Methods of detection of mechanically-activated platelet activation and uses thereof
Biochemical markers that can be measured to determine the level of mechanical activation of a population of platelets are provided, and their use to prepare molecular signatures thereof are provided. The markers include phosphatidylserine, thrombin, integrin GPIIb/IIIa activation, glycoprotein GP Ib, P-selectin; platelet size; microparticle generation, or lipidomic profile of the membrane. The disclosed markers, measurement thereof, and signatures composed therefrom can be used in a variety of methods of patient selection, treatment monitoring, treatment selection, including both devices and active agents, and methods of treating subjects in need thereof, particularly humans. Examples of such methods include, but are not limited to, reducing shear-activated platelets; selecting a blood-contacting medical device; selecting between two or more medical devices; identifying a subject at a risk of developing a thrombogenic event; monitoring the prophylactic treatment of a subject; selecting a mechanoceutical agent; and delivering an agent to a subject.
1 . A method comprising
(i) assaying isolated platelets from a subject at risk of developing a thrombotic disease, state, or condition for levels of
(b1) thrombin, (a1) phosphatidylserine, (c1) integrin GPIIb/IIIa activation, (e1) P-selectin; and optionally one or more of (d1) glycoprotein GP Ib, (f1) platelet size; (g1) microparticle generation, and (h1) lipidomic profile of the membrane; and
(ii) determining the isolated platelets contain one or more platelets activated by one or more mechanical stimuli and the risk of developing a thrombotic disease, state, or condition is related thereto when
(b2) thrombin level on the external surface of the platelets is elevated relative to the thrombin level of the control;
(a2) phosphatidylserine level on the external surface of the platelets is elevated relative to the phosphatidylserine level of a control;
(c2) integrin GPIIb/IIIa activation level on the external surface of the platelets is not increased by more than 20% compared to the integrin GPIIb/IIIa activation level of the control;
and
(e2) P-selectin level on the external surface of the platelets is not increased by more than 20% compared to the P-selectin level of the control; and optionally one or more of
(d2) glycoprotein GP Ib level on the external surface of the platelets is about the same or less compared to the glycoprotein GP Ib level of the control;
(f2) platelet size is decreased relative to the platelet size of the control;
(g2) microparticle generation is increased relative to the microparticle generation of the control, and
(h2) membrane lipidomic profile is changed compared to the membrane lipidomic profile of the control; and
(iii) treating the subject to prevent, reduce, or manage the onset or development of mechanical stimuli-associated thrombosis.
2 . The method of claim 1 , wherein the mechanical stimuli is selected from shear, vibration, audible sound, ultrasound, acoustic stimulation, pressure, and combinations thereof.
3 . The method of claim 1 , wherein the platelets are isolated from a blood sample of a subject.
4 . The method of claim 2 , wherein the mechanical stimuli is shear and further comprising reducing shear-activated platelets in the blood of the subject comprising administering to the subject a pharmaceutical composition comprising one or more mechanoceuticals in an amount effective to reduce the level of phosphatidylserine, the level of thrombin, and/or the level of microparticle generation; to increase in platelet size; or to change membrane lipidomic profile; or a combination thereof; optionally without affecting the level of integrin GPIIb/IIIa activation, the level of integrin GP Ib, and/or the level of P-selectin in the platelets of the subject.
5 . The method of claim 4 , further comprising monitoring the treatment of a subject comprising:
assaying levels of (b1), (a1), (c1), and (e1) in blood samples collected from a subject before and after treatment respectively, one or more times with mechanoceutical, and
repeating treatment if the level of phosphatidylserine, the level of thrombin, the level of microparticle generation is reduced; the platelet size is increased; and/or the membrane lipidomic profile is changed; optionally the level of integrin GPIIb/IIIa activation, the level of integrin GP Ib, and/or level of P-selectin in the platelets of the subject is not affected.
6 . The method of claim 5 , wherein if the level of phosphatidylserine, the level of thrombin, the level of microparticle generation is not reduced; the platelet size is not increased; and/or the membrane lipidomic profile is not changed;
increasing the dose, the frequency of administration of the mechanoceutical, or a combination thereof, or administering to the subject a different mechanoceutical.
7 . The method of claim 6 , further comprising one or more additional cycles of assaying levels of (b1), (a1), (c1), and (e1) and treating the subject.
8 . The method of claim 1 , wherein the subject has a blood-contacting medical device implanted in the body prior to assaying levels of (b1), (a1), (c1), and (e1).
9 . The method of claim 8 , further comprising implanting a blood-contacting medical device into the subject simultaneously or subsequently to assaying levels of (b1), (a1), (c1), and (e1).
10 . The method of claim 1 , wherein the control is a population of resting platelets.
11 . The method of claim 1 , wherein the subject is a human.
12 . The method of claim 1 , wherein the subject is one with a blood-contacting device optionally selected from mechanical circulatory support devices and ventricular assist devices (VADs).
13 . The method of claim 1 , wherein the control is platelets from healthy subjects with minimal risk of developing thrombosis.
14 . The method of claim 4 , wherein the mechanoceutical is a lipid or lipid-related compound, dimethysulfoxide (DMSO), a ganglioside, a hormone, a sterol, cholesterol hemisuccinate, lidocaine, a procaine, a sex steroid, phenytoin, docohexanoic acid, cortisol, estradiol, PGE2, progesterone, medroxyprogesterone, insulin, glucagon, atropine, carbachol, lutropin, neuropeptide Y, thyroid hormone, aldosterone, vasopressin, perylene, 9-(di-cyanovinyl) julodinine, 1,6-diphenyl-1,3,5-hexatiene (DPH), TMA-DPH, DPH-PA, cis or trans-parinaric acid, a polyunsaturated fatty acid, phospatidyl choline, phospahtidylserine, phospatidyl inositol, insitol, choline, cerebroside, a glycoshpingolipid, sphingomyelin, or a combinations thereof.
15 . The method of claim 1 further comprising one or more of the measurements of (d1), and (f1)-(h1) the corresponding result(s) in (d2), and (f2)-(h2).
16 . The method of claim 1 comprising further comprising two or more of the measurements of (d1), and (f1)-(h1) the corresponding result(s) in (d2), and (f2)-(h2).
17 . The method of claim 1 comprising further comprising all four of the measurements of (d1), and (f1)-(h1) the corresponding result(s) in (d2), and (f2)-(h2).
18 . The method of claim 1 , comprising treating the subject to prevent, reduce, or manage non-mechanical stimuli-associated thrombosis when the subject is not determined to be at risk of developing a thrombogenic disease, state, or condition caused by mechanical stimuli.
19 . The method of claim 18 , wherein the non-mechanical stimuli comprises chemical or biochemical platelet activation.
20 . The method of claim 1 , further comprising
(iv) determining the isolated platelets contain one or more platelets activated by one or more non-mechanical stimuli-associated and the risk of developing a thrombotic disease, state, or condition is related thereto when
(b3) thrombin level on the external surface of the platelets is not elevated relative to the thrombin level of the control;
(a3) phosphatidylserine level on the external surface of the platelets is not elevated relative to the phosphatidylserine level of a control; and optionally
(c3) integrin GPIIb/IIIa activation level on the external surface of the platelets is increased compared to the integrin GPIIb/IIIa activation level of the control; and
(e3) P-selectin level on the external surface of the platelets is increased compared to the P-selectin level of the control; and optionally one or more of
(d3) glycoprotein GP Ib level on the external surface of the platelets is about the same or more compared to the glycoprotein GP Ib level of the control;
(f3) platelet size is not decreased relative to the platelet size of the control;
(g3) microparticle generation is not increased relative to the microparticle generation of the control, and
(h2) membrane lipidomic profile is changed compared to the membrane lipidomic profile of the control;
(v) treating the subject to prevent, reduce, or manage the onset or development of non-mechanical stimuli-associated thrombosis.