Academic literature on the topic 'Clot retraction'

Primary hemostasis consists in the activation of platelets, which spread on the exposed extracellular matrix at the injured vessel surface. Secondary hemostasis, the coagulation cascade, generates a fibrin clot in which activated platelets and other blood cells get trapped. Active platelet-dependent clot retraction reduces the clot volume by extruding the serum. Thus, the clot architecture changes with time of contraction, which may have an important impact on the healing process and the dissolution of the clot, but the precise physiological role of clot retraction is still not completely understood. Since platelets are the only actors to develop force for the retraction of the clot, their distribution within the clot should influence the final clot architecture. We analyzed platelet distributions in intracoronary thrombi and observed that platelets and fibrin co-accumulate in the periphery of retracting clots in vivo. A computational mechanical model suggests that asymmetric forces are responsible for a different contractile behavior of platelets in the periphery versus the clot center, which in turn leads to an uneven distribution of platelets and fibrin fibers within the clot. We developed an in vitro clot retraction assay that reproduces the in vivo observations and follows the prediction of the computational model. Our findings suggest a new active role of platelet contraction in forming a tight fibrin- and platelet-rich boundary layer on the free surface of fibrin clots.

Abstract Talin functions both as a regulator of integrin affinity and as an important mechanical link between integrins and the cytoskeleton. Using genetic deletion of talin, we show for the first time that the capacity of talin to activate integrins is required for fibrin clot retraction by platelets. To further dissect which talin functions are required for this process, we tested clot retraction in platelets expressing a talin1(L325R) mutant that binds to integrins, but exhibits impaired integrin activation ascribable to disruption of the interaction between talin and the membrane-proximal region (MPR) in the β-integrin cytoplasmic domain. Talin-deficient and talin1(L325R) platelets were defective in retracting fibrin clots. However, the defect in clot retraction in talin1(L325R) platelets, but not talin-deficient platelets, was rescued by extrinsically activating integrins with manganese, thereby proving that integrin activation is required and showing that talin1(L325R) can form functional links to the actin cytoskeleton.

Clot retraction, measured by serum expression, is absent in some cases of multiple myeloma. Decreased clot retraction has been attributed to platelet dysfunction. A new instrument allows simultaneous measurement of platelet-mediated force development during clot retraction and of clot elastic modulus. We report 10 patients with immunoglobulin (Ig) G myeloma in whom the abnormalities of fibrin structure were quantitatively defined and platelet-fibrin interactions were assessed. Fiber mass-to-length ratios were calculated from gel turbidity. Platelet force development and clot elastic modula were measured in platelet-rich plasma gels. Fiber mass-to-length ratios for IgG myeloma patients were smaller (means +/- SE) (0.98 +/- 0.19 x 10(13) Da/cm) than for normal controls (1.36 +/- 0.06 x 10(13) Da/cm), indicating thinner fiber formation. Elastic modula of myeloma clots (51,013 +/- 14,660 dyn/cm2) were strikingly larger than modula for normal controls (23,355 +/- 1,887 dyn/cm2), indicating that such clots are mechanically less flexible. Platelet force development 1,200 s after thrombin addition was not diminished in myeloma patients (8,315 +/- 1,155 dyn) vs. controls (6,906 +/- 606 dyn). Abnormal clot retraction in myeloma appears to be primarily due to altered clot structure rather than platelet dysfunction.

Abstract Fibrin clot retraction may be important in resolution of thrombi and, in platelets, is mediated by integrin alpha IIb beta 3 (GPIIb-IIIa). Nucleated cells that lack alpha IIb beta 3 can retract fibrin clots, and we now report that integrin alpha v beta 3 can support this process. In addition, we compared the capacities of recombinant beta 3 integrins to mediate clot retraction in Chinese hamster ovary and M21 melanoma cells. We found that alpha v beta 3, but not alpha IIb beta 3, could spontaneously support retraction. Transferring the cytoplasmic domain of alpha v to alpha IIb enabled the resulting chimeric alpha IIb beta 3 to support clot retraction. The capacity of the alpha v cytoplasmic domain to support clot retraction was not caused by activation of the ligand binding function of alpha IIb beta 3 or by enhancement of alpha IIb beta 32s capacity to stimulate the formation of focal adhesions or the tyrosine phosphorylation of pp125FAK. These experiments define requirements for alpha IIb beta 3-mediating clot retraction, establish the capacity of alpha v beta 3 to mediate this process, and suggest differing functional roles of the alpha v and alpha IIb cytoplasmic domains.

Fibrin clot retraction may be important in resolution of thrombi and, in platelets, is mediated by integrin alpha IIb beta 3 (GPIIb-IIIa). Nucleated cells that lack alpha IIb beta 3 can retract fibrin clots, and we now report that integrin alpha v beta 3 can support this process. In addition, we compared the capacities of recombinant beta 3 integrins to mediate clot retraction in Chinese hamster ovary and M21 melanoma cells. We found that alpha v beta 3, but not alpha IIb beta 3, could spontaneously support retraction. Transferring the cytoplasmic domain of alpha v to alpha IIb enabled the resulting chimeric alpha IIb beta 3 to support clot retraction. The capacity of the alpha v cytoplasmic domain to support clot retraction was not caused by activation of the ligand binding function of alpha IIb beta 3 or by enhancement of alpha IIb beta 32s capacity to stimulate the formation of focal adhesions or the tyrosine phosphorylation of pp125FAK. These experiments define requirements for alpha IIb beta 3-mediating clot retraction, establish the capacity of alpha v beta 3 to mediate this process, and suggest differing functional roles of the alpha v and alpha IIb cytoplasmic domains.

Platelets have important functions in hemostasis. Best investigated is the aggregation of platelets for primary hemostasis and their role as the surface for coagulation leading to fibrin- and clot-formation. Importantly, the function of platelets does not end with clot formation. Instead, platelets are responsible for clot retraction through the concerted action of the activated αIIbβ3 receptors on the surface of filopodia and the platelet’s contractile apparatus binding and pulling at the fibrin strands. Meanwhile, the signal transduction events leading to clot retraction have been investigated thoroughly, and several targets to inhibit clot retraction have been demonstrated. Clot retraction is a physiologically important mechanism allowing: (1) the close contact of platelets in primary hemostasis, easing platelet aggregation and intercellular communication, (2) the reduction of wound size, (3) the compaction of red blood cells to a polyhedrocyte infection-barrier, and (4) reperfusion in case of thrombosis. Several methods have been developed to measure clot retraction that have been based on either the measurement of clot volume or platelet forces. Concerning the importance of clot retraction in inborn diseases, the failure of clot retraction in Glanzmann thrombasthenia is characterized by a bleeding phenotype. Concerning acquired diseases, altered clot retraction has been demonstrated in patients with coronary heart disease, stroke, bronchial asthma, uremia, lupus erythematodes, and other diseases. However, more studies on the diagnostic and prognostic value of clot retraction with methods that have to be standardized are necessary.

AbstractFibrinogen is a plasma protein that interacts with integrin αIIbβ3 to mediate a variety of platelet responses including adhesion, aggregation, and clot retraction. Three sites on fibrinogen have been hypothesized to be critical for these interactions: the Ala-Gly-Asp-Val (AGDV) sequence at the C-terminus of the γ chain and two Arg-Gly-Asp (RGD) sequences in the Aα chain. Recent data showed that AGDV is critical for platelet adhesion and aggregation, but not retraction, suggesting that either one or both of the RGD sequences are involved in clot retraction. Here we provide evidence, using engineered recombinant fibrinogen, that no one of these sites is critical for clot retraction; fibrinogen lacking all three sites still sustains a relatively normal, albeit delayed, retraction response. Three fibrinogen variants with the following mutations were examined: a substitution of RGE for RGD at position Aα 95-97, a substitution of RGE for RGD at position Aα 572-574, and a triple substitution of RGE for RGD at both Aα positions and deletion of AGDV from the γ chain. Retraction rates and final clot sizes after a 20-minute incubation were indistinguishable when comparing the Aα D97E fibrinogen or Aα D574E fibrinogen with normal recombinant fibrinogen. However, with the triple mutant fibrinogen, clot retraction was delayed compared with normal recombinant fibrinogen. Nevertheless, the final clot size measured after 20 minutes was the same size as a clot formed with normal recombinant fibrinogen. Similar results were observed using platelets isolated from an afibrinogenemic patient, eliminating the possibility that the retraction was dependent on secretion of plasma fibrinogen from platelet α-granules. These findings indicate that clot retraction is a two-step process, such that one or more of the three putative platelet binding sites are important for an initial step in clot retraction, but not for a subsequent step. With the triple mutant fibrinogen, the second step of clot retraction, possibly the development of clot tension, proceeds with a rate similar to that observed with normal recombinant fibrinogen. These results are consistent with a mechanism where a novel site on fibrin is involved in the second step of clot retraction.

Fibrinogen is a plasma protein that interacts with integrin αIIbβ3 to mediate a variety of platelet responses including adhesion, aggregation, and clot retraction. Three sites on fibrinogen have been hypothesized to be critical for these interactions: the Ala-Gly-Asp-Val (AGDV) sequence at the C-terminus of the γ chain and two Arg-Gly-Asp (RGD) sequences in the Aα chain. Recent data showed that AGDV is critical for platelet adhesion and aggregation, but not retraction, suggesting that either one or both of the RGD sequences are involved in clot retraction. Here we provide evidence, using engineered recombinant fibrinogen, that no one of these sites is critical for clot retraction; fibrinogen lacking all three sites still sustains a relatively normal, albeit delayed, retraction response. Three fibrinogen variants with the following mutations were examined: a substitution of RGE for RGD at position Aα 95-97, a substitution of RGE for RGD at position Aα 572-574, and a triple substitution of RGE for RGD at both Aα positions and deletion of AGDV from the γ chain. Retraction rates and final clot sizes after a 20-minute incubation were indistinguishable when comparing the Aα D97E fibrinogen or Aα D574E fibrinogen with normal recombinant fibrinogen. However, with the triple mutant fibrinogen, clot retraction was delayed compared with normal recombinant fibrinogen. Nevertheless, the final clot size measured after 20 minutes was the same size as a clot formed with normal recombinant fibrinogen. Similar results were observed using platelets isolated from an afibrinogenemic patient, eliminating the possibility that the retraction was dependent on secretion of plasma fibrinogen from platelet α-granules. These findings indicate that clot retraction is a two-step process, such that one or more of the three putative platelet binding sites are important for an initial step in clot retraction, but not for a subsequent step. With the triple mutant fibrinogen, the second step of clot retraction, possibly the development of clot tension, proceeds with a rate similar to that observed with normal recombinant fibrinogen. These results are consistent with a mechanism where a novel site on fibrin is involved in the second step of clot retraction.

Abstract Mitogen-activated protein kinases (MAPK), p38, and extracellular stimuli-responsive kinase (ERK), are acutely but transiently activated in platelets by platelet agonists, and the agonist-induced platelet MAPK activation is inhibited by ligand binding to the integrin αIIbβ3. Here we show that, although the activation of MAPK, as indicated by MAPK phosphorylation, is initially inhibited after ligand binding to integrin αIIbβ3, integrin outside-insignaling results in a late but sustained activation of MAPKs in platelets. Furthermore, we show that the early agonist-induced MAPK activation and the late integrin-mediated MAPK activation play distinct roles in different stages of platelet activation. Agonist-induced MAPK activation primarily plays an important role in stimulating secretion of platelet granules, while integrin-mediated MAPK activation is important in facilitating clot retraction. The stimulatory role of MAPK in clot retraction is mediated by stimulating myosin light chain (MLC) phosphorylation. Importantly, integrin-dependent MAPK activation, MAPK-dependent MLC phosphorylation, and clot retraction are inhibited by a Rac1 inhibitor and in Rac1 knockout platelets, indicating that integrin-induced activation of MAPK and MLC and subsequent clot retraction is Rac1-dependent. Thus, our results reveal 2 different activation mechanisms of MAPKs that are involved in distinct aspects of platelet function and a novel Rac1-MAPK–dependent cell retractile signaling pathway.

Endocytic trafficking of platelet surface receptors plays a role in the accumulation of granule cargo (i.e. fibrinogen and VEGF) and thus could contribute to hemostasis, angiogenesis, or inflammation. However, the mechanisms of platelet endocytosis are poorly understood. The small GTP-binding protein, ADP-ribosylation factor 6 (Arf6), regulates integrin trafficking in nucleated cells; therefore, we posited that Arf6 functions similarly in platelets. To address this, we generated platelet-specific, Arf6 knockout mice. Arf6-/- platelets had a storage defect for fibrinogen but not other cargo, implying Arf6’s role in integrin αIIbβ3 trafficking. Additionally, platelets from Arf6-/- mice injected with biotinylated-fibrinogen, showed lower accumulation of the modified protein than did WT mice. Resting and activated αIIbβ3 levels, measured by FACS, were unchanged in Arf6-/- platelets. Arf6-/- platelets had normal agonist-induced aggregation and ATP release; however, they showed faster clot retraction and enhanced spreading, which appears due to altered αIIbβ3 trafficking since myosin light chain phosphorylation and Rac1 activation, in response to thrombin, were unaffected. Arf6-/- mice showed no hemostasis defect in tail-bleeding or FeCl3–induced carotid injury assays. These data suggest a role for Arf6 in integrin αIIbβ3 trafficking in platelets. Additionally, the regulation of Arf6 in platelets was also investigated, focusing on integrin αIIbβ3 outside-in signaling which was suggested to be responsible for the second wave of Arf6-GTP loss. G protein-coupled receptor kinase-interacting protein 1 (GIT1), a GTPase-activating protein (GAP) toward Arf6, is suggested to be involved in αIIbβ3 downstream signaling. I found that GIT1, complex with β-PIX, was translocated to the detergent-insoluble pellet upon human platelet activation, a process that is blocked by RGDS and myrArf6 peptide treatment. Moreover, tyrosine-phosphorylation of GIT1 was impaired by treatment with both peptides or with actin polymerization inhibitors. GIT1’s role in platelets was further studied using platelet-specific, GIT1 knockout mice. GIT1-/- platelets failed to show any defect, including clot retraction or fibrinogen storage. Unlike human platelets, GIT1 expression levels were much lower in mouse platelets, suggesting that GIT2 may be the functionally relevant Arf6-GAP in mouse platelets. The data in this dissertation identify that Arf6 mediates fibrinogen storage, implying its role in integrin αIIbβ3 trafficking in platelets.

L’hémostase primaire est un processus permettant la formation d’un clou plaquettaire qui sera stabilisé par un réseau de fibrine. Ce caillot est également consolidé grâce à des phases tardives de l’hémostase primaire résultant des fonctions plaquettaires ; il s’agit principalement de la rétraction qui diminue la taille du caillot afin de le stabiliser. Cette phase est déclenchée par une signalisation « outside-in », consécutive à l’activation de l’intégrine αIIbβ3 et à l’agrégation plaquettaire, et est dépendante d’une réorganisation du cytosquelette. Le premier objectif de ce travail a été d’étudier la signalisation impliquée dans la rétraction, et en particulier l’implication des protéines ROCK, MLCK, Rac-1 et de l’actine dans l’activité de la chaine légère de la myosine (MLC) . MLC est en effet une protéine clé de la réorganisation du cytosquelette. Nous avons mis en évidence une phosphorylation biphasique de MLC dont le deuxième pic, corrélé à la rétraction, est dépendant de Rac1 et de la polymérisation de l’actine. Cette étude a été appliquée à une pathologie, le syndrome de Lowe. Il s’agit d’une maladie génétique rare, également appelée OCRL (Oculo cérébro rénal de Lowe) en référence aux organes majoritairement touchés. Suite à l’observation d’événements hémorragiques per et postopératoires suggérant une instabilité du caillot et l’observation dans une étude précédente d’un temps d’occlusion allongé au PFA100®, nous avons mis en place une étude sur 15 patients et 15 témoins pour lesquels nous avons étudié les différentes phases de l’hémostase primaire. Outre une anomalie et un retard de maturation des mégacaryocytes, nous avons mis en évidence pour la première fois chez ces patients un défaut de la voie « outside-in » responsable d’une anomalie de l’étalement plaquettaire et de la rétraction du caillot. Ce défaut de rétraction, dû à un défaut d’activation de MLC, pourrait être en partie responsable des événements hémorragiques observés chez ces patients
Primary hemostasis is a mechanism allowing platelet clot formation that is thereafter stabilized by a fibrin network. Fibrin clot is also consolidated following post occupancy events, mainly clot retraction that decrease clot size and thus strengthen it. This phase is triggered by « outside-in » signaling. It is consecutive to αIIbβ3 integrin activation and platelet aggregation, dependent on cytoskeleton organization. Our first objective was to investigate signaling events underlying retraction, and particularly the involvement of ROCK, MLCK, Rac-1, and actin in MLC (Myosin Light Chain) phosphorylation. Indeed, MLC, involved in cytoskeleton rearrangement, is a key protein of this mechanism. We described a MLC biphasic phosphorylation profile, which second peak was dependent of Rac1 and actin polymerization. In a second part, we studied clot retraction signaling in patients with the Lowe syndrome. It is a rare genetic disease, caused by absence of OCRL (oculo cerebro renal of Lowe) protein in reference to the majority of affected organs. The rationale of this study was a previous observation of hemorrhagic events during and after surgeries, suggesting clot instability. A thrombopathy was suggested by a closure time lengthening in the PFA-100 system. The study enrolled 15 patients and 15 controls. Besides a defect of megakaryocyte maturation, we described a defect of « outside-in » signaling responsible for spreading and clot retraction abnormality. This retraction defect, caused by a MLC activity defect, could be partly responsible for hemorrhagic events reported in these patients

Les plaquettes sont la principale source de CD40L soluble (sCD40L), une molécule thrombo-inflammatoire dont les taux élevés chez les patients atteints des maladies coronariennes (CAD) prédisent des événements athérothrombotiques. Nous avons déjà démontré que le sCD40L active deux voies de signalisation dans les plaquettes, la p38 MAPK et le facteur nucléaire-κB (NF-κB), non affectées par l’activité antiplaquettaire de l'aspirine (ASA). Nous avons montré aussi que le sCD40L, en réponse à des doses sous-optimales d'agonistes plaquettaires comme la thrombine et le collagène, potentialise l'agrégation des plaquettes via le récepteur CD40 et son effecteur cible présent en aval le NF-κB. En effet, le NF-κB appartient à une famille de dimères cytoplasmiques inactivés par l'inhibiteur IκB et régulés par l’IκB kinase (IKK). Suite à des signaux immunologiques, l’IKK phosphoryle l’IκB, ce qui entraîne sa dégradation par le protéasome. Par conséquent, le NF-κB, une fois libre, se déplace vers les noyaux des cellules immunitaires où il agit sur le génome pour maintenir la survie et la prolifération cellulaires. Contrairement aux cellules immunitaires, la régulation et les fonctions de NF-κB dans les plaquettes, fragments cellulaires dépourvus de génome, sont moins bien comprises. Dans ce projet, nous proposons l'hypothèse que l’axe sCD40L/NF-κB/protéasome amorce les plaquettes en les prédisposant à une activation et une agrégation prononcées. Nos objectifs seront donc (i) d'étudier l'interaction entre le NF-κB et le protéasome en réponse au sCD40L et (ii) d'examiner les rôles de cet axe sur les fonctions plaquettaires. Pour cela, des plaquettes ont été fraîchement isolées à partir du sang des donneurs humains sains qui ne prennent pas des médicaments antiplaquettaires ou anti-inflammatoires. Ces plaquettes ont été par la suite stimulées par le sCD40L. En étudiant l'activation de NF-κB, l'analyse par Western blot a montré que le sCD40L induit la phosphorylation d’IκB et la dégradation de sa forme phosphorylée (p-IκB) dans un délai de 30 minutes, d'une manière similaire à l’action de la thrombine, l’agoniste plaquettaire le plus puissant. Le prétraitement des plaquettes avec deux classes d'inhibiteurs de NF-κB, le répresseur d’IKK (BAY 11-7082) et l’antagoniste du protéasome (MG132), a montré que l'activation du NF-κB dans les plaquettes est régulée par l’IKK et le protéasome, identiquement aux cellules nucléées. L'examen des événements de signalisation induits par le sCD40L a montré que l'inhibition du NF-κB plaquettaire n'affecte pas la phosphorylation de p38 MAPK ou le clivage protéasomique de la Taline-1 qui est impliquée dans le changement de la forme des plaquettes. Concernant les effets sur les fonctions plaquettaires, l'inhibition de NF-κB ou du protéasome n'a pas influencé l'agrégation des plaquettes induite par des doses élevées de collagène ou de thrombine. Cependant, elle a considérablement réduit l'agrégation plaquettaire suite à un amorçage avec le sCD40L, suivie d'une stimulation avec des doses sous-optimales de collagène ou de thrombine. Nous avons également constaté que le sCD40L exacerbe la rétraction des caillots fibrino-plaquettaire formés par de faibles doses de thrombine. Cet effet d'amorçage est régulé par l’axe NF-κB/protéasome. En bref, l’axe sCD40L/NF-κB/protéasome fonctionne de manière non génomique, en amorçant les plaquettes, induisant ainsi la potentialisation de l'agrégation plaquettaire et l'augmentation de la rétraction des caillots fibrino-plaquettaire. Par conséquent, le ciblage de cet axe dans les plaquettes pourrait avoir un rôle thérapeutique chez les patients atteints de CAD et dont les plaquettes ne répondent pas ou sont moins sensibles aux traitements antiplaquettaires conventionnels.
Platelets are the principal source of soluble CD40L (sCD40L), a thrombo-inflammatory molecule whose high levels in coronary artery disease (CAD) patients predict atherothrombotic events. We have previously demonstrated that sCD40L activates two signaling pathways in platelets, p38 MAPK and the nuclear factor-κB (NF-κB), both of which were unaffected by the anti-platelet activity of aspirin (ASA). We have also shown that sCD40L, in response to suboptimal doses of platelet agonists like thrombin and collagen, potentiates platelet aggregation through CD40 receptor and its downstream effector target NF-κB. Indeed, NF-κB belongs to a family of cytoplasmic dimers that are inactivated by the inhibitor IκB and regulated by IκB kinase (IKK). Following immunological signals, IKK phosphorylates IκB, driving the degradation of its phosphorylated form (p-IκB) by the proteasome. Consequently, NF-κB becomes free to translocate to the nuclei of immune cells where it acts genomically to maintain survival and proliferation. That is the case in immune cells, but in platelets which are devoid of genome, the regulation and functions of NF-κB are less understood. Herein, we hypothesized that sCD40L/NF-κB/proteasome axis primes platelets, predisposing them to pronounced activation and aggregation. We thus aimed to (i) assess the interplay between NF-κB and proteasome in response to sCD40L and (ii) investigate the roles of this axis at the level of platelet functions. For this purpose, platelets were freshly isolated from the blood of healthy human donors who are not on anti-platelet or anti-inflammatory medication and then stimulated with sCD40L. In monitoring the activation of NF-κB, western blot analysis showed that sCD40L induces the phosphorylation of IκB and the degradation of p-IκB during a 30-mins time window, in a similar fashion to the most potent platelet agonist thrombin. The pre-treatment of platelets with two classes of NF-κB inhibitors, an IKK repressor (BAY 11-7082) and a proteasome antagonist (MG132), showed that the activation of platelet NF-κB is regulated by IKK and the proteasome as in nucleated cells. The examination of the functional signaling events induced by sCD40L showed that NF-κB inhibition does not affect the phosphorylation of p38 MAPK or the proteasomal cleavage of shape change-involved Talin-1. In functional studies, NF-κB or proteasomal inhibition did not influence the aggregation of platelets induced by high doses of collagen or thrombin; however, it markedly reduced platelet aggregation primed with sCD40L followed by stimulation with sub-optimal doses of collagen or thrombin. We also found that sCD40L exacerbates the retraction of fibrin-platelet clots formed by low doses of thrombin. This priming effect was regulated by NF-κB/proteasome dyad. In brief, sCD40L/NF-κB/proteasome axis primes platelets and functions non-genomically, inducing the potentiation of platelet aggregation and augmenting the retraction of fibrin-platelet clots. Hence, targeting this axis in platelets might have a therapeutic potential in CAD patients whose platelets are not or less responsive to conventional antiplatelet therapies.

• A tear in the anterior face of the ciliary body, with damage to the major arterial circle of the iris, arterial branches to the ciliary body, or veins coursing between the ciliary body and episcleral venous plexus • In most cases, the hyphema clears in a few days, with the red blood cells exiting the eye through the trabecular meshwork • The size of initial hyphema has prognostic significance regarding final visual acuity. • 76% of subtotal hyphemas attain a visual acuity of 20/50 or better, whereas only 35% of total hyphemas attain a visual acuity of 20/50 or better. •Overall in literature: 3.5% to 38% • Scandinavian literature: 2% to 9% • Most studies in urban North American centers: 20% to 30% •Clot lysis and retraction from the traumatized vessel can lead to a rebleed. • Usually between the third and the fifth day Increase in the size of the hyphema, a layer of fresh blood over older blood, and dispersed erythrocytes over the clot once the blood has settled •Ocular hypotony, hypertension, use of aspirin, and African-American race • The incidence of rebleed does not seem to correlate with the size of hyphema. Therefore, the use of medications to prevent rebleed should not depend on the size of hyphema. • Approximately one third of all patients with hyphema have increased IOP. • Obstruction of the trabecular meshwork by erythrocytes and blood products or damage to the trabecular meshwork function • In larger hyphemas, pupillary block by a blood clot can also contribute to increase in IOP. • Peripheral anterior synechiae (PAS) •Persistence of hyphema for more than 1 week can result in the formation of PAS. •Approximately 6% of patients have optic atrophy, exhibited by optic nerve pallor. • Secondary to elevated IOP or optic nerve contusion •The risk of optic atrophy appears to be greater if the IOP is allowed to remain 50 mmHg or more for 5 days or 35 mmHg or more for 7 days in sickle cell-negative patients without prior optic nerve damage. •The incidence of corneal blood staining is between 2% and 11% and is much higher in patients with a total hyphema.

When a blood vessel is damaged, platelets aggregate together to form a thrombus that seals vascular leakage and promotes healing. The process of thrombosis involves activation of platelets by soluble ligands, adhesion to the wound site, change in shape from a discoidal to a stellate structure, and the attachment of additional platelets onto the nascent clot through adhesive ligand bridges. Once formed, a clot will undergo a retraction in volume that packs platelets together and allows blood flow to recommence. Much attention has been paid to the early phases of thrombosis — adhesion and aggregation — but the process of clot retraction is vital to stabilizing the clot.

We present a new biomechanical approach to measure nanoscale platelet contractile forces, which play an important role in the regulation of hemostasis and thrombosis. Previous studies have indicated that platelets generate contractile forces through actin-myosin interactions that lead to clot retraction and stability. If platelets are unable to generate forces, then the clots they form are loosely-bound and may detach to cause an embolism. Likewise, a higher propensity toward contractility by platelets may cause excessive clot formation in arteries and block blood flow.

The molecular basis of platelet-fibrin interactions has been investigated by using synthetic peptides as potential inhibitors of binding fibrin protofibrils and fibrinogen to ADP-stimulated platelets, adhesion of fibrin fibers to the platelet surface, and platelet-mediated clot retraction. Synthetic peptides RGDS and HHLGGAKQAGDV, corresponding to regions of the fibrinogen α and γ chains previously identified as platelet recognition sites, inhibited the binding of radiolabelled soluble fibrin oligomers to ADP-stimulated platelets with IC50 values of 12 and 40 μM, respectively. The IC50 values obtained with fibrinogen as the ligand were 3-fold higher. Synthetic GPRP and GHRP, corresponding to the N-terminal sequences of the fibrin α and β chains, were minimally effective in blocking soluble fibrin oligomer binding to ADP-stimulated platelets. The extent of fibrin:platelet adhesion was determined with a microfluorimetric technique which measures the quantity of fluorescein-labelled fibrin attached to the surface of platelets. The signal obtained from the brightly fluorescent platelet:fibrin adducts was time- and concentration-dependent, and was fully inhibited by a monoclonal antibody directed against the glycoprotein II:IIIa complex (HP1-1D, kindly provided by Dr. W. Nichols). Inhibition of fibrin:platelet adhesion by RGDS, HHGGAKQAGDV, and GHRP all exhibited a similar, linear dependence on the peptide concentration, reaching 1/2 maximum at about 200 μM, suggesting nonspecific effects. GPRP inhibited fibrin assembly but did not appear to have specific effects on fibrin:platelet adhesion. The time course of clot retraction was followed by right angle light scattering intensity measurements. Only RGDS affected clot retraction, causing a 4-fold decrease in rate at 230 μM. These results indicate that fibrinogen and fibrin protofibrils, which are obligatory intermediates in the fibrin assembly pathway, share a set of common platelet recognition sites located at specific regions of the α and γ chains of the multinodular fibrin(ogen) molecules. The RGDS site is also involved in mediating interactions between the three dimensional fibrin network and ADP-stimulated platelets.

In view of the therapeutic applications of rt-PA it is of interest to investigate whether there is any difference in the lysability between fresh and aged thrombi. The efficiency of fibrinolysis by rt-PA was studied in 3 different ways: In vivo, by measuring the thrombus weight of fresh (1 h) or aged (24 h) thrombi in the carotid artery of rabbits which had been treated with rt-PA (0.4 mg/kg) or saline for 1 h. Ex vivo, by measuring I125-release of in vivo fresh (1 h) and aged (24 h) thrombi (labelled with I125-fibrinogen) suspended in vitro in plasma containing rt-PA (1 μg/ml) ; the thrombi were formed in the jugular vein and the carotid artery of each rabbit. In vitro, by measuring I125-release of fresh (1 h) and aged (6 or 24 h) human native whole blood clots, PPP-clots, PRP-clots and squeezed PPP-clots which were formed and lysed in vitro with rt-PA (1 μg/ml) . In vivo as well as ex vivo rt-PA lysed fresh (1 h) thrombi much better than aged (24 h) thrombi. This difference was more pronounced immediately after the onset of fibrinolysis, but decreased with time. However, in vitro relatively little difference was observed in fibrinolysis efficiency between fresh (1 h) and aged (6 or 24 h) clots; fibrinolysis of these clots was decreased (PPP > whole blood > PRP) with increasing clot retraction, which was almost complete within 1 h. This result was also confirmed when PPP-clots were “retracted” by simply squeezing them just before lysis. Therefore we conclude that a considerable difference in lysis efficiency between fresh and aged thrombi was only observed when thrombi were formed and aged in vivo. This difference was less pronounced with increasing fibrinolysis time.

This study was done to clarify the intracellular dynamic arrangements of myosin(My) and actin(Ac) in activation process of human platelets (PLs) from unactivated to activated stage (clot retraction) in electron microscopy. The observation of unactivated PLs was done either in the fresh whole blood fixed directly with 0.1 % glutaraldehyde or in PLs isolated by gel filtration of platelet rich plasma(PRP) containing prostaglandin I2 (10 ng/ml). The isolated PLs mounted on a glass cover slip were used as activated PLs (adrerent ones). The contracted PLs were prepared in PRP incubated with thrombin (0.5 u/ml) and 20 mM CaCl- for 10-60 min. Treating PLs with 0.15 % Triton X-100 containing 0.05 % glutaraldehyde produced cytoskeleton. My and F-Ac were identified by an indirect immuno-cytochemical method using the specific antibody (rabbit IgG) against PL-My and protein A-gold and by demonstration of in “arrow-head” decoration by Ishikawa's method using skeletal meromyosin (HMM), respectively. [Results] (1) Unactivated PLs. Mys in monomer or oligomer distributed homogenously in scare association with cytoskeleton. Cytoskeletons were exclusively composed of F-Ac networks of crossolinked short filaments which were thinly distributed in the cytoplasm with partial connection to the cell membrance. (2) Surface activated spreading PLs. PLs adhered to the glass cover slip in dendritic forms. Mys were densely located around granulomere and formed linear arrays associated with F-Ac filaments of the cytoskeleton surrounding the granulomere and running straightly in cytoplasm. (3) Contracted PLs. Activated PLs protruded several filopodia in which networks or bundles of F-Ac filaments were found connecting to extracellular fibrin strand through cell membrene. Microfilaments formed arrow-head decoration with HMM pointing toward the cell body. The cytoskeleton in contracted PLs contained thick filaments of My-polymers attaching to F-Ac filaments end by end. It is concluded that the reorganization of Ac-My is the basis for the shape change, secretion and clot retraction of activated PLs.

It is established that stimulation of human platelets with thrombin for 60 s in the absence of fibrinogen increases the amount of PIPp compared with unstimulated controls (4.7 ± 0.24 nmol/109 plat, vs 3.83 ± 0.14 nmol/109 plat., p<0.01, n=8). However, stimulation with thrombin for 60 s in the presence of fibrinogen causes a large decrease in the amount of PIP2 that can be extracted with acidified chloroform/methanol compared with unstimulated controls (1.62 ± 0.39 nmol/109 plat, vs 3.84 ± 0.44 nmol/109 plat., p<0.001, n=6). Stimulation of rabbit platelets with thrombin in the presence of fibrinogen also decreases the amount of extractable PIP2 (60% at 60 s, p<0.001, n=8). Similar decreases in amount can not be demonstrated for phosphatidylinositol 4-phosphate, phosphatidylinositol, phosphatidic acid or phosphatidylcholine under the same conditions, indicating that the decrease is specific for PIP2. With rabbit platelets, polymerized fibrin formed by reptilase, which does not stimulate platelets or induce clot retraction, does not cause the decrease in extractable PIP, (3.06 ± 0.05 nmol/109 plat, were extracted compared with 3.182 ± 0.07 nmol/109 plat, without reptilase). However, stimulation of rabbit platelets with ADP in the presence of polymerizing fibrin formed by reptilase causes | larger decrease in extractable PIP2 (to 2.54 ± 0.19 nmol/109 plat., p<0.05, n=4) than is caused Dy ADP and fibrinogen alone (to 2.87 ± 0.06 nmol/10 plat., p<0.05, n=4). Inhibition by glycyl-L-prolyl-L-arginyl-L-proline of polymerization of fibrin formed by the action of thrombin prevents the large.decrease in the amount of extractable PIP2 (4.37 ± 0.30 nmol/10 plat, were extracted) from human platelets. These results indicate that the interaction of polymerizing fibrin with stimulated platelets is required for the decrease in PIP2. The decrease in extractable PIP2 seen with polymerizing fibrin can not be explained by increased degradation of PIP2 to IP3 or PIP. Thus, when human or rabbit platelets are stimulated with thrombin in the presence of fibrinogen, an association of polymerizing fibrin with the stimulated platelets occurs that leads to decreased extractability of PIP2. This may mean that PIP2 forms a specific association with pratelet proteins that are involved in clot retraction.

A 17-year-old boy with a life long history of easy bruising, epistaxis, subcutaneous hematoma and prolonged bleeding time from minor injuries, was initially diagnosed as having von Willebrand's disese, when he presented epistaxis at 2 years of age. Since his initial diagnosis, he has been treated with cryoprecipitate on many occasions to correct his bleeding tendency. The laboratory findings in the patient and his family are summarized in the table. The patient's mother, father and one brother have not complained any bleeding tendency.Multimeric analysis of vWF using SDS agarose gels showed absence of large multimer in the patient's plasma, decreased large multimer in mother's and brother's plasma. When the patient's PRP was tested for aggregation and release of ATP by ADP, epinephrine and collagen, using lumi aggregometer, platelet aggregation was abnormal as shown by disaggregation and almost no ATP activity was detectable in the supernatant. ATP contents of patient's and father's platelet was about 50% of normal platelets. Washed platelets of the patient in normal plasma did not aggregate normally, but washed normal platelets in the patient's plasma aggregate normally. No inhibitor of vWF could be demonstrated in the patient's plasma. Clot retraction was normal. These findings suggest that our patient has inherited vWD from materal side and the platelet aggregation defect, probably a kind of storage pool disease, from the paternal side of the family.

A new drug, DN.9693, has low Km phosphodiesterase inhibitory properties. Its effect on seven broad spectrum platelet "function" tests has been compared with the effects of prostacyclin E1 (PGI1) and prostaglandin E (PGE ). The tests were (1) platelet aggregation induced by ADP, collagen, adrenaline, thrombin, arachidonic acid and ristocetin; (2) a new test in which platelets aggregate after adding distilled water to cause osmotic stress; (3) the loss of platelets washed in buffered saline; (4) clot retraction; (5) the glass bead column platelet retention test; (6) the in vitro filter "bleeding time" (see two other submitted abstracts); (7) the amount of platelet factor 4 (PF4) which "leaks" from platelets at room temperature.PGI2 inhibited all seven tests, 50% inhibition of the various tests required from 0.1 to 44ng/ml of PGI2. PGE1 also inhibited in all tests but on average required 18 times higher concentrations. Thus an increase in cAMP may be relevant to all these tests, but an understanding of the mechanisms involved is incomplete. DN.9693 inhibited only the first four tests; the equi-active concentration was about 600 times that of PGI2. DN.9693, 2.5μg/ml, caused 50% inhibition of ristocetin induced aggregation and at 4μg/ml had a minor effect on the filter bleeding time. Thus DN.9693 may affect the platelet membrane glycoproteins. In conclusion it is confirmed that PGE1 is less active than PGI^ but has similar activities. DN.9693 whenstudied in these tests has many, but notall, of the prostaglandin-like properties.

Lomustin (CCNU) is a cytostatic drug that is used in the trea-tement of some forms of solid tumors and hemoblastosis. The most important form of toxicity associated with its use consists of thrombocytopenia often associated with hemorrhagic syndrome. Lomustin may exert its action on the formation of platelets, but it may also interfere with platelets themselves.In the present study its influence on the platelet function was investigated using a wide battery of tests.Platelet-rich plasma was incubated with lomustin (1,5 to 15 jjg/ml and 30 minutes at 37°C) in vitro.This inhibited strongly aggregation by ADP (2 × 10-6 M), adrenaline (2×10−6 M) and collagen (15 ¼g/ml). Platelet factor 4 release was almost completly inhibited independently of the inducer used. 14C-serotonin release was decreased by approximately 70% when incubation proceeded in the presence of 15 ¼g/ml of lomustin, and completly at higher concentration. Platelet factor 3 availability was also significantly impaired. Reptilase clot retraction was diminished, regardless of inducer used. In the presence of N-ethyl maleimide (1 mmol) significantLy lower malondialdehyde was produced in platelets incubated with lomustin, than in that from normal controls. After addition of arachidonic acid (1 mmol), the platelet synthesized Less thromboxane B2. Lomustin did not interfere with coagulation factors and did not induce overt fibrinolysis.Its is concluded that lomustin acts as an inhibitor of platelet functions and can induce an acquired thrombocytopathy.Thus impairement of platelet functions might play a part in hemorrhagic complications accompanying in some cases lomustin therapy.