Immune heparin-induced thrombocytopenia (HIT) is a potentially serious complication of heparin therapy and is associated with antibodies directed against a complex of platelet factor 4 (PF4) and heparin. Early diagnosis of HIT is important to reduce morbidity and mortality. I developed an enzyme immunoassay that detects the binding of HIT IgG to PF4-heparin in the fluid phase. This required techniques to purify and biotinylate PF4. The fluid phase assay produces consistently low background and can detect low levels of anti-PF4-heparin. It is suited to testing alternative anticoagulants because, unlike in an ELISA, a clearly defined amount of antigen is available for antibody binding. I was able to detect anti-PF4-heparin IgG in 93% of HIT patients. I also investigated cross-reactivity of anti-PF4-heparin antibodies with PF4 complexed to alternative heparin-like anticoagulants. Low molecular weight heparins cross-reacted with 88% of the sera from HIT patients while half of the HIT sera weakly cross-reacted with PF4-danaparoid (Orgaran). The thrombocytopenia and thrombosis of most of these patients resolved during danaparoid therapy, indicating that detection of low affinity antibodies to PF4-danaparoid by immunoassay may not be an absolute contraindication for danaparoid administration. While HIT patients possess antibodies to PF4-heparin, I observed that HIT antibodies will also bind to PF4 alone adsorbed on polystyrene ELISA wells but not to soluble PF4 in the absence of heparin. Having developed a technique to affinity-purify anti-PF4-heparin HIT IgG, I provide the first estimates of the avidity of HIT IgG. HIT IgG displayed relatively high functional affinity for both PF4-heparin (Kd=7-30nM) and polystyrene adsorbed PF4 alone (Kd=20-70nM). Furthermore, agarose beads coated with PF4 alone were almost as effective as beads coated with PF4 plus heparin in depleting HIT plasmas of anti-PF4-heparin antibodies. I conclude that the HIT antibodies which bind to polystyrene adsorbed PF4 without heparin are largely the same IgG molecules that bind PF4-heparin and thus most HIT antibodies bind epitope(s) on PF4 and not epitope(s) formed by part of a PF4 molecule and part of a heparin molecule. Binding of PF4 to heparin (optimal) or polystyrene/agarose (sub-optimal) promotes recognition of this epitope. Under conditions that are more physiological and sensitive than previous studies, I observed that affinity-purified HIT IgG will cause platelet aggregation upon the addition of heparin. Platelets activated with HIT IgG increased their release and surface expression of PF4. I quantitated the binding of affinity-purified HIT 125I-IgG to platelets as they activate in a plasma milieu. Binding of the HIT IgG was dependent upon heparin and some degree of platelet activation. Blocking the platelet Fc??? receptor-II with the monoclonal antibody IV.3 did not prevent HIT IgG binding to activated platelets. I conclude that anti-PF4-heparin IgG is the only component specific to HIT plasma that is required to induce platelet aggregation. The Fab region of HIT IgG binds to PF4-heparin that is on the surface of activated platelets. I propose that only then does the Fc portion of the bound IgG activate other platelets via the Fc receptor. My data support a dynamic model of platelet activation where released PF4 enhances further antibody binding and more release.

O gene fator regulador de interferon 4 (IRF4), localizado na região cromossômica 6p25- p23, é um membro da família de fatores reguladores de interferon (IRF), um grupo de fatores de transcrição de ligação ao DNA, sendo IRF4 primariamente associado ao desenvolvimento e resposta imune e expresso exclusivamente em células do sistema imunológico e em linhagens melanocíticas. Embora muitos estudos tenham associado IRF4 a diversas condições, como melanoma e leucemia linfocítica crônica, um recente Genome-Wide Association Study (GWAS) identificou que alelos do SNP rs12203592 (intron 4) estão associados com variação fenotípica em relação à presença de sardas, pigmentação da pele, cabelos e olhos. Estudos funcionais realizados em células melanocíticas humanas e de camundongos revelaram que este SNP está diretamente envolvido na regulação da expressão de IRF4, sugerindo uma clara função na pigmentação do melanócito. Apesar destes achados, a diversidade das regiões regulatórias e codificadora de IRF4 não foi até o momento analisada em populações miscigenadas. A fim de avaliar se outros sítios de variação ao longo do gene IRF4 podem estar associados à pigmentação humana, as regiões regulatórias (promotora e 3´UTR) e codificadora (9 exons e regiões intrônicas flanqueadoras, incluindo o SNP rs12203592) foram analisadas por sequenciamento de nova geração em uma amostra miscigenada da população brasileira. A amostra populacional foi composta por 228 indivíduos não aparentados de Ribeirão Preto, estado de São Paulo, Brasil, os quais foram estratificados de acordo com a pigmentação da pele (clara, média e escura), olhos (azul, verde, castanho-claros e castanho-escuros), cabelo (ruivo, loiro-claro, loiroescuro, castanho-claro, castanho-escuro e preto) bem como em relação à presença de sardas e intensidade de cabelos grisalhos. Bibliotecas de DNA foram preparadas utilizando o Sistema de Enriquecimento de Alvo Haloplex (Agilent Technologies) e sequenciadas na plataforma MiSeq (Illumina). Os pacotes de software CutAdapt, BWA and GATK foram utilizados, respectivamente, para trimagem das sequências dos adaptadores, alinhamento e identificação de variantes. Haplótipos e alelos não identificados foram inferidos pelo método PHASE, embora a fase conhecida entre os sítios de variação (obtida pelo GATK) tenha sido levada em consideração. Um total de 105 sítios de variação foram identificados. Apenas dois deles apresentaram frequências genotípicas que não atendem ao esperado pelo equilíbrio de Hardy-Weinberg (EHW). Dezoito destes SNPs apresentaram forte associação a pelo menos uma característica de pigmentação. Entretanto, se a conservadora correção de Bonferroni para múltiplos testes for levada em consideração, apenas duas associações, ambas envolvendo o SNP rs12203592, permanecem significativas: a associação do alelo T com pele clara e olhos azuis. Este resultado está de acordo com estudos prévios, que reportam que o alelo rs12203592*T leva a uma menor ativação de IRF4 e a uma expressão reduzida da tirosinase, resultando em sensibilidade ao sol e olhos azuis. Foi inferido um total de 101 haplótipos, estando a distribuição destes de acordo com o esperado pelo EHW. Quando os haplótipos foram divididos em haplótipos da promotora, codificadora e 3´UTR foram observadas, respectivamente, 17, 29 e 37 diferentes combinações haplotípicas. Várias associações foram identificadas, particularmente envolvendo o haplótipo mais frequente da promotora, os dois haplótipos mais frequentes da codificadora e o haplótipo mais frequente da 3´UTR, todos associados com pele clara, olhos azuis, cabelos castanhos e cabelos grisalhos. Estes resultados sugerem que outras variantes além de rs12203592, quando consideradas em um contexto haplotípico, são associadas com a pigmentação humana. / The Interferon Regulatory Factor 4 (IRF4) gene, located at chromosomal region 6p25- p23, is a member of the interferon regulatory factor (IRF) family, a group of DNAbinding transcription factors, with the IRF4 primarily associated with immune system development and response and expressed exclusively in immune system cells and melanocytic lineages. Although many studies have shown that IRF4 is associated with many human conditions, such as melanoma and chronic lymphocytic leukemia, a recent Genome-Wide Association Study (GWAS) identified that alleles from the SNP rs12203592 (intron 4) is also associated with phenotypic variation regarding presence of freckles, hair, eye and skin pigmentation. Functional studies in human and mice melanin-containing cells revealed that such SNP is directly involved in the regulation of IRF4 expression, suggesting a clear role in melanocyte pigmentation. In spite of these findings, the regulatory and coding IRF4 diversities in admixed populations have not been evaluated so far. In order to verify if other variation sites spread across the IRF4 gene may be associated with human pigmentation, the regulatory (promoter and 3\'UTR regions) and coding (9 exons and flanking intronic regions, including the SNP rs12203592) regions were analyzed by next-generation sequencing procedures in a Brazilian admixed population sample. The population sample was composed of 228 unrelated individuals from the Ribeirão Preto area, São Paulo State, Brazil, which were stratified according to eye (blue, green, hazel, light-brown, and dark-brown), hair (red, blond, dark-blond, light-brown, dark-brown and black) and skin (light, intermediate and dark) pigmentation, as well as regarding the presence of freckles and intensity of hair greying. DNA libraries were prepared using the Haloplex Target Enrichment System (Agilent Technologies) and sequenced at the MiSeq platform (Illumina). CutAdapt, BWA and GATK software packages were used for trimming adaptor sequences, alignment and genotype calling, respectively. Missing alleles and haplotypes were inferred by using the PHASE method, although the known phase between variable sites (obtained by GATK) was taken into account. A total of 105 variation sites were identified. Only two of them presented genotype frequencies that did not fit Hardy- Weinberg equilibrium (HWE) expectations. Eighteen of these SNPs presented strong association with at least one pigmentation feature. However, if the conservative Bonferroni correction for multiple tests is taken into account, only two associations, both of them involving the rs12203592 SNP, remain significant: allele T associated with light skin and blue eyes. This result is in agreement with previous reports that the rs12203592*T allele leads to reduced IRF4 activation and reduced tyrosinase expression, leading to sun sensitivity and blue eyes. A total of 101 different haplotypes were inferred, and haplotype distribution was in agreement to HWE expectations. When haplotypes were subdivided in promoter, coding and 3\'UTR haplotypes, 17, 29 and 37 different haplotypes were observed, respectively. Various associations were identified, particularly involving the most frequent promoter haplotype, the two most frequent coding (only one of them with allele rs12203592*T), and the most frequent 3\'UTR, all of them with light skin, blue eyes, brown hair and hair greying. These results suggest that other variation sites besides rs12203592, when considered in a haplotypic background, are associated with human pigmentation.

Le facteur 4 plaquettaire (PF4/CXCL4) est un tétramère constitué de quatre sous-unités identiques de 7,8 kDa qui est libéré en grande quantité par les plaquettes lors de l’hémostase primaire (ensemble des phénomènes permettant un colmatage initial d’une lésion vasculaire). L’étude de la formation d’un caillot de fibrine en présence de PF4 montre une augmentation de la turbidité finale du caillot : le PF4 modifie le réseau formé. Etant donné que la plupart des acteurs de la fibrinolyse se lie au caillot de fibrine et que le PF4 modifie sa structure, nous avons pensé qu’il serait intéressant de rechercher si le PF4 influençait aussi la fibrinolyse. La lyse d'un caillot est effectuée par la plasmine issue de l'activation du plasminogène par son activateur d’origine tissulaire (t-PA) en présence d’un cofacteur qui n'est autre que la fibrine. Nous avons étudié la lyse de caillots de plasma, obtenus par activation de la cascade de la coagulation, en condition statique et à l'aide d'un modèle de thrombose artérielle (système Chandler loop). Dans les deux cas, une diminution du temps de demi-lyse a été observée en présence de PF4. Cependant, la lyse de caillots préparés par simple ajout de thrombine sur du fibrinogène ne permet pas de retrouver cet effet du PF4. Ceci suggère que l’influence du PF4 sur la structure du caillot n’est pas à l’origine de l’effet sur sa lyse et que le PF4 n’influence pas (ou très peu) l'activation du plasminogène, ainsi que l'activité de la plasmine résultante. Cette hypothèse a été confirmée par l’étude de l’activité amydolytique du t-PA et de la plasmine (quelle soit ajoutée ou générée). En système purifié, les inhibiteurs plasmatiques de la fibrinolyse sont absents. Les deux principaux sont l'inhibiteur de l'activateur du plasminogène de type 1 (PAI-1) et l’α2-antiplasmine (α2-AP). La lyse de caillots préparés à partir de plasma déficient en α2-AP montre une diminution du temps de demi-lyse en présence de PF4 (comme pour le plasma normal), alors qu’avec le plasma dépourvu de PAI-1 le temps de demi-lyse n'est plus influencé. De plus, l’ajout de PAI-1 dans le système purifié entraine une diminution du temps de demi-lyse en présence de PF4. Ceci suggère que le PF4 prévient directement ou indirectement l'inhibition du t-PA par PAI-1. L’étude de la cinétique d'inhibition de l’activité amidolytique du t-PA par le PAI-1, la détermination de la stœchiométrie de cette inhibition, et l’analyse de ces cinétiques par immuno-empreinte montrent que le PF4 est un modulateur de la fibrinolyse qui agit en retardant la formation d'un complexe initial entre le t-PA et le PAI-1. Cette nouvelle fonction du PF4 est cohérente, et vient en complément de celle décrite récemment d’inhibiteur de l'activation du TAFI. / Platelet factor 4 (PF4/CXCL4) is a tetramer constituted of four identical 7,8 kDa subunits released in large quantities by platelets during primary heamostasis (allowing initial clogging of a vascular injury). Study of fibrin clot formation in the presence of PF4 shows an increase of the final clot turbidity: PF4 modifies the formed network. Given that most fibrinolysis actors are bound to the fibrin clot and that PF4 modifies its structure we thought it would be interesting to investigate if PF4 also influences fibrinolysis. Clot lysis is performed by plasmin originating from activation of its precursor by tissue plasminogen activator (t-PA) with fibrin itself as cofactor of the reaction. We have studied lysis of plasma clots formed by activation of the coagulation cascade in static condition and in a Chandler loop model mimicking arterial thrombosis. Half-times of lysis decreased in the presence of PF4 in both systems. However, PF4 had no longer detectable influence on the half-time of lysis with clots formed by direct addition of thrombin on purified fibrinogen. Observation suggested that the observed decrease of the half-time of lysis induced by PF4 did not originate from its influence on fibrin clot formation and that PF4 had little effect if any on plasminogen activation or plasmin activity. We confirmed this hypothesis by comparing amydolytic activities of t-PA and plasmin (added or generated through plasminogen activation). In purified system, fibrinolysis inhibitors are absent. The two main inhibitors are plasminogen activator inhibitor-1 (PAI-1) and α2-antiplasmin (α2-AP). Lysis of clots obtained from α2-AP deficient plasma showed a decrease of the half-time of lysis in the presence of PF4 (as in normal plasma), whereas in PAI-1 deficient plasma half-time of lysis was unchanged. Moreover if PAI-1 was added to the purified system, half-time of lysis decreased in the presence of PF4. Observations therefore suggested that PF4 prevented directly or indirectly t-PA inhibition by PAI-1. Kinetics of the amidolytic activity of t-PA inhibition by PAI-1 in the presence or not of PF4, determination of its stoichiometry and Western blot analysis of these inhibition kinetics revealed that PF4 is a fibrinolysis modulator which delays formation of the initial (Michaelis) complex between t-PA and PAI-1. This new feature of PF4 is consistent and complementary with its recently described role as a modulator of TAFI activation.

Glia are the understudied brain cells that perform many functions essential to maintain nervous system homeostasis and protect the brain from injury. If brain damage occurs, glia rapidly adopt the reactive state and elicit a series of cellular and molecular events known as reactive gliosis, the hallmark of many neurodegenerative diseases. However, the molecular pathways that trigger and regulate this process remain poorly defined. The fruit fly Drosophila melanogaster has glial cells that are strikingly similar to mammalian glia, and which also exhibit reactive responses after neuronal injury. By exploiting its powerful genetic toolbox, we are uniquely positioned to identify the genes that activate and execute glial responses to neuronal injury in vivo. In this dissertation, I use Wallerian degeneration in Drosophila as a model to characterize molecular pathways responsible for glia to recognize neural injury, become activated, and ultimately engulf and degrade axonal debris. I demonstrate a novel role for the GEF (guanine nucleotide exchange factors) complex DRK/DOS/SOS upstream of small GTPase Rac1 in glial engulfment activity and show that it acts redundantly with previously discovered Crk/Mbc/dCed-12 to execute glial activation after axotomy. In addition, I discovered an exciting new role for the TNF receptor associated factor 4 (TRAF4) in glial response to axon injury. I find that interfering with TRAF4 and the downstream kinase misshapen (msn) function results in impaired glial activation and engulfment of axonal debris. Unexpectedly, I find that TRAF4 physically associates with engulfment receptor Draper – making TRAF4 only second factor to bind directly to Draper – and show it is essential for Draper-dependent activation of downstream engulfment signaling, including transcriptional activation of engulfment genes via the JNK and STAT transcriptional cascades. All of these pathways are highly conserved from Drosophila to mammals and most are known to be expressed in mouse brain glia, suggesting functional conservation. My work should therefore serve as an excellent starting point for future investigations regarding their roles in glial activation/reactive gliosis in various pathological conditions of the mammalian central nervous system.

CD8+ T Zellen unterstützen die Beseitigung von Pathogenen und sind somit entscheidend bei der Bekämpfung von Infektionen. Neben der Antigendosis und dem inflammatorischen Zytokinemilieu hat auch die Stimulation durch den TZR einen entscheidenden Einfluss auf die CD8+ T Zellantwort. Das transkriptionelle Programm, die finale Größe und Dauer der klonalen Expansion und der Start der Kontraktionsphase werden durch die TZR-Signalstärke bestimmt. Schwache TZR-Stimulation führt zu einer verminderten Expansion und vermittelt eine frühzeitige Kontraktionsphase, die eine Entwicklung von Gedächtniszellen auf den Kosten der Effektorzellen favorisiert. IRF4 wird nach TZR-Ligand-Interaktion in CD8+ T-Zellen hoch reguliert. Seine Expressionskinetik ist stark von der TZR-Signalstärke der Aktivierung abhängig, übersetzt diese und sorgt für die Umsetzung in ein entsprechendes transkriptionelles und differentielles Programm. In dieser Arbeit konnte erstmals gezeigt werden, dass die IRF4-Defizienz in CD8+ T-Zellen zu einem verfrühten Abbruch der Expansion und zu einem vorzeitigen Beginn der Kontraktion führt, die durch den FAS-vermittelten Tod-induzierenden Signalweg initiiert wird. Außerdem präsentieren IRF4-defiziente CD8+ T-Zellen vermehrt Phosphatidylserine an ihrer Oberfläche und Komplementdeposition, beides begünstigt die Erkennung und Aufnahme durch Phagozyten. Diese Ergebnisse weisen zudem stark darauf hin, dass durch die fehlende Expression von IRF4 in CD8+ T Zellen, ein schwaches TZR-Signal übermittelt wird, unabhängig von der tatsächlichen Stärke und Dauer des aktivierenden Signals, dass zu einer Verkürzung der Expansionsphase führt und eine verfrühte Kontraktionsphase der Effektorzellen auslöst. Diese Arbeit erweitert schon bekanntes Wissen um IRF4 als Schlüsselregulator für die Differenzierung und Funktionalität der ag-spezifischen CD8+ T-Zellen, da es den Beginn der Kontraktionsphase diktiert mittels Aktivierung von verschiedenen Apoptose- und Phagocytose Signalwegen. / CD8+ T cells promote pathogen clearance and play a crucial role in controlling infections. Besides antigen dose and inflammatory cytokine milieu, the TCR stimulation contributes to the programming of the CD8+ T cell response. A distinct developmental program, the final magnitude and duration of clonal expansion, as well as the timing of the onset of T cell contraction, are determined by the TCR signaling strength. Weak TCR stimulation results in a diminished magnitude of expansion and accelerates the onset of contraction, as it favors the development of memory cells at the expense of effector cells. IRF4 is a transcription factor, that is upregulated in CD8+ T cells following TCR stimulation. Furthermore, its expression kinetic is highly dependent on the TCR signaling strength, which initiated activation. Therefore, it translates the strength of the activating signal and transmits it into a proper transcriptional and developmental program. This study provides unique evidence that the absence of IRF4 expression in CD8+ T cells leads to a hasted termination of clonal expansion and a premature contraction, initiated by the FAS-mediated cell death pathway. Moreover, IRF4-deficient CD8+ T cells exposed phosphatidylserine on their cell surface and showed complement deposition, both facilitating their recognition and uptake by phagocytes. The findings of this study additionally strongly indicate that IRF4 deficiency mimics weak TCR engagement and in turn transmits every TCR signal, independent of its actually affinity and duration, into a developmental program, that give rise to an early memory formation and results in a premature onset of effector CD8+ T cell contraction. This data extend previous knowledge of IRF4 being essential for the differentiation and functionality of ag-specific effector CD8+ T cells, as it furthermore dictates the onset of CD8+ T cell contraction via the activation of several death and phagocytosis inducing pathways.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

Abstract Cytochrome P450 (CYP) enzymes are the major metabolizers of xenobiotics, e.g. drugs, and environmental toxins. Thus, changes in CYP expression have an important impact on drug metabolism and susceptibility to chemical toxicity. In the present study, the transcriptional mechanisms of both constitutive and inducible regulation of the Cyp2a5 gene in mouse liver were investigated. Mouse primary hepatocyte cultures were used as the main model system together with cell and molecular biology methods. The key activation regions of the Cyp2a5 5' promoter were determined using reporter gene assays. Two major transcription activation sites of the Cyp2a5 5' promoter, called the proximal and the distal, were found. Transcription factors hepatocyte nuclear factor-4 (HNF-4) and nuclear factor I were shown to bind to the proximal promoter. Aryl hydrocarbon receptor nuclear translocator (ARNT) and upstream stimulatory factor bound to a common palindromic E-box element in the distal promoter region. All three response elements were shown to be essential for constitutive expression of CYP2A5 in murine hepatocytes. ARNT appeared to control Cyp2a5 transcription without a heterodimerization partner suggesting active involvement of the ARNT homodimer in mammalian gene regulation. Aryl hydrocarbon receptor (AHR) ligands were shown to induce Cyp2a5 transcriptionally by an AHR-dependent mechanism, and established Cyp2a5 as a novel AHR-regulated gene. The AHR response element and the E-box, identified in these studies, were located near to each other and close to a separately defined nuclear factor (erythroid-derived 2)-like 2 binding site in the distal region of the Cyp2a5 promoter, suggesting cooperation between these elements. Peroxisome proliferator-activated receptor gamma coactivator-1α was shown to up-regulate Cyp2a5 transcription through coactivation of HNF-4α. This indicates that xenobiotic metabolism can be regulated by modification of co-activation. The present results show that CYP2A5 is regulated by several different cross-regulatory pathways. The regulatory mechanisms involved in the transcription of the Cyp2a5 gene may also control other CYP genes, especially the human ortholog CYP2A6, and may explain some of the individual variations in the metabolism of xenobiotics.

Que o envenenamento pela serpente Bothrops jararaca causa distúrbios hemorrágicos sistêmicos, com alteração da coagulação e fibrinólise sangüíneas, é notório. Contudo, pouco se sabe sobre a ação in vivo desse veneno sobre as plaquetas. Em estudos recentes, demonstrou-se que esse veneno causa trombocitopenia, distúrbios da agregação e diminuição do número de corpos densos plaquetários, que, dessarte, sugeriam a ativação das plaquetas circulantes. Com o escopo de comprovar esta hipótese e melhor caracterizar as ações in vivo desse veneno sobre as plaquetas, serviu-se de um modelo experimental que empregava coelhos para o envenenamento pela B. jararaca. No grupo experimental, os animais foram injetados i.v. com o veneno da B. jararaca (60 µg/kg) e no grupo controle com salina. Previamente à administração de salina ou veneno, os coelhos tiveram suas plaquetas marcadas ex vivo com NHS-biotina. Para a avaliação das alterações plaquetárias, amostras de sangue foram coletadas seqüencialmente, em intervalos de tempo que variaram de 1 a 144 horas após a administração do veneno ou salina. Durante o envenenamento, houve trombocitopenia, hipofibrinogenemia, elevação dos níveis plasmáticos do fator de von Willebrand, diminuição da função plaquetária no sangue total induzida pela botrocetina e pelo colágeno e diminuição da secreção de ATP. Não obstante, os níveis plasmáticos de fator plaquetário 4, um marcador específico da ativação plaquetária in vivo, e os níveis intraplaquetários de serotonina se mantiveram constantes. Pela citometria de fluxo, observou-se um decréscimo significativo da expressão do epítopo da GPIIb-IIIa reconhecido pelo anticorpo monoclonal P2, porém isso não foi observado ao utilizar-se anticorpos policlonais. A expressão de fibrinogênio ou dos produtos de degradação do fibrinogênio/fibrina (PDF) na membrana plaquetária também não sofreu alteração significativa ao longo do tempo. Houve, todavia, elevações significativas da P-selectina plaquetária, um receptor cuja expressão é indicativa de ativação plaquetária, e do epítopo induzido por ligantes (LIBS1) da GPIIIa. A porcentagem de plaquetas reticuladas na circulação, assim como os tempos de sobrevivência plaquetária, não foram estatisticamente diferentes entre os dois grupos. As análises histológicas e imuno-histoquímicas dos órgãos dos coelhos mostraram que as plaquetas circulantes são retidas entre redes de fibrina nos capilares pulmonares. Os resultados obtidos sugerem que a trombina engendrada pelos componentes pró-coagulantes deste veneno desempenha uma função essencial na patogenia dos distúrbios da coagulação e plaquetários observados neste modelo de envenenamento. O aumento da expressão de P-selectina no grupo experimental comprovou a hipótese inicial de que as plaquetas dos coelhos envenenados são verdadeiramente ativadas na circulação. Os dados ora apresentados demonstram definitivamente que a diminuição do fibrinogênio ou o aumento dos PDF não são a causa fundamental da disfunção plaquetária observada no envenenamento botrópico e que outro(s) composto(s) parece(m) estar envolvido(s) com estes distúrbios plaquetários. / In spite of being well established that Bothrops jararaca snake venom causes blood coagulation and fibrinolysis disturbances in patients, scant information about blood platelet disorders during envenomation is available. In recent investigations, thrombocytopenia, platelet aggregation disturbances and decreased numbers of platelet dense bodies were observed following venom administration, suggesting that circulating platelets had been activated. In order to prove this hypothesis and to gain a better characterization of the in vivo role of this venom on platelets, an experimental model of B. jararaca envenomation was utilized. Rabbits were injected i.v. either with B. jararaca venom (60 µg/kg) (experimental group) or saline (control group). Previously to saline or venom administration, rabbit platelets were labeled ex vivo with NHS-biotin. To evaluate platelet disturbances, blood samples were collected consecutively, at time intervals that varied from 1 to 144 hours after venom or saline administration. During envenomation, there were thrombocytopenia, hypofibrinogenemia, elevation of von Willebrand factor plasma levels, reduced botrocetin- and collagen-induced platelet aggregation in whole blood, and decreased ATP secretion. However, plasma levels of platelet factor 4, a specific marker of in vivo platelet activation, and intraplatelet serotonin levels remained constant. By flow cytometry, a significant decrease on the expression of GPIIb-IIIa epitope recognized by P2 monoclonal antibody was observed; however, this was not observed when polyclonal antibodies were employed. Fibrinogen or fibrin(ogen) degradation product (FDP) expression on platelet surface showed no significant alteration. Nonetheless, significant elevations of platelet P-selectin, a receptor whose expression is indicative of platelet activation, and of ligand-induced binding sites (LIBS1) of GPIIIa were noted. The percentage of circulating reticulated platelets, as well as platelet survival times, were not statistically different between the two groups. Histopathological and immunohistochemical analyses of rabbit organs demonstrated that circulating platelets were sequestered among fibrin deposits in pulmonary capillaries. These results suggest that thrombin generated by procoagulating components of B. jararaca venom has an essential role in the pathogenesis of platelet and coagulation disorders in this experimental model. Increased expression of P-selectin in the experimental group proves the initial hypothesis that platelets of envenomed rabbits are indeed activated in the circulation. The data presented herein demonstrate definitively that decreased fibrinogen or increased FDP levels are not the primary cause of the platelet dysfunction observed in bothropic envenomation, but other substances seem to be responsible for it.

Que o envenenamento pela serpente Bothrops jararaca causa distúrbios hemorrágicos sistêmicos, com alteração da coagulação e fibrinólise sangüíneas, é notório. Contudo, pouco se sabe sobre a ação in vivo desse veneno sobre as plaquetas. Em estudos recentes, demonstrou-se que esse veneno causa trombocitopenia, distúrbios da agregação e diminuição do número de corpos densos plaquetários, que, dessarte, sugeriam a ativação das plaquetas circulantes. Com o escopo de comprovar esta hipótese e melhor caracterizar as ações in vivo desse veneno sobre as plaquetas, serviu-se de um modelo experimental que empregava coelhos para o envenenamento pela B. jararaca. No grupo experimental, os animais foram injetados i.v. com o veneno da B. jararaca (60 µg/kg) e no grupo controle com salina. Previamente à administração de salina ou veneno, os coelhos tiveram suas plaquetas marcadas ex vivo com NHS-biotina. Para a avaliação das alterações plaquetárias, amostras de sangue foram coletadas seqüencialmente, em intervalos de tempo que variaram de 1 a 144 horas após a administração do veneno ou salina. Durante o envenenamento, houve trombocitopenia, hipofibrinogenemia, elevação dos níveis plasmáticos do fator de von Willebrand, diminuição da função plaquetária no sangue total induzida pela botrocetina e pelo colágeno e diminuição da secreção de ATP. Não obstante, os níveis plasmáticos de fator plaquetário 4, um marcador específico da ativação plaquetária in vivo, e os níveis intraplaquetários de serotonina se mantiveram constantes. Pela citometria de fluxo, observou-se um decréscimo significativo da expressão do epítopo da GPIIb-IIIa reconhecido pelo anticorpo monoclonal P2, porém isso não foi observado ao utilizar-se anticorpos policlonais. A expressão de fibrinogênio ou dos produtos de degradação do fibrinogênio/fibrina (PDF) na membrana plaquetária também não sofreu alteração significativa ao longo do tempo. Houve, todavia, elevações significativas da P-selectina plaquetária, um receptor cuja expressão é indicativa de ativação plaquetária, e do epítopo induzido por ligantes (LIBS1) da GPIIIa. A porcentagem de plaquetas reticuladas na circulação, assim como os tempos de sobrevivência plaquetária, não foram estatisticamente diferentes entre os dois grupos. As análises histológicas e imuno-histoquímicas dos órgãos dos coelhos mostraram que as plaquetas circulantes são retidas entre redes de fibrina nos capilares pulmonares. Os resultados obtidos sugerem que a trombina engendrada pelos componentes pró-coagulantes deste veneno desempenha uma função essencial na patogenia dos distúrbios da coagulação e plaquetários observados neste modelo de envenenamento. O aumento da expressão de P-selectina no grupo experimental comprovou a hipótese inicial de que as plaquetas dos coelhos envenenados são verdadeiramente ativadas na circulação. Os dados ora apresentados demonstram definitivamente que a diminuição do fibrinogênio ou o aumento dos PDF não são a causa fundamental da disfunção plaquetária observada no envenenamento botrópico e que outro(s) composto(s) parece(m) estar envolvido(s) com estes distúrbios plaquetários. / In spite of being well established that Bothrops jararaca snake venom causes blood coagulation and fibrinolysis disturbances in patients, scant information about blood platelet disorders during envenomation is available. In recent investigations, thrombocytopenia, platelet aggregation disturbances and decreased numbers of platelet dense bodies were observed following venom administration, suggesting that circulating platelets had been activated. In order to prove this hypothesis and to gain a better characterization of the in vivo role of this venom on platelets, an experimental model of B. jararaca envenomation was utilized. Rabbits were injected i.v. either with B. jararaca venom (60 µg/kg) (experimental group) or saline (control group). Previously to saline or venom administration, rabbit platelets were labeled ex vivo with NHS-biotin. To evaluate platelet disturbances, blood samples were collected consecutively, at time intervals that varied from 1 to 144 hours after venom or saline administration. During envenomation, there were thrombocytopenia, hypofibrinogenemia, elevation of von Willebrand factor plasma levels, reduced botrocetin- and collagen-induced platelet aggregation in whole blood, and decreased ATP secretion. However, plasma levels of platelet factor 4, a specific marker of in vivo platelet activation, and intraplatelet serotonin levels remained constant. By flow cytometry, a significant decrease on the expression of GPIIb-IIIa epitope recognized by P2 monoclonal antibody was observed; however, this was not observed when polyclonal antibodies were employed. Fibrinogen or fibrin(ogen) degradation product (FDP) expression on platelet surface showed no significant alteration. Nonetheless, significant elevations of platelet P-selectin, a receptor whose expression is indicative of platelet activation, and of ligand-induced binding sites (LIBS1) of GPIIIa were noted. The percentage of circulating reticulated platelets, as well as platelet survival times, were not statistically different between the two groups. Histopathological and immunohistochemical analyses of rabbit organs demonstrated that circulating platelets were sequestered among fibrin deposits in pulmonary capillaries. These results suggest that thrombin generated by procoagulating components of B. jararaca venom has an essential role in the pathogenesis of platelet and coagulation disorders in this experimental model. Increased expression of P-selectin in the experimental group proves the initial hypothesis that platelets of envenomed rabbits are indeed activated in the circulation. The data presented herein demonstrate definitively that decreased fibrinogen or increased FDP levels are not the primary cause of the platelet dysfunction observed in bothropic envenomation, but other substances seem to be responsible for it.