1
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Reeves B. Blood cell JAKtivation aggravates cerebral venous thrombosis. Blood Adv 2024; 8:3327-3329. [PMID: 38916898 PMCID: PMC11258618 DOI: 10.1182/bloodadvances.2024012977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Affiliation(s)
- Brandi Reeves
- Department of Medicine, Division of Hematology, University of North Carolina, Chapel Hill, NC
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2
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Li L, Stegner D. Immunothrombosis versus thrombo-inflammation: platelets in cerebrovascular complications. Res Pract Thromb Haemost 2024; 8:102344. [PMID: 38433977 PMCID: PMC10907225 DOI: 10.1016/j.rpth.2024.102344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
A State-of-the Art lecture titled "Thrombo-Neuroinflammatory Disease" was presented at the International Society on Thrombosis and Haemostasis Congress in 2023. First, we would like to advocate for discrimination between immunothrombosis and thrombo-inflammation, as immunothrombosis describes an overshooting inflammatory reaction that results in detrimental thrombotic activity. In contrast, thrombo-inflammation describes the interplay of platelets and coagulation with the immunovascular system, resulting in the recruitment of immune cells and loss of barrier function (hence, hallmarks of inflammation). Both processes can be observed in the brain, with cerebral venous thrombosis being a prime example of immunothrombosis, while infarct progression in response to ischemic stroke is a paradigmatic example of thrombo-inflammation. Here, we review the pathomechanisms underlying cerebral venous thrombosis and ischemic stroke from a platelet-centric perspective and discuss translational implications. Finally, we summarize relevant new data on this topic presented during the 2023 International Society on Thrombosis and Haemostasis Congress.
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Affiliation(s)
- Lexiao Li
- Julius-Maximilians-Universität Würzburg, Rudolf Virchow Center for Integrative and Translational Bioimaging, Würzburg, Germany
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
| | - David Stegner
- Julius-Maximilians-Universität Würzburg, Rudolf Virchow Center for Integrative and Translational Bioimaging, Würzburg, Germany
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
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3
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Huynh A, Arnold DM, Ivetic N, Clare R, Hadzi-Tosev M, Liu Y, Smith JW, Bissola AL, Daka M, Kelton JG, Nazy I. Antibodies against platelet factor 4 and the risk of cerebral venous sinus thrombosis in patients with vaccine-induced immune thrombotic thrombocytopenia. J Thromb Haemost 2023; 21:2833-2843. [PMID: 37394121 DOI: 10.1016/j.jtha.2023.06.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare complication of adenoviral vector-based vaccines against SARS-CoV-2. This syndrome is caused by antibodies against platelet factor 4 (PF4; CXCL4) that lead to platelet activation and is characterized by thrombocytopenia and thrombosis in unusual locations, including cerebral venous sinus thrombosis (CVST). VITT can be classified based on anti-PF4 antibodies properties in vitro: those that require PF4 to activate platelets (PF4-dependent) and those that can activate platelets without additional PF4 (PF4-independent) in the serotonin release assay. OBJECTIVES We aim to characterize the relationship of VITT platelet-activating profiles with CVST. METHODS We conducted a retrospective cohort study involving patients with confirmed VITT who were tested between March and June 2021. Data were collected with an anonymized form and cases were identified as VITT with high clinical suspicion according to platelet activation assays. Anti-PF4 antibody binding regions on PF4 were further characterized with alanine scanning mutagenesis. RESULTS Of the patients with confirmed VITT (n = 39), 17 (43.6%) had PF4-dependent antibodies and 22 (56.4%) had PF4-independent antibodies. CVST occurred almost exclusively in PF4-independent patients (11 of 22 vs 1 of 17; P < .05). Additionally, PF4-independent antibodies bound to 2 distinct epitopes on PF4, the heparin-binding region and a site typical for heparin-induced thrombocytopenia antibodies, whereas PF4-dependent antibodies bound to only the heparin-binding region. CONCLUSION These findings suggest that VITT antibodies that cause PF4-independent platelet activation represent a unique subset of patients more likely to be associated with CVST, possibly due to the 2 different types of anti-PF4 antibodies.
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Affiliation(s)
- Angela Huynh
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Donald M Arnold
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Nikola Ivetic
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rumi Clare
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Milena Hadzi-Tosev
- Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Yang Liu
- Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - James W Smith
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anna-Lise Bissola
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mercy Daka
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - John G Kelton
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Ishac Nazy
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada.
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4
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Karwen T, Kolczynska‐Matysiak K, Gross C, Löffler MC, Friedrich M, Loza‐Valdes A, Schmitz W, Wit M, Dziaczkowski F, Belykh A, Trujillo‐Viera J, El‐Merahbi R, Deppermann C, Nawaz S, Hastoy B, Demczuk A, Erk M, Wieckowski MR, Rorsman P, Heinze KG, Stegner D, Nieswandt B, Sumara G. Platelet-derived lipids promote insulin secretion of pancreatic β cells. EMBO Mol Med 2023; 15:e16858. [PMID: 37490001 PMCID: PMC10493578 DOI: 10.15252/emmm.202216858] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
Hyperreactive platelets are commonly observed in diabetic patients indicating a potential link between glucose homeostasis and platelet reactivity. This raises the possibility that platelets may play a role in the regulation of metabolism. Pancreatic β cells are the central regulators of systemic glucose homeostasis. Here, we show that factor(s) derived from β cells stimulate platelet activity and platelets selectively localize to the vascular endothelium of pancreatic islets. Both depletion of platelets and ablation of major platelet adhesion or activation pathways consistently resulted in impaired glucose tolerance and decreased circulating insulin levels. Furthermore, we found platelet-derived lipid classes to promote insulin secretion and identified 20-Hydroxyeicosatetraenoic acid (20-HETE) as the main factor promoting β cells function. Finally, we demonstrate that the levels of platelet-derived 20-HETE decline with age and that this parallels with reduced impact of platelets on β cell function. Our findings identify an unexpected function of platelets in the regulation of insulin secretion and glucose metabolism, which promotes metabolic fitness in young individuals.
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Affiliation(s)
- Till Karwen
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | | | - Carina Gross
- Institute of Experimental Biomedicine IUniversity Hospital WürzburgWürzburgGermany
| | - Mona C Löffler
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - Mike Friedrich
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - Angel Loza‐Valdes
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Werner Schmitz
- Theodor Boveri Institute, BiocenterUniversity of WürzburgWürzburgGermany
| | - Magdalena Wit
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Filip Dziaczkowski
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Andrei Belykh
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Jonathan Trujillo‐Viera
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - Rabih El‐Merahbi
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - Carsten Deppermann
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
- Center for Thrombosis and HemostasisUniversity Medical Center of the Johannes Gutenberg‐UniversityMainzGermany
| | - Sameena Nawaz
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and MetabolismChurchill HospitalOxfordUK
| | - Benoit Hastoy
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and MetabolismChurchill HospitalOxfordUK
| | - Agnieszka Demczuk
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Manuela Erk
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - Mariusz R Wieckowski
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
| | - Patrik Rorsman
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and MetabolismChurchill HospitalOxfordUK
- Department of Physiology, Institute of Neuroscience and PhysiologyUniversity of GöteborgGöteborgSweden
- Oxford National Institute for Health Research, Biomedical Research CentreChurchill HospitalOxfordUK
| | - Katrin G Heinze
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
| | - David Stegner
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
- Institute of Experimental Biomedicine IUniversity Hospital WürzburgWürzburgGermany
| | - Bernhard Nieswandt
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
- Institute of Experimental Biomedicine IUniversity Hospital WürzburgWürzburgGermany
| | - Grzegorz Sumara
- Rudolf Virchow Center for Integrative and Translational BioimagingJulius‐Maximilians University of WürzburgWürzburgGermany
- Nencki Institute of Experimental BiologyPolish Academy of SciencesWarszawaPoland
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5
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Elgheznawy A, Öftering P, Englert M, Mott K, Kaiser F, Kusch C, Gbureck U, Bösl MR, Schulze H, Nieswandt B, Vögtle T, Hermanns HM. Loss of zinc transporters ZIP1 and ZIP3 augments platelet reactivity in response to thrombin and accelerates thrombus formation in vivo. Front Immunol 2023; 14:1197894. [PMID: 37359521 PMCID: PMC10285393 DOI: 10.3389/fimmu.2023.1197894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Zinc (Zn2+) is considered as important mediator of immune cell function, thrombosis and haemostasis. However, our understanding of the transport mechanisms that regulate Zn2+ homeostasis in platelets is limited. Zn2+ transporters, ZIPs and ZnTs, are widely expressed in eukaryotic cells. Using mice globally lacking ZIP1 and ZIP3 (ZIP1/3 DKO), our aim was to explore the potential role of these Zn2+ transporters in maintaining platelet Zn2+ homeostasis and in the regulation of platelet function. While ICP-MS measurements indicated unaltered overall Zn2+ concentrations in platelets of ZIP1/3 DKO mice, we observed a significantly increased content of FluoZin3-stainable free Zn2+, which, however, appears to be released less efficiently upon thrombin-stimulated platelet activation. On the functional level, ZIP1/3 DKO platelets exhibited a hyperactive response towards threshold concentrations of G protein-coupled receptor (GPCR) agonists, while immunoreceptor tyrosine-based activation motif (ITAM)-coupled receptor agonist signalling was unaffected. This resulted in enhanced platelet aggregation towards thrombin, bigger thrombus volume under flow ex vivo and faster in vivo thrombus formation in ZIP1/3 DKO mice. Molecularly, augmented GPCR responses were accompanied by enhanced Ca2+ and PKC, CamKII and ERK1/2 signalling. The current study thereby identifies ZIP1 and ZIP3 as important regulators for the maintenance of platelet Zn2+ homeostasis and function.
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Affiliation(s)
- Amro Elgheznawy
- Medical Clinic II, Division of Hepatology, University Hospital Würzburg, Würzburg, Germany
| | - Patricia Öftering
- Institute of Experimental Biomedicine I, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Maximilian Englert
- Institute of Experimental Biomedicine I, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Kristina Mott
- Institute of Experimental Biomedicine I, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Friederike Kaiser
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Charly Kusch
- Institute of Experimental Biomedicine I, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University Hospital Würzburg, Würzburg, Germany
| | - Michael R. Bösl
- Institute of Experimental Biomedicine I, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Harald Schulze
- Institute of Experimental Biomedicine I, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine I, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Timo Vögtle
- Institute of Experimental Biomedicine I, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Heike M. Hermanns
- Medical Clinic II, Division of Hepatology, University Hospital Würzburg, Würzburg, Germany
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6
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Kahn SR, Arnold DM, Casari C, Desch KC, Devreese KMJ, Favaloro EJ, Gaertner F, Gouw SC, Gresele P, Griffioen AW, Heger L, Kini RM, Kohli S, Leader A, Lisman T, Lordkipanidzé M, Mullins E, Okoye HC, Rosovsky RP, Salles-Crawley II, Selby R, Sholzberg M, Stegner D, Violi F, Weyand AC, Williams S, Zheng Z. Illustrated State-of-the-Art Capsules of the ISTH 2023 Congress. Res Pract Thromb Haemost 2023; 7:100193. [PMID: 37538494 PMCID: PMC10394567 DOI: 10.1016/j.rpth.2023.100193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
This year's Congress of the International Society of Thrombosis and Haemostasis (ISTH) took place in person in Montréal, Canada, from June 24-28, 2023. The conference, held annually, highlighted cutting-edge advances in basic, translational, population and clinical sciences relevant to the Society. As for all ISTH congresses, we offered a special, congress-specific scientific theme; this year, the special theme was immunothrombosis. Certainly, over the last few years, COVID-19 infection and its related thrombotic and other complications have renewed interest in the concepts of thromboinflammation and immunothrombosis; namely, the relationship between inflammation, infection and clotting. Other main scientific themes of the Congress included Arterial Thromboembolism, Coagulation and Natural Anticoagulants, Diagnostics and Omics, Fibrinolysis and Proteolysis, Hemophilia and Rare Bleeding Disorders, Hemostatic System in Cancer, Inflammation and Immunity, Pediatrics, Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies, Platelets and Megakaryocytes, Vascular Biology, Venous Thromboembolism and Women's Health. Among other sessions, the program included 28 State-of-the-Art (SOA) sessions with a total of 84 talks given by internationally recognized leaders in the field. SOA speakers were invited to prepare brief illustrated reviews of their talks that were peer reviewed and are included in this article. These illustrated capsules highlight the major scientific advances with potential to impact clinical practice. Readers are invited to take advantage of the excellent educational resource provided by these illustrated capsules. They are also encouraged to use the image in social media to draw attention to the high quality and impact of the science presented at the Congress.
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Affiliation(s)
- Susan R Kahn
- Medicine, Sir Mortimer B Davis Jewish General Hospital, McGill University, 3755 Cote Ste Catherine, Montreal, Quebec
| | - Donald M Arnold
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Caterina Casari
- Université Paris-Saclay, INSERM, Hémostase inflammation thrombose HITH U1176, 94276, Le Kremlin-Bicêtre, France
| | - Karl C Desch
- Cell and Molecular Biology Program, University of Michigan, Ann Arbor, USA
| | - Katrien M J Devreese
- Coagulation Laboratory, Department of Laboratory Medicine, Ghent University Hospital, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Emmanuel J Favaloro
- Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW Australia
| | - Florian Gaertner
- Technische Universität München (TUM), Ismaninger Straße 22, München, Bayern 81675, Germany
| | - Samantha C Gouw
- Amsterdam UMC location University of Amsterdam, Department of Pediatric Hematology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Paolo Gresele
- University of Perugia, Department of Medicine and Surgery, Head Section of Internal and Cardiovascular Medicine
| | - Arjan W Griffioen
- Angiogenesis Laboratory, Department of Medical Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Lukas Heger
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Departement of Cardiology and Angiology, University Hospital Freiburg Bad Krozingen, 79106 Freiburg, Germany
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA 02115, USA
- Departement of Cardiology and Angiology, University Hospital Freiburg Bad Krozingen, 79106 Freiburg, Germany
| | | | - Shrey Kohli
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Universitätsklinikum Leipzig, Leipzig University, 04103 Leipzig, Germany
| | - Avi Leader
- Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ton Lisman
- Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Eric Mullins
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati - College of Medicine, Cincinnati, OH, USA
| | - Helen Chioma Okoye
- College of Medicine, University of Nigeria, Ituku Ozalla campus, Enugu Nigeria
| | | | | | - Rita Selby
- Departments of Laboratory Medicine & Pathobiology and Department of Medicine, University of Toronto
| | | | | | - Francesco Violi
- Department of Clinical, Internal Medicine, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Angela C Weyand
- Department of Pediatrics, University of Michigan Medical School
| | | | - Ze Zheng
- Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
- Versiti Blood Research Institute, Milwaukee, Wisconsin 53226, USA
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7
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Clark JC, Martin EM, Morán LA, Di Y, Wang X, Zuidscherwoude M, Brown HC, Kavanagh DM, Hummert J, Eble JA, Nieswandt B, Stegner D, Pollitt AY, Herten DP, Tomlinson MG, García A, Watson SP. Divalent nanobodies to platelet CLEC-2 can serve as agonists or antagonists. Commun Biol 2023; 6:376. [PMID: 37029319 PMCID: PMC10082178 DOI: 10.1038/s42003-023-04766-6] [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: 01/03/2023] [Accepted: 03/27/2023] [Indexed: 04/09/2023] Open
Abstract
CLEC-2 is a target for a new class of antiplatelet agent. Clustering of CLEC-2 leads to phosphorylation of a cytosolic YxxL and binding of the tandem SH2 domains in Syk, crosslinking two receptors. We have raised 48 nanobodies to CLEC-2 and crosslinked the most potent of these to generate divalent and tetravalent nanobody ligands. Fluorescence correlation spectroscopy (FCS) was used to show that the multivalent nanobodies cluster CLEC-2 in the membrane and that clustering is reduced by inhibition of Syk. Strikingly, the tetravalent nanobody stimulated aggregation of human platelets, whereas the divalent nanobody was an antagonist. In contrast, in human CLEC-2 knock-in mouse platelets, the divalent nanobody stimulated aggregation. Mouse platelets express a higher level of CLEC-2 than human platelets. In line with this, the divalent nanobody was an agonist in high-expressing transfected DT40 cells and an antagonist in low-expressing cells. FCS, stepwise photobleaching and non-detergent membrane extraction show that CLEC-2 is a mixture of monomers and dimers, with the degree of dimerisation increasing with expression thereby favouring crosslinking of CLEC-2 dimers. These results identify ligand valency, receptor expression/dimerisation and Syk as variables that govern activation of CLEC-2 and suggest that divalent ligands should be considered as partial agonists.
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Affiliation(s)
- Joanne C Clark
- Institute of Cardiovascular Sciences, Level 1 IBR, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Centre of Membrane Proteins and Receptors (COMPARE), The Universities of Birmingham and Nottingham, The Midlands, UK.
| | - Eleyna M Martin
- Institute of Cardiovascular Sciences, Level 1 IBR, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Luis A Morán
- Institute of Cardiovascular Sciences, Level 1 IBR, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela, and Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Ying Di
- Institute of Cardiovascular Sciences, Level 1 IBR, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Xueqing Wang
- Institute of Cardiovascular Sciences, Level 1 IBR, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela, and Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Malou Zuidscherwoude
- Institute of Cardiovascular Sciences, Level 1 IBR, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre of Membrane Proteins and Receptors (COMPARE), The Universities of Birmingham and Nottingham, The Midlands, UK
| | - Helena C Brown
- Institute of Cardiovascular Sciences, Level 1 IBR, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Institute of Experimental Biomedicine I, University Hospital and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Deirdre M Kavanagh
- Department of Biochemistry, University of Oxford, South Parks Road, Oxford, OX1 QU3, UK
| | - Johan Hummert
- Institute of Cardiovascular Sciences, Level 1 IBR, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre of Membrane Proteins and Receptors (COMPARE), The Universities of Birmingham and Nottingham, The Midlands, UK
| | - Johannes A Eble
- Institute for Physiological Chemistry & Pathobiochemistry, University of Münster, Waldeyerstraße 15, 48149, Münster, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine I, University Hospital and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - David Stegner
- Institute of Experimental Biomedicine I, University Hospital and Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Alice Y Pollitt
- Institute for Cardiovascular and Metabolic Research, School of Biological Sciences, University of Reading, Reading, RG6 6AS, UK
| | - Dirk-Peter Herten
- Institute of Cardiovascular Sciences, Level 1 IBR, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Centre of Membrane Proteins and Receptors (COMPARE), The Universities of Birmingham and Nottingham, The Midlands, UK
| | - Michael G Tomlinson
- Centre of Membrane Proteins and Receptors (COMPARE), The Universities of Birmingham and Nottingham, The Midlands, UK
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Angel García
- Centre for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade de Santiago de Compostela, and Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Steve P Watson
- Institute of Cardiovascular Sciences, Level 1 IBR, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Centre of Membrane Proteins and Receptors (COMPARE), The Universities of Birmingham and Nottingham, The Midlands, UK.
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8
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Beck S, Öftering P, Li R, Hemmen K, Nagy M, Wang Y, Zarpellon A, Schuhmann MK, Stoll G, Ruggeri ZM, Heinze KG, Heemskerk JW, Ruf W, Stegner D, Nieswandt B. Platelet glycoprotein V spatio-temporally controls fibrin formation. NATURE CARDIOVASCULAR RESEARCH 2023; 2:368-382. [PMID: 37206993 PMCID: PMC10195106 DOI: 10.1038/s44161-023-00254-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 02/15/2023] [Indexed: 05/21/2023]
Abstract
The activation of platelets and coagulation at vascular injury sites is crucial for haemostasis but can promote thrombosis and inflammation in vascular pathologies. Here, we delineate an unexpected spatio-temporal control mechanism of thrombin activity that is platelet orchestrated and locally limits excessive fibrin formation after initial haemostatic platelet deposition. During platelet activation, the abundant platelet glycoprotein (GP) V is cleaved by thrombin. We demonstrate with genetic and pharmacological approaches that thrombin-mediated shedding of GPV does not primarily regulate platelet activation in thrombus formation, but rather has a distinct function after platelet deposition and specifically limits thrombin-dependent generation of fibrin, a crucial mediator of vascular thrombo-inflammation. Genetic or pharmacologic defects in haemostatic platelet function are unexpectedly attenuated by specific blockade of GPV shedding, indicating that the spatio-temporal control of thrombin-dependent fibrin generation also represents a potential therapeutic target to improve haemostasis.
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Affiliation(s)
- Sarah Beck
- Julius-Maximilians-Universität Würzburg, Rudolf Virchow Center for Integrative and Translational Bioimaging, Würzburg, Germany
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
| | - Patricia Öftering
- Julius-Maximilians-Universität Würzburg, Rudolf Virchow Center for Integrative and Translational Bioimaging, Würzburg, Germany
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
| | - Renhao Li
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine; Atlanta, USA
| | - Katherina Hemmen
- Julius-Maximilians-Universität Würzburg, Rudolf Virchow Center for Integrative and Translational Bioimaging, Würzburg, Germany
| | - Magdolna Nagy
- Department of Biochemistry, CARIM, Maastricht University; Maastricht, The Netherlands
| | - Yingchun Wang
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine; Atlanta, USA
| | | | | | - Guido Stoll
- University Hospital Würzburg, Department of Neurology, Würzburg, Germany
| | | | - Katrin G. Heinze
- Julius-Maximilians-Universität Würzburg, Rudolf Virchow Center for Integrative and Translational Bioimaging, Würzburg, Germany
| | - Johan W.M. Heemskerk
- Department of Biochemistry, CARIM, Maastricht University; Maastricht, The Netherlands
| | - Wolfram Ruf
- Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University Medical Center Mainz; Mainz, Germany
- Department of Immunology and Microbiology, Scripps Research; La Jolla, CA, USA
| | - David Stegner
- Julius-Maximilians-Universität Würzburg, Rudolf Virchow Center for Integrative and Translational Bioimaging, Würzburg, Germany
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
| | - Bernhard Nieswandt
- Julius-Maximilians-Universität Würzburg, Rudolf Virchow Center for Integrative and Translational Bioimaging, Würzburg, Germany
- University Hospital Würzburg, Institute of Experimental Biomedicine, Würzburg, Germany
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9
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Huang Y, Lu M, Wang Y, Zhang C, Cao Y, Zhang X. Podoplanin: A potential therapeutic target for thrombotic diseases. Front Neurol 2023; 14:1118843. [PMID: 36970507 PMCID: PMC10033871 DOI: 10.3389/fneur.2023.1118843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
As a specific lymphatic marker and a key ligand of C-type lectin-like receptor 2 (CLEC-2), podoplanin (Pdpn) is involved in various physiological and pathological processes such as growth and development, respiration, blood coagulation, lymphangiogenesis, angiogenesis, and inflammation. Thrombotic diseases constitute a major cause of disability and mortality in adults, in which thrombosis and inflammation play a crucial role. Recently, increasing evidence demonstrates the distribution and function of this glycoprotein in thrombotic diseases such as atherosclerosis, ischemic stroke, venous thrombosis, ischemic-reperfusion injury (IRI) of kidney and liver, and myocardial infarction. Evidence showed that after ischemia, Pdpn can be acquired over time by a heterogeneous cell population, which may not express Pdpn in normal conditions. In this review, the research progresses in understanding the roles and mechanisms of podoplanin in thromobotic diseases are summarized. The challenges of podoplanin-targeted approaches for disease prognosis and preventions are also discussed.
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Affiliation(s)
- Yaqian Huang
- Department of Neurology, Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Manli Lu
- Department of Neurology, Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Wang
- Department of Neurology, Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunyuan Zhang
- Department of Rehabilitation, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Chunyuan Zhang
| | - Yongjun Cao
- Department of Neurology, Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Yongjun Cao
| | - Xia Zhang
- Department of Neurology, Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Xia Zhang
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10
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Affiliation(s)
- Zoltan Nagy
- Institute of Experimental Biomedicine, University of Würzburg, University Hospital, Würzburg, Germany.,Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine, University of Würzburg, University Hospital, Würzburg, Germany.,Rudolf Virchow Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
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11
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Weiss LJ, Drayss M, Mott K, Droste M, Just B, Arold AM, Nieswandt B, Weismann D, Stegner D, Schulze H. The homophilic CD84 receptor is upregulated on platelets in COVID-19 and sepsis. Thromb Res 2022; 220:121-124. [PMID: 36334399 PMCID: PMC9595407 DOI: 10.1016/j.thromres.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Lukas J. Weiss
- Institute of Experimental Biomedicine, University Hospital Würzburg, Germany,Department of Internal Medicine I, University Hospital Würzburg, Germany
| | - Maria Drayss
- Institute of Experimental Biomedicine, University Hospital Würzburg, Germany,Department of Internal Medicine I, University Hospital Würzburg, Germany
| | - Kristina Mott
- Institute of Experimental Biomedicine, University Hospital Würzburg, Germany
| | - Margret Droste
- Institute of Experimental Biomedicine, University Hospital Würzburg, Germany
| | - Bastian Just
- Institute of Experimental Biomedicine, University Hospital Würzburg, Germany
| | - Anna M. Arold
- Institute of Experimental Biomedicine, University Hospital Würzburg, Germany
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine, University Hospital Würzburg, Germany,Rudolf Virchow Center, University of Würzburg, Germany
| | - Dirk Weismann
- Department of Internal Medicine I, University Hospital Würzburg, Germany
| | - David Stegner
- Institute of Experimental Biomedicine, University Hospital Würzburg, Germany,Rudolf Virchow Center, University of Würzburg, Germany
| | - Harald Schulze
- Institute of Experimental Biomedicine, University Hospital Würzburg, Germany,Corresponding author at: University Hospital Würzburg, Institute for Experimental Biomedicine, Chair I, Josef-Schneider-Str. 2/D15, 97080 Würzburg, Germany
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12
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Bourrienne M, Gay J, Mazighi M, Ajzenberg N. State of the art in cerebral venous sinus thrombosis animal models. J Thromb Haemost 2022; 20:2187-2196. [PMID: 35815379 PMCID: PMC9796510 DOI: 10.1111/jth.15816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 01/01/2023]
Abstract
Cerebral venous sinus thrombosis (CVST) is an uncommon venous thromboembolic event accounting for less than 1% of strokes resulting in brain parenchymal injuries. Diagnosis and prognosis are still challenging due to highly variable clinical course and etiologies. Beyond thrombosis, different CVST-related parenchymal injuries may occur and include edema, ischemic strokes, and intra-cerebral hemorrhage (ICH; i.e., parenchymal/subdural hematomas, and subarachnoid hemorrhages), which are identified in 40%-60% of patients without clearly identified mechanisms. In this perspective, experimental animal models contribute to the understanding of initiation, propagation, and resolution of thrombosis, as well as brain-related damages. Last but not least, animal models may be useful to study new therapeutic approaches. In this review, we provide a comprehensive overview of CVST experimental models, focusing on their strengths, limits, and contribution to the current knowledge.
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Affiliation(s)
- Marie‐Charlotte Bourrienne
- Université Paris Cité & Université Sorbonne Paris Nord, INSERM U1148, LVTSF‐75018 ParisFrance
- Laboratoire d'Hématologie, AP‐HP, Hôpital BeaujonClichyFrance
| | - Juliette Gay
- Université Paris Cité & Université Sorbonne Paris Nord, INSERM U1148, LVTSF‐75018 ParisFrance
- Laboratoire d'Hématologie, AP‐HP, Hôpital Bichat Claude‐BernardParisFrance
| | - Mikaël Mazighi
- Université Paris Cité & Université Sorbonne Paris Nord, INSERM U1148, LVTSF‐75018 ParisFrance
- Département de NeurologieAP‐HP, Hôpital Lariboisière, FHU NeurovascParisFrance
| | - Nadine Ajzenberg
- Université Paris Cité & Université Sorbonne Paris Nord, INSERM U1148, LVTSF‐75018 ParisFrance
- Laboratoire d'Hématologie, AP‐HP, Hôpital Bichat Claude‐BernardParisFrance
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13
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Navarro S, Starke A, Heemskerk JWM, Kuijpers MJE, Stegner D, Nieswandt B. Targeting of a Conserved Epitope in Mouse and Human GPVI Differently Affects Receptor Function. Int J Mol Sci 2022; 23:8610. [PMID: 35955743 PMCID: PMC9369317 DOI: 10.3390/ijms23158610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
Glycoprotein (GP) VI is the major platelet collagen receptor and a promising anti-thrombotic target. This was first demonstrated in mice using the rat monoclonal antibody JAQ1, which completely blocks the Collagen-Related Peptide (CRP)-binding site on mouse GPVI and efficiently inhibits mouse platelet adhesion, activation and aggregation on collagen. Here, we show for the first time that JAQ1 cross-reacts with human GPVI (huGPVI), but not with GPVI in other tested species, including rat, rabbit, guinea pig, swine, and dog. We further demonstrate that JAQ1 differently modulates mouse and human GPVI function. Similar to its effects on mouse GPVI (mGPVI), JAQ1 inhibits CRP-induced activation in human platelets, whereas, in stark contrast to mouse GPVI, it does not inhibit the adhesion, activation or aggregate formation of human platelets on collagen, but causes instead an increased response. This effect was also seen with platelets from newly generated human GPVI knockin mice (hGP6tg/tg). These results indicate that the binding of JAQ1 to a structurally conserved epitope in GPVI differently affects its function in human and mouse platelets.
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Affiliation(s)
- Stefano Navarro
- Institute of Experimental Biomedicine, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; (S.N.); (A.S.); (D.S.)
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (J.W.M.H.); (M.J.E.K.)
| | - Andreas Starke
- Institute of Experimental Biomedicine, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; (S.N.); (A.S.); (D.S.)
| | - Johan W. M. Heemskerk
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (J.W.M.H.); (M.J.E.K.)
- Synapse Research Institute, Kon. Emmaplein 7, 6214 AC Maastricht, The Netherlands
| | - Marijke J. E. Kuijpers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (J.W.M.H.); (M.J.E.K.)
- Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center+, Professor Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - David Stegner
- Institute of Experimental Biomedicine, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; (S.N.); (A.S.); (D.S.)
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine, University Hospital Würzburg and Rudolf Virchow Center for Integrative and Translational Bioimaging, Josef-Schneider-Straße 2, 97080 Würzburg, Germany; (S.N.); (A.S.); (D.S.)
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14
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Impaired microtubule dynamics contribute to microthrombocytopenia in RhoB-deficient mice. Blood Adv 2022; 6:5184-5197. [PMID: 35819450 PMCID: PMC9631634 DOI: 10.1182/bloodadvances.2021006545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
RhoB-deficient mice display microthrombocytopenia. RhoB exerts nonredundant functions in the megakaryocyte lineage compared with RhoA and regulates microtubule dynamics.
Megakaryocytes are large cells in the bone marrow that give rise to blood platelets. Platelet biogenesis involves megakaryocyte maturation, the localization of the mature cells in close proximity to bone marrow sinusoids, and the formation of protrusions, which are elongated and shed within the circulation. Rho GTPases play important roles in platelet biogenesis and function. RhoA-deficient mice display macrothrombocytopenia and a striking mislocalization of megakaryocytes into bone marrow sinusoids and a specific defect in G-protein signaling in platelets. However, the role of the closely related protein RhoB in megakaryocytes or platelets remains unknown. In this study, we show that, in contrast to RhoA deficiency, genetic ablation of RhoB in mice results in microthrombocytopenia (decreased platelet count and size). RhoB-deficient platelets displayed mild functional defects predominantly upon induction of the collagen/glycoprotein VI pathway. Megakaryocyte maturation and localization within the bone marrow, as well as actin dynamics, were not affected in the absence of RhoB. However, in vitro–generated proplatelets revealed pronouncedly impaired microtubule organization. Furthermore, RhoB-deficient platelets and megakaryocytes displayed selective defects in microtubule dynamics/stability, correlating with reduced levels of acetylated α-tubulin. Our findings imply that the reduction of this tubulin posttranslational modification results in impaired microtubule dynamics, which might contribute to microthrombocytopenia in RhoB-deficient mice. Importantly, we demonstrate that RhoA and RhoB are localized differently and have selective, nonredundant functions in the megakaryocyte lineage.
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15
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Salih F, Kohler S, Schönborn L, Thiele T, Greinacher A, Endres M. Early recognition and treatment of pre-VITT syndrome after adenoviral vector-based SARS-CoV-2 vaccination may prevent from thrombotic complications: review of published cases and clinical pathway. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac036. [PMID: 35919343 PMCID: PMC9242075 DOI: 10.1093/ehjopen/oeac036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 04/30/2022] [Indexed: 11/26/2022]
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but highly morbid complication after adenoviral vector-based SARS-CoV-2 vaccination. The pre-VITT syndrome is defined as vaccine-induced immune thrombocytopenia without thrombosis typically presenting with new-onset headache. This review aims to identify at-risk patients before complications such as cerebral venous sinus thrombosis occur. We review previously published reports of 19 patients (median age 35 years, range 23-74; 16 females) who met the diagnostic criteria for a pre-VITT syndrome. Seven patients progressed to VITT, 12 patients did not. Patients who experienced VITT received delayed treatment. The median interval between the onset of headache and VITT-treatment (i.e. anticoagulation, immune globulins, or corticosteroids) was 5 days (range 1-8 days) compared with 2 days (0-5 days) in those without subsequent VITT (P = 0.033). The interval from onset of headache to anticoagulation was longer in patients with VITT (median 7 vs. 2 days; range 3-9 vs. 0-7 days; P = 0.01). Anticoagulation was safe in all patients with a pre-VITT syndrome as no haemorrhagic complications occurred after anticoagulation was started despite low platelets. The transient decline of platelet count after admission was significantly more pronounced in patients who progressed to VITT (median 67 vs. 0 × 103/µL; range 0-77 × 103/µL vs. 0-10 × 103/µL; P = 0.005). d-dimers did not differ between groups. Pre-VITT syndrome is a 'red flag' and allows to identify and preemptively treat patients at-risk of further progression to VITT. However, it must be distinguished from post-vaccination immune thrombocytopenia.
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Affiliation(s)
| | | | - Linda Schönborn
- Universitätsmedizin Greifswald, Institute of Immunology and Transfusion Medicine, Sauerbruch-Straße, 17489 Greifswald, Germany
| | - Thomas Thiele
- Universitätsmedizin Greifswald, Institute of Immunology and Transfusion Medicine, Sauerbruch-Straße, 17489 Greifswald, Germany
| | | | - Matthias Endres
- Corresponding author. Tel: +49 30 450 560101, Fax: +49 30 450 7560 932,
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