Stability of Prostacyclin in Human Plasma and Whole Blood: Studies on the Protective Effect of Albumin

Prostanoid Metabolites as Biomarkers in Human Disease

Prostaglandins (PGD₂, PGE₂, PGF_2α), prostacyclin (PGI₂), and thromboxane A₂ (TXA₂) together form the prostanoid family of lipid mediators. As autacoids, these five primary prostanoids propagate intercellular signals and are involved in many physiological processes. Furthermore, alterations in their biosynthesis accompany a wide range of pathological conditions, which leads to substantially increased local levels during disease. Primary prostanoids are chemically instable and rapidly metabolized. Their metabolites are more stable, integrate the local production on a systemic level, and their analysis in various biological matrices yields valuable information under different pathological settings. Therefore, prostanoid metabolites may be used as diagnostic, predictive, or prognostic biomarkers in human disease. Although their potential as biomarkers is great and extensive research has identified major prostanoid metabolites that serve as target analytes in different biofluids, the number of studies that correlate prostanoid metabolite levels to disease outcome is still limited. We review the metabolism of primary prostanoids in humans, summarize the levels of prostanoid metabolites in healthy subjects, and highlight existing biomarker studies. Since analysis of prostanoid metabolites is challenging because of ongoing metabolism and limited half-lives, an emphasis of this review lies on the reliable measurement and interpretation of obtained levels.

Preservation of platelet function in cryopreserved platelet concentrates with prostacyclin

Prostacyclin (Epoprostenol) or a stable prostacyclin analogue (ZK 36,374) were added to platelet concentrates prior to cryopreservation. This resulted in significantly better preserved function of the thawed platelet concentrate, assessed by platelet aggregation to various concentrations of ADP, collagen and ristocetin, compared to control cryopreserved platelet concentrates. The use of prostacyclin or one of its stable analogues should be considered to reduce platelet activation and subsequent loss of function during the various manipulative procedures when preparing standard and cryopreserved platelet concentrates.

Differential formation of a bioactive antiaggregating substance (BAS) by layers of the vein wall

Human umbilical veins were analyzed with and without endothelium in order to study the ability of endothelial cells and subendothelium to release a bioactive anti-aggregating substance (BAS: MW > 30kDa) independent of prostacyclin (PGI(2)). To evaluate the role of the subendothelium, the endothelial cells were removed by rubbing on filter paper for 1 min. We performed a histopathological study of the vessels using hematoxylin and eosine, and stained for elastic tissue fibers in order to confirm the presence of endothelium. The supernatant from incubated vascular rings was partially purified by Sephadex G-50 to rule out PGI(2). The void volume fractions were collected and the anti-aggregating activity was tested on platelet aggregation induced by arachidonic acid, ADP, collagen and epinephrine. We observed that the activity was taking place with the use of the intact endothelium while there was no activity in the denuded vein. These observations could help to explain the well known antithrombotic properties of vascular endothelium.

Pathogenesis of acute myocardial infarction. Novel regulatory systems of bioactive substances in the vessel wall

Rupture of the lipid-rich atheromatous plaque, intraplaque hemorrhage, and intraluminal thrombus are three pathological hallmarks most commonly recognized in the infarct-related coronary artery at the site of acute myocardial infarction. Rupture of the atheromatous plaque is closely related to but does not fully explain the genesis of occlusive intracoronary thrombus formation and thus the development of acute myocardial infarction. Besides a variety of hematologic disorders, one should emphasize the role of the platelet-derived mediators that promote an environment where thrombosis and vasoconstriction occur, including TXA2, serotonin, ADP, platelet-derived growth factor, tissue factor, and the diminished availability of those natural endogenous substances that inhibit platelet aggregation, such as EDRF, tissue plasminogen activator, and PGI2. PGI2 released from vascular endothelial cells is extremely unstable. Our group provided the first evidence that HDL stabilizes PGI2 through the newly discovered function of Apo A-I, which is associated with the surface of HDL particles and identified as PGI2 stabilizing factor. Decrease in HDL-associated Apo A-I in patients with unstable angina and during the acute phase of myocardial infarction indicates that HDL plays an important role in preventing coronary atherosclerosis and intracoronary thrombus formation by stabilizing PGI2 in addition to the generally accepted biochemical property of HDL to prevent the accumulation of cholesterol by mobilizing free cholesterol from tissues or macrophages. There is also a PGI2 synthesis-stimulating factor in serum that has not yet been identified chemically. EDRF or nitric oxide provides another important regulating system in the vessel wall. Lipoproteins are inhibitors of endothelium-dependent relaxation of rabbit aorta.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of sample age on collagen-induced platelet aggregation in whole blood

Whole blood electrical aggregometry (WBEA) has become an accepted method to gain quick information on platelet disorders. Compared to the optical method WBEA is closer to physiology and less complicated, but on the other hand more difficult to standardize. Different approaches have been attempted in the past to improve the reliability and practicability of this technique. The influence of sample age has not been defined so far. In a first step a mathematical modelling program was established, which is able to characterize the aggregation curves obtained after collagen stimulation. In a mathematical analysis various characteristics of the curve function were calculated and their sensitivity for aging investigated. Regression was performed for each characteristic, and correction factors defined. Our results indicate, that whole blood specimen for collagen induced aggregation can be used without correction factor up to 30 minutes. Data obtained with an age exceeding half an hour have to be corrected following a quadratic regression.

The association between apolipoprotein A-I and prostacyclin binding in human serum

The stability of Prostacyclin in human blood is dependent upon binding to circulating proteins. Although this binding has been considered to be primarily due to albumin, a recent report has suggested that apolipoprotein A-I is responsible. We compared prostacyclin binding to the concentration of albumin and apolipoprotein A-I in several groups of sera with known differences in the ability to bind prostacyclin. Our results indicate a strong correlation with albumin concentration but no correlation between binding and the concentration of apolipoprotein A-I. It appears that in the human circulation albumin concentration is the most important determinant of prostacyclin binding.

Prostacyclin degradation in patients with quantitative platelet disorders

Plasma prostacyclin (PGI2) degradation rates were measured at 1, 5, 15 and 30 min in a group of patients with platelet quantitative disorders of various pathogeneses, including 13 with thrombocytosis, 16 with thrombocytopenia from impaired production in the bone marrow, 11 with thrombocytopenia from peripheral destruction, and 28 normal, healthy persons. Patients with thrombocytosis had a low PGI2 degradation rate, whereas patients with thrombocytopenia due to impaired production had a high PGI2 degradation rate. Of the patients with thrombocytopenia caused by peripheral destruction, six with idiopathic thrombocytopenia purpura (ITP) had a slow PGI2 degradation in contrast to five with systemic lupus erythematosus (SLE) - four concurrently had cryoglobulinemia - who had a rapid PGI2 degradation. The findings suggest that: (1) a platelet-derived substance in the human plasma may have a PGI2 stabilising activity; (2) presence of cryoglobulin or immune complex in plasma may interfere with PGI2 stability.

Binding of prostacyclin by plasma glycoproteins

The binding of prostacyclin (PGI2) to plasma proteins and the resulting increase in PGI2 stability was investigated. Using gel filtration to separate bound and free PGI2, we have found that Cohn Fraction VI can bind PGI2, and retard its hydrolysis to 6-keto-PGF1 alpha (6KPGF1 alpha). The biological activity of the bound PGI2 correlated well with the quantity of bound PGI2, measured as 6KPGF1 alpha by RIA. Fraction VI bound a greater percentage of PGI2 than the other eicosanoids tested (i.e., PGI2 greater than TXB2 greater than LTB4 greater than PGE1 greater than PGF2 alpha). The PGI2 binding activity of Fraction VI was lost after neuraminidase treatment. Our data suggest that Fraction VI glycoproteins may play an important role in the binding and stabilization of PGI2 by plasma proteins.

Stimulatory cholinergic effect on the release of antiaggregatory activity into the circulation of cat and man and its modification by beta-adrenergic antagonists

The release of PGI2-like activity into the circulation in response to cholinergic agonists and modification of this response by beta-adrenergic antagonists was investigated in anaesthetized cats and healthy humans. Antiaggregatory activity in the arterial blood was continuously assayed by measuring platelet aggregation on blood superfused collagen strip. In some of the human experiments, after the administration of the drugs, the conversion of [14C]-arachidonate to [14C]-prostaglandins in the pulmonary vascular bed was studied. Cholinergic agonists stimulated the release of PGI2-like activity into the circulation, which effect was potentiated in cats by beta-adrenergic antagonists. In humans the latter agents did not stimulate the conversion of [14C]-arachidonate to prostaglandins in the pulmonary circulation and, moreover, inhibited the stimulatory cholinergic effect. The results suggest that an interplay between cholinergic and beta-adrenergic mediators may be involved, although in a different way in cats and in humans, in the release of PGI2-like activity into the systemic circulation.

Does human placenta produce prostacyclin?

We have previously demonstrated that the human placenta possesses potent platelet anti-aggregatory activity. This activity was exhibited only when aggregation was induced by adenosine diphosphate (ADP), but not when induced by adrenaline, ristocetin or collagen. We have also shown that placental extracts degrade ADP. We therefore concluded that the placenta's anti-aggregatory activity, in vitro, was not due to prostacyclin (PGI2) but to an 'ADPase'. In view of some reports claiming that the human placenta produces PGI2, we carried out a series of experiments to establish whether human placental tissue can convert [14C]-arachidonic acid [( 14C]-AA) to 6-oxo-PGF1 alpha, the stable metabolite of PGI2. Tissue from placenta and the membranes did not show any appreciable conversion of [14C]-AA into 6-oxo-PGF1 alpha. This finding was confirmed by radioimmunoassay techniques where the placenta was shown to produce spontaneously only minimal amounts of 6-oxo-PGF1 alpha. We conclude that placental tissue and the fetal membranes do not synthesize a significant amount of PGI2, certainly not enough to account for the potent platelet anti-aggregatory activity of the placenta in vitro. Placental platelet anti-aggregatory activity in vitro, is probably due entirely to ADPase activity.

Reduction of serum prostacyclin stability in ischemic stroke

Prostacyclin is a powerful vasodilator and inhibitor of platelet aggregation that has been implicated to play a role in cerebrovascular disease. Prostacyclin is unstable in aqueous solution and stabilized in serum by binding to an unidentified serum protein as measured by gel filtration. In 15 patients with ischemic stroke we measured the serum prostacyclin binding capacity and the rate of degradation of exogenously added prostacyclin. There was a significant reduction in serum prostacyclin binding capacity and a significant increase in rate of degradation in the patients with ischemic stroke as a whole compared to controls, and in patients with persistent deficits. Decreased serum prostacyclin binding capacity and accelerated rate of prostacyclin degradation in vitro, may reflect an accelerated rate in vivo of prostacyclin degradation, thereby increasing susceptibility to stroke. Since only a small number of patients were investigated, the findings are of a preliminary nature and must be confirmed by further studies with large numbers of patients and appropriate patient controls.

Platelet impedance aggregation in whole blood and its inhibition by antiplatelet drugs

Platelet aggregation was studied in citrated whole blood by an electrical impedance method. Blood samples from normal volunteers were studied with the aim of finding a suitable method for the routine study of samples from patients. An erratic tracing and low maximum aggregation were seen in samples with a high normal haematocrit. Optimal aggregation was seen when blood was diluted to a haematocrit of .300; isotonic saline was a better diluent than platelet poor plasma. No appreciable differences were seen when the platelet count was diluted down to 50 X 10(9)/l, after which there was a progressive reduction in response. Dose response curves were obtained, and normal ranges for ADP, collagen, and sodium arachidonate were determined. Acetylsalicylic acid had a more pronounced effect on ADP aggregation than on collagen. Prostacyclin (Epoprostenol) and the synthetic prostacyclin analogue ZK 36,374 both showed dose dependent inhibition of aggregation, but the duration of effect of the latter was much longer (greater than 6 h).

Relationship between platelet phospholipase activity and plasma in ischemic heart disease

Platelet phospholipase plays an important role in the metabolic responses of platelets to exogenous stimuli. The platelet phospholipase activity (PLA) was therefore studied in 38 patients with ischemic heart disease (IHD) and in 26 age-matched normal subjects who served as controls. The mean platelet PLA in the IHD group was 12.72 +/- 1.03 nmol/mg protein/30 sec which was significantly (p less than 0.005) higher than that of the normal controls (8.72 +/- 0.76). When they were classified into acute stage, such as unstable angina or acute myocardial infarction (AMI), and chronic stage, such as stable angina or old myocardial infarction (OMI), there was no significant difference between them. On the other hand, about two-fold activation of platelet PLA was observed in acute stage IHD, and 20-30% inhibition of it was demonstrated in chronic stage IHD following the addition of autologous plasma to washed platelet suspensions, suggesting that certain plasma factor(s) are responsible for such phenomena. In an attempt to identify these plasma factor(s), various substances such as serum albumin, high density lipoprotein, prostaglandin E1 (PGE1) and E2 (PGE2), and platelet activating factor were assessed by in vitro experiments. Only PGE1 and PGE2 revealed a significant effect on the platelet PLA. The relationship between plasma and platelet activity in terms of platelet PLA deserves attention since it varies according to the type and stage of IHD.

Comparison of the effect of a conventional heparin and a low molecular weight heparinoid on platelet function

In a study comparing the in vitro effects of heparin and a low molecular weight heparinoid (Organon 10172) on aggregation of platelets from normal subjects, we have demonstrated that whereas heparin markedly enhances platelet aggregation induced by other aggregators and inhibits the anti-aggregatory effect of epoprostenol (prostacyclin, PGI2), heparinoid does not produce such effects. The use of heparinoid may thus have a significant advantage over that of heparin in situations where enhanced platelet aggregation is the main factor leading to thrombosis or where heparin treatment is followed by thrombocytopaenia.

Release of prostacyclin from the human pulmonary vascular bed in response to cholinergic stimulation

The ability of the human pulmonary vascular bed to synthesize prostaglandins (PGs) in response to cholinergic stimulation was investigated in healthy male volunteers. In all of them, except controls, carbaminoylcholine (CCh) was injected subcutaneously at a dose of 5 micrograms/kg. In 3 subjects [1-14C]-labelled arachidonate was then infused at a constant rate into the right atrium between 10 and 15 min after the administration of the drug and the blood from the subclavian artery was sampled simultaneously. The arterial content of [14C]-labelled metabolites was extracted, separated by thin-layer chromatography and quantified using liquid scintillation spectrometry. In 8 other subjects PGI2-like activity after the administration of CCh was assayed in the arterial blood and in 1 subject in the venous blood, using a technique for continuous measurement of platelet aggregation on blood-superfused collagen strip. The major portion of [14C]-activity in the radiochromatograms migrated in parallel with the 6-keto-PGF1 alpha standard. No early defined peaks corresponding to any of the unlabelled PGs D2, E2 or F2 alpha, appeared, but in one chromatogram a minor radiopeak corresponding to authentic thromboxane B2 was observed. Also in the platelet aggregation experiments, 5-15 min after the administration of CCh, a significant increase in the PGI2-like activity was observed in the arterial as well as in the peripheral venous blood, which effect of the drug was abolished by pretreatment with atropine and acetylsalicylic acid.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of nonesterified fatty acids on the stability of prostacyclin activity

The half-life of the platelet antiaggregatory activity of prostacyclin (PGI2) is prolonged when PGI2 is incubated in human plasma or in fatty-acid-free human albumin solutions. This "PGI2-protective" effect is diminished when fatty acids are added to the incubate, and the diminution is proportional to the concentration of the nonesterified fatty acids added. Unsaturated fatty acids were more potent in causing this reduction than saturated acids. It is possible that nonesterified fatty acids displace PGI2 from binding sites on the albumin molecule and that they may thus alter the biologic half-life of any circulating PGI2. This observation may partly account for the well-documented association between raised serum nonesterified fatty acid levels and thrombosis/platelet activation.

Inhibition of vascular epoprostenol (prostacyclin, PGI2) production in vitro by plasma from healthy subjects and patients with severe renal impairment

1 The production of 6-oxo-prostaglandin F_1α (6-oxo-PGF_1α) and epoprostenol (prostacyclin, PGI₂) by fresh rat aortic rings were measured by radioimmunoassay (RIA). The effect of citrated platelet poor plasma (PPP) from subjects with renal failure (U-PPP) and healthy age/sex matched controls (C-PPP) on 6-oxo-PGF_1α production were compared.

2 No difference was detected between either 6-oxo-PGF_1α or PGI₂ concentration when rings were incubated with U-PPP or C-PPP for 4, 8 and 30 min for 6-oxo-PGF_1α (P > 0.05, n = 8); and 30 min for PGI₂ (P > 0.05, n = 8).

3 Consistently more 6-oxo-PGF_1α was produced in PPP that had been heated at 100°C for 5 min (H-PPP) than in C-PPP: mean 6-oxo-PGF_1α was increased by factors of 1.45, 1.61, 1.57 and 1.57 at 4, 8, 30 and 60 min respectively (P < 0.005 at each time, n = 8).

4 Similar amounts of 6-oxo-PGF_1α were produced by aortic rings incubated in H-PPP and in Tris buffer (50 mM, pH 7.5), P > 0.05 at all times (n = 8).

5 The half-life of PGI₂ in U-PPP was similar to that in C-PPP; 7.8 ± 0.6 min and 10.2 ± 1.9 min (mean ± s.e. mean) respectively (P > 0.05).

6 In separate experiments a comparison was made of 6-oxo-PGF_1α production by aortic rings incubated in C-PPP, H-PPP and H-PPP to which albumin had been added to restore its original concentration. It was confirmed that more 6-oxo-PGF_1α was produced in H-PPP than in C-PPP (P < 0.05, n = 4). This increment was abolished in the H-PPP to which albumin had been added.

7 It was concluded that the heat-labile inhibitor of vascular PGI₂ synthesis in human plasma is albumin.

8 The failure to demonstrate a stimulator of PGI₂ synthesis in fresh aortic rings by U-PPP does not support the hypothesis that the bleeding diathesis of renal failure is due to an excess of a PGI₂ stimulating factor in plasma.