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Infect Immun, March 1998, p. 1181-1189, Vol. 66, No. 3
0019-9567/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Human Platelets Damage Aspergillus
fumigatus Hyphae and May Supplement Killing by
Neutrophils
Laurent
Christin,1
Deborah R.
Wysong,1
Tova
Meshulam,1
Ryan
Hastey,2
Elizabeth R.
Simons,2 and
Richard
D.
Diamond1,*
Department of Medicine, Section of Infectious
Diseases, Boston Medical Center,1 and
Department of Biochemistry, Boston University School of
Medicine,2 Boston, Massachusetts
Received 29 April 1997/Returned for modification 20 June
1997/Accepted 4 December 1997
 |
ABSTRACT |
Neutropenia is considered a significant risk factor for invasive
aspergillosis but is almost always associated with concurrent thrombocytopenia. Studies determined that platelets, like neutrophils, attached to cell walls of the invasive hyphal form of Aspergillus fumigatus. Organisms were damaged as shown by loss of cell wall integrity in scanning laser confocal microscopy and release of defined
hyphal surface glycoproteins. Rapid expression appearance of surface
antigen CD63 and release of markers of platelet degranulation confirmed
activation during attachment to hyphae. Optimal platelet activation
required opsonization of hyphae with fresh or heat-inactivated whole
plasma. These effects of opsonization with whole plasma could not be
duplicated by pooled human serum, immunoglobulin G, or fibrinogen,
whether used separately or combined. Thus, platelets in the presence of
whole plasma have the potential to play an important role in normal
host defenses against invasive aspergillosis.
 |
INTRODUCTION |
The crucial role of phagocytic
cells, particularly polymorphonuclear neutrophils (PMN), in host
defenses against invasive aspergillosis is supported by the occurrence
of the disease under well-characterized clinical conditions where these
cells are either dysfunctional (7) or scarce
(37). A large body of in vitro evidence and animal data from
our own (14, 15, 20) and other (30) laboratories
corroborates and helps to explain the frequent association between
neutropenia and disseminated aspergillosis.
However, chemotherapy-induced neutropenia rarely occurs without
concomitant thrombocytopenia. Several clinical and experimental observations suggest that platelets, besides preventing hemorrhage, may
contribute to host defenses against a broad range of infections (6, 5). For example, thrombocytopenic rabbits tend to have larger vegetations and higher density of streptococci in an
experimental model of bacterial endocarditis (32). Platelets
stimulated with
-thrombin release a cationic protein (platelet
microbicidal protein [PMP]) which is microbicidal to some strains of
Staphylococcus aureus (35) and Candida
albicans (29). Recent data have shown that resistance
of C. albicans to PMP increases the severity of experimental
Candida endocarditis (36). Platelets also are
cytotoxic in vitro against larvae of Schistosoma sp.
(10, 18, 25) and inhibit growth of Plasmodium
malariae in vitro (26).
Aspergillus hyphae typically invade blood vessels, causing
local thrombosis with consequent distal hemorrhagic infarction. This
characteristic propensity for intravascular invasion preceding and
during dissemination, the association of dissemination with thrombocytopenia, and the known microbicidal capabilities of platelets led us to examine the potential role of platelets in host defenses against infection by Aspergillus fumigatus, the most common
cause of invasive aspergillosis.
Our results established that A. fumigatus hyphae strongly
activated human platelets in vitro and that platelets damaged A. fumigatus hyphae in vitro.
(This work was presented in part at the 34th Annual Meeting of the
Infectious Diseases Society of America, New Orleans, La., 18-20
September 1996 [4a].)
 |
MATERIALS AND METHODS |
Reagents.
All reagents were purchased from Sigma Chemical,
St. Louis, Mo., unless otherwise stated. Experiments involving PMN were
done in phosphate-buffered saline (PBS; BioWhittaker, Walkersville, Md.) with 5.5 mM glucose, 3.4 mM CaCl2, and 5.25 mM
MgCl2 (supplemented PBS). Platelets were suspended in
buffer containing 3.8 mM HEPES with 140 mM NaCl, 3.75 mM
NaH2PO4, 21 mM KCl, 1 mM CaCl2, and 5.5 mM glucose (HEPES-Ca2+).
Organisms.
As in past experiments (22), A. fumigatus conidia from a clinical isolate were harvested from
culture on Sabouraud dextrose agar slants, then suspended in Sabouraud
dextrose broth at 106/ml, and left overnight at room
temperature on a gyrotatory shaker. The swollen conidia were then
germinated at 37°C for 2.5 h. Under these conditions,
90%
formed hyphae.
Opsonization of hyphae.
Samples of fresh blood were either
anticoagulated with EDTA or left to clot at 37°C and then centrifuged
for preparation of autologous plasma or serum, respectively.
Platelet-poor plasma was obtained by centrifugation (2,000 × g for 10 min). Germinated hyphae were resuspended in glass
tubes at 50 × 106/ml with the following opsonic
solutions: pooled human plasma (BioWhittaker), fresh or
heat-inactivated (30 min at 56°C) autologous plasma or serum,
fibrinogen (3 mg/ml), human immunoglobulin G (IgG; 1 mg/ml), and
various combinations of these opsonins. Following 20 min of incubation
at 37°C, hyphae were washed twice, resuspended in the working buffer,
and kept at room temperature until used.
Fluorescent labeling of A. fumigatus hyphae.
Biotinylation of hyphal cell wall glycoproteins was performed by a
previously published method (4), with the following modifications. Freshly germinated hyphae were suspended at 3 × 107/ml in 3 ml of 100 mM phosphate buffer (pH 8.0)
containing N-hydroxysuccinimidobiotin (0.1 mg/ml). Following
15 min of incubation at 37°C with gentle shaking, the hyphae were
washed sequentially with 50 mM (pH 6.0) and 10 mM (pH 7.4) phosphate
buffers and were resuspended (3 × 107/ml) in
HEPES-Ca2+. The biotinylated hyphae were then incubated
with 5 µg of 5-([4, 6-dichlorotriazin-2-yl]amino)fluorescein
(DTAF)-conjugated streptavidin (Jackson ImmunoResearch Laboratories,
West Grove, Pa.) per ml for 10 min at room temperature, hand mixed, and
protected from light. Following two washes with supplemented PBS to
remove any excess of DTAF-conjugated streptavidin, hyphae were
resuspended in working buffer and wrapped in aluminum foil until used.
Biotinylation with or without labeling with fluorescent conjugate did
not alter hyphal viability, ability to activate platelets, or
susceptibility to damage by either platelets or neutrophils.
Microscopy.
Transmitted light imaging and fluorescent light
imaging were performed with a Nikon (Garden City, N.Y.) microscope.
Samples obtained at intervals were photographed with a Nikon 2000 camera and Ektachrome film (Eastman Kodak, Rochester, N.Y.). For
selected experiments, hyphal damage was visualized with a Leica laser
scanning confocal microscope (Leica, Lasertechnik, GmbH, Heidelberg,
Germany) equipped with an argon ion laser (2 to 50 mW). The smallest
apertures were applied to the detection pinhole for optimal signal.
Z-series optical sections were recorded at 0.5 to 1.0 µm, using a
63× (numerical aperture = 1.4) oil immersion lens and stored on
optical disks (27, 34). Computer images were generated and
prints were made with Adobe Photoshop software (San Jose, Ca.).
Preparation of PMN and platelets.
As in past experiments,
PMN (20) and platelets (11) were freshly prepared
for each experiment from blood of healthy volunteer donors. Blood was
anticoagulated with either heparin or citrate for PMN or platelet
preparation, respectively. Blood for PMN preparation was diluted 1:1
with isotonic 3% dextran and incubated for 20 min at 37°C to
accelerate erythrocyte sedimentation. Supernatants were then
centrifuged on Ficoll-metrizoate gradients. Residual erythrocytes were
lysed twice with hypotonic NaCl. Yield of functional PMN, assessed by
nitroblue tetrazolium reduction, was >98%. Immediately before use,
PMN were resuspended in supplemented PBS to final concentrations of
3 × 106 to 6 × 106/ml and kept on
ice until used. Platelet-rich plasma was obtained by centrifugation
of citrate anticoagulated blood. Platelets were separated on Sepharose
2B columns (11), then diluted to final concentrations of
6 × 107 to 20 × 107/ml in
HEPES-Ca2+, and kept at 37°C with continuous gentle
rocking until used. Platelets were prepared in this manner to minimize
the potential for spontaneous activation as shown previously
(11). Spontaneous activation of platelets during the
preparation procedure was identified by change in platelet shape,
aggregation, spontaneous degranulation (judged by
-glucuronidase
release), and lack of response to thrombin stimulation in controls.
Platelets evidencing activation during preparation were discarded.
Platelet activation by Aspergillus was detected by
fluorescent labeling of CD42b (GPIb), an antigen present on plasma
membranes of both resting and activated platelets (31), and
of CD63, which is present on plasma membranes of activated platelets
only (24). Platelets were mixed with Aspergillus
hyphae (ratio 100:1) or activated with
-thrombin (9 nM) and
incubated for 1 h at 37°C. DTAF-conjugated mouse anti-human
CD42b or DTAF-conjugated mouse anti-human CD63 (Becton Dickinson, San
Jose, Calif.) was added at 5 µg/ml (final concentration). After
incubation for 15 min at 37°C, reactions were stopped with 3.7%
buffered formalin. Samples were compared by fluorescence microscopy.
Platelet degranulation.
Following germination, hyphae were
washed once with HEPES-Ca2+ and resuspended in this buffer
at 4 × 107/ml. Resting platelets were mixed with
germinated hyphae in a 40/1 ratio and incubated for 30 min at 37°C
with gentle mixing. Supernatants were obtained by rapid centrifugation
(twice at 104 × g for 4 min) through 80:20
(vol/vol) Dow Corning Contour oil (Nye Lubricants, New Bedford, Mass.).
Samples were kept frozen at
70°C. Samples were diluted 1:10 in
HEPES-Ca2+ buffer for assays of released platelet granule
constituents. Markers used were platelet factor 4 (PF4) for
-granule
release,
-glucuronidase for lysosomal granule release, and serotonin
for
(dense)-granule release.
To determine
-glucuronidase release, 100 µl of sample was mixed
with 200 µl of 6 mM
4-methylumbelliferyl-
-D-glucuronide in 100 mM acetate
buffer (pH 5.0) plus 200 µl of acetate buffer (500 µl, final
volume). Samples were incubated for 30 min at 37°C shielded from
light, 500 µl of 200 mM glycine (pH 10.5) was added to each sample,
and fluorescence was read immediately (excitation, 360 nm; emission,
448 nm; Perkin-Elmer [Weston, Mass.] 650-10S fluorescence
spectrophotometer).
-Glucuronidase release was determined as a
fraction of total
-glucuronidase content obtained from 0.1% Triton
X-100-lysed platelets corrected for background supernatant fluorescence
prior to stimulation.
Serotonin release was measured as previously reported (
12).
Concentrated gel-filtered platelets (4 × 10
9/ml) were
loaded with [
3H]serotonin (4 × 10
5
mCi/ml) for 20 min at 37°C. To prevent serotonin reuptake, the
serotonin analog 13.3 nM imipramine was added within 30 s prior
to
activation. After stimulation, platelets were centrifuged through
contour oil as noted above. After determination of
3H in
each supernatant, serotonin content was expressed as a fraction
of
total serotonin content of 0.1% Triton X-100-lysed platelets.
PF4 release was determined by enzyme-linked immunosorbent assay
(ELISA). After centrifugation of platelet supernatants through
contour
oil, 10 µl of each supernatant was diluted with 90 µl
buffer in
96-well ELISA microtiter plates (Dynatech Laboratories,
Inc.,
Chantilly, Va.) and kept at 4°C for 14 to 16 h. Following
serial
washes to remove unbound contents, plates were blocked
with 3% bovine
serum albumin in PBS and labeled with 0.17 µg of
horseradish
peroxidase-bound mouse anti-PF4 antibody (a generous
gift from
Repligen, Inc., Needham, Mass.) per ml, incubated, and
washed again.
TBM Microwell substrate (Kirkegaard & Perry, Inc.,
Gaithersburg, Md.)
was used for development, and reactions were
stopped with 0.36 N
sulfuric acid. Absorbance was read at 450
nm. Data were normalized to
PF4 release by platelets maximally
stimulated with 9 nM

-thrombin.
Comparison of hyphal damage by platelets and activated platelet
supernatants.
Resting platelets were split into two batches, one
kept resting and the other maximally stimulated with 9 nM
-thrombin
for 5 min. Supernatants were obtained by centrifugation (2,000 × g for 10 min). Following germination and opsonization with
pooled human serum, hyphae were resuspended in HEPES-Ca2+.
Hyphae were incubated for 30 min at 37°C with gentle mixing together
with platelets (platelet/hypha ratio of 100:1 or 400:1)
or with
supernatants (originally obtained from maximally activated
or resting
platelets). Reactions were stopped with 0.5 ml of ice-cold
double-distilled H
2O (ddH
2O). Hyphal pellets
were washed twice
with cold ddH
2O to lyse platelets and
remove supernatants. For
measurement of hyphal metabolic
activity,
2,3-bis[2-methoxy-4-nitro-5-sulfophenyl]2H-tetrazolium-5-carboxanilide
inner salt (XTT) was dissolved by warming in a water bath at 60°C
for
30 min, cooled to room temperature, and mixed with 8 µg of
2,3-dimethoxy-5-methyl-1,4-benzoquinone (Co-Q
0) per ml in
PBS.
Hyphal pellets were resuspended and mixed with 0.5 ml of the
XTT-Co-Q
0 mixture in PBS (
22). Samples were
incubated at 37°C for 30 min
with gentle tumbling, and 100 µl of
centrifuged (10 times at 10
3 ×
g for 2 min at
4°C) supernatants were transferred to microtiter
plate wells.
Absorption was measured at 570 nm. Optical density
at 650 (OD
650) nm was also read to control for nonspecific
absorption.
Hyphal damage was calculated by using the equation 1

([OD
570 hyphae + PMN or platelets or PMN + platelets]/OD
570 hyphae

[OD
570 PMN or
platelets or PMN + platelets/OD
570 hyphae]) × 100.
Estimate of hyphal damage by PMN and platelets.
Triplicate
experiments were performed in 1.5-ml polypropylene microcentrifuge
tubes. Tubes containing hyphae were filled with 60 µl (6 × 105 hyphae) of organisms in HEPES-Ca2+. PMN and
platelets, separately or in combination, were incubated with hyphae.
Incubations were performed as noted above. Incubations thus included
hyphae alone, PMN alone, platelets alone, and PMN plus platelets
combined in each concentration tested (660-µl final volumes in
HEPES-Ca2+).
Following 1 h of incubation at 37°C with gentle tumbling, 0.5 ml
of ice-cold ddH
2O was added to stop reactions. Samples were
centrifuged at 10
4 ×
g for 2 min at 4°C.
Pellets were resuspended with 1 ml of sterile
ddH
2O,
briskly mixed, and allowed to stand at room temperature
for 10 min to
achieve hypotonic lysis of PMN. Platelets and hyphal
pellets were
washed again with ddH
2O; hyphae were resuspended
in 1 ml of
fresh Sabouraud dextrose broth and incubated for 0
to 4 h at
37°C with gentle tumbling. Specimens were centrifuged
(10 times at
10
3 ×
g for 2 min at 4°C), and pellets were
resuspended with 0.5
ml of XTT-Co-Q. Following 30 min of incubation at
37°C with mixing,
damage was calculated by using the formula stated
above.
Data analysis.
Data were analyzed with Sigmastat 1.0 software (Jandel Scientific, San Rafael, Calif.). The Student
t test was used to assess differences of means for normally
distributed variables. Results are presented as mean ± standard
error of the mean (SEM) of percentage of controls unless otherwise
specified.
 |
RESULTS |
Platelet adherence and associated loss of hyphal surface
proteins.
Platelets adhered to surfaces of opsonized A. fumigatus hyphae (Fig. 1 and
2A).
In the early period after attachment, platelets retained rounded oval
configurations (Fig. 2A). With activation, attached platelets tended to
contract and flatten as they spread over hyphal surfaces, imparting a
markedly irregular appearance to hyphal surfaces (Fig. 1). In contrast,
hyphal surfaces without attached platelets retained their normally
smooth, regular appearances (Fig. 2A to C). Over a 1-h incubation
period, platelets induced loss of fluorescent hyphal cell wall
constituents, as observed by laser scanning confocal microscopy (Fig.
2). Fluorescence of fluorescein isothiocyanate-labeled cell walls in
direct contact with attached platelets decreased progressively, whereas
fluorescence intensity did not decrease on the surfaces of hyphal walls
without attached platelets (Fig. 2B to J). Eventually, hyphae within
masses of surrounding, attached platelets lost nearly all fluorescence, while the masses of surrounding platelets accumulated fluorescence in
homogeneous patterns (Fig. 2D to J).

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FIG. 1.
Aggregated platelets completely covering A. fumigatus hyphae. Arrows (length of wide arrow = 5 µm)
denote the irregular pattern formed by the complete coating of hyphal
surfaces with spread, retracted platelets, which have lost the typical
round or oval appearance of unactivated platelets (arrows), consistent
with platelet activation. A broader mass of platelets was present at
the hyphal tip (wide arrow), reflecting the focal variations in the
sizes of platelet aggregates attached to hyphae in these experiments.
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FIG. 2.
Light and laser confocal scanning microscopy of
fluorescein-labeled, biotinylated A. fumigatus hypha during
the course of 0 to 1 h of incubation with platelets. Color images
depict computer-reconstructed stereoscopic fluorescence images formed
by summation of fluorescence of all optical sections of 1-µm
thickness. The intensity of fluorescence is represented by a range of
colors, with brown, orange, yellow, and blue-white reflecting
progression from low to intermediate to high fluorescence intensities.
These color differences can be compared within each of the separate
color images. However, apparent color differences between each of the
separate photographs do not necessarily represent relative changes or
differences in fluorescence intensities. The system did not allow
sufficiently reliable calibration of hyphal and background fluorescence
to permit accurate comparisons of relative differences in fluorescence
between independent color images. (A) A transmitted light image after 5 min of incubation shows early attachment of platelets to a hyphal
surface. Note the oval shapes suggesting unactivated platelets
(straight arrows), as well as the preservation of the normally smooth
hyphal surface (curved arrows). (B) A color confocal image (left) shows
a regular pattern of orange to yellow fluorescence of the hyphal
surface (straight arrow = 10 µm) surrounding the less
fluorescent brown hyphal interior after 1 h of incubation (curved
arrow). (C) Corresponding to panel B, the transmitted light image
(right) defines a single oval platelet (curved arrow) attached to a
small portion of the surface of one hypha after 1 h of incubation.
Note the distinct, regular outline of the hyphal surface in the absence
of attached platelets (straight arrows). (D) In this confocal image
showing opsonized hyphae completely coated by an aggregated mass of
platelets after 1 h of incubation, note the almost complete loss
of discernible hyphal outline and some focal areas of increased
fluorescence within platelet aggregates. Arrows delineate a small area
corresponding to a remnant of a hyphal cell wall within the platelet
mass. (E) A transmitted light image corresponding to panel D shows a
discernible hyphal cell wall remnant within the mass of aggregated
platelets (arrows). (F) A confocal image shows diffuse redistribution
of increased fluorescence throughout a mass of aggregated platelets
(arrows) after 1 h of incubation. (G) Arrows indicate a definable
remnant of a hyphal cell wall in this transmitted light image
corresponding to panel F. Note the location of the hyphal remnant
compared to the irregular distribution of increased fluorescence shown
in the confocal image (F). (H) For most of the hyphae that were
completely surrounded by platelets, cell walls became indistinct and
fluorescence was dispersed throughout the masses of platelets (arrows;
top arrow = 22.5 µm) within 2 h or less, as in this
confocal image taken after 1 h of incubation. (I) In this barely
visible negative image of nonfluorescent hyphal remnant marked by
arrows, some residual fluorescence is scattered within the mass of
adherent platelets. (J) Shown here in a mixed confocal/transmitted
light image, hyphae free of platelets retained relatively uniform
surface fluorescence during 3 h of incubation, even though some
labeled hyphal proteins were released spontaneously over time (Fig. 3),
as expected from previously published work by others (33).
An unattached, oval, apparently unactivated platelet is shown near the
labeled hypha (arrow).
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Consistent with this apparent loss of hyphal wall integrity observed by
microscopy, platelets induced a time-dependent increase
in release of
distinctive fluorescent biotinylated cell wall proteins
into
supernatants (Fig.
3A).
Data previously published by others
established that live hyphae
release certain surface proteins
during normal growth (
33).
Evidence from Wosten and colleagues
(
33) suggests that most
such proteins are released by secretion
at hyphal tips. Beyond this
spontaneous release of hyphal proteins,
separation of
A. fumigatus proteins from supernatants established
that platelets
induced release of additional proteins, in levels
well above those
occurring spontaneously over time (Fig.
3B).
Controls verified that
biotinylation and fluorescent labeling
did not alter hyphal viability,
ability to activate platelets,
or susceptibility to damage by host
cells.

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FIG. 3.
Platelet-triggered release of biotinylated hyphal
cell wall surface proteins. (A) Time-dependent release of
fluorescein-labeled cell wall surface glycoproteins into supernatants
of hyphae incubated with ( ) and without ( ) platelets. (B) Western
blot showing time-dependent release of biotinylated cell wall surface
glycoproteins into supernatants of hyphae exposed to platelets. Lanes 1 to 3, sequential protein release into supernatants from hyphae
incubated with platelets for 1, 2, and 3 h, respectively; lanes 4 and 5, spontaneous protein release into supernatants from hyphae
incubated for 0 and 3 h without platelets. Consistent with
previously published observations by other investigators
(33), certain particular hyphal proteins were secreted
spontaneously and were detectable in increasing amounts over time.
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Platelet activation and degranulation.
Adherence to A. fumigatus hyphae resulted in platelet activation. As expected from
published data by others (31), the CD42b surface antigen
proved to be constitutively expressed on surfaces of both resting and
activated platelets (Fig.
4A).
Interaction of platelets with hyphae clearly induced expression of the
CD63 antigen on platelet surfaces (Fig. 4B), an established antigenic marker for platelet activation (24). In contrast, surfaces
of resting platelets with no attached hyphae did not bind antibodies to
the CD63 activation antigen, as they remained nonfluorescent.

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FIG. 4.
(A) Staining with fluorescein-conjugated monoclonal
anti-CD42b (GPIb) antibody, which binds to an antigen that is
constitutively expressed on surfaces of both resting (arrowhead) and
stimulated platelets (arrows), identifying platelets adhering to large
areas of hyphal cell wall (arrow = 5 µm). (B) Staining of
platelets attached to hyphae with fluorescein-conjugated monoclonal
anti-CD63 (GPIIIa) antibody, reactive with an antigen that is present
exclusively on surfaces of activated platelets. Platelets coating
hyphal cell wall were brightly fluorescent, consistent with activation.
(C) Corresponding transmitted light image showing unattached platelets
(arrows) which remained nonfluorescent (arrow = 5 µm).
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Further supporting hypha-induced platelet activation,
A. fumigatus hyphae that were opsonized with autologous human plasma
also triggered release from all three platelet granule types:
PF4 from

-granules,

-glucuronidase from lysosomal granules,
and serotonin
from

-granules (Fig.
5A). The relative
efficiency
of different opsonins in supporting platelet activation was
assessed
by comparing hypha-induced

-glucuronidase release to
release
of that enzyme from platelets after maximal stimulation with

-thrombin
(MAX). Optimal opsonization occurred with whole plasma
(Fig.
5B).
No significant differences occurred with fresh autologous
plasma
(82.4% ± 9.2% of MAX; mean ± SEM of 12 separate
triplicate experiments),
heat-inactivated (56°C, 30 min) autologous
plasma (98.8% ± 11.7%
of MAX; mean ± SEM of 3 separate
triplicate experiments), or pooled
plasma (60.0% ± 8.3% of MAX;
mean ± SEM of 8 separate triplicate
experiments). In contrast,
only minimal release from platelet
granules was triggered by
unopsonized hyphae or by hyphae which
had been opsonized with pooled
human serum, IgG, or fibrinogen,
whether used separately or in various
combinations in three or
more separate experiments.

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FIG. 5.
Platelet degranulation following interaction with
A. fumigatus hyphae. (A) Effects of A. fumigatus
hyphae opsonized with fresh autologous plasma on release of markers for
platelet -granules (PF4), -granules (serotonin [5-OHT]), and
lysosomal granules ( -glucuronidase [ -glu]). Results depict
mean ± SEM of 3 to 12 separate experiments, each performed in
triplicate. Open bars, responses to opsonized hyphae; solid bars,
responses to unopsonized hyphae. (B) Effects of various opsonins on
platelet degranulation triggered by A. fumigatus hyphae.
-Glucuronidase release following hyphal opsonization with fresh
autologous plasma (AP), heat-inactivated fresh autologous plasma
(HI-AP), pooled plasma (PP), pooled human serum (PHS), heat-inactivated
pooled human serum (HI-PHS), fibrinogen (F), pooled human IgG, and
various combinations compared to that of unopsonized hyphae (UOH).
Results represent mean ± SEM of 3 to 12 separate experiments,
each performed in triplicate.
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Platelet and PMN effects on hyphal metabolic responses.
Activated platelets decreased the ability of hyphae to reduce XTT, a
previously established indicator of fungal cell damage (22).
As shown in Fig. 6A, increasing ratios of
platelets to hyphae from 50:1 to 400:1 in incubations induced
progressive declines in the ability of hyphae to reduce XTT. A 50:1
ratio of platelets to hyphae resulted in a 12.5% ± 4.9% decrease in
hyphal reduction of XTT (P <0.01 compared to corresponding
controls incubated for 1 h in buffer with no platelets or to
zero-time controls, i.e., hyphae mixed with platelets but not
incubated). Significantly greater effects occurred with a 200:1 ratio
of platelets to hyphae (P < 0.001 compared to results
obtained with a 50:1 ratio). Prolongation of hyphal incubations with
platelets beyond 1 h did not further alter effects of platelets on
XTT reduction. However, it remained possible that platelet-mediated
effects on hyphal metabolism were reversible, causing only temporary
suppression of the ability of hyphae to reduce XTT. To determine
whether platelets induced sustained suppression of hyphal metabolic
activity, after 1 h of exposure to platelets, incubations of
hyphae with XTT were prolonged for up to 2 h. Platelet/hypha
ratios of 50:1 and 167:1 were used in eight separate experiments, each
performed with two to four replicates. With both ratios,
platelet-induced decrements in hyphal metabolic activity were
sustained, as there was no recovery of the ability to reduce XTT during
more prolonged incubation with the dye (Fig. 6B). In contrast to intact
platelets, supernatants of
-thrombin-activated platelets induced no
detectable alterations in the capacity of hyphae to reduce XTT.

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FIG. 6.
Effects of platelets on XTT reduction by hyphae. (A)
Effects of various ratios of platelets to hyphae on reduction of XTT by
A. fumigatus hyphae. Platelets were incubated with hyphae
for 1 h in ratios ranging from 50 platelets/1 hypha to 400 platelets/1 hypha. Effects of platelets on reduction of XTT by hyphae
were then determined by incubations of hyphae with XTT for the standard
1-h time period. Results represent mean ± SEM percentage decrease
in XTT reduction determined in three to eight experiments, each
performed with two to four replicates, except for the two experiments
performed with a 400:1 ratio of platelets to hyphae. (B) Time course of
XTT reduction by hyphae. After incubation with platelets for 1 h,
XTT reduction by hyphae was measured after the standard 1-h period of
exposure to XTT and after a second hour in XTT ( , results of
incubations using a 50:1 ratio of platelets to hyphae; , results of
incubations using a 167:1 ratio of platelets to hyphae).
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Optimum numbers of intact platelets were less effective than PMN in
damaging hyphae, as 10:1 to 30:1 ratios of PMN to hyphae
resulted in
>65% decrements in hyphal XTT reduction. The high
efficiency of PMN
fungicidal effects precluded detection of any
potential effects of
platelets on augmenting PMN responses at
optimum ratios of PMN to
hyphae. Experiments performed with platelets
combined with suboptimum
numbers of PMN did not reveal any significant
increase in damage
compared to effects of PMN alone. However,
incubation of organisms
together with both PMN and platelets resulted
in more pronounced
aggregation (data not shown), so that irregular
loss of hyphae prior to
incubations with XTT might then have contributed
to an observed high
variability in results of these assays (data
not shown).
 |
DISCUSSION |
These data show that platelets adhered to A. fumigatus
hyphae, the invasive form of the fungus, and tended to spread over hyphal surfaces. This interaction induced platelet activation. Opsonization of hyphae with whole plasma was required for optimal platelet activation. Plasma would be readily available for any interactions in vivo, since platelets encounter hyphae only in the
circulation. Invading hyphae would then be coated with plasma opsonins
under such normal conditions. Plasma contains several factors that
might potentially serve as opsonins and potentiate platelet adhesion to
hyphae and/or activation. Despite the presence of Fc receptors on
platelet surfaces (1) which could interact with
antibody-coated hyphae, our data indicated that opsonization of hyphae
with normal human IgG alone resulted in only weak platelet activation.
Although gamma globulins from healthy individuals include
anti-Aspergillus antibodies (28), this does not
preclude the possibility that higher antibody titers of patients with
aspergillosis might improve platelet responses. Nevertheless, our data
do not support a major role for immunoglobulins in platelet-mediated host defenses in nonimmunosuppressed individuals.
Fibrinogen also binds to fungal cell surfaces (9) and has
been postulated to play a significant role in platelet attachment to
C. albicans (21). Nevertheless, opsonization with
fibrinogen, even in concentrations exceeding those present in normal
plasma, did not trigger optimal platelet activation in our studies.
This was not completely surprising, as components of the active
platelet fibrinogen receptor are assembled not before, but only during the platelet activation process (17). Even so, fibrinogen
opsonization of hyphae still might contribute to platelet activation in
vivo. Coactivation processes might lead to fibrinogen receptor assembly which, in turn, might then contribute to further platelet activation after binding its ligand.
Aspergillus hyphae also activate complement (19),
and platelets carry complement surface receptors (8).
However, heat inactivation of complement did not impair the ability of
plasma to support optimum platelet activation.
Supplementation of serum with pooled IgG, fibrinogen, alone or in
combination, failed to restore the opsonic effect of whole fresh or
heat-treated plasma (Fig. 5). Thus, further studies will be required to
define specific plasma factors responsible for optimum opsonization.
The nature of hyphal cell wall surface constituents binding these
plasma factors also remains to be defined. We have initiated studies of
mechanisms involved in these processes.
Taken together, results of confocal microscopic analysis, measurements
of biotinylated surface wall glycoprotein release, and changes in
ability to reduce the tetrazolium dye XTT indicated that platelets
inflicted significant damage to hyphae. Confocal microscopy showed loss
of cell wall constituents from hyphal surfaces that were covered by
platelets (Fig. 2). Hyphae without surface-adherent platelets did not
evidence loss of labeled surface proteins. Assays of biotinylated
surface glycoprotein release showed increased shedding of hyphal cell
wall components following exposure to platelets. Biotinylation with or
without labeling with fluorescent conjugate did not alter hyphal
viability, ability to activate platelets, or susceptibility to damage
by either platelets or neutrophils. Of course, these data did not
establish that shedding of these biotinylated wall constituents
necessarily represented the sole sites of platelet-mediated damage. It
is certainly possible that other unmeasured constituents of the cell
wall or other sites might have sustained damage by platelets as well.
Likewise, these data do not allow for quantification of the relative
importance of biotinylated surface glycoprotein release compared to
damage to or release of other cell wall constituents. Presumably,
surface proteins are more likely to undergo biotinylation than deeper wall proteins. Release of these deeper proteins, if present, might go
undetected because of absent labeling.
In addition, platelets impaired the capacity of the fungi to reduce
XTT, a previously established indicator of the degree of damage to
A. fumigatus hyphae (22). Detrimental effects of platelets on XTT reduction by hyphae were significant with ratios of
platelets to hyphae between 50:1 and 400:1. Higher ratios of platelets
to hyphae resulted in progressively greater declines in XTT reduction,
though the increment between ratios of 200:1 and 400:1 were minimal.
Hyphae did not show signs of recovering their ability to reduce XTT
when incubations of hyphae with the dye were prolonged to 2 h,
beyond the usual 1-h time period. Together with previously published
data on XTT as an indicator of damage to A. fumigatus hyphae
(22), these effects of platelets on XTT reduction are
consistent with damage to the organisms by human platelets.
Invasive aspergillosis is a vasculotropic infection (37).
Our previous studies showed that PMN protected endothelial cells against invasion by C. albicans hyphae (16).
Interactions between damaged endothelial cells, platelets, and PMN have
been extensively studied over the last decade, focusing essentially on
vessel wall injury and degeneration. Since fungi have now been shown to
readily interact with vascular endothelium, circulating platelets, and circulating phagocytes, and since all of these types of cell types have
modulatory effects on one another (2, 13, 15, 23), it seems
crucial to study fungal interactions with each one of them. The
abundance of platelets in the circulation, the circumstantial association of thrombocytopenia with the occurrence of invasive aspergillosis, and our current data showing platelet-mediated damage to
hyphae suggest that these latter cells may play a significant role in
normally potent coordinated host defenses against this common
opportunistic infection.
 |
ACKNOWLEDGMENTS |
This work was supported by National Institutes of Health grants
RO1-DK-51478-02 and 2RO1-DK-31056. L. Christin was supported in part by
the Evans Memorial Department of Clinical Research, Boston Medical
Center, Boston, Mass.
We thank K. K. H. Svoboda, Department of Anatomy and
Neurobiology, Boston University School of Medicine, for expert
assistance with laser confocal scanning microscopy.
 |
FOOTNOTES |
*
Corresponding author. Mailing address: Boston Medical
Center, Room E-336, Section of Infectious Diseases, 88 E. Newton
St., Boston, MA 02118. Phone: (617) 638-7909. Fax: (617)
638-8070. E-mail: rdiamond{at}med-med1.bu.edu.
Editor: T. R. Kozel
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