Fibrinogen and glycoprotein IIb/IIIa localization during platelet adhesion. Localization to the granulomere and at sites of platelet interaction.

Platelet membrane glycoprotein IIb-IIIa plays a focal role in primary hemostasis by serving as the cell surface receptor for fibrinogen. Recent studies by several groups have suggested that GPIIb-IIIa, which is dispersed randomly in the resting cell, undergoes migration leading to receptor clustering after platelet activation. The authors have investigated this activation-dependent relocation of fibrinogen receptors on platelets adherent to a standardized artificial surface. The correlative use of immunogold electron microscopy, ligand-gold binding, and stereo (three-dimensional) electron microscopy (EM) revealed specific localization of fibrinogen and its receptor at points of platelet to platelet interaction. Fibrinogen distribution on the plasma membrane, studied through the use of fibrinogen-gold conjugates with whole-mount adherent platelets, was primarily over the granulomere and at the cell periphery corresponding to sites of platelet-platelet interaction. Compared with the general hyalomere, fibrinogen density over the granulomere and at contact regions was increased 12-fold and 22-fold, respectively, and the specificity of binding at these sites was verified by positive competition with native fibrinogen, one of its degradation products (Fragment D1), and by monoclonal antibodies (HP1-1d and AP-2) specific for GPIIb-IIIa. The distribution of receptor antigens, localized by immunogold EM using antibodies against GPIIb-IIIa, also was localized over the hyalomere, where fibrinogen did not bind. To understand this apparently nonfunctional hyalomere GPIIb-IIIa further, correlative immunocytochemistry was performed using polyclonal and monoclonal antibodies for GPIIb and GPIIIa simultaneously. Colocalization of the antigens was observed consistently over the granulomere and at regions of cell contact, whereas the hyalomere antigens tended to be nonassociated. The studies document GPIIb-IIIa as a function complex at sites of cell interaction where fibrinogen binds.     

Analysis of platelet surface conformation in thrombin-induced aggregation

We used flow cytometry to investigate the change of platelet membrane glycoproteins (GPIb and GP IIb/IIIa) and the distributions of fibrinogen (Fbg), thrombospondin (TSP) and fibronectin (Fn) on the surface of thrombin-stimulated platelets. The binding of a monoclonal antibody directed at the von Willebrand factor binding site on GPIb decreased in thrombin-stimulated platelets. This antibody caused a reactive delay in thrombin-induced aggregation, but had little influence on aggregability. Slight thrombin-induced aggregation was observed even after blocking the binding of Fbg to GP II b/IIIa. The new expression of GP II b/IIIa was detected on the surface of thrombin-stimulated platelets, whereas there was little increase of Fbg dependent on this GP II b/IIIa. An increase of TSP after thrombin stimulation was observed on the surface of platelets of healthy controls and patients with Glanzmann's thrombasthenia (Type I). The level of on platelet surface was slightly increased by thrombin stimulation. The mechanism involved in thrombin-induced aggregation appears to differ from that in ADP-induced aggregation.     

Co-adsorbed fibrinogen and von Willebrand factor augment platelet procoagulant activity and spreading

Previously we observed that platelets adherent to surfaces preadsorbed with blood plasma exhibited 1.3 to 2.4 times greater procoagulant activity than platelets on surfaces adsorbed with fibrinogen (Fg) only. These observations suggested that the adhesion proteins adsorbed from plasma may activate platelets in a cooperative, or synergistic manner. In the present study, polystyrene surfaces adsorbed with both Fg and vWF induced up to three times greater procoagulant activity than surfaces adsorbed with Fg or vWF only. The amounts of Fg and vWF adsorbed from binary mixtures that resulted in increased procoagulant activity were found to be similar to the amounts that adsorbed to PS from 100% plasma. The effect of adsorbed adhesion proteins on platelet spreading was also investigated. The proportion of fully spread platelets increased, depending on the adhesion protein preadsorbed to the surface, in the following order: vWF < Fg < Fn < (vWF + Fg) < Vn < plasma.     

The effect of adsorbed fibrinogen, fibronectin, von Willebrand factor and vitronectin on the procoagulant state of adherent platelets

Procoagulant (activated) platelets provide a site for assembly of the prothrombinase complex which can rapidly convert prothrombin into thrombin (a potent inducer of clot formation). Previously, we reported that adhesion of platelets to surfaces preadsorbed with blood plasma caused them to become procoagulant. In the present study we investigated the effect of adsorbed adhesion proteins (fibrinogen (Fg), fibronectin (Fn), von Willebrand factor (vWF) and vitronectin (Vn)) on the procoagulant activity of adherent platelets. Adsorbed Fn, vWF and Fg promoted platelet adhesion in the following order: Fn < vWF = Fg. However, these proteins promoted platelet activation (thrombin generation per adherent platelet) in the following order: Fg < Fn < vWF. Adsorption with a series of dilutions of normal plasma, serum, and plasmas deficient in or depleted of von Willebrand factor (de-vWF), fibronectin (de-Fn), vitronectin (de-Vn), or both vitronectin and fibronectin (de-VnFn) resulted in varied platelet adhesion, but little difference in platelet activation. However, preadsorption with dilute de-vWF plasma induced lower procoagulant activity than normal plasma. Preadsorption with normal plasma resulted in higher levels of platelet activation than preadsorption with Fg, suggesting that adsorption of plasma proteins other than Fg caused the high levels of activation observed for plasma preadsorbed surfaces.     

Dynamic redistribution of glycoprotein Ib/IX on surface-activated platelets. A second look.

The present study has re-evaluated the mobility of glycoprotein Ib/IX (GPIb/IX), the von Willebrand factor receptor, on surface-activated platelets. A previous report employing immunogold cytochemistry with monoclonal and polyclonal antibodies specific for GPIb/IX concluded that the receptor remained stabilized in plasma membranes and did not move during platelet attachment and spreading on formvar grids, despite the observation that immunogold particles marking GPIb/IX were missing from peripheral margins and pseudopods of the surface-activated platelets. Addition of thrombin to surface-activated, spread platelets freed GPIb/IX from its anchor to the membrane and stimulated movement of receptor-ligand complexes into caps over centers of spread platelets. In our investigation, surface-activated platelets, stimulated or not by thrombin, were fixed in a higher concentration of glutaraldehyde than used by the earlier workers before exposure to monoclonal or polyclonal antibody to GPIb/IX, after incubation with the antibody, but before treatment with the immunogold marker, protein A gold (PAG), or after both antibody and PAG. When fixed before exposure to antibody and PAG, GPIb/IX receptors were dispersed evenly over dendritic and spread platelets from edge to edge, including peripheral margins and pseudopods. Thrombin had no influence on distribution of the receptors. Exposure to antiglycocalicin antibody before fixation caused movement of GPIb/IX receptors from peripheral margins of spread cells and pseudopods of dendritic forms. Thrombin treatment did not enhance the movement. Fixation after exposure of surface-activated platelets, treated or not with thrombin, to antibody and PAG caused movement of GPIb/IX receptors into caps over cell centers. Results indicate that central movement of GPIb/IX receptors is unrelated to surface activation, spreading, or thrombin stimulation. Rather, the translocation is caused by the antiglycocalicin antibody and accentuated by PAG.     

Glow discharge plasma treatment of polyethylene tubing with tetraglyme results in ultralow fibrinogen adsorption and greatly reduced platelet adhesion

Previous studies from our lab have shown that fibrinogen adsorption (Gamma(Fg)) must be reduced below 10 ng/cm(2) to significantly reduce platelet adhesion, and that radio frequency glow discharge (RFGD) treatment of polymeric films in the presence of tetraethylene glycol dimethyl ether (tetraglyme) can reduce Gamma(Fg) to the desired ultralow value. In this report, the effects of RFGD coatings of tetraglyme on the lumenal surface of PE tubing on Gamma(Fg) and on blood interactions both in vitro and ex vivo are described. Gamma(Fg) on the tetraglyme-coated PE tubing was reduced to the desired ultralow level (<10 ng/cm(2)), and we also observed a significant decrease in adsorption of von Willebrand's factor. In vitro platelet adhesion from washed platelet suspensions, platelet rich plasma, or whole blood to tetraglyme-coated PE tubing was decreased compared to PE, polyurethane, or silicone rubber tubes. In addition, thrombin generation by platelets adherent to tetraglyme-coated PE was also much less than by platelets adherent to PE. When inserted in an ex vivo carotid artery-carotid artery shunt in sheep, the RFGD tetraglyme-coated PE exhibited a very low number of adherent platelets compared to heparin-coated, chromic acid-etched, or plain PE. The RFGD tetraglyme-coated PE tubes exhibited high protein and platelet resistance in vitro, and high platelet resistance ex vivo. The improved hemocompatibility is attributed to the unique chemical structure of RFGD tetraglyme that makes it highly protein resistant.     

Facilitating roles of murine platelet glycoprotein Ib and αIIbβ3 in phosphatidylserine exposure during vWF–collagen-induced thrombus formation

Vessel wall damage exposes collagen fibres, to which platelets adhere directly via the collagen receptors glycoprotein (GP) VI and integrin α₂β₁ and indirectly by collagen-bound von Willebrand factor (vWF) via the GPIb-V-IX and integrin αIIbβ3 receptor complexes. Platelet–collagen interaction under shear stimulates thrombus formation in two ways, by integrin-dependent formation of platelet aggregates and by surface exposure of procoagulant phosphatidylserine (PS). GPVI is involved in both processes, complemented by α2β1. In mouse blood flowing over collagen, we investigated the additional role of platelet–vWF binding via GPIb and αIIbβ3. Inhibition of GPIb as well as blocking of vWF binding to collagen reduced stable platelet adhesion at high shear rate. This was accompanied by delayed platelet Ca²⁺ responses and reduced PS exposure, while microaggregates were still formed. Inhibition of integrin αIIbβ3 with JON/A antibody, which blocks αIIbβ3 binding to both vWF and fibrinogen, reduced PS exposure and aggregate formation. The JON/A effects were not enhanced by combined blocking of GPIb–vWF binding, suggesting a function for αIIbβ3 downstream of GPIb. Typically, with blood from FcR γ-chain +/− mutant mice, expressing 50% of normal platelet GPVI levels, GPIb blockage almost completely abolished platelet adhesion and PS exposure. Together, these data indicate that, under physiological conditions of flow, both adhesive receptors GPIb and αIIbβ3 facilitate GPVI-mediated PS exposure by stabilizing platelet binding to collagen. Hence, these glycoproteins have an assistant procoagulant role in collagen-dependent thrombus formation, which is most prominent at reduced GPVI activity and is independent of the presence of thrombin.     

Platelet aggregations and glycoproteins]

Platelet membrane glycoproteins play important roles in platelet functions. In this symposium, we reported three types of deficiency of platelet membrane glycoproteins; Glanzmann's thrombasthenia, Bernard-Soulier syndrome, GPIV-deficiency and discussed the roles of GPIIb/IIIa, GPIb and GPIV, respectively, in the aggregation of these abnormal platelets. In a patient with Bernard-Soulier syndrome, the abnormality in the patient's GPIb was caused by the double heterozygote from her parents who were unrelated. Roles of GPIV were negligible in platelet aggregation since the GPIV-deficient platelets (Naka-) found in healthy donors showed normal platelet aggregations. We developed two monoclonal antibodies, TM83 and TM60 against GPIIIa and GPIb, respectively, and showed that these antibodies inhibited the function of GPIb and GPIIb/IIIa complex, respectively. We demonstrated that TM83 inhibited an epitope of GPIIIa and/or GPIIb/IIIa complex which changes its conformation due to Ca2+ deprivation and is essential for exposure of the fibrinogen-binding site.     

Morphometry of platelet internal contraction.

Blood platelets have a characteristic discoid shape supported by a circumferential band of microtubules. Following stimulation by aggregating agents or foreign surfaces, platelets lose their discoid form, extend pseudopods, and undergo a process of internal reorganization. Randomly dispersed cytoplasmic organelles become concentrated in cell centers within rings of microtubules and masses of microfilaments. Questions have been raised about this process and its contractile nature by studies demonstrating that platelet microtubules dissolve within seconds after activation and reassemble several minutes later in new locations. Earlier investigations showed that Taxol, a microtubule-stabilizing agent, did not inhibit platelet shape change, internal transformation, secretion, aggregation, or clot retraction. In the present study the diameters of microtubule coils in discoid platelets treated or not treated with Taxol and in platelets activated by thrombin, ADP, and a foreign surface were measured. The results of the study reveal no significant differences in diameters of microtuble rings in control or Taxol-treated cells. However, after activation by ADP, thrombin, or the grid surface, the diameter of coiled microtubules decreased by 30% or more. The results support the concept that internal transformation is a contractile event.     

Platelet adhesion to polystyrene-based surfaces preadsorbed with plasmas selectively depleted in fibrinogen, fibronectin, vitronectin, or von Willebrand's factor

Four plasma proteins have been shown to be able to mediate platelet adhesion to synthetic materials when they are adsorbed as purified proteins: fibrinogen (Fg), fibronectin (Fn), vitronectin (Vn), and von Willebrand factor (vWF). Among them, Fg is thought to play a leading role in mediating platelet adhesion to plasma-preadsorbed biomaterials, but this has been established for only three types of materials so far in our laboratory. Furthermore, the role of Fn, Vn, and vWF in mediating platelet adhesion to plasma-preadsorbed surfaces is still unclear. The aim of the current study was to assess the importance of Fg, Fn, Vn, and vWF in mediating platelet adhesion to a series of polystyrene-based surfaces. The strategy applied in the present investigation was to compare platelet adhesion to surfaces preadsorbed with normal plasma, plasma selectively depleted in Fn or Vn or both Fn and Vn, plasma from donors who were genetically deficient in vWF, and serum. Few platelets adhered to the surfaces preadsorbed with serum, whereas depletion of Fn, Vn, or vWF from plasma did not decrease platelet adhesion significantly. Replenishment of exogenous Fg to serum before protein adsorption restored platelet adhesion to the surfaces, suggesting that Fg was the major plasma protein that mediated platelet adhesion. Also, we found that a surface density of adsorbed Fg far below the amount that usually adsorbs to synthetic surfaces was sufficient to support full-scale platelet adhesion.     

Role of platelet surface receptor abnormalities in the bleeding and thrombotic diathesis of uremic patients on hemodialysis and peritoneal dialysis

BACKGROUND: Patients with chronic renal failure suffer from bleeding diathesis and a tendency to accelerated atherosclerosis. Altered platelet function plays a well defined role in the hemorrhagic complications of these patients and has a probable impact on atherothrombotic disease in uremia. In this study we investigated the expression of platelet surface receptors, the glycoprotein GPIb (receptor for von Willebrand Factor(vWF) and GPIIb/IIIa (receptor for fibrinogen) in patient with chronic renal failure in pre-dialysis status, under hemodialysis and peritoneal dialysis treatment, in order to assess the impact of the abnormal receptorial status of uremic platelets on the clinical manifestations of hemostatic alterations in uremic patients. METHODS: Thirty-seven normal healthy subjects (controls = Group A), 18 patients with mild chronic renal failure (creatinine = 1.8 +/- 0.5 mg% - Group B), 15 patients with advanced renal failure (creatinine = 5.4 +/- 2. 1 mg% - Group C), 18 hemodialysis patients (Group D) and 11 peritoneal dialysis patients (Group E) were included in the study. The expression of platelet surface receptors GPIb and GPIIb/IIIa was investigated with monoclonal antibodies CD42 and CD41 (Immunotech, Marseille, France) and a FACScan flowcytometer (Becton-Dickinson, USA). RESULTS: Mean values of GPIb glycoprotein (mean flow +/- SD) were: group A = 48.14 +/- 9.31; group B = 40.48 +/- 8.18 (p < 0.005); group C = 34.05 +/- 7.55 (p < 0.0005) versus group A; p = 0.025 versus group B); group D = 34.51 +/- 7.22 (p < 0.0005 versus group A; p = 0.025 group B and p = ns versus group C); group E = 26.34 +/- 4.06 (p < 0.0005 versus group A, p < 0.0005 versus group B, p < 0.005 versus groups C and D). Mean values of glycoprotein GPIIb/IIIa were: group A = 375.32 +/- 90.58; group B = 398.48 +/- 54.26 (p = ns); group C = 426.86 +/- 52.78 (p < 0.025 versus group A; p = ns versus group B); group D = 425.17 +/- 75.03 (p < 0.025 versus group A; p = ns versus groups B and C); group E = 336.39 +/- 43.26 (p = ns versus group A; p < 0.005 versus group B, p < 0.0005 versus group C and p < 0.001 versus group D). CONCLUSIONS: Our data confirm the receptorial defect of glycoprotein GPIb (the receptor for vWF) on the surface of uremic platelets: a negative correlation between serum creatinine and the expression of glycoprotein GPIb was found. The defect was not corrected by hemodialysis and/or peritoneal dialysis. Hemodialysis and peritoneal dialysis have a different impact on the expression of GPIIb/IIIa glycoprotein (the receptor for vWF): peritoneal dialysis seems to have a more favourable effect by restoring normal values of the expression of this membrane integrine. Theoretically the data could be correlated to the better biocompatibility of the peritoneal dialysis and to more favorable clinical behaviour in terms of accelerated atherosclerosis and athero-thrombotic complications in the uremic patients with end stage renal disease. Finally the abnormalities of platelet surface receptors may play a main role in the hemostatic alterations of uremic patients.     

Infusible platelet membranes retain partial functionality of the platelet GPIb/IX/V receptor complex

Infusible platelet membranes (IPMs) prepared from fresh or outdated human platelets have been shown to correct prolonged bleeding times in thrombocytopenic rabbits. In previous trials, IPMs did not seem to be immunogenic and lacked dose-limiting toxicity. The present study was undertaken to explore whether the platelet glycoprotein (GP) Ib/IX/V complex might retain functionality in the IPM preparation. IPMs did not spontaneously bind von Willebrand factor (vWF), but saturable binding could be induced by ristocetin, with a dissociation constant (Kd) of 0.31 +/- 0.03 microgram/mL at 1.0 mg/mL of ristocetin. Of 4 anti-GPIb-alpha monoclonal antibodies tested, AN-51 inhibited vWF binding 67.8% +/- 5.8%, whereas AS-2, AS-7, and SZ-2 were ineffective. Maximal vWF binding induced by botrocetin was only 10% to 15% of that observed with ristocetin. Retention of partial functionality of the GPIb/IX/V receptor allowing vWF binding in a modulated manner seems to represent a critical mechanism by which IPMs may provide hemostatic efficacy.     

Glycoprotein Ib is homogeneously distributed on external and internal membranes of resting platelets

Recent ultrastructural studies have suggested that Glycoprotein Ib (GPIb) has a different distribution on external (surface) versus internal (open canalicular system) membranes in resting discoid platelets. The differential distribution proposed for GPIb differs from that reported for the fibrinogen receptor, GPIIb-IIIa, and could have profound physiological significance when platelets are activated by surfaces. The present study explored the distribution of GPIb on external and internal membranes of resting platelets. Immunogold cytochemical techniques were applied to ultrathin cryosections of washed platelets. Polyclonal antibodies or mixtures of monoclonal antibodies (AP1 and 6D1) were used for labeling. To avoid the technical problem posed by limited accessibility of antigens located in very narrow portions of the open canalicular system (OCS) to antibodies, the same methods were applied to patients with giant platelets syndromes. The OCS of normal resting platelets was also dilated by exposure of platelets to hypertonic conditions or to cytochalasin-B, an agent that prevents assembly of actin, and, reportedly, movement of GPIb. Morphometric analysis revealed that rates of labeling on internal versus external membranes of giant platelets does not differ significantly (0.93 +/- 0.20), provided the OCS is sufficiently dilated. Platelets exposed to cytochalasin B (1.01 +/- 0.31) or to hypertonic conditions (0.96 +/- 0.20) revealed similar ratios for immunogold particles on external and internal membranes. Results of our study indicate that membranes of the exposed surface and lining OCS channels of resting platelets are continuous, identical structures and GPIb is homogeneously distributed on external and internal membranes.     

Fibrinogen surface distribution correlates to platelet adhesion pattern on fluorinated surface-modified polyetherurethane

In previous work, it had been shown that platelet adhesion could be reduced by fluorinating surfaces with oligomeric fluoropolymers, referred to as surface-modifying macromolecules (SMMs). In the current study, two in vitro blood-contacting experiments were carried out on a polyetherurethane modified with three different SMMs in order to determine if altered platelet adhesion levels could be related to the pattern of adsorbed protein and more specifically to the manner in which fibrinogen (Fg) distribution occurs at the surface. In the first experiment, the materials were placed in whole human blood and the adherent platelets were viewed with high-resolution scanning electron microscopy (SEM). In a second experiment, the materials were incubated with human plasma with the absence of platelets. The plasma contained 5% fluorescent-Fg. The materials were then viewed with a fluorescence microscope and images were collected to define the distribution of high-density fluorescent-Fg areas. The SEM and fluorescent-Fg images were imported to Image Pro Plus imaging software to measure the area, length and circularity and a bivariate correlation test was conducted between the two sets of data. For area and length morphology parameters, there were high and significant correlations (r > 0.9, p < 0.05) between the platelets and Fg aggregates. The data suggest that the Fg distribution may serve as a predictor of platelet morphology/activation and provides insight into the non-thrombogenic character of biomaterials containing the fluorinated SMMs.     

New families of adhesion molecules play a vital role in platelet functions

Adhesion molecules play a crucial part in cell-matrix and in cell-cell interactions. These interactions, which are essential to the body's defense processes, involve adhesion molecules belonging to different families: integrins, immunoglobulins and selectins. Integrins are expressed by a large number of tissues, whereas other adhesion molecule families are restricted to a small number of cell types. A recent symposium dealt with the recruitment of circulating platelets at specific sites, their adhesion to extracellular matrix components and their activation by agonists leading to aggregation or attachment to other cells. These events, supporting hemostasis and thrombosis, involve integrins, selectins and other adhesion molecules. This report focuses on newly reported integrins (GPIa, GPIc, GPIIa), selectins (GMP-140) and GPIIIb, previously known as 'minor' surface oriented platelet glycoproteins. Major membrane glycoproteins such as GPIIb-IIIa (an integrin) and GPIb, which also play a vital role in platelet functions, have been extensively reviewed elsewhere.     

Localization of internal pools of membrane glycoproteins involved in platelet adhesive responses.

To investigate the existence of intracellular pools of membrane glycoproteins involved in platelet adhesive reactions, the authors have studied the distribution of glycoprotein (GP) Ib and IIb/IIIa by immunofluorescence and immunoelectron microscopy. Studies on whole cells and frozen thick sections revealed a rim pattern of fluorescence for GPIb and GPIIb/IIIa consistent with a surface distribution. In addition, extensive staining occupying the entire cell interior was observed for anti-GPIIb/IIIa, whereas anti-GPIb revealed staining of large intracellular structures that contained no stainable fibrinogen. On the ultrastructural level, the extracellular face of the plasma membrane and the intraluminal face of vacuolar structures were stained with both anti-GPIb and anti-GPIIb/IIIa. Additionally, GPIIb/IIIa antigen was localized to alpha-granule membranes. To determine whether alpha-granule GPIIb/IIIa could be transported to the cell surface, the authors employed a calcium-dependent monoclonal anti-GPIIb/IIIa antibody. Incubation of platelets with EGTA at 37 C abolished staining of plasma membrane and vacuolar but not alpha-granule GPIIb/IIIa. Recalcification of these cells failed to restore the epitope; however, thrombin treatment of recalcified cells reconstituted surface staining with a concurrent loss of internal staining. These data suggest that GPIIb/IIIa is present in alpha-granule membranes and may be transported to the cell surface in response to thrombin treatment. In addition, both GPIb and GPIIb/IIIa antigens are present in intracellular membrane-bounded vacuolar structures which are closed to antibody probes in fixed cells. Redistribution of these internal pools of adhesive protein "receptors" may participate in the regulation of platelet adhesive properties.     

The platelet fibrinogen receptor: a model for the analysis of cellular adhesion mechanisms and their modification in pathology

Blood platelets are implicated in a series of cellular recognition and adhesion phenomena (adhesion to the subendothelial matrix and platelet aggregation) which are key events in the processes of haemostasis and thrombosis. Platelet aggregation is a model of homotypic cellular adhesion. It is mediated by the binding of bifunctional molecules of fibrinogen to the plasma membrane of adjacent platelets, following stimulation of the platelets by agonists such as ADP, thrombin or collagen, with the fibrinogen serving as an intercellular glue. The platelet receptor for fibrinogen is a macromolecular complex, GPIIb-IIIa, made of two transmembrane glycoproteins, GPIIb (Mr = 142,000) and GPIIIa (Mr = 99,000), assembled into a heterodimer whose conformation depends upon the binding of calcium (Ca2+) to GPIIb. Furthermore, the GPIIb-IIIa complex represents the prototype, and one of the most studied, among a large family of membrane receptors, the integrins, all implicated in various adhesion processes. Binding of fibrinogen to GPIIb-IIIa occurs through interactions between peptide sequences within the receptor and particular adhesive sites within the ligand: thus, GPIIIa can bind to a tetrapeptide sequence of the A alpha chain of fibrinogen, whereas a dodecapeptide of the gamma chain can be preferentially bound to GPIIb. On a physiopathological point of view, qualitative or quantitative defects of GPIIb-IIIa are associated with a rare haemorrhagic syndrome, Glanzmann' thrombasthenia. Its central role in platelet aggregation and thrombogenesis, together with a potential role in tumor cell-platelet interactions and in metastasis, make GPIIb-IIIa, nowadays, an important pharmacological target.     

Fibrinogen and von Willebrand factor mediated platelet adhesion to polystyrene under flow conditions

The roles of adsorbed fibrinogen (Fg) and von Willebrand factor (VWF) in mediating platelet adhesion to synthetic surfaces under flow were investigated using polystyrene (PS) as a model hydrophobic surface. We measured platelet adhesion to PS pre-adsorbed with Fg, VWF, normal plasma, afibrinogenemic plasma, VWF-deficient plasma and deficient plasmas with various concentrations of added Fg or VWF. Platelets in a red blood cell suspension were passed through a flow chamber at either low (50 or 100 s(-1)) or high (500 or 1000 s(-1)) shear. Adhesion to PS pre-adsorbed with afibrinogenemic plasma was very low under both low and high shear conditions, but was restored in a dose-dependent manner with addition of Fg. Less than 20 ng/cm(2)of adsorbed Fg was sufficient to support full-scale platelet adhesion under flow. At high shear rate, platelet adhesion on PS pre-adsorbed with VWF-deficient plasma was much less than on PS pre-adsorbed with normal plasma, but adhesion to PS pre-adsorbed with VWF-deficient plasma with added VWF was very similar to adhesion to PS pre-adsorbed with normal plasma. At low shear, adhesion to PS pre-adsorbed with VWF-deficient plasma was the same as on PS pre-adsorbed with normal plasma. As little as 1 ng/cm(2) of VWF adsorbed from plasma made platelet adhesion higher under high shear than under low shear. The effects of adsorbed Fg and VWF on the morphologies of platelets that adhered from suspensions flowing at high shear rates were also investigated. The lack of either Fg or VWF resulted in marked decreases in the extent of platelet spreading. Real-time observation of platelet adhesion under an epifluorescent microscope showed that platelets adhered to the surface in a linear pattern aligned in the direction of flow under high shear conditions.     

Redistribution and hemostatic action of recombinant activated factor VII associated with platelets

Clinical evidence accumulated from hemophilic patients during prophylaxis with recombinant activated factor VII (rFVIIa) suggests that the duration of the hemostatic action of rFVIIa exceeds its predicted plasma half-life. Mechanisms involved in this outcome have not been elucidated. We have investigated in vitro the redistribution of rFVIIa in platelets from healthy donors, patients with FVII deficiency, and one patient with Bernard-Soulier syndrome. Platelet-rich plasma was exposed to rFVIIa (3 to 60 μg/mL). Flow cytometry, immunocytochemistry, and coagulation tests were applied to detect and quantify rFVIIa. The hemostatic effect of rFVIIa associated to platelets was evaluated using perfusion models. Our studies revealed a dose-dependent association of rFVIIa to the platelet cytoplasm with redistribution into the open canalicular system, and α granules. Mechanisms implicated in the internalization are multiple, involve GPIb and GPIV, and require phospholipids and cytoskeletal assembly. After platelet activation with thrombin, platelets exposed rFVIIa on their membrane. Perfusion studies revealed that the presence of 30% of platelets containing FVIIa improved platelet aggregate formation and enhanced fibrin generation (P < 0.01 versus control). Our results indicate that, at therapeutic concentrations, rFVIIa can be internalized into platelets, where it is protected from physiological clearance mechanisms and can still promote hemostatic activity. Redistribution of rFVIIa into platelets may explain the prolonged prophylactic effectiveness of rFVIIa in hemophilia.     

Bound fibrinogen distribution on stimulated platelets. Examination by confocal scanning laser microscopy.

Previous studies have suggested that qualitative changes in platelet bound fibrinogen modulate platelet aggregation. The present study used confocal scanning laser microscopy to further evaluate post-ligand binding events over a 60-minute time course. When fluorescein isothiocyanate (FITC)-streptavidin was added to ADP-stimulated platelets 1 minute after biotinylated fibrinogen binding at 22 degrees C, bound fibrinogen was found in variously sized patches on the cell surface. When streptavidin was added 60 minutes later, bound fibrinogen had been cleared from the platelet surface and was observed in clusters penetrating into platelets to various extents. ADP-activated platelets did not stain with a monoclonal antibody against CD62 suggesting that platelets were not permeabilized during the experiment and had not released alpha-granules. Additional studies using either biotinylated fibrinogen that had been prelabeled with FITC-streptavidin or FITC-labeled fibrinogen revealed similar patterns of platelet-associated fibrinogen clearance and redistribution. Pretreatment of platelets with cytochalasin D prevented this redistribution. Dual labeling experiments using biotinylated fibrinogen and FITC-streptavidin as well as a monoclonal anti-GPIIIa antibody labeled with rhodamine-conjugated anti-mouse IgG demonstrated the co-localization of fibrinogen and GPIIIa. Similar observations were made with fibrinogen bound to thrombin-stimulated platelets. In contrast, fibronectin bound to thrombin-activated platelets retained a predominantly surface membrane distribution under identical experimental conditions. Since surface-cleared fibrinogen was accessible to exogenous FITC-streptavidin under conditions that did not lead to platelet permeabilization, the data suggest fibrinogen deposition in compartments that are accessible to the extracellular milieu. This is consistent with the ability of exogenous plasmin to completely remove cleared fibrinogen pools without detectable fibrinogen reexpression on the platelet surface or alpha-granule secretion. The data provide morphological evidence for the selective, GPIIb-IIIa mediated, actin-dependent clearance of bound fibrinogen from the activated platelet surface, suggesting a mechanism for preventing and limiting thrombus development.