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Vol. 305, Issue 1, 9-16, April 2003
Departments of Medicine (A.J.M., M.J.B., J.H.F., N.I.), Pathology
(A.J.M.), and Pharmacology (C.S., R.L.); Weill Medical College of
Cornell University, Medical Service/Hematology-Oncology (A.J.M.,
M.J.B., J.H.F., N.I.), Veterans Affairs New York Harbor Healthcare
System, Division of Cardiology (D.J.P.) and Division of Circulatory
Physiology (D.J.P.), Department of Medicine, College of Physicians and
Surgeons, Columbia University, New York, New York
Platelets are responsible for maintaining vascular integrity. In
thrombocytopenic states, vascular permeability and fragility increase,
presumably due to the absence of this platelet function. Chemical or
physical injury to a blood vessel induces platelet activation and
platelet recruitment. This is beneficial for the arrest of bleeding
(hemostasis), but when an atherosclerotic plaque is ulcerated or
fissured, it becomes an agonist for vascular occlusion (thrombosis).
Experiments in the late 1980s cumulatively indicated that endothelial
cell CD39
an ecto-ADPase
reduced platelet reactivity to most
agonists, even in the absence of prostacyclin or nitric oxide. As
discussed herein, CD39 rapidly and preferentially metabolizes ATP and
ADP released from activated platelets to AMP, thereby drastically
reducing or even abolishing platelet aggregation and recruitment. Since
ADP is the final common agonist for platelet recruitment and thrombus
formation, this finding highlights the significance of CD39. A
recombinant, soluble form of human CD39, solCD39, has enzymatic and
biological properties identical to the full-length form of the molecule
and strongly inhibits human platelet aggregation induced by ADP,
collagen, arachidonate, or TRAP (thrombin receptor agonist peptide). In
sympathetic nerve endings isolated from guinea pig hearts, where
neuronal ATP enhances norepinephrine exocytosis, solCD39 markedly
attenuated norepinephrine release. This suggests that NTPDase
(nucleoside triphosphate diphosphohydrolase) could exert a
cardioprotective action by reducing ATP-mediated norepinephrine
release, thereby offering a novel therapeutic approach to myocardial
ischemia and its consequences. In a murine model of stroke, driven by
excessive platelet recruitment, solCD39 reduced the sequelae of stroke,
without an increase in intracerebral hemorrhage. CD39 null mice,
generated by deletion of apyrase-conserved regions 2 to 4, exhibited a
decrease in postischemic perfusion and an increase in cerebral infarct
volume when compared with controls. "Reconstitution" of CD39 null
mice with solCD39 reversed these changes. We hypothesize that solCD39
has potential as a novel therapeutic agent for thrombotic diatheses.
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