Partially desulfated heparin modulates the interaction between anti-protamine/heparin antibodies and platelets

Partially desulfated heparin modulates the interaction between anti-protamine/heparin antibodies and platelets
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部分脱硫肝素调节抗鱼精蛋白/肝素抗体与血小板之间的相互作用

DOI:
10.1160/th15-07-0539
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发表时间:
2015
影响因子:
6.7
通讯作者:
Bakchoul T
Bakchoul T
中科院分区:
医学2区
文献类型:
--
作者:
Jouni R;Zollner H;Khadour A;Wesche J;Delcea M;Krauel K;Schwertz H;Sachs UJ;Greinacher A;Bakchoul T

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鱼精蛋白(PRT)是中和肝素的标准药物。PRT/肝素复合物诱导的免疫应答与肝素诱导的血小板减少症(HIT)中观察到的免疫应答相似。部分肝素化(ODSH)被证明会干扰抗血小板因子4/肝素抗体(Ab),这是HIT的原因。在这项研究中,我们分析了ODSH对抗PRT/肝素抗体与血小板之间相互作用的影响。用NOD/ SCID小鼠模型研究ODSH对抗PRT/肝素Ab诱导的血小板破坏的能力。在PRT、肝素和抗PRT/肝素抗体存在下,ODSH改善了血小板存活率(在300分钟(min)后,具有20 μg/ml ODSH的中位血小板存活率:75%,范围70- 81%,相比于没有ODSH的中位血小板存活率:49%,范围44- 59%,p=0.006)。此外,当在Ab注射后60分钟应用ODSH时,血小板存活率得到改善(300分钟后用ODSH的中位血小板存活率:83%,范围77- 93%,与不用ODSH的中位血小板存活率:59%,范围29- 61%,p=0.02)。体外实验ODSH在浓度> 16 μg/mL时抑制血小板活化(p< 0.001),以及PRT/肝素复合物与血小板的结合(无ODSH时的平均荧光强度[MFI]:85 ± 14 vs有ODSH时:15 ± 0.6,p=0.013)。ODSH还从血小板表面置换了预先结合的复合物(无ODSH的MFI:324 ± 43 vs有32 μg/ml ODSH的MFI:53 ± 9,p< 0.001)。虽然抗PRT/肝素抗体干扰血小板活化,但浓度高达16 μg/ml时,ODSH对PRT中和肝素的影响极小。总之,我们的研究表明,ODSH能够抑制血小板活化和破坏,这表明了潜在的临床用途,以减少抗PRT/肝素Ab介导的不良反应。
Protamine (PRT) is the standard drug to neutralise heparin. PRT/heparin complexes induce an immune response similar to that observed in heparin-induced thrombocytopenia (HIT). Partially desulfated heparin (ODSH) was shown to interfere with anti-platelet factor 4/heparin antibodies (Abs), which are responsible for HIT. In this study, we analyse the impact of ODSH on the interaction between anti-PRT/heparin Abs and platelets. The ability of ODSH to prevent anti-PRT/heparin Ab-induced platelet destructionin vivowas investigated using the NOD/ SCID mouse model. ODSH improved platelet survival in the presence of PRT, heparin and anti-PRT/heparin Abs (median platelet survival after 300 minutes (min) with 20 μg/ml ODSH: 75 %, range 70–81 % vs without ODSH: 49%, range 44–59%, p=0.006). Furthermore, when ODSH was applied 60 min after Ab injection platelet survival was improved (median platelet survival after 300 min with ODSH: 83 %, range 77–93 % vs without ODSH: 59 %, range 29–61 %, p=0.02). Inin vitroexperiments ODSH inhibited platelet activation at concentrations > 16 μg/mL (p< 0.001), as well as PRT/heparin complex binding to platelets (mean fluorescence intensity [MFI] without ODSH: 85 ± 14 vs with ODSH: 15 ± 0.6, p=0.013). ODSH also displaced pre-bound complexes from the platelet surface (MFI without ODSH: 324 ± 43 vs with 32 μg/ml ODSH: 53 ± 9, p< 0.001). While interfering with platelet activation by anti-PRT/heparin Abs, up to a concentration of 16 μg/ml, ODSH had only minimal impact on neutralisation of heparin by PRT. In conclusion, our study shows that ODSH is able to inhibit platelet activation and destruction suggesting a potential clinical use to reduce anti-PRT/heparin Ab-mediated adverse effects.
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