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Background: Neutrophils by releasing extracellular traps (NETs) provide a scaffold for platelet activation and coagulation, thereby facilitating venous thrombosis (VT) development. Emerging evidence suggests that neutrophil activation and NETs formation (NETosis) is an energy-intensive process, accompanied by an increased rate of aerobic glycolysis (lactate formation in the presence of oxygen). The metabolic enzymes pyruvate dehydrogenase kinases (PDKs) inhibit the pyruvate dehydrogenase complex to divert the pyruvate flux (final product of glycolysis) from oxidative phosphorylation towards aerobic glycolysis. Recently, we reported the role of PDK2 and PDK4 (PDK2/4) in platelet activation and arterial thrombosis. The regulatory role of PDKs in neutrophils and VT has not been explored. Aim: To test the hypothesis that PDK2/4 promotes NETosis and VT by promoting glycolysis in neutrophils. Methods: Double-deficient PDK2/4 -/- and wild-type (WT) mice were subjected to 48 hours of inferior vena cava stenosis to test the susceptibility to VT. In vitro , neutrophils were stimulated with Phorbol 12-myristate 13-acetate (PMA) and the glycolytic proton efflux rate (glycoPER) was measured using the Seahorse XF Analyzer. Results: The PDK2/4 -/- mice were less susceptible to DVT as measured by the primary outcome of reduced thrombus burden (weight, length and % incidence) and marker of NETs such as citrullinated histones (P<0.05 vs WT). In the WT platelet aggregation assay mediated by PMA-stimulated WT or PDK2/4 -/- neutrophils, we observed reduced platelet aggregation evoked by PMA-stimulated PDK2/4 -/- neutrophils (P<0.05 vs WT). Impaired aggregation was associated with reduced release of cathepsin G and elastase from PMA-stimulated PDK2/4 -/- neutrophils (P<0.05 vs WT). Mechanistically, PMA-stimulated PDK2/4 -/- neutrophils exhibited reduced NETosis that was associated with decreased calcium mobilization and Erk1/2 phosphorylation (P<0.05 vs WT), known contributors of NETosis. Furthermore, PMA-stimulated PDK2/4 -/- neutrophils displayed reduced glycoPER (P<0.05 vs WT), suggesting reduced aerobic glycolysis. Conclusions: These findings for the first time demonstrate the regulatory role of PDK2/4 in NETosis and acute progression of VT.
Flora et al. (Wed,) studied this question.