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ObjectiveTo explore the associations between metabolic syndrome (MetS) and its individual components and the risk of rheumatoid arthritis (RA).MethodsA total of 369,065 individuals were included in the present study based on the UK Biobank. Multivariable Cox proportional hazards regression models were applied to estimate the associations between MetS and its individual components and the risk of RA. Mediation analysis was performed to further assess the potential mediating role of C-reactive protein (CRP) in the relationship between MetS and RA.ResultsDuring a median follow-up period of 12.04 years, a total of 4901 incident RA cases were documented. MetS (hazard ratio [HR] 1.22, 95% CI 1.14-1.30) and 4 of its 5 components (elevated waist circumference [WC; HR 1.21, 95% CI 1.12-1.32], elevated triglyceride [TG] level [HR 1.12, 95% CI 1.05-1.19], reduced high-density lipoprotein cholesterol [HDL-C] level [HR 1.31, 95% CI 1.23-1.39], and hyperglycemia [HR 1.15, 95% CI 1.05-1.25]) were associated with an increased risk of RA. In addition, the risk of RA increased as the number of diagnosed MetS components increased, with the highest risk in participants with all 5 components. Mediation analysis showed that CRP might mediate the association between MetS and RA, accounting for 9.27% of the total effect.ConclusionThese findings indicated positive associations between MetS and 4 of its components (WC, TG, HDL-C, and hyperglycemia) and the risk of RA, highlighting the importance of MetS management in the prevention of RA.

ObjectiveAlthough previous studies have explored the association of drinking with gout risk, we sought to explore the dose-response relationship and the evidence between subtypes of alcoholic beverages and gout risk.MethodsThe weekly alcoholic beverage consumption of patients in the UK Biobank was collected and calculated. The Cox regression model was applied to assess the effects of drinking alcohol in general and its subtypes on gout risk by calculating the hazard ratio (HR) and 95% CIs. Additionally, the restricted cubic splines were used to estimate the dose-response relationship between alcohol consumption and gout risk. To evaluate the robustness, we performed subgroup analysis across various demographic characteristics.ResultsDuring a mean follow-up period of 11.7 years, a total of 5728 new incident gout cases were diagnosed among 331,865 participants. We found that light alcohol consumption was linked to a slight decrease in gout incidence among female individuals (HR 0.78, 95% CI 0.65-0.94, P= 0.01), whereas there was no significant association in male individuals. Moreover, the dose-response relationship showed that drinking light red wine and fortified wine could reduce the gout risk, whereas beer or cider, champagne or white wine, and spirits increased the gout risk at any dose.ConclusionOur study suggested a J-shaped dose-response relationship between drinking and gout risk in female individuals, but not in male individuals. For specific alcoholic beverages, light consumption of red wine and fortified wine was associated with reduced gout risk. These findings offer new insights into the roles of alcoholic beverages in gout incidence risk, although further validation is warranted.

To investigate the association of long-term exposure to ambient air pollution with the risk of allergic rhinitis (AR), we performed a longitudinal analysis of 379,488 participants (47.4% women) free of AR at baseline in the UK Biobank. The annual average concentrations of PM2.5, PMcoarse, PM10, NO2, and NOxwere estimated by land use regression models. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). A weighted polygenic risk score was constructed. During a median follow-up period of 12.5 years, 3095 AR cases were identified. We observed significant associations between the risk of AR and PM2.5(HR: 1.51, 95% CI: 1.27–1.79, per 5 μg/m3), PMcoarse(HR: 1.28, 95% CI: 1.06–1.55, per 5 μg/m3), PM10(HR: 1.45, 95% CI: 1.20–1.74, per 10 μg/m3), NO2(HR: 1.14, 95% CI: 1.09–1.19, per 10 μg/m3), and NOx(HR: 1.10, 95% CI: 1.05–1.15, per 20 μg/m3). Moreover, participants with high air pollution combined with high genetic risk showed the highest risk of AR, although no multiplicative or additive interaction was observed. In conclusion, long-term exposure to air pollutants was associated with an elevated risk of AR, particularly in high-genetic-risk populations, emphasizing the urgent need to improve air quality.

The investigation of dietary micronutrient intakes and risk of alcoholic liver disease (ALD) based on observational studies was limited.

The association between Alumethylation and risk of cancer remains uncertain. This meta-analysis was conducted to elucidate this issue.

Increasing single nucleotide polymorphisms (SNPs) have been identified to be associated with colorectal cancer (CRC). We aimed to investigate whether genetic risk scores (GRS) that aggregate information from multiple genetic variants can predict the risk of CRC in a Chinese population. Fifty candidate SNPs were selected to explore the associations with CRC in a discovery sample with 1002 CRC cases and 999 healthy controls. We modeled the significant SNPs identified by the case–control study as a multilocus weighted GRS and estimated the association of GRS with CRC. Furthermore, 300 pairs of cases and controls were included as a validation sample to confirm the finding. Area under the receiver operating characteristic curve (AUROC) was used to evaluate the predictive power of GRS in CRC. A total of seven SNPs were found to increase the risk of CRC, and two SNPs were found to be negatively associated with CRC in the discovery sample. Relative to participants with the lowest quartile of GRS, those with the highest quartile had a 2.64-fold (95% CI: 1.99–3.51) higher risk for CRC. For every 0.1 point of GRS increase, the risk of CRC increase by 11% (95% CI: 8–14%). AUROC for GRS alone were 0.59 (95% CI: 0.57–0.62) and 0.52 (95% CI: 0.46–0.58) in the discovery and validation sample, respectively. AUROC increased to 0.62 (95% CI: 0.59–0.64) and 0.71 (95% CI: 0.65–0.76) by combining environmental risk factors. Our findings support an association between GRS and risk of CRC, which provides evidence of improved prediction model for CRC in China.

Many features are shared between esophageal cancer (EC) and gastric cancer (GC). This study aimed to explore whether known EC susceptibility loci are also important in the development of GC. A total of 21 genetic variants associated with EC in genome-wide association studies were evaluated with association of GC risk in 2631 cases and 4373 controls of Chinese ancestry. Single variant and weighted genetic scores (WGS) for esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), and overall EC were analyzed with GC risk, respectively. Genetic variants of rs2274223 in PLCE1at 10q23.33 (per G allele: odds ratio (OR) = 1.26, 95% confidence interval (CI): 1.16–1.38, P= 6.51 × 10−8), rs10052657 in PDE4Dat 5q11.2 (per C allele: OR = 1.12, 95% CI: 1.01–1.25, P= 3.28 × 10−2) and rs671 in ALDH2at 12q24.12 (per A-allele: OR = 0.83, 95% CI: 0.75–0.91, P= 1.14 × 10−4) were significantly associated with GC risk. The combined effect of those three variants had stronger influence on GC risk (OR = 1.31, 95% CI: 1.19–1.44, P= 2.34 × 10−8). High WGS of ESCC was also associated with increased risk of GC (P= 5.52 × 10−4as a continuous variable) (trend test P= 2.71 × 10−4), whereas no statistically significant associations were observed between the WGS of EAC and GC risk (P= 0.66 as a continuous variable) (trend test P= 0.70). ESCC rather than EAC may share genetic susceptibility with GC. Genetic variants at 10q23.33, 5q11.2, and 12q24.12 may be useful as biomarkers to identify individuals with high risk for both ESCC and GC.

Single-nucleotide polymorphisms (SNPs) in the promoter region of long intergenic non-coding RNAs (lincRNAs) could play a regulatory role in its expression level and then get involved in colorectal cancer (CRC). Thus, we conducted a two-stage case–control study to investigate the associations of Tag SNPs within the promoter region of selected lincRNAs from microarray data with risk of CRC. A total of 320 cases and 319 controls were recruited in the test set to explore the associations between 16 SNPs with no deviations from Hardy–Weinberg equilibrium (HWE) and risk of CRC. Furthermore, 501 cases and 538 controls were included as the validation set to confirm the significant associations. RP11-3N2.1 rs13230517 polymorphism was found to be negatively associated with CRC in both test set (AA vs. GG, OR = 0.68, 95% CI = 0.48–0.96) and validation set (AA vs. GG, OR = 0.76, 95% CI = 0.59–0.98). Pooled analysis showed that individuals with GA/AA genotypes had a significantly decreased risk of CRC when compared with those carrying GG genotype (OR = 0.74, 95% CI = 0.60–0.90) in the combined set. The crossover analysis revealed that rs13230517 GA/AA carriers had a decreased risk of CRC than GG carriers among non-drinkers in both test and combined set. However, no gene-environment multiplicative interactions were found on risk of CRC. Our findings suggest that rs13230517 polymorphism might participate in the pathogenesis of CRC and have the potential to be a biomarker for predicting the risk of CRC.

Epidemiological studies have linked body mass index (BMI) with risk of gastrointestinal cancers. However, for gastric cancer, the relationship is more controversial. In particular, it is unclear whether the observed association is due to confounding or bias inherent in conventional observational studies. To investigate whether BMI is causally associated with gastric cancer risk, we applied Mendelian randomization using individual-level data from 2631 gastric cancer cases and 4373 cancer-free controls. We derived a weighted genetic risk score (wGRS) using 37 BMI-associated genetic variants as an instrumental variable. We used logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between genetically predicted BMI and gastric cancer risk. We observed that higher genetically determined BMI was associated with increased gastric cancer risk (per standard deviation (SD) increase in the wGRS: OR=1.07, 95% CI: 1.02–1.13, P=4.94 × 10−3). Compared with individuals in the bottom tertile of the BMI wGRS, those in the top tertile had 1.14-fold (95% CI: 1.01–1.29) increased risk of developing gastric cancer. Sensitivity analyses using alternative causal inference measures demonstrated consistent association. Our study indicated that genetically high BMI was associated with increased gastric cancer risk, suggesting that high BMI may have a causal role in the etiology of gastric cancer.

Complement plays a key role in host defense, but its dysregulation can cause autologous tissue injury. Complement activation is normally controlled by regulatory proteins, including factor H (FH) in plasma and membrane cofactor protein (MCP) on the cell surface. Mutations in FH and MCP are linked to atypical hemolytic uremic syndrome, a type of thrombotic microangiopathy (TMA) that causes renal failure. We describe here that disruption of FH function on the cell surface can also lead to disseminated complement-dependent macrovascular thrombosis. By gene targeting, we introduced a point mutation (W1206R) into murine FH that impaired its interaction with host cells but did not affect its plasma complement-regulating activity. Homozygous mutant mice carrying this mutation developed renal TMA as well as systemic thrombophilia involving large blood vessels in multiple organs, including liver, lung, spleen, and kidney. Approximately 30% of mutant mice displayed symptoms of stroke and ischemic retinopathy, and 48% died prematurely. Genetic deficiency of complement C3 and factor D prevented both the systemic thrombophilia and renal TMA phenotypes. These results demonstrate a causal relationship between complement dysregulation and systemic angiopathy and suggest that complement activation may contribute to various human thrombotic disorders involving both the micro- and macrovasculature.

Complement plays a key role in host defense, but its dysregulation can cause autologous tissue injury. Complement activation is normally controlled by regulatory proteins, including factor H (FH) in plasma and membrane cofactor protein (MCP) on the cell surface. Mutations in FH and MCP are linked to atypical hemolytic uremic syndrome, a type of thrombotic microangiopathy (TMA) that causes renal failure. We describe here that disruption of FH function on the cell surface can also lead to disseminated complement-dependent macrovascular thrombosis. By gene targeting, we introduced a point mutation (W1206R) into murine FH that impaired its interaction with host cells but did not affect its plasma complement-regulating activity. Homozygous mutant mice carrying this mutation developed renal TMA as well as systemic thrombophilia involving large blood vessels in multiple organs, including liver, lung, spleen, and kidney. Approximately 30% of mutant mice displayed symptoms of stroke and ischemic retinopathy, and 48% died prematurely. Genetic deficiency of complement C3 and factor D prevented both the systemic thrombophilia and renal TMA phenotypes. These results demonstrate a causal relationship between complement dysregulation and systemic angiopathy and suggest that complement activation may contribute to various human thrombotic disorders involving both the micro- and macrovasculature.

Thrombotic thrombocytopenic purpura (TTP), a potentially fatal blood clot disorder, is primarily caused by severe deficiency of plasma ADAMTS13 activity resulting from acquired autoantibodies. Plasma exchange is the only effective initial therapy. However, the high mortality rate and the complications associated with plasma exchange therapy remain a major concern. To address unmet clinical needs, therapeutic efficacies of anfibatide, a snake venom-derived platelet glycoprotein Ib antagonist, in murine models of spontaneous thrombocytopenia and shigatoxin-induced TTP were determined. A light scattering platelet aggregometry, microfluidic shear-based assay, and murine models of TTP were used in the study. We showed that purified anfibatide inhibits ristocetin- or botrocetin-induced human or murine platelet agglutination in the presence of von Willebrand factor in a concentration-dependent manner. Anfibatide could also dramatically inhibit the adhesion and aggregation of murine and human platelets on a collagen surface under arterial shear stress, in the presence or absence of plasma ADAMTS13 activity. Most importantly, we demonstrated that an intraperitoneal administration of anfibatide at the dose of 60 ng/g body weight twice daily mitigated spontaneous thrombocytopenia and prevented shigatoxin-induced TTP in Adamts13−/−and disease-susceptible mice (CAST/Ei strain). Thus, we conclude that anfibatide, when administered at the optimal dosage, route, and interval, is efficacious in treating spontaneous and bacterial shigatoxin-induced TTP in the murine models. Our findings may provide the basis for further development of anfibatide for the treatment of acute TTP in humans.

Thrombotic thrombocytopenic purpura (TTP), a potentially fatal blood clot disorder, is primarily caused by severe deficiency of plasma ADAMTS13 activity resulting from acquired autoantibodies. Plasma exchange is the only effective initial therapy. However, the high mortality rate and the complications associated with plasma exchange therapy remain a major concern. To address unmet clinical needs, therapeutic efficacies of anfibatide, a snake venom-derived platelet glycoprotein Ib antagonist, in murine models of spontaneous thrombocytopenia and shigatoxin-induced TTP were determined. A light scattering platelet aggregometry, microfluidic shear-based assay, and murine models of TTP were used in the study. We showed that purified anfibatide inhibits ristocetin- or botrocetin-induced human or murine platelet agglutination in the presence of von Willebrand factor in a concentration-dependent manner. Anfibatide could also dramatically inhibit the adhesion and aggregation of murine and human platelets on a collagen surface under arterial shear stress, in the presence or absence of plasma ADAMTS13 activity. Most importantly, we demonstrated that an intraperitoneal administration of anfibatide at the dose of 60 ng/g body weight twice daily mitigated spontaneous thrombocytopenia and prevented shigatoxin-induced TTP in Adamts13-/- and disease-susceptible mice (CAST/Ei strain). Thus, we conclude that anfibatide, when administered at the optimal dosage, route, and interval, is efficacious in treating spontaneous and bacterial shigatoxin-induced TTP in the murine models. Our findings may provide the basis for further development of anfibatide for the treatment of acute TTP in humans.

ADAMTS13 metalloprotease cleaves von Willebrand factor (VWF), thereby inhibiting platelet aggregation and arterial thrombosis. An inability to cleave ultralarge VWF resulting from hereditary or acquired deficiency of plasma ADAMTS13 activity leads to a potentially fatal syndrome, thrombotic thrombocytopenic purpura (TTP). Plasma exchange is the most effective initial therapy for TTP to date. Here, we report characterization of transgenic mice expressing recombinant human ADAMTS13 (rADAMTS13) in platelets and its efficacy in inhibiting arterial thrombosis and preventing hereditary and acquired antibody-mediated TTP in murine models. Western blotting and fluorescent resonance energy transfer assay detect full-length rADAMTS13 protein and its proteolytic activity, respectively, in transgenic (Adamts13−/−PltA13), but not in wild-type and Adamts13−/−, platelets. The expressed rADAMTS13 is released on stimulation with thrombin and collagen, but less with 2MesADP. Platelet-delivered rADAMTS13 is able to inhibit arterial thrombosis after vascular injury and prevent the onset and progression of Shigatoxin-2 or recombinant murine VWF-induced TTP syndrome in mice despite a lack of plasma ADAMTS13 activity resulting from the ADAMTS13 gene deletion or the antibody-mediated inhibition of plasma ADAMTS13 activity. These findings provide a proof of concept that platelet-delivered ADAMTS13 may be explored as a novel treatment of arterial thrombotic disorders, including hereditary and acquired TTP, in the presence of anti-ADAMTS13 autoantibodies.

ADAMTS13 metalloprotease cleaves von Willebrand factor (VWF), thereby inhibiting platelet aggregation and arterial thrombosis. An inability to cleave ultralarge VWF resulting from hereditary or acquired deficiency of plasma ADAMTS13 activity leads to a potentially fatal syndrome, thrombotic thrombocytopenic purpura (TTP). Plasma exchange is the most effective initial therapy for TTP to date. Here, we report characterization of transgenic mice expressing recombinant human ADAMTS13 (rADAMTS13) in platelets and its efficacy in inhibiting arterial thrombosis and preventing hereditary and acquired antibody-mediated TTP in murine models. Western blotting and fluorescent resonance energy transfer assay detect full-length rADAMTS13 protein and its proteolytic activity, respectively, in transgenic (Adamts13−/−PltA13), but not in wild-type and Adamts13−/−, platelets. The expressed rADAMTS13 is released on stimulation with thrombin and collagen, but less with 2MesADP. Platelet-delivered rADAMTS13 is able to inhibit arterial thrombosis after vascular injury and prevent the onset and progression of Shigatoxin-2 or recombinant murine VWF-induced TTP syndrome in mice despite a lack of plasma ADAMTS13 activity resulting from the ADAMTS13gene deletion or the antibody-mediated inhibition of plasma ADAMTS13 activity. These findings provide a proof of concept that platelet-delivered ADAMTS13 may be explored as a novel treatment of arterial thrombotic disorders, including hereditary and acquired TTP, in the presence of anti-ADAMTS13 autoantibodies.

AbstractAimsSleep disturbance is an important factor in the pathophysiology and progression of psychiatric disorders, but whether it is a cause, or a downstream effect is still not clear.MethodsTo investigate causal relationships between three sleep-associated traits and seven psychiatric diseases, we used genetic variants related to insomnia, chronotype and sleep duration to perform a two-sample bidirectional Mendelian randomisation analysis. Summary-level data on psychiatric disorders were extracted from the Psychiatric Genomics Consortium. Effect estimates were obtained by using the inverse-variance-weighted (IVW), weights modified IVW, weighted-median methods, MR-Egger regression, MR pleiotropy residual sum and outlier (MR-PRESSO) test and Robust Adjusted Profile Score (RAPS).ResultsThe causal odds ratio (OR) estimate of genetically determined insomnia was 1.33 (95% confidence interval (CI) 1.22–1.45; p= 5.03 × 10−11) for attention-deficit/hyperactivity disorder (ADHD), 1.31 (95% CI 1.25–1.37; p= 6.88 × 10−31) for major depressive disorder (MDD) and 1.32 (95% CI 1.23–1.40; p= 1.42 × 10−16) for post-traumatic stress disorder (PTSD). There were suggestive inverse associations of morningness chronotype with risk of MDD and schizophrenia (SCZ). Genetically predicted sleep duration was also nominally associated with the risk of bipolar disorder (BD). Conversely, PTSD and MDD were associated with an increased risk of insomnia (OR = 1.06, 95% CI 1.03–1.10, p= 7.85 × 10−4for PTSD; OR = 1.37, 95% CI 1.14–1.64; p= 0.001 for MDD). A suggestive inverse association of ADHD and MDD with sleep duration was also observed.ConclusionsOur findings provide evidence of potential causal relationships between sleep disturbance and psychiatric disorders. This suggests that abnormal sleep patterns may serve as markers for psychiatric disorders and offer opportunities for prevention and management in psychiatric disorders.

Background and Purpose:Linoleic acid (LA) is an essential fatty acid involved in eicosanoid synthesis. Epidemiological studies have suggested an inverse association between circulating LA levels and ischemic stroke (IS), however, it is unclear whether the observed association is causal or due to confounding or reverse causation. We conducted a Mendelian randomization (MR) to evaluate the potential causal relationship between circulating LA levels and risk of IS.Methods:Summary statistics for IS were obtained from the MEGASTROKE consortium, including 34,217 IS cases and 404,630 controls of European ancestry. Seventeen single nucleotide polymorphisms (SNPs) associated with circulating LA levels were used as instrumental variables (IVs) in the MR analysis, with another two SNP sets used in sensitivity analyses. We used the inverse-variance weighted method to evaluate the potential causal associations of circulating LA levels with IS, complemented with other MR approaches including weighted-median, weighted-mode, MR Pleiotropy RESidual Sum and Outlier test and MR-Egger regression.Results:Each 1-standard deviation increase of genetically-predicted LA levels was inversely associated with a 2% (95% confidence interval [CI], 1%-3%) reduction in IS incidence. Subgroup analyses showed significant causal associations for large artery stroke (OR, 0.95; 95% CI, 0.92-0.98; P=3.45х10-4), but not for cardioembolic stroke (OR, 0.98; 95% CI, 0.96-1.00; P=0.05) and small vessel stroke (OR, 1.02; 95% CI, 0.99-1.05; P=0.11). Sensitivity analyses using two additional SNP sets as IVs produced consistent findings.Conclusions:Our study provides evidence for an inverse causal association of circulating LA levels with risk of IS, particularly large artery stroke. Further studies are warranted to clarify the underlying mechanism of LA in the prevention of IS.

Background: Although observational epidemiological studies have found that smoking is positively associated with risk of rheumatoid arthritis (RA), assessing the causality of this relationship has remained elusive because conventional observational studies are susceptible to bias such as confounding and reverse causation. Here, we applied the Mendelian randomization (MR) approach to examine the potential causal relationship between smoking and risk of RA. Methods: Summary statistics data for RA were obtained from a meta-analysis of genome-wide association studies (GWAS), including 14,361 RA cases and 43,923 controls of European ancestry. The instrumental variables (IV) and the genetic association estimates for smoking initiation and lifetime smoking were obtained from a GWAS meta-analysis including 1,232,091 individuals and a GWAS of 462,690 individuals of European ancestry, respectively. MR analyses were performed using the inverse-variance weighted (IVW) method and supplemented with the weighted-median method. Potential pleiotropy was assessed using the MR-Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test and MR-Egger regression. Sensitivity analyses were further performed to test the robustness of the association. Results: We found that compared with never smokers, genetic predisposition to smoking initiation was positively associated with risk of RA (odds ratio (OR) = 1.32, 95% confidence interval (CI) = 1.15–1.52, P= 9.17 × 10−5using the IVW method). Similarly, genetically predicted lifetime smoking was associated with an increased risk of RA (OR = 1.55, 95% CI = 1.13–2.14, P= 0.007). Sensitivity analyses using alternative MR methods and different sets of IVs produced similar results, suggesting the robustness of our findings. Conclusions: These results provide support for a causal association between smoking and increased risk of RA. Further studies are warranted to explain the underlying mechanisms of smoking in the development of RA.

Li: 3Lee's Pharmaceutical Holdings Limited, Shatin, Hong Kong: Employment. Dai:4Zhaoke Pharmaceutical Co. Limited, Hefei, Anhui, China: Employment. Li:3Lee's Pharmaceutical Holdings Limited, Shatin, Hong Kong, China: Employment.

Thrombotic thrombocytopenic purpura (TTP) is a rare but potentially fatal blood disorder, resulting from severe deficiency of plasma ADAMTS13 activity. Plasma infusion or exchange is the mainstay of treatment. However, complications associated with the administration of blood products and with the placement of a central venous line remain to be a major concern. To address the unmet clinical need, we test hypothesis that anfibatide, a novel snake venom-derived glycoprotein (GP) Ib antagonist, may be efficacious in treating TTP. Here, we show that purified anfibatide from snake venom inhibited murine platelet agglutination induced by botrocetin in the presence of recombinant murine VWF in a concentration-dependent manner. At 6-9 micro grams per ml (final concentrations), anfibatide nearly completely abolished botrocetin-induced murine platelet agglutination (Fig. 1A). As expected, anfibatide at the same concentrations showed little or no inhibitory effect on the protease-activating receptor 4 (PAR4) agonist (AYPGKF)-induced murine platelet aggregation. In vivo, an intravenously infused radiolabeled anfibatide exhibited a half-life of 5-7 hours depending on the initial loading dose. This information provided pharmacokinetic basis for therapeutic strategy for TTP in the murine model. An infusion of purified anfibatide at the dose of 60-90 ng per gram of body weight twice daily significantly reduced the rate of thrombocytopenia in Adamts13-/-mice triggered by intravenous infusion of a bacterial toxin, i.e. shigatoxin-2 (Stx2) (250 pg per gram body weight). As shown, 5/5 (100%) Adamts13-/-mice after being challenged with Stx2 and but treated with normal saline (control) exhibited severe thrombocytopenia (defined by 50% reduction of platelet counts from the baseline). Similarly, treatment of Adamts13-/-mice with anfibatide at the dose of 30 ng per gram body weight twice daily had little or no effect in preventing thrombocytopenia. However, treatment of the same mice with anfibatide at doses of 60-90 ng per gram body weight twice daily resulted in significantly reduced rate of severe thrombocytopenia to 11%-37.5% (Fig. 1B). Our ongoing effort is to determine the efficacy of anfibatide in treatment of acquired TTP associated with inhibitors. We conclude that anfibatide when given at the optimal doses and interval can efficiently prevent Stx2-induced TTP syndrome in the murine model. These findings support a rationale for further development of anfibatide as a novel therapeutic for TTP in humans.

von Willebrand factor (VWF) undergoes self-association mediated by free cysteine residues between two apposed VWF multimers. This process occurs in solution or between soluble and ultra large (UL) VWF on endothelial cells or matrix under flow. ADAMTS13 is a key regulator for the ULVWF string formation and adhesive function, primarily through its proteolytic cleavage at the Tyr1605-Met1606 bond in the central A2 domain of VWF. The proteolytic cleavage of VWF by ADAMTS13 rapidly removes newly secreted ULVWF on activated endothelial cell surface, thereby preventing excessive platelet aggregation and thrombus formation under physiological conditions. Previous studies have shown that the proteolytic cleavage of both cell-bound and soluble ULVWF by ADAMTS13 depends on its amino terminal MDTCS domains. However, the role of more distal carboxyl-terminal domains is not fully established. Here, we show by N-ethylmaleimide (NEM) labeling and mass spectrometry that TSP1 2-8 repeats and CUB domains of human recombinant ADAMTS13 contain multiple free cysteine residues (-SH). We hypothesize that these free thiols may directly interact with those on the surface of VWF multimers, thereby preventing their lateral association, thereby inhibiting thrombus formation under flow. Using an intravital microscopic imaging technique we demonstrate that even in the absence of circulating ADAMTS13 (Adamts13-/-) the formation and elongation of ULVWF strings on endothelial cells of mesenteric venules after FeCl3 injury are highly dynamic over time (180 seconds), suggesting other proteases or reductases in blood are able cleave or reduce ULVWF strings under flow. However, the average length of ULVWF strings remains relatively constant. Recombinant ADAMTS13 (rA13) at physiological concentration (10 nM), when infused, rapidly cleaves or eliminates preformed ULVWF strings and platelet/leukocyte aggregates on endothelial cells. The efficacy of rA13 in reducing the average length of ULVWF strings and platelet/leukocyte aggregation decreases by ∼50% if rA13 is pretreated with NEM. Moreover, a C-terminal fragment of ADAMTS13 comprising 2-8 TSP1 repeats and two CUB domains (T2C) or containing 5-8 TSP1 repeats and two CUB domains (T5C), when infused, also significantly attenuates the formation and/or elongation of ULVWF strings/bundles and platelet/leukocyte aggregation on endothelial cells under the same conditions. The inhibitory activity of T2C and T5C is dose-dependent. At the concentration of 0.5 µM, the average length of the ULVWF strings and the surface coverage of platelets/leukocytes decrease by ∼50% and ∼40% (p<0.001), respectively. Also, treatment with NEM abolishes the inhibitory effect of T2C and T5C on the ULVWF string formation and platelet/leukocyte aggregation on activated endothelial cells surface (Fig. 1). In conclusion, our results demonstrate for the first time that the distal C-terminal fragments of ADAMTS13 lacking the protease domain are of direct anti-thrombotic activity, which is mediated through its disulfide-bond reduction mechanism. Furthermore, the carboxyl-terminal disulfide bond reducing activity may contribute to the overall anti-thrombotic activity of ADAMTS13 in vivo.No relevant conflicts of interest to declare.

No relevant conflicts of interest to declare.

ADAMTS13, a plasma metalloprotease, cleaves von Willebrand factor (VWF) and inhibits arterial thrombosis and inflammatory response. Deficiency of plasma ADAMTS13, due hereditary mutations in ADAMTS13 gene or autoantibodies against ADAMTS13 protease, results in a potentially fatal syndrome, thrombotic thrombocytopenic purpura (TTP). Plasma infusion or exchange is the only effective therapy available to date. To develop novel therapeutics against TTP, we tested a hypothesisthat recombinant ADAMTS13, expressed specifically in platelets, may offer systemic protection against arterial thrombosis and therefore provide therapeutic benefit for TTP. To test this hypothesis, we first generated transgenic mice (JAX B6SJL) carrying a human full-length ADAMTS13gene under a murine platelet glycoprotein 1b (CD41) promoter. The transgenic mice were then bred with Adamts13-/-(CAST/Ei) mice for >4 generations. By Western blotting and activity assay, we show that a full-length human ADAMTS13 protein (∼195 kDa) and its proteolytic activity toward a FRETS-hVWF73 peptide are detected in platelet lysate obtained from transgenic (rA13-PltTG) mice but not in Adamts13-/-mice or wild-type mice. Little to no ADAMTS13 activity was detected in plasma in transgenic mice, suggesting the expressed human ADAMTS13 is stored inside platelets. ADAMTS13 was releasable upon stimulation with thrombin (1 U/ml), collagen (10 µg/ml), and AYPGKF (0.5 mM). More significantly, rA13-PltTGmice had higher baseline platelet count than Adamts13-/-mice, but exhibited a dramatically reduced rate of thrombus formation in mesenteric arterioles after oxidative injury with 10% ferric chloride as compared with Adamts13-/-mice and wild-type mice. Finally, rA13-PltTGmice were protected from Shigatoxin-2 (Stx-2) or murine recombinant VWF (mVWF)-induced “TTP-like” syndrome, as demonstrated by fewer rA13-PltTGmice having thrombocytopenia (defined by a 40% drop in platelet count from the baseline after challenge with Stx-2 or mVWF), faster and more complete recovery of thrombocytopenia, and significantly higher survival rate than Adamts13-/-mice. In summary, we have generated transgenic mice expressing human ADAMTS13 in platelets. Platelet ADAMTS13 is releasable upon stimulation by agonists and biologically functional in proteolytic cleavage of VWF in vitro.The platelet-derived ADAMTS13 offers systemic protection against arterial thrombosis after oxidative injury and provide a therapeutic benefit to murine models of TTP, resulting from hereditary ADAMTS13 deficiency. We are now in the process testing the efficacy of this strategy as a novel therapeutic for acquired TTP with inhibitors.

von Willebrand factor (VWF) undergoes self-association mediated by free cysteine residues between two apposed VWF multimers. This process occurs in solution or between soluble and ultra large (UL) VWF on endothelial cells or matrix under flow. ADAMTS13 is a key regulator for the ULVWF string formation and adhesive function, primarily through its proteolytic cleavage at the Tyr1605-Met1606bond in the central A2 domain of VWF. The proteolytic cleavage of VWF by ADAMTS13 rapidly removes newly secreted ULVWF on activated endothelial cell surface, thereby preventing excessive platelet aggregation and thrombus formation under physiological conditions. Previous studies have shown that the proteolytic cleavage of both cell-bound and soluble ULVWF by ADAMTS13 depends on its amino terminal MDTCS domains. However, the role of more distal carboxyl-terminal domains is not fully established. Here, we show by N-ethylmaleimide (NEM) labeling and mass spectrometry that TSP1 2-8 repeats and CUB domains of human recombinant ADAMTS13 contain multiple free cysteine residues (-SH). We hypothesizethat these free thiols may directly interact with those on the surface of VWF multimers, thereby preventing their lateral association, thereby inhibiting thrombus formation under flow. Using an intravital microscopic imaging technique we demonstrate that even in the absence of circulating ADAMTS13 (Adamts13-/-) the formation and elongation of ULVWF strings on endothelial cells of mesenteric venules after FeCl3injury are highly dynamic over time (180 seconds), suggesting other proteases or reductases in blood are able cleave or reduce ULVWF strings under flow. However, the average length of ULVWF strings remains relatively constant. Recombinant ADAMTS13 (rA13) at physiological concentration (10 nM), when infused, rapidly cleaves or eliminates preformed ULVWF strings and platelet/leukocyte aggregates on endothelial cells. The efficacy of rA13 in reducing the average length of ULVWF strings and platelet/leukocyte aggregation decreases by ∼50% if rA13 is pretreated with NEM. Moreover, a C-terminal fragment of ADAMTS13 comprising 2-8 TSP1 repeats and two CUB domains (T2C) or containing 5-8 TSP1 repeats and two CUB domains (T5C), when infused, also significantly attenuates the formation and/or elongation of ULVWF strings/bundles and platelet/leukocyte aggregation on endothelial cells under the same conditions. The inhibitory activity of T2C and T5C is dose-dependent. At the concentration of 0.5 µM, the average length of the ULVWF strings and the surface coverage of platelets/leukocytes decrease by ∼50% and ∼40% (p<0.001), respectively. Also, treatment with NEM abolishes the inhibitory effect of T2C and T5C on the ULVWF string formation and platelet/leukocyte aggregation on activated endothelial cells surface (Fig. 1). In conclusion, our results demonstrate for the first time that the distal C-terminal fragments of ADAMTS13 lacking the protease domain are of direct anti-thrombotic activity, which is mediated through its disulfide-bond reduction mechanism. Furthermore, the carboxyl-terminal disulfide bond reducing activity may contribute to the overall anti-thrombotic activity of ADAMTS13 in vivo.

Abstract 2197

No relevant conflicts of interest to declare.

No relevant conflicts of interest to declare.

Abstract 770

Protein Kinase Cδ (PKCδ), a novel PKC isoform is expressed and activated in platelets downstream of PARs and GPVI receptors. In the current study, the role of PKCδ in regulating platelet functional responses was investigated using a pharmacological inhibitor, (δV1-1)TAT (a PKCδ inhibitor) in human platelets. These studies were further confirmed by a knockout approach using PKCδ+/+ and PKCδ−/− mice. In both human and murine platelets, PAR4-mediated dense granule secretions were inhibited, whereas GPVI-mediated dense granule secretions were potentiated. Furthermore, α-granule secretions and thromboxane A2 (TXA2) generation were differentially regulated in murine platelets.. These data suggest a differential role for this isoform in regulating dense granule secretion, α-granule secretion and TXA2 generation. Previous studies have shown that PAR-mediated fibrinogen receptor activation is regulated by a Calcium-dependent and a PKC-dependent pathway. The contribution of PKCδ to PAR-mediated fibrinogen receptor activation was studied by pretreating human and murine platelets with BAPTA. Our results showed a inhibition of AYPGKF-induced aggregation in human and murine platelets in the presence of BAPTA and fibrinogen. These results suggest a small contribution of PKCδ to PAR-4- mediated platelet aggregation and aIIbb3 activation. The in vivo significance of PKCδ was tested using a FeCl3 injury model. While the wildtype mice occluded in 7 minutes, PKCδ −/− mice occluded after 4 minutes of injury with 10 % FeCl3. Therefore, we conclude that PKCδ regulates platelet functional responses such as dense, α-granule secretions, TXA2 generation downstream of both PARs and GPVI receptors, contributes to PAR-4-mediated fibrinogen receptor activation ex vivo and plays a critical role in the thrombus formation in vivo. This study is supported by predoctoral fellowships to Ramya Chari and Swaminathan Murugappan from American Heart Association, Great Rivers affiliate.

Protein Kinase Cδ (PKCδ), a novel PKC isoform is expressed and activated in platelets downstream of PARs and GPVI receptors. In the current study, the role of PKCδ in regulating platelet functional responses was investigated using a pharmacological inhibitor, (δV1-1)TAT (a PKCδ inhibitor) in human platelets. These studies were further confirmed by a knockout approach using PKCδ+/+and PKCδ−/−mice. In both human and murine platelets, PAR4-mediated dense granule secretions were inhibited, whereas GPVI-mediated dense granule secretions were potentiated. Furthermore, α-granule secretions and thromboxane A2(TXA2) generation were differentially regulated in murine platelets.. These data suggest a differential role for this isoform in regulating dense granule secretion, α-granule secretion and TXA2generation. Previous studies have shown that PAR-mediated fibrinogen receptor activation is regulated by a Calcium-dependent and a PKC-dependent pathway. The contribution of PKCδ to PAR-mediated fibrinogen receptor activation was studied by pretreating human and murine platelets with BAPTA. Our results showed a inhibition of AYPGKF-induced aggregation in human and murine platelets in the presence of BAPTA and fibrinogen. These results suggest a small contribution of PKCδ to PAR-4- mediated platelet aggregation and aIIbb3activation. The in vivosignificance of PKCδ was tested using a FeCl3injury model. While the wildtype mice occluded in 7 minutes, PKCδ −/−mice occluded after 4 minutes of injury with 10 % FeCl3. Therefore, we conclude that PKCδ regulates platelet functional responses such as dense, α-granule secretions, TXA2generation downstream of both PARs and GPVI receptors, contributes to PAR-4-mediated fibrinogen receptor activation ex vivoand plays a critical role in the thrombus formation in vivo. This study is supported by predoctoral fellowships to Ramya Chari and Swaminathan Murugappan from American Heart Association, Great Rivers affiliate.

Plasmin, a major extracellular protease, causes intracellular signals to mediate platelet aggregation. Previously, we reported that plasmin-mediated platelet aggregation predominantly occurs through proteolytic cleavage of protease-activated receptor 4 (Quinton et al J. Biol. Chem 2004). We showed that plasmin caused aggregation of mouse platelets more readily than human platelets. In this study, we investigated the mechanism of such a differential sensitivity of mouse platelets to plasmin, using transfected cell lines and platelets. In the platelet system, plasmin caused both human and mouse platelets to shape change and aggregate in a concentration-dependent manner with a different efficiency. Whereas 0.1 U/ml of plasmin causes full aggregation of mouse platelets, that dose only induces shape change in human platelets. In transfected COS7 cells, 1 U/ml plasmin caused a higher intracellular calcium mobilization through mouse PAR4 (mPAR4) than human PAR4 (hPAR4) activation. These results indicate that the mPAR4 is primarily more readily activated by plasmin than hPAR4, possibly due to differences in the primary sequence. Further, mouse and human platelets also differ in terms of the expression of PAR3. It is known that PAR3 acts as a co-receptor for thrombin-induced PAR4 activation. In order to evaluate the contribution of mouse PAR3 to plasmin-mediated mPAR4 activation, we co-expressed mPAR3 and mPAR4 in COS7 cells. Plasmin caused lower mobilization of intracellular calcium when mPAR3 and mPAR4 are co-expressed, compared to the expression of mPAR4 alone. These results indicate that mPAR3, instead of acting as a cofactor to potentiate mPAR4 activation, inhibits plasmin-mediated mPAR4 activation. Consistent with these results, PAR3 null mouse platelets also show a greater plasmin-induced calcium mobilization and aggregation compared to wild-type mouse platelets, which express PAR3 and PAR4. In conclusion, mouse platelets are more readily activated by plasmin than human platelets due to differences in the primary sequence of PAR4. In addition, mPAR3 acts as an inhibitory receptor to plasmin-mediated PAR4 activation, instead of acting as a co-receptor.

Plasmin, a major extracellular protease, causes intracellular signals to mediate platelet aggregation. Previously, we reported that plasmin-mediated platelet aggregation predominantly occurs through proteolytic cleavage of protease-activated receptor 4 (Quinton et al J. Biol. Chem 2004). We showed that plasmin caused aggregation of mouse platelets more readily than human platelets. In this study, we investigated the mechanism of such a differential sensitivity of mouse platelets to plasmin, using transfected cell lines and platelets. In the platelet system, plasmin caused both human and mouse platelets to shape change and aggregate in a concentration-dependent manner with a different efficiency. Whereas 0.1 U/ml of plasmin causes full aggregation of mouse platelets, that dose only induces shape change in human platelets. In transfected COS7 cells, 1 U/ml plasmin caused a higher intracellular calcium mobilization through mouse PAR4 (mPAR4) than human PAR4 (hPAR4) activation. These results indicate that the mPAR4 is primarily more readily activated by plasmin than hPAR4, possibly due to differences in the primary sequence. Further, mouse and human platelets also differ in terms of the expression of PAR3. It is known that PAR3 acts as a co-receptor for thrombin-induced PAR4 activation. In order to evaluate the contribution of mouse PAR3 to plasmin-mediated mPAR4 activation, we co-expressed mPAR3 and mPAR4 in COS7 cells. Plasmin caused lower mobilization of intracellular calcium when mPAR3 and mPAR4 are co-expressed, compared to the expression of mPAR4 alone. These results indicate that mPAR3, instead of acting as a cofactor to potentiate mPAR4 activation, inhibits plasmin-mediated mPAR4 activation. Consistent with these results, PAR3 null mouse platelets also show a greater plasmin-induced calcium mobilization and aggregation compared to wild-type mouse platelets, which express PAR3 and PAR4. In conclusion, mouse platelets are more readily activated by plasmin than human platelets due to differences in the primary sequence of PAR4. In addition, mPAR3 acts as an inhibitory receptor to plasmin-mediated PAR4 activation, instead of acting as a co-receptor.