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Sim MM, Mollica MY, Alfar HR, Hollifield M, Chung DW, Fu X, Gandhapudi S, Coenen DM, Prakhya KS, Mahmood DFD, Banerjee M, Peng C, Li X, Thornton AC, Porterfield JZ, Sturgill JL, Sievert GA, Barton-Baxter M, Zheng Z, Campbell KS, Woodward JG, López JA, Whiteheart SW, Garvy BA, Wood JP. Unfolded Von Willebrand Factor Binds Protein S and Reduces Anticoagulant Activity. bioRxiv 2024:2024.02.08.579463. [PMID: 38370737 PMCID: PMC10871343 DOI: 10.1101/2024.02.08.579463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Protein S (PS), the critical plasma cofactor for the anticoagulants tissue factor (TF) pathway inhibitor (TFPI) and activated protein C (APC), circulates in two functionally distinct pools: free (anticoagulant) or bound to complement component 4b-binding protein (C4BP) (anti-inflammatory). Acquired free PS deficiency is detected in several viral infections, but its cause is unclear. Here, we identified a shear-dependent interaction between PS and von Willebrand Factor (VWF) by mass spectrometry. Consistently, plasma PS and VWF comigrated in both native and agarose gel electrophoresis. The PS/VWF interaction was blocked by TFPI but not APC, suggesting an interaction with the C-terminal sex hormone binding globulin (SHBG) region of PS. Microfluidic systems, mimicking arterial laminar flow or disrupted turbulent flow, demonstrated that PS stably binds VWF as VWF unfolds under turbulent flow. PS/VWF complexes also localized to platelet thrombi under laminar arterial flow. In thrombin generation-based assays, shearing plasma decreased PS activity, an effect not seen in the absence of VWF. Finally, free PS deficiency in COVID-19 patients, measured using an antibody that binds near the C4BP binding site in SHBG, correlated with changes in VWF, but not C4BP, and with thrombin generation. Our data suggest that PS binds to a shear-exposed site on VWF, thus sequestering free PS and decreasing its anticoagulant activity, which would account for the increased thrombin generation potential. As many viral infections present with free PS deficiency, elevated circulating VWF, and increased vascular shear, we propose that the PS/VWF interaction reported here is a likely contributor to virus-associated thrombotic risk.
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Affiliation(s)
- Martha M.S. Sim
- Department of Molecular and Cellular Biochemistry, University of Kentucky, KY, USA
| | - Molly Y. Mollica
- Bloodworks Northwest Research Institute, WA, USA
- Division of Hematology, School of Medicine, University of Washington, WA, USA
- Department of Mechanical Engineering, University of Maryland, Baltimore County, MD, USA
| | - Hammodah R. Alfar
- Department of Molecular and Cellular Biochemistry, University of Kentucky, KY, USA
| | - Melissa Hollifield
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, KY, USA
| | - Dominic W. Chung
- Bloodworks Northwest Research Institute, WA, USA
- Department of Biochemistry, University of Washington, WA, USA
| | - Xiaoyun Fu
- Bloodworks Northwest Research Institute, WA, USA
- Division of Hematology, School of Medicine, University of Washington, WA, USA
| | - Siva Gandhapudi
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, KY, USA
| | - Daniëlle M. Coenen
- Department of Molecular and Cellular Biochemistry, University of Kentucky, KY, USA
| | | | | | - Meenakshi Banerjee
- Department of Molecular and Cellular Biochemistry, University of Kentucky, KY, USA
| | - Chi Peng
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, KY, USA
| | - Xian Li
- Saha Cardiovascular Research Center, University of Kentucky, KY, USA
| | | | - James Z. Porterfield
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, KY, USA
- Division of Infectious Disease, University of Kentucky, KY, USA
| | - Jamie L. Sturgill
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, KY, USA
| | - Gail A. Sievert
- Center for Clinical and Translational Science, University of Kentucky, KY, USA
| | | | - Ze Zheng
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Versiti Blood Research Institute, Milwaukee, WI, USA
| | - Kenneth S. Campbell
- Center for Clinical and Translational Science, University of Kentucky, KY, USA
| | - Jerold G. Woodward
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, KY, USA
| | - José A. López
- Bloodworks Northwest Research Institute, WA, USA
- Division of Hematology, School of Medicine, University of Washington, WA, USA
| | - Sidney W. Whiteheart
- Department of Molecular and Cellular Biochemistry, University of Kentucky, KY, USA
- Saha Cardiovascular Research Center, University of Kentucky, KY, USA
| | - Beth A. Garvy
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky, KY, USA
| | - Jeremy P. Wood
- Department of Molecular and Cellular Biochemistry, University of Kentucky, KY, USA
- Saha Cardiovascular Research Center, University of Kentucky, KY, USA
- Division of Cardiovascular Medicine Gill Heart and Vascular Institute, University of Kentucky, KY, USA
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Matharu SS, Nordmann CS, Ottman KR, Akkem R, Palumbo D, Cruz DRD, Campbell K, Sievert G, Sturgill J, Porterfield JZ, Joshi S, Alfar HR, Peng C, Pokrovskaya ID, Kamykowski JA, Wood JP, Garvy B, Aronova MA, Whiteheart SW, Leapman RD, Storrie B. Deep learning, 3D ultrastructural analysis reveals quantitative differences in platelet and organelle packing in COVID-19/SARSCoV2 patient-derived platelets. Platelets 2023; 34:2264978. [PMID: 37933490 PMCID: PMC10809228 DOI: 10.1080/09537104.2023.2264978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/20/2023] [Indexed: 11/08/2023]
Abstract
Platelets contribute to COVID-19 clinical manifestations, of which microclotting in the pulmonary vasculature has been a prominent symptom. To investigate the potential diagnostic contributions of overall platelet morphology and their α-granules and mitochondria to the understanding of platelet hyperactivation and micro-clotting, we undertook a 3D ultrastructural approach. Because differences might be small, we used the high-contrast, high-resolution technique of focused ion beam scanning EM (FIB-SEM) and employed deep learning computational methods to evaluate nearly 600 individual platelets and 30 000 included organelles within three healthy controls and three severely ill COVID-19 patients. Statistical analysis reveals that the α-granule/mitochondrion-to-plateletvolume ratio is significantly greater in COVID-19 patient platelets indicating a denser packing of organelles, and a more compact platelet. The COVID-19 patient platelets were significantly smaller -by 35% in volume - with most of the difference in organelle packing density being due to decreased platelet size. There was little to no 3D ultrastructural evidence for differential activation of the platelets from COVID-19 patients. Though limited by sample size, our studies suggest that factors outside of the platelets themselves are likely responsible for COVID-19 complications. Our studies show how deep learning 3D methodology can become the gold standard for 3D ultrastructural studies of platelets.
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Affiliation(s)
- Sagar S Matharu
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Cassidy S Nordmann
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Kurtis R Ottman
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Rahul Akkem
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Douglas Palumbo
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Denzel R D Cruz
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth Campbell
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Gail Sievert
- Center for Clinical Translational Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jamie Sturgill
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - James Z Porterfield
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Smita Joshi
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hammodah R Alfar
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Chi Peng
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Irina D Pokrovskaya
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey A Kamykowski
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeremy P Wood
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Beth Garvy
- Department of Microbiology, Immunology and Molecular Genetics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Maria A Aronova
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Sidney W Whiteheart
- Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Richard D Leapman
- Laboratory of Cellular Imaging and Macromolecular Biophysics, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD, USA
| | - Brian Storrie
- Department of Physiology and Cell Biology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Moradi H, Bunnell HT, Price BS, Khodaverdi M, Vest MT, Porterfield JZ, Anzalone AJ, Santangelo SL, Kimble W, Harper J, Hillegass WB, Hodder SL. Assessing the effects of therapeutic combinations on SARS-CoV-2 infected patient outcomes: A big data approach. PLoS One 2023; 18:e0282587. [PMID: 36893086 PMCID: PMC9997963 DOI: 10.1371/journal.pone.0282587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has demonstrated the need for efficient and comprehensive, simultaneous assessment of multiple combined novel therapies for viral infection across the range of illness severity. Randomized Controlled Trials (RCT) are the gold standard by which efficacy of therapeutic agents is demonstrated. However, they rarely are designed to assess treatment combinations across all relevant subgroups. A big data approach to analyzing real-world impacts of therapies may confirm or supplement RCT evidence to further assess effectiveness of therapeutic options for rapidly evolving diseases such as COVID-19. METHODS Gradient Boosted Decision Tree, Deep and Convolutional Neural Network classifiers were implemented and trained on the National COVID Cohort Collaborative (N3C) data repository to predict the patients' outcome of death or discharge. Models leveraged the patients' characteristics, the severity of COVID-19 at diagnosis, and the calculated proportion of days on different treatment combinations after diagnosis as features to predict the outcome. Then, the most accurate model is utilized by eXplainable Artificial Intelligence (XAI) algorithms to provide insights about the learned treatment combination impacts on the model's final outcome prediction. RESULTS Gradient Boosted Decision Tree classifiers present the highest prediction accuracy in identifying patient outcomes with area under the receiver operator characteristic curve of 0.90 and accuracy of 0.81 for the outcomes of death or sufficient improvement to be discharged. The resulting model predicts the treatment combinations of anticoagulants and steroids are associated with the highest probability of improvement, followed by combined anticoagulants and targeted antivirals. In contrast, monotherapies of single drugs, including use of anticoagulants without steroid or antivirals are associated with poorer outcomes. CONCLUSIONS This machine learning model by accurately predicting the mortality provides insights about the treatment combinations associated with clinical improvement in COVID-19 patients. Analysis of the model's components suggests benefit to treatment with combination of steroids, antivirals, and anticoagulant medication. The approach also provides a framework for simultaneously evaluating multiple real-world therapeutic combinations in future research studies.
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Affiliation(s)
- Hamidreza Moradi
- University of Mississippi Medical Center, Jackson, MS, United States of America
| | | | - Bradley S. Price
- West Virginia University, Morgantown, WV, United States of America
| | - Maryam Khodaverdi
- West Virginia Clinical and Translational Science Institute, Morgantown, WV, United States of America
| | - Michael T. Vest
- Christiana Care Health System, Newark, DE, United States of America
| | | | - Alfred J. Anzalone
- University of Nebraska Medical Center, Omaha, NE, United States of America
| | | | - Wesley Kimble
- West Virginia Clinical and Translational Science Institute, Morgantown, WV, United States of America
| | - Jeremy Harper
- Owl Health Works LLC, Indianapolis, IN, United States of America
| | | | - Sally L. Hodder
- West Virginia Clinical and Translational Science Institute, Morgantown, WV, United States of America
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