The phenomenon known as immunothrombosis has garnered increased attention over the last few years. Much work has been done to characterize the cross talk between hemostasis and the innate immune system. This thesis outlines the role of the vascular endothelial cells during immunothrombotic events as regulators of coagulation, platelet-, and leukocyte recruitment. A newly developed method for investigating the interaction between endothelial cells and the blood compartment illustrated the procoagulant and proinflammatory effects elicited by tumor necrosis factor α activated endothelial cells upon exposure to whole blood. The method was utilized in evaluating treatment of endothelial dysfunction and disruption with a heparin conjugate. Damaged or hypoxic endothelial cells, in addition to basement membrane collagen, that were pretreated with the heparin conjugate prior to contact with blood were found to have reduced activation of coagulation, platelet-, and leukocyte recruitment; in contrast to unfractionated heparin, which had no effect on the aforementioned parameters. The treatment was then investigated in the setting of ischemia reperfusion injury during kidney transplantation and the heparin conjugate was found to bind cultured endothelial cells with high avidity under cold storage conditions. Furthermore, it was found to bind to the renal vasculature during static cold storage and was subsequently found to be beneficial with regard to early graft function in an experimental mouse model of syngeneic kidney transplantation. Recipients of kidneys treated with the heparin conjugate had reduced serum creatinine compared to controls 24 hours after transplantation. Lastly, the anticoagulant properties of the heparin conjugate were investigated in comparison to unfractionated heparin. While the conjugate exerted reduced capacity with regard to thrombin inhibition, it rapidly inhibited the binding of platelets to exposed collagen. The conjugate was furthermore found to preferentially locate to sites of endothelial cell activation at early stage during endotoxic shock in mice. In conclusion, this thesis demonstrates that disrupted functioning of the vascular endothelial cells actively contributes to immunothrombosis, and that it is possible to model endothelial cell function using whole blood assays. Furthermore, this thesis presents a treatment that enhances the hemocompatibility of damaged endothelial cells and subsequently improves the early renal function after kidney transplantation.

Thesis / Doctor of Philosophy (PhD)

Sepsis is a life-threatening condition characterized by organ dysfunction due to an uncontrolled response to infection. Despite decades of research, the mortality rate remains high, emphasizing the need for an improved understanding of sepsis pathophysiology and improvements in preclinical animal research. Recently, extracellular histones, major mediators of organ dysfunction and death, have emerged as a potential therapeutic target for sepsis. In this thesis, we reported that the ability of heparin to neutralize the cytotoxic and procoagulant effects of histones is size-dependent but independent of the antithrombin- binding pentasaccharide. In contrast, the ability of heparin to neutralize histone-mediated impairment of activated protein C generation is independent of size and anticoagulant activity. These findings suggest that heparin variants may have differential therapeutic potential in vascular disease states that are associated with elevated levels of histones. Before testing the therapeutic efficacy of the heparin variants in vivo, we aimed to develop and standardize a murine model of sepsis that can be utilized in a multi-center platform. As one of the lead sites for the National Preclinical Sepsis Platform (NPSP), we optimized a 72-hour model of abdominal sepsis using supportive treatments. As sepsis predominately impacts the elderly, we also explored the impact of aging on the host response to sepsis using our fecal induced peritonitis (FIP) model. Aged FIP mice exhibited a higher mortality rate compared to young FIP mice. The worsened organ injury and poor survival in aged mice may be attributed to heightened inflammation in aged mice. We also observed trends in increased bacterial loads, increased coagulation, elevated cell free DNA, and decreased ADAMTS13 activity in aged septic mice. These findings help to improve our understanding of how aging impacts the host response to sepsis, which may be translated into therapeutic strategies that considers advanced age as a risk factor for sepsis. / Thesis / Candidate in Philosophy