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Thrombosis |
From the Section of Cardiology (I.D.C., N.S.K.), Thrombosis Research Section (I.D.C., P.T., J.A.L., N.S.K.), Department of Pathology (P.T.), and Department of Medicine (F.N.), Baylor College of Medicine, Houston, Texas; and Servei dHemoterapia i Hemostasia (R.T.), Hospital Clinic, Barcelona, Spain.
Correspondence to Neal S. Kleiman, MD, The Methodist Hospital, 6565 Fannin St, MS F1090, Houston, TX 77030. E-mail nkleiman{at}bcm.tmc.edu
| Abstract |
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Methods and Results Using flow cytometry, we studied the effect of P-selectin on phosphatidylserine expression in blood monocytes and in the monocytic cells, THP-1. Soluble P-selectin at biologically relevant concentrations (0.31 to 2.5 µg/mL) induced a time-dependent increase in phosphatidylserine expression, an effect that could be inhibited with an antiPSGL-1 blocking antibody, and by genistein, a tyrosine kinase inhibitor. Binding of activated platelets to THP-1 cells also resulted in a significant increase in phosphatidylserine expression that was dependent on PSGL-1. Consistent with the role of phosphatidylserine on surface-dependent reactions of coagulation, treatment of monocytic cells with soluble P-selectin led to increased thrombin generation. We excluded P-selectin induced apoptosis of monocyte as a mechanism for the increased phosphatidylserine exposure.
Conclusion In summary, we show that P-selectin, either soluble or in its membrane-bound form, induces phosphatidylserine exposure in monocytes through a mechanism dependent on PSGL-1.
Phosphatidylserine expression on monocytes is an important cofactor in the enzymatic reactions of coagulation. Stimulation of monocytes with P-selectin leads to cell activation and the expression of tissue factor, the main initiator of coagulation. Here we show that P-selectin induces phosphatidylserine expression on monocytes through a mechanism dependent on PSGL-1 on the monocyte.
Key Words: monocyte platelet phosphatidylserine phospholipid P-selectin
| Introduction |
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See page 877
Binding of P-selectin to its main counter-receptor on monocytes, P-selectin glycoprotein ligand-1 (PSGL-1), leads to monocyte activation marked by the conformational activation of the ß-2 integrin, MAC-1,9 the synthesis and release of various cytokines,10 chemokines,11 and of reactive oxygen species.12 Importantly, binding of P-selectin to PSGL-1 on monocytes also induces the expression of tissue factor (TF),2 the main initiator of coagulation in vivo.
TF expressed on the surface of monocytes initiates coagulation when it binds to the serine protease factor (F) VIIa, forming the extrinsic tenase. This tenase in turn catalyzes the activation of FX, which together with its nonenzymatic cofactor, FVa, forms the prothrombinase complex, leading to thrombin generation. The reaction rates of both the tenase and the prothrombinase complexes are critically dependent on the presence of phosphatidylserine on the surface of cells.13 It is on this anionic phospholipid where the components of the enzymatic complexes of coagulation assemble. Kinetic studies reveal that the interaction between the enzyme and substrate with the membrane significantly affects the reaction rate of the tenase and prothrombinase complexes.14,15 Abrogation of the catalytic component provided by the phosphatidylserine-rich surface decreases the reaction rate of both the extrinsic tenase and prothrombinase complex by
200-fold and 1000-fold, respectively.14,15 Likewise, increased phosphatidylserine exposure is likely to be a major contributor to the increased prothrombinase activity in endotoxin-stimulated monocytes.16 It is thus conceivable that factors affecting the extent of phosphatidylserine exposure on cells result in substantial modifications in the rate of thrombin generation. In the current study, we show that P-selectin binding to PSGL-1 induces phosphatidylserine exposure and increased surface-dependent thrombin generation on monocytes.
| Materials and Methods |
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120 kDa. We also tested this P-selectin for endotoxin contamination using the limulus amebocyte lysate test (Associates of Cape Cod, East Falmouth, Mass) and found it to contain very low levels (<0.03 endotoxin U/mL) of endotoxin. The well-characterized monocytic cell line, THP-1,17 was from American Type Culture Collection (ATCC, Manassas, Mass). RPMI 1640 medium was from Invitrogen (Carlsbad, Calif). The PSGL-1blocking mouse monoclonal antibody, KPL-1, was a generous gift from Dr Karen R. Snapp (University of Illinois at Chicago).18 Nonspecific mouse IgG was purchased from Pierce (Rockford, Ill). Annexin-V was produced as previously described.19 Some of the annexin-V was conjugated with the fluorophore fluorescein isothiocyanate (FITC) using the FluoReproter protein labeling kit (Molecular probes, Eugene, Ore), following the manufacturers instructions. All other reagents were purchased from Sigma (St. Louis, Mo).
Isolation of Platelets and Monocytes
Blood was drawn from healthy individuals into a sodium citrate (0.38%, final concentration)-anticoagulated syringe. All donors gave their informed consent under a protocol approved by the institutional review board of Baylor College of Medicine. Platelets were isolated by centrifuging blood at 700gx6 minutes. Platelet-rich plasma was collected and 5 ng/mL prostacyclin was added to prevent platelet activation. Platelets were washed twice in Tyrode buffer (NaCl 137 mmol/L, HEPES 1.2 mmol/L, KCl 2.7 mmol/L, NaH2PO4·H2O 0.04 mmol/L, glucose 5.6 mmol/L, pH=6.4) by pelleting them at 1200g x15 minutes and were then resuspended in Tyrode buffer, pH 7.4, with 2 mmol/L CaCl2.
Blood monocytes were isolated as described previously.20 Briefly, 10 mL of EDTA-anticoagulated buffy coat were mixed with 4 mL of Optiprep (Accurate, Westbury, NY) and carefully overlaid with 2 different solutions, the first one with a density of 1.078 g/mL, and the second with a density of 1.068 g/mL. The sample was centrifuged at 600g x20 minutes at 4°C, and an upper band corresponding to monocytes was isolated. Monocytes were washed once in TBS and resuspended in phenol red-free RPMI medium with 10% fetal bovine serum and 2 mmol/L CaCl2. By light microscopy and Wright staining, the monocyte purity was >80%; lymphocytes were the most common contaminating cells.
Annexin V Binding in Monocytes Stimulated With P-selectin
Annexin-V is a 34-Kd protein that binds phosphatidylserine with high affinity and specificity in a Ca2+-dependent manner.19 Annexin V binding is therefore a well-established method for measuring phosphatidylserine exposure.19 We incubated 1x107 cells, monocytes or THP-1 cells, suspended in 10% fetal bovine serum phenol red-free RPMI medium with various concentrations of soluble P-selectin that ranged from 0.15 µg/mL to 2.5 µg/mL in the presence of either KPL-1 (5 µg/mL) or mouse IgG (5 µg/mL), for the indicated time points, at 37°C. After incubation, we labeled the cells with saturating concentrations of FITC-conjugated annexin-V for 30 minutes at room temperature, washed the cells once in TBS with 2 mmol/L CaCl2, and analyzed them in an EPICS XL Coulter flow cytometer. Fluorescence was measured in 7500 events that were within a forward scatter-defined gate that only recognizes monocyte-size particles (15 to 20 µ), and not cell fragments. To set the background fluorescence, we treated samples with 20 mmol/L EDTA, because in the absence of calcium, annexin-V does not bind phosphatidylserine. In some experiments, cells were treated for 5 minutes with either 100 µmol/L genistein, a tyrosine kinase inhibitor, or with an equal volume of DMSO as a vehicle control, before the addition of P-selectin. Results are presented as fold increases over control and expressed numerically as arbitrary units of mean fluorescence intensity (MFI).
Annexin-V Binding in Monocytes Stimulated With Activated Platelets
Washed platelets were prepared as described. Platelets (2x107) suspended in 100 µL TBS with 2 mmol/L CaCl2 were either left resting or activated with 10 µmol/L thrombin receptor-activating peptide (TRAP-SFLLRN) for 15 minutes at 37°C. Phosphatidylserine on the platelets was "cloaked" by incubating the platelets with 100 µg/mL unlabeled annexin V for 30 minutes at room temperature. Samples were then fixed with paraformaldehyde 1% for 45 minutes at 4°C, and washed 3 times in 15 mL TBS with 2 mmol/L CaCl2. P-selectin expression in the fixed, activated platelets was confirmed by flow cytometry using a FITC-conjugated antiP-selectin antibody (Becton Dickinson, Franklin Lakes, NJ). Also, complete blockade of annexin-V binding sites was demonstrated by showing no additional binding of FITC-annexin V to these platelets above background levels set with a sample treated with 20 mmol/L EDTA. THP-1 cells (5x105) were incubated with 2x107 fixed "phosphatidylserine-cloaked" washed platelets for 8 hours at 37°C, and then sedimented at 200gx5 minutes, removing all unbound platelets in the supernatant. Cells were resuspended in TBS with 2 mmol/L CaCl2 and probed with saturating concentrations of FITC-annexin V and then analyzed by flow cytometry, as described.
Thrombin Generation
THP-1 cells (1x106) were treated with either 2.5 µg/mL sP-selectin or buffer control, at 37°C. At the indicated time points, an aliquot of the sample was taken, cells were sedimented at 200gx5 minutes, and gently resuspended in equal volumes of Trishuman serum albumin buffer with calcium (0.05 mol/L Tris-HCl, 0.12 mol/L NaCl, 3 mmol/L CaCl2, 0.5 mg/mL human serum albumin). Suspended cells were transferred onto a glass cuvette with a Teflon-coated stir bar, stirring at 300 rpm, at 37°C. A mixture of 6 nM Xa and 3 nM Va (both final concentrations) in Trishuman serum albumin buffer was added, and 1 minute later, 4 µmol/L purified prothrombin was added. The reaction was allowed to continue for 5 minutes. Aliquots (25 µL) of the reaction sample were then taken and quenched by adding them to 1 mL of TBS with 2 mmol/L EDTA. The amount of thrombin generated was measured by adding 25 µL of thrombin-specific chromogenic substrate (S-2338; Chromogenix). The changes in color were recorded in a microplate reader at an absorbance of 405 nm.
Apoptosis Assay
Apoptosis in THP-1 cells was determined using the Vybrant Apoptosis Assay Kit #4 (Molecular Probes, Eugene, Ore), according to the manufacturers instructions. Briefly, THP-1 cells (1x106 cells/mL) suspended in 10% fetal bovine serum phenol red-free RPMI medium were treated with either a vehicle control or 2.5 µg/mL sP-selectin for 8 hours at 37°C. Cells were then pelleted at 500g x7 minutes, resuspended in 100 µL of TBS 2 mmol/L CaCl2, and incubated with YO-PRO-1 and propidium iodide; 10 000 events were analyzed. The number of cells positive for YO-PRO-1 but not for propidium iodide representing apoptotic cells. Cells treated for 8 hours at 37°C with 500 ng/mL of actinomycin D served as a positive control for apoptosis.
Statistical Analysis
The data were analyzed using ANOVA to assess the effects of various treatments of THP-cells and monocytes on their expression of phosphatidylserine. Data are presented as mean values±SD. P
0.05 was considered statistically significant.
| Results |
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Soluble P-SelectinInduced Phosphatidylserine Exposure in Monocytes Is Time-Dependent
To determine the time course of the P-selectininduced phosphatidylserine exposure on monocytes, we treated THP-1 cells with either a buffer control or 2.5 µg/mL of sP-selectin for up to 24 hours. Within the 1 hour incubation period, cells treated with sP-selectin exhibited a 1.2-fold increase in phosphatidylserine expression relative to untreated cells (MFI, 40.7 versus 18.3; n=3; P=0.02). This difference increased in a time-dependent manner, until it leveled-off at 8 hours with sP-selectintreated cells having, on average, a phosphatidylserine expression that was 4.4-fold greater than that in control cells, and that persisted for at least 24 hours (Figure 1b). Similar findings were obtained with freshly isolated blood monocytes, recapitulating our observations in THP-1 cells (Figure 1c).
Soluble P-Selectin Induces Phosphatidylserine Exposure in Monocytes Via PSGL-1
We next investigated the identity of the molecule on the monocyte surface involved in P-selectininduced phosphatidylserine exposure. The obvious candidate was P-selectin glycoprotein ligand-1, or PSGL-1, because this receptor is known to mediate the earliest adhesive interactions between activated endothelial cells or platelets and monocytes,21 and also because it has been shown in the past to mediate other P-selectininduced responses in monocytes.22 We therefore tested the effect of the PSGL-1 blocking monoclonal antibody, KPL-1, on P-selectininduced phosphatidylserine exposure on monocytes. Pretreatment of THP-1 cells with 10 µg/mL KPL-1 prevented almost all of the phosphatidylserine exposure induced by sP-selectin. In contrast, phosphatidylserine expression in cells treated with nonspecific mouse IgG was not significantly different than that of sP-selectin alone (Figure 1d).
P-Selectin on the Surface of Activated Platelets Induces Phosphatidylserine Exposure
Next, because several important differences may exist between membrane-bound P-selectin and its soluble, monomeric form, for example, in their ability to cluster PSGL-1, we investigated the effect of P-selectin on the surface of activated platelets on phosphatidylserine exposure on monocytic cells. For this, we prepared fixed, activated, washed platelets expressing P-selectin on their surfaces. Because activated platelets also express phosphatidylserine,23 we cloaked all annexin-V binding sites on platelets by incubating them with saturating concentrations of unlabeled annexin-V. TRAP-activated, but not resting, platelets prepared in this manner expressed a considerable amount of P-selectin (Figure 2a) but did not bind fluorescently labeled annexin-V (Figure 2b). Incubation of THP-1 cells with resting platelets for 8 hours led to a small but consistent increase in phosphatidylserine expression relative to THP-1 cells treated with buffer alone (MFI, 70.2 versus 38.4). In contrast, THP-1 cells that were incubated with activated platelets had a significant 3.4-fold increase in their expression of phosphatidylserine relative to the control sample (MFI, 132.1 versus 38.4; P=0.04) (Figure 2c). Similar to the experiments using soluble P-selectin, KPL-1 prevented the expression of phosphatidylserine on the outer membrane leaflet of the THP-1 cells, indicating that PSGL-1 is also required for the P-selectininduced effects (Figure 2c).
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Tyrosine Phosphorylation Induced by P-selectin Binding to PSGL-1 Is Required for Phosphatidylserine Exposure
It is well-established that P-selectin binding to PSGL-1 induces intracellular signaling in neutrophils and monocytes, with concomitant protein tyrosine phosphorylation.24 We investigated whether transmembrane signaling through ligated PSGL-1 was required for phosphatidylserine exposure on THP-1 cells. Treatment of cells with 100 µmol/L genistein, a tyrosine kinase inhibitor, completely prevented the increased phosphatidylserine expression elicited by sP-selectin (Figure 3).
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P-Selectin Increases Surface-Dependent Thrombin Generation on Monocytes
Our findings indicated that P-selectin engages PSGL-1 and induces phosphatidylserine exposure on the surface of monocytes. Because there is ample evidence that this anionic phospholipid plays a critical role in surface-bound reactions of coagulation, we studied the effect of sP-selectin on surface-dependent thrombin generation. For this, we used a reconstituted system in which all of the soluble components of the prothrombinase complex (factors Xa, Va, and prothrombin) are in high concentrations and in the presence of calcium ions. This leaves the surface on which these coagulation factors assemble as the only variable determining thrombin generation during the course of our experiments. THP-1 cells were treated for 0, 1, 6, and 12 hours with 2.5 µg/mL sP-selectin or a buffer control. Cells treated with sP-selectin generated more thrombin than untreated cells, with the difference becoming discernible at 1 hour incubation and increasing in a time-dependent manner (Figure 4). By 12 hours of incubation, sP-selectintreated cells generated
2.5-fold more thrombin than did control cells (OD 405 nm: 0.646 versus 0.254; n=3; P=0.01) (Figure 4).
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P-Selectin Does Not Induce Apoptosis in Monocytes
One possible explanation for the P-selectininduced phosphatidylserine exposure we found is that prolonged stimulation of monocytes with P-selectin stimulates them to undergo apoptosis. We addressed this possibility by treating monocytes for 8 hours with either a buffer control or 2.5 µg/mL of sP-selectin. Cells treated with actinomycin D, a chemotherapeutic agent known to induce apoptosis, served as a positive control for inducing apoptosis. The number of apoptotic cells in the control and sP-selectintreated samples was comparable (2.28% versus 3.0%, respectively; P=0.75; n=3). In contrast, 12.59% of cells treated with actinomycin D underwent apoptosis (Figure 5).
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| Discussion |
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Monocytic cells stimulated with sP-selectin expressed phosphatidylserine within 1 hour of stimulation, reached a plateau at 8 hours, and persisted for up to 24 hours. Taking this time course in the context of the findings of Celi et al, who showed that sP-selectininduced TF expression in monocytes peaks at 6 hours,2 it is likely that sP-selectininduced TF expression coincides with increased phosphatidylserine exposure. Because the efficiency by which TF initiates coagulation is greatly influenced by phosphatidylserine on the cell surface,14,30 increased phosphatidylserine expression induced by P-selectin may have a significant impact on the initial phases of coagulation occurring on the surface of TF-bearing monocytes. However, given these long time courses, it is unlikely that such a mechanism plays an important role in the acute thrombosis in response to vessel injury. Instead, P-selectininduced phosphatidylserine exposure in monocytes may contribute to a more systemic hypercoagulable state. Such an effect may be advantageous in settings such as autoimmune thrombocytopenia, in which a bleeding tendency coexists with elevated levels of plasma sP-selectin.31
Treatment with the antiPSGL-1 blocking monoclonal antibody, KPL-1, prevented nearly all the exposure of phosphatidylserine induced by sP-selectin, indicating that PSGL-1 is the receptor on the monocyte surface mediating the effects elicited by sP-selectin. There is internal consistency between these findings and those of several studies. It has been shown both in vitro3 and in vivo4 that monocytes stimulated with P-selectin shed microvesicles. Because the outer membrane leaflet of the microvesicles is rich in phosphatidylserine,32 this phospholipid is likely to have also been present on the surface of the monocytes at the time of microvesicle shedding.33
In addition to sP-selectin, monocytes in flowing blood may also be exposed for prolonged periods of time to membrane-bound P-selectin, either in P-selectinbearing microparticles,34 or expressed on activated platelets forming platelet-monocytes complexes.5 We found that similar to its soluble form, P-selectin on platelets increased phosphatidylserine expression on monocytic cells through a mechanism dependent on PSGL-1. These findings are particularly relevant to diseases in which circulating plateletmonocyte complexes increase, such as in acute coronary syndromes5 or in percutaneous coronary intervention.35 Increased exposure of phosphatidylserine on monocytes forming these complexes may play various roles. For example, increased expression of phosphatidylserine on plateletmonocyte complexes may promote coagulation and may also mark the complexes for their clearance by the reticuloendothelial system, similar to the way in which apoptotic bodies are removed from the circulation.36
Because we used washed platelets in the experiments using activated platelets as a source of P-selectin, the effects observed are unlikely to be the result of soluble mediators released by activated platelets. Although our data point out that PSGL-1 is required for phosphatidylserine exposure induced by activated platelets, it is likely that the P-selectinPSGL-1 adhesive interaction serves as an initial docking system allowing other platelet membrane proteins to interact with receptors on monocytes, inducing (or inhibiting) the exposure of phosphatidylserine on the monocyte. For example, binding of activated platelets to monocytes via P-selectinPSGL-1 would allow the cross-linking of other receptor-ligand pairs (eg, CD40-CD40L) known to activate monocytes.37 Similarly, one possibility is that the P-selectininduced phosphatidylserine exposure is not a direct effect of signaling through ligated PSGL-1, but rather the effect of mediators (eg, tumor necrosis factor-
) released by the monocyte when stimulated with P-selectin.10 The small amount of phosphatidylserine expression on THP-1 cells incubated with unstimulated platelets very likely resulted from a slight degree of activation of the platelets that occurred during their preparation. This interpretation is supported by the observation that an antiPSGL-1 antibody reduced phosphatidylserine exposure in the cells incubated with activated platelets to levels below those observed in THP-1 cells incubated with unstimulated platelets.
Consistent with the role of phosphatidylserine in prothrombinase activity, sP-selectintreated cells had increased surface-dependent thrombin generation. Although the sP-selectininduced increase in thrombin generation is most probably a direct consequence of increased phosphatidylserine exposure, other effects cannot be ruled out. Signaling through PSGL-1 may induce the synthesis of membrane proteins that facilitate the binding and assembly of the prothrombinase complex to the monocyte membrane.38
In summary, we have shown that P-selectin binding to PSGL-1 induces phosphatidylserine exposure and increases surface-dependent thrombin generation on monocytes. These studies reveal an additional mechanism by which P-selectin may exert a prothrombotic effect through its interaction with PSGL-1 on monocytes.
Received February 3, 2004; accepted February 2, 2005.
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