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Anti-TNFα agents curb platelet activation in patients with rheumatoid arthritis
  1. Angelo A Manfredi1,
  2. Mattia Baldini1,
  3. Marina Camera2,3,
  4. Elena Baldissera1,
  5. Marta Brambilla3,
  6. Giuseppe Peretti4,5,
  7. Attilio Maseri1,
  8. Patrizia Rovere-Querini1,
  9. Elena Tremoli2,3,
  10. Maria Grazia Sabbadini1,
  11. Norma Maugeri1
  1. 1Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, Milano, Italy
  2. 2Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy
  3. 3Centro Cardiologico Monzino IRCCS, Milan, Italy
  4. 4Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
  5. 5IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
  1. Correspondence to Dr Norma Maugeri, Università Vita-Salute San Raffaele and IRCCS San Raffaele Scientific Institute, via Olgettina 58, Milano 20132, Italy; maugeri.norma{at}


Background Cardiovascular disease is important in rheumatoid arthritis (RA). Tissue factor (TF) is expressed upon platelet activation and initiates coagulation. Anti-tumour necrosis factor-α (TNFα) agents seem to decrease RA-associated cardiovascular events. We investigated whether (1) TNFα activates human platelets and (2) TNFα pharmacological blockade modulates the platelet-leucocyte reciprocal activation in RA.

Design The expression of platelet TNFα receptors has been assessed by flow cytometry and immunogold electron microscopy. Platelet and leucocyte activation has been assessed also in the presence of antibodies against the TNFα receptors 1 and 2 and of infliximab. TF expression, binding to fibrinogen and phosphatidylserine exposure, has been assessed by flow cytometry, TF activity by coagulation time and by endogenous thrombin generation. Markers of platelet and leucocyte activation have been assessed in 161 subjects: 42 patients with RA, 12 with osteoarthritis, 37 age-matched and sex-matched patients with chronic stable angina and 70 age-matched and sex-matched healthy subjects.

Results TNFα elicited the platelet activation and the expression of TF, which in turn prompted thrombin generation and clot formation. Inhibition of the TNFα-induced activation restricted platelet ability to activate leucocytes and to induce leucocyte TF. TNFα inhibition did not influence platelet activation induced by collagen, ADP or thrombin receptor activating peptide-6. Platelets of patients with RA were more activated than those of controls. Activation was reduced in patients treated with TNFα inhibitors.

Conclusions TNFα-dependent pathways control platelet activation and TF expression in RA. Further studies will verify whether the protective effect of TNFα inhibitors on cardiovascular events involves their ability to modulate platelet function.

  • Anti-TNF
  • Rheumatoid Arthritis
  • TNF-alpha
  • Cardiovascular Disease
  • Atherosclerosis

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