In vitro effects of platelet factor 4 on normal human neutrophil functions

Platelet factor (PF4) prepared from human outdated platelets by heparinagarose affinity chromatography was confirmed to be chemotactic for human neutrophils and in a concentration-dependent fashion caused significant release of lysosomal enzymes (myeloperoxidase, lysozyme, beta-glucuronidase) from human neutrophils treated with cytochalasin B. Lysosomal enzyme release from PF4-stimulated neutrophils was rapid and reached a plateau by 1-3 min. PF4 did not cause release of the cytoplasmic enzyme lactate dehydrogenase which indicates that exocytosis of granule-containing lysosomal enzymes did not result from cytolysis. In contrast, superoxide anion generation from human neutrophils stimulated with PF4 was undetectable even at the highest PF4 concentration tested (2 X 10(-5) M). Pretreatment of neutrophils with PF4 caused significant increased adherence of neutrophils to plastic surfaces and cultured pulmonary artery endothelial cells. The concentration of PF4 that elicited neutrophil chemotaxis, lysosomal enzyme release and increased adherence is slightly higher than those concentrations found in normal human sera. However, the results suggest that PF4 may be an important mediator in neutrophil-platelet interactions and the induction of acute inflammation especially at sites of platelet microthrombi where the concentration of PF4 would be elevated.

Binding of heparin to human platelet factor 4

Platelet factor 4 is a small protein (Mr 7756) from the alpha-granules of blood platelets which binds strongly to and neutralizes the anticoagulant properties of heparin. From an analysis of X-ray crystallographic data a model for the binding of platelet factor 4 to heparin is proposed.

Effect of a new anticoagulant (MD 805) on platelet activation in the hemodialysis circuit

MD 805 ((2R, 4R) 4-methyl-1-[N alpha-(3-methyl-1,2,3,4-tetra-hydro-8-quinoline-sulfonyl)L- arginyl]-2-piperidine carboxylic acid monohydrate), an anticoagulant, was used in patients with chronic renal failure undergoing maintenance hemodialysis, and the results were compared with those of heparin. MD 805 produced no significant increase in PF-4 which was observed on hemodialysis with heparin. Moreover, the arterio-venous difference in beta-TG during hemodialysis with MD 805 was significantly lower than that during hemodialysis with heparin. MD 805, even at the small amount of 15 mg/hr, exhibited a stable antithrombin effect without marked interindividual differences in coagulation time as monitored by aPTT. Consequently, it caused no increase in the proteins released as a result of platelet activation in the hemodialysis circuit. MD 805 thus proved very useful in maintenance anticoagulation therapy for patients on hemodialysis.

The heparin-mobilisable pool of platelet factor 4: a comparison of intravenous and subcutaneous heparin and Kabi heparin fragment 2165

Some clinical advantages are claimed for low molecular weight heparin so the mobilisation of platelet factor 4 (PF 4) from the endothelial pool by the heparins may be relevant. Unfractionated (UF) heparin has been compared with Kabi heparin fragment 2165. A single intravenous (i.v.) injection of 60 iu/kg heparin was compared with 5000 anti-Xa units of Kabi-2165. Less PF 4 was mobilised by Kabi-2165 and some apparently remained in the pool and was released when the pool was subsequently challenged by giving i.v. heparin. Subcutaneous (s.c.) injections of 5000 iu heparin twice daily were compared with 5000 anti-Xa units of Kabi-2165 once daily, each given for a week. The plasma PF 4 was never raised yet when finally challenged with i.v. heparin the pool was "empty" or refractory after the s.c. heparin but some PF 4 remained after the s.c. Kabi-2165. The two glycosaminoglycans (GAGs) had widely differing half-lives but the t/2 of the PF 4 mobilised by the two GAGs was similar even though the PF 4 is apparently bound to the GAG.

Anticoagulant effects of a low molecular weight heparinoid (Org 10172) in human volunteers and haemodialysis patients

Org 10172, a low MW heparinoid derived from animal intestinal mucosal tissue, has a mean molecular weight of 6500 D and a specific activity of 8.0 anti-Xa U/mg. Its elimination half-life after i.v. administration is 18 hours. Six human volunteers received repeated single i.v. injections of 800 and 3200 anti-Xa units of Org 10172, 5000 IU heparin or placebo. Bleeding time, platelet count and plasma beta thromboglobulin were not affected by Org 10172 or heparin. Heparin stimulated ADP-induced platelet aggregation (0.2 uM; p less than 0.05) and inhibited thrombin induced aggregation (0.3 U/ml; p less than 0.05), while the heparinoid lacked these effects. Heparin increased plasma platelet factor 4, whereas Org 10172 had no effect. In contrast to heparin Org 10172 had only a minor effect on the activated partial thromboplastin time and thrombin time, while both compounds induced anti-Xa activity in plasma. In a crossover study in six haemodialysis patients, both heparin and Org 10172 (34.4 and 22.4 anti-Xa units/kg/body weight) successfully prevented clotting of the extracorporeal circuit. Microscopical analysis of the artificial kidney membranes showed that the 34.4 unit Org 10172 dosage was as effective as heparin in preventing fibrin deposition. The haemostatic and coagulation effects were as expected from those observed in the volunteers except that there was a slower elimination of the plasma anti-Xa response. In addition heparin and Org 10172 (34.4 anti-Xa units/kg) inhibited the Xa-induced platelet aggregation (0.5 U/ml; p less than 0.01 and p less than 0.001 respectively).

Nephrotic syndrome: a platelet hyperaggregability state

Nephrotic syndrome characterized by hypoalbuminemia and hyperlipidemia is associated with an increased incidence of thromboembolism and increased platelet hyperaggregability. Although plasma coagulation proteins are also abnormal, changes are too inconsistent to attribute thromboembolic complications to the coagulation cascade alone. Antithrombin III (ATIII) has been shown to be deficient in nephrotic syndrome. There is, however, an increase in alpha 2 macroglobulin. It is clear that platelet to platelet interactions require exposure of platelet fibrinogen receptors, the binding of fibrinogen to these receptors, platelet crossbridging, and subsequent platelet aggregation. Fibrinogen is consistently elevated in nephrotic syndrome. Hyperlipidemia and hypoalbuminemia in nephrotic syndrome increases the availability of thromboxane A2 (TxA2) by increasing the availability of TxA2 precursors and the removal of TxA2 inhibitors. Thromboxane A2 is a known inducer of platelet aggregation probably through the exposure of platelet fibrinogen receptors. Recently, fibronectins a group of adhesive proteins, were implicated in platelet to platelet interactions. Since thrombin increases the expression of platelet surface fibronectin, fibronectin may be involved in thrombus formation in nephrotic syndrome. Thromboembolic formation in nephrotic syndrome is a composite mechanism involving the coagulation cascade, platelet-platelet interactions, and platelet-surface interactions.

Nomenclature of secreted platelet proteins--report of the Working Party on Secreted Platelet Proteins of the Subcommittee on Platelets

Standard nomenclature for a number of secreted platelet proteins was agreed upon by The Working Party on Secreted Platelet Proteins of the Subcommittee on Platelets. Platelet factor 4 will continue to be used for the molecule with high heparin affinity, subunit molecular weight of 7780, and the described amino acid sequence. beta-Thromboglobulin will be used to designate beta-Thromboglobulin (81 amino acids/subunit, beta-mobility on cellulose-acetate electrophoresis, pI 7), low-affinity platelet factor 4 (85 amino acids/subunit, gamma-mobility on cellulose-acetate electrophoresis, pI 8), and platelet basic protein (94 amino acids/subunit, pI 10) when these are measured immunologically in plasma, but that thromboglobulin with a superscript designation of the pI should be used when assays are conducted on samples after isoelectric focusing, and a subscript amino-terminal amino acid can be added when a purified protein is described. Thrombospondin will continue to be the designation for the high molecular weight trimer that has previously been called thrombospondin or glycoprotein G. Platelet derived growth factor will be used for the group of closely related proteins of molecular weight about 30,000 and isoelectric point about 10.

Interaction of platelet factor 4 with human platelets

Human washed resting platelets bound 125I-labeled platelet factor 4 in a reaction which was saturable and approached equilibrium within 15-30 min. Scatchard plot analysis of the binding isotherms suggested a single class of specific binding sites. Excess of unlabeled protein and low- and high-affinity heparin competed for platelet factor 4 binding sites on the platelet surface and caused a partial displacement of this molecule. Anti-platelet factor 4 Fab fragments caused inhibition of binding of 125I-platelet factor 4 to platelets. Most of the labeled platelet factor 4 which was bound to intact platelets was recovered in the Triton X-100-insoluble cytoskeletal fraction prepared from the same platelets after their stimulation by thrombin. The association with the cytoskeleton was inhibited by anti-platelet factor 4 Fab fragments and by low-affinity heparin. Anti-platelet factor 4 125I-labeled Fab fragments bound to resting platelets, and this binding was greatly increased following platelet stimulation with thrombin. This suggested that endogenously secreted platelet factor 4 also binds to the platelet surface. No significant binding to platelets of 125I-labeled beta-thromboglobulin and 125I-labeled anti-beta-thromboglobulin Fab fragments was observed. Fab fragments of monospecific anti-human platelet factor 4 antibody raised in rabbits inhibited platelet aggregation and secretion induced by low concentrations of thrombin. Fab fragments of anti-beta-thromboglobulin antibody had no inhibitory effect. We suggest that the binding of alpha-granule-derived platelet factor 4 to the specific sites on the surface of platelets may modulate platelet aggregation and secretion induced by low levels of platelet agonists.

Modulation of heparin cofactor II activity by histidine-rich glycoprotein and platelet factor 4

Heparin cofactor II is a plasma protein that inhibits thrombin rapidly in the presence of either heparin or dermatan sulfate. We have determined the effects of two glycosaminoglycan-binding proteins, i.e., histidine-rich glycoprotein and platelet factor 4, on these reactions. Inhibition of thrombin by heparin cofactor II and heparin was completely prevented by purified histidine-rich glycoprotein at the ratio of 13 micrograms histidine-rich glycoprotein/microgram heparin. In contrast, histidine-rich glycoprotein had no effect on inhibition of thrombin by heparin cofactor II and dermatan sulfate at ratios of less than or equal to 128 micrograms histidine-rich glycoprotein/microgram dermatan sulfate. Removal of 85-90% of the histidine-rich glycoprotein from plasma resulted in a fourfold reduction in the amount of heparin required to prolong the thrombin clotting time from 14 s to greater than 180 s but had no effect on the amount of dermatan sulfate required for similar anti-coagulant activity. In contrast to histidine-rich glycoprotein, purified platelet factor 4 prevented inhibition of thrombin by heparin cofactor II in the presence of either heparin or dermatan sulfate at the ratio of 2 micrograms platelet factor 4/micrograms glycosaminoglycan. Furthermore, the supernatant medium from platelets treated with arachidonic acid to cause secretion of platelet factor 4 prevented inhibition of thrombin by heparin cofactor II in the presence of heparin or dermatan sulfate. We conclude that histidine-rich glycoprotein and platelet factor 4 can regulate the antithrombin activity of heparin cofactor II.

Failure of percutaneous transluminal coronary angioplasty to stimulate platelet and prostaglandin activity

Platelet function and prostaglandin activity were evaluated in nine patients with coronary artery disease undergoing percutaneous left anterior descending coronary artery angioplasty (PTCA) and compared to nine normal controls. Transcoronary measurements (arterial-coronary sinus) of platelet counts, mean platelet volume, platelet factor 4 (PF4), beta thromboglobulin, thromboxane (B2), and 6-keto-PGF 1 alpha were made. When compared to normal controls, the patients with coronary artery disease had higher circulating baseline levels of PF4 in the coronary sinus. There was no transcardiac production of any factor at baseline or immediately after infusion of nitroglycerin or performance of PTCA. These results suggest that PTCA does not grossly alter arachidonic acid metabolism or platelet activity.

Platelet factor 4 does not promote von Willebrand factor binding to human platelets

Ristocetin, protamine and Polybrene promote factor VIII:vWF binding and agglutination of formalinized platelets. It has been suggested that these polycations neutralize platelet negative surface charges and promote the attachment of VIII:vWF to platelets. Platelet factor 4 (PF4), protamine, and Polybrene inhibit heparin activity by neutralizing heparin negative charges. We tested the hypothesis that PF4, which is bound to the platelet surface after platelet activation and secretion, could promote the binding of VIII:vWF and subsequent platelet agglutination. Purified PF4 in concentrations comparable to those of ristocetin did not agglutinate formalinized platelets or induce the disappearance of VIII:vWF from the suspending plasma. Platelets were thrombin-treated in order to induce the release of PF4, and then formalinized and resuspended in normal plasma. These platelets did not agglutinate spontaneously, or at lower ristocetin concentrations than platelets that were not treated with thrombin before formalin fixation. Platelets were also activated by thrombin in the presence of EDTA to prevent surface binding of VIII:vWF or secreted PF4, and then formalinized. These platelets did not bind VIII:vWF in the presence of purified PF4. We conclude that even though PF4 binds to both polyanions and the platelet membrane, it does not promote the attachment of VIII:vWF.

Release of platelet factor 4 into the blood after cold challenge of patients with cold urticaria

Five individuals with idiopathic cold urticaria but not normal volunteers released platelet factor 4 (PF4) detected by radioimmunoassay into the circulation after cold challenge. In three patients, a biphasic rise in PF4 was noted with increases at 1 and 10 to 20 min after immersion, whereas in two others only the later rise was detected. Peak levels of PF4 were detected in all five patients 20 min after cold immersion, whereas peak levels of other mediators such as histamine and eosinophil and neutrophil chemotactic activity occurred earlier at 10, 3 to 10, and 5 to 10 min, respectively. The identification of PF4 in the circulation of patients with cold urticaria after cold challenge provides further evidence for the activation of platelets in mast cell-dependent disorders and suggests new potential mechanisms for the expression of cold urticaria.

The effect of platelet factor 4 (PF4) on assays of plasma heparin

Platelet factor 4 (PF4) is a potent antiheparin in vitro. In view of the large amount of PF4 secreted from platelet alpha-granules during routine blood collection and processing techniques, the potential significance of this release was investigated using three measurements of heparin activity: the activated partial thromboplastin time (aPTT), the thrombin time, and factor Xa inactivation using the chromogenic substrate S2222 for assay of factor Xa. The results demonstrate that purified PF4 neutralizes heparin activity when added in increasing amounts to normal platelet-poor plasma containing a fixed concentration of commercial porcine gut mucosal heparin. This effect was seen when assaying heparin activity by all three methods. In addition, when heparin was added in increasing concentrations to pooled plasma samples that were collected from normal volunteers, there was neutralization of heparin activity in blood samples collected by routine citrate anticoagulation (CIT60) in comparison to blood samples collected simultaneously with platelet secretion inhibiting agents added to the anticoagulant (CIT+). This effect was seen when assaying heparin by the aPTT and thrombin time. These data confirm that both purified and secreted PF4 have significant antiheparin activity when heparin is added in vitro to normal plasma. Neutralization of circulating heparin by PF4 secreted during blood collection from anticoagulated patients could result in underestimation of the actual in vivo heparin concentration. In order to evaluate the significance of this effect, purified PF4 was added to plasma collected from heparinized patients and again PF4 neutralized heparin activity. This was seen, however, only when heparin activity was measured by the thrombin time or Xa inactivation assays. There was minimal shortening of the aPTT when PF4 was added in final concentrations up to 1000 ng/ml. When blood samples were simultaneously collected from anticoagulated patients by both routine and special collection methods, these results were confirmed. There was a significant difference between heparin activities measured in the CIT+ (secreted PF4 58 ng/ml) and CIT60 (secreted PF4 1074 ng/ml) plasma samples by both thrombin time and Xa inactivation. There was no difference, however, in the aPT when both types of plasma samples were simultaneously collected and assayed for each anticoagulated patient. This suggests that there may be circulating heparin fractions which can prolong the aPTT but which do not interact with PF4.(ABSTRACT TRUNCATED AT 400 WORDS)

The interaction of platelet proteins with three fibroblast-derived collagenases

Three collagenases were purified from the culture medium of human skin fibroblasts using ammonium sulfate fractionation, ion-exchange chromatography and gel filtration. The cationic collagenase had a molecular weight of 42,000; two anionic collagenases had molecular weights of 63,000 and 115,000. Preincubation of the individual collagenases with purified human and bovine platelet heparin binding proteins resulted in the inhibition of the two anionic activities, but only by bovine low heparin affinity platelet protein (beta-TG). Such inhibition was dose-dependent at the microgram level, was not antagonized by heparin, and persisted even when the collagenases had been transformed into their 53,000 and 105,000 forms through treatment with p-aminophenylmercuric acetate. Neither human nor bovine high heparin affinity platelet factors (PF-4) nor human low heparin affinity platelet protein (beta-TG) were inhibitory to any of the three collagenases studied. This suggests that the ability of platelet proteins to inhibit collagenase is specifically influenced by the ionic nature of the enzyme and this inhibition is specifically dependent upon the species and type of platelet protein.

Binding of platelet factor four (PF 4) to glomerular polyanion

Synthetic polycations have been shown to bind to glomerular polyanion (GPA) and increase glomerular permeability. Here, we show that human platelet factor 4 (PF 4), a platelet secretory protein, binds to GPA. The following methods were used to assess PF 4 binding to GPA: (1) Sections of human and rat renal cortex were incubated with PF 4 or PF 4 was injected intravenously into rats followed by immunofluorescence techniques; (2) 125I-PF 4 was added to isolated glomerular basement membrane (GBM) suspensions and binding assessed isotopically; (3) PF 4 was perfused through rat kidneys ex vivo followed by immunoperoxidase methods for electron microscopy (EM). In vitro and in vivo, PF 4 bound to the mesangium and linearly to capillary walls. Isotopic studies showed dose-dependent saturable binding of PF 4 to GBM which was reversed by heparin. By EM, PF 4 binding sites were resolved in the GBM, particularly in the laminae rarae as punctate densities similar in distribution to anionic sites revealed by cationic dyes. Also, endothelial and epithelial cell surfaces stained. An ionic interaction between PF 4 and GPA was indicated by elimination of staining by washing PF 4-treated sections with buffer containing 1.0 and 3.0 M NaCl or with heparin. Pretreatment of rats with polyethyleneimine (a synthetic polycation) blocked PF 4 binding. Heparin administration in vivo removed previously bound PF 4. By virtue of its affinity for GPA and behavior like a polycation, PF 4 may alter glomerular permeability and play a role in glomerular disease.

Observations on the heparin neutralizing activity of outdated platelet concentrates

A crude extract of outdated, washed, frozen and thawed, platelet concentrates was prepared and optimally diluted for use in the A.P.T.T. test as a source of platelet phospholipid (P.F. 3). The extract contained, in addition to P.F. 3, active heparin neutralizing activity (P.F. 4), which was able to neutralize plasma heparin up to a concentration of approximately 0.8 units/ml plasma. Although these observations are of a preliminary nature, it is felt that the extract can be used to follow the "intrinsic" coagulability of plasma samples from patients receiving therapeutic heparin. Utilizing the A.P.T.T. test system, the determination of coagulability and the neturalization of heparin result from the use of this extract in a single test.

Some biochemical correlates of panic attacks with agoraphobia and their response to a new treatment

Thirty-two patients with chronic debilitating agoraphobia and panic attacks participated in a comparative study of the triazolobenzodiazepine alprazolam and the anti-inflammatory agent ibuprofen. After a 2-week placebo washout period, patients were randomly assigned to 8 weeks of treatment with alprazolam (2 to 6 mg/day) or ibuprofen (0.8 to 2.4 g/day). Medication was identically packaged and patients were blind to the treatment condition, but investigators were aware of which medication was dispensed. Alprazolam recipients (mean daily dose: 5.4 mg) improved markedly with respect to physician and patient global rating of disease severity, frequency and severity of panic attacks, and phobic anxiety target symptoms on the 90-Item Hopkins Symptom Check List. Ibuprofen recipients (mean daily dose: 2.13 g) experienced significantly less clinical improvement than patients on alprazolam. After 8 weeks of treatment, ibuprofen patients were crossed over to alprazolam, while the original alprazolam group continued on that drug. The daily dosage ceiling was increased to 10 mg. In the ensuing 4 weeks (mean daily alprazolam dose: 6.3 mg), all patients achieved comparably marked clinical improvement relative to baseline. Pretreatment plasma concentrations of platelet factor 4 and beta-thromboglobulin--two measures of platelet turnover and release--were significantly elevated in patients relative to normal controls. The elevated platelet factor 4 and beta-thromboglobulin normalized during treatment with both drugs. Alprazolam appears to produce rapid and specific clinical improvement in patients with severe agoraphobia and panic attacks and deserves further evaluation under double-blind conditions.

Inhibition of the cerebroside sulphate (sulphatide)-induced contact activation reactions by platelet factor four

Cerebroside sulphate or sulphatides, present in erythrocyte and leucocyte cell membranes, have recently been shown to be a potent activator of the contact phase of coagulation. Platelet factor-four (PF4), purified from human washed platelets, was found to inhibit the sulphatide induced APTT and plasma prekallikrein activation in a dose dependent manner. A four-fold increase in the sulphatide-APTT was observed in 156pM PF4 in the reaction mixture and 30% inhibition of prekallikrein activation was observed at 1.6nM. PF4 was found to be an approximately 1000-fold more potent inhibitor than protamine sulphate in inhibiting activation of clotting but was not as potent in inhibiting activation of prekallikrein. The physiological form of PF4 as released from platelets, was also found to cause inhibition of plasma prekallikrein activation, with 50% inhibition observed when the concentration of PF4 in plasma was 2.25 g/ml (0.29 M). The ability of PF4 to inhibit the contact activation reactions induced by sulphatides may be of some physiological significance in that when released during platelet activation and vessel wall injury, it may have a protective effect against the development of thrombosis.