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2015 ; 126
(15
): 1844-55
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Genetic diminution of circulating prothrombin ameliorates multiorgan pathologies
in sickle cell disease mice
#MMPMID26286849
Arumugam PI
; Mullins ES
; Shanmukhappa SK
; Monia BP
; Loberg A
; Shaw MA
; Rizvi T
; Wansapura J
; Degen JL
; Malik P
Blood
2015[Oct]; 126
(15
): 1844-55
PMID26286849
show ga
Sickle cell disease (SCD) results in vascular occlusions, chronic hemolytic
anemia, and cumulative organ damage. A conspicuous feature of SCD is chronic
inflammation and coagulation system activation. Thrombin (factor IIa [FIIa]) is
both a central protease in hemostasis and a key modifier of inflammatory
processes. To explore the hypothesis that reduced prothrombin (factor II [FII])
levels in SCD will limit vaso-occlusion, vasculopathy, and inflammation, we used
2 strategies to suppress FII in SCD mice. Weekly administration of FII antisense
oligonucleotide "gapmer" to Berkeley SCD mice to selectively reduce circulating
FII levels to ?10% of normal for 15 weeks significantly diminished early
mortality. More comprehensive, long-term comparative studies were done using mice
with genetic diminution of circulating FII. Here, cohorts of FII(lox/-) mice
(constitutively carrying ?10% normal FII) and FII(WT) mice were tracked in
parallel for a year following the imposition of SCD via hematopoietic stem cell
transplantation. This genetically imposed suppression of FII levels resulted in
an impressive reduction in inflammation (reduction in leukocytosis,
thrombocytosis, and circulating interleukin-6 levels), reduced endothelial cell
dysfunction (reduced endothelial activation and circulating soluble vascular cell
adhesion molecule), and a significant improvement in SCD-associated end-organ
damage (nephropathy, pulmonary hypertension, pulmonary inflammation, liver
function, inflammatory infiltration, and microinfarctions). Notably, all of these
benefits were achieved with a relatively modest 1.25-fold increase in prothrombin
times, and in the absence of hemorrhagic complications. Taken together, these
data establish that prothrombin is a powerful modifier of SCD-induced end-organ
damage, and present a novel therapeutic target to ameliorate SCD pathologies.