Kinetics of platelet adhesion to a fibrinogen-coated surface in whole blood under flow conditions.

AIM: To test a novel method of assessment of platelet adhesion to a fibrinogen-coated surface in whole blood under flow conditions. METHODS: We developed a fluidic device that mimics blood flow in vessels. The method of detection of platelet adhesion is based on recording of a scattered laser light signal from a fibrinogen-covered surface. Testing was performed in platelet-rich plasma (PRP) and whole blood of healthy volunteers. Control measurements were performed, followed by tests with inhibition of platelet GPIIa/IIIb and GPIb receptors. Then, the same testing sequence was performed in whole blood of persons with autoimmune thrombocytopenia and type 3 von Willebrand disease. RESULTS: The change in intensity of scattered light was 2.7 (2.4; 4.1) times higher in whole blood (0.2 ± 0.08V, n = 7) than in PRP (0.05 ± 0.02 V, n = 7), p < 0.01. The blocking of GP IIb/IIIa receptors decreased the intensity of scattered light to 8.5 (6.5;12)%; the blocking of GPIb receptors decreased it to 34 (23;58)%, p < 0.01. In the whole blood of a person with autoimmune thrombocytopenia, the inhibition of GPIb receptors decreased platelet adhesion, but no effect was observed in type 3 von Willebrand disease. Inhibition of platelet GPIIb/IIIa receptors alone or combined inhibition of GPIb and GPIIb/IIIa receptors resulted in almost total suppression of adhesion in both cases. CONCLUSION: Our system effectively registers platelet adhesion to a fibrinogen-coated surface under controlled-flow conditions and may successfully be applied to the investigation of platelet adhesion kinetics.

Monomeric C-reactive protein evokes TCR Signaling-dependent bystander activation of CD4+ T cells.

Bystander activation of T cells is defined as induction of effector responses by innate cytokines in the absence of cognate antigens and independent of T cell receptor (TCR) signaling. Here we show that C-reactive protein (CRP), a soluble pattern-recognition receptor assembled noncovalently by five identical subunits, can instead trigger bystander activation of CD4 + T cells by evoking allosteric activation and spontaneous signaling of TCR in the absence of cognate antigens. The actions of CRP depend on pattern ligand-binding induced conformational changes that result in the generation of monomeric CRP (mCRP). mCRP binds cholesterol in plasma membranes of CD4 + T cells, thereby shifting the conformational equilibrium of TCR to the cholesterol-unbound, primed state. The spontaneous signaling of primed TCR leads to productive effector responses manifested by upregulation of surface activation markers and release of IFN-γ. Our results thus identify a novel mode of bystander T cell activation triggered by allosteric TCR signaling, and reveal an interesting paradigm wherein innate immune recognition of CRP transforms it to a direct activator that evokes immediate adaptive immune responses.

In-stent restenosis after revascularization of myocardium with drug-eluting stents is accompanied by elevated level of blood plasma eosinophil cationic protein.

The aim of this study was to assess the involvement of eosinophil cationic protein, a marker of eosinophil activation, in the development of in-stent restenosis after drug-eluting stent implantation. Follow-up angiography at 6 to 12 months was performed in 32 patients who were treated with percutaneous coronary intervention and implantation of sirolimus-eluting stents. Blood plasma levels of eosinophil cationic protein (ECP) and total immunoglobulin E (IgE) were measured by enzyme-linked immunosorbent assay and the level of C-reactive protein (hs-CRP) by high-sensitivity nephelometry. According to angiography data, in-stent restenosis occurred in 13 patients, while 19 patients did not develop it. There were no differences between the hs-CRP and IgE levels in patients with or without restenosis. In contrast, ECP level was higher in patients with restenosis compared with that in patients without restenosis [17.7 ng/mL (11.2-24.0) vs. 9.0 ng/mL (6.4-12.9), p = 0.017]. The incidence of in-stent restenoses was 63% in patients with ECP level higher than or equal to 11 ng/mL, and 19% in patients with an ECP level lower than 11 ng/mL (p = 0.019). These findings suggest that elevated eosinophil activation may play an important role in the pathogenesis of in-stent restenosis after implantation of drug-eluting stents.

Current Position on the Role of Monomeric C-reactive Protein in Vascular Pathology and Atherothrombosis.

C-reactive Protein (CRP) is an acute phase reactant, belonging to the pentraxin family of proteins. Its level rises up to 1000-fold in response to acute inflammation. High sensitivity CRP level is utilized as an independent biomarker of inflammation and cardiovascular disease. The accumulating data suggests that CRP has two distinct forms. It is predominantly produced in the liver in a native pentameric form (nCRP). At sites of local inflammation and tissue injury it may bind to phosphocholine-rich membranes of activated and apoptotic cells and their microparticles, undergoing irreversible dissociation to five monomeric subunits, termed monomeric CRP (mCRP). Through dissociation, CRP deposits into tissues and acquires distinct proinflammatory properties. It activates both classic and alternative complement pathways, binding complement component C1q and factor H. mCRP actively participates in the development of endothelial dysfunction. It activates leukocytes, inducing cytokine release and monocyte recruitment. It may also play a role in the polarization of monocytes and T cells into proinflammatory phenotypes. It may be involved in low-density lipoproteins (LDL) opsonization and uptake by macrophages. mCRP deposits were detected in samples of atherosclerotic lesions from human aorta, carotid, coronary and femoral arteries. mCRP may also induce platelet aggregation and thrombus formation, thus contributing in multiple ways in the development of atherosclerosis and atherothrombosis. In this mini-review, we will provide an insight into the process of conformational rearrangement of nCRP, leading to dissociation, and describe known effects of mCRP. We will provide a rationalization for mCRP involvement in the development of atherosclerosis and atherothrombosis.

Circulating bone marrow stem/progenitor cells in vascular atherogenesis and in the noninvasive diagnosis of coronary stenosis.

Using autopsy specimens and clonal technique, the authors showed that hematopoietic and stromal stem colony-forming units are present in human atheromatous vascular intima. Stromal colony-forming units were also detected in the mononuclear fraction of the blood of patients with hyperlipidemia and coronary stenosis, and were not found in the peripheral blood of normolipidemic volunteers. Using flow cytometry, the absence of stromal circulating colony-forming units in healthy volunteers and their presence in coronary patients was confirmed. It was thought that the presence of circulating stromal precursors with a certain phenotype and variations in their level in blood could serve as an informative noninvasive indicator of coronary stenosis.

Polymorphonuclear blood leukocytes and restenosis after intracoronary implantation of drug-eluting stents.

Peripheral blood contents of osteonectin-positive progenitor cells and polymorphonuclear granulocytes were examined by flow cytometry in 38 patients after myocardial revascularisation with drug-eluting stents. Repeat coronary angiography performed 6-12 months after stent implantation revealed in-stent restenosis in 15 patients and its absence in 23 patients. The plasma levels of osteonectin-positive progenitor cells, neutrophils, and basophils did not differ in patients with and without restenosis. Eosinophil blood levels in patients with and without restenosis were 262+/-68 and 124+/-67 cells/microL (mean+/-SD, p<0.001), respectively. Only one of 19 patients (5%) with eosinophil content lower than the distribution median for the entire group developed restenosis, whereas in the group with eosinophil contents higher than the median (n=19) restenosis occurred in 14 patients (74%, p<0.001). Our findings suggest that the frequency of restenoses after stenting is related to high peripheral blood eosinophil content.

Circulating stromal osteonectin-positive progenitor cells and stenotic coronary atherosclerosis.

The level of circulating stromal progenitor cells carrying osteonectin (ON), a marker of osteogenic differentiation, was evaluated by flow cytometry in blood of patients with coronary artery disease (CAD). Ninety-nine patients with CAD were included into the study. Coronary angiography of all patients showed critical stenosis of at least 2 coronary arteries or their major branches. The control groups included 8 patients without CAD and 19 healthy volunteers. In control patients, no lesions of the coronary bed were found by angiography. The absence of CAD in the volunteers was confirmed by bicycle stress test. The content of ON-positive cells in blood was examined in various populations of lymphocyte-like cells. It was found that the number of ON+ lymphocyte-like cells with CD41 positivity in blood of patients without coronary stenosis (0.27%+/-0.11%, mean+/-SD) did not differ significantly from corresponding value in healthy volunteers (0.26%+/-0.07%, p=0.94). In CAD patients, the percent of these ON+ cells was 1.01%+/-0.49% and was significantly higher than in blood of healthy volunteers (p<0.0001) and patients without CAD (p<0.0001). High content of ON+ lymphocyte-like cells with CD41 positivity in blood may serve as noninvasive marker of arterial atherosclerosis.