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Martyanov AA, Tesakov IP, Khachatryan LA, An OI, Boldova AE, Ignatova AA, Koltsova EM, Korobkin JJD, Podoplelova NA, Svidelskaya GS, Yushkova E, Novichkova GA, Eble JA, Panteleev MA, Kalinin DV, Sveshnikova AN. Platelet functional abnormalities in pediatric patients with kaposiform hemangioendothelioma/Kasabach-Merritt phenomenon. Blood Adv 2023; 7:4936-4949. [PMID: 37307200 PMCID: PMC10463204 DOI: 10.1182/bloodadvances.2022009590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/05/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023] Open
Abstract
Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of infancy that is commonly associated with a life-threatening thrombocytopenic condition, Kasabach-Merritt phenomenon (KMP). Platelet CLEC-2, tumor podoplanin interaction is considered the key mechanism of platelet clearance in these patients. Here, we aimed to assess platelet functionality in such patients. Three groups of 6 to 9 children were enrolled: group A with KHE/KMP without hematologic response (HR) to therapy; group B with KHE/KMP with HR; and group C with healthy children. Platelet functionality was assessed by continuous and end point flow cytometry, low-angle light scattering analysis (LaSca), fluorescent microscopy of blood smears, and ex vivo thrombi formation. Platelet integrin activation in response to a combination of CRP (GPVI agonist) and TRAP-6 (PAR1 agonist), as well as calcium mobilization and integrin activation in response to CRP or rhodocytin (CLEC-2 agonist) alone, were significantly diminished in groups A and B. At the same time, platelet responses to ADP with or without TRAP-6 were unaltered. Thrombi formation from collagen in parallel plate flow chambers was also noticeably decreased in groups A and B. In silico analysis of these results predicted diminished amounts of CLEC-2 on the platelet surface of patients, which was further confirmed by immunofluorescence microscopy and flow cytometry. In addition, we also noted a decrease in GPVI levels on platelets from group A. In KHE/KMP, platelet responses induced by CLEC-2 or GPVI activation are impaired because of the diminished number of receptors on the platelet surface. This impairment correlates with the severity of the disease and resolves as the patient recovers.
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Affiliation(s)
- Alexey A. Martyanov
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Ivan P. Tesakov
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Lili A. Khachatryan
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Olga I. An
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Anna E. Boldova
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Anastasia A. Ignatova
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Ekaterina M. Koltsova
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Julia-Jessica D. Korobkin
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Nadezhda A. Podoplelova
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Galina S. Svidelskaya
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Eugenia Yushkova
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
| | - Galina A. Novichkova
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Johannes A. Eble
- Institute of Physiological Chemistry and Pathobiochemistry, University of Münster, Münster, Germany
| | - Mikhail A. Panteleev
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
- Lomonosov Moscow State University, Moscow, Russia
| | - Dmitrii V. Kalinin
- Institute of Pharmaceutical and Medicinal Chemistry, University of Münster, Münster, Germany
| | - Anastasia N. Sveshnikova
- Dmitry Rogachev National Medical Research Centеr of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
- Center for Theoretical Problems of Physico-Сhemical Pharmacology, Russian Academy of Sciences, Moscow, Russia
- Lomonosov Moscow State University, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
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