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Effects of prostaglandins, derivatives of cyclic 3':5'-AMP, theophylline, cholinergic agents and colchicine on clot retraction in dilute platelet-rich plasma and gel-separated platelet test systems.

In dilute suspensions of platelet-rich plasma (PRP) or gel-separated platelets (GSP), dibutyryl-cAMP (DBcAMP) and monobutyryl-cAMP inhibited platelet-mediated fibrin clot retraction in concentrations of 2--3 X 10(-6) M, with complete inhibition at 1--3 X 10(-4) M. Prostaglandin E1 (PGE1), which inhibited fibrin clot retraction in concentrations greater than 1.5--3 X 10(-8) M, was a more effective inhibitor than either PGE2 or PGF2 alpha. In the presence of theophylline (10-4 M), concentrations of DBcAMP, PGE1, PGE2 and PGF2 alpha necessary to inhibit fibrin clot retraction were reduced 50-fold for DBcAMP and 2.5 to 20-fold for the prostaglandins. In dilute PRP or GSP, inhibition of fibrin clot retraction does not result from inhibition of thrombin-induced platelet aggregation. Thus, compounds which increase platelet cAMP levels result in the inhibition of platelet-mediated fibrin clot retraction, and this inhibitory effect may be mediated, at least in part, through suppression of platelet contractility. Cyclic GMP, dibutyryl-cGMP and carbamylcholine-Cl (which stimulate guanylate cyclase) did not influence fibrin clot retraction, and did not prevent inhibition of fibrin clot retraction by DBcAMP and PGE1. Colchicine, in concentrations known to disrupt platelet microtubules (2.5 X 10(-6) M to 2.5 X 10(-3) M), had little inhibitory effect on either fibrin clot retraction or platelet (3H)-serotonin release.

Blood Coagulation

Tanshinone IIA impairs platelet function and thrombus formation.

BACKGROUND: Tanshinone IIA (T-IIA) is a fat-soluble active ingredient derived from the traditional Chinese medicine Danshen and possesses cardioprotective property. However, its exact role in platelet function is unknown. OBJECTIVES: This study investigated T-IIA's role in platelet aggregation, granules release, spreading, clot retraction, as well as in vivo hemostasis and thrombus formation. METHODS: Human platelets were treated with different doses of T-IIA (10, 50, and 100 μM) to measure platelet function and activation. In addition, T-IIA was administrated into wild-type mice to evaluate hemostasis and thrombus formation. RESULTS: T-IIA significantly impaired platelet aggregation, adenosine triphosphate secretion, P-selectin expression, and spreading and clot retraction dose dependently without affecting the expression profiles of αIIbβ3 and glycoprotein VI or Ibα. Administration of T-IIA significantly prolonged mice tail bleeding time and inhibited arterial and venous thrombosis. Further analysis showed that T-IIA dose dependently reduced platelet reactive oxygen species generation. Quantitative proteomic and phosphoproteimic assays analyzing T-IIA-treated vs vehicle-treated platelets after stimulation identified dysregulated phosphorylation of several proteins, which were enriched in platelet activation. Among the downregulated phosphoproteins, Rho-associated protein kinase (ROCK)1, integrin β3, and talin1 exhibited the lower fold change of phosphorylation in T-IIA-treated platelets compared with those in vehicle-treated platelets. Consistently, T-IIA treatment inhibited the phosphorylation of ROCK1, p47phox, integrin β3, and talin1 in activated platelets. CONCLUSION: T-IIA impairs platelet function and thrombosis via inhibition of several signaling pathways including ROCK1/p47phox, β3, and talin1, implying that T-IIA may represent a promising therapeutic candidate for treating thrombotic diseases.

Animals

Platelets and platelet function in patients with chronic uremia on maintenance hemodialysis.

In 20 chronic uremic patients on maintenance hemodialysis, who were not taking any medication known to affect platelet function, the following investigations were carried out: platelet count, fibrin/fibrinogen degradation products, fibrinogen and plasminogen concentration, platelet adhesiveness, clot retraction and platelet aggregation induced by ADP, ristocetin, fibrinogen, collagen and epinephrine. The only significant abnormal result was a decreased clot retraction. We consider many cases of so-called uremic bleeding to be caused by the medication taken and conclude that on well-controlled hemodialysis treatment, bleeding tendency should not be a major problem.

Blood Coagulation Disorders

Binding of anti-actin autoantibodies to platelets.

Normal platelets incubated with anti-actin autoantibodies (AAA) (from the serum of patients with chronic aggressive hepatitis) do not show binding of these antibodies as seen by indirect immunofluorescence. AAA serum does not inhibit thrombin-induced clot retraction, despite the binding of the antibodies to platelets in the clot. Similarly, AAA serum does not affect "reversible" or "irreversible" aggregation (induced by ADP, collagen or epinephrine), despite the binding of the antibodies to platelet actin under such circumstances. AAA also bind to platelets when aggregation is inhibited by EDTA. The incubation of "reversibly" aggregated platelet with AAA results in a small but definite binding of AAA to platelets. These findings suggest that during "irreversible" and/or "reversible" aggregation, changes take place at the surface of platelets which expose the antigen at the surface of the cell.

Actins

Ditazole and platelets. I. Effect of ditazole on human platelet function in vitro.

Ditazole (4,5-diphenyl-2-bis-(2-hydroxyethyl)-aminoxazol) has been shown to be a strong in vitro inhibitor of human platelet aggregation brought about by release reaction inducers; in contrast, it did not significantly affect primary ADP-induced aggregation. Ditazole strongly inhibited the release of platelet-bound 14C-serotonin under the influence of Thrombofax, whereas it did not interfere with the transport and storage of serotonin in nonstimulated platelets. The effect of ditazole was not potentiated by acetylsalicylic acid. Ditazole also inhibited ADP-reptilase clot retraction and modified thrombin-induced clot formation. The inhibition of platelet aggregation exerted by ditazole in plasma could be removed following gel filtration of platelets on Sepharose 2-B gel. This would indicate that ditazole does not act on platelets by a 'hit and run' mechanism.

Adenosine Diphosphate

Effect of vitamin E on platelet aggregation in diabetic retinopathy.

The effect of vitamin E on platelet aggregation was investigated in a group of 10 patients with diabetic retinopathy. Adenosine diphosphate induced platelet aggregation was inhibited in the patients' group as well as in the controls in the presence of vitamin E. An increased platelet aggregation was obtained with arachidonic acid in both groups when platelet-rich plasma was incubated prior with vitamin E. The clot retraction inhibition test parallels the findings of aggregation obtained with the platelet aggregation meter.

Adenosine Diphosphate

Biochemical mechanism of platelet activation. Involvement of contractile proteins.

The present state of knowledge of the biochemical mechanism of platelet activation (adhesion, shape change, microspike formation, aggregation, release reaction, clot retraction) is presented under involvement of contractile proteins. The working hypothesis on the contractile mechanism of platelet activation is explained.

Actomyosin

[Effect of phosphatidylserine on formation and lysis of fibrin].

Phosphatidyl serine inhibited non-enzymatic step of fibrin formation (selfassociation of monomeric fibrin). But phosphatidyl serine did not affect the factor XIII activity, the rate of fibrin clot retraction and its tolerance to plasmin. Activity of plasmin was not altered in presence of phosphatidyl serine but influence of slowly acting antiplasmin on plasmin was slightly limited by the lipoid. Due to this phenomenon phosphatidyl serine caused the activation of fibrinolysis in native system (blood plasma). The data obtained support the earlier advanced assumptions on inhibition of thrombin-fibrinogene reaction by phosphatidyl serine.

Antifibrinolytic Agents

Inhibition of collagen-induced platelet aggregation by antibodies to distinct types of collagens.

Aggregation of platelets by fibrils formed from collagens type I, II and III could be inhibited by coating the fibrils with anti-collagen antibodies or Fab fragments. Similar results were obtained in a clot-retraction assay. Inhibition was achieved with stoichiometric amounts of antibodies and was specific for each type of collagen. Aggregation caused by a mixture of type-I and -III collagens could only be inhibited by a mixture of antibodies against both collagens. The data show that each interstitial collagen is capable of interacting with platelets and do not support the concept of an outstanding activity of type-III collagen.

Antibodies

Specificity of the effects of cytochalasin B on transport and motile processes.

The effects of cytochalasin B (CB) and dihydrocytochalasin B (H2CB) on a variety of transport and motile processes have been compared. CB inhibited transport of D-glucose and L-glucose but not transport of thymidine in human erythrocytes. In contrast, H2CB, which differs from CB by the absence of a single double bond, had little or no effect on any of these processes. Both cytochalasins, however, affected the morphology of cultured fibroblasts and inhibited motile processes such as membrane ruffling, axon growth cone activity, blood clot retraction, cytoplasmic streaming, photodinesis, and cytokinesis. Determination of the partition coefficient of the two cytochalasins in several organic solvent/phosphate-buffered saline systems showed that H2CB has a higher affinity for the hydrophobic phase than CB. These results indicate that the inhibitory effects of CB on sugar transport and on cell motility and morphology are separable and independent events, mediated by the binding of the drug to specific cellular receptors.

Axons

Thrombocytin, a serine protease from Bothrops atrox venom. 2. Interaction with platelets and plasma-clotting factors.

Thrombocytin, a serine protease from Bothrops atrox venom, caused platelet aggregation and release of platelet constituents at a concentration of 10(-7) M and clot retraction at a concentration of 2 x 10(-9) M. Thrombocytin was slightly more active when tested on platelets in plasma than on washed platelets suspended in Tyrode--albumin solution. Thrombin was 5 times more active than thrombocytin when tested on platelets in plasma and 50 times more active when tested on washed platelets. The patterns or release induced by thrombocytin and thrombin were similar. Prostaglandin E1 (10(-5) M) produced complete inhibition of platelet release induced by thrombocytin and thrombin. Indomethacin (10(-4) M) was without any effect. Antithrombin III, in the presence of heparin, inhibited the action of thrombocytin on platelets and on a synthetic peptide substrate (Tos-Gly-Pro-Arg-pNA.HCl). formation of an antithrombin III--thrombocytin complex was demonstrated on NaDodSO4--polyacrylamide gel electrophoresis. Hirudin and alpha 1-antitrypsin did not inactivate thrombocytin. Thrombocytin had a low fibrinogen-clotting activity (less than 0.06% that of thrombin). Thrombocytin also caused progressive degradation of the alpha chain of human fibrinogen, and it cleaved prothrombin, releasing products similar to intermediate 1 and fragment 1 produced by thrombin. Thrombocytin activated factor XIII by limited proteolysis and increased the procoagulant activity of factor VIII in a manner analogous to that of thrombin.

Animals

Effect of propranolol on platelet function.

Excessive reactivity of blood platelets may contribute to atherosclerotic vascular disease. Hence drugs which alter platelet function may be protective. Prompted by findings that propranolol therapy normalized hyperactive platelet aggregation in patients with coronary artery disease, we studied propranolol in vitro to assess its action on platelets. At concentrations similar to those achieved in vivo (0.1-1 muM), propranolol raised the thresholds for aggregation of some normal paltelets by adenosine diphosphate (ADP). At higher concentrations (10-50 muM), propranolol abolished the second wave of platelet aggregation induced by ADP and epinephrine, and inhibited aggregation induced by collagen, thrombin, and the ionophore A23187. Propanolol blocked the release of 14C-serotonin from platelets, inhibited platelet adhesion to collagen, and interfered with clot retraction. Propranolol blocked ionophore-induced uptake of 45Ca by platelets. Inhibition appeared unrelated to beta-adrenergic blockage, as d(+) propranolol (which lacks beta-blocking activity) was equipotent with 1(-) propranolol. Moreover, practolol, a beta-blockading drug which is nonlipophilic, did not inhibit platelet function. These studies suggested that propranolol, like local anesthetics, decreased platelet responsiveness by a direct action on the platelet membrane, possibly by interfering with calcium availability. Modulation of platelet function by propranolol may occur at concentrations achieved at usual clinical doses of the drug.

Blood Coagulation Tests

The use of fresh blood in the treatment of critically injured patients.

Initial transfusion needs aremet by type-specific rather than low titer O-negative blood. When the patient's problem approaches the magnitude of exchange transfusion (5 to 10 units) in less than 4 hours, platelet transfusion to treat dilutional thrombocytopenia is administered. Fresh frozen plasma is administered to provide clotting factors. When five units have been exceeded, platelet, pro-thrombin, and partial thromboplastin are measured. A blood clot is checked for clotting, retraction, and lysis. These tests screen platelet quantity and the intrinsic and extrinsic clotting system. Administered blood is warmed in a water bath or heating coil. Blood gas analysis (pH, pO2, and pCO2) is performed every five units to allow for precise administration of bicarbonate. The electrocardiogram is used to monitor potassium and calcium abnormalities. Hyperkalemia is seldom a problem. Hypocalcemia may be present transiently and is treated with calcium choride. Component therapy is the standard recommended practice. Fresh blood is recommended for the patient who has had an acute exchange transfusion and continues to require large quantities of blood. Fresh blood obviates the need for combining components and allows one transfusion unit to address itself to the multiple needs of the patient.

Acid-Base Equilibrium

Congenital deficiency of alpha 2-plasmin inhibitor associated with severe hemorrhagic tendency.

alpha(2)-Plasmin inhibitor (alpha(2)PI) is a recently characterized, fast-reacting plasmin inhibitor in human plasma that appears to play an important role in regulation of in vivo fibrinolysis. We report here a case of complete deficiency of alpha(2)PI in man. The patient, a 25-yr-old Japanese man, had a life-long severe bleeding tendency (hemarthrosis and excessive bleeding after trauma). The following tests were within normal limits: platelet count, bleeding time, thrombin time, prothrombin time, partial thromboplastin time, titers of known clotting factors, platelet glass bead retention, Factor VIII-related antigen, platelet aggregation by ADP, collagen and ristocetin, and clot retraction. Routine liver function tests were also normal. The only abnormal finding was that whole blood clot lysis was extemely rapid and was complete in 4-8 h. The concentration of plasma protease inhibitors, including alpha(2)-macro-globulin, antithrombin III, alpha(1)-antitrypsin, and C1INH, were all normal. The concentration of alpha(2)-PI in the patient's plasma, assayed by immunological methods, was <0.1 mg/100 ml (normal concentration, 6.1+/-0.88 mg/100 ml [mean+/-SE]) and functional assays showed a complete deficiency of alpha(2)PI. Addition of purified alpha(2)PI to the patient's whole blood completely corrected the accelerated fibrinolysis. The patient's parents, four siblings, and four other members of this family were asymptomatic, but the titers of alpha(2)PI in their plasmas were congruent with50% of normal pooled plasma. There were three consanguineous marriages in this family, and the alpha(2)PI deficiency appears to have been inherited as an autosomal recessive trait. We speculate that alpha(2)PI deficiency in this patient has led to uninhibited in vivo fibrinolysis that probably causes the severe hemorrhagic tendency. Thus, this study indicates the important role of alpha(2)PI in hemostasis.

Adult

Role of reduced glutathione on platelet functions.

The role of reduced glutathione (GSH) on platelet functions was investigated utilizing thiol oxidizing agent, "diamide". Diamide reacted rapidly with GSH in platelets, but not with protein thiols. Platelets treated with diamide showed inhibition of platelet aggregation induced by ADP, epinephrine and collagen in a concentration dependent manner. Clot retraction was grossly inhibited by diamide. Platelet interaction with polymerizing fibrin was examined by the method of Niewiarowski et al. (1972). There was no interaction obeserved between diamide-treated platelets and polymerizing fibrin. Ultrastructural observation of clots formed in the presence of diamide also showed no direct contact between platelets and fibrin strands. Platelets retained their granular contents, but showed loss of microtubules and dilatation of open canalicular system. Our findings may further support the idea that GSH plays an important role on platelet functions.

Adenosine Diphosphate

Platelet aggregation following electrical stimulation.

It was demonstrated that the previous in vitro electrical stimulation of human and rat platelet-rich plasma does not modify the subsequent response of platelets to the aggregating activity of ADP, thrombin, thrombofax or adrenaline. This is interesting in view of the fact that the electrical stimulation can induce clot retraction.

Adenosine Diphosphate

Platelet dysfunction in vincristine treated patients.

Recent revival of interest in the use of vincristine (VCR) for the treatment of idiopathic thrombocytopenic purpura prompted us to evaluate the platelet function of our patients on VCR. Eighteen patients with acute lymphoblastic leukaemia (ALL) in remission, and nine children with solid tumours were studied on 80 occasions at different time intervals after their last VCR dose. A mildly elevated threshold for epinephrine-induced second phase aggregation and a delay in the onset of collagen-induced aggregation was found in patients with ALL not on VCR. Vincristine induced unobtainable second phase aggregation to epinephrine in 67%, 38%, 30% and to ADP in 53%, 13%, 33% of the patients 1 week, 2-3 weeks and 4 weeks respectively after administration. The thrombocytopathy was relative, not absolute, since collagen induced aggregation at all times. Platelet counts, uptake and release of serotonin, bleeding times, clot retractions and release of platelet factor 3 were normal. Platelet adhesion was abnormal in five of 12 patients tested. In vitro platelets are a hundred-fold less sensitive to VCR than in vivo. Cyclic adenosine monophosphate, cyclic guanosine monophosphate and dimethylsulfoxide do not protect platelets from VCR. The exact mechanism by which VCR abolishes second phase aggregation in patients is uncertain. Because of VCR's narrow therapeutic index between thrombocytopenia and thrombocythaemia, the use of VCR should be reserved for life-threatening haematologic disorders when treating non-malignant conditions.

Adenosine Diphosphate