• Vimentin expressed on the platelet surface serves as adhesive receptor for VWF.The interaction between platelet receptor glycoprotein Iba and the A1 domain of von Willebrand factor (VWF) mediates tethering/translocation of platelets to sites of vascular injury. Unexpectedly, we observed platelets translocating over A1A2A3 domains protein slower than on A1 domain at high shear stress. This observation suggests an additional interaction between A domains and an adhesive receptor. We investigated vimentin because we have data showing the interaction of vimentin with the A2 domain of VWF. Moreover, vimentin is expressed on the platelet surface. This novel interaction was analyzed by using purified VWF, recombinant proteins, anti-vimentin antibodies, parallel flow chamber adhesion assays, flow cytometry, and vimentin-deficient murine platelets. The active form of VWF bound to vimentin, and the purified A2 domain blocked that binding. The interaction of a gain-of-function A1A2A3 mutant with platelet was reduced using anti-vimentin antibody. Platelet adhesion to wild-type (WT) A1A2A3 protein, collagen, and fibrin(ogen) was inhibited (32-75%) by anti-vimentin antibody under high shear stress. Compared with WT mice, platelets from vimentin-deficient mice had a reduced flow-dependent adhesion to both collagen and purified murine VWF. Last, the vimentin knockout mice had a prolonged tail bleeding time. The results describe that platelet vimentin engages VWF during platelet adhesion under high shear stress. (Blood. 2014;123(17):2715-2721 Introduction Atherothrombotic events, including acute coronary syndrome and stroke, are the result of platelet adhesion and activation on the ruptured atherosclerotic plaques. This platelet-mediated arterial thrombosis starts with the contact of the rapidly flowing platelets to components of the damaged blood vessel. von Willebrand factor (VWF), a multimeric plasma and subendothelial glycoprotein, is relevant in mediating platelet adhesion and activation at sites of lesions in the coronary arteries, where high shear conditions prevail.1,2 VWF captures the circulating platelets through its interaction with the platelet receptor glycoprotein (GP)Ib/IX/V complex. This interaction is responsible for the tethering, rolling, and activation of platelets that eventually become firmly adhered, leading to thrombus formation within a coronary artery. 3,4 Mature VWF consists of a 2050-residue subunit formed by domains arranged in the order of D9-D3-A1-A2-A3-D4-B-C. 5 The A1 domain contains the binding site for the platelet receptor GPIba 6 ; the cleavage site for the enzyme ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs)-13 is localized in the A2 domain, 7 and the A3 domain binds to collagen. 8 Unlike the A3 domain, both the A1 and A2 domains do not have access to their ligands until their domain structure is altered.9 This structural modification can be induced by mutations, 10 hydrodynamic forces, 11 immobilization on a surface, or artificially with the modulator ristocetin....

Introduction Disseminated fibrin deposition in the microvasculature such as in disseminated intravascular coagulation (DIC) arises from uninhibited activated coagulation secondary to sustained systemic inflammation. Currently there is no treatment for DIC. Treating the underlying trigger and supportive care are the current recommendations to manage DIC. This study aims at using recombinant von Willebrand factor (VWF) A2 domain polypeptide to inhibit VWF–mediated platelet adhesion to fibrin and prevent DIC. Materials and Methods We use flow chamber assay to test the capacity of purified A2 protein to inhibit platelet adhesion to immobilized fibrin(ogen) and platelet-fibrin clot formation. We use a murine model of lipopolysaccharide-induced DIC to examine the effect of A2 protein on DIC. Results The A2 protein blocked flow-dependent platelet adhesion to fibrin, delayed fibrin polymerization, and inhibited platelet-fibrin clot formation in vitro. The infusion of the purified A2 protein to the endotoxin-treated mice prevented fibrin-rich microthrombi formation in brain, lung, kidney, and liver. It also attenuated levels of inflammatory mediators, and markedly reduced mortality rates at 96 hours. Conclusions The A2 protein inhibited platelet interaction with fibrin(ogen). Furthermore, A2 prevented disseminated fibrin-rich microthrombi and decrease mortality in a lipopolysaccharide-induced DIC murine model. A2 could provide a novel therapeutic approach in critically ill patients with uninhibited activated coagulation and disseminated fibrin deposition such as DIC.