Journal of Thrombosis and Haemostasis

Background: Uncontrolled bleeding complicates trauma, surgery and many medical conditions. While currently available procoagulant therapies (e.g., plasma-derived factors, recombinant proteins, antifibrinolytics) have crucial limitations. Methods: N389 (CQQTVTLLPAADLDDFSC) was synthesized by Fmoc solid-phase chemistry, characterized by HPLC and LC-MS, then tested in normal human pooled plasma in microplate mechanical clot-formation assays using incubated and immediate addition formats. Kinetic parameters (plasma recalcification, PRT; maximum absorbance, Amax) were obtained from absorbance curves fit to four-parameter logistic models. Mixing studies with modified (i.e., aged, adsorbed) plasma probed factor dependence. Results: In plasma coagulation assays activated with 25 mM CaCl2, baseline clotting showed a PRT of 23.74 +/- 0.27 min and Amax of 0.1813 +/- 0.0043 (n = 3), whereas N389 significantly reduced PRT to 8.442 +/- 6.0395 min without incubation (p = 0.0012), further decreased PRT after incubation (p < 0.0001), increased Amax to 0.2523, and retained comparable activity across normal, adsorbed, and aged plasma, in contrast to S1255 which showed a faster but incubation-labile effect with PRT 2.353 +/- 1.3685 min (p = 0.0007) and marked attenuation in factor-depleted and aged plasma. Mixing studies showed N389 activity persisted across normal, aged and adsorbed plasma, consistent with a mechanism that does not require intact plasma coagulation factor profiles (specifically factors II, V, VIII, VII, IX, X). Discussion: Collectively with prior evidence on anionic surfaces, Ca2+-binding Gla domains, and peptide-modulated fibrin polymerization, these results support a model in which N389 functions as a stable, charge-based scaffold that coordinates divalent cations and/or directly nucleates fibrin(ogen), while highlighting limitations of bulk clotting assays and the need for targeted thrombin generation, binding, aggregation, and contact-activation studies. Conclusions: The aspartate-rich peptide N389 is a sustained, factor-independent procoagulant at least in vitro. N389 thus merits further mechanistic and translational evaluation as a synthetic hemostatic agent.

Background: Growing evidence suggests persistent thrombotic endothelial damage (together with elevated (fibrinaloid) microclot complexes (FMCs)) and immune dysfunction in the pathophysiology of Long COVID. Recently we proposed that there are different FMC phenotypes. Here we seek to determine the nature of these FMCs and aggregates in platelet-poor plasma (PPP) by using different markers, as well as thromboelastography (TEG) to assess for hypercoagulability of samples. Material and Methods: Whole-blood and PPP from control (n=19) and Long COVID (n=20) participants were assessed by thromboelastography. FMCs were quantified by imaging flow cytometry of Thioflavin-T (ThT)-stained PPP, 10X diluted PPP, and resuspended PPP pellets. The resuspended pellets were separately stained with a CD62P-PE antibody or Hoechst 33342 to label aggregates and FMCs containing amyloid, platelet, and nuclear material. ThT and CellMask Red were co-stained for confocal microscopy. ThT and myeloperoxidase (MPO), and ThT, Congo Red, and Hoechst were co-stained for fluorescence and polarized microscopy. Whole-blood smears were imaged by scanning electron microscopy (SEM). Results: Long COVID samples showed pronounced hypercoagulability in both whole blood and PPP, with shortened R, K and TMRTG and elevated alpha-angle and MRTG, but unchanged MA and TTG, indicating altered clotting kinetics. Persistence of this phenotype in PPP implicates soluble plasma constituents. ThT-positive FMCs were significantly increased in Long COVID across undiluted, diluted, and resuspended pellet samples; counts were processing-sensitive and a substantial ThT-positive population remained in the supernatant after centrifugation, indicating heterogeneity in density. Across probes, leukocyte material was the most abundant, then platelet material, and ThT-positive FMCs were the least abundant, with the three populations exhibiting unique morphology and occupying distinct size domains. Platelet-derived material was significantly elevated in Long COVID, whereas nuclear material was not. Co-stained samples subject to confocal, fluorescence, and polarized microscopy imaging showed that FMCs are heterogeneous, including events positive for ThT, CellMask, Hoechst, MPO, and Congo Red, and also a distinct subset of membrane-free, ThT-only events. Conclusion: In this Long COVID cohort, plasma is characterised by hypercoagulability and an increased burden of ThT-positive FMCs that are numerically minor relative to, and morphologically distinct from, aggregates and amyloidogenic FMCs marked with platelet- and leukocyte-derived material. The increased burden of platelet debris in PPP is likely indicative of persistent platelet activity. The existence of membrane-free, ThT-only FMCs, in addition to FMCs associated with cellular material, confirms an amyloid-dominated FMC population. Furthermore, positive Congo Red signal further confirms the amyloid nature of FMCs in PPP.

BackgroundBlood clot contraction/retraction depends on the force-generating actomyosin and on the platelet integrin IIb{beta}3, which transmits intracellular forces to fibrin. Before clotting, fibrinogen binds to activated integrin IIb{beta}3, mediating platelet aggregation. The relationship between platelet aggregation and subsequent platelet-driven clot contraction remains unclear. MethodsWe investigated the effects of platelet aggregation on clot contraction by selectively blocking the IIb{beta}3-fibrinogen binding using the RGDW peptide. The ability of RGDW to disrupt IIb{beta}3-fibrinogen binding was assessed by platelet aggregometry. The time-course of clot contraction was monitored optically in whole blood or platelet-rich plasma and modeled mathematically. Clot stiffness was assessed using Thromboelastography. The effect of the RGDW peptide on the structure of PRP-clots was examined using scanning electron microscopy. ResultsThe RGDW peptide dose-dependently inhibited TRAP-induced platelet aggregation. Both in whole blood and in plasma, the peptide dose-dependently prolonged the lag-period and slowed the rate without affecting the final extent of contraction. Thromboelastography showed that RGDW dose-dependently increased maximum clot stiffness in blood. Scanning electron microscopy revealed that RGDW treatment resulted in formation of smaller fibrin agglomerates surrounding non-aggregated platelets. A theoretical model allowed us to decipher mechanisms underlying the kinetic effects of RGDW. ConclusionBlocking the binding of integrin IIb{beta}3 to fibrinogen and preventing platelet aggregation delays and slows subsequent clot contraction without affecting the final degree of shrinkage. These findings indicate a modulatory role of fibrinogen-mediated platelet aggregation in clot contraction and highlight the unforeseen effects of selective inhibitors of platelet aggregation on the contraction of blood clots and thrombi.

Background: Histidine-rich glycoprotein (HRG) is a regulator of coagulation that has been linked to experimental thrombosis, but its causal role in human thrombotic disease remains unclear. Objectives: To determine whether HRG has a role in thrombosis, we evaluated the association between genetically determined HRG variation and thrombosis risk using Mendelian randomisation (MR). Methods: We performed a two sample MR analysis in UK Biobank using non-overlapping samples. Separate genome wide association studies (GWAS) were conducted to identify single nucleotide polymorphisms (SNPs) associated with circulating HRG protein levels and to estimate SNP associations with thrombosis outcomes. Genetic instruments were derived from the HRG GWAS measurements and applied to assess associations with overall, venous, and arterial thrombosis. Sensitivity analyses using multiple MR methods were undertaken, alongside adjusted logistic regression models in participants with measured HRG levels. Results: Among 30,680 participants with HRG measurements, GWAS identified multiple loci associated with HRG levels, with the strongest signal at the rs9898 SNP ({beta} =0.52; P=1.1x10-306). Single instrument MR found no association between HRG protein levels predicted by the rs9898 SNP and risk of overall thrombosis ({beta} =-0.00660; P=0.622), venous thrombosis ({beta} =0.0101; P=0.650) and arterial thrombosis ({beta} =-0.0137; P=0.384). Similar null findings were observed using multi-instrument MR approaches. In complementary analyses, measured HRG levels were not associated with thrombosis after adjustment for age, sex, and C reactive protein, and results were unchanged after stratification by rs9898 genotype. Conclusion: Genetically determined variation in HRG is not associated with thrombotic risk, indicating that HRG related coagulation phenotypes do not translate into clinically meaningful thrombosis.

Increased platelet microparticle (PMP) levels in individuals with risk factors for cardiovascular disease correlate with clinical outcomes in these patient groups. PMPs promote thrombosis through enhancing platelet aggregation and binding to the sub-endothelial matrix following vascular injury. Thus, PMPs behave as soluble ligands and adhesive substrates for platelets, and may drive cardiovascular disease progression. Nitric oxide (NO) is released continually from the endothelium as a potent regulator of platelet activation that is crucial to the balance between haemostasis and thrombosis. However, it is unknown if NO regulates PMP-induced platelet activation. In this study we isolated platelets and PMPs from whole blood and measured their interactions in adhesion assays and by flow cytometry. Platelet activation was analysed by ELISA for ADP and thromboxane-B2; both secondary platelet agonists released by activated platelets which enhance thrombosis. The affinity upregulation of the principal platelet integrin receptor responsible for platelet aggregation, integrin IIb{beta}3, was measured using the antibody PAC-1. Our data show that PMP induced platelet adhesion was associated with, and partially dependent upon, platelet ADP release, TxA2 production and IIb{beta}3 upregulation. Crucially, NO dose-dependently reduced these events through cGMP dependent signalling. This is the first report that NO signalling can regulate PMP induced platelet activation and may open an avenue of exploration for clinically targeting PMP driven cardiovascular disease processes.

Functionally competent, highly purified neutrophils were isolated from healthy human donors. Neutrophil necroptosis and neutrophil extracellular trap (NET) formation were induced using TNF- in combination with the pan-caspase inhibitor zVAD-FMK and the IAP antagonist BV6. NETs were visualized, quantified, and morphologically characterized by fluorescence microscopy following staining with Hoechst 33342 and Sytox Green. Levels of extracellular, cell-free neutrophil elastase (NE), myeloperoxidase (MPO), and DNA were also measured as indicators of NET release. The ability of TACT507, a proprietary RIPK3 antagonist, to efficiently block NETs formation and NET related necroptosis was evaluated. TACT507 demonstrated concentration dependent, significant inhibition of neutrophil necroptosis and NETs formation. Summary SentenceIsolated human neutrophils treated ex vivo by TNF- in combination with apoptosis inhibitors, underwent necroptosis causing formation of neutrophil extracellular traps. This process was inhibited by the proprietary antagonist of RIPK3.

BACKGROUND: The transport and storage conditions of thawed plasma are not strictly regulated by the FDA and applying red blood cell transport standard of 1-10 degrees Celcius to recently thawed plasma often results in high discard rates. This study evaluated the extended 120-hour (5-day) coagulation factor stability and sterility of thawed plasma frozen within 24 hours (PF24) following a 6-hour transport cooler simulation. STUDY DESIGN AND METHODS: Fourteen PF24 units (8 group O, 6 group B) were thawed at 30-37 degrees Celcius and assigned as control (n=7, direct 1-6 degrees Celcius refrigeration) or experiment (n=7) units. Experiment units were held at room temperature for 30 minutes, stored in validated transport coolers for 6 hours, and then transferred to 1-6 degrees Celcius refrigeration. Measurements of temperature, prothrombin time (PT), Factor V (FV) activity, and Factor VIII (FVIII) activity were conducted at 0-, 6-, 24-, and 120-hour post-thaw. Sterility testing was performed at 0-hour and 120-hour using automated aerobic and anaerobic blood cultures. RESULTS: No statistically significant differences were observed between control and experiment units at 120-hour for mean PT (15.09 vs. 15.16 seconds, p = .44), FV activity (81.14 vs. 74.57%, p = .23), or FVIII activity (61.86 vs. 53.00%, p = .22). Delta analysis (120h-0h) confirmed equivalent factor decay rates between groups. All bacterial cultures showed no growth at 120-hour. CONCLUSION: A 6-hour cooler time of thawed PF24 does not accelerate coagulation factor degradation or compromise sterility over an extended 5-day shelf life. These findings validate flexible inventory return policies, allowing blood banks to reduce product waste.

Background Monoclonal gammopathy of thrombotic significance (MGTS) is a recently described chronic prothrombotic condition characterized by monoclonal anti-PF4 antibodies that are detected above the polyclonal antibody background in patient sera (i.e. present as monoclonal gammopathy of undetermined significance, MGUS). Due to conflicting data in the published literature on antibody clonality in heparin-induced thrombocytopenia (HIT), we evaluated clonality and abundance of anti-PF4 antibodies in HIT, including investigating whether an MGUS, if present in HIT, represents the causative anti-PF4 antibody. Methods Blood samples from 15 patients with HIT were subject to Platelet Factor 4-dependent antigen-based and functional tests. The unmanipulated serum antibody repertoire and isolated anti-PF4 antibodies were subjected to mass spectrometric evaluation. Results Two of the 15 HIT patients had an IgG MGUS. Notably, anti-PF4 antibodies were not synonymous with the MGUS antibody in either of the two patients. Eight of the 15 patients demonstrated monoclonal anti-PF4 antibodies, however, none of the anti-PF4 antibodies were detectable as an MGUS upon evaluation of the entire serum antibody repertoire, reflecting their low abundance. In the seven patients with multiple anti-PF4 antibodies, non-monoclonality was confirmed by analysis of deglycosylated antibody heavy chains. Conclusions Anti-PF4 HIT antibodies are monoclonal in approximately 50% of HIT patients, however, antibody abundance is low such that they are not detectable over the polyclonal IgG background (i.e. are MGUS-negative), differentiating HIT from MGTS. This observation helps explain the transient nature of HIT relative to the persistent prothrombotic state seen in MGTS.

Background: While haematological and coagulation changes following AstraZeneca vaccination have been described, the molecular mechanisms linking TMPRSS2 expression to coagulation remain underexplored, particularly in African populations. Methods: In this case-control study, 102 adults (51 vaccinated with AstraZeneca >=6 months prior, 51 unvaccinated controls) aged 18-65 years in Port Harcourt, Nigeria, were evaluated. Full blood count (Sysmex XN-1000), PT/aPTT (Erba Mannheim), RNA concentration, and qRT-PCR for ACE2/TMPRSS2 (normalized to GAPDH) were performed. Pearson correlations and t-tests were conducted (SPSS v26, p<0.05). Results: Because primary between-group comparisons from this cohort have been reported previously, the present analysis focused on correlation patterns. A statistically significant inverse correlation was observed between TMPRSS2 Ct values and activated partial thromboplastin time (aPTT) among vaccinated participants (r = -0.325, p = 0.0202), whereas no corresponding association was detected in unvaccinated controls. Sex-specific differences in TMPRSS2 expression were also observed. No participant reported severe thrombotic or haemorrhagic complications at the time of recruitment. Conclusion: This secondary analysis identified a statistically significant inverse correlation between TMPRSS2 Ct values and aPTT among AstraZeneca-vaccinated individuals. Although causality cannot be inferred, the findings suggest a potential relationship between TMPRSS2 expression and haemostatic pathways in the post-vaccination setting. Larger longitudinal studies are required to validate the observation and clarify its biological significance.

BackgroundComplement-mediated hemolysis assays are essential for assessing immune function and diagnosing complement-related disorders. Conventional human erythrocyte derivatization with 2,4,6-trinitrobenzene sulfonic acid (TNBS) can induce nonspecific hemolysis and optical interference, complicating interpretation. Identifying a more biocompatible electrophile could improve assay specificity and reliability. MethodsA panel of aldehydes was screened for electrophilicity using a nucleophile consumption assay with glycine as a model nucleophile. Glyoxylic acid was selected based on reactivity, solubility, and visual neutrality, then neutralized with sodium bicarbonate to minimize baseline hemolysis. Human erythrocytes were sequentially treated with pancreatin and glyoxylic acid to generate glyoxylic acid-pancreatin-treated erythrocytes (GxPEs). Complement-mediated hemolysis was assessed using normal human serum, heat-inactivated serum, and pathway-specific conditions, with CH50 values calculated for total, alternative, and non-alternative pathways. ResultsGxPEs exhibited robust complement-specific hemolysis (maximum 93.56%) with negligible background activity in heat-inactivated serum. CH50 analysis confirmed activation via both alternative (0.9514 L) and non-alternative (1.963 L) pathways. Reconstitution experiments with factor B-depleted cryoprecipitate and cryosupernatant fractions demonstrated dependence on small complement components such as C2 and C4. ConclusionsGlyoxylic acid derivatization yields a reproducible, optically quiet, and complement-specific erythrocyte substrate suitable for functional hemolysis assays. This method offers a practical platform for complement diagnostics, research applications, and therapeutic evaluation.

Syndecans are transmembrane proteoglycans that regulate angiogenesis through both their glycosaminoglycan chains and core proteins. While roles for all four mammalian syndecans in new blood vessel formation are well established, it has more recently emerged that their extracellular core proteins contain discrete bioactive regulatory sequences capable of influencing cellular processes, including angiogenesis. We previously demonstrated that the syndecan-3 (SDC3) ectodomain possesses anti-angiogenic activity independent of its heparan sulphate chains. Here, we identified and characterised a novel anti-angiogenic sequence within the SDC3 ectodomain. Using recombinant truncation mutants, endothelial migration assays and peptide mapping, we localised activity to a discrete region of the extracellular domain and subsequently defined a conserved minimal nine amino acid peptide, QM111, that retained full biological activity. QM111 inhibited endothelial cell migration and angiogenic sprouting in both rat aortic ring and mouse choroidal explant models. Intrinsic disorder analysis revealed that QM111 resides within a region of comparatively reduced disorder, consistent with other syndecan regulatory sequences. This supports the concept that syndecan ectodomains contain conserved functional modules embedded within intrinsically disordered extracellular domains. QM111 did not induce inflammatory chemokine production, exhibited no detectable cytotoxicity, and retained substantial stability in human serum and vitreous humour. Finally, QM111 displayed anti-angiogenic activity comparable to the previously described syndecan-2-derived peptide QM107, with combination treatment producing more robust inhibition of angiogenesis. These findings identify QM111 as a novel endogenous anti-angiogenic peptide and support the concept that syndecan ectodomains are reservoirs of biologically active regulatory sequences with therapeutic potential. The work further establishes syndecan-derived peptides as a promising platform for the development of next-generation anti-angiogenic therapies.

Heparin, a naturally derived glycosaminoglycan, is the most commonly used anti-thromboembolic in the world. However, the biological origin of heparin inherently results in batch-to-batch variability, large dispersity indexes, and potential contamination, leading to inconsistent activity and patient-dependent dose-response. As such, new synthetic anticoagulants are of keen interest, particularly those that mimic heparin while being amenable to alterations in polymer structure and composition for performance optimization. Herein, we report the strategy, synthesis, and evaluation of well-defined, regioselectively functionalized di-sulfated polyamidosaccharides (disulPASs) including exploration of the structure-function relationship of molecular weight and sulfation density on anticoagulant activity. Polymerization of an orthogonally protected beta-lactam monomer via anionic ring-opening, followed by selective deprotection and sulfation reactions affords disulPAS. Similar to heparin, disulPASs elongate clotting time through the intrinsic and extrinsic pathways, showing molecular weight and dose-dependent responses in clotting time; are non-cytotoxic and non-hemolytic, partially neutralized by protamine sulfate, and unlike heparin, are not degraded by heparinases. As compared to less sulfated and randomly sulfated iterations of PAS, disulPAS performs superiorly, with in vitro and in vivo clotting activity most similar to native heparin.

Snake venom metalloproteinases (SVMPs) are major drivers of pathology following viper envenomation and represent important targets for the development of next-generation recombinant antivenoms. PIII SVMPs are among the most potent haemorrhagic toxins and contain disintegrin-like (Dis) and cysteine-rich (C-rich) accessory domains. Despite their biomedical importance, the mechanistic roles of these accessory domains in substrate recognition and catalysis remain poorly understood. We produced recombinant full-length and domain-deletion variants of two functionally distinct PIII SVMPs: the broadly proteolytic, cytotoxic cPIII and the highly specific prothrombin activator Ecarin. Proteins were expressed as latent zymogens in insect cells, auto-activated by Zn2+, and analysed using enzymatic, blood clotting, and cell-based assays. Progressive removal of the C-rich and Dis domains reduced zymogen auto-activation and markedly diminished catalytic activity in both toxins. In cPIII, domain deletion caused a stepwise loss of proteolytic and cytotoxic activity without altering substrate preference. In Ecarin, removal of the accessory domains strongly impaired prothrombin activation, and thus plasma clotting, demonstrating a critical role in substrate recognition. Conversely, deletion of the C-rich domain increased fibrinogenolytic activity, revealing a substrate-dependent gatekeeping function. Deglycosylation showed that N-linked glycans modulate SVMP activity in a construct-dependent manner. Recombinant Ecarin closely recapitulated the biochemical properties of the native venom-derived toxin. Our data support a model in which PIII SVMP accessory domains enhance substrate positioning and catalytic efficiency while selectively restricting access to non-cognate substrates. These findings establish accessory-domain-mediated substrate recognition as a key determinant of SVMP function, informing rational antivenom design.

Background aimsThe development of next-generation therapies for sickle cell disease (SCD) and beta thalassemia (beta thal), including fetal globin-inducing small molecules and gene therapy approaches, depends on patient-derived CD34+ hematopoietic stem and progenitor cells (HSPCs) for discovery and preclinical validation, but commercial vendors stock only healthy donor material and disease-specific banks hold limited inventories. Recent US Food and Drug Administration and National Institutes of Health guidance favoring human cell-based methods over animal testing underscores the value of authentic patient cells. Methods: Over 14 months we recovered, purified, and biobanked CD34+ HSPCs from clinical apheresis product waste and mobilized peripheral blood (PB) otherwise discarded after clinical procedures, using immunomagnetic selection adapted for hemoglobinopathy specimens; a microfluidic technology was evaluated separately. We quantified yield and purity for bead-selected material and cell number and viability for the microfluidic pilot; engraftment was tested in NBSGW mice. Results: Immunomagnetic selection recovered a median of 4.71 x 106 CD34+ cells from just 1 to 2 mL of apheresis product waste, comparable to the 6.0 x 106 cells from a 10 to 40 fold larger volume of PB waste, with similar purity across sources and diagnoses. Because apheresis product waste is far more concentrated, it reaches equivalent yields without the density-gradient steps required for PB waste, approximately halving processing time. Recovered cells engrafted NBSGW mice, confirming preserved repopulating capacity. The microfluidic pilot (two patients, 11 specimens) recovered 2.17 x 106 CD34+ cells per specimen at greater than 90% viability and purity. Conclusions: A center with existing apheresis infrastructure can reproducibly recover, bank, and distribute research-grade patient CD34+ HSPCs, addressing a recognized gap in the hemoglobinopathy pipeline. HighlightsO_LIClinical apheresis waste is used to generate a single-center biobank of high-quality, research-grade CD34+ HSPCs from patients with sickle cell disease and beta-thalassemia. C_LIO_LIConcentrated apheresis waste matches large-volume PB waste in CD34+ yield and purity. C_LIO_LIMicrofluidic enrichment recovers CD34+ cells at >90% viability and purity across 2 patients. C_LIO_LIRecovered CD34+ HSPCs engraft mice and form erythroid cells, preserving function. C_LI

BackgroundNeutrophil extracellular traps (NETs) contribute to immunothrombosis and arterial thrombosis. Mechanisms underlying myocardial infarction after SARS-CoV-2 vaccination remain poorly understood. ObjectivesTo investigate histopathologic and immunothrombotic features of coronary thrombi in patients with ST-elevation myocardial infarction (STEMI) after SARS-CoV-2 vaccination. MethodsWe performed a retrospective matched cohort study including patients with STEMI undergoing primary percutaneous coronary intervention between January 2021 and March 2023. Coronary thrombi obtained by aspiration were analyzed by histopathology, immunohistochemistry, and confocal microscopy for NET detection. Vaccinated and unvaccinated patients were matched by age and sex. Associations between vaccination status and thrombus characteristics were assessed after adjustment for SARS-CoV-2 serologic status. ResultsAmong 44 matched patients (23 vaccinated and 21 unvaccinated), NETs were identified in 14 vaccinated patients (61%) and 5 unvaccinated patients (24%; P = .01). Vaccination was associated with increased odds of NET-positive thrombi after adjustment for SARS-CoV-2 serology (odds ratio, 5.1; 95% CI, 1.36-19.45; P = .02). No associations were observed between vaccination and polymorphonuclear cell density, fibrin deposits, plaque fragments, or anti-platelet factor 4 staining. Among patients vaccinated within 100 days before STEMI, NET-positive thrombi were associated with shorter intervals between vaccination and myocardial infarction (median [IQR], 25 [11-64] vs 57 [40-84] days; P = .02). ConclusionsSARS-CoV-2 vaccination was associated with increased NET presence in coronary thrombi from patients with STEMI, suggesting a potential NET-mediated immunothrombotic mechanism independent of classical vaccine-induced immune thrombotic thrombocytopenia.

Sickle-hemoglobin-C (HbSC) sickle cell disease is characterized by RBC dehydration (xerocytosis), which promotes polymerization of HbS. HbSC causes substantial morbidity despite lower sickling potential than HbSS, suggesting a critical detrimental role of HbC in the disease pathophysiology. We derived HbCC mice by interbreeding our HbSC mice, which demonstrated a similar RBC phenotype of xerocytosis as humans with HbCC. We compared RBCs from HbCC, HbSC, and HbSS mice. Oxidized ferryl (Fe4+)-Hb, and its oxidative-denaturation, which results in hemichrome formation (Heinz-bodies), was most pronounced in HbCC>HbSC>HbSS, despite significantly higher reactive oxygen species in HbSS, illustrating a higher propensity of HbC to denaturation than HbS. RBC deformability followed a similar pattern, with Elongation Index lowest in HbCC<HbSC<HbSS. Next, we determined if RBC from HbSC patients on hydroxyurea showed improved membrane damage. Hydroxyurea treatment reduced Heinz-body formation and improved RBC deformability, despite negligible/modest fetal hemoglobin (HbF) induction, compared to non-hydroxyurea HbSC controls. The antioxidant quercetin showed a similar reduction in Heinz-body burden and improvement in RBC deformability as hydroxyurea, without affecting Hb or HbF concentration, reticulocyte count, or RBC xerocytosis. HbC-driven oxidative denaturation and membrane damage represent important contributors of RBC dysfunction in HbSC disease; hence, oxidative membrane injury could be targeted besides antisickling approaches.

The Src homology 2 (SH2) domain-containing non-transmembrane protein-tyrosine phosphatases 1 and 2 (Shp1 and Shp2) have been implicated in regulating signaling from a variety of receptors and cell types, including the thrombopoietin (Tpo) receptor Mpl in megakaryocytes (MKs) and platelets. We previously showed that deletion of Shp1 and Shp2 in the MK/platelet lineage in mice using the Pf4-Cre transgene/loxP system impairs megakaryopoiesis and thrombopoiesis. However, we also observed unexpected phenotypes including a motheaten-like phenotype in Shp1-deficient mice and severe myelofibrosis in mice lacking both phosphatases. To determine whether these were lineage-specific effects, we utilized the Gp1ba-Cre transgenic mouse to delete loxP-flanked Shp1 and Shp2 in mice. Bone marrow-derived MKs from these mice expressed approximately 20-25% of Shp1 and Shp2, whereas platelets contain 5-10% of each phosphatase compared with controls. Minor MK/platelet defects were observed in mice lacking either Shp1 or Shp2 alone, however mice lacking both Shp1 and Shp2 exhibited macrothrombocytopenia, mild bleeding following tail injury, and impaired GPVI-mediated platelet aggregation and Syk phosphorylation, associated with reduction GPVI and integrin 2 subunit expression. Reduced Shp1 and Shp2 expression resulting in a significant reduction in ploidy, a block in MK maturation and proplatelet-producing MKs. Tpo-mediated Ras/MAPK signaling was reduced in Shp1/2-deficient MKs. Treatment of MKs with structurally distinct Shp2 allosteric inhibitors recapitulated key aspects of the Shp2-deficient phenotype, including aberrant megakaryopoiesis and reduced Mpl signaling. Our study highlights the synergistic functions of Shp1 and Shp2 in the MK/platelet lineage, and identifies Shp2 as a potential therapeutic target in myeloproliferative neoplasms. Key PointsO_LIDeletion of Shp1 and Shp2 in the MK/platelet lineage in mice results in macrothrombocytopenia and minor effects on platelet function. C_LIO_LIDefects can be partially explained by reduced Mpl signaling and aberrant megakaryopoiesis in the absence of Shp2 activity. C_LI

Introduction Complement and coagulation are tightly interconnected systems that contribute to immunothrombosis and can drive inflammatory or thrombotic diseases. Leveraging this relationship and crosstalk we developed a method to functionally evaluate complement-induced coagulation activity using thromboelastometry (thermoelastometry of complement-driven immunothrombosis; TCDI). Methods To study the complement-dependent activation of coagulation, platelet-poor plasma (PPP) from patients was mixed with healthy blood in the presence or absence of the compstatin-based C3 inhibitor Cp40. PPP from healthy controls (n=10), or from patients with antiphospholipid syndrome (APS; n=6), severe COVID-19 (n=13), rheumatoid arthritis (RA; n=7), or synovial fluid (SF) from RA patients, were analyzed for their capacity to induce complement activation in healthy blood. Whole blood coagulation was analyzed by thromboelastometry and complement-driven immunothrombosis was quantified as clotting time (CT) prolongation following Cp40 treatment, expressed as fractional difference percentage (FD%). In parallel, C3a generation was measured by ELISA to monitor the C3 inhibitory activity of Cp40. Results Plasma from patients with APS and COVID-19 induced significant CT prolongation following C3 inhibition by Cp40 and increased FD% values compared with controls, indicating active complement-driven immunothrombosis. Higher TCDI levels were associated with mortality in severe COVID-19. In RA, TCDI positivity was detected in synovial fluid (SF) rather than peripheral plasma. Moreover, TCDI-positive samples treated with Cp40 exhibited significant inhibition of C3a generation, which strongly correlated with FD% values (r=0.67, p=0.0005). Conclusion The TCDI assay may provide a rapid, real-time evaluation of immunothrombotic activity in inflammatory and thrombotic disorders, which could inform timely medical prevention.

BackgroundThe CXCR2 receptor pathway plays a major role in inflammatory and invasive angiogenesis in human disease. ObjectiveWe evaluated AZD5069, a selective CXCR2 antagonist, as an angiogenesis inhibitor in human cell culture. MethodsHuman Umbilical Venous Endothelial Cells (HUVECs), Human Aortic Endothelial Cells (HAECs), and Human Pulmonary Artery Endothelial Cells (HPAECs) were cultured with standard in vitro techniques. AZD5069 (0, 8, 16, 32, 64, 128, 256 M) was evaluated as an angiogenesis inhibitor with fluorescent-labeled 5-Ethynyl-2-deoxyuridine (EdU) uptake to quantify endothelial cell proliferation, scratch assay to quantify endothelial cell migration, and Geltrex assay to quantify endothelial cell tubule and hub formation. AZD5069 cytotoxicity was evaluated with in situ terminal deoxynucleotidyl transferase 2-Deoxyuridine triphosphate- 5 (dUTP) nick-end labeling (TUNEL) to quantify apoptosis and membrane-impermeable cyanine dye uptake to quantify necrotic cell death. ResultsAZD5069 significantly reduced HUVEC, HAEC, and HPAEC proliferation, migration, tubule count, total tubule length, and node count with a dose-response. AZD5069 did not cause apoptosis nor necrotic cell death. ConclusionsAZD5069 inhibited angiogenesis without cytotoxicity in human endothelial cell culture. The endothelial cell CXCR2 receptor pathway may be a novel target for anti-angiogenesis therapy. AZD5069 may have clinical utility in cardiovascular, oncologic, and inflammatory disease. Condensed AbstractThe CXCR2 receptor pathway plays a major role regulating angiogenesis in inflammation and cancer. The CXCR2 receptor pathway has been evaluated in humans as a target for therapy in inflammatory disease and cancer but not as a therapeutic approach to block pathologic angiogenesis. AZD5069 is a clinical stage, direct CXCR2 antagonist. In human endothelial cell culture, AZD5069 inhibited angiogenesis without causing apoptosis or necrotic cell death. The endothelial cell CXCR2 receptor pathway may be a novel target for anti-angiogenesis therapy. AZD5069 may have clinical utility as a novel angiogenesis blocker in human disease. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=137 SRC="FIGDIR/small/731993v1_ufig1.gif" ALT="Figure 1"> View larger version (22K): org.highwire.dtl.DTLVardef@1ac8fb4org.highwire.dtl.DTLVardef@ea89forg.highwire.dtl.DTLVardef@607f94org.highwire.dtl.DTLVardef@157cec4_HPS_FORMAT_FIGEXP M_FIG Visual Abstract: AZD5069, a selective CXCR2 antagonist, significantly reduced endothelial cell proliferation, migration, and vascular tubule formation without causing necrotic or apoptotic cell death. The endothelial cell CXCR2 receptor pathway may be a novel target for anti-angiogenesis therapy. AZD5069 may have clinical utility in human cardiovascular, oncologic, and inflammatory disease with pathologic, dysregulated, or excessive angiogenesis. C_FIG

Mechanical circulatory support essential for managing severe heart failure frequently triggers bleeding complications, driven by shear stress-induced over-proteolysis of von Willebrand factor (VWF) by ADAMTS13. Inhibiting ADAMTS13 presents a rationale to treat this condition, known as acquired von Willebrand syndrome (AVWS). However, conventional therapeutic strategies remain limited due to the risk of triggering thrombotic thrombocytopenic purpura. Here we show that HA10, a humanized anti-ADAMTS13 antibody, preserves a residual level of ADAMTS13 activity above the thrombosis-associated threshold. Multimodal structural and biophysical analyses--including NMR, SAXS, and SANS--revealed that HA10 bound to the disintegrin-like domain of ADAMTS13, dynamically competing with VWF while leaving 10- 20% residual enzymatic activity. The therapeutic efficacy and safety of HA10 were verified in non-human primate models of AVWS. Our findings establish a novel paradigm of enzymatic calibration rather than complete blockade, offering a mechanistically targeted and safe therapeutic approach for cardiovascular bleeding.