Studies on oral contraceptive-induced changes in blood coagulation and fibrinolysis and the estrogen effect on endothelial cells

Summary Blood coagulation (fibrinogen, thrombinantithrombin III complexes, TAT, and prothrombin fragment F₁₊₂) and fibrinolytic parameters [fibrin split-product D-dimer, tissue plasminogen activator (t-PA) activity, plasminogen activator inhibitor-1 activity (PAI-1), and plasmin-antiplasmin-complexes (PAP)] were evaluated in 16 women on low estrogen (EE) oral contraceptive (OC) therapy. Blood samples were taken before and between days 18 and 22 of the first, third, and sixth treatment cycle. Fibrinogen levels were found significantly elevated during OC treatment compared with pretreatment values, while TAT and also F₁₊₂ levels remained unchanged. Treatment-induced activation of fibrinolysis was documented by elevated D-dimer [pretreatment (pt): 172 ng/ml (range: 65–640 ng/ml), cycle 6 (c.6): 351 ng/ml (range: 93–960 ng/ ml),p<0.05)] and PAP [(pt: 46.6 ng/ml (13–220 ng/ml), c.6: 66.4 ng/ml (21–200 ng/ml),p<0.05] plasma levels. Among the fibrinolytic components a decrease in PAI-1 [pt: 10.8 ng/ml (2–56 ng/ml), c.6: 5.3 ng/ml (2.2–14.4 ng/ml),p<0.05] and an increase in t-PA activity [pt: 0.23 U/ml (0.17–0.45 U/ml), c.6: 0.33 U/ml (0.2–0.9 U/ml),p<0.05] were detected. Experiments with cultured human endothelial cells (EC) showed that EE influenced neither EC hemostatic regulatory activities (tissue factor, thrombomodulin) nor the secretion of the fibrinolytic components t-PA and PAI-1.     

The role of angiopoietins in the development of endothelial cells from cord blood CD34+ progenitors

Circulating endothelial progenitors contribute to neovascularization at sites of injury and tumorigenesis in postnatal life. Yet, the molecular mechanisms initiating the endothelial developmental program of these precursors remain elusive. Here we provide evidence that endothelial development from progenitors circulating in human cord blood requires angiopoietins, a set of growth factors also involved in vascular branching during embryogenesis. We show that cord blood cells with the potential for endothelial development reside in a CD34⁺CD11b⁺ subset capable of autonomously producing and binding angiopoietins. Functionally, endogenous angiopoietin-1 regulates initial endothelial cell commitment, whereas angiopoietin-2 enhances expansion of the endothelial cell progeny. These findings suggest a role for angiopoietins as regulators of endothelial development from circulating progenitors and imply a function of angiopoietins at distinct developmental steps in postnatal angiogenesis.      

Regulation of the coagulation system by vascular endothelial cells

The endothelium plays an active role in the regulation of the coagulation mechanism. Multiple anticoagulant properties are operative on the cell surface in homeostasis. In the protein C/protein S pathway, for example, endothelium provides cofactors promoting activation of protein C, assembly of the activated protein C/protein S complex, and synthesizes protein S. In contrast, following exposure to cytokines and other pathologic stimuli, endothelial cell activation occurs. This activated state includes upregulation of procoagulant properties, such as tissue factor, with concomitant downregulation of anticoagulant cofactors, such as thrombomodulin. Modulation of endothelial cell coagulant properties by cytokines provides a mechanism linking activation of the clotting mechanism to the cellular response to environmental stimuli.     

The role of stress hormones in the relationship between resting blood pressure and coagulation activity

BACKGROUND: Systemic hypertension confers a hypercoagulable state. We hypothesized that resting mean blood pressure (MBP) interacts with stress hormones in predicting coagulation activity at rest and with acute mental stress. METHODS: We measured plasma clotting factor VII activity (FVII:C), FVIII:C, fibrinogen, D-dimer, epinephrine and norepinephrine, and saliva cortisol in 42 otherwise healthy normotensive and hypertensive medication-free men (mean age 43 +/- 14 years) at rest, immediately after stress, and twice during 60 min of recovery from stress. RESULTS: At rest, the MBP-by-epinephrine interaction predicted FVII:C (beta = -0.33, P < 0.04) and D-dimer (beta = 0.26, P < 0.05), and the MBP-by-cortisol interaction predicted D-dimer (beta = 0.43, P = 0.001), all independent of age and body mass index (BMI). Resting norepinephrine predicted fibrinogen (beta = 0.42, P < 0.01) and D-dimer (beta = 0.37, P < 0.03), both independent of MBP. MBP predicted FVIII:C change from rest to immediately post-stress independent of epinephrine (beta = -0.37, P < 0.03) and norepinephrine (beta = -0.38, P < 0.02). Cortisol change predicted FVIII:C change (beta = -0.30, P < 0.05) independent of age, BMI and MBP. Integrated norepinephrine change from rest to recovery (area under the curve, AUC) predicted D-dimer AUC (beta = 0.34, P = 0.04) independent of MBP. The MBP-by-epinephrine AUC interaction predicted FVII:C AUC (beta = 0.28) and fibrinogen AUC (beta = -0.30), and the MBP-by-norepinephrine AUC interaction predicted FVIII:C AUC (beta = -0.28), all with borderline significance (Ps < 0.09) and independent of age and BMI. CONCLUSIONS: MBP significantly altered the association between stress hormones and coagulation activity at rest and, with borderline significance, across the entire stress and recovery interval. Independent of MBP, catecholamines were associated with procoagulant effects and cortisol reactivity dampened the acute procoagulant stress response.     

Effects of storage-induced platelet microparticles on the initiation and propagation phase of blood coagulation

Platelets shed microparticles, which support haemostasis via adherence to the damaged vasculature and by promoting blood coagulation. We investigated mechanisms through which storage-induced microparticles might support blood coagulation. Flow cytometry was used to determine microparticle number, cellular origin and surface expression of tissue factor (TF), procoagulant phosphatidylserine (PtdSer) and glycoprotein (GP) Ib-alpha. The influence of microparticles on initiation and propagation of coagulation were examined in activated factor X (factor Xa; FXa) and thrombin generation assays and compared with that of synthetic phospholipids. About 75% of microparticles were platelet derived and their number significantly increased during storage of platelet concentrates. About 10% of the microparticles expressed functionally active TF, as measured in a FXa generation assay. However, TF-driven thrombin generation was only found in plasma in which tissue factor pathway inhibitor (TFPI) was neutralised, suggesting that microparticle-associated TF in platelet concentrates is of minor importance. Furthermore, 60% of all microparticles expressed PtdSer. In comparison with synthetic procoagulant phospholipids, the maximal rate of thrombin formation in TF-activated plasma was 15-fold higher when platelet-free plasma was titrated with microparticles. This difference could be attributed to the ability of microparticles to propagate thrombin generation by thrombin-activated FXI. Collectively, our findings indicate a role of microparticles in supporting haemostasis by enhancement of the propagation phase of blood coagulation.     

The role of endothelial cells in inflamed adipose tissue

In recent years, the general concept has emerged that chronic low-grade inflammation can be the condition linking excessive development of adipose tissue (AT) and obesity-associated pathologies such as type II diabetes and atherosclerosis. Moreover, the evidence that the growth of the fat mass was associated with an accumulation of adipose tissue macrophages (ATM) has raised the hypothesis that the development of an inflammatory process within the growing fat mass is a primary event involved in the genesis of systemic metabolic and vascular alterations. As ATM originate from the bone marrow/blood compartment, enhanced macrophage recruitment to growing AT is suspected. However, the mechanisms responsible for attracting the blood cells and their entry into the fat mass remain to be clearly defined. The present review highlights the key role of endothelial cells in the control of the inflammatory process and describes the potential involvement of AT-endothelial cells as well as the factors involved in the regulation of their phenotype in the 'inflamed fat tissue'.     

The activation of human blood coagulation factor X on the surface of endothelial cells: a comparison with various vascular cells, platelets and monocytes

SUMMARY. Rates of factor X activation on endothelial cells were compared with activation rates on other vascular cells, platelets, monocytes and negatively charged phospholipid vesicles. Factor VIIa-mediated factor X activation was observed on smooth muscle cells and fibroblasts in the absence of cell-perturbing agents, whereas endothelial cells required activation in order to allow extrinsic activation of factor X. On the other hand, unperturbed endothelial cells did promote intrinsic, factor VIII/IXa-dependent activation of factor X. The rate of factor X activation on these cells was about one-sixth of that on ionophore A23187-stimulated platelets. Also, smooth muscle cells and fibroblasts were able to activate factor X through the intrinsic pathway, altough to a lesser extent than endothelial cells. Monocytes were ineffective in this respect. Prothrombin fragment 1, the prothrombin fragment containing the γ-carboxyglutamic acid domain known to mediate binding of vitamin K-dependent coagulation factors to phospholipid surfaces, inhibited factor VIII/IXa-dependent factor X activation on endothelial cells (IC₅₀ 3.2 μM) to a lesser extent than on phospholipid vesicles (IC₅₀ 0.2 μM). Therefore, besides negatively charged phospholipids, other membrane constituents seem to be involved in endothelial cell mediated, intrinsic activation of factor X. Perturbation of endothelial cells with phorbol myristate acetate (PMA) or lipopoly-saccharide (LPS) was without effect on intrinsic activation of factor X. This observation indicates that membrane constituents of endothelial cells involved in factor VIII/IXa-dependent activation of factor-X are constitutively expressed.     

脐血外周血内皮祖细胞成内皮细胞的体外比较研究

目的:探讨人脐血、外周血内皮祖细胞(EPCs)体外分离、纯化、诱导扩增和分化为内皮细胞的可行性,并对两者分化成内皮细胞的能力进行比较。方法:新鲜脐血和健康成年人的外周血,Ficoll密度梯度离心法得单个核细胞,磁珠分选方法(MACS)分离脐血CD34 单个核细胞(MNCCD34 )。脐血单个核细胞(CBMC)、外周血单个核细胞(PBMC)和MNCCD34 在M-199培养基体外培养,血管内皮生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)诱导EPCs增殖和分化。采用细胞形态学观察比较细胞克隆形成率的区别,流式细胞仪检测不同来源的EPCs分化后CD31阳性细胞率。结果:MNCCD34 培养3 d后,细胞克隆形成率为(24.25±6.5)/(3×107)细胞;CBMC贴壁细胞培养3 d后,为(103.00±10.10)/(3×107)细胞;PBMC贴壁细胞培养3 d后,为(74.25±5.44)/(3×107)细胞。CBMC分化形成的贴壁细胞和细胞簇数目多于PBMC(P<0.05),但单个核细胞分化形成的克隆率均明显高于MNCCD34 细胞(均P<0.05)。细胞培养10 d后CD31阳性率为:CBMC为(76.24±16.54)%,PBMC为(82.2±9.0)%,MNCCD34 为(70.03±10.27)%,MNCCD34-仅为(36.5±11.78)%。结论:相似数目的细胞,CD34 细胞单独培养形成的贴壁细胞和细胞簇数目明显少于CBMC和PB-MC(均P<0.05)。培养10 d后CD31阳性细胞率则差异无统计学意义(P>0.05),提示不同来源的EPCs分化率无显著区别,主要来自CD34 细胞群。     

内皮祖细胞在心血管疾病治疗中的作用

1997年,Asahara等[1]定义了从外周血中分离出来的内皮祖细胞（endothelial progenitor cells,EPCs）.EPCs在动员、迁移后亦能形成新血管,这一过程后来被称为“血管新生”.EPCs对血管新生和内皮修复的作用展现了其潜在的治疗价值,改善EPCs功能、EPCs移植、内皮捕获支架等治疗心血管疾病提示有广泛的前景. 1 EPCs概述 自从发现外周循环中的EPCs以来,研究者已经应用多种方法来识别和分离此类细胞群.然而,EPCs仍未有共识性的定义.EPCs包含着一组细胞,这些细胞在不同的发展阶段中存在,从成血管细胞到分化成熟的内皮细胞不等.     

The possible role of mutated endothelial cells in myeloproliferative neoplasms

Myeloproliferative neoplasms (MPN) are chronic, clonal hematologic malignancies characterized by myeloproliferation and a high incidence of vascular complications (thrombotic and bleeding). Although MPN-specific driver mutations have been identified, the underlying events that culminate in these clinical manifestations require further clarification. We reviewed the numerous studies performed during the last decade identifying endothelial cell (EC) dysregulation as a factor contributing to MPN disease development. The JAK2V617F MPN mutation and other myeloid-associated mutations have been detected not only in hematopoietic cells but also in EC and their precursors in MPN patients, suggesting a link between mutated EC and the high incidence of vascular events. To date, however, the role of EC in MPN continues to be questioned by some investigators. In order to further clarify the role of EC in MPN, we first describe the experimental strategies used to study EC biology and then analyze the available evidence generated using these assays which implicate mutated EC in MPN-associated abnormalities. Mutated EC have been reported to possess a pro-adhesive phenotype as a result of increased endothelial Pselectin exposure, secondary to degranulation of Weibel-Palade bodies, which is further accentuated by exposure to pro-inflammatory cytokines. Additional evidence indicates that MPN myeloproliferation requires JAK2V617F expression by both hematopoietic stem cells and EC. Furthermore, the reports of JAK2V617F and other myeloid malignancy- associated mutations in both hematopoietic cells and EC in MPN patients support the hypothesis that MPN driver mutations may first appear in a common precursor cell for both EC and hematopoietic cells.