title: Aspirin insensitive thrombophilia: transcript profiling of blood identifies platelet abnormalities and HLA restriction.
abstract: 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.
authors: Department of Medicine, The George Washington University Medical Center, Washington, DC 20037, USA.
authors: Payam
authors: P
authors: Fallahi
authors: Richard
authors: R
authors: Katz
authors: Ian
authors: I
authors: Toma
authors: Ranyang
authors: R
authors: Li
authors: Jonathan
authors: J
authors: Reiner
authors: Kiersten
authors: K
authors: VanHouten
authors: Larry
authors: L
authors: Carpio
authors: Lorraine
authors: L
authors: Marshall
authors: Yi
authors: Y
authors: Lian
authors: Sujata
authors: S
authors: Bupp
authors: Sidney W
authors: SW
authors: Fu
authors: Frederick
authors: F
authors: Rickles
authors: David
authors: D
authors: Leitenberg
authors: Yinglei
authors: Y
authors: Lai
authors: Babette B
authors: BB
authors: Weksler
authors: Frederik
authors: F
authors: Rebling
authors: Zhaoqing
authors: Z
authors: Yang
authors: Timothy A
authors: TA
authors: McCaffrey
mesh_terms: D001241:Aspirin / Q000494:pharmacology / Q000627:therapeutic use*; D001769:Blood / Q000378:metabolism*; D001791:Blood Platelet Disorders / Q000097:blood / Q000175:diagnosis / Q000235:genetics*; D001792:Blood Platelets / Q000378:metabolism / Q000473:pathology*; D004351:Drug Resistance / Q000235:genetics*; D005260:Female; D020869:Gene Expression Profiling; D059848:HLA-DQ alpha-Chains / Q000235:genetics / Q000378:metabolism / Q000502:physiology*; D059845:HLA-DRB4 Chains / Q000235:genetics / Q000378:metabolism / Q000502:physiology*; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D046228:Microarray Analysis; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D012333:RNA, Messenger / Q000032:analysis / Q000378:metabolism; D019851:Thrombophilia / Q000097:blood / Q000188:drug therapy / Q000235:genetics* / Q000473:pathology
chemical_list: D059848:HLA-DQ alpha-Chains; C069050:HLA-DQA1 antigen; D059845:HLA-DRB4 Chains; D010975:Platelet Aggregation Inhibitors; D012333:RNA, Messenger; D001241:Aspirin