Platelet aggregation and serum adenosine deaminase (ADA) activity in pregnancy associated with diabetes, hypertension and HIV

Platelets and endothelial dysfunction in gestational diabetes mellitus

The prevalence of gestational diabetes mellitus (GDM) has increased in recent years, along with the higher prevalence of obesity in women of reproductive age. GDM is a pathology associated with vascular dysfunction in the fetoplacental unit. GDM-associated endothelial dysfunction alters the transfer of nutrients to the foetus affecting newborns and pregnant women. Various mechanisms for this vascular dysfunction have been proposed, of which the most studied are metabolic alterations of the vascular endothelium. However, different cell types are involved in GDM-associated endothelial dysfunction, including platelets. Platelets are small, enucleated cell fragments that actively take part in blood haemostasis and thrombus formation. Thus, they play crucial roles in pathologies coursing with endothelial dysfunction, such as atherosclerosis, cardiovascular diseases, and diabetes mellitus. Nevertheless, platelet function in GDM is understudied. Several reports show a potential relationship between platelet volume and mass with GDM; however, platelet roles and signaling mechanisms in GDM-associated endothelial dysfunction are unclear. This review summarizes the reported findings and proposes a link among altered amount, volume, mass, reactivity, and function of platelets and placenta development, resulting in fetoplacental vascular dysfunction in GDM.

Pregnancy Related Venous Thromboembolism-Associated with HIV Infection and Antiretroviral Therapy

Human immunodeficiency virus (HIV) infection in pregnancy is associated with substantial morbidity and mortality. Improved access to effective antiretroviral therapy (ART) has shifted the spectrum of pregnancy-related complications among HIV-infected pregnant women. In addition to placental vascular complications and preterm delivery, increased rates of venous thromboembolism (VTE) have been described. HIV infection is characterized by immune activation, inflammation, and endothelial dysfunction, which contribute to the activation of coagulation and its prothrombotic consequences. Indeed, activated coagulation factors have been reported to be increased and natural anticoagulants reduced in HIV. Several mechanisms for this persistent prothrombotic balance on ART have been identified. These may include: co-infections, immune recovery, and loss of the gastrointestinal mucosal integrity with microbial translocation. In addition to the direct effects of HIV and ART, traditional venous and obstetric risk factors also contribute to the risk of VTE. A research priority has been to understand the mechanisms of VTE in HIV-infected pregnant women receiving suppressive ART and to translate this into HIV-specific thromboprophylaxis recommendations. Management requires a multidisciplinary approach and further studies are indicated to guide the prevention and management of pregnancy-associated VTE in this population. The current review describes the epidemiology, mechanisms, and management of VTE in HIV-infected women in pregnancy and the postpartum period.

Association of circulating inflammatory cells and platelets with gestational diabetes and pregnancy outcomes

Gestational diabetes mellitus (GDM) is the most common cause of hyperglycemia during pregnancy, and its prevalence has increased over the past decades. GDM is directly related to the recent obstetric outcomes and long-term maternal and child health, which can be greatly improved by early identification and diagnosis of GDM. However, the prediction of the disease has always been a difficult problem due to the lack of simple and practical serological markers. Despite the controversy, recent studies have identified that circulating inflammatory cells and platelets, routinely included in the obstetric blood tests, are related to the development of GDM and adverse pregnancy outcomes. In this review, we summarized the studies in this field based on the recent literature. The inflammatory cell components we included were the total number of white blood cells, neutrophils, lymphocytes, monocytes and platelets, which were routinely examined in the blood tests in pregnancy. The aim of this review is not only to enrich our understanding of the pathogenesis of GDM but also to provide evidence for the value of these novel and practical serological markers in early identification of GDM and the prevention and its adverse outcomes.

Therapeutic Perspectives of Adenosine Deaminase Inhibition in Cardiovascular Diseases

Adenosine deaminase (ADA) is an enzyme of purine metabolism that irreversibly converts adenosine to inosine or 2'deoxyadenosine to 2'deoxyinosine. ADA is active both inside the cell and on the cell surface where it was found to interact with membrane proteins, such as CD26 and adenosine receptors, forming ecto-ADA (eADA). In addition to adenosine uptake, the activity of eADA is an essential mechanism that terminates adenosine signaling. This is particularly important in cardiovascular system, where adenosine protects against endothelial dysfunction, vascular inflammation, or thrombosis. Besides enzymatic function, ADA protein mediates cell-to-cell interactions involved in lymphocyte co-stimulation or endothelial activation. Furthermore, alteration in ADA activity was demonstrated in many cardiovascular pathologies such as atherosclerosis, myocardial ischemia-reperfusion injury, hypertension, thrombosis, or diabetes. Modulation of ADA activity could be an important therapeutic target. This work provides a systematic review of ADA activity and anchoring inhibitors as well as summarizes the perspectives of their therapeutic use in cardiovascular pathologies associated with increased activity of ADA.

[Changes in the indicators of thromboelastography and platelet function in pregnant women with various forms of hypertensive disorders in the third trimester of pregnancy.]

The aim of this research is the study of haemostasis of pregnant women suffering from various forms of hypertensive disorders in their III trimester of pregnancy. 165 women at 26-41 weeks of pregnancy were examined: 22 women had moderate preeclampsia, 31 had severe preeclampsia, 45 women suffered from chronic hypertension, 20 women have developed preeclampsia on the background of chronic hypertension and 47 women had no hypertensive disorders (control group). The hemostasis system has been assessed using the results of the following investigations: thromboelastography, induced platelet aggregation with ADP and adrenaline at a dosage of 1.25 and 2.5 μg/ml respectively and collagen at a dosage of 20 mg/ml, platelet ATP secretion and the average concentration of platelet components. Thromboelastography has been performed using TEG® 5000 thromboelastograph (Haemoscope Corporation, USA). The study of platelet aggregation and platelet ATP secretion has been performed at automatic aggregometer CHRONO-LOG® Model 700 (USA). The mean platelet component concentration has been measured using SIEMENS ADVIA 2120i automated hematology analyzer (Siemens Healthcare Diagnostics Inc., USA). Thromboelastogram analysis showed a decrease in the plasma hemostasis activity in all groups of women with hypertensive disorders. The functional activity of platelets of women with moderate preeclampsia and chronic arterial hypertension did not change in comparison with to the control group. The disorder of dense platelet granules degranulation and decrease in their aggregation ability have been detected in a cohort with severe preeclampsia. The decrease in adrenaline induced platelet aggregation has been noted in the group of women suffering from preeclampsia on the background of chronic arterial hypertension. Thromboelastography analysis (R, K, angle α, TMA, Cl, LY30) may be useful for the differential diagnosis of severe preeclampsia and chronic arterial hypertension. The results of the study led to the conclusion that it is advisable to use low doses of ADP and adrenaline as inducers of platelet aggregation, considering their granulocyticity and the ability to secrete ATP.

A Network Pharmacology Approach to Uncover the Molecular Mechanisms of Herbal Formula Ban-Xia-Xie-Xin-Tang

Ban-Xia-Xie-Xin-Tang (BXXXT) is a classical formula from Shang-Han-Lun which is one of the earliest books of TCM clinical practice. In this work, we investigated the therapeutic mechanisms of BXXXT for the treatment of multiple diseases using a network pharmacology approach. Here three BXXXT representative diseases (colitis, diabetes mellitus, and gastric cancer) were discussed, and we focus on in silico methods that integrate drug-likeness screening, target prioritizing, and multilayer network extending. A total of 140 core targets and 72 representative compounds were finally identified to elucidate the pharmacology of BXXXT formula. After constructing multilayer networks, a good overlap between BXXXT nodes and disease nodes was observed at each level, and the network-based proximity analysis shows that the relevance between the formula targets and disease genes was significant according to the shortest path distance (SPD) and a random walk with restart (RWR) based scores for each disease. We found that there were 22 key pathways significantly associated with BXXXT, and the therapeutic effects of BXXXT were likely addressed by regulating a combination of targets in a modular pattern. Furthermore, the synergistic effects among BXXXT herbs were highlighted by elucidating the molecular mechanisms of individual herbs, and the traditional theory of "Jun-Chen-Zuo-Shi" of TCM formula was effectively interpreted from a network perspective. The proposed approach provides an effective strategy to uncover the mechanisms of action and combinatorial rules of BXXXT formula in a holistic manner.

The Impact of Purinergic System Enzymes on Noncommunicable, Neurological, and Degenerative Diseases

Evidences show that purinergic signaling is involved in processes associated with health and disease, including noncommunicable, neurological, and degenerative diseases. These diseases strike from children to elderly and are generally characterized by progressive deterioration of cells, eventually leading to tissue or organ degeneration. These pathological conditions can be associated with disturbance in the signaling mediated by nucleotides and nucleosides of adenine, in expression or activity of extracellular ectonucleotidases and in activation of P2X and P2Y receptors. Among the best known of these diseases are atherosclerosis, hypertension, cancer, epilepsy, Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS). The currently available treatments present limited effectiveness and are mostly palliative. This review aims to present the role of purinergic signaling highlighting the ectonucleotidases E-NTPDase, E-NPP, E-5'-nucleotidase, and adenosine deaminase in noncommunicable, neurological, and degenerative diseases associated with the cardiovascular and central nervous systems and cancer. In conclusion, changes in the activity of ectonucleotidases were verified in all reviewed diseases. Although the role of ectonucleotidases still remains to be further investigated, evidences reviewed here can contribute to a better understanding of the molecular mechanisms of highly complex diseases, which majorly impact on patients' quality of life.