Purification and characterisation of a snake venom phospholipase A2: A potent inhibitor of platelet aggregation

An inhibitor of human platelet aggregation was identified from the venom of an Australian Copperhead snake, Austrelaps superba, as a novel phospholipase A₂. The inhibitor was purified to homogeneity by chromatography on Q-Sepharose, S-Sepharose and C8 reverse phase HPLC. The purified phospholipase A₂ has a molecular weight of 15 kDa as assessed by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). N-terminal sequence analysis of the platelet inhibitor revealed 70–80% sequence identity to other previously described secretory phospholipase A₂. Phospholipase activity of the purified protein was confirmed by the ability of the enzyme to hydrolyse lecithin. Pretreatment of the purified protein with the specific phospholipase A₂ inhibitor p-bromophenacyl bromide, resulted in abrogation of both its enzyme and platelet inhibitory activity. The phospholipase A₂ inhibited platelet aggregation and serotonin release, induced by a variety of platelet agonists, in a time and dose dependent manner.     

Effect of ketanserin on platelet function and bleeding time in uremic patients treated with erythropoietin

Hemostatic abnormalities are frequently observed in uremic patients and anemia is one of the clinical features of chronic renal failure and also a major factor in the pathogenesis of the uremic bleeding (1). There is a risk of bleeding and at the same time arterio-venous shunt thromboses occur (2). This may be due to a defective both platelet aggregation and platelet/vessel wall interactions (3). It is well established that treatment with recombinant human erythropoietin (rHuEPO) is efficacious in correcting anemia and improving hemostasis in uremic patients due to increased erythrocyte and thrombocyte counts, direct effect on hemostasis and/or improved platelet functions (4,5). Serotonin (5-hydroxytryptamine, 5-HT) released from platelets during their aggregation can play a role in hemostasis and platelet/vessel wall interactions (6). Although being a weak agonist, it markedly amplifies platelet response to variety of aggregating agents (7). Serotonin is also thought to contribute to the pathogenesis of vasospasm, thrombus formation,

(8). These effects may be attenuated by a blockade of vascular and platelet 5HT₂ receptors with ketanserin. On the other hand, erythropoietin therapy may increase a risk of thromboembolic complications in uremic patients. As reported previously, human recombinant erythropoietin (rHuEPO) led to an increase in blood and platelet serotonin (9). Therefore ketanserin might provide a protection against thrombosis (10). The purpose of the work was to study the effects of ketanserin on platelet function and bleeding time in uremic patients treated with rHuEPO.     

Comparison of platelet thromboxane synthesis in diabetic patients on conventional insulin therapy and continuous insulin infusions

Previous work has shown enhanced aggregation and thromboxane synthesis by platelets from diabetic subjects. We have compared thromboxane synthesis by platelets from normal subjects with that of platelets from two groups of insulin-dependent diabetic patients: one group receiving conventional depot insulin therapy and the other continuous subcutaneous insulin infusions. Thromboxane synthesis was significantly higher with platelets from the conventionally-treated diabetic patients than that observed for control subjects. Patients on continuous insulin infusions were similar to control subjects. This group of patients also had better control of glycemia. The effect on thromboxane production might be related to normalization of plasma lipids which occurs with continuous infusion insulin therapy.     

Studies on the pathophysiology and treatment of von willebrand''s disease. IV. Mechanism of increased ristocetin-induced platelet aggregation in von willebrand''s disease

The binding of factor VIII to platelets in the presence of ristocetin was investigated in four patients with von Willebrand's disease that showed an increased ristocetin-induced platelet aggregation (RIPA). The binding of plasma factor VIII-related antigen (VIIIR:Ag) from these patients to normal washed or formalin-fixed platelets was decreased in three patients and was normal in one patient. Washed platelets prepared from these patients, however, showed an increased binding affinity for normal VIIIR:Ag. It was suggested that the increased RIPA was brought about by an increased ristocetin-induced binding affinity of patients' platelets for factor VIII.     

Platelet aggregability and in vivo platelet deposition in patients with ischemic cerebrovascular disease - evaluation by indium-111-platelet scintigraphy -

In ischemic cerebrovascular disease, it is not clear whether platelet function in vitro actually reflects the situation in vivo. Using indium-111 platelet scintigraphy as a method for detecting platelet activation in vivo, we tried to elucidate this problem. Twenty eight patients with chronic stage of ischemic cerebrovascular disease (CVD) and 17 control subjects were examined. Platelet scintigrams were positive in 9 of 28 patients in CVD, while all were negative in control. A comparison of the results obtained from qualitative platelet imaging and platelet aggregability was performed to evaluate whether threshold aggregation concentration (TAC) grade differed across the three groups(control, CVD patients without platelet deposition and CVD patients with platelet deposition). CVD patients with platelet deposition showed a higher TAC than those patients who did not show platelet deposition (P < 0.05) or control subjects without platelet deposition (P < 0.05). These results suggest that some patients in chronic stages of CVD may have active platelet deposition on carotid atheromatous lesions, and presence of platelet deposition in vivo could contribute to reduce platelet reactivity in peripheral blood.     

Increased platelet and coagulatory activity indicate ongoing thrombogenesis in peripheral arterial disease

In peripheral arterial disease (PAD) risk of thrombosis is high and systemic haemostatic derangement thought contributory. We investigated platelet and coagulatory activity in patients with PAD and sought to find the best disease indicator. Stagnation point flow adhesio-aggregometry (SPAA) enables real-time quantitative assessment of platelet adhesion and aggregation under well-defined flow conditions. SPAA and agonist-induced aggregometry (Born method) were performed and concentrations of fibrinogen, fibrin monomer (FM), D-dimer, and thrombin-antithrombin complex (TAT) measured in 92 PAD patients and 70 healthy volunteers. Agonist-induced aggregometry detected no differences between patients and controls. SPAA-measured platelet adhesion and spontaneous aggregation (p < 0.001), and concentrations of fibrinogen (p < 0.001), FM (p < 0.001), TAT (p < 0.02) and D-dimer (p < 0.001) were all significantly increased in patients. Neither platelet function nor coagulatory activity was altered in patients receiving aspirin. Sensitivity and specificity in detecting PAD were as follows: SPAA (95%,93%), fibrinogen (36%,91%), FM (48%,84%), TAT (36%,78%), D-dimer (73%,80%). Our findings support the concept of ongoing thrombogenesis as being contributory to the progression and possibly to the initiation of PAD. Aspirin alone did not prevent haemostatic hyperreactivity in these patients and flow-mediated platelet function was the most sensitive and specific indicator of advanced disease. This technique thus appears to be valuable, not only for evaluating therapeutic strategies to prevent platelet activation, but also in elaborating platelet-related mechanisms involved in thrombogenesis and atheroma formation.     

Dual effect of naloxone on blood platelet aggregation and cerebral blood flow in gerbils

The effect of naloxone on blood platelet aggregation and cerebral blood flow in gerbils was studied. Administration of naloxone in dose 1 mg/kg to intact gerbils resulted in a marked increase in platelet aggregability accompanied by 27% reduction in cerebral blood flow. Focal cerebral ischemic injury significantly enhanced platelet aggregatory response and treatment with naloxone was without any additional effect on platelet aggregation. Cerebral blood flow in ischemic hemisphere, however, increased following naloxone injection by 46%. In vitro naloxone in millimolar concentrations inhibited platelet aggregation in a dose-dependent way. Apparent decrease in fluorescence of platelet membranes tagged with fluorescence probe due to naloxone suggests conformational changes in platelet membrane as a primary mechanism for the antiaggregatory effect of naloxone in vitro.     

Relationships between the chemical constitution of carbamoylpiperidines and related compounds, and their inhibition of ADP-induced human blood platelet aggregation

The effect of a series of carbamoylpiperidines and related compounds on ADP-induced human blood platelet aggregation was studied. The systematic and gradual changes in the chemical structure of these synthetic entities disclosed highly significant relationships between molecular constitution, physicochemical properties and biodynamic effects, and yielded data suggesting -for the first time- platelet membrane inhibitory target sites spaced at 8 Å. Inhibitory potencies culminated with a compound active at 5 μM concentrations; the latter and a number of other derivatives were much more effective than aspirin.     

Platelet count ratio (PCR) as an additional parameter in the quantitation of platelet aggregation in vitro

An additional parameter, the platelet count ratio (PCR), has been introduced to describe further platelet aggregation as determined by nephelometric measurements. This parameter is the ratio of the count of individual platelets a specified time after the addition of an aggregating agent to the original platelet count of the plateletrich plasma with stabilization of the systems by fixation of the platelets with glutaraldehyde. The value of the PCR was assessed for approximately 40 platelet-rich plasma samples from 37 healthy human male and female donors. The application of the PCR was explored in studies on the in vitro aggregation of platelets induced by ristocetin, collagen and adenosine diphosphate (ADP).     

The antiplatelet effect of daily low dose enteric-coated aspirin in man: A time course of onset and recovery

We have studied the onset and recovery of inhibition of platelet function by low dose aspirin. Enteric-coated aspirin 50mg daily was administered to five human volunteers for five weeks and then 100mg daily was given for a further five weeks. We studied platelet aggregation and thromboxane formation in response to a range of stimuli: ADP, adrenaline, arachidonate and collagen, and also measured thromboxane formation after coagulation of whole blood (serum thromboxane). The onset of inhibition of platelet aggregation was progressive over several days for each of the four platelet stimuli, and was synchronous with the inhibition of thromboxane formation. Maximum inhibition occurred by day three for the weak stimuli ADP and adrenaline, by day five for the stronger stimuli arachidonate and collagen, but did not occur until day eight for serum thromboxane. Further inhibitory effects on both aggregation and thromboxane generation were observed after 100mg daily. Two weeks after the cessation of aspirin the responses to collagen and arachidonate and serum thromboxane had returned to normal. Platelet aggregation in response to the weaker stimuli, ADP and adrenaline, still showed detectable inhibition two weeks after cessation of aspirin, but had returned to normal by four weeks. These experiments provided no evidence for an effect of aspirin on platelets separate to its effect on cyclooxygenase. The onset and recovery of inhibition of platelet function by low dose aspirin was dependent on the strength of the stimulus studied.     

Activation of protein kinase C by the action of 9,11-epithio-11,12-methano-thromboxane A2 (STA2), a stable analogue of thromboxane A2, in human platelets

Incubation of human washed platelets with 9,11-epithio-11,12-methano-thromboxane A₂ (STA₂), a stable analogue of thromboxane A₂, caused the activation of protein kinase C and myosin light chain (MLC) kinase to the same extents as those induced by thrombin as judged by measuring the phosphorylation of a 40-kilodalton protein and MLC, respectively. However, STA₂ stimulated much less phosphoinositide turnover than thrombin. Furthermore, the doses of STA₂ necessary for protein kinase C activation and phosphoinositide turnover were higher than those necessary for MLC kinase activation, although the doses of thrombin necessary for these three reactions were nearly the same. These results suggest that protein kinase C may be activated at the Ca²⁺ concentrations higher than those required for MLC kinase activation by the action of STA₂, presumably due to the inability of this agonist to produce diacylglycerol in an amount enough to increase the affinity of the enzyme for Ca²⁺.     

A radioimmunoassay for thrombospondin, used in a comparative study of thrombospondin, β-thromboglobulin and platelet factor 4 in healthy volunteers

A radioimmunoassay was developed for the platelet α-granule protein thrombospondin; concentrations of thrombospondin as low as 3 ng ml^?1 could be measured. There was no interference from other components of human biological fluids and no crossreactivity with β-thromboglobulin (β-TG) or platelet factor 4 (PF4). Plasma samples were stable when stored at ?20°C. Normal human plasma contained 105.0 ± 31.0 ng thrombospondin ml^?1 compared with β-TG concentrations of 37.2 ± 10.9 ng ml^?1 and PF4 concentrations of 14.7 ± 10.1 ng ml^?1 when samples were carefully taken into a platelet inhibitor cocktail and processed at 0–4°C. Release of thrombospondin during clotting of blood occurred at the same time as that of β-TG and PF4 and resulted in a serum concentration of 17.5 ± 5.5 μg ml^?1. Assay of whole blood gave a platelet thrombospondin content of 89.1 ± 28.3 ng/ 10⁶ platelets. The concentration in normal urine fluctuated widely from 3 to 22.5 ng ml^?1, and was unrelated to urine flow. The half-life of thrombospondin $\text{in vivo}$ was about 9 h, much longer than that of either β-TG or PF4. Unlike PF4, it was not released into the blood following an intravenous heparin injection. Bovine, ovine, canine and porcine sera contained thrombospondin which crossreacted immunologically with the human molecule; these species would be suitable animal models for the study of thrombospondin and its value as a platelet release marker.     

Inhibition of red blood cell-induced platelet aggregation in whole blood by a nonionic surfactant, poloxamer 188 (Rheothrx Injection)

RheothRx Injection, an aqueous solution of a nonionic block copolymer (poloxamer 188) formulated for intravenous administration, was investigated as an inhibitor of red blood cell (RBC)-induced platelet aggregation at plasma concentrations of 0.05-5mgmL⁻¹. Platelet aggregation was determined by measuring the fall in single platelet counts after mechanical agitation of 2mL aliquots of citrated whole blood in a 37°C shaking waterbath. Inhibition of RBC-induced platelet aggregation of >95% was observed for poloxamer 188 at a concentration of 1mgmL⁻¹, and 41% inhibition was observed at 0.05mgmL⁻¹. Poloxamer 188 was observed to be a more effective inhibitor of RBC-induced platelet aggregation than 2-chloradenosine (2-ClAd) or phosphoenolpyruvate/pyruvate kinse (PEP/PK). Studies using platelet rich plasma (PRP) showed that platelet aggregation could not be induced by shaking in the absence of RBC, though aggregation was induced by the addition of exogenous adenosine diphosphate (ADP). Poloxamer 188 did not inhibit ADP-induced platelet aggregation. We propose that poloxamer 188 protects RBC from mechanical trauma by non-specific adsorption of copolymer to the RBC surface (via the hydrophobic polyoxypropylene moiety), and that this effect prevents mechanical damage and hence leakage of ADP from RBC. RheothRx Injection has been shown to have value in the treatment of acute ischemic disorders such as myocardial infarction. The observation of significant inhibition of RBC-induced platelet aggregation at clinically relevant concentrations suggests that RheothRx Injection may have antithrombotic properties in vivo, and may therefore have potential not only in acute ischemia but also to prevent thrombosis within vascular prostheses or to prevent rethrombosis after angioplasty or endarterectomy.     

Properties of PAF-acether-induced platelet aggregation and secretion. Studies in gel-filtered human platelets

Human platelets rapidly lose their responsiveness to PAF-acether after blood collection. We collected blood from fasting donors and prepared gel-filtered platelets that remained responsive to PAF-acether for about 6 hours. Log-dose response studies showed bi-phasic aggregation between 20 and 100 nM PAF-acether with secretion of dense-, - and lysosomal granule contents during the second wave of aggregation. Between 0.2 and 10 nM PAF-acether aggregation was weak and no secretion occurred whereas 300 nM PAF-acether or more induced maximal aggregation and secretion. Secretion, however, was never more than 70, 55, and 30% of maximal secretable amount of 5HT, βTG and βN, respectively. Aggregation and secretion were enhanced by fibrinogen (optimal concentration 0.3–0.7 g.l⁻¹), required Ca²⁺ or Mg²⁺ but were inhibited when Mg²⁺ or Ca²⁺ were present at a concentration of 2 mM or more. These date show that human platelets are almost equally sensitive to PAF-acether as rabbit platelets, and respond with incomplete secretion of dense-, - and lysosomal granule contents.     

Action of some salicylate derivatives on in vitro platelet aggregation. Inhibitory and inhibition antagonistic effects

Twenty salicylate derivatives were tested for their antagonistic activity on the inhibitory effect of aspirin on platelet aggregation. The blocking effect was not limited to the salicylate but also characterised some of its substituted compounds. The substituant influence did not seem to be related to electronic or size parameters. This antagonistic activity of these derivatives decreased as concentrations increased, owing to the emergence of their own inhibitory activity: several salicylate derivatives showed dual inhibitory and inhibition antagonistic activity, with both properties present at the same concentration. A mechanism involving dissociated activities on the two enzymatic sites of cyclooxygenase is proposed.     

Elevation of platelet cyclic AMP level by thromboxane A2/prostaglandin H2 receptor agonists.

Arachidonic acid (AA)-or thromboxane A₂/prostaglandin H₂ (TXA₂/ PGH₂) analog (STA₂ and U-46619)-induced aggregations yielded a bell-shaped dose-response curve. The inhibitory mechanism by high concentrations of the agonists was examined. STA₂ elevated cAMP level of platelet in a dose-dependent manner. And the aggregation was affected by metabolic inhibitors of cAMP. AA also rised cAMP level, and the rise was suppressed by indomethacin. These results indicate that the reduction of aggregation by high dose of the agonists is through cAMP elevation. The cAMP elevation was not suppressed by ruling out phospholipase C effects by chelation of cytoplasmic Ca²⁺ and inhibition of protein kinase C (PKC). These results suggest that the cAMP elevation is not due to activation of phospholipase C-linked TXA₂/PGH₂ receptor. 13-APA, an antagonist of TXA₂/PGH₂ receptor, suppressed the cAMP elevation, although ONO-3708, another antagonist, had no effect. As to be expected from this result, inhibitory effect of 13-APA on high STA₂ level-induced aggregation was weaker than that of ONO-3708. The antagonists did not inhibit PGE,- or PGD₂-induced cAMP elevation. These findings suggest that platelet has adenylate cyclase-linked TXA₂/PGH₂ receptor.     

Behavioral,emotional and neurobiological determinants of coronary heart disease risk in women

Women have more of the stress-related behavioral profile that has been linked to cardiovascular disease than men. For example, women double the rates of stress-related mental disorders such as depression and posttraumatic stress disorder (PTSD) than men, and have higher rates of exposure to adversity early in life. This profile may increase women’s long-term risk of cardiometabolic conditions linked to stress, especially coronary heart disease (CHD). In addition to having a higher prevalence of psychosocial stressors, women may be more vulnerable to the adverse effects of these stressors on CHD, perhaps through altered neurobiological physiology. Emerging data suggest that young women are disproportionally susceptible to the adverse effects of stress on the risk of cardiovascular disease, both in terms of initiating the disease as well as worsening the prognosis in women who have already exhibited symptoms of the disease. Women’s potential vulnerability to psychosocial stress could also help explain their higher propensity toward abnormal coronary vasomotion and microvascular disease compared with men.