Oral Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Its reticulated: The liver at the heart of atherosclerosis (#71)

Man KS Lee 1 , Michael J Kraakman 1 2 , Michelle C Flynn 1 , Helene L Kammoun 1 , Ira J Goldberg 3 , Prabhakara R Nagareddy 4 , Andrew J Murphy 1
  1. Baker Heart and Diabetes Institute, St Kilda Road Central, VIC, Australia
  2. Columbia University, New York, USA
  3. New York University, New York, USA
  4. Nutrition Science, University of Alabama at Birmingham, Birmingham, AL, USA

Platelets play a critical role in atherogenesis and thrombosis-mediated myocardial ischemia, processes that are accelerated in diabetes. It remains unknown if hyperglycemia promotes platelet production and whether this contributes to enhanced atherothrombosis. Here we show that in response to hyperglycemia, neutrophil-derived S100A8/A9 interacts with the receptor for advanced glycated end-products (RAGE) on hepatic Kupffer cells resulting in increased production of interleukin-6 (IL-6), a pleiotropic cytokine implicated in inflammatory thrombocytosis. IL-6 acts on hepatocytes to enhance the production of thrombopoietin, which in turn interacts with its cognate receptor, c-MPL on megakaryocytes and bone marrow progenitor cells to promote their expansion and proliferation resulting in reticulated thrombocytosis. Lowering blood glucose using a sodium-glucose co-transporter 2 inhibitor (dapagliflozin), depleting neutrophils/Kupffer cells or inhibiting S100A8/A9 binding to RAGE (paquinimod) all reduced diabetes-induced thrombocytosis. Inhibiting S100A8/A9 also decreased atherogenesis in diabetic mice. These studies provide novel insights into the communication between innate immune cells, the liver and the bone marrow to regulate platelet production. These findings contribute to our understanding of the disease process and may help to develop strategies to improve on current antiplatelet therapies and to reduce cardiovascular disease risk in diabetes.