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Lung vaso-occlusion in sickle cell disease mediated by arteriolar neutrophil-platelet microemboli
Margaret F. Bennewitz, Maritza A. Jimenez, Ravi Vats, Egemen Tutuncuoglu, Jude Jonassaint, Gregory J. Kato, Mark T. Gladwin, Prithu Sundd
Margaret F. Bennewitz, Maritza A. Jimenez, Ravi Vats, Egemen Tutuncuoglu, Jude Jonassaint, Gregory J. Kato, Mark T. Gladwin, Prithu Sundd
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Research Article Hematology Inflammation

Lung vaso-occlusion in sickle cell disease mediated by arteriolar neutrophil-platelet microemboli

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Abstract

In patients with sickle cell disease (SCD), the polymerization of intraerythrocytic hemoglobin S promotes downstream vaso-occlusive events in the microvasculature. While vaso-occlusion is known to occur in the lung, often in the context of systemic vaso-occlusive crisis and the acute chest syndrome, the pathophysiological mechanisms that incite lung injury are unknown. We used intravital microscopy of the lung in transgenic humanized SCD mice to monitor acute vaso-occlusive events following an acute dose of systemic lipopolysaccharide sufficient to trigger events in SCD but not control mice. We observed cellular microembolism of precapillary pulmonary arteriolar bottlenecks by neutrophil-platelet aggregates. Blood from SCD patients was next studied under flow in an in vitro microfluidic system. Similar to the pulmonary circulation, circulating platelets nucleated around arrested neutrophils, translating to a greater number and duration of neutrophil-platelet interactions compared with normal human blood. Inhibition of platelet P-selectin with function-blocking antibody attenuated the neutrophil-platelet interactions in SCD patient blood in vitro and resolved pulmonary arteriole microembolism in SCD mice in vivo. These results establish the relevance of neutrophil-platelet aggregate formation in lung arterioles in promoting lung vaso-occlusion in SCD and highlight the therapeutic potential of targeting platelet adhesion molecules to prevent acute chest syndrome.

Authors

Margaret F. Bennewitz, Maritza A. Jimenez, Ravi Vats, Egemen Tutuncuoglu, Jude Jonassaint, Gregory J. Kato, Mark T. Gladwin, Prithu Sundd

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Figure 5

LPS promotes neutrophil-platelet aggregation in sickle cell disease (SCD) human blood.

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LPS promotes neutrophil-platelet aggregation in sickle cell disease (SCD...
African American control (AA) or steady-state SCD (SS) human whole blood with or without LPS pretreatment was perfused through micro-channels presenting P-selectin, ICAM-1, and IL-8; and neutrophil-platelet interactions were monitored using quantitative microfluidic fluorescence microscopy (qMFM) over a 2-minute period. (A) Total platelet interactions with arrested neutrophils in SCD (steady state) whole blood with or without pretreatment with 0.25 μg/ml of LPS. Representative of 6 experiments with 6 SCD subjects. (B) Total platelet interactions with arrested neutrophils in control human blood with or without pretreatment with 0.25 or 1 μg/ml LPS. Representative of 6 experiments with 5 control subjects. (C) Comparison of total platelet-neutrophil interactions following pretreatment of control and SCD blood with 0.25 μg/ml LPS. Representative of 8 experiments with 3 control and 5 SCD subjects. (D and E) Effect of TAK-242 and/or intralipid (vehicle) pretreatment on (D) the total number of platelet interactions with arrested neutrophils and (E) total number of arrested neutrophils over a 2-minute observation period in 0.25 or 1 μg/ml LPS–treated SCD or control human blood, respectively. TAK-242 was added to the blood (50 μg/ml) and incubated for 5 minutes. After 5 minutes, LPS was added to the blood and incubated for 10 minutes before perfusion through the micro-channels. Representative of 6 experiments with 3 control and 3 SCD subjects. Data represent mean ± SEM. #P < 0.05 when comparing with baseline; +P < 0.05 when comparing with TAK-242. Means were compared using Student’s t test with Bonferroni correction. Each data point represents a single field of view (FOV), and observations were made over multiple FOVs in some experiments. See Supplemental Methods for details. Wall shear stress: 6 dyn/cm2. FOV: ~14,520 μm2.

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