Abstract WMP76: Clots are Potent Triggers of Inflammatory Cell Gene Expression - Indications for Timely Fibrinolysis in Stroke

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Rationale: Blood vessel wall damage often results in the formation of a fibrin clot that traps inflammatory cells, including monocytes. The effect of clot formation and subsequent lysis on the expression of monocyte-derived genes involved in the development and progression of ischemic stroke and other vascular diseases, however, is unknown.Objective: Determine if clot formation and lysis regulate the expression of human monocyte-derived genes that modulate vascular diseases.Methods and Results: We performed Next Generation RNA sequencing on monocytes extracted from whole blood clots. Thousands of mRNAs were significantly differentially expressed by monocytes from clotted versus unclotted whole blood (p>0.05), including upregulation of many inflammatory cytokines such as interleukin 8 (IL-8), IL-1β, tumor necrosis factor alpha, and monocyte chemoattractant protein-1 (MCP-1). Clotted plasma also increased expression of IL-8 and MCP-1, which far exceeded responses observed in LPS-stimulated monocytes. Upregulation of IL-8 and MCP-1 occurred in a thrombin-independent, but fibrin-dependent, manner. Fibrinolysis initiated shortly after plasma clot formation (i.e., 1-2 hours) reduced the global inflammatory response based on RNA-seq analysis and significantly reduced the synthesis of IL-8 and MCP-1 (p>0.05). Delayed fibrinolysis was far less effective in reducing inflammation. Consistent with these in vitro models, monocytes embedded in unresolved thrombi from patients undergoing thrombectomy stained positively for IL-8 and MCP-1.Conclusion: These findings demonstrate that clots are potent inducers of monocyte gene expression, and that timely fibrinolysis attenuates inflammatory responses. Dampening of inflammatory gene expression by timely clot lysis may contribute to the clinically-proven efficacy of fibrinolytic drug treatment within hours of stroke onset.

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