Aims: Evidence suggests that platelets are involved in acute rejection and long-term renal allograft dysfunction. We hypothesised that immunosuppressive drugs play a role in activating platelets and therefore allograft dysfunction. We studied the effect of varying doses of cyclosporin A and tacrolimus on platelet activation and degranulation. Methods: Using a standardised phlebotomy technique, blood samples were collected from 20 patients with chronic renal failure and incubated with physiological high and low doses of cyclosporin A (CyA) and tacrolimus. Unstimulated platelets and those stimulated with endogenous agonist ADP were analysed by flow cytometry for P-selectin expression and fibrinogen binding as measures of platelet degranulation and activation, respectively. Results: Relative to control samples, resting platelet degranulation (expression of P-selectin) was increased by both high-dose CyA (17·5%, P = 0·0003) and highdose tacrolimus (23·3%, P < 0·0001). Activation of resting platelets, as measured by fibrinogen binding, was not increased by any of the drug regimes (P > 0·19 for all). However, stimulation of platelets with 10 −6 M ADP caused a significant increase in fibrinogen binding in those platelets incubated with drugs relative to control (high-dose CyA 25·4%, P < 0·0001; low-dose CyA 4·15%, P = 0·045; high-dose tacrolimus 15·3%, P = 0.0001 and low-dose tacrolimus 14·0%, P = 0·0094) and CyA also demonstrated a dose effect (P < 0·0001). Conclusions: CyA and tacrolimus increase resting platelet degranulation and increase fibrinogen binding in platelets stimulated by physiological agonists in a dose-responsive manner. These properties of calcineurin channel inhibitors may have a role in the pathogenesis of chronic allograft nephropathy.
Moynihan Prize 02Recurrence of ductal carcinoma in situ: the role of cyclooxygenase-2 expression