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Role of the Inflammatory Response in the Hemorrhagic Syndrome Induced

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Role of the Inflammatory Response in the Hemorrhagic Syndrome Induced Toxicon 121 (2016) 77e85 Contents lists available at ScienceDirect Toxicon journal homepage: www.elsevier.com/locate/toxicon Role of the inflammatory response in the hemorrhagic syndrome induced by the hemolymph of the caterpillar Lonomia achelous Peter Taylor a, 1, Emelyn Salazar b, 1, Mariana Barrios b, Ana María Salazar b, María-Jesús Abad a, Izaskun Urdanibia a, David Shealy c, Carmen Luisa Arocha-Pinango~ b, * Belsy Guerrero b, a Laboratorio de Patología Celular y Molecular, Centro de Medicina Experimental, Instituto Venezolano de Investigaciones Científicas, IVIC Apartado 20632, Caracas 1020A, Venezuela b Laboratorio de Fisiopatología, Centro de Medicina Experimental, Instituto Venezolano de Investigaciones Científicas, IVIC Apartado 20632, Caracas 1020A, Venezuela c Centocor R&D, Division of Johnson and Johnson Pharmaceutical R&D, LLC, Malvern, PA, USA article info abstract Article history: Introduction: Contact with the caterpillar of Lonomia achelous causes a hemorrhagic syndrome in Received 17 February 2016 humans prompted by two processes, an initial mild DIC that is later masked by overwhelming fibrinolytic Received in revised form activity. Although the venom affects both the hemostatic and inflammatory systems separately, it is not 19 August 2016 clear whether the hematological and hemostatic disturbances may in part be due to an indirect effect via Accepted 25 August 2016 inflammatory mediators. Here we report results on the crosstalk between these systems, particularly the Available online 26 August 2016 effect of the pro-inflammatory cytokine TNF-a on hemostatic parameters. Materials and Methods: the nitric oxide and TNF-a responses, as well as activation of the coagulation and fibrinolytic systems, were Keywords: Lonomia achelous measured in macrophages and endothelial cells treated with Lonomia achelous hemolymph (LAH). The hemostasis same responses were then determined, in a mouse model of LAH envenomation, after treatment with an Inflammation anti-TNF-a antibody. Results: Both macrophages and endothelial cells responded strongly to LAH in terms TNF of pro-inflammatory mediator release and fibrinolytic activities as well as pro-coagulant activity (TF À À Nitric oxide activity) in endothelial cells. Treatment with antibody against TNF-a decreased both TNF-a and NO3 /NO2 Hemorrhagic syndrome serum levels in the mice, after LAH injection. Blocking TNF-a also modified significantly the serum levels of plasminogen, fibrinogen and FXIII in mice, as well as decreased TF activity in endothelial cells. Con- clusions: LAH may induce a hemostatic effect through endothelial and macrophage activation. These activated cell release hemostatic enzymes as well as pro-inflammatory mediators, principally TNF-a, that potentiate this release in an autocrine fashion, amplifying the fibrinolytic effect, which may in turn exacerbate the hemorrhagic manifestations. As far as we are aware, this is the first report of the rela- tionship between the hemostatic system and the inflammatory responses in a hemorrhagic syndrome induce by animal secretions. © 2016 Elsevier Ltd. All rights reserved. 1. Introduction may be fatal (Arocha-Pinango~ et al., 1977; Arocha-Pinango et al., 1992). In some cases, recently formed wounds reopen and begin to Contact with the caterpillar of the moth Lonomia achelous (LA) bleed. Hematological tests show: mild anemia with leukocytosis; causes a hemorrhagic syndrome clinically characterized in the prolonged prothrombin (PT), partial thromboplastin (aPTT) and affected subjects by hematomas, ecchymosis, hematuria and thrombin (TT) times; decreased fibrinogen (Fg), factor V (FV), factor digestive, pulmonary, peritoneal and cerebral hemorrhages that XIII (FXIII), plasminogen (Pg) and a2-antiplasmin (AP) levels; increased factor VIII:c (FVIII:C), von Willebrand factor (vWF), and fibrin degradation products/D-dimers levels with normal anti- thrombin III and platelets. Factor VII (FVII), prothrombin and pro- * Corresponding author. tein C levels vary (Arocha-Pinango et al., 2000). E-mail addresses: [email protected], [email protected] (B. Guerrero). Arocha-Pinango~ et al., demonstrated that the hair secretion of 1 These authors contributed equally to this work. http://dx.doi.org/10.1016/j.toxicon.2016.08.018 0041-0101/© 2016 Elsevier Ltd. All rights reserved. 78 P. Taylor et al. / Toxicon 121 (2016) 77e85 Abbreviations iNOS inducible nitric oxide synthase TNF-a tumor necrosis factor alpha LA Lonomia achelous FXIII Factor XIII LAH Lonomia achelous hemolymph tPA tissue plasminogen activator PT prothrombin time PAI-1 plasminogen activator inhibitor type 1 aPTT partial thromboplastin time activated uPA urokinase plasminogen activator TT thrombin time AP a2-antiplasmin Fg fibrinogen TF tissue factor Pg plasminogen IL-1, IL-2, IL-6 e IL-8 Interleukins 1, 2, 6 and 8 FV Factor V DIC disseminated intravascular coagulation FVII Factor VII LEB Lonomia obliqua bristle FVIII:C Factor VIII:c Lopap Lonomia obliqua prothrombin activator protease vWF von Willebrand factor LO Lonomia obliqua À NO2 nitrites Losac Lonomia obliqua Stuart-factor activator À NO3 nitrates FX Factor X NO nitric oxide the LA caterpillar is almost identical in terms of fibrinolytic activity state (Carrijo-Carvalho and Chudzinski-Tavassi, 2007; Alvarez to the hemolymph itself (Arocha-Pinango~ et al., 1973). Several ac- Flores et al., 2010). tivities similar to, or directed against, blood clotting factors have The close relationship between hemostasis and inflammation is been identified in the L. achelous hemolymph (LAH) including well known and is an important relationship as these systems must urokinase-like fibrinolytic enzymes which induce plasmin gener- act together. The inflammatory response activates hemostasis ation producing abnormal fibrinogen/fibrin degradation products through various mechanisms including endothelial cell activation, (Lonomin I) and two serine proteases, achelase I and II (Lonomin II), platelet activation and aggregation, thrombin generation, and which in turn exert direct fibrinolytic activity, leading to a very activation of the fibrinolytic system (Cambien et al., 2003; Joseph rapid degradation of the fibrinogen a-chain. Additionally, an FXIII et al., 2002; Levi et al., 2002), but the hemostatic system may also proteolytic/urokinase-like enzyme (Lonomin I/V), two types of reciprocally affect the immune system and promote inflammatory prothrombin activators, one direct (Lonomin III) and another FXa- activity (O'Brien, 2012; Levi and Van Der Poll, 2005). Many types of like (Lonomin IV), were also demonstrated (Arocha-Pinango et al., venom affect both systems, with a variety of effects on hemostasis 2000). as well as the release of pro-inflammatory cytokines and chemo- Furthermore, in vivo studies demonstrated that subcutaneous kines. The principal inflammatory mediators involved appear to be injections of LAH in rabbits induce a dose-dependent decrease in nitric oxide (NO), tumor necrosis factor alpha (TNF-a) and in- Fg, Pg and FXIII without bleeding manifestations, followed by a terleukins 1 and 6 (IL-1/6) (Farsky et al., 2005; Petricevich, 2004). rapid return to normal baseline values. No significant changes in PT, Spider, scorpion and snake venoms have all been shown to aPTT or TT were observed (Marval et al., 1999). Lonomin V, in a activate endothelial cells, which are pivotal in both hemostasis and rabbit jugular vein thrombosis model, also induced dose- inflammation (White, 2005; De Moraes et al., 2008; Patel et al., dependent thrombolysis in combination with a decrease in Fg, Pg, 1994; Petricevich, 2010). In human umbilical vascular endothelial AP and FXIII, without an increase in fibrinogen/fibrin degradation cells, Lopap increases the secretion of molecules such as NO and products or any bleeding manifestations (Guerrero et al., 2001). prostacyclin PGI2, both potent vasodilators and inhibitors of In victims of LA envenomation, clinical deterioration is observed platelet activation. Additionally, it was suggested that this enzyme when whole blood or plasma (fresh or frozen) are administered, also could contribute to inflammation induced by the venom, since with a concomitant decrease in platelets, FII, FV, FVII, VIII:C, FXIII, it is able to upregulate interleukin 8, intracellular adhesion Pg and AP levels and a slight increase in Fg concentration. Some molecule-1 and E-selectin (Carrijo-Carvalho and Chudzinski- patients died of cerebral hemorrhage, and those who recovered did Tavassi, 2007). so very slowly (Arocha-Pinango et al., 1992, 2000). In the case of LA envenomation, although it is evident that Correlating clinical and laboratory alterations observed in the components of the venom may affect the hemostatic and inflam- patients after contact with LA caterpillars (an intense fibrinolytic matory systems separately, it is not clear whether the hematolog- activity, but little effect on coagulation and on platelets), and ical disturbances may in part be due to an indirect effect via considering the different hemolymph activities, as well as the re- inflammatory mediators. In a previous paper, we reported results sults observed in animal models, it was concluded that two pro- showing that in an animal model of LA envenomation, the hema- cesses coexisted in the pathogenesis of the bleeding syndrome, an tological response of the C57BL/6 mice was similar to that observed initial mild DIC which is then masked by overwhelming fibrinolytic in humans and that venom injection induced an inflammatory activity (Arocha-Pinango et al., 2000). response (TNF-a) within
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