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Yilmaz MF, Acar E, Inanir M, Karabay CY, Izgi IA. Serum heparanase levels and left atrial/left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Herz 2021; 47:251-257. [PMID: 34351431 DOI: 10.1007/s00059-021-05052-z] [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: 10/02/2020] [Revised: 05/05/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Data regarding the possible role of heparanase (HPA) in the occurrence of left atrial/left atrial appendage (LA/LAA) thrombus in patients with atrial fibrillation (AF) is lacking. The goal of the present study was to assess the association between plasma levels of HPA and LA/LAA thrombus in AF. METHODS A total of 687 patients with nonvalvular AF (NVAF) without anticoagulation therapy were included from January 2016 to June 2019. Serum HPA analysis was performed with a commercially available human ELISA kit. Logistic regression models were used to test for association. RESULTS Serum HPA levels were significantly higher in patients with LA/LAA thrombus than in those without LA/LAA thrombus (270.8 [193.4 ± 353.2] pg/mL vs 150.3 [125.2 ± 208.4] pg/mL; P < 0.001). In multivariate analysis, serum HPA remained a significantly independent predictor of LA/LAA thrombus (odds ratio 1.674, 95% confidence interval [CI] 1.339-2.289, P < 0.001). In the receiver operating characteristic (ROC) curve analysis, HPA showed a predictive value with an area under the curve (AUC) of 0.757 (95% CI 0.652-0.810, P < 0.001). The optimal cutoff level for HPA predicting LA/LAA thrombus was 210.7 pg/mL, with a sensitivity of 74.3% and a specificity of 64.8%. CONCLUSION An elevated HPA level was associated with the presence of LA/LAA thrombus in patients with AF. HPA might portend the risk for the prothrombotic state in AF patients.
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Affiliation(s)
- Mehmet Fatih Yilmaz
- Siyami Ersek High Specialization Health Application and Research Center, Department of Cardiology, University of Health Sciences, Istanbul, Turkey.
| | - Emrah Acar
- Department of Cardiology, Gumushane State Hospital, Gumushane, Turkey
| | - Mehmet Inanir
- Department of Cardiology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Can Yücel Karabay
- Siyami Ersek High Specialization Health Application and Research Center, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Ibrahim Akin Izgi
- Kartal Kosuyolu High Specialization Health Application and Research Center, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
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Abstract
Heparanase, the only mammalian enzyme known to degrade heparan sulfate chains, affects the hemostatic system through several mechanisms. Along with the degrading effect, heparanase engenders release of syndecan-1 from the cell surface and directly enhances the activity of the blood coagulation initiator, tissue factor, in the coagulation system. Upregulation of tissue factor and release of tissue factor pathway inhibitor from the cell surface contribute to the prothrombotic effect. Tissue factor pathway inhibitor and the strongest physiological anticoagulant antithrombin are attached to the endothelial cell surface by heparan sulfate. Hence, degradation of heparan sulfate induces further release of these two natural anticoagulants from endothelial cells. Elevated heparanase procoagulant activity and heparan sulfate chain levels in plasma, demonstrated in cancer, pregnancy, oral contraceptive use, and aging, could suggest a potential mechanism for increased risk of thrombosis in these clinical settings. In contrast to the blood circulation, accumulation of heparan sulfate chains in transudate and exudate pleural effusions induces a local anticoagulant milieu. The anticoagulant effect of heparan sulfate chains in other closed spaces such as peritoneal or subdural cavities should be further investigated.
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Affiliation(s)
- Yona Nadir
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Abstract
Heparanase is the only mammalian enzyme that cleaves heparan sulphate, an important component of the extracellular matrix. This leads to the remodelling of the extracellular matrix, whilst liberating growth factors and cytokines bound to heparan sulphate. This in turn promotes both physiological and pathological processes such as angiogenesis, immune cell migration, inflammation, wound healing and metastasis. Furthermore, heparanase exhibits non-enzymatic actions in cell signalling and in regulating gene expression. Cancer is underpinned by key characteristic features that promote malignant growth and disease progression, collectively termed the 'hallmarks of cancer'. Essentially, all cancers examined to date have been reported to overexpress heparanase, leading to enhanced tumour growth and metastasis with concomitant poor patient survival. With its multiple roles within the tumour microenvironment, heparanase has been demonstrated to regulate each of these hallmark features, in turn highlighting the need for heparanase-targeted therapies. However, recent discoveries which demonstrated that heparanase can also regulate vital anti-tumour mechanisms have cast doubt on this approach. This review will explore the myriad ways by which heparanase functions as a key regulator of the hallmarks of cancer and will highlight its role as a major component within the tumour microenvironment. The dual role of heparanase within the tumour microenvironment, however, emphasises the need for further investigation into defining its precise mechanism of action in different cancer settings.
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Affiliation(s)
- Krishnath M Jayatilleke
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Plenty Road & Kingsbury Drive, Melbourne, VIC, 3086, Australia
| | - Mark D Hulett
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Plenty Road & Kingsbury Drive, Melbourne, VIC, 3086, Australia.
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Abstract
The hemostatic cascade is initiated by the transmembrane coagulation protein - tissue factor (TF) and eventuates in fibrin formation. Heparanase protein was demonstrated to directly enhance TF activity resulting in increased activation of the coagulation system. In addition, heparanase was found to increase hemostatic system activation via two other mechanisms: up-regulating TF expression in endothelial cells and releasing the protein tissue factor pathway inhibitor (TFPI) from the cell surface. Peptides derived from TFPI-2, a protein similar to TFPI, were shown to inhibit the TF/heparanase complex as well as attenuate sepsis and tumor growth. Increased heparanase procoagulant activity was observed in several clinical settings, including women using oral contraceptives, women at delivery, patients following orthopedic surgery and patients with diabetic foot, shift work female nurses, patients with lung cancer, retinal vein thrombosis and prosthetic heart valve thrombosis. Remarkably, the heparanase profile was significantly different across the tested groups. Inhibition of TF / heparanase interaction may represent a new target for attenuating coagulation, cancer and inflammation.
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Affiliation(s)
- Yona Nadir
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
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Gurbuz AS, Ozturk S, Efe SC, Yılmaz MF, Yanik RE, Yaman A, Kirma C. Heparanase is a predictive marker for high thrombus burden in patients with ST-segment elevation myocardial infarction. Biomarkers 2019; 24:600-606. [PMID: 31215255 DOI: 10.1080/1354750x.2019.1628809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective: Heparanase (HPA) is an endo-β-D-glucuronidase capable of degrading heparin sulphate (HS) and heparin side chains. HPA plays a role in tumour growth, angiogenesis, cell invasion and in activation of the coagulation system. We aimed to investigate the relationship between HPA and thrombus burden (TB) in patients with ST-Segment Elevation Myocardial Infarction (STEMI). Methods: This prospective study enrolled 187 patients with STEMI who were treated with primary percutaneous coronary intervention (pPCI). Blood samples were taken to determine serum HPA levels prior to coronary angiography and heparin administration. Serum HPA analysis was performed with a commercially available Human Elisa kit. Results: Patients were divided into two groups: high TB (n:58) and low TB (n:129) group. Serum HPA levels were significantly higher in patients with high TB than low TB [250.1 (188.5-338.1) vs. 173.6 (134.3-219.8) pg/mL] (p < 0.001). Serum HPA levels were higher in patients with no-reflow phenomenon compared with others [(409.3 (375.6-512.5) pg/mL vs. 186.2 (144.2-247.4) pg/mL, p < 0.001]. In multiple logistic regression analysis HPA was a predictor of high TB. Conclusion: Elevated HPA level in patients with STEMI is related to high TB. Furthermore, increased HPA level may be associated with thrombotic complications such as no-reflow phenomenon in patients with STEMI.
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Affiliation(s)
- Ahmet Seyfeddin Gurbuz
- a Department of Cardiology, Necmettin Erbakan University Meram Medicine Faculty , Konya , Turkey
| | - Semi Ozturk
- b Department of Cardiology, Haseki Training and Research Hospital , Istanbul , Turkey
| | - Suleyman Cagan Efe
- c Department of Cardiology, Kosuyolu Training and Research Hospital , Istanbul , Turkey
| | - Mehmet Fatih Yılmaz
- b Department of Cardiology, Haseki Training and Research Hospital , Istanbul , Turkey
| | - Raziye Ecem Yanik
- c Department of Cardiology, Kosuyolu Training and Research Hospital , Istanbul , Turkey
| | - Ali Yaman
- d Department of Biochemistry, Marmara University School of Medicine , Istanbul , Turkey
| | - Cevat Kirma
- c Department of Cardiology, Kosuyolu Training and Research Hospital , Istanbul , Turkey
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Bayam E, Kalçık M, Gürbüz AS, Yesin M, Güner A, Gündüz S, Gürsoy MO, Karakoyun S, Cerşit S, Kılıçgedik A, Candan Ö, Yaman A, Özkan M. The relationship between heparanase levels, thrombus burden and thromboembolism in patients receiving unfractionated heparin treatment for prosthetic valve thrombosis. Thromb Res 2018; 171:103-110. [PMID: 30273810 DOI: 10.1016/j.thromres.2018.09.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 09/08/2018] [Accepted: 09/25/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Procoagulant activity of heparanase has been recently described in several arterial and venous thrombotic disorders. In this study, we aimed to investigate the role of heparanase with regard to thrombus burden, thromboembolism, and treatment success with unfractionated heparin (UFH) in patients with prosthetic valve thrombosis (PVT). METHODS This study enrolled 79 PVT patients who received UFH for PVT and 82 controls. Plasma samples which were collected from patients both at baseline and after the UFH treatment and from controls at baseline only, were tested for heparanase levels by heparanase enzyme-linked immunosorbent assay. RESULTS The PVT group included 18 obstructive and 61 non-obstructive PVT patients who received UFH infusions for a median duration of 15 (7-20) days. The UFH treatment was successful in 37 (46.8%) patients. Baseline heparanase levels were significantly higher in the patient group than in the controls [0.29 (0.21-0.71) vs. 0.25 (0.17-0.33) ng/mL; p = 0.002]. Baseline heparanase levels were significantly higher in obstructive PVT patients. There was a significant increase in heparanase levels after UFH treatment. Post-UFH heparanase levels were higher in patients who experienced treatment failure compared to successfully treated group. Baseline and post-UFH heparanase levels were significantly higher in patients with a thrombus area ≥1 cm2 and with a recent history of thromboembolism. CONCLUSIONS Increased heparanase levels may be one of the esoteric causes for PVT. UFH treatment may trigger an increase in heparanase levels which may affect the treatment success. Increased heparanase levels may be associated with high risk of thromboembolism and increased thrombus burden in PVT patients.
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Affiliation(s)
- Emrah Bayam
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey.
| | - Ahmet Seyfeddin Gürbüz
- Department of Cardiology, Necmeddin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Mahmut Yesin
- Department of Cardiology, Kars Harakani State Hospital, Kars, Turkey
| | - Ahmet Güner
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Sabahattin Gündüz
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Ozan Gürsoy
- Department of Cardiology, Izmir Katip Çelebi University Atatürk Training and Research Hospital, Izmir, Turkey
| | - Süleyman Karakoyun
- Department of Cardiology, Kars Kafkas University, Faculty of Medicine, Kars, Turkey
| | - Sinan Cerşit
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Alev Kılıçgedik
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Özkan Candan
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey
| | - Ali Yaman
- Department of Biochemistry, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Özkan
- Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey; Division of Health Sciences, Ardahan University, Ardahan, Turkey
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Matan M, King D, Peled E, Ackerman S, Bar-Lavi Y, Brenner B, Nadir Y. Heparanase level and procoagulant activity are reduced in severe sepsis. Eur J Haematol 2017; 100:182-188. [PMID: 29120525 DOI: 10.1111/ejh.12997] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND During severe sepsis, levels and activity of all coagulation proteins are reduced. Heparanase is implicated in angiogenesis and tumor progression. We previously demonstrated that heparanase also affected the hemostatic system. It forms a complex and increases the activity of the blood coagulation initiator tissue factor. AIM To evaluate heparanase levels and procoagulant activity as predictors of sepsis severity. MATERIALS AND METHODS Twenty-one patients with non-trauma, non-surgical sepsis admitted to the intensive care unit and 35 controls were recruited. Plasma samples were drawn from the study participants on days 1 and 7 following admission. RESULTS Heparanase levels and procoagulant activity on day 1 were significantly reduced in patients compared to controls (P < .0001, P < .0001, respectively). Day 1 heparanase procoagulant activity ≥350 ng/mL yielded a negative predictive value for severe sepsis of 89%. Additionally, heparanase procoagulant activity on day 7 correlated with the change in the APACHE score between days 1 and 7 (r = .66, P = .007). CONCLUSIONS Heparanase procoagulant activity decreases during sepsis and returns to normal levels as soon as the patient recovers. Hence, it can be potentially used to predict the risk of severe sepsis. These findings need to be further explored in large-scale studies.
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Affiliation(s)
- Moshe Matan
- Intensive Care Unit, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel
| | - Daniel King
- Intensive Care Unit, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel
| | - Eli Peled
- Department of Orthopedic B, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shanny Ackerman
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yaron Bar-Lavi
- Intensive Care Unit, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, The Technion, Haifa, Israel
| | - Benjamin Brenner
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yona Nadir
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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