Apixaban Downregulates Endothelial Inflammatory and Prothrombotic Phenotype in an In Vitro Model of Endothelial Dysfunction in Uremia

• DOI: 10.1007/s10557-020-07010-z
• Publication Date: 2020-07-10T08:03:51Z
• Authors: Sergi Torramade-Moix; Marta Palomo; Manel Vera; Didac Jerez; Ana Belen Moreno-...; M Urooj Zafar; Jordi Rovira; Fritz Diekmann; Joan Carles Garci...; Gines Escolar; Aleix Cases; Maribel Diaz-Ricart
• Keywords: Inflammation; 0301 basic medicine; Nitric Oxide Synthase Type III; Pyridones; Endothelial Cells; Vascular Cell Adhesion Molecule-1; Intercellular Adhesion Molecule-1; Extracellular Matrix; 3. Good health; 03 medical and health sciences; Phenotype; Oxidative stress; Chronic kidney disease; von Willebrand Factor; Human Umbilical Vein Endothelial Cells; Humans; Pyrazoles; Endothelial dysfunction; Reactive Oxygen Species; Direct oral anticoagulant; Factor Xa Inhibitors; Signal Transduction; Uremia

Chronic kidney disease (CKD) associates with inflammatory and prothrombotic phenotypes, resulting in higher cardiovascular risk. Factor Xa displays functions beyond coagulation, exhibiting proinflammatory effects. The aim of the present study was to investigate whether a direct FXa inhibitor protects from the endothelial dysfunction (ED) caused by uremia.Macro (HUVEC) and microvascular (HMEC) endothelial cells (ECs) were exposed to serum from uremic patients or healthy donors, in absence and presence of apixaban (60 ng/ml). We evaluated changes in surface VCAM-1 and ICAM-1, intracellular eNOS, reactive oxygen species (ROS), and von Willebrand Factor (VWF) production by immunofluorescence, reactivity of the extracellular matrix (ECM) towards platelets, and intracellular signaling.ECs exposed to uremic serum triggered dysregulation of all the parameters. Presence of apixaban resulted in decreased expression of VCAM-1 (178 ± 14 to 89 ± 2% on HMEC and 324 ± 71 to 142 ± 25% on HUVEC) and ICAM-1 (388 ± 60 to 111 ± 10% on HMEC and 148 ± 9% to 90 ± 7% on HUVEC); increased eNOS (72 ± 8% to 95 ± 10% on HMEC); normalization of ROS levels (173 ± 21 to 114 ± 13% on HMEC and 165 ± 14 to 127 ± 7% on HUVEC); lower production of VWF (168 ± 14 to 92 ± 4% on HMEC and 151 ± 22 to 99 ± 11% on HUVEC); and decreased platelet adhesion onto ECM (134 ± 22 to 93 ± 23% on HMEC and 161 ± 14 to 117 ± 7% on HUVEC). Apixaban inhibited p38MAPK and p42/44 activation in HUVEC (139 ± 15 to 48 ± 15% and 411 ± 66 to 177 ± 57%, respectively) (p < 0.05 vs control for all parameters).Anti-FXa strategies, such as apixaban, prevented ED caused by the uremic milieu, exhibiting anti-inflammatory and antioxidant properties and modulating the reactivity of the ECM.