Thromb Haemost 2008; 100(04): 663-669
DOI: 10.1160/TH07-10-0602
Cellular Proteolysis and Oncology
Schattauer GmbH

Platelet-derived microparticles and coagulation activation in breast cancer patients

Bettina Toth
1   Department of Obstetrics and Gynecology – Großhadern, Ludwig-Maximilians-University, Munich, Germany
,
Susanne Liebhardt
1   Department of Obstetrics and Gynecology – Großhadern, Ludwig-Maximilians-University, Munich, Germany
,
Kerstin Steinig
1   Department of Obstetrics and Gynecology – Großhadern, Ludwig-Maximilians-University, Munich, Germany
,
Nina Ditsch
1   Department of Obstetrics and Gynecology – Großhadern, Ludwig-Maximilians-University, Munich, Germany
,
Andreas Rank
2   Department of Internal Medicine III – Großhadern, Ludwig-Maximilians-University, Munich, Germany
,
Ingo Bauerfeind
1   Department of Obstetrics and Gynecology – Großhadern, Ludwig-Maximilians-University, Munich, Germany
,
Michael Spannagl
3   Department of Transfusion Medicine and Haemostaseology, Clinic of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany
,
Klaus Friese
1   Department of Obstetrics and Gynecology – Großhadern, Ludwig-Maximilians-University, Munich, Germany
,
Armin J. Reininger
3   Department of Transfusion Medicine and Haemostaseology, Clinic of Anaesthesiology, Ludwig-Maximilians-University, Munich, Germany
› Institutsangaben
Financial support: Bettina Toth was supported by grants of the “Friedrich Baur Stiftung”, the “Förderung für Forschung und Lehre” (FöFoLe) Program, the “Hochschul-Wissenschafts-Programm“, and the LMUexcellent Mentoring Program, all Ludwig-Maximilians-University, Munich, Germany.
Weitere Informationen

Publikationsverlauf

Received 10. Oktober 2007

Accepted after major revision 10. Juli 2008

Publikationsdatum:
22. November 2017 (online)

Summary

In the mid 1800s Trousseau observed cancer-associated thrombosis, of which the underlying pathogenesis still remains unknown. We performed a prospective study on platelet-derived microparticles (PMP) and their procoagulant potential in breast cancer patients. Fifty-eight breast cancer patients and 13 women with benign breast tumors were included in the study. Microparticles (MP) were examined by electron microscopy and FACS analysis using labels for annexinV (total numbers), CD61 (PMP), CD62P and CD63 (activated platelets), CD62E (endothelial cells), CD45 (leukocytes) as well as CD142 (tissue factor). Prothrombin fragment 1+2 (F1+2) and thrombin generation were measured as blood coagulation markers. Numbers of annexin V+-MP were highest in breast cancer patients with larger tumor size (T2; median = 5,637×106/l; range = 2,852–8,613) and patients with distant metastases (M1; median = 6,102×106/l; range = 3,350–7,445), and differed significantly from patients with insitu tumor (Tis; median = 3,220×106/l; range = 2,277–4,124; p = 0.019), small tumor size (T1; median = 3,281×106/l; range 2,356–4,861; p = 0.043) and women with benign breast tumor (median = 4,108×106/l; range = 2,530–4,874; p = 0.040). A total of 82.3% of MP were from platelets,14.6 % from endothelial cells and 0.3% from leukocytes. Less than 10% of PMP showed degranulation markers. Larger tumor size (T2) and metastases correlated with high counts of PMP and with highest F1+2 levels. Since prothrombin levels and thrombin generation did not parallel MP levels, we speculate that MP act in the microenvironment of tumor tissue and may thus not be an exclusive parameter reflecting in-vivo procoagulant activity.

Footnote: This work contains part of the doctoral thesis of Kerstin Steinig and Susanne Liebhardt.


 
  • References

  • 1 Pruemer J. Prevalence, causes, and impact of cancer-associated thrombosis. Am J Health Syst Pharm 2005; 62 (22) (Suppl. 05) S4-6.
  • 2 Lee AY. Thrombosis and cancer: the role of screening for occult cancer and recognizing the underlying biological mechanisms. HematologyAm Soc Hematol Educ Program 2006; 438-443.
  • 3 Iversen LH, Okholm M, Thorlacius-Ussing O. Pre-and postoperative state of coagulation and fibrinolysis in plasma of patients with benign and malignant colorectal disease--a preliminary study. Thromb Haemost 1996; 76: 523-528.
  • 4 Sallah S, Husain A, Sigounas V. et al. Plasma coagulation markers in patients with solid tumors and venous thromboembolic disease receiving oral anti-coagulation therapy. Clin Cancer Res 2004; 10: 7238-7243.
  • 5 Oya M, Akiyama Y, Okuyama T. et al. High pre-operative plasma D-dimer level is associated with advanced tumor stage and short survival after curative resection in patients with colorectal cancer. Jpn J Clin Oncol 2001; 31: 388-394.
  • 6 Callander NS, Varki N, Rao LV. Immunohisto-chemical identification of tissue factor in solid tumors. Cancer 1992; 70: 1194-1201.
  • 7 Nakasaki T, Wada H, Shigemori C. et al. Expression of tissue factor and vascular endothelial growth factor is associated with angiogenesis in colorectal cancer. Am J Hematol 2002; 69: 247-254.
  • 8 Boccaccio C, Sabatino G, Medico E. et al. The MET oncogene drives a genetic programme linking cancer to haemostasis. Nature 2005; 434: 396-400.
  • 9 Rauch U, Antoniak S. Tissue factor-positive microparticles in blood associated with coagulopathy in cancer. Thromb Haemost 2007; 97: 9-10.
  • 10 Kim HK, Song KS, Park YS. et al. Elevated levels of circulating platelet microparticles, VEGF, IL-6 and RANTES in patients with gastric cancer: possible role of a metastasis predictor. Eur J Cancer 2003; 39: 184-191.
  • 11 Kanazawa S, Nomura S, Kuwana M. et al. Mono-cyte-derived microparticles may be a sign of vascular complication in patients with lung cancer. Lung Cancer 2003; 39: 145-149.
  • 12 Del Conde I, Bharwani LD, Dietzen DJ. et al. Microvesicle-associated tissue factor and Trousseau's syndrome. J Thromb Haemost 2007; 05: 70-74.
  • 13 Hron G, Kollars M, Weber H. et al. Tissue factor-positive microparticles: cellular origin and association with coagulation activation in patients with colorectal cancer. Thromb Haemost 2007; 97: 119-123.
  • 14 Savasan S, Buyukavci M, Buck S. et al. Leukaemia/ lymphoma cell microparticles in childhood mature B cell neoplasms. J Clin Pathol 2004; 57: 651-653.
  • 15 Pihusch V, Rank A, Steber R. et al. Endothelial cell-derived microparticles in allogeneic hematopoietic stem cell recipients. Transplantation 2006; 81: 1405-1409.
  • 16 Tesselaar ME, Romijn FP, Van Der Linden IK. et al. Microparticle-associated tissue factor activity: a link between cancer and thrombosis?. J Thromb Haemost 2007; 05: 520-527.
  • 17 Furie B, Furie BC. Role of platelet P-selectin and microparticle PSGL-1 in thrombus formation. Trends Mol Med 2004; 10: 171-178.
  • 18 Nieuwland R, Berckmans RJ, Rotteveel-Eijkman RC. et al. Cell-derived microparticles generated in patients during cardiopulmonary bypass are highly procoagulant. Circulation 1997; 96: 3534-3541.
  • 19 Berckmans RJ, Nieuwland R, Tak PP. et al. Cell-derived microparticles in synovial fluid from inflamed arthritic joints support coagulation exclusively via a factor VII-dependent mechanism. Arthritis Rheum 2002; 46: 2857-2866.
  • 20 Biro E, Sturk-Maquelin KN, Vogel GM. et al. Human cell-derived microparticles promote thrombus formation in vivo in a tissue factor-dependent manner. J Thromb Haemost 2003; 01: 2561-2568.
  • 21 Nieuwland R, Berckmans RJ, McGregor S. et al. Cellular origin and procoagulant properties of microparticles in meningococcal sepsis. Blood 2000; 95: 930-935.
  • 22 Satta N, Toti F, Feugeas O. et al. Monocyte vesiculation is a possible mechanism for dissemination of membrane-associated procoagulant activities and adhesion molecules after stimulation by lipopolysaccharide. J Immunol 1994; 153: 3245-3255.
  • 23 Falati S, Liu Q, Gross P. et al. Accumulation of tissue factor into developing thrombi in vivo is dependent upon microparticle P-selectin glycoprotein ligand 1 and platelet P-selectin. J Exp Med 2003; 197: 1585-1598.
  • 24 Del Conde I, Shrimpton CN, Thiagarajan P. et al. Tissue-factor-bearing microvesicles arise from lipid rafts and fuse with activated platelets to initiate coagulation. Blood 2005; 106: 1604-1611.
  • 25 Berckmans RJ, Neiuwland R, Boing AN. et al. Cell-derived microparticles circulate in healthy humans and support low grade thrombin generation. Thromb Haemost 2001; 85: 639-646.
  • 26 Reininger AJ, Heijnen HF, Schumann H. et al. Mechanism of platelet adhesion to von Willebrand factor and microparticle formation under high shear stress. Blood 2006; 107: 3537-3545.
  • 27 Villmow T, Kemkes-Matthes B, Matzdorff AC. Markers of platelet activation and platelet-leukocyte interaction in patients with myeloproliferative syndromes. Thromb Res 2002; 108: 139-145.
  • 28 Ruggeri ZM, Dent JA, Saldivar E. Contribution of distinct adhesive interactions to platelet aggregation in flowing blood. Blood 1999; 94: 172-178.
  • 29 Toth B, Nieuwland R, Liebhardt S. et al. Circulating microparticles in breast cancer patients: a comparative analysis with established biomarkers. Anti-cancer Res 2008; 28 2A 1107-1112.
  • 30 Okorie UM, Denney WS, Chatterjee MS. et al. Determination of surface tissue factor thresholds that trigger coagulation at venous and arterial shear rates: amplification of 100 fM circulating tissue factor requires flow. Blood. 2008 in print.
  • 31 van der Zee PM, Biro E, Ko Y. et al. P-selectin- and CD63-exposing platelet microparticles reflect platelet activation in peripheral arterial disease and myocardial infarction. Clin Chem 2006; 52: 657-664.
  • 32 Michelson AD, Barnard MR, Hechtman HB. et al. In vivo tracking of platelets: circulating degranulated platelets rapidly lose surface P-selectin but continue to circulate and function. Proc Natl Acad Sci USA 1996; 93: 11877-11882.
  • 33 Blann AD, Gurney D, Wadley M. et al. Increased soluble P-selectin in patients with haematological and breast cancer: a comparison with fibrinogen, plasminogen activator inhibitor and von Willebrand factor. Blood Coagul Fibrinolysis 2001; 12: 43-50.