Effects of aggregating agents and of blood cells on the aggregation of whole blood by impedance technique

In this study the effects of different aggregating agents on platelet rich plasma (PRP) and whole blood (WB) aggregation, as determined by the optical and the impedance method, are evaluated. While the response of PRP to PAF, epinephrine and sodium arachidonate was comparable using the two methods, significantly greater amounts of collagen and ADP were required to obtain 50% aggregation of PRP. In addition, when the response of WB to the aggregation induced by different agents was compared to that of PRP (impedance method), no difference between WB and PRP was detected, with exception for ADP and sodium arachidonate induced aggregation. In vitro data on the aggregation of PRP induced by collagen and ADP in the presence of different concentrations of red cells and of white cells, suggest that WC and RC may affect PRP aggregation only in selected experimental conditions.     

Collagen-induced platelet aggregation:--evidence against the essential role of platelet adenosine diphosphate

The hypothesis that platelet ADP is responsible for collagen-induced aggregation has been re-examined. It was found that the concentration of ADP obtaining in human PRP at the onset of aggregation was not sufficient to account for that aggregation. Furthermore, the time-course of collagen-induced release in human PRP was the same as that in sheep PRP where ADP does not cause release. These findings are not consistent with claims that ADP alone perpetuates a collagen-initiated release-aggregation-release sequence. The effects of high doses of collagen, which released 4-5 microM ADP, were not inhibited by 500 microM adenosine, a concentration that greatly reduced the effect of 300 microM ADP. Collagen caused aggregation in ADP-refractory PRP and in platelet suspensions unresponsive to 1 mM ADP. Thus human platelets can aggregate in response to collagen under circumstances in which they cannot respond to ADP. Apyrase inhibited aggregation and ATP release in platelet suspensions but not in human PRP. Evidence is presented that the means currently used to examine the role of ADP in aggregation require investigation.     

Epinephrine-induced aggregation of rabbit platelets refractory to ADP

The mechanisms involved in platelet aggregation induced by epinephrine are unclear. Although epinephrine does not aggregate washed rabbit platelets, platelets made refractory to ADP will aggregate in response to epinephrine in the presence of ADP. We have examined whether the mechanism(s) by which epinephrine induces aggregation of refractory platelets involves fibrinogen binding and Ca2+ association. With normal platelets, ADP causes aggregation, fibrinogen binding and Ca2+ association in a medium containing 0.2 mM 45Ca2+. After 3 min of incubation with ADP, fibrinogen dissociates from platelets, but 45Ca2+ does not. Epinephrine alone does not cause aggregation, fibrinogen binding or 45Ca2+ association. Platelets that are refractory to ADP do not aggregate and bind fibrinogen upon addition of ADP, but aggregate and bind fibrinogen in response to epinephrine, provided ADP is still present. These effects of epinephrine are mediated by the alpha-adrenergic receptor since they are blocked by phentolamine or verapamil and potentiated by propranolol. However, epinephrine-induced aggregation of platelets refractory to ADP does not involve further detectable increase in the amount of 45Ca2+ associated with the platelets.     

Synergism between platelet aggregating agents: the role of the arachidonate pathway.

Aggregation of platelets by low concentrations of ADP is augmented by non-aggregating concentrations of collagen, thrombin, arachidonate or the divalent cation ionophore A23,187. Release-inducing agents act synergistically with ADP and with each other. Both collagen and thrombin cause aggregation by releasing ADP and by freeing platelet arachidonate to form prostaglandin endoperoxides which give rise to thromboxane A₂. In these experiments the role of the arachidonate pathway in the synergism between pairs of aggregating and release-inducing agents was examined. Indomethacin was used to inhibit conversion of arachidonate to prostaglandin endoperoxides and thromboxane A₂ and creatine phosphate/creatine phosphokinase (CP/CPK) was used in some experiments to convert released ADP to ATP. Synergism of collagen with ADP, arachidonate or thrombin was inhibited by indomethacin indicating that the arachidonate pathway plays a major role in the synergistic effects to which collagen contributes. Synergism of thrombin with collagen or arachidonate was inhibited by indomethacin but synergism of thrombin with ADP was only slightly affected. Indomethacin had little influence on the combined effects of these two agents on platelet aggregation. Thus it appears that the conversion of platelet arachidonate to prostaglandin endoperoxides and thromboxane A₂ plays a minor part in the synergistic effects in which thrombin or A23,187 are involved. Thus, the non-steroidal anti-inflammatory drugs may have only limited use in inhibiting the contribution of thrombin and ADP to the formation of platelet thrombi at sites of vessel injury.     

Correlation between chemical stimulation and filtration flow resistance in human platelet aggregates

Human platelet-rich plasma (PRP) was aggregated with ADP to produce varying degrees of reversibility and platelet release, and then the chemical stimulation (as evidenced by optical transmittance) was compared with the flow resistance of physiologically-significant microaggregates, determined by constant-pressure filtration. The aggregate flow resistance was attributed to "weak" aggregates (which occluded the micropore filter at 20 mm Hg but which passed through the filter at 80 mm Hg) and "strong" aggregates (which occluded the filter at 80 mm Hg). As the ADP concentration was increased from 1 microM to 10 microM, the flow resistance of both the "weak" and "strong" aggregates generally increased, as did the maximum transmittance. No consistent trend was seen as the time after ADP addition increased from 5 to 30 minutes. Pretreatment of the PRP with epinephrine increased the maximum transmittance during ADP aggregation, produced less-reversible aggregates (less subject to deaggregation by PGE1), and increased the aggregate flow resistance over the range of filtration pressures tested. The addition of PGE1 to the aggregated sample before filtration nearly eliminated the flow resistance of the aggregates at all filtration pressures tested and partially reversed the optically-apparent aggregation. Pretreatment of PRP with PGE1 before epinephrine or ADP addition inhibited both the optically-detected aggregation and the development of flow resistance. The physical (hydrodynamic) strength of platelet aggregates is apparently related to the chemical stimulation of the release reaction and to aggregation irreversibility, possibly through the mediation of adenylate cyclase and cyclic AMP.     

Platelet aggregation following exposure of phospholipase-treated platelet rich plasma to hydrogen peroxide

Hydrogen peroxide at micromolar concentrations (250–500 μM) can induce platelet aggregation of phospholipase-treated PRP. This effect, which occurs independently of the release of ADP, is blocked by aspirin, furosemide, catalase and 2-mercaptoethanol. PRP preincubated with H₂O₂ for 2–5 min. does not respond to Phl-H₂O₂ or collagen. This inhibitory effect is abolished with longer preincubations. In the presence of ADP or epinephrine, H₂O₂ enhances aggregation, if added to PRP with the inducers, and decreases the platelet response to the inducers, if preincubated with PRP for 2 min. The data suggest that micromolar concentrations of H₂O₂, which could be generated at sites of platelet plug formation by granulocytes, could influence the processes of hemostasis and thrombosis.     

Why single daily dose of aspirin may not prevent platelet aggregation

The effect of different doses of aspirin on the synergistic activity of sodium arachidonate plus platelet activating factor (paf) ADP or collagen in platelet aggregation was studied in human volunteers. Aggregation studies in platelet rich plasma (PRP) showed that aspirinated platelets, unresponsive to arachidonate, when stirred with threshold concentrations of paf, ADP or collagen, reacted differently according to the dose of aspirin and the time elapsed since ingestion. After a single or daily 50 mg dose for 7-10 days independent of elapsed time until blood withdrawal, a complete synergistic activity was obtained. In PRP samples obtained 24 hours after the last aspirin intake, a complete synergistic aggregation was achieved after a single dose or after 7-10 days of 500 mg aspirin ingestion; synergistic effect did not appear when blood was drawn 2.5 hours after intake. The thromboxane B2 concentrations were very low in all samples after PRP stimulation with sodium arachidonate or paf or both. As rationale is that platelet activation in vivo occurs in response to several stimuli, the therapeutic implications of our results is that aspirin may not prevent the agonist potentiation effect when low dose or daily high dose (500mg) are administrated. This may explain the erratic results of most aspirin trials in which this drug was used to suppress platelet function.     

Some properties of mouse platelets

Mouse platelets were aggregated by arachidonate, thrombin, collagen and ADP. In general they were, like rat platelets, more aggregable in heparinized PRP than in citrated (3.8%) PRP. Mouse platelets underwent the release reaction when aggregated by arachidonate, collagen and thrombin, but not when stimulated by ADP. The aggregation of the platelets to arachidonate was inhibited by cyclooxygenase inhibitors and by prostacyclin. Studies with tritiated arachidonate showed that mouse platelets possess the lipoxygenase and cyclooxygenase pathways found in other mammalian platelets and produce thromboxane and 12-HETE. The mouse provides a convenient model for the study of many conditions known to affect platelet aggregation. The similarity of mouse platelets to the platelets of other mammals together with the ability to study large numbers of animals at low cost, should encourage further use of mouse platelets.     

Characteristics of the major platelet membrane site used in binding to collagen

Meyer and Weisman (1) showed that the adhesion of washed rabbit platelets to soluble collagen adsorbed to glass is inhibited by the presence of soluble proline/hydroxyproline-rich materials in the platelet suspension suggesting that there are sites on the platelet that recognize the high content of these two amino acids on the surface of collagen in its triple helical state. It is now found that similar inhibition can be obtained on a collagen fiber surface using human as well as rabbit platelets in platelet-rich plasma (PRP) or in various washed platelet suspensions. Using polyhydroxyproline (PHP) and rabbit platelets it could be shown that the action of PHP is on the platelet membrane since inhibition occurs almost immediately and is also seen when fixed platelets are used. Inhibition is still seen when free PHP is removed from the platelet suspension. The inhibitory effect of PHP is specific to collagen and was not seen for platelet adhesion to albumin- or globulin-coated surface.

We have shown earlier that non-aggregating concentrations of ADP inhibit platelet adhesion as a result of binding to the platelet membrane but independent of the induced shape change (2). PHP action, however, differs from that of ADP since no time lag occurs and it is not blocked by AMP. Furthermore, PHP does not induce a shape change. Therefore, ADP release cannot have occurred.

A maximum of inhibition of adhesion by PHP of 60±10% was similar to that given by ADP. However, addition of both agents together did not produce greater inhibition than either alone. This suggests that the same site is affected but that ADP action on the platelet surface is not direct but operates through a delayed lodal interaction mechanism. This indirect action of ADP probably also affects binding sites to other surfaces since adhesion to albumin- and globulin-coated surfaces is also reduced by ADP.     

Clinical evaluation of a new test of hemostasis: the Filter Bleeding Time

The clinical value of a new in vitro test of hemostasis, which we have called Filter Bleeding Time (FBT), was determined in 59 patients referred because of a suspected bleeding disorder. FBT is based on the progressive slowing of the drop rate of citrated blood through a filter of woven Dacron under constant pressure as platelet aggregates occlude the filter. The value for FBT is defined as the time when the blood drop interval has reached 1 minute. The Mayo modification of the Ivy bleeding time (IBT) was performed in all patients; platelet response to ADP, collagen, epinephrine and arachidonate was performed in 24 patients. In 30 normal volunteers FBT measured 1-3 hr after venipuncture was 2.8 +/- 1.5 (means +/- 1SD) min. The FBT was prolonged in 3 of 3 patients with Glanzmann's thrombasthenia, 2 with disseminated intravascular coagulation, 1 with chronic lymphocytic leukemia, 1 with myelofibrosis, and 1 who had taken aspirin. In 6 patients FBT was prolonged while IBT was normal: 4 after taking aspirin, 2 with polycythemia vera. All 6 had reduced platelet aggregation (PA) to ADP (5 microM), collagen (2 mg/ml), epinephrine (5 microM) and/or arachidonate (1.7 mM). In 3 patients FBT was normal while IBT was abnormal: 1 with disseminated intravascular coagulation, 2 undiagnosed; 1 of these 3 had abnormal PA. Of 6 patients with von Willebrand's disease, FBT was prolonged in 5 and borderline in 1; IBT was prolonged in 3, normal in 1, and not done in 2 infants.(ABSTRACT TRUNCATED AT 250 WORDS)     

Newborn platelet dysfunction: a storage pool and release defect.

Per cent aggregation, release and content of adenine nucleotides, and specific radioactivity were evaluated in citrated platelet-rich plasma (PRP) prepared from paired samples of maternal and cord blood. Platelets of newborn infants aggregated normally in response to highdose ADP (20 muM), strong collagen suspensions, and thrombin; however, when compared with PRP from the mothers or from normal adults, per cent aggregation in response to lower concentrations of ADP (2 muM), weak collagen, and part particularly epinephrine was markedly reduced. Nucleotide release after stimulation of the newborns' PRP with the latter two inducers was also impaired. ATP and ADP content of the newborns' platelets was also significantly less than that of their mothers or of normal adults, but specific activity was normal. The data suggest that the impairment of ADP release in the platelets of newborn infants is due to decreased sensitivity to external stimuli. Since metabolic ATP is necessary for the platelet release reaction, it is postulated that the platelet dysfunction results from a lack of metabolic ATP.     

Effects of garlic extract and of three pure components isolated from it on human platelet aggregation, arachidonate metabolism, release reaction and platelet ultrastructure

We studied the effect of the methanol extract of garlic bulbs (EOG) and of three pure components isolated from it (F1, F2, F3), on human platelet aggregation induced by ADP, epinephrine, collagen, thrombin, arachidonate, PAF, and the ionophore A-23187. Incubation of PRP with EOG, either in methanol or in homologous PPP, inhibits platelet aggregation induced by all of the above mentioned agonists. F1, F2, and F3 also inhibit platelet aggregation, however, F3 was about four times more potent. Addition of EOG or F3 to platelets that have already been irreversibly aggregated by 10 microM ADP, induces rapid deaggregation. Inhibition of aggregation was still present after three hours. The inhibitory effect persisted even after the treated platelets were Gel-Filtered (GFP) or separated from plasma through a metrizamide gradient and resuspended in new homologous PPP. Thrombin-induced release of ATP from GFP was inhibited by 75-80% after EOG or F3 treatment. Incorporation of [3-H]-arachidonate by intact platelets was decreased by 50-60% in treated platelets. However, platelets incubated with the inhibitors after incorporation of radiolabeled arachidonate, although did not aggregate, produced, after thrombin activation similar amounts of radiolabeled TXB2 and lipoxygenase products as the controls. Electron microscopy of inhibited platelets, in the presence of thrombin, showed no degranulation but an increase of spherical forms. Our results suggest that the effects described might be mediate by a perturbation of the physicochemical properties of the plasma membrane rather than by affecting arachidonate or calcium metabolism in the cells. Chemical structures of F1, F2 and F3 have been provisionally assigned: F1 is diallytrisulfide, F2 is 2-vinyl-1,3-dithiene, and F3 is most probably allyl 1,5-hexadienyltrisulfide.     

Enhancement of collagen-induced aggregation of platelets in whole blood

In order to elucidate the features of platelet aggregation in whole blood, studies were carried out on human blood. The platelet aggregation reaction was monitored by counting the residual free platelet number with an electronic particle counter (Coulter). Platelets in citrated whole blood were aggregated by a very small amount of collagen which did not aggregate platelets in citrated plasma. Such enhancement was not observed if ADP or epinephrine was used. By addition of isolated erythrocytes to platelet rich plasma, enhancement of the platelet response to collagen was obtained. The erythrocyte membrane stabilizer, Dilazep, abolished the enhancement effect of erythrocytes. Those results indicated that erythrocytes enhanced the platelet response to collagen. Although participation of ADP from the erythrocytes in the enhancement was suggested, the results of ADP determinations on suspensions of erythrocytes indicated that other factors of the erythrocytes might be involved in the enhancement.     

Impairment of phosphatidylinositol metabolism in a patient with a bleeding disorder associated with defects of initial platelet responses

Phosphoinositide/polyphosphoinositide (PI/PPI) metabolism, measured by the increase of 3H-phosphatidic acid (PA) and the decrease of 3H-phosphatidylinositol (PI) in 3H-arachidonate-labeled platelet suspensions, was assessed in five patients whose platelet functional defects included impaired initial rates of ADP, epinephrine and U44069 aggregation in platelet-rich plasma (PRP). In one patient, 3H-PA formation induced by collagen and thrombin was reduced or absent on two of three occasions, and the decrease in 3H-PI was reduced on one of these two occasions in response to collagen and A23187, and on all 3 occasions in response to thrombin. The variations in the formation of 3H-PA in this patient on different occasions broadly paralleled the variations in the initial rates of ADP and U44069 aggregation and in epinephrine aggregation seen in PRP. No such abnormalities of PI metabolism were found in four other patients with similar, but not identical, functional defects. These results suggest an impairment affecting metabolism of PI/PPI via the PI/PPI cycle in this patient's platelets. The association of abnormalities of PI metabolism with defects of initial platelet responses provides further support for a physiological role of phosphoinositide metabolism in the early activation mechanism of platelets.     

The effects of argon laser on in vitro aggregation of platelets in platelet rich plasma and whole blood

The effects of an Argon laser on platelet aggregation were studied, since platelets may be exposed to laser energy when used intravascularly. Various preparations of platelets in platelet rich plasma (PRP) and whole blood, with or without aspirin, were tested with the aggregating agents ADP, collagen, thrombin, and epinephrine. Simultaneous release of ATP was also measured in PRP. At relatively low levels of irradiation, platelet aggregation was potentiated. Enhancement was evidenced by an increase in percent aggregation, earlier onset of the reaction, and reduction in the amount of aggregating agent required. In PRP, the mechanism of laser potentiation appeared to be the release of endogenous ATP from platelets. At relatively high levels of irradiation, platelets were destroyed and aggregation abolished. In whole blood, the mechanism was somewhat more complicated since release of ATP occurred from RBCs as well as platelets. Spontaneous aggregation following laser treatment occurred in isolated instances in PRP and in every trial in whole blood preparations. Aspirin ingestion inhibited the laser's effects in PRP but not in whole blood. These results may have important clinical implications for laser angioplasty, and the potentiated aggregation response may prove useful in laboratory studies of platelet function.     

Studies on the stimulation of human blood platelets by semi-synthetic platelet-activating factor

"Saturated" and "unsaturated" platelet-activating factor (PAF) obtained from ratfish liver oil were proved to exert potent stimulation on human blood platelets. Using 0.025 to 1.0 mumol/1 PAF a dose-dependent platelet aggregation in platelet-rich plasma was observed. During PAF-induced irreversible aggregation a 9 to 40% release of platelet bound serotonin occurred. The specific effect of PAF, however, seems to be limited to induce reversible aggregation since second wave of aggregation and serotonin release were suppressed by a combination of acetylsalicylic acid and an ADP scavenging system. Incubation of PAF for 30 min in plasma resulted in a 90% loss of its platelet aggregating power. Subthreshold concentrations of PAF enhanced the platelet aggregation triggered by suboptimal concentrations of ADP, epinephrine, or collagen. Vice versa non-aggregating concentrations of ADP, epinephrine, collagen, Ca-ionophore A 23,187, or arachidonic acid amplified PAF-induced platelet aggregation. The synergistic effect of PAF and other stimuli of blood platelet activation can be partly interpreted as a stimulating effect of PAF on the metabolization of arachidonic acid.     

Increase of platelet thromboxane A2 formation and of its plasmatic half-life in diabetes mellitus

Platelet-rich plasmas (PRP) of diabetic subjects exhibited a hyperaggregability to either collagen or sodium arachidonate. These platelets, isolated from their plasma, only showed a normal response to sodium arachidonate. Moreover, the biosynthesis of prostaglandins and related compounds from endogenous arachidonate (thrombin as inducer) was enhanced in diabetic platelets whereas the biosynthesis from exogenous arachidonate was normal. On the other hand, the half-life of thromboxane A₂ was longer in diabetic platelet-poor plasma than in the control. It is concluded that a part of the hyperaggregability of diabetic PRP to sodium arachidonate could be due to the increase of the half-life of thromboxane A₂. Otherwise, hypersensitivity of isolated diabetic platelets to either collagen or thrombin shows a greater availability of phospholipidic arachidonate to the prostaglandin synthetase system.     

Total and selective desensitisation of human platelets to synthetic platelet activating factor (PAF): evidence that extracellular PAF does not mediate collagen-induced aggregation

A technique is described that renders human platelets totally insensitive to synthetic PAF. The procedure involves gently mixing human citrated platelet-rich plasma (PRP) with 0.1 microM PAF at room temperature. After 3-5 min, a further addition of 0.1 microM PAF is made, followed 3-5 min later by 1 microM PAF. Preparations so treated did not aggregate in response to 50 microM PAF whereas control PRP always responded to 0.05 microM PAF. The selectivity of the desensitisation procedure depended on the presence of aspirin. In the absence of aspirin, collagen-induced aggregation was slightly inhibited, but so too was primary aggregation in response to ADP and the thromboxane receptor agonist, U46619. When PRP was pretreated with aspirin to prevent any secondary aggregation during the desensitisation procedure, collagen-induced aggregation and primary aggregation in response to ADP were essentially unchanged by total desensitisation to PAF. It is concluded that endogenous PAF acting extracellularly does not mediate or help to mediate collagen-induced aggregation in human citrated PRP.     

Inhibitory effects of beraprost on platelet aggregation: comparative study utilizing two methods of aggregometry

We evaluated the inhibitory effects of beraprost, a stable prostacyclin analogue, on platelet aggregation, assessed by two methods of platelet aggregometry. The conventional aggregometry detects changes in light transmission (LT) of a platelet suspension, and a recently developed aggregometry based upon a particle counting principle detects light scattering (LS) generated by platelet aggregates. Since LS is more sensitive than LT in detecting platelet aggregates of small size, the minimal concentrations of agonists (ADP, epinephrine, collagen, and U46619) to induce detectable aggregate formation were consistently lower with LS (1/2 to 1/6) than with LT. The effects of beraprost were evaluated on platelet aggregation induced by the optimal concentrations of agonists thus determined for each sample. The IC50 values of beraprost on platelet aggregation, as assessed by LS, were 1/2 to 1/10 of those assessed by LT. In suppressing platelet aggregation assessed by LS, beraprost was especially potent with IC50 of 0.2-0.5 nM when platelets were activated by U46619, a thromboxane A2 analogue, or low concentrations of collagen which activates platelets through thromboxane A2 production. The IC50 values were 2-5 nM with ADP and epinephrine, which induce the formation of small aggregates independently of thromboxane A2 production. These findings suggest that LS can detect inhibitory effects of lower concentrations of antiplatelet agents, since it detects the formation of small aggregates induced by agonists in the lower concentration range than LT. It is also suggested that beraprost potently inhibits thromboxane A2-elicited initial signal transduction pathway, reflected by the formation of small aggregates.     

The use of laser-light scattering and controlled shear in platelet aggregometry

Laser-light scattering was used to observe and quantify the dynamics of human blood platelet aggregation in platelet-rich plasma (PRP). Aggregation was performed in a controlled shear environment by placing the PRP in the annular space between a rotating cylindrical rod and a stationary cylindrical tube. The instrument was capable of very sensitive continuous semi-quantitative measurements of chemically-induced microaggregation. As a demonstration of the technique, results are presented for ADP-induced aggregation at doses of 10, 1, and 0.1 microM and collagen-induced aggregation at a dose of 5 micrograms/ml, each at shear rates of 1,000 s-1 and 500 s-1. Extensive aggregation was observed in response to ADP at even the low dose of 0.1 microM, indicating a high sensitivity to microaggregates. The sensitivity of the ultimate size of the ADP-induced aggregates to ADP concentration was shear dependent. The formation of microaggregates by collagen stimulation was shown to be almost immediate, as contrasted with a 10-20 s typical lag when observed turbidometrically. Disaggregation was observed with 1 microM ADP, but this was only partial, as contrasted with the complete recovery of transmittance observed in the turbidometric technique. Electronic particle sizing and counting was employed to semiquantitatively verify the aggregate size distributions found from mathematical conversion of the laser-light scattering data.