, this dose also prolonged platelet survival in sham-operated animals. Ticlopidine did not have a significant effect on the clearance of rabbit platelets when their survival had been shortened by pretreatment with neuraminidase. Ticlopidine did not affect the number of 51Cr-labeled platelets that accumulated on the injured vessel wall in rats with indwelling aortic catheters or the amount of thrombus that formed around the catheters in the aortas of the rabbits. It also did not affect the accumulation of platelets in vivo on rabbit aortas de-endothelialized with a balloon catheter. Thus, although ticlopidine inhibited platelet aggregation and release and prolonged shortened platelet survival, it did not inhibit platelet adherence to the damaged wall or thrombosis caused by chronic arterial injury. It is evident that effects on platelet survival and thrombosis do not correlate. The reason for the prolongation of platelet survival is unknown.
The response by normal rabbit aortas to the removal of the endothelium with a balloon catheter, was compared to the response to the removal of regenerated endothelium from rabbit aortas that had been previously de-endothelialized. De-endothelialization results in the formation of a neo-intima. Thrombus formation following a second balloon catheter injury was compared among injured neo-intima that had been re-endothelialized, non-re-endothelialized neo-intima, and the subendothelium of normal vessels following a single injury. Rabbit aortas were examined by scanning electron microscopy of full circumference segments of the aorta and by transmission electron microscopy. Thirty minutes after a single de-endothelialization injury with a balloon catheter the luminal surface is covered by a monolayer of platelets adhering to the subendothelial connective tissues. Two weeks later there is neo-intimal formation and endothelial regeneration around branch vessel orifices. The remainder of the luminal surface is composed of smooth muscle cells (SMC). A balloon catheter injury to a vessel injured 2 weeks previously results in fibrin formation and platelet-fibrin microthrombi on the aortic intimal surface. The response of the aortic wall to re-injury does not seem to be related to the prior existence of endothelium. Both single and repeated injuries result in a distribution of formed elements which may depend, in part, on haemodynamic factors.
Rabbit aortae were removed from exsanguinated rabbits, washed, everted on probes, treated with thrombin, washed to remove unbound thrombin and used to measure the accumulation of 51Cr-labeled platelets in vitro. Thrombin pretreatment of normal rabbit aortae did not cause platelet accumulation on the endothelium; platelets appeared to accumulate only at sites where the subendothelium had been exposed. The quantitative data obtained with 51Cr-labelled platelets was reinforced by observations by scanning electron microscopy. 125I-labelled thrombin became associated with the endothelium and also with de-endothelialized vessels, and some of it could be displaced by high concentrations of heparin. Exposure of vessels to heparin after thrombin treatment eliminated the enhanced platelet accumulation caused by the thrombin treatment, probably because heparin displaced thrombin from the aortae, as demonstrated in experiments with 125I-thrombin. Inhibition of PGI2 production by aspirin treatment of the vessels did not enhance platelet accumulation on normal or thrombin-treated aortae. Thus, although thrombin treatment of the endothelium does not cause platelets to adhere to it, thrombin does cause increased platelet accumulation on the areas where the subendothelium is exposed or where endothelial cells are damaged.
The adherence of 51Cr-labeled platelets to the subendothelium of rabbit aortas was inhibited in vitro and in vivo by high concentrations of dipyridamole (100 microM in vitro, 2.5 or 12.5 mg/kg in vivo). Dipyridamole (100 microM) inhibited release of 14C-serotonin from platelets that adhered to the subendothelium or to a collagen-coated glass surface; lower concentrations of dipyridamole had only a slight inhibitory effect. Scanning electron microscopy showed that many of the platelets that adhered to the subendothelium were rounded, with few pseudopodia. The combination of dipyridamole with PGI2 was no more inhibitory of platelet adherence than either agent alone; however, this combination of inhibitors exerted synergistic inhibitory effects on aggregation and release of 14C-serotonin from platelets aggregated by collagen. The effects of dipyridamole on platelet adherence are a consequence of the action of dipyridamole alone and do not appear to result from its interaction with PGI2 formed by injured vessels in vivo, since the inhibitory effect is not influenced by aspirin inhibition of PGI2 formation, either at the shear rates in the in vitro studies or under the shear conditions found in rabbit aortas in vivo.
Using platelets prelabeled with 51Cr, we have quantified the effect of injury to the neointima on platelet accumulation, thrombus formation at different times following injury, and the effect of injury to the neointima on platelet survival. Platelet accumulation on the neointima is largely determined by activation of coagulation and thrombus formation; this contrasts with platelet accumulation on the subendothelium where coagulation does not play a major role and where few thrombi form. Heparin treatment significantly inhibits platelet accumulation on the injured neointima but is without effect on platelet accumulation on the subendothelium. Like the subendothelium, the neointima rapidly becomes nonreactive to further platelet accumulation, and the platelets and platelet-fibrin thrombi are lost from the surface in the first few days after injury. Despite the formation of extensive platelet thrombi on the injured neointima, platelet survival is unaffected.
We have quantified the accumulation of 51Cr-labeled washed rabbit platelets on the subendothelium of rabbit aortae following injury with a balloon catheter. The amount of radioactivity that became associated with the damaged wall within 10 minutes of the injury did not change appreciably during the following 24 hours, indicating that there was little turnover of platelets on the injured vessel wall. In addition, by injecting 51Cr-labeled platelets into rabbits at different times after injury, it was possible to estimate the reactivity of the exposed surface to newly injected platelets. Scanning electron microscopy showed that a monolayer of platelets initially formed on the injured surface; the number of platelets associated with the surface decreased over the 7-day observation period. The amount of 51Cr associated with the injured vessel wall also diminished during this period. The ability of the damaged surface to attract fresh platelets gradually decreased during the 7 days following injury. Platelet survival in rabbits was not significantly reduced following the removal of the aortic endothelium (balloon catheter injury 66.3 +/- 12.2 hours, sham operated 72.1 +/- 7.2 hours, untreated controls 76.2 +/- 3.8 hours). Thus, in rabbits, it cannot be assumed that platelet survival provides an estimate of endothelial injury in all circumstances.
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After removal of the endothelium from normal rabbit aortas or after injury to the neointima, the injured surfaces rapidly become nonreactive to circulating platelets. Experiments were done to determine whether prevention of the initial interaction of platelets with the surfaces would influence the loss of vessel wall reactivity. Inhibition of platelet accumulation on the subendothelium by the infusion of PGI2 (850 ng/kg/min) or the administration of dipyridamole (12.5 mg/kg initially followed by 5 mg/kg/hr) for periods of less than 8 hours inhibited platelet accumulation of platelets on the surfaces when the infusions were stopped. If the animals were treated for 8 hours, platelets did not accumulate on the surface when the drugs were discontinued. Thus, an injured vessel wall can develop a nonthrombogenic surface even when platelet adherence is prevented, although approximately 8 hours are required before the surface loses its ability to interact with platelets.