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Hypofibrinolysis induced by tranexamic acid does not influence inflammation and mortality in a polymicrobial sepsis model. PLoS One 2019; 14:e0226871. [PMID: 31891611 PMCID: PMC6938370 DOI: 10.1371/journal.pone.0226871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/08/2019] [Indexed: 01/08/2023] Open
Abstract
The biological relevance of fibrinolysis to the host response to sepsis is illustrated by pathogens such as S. pyogenes and Y. pestis, whose virulence factors are proteins that challenge the balance between pro- and anti-fibrinolytic factors of the host, and by the consistent finding of hypofibrinolysis in the early stages of sepsis. Whether this hypofibrinolytic response is beneficial or detrimental to the host, by containing the spread of pathogens while at the same time limiting the access of immune cell to infectious foci, is still a matter of debate. Tranexamic acid (TnxAc) is an antifibrinolytic agent that is being increasingly used to prevent and control bleeding in conditions such as elective orthopedic surgery, trauma, and post-partum-hemorrhage, which are frequently followed by infection and sepsis. Here we used a model of polymicrobial sepsis to evaluate whether hypofibrinolysis induced by TnxAc influenced survival, tissue injury and pathogen spread. Mice were treated with two doses of TnxAc bid for 48h, and then sepsis was induced by cecal ligation and puncture. Despite the induction of hypofibrinolysis by TnxAc, no difference could be observed in survival, tissue injury (measured by biochemical and histological parameters), cytokine levels or pathogen spread. Our results contribute with a new piece of data to the understanding of the complex interplay between fibrinolysis and innate immunity. While our results do not support the use of TnxAc in sepsis, they also address the thrombotic safety of TnxAc, a low cost and widely used agent to prevent bleeding.
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2
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Ly D, Donahue D, Walker MJ, Ploplis VA, McArthur JD, Ranson M, Castellino FJ, Sanderson-Smith ML. Characterizing the role of tissue-type plasminogen activator in a mouse model of Group A streptococcal infection. Microbes Infect 2019; 21:412-417. [PMID: 31009808 PMCID: PMC7707001 DOI: 10.1016/j.micinf.2019.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 11/20/2022]
Abstract
Plasmin(ogen) acquisition is critical for invasive disease initiation by Streptococcus pyogenes (GAS). Host urokinase plasminogen activator (uPA) plays a role in mediating plasminogen activation for GAS dissemination, however the contribution of tissue-type plasminogen activator (tPA) to GAS virulence is unknown. Using novel tPA-deficient ALBPLG1 mice, our study revealed no difference in mouse survival, bacterial dissemination or the pathology of GAS infection in the absence of tPA in AlbPLG1/tPA-/- mice compared to AlbPLG1 mice. This study suggests that tPA has a limited role in this humanized model of GAS infection, further highlighting the importance of its counterpart uPA in GAS disease.
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Affiliation(s)
- Diane Ly
- Illawarra Health and Medical Research Institute and School of Chemistry and Molecular Bioscience, Molecular Horizons, University of Wollongong, Wollongong, New South Wales, Australia
| | - Deborah Donahue
- W. M. Keck Center for Transgene Research, Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, United States
| | - Mark J Walker
- School of Chemistry and Molecular Bioscience, Australian Infectious Diseases Research Centre, University of Queensland, St. Lucia, Queensland, Australia
| | - Victoria A Ploplis
- W. M. Keck Center for Transgene Research, Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, United States
| | - Jason D McArthur
- Illawarra Health and Medical Research Institute and School of Chemistry and Molecular Bioscience, Molecular Horizons, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marie Ranson
- Illawarra Health and Medical Research Institute and School of Chemistry and Molecular Bioscience, Molecular Horizons, University of Wollongong, Wollongong, New South Wales, Australia
| | - Francis J Castellino
- W. M. Keck Center for Transgene Research, Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN, United States
| | - Martina L Sanderson-Smith
- Illawarra Health and Medical Research Institute and School of Chemistry and Molecular Bioscience, Molecular Horizons, University of Wollongong, Wollongong, New South Wales, Australia.
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3
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Khashim Z, Fitzgerald S, Kadirvel R, Dai D, Doyle KM, Brinjikji W, Kallmes DF. Clots retrieved by mechanical thrombectomy from acute ischemic stroke patients show no evidence of bacteria. Interv Neuroradiol 2019; 25:502-507. [PMID: 30939960 DOI: 10.1177/1591019918819707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Bacteria and bacterial components have been associated with the activation of coagulation factors and initiating the blood clot formation. The aim of this study was to investigate whether bacterial populations are present in clots retrieved from patients that have suffered a large vessel occlusion acute ischemic stroke (AIS). MATERIALS AND METHODS Clot samples were collected from 20 AIS patients who underwent clot retrieval with mechanical thrombectomy. Patient clinical demographic details were noted. Expression of bacterial 16S rDNA was analyzed by standard and real-time polymerase chain reaction (PCR). Gram staining was performed to identify Gram-positive and Gram-negative bacteria. RESULTS Both the real-time and standard PCR demonstrated no expression of 16S rDNA in any of the 20 clots samples from AIS patients. Gram staining results showed no expression of Gram-positive or Gram-negative bacteria present in the clot samples. CONCLUSION Our current study found no bacteria populations in the clots of AIS patients.
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Affiliation(s)
| | - Seán Fitzgerald
- Department of Radiology, Mayo Clinic, Rochester, USA.,Department of Physiology and CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | | | - Daying Dai
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - Karen M Doyle
- Department of Physiology and CÚRAM-Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
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Ko YP, Flick MJ. Fibrinogen Is at the Interface of Host Defense and Pathogen Virulence in Staphylococcus aureus Infection. Semin Thromb Hemost 2016; 42:408-21. [PMID: 27056151 PMCID: PMC5514417 DOI: 10.1055/s-0036-1579635] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fibrinogen not only plays a pivotal role in hemostasis but also serves key roles in antimicrobial host defense. As a rapidly assembled provisional matrix protein, fibrin(ogen) can function as an early line of host protection by limiting bacterial growth, suppressing dissemination of microbes to distant sites, and mediating host bacterial killing. Fibrinogen-mediated host antimicrobial activity occurs predominantly through two general mechanisms, namely, fibrin matrices functioning as a protective barrier and fibrin(ogen) directly or indirectly driving host protective immune function. The potential of fibrin to limit bacterial infection and disease has been countered by numerous bacterial species evolving and maintaining virulence factors that engage hemostatic system components within vertebrate hosts. Bacterial factors have been isolated that simply bind fibrinogen or fibrin, promote fibrin polymer formation, or promote fibrin dissolution. Staphylococcus aureus is an opportunistic gram-positive bacterium, the causative agent of a wide range of human infectious diseases, and a prime example of a pathogen exquisitely sensitive to host fibrinogen. Indeed, current data suggest fibrinogen serves as a context-dependent determinant of host defense or pathogen virulence in Staphylococcus infection whose ultimate contribution is dictated by the expression of S. aureus virulence factors, the path of infection, and the tissue microenvironment.
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Affiliation(s)
- Ya-Ping Ko
- Center for Infectious and Inflammatory Diseases, Institute for Biosciences and Technology, Texas A&M Health Science Center, Houston, Texas
| | - Matthew J. Flick
- Division of Experimental Hematology and Cancer Biology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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5
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The lectin like domain of thrombomodulin is involved in the defence against pyelonephritis. Thromb Res 2015; 136:1325-31. [PMID: 26573396 DOI: 10.1016/j.thromres.2015.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 10/22/2015] [Accepted: 11/06/2015] [Indexed: 11/21/2022]
Abstract
Pyelonephritis, a common complication of urinary tract infections, is frequently associated with kidney scarring and may lead to end-stage renal disease. During bacterial infections inflammatory and coagulation pathways and their mutual interaction are playing pivotal roles in the host response. Given that thrombomodulin (TM) is crucially involved in the interplay between coagulation and inflammation, we aimed to investigate the roles of its EGF and lectin-like domains in inflammation during acute pyelonephritis. Indeed, the EGF-like and the lectin-like domains of TM, are especially known to orchestrate inflammation and coagulation in different ways. Acute pyelonephritis was induced by intravesical inoculation of 1 × 10(8) CFU of uropathogenic Escherichia coli in two strains of TM transgenic mice. TM(pro/pro) mice carry a mutation in the EGF-like domain making them unable to activate protein C, an anticoagulant and anti-inflammatory protein. TM(LeD/LeD) mice lack the lectin-like domain of TM, which is critical for its anti-inflammatory and cytoprotective properties. Mice were sacrificed 24 and 48 h after inoculation. Bacterial loads, the immune response and the activation of coagulation were evaluated in the kidney and the bladder. TM(LeD/LeD) mice showed elevated bacterial load in bladder and kidneys compared to WT mice, whereas TM(pro/pro) had similar bacterial load as WT mice. TM(LeD/LeD) mice displayed a reduced local production of pro-inflammatory cytokines and neutrophil renal infiltration. Activation of coagulation was comparable in TM(LeD/LeD) and WT mice. From these data, we conclude that the lectin-like domain of thrombomodulin is critically involved in host defence against E. coli induced acute pyelonephritis.
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Peetermans M, Vanassche T, Liesenborghs L, Lijnen RH, Verhamme P. Bacterial pathogens activate plasminogen to breach tissue barriers and escape from innate immunity. Crit Rev Microbiol 2015; 42:866-82. [PMID: 26485450 DOI: 10.3109/1040841x.2015.1080214] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Both coagulation and fibrinolysis are tightly connected with the innate immune system. Infection and inflammation cause profound alterations in the otherwise well-controlled balance between coagulation and fibrinolysis. Many pathogenic bacteria directly exploit the host's hemostatic system to increase their virulence. Here, we review the capacity of bacteria to activate plasminogen. The resulting proteolytic activity allows them to breach tissue barriers and evade innate immune defense, thus promoting bacterial spreading. Yersinia pestis, streptococci of group A, C and G and Staphylococcus aureus produce a specific bacterial plasminogen activator. Moreover, surface plasminogen receptors play an established role in pneumococcal, borrelial and group B streptococcal infections. This review summarizes the mechanisms of bacterial activation of host plasminogen and the role of the fibrinolytic system in infections caused by these pathogens.
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Affiliation(s)
- Marijke Peetermans
- a Center for Molecular and Vascular Biology, KU Leuven , Leuven , Belgium
| | - Thomas Vanassche
- a Center for Molecular and Vascular Biology, KU Leuven , Leuven , Belgium
| | | | - Roger H Lijnen
- a Center for Molecular and Vascular Biology, KU Leuven , Leuven , Belgium
| | - Peter Verhamme
- a Center for Molecular and Vascular Biology, KU Leuven , Leuven , Belgium
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7
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Fiusa MML, Carvalho-Filho MA, Annichino-Bizzacchi JM, De Paula EV. Causes and consequences of coagulation activation in sepsis: an evolutionary medicine perspective. BMC Med 2015; 13:105. [PMID: 25943883 PMCID: PMC4422540 DOI: 10.1186/s12916-015-0327-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/16/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Coagulation and innate immunity have been linked together for at least 450 million years of evolution. Sepsis, one of the world's leading causes of death, is probably the condition in which this evolutionary link is more evident. However, the biological and the clinical relevance of this association have only recently gained the attention of the scientific community. DISCUSSION During sepsis, the host response to a pathogen is invariably associated with coagulation activation. For several years, coagulation activation has been solely regarded as a mechanism of tissue damage, a concept that led to several clinical trials of anticoagulant agents for sepsis. More recently, this paradigm has been challenged by the failure of these clinical trials, and by a growing bulk of evidence supporting the concept that coagulation activation is beneficial for pathogen clearance. In this article we discuss recent basic and clinical data that point to a more balanced view of the detrimental and beneficial consequences of coagulation activation in sepsis. Reappraisal of the association between coagulation and immune activation from an evolutionary medicine perspective offers a unique opportunity to gain new insights about the pathogenesis of sepsis, paving the way to more successful approaches in both basic and clinical research in this field.
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Affiliation(s)
- Maiara Marx Luz Fiusa
- Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz, 13083-878, Campinas, SP, Brazil.
| | - Marco Antonio Carvalho-Filho
- Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz, 13083-878, Campinas, SP, Brazil.
| | - Joyce M Annichino-Bizzacchi
- Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz, 13083-878, Campinas, SP, Brazil. .,Hematology and Hemotherapy Center, University of Campinas, Campinas, SP, Brazil.
| | - Erich V De Paula
- Faculty of Medical Sciences, University of Campinas, Rua Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz, 13083-878, Campinas, SP, Brazil. .,Hematology and Hemotherapy Center, University of Campinas, Campinas, SP, Brazil.
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8
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Kager LM, van der Poll T, Wiersinga WJ. The coagulation system in melioidosis: from pathogenesis to new treatment strategies. Expert Rev Anti Infect Ther 2014; 12:993-1002. [PMID: 24962103 DOI: 10.1586/14787210.2014.928198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Melioidosis, caused by the Gram-negative bacterium Burkholderia pseudomallei, is a dreadful disease common in South-East Asia and Northern Australia and is characterized by chronic suppurative lesions and pneumonia. Melioidosis may evolve into severe sepsis with multi-organ failure with high mortalities, despite proper antibiotic therapy. Besides activation of a strong pro-inflammatory host response, the coagulation system plays an important role during melioidosis, which is thought to be host-protective. In particular, a procoagulant state together with downregulation of anticoagulant pathways and activation of fibrinolysis are present, all closely interrelated with parameters of inflammation. This review presents an overview of recent studies in which the role of coagulation, anti-coagulation and fibrinolysis during melioidosis was investigated both in patients and in experimental settings.
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Affiliation(s)
- Liesbeth Martine Kager
- Academic Medical Center, Center for Experimental and Molecular Medicine (CEMM), University of Amsterdam, Meibergdreef 9, Room G2-130,1105 AZ, Amsterdam, The Netherlands
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9
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Kager LM, Wiersinga WJ, Roelofs JJTH, de Boer OJ, Weiler H, van 't Veer C, van der Poll T. A thrombomodulin mutation that impairs active protein C generation is detrimental in severe pneumonia-derived gram-negative sepsis (melioidosis). PLoS Negl Trop Dis 2014; 8:e2819. [PMID: 24762740 PMCID: PMC3998929 DOI: 10.1371/journal.pntd.0002819] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 03/11/2014] [Indexed: 11/18/2022] Open
Abstract
Background During severe (pneumo)sepsis inflammatory and coagulation pathways become activated as part of the host immune response. Thrombomodulin (TM) is involved in a range of host defense mechanisms during infection and plays a pivotal role in activation of protein C (PC) into active protein C (APC). APC has both anticoagulant and anti-inflammatory properties. In this study we investigated the effects of impaired TM-mediated APC generation during melioidosis, a common form of community-acquired Gram-negative (pneumo)sepsis in South-East Asia caused by Burkholderia (B.) pseudomallei. Methodology/Principal Findings (WT) mice and mice with an impaired capacity to activate protein C due to a point mutation in their Thbd gene (TMpro/pro mice) were intranasally infected with B. pseudomallei and sacrificed after 24, 48 or 72 hours for analyses. Additionally, survival studies were performed. When compared to WT mice, TMpro/pro mice displayed a worse survival upon infection with B. pseudomallei, accompanied by increased coagulation activation, enhanced lung neutrophil influx and bronchoalveolar inflammation at late time points, together with increased hepatocellular injury. The TMpro/pro mutation had limited if any impact on bacterial growth and dissemination. Conclusion/Significance TM-mediated protein C activation contributes to protective immunity after infection with B. pseudomallei. These results add to a better understanding of the regulation of the inflammatory and procoagulant response during severe Gram-negative (pneumo)sepsis. Pneumonia and sepsis are conditions in which a procoagulant state is observed, with activation of coagulation and downregulation of anticoagulant pathways, both closely interrelated with inflammation. The protein C (PC) system is an important anticoagulant pathway implicated in the pathogenesis of sepsis. After binding to thrombomodulin (TM), PC is converted into active protein C (APC), mediated via high-affinity binding of thrombin to thrombomodulin (TM) and further augmented via association of the endothelial protein C receptor (EPCR) to the TM-thrombin complex. We studied the role of TM-associated PC-activation during the host response during pneumonia-derived sepsis caused by Burkholderia (B.) pseudomallei, the causative agent of melioidosis, a common form of community-acquired Gram-negative (pneumo)sepsis in South-East Asia and a serious potential bioterrorism threat agent. Mice with an impaired capacity to activate protein C displayed a worse survival upon infection with B. pseudomallei, accompanied by increased coagulation activation, enhanced lung neutrophil influx and bronchoalveolar inflammation at late time points, together with increased hepatocellular injury. These data further expand the knowledge about the role of the protein C system during melioidosis and may be of value in the development of therapeutic strategies against this dangerous pathogen.
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Affiliation(s)
- Liesbeth M. Kager
- Center for Experimental and Molecular Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - W. Joost Wiersinga
- Center for Experimental and Molecular Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Joris J. T. H. Roelofs
- Department of Pathology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Onno J. de Boer
- Department of Pathology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Hartmut Weiler
- Blood Research Institute, Blood Center of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Cornelis van 't Veer
- Center for Experimental and Molecular Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Tom van der Poll
- Center for Experimental and Molecular Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
- Division of Infectious Diseases, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
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van der Poll T, Herwald H. The coagulation system and its function in early immune defense. Thromb Haemost 2014; 112:640-8. [PMID: 24696161 DOI: 10.1160/th14-01-0053] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 02/18/2014] [Indexed: 02/06/2023]
Abstract
Blood coagulation has a Janus-faced role in infectious diseases. When systemically activated, it can cause serious complications associated with high morbidity and mortality. However, coagulation is also part of the innate immune system and its local activation has been found to play an important role in the early host response to infection. Though the latter aspect has been less investigated, phylogenetic studies have shown that many factors involved in coagulation have ancestral origins which are often combined with anti-microbial features. This review gives a general overview about the most recent advances in this area of research also referred to as immunothrombosis.
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Affiliation(s)
| | - Heiko Herwald
- Heiko Herwald, Department of Clinical Sciences, Lund, Division of Infection Medicine, BMC B14, Lund University, Tornavägen 10, SE-221 84 Lund, Sweden, Tel.: +46 46 2224182, Fax: +46 46 157756, E-mail
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Mice Lacking the Lectin-Like Domain of Thrombomodulin Are Protected Against Melioidosis. Crit Care Med 2014; 42:e221-30. [DOI: 10.1097/ccm.0000000000000134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Kager LM, Weehuizen TA, Wiersinga WJ, Roelofs JJTH, Meijers JCM, Dondorp AM, van 't Veer C, van der Poll T. Endogenous α2-antiplasmin is protective during severe gram-negative sepsis (melioidosis). Am J Respir Crit Care Med 2013; 188:967-75. [PMID: 23992406 DOI: 10.1164/rccm.201307-1344oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE α2-Antiplasmin (A2AP) is a major inhibitor of fibrinolysis by virtue of its capacity to inhibit plasmin. Although the fibrinolytic system is strongly affected by infection, the functional role of A2AP in the host response to sepsis is unknown. OBJECTIVES To study the role of A2AP in melioidosis, a common form of community-acquired sepsis in Southeast Asia and Northern Australia caused by the gram-negative bacterium Burkholderia pseudomallei. METHODS In a single-center observational study A2AP was measured in patients with culture-proven septic melioidosis. Wild-type and A2AP-deficient (A2AP(-/-)) mice were intranasally infected with B. pseudomallei to induce severe pneumosepsis (melioidosis). Parameters of inflammation and coagulation were measured, and survival studies were performed. MEASUREMENTS AND MAIN RESULTS Patients with melioidosis showed elevated A2AP plasma levels. Likewise, A2AP levels in plasma and lung homogenates were elevated in mice infected with B. pseudomallei. A2AP-deficient (A2AP(-/-)) mice had a strongly disturbed host response during experimental melioidosis as reflected by enhanced bacterial growth at the primary site of infection accompanied by increased dissemination to distant organs. In addition, A2AP(-/-) mice showed more severe lung pathology and injury together with an increased accumulation of neutrophils and higher cytokine levels in lung tissue. A2AP deficiency further was associated with exaggerated systemic inflammation and coagulation, increased distant organ injury, and enhanced lethality. CONCLUSIONS This study is the first to identify A2AP as a protective mediator during gram-negative (pneumo)sepsis by limiting bacterial growth, inflammation, tissue injury, and coagulation.
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Overexpression of Activated Protein C is Detrimental During Severe Experimental Gram-Negative Sepsis (Melioidosis)*. Crit Care Med 2013; 41:e266-74. [DOI: 10.1097/ccm.0b013e31828a4316] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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14
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Activated Protein C. Crit Care Med 2013; 41:2463-4. [DOI: 10.1097/ccm.0b013e31829136ae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Kager LM, Schouten M, Wiersinga WJ, de Boer JD, Lattenist LCW, Roelofs JJTH, Meijers JCM, Levi M, Dondorp AM, Esmon CT, van 't Veer C, van der Poll T. Overexpression of the endothelial protein C receptor is detrimental during pneumonia-derived gram-negative sepsis (Melioidosis). PLoS Negl Trop Dis 2013; 7:e2306. [PMID: 23875041 PMCID: PMC3708857 DOI: 10.1371/journal.pntd.0002306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 05/28/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The endothelial protein C receptor (EPCR) enhances anticoagulation by accelerating activation of protein C to activated protein C (APC) and mediates anti-inflammatory effects by facilitating APC-mediated signaling via protease activated receptor-1. We studied the role of EPCR in the host response during pneumonia-derived sepsis instigated by Burkholderia (B.) pseudomallei, the causative agent of melioidosis, a common form of community-acquired Gram-negative (pneumo)sepsis in South-East Asia. METHODOLOGY/PRINCIPAL FINDINGS Soluble EPCR was measured in plasma of patients with septic culture-proven melioidosis and healthy controls. Experimental melioidosis was induced by intranasal inoculation of B. pseudomallei in wild-type (WT) mice and mice with either EPCR-overexpression (Tie2-EPCR) or EPCR-deficiency (EPCR(-/-)). Mice were sacrificed after 24, 48 or 72 hours. Organs and plasma were harvested to measure colony forming units, cellular influxes, cytokine levels and coagulation parameters. Plasma EPCR-levels were higher in melioidosis patients than in healthy controls and associated with an increased mortality. Tie2-EPCR mice demonstrated enhanced bacterial growth and dissemination to distant organs during experimental melioidosis, accompanied by increased lung damage, neutrophil influx and cytokine production, and attenuated coagulation activation. EPCR(-/-) mice had an unremarkable response to B. pseudomallei infection as compared to WT mice, except for a difference in coagulation activation in plasma. CONCLUSION/SIGNIFICANCE Increased EPCR-levels correlate with accelerated mortality in patients with melioidosis. In mice, transgenic overexpression of EPCR aggravates outcome during Gram-negative pneumonia-derived sepsis caused by B. pseudomallei, while endogenous EPCR does not impact on the host response. These results add to a better understanding of the regulation of coagulation during severe (pneumo)sepsis.
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Affiliation(s)
- Liesbeth M Kager
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Kager LM, Wiersinga WJ, Roelofs JJ, Meijers JCM, Zeerleder SS, Esmon CT, van't Veer C, van der Poll T. Endogenous protein C has a protective role during Gram-negative pneumosepsis (melioidosis). J Thromb Haemost 2013; 11:282-92. [PMID: 23216621 DOI: 10.1111/jth.12094] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 11/21/2012] [Indexed: 01/21/2023]
Abstract
BACKGROUND Activated protein C (APC) exerts anticoagulant effects via inactivation of factors Va and VIIIa and cytoprotective effects via protease activated receptor (PAR)1. Inhibition of endogenous APC in endotoxemia and sepsis results in exacerbation of coagulation and inflammation, with consequent enhanced lethality. OBJECTIVES We here sought to dissect the distinct roles of the anticoagulant and cytoprotective functions of endogenous APC in severe Gram-negative pneumonia-derived sepsis (melioidosis). METHODS We infected wild-type (WT) mice with Burkholderia pseudomallei, a common sepsis pathogen in southeast Asia, and treated them with antibodies inhibiting both the anticoagulant and cytoprotective functions of APC (MPC1609) or the anticoagulant functions of APC (MAPC1591) only. Additionally, we administered SEW2871 (stimulating the S1P1-pathway downstream from PAR1) to control and MPC1609-treated mice. RESULTS MPC1609, but not MAPC1591, significantly worsened survival, increased coagulation activation, facilitated bacterial growth and dissemination and enhanced the inflammatory response. The effects of MPC1609 could not be reversed by SEW2871, suggesting that S1P1 does not play a major role in this model. CONCLUSIONS These results suggest that the mere inhibition of the anticoagulant function of APC does not interfere with its protective role during Gram-negative pneumosepsis, suggesting a more prominent role for cytoprotective effects of APC .
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Affiliation(s)
- L M Kager
- Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Differential host response to Burkholderia pseudomallei. Crit Care Med 2012; 40:2257. [DOI: 10.1097/ccm.0b013e3182536cab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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