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Jeyakumar S, Nguyen H, Robson D, Olsen N, Schnegg B, Macdonald P, Fraser CL, Liew G, Jiang J, Hayward C, Muthiah K. Retinal microvascular remodeling associates with adverse events in continuous-flow left ventricular assist device supported patients. J Heart Lung Transplant 2024:S1053-2498(24)01750-9. [PMID: 39089605 DOI: 10.1016/j.healun.2024.07.017] [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: 12/14/2023] [Revised: 06/13/2024] [Accepted: 07/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Continuous-flow left ventricular assist device (cfLVAD) use is effective in supporting patients with end-stage heart failure (ESHF). Reduced flow pulsatility within the systemic circulation in cfLVAD-supported patients may lead to alterations within the microcirculation. Temporal changes in microvasculature in relation to adverse events in cfLVAD supported patients has not been studied. We aimed to profile changes within retinal microvasculature and its association with adverse events. METHODS Retinal photography was performed using Topcon TRC-NW8 non-mydriatic fundus camera in cfLVAD supported patients and ESHF control patients. Retinal measurements including arteriolar and venular caliber, fractal dimension, branching angle, and vessel tortuosity were evaluated using a validated semi-automated program. Demographic and adverse event data were documented. RESULTS 172 images were recorded from 48 patients (n=29 cfLVAD, n=19 ESHF, mean age 54.2 ± 11.9 years). There were significant trends in retinal arteriolar caliber (B = -0.53 µm, 95% CI: -0.96 - -0.10, p = 0.016) and retinal fractal dimension parameters (B = 0.014, 95% CI: 0.001 - 0.002, p = 0.016) in linear mixed model regressions. Amongst cfLVAD patients, there was a significant association between the incidence of gastrointestinal bleeding and stepwise increases in retinal arteriolar-venular caliber ratio (HR: 3.03, 95% CI: 2.06 - 4.45, p = 0.005), a measure of arteriolar narrowing. CONCLUSIONS We have observed for the first time that alterations in retinal microvasculature in cfLVAD-supported patients may be associated with gastrointestinal bleeding. While understanding these temporal changes may predict future adverse events in cfLVAD-supported patients, further multi-center studies are required to confirm the associations observed.
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Affiliation(s)
| | - Helen Nguyen
- Westmead Institute for Medical Research, The University of Sydney
| | | | | | | | - Peter Macdonald
- University of New South Wales Sydney; St. Vincent's Hospital Sydney; Victor Chang Cardiac Research Institute
| | | | - Gerald Liew
- University of New South Wales Sydney; Westmead Institute for Medical Research, The University of Sydney
| | | | - Christopher Hayward
- University of New South Wales Sydney; St. Vincent's Hospital Sydney; Victor Chang Cardiac Research Institute
| | - Kavitha Muthiah
- University of New South Wales Sydney; St. Vincent's Hospital Sydney; Victor Chang Cardiac Research Institute.
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2
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Lahu S, Adler K, Mayer K, Hein-Rothweiler R, Bernlochner I, Ndrepepa G, Schüpke S, Holdenrieder S, Bongiovanni D, Laugwitz KL, Schunkert H, Gawaz M, Massberg S, Kastrati A, Münch G. Plasma Soluble Glycoprotein VI, Platelet Function, Bleeding, and Ischemic Events in Patients Undergoing Elective Percutaneous Coronary Intervention. Thromb Haemost 2024; 124:297-306. [PMID: 37591289 DOI: 10.1055/s-0043-1772221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND AIMS Glycoprotein VI (GPVI) is the major platelet-specific collagen receptor. GPVI shedding with generation of soluble GPVI (sGPVI) is an endogenous feedback mechanism preventing platelet overstimulation. sGPVI has not been investigated in patients with chronic coronary syndrome (CCS) undergoing percutaneous coronary intervention (PCI), especially regarding its potential value as a predictor of ischemic and bleeding risk. METHODS Baseline plasma sGPVI levels were available in 318 patients with CCS undergoing PCI. Platelet function was assessed by measuring both adenosine diphosphate (ADP) and collagen-induced platelet aggregation. Co-primary endpoints were a composite of death or myocardial injury at 48 hours after PCI, and Bleeding Academic Research Consortium (BARC) type 1 to 5 bleeding at 30 days. RESULTS There was no significant correlation between sGPVI and platelet function at baseline or at 48 hours after PCI and loading with antiplatelet drugs. Baseline plasma sGPVI levels were not associated with the ischemic risk: the incidence of the ischemic endpoint was 25.0% in the lower, 22.9% in the middle, and 26.7% in the upper sGPVI tertile (p = 0.82). There was a significant nonlinear relationship between sGPVI and the risk of bleeding: the incidence of the bleeding endpoint was 11.8% in the lower, 12.6% in the middle, and 26.4% in the upper sGPVI tertile (p = 0.006). CONCLUSION In patients with CCS undergoing PCI, plasma levels of sGPVI did not correlate with ADP- or collagen-induced platelet aggregation. Patients with higher baseline levels of sGPVI may carry an increased risk of bleeding at 30 days after PCI but no excess risk of ischemic events.
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Affiliation(s)
- Shqipdona Lahu
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | | | - Katharina Mayer
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Ralph Hein-Rothweiler
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Isabell Bernlochner
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Gjin Ndrepepa
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Stefanie Schüpke
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Privatpraxis für Kardiologie, Kaiserstr. 10, 60311 Frankfurt am Main, Germany
| | - Stefan Holdenrieder
- Institut für Laboratoriumsmedizin, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Dario Bongiovanni
- Klinik für Kardiologie, Pneumologie, Endokrinologie, Intensivmedizin, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Karl-Ludwig Laugwitz
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Steffen Massberg
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany
| | - Adnan Kastrati
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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3
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Schneider DJ. Plasma Soluble Glycoprotein VI: A Biomarker of Bleeding. Thromb Haemost 2024; 124:307-309. [PMID: 37619610 DOI: 10.1055/a-2160-0368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- David J Schneider
- Department of Medicine, Cardiovascular Research Institute, The University of Vermont, Burlington, Vermont, United States
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4
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Tanaka S, Nishinaka T, Umeki A, Murakami T, Imaoka S, Mizuno T, Tsukiya T, Ono M. Hemodynamic Evaluation of Asynchronous Speed Modulation of a Continuous-Flow Left Ventricular Assist Device in an Acute-Myocardial Injury Sheep Model. Ann Biomed Eng 2024; 52:364-375. [PMID: 37851145 DOI: 10.1007/s10439-023-03383-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
Asynchronous rotational-speed modulation of a continuous-flow left ventricular assist device (LVAD) can increase pulsatility; however, the feasibility of hemodynamic modification by asynchronous modulation of an LVAD has not been sufficiently verified. We evaluated the acute effect of an asynchronous-modulation mode under LVAD support and the accumulated effect of 6 consecutive hours of driving by the asynchronous-modulation mode on hemodynamics, including both ventricles, in a coronary microembolization-induced acute-myocardial injury sheep model. We evaluated 5-min LVAD-support hemodynamics, including biventricular parameters, by switching modes from constant-speed to asynchronous-modulation in the same animals ("acute-effect evaluation under LVAD support"). To determine the accumulated effect of a certain driving period, we evaluated hemodynamics including biventricular parameters after weaning from 6-hour (6 h) LVAD support by constant-speed or asynchronous-modulation mode ("6h-effect evaluation"). The acute-effect evaluation under LVAD support revealed that, compared to the constant-speed mode, the asynchronous-modulation mode increased vascular pulsatility but did not have significantly different effects on hemodynamics, including both ventricles. The 6 h-effect evaluation revealed that the hemodynamics did not differ significantly between the two groups except for some biventricular parameters which did not indicate negative effects of the asynchronous-modulation mode on both ventricles. The asynchronous-modulation mode could be feasible to increase vascular pulsatility without causing negative effects on hemodynamics including both ventricles. Compared to the constant-speed mode, the asynchronous-modulation mode increased pulsatility during LVAD support without negative effects on hemodynamics including both ventricles in the acute phase. Six hours of LVAD support with the asynchronous-modulation mode exerted no negative effects on hemodynamics, including both ventricles, after weaning from the LVAD.
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Affiliation(s)
- Shun Tanaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan.
| | - Tomohiro Nishinaka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Akihide Umeki
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Takashi Murakami
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Shusuke Imaoka
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Toshihide Mizuno
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Tomonori Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo, 7-3-1, Hongo, Bunkyo , Tokyo, 113-8654, Japan
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5
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Favaloro EJ. The Role of the von Willebrand Factor Collagen-Binding Assay (VWF:CB) in the Diagnosis and Treatment of von Willebrand Disease (VWD) and Way Beyond: A Comprehensive 36-Year History. Semin Thromb Hemost 2024; 50:43-80. [PMID: 36807283 DOI: 10.1055/s-0043-1763259] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The von Willebrand factor (VWF) collagen binding (VWF:CB) assay was first reported for use in von Willebrand diagnostics in 1986, by Brown and Bosak. Since then, the VWF:CB has continued to be used to help diagnose von Willebrand disease (VWD) (correctly) and also to help assign the correct subtype, as well as to assist in the monitoring of VWD therapy, especially desmopressin (DDAVP). However, it is important to recognize that the specific value of any VWF:CB is predicated on the use of an optimized VWF:CB, and that not all VWF:CB assays are so optimized. There are some good commercial assays available, but there are also some "not-so-good" commercial assays available, and these may continue to give the VWF:CB "a bad reputation." In addition to VWD diagnosis and management, the VWF:CB found purpose in a variety of other applications, from assessing ADAMTS13 activity, to investigation into acquired von Willebrand syndrome (especially as associated with use of mechanical circulatory support or cardiac assist devices), to assessment of VWF activity in disease states in where an excess of high-molecular-weight VWF may accumulate, and lead to increased (micro)thrombosis risk (e.g., coronavirus disease 2019, thrombotic thrombocytopenic purpura). The VWF:CB turns 37 in 2023. This review is a celebration of the utility of the VWF:CB over this nearly 40-year history.
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Affiliation(s)
- Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia
- School of Dentistry and Medical Sciences, Faculty of Science and Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
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6
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Hidiatov O, Gaupp A, Marini I, Pelzl L, Wagner M, Rigoni F, Witzemann A, Häberle H, Martus P, Ngamsri KC, Konrad FM, Rosenberger P, Straub A, Bakchoul T, Althaus K. Characterization of Shear Stress Mediated Platelet Dysfunction: Data from an Ex Vivo Model for Extracorporeal Circulation and a Prospective Clinical Study. Thromb Haemost 2023; 123:415-426. [PMID: 36442804 DOI: 10.1055/a-1988-3174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Extracorporeal circulation (ECC) is frequently used in intensive care patients with impaired lung or cardiac function. Despite being a life-saving therapeutic option, ECC is associated with increased risk for both bleeding and thrombosis. The management of bleeding and thromboembolic events in ECC patients is still challenging partly due to the lack of information on the pathophysiological changes in hemostasis and platelet function during the procedure. Using a combination of an ex vivo model for shear stress and a sensitive and easy-to-use laboratory method, we analyzed platelet responsiveness during ECC. After shear stress simulation in an ex vivo closed-loop ECC model, we found a significantly decreased response of α-granules after activation with adenosine diphosphate and thrombin receptor activating peptide (TRAP-6) and CD63 expression after activation with TRAP-6. Mepacrine uptake was also significantly reduced in the ex vivo shear stress model.In the same line, platelets from patients under ECC with venovenous systems and venoarterial systems showed impaired CD62P degranulation after stimulation with ADP and TRAP-6 compared with healthy control on day 1, 6, and 10 after implantation of ECC. However, no correlation between platelet degranulation and the occurrence of bleeding or thromboembolic events was observed.The used whole blood flow cytometry with immediate fixation after drawing introduces a sensitive and easy-to-use method to determine platelet activation status and our data confirm that increased shear stress conditions under ECC can cause impaired degranulation of platelet.
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Affiliation(s)
- Oleg Hidiatov
- Department of Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
| | - Alisha Gaupp
- Department of Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
| | - Irene Marini
- Department of Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
| | - Lisann Pelzl
- Department of Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
| | - Miriam Wagner
- Department of Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
| | - Flavianna Rigoni
- Department of Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
| | - Andreas Witzemann
- Department of Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany
| | - Helene Häberle
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany
| | - Peter Martus
- Institute for Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | | | - Franziska M Konrad
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany
| | - Andreas Straub
- Department of Anesthesiology and Intensive Care Medicine, University of Tübingen, Tübingen, Germany.,Department of Anesthesiology, Intensive Care, Emergency, and Pain Medicine, St. Elisabethen Klinikum, Ravensburg, Germany
| | - Tamam Bakchoul
- Department of Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany.,Centre for Clinical Transfusion Medicine, Tübingen ZKT gGmbH, Tübingen, Germany
| | - Karina Althaus
- Department of Transfusion Medicine, Medical Faculty of Tübingen, University of Tübingen, Tübingen, Germany.,Centre for Clinical Transfusion Medicine, Tübingen ZKT gGmbH, Tübingen, Germany
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7
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Decreased Platelet Specific Receptor Expression of P-Selectin and GPIIb/IIIa Predict Future Non-Surgical Bleeding in Patients after Left Ventricular Assist Device Implantation. Int J Mol Sci 2022; 23:ijms231810252. [PMID: 36142161 PMCID: PMC9499488 DOI: 10.3390/ijms231810252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Non-surgical bleeding (NSB) is one of the major clinical complications in patients under continuous-flow left ventricular assist device (LVAD) support. The increased shear stress leads to an altered platelet receptor composition. Whether these changes increase the risk for NSB is unclear. Thus, we compared the platelet receptor composition of patients with (bleeder group, n = 18) and without NSB (non-bleeder group, n = 18) prior to LVAD implantation. Blood samples were obtained prior to LVAD implantation and after bleeding complications in the post-implant period. Platelet receptor expression of GPIbα, GPIIb/IIIa, P-selectin and CD63 as well as intra-platelet oxidative stress levels were quantified by flow cytometry. Bleeders and non-bleeders were comparable regarding clinical characteristics, von Willebrand factor diagnostics and the aggregation capacity before and after LVAD implantation (p > 0.05). LVAD patients in the bleeder group suffered from gastrointestinal bleeding (33%; n = 6), epistaxis (22%; n = 4), hematuria or hematoma (17%; n = 3, respectively) and cerebral bleeding (11%; n = 2). Prior to LVAD implantation, a restricted surface expression of the platelet receptors P-selectin and GPIIb/IIIa was observed in the bleeder group (P-selectin: 7.2 ± 2.6%; GPIIb/IIIa: 26,900 ± 13,608 U) compared to non-bleeders (P-selectin: 12.4 ± 8.1%, p = 0.02; GPIIb/IIIa: 36,259 ± 9914 U; p = 0.02). We hypothesized that the reduced platelet receptor expression of P-selectin and GPIIb/IIIa prior to LVAD implantation may be linked to LVAD-related NSB.
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The Anemia Stress Index—Anemia, Transfusions, and Mortality in Patients with Continuous Flow Ventricular Assist Devices. J Clin Med 2022; 11:jcm11154517. [PMID: 35956132 PMCID: PMC9369576 DOI: 10.3390/jcm11154517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/12/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
We aimed to identify a simple metric accounting for peri-procedural hemoglobin changes, independent of blood product transfusion strategies, and assess its correlation with outcomes in patients undergoing left ventricular assist device (LVAD) implantation We included consecutive patients undergoing LVAD implantation at a single center between 10/1/2008 and 6/1/2014. The anemia stress index (ASI), defined as the sum of number of packed red blood cells transfused and the hemoglobin changes after LVAD implantation, was calculated for each patient at 24 h, discharge, and 3 months after LVAD implantation. Our cohort included 166 patients (80.1% males, mean age 56.3 ± 15.6 years) followed up for a median of 12.3 months. Increases in ASI per unit were associated with a higher hazard for all-cause mortality and early RV failure. The associations between the ASI and all-cause mortality persisted after multivariable adjustment, irrespective of when it was calculated (adjusted HR of 1.11, 95% CI 1.03–1.20 per unit increase in ASI). Similarly, ASI at 24 h after implant was associated with early RV failure despite multivariable adjustment (OR 1.09, 95% CI 1.05–1.14). We present a novel metric, the ASI, that is correlated with an increased risk for all-cause mortality and early RV failure in LVAD recipients.
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9
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Wang Y, Nguyen KT, Ismail E, Donoghue L, Giridharan GA, Sethu P, Cheng X. Effect of pulsatility on shear-induced extensional behavior of Von Willebrand factor. Artif Organs 2022; 46:887-898. [PMID: 34866200 PMCID: PMC9791949 DOI: 10.1111/aor.14133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Patients with continuous flow ventricular assist devices (CF-VADs) are at high risk for non-surgical bleeding, speculated to associate with the loss of pulsatility following CF-VAD placement. It has been hypothesized that continuous shear stress causes elongation and increased enzymatic degradation of von Willebrand Factor (vWF), a key player in thrombus formation at sites of vascular damage. However, the role of loss of pulsatility on the unravelling behavior of vWF has not been widely explored. METHODS vWF molecules were immobilized on the surface of microfluidic devices and subjected to various pulsatile flow profiles, including continuous flow and pulsatile flow of different magnitudes, dQ/dt (i.e., first derivative of flow rate) of pulsatility and pulse frequencies to mimic in vivo shear flow environments with and without CF-VAD support. VWF elongation was observed using total internal reflection fluorescence (TIRF) microscopy. Besides, the vWF level is measured from the patients' blood sample before and after CF-VAD implantation from a clinical perspective. To our knowledge, this work is the first in providing direct, visual observation of single vWF molecule extension under controlled-pulsatile shear flow. RESULTS Unravelling of vWF (total sample size n ~ 200 molecules) is significantly reduced under pulsatile flow (p < 0.01) compared to continuous flow. An increase in the magnitude of pulsatility further reduces unravelling lengths, while lower frequency of pulsatility (20 vs. 60 pulses per min) does not have a major effect on the maximum or minimum unravelling lengths. Evaluation of CF-VAD patient blood samples (n = 13) demonstrates that vWF levels decreased by ~40% following CF-VAD placement (p < 0.01), which correlates to single-molecule observations from a clinical point of view. CONCLUSIONS Pulsatile flow reduces unfolding of vWF compared to continuous flow and a lower pulse frequency of 20 pulses/minute yielded comparable vWF unfolding to 60 pulses/minute. These findings could shed light on non-surgical bleeding associated with the loss of pulsatility following CF-VAD placement.
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Affiliation(s)
- Yi Wang
- Department of Materials Science and Engineering, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Khanh T. Nguyen
- Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Biomedical Engineering, School of Engineering and School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Esraa Ismail
- Department of Bioengineering, Lehigh University, Bethlehem, Pennsylvania, USA
| | - Leslie Donoghue
- Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Biomedical Engineering, School of Engineering and School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Guruprasad A. Giridharan
- Department of Bioengineering, J. B. Speed School of Engineering, University of Louisville, Louisville, Kentucky, USA
| | - Palaniappan Sethu
- Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA,Department of Biomedical Engineering, School of Engineering and School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Xuanhong Cheng
- Department of Materials Science and Engineering, Lehigh University, Bethlehem, Pennsylvania, USA,Department of Bioengineering, Lehigh University, Bethlehem, Pennsylvania, USA
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10
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Muthiah K, Wilhelm K, Robson D, Raju H, Aili SR, Jha SR, Pierce R, Fritis-Lamora R, Montgomery E, Gorrie N, Deveza R, Brennan X, Schnegg B, Jabbour A, Kotlyar E, Keogh AM, Bart N, Conellan M, Iyer A, Watson A, Granger E, Jansz PC, Hayward C, Macdonald PS. Impact of frailty on mortality and morbidity in bridge to transplant recipients of contemporary durable mechanical circulatory support. J Heart Lung Transplant 2022; 41:829-839. [DOI: 10.1016/j.healun.2022.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 01/30/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
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11
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Montague SJ, Patel P, Martin EM, Slater A, Quintanilla LG, Perrella G, Kardeby C, Nagy M, Mezzano D, Mendes PM, Watson SP. Platelet activation by charged ligands and nanoparticles: platelet glycoprotein receptors as pattern recognition receptors. Platelets 2021; 32:1018-1030. [PMID: 34266346 DOI: 10.1080/09537104.2021.1945571] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 02/08/2023]
Abstract
Charge interactions play a critical role in the activation of the innate immune system by damage- and pathogen-associated molecular pattern receptors. The ability of these receptors to recognize a wide spectrum of ligands through a common mechanism is critical in host defense. In this article, we argue that platelet glycoprotein receptors that signal through conserved tyrosine-based motifs function as pattern recognition receptors (PRRs) for charged endogenous and exogenous ligands, including sulfated polysaccharides, charged proteins and nanoparticles. This is exemplified by GPVI, CLEC-2 and PEAR1 which are activated by a wide spectrum of endogenous and exogenous ligands, including diesel exhaust particles, sulfated polysaccharides and charged surfaces. We propose that this mechanism has evolved to drive rapid activation of platelets at sites of injury, but that under some conditions it can drive occlusive thrombosis, for example, when blood comes into contact with infectious agents or toxins. In this Opinion Article, we discuss mechanisms behind charge-mediated platelet activation and opportunities for designing nanoparticles and related agents such as dendrimers as novel antithrombotics.
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Affiliation(s)
- Samantha J Montague
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pushpa Patel
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, UK
- Centre of Membrane Proteins and Receptors, Universities of Birmingham and Nottingham, UK
| | - Eleyna M Martin
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alexandre Slater
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Lourdes Garcia Quintanilla
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gina Perrella
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Caroline Kardeby
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Magdolna Nagy
- Departments of Biochemistry and Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Diego Mezzano
- Laboratorio de Trombosis y Hemostasia, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Paula M Mendes
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, UK
- Centre of Membrane Proteins and Receptors, Universities of Birmingham and Nottingham, UK
| | - Steve P Watson
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre of Membrane Proteins and Receptors, Universities of Birmingham and Nottingham, UK
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12
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Soluble glycoprotein VI is a predictor of major bleeding in patients with suspected heparin-induced thrombocytopenia. Blood Adv 2021; 4:4327-4332. [PMID: 32915974 DOI: 10.1182/bloodadvances.2020002861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
We have shown that patients with suspected heparin-induced thrombocytopenia (HIT) have a high incidence of major bleeding. Recent studies have implicated elevated soluble glycoprotein VI (sGPVI) levels as a potential risk factor for bleeding. We sought to determine if elevated sGPVI plasma levels are associated with major bleeding events in patients with suspected HIT. We used a cohort of 310 hospitalized adult patients with suspected HIT who had a blood sample collected at the time HIT was suspected. Plasma sGPVI levels were measured by using enzyme-linked immunosorbent assay. Patients were excluded who had received a platelet transfusion within 1 day of sample collection because of the high levels of sGPVI in platelet concentrates. We assessed the association of sGPVI (high vs low) with International Society on Thrombosis and Haemostasis major bleeding events by multivariable logistic regression, adjusting for other known risk factors for bleeding. Fifty-four patients were excluded due to recent platelet transfusion, leaving 256 patients for analysis. Eighty-nine (34.8%) patients had a major bleeding event. Median sGPVI levels were significantly elevated in patients with major bleeding events compared with those without major bleeding events (49.09 vs 31.93 ng/mL; P < .001). An sGPVI level >43 ng/mL was independently associated with major bleeding after adjustment for critical illness, sepsis, cardiopulmonary bypass surgery, and degree of thrombocytopenia (adjusted odds ratio, 2.81; 95% confidence interval, 1.51-5.23). Our findings suggest that sGPVI is associated with major bleeding in hospitalized patients with suspected HIT. sGPVI may be a novel biomarker to predict bleeding risk in patients with suspected HIT.
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13
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Loss of GPVI and GPIbα contributes to trauma-induced platelet dysfunction in severely injured patients. Blood Adv 2021; 4:2623-2630. [PMID: 32556282 DOI: 10.1182/bloodadvances.2020001776] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/17/2020] [Indexed: 11/20/2022] Open
Abstract
Trauma-induced coagulopathy (TIC) is a complex, multifactorial failure of hemostasis that occurs in 25% of severely injured patients and results in a fourfold higher mortality. However, the role of platelets in this state remains poorly understood. We set out to identify molecular changes that may underpin platelet dysfunction after major injury and to determine how they relate to coagulopathy and outcome. We performed a range of hemostatic and platelet-specific studies in blood samples obtained from critically injured patients within 2 hours of injury and collected prospective data on patient characteristics and clinical outcomes. We observed that, although platelet counts were preserved above critical levels, circulating platelets sampled from trauma patients exhibited a profoundly reduced response to both collagen and the selective glycoprotein VI (GPVI) agonist collagen-related peptide, compared with those from healthy volunteers. These responses correlated closely with overall clot strength and mortality. Surface expression of the collagen receptors GPIbα and GPVI was reduced on circulating platelets in trauma patients, with increased levels of the shed ectodomain fragment of GPVI detectable in plasma. Levels of shed GPVI were highest in patients with more severe injuries and TIC. Collectively, these observations demonstrate that platelets experience a loss of GPVI and GPIbα after severe injury and translate into a reduction in the responsiveness of platelets during active hemorrhage. In turn, they are associated with reduced hemostatic competence and increased mortality. Targeting proteolytic shedding of platelet receptors is a potential therapeutic strategy for maintaining hemostatic competence in bleeding and improving the efficacy of platelet transfusions.
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14
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Converse MP, Sobhanian M, Taber DJ, Houston BA, Meadows HB, Uber WE. Effect of Angiotensin II Inhibitors on Gastrointestinal Bleeding in Patients With Left Ventricular Assist Devices. J Am Coll Cardiol 2020; 73:1769-1778. [PMID: 30975293 DOI: 10.1016/j.jacc.2019.01.051] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Angiotensin II receptor activation may result in angiogenesis, and ultimately arteriovenous malformations (AVM), through transforming growth factor (TGF)-β and angiopoietin-2 pathway activation. OBJECTIVES The goal of this study was to determine whether angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) were associated with lower risk of major gastrointestinal bleeds (GIB) and AVM-related GIBs in continuous-flow left ventricular assist device (CF-LVAD) patients. METHODS The authors reviewed HeartMate II CF-LVAD recipients between January 2009 and July 2016. Major GIBs were endoscopically confirmed requiring ≥2 U of packed red blood cells or resulting in death. ACE inhibitor/ARB dose was abstracted from medical records. ACE inhibitor/ARB exposure status was landmarked at 30 days post-operatively to avoid immortal time bias. Fine and Gray hazard models assessed the impact of ACE inhibitor/ARB therapy on major GIB and AVM-related GIB, whereas standard Cox regression assessed the impact on mortality, adjusting for baseline variables. RESULTS One-hundred and eleven patients were included with a mean 2.1 ± 1.4 years follow-up. Patients who received an ACE inhibitor/ARB within 30 days post-operatively had a 57% reduction in the risk of major GIB (adjusted hazard ratio [aHR]: 0.43; 95% confidence interval [CI]: 0.19 to 0.97; p = 0.042) and a 63% reduction in the risk of AVM-related GIB (aHR: 0.37; 95% CI: 0.16 to 0.84; p = 0.017). When the mean daily post-operative lisinopril-equivalent ACE inhibitor/ARB dose was >5 mg, the risk of major GIB decreased in a dose-threshold manner (aHR: 0.28; 95% CI: 0.09 to 0.85; p = 0.025). CONCLUSIONS ACE inhibitor/ARB therapy is associated with a protective effect of developing GIBs in CF-LVAD patients, with a dose threshold of >5 mg of daily lisinopril equivalence, possibly due to prevention of AVM formation.
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Affiliation(s)
- Maureen P Converse
- Department of Pharmacy Services, University of Florida Health Shands Hospital, Gainesville, Florida.
| | - Minoosh Sobhanian
- Department of Pharmacy Services, Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | - David J Taber
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Holly B Meadows
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina
| | - Walter E Uber
- Department of Pharmacy Services, Medical University of South Carolina, Charleston, South Carolina
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15
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Wu WT, Zhussupbekov M, Aubry N, Antaki JF, Massoudi M. Simulation of thrombosis in a stenotic microchannel: The effects of vWF-enhanced shear activation of platelets. INTERNATIONAL JOURNAL OF ENGINEERING SCIENCE 2020; 147:103206. [PMID: 34565829 PMCID: PMC8462794 DOI: 10.1016/j.ijengsci.2019.103206] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study was undertaken to develop a numerical/computational simulation of von Willebrand Factor (vWF) - mediated platelet shear activation and deposition in an idealized stenosis. Blood is treated as a multi-constituent mixture comprised of a linear fluid component and a porous solid component (thrombus). Chemical and biological species involved in coagulation are modeled using a system of coupled convection-reaction-diffusion (CRD) equations. This study considers the cumulative effect of shear stress (history) on platelet activation. The vWF activity is modeled as an enhancement function for the shear stress accumulation and is related to the experimentally-observed unfolding rate of vWF. A series of simulations were performed in an idealized stenosis in which the predicted platelets deposition agreed well with previous experimental observations spatially and temporally, including the reduction of platelet deposition with decreasing expansion angle. Further simulation indicated a direct relationship between vWF-mediated platelet deposition and degree of stenosis. Based on the success with these benchmark simulations, it is hoped that the model presented here may provide additional insight into vWF-mediated thrombosis and prove useful for the development of more hemo-compatible blood-wetted devices in the future.
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Affiliation(s)
- Wei-Tao Wu
- School of Mechanical Engineering, Nanjing University of Science and Technology, Nanjing, J.S., 210094, China
| | - Mansur Zhussupbekov
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Nadine Aubry
- Department of Mechanical Engineering, Northeastern University, Boston, MA, 02115, USA
| | - James F Antaki
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Mehrdad Massoudi
- U. S. Department of Energy, National Energy Technology Laboratory (NETL), Pittsburgh, PA, 15236, USA
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16
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Elder T, Raghavan A, Smith A, Wright CH, Wright J, Burant C, Sajatovic M, Hoffer A. Outcomes After Intracranial Hemorrhage in Patients with Left Ventricular Assist Devices: A Systematic Review of Literature. World Neurosurg 2019; 132:265-272. [DOI: 10.1016/j.wneu.2019.08.211] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/25/2019] [Accepted: 08/26/2019] [Indexed: 12/30/2022]
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17
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SSRI/SNRI Therapy is Associated With a Higher Risk of Gastrointestinal Bleeding in LVAD Patients. Heart Lung Circ 2019; 29:1241-1246. [PMID: 31635997 DOI: 10.1016/j.hlc.2019.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/29/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gastrointestinal bleeding (GIB) is common in left ventricular assist device (LVAD) patients. Serotonin release from platelets promotes platelet aggregation, and selective serotonin reuptake inhibitor/serotonin-norepinephrine reuptake inhibitor (SSRI/SNRI) therapy inhibits the transporter responsible for re-uptake. METHODS We reviewed the records of LVAD (HeartMateII™, Abbott Medical, Lake Bluff, IL, USA and Heartware™, Medtronic, Minneapolis, MN, USA) patients at the Medical University of South Carolina and Johns Hopkins Hospital between January 2009 and January 2016. After exclusions, 248 patients were included for analysis. After univariate analysis, logistic regression multivariate analysis was performed to adjust for any demographic, cardiovascular, and laboratory data variables found to be associated with GI bleeding post-LVAD. RESULTS Gastrointestinal bleeding occurred in 85 patients (35%) with 55% of GIBs due to arteriovenous malformations (AVMs). Of the total cohort, 105 patients received an SSRI or SNRI during LVAD support. Forty-four (44) SSRI/SNRI (41.9%) and 41 non-SSRI/SNRI (28.7%) patients had a GIB (RR 1.46, p = 0.03). Twenty-six (26) (24.8%) of the SSRI/SNRI patients had a GIB due to AVMs versus 21 (14.7%) of the non-SSRI/SNRI patients (RR 1.69, p = 0.05). In fully-adjusted multivariate regression analysis, SSRI/SNRI therapy was independently associated with GIB (OR 1.78, p = 0.045). For GIB, the number needed to harm (NNH) was 7.6. CONCLUSION In conclusion, SSRI/SNRI therapy is independently associated with an increased risk of GIB in LVAD patients.
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18
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Novel Stenotic Microchannels to Study Thrombus Formation in Shear Gradients: Influence of Shear Forces and Human Platelet-Related Factors. Int J Mol Sci 2019; 20:ijms20122967. [PMID: 31216638 PMCID: PMC6627598 DOI: 10.3390/ijms20122967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/11/2019] [Accepted: 06/15/2019] [Indexed: 01/14/2023] Open
Abstract
Thrombus formation in hemostasis or thrombotic disease is initiated by the rapid adhesion, activation, and aggregation of circulating platelets in flowing blood. At arterial or pathological shear rates, for example due to vascular stenosis or circulatory support devices, platelets may be exposed to highly pulsatile blood flow, while even under constant flow platelets are exposed to pulsation due to thrombus growth or changes in vessel geometry. The aim of this study is to investigate platelet thrombus formation dynamics within flow conditions consisting of either constant or variable shear. Human platelets in anticoagulated whole blood were exposed ex vivo to collagen type I-coated microchannels subjected to constant shear in straight channels or variable shear gradients using different stenosis geometries (50%, 70%, and 90% by area). Base wall shears between 1800 and 6600 s−1, and peak wall shears of 3700 to 29,000 s−1 within stenoses were investigated, representing arterial-pathological shear conditions. Computational flow-field simulations and stenosis platelet thrombi total volume, average volume, and surface coverage were analysed. Interestingly, shear gradients dramatically changed platelet thrombi formation compared to constant base shear alone. Such shear gradients extended the range of shear at which thrombi were formed, that is, platelets became hyperthrombotic within shear gradients. Furthermore, individual healthy donors displayed quantifiable differences in extent/formation of thrombi within shear gradients, with implications for future development and testing of antiplatelet agents. In conclusion, here, we demonstrate a specific contribution of blood flow shear gradients to thrombus formation, and provide a novel platform for platelet functional testing under shear conditions.
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19
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McVey MJ, Kuebler WM. Extracellular vesicles: biomarkers and regulators of vascular function during extracorporeal circulation. Oncotarget 2018; 9:37229-37251. [PMID: 30647856 PMCID: PMC6324688 DOI: 10.18632/oncotarget.26433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 11/26/2018] [Indexed: 12/12/2022] Open
Abstract
Extracellular vesicles (EVs) are generated at increased rates from parenchymal and circulating blood cells during exposure of the circulation to abnormal flow conditions and foreign materials associated with extracorporeal circuits (ExCors). This review describes types of EVs produced in different ExCors and extracorporeal life support (ECLS) systems including cardiopulmonary bypass circuits, extracorporeal membrane oxygenation (ECMO), extracorporeal carbon dioxide removal (ECCO2R), apheresis, dialysis and ventricular assist devices. Roles of EVs not only as biomarkers of adverse events during ExCor/ECLS use, but also as mediators of vascular dysfunction are explored. Manipulation of the number or subtypes of circulating EVs may prove a means of improving vascular function for individuals requiring ExCor/ECLS support. Strategies for therapeutic manipulation of EVs during ExCor/ECLS use are discussed such as accelerating their clearance, preventing their genesis or pharmacologic options to reduce or select which and how many EVs circulate. Strategies to reduce or select for specific types of EVs may prove beneficial in preventing or treating other EV-related diseases such as cancer.
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Affiliation(s)
- Mark J McVey
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia and Pain Medicine, SickKids, Toronto, ON, Canada
| | - Wolfgang M Kuebler
- Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, ON, Canada.,Department of Physiology, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, ON, Canada.,Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Heart Institute, Berlin, Germany
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20
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Mechanisms of receptor shedding in platelets. Blood 2018; 132:2535-2545. [DOI: 10.1182/blood-2018-03-742668] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 10/12/2018] [Indexed: 02/07/2023] Open
Abstract
Abstract
The ability to upregulate and downregulate surface-exposed proteins and receptors is a powerful process that allows a cell to instantly respond to its microenvironment. In particular, mobile cells in the bloodstream must rapidly react to conditions where infection or inflammation are detected, and become proadhesive, phagocytic, and/or procoagulant. Platelets are one such blood cell that must rapidly acquire and manage proadhesive and procoagulant properties in order to execute their primary function in hemostasis. The regulation of platelet membrane properties is achieved via several mechanisms, one of which involves the controlled metalloproteolytic release of adhesion receptors and other proteins from the platelet surface. Proteolysis effectively lowers receptor density and reduces the reactivity of platelets, and is a mechanism to control robust platelet activation. Recent research has also established clear links between levels of platelet receptors and platelet lifespan. In this review, we will discuss the current knowledge of metalloproteolytic receptor regulation in the vasculature with emphasis on the platelet receptor system to highlight how receptor density can influence both platelet function and platelet survival.
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21
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Clifford R, Robson D, Gross C, Moscato F, Schima H, Jansz P, Macdonald PS, Hayward CS. Beat‐to‐beat detection of aortic valve opening in HeartWare left ventricular assist device patients. Artif Organs 2018; 43:458-466. [DOI: 10.1111/aor.13381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/26/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Rachel Clifford
- Heart and Lung Transplant Unit St. Vincent's Hospital Darlinghurst New South Wales Australia
- St. Vincent's Clinical School, University of New South Wales Sydney Australia
| | - Desiree Robson
- Heart and Lung Transplant Unit St. Vincent's Hospital Darlinghurst New South Wales Australia
| | - Christoph Gross
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research Vienna Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research Vienna Austria
| | - Heinrich Schima
- Center for Medical Physics and Biomedical Engineering Medical University of Vienna Vienna Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research Vienna Austria
- Department of Cardiac Surgery Medical University of Vienna Vienna Austria
| | - Paul Jansz
- Heart and Lung Transplant Unit St. Vincent's Hospital Darlinghurst New South Wales Australia
| | - Peter S. Macdonald
- Heart and Lung Transplant Unit St. Vincent's Hospital Darlinghurst New South Wales Australia
- St. Vincent's Clinical School, University of New South Wales Sydney Australia
- Victor Chang Cardiac Research Institute Darlinghurst New South Wales Australia
| | - Christopher S. Hayward
- Heart and Lung Transplant Unit St. Vincent's Hospital Darlinghurst New South Wales Australia
- St. Vincent's Clinical School, University of New South Wales Sydney Australia
- Victor Chang Cardiac Research Institute Darlinghurst New South Wales Australia
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22
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Joly JM, El-Dabh A, Kirklin JK, Marshell R, Smith MG, Acharya D, Rajapreyar IN, Tallaj JA, Tresler M, Pamboukian SV. High Right Atrial Pressure and Low Pulse Pressure Predict Gastrointestinal Bleeding in Patients With Left Ventricular Assist Device. J Card Fail 2018; 24:487-493. [DOI: 10.1016/j.cardfail.2018.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 02/11/2018] [Accepted: 03/09/2018] [Indexed: 11/17/2022]
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23
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Luu S, Gardiner EE, Andrews RK. Bone Marrow Defects and Platelet Function: A Focus on MDS and CLL. Cancers (Basel) 2018; 10:E147. [PMID: 29783667 PMCID: PMC5977120 DOI: 10.3390/cancers10050147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/11/2018] [Accepted: 05/16/2018] [Indexed: 12/16/2022] Open
Abstract
The bloodstream typically contains >500 billion anucleate circulating platelets, derived from megakaryocytes in the bone marrow. This review will focus on two interesting aspects of bone marrow dysfunction and how this impacts on the quality of circulating platelets. In this regard, although megakaryocytes are from the myeloid lineage leading to granulocytes (including neutrophils), erythrocytes, and megakaryocytes/platelets, recent evidence has shown that defects in the lymphoid lineage leading to B cells, T cells, and natural killer (NK) cells also result in abnormal circulating platelets. Current evidence is limited regarding whether this latter phenomenon might potentially arise from (a) some form of as-yet-undetected defect common to both lineages; (b) adverse interactions occurring between cells of different lineages within the bone marrow environment; and/or (c) unknown disease-related factor(s) affecting circulating platelet receptor expression/function after their release from megakaryocytes. Understanding the mechanisms underlying how both myeloid and lymphoid lineage bone marrow defects lead to dysfunction of circulating platelets is significant because of the potential diagnostic and predictive value of peripheral platelet analysis for bone marrow disease progression, the additional potential effects of new anti-cancer drugs on platelet function, and the critical role platelets play in regulation of bleeding risk, inflammation, and innate immunity.
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Affiliation(s)
- Sarah Luu
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC 3004, Australia.
| | - Elizabeth E Gardiner
- ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, ACT 2600, Australia.
| | - Robert K Andrews
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC 3004, Australia.
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24
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Vincent F, Rauch A, Loobuyck V, Robin E, Nix C, Vincentelli A, Smadja DM, Leprince P, Amour J, Lemesle G, Spillemaeker H, Debry N, Latremouille C, Jansen P, Capel A, Moussa M, Rousse N, Schurtz G, Delhaye C, Paris C, Jeanpierre E, Dupont A, Corseaux D, Rosa M, Sottejeau Y, Barth S, Mourran C, Gomane V, Coisne A, Richardson M, Caron C, Preda C, Ung A, Carpentier A, Hubert T, Denis C, Staels B, Lenting PJ, Van Belle E, Susen S. Arterial Pulsatility and Circulating von Willebrand Factor in Patients on Mechanical Circulatory Support. J Am Coll Cardiol 2018; 71:2106-2118. [DOI: 10.1016/j.jacc.2018.02.075] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 01/25/2018] [Accepted: 02/25/2018] [Indexed: 01/27/2023]
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25
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Gardiner EE. Proteolytic processing of platelet receptors. Res Pract Thromb Haemost 2018; 2:240-250. [PMID: 30046726 PMCID: PMC6055504 DOI: 10.1002/rth2.12096] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/01/2018] [Indexed: 12/17/2022] Open
Abstract
Platelets have a major role in hemostasis and an emerging role in biological processes including inflammation and immunity. Many of these processes require platelet adhesion and localization at sites of tissue damage or infection and regulated platelet activation, mediated by platelet adheso-signalling receptors, glycoprotein (GP) Ib-IX-V and GPVI. Work from a number of laboratories has demonstrated that levels of these receptors are closely regulated by metalloproteinases of the A Disintegrin And Metalloproteinase (ADAM) family, primarily ADAM17 and ADAM10. It is becoming increasingly evident that platelets have important roles in innate immunity, inflammation, and in combating infection that extends beyond processes of hemostasis. This overview will examine the molecular events that regulate levels of platelet receptors and then assess ramifications for these events in settings where hemostasis, inflammation, and infection processes are triggered.
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Affiliation(s)
- Elizabeth E. Gardiner
- ACRF Department of Cancer Biology and TherapeuticsJohn Curtin School of Medical ResearchThe Australian National UniversityCanberraACTAustralia
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26
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Bleeding and thrombosis associated with ventricular assist device therapy. J Heart Lung Transplant 2017; 36:1164-1173. [DOI: 10.1016/j.healun.2017.05.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 01/03/2023] Open
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27
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Sieg AC, Moretz JD, Horn E, Jennings DL. Pharmacotherapeutic Management of Gastrointestinal Bleeding in Patients with Continuous-Flow Left Ventricular Assist Devices. Pharmacotherapy 2017; 37:1432-1448. [DOI: 10.1002/phar.2016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Adam C. Sieg
- Department of Pharmacy; University of Kentucky; Lexington Kentucky
| | - Jeremy D. Moretz
- Department of Pharmacy; Vanderbilt University Medical Center; Nashville Tennessee
| | - Edward Horn
- Department of Pharmacy; Allegheny General Hospital; Pittsburgh Pennsylvania
| | - Douglas L. Jennings
- Department of Pharmacy; New York-Presbyterian Hospital - Columbia University Medical Center; New York New York
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28
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Uriel N, Colombo PC, Cleveland JC, Long JW, Salerno C, Goldstein DJ, Patel CB, Ewald GA, Tatooles AJ, Silvestry SC, John R, Caldeira C, Jeevanandam V, Boyle AJ, Sundareswaran KS, Sood P, Mehra MR. Hemocompatibility-Related Outcomes in the MOMENTUM 3 Trial at 6 Months. Circulation 2017; 135:2003-2012. [DOI: 10.1161/circulationaha.117.028303] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/24/2017] [Indexed: 11/16/2022]
Abstract
Background:
The HeartMate 3 (HM3) Left Ventricular Assist System (LVAS) (Abbott) is a centrifugal, fully magnetically levitated, continuous-flow blood pump engineered to enhance hemocompatibility and reduce shear stress on blood components. The MOMENTUM 3 trial (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) compares the HM3 LVAS with the HeartMate II (HMII) LVAS (Abbott) in advanced heart failure refractory to medical management, irrespective of therapeutic intention (bridge to transplant versus destination therapy). This investigation reported its primary outcome in the short-term cohort (n=294; 6-month follow-up), demonstrating superiority of the HM3 for the trial primary end point (survival free of a disabling stroke or reoperation to replace the pump for malfunction), driven by a reduced need for reoperations. The aim of this analysis was to evaluate the aggregate of hemocompatibility-related clinical adverse events (HRAEs) between the 2 LVAS.
Methods:
We conducted a secondary end point evaluation of HRAE (survival free of any nonsurgical bleeding, thromboembolic event, pump thrombosis, or neurological event) in the short-term cohort (as-treated cohort n=289) at 6 months. The net burden of HRAE was also assessed by using a previously described hemocompatibility score, which uses 4 escalating tiers of hierarchal severity to derive a total score for events encountered during the entire follow-up experience for each patient.
Results:
In 289 patients in the as-treated group (151 the HM3 and 138 the HMII), survival free of any HRAE was achieved in 69% of the HM3 group and in 55% of the HMII group (hazard ratio, 0.62; confidence interval, 0.42–0.91;
P
=0.012). Using the hemocompatibility score, the HM3 group demonstrated less pump thrombosis requiring reoperation (0 versus 36 points,
P
<0.001) or medically managed pump thrombosis (0 versus 5 points,
P
=0.02), and fewer nondisabling strokes (6 versus 24 points,
P
=0.026) than the control HMII LVAS. The net hemocompatibility score in the HM3 in comparison with the HMII patients was 101 (0.67±1.50 points/patient) versus 137 (0.99±1.79 points/patient) (odds ratio, 0.64; confidence interval, 0.39–1.03;
P
=0.065).
Conclusions:
In this secondary analysis of the MOMENTUM 3 trial, the HM3 LVAS demonstrated greater freedom from HRAEs in comparison with the HMII LVAS at 6 months.
Clinical Trial Registration:
URL:
http://clinicaltrials.gov
. Unique identifier: NCT02224755.
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Affiliation(s)
- Nir Uriel
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Paolo C. Colombo
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Joseph C. Cleveland
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - James W. Long
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Christopher Salerno
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Daniel J. Goldstein
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Chetan B. Patel
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Gregory A. Ewald
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Antone J. Tatooles
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Scott C. Silvestry
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Ranjit John
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Christiano Caldeira
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Valluvan Jeevanandam
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Andrew J. Boyle
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Kartik S. Sundareswaran
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Poornima Sood
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
| | - Mandeep R. Mehra
- From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.)
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29
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Hayward CS. Red blood cells and left ventricular assist devices-A lifespan under stress. J Heart Lung Transplant 2017; 36:609-610. [PMID: 28431982 DOI: 10.1016/j.healun.2017.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/15/2017] [Accepted: 03/22/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Christopher S Hayward
- Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia.
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30
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Pediatric Acquired von Willebrand Syndrome in Cardiopulmonary Disorders: Do Laboratory Abnormalities Predict Bleeding Risk? J Pediatr Hematol Oncol 2017; 39:121-125. [PMID: 28060126 DOI: 10.1097/mph.0000000000000738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are conflicting reports on whether or not laboratory abnormalities in pediatric acquired von Willebrand syndrome (AVWS) predict bleeding manifestations in patients with cardiopulmonary disorders (CPD). We retrospectively reviewed charts of patients with AVWS and CPD (n=16) seen at Texas Children's Hospital from 2003 to 2012. The most common CPD were valve stenoses, ventricular septal defects, and pulmonary hypertension. All patients had loss of high molecular weight multimers. Fifteen (94%) patients presented with bleeding symptoms, with menorrhagia and epistaxis being the most common. Von Willebrand ristocetin cofactor activity (VWF:RCo), as well as the use of anticoagulant or antiplatelet medication, did not predict bleeding manifestations (P=0.70 and 0.84, respectively). VWF:RCo/VWF antigen (Ag) ratio of <0.7 was significantly associated with presence of bleeding symptoms. All patients who had complete repair of their cardiac defect experienced normalization of VWF multimers and VWF:RCo/Ag ratio, as well as bleeding symptom resolution. We conclude that increased bleeding risk is associated with low VWF:RCo/Ag ratio in pediatric AVWS due to CPD. However, other laboratory abnormalities such as VWF:RCo level and qualitative multimer analysis, do not appear to predict bleeding. Future studies exploring quantification of multimer loss may be helpful in further assessing bleeding risk associations.
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31
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Lukito P, Wong A, Jing J, Arthur JF, Marasco SF, Murphy DA, Bergin PJ, Shaw JA, Collecutt M, Andrews RK, Gardiner EE, Davis AK. Mechanical circulatory support is associated with loss of platelet receptors glycoprotein Ibα and glycoprotein VI. J Thromb Haemost 2016; 14:2253-2260. [PMID: 27601054 DOI: 10.1111/jth.13497] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/22/2016] [Indexed: 11/25/2022]
Abstract
Essentials Relationship of acquired von Willebrand disease (VWD) and platelet dysfunction is explored. Patients with ventricular assist devices and on extracorporeal membrane oxygenation are investigated. Acquired VWD and platelet receptor shedding is demonstrated in the majority of patients. Loss of platelet adhesion receptors glycoprotein (GP) Ibα and GPVI may increase bleeding risk. SUMMARY Background Ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO) are associated with bleeding that is not fully explained by anticoagulant or antiplatelet use. Exposure of platelets to elevated shear in vitro leads to increased shedding. Objectives To investigate whether loss of platelet receptors occurs in vivo, and the relationship with acquired von Willebrand syndrome (AVWS). Methods Platelet counts, coagulation tests and von Willebrand factor (VWF) analyses were performed on samples from 21 continuous flow VAD (CF-VAD), 20 ECMO, 12 heart failure and seven aortic stenosis patients. Levels of platelet receptors were measured by flow cytometry or ELISA. Results The loss of high molecular weight VWF multimers was observed in 18 of 19 CF-VAD and 14 of 20 ECMO patients, consistent with AVWS. Platelet receptor shedding was demonstrated by elevated soluble glycoprotein (GP) VI levels in plasma and significantly reduced surface GPIbα and GPVI levels in CF-VAD and ECMO patients as compared with healthy donors. Platelet receptor levels were also significantly reduced in heart failure patients. Conclusions These data link AVWS and increased platelet receptor shedding in patients with CF-VADs or ECMO for the first time. Loss of the platelet surface receptors GPIbα and GPVI in heart failure, CF-VAD and ECMO patients may contribute to ablated platelet adhesion/activation, and limit thrombus formation under high/pathologic shear conditions.
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Affiliation(s)
- P Lukito
- Haematology Unit, Alfred Hospital, Melbourne, Australia
| | - A Wong
- Haematology Unit, Alfred Hospital, Melbourne, Australia
| | - J Jing
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - J F Arthur
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - S F Marasco
- Cardiothoracic Unit, Alfred Hospital, Melbourne, Australia
| | - D A Murphy
- Intensive Care Unit, Alfred Hospital, Melbourne, Australia
| | - P J Bergin
- Cardiology Unit, Alfred Hospital, Melbourne, Australia
| | - J A Shaw
- Cardiology Unit, Alfred Hospital, Melbourne, Australia
| | - M Collecutt
- Haematology Laboratory, Alfred Hospital, Melbourne, Australia
| | - R K Andrews
- Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - E E Gardiner
- Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, The Australian National University, Canberra, Australia
| | - A K Davis
- Haematology Unit, Alfred Hospital, Melbourne, Australia
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32
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Abstract
Proteolytic shedding of the extracellular ectodomain of platelet receptors provides a key mechanism for irreversible loss of ligand-binding capacity, and for regulating platelet function in health and disease. Platelets derived from megakaryocytes are small anucleate cells in peripheral blood, with the ability to rapidly adhere, become activated, and secrete an array of procoagulant and proinflammatory factors at sites of vascular injury or disease, and to form a platelet aggregate (thrombus) which is not only critical in normal hemostasis and wound healing, but in atherothrombotic diseases including myocardial infarction and ischemic stroke. Basic mechanisms of receptor shedding on platelets have important distinctions from how receptors on other cell types might be shed, in that shedding is rapidly initiated (within seconds to minutes) and occurs under altered shear conditions encountered in flowing blood or experimentally ex vivo. This review will consider the key components of platelet receptor shedding, that is, the receptor with relevant cleavage site, the (metallo)proteinase or sheddase and how its activity is regulated, and the range of known regulatory factors that control platelet receptor shedding including receptor-associated molecules such as calmodulin, factors controlling sheddase surface expression and activity, and other elements such as shear stress, plasma membrane properties, cellular activation status or age. Understanding these basic mechanisms of platelet receptor shedding is significant in terms of utilizing receptor surface expression or soluble proteolytic fragments as platelet-specific biomarkers and/or ultimately therapeutic targeting of these mechanisms to control platelet reactivity and function.
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Affiliation(s)
- Robert K Andrews
- a Australian Centre for Blood Diseases , Monash University , Melbourne , Australia 3004.,b Department of Cancer Biology and Therapeutics, the John Curtin School of Medical Research , Australian National University , Canberra , Australia 2600
| | - Elizabeth E Gardiner
- a Australian Centre for Blood Diseases , Monash University , Melbourne , Australia 3004.,b Department of Cancer Biology and Therapeutics, the John Curtin School of Medical Research , Australian National University , Canberra , Australia 2600
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33
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Jeske WP, Walenga JM, Menapace B, Schwartz J, Bakhos M. Blood cell microparticles as biomarkers of hemostatic abnormalities in patients with implanted cardiac assist devices. Biomark Med 2016; 10:1095-1104. [DOI: 10.2217/bmm-2016-0150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
For heart failure patients unable to undergo cardiac transplantation, mechanical circulatory support with left ventricular assist devices can be utilized. These devices improve quality of life and prolong life expectancy, but they are associated with bleeding and thrombotic complications impacting patient survival. Little is known of the relevant mechanisms of these hemostatic issues, hindering identification of a clinically useful biomarker. However, there is suggestive evidence that blood cell-derived microparticles may fulfill this unmet clinical need. Recent publications have shown an association of up regulated microparticle production with implanted left ventricular assist devices and the potential to use this as a biomarker to predict thrombosis (and perhaps other adverse events) with an onset time earlier than currently used clinical indicators.
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Affiliation(s)
- Walter P Jeske
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Jeanine M Walenga
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Bryan Menapace
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Jeffrey Schwartz
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Mamdouh Bakhos
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL 60153, USA
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