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Al-Ghumlas AK. Ramadan intermittent fasting is associated with improved anticoagulant activity among healthy people: a case-control study. Sci Rep 2024; 14:13855. [PMID: 38879576 PMCID: PMC11180170 DOI: 10.1038/s41598-024-64582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 06/11/2024] [Indexed: 06/19/2024] Open
Abstract
Data on the pathophysiological mechanisms of hemostatic alterations in the thrombotic events that occur during Ramadan intermittent fasting (RIF), particularly in the natural coagulation inhibitors, are very limited. Thus, our objective was to evaluate the effect of RIF on the natural anticoagulants level, antithrombin, protein C, and total and free protein S (PS) in healthy participants. Participants were divided into two groups. Group I consisted of 29 healthy fasting participants whose blood samples were taken after 20 days of fasting. Group II included 40 healthy non-fasting participants whose blood samples were taken 2-4 weeks before the month of Ramadan. Coagulation screening tests including prothrombin time (PT), activated partial thromboplastin time (APTT) and plasma fibrinogen level, natural anticoagulants; antithrombin, protein C, free and total PS and C4 binding protein (C4BP) levels were evaluated in the two groups. High levels of total and free PS without change in antithrombin, protein C, and C4BP levels were noted in the fasting group as compared with non-fasting ones (p < 0.05). PT and APTT showed no difference between the two groups. However, the fibrinogen level was higher in the fasting group. In conclusion, RIF was found to be associated with improved anticoagulant activity in healthy participants, which may provide temporal physiological protection against the development of thrombosis in healthy fasting people.
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Affiliation(s)
- Abeer Khalid Al-Ghumlas
- The Coagulation Research Laboratory, Physiology Department, College of Medicine and King Saud University Medical City, King Saud University, 11461, Riyadh, Saudi Arabia.
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Cao X, Cao Z, Ou C, Zhang L, Chen Y, Li Y, Zhu B, Shu H. Combination of serum paraoxonase/arylesterase 1 and antithrombin-III is a promising non-invasion biomarker for discrimination of AFP-negative HCC versus liver cirrhosis patients. Clin Res Hepatol Gastroenterol 2021; 45:101583. [PMID: 33756265 DOI: 10.1016/j.clinre.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE α-fetoprotein is often used in the diagnosis of hepatocellular carcinoma (HCC). However, there are currently less efficient and highly specific biomarkers to distinguish AFP-negative HCC from liver cirrhosis (LC) patients. PATIENTS AND METHODS We retrospectively analyzed the data of patients who were treated in our hospitals. iTRAQ coupled with mass spectrometry was used to identify candidate serum proteins in a discovery set (n = 36) including AFP-negative HCC and LC patients. After Western blot detection, potential serum biomarkers were confirmed using ELISA in a validation set (n = 90). The diagnostic performance of the selected proteins was assessed using receiver operating characteristic (ROC). RESULTS PON1 and ATIII were selected as target proteins and were significantly higher in LC than those in AFP-negative HCC patients as validated by Western blot and ELISA, which was consistent with the result of iTRAQ. The AUC was 0.848 as PON1 and ATIII were combined (sensitivity: 80.0%; specificity: 73.3%), and performed much better than that of a single biomarker. CONCLUSION These findings suggest that PON1 and ATIII have the potential to serve as effective biomarkers for distinguishing AFP-negative HCC from cirrhosis.
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Affiliation(s)
- Xinyi Cao
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China; Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, PR China
| | - Zhao Cao
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China
| | - Chao Ou
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China
| | - Lei Zhang
- Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, PR China
| | - Yanhua Chen
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China
| | - Yanqiu Li
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China
| | - Bo Zhu
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China.
| | - Hong Shu
- Department of Clinical Laboratory, Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi, PR China; Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai 200032, PR China.
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Abstract
Snake venoms have evolved primarily to immobilize and kill prey, and consequently, they contain some of the most potent natural toxins. Part of that armory is a range of hemotoxic components that affect every area of hemostasis, which we have harnessed to great effect in the study and diagnosis of hemostatic disorders. The most widely used are those that affect coagulation, such as thrombin-like enzymes unaffected by heparin and direct thrombin inhibitors, which can help confirm or dispute their presence in plasma. The liquid gold of coagulation activators is Russell's viper venom, since it contains activators of factor X and factor V. It is used in a range of clotting-based assays, such as assessment of factor X and factor V deficiencies, protein C and protein S deficiencies, activated protein C resistance, and probably the most important test for lupus anticoagulants, the dilute Russell's viper venom time. Activators of prothrombin, such as oscutarin C from Coastal Taipan venom and ecarin from saw-scaled viper venom, are employed in prothrombin activity assays and lupus anticoagulant detection, and ecarin has a valuable role in quantitative assays of direct thrombin inhibitors. Snake venoms affecting primary hemostasis include botrocetin from the jararaca, which can be used to assay von Willebrand factor activity, and convulxin from the cascavel, which can be used to detect deficiency of the platelet collagen receptor, glycoprotein VI. This article takes the reader to every area of the diagnostic hemostasis laboratory to appreciate the myriad applications of snake venoms available in diagnostic practice.
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Affiliation(s)
- Gary William Moore
- Department of Haematology, Specialist Haemostasis Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Faculty of Science and Technology, Middlesex University London, London, United Kingdom
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Abo-Elenein AM, Mabrouk MM, Abou-Saif S, Saeed OM, Khodeir S, Elkadeem M, Elashry H, Haydara T, Zaghloul MS, Seleem WM, Elshweikh SA, Abd-Elsalam S. Role of Both Protein C and Antithrombin III as Predictors of Stage of Liver Disease in Chronic Viral Hepatitis B or C Infected Patients. Endocr Metab Immune Disord Drug Targets 2020; 20:112-117. [PMID: 31142255 DOI: 10.2174/1871530319666190529092555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/06/2019] [Accepted: 04/17/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Chronic liver disease is characterized by complex hemostatic disorders because the liver is the site where most of the coagulation factors and their inhibitors are synthesized. The aim of this study was the evaluation of protein C and antithrombin III in different stages of chronic hepatitis B and C and to determine their possible role as markers of liver cell damage in different clinical stages. METHODS The study included 60 subjects who were subdivided into 4 groups: (Group I): 15 patients diagnosed as chronic viral hepatitis B or C, (Group II): 15 patients with compensated liver cirrhosis, (Group III): 15 patients with decompensated liver cirrhosis, and (Group IV) (control group): 15 healthy individuals. History taking, clinical examination and abdominal ultrasonography were made for all subjects. Investigations were done in the form of liver function tests (ALT, AST, ALP, serum bilirubin, and serum albumin), PT, PTT, CBC. Plasma levels of Antithrombin III & protein C were estimated by automated Stago compact coagulation analyzer. RESULTS In all patient groups, the mean value of Protein C showed significant decrease when compared to control group, mean value of antithrombin III showed a significant decrease in compensated and decompensated subjects when compared to chronic hepatitis and control groups. Antithrombin III and protein C showed a significant negative correlation with (ALT, AST, PT, PTT, INR). However, this correlation was positive with Albumin. CONCLUSION Antithrombin III and protein C are natural anticoagulants and can be considered as markers of different stages of chronic liver disease. This is supported further by the comparison between the levels of these parameters and clinical stages of liver disease. Protein C is more sensitive than ATIII as a marker of hepatocellular damage.
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Affiliation(s)
- Amany M Abo-Elenein
- Department of Clinical Pathology, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Maaly M Mabrouk
- Department of Clinical Pathology, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Sabry Abou-Saif
- Tropical Medicine & Infectious Diseases, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Ola M Saeed
- Department of Clinical Pathology, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Samy Khodeir
- Internal Medicine Department, Tanta University, Tanta, Egypt
| | - Mahmoud Elkadeem
- Tropical Medicine & Infectious Diseases, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Heba Elashry
- Tropical Medicine & Infectious Diseases, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Tamer Haydara
- Internal Medicine Department, Kafr-Elsheikh University, Egypt
| | - Mariam S Zaghloul
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafr-Elsheikh University, Egypt
| | - Waseem M Seleem
- Internal medicine department -Hepatology and endoscopy division - Zagazig University, Zagazig, Egypt
| | | | - Sherief Abd-Elsalam
- Tropical Medicine & Infectious Diseases, Tanta University Faculty of Medicine, Tanta, Egypt
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Cagin YF, Bilgic Y, Berber İ, Yildirim O, Erdogan MA, Firat F, Arslan AK, Colak C, Seckin Y, Harputluoglu M. The risk factors of portal vein thrombosis in patients with liver cirrhosis. Exp Ther Med 2019; 17:3189-3194. [PMID: 30936992 DOI: 10.3892/etm.2019.7300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 11/23/2018] [Indexed: 12/17/2022] Open
Abstract
This study was designed to identify and assess risk factors for portal vein thrombosis (PVT) in patients with cirrhosis. A total of 98 cirrhosis patients with PVT were identified and 101 cirrhosis patients without PVT were chosen as the control group in this retrospective study. Several variables were measured and the two groups PVT and non-PVT were compared statistically. PVT was identified in 98 patients (10%). Significant differences in hematocrit, international normalized ratio, albumin, bilirubin and glucose were determined between the groups (P<0.05). Out of the thrombophilic risk factors in the patients with PVT factor V Leiden was identified in 8.8%, prothrombin gene 6.6% and methylenetetrahydrofolate reductase 2.2%. There was no difference in survival time between groups (P>0.05).
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Affiliation(s)
- Yasir Furkan Cagin
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Yilmaz Bilgic
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - İlhami Berber
- Clinic of Hematology, Malatya Training and Education Hospital, 44330 Malatya, Turkey
| | - Oguzhan Yildirim
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Mehmet Ali Erdogan
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Feyza Firat
- Department of Internal Medicine, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Ahmet Kadir Arslan
- Department of Biostatistics and Medical Informatics, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Yuksel Seckin
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
| | - Murat Harputluoglu
- Department of Gastroenterology, Medical Faculty, Inonu University, 44280 Malatya, Turkey
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Huang G, Jiang H, Lin Y, Wu Y, Cai W, Shi B, Luo Y, Jian Z, Zhou X. Prognostic value of plasma fibrinogen in hepatocellular carcinoma: a meta-analysis. Cancer Manag Res 2018; 10:5027-5041. [PMID: 30464603 PMCID: PMC6214315 DOI: 10.2147/cmar.s175780] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Elevated plasma fibrinogen levels have been associated with tumor progression in several malignancies. Our study aims to characterize the clinical significance of elevated plasma fibrinogen levels in patients with hepatocellular carcinoma (HCC). Materials and methods Relevant published articles were systematically searched in electronic databases including PubMed, Embase, and Web of Science. The pooled differences in plasma fibrinogen levels among HCC, cirrhotic, and control groups were expressed as weighted mean differences (WMDs) and their corresponding 95% CIs. The associations between elevated fibrinogen and overall survival (OS) and disease-free survival (DFS)/recurrence-free survival (RFS) were expressed as HRs and their 95% CIs, whereas the associations between elevated fibrinogen and various types of clinical characteristic of patients with HCC were expressed as ORs and their corresponding 95% CIs. Results Results showed that the plasma fibrinogen levels in patients with HCC were not significantly different than that in healthy controls (WMD = 0.50, 95% CI = [−0.82, 1.82], P = 0.457) or patients with cirrhosis (WMD = −0.62, 95% CI = [−1.56, 0.33], P = 0.200). However, our results showed that compared to those with normal levels, patients with HCC and elevated plasma fibrinogen levels showed poorer OS (HR = 2.08, 95% CI = [1.67, 2.59], P < 0.0001) and DFS/RFS (HR = 1.90, 95% CI = [1.52, 2.37], P < 0.0001). Results of trial sequential analysis of the OS indicated that currently available studies were sufficient to validate the negative prognostic value of elevated plasma fibrinogen in patients with HCC. Clinicopathological analyses showed that high plasma fibrinogen levels were associated with tumor progression as indicated by advanced tumor stage, larger tumor size, increased tumor number, and the presence of vascular invasion. Conclusion Elevated plasma fibrinogen levels are associated with poor prognosis and advanced tumor progression. Plasma fibrinogen may serve as a negative prognostic biomarker in patients with HCC.
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Affiliation(s)
- Guanqun Huang
- Department of General Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, People's Republic of China
| | - Hui Jiang
- Department of Abdominal Oncology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, People's Republic of China,
| | - Ye Lin
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, People's Republic of China,
| | - Yanpeng Wu
- Department of General Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, People's Republic of China
| | - Weilong Cai
- Department of General Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, People's Republic of China
| | - Boyun Shi
- Department of Abdominal Oncology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, People's Republic of China,
| | - Yuanwei Luo
- Department of General Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, People's Republic of China
| | - Zhixiang Jian
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, People's Republic of China,
| | - Xinke Zhou
- Department of Abdominal Oncology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, People's Republic of China,
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Patil AG, Bihari C, Shewade HD, Nigam N, Sarin SK. Decreased protein C function predicts mortality in patients with cirrhosis. Int J Lab Hematol 2018; 40:466-472. [PMID: 29704446 DOI: 10.1111/ijlh.12836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/14/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Protein C (PrC), a physiological anticoagulant, regulates inflammation and cell death and has known predictive/therapeutic roles in sepsis. Accumulating evidences suggest plasma hypercoagulability results in progression of fibrosis and formation of microclots causing end-organ dysfunction. We investigated a possible association between natural anticoagulants-PrC, protein S (PrS) and antithrombin III (AT)-and clinical outcomes in cirrhotics. METHODS Functional PrC, PrS and AT were analysed in 515 cirrhotic patients and compared with 229 noncirrhotics. Among those with cirrhosis, we conducted multivariable predictive model on 3-month survival to assess the prognostic ability of anticoagulants. RESULTS Protein C (P < .001), PrS (P < .001) and AT (P < .001) levels were lower in cirrhotics compared with noncirrhotics. In addition, patients with Child-Pugh (CP)-C had significantly lower (P < .05) functional PrC, PrS and AT levels than CP-B, CP-A and noncirrhotic patients. Low PrC function correlated with markers of liver dysfunction and inflammation: INR(r = -.72, P < .001), bilirubin (r = -.620, P < .001), albumin (r = .539, P < .001), creatinine (r = -.417, P < .001), ferritin (r = -.68, P = .035), procalcitonin (r = -.79, P = .01), raised ESR (r = .56, P < .001) and liver fibrosis (r = -.840, P < .001). Patients who died (n = 160) had significantly lower median PrC function (23.8%, 16.3-33.0]) compared with those who remained alive (74.9%, [59.7-92.5]); P < .001. In a multivariable predictive model using PrC, and MELD score, we found a significant impact of low PrC levels on survival (P < .001, IRR = 0.97, 95% CI = 0.96-0.98). Receiver operating characteristic (ROC) curve analysis revealed that functional PrC levels <52% were associated with increased mortality (P < .001). CONCLUSION Low functional protein C level correlated with markers of liver dysfunction, inflammation and sepsis and independently predicted mortality at 3 months in cirrhotics, especially if functional levels were <52%.
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Affiliation(s)
- A G Patil
- Department of Clinical Haematology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - C Bihari
- Department of Clinical Haematology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - H D Shewade
- South-East Asia Office, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - N Nigam
- Department of Clinical Haematology, Institute of Liver & Biliary Sciences, New Delhi, India
| | - S K Sarin
- Department of Hepatology, Institute of Liver & Biliary Sciences, New Delhi, India
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Rai V, Dhameja N, Kumar S, Shukla J, Singh R, Dixit VK. Haemostatic Profile of Patients with Chronic Liver Disease- its Correlation with Severity and Outcome. J Clin Diagn Res 2017; 11:EC24-EC26. [PMID: 28969137 DOI: 10.7860/jcdr/2017/24975.10451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/05/2017] [Indexed: 01/11/2023]
Abstract
INTRODUCTION The liver plays an important role in the haemostatic system as it synthesizes the majority of coagulation factors and fibrinolytic proteins. AIM The present study was planned to determine the range of haemostatic defects in patients of chronic liver diseases. MATERIALS AND METHODS Test performed included Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), Thrombin Time (TT), Fibrinogen, Protein C, D Dimer and platelet count. Comparisons between groups frequencies and groups means were made using Chi-square test and Student's t-test, respectively. RESULTS In cirrhosis group PT, aPTT, TT and D Dimer level were significantly increased compared to Chronic Hepatitis (CH) and control group (p<0.001 for all comparisons). Serum fibrinogen, Protein C and platelet count were significantly reduced in cirrhosis patients compared to CH and control group. (p<0.001 for all comparisons). All studied coagulation parameters were within normal limit in CH group. However, statistically significant difference was found in protein C and mean platelet count in CH group compared to control (p=0.03 and p<0.001 respectively). No evidence of bleeding or thrombosis was present in study group. CONCLUSION In cirrhosis patients severe derangement in both anti and procoagulant factors occurs. Haemostatic profile in chronic hepatitis patient remains within normal limits.
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Affiliation(s)
- Varnika Rai
- Resident, 24 Hour Laboratory, SGPGI, Lucknow, Uttar Pradesh, India
| | - Neeraj Dhameja
- Assistant Professor, Department of Pathology, IMS BHU, Varanasi, Uttar Pradesh, India
| | - Sandip Kumar
- Assistant Professor, Department of Pathology, IMS BHU, Varanasi, Uttar Pradesh, India
| | - Jyoti Shukla
- Professor, Department of Pathology, IMS BHU, Varanasi, Uttar Pradesh, India
| | - Rajeev Singh
- Senior Resident, Department of Radiodiagnosis, SGPGI, Lucknow, Uttar Pradesh, India
| | - Vinod Kumar Dixit
- Professor, Department of Gastroenterology, IMS BHU, Varanasi, Uttar Pradesh, India
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Abstract
Despite the prolongation of coagulation tests, recent studies reported an increased frequency of thromboembolic events in patients with cirrhosis. The aim of this study was to evaluate the haemostatic balance in cirrhotic patients through assessing the variation of pro- and anticoagulant factors and evaluating the in-vitro thrombin generation in patients with cirrhosis and in healthy patients. Fifty-one cirrhotic patients with or without thromboembolic events and 50 controls matched by age and sex were enrolled. Procoagulant (factors VII, II, V, VIII, and XII) and inhibitor (protein C, protein S and antithrombin) factor activities were determined. Thrombin generation was measured as endogenous thrombin potential (ETP). Haemostatic balance was assessed by means of both procoagulant to inhibitor coagulation factor ratios and ETP with to without protein C activation ratios. There were 24 males and 27 females. The mean age was 57.8 years [16-91 years]. Pro and anticoagulant factors were significantly lower in patients than in controls (P < 0.001) except for factor VIII and protein S. In fact factor VIII level was significantly higher in patients than in controls and protein S levels were not significantly different between patients and controls. Almost all the pro to anticoagulant factor ratios were higher in cirrhotics than in controls, especially the factor VIII to protein C ratios which increased significantly from Child Pugh A to C (P < 0.001), the ratio of ETP with to without protein C activator was higher in patients than in controls, but did not reach a significant level (0.8 vs. 0.52) There was no statistically significant difference between Child classes. When comparing patients with history of thrombosis (n = 7) to those matched by age and sex and without history of thrombosis (n = 14), the ratios were not statistically different between the two groups. Haemostatic changes in cirrhosis tend to rebalance the haemostatic system. This state often results in a hypercoagulable state attested by increased pro- to anticoagulant factor ratios and a normal thrombin generation.
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Abstract
There is accumulating evidence that the coagulation system is involved in the process of fibrogenesis in chronic liver disease. Recent studies postulated a possible connection between plasmatic hypercoagulability and progression of fibrosis. The aim of the study was to investigate disorders of the coagulation system in patients with chronic hepatitis C having different extent of hepatic fibrosis well defined by liver histology. A total of 62 patients with chronic hepatitis C were recruited and categorized into 2 groups according to their histological fibrosis stage : mild/moderate fibrosis group (F0-F3 group, n = 30) and extensive fibrosis/cirrhosis group (F4-F6 group, n = 32). The control group consisted of 31 healthy individuals. The following hemostatic assays were evaluated: antithrombin III (AT), protein C (PC) activity, activated partial thromboplastin time, prothrombin time, plasma fibrinogen as well as conventional liver function test. The PC level exhibited a significant reduction in both patient groups when compared to the normal control group (89.25% ± 10.05% and 48.33% ± 15.86% vs 111.86 ± 10.90; P < .001 and P < .001). The PC was found to be the strongest associated factor to histological fibrosis stage ( r = –.834; P < .0001). Univariate and multivariate analysis showed that AT ( P = .003) and PC ( P = .0001) were the most important factors associated with advanced fibrosis. The PC ( P = .001) was found to be the only predictor of mild fibrosis. In conclusion, PC deficiency occurs in an early stage of liver fibrosis. The severity of deficiency is proportional to extent of fibrosis. The PC may have a key role in linking hypercoagulability with hepatic fibrogenesis in chronic liver disease.
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11
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Korish AA, Abdel Gader AGM, Alhaider AA. Camel milk ameliorates the coagulopathy in streptozotocin diabetic rat model. INT J DAIRY TECHNOL 2014. [DOI: 10.1111/1471-0307.12168] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Aida A Korish
- Department of Physiology (29) College of Medicine and King Khalid University Hospital King Saud University PO Box 2925 11461 Riyadh Saudi Arabia
| | - Abdel Galil M Abdel Gader
- Department of Physiology (29) College of Medicine and King Khalid University Hospital King Saud University PO Box 2925 11461 Riyadh Saudi Arabia
| | - Abdulqader A Alhaider
- Department of Physiology (29) College of Medicine and King Khalid University Hospital King Saud University PO Box 2925 11461 Riyadh Saudi Arabia
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Saray A, Mesihović R, Vukobrat-Bijedić Z, Gornjaković S, Vanis N, Mehmedović A, Papović V, Glavaš S. Impact of sustained virus elimination on natural anticoagulant activity in patients with chronic viral hepatitis C. Bosn J Basic Med Sci 2014; 13:84-8. [PMID: 23725503 DOI: 10.17305/bjbms.2013.2370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Previous studies have reported reduced synthesis of various hemostatic factors in patients with chronic liver disease. Whether changes in plasma levels of these proteins reflect recovered liver synthetic function following virological eradication therapy has not been approved yet. The aim of the study was to determine the impact of sustained viral suppression achieved with pegylated interferon alpha and ribavirin on hemostatic parameters including natural anticoagulants in patients with chronic hepatitis C. The following coagulation screening tests were obtained in thirty patients with chronic viral hepatitis C before and after completion of antiviral treatment: activated partial thromboplastin time, prothrombin time, plasma fibrinogen and natural anticoagulant proteins antithrombin III, protein C (PC) and total protein S (PS) activity. Only patients who achieved durable virus suppression were included. The mean PC and PS levels were significantly lower in patients with chronic viral hepatitis C before antiviral therapy than in healthy controls (79.04 ± 16.19 % vs. 109.92 ± 21.33% and 54.04 ± 16.11% vs. 87.60 ± 8.15%, respectively; (p<0.001). Mean levels of PC exhibited a significant increase by 14.69 % after the completion of antiviral treatment (93.73 ± 14.18%, p<0.001) as well as PS levels, which significantly increased by 21.46% (75.50 ± 15.43, p<0.001) when compared with pre-treatment values. No remarkable fluctuations in other hemostatic parameters were noted. Protein C and protein S are sensitive markers of hepatocyte synthetic impairment and are valuable markers in monitoring the efficacy of antiviral treatment in chronic hepatitis C patients. Larger studies are needed to confirm our results.
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Affiliation(s)
- Aida Saray
- Department of Gastroenterology and Hepatology, Clinical Centre of Sarajevo University, Bolnička 25, 71000 Sarajevo, Bosnia and Herzegovina.
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Abstract
Bleeding in patients in pediatric intensive care units is associated with an increased risk of mortality. Fortunately, most patients with an abnormal coagulation profile do not bleed because this is generally secondary to liver disease or dietary-induced vitamin K deficiency. When the laboratory markers of coagulopathy are the result of disseminated intravascular coagulation, bleeding is common and the risk of mortality extreme. Although interventions directed toward correcting the abnormal coagulation test results are generally initiated, they are also generally either not warranted or not fully successful.
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Affiliation(s)
- Robert I Parker
- Pediatric Hematology/Oncology, Stony Brook Long Island Children's Hospital, Stony Brook University School of Medicine, 100 Nicolls Road, Stony Brook, NY 11794, USA.
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Pawlak K, Mysliwiec M, Pawlak D. Impact of residual renal function and HCV seropositivity on plasma CD40/CD40L system and oxidative status in haemodialysis patients. Clin Biochem 2010; 43:1393-8. [DOI: 10.1016/j.clinbiochem.2010.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 08/24/2010] [Accepted: 09/01/2010] [Indexed: 10/19/2022]
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Natural anticoagulants can be useful predictors of severity in chronic liver disease. Blood Coagul Fibrinolysis 2010; 21:122-7. [DOI: 10.1097/mbc.0b013e328335d03a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
OBJECTIVES Liver has a major role in coagulation. The hemostatic derangements measured by the mostly used coagulation parameters as prothrombin time, activated partial thromboplastin time, and thrombocyte count do not always correlate with the bleeding associated with liver diseases and these factors do not measure the thrombotic risks. So, thromboelastography is used in new clinical and laboratory research. The aim of this study is to study the effect of different levels of hepatectomy on coagulation. METHODS Laparatomy, 40% hepatectomy, and 70% hepatectomy was performed in three different groups of rats. Prothrombin time, international normalized ratio, activated partial thromboplastin time, thrombocyte count, fibrinogen levels, and thromboelastography parameters were obtained at the 0, 6, and 24th hour of the study. RESULTS Fibrinogen level at the 24th hour was greater than the early hours in both of the hepatectomy groups. Prothrombin time and international normalized ratio values were significantly higher in hepatectomy groups than in the sham group. There were no statistically significant difference in the clotting time, clot formation time, alpha-angle, and maximum clot firmness values in any of the thromboelastography channels, in any of the study times, in between the sham, 40% hepatectomy, and 70% hepatectomy groups. CONCLUSION There is no difference between 40 and 70% hepatectomy when the coagulopathy is evaluated. The coagulation derangements as reflected by the increase in fibrinogen and prolongation of prothrombin time and activated partial thromboplastin time after hepatectomy were not supported by thromboelastography parameters in this study.
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Lee HJ, Na K, Choi EY, Kim KS, Kim H, Paik YK. Simple Method for Quantitative Analysis of N-Linked Glycoproteins in Hepatocellular Carcinoma Specimens. J Proteome Res 2009; 9:308-18. [DOI: 10.1021/pr900649b] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Hyoung-Joo Lee
- Department of Biochemistry and Biomedical Sciences, College of Life Sciences and Biotechnology, World Class University Program, Yonsei Proteome Research Center and Biomedical Proteome Research Center, Department of Surgery, and Department of Pathology, College of Medicine, Yonsei University, Seoul 120-749, Korea
| | - Keun Na
- Department of Biochemistry and Biomedical Sciences, College of Life Sciences and Biotechnology, World Class University Program, Yonsei Proteome Research Center and Biomedical Proteome Research Center, Department of Surgery, and Department of Pathology, College of Medicine, Yonsei University, Seoul 120-749, Korea
| | - Eun-Young Choi
- Department of Biochemistry and Biomedical Sciences, College of Life Sciences and Biotechnology, World Class University Program, Yonsei Proteome Research Center and Biomedical Proteome Research Center, Department of Surgery, and Department of Pathology, College of Medicine, Yonsei University, Seoul 120-749, Korea
| | - Kyung Sik Kim
- Department of Biochemistry and Biomedical Sciences, College of Life Sciences and Biotechnology, World Class University Program, Yonsei Proteome Research Center and Biomedical Proteome Research Center, Department of Surgery, and Department of Pathology, College of Medicine, Yonsei University, Seoul 120-749, Korea
| | - Hoguen Kim
- Department of Biochemistry and Biomedical Sciences, College of Life Sciences and Biotechnology, World Class University Program, Yonsei Proteome Research Center and Biomedical Proteome Research Center, Department of Surgery, and Department of Pathology, College of Medicine, Yonsei University, Seoul 120-749, Korea
| | - Young-Ki Paik
- Department of Biochemistry and Biomedical Sciences, College of Life Sciences and Biotechnology, World Class University Program, Yonsei Proteome Research Center and Biomedical Proteome Research Center, Department of Surgery, and Department of Pathology, College of Medicine, Yonsei University, Seoul 120-749, Korea
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Zocco MA, Di Stasio E, De Cristofaro R, Novi M, Ainora ME, Ponziani F, Riccardi L, Lancellotti S, Santoliquido A, Flore R, Pompili M, Rapaccini GL, Tondi P, Gasbarrini GB, Landolfi R, Gasbarrini A. Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol 2009; 51:682-9. [PMID: 19464747 DOI: 10.1016/j.jhep.2009.03.013] [Citation(s) in RCA: 337] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 02/19/2009] [Accepted: 03/17/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS Prognostic scores currently used in cirrhotic patients do not include thrombotic risk factors (TRFs). Predicting factors of portal vein thrombosis (PVT) development are still unknown. We wanted to describe TRFs as a function of liver disease severity using the MELD score and assess the role of local and systemic TRFs as predictors of PVT development in cirrhotic patients. METHODS One hundred consecutive patients with liver cirrhosis were included in the study. TRFs, D-dimers, MELD score, portal vein patency and flow velocity were evaluated in all subjects at baseline and every 6 months thereafter. Variables able to predict PVT development within 1 year were identified by means of multiple logistic regression. RESULTS The plasma levels of protein C and antithrombin were lower and the concentration of D-dimers was higher in patients with advanced disease. Plasma levels of antithrombin, protein C and protein S resulted significantly lower in PVT group at univariate analysis, but reduced portal vein flow velocity was the only variable independently associated with PVT development. CONCLUSIONS Lower concentrations of natural coagulation inhibitors are frequently detected in patients with liver cirrhosis. A reduced portal flow velocity seems to be the most important predictive variable for PVT development in patients with cirrhosis.
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Affiliation(s)
- Maria Assunta Zocco
- Department of Internal Medicine, Catholic University of Rome, Gemelli Hospital, Largo A. Gemelli 8, 00168 Rome, Italy.
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Giráldez Gallego A, Sousa JM, Pascasio JM, Prats C, Cayuela A, Garrido A. [Blood coagulation factor levels in candidates for liver transplantation: correlation with disease severity]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:465-71. [PMID: 19595482 DOI: 10.1016/j.gastrohep.2009.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 02/23/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To correlate blood coagulation factor levels with disease severity in cirrhotic patients evaluated as candidates for liver transplantation. MATERIAL AND METHOD We included 87 patients (75.9% men) with a mean age of 54+/-9.4 years. Etiology and Child-Turcotte-Pugh (CTP) class were as follows: alcohol-related (36.8%), hepatitis C virus infection (35.6%), hepatitis B virus infection (11.5%) and other (16.1%); class A (13.8%), class B (40.2%) and class C (46%), respectively. The mean value of the Model for End-Stage Liver Disease (MELD) score was 14.5+/-5.9. Levels of factors II, V, VII, VIII, IX and X were compared between each CTP grade and with the MELD score. RESULTS Except for factor VIII, all the clotting factors were reduced in our series (in particular factors II, V and VII) and deficiencies in these factors were closely related to CTP grade with statistical significance for stage C (p <0.05). We also found a marked inverse correlation between the MELD score and factors II, V, VII, IX and X values (p <0.05). CONCLUSIONS A correlation was found between reduced levels of factors II, V, VII, IX and X in liver cirrhosis and the severity of liver disease.
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Yeast and mammalian two-hybrid systems for studying protein-protein interactions. Blood Coagul Fibrinolysis 2008; 19:263-7. [PMID: 18217688 DOI: 10.1097/mbc.0b013e3282f9b17f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An important step in the analysis of protein function is identification of the interaction partners of each protein. The two-hybrid system has been widely used to identify and explore protein-protein interactions. By using various two-hybrid systems, numerous protein interactions that regulate apoptosis signaling have been discovered that reveal unexpected functions of cancer-relevant proteins. Methods for performing two-hybrid experiments using either yeast or mammalian cells will be described in this chapter.
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Saha JK, Xia J, Sandusky GE, Chen YF, Gerlitz B, Grinnell B, Jakubowski JA. Study of plasma protein C and inflammatory pathways: biomarkers for dimethylnitrosamine-induced liver fibrosis in rats. Eur J Pharmacol 2007; 575:158-67. [PMID: 17719030 DOI: 10.1016/j.ejphar.2007.07.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 07/10/2007] [Accepted: 07/17/2007] [Indexed: 01/28/2023]
Abstract
The present investigation was designed to identify potential biomarker(s) and assess the involvement of inflammatory pathway in dimethylnitrosamine (DMN)-induced liver fibrosis in rats. Following DMN-treatment (10 mg/ml/kg, i.p., given three consecutive days each week for 4 weeks) body and liver weights were significantly decreased concurrent with increasing severity of liver damage assessed by bridging fibrosis, a histopathologic assessment and characteristic of human liver disease. Protein C along with albumin, C-reactive-protein (CRP), haptoglobin and total protein were significantly reduced and correlated with changes in liver histopathology. Biochemical markers of liver functions were significantly increased and correlated with changes in liver histopathology and plasma levels of protein C. Soluble intracellular-adhesion-molecule-1 (sICAM-1) levels were increased significantly but were poorly correlated with histopathology and protein C levels. Inflammatory chemokines and other analytes, monocyte-chemoattractant-protein-1 and 3 (MCP-1 and MCP-3), macrophage-colony-stimulating-factor (M-CSF) were significantly increased during the disease progression, whereas macrophage-derived-chemokine (MDC) and CRP were significantly suppressed. Circulating neutrophils and monocytes were also increased along with disease progression. The differential changes in sICAM-1, hyaluronic acid, gamma-glutamyltranspeptidase (GGT), neutrophil and other inflammatory chemokines suggest the involvement of inflammatory pathways in DMN-induced liver fibrosis. In conclusion, the progressive changes in protein C along with other noninvasive biochemical parameters whose levels were significantly correlated with disease progression may serve as biomarkers for pharmacological assessment of targeted therapy for liver fibrosis.
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Affiliation(s)
- Joy K Saha
- BioTherapeutic Discovery Research, Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
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