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Altobelli C, Fabiani FC, Anastasio P, Pluvio C, de Pascale E, Vernaglione L, Gernone G, Di Luca M, Bertuzzi V, Brescia P, Toffoletto P, D'Arezzo M, Brustia M, Andreana De Mauri, Chiarinotti D, Loschiavo C, Grecò M, D'Elia F, Gallo MA, Tarroni G, Di Liberato L, Perna AF, Capasso G, Capolongo G. Effects of Rheopheresis in dialysis patients with peripheral artery disease and diabetic foot ulcers: A multicentric Italian study. J Clin Apher 2024; 39:e22132. [PMID: 39105437 DOI: 10.1002/jca.22132] [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: 02/11/2024] [Revised: 05/08/2024] [Accepted: 05/23/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Peripheral artery disease (PAD) in hemodialysis (HD) patients has a significant social impact due to its prevalence, poor response to standard therapy and dismal prognosis. Rheopheresis is indicated by guidelines for PAD treatment. MATERIALS AND METHODS Twenty-five HD patients affected by PAD stage IV Lerichè-Fontaine and ischemic ulcer 1C or 2C according to the University of Texas Wound Classification System (UTWCS), without amelioration after traditional medical therapy and/or revascularization, were selected and underwent 12 Rheopheresis sessions in 10 weeks. Improvements in pain symptoms using Numerical Rating Scale (NRS), healing ulcers and laboratory hemorheological parameters have been evaluated. RESULTS A clinically and statistically significant mean value reduction and of relative percentage differences between estimated marginal means (Δ), calculated at each visits, of NRS was observed, with a maximum value (-48.5%) between the first and last visit. At the end of the treatment period 14.3% of ulcers were completely healed, 46.4% downgraded, 53.6% were stable. Overall, no ulcers upgraded. A statistically significant reduction of the Δ, between the first and last visit, for fibrinogen (-16%) was also observed. CONCLUSION Rheopheresis reduced overall painful symptoms; data suggest that it could heal or improve ulcers and hemorheological laboratory parameters in HD patients with PAD and ischemic ulcers resistant to standard therapies.
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Affiliation(s)
- Claudia Altobelli
- Department of Critical Area, Nephrology and Dialysis Unit, Cotugno Hospital - AORN Ospedali dei Colli, Naples, Italy
| | - Filippo Carone Fabiani
- Department of Economics, Management and Statistics, University Milano-Bicocca, Milan, Italy
| | - Pietro Anastasio
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Corrado Pluvio
- Department of Critical Area, Nephrology and Dialysis Unit, Cotugno Hospital - AORN Ospedali dei Colli, Naples, Italy
| | - Emanuela de Pascale
- Department of Critical Area, Nephrology and Dialysis Unit, Cotugno Hospital - AORN Ospedali dei Colli, Naples, Italy
| | | | - Giuseppe Gernone
- Nephro-Urologyc Department, Nephrology and Dialysis Unit, "S. Maria degli Angeli" Putignano & "S. Giacomo" Monopoli Hospitals ASL Bari, Bari, Italy
| | | | | | | | | | - Mario D'Arezzo
- "Ospedali Riuniti" University Hospital, Ancona, Italy
- IRCCS INRCA Research Institute, Ancona, Italy
| | | | | | | | | | - Matteo Grecò
- Nephrology and Dialysis, ULSS 09 Scaligera, Legnago, Italy
| | - Filomena D'Elia
- Nephrology and Dialysis Unit, Molfetta Hospital ASL Bari, Molfetta, Italy
- Nephrology and Dialysis Unit, Di Venere Hospital ASL Bari, Bari, Italy
| | - Maria Anna Gallo
- Nephrology and Dialysis Unit, Molfetta Hospital ASL Bari, Molfetta, Italy
| | | | - Lorenzo Di Liberato
- Simple Departmental Unit of Dialysis, "SS Annunziata" Hospital, Chieti, Italy
| | - Alessandra F Perna
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy
- Biogem Scarl, Ariano Irpino, Italy
| | - Giovanna Capolongo
- Department of Translational Medical Science, University of Campania Luigi Vanvitelli, Naples, Italy
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2
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Bakhtiaridoost S, Musuroi C, Volmer M, Florescu M. Optoelectronic microfluidic device for point-of-care blood plasma viscosity measurement. LAB ON A CHIP 2024; 24:3305-3314. [PMID: 38869225 DOI: 10.1039/d4lc00211c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Physical properties of blood plasma, such as viscosity, serve as crucial indicators of disease. The inherent capillary effect of paper microchannels, coupled with minimal sample requirement, stimulated the advancement of paper-based viscometers. This study presents a precise, non-contact optoelectronic system using a microfluidic platform for the measurement of blood plasma viscosity. Microchannels were defined onto the filter paper using an available and inexpensive wax crayon, without the need for conventional wax printing equipment. The time required for the 5 μL sample to pass a specific distance was measured using two pairs of infrared sensors. Subsequently, this data was sent to the microcontroller, which automatically calculated the viscosity. Throughout the measurements, sample temperature was maintained at a constant 37 °C through an integrated heater with automated control. The microfluidic platform successfully processed real samples, yielding viscosity measurements in under three minutes. Evaluation with fetal bovine serum, spiked with varying protein concentrations in both native and denatured states, demonstrated a precision exceeding 96% compared to conventional Ostwald viscometer readings. For human subjects exhibiting pathologies affecting serum and plasma viscosity compared to physiological norms, strong correlations were observed between resultant values and clinical diagnoses. The proposed device aims to replace expensive and complex optical equipment, offering a safer alternative for measuring plasma viscosity. Unlike similar devices, it eliminates the risk of component deformation due to chemical contact or unsafe irradiation.
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Affiliation(s)
- Somayyeh Bakhtiaridoost
- Department of Fundamental, Prophylactic and Clinical Disciplines, Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania.
| | - Cristian Musuroi
- Department of Electrical Engineering and Applied Physics, Transilvania University of Brasov, Brasov, Romania.
| | - Marius Volmer
- Department of Electrical Engineering and Applied Physics, Transilvania University of Brasov, Brasov, Romania.
| | - Monica Florescu
- Department of Fundamental, Prophylactic and Clinical Disciplines, Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania.
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3
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Yuan Q, Han Y, Fang S, Lei H, Huang H, Lin H, Wu X, Chen R, Chen Z, Chen J, Li H, Liu N, Du H. Sex difference in the association between triglyceride and intracerebral bleeding risk after intravenous thrombolysis for acute ischemic stroke, a multi-center retrospective study. PeerJ 2024; 12:e17558. [PMID: 38938613 PMCID: PMC11210480 DOI: 10.7717/peerj.17558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/21/2024] [Indexed: 06/29/2024] Open
Abstract
Background Whether the relationship of intracerebral bleeding risk with lipid profile may vary by sex remains unclear. This study aims to investigate potential sex differences in the association between lipid profile and the risk of symptomatic intracerebral hemorrhage (sICH) in patients with acute ischemic stroke (AIS) who received intravenous thrombolysis using recombinant tissue plasminogen activator (r-tPA). Methods This multicenter retrospective observational study analyzed patients with AIS treated with intravenous r-tPA. sICH was defined as a worsening of 4 or higher points in the National Institutes of Health Stroke Scale (NIHSS) score within 36 hours after intravenous thrombolysis in any hemorrhage subtype. We assessed the odds ratio (OR) with 95% confidence interval (CI) of lipid profile for sICH for each sex using logistic regression models adjusted for potential confounding factors. Results Of 957 participants (median age 68 (interquartile range, 59-75), men 628 (65.6%)), 56 sICH events (36 (5.7%) in men and 20 (6.1%) in women) were observed. The risk of sICH in men decreased with increasing serum levels of triglyceride after adjustment for confounding factors (vs lowest tertile, medium tertile OR 0.39, 95% CI [0.17-0.91], top tertile OR 0.33, 95% CI [0.13-0.84], overall p = 0.021; per point increase, adjusted OR 0.29, 95% CI [0.13-0.63], p = 0.002). Neither serum levels of total cholesterol nor low-density lipoprotein (LDL) was associated with sICH in men. In women, there was no association between any of the lipid levels and the risk of sICH. Conclusions This study indicated that the association between serum levels of triglyceride and sICH may vary by sex. In men, increased triglyceride levels decrease the risk of sICH; in women, this association was lost. Further studies on the biological mechanisms for sex differences in stroke risk associated with triglyceride are needed.
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Affiliation(s)
- Qilin Yuan
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ying Han
- Department of Geriatrics, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Shuangfang Fang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Hanhan Lei
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Huapin Huang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Huiying Lin
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Xiaomin Wu
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Ronghua Chen
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Zhiting Chen
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian Province, China
| | - Jie Chen
- Department of Neurology, Fujian Provincial Hospital South Branch, Fuzhou, Fujian Province, China
| | - Hangfeng Li
- Department of Neurology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian Province, China
| | - Nan Liu
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
| | - Houwei Du
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China
- Institute of Clinical Neurology, Fujian Medical University, Fuzhou, Fujian Province, China
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4
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Tazoe K, Harada N, Takemura K, Nakamae M, Hino M. A Case of IgG1-Lambda Multiple Myeloma With Hyperviscosity Syndrome and Cryoglobulinemia: Identification of the Subclass Fraction by Immunoelectrophoresis and Immunofixation Electrophoresis. Cureus 2023; 15:e48253. [PMID: 38054160 PMCID: PMC10694783 DOI: 10.7759/cureus.48253] [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] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Hyperviscosity syndrome (HVS) is a complication of monoclonal plasma cell tumors. The frequency of HVS depends on the type of monoclonal protein. Immunoglobulin M (IgM) is more closely associated with HVS than IgG, and among IgG subclass monoclonal proteins, IgG3 is most frequently associated with HVS. We herein report a 44-year-old woman with multiple myeloma (MM), HVS, and cryoglobulinemia. Her monoclonal protein and cryoglobulin were IgG1-lambda (λ). She developed HVS at a lower monoclonal protein level because of the properties of the IgG1-derived monoclonal protein and cryoglobulin. Our case highlights the fact that identifying the IgG subclass is useful in predicting the risk of complicating HVS.
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Affiliation(s)
- Kumiyo Tazoe
- Hematology, Osaka Metropolitan University Hospital, Osaka, JPN
| | - Naonori Harada
- Hematology, Osaka Metropolitan University Hospital, Osaka, JPN
- Hematology, Fuchu Hospital, Osaka, JPN
| | - Kazuya Takemura
- Clinical Laboratory, Osaka Metropolitan University Hospital, Osaka, JPN
| | - Mika Nakamae
- Laboratory Medicine and Medical Informatics, Osaka Metropolitan University Hospital, Osaka, JPN
- Clinical Laboratory, Osaka Metropolitan University Hospital, Osaka, JPN
| | - Masayuki Hino
- Hematology, Osaka Metropolitan University Hospital, Osaka, JPN
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5
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Hsu PS, Chen JL, Sung SY, Tsai YT, Lin CY, Wu YF, Tsai CS. Inflammatory Biomarkers and Blood Physical Property Transformations Following On-Pump Coronary Artery Bypass Graft Surgery. J Pers Med 2023; 13:1434. [PMID: 37888046 PMCID: PMC10607935 DOI: 10.3390/jpm13101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE This study aimed to compare the hemorheological and inflammatory changes before and after coronary artery bypass graft (CABG) surgery, as factors such as hypothermia, hemodilution, transfusion, and other variables affect blood viscosity and inflammation during the procedure. METHODS A total of 25 patients who underwent CABG surgery were enrolled in this study. Whole blood was collected just before the CABG (D0), 2 days after surgery (D2), and 5 days after surgery (D5). The plasma viscosity (PV) and whole blood viscosity (WBV) were measured at shear rates ranging from 0.1 to 1000 s-1 using a rheometer, and the mean values were compared. Inflammatory markers were also assessed and analyzed in relation to the hemorheological changes. RESULTS Compared with the baseline values, the PV significantly increased after 5 days. WBV showed a significant increase on day 2 and after 5 days. The WBV and fibrinogen were significantly correlated on day 2 and day 5 but not before surgery. Inflammatory markers such as CRP, WBC, platelets, and fibrinogen also demonstrated notable changes in relation to the hemorheological alterations. CONCLUSIONS This study highlights the crucial finding that hyperviscosity, characterized by elevated PV and WBV, persists for almost one week after on-pump CABG surgery. Understanding the interplay between inflammation and hemorheological properties during the postoperative period is crucial for optimizing patient care. Future research should focus on exploring the underlying mechanisms and potential therapeutic interventions to mitigate the impact of inflammation on blood viscosity and improve patient outcomes following CABG surgery.
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Affiliation(s)
- Po-Shun Hsu
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Jia-Lin Chen
- Department of Anesthesia, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Shih-Ying Sung
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Yi-Ting Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Chih-Yuan Lin
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
| | - Yi-Fan Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Institute of Physics, Academia Sinica, Taipei 115201, Taiwan
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
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6
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Nader E, Nougier C, Boisson C, Poutrel S, Catella J, Martin F, Charvet J, Girard S, Havard‐Guibert S, Martin M, Rezigue H, Desmurs‐Clavel H, Renoux C, Joly P, Guillot N, Bertrand Y, Hot A, Dargaud Y, Connes P. Increased blood viscosity and red blood cell aggregation in patients with COVID-19. Am J Hematol 2022; 97:283-292. [PMID: 34939698 DOI: 10.1002/ajh.26440] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/11/2022]
Abstract
The aim of this study was to (1) analyze blood viscosity, red blood cell (RBC) deformability, and aggregation in hospitalized patients with Coronavirus disease 19 (COVID-19); (2) test the associations between impaired blood rheology and blood coagulation; and (3) test the associations between impaired blood rheology and several indicators of clinical severity. A total of 172 patients with COVID-19, hospitalized in COVID-unit of the Internal Medicine Department (Lyon, France) participated in this study between January and May 2021. Clinical parameters were collected for each patient. Routine hematological/biochemical parameters, blood viscosity, RBC deformability and aggregation, and RBC senescence markers were measured on the first day of hospitalization. A control group of 38 healthy individuals was constituted to compare the blood rheological and RBC profile. Rotational thromboelastography was performed in 76 patients to study clot formation dynamics. Our study demonstrated that patients with COVID-19 had increased blood viscosity despite lower hematocrit than healthy individuals, as well as increased RBC aggregation. In-vitro experiments demonstrated a strong contribution of plasma fibrinogen in this RBC hyper-aggregation. RBC aggregation correlated positively with clot firmness, negatively with clot formation time, and positively with the length of hospitalization. Patients with oxygen supplementation had higher RBC aggregation and blood viscosity than those without, and patients with pulmonary lesions had higher RBC aggregation and enhanced coagulation than those without. This study is the first to demonstrate blood hyper-viscosity and RBC hyper-aggregation in a large cohort of patients with COVID-19 and describe associations with enhanced coagulation and clinical outcomes.
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Affiliation(s)
- Elie Nader
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
| | - Christophe Nougier
- Laboratoire d'Hématologie, Groupement Hospitalier Est Hospices Civils de Lyon Lyon France
| | - Camille Boisson
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
- Service de Biochimie et Biologie Moléculaire, Centre de Biologie et de Pathologie Est Hospices Civils de Lyon Lyon France
| | - Solene Poutrel
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
- Service de Médecine Interne, Hôpital Edouard Herriot Hospices Civils de Lyon Lyon France
| | - Judith Catella
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
- Service de Médecine Interne, Hôpital Edouard Herriot Hospices Civils de Lyon Lyon France
| | - Fiona Martin
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
| | - Juliette Charvet
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
| | - Sandrine Girard
- Laboratoire d'Hématologie, Groupement Hospitalier Est Hospices Civils de Lyon Lyon France
| | - Salomé Havard‐Guibert
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
| | - Marie Martin
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
| | - Hamdi Rezigue
- Laboratoire d'Hématologie, Groupement Hospitalier Est Hospices Civils de Lyon Lyon France
| | - Helene Desmurs‐Clavel
- Service de Médecine Interne, Hôpital Edouard Herriot Hospices Civils de Lyon Lyon France
- GEMMAT, Groupe d'Etude Multidisciplinaire en Maladies Thrombotiques, Lyon, France 4 Service de Medecine Intensive Reanimation Hopital Edouard Herriot Lyon France
| | - Céline Renoux
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
- Service de Biochimie et Biologie Moléculaire, Centre de Biologie et de Pathologie Est Hospices Civils de Lyon Lyon France
| | - Philippe Joly
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
- Service de Biochimie et Biologie Moléculaire, Centre de Biologie et de Pathologie Est Hospices Civils de Lyon Lyon France
| | - Nicolas Guillot
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
| | - Yves Bertrand
- Institut d'Hématologique et d'Oncologique Pédiatrique Hospices Civils de Lyon Lyon France
| | - Arnaud Hot
- Service de Médecine Interne, Hôpital Edouard Herriot Hospices Civils de Lyon Lyon France
| | - Yesim Dargaud
- Laboratoire d'Hématologie, Groupement Hospitalier Est Hospices Civils de Lyon Lyon France
- GEMMAT, Groupe d'Etude Multidisciplinaire en Maladies Thrombotiques, Lyon, France 4 Service de Medecine Intensive Reanimation Hopital Edouard Herriot Lyon France
- Unite d'Hemostase Clinique Hopital Cardiologique Louis Pradel, Lyon, France 6 UR4609 Hemostase & Thrombose Universite Claude Bernard Lyon 1 Lyon France
- UR4609 Hemostase & Thrombose Universite Claude Bernard Lyon 1 Lyon France
| | - Philippe Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team Vascular Biology and Red Blood Cell Université Claude Bernard Lyon 1 Villeurbanne France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
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7
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Louloudis G, Ambrosini S, Paneni F, Camici GG, Benke D, Klohs J. Adeno-Associated Virus-Mediated Gain-of-Function mPCSK9 Expression in the Mouse Induces Hypercholesterolemia, Monocytosis, Neutrophilia, and a Hypercoagulative State. Front Cardiovasc Med 2021; 8:718741. [PMID: 34631822 PMCID: PMC8492965 DOI: 10.3389/fcvm.2021.718741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/20/2021] [Indexed: 01/20/2023] Open
Abstract
Hypercholesterolemia has previously been induced in the mouse by a single intravenous injection of adeno-associated virus (AAV)-based vector harboring gain-of-function pro-protein convertase subtilisin/kexin type 9. Despite the recent emergence of the PCSK9-AAV model, the profile of hematological and coagulation parameters associated with it has yet to be characterized. We injected 1.0 × 1011 viral particles of mPCSK9-AAV or control AAV into juvenile male C57BL/6N mice and fed them with either a Western-type high-fat diet (HFD) or standard diet over the course of 3 weeks. mPCSK9-AAV mice on HFD exhibited greater plasma PCSK9 concentration and lower low-density lipoprotein levels, concomitant with increased total cholesterol and non-high-density lipoprotein (non-HDL)-cholesterol concentrations, and lower HDL-cholesterol concentrations than control mice. Furthermore, mPCSK9-AAV-injected mice on HFD exhibited no signs of atherosclerosis at 3 weeks after the AAV injection. Hypercholesterolemia was associated with a thromboinflammatory phenotype, as neutrophil levels, monocyte levels, and neutrophil-to-lymphocyte ratios were higher and activated partial thromboplastin times (aPTTs) was lower in HFD-fed mPCSK9-AAV mice. Therefore, the mPCSK9-AAV is a suitable model of hypercholesterolemia to examine the role of thromboinflammatory processes in the pathogenesis of cardiovascular and cerebrovascular diseases.
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Affiliation(s)
- Georgios Louloudis
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,Zurich Neuroscience Center (ZNZ), Zurich, Switzerland
| | - Samuele Ambrosini
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.,University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland.,Department of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Giovanni G Camici
- Zurich Neuroscience Center (ZNZ), Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Dietmar Benke
- Zurich Neuroscience Center (ZNZ), Zurich, Switzerland.,Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Jan Klohs
- Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland.,Zurich Neuroscience Center (ZNZ), Zurich, Switzerland
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8
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Acute hyperviscosity: syndromes and management. Blood 2018; 132:1379-1385. [PMID: 30104220 DOI: 10.1182/blood-2018-06-846816] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/11/2018] [Indexed: 12/20/2022] Open
Abstract
Plasma hyperviscosity is a rare complication of both monoclonal and polyclonal disorders associated with elevation of immunoglobulins. Asymptomatic patients with an elevation in the serum viscosity do not require plasma exchange, and the majority will have other indications for therapeutic intervention. For patients with hemorrhagic or central nervous system manifestations, plasma exchange is the therapy of choice and is relatively safe. Viscosity measurements are not required to initiate therapy if the index of suspicion is high and the clinical presentation is typical. However, patients should have a sample sent for confirmation of the diagnosis. Whole-blood hyperviscosity is seen in patients with extreme elevation of the red cell and white cell count. Phlebotomy of patients with primary and secondary elevation of the red cell count is a well-established therapy.
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9
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Jung JH, Chae YJ, Lee DH, Cho YI, Ko MM, Park SK, Kim W. Changes in whole blood viscosity during hemodialysis and mortality in patients with end-stage renal disease. Clin Hemorheol Microcirc 2017; 65:285-297. [DOI: 10.3233/ch-16183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jong Hwan Jung
- Department of Internal Medicine, Divsion of Nephrology, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Yoon Jung Chae
- College of Nursing, Chonbuk National University, Jeonju, Republic of Korea
| | - Dong Hwan Lee
- Department of Mechanical Design Engineering, Engineering College, Chonbuk National University, Jeonju, Republic of Korea
| | - Young I. Cho
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, Pennsylvania, USA
| | - Mi Mi Ko
- KM Fundamental Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Sung Kwang Park
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Republic of Korea
| | - Won Kim
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Republic of Korea
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10
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Singh N, Vanlandingham S, Halverson C, Marques MB, Tallaj J, Kirklin J, Adamski J. Therapeutic plasma exchange rapidly improves cardiac allograft function in patients with presumed antibody-mediated rejection. J Clin Apher 2014; 29:316-21. [DOI: 10.1002/jca.21338] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/20/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Nirupama Singh
- Department of Pathology; University of Alabama at Birmingham; Birmingham Alabama
| | - Sean Vanlandingham
- Department of Emergency Medicine; University of Alabama at Birmingham; Birmingham Alabama
| | - Catlin Halverson
- Department of Pathology; University of Alabama at Birmingham; Birmingham Alabama
| | - Marisa B. Marques
- Department of Pathology; University of Alabama at Birmingham; Birmingham Alabama
| | - Jose Tallaj
- Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama
| | - James Kirklin
- Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology; Mayo Clinic Hospital; Phoenix Arizona
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11
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Dynamics of blood count after rheohemapheresis in age-related macular degeneration: possible association with clinical changes. BIOMED RESEARCH INTERNATIONAL 2014; 2014:858219. [PMID: 24734249 PMCID: PMC3966403 DOI: 10.1155/2014/858219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/22/2014] [Indexed: 12/03/2022]
Abstract
Background. Rheohemapheresis (RHF) is a method that can stop the activity of the dry form of age-related macular degeneration (AMD). The pathophysiologic mechanisms are not well understood, and the effects of the RHF procedures extend beyond the time of the individual procedures. Patients and Methods. We present the data for 46 patients with AMD treated with a series of 8 rheohemapheretic procedures. Blood count parameters were measured before the first and the last procedures. The clinical effect was judged by changes in the drusenoid pigment epithelium detachment (DPED) area before and after the rheopheretic sessions. Results. Rheopheresis caused a decrease in hemoglobin (P < 0.001), a decrease in leukocytes (P < 0.034), and an increase in platelets (P < 0.005). We found a negative correlation between the amount of platelets and their volume (P < 0.001, Pearson correlation coefficient: −0.509). We identified the platelet/MPV ratio as a good predictor of the clinical outcome. Patients with a platelet/MPV ratio greater than 21.5 (before the last rheopheresis) had a significantly better outcome (P = 0.003, sensitivity of 76.9% and specificity of 80%). Conclusion. Several basic blood count parameters after RHF can be concluded to significantly change, with some of those changes correlating with the clinical results (reduction of the DPED area).
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12
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Abstract
In microcirculation disorders, the therapeutic apheresis seems to have two different effects. The first, achieved after only a few sessions, is acute, consisting of drastic reduction of blood viscosity and obtained with the use of low-density lipoprotein (LDL) apheresis, rheopheresis, or fibrinogen apheresis. The second effect is long term, or chronic, and needs to be evaluated after a long course of treatment. The mechanisms underlying the chronic effect are still objects of debate and take into account the pleiotropic effects of apheresis. However, it is likely that the acute effect of apheresis mainly influences the functional components of the vascular damage, and so the derived rheological benefit might last only for a short period. The chronic effect, on the contrary, by acting on the morphological alterations of the vascular walls, requires the apheresis treatment to be prolonged for a longer period or even cycles of treatment to be programmed.
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13
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Cardiovascular Risks of Anemia Correction with Erythrocyte Stimulating Agents: Should Blood Viscosity Be Monitored for Risk Assessment? Cardiovasc Drugs Ther 2010; 24:151-60. [DOI: 10.1007/s10557-010-6239-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Ramunni A, Brescia P, Quaranta D, Plantamura M, Ria R, Coratelli P. Fibrinogen Apheresis in the Treatment of Peripheral Arterial Disease. Blood Purif 2007; 25:404-10. [PMID: 17901692 DOI: 10.1159/000109101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 05/30/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Fibrinogen is mainly responsible for determining the viscosity of whole blood. In peripheral arterial disease (PAD) the fibrinogen concentration seems to affect the microcirculation flow. AIM To study the effects of an abrupt reduction of fibrinogen on the hemodynamics of the lower extremities and the clinical picture of patients with PAD. METHODS Ten patients affected by various stages of PAD underwent 1 session of fibrinogen apheresis (TheraSorb, Miltenyi Biotec, Germany). Laboratory parameters of endothelial activation were assessed before and after the session, as well as walking distance (WD), the ankle-brachial index and laser Doppler flowmetry. RESULTS A significant reduction in the laboratory parameters was observed: fibrinogen (50%), total cholesterol (18%), LDL cholesterol (24%), sE-selectin (23%), sICAM-1 (19%) and sVCAM-1 (10%). The procoagulant factors, factor VIII and von Willebrand factor, did not vary significantly. Both pain-free and total WD were significantly improved (p < 0.003 and p <0.006, respectively), the ankle-brachial index remained unchanged, and laser Doppler flowmetry showed a modest but not significant increase. CONCLUSIONS Fibrinogen apheresis allowed us to study the effects of an acute modification of fibrinogen in PAD, on both some aspects of the endothelial function and on the hemodynamics, demonstrating an improvement of WD and a minimal increase in the skin microcirculation.
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Affiliation(s)
- A Ramunni
- Division of Nephrology, Department of Internal and Public Medicine, University of Bari, Bari, Italy.
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15
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Borberg H. Quo vadis haemapheresis. Current developments in haemapheresis. Transfus Apher Sci 2006; 34:51-73. [PMID: 16412691 DOI: 10.1016/j.transci.2005.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 11/08/2005] [Indexed: 01/13/2023]
Abstract
The techniques of haemapheresis originated in the development of centrifugal devices separating cells from plasma and later on plasma from cells. Subsequently membrane filtration was developed allowing for plasma-cell separation. The unspecificity of therapeutic plasma exchange led to the development of secondary plasma separation technologies being specific, semi-selective or selective such as adsorption, filtration or precipitation. In contrast on-line differential separation of cells is still under development. Whereas erythrocytapheresis, granulocytapheresis, lymphocytapheresis and stem cell apheresis are technically advanced, monocytapheresis may need further improvement. Also, indications such as erythrocytapheresis for the treatment of polycythaemia vera or photopheresis though being clinically effective and of considerable importance for an appropriate disease control are to some extent under debate as being either too costly or without sufficient understanding of the mechanism. Other forms of cell therapy are under development. Rheohaemapheresis as the most advanced technology of extracorporeal haemorheotherapy is a rapidly developing approach contributing to the treatment of microcirculatory diseases and tissue repair. Whereas the control of a considerable number of (auto-) antibody mediated diseases is beyond discussion, the indication of apheresis therapy for immune complex mediated diseases is quite often still under debate. Detoxification for artificial liver support advanced considerably during the last years, whereas conclusions on the efficacy of septicaemia treatment are debatable indeed. LDL-apheresis initiated in 1981 as immune apheresis is well established since 24 years, other semi-selective or unspecific procedures, allowing for the elimination of LDL-cholesterol among other plasma components are also being used. Correspondingly Lp(a) apheresis is available as a specific, highly efficient elimination procedure superior to techniques which also eliminate Lp(a). Quality control systems, more economical technologies as for instance by increasing automation, influencing the over-interpretation of evidence based medicine especially in patients with rare diseases without treatment alternative, more insight into the need of controlled clinical trials or alternatively improved diagnostic procedures are among others tools ways to expand the application of haemapheresis so far applied in cardiology, dermatology, haematology, immunology, nephrology, neurology, ophthalmology, otology, paediatrics, rheumatology, surgery and transfusion medicine.
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Affiliation(s)
- Helmut Borberg
- German Haemapheresis Centre, Deutsches Haemapherese Zentrum, Maarweg 165, D-50 825 Köln, Germany.
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16
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Bacher A, Eggensperger E, Koppensteiner R, Mayer N, Klimscha W. Pentoxifylline attenuates the increase in whole blood viscosity after transfusion. Acta Anaesthesiol Scand 2005; 49:41-6. [PMID: 15675980 DOI: 10.1111/j.1399-6576.2004.00547.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pentoxifylline improves tissue oxygenation and intestinal blood flow in models of haemorrhagic shock, and it has been used for the treatment of intermittent claudication due to its beneficial effects on haemorheology. We investigated the effects of pentoxifylline on whole blood viscosity during packed red-blood cell transfusion in critically ill adult patients. METHODS Twenty critically ill patients were randomly assigned to one of two groups (pentoxifylline group: n = 11, placebo group: n = 9) and prospectively studied. Forty-five minutes before and during the packed red-blood cell transfusion (10 ml min(-1)) over a period of 80 min, 1.5 mg kg(-1) . h(-1) pentoxifylline or placebo were administered intravenously. Haematocrit, plasma fibrinogen concentration, total protein concentration, whole blood viscosity (at a shear rate of 10 s(-1), 50 s(-1), and 100 s(-1)) and plasma viscosity were measured. RESULTS After the packed red-blood cell transfusion, haematocrit levels increased significantly in both groups (pentoxifylline group: from 26.1 +/- 2.8% to 33.0 +/- 3.2; placebo group: from 24.4 +/- 3.3% to 32.6 +/- 2.6%; means +/- standard deviation). Compared to baseline, whole blood viscosity increased in both groups at all shear rates after the transfusion, but the increase was significantly less in the pentoxifylline group (26 +/- 15% vs. 49 +/- 14%, 23 +/- 11% vs. 39 +/- 12%, and 22 +/- 11% vs. 35 +/- 12% for the pentoxifylline vs. placebo groups at shear rates of 10 s(-1), 50 s(-1), and 100 s(-1), respectively). Plasma viscosity, total protein concentration, and fibrinogen concentration remained unchanged and no significant differences among groups were observed. CONCLUSIONS These results suggest that pentoxifylline is effective in attenuating the increase in whole blood viscosity after a transfusion of packed red-blood cells. Plasma viscosity is not influenced by pentoxifylline.
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Affiliation(s)
- A Bacher
- Department of Anaesthesiology and General Intensive Care, Medical University of Vienna, Vienna, Austria.
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17
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Mark M, Walter R, Contesse J, Reinhart WH. Impairment of blood rheology by cholestatic jaundice in human beings. ACTA ACUST UNITED AC 2004; 142:391-8. [PMID: 14713891 DOI: 10.1016/s0022-2143(03)00156-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Bilirubin and bile acids may affect erythrocytes. We investigated blood viscosity and erythrocyte structure in patients with cholestatic jaundice ex vivo and studied the short-term effects of bilirubin and bile acids in vitro. Seventeen patients with cholestatic jaundice and controls were studied. Whole-blood viscosity (adjusted hematocrit 45%) at high (94.5 sec(-1)) and low (0.1 sec(-1)) shear rate and plasma viscosity were measured. Erythrocyte structure was assessed in wet preparations of fixed cells. In vitro whole blood was incubated with increasing concentrations of bilirubin (83% conjugated) and bile acids (cholic, lithocholic, deoxycholic, and chenodeoxycholic acid) and the abovementioned investigations were performed. In patients we observed increased whole-blood viscosity at high shear rate (5.82 +/- 0.69 vs 5.04+/- 0.27 mPa. sec, P =.0001), plasma viscosity (1.48 +/- 0.22 vs. 1.23 +/- 0.07 mPa. sec, P =.0004), and fibrinogen level (4.70 +/- 0.98 g/L vs 2.63 +/- 0.21 g/L, P < 0.001) were observed. The incubation of normal erythrocytes in patients' plasma confirmed an increase in blood viscosity at high shear rate. Erythrocytes from patients with jaundice demonstrated a slight degree of stomatocytic shape transformation (P <.0001). In vitro, bilirubin did not affect erythrocyte shape. Cholic and lithocholic acids caused a slight stomatocytic shape transformation, whereas deoxycholic acid and chenodeoxycholic acid influenced neither blood viscosity nor erythrocyte structure. Patients with cholestatic jaundice have increased whole-blood and plasma viscosity and slightly altered red blood cell shape, possibly the result of a combination of increased levels of bilirubin and bile acids plus an acute-phase reaction.
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Affiliation(s)
- Michael Mark
- Department of Internal Medicine, Kantonsspital, Chur, Switzerland
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18
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Ullrich H, Kleinjung T, Steffens T, Jacob P, Schmitz G, Strutz J. Improved treatment of sudden hearing loss by specific fibrinogen aphaeresis. J Clin Apher 2004; 19:71-8. [PMID: 15274199 DOI: 10.1002/jca.20001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The etiology of sudden sensorineural hearing loss is still unclear and is thought to result from disturbances of microcirculation, infectious causes, or autoimmune disorders. So far standard therapy did not show clear improvement over spontaneous remission rate, which is assumed to be about 50% [Nakashima et al., Acta. Otolaryngol. Stockh. 514:14-16, 1994; Schuknecht and Donovan, Arch. Otorhinolaryngol. 243:1-15, 1986; Harris and Sharp, Laryngoscope 100:516-524, 1990; Mayot et al., Clin. Immunol. Immunopath. 68:41-45, 1993; Gussen, Ann. Otol. Rhinol. Laryngol. 85:94-100, 1976]. Elevated blood viscosity due to high fibrinogen levels is supposed to cause decreased cochlear blood flow and thus initiate sudden hearing loss. The specific lowering of fibrinogen immediately decreases plasma viscosity exactly to the desired extent and should lead to improved cochlear blood flow [Suckfüll et al., Acta. Otolaryngol 119:763-766, 1999; Suckfüll, Lancet 360:1811-1817, 2002; Walch et al., Laryngol. Rhino. Otol. 75:641-645, 1996; Suckfüll et al., Otol. Neurotol. 23:309-311, 2002]. In a prospective uncontrolled pilot study on 36 patients with unilateral sudden onset sensorineural hearing loss (SHL) we tried to establish that 1-3 specific fibrinogen aphaereses alone improve recovery of hearing and that it is possible to lower fibrinogen to the target of 80-100 mg/dl without important side effects. Pure tone audiometry was carried out immediately before and after each aphaeresis as well as at 2 and 4 weeks and 6 months after treatment. Sixteen patients recovered spontaneously before undergoing fibrinogen adsorption. All 20 aphaeresis patients improved during immunoadsorption; in 60% of patients auditory thresholds returned to normal after the first immunoadsorption and treatment could be discontinued, in another 20% of patients complete recovery was reached after 4 weeks. The mean plasma fibrinogen concentration of the 20 patients before the first aphaeresis session was 308.1 +/- 51.5 mg/dl. Immediately after the first treatment session, the fibrinogen concentration was lowered to 100.7 +/- 25.3 mg/dl (P < 0.001). The second and third sessions also showed highly significant reductions in plasma fibrinogen. No important side effects were seen. In conclusion, specific fibrinogen adsorption is a promising new treatment modality that should be tested in a prospective, randomized controlled trial in patients with sudden hearing loss.
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Affiliation(s)
- Heidrun Ullrich
- Institute of Transfusion Medicine, University of Hamburg, Hamburg, Germany.
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19
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Otto C, Geiss HC, Laubach E, Schwandt P. Effects of direct adsorption of lipoproteins apheresis on lipoproteins, low-density lipoprotein subtypes, and hemorheology in hypercholesterolemic patients with coronary artery disease. Ther Apher Dial 2002; 6:130-5. [PMID: 11982953 DOI: 10.1046/j.1526-0968.2002.00366.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Direct adsorption of lipoproteins (DALI) apheresis has been shown to reduce effectively low-density lipoprotein (LDL) cholesterol and lipoprotein (a) concentrations. However, the effects on nontraditional risk indicators such as hemorheology and LDL subtypes have not been investigated so far. Five patients (2 women, 3 men, age 53 +/- 8 years) with coronary artery disease and severe LDL hypercholesterolemia regularly treated with other LDL apheresis devices entered the study and were then treated with DALI for the first time. Hemorheological and lipoprotein parameters were measured before and immediately after the initial DALI apheresis as well as before the fourth DALI apheresis. Compared to baseline (before the first DALI apheresis), the following parameters were significantly improved (p < 0.05) after the first DALI apheresis: LDL cholesterol (69 +/- 28 versus 208 +/- 82 mg/dl) and cholesterol in each LDL subfraction as well as plasma viscosity (1.23 +/- 0.04 versus 1.37 +/- 0.06 mPa), C-reactive protein, native blood viscosity, red cell aggregation, and red cell deformability. When parameters before the fourth DALI apheresis were compared to baseline, LDL cholesterol was still lower, and red cell deformability was still improved while cholesterol in each subfraction showed a statistical trend to lower concentrations (0.08 < p < 0.14). In conclusion, DALI apheresis not only reduces LDL cholesterol but also induced a significant reduction of cholesterol in all LDL subfractions and improved various hemorheological parameters.
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Affiliation(s)
- Carsten Otto
- Medical Department II, Klinikum Grosshadern, University of Munich, Munich, Germany.
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20
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Koll RA, Klinkmann J, Richter WO. RheoSorb: a specific adsorber for fibrinogen elimination in clinical situations with impaired rheology. Artif Organs 2002; 26:145-51. [PMID: 11879243 DOI: 10.1046/j.1525-1594.2002.06880.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A functional microcirculation is crucial for the normal function of an organism. In many physiopathological situations, impaired microcirculation may contribute to the development or progress of diseases. Microcirculation is closely interrelated with blood and especially plasma rheology. Thus, improvement of plasma viscosity has beneficial effects on rheology, microcirculation, and the related tissue microenvironment. However, at best tools that only have a minor influence on plasma viscosity exist so far. Fibrinogen is known to be the major contributor to plasma viscosity, making it an interesting target for therapeutic intervention. An adsorber specific for fibrinogen was developed on the basis of the TheraSorb technology. The TheraSorb technology (PlasmaSelect AG, Teterow, Germany) allows the selective removal of components from human blood plasma by means of an affinity chromatography column. A ligand specific for a defined plasma component is coupled to a solid matrix (sepharose) thus binding and eliminating the target molecule from plasma. Using a fibrinogen specific pentapeptide as ligand, selective removal of fibrinogen, fibrin, and degradation products, containing the target sequence of these molecules, can be obtained. The LIFE-18, a state-of-the-art integrated plasma therapy instrument, is used to perform the treatment. The procedure improves plasma and whole blood viscosity in a dose dependent manner as shown in Phase 1 and 2 clinical trials. This article describes the first clinical experience in patients with diabetic foot syndrome and provides an outlook for further clinical and scientific investigations related to this promising new procedure.
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Affiliation(s)
- R A Koll
- PlasmaSelect GmbH, Teterow, Germany.
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21
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Sprecher DL. Targeting triglycerides as prognostic indicators and determining lowest values for patient benefit. Curr Cardiol Rep 2001; 3:424-32. [PMID: 11504580 DOI: 10.1007/s11886-001-0060-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A number of reports demonstrate the importance of serum triglyceride values in predicting the clinical onset of vascular disease. However, adjustment for measurements highly correlated with triglyceride (TG) levels, such as history of diabetes, body mass index, and high-density lipoprotein cholesterol (HDL-C), lessen if not remove the TG contribution to outcomes. More recently, improved analytic approaches have more persuasively implicated triglycerides as independently relevant to the onset of cardiovascular disease. Elevated TG values are the consequence of larger TG-rich particles, including very low density lipoprotein and atherogenic intermediate particles, which are in turn associated with dense low-density lipoprotein. It has been observed that a reduction in TG concentrations often proceeds in parallel with improved clinical outcomes; however, direct correlation between the two has been elusive. This has been demonstrated in multiple pharmacologic trials. However, an improvement in these relationships has been observed when TG-correlated measurements of intermediate particles, low-density lipoprotein density, and HDL-C have been made. National guidelines for cholesterol treatment have now incorporated a TG greater than 200 mg/dL as a secondary treatment trigger, which targets apolipoprotein B-related particles, represented by non-HDL-C (total cholesterol minus HDL-C), as the suggested goal of therapy.
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Affiliation(s)
- D L Sprecher
- Preventive Cardiology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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