6. Biology of hemolysis-triggered pulmonary thrombosis
Patients with hereditary or acquired hemolytic anemias have a high risk of developing in-situ thrombosis of the pulmonary vasculature. While pulmonary thrombosis is a major morbidity associated with hemolytic disorders, the etiological mechanism underlying hemolysis-induced pulmonary thrombosis remains largely unknown. Recently (Brzoska et al JCI-Insight 2020), we used intravital lung microscopy in mice for the first time to assess the pathogenesis of pulmonary thrombosis following deionized-water induced acute intravascular hemolysis. Acute hemolysis triggered the development of αIIbβ3-dependent platelet-rich thrombi in precapillary pulmonary arterioles, which led to the transient impairment of pulmonary blood flow (movie #1 below). The hemolysis-induced pulmonary thrombosis was phenocopied with intravenous ADP- (movie #2 below) but not thrombin-triggered pulmonary thrombosis. Consistent with a mechanism involving ADP release from hemolyzing erythrocytes, the inhibition of platelet-P2Y12 purinergic-receptor signaling attenuated pulmonary thrombosis and rescued blood flow in the pulmonary arterioles of mice following intravascular hemolysis. These findings are the first in vivo studies to suggest that acute intravascular hemolysis promotes ADP-dependent platelet activation leading to thrombosis in the pre-capillary pulmonary arterioles and that thrombin generation most likely does not play a significant role in the pathogenesis of acute hemolysis-triggered pulmonary thrombosis.
Movie #1: https://insight.jci.org/articles/view/139437/sd/3
Legend: Transient pulmonary thrombosis in WT mouse following 150 µl IV dH2O. Platelets (green) and pulmonary microcirculation (purple). t = 0 s corresponds to time before and t > 0 s correspond to time following IV dH2O administration, respectively. White arrow-direction of blood flow within the feeding arteriole.
Movie #2: https://insight.jci.org/articles/view/139437/sd/10.
Legend: Transient pulmonary thrombosis in WT mouse following 2.5 mg/kg IV ADP. Platelets (green) and pulmonary microcirculation (purple). t = 0 s corresponds to time before and t > 0 s correspond to time following IV ADP administration, respectively. White arrow-direction of blood flow within the feeding arteriole. 1.5x original acquisition rate.