Pro-Coagulant and Pro-Thrombotic Effects of Paclitaxel Mediated by Red Blood Cells

• Published in: Thrombosis and haemostasis Vol. 118; no. 10; p. 1765
• Main Authors: Kim, Keunyoung, Chang, Youn-Kyeong, Bian, Yiying, Bae, Ok-Nam, Lim, Kyung-Min, Chung, Jin-Ho
• Format: Journal Article
• Language: English
• Published: Germany 01.10.2018
• Subjects: Adolescent; Animals; Antineoplastic Agents - adverse effects; Antineoplastic Agents - pharmacology; Antineoplastic Agents - therapeutic use; Cell-Derived Microparticles - metabolism; Drug-Related Side Effects and Adverse Reactions - prevention & control; Erythrocytes - physiology; Human Umbilical Vein Endothelial Cells; Humans; Male; Neoplasms - drug therapy; Paclitaxel - adverse effects; Paclitaxel - pharmacology; Paclitaxel - therapeutic use; Phosphatidylserines - metabolism; Phospholipid Transfer Proteins - metabolism; Rats; Rats, Sprague-Dawley; Thrombin - metabolism; Thrombosis - etiology; Thrombosis - prevention & control; Young Adult
• ISSN: 2567-689X
• DOI: 10.1055/s-0038-1670659

Paclitaxel is one of the most widely used anti-cancer drugs, but numerous case reports of thrombotic events in the cancer patients using paclitaxel raise concern over its pro-thrombotic risk.  We investigated whether paclitaxel can elicit pro-thrombotic properties in red blood cells (RBCs) through phosphatidylserine (PS) exposure and microvesicle (MV) release.  In freshly isolated human RBCs, paclitaxel induced thrombin generation through PS exposure and MV release, whereas either coagulation factors or platelets were unaffected. Paclitaxel-induced PS exposure in RBC was mediated by scramblase activation which was induced by calcium-independent protein kinase C (PKC)ζ activation. Paclitaxel also increased RBC-endothelial cell adhesion and RBC aggregate formation which can also contribute to thrombosis. Indeed, intravenous administration of paclitaxel to rats induced PS exposure and PKCζ activation in RBCs in vivo which ultimately promoted venous thrombus formation.  These results demonstrated that paclitaxel may elicit pro-thrombotic properties in RBCs through PS exposure and MV release, which can ultimately promote thrombus formation.