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Ji HL, Zhao R, Matalon S, Matthay MA. Elevated Plasmin(ogen) as a Common Risk Factor for COVID-19 Susceptibility. Physiol Rev 2020; 100:1065-1075. [PMID: 32216698 PMCID: PMC7191627 DOI: 10.1152/physrev.00013.2020] [Citation(s) in RCA: 257] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 01/08/2023] Open
Abstract
Patients with hypertension, diabetes, coronary heart disease, cerebrovascular illness, chronic obstructive pulmonary disease, and kidney dysfunction have worse clinical outcomes when infected with SARS-CoV-2, for unknown reasons. The purpose of this review is to summarize the evidence for the existence of elevated plasmin(ogen) in COVID-19 patients with these comorbid conditions. Plasmin, and other proteases, may cleave a newly inserted furin site in the S protein of SARS-CoV-2, extracellularly, which increases its infectivity and virulence. Hyperfibrinolysis associated with plasmin leads to elevated D-dimer in severe patients. The plasmin(ogen) system may prove a promising therapeutic target for combating COVID-19.
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Affiliation(s)
- Hong-Long Ji
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, Texas; Texas Lung Injury Institute, University of Texas Health Science Centre at Tyler, Tyler, Texas; Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine, Pulmonary Injury and Repair Center, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and Department of Medicine and Anesthesia, University of California San Francisco, San Francisco, California
| | - Runzhen Zhao
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, Texas; Texas Lung Injury Institute, University of Texas Health Science Centre at Tyler, Tyler, Texas; Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine, Pulmonary Injury and Repair Center, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and Department of Medicine and Anesthesia, University of California San Francisco, San Francisco, California
| | - Sadis Matalon
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, Texas; Texas Lung Injury Institute, University of Texas Health Science Centre at Tyler, Tyler, Texas; Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine, Pulmonary Injury and Repair Center, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and Department of Medicine and Anesthesia, University of California San Francisco, San Francisco, California
| | - Michael A Matthay
- Department of Cellular and Molecular Biology, University of Texas Health Science Centre at Tyler, Tyler, Texas; Texas Lung Injury Institute, University of Texas Health Science Centre at Tyler, Tyler, Texas; Department of Anesthesiology and Perioperative Medicine, Division of Molecular and Translational Biomedicine, Pulmonary Injury and Repair Center, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; and Department of Medicine and Anesthesia, University of California San Francisco, San Francisco, California
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Keyte SV, Kenny PJ, Forcada Y, Church DB, Niessen SJM. Serum N-Terminal Type III Procollagen Propeptide: An Indicator of Growth Hormone Excess and Response to Treatment in Feline Hypersomatotropism. J Vet Intern Med 2016; 30:973-82. [PMID: 27425382 PMCID: PMC5108467 DOI: 10.1111/jvim.14373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/25/2016] [Accepted: 06/11/2016] [Indexed: 01/03/2023] Open
Abstract
Background N‐terminal type III procollagen propeptide (PIIINP) is a biomarker of soft tissue proliferation. Hypersomatotropism (HS) is associated with soft tissue proliferation. Hypothesis Serum PIIINP is increased in cats with HS and decreases with effective treatment, and may be an additional tool in the diagnosis and treatment of feline HS. Animals Cats with uncomplicated diabetes mellitus (DM; n = 30) and with HS‐induced DM (HSDM; n = 30). Pre‐ and posttreatment samples were available from 5 cats undergoing radiotherapy (RT) and 16 cats undergoing hypophysectomy (HPX). Methods Retrospective and prospective cross‐sectional study. Analytical performance of a serum PIIINP ELISA was assessed and validated for use in cats. PIIINP and insulin‐like growth factor 1 (IGF‐1) radioimmunoassays (RIA) were performed pre‐ and post‐treatment in cats with DM and HSDM. PIIINP and IGF‐1 were compared between cats treated by RT and HPX. Results Serum PIIINP concentrations were significantly higher (P < .001) in HSDM cats (median, 19.6 ng/mL; range, 1.7–27.9) compared to DM cats (median, 5.0 ng/mL; range, 2.1–10.4). A cut‐off of 10.5 ng/mL allowed differentiation between DM and HSDM cats with 87% sensitivity and 100% specificity (area under the curve [AUC], 0.91; 95% confidence interval [CI], 0.82‐1). After RT, PIIINP increased significantly (P = .043) with no significant change in IGF‐1 concentrations. After HPX, serum PIIINP (P = .034) and IGF‐1 concentrations (P < .001) decreased significantly. Conclusion and clinical importance PIIINP concentrations are increased in cats with untreated HSDM compared to those with DM, demonstrating the effect of excess GH on soft tissue. PIIINP concentrations decreased after HPX in most HSDM cats.
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Affiliation(s)
- S V Keyte
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - P J Kenny
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - Y Forcada
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - D B Church
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - S J M Niessen
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
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Travis EL, Rachakonda G, Zhou X, Korhonen K, Sekhar KR, Biswas S, Freeman ML. NRF2 deficiency reduces life span of mice administered thoracic irradiation. Free Radic Biol Med 2011; 51:1175-83. [PMID: 21712086 PMCID: PMC3156301 DOI: 10.1016/j.freeradbiomed.2011.05.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/11/2011] [Accepted: 05/27/2011] [Indexed: 12/25/2022]
Abstract
Subsets of cancer survivors who have been subjected to thoracic irradiation face the prospect of developing pulmonary injury. Radiation-induced pulmonary fibrosis is an insidious injury that presents 6 to 24 months after irradiation and continues to progress over a period of years. TGF-β and reactive oxygen species contribute significantly to the pathogenesis of this injury. The transcription factor NRF2 controls antioxidant gene expression and therefore regulates the cellular oxidant burden. This work demonstrates an additional paradigm for NRF2: suppression of TGF-β-mediated signaling, assessed by measuring expression of a surrogate TGF-β1 target gene (PAI-1) in lung fibroblasts. Thoracic irradiation of Nfe2l2(-/-) mice resulted in rapid expression of PAI-1 and FSP-1 compared to irradiated wild-type mice. Examination of lung tissue 16 weeks after thoracic irradiation of Nfe2l2(-/-) mice revealed the presence of distended alveoli and decreased numbers of alveoli compared to wild-type mice. Suppression of NRF2 expression shortened life span in mice administered 16 Gy to the thorax. Nfe2l2(+/-) and Nfe2l2(-/-) mice exhibited a mean life span of 176 days compared to wild-type mice, which lived an average of 212 days. These novel results identify NRF2 as a susceptibility factor for the development of late tissue injury.
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Affiliation(s)
- Elizabeth L. Travis
- Department of Experimental Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0066, Houston, TX 77030
| | - Girish Rachakonda
- Department of Radiation Oncology, Vanderbilt University School of Medicine and the Vanderbilt-Ingram Cancer Center, Nashville, TN 37232
| | - Xinhui Zhou
- Department of Experimental Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0066, Houston, TX 77030
| | - Katrina Korhonen
- Department of Radiation Oncology, Vanderbilt University School of Medicine and the Vanderbilt-Ingram Cancer Center, Nashville, TN 37232
| | - Konjeti R Sekhar
- Department of Radiation Oncology, Vanderbilt University School of Medicine and the Vanderbilt-Ingram Cancer Center, Nashville, TN 37232
| | - Swati Biswas
- Department of Radiation Oncology, Vanderbilt University School of Medicine and the Vanderbilt-Ingram Cancer Center, Nashville, TN 37232
| | - Michael L. Freeman
- Department of Radiation Oncology, Vanderbilt University School of Medicine and the Vanderbilt-Ingram Cancer Center, Nashville, TN 37232
- To whom correspondence should be addressed: Michael L. Freeman, PhD, B 902 TVC Radiation Oncology, Vanderbilt University School of Medicine, Nashville, TN 37232. Phone: 615-322-3606;
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Fleckenstein K, Gauter-Fleckenstein B, Jackson IL, Rabbani Z, Anscher M, Vujaskovic Z. Using Biological Markers to Predict Risk of Radiation Injury. Semin Radiat Oncol 2007; 17:89-98. [PMID: 17395039 DOI: 10.1016/j.semradonc.2006.11.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Recent advances in our understanding of the molecular events leading to the development of normal tissue complications after radiotherapy has led to an effort to identify biological markers that could identify patients at increased or decreased risk for treatment related injury. The goal of this effort is to improve the therapeutic ratio and enable physicians to optimize therapy for individual patients. In radiotherapy of the thoracic region, the lung is one of the most critical dose-limiting organs. This review briefly introduces the mechanisms of radiation-induced lung injury and gives a summary of clinical research focused on evaluating changes in biological markers before, during, and after radiation therapy of the thorax.
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Gridley DS, Bonnet RB, Bush DA, Franke C, Cheek GA, Slater JD, Slater JM. Time course of serum cytokines in patients receiving proton or combined photon/proton beam radiation for resectable but medically inoperable non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004; 60:759-66. [PMID: 15465192 DOI: 10.1016/j.ijrobp.2004.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2003] [Revised: 02/27/2004] [Accepted: 04/02/2004] [Indexed: 01/04/2023]
Abstract
PURPOSE We prospectively measured the levels of basic fibroblast growth factor (bFGF), tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta, IL-6, IL-10, and procollagen III peptide (P III P) in serum from non-small-cell lung cancer patients treated with photons combined with protons or protons alone. These factors were quantified because they may be extremely important in the development of side effects, and the treated volume integral dose may be crucial in inducing them. METHODS Of the 12 participating patients, 6 with squamous cell carcinoma (SCC) and 3 with adenocarcinoma received combined photon/proton beam radiation, whereas 2 with SCC and 1 with large-cell carcinoma (LCC) received only proton radiation. Mean age was 73.6 years. There were 4 male and 8 female patients with a mean smoking history of 87.0 packyears. Nine patients had Stage I, 2 had Stage II, and 1 had stage IIIA lung cancer. Serum samples were obtained at baseline and on Days 15, 30, 45, 60, 90, 120, 150, 180, and 210 after initiation of radiation therapy. Injury scores for pneumonitis and fibrosis based on computed tomography (CT) scans were assigned. RESULTS The percentage of lung volume irradiated was significantly less for patients treated with protons alone compared with those receiving photon plus proton therapy (p < 0.001). Injury scores were also lower for proton only treatment (p = 0.039). When evaluated collectively, bFGF, TNF-alpha, and IL-6 concentrations were significantly higher in the photon/proton group (p < 0.05 or less); radiation regimen, but not time after treatment initiation, was a significant factor in their levels. P III P level was also higher in the photon/proton patients (p < 0.001) and both radiation regimen (p = 0.027) and time after treatment (p = 0.019) had an impact. CONCLUSIONS Although significant changes occurred in some of the measured cytokines and P III P, it was the difference in the volume integral dose that occurred when protons were used alone vs. mixed photon/proton therapy that correlated with the incidence of pneumonitis and/or fibrosis. However, it cannot be ruled out that differences in cytokine levels before radiotherapy initiation may have contributed to the outcome.
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Affiliation(s)
- Daila S Gridley
- Department of Radiation Medicine, School of Medicine, Loma Linda University and Medical Center, Chan Shuh Pavilion, 11175 Campus Street, Loma Linda, CA 92354, USA.
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Abstract
Fibrosis is a common sequela of both cancer treatment by radiotherapy and accidental irradiation and has been described in many tissues including skin, lung, heart and liver. The underlying mechanisms of the radiation-induced fibrosis still remain to be resolved. In the present review we tried to illustrate the basic cellular mechanisms of radiation-induced fibrosis based on the newest findings arising from molecular radiobiology and cell biology. Based on these findings the cellular mechanism of radiation-induced fibrosis can be seen as a multicellular process involving various interacting cell systems in the target organ resulting in the fibrotic phenotype of the fibroblast/fibrocyte cell system.
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Affiliation(s)
- H P Rodemann
- Department of Radiotherapy, Eberhard-Karls-University, Tübingen, Germany
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Affiliation(s)
- K Mattson
- Department of Pulmonary Medicine, Helsinki University Central Hospital, Finland
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Steinberg F, Quabeck K, Rehn B, Kraus R, Mohnke M, Costabel U, Kreuzfelder E, Molls M, Bruch J, Schaefer UW. Lung effects after total body irradiation of mice and bone marrow transplant patients: comparison of experimental and preliminary clinical data. Recent Results Cancer Res 1993; 130:133-43. [PMID: 8362083 DOI: 10.1007/978-3-642-84892-6_12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- F Steinberg
- Institute of Medical Radiation Biology, University Clinic, Essen, Federal Republic of Germany
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Molls M, Herrmann TH, Steinberg F, Feldmann HJ. Radiopathology of the lung: experimental and clinical observations. Recent Results Cancer Res 1993; 130:109-21. [PMID: 8362081 DOI: 10.1007/978-3-642-84892-6_10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M Molls
- Klinik für Strahlentherapie, Technische Universität, München, Fed, Rep. of Germany
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Mattson K, Holsti LR, Tammilehto L, Maasilta P, Pyrhönen S, Mäntylä M, Kajanti M, Salminen US, Rautonen J, Kivisaari L. Multimodality treatment programs for malignant pleural mesothelioma using high-dose hemithorax irradiation. Int J Radiat Oncol Biol Phys 1992; 24:643-50. [PMID: 1429086 DOI: 10.1016/0360-3016(92)90709-q] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The characteristic of malignant pleural mesothelioma is a tumor that grows by plate-like extension over the pleura, and invades adjacent tissues and organs. Radical surgical removal of the tumor is generally not possible, and most treatment regimens involve combined chemotherapy and radiotherapy, as well as debulking surgery. We have prospectively evaluated five locally-aggressive multi-modality treatment programs, using different hemithorax irradiation schedules and chemotherapy regimens. One hundred patients with confirmed malignant pleural mesothelioma entered the study between 1977 and 1989. The treatment programs, which can consecutively, were: I, 20 Gy (10 x 2 Gy) to the hemithorax + CYVADIC (cyclophosphamide 500 mg/m2 d 1, vincristine 1 mg/m2 d 1 and 5, adriamycin 40 mg/m2 d 1 and dacarbazine 200 mg/m2 d 1 and 5, several cycles before and after irradiation); II, 55 Gy (25 x 2.2 Gy) to the hemithorax + 15 Gy (6 x 2.5 Gy) to the tumor + CYVADIC (2 cycles before, 1 cycle during, and 2 cycles after irradiation); III, Mitoxantrone (14 mg/m2 q 28 d, < or = 6 cycles) followed by 70 Gy (56 x 1.25 Gy, twice a day); IV, 4-Epirubicin (110-130 mg/m2 q 28 d, < or = 6 cycles) followed by 35 Gy (28 x 1.25 Gy twice a day) to the hemithorax + 36 Gy (9 x 4 Gy every 2 days) to the tumor; V, Etoposide (150 mg/m2 1, 3, 5 q 28 d) followed by 38.5 Gy (11 x 3.5 Gy) to the hemithorax. A new system for evaluating tumor response in pleural mesothelioma was applied. None of the combined treatment programs prevented local invasive growth or the spread of mesothelioma outside the hemithorax. The median survival time was slightly increased from 8 to 12 months for those patients who completed the protocol treatments, but progressive disease was the invariable outcome. Radiation pneumonitis and fibrosis were severe and compatible with results of total loss of lung function on the irradiated side. We conclude that data relating to therapeutic responses and treatment programs in malignant mesothelioma should be better correlated internationally, if the problems associated with the evaluation of treatment and the management of patients with mesothelioma are to be improved.
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Affiliation(s)
- K Mattson
- Dept. of Pulmonary Medicine, Helsinki University Central Hospital, Finland
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