Emergence of AnnexinV(pos) CD31(neg) CD42b(low/neg) extracellular vesicles in plasma of humans at extreme altitude

BACKGROUND: Hypobaric hypoxia has been reported to cause endothelial cell and platelet dysfunction implicated in the formation of microvascular lesions, and in its extremes may contribute to vascular leakage in high altitude pulmonary edema or blood brain barrier disruption leading to cerebral micro-hemorrhage (MH). Platelet function in the development of microvascular lesions remained ill defined, and is still incompletely understood. In this study platelet- and endothelial cell-derived extracellular vesicles (PEV and EEV, respectively) and cell adhesion molecules were characterized in plasma samples of members of a high altitude expedition to delineate the contribution of platelets and endothelial cells to hypobaric hypoxia-induced vascular dysfunction. METHODS AND FINDINGS: In this observational study, platelet and endothelial cell-derived extracellular vesicles were analysed by flow-cytometry in plasma samples from 39 mountaineers participating in a medical research climbing expedition to Himlung Himal, Nepal, 7,050m asl. Megakaryocyte/platelet-derived AnnexinV(pos), PECAM-1 (CD31) and glycoprotein-1b (GP1b, CD42b) positive extracellular vesicles (PEV) constituted the predominant fraction of EV in plasma samples up to 6,050m asl. Exposure to an altitude of 7,050m led to a marked decline of CD31(pos) CD42(neg) EEV as well as of CD31(pos) CD42b(pos) PEV at the same time giving rise to a quantitatively prevailing CD31(neg) CD42b(low/neg) subpopulation of AnnexinV(pos) EV. An almost hundredfold increase in the numbers of this previously unrecognized population of CD31(neg) CD42b(low/neg) EV was observed in all participants reaching 7,050m asl. CONCLUSIONS: The emergence of CD31(neg) CD42b(low/neg) EV was observed in all participants and thus represents an early hypoxic marker at extreme altitude. Since CD31 and CD42b are required for platelet-endothelial cell interactions, these hypobaric hypoxia-dependent quantitative and phenotypic changes of AnnexinV(pos) EV subpopulations may serve as early and sensitive indicators of compromised vascular homeostasis.