1
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Shapira M, Roguin A, Fayad I, Medlij L, khateeb A, Egbaria D, Amsalem N, Abu Fanne R. Predictive value of baseline alpha defensin level in patients with stable coronary artery disease: A retrospective single center study. IJC HEART & VASCULATURE 2024; 53:101465. [PMID: 39091435 PMCID: PMC11292519 DOI: 10.1016/j.ijcha.2024.101465] [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: 03/04/2024] [Revised: 06/24/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024]
Abstract
Background Inflammation plays a central role in atherogenesis. The major neutrophilic peptide alpha-defensin is a promising evolving risk factor for atherosclerosis. The aim of the present study was to examine the role of alpha-defensin in predicting future major adverse cardiovascular events (MACE) occurrence in fully revascularized patients with stable CAD under optimal medical therapy. Methods and results We retrospectively examined the prognostic value of baseline plasma alpha-defensin levels in predicting MACE occurrence in 174 fully revascularized patients for stable CAD between March 2016 and January 2017. Alpha-defensin levels were found 20 % higher among demised patients (10,859 pg/ml, IQR [6,920 to 23,320] vs. 9,020 pg/ml, IQR [5,540 to 16,180] pg/ml, P = 0.15). The absolute increase in mortality risk in patients with alpha-defensin levels greater than the median values was 72.5 % (P = 0.33). Log-rank analysis proved both recurrent PCI for de novo lesions (14.9 % and 2.3 %) and the composite of mortality and recurrent PCI for de novo lesions (27.6 % vs. 9.2 %) were significantly related to alpha-defensin values greater than the median (>9200 pg/ml). Conclusion Baseline plasma alpha-defensin is an independent predictor of mortality and recurrent PCI among patients with stable CAD. Alpha-defensin may evolve as a promising factor in cardiovascular risk assessment beyond traditional risk factors. Targeting alpha-defensin to ameliorate MACE occurrence should be addressed in future studies.
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Affiliation(s)
- Maanit Shapira
- Division of laboratories, Hillel Yaffe Medical Center, Hadera, Israel
- Faculty of Medicine - Technion Israel Institute of Technology, Israel
| | - Ariel Roguin
- Faculty of Medicine - Technion Israel Institute of Technology, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ibraheem Fayad
- Faculty of Medicine - Technion Israel Institute of Technology, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Lina Medlij
- Faculty of Medicine - Technion Israel Institute of Technology, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Aysha khateeb
- Faculty of Medicine - Technion Israel Institute of Technology, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Dema Egbaria
- Faculty of Medicine - Technion Israel Institute of Technology, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Naama Amsalem
- Faculty of Medicine - Technion Israel Institute of Technology, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Rami Abu Fanne
- Faculty of Medicine - Technion Israel Institute of Technology, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
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2
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Higazi AAR, Maraga E, Baraghithy S, Udi S, Azar S, Saada A, Glaser B, Avrahami D, Abdeen S, Hamdan Z, Tam J, Fanne RA. Characterization of metabolic alterations in the lean metabolically unhealthy alpha defensin transgenic mice. iScience 2024; 27:108802. [PMID: 38318380 PMCID: PMC10839648 DOI: 10.1016/j.isci.2024.108802] [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: 05/19/2023] [Revised: 11/25/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024] Open
Abstract
Inflammation is consistently linked to dysmetabolism. In transgenic mice (Def+/+) model the neutrophilic peptide, alpha defensin, proved atherogenic. This phenotype occurred despite favorable cholesterol and glucose levels, and lower body weight and blood pressure. In this study, integration of metabolic&behavioral phenotyping system, endocrine, biochemical and mitochondrial assessment, pathological and immunohistochemical tests, and multiple challenge tests was established to explore the metabolic impact of alpha defensin. Compared to the control group, Def+/+ mice exhibited lower total energy expenditure and carbohydrate utilization, and higher fat oxidation. Their ACTH-cortisol and thyroid profiles were intact. Intriguingly, they had low levels of glucagon, with high ammonia, uric acid, triglyceride, and lactate. Mitochondrial evaluations were normal. Overall, defensin-induced hypoglucagonemia is associated with lipolysis, restricted glucose oxidation, and enhanced wasting. Def+/+ mice may be a useful model for studying the category of lean, apparently metabolically healthy, and atherosclerotic phenotype, with insight into a potential inflammatory-metabolic link.
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Affiliation(s)
- Abd Al-Roof Higazi
- Department of Clinical Biochemistry, Hebrew University-Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Emad Maraga
- Department of Clinical Biochemistry, Hebrew University-Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Saja Baraghithy
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Shiran Udi
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Shahar Azar
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Ann Saada
- Department of Genetics, Hadassah Medical Center, Jerusalem, Isarel
- Faculty of Medicine, Hebrew University, Jerusalem, Isarel
- Department of Laboratory Sciences, Hadassah Academic College, Jerusalem, Isarel
| | - Benjamin Glaser
- Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Dana Avrahami
- Department of Developmental Biology and Cancer Research, The Hebrew University-Hadassah Medical School, Jerusalem 91120, Israel
| | - Suhair Abdeen
- Department of Clinical Biochemistry, Hebrew University-Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Zenab Hamdan
- Endocrinology and Metabolism Department, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Joseph Tam
- Obesity and Metabolism Laboratory, The Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel
| | - Rami Abu Fanne
- Department of Clinical Biochemistry, Hebrew University-Hadassah Medical Center, Jerusalem 9112001, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
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3
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Kassem E, Shapira M, Sussan M, Mahamid L, Amsalem N, Abu Fanne R. The Diagnostic Value of Human Neutrophilic Peptides 1-3 in Acute Pediatric Febrile Illness. J Clin Med 2023; 12:6514. [PMID: 37892652 PMCID: PMC10607217 DOI: 10.3390/jcm12206514] [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: 09/05/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Background: It is prudent to develop biomarkers that enhance the differentiation between viral and bacterial infection in order to support expeditious and judicious antimicrobial implementation in emergency department admissions. Human neutrophilic peptides 1-3 (HNP1-3) are the major neutrophilic peptides with potent antimicrobial activity. Methods: We tested the performance of the plasma HNP1-3 test in a prospective observational cohort of children admitted to the emergency department for fever. We validated this test with traditionally used biomarkers and final diagnoses. An expert panel reviewed the patient's data and gave a final diagnosis. The final diagnosis was classified as definite, probable, or possible. Results: A total of 111 children (98 with fever and 13 control) were recruited: 55% male, mean age 6.3 years. Plasma HNP1-3 levels were higher with bacterial infections: 10,428 (5789-14,866) vs. 7352 (3762-10,672) pg/mL, p = 0.007. HNP1-3 were negatively correlated with age: r = -0.207, p = 0.029. Of the different categorical variables tested, only c-reactive protein (CRP) (≥42.3 mg/dL), neutrophil count (≥10.2), and age (odds ratio = 1.185, p = 0.013 and 95%CI = 1.037-1.354) had significant diagnostic capability for bacterial disease prediction. Conclusions: Due to its low diagnostic value in febrile patients, the HNP1-3 value is not currently recommended to support pathogen differentiation in children in an emergency setting. Further studies are needed to support its clinical use.
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Affiliation(s)
- Eiass Kassem
- Department of Pediatrics, Hillel Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion Institute of Technology, Hadera 3810101, Israel; (E.K.); (M.S.); (L.M.)
| | - Maanit Shapira
- Laboratory Division, Hillel Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion Institute of Technology, Hadera 3810101, Israel;
| | - Miral Sussan
- Department of Pediatrics, Hillel Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion Institute of Technology, Hadera 3810101, Israel; (E.K.); (M.S.); (L.M.)
| | - Loay Mahamid
- Department of Pediatrics, Hillel Yaffe Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion Institute of Technology, Hadera 3810101, Israel; (E.K.); (M.S.); (L.M.)
| | - Naama Amsalem
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel;
| | - Rami Abu Fanne
- Department of Cardiology, Hillel Yaffe Medical Center, Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel;
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4
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Zhang X, Kang Z, Yin D, Gao J. Role of neutrophils in different stages of atherosclerosis. Innate Immun 2023; 29:97-109. [PMID: 37491844 PMCID: PMC10468622 DOI: 10.1177/17534259231189195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 07/27/2023] Open
Abstract
Neutrophils constitute the first line of defense in human immunity and can be attracted to inflamed and infected sites by various chemokines. As essential players in immune processes, neutrophils theoretically play integral roles in the course of chronic inflammation-induced atherosclerosis. However, because neutrophils are rarely found in atherosclerotic lesions, their involvement in the pathophysiological progression of atherosclerosis has been largely underestimated or ignored. Recent research has revealed convincing evidence showing the presence of neutrophils in atherosclerotic lesions and has revealed neutrophil contributions to different atherosclerosis stages in mice and humans. This review describes the underlying mechanisms of neutrophils in different stages of atherosclerosis and highlights potential neutrophil-targeted therapeutic strategies relevant to atherosclerosis. An in-depth understanding of neutrophils' roles in atherosclerosis pathology will promote exploration of new methods for the prevention and treatment of atherogenesis and atherothrombosis.
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Affiliation(s)
- Xiaojing Zhang
- Department of Basic Medical Research, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan City People's Hospital, Qingyuan, Guangdong, China
| | - Zhanfang Kang
- Department of Basic Medical Research, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan City People's Hospital, Qingyuan, Guangdong, China
| | - Dazhong Yin
- Department of Basic Medical Research, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan City People's Hospital, Qingyuan, Guangdong, China
| | - Jun Gao
- Department of Basic Medical Research, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan City People's Hospital, Qingyuan, Guangdong, China
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5
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Maraga E, Safadi R, Amer J, Higazi AAR, Fanne RA. Alleviation of Hepatic Steatosis by Alpha-Defensin Is Associated with Enhanced Lipolysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050983. [PMID: 37241215 DOI: 10.3390/medicina59050983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: The neutrophilic peptide, alpha-defensin, is considered an evolving risk factor intimately linked with lipid mobilization. It was previously linked to augmented liver fibrosis. Here, we assess a potential association between alpha-defensin and fatty liver. Materials and Methods: A cohort of transgenic C57BL/6JDef+/+ male mice that overexpress the human neutrophil-derived alpha-defensin in their polymorphonuclear neutrophils (PMNs) were assessed for liver steatosis and fibrosis development. Wild type (C57BL/6JDef.Wt) and transgenic (C57BL/6JDef+/+) mice were maintained on a standard rodent chow diet for 8.5 months. At the termination of the experiment, systemic metabolic indices and hepatic immunological cell profiling were assessed. Results: The Def+/+ transgenic mice exhibited lower body and liver weights, lower serum fasting glucose and cholesterol, and significantly lower liver fat content. These results were associated with impaired liver lymphocytes count and function (lower CD8, NK cells, and killing marker CD107a). The metabolic cage demonstrated dominant fat utilization with a comparable food intake in the Def+/+ mice. Conclusions: Chronic physiological expression of alpha-defensin induces favorable blood metabolic profile, increased systemic lipolysis, and decreased hepatic fat accumulation. Further studies are needed to characterize the defensin net liver effect.
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Affiliation(s)
- Emad Maraga
- Department of Clinical Biochemistry, Hadassah Hebrew University Hospital, Jerusalem IL-91120, Israel
| | - Rifaat Safadi
- Liver Unit, Hadassah Hebrew University Hospital, Jerusalem IL-91120, Israel
| | - Johnny Amer
- Liver Unit, Hadassah Hebrew University Hospital, Jerusalem IL-91120, Israel
| | - Abd Al-Roof Higazi
- Department of Clinical Biochemistry, Hadassah Hebrew University Hospital, Jerusalem IL-91120, Israel
| | - Rami Abu Fanne
- Department of Clinical Biochemistry, Hadassah Hebrew University Hospital, Jerusalem IL-91120, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3200003, Israel
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6
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Human Neutrophil α-Defensins 1–3 Are Upregulated in the Microenvironment of Fibrotic Liver. Medicina (B Aires) 2023; 59:medicina59030496. [PMID: 36984497 PMCID: PMC10058849 DOI: 10.3390/medicina59030496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Background and Objectives: Neutrophil infiltration is an established signature of Non-Alcoholic Fatty Liver Disease (NAFLD) and Steatohepatitis (NASH). The most abundant neutrophilic peptide, alpha-defensin, is considered a new evolving risk factor in the inflammatory milieu, intimately involved in lipid mobilization. Our objective is to assess for potential association between alpha-defensin immunostains and NAFLD severity. Materials and Methods: We retrospectively investigated the liver biopsies of NAFLD/NASH patients, obtained at Hillel Yaffe Medical center between the years 2012 and 2016. Patients’ characteristics were recorded, including relevant blood tests at the time of biopsy. Each biopsy was semi-quantitatively scored using NAFLD Activity Score (NAS) and NASH fibrosis stage. The biopsies were immunostained for alpha-defensin. The precipitation of alpha-defensin was correlated to NAS and fibrosis. Results: A total of 80 biopsies were evaluated: male ratio 53.2%, mean age 44.9 ± 13.2 years, 54 had fibrosis grades 0–2, and 26 were grade 3–4. Conventional metabolic risk factors were more frequent in the high-grade fibrosis group. Immunostaining for alpha-defensin disclosed higher intensity (a.u.) in grade 3–4 fibrosis relative to grades 0–2, 25% vs. 6.5%, p < 0.05, respectively. Moreover, alpha-defensin staining was nicely co-localized with fibrosis. Conclusions: In our group of NASH/NAFLD patients, higher metabolic risk profile was associated with higher fibrosis grade. Immunostaining for alpha-defensin showed patchy intense staining concordant with high fibrosis, nicely co-localized with histological fibrosis. Whether alpha-defensin is a profibrotic risk factor or merely risk marker for fibrosis must be clarified in future studies.
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7
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Di Francesco V, Di Francesco M, Palomba R, Brahmachari S, Decuzzi P, Ferreira M. Towards potent anti-inflammatory therapies in atherosclerosis: The case of methotrexate and colchicine combination into compartmentalized liposomes. J Drug Deliv Sci Technol 2023. [DOI: 10.1016/j.jddst.2023.104179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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8
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Abu Fanne R, Arbel Y, Chorin E, Maraga E, Groisman GM, Higazi AA, Banai S. Association between tissue human neutrophil peptide 1-3 levels and cardiovascular phenotype: a prospective, longitudinal cohort study. J Int Med Res 2022; 50:3000605221127099. [PMID: 36268757 PMCID: PMC9597035 DOI: 10.1177/03000605221127099] [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] [Indexed: 11/05/2022] Open
Abstract
Objective Inflammation is associated with atherogenesis. Although a higher neutrophil
count is associated with the plaque burden, the role of neutrophil
activation is unclear. Human neutrophil peptides 1–3 (HNP1–3) are a risk
factor for atherogenesis in bench models and are elevated in human
atheromas. This study aimed to examine the association between skin HNP1–3
deposition and the severity of coronary artery disease (CAD), including
long-term outcomes. Methods HNP1–3 levels were immunohistochemically quantified in skin biopsies, which
were prospectively taken from 599 consecutive patients before clinically
indicated coronary angiography. Established cardiovascular risk factors and
blood markers for atheroinflammation were obtained. CAD severity and the
incidence of repeat revascularization and mortality at 48 months of
follow-up were assessed in relation to HNP1–3 levels. Results The risk of CAD was independently associated with age and HNP1–3 in the
entire cohort (F = 0.71 and F = 7.4, respectively). Additionally, HNP1–3
levels were significantly associated with myocardial necrosis (R = 0.26). At
the follow-up, high HNP1–3 levels negatively affected mortality (19.54%) and
recurrent revascularization (8.05%). Conclusion HNP1–3 tissue deposition is positively associated with the severity of CAD,
myonecrosis, and long-term sequelae. HNP1–3 levels may be suppressed using
colchicine.
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Affiliation(s)
- Rami Abu Fanne
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera,
Israel,Department of Clinical Biochemistry, Hadassah University
Hospital, Jerusalem, Israel,Rami Abu Fanne, Hillel Yaffe Medical
Center, Rappaport Faculty of Medicine, Technion, POB 169, Hashalom Street,
Hadera 38100, Israel.
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Medical Center Affiliated to
the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Chorin
- Department of Cardiology, Tel Aviv Medical Center Affiliated to
the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emad Maraga
- Department of Clinical Biochemistry, Hadassah University
Hospital, Jerusalem, Israel
| | | | - Abd Alroof Higazi
- Department of Clinical Biochemistry, Hadassah University
Hospital, Jerusalem, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Medical Center Affiliated to
the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Abstract
Coronary atherosclerosis is a chronic inflammatory disease that can lead to varying degrees of blood flow obstruction and a common pathophysiological basis of cardiovascular disease. Inflammatory factors run through the whole process of atherosclerotic lesions. Macrophages, T cells, and neutrophils play important roles in the process of atherosclerotic inflammation. Considering the evolutionary characteristics, atherosclerosis can be divided into different stages as early atherosclerotic plaque, plaque formation stage, and plaque rupture stage. In this paper, the changes in inflammatory cells at different stages of lesions and their related mechanisms are discussed, which can provide new insights from a clinical to bench perspective for atherosclerosis me chanism.
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10
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Abdeen S, Abu-Fanne R, Bdeir K, Maraga E, Higazi M, Cines DB, Heyman SN, Higazi AAR. Divergent impacts of tocilizumab and colchicine in COVID-19-associated coagulopathy: the role of alpha-defensins. Br J Haematol 2021; 196:923-927. [PMID: 34622440 PMCID: PMC8653210 DOI: 10.1111/bjh.17885] [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: 07/29/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/22/2023]
Abstract
Patients who are severely affected by coronavirus disease 2019 (COVID-19) may develop a delayed onset 'cytokine storm', which includes an increase in interleukin-6 (IL-6). This may be followed by a pro-thrombotic state and increased D-dimers. It was anticipated that tocilizumab (TCZ), an anti-IL-6 receptor monoclonal antibody, would mitigate inflammation and coagulation in patients with COVID-19. However, clinical trials with TCZ have recorded an increase in D-dimer levels. In contrast to TCZ, colchicine reduced D-dimer levels in patients with COVID-19. To understand how the two anti-inflammatory agents have diverse effects on D-dimer levels, we present data from two clinical trials that we performed. In the first trial, TCZ was administered (8 mg/kg) to patients who had a positive polymerase chain reaction test for COVID-19. In the second trial, colchicine was given (0·5 mg twice a day). We found that TCZ significantly increased IL-6, α-Defensin (α-Def), a pro-thrombotic peptide, and D-dimers. In contrast, treatment with colchicine reduced α-Def and Di-dimer levels. In vitro studies show that IL-6 stimulated the release of α-Def from human neutrophils but in contrast to colchicine, TCZ did not inhibit the stimulatory effect of IL-6; raising the possibility that the increase in IL-6 in patients with COVID-19 treated with TCZ triggers the release of α-Def, which promotes pro-thrombotic events reflected in an increase in D-dimer levels.
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Affiliation(s)
- Suhair Abdeen
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Rami Abu-Fanne
- Heart Institute, Hillel Yaffe Medical Center Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Khalil Bdeir
- Departments of Pathology and Laboratory Medicine, Philadelphia, PA, USA
| | - Emad Maraga
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Mohamed Higazi
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Douglas B Cines
- Heart Institute, Hillel Yaffe Medical Center Affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Medicine, University of Pennsylvania-Perelman School of Medicine, Philadelphia, PA, USA
| | - Samuel N Heyman
- Department of Medicine, Hadassah University Hospital, Mt. Scopus, Jerusalem, Israel
| | - Abd Al-Roof Higazi
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
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11
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Pérez-Olivares L, Soehnlein O. Contemporary Lifestyle and Neutrophil Extracellular Traps: An Emerging Link in Atherosclerosis Disease. Cells 2021; 10:1985. [PMID: 34440753 PMCID: PMC8394440 DOI: 10.3390/cells10081985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Neutrophil extracellular traps (NETs) are networks of extracellular genetic material decorated with proteins of nuclear, granular and cytosolic origin that activated neutrophils expel under pathogenic inflammatory conditions. NETs are part of the host's innate immune defense system against invading pathogens. Interestingly, these extracellular structures can also be released in response to sterile inflammatory stimuli (e.g., shear stress, lipidic molecules, pro-thrombotic factors, aggregated platelets, or pro-inflammatory cytokines), as in atherosclerosis disease. Indeed, NETs have been identified in the intimal surface of diseased arteries under cardiovascular disease conditions, where they sustain inflammation via NET-mediated cell-adhesion mechanisms and promote cellular dysfunction and tissue damage via NET-associated cytotoxicity. This review will focus on (1) the active role of neutrophils and NETs as underestimated players of the inflammatory process during atherogenesis and lesion progression; (2) how these extracellular structures communicate with the main cell types present in the atherosclerotic lesion in the arterial wall; and (3) how these neutrophil effector functions interplay with lifestyle-derived risk factors such as an unbalanced diet, physical inactivity, smoking or lack of sleep quality, which represent major elements in the development of cardiovascular disease.
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Affiliation(s)
- Laura Pérez-Olivares
- Center for Molecular Biology of Inflammation (ZMBE), Institute for Experimental Pathology (ExPat), Westfälische Wilhelms-Universität (WWU), 48149 Münster, Germany;
| | - Oliver Soehnlein
- Center for Molecular Biology of Inflammation (ZMBE), Institute for Experimental Pathology (ExPat), Westfälische Wilhelms-Universität (WWU), 48149 Münster, Germany;
- Department of Physiology and Pharmacology (FyFa), Karolinska Institute, 17165 Stockholm, Sweden
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12
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Morales-Primo AU, Becker I, Zamora-Chimal J. Neutrophil extracellular trap-associated molecules: a review on their immunophysiological and inflammatory roles. Int Rev Immunol 2021; 41:253-274. [PMID: 34036897 DOI: 10.1080/08830185.2021.1921174] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neutrophil extracellular traps (NETs) are a defense mechanism against pathogens. They are composed of DNA and various proteins and have the ability to hinder microbial spreading and survival. However, NETs are not only related to infections but also participate in sterile inflammatory events. In addition to DNA, NETs contain histones, serine proteases, cytoskeletal proteins and antimicrobial peptides, all of which have immunomodulatory properties that can augment or decrease the inflammatory response. Extracellular localization of these molecules alerts the immune system of cellular damage, which is triggered by recognition of damage-associated molecular patterns (DAMPs) through specific pattern recognition receptors. However, not all of these molecules are DAMPs and may have other immunophysiological properties in the extracellular space. The release of NETs can lead to production of pro-inflammatory cytokines (due to TLR2/4/9 and inflammasome activation), the destruction of the extracellular matrix, activation of serine proteases and of matrix metallopeptidases (MMPs), modulation of cellular proliferation, induction of cellular migration and adhesion, promotion of thrombogenesis and angiogenesis and disruption of epithelial and endothelial permeability. Understanding the dynamics of NET-associated molecules, either individually or synergically, will help to unravel their role in inflammatory events and open novel perspectives for potential therapeutic targets. We here review molecules contained within NETS and their immunophysiological roles.
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Affiliation(s)
- Abraham U Morales-Primo
- Laboratory of Immunoparasitology, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Hospital General de México, Mexico City, Mexico
| | - Ingeborg Becker
- Laboratory of Immunoparasitology, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Hospital General de México, Mexico City, Mexico
| | - Jaime Zamora-Chimal
- Laboratory of Immunoparasitology, Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Hospital General de México, Mexico City, Mexico
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13
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Higazi M, Abdeen S, Abu-Fanne R, Heyman SN, Masarwy A, Bdeir K, Maraga E, Cines DB, Higazi AAR. Opposing effects of HNP1 (α-defensin-1) on plasma cholesterol and atherogenesis. PLoS One 2020; 15:e0231582. [PMID: 32302327 PMCID: PMC7164655 DOI: 10.1371/journal.pone.0231582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 03/26/2020] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis, the predominant cause of death in well-resourced countries, may develop in the presence of plasma lipid levels within the normal range. Inflammation may contribute to lesion development in these individuals, but the underlying mechanisms are not well understood. Transgenic mice expressing α-def-1 released from activated neutrophils develop larger lipid and macrophage-rich lesions in the proximal aortae notwithstanding hypocholesterolemia caused by accelerated clearance of α-def-1/low-density lipoprotein (LDL) complexes from the plasma. The phenotype does not develop when the release of α-def-1 is prevented with colchicine. However, ApoE-/- mice crossed with α-def-1 mice or given exogenous α-def-1 develop smaller aortic lesions associated with reduced plasma cholesterol, suggesting a protective effect of accelerated LDL clearance. Experiments were performed to address this seeming paradox and to determine if α-def-1 might provide a means to lower cholesterol and thereby attenuate atherogenesis. We confirmed that exposing ApoE-/- mice to α-def-1 lowers total plasma cholesterol and decreases lesion size. However, lesion size was larger than in mice with total plasma cholesterol lowered to the same extent by inhibiting its adsorption or by ingesting a low-fat diet. Furthermore, α-def-1 levels correlated independently with lesion size in ApoE-/- mice. These studies show that α-def-1 has competing effects on atherogenesis. Although α-def-1 accelerates LDL clearance from plasma, it also stimulates deposition and retention of LDL in the vasculature, which may contribute to development of atherosclerosis in individuals with normal or even low plasma levels of cholesterol. Inhibiting α-def-1 may attenuate the impact of chronic inflammation on atherosclerotic vascular disease.
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Affiliation(s)
- Mohamed Higazi
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Suhair Abdeen
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Rami Abu-Fanne
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Samuel N. Heyman
- Department of Medicine, Hadassah University Hospital, Mt. Scopus, Jerusalem, Israel
| | - Aseel Masarwy
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Khalil Bdeir
- Departments of Pathology and Laboratory Medicine, University of Pennsylvania-Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Emad Maraga
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Douglas B. Cines
- Departments of Pathology and Laboratory Medicine, University of Pennsylvania-Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Abd Al-Roof Higazi
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
- Departments of Pathology and Laboratory Medicine, University of Pennsylvania-Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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14
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Abu-Fanne R, Stepanova V, Litvinov RI, Abdeen S, Bdeir K, Higazi M, Maraga E, Nagaswami C, Mukhitov AR, Weisel JW, Cines DB, Higazi AAR. Neutrophil α-defensins promote thrombosis in vivo by altering fibrin formation, structure, and stability. Blood 2019; 133:481-493. [PMID: 30442678 PMCID: PMC6356988 DOI: 10.1182/blood-2018-07-861237] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/17/2018] [Indexed: 02/06/2023] Open
Abstract
Inflammation and thrombosis are integrated, mutually reinforcing processes, but the interregulatory mechanisms are incompletely defined. Here, we examined the contribution of α-defensins (α-defs), antimicrobial proteins released from activated human neutrophils, on clot formation in vitro and in vivo. Activation of the intrinsic pathway of coagulation stimulates release of α-defs from neutrophils. α-Defs accelerate fibrin polymerization, increase fiber density and branching, incorporate into nascent fibrin clots, and impede fibrinolysis in vitro. Transgenic mice (Def++) expressing human α-Def-1 developed larger, occlusive, neutrophil-rich clots after partial inferior vena cava (IVC) ligation than those that formed in wild-type (WT) mice. IVC thrombi extracted from Def++ mice were composed of a fibrin meshwork that was denser and contained a higher proportion of tightly packed compressed polyhedral erythrocytes than those that developed in WT mice. Def++ mice were resistant to thromboprophylaxis with heparin. Inhibiting activation of the intrinsic pathway of coagulation, bone marrow transplantation from WT mice or provision of colchicine to Def++ mice to inhibit neutrophil degranulation decreased plasma levels of α-defs, caused a phenotypic reversion characterized by smaller thrombi comparable to those formed in WT mice, and restored responsiveness to heparin. These data identify α-defs as a potentially important and tractable link between innate immunity and thrombosis.
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Affiliation(s)
- Rami Abu-Fanne
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | | | - Rustem I Litvinov
- Department of Cell and Developmental Biology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Suhair Abdeen
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Khalil Bdeir
- Department of Pathology and Laboratory Medicine and
| | - Mohamed Higazi
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Emad Maraga
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
| | - Chandrasekaran Nagaswami
- Department of Cell and Developmental Biology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | - Alexander R Mukhitov
- Department of Cell and Developmental Biology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | - John W Weisel
- Department of Cell and Developmental Biology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; and
| | | | - Abd Al-Roof Higazi
- Department of Clinical Biochemistry, Hadassah-Hebrew University, Jerusalem, Israel
- Department of Pathology and Laboratory Medicine and
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15
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Zhao H, Han T, Hong X, Sun D. Adipose differentiation‑related protein knockdown inhibits vascular smooth muscle cell proliferation and migration and attenuates neointima formation. Mol Med Rep 2017; 16:3079-3086. [PMID: 28713961 PMCID: PMC5548019 DOI: 10.3892/mmr.2017.6997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 04/06/2017] [Indexed: 12/31/2022] Open
Abstract
Vascular smooth muscle cells (VSMCs) have an important role in atherosclerosis development. Evidence has demonstrated that adipose differentiation-related protein (ADRP) is associated with foam cell formation and atherosclerosis progression. However, to the best of our knowledge, no previous studies have investigated the role of ADRP knockdown in platelet-derived growth factor (PDGF)-stimulated proliferation and migration of VSMCs in vitro. Furthermore, the effect of ADRP knockdown on neointima formation in vivo remains unclear. In the present study, primary human aortic VSMCs were incubated with PDGF following ADRP small interfering (si)RNA transfection. Cell viability, migration and cell cycle distribution were analyzed by MTT, wound healing and Transwell assays and flow cytometry, respectively. Extracellular signal-regulated kinase (ERK), phosphorylated (p)-ERK, Akt, p-Akt, proliferating cell nuclear antigen (PCNA), matrix metalloproteinase (MMP)-2 and MMP-9 protein levels were determined by western blotting. Apolipoprotein E−/− mice fed an atherogenic diet were injected with siADRP or control siRNA twice a week. After 3 weeks of therapy, aortas were excised and ADRP mRNA and protein expression was determined. Neointima formation was assessed by hematoxylin and eosin staining. The results of the current study demonstrated that ADRP knockdown significantly inhibited PDGF-induced increases in VSMC viability, caused G1 phase cell cycle arrest and decreased PCNA expression. Knockdown of ADRP inhibited PDGF-induced migration of VSMCs by reducing MMP protein expression and activity. In addition, the present study also demonstrated that ADRP knockdown inhibited ERK and Akt signaling pathways in response to PDGF. Furthermore, siADRP administration suppressed neointima formation in the mouse model. The results of the present study indicate that ADRP may be a potential target for the treatment of atherosclerosis.
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Affiliation(s)
- Haomin Zhao
- Department of Vascular Surgery, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Tao Han
- Department of Vascular Surgery, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Xin Hong
- Department of Vascular Surgery, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
| | - Dajun Sun
- Department of Vascular Surgery, China‑Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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16
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Paulin N, Döring Y, Kooijman S, Blanchet X, Viola JR, de Jong R, Mandl M, Hendrikse J, Schiener M, von Hundelshausen P, Vogt A, Weber C, Bdeir K, Hofmann SM, Rensen PCN, Drechsler M, Soehnlein O. Human Neutrophil Peptide 1 Limits Hypercholesterolemia-induced Atherosclerosis by Increasing Hepatic LDL Clearance. EBioMedicine 2017; 16:204-211. [PMID: 28111237 PMCID: PMC5474437 DOI: 10.1016/j.ebiom.2017.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 11/20/2022] Open
Abstract
Increases in plasma LDL-cholesterol have unequivocally been established as a causal risk factor for atherosclerosis. Hence, strategies for lowering of LDL-cholesterol may have immediate therapeutic relevance. Here we study the role of human neutrophil peptide 1 (HNP1) in a mouse model of atherosclerosis and identify its potent atheroprotective effect both upon transgenic overexpression and therapeutic delivery. The effect was found to be due to a reduction of plasma LDL-cholesterol. Mechanistically, HNP1 binds to apolipoproteins enriched in LDL. This interaction facilitates clearance of LDL particles in the liver via LDL receptor. Thus, we here identify a non-redundant mechanism by which HNP1 allows for reduction of LDL-cholesterol, a process that may be therapeutically instructed to lower cardiovascular risk. Mice with transgenic expression of human neutrophil peptide 1 (HNP1) exhibit lower plasma VLDL/LDL levels and smaller atherosclerotic lesion sizes. Repetitive HNP1 delivery is atheroprotective by reducing hypercholesterolemia. HNP1 binds to apolipoproteins in LDL and facilitates LDL clearance in the liver involving LDL receptor.
Increased plasma lipid levels (i.e. hypercholesterolemia) are a primary risk factor for atherosclerosis, the pathology underlying myocardial infarction and stroke. Here we show that human neutrophil peptide 1 (HNP1, also known as α-defensin), an antimicrobial protein typically released from activated neutrophils, binds to apolipoproteins within plasma lipoproteins and facilitates the clearance of plasma lipids in the liver. As a consequence, repeated injection of hypercholesterolemic mice with HNP1 reduces atherosclerotic lesion formation. Thus, this study provides an innovative strategy to reduce hypercholesterolemia and hence a way to potentially reduce cardiovascular risk.
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MESH Headings
- Animals
- Apolipoproteins/blood
- Apolipoproteins/metabolism
- Atherosclerosis/genetics
- Atherosclerosis/metabolism
- Atherosclerosis/prevention & control
- Cholesterol, LDL/blood
- Cholesterol, LDL/metabolism
- Female
- Hep G2 Cells
- Humans
- Hypercholesterolemia/genetics
- Hypercholesterolemia/metabolism
- Hypercholesterolemia/prevention & control
- Immunohistochemistry
- Lipoproteins, LDL/blood
- Lipoproteins, LDL/metabolism
- Lipoproteins, LDL/pharmacokinetics
- Liver/drug effects
- Liver/metabolism
- Mice, Inbred C57BL
- Mice, Knockout
- Mice, Transgenic
- Microscopy, Confocal
- Protein Binding
- RNA Interference
- Receptors, LDL/genetics
- Receptors, LDL/metabolism
- alpha-Defensins/administration & dosage
- alpha-Defensins/genetics
- alpha-Defensins/metabolism
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Affiliation(s)
- Nicole Paulin
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany
| | - Yvonne Döring
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany
| | - Sander Kooijman
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Einthoven Laboratory for Vascular Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Xavier Blanchet
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany
| | - Joana R Viola
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany; Department of Pathology, AMC, 1105 AZ Amsterdam, The Netherlands
| | - Renske de Jong
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany; Department of Pathology, AMC, 1105 AZ Amsterdam, The Netherlands
| | - Manuela Mandl
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany
| | - Jeffrey Hendrikse
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany; Department of Pathology, AMC, 1105 AZ Amsterdam, The Netherlands
| | - Maximilian Schiener
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany
| | | | - Anja Vogt
- Medizinische Klinik und Poliklinik IV, Klinikum der LMU München, Munich 80336, Germany
| | - Christian Weber
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany; DZHK, Partner Site Munich Heart Alliance, Munich 80336, Germany
| | - Khalil Bdeir
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Susanna M Hofmann
- Medizinische Klinik und Poliklinik IV, Klinikum der LMU München, Munich 80336, Germany; Institute for Diabetes and Regeneration, Helmholtz Center Munich, Germany; German Center for Diabetes Research (DZD) München-Neuherberg, Germany
| | - Patrick C N Rensen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands; Einthoven Laboratory for Vascular Medicine, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - Maik Drechsler
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany; Department of Pathology, AMC, 1105 AZ Amsterdam, The Netherlands; DZHK, Partner Site Munich Heart Alliance, Munich 80336, Germany
| | - Oliver Soehnlein
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich 80336, Germany; Department of Pathology, AMC, 1105 AZ Amsterdam, The Netherlands; DZHK, Partner Site Munich Heart Alliance, Munich 80336, Germany.
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17
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Human neutrophil peptides inhibit cleavage of von Willebrand factor by ADAMTS13: a potential link of inflammation to TTP. Blood 2016; 128:110-9. [PMID: 27207796 DOI: 10.1182/blood-2015-12-688747] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 04/30/2016] [Indexed: 12/16/2022] Open
Abstract
Infection or inflammation may precede and trigger formation of microvascular thrombosis in patients with acquired thrombotic thrombocytopenic purpura (TTP). However, the mechanism underlying this clinical observation is not fully understood. Here, we show that human neutrophil peptides (HNPs) released from activated and degranulated neutrophils inhibit proteolytic cleavage of von Willebrand factor (VWF) by ADAMTS13 in a concentration-dependent manner. Half-maximal inhibitory concentrations of native HNPs toward ADAMTS13-mediated proteolysis of peptidyl VWF73 and multimeric VWF are 3.5 μM and 45 μM, respectively. Inhibitory activity of HNPs depends on the RRY motif that is shared by the spacer domain of ADAMTS13. Native HNPs bind to VWF73 (KD = 0.72 μM), soluble VWF (KD = 0.58 μM), and ultra-large VWF on endothelial cells. Enzyme-linked immunosorbent assay (ELISA) demonstrates markedly increased plasma HNPs1-3 in most patients with acquired autoimmune TTP at presentation (median, ∼170 ng/mL; range, 58-3570; n = 19) compared with healthy controls (median, ∼23 ng/mL; range, 6-44; n = 18) (P < .0001). Liquid chromatography plus tandem mass spectrometry (LC-MS/MS) reveals statistically significant increases of HNP1, HNP2, and HNP3 in patient samples (all P values <.001). There is a good correlation between measurement of HNPs1-3 by ELISA and by LC-MS/MS (Spearman ρ = 0.7932, P < .0001). Together, these results demonstrate that HNPs1-3 may be potent inhibitors of ADAMTS13 activity, likely by binding to the central A2 domain of VWF and physically blocking ADAMTS13 binding. Our findings may provide a novel link between inflammation/infection and the onset of microvascular thrombosis in acquired TTP and potentially other immune thrombotic disorders.
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