Thrombocytopenia has been consistently reported following the administration of adenoviral gene transfer vectors. The mechanism underlying this phenomenon is currently unknown. In this study, we have assessed the influence of von Willebrand Factor (VWF) and P-selectin on the clearance of platelets following adenovirus administration. In mice, thrombocytopenia occurs between 5 and 24 hours after adenovirus delivery. The virus activates platelets and induces platelet-leukocyte aggregate formation. There is an associated increase in platelet and leukocyte-derived microparticles. Adenovirus-induced endothelial cell activation was shown by VCAM-1 expression on virus-treated, cultured endothelial cells and by the release of ultra-large molecular weight multimers of VWF within 1 to 2 hours of virus administration with an accompanying elevation of endothelial microparticles. In contrast, VWF knockout (KO) mice did not show significant thrombocytopenia after adenovirus administration. We have also shown that adenovirus interferes with adhesion of platelets to a fibronectincoated surface and flow cytometry revealed the presence of the Coxsackie adenovirus receptor on the platelet surface. We conclude that VWF and P-selectin are critically involved in a complex platelet-leukocyteendothelial interplay, resulting in platelet activation and accelerated platelet clearance following adenovirus administration.
IntroductionAcute thrombocytopenia has been consistently reported following intravenous administration of adenovirus. [1][2][3] Thrombocytopenia is transient and vector dose-dependent but the mechanism underlying this adverse event currently remains unclear.P-selectin is a member of the selectin family of cell adhesion molecules that mediate binding to specific carbohydrate-containing ligands. The protein is localized in the ␣ granules of platelets and the Weibel-Palade bodies of endothelial cells. 4,5 The most clearly identified ligand for P-selectin is PSGL-1, which is detected on the majority of leukocytes and also present in small amounts on platelets. 6,7 P-selectin supports initial tethering of leukocytes to activated endothelial cells and to activated platelets and mediates leukocyte rolling on the endothelial cell surface. 8 A soluble form of P-selectin resulting from proteolytic shedding of the extracellular domain has been detected in human 9 and mouse 10 plasma and was found to maintain the requirements for ligand binding. 11 Elevated levels of plasma P-selectin are seen in a variety of inflammatory, autoimmune, and thrombotic disorders. 12,13 A critical step in the response to vascular injury is the interaction between platelets and the adhesive protein von Willebrand factor (VWF), which mediates platelet translocation and adhesion to the exposed subendothelium. 14 VWF binding to platelets is mediated through platelet GPIb and this interaction acts as a complementary binding event to the tethering of leukocytes to platelets through a Mac1-P-selectin interaction. 15 Furthermore, activation of the endothelium is...