A randomised controlled trial comparing a dietary antiplatelet, the water-soluble tomato extract Fruitflow, with 75 mg aspirin in healthy subjects.

BACKGROUND/OBJECTIVES: Increasing numbers of food ingredients are gaining acknowledgement, via regulated health claims, of benefits to human health. One such is a water-soluble tomato extract, Fruitflow (FF), a dietary antiplatelet. We examined relative platelet responses to FF and to 75 mg aspirin (ASA) in healthy subjects. SUBJECTS/METHODS: A total of 47 healthy subjects completed a double-blinded randomised controlled trial following a crossover design. Acute and 7-day treatments with 75 mg ASA were compared with control with and without concomitant FF, over a 5-h timecourse. Platelet aggregation response agonist, platelet thromboxane A2 release, plasma clotting times and time to form a primary haemostatic clot (PFA-100 closure time, TTC) were measured. RESULTS: Administration of all treatments lowered platelet function and thromboxane A2 generation, and extended the TTC, relative to baseline (P<0.001) and to control (P<0.001). Plasma clotting times were not affected. A single 75 mg dose of ASA showed approximately equal efficacy to a dose of FF, whereas daily 75 mg ASA was approximately three times as effective after 7 days (P=0.002). Platelet responses were heterogenous with distinct weak and strong responder groups. Weak ASA responders retained a functional platelet response to collagen agonist and were responsive to FF. Concomitant FF and ASA did not lead to significant additive effects. CONCLUSIONS: The suppression of platelet function observed after consuming FF is approximately one-third that of daily 75 mg ASA. The reversible action of FF renders it less likely to overextend the time to form a primary haemostatic clot than ASA, an important safety consideration for primary prevention.

Does lipoprotein(a) (Lp(a)) complete with plasminogen in human atherosclerotic lesions and thrombi?

Thrombotic occlusion is the major cause of myocardial infarction (MI), and fibrin accumulation appears to play a significant role in development of atherosclerotic lesions. Any factor that reduces the lysis of fibrin may thus increase the risk of MI, and it has been suggested that this accounts for the atherogenicity of the lipoprotein variant Lp(a). The characteristic feature of Lp(a) is an apoprotein which is homologous with part of the plasminogen molecule, and experiments in vitro suggest that it interferes with uptake and activation of plasminogen on cell surfaces and fibrin. The presence of Lp(a) also seemed to offer an explanation for the apparent absence of plasminogen from 70-80% of intimal samples. We have compared the levels of Lp(a) and plasminogen in normal intima and atherosclerotic lesions. In aortic intima there was no relation between Lp(a) and plasminogen, which was absent in some samples with no Lp(a), and present in others with high levels. In intravascular thrombi plasminogen was present at a rather constant concentration (16.3 +/- 4.6 micrograms/100 mg wet tissue), whereas Lp(a) varied over a 100 fold range (0-104 micrograms/100 mg). Plasminogen binds to fibrin and is activated on the fibrin clot, so levels in extracts may not fully represent Lp(a)/plasminogen interactions. After extraction the residual tissues and thrombi were treated with 1 M epsilon-aminocaproic acid (epsilon-aca) to elute lysine-bound components. Lp(a) was eluted from all but one intimal sample, confirming previous findings on its binding to fibrin in lesions, but there was no relation between the amounts of Lp(a) and plasminogen in the tissue eluates. Paradoxically, in the thrombi there was a weak positive correlation between Lp(a) and plasminogen in epsilon-aca eluates (r = 0.504, P = 0.05). These results do not support the hypothesis that Lp(a) displaces plasminogen in vivo, but the large amount of Lp(a) eluted by epsilon-aca suggests that its atherogenicity resides in preferential binding to fibrin, leading to increased lipid accumulation in lesions.

The effects of structurally defined triglycerides of differing fatty acid composition on postprandial haemostasis in young, healthy men.

The aim of this study was to investigate whether a number of key haemostatic factors were altered when healthy young individuals were challenged with a fat load of physiological size contained within a meal composed of normal ingredients and whether this response was modified when the fatty acid composition of the meal was altered radically. Eight healthy male volunteers each randomly consumed four meals which were identical in terms of gross nutritional content (41% of energy provided as fat, 17% as protein and 42% as carbohydrate) but which differed in fatty acid composition. To reduce the possible influence of fatty acid position within the triglyceride molecule on lipid absorption and subsequent metabolic effects, the structural integrity of 91% of fat (test triglycerides such as 1,3 distearoyl-2-oleoyl glycerol (S-O-S), trioleine (O-O-O), and 1,3 dilinoleoyl-2-oleoyl glycerol, (L-O-L)) in the meals was controlled so that the principal fatty acid in the sn-2 position was oleic acid (18:1n-9). Meals rich in either a test triglyceride or a control oil provided 44+/-6 g of fat. No significant alterations from fasted values of elevated plasma factor VII coagulant activity (FVIIc) or F1 + 2 were observed. FVIIA varied significantly over the postprandial time course; however, when expressed as a percentage of the fasting value, the FVIIa responses to O-O-O and L-O-L differed significantly but this was not evident when the absolute values were analysed. Similarly, no difference in plasma fibrinopeptide A (FPA) concentrations were evident. After all four meals, chylomicron contained proportionately more palmitic acid and generally less oleic acid than the ingested lipids. This study clearly demonstrates that postprandial haemostatic responses of young healthy individuals to a physiological fat load are minimal, (irrespective of triglyceride structure).

A residential study comparing the effects of diets rich in stearic acid, oleic acid, and linoleic acid on fasting blood lipids, hemostatic variables and platelets in young healthy men.

Dietary fat is known to influence the variables of blood coagulation and fibrinolysis associated with vascular disease. However, the role of fat content and/or fat composition of the diet in this regard is still not well understood. In the present study, we investigated the effects of three isoenergic diets of differing fat composition in nine healthy young men in a strictly controlled residential study. Subjects consumed the three experimental diets for periods of 2 weeks each, separated by a washout period of at least 5 weeks in a randomized crossover design. The diets provided 38% of total energy intake as fat, 45% as carbohydrate, and 17% as protein, and differed only with respect to the fatty acid composition (stearic acid-rich diet: 34.1% stearic acid, 36.6% oleic acid; oleic acid-rich diet: 65.8% oleic acid; linoleic acid-rich diet: 36.5% linoleic acid, 38% oleic acid). Blood samples were collected at the beginning and at the end of each dietary period from fasted subjects for determination of factor VII coagulant activity (FVIIc), activated factor VII (FVIIa), factor VII antigen (FVIIag), tissue plasminogen activator (tPA) activity, plasminogen activator inhibitor type 1 (PAI-1) activity, fibrinogen, prothrombin fragment 1+2 (F(1+2)), and plasma lipids. There were no significant differences between diets in fasting plasma concentrations of FVIIc, FVIIa, FVIIag, fibrinogen, F(1+2), PAI-1 activity, and tPA activity. Plasma concentrations of lipids (high density lipoproteins, low density lipoproteins, triacylglycerols, and total cholesterol) were also unaffected. Although there were no changes in platelet aggregation response and membrane fluidity observed in any of the diets, increased anti-aggregatory prostaglandin E(1) binding to platelet membranes was observed only in the case of linoleic acid-rich diet. In conclusion, diets with very different fatty acid compositions, at 38% of energy as fat intake, did not significantly influence blood coagulation, fibrinolysis, or blood lipids in the fasting state in young healthy men.

The inter-relation of fibrin, lipoprotein(a) and plasminogen in human atherosclerotic lesions.

The low density lipoprotein (LDL) variant, lipoprotein(a) (Lp(a)) is a risk factor for coronary heart disease, and in this study we have examined its interaction with the arterial wall. Samples of normal intima and atherosclerotic lesions were extracted with buffer containing EDTA and protease inhibitors and assayed for LDL and Lp(a) by radial immunodiffusion. The extract tissues were washed, then incubated with plasmin and the amounts of LDL and Lp(a) released into the digest were measured. Intimal Lp(a) concentrations were compared to Lp(a) in the patients' blood. Levels of both soluble and plasmin-releasable Lp(a) were related to type of intimal sample and blood Lp(a) level. In early proliferative lesions there was a significant correlation between plasmin-releasable Lp(a) and blood Lp(a) (r = 0.631, P less than 0.002). Highest levels of plasmin-releasable Lp(a) were found in more advanced lesions that had accumulated some lipid. In extracts the amounts of LDL were 5-20 fold greater than Lp(a) but in the plasmin digests Lp(a) could account for most of the apoB detected, suggesting that Lp(a) may bind to fibrin in the lesion through its plasminogen-like structures and thus contribute to lipid accumulation in fibrous plaques. Plasminogen cannot be detected by rocket immunoelectrophoresis in samples from about two-thirds of aortas, and it seemed possible that the large plasminogen-like apo(a) component of Lp(a) was interfering with intimal uptake or retention of plasminogen, or its immunoassay. However, in 28 samples of intima or thrombi from 16 patients there was no relation between amounts of Lp(a) and plasminogen.

Prothrombin-related antigens in human aortic intima.

Most plasma proteins are present in both normal and atherosclerotic intima, and their concentrations in intimal interstitial fluid are directly related to plasma concentration and molecular size. All intimal samples also contain soluble fibrin-fibrinogen-related antigens, consisting of variable mixtures of fibrinogen and fibrinogen and fibrin degradation products; the extracted washed tissue contains insoluble fibrin. It appears that the fibrinogen is subjected both to degradation and to conversion to fibrin, which in turn undergoes lysis. Biochemically, insoluble "fibrin" can be detected by incubating the washed tissue with plasmin, and assaying the fibrin degradation products that are released; they are released from all samples, including small amounts from normal intima. The fibrin could arise by incorporation of a mural fibrin clot and/or clotting of the fibrinogen within the intima, which contains a "cocktail" of clotting-related factors including prothrombin/thrombin-related antigens, antithrombin III (AT III), and other protease inhibitors: in recent experiments stripped intima was immediately treated with ethylenediaminetetraacetic acid, minced, extracted with Tris-buffered saline, and the extracts analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting with antisera to prothrombin and AT III. Surprisingly, all blots treated with antiprothrombin antisera showed large bands migrating with free thrombin (36 to 37 kDa) and prothrombin (74 kDa) and four intermediate bands. In addition, in all 10 samples examined a band of high molecular mass (170 kDa) but variable intensity was present. This 170-kDa band comigrated with the major band reacting with anti-serum to AT III. The theoretical 1:1 thrombin:AT III complex (98 kDa) was not detected. Thus active thrombin appears to be present in intima, and this may be a highly atherogenic factor, both causing fibrin deposition and acting as a potent mitogen for arterial smooth muscle cells.

Effects of tomato extract on human platelet aggregation in vitro.

Among all fruits tested in vitro for their anti-platelet property, tomato had the highest activity followed by grapefruit, melon, and strawberry, whereas pear and apple had little or no activity. Tomato extract (20-50 microl of 100% juice) inhibited both ADP- and collagen-induced aggregation by up to 70% but could not inhibit arachidonic acid-induced platelet aggregation and concomitant thromboxane synthesis under similar experimental conditions. The anti-platelet components (MW <1000 Da) in tomatoes are water soluble, heat stable and are concentrated in the yellow fluid around the seeds. The active fractions were separated using gel filtration and HPLC. The aqueous fraction (110 000 xg supernatant) of tomatoes containing anti-platelet activity was subjected to gel filtration column chromatography (Biogel P2 column). The activity was fractionated into two peaks, peak-3 and peak-4 (major peak). Subsequently, peak-4 was further purified by HPLC using a reversed-phase column. NMR and mass spectroscopy studies indicated that peak F2 (obtained from peak 4) contained adenosine and cytidine. Deamination of peak F2 with adenosine deaminase almost completely abolished its anti-platelet activity, confirming the presence of adenosine in this fraction. In comparison, deamination of peak-4 resulted in only partial loss of inhibitory activity while the activity of peak-3 remained unaffected. These results indicate that tomatoes contain anti-platelet compounds in addition to adenosine. Unlike aspirin, the tomato-derived compounds inhibit thrombin-induced platelet aggregation. All these data indicate that tomato contains very potent anti-platelet components, and consuming tomatoes might be beneficial both as a preventive and therapeutic regime for cardiovascular disease.

Fibrinogen/fibrin in atherogenesis.

Fibrin is a major component of many atherosclerotic plaques. Within the intima there is continuous formation of fibrin, and continuous fibrinolysis. In aortic lesions, a lipoprotein bound to fibrin can be released by incubation with plasmin. Most of this lipoprotein is accounted for by Lp(a). The atherogenicity of Lp(a) may be more associated with lipid deposition than with inhibition of fibrinolysis. Fibrin degradation products may be chemotactic to monocyte-macrophages and stimulate smooth muscle cell proliferation.

Arachidonic acid uptake by human platelets is mediated by CD36.

The involvement of glycoprotein (GP) IV (CD36) in arachidonic acid uptake by human platelets was investigated using an anti-CD36 monoclonal antibody (MAB). The binding of [(14)C]arachidonic acid to MAB-treated platelets was significantly reduced compared with untreated platelets. The MAB also inhibited arachidonic acid-induced platelet aggregation and thromboxane A(2) synthesis in a dose-dependent manner. Pre-incubation of gel-filtered platelets with the MAB (10mg/I) inhibited arachidonic acid-induced platelet aggregation by 50% and collagen-induced platelet aggregation by 7-8% and the lag time was increased by 200%. Although the mechanism of platelet aggregation is not fully understood yet, the inhibition of arachidonic acid-induced platelet aggregation by the MAB could be the result of a reduced uptake of exogeneously added arachidonic acid by the MAB-treated platelets. Our data clearly indicate that arachidonic acid uptake by platelets is mediated, at least in part, by CD36.

Effect of diets rich in oleic acid, stearic acid and linoleic acid on postprandial haemostatic factors in young healthy men.

The aim of the present study was to investigate the effects of stearic acid-, oleic acid- and linoleic acid-rich meals on postprandial haemostasis in young healthy volunteers whose background diets had been controlled for 14 d in a residential study. Six healthy male volunteers were assigned randomly to consume diets rich in stearic acid, oleic acid or linoleic acid for 14 d. On day 15, plasma lipids and haematological variables were measured in the fasted state, and 3 and 7 h (factor VII and prothrombin activation peptide fragments, 1 and 2 only) after consumption of a test meal. Test meals provided 40 % of the subjects' daily energy requirement, with 41 % of the energy provided as fat, 17 % energy as protein and 42 % energy as carbohydrate. The mean fat content of the meal was 45 (sd 5) g. Significant alterations from fasted values were observed for activated factor VII after 7 h), factor VII antigen after 7 h), prothrombin activation peptide fragments 1 and 2 after 7 h) and plasminogen activator inhibitor type 1 activity after 3 h) after consumption of each of the three meals. No significant differences were observed in haemostatic values (factor VII coagulant activity, factor VII antigen, tissue plasminogen activator activity prothrombin activation peptide fragment and plasminogen activator inhibitor type-1) with regard to diet except for activated factor VII at 3 h; values were higher after the oleic acid- and linoleic acid-rich meals than after the stearic acid-rich meal After consumption of each of the three meals, chylomicrons contained proportionately more palmitic acid than the lipids ingested. The present study shows that there are demonstrable changes in postprandial haemostasis when young healthy volunteers with controlled dietary backgrounds are challenged with a physiological fat load. These changes are independent of the fatty acid composition of the test meals.

Inhibitory effect of Ginkgo biloba extract on human platelet aggregation.

The effect of pure flavonoids and Gingko biloba extract (GBE) on human platelet aggregation was investigated. Most of the flavonoids and vitamin E did not affect platelet aggregation in platelet-rich plasma (PRP); however some of these flavonoids inhibited platelet aggregation in gel-filtered platelets (GFP). GBE inhibited both ADP- and collagen-induced platelet aggregation in PRP, GFP and in whole blood in a dose-dependent manner. GBE at very low concentrations inhibited whole blood aggregation induced by ADP compared with those used for PRP or GFP. Flavonoids and GBE decreased the production of TxA(2) induced by collagen and ADP in PRP. However, no correlation was observed between the inhibition of platelet aggregation and the decrease of TxA(2) synthesis. GBE and flavonoids did not affect platelet membrane fluidity. However, the incubation of PRP with GBE increased cAMP levels in platelets, which is known to inhibit platelet activation by lowering intracellular Ca2+ levels. GBE is a mixture of many compounds, including flavonoids and gingkoglides, which affect metabolism of cAMP, TxA(2) and Ca2+ in platelets. It is effective in the inhibition of platelet aggregation, both in PRP and whole blood, and thus may be potentially used as an effective oral anti-platelet therapeutic agent.