Comparative investigation on the influence of human and bovine collagen types I, II and III on the aggregation of human platelets

Preparation and characterization of a novel humanized collagen III with repeated fragments of Gly300-Asp329

Recombinant human collagens have attracted intensive interest in the past two decades, demonstrating considerable potential in medicine, tissue engineering, and cosmetics. Several humanized recombinant collagens have been produced, exhibiting similar characteristics as the native species. To get insight into the structural and bioactive properties of different parts of collagen, in this study, the segment of Gly300-Asp329 of type III collagen was first adopted and repeated 18 times to prepare a novel recombinant collagen (named rhCLA). RhCLA was successfully expressed in E. coli, and a convenient separation procedure was established through reasonably combining alkaline precipitation and acid precipitation, yielding crude rhCLA with a purity exceeding 90%. Additionally, a polishing purification step utilizing cation exchange chromatography was developed, achieving rhCLA purity surpassing 98% and an overall recovery of approximately 120 mg/L culture. Simultaneously, the contents of endotoxin, nucleic acids, and host proteins were reduced to extremely low levels. This fragmented type III collagen displayed a triple-helical structure and gel-forming capability at low temperatures. Distinct fibrous morphology was also observed through TEM analysis. In cell experiments, rhCLA exhibited excellent biocompatibility and cell adhesion properties. These results provide valuable insights for functional studies of type III collagen and a reference approach for the large-scale production of recombinant collagens.

Main and Minor Types of Collagens in the Articular Cartilage: The Role of Collagens in Repair Tissue Evaluation in Chondral Defects

Several collagen subtypes have been identified in hyaline articular cartilage. The main and most abundant collagens are type II, IX and XI collagens. The minor and less abundant collagens are type III, IV, V, VI, X, XII, XIV, XVI, XXII, and XXVII collagens. All these collagens have been found to play a key role in healthy cartilage, regardless of whether they are more or less abundant. Additionally, an exhaustive evaluation of collagen fibrils in a repaired cartilage tissue after a chondral lesion is necessary to determine the quality of the repaired tissue and even whether or not this repaired tissue is considered hyaline cartilage. Therefore, this review aims to describe in depth all the collagen types found in the normal articular cartilage structure, and based on this, establish the parameters that allow one to consider a repaired cartilage tissue as a hyaline cartilage.

Type III collagen (COL3A1): Gene and protein structure, tissue distribution, and associated diseases

Collagen alpha-1(III) chain, also known as the alpha 1 chain of type III collagen, is a protein that in humans is encoded by the COL3A1 gene. Three alpha 1 chains are required to form the type III collagen molecule which has a long triple-helical domain. Type III collagen, an extracellular matrix protein, is synthesized by cells as a pre-procollagen. It is found as a major structural component in hollow organs such as large blood vessels, uterus and bowel. Other functions of type III collagen include interaction with platelets in the blood clotting cascade and it is also an important signaling molecule in wound healing. Mutations in the COL3A1 gene cause the vascular type of Ehlers-Danlos syndrome (vEDS; OMIM 130050). It is the most serious form of EDS, since patients often die suddenly due to a rupture of large arteries. Inactivation of the murine Col3a1 gene leads to a shorter life span in homozygous mutant mice. The mice die prematurely from a rupture of major arteries mimicking the human vEDS phenotype. The biochemical and cellular effects of COL3A1 mutations have been studied extensively. Most of the glycine mutations lead to the synthesis of type III collagen with reduced thermal stability, which is more susceptible for proteinases. Intracellular accumulation of this normally secreted protein is also found. Ultrastructural analyses have demonstrated dilated rough endoplasmic reticulum and changes in the diameter of collagen fibers. Other clinical conditions associated with type III collagen are several types of fibroses in which increased amounts of type III collagen accumulate in the target organs.

New aspects on efficient anticoagulation and antiplatelet strategies in sheep

BACKGROUND

After addressing fundamental questions in preclinical models in vitro or in small animals in vivo, the translation into large animal models has become a prerequisite before transferring new findings to human medicine. Especially in cardiovascular, orthopaedic and reconstructive surgery, the sheep is an important in vivo model for testing innovative therapies or medical devices prior to clinical application. For a wide variety of sheep model based research projects, an optimal anticoagulation and antiplatelet therapy is mandatory. However, no standardised scheme for this model has been developed so far. Thus the efficacy of antiplatelet (acetylsalicylic acid, clopidogrel, ticagrelor) and anticoagulant (sodium enoxaparin, dabigatran etexilate) strategies was evaluated through aggregometry, anti-factor Xa activity and plasma thrombin inhibitor levels in sheep of different ages.

RESULTS

Responses to antiplatelet and anticoagulant drugs in different concentrations were studied in the sheep. First, a baseline for the measurement of platelet aggregation was assessed in 20 sheep. The effectiveness of 225 mg clopidogrel twice daily (bid) in 2/5 sheep and 150 mg bid in 3/5 lambs could be demonstrated, while clopidogrel and its metabolite carboxylic acid were detected in every plasma sample. High dose ticagrelor (375 mg bid) resulted in sufficient inhibition of platelet aggregation in 1/5 sheep, while acetylsalicylic acid did not show any antiplatelet effect. Therapeutic anti-factor Xa levels were achieved with age-dependent dosages of sodium enoxaparin (sheep 3 mg/kg bid, lambs 5 mg/kg bid). Administration of dabigatran etexilate resulted in plasma concentrations similar to human ranges in 2/5 sheep, despite receiving quadruple dosages (600 mg bid).

CONCLUSION

High dosages of clopidogrel inhibited platelet aggregation merely in a low number of sheep despite sufficient absorption. Ticagrelor and acetylsalicylic acid cannot be recommended for platelet inhibition in sheep. Efficient anticoagulation can be ensured using sodium enoxaparin rather than dabigatran etexilate in age-dependent dosages. The findings of this study significantly contribute to the improvement of a safe and reliable prophylaxis for thromboembolic events in sheep. Applying these results in future translational experimental studies may help to avoid early dropouts due to thromboembolic events and associated unnecessary high animal numbers.

The interaction of plasma sialylated and desialylated lipoproteins with collagen from the intima and media of uninvolved and atherosclerotic human aorta

We have evaluated the binding of sialylated and desialylated lipoproteins to collagen isolated from the proteoglycan and musculoelastic layers of intima and media of uninvolved human aorta and atherosclerotic lesions. Comparing various collagen preparations from the uninvolved intima-media, the binding of sialylated apoB-containing lipoproteins was best to collagen from the intimal PG-rich layer. Binding of sialylated apoB-containing lipoproteins to collagen from this layer of fatty streak and fibroatheroma was 1.4- and 3.1-fold lower, respectively, in comparison with normal intima. Desialylated VLDL versus sialylated one exhibited a greater binding (1.4- to 3.0-fold) to all the collagen preparations examined. Desialylated IDL and LDL showed a higher binding than sialylated ones when collagen from the intimal layers of fibroatheroma was used. Binding of desialylated HDL to collagen from the intimal PG-rich layer of normal tissue, initial lesion, and fatty streak was 1.2- to 2.0-fold higher compared with sialylated HDL.

Collagen-type specificity of glycoprotein VI as a determinant of platelet adhesion

Of the two physiologically important platelet collagen receptors, glycoprotein (GP) VI is the receptor responsible for platelet activation. However, its reactivities towards different types of vascular collagen have not been directly and quantitatively analysed with collagen preparations of defined composition, although the other major platelet collagen receptor integrin alpha(2)beta(1) was shown to react with collagen types I-VI and VIII under either static or flow conditions. We analysed the collagen type specificity of GPVI binding to identify the physiological contribution of the various vascular collagens and how platelet reactivity towards the various collagens may be affected by fibril size. We used two methods to analyse the binding of recombinant GPVI (GPVI-Fc(2)) to different types of bovine collagen: binding to collagen microparticles in suspension and binding to immobilized collagen. GPVI-Fc(2) bound to type I-III collagens that can form large fibrils, but not to type V that only forms small fibrils. The apparent GPVI binding to types IV and V could be ascribed to type I collagen that was a contaminant in each of these preparations. Kinetic analyses of the binding data showed that type III collagen fibrils have both a higher Kd and Bmax than types I and II. Flow adhesion studies demonstrated that type III collagen supports the formation of larger platelet aggregates than type I. Our present results suggest that the physiological importance of type III collagen is to induce thrombus formation. Furthermore, these studies indicate that GPVI mainly binds to collagen types that can form large collagen fibrils.

Evaluation of phytoconstituents of Terminalia arjuna for wound healing activity in rats

The effect of topical application of phytoconstituents (fraction I, II and III) fractionated from a hydroalcohol extract of the bark of the plant, Terminalia arjuna, was assessed on the healing of rat dermal wounds using in vivo models. The results indicated a statistically significant increase in the tensile strength of the incision wounds and the percent epithelialization of excision wounds compared with control (p < 0.05). However, topical treatment with fraction I, consisting mainly of tannins, was found to demonstrate a maximum increase in the tensile strength of incision wounds. Even with respect to excision wounds, the fastest rate of epithelialization was seen with fraction I. Hexosamine estimation of granulation tissue obtained from excision wounds revealed an increase in the hexosamine content with fraction I compared with the control. In addition, fraction I from the hydroalcohol extract of Arjuna bark possessed antimicrobial activity against tested microorganisms such as Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Streptococcus pyogenes but not Candida albicans. These results strongly document the beneficial effects of fraction I, consisting mainly of tannins, of Terminalia arjuna in the acceleration of the healing process. Thus, the present study validates the claim made with respect to the plant as well as corroborating the astringent effect of tannins by drawing the tissues closer together.

Development of a recombinant human collagen-type III based hemostat

Animal-tissue-derived collagen, containing mostly type I collagen with a minor amount of type III collagen, has been widely used in the production of hemostats for many decades, although it has been known for a long time that type III collagen is more likely to induce platelet aggregation in vitro. Because it is hard to purify type III from animal tissue, it has not been possible to correlate this finding with in vivo data. In this report, it is demonstrated that recombinant human collagen III fibrils are more capable of inducing platelet aggregation in vitro than those comprised of bovine collagen I, in agreement with previously published data on tissue-derived type III collagen. When formed into three-dimensional matrices, the use of type III collagen results in formulations with better mechanical integrity, larger surface area, and higher hemostatic activity in a rabbit spleen injury model as compared with commercially available hemostats formed from bovine type I collagen.

Distinct roles of GPVI and integrin alpha(2)beta(1) in platelet shape change and aggregation induced by different collagens

1. Various platelet membrane glycoproteins have been proposed as receptors for collagen, in some cases as receptors for specific collagen types. In this study we have compared the ability of a range of collagen types to activate platelets. 2. Bovine collagen types I-V, native equine tendon collagen fibrils and collagen-related peptide (CRP) all induced platelet aggregation and shape change. 3. Responses were abolished in FcRgamma chain-deficient platelets, which also lack GPVI, indicating a critical dependence on the GPVI/FcRgamma chain complex. 4. Responses to all collagens were unaffected in CD36-deficient platelets. 5. A monoclonal antibody (6F1) which binds to the alpha(2) integrin subunit of human platelets had a minimal effect on the rate and extent of aggregation induced by the collagens; however, it delayed the onset of aggregation following addition of all collagens. For shape change, 6F1 abolished the response induced by collagen types I and IV, substantially attenuated that to collagen types II, III and V, but only partially inhibited Horm collagen. 6. Simultaneous blockade of the P2Y(1) and P2Y(12) receptors, and inhibition of cyclo-oxygenase demonstrated that CRP can activate platelets independently of ADP and TxA(2); however, responses to the collagens were dependent on these mediators. 7. This study confirms the importance of the GPVI/FcRgamma chain complex in platelet responses induced by a range of collagen agonists, while providing no evidence for collagen type-specific receptors. It also provides evidence for a modulatory role of alpha(2)beta(1), the significance of which depends on the collagen preparation.

Influence of Terminalia chebula on dermal wound healing in rats

The effects of topical administration of an alcohol extract of the leaves of an evergreen plant, Terminalia chebula, on the healing of rat dermal wounds, in vivo, was assessed. T. chebula treated wounds healed much faster as indicated by improved rates of contraction and a decreased period of epithelialization. Biochemical studies revealed a significant increase in total protein, DNA and collagen contents in the granulation tissues of treated wounds. The levels of hexosamine and uronic acid in these tissues, also increased upto day 8 post-wounding. Reduced lipid peroxide levels in treated wounds, as well as ESR measurement of antioxidant activity by DPPH radical quenching, suggested that T. chebula possessed antioxidant activities. The tensile strength of tissues from extract-treated incision wounds increased by about 40%. In addition, T. chebula possessed antimicrobial activity and was active largely against Staphylococcus aureus and Klebsiella. These results strongly document the beneficial effects of T. chebula in the acceleration of the healing process.

Calcification of cross-linked collagen-elastin membrane implants in vivo and their proposed use in bone regeneration

Factors influencing the in vivo calcification of porcine collagen membranes containing elastic fibres were investigated by light and confocal microscopy. Two glutaraldehyde (GA) cross-linking protocols were used: a new one involving microwaving (NEWGA), and a conventional method using GA treatment at room temperature (OLDGA). We observed that the physical and chemical properties of implanted membranes will influence the acute inflammatory response, which initially checks the calcification process. The NEWGA membranes are superior in cases where rapid calcification is desired. In this context, it is proposed that NEWGA membranes may serve as a useful delivery system for bone morphogenetic protein (BMP).

Chemical and physical properties of collagen implants influence their fate in vivo as evaluated by light and confocal microscopy

Porcine collagen membranes having a rough and a smooth side were used for subcutaneous implantation studies in rats. Two tanning protocols were used for the membranes, a new one involving microwaving and glutaraldehyde treatment (NEWGA), and the other, a conventional method using glutaraldehyde treatment at room temperature (OLDGA). Untreated membranes (NONGA) were also implanted. Sections of the implants were examined by light microscopy and with the confocal laser scanning microscope focusing on neovascularization and incorporation of the implant. At 64 days, the smooth sides of NEWGA and OLDGA implants were not well incorporated, with scarring subjacent to the surface and dystrophic calcification of that side of the membrane. At the same time, the rough sides of the NEWGA and OLDGA were not calcified with a giant cell reaction around the porcine collagen. The best incorporation was found in the NONGA membranes with no dystrophic calcification, excellent neovascularization of all layers, and complete remodeling at day 64. After 5 months, the completely remodeled NONGA membrane still could be identified, and the NEWGA and OLDGA membranes were calcified with a giant cell reaction having a dense fibrous capsule. It is concluded that if cross-linking is deemed necessary, the microwave cross-linking method is advisable because in the early stages there is less reactive inflammation around it, and the implant surfaces should be rough with an open structure, making calcification of cross-linked collagen unlikely.

Neurovascular manifestations of heritable connective tissue disorders. A review

BACKGROUND

Heritable disorders of connective tissue are recognized in a small minority of patients with neurovascular diseases. In this report, we review the neurovascular manifestations of four heritable connective tissue disorders: Ehlers-Danlos syndrome, Marfan's syndrome, osteogenesis imperfecta, and pseudoxanthoma elasticum, as well as two other systemic disorders with potential vascular manifestations: neurofibromatosis and polycystic kidney disease.

SUMMARY OF REVIEW

Typical neurovascular complications of Ehlers-Danlos syndrome are carotid-cavernous fistulae, intracranial aneurysms, and cervical artery dissections. Arterial dissections and intracranial aneurysms cause the majority of neurovascular symptoms in Marfan's syndrome. Neurovascular disease is uncommon in osteogenesis imperfecta, although carotid-cavernous fistulae and vertebral artery dissections have been reported. Neurovascular disease in pseudoxanthoma elasticum is characterized by intracranial aneurysms and cerebral ischemia caused by premature arterial occlusive disease. Intracranial occlusive arterial disease is the most common neurovascular manifestation of neurofibromatosis, followed by cervical arteriovenous fistulae and aneurysms and intracranial aneurysms. Intracranial aneurysms are the hallmark of polycystic kidney disease.

CONCLUSIONS

Recognition of an underlying generalized connective tissue disorder may be of considerable importance, although marked phenotypic heterogeneity often complicates the diagnosis of these disorders. Conversely, the association of certain neurovascular anomalies with generalized connective tissue disorders and recognition of their basic molecular defect may offer clues to the etiology and pathogenesis of these neurovascular diseases in general.

Spatial organization of the extracellular matrix modulates the expression of PDGF-receptor subunits in mesangial cells

The aim of this study was to test the hypothesis that changes in the extracellular matrix environment regulate rat mesangial cell growth by modulation of the expression of both PDGF-receptor alpha- and beta-subunits. We investigated the mitogenic effects of the PDGF isoforms AA, AB and BB in conventional two-dimensional (2D) culture on laminin, fibronectin, type I, IV and V collagen and in the different spatial organization of matrix in type I collagen gels in three-dimensional culture (3D). In 2D culture PDGF BB was a potent mitogen, AB elicited an intermediate response while AA had no effect on cell proliferation. Extracellular matrix did not modify the PDGF responsiveness in 2D-culture. The different effects of the three PDGF isoforms were due to differential expression and isoform specific association of the PDGF-receptor subunits. Specifically, the beta-receptor was strongly expressed, whereas the alpha-receptor was only barely detectable on the cell surface. Metabolic labeling revealed synthesis and intracellular accumulation of the complete alpha-receptor protein, and treatment with suramin increased its surface expression, suggesting continuous receptor down-regulation by endogenous PDGF. Morphological and ultrastructural analysis in 3D culture revealed a change in mesangial cell phenotype, forming a branching network of multicellular structures. Assessment of proliferation in 3D culture showed quiescent cells and PDGF unresponsiveness. Investigation of the PDGF beta-receptors revealed a rapid down-regulation in 3D culture; both receptor subunits were not detectable on the cell surface. We conclude that 3D culture promotes the induction of a different mesangial cell phenotype.(ABSTRACT TRUNCATED AT 250 WORDS)

The de-endothelialized rat carotid arterial graft: a versatile experimental model for the investigation of arterial thrombosis

A novel model of arterial thrombosis was developed. A mechanical endothelium-denuding injury was created (using a scalpel blade) on harvested, freezer-stored rat carotid arteries. Vessel length of 5 mm. were grafted into the femoral arteries of recipient Sprague-Dawley rats using microvascular anastomotic technique. Patency rates in untreated animals were compared with those in animals receiving systemic aspirin or heparin. The control group patency after 2 hours of flow was 15%, while grafts in aspirin- and heparin-treated animals achieved 35% and 95% patency rates, respectively. Uninjured non-frozen carotid grafts in untreated animals yielded a 95% patency rate, while frozen grafts achieved an 80% patency. Therapeutic levels of aspirin, heparin, and urokinase were confirmed through tail bleeding and whole blood clotting tests, as well as platelet aggregation studies and scanning electron microscopy of the graft lumenal surfaces. A long-term series using syngeneic grafts placed in recipients (Lewis-to-Lewis) and employing systemic heparinization demonstrated maintenance of patency for 4 weeks. Scanning electron microscopy revealed good re-endothelialization, well advanced by one week. Histology confirmed the regrowth of endothelial cells, but showed sparse cellular repopulation of medial and adventitial layers. The mechanical injury model was compared to enzymatic de-endothelialization (using trypsin or collagenase), for which patency rates were similar (10% and 0%, respectively). Trypsin de-endothelialized vessels were tested in vitro for the amount of active trypsin remaining bound to the lumenal surface; no detectable activity was found when trypsin inhibitor was applied following trypsin treatment. The versatility of allowing both in vitro evaluation and in vivo patency assessment demonstrates the uniqueness and value of this new model, offering an avenue toward more direct investigations of surface-mediated thrombotic processes.

Antithrombotic benefit of subendothelium-bound urokinase: an experimental study

To improve the outcome of extremity replantation, microsurgeons have administered systemic antithrombotic agents (e.g., heparin, aspirin, dextran). To obviate the risks associated with systemic anticoagulation, we have investigated the use of topically applied urokinase for its binding capacity to arterial subendothelium and for its ability to prevent subsequent thrombosis. An arterial model of thrombosis associated with intimal deendothelialization was developed. Donor rat carotid arteries were everted and mechanically deendothelialized with a scalpel blade. The vessels were next subjected to one of several treatments, which included 30-minute incubation with urokinase, heparin, or vehicle (lactated Ringer's solution). The vessels were then washed, reinverted to normal orientation, sectioned into 5 mm lengths, and grafted into the femoral arteries of recipient rats. Two-hour patency rates were 25% for controls (n = 20), 10% for heparin-treated vessels (n = 10), and 55% for urokinase-treated vessels (n = 20); this last was significantly greater than the other two groups. In vitro investigations revealed that urokinase has a high capacity for binding to subendothelium, with a release half-life of approximately 20 minutes. Surface-bound urokinase was found to have proteolytic activity similar to that of urokinase in solution. These results indicate that urokinase may be a more beneficial irrigating solution additive than heparin for repair of traumatized vessels.

Spontaneous carotid-cavernous fistulae in Ehlers-Danlos syndrome Type IV. Case report

Spontaneous bilateral carotid-cavernous fistulae and cervical artery dissection is reported in a 20-year-old woman with Ehlers-Danlos syndrome Type IV. The clinical features of 16 previously published cases of spontaneous carotid-cavernous fistulae associated with Ehlers-Danlos syndrome Type IV are reviewed, for a total of 17 cases. The mean age of the 14 women and three men was 31.6 years. Only direct fistulae were encountered. Diagnostic neuroangiography carried morbidity and mortality rates of 36% and 12%, respectively; neuroradiological treatment resulted in death in one of six patients. The possible value of desmopressin in the management of these patients is discussed. In view of the risks of arterial puncture and surgery, the authors emphasize the importance of early recognition of Ehlers-Danlos syndrome.

Stimulation of phospholipase A2 activity in human platelets by trypsin and collagen

Type I collagen enhanced human platelet phospholipase A2 activity whether added to platelet-rich plasma or washed platelets. The stimulatory effect of type I collagen on platelet membrane phospholipase A2 activity was also observed in a cell-free system utilizing platelet membranes. The release of arachidonic acid was enhanced by types I and III but not by type V collagen. The activation of platelet phospholipase A2 by type I collagen was inhibited by soybean trypsin inhibitor and mimicked by trypsin. However, type I collagen addition was not associated with any detectable changes in platelet membrane proteins while trypsin altered many proteins. These results point to acid soluble phospholipase A2 activity of platelets as an enzyme activated by type I collagen.

Collagen-platelet interaction: type XI collagen-induced platelet aggregation

Type XI collagen in its native fibrillar but not in soluble monomeric form mediates human platelet aggregation and release of adenosine triphosphate in a dose-dependent manner. Its action is inhibited by aspirin. Type XI collagen also increased radiolabelled phosphate incorporation into protein bands with molecular weights of 42 KDa and 22 KDa, respectively. In contract, these events were not observed in platelets incubated with type IX collagen. These results suggest that the fibrillar type XI collagen has the same ability as other types of collagen to induce human platelet aggregation.

Collagen type III induced ex vivo thrombogenesis in humans. Role of platelets and leukocytes in deposition of fibrin

Exposure of type III collagen coats on plastic cover slips in parallel-plate perfusion chambers to flowing nonanticoagulated human blood resulted in deposition of platelets and fibrin. Blood was drawn directly from an antecubital vein by an occlusive roller pump over the collagen coats in chambers having flow slits of different dimensions, so that wall shear rates of 100, 650, and 2600 s-1 were obtained at 10 ml/min. Coagulation was minimally activated during the passage of blood from the vein to the chamber as shown by fibrinopeptide A levels of 3.7 ng/ml after 5-minute perfusions. The surface coverage with platelets increased from 18% at 100 s-1 to 59% at 2600 s-1, and the corresponding thrombus volumes increased from 2 to 22 microns 3/microns 2, respectively. This contrasted with the coverage with fibrin on collagen, which decreased from 28% at 100 s-1 to 9% at 2600 s-1. Fibrin deposits on the thrombi covered 6% of the surface irrespective of the shear rate, indicating that some of the deposited platelets accelerated the deposition of fibrin. The type III collagen preparation did not activate factor XII and did not possess tissue factor activity, indicating that the surface itself was not procoagulant. However, a correlation between deposited leukocytes and surface coverage with fibrin was observed (r = 0.78, p less than 0.01), suggesting a role for these cells in the deposition of fibrin. The data demonstrate that thrombogenesis is triggered by pure type III collagen, although the deposition of fibrin is not initiated by the collagen itself but presumably by deposited leukocytes.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence for activation of platelets in the synovial fluid from patients with rheumatoid arthritis

Platelets were isolated by gel filtration from paired samples of peripheral blood and synovial fluid (SF) aspirated from inflamed knee joints from 20 adult patients with rheumatoid arthritis (RA) as well as from peripheral blood obtained from 20 healthy subjects. The platelets from the three different sources were investigated for quantitative differences in the number of two distinct types of intracellular storage organelles using immunofluorescence staining for platelet factor 4 (PF4) and labelling with the fluorescent substance mepacrine (MC). The number of PF4-stained organelles per cell was the same in the peripheral normal and RA platelets. This number was distinctly lower in the SF platelets. The peripheral and SF platelets from the RA patients had the same number of MC-labelled organelles. This number was distinctly lower than in the normal cells. The results suggest that the peripheral RA platelets had been activated to liberate serotonin and other substances from one type of organelles, and that the SF platelets had been activated to an additional liberation of PF4 from another such type. Liberated PF4, serotonin, and other substances from SF platelets may, in several ways, contribute to the inflammatory responses of RA.

The effect of low dose of 12-O-tetradecanoyl-phorbol-13-acetate on collagen platelet interactions

We and others have reported that phorbol ester doses ranging from 0.25 to 25 micrograms/ml induce human platelets to aggregate and release serotonin. In this paper, we report the effect of low doses of phorbol (0.5 to 50 ng/ml) on subthreshold amounts of collagen induced platelet aggregation. The platelet aggregation induced by the addition of subthreshold amounts of collagen can be enhanced by low doses of phorbol. The combined low doses of phorbol and subthreshold amounts of collagen induced platelet aggregation can be inhibited by the addition of aspirin and imidazole. The increase in platelet aggregation induced by the combined low doses of phorbol and subthreshold amounts of collagen is probably mediated by the collagen fibril formation.

Enhanced in vitro fibrinolytic activity of immobilized plasmin on collagen beads

Plasmin was immobilized on collagenous substrates using carbodiimide as a linking agent. The kinetics of soluble and immobilized plasmin were monitored by reacting them with the chromogenic substrate S-2251 (H-D-Val-Leu-Lys-pNA) in the presence and absence of a2-antiplasmin (a2-PI). The ability of immobilized plasmin to lyse synthetic clots formed from fibrinogen and thrombin was determined by detecting the formation of fibrin degradation products (FDP). The activity of immobilized plasmin was 0.02 casein units (CU)/mg of collagen. The kinetic analysis of soluble and immobilized plasmin in the presence and absence of a2-PI shows that while soluble plasmin activity was inhibited by the presence of a2-PI, the plasmin inhibitor did not interfere with the ability of immobilized plasmin to attack fibrin. In the absence of a2-PI, the ability of the immobilized plasmin to lyse synthetic clots was the same as that of soluble plasmin. In the presence of a2-PI, immobilized plasmin produced twice the amount of FDP as did soluble plasmin. The immobilized plasmin activity was stable for a period of at least 3 months.

Chemically modified collagen: a natural biomaterial for tissue replacement

Glutaraldehyde crosslinking of native or reconstituted collagen fibrils and tissues rich in collagen significantly reduces biodegradation. Other aldehydes are less efficient than glutaraldehyde in generating chemically, biologically, and thermally stable crosslinks. Tissues crosslinked with glutaraldehyde retain many of the viscoelastic properties of the native collagen fibrillar network which render them suitable for bioprostheses. Implants of collagenous materials crosslinked with glutaraldehyde are subject long-term to calcification, biodegradation, and low-grade immune reactions. We have attempted to overcome these problems by enhancing crosslinking through bridging of activated carboxyl groups with diamines and using glutaraldehyde to crosslink the epsilon-NH2 groups in collagen and the unreacted amines introduced by aliphatic diamines. This crosslinking reduces tissue degradation and nearly eliminates humoral antibody induction. Covalent binding of diphosphonates, specifically 3-amino-1-hydroxypropane-1, 1-diphosphonic acid (3-APD), and chondroitin sulfate to collagen or to the crosslink-enhanced collagen network reduces its potential for calcification. Platelet aggregation is also reduced by glutaraldehyde crosslinking and nearly eliminated by the covalent binding of chondroitin sulfate to collagen. The cytotoxicity of residual glutaraldehyde--leaching through the interstices of the collagen fibrils or the tissue matrix--and of reactive aldehydes associated with the bound polymeric glutaraldehyde can be minimized by neutralization and thorough rinsing after crosslinking and storage in a nontoxic bacteriostatic solution.

Procollagen-III peptide serum levels in Paget's disease of the bone

A commercially available radioimmunoassay kit was used to determine aminoterminal procollagen-III peptide (pNcoll III) serum levels in patients with Paget's disease of the bone and control subjects. In patients with Paget's disease pNcoll III concentrations were significantly elevated. They decreased to varying degrees under chronic therapy with human and salmon calcitonin, disodium ethane 1-hydroxy 1,1-diphosphonate (EHDP), or a combination therapy of EHDP and human calcitonin. The results were compared with the effect on traditional biochemical markers of disease activity: serum alkaline phosphatase and urinary hydroxyproline excretion, both of which reacted more acutely to the various therapies than pNcoll III, although pretreatment correlations were close. The most probable source of pNcoll III is not the Pagetic bone per se, but the vascular, fibrous connective tissue replacing normal bone marrow.

Localization of collagen types I, III, IV and V, fibronectin and laminin in human arteries by the indirect immunofluorescence method

The distribution of types I, III, IV and V collagen and of the glycoproteins fibronectin and laminin in sections of human aortas, arteries and atherosclerotic plaques were studied using monospecific antibodies and indirect fluorescence microscopy. Types IV and V collagen and laminin were present in a narrow zone, representing the basement membrane, apposed to the endothelial layers of all these tissues. Types I and III collagen and fibronectin were located in the interstitial spaces of the intima and the media of blood vessels walls, whereas types IV and V collagen and laminin were found in the basement membranes underlying smooth muscle cells in these areas. Two types of atherosclerotic plaques were observed. Lipid-rich plaques contained less collagen and reduced amounts of the glycoproteins. Fibrous plaques consisted of regions deficient in types I and III collagen and collagen-rich regions with elevated levels of these two collagens as well as more fibronectin. The collagen-rich regions of fibrous plaques contained, however, little type IV and type V collagen and little of the glycoproteins laminin and fibronectin. This may be due to the reduced number of cells involved in the biosynthesis of these basement membrane proteins.

Interaction of platelets and purified collagens in a laminar flow model

Damage to the endothelial surface of the vessel wall can result in exposure of circulating blood components to collagen and other subendothelial structures. Collagen types I, III, IV, and V have been demonstrated in the vessel wall by chemical and immunohistological methods; type V is thrombin-sensitive, and is present on the endothelial cell surface. In an earlier study using a rocking model, both unstimulated and ADP-induced platelet adherence was reduced on wells coated with type V collagen in comparison to uncoated wells; and increased on plastic surfaces coated with types III and IV collagen in comparison to those coated with type V collagen. The present study was designed to determine the effect of erythrocytes and shear rate on platelet adherence to these purified collagen types in a laminar flow system. With platelet-rich plasma, adherence of labeled platelets was much lower in the laminar flow system compared with the rocking model. Erythrocytes significantly enhanced platelet adherence to surfaces that were untreated or absorbed with collagen types I, III, and IV. However, this enhancement was not seen in the presence of type V collagen. These studies provide additional evidence for the selectively nonthrombogenic nature of type V collagen.

Collagen types in various layers of the human aorta and their changes with the atherosclerotic process

The types of collagen components extracted from human aortas by repeated pepsin digestion were investigated by SDS-polyacrylamide gel electrophoresis (SDS-PAGE), after differential salt precipitation, cyanogen bromide (CNBr) cleavage and beta-mercaptoethanol reduction. For further extraction of collagen components, repeated pepsin digestion was carried out, and two extracts, the former and latter, were obtained. The greatest increase was seen in type V collagen followed by type III in the former extract. Type I collagen was continually extracted, so the proportion of type I to other types became greater with the number of extractions. SDS-PAGE of the residue treated with CNBr revealed that it contained the greatest amount of type I, followed by the latter extract. Type I collagen comprised approximately two-thirds of the total collagen. It was the most predominant in the intima and adventitia but was also obviously abundant in the media. The proportion of type III collagen to total collagen fell slightly with advancing atherosclerosis, since the amounts of types I and V showed some increase. A band of the alpha 3(V) chain of type V collagen in the intima was occasionally detected between the bands of the alpha 1(V) and alpha 2(V) chains. Basement membrane collagen, type IV, which was extracted predominantly from the intima and subintima, showed a heterogenous distribution as to molecular size, ranging from 50 Kd to 140 Kd. The alpha 1(IV) and alpha 2(IV) collagens were found at positions corresponding to 100 Kd and 80 Kd, respectively. The content of collagen type IV also increased with the proliferative fibrotic process. Type VI collagen was found in the intima and subintima of the human aorta at a position corresponding to an approximate molecular weight of 150 Kd, and it was reduced to fragments of 40 Kd, 45 Kd and 52 Kd.

[Significance of the endothelium of the vascular wall for maintaining hemostasis]

The endothelial lining contributes in many respects to the patency of the vasculature. The production of heparan sulphate, release of prostacyclin and expression of the membrane cofactor thrombomodulin that is essentially required for the activation of protein C represent important mechanisms that warrant thromboresistance. If the integrity of the vessel wall is lost, the exposed subendothelium that has been built up by the endothelial cells serves as a highly reactive surface for platelets whose adherence is facilitated by another endothelial cell product, the von Willebrand Factor. Induction of tissue factor production after exposure to endotoxin also emphasizes an important role für the endothelium in the pathogenesis of disseminated intravascular coagulation. Once thrombosis has occurred the release of plasminogen activator of tissue-type from the endothelium leads to dissolution of the clot and a functional restoration of the blood vessel.

The platelet reactivity of collagen type VI

Collagen type VI in native (undenatured or triple-helical) form has been shown, like collagen types I-V, alpha 1(I) trimer and alpha 2(I) trimer, to possess platelet reactivity provided that essential quaternary structural needs are first satisfied. Thus platelet aggregation was induced by the collagenous domain of collagen type VI, isolated free of the non-collagenous elements, when this entity was presented to platelets in fibrillar form. This implies that platelet recognition sites in collagen type VI are located in the collagenous sequence of the molecule. Aggregation of platelets was also induced, although a higher concentration was required, by the intact, "parent" collagen following its polymerisation by random association of molecules with the aid of a cross-linking agent (glutaraldehyde) to yield an amorphous polymer. This permits the suggestion that the more ordered molecular assembly of collagen type VI thought to occur in vivo, to yield a microfibrillar form, is likely to be associated with significant platelet reactivity. Our results support the notion that any collagenous species may be reactive towards platelets provided that essential tertiary and quaternary structural requirements are met and in this sense, therefore, they favour more the idea of multiple platelet-reactive sites in collagen of relatively low structural specificity and low affinity.

The platelet reactivity of the alpha 2(I)-chain of type I collagen: platelet aggregation induced by polymers of the molecule [alpha 2(I)]3

Polymers of the collagenous species alpha 2(I) trimer, a molecule of which contains three alpha 2(I) chains derived from type I collagen, have been shown to induce the aggregation of platelets when tested at a temperature low enough to avoid loss of the tertiary structure of the molecule. Under these conditions, the alpha 2(I) chain appears to possess greater platelet reactivity than the corresponding type I collagen-derived alpha 1(I) chain. In contrast to previous reports of its lack of reactivity, our results indicate that the alpha 2(I) chain must contribute importantly to the overall platelet reactivity of collagen type I in vivo. Our findings furthermore support the concept that any collagen-like structure may be expected to interact with platelets provided due regard is given to tertiary and quaternary structural requirements.

The effect of pepsin solubilization on platelet aggregation by types I and III collagens

The effect of pepsin solubilization on the platelet aggregating activity of type I collagen and type III collagen was examined. Pepsin-digested type I collagen was unable to initiate platelet aggregation in either soluble form or as pre-formed fibrils. In contrast, pepsin-digested type III collagen was active in soluble form or as preformed fibrils. Mixtures of type I and type III collagen were assayed for platelet aggregating activity. In soluble form, these mixtures demonstrated elevated activity with increasing type III concentration. When the mixtures were tested as pre-formed fibrils, the rate of aggregation was relatively constant with the combination 75% type III and 25% type I manifesting the highest activity. The lag time for onset of aggregation was also minimized for this same type III/type I ratio. The combinations of the two collagen types formed fibrils which reflected the amounts of types I and III collagens in solution.

[Light and electron microscopic studies on local reactions to implanted collagen hemostypticum--an experimental animal study]

A light and electron microscopic study was made on the resorption of native collagen fleece following its subcutaneous implantation or its application on a bleeding liver surface in 132 Wistar rats. Resorption of collagen began with the immigration of micro- and macrophages. Organisation of subcutaneous connective tissue was seen from day 5 p.o. to day 15 p.o. The excessive connective tissue was removed after 25 days and foreign body granulomas were eliminated after 50 to 100 days. Typical characteristics of application of the collagen fleece on bleeding liver surface are: Rapid hemostasis, mesothelisation of collagen towards the peritoneum after 1 day, resorption and organisation without adhesion after 10 days. The final heeling leads to a smooth thickening of the liver capsula with a few residual granulomas after 100 days.

Demonstration of fibronectin associated with platelets in synovial fluid from patients with rheumatoid arthritis

Paired samples of peripheral blood and synovial fluid (SF) aspirated from inflamed knee joints from 15 adult patients with classical rheumatoid arthritis, as well as peripheral blood obtained from 15 healthy subjects, were anticoagulated with ACD. Peripheral blood platelets were separated from other plasma constituents by gel filtration of platelet-rich plasma on Sepharose 2B. When using this technique on SF, it was found that platelets could be isolated from other SF constituents, and that each of the SF's gave a high yield of eluted platelets. Direct immunofluorescent staining for human fibronectin was performed with isolated and suspended platelets obtained from the three different sources. Aliquots of both intact and permeabilized platelets were stained. Intact peripheral platelets from all patients and normal subjects revealed a weakly positive staining, whereas the staining of intact SF platelets from all patients was clear and bright. The fluorescence of intact cells was surface-located and speckled. For permeabilized platelets, the staining had a punctate intracellular pattern, with a varying number of discrete and bright fluorescent foci per cell. Counting of the foci in each platelet specimen revealed that this number, which was also found in peripheral platelets from all patients and normal subjects, was distinctly greater than the number of foci in all the SF platelet specimens. No relationship was found between the various staining results and medical treatment or Waaler-Rose serology of the patients. The findings indicate that the SF platelets had large amounts of surface-bound and small amounts of intracellular fibronectin, whereas the converse was found in the case of peripheral platelets from the patients and normal subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Diminished platelet adherence to type V collagen

Different types of collagen vary in their influence on platelet reactivity. Collagen Types III, IV, and V were obtained from human placental tissue, and Type I collagen was prepared from rat skin. Each collagen type was coated onto a plastic surface. Each collagen-coated surface or appropriate plastic surface control was studied using citrated human 51Cr-labeled platelet-rich plasma in both the presence and absence of 10 microM adenosine 5'-diphosphate (ADP). Both unstimulated and ADP-induced platelet adherence were: 1) reduced by Type V collagen coating in comparison to uncoated wells; and 2) increased by Types III and IV collagen coating in comparison to Type V coated or plastic surfaces. Addition of the fast-acting thrombin inhibitor dansylarginine (DAPA) had no significant effect on unstimulated and ADP-induced platelet adherence to Type III, IV or V collagen-coated surfaces. Type I collagen-coated surfaces, studied only in the presence of DAPA, caused greater platelet adherence than those coated with Types III, IV, or V collagen. We conclude that Type V collagen may be less thrombogenic than Types, I, III, or IV.

Biochemical features of pseudomembrane at the bone-cement interface of loosened total hip prostheses

Biochemical features of pseudomembrane formed at the bone-cement interface of 13 failed total hip replacements were studied and histological examination of the pseudomembrane was conducted. The results of biochemical analyses revealed on average hydroxyproline, 86 micrograms/mg; water content, 57%; hexosamine, 12 micrograms/mg; glucosamine/galactosamine, 1.4%; and calcium, 2.1%. Approximately 78% of collagen was extracted with pepsin, whereas only 8 and 0.3% collagen were extracted with acetic acid and neutral salt, respectively. On further differential salting out of the extracted collagen, about 77% was type I collagen, 19% type III, and 2.6% type V. Unlike pseudoarthrosis of fracture, no type II collagen was identified. Overall biochemical features in the light of the histological appearance suggested that pseudomembrane resembles granulation tissue. Bone healing mechanisms at the bone-cement interface appear to differ from that of fracture healing.

Content and distribution of collagen in venous and polyester aortal grafts

The studies were carried out on autogenous venous and polyester grafts implanted in the abdominal aorta of dogs. These grafts were excised 1,4 and 36 months after implantation and together with the normal arteries and veins, after dissection into intimal, medial, and adventitial layers, tested for their hydroxyproline and nitrogen content. It was found that the collagen content and the hydroxyproline/nitrogen ratio in the various layers of the venous and polyester grafts increased as time elapsed after the operation. The increase in collagen content was, however much higher in the polyester grafts than in the venous. The relative index of the collagen content expressed by the above ratio was found to be almost equal in the intimal and medial layers of the venous and polyester grafts 3 years after the operation and to be slightly higher than the content in the corresponding layers of the normal arteries and veins.

Immunohistochemical study of collagen types in human foetal lung and fibrotic lung disease

Highly purified type-specific anti-collagen antibodies (prepared in animals to types I, II, III, and IV bovine collagen) were used in an indirect immunofluorescence method for the study of human lung collagen. The tissue localisation of each collagen type, and the apparent type I:III collagen ratio was assessed in normal foetal and adult lung and in fibrotic lung lesions. In the latter, the relationship of the findings to the natural history of the lesion was considered. This method was compared with routine connective tissue stains. The following observations were made. (1) Foetal lung in the canalicular phase of development proved a useful substrate for validating and standardizing the procedure. (2) Collagen fluorescence was more sensitive than connective tissue stains in detecting collagen in foetal tissues and sites of early fibrosis. (3) On the basis of collagen-type fluorescence, two distinctive patterns of fibrosis were recognised. Areas of mature collagen surrounding vessels and bronchi and in established scar tissue, for example in asbestotic pleural plaques, were virtually exclusively type I collagen. By contrast, areas of early active fibrosis like sarcoid nodules and organising pneumonia, which usually contained variable numbers of fibroblasts and chronic inflammatory cells, were characterised by an increased proportion of type III collagen and a greater intensity of both types I and III collagen fluorescence. The possible significance of this change in type III:I collagen ratio is discussed. Determination of the stage of fibrotic lesions by this method might have applications in the prediction of disease progression, and influence management of some conditions.

Anti-collagen antibodies in sera from rheumatoid arthritis patients

Anti-cartilage antibodies, demonstrable by immunofluorescence, were found in 3.3% of rheumatoid arthritis patients. In most of these patients antibodies to type II collagen were detected. In specificity studies on these anti-collagen antibodies, they appeared to be type specific, showing no reaction with collagen types I and III. Denatured type II collagen reacted much less well than native type II, but isolated peptides from different regions of the collagen molecule were differentiated by individual sera. Removal of the glycoside side chains from native type II collagen had no effect on its antigenicity. The findings suggest that these patients produce highly specific antibodies which react with the triple helix of type II collagen.

Collagen-induced platelet aggregation and bleeding time in adolescent idiopathic scoliosis

Collagen is the main supportive protein of connective tissue. Another of its functions is the initiation of haemostasis by activation of the platelets. It has been suggested that collagen is abnormal in idiopathic scoliosis. The present study lends further support to this view: collagen of fascia specimens from patients with adolescent idiopathic scoliosis was found to aggregate platelets less readily than collagen from non-scoliotic controls and suspensions of fascia patients with adolescent idiopathic scoliosis contained more collagen than those from the controls. The collagen abnormality is probably also reflected in a prolonged bleeding time. The changes in the collagen in patients with scoliosis persist at least for some years after the cessation of growth.

Collagen changes in congenital and idiopathic scoliosis

Collagen abnormalities in adolescent idiopathic scoliosis have been recorded. In this condition the platelet aggregating power of collagen is decreased and the amount of collagen in suspensions prepared from fascia is increased. We found the same abnormalities in two out of four patients with congenital scoliosis, operated on according to Harrington. In idiopathic as well as in congenital scoliosis the decrease in the platelet aggregating power was more conspicuous in the younger patients.

[Experimental study on tissue and cell reactions after implantation of xenogeneic collagen sponges (author's transl)]

164 inbred Wistar rats received subcutaneous and intraperitoneal implants of xenogeneic collagen sponges and were examined by light- and electron microscopy as well as immunohistologically, to establish tissue and cell reactions and the time of collagen reabsorption. 4 to 5 weeks after implantation the xenogeneic collagen sponge was completely absorbed. All the inflammatory and reparative reactions were non-specific. Granulation tissue appeared soon (3 days after implantation) with new synthesis of fine collagen fibrils, mainly of type III, followed by type I collagen fibers. Myofibroblasts, with intracellular evidence of myosin and collagen (Type I and III) were sporadically present in the granulation tissue after day 5 and regularly after day 10. Small scar granulomas without xenogenic collagen were detectable even 4 to 6 months after collagen implantation. Reabsorption and regression of collagen granulomas occurred faster after xenogeneic collagen implantation than after using surgical cat sutures. From the morphological point of view, there is no indication of specific sensitization against xenogeneic collagen or of a specific immunologic process.