GPⅡb/Ⅲa抗体及ACA在系统性红斑狼疮血小板减少患者中临床意义探讨

目的:探讨血小板膜糖蛋白(GP) Ⅱb/Ⅲa抗体及抗心磷脂抗体(ACA)在系统性红斑狼疮血小板减少(SLE-TP)患者中的临床意义.方法:采用酶联免疫吸附试验(ELISA)法检测SLE血小板减少组35例、非血小板减少组27例、ITP组14例及健康对照组16例血清中抗GP Ⅱb/Ⅲa抗体及ACA的水平,分析其与SLE-TP患者临床、实验室指标及SLEDAI评分的相关性;统计方法采用x2检验、Fisher确切概率法.结果:①SLE血小板减少组抗GP Ⅱb/Ⅲa抗体表达水平显著高于非血小板减少组及健康对照组(P＜0.01);②抗GP Ⅱb/Ⅲa抗体在SLE血小板减少组与ITP组间的表达差异无统计学意义;③各组间ACA阳性率差异无统计学意义;④在SLE血小板减少组,抗GP Ⅱb/Ⅲa抗体与SLEDAI评分等级有显著关联(P＜0.05),与血小板减少程度、皮疹、光过敏、脾大、关节炎、粒细胞减少、肾脏及神经系统受累等临床指标无相关性,与dsDNA、Sm、SS-A、C3、C4、Coombs实验及ACA无显著关联.结论:SLE-TP患者血清中抗GP Ⅱb/Ⅲa抗体高表达,且与疾病的活动呈正相关,可能在SLE-TP的发病过程中发挥了重要作用.     

一种快速、灵敏的血小板释放功能检测方法及其在抗血小板药物研究中的应用

本文报道了一种快速、灵敏的血小板释放功能检测方法:利用荧光素-荧光素酶在有ATP、Mg~(2+)、O_2存在时产生的生物发光素测定血小板ATP的释放量,以反映血小板的释放功能;研究了ADP、AA、胶原、凝血酶等四种诱导剂对血小板释放功能的作用,发现ADP的诱导释放能力较其他三者为弱;观察在不同剂量ADP和AA的诱导下,血小板聚集强度和释放能力之间的关系,研究了血小板数等因素对ATP释放功能测定的影响。应用该方法研究了Aspirin及活血化淤药物川芎嗪,毛冬青甲素对血小板释放功能的影响,发现Aspirin对AA诱导的释放反应有强烈的抑制作用。在以ADP诱导的释放反应中,川芎嗪的抑制作用较毛冬青甲素更为强烈。     

尖吻蝮蛇毒活性肽K组分对血小板聚集和超微结构的影响

目的应用电镜研究尖吻蝮蛇毒活性肽(K组分)对血小板聚集和超微结构的影响,以探讨其抗血小板聚集的机制。方法取2周内未服任何药物健康志愿者静脉血,观察K组分对二磷酸腺苷(ADP)和胶原(collagen)诱导的血小板聚集作用的影响。将已调好的PRP分为5组,A组为空白对照组,B、D组为加入等体积的生理盐水组,C、E组为加K组分组。B、C组分别加血小板聚集诱导剂ADP,D、E组分别加血小板聚集诱导剂胶原,各组分别制成超薄切片样品进行电镜观察、摄片,测出其聚集抑制率。结果K组分能抑制由ADP和胶原诱导的血小板聚集,剂量与抑制率成量效关系,IC50经直线回归分别为0.067和0.088μmol/L。ADP和胶原组血小板形态不规则,突起明显增多。K组分组血小板形态基本规则,膜表面清晰光滑,颗粒较ADP与胶原组明显增加,胞浆空泡化现象减轻。结论K组分明显抑制ADP和胶原诱导的血小板聚集反应及其超微结构的改变。     

钙离子通道A23187对血小板聚集和蛋白质磷酸化的影响

以 ³²P-Na₂HPO₄标记猪血小板,在阿斯匹林阻断花生四烯酸代谢,Apyrase去除分泌的ADP情况下,以A23187和PMA为血小板激动剂,staurosporine为PKC抑制剂,研究Ca²⁺和蛋白激酶C在血小板聚集中的作用.结果表明,a.A23187在1～20 μmol/L引起血小板聚集,相应地,明显地引起40 ku、20 ku蛋白质磷酸化,且存在剂量和时间效应关系.b.A23187和PMA在血小板聚集和蛋白质磷酸化上都存在着协同效应.c.1 μmol/L staurosporine可大部分抑制20 μmol/L A23187诱导的血小板聚集和20 ku、40 ku蛋白质磷酸化.结果提示,Ca²⁺激活血小板是建立在激活PKC的基础上,Ca²⁺通过激活PKC诱导血小板聚集,这是Ca²⁺激活血小板的主要途径.     

L—精氨酸L—门冬氨酸盐对血小板功能的抑制

用血小板聚集、粘附、释放实验和出血时间测定观察L-精氨酸*L-门冬氨酸盐(DR)对血小板功能的作用。实验结果显示DR15mg/kg静脉给药,可明显抑制腺苷二磷酸(ADP)诱导的大鼠血小板聚集(P<0.01);15mg/kg单次口服给药可明显抑制ADP诱导的家兔血小板聚集;其药效可持续8h以上(P<0.01);DR7.5、15、30mg/kg灌胃给药(Bid×3.5d),可明显抑制ADP、胶原或凝血酶诱导的大鼠血小板聚集(P<0.01),并延长出血时间(P<0.05)。DR30mg/kg可明显抑制大鼠血小板粘附,并促进血管内皮释放前列环素(PGI2),但对活化的血小板释放血拴素(TXA2)无明显影响。本研究发现,DR可抑制血小板聚集和粘附功能,其作用机制不同于阿司匹林。这些作用部分是由于DR增加了血管内皮PGI2的释放。此结果为血小板功能的调节提供了新线索。     

新型抗血小板多肽类药物研究进展

抗血小板治疗在血栓性疾病的防治中发挥重要作用,血小板膜糖蛋白 GP IIb/IIIa 受体的活化是血小板聚集的最终共同通路。目 前的研究发现,多种新型多肽能与 GP IIb/IIIa 受体特异性结合,从而发挥抗血小板聚集的药理作用。分类综述含有或类似 RGD 序列和非 RGD 序列的新型抗血小板多肽类药物研究进展。     

长角血蜱唾液腺中胶原特异性血小板聚集抑制因子的纯化及机制的研究

从长角血蜱唾液腺匀浆纯化出一种新的胶原特异性血小板聚集抑制因子 ,命名为“longicornin” ,它能特异性地抑制胶原诱导的血小板聚集反应 ,而对其他激动剂如ADP、花生四烯酸、凝血酶、瑞斯托霉素、A2 31 87、U46 6 1 9、乙酸豆寇佛波醇所诱导的纯化的血小板聚集均无抑制作用 .longicornin还能抑制血小板激活过程 ,包括血小板颗粒的释放和细胞间质游离Ca ²⁺浓度的升高 ,对胶原与血小板的粘附无抑制作用 .longicornin可能与胶原在血小板上有同一受体 ,并且与血小板受体的结合是可逆的 .     

天麻醒脑胶囊对家兔血小板聚集和花生四烯酸诱导大鼠脑血栓形成的影响

采用比浊方法测定天麻醒脑胶囊在体内和体外对腺苷二磷酸（ADP）、花生四烯酸（arachidonic acid,AA）和血小板活化因子（platelet activating factor,PAF）诱导家兔血小板活化聚集的影响。采用从经大鼠颈内动脉注射诱发同侧大脑半球脑血栓形成方法评价天麻醒脑胶囊的抗脑血栓形成作用。天麻醒脑胶囊在体外呈浓度依赖性明显抑制从和ADP引起的血小板聚集,其半数抑制浓度（50％of inhibitory concentration,IC50）分别为1．83和3．25g/L。0．5和1g/kg的天麻醒脑胶囊于灌胃后明显抑制从诱导的家兔血小板聚集,本品1g/kg时显著阻抑ADP引起的血小板聚集。天麻醒脑胶囊在体内外对PAF诱导的血小板聚集均无明显影响。1、2g/kg天麻醒脑胶囊组的右侧与左侧脑重差值均显著减小,显著降低右脑伊文思蓝吸光度与右脑重的比值。结果提示,天麻醒脑胶囊具有较强的抗血小板和减轻脑血栓形成作用,有利于血小板聚集性增高的血栓栓塞性疾病的防治。     

含RGD模体的人白细胞介素18(IL-18)突变体的酵母表达及其抗血小板聚集活性

利用定点突变及DNA重组技术,在人白细胞介素18(IL18)cDNA序列中插入GGC序列,使IL18第39位精氨酸残基和第40位天冬氨酸残基之间插入一个甘氨酸残基,从而构建了RGD模体.此重组的cDNA序列构建入表达质粒pPIC9K,并转化Pichiapastoris酵母GS115,利用表达系统进行了高效表达.用SephadexG100凝胶过滤纯化表达产物,获得初步纯化的蛋白.对该蛋白进行了血小板聚集抑制实验和对GPⅡbⅢa与Fn结合的抑制实验.含RGD模体的重组IL18(IL18RGD)显示了较强的体外抑制血小板聚集活性,IC50=8.8μmolL;并具有与GPⅡbⅢa的竞争结合活性,IC50=8.0μmolL.该含有RGD模体的重组IL18仍保存对PBMC诱导产生IFNγ能力.结果表明,此IL18RGD嵌合体在具有抗炎,抗感染的同时增添了新的抑制血小板聚集功能.     

血小板膜糖蛋白(GP)Ⅲa PLA、Ⅰa807C/T 基因多态性与阿司匹林 抵抗的相关性研究

目的:探讨青岛地区汉族人群阿司匹林抵抗与血小板膜糖蛋白GPⅢaPLA、Ⅰ a807C/T基因多态性之间的关系.方法:筛选150例动脉粥样硬化患者服用阿司匹林(100mg/d)至少14d以上,根据血小板聚集功能测定将其分为阿司匹林抵抗(AR)组、阿司匹林半抵抗(ASR)组,阿司匹林敏感(AS)组.用PCR-RFLP法确定各组GPⅢaPLA、GP Ⅰa 807C/T基因型.结果:仅于ASR组检出1例PLA1/A2基因型,其余均为PLA1/A1基因型,未发现PLA2/A2基因型,差异无统计学意义(P＞0.005);GP Ⅰ a807C/T基因位点AR组、ASR组的T等位基因频率均显著高于AS组,有统计学意义(P＜0.005).结论:GPⅢaPLA2基因可能不是阿司匹林抵抗的遗传危险因素.而GP Ⅰ a 807C/T基因位点的T等位基因与阿司匹林抵抗的发生相关联,可能是阿司匹林抵抗遗传易感因素.     

ATP augments von Willebrand factor-dependent shear-induced platelet aggregation through Ca2+-calmodulin and myosin light chain kinase activation

Shear stress triggers von Willebrand factor (VWF) binding to platelet glycoprotein Ibalpha and subsequent integrin alpha(IIb)beta(3)-dependent platelet aggregation. Concomitantly, nucleotides are released from plateletdense granules, and ADP is known to contribute to shear-induced platelet aggregation (SIPA). We found that the impaired SIPA of platelets from a Hermansky-Pudlak patient lacking dense granules was restored by exogenous l-beta,gamma-methylene ATP, a stable P2X(1) agonist, as well as by ADP, confirming that in addition to ADP (via P2Y(1) and P2Y(12)), ATP (via P2X(1)) also contributes to SIPA. Likewise, SIPA of apyrase-treated platelets was restored upon P2X(1) activation with l-beta,gamma-methylene ATP, which promoted granule centralization within platelets and stimulated P-selectin expression, which is a marker of alpha-granule release. In addition, during SIPA, platelet degranulation required both extracellular Ca(2+) and VWF-glycoprotein Ibalpha interactions without involving alpha(IIb)beta(3). Neither platelet release nor SIPA was affected by protein kinase C inactivation, even though protein kinase C blockade inhibits platelet responses to collagen and thrombin in stirring conditions. In contrast, inhibiting myosin light chain (MLC) kinase with ML-7 reduced platelet release and SIPA by 30%. Accordingly, the potentiating effect of P2X(1) stimulation on the aggregation of apyrase-treated platelets coincided with intensified phosphorylation of MLC and was abrogated by ML-7. SIPA-induced MLC phosphorylation occurred exclusively through released nucleotides and selective antagonism of P2X(1) with MRS2159-reduced SIPA, ATP release, and potently inhibited MLC phosphorylation. We conclude that the P2X(1) ion channel induces MLC-mediated cytoskeletal rearrangements, thus contributing to SIPA and degranulation during VWF-triggered platelet activation.     

P2 receptors and platelet function

Following vessel wall injury, platelets adhere to the exposed subendothelium, become activated and release mediators such as TXA₂ and nucleotides stored at very high concentration in the so-called dense granules. Released nucleotides and other soluble agents act in a positive feedback mechanism to cause further platelet activation and amplify platelet responses induced by agents such as thrombin or collagen. Adenine nucleotides act on platelets through three distinct P2 receptors: two are G protein-coupled ADP receptors, namely the P2Y₁ and P2Y₁₂ receptor subtypes, while the P2X₁ receptor ligand-gated cation channel is activated by ATP. The P2Y₁ receptor initiates platelet aggregation but is not sufficient for a full platelet aggregation in response to ADP, while the P2Y₁₂ receptor is responsible for completion of the aggregation to ADP. The latter receptor, the molecular target of the antithrombotic drugs clopidogrel, prasugrel and ticagrelor, is responsible for most of the potentiating effects of ADP when platelets are stimulated by agents such as thrombin, collagen or immune complexes. The P2X₁ receptor is involved in platelet shape change and in activation by collagen under shear conditions. Each of these receptors is coupled to specific signal transduction pathways in response to ADP or ATP and is differentially involved in all the sequential events involved in platelet function and haemostasis. As such, they represent potential targets for antithrombotic drugs.     

Interaction between ATP and catecholamines in stimulation of platelet aggregation

Platelets, on activation by endothelial damage, release ADP, ATP, serotonin, epinephrine, and norepinephrine. Although ATP is known to augment the action of norepinephrine in cardiovascular and endocrine systems, the possible interaction between ATP and catecholamines in regulation of platelet reactivity has not been reported. The addition of ATP (1-5 microM) to human platelet-rich plasma did not induce platelet aggregation; however, it selectively augmented the aggregatory response to norepinephrine and epinephrine, but not to serotonin. This potentiating action of ATP was dose dependent and was not due to contamination by, or hydrolysis to, ADP. The action of ATP was blocked by 10 microM of adenosine 3'-phosphate 5'-phosphosulfate, a selective P(2)Y(1) receptor antagonist. ATP alone did not cause release of intracellular Ca(2+), but produced a significant Ca(2+) response in the presence of norepinephrine. In contrast, the P(2)X(1) receptor agonists P(1),P(6)-diadenosine-5' hexophosphate and alpha,beta-methylene-ATP had no effect on norepinephrine-induced platelet aggregation even when added at 100 microM. This synergistic interaction between ATP and norepinephrine in stimulating platelet aggregation may have significant clinical implications and suggests a prothrombotic role for ATP in stress.     

Benzoyl ATP is an antagonist of rat and human P2Y1 receptors and of platelet aggregation

The effects of 2'- and 3'-O-(4-benzoylbenzoyl)-ATP (BzATP) on intracellular Ca2+ mobilization and cyclic AMP accumulation were investigated using rat brain capillary endothelial cells which express an endogenous P2Y1 receptor, human platelets which are known to express a P2Y1 receptor, and Jurkat cells stably transfected with the human P2Y1 receptor. In endothelial cells, BzATP was a competitive inhibitor of 2-methylthio ADP (2-MeSADP) and ADP induced [Ca2+]i responses (Ki = 4.7 microM) and reversed the inhibition by ADP of adenylyl cyclase (Ki = 13 microM). In human platelets, BzATP inhibited ADP-induced aggregation (Ki = 5 microM), mobilization of intracellular Ca2+ stores (Ki = 6.3 microM), and inhibition of adenylyl cyclase. In P2Y1-Jurkat cells, BzATP inhibited ADP and 2-MeSADP-induced [Ca2+]i responses (Ki = 2.5 microM). It was concluded that BzATP is an antagonist of rat and human P2Y1 receptors and of platelet aggregation. In contrast to other P2Y1 receptor antagonists (A2P5P and A3P5P) which inhibit only ADP-induced Ca2+ mobilization, BzATP inhibits both the Ca2+- and the cAMP-dependent intracellular signaling pathways of ADP. These results provide further evidence that P2Y1 receptors contribute to platelet ADP responses.     

Proteolytic degradation of vimentin and glial fibrillary acidic protein in rat astrocytes in primary culture

The receptor for ADP on the platelet membrane, which triggers exposure of fibrinogen-binding sites and platelet aggregation, has not yet been identified. Two enzymes with which ADP interacts on the platelet surface, an ecto-ATPase and nucleosidediphosphate kinase, have been proposed as possible receptors for ADP in ADP-induced platelet aggregation. In the present study, experiments were conducted with washed human platelets to examine if a relationship existed between platelet aggregation, fibrinogen binding and the enzymatic degradation of ADP. With 12 different platelet suspensions, a good correlation (P less than 0.01) was found between the extent of platelet aggregation and the amount of 125I-fibrinogen bound to platelets after ADP stimulation. No correlation was found between these parameters and the rate or extent of transformation of [14C]ADP to [14C]ATP or [14C]AMP. The binding of fibrinogen to platelets was inhibited in parallel with aggregation when ADP stimulation was impaired by the enzymatic degradation of ADP by the system creatine phosphate/creatine phosphokinase, or by the use of specific antagonists, such as ATP and AMP. These antagonists also influenced the enzymatic degradation of ADP. This effect occurred at lower concentrations of ATP or AMP than those required to inhibit ADP-induced platelet aggregation and fibrinogen binding. Our results demonstrate that ATP and AMP may be used as specific antagonists of the ADP-induced fibrinogen binding to platelets. They do not provide evidence to suggest that enzymes which metabolize ADP on the platelet surface are involved in the mechanism of ADP-induced platelet aggregation.     

Calmodulin interacts with the platelet ADP receptor P2Y1

P2Y1 [P2 (purinergic type-2)-receptor 1] is a G-protein-coupled ADP receptor that regulates platelet activation and ADP-induced Ca2+ signalling. Studies using P2Y1-knockout mice, G(q)-deficient mice or P2Y1-selective inhibitors have previously identified a key role for P2Y1 in pathophysiological thrombus formation at high shear stress. We provide evidence that a positively charged juxtamembrane sequence within the cytoplasmic C-terminal tail of P2Y1 can bind directly to the cytosolic regulatory protein calmodulin. Deletion by mutagenesis of the calmodulin-binding domain of P2Y1 inhibits intracellular Ca2+ flux in transfected cells. These results suggest that the interaction of calmodulin with the P2Y1 C-terminal tail may regulate P2Y1-dependent platelet aggregation.     

Signal transducing mechanisms in platelets.

Platelets respond through discrete receptors to a number of physiological stimuli and foreign surfaces with a sequence of measurable responses: shape change, aggregation, secretion and arachidonate liberation. Three secretory responses are distinguished: release of substances from 1) dense granules (ADP, serotonin), 2) alpha-granules (coagulation factors, platelet-specific proteins, adhesive proteins) and 3) lysosomes (acid hydrolases). The liberated arachidonate is converted to prostaglandins and thromboxanes which, together with secreted ADP and close cell contact, will cause further platelet activation through "positive feedback" (autocrine stimulation). Some agonists are "weak" (ADP, vasopressin, platelet-activating factor) and depend on positive feedback to promote the full sequence of responses, while other agonists are "strong" (thrombin, collagen) and stimulate the entire response sequence without positive feedback. Most agonists appear to stimulate platelet responses via G-protein-dependent activation of phospholipase C, resulting in diesteratic hydrolysis of phosphatidylinositol-4,5-bisphosphate yielding inositol-1,4,5-trisphosphate and diacylglycerol. These are signal molecules which mobilize cytoplasmic Ca2+ and stimulate protein kinase C, respectively. Cytoplasmic Ca2+ will in turn activate protein phosphorylations which eventually lead to execution of the various responses while activation of protein kinase C appears to be linked to regulation of intracellular pH through Na+/H+ exchanger and to termination of the Ca(2+)-mediated signal processing. Other agonists (prostaglandins I2 and D2) counteract platelet stimulation through classical activation of adenylate cyclase.     

Adenosine diphosphate receptors on blood platelets: potential new targets for antiplatelet therapy

Platelets play a key role not only in physiological haemostasis, but also under pathological conditions such as thrombosis. Platelet activation may be initiated by a variety of agonists including thrombin, collagen, thromboxane or adenosine diphosphate (ADP). Although ADP is regarded as a weak agonist of blood platelets, it remains an important mediator of platelet activation evoked by other agonists, which induce massive ADP release from dense granules, where it occurs in molar concentrations. Thus, ADP action underlies a positive feedback that facilitates further platelet aggregation and leads to platelet plug formation. Additionally, ADP acts synergistically to other, even weak, agonists such as serotonin, adrenaline or chemokines. Blood platelets express two types of P2Y ADP receptors: P2Y(1) and P2Y(12). ADP-dependent platelet aggregation is initiated by the P2Y1 receptor, whereas P2Y(12) receptor augments the activating signal and promotes platelet release reaction. Stimulation of P2Y(12) is also essential for ADP-mediated complete activation of GPIIb-IIIa and GPIa-IIa, and further stabilization of platelet aggregates. The crucial role in blood platelet biology makes P2(Y12) an ideal candidate for pharmacological approaches for anti-platelet therapy.     

Selective activation of Ca2+ influx by extracellular ATP in a pancreatic beta-cell line (HIT)

The action of exogenous ATP on cytoplasmic free Ca2+ ([Ca2+]i) was studied in insulin secreting cells using fura-2. Stimulation of clonal pancreatic beta-cells (HIT) with ATP (range 2-20 microM) evoked a sustained elevation in [Ca2+]i. ATP selectively promoted Ca2+ influx and not Ca2+ mobilization since (1) the effect required external Ca1+ and (2) was observed in cells in which internal stores were depleted with ionomycin (3) the rate of Mn2+ influx, measured as the quenching of the fura-2 signal, was accelerated by ATP. The action of ATP was unaffected by the voltage-sensitive Ca2+ channel blockers nifedipine and verapamil as well as by a depolarizing concentration of K+. The effect on [Ca2+]i was highly specific for ATP since AMP, ADP, adenosine 5'-[gamma-thio]triphosphate, adenosine 5'-[beta, gamma-methylene]triphosphate, GTP and adenosine were ineffective. In normal pancreatic islet cells, both exogenous ATP (range 0.2-2 microM) and ADP induced a transient Ca2+ elevation that did not require external Ca2+. The nucleotide specificity of the effect on [Ca2+]i suggests that ATP activates P2 gamma purinergic receptors in normal beta-cells. Thus, ATP evokes a Ca2+ signal in clonal HIT cells and normal islet cells by different transducing systems involving distinct purinoreceptors. A novel mechanism for increasing [Ca2+]i by extracellular ATP is reported in HIT cells, since the nucleotide specificity and the selective activation of Ca2+ influx without mobilization of internal Ca2+ stores cannot be explained by mechanisms already described in other cell systems.     

Possible mechanisms of the potentiation of blood-platelet activation by adrenaline.

Vasopressin and adrenaline in combination exert synergistic effects on platelet activity. This study investigated the effects of sub-threshold concentrations of adrenaline (0.1-1 microM) on vasopressin (10 nM-1 microM)-induced platelet aggregation, ATP secretion, elevation of cytosolic free Ca2+ concentration ([Ca2+]i) and hydrolysis of inositol phospholipids, monitored as [32P]phosphatidic acid formation. Potentiation of vasopressin-induced aggregation and ATP secretion by adrenaline was accompanied by enhanced elevation of [Ca2+]i and [32P]phosphatidic acid formation. The stimulatory effects of adrenaline on vasopressin-induced platelet activation were mimicked by the combination of the Ca2+ ionophore, ionomycin, and the protein kinase C activator, phorbol 12-myristate 13-acetate, but not by either of these agents alone. These results suggest that the potentiation of vasopressin-induced platelet activation by adrenaline is mediated via enhancement of inositol phospholipid hydrolysis and elevation of [Ca2+]i.