Identification of platelet activating antibodies
Described is a method for identifying pathogenic platelet-activating antibodies in a subject's blood and particularly antibodies implicated in heparin-induced thrombocytopenia (HIT) which comprises the preparation of a platelet releasate from a normal subject's platelets, the combination of the platelet release with a normal subject's platelets, a test subject's blood sample, and analyzing the sample for platelet activation.
1. A method for identifying platelet-activating heparin-induced thrombocytopenia (HIT) antibodies in a blood sample from a subject suspected of having platelet-activating HIT antibodies, the method comprising:
obtaining a blood sample comprising serum, plasma, or fractionated blood from a subject suspected of having platelet-activating HIT antibodies;
obtaining platelets from one or more normal subjects;
obtaining a platelet releasate from the platelets from one or more normal subjects by activating the platelets from the one or more normal subjects with a platelet activator and collecting material released from the activated platelets, forming a platelet releasate;
combining the platelet releasate from the one or more normal subjects, the platelets from the one or more normal subjects, and the sample from the subject suspected of having platelet-activating antibodies, forming a combined sample, and incubating the combined sample for about 5 min. to about 4 hours; and
measuring platelet activation in the combined sample;
wherein platelet activation in the combined sample is indicative of the presence of platelet-activating HIT antibodies in the blood sample from the subject suspected of having platelet-activating antibodies.
2. The method of claim 1 , wherein the platelet releasate is prepared by:
activating platelets from the one or more normal subjects by the addition of a platelet activator;
collecting material released from the activated platelets and incubating at about 40° C. to about 75° C. for about 15 min. to about 10 hours; and
contacting the material released from the activated platelets with an anion-exchanger for about 15 min. to about 4 hours and obtaining a platelet releasate.
3. The method of claim 1 , wherein measuring platelet activation comprises one or more of: analyzing the release of platelet granule components; detecting the expression of platelet cell surface markers that are expressed upon platelet activation; detecting increase in expression of p-selectin on the platelet; detecting an increase in binding of annexin V to the platelet, detecting an increased proteolytic cleavage of the platelet membrane protein Fc gamma RII (CD32); detecting a change in platelet shape; detecting an increased level of ionized calcium in the platelet cytoplasm; detecting changes in expression levels of one or more cell surface markers indicative of activated platelets; detecting a change in platelet integrin conformation; detecting a change in platelet membrane potential; detecting a change in platelet impedance; detecting platelet agglutination; detecting platelet aggregation; detecting activated-platelet metabolic state; or detecting activated-platelet metabolites or byproducts.
4. The method of claim 3 , wherein the platelet cell surface markers comprise one or more of selectins, integrins, or immunoglobulins.
5. The method of claim 3 , wherein the platelet cell surface markers comprise p-selectin.
6. The method of claim 1 , wherein measuring platelet activation comprises analyzing the expression of platelet cell surface markers that are expressed upon platelet activation using flow cytometry, radioimmunoassays (RIA), or enzyme-linked immunosorbent assays (ELISAs).
7. The method of claim 1 , wherein measuring platelet activation comprises analyzing the release of platelet granule components.
8. The method of claim 1 , further comprising combining heparin or a heparin-like compound with the platelet releasate from one or more normal subjects, platelets from one or more normal subjects, and the blood sample from the subject suspected of having platelet-activating HIT antibodies.
9. The method of claim 8 , wherein the heparin or heparin-like compound has a final concentration of about 0.05 U/mL to about 200 U/mL.
10. The method of claim 1 , wherein the platelets from one or more normal subjects comprises one or more of isolated platelets, platelet-rich plasma, or washed platelets.
11. The method of claim 1 , wherein the platelets have been stabilized for storage by one or more of cooling, freezing, chemical storage, or lyophilization.
12. The method of claim 1 , wherein the platelet activation is compared to one or more controls comprising blood from a normal subject, historical data, or blood from a subject diagnosed as having platelet-activating HIT antibodies.
13. A method for identifying platelet-activating heparin-induced thrombocytopenia (HIT) antibodies in a blood sample from a subject suspected of having platelet-activating HIT antibodies, the method comprising:
obtaining a blood sample comprising serum, plasma, or fractionated blood from a subject suspected of having platelet-activating HIT antibodies;
obtaining platelets from one or more normal subjects;
obtaining a platelet releasate from the platelets from one or more normal subjects by activating the platelets from one or more normal subjects with a platelet activator, collecting material released from the activated platelets, and contacting the material released from the activated platelets with an anion-exchanger forming a platelet releasate;
combining the platelet releasate with platelets from one or more normal subjects, forming a first combined sample and incubating the first combined sample for about 5 min. to about 1 hour;
combining the subject sample with the first combined sample, forming a second combined sample, and incubating the second combined sample for 5 min. to about 5 hours;
measuring platelet activation in the second combined sample;
wherein platelet activation in the second combined sample is indicative of the presence of platelet-activating HIT antibodies in the blood sample from the subject suspected of having platelet-activating antibodies.
14. The method of claim 13 , wherein the platelet releasate is prepared by:
activating platelets from one or more normal subjects by the addition of a platelet activator;
collecting material released from the activated platelets and incubating at about 40° C. to about 75° C. for about 15 min. to about 10 hours; and
contacting the material released from the activated platelets with an anion-exchanger for about 15 min. to about 4 hours and obtaining the platelet releasate.
15. The method of claim 13 , wherein measuring platelet activation comprises one or more of: analyzing the release of platelet granule components; detecting the expression of platelet cell surface markers that are expressed upon platelet activation; detecting increase in expression of p-selectin on the platelet; detecting an increase in binding of annexin V to the platelet, detecting an increased proteolytic cleavage of the platelet membrane protein Fc gamma RII (CD32); detecting a change in platelet shape; detecting an increased level of ionized calcium in the platelet cytoplasm; detecting changes in expression levels of one or more cell surface markers indicative of activated platelets; detecting a change in platelet integrin conformation; detecting a change in platelet membrane potential; detecting a change in platelet impedance; detecting platelet agglutination; detecting platelet aggregation; detecting activated-platelet metabolic state; or detecting activated-platelet metabolites or byproducts.
16. The method of claim 15 , wherein the platelet cell surface markers comprise one or more of selectins, integrins, or immunoglobulins.
17. The method of claim 15 , wherein the platelet cell surface markers comprise p-selectin.
18. The method of claim 13 , wherein measuring platelet activation comprises analyzing the expression of platelet cell surface markers that are expressed upon platelet activation using flow cytometry, radioimmunoassays (RIA), or enzyme-linked immunosorbent assays (ELISAs).
19. The method of claim 13 , wherein measuring platelet activation comprises analyzing the release of platelet granule components.
20. The method of claim 13 , further comprising combining heparin or a heparin-like compound with the platelet releasate from one or more normal subjects, platelets from one or more normal subjects, and the blood sample from the subject suspected of having platelet-activating HIT antibodies.
21. The method of claim 20 , wherein the heparin or heparin-like compound has a final concentration of about 0.05 U/mL to about 200 U/mL.
22. The method of claim 13 , wherein the platelets from one or more normal subjects comprises one or more of isolated platelets, platelet-rich plasma, or washed platelets.
23. The method of claim 13 , wherein the platelets have been stabilized for storage by one or more of cooling, freezing, chemical storage, or lyophilization.
24. The method of claim 13 , wherein the platelet activation is compared to one or more controls comprising blood from a normal subject, historical data, or blood from a subject diagnosed as having platelet-activating HIT antibodies.
25. A kit for identifying platelet-activating heparin-induced thrombocytopenia (HIT) antibodies in a blood sample from a subject configured for use with the method of claim 1 or claim 13 , wherein the subject is suspected of having platelet-activating heparin-induced thrombocytopenia, the kit comprising one or more of:
(a) a container and means for collecting blood from a subject suspected of having platelet-activating HIT antibodies;
(b) a container comprising a platelet releasate from one or more normal subjects;
(c) a container comprising platelets from one or more normal subjects;
(d) a container comprising heparin or other polyanion;
(e) a container for combining (a)-(d);
(f) reagents for analyzing platelet activation;
(g) one or more control samples comprising blood from a normal subject or blood from a subject diagnosed as having platelet-activating HIT antibodies; or
(h) instructions or directions for use.
26. A kit for preparing a platelet releasate configured for use with the method of claim 1 or claim 13 , the kit comprising one or more of:
(a) a container and means for obtaining blood from one or more normal subjects;
(b) a means for isolating platelets from the one or more normal subject's blood;
(c) a container for activating platelets;
(d) a platelet activator;
(e) an anion-exchange resin or cartridge;
(f) a means for collecting the platelet releasate; or
(f) instructions or directions for use.