Aspirin insensitive thrombophilia: Transcript profiling of blood identifies platelet abnormalities and HLA restriction

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• 作者：Payam Fallahi^a ; ^c ; Richard Katz^a ; ^c ; Ian Toma^a ; ^b ; Ranyang Li^a ; ^b ; Jonathan Reiner^a ; ^c ; Kiersten VanHouten^a ; ^b ; Larry Carpio^a ; ^b ; Lorraine Marshall^a ; ^c ; Yi Lian^a ; ^b ; Sujata Bupp^a ; ^b ; Sidney W. Fu^a ; ^b ; ^e ; Frederick Rickles^a ; ^d ; David Leitenberg^e ; Yinglei Lai^f ; Babette B. Weksler^g ; Frederik Rebling^a ; ^b ; Zhaoqing Yang^a ; ^b ; Timothy A. McCaffrey^a ; ^b ; ^e ; ^mcc@gwu.edu
• 关键词：AA ; arachidonic acid ; aPLs ; antiphospholipid antibodies ; APS ; antiplatelet syndrome ; AR ; aspirin resistance ; ARU ; aspirin reaction units ; CAD ; coronary artery disease ; CEACAM8 ; carcinoembryonic antigen-related cell adhesion molecule 8 ; CLEC7A ; C-type lect
• 刊名：Gene
• 出版年：2013
• 出版时间：15 May, 2013
• 年：2013
• 卷：520
• 期：2
• 页码：131-138
• 全文大小：1105 K

文摘

Aspirin is the most widely used antiplatelet agent because it is safe, efficient, and inexpensive. However, a significant subset of patients does not exhibit a full inhibition of platelet aggregation, termed ¡®aspirin resistance¡¯ (AR). Several major studies have observed that AR patients have a 4-fold increased risk of myocardial infarction (MI), stroke, and other thrombotic events. Arachidonic acid-stimulated whole blood aggregation was tested in 132 adults at risk for ischemic events, and identified an inadequate response to aspirin therapy in 9 patients (6.8 % ). Expression profiling of blood RNA by microarray was used to generate new hypotheses about the etiology of AR. Among the differentially expressed genes, there were decreases in several known platelet transcripts, including clusterin (CLU), glycoproteins IIb/IIIa (ITGA2B/3), lipocalin (LCN2), lactoferrin (LTF), and the thrombopoetin receptor (MPL), but with increased mRNA for the T-cell Th1 chemokine CXCL10. There was a strong association of AR with expression of HLA-DRB4 and HLA-DQA1. Similar HLA changes have been linked to autoimmune disorders, particularly antiphospholipid syndrome (APS), in which autoantibodies to phospholipid/protein complexes can trigger platelet activation. Consistent with APS, AR patients exhibited a 30 % reduction in platelet counts. Follow-up testing for autoimmune antibodies observed only borderline titers in AR patients. Overall, these results suggest that AR may be related to changes in platelet gene expression creating a hyperreactive platelet, despite antiplatelet therapy. Future studies will focus on determining the protein levels of these differential transcripts in platelets, and the possible involvement of HLA restriction as a contributing factor.