A perspective on the potential problems with aspirin as an antithrombotic agent: a comparison of studies in an animal model with clinical trials

AbstractAspirin is the most widely prescribed agent to reduce the platelet-mediated contributions to atherosclerosis, coronary thrombosis and restenosis after angioplasty. While aspirin treatment has led to significant reductions in morbidity and mortality in many clinical trials, there are several scenarios in which aspirin may fail to provide a full antithrombotic benefit. The cyclic flow model of experimental coronary thrombosis suggests that elevations of plasma catecholamines, high shear forces acting on the platelets in the stenosed lumen and the presence of multiple, input stimuli can activate platelets through different mechanisms that may lead to thrombosis despite aspirin therapy. Aspirin therapy is limited because it only blocks some of the input stimuli, leaving aspirin-independent pathways through which coronary thrombosis can be precipitated. These include thrombin and thrombogenic arterial wall substrates such as tissue factor. New agents that block the adenosine diphosphate (ADP) receptor, or regulate platelet free cytosolic calcium, such as direct nitric oxide donors, may be more potent overall than aspirin. Agents that block the platelet integrin GPIIb-IIIa receptor inhibit the binding of fibrinogen to platelets regardless of which input stimuli activate the platelet and, thus, as demonstrated in the cyclic flow model, would be much more potent than aspirin as an antithrombotic agent. The cyclic flow model has been useful in predicting which agents are likely to be of benefit in clinical trials

Cyclical coronary flow reductions in conscious dogs equipped with ameroid constrictors to produce severe coronary narrowing

In conscious dogs equipped with ameroid constrictors to produce gradual coronary occlusion, coronary flow velocity was monitored prior to complete occlusion when coronary constriction was severe (resting flow velocity reduced by 10–50% from control recordings made 7–10 days after ameroid implantation). In six of the ten dogs, we observed spontaneous cyclical variations in coronary flow velocity, characterized by gradual reduction in flow followed by very abrupt restoration of flow. The cyclic coronary flow reductions were observed between 20 and 31 days after ameroid implantation. These changes in flow bear striking similarity to those observed by previous investigators using anesthetized, open-chest canine preparations, in which the role of platelets was clearly demonstrated. Consequently, we hypothesize that spontaneous platelet aggregation and de-aggregation within the severely narrowed coronary lumen (enclosed by the ameroid constrictors) could account for our observations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41746/1/395_2005_Article_BF01906748.pd

JLab Measurement of the 4^4He Charge Form Factor at Large Momentum Transfers

The charge form factor of ^4He has been extracted in the range 29 fm$^{-2}$ $\le Q^2 \le 77$ fm$^{-2}$ from elastic electron scattering, detecting $^4$He nuclei and electrons in coincidence with the High Resolution Spectrometers of the Hall A Facility of Jefferson Lab. The results are in qualitative agreement with realistic meson-nucleon theoretical calculations. The data have uncovered a second diffraction minimum, which was predicted in the $Q^2$ range of this experiment, and rule out conclusively long-standing predictions of dimensional scaling of high-energy amplitudes using quark counting.Comment: 4 pages, 2 figure

JLab Measurements of the 3He Form Factors at Large Momentum Transfers

The charge and magnetic form factors, FC and FM, of 3He have been extracted in the kinematic range 25 fm-2 < Q2 < 61 fm-2 from elastic electron scattering by detecting 3He recoil nuclei and electrons in coincidence with the High Resolution Spectrometers of the Hall A Facility at Jefferson Lab. The measurements are indicative of a second diffraction minimum for the magnetic form factor, which was predicted in the Q2 range of this experiment, and of a continuing diffractive structure for the charge form factor. The data are in qualitative agreement with theoretical calculations based on realistic interactions and accurate methods to solve the three-body nuclear problem

Search for a new gauge boson in the A′A' Experiment (APEX)

We present a search at Jefferson Laboratory for new forces mediated by sub-GeV vector bosons with weak coupling $\alpha'$ to electrons. Such a particle $A'$ can be produced in electron-nucleus fixed-target scattering and then decay to an $e^+e^-$ pair, producing a narrow resonance in the QED trident spectrum. Using APEX test run data, we searched in the mass range 175--250 MeV, found no evidence for an $A'\to e^+e^-$ reaction, and set an upper limit of $\alpha'/\alpha \simeq 10^{-6}$. Our findings demonstrate that fixed-target searches can explore a new, wide, and important range of masses and couplings for sub-GeV forces.Comment: 5 pages, 5 figures, references adde

JLab Measurements of the He-3 Form Factors at Large Momentum Transfers

The charge and magnetic form factors, F-C and F-M, respectively, of He-3 are extracted in the kinematic range 25 fm(-2) \u3c= Q(2) \u3c= 61 fm(-2) from elastic electron scattering by detecting He-3 recoil nuclei and scattered electrons in coincidence with the two High Resolution Spectrometers of the Hall A Facility at Jefferson Lab. The measurements find evidence for the existence of a second diffraction minimum for the magnetic form factor at Q(2) = 49.3 fm(-2) and for the charge form factor at Q(2) = 62.0 fm(-2). Both minima are predicted to exist in the Q(2) range accessible by this Jefferson Lab experiment. The data are in qualitative agreement with theoretical calculations based on realistic interactions and accurate methods to solve the three-body nuclear problem

Spectroscopy of Lambda-9Li by electroproduction

In the absence of accurate data on the free two-body hyperon-nucleon interaction, the spectra of hypernuclei can provide information on the details of the effective hyperon-nucleon interaction. Electroproduction of the hypernucleus Lambda-9Li has been studied for the first time with sub-MeV energy resolution in Hall A at Jefferson Lab on a 9Be target. In order to increase the counting rate and to provide unambiguous kaon identification, two superconducting septum magnets and a Ring Imaging CHerenkov detector (RICH) were added to the Hall A standard equipment. The cross section to low-lying states of Lambda-9Li is concentrated within 3 MeV of the ground state and can be fitted with four peaks. The positions of the doublets agree with theory while a disagreement could exist with respect to the relative strengths of the peaks in the doublets. A Lambda separation energy of 8.36 +- 0.08 (stat.) +- 0.08 (syst.) MeV was measured, in agreement with an earlier experiment.Comment: 14 pages, 8 figure

A Molecular Signature of Proteinuria in Glomerulonephritis

Proteinuria is the most important predictor of outcome in glomerulonephritis and experimental data suggest that the tubular cell response to proteinuria is an important determinant of progressive fibrosis in the kidney. However, it is unclear whether proteinuria is a marker of disease severity or has a direct effect on tubular cells in the kidneys of patients with glomerulonephritis. Accordingly we studied an in vitro model of proteinuria, and identified 231 “albumin-regulated genes” differentially expressed by primary human kidney tubular epithelial cells exposed to albumin. We translated these findings to human disease by studying mRNA levels of these genes in the tubulo-interstitial compartment of kidney biopsies from patients with IgA nephropathy using microarrays. Biopsies from patients with IgAN (n = 25) could be distinguished from those of control subjects (n = 6) based solely upon the expression of these 231 “albumin-regulated genes.” The expression of an 11-transcript subset related to the degree of proteinuria, and this 11-mRNA subset was also sufficient to distinguish biopsies of subjects with IgAN from control biopsies. We tested if these findings could be extrapolated to other proteinuric diseases beyond IgAN and found that all forms of primary glomerulonephritis (n = 33) can be distinguished from controls (n = 21) based solely on the expression levels of these 11 genes derived from our in vitro proteinuria model. Pathway analysis suggests common regulatory elements shared by these 11 transcripts. In conclusion, we have identified an albumin-regulated 11-gene signature shared between all forms of primary glomerulonephritis. Our findings support the hypothesis that albuminuria may directly promote injury in the tubulo-interstitial compartment of the kidney in patients with glomerulonephritis