Acquired platelet antagonism: off-target antiplatelet effects of malignancy treatment with tyrosine kinase inhibitors

Platelets can contribute to tumor progression and metastasis. Cancer patients are at increased risk of thrombosis, and advanced stages of cancer are associated with thrombocytosis or increased platelet reactivity. Tyrosine kinase inhibitors (TKIs) are widely used as a targeted strategy for cancer treatment, with the aim of prolonging progression-free survival of the patients. Because of their broad kinase target spectrum, most TKIs inevitably have off-target effects. Platelets rely on tyrosine kinase activity for their activation. Frequently observed side effects are lowering of platelet count and inhibition of platelet functions, whether or not accompanied by an increased bleeding risk. In this review, we aim to give insights into: (i) 38 TKIs that are currently used for the treatment of different types of cancer, either on the market or in clinical trials; (ii) how distinct TKIs can inhibit activation mechanisms in platelets; and (iii) the clinical consequences of the antiplatelet effects of TKI treatment. For several TKIs, the knowledge on affinity for their targets does not align with the published effects on platelets and reported bleeding events. This review should raise awareness of the potential antiplatelet effects of several TKIs, which will be enhanced in the presence of antithrombotic drugs

Scale-free equilibria of self-gravitating gaseous disks with flat rotation curves

We introduce exact analytical solutions of the steady-state hydrodynamic equations of scale-free, self-gravitating gaseous disks with flat rotation curves. We express the velocity field in terms of a stream function and obtain a third-order ordinary differential equation (ODE) for the angular part of the stream function. We present the closed-form solutions of the obtained ODE and construct hydrodynamical counterparts of the power-law and elliptic disks, for which self-consistent stellar dynamical models are known. We show that the kinematics of the Large Magellanic Cloud can well be explained by our findings for scale-free elliptic disks.Comment: AAS preprint format, 21 pages, 8 figures, accepted for publication in The Astrophysical Journa

Targeting platelet receptor function in thrombus formation: The risk of bleeding

In this review, we presume that the process of thrombus formation, as assessed in whole blood flow studies and in experimental (murine) thrombosis studies, reflects the platelet responses in human haemostasis and thrombosis. Following this concept, we give an up-to-date overview of the main platelet receptors and signalling pathways that contribute to thrombus formation and are used as targets in (pre)clinical intervention studies to prevent cardiovascular disease. Discussed are receptors for thrombin, thromboxane, ADP, ATP, prostaglandins, von Willebrand factor, collagen, CLEC-2 ligand, fibrinogen and laminin. Sketched are the consequences of receptor deficiency or blockage for haemostasis and thrombosis in mouse and man. Recording of bleeding due to (congenital) platelet dysfunction or (acquired) antiplatelet treatment occurs according to different protocols, while common laboratory methods are used to determine platelet function

Stabilizing role of platelet P2Y(12) receptors in shear-dependent thrombus formation on ruptured plaques

Background: In most models of experimental thrombosis, healthy blood vessels are damaged. This results in the formation of a platelet thrombus that is stabilized by ADP signaling via P2Y(12) receptors. However, such models do not predict involvement of P2Y(12) in the clinically relevant situation of thrombosis upon rupture of atherosclerotic plaques. We investigated the role of P2Y(12) in thrombus formation on (collagen-containing) atherosclerotic plaques in vitro and in vivo, by using a novel mouse model of atherothrombosis. Methodology: Plaques in the carotid arteries from Apoe(-/-) mice were acutely ruptured by ultrasound treatment, and the thrombotic process was monitored via intravital fluorescence microscopy. Thrombus formation in vitro was assessed in mouse and human blood perfused over collagen or plaque material under variable conditions of shear rate and coagulation. Effects of two reversible P2Y(12) blockers, ticagrelor (AZD6140) and cangrelor (AR-C69931MX), were investigated. Principal Findings: Acute plaque rupture by ultrasound treatment provoked rapid formation of non-occlusive thrombi, which were smaller in size and unstable in the presence of P2Y(12) blockers. In vitro, when mouse or human blood was perfused over collagen or atherosclerotic plaque material, blockage or deficiency of P2Y(12) reduced the thrombi and increased embolization events. These P2Y(12) effects were present at shear rates >500 s(-1), and they persisted in the presence of coagulation. P2Y(12)-dependent thrombus stabilization was accompanied by increased fibrin(ogen) binding. Conclusions/Significance: Platelet P2Y(12) receptors play a crucial role in the stabilization of thrombi formed on atherosclerotic plaques. This P2Y(12) function is restricted to high shear flow conditions, and is preserved in the presence of coagulation

Rate-limiting roles of the tenase complex of factors VIII and IX in platelet procoagulant activity and formation of platelet-fibrin thrombi under flow

The importance of factor Xa generation in thrombus formation has not been studied extensively so far. Here, we used mice deficient in either factor VIII or factor IX to determine the role of platelet-stimulated tenase activity in the formation of platelet-fibrin thrombi on collagen. With tissue factor present, deficiency in factor VIII or IX markedly suppressed thrombus growth, fibrin formation and platelet procoagulant activity (phosphatidylserine exposure). In either case, residual fibrin formation was eliminated in the absence of tissue factor. Effects of factor deficiencies were antagonized by supplementation of the missing coagulation factor. In wild-type thrombi generated under flow, phosphatidylserine-exposing platelets bound (activated) factor IX and factor X, whereas factor VIII preferentially co-localized at sites of von Willebrand factor binding. Furthermore, proteolytic activity of the generated activated factor X and thrombin was confined to the sites of phosphatidylserine exposure. With blood from a hemophilia A or B patient, the formation of platelet-fibrin thrombi was greatly delayed and reduced, even in the presence of high concentrations of tissue factor. A direct activated factor X inhibitor, rivaroxaban, added to human blood, suppressed both thrombin and fibrin formation. Together, these data point to a potent enforcement loop in thrombus formation due to factor X activation, subsequent thrombin and fibrin generation, causing activated factor X-mediated stimulation of platelet phosphatidylserine exposure. This implies that the factor VIII/factor IX-dependent stimulation of platelet procoagulant activity is a limiting factor for fibrin formation under flow conditions, even at high tissue factor concentrations

Testing Hydrodynamic Models of LMC X-4 with UV and X-ray Spectra

We compare the predictions of hydrodynamic models of the LMC X-4 X-ray binary system with observations of UV P Cygni lines with the GHRS and STIS spectrographs on the Hubble Space Telescope. The hydrodynamic model determines density and velocity fields of the stellar wind, wind-compressed disk, accretion stream, Keplerian accretion disk, and accretion disk wind. We use a Monte Carlo code to determine the UV P Cygni line profiles by simulating the radiative transfer of UV photons that originate on the star and are scattered in the wind. The qualitative orbital variation predicted is similar to that observed, although the model fails to reproduce the strong orbital asymmetry (the observed absorption is strongest for phi>0.5). The model predicts a mid-eclipse X-ray spectrum, due almost entirely to Compton scattering, with a factor 4 less flux than observed with ASCA. We discuss how the model may need to be altered to explain the spectral variability of the system.Comment: 11 figures, accepted by Ap

Genetic analysis of the role of protein kinase Ctheta in platelet function and thrombus formation.

BACKGROUND: PKCtheta is a novel protein kinase C isozyme, predominately expressed in T cells and platelets. PKCtheta(-/-) T cells exhibit reduced activation and PKCtheta(-/-) mice are resistant to autoimmune disease, making PKCtheta an attractive therapeutic target for immune modulation. Collagen is a major agonist for platelets, operating through an immunoreceptor-like signalling pathway from its receptor GPVI. Although it has recently been shown that PKCtheta positively regulates outside-in signalling through integrin alpha(IIb)beta(3) in platelets, the role of PKCtheta in GPVI-dependent signalling and functional activation of platelets has not been assessed. METHODOLOGY/PRINCIPAL FINDINGS: In the present study we assessed static adhesion, cell spreading, granule secretion, integrin alpha(IIb)beta(3) activation and platelet aggregation in washed mouse platelets lacking PKCtheta. Thrombus formation on a collagen-coated surface was assessed in vitro under flow. PKCtheta(-/-) platelets exhibited reduced static adhesion and filopodia generation on fibrinogen, suggesting that PKCtheta positively regulates outside-in signalling, in agreement with a previous report. In contrast, PKCtheta(-/-) platelets also exhibited markedly enhanced GPVI-dependent alpha-granule secretion, although dense granule secretion was unaffected, suggesting that PKCtheta differentially regulates these two granules. Inside-out regulation of alpha(IIb)beta(3) activation was also enhanced downstream of GPVI stimulation. Although this did not result in increased aggregation, importantly thrombus formation on collagen under high shear (1000 s(-1)) was enhanced. CONCLUSIONS/SIGNIFICANCE: These data suggest that PKCtheta is an important negative regulator of thrombus formation on collagen, potentially mediated by alpha-granule secretion and alpha(IIb)beta(3) activation. PKCtheta therefore may act to restrict thrombus growth, a finding that has important implications for the development and safe clinical use of PKCtheta inhibitors

Platelet glycoprotein VI cluster size is related to thrombus formation and phosphatidylserine exposure in collagen-adherent platelets under arterial shear

Background: Collagen-induced platelet activation is predominantly mediated by glycoprotein (GP) VI through formation of receptor clusters that coincide with the accumulation of signaling molecules and are hypothesized to drive strong and sustained platelet activation. Objectives: To determine the importance of GPVI clusters for thrombus formation in whole blood under shear. Methods: We utilized whole blood microfluidics and an anti-GPVI nanobody (Nb), Nb28, labeled with AlexaFluor 488, to assess the distribution of GPVI on the surface of platelets adhering to a range of collagen-like substrates with different platelet activation potentials. Results: Automated analysis of GPVI surface distribution on platelets supported the hypothesis that there is a relationship between GPVI cluster formation, thrombus size, and phosphatidylserine (PS) exposure. Substrates that supported the formation of macroclusters also induced significantly bigger aggregates, with increased amounts of PS-exposing platelets in comparison to substrates where no GPVI clusters were detected. Furthermore, we demonstrate that only direct inhibition of GPVI binding, but not of downstream signaling, is able to disrupt cluster formation. Conclusion: Labeled anti-GPVI Nb28 permits visualization of GPVI clustering under flow conditions. Furthermore, whilst inhibition of downstream signaling does not affect clustering, it does prevent thrombus formation. Therefore, GPVI macroclustering is a prerequisite for thrombus formation and platelet activation, namely, PS exposure, on highly GPVI-dependent collagen surfaces

Models of X-ray Photoionization in LMC X-4: Slices of a Stellar Wind

We show that the orbital variation in the UV P Cygni lines of the X-ray binary LMC X-4 results when X-rays photoionize nearly the entire region outside of the X-ray shadow of the normal star. We fit models to HST GHRS observations of N V and C IV P Cygni line profiles. Analytic methods assuming a spherically symmetric wind show that the wind velocity law is well-fit by v~(1-1/r)^beta, where beta is likely 1.4-1.6 and definitely <2.5. Escape probability models can fit the observed P Cygni profiles, and provide measurements of the stellar wind parameters. The fits determine Lx/Mdot=2.6+/-0.1 x10^43 erg/s/Msun yr, where Lx is the X-ray luminosity and Mdot is the mass-loss rate of the star. Allowing an inhomogeneous wind improves the fits. IUE spectra show greater P Cygni absorption during the second half of the orbit than during the first. We discuss possible causes of this effect.Comment: 56 pages, 12 figures, to be published in the Astrophysical Journa

Quasi-Periodic Occultation by a Precessing Accretion Disk and Other Variabilities of SMC X-1

We have investigated the variability of the binary X-ray pulsar, SMC X-1, in data from several X-ray observatories. We confirm the ~60-day cyclic variation of the X-ray flux in the long-term monitoring data from the RXTE and CGRO observatories. X-ray light curves and spectra from the ROSAT, Ginga, and ASCA observatories show that the uneclipsed flux varies by as much as a factor of twenty between a high-flux state when 0.71 second pulses are present and a low-flux state when pulses are absent. In contrast, during eclipses when the X-rays consist of radiation scattered from circumsource matter, the fluxes and spectra in the high and low states are approximately the same. These observations prove that the low state of SMC X-1 is not caused by a reduction in the intrinsic luminosity of the source, or a spectral redistribution thereof, but rather by a quasi-periodic blockage of the line of sight, most likely by a precessing tilted accretion disk. In each of two observations in the midst of low states a brief increase in the X-ray flux and reappearance of 0.71 second pulses occurred near orbital phase 0.2. These brief increases result from an opening of the line of sight to the pulsar that may be caused by wobble in the precessing accretion disk. The records of spin up of the neutron star and decay of the binary orbit are extended during 1991-1996 by pulse-timing analysis of ROSAT, ASCA, and RXTE PCA data. The pulse profiles in various energy ranges from 0.1 to >21 keV are well represented as a combination of a pencil beam and a fan beam. Finally, there is a marked difference between the power spectra of random fluctuations in the high-state data from the RXTE PCA below and above 3.4 keV. Deviation from the fitted power law around 0.06 Hz may be QPO.Comment: Accepted to ApJ. 33 pages including 11 figure