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The biomechanical (Young's modulus, adhesion force, deformability) properties of platelets depend on the cytoskeleton and have an undisputed influence on physiological and pathological processes such as hemostasis and thrombosis. The alterations of these biomechanical properties can be used as label-free diagnostic markers in initiation or progressive diseases such as MYH9-inherited disease. Therefore, the focus of my thesis was to investigate the relationship between the changes in platelet cytoskeleton proteins and the resulting biomechanical properties using biophysical methods.
In the first chapter of my thesis I focused on my review of the biophysical methods that are most commonly used to assess and quantify the biomechanical properties of platelets. In this review, I provide an in-depth insight into the governing principles and instrumentation setup and discuss relevant examples applied to platelet mechanics. In addition, my review also summarizes the limitations of these biophysical methods and highlight latest improvements. The review covers the following techniques: micropipette aspiration, atomic force microscopy (AFM), scanning ion conductance microscopy (SICM), tensile force microscopy on hydrogel substrates, microcolumns, and deformable 3D substrates, and real-time deformability cytometry (RT-DC). This review is directed toward clinician scientists who are interested in exploring applications of single-cell based biophysical approaches in unraveling the role of platelet biomechanics in hemostasis and thrombosis research.
In the second chapter of my thesis, I present my research paper on the influence of commonly used ex vivo anticoagulants on the intrinsic biomechanical properties and functional parameters (e.g. activation profils) of human platelets. To comprehensively assess this, platelets obtained in different ex vivo anticoagulants such as ACD-A, Na-Citrate, K2-EDTA, Li-Heparin, and r-Hirudin were used, and their biomechanical properties were determined by real-time fluorescence and deformability cytometry (RT-FDC). Flow cytometry, and confocal laser scanning fluorescence microscopy were used to determine platelet function properties. K2-EDTA and Li-Heparin were found to affect platelet biomechanics by increasing actin polymerization of non-stimulated human platelets. This increased actin polymerization results in decreased platelet deformation. It is recommended that an ex vivo anticoagulant such as ACD-A, Na-Citrate, or r-Hirudin be chosen for the study of the cytoskeleton of human platelets and, if possible, that it not be exchanged, because comparability of results is not assured. Furthermore, I demonstrate the significance of choosing correct ex vivo anticoagulants in RT-FDC by showing that platelets from a healthy donor and a MYH9 patient with the E1841K point mutation differ in their deformation. This paper is the first comprehensive investigation at the single platelet level to establish the relevance of preanalytical standardization in platelet sample preparation for biomechanical studies.
The third chapter of my thesis is focused on the biomechanical analyses of platelets and thrombi from MYH9-related disease. Here I studied three Myh9 mouse lines with a point mutation in the Myh9 gene at positions 702, 1424, or 1841. Furthermore, two MYH9 patients (MYH9 p.D1424N, MYH9 p.E1841K) were examined. MYH9-related disease (MYH9-RD) presents with macrothrombocytopenia with a moderate bleeding tendency. It is caused by mutations in the MYH9 gene that lead to alteration of non-muscle myosin heavy chains type IIA (NMMHC IIA), resulting in disruption of the platelet cytoskeleton. Western blot analysis, flow cytometry, in vitro aggregometry, and transmission electron microscopy demonstrated that Myh9 point mutant mice have comparable primary function compared to the control group. The heterozygous point mutations in the Myh9 gene resulted in decreased platelet deformation (RT-FDC), decreased platelet adhesion to collagen (single platelet force spectroscopy-SPFS), and decreased platelet-platelet interaction forces (SPFS). Decreased platelet force (Micropost Arrays) results in softer thrombi (colloidal probe Spectroscopy), impaired clot retraction, and thus prolonged bleeding time. The R702C, D1424N, and E1841K mutations have a similar effect on platelet biomechanical functions, although the E1841K mutation had less impact on thrombus formation and stiffness. MYH9-RD patients have an increased risk of bleeding, and the antifibrinolytic drug tranexamic acid (TXA) is one way to control bleeding complications in these patients. It was shown that TXA treatment significantly reduced bleeding time in the three Myh9 mouse models, confirming that the enhanced bleeding phenotype due to decreased platelet forces in Myh9 mutant mice can be compensated by the addition of TXA.
With the biophysical methods and research results presented in my thesis, it is clear that it is essential to study the altered response of the platelet cytoskeleton by cytoskeletal mutations, biochemical, physical stimuli, or by pharmacological aspects. This will provide us with an opportunity to better understand the underlying mechanisms and thus contribute to better clinical treatment.