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2015 ; 36
(22
): 1405-14
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Expression of functional tissue factor by neutrophil extracellular traps in
culprit artery of acute myocardial infarction
#MMPMID25660055
Stakos DA
; Kambas K
; Konstantinidis T
; Mitroulis I
; Apostolidou E
; Arelaki S
; Tsironidou V
; Giatromanolaki A
; Skendros P
; Konstantinides S
; Ritis K
Eur Heart J
2015[Jun]; 36
(22
): 1405-14
PMID25660055
show ga
AIMS: Neutrophil extracellular traps (NETs) are chromatin ?laments released by
activated polymorphonuclear neutrophils (PMNs) and decorated with granule
proteins with various properties. Several lines of evidence implicate NETs in
thrombosis. The functional significance and the in vivo relevance of NETs during
atherothrombosis in humans have not been addressed until now. METHODS AND
RESULTS: Selective sampling of thrombotic material and surrounding blood from the
infarct-related coronary artery (IRA) and the non-IRA was performed during
primary percutaneous revascularization in 18 patients with ST-segment elevation
acute myocardial infarction (STEMI). Thrombi isolated from IRA contained PMNs and
NETs decorated with tissue factor (TF). Although TF was expressed intracellularly
in circulating PMNs of STEMI patients, active TF was specifically exposed by NETs
obtained from the site of plaque rupture. Treatment of NET structures with DNase
I abolished TF functionality measurement. In vitro treatment of control PMNs with
plasma obtained from IRA and non-IRA was further shown to induce intracellular
up-regulation of TF but not NET formation. A second step consisting of the
interaction between PMNs and thrombin-activated platelets was required for NET
generation and subsequent TF exposure. CONCLUSION: The interaction of
thrombin-activated platelets with PMNs at the site of plaque rupture during acute
STEMI results in local NET formation and delivery of active TF. The notion that
NETs represent a mechanism by which PMNs release thrombogenic signals during
atherothrombosis may offer novel therapeutic targets.