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Bennett JA, Ture SK, Schmidt RA, Mastrangelo MA, Cameron SJ, Terry LE, Yule DI, Morrell CN, Lowenstein CJ. Acetylcholine Inhibits Platelet Activation. J Pharmacol Exp Ther 2019; 369:182-187. [PMID: 30765424 DOI: 10.1124/jpet.118.253583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/12/2019] [Indexed: 12/18/2022] Open
Abstract
Platelets are key mediators of thrombosis. Many agonists of platelet activation are known, but fewer endogenous inhibitors of platelets, such as prostacyclin and nitric oxide (NO), have been identified. Acetylcholinesterase inhibitors, such as donepezil, can cause bleeding in patients, but the underlying mechanisms are not well understood. We hypothesized that acetylcholine is an endogenous inhibitor of platelets. We measured the effect of acetylcholine or analogs of acetylcholine on human platelet activation ex vivo. Acetylcholine and analogs of acetylcholine inhibited platelet activation, as measured by P-selectin translocation and glycoprotein IIb IIIa conformational changes. Conversely, we found that antagonists of the acetylcholine receptor, such as pancuronium, enhance platelet activation. Furthermore, drugs inhibiting acetylcholinesterase, such as donepezil, also inhibit platelet activation, suggesting that platelets release acetylcholine. We found that NO mediates acetylcholine inhibition of platelets. Our data suggest that acetylcholine is an endogenous inhibitor of platelet activation. The cholinergic system may be a novel target for antithrombotic therapies.
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Affiliation(s)
- John A Bennett
- Aab Cardiovascular Research Institute, Department of Medicine (J.A.B., S.K.T., R.A.S., M.A.M., S.J.C., C.N.M., C.J.L.) and Department of Pharmacology and Physiology (L.E.T., D.I.Y.), University of Rochester Medical Center, Rochester, New York
| | - Sara K Ture
- Aab Cardiovascular Research Institute, Department of Medicine (J.A.B., S.K.T., R.A.S., M.A.M., S.J.C., C.N.M., C.J.L.) and Department of Pharmacology and Physiology (L.E.T., D.I.Y.), University of Rochester Medical Center, Rochester, New York
| | - Rachel A Schmidt
- Aab Cardiovascular Research Institute, Department of Medicine (J.A.B., S.K.T., R.A.S., M.A.M., S.J.C., C.N.M., C.J.L.) and Department of Pharmacology and Physiology (L.E.T., D.I.Y.), University of Rochester Medical Center, Rochester, New York
| | - Michael A Mastrangelo
- Aab Cardiovascular Research Institute, Department of Medicine (J.A.B., S.K.T., R.A.S., M.A.M., S.J.C., C.N.M., C.J.L.) and Department of Pharmacology and Physiology (L.E.T., D.I.Y.), University of Rochester Medical Center, Rochester, New York
| | - Scott J Cameron
- Aab Cardiovascular Research Institute, Department of Medicine (J.A.B., S.K.T., R.A.S., M.A.M., S.J.C., C.N.M., C.J.L.) and Department of Pharmacology and Physiology (L.E.T., D.I.Y.), University of Rochester Medical Center, Rochester, New York
| | - Lara E Terry
- Aab Cardiovascular Research Institute, Department of Medicine (J.A.B., S.K.T., R.A.S., M.A.M., S.J.C., C.N.M., C.J.L.) and Department of Pharmacology and Physiology (L.E.T., D.I.Y.), University of Rochester Medical Center, Rochester, New York
| | - David I Yule
- Aab Cardiovascular Research Institute, Department of Medicine (J.A.B., S.K.T., R.A.S., M.A.M., S.J.C., C.N.M., C.J.L.) and Department of Pharmacology and Physiology (L.E.T., D.I.Y.), University of Rochester Medical Center, Rochester, New York
| | - Craig N Morrell
- Aab Cardiovascular Research Institute, Department of Medicine (J.A.B., S.K.T., R.A.S., M.A.M., S.J.C., C.N.M., C.J.L.) and Department of Pharmacology and Physiology (L.E.T., D.I.Y.), University of Rochester Medical Center, Rochester, New York
| | - Charles J Lowenstein
- Aab Cardiovascular Research Institute, Department of Medicine (J.A.B., S.K.T., R.A.S., M.A.M., S.J.C., C.N.M., C.J.L.) and Department of Pharmacology and Physiology (L.E.T., D.I.Y.), University of Rochester Medical Center, Rochester, New York
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Chemtob RA, Moeller-Soerensen H, Holmvang L, Olsen PS, Ravn HB. Outcome After Surgery for Acute Aortic Dissection: Influence of Preoperative Antiplatelet Therapy on Prognosis. J Cardiothorac Vasc Anesth 2017; 31:569-574. [DOI: 10.1053/j.jvca.2016.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Indexed: 11/11/2022]
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Ramakrishna H, Gutsche JT, Patel PA, Evans AS, Weiner M, Morozowich ST, Gordon EK, Riha H, Bracker J, Ghadimi K, Murphy S, Spitz W, MacKay E, Cios TJ, Malhotra AK, Baron E, Shaefi S, Fassl J, Weiss SJ, Silvay G, Augoustides JGT. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2016. J Cardiothorac Vasc Anesth 2016; 31:1-13. [PMID: 28041810 DOI: 10.1053/j.jvca.2016.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Indexed: 12/11/2022]
Affiliation(s)
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Adam S Evans
- Department of Anesthesiology, Cleveland Clinic Florida, Weston, FL
| | - Menachem Weiner
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | | | - Emily K Gordon
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hynek Riha
- Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Joseph Bracker
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care, Duke University, Durham, NC
| | - Sunberri Murphy
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Warren Spitz
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Elvera Baron
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - Shahzad Shaefi
- Cardiothoracic Anesthesiology and Critical Care, Department of Anesthesiology, Harvard Medical School, Boston, MA
| | - Jens Fassl
- Cardiovascular and Thoracic Section, Department of Anesthesia and Intensive Care Medicine, University of Basel, Basel, Switzerland
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - George Silvay
- Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, NY
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Gutsche JT, Patel PA, Cobey FC, Ramakrishna H, Gordon EK, Riha H, Sophocles A, Ghadimi K, Fabbro M, Al-Ghofaily L, Chern SYS, Cisler S, Sahota GS, Valentine E, Weiss SJ, Andritsos M, Silvay G, Augoustides JGT. The year in Cardiothoracic and Vascular Anesthesia: selected highlights from 2014. J Cardiothorac Vasc Anesth 2014; 29:1-7. [PMID: 25481390 DOI: 10.1053/j.jvca.2014.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Harish Ramakrishna
- Mayo Clinic, Scottsdale, Arizona; §Cardiothoracic Anesthesiology and Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Emily K Gordon
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hynek Riha
- Department of Anesthesiology and Critical Care, Duke University, Durham, North Carolina
| | - Aris Sophocles
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kamrouz Ghadimi
- Department of Anesthesiology, Ohio State University, Columbus, Ohio
| | - Michael Fabbro
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lourdes Al-Ghofaily
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sy-Yeu S Chern
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sophia Cisler
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gurmukh S Sahota
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Valentine
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - George Silvay
- Department of Anesthesiology and Critical Care, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Vistoli G, Brizzolari A, Faioni E, Razzari C, Santaniello E. Naturally occurring N(6)-substituted adenosines (cytokinin ribosides) are in vitro inhibitors of platelet aggregation: an in silico evaluation of their interaction with the P2Y(12) receptor. Bioorg Med Chem Lett 2014; 24:5652-5655. [PMID: 25467153 DOI: 10.1016/j.bmcl.2014.10.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 12/21/2022]
Abstract
A few naturally occurring N(6)-substituted adenosine derivatives (cytokinin ribosides) were investigated as inhibitors of platelet aggregation induced in vitro by collagen and their activity range was demonstrated (IC50: 6.77-141 μM). A docking study suggests that anti-aggregation activity of these compounds could involve an interaction with the P2Y12 receptor binding site.
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Affiliation(s)
- Giulio Vistoli
- Department of Pharmaceutical Science, Università degli Studi, Via Celoria 2, 20100 Milano, Italy
| | - Andrea Brizzolari
- Department of Health Sciences, Università degli Studi, Via A. Di Rudinì 8, 20142 Milano, Italy
| | - Elena Faioni
- Department of Health Sciences, Università degli Studi, Via A. Di Rudinì 8, 20142 Milano, Italy; S. Paolo Hospital, Via A. Di Rudinì 8, 20142 Milano, Italy
| | | | - Enzo Santaniello
- Department of Health Sciences, Università degli Studi, Via A. Di Rudinì 8, 20142 Milano, Italy.
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Abstract
The rising use of antiplatelet therapy for primary prevention and secondary prevention of cardiovascular and cerebrovascular events poses a dilemma for physicians in the perioperative period. The proven benefits of aspirin in preventing further thrombotic events in patients with prior ACS or stroke make it difficult to withdraw this therapy. The risk of hypercoagulability associated with surgery is also independent of antiplatelet withdrawal, but adds to the rebound effect of platelet responsiveness. Therefore, aspirin should be continued whenever feasible. Similarly, the use of thienopyridines such as clopidogrel, especially for the prevention of stent thrombosis, should be maintained for at least the recommended time frame, if not longer. It is recognized that maintaining antiplatelet therapy is also not without risk, as bleeding complications have been well documented. Unfortunately, current perioperative guidelines do not often provide a simple solution for management. Therefore, the risk of bleeding has to be weighed against the risk of thrombosis, and decisions should be made with all providers caring for the patient on an individual basis.
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Gao B, Huang L, Liu H, Wu H, Zhang E, Yang L, Wu X, Wang Z. Platelet P2Y₁₂ receptors are involved in the haemostatic effect of notoginsenoside Ft1, a saponin isolated from Panax notoginseng. Br J Pharmacol 2014; 171:214-23. [PMID: 24117220 DOI: 10.1111/bph.12435] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/29/2013] [Accepted: 09/23/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE Saponins isolated from Panax notoginseng (Burk.) F.H. Chen have been shown to relieve thrombogenesis and facilitate haemostasis. However, it is not known which saponin accounts for this haemostatic effect. Hence, in the present study we aimed to identify which saponins contribute to its haemostatic activity and to elucidate the possible underlying mechanisms. EXPERIMENTAL APPROACH Platelet aggregation was analysed using a platelet aggregometer. Prothrombin time, activated partial thromboplastin time and thrombin time were measured using a blood coagulation analyser, which was further corroborated with bleeding time and thrombotic assays. The interaction of notoginsenoside Ft1 with the platelet P2Y₁₂ receptor was determined by molecular docking analysis, cytosolic Ca(2+) and cAMP measurements, and phosphorylation of PI3K and Akt assays. KEY RESULTS Among the saponins examined, Ft1 was the most potent procoagulant and induced dose-dependent platelet aggregation. Ft1 reduced plasma coagulation indexes, decreased tail bleeding time and increased thrombogenesis. Moreover, it potentiated ADP-induced platelet aggregation and increased cytosolic Ca(2+) accumulation, effects that were attenuated by clopidogrel. Molecular docking analysis suggested that Ft1 binds to platelet P2Y₁₂ receptors. The increase in intracellular Ca(2+) evoked by Ft1 in HEK293 cells overexpressing P2Y₁₂ receptors could be blocked by ticagrelor. Ft1 also affected the production of cAMP and increased phosphorylation of PI3K and Akt downstream of P2Y₁₂ signalling pathways. CONCLUSION AND IMPLICATIONS Ft1 enhanced platelet aggregation by activating a signalling network mediated through P2Y₁₂ receptors. These novel findings may contribute to the effective utilization of this compound in the therapy of haematological disorders.
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Affiliation(s)
- B Gao
- Shanghai Key laboratory of Complex Prescriptions, The Ministry of Education Key Laboratory for Standardization of Chinese Medicines, Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, Shanghai, China; Department of Pharmacognosy, China Pharmaceutical University, Nanjing, China
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Ogawa S, Hosokawa K, Tanaka KA. Influences of Hemodilution and Anticoagulation on Antiplatelet P2Y12 Therapy: In Vitro Whole Blood Perfusion Model. J Cardiothorac Vasc Anesth 2013; 27:e69-71. [DOI: 10.1053/j.jvca.2013.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Indexed: 11/11/2022]
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Jagroop IA. Plant extracts inhibit ADP-induced platelet activation in humans: their potential therapeutic role as ADP antagonists. Purinergic Signal 2013; 10:233-9. [PMID: 24190032 PMCID: PMC4040171 DOI: 10.1007/s11302-013-9393-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 10/10/2013] [Indexed: 01/19/2023] Open
Abstract
Adenosine diphosphate (ADP) plays a pivotal role in platelet activation. Platelet hyperactivity is associated with vascular disease and also has a key role in haemostasis and thrombosis. ADP activates platelets through three purinoceptor subtypes, the G(q)-coupled P2Y(1) receptor, G(i)-coupled P2Y(12) receptor and P2X(1) ligand-gated cation channel. Platelet ADP purinergic receptors are therefore suitable targets for antiplatelet drugs. Thienopyridines such as clopidogrel and ticlopidine, as well as other ADP receptor antagonists like prasugrel, ticagrelor, cangrelor and elinogrel have demonstrated clinical benefits via the inhibition of the selective purinergic ADP receptor, P2Y(12). However, they still have limitations in their mode of action and efficacy, like increased risk of bleeding. Thus, the ongoing pursuit to develop newer and more effective antiplatelet agents continues. There is a growing interest in the purinergic antiplatelet properties exhibited by plant extracts. This article considers the following: pomolic acid isolated from Licania pittieri, brazilin isolated from the heartwood of Caesalpinia sappan L, phylligenin isolated from the twigs of Muraltia vulpina, bark oil of Gonystylus velutinus, seed and bark extracts from Aesculus hippocastanum L. and red wine phenolics and catechins isolated from green tea. Moreover, the method used to investigate platelet purinergic receptors should be considered, since using a more sensitive, high-resolution platelet sizer can sometimes detect platelet variations when the light transmission method was not able to do so. The exact mechanisms by which these plant extracts work need further investigation. They all however inhibit ADP-induced activation in human platelets. This could explain, at least in part, the protective effect of plant extracts as antiplatelet agents.
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Affiliation(s)
- Indera Anita Jagroop
- Academic Department of Surgery, Division of Surgical and Interventional Science, Royal Free Campus, University College London Medical School, University College London (UCL), Pond Street, London, NW3 2QG, UK,
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Dalén M, Ivert T, Lindvall G, van der Linden J. Ticagrelor-Associated Bleeding in a Patient Undergoing Surgery for Acute Type A Aortic Dissection. J Cardiothorac Vasc Anesth 2013; 27:e55-7. [DOI: 10.1053/j.jvca.2013.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Indexed: 11/11/2022]
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Dalén M, Ivert T, Lindvall G, van der Linden J. Prasugrel-related late cardiac tamponade after coronary artery bypass surgery in a patient with a recently implanted bare metal stent. J Cardiothorac Vasc Anesth 2013; 27:e57-8. [PMID: 24054197 DOI: 10.1053/j.jvca.2013.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Magnus Dalén
- Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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