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Koay YC, Chen YC, Wali JA, Luk AWS, Li M, Doma H, Reimark R, Zaldivia MTK, Habtom HT, Franks AE, Fusco-Allison G, Yang J, Holmes A, Simpson SJ, Peter K, O’Sullivan JF. Plasma levels of trimethylamine-N-oxide can be increased with 'healthy' and 'unhealthy' diets and do not correlate with the extent of atherosclerosis but with plaque instability. Cardiovasc Res 2021; 117:435-449. [PMID: 32267921 PMCID: PMC8599768 DOI: 10.1093/cvr/cvaa094] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/12/2020] [Accepted: 04/02/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS The microbiome-derived metabolite trimethylamine-N-oxide (TMAO) has attracted major interest and controversy both as a diagnostic biomarker and therapeutic target in atherothrombosis. METHODS AND RESULTS Plasma TMAO increased in mice on 'unhealthy' high-choline diets and notably also on 'healthy' high-fibre diets. Interestingly, TMAO was found to be generated by direct oxidation in the gut in addition to oxidation by hepatic flavin-monooxygenases. Unexpectedly, two well-accepted mouse models of atherosclerosis, ApoE-/- and Ldlr-/- mice, which reflect the development of stable atherosclerosis, showed no association of TMAO with the extent of atherosclerosis. This finding was validated in the Framingham Heart Study showing no correlation between plasma TMAO and coronary artery calcium score or carotid intima-media thickness (IMT), as measures of atherosclerosis in human subjects. However, in the tandem-stenosis mouse model, which reflects plaque instability as typically seen in patients, TMAO levels correlated with several characteristics of plaque instability, such as markers of inflammation, platelet activation, and intraplaque haemorrhage. CONCLUSIONS Dietary-induced changes in the microbiome, of both 'healthy' and 'unhealthy' diets, can cause an increase in the plasma level of TMAO. The gut itself is a site of significant oxidative production of TMAO. Most importantly, our findings reconcile contradictory data on TMAO. There was no direct association of plasma TMAO and the extent of atherosclerosis, both in mice and humans. However, using a mouse model of plaque instability we demonstrated an association of TMAO plasma levels with atherosclerotic plaque instability. The latter confirms TMAO as being a marker of cardiovascular risk.
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Affiliation(s)
- Yen Chin Koay
- Heart Research Institute, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Yung-Chih Chen
- Baker Heart & Diabetes Institute, Melbourne, VIC, Australia
| | - Jibran A Wali
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Alison W S Luk
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Mengbo Li
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW, Australia
| | - Hemavarni Doma
- Baker Heart & Diabetes Institute, Melbourne, VIC, Australia
| | - Rosa Reimark
- Baker Heart & Diabetes Institute, Melbourne, VIC, Australia
| | | | - Habteab T Habtom
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, VIC, Australia
- Centre for Future Landscapes, La Trobe University, Melbourne, VIC, Australia
| | - Ashley E Franks
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, VIC, Australia
- Centre for Future Landscapes, La Trobe University, Melbourne, VIC, Australia
| | - Gabrielle Fusco-Allison
- Heart Research Institute, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jean Yang
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- School of Mathematics and Statistics, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Holmes
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Stephen J Simpson
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | | | - John F O’Sullivan
- Heart Research Institute, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Central Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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2
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Zaldivia MTK, Hering D, Marusic P, Sata Y, Lee R, Esler MD, Htun NM, Duval J, Hammond L, Flierl U, Wang X, Drummond GR, Walton A, Gardiner EE, Andrews RK, Schlaich MP, Peter K. Successful renal denervation decreases the platelet activation status in hypertensive patients. Cardiovasc Res 2020; 116:202-210. [PMID: 30715163 DOI: 10.1093/cvr/cvz033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/18/2018] [Accepted: 01/31/2019] [Indexed: 12/23/2022] Open
Abstract
AIMS To determine whether renal denervation (RDN) in hypertensive patients affects the platelet activation status. METHODS AND RESULTS We investigated the effect of RDN on the platelet activation status in 41 hypertensive patients undergoing RDN. Ambulatory blood pressure (BP), plasma sympathetic neurotransmitter Neuropeptide Y, and platelet activation markers were measured at baseline, at 3 months, and 6 months after RDN. RDN significantly decreased BP at 3 months (150.6 ± 11.3/80.9 ± 11.4 mmHg to 144.7 ± 12.0/77.1 ± 11.1 mmHg; P < 0.01) and at 6 months (144.3 ± 13.8/78.3 ± 11.1 mmHg; P < 0.01). Plasma levels of the sympathetic neurotransmitter Neuropeptide Y, an indicator of sympathetic nerve activity, were significantly decreased at 3 months (0.29 ± 0.11 ng/mL to 0.23 ± 0.11 ng/mL; P < 0.0001) and at 6 months (0.22 ± 0.12 ng/mL; P < 0.001) after RDN. This was associated with a reduction in platelet membrane P-selectin expression (3 months, P < 0.05; 6 months, P < 0.05), soluble P-selectin (6 months, P < 0.05), circulating numbers of platelet-derived extracellular vesicles (EVs) (3 months, P < 0.001; 6 months, P < 0.01), and phosphatidylserine expressing EVs (3 months, P < 0.001; 6 months, P < 0.0001), indicative of a reduction in platelet activation status and procoagulant activity. Only patients who responded to RDN with a BP reduction showed inhibition of P-selectin expression at 3 months (P < 0.05) and 6 months (P < 0.05) as well as reduction of glycoprotein IIb/IIIa activation at 3 months (P < 0.05). Notably, 13 patients who took aspirin did not show significant reduction in platelet P-selectin expression following RDN. CONCLUSION Our results imply a connection between the sympathetic nervous system and the platelet activation status and provide a potential mechanistic explanation by which RDN can have favourable effects towards reducing cardiovascular complications.
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Affiliation(s)
- Maria T K Zaldivia
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Dagmara Hering
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Petra Marusic
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia
| | - Yusuke Sata
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Rebecca Lee
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Murray D Esler
- Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Nay M Htun
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Jacqueline Duval
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Louise Hammond
- Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Ulrike Flierl
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Xiaowei Wang
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Grant R Drummond
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, Australia
| | - Antony Walton
- Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Elizabeth E Gardiner
- ACRF Department of Cancer Biology and Therapeutics, John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Robert K Andrews
- Department of Medicine, Monash University, Melbourne, Australia.,Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Markus P Schlaich
- Department of Medicine, Monash University, Melbourne, Australia.,Neurovascular Hypertension and Kidney Disease, Baker Heart and Diabetes Institute, Melbourne, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.,Department of Medicine, Monash University, Melbourne, Australia.,Heart Centre, Alfred Hospital, Melbourne, Australia
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3
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Baratchi S, Zaldivia MTK, Wallert M, Loseff-Silver J, Al-Aryahi S, Zamani J, Thurgood P, Salim A, Htun NM, Stub D, Vahidi P, Duffy SJ, Walton A, Nguyen TH, Jaworowski A, Khoshmanesh K, Peter K. Transcatheter Aortic Valve Implantation Represents an Anti-Inflammatory Therapy Via Reduction of Shear Stress-Induced, Piezo-1-Mediated Monocyte Activation. Circulation 2020; 142:1092-1105. [PMID: 32697107 DOI: 10.1161/circulationaha.120.045536] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Aortic valve stenosis is an increasingly prevalent degenerative and inflammatory disease. Transcatheter aortic valve implantation (TAVI) has revolutionized its treatment, thereby avoiding its life-threatening/disabling consequences. Whether aortic valve stenosis is accelerated by inflammation and whether it is itself a cause of inflammation are unclear. We hypothesized that the large shear forces exerted on circulating cells, particularly on the largest circulating cells, monocytes, while passing through stenotic aortic valves result in proinflammatory effects that are resolved with TAVI. METHODS TAVI provides a unique opportunity to compare the activation status of monocytes under high shear stress (before TAVI) and under low shear stress (after TAVI). The activation status of monocytes was determined with a single-chain antibody, MAN-1, which is specific for the activated β2-integrin Mac-1. Monocyte function was further characterized by the adhesion of myocytes to stimulated endothelial cells, phagocytic activity, uptake of oxidized low-density lipoprotein, and cytokine expression. In addition, we designed a microfluidic system to recapitulate the shear rate conditions before and after TAVI. We used this tool in combination with functional assays, Ca2+ imaging, siRNA gene silencing, and pharmacological agonists and antagonists to identify the key mechanoreceptor mediating the shear stress sensitivity of monocytes. Last, we stained for monocytes in explanted stenotic aortic human valves. RESULTS The resolution of high shear stress through TAVI reduces Mac-1 activation, cellular adhesion, phagocytosis, oxidized low-density lipoprotein uptake, and expression of inflammatory markers in monocytes and plasma. Using microfluidics and pharmacological and genetic studies, we could recapitulate high shear stress effects on isolated human monocytes under highly controlled conditions, showing that shear stress-dependent calcium influx and monocyte adhesion are mediated by the mechanosensitive ion channel Piezo-1. We also demonstrate that the expression of this receptor is shear stress dependent and downregulated in patients receiving TAVI. Last, we show monocyte accumulation at the aortic side of leaflets of explanted aortic valves. CONCLUSIONS We demonstrate that high shear stress, as present in patients with aortic valve stenosis, activates multiple monocyte functions, and we identify Piezo-1 as the mainly responsible mechanoreceptor, representing a potentially druggable target. We demonstrate an anti-inflammatory effect and therefore a novel therapeutic benefit of TAVI.
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Affiliation(s)
- Sara Baratchi
- School of Health and Biomedical Sciences (S.B., S.A.-A., P.V., A.J., K.P.), RMIT University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (S.B., M.T.K.J., M.W., J.L.-S., A.S., N.M.H., D.S., K.P.)
| | - Maria T K Zaldivia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (S.B., M.T.K.J., M.W., J.L.-S., A.S., N.M.H., D.S., K.P.)
| | - Maria Wallert
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (S.B., M.T.K.J., M.W., J.L.-S., A.S., N.M.H., D.S., K.P.)
| | - Julia Loseff-Silver
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (S.B., M.T.K.J., M.W., J.L.-S., A.S., N.M.H., D.S., K.P.)
| | - Sefaa Al-Aryahi
- School of Health and Biomedical Sciences (S.B., S.A.-A., P.V., A.J., K.P.), RMIT University, Melbourne, Victoria, Australia
| | - Jalal Zamani
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (J.Z., N.M.H., D.S., S.J.D., A.W., K.P.)
| | - Peter Thurgood
- School of Engineering (P.T., K.K.), RMIT University, Melbourne, Victoria, Australia
| | - Agus Salim
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (S.B., M.T.K.J., M.W., J.L.-S., A.S., N.M.H., D.S., K.P.)
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia (A.S.)
| | - Nay M Htun
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (S.B., M.T.K.J., M.W., J.L.-S., A.S., N.M.H., D.S., K.P.)
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (J.Z., N.M.H., D.S., S.J.D., A.W., K.P.)
| | - Dion Stub
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (S.B., M.T.K.J., M.W., J.L.-S., A.S., N.M.H., D.S., K.P.)
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (J.Z., N.M.H., D.S., S.J.D., A.W., K.P.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (D.S.)
| | - Parisa Vahidi
- School of Health and Biomedical Sciences (S.B., S.A.-A., P.V., A.J., K.P.), RMIT University, Melbourne, Victoria, Australia
| | - Stephen J Duffy
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (J.Z., N.M.H., D.S., S.J.D., A.W., K.P.)
| | - Antony Walton
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (J.Z., N.M.H., D.S., S.J.D., A.W., K.P.)
| | - Thanh Ha Nguyen
- Cardiology Department, Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia (T.H.N.)
| | - Anthony Jaworowski
- School of Health and Biomedical Sciences (S.B., S.A.-A., P.V., A.J., K.P.), RMIT University, Melbourne, Victoria, Australia
| | | | - Karlheinz Peter
- School of Health and Biomedical Sciences (S.B., S.A.-A., P.V., A.J., K.P.), RMIT University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (S.B., M.T.K.J., M.W., J.L.-S., A.S., N.M.H., D.S., K.P.)
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia (J.Z., N.M.H., D.S., S.J.D., A.W., K.P.)
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4
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Diehl P, Nienaber F, Zaldivia MTK, Stamm J, Siegel PM, Mellett NA, Wessinger M, Wang X, McFadyen JD, Bassler N, Puetz G, Htun NM, Braig D, Habersberger J, Helbing T, Eisenhardt SU, Fuller M, Bode C, Meikle PJ, Chen YC, Peter K. Lysophosphatidylcholine is a Major Component of Platelet Microvesicles Promoting Platelet Activation and Reporting Atherosclerotic Plaque Instability. Thromb Haemost 2019; 119:1295-1310. [PMID: 31378855 DOI: 10.1055/s-0039-1683409] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Microvesicles (MVs) are small cell-derived vesicles, which are mainly released by activated cells. They are part of a communication network delivering biomolecules, for example, inflammatory molecules, via the blood circulation to remote cells in the body. Platelet-derived MVs are known to induce vascular inflammation. Research on the mediators and mechanisms of their inflammatory effects has attracted major interest. We hypothesize that specific lipids are the mediators of vascular inflammation caused by platelet-derived MVs. METHODS AND RESULTS Liquid chromatography electrospray ionization-tandem mass spectrometry was used for lipid profiling of platelet-derived MVs. Lysophosphatidylcholine (LPC) was found to be a major component of platelet-derived MVs. Investigating the direct effects of LPC, we found that it induces platelet activation, spreading, migration and aggregation as well as formation of inflammatory platelet-monocyte aggregates. We show for the first time that platelets express the LPC receptor G2AR, which mediates LPC-induced platelet activation. In a mouse model of atherosclerotic plaque instability/rupture, circulating LPC was detected as a surrogate marker of plaque instability. These findings were confirmed by matrix-assisted laser desorption ionization imaging, which showed that the LPC concentration of human plaques was highest in vulnerable plaque regions. CONCLUSION LPC is a major component of platelet-derived MVs and via its interaction with G2AR on platelets contributes to platelet activation, spreading, migration and aggregation and ultimately to vascular inflammation. Circulating LPC reports on atherosclerotic plaque instability in mice and is significantly increased in unstable areas of atherosclerotic plaques in both mice and humans, linking LPC to plaque instability.
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Affiliation(s)
- Philipp Diehl
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Frederik Nienaber
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Maria T K Zaldivia
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Johannes Stamm
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Patrick M Siegel
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Natalie A Mellett
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Marius Wessinger
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Xiaowei Wang
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - James D McFadyen
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Nicole Bassler
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Gerhard Puetz
- Institute for Clinical Chemistry and Laboratory Medicine, University of Freiburg, Freiburg, Germany
| | - Nay M Htun
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - David Braig
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia.,Department of Plastic and Hand Surgery, University of Freiburg, Freiburg, Germany
| | - Jonathon Habersberger
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Thomas Helbing
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, University of Freiburg, Freiburg, Germany
| | - Maria Fuller
- Centre for Molecular Pathology, University of Adelaide, Adelaide, Australia
| | - Christoph Bode
- Department of Cardiology and Angiology I, Faculty of Medicine, Heart Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Peter J Meikle
- Metabolomics Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Yung Chih Chen
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Karlheinz Peter
- Department of Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Australia
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5
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Carnagarin R, Matthews V, Zaldivia MTK, Peter K, Schlaich MP. The bidirectional interaction between the sympathetic nervous system and immune mechanisms in the pathogenesis of hypertension. Br J Pharmacol 2018; 176:1839-1852. [PMID: 30129037 DOI: 10.1111/bph.14481] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/26/2018] [Accepted: 08/05/2018] [Indexed: 12/14/2022] Open
Abstract
Over the last few years, evidence has accumulated to suggest that hypertension is, at least in part, an immune-mediated inflammatory disorder. Many links between immunity and hypertension have been established and provide a complex framework of mechanistic interactions contributing to the rise in BP. These include immune-mediated inflammatory processes affecting regulatory brain nuclei and interactions with other mediators of cardiovascular regulation such as the sympathetic nervous system. Sympathoexcitation differentially regulates T-cells based upon activation status of the immune cell as well as the resident organ. Exogenous and endogenous triggers activate signalling pathways in innate and adaptive immune cells resulting in pro-inflammatory cytokine production and activation of T-lymphocytes in the cardiovascular and renal regions, now considered major factors in the development of essential hypertension. The inflammatory cascade is sustained and exacerbated by the immune flow via the brain-bone marrow-spleen-gastrointestinal axis and thereby further aggravating immune-mediated pathways resulting in a vicious cycle of established hypertension and target organ damage. This review summarizes the evidence and recent advances in linking immune-mediated inflammation, sympathetic activation and their bidirectional interactions with the development of hypertension. LINKED ARTICLES: This article is part of a themed section on Immune Targets in Hypertension. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.12/issuetoc.
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Affiliation(s)
- Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Vance Matthews
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Maria T K Zaldivia
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia.,Department of Medicine, Monash University, Royal Perth Hospital, Perth, WA, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia.,Department of Medicine, Monash University, Royal Perth Hospital, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine - Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia.,Department of Nephrology, Royal Perth Hospital, Perth, WA, Australia
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6
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Zaldivia MTK, McFadyen JD, Lim B, Wang X, Peter K. Platelet-Derived Microvesicles in Cardiovascular Diseases. Front Cardiovasc Med 2017; 4:74. [PMID: 29209618 PMCID: PMC5702324 DOI: 10.3389/fcvm.2017.00074] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022] Open
Abstract
Microvesicles (MVs) circulating in the blood are small vesicles (100–1,000 nm in diameter) derived from membrane blebs of cells such as activated platelets, endothelial cells, and leukocytes. A growing body of evidence now supports the concept that platelet-derived microvesicles (PMVs), the most abundant MVs in the circulation, are important regulators of hemostasis, inflammation, and angiogenesis. Compared with healthy individuals, a large increase of circulating PMVs has been observed, particularly in patients with cardiovascular diseases. As observed in MVs from other parent cells, PMVs exert their biological effects in multiple ways, such as triggering various intercellular signaling cascades and by participating in transcellular communication by the transfer of their “cargo” of cytoplasmic components and surface receptors to other cell types. This review describes our current understanding of the potential role of PMVs in mediating hemostasis, inflammation, and angiogenesis and their consequences on the pathogenesis of cardiovascular diseases, such as atherosclerosis, myocardial infarction, and venous thrombosis. Furthermore, new developments of the therapeutic potential of PMVs for the treatment of cardiovascular diseases will be discussed.
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Affiliation(s)
- Maria T K Zaldivia
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - James D McFadyen
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia.,Department of Haematology, The Alfred Hospital, Melbourne, VIC, Australia
| | - Bock Lim
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Xiaowei Wang
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia
| | - Karlheinz Peter
- Atherothrombosis and Vascular Biology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Medicine, Monash University, Melbourne, VIC, Australia.,Heart Centre, The Alfred Hospital, Melbourne, VIC, Australia
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7
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Zaldivia MTK, Rivera J, Hering D, Marusic P, Sata Y, Lim B, Eikelis N, Lee R, Lambert GW, Esler MD, Htun NM, Duval J, Hammond L, Eisenhardt SU, Flierl U, Schlaich MP, Peter K. Renal Denervation Reduces Monocyte Activation and Monocyte-Platelet Aggregate Formation: An Anti-Inflammatory Effect Relevant for Cardiovascular Risk. Hypertension 2016; 69:323-331. [PMID: 27956575 DOI: 10.1161/hypertensionaha.116.08373] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/17/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023]
Abstract
Overactivation of renal sympathetic nervous system and low-grade systemic inflammation are common features of hypertension. Renal denervation (RDN) reduces sympathetic activity in patients with resistant hypertension. However, its effect on systemic inflammation has not been examined. We prospectively investigated the effect of RDN on monocyte activation and inflammation in patients with uncontrolled hypertension scheduled for RDN. Ambulatory blood pressure, monocyte, and monocyte subset activation and inflammatory markers were assessed at baseline, 3 months, and 6 months after procedure in 42 patients. RDN significantly lowered blood pressure at 3 months (150.5±11.2/81.0±11.2 mm Hg to 144.7±11.8/77.9±11.0 mm Hg), which was sustained at 6 months (144.7±13.8/78.6±11.0 mm Hg). Activation status of monocytes significantly decreased at 3 months (P<0.01) and 6 months (P<0.01) after the procedure. In particular, classical monocyte activation was reduced at 6 months (P<0.05). Similarly, we observed a reduction of several inflammatory markers, including monocyte-platelet aggregates (3 months, P<0.01), plasma monocyte chemoattractant protein-1 levels (3 months, P<0.0001; 6 months, P<0.05), interleukin-1β (3 months, P<0.05; 6 months, P<0.05), tumor necrosis factor-α (3 months, P<0.01; 6 months, P<0.05), and interleukin-12 (3 months, P<0.01; 6 months, P<0.05). A positive correlation was observed between muscle sympathetic nerve activity and monocyte activation before and after the procedure. These results indicate that inhibition of sympathetic activity via RDN is associated with a reduction of monocyte activation and other inflammatory markers in hypertensive patients. These findings point to a direct interaction between the inflammatory and sympathetic nervous system, which is of central relevance for the understanding of beneficial cardiovascular effects of RDN.
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Affiliation(s)
- Maria T K Zaldivia
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Jennifer Rivera
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Dagmara Hering
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Petra Marusic
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Yusuke Sata
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Bock Lim
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Nina Eikelis
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Rebecca Lee
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Gavin W Lambert
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Murray D Esler
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Nay M Htun
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Jacqueline Duval
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Louise Hammond
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Steffen U Eisenhardt
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Ulrike Flierl
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Markus P Schlaich
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.)
| | - Karlheinz Peter
- From the Atherothrombosis and Vascular Biology (M.T.K.Z., J.R., B.L., N.M.H., S.U.E., U.F., K.P.) and Neurovascular Hypertension and Kidney Disease Laboratory (D.H., P.M., Y.S., N.E., R.L., G.W.L., M.D.E., J.D., L.H., M.P.S.), Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Department of Medicine, Monash University, Melbourne (M.T.K.Z., N.M.H., M.P.S., K.P.); Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, University of Western Australia, Australia (D.H., P.M., M.P.S.); and Department of Plastic and Hand Surgery, University Medical Centre, Freiburg, Germany (S.U.E.).
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8
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Flierl U, Nero TL, Lim B, Arthur JF, Yao Y, Jung SM, Gitz E, Pollitt AY, Zaldivia MTK, Jandrot-Perrus M, Schäfer A, Nieswandt B, Andrews RK, Parker MW, Gardiner EE, Peter K. Phosphorothioate backbone modifications of nucleotide-based drugs are potent platelet activators. ACTA ACUST UNITED AC 2015; 212:129-37. [PMID: 25646267 PMCID: PMC4322051 DOI: 10.1084/jem.20140391] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Flierl et al. show that phosphorothioate (PS) oligonucleotides activate platelets via interacting with the collagen receptor GPVI. As PS backbone modification is currently used for nucleotide-based drug candidates, the findings suggest that this widely used method may present a risk to patients in the form of arterial thrombosis. Nucleotide-based drug candidates such as antisense oligonucleotides, aptamers, immunoreceptor-activating nucleotides, or (anti)microRNAs hold great therapeutic promise for many human diseases. Phosphorothioate (PS) backbone modification of nucleotide-based drugs is common practice to protect these promising drug candidates from rapid degradation by plasma and intracellular nucleases. Effects of the changes in physicochemical properties associated with PS modification on platelets have not been elucidated so far. Here we report the unexpected binding of PS-modified oligonucleotides to platelets eliciting strong platelet activation, signaling, reactive oxygen species generation, adhesion, spreading, aggregation, and thrombus formation in vitro and in vivo. Mechanistically, the platelet-specific receptor glycoprotein VI (GPVI) mediates these platelet-activating effects. Notably, platelets from GPVI function–deficient patients do not exhibit binding of PS-modified oligonucleotides, and platelet activation is fully abolished. Our data demonstrate a novel, unexpected, PS backbone–dependent, platelet-activating effect of nucleotide-based drug candidates mediated by GPVI. This unforeseen effect should be considered in the ongoing development programs for the broad range of upcoming and promising DNA/RNA therapeutics.
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Affiliation(s)
- Ulrike Flierl
- Baker IDI Heart and Diabetes Institute, St. Vincent's Institute of Medical Research, and Bio21 Institute, University of Melbourne, Melbourne, Victoria 3010, Australia Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | - Tracy L Nero
- Baker IDI Heart and Diabetes Institute, St. Vincent's Institute of Medical Research, and Bio21 Institute, University of Melbourne, Melbourne, Victoria 3010, Australia Baker IDI Heart and Diabetes Institute, St. Vincent's Institute of Medical Research, and Bio21 Institute, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Bock Lim
- Baker IDI Heart and Diabetes Institute, St. Vincent's Institute of Medical Research, and Bio21 Institute, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Jane F Arthur
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria 3004, Australia
| | - Yu Yao
- Baker IDI Heart and Diabetes Institute, St. Vincent's Institute of Medical Research, and Bio21 Institute, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Stephanie M Jung
- Department of Biochemistry, University of Cambridge, Cambridge CB2 1GA, England, UK
| | - Eelo Gitz
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, England, UK
| | - Alice Y Pollitt
- Centre for Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, England, UK
| | - Maria T K Zaldivia
- Baker IDI Heart and Diabetes Institute, St. Vincent's Institute of Medical Research, and Bio21 Institute, University of Melbourne, Melbourne, Victoria 3010, Australia
| | | | - Andreas Schäfer
- Department of Cardiology and Angiology, Hannover Medical School, 30625 Hannover, Germany
| | - Bernhard Nieswandt
- Rudolf Virchow Centre for Experimental Biomedicine, D-97080 Würzburg, Germany
| | - Robert K Andrews
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria 3004, Australia
| | - Michael W Parker
- Baker IDI Heart and Diabetes Institute, St. Vincent's Institute of Medical Research, and Bio21 Institute, University of Melbourne, Melbourne, Victoria 3010, Australia Baker IDI Heart and Diabetes Institute, St. Vincent's Institute of Medical Research, and Bio21 Institute, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Elizabeth E Gardiner
- Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria 3004, Australia
| | - Karlheinz Peter
- Baker IDI Heart and Diabetes Institute, St. Vincent's Institute of Medical Research, and Bio21 Institute, University of Melbourne, Melbourne, Victoria 3010, Australia
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