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Lipoprotein(a) in Atherosclerotic Diseases: From Pathophysiology to Diagnosis and Treatment. Molecules 2023; 28:molecules28030969. [PMID: 36770634 PMCID: PMC9918959 DOI: 10.3390/molecules28030969] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Lipoprotein(a) (Lp(a)) is a low-density lipoprotein (LDL) cholesterol-like particle bound to apolipoprotein(a). Increased Lp(a) levels are an independent, heritable causal risk factor for atherosclerotic cardiovascular disease (ASCVD) as they are largely determined by variations in the Lp(a) gene (LPA) locus encoding apo(a). Lp(a) is the preferential lipoprotein carrier for oxidized phospholipids (OxPL), and its role adversely affects vascular inflammation, atherosclerotic lesions, endothelial function and thrombogenicity, which pathophysiologically leads to cardiovascular (CV) events. Despite this crucial role of Lp(a), its measurement lacks a globally unified method, and, between different laboratories, results need standardization. Standard antilipidemic therapies, such as statins, fibrates and ezetimibe, have a mediocre effect on Lp(a) levels, although it is not yet clear whether such treatments can affect CV events and prognosis. This narrative review aims to summarize knowledge regarding the mechanisms mediating the effect of Lp(a) on inflammation, atherosclerosis and thrombosis and discuss current diagnostic and therapeutic potentials.
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Boffa MB. Beyond fibrinolysis: The confounding role of Lp(a) in thrombosis. Atherosclerosis 2022; 349:72-81. [DOI: 10.1016/j.atherosclerosis.2022.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/24/2022] [Accepted: 04/05/2022] [Indexed: 12/20/2022]
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Ugovšek S, Šebeštjen M. Lipoprotein(a)—The Crossroads of Atherosclerosis, Atherothrombosis and Inflammation. Biomolecules 2021; 12:biom12010026. [PMID: 35053174 PMCID: PMC8773759 DOI: 10.3390/biom12010026] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022] Open
Abstract
Increased lipoprotein(a) (Lp(a)) levels are an independent predictor of coronary artery disease (CAD), degenerative aortic stenosis (DAS), and heart failure independent of CAD and DAS. Lp(a) levels are genetically determinated in an autosomal dominant mode, with great intra- and inter-ethnic diversity. Most variations in Lp(a) levels arise from genetic variations of the gene that encodes the apolipoprotein(a) component of Lp(a), the LPA gene. LPA is located on the long arm of chromosome 6, within region 6q2.6–2.7. Lp(a) levels increase cardiovascular risk through several unrelated mechanisms. Lp(a) quantitatively carries all of the atherogenic risk of low-density lipoprotein cholesterol, although it is even more prone to oxidation and penetration through endothelia to promote the production of foam cells. The thrombogenic properties of Lp(a) result from the homology between apolipoprotein(a) and plasminogen, which compete for the same binding sites on endothelial cells to inhibit fibrinolysis and promote intravascular thrombosis. LPA has up to 70% homology with the human plasminogen gene. Oxidized phospholipids promote differentiation of pro-inflammatory macrophages that secrete pro-inflammatory cytokines (e. g., interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-α). The aim of this review is to define which of these mechanisms of Lp(a) is predominant in different groups of patients.
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Affiliation(s)
- Sabina Ugovšek
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Miran Šebeštjen
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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van den Berg VJ, Vroegindewey MM, Kardys I, Boersma E, Haskard D, Hartley A, Khamis R. Anti-Oxidized LDL Antibodies and Coronary Artery Disease: A Systematic Review. Antioxidants (Basel) 2019; 8:antiox8100484. [PMID: 31618991 PMCID: PMC6826549 DOI: 10.3390/antiox8100484] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 01/11/2023] Open
Abstract
Antibodies to oxidized LDL (oxLDL) may be associated with improved outcomes in cardiovascular disease. However, analysis is restricted by heterogenous study design and endpoints. Our objective was to conduct a comprehensive systematic review assessing anti-oxLDL antibodies in relation to coronary artery disease (CAD). Through a systematic literature search, we identified all studies assessing the relationship of either, IgG or IgM ox-LDL/ copper-oxLDL/ malondialdehyde-LDL, with coronary atherosclerosis or cardiovascular events in populations with, and without, established CAD. Systematic review best practices were adhered to and study quality was assessed. An initial electronic database search identified 2059 records, which was subsequently followed by abstract and full-text review. Finally, we included 18 studies with over 1811 patients with CAD. The studies varied according to populations studied, conventional cardiovascular risk factors and interventional modalities used to assess CAD. IgM anti-oxLDL antibodies were found to indicate protection from more severe CAD and possibly cardiovascular events, whilst the relationship with IgG is more complex and difficult to elucidate, with studies reporting divergent results. In this systematic review, there is evidence that suggests a relationship between anti-oxLDL antibodies and CAD, especially for the IgM subclass. However, further studies, with well-characterized prospective cohorts, will be important to clarify these associations.
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Affiliation(s)
- Victor J van den Berg
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.
| | - Maxime M Vroegindewey
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands.
| | - Dorian Haskard
- National Heart and Lung Institute, Imperial College London W12 0NN London, UK.
| | - Adam Hartley
- National Heart and Lung Institute, Imperial College London W12 0NN London, UK.
| | - Ramzi Khamis
- National Heart and Lung Institute, Imperial College London W12 0NN London, UK.
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Toprak MS, Ozturk ZG, Ekmekci OB, Ekmekci H, Ikitimur B, Karadag B, Cakmak HA, Ilerigelen B, Sonmez H. Comparison of exercise treadmill test, flow mediated dilatation, and inflammation in individuals with low risk of adverse cardiovascular events. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0902.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
The relationship between endothelial dysfunction, a risk factor for coronary artery disease, and the incidence of cardiovascular disease (CVD) in the general population is not well known.
Objectives
To determine the utility of an exercise treadmill test (ETT) combined with inflammatory markers to show endothelial dysfunction for individuals with a low risk of adverse cardiovascular (CV) events.
Methods
Biomarkers of inflammation (lipoprotein-related phospholipase A2 (Lp-PLA2) and high-sensitive C-reactive protein (hs-CRP)) and biomarkers of endothelial dysfunction (nitric oxide, oxidized low-density lipoprotein (Ox-LDL), and sialic acid) were assessed in 60 apparently healthy patients with a positive (+) or negative (−) ETT and across endothelial function assessed by flow mediated dilatation (FMD) and Lp-PLA2 tertiles.
Results
Lp-PLA2 levels were increased in ETT (−) compared with ETT (+) patients. Half of ETT (−) patients were found to have levels of Lp-PLA2 in the highest tertile. There was a significant inverse relationship between ETT and inflammatory biomarkers when adjusted for age, Lp-PLA2 (r = −0.28, P = 0.04), or hs-CRP (r = −0.35, P = 0.01). No differences were found for biomarkers of endothelial dysfunction. All variables were reassessed across FMD tertiles. Total lipids, Ox-LDL, triglyceride, and Lp-PLA2 were higher for the lowest FMD tertile.
Conclusion
The elevation of Lp-PLA2 in ETT (−) patients and the inverse relationship with inflammatory biomarkers, suggest that ETT cannot address endothelial dysfunction for individuals with apparently low risk of adverse CV events, and cannot be used for risk stratification of the general population.
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Affiliation(s)
- Muhammed Sait Toprak
- Department of Medical Biochemistry , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Zeynep Gungor Ozturk
- Department of Medical Biochemistry , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Ozlem Balci Ekmekci
- Department of Medical Biochemistry , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Hakan Ekmekci
- Department of Medical Biochemistry , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Baris Ikitimur
- Department of Cardiology , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Bilgehan Karadag
- Department of Cardiology , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Huseyin Altug Cakmak
- Department of Cardiology , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Baris Ilerigelen
- Department of Cardiology , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
| | - Huseyin Sonmez
- Department of Medical Biochemistry , Cerrahpasa Medical School , University of Istanbul , Istanbul 34452 , Turkey
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Boffa MB, Koschinsky ML. Lipoprotein (a): truly a direct prothrombotic factor in cardiovascular disease? J Lipid Res 2015; 57:745-57. [PMID: 26647358 DOI: 10.1194/jlr.r060582] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Indexed: 01/13/2023] Open
Abstract
Elevated plasma concentrations of lipoprotein (a) [Lp(a)] have been determined to be a causal risk factor for coronary heart disease, and may similarly play a role in other atherothrombotic disorders. Lp(a) consists of a lipoprotein moiety indistinguishable from LDL, as well as the plasminogen-related glycoprotein, apo(a). Therefore, the pathogenic role for Lp(a) has traditionally been considered to reflect a dual function of its similarity to LDL, causing atherosclerosis, and its similarity to plasminogen, causing thrombosis through inhibition of fibrinolysis. This postulate remains highly speculative, however, because it has been difficult to separate the prothrombotic/antifibrinolytic functions of Lp(a) from its proatherosclerotic functions. This review surveys the current landscape surrounding these issues: the biochemical basis for procoagulant and antifibrinolytic effects of Lp(a) is summarized and the evidence addressing the role of Lp(a) in both arterial and venous thrombosis is discussed. While elevated Lp(a) appears to be primarily predisposing to thrombotic events in the arterial tree, the fact that most of these are precipitated by underlying atherosclerosis continues to confound our understanding of the true pathogenic roles of Lp(a) and, therefore, the most appropriate therapeutic target through which to mitigate the harmful effects of this lipoprotein.
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Affiliation(s)
- Michael B Boffa
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, ON, Canada
| | - Marlys L Koschinsky
- Department of Chemistry and Biochemistry, University of Windsor, Windsor, ON, Canada Robarts Research Institute, Western University, London, ON, Canada
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Habib SS. Plasma tissue factor pathway inhibitor levels in angiographically defined coronary artery disease among saudis. Oman Med J 2013; 28:191-4. [PMID: 23772285 DOI: 10.5001/omj.2013.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/26/2013] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES This study was aimed to determine plasma levels of total (TFPI-T) and free (TFPI-F) tissue factor pathway inhibitor, plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator (t-PA) in a cohort of Saudi patients with chronic stable angiographically defined coronary artery disease (CAD) and to determine its correlation with its severity. METHODS This cross sectional study was conducted in the department of physiology and department of cardiology, College of Medicine, and King Khalid University Hospital and King Saud University, Riyadh. Sixty known cases of CAD who had undergone angiography (35 males and 25 females) were selected. A control group included 39 (20 males and 19 females) healthy subjects. Fasting venous blood samples were analyzed for total (TFPI-T) and free (TFPI-F) tissue factor pathway inhibitor, plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator (t-PA). Gensini scores and vessel scores were determined for assessing CAD severity. RESULTS There were non-significant differences between age, body mass index (BMI) and Blood pressure between the controls and CAD subjects. A comparison of hemostatic markers between control and CAD patients showed significantly higher levels of Fibrinogen, PAI-1, TFPI-T and TFPI-F in CAD patients compared to control subjects. But there was no difference in plasma t-PA levels. TFPI-T had a significant positive correlation with severity of disease determined by Gensini Scores (r=0.344; p=0.006) and vessel scores (r=0.338; p=0.015). CONCLUSION Plasma levels of total tissue factor pathway inhibitor are significantly related with the presence and severity of CAD. Elevated levels of TFPI-T may be considered as useful diagnostic and prognostic markers in patients with CAD.
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Affiliation(s)
- Syed Shahid Habib
- Associate Professor, Department of Physiology (29), College of Medicine, PO Box 2925, King Saud University, Riyadh 11461, Kingdom of Saudi Arabia
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Factor VIIa-antithrombin complexes plasma levels in cancer patients with and without thrombosis. Thromb Res 2012; 129:818-9. [DOI: 10.1016/j.thromres.2012.02.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 02/22/2012] [Accepted: 02/28/2012] [Indexed: 11/20/2022]
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Sebag SC, Bastarache JA, Ware LB. Therapeutic modulation of coagulation and fibrinolysis in acute lung injury and the acute respiratory distress syndrome. Curr Pharm Biotechnol 2012; 12:1481-96. [PMID: 21401517 DOI: 10.2174/138920111798281171] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 10/21/2010] [Accepted: 10/21/2010] [Indexed: 01/01/2023]
Abstract
Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are characterized by excessive intraalveolar fibrin deposition, driven, at least in part by inflammation. The imbalance between activation of coagulation and inhibition of fibrinolysis in patients with ALI/ARDS favors fibrin formation and appears to occur both systemically and in the lung and airspace. Tissue factor (TF), a key mediator of the activation of coagulation in the lung, has been implicated in the pathogenesis of ALI/ARDS. As such, there have been numerous investigations modulating TF activity in a variety of experimental systems in order to develop new therapeutic strategies for ALI/ARDS. This review will summarize current understanding of the role of TF and other proteins of the coagulation cascade as well the fibrinolysis pathway in the development of ALI/ARDS with an emphasis on the pathways that are potential therapeutic targets. These include the TF inhibitor pathway, the protein C pathway, antithrombin, heparin, and modulation of fibrinolysis through plasminogen activator- 1 (PAI-1) or plasminogen activators (PA). Although experimental studies show promising results, clinical trials to date have proven unsuccessful in improving patient outcomes. Modulation of coagulation and fibrinolysis has complex effects on both hemostasis and inflammatory pathways and further studies are needed to develop new treatment strategies for patients with ALI/ARDS.
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Affiliation(s)
- Sara C Sebag
- Department of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, T1218 MCN, 1161 21st Avenue S. Nashville, TN 37232-2650, USA
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Leopold JA, Loscalzo J. Oxidative risk for atherothrombotic cardiovascular disease. Free Radic Biol Med 2009; 47:1673-706. [PMID: 19751821 PMCID: PMC2797369 DOI: 10.1016/j.freeradbiomed.2009.09.009] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 08/31/2009] [Accepted: 09/06/2009] [Indexed: 02/07/2023]
Abstract
In the vasculature, reactive oxidant species, including reactive oxygen, nitrogen, or halogenating species, and thiyl, tyrosyl, or protein radicals may oxidatively modify lipids and proteins with deleterious consequences for vascular function. These biologically active free radical and nonradical species may be produced by increased activation of oxidant-generating sources and/or decreased cellular antioxidant capacity. Once formed, these species may engage in reactions to yield more potent oxidants that promote transition of the homeostatic vascular phenotype to a pathobiological state that is permissive for atherothrombogenesis. This dysfunctional vasculature is characterized by lipid peroxidation and aberrant lipid deposition, inflammation, immune cell activation, platelet activation, thrombus formation, and disturbed hemodynamic flow. Each of these pathobiological states is associated with an increase in the vascular burden of free radical species-derived oxidation products and, thereby, implicates increased oxidant stress in the pathogenesis of atherothrombotic vascular disease.
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Affiliation(s)
- Jane A Leopold
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Miller MA, Strazzullo P, Karanam S, Cappuccio FP. Ethnic variation in levels of circulating IgG autoantibodies to oxidised low-density lipoprotein. Atherosclerosis 2008; 203:126-36. [PMID: 18606413 DOI: 10.1016/j.atherosclerosis.2008.05.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 04/14/2008] [Accepted: 05/29/2008] [Indexed: 01/22/2023]
Abstract
BACKGROUND Oxidised low-density lipoprotein (Ox-LDL) plays a key role in atherosclerosis. Our aim was to determine whether serum autoantibodies against Ox-LDL (Ab Ox-LDL) differ by ethnic group. DESIGN AND METHODS Soluble serum Ab Ox-LDL levels were measured in 250 white (113 females), 169 African origin (91 females) and 196 South Asian (92 females) individuals from the Wandsworth Heart and Stroke Study (WHSS) population. All were free from coronary heart disease (CHD), stroke, other cardiovascular disease, diabetes, drug therapy for hypertension or high lipids, hormone replacement therapy or oral contraceptive pill. RESULTS There were no sex differences in levels of Ab Ox-LDL, but levels were higher in non-smokers (430U/L [95% CI 471-596]) than in smokers (384U/L [316-468]) (p<0.009). Age- and sex-adjusted levels of Ab Ox-LDL were higher in people of African origin and South Asians compared to whites. This difference was maintained in South Asian women following adjustment for multiple risk factors (82% [21-175]; p=0.004). Ab Ox-LDL levels were negatively associated with serum triglycerides and positively associated with sVCAM-1. CONCLUSIONS Higher IgG Ab to Ox-LDL are associated with higher levels of sVCAM-1 and, are elevated in female South Asian individuals who have an increased risk of atherosclerosis compared to whites.
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Affiliation(s)
- Michelle A Miller
- Warwick University, Clinical Sciences Research Institute, Clinical Sciences Building, UHCW Campus, Warwick Medical School, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom.
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Lima LM, Sousa MO, Dusse LMS, Lasmar MC, das Graças Carvalho M, Lwaleed BA. Tissue factor and tissue factor pathway inhibitor levels in coronary artery disease: Correlation with the severity of atheromatosis. Thromb Res 2007; 121:283-7. [PMID: 17582470 DOI: 10.1016/j.thromres.2007.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 03/12/2007] [Accepted: 04/20/2007] [Indexed: 10/23/2022]
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Abstract
Enhanced coagulation and thrombosis are linked to a variety of cardiovascular and metabolic diseases, as well as to cancer. Many of these diseases are also associated with enhanced levels of reactive oxygen species (ROS). Indeed, ROS have been made responsible for promoting many of these diseases. They have been shown not only to be cytotoxic, but also to serve as signaling molecules in a variety of cells. Recently, evidence accumulated that ROS and the redox state are also important in the control of blood coagulation and thrombosis.
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Affiliation(s)
- Agnes Görlach
- Experimental Pediatric Cardiology, Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the Technical University Munich, Munich, Germany.
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Di Nisio M, Nisio MD, ten Wolde M, Meijers JC, Meijers JCM, Buller HR. Effects of high plasma lipoprotein (a) levels on tissue factor pathway inhibitor and the protein C pathway. J Thromb Haemost 2005; 3:2123-5. [PMID: 16102130 DOI: 10.1111/j.1538-7836.2005.01517.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ariëns RAS. The quest for the Holy Grail of tissue factor pathway inhibitor deficiency has just begun. J Thromb Haemost 2005; 3:649-50. [PMID: 15842348 DOI: 10.1111/j.1538-7836.2005.01263.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R A S Ariëns
- Academic Unit of Molecular Vascular Medicine, the Leeds Institute for Genetics Health and Therapeutics (LIGHT), University of Leeds, UK.
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