Articles |
From the Departments of Laboratory Medicine and Pathology, Pediatrics, University of Minnesota Medical School, Minneapolis, and the Servicio de Hemoterapia y Hemostasia (G.E.), Hospital Clinico y Provincial, Barcelona, Spain.
Correspondence to James G. White, MD, Regents' Professor, Departments of Laboratory Medicine and Pathology, Pediatrics, University of Minnesota Medical School, UMHC Box 490, 420 Delaware St SE, Minneapolis, MN 55455.
| Abstract |
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Key Words: surface activation spread platelets von Willebrand factor antivon Willebrand factor protein A gold
| Introduction |
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We have, however, found one way to induce the translocation of GPIb/IX receptors on platelet surfaces,13 confirming that the receptor-ligand complexes are mobile.5 When previously spread platelets coated with vWF multimers are exposed to an anti-vWF antibody, the multimers move from peripheral margins into caps over cell centers. The present study has investigated the antibody-induced translocation of GPIb/IX-vWF complexes on spread platelets.
| Methods |
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Preparation of Plasmas
Human platelet-poor plasma (PPP) was prepared from PRP by
centrifugation at 1000g for 10 minutes. Human PPP was
incubated with ristocetin (1.2 mg/mL) antibiotic before use. Bovine
blood was obtained from healthy adult cattle housed under supervision
of the School of Veterinary Sciences at the University of Minnesota.
Samples aspirated from the external jugular vein were mixed immediately
with the CCD anticoagulant described above in a ratio of
9:1.16 Bovine PPP was prepared in the same manner as human
PPP for vWF. Immunoblots of the human and bovine plasmas were prepared
to be sure their content of vWF was comparable (data not shown).
Multimers of human and bovine vWF are virtually identical.
Surface Activation
Small drops, 10 µL in volume, of washed platelet suspension
were placed on carbon-stabilized, formvar-coated grids and allowed to
interact with this surface for 20 minutes at 37°C.17
After this period unattached platelets were washed away by passing the
grid through successive drops of HBSS. For evaluation of vWF multimer
frequency and distribution, grids of spread platelets were fixed in
0.01% glutaraldehyde in HBSS for 30 minutes at 37°C.
Interaction of Bovine and Ristocetin-Activated Human Plasma vWF
With Spread Human Platelets
Grids of platelets fixed after spreading were incubated with
bovine plasma or ristocetin-activated human plasma for 15 minutes,
washed in drops of HBSS, and then exposed to a polyclonal anti-vWF
(Dako A082, Dako) antibody in various dilutions, usually
1:50.10 11 After 15 minutes the antibody was removed, and
the grid was washed in several changes of HBSS. The grids were then
incubated with staph protein A coupled to either 5- or 10-nm gold
particles (PAG5 and PAG10, respectively)
(Amersham) for 15 minutes. After 15 minutes the grids were rinsed
several times, fixed in 2% glutaraldehyde in cacodylate buffer for 30
minutes, and rinsed in buffer. Excess fluid was removed from the grid
edge with filter paper, and the grid was air dried.
Organization of vWF Multimers on Unfixed, Spread Platelets
Formvar grids incubated with platelets for 20 minutes were
rinsed in HBSS and combined with either human or bovine plasma for 15,
30, 45, or 60 minutes before being rinsed in HBSS and fixed in 0.01%
glutaraldehyde.12 13 After fixation the grids were washed,
exposed to anti-vWF antibody for 15 minutes, rinsed, and combined with
5 or 10 nm protein A gold. The grids were rinsed and fixed again in 2%
glutaraldehyde in cacodylate buffer as described above.
Influence of Anti-vWF Antibody on Organization of Multimers
Platelets spread for 20 minutes were incubated with bovine
plasma for 15 minutes and then exposed to anti-vWF antibody for 15
minutes before fixation. The fixed samples were stained with
PAG10 and fixed again in 2% glutaraldehyde.
Second Exposure to Bovine Plasma vWF After Fixation
Spread platelets combined with bovine plasma for 15 minutes
followed by anti-vWF antibody for 15 minutes were fixed and incubated
with PAG10. The grids were washed and incubated with bovine
plasma a second time, washed, fixed again, and stained with anti-vWF
antibody and PAG5. The grids were fixed once more in 2.0%
glutaraldehyde in 0.1 mol/L cacodylate buffer, rinsed, and air
dried.
Second Exposure to vWF and Anti-vWF Antibody Before Fixation
Spread platelets with central caps of GPIb/IX-vWF complexes
induced by anti-vWF antibody were washed and covered a second time with
vWF for 15 minutes, washed, and exposed to anti-vWF antibody for 15
minutes, washed, fixed in 0.01% glutaraldehyde, and stained with
PAG5 before a final fix in 2% glutaraldehyde.
Third Exposure to vWF
Spread platelets with caps and rings of GPIb/IX-vWF caused by
exposure to anti-vWF antibody and stained respectively with
PAG10 and PAG5 before fixation were washed,
fixed in 0.01% glutaraldehyde, incubated with vWF for 15 minutes,
washed, refixed in 0.01% glutaraldehyde, and stained with anti-vWF
antibody and PAG10 before final fixation in 2%
glutaraldehyde.
Effects of Antibodies on Second Deposition of vWF
The possibility that GPIIb/IIIa or a nonspecific receptor was
binding the second wave of vWF after the initial GPIb/IX-vWF complexes
had been cleared to the spread cell centers by the influence of
anti-vWF antibody required consideration.10 Grids of
spread platelets incubated with bovine vWF for 15 minutes and anti-vWF
for 15 minutes were fixed in 0.01% glutaraldehyde, rinsed and exposed
to either AP1, AP2, or anti-glycocalicin antibody at dilutions of 1:100
for 15 minutes, rinsed and incubated with bovine vWF a second time,
fixed again, and stained with anti-vWF antibody followed by PAG before
the final fixation in 2% glutaraldehyde. AP1, a monclonal antibody to
GPIb/IX, and AP2, a monoclonal antibody specific for GPIIb/IIIa, were
kindly provided by Dr Tom Kunicki, Scripps Institute, La Jolla, Calif.
Anti-glycocalicin antibody was provided by Dr Kenneth Clemetson,
Theodor-Kocher Institute, Bern, Switzerland.
Preparation of Cross Sections of Spread Platelets
Lab-Tek 4 chamber slides (Nunc, Inc) were used to prepare cross
sections of surface-activated platelets. The glass surface of each
chamber was coated initially with 0.1% polylysine for 5 minutes and
washed several times before being air dried. Volumes (0.5 mL) of washed
platelet suspension prepared as described above were added to each well
and incubated at 37°C for 20 minutes. The chambers of spread
platelets were rinsed well and then exposed to bovine or
ristocetin-activated human plasmas, anti-vWF antibody,
PAG5, and PAG10 in the same manner as
described for studies on formvar grids (see above). After completion of
incubation, fixation, and immunocytochemical procedures, the chambers
were fixed again in 3% glutaraldehyde in White's
saline16 17 18 for 15 minutes and then with 1% osmic acid
combined with 1.5% potassium ferrocyanide in distilled water for 30
minutes at room temperature.18 After fixation the samples
were washed and dehydrated in a series of alcohols and exposed to
increasing concentrations of epon in alcohol. After the final rinse in
100% epon, the chambers were drained, and 0.3 mL of 100% epon was
added to each chamber. Some of the epon was saved in a syringe for
final embedding. The chambers were placed in a 45°C oven overnight
and in a 60°C oven for 1 to 2 days. The slab of embedded platelets
was cut into rectangular wedges, mounted in holders, and sectioned on
an ultramicrotome. Thin sections were stained with lead citrate and
uranyl acetate to enhance contact.
Evaluation
Each experiment was performed in duplicate and repeated on at
least three different occasions. After final fixation and air drying
the grids were evaluated in a Philips 301 electron microscope.
| Results |
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Organization of vWF on Human Platelets Fixed After Spreading
Spread human platelets have the ability to bind vWF from bovine
plasma, ristocetin-treated human plasma, and purified vWF (kindly
provided by David Fass, Mayo Clinic, Rochester, Minn).10
Multimers of vWF selectively stained by anti-vWF antibody and
PAG10 covered surface-activated fixed platelets from edge
to edge (Fig 1
). The multimers presented a linear,
serpentine appearance, resembling a mosaic of rope-like proteins. Cross
sections of spread platelets covered with vWF revealed the multimers
stained by anti-vWF antibody as discrete patches. The appearance
indicates that the rope-like multimers lie in the plane of the surface
and are not perpendicular to it20 (Fig 2
).
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Organization of vWF on Unfixed, Spread Human Platelets
The density and distribution of vWF multimers on platelets spread
on formvar grids without fixation and incubated with vWF from bovine or
ristocetin-treated human plasma for 15 to 60 minutes were
indistinguishable from the organization of vWF multimers on fixed,
spread platelets.12 13 Multimers covered the spread
platelet surfaces from edge to edge. No evidence of multimer movement
away from peripheral margins and/or into channels of the OCS could be
identified (Fig 3
).
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Effects of Anti-vWF Antibody on Organization of vWF
Grids of spread platelets exposed to vWF from ristocetin-activated
human plasma or bovine plasma for 15 minutes and then combined with
anti-vWF antibody for 15 minutes before fixation and staining revealed
a dramatic reorganization of multimers (Fig 4
). Linear,
serpentine multimers of vWF were cleared from spread cell margins and
peripheral zones to cell centers. Multimers in cell centers often
appeared to coalesce (Fig 5
). The extent of clearance to
central zones varied from cell to cell, but every platelet was
affected. In contrast to the response of GPIIb/IIIa bound to
fibrinogen-coated gold particles,21 resting the grids of
spread platelets combined with vWF and the antibody to vWF on drops of
HBSS had no apparent effect on the extent of vWF multimer concentration
in platelet centers. Cross sections of spread platelets exposed to vWF
for 15 minutes and anti-vWF antibody and PAG5 for 15
minutes before fixation revealed central caps of GPIb/IX-vWF
multimers. However, despite centralization of vWF on virtually
every spread platelet, only two platelets in over 300 cross sections
revealed any uptake of receptor-ligand complexes into the OCS (Figs 6
and 7
).
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Second Exposure of Spread Platelets With Centrally Concentrated
Multimers to vWF After Fixation
Spread platelets combined with bovine or
ristocetin-activated human plasma and anti-vWF antibody to concentrate
multimers in cell centers, then fixed and incubated with either plasma
a second time and stained with PAG5 revealed the
persistence of GPIb/IX receptors over peripheral zones of the spread
cells (Fig 8
). Centrally concentrated vWF multimers
marked by PAG5 and PAG10 were surrounded by
multimers stained by PAG5 extending to the edge of the
cells. Cross sections of spread platelets prepared in an identical
manner in glass chambers revealed a similar appearance (Fig 9
). The first wave of vWF bound to GPIb/IX and
stimulated to move by anti-vWF was concentrated into caps stained by
PAG10 over platelet centers. The second wave of vWF was
deposited as linear polymers stained by PAG5 extending from
central caps of vWF to platelet edges.
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Second Exposure of Spread Platelets to vWF and Anti-vWF Antibody
Before Fixation
Spread platelets with central caps of GPIb/IX-vWF complexes moved
by treatment with anti-vWF and exposed to a second wave of vWF,
anti-vWF, and PAG5 revealed rings around the
PAG10-stained central mass (Figs 10
and 11
). A space between the ring and
platelet margins was clear of receptor-ligand complexes. Thus, anti-vWF
was able to trigger translocation of GPIb/IX-vWF from the peripheral
zone a second time.
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Third Exposure to vWF
Spread platelets with caps and rings of vWF caused by
double exposure to multimers and anti-vWF antibody, fixed, incubated
with vWF, fixed again, and re-treated with anti-vWF and
PAG10 revealed a second ring. The peripheral zone from the
cell edge to the ring of multimers stained mainly by PAG5
surrounding the central cap marked by PAG10 contained
multimers of vWF stained by anti-vWF and PAG10 (Fig 12
). The last exposure to PAG10 also
stained the first ring. However, the PAG5 marking ring 1
was not obscured by PAG10.
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Influence of Monoclonal Antibodies on the Second Exposure to
vWF
The influence of specific antibodies on the second exposure to vWF
was tested on spread platelets covered with multimers centralized into
caps by anti-vWF antibody and fixed. Grids of platelets prepared in
this manner and incubated with either AP1 or AP2, monoclonal antibodies
against GPIb/IX and GPIIb/IIIa, respectively, or with
anti-glycocalicin, the polyclonal antibody against GPIb/IX, before the
second exposure to bovine vWF gave sharply contrasting results.
Incubation with AP2 had no effect on the subsequent deposition of vWF
multimers on the peripheral zone (Fig 13A
). Prior
exposure to AP1 (Fig 13B
) or anti-glycocalicin antibody (Fig 13C
)
prevented binding of vWF multimers to the cleared peripheral zone.
PAG5 did bind to the anti-glycocalicin coupled to GPIb/IX,
adding further support to the presence of GPIb/IX receptors remaining
on the peripheral zone (Fig 13C
).
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| Discussion |
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The residual GPIb/IX receptors on the peripheral zone not only bound vWF but were also able to translocate the multimers. Spread platelets with central caps of GPIb/IX-vWF complexes covered a second time with vWF and anti-vWF antibody formed rings of multimers stained by 5-nm PAG particles around the PAG10-marked central caps, leaving clear areas extending to cell margins.
Yet the cleared areas after two exposures to vWF and anti-vWF antibody were not devoid of GPIb/IX receptors. Incubation of spread platelets with central caps of vWF, surrounded by rings of multimers, to vWF a third time after fixation revealed another ring of vWF attached to GPIb/IX extending from the edge of the first ring around the central cap to the cell margin.
The persistence of receptor binding sites for vWF on areas cleared of GPIb/IX-vWF complexes after two exposures to vWF and anti-vWF antibody is reminiscent of the tenacity of GPIIb/IIIa receptors.22 Loftus and Albrecht23 and later Albrecht and coworkers24 demonstrated that exposure of spread platelets to fibrinogen-coated gold particles (Fgn/Au) resulted in translocation of GPIIb/IIIa-Fgn/Au complexes toward cell centers. Work in our laboratory noted that the receptor-ligand complexes could be moved into caps over spread platelet central zones by incubating the grids on drops of HBSS for 10 to 15 minutes.17 21 The cleared peripheral and intermediate zones, however, were not devoid of receptors for Fgn/Au. Fixation and exposure to a second wave of Fgn/Au resulted in deposit of the electron-dense probes for GPIIb/IIIa from the central cap of receptor-ligand complexes to the cell margins.17 21 22
Exposure of spread platelets with caps of GPIIb/IIIa-Fgn/Au complexes to alternating waves of small latex particles and Fgn/Au did not exhaust the binding capacity for Fgn/Au.22 As many as two rings of Fgn/Au bound to GPIIb/IIIa separated by circles of latex surrounding the central cap of GPIIb/IIIa-Fgn/Au complexes could be deposited on single spread platelets. The receptors binding the rings of Fgn/Au outside the central cap of receptor-ligand complexes were shown to be GPIIb/IIIa.22
The present study has demonstrated that the receptors remaining over cleared areas on platelets with central caps of GPIb/IX-vWF complexes are GPIb/IX. AP2 had no effect on the frequency or distribution of multimers deposited on the peripheral and intermediate zone of spread platelets with central zones occupied by GPIb/IX-vWF complexes. Exposure of spread platelets with centrally concentrated masses of receptor-ligand complexes to AP1 completely inhibited deposition of multimers during the second exposure to human or bovine vWF. The polyclonal antibody glycocalicin also blocked binding of multimers to the peripheral zone and demonstrated persistence of GPIb/IX receptors remaining in cleared areas.
The results indicate, as they did for GPIIb/IIIa,21 22 that complete clearance of GPIb/IX from the platelet surface is virtually impossible. Despite the translocation of significant numbers of GPIb/IX receptors to cell centers with vWF multimers, many remained available in the cleared zones to bind additional vWF. As in the case of the GPIIb/IIIa receptors replacing those cleared from peripheral and intermediate zones and concentrated in caps over centers of spread platelets,17 21 the origin of the GPIb/IX receptors binding the second and third waves of vWF is uncertain.
However, two mechanisms might explain the persistence of GPIb/IX receptors in the twice-cleared zones. Lu and colleagues7 have shown that downregulation of GPIb/IX caused by thrombin in suspension is almost completely reversible. Their findings have been confirmed by Michelson and associates.25 To evaluate that possibility, samples exposed to vWF and anti-vWF antibody were stained with PAG10, fixed, and exposed to vWF, anti-vWF, and PAG5 for intervals of 5, 10, 15, 20, and 30 minutes. The cleared area became more extensive with each successive exposure up to 15 minutes, but staining the fixed cell with a second wave of vWF after fixation revealed the same extent of residual GPIb/IX receptors covering the peripheral zone at each stage in formation of the central caps of vWF multimers. Thus, clearance followed by a time-dependent reversal does not readily explain the findings observed in the present study.
Another mechanism that might explain restoration of GPIb/IX to cleared areas on spread platelets previously exposed to vWF and anti-vWF antibody is receptor cycling. Wencel-Drake and colleagues26 27 have proposed that GPIIb/IIIa receptors on discoid platelets are in a constant state of flux. A significant number appear to be taken up into the platelet each hour, and a similar number are returned to the outside surface over the same interval. Behnke28 as well as Morgenstern et al29 report that plasma-borne particulates and antibodies binding to platelets are taken up into clathrin-coated vesicles and transferred to alpha granules. Thus, uptake of receptors by platelets stimulated by thrombin and a vesicular mechanism that could facilitate transfer from channels of the OCS through the platelet cytoplasm under the surface membrane and back to the spread exterior surface appear to exist.
However, nearly all of the OCS channels have been evaginated to contribute to increased surface areas of fully spread platelets.19 Cross sections of over 300 platelets revealed only two examples in which GPIb/IX-vWF complexes marked by PAG5 were in the process of uptake into OCS channels and transfer to vesicles or alpha granules. No evidence of coated or uncoated vesicle formation from OCS channels or development on the undersides of spread cell membranes was observed in our studies. Thus, receptor recycling does not appear to provide a plausible explanation for the origin of residual GPIb/IX receptors present on peripheral zones of spread platelets cleared by prior exposure to vWF and anti-vWF antibody.
If neither recycling nor reversal adequately explain the persistence of GPIb/IX on peripheral zones of spread platelets, the possibility that the continuing availability of receptors is due to the fact that they never left must be considered. The size of the serpentine multimers may result in coverage of the platelet surface without contacting all of the available GPIb/IX receptors.30 Even a second exposure to vWF may fail to bind all the remaining receptors, leaving some available to interact with the third wave of multimers.
The present results show that GPIb/IX receptors coupled to vWF, their natural ligand, can move on spread platelet surfaces, even though they do not appear to do so as a result of thrombin activation in suspension, surface activation, receptor occupancy, or a combination of all three stimuli.13 Demonstration that GPIb/IX attached to its ligand vWF can move in the plane of the exposed membrane on surface-activated, spread platelets is important to understanding the role of the receptor in hemostatic physiology. The importance, however, does not reside in the ability of the receptor-ligand complexes to move for long distances on the free surface. Rather, just as in the case of GPIIb/IIIa,31 the fundamental value of the observation relates to the downside of platelet-vessel wall interaction.
Platelets driven to an area of denuded vascular surface under high shear force have only microseconds during which to interact. Mobile but resilient GPIb/IX receptors can soften the impact by moving on attachment to vWF. Giving on contact would slow the cell sufficiently to permit it to bind more multimers and enhance adhesion. If the receptors were rigid, interaction time would be reduced, and the platelet would be more likely to bounce off the damaged surface. On the other hand, if the GPIb/IX receptors were as mobile as other studies have suggested,2 3 4 5 6 7 8 9 they might not hold the platelet firmly enough or long enough to facilitate adhesion. The loosely attached cell might tether under high shear force and break loose, leaving a vesicular remnant on the damaged surface.
The ability of GPIb/IX-vWF complexes to move in the lipid bilayer of the exposed surface of spread platelets has an even more important relation to events following attachment than to the process of adhesion itself.32 Following the binding of discoid platelets to the damaged vascular surface, the cell must spread in order to establish a hemostatic plug. Attachment of the mobile receptor, GPIb/IX, to vWF multimers covering the damaged site makes spreading possible.
Multimers of vWF on the injured surface are unlikely to move.32 As a result, the GPIb/IX receptors form immobile associations with vWF. The receptor-ligand complexes cannot move in the plane of the downside platelet surface to channels of the OCS. However, the downside surface and membranes lining the channels of the OCS can move through the immobilized GPIb/IX-vWF complexes, thus permitting the platelet to spread during assembly of new actin filaments.31 If the GPIb/IX receptors were not mobile, then the platelet surface membrane could not move through them, and spreading would be limited or impossible. Further experiments employing fixed and chemically stabilized or softened platelets under high shear conditions in the Baumgartner chamber are in progress to test this hypothesis.
| Acknowledgments |
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Received July 27, 1994; accepted February 16, 1995.
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