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Jasser‐Nitsche H, Haidl H, Cvirn G, Pohl S, Gallistl S, Fröhlich‐Reiterer E, Schlagenhauf A. Increased tissue factor activity promotes thrombin generation at type 1 diabetes onset in children. Pediatr Diabetes 2020; 21:1210-1217. [PMID: 32691481 PMCID: PMC7589270 DOI: 10.1111/pedi.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE In type 1 diabetes (T1D), a prothrombotic status due to elevated coagulation factors coincides with metabolic derailment. In a previous study, we discovered altered thrombin generation profiles in children with T1D. These alterations are potentially most pronounced at T1D onset and ameliorated after insulin treatment. We tested this hypothesis in a longitudinal study, measuring thrombin generation together with coagulation parameters in children at T1D onset and during follow-up. MATERIALS AND METHODS Twenty-three children (12 female, age: 9.4 [2.7-17.3] years; median [range]) were tested at T1D onset and after long-term insulin treatment. Thrombin generation was measured using calibrated automated thrombography. Tissue factor (TF) activity and tissue factor pathway inhibitor (TFPI) activity were measured using enzyme-linked immunosorbent assay (ELISA). RESULTS A procoagulant shift was observed in thrombin generation traces at T1D onset compared to follow-up (time to peak: 5.67 [4.11-7.67] min vs 6.39 [4.89-10.44] min, P < .001). These alterations at T1D onset coincided with increased TF activity (5.18 [0.01-12.97] pmol/L vs 2.67 [0.04-10.41] pmol/L, P < .05) and increased TFPI activity (0.051 [0.038-0.074] U/mL vs 0.035 [0.026-0.056] U/mL, P < .05). CONCLUSION The procoagulant shift in thrombin generation at T1D onset is a result of increased TF activity, but this effect is partially counterbalanced by increased TFPI levels. Elevated TF and TFPI levels hint to a fragile hemostatic balance at the endothelial lining of blood vessels. Additional prothrombotic stimuli may tip over this balance explaining the increased thrombotic risk of children with T1D.
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Affiliation(s)
- Hildegard Jasser‐Nitsche
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
| | - Harald Haidl
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
| | - Gerhard Cvirn
- Otto Loewi Research Center, Physiological ChemistryMedical University of GrazGrazAustria
| | - Sina Pohl
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
| | - Siegfried Gallistl
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
| | - Elke Fröhlich‐Reiterer
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
| | - Axel Schlagenhauf
- Department of Paediatrics and Adolescent Medicine, Division of General PaediatricsMedical University of GrazGrazAustria
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Bratseth V, Margeirsdottir HD, Heier M, Solheim S, Arnesen H, Dahl-Jørgensen K, Seljeflot I. Procoagulant activity in children and adolescents on intensive insulin therapy. Pediatr Diabetes 2020; 21:496-504. [PMID: 31943582 DOI: 10.1111/pedi.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/19/2019] [Accepted: 01/09/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Type 1 diabetes is associated with atherothrombosis, but limited data exist on procoagulant activity in the young. We investigated procoagulant activity in children/adolescents with type 1 diabetes using intensified insulin treatment compared with controls in a 5-year follow-up study, and further any associations with cardiovascular risk factors. METHODS The study included 314 diabetes children/adolescents and 120 healthy controls. Prothrombin fragment 1+2 (F1+2), D-dimer, tissue-factor-procoagulant-activity (TF-PCA), and tissue-factor-pathway-inhibitor (TFPI) were analyzed with ELISAs. RESULTS F1+2, D-dimer, and TF-PCA did not differ between the groups or correlate to HbA1c in the diabetes group at either time points. TFPI was significantly higher in the diabetes group compared with controls both at inclusion and follow-up (both P < .001). In the diabetes group, TFPI correlated significantly to HbA1c at both time points (r = 0.221 and 0.304, both P < .001). At follow-up, females using oral contraceptives had significantly elevated F1+2, D-dimer, and TF-PCA and lower TFPI compared to no-users (all P < .005), and females had lower TFPI (P = .017) and higher F1+2 compared with males (P = .052), also after adjusting for the use of oral contraceptives. CONCLUSIONS The current results show similar procoagulant activity in children/adolescents with type 1 diabetes compared with controls over a 5-year period, indicating that these children using modern intensified insulin treatment are not at high thrombotic risk at younger age. The elevated levels of TFPI in the diabetes group, related to hyperglycaemia, are probably reflecting increased endothelial activation. These findings highlight the significance of optimal blood glucose control in children/adolescents with type 1 diabetes, to maintain a healthy endothelium.
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Affiliation(s)
- Vibeke Bratseth
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanna D Margeirsdottir
- Pediatric Department, Oslo University Hospital Ullevaal, Oslo, Norway.,Oslo Diabetes Research Centre, Oslo, Norway
| | - Martin Heier
- Pediatric Department, Oslo University Hospital Ullevaal, Oslo, Norway.,Oslo Diabetes Research Centre, Oslo, Norway
| | - Svein Solheim
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Harald Arnesen
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Knut Dahl-Jørgensen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Pediatric Department, Oslo University Hospital Ullevaal, Oslo, Norway.,Oslo Diabetes Research Centre, Oslo, Norway
| | - Ingebjørg Seljeflot
- Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Haidl H, Zöhrer E, Pohl S, Leschnik B, Weiss EC, Gallistl S, Muntean W, Schlagenhauf A. New insights into neonatal coagulation: normal clot formation despite lower intra-clot thrombin levels. Pediatr Res 2019; 86:719-724. [PMID: 31404918 DOI: 10.1038/s41390-019-0531-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Healthy neonates exhibit no bleeding tendencies, but exhibit longer partial thromboplastin times than adults. Lower clotting factor levels may be balanced by lower inhibitor levels, which is not reflected in routine coagulation assays, but could result in normal clot formation in vivo. The novel thrombodynamics assay simulates a damaged vessel with tissue factor immobilized to a surface. We hypothesized that intra-clot thrombin levels and spatial fibrin clot formation with this assay are comparable in neonates and adults. METHODS Coagulation was tested in plasma from venous neonatal blood (N = 12), cord blood (N = 30), and adult blood (N = 20) using thrombodynamics and calibrated automated thrombography. RESULTS Neonates exhibited a higher initial rate of clot formation than adults (adult: 60.7 ± 3.9 µm/min; neonatal: 66.8 ± 3.9 µm/min; cord: 68.1 ± 3.3 µm/min; P < 0.001) and a comparable stationary rate of clot formation (adult: 35.8 ± 8.5 µm/min; neonatal: 37.0 ± 4.6 µm/min; cord: 36.0 ± 5.2 µm/min; P = 0.834). Intra-clot thrombin levels were lower in neonates (adult: 41.9 ± 11.2 AU/l; neonatal: 22.6 ± 10.2 AU/l; cord: 23.6 ± 9.7 AU/l; P < 0.001), but the longitudinal rate of thrombin propagation was comparable (adult: 27.2 ± 4.2 µm/min neonatal; 27.9 ± 2.9 µm/min; cord: 27.6 ± 3.4 µm/min; P = 0.862). CONCLUSIONS Despite lower intra-clot thrombin levels, neonates exhibit normal spatial fibrin clot growth, which concurs with clinically well-functioning hemostasis in healthy neonates.
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Affiliation(s)
- Harald Haidl
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Evelyn Zöhrer
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Sina Pohl
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bettina Leschnik
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Eva-Christine Weiss
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Siegfried Gallistl
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Wolfgang Muntean
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Axel Schlagenhauf
- Department of General Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
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Hao JS, Zhu CJ, Yan BY, Yan CY, Ling R. Stimulation of KLF14/PLK1 pathway by thrombin signaling potentiates endothelial dysfunction in Type 2 diabetes mellitus. Biomed Pharmacother 2018; 99:859-866. [PMID: 29710485 DOI: 10.1016/j.biopha.2018.01.151] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/25/2018] [Accepted: 01/29/2018] [Indexed: 12/11/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) promotes a high oxidative stress and hypercoagulable state that drives microvascular injury and multiple-organ abnormality. Elevated thrombin activity underlies T2DM-linked endothelial dysfunction, but the mechanistic links between T2DM/oxidative stress axis and thrombin-associated endothelial pathologies are incompletely understood. In this work, immunohistochemical studies and quantitative analysis using isolated endothelial cells (ECs) identified accumulated Kru¨ppel-like family of transcription factor 14 (KLF14) deposits in ECs from multiple organs as distinct features of T2DM mice. KLF14 upregulation in ECs, which was stimulated by thrombin treatment, was dependent on multiple pathways including calcium mobilization, activation of PKC and AMPK pathways. Functionally, inhibition of endogenous KLF14 expression significantly attenuated thrombin-induced endotheliocyte proliferation, endothelial cell migration and oxidative stress. Molecularly, by directly binding the promoter, KLF14 functions as a transcriptional activator of PLK1, a polo-like kinase whose overexpression induced excessive reactive oxygen species (ROS) production. Transient knockdown of PLK1 was sufficient to suppress KLF14 overexpression-potentiated endothelial dysfunction. Collectively, these data provide proof of concept that deregulation of KLF14/PLK1 cascade plays a key role in thrombin-induced endothelial dysfunction and targeting KLF14 or PLK1 may limit thrombin-associated pathologies in T2DM patients.
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Affiliation(s)
- Jun-Sheng Hao
- Department of Thyroid Gland and Breast Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China
| | - Chao-Juan Zhu
- Department of Emergency Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China
| | - Bin-Yuan Yan
- Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi'an 710032, PR China
| | - Chang-You Yan
- Family Planning Service Stations of Health and Family Planning Commission of Chengcheng County, Weinan City 714000, PR China.
| | - Rui Ling
- Department of Thyroid Gland and Breast Vascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China.
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