The possible role of physiologic stress hormones in enhancing adhesion of sickle erythrocytes (SS RBCs) to endothelial cells (ECs) in sickle cell disease (SCD) has not been previously explored. We have now found that up-regulation of intracellular cyclic adenosine monophosphate (cAMP)-dependent protein kinase A (PKA) by epinephrine significantly increased sickle but not normal erythrocyte adhesion to both primary and immortalized ECs. Inhibition of serine/threonine phosphatases also enhanced sickle erythrocyte adhesion at least partially through a PKA-dependent mechanism. Adhesion was mediated through LW (intercellular adhesion molecule-4 [ICAM-4], CD242) blood group glycoprotein, and immunoprecipitation studies showed that LW on sickle but not on normal erythrocytes undergoes increased PKA-dependent serine phosphorylation as a result of activation. The major counter receptor for LW was identified as the ␣v3 integrin on ECs. These data suggest that adrenergic hormones such as epinephrine may initiate or exacerbate vaso-occlusion and thus contribute to the association of vasoocclusive events with physiologic stress.
IntroductionIn sickle cell disease (SCD), abnormal adherence of sickle erythrocytes (SS RBCs) to endothelial cells (ECs) has been postulated to be important in the initiation and/or progression of vaso-occlusive crises. [1][2][3] Although many vaso-occlusive episodes are associated with intercurrent illnesses, and thus with release of endotheliumactivating cytokines such as tumor necrosis factor ␣ (TNF-␣), other vaso-occlusive episodes are associated with other types of stressors. We are interested in exploring whether physiologic stress may precipitate vaso-occlusion via activation of red cell adhesion.Human erythrocytes are equipped with a diversity of receptors and effectors that are known to mediate well-characterized signal transduction pathways in nonerythroid cells. 4 Although activation of adhesion receptors via signal transduction is well accepted in nonerythroid cells, until recently, little attention had been paid to the possibility that abnormal SS RBC adhesion might be mediated via signaling mechanisms inducing activation of RBC adhesion receptors. 5,6 Nevertheless, such events could promote, or even initiate, vaso-occlusion.A variety of stimuli, including epinephrine, have been shown to activate the basal cell adhesion molecule-Lutheran (B-CAM/LU) laminin receptor on SS RBCs through a cyclic adenosine monophosphate (cAMP)-dependent protein kinase A (PKA) pathway. 7 Epinephrine is a major stress mediator that elevates cAMP in SS RBCs through stimulation of adrenergic receptors. 7 Cyclic AMP mediates at least some of its effects through activation of PKA. Based on these observations, we postulated that activation of SS RBC adhesion via known signaling pathways might lead to upregulation of SS RBC adhesion to endothelium, even in the absence of plasma bridging proteins. Study of up-regulation of cAMPdependent PKA signaling pathway by epinephrine in SS RBCs has now led to the identificatio...