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Preparation of Washed Human Platelets for Quantitative Metabolic Flux Studies
Published on: January 10, 2025
Aspirin sensitivity of platelet aggregation in diabetes mellitus
Stewart G Albert1, Bibi I Hasnain, Detlef G Ritter
1Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Saint Louis University School of Medicine, 1402 South Grand Blvd., St. Louis, MO 63104, USA. albertsg@slu.edu
Insights
Patients with poorly controlled diabetes show normal aspirin sensitivity in platelet aggregation and prostaglandin suppression. However, aspirin resistance is noted with ADP-mediated platelet aggregation, suggesting other factors may affect aspirin
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Pharmacology
Background:
- Aspirin is cardioprotective in high-risk individuals.
- Many patients with diabetes mellitus (DM) do not experience aspirin's cardioprotective benefits.
- Poorly controlled diabetes may influence aspirin responsiveness.
Purpose of the Study:
- To investigate aspirin sensitivity in platelet function in individuals with poorly controlled diabetes mellitus.
- To determine if cardiovascular unresponsiveness to aspirin in diabetes is linked to in vitro platelet function.
Main Methods:
- Assessed aspirin sensitivity via platelet aggregation assays and urinary prostaglandin metabolite levels (2,3 dinor thromboxane B2 and 2,3 dinor 6-keto PGF1alpha).
- Compared 10 individuals with poorly controlled diabetes (glycohemoglobin 11.9+/-2.2%) to 10 age- and sex-matched controls.
- All participants received 81 mg aspirin daily after a 2-week washout period.
Main Results:
- Individuals with poorly controlled diabetes and controls demonstrated similar aspirin sensitivity to platelet aggregation induced by arachidonic acid and collagen.
- Aspirin sensitivity to ADP-mediated platelet aggregation was observed in half of the participants with diabetes and half of the controls.
- Urinary prostaglandin metabolites (TxB2 and PGF1alpha) were suppressed in both groups, with no significant differences between those with and without diabetes.
Conclusions:
- Poorly controlled diabetes does not appear to cause differential lack of aspirin sensitivity in platelet aggregation or prostaglandin suppression.
- Aspirin resistance was most evident in ADP-mediated platelet aggregation, irrespective of diabetes status.
- The lack of aspirin's cardioprotective effect in diabetes may stem from undefined platelet function aspects beyond the tested parameters.
Abstract:
Although aspirin is cardioprotective in high-risk populations, many with diabetes mellitus (DM) are unresponsive to these benefits. We questioned whether cardiovascular unresponsiveness might be demonstrated by lack of aspirin sensitivity to in vitro platelet functions especially in subjects with poorly controlled diabetes. Six women and 4 men (48+/-8 years [mean+/-S.D.]), selected for poor control (glycohemoglobin 11.9+/-2.2%) and 10 sex-age (+/-5 years) matched controls received 81 mg aspirin daily. There was a 2-week washout from aspirin and related drugs. After the aspirin dose on day-7, blood for platelet aggregation assays, and 24-h urine for 2,3 dinor thromboxane B2 (TxB2) and 2,3 dinor 6-keto (PGF1alpha) were obtained. Aspirin sensitivity was defined as inhibition (i.e., lower than expected) platelet aggregation after exposure to an agonist. Those with diabetes and controls were sensitive to aspirin inhibition of platelet aggregation induced by 1.6 mM arachidonic acid (9.5+/-3.9% versus 9.1+/-3.1%, normal range 40-100%) and by 0.83 microg/mL collagen (17.4+/-13.9% versus 13.2+/-9.3%, normal range 60-93%), respectively. Aspirin sensitivity to 2 microM ADP was present in five with diabetes and five controls. Urinary prostaglandin metabolites were suppressed below reference ranges, without differences between those with DM or controls for TxB2 (350+/-149 pg/mg versus 348+/-93 pg/mg creatinine) and PGF1alpha (255+/-104 pg/mg versus 222+/-88 pg/mg creatinine). In conclusion, in poorly controlled diabetes, there was no differential lack of aspirin sensitivity to platelet aggregation, or lack of aspirin suppression of urinary TxB2 or PGF1alpha, compared with controls on aspirin. Despite suppression of urinary prostaglandin metabolites, aspirin resistance was most apparent to ADP-mediated platelet aggregation. It is not known what level of inhibition of in vitro tests is necessary for the cardioprotective benefits of aspirin in diabetes mellitus. Thus, the lack of aspirin protection in diabetes may be due to undefined aspects of platelet function.
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