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Nunes JM, Kell DB, Pretorius E. Cardiovascular and haematological pathology in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): A role for viruses. Blood Rev 2023; 60:101075. [PMID: 36963989 PMCID: PMC10027292 DOI: 10.1016/j.blre.2023.101075] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
ME/CFS is a debilitating chronic condition that often develops after viral or bacterial infection. Insight from the study of Long COVID/Post Acute Sequelae of COVID-19 (PASC), the post-viral syndrome associated with SARS-CoV-2 infection, might prove to be useful for understanding pathophysiological mechanisms of ME/CFS. Disease presentation is similar between the two conditions, and a subset of Long COVID patients meet the diagnostic criteria for ME/CFS. Since Long COVID is characterized by significant vascular pathology - including endothelial dysfunction, coagulopathy, and vascular dysregulation - the question of whether or not the same biological abnormalities are of significance in ME/CFS arises. Cardiac abnormalities have for a while now been documented in ME/CFS cohorts, with recent studies demonstrating major deficits in cerebral blood flow, and hence vascular dysregulation. A growing body of research is demonstrating that ME/CFS is accompanied by platelet hyperactivation, anomalous clotting, a procoagulant phenotype, and endothelial dysfunction. Endothelial damage and dysregulated clotting can impair substance exchange between blood and tissues, and result in hypoperfusion, which may contribute to the manifestation of certain ME/CFS symptoms. Here we review the ME/CFS literature to summarize cardiovascular and haematological findings documented in patients with the condition, and, in this context, briefly discuss the potential role of previously-implicated pathogens. Overall, cardiac and haematological abnormalities are present within ME/CFS cohorts. While atherosclerotic heart disease is not significantly associated with ME/CFS, suboptimal cardiovascular function defined by reduced cardiac output, impaired cerebral blood flow, and vascular dysregulation are, and these abnormalities do not appear to be influenced by deconditioning. Rather, these cardiac abnormalities may result from dysfunction in the (autonomic) nervous system. Plenty of recently published studies are demonstrating significant platelet hyperactivity and endothelial dysfunction in ME/CFS, as well as anomalous clotting processes. It is of particular importance to determine to what extent these cardiovascular and haematological abnormalities contribute to symptom severity, and if these two systems can be targeted for therapeutic purposes. Viral reservoirs of herpesviruses exist in ME/CFS, and most likely contribute to cardiovascular and haematological dysfunction directly or indirectly. This review highlights the potential of studying cardiac functioning, the vasculature, and coagulation system in ME/CFS.
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Affiliation(s)
- Jean M Nunes
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland 7602, South Africa.
| | - Douglas B Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland 7602, South Africa; Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK; The Novo Nordisk Foundation Centre for Biosustainability, Building 220, Chemitorvet 200, Technical University of Denmark, 2800 Kongens Lyngby, Denmark.
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland 7602, South Africa; Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK.
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Laengst E, Crettaz D, Tissot JD, Prudent M. The Effect of the Donor's and Recipient's Sex on Red Blood Cells Evaluated Using Transfusion Simulations. Cells 2023; 12:1454. [PMID: 37296575 PMCID: PMC10252512 DOI: 10.3390/cells12111454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/21/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023] Open
Abstract
The hypothesis of the potential impact of the sex of red blood cell (RBC) concentrate (RCC) donors, as well as the sex of the recipients, on the clinical outcome, is still under evaluation. Here, we have evaluated the sex impact on RBC properties using in vitro transfusion models. Using a "flask model", RBCs from RCCs (representing the donor)-at different storage lengths-were incubated in a sex-matched and sex-mismatched manner with fresh frozen plasma pools (representing the recipient) at 37 °C, with 5% of CO2 up to 48 h. Standard blood parameters, hemolysis, intracellular ATP, extracellular glucose and lactate were quantified during incubation. Additionally, a "plate model", coupling hemolysis analysis and morphological study, was carried out in similar conditions in 96-well plates. In both models, RBCs from both sexes hemolyzed significantly less in female-derived plasma. No metabolic or morphological differences were observed between sex-matched and -mismatched conditions, even though ATP was higher in female-derived RBCs during incubations. Female plasma reduced hemolysis of female- as well as male-derived RBCs, which may be related to a sex-dependent plasma composition and/or sex-related intrinsic RBC properties.
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Affiliation(s)
- Emmanuel Laengst
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, 1066 Epalinges, Switzerland; (E.L.)
- Faculté de Biologie et de Médecine, University of Lausanne, 1011 Lausanne, Switzerland
| | - David Crettaz
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, 1066 Epalinges, Switzerland; (E.L.)
| | - Jean-Daniel Tissot
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, 1066 Epalinges, Switzerland; (E.L.)
| | - Michel Prudent
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, 1066 Epalinges, Switzerland; (E.L.)
- Faculté de Biologie et de Médecine, University of Lausanne, 1011 Lausanne, Switzerland
- Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, 1211 Geneva, Switzerland
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Brun JF, Varlet-Marie E, Myzia J, Raynaud de Mauverger E, Pretorius E. Metabolic Influences Modulating Erythrocyte Deformability and Eryptosis. Metabolites 2021; 12:4. [PMID: 35050126 PMCID: PMC8778269 DOI: 10.3390/metabo12010004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 12/17/2022] Open
Abstract
Many factors in the surrounding environment have been reported to influence erythrocyte deformability. It is likely that some influences represent reversible changes in erythrocyte rigidity that may be involved in physiological regulation, while others represent the early stages of eryptosis, i.e., the red cell self-programmed death. For example, erythrocyte rigidification during exercise is probably a reversible physiological mechanism, while the alterations of red blood cells (RBCs) observed in pathological conditions (inflammation, type 2 diabetes, and sickle-cell disease) are more likely to lead to eryptosis. The splenic clearance of rigid erythrocytes is the major regulator of RBC deformability. The physicochemical characteristics of the surrounding environment (thermal injury, pH, osmolality, oxidative stress, and plasma protein profile) also play a major role. However, there are many other factors that influence RBC deformability and eryptosis. In this comprehensive review, we discuss the various elements and circulating molecules that might influence RBCs and modify their deformability: purinergic signaling, gasotransmitters such as nitric oxide (NO), divalent cations (magnesium, zinc, and Fe2+), lactate, ketone bodies, blood lipids, and several circulating hormones. Meal composition (caloric and carbohydrate intake) also modifies RBC deformability. Therefore, RBC deformability appears to be under the influence of many factors. This suggests that several homeostatic regulatory loops adapt the red cell rigidity to the physiological conditions in order to cope with the need for oxygen or fuel delivery to tissues. Furthermore, many conditions appear to irreversibly damage red cells, resulting in their destruction and removal from the blood. These two categories of modifications to erythrocyte deformability should thus be differentiated.
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Affiliation(s)
- Jean-Frédéric Brun
- UMR CNRS 9214-Inserm U1046 Physiologie et Médecine Expérimentale du Cœur et des Muscles-PHYMEDEXP, Unité D’explorations Métaboliques (CERAMM), Département de Physiologie Clinique, Université de Montpellier, Hôpital Lapeyronie-CHRU de Montpellier, 34295 Montpellier, France; (J.M.); (E.R.d.M.)
| | - Emmanuelle Varlet-Marie
- UMR CNRS 5247-Institut des Biomolécules Max Mousseron (IBMM), Laboratoire du Département de Physicochimie et Biophysique, UFR des Sciences Pharmaceutiques et Biologiques, Université de Montpellier, 34090 Montpellier, France;
| | - Justine Myzia
- UMR CNRS 9214-Inserm U1046 Physiologie et Médecine Expérimentale du Cœur et des Muscles-PHYMEDEXP, Unité D’explorations Métaboliques (CERAMM), Département de Physiologie Clinique, Université de Montpellier, Hôpital Lapeyronie-CHRU de Montpellier, 34295 Montpellier, France; (J.M.); (E.R.d.M.)
| | - Eric Raynaud de Mauverger
- UMR CNRS 9214-Inserm U1046 Physiologie et Médecine Expérimentale du Cœur et des Muscles-PHYMEDEXP, Unité D’explorations Métaboliques (CERAMM), Département de Physiologie Clinique, Université de Montpellier, Hôpital Lapeyronie-CHRU de Montpellier, 34295 Montpellier, France; (J.M.); (E.R.d.M.)
| | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Private Bag X1 MATIELAND, Stellenbosch 7602, South Africa;
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Längst E, Tissot JD, Prudent M. Storage of red blood cell concentrates: Clinical impact. Transfus Clin Biol 2021; 28:397-402. [PMID: 34464712 DOI: 10.1016/j.tracli.2021.08.344] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/25/2021] [Indexed: 01/11/2023]
Abstract
The storage of red blood cells for transfusion purposes induces modifications of biochemical and biological properties. Moreover, these modifications are modulated by the donors' characteristics and the cell processing. These ex vivo alterations were suspected to decrease the transfusion efficiency and even to induce adverse events. This short article will review the red blood cells storage lesions and the clinical data related to them. In particular, the questions regarding the donors and recipients sex will be discussed.
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Affiliation(s)
- E Längst
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, Épalinges, Switzerland; Faculté de Biologie et de Médecine, université de Lausanne, Lausanne, Switzerland
| | - J-D Tissot
- Faculté de Biologie et de Médecine, université de Lausanne, Lausanne, Switzerland
| | - M Prudent
- Laboratoire de Recherche sur les Produits Sanguins, Transfusion Interrégionale CRS, Épalinges, Switzerland; Faculté de Biologie et de Médecine, université de Lausanne, Lausanne, Switzerland; Center for Research and Innovation in Clinical Pharmaceutical Sciences, Institute of Pharmaceutical Sciences of Western Switzerland, University Hospital and University of Lausanne, Lausanne, Switzerland.
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Treger S, Ackerman S, Kaplan V, Ghanem S, Nadir Y. Progestin type affects the increase of heparanase level and procoagulant activity mediated by the estrogen receptor. Hum Reprod 2021; 36:61-69. [PMID: 33306105 DOI: 10.1093/humrep/deaa263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/22/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Does progestin have an effect on heparanase level and procoagulant activity? SUMMARY ANSWER Progestin increases the heparanase level and procoagulant activity via the estrogen receptor and the magnitude of the effect depends on the progestin type. WHAT IS KNOWN ALREADY Users of combined oral contraceptives (COCs) containing third- and fourth-generation progestins have a higher risk of venous thrombosis compared to those employing second-generation progestins. Heparanase protein is capable of degrading heparan sulfate (HS) chains and enhancing activation of the coagulation system. We have previously demonstrated that estrogen enhances the expression and procoagulant activity of heparanase. STUDY DESIGN, SIZE, DURATION Estrogen and progestin receptor positive breast carcinoma cell lines: EMT6, T47D and MCF-7 were compared to the MDA-231 breast carcinoma cell line devoid of these receptors. This observational study incorporated 45 users of third-generation COCs progestins, 21 users of fourth-generation COCs progestins and 28 individuals not using hormonal therapy and not pregnant per history. PARTICIPANTS/MATERIALS, SETTING, METHODS Second-generation progestin-levonorgestrel, third-generation progestin-desogastrel (DSG), an estrogen receptor antagonist-ICI 182.780 and a progestin receptor antagonist-mifepristone, were added to cell lines. Heparanase level and procoagulant activity, HS levels, tissue factor (TF) activity and factor Xa levels were evaluated in the plasma of the study group. MAIN RESULTS AND THE ROLE OF CHANCE Levonorgestrel and DSG increased heparanase levels in the cells and medium. The effect of DSG was more prominent and additive to that of estrogen. The effect was inhibited by ICI 182.780. In the plasma of COC users, heparanase procoagulant activity, HS levels, TF activity and factor Xa levels were significantly higher compared to controls. In COC pills containing the same dose of estrogen, the procoagulant effect of drospirenone was significantly stronger than that of DSG and gestodene. LIMITATIONS, REASONS FOR CAUTION The limitations of the study include a small number of participants in each study group, although the results are statistically significant and evaluated by several different coagulation parameters. WIDER IMPLICATIONS OF THE FINDINGS The study demonstrates a new mechanism through which progestin affects coagulation system activation and shows that this effect is progestin type-dependent. Development of a progestin derivative with an attenuated effect on heparanase procoagulant activity may reduce thrombotic risk. STUDY FUNDING/COMPETING INTEREST(S) No external funding was sought for this study. Y.N. is named in a European patent application No. IL201200027 filed on 18 January 2012. Other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Sharon Treger
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shanny Ackerman
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Victoria Kaplan
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Shourouk Ghanem
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Yona Nadir
- Thrombosis and Hemostasis Unit, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Large left ventricular thrombus surgically resected in a patient with normal ejection: A case report. Int J Surg Case Rep 2021; 81:105842. [PMID: 33887846 PMCID: PMC8027285 DOI: 10.1016/j.ijscr.2021.105842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION A left ventricular thrombus is very rare in a patient with normal systolic function. We are reporting a case of left ventricular thrombus in a patient with an abnormal presentation and normal ejection fraction. PRESENTATION OF CASE A 57-year-old female patient presented with severe epigastric and central abdominal pain associated with nausea, vomiting, constipation, and a decrease in appetite. Post-contrast abdominal computerized tomography (CT) scan revealed multiple splenic infarcts. On echocardiographic study, a huge hyperechogenic, mobile mass was seen attached to the septo-apical wall of the left ventricle measuring 20 mm × 40 mm. Magnetic resonance imaging (MRI) also showed transmural late gadolinium enhancement in the apex which is suggestive of small myocardial infarction in the distal left anterior descending territory. Coronary angiogram showed non-occluded coronaries. The patient was treated surgically due to the urgency of the situation and the high risk of embolization. DISCUSSION Our patient was on both progesterone and high dose tofacitinib. It is hypothesised that patient most likely experienced asymptomatic myocardial injury with non-occluded coronaries (MINOCA) weeks prior to the presentation. Involvement of distal left anterior descending artery caused apical akinesia resulting in blood stasis. Accompanying subendocardial injury and hypercoagulable state, due to being on progesterone and tofacitinib, led to the formation of the left ventricular thrombus. CONCLUSION Due to the serious outcomes associated with an untreated left ventricular thrombus, it is necessary to carefully assess all patients suffering from systemic embolism with echocardiogram. Assessing the left ventricular mass with MRI was crucial to understanding the nature of the mass. Size, mobility, and protruding nature where characteristics that warranted urgent surgical intervention due to the high risk of embolization. Finally, it is important to note that tofacitinib might be a new suspect for left ventricular clots.
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Papadakis E, Sarigianni M, Tziomalos K, Mavromatidis G, Panidis D. Oral contraceptives increase platelet microparticle levels in normal-weight women with polycystic ovary syndrome. Hormones (Athens) 2020; 19:565-571. [PMID: 32078734 DOI: 10.1007/s42000-020-00182-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Platelet microparticles (PMPs), which are microvesicles shed from platelets, participate in inflammation, vascular homeostasis, and thrombosis. PMPs are increased in obese women with polycystic ovary syndrome (PCOS). Agents that modulate hormonal aspects of PCOS could affect the levels of PMPs. The aim of the present study was to evaluate the effects of oral contraceptives (OCPs), antiandrogen, and metformin use for 6 and 12 months on PMPs in normal-weight women with PCOS. METHODS Forty-five women with PCOS and 13 healthy women were recruited. Biochemical, hormonal, and clinical parameters were recorded. Women with PCOS received treatment with OCPs, OCPs+antiandrogens, or metformin, depending on their main complaint or clinical/biochemical findings. PMPs were measured at baseline and after 6 and 12 months. RESULTS At baseline, patients with PCOS had higher levels of PMPs than controls (p = 0.017), which increased after 6-month treatment with OCPs (p = 0.006). Subsequently, they decreased after 12-month treatment (p = 0.046). Metformin had no effect on PMP levels. CONCLUSION In conclusion, PMP levels are increased in PCOS and further increase with OCP use. This effect could possibly contribute to the increased risk of venous thromboembolism associated with OCP use. However, further studies are needed to elucidate the exact role of PMPs in PCOS.
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Affiliation(s)
- Efstathios Papadakis
- Second Department of Obstetrics and Gynecology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Maria Sarigianni
- Second Medical Department of Internal Medicine, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Georgios Mavromatidis
- Second Department of Obstetrics and Gynecology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Panidis
- Second Department of Obstetrics and Gynecology, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Luo X, Feng L, Bai X, Zhu J, Zhao G, Wu M, Yan Z. Continuous changes in biological levels of complete blood count in a high altitude area of China. SAGE Open Med 2020; 8:2050312120931334. [PMID: 32587693 PMCID: PMC7294479 DOI: 10.1177/2050312120931334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/11/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives We aimed to establish a new reference interval of blood cell parameters by classifying and counting blood Cells of 16- to 85-year-old healthy volunteers and observing continuous changes with age. Methods We analyzed the blood cell parameters of 42,678 cases (men, 24,406; women, 18,272), and compared the blood cell parameters of men and women in different age groups using an independent samples t-test. Using limits of 2.5%-97.5%, a 90% confidence interval was used to develop new reference intervals. Results Counts of blood cell parameters, including white blood Cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils, red blood Cells, hemoglobin, hematocrit, distribution width of red blood Cells and platelets, were found to differ between men and women in different age groups. These parameters were used to establish a new reference interval of blood Cells. Conclusion The blood cell parameters of both men and women changed with increasing age. The reference interval that we established will provide more accurate basic evidence for clinical diagnosis and treatment of diseases.
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Affiliation(s)
- Xuan Luo
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, P.R. China
| | - Lei Feng
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, P.R. China
| | - XueJing Bai
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, P.R. China
| | - JiangXian Zhu
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, P.R. China
| | - GuanCheng Zhao
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, P.R. China
| | - MengNa Wu
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, P.R. China
| | - ZeFeng Yan
- Department of Laboratory, People's Hospital of Yuxi City, Yuxi, P.R. China
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Swanepoel AC, Bester J, Emmerson O, Soma P, Beukes D, van Reenen M, Loots DT, du Preez I. Serum Metabolome Changes in Relation to Prothrombotic State Induced by Combined Oral Contraceptives with Drospirenone and Ethinylestradiol. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2020; 24:404-414. [PMID: 32471328 DOI: 10.1089/omi.2020.0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The association between hypercoagulability and use of drospirenone (DRSP) and ethinylestradiol (EE) containing combined oral contraceptives (COCs) is an important clinical concern. We have previously reported that the two formulations of DRSP combined with EE (namely, DRSP/20EE and DRSP/30EE) bring about a prothrombotic state in hemostatic traits of female users. We report here the serum metabolomic changes in the same study cohort in relation to the attendant prothrombotic state induced by COC use, thus offering new insights on the underlying biochemical mechanisms contributing to the altered coagulatory profile with COC use. A total of 78 healthy women participated in this study and were grouped as follows: control group not using oral contraceptives (n = 25), DRSP/20EE group (n = 27), and DRSP/30EE group (n = 26). Untargeted metabolomics revealed changes in amino acid concentrations, particularly a decrease in glycine and an increase in both cysteine and lanthionine in the serum, accompanied by variations in oxidative stress markers in the COC users compared with the controls. Of importance, this study is the first to link specific amino acid variations, serum metabolites, and the oxidative metabolic profile with DRSP/EE use. These molecular changes could be linked to specific biophysical coagulatory alterations observed in the same individuals. These new findings lend evidence on the metabolomic substrates of the prothrombotic state associated with COC use in women and informs future personalized/precision medicine research. Moreover, we underscore the importance of an interdisciplinary approach to evaluate venous thrombotic risk associated with COC use.
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Affiliation(s)
- Albe Carina Swanepoel
- Department of Physiology and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Janette Bester
- Department of Physiology and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Odette Emmerson
- Department of Physiology and Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Prashilla Soma
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Derylize Beukes
- Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Mari van Reenen
- Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Du Toit Loots
- Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Ilse du Preez
- Human Metabolomics, North-West University, Potchefstroom, South Africa
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Gu C, Cheng Y, Zhen X, Chen X, Zhou K. Determination of Progestin Residues in Fish by UPLC-Q-TOF/MS Coupled with QuEChERS. JOURNAL OF ANALYTICAL METHODS IN CHEMISTRY 2019; 2019:6426958. [PMID: 31192021 PMCID: PMC6525950 DOI: 10.1155/2019/6426958] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/14/2019] [Indexed: 05/06/2023]
Abstract
A novel method was developed for simultaneous determination of 10 progestin residues in fish by ultra-performance liquid chromatography-quadrupole-time-of-flight mass spectrometry (UPLC-Q-TOF/MS) combined with a modified quick, easy, cheap, effective, rugged, and safe (QuEChERS) method. The homogenized samples were dispersed by water, extracted with acetonitrile, and then purified by QuEChERS reagent. The concentrated analytes were detected by UPLC-Q-TOF/MS. High linearities (R 2 > 0.995) and recoveries (85.71-117.08%) at three spiked levels (5, 10, and 20 ng/g) and low relative standard deviation values (<8.83%, n = 7) and limits of detection (0.23-0.66 ng/g) were obtained. This method is simple, rapid, reliable, sensitive, and efficient and can be used for monitoring of progestin residues in fish. This method provides a strong guarantee to deal with food emergencies for the laboratory, provides technical support for the screening and quantitative detection of progesterone in fish, and provides technical support for the food safety of aquatic products.
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Affiliation(s)
- Chunxiu Gu
- Biochemical Engineering College, Beijing Union University, Beijing 100023, China
- Beijing Key Laboratory of Biomass Waste Resource Utilization, Beijing 100023, China
| | - Yanling Cheng
- Biochemical Engineering College, Beijing Union University, Beijing 100023, China
- Beijing Key Laboratory of Biomass Waste Resource Utilization, Beijing 100023, China
| | - Xin Zhen
- Biochemical Engineering College, Beijing Union University, Beijing 100023, China
| | - Xiaoxuan Chen
- Biochemical Engineering College, Beijing Union University, Beijing 100023, China
| | - Kaowen Zhou
- Biochemical Engineering College, Beijing Union University, Beijing 100023, China
- Beijing Key Laboratory of Biomass Waste Resource Utilization, Beijing 100023, China
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Emmerson O, Bester J, Lindeque BG, Swanepoel AC. The Impact of Two Combined Oral Contraceptives Containing Ethinyl Estradiol and Drospirenone on Whole Blood Clot Viscoelasticity and the Biophysical and Biochemical Characteristics of Erythrocytes. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2018; 24:713-728. [PMID: 30588913 DOI: 10.1017/s1431927618015453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Venous thrombosis is associated with combined oral contraceptive (COC) use. We investigated the impact of two ethinyl estradiol (EE) and drospirenone (DRSP) containing COCs (3 mg DRSP/20 µg EE and 3 µg DRSP/30 µg EE) on the viscoelasticity of whole blood clots along with the biophysical and biochemical characteristics of erythrocytes. Thromboelastography (TEG) analysis showed a tendency toward a hypercoagulable state in the COCs groups that was more pronounced with higher EE concentrations. Light microscopy and scanning electron microscopy (SEM) showed rouleaux formation of erythrocytes and alterations to the erythrocyte shape for both COC groups, which was attributed to membrane damage. SEM analysis showed spontaneous activation of fibrin and platelets in the COC groups, along with interactions between erythrocytes and platelets and/or fibrin. Confocal microscopy confirmed compromised membrane integrity in the COC groups compared to controls. Global thrombosis test analysis showed increased platelet activation and low thrombolysis in both COC groups when compared to controls. In conclusion, DRSP/EE formulations impact erythrocytes' biophysical and biochemical properties to cause a shift in hemostasis to a prothrombotic state. Although these effects are mostly subclinical the long-term effects and risks involved with the use of these hormones should be considered carefully for each individual.
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Affiliation(s)
- Odette Emmerson
- 1Department of Physiology, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Arcadia, 0007,South Africa
| | - Janette Bester
- 1Department of Physiology, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Arcadia, 0007,South Africa
| | - Barend G Lindeque
- 2Department of Obstetrics and Gynaecology,School of Medicine, Faculty of Health Sciences,University of Pretoria,P.O. Box 667,Pretoria 0001,South Africa
| | - Albe C Swanepoel
- 1Department of Physiology, Faculty of Health Sciences,University of Pretoria,Private Bag x323,Arcadia, 0007,South Africa
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Swanepoel AC, Roberts HC, Soma P, Lindeque BG, Bester J. Hemorheological mechanisms for increased thrombosis in subjects using gestodene. Microsc Res Tech 2018; 81:1489-1500. [PMID: 30365192 DOI: 10.1002/jemt.23149] [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: 05/02/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 11/07/2022]
Abstract
There are several possible mechanisms by which combined oral contraceptives (COC) use increase venous thromboembolism (VTE) risk. Melodene® is a monophasic COC containing the third-generation progestin Gestodene (GSD), which is associated with increased risk of VTE. Therefore, the aim of this study was to investigate the possible alterations in viscoelastic parameters of whole blood and plasma clots along with the biophysical characteristics of erythrocytes and specifically fibrin fibers in females using a COC containing GSD. GSD appeared to have a significant impact on the biophysical characteristics of fibrin fiber networks. When GSD is combined with ethinylestradiol the viscoelastic properties of whole blood clots tend to become more prothrombotic. The alterations to and aggregation of erythrocytes accompanied with spontaneous formation of a fibrin "blanket" provides a possible mechanism for the increased occurrence of "red" clots, which can lead to occlusions in the vascular system. Thus, the increased risk of VTE associated with these COCs can be attributed to these erythrocyte-and-fibrin-rich-clots occluding venous vessels. However, our findings also propose that these changes to the biophysical properties of both erythrocytes and fibrin, specifically spontaneous expansion of deformed fibrin networks, can also occlude vessels in the microcirculation, which could have lasting, subclinical complications for female users. We recommend that a thorough risk assessment, with specific focus on coagulation and other factors affecting fibrin formation, be done for each female before prescribing a GSD-containing COC. Females that "qualify" then need to be monitored on a regular basis to lower the risk of thrombotic events. RESEARCH HIGHLIGHTS: Gestodene in combination with ethinyl estradiol significantly impacts the biophysical characteristics of erythrocytes and fibrin fiber networks. These changes, specifically spontaneous expansion of deformed fibrin networks, can occlude vessels in the microcirculation, which could have lasting, subclinical complications for the female user. The changes observed for specifically erythrocytes and fibrin show that the hormone formulation investigated contribute to a thrombogenic profile for female users.
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Affiliation(s)
- Albe Carina Swanepoel
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Hildegarde Cecilia Roberts
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Prashilla Soma
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Barend Gerhardus Lindeque
- Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Janette Bester
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
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