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Relationship between serum zinc level and sepsis-induced coagulopathy. Int J Hematol 2021; 115:87-95. [PMID: 34669153 DOI: 10.1007/s12185-021-03225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND We investigated whether a decrease in the serum zinc level (SZL) among patients with sepsis admitted to the intensive care unit (ICU) was related to sepsis-induced coagulopathy. METHODS All patients (≥20 years) with a diagnosis of sepsis defined by Sepsis-3 criteria, presenting to the ICU between June 2016 and July 2017, were enrolled. Demographic characteristics and the Sequential Organ Failure Assessment (SOFA) and Japanese Association of Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) scores were recorded. Blood samples were collected upon admission and analyzed for SZL. RESULTS One hundred patients with sepsis (median age, 70 years) were enrolled. Patients with SOFA scores ≥8 had a significantly lower SZL compared to those with SOFA scores <8 (p < 0.001). The SZL in the DIC group (JAAM DIC score ≥4) was significantly lower than that in the non-DIC group (JAAM DIC score <4) (p < 0.001). Analysis of receiver operating characteristic (ROC) curves for prediction of sepsis-induced DIC based on SZL in patients with sepsis showed a cut-off value of 25 µg/dL for zinc level and a sensitivity of 63% and a specificity of 72% with AUC of 0.7 (p = 0.0065). CONCLUSION We observed that SZL reflects organ failure, particularly coagulopathy, in patients with sepsis.
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Kell DB, Pretorius E. The simultaneous occurrence of both hypercoagulability and hypofibrinolysis in blood and serum during systemic inflammation, and the roles of iron and fibrin(ogen). Integr Biol (Camb) 2015; 7:24-52. [PMID: 25335120 DOI: 10.1039/c4ib00173g] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although the two phenomena are usually studied separately, we summarise a considerable body of literature to the effect that a great many diseases involve (or are accompanied by) both an increased tendency for blood to clot (hypercoagulability) and the resistance of the clots so formed (hypofibrinolysis) to the typical, 'healthy' or physiological lysis. We concentrate here on the terminal stages of fibrin formation from fibrinogen, as catalysed by thrombin. Hypercoagulability goes hand in hand with inflammation, and is strongly influenced by the fibrinogen concentration (and vice versa); this can be mediated via interleukin-6. Poorly liganded iron is a significant feature of inflammatory diseases, and hypofibrinolysis may change as a result of changes in the structure and morphology of the clot, which may be mimicked in vitro, and may be caused in vivo, by the presence of unliganded iron interacting with fibrin(ogen) during clot formation. Many of these phenomena are probably caused by electrostatic changes in the iron-fibrinogen system, though hydroxyl radical (OH˙) formation can also contribute under both acute and (more especially) chronic conditions. Many substances are known to affect the nature of fibrin polymerised from fibrinogen, such that this might be seen as a kind of bellwether for human or plasma health. Overall, our analysis demonstrates the commonalities underpinning a variety of pathologies as seen in both hypercoagulability and hypofibrinolysis, and offers opportunities for both diagnostics and therapies.
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Affiliation(s)
- Douglas B Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, 131, Princess St, Manchester M1 7DN, Lancs, UK.
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Henderson SJ, Stafford AR, Leslie BA, Kim PY, Vaezzadeh N, Ni R, Fredenburgh JC, Weitz JI. Zinc delays clot lysis by attenuating plasminogen activation and plasmin-mediated fibrin degradation. Thromb Haemost 2015; 113:1278-88. [PMID: 25789495 DOI: 10.1160/th14-09-0771] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/15/2015] [Indexed: 11/05/2022]
Abstract
Zinc circulates free in plasma at a concentration of 0.1-2 µM, but its levels increase locally when it is released from activated platelets. Although zinc influences many processes in haemostasis, its effect on fibrinolysis has not been thoroughly investigated. Using a fluorescent zinc-binding probe, we demonstrated that zinc binds tissue-type plasminogen activator (tPA) and plasmin with high affinity (Kd values of 0.2 µM), and surface plasmon resonance studies revealed that zinc binds fibrin with a Kd of 12.8 µM. Zinc had no effect on the affinity of plasminogen or plasmin for fibrin, but increased the affinity of tPA by two-fold. In the presence of 5 µM zinc, the catalytic efficiency of plasminogen activation by tPA was reduced by approximately two-fold, both in the absence or presence of fibrin. Zinc attenuated plasmin-mediated degradation of the fibrinogen alpha-chain by 43 %, but had no effect on trypsin degradation. tPA-mediated fibrin clot lysis was prolonged 2.5-fold by zinc in a concentration-dependent fashion, and tPA-mediated plasma clot lysis was attenuated by 1.5-fold. Therefore, our data indicate that zinc modulates fibrinolysis by attenuating tPA-mediated plasminogen activation and plasmin-induced fibrin degradation. These findings suggest that local release of zinc by platelets attenuates fibrinolysis.
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Affiliation(s)
| | | | | | | | | | | | | | - Jeffrey I Weitz
- Jeffrey I. Weitz, Thrombosis and Atherosclerosis Research Institute, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada, Tel.: +1 905 521 2100 ext. 40721, E-mail:
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Marx G, Gilon C. The molecular basis of memory. Part 2: chemistry of the tripartite mechanism. ACS Chem Neurosci 2013; 4:983-93. [PMID: 23419130 DOI: 10.1021/cn300237r] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We propose a tripartite mechanism to describe the processing of cognitive information (cog-info), comprising the (1) neuron, (2) surrounding neural extracellular matrix (nECM), and (3) numerous "trace" metals distributed therein. The neuron is encased in a polyanionic nECM lattice doped with metals (>10), wherein it processes (computes) and stores cog-info. Each [nECM:metal] complex is the molecular correlate of a cognitive unit of information (cuinfo), similar to a computer "bit". These are induced/sensed by the neuron via surface iontophoretic and electroelastic (piezoelectric) sensors. The generic cuinfo are used by neurons to biochemically encode and store cog-info in a rapid, energy efficient, but computationally expansive manner. Here, we describe chemical reactions involved in various processes that underline the tripartite mechanism. In addition, we present novel iconographic representations of various types of cuinfo resulting from"tagging" and cross-linking reactions, essential for the indexing cuinfo for organized retrieval and storage of memory.
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Affiliation(s)
| | - Chaim Gilon
- Institute of Chemistry, Hebrew University, Jerusalem, Israel
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Chan HH, Leslie BA, Stafford AR, Roberts RS, Al-Aswad NN, Fredenburgh JC, Weitz JI. By Increasing the Affinity of Heparin for Fibrin, Zn2+ Promotes the Formation of a Ternary Heparin–Thrombin–Fibrin Complex That Protects Thrombin from Inhibition by Antithrombin. Biochemistry 2012; 51:7964-73. [DOI: 10.1021/bi301046b] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Howard H. Chan
- Departments of Medicine, ‡Biochemistry and Biomedical Sciences, and §Clinical Epidemiology & Biostatistics, McMaster University, and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Beverly A. Leslie
- Departments of Medicine, ‡Biochemistry and Biomedical Sciences, and §Clinical Epidemiology & Biostatistics, McMaster University, and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Alan R. Stafford
- Departments of Medicine, ‡Biochemistry and Biomedical Sciences, and §Clinical Epidemiology & Biostatistics, McMaster University, and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Robin S. Roberts
- Departments of Medicine, ‡Biochemistry and Biomedical Sciences, and §Clinical Epidemiology & Biostatistics, McMaster University, and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Nadine N. Al-Aswad
- Departments of Medicine, ‡Biochemistry and Biomedical Sciences, and §Clinical Epidemiology & Biostatistics, McMaster University, and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - James C. Fredenburgh
- Departments of Medicine, ‡Biochemistry and Biomedical Sciences, and §Clinical Epidemiology & Biostatistics, McMaster University, and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Jeffrey I. Weitz
- Departments of Medicine, ‡Biochemistry and Biomedical Sciences, and §Clinical Epidemiology & Biostatistics, McMaster University, and the Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
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Tubek S, Grzanka P, Tubek I. Role of zinc in hemostasis: a review. Biol Trace Elem Res 2008; 121:1-8. [PMID: 17968515 DOI: 10.1007/s12011-007-8038-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2007] [Accepted: 10/01/2007] [Indexed: 10/22/2022]
Abstract
Zinc is a multi-functional element that is found in almost 300 enzymes where it performs catalytic, co-catalytic, and/or structural functions. In 1982, Gordon et al. (Am J Clin Ntr 35:849-857, 1982) found that a low zinc diet caused poor platelet aggregation and increased bleeding tendency in adult males. This fact drew interest to the role of zinc in blood clotting. It has been shown that hyperzincemia predisposes to increased coagulability, and hypozincemia to poor platelet aggregation and increased bleeding time. The blood clotting disturbances can be regressed by appropriate zinc intake management. Considering the importance of zinc as an essential element, its participation in regulation of the equilibrium between pro- and anti-thrombotic factors originating in platelets and endothelium prompted further investigations.
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Affiliation(s)
- Sławomir Tubek
- Faculty of Physical Education and Physiotherapy, Institute of Technology, Opole, Prószkowska Street 76, 45-758, Opole, Poland.
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Marx G, Korner G, Mou X, Gorodetsky R. Packaging zinc, fibrinogen, and factor XIII in platelet alpha-granules. J Cell Physiol 1993; 156:437-42. [PMID: 8360253 DOI: 10.1002/jcp.1041560302] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Zinc(II) accumulated by platelets has profound effects on platelet activity. This study is focused on the distribution of Zn(II) between human platelet subcellular compartments. After incubation with 86Rb+ and platelet lysis, the organelles were separated by sucrose density gradient centrifugation. Fibrinogen served as a marker for alpha-granules. 86Rb+ and factor XIII served as markers for the cytoplasmic fractions. Zn(II) was found to be distributed between the cytoplasm and the alpha-granules, with variations between different individual units. The total platelet Zn concentration and its relative subcellular distribution were dependent on its extracellular level. Incubation of platelets with 100 microM Zn(II) resulted in a twofold increase of its level in the cytoplasm and by one order of magnitude in the alpha-granules. In addition to the anticipated factor XIII activity in the cytoplasmic pool fraction, we found thrombin-inducible factor XIII activity within the alpha-granules. Immunoblotting confirmed the presence of both the a and b subunits of plasma factor XIII (a2b2 form) in the alpha-granules. As fibrinogen is not synthesized in the platelet, we propose that by virtue of their mutual binding, fibrinogen, Zn(II) and plasma factor XIII-a2b2 are simultaneously taken up into the alpha-granules by endocytosis, presumably through the vehicle of the GPIIb/IIIa fibrinogen receptor. A rationale for co-packaging these components within the alpha-granules is that Zn(II) inhibits factor XIII activity and thereby prevents the premature cross-linking of the concentrated fibrinogen prior to platelet activation and secretion. By contrast, cytoplasmic Zn(II) may increase platelet responsiveness to agonists due to its interaction with cytoplasmic modulators of platelet activity.
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Affiliation(s)
- G Marx
- New York Blood Center, New York 10021
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Gorodetsky R, Mou X, Blankenfeld A, Marx G. Platelet multielemental composition, lability, and subcellular localization. Am J Hematol 1993; 42:278-83. [PMID: 8438901 DOI: 10.1002/ajh.2830420307] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Diagnostic X-ray spectrometry (DXS), based on X-ray fluorescence, was used to quantitate directly the multiple elemental composition of washed, intact human platelets (n = 16), with the following results: K = 3.08 +/- 1.00 mg/g, Ca = 1.18 +/- 0.29 mg/g, Zn = 35 +/- 9 micrograms/g. These values show that washed platelets contain significant pools of K, Ca, and Zn, the latter some 30-60-fold higher than plasma levels. Dialysis of whole platelets against cation exchange resin (Chelex-100) did not extract Ca(II) and Zn(II) sequestered within whole cells. To identify the subcellular locale of the elements, platelet lysate was subjected to 30-70% sucrose gradient ultracentrifugation and subcellular enriched fractions were obtained. Fractions were analyzed by DXS (for elements), electron microscopy (for dense granules), and subcellular markers fibrinogen and von Willebrand factor. In contrast to Ca and K, which accumulate in the dense granules and the cytoplasm, respectively, Zn appears to be distributed in the alpha-granules (40%) and the cytoplasm (60%). The subcellular distribution of Zn(II) is discussed within the context of the sensitivity of platelet response to the availability of Zn(II) and the platelet release reactions following stimulation.
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Affiliation(s)
- R Gorodetsky
- Sharett Institute of Oncology, Hadassah University Hospital, Jerusalem, Israel
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