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Platelet activation independent of pulmonary inflammation contributes to diesel exhaust particulate-induced promotion of arterial thrombosis
Particle and Fibre Toxicologyvolume 13, Article number: 6 (2016)
Accelerated thrombus formation induced by exposure to combustion-derived air pollution has been linked to alterations in endogenous fibrinolysis and platelet activation in response to pulmonary and systemic inflammation. We hypothesised that mechanisms independent of inflammation contribute to accelerated thrombus formation following exposure to diesel exhaust particles (DEP).
Thrombosis in rats was assessed 2, 6 and 24 h after administration of DEP, carbon black (CB; control carbon nanoparticle), DQ12 quartz microparticles (to induce pulmonary inflammation) or saline (vehicle) by either intra-tracheal instillation (0.5 mg, except Quartz; 0.125 mg) or intravenous injection (0.5 mg/kg). Thrombogenicity was assessed by carotid artery occlusion, fibrinolytic variables and platelet-monocyte aggregates. Measures of inflammation were determined in plasma and bronchoalveolar lavage fluid. Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI)-1 were measured following direct in vitro exposure of human umbilical vein endothelial cells (HUVECs) to DEP (10–150 μg/mL).
Instillation of DEP reduced the time to thrombotic occlusion in vivo, coinciding with the peak of DEP-induced pulmonary inflammation (6 h). CB and DQ12 produced greater inflammation than DEP but did not alter time to thrombotic occlusion. Intravenous DEP produced an earlier (2 h) acceleration of thrombosis (as did CB) without pulmonary or systemic inflammation. DEP inhibited t-PA and PAI-1 release from HUVECs, and reduced the t-PA/PAI-1 ratio in vivo; similar effects in vivo were seen with CB and DQ12. DEP, but not CB or DQ12, increased platelet-monocyte aggregates.
DEP accelerates arterial thrombus formation through increased platelet activation. This effect is dissociated from pulmonary and systemic inflammation and from impaired fibrinolytic function.
The association between air pollution and cardiovascular disease is well-established , with exposure to traffic-derived pollutants implicated in acute myocardial infarction [2, 3]. The adverse cardiovascular effects of airborne pollution have been attributed to combustion-derived particulate matter (PM), especially ultrafine particles from diesel exhaust (DEP), that has a large reactive surface area and can penetrate deep within the lung (reviewed in ). Recent investigations suggest that DEP  and ambient particulate matter [6, 7] increase cardiovascular events by accelerating thrombosis .
The mechanisms responsible for PM-induced enhancement of thrombosis remain controversial. Diesel exhaust inhalation in humans produced endothelial cell dysfunction 2–24 hours after exposure [8–10], accompanied by impaired endogenous fibrinolysis , increased thrombogenicity and platelet activation . These effects could be directly attributed to the exhaust particles as they were markedly reduced following removal of particles from the exhaust [11, 12]. Investigations using appropriate animal models support the contention that DEP increases the likelihood of thrombus formation [13, 14]. However, whilst several different mechanisms for enhanced coagulation in response to particles have been implicated (including impaired fibrinolysis  and platelet activation [7, 15, 16]), there remains much disagreement. A recent study in mice, indicated that increased thrombus formation could be attributed to PM-induced pulmonary and systemic inflammation via multiple mechanisms ; including an increased tumour necrosis factor (TNF)-α-dependent impairment of fibrinolysis and an interleukin (IL)-6-dependent activation of coagulation. However, whether the cardiovascular effects of DEP require direct interaction with the lung is uncertain since intravenous (i.v.) injection caused systemic and pulmonary inflammation associated with alterations in the cardiovascular system in spontaneously hypertensive rats .
There is also some evidence that DEP can, at least acutely, increase coagulation independent of pulmonary inflammation. Inhibition of pulmonary inflammation 1 h after exposure of hamsters to DEP had no effect on coagulation or platelet activation, whereas the same intervention did reduce DEP-mediated enhancement of coagulation 3 and 24 h after exposure . It was suggested that penetration of DEP, or components of DEP, into the blood could account for this early pro-thrombotic effect. This would certainly be consistent with the demonstration that direct exposure of blood to DEP can enhance thrombus formation ex vivo .
Whilst previous investigations have considered the role of pulmonary inflammation, uncertainty remains about its influence on the pro-thrombotic actions of DEP. The current investigation addressed the hypothesis that exposure to DEP induces an increase in thrombosis independent of pulmonary inflammation. This was addressed in vivo by using (1) intra-pulmonary and (2) intravenous administration of DEP or appropriate ‘control particles’ (carbon black, DQ12 quartz). These studies were complemented by in vitro experiments to determine whether direct exposure to DEP alters endogenous fibrinolysis in endothelial cells.
IT instillation of particles
IT instillation (500 μg DEP/rat) resulted in successful administration of DEP, with particle aggregates evident in alveoli (but not in liver, kidney or carotid artery thrombi) collected 2 or 6 h after administration (data not shown).
Pulmonary & systemic inflammation
IT instillation of DEP, CB or DQ12 quartz induced clear, transient pulmonary inflammation with a marked influx of cells (predominantly neutrophils), peaking 6 h post instillation (Fig. 1). The responses produced by CB and DQ-12 particles were greater than those produced by DEP (Fig. 1). Cellular infiltration was accompanied by increased concentrations of interleukin (IL)-6 in bronchoalveolar lavage fluid (BALF) 6 h after instillation (Fig. 2i), although apparent increases in tumour necrosis factor (TNF)-α (Fig. 2ii) and C-reactive protein (CRP; Fig. 2iii) did not achieve statistical significance. The indication that the pulmonary inflammation produced by control particles was more marked than that induced by DEP was supported by the demonstration that CB increased both IL-6 (Fig. 2i) and CRP (Fig. 2iii), whilst DQ12 quartz increased CRP concentrations in BALF (Fig. 2iii). Furthermore, control particles induced systemic inflammation: concentrations of CRP in plasma (6 h) were increased by IT instillation of CB or DQ12 quartz, but unaltered after IT instillation of DEP (Fig. 2v). Plasma concentrations of IL-6 and TNFα were not affected by IT instillation of any of the particles (data not shown).
FeCl3 produced thrombus formation, leading to total occlusion (cessation of blood flow) of the carotid artery after 12–15 min in vehicle-treated rats. IT instillation of DEP (Fig. 3i) produced a pattern of reduced time-to-occlusion at all three time-points assessed (2, 6 & 24 h), with the difference achieving significance 6 h after exposure (DEP 9.4 ± 0.8 min vs vehicle 13.8 ± 0.7 min; n = 6). In contrast, neither CB nor DQ12 quartz accelerated thrombus formation (Fig. 3ii).
Plasma PAI-1 and t-PA concentrations were measured to determine whether altered endogenous fibrinolysis could account for the accelerated thrombosis induced by DEP. These measurements demonstrated that IT instillation of DEP reduced plasma t-PA and increased PAI-1 concentrations, reducing the t-PA:PAI-1 ratio (Fig. 3(iii)). Instillation of CB or DQ12 quartz produced a similar impairment in fibrinolytic function (Fig. 3(iii)).
IV injection of particulate
Successful administration of particles to the circulation was confirmed by the identification of DEP aggregates in sections of liver (although not in kidney) 2 h after intravenous injection (data not shown). No particles were identified in these organs 6 or 24 h after injection.
Absence of pulmonary and systemic inflammation
In contrast to IT instillation, i.v. injection of DEP or CB did not cause pulmonary inflammation. There was no influx of inflammatory cells into the lung (Fig. 4i), and no change in the inflammatory cell populations (Fig. 4ii & iii) or the cytokine concentrations in BALF: TNFα (Additional file 1: Figure S1i), CRP (Additional file 1: Figure S1ii). IL-6 concentrations were below the limit of detection (data not shown). In addition, there was no evidence of systemic inflammation as plasma concentrations of CRP, IL-6 and TNFα were unaffected by i.v. DEP. Interestingly, plasma CRP (but not IL-6 or TNFα; data not shown) was increased 2 h after injection of CB (Additional file 1: Figure S1iii).
In the FeCl3-induced thrombosis model, DEP (0.5 mg/kg, i.v.) produced a transient reduction in time-to-occlusion 2 h following administration, which was no longer evident after 6 or 24 h (Fig. 5ii). The control particles, CB, also produced a small reduction in time-to-occlusion at the 2 h time-point (Fig. 5ii). No particles were identified by histological analysis of the thrombosed vessel.
In vitro exposure of HUVECs to DEP
In order to determine whether DEP can directly alter the fibrinolytic system in endothelial cells, cultured human umbilical vein endothelial cells (HUVECs) were exposed (16 h) to DEP (10–150 μg/mL) or vehicle, with or without thrombin (1.0 U/ml, 24 h) stimulation.
Exposure to DEP was not cytotoxic as treatment had no effect on cell viability as measured by LDH assay (Additional file 2: Figure S2). Pre-exposure to DEP reduced expression of t-PA (Fig. 6i) and PAI-1 (Fig. 6ii). Exposure to DEP (150 μg/ml; 6–24 h) also reduced t-PA antigen concentrations (Fig. 6iii) and PAI-1 activity (Fig. 6iv) in culture media. Stimulation with thrombin had no effect on t-PA antigen levels (Fig. 6v) but increased PAI-1 activity (Fig. 6vi) in media, an effect that was attenuated in the presence of DEP.
This investigation addressed the hypothesis that exposure to DEP induces accelerated thrombus formation independent of pulmonary inflammation. This was achieved by comparing the effects of pulmonary and systemic DEP administration with appropriate control particles (CB, a “clean” carbon particle to control for the nano-carbon core of DEP and DQ12 quartz, a large pro-inflammatory particle that will not translocate into the blood [19, 20]). Instillation and injection of DEP (and other nanoparticles) have been shown to increase pulmonary and systemic inflammation, with circulating levels of IL-6, TNFα and leukotriene-B4 elevated in the rat [14, 20–24]. The current investigation demonstrated that control particles caused pulmonary and/or systemic inflammation but did not promote thrombosis. In contrast, DEP-induced acceleration of thrombus formation was evident in the absence of pulmonary or systemic inflammation. The outcomes of these experiments are summarised in Table 1.
Inflammation and accelerated thrombosis following intra-tracheal instillation of DEP
Intra-tracheal (IT) instillation has been used extensively to investigate the effects of pulmonary exposure to a number of different particles [13, 24, 25]. It provides excellent alveolar penetration and distribution, and allows direct comparison of different particle types, with increased thrombus formation and platelet activation reported after pulmonary instillation of silica , titanium dioxide (TiO2) nanorods , ambient particulate matter , and carbon nanotubes . Instillation has the advantage of ensuring direct administration of a controlled particle dose, whereas with inhalation there can be uncertainty about the proportion of particles that actually reaches the lungs (due to retention in the nasal cavity) . IT instillation or inhalation of combustion-derived particles produce similar effects on thrombus formation in vivo . The dose of DEP used for IT instillation (500 μg DEP/rat) is comparable with previous studies in animals (5–500 μg/animal for hamsters [13, 21, 24]) exploring particle activity, and can be used to consistently induce pulmonary inflammation.
The accelerated thrombosis induced 6 h after IT instillation of DEP was consistent with the pro-thrombotic effect described both in clinical [5, 8–10], and in animal (hamsters [13, 21, 30], mice [14, 22], or rats [23, 31]) studies. This enhanced thrombus formation was co-incident with the peak in pulmonary inflammation. Whilst this would be consistent with thrombosis increasing as a consequence of pulmonary inflammation , neither CB nor DQ12 quartz (which both induced inflammation) accelerated thrombus formation. This contrasts with the relationship between increased thrombosis and pulmonary inflammation reported for a number of different particles (silica , TiO2 , carbon nanotubes , DEP [13, 22]). More recent evidence, however, has suggested that CB-induced thrombogenic effects are independent of pulmonary and systemic inflammation .
The possibility that increased thrombosis is the result of impaired endogenous fibrinolysis has been indicated in a number of investigations . Endothelial t-PA release was reduced in healthy volunteers  and in men with stable coronary heart disease  2–6 hours after exposure to DE. The particulate constituents of these emissions contributed to the impaired t-PA release . Impaired endogenous fibrinolysis has also been reported in some (but not all [33, 34]) studies in animals, with increased PAI-1 and reduced tissue factor pathway inhibitor following exposure to urban particulate matter [7, 14, 35]. The timing of these changes suggests involvement of an inducible pathway or changes in protein synthesis. Whether these changes are secondary to effects in the lung or are a consequence of direct interaction of DEP with the arterial wall has not been determined. The presence of pulmonary and systemic inflammation following particle administration may be expected to influence fibrinolysis since chronic inflammation is associated with impairment of the endogenous fibrinolytic system in vivo  and in cultured endothelial cells . Furthermore, reduction of systemic inflammation (with the antioxidant ascorbic acid) restored fibrinolytic function in chronic smokers . However, whereas our demonstration that IT instillation of DEP alters the endogenous fibrinolytic system is consistent with the impaired fibrinolysis reported after inhalation of DE in humans , the use of control particles indicated that altered fibrinolysis could not be the sole cause of increased thrombosis following instillation. CB or DQ12 quartz, which produced a similar impairment in fibrinolytic function, did not alter thrombus formation. These results suggest, therefore, that altered endogenous fibrinolysis may be just one component of DEP-mediated acceleration of thrombosis. Interestingly, although pulmonary inflammation induced by urban particulate matter can alter endogenous fibrinolysis (increased PAI-1) through a TNF-α-mediated process, it activates coagulation via a distinct IL-6-mediated pathway [7, 39, 40]. The mechanism responsible for DQ12-induced alteration of fibrinolytic function has not been identified, but may be related to the ability of particulate exposure to stimulate cytokine release from inflammatory cells  or release of an as yet unidentified mediator into the circulation .
Since our data suggest that alteration of endogenous fibrinolysis cannot solely account for acceleration of thrombosis, we addressed the role of platelet activation. Instillation of polystyrene particles increased platelet activation  and platelet-granulocyte aggregation in experimental animals . The increase in platelet-monocyte aggregation 6 h after IT instillation of DEP in our investigation coincided with accelerated thrombus formation. This is consistent with previous work , and with a clinical study from our group . In contrast, exposure to CB or DQ12 quartz had no effect, paralleling the pattern of thrombus effects across these particles. Thus, in contrast to inflammation and altered fibrinolysis, platelet activation was only seen following exposure to the particle (DEP) that accelerated thrombosis.
Accelerated thrombosis without inflammation following i.v. injection of DEP
In addition to the role of inflammation, the cardiovascular consequences of particle exposure have also been attributed variously to alteration of the autonomic nervous system, translocation of particles from the lung into the systemic circulation, and oxidative stress . Particle translocation has attracted attention since direct (i.v.) administration of particles to the blood increases thrombosis in vivo . This may be due to direct effects on components of the cardiovascular system since ex vivo administration of DEP to blood accelerates clot formation . We addressed the proposal that DEP could accelerate thrombus formation by direct interaction with the cardiovascular system using i.v administration of DEP (0.5 mg/kg) or control (CB) particles. The dose selected was based on previous i.v. exposures in rats (0.01-0.5 mg/kg; [21, 23, 31]. As expected i.v. injection of particles did not cause pulmonary inflammation.
Enhanced thrombus formation 2 h after i.v. injection of DEP is consistent with the proposal that this response is not secondary to inflammation. Interestingly, injection of CB (which also accelerated thrombus formation) did increase plasma CRP adding to the evidence that CB is not an “inert” control particle [41, 44]). This suggests that the nanocarbon core of injected DEP contributes to its pro-thrombotic action. This may be through direct interaction with the endothelium or generation of free radicals . Certainly, CB (which models the nanocarbon core of DEP) alters endothelial cell function [41, 44], including inhibiting t-PA expression and protein production in cultured HUVECs . The reduced t-PA:PAI-1 ratio observed after injection of DEP or CB suggests that alterations in endogenous fibrinolysis contribute to accelerated thrombosis following i.v. administration.
The use of cultured HUVECs demonstrated that DEP can alter endogenous fibrinolysis through direct interaction with the vascular endothelium. In the current investigation there was a pattern for lower thrombin-induced release of t-PA in cultured endothelial cells after exposure to DEP but this did not achieve significance . However, our results are consistent with the suggestion that DEP can alter the endogenous fibrinolytic system by direct interaction with endothelial cells. Whether this occurs in vivo is debatable since the concentrations of DEP used were high and unlikely to be experienced by endothelial cells following pulmonary or systemic administration.
Particle administration to the blood in vitro directly activates platelets [5, 13, 43]. Since nanoparticles may translocate into the systemic circulation , it remains possible that inhaled particles could interact directly with platelets to accelerate thrombosis. In support of this notion, a reduction in platelet number (6 h) following i.v. injection of DEP in rats has been attributed to removal of aggregated platelets from the circulation . Furthermore, the pro-thrombotic response to DEP has been linked to changes in platelet function [11, 13, 21, 49]. As with IT instillation, i.v. injection increased platelet-monocyte interaction, co-incident with accelerated thrombosis. Because both DEP and CB have been shown to be internalised by platelets , the ability of DEP to activate platelets is likely to be mediated by chemical species on the surface of DEP. Further studies are required to more precisely determine the mechanisms of DEP-induced platelet activation, including the role of platelet surface makers and glycoproteins [49, 50], interaction with circulating leucocytes and the blood vessel wall , changes in catecholamines  and the alterations in other blood constituents in susceptible models [53, 54]. Overall, these findings suggest that platelet activation, independent of pulmonary or systemic inflammation, contributes to the accelerated thrombus formation induced by DEP.
Identifying the mechanisms responsible for particle-induced acceleration of thrombus formation has proved challenging despite considerable research effort. The current study suggests a mechanism independent of systemic and pulmonary inflammation. It was designed to compare DEP suitable control particles, showing that particle induced inflammation does not necessarily increase thrombosis. As with all investigations, however, consideration must be given to potential limitations. An alternative approach to addressing this mechanism would be to use anti-inflammatory drugs or to study DEP-induced thrombosis in transgenic animals with impaired inflammatory pathways. The doses/exposures used in the experiments described here are higher than would be expected in the real world and are designed to provide conceptual insight into the mechanisms involved. They are also, however, single exposures in healthy animals; it is possible that chronic exposure of lower doses could be detrimental and may also have more effect in patients with underlying cardiovascular and/or respiratory disease. Furthermore, the magnitude of the effects produced is striking, suggesting that even lower levels could produce prominent effects in the blood. Blood thrombogenicity plays a key role in cardiovascular health and small imbalances towards increased clotting are associated with marked increases in the risk of cardiovascular events in patients with coronary artery disease and stroke.
This study has used comparison with control particles and different routes of administration to demonstrate that DEP-mediated acceleration of thrombosis in vivo is independent of systemic and pulmonary inflammation. DEP directly altered components of the endogenous fibrinolytic system in endothelial cells but these changes alone could not account for the acceleration of thrombus formation. In contrast, platelet activation in response to DEP did not require pulmonary or systemic inflammation and may play an important role in increased thrombus formation. Although nanoparticle translocation is possible [48, 55–57], it seems unlikely that it would result in sufficient exposure to account for the acute acceleration of thrombus following instillation or inhalation . Furthermore, similar changes in fibrinolytic function have been reported following pulmonary administration of DQ12 quartz, a particle considered too large to translocate [19, 20]. It is possible that this DEP-induced increase in thrombosis contributes to the increased cardiovascular disease risk in individuals exposed to vehicle emissions but whether this is the case remains to be determined.
Diesel exhaust particles (DEP; 1 mg/mL; Standard Reference Material 2975; National Institute of Standards and Technology (NIST) Gaithersburg, MD, USA), nano-Carbon Black (CB; 1 mg/mL; Printex90, Degussa, Germany) and quartz microparticles (0.25 mg/mL; DQ12, IUF, Germany) were suspended in sterile 0.9 % saline (in vivo experiments) or culture medium (EGM-2; Lonza Walkersville, USA; in vitro experiments) and dispersed by sonication (5 min; 70 % power, 5 cycles/s; Status Homogenisers, Philip Harris Scientific, UK). Suspensions were prepared immediately before use and were endotoxin free (Limulus Amebocyte Lysate assay, Cambrex, USA; ; data not shown). CB lacks the organic and metal constituents of DEP and represents a ‘clean’ carbon particle of a similar primary particle size to DEP. DQ12 quartz particles induce pulmonary inflammation but do not translocate from the lung due to their large particle diameter (~1 μm; ).
Impact of particle administration on thrombosis in vivo
Animal work was performed under Home Office Licence (UK) in accordance with the Animals (Scientific Procedures) Act, 1986 and following local ethical committee review. Adult male Wistar Rats (Charles River, UK; 175–275 g) were housed under standard light cycle (lights on 08:00-20:00) and temperature (21–22 °C).
Administration of particle suspensions
Rats were anaesthetised by inhalation of isoflurane (Merial; Essex, UK) prior to administration of suspensions (0.5 mL) of DEP (1 mg/mL), CB (1 mg/mL) or DQ12 quartz (0.25 mg/mL; a dose previously shown to induce significant pulmonary inflammation) by intra-tracheal (IT) instillation . A separate group of rats received 0.5 mL (0.5 mg/kg) DEP or CB suspensions, or vehicle (0.9 % saline), via tail vein intravenous (IV) injection.
Carotid artery thrombosis
Arterial thrombus was induced by application of ferric chloride (FeCl3; adapted from ). Briefly, carotid artery blood flow was measured in anaesthetised (isoflurane) rats using an ultrasonic flow probe (Transonic Systems Inc, Netherlands). FeCl3 solution (20 %) was applied topically to the carotid artery (10 min), arterial blood flow monitored, and the time to cessation of blood flow recorded.
Rats were killed by exsanguination. Blood was collected from the abdominal aorta, citrated (10:1 in 3.8 % sodium citrate solution), and either analysed immediately (flow cytometry) or stored as plasma. Tissues (carotid artery, kidney, liver, lung) were processed for histological analysis. Serial sections (4 μm thick) were stained with hematoxylin and eosin.
Bronchoalveolar lavage fluid collection and analysis
Bronchoalveolar lavage fluid (BALF) was obtained post-mortem by lavaging with sterile 0.9 % saline, centrifuged (180 g, 5 min, 4 °C) and the supernatant stored (−80 °C) for analysis. The cell pellet was re-suspended and a total cell count performed by an automatic cell counter (ChemoMetec A/S. Denmark). Additionally, cells (1 × 106 cells per 300 μL) were re-suspended in saline containing 0.1 % bovine serum albumin, cytocentrifuged (300 rpm; 3 min) onto glass microscope slides (Superfrost Plus; VWR International Ltd, UK) and stained with Diff-Quick (Raymond Lamb, UK) for differential cell counting . Lactate dehydrogenase (LDH) was measured using the Cytotoxicity Detection Kit (Roche Diagnostics, UK), according to manufacturer’s instructions.
Pro-inflammatory cytokines in the lungs and systemic circulation
Plasma and BALF were assessed for inflammatory markers (interleukin (IL)-6, C reactive protein (CRP) and tumour necrosis factor alpha (TNFα)) by ELISA (R&D Systems, UK) to manufacturer’s instructions, using an automated Triturus ELISA analyser (Grifols, Spain).
Plasma samples were assessed for t-PA and active PAI-1 using commercially-available ELISA kits (Patricell Ltd, UK).
Platelet-monocyte aggregates were measured by flow cytometry using fluorescein isothiocyanate (FITC)-labelled anti-rat CD42d antibody  and phycoerythrin (PE)-labelled hamster anti-rat CD61 . PE-labelled hamster IgG1κ was used as a negative isotype control (antibodies from BD Biosciences, UK). Samples were analysed by BD FACscan flow cytometer equipped with CellQuest software for data acquisition and FlowJo software for data analysis. Platelet-monocyte aggregates were defined as double positive for CD42d and CD61.
The endogenous fibrinolytic pathway in HUVECs
Human umbilical vein endothelial cells (HUVECs; Promocell, Germany; Passage ≤6) were maintained in EGM-2. Confluent HUVECs were exposed to DEP (10–150 μg/mL) or vehicle (medium alone) for 2–24 h. Following exposure, cells and supernatants were stored (−80 °C) for subsequent analysis. Alternatively, DEP suspensions were removed and the cells stimulated with thrombin (0.1–1 U/mL; 24 h) before harvesting. The effect of DEP on cell viability was assessed by LDH assay (Cyotoxicity Detection kit; Roche Diagnostics, UK).
Concentrations of t-PA (antigen and activity) and PAI-1 (activity) in HUVEC supernatants were measured by ELISA, to manufacturer’s instructions (t-PA Combi Actibind ELISA kit and TECHNOZYM® PAI-1 Actibind® ELISA kit; Technoclone Ltd, UK). RNA was extracted from HUVECs and reverse transcribed to cDNA in order to measure t-PA and PAI-1 expression by real time polymerase chain reaction (PCR). Real time PCR primers (Invitrogen; UK; Additional file 3: Table S1) and probes (Roche Universal Probe library) were designed by the Roche UPL Design Centre (Roche, UK) using the species-specific gene and nucleotide sequences. Samples were analysed using a Roche LightCycler 480 and normalised to the housekeeping genes GAPDH and β-actin. Additional reagents were purchased from Sigma-Aldrich (UK).
Data are expressed as mean ± s.e.mean, n = 6 unless otherwise indicated. Results were analysed using GraphPad Prism software. Analyses were performed using Student’s unpaired, two-tailed t-test, one-way ANOVA followed by Tukey’s multiple comparison post-test or two-way ANOVA with a Bonferroni post-test. Equality of variance was confirmed using an F test or Kolmogorov-Smirnov test. Significance was assumed when P < 0.05.
Analysis of variance
Complementary deoxyribonucleic acid
C reactive protein
Diesel exhaust particles
Enzyme-linked immuno sorbent assay
Fluorescence-activated cell sorting
- FeCl3 :
Glyceraldehyde 3-phosphate dehydrogenase
Human umbilical vein endothelial cells
National Institute of Standards and Technology
Plasminogen activator inhibitor-1
Phosphate buffered saline
Polymerase chain reaction
Revolutions per minute
Standard error of the mean
Tumour necrosis factor-α
Tissue plasminogen activator
Cohen AJ, Anderson HR, Ostro B, Pandey KD, Krzyzanowski M, Kunzli N, et al. The global burden of disease due to outdoor air pollution. J Toxicol Environ Health A. 2005;68:1301–7.
Peters A, von Klot S, Heier M, Trentinaglia I, Hormann A, Wichmann HE, et al. Exposure to traffic and the onset of myocardial infarction. N Engl J Med. 2004;351:1721–30.
Emmerechts J, Hoylaerts MF. The effect of air pollution on haemostasis. Hamostaseologie. 2012;32:5–13.
Donaldson K, Stone V, Clouter A, Renwick L, MacNee W. Ultrafine particles. Occup Environ Med. 2001;58:211–6.
Lucking AJ, Lundback M, Mills NL, Faratian D, Barath SL, Pourazar J, et al. Diesel exhaust inhalation increases thrombus formation in man. Eur Heart J. 2008;29(24):3043–51.
Mills NL, Robinson SD, Fokkens PH, Leseman DL, Miller MR, Anderson D, et al. Exposure to concentrated ambient particles does not affect vascular function in patients with coronary heart disease. Environ Health Perspect. 2008;116(6):709–15.
Budinger GRS, McKell JL, Urich D, Foiles N, Weiss I, Chiarella SE, et al. Particulate matter-induced lung inflammation increases systemic levels of PAI-1 and activates coagulation through distinct mechanisms. PLoS One. 2011;6(4):e18525.
Mills NL, Tornqvist H, Robinson SD, Gonzalez M, Darnley K, MacNee W, et al. Diesel exhaust inhalation causes vascular dysfunction and impaired endogenous fibrinolysis. Circulation. 2005;112:3930–6.
Mills N, Tornqvist H, Gonzalez M, Vink E, Robinson SD, Soderberg S, et al. Ischemic and thrombotic effects of dilute diesel exhaust inhalation in men with coronary heart disease. N Engl J Med. 2007;357:1075–82.
Tornqvist H, Mills NL, Gonzalez M, Miller MR, Robinson SD, Megson IL, et al. Persistent endothelial dysfunction following diesel exhaust inhalation in man. Am J Respir Crit Care Med. 2007;176:325–6.
Lucking AJ, Lundback M, Barath SL, Mills NL, Sidhu MK, Langrish JP, et al. Particle traps prevent adverse vascular and prothrombotic effects of diesel engine exhaust inhalation in men. Circulation. 2011;123:1721–8.
Mills NL, Miller MR, Lucking AJ, Beveridge J, Flint L, Boere AJF, et al. Combustion-derived nanoparticulate induces the adverse vascular effects of diesel exhaust inhalation. Eur Heart J. 2011;32(21):2660–71.
Nemmar A, Hoet PH, Dinsdale D, Vermylen J, Hoylaerts MF, Nemery B. Diesel exhaust particles in lung acutely enhance experimental peripheral thrombosis. Circulation. 2002;107(8):1202–8.
Cozzi E, Wingard CJ, Cascio WE, Devlin RB, Miles JJ, Bofferding AR, et al. Effect of ambient particulate matter exposure on hemostasis. Transl Res. 2007;149(6):324–32.
Bihari P, Holzer M, Praetner M, Fent J, Lerchenberger M, Reichel CA, et al. Single-walled carbon nanotubes activate platelets and accelerate thrombus formation in the microcirculation. Toxicology. 2009;269(2–3):148–54.
Radomski A, Jurasz P, Alonso-Escolano D, Drews M, Morandi M, Malinski T, et al. Nanoparticle-induced platelet aggregation and vascular thrombosis. Br J Pharmacol. 2005;146(6):882–93.
Nemmar A, Dhanasekaran S, Yasin J, Ba-Omar H, Fahim MA, Kazzam EE, et al. Evaluation of the direct systemic and cardiopulmonary effects of diesel particles in spontaneously hypertensive rats. Toxicology. 2009;262(1):50–6.
Nemmar A, Nemery B, Hoet PH, Vermylen J, Hoylaerts MF. Pulmonary inflammation and thrombogenicity caused by diesel particles in hamsters: role of histamine. Am J Respir Crit Care Med. 2003;168(11):1366–72.
Clouter A, Brown D, Hohr D, Borm P, Donaldson K. Inflammatory effects of respirable quartz collected in workplaces versus standard DQ12 quartz: particle surface correlates. Toxicol Sci. 2001;63(1):90–8.
Duffin R, Gilmour PS, Schins RP, Clouter A, Guy K, Brown DM, et al. Aluminium lactate treatment of DQ12 quartz inhibits its ability to cause inflammation, chemokine expression, and nuclear factor-kappaB activation. Toxicol Appl Pharmacol. 2001;176(1):10–7.
Nemmar A, Hoylaerts MF, Hoet PH, Nemery B. Possible mechanisms of the cardiovascular effects of inhaled particles: systemic translocation and prothrombotic effects. Toxicol Lett. 2004;149(1–3):243–53.
Nemmar A, Al-Salam S, Dhanasekaran S, Sudhadevi M, Ali BH. Pulmonary exposure to diesel exhaust particles promotes cerebral microvessel thrombosis: protective effect of a cysteine prodrug l-2-oxothiazolidine-4-carboxylic acid. Toxicology. 2009;263(2–3):84–92.
Nemmar A, Al-Salam S, Zia S, Dhanasekaran S, Shudadevi M, Ali BH. Time-course effects of systemically administered diesel exhaust particles in rats. Toxicol Lett. 2010;194(3):58–65.
Robertson S, Duffin R, Mclean SG, Shaw CA, Hadoke PWF, Gray GA, et al. In vivo and ex vivo models to study the vasodilator function of diesel exhaust particles in rats. Part Fibre Toxicol. 2012;9:9. doi:10.1186/1743-8977-9-9.
McQueen DS, Donaldson K, Bond SM, McNeilly JD, Newman S, Barton NJ, et al. Bilateral vagotomy or atropine pre-treatment reduces experimental diesel-soot induced lung inflammation. Toxicol Appl Pharmacol. 2007;219(1):62–71.
Nemmar A, Nemery B, Hoet PH, Van Rooijen N, Hoylaerts MF. Silica particles enhance peripheral thrombosis: key role of lung macrophage-neutrophil cross-talk. Am J Respir Crit Care Med. 2005;171(8):872–9.
Nemmar A, Melghit K, Ali BH. The acute proinflammatory and prothrombotic effects of pulmonary exposure to rutile TiO2 nanorods in rats. Exp Biol Med. 2008;233(5):610–9.
Nemmar A, Hoet PH, Vandervoort P, Dinsdale D, Nemery B, Hoylaerts MF. Enhanced peripheral thrombogenicity after lung inflammation is mediated by platelet-leukocyte activation: role of P-selectin. J Thromb Haemost. 2007;5(6):1217–26.
Chan TL, Lee PS, Hering WE. Deposition and clearance of inhaled diese exhaust particulate in the respiratory tract of Fischer rats. J Apppl Toxicol. 1981;1(2):77–82.
Nemmar A, Nemery B, Hoylaerts MF, Vermylen J. Air pollution and thrombosis: an experimental approach. Pathophysiol Haemost Thromb. 2002;32(5–6):349–50.
Nemmar A, Al-Maskari S, Ali BH, Al-Amri IS. Cardiovascular and lung inflammatory effects induced by systemically administered diesel exhaust particles in rats. Am J Physiol. 2007;292(3):L664–70.
Khandoga A, Stoeger T, Khandoga AG, Bihari P, Karg E, Ettehadieh D, et al. Platelet adhesion and fibrinogen deposition in murine microvessesl upon inhalation of nanosized carbon particles. J Thromb Haemost. 2010;8:1632–40.
Carlsten C, Kaufman JD, Peretz A, Trenga CA, Sheppard L, Sullivan JH. Coagulation markers in healthy human subjects exposed to diesel exhaust. Thromb Res. 2007;120(6):849–55.
Baccarelli A, Zanobetti A, Martinelli I, Grillo P, Hou L, Giacomini S, et al. Effects of exposure to air pollution on blood coagulation. J Thromb Haemost. 2007;5(2):252–60.
Sun Q, Yue P, Deiuliis JA, Lumeng CN, Kampfrath T, Mikolaj MB, et al. Ambient air pollution exaggerates adipose inflammation and insulin resistance in a mouse model of diet-induced obesity. Circulation. 2009;119:538–46.
Agirbasli M, Inanc N, Baykan OA, Direskeneli H. The effects of TNF alpha inhibition on plasma fibrinolytic balance in patients with chronic inflammatory rheumatical disorders. Clin Expl Rheumatol. 2006;24(5):580–3.
al-Azhary DB, Wojta J, Binder BR. Fibrinolytic system of cultured rabbit aortic endothelial cells. Thromb Res. 1994;75(5):559–68.
Kaehler J, Koeke K, Karstens M, Schneppenheim R, Meinertz T, Heitzer T. Impaired capacity for acute endogenous fibrinolysis in smokers is restored by ascorbic acid. Free Radic Biol Med. 2008;44(3):315–21.
Emmerechts J, Alfaro-Moreno E, Van Audenaerde BM, Nemery B, Hoylaerts MF. Short-term exposure to particulate matter induces arterieal but not venous thrombosis in healthy mice. Thromb Haemost. 2010;8(12):2651–61.
Mutlu GM, Green D, Bellmeyer A, Baker CM, Burgess Z, Rajamannan N, et al. Ambient particulate matter accelerates coagulation via an IL-6–dependent pathway. J Clin Invest. 2007;117(10):2952–61.
Shaw CA, Robertson S, Miller MR, Duffin R, Tabor CM, Donaldson K, et al. Diesel particulate-exposed macrophages cause marked endothelial cell activation and increase chemotaxis. Am J Respir Cell Mol Biol. 2011;44(6):840–51.
Channell MM, Paffett ML, Devlin RB, Madden MC, Campen MJ. Circulating factors induce coronary endothelial cell activation following exposure to inhaled diesel exhaust and nitrogen dioxide in humans: evidence from a novel translational in vitro model. Toxicol Sci. 2012;127(1):179–86.
Nemmar A, Hoylaerts MF, Hoet PH, Vermylen J, Nemery B. Size effect of intratracheally instilled particles on pulmonary inflammation and vascular thrombosis. Toxicol Appl Pharmacol. 2003;186(1):38–45.
Yamawaki H, Iwai N. Mechanisms underlying nano-sized air-pollution-mediated progression of atherosclerosis: carbon black causes cytotoxic injury/inflammation and inhibits cell growth in vascular endothelial cells. Circ J. 2006;70(1):129–40.
Metassan S, Charlton AJ, Routledge MN, Scott DJ, Ariens RA. Alteration of fibrin clot properties by ultrafine particulate matter. Thromb Haemost. 2010;103:103–13.
Gilmour PS, Morrison ER, Vickers MA, Ford I, Ludlam CA, Greaves M, et al. The procoagulant potential of environmental particles (PM10). Occup Environ Med. 2005;62(3):164–71.
Fukushima M, Nakashima Y, Sueishi K. Thrombin enhances release of tissue plasminogen activator from bovine corneal endothelial cells. Invest Ophthalmol Vis Sci. 1989;30(7):1576–83.
Oberdorster G, Sharp Z, Atudorei V, Elder A, Gelein R, Lunts A, et al. Extrapulmonary translocation of ultrafine carbon particles following whole-body inhalation exposure of rats. J Toxicol Environ Health A. 2002;65:1531-43.
Forestier M, Al-Tamimi M, Gardiner EE, Hermann C, Meyer S, Beer JH. Diesel exhaust particles impair platelet response to collagen and are associated with GPIba shedding. Toxicol In Vitro. 2012;26:930–8.
Solomon A, Smyth E, Mitha N, Pitchford S, Vydyanath A, Luther PK, et al. Induction of platelet aggregation after a direct physical interaction with diesel exhaust particles. J Thromb Haemost. 2013;11(2):325–34.
Nurkiewicz TJ, Porter DW, Barger M, Millecchia L, Rao KMK, Marver PJ, et al. Systemic microvascular dysfunction and inflammation after pulmonary particulate matter exposure. Environ Health Perspect. 2006;114(3):412–9.
Chiarella SE, Soberanes S, Urich D, Morales-Nebreda L, Nigdelioglu R, Green D, et al. β2-Adrenergic agonists augment air pollution–induced IL-6 release and thrombosis. J Clin Invest. 2014;124(7):2935–46.
Nemmar A, Subramaniyan D, Yasin J, Badreldin HA. Impact of experimental type 1 diabetes mellitus on systemic and coagulation vulnerability in mice acutely exposed to diesel exhaust particles. Part Fibre Toxicol. 2013;10:14.
Carlsten C, Kaufman JD, Trenga CA, Allen J, Peretz A, Sullivan JH. Thrombotic markers in metabolic syndrome subjects exposed to diesel exhaust. Inhal Toxicol. 2008;20(10):917–21.
Chen J, Tan M, Nemmar A, Song W, Dong M, Zhang G, et al. Quantification of extrapulmonary translocation of intratracheal-instilled particles in vivo in rats: effect of lipopolysaccharide. Toxicology. 2006;222(3):195–201.
Kreyling WG, Hirn S, Moller W, Schleh C, Wenk A, Celik G, et al. Air blood barrier translocation of tracheally instilled gold nanoparticles inversely depends on particle size. ACS Nano. 2014;8(1):222–33.
Geiser M, Kreyling WG. Deposition and biokinetics of inhaled nanoparticles. Part Fibre Tox. 2010;7:2.
Miller MR. The role of oxidative stress in the cardiovascular actions of particulate air pollution. Biochem Soc Trans. 2014;42(4):1006–11.
Kurz KD, Main BW, Sandusky GE. Rat model of arterial thrombosis induced by ferric chloride. Thromb Res. 1990;60(4):269–80.
Sato N, Kiyokawa N, Takada K, Itagaki M, Saito M, Sekino T, et al. Characterization of monoclonal antibodies against mouse and rat platelet glycoprotein V (CD42d). Hybridoma. 2000;19(6):455–61.
Wiwanitkit V. Platelet CD61 might have an important role in causing hemorrhagic complication in dengue infection. Clin Appl Thromb Hemost. 2005;11(1):112.
Mrs Shonna Johnston (Centre for Inflammation Research) and the University of Edinburgh Flow Cytometry Facility assisted with measurement of platelet-monocyte aggregation. The authors are grateful for support from the British Heart Foundation (Studentship (CT), Centre of Research Excellence Award (RE/08/001), Programme Grant (RG/10/009), Chair Award (CH/09/002)).
On behalf of the authors of this paper, I hereby certify that there are no financial or non-financial competing interests.
CT contributed to study design, carried out the experimental work, and performed data and image analysis, interpretation and revision of the manuscript. CAS contributed to cell culture experiments, measurement of inflammatory cytokines and drafting the manuscript. SR contributed to measurement of inflammatory cytokines and drafting the manuscript. MRM contributed to study design, data interpretation and drafting the manuscript. RD assisted with the particle instillations and contributed to drafting the manuscript. KD participated in the design and interpretation of the study. DEN contributed to the design and interpretation of the study, and to drafting the manuscript. PWFH designed the study, contributed to method development, data analysis and interpretation, and drafted the manuscript. All authors read and approved the final manuscript.
Intravenous administration of DEP does not increase systemic CRP or pulmonary pro-inflammatory cytokines. Intravenous injection of DEP (black columns) or CB (light grey columns) did not increase bronchoalveolar lavage fluid concentrations of (i) TNF-α or (ii) C-reactive protein (CRP) when compared to saline (white column) collected 2 h after injection. Levels of IL-6 were below the limit of detection. (iii) Systemic inflammation was assessed by measuring CRP in plasma taken from rats 2 h (the time-point at which thrombus formation was increased by DEP) after intravenous injection of diesel exhaust particulate (DEP) or carbon black (CB). CB (light grey column), increased plasma concentrations of CRP whereas DEP did not (black column). Data are mean ± s.e.mean (n = 6) and were compared using Student’s unpaired t-test ((i) & (ii)) or one-way ANOVA (iii); ns = not significant ***P < 0.001 compared with saline-treated control. (TIF 55 kb)
Assessment of cytotoxicity in endothelial cells exposed to DEP suspensions. Cell death was induced in human umbilical vein endothelial cells by exposure (24 h) to (a) H2O2 (1–1000 μM; n = 1) or (b) Tween 20 (0.1–10 %; n = 1) (c) but not by diesel exhaust particles (DEP; 10–80 μg/ml) after 2 (red), 6 (blue) 16 (green) or 24 (purple) hours incubation. Data are mean ± s.e.mean (n = 6). (TIF 81 kb)
Real time polymerase chain reaction primers. (TIF 53 kb)