BLOOD COAGULATION FACTORS AT PHOSPHOLIPID SURFACES

Effects of the glycoprotein IIb/IIIa receptor antagonist c7E3 Fab and anticoagulants on platelet aggregation and thrombin potential under high coagulant challenge in vitro

The present study was performed to investigate the combined effects of the platelet glycoprotein IIb/IIIa receptor antagonist c7E3 Fab (abciximab) and the anticoagulants unfractionated heparin (UH), low molecular weight heparin (LMWH), and recombinant hirudin (rH) on platelet aggregation and thrombin generation under high coagulant challenge by extrinsic activation of platelet-rich plasma. Platelet aggregation and thrombin generation were assessed simultaneously in the presence of different concentrations of abciximab and anticoagulants. Increasing concentrations of abciximab resulted in a dose-dependent anti-aggregating effect with a maximum at 20 microg/ml. Doses of 5, 10, and 20 microg/ml abciximab prolonged the lag phase until the onset of platelet aggregation, but this effect was independent of the dosage used. Abciximab had no influence on the thrombin potential under our high coagulant challenge. UH, LMWH, and rH showed a dose-dependent prolongation of the lag phase until the onset of platelet aggregation and decreased the thrombin potential. Addition of anticoagulants did not contribute to further inhibition of platelet aggregation in the presence of abciximab, but the combination of abciximab and anticoagulants exhibited an additive effect on prolongation of the lag phase until the onset of platelet aggregation. Addition of abciximab to anticoagulants did not result in further decrease of the thrombin potential. Our study demonstrates the respective specific effects of abciximab and anticoagulants on platelet aggregation and thrombin potential under high coagulant challenge, and also an additive effect of abciximab and the anticoagulants UH, LMWH, and rH on the lag phase until the onset of platelet aggregation.

Effects of red blood cells on the coagulation of blood in normal and preeclamptic pregnancies

OBJECTIVE

The objective of this study was to determine the cellular effects of whole blood, especially of red blood cells, on the hypercoagulability of blood from patients with preeclampsia.

STUDY DESIGN

The time elapsed between mixing and the onset of coagulation was measured by means of a highly sensitive rheometer for whole blood, platelet-rich plasma (in which red blood cells had been removed from whole blood), and platelet-free plasma from 3 groups of subjects: 25 nonpregnant women, 25 women with normal pregnancies, and 10 patients with preeclampsia.

RESULTS

Time to coagulation for whole blood from patients with preeclampsia was significantly shorter than that for whole blood from women with normal pregnancies. However, there was no significant difference in time to coagulation for platelet-rich plasma between women with preeclampsia and those with normal pregnancies.

CONCLUSION

Hypercoagulability of blood in preeclampsia appears to be strongly related to red blood cell alterations.

Effect of various drugs on adriamycin-enhanced venous thrombosis in the rat: importance of PAF

In the rat, adriamycin increased stasis-induced thrombosis in a dose- and time-dependent manner. Two potent antiplatelet agents, clopidogrel (20 mg/kg, po) and aspirin (200 mg/kg, po) showed a strong antithrombotic efficacy (92 and 77% inhibition of thrombus formation respectively) therefore suggesting that platelets play a major role in the prothrombotic effect of adriamycin. Standard heparin, administered as a single bolus injection (3 mg/kg, iv), 5 min prior to stasis did not affect adriamycin-induced thrombosis whereas hirudin (1 mg/kg, iv) suppressed thrombus formation (98% inhibition). SR 27417, a potent PAF receptor antagonist injected iv, reduced venous thrombosis in a dose-dependent manner (14, 29 and 63% inhibition after 1, 3 and 6 mg/kg respectively). These results therefore demonstrate that adriamycin-induced venous thrombosis is highly dependent upon platelet activation.

Aurin tricarboxylic acid inhibits experimental venous thrombosis

In vitro, aurin tricarboxylic acid (ATA) inhibited ristocetin-induced human platelet agglutination in a dose-dependent manner. The IC50 value (dose which inhibits 50% of platelet agglutination) was 60 +/- 8.7 micrograms/ml. In vivo, the i.v. administration of ATA to rats reduced the thrombus formation in an arteriovenous shunt with an ED50 value of 9.0 +/- 1.6 mg/kg. In a venous thrombosis model, using a combination of a thrombogenic challenge and stasis, ATA displayed a significant, dose-dependent antithrombotic effect, the ED50 value being of 18.3 +/- 2.0 mg/kg. In an experimental model of disseminated intravascular coagulation, ATA protected mice from the lethal effect of thromboplastin-induced thromboembolism with a ED50 value of 1.1 +/- 0.15 mg/kg, being in that respect 12 times less potent than standard heparin (ED50 = 90 +/- 15 micrograms/kg). These observations therefore show that ATA is active in both arterial- or venous-type thrombosis models and suggest that von Willebrand Factor might be important not only in arterial but also in venous thrombosis.

Effect of polyurethane surface chemistry on its lipid sorption behavior

The relationships among surface, bulk properties and lipid sorption behaviors of segmented polyurethanes (SPUs) with various polyol soft segments were investigated. The polyols used in this study were poly(ethylene oxide) (PEO), poly(tetramethylene oxide) (PTMO), and poly(dimethylsiloxane) (PDMS). The hard segment of these segmented polyurethanes was composed of 4,4'-diphenylmethane diisocyanate and 1,4-butanediol, present at 50 wt%. X-ray photoelectron spectroscopic (XPS) and dynamic contact angle measurements were carried out in order to analyze the surface chemical structure in the air- and water-equilibrated states. XPS revealed that in the air-equilibrated state, lower surface free energy components were enriched at the air-solid interface, whereas in the water-equilibrated state, higher surface free energy components were enriched at the water-solid interface. The change in environment from air to water induced the surface reorganization in order to minimize interfacial free energy. Lipid sorption behaviors of SPUs were investigated by means of infrared spectroscopy. Even after extensive rinsing of the surface, the amount of lipid present on the SPU surface was more than that calculated on the assumption that a monolayer covers the SPU surface. Therefore, the lipid was not only adsorbed on the surface of SPU but absorbed into SPU. The SPU with hydrophilic PEO sorbed larger amount of phospholipid compared with that with hydrophobic polyol such as PTMO and PDMS. Also, the competitive sorption behaviors of phospholipid and cholesterol from their mixed liposome solution were studied. The ratio of sorbed cholesterol to phospholipid increased with an increase in surface hydrophobicity owing to the hydrophobic nature of cholesterol.

Venostasis-induced thrombosis in rats is not influenced by circulating platelet or leukocyte number

In this paper experiments were designed to evaluate the role of platelet and leukocyte number in experimental venous thrombosis in rats. For this purpose venous thrombosis was induced by ligature of the inferior vena cava in animals made thrombocytopenic (5% of control) by antiplatelet antiserum or leukopenic (5-10% of control), by myelotoxic drugs. In normal animals the platelet count did not change after 2 or 3 hours of venous stasis, independently of whether a thrombus was present or not; the leukocyte count was significantly raised after ligature depending mainly on the duration of the stasis. Neither thrombocytopenia nor leukopenia, on the other hand, did influence the development of venous thrombosis.

Epidemiology and pathogenesis of venous thrombosis

Venous thrombi are intravascular deposits composed predominantly of fibrin and red blood cells with a variable platelet and leukocyte component. They frequently arise in large venous sinuses in the calf, in valve cusp pockets either in the deep veins of the calf or thigh or in venous segments that have been exposed to direct trauma. Venous thrombosis can be produced experimentally by a combination of stasis and systemic hypercoagulability or by stasis and endothelial damage. Thrombosis is augmented if the fibrinolytic mechanism is inhibited or defective. A number of clinical conditions and laboratory abnormalities are associated with and predispose to venous thrombosis and, in many of these, it is possible to identify one or more of the thrombogenic factors discussed. Venous thromboembolism (venous thrombosis and pulmonary embolism) is a serious and potentially fatal disorder that usually complicates the course of sick hospitalized patients, but occasionally affects ambulant and otherwise healthy individuals. Screening studies with iodine-125 fibrinogen leg scanning, impedance plethysmography and perfusion lung scanning have shown that the majority of venous thrombi and pulmonary emboli that occur in hospitalized patients are small and asymptomatic, and it is likely that most are clinically insignificant. In bedridden patients, most thrombi commence in the calf and are asymptomatic. When a calf vein thrombus extends into the proximal venous segment, the risk of clinically significant pulmonary embolism increases. Less is known about the incidence and clinical significance in a nonhospital population; although asymptomatic disease occurs, its frequency is unknown. In contrast to the patients with asymptomatic venous thrombosis, symptomatic patients with venous thrombosis usually have large occulsive thrombi localized in their proximal veins.

Biomembranes as models for polymer surfaces. III. Characterization of a phosphorylcholine surface covalently bound to glass

A surface layer of phosphorylcholine has been chemically linked with the surface hydroxyl groups present on glass and silica by reaction with mono- and bifunctional reagents. Evidence for the structural integrity of the deposited group was provided by the equimolar association of phosphorus and choline with the reacted surfaces. Modified glass surfaces yielded contact angles which are consistent with those found previously for other models of biological membranes. Covalent modification of the treated surfaces was demonstrated by i.r. spectroscopy via the removal of surface hydroxyl groups. The modified surfaces were thermostable at temperatures up to 375 degrees C for extended periods. The relevance of these results to the generation of new biomaterials is discussed.

Biomembrane surfaces as models for polymer design: the potential for haemocompatibility

A major restriction in the application of polymeric biomaterials is the propensity of their surfaces to support thrombosis. Theoretical approaches to the design of thromboresistant polymers have been inadequate because of the complexity of surface thrombosis. We have developed a new, practical approach to this problem--the design of polymers which mimic the thromboresistant surfaces of blood cell membranes. Haemostatic processes are mediated by reactions which occur at membrane-plasma interfaces. The extra-cellular surfaces of the plasma membranes of red blood cells and quiescent platelets are thromboresistant; in contrast, their cytoplasmic surfaces are thrombogenic. The simplest common feature among the blood-compatible cellular and model membranes is the high content of the electrically neutral phospholipids which contain the phosphorylcholine head group. We have developed model systems of biological membranes which utilize polymerizable phosphatidylcholines and which mimic nonreactive cell surfaces. Polymeri phospholipids represent a new class of hybrid biomaterials with characteristics both of biomembranes (polar surfaces, nonthrombogenic, low antigenic potential and low permeability) and of synthetic polymers (chemical and physical stability).

Phospholipids accelerate factor IX activation by surface bound factor XIa

Activation of bovine factor IX by surface bound factor XIa which was generated either by activation of human citrated factor IX deficient plasma or a mixture of purified human factors XII, high molecular weight kininogen (HMWK) and XI in glass tubes, is accelerated by cephalin. Human brain cephalin in dilutions ranging from 1:5 to 1:500 was studied for its effect on the activation of factor IX in concentrations of 1.0 u/ml and 16 u/ml. Cephalin dilutions from 1:5 to 1:30 accelerated the activation of the concentrated factor IX sample two- to threefold. Protein cleavage of this factor IX sample in the presence of 1:30 cephalin occurred twice as fast as in the absence of cephalin. Activation of the dilute factor IX sample (1.0 u/ml) was most effectively accelerated by cephalin in dilutions from 1:30 to 1:250. In all experiments the presence of phospholipid led to an increased factor IX cleavage concomitantly with faster generation of factor IXa activity. The results demonstrate that phospholipids actively participate in blood coagulation at an earlier stage than previously described.

Surface-governed molecular regulation of blood coagulation

Among extracellular biological processes the spatial control of blood clotting is a unique phenomenon. Localization in space has very important consequences in both normal and pathological conditions. Under physiological circumstances a clot is formed only in the vicinity of injury, albeit the prerequisites of coagulation are almost completely given in the whole circulation. The local character of blood clotting is secured by the following major conditions: The regulatory signal initiating coagulation-the damaged vascular wall-is itself a surface on which the majority of clotting reactions take place. The first enzyme, factor XII, of the intrinsic coagulation pathway is activated on the collagen fibers exposed in the damaged vascular wall, although the significance of this reaction in respect of the clotting process is ambiguous. On the membrane of platelets adhered to the damaged blood vessel is activated factor XI, too, which is a well-established participant of the intrinsic clotting process. The further consecutive reactions of coagulation are confined to the surface produced by injury, because the enzymes involved contain gamma-carboxyl-glutamyl side chains which are anchored through calcium bridges to the phospholipids of the platelet membrane. The last enzyme of the sequence is thrombin, which is released from the surface. The reactions taking place on the surface form an enzyme cascade, which amplifies the relatively weak triggering signal by several orders of magnitudes. Amplification is ensured not only by the enzyme-substrate relationship of the consecutive reaction partners, but also by spatial confinement, which endows the process with higher efficacy than could be expected on a statistical basis from reactions in solution. It contributes to the efficiency of enzyme cascade that the non-enzymatic regulatory proteins increase the activity of factors IXa and Xa, and thereby the overall process. While the partner of factor IXa, factor VIII, is captured from plasma, factor V, the partner of factor Xa, is derived from the platelets adhered to the damaged surface and orients the binding of factor Xa. The surface localization ensures the protection of the members of clotting system: In the activator complexes found on the surface, the spatial arrangement of clotting factors prevents the inactivation of factors by physiological inhibitors or by proteolytic enzymes and specific antibodies that appear in the circulation in pathological conditions. Platelet factor 4, derived from platelets, binds heparin and thereby markedly decreases the reactivity of antithrombin III, the physiological inhibitor of clotting factors. The above two circumstances are

The role of blood clotting factor V in the conversion of prothrombin and a decarboxy prothrombin into thrombin

Purified PIVKA-II exhibits some factor II (prothrombin) activity in the one-stage coagulation assay and this factor II activity does not come from residual amounts of factor II but originates from PIVKA-II itself. It is shown that PIVKA-II is converted by a normal prothrombinase complex (factor Va and factor Xa adsorbed onto a phospholipid interface) more readily than by phospholipids and factor Xa alone. This suggests that binding between PIVKA-II and factor Va is an essential feature in the formation of the enzyme . substrate complex and from this we infer that a direct interaction between factor Va and prothrombin plays a rôle in the prothrombinase . prothrombin complex.

The "Hageman" connection: interrelationships of blood coagulation, fibrino(geno)lysis, kinin generation, and complement activation

The activation pathways for the generation of enzymes involved in blood clotting, clot lysis, complement activation, and kinin generation are briefly reviewed. The interrelationship of the four systems is illustrated by the multiple functions of four key enzymes: Factor XIIa, kallikrein, plasmin, and C1 esterase. The pivotal role of Factor XIIa in establishing this connection is elucidated.