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Seneviratne A, Han Y, Wong E, Walter ERH, Jiang L, Cave L, Long NJ, Carling D, Mason JC, Haskard DO, Boyle JJ. Hematoma Resolution In Vivo Is Directed by Activating Transcription Factor 1. Circ Res 2020; 127:928-944. [PMID: 32611235 PMCID: PMC7478221 DOI: 10.1161/circresaha.119.315528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
RATIONALE The efficient resolution of tissue hemorrhage is an important homeostatic function. In human macrophages in vitro, heme activates an AMPK (AMP-activated protein kinase)/ATF1 (activating transcription factor-1) pathway that directs Mhem macrophages through coregulation of HO-1 (heme oxygenase-1; HMOX1) and lipid homeostasis genes. OBJECTIVE We asked whether this pathway had an in vivo role in mice. METHODS AND RESULTS Perifemoral hematomas were used as a model of hematoma resolution. In mouse bone marrow-derived macrophages, heme induced HO-1, lipid regulatory genes including LXR (lipid X receptor), the growth factor IGF1 (insulin-like growth factor-1), and the splenic red pulp macrophage gene Spic. This response was lost in bone marrow-derived macrophages from mice deficient in AMPK (Prkab1-/-) or ATF1 (Atf1-/-). In vivo, femoral hematomas resolved completely between days 8 and 9 in littermate control mice (n=12), but were still present at day 9 in mice deficient in either AMPK (Prkab1-/-) or ATF1 (Atf1-/-; n=6 each). Residual hematomas were accompanied by increased macrophage infiltration, inflammatory activation and oxidative stress. We also found that fluorescent lipids and a fluorescent iron-analog were trafficked to lipid-laden and iron-laden macrophages respectively. Moreover erythrocyte iron and lipid abnormally colocalized in the same macrophages in Atf1-/- mice. Therefore, iron-lipid separation was Atf1-dependent. CONCLUSIONS Taken together, these data demonstrate that both AMPK and ATF1 are required for normal hematoma resolution. Graphic Abstract: An online graphic abstract is available for this article.
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Affiliation(s)
- Anusha Seneviratne
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus
| | - Yumeng Han
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus.,Molecular Sciences Research Hub, Imperial College London White City Campus (Y.H., E.W., E.R.H.W., L.J., N.J.L.)
| | - Eunice Wong
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus.,Molecular Sciences Research Hub, Imperial College London White City Campus (Y.H., E.W., E.R.H.W., L.J., N.J.L.)
| | - Edward R H Walter
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus.,Molecular Sciences Research Hub, Imperial College London White City Campus (Y.H., E.W., E.R.H.W., L.J., N.J.L.)
| | - Lijun Jiang
- Molecular Sciences Research Hub, Imperial College London White City Campus (Y.H., E.W., E.R.H.W., L.J., N.J.L.)
| | - Luke Cave
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus
| | - Nicholas J Long
- Molecular Sciences Research Hub, Imperial College London White City Campus (Y.H., E.W., E.R.H.W., L.J., N.J.L.)
| | - David Carling
- MRC London Institute of Medical Sciences (D.C.), Imperial College London Hammersmith Campus
| | - Justin C Mason
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus
| | - Dorian O Haskard
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus
| | - Joseph J Boyle
- From the National Heart and Lung Institute (A.S., Y.H., E.W., E.R.H.W., L.C., J.C.M., D.O.H., J.J.B.), Imperial College London Hammersmith Campus
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Abstract
Radioisotope synovectomy has been extensively used to treat patients with chronic inflammatory joint disease but has moved to a less prominent position since the introduction of new and highly effective drugs. Remaining indications are refractory synovitis, pigmented villonodular synovitis as an adjunct to surgery, and hemophilic arthropathy. The three main radioisotopes used are yttrium-90, rhenium-186, and erbium-189. Radioisotope synovectomy should be performed only by highly experienced professionals, to minimize the risk of injection-related complications. The available safety data, in particular regarding the risk of malignancy, are reassuring. The efficacy of yttrium-90 in chronic inflammatory joint disease remains controversial.
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Gómez-Moreno G, Cutando-Soriano A, Arana C, Scully C. Hereditary Blood Coagulation Disorders: Management and Dental Treatment. J Dent Res 2016; 84:978-85. [PMID: 16246926 DOI: 10.1177/154405910508401102] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patients with hereditary hemostatic disorders, characterized by a tendency to bleeding or thrombosis, constitute a serious challenge in the dental practice. Advances in the medical diagnosis of hemostatic disorders have exposed dental professionals to new patients not amenable to the application of the management protocols associated with other, more well-known, disorders. It is the aim of this paper to review the evidence, to highlight the areas of major concern, and to suggest management regimens for patients with hereditary hemostatic disorders. An extensive review has been made (PubMed, Science Direct, Web of Knowledge, etc.) of literature pertaining to hereditary disorders affecting blood coagulation factors and how they affect the practice of dentistry. Several aspects relating to the care of such patients must be recognized and taken into consideration when dental treatment is planned. Replacement of deficient coagulation factors ensures that safe dental treatment will be carried out. However, the half-life of such coagulation factors requires that dental treatment be specifically planned and adapted to the type of pathology involved.
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Affiliation(s)
- G Gómez-Moreno
- Department of Special Care in Dentistry, School of Dentistry, University of Granada, Colegio Máximo s/n, Campus de Cartuja, E-18071 Granada, Spain
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Abstract
UNLABELLED The many causes of hemarthrosis include acquired hemophilia due to production of autoantibodies to factor VIII. We report two very different cases. CASE 1: This woman experienced onset of juvenile idiopathic arthritis at 8 years of age. Her first child was born when she was 28-years-old. Three months after delivery, vaginal bleeding and recurrent hemarthrosis led to a diagnosis of acquired hemophilia (isolated APTT prolongation, 1% VIIIc activity, and 58 U of anti-factor VIII antibody). Treatment included glucocorticoid therapy, prothrombin complex, and intravenous immunoglobulins. She achieved a full recovery within a year. CASE 2: In this 84-year-old woman, spontaneous recurrent hemarthrosis with hematomas revealed idiopathic acquired hemophilia. Treatment included prothrombin complex, factor VIII concentrates, and intravenous immunoglobulins, followed by cyclophosphamide and glucocorticoid therapy. Recovery was complete within a year. The diagnosis, etiology, prognosis, and treatment of acquired hemophilia are discussed. CONCLUSION Although rare, acquired hemophilia should be considered among the causes of hemarthrosis, particularly as a favorable outcome can be expected with early diagnosis and appropriate treatment.
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Affiliation(s)
- Daniel Wendling
- Rheumatology Department, Jean Minjoz Teaching Hospital, 25030 Besançon, France.
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