The mechanism by which thrombotic vessel occlusion occurs independently of plaque development or endothelial cell (EC) disruption remains unclear, largely because of an inability to visualize the formation of thrombus, especially at the single-platelet level in real time. Here we demonstrate that rapidly developing thrombi composed of discoid platelets can be induced in the mesenteric capillaries, arterioles, and large-sized arteries of living mice, enabling characterization of the kinetics of thrombosis initiation and the multicellular interrelationships during thrombus development. Platelet aggregation without EC disruption was triggered by reactive oxygen species (ROS) photochemically induced by moderate power laser irradiation. The inflammatory cytokines TNF-␣ and IL-1 could be key components of the EC response, acting through regulation of VWF mobilization to the cell surface. Thrombus formation was then initiated by the binding of platelet GPIb␣ to endothelial VWF in our model, and this effect was inhibited by the ROS scavenger N-acetylcysteine. Actin linker talindependent activation of alphaIIb-beta3 integrin or Rac1 in platelets was required for late-phase thrombus stability. Our novel imaging technology illustrates the molecular mechanism underlying inflammation-based thrombus formation by discoid platelets on undisrupted ECs and suggests control of ROS could be a useful therapeutic target for the prevention of thrombotic diseases. (Blood. 2012;119(8): e45-e56)
IntroductionIt is evident that inflammation plays a central role in the pathogenesis of cerebral and cardiovascular diseases, and the thrombotic response is an integral part of these inflammatory processes. Proinflammatory cytokines such as TNF-␣ and IL-1 promote coagulation with increased tissue factor expression, 1 which in turn induces synthesis of pro-IL-1 in platelets. 2 However, the cytokinerelated, multicellular kinetics at the single-platelet level during the development of thrombus in vivo remain unclear because of the absence of a real-time visualization technique with sufficient resolution to assess single-platelet kinetics in living animals.FeCl 3 -induced thrombus formation in carotid arteries is a frequently used model, but it takes minutes to completely occlude the affected vessel. 3,4 Moreover, this method does not allow one to track single-platelet kinetics during the formation of thrombus. Jackson et al succeeded in following a single discoid platelet in a developing thrombus and suggested activated platelets mediate the formation of thrombus via shape changes under low shear conditions, whereas discoid platelets are incorporated into growing thrombi only under high shear conditions. 5,6 However, the precise mechanisms are unknown. In addition, conventional thrombosis models appear to involve endothelial cell (EC) disruption and exposure of the subendothelial matrix.However, it is now clinically evident that platelet aggregation can occur on undisrupted endothelium within atherosclerotic lesions, 7 making it important for us to...