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Kalbhenn J, Glonnegger H, Wilke M, Bansbach J, Zieger B. Hypercoagulopathy, acquired coagulation disorders and anticoagulation before, during and after extracorporeal membrane oxygenation in COVID-19: a case series. Perfusion 2021; 36:592-602. [PMID: 33719738 DOI: 10.1177/02676591211001791] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Thromboembolism and bleeding contribute to Coronavirus disease 2019 (COVID-19)'s morbidity and mortality and are also frequent complications of venovenous extracorporeal membrane oxygenation (vvECMO). As the interaction of the underlying pathologies caused by vvECMO in COVID-19 is barely understood, we designed this study to better differentiate coagulation disorders in COVID-19 patients before, during and after vvECMO-support. METHODS Observational case series, six consecutive patients with Coronavirus acute respiratory distress syndrome supported with vvECMO treated in the anaesthesiologic ICU in a third level University ECMO-centre. We measured routine coagulation parameters and assessed coagulation factors. We also conducted advanced von Willebrand factor (VWF) multimer analysis, platelet aggregometry and immunological screening. RESULTS We identified various phases of coagulation disorders: Initially, intensely activated coagulation with highly increased VWF and factor VIII activity in acute COVID-19, then severe acquired von Willebrand syndrome and platelet dysfunction during vvECMO leading to spontaneous bleeding and finally, hypercoagulopathy after vvECMO explantation. Five of six patients developed immunological abnormalities enhancing coagulation. CONCLUSIONS Coronavirus-induced coagulopathy and bleeding disorders during vvECMO cannot be discriminated via 'routine' coagulation tests. Precise and specific analyses followed by the appropriate treatment of coagulation disorders may help us develop tailored therapeutic concepts to better manage the phases described above.
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Affiliation(s)
- Johannes Kalbhenn
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hannah Glonnegger
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maya Wilke
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joachim Bansbach
- Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Barbara Zieger
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Kelkar AH, Loc BL, Tarantino MD, Rajasekhar A, Wang H, Kelkar M, Farrell J. Cytomegalovirus-Associated Venous and Arterial Thrombotic Disease. Cureus 2020; 12:e12161. [PMID: 33489573 PMCID: PMC7813978 DOI: 10.7759/cureus.12161] [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] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) infection has been associated with venous thromboembolism (VTE) and acute coronary syndromes (ACS). METHODS A retrospective study was conducted within the OSF HealthCare System in Peoria, IL. The objectives were to determine the incidence of acute VTE and ACS within one year of CMV testing. The "study group" included patients with positive CMV immunoglobulin M (IgM) or positive CMV polymerase chain reaction (PCR). The "seropositive control" group included patients with positive CMV immunoglobulin G (IgG) and negative IgM. The "seronegative control" group included patients with negative CMV IgG and IgM, or negative PCR. RESULTS Within one year of CMV infection, 38 of 379 patients (10.0%) developed VTE in the study group compared to 41 of 1334 patients (3.1%) in the seropositive control and 37 of 1249 (3.0%) in the seronegative control. Adjusting for age and gender, both control groups were less likely to have VTE than the study group within one year (seropositive control: odds ratio (OR) = 0.3, 95% confidence interval (CI) 0.2-0.5, p < 0.0001; seronegative control: OR = 0.4, 95% CI 0.2-0.6, p < 0.0001). ACS was more likely to occur in the study group, with the incidence of 7.7% compared to 4.7% (p < 0.0001) in the seropositive control and 1.9% (p <0.0001) in the seronegative control. Adjusting for age and gender, the seronegative control was less likely to develop ACS than the study group within one year (OR = 0.4, 95% CI 0.2-0.7, p = 0.003). CONCLUSIONS This retrospective study demonstrates that CMV infection may be a significant risk factor for VTE and ACS.
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Affiliation(s)
- Amar H Kelkar
- Division of Hematology & Oncology, University of Florida College of Medicine, Gainesville, USA
| | - Brian L Loc
- Department of Cardiology, OSF Saint Francis Medical Center, Peoria, USA
| | - Michael D Tarantino
- Department of Hematology, Bleeding & Clotting Disorders Institute, Peoria, USA
| | - Anita Rajasekhar
- Division of Hematology & Oncology, University of Florida College of Medicine, Gainesville, USA
| | - Huaping Wang
- Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Mona Kelkar
- Department of Biostatistics & Epidemiology, Harvard School of Public Health, Cambridge, USA
| | - John Farrell
- Department of Microbiology & Immunology, OSF System Laboratory, Peoria, USA
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3
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Allard M, Tonnerre P, Nedellec S, Oger R, Morice A, Guilloux Y, Houssaint E, Charreau B, Gervois N. HLA-E-restricted cross-recognition of allogeneic endothelial cells by CMV-associated CD8 T cells: a potential risk factor following transplantation. PLoS One 2012; 7:e50951. [PMID: 23226431 PMCID: PMC3511380 DOI: 10.1371/journal.pone.0050951] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 10/29/2012] [Indexed: 11/18/2022] Open
Abstract
Although association between CMV infection and allograft rejection is well admitted, the precise mechanisms involved remain uncertain. Here, we report the characterization of an alloreactive HLA-E-restricted CD8 T cell population that was detected in the PBL of a kidney transplant patient after its CMV conversion. This monoclonal CD8 T cell population represents a sizable fraction in the blood (3% of PBL) and is characterized by an effector-memory phenotype and the expression of multiple NK receptors. Interestingly, these unconventional T cells display HLA-E-dependent reactivity against peptides derived from the leader sequences of both various HCMV-UL40 and allogeneic classical HLA-I molecules. Consequently, while HLA-E-restricted CD8 T cells have potential to contribute to the control of CMV infection in vivo, they may also directly mediate graft rejection through recognition of peptides derived from allogeneic HLA-I molecules on graft cells. Therefore, as HLA-E expression in nonlymphoid organs is mainly restricted to endothelial cells, we investigated the reactivity of this HLA-E-restricted T cell population towards allogeneic endothelial cells. We clearly demonstrated that CMV-associated HLA-E-restricted T cells efficiently recognized and killed allogeneic endothelial cells in vitro. Moreover, our data indicate that this alloreactivity is tightly regulated by NK receptors, especially by inhibitory KIR2DL2 that strongly prevents TCR-induced activation through recognition of HLA-C molecules. Hence, a better evaluation of the role of CMV-associated HLA-E-restricted T cells in transplantation and of the impact of HLA-genotype, especially HLA-C, on their alloreactivity may determine whether they indeed represent a risk factor following organ transplantation.
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Affiliation(s)
- Mathilde Allard
- Inserm, U892, Nantes, France
- Univ Nantes, Nantes, France
- CNRS, UMR 6299, Nantes, France
| | | | - Steven Nedellec
- Inserm, U892, Nantes, France
- Univ Nantes, Nantes, France
- CNRS, UMR 6299, Nantes, France
| | - Romain Oger
- Inserm, U892, Nantes, France
- Univ Nantes, Nantes, France
- CNRS, UMR 6299, Nantes, France
| | - Alexis Morice
- Inserm, U892, Nantes, France
- Univ Nantes, Nantes, France
- CNRS, UMR 6299, Nantes, France
| | - Yannick Guilloux
- Inserm, U892, Nantes, France
- Univ Nantes, Nantes, France
- CNRS, UMR 6299, Nantes, France
| | - Elisabeth Houssaint
- Inserm, U892, Nantes, France
- Univ Nantes, Nantes, France
- CNRS, UMR 6299, Nantes, France
| | - Béatrice Charreau
- Univ Nantes, Nantes, France
- Inserm, U1064, Nantes, France
- CHU Nantes, Nantes, France
| | - Nadine Gervois
- Inserm, U892, Nantes, France
- Univ Nantes, Nantes, France
- CNRS, UMR 6299, Nantes, France
- * E-mail:
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Pastano R, Dell'Agnola C, Bason C, Gigli F, Rabascio C, Puccetti A, Tinazzi E, Cetto G, Peccatori F, Martinelli G, Lunardi C. Antibodies against human cytomegalovirus late protein UL94 in the pathogenesis of scleroderma-like skin lesions in chronic graft-versus-host disease. Int Immunol 2012; 24:583-91. [PMID: 22773152 DOI: 10.1093/intimm/dxs061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Human cytomegalovirus (hCMV) infection and its reactivation correlate both with the increased risk and with the worsening of graft-versus-host disease (GVHD). Because scleroderma-like skin lesions can occur in chronic GVHD (cGVHD) in allogeneic stem-cell transplant (HCT) patients and hCMV is relevant in the pathogenesis of systemic sclerosis (SSc), we evaluated the possible pathogenetic link between hCMV and skin cGVHD. Plasma from 18 HCT patients was tested for anti-UL94 and/or anti-NAG-2 antibodies, identified in SSc patients, by direct ELISA assays. Both donors and recipients were anti-hCMV IgG positive, without autoimmune diseases. Patients' purified anti-UL94 and anti-NAG-2 IgG binding to human umbilical endothelial cells (HUVECs) and fibroblasts was performed by FACS analysis and ELISA test. HUVECs apoptosis and fibroblasts proliferation induced by patients' anti-NAG-2 antibodies were measured by DNA fragmentation and cell viability, respectively. About 11/18 patients developed cGVHD and all of them showed skin involvement, ranging from diffuse SSc-like lesions to limited erythema. Eight of eleven cGVHD patients were positive for anti-UL94 and/or anti-NAG-2 antibodies. Remarkably, 4/5 patients who developed diffuse or limited SSc-like lesions had antibodies directed against both UL94 and NAG-2; their anti-NAG-2 IgG-bound HUVECs and fibroblasts induce both endothelial cell apoptosis and fibroblasts proliferation, similar to that induced by purified anti-UL94 and anti-NAG-2 antibodies obtained from SSc patients. In conclusion, our data suggest a pathogenetic link between hCMV infection and scleroderma-like skin cGVHD in HCT patients through a mechanism of molecular mimicry between UL94 viral protein and NAG-2 molecule, as observed in patients with SSc.
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Affiliation(s)
- Rocco Pastano
- Hematoncology Division, Bone Marrow Transplant Unit, European Institute of Oncology, Milan, Italy
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5
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From bench to bedside and back: the SENIEUR Protocol and the efficacy of influenza vaccination in the elderly. Biogerontology 2008; 10:83-94. [DOI: 10.1007/s10522-008-9155-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 06/02/2008] [Indexed: 01/08/2023]
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6
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Valbuena G, Walker DH. The endothelium as a target for infections. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2007; 1:171-98. [PMID: 18039112 DOI: 10.1146/annurev.pathol.1.110304.100031] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The endothelial cells lining vascular and lymphatic vessels are targets of several infectious agents, including viruses and bacteria, that lead to dramatic changes in their functions. Understanding the pathophysiological mechanisms that cause the clinical manifestations of those infections has been advanced through the use of animal models and in vitro systems; however, there are also abundant studies that explore the consequences of endothelial infection in vitro without supporting evidence that endothelial cells are actual in vivo targets of infection in human diseases. This article defines criteria for considering an infection as truly endothelium-targeted and reviews the literature that offers insights into the pathogenesis of human endothelial-target infections.
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7
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Magro CM, Crowson AN, Ferri C. Cytomegalovirus-associated cutaneous vasculopathy and scleroderma sans inclusion body change. Hum Pathol 2007; 38:42-9. [PMID: 17084440 DOI: 10.1016/j.humpath.2006.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 05/23/2006] [Accepted: 06/01/2006] [Indexed: 11/30/2022]
Abstract
Viruses have long been held to be of pathogenetic importance in the evolution of autoimmune connective tissue disease. We describe 7 adults who developed cutaneous connective tissue disease stigmata in temporal association with recent cytomegalovirus (CMV) infection but without the classic cytopathic changes of CMV infection. We examined 7 adults with clinical presentations encompassing cutaneous vasculitis in 4 and scleroderma in 3. In all 7 patients, there was either IgM seropositivity for CMV and/or CMV DNA isolation from peripheral blood. Although no CMV inclusions were seen, in situ hybridization studies revealed very focal CMV RNA transcript expression with localization mainly to the endothelium. The patients with vasculitis treated with ganciclovir had improvement or resolution of symptoms, whereas only 1 patient with scleroderma received antiviral therapy, without benefit. Another scleroderma patient responded to infliximab therapy. Abortive/partial CMV reactivation can be associated with a syndrome complex mimicking and/or triggering a primary immune-based cutaneous microvascular injury syndrome. Antiviral therapy appears to be of therapeutic value in those cases associated with active necrotizing vasculitic changes. The role of tumor necrosis factor alpha blockers in scleroderma cases temporally associated with CMV infection requires further evaluation.
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MESH Headings
- Adult
- Aged
- Antibodies, Bacterial/blood
- Cytomegalovirus/genetics
- Cytomegalovirus/growth & development
- Cytomegalovirus/immunology
- Cytomegalovirus Infections/complications
- Cytomegalovirus Infections/virology
- DNA, Viral/blood
- Female
- Humans
- Immunoglobulin M/blood
- In Situ Hybridization
- Inclusion Bodies/pathology
- Male
- Middle Aged
- RNA, Messenger/analysis
- RNA, Messenger/genetics
- RNA, Viral/analysis
- RNA, Viral/genetics
- Scleroderma, Systemic/blood
- Scleroderma, Systemic/etiology
- Scleroderma, Systemic/pathology
- Skin Diseases, Vascular/blood
- Skin Diseases, Vascular/etiology
- Skin Diseases, Vascular/pathology
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Affiliation(s)
- Cynthia M Magro
- Department of Pathology, Weill College of Medicine, Cornell University, New York, NY 10021, USA.
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8
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Abstract
Two forms of post-transplant thrombotic microangiopathy (TMA) may be recognized: recurrent TMA and de novo TMA. Recurrent TMA may occur in patients who developed a nondiarrhoeal form of haemolytic uraemic syndrome (HUS) being particularly frequent in patients with autosomal recessive or dominant HUS. The recurrence is almost the rule in patients with mutation in complement factor H gene. Most patients eventually lose the graft. Treatment with plasma infusions or plasmapheresis is often disappointing, but few cases may be rescued. Intravenous immunoglobulins and rituximab have also been successful in anedoctic cases. De novo TMA is rarer. A number of factors including viral infection may be responsible of de novo TMA, but in most cases TMA is triggered by calcineurin inhibitors or mTOR inhibitors. The clinical presentation of de novo TMA may be variable with some patients showing clinical and laboratory features of HUS while others showing only a progressive renal failure. The prognosis is less severe than with recurrent TMA. Complete withdrawal of the offending drug may lead to improvement in many cases. The addition of plasma exchange may result in graft salvage in about 80% of cases.
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Affiliation(s)
- Claudio Ponticelli
- Department of Immunology, IRCCS, Istituto Auxologico Italiano, Milan, Italy.
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9
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Kartikasari AER, Georgiou NA, de Geest M, van Kats-Renaud JH, Bouwman JJM, van Asbeck BS, Marx JJM, Visseren FLJ. Iron enhances endothelial cell activation in response to Cytomegalovirus or Chlamydia pneumoniae infection. Eur J Clin Invest 2006; 36:743-52. [PMID: 16968471 DOI: 10.1111/j.1365-2362.2006.01709.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Chronic inflammation has been implemented in the pathogenesis of inflammatory diseases like atherosclerosis. Several pathogens like Chlamydia pneumoniae (Cp) and cytomegalovirus (CMV) result in inflammation and thereby are potentially artherogenic. Those infections could trigger endothelial activation, the starting point of the atherogenic inflammatory cascade. Considering the role of iron in a wide range of infection processes, the presence of iron may complicate infection-mediated endothelial activation. MATERIALS AND METHODS Endothelial intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and endothelial selectin (E-selectin) expression were measured using flow cytometry, as an indication of endothelial activation. Cytotoxicity was monitored using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Immunostaining was applied to measure Cp and CMV infectivity to endothelial cells. RESULTS An increased number of infected endothelial cells in a monolayer population leads to a raised expression of adhesion molecules of the whole cell population, suggesting paracrine interactions. Iron additively up-regulated Cp-induced VCAM-1 expression, whereas synergistically potentiated Cp-induced ICAM-1 expression. Together with CMV, iron also enhanced ICAM-1 and VCAM-1 expression. These iron effects were observed without modulation of the initial infectivity of both microorganisms. Moreover, the effects of iron could be reversed by intracellular iron chelation or radical scavenging, conforming modulating effects of iron on endothelial activation after infections. CONCLUSIONS Endothelial response towards chronic infections depends on intracellular iron levels. Iron status in populations positive for Cp or CMV infections should be considered as a potential determinant for the development of atherosclerosis.
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Girszyn N, Leport J, Baux N, Kahn JE, Blétry O. Thrombose portale au cours d'une hépatite aiguë de primo-infection à cytomégalovirus de l'immunocompétent. Rev Med Interne 2006; 27:426-8. [PMID: 16413637 DOI: 10.1016/j.revmed.2005.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 12/13/2005] [Indexed: 11/20/2022]
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Magro C, Ali N, Williams JD, Allen JN, Ross P. Cytomegalovirus-Associated Pulmonary Septal Capillary Injury Sine Inclusion Body Change. Appl Immunohistochem Mol Morphol 2005; 13:268-72. [PMID: 16082254 DOI: 10.1097/01.pai.0000137911.39736.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors describe four patients with symptomatic lung disease morphologically representing a septal capillary injury syndrome temporally associated with serologic and culture evidence of active cytomegalovirus (CMV) infection but without classic cytopathic changes. The authors conducted a thorough review of clinical data, microscopic examination, and in situ hybridization to detect CMV mRNA encoding immediate early protein. The assay detects transcripts that encode early and immediate early proteins. In two cases additional tissue was available for direct immunofluorescent studies. The disease process in each of the patients was morphologically indistinguishable from the pattern of organ injury associated with autoimmune diseases including a small vessel microvascular injury syndrome involving skin and lung and immune complex- mediated glomerulonephritis. Cytopenias were seen in all cases, most commonly thrombocytopenia. All treated patients demonstrated improvement on combined ganciclovir and low-dose steroid therapy. CMV infection may be of pathogenetic importance in some cases of alveolar hemorrhage, especially when accompanied by peripheral blood cytopenia in otherwise healthy patients and if clinical worsening occurs in the setting of a traditional immunosuppressive regimen typically used to treat vasculitis.
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Affiliation(s)
- Cynthia Magro
- Department of Pathology, Ohio State University, Columbus, Ohio 43210, USA.
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12
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Aceti A, Are R, Sabino G, Fenu L, Pasquazzi C, Quaranta G, Zechini B, Terrosu P. Helicobacter pylori active infection in patients with acute coronary heart disease. J Infect 2004; 49:8-12. [PMID: 15194241 DOI: 10.1016/j.jinf.2004.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the possible role of the active Helicobacter pylori infection as a trigger factor in acute coronary heart disease (CHD). METHODS Forty patients with acute coronary syndromes, 40 patients with infections other than H. pylori (control group A) and 40 healthy subjects (control group B), pair matched for age, sex and CHD risk factors were studied. In each patient and control subject the presence of H. pylori stool antigen (HpsA) and serum anti-CagA were tested. RESULTS Twenty-eight of patients with CHD resulted positive for HpSA compared to 14 patients of control group A and 16 subjects of group B (p=0.00095). No significant difference was found in the anti-CagA positivity among patients with CHD and control groups. Concomitant positivity for anti-CagA and HpSA was found in 13 patients with CHD, four controls of group A and five controls of group B (p=0.017) CONCLUSIONS Our findings revealed a higher rate of HpSA positivity and a significantly higher association between HpSA and anti-CagA positivity in patients with acute CHD compared to control groups. These data suggest that active H. pylori infection may play a role as a trigger factor in acute cardiovascular events.
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Affiliation(s)
- Antonio Aceti
- Department of Infectious Diseases, II Faculty of Medicine, University of Rome La Sapienza, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189 Rome, Italy.
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13
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Nerheim PL, Meier JL, Vasef MA, Li WG, Hu L, Rice JB, Gavrila D, Richenbacher WE, Weintraub NL. Enhanced cytomegalovirus infection in atherosclerotic human blood vessels. THE AMERICAN JOURNAL OF PATHOLOGY 2004; 164:589-600. [PMID: 14742264 PMCID: PMC1602282 DOI: 10.1016/s0002-9440(10)63148-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/22/2003] [Indexed: 12/17/2022]
Abstract
Human cytomegalovirus (CMV) is a possible co-factor in atherogenesis and vascular occlusion, but its ability to actively infect medium and large blood vessels is unclear. A vascular explant model was adapted to investigate CMV infection in human coronary artery, internal mammary artery (IMA), and saphenous vein (SV). Vascular explants were inoculated with CMV Towne or low-passage clinical isolate and examined in situ for CMV cytopathic effect and immediate-early and early antigens, as indicators of active infection. At 5 to 7 days after inoculation, we found that CMV Towne actively infected eight of eight different atherosclerotic blood vessel explants (coronary artery, n = 4; SV and IMA grafts, n = 4), whereas it only infected 2 of 14 nonatherosclerotic blood vessel explants (SV, n = 10; IMA, n = 4) (P = 0.001). The CMV clinical isolate actively infected none of six sets of nonatherosclerotic SV explants at 5 to 7 days after inoculation. The active CMV infections involved adventitial and, less frequently, intimal cells. A small subset of infected cells in atherosclerotic tissue expresses the endothelial cell marker CD31. Smooth muscle cells residing in both atherosclerotic and nonatherosclerotic blood vessels were free of active CMV infections even after all vascular tissue layers were exposed to the virus. In contrast, active CMV Towne infection was evident at 2 days after inoculation in smooth muscle cells and endothelial cells previously isolated from the SV tissues. We conclude that active CMV infection is enhanced in atherosclerotic blood vessels compared to atherosclerosis-free vascular equivalents, and this viral activity is restricted to subpopulations of intimal and adventitial cells.
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Affiliation(s)
- Pamela L Nerheim
- Department of Internal Medicine, University of Iowa College of Medicine, Iowa City 52242, USA
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14
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Bason C, Corrocher R, Lunardi C, Puccetti P, Olivieri O, Girelli D, Navone R, Beri R, Millo E, Margonato A, Martinelli N, Puccetti A. Interaction of antibodies against cytomegalovirus with heat-shock protein 60 in pathogenesis of atherosclerosis. Lancet 2003; 362:1971-7. [PMID: 14683657 DOI: 10.1016/s0140-6736(03)15016-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Infections and autoimmunity have been implicated in the pathogenesis of atherosclerosis. Cytomegalovirus has been shown to contribute to the disease. Autoantibodies against human heat-shock protein (HSP) 60 are present in most atherosclerotic patients, and their titre correlates with disease severity, suggesting that anti-HSP60 might be implicated in disease pathogenesis. We postulated that cytomegalovirus infection might induce antibodies able to bind human HSP60 and to cause endothelial-cell damage. METHODS We studied 180 patients with coronary-artery disease, raised high sensitivity C-reactive protein concentrations, and presence or absence of traditional risk factors; 90 patients with coronary-artery disease, normal values for high sensitivity C-reactive protein, and no traditional risk factors; and 98 controls. Individual sera were used to define the relevant epitope of HSP60 by ELISA. Affinity purified IgGs were used to identify endothelial cell-surface ligands by western blot and to induce apoptotic cell death. FINDINGS We identified an 11 aminoacid sequence of HSP60 that was recognised by most patients with coronary-artery disease. This peptide shares homology with cytomegalovirus-derived proteins UL122 and US28. The same patients' sera recognised UL122-derived and US28-derived peptides. Purified IgGs against HSP60 and the viral peptides bound non-stressed human endothelial cells and induced endothelial-cell apoptosis by interaction with cell-surface molecules. INTERPRETATION During cytomegalovirus infection, antibodies against the virus can arise that are able to crossreact with human HSP60 and cause apoptosis of non-stressed endothelial cells, which is judged a primary event in the pathogenesis of atherosclerosis.
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Affiliation(s)
- Caterina Bason
- Department of Experimental Medicine, University of Genova, Genova, Italy
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15
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Scholz M, Vogel JU, Höver G, Prösch S, Kotchetkov R, Cinatl J, Koch F, Doerr HW, Cinatl J. Thrombin induces Sp1-mediated antiviral effects in cytomegalovirus-infected human retinal pigment epithelial cells. Med Microbiol Immunol 2003; 193:195-203. [PMID: 13680213 DOI: 10.1007/s00430-003-0194-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2003] [Indexed: 12/21/2022]
Abstract
Human cytomegalovirus (HCMV) retinitis causing retinal detachment and destruction of the blood-retina barrier is closely related to retinal hemorrhage/coagulation. However, the effects of procoagulants on HCMV (re)activation in retinal cells have not been investigated yet. Therefore, we studied whether thrombin modulates the expression of HCMV immediate early (IE) and late (L) genes in cultured human retinal pigment epithelial cells (RPE). Thrombin specifically stimulated the protease-activated receptor-1 (PAR-1) on RPE and, surprisingly, inhibited basal and 12,0-tetradecanoylphorbol 13-acetate-stimulated HCMV IE gene expression in infected RPE. On the other hand, HCMV strongly induced Sp1 DNA binding activity, which was prevented by thrombin/PAR1-mediated Sp1 hyperphosphorylation. Our data suggest that thrombin/PAR-1 may inhibit Sp1-dependent HCMV replication, which might be an important regulatory mechanism for HCMV persistence and replication in RPE.
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Affiliation(s)
- Martin Scholz
- Zentrum der Hygiene, Institut für Medizinische Virologie, Johann Wolfgang Goethe-Universität, Paul Ehrlich Str. 40, 60596 Frankfurt am Main, Germany
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