COAT platelets

Role of Serotonylation and SERT Posttranslational Modifications in Alzheimer's Disease Pathogenesis

The neurotransmitter serotonin (5-hydroxytryptamine, 5-HT) is implicated mainly in Alzheimer's disease (AD) and reported to be responsible for several processes and roles in the human body, such as regulating sleep, food intake, sexual behavior, anxiety, and drug abuse. It is synthesized from the amino acid tryptophan. Serotonin also functions as a signal between neurons to mature, survive, and differentiate. It plays a crucial role in neuronal plasticity, including cell migration and cell contact formation. Various psychiatric disorders, such as depression, schizophrenia, autism, and Alzheimer's disease, have been linked to an increase in serotonin-dependent signaling during the development of the nervous system. Recent studies have found 5-HT and other monoamines embedded in the nuclei of various cells, including immune cells, the peritoneal mast, and the adrenal medulla. Evidence suggests these monoamines to be involved in widespread intracellular regulation by posttranslational modifications (PTMs) of proteins. Serotonylation is the calcium-dependent process in which 5-HT forms a long-lasting covalent bond to small cytoplasmic G-proteins by endogenous transglutaminase 2 (TGM2). Serotonylation plays a role in various biological processes. The purpose of our article is to summarize historical developments and recent advances in serotonin research and serotonylation in depression, aging, AD, and other age-related neurological diseases. We also discussed several of the latest developments with Serotonin, including biological functions, pathophysiological implications and therapeutic strategies to treat patients with depression, dementia, and other age-related conditions.

Mechanisms Underlying Dichotomous Procoagulant COAT Platelet Generation-A Conceptual Review Summarizing Current Knowledge

Procoagulant platelets are a subtype of activated platelets that sustains thrombin generation in order to consolidate the clot and stop bleeding. This aspect of platelet activation is gaining more and more recognition and interest. In fact, next to aggregating platelets, procoagulant platelets are key regulators of thrombus formation. Imbalance of both subpopulations can lead to undesired thrombotic or bleeding events. COAT platelets derive from a common pro-aggregatory phenotype in cells capable of accumulating enough cytosolic calcium to trigger specific pathways that mediate the loss of their aggregating properties and the development of new adhesive and procoagulant characteristics. Complex cascades of signaling events are involved and this may explain why an inter-individual variability exists in procoagulant potential. Nowadays, we know the key agonists and mediators underlying the generation of a procoagulant platelet response. However, we still lack insight into the actual mechanisms controlling this dichotomous pattern (i.e., procoagulant versus aggregating phenotype). In this review, we describe the phenotypic characteristics of procoagulant COAT platelets, we detail the current knowledge on the mechanisms of the procoagulant response, and discuss possible drivers of this dichotomous diversification, in particular addressing the impact of the platelet environment during in vivo thrombus formation.

Effect of DDAVP on Platelet Activation and Platelet-Derived Microparticle Generation

BACKGROUND

 The way by which 1-deamino-8-D-arginine vasopressin (DDAVP) acts on platelets remains unclear. Data from the literature tend to show that there is no definite effect on platelet activation, but recent work has suggested that a subtype of platelets, activated by the combined action of collagen and thrombin, was triggered by DDAVP. Moreover, platelet microparticles (PMPs), which have been shown to be procoagulant, have rarely been studied in this context. The goal of this study was to analyze the effects of DDAVP on PMPs' release through platelet activation.

METHODS

 Fifteen out of 18 consecutive patients undergoing a therapeutic test with DDAVP were included. They were suffering from factor VIII deficiency or from von Willebrand disease. The expression of P-selectin and PAC-1 binding on platelets and the numbers of circulating PMPs were evaluated ex vivo before and after DDAVP infusion. Peripheral blood was collected on CTAD to limit artifactual platelet activation.

RESULTS

 DDAVP induced a significant decrease of platelet counts and volume. Only small changes of P-selectin expression and PAC-1 binding were observed. Considering PMPs, two populations of patients could be defined, respectively, with (120%, n = 6) or without (21%, n = 7) an increase of PMPs after DDAVP. The decrease in platelet counts and volume remained significant in the group of responders.

CONCLUSION

 This study shows that DDAVP induces the generation/release of PMPs in some patients with factor VIII deficiency and von Willebrand disease 1 hour after DDAVP infusion.

Thrombocytopathies: Not Just Aggregation Defects-The Clinical Relevance of Procoagulant Platelets

Platelets are active key players in haemostasis. Qualitative platelet dysfunctions result in thrombocytopathies variously characterized by defects of their adhesive and procoagulant activation endpoints. In this review, we summarize the traditional platelet defects in adhesion, secretion, and aggregation. In addition, we review the current knowledge about procoagulant platelets, focusing on their role in bleeding or thrombotic pathologies and their pharmaceutical modulation. Procoagulant activity is an important feature of platelet activation, which should be specifically evaluated during the investigation of a suspected thrombocytopathy.

Clopidogrel use and smoking cessation result in lower coated-platelet levels after stroke

Coated-platelets are a subset of highly procoagulant platelets elevated in patients with non-lacunar ischemic stroke and associated with stroke recurrence. Cross-sectional studies in controls have shown that smoking is associated with higher coated-platelet levels while chronic use of serotonin reuptake inhibitors (SSRIs), statins or aspirin is associated with lower coated-platelet levels. We now investigate if initiation of treatment with SSRIs, statins, clopidogrel, aspirin or oral anticoagulants and smoking cessation impacts coated-platelet levels at 90 days after ischemic stroke. Coated-platelet levels, reported as percent of cells converted to coated-platelets, were measured in 87 consecutive patients with stroke at baseline and repeated at 90 days. Repeated-measure ANOVA was used to determine if initiation of treatment with individual medications or smoking cessation impacted coated-platelet levels. Decreased coated-platelets levels at 90 days as compared to baseline were observed after initiation of treatment with clopidogrel (p = .0001, partial η² = 0.17) and smoking cessation (p = .014, partial η² = 0.10). Initiation of treatment with SSRIs, statins, aspirin or oral anticoagulants did not result in significant changes in coated-platelet potential. These novel longitudinal data suggest that clopidogrel therapy and smoking cessation attenuate coated-platelet potential at 90 days after ischemic stroke.

Farnesoid X Receptor and Liver X Receptor Ligands Initiate Formation of Coated Platelets

OBJECTIVES

The liver X receptors (LXRs) and farnesoid X receptor (FXR) have been identified in human platelets. Ligands of these receptors have been shown to have nongenomic inhibitory effects on platelet activation by platelet agonists. This, however, seems contradictory with the platelet hyper-reactivity that is associated with several pathological conditions that are associated with increased circulating levels of molecules that are LXR and FXR ligands, such as hyperlipidemia, type 2 diabetes mellitus, and obesity.

APPROACH AND RESULTS

We, therefore, investigated whether ligands for the LXR and FXR receptors were capable of priming platelets to the activated state without stimulation by platelet agonists. Treatment of platelets with ligands for LXR and FXR converted platelets to the procoagulant state, with increases in phosphatidylserine exposure, platelet swelling, reduced membrane integrity, depolarization of the mitochondrial membrane, and microparticle release observed. Additionally, platelets also displayed features associated with coated platelets such as P-selectin exposure, fibrinogen binding, fibrin generation that is supported by increased serine protease activity, and inhibition of integrin αIIbβ3. LXR and FXR ligand-induced formation of coated platelets was found to be dependent on both reactive oxygen species and intracellular calcium mobilization, and for FXR ligands, this process was found to be dependent on cyclophilin D.

CONCLUSIONS

We conclude that treatment with LXR and FXR ligands initiates coated platelet formation, which is thought to support coagulation but results in desensitization to platelet stimuli through inhibition of αIIbβ3 consistent with their ability to inhibit platelet function and stable thrombus formation in vivo.

Lymphovenous hemostasis and the role of platelets in regulating lymphatic flow and lymphatic vessel maturation

Aside from the established role for platelets in regulating hemostasis and thrombosis, recent research has revealed a discrete role for platelets in the separation of the blood and lymphatic vascular systems. Platelets are activated by interaction with lymphatic endothelial cells at the lymphovenous junction, the site in the body where the lymphatic system drains into the blood vascular system, resulting in a platelet plug that, with the lymphovenous valve, prevents blood from entering the lymphatic circulation. This process, known as "lymphovenous hemostasis," is mediated by activation of platelet CLEC-2 receptors by the transmembrane ligand podoplanin expressed by lymphatic endothelial cells. Lymphovenous hemostasis is required for normal lymph flow, and mice deficient in lymphovenous hemostasis exhibit lymphedema and sometimes chylothorax phenotypes indicative of lymphatic insufficiency. Unexpectedly, the loss of lymph flow in these mice causes defects in maturation of collecting lymphatic vessels and lymphatic valve formation, uncovering an important role for fluid flow in driving endothelial cell signaling during development of collecting lymphatics. This article summarizes the current understanding of lymphovenous hemostasis and its effect on lymphatic vessel maturation and synthesizes the outstanding questions in the field, with relationship to human disease.

Partially Defective Store Operated Calcium Entry and Hem(ITAM) Signaling in Platelets of Serotonin Transporter Deficient Mice

BACKGROUND

Serotonin (5-hydroxytryptamin, 5-HT) is an indolamine platelet agonist, biochemically derived from tryptophan. 5-HT is secreted from the enterochromaffin cells into the gastrointestinal tract and blood. Blood 5-HT has been proposed to regulate hemostasis by acting as a vasoconstrictor and by triggering platelet signaling through 5-HT receptor 2A (5HTR2A). Although platelets do not synthetize 5-HT, they take 5-HT up from the blood and store it in their dense granules which are secreted upon platelet activation.

OBJECTIVE

To identify the molecular composite of the 5-HT uptake system in platelets and elucidate the role of platelet released 5-HT in thrombosis and ischemic stroke.

METHODS

5-HT transporter knockout mice (5Htt-/-) were analyzed in different in vitro and in vivo assays and in a model of ischemic stroke.

RESULTS

In 5Htt-/- platelets, 5-HT uptake from the blood was completely abolished and agonist-induced Ca2+ influx through store operated Ca2+ entry (SOCE), integrin activation, degranulation and aggregation responses to glycoprotein VI (GPVI) and C-type lectin-like receptor 2 (CLEC-2) were reduced. These observed in vitro defects in 5Htt-/- platelets could be normalized by the addition of exogenous 5-HT. Moreover, reduced 5-HT levels in the plasma, an increased bleeding time and the formation of unstable thrombi were observed ex vivo under flow and in vivo in the abdominal aorta and carotid artery of 5Htt-/- mice. Surprisingly, in the transient middle cerebral artery occlusion (tMCAO) model of ischemic stroke 5Htt-/- mice showed nearly normal infarct volume and the neurological outcome was comparable to control mice.

CONCLUSION

Although secreted platelet 5-HT does not appear to play a crucial role in the development of reperfusion injury after stroke, it is essential to amplify the second phase of platelet activation through SOCE and plays an important role in thrombus stabilization.

Monoaminylation of Fibrinogen and Glia-Derived Proteins: Indication for Similar Mechanisms in Posttranslational Protein Modification in Blood and Brain

Distinct proteins have been demonstrated to be posttranslationally modified by covalent transamidation of serotonin (5-hydropxytryptamin) to glutamine residues of the target proteins. This process is mediated by transglutaminase (TGase) and has been termed "serotonylation." It has also been shown that other biogenic amines, including the neurotransmitters dopamine and norepinephrine, can substitute for serotonin, implying a more general mechanism of "monoaminylation" for this kind of protein modification. Here we transamidated the autofluorescent monoamine monodansylcadaverine (MDC) to purified plasma fibrinogen and to proteins from a primary glia cell culture. Electrophoretic separation of MDC-conjugated proteins followed by mass spectrometry identified three fibrinogen subunits (Aα, Bβ, γ), a homomeric Aα2 dimer, and adducts of >250 kDa molecular weight, as well as several glial proteins. TGase-mediated MDC incorporation was strongly reduced by serotonin, underlining the general mechanism of monoaminylation.

Lower Coated-Platelet Levels Are Associated With Increased Mortality After Spontaneous Intracerebral Hemorrhage

BACKGROUND AND PURPOSE

Coated-platelets are highly procoagulant platelets observed on dual-agonist stimulation with collagen and thrombin. Coated-platelet levels are decreased in patients with spontaneous intracerebral hemorrhage when compared with controls and inversely correlated with bleed volume. We sought to investigate whether coated-platelets are associated with increased mortality at 30 days after spontaneous intracerebral hemorrhage.

METHODS

Coated-platelet levels were assayed in 95 consecutive patients with spontaneous intracerebral hemorrhage. The main outcome was mortality at 30 days according to coated-platelet levels at enrollment. Subjects were grouped into tertiles of the observed coated-platelet level distribution. Groups defined by tertile of coated-platelet level were compared using either ANOVA or a Kruskal-Wallis test for small group size for continuous measures and an exact Cochrane-Armitage trend test for categorical measures. Logistic regression was used to estimate the adjusted odds of death within 30 days associated with coated-platelet levels.

RESULTS

Cumulative mortality at 30 days was 23% (22 subjects). Mortality at 30 days differed among the coated-platelet tertiles: 44% for the first tertile (lowest coated-platelet levels), 19% for the second tertile, and 6% for the third tertile (trend test; P=0.0004). Logistic regression examining the association between mortality and coated-platelet levels showed that the odds of death at 30 days in those with levels <27% (n=47) were 6.83× the odds for patients with levels ≥27% (95% confidence interval, 2.10-22.23).

CONCLUSIONS

These results support a link between impaired coated-platelet potential and outcome in intracerebral hemorrhage.

Down-regulation of the serotonin transporter in hyperreactive platelets counteracts the pro-thrombotic effect of serotonin

An elevated plasma concentration of serotonin ([5-HT]) is a common feature of cardiovascular disease often associated with enhanced platelet activation and thrombosis. Whether elevated in vivo plasma 5-HT per se represents an independent risk factor for platelet hyperreactivity or only is an epiphenomenon of cardiovascular disease is poorly understood. We examined in vitro and in vivo platelet function following a 24h elevation of plasma [5-HT] in mice. In vivo administration of 5-HT using osmotic minipumps increased plasma [5-HT] in treated mice compared to control mice instrumented with saline loaded pumps. 5-HT infusion did not increase systolic blood pressure, but markers of platelet activation including P-selectin and (PE)Jon/A staining were increased and these findings coincided with the enhanced aggregation of isolated platelets in response to type I fibrillar collagen. Tail bleeding times and the time to occlusion following chemical damage to the carotid artery were shortened in 5-HT-infused mice. 5-HT-infused mice were treated with paroxetine (Prx) to block 5-HT uptake via the serotonin transporter (SERT). Prx lowered platelet [5-HT] and attenuated platelet activation and aggregation. These results and our biochemical indices of enhanced 5-HT intracellular signaling in the platelets of 5-HT-infused mice reveal a mechanistic link between elevated plasma [5-HT], abnormal intracellular 5-HT signaling and accentuated platelet aggregation. Although a down-regulation of the serotonin transporter (SERT) on the platelet surface may counteract the pro-thrombotic influence of elevated plasma [5HT], this compensatory mechanism may fail to prevent the increased thrombotic risk caused by elevated plasma [5-HT].

Immature myeloid dendritic cells capture and remove activated platelets from preformed aggregates

BACKGROUND

Immature dendritic cells (DCs) patrol the circulation, where they can uptake antigens. It has been reported that mature monocyte-derived DCs have the ability to interact with an activated platelet monolayer under high shear conditions (1500s(-1) ).

OBJECTIVES

In this study, we investigated whether platelets can recruit immature myeloid DCs (CD1c(+) ) directly isolated from blood (BDCs) and if so, which receptors are involved.

RESULTS

Using flow cytometry and electron microscopy, we showed that BDCs interact with activated but not resting platelets in suspension. Interaction was also observed after perfusing BDCs under low flow conditions (150 s(-1) ) through collagen-coated microcapillaries in which platelets had adhered and formed aggregates. No such interaction could be detected at higher shear rates. Whereas initial transient attachment required the exposure of P-selectin on activated platelets and PSGL-1 on BDCs, subsequent stationary adhesion was dependent on α(IIb) β(3) and α(M) β(2) integrins on platelets and BDCs, respectively. Moreover, during their transient interaction, BDCs preferentially removed platelets located at the outer margin of the thrombus in a P-selectin- and integrin-dependent manner.

CONCLUSION

This study provides evidence for an interaction between activated platelets and immature myeloid DCs only under low shear conditions. This could be of importance for BDC maturation and antigen uptake during normal hemostasis or in the context of atherothrombosis at sites of reduced blood flow.

Tetraspanin CD9 is required for microparticle release from coated-platelets

CD9, a member of the tetraspanin superfamily, is the third most abundant protein on the platelet surface, but its function remains unknown. In this report, we demonstrate that CD9 is required for the release of microparticles from coated-platelets. Coated-platelets are formed as a result of dual agonist activation with collagen and thrombin, and each coated-platelet releases 15-25 microparticles averaging 0.4 microm in diameter. We report here that four separate monoclonal antibodies against CD9 inhibited microparticle release from coated-platelets by 72-102% with an IC(50) of approximately 500 ng/mL for ALB6 and SN4. In addition, the anti-alpha(IIb)beta(3) monoclonal antibody AP2 also inhibited microparticle release although additional anti-alpha(IIb)beta(3) monoclonals did not. These data support participation of the tetraspanin CD9, together with the integrin alpha(IIb)beta(3), in the membrane vesiculation process associated with platelet microparticle release.

Serotonin--more than a neurotransmitter: transglutaminase-mediated serotonylation of C6 glioma cells and fibronectin

In the central nervous system serotonin plays important roles as a neurotransmitter as well as during neuronal development and in synaptogenesis. Outside the central nervous system, serotonin is covalently transamidated to procoagulant proteins involved in blood clotting. This process is mediated by transglutaminases and named "serotonylation". Serotonylated proteins then tightly bind to specific serotonin binding sites on fibrinogen and thrombospondin to form stable extracellular multivalent complexes needed for thrombus formation. Here, we have investigated whether transglutaminases can also covalently incorporate extracellular serotonin to neural proteins and whether this might affect extracellular protein expression. Our data reveal that recombinant transglutaminase specifically transamidates [(3)H]-serotonin to cell-surface proteins from C6 glioma cells and the extracellular matrix protein fibronectin. Serotonylation of [(3)H]-serotonin was inhibited by the transglutaminase inhibitor cystamine and unlabelled serotonin. Transglutaminase-mediated transamidation of unlabelled serotonin to C6 cells induced an aggregation of extracellular protein matrices adjacent to and between single cells. Transglutaminase also transamidated the autofluorescent serotonin analogue 5,7-dihydroxytryptamine and monodansylcadaverine (MDC) into living C6 glioma cells. Electrophoretic separation of MDC-labelled C6 cells identified several distinct fluorescent proteins one of which was fibronectin.

Coated-platelet levels in patients with Type 1 and with Type 2 diabetes mellitus

Coated-platelet levels were quantified in 58 people with Type 1 diabetes, 90 with Type 2 diabetes, and 54 non-diabetic controls. In diabetes high coated-platelet levels were related to smoking and glucose control drugs, but not to glycaemia or other drugs. Prospective studies should evaluate coated-platelets and complications and drug effects.

Coated-platelets are higher in amnestic versus nonamnestic patients with mild cognitive impairment

Coated-platelets, a subset of platelets produced by coactivation with both collagen and thrombin, retain intact amyloid precursor protein on their surface. We analyzed blood samples from 66 individuals with mild cognitive impairment (36 amnestic and 30 nonamnestic) for coated-platelet production. Coated-platelet levels were significantly higher in amnestic compared with nonamnestic patients (P=0.037). These findings support the hypothesis that coated-platelets may be linked to the requisite alteration in amyloid precursor protein metabolism that occurs in Alzheimer disease.

Conversion of platelets from a proaggregatory to a proinflammatory adhesive phenotype: role of PAF in spatially regulating neutrophil adhesion and spreading

The ability of platelets to provide a highly reactive surface for the recruitment of other platelets and leukocytes to sites of vascular injury is critical for hemostasis, atherothrombosis, and a variety of inflammatory diseases. The mechanisms coordinating platelet-platelet and platelet-leukocyte interactions have been well defined and, in general, it is assumed that increased platelet activation correlates with enhanced reactivity toward other platelets and neutrophils. In the current study, we demonstrate a differential role for platelets in supporting platelet and neutrophil adhesive interactions under flow. We demonstrate that the conversion of spread platelets to microvesiculated procoagulant (annexin A5–positive [annexin A5+ve]) forms reduces platelet-platelet adhesion and leads to a paradoxical increase in neutrophil-platelet interaction. This enhancement in neutrophil adhesion and spreading is partially mediated by the proinflammatory lipid, platelet-activating factor (PAF). PAF production, unlike other neutrophil chemokines (IL-8, GRO-α, NAP-2, IL-1β) is specifically and markedly up-regulated in annexin A5+ve cells. Physiologically, this spatially controlled production of PAF plays an important role in localizing neutrophils on the surface of thrombi. These studies define for the first time a specific proinflammatory function for annexin A5+ve platelets. Moreover, they demonstrate an important role for platelet-derived PAF in spatially regulating neutrophil adhesion under flow.

Effect of physiologic shear stresses and calcium on agonist-induced platelet aggregation, secretion, and thromboxane A2 formation

INTRODUCTION

Platelets in vivo react under low-shear venous-flow as well as high-shear arterial-flow conditions. Because most studies were carried out at low shear stresses, platelet granule secretion at high shear has not been examined thoroughly. We investigated the secretion of all three types of platelet granules and thromboxane A(2) formation at high shear after stimulation with ADP or thrombin.

MATERIALS AND METHODS

Washed human platelets were reacted rapidly (<5 s) in a quenched-flow system simulating high-shear arterial-flow conditions (30 dyn/cm(2)). For comparison, we employed a low-shear stirring system (1-5 dyn/cm(2)). Serotonin release and membrane exposure of P-selectin (alpha), CD63 (dense), and CD107a (lysosomes) were used to assess granule secretion. Aggregation was evaluated by resistive-particle counting of the remaining platelet singlets.

RESULTS AND CONCLUSIONS

ADP and thrombin induced similar strong levels of aggregation ( approximately 70%) at high shear by 5 s. Thrombin also caused release of about 40% of all alpha and dense granules within 5 s. However, by 5 s at high shear, ADP failed to induce significant granule secretion or thromboxane A(2) formation (<5%, p>0.05). By 10 min at low shear, ADP caused secretion and thromboxane A(2) formation only at non-physiological, micromolar extracellular Ca(2+) concentrations. These results emphasize the ability of thrombin to initiate multiple aspects of platelet function within seconds, while ADP was only able to induce rapid aggregation.

Clot Stabilization for the Prevention of Bleeding

Coagulation is a finely tuned sequence of reactions beginning with the interaction between tissue factor (TF) and its substrate, factor VII (FVII), and resulting in the formation of a fibrin clot localized to the site of vascular endothelial disruption. While important for fibrin clot formation, thrombin also plays a role in stabilizing the clot against premature fibrinolysis by activating thrombin activatable fibrinolysis inhibitor (TAFI) and factor XIII (FXIII), the terminal enzyme in the coagulation cascade. Despite use of antifibrinolytic agents in various types of surgery to inhibit clot lysis. thereby limiting blood loss and patient exposure to allogeneic blood products, numerous patients still require transfusions for nonsurgical bleeding. This article describes new concepts of localized hemostasis, a potential role for clot stabilization, and inhibition of fibrinolysis for control of bleeding.

Bax activators potentiate coated-platelet formation

BACKGROUND

Activation of platelets with collagen plus thrombin produces a subset of cells known as coated-platelets. Coated-platelets retain several alpha-granule proteins on their surface, express phosphatidylserine (PS), lose mitochondrial potential and release microparticles.

OBJECTIVE

A number of these characteristics are also observed in apoptotic cells, and this similarity leads to the hypothesis that mechanisms controlling initiation of apoptosis might also affect generation of coated-platelets.

RESULTS

In this report, we demonstrate that BH3 mimetics, molecules that facilitate apoptosis by releasing pro-apoptotic Bax from its antiapoptotic partner Bcl-2, are able to promote coated-platelet formation as monitored by several different markers of these cells. Specifically, gossypol and methoxy-antimycin (MAM) promote fibrinogen retention, mitochondrial depolarization, and PS exposure upon activation with thrombin plus convulxin, a ligand of the glycoprotein VI collagen receptor. Gossypol also potentiates microparticle release by convulxin plus thrombin activated platelets although MAM does not. In addition, Bax activators together with thrombin generate coated-platelets, effectively bypassing the requirement for convulxin.

CONCLUSION

These findings further support a close relationship between apoptotic-like events and the production of coated-platelets.

Coated-platelets retain amyloid precursor protein on their surface

Coated-Platelets are a subset of platelets produced by dual-agonist activation with collagen plus thrombin and are characterized by strong retention of several procoagulant, alpha-granule proteins on the cell surface. In this report we demonstrate that coated-platelets also retain full-length amyloid precursor protein (APP) on their surface in contrast to the cleavage of APP in platelets activated with a single agonist. In addition, western blot analysis indicated that APP is derivatized during coated-platelet synthesis. We subsequently measured coated-platelet production in patients with Alzheimer's disease (AD). Twenty-two AD patients showed a wide distribution of coated-platelet values; however the least impaired AD patients produced coated-platelets at a level significantly above that of aged controls (41.0 +/- 9.9 vs. 28.7 +/- 11.4%; mean +/- 1SD; p = 0.017). These findings suggest that coated-platelets may be a model of aberrant APP processing in early AD patients.

Recent advances in blood-related proteomics

Blood is divided in two compartments, namely, plasma and cells. The latter contain red blood cells, leukocytes, and platelets. From a descriptive medical discipline, hematology has evolved towards a pioneering discipline where molecular biology has permitted the development of prognostic and diagnostic indicators for disease. The recent advance in MS and protein separation now allows similar progress in the analysis of proteins. Proteomics offers great promise for the study of proteins in plasma/serum, indeed a number of proteomics databases for plasma/serum have been established. This is a very complex body fluid containing lipids, carbohydrates, amino acids, vitamins, nucleic acids, hormones, and proteins. About 1500 different proteins have recently been identified, and a number of potential new markers of diseases have been characterized. Here, examples of the enormous promise of plasma/serum proteomic analysis for diagnostic/prognostic markers and information on disease mechanism are given. Within the blood are also a large number of different blood cell types that potentially hold similar information. Proteomics of red blood cells, until now, has not improved our knowledge of these cells, in contrast to the major progresses achieved while studying platelets and leukocytes. In the future, proteomics will change several aspects of hematology.

Coated-platelets: an emerging component of the procoagulant response

Coated-platelets, formerly known as COAT-platelets, represent a subpopulation of cells observed after dual agonist stimulation of platelets with collagen and thrombin. This class of platelets retains on its surface high levels of several procoagulant proteins, including fibrinogen, von Willebrand factor, fibronectin, factor V and thrombospondin. Coated-platelets also express surface phosphatidylserine and strongly support prothrombinase activity. Retention of alpha-granule proteins on the surface of coated-platelets involves an unexpected derivatization of these proteins with serotonin and an interaction of serotonin-conjugated proteins with serotonin binding sites on fibrinogen and thrombospondin. This review will also detail experimental systems where coated-platelets are generated as a result of other agonist(s). Finally, the putative physiological consequences of coated-platelet formation will be discussed.

Quantitation of microparticles released from coated-platelets

Dual agonist stimulation of platelets with thrombin and convulxin results in generation of coated-platelets, a sub-population of cells known formerly as COAT-platelets (collagen and thrombin). Coated-platelets retain several procoagulant proteins on their surface and express phosphatidylserine (PS). In this report, we utilize a new methodology to demonstrate that coated-platelets also release microparticles. Platelets were prelabeled with 2.5 microm Bodipy-maleimide and then stimulated with convulxin plus thrombin. Microparticles, 0.3-0.5 microm in diameter, were observed by fluorescence confocal microscopy. Confocal microscopy was also used to demonstrate that microparticles were positive for glycoprotein IIb/IIIa, glycoprotein Ib, CD9, and PS, but negative for fibrinogen and thrombospondin. Furthermore, microparticles released from Bodipy-labeled platelets were observed by flow cytometry, and activation with convulxin plus thrombin produced 15 +/- 5 microparticles per coated-platelet. In contrast, platelets stimulated with thrombin or convulxin alone produced few microparticles. Phenylarsine oxide and diamide, both of which potentiate the mitochondrial permeability transition pore and coated-platelet production, significantly increased the number of microparticles released per coated-platelet.

Role of FcRgamma and factor XIIIA in coated platelet formation

Platelet activation in response to dual stimulation with collagen and thrombin results in the formation of a subpopulation of activated platelets known as coated platelets. Coated platelets are characterized by high surface levels of alpha-granule proteins and phosphatidylserine, which support the assembly of procoagulant protein complexes. Using murine models, we tested the hypothesis that the collagen receptor-associated molecule FcRgamma and the transglutaminase factor XIIIA are required for the formation of coated platelets. Following dual stimulation with the collagen receptor agonist convulxin and thrombin, 68% of platelets from C57BL/6 mice acquired the coated platelet phenotype, defined by high surface levels of fibrinogen and von Willebrand factor and decreased binding of the alphaIIbbeta3 activation-dependent antibody PE-JON/A. In FcRgamma-/- mice, only 10% of platelets became "coated" after dual stimulation with convulxin plus thrombin (P < .05 vs C57BL/6 platelets). Decreased coated platelet formation in FcRgamma-/- platelets was accompanied by decreased annexin V binding (P < .01) and decreased platelet procoagulant activity (P < .05). Platelets from FXIIIA-/- mice did not differ from control platelets in coated platelet formation or annexin V binding. We conclude that FcRgamma, but not factor XIIIA, is essential for formation of highly procoagulant coated platelets following dual stimulation with collagen and thrombin.

Role of Mitochondrial Permeability Transition Pore in Coated-Platelet Formation

OBJECTIVE

Coated-platelets are a subset of cells observed during costimulation of platelets with collagen and thrombin. Important characteristics of coated-platelets include retention of multiple alpha-granule proteins and expression of phosphatidylserine on the cell surface. The mitochondrial permeability transition pore (MPTP) is a key step in apoptosis and is suggested to be involved in some forms of platelet activation. The objective of this study was to examine the role of MPTP in the synthesis of coated-platelets.

METHODS AND RESULTS

Flow cytometric analysis of coated-platelet production was used to examine the impact of pharmacological effectors of MPTP formation. Cyclosporin A, coenzyme Q, and bongkrekic acid all inhibit MPTP formation as well as production of coated-platelets. Phenylarsine oxide and diamide, both potentiators of MPTP formation, stimulate coated-platelet synthesis. Atractyloside, another inducer of MPTP formation, does not affect the percentage of coated-platelets synthesized; however, it does increase the level of phosphatidylserine exposed on the surface of coated-platelets.

CONCLUSIONS

These findings indicate that MPTP formation is an integral event in the synthesis of coated-platelets. Although the exact function of the MPTP remains to be determined, these data support a growing body of evidence that apoptosis-associated events are vital components of the platelet activation process. Formation of coated-platelets involves a complex set of activation events initiated by dual agonist activation. The mitochondrial permeability transition pore (MPTP) is a key intermediate in apoptosis and has been suggested to impact platelet activation. This report demonstrates that MPTP formation is essential to production of coated-platelets.