Prothrombin Loading of Vascular Smooth Muscle Cell-Derived Exosomes Regulates Coagulation and Calcification

Alexander N. Kapustin, Michael Schoppet, Leon J. Schurgers, Joanne L. Reynolds, Rosamund McNair, Alexander Heiss, Willi Jahnen-Dechent, Tilman M. Hackeng, Georg Schlieper, Paul Harrison, Catherine M. Shanahan*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

66 Citations (Web of Science)
16 Downloads (Pure)

Abstract

Objective-The drug warfarin blocks carboxylation of vitamin K-dependent proteins and acts as an anticoagulant and an accelerant of vascular calcification. The calcification inhibitor MGP (matrix Gla [carboxyglutamic acid] protein), produced by vascular smooth muscle cells (VSMCs), is a key target of warfarin action in promoting calcification; however, it remains unclear whether proteins in the coagulation cascade also play a role in calcification.

Approach and Results-Vascular calcification is initiated by exosomes, and proteomic analysis revealed that VSMC exosomes are loaded with Gla-containing coagulation factors: IX and X, PT (prothrombin), and proteins C and S. Tracing of Alexa488-labeled PT showed that exosome loading occurs by direct binding to externalized phosphatidylserine (PS) on the exosomal surface and by endocytosis and recycling via late endosomes/multivesicular bodies. Notably, the PT Gla domain and a synthetic Gla domain peptide inhibited exosome-mediated VSMC calcification by preventing nucleation site formation on the exosomal surface. PT was deposited in the calcified vasculature, and there was a negative correlation between vascular calcification and the levels of circulating PT. In addition, we found that VSMC exosomes induced thrombogenesis in a tissue factor-dependent and PS-dependent manner.

Conclusions-Gamma-carboxylated coagulation proteins are potent inhibitors of vascular calcification suggesting warfarin action on these factors also contributes to accelerated calcification in patients receiving this drug. VSMC exosomes link calcification and coagulation acting as novel activators of the extrinsic coagulation pathway and inducers of calcification in the absence of Gla-containing inhibitors.

Original languageEnglish
Pages (from-to)E22-E32
Number of pages11
JournalArteriosclerosis Thrombosis and Vascular Biology
Volume37
Issue number3
DOIs
Publication statusPublished - Mar 2017

Keywords

  • anticoagulants
  • exosomes
  • myocytes
  • smooth muscle
  • prothrombin
  • vascular calcification
  • MATRIX GLA PROTEIN
  • HUMAN ATHEROSCLEROTIC PLAQUES
  • FETUIN-MINERAL COMPLEX
  • TISSUE FACTOR
  • CARDIOVASCULAR CALCIFICATION
  • CALCIPROTEIN PARTICLES
  • EXTRACELLULAR CALCIUM
  • POTENTIAL MECHANISM
  • CHEMICAL SYNTHESIS
  • ENDOTHELIAL-CELLS

Cite this