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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 6

LPS-induced neutrophil-platelet aggregation is P-selectin and Mac-1 dependent.

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LPS-induced neutrophil-platelet aggregation is P-selectin and Mac-1 depe...
African American control (AA) or steady -state sickle cell disease (SS) human whole blood with or without LPS pretreatment and with or without addition of a cocktail of P-selectin and Mac-1 function-blocking mAbs was perfused through micro-channels presenting P-selectin, ICAM-1, and IL-8; and neutrophil-platelet interactions were monitored in a field of view (FOV) using quantitative microfluidic fluorescence microscopy (qMFM) over a 2-minute period. LPS was added to the blood and incubated at room temperature for 10 minutes before perfusion through the micro-channels. Flow was stopped after 2 minutes of perfusion, and function-blocking antibodies were added to the blood. Flow was resumed, and observations were made for another 2 minutes. (A and B) Effect of simultaneous inhibition of platelet P-selectin and neutrophil Mac-1 on (A) total platelet interactions with arrested neutrophils and (B) number of platelet interaction events per arrested neutrophil in control or SCD human blood with or without pretreatment with LPS (0.25 or 1 μg/ml). *P < 0.05 when compared with baseline; #P < 0.05 when comparing control with SCD; +P < 0.05 when comparing LPS with Ab treatment. Representative of 8 experiments with 4 control and 4 SCD subjects. (C and D) No effect of isotype IgG1 control Ab treatment on the total number of platelet interactions with arrested neutrophils in (C) 1 μg/ml LPS–treated control and (D) 0.25 μg/ml LPS–treated SCD human blood. Representative of 5 experiments done with 2 control and 3 SCD subjects. Data represent mean ± SEM. Means were compared using Student’s t test with Bonferroni correction for multiple comparisons. Each data point represents a single field of view (FOV), and observations were made over multiple FOVs in individual experiments. See Supplemental Methods for details. Wall shear stress: 6 dyn/cm2. FOV: ~14,520 μm2.

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