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HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
From the Department of Internal Medicine and Blood
Center, Keio University, Tokyo, Japan; and Toray Industries, Kanagawa,
Japan.
Liposomes carrying both recombinant glycoprotein Ia/IIa (rGPIa/IIa)
and Ib The basic and important platelet functions for
primary hemostasis are adhesion and aggregation, and this can be easily
understood from the observations that patients with congenital platelet
membrane defects such as Bernard-Soulier syndrome or Glanzmann
thrombasthenia are deficient in platelet adhesion or aggregation and
have severe bleeding tendencies. The contribution of specific platelet
receptors or adhesive proteins to platelet adhesion and aggregation
onto immobilized collagen under flow conditions is usually studied with
monoclonal antibodies or inhibitors specific to particular platelet
receptors or adhesive proteins or, also, with blood from patients with
congenital bleeding disorders deficient in specific receptors or
adhesive proteins. These analyses indicate that initial platelet
adhesion depends on the interaction of glycoprotein (GP) Ib/IX/V
complexes on platelets with von Willebrand factor (VWF) adsorbed on the
collagen surface. This is a rapid but low-affinity interaction,
suggesting that it serves to tether platelets, flowing at high speed in
the bloodstream, to the collagen surface.1-4 The collagen
receptors of the tethered platelets then bind strongly with the
collagen surface, activating platelets to form aggregates. This was
supported by observations that platelets deficient in one of the
collagen receptors failed to adhere and form aggregates on
subendothelium or the collagen surface under flow
conditions.4,5 GPIa/IIa and GPVI are known to be involved
in platelet adhesion under static conditions.6,7 GPIa/IIa
(integrin Materials
Preparation of reconstituted blood
Preparation of liposomes Liposomes were prepared by the detergent-dialysis method,21,22 originally developed for the reconstitution of membrane proteins, using the detergent OG. The protein was first conjugated to NGPE in the presence of detergent. The conjugated protein was then mixed with the lipid-detergent mixture, and the incorporation of protein is achieved upon the removal of the detergent by dialysis. Thus, NHSS (0.1 M in H2O) and EDCI (0.25 M in H2O) were added to NGPE solubilized with 2% (wt/vol) OG in 50 mM MES buffer, pH 5.5, and the mixture was incubated for 10 minutes at room temperature. NGPE with an NHSS-activated carboxylic derivative was purified using a Sephadex G-25 column with 50 mM HEPES/0.1% (wt/vol) OG, pH 8.0, and was added to a solution of recombinant protein. The resultant solution was incubated for 12 hours at 4°C with gentle stirring. For rhodamine-labeled liposome preparation,23 a thin film of the lipid mixture containing EPC, CHO, and N-Rh-PE in a molar ratio of 2:1:0.024 was solubilized with OG in 50 mM HEPES/110 mM NaCl buffer, pH 7.4. The resultant solution was mixed vigorously with the NGPE-conjugated protein. The liposomes were then purified using a Sephadex G-75 column, CsCl density gradient centrifugation, and dialysis against 0.9% NaCl. Control liposomes were made with EPC, CHO, and N-Rh-PE in a molar ratio of 2:1:0.024 in the absence of the NGPE-conjugated protein. The liposomes were extruded repeatedly through double-stacked 1.0- and 0.8-µm pore-size polycarbonate membranes (Whatman/Nuclepore, Clifton, NJ) in a high-pressure extrusion cell (Lipex Biomembrane, Vancouver, British Columbia, Canada) as described before24 to produce a final mean diameter range of 800 to 900 nm. Liposomes with different protein-to-lipid ratios were obtained by altering the initial protein-to-lipid ratio. EPC and CHO were quantified using a phospholipid-test Wako and F-kit CHO, respectively. The exofacial densities of rGPIa/IIa and rGPIb were determined using an ELISA with
Integrin 1 EIA Kit (Takara Shuzo, Otsu, Japan) and
Glycocalicin EIA Kit (Takara Shuzo), respectively. The
exofacial density of rGPIa/IIa was also determined using an ELISA with
anti-GPIIa monoclonal antibody, Lia1/2, and horseradish
peroxidase-conjugated functional anti-GPIa monoclonal antibody,
HRP-Gi9. The amount of rGPIa/IIa or rGPIb associated with the
liposome bilayer was determined using the same method as described
above in the presence of 1% (vol/vol) Nonidet P-40. The rGPIa/IIa and
rGPIb solutions were used as standards for measuring receptor
density. Absorbance at 492 nm was measured with an Easy Reader EAR 340 (SLT-Lab Instruments, Grodig, Austria). The exofacial densities of
rGPIa/IIa determined with Integrin 1 EIA Kit and
Lia1/2/HRP-Gi9 system were very consistent within standard deviation.
The liposome size was measured with a dynamic light scattering
technique using a particle analyzer N4 PLUS (Beckman, Fullerton, CA).
The particle numbers of liposomes were calculated based on particle
size, EPC concentration, bilayer thickness (15.0 nm), and EPC
specific gravity (1.0305).
Preparation of the immobilized collagen surface Glass slides, 2.5-cm diameter and 0.5-mm thick, were spin-coated with 6% (wt/vol) polycarbonate solution in tetrachloroethane. The glass slides were then incubated with 30 µg/mL porcine tendon acid soluble type I collagen (Nitta Gelatin, Osaka, Japan) in phosphate-buffered saline overnight at 4°C followed by blocking with 1% (wt/vol) BSA in phosphate-buffered saline. After removing excess BSA with 3 sequential phosphate-buffered saline rinses, the glass slides were assembled in the chamber to measure the interaction of the liposomes with the immobilized collagen.Measurements of the interaction of the liposomes with immobilized collagen The interaction of rhodamine-labeled liposomes with immobilized collagen was studied using a recirculating chamber, mounted on an epifluorescence microscope, (ECLIPS TE300, Nikon, Tokyo, Japan), using the excitation and emission wavelengths of 550 and 590 nm, respectively. This allowed direct visualization in real time of the liposome interaction with the collagen surface, which was recorded with a videocassette recorder. The flow chamber consisted of upper lid, packing, and glass slide. The upper lid had a depression of 0.030 cm perpendicular to the blood flow and served as part of the roof of the flow chamber that was formed when the upper lid and the glass slide were joined with 4 screws. The packing, hollowed out of a square 1.5 × 1.5 cm, was put between the upper lid and the glass slide, making a flow chamber with a width, length, and depth of 1.5 × 1.5 cm by 0.030 cm. The wall shear rate ( W) is given by the
Muggli equation25:
W = 1.03 × 6Q/ab2, where Q is the flow
rate (cm3/sec), and a and b are the chamber width and
height (cm).
Perfusion studies were performed in the presence of liposomes at a
final particle number of 2.5 × 105/µL, Hct 37.5%,
platelet count 1.25 × 104/µL
(12.5 × 109/L), 2 mM Mg2+, 10 µg/mL
soluble VWF, and 37°C. Some experiments were performed in the absence
of soluble VWF. Single-frame images of the liposomes interacting with
the surface were obtained using the image processor ARGUS-50 (Hamamatsu
Photonics, Hamamatsu, Japan). The percentages of surface coverage of
liposomes were obtained using the image processor ARGUS-20 (Hamamatsu
Photonics). For the inhibition experiments, the liposomes were
incubated with 10 µg/mL mouse anti-GPIb
Adhesion of rGPIa/IIa-liposomes to the collagen surface under flow conditions In marked contrast with the translocation of rGPIb -liposomes on
the VWF surface,14 rGPIa/IIa-liposomes instantaneously and
irreversibly adhered to the collagen surface. Each single frame shown
in Figure 1 was obtained after 3 minutes
of perfusion of rGPIa/IIa-liposomes with an exofacial rGPIa/IIa density
of 2.22 × 103 molecules per particle on the collagen
surface at different shear rates, as indicated. When exposed to shear
rates of 600 s 1 for 3 minutes, the percentages of surface
coverage of rGPIa/IIa-liposomes were 23.0% ± 2.2% and
23.8% ± 2.0%, in the presence and absence of soluble VWF,
respectively. At a shear rate of 2400 s 1, the percentages
of surface coverage remarkably decreased to 3.5% ± 0.6% and
3.0% ± 0.6%, in the presence and absence of soluble VWF,
respectively. No interaction was observed between rGPIa/IIa-liposomes and the BSA surface at any shear rates tested regardless of whether or
not soluble VWF was present (data not shown). The liposome adhesion was
abolished by preincubation of the liposomes with the functional
anti-GPIa monoclonal antibody, Gi9, or in the presence of free
rGPIa/IIa (Figure 2). No effect of
control mouse IgG on the liposome adhesion was observed (Figure 2).
These results indicate that rGPIa/IIa-liposomes retain a receptor
function against immobilized collagen, and the targeting of
rGPIa/IIa-liposomes is specific to the collagen surface under flow
conditions. Also, the adhesion of rGPIa/IIa-liposomes is more efficient
in lower flow environments and is independent of VWF.
Adhesion of rGPIa/IIa-Ib -liposomes to the collagen
surface was also instantaneous and irreversible. The images shown in
Figure 3 are composites created by the
superimposition of 30 successive frames, taken at
66-millisecond intervals. In the case of rGPIa/IIa-Ib - or
rGPIa/IIa-liposomes, the fluorescent dots of the liposomes stayed on
the collagen surface, representing irreversible adhesion of the
liposomes to the surface (Figure 3A,B). Short tracks formed by closely
spaced fluorescent dots of rGPIb -liposomes extending in the
direction of flow can be seen, demonstrating transient interaction of
rGPIb -liposomes with VWF adsorbed on the collagen surface (Figure
3C). No interaction of control liposomes with the collagen surface was
observed (Figure 3D).
Each single-frame image shown in Figure 4
was obtained after 3 minutes of perfusion of rGPIa/IIa-Ib
Surface coverage of the liposomes with different exofacial
rGPIb
Inhibitory effect of anti-rGPIb -VWF axis was
blocked by the anti-rGPIb antibody, GUR 83-35, the liposomes still
adhered irreversibly to the collagen surface in a shear rate-dependent
fashion. The relative surface coverage decreased from 66.2% ± 3.9%
to 6.5% ± 2.6% with the shear rate increasing from 600 to 2400 s 1 for the liposomes with exofacial densities of
rGPIa/IIa and rGPIb of 2.17 × 103 and
1.00 × 104 molecules per particle, respectively (Figure
6A). The same trend was observed for liposomes with exofacial densities
of rGPIa/IIa and rGPIb of 2.19 × 103 and
5.27 × 103 molecules per particle, respectively (Figure
6B), although the inhibitory effects were smaller than those in
liposomes with a higher exofacial density of rGPIb at a shear rate
of 2400 s 1 (compare Figures 6A and 6B). No effect of GUR
83-35 was observed for the liposomes carrying rGPIa/IIa alone (Figure
6C). These results suggest that the inhibitory effect of GUR 83-35 is
greater at high shear rates and the extent of dependence of liposome
adhesion on the rGPIb -VWF interaction is greater at higher shear
rates. When the rGPIa/IIa-collagen axis was blocked by the anti-rGPIa antibody, Gi9, the liposome displacement on the surface was observed, as with the rGPIb -liposomes on the collagen surface. The inhibitory effect of Gi9 was always greater than that of GUR 83-35, especially at
low shear rates. No effect of control mouse IgG on the liposome adhesion was observed. These observations indicate that both the rGPIa/IIa-collagen interaction and the tethering of the liposomes by
the rGPIb -VWF interaction are required for liposome adhesion, and
they synergistically contribute to stable adhesion of
rGPIa/IIa-Ib -liposomes, especially at high shear rates.
The recognition of exposed subendothelial collagen by blood
platelets is a key early step in the formation of a hemostatic plug
after vascular injury. Many different platelet surface and platelet
surface-associated proteins have been proposed as mediators of
platelet-collagen adhesion. Santoro has defined a
Mg2+-dependent mechanism of platelet adhesion to
collagen6 apparently identical to that observed by Shadle
and Barondes26 and have isolated a platelet surface
Mg2+-dependent heterodimeric collagen-binding complex
composed of platelet membrane GPIa and GPIIa.27 When
incorporated into liposomes, the purified complex mediated the
Mg2+-dependent adhesion of the liposomes to collagen
substrates at static conditions.28,29 The rGPIa/IIa used
in this study has an activated form and the specific binding to
collagen characterized by a dissociation constant of the same order of
magnitude as that for the binding of collagen to GPIa/IIa on activated
platelets.12 Also, rGPIb In the present study, liposomes carrying rGPIa/IIa and rGPIb Our results suggest that 2 distinct substrates, collagen and VWF,
are required in order to provide the biomechanical properties necessary
to mediate stable liposome adhesion, especially at high shear rates.
The rGPIa/IIa supports immediate arrest of flowing liposomes onto the
collagen surface but works efficiently only at the lower shear rates,
presumably because of a relatively slow rate of bond formation with
immobilized collagen and a low resistance of the bond to tensile
stress. In contrast, the interaction of rGPIb Our findings now define a unique function for rGPIa/IIa, expressed by
its ability to act in concert with the rGPIb These results contribute to the long-term purpose of our studies, which is to prepare liposome systems that improve primary hemostasis under thrombocytopenic conditions and that are promising agents for the prophylaxis and treatment of bleeding in patients with severe thrombocytopenia. The simplest type of artificial platelets might be particles carrying platelet membrane proteins and/or ligands of the proteins involved in platelet adhesion and aggregation. Based on this idea, some materials have been developed as platelet substitutes, such as erythrocytes with fibrinogen, or RGD peptides, covalently linked to their surfaces,34,35 liposomes bearing more than 15 kinds of platelet membrane proteins (eg, GPIb, GPIIb/IIIa, GPVI) isolated from the platelet membranes with deoxycholate,36 and fibrinogen-coated albumin microparticles.37,38 Some of these are reactive with adhesive ligands or with normal platelets in vitro, or are effective in enhancing hemostatic function in thrombocytopenic or thrombocytopathic animals in vivo. Recently, it has been determined that rGPIa/IIa-liposomes have hemostatic activity in vivo.12 However, no platelet substitute has yet been reported to be effective for hemostasis in large clinical studies so far. In conclusion, we have developed an effective tool for studying
adhesive interactions of platelets under flow conditions and proved
that 2 distinct receptor-ligand pairs with unique properties, GPIa/IIa-collagen and GPIb
We thank Welfide Corporation (Osaka, Japan) for preparation of
rGPIb
Submitted December 28, 2000; accepted February 22, 2002.
Supported by health science research grants for research on advanced medical technology from the Ministry of Health and Welfare, Tokyo, Japan.
The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked "advertisement" in accordance with 18 U.S.C. section 1734.
Reprints: Takako Nishiya, Department of Internal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; e-mail: nishiya{at}med.keio.ac.jp.
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© 2002 by The American Society of Hematology.
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