Bubble-induced aggregation of platelets: effects of gas species, proteins, and decompression

We show that bubbles containing different gases (N2, He, Ne, Ar, or an O2-CO2-N2 mixture) are equally potent platelet agonists. The synergistic effect of different platelet antagonists does not seem to be affected by the type of gas in the bubbles. In contrast to aggregation in platelet-rich plasma (PRP), bubbles cause only a weak response in gel-filtered platelets (GFP), i.e., comparison of aggregation in protein-rich and protein-poor platelet suspensions may shed light on the role of different plasma proteins. Extracellular fibrinogen promotes bubble-induced platelet aggregation similar to known physiologic agonists, whereas albumin counteracts this aggregation. Bubble-induced aggregation is inhibited in GFP-fibrinogen by 2-deoxy-D-glucose plus antimycin A, suggesting dependency on ATP generation in the platelets and evidence for direct exposure of the "cryptic" fibrinogen receptor by bubbles. Hyperbaric compression and subsequent rapid, inadequate decompression of PRP caused little change in the aggregation response to gas bubbles and epinephrine at 1 bar, but reduced the response to ADP. Bubbles tended not to form before the surface film was broken. Pressure-induced aggregation was apparently metabolically active and not due to passive agglutination; electron microscopic studies and PRP with added glutaraldehyde did not show platelet activation, clumping, or reduced platelet count. In contrast to aggregation caused by pressure, bubble-induced aggregation in PRP at 1 bar (after treatment in the pressure chamber) was nearly completely inhibited by theophylline, a phosphodiesterase inhibitor that increases intracellular platelet cyclic AMP.