Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment

PURPOSE OF REVIEW: The present contribution will illustrate some evolving concepts on the pathogenesis and clinical management of heparin-induced thrombocytopenia (HIT) and describe how we approach patients with suspected HIT at our institution. RECENT FINDINGS: HIT is caused by an autoimmune reaction leading to the formation of antibodies directed against platelet factor 4. Conditions favoring the development of anti-platelet factor 4/heparin antibodies differ from those required for the formation of macromolecular ternary complexes (HIT antibody/platelet factor 4/heparin), which are able to activate platelets and induce clinical HIT. HIT can be diagnosed by combining its pretest probability with the quantitative result of rapid HIT-antibody assays. Treatment of acute HIT requires inhibition of in-vivo thrombin generation by means of alternative nonheparin anticoagulant drugs, whose effective dosage appears to be significantly lower than the official recommendations. As HIT antibodies are transient, HIT patients can be re-exposed to heparin, provided that previous heparin treatment is remote and that anti-platelet factor 4/heparin antibodies are undetectable. SUMMARY: In recent years, there has been a continuing elucidation of pathogenic and clinically relevant issues, which are intellectually rewarding to follow and should enable us to offer a steadily improving treatment to the HIT patients we are in charge of.

Variation of the detergent-binding capacity and phospholipid content of membrane proteins when purified in different detergents.

Purified membrane proteins are ternary complexes consisting of protein, lipid, and detergent. Information about the amounts of detergent and endogenous phospholipid molecules bound to purified membrane proteins is largely lacking. In this systematic study, three model membrane proteins of different oligomeric states were purified in nine different detergents at commonly used concentrations and characterized biochemically and biophysically. Detergent-binding capacities and phospholipid contents of the model proteins were determined and compared. The insights on ternary complexes obtained from the experimental results, when put into a general context, are summarized as follows. 1), The amount of detergent and 2) the amount of endogenous phospholipids bound to purified membrane proteins are dependent on the size of the hydrophobic lipid-accessible protein surface areas and the physicochemical properties of the detergents used. 3), The size of the detergent and lipid belt surrounding the hydrophobic lipid-accessible surface of purified membrane proteins can be tuned by the appropriate choice of detergent. 4), The detergents n-nonyl-β-D-glucopyranoside and Cymal-5 have exceptional delipidating effects on ternary complexes. 5), The types of endogenous phospholipids bound to membrane proteins can vary depending on the detergent used for solubilization and purification. 6), Furthermore, we demonstrate that size-exclusion chromatography can be a suitable method for estimating the molecular mass of ternary complexes. The findings presented suggest a strategy to control and tune the numbers of detergent and endogenous phospholipid molecules bound to membrane proteins. These two parameters are potentially important for the successul crystallization of membrane proteins for structure determination by crystallographic approaches.