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Blood, 15 July 2008, Vol. 112, No. 2, pp. 340-349.
Prepublished online as a Blood First Edition Paper on March 13, 2008; DOI 10.1182/blood-2007-10-119552.


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HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY

Synergistic interactions between interferon-{gamma} and TRAIL modulate c-FLIP in endothelial cells, mediating their lineage-specific sensitivity to thrombotic thrombocytopenic purpura plasma–associated apoptosis

Radu Stefanescu1, Dustin Bassett1, Rozbeh Modarresi1, Francisco Santiago1, Mohamad Fakruddin2, and Jeffrey Laurence1

1 Department of Medicine, Division of Hematology-Oncology, Weill Medical College–Cornell University, New York, NY; and 2 Aeras Global TB Vaccine Foundation, Rockville, MD

Microvascular endothelial cell (MVEC) injury coupled to progression of platelet microthrombi facilitated by ADAMTS13 deficiency is characteristic of idiopathic and HIV-linked thrombotic thrombocytopenic purpura (TTP). Cytokines capable of inducing MVEC apoptosis in vitro are up-regulated in both TTP and HIV infection. However, the concentrations of these cytokines required to elicit EC apoptosis in vitro are 2- to 3-log–fold greater than present in patient plasmas. We report that clinically relevant levels of tumor necrosis factor–related apoptosis-inducing ligand (TRAIL) and interferon (IFN)–{gamma} act in synergy to induce apoptosis in dermal MVECs, but have no effect on large-vessel ECs or pulmonary MVECs. This reflects the tissue distribution of TTP lesions in vivo. Sensitivity to TTP plasma or TRAIL plus IFN-{gamma} is paralleled by enhanced ubiquitination of the caspase-8 regulator cellular FLICE-like inhibitory protein (c-FLIP), targeting it for proteasome degradation. c-FLIP silencing with anti-FLIP short interfering RNA (siRNA) in pulmonary MVECs rendered them susceptible to TTP plasma– and cytokine-mediated apoptosis, while up-regulation of c-FLIP by gene transfer partially protected dermal MVECs from such injury. TTP plasma–mediated apoptosis appears to involve cytokine-induced acceleration of c-FLIP degradation, sensitizing cells to TRAIL-mediated caspase-8 activation and cell death. Suppression of TRAIL or modulation of immunoproteasome activity may have therapeutic relevance in TTP.


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Related Article in Blood Online:

Endothelial cells are not all alike
Hau C. Kwaan
Blood 2008 112: 218. [Full Text] [PDF]





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