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Tang X, Fang M, Cheng R, Zhang Z, Wang Y, Shen C, Han Y, Lu Q, Du Y, Liu Y, Sun Z, Zhu L, Mwangi J, Xue M, Long C, Lai R. Iron-Deficiency and Estrogen Are Associated With Ischemic Stroke by Up-Regulating Transferrin to Induce Hypercoagulability. Circ Res 2020; 127:651-663. [PMID: 32450779 DOI: 10.1161/circresaha.119.316453] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
RATIONALE Epidemiological studies have identified an associate between iron deficiency (ID) and the use of oral contraceptives (CC) and ischemic stroke (IS). To date, however, the underlying mechanism remains poorly understood. Both ID and CC have been demonstrated to upregulate the level and iron-binding ability of Tf (transferrin), with our recent study showing that this upregulation can induce hypercoagulability by potentiating FXIIa/thrombin and blocking antithrombin-coagulation proteases interactions. OBJECTIVE To investigate whether Tf mediates IS associated with ID or CC and the underlying mechanisms. METHODS AND RESULTS Tf levels were assayed in the plasma of IS patients with a history of ID anemia, ID anemia patients, venous thromboembolism patients using CC, and ID mice, and in the cerebrospinal fluid of some IS patients. Effects of ID and estrogen administration on Tf expression and coagulability and the underlying mechanisms were studied in vivo and in vitro. High levels of Tf and Tf-thrombin/FXIIa complexes were found in patients and ID mice. Both ID and estrogen upregulated Tf through hypoxia and estrogen response elements located in the Tf gene enhancer and promoter regions, respectively. In addition, ID, administration of exogenous Tf or estrogen, and Tf overexpression promoted platelet-based thrombin generation and hypercoagulability and thus aggravated IS. In contrast, anti-Tf antibodies, Tf knockdown, and peptide inhibitors of Tf-thrombin/FXIIa interaction exerted anti-IS effects in vivo. CONCLUSIONS Our findings revealed that certain factors (ie, ID and CC) upregulating Tf are risk factors of thromboembolic diseases decipher a previously unrecognized mechanistic association among ID, CC, and IS and provide a novel strategy for the development of anti-IS medicine by interfering with Tf-thrombin/FXIIa interactions.
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Affiliation(s)
- Xiaopeng Tang
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.)
| | - Mingqian Fang
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.).,Kunming College of Life Science, University of Chinese Academy of Sciences, Yunnan, China (M.F., R.C., J.M.)
| | - Ruomei Cheng
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.).,Kunming College of Life Science, University of Chinese Academy of Sciences, Yunnan, China (M.F., R.C., J.M.)
| | - Zhiye Zhang
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.).,Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming, Yunnan, China (Z.Z., Q.L.)
| | - Yuming Wang
- Department of Clinical Laboratory, the Second Affiliated Hospital of Kunming Medical University, Yunnan, China (Y.W.)
| | - Chuanbin Shen
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.)
| | - Yajun Han
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.)
| | - Qiumin Lu
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.).,Key Laboratory of Cardiovascular Disease of Yunnan Province, Kunming, Yunnan, China (Z.Z., Q.L.)
| | - Yingrong Du
- Department of Cardiology (Y.D.), the Third People's Hospital of Kunming, Yunnan, China
| | - Yingying Liu
- Department of Clinical Laboratory (Y.L.), the Third People's Hospital of Kunming, Yunnan, China
| | - Zhaohui Sun
- Department of Clinical Laboratory, Guangzhou General Hospital of Guangzhou Military Command, Guangdong, China (Z.S.)
| | - Liping Zhu
- Department of Clinical Laboratory, the First Affiliated Hospital of Kunming Medical University, Yunnan, China (L.Z.)
| | - James Mwangi
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.).,Kunming College of Life Science, University of Chinese Academy of Sciences, Yunnan, China (M.F., R.C., J.M.)
| | - Min Xue
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.)
| | - Chengbo Long
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.)
| | - Ren Lai
- From the Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences/Key Laboratory of Bioactive Peptides of Yunnan Province, Kunming Institute of Zoology, China (X.T., M.F., R.C., Z.Z., C.S., Y.H., Q.L., J.M., M.X., C.L., R.L.).,Institute for Drug Discovery and Development, Chinese Academy of Sciences, Shanghai, China (R.L.).,KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research in Common Diseases (R.L.), Kunming Institute of Zoology, Chinese Academy of Sciences, Yunnan, China.,Sino-African Joint Research Center (R.L.), Kunming Institute of Zoology, Chinese Academy of Sciences, Yunnan, China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei, China (R.L.)
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Sundell M, Ginstman C, Månsson A, Forslund I, Brynhildsen J. Patterns of prescription and discontinuation of contraceptives for Swedish women with obesity and normal-weight women. EUR J CONTRACEP REPR 2019; 24:192-197. [PMID: 31112059 DOI: 10.1080/13625187.2019.1610873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: This study aimed to explore the prescription of different contraceptive methods to Swedish women with obesity and to compare the pattern of prescription and adherence to treatment between this group and normal-weight women. Materials and methods: This study included 371 women with obesity and 744 matched normal-weight women, aged 18-40. Medical records were scrutinised for the period 1 January 2010 to 31 December 2014. The retrieved variables included: background characteristics, prescribed contraceptive methods, adverse effects, duration of treatment, reason for discontinuation and bleeding pattern. Result: Progestin-only pills were mainly prescribed to women with obesity (44% vs. 20%, p = 0.001) whereas combined hormonal contraception was mainly prescribed to normal-weight women (60% vs. 21%, p < 0.0001). Thirty-three percent vs. 25% (p = 0.003) discontinued their contraceptive method within 1 year. The most commonly declared reason for discontinuation was bleeding disturbance (14.7% vs. 9.6%, p = 0.008). Conclusion: The most commonly prescribed contraceptive method in women with obesity was progestin-only pills, but surprisingly many women with obesity were prescribed combined hormonal contraception despite current Swedish and European guidelines. Incident users with obesity were significantly more likely to discontinue their contraceptive method within the first year of the study period, compared with incident normal-weight users.
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Affiliation(s)
- Micaela Sundell
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Charlotte Ginstman
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Agnes Månsson
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Ingrid Forslund
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
| | - Jan Brynhildsen
- a Department of Obstetrics and Gynecology , Linköping University , Linköping , Sweden.,b Department of Clinical and Experimental Medicine , Linköping University , Linköping , Sweden
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Oslakovic S, Zadro R. Comparison of the impact of four generations of progestins on hemostatic variables. Clin Appl Thromb Hemost 2012; 20:448-55. [PMID: 23091282 DOI: 10.1177/1076029612463426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study was undertaken to evaluate the impact of progestins as part of low-estrogen (ethinyl estradiol [EE2] ≤35 μg) combined oral contraceptives (COCs) on hemostatic variables. One hundred ninety-five healthy women took oral contraceptives with following formulations: 35 EE2/norgestimate (NGM), 35 EE2/cyproterone acetate, 35 EE2/norethisterone, 30 EE2/levonorgestrel, 30 EE2/drospirenone (DRSP), 20 EE2/gestodene, and 20 EE2/DRSP, for 6 months. Hemostatic assays (prothrombin time, activated partial thromboplastin time, fibrinogen, resistance to activated protein C ratio, protein C, protein S, factor VIII [FVIII], antithrombin, plasminogen, α2-antiplasmin, inhibitor of plasminogen activator type 1 [PAI-1] and d-dimers) were performed in 3 time points: at baseline, after 3, and 6 cycles. For each formulation, results were compared according to baseline values, intergroup analysis, and the amount of estrogen or progestin component. Most of the variables were changed except FVIII. Significant difference between oral contraceptives was found in antithrombin, protein C, protein S activities, and PAI-1 values, but changes were mostly within reference range.
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Affiliation(s)
- Sandra Oslakovic
- 1Department of Transfusion Medicine, Cakovec County Hospital, Cakovec, Croatia
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