Prevention of monocyte adhesion and inflammatory cytokine production during blood platelet storage: an in vitro model with implications for transfusion practice

Procoagulant platelets: are they necrotic?

Apoptosis and necrosis represent distinct cell death processes that regulate mammalian development, physiology and disease. Apoptosis characteristically leads to the silent destruction and removal of cells in the absence of an inflammatory response. In contrast, necrotic cell death can induce physiologic inflammatory responses linked to tissue defense and repair. Although anucleate, platelets undergo programmed cell death, with apoptosis playing an important role in clearing effete platelets from the circulation. While it has long been recognized that procoagulant platelets exhibit characteristic features of dying cells, recent studies have demonstrated that platelet procoagulant function can occur independent of apoptosis. A growing body of evidence suggest that the biochemical, morphologic and functional changes underlying agonist-induced platelet procoagulant function are broadly consistent with cell necrosis, raising the possibility that distinct death pathways regulate platelet function and survival. In this article, we will discuss the mechanisms underlying apoptotic and necrotic cell death pathways and examine the evidence linking these pathways to the platelet procoagulant response. We will also discuss the potential contribution of these pathways to the platelet storage lesion and propose a simplified nomenclature to describe procoagulant platelets.

Nitric oxide infusion alleviates cellular activation during preparation, leukofiltration and storage of platelets

Nitric oxide (NO) is a reversible inhibitor of platelet activation that generates S-nitrosylated compounds in plasma. Since platelets are activated during processing to platelet concentrates and storage, NO is anticipated to dampen the rate of lesion development. Platelet-rich plasma (PRP) was separated into aliquots that were unfiltered, filtered to remove leukocytes, or treated with NO or nitrite before filtration. Platelets were resuspended and stored up to four days at 22 degrees C. Samples removed were measured for S-nitrosylation of plasma, P-Selectin release, complement activation, and cGMP levels. Direct infusion of a NO solution (authentic NO) to PRP before filtration decreased adherence of platelets and improved yields. An infusion rate resulting in 1/1000 dilution of a saturated NO solution was optimal. C3a formation and soluble P-Selectin released from NO-treated-filtered platelets were about half that in unfiltered and filtered controls after four days (p<0.05 by Student-Newman-Keuls method after ANOVA for repeated measures). Plasma isolated from NO-treated PRP combined with untreated platelets protected the latter to a similar extent. Increases in S-nitrosylated compounds in PRPs were correlated with NO effects on platelet recovery and storage. Sodium nitrite failed to inhibit platelet activation and cyclic GMP levels were significantly increased in NO-treated cells. Results indicate that NO inhibited platelet activation associated with processing and storage and suggest that slow release of NO from S-nitrosylated plasma components afforded long-term protection. The infusion of authentic NO into PRPs is potentially an efficacious method for generating anti-platelet compounds to inhibit storage lesions.

Simultaneous determination of amiloride and furosemide in pharmaceutical formulations by first digital derivative spectrophotometry

This work presents a simple and fast method for the simultaneous determination of amiloride and furosemide by digital derivative spectrophotometry. HCl 1 x 10(-2) mol/l dissolved in ethanol was used as solvent and to extract drugs from formulations. Subsequently the samples were evaluated directly by first digital derivative spectrophotometry, using a smoothing factor of 8 and scale factor of 1 x 10(-4). The simultaneous determination of furosemide and amiloride can be carried out at 241.4 and 343.6 nm, respectively. In both cases, the zero crossing approach was used. When both compounds are present together in a sample, it is possible to quantify one in the presence of the other, without mutual interference. The determination range was found to be of 6.9 x 10(-8) to 16 x 10(-5) and 6.8 x 10(-8) to 8 x 10(-5) mol/l, for amiloride and furosemide, respectively. A good level of repeatability (RSD) of 0.9 and 0.6% was observed for amiloride and furosemide, respectively. The ingredients commonly found in commercial pharmaceutical formulations do not interfere. The proposed method was applied to the determination of these drugs in pharmaceutical formulations.

Amiloride blockades lipopolysaccharide-induced proinflammatory cytokine biosynthesis in an IkappaB-alpha/NF-kappaB-dependent mechanism. Evidence for the amplification of an antiinflammatory pathway in the alveolar epithelium

It has been previously reported that amiloride suppresses inflammatory cytokine biosynthesis. However, the molecular mechanism involved has yet to be ascertained. Therefore, the immunoregulatory potential mediated by amiloride and the underlying signaling transduction pathway was investigated. Exposure of alveolar epithelial cells to amiloride or its analog, 5-(N,N-hexamethylene)-amiloride (HMA), reduced, in a dose-dependent manner, lipopolysaccharide (LPS)-induced secretion of interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha. This inhibitory effect was associated with the augmentation of a counter antiinflammatory response, mediated by IL-6 and IL-10. Analysis of the mechanism implicated revealed the involvement of an inhibitory kappaB (IkappaB-alpha)/nuclear factor kappaB (NF- kappaB)-sensitive pathway. Amiloride and HMA suppressed the phosphorylation of IkappaB-alpha mediated by LPS, thereby allowing its cytosolic accumulation. Furthermore, both inhibitors interfered with the nuclear translocation of selective NF-kappaB subunits, an effect associated with blockading the DNA-binding activity of NF-kappaB. Recombinant IL-10 blockaded LPS-induced biosynthesis of IL-1beta and TNF-alpha and reduced NF-kappaB activation. Immunoneutralization of endogenous IL-10 reversed the inhibitory effect of amiloride on proinflammatory cytokines and restored the DNA-binding activity of NF-kappaB. These results indicate that amiloride acts as a novel dual immunoregulator in the alveolar epithelium: it downregulates an inflammatory signal and at the same time upregulates an antiinflammatory response. This biphasic effect is IL-10 sensitive and is associated with the selective targeting of the IkappaB-alpha/NF-kappaB signaling transduction pathway.

Preservation of platelet function on 2-methacryloyloxyethyl phosphorylcholine-graft polymer as compared to various water-soluble graft polymers

The chemical structures of water-soluble polymers grafted onto PE surfaces affect platelet function when the platelets contact the polymer surfaces. To improve our understanding of this effect, this study sought to control the blood/materials interaction on the surfaces of polyethylene (PE) by grafting with various water-soluble polymers. Such polymers as poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC), poly(acrylamide) (PAAm), poly(N-vinylpyrrolidone) (PVPy), and poly[monomethacryloyl poly(ethylene glycol)] (PMPEG) were grafted on low-density PE sheets by photoinduced graft polymerization. Both the PE bags modified with water-soluble polymers and those nonmodified were prepared by heat processing. Activation of platelets after storage in the PE bags was evaluated by measuring the cytoplasmic free calcium ion concentration ([Ca(2+)]i). The concentration of [Ca(2+)]i of platelets in contact with the PE surface grafted with PMPC was the same as that of native platelets and significantly less than that in contact with other PE surfaces grafted with water-soluble polymers. The number of adherent platelets was effectively decreased on PE surfaces grafted with PMPC and PMPEG, as compared with nontreated PE. The aggregation ability of platelets was also measured after storage of platelet-rich plasma in the PE bags. The PE surface grafted with PMPC effectively maintained aggregation ability as compared with both the nontreated PE and with PE grafted with PAAm, PVPy, and PMPEG. It was concluded that for preserving platelet function, PMPC was the most effective of these water-soluble polymers used for surface modification.