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Tekavec E, Nilsson T, Dahlin LB, Huynh E, Nordander C, Riddar J, Kåredal M. Serum levels of biomarkers related to severity staging of Raynaud's phenomenon, neurosensory manifestations, and vibration exposure in patients with hand-arm vibration injury. Sci Rep 2024; 14:18128. [PMID: 39103464 PMCID: PMC11300662 DOI: 10.1038/s41598-024-68846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 07/29/2024] [Indexed: 08/07/2024] Open
Abstract
Our aim was to explore possible relationships between serum levels of biomarkers in patients with hand-arm vibration injury in relation to the severity of the vascular, i.e., Raynaud's phenomenon (RP), and neurosensory manifestations, the current exposure level, and the duration of exposure. This study was of case series design and involved 92 patients diagnosed with hand-arm vibration injury. Jonckheere's trend test was used to assess any association between serum levels of biomarkers and RP as well as neurosensory manifestations, graded by the International Consensus Criteria. Generalized linear models with adjustment for possible confounders were also used for associations between serum levels of biomarkers and; (1) severity of RP recorded as the extent of finger blanching calculated with Griffin score, (2) vibration perception thresholds, (3) magnitude of current exposure as [A(8); (m/s2)] value, and (4) the duration of exposure in years. Serum levels of thrombomodulin, von Willebrand factor, calcitonin gene related peptide (CGRP), heat shock protein 27, and caspase-3 were positively associated with severity of RP. Serum levels of CGRP were positively associated with the neurosensory component. No associations with exposure were shown for these biomarkers. For Intercellular adhesion molecule 1 and monocyte chemoattractant protein 1, no associations were found with neither severity nor exposure. Levels of serum biomarkers associated with endothelial injury or dysfunction, inflammation, vasodilation, neuroprotection, and apoptosis were positively associated with the severity of hand-arm vibration injury.
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Affiliation(s)
- Eva Tekavec
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden.
| | - Tohr Nilsson
- Division of Sustainable Health and Medicine, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine - Hand Surgery, Lund University, 221 00, Lund, Sweden
| | - Elizabeth Huynh
- Department of Occupational and Environmental Medicine, Region Skåne, 223 63, Lund, Sweden
| | - Catarina Nordander
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
| | - Jakob Riddar
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
| | - Monica Kåredal
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
- Department of Occupational and Environmental Medicine, Region Skåne, 223 63, Lund, Sweden
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Zhuang H, Han S, Harris NS, Reeves WH. MEK1/2- and ERK1/2-Mediated Lung Endothelial Injury and Altered Hemostasis Promote Diffuse Alveolar Hemorrhage in Murine Lupus. Arthritis Rheumatol 2024. [PMID: 38923837 DOI: 10.1002/art.42936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/25/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE About 3% of patients with lupus develop severe diffuse alveolar hemorrhage (DAH) with pulmonary vasculitis. C57BL/6 (B6) mice with pristane-induced lupus also develop DAH, but BALB/c mice are resistant. DAH is independent of Toll-like receptor signaling and other inflammatory pathways. This study examined the role of the MEK1/2 pathway (MEK1/2-ERK1/2, JNK, p38). METHODS B6 and BALB/c mice were treated with pristane with or without inhibitors of MEK1/2 (trametinib/GSK1120212 [GSK]), ERK1/2 (SCH772984 [SCH]), JNK, or p38. Effects on lung hemorrhage and hemostasis were determined. RESULTS GSK and SCH abolished DAH, whereas JNK and p38 inhibitors were ineffective. Apoptotic cells were present in lung samples from pristane-treated mice but not in mice receiving pristane and GSK, and endothelial dysfunction was normalized. Expression of the ERK1/2-regulated transcription factor early growth response 1 increased in pristane-treated B6, but not BALB/c, mice and was normalized by GSK. Pristane also increased expression of the anticoagulant genes Tfpi and Thbd in B6 mice. The ratio of Tfpi to tissue factor (F3) to Tfpi increased in B6 (but not BALB/c) mice and was normalized by GSK. Circulating thrombomodulin protein levels increased in B6 mice and returned to normal after GSK treatment. Consistent with augmented endothelial anticoagulant activity, pristane treatment increased tail bleeding in B6 mice. CONCLUSION Pristane treatment promotes lung endothelial injury and DAH in B6 mice by activating the MEK1/2-ERK1/2 pathway and impairing hemostasis. The hereditary factors determining susceptibility to lung injury and bleeding in pristane-induced lupus are relevant to the pathophysiology of life-threatening DAH in systemic lupus erythematosus and may help to optimize therapy.
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Affiliation(s)
- Haoyang Zhuang
- University of Florida College of Medicine, Gainesville, Florida
| | - Shuhong Han
- University of Florida College of Medicine, Gainesville, Florida
| | - Neil S Harris
- University of Florida College of Medicine, Gainesville, Florida
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Tadokoro T, Kato A, Ohmori H, Matsumoto T, Kuro-O M, Kobayashi T, Ohdan H. Serum Calcification Propensity T50 Is Associated with Soluble Thrombomodulin in Patients on Hemodialysis. J Clin Med 2024; 13:3491. [PMID: 38930020 PMCID: PMC11205071 DOI: 10.3390/jcm13123491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Levels of circulating soluble thrombomodulin (sTM), an anticoagulant factor, are associated with the severity and progression of arteriosclerotic diseases. However, the role of elevated sTM levels remains to be clarified in patients on dialysis. As the calcification propensity time T50 is a novel marker of arterial calcification, we aimed to determine the association between sTM and T50 in patients on hemodialysis (HD). Methods: This cross-sectional study included 49 adult patients on maintenance HD. Correlation analysis was performed to test the association between T50 and patient characteristics. Linear regression was used to evaluate the association between T50 and sTM. Results: Partial correlation analysis showed a strong association between T50 and glycated albumin, phosphorous, and sTM levels (partial correlation coefficient: r [partial] = -0.359, p = 0.023; r [partial] = -0.579, p < 0.001; and r [partial] = 0.346, p = 0.029, respectively). Multivariate linear regression analysis revealed that only sTM level was significantly and positively associated with T50 (β = 0.288; t = 2.27; p = 0.029; 95% confidence interval, 0.082-1.403). Conclusions: sTM is independently and positively associated with the propensity time for calcification, suggesting that sTM could be a good marker of arterial calcification progression in patients on HD.
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Affiliation(s)
- Takeshi Tadokoro
- Department of Surgery, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai-shi 742-1352, Yamaguchi, Japan;
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City 734-8551, Hiroshima, Japan; (T.K.); (H.O.)
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, 1-20-1 Handayama, Chūō-ku, Hamamatsu 431-3192, Shizuoka, Japan;
| | - Hiromitsu Ohmori
- Department of Pediatrics, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai-shi 742-1352, Yamaguchi, Japan;
| | - Tomio Matsumoto
- Department of Surgery, National Hospital Organization Yanai Medical Center, 95 Ihonosho, Yanai-shi 742-1352, Yamaguchi, Japan;
| | - Makoto Kuro-O
- Division of Anti-aging Medicine, Center for Molecular Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke 329-0498, Tochigi, Japan;
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City 734-8551, Hiroshima, Japan; (T.K.); (H.O.)
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City 734-8551, Hiroshima, Japan; (T.K.); (H.O.)
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Yee EJ, Vigil I, Sun Y, Torphy RJ, Schulick RD, Zhu Y. Group XIV C-type lectins: emerging targets in tumor angiogenesis. Angiogenesis 2024; 27:173-192. [PMID: 38468017 PMCID: PMC11021320 DOI: 10.1007/s10456-024-09907-x] [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: 10/25/2023] [Accepted: 01/23/2024] [Indexed: 03/13/2024]
Abstract
C-type lectins, distinguished by a C-type lectin binding domain (CTLD), are an evolutionarily conserved superfamily of glycoproteins that are implicated in a broad range of physiologic processes. The group XIV subfamily of CTLDs are comprised of CD93, CD248/endosialin, CLEC14a, and thrombomodulin/CD141, and have important roles in creating and maintaining blood vessels, organizing extracellular matrix, and balancing pro- and anti-coagulative processes. As such, dysregulation in the expression and downstream signaling pathways of these proteins often lead to clinically relevant pathology. Recently, group XIV CTLDs have been shown to play significant roles in cancer progression, namely tumor angiogenesis and metastatic dissemination. Interest in therapeutically targeting tumor vasculature is increasing and the search for novel angiogenic targets is ongoing. Group XIV CTLDs have emerged as key moderators of tumor angiogenesis and metastasis, thus offering substantial therapeutic promise for the clinic. Herein, we review our current knowledge of group XIV CTLDs, discuss each's role in malignancy and associated potential therapeutic avenues, briefly discuss group XIV CTLDs in the context of two other relevant lectin families, and offer future direction in further elucidating mechanisms by which these proteins function and facilitate tumor growth.
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Affiliation(s)
- Elliott J Yee
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12800 E 19th Avenue, RC1-North, P18-8116, Aurora, CO, 80045, USA
| | - Isaac Vigil
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12800 E 19th Avenue, RC1-North, P18-8116, Aurora, CO, 80045, USA
| | - Yi Sun
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12800 E 19th Avenue, RC1-North, P18-8116, Aurora, CO, 80045, USA
| | - Robert J Torphy
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Richard D Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12800 E 19th Avenue, RC1-North, P18-8116, Aurora, CO, 80045, USA
| | - Yuwen Zhu
- Department of Surgery, University of Colorado Anschutz Medical Campus, 12800 E 19th Avenue, RC1-North, P18-8116, Aurora, CO, 80045, USA.
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Urano T, Sano Y, Suzuki Y, Okada M, Sano H, Honkura N, Morooka N, Doi M, Suzuki Y. Evaluation of thrombomodulin/thrombin activatable fibrinolysis inhibitor function in plasma using tissue-type plasminogen activator-induced plasma clot lysis time. Res Pract Thromb Haemost 2024; 8:102463. [PMID: 39026660 PMCID: PMC11255936 DOI: 10.1016/j.rpth.2024.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/22/2024] [Accepted: 05/09/2024] [Indexed: 07/20/2024] Open
Abstract
Background Thrombin activatable fibrinolysis inhibitor (TAFI) is one of the most important physiological fibrinolysis inhibitors. Its inhibitory efficacy under physiological conditions remains uncertain. Objectives Elucidate the role of soluble thrombomodulin (sTM)/TAFI axis in the regulation of fibrinlysis. Methods Since thrombin is required to generate activated TAFI (TAFIa) that targets the C-terminal lysine of partially digested fibrin, a clot lysis assay is suitable for evaluating its function. Using tissue-type plasminogen activator-induced plasma clot lysis time (tPA-PCLT) together with TAFIa inhibitor and recombinant sTM (rsTM), we evaluated the specific function of TM/TAFI in the plasma milieu. Results tPA-PCLT values were significantly shortened by the TAFIa inhibitor. rsTM supplementation prolonged tPA-PCLT, which was shortened by the TAFIa inhibitor to a time similar to that obtained without rsTM and with the TAFIa inhibitor. Plasma obtained from patients treated with rsTM showed prolonged tPA-PCLT, which was shortened by the TAFIa inhibitor but not further prolonged by rsTM. However, no significant correlation was observed between tPA-PCLT and parameters of TM/TAFI system in the plasma. Conclusion The role of the TM/TAFI system in regulating fibrinolysis was successfully evaluated using TAFIa inhibitor and rsTM. Trace amounts of soluble TM in normal plasma appeared sufficient to activate TAFI and inhibit fibrinolysis. Further, a therapeutic dose of rsTM appeared sufficient to activate TAFI and regulate fibrinolysis in the plasma milieu.
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Affiliation(s)
- Tetsumei Urano
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Yoshie Sano
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuji Suzuki
- Department of Anesthesiology and Intensive Care Unit, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masahiko Okada
- Misakaeno-sono Ayumino-ie for Children and Persons with Severe Motor and Intellectual Disabilities, Omura, Nagasaki, Japan
| | - Hideto Sano
- Department of Physiology, Tokai University School of Medicine, Tokyo, Japan
| | - Naoki Honkura
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Nanami Morooka
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Matsuyuki Doi
- Department of Anesthesiology and Intensive Care Unit, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
- Intensive Care Unit, Hamamatsu Medical Center, Hamamatsu, Shizuoka, Japan
| | - Yuko Suzuki
- Department of Medical Physiology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Ho JW, Dawood ZS, Taylor ME, Liggett MR, Jin G, Jaishankar D, Nadig SN, Bharat A, Alam HB. THE NEUROENDOTHELIAL AXIS IN TRAUMATIC BRAIN INJURY: MECHANISMS OF MULTIORGAN DYSFUNCTION, NOVEL THERAPIES, AND FUTURE DIRECTIONS. Shock 2024; 61:346-359. [PMID: 38517237 DOI: 10.1097/shk.0000000000002307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
ABSTRACT Severe traumatic brain injury (TBI) often initiates a systemic inflammatory response syndrome, which can potentially culminate into multiorgan dysfunction. A central player in this cascade is endotheliopathy, caused by perturbations in homeostatic mechanisms governed by endothelial cells due to injury-induced coagulopathy, heightened sympathoadrenal response, complement activation, and proinflammatory cytokine release. Unique to TBI is the potential disruption of the blood-brain barrier, which may expose neuronal antigens to the peripheral immune system and permit neuroinflammatory mediators to enter systemic circulation, propagating endotheliopathy systemically. This review aims to provide comprehensive insights into the "neuroendothelial axis" underlying endothelial dysfunction after TBI, identify potential diagnostic and prognostic biomarkers, and explore therapeutic strategies targeting these interactions, with the ultimate goal of improving patient outcomes after severe TBI.
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Affiliation(s)
- Jessie W Ho
- Department of Surgery, Division of Trauma Surgery and Critical Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Zaiba Shafik Dawood
- Department of Surgery, Division of Trauma Surgery and Critical Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Meredith E Taylor
- Department of Surgery, Division of Organ Transplant, and Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University Chicago, Illinois
| | - Marjorie R Liggett
- Department of Surgery, Division of Trauma Surgery and Critical Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Guang Jin
- Department of Surgery, Division of Trauma Surgery and Critical Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dinesh Jaishankar
- Department of Surgery, Division of Organ Transplant, and Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University Chicago, Illinois
| | - Satish N Nadig
- Department of Surgery, Division of Organ Transplant, and Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University Chicago, Illinois
| | - Ankit Bharat
- Department of Surgery, Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Hasan B Alam
- Department of Surgery, Division of Trauma Surgery and Critical Care, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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7
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Tekavec E, Nilsson T, Dahlin LB, Huynh E, Axmon A, Nordander C, Riddar J, Kåredal M. Serum biomarkers in patients with hand-arm vibration injury and in controls. Sci Rep 2024; 14:2719. [PMID: 38302542 PMCID: PMC10834969 DOI: 10.1038/s41598-024-52782-1] [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: 10/24/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
Hand-arm vibration injury is a well-known occupational disorder that affects many workers globally. The diagnosis is based mainly on quantitative psychophysical tests and medical history. Typical manifestations of hand-arm vibration injury entail episodes of finger blanching, Raynaud's phenomenon (RP) and sensorineural symptoms from affected nerve fibres and mechanoreceptors in the skin. Differences in serum levels of 17 different biomarkers between 92 patients with hand-arm vibration injury and 51 controls were analysed. Patients with hand-arm vibration injury entailing RP and sensorineural manifestations showed elevated levels of biomarkers associated with endothelial injury or dysfunction, inflammation, vaso- or neuroprotective compensatory, or apoptotic mechanisms: intercellular adhesion molecule-1 (ICAM-1), monocyte chemoattractant protein-1 (MCP-1); thrombomodulin (TM), heat shock protein 27 (HSP27); von Willebrand factor, calcitonin gene-related peptide (CGRP) and caspase-3. This study adds important knowledge on pathophysiological mechanisms that can contribute to the implementation of a more objective method for diagnosis of hand-arm vibration injury.
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Affiliation(s)
- Eva Tekavec
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden.
| | - Tohr Nilsson
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine-Hand Surgery, Lund University, 221 00, Lund, Sweden
| | - Elizabeth Huynh
- Occupational and Environmental Medicine, Region Skåne, 223 63, Lund, Sweden
| | - Anna Axmon
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
| | - Catarina Nordander
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
| | - Jakob Riddar
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
| | - Monica Kåredal
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, 221 00, Lund, Sweden
- Occupational and Environmental Medicine, Region Skåne, 223 63, Lund, Sweden
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Delgadinho M, Veiga L, Ginete C, Santos B, Miranda A, de Vasconcelos JN, Brito M. Differential expression of adhesion molecules in sickle cell anemia and gut microbiome effect. Ann Hematol 2024; 103:409-419. [PMID: 38153527 PMCID: PMC10799142 DOI: 10.1007/s00277-023-05589-5] [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: 10/04/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
Sickle cell anemia (SCA) causes a long-standing vascular inflammation state, leading to endothelial dysfunction and chronic overexpression of several adhesion molecules, which contributes to acute and constant vaso-occlusive (VOC) episodes. It has been demonstrated that hydroxyurea (HU) can reduce VOC events, organ damage, blood transfusions, and even the adhesion properties to endothelial cells of SCA subjects. Due to VOC episodes, these patients are also more susceptible to recurrent bacterial translocation and dysbiosis. Given this, our study aimed to uncover the interplay between adhesion molecules, gut microbiome, and hydroxyurea in a population of Angolan SCA children. Serum and fecal samples were obtained before and after HU treatment in 35 children. After HU, four of these adhesion molecules were significantly reduced: sE-selectin (p = 0.002), ADAMTS13 (p = 0.023), sICAM-1 (p = 0.003), and sVCAM-1 (p = 0.018). A positive correlation was observed between the number of neutrophils and sICAM-1, platelets, and sP-selectin, and also between leukocytes, sICAM-1, and sVCAM-1. Most taxa showing a significant correlation mainly belonged to the Clostridiales order. Specifically, from the Clostridium genera, the groups g19, g21, and g34 were all negatively correlated with HbF levels; g19, g21, and g24 positively correlated with leukocytes; g19 positively with neutrophils and sVCAM-1; and g34 positively with E- and P-selectin. Serratia, an opportunistic pathogen, was positively correlated with sE-selectin and sICAM-1 levels. Additionally, a negative correlation was observed between sP-selectin and Bifidobacterium. Research studies in this area could improve our understanding and contribute to finding new prognostic biomarkers to guarantee precise SCA patient stratification and predict severe complications.
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Affiliation(s)
- Mariana Delgadinho
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Luísa Veiga
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Catarina Ginete
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Brígida Santos
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Bengo, Angola
- Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola
| | - Armandina Miranda
- Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal
| | | | - Miguel Brito
- H&TRC - Health & Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal.
- Centro de Investigação em Saúde de Angola (CISA), Caxito, Bengo, Angola.
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Rosenfeld MA, Yurina LV, Gavrilina ES, Vasilyeva AD. Post-Translational Oxidative Modifications of Hemostasis Proteins: Structure, Function, and Regulation. BIOCHEMISTRY. BIOKHIMIIA 2024; 89:S14-S33. [PMID: 38621742 DOI: 10.1134/s0006297924140025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 04/17/2024]
Abstract
Reactive oxygen species (ROS) are constantly generated in a living organism. An imbalance between the amount of generated reactive species in the body and their destruction leads to the development of oxidative stress. Proteins are extremely vulnerable targets for ROS molecules, which can cause oxidative modifications of amino acid residues, thus altering structure and function of intra- and extracellular proteins. The current review considers the effect of oxidation on the structural rearrangements and functional activity of hemostasis proteins: coagulation system proteins such as fibrinogen, prothrombin/thrombin, factor VII/VIIa; anticoagulant proteins - thrombomodulin and protein C; proteins of the fibrinolytic system such as plasminogen, tissue plasminogen activator and plasminogen activator inhibitor-1. Structure and function of the proteins, oxidative modifications, and their detrimental consequences resulting from the induced oxidation or oxidative stress in vivo are described. Possible effects of oxidative modifications of proteins in vitro and in vivo leading to disruption of the coagulation and fibrinolysis processes are summarized and systematized, and the possibility of a compensatory mechanism in maintaining hemostasis under oxidative stress is analyzed.
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Affiliation(s)
- Mark A Rosenfeld
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, 119334, Russia.
| | - Lyubov V Yurina
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, 119334, Russia
| | - Elizaveta S Gavrilina
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, 119334, Russia
| | - Alexandra D Vasilyeva
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, 119334, Russia
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Ren Y, Zhu D, Han X, Zhang Q, Chen B, Zhou P, Wei Z, Zhang Z, Cao Y, Zou H. HMGB1: a double-edged sword and therapeutic target in the female reproductive system. Front Immunol 2023; 14:1238785. [PMID: 37691930 PMCID: PMC10484633 DOI: 10.3389/fimmu.2023.1238785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
HMGB1 that belongs to the High Mobility Group-box superfamily, is a nonhistone chromatin associated transcription factor. It is present in the nucleus of eukaryotes and can be actively secreted or passively released by kinds of cells. HMGB1 is important for maintaining DNA structure by binding to DNA and histones, protecting it from damage. It also regulates the interaction between histones and DNA, affecting chromatin packaging, and can influence gene expression by promoting nucleosome sliding. And as a DAMP, HMGB1 binding to RAGE and TLRs activates NF-κB, which triggers the expression of downstream genes like IL-18, IL-1β, and TNF-α. HMGB1 is known to be involved in numerous physiological and pathological processes. Recent studies have demonstrated the significance of HMGB1 as DAMPs in the female reproductive system. These findings have shed light on the potential role of HMGB1 in the pathogenesis of diseases in female reproductive system and the possibilities of HMGB1-targeted therapies for treating them. Such therapies can help reduce inflammation and metabolic dysfunction and alleviate the symptoms of reproductive system diseases. Overall, the identification of HMGB1 as a key player in disease of the female reproductive system represents a significant breakthrough in our understanding of these conditions and presents exciting opportunities for the development of novel therapies.
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Affiliation(s)
- Yu Ren
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
| | - Damin Zhu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui, China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, Anhui, China
| | - Xingxing Han
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui, China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, Anhui, China
| | - Qiqi Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui, China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, Anhui, China
| | - Beili Chen
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui, China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, Anhui, China
| | - Ping Zhou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui, China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, Anhui, China
| | - Zhaolian Wei
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, Anhui, China
- Biopreservation and Artificial Organs, Anhui Provincial Engineering Research Center, Anhui Medical University, Hefei, Anhui, China
| | - Zhiguo Zhang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
| | - Huijuan Zou
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- National Health Commission (NHC) Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Anhui Medical University, Hefei, China
- Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Hefei, Anhui, China
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11
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Nguyen VT, Nguyen-Phan HN, Ton TN, Hoang BB. Value of Serum Thrombomodulin as a Marker and Predictor in Patients with Sepsis-Associated Acute Kidney Injury. Int J Gen Med 2023; 16:2933-2941. [PMID: 37457752 PMCID: PMC10348376 DOI: 10.2147/ijgm.s417410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To investigate the serum soluble thrombomodulin (sTM) concentration in patients with sepsis-associated acute kidney injury (AKI) and to determine the value of sTM in predicting AKI and mortality in sepsis patients. Methods This prospective observational study was conducted on 71 patients diagnosed with sepsis according to Sepsis 3 at the Intensive Care Unit, Hue Central Hospital, Vietnam, from September 2021 to February 2023. Results Among 71 sepsis patients, there were 38 (53.5%) AKI cases, including 16 (22.5%) cases of stage 1 AKI, 14 (19.7%) cases of stage 2 AKI, 8 (11.3%) cases of stage 3 AKI, 16 (22.5%) cases of renal replacement therapy, 28 (39.4%) cases of septic shock, and 21 (29.6%) cases of mortality within 28 days. The concentrations of lactate and IL-6 in the AKI and mortality groups were statistically significantly greater than those in the non-AKI and survival groups (p < 0.05). The serum sTM concentration was 4.33 ng/mL, the serum sTM level in the AKI group was statistically significantly higher than that in the non-AKI group (sTM [4.71 vs 2.54 ng/mL, p < 0.001]), and the serum sTM level in the mortality group was statistically significantly higher than the survival group (sTM [4.78 vs 3.87 ng/mL, p < 0.001]). The AUC of sTM for predicting AKI was 0.864; the AUCs of sTM, IL-6, SOFA, and APACHE II for predicting mortality were 0.811, 0.671, 0.816, and 0.705, respectively. Conclusion AKI was a prevalent complication among sepsis patients at the ICU. In the AKI and mortality groups, sTM concentration was statistically significantly higher than that in the non-AKI and survival groups. sTM was the predictor of acute kidney injury and mortality in patients with sepsis.
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Affiliation(s)
- Van Tri Nguyen
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
- Department of Anesthesiology of Hue International Medical Center, Hue Central Hospital, Hue City, Vietnam
| | - Hong Ngoc Nguyen-Phan
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - That Ngoc Ton
- Department of Biochemistry, Hue Central Hospital, Hue City, Vietnam
| | - Bui Bao Hoang
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
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12
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Barrett L, Curry N, Abu-Hanna J. Experimental Models of Traumatic Injuries: Do They Capture the Coagulopathy and Underlying Endotheliopathy Induced by Human Trauma? Int J Mol Sci 2023; 24:11174. [PMID: 37446351 PMCID: PMC10343021 DOI: 10.3390/ijms241311174] [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: 06/13/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
Trauma-induced coagulopathy (TIC) is a major cause of morbidity and mortality in patients with traumatic injury. It describes the spectrum of coagulation abnormalities that occur because of the trauma itself and the body's response to the trauma. These coagulation abnormalities range from hypocoagulability and hyperfibrinolysis, resulting in potentially fatal bleeding, in the early stages of trauma to hypercoagulability, leading to widespread clot formation, in the later stages. Pathological changes in the vascular endothelium and its regulation of haemostasis, a phenomenon known as the endotheliopathy of trauma (EoT), are thought to underlie TIC. Our understanding of EoT and its contribution to TIC remains in its infancy largely due to the scarcity of experimental research. This review discusses the mechanisms employed by the vascular endothelium to regulate haemostasis and their dysregulation following traumatic injury before providing an overview of the available experimental in vitro and in vivo models of trauma and their applicability for the study of the EoT and its contribution to TIC.
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Affiliation(s)
- Liam Barrett
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge CB2 1TN, UK;
- Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Nicola Curry
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK;
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LD, UK
| | - Jeries Abu-Hanna
- Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK;
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13
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Gruzdys V, Wang L, Wang D, Huang R, Sun XL. Investigation of cofactor activities of endothelial microparticle-thrombomodulin with liposomal surrogate. Biochem Biophys Res Commun 2023; 651:79-84. [PMID: 36801612 PMCID: PMC9992332 DOI: 10.1016/j.bbrc.2023.02.024] [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: 01/10/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023]
Abstract
Thrombomodulin (TM) is a type I transmembrane glycoprotein mainly expressed on the endothelial cells, where it binds thrombin to form the thrombin-TM complex that can activate protein C and thrombin-activable fibrinolysis inhibitor (TAFI) and induce anticoagulant and anti-fibrinolytic reactions, respectively. Cell activation and injury often sheds microparticles that contain membrane TM, which circulate in biofluids like blood. However, the biological function of circulating microparticle-TM is still unknown even though it has been recognized as a biomarker of endothelial cell injury and damage. In comparison with cell membrane, different phospholipids are exposed on the microparticle surface due to cell membrane ''flip-flop'' upon cell activation and injury. Liposomes can be used as a microparticle mimetics. In this report, we prepared TM-containing liposomes with different phospholipids as surrogates of endothelial microparticle-TM and investigated their cofactor activities. We found that liposomal TM with phosphatidylethanolamine (PtEtn) showed increased protein C activation but decreased TAFI activation in comparison to liposomal TM with phosphatidylcholine (PtCho). In addition, we investigated whether protein C and TAFI compete for the thrombin/TM complex on the liposomes. We found that protein C and TAFI did not compete for the thrombin/TM complex on the liposomes with PtCho alone and with low concentration (5%) of PtEtn and phosphatidylserine (PtSer), but competed each other on the liposomes with higher concentration (10%) of PtEtn and PtSer. These results indicate that membrane lipids affect protein C and TAFI activation and microparticle-TM may have different cofactor activities in comparison to cell membrane TM.
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Affiliation(s)
- Valentinas Gruzdys
- Department of Chemistry, Chemical and Biomedical Engineering, Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, OH, 44115, USA
| | - Lin Wang
- Department of Chemistry, Chemical and Biomedical Engineering, Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, OH, 44115, USA
| | - Dan Wang
- Department of Chemistry, Chemical and Biomedical Engineering, Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, OH, 44115, USA
| | - Rachel Huang
- Department of Chemistry, Chemical and Biomedical Engineering, Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, OH, 44115, USA
| | - Xue-Long Sun
- Department of Chemistry, Chemical and Biomedical Engineering, Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, OH, 44115, USA.
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14
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Liu Z, Li Y, Zhao Q, Kang Y. Association and predictive value of soluble thrombomodulin with mortality in patients with acute respiratory distress syndrome: systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:181. [PMID: 36923081 PMCID: PMC10009569 DOI: 10.21037/atm-23-432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023]
Abstract
Background Acute respiratory distress syndrome (ARDS) is a heterogeneous illness that has a high mortality rate. The role and predictive value of soluble thrombomodulin (sTM) in ARDS mortality is disputable, so the present study aimed to evaluate the association and predictive value of sTM for the in-hospital mortality of ARDS. Methods PubMed, Web of Science, Embase, Cochrane Library, Chongqing VIP, WanFang, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Literature databases were searched for relevant literature published before October 10, 2022. Relevant observable studies were included for analysis. The Newcastle-Ottawa Scale and QUAPAS (Quality Assessment of Prognostic Accuracy Studies) were employed to appraise the quality of the included studies. Results Thirteen articles were included in the present study. The eligible studies were of moderate to high quality [Newcastle-Ottawa Scale (NOS) 5-8 scores], and the high risk of bias in the included studieson predictive value was mainly distributed in participant and analysis domains of QUAPAS. There were 1,992 patients with ARDS, and 538 died. Our meta-analysis demonstrated that nonsurvivors had more significantly increased sTM levels than did survivors [standardized mean difference (SMD) =1.473; 95% CI: 0.874-2.072; P<0.001]. Elevated sTM levels had an independent correlation with higher mortality in patients with ARDS [pooled odds ratio (OR) =2.126; 95% CI: 1.548-2.920; P<0.001]. sTM showed satisfactory performance in predicting the mortality of ARDS [summary receiver operating characteristic curve (SROC) =0.78; 95% CI: 0.64-0.89]. The pooled sensitivity was 72% (95% CI: 66-77%), and the pooled specificity was 77% (95% CI: 72-82%). Subgroup analysis showed no significant difference in the sTM levels between nonsurvivors and survivors in terms of patients with direct ARDS (SMD =0.813; 95% CI: -0.673 to 2.229; P=0.253). Conclusions sTM is associated with hospital mortality in ARDS and shows moderate predictive performance. As a result, it is a potential candidate for predicting the mortality of ARDS. However, caution is needed when sTM is used to predict adverse outcomes in patients with direct ARDS.
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Affiliation(s)
- Zhenjun Liu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.,Department of Critical Care Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Li
- Department of Critical Care Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Qian Zhao
- Department of Critical Care Medicine, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
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Fioretto BS, Rosa I, Matucci-Cerinic M, Romano E, Manetti M. Current Trends in Vascular Biomarkers for Systemic Sclerosis: A Narrative Review. Int J Mol Sci 2023; 24:ijms24044097. [PMID: 36835506 PMCID: PMC9965592 DOI: 10.3390/ijms24044097] [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: 01/27/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Systemic sclerosis (SSc, scleroderma) is a multifaceted rare connective tissue disease whose pathogenesis is dominated by immune dysregulation, small vessel vasculopathy, impaired angiogenesis, and both cutaneous and visceral fibrosis. Microvascular impairment represents the initial event of the disease, preceding fibrosis by months or years and accounting for the main disabling and/or life-threatening clinical manifestations, including telangiectasias, pitting scars, periungual microvascular abnormalities (e.g., giant capillaries, hemorrhages, avascular areas, ramified/bushy capillaries) clinically detectable by nailfold videocapillaroscopy, ischemic digital ulcers, pulmonary arterial hypertension, and scleroderma renal crisis. Despite a variety of available treatment options, treatment of SSc-related vascular disease remains problematic, even considering SSc etherogenity and the quite narrow therapeutic window. In this context, plenty of studies have highlighted the great usefulness in clinical practice of vascular biomarkers allowing clinicians to assess the evolution of the pathological process affecting the vessels, as well as to predict the prognosis and the response to therapy. The current narrative review provides an up-to-date overview of the main candidate vascular biomarkers that have been proposed for SSc, focusing on their main reported associations with characteristic clinical vascular features of the disease.
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Affiliation(s)
- Bianca Saveria Fioretto
- Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Irene Rosa
- Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Marco Matucci-Cerinic
- Section of Internal Medicine, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Eloisa Romano
- Section of Internal Medicine, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Mirko Manetti
- Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Imaging Platform, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
- Correspondence:
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16
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Nguyen VT, Nguyen-Phan HN, Hoang BB. Serum Thrombomodulin Level Can Predict Mortality in Patients With Sepsis? Med Arch 2023; 77:433-439. [PMID: 38313115 PMCID: PMC10834048 DOI: 10.5455/medarh.2023.77.433-439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024] Open
Abstract
Background Thrombomodulin (TM) is a type-1 trans-membrane glycoprotein on endothelial cells which is known to be involved in various biochemical pathways. TM can be detected in biological fluids such as blood and urine under many forms. Soluble thrombomodulin (sTM), consist of various particles of TM, is the predominant agent which is created by enzymatic or chemical catalysis of the whole protein under divergent conditions. TM plays a vital role in protein C system and is crucial in the pathogenesis of Sepsis. Objective To identify the serum level of soluble thrombomodulin (sTM) in groups of patients: sepsis and septic shock including their survival and fatal in-hospital outcome; and validate the death prediction of serum sTM in patients with sepsis. Methods This prospective observational study was conducted in 63 patients who were diagnosed with sepsis, septic shock according to Sepsis 3 criteria at the ICU Department of Hue Central Hospital, Vietnam, from 3/2022 to 3/2023. Results Twenty participants developed septic shock (31.7%), morality within 28-days was 19 patients (30.2%), 22 patients complicated with acute kidney injury that necessitated renal replacement therapy (34.9%), 30 patients required mechanical ventilation (47.6%), the median length of ICU stay was 8 (3-28) days. Serum level of lactate and creatinine were significantly higher in septic shock group compared with sepsis and survival group (p<0.05). The median sTM level in septic shock group and fatal group were 4.68(3.38-6.46) ng/mL and 4.68 (1.69-6.46) ng/mL, respectively. These results were significantly higher than sepsis group [3.62 (1.51-1.94) ng/mL] and survival group [3.73 (1.51-5.9) ng/mL] (p<0.05). The death predictive power of DIC score, APACHE II score, creatinine, sTM and SOFA presented with AUC values of 0.723, 0.726, 0.777, 0.803 and 0.807, respectively. There were no significant difference of serum level IL-6 and PCT between survival and fatal group. The median DIC score in fatal group was 7 (3-7), which was significantly higher than survival group 4 (2-7) (p= 0.001). Conclusion Sepsis is a common diagnosis among ICU settings which links the critically ill patients to higher complications and mortalities. Serum level of sTM in septic shock and fatal groups were significantly higher than sepsis and survival groups. sTM is a reliable marker and should be used in predict severity and mortality in sepsis patients.
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Affiliation(s)
- Van Tri Nguyen
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
- Department of Anesthesiology of Hue International Medical Center, Hue Central Hospital, Hue City, Vietnam
| | | | - Bui Bao Hoang
- Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
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