Prothrombogenic thrombocytic phenotype in patients with nonproliferative diabetic retinopathy
Background. Patients with type 2 diabetes mellitus (DM) have increased reactivity of thrombocytes (Tc), the causes of which remain unclear. The hypothesis of the dependence of Tc receptors functional activity on the individual reactivity of the organism is tested. The purpose of the study was to establish whether the individual reactivity of Tc differs in patients with diabetic nonproliferative retinopathy (DNPR). Materials and methods. The study included 19 patients (19 eyes) with type 2 DM, who, according to the results of the clinical and instrumental examination and according to the Early Treatment of Diabetic Retinopathy Study classification, had mild DNPR. Ophthalmological examination was performed before the beginning of treatment and included the collection of anamnesis, visual acuity study with optimal optical correction, tonometry, gonioscopy, biomicroscopy, ophthalmoscopy, optical coherence tomography (Stratus OCT apparatus). Thrombocytes were isolated by centrifugation from citrated peripheral blood of patients. To activate Tc, agonists were used: adenosine diphosphate (2.5 μM), adrenaline (2.5 μM), angiotensin II (1.0 μM), platelet activating factor (75.0 μM) and collagen (1.0 mg/ml). The Tc aggregation was evaluated by a spectrophotometric method on the ChronoLog aggregometer (USA). Results. The revealed individual reactivity of Tc in patients with DNPR was manifested by the features of thrombogenesis induction. A hyperreactivity of Tc to three agonists was detected: adrenaline, collagen and angiotensin II, which was characteristic of prothrombogenic phenotype. Depending on the functional activity of the investigated receptors, two main clusters of Tc receptors were identified, which were equal by the activity of α2-adrenoreceptors and angiotensin type 1 receptors, but differed by the response of Tc to collagen. Conclusions. Determination of the prothrombogenic phenotype and clusters of functionally active Tc receptors opens the possibility for evaluating the proaggregant effect of etiological and pathogenetic factors of type 2 DM in order to establish the factors of diabetic retinopathy progression.
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