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Prepublished online as a Blood First Edition Paper on January 16, 2003; DOI 10.1182/blood-2002-10-3242.
HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
From the Rudolf Virchow Center for Experimental
Biomedicine, University of Würzburg, Würzburg,
Germany.
Glycoprotein (GP) VI is an essential collagen receptor on platelets
and may serve as an attractive target for antithrombotic therapy. We
have previously shown that a monoclonal antibody (mAb) against the
major collagen-binding site on mouse GPVI (JAQ1) induces irreversible
down-regulation of the receptor and, consequently, long-term
antithrombotic protection in vivo. To determine whether this unique in
vivo effect of JAQ1 is based on its interaction with the ligand-binding
site on GPVI, we generated new mAbs against different epitopes on GPVI
(JAQ2, JAQ3) and tested their in vitro and in vivo activity. We show
that none of the mAbs inhibited platelet activation by collagen or the
collagen-related peptide in vitro. Unexpectedly, however, injection of
either antibody induced depletion of GPVI with the same efficacy and
kinetics as JAQ1. Importantly, this effect was also seen with
monovalent F(ab) fragments of JAQ2 and JAQ3, excluding the involvement
of the Fc part or the dimeric form of anti-GPVI antibodies in this process. This indicates that anti-GPVI agents, irrespective of their
binding site may generally induce down-regulation of the receptor in vivo.
(Blood. 2003;101:3948-3952) Coronary artery thrombosis is often initiated by
platelet adhesion and aggregation on subendothelial collagens exposed
on the surface of the ruptured atherosclerotic plaque.1-4
Platelet-collagen interactions are complex and involve a large number
of receptors that directly or indirectly interact with the matrix
protein, most importantly GPIb-V-IX,5 integrins
The first direct proof for effective antithrombotic protection by
anti-GPVI treatment came from studies in mice using the anti-GPVI
monoclonal antibody (mAb), JAQ1. JAQ1 is directed against the major
collagen-binding site on GPVI and inhibits platelet activation by
collagen and the collagen-related peptide (CRP).15,17 In
vivo treatment of mice with JAQ1 or monovalent F(ab) fragments of the
antibody induces the internalization and proteolytic degradation of
GPVI in circulating platelets resulting in a prolonged
GPVI-knock-out-like phenotype.18 Similar mechanisms of
GPVI down-regulation appear to exist in humans because one
GPVI-deficient patient had developed highly specific antibodies against
the apparently absent receptor suggesting that she suffered from an
acquired GPVI deficiency based on antibody-induced clearing of the
receptor from her platelets.13 F(ab) fragments of the
antibodies isolated from this patient inhibited collagen-induced
activation of normal human platelets.7,13 Together, these
observations led to the hypothesis that targeting of the
collagen-binding site on GPVI may elicit signals that finally result in
down-regulation of the receptor in vivo.18
To develop effective anti-GPVI agents and to predict their mode of
action in vivo, a better understanding of the mechanisms underlying
GPVI down-regulation is required. To test the hypothesis that targeting
of the ligand-binding site on the receptor is essential for this
process to occur, we generated mAbs against other epitopes on mouse
GPVI and examined their in vivo activity. Unexpectedly, we found that
the in vivo depletion of GPVI was induced by all anti-GPVI mAbs or
F(ab) fragments thereof, irrespective of their binding site on the receptor.
Animals
Antibodies
Platelet preparation Mice were bled under ether anesthesia from the retro-orbital plexus. Blood was collected in a tube containing 10 U/mL heparin, and platelet-rich plasma (prp) was obtained by centrifugation at 300g for 10 minutes at room temperature (RT). For washed platelets, prp was centrifuged at 1000g for 8 minutes and the pellet was resuspended twice in modified Tyrode-HEPES (N-2-hydroxyethylpiperazine-N'2-ethanesulfonic acid) buffer (134 mM NaCl, 0.34 mM Na2HPO4, 2.9 mM KCl, 12 mM NaHCO3, 20 mM HEPES, 5 mM glucose, 0.35% bovine serum albumin, pH 6.6) in the presence of prostacyclin (0.1 µg/mL) and apyrase (0.02 U/mL). Platelets were then resuspended in the same buffer (pH 7.0, 0.02 U/mL apyrase) and incubated at 37°C for at least 30 minutes before analysis.Immunoblotting and immunoprecipitation Immunoprecipitation was performed as described previously.15 Briefly, 108 washed platelets were surface labeled with EZ-Link sulfo-NHS-LC-biotin (Pierce, 100 µg/mL in phosphate-buffered saline [PBS]) and subsequently solubilized in 1 mL lysis buffer (Tris-buffered saline containing 20 mM Tris [tris(hydroxymethyl)aminomethane])/HCl, pH 8.0, 150 mM NaCl, 1 mM EDTA [ethylenediaminetetraacetic acid], 1 mM phenylmethylsulfonyl fluoride, and 1% Nonidet P-40). Cell debris was removed by centrifugation (15 000g, 10 minutes). Following preclearing (8 hours), 10 µg mAb was added together with 25 µL protein G-Sepharose (Pharmacia) and precipitation took place overnight with rotation at 4°C. Samples were separated by 12% SDS-PAGE along with a molecular weight marker and transferred onto a polyvinylidene difluoride membrane. The membrane was incubated with streptavidin-HRP (1 µg/mL) for 1 hour after blocking. After extensive washing, biotinylated proteins were visualized by enhanced chemiluminescence (ECL; Amersham, Freiburg, Germany). For immunoblotting, platelets were not surface labeled. After lysis, whole cell extract was run on an SDS-polyacrylamide gel and transferred onto a polyvinylidene difluoride membrane. The membrane was first incubated with 5 µg/mL JAQ1 followed by HRP-labeled rabbit antirat immunoglobulin and proteins were visualized by ECL.Flow cytometry Washed platelets (2 × 106) or whole blood samples were incubated with fluorophore-conjugated mAbs at saturating concentrations for 15 minutes at RT and directly analyzed on a FACScalibur (Becton Dickinson, Heidelberg, Germany). Platelets were gated by forward scatter/side scatter (FSC/SSC) characteristics. For competition studies, platelets were preincubated with unlabeled antibodies (50 µg/mL, 30 minutes), washed with PBS, and then incubated with fluorescein isothiocyanate (FITC)-labeled JAQ1, JAQ2, or JAQ3.Aggregometry To determine platelet aggregation, light transmission was measured using prp (200 µL with 0.5 × 106 platelets/µL). Transmission was recorded in a Fibrintimer 4 channel aggregometer (APACT Laborgeräte und Analysensysteme, Hamburg, Germany) over 10 minutes and was expressed as arbitrary units with 100% transmission adjusted with plasma. Platelet aggregation was induced by addition of CRP (0.25-5 µg/mL), collagen (1-20 µg/mL), adenosine diphosphate (ADP; 5 µM), or cross-linking of bound antibodies by antirat IgG. For inhibition studies, prp was preincubated with various concentrations of JAQ1, JAQ2, JAQ3, or control IgG followed by addition of CRP or collagen.Adhesion under flow conditions Mouse blood (1 vol) was collected into 0.5 vol HEPES buffer, pH 7.4, containing 20 U/mL heparin and Ca2+ (1 mM). Coverslips (24 × 60 mm) were coated with fibrillar (Horm) collagen (0.25 mg/mL, Nycomed, Munich, Germany), and blocked for 1 hour with 1% bovine serum albumin. Perfusion studies were then performed as described.8 Briefly, transparent flow chambers with a slit depth of 50 µm, equipped with the collagen-coated coverslips, were connected to a syringe filled with the anticoagulated blood. Perfusion was performed using a pulse-free pump under high shear stress equivalent to a wall shear rate of 1000 s 1 (4 minutes).
Thereafter, chambers were rinsed by a 4-minute perfusion with HEPES
buffer at the same shear stress, and phase-contrast images were
recorded from at least 5 different microscope fields (× 63 objectives).
To determine whether the in vivo depletion of GPVI is dependent on
targeting of the ligand-binding site on the receptor, we generated new
anti-GPVI mAbs recognizing different epitopes on the receptor and
tested their in vitro and in vivo activity. Both antibodies (JAQ2,
JAQ3, rat IgG2a) precipitated a single-chain protein of an apparent
molecular weight of approximately 60 kDa (Figure
1A, IP). The identity of the precipitated
protein with GPVI was verified by immunoblotting with JAQ1 (not shown).
JAQ2 and JAQ3 also recognized GPVI in Western blot analysis under
nonreducing conditions (Figure 1A, WB). JAQ2 and JAQ3 did not bind to
platelets from FcR
To test the effects of JAQ2 and JAQ3 on the in vivo expression of GPVI,
mice received 100 µg of the respective antibodies and platelets were
monitored for 10 days. As controls, mice received 100 µg nonspecific
rat immunoglobulin or DOM2, a rat IgG2a directed against mouse GPV.
Similar to JAQ1,18 JAQ2, JAQ3, and DOM2 had a mild and
transient effect on platelet counts with a maximum drop of about 40%
on day 1 and a return to almost normal after 48 to 72 hours (Figure
3A). Circulating platelets in JAQ-treated mice were not activated at any time point after injection as shown by
flow cytometric analysis of P-selectin expression and integrin activation19 (Figure 3B). GPVI expression on the platelet
surface was analyzed by flow cytometry at different time points after antibody injection using JAQ1FITC. Very
unexpectedly, as soon as 6 hours after antibody injection GPVI was
undetectable on platelets from JAQ2- or JAQ3-treated mice and this
remained unchanged for 10 days (Figure 3C). In contrast, GPVI levels on
circulating platelets were not altered significantly at any time in
DOM2-treated mice. These findings suggested that GPVI had been
specifically depleted by JAQ2 and JAQ3 in vivo. This was confirmed when
separate groups of mice received the antibodies (100 µg/mouse) and
platelets were tested on day 5 for the presence of GPVI in Western blot
analysis. As shown in Figure 3D, GPVI was undetectable in platelets
from mice treated with JAQ1, JAQ2, or JAQ3, whereas normal amounts of
GPIIIa were found in all platelets. Importantly, the expression of
other receptors including GPIb-IX, GPV, and
To address the question whether the Fc part or the dimeric form of
anti-GPVI antibodies plays a role in depletion of the receptor, we
produced monovalent F(ab) fragments of JAQ1, JAQ2, and JAQ3 and tested
their in vivo effects. After injection of F(ab) fragments (100 µg),
platelet counts and GPVI expression were monitored for 10 days.
Interestingly, F(ab) fragments of JAQ2 or JAQ3 induced a similar
transient decrease in platelet counts as the intact IgG (Figure
5A), demonstrating that this effect was
not mediated by antibody-induced Fc receptor or complement activation.
Strikingly, both F(ab) fragments of JAQ2 and JAQ3 induced the depletion
of GPVI (Figure 5B). However, the duration of F(ab)-induced GPVI depletion was significantly reduced as compared to intact IgG. As shown
in Figure 5B-C, very low levels of GPVI were detected in platelets on
day 3 by flow cytometry and Western blot analysis, respectively, and
this increased to almost normal on day 10. Consequently, during the
first 3 days, platelets from these mice were resistant to activation
with CRP (Figure 5D) and did not adhere to collagen in whole blood
perfusion experiments (not shown).
Our findings show that neither the Fc part nor the dimeric form of anti-GPVI antibodies is responsible for the observed transient thrombocytopenia or the depletion of the receptor. However, the significantly shorter absence of GPVI in F(ab) versus IgG-treated mice strongly suggests that in vivo stability and avidity of anti-GPVI agents may have a major influence on their potential to induce long-term antithrombotic protection. At present, the mechanisms underlying anti-GPVI-induced transient thrombocytopenia are not clear, but it may be based on weak activation of GPIIb/IIIa leading to the formation of loose aggregates and their temporary sequestration to the spleen where the actual loss of GPVI may occur. This assumption may be supported by the observation that GPVI down-regulation cannot be induced by antibodies in vitro, suggesting that a second signal is required for the induction of this process and that this signal is provided by other cells in vivo.18 In summary, our results demonstrate that the antibody-induced depletion of GPVI from circulating platelets in vivo is neither dependent on the exact binding epitope recognized by the antibody nor its Fc part or dimeric form. This unexpected finding strongly suggests that anti-GPVI agents that do not directly activate the platelet may generally induce the down-regulation of the receptor in vivo, resulting in long-term antithrombotic protection. This may have important implications for the development of anti-GPVI- based therapeutics for the prevention of ischemic cardiovascular diseases.
We would like to thank M. Koch and S. Hartmann for excellent technical assistance and U. Barnfred for constant support throughout the study.
Submitted October 28, 2002; accepted January 2, 2003.
Prepublished online as Blood First Edition Paper, January 16, 2003; DOI 10.1182/blood-2002-10-3242.
Supported by grant Ni556/4-1 (B.N.) from the Deutsche Forschungsgemeinschaft.
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: Bernhard Nieswandt, Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Versbacher Str 9, 97078 Würzburg, Germany; e-mail: bernhard.nieswandt{at}virchow.uni-wuerzburg.de.
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