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Zhao M, Peng D, Li Y, He M, Zhang Y, Zhou Q, Sun S, Ma P, Lv L, Wang X, Zhan L. Hemin regulates platelet clearance in hemolytic disease by binding to GPIbα. Platelets 2024; 35:2383642. [PMID: 39072582 DOI: 10.1080/09537104.2024.2383642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
Hemolysis is associated with thrombosis and vascular dysfunction, which are the pathological components of many diseases. Hemolytic products, including hemoglobin and hemin, activate platelets (PLT). Despite its activation, the effect of hemolysis on platelet clearance remains unclear, It is critical to maintain a normal platelet count and ensure that circulating platelets are functionally viable. In this study, we used hemin, a degradation product of hemoglobin, as a potent agonist to treat platelets and simulate changes in vivo in mice. Hemin treatment induced activation and morphological changes in platelets, including an increase in intracellular Ca2+ levels, phosphatidylserine (PS) exposure, and cytoskeletal rearrangement. Fewer hemin-treated platelets were cleared by macrophages in the liver after transfusion than untreated platelets. Hemin bound to glycoprotein Ibα (GPIbα), the surface receptor in hemin-induced platelet activation and aggregation. Furthermore, hemin decreased GPIbα desialylation, as evidenced by reduced Ricinus communis agglutinin I (RCA- I) binding, which likely extended the lifetime of such platelets in vivo. These data provided new insight into the mechanisms of GPIbα-mediated platelet activation and clearance in hemolytic disease.
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Affiliation(s)
- Man Zhao
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Dongxin Peng
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Yuxuan Li
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Minwei He
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Yulong Zhang
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Qianqian Zhou
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Sujing Sun
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Ping Ma
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Liping Lv
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Xiaohui Wang
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Linsheng Zhan
- Field Blood Transfusion, Institute of Health Service and Transfusion Medicine, Beijing, China
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Roka-Moiia Y, Lewis S, Cleveland E, Italiano JE, Slepian MJ. Shear Stress Promotes Remodeling of Platelet Glycosylation via Upregulation of Platelet Glycosidase Activity: One More Thing. Thromb Haemost 2024. [PMID: 39168140 DOI: 10.1055/a-2398-9532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND Mechanical circulatory support (MCS) is a mainstay of therapy for advanced and end-stage heart failure. Accompanied by systemic anticoagulation, contemporary MCS has become less thrombogenic, with bleeding complications emerging as a major cause of readmission and 1-year mortality. Shear-mediated platelet dysfunction and thrombocytopenia of undefined etiology are primary drivers of MCS-related bleeding. Recently, it has been demonstrated that deprivation of platelet surface glycosylation is associated with the decline of hemostatic function, microvesiculation, and premature apoptosis. We test the hypothesis that shear stress induces remodeling of platelet surface glycosylation via upregulation of glycosidase activity, thus facilitating platelet count decline and intense microvesiculation. METHODS Human gel-filtered platelets were exposed to continuous shear stress in vitro. Platelets and platelet-derived microparticles (PDMPs) were quantified via flow cytometry using size standard fluorescent nanobeads. Platelet surface glycosylation and NEU1 expression were evaluated using lectin- or immune-staining and multicolor flow cytometry; lectin blotting was utilized to verify glycosylation of individual glycoproteins. Platelet neuraminidase, galactosidase, hexosaminidase, and mannosidase activities were quantified using 4-methylumbelliferone-based fluorogenic substrates. RESULTS We demonstrate that shear stress promotes selective remodeling of platelet glycosylation via downregulation of 2,6-sialylation, terminal galactose, and mannose, while 2,3-sialylation remains largely unchanged. Shear-mediated deglycosylation is partially attenuated by neuraminidase inhibitors, strongly suggesting the involvement of platelet neuraminidase in observed phenomena. Shear stress increases platelet NEU1 surface expression and potentiates generation of numerous NEU1+ PDMPs. Platelets exhibit high basal hexosaminidase and mannosidase activities; basal activities of platelet neuraminidase and galactosidase are rather low and are significantly upregulated by shear stress. Shear stress of increased magnitude and duration promotes an incremental decline of platelet count and immense microvesiculation, both being further exacerbated by neuraminidase and partially attenuated by neuraminidase inhibition. CONCLUSION Our data indicate that shear stress accumulation, consistent with supraphysiologic conditions of device-supported circulation, promotes remodeling of platelet glycosylation via selective upregulation of platelet glycosidase activity. Shear-mediated platelet deglycosylation is associated with platelet count drop and increased microvesiculation, thus offering a direct link between deglycosylation and thrombocytopenia observed in device-supported patients. Based on our findings, we propose a panel of molecular markers to be used for reliable detection of shear-mediated platelet deglycosylation in MCS.
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Affiliation(s)
- Yana Roka-Moiia
- Department of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, Arizona, United States
- Arizona Center for Accelerated Biomedical Innovation, Tucson, Arizona, United States
| | - Sabrina Lewis
- Department of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, Arizona, United States
| | - Estevan Cleveland
- Department of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, Arizona, United States
| | - Joseph E Italiano
- Vascular Biology Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Marvin J Slepian
- Department of Medicine and Biomedical Engineering, Sarver Heart Center, University of Arizona, Tucson, Arizona, United States
- Arizona Center for Accelerated Biomedical Innovation, Tucson, Arizona, United States
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Debaene C, Feys HB, Six KR. Shedding light on GPIbα shedding. Curr Opin Hematol 2024; 31:224-229. [PMID: 38728102 DOI: 10.1097/moh.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
PURPOSE OF REVIEW Ectodomain shedding has been investigated since the late 1980s. The abundant and platelet specific GPIbα receptor is cleaved by ADAM17 resulting in the release of its ectodomain called glycocalicin. This review will address the role of glycocalicin as an end-stage marker of platelet turnover and storage lesion and will consider a potential function as effector in processes beyond hemostasis. RECENT FINDINGS Glycocalicin has been described as a marker for platelet senescence, turnover and storage lesion but is not routinely used in a clinical setting because its diagnostic value is nondiscriminatory. Inhibition of glycocalicin shedding improves posttransfusion recovery but little is known (yet) about potential hemostatic improvements. In physiological settings, GPIbα shedding is restricted to the intracellular GPIbα receptor subpopulation suggesting a role for shedding or glycocalicin beyond hemostasis. SUMMARY So far, all evidence represents glycocalicin as an end-stage biomarker of platelet senescence and a potential trigger for platelet clearance. The extensive list of interaction partners of GPIbα in fields beyond hemostasis opens new possibilities to investigate specific effector functions of glycocalicin.
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Affiliation(s)
- Caitlin Debaene
- Transfusion Research Center, Belgian Red Cross Flanders
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross Flanders
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Katrijn R Six
- Transfusion Research Center, Belgian Red Cross Flanders
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Herrmann J, Weiss LJ, Just B, Mott K, Drayss M, Kleiss J, Riesner J, Notz Q, Röder D, Leyh R, Beck S, Weismann D, Nieswandt B, Lotz C, Meybohm P, Schulze H. Extracorporeal membrane oxygenation aggravates platelet glycoprotein V shedding and δ-granule deficiency in COVID-19-associated acute respiratory distress syndrome. J Thromb Haemost 2024; 22:2316-2330. [PMID: 38763215 DOI: 10.1016/j.jtha.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy in patients with acute respiratory distress syndrome (ARDS). Hemostatic complications are frequently observed in patients on ECMO and limit the success of this therapy. Platelets are key mediators of hemostasis enabling activation, aggregation, and thrombus formation by coming in contact with exposed matrix proteins via their surface receptors such as glycoprotein (GP) VI or GPIb/V/IX. Recent research has elucidated a regulatory role of the GPV subunit. The cleaved soluble GPV (sGPV) ectodomain was identified to spatiotemporally control fibrin formation through complex formation with thrombin. OBJECTIVES We aimed to decipher the impact of ECMO on platelet phenotype and function, including the role of GPV and plasmatic sGPV. METHODS We recruited 36 patients with ARDS in the wake of COVID-19 pneumonia and performed a longitudinal comparison of platelet phenotype and function in non-ECMO (n = 23) vs ECMO (n = 13) compared with those of healthy controls. Patients were assessed at up to 3 time points (t1 = days 1-3; t2 = days 4-6; and t3 = days 7-14 after cannulation/study inclusion). RESULTS Agonist-induced platelet activation was assessed by flow cytometry and revealed decreased GPIIb/IIIa activation and α-granule release in all ARDS patients. During ECMO treatment, agonist-induced δ-granule release continuously decreased, which was independently confirmed by electron microscopy and was associated with a prolonged in vitro bleeding time. GPV expression on the platelet surface markedly decreased in ECMO patients compared with that in non-ECMO patients. Plasma sGPV levels were increased in ECMO patients and were associated with poor outcome. CONCLUSION Our data demonstrate an ECMO-intrinsic platelet δ-granule deficiency and hemostatic dysfunction beyond the underlying ARDS.
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Affiliation(s)
- Johannes Herrmann
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany.
| | - Lukas J Weiss
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Bastian Just
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Kristina Mott
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Maria Drayss
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Judith Kleiss
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Jonathan Riesner
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Quirin Notz
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Daniel Röder
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Rainer Leyh
- Department of Cardiothoracic Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Sarah Beck
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany; Rudolf Virchow Center for Integrative and Translational Bioimaging, Julius Maximilians University Würzburg, Würzburg, Germany
| | - Dirk Weismann
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Bernhard Nieswandt
- Rudolf Virchow Center for Integrative and Translational Bioimaging, Julius Maximilians University Würzburg, Würzburg, Germany
| | - Christopher Lotz
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Harald Schulze
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany.
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Schiller O, Pula G, Shostak E, Manor-Shulman O, Frenkel G, Amir G, Yacobovich J, Nellis ME, Dagan O. Patient-tailored platelet transfusion practices for children supported by extracorporeal membrane oxygenation. Vox Sang 2024; 119:326-334. [PMID: 38175143 DOI: 10.1111/vox.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND AND OBJECTIVES Extracorporeal membrane oxygenation (ECMO) serves as cardiopulmonary therapy in critically ill patients with respiratory/heart failure and often necessitates multiple blood product transfusions. The administration of platelet transfusions during ECMO is triggered by the presence or risk of significant bleeding. Most paediatric ECMO programmes follow guidelines that recommend a platelet transfusion threshold of 80-100 × 109/L. To reduce exposure to platelets, we developed a practice to dynamically lower the threshold to ~20 × 109/L. We describe our experience with patient-tailored platelet thresholds and related bleeding outcomes. MATERIALS AND METHODS We retrospectively evaluated our platelet transfusion policy, bleeding complications and patient outcome in 229 ECMO-supported paediatric patients in our unit. RESULTS We found that more than 97.4% of patients had a platelet count <100 × 109/L at some point during their ECMO course. Platelets were transfused only on 28.5% of ECMO days; and 19.2% of patients never required a platelet transfusion. The median lowest platelet count in children who had bleeding events was 25 × 109/L as compared to 33 × 109/L in children who did not bleed (p < 0.001). Our patients received fewer platelet transfusions and did not require more red blood cell transfusions, nor did they experience more haemorrhagic complications. CONCLUSION We have shown that a restrictive, 'patient-tailored' rather than 'goal-directed' platelet transfusion policy is feasible and safe, which can greatly reduce the use of platelet products. Although there was a difference in the lowest platelet counts in children who bled versus those who did not, the median counts were much lower than current recommendations.
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Affiliation(s)
- Ofer Schiller
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giulia Pula
- Children's Heart Centre, Division of Cardiology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Eran Shostak
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Manor-Shulman
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Georgy Frenkel
- Division of Pediatric Cardiothoracic Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Gabriel Amir
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Pediatric Cardiothoracic Surgery, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Joanne Yacobovich
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Hematology-Oncology Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Marianne E Nellis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, New York, USA
| | - Ovadia Dagan
- Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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