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Platelets have a key physiological role in haemostasis however, inappropriate thrombus formation can lead to cardiovascular diseases such as myocardial infarction or stroke. Although, such diseases are common worldwide there are comparatively few anti-platelet drugs, and these are associated with an increased risk of bleeding. Platelets also have roles in thrombo-inflammation, immuno-thrombosis and cancer, in part via C-type lectin-like receptor 2 (CLEC-2) and its ligand podoplanin. Although CLEC-2 contributes to these diseases in mice, as well as to thrombus stability, it is unclear whether CLEC-2 has similar roles in humans, particularly as human CLEC-2 (hCLEC-2) cannot be investigated experimentally in vivo.
To investigate hCLEC-2 in vivo, we generated a humanised CLEC-2 mouse (hCLEC-2KI) model, as well as a novel monoclonal antibody, HEL1, that binds to a different site than an existing antibody, AYP1. Using these antibodies, we have provided proof of principle for the use of hCLEC-2KI mice to test potential therapeutics targeting hCLEC-2, and shown for the first time that hCLEC-2 can be immunodepleted, with little effect on haemostasis. However, our results have also suggested that there are species differences in the role of CLEC-2 in arterial thrombosis. We further confirmed this using human blood where blocking CLEC-2 ligand binding had no effect on thrombosis, whereas we confirmed a minor role for mouse CLEC-2 in thrombus stability. We also investigated the effect of blocking CLEC-2 signalling using the Bruton’s tyrosine kinase inhibitor PRN473 on CLEC-2 mediated immuno-thrombosis in a Salmonella typhimurium infection model. However, no effect on thrombosis was observed suggesting that CLEC-2 signalling is not involved.
Overall, our results suggest that there may be differences in the role of human and mouse CLEC-2, at least in arterial thrombosis, which could limit the potential of CLEC-2 as an anti-thrombotic target. However, it appears that the interaction between CLEC-2 and podoplanin is conserved and therefore CLEC-2 could still be a therapeutic target in immuno-thrombosis, thrombo-inflammation and cancer. Furthermore, any potential human specific therapeutics could be investigated in vivo using hCLEC-2KI mice.
Platelets, small anucleate cell fragments in the blood stream, derive from large precursor cells, so-called megakaryocytes (MK) residing in the bone marrow (BM). In addition to their role in wound healing, platelets have been shown to play a significant role during inflammatory bleeding. Above all, the immunoreceptor tyrosine-based activation motif (ITAM) receptors GPVI as well as CLEC-2 have been identified as main regulators of vascular integrity.
In addition to ITAM-bearing receptors, our group identified GPV as another potent regulator of hemostasis and thrombosis. Surprisingly, concomitant lack of GPV and CLEC-2 deteriorated blood-lymphatic misconnections observed in Clec2-/- mice resulting in severe edema formation and intestinal inflammation. Analysis of lymphatic and vascular development in embryonic mesenteries revealed severely defective blood-lymph-vessel separation, which translated into thrombocytopenia and increased vascular permeability due to reduced tight junction density in mesenteric blood vessels and consequent leakage of blood into the peritoneal cavity.
Recently, platelet granule release has been proposed to ameliorate the progression of retinopathy of prematurity (ROP), a fatal disease in newborns leading to retinal degradation. The mechanisms governing platelet activation in this process remained elusive nonetheless, which prompted us to investigate a possible role of ITAM signaling. In the second part of this thesis, granule release during ROP was shown to be GPVI- and partly CLEC-2-triggered since blockade or loss of these receptors markedly deteriorated ROP progression.
Proplatelet formation from MKs is highly dependent on a functional microtubule and actin cytoskeleton, the latter of which is regulated by several actin-monomer binding proteins including Cofilin1 and Twinfilin1 that have been associated with actin-severing at pointed ends. In the present study, a redundancy between both proteins especially important for the guided release of proplatelets into the bloodstream was identified, since deficiency in both proteins markedly impaired MK functionality mainly due to altered actin-microtubule crosstalk.
Besides ITAM-triggered activation, platelets and MKs are dependent on inhibitory receptors, which prevent overshooting activation. We here identified macrothrombocytopenic mice with a mutation within Mpig6b encoding the ITIM-bearing receptor G6b-B. G6b-B-mutant mice developed a severe myelofibrosis associated with sex-specific bone remodeling defects resulting in osteosclerosis and -porosis in female mice. Moreover, G6b-B was shown to be indispensable for MK maturation as verified by a significant reduction in MK-specific gene expression in G6b-B-mutant MKs due to reduced GATA-1 activity.
Platelets are small anucleated cell fragments that originate from megakaryocytes (MKs), which are large cells located in the bone marrow (BM). MKs extend long cytoplasmic protrusions, a process which is called proplatelet formation, into the lumen of the sinusoidal vessels where platelets are sized by the bloodstream. During the process of platelet biogenesis, segments of the MK penetrate the endothelium and, through cytoskeletal remodeling inside the MK, proplatelet fragments are released. Rho GTPases, such as RhoA and RhoB, are critically involved in cytoskeletal rearrangements of both the actin and the tubulin cytoskeleton.
The first part of this thesis concentrated on the protein RhoB and its involvement in cytoskeletal organization in MKs and platelets. Single knockout (KO) mice lacking RhoB had a minor microthrombocytopenia, which means a smaller platelet size and reduced platelet number, accompanied by defects in the microtubule cytoskeleton in both MKs and platelets. In particular, tubulin organization and stability, which is regulated by posttranslational modifications of α-tubulin, were disturbed in RhoB-/- platelets. In contrast, RhoB-/- MKs produced abnormally shaped proplatelets but had unaltered posttranslational modifications of α-tubulin.
The second part focused on the influence of RhoA and RhoB on MK localization and platelet biogenesis in murine BM. Many intact RhoA-/- MKs are able to transmigrate through the endothelial layer and stay attached to the vessel wall, whereas only 1% of wildtype (wt) MKs are detectable in the intrasinusoidal space. Concomitant deficiency of RhoA and RhoB reverts this transmigration and results in macrothrombocytopenia, MK clusters around the vessel in the BM and defective MK development. The underlying mechanism that governs MKs to distinct localizations in the BM is poorly understood, thus this thesis suggests that this process may be dependent on RhoB protein levels, as RhoA deficiency is coincided with increased RhoB levels in MKs and platelets.
The third part of this thesis targeted the protein PDK1, a downstream effector of Rho GTPases, in regard to MK maturation and polarization throughout thrombopoiesis. MK- and platelet-specific KO in mice led to a significant macrothrombocytopenia, impaired actin cytoskeletal reorganization during MK spreading and proplatelet formation, with defective MK maturation. This was associated with decreased PAK activity and, subsequently, phosphorylation of its substrates LIMK and Cofilin. Together, the observations of this thesis highlight the importance of Rho GTPases and their downstream effectors on the regulation of the MK and platelet cytoskeleton.
Divalent cations are important second messengers triggering various signal transduction events in platelets. Whereas calcium channel blockers have an established antithrombotic effect and the regulation of Ca2+ homeostasis has been elucidated in platelets, the molecular regulation of Mg2+ and Zn2+ homeostasis has not been investigated so far.
In the first part of the thesis, the role of -type serine-threonine kinase linked to transient receptor potential cation channel, subfamily M, member 7 (TRPM7) in platelets was investigated. Using Trpm7R/R mice with a point mutation deleting the kinase activity, we showed that the TRPM7 kinase regulates platelet activation via immunoreceptor tyrosine-based activation motif (ITAM), hem(ITAM) and protease-activated receptor (PAR) signaling routes. Furthermore, Trpm7R/R mice were protected from in vivo thrombosis and stroke, thus establishing TRPM7 kinase as a promising anti-thrombotic target.
In the second part of the thesis, the role of TRPM7 channel in a megakaryocyte (MK) and platelet-specific knockout mouse, Trpm7fl/fl-Pf4Cre, was investigated. Here, we observed that depending on the type of stimulation, Trpm7fl/fl-Pf4Cre platelets showed either enhanced or inhibited responses. Although Trpm7fl/fl-Pf4Cre mice were thrombocytopenic, no differences to wildtype mice were observed in models of in vivo thrombosis and stroke. The above two studies highlight that inhibition of TRPM7 kinase but not the channel itself (in MKs and platelets) may be a promising anti-thrombotic strategy.
Besides TRPM7, we investigated the role of magnesium transporter 1 (MAGT1) in platelet Mg2+ homeostasis and found that MAGT1 primarily regulates receptor-operated calcium entry (ROCE) in platelets specifically upon GPVI activation. This physiological crosstalk is triggered by protein kinase C (PKC) isoforms. Platelets from Magt1-/y mice hyper-reacted to GPVI and thromboxane A2 (TXA2) receptor stimulation in vitro. Consequently, Magt1-/y platelets were found to be pro-thrombotic in disease models of thrombosis and stroke.
To compare platelet ITAM-signaling to the immune system, we further investigated the role of MAGT1 in T and B cells. We described the primary role of MAGT1 in mice under pathogen-free conditions. Magt1-/y B cells showed dysregulated Mg2+ and Ca2+ homeostasis upon B-cell receptor activation, thereby altering Syk, LAT, phospholipase C (PLC)2 and PKC phosphorylation. In contrast to human MAGT1-deficient T cells, development and effector functions of mouse Magt1-/y T cells showed no alterations.
Finally, in the last part of the thesis, we described methods to measure intracellular free zinc [Zn2+]i in human and mouse platelets with storage pool disease (SPD). We propose to measure the [Zn2+]i status in SPD platelets as a relatively easy diagnostic to screen platelet granule abnormalities.
Platelet activation and aggregation at sites of vascular injury involves massive cytoskeletal re-organization, which is required for proper platelet function. Moreover, the cytoskeleton plays central roles in megakaryo- and thrombopoiesis. Thus, cytoskeletal protein aberrations can be the underlying reason for many pathological phenotypes. Although intensive research is carried out to identify the key players involved in cytoskeletal reorganization, the signaling cascades orchestrating these complex processes are still poorly understood. This thesis investigates the role of three actin-binding proteins, Coactosin-like (Cotl) 1, Profilin (Pfn) 1 and Thymosin (T) β4, in platelet formation and function using genetically modified mice.
ADF-H-containing proteins such as Twinfilin or Cofilin are well characterized as regulators of thrombopoesis and cytoskeletal reorganization. Although Cotl1 belongs to the ADF-H protein family, lack of Cotl1 did not affect platelet count or cytoskeletal dynamics. However, Cotl1-deficiency resulted in significant protection from arterial thrombus formation and ischemic stroke in vivo. Defective GPIb-vWF interactions and altered second wave mediator release present potential reasons for the beneficial effect of Cotl1-deficiency. These results reveal an unexpected function of Cotl1 as a regulator of thrombosis and hemostasis, establishing it as a potential target for a safe therapeutic therapy to prevent arterial thrombosis or ischemic stroke.
Recent studies showed that the organization of the circumferential actin cytoskeleton modulates calpain-mediated αIIbβ3 integrin closure, thereby also controlling αIIbβ3 integrin localization. The second part of this thesis identified the actin-sequestering protein Pfn1 as a central regulator of platelet integrin function as Pfn1-deficient platelets displayed almost abolished αIIbβ3 integrin signaling. This translated into a profound protection from arterial thrombus formation and prolonged tail bleeding times in vivo which was caused by enhanced calpain-dependent integrin closure. These findings further emphasize the importance of a functional actin cytoskeleton for intact platelet function in vitro and in vivo.
Tβ4 is a moonlighting protein, acting as one of the major actin-sequestering proteins in cells of higher eukaryotes and exerting various paracrine functions including anti-inflammatory, immunomodulatory and pro-angiogenic effects. Although excessively studied, its role for cytoskeletal dynamics, the distinction between endo- and exogenous protein function and its uptake and release mechanisms are still poorly understood. Constitutive Tβ4-deficiency resulted in thrombocytopenia accompanied by a largely diminished G-actin pool in platelets and divergent effects on platelet reactivity. Pre-incubation of platelets with recombinant Tβ4 will help to understand the function of endo- and exogenous protein, which is under current investigation.
Maintenance of tumor vasculature integrity is indispensable for tumor growth and thus affects tumor progression. Previous studies have identified platelets as major regulators of tumor vascular integrity, as their depletion selectively renders tumor vessels highly permeable, causing massive intratumoral hemorrhage. While these results establish platelets as potential targets for anti-tumor therapy, depletion is not a treatment option due to the essential role of platelets for hemostasis. This thesis demonstrates for the first time that functional inhibition of glycoprotein (GP) VI on the platelet surface rapidly induces tumor hemorrhage and diminishes tumor growth similar to complete platelet depletion but without inducing systemic bleeding complications. Both, the intratumoral bleeding and tumor growth arrest could be reverted by depletion of Ly6G+ cells confirming them to be responsible for the induction of bleeding and necrosis within the tumor. In addition, GPVI inhibition increased intra-tumoral accumulation of co-administered chemotherapeutic agents, thereby resulting in a profound anti-tumor effect. In summary, this thesis manifests platelet GPVI as a key regulator of vascular integrity specifically in growing tumors, serving as a potential basis for the development of anti-tumor strategies.
In the second part of this thesis, light is shed on the modulating role of bridging integrator 2 (BIN2) in platelet Ca2+ signaling. Stromal interaction molecule 1 (STIM1) mediated store-operated calcium entry (SOCE) is the major route of Ca2+ influx in platelets, triggered by inositol trisphosphate receptor (IP3R)-dependent Ca2+ store release. In this thesis, the BAR domain superfamily member BIN2 was identified as the first Ca2+ signaling modulator, interacting with both, STIM1 and IP3R in platelets. Deletion of BIN2 resulted in reduced Ca2+ store release and Ca2+ influx in response to all tested platelet agonists. These defects were a consequence of impaired IP3R function in combination with defective STIM1-mediated SOC channel activation, while Ca2+ store content and agonist-induced IP3 production were unaltered. These results establish BIN2 as a central regulator of platelet Ca2+ signaling.
The third part of this thesis focuses on the effect of the soluble neuronal guidance protein Sema7A on platelet function. Rosenberger et al. discovered that Sema7A cleavage from red blood cells increases the formation of platelet-neutrophil complexes, thereby reinforcing thrombo-inflammation in myocardial ischemia-reperfusion injury (MIRI). This thesis establishes soluble Sema7A as a stimulator of platelet thrombus formation via its interaction with platelet GPIbα, thereby reinforcing PNC formation. Thus, interfering with the GPIb-Sema7A interaction during MIRI represents a potential strategy to reduce cardiac damage and improve clinical outcome following MI.
Zusammenhang zwischen der Serumkonzentration serotonerger Antidepressiva und der Blutgerinnung
(2019)
Das Verordnungsvolumen von Antidepressiva in Deutschland hat sich in den letzten zehn Jahren etwa verdoppelt. Gleichzeitig liegen zahlreiche Untersuchungen über erhöhte Blutungstendenzen unter der Therapie mit serotonergen Antidepressiva vor. Die aktuelle Studienlage deutet darauf hin, dass es unter anderem über das serotonerge System zu Beeinflussungen der Thrombozyteneigenschaften und in Folge dessen zu Veränderungen der Blutgerinnung kommen könnte.
Ziel der vorliegenden Arbeit war es, den Zusammenhang zwischen der Serumkonzentration serotonerger Antidepressiva und der Blutgerinnung zu untersuchen. Im Gegensatz zur Dosis bietet die Serumkonzentration exakte Informationen über die tatsächlich wirkende Antidepressivamenge und berücksichtigt neben der Patientenadhärenz die interindividuelle Variabilität der pharmakokinetischen Eigenschaften. Die Beurteilung der Blutgerinnung erfolgte unter Zuhilfenahme von Gerinnungsparametern (Thrombozytenzahl, mittleres Plättchenvolumen, Quick, INR, partielle Thromboplastinzeit). Es wurde die Hypothese aufgestellt, dass mit steigender Serumkonzentration Veränderungen der Blutgerinnung und in Folge dessen auch der Gerinnungsparameter entstehen können. Darüber hinaus sollte untersucht werden unter welchen Antidepressiva potentielle Veränderungen auftreten. Es wurden Antidepressiva unterschiedlicher Wirkungsgruppen analysiert: Amitriptylin, Doxepin, Es‑Citalopram, Mirtazapin und Venlafaxin. Besonders selektive Serotonin-Wiederaufnahmehemmer standen auf Grund der aktuellen Studienlage im Verdacht Einfluss auf die Gerinnung zu nehmen. Um Antidepressiva spezifische Aussagen treffen zu können, war das Vorliegen einer antidepressiven Monotherapie grundlegendes Selektionskriterium. Alle potenziell gerinnungsbeeinflussenden sowie serotonerg wirkenden Arzneimittel wurden ausgeschlossen. Die Daten wurden retrospektiv erhoben und stammten von stationär therapierten Patienten der Klinik für Psychiatrie, Psychosomatik und Psychotherapie am Universitätsklinikum Würzburg.
Die Untersuchungen ergaben für das trizyklische Antidepressivum Amitriptylin signifikante Ergebnisse. Die interindividuelle Analyse zeigte signifikant positive Korrelationen zwischen der partiellen Thromboplastinzeit (PTT) und dem Metabolitenspiegel (Nortriptylin‑Konzentration, rs=0,564; p=0,010, N=20) sowie dem Summenspiegel von Amitriptylin (Amitriptylin- und Nortriptylin‑Konzentration, rs=0,477; p=0,033, N=20). Darüber hinaus stellten sich im Rahmen der intraindividuellen Analyse signifikante Unterschiede zwischen der Thrombozytenzahl unter niedriger und hoher Amitriptylin‑Konzentration dar (Z= ‑2,867; p=0,004, N=45). Ergänzend wurde im Rahmen von explorativen Untersuchungen der Zusammenhang zwischen der verabreichten Dosis und der Serumkonzentration der Antidepressiva analysiert. Die Ergebnisse zeigten Schwankungen um den Faktor 3 bis 11, die im Vergleich zu anderen Studien geringer ausfielen.
Der Verdacht, dass besonders selektive Serotonin-Wiederaufnahmehemmer einen erhöhten Einfluss auf die Gerinnungsparameter haben, wurde in der aktuellen Arbeit nicht bestätigt. Ebenso waren unter Doxepin, Mirtazapin und Venlafaxin keine Zusammenhänge zur Serumkonzentration zu beobachten. Die signifikanten Ergebnisse unter Amitriptylin lassen vermuten, dass nicht nur die Inhibition von Serotonintransportern, wie bei selektiven Serotonin-Wiederaufnahmehemmern, sondern zusätzlich auch die Hemmung von Serotoninrezeptoren, wie dem 5‑HT2A‑Rezeptor, eine Rolle im Hinblick auf Veränderungen von Thrombozyteneigenschaften spielen. Dennoch lagen im Rahmen dieser Untersuchung 98% der Gerinnungsparameter aller analysierten Antidepressiva im Normbereich.
Die Ergebnisse legen die Vermutung nahe, dass das Risiko immer wieder berichteter Blutungskomplikationen unter der Behandlung mit Antidepressiva trotz zunehmender Verordnungszahlen überschaubar scheint. Entsprechend aktueller Publikationen ist vermutlich erst bei zusätzlicher Einnahme von nichtsteroidalen Antirheumatika sowie antikoagulativen Arzneimitteln von einem erhöhten Blutungsrisiko auszugehen. Besonders gastrointestinale Blutungen spielen bei Kombination dieser Medikamente auf Grund der gesteigerten Magensäuresekretion eine Rolle. Ob die Serumkonzentration der Antidepressiva bei entsprechender Komedikation ebenfalls eine Rolle im Hinblick auf Veränderungen der Gerinnungsparameter spielt, sollte im Rahmen weiterführender Längsschnittstudien genauer untersucht werden. Ergänzend wären Untersuchungen zur Klärung des Kausalzusammenhangs wünschenswert, um das Blutungsrisiko im Zusammenhang mit Antidepressiva in Zukunft weiter minimieren zu können.
Cyclase-associated protein (CAP)2 is an evolutionarily highly conserved actin-binding protein implicated in striated muscle development, carcinogenesis, and wound healing in mammals. To date, the presence as well as the putative role(s) of CAP2 in platelets, however, remain unknown. Therefore, mice constitutively lacking CAP2 (Cap2gt/gt mice) were examined for platelet function. These studies confirmed the presence of both mammalian CAP isoforms, CAP1 and CAP2, in platelets. CAP2-deficient platelets were slightly larger than WT controls and displayed increased GPIIbIIIa activation and P-selectin recruitment in response to the (hem)ITAM-specific agonists collagen-related peptide and rhodocytin. However, spreading of CAP2-deficient platelets on a fibrinogen matrix was unaltered. In conclusion, the functionally redundant CAP1 isoform may compensate for the lack of CAP2 in murine platelets. Moreover, the studies presented in this thesis unveiled a severe macrothrombocytopenia that occurred independently of the targeted Cap2 allele and which was preliminarily termed orphan (orph). Crossing of the respective mice to C57BL/6J wild-type animals revealed an autosomal recessive inheritance. Orph mice were anemic and developed splenomegaly as well as BM fibrosis, suggesting a general hematopoietic defect. Strikingly, BM MKs of orph mice demonstrated an aberrant morphology and appeared to release platelets ectopically into the BM cavity, thus pointing to defective thrombopoiesis as cause for the low platelet counts. Orph platelets exhibited marked activation defects and spread poorly on fibrinogen. The unaltered protein content strongly suggested a defective alpha-granule release to account for the observed hyporesponsiveness. In addition, the cytoskeleton of orph platelets was characterized by disorganized microtubules and accumulations of filamentous actin. However, further experiments are required to elucidate the activation defects and cytoskeletal abnormalities in orph platelets. Above all, the gene mutation responsible for the phenotype of orph mice needs to be determined by next-generation sequencing in order to shed light on the underlying genetic and mechanistic cause.
Activated platelets and coagulation jointly contribute to physiological hemostasis. However, pathological conditions can also trigger unwanted platelet activation and initiation of coagulation resulting in thrombosis and precipitation of ischemic damage of vital organs such as the heart or brain. The specific contribution of procoagulant platelets, positioned at the interface of the processes of platelet activation and coagulation, in ischemic stroke had remained uninvestigated. The first section of the thesis addresses this aspect through experiments conducted in novel megakaryocyte- and platelet-specific TMEM16F conditional KO mice (cKO). cKO platelets phenocopied defects in platelets from Scott Syndrome patients and had severely impaired procoagulant characteristics. This led to decelerated platelet-driven thrombin generation and delayed fibrin formation. cKO mice displayed prolonged bleeding times and impaired arterial thrombosis. However, infarct volumes in cKO mice were comparable to wildtype (WT) mice in an experimental model of ischemic stroke. Therefore, while TMEM16F-regulated platelet procoagulant activity is critical for hemostasis and thrombosis, it is dispensable for cerebral thrombo-inflammation in mice.
The second section describes the generation and initial characterization of a novel knockin mouse strain that expresses human coagulation factor XII (FXII) instead of endogenous murine FXII. These knockin mice had normal occlusion times in an experimental model of arterial thrombosis demonstrating that human FXII is functional in mice. Therefore, these mice constitute a valuable tool for testing novel pharmacological agents against human FXII – an attractive potential target for antithrombotic therapy.
Glycoprotein (GP)VI and C-type lectin-like receptor 2 (CLEC-2)-mediated (hem)immunoreceptor tyrosine-based activation motif (ITAM) signaling represent a major pathway for platelet activation. The last section of the thesis provides experimental evidence for redundant functions between the two members of the Grb2 family of adapter proteins - Grb2 and Gads that lie downstream of GPVI and CLEC-2 stimulation. In vitro and in vivo studies in mice deficient in both Grb2 and Gads (DKO) revealed that DKO platelets had defects in (hem)ITAM-stimulation-specific activation, aggregation and signal transduction that were more severe than the defects observed in single Grb2 KO or Gads KO mice. Furthermore, the specific role of these adapters downstream of (hem)ITAM signaling was essential for maintenance of hemostasis but dispensable for the known CLEC-2 dependent regulation of blood-lymphatic vessel separation.
Nach der Präparation von gewaschenen Thrombozyten, einem wichtigen Ausgangsmaterial für die experimentelle Forschung oder für die Transfusionsmedizin, tritt bekannterweise ein zunehmender Verlust der ADP-vermittelten Aggregationsfähigkeit ein. Die verminderte Funktionsfähigkeit von Thromboyzten nach dem Waschvorgang kann somit auch experimentelle Ergebnisse beeinflussten.
Allerdings sind die dafür verantwortlichen molekularen Mechanismen bisher nicht aufgeklärt, sodass in dieser Dissertationsarbeit molekulare sowie auch funktionelle Vorgänge untersucht wurden, die zum bekannten Phänomen des raschen Verlustes der ADP-vermittelten Aggregationsfähigkeit gewaschener Thrombozyten führen.
Die Wirkung von ADP wird über die drei purinergen Rezeptoren P2Y1, P2X1 und P2Y12 vermittelt wird. Daher wurde zunächst die ADP-induzierte Aggregationsfähigkeit alleine bzw. unter Kostimulation mit Epinephrin oder Serotonin - zwei Induktoren, deren Rezeptoren mit analogen Signalwegen wie die ADP-Rezeptoren P2Y1 bzw. P2Y12 gekoppelt sind - bestimmt. Um Hinweise zu erhalten, wie die Abnahme der ADP-vermittelten Reaktivität von gewaschenen Thrombozyten mit der purinergen Rezeptorexpression und -distribution sowie mit der nachgeschalteten Signalweiterleitung im Zusammenhang steht, wurde zudem die Expression purinerger Rezeptoren auf der Thrombozytenoberfläche bzw. die Konzentration von purinergen Rezeptoren im Zytosol gewaschener Thrombozyten mittels Durchflusszytometrie bzw. ELISA gemessen.
Es zeigte sich, dass die Funktion der den purinergen Rezeptoren nachgeschalteten Signalwege während der Lagerungszeit zunehmend beeinträchtigt wird, aber zumindest teilweise erhalten bleibt, wie anhand von Effekten durch Kostimulation mit den Induktoren Epinephrin und Serotonin gezeigt werden konnte. Die Distribution der Rezeptoren zwischen der Thrombozytenoberfläche und den intrazellulären Kompartimenten unterliegt komplexen Prozessen, die induktorabhängig reguliert sind. Eine initiale Zunahme der Expression von ADP-Rezeptoren während der Lagerung von gewaschenen Thrombozyten geht dabei nicht einher mit der Aufrechterhaltung der ADP-induzierten Aggregation.
In der Schlussfolgerung ist die fortschreitende Degeneration der ADP-vermittelten Aggregation - neben einem Rückgang der Rezeptorexpression nach mehr als einer Stunde Lagerungszeit - vor allem auf einen funktionellen Verlust der purinergen Rezeptoren zurückzuführen.