Heparin-induced thrombocytopenia (HIT)is due primarily to IgG antibodies specific to platelet factor 4/heparin complexes (PF4/Hs) that activate platelets via Fc␥RIIA. CD148 is a protein tyrosine phosphatase that regulates Src kinases and collagen-induced platelet activation. Three polymorphisms affecting CD148 (Q276P, R326Q, and D872E) were studied in HIT patients and 2 control groups, with or without antibodies to PF4/Hs. Heterozygote status for CD148 276P or 326Q alleles was less frequent in HIT patients, suggesting a protective effect of these polymorphisms. Aggregation tests performed with collagen, HIT plasma, and monoclonal antibodies cross-linking Fc␥RIIA showed consistent hyporesponsiveness of platelets expressing the 276P/ 326Q alleles. In addition, platelets expressing the 276P/326Q alleles exhibited a greater sensitivity to the Src family kinases inhibitor dasatinib in response to collagen or ALB6 cross-linking Fc␥RIIA receptors. Moreover, the activatory phosphorylation of Src family kinases was considerably delayed as well as the phosphorylation of Linker for activation of T cells and phospholipase C␥2, 2 major signaling proteins downstream from Fc␥RIIA. In conclusion, this study shows that CD148 polymorphisms affect platelet activation and probably exert a protective effect on the risk of HIT in patients with antibodies to PF4/Hs. (Blood. 2012; 120(6):1309-1316)
IntroductionHeparin-induced thrombocytopenia (HIT) results from an atypical immune response to platelet factor 4/heparin complexes (PF4/Hs), with rapid synthesis of platelet-activating IgG antibodies that activate platelets via Fc␥RIIA receptors. 1 The risk of HIT is probably dependent on the intensity of this immune response, because the likelihood of developing thrombocytopenia and thrombotic complications has been related to the plasma levels of IgG antibodies to PF4. 2,3 However, the reasons explaining why only a subset of patients treated with heparin and who develop significant levels of IgG to PF4/Hs will present with HIT remain to be fully defined.Protein tyrosine kinases (PTKs) and protein tyrosine phosphatases (PTPs) are crucial for the regulation of signaling pathways involved in the control of several cellular processes, including immune responses and platelet activation. Dysregulation of the equilibrium between PTK and PTP function can therefore have pathologic consequences. 4,5 Among PTKs, Src family kinases (SFKs) have an important role in regulating immune responses and platelet adhesion, activation, and aggregation. 6 SFKs are essential in the platelet Fc␥RIIA-dependent signaling pathway, and it was recently demonstrated that dasatinib, a SFK inhibitor, prevents platelet activation induced by HIT antibodies. 7 In addition, SFKs are involved in collagen-dependent platelet activation via glycoprotein VI (GPVI). 8 After collagen/GPVI interaction or Fc␥RIIA cross-linking, SFKs induce phosphorylation of conserved tyrosine residues within the immunoreceptor tyrosine-based activation motif, providing a docking site for the tyrosine...