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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.
Die vorliegende Arbeit untersucht die positiven Auswirkungen des Angiotensin-II-Rezeptor-Antagonisten Telmisartan auf die endotheliale Funktion und Thrombozytenaktivierung bei Ratten mit Streptozotocin-induziertem Diabetes mellitus. In Gefäßreaktivitätsstudien, Luminometer- und Fluoreszenzmessungen und mit Hilfe der Durchflusszytometrie wurden die Wirkungen des Medikamentes überprüft. Es konnte gezeigt werden, dass sich durch Telmisartan die NO-Bioverfügbarkeit verbessert, welche maßgeblich für die endotheliale Funktion verantwortlich ist und durch Ca2+-abhängige Aktivierung der eNOS und dehnungsinduzierte, Ca2+-unabhängigen NO-Bildung beeinflusst wird. Positiv wird des Weiteren die Sensitivität der glatten Gefäßmuskelzellen gegenüber NO beeinflusst, was zur Vasodilatation führt. Die atherosklerosefördernde Superoxidbildung wird zusätzlich reduziert. Es erfolgten außerdem Messungen von thrombozytengebundenem Fibrinogen, dementsprechend der GP IIb/IIIa-Aktivität, und der VASP-Phosphorylierung, demzufolge dem NO/cGMP-Signalweg, in Thrombozyten durch FITC-markierte Antikörper mit Hilfe der Durchflusszytometrie. Es wurde gezeigt, dass die Thrombozytenaktivierung, die für den initialen Schritt der Atherosklerose verantwortlich gemacht wird, durch Telmisartan verringert wird. Alle Messungen wurden vergleichend in einer Kontroll-, Placebo- und Telmisartangruppe durchgeführt. Die beobachtete Blutdrucksenkung ist, nach früheren Betrachtungen, nicht alleine verantwortlich für die verbesserte endotheliale Funktion, welche bei dem Einsatz von AT-II-Antagonisten beobachtet wird. Telmisartan wirkt, laut einer Studie, als einziger AT-II-Antagonist als partieller PPAR-Rezeptor, so dass Insulinresistenz und metabolische Parameter verbessert werden. Über diese Wirkungen beeinflusst Telmisartan auch die endotheliale Funktion und die Thrombozytenaktivierung. Zur Reduktion von vaskulären Komplikationen bei Diabetes mellitus erscheint Telmisartan aufgrund der vorliegenden Ergebnisse als sinnvolle medikamentöse Therapie.
Zum Nachweis einer interindividuellen Variabilität bei der Therapie mit Clopidogrel wurden in dieser Promotionsarbeit Patienten mit ausreichender Therapiedauer auf eine verbleibende Aktivierbarkeit der Thrombozyten untersucht. Hierfür wurde eine auf Phosphorylierung des Proteins VASP basierender Assay, der mittlerweile auch kommerziell verfügbar ist, eingesetzt. Dieser auf einer durchflusszytometrische Analyse beruhende Test zeigte bei 10 % der untersuchten Patienten eine Restaktivierbarkeit der Thrombozyten trotz ausreichender Thienopyridin-Einnahme. Die statistische Analyse erbrachte den Nachweis von zwei Untergruppen: Eine Untergruppe zeigte trotz Clopidogrel-Therapie eine fast normale Aktivierbarkeit der Thrombozyten („non-responder“), die andere zeigt eine teilweise Thrombozytenfunktionshemmung („low-responder“). In der statistischen Analyse wurde eine deutliche Signifikanz der Ergebnisse mittels Students-t-Test festgestellt. Aus zufällig ausgewählten Proben der „non-responder“ und der adäquat reagierenden Patienten konnte eine Veränderung intrazelluläre Signalwege nicht nachgewiesen werden. Nach Veröffentlichung der Gensequenz für den P2Y12 Rezeptor erfolgte die entsprechende Genanalyse bei diesen Patienten. Es konnten 2 stumme Polymophismen nachgewiesen werden, diese jedoch sowohl in der Gruppe der Responder als auch bei Low-/Non-Respondern. Somit wurde in dieser Promotionsarbeit das mittlerweile von verschiedenen Arbeitsgruppen diskutierte, bei etwa 10 % der Patienten auftretende Therapieversagen von Thienopyridinen bestätigt. Eine Genveränderung oder Änderungen intrazellulärer Signalwege konnte als molekulare Ursache nicht gezeigt werden.
In der vorliegenden Arbeit ging es darum, die inhibierende Wirkung von extrazellulär zugefügten GMP-Derivaten auf die Thrombozytenaktivierung nachzuweisen. Anhand verschiedener thrombozytärer Aktivierungsmarker wie ERK, der Expression von P-Selektin und intrazellulärem Kalziumeinstrom zeigte sich eine signifikante Inhibition der Thrombozytenaktivierung durch zyklische GMP-Analoga. Neu ist, dass auch nicht-zyklische GMP-Derivate eindeutig einen hemmenden Effekt aufweisen. Guanosin-Derivate alleine führen dagegen weder zu einer Hemmung noch zu einer vermehrten Stimulation der Plättchenaktivierung. Die Wirkung der GMP-Analoga scheint von der negativen Phosphatgruppe abhängig zu sein. Der frühe Zeitpunkt der Inhibition und die Tatsache, dass auch Hemmer der PKG einen inhibierenden Effekt auf die Thrombozytenaktierung aufweisen, führen zu der Hypothese, dass es sich um PGK-unabhängige Effekte handelt. Der Thrombinrezeptor als Wirkort der GMP-Analoga konnte in Biacore-Messungen ausgeschlossen werden. Es gilt nun, speziell den Thromboxanrezeptor auf mögliche Interaktionen mit GMP-Derivaten hin zu untersuchen.
Sepsis ist ein häufiges und akut lebensbedrohliches Syndrom, das eine Organfunktionsstörung in Folge einer dysregulierten Immunantwort auf eine Infektion beschreibt. Eine frühzeitige Diagnosestellung und Therapieeinleitung sind von zentraler Bedeutung für das Überleben der Patient:innen. In einer Pilotstudie konnte unsere Forschungsgruppe mittels Durchflusszytometrie eine ausgeprägte Hyporeaktivität der Thrombozyten bei Sepsis nachweisen, die einen potenziell neuen Biomarker zur Sepsis-Früherkennung darstellt. Zur Evaluation des Ausmaßes und Entstehungszeitpunktes der detektierten Thrombozytenfunktionsstörung wurden im Rahmen der vorliegenden Arbeit zusätzlich zu Patient:innen mit Sepsis (SOFA-Score ≥ 2; n=13) auch hospitalisierte Patient:innen mit einer Infektion ohne Sepsis (SOFA-Score < 2; n=12) rekrutiert. Beide Kohorten wurden zu zwei Zeitpunkten (t1: <24h; t2: Tag 5-7) im Krankheitsverlauf mittels Durchflusszytometrie und PFA-200 untersucht und mit einer gesunden Kontrollgruppe (n=28) verglichen.
Phänotypische Auffälligkeiten der Thrombozyten bei Sepsis umfassten: (i) eine veränderte Expression verschiedener Untereinheiten des GPIb-IX-V-Rezeptorkomplexes, die auf ein verstärktes Rezeptor-Shedding hindeutet; (ii) ein ausgeprägtes Mepacrin-Beladungsdefizit, das auf eine zunehmend reduzierte Anzahl von δ-Granula entlang des Infektion-Sepsis Kontinuums hinweist; (iii) eine Reduktion endständig gebundener Sialinsäure im Sinne einer verstärkten Desialylierung. Die funktionelle Analyse der Thrombozyten bei Sepsis ergab bei durchflusszytometrischer Messung der Integrin αIIbβ3-Aktivierung (PAC-1-Bindung) eine ausgeprägte generalisierte Hyporeaktivität gegenüber multiplen Agonisten, die abgeschwächt bereits bei Infektion nachweisbar war und gemäß ROC-Analysen gut zwischen Infektion und Sepsis diskriminierte (AUC >0.80 für alle Agonisten). Im Gegensatz dazu zeigten Thrombozyten bei Sepsis und Analyse mittels PFA-200 unter Einfluss physiologischer Scherkräfte eine normale bis gar beschleunigte Aggregation.
Die Reaktivitätsmessung von Thrombozyten mittels Durchflusszytometrie stellt weiterhin einen vielversprechenden Biomarker für die Sepsis-Früherkennung dar. Für weitere Schlussfolgerungen ist jedoch eine größere Kohorte erforderlich. In nachfolgenden Untersuchungen sollten zudem mechanistische Ursachen der beschriebenen phänotypischen und funktionellen Auffälligkeiten von Thrombozyten bei Infektion und Sepsis z.B. mittels Koinkubationsexperimenten untersucht werden.
Platelet activation induces cytoskeletal rearrangements involving a change from discoid to spheric shape, secretion, and eventually adhesion and spreading on immobilized ligands. Small GTPases of the Rho family, such as Rac1 and Cdc42, are known to be involved in these processes by facilitating the formation of lamellipodia and filopodia, respectively. This thesis focuses on the role Rac1 and Cdc42 for platelet function and formation from their precursor cells, the megakaryocytes (MKs), using conditional knock-out mice. In the first part of the work, the involvement of Rac1 in the activation of the enzyme phospholipase (PL) C2 in the signaling pathway of the major platelet collagen receptor glycoprotein (GP) VI was investigated. It was found that Rac1 is essential for PLC2 activation independently of tyrosine phosphorylation of the enzyme, resulting in a specific platelet activation defect downstream of GPVI, whereas signaling of other activating receptors remains unaffected. Since Rac1-deficient mice were protected from arterial thrombosis in two different in vivo models, the GTPase might serve as a potential target for the development of new drugs for the treatment and prophylaxis of cardio- and cerebrovascular diseases. The second part of the thesis deals with the first characterization of MK- and platelet-specific Cdc42 knock-out mice. Cdc42-deficient mice displayed mild thrombo-cytopenia and platelet production from mutant MKs was markedly reduced. Unexpectedly, Cdc42-deficient platelets showed increased granule content and release upon activation, leading to accelerated thrombus formation in vitro and in vivo. Furthermore, Cdc42 was not generally required for filopodia formation upon platelet activation. Thus, these results indicate that Cdc42, unlike Rac1, is involved in multiple signaling pathways essential for proper platelet formation and function. Finally, the outcome of combined deletion of Rac1 and Cdc42 was studied. In contrast to single deficiency of either GTPase, platelet production from double-deficient MKs was virtually abrogated, resulting in dramatic macrothrombocytopenia in the animals. Formed platelets were largely non-functional leading to a severe hemostatic defect and defective thrombus formation in double-deficient mice in vivo. These results demonstrate for the first time a functional redundancy of Rac1 and Cdc42 in the hematopoietic system.
Platelets are continuously produced from megakaryocytes (MK) in the bone marrow by a cytoskeleton-driven process of which the molecular regulation is not fully understood.
As revealed in this thesis, MK/ platelet-specific Profilin1 (Pfn1) deficiency results in micro- thrombocytopenia, a hallmark of the Wiskott-Aldrich syndrome (WAS) in humans, due to accelerated platelet turnover and premature platelet release into the bone marrow. Both Pfn1-deficient mouse platelets and platelets isolated from WAS patients contained abnormally organized and hyper-stable microtubules. These results reveal an unexpected function of Pfn1 as a regulator of microtubule organization and point to a previously unrecognized mechanism underlying the platelet formation defect in WAS patients.
In contrast, Twinfilin2a (Twf2a) was established as a central regulator of platelet reactivity and turnover. Twf2a-deficient mice revealed an age-dependent macrothrombocytopenia that could be explained by a markedly decreased platelet half-life, likely due to the pronounced hyper-reactivity of \(Twf2a^{-/-}\) platelets. The latter was characterized by sustained integrin acti- vation and thrombin generation in vitro that translated into accelerated thrombus formation in vivo. To further elucidate mechanisms of integrin activation, Rap1-GTP-interacting adaptor molecule (RIAM)-null mice were generated. Despite the proposed critical role of RIAM for platelet integrin activation, no alterations in this process could be found and it was concluded that RIAM is dispensable for the activation of β1 and β3 integrins, at least in platelets. These findings change the current mechanistic understanding of platelet integrin activation.
Outside-in signaling by integrins and other surface receptors was supposed to regulate MK migration, but also the temporal and spatial formation of proplatelet protrusions. In this the- sis, phospholipase D (PLD) was revealed as critical regulator of actin dynamics and podo- some formation in MKs. Hence, the unaltered platelet counts and production in \(Pld1/2^{-/-}\) mice and the absence of a premature platelet release in the bone marrow of \(Itga2^{-/-}\) mice question the role of podosomes in platelet production and raise the need to reconsider the proposed inhibitory signaling by α2β1 integrins on proplatelet formation.
Non-muscle myosin IIA (NMMIIA) has been implicated as a downstream effector of the in- hibitory signals transmitted via α2β1 integrins. Besides Rho-GTPase signaling, also \(Mg^{2+}\) and transient receptor potential melastatin-like 7 (TRPM7) channel α-kinase are known regulators of NMMIIA activity. In this thesis, TRPM7 was identified as major regulator of \(Mg^{2+}\) homeostasis in MKs and platelets. Furthermore, decreased \([Mg^{2+}]_i\) led to deregulated NMMIIA activity and altered cytoskeletal dynamics that impaired thrombopoiesis and resulted in macrothrombocytopenia in humans and mice.
Platelet activation and adhesion results in thrombus formation that is essential for normal hemostasis, but can also cause irreversible vessel occlusion leading to myocardial infarction or stroke. The C-type lectin-like receptor 2 (CLEC-2) was recently identified to be expressed on the platelet surface, however, a role for this receptor in hemostasis and thrombosis had not been demonstrated. In the current study, the involvement of CLEC-2 in platelet function and thrombus formation was investigated using mice as a model system. In the first part of the thesis, it was found that treatment of mice with a newly generated monoclonal antibody against murine CLEC-2 (INU1) led to the complete and highly specific loss of the receptor in circulating platelets (a process termed “immunodepletion”). CLEC-2-deficient platelets were completely unresponsive to the CLEC-2-specific agonist rhodocytin, whereas activation induced by all other tested agonists was unaltered. This selective defect translated into severely decreased platelet aggregate formation under flow ex vivo; and in vivo thrombosis models revealed impaired stabilization of formed thrombi with enhanced embolization. Consequently, CLEC-2 deficiency profoundly protected mice from occlusive arterial thrombus formation. Furthermore, variable bleeding times in INU1-treated mice indicated a moderate hemostatic defect. This reveals for the first time that CLEC-2 significantly contributes to thrombus stability in vitro and in vivo and plays a crucial role in hemostasis and arterial thrombosis. Thus, CLEC-2 represents a potential novel anti-thrombotic target that can be functionally inactivated in vivo. This in vivo down-regulation of platelet surface receptors might be a promising approach for future anti-thrombotic therapy. The second part of the work investigated the effect of double-immunodepletion of the immunoreceptor tyrosine-based activation motif (ITAM)- and hemITAM-coupled receptors, platelet glycoprotein (GP) VI and CLEC-2, on hemostasis and thrombosis using a combination of the GPVI- and CLEC-2-specific antibodies, JAQ1 and INU1, respectively. Isolated targeting of either GPVI or CLEC-2 in vivo did not affect expression or function of the respective other receptor. However, simultaneous treatment with both antibodies resulted in the sustained loss of GPVI and CLEC-2 signaling in platelets, while leaving other activation pathways intact. In contrast to single deficiency of either receptor, GPVI/CLEC-2 double-deficient mice displayed a dramatic hemostatic defect. Furthermore, this treatment resulted in profound impairment of arterial thrombus formation that far exceeded the effects seen in single-depleted animals. Importantly, similar results were obtained in Gp6-/- mice that were depleted of CLEC-2 by INU1-treatment, demonstrating that this severe bleeding phenotype was not caused by secondary effects of combined antibody treatment. These data suggest that GPVI and CLEC-2 can be independently or simultaneously down-regulated in platelets in vivo and reveal an unexpected functional redundancy of the two receptors in hemostasis and thrombosis. Since GPVI and CLEC-2 have intensively been discussed as potential anti-thrombotic targets, these results may have important implications for the development of novel, yet save anti-GPVI or anti-CLEC-2-based therapies.
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.
Recent development of proteomic approaches and generation of large-scale proteomic datasets calls for new methods for biological interpretation of the obtained results. Systems biological approaches such as integrated network analysis and functional module search have become an essential part of proteomic investigation. Proteomics is especially applied in anucleate cells such as platelets. The underlying molecular mechanisms of platelet activation and their pharmacological modulation are of immense importance for clinical research. Advances in platelet proteomics have provided a large amount of proteomic data, which has not yet been comprehensively investigated in a systems biological perspective. To this end, I assembled platelet specific data from proteomic and transcriptomic studies by detailed manual curation and worked on the generation of a comprehensive human platelet repository for systems biological analysis of platelets in the functional context of integrated networks (PlateletWeb) (http:/PlateletWeb.bioapps.biozentrum.uni-wuerzburg.de). I also added platelet-specific experimentally validated phosphorylation data and generated kinase predictions for 80% of the newly identified platelet phosphosites. The combination of drug, disease and pathway information with phosphorylation and interaction data makes this database the first integrative platelet platform available for platelet research. PlateletWeb contains more than 5000 platelet proteins, which can also be analyzed and visualized in a network context, allowing identification of all major signaling modules involved in platelet activation and inhibition. Using the wealth of integrated data I performed a series of platelet-specific analyses regarding the platelet proteome, pathways, drug targets and novel platelet phosphorylation events involved in crucial signaling events. I analyzed the statistical enrichment of known pathways for platelet proteins and identified endocytosis as a highly represented pathway in platelets. Further results revealed that highly connected platelet proteins are more often targeted by drugs. Using integrated network analysis offered by PlateletWeb, I analyzed the crucial activation signaling pathway of adenosine diphosphate (ADP), visualizing how the signal flow from receptors to effectors is maintained. My work on integrin inside-out signaling was also based on the integrated network approach and examined new platelet-specific phosphorylation sites and their regulation using kinase predictions. I generated hypothesis on integrin signaling, by investigating the regulation of Ser269 phosphorylation site on the docking protein 1 (DOK1). This phosphorylation site may influence the inhibiting effect of DOK1 on integrin a2bb3. Extending the integrated network approach to further cell lines, I used the assembled human interactome information for the analysis of functional modules in cellular networks. The investigation was performed with a previously developed module detection algorithm, which finds maximum-scoring subgraphs in transcriptomic datasets by using assigned values to the network nodes. We extended the algorithm to qualitative proteomic datasets and enhanced the module search by adding functional information to the network edges to concentrate the solution onto modules with high functional similarity. I performed a series of analyses to validate its performance in small-sized (virus-infected gastric cells) and medium-sized networks (human lymphocytes). In both cases the algorithm extracted characteristic modules of sample proteins with high functional similarity. The functional module search is especially useful in site-specific phosphoproteomic datasets, where kinase regulation of the detected sites is often sparse or lacking. Therefore, I used the module detection algorithm in quantitative phosphoproteomic datasets. In a platelet phosphorylation dataset, I presented a pipeline for network analysis of detected phosphorylation sites. In a second approach, the functional module detecting algorithm was used on a phosphoproteome network of human embryonic stem cells, in which nodes represented the maximally changing phosphorylation sites in the experiment. Additional kinases from the human phosphoproteome in PlateletWeb were included to the network to investigate the regulation of the signal flow. Results indicated important phosphorylation sites and their upstream kinases and explained changes observed in embryonic stem cells during differentiation. This work presents novel approaches for integrated network analysis in cells and introduces for the first time a systematic biological investigation of the human platelet proteome based on the platelet-specific knowledge base PlateletWeb. The extended methods for optimized functional module detection offer an invaluable tool for exploring proteomic datasets and covering gaps in complex large-scale data analysis. By combining exact module detection approaches with functional information data between interacting proteins, characteristic functional modules with high functional resemblance can be extracted from complex datasets, thereby focusing on important changes in the observed networks.
Thrombozyten (Blutplättchen) sind die Vermittler der zellulären Hämostase. Ihre Fähigkeit zu Aggregieren und sich an das umgebende Gewebe verletzter Blutgefässe anzulagern, wird durch ein komplexes intrazelluläres Signaltransduktionsnetzwerk bestimmt, das sowohl aktivierende, als auch inhibierende Subnetzwerke beinhaltet. Das Verständnis dieser Prozesse ist von hoher medizinischer Bedeutung. Im Rahmen dieser Arbeit wurde die thrombozytäre Signaltransduktion sowohl mittels eines Boole'schen, als auch verschiedener dynamischer Modelle analysiert. Die Boole'sche Modellierung führte zu interessanten Erkenntnissen über das Zusammenwirken einzelner Subnetzwerke bei der Vermittlung irreversibler Plättchenaktivierung und zeigte Mechanismen der Interaktion mit dem hemmenden Prostaglandinsystem auf. Das Modell beinhaltet unter Anderem wichtige Systemkomponenten wie Calciumsignalgebung, Aktivierung von Schlüsselkinasen wie Src und PKC, Integrin-vermitteltes outside-in sowie inside-out Signalgebung und autokrine ADP- und Thromboxan-Produktion. Unter Verwendung dieses Boole'schen Ansatzes wurde weiterhin das System-eigene Schwellenwertverhalten analysiert. Dabei stellte sich eine umgekehrt proportionale Abhängigkeit des relativen aktivierenden Reizes, der notwendig ist um den Schwellenwert zu überschreiten, vom absoluten hemmenden Input heraus. Das System adaptiert demnach an höhere Prostaglandinkonzentrationen durch eine Erhöhung der Sensitivität für Aktivatoren wie dem van-Willebrandt-Faktor und Kollagen, und ermöglicht somit auch unter lokal hemmenden Bedingungen eine Plättchen-vermittelte Hämostase. Der nächste Schritt bestand in der Implementierung eines Differentialgleichungs-basierten Modells der thrombozytären Prostaglandin-Signaltransduktion, um einen detaillierten Überblick über die Dynamik des inhibierenden Netzwerkteils zu erhalten. Die kinetischen Parameter dieses Modells wurden teilweise der Literatur entnommen. Der andere Teil wurde anhand einer umfassenden Kombination dosis- und zeitabhängiger cAMP und phospho-VASP Messdaten geschätzt. Der Prozess beinhaltete mehrere Iterationen aus Modellvorhersagen einerseits und experimentellem Design andererseits. Das Modell liefert die quantitativen Effekte der Prostaglandinrezeptoren IP, DP1, EP3 und EP4 und des ADP-Rezeptors P2Y12 auf die zugrunde liegende Signalkaskade. EP4 zeigt den stärksten Effekt in der aktivierenden Fraktion, wohingegen EP3 einen stärkeren inhibitorischen Effekt ausübt, als der durch Clopidogrel hemmbare ADP-Rezeptor P2Y12. Weiterhin wurden die Eigenschaften des negativen feedback-loops der PKA auf den cAMP-Spiegel untersucht, und eine direkte Beeinflussung der Adenylatzyklase durch die PKA festgestellt, in Form einer Reduzierung der maximalen katalytischen Geschwindigkeit. Die Identifizierbarkeit der geschätzten Parameter wurde mittels profile-Likelihood-Schätzung untersucht. In einem dritten Schritt wurde ein sowohl die aktivierenden, als auch die hemmenden Netzwerkteile umfassendes dynamisches Modell implementiert. Die Topologie dieses Modells wurde in Anlehnung an die des Boole'schen Modells auf der Basis von a priori Wissen festgelegt. Die Modellparameter wurden anhand von Western-Blot, Calcium- und Aggregationsmessungen geschätzt. Auch hier wurde die Identifizierbarkeit der Modellparameter durch profile-likelihood-Schätzung überprüft. Die bei niedrigen Ligandenkonzentrationen auftretende Reversibilität der Plättchen-Aggregation konnte mittels dieses Modells reproduziert werden. Jedoch zeigte sich bei mittleren ADP-Konzentrationen ein Fließgleichgewicht in einem teilweise aktivierten Zustand, und damit kein bistabiles Schwellenwertverhalten. Inwiefern dieses Verhalten durch einen Umgebungs-basierteren Mechanismus des Alles-Oder-Nichts-Verhaltens begründet wird, bei dem der Übergang von reversibler zu irreversibler Aggregation mehr durch parakrine Effekte des gesammten Thrombus bestimmt wird, als durch spezifische Signaltransduktionseigenschaften der einzelnen Zelle, müssen zukünftige Experimente zeigen. Insgesamt geben die erstellten Modelle interessante Einblicke in die Funktionsweise der Thrombozyten und ermöglichen die Simulation von pharmakologischen und genetischen Einflüssen, wie Rezeptormodulationen und knock-outs. Sie geben damit Implikationen zur Entstehung und Behandlung pathophysiologischer Zustände, und wertvolle Denkanstöße für die weitere Forschung.
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.
Platelet activation and aggregation are essential processes for the sealing of injured vessel walls and preventing blood loss. Under pathological conditions, however, platelet aggregation can lead to uncontrolled thrombus formation, resulting in irreversible vessel occlusion. Therefore, precise regulation of platelet activation is required to ensure efficient platelet plug formation and wound sealing but also to prevent uncontrolled thrombus formation. Rapid elevations in the intracellular levels of cations are a core signaling event during platelet activation. In this thesis, the roles of Ca2+ and Mg2+ channels in the regulation of platelet function were investigated.
Orai1, the major store-operated calcium (SOC) channel in platelets, is not only vital for diverse signaling pathways, but may also regulate receptor-operated calcium entry (ROCE). The coupling between the Orai1 signalosome and canonical transient receptor potential channel (TRPC) isoforms has been suggested as an essential step in the activation of store-operated calcium entry (SOCE) and ROCE in human platelets. However, the functional significance of the biochemical interaction between Orai and TRPC isoforms still remains to be answered. In the first part of this thesis, the functional crosstalk between Orai1 and TRPC6 was addressed. Orai1-mediated SOCE was found to enhance the activity of phospholipases (PL) C and D, to increase diacylglycerol (DAG) production and finally to regulate TRPC6-mediated ROCE via DAG, indicating that the regulation of TRPC6 channel activity seems to be independent of the physical interaction with Orai1. Furthermore, Orai1 and TRPC6 double deficiency led to a reduced Ca2+ store content and basal cytoplasmic Ca2+ concentrations, but surprisingly also enhanced ATP secretion, which may enhance Ca2+ influx via P2X1 and compensate for the severe Ca2+ deficits seen in double mutant platelets. In addition, Orai1 and TRPC6 were not essential for G protein-coupled receptor (GPCR)-mediated platelet activation, aggregation and thrombus formation.
Transient receptor potential melastatin-like 7 (TRPM7) contains a cytosolic serine/threonine protein kinase. To date, a few in vitro substrates of the TRPM7 kinase have been identified, however, the physiological role of the kinase remains unknown. In the second part of this thesis, mice with a point mutation which blocks the catalytic activity of the TRPM7 kinase (Trpm7KI) were used to study the role of the TRPM7 kinase in platelet function. In Trpm7KI platelets phosphatidylinositol-4,5-bisphosphate (PIP2) metabolism and Ca2+ mobilization were severely impaired upon glycoprotein (GP) VI activation, indicating that the TRPM7 kinase regulates PLC function. This signaling defect in Trpm7KI platelets resulted in impaired aggregate formation under flow and protected animals from arterial thrombosis and ischemic brain infarction. Altogether, these results highlight the kinase domain of TRPM7 as a pivotal signaling moiety implicated in the pathogenesis of thrombosis and cerebrovascular events.
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.
The platelet cytoskeleton ensures normal size and discoid shape under resting conditions and undergoes immediate reorganization in response to changes in the extracellular environment through integrin-based adhesion sites, resulting in actomyosin-mediated contractile forces. Mutations in the contractile protein non-muscle myosin heavy chain IIA display, among others, macrothrombocytopenia and a mild to moderate bleeding tendency in human patients. It is insufficiently understood which factors contribute to the hemostatic defect found in MYH9-related disease patients. Therefore, a better understanding of the underlying biophysical mechanisms in thrombus formation and stabilization is warranted.
This thesis demonstrates that an amino acid exchange at the positions 702, 1424 and 1841 in the heavy chain of the contractile protein non-muscle myosin IIA, caused by heterozygous point mutations in the gene, resulted in macrothrombocytopenia and increased bleeding in mice, reflecting the clinical hallmark of the MYH9-related disease in human patients. Basic characterization of biological functions of Myh9 mutant platelets revealed overall normal surface glycoprotein expression and agonist-induced activation when compared to wildtype platelets. However, myosin light chain phosphorylation after thrombin-activation was reduced in mutant platelets, resulting in less contractile forces and a defect in clot retraction. Altered biophysical characteristics with lower adhesion and interaction forces of Myh9 mutant platelets led to reduced thrombus formation and stability. Platelets from patients with the respective mutations recapitulated the findings obtained with murine platelets, such as impaired thrombus formation and stiffness.
Besides biological and biophysical characterization of mutant platelets from mice and men, treatment options were investigated to prevent increased bleeding caused by reduced platelet forces. The antifibrinolytic agent tranexamic acid was applied to stabilize less compact thrombi, which are presumably more vulnerable to fibrinolysis. The hemostatic function in Myh9 mutant mice was improved by interfering with the fibrinolytic system. These results show the beneficial effect of fibrin stabilization to reduce bleeding in MYH9-related disease.
Platelet activation and aggregation at sites of vascular injury are essential processes to limit blood loss but they also contribute to arterial thrombosis, which can lead to myocardial infarction and stroke. Stable thrombus formation requires a series of events involving platelet receptors which contribute to adhesion, activation and aggregation of platelets. Regulation of receptor expression by (metallo-)proteinases has been described for several platelet receptors, but the molecular mechanisms are ill-defined. The signaling lymphocyte activation molecule (SLAM) family member CD84 is expressed in immune cells and platelets, however its role in platelet physiology was unclear. In this thesis, CD84 deficient mice were generated and analyzed. In well established in vitro and in vivo assays testing platelet function and thrombus formation, CD84 deficient mice displayed phenotypes indistinguishable from wild-type controls. It was concluded that CD84 in platelets does not function as modulator of thrombus formation, but rather has other functions. In line with this, in the second part of this thesis, a novel regulation mechanism for platelet CD84 was discovered and elucidated. Upon platelet activation, the N-terminus of CD84 was found to be cleaved exclusively by the a disintegrin and metalloproteinase 10 (ADAM10), whereas the intracellular part was cleaved by calpain. In addition, regulation of the platelet activating collagen receptor glycoprotein VI (GPVI) was studied and it was shown that GPVI is in contrast to CD84 differentially regulated by ADAM10 and ADAM17. A novel role of CD84 under pathophysiological conditions was revealed as CD84 deficient mice were protected from ischemic stroke in the model of transient middle cerebral artery occlusion and this protection was based on the lack of CD84 in T cells. Ca2+ is an essential second messenger that facilitates activation of platelets and diverse functions in different eukaryotic cell types. Store-operated Ca2+ entry (SOCE) represents the major mechanism leading to rise in intracellular Ca2+ concentration in non-excitable cells. The Ca2+ sensor STIM1 (stromal interaction molecule 1) and the SOC channel subunit protein Orai1 are established mediators of SOCE in platelets. STIM2 is the major STIM isoform in neurons, but the role of the SOC channel subunit protein Orai2 in platelets and neurons has remained elusive. In the third part of this thesis, Orai2 deficient mice were generated and analyzed. Orai2 was dispensable for platelet function, however, Orai2 deficient mice were protected from ischemic neurodegeneration and this phenotype was attributed to defective SOCE in neurons.
Platelets are crucial to inhibit extensive blood loss at sites of vascular injury. However, under pathological conditions such as rupture of an atherosclerotic plaque, activated platelets form aggregates that may occlude the vessel. This can lead to heart attack and stroke. Various and complex signaling pathways in the cell are involved in the steps of platelet adhesion, activation and aggregation. Single aspects of these processes were studied in three different subprojects in this work. The Glycoprotein (GP) Ib-V-IX complex is responsible for the first contact of platelets with the vessel wall. Subsequently, GPVI can bind to collagen of the subendothelium, which initiates a signaling cascade leading to platelet activation, aggregation, characterized by integrin activation and granule secretion and platelet procoagulant activity. The latter is characterized by exposed phosphatidylserine (PS) on the platelet surface, which enhances thrombin generation and thereby the coagulation cascade. A controlled regulation of GP receptors on the platelet surface is vital for an intact response of the cell to platelet agonists. In the first subproject described here the regulation of GPV and GPVI on mouse platelets was investigated and it was found that both receptors are shed from the platelet surface in a metalloproteinase dependent manner. However, GPVI is shed upon mitochondrial injury, while GPV cleavage could be observed upon platelet stimulation. The metalloproteinase responsible for GPVI shedding remains unknown whereas the metallproteinase that sheds GPV was identified in this work as being ADAM17. This shows that the expression of both receptors underlies a controlled mechanism regulated through distinct metalloproteinases. In the second subproject the role of protein kinase C (PKC) in platelet activation and procoagulant response was investigated using PKC specific inhibitors. It was found that PKC blockage reduced platelet activation but enhanced platelet procoagulant activity. This is the first time that a dual role in platelet activation and procoagulant activity is defined for PKC. In the third project the role of the small GTPase Rac1 in platelet signaling was studied using conditional Rac1 knock out mice. It is reported here that Rac1 lies downstream of GPVI and is involved in integrin activation and cytsolic Ca2+ changes in vitro and platelet adhesion and thrombus formation in vivo. This is the first time that Rac1 is demonstrated to have a pivotal role in GPVI signaling and furthermore points to a novel, unknown pathway downstream of GPVI.
Studies on receptor signaling and regulation in platelets and T cells from genetically modified mice
(2014)
Receptors with tyrosine-based signaling motifs control essential functions of hematopoietic cells, including lymphocytes and platelets. Downstream of the platelet receptor glycoprotein (GP) VI and the T cell receptor (TCR) the immunoreceptor tyrosine-based activation motif (ITAM) initiates a signaling cascade that involves kinases, adapter and effector proteins and finally leads to cellular activation. This thesis summarizes the results of three studies investigating different aspects of receptor signaling and regulation in platelets and T cells.
In the first part, the impact of constitutive Ca2+ influx on TCR signaling and T cell physiology was investigated using a transgenic mouse line with a mutation in the Ca2+ sensor stromal interaction molecule 1 (STIM1). The elevated cytoplasmic Ca2+ level resulted in an altered phosphorylation pattern of the key enzyme phospholipase (PL) Cγ1 in response to TCR stimulation, but without affecting its enzymatic activity. Withdrawal of extracellular Ca2+ or inhibition of the phosphatase calcineurin restored the normal phosphorylation pattern. In addition, there was a decrease in the release of Th2-type cytokines interleukin 4, 5 and 13 upon stimulation in vitro.
The second part of the thesis deals with the role of the adapter protein growth factor receptor-bound protein 2 (Grb2) in platelets using a megakaryocyte/platelet-specific knockout mouse line. Loss of Grb2 severely impaired signaling of GPVI and C-type lectin-like receptor 2 (CLEC-2), a related hemITAM receptor. This was attributed to defective stabilization of the linker for activation of T cells (LAT) signalosome and resulted in reduced adhesion, aggregation, Ca2+ mobilization and procoagulant activity downstream of (hem)ITAM-coupled receptors in vitro. In contrast, the signaling pathways of G protein-coupled receptors (GPCRs) and the integrin αIIbβ3, which do not utilize the LAT signalosome, were unaffected. In vivo, the defective (hem)ITAM signaling caused prolonged bleeding times, however, thrombus formation was only affected under conditions where GPCR signaling was impaired (upon acetylsalicylic acid treatment). These results establish Grb2 as an important adapter protein in the propagation of GPVI- and CLEC-2-induced signals.
Finally, the proteolytic regulation of the immunoreceptor tyrosine-based switch motif (ITSM)-bearing receptor CD84 in platelets was investigated. This study demonstrated that in mice CD84 is cleaved by two distinct and independent proteolytic mechanisms upon platelet activation: shedding of the extracellular part, which is exclusively mediated by a disintegrin and metalloproteinase (ADAM) 10 and cleavage of the intracellular C-terminus by the protease calpain. Finally, the analysis of soluble CD84 levels in the plasma of transgenic mice revealed that shedding of CD84 by ADAM10 occurs constitutively in vivo.
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.