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Yao M, Yang Y, Fan J, Ma C, Liu X, Wang Y, Wang B, Sun Z, McClements DJ, Zhang J, Liu L, Xia G, Zhang N, Sun Q. Production, purification, and functional properties of microbial fibrinolytic enzymes produced by microorganism obtained from soy-based fermented foods: developments and challenges. Crit Rev Food Sci Nutr 2022; 64:3725-3750. [PMID: 36315047 DOI: 10.1080/10408398.2022.2134980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
According to the World Health Organization, cardiovascular disease (CVD) has become a major cause of chronic illness around the globe. It has been reported that soy-based fermented food (SFF) is very effective in preventing thrombus (one of the most important contributing factors to CVD), which are mainly attributed to the bioactive substances, especially the fibrinolytic enzymes (FE) generated by microorganisms during the fermentation process of soybean food. This paper therefore mainly reviewed the microbial fibrinolytic enzymes (MFE) from SFF. We first discuss the use of microbial fermentation to produce FE, with an emphasis on the strains involved. The production, purification, physicochemical properties, structure-functional attributes, functional properties and possible application of MFE from SFF are then discussed. Finally, current limitations and future perspectives for the production, purification, and the practical application of MFE are discussed. MFE from SFF pose multiple health benefits, including thrombolysis, antihypertension, anti-inflammatory, anti-hyperlipidemia, anticancer, neuroprotective, antiviral and other activities. Therefore, they exhibit great potential for functional foods and nutraceutical applications, especially foods with CVDs prevention potential.
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Affiliation(s)
- Mingjing Yao
- School of Food Engineering, Harbin University of Commerce, Harbin, China
- Shandong Provincial Key Laboratory of Food and Fermentation Engineering, Shandong Food Ferment Industry Research & Design Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
| | - Yang Yang
- School of Food Engineering, Harbin University of Commerce, Harbin, China
| | - Jing Fan
- School of Food Engineering, Harbin University of Commerce, Harbin, China
| | - Chunmin Ma
- School of Food Engineering, Harbin University of Commerce, Harbin, China
| | - Xiaofei Liu
- School of Food Engineering, Harbin University of Commerce, Harbin, China
| | - Yan Wang
- School of Food Engineering, Harbin University of Commerce, Harbin, China
| | - Bing Wang
- School of Food Engineering, Harbin University of Commerce, Harbin, China
| | - Zhihui Sun
- School of Food Engineering, Harbin University of Commerce, Harbin, China
| | | | - Jiaxiang Zhang
- Shandong Provincial Key Laboratory of Food and Fermentation Engineering, Shandong Food Ferment Industry Research & Design Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
| | - Liping Liu
- Shandong Provincial Key Laboratory of Food and Fermentation Engineering, Shandong Food Ferment Industry Research & Design Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, China
| | - Guanghua Xia
- College of Food Science and Technology, Hainan University, Hainan, China
| | - Na Zhang
- School of Food Engineering, Harbin University of Commerce, Harbin, China
| | - Quancai Sun
- Department of Food Science and Technology, National University of Singapore, Singapore
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang, China
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Moula Ali AM, Bavisetty SCB. Purification, physicochemical properties, and statistical optimization of fibrinolytic enzymes especially from fermented foods: A comprehensive review. Int J Biol Macromol 2020; 163:1498-1517. [PMID: 32781120 DOI: 10.1016/j.ijbiomac.2020.07.303] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022]
Abstract
Fibrinolytic enzymes are proteases responsible for cleavage of fibrin mesh in thrombus clots, which are the primary causative agents in cardiovascular diseases. Developing safe, effective and cheap thrombolytic agents are important for prevention and cure of thrombosis. Although a wide variety of sources have been discovered for fibrinolytic enzymes, only few of them have been employed in clinical and therapeutic applications due to the drawbacks such as high cost of production, low stability of enzyme or therapeutic side effects. However, the discovery of new fibrinolytic enzymes requires complex purification stages and characterization, which gives an insight into their diverse modes of action. Post-discovery, approaches such as a) statistical optimization for fermentative bioprocessing and b) genetic engineering are advantageous in providing economic viability by finding simple and cost-effective medium, strain development with sufficient nutrient supplements for stable and high-level production of recombinant enzyme. This review provides a comprehensive understanding of different sources, purification techniques, production through genetic engineering approaches and statistical optimization of fermentation parameters as proteases have a wide variety of industrial and biotechnological applications making 60% of total enzyme market worldwide. New strategies targeting increased enzyme yields, non-denaturing environments, improved stability, enzyme activity and strain improvement have been discussed.
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Affiliation(s)
- Ali Muhammed Moula Ali
- Department of Food Science and Technology, Faculty of Food-Industry, King Mongkut's Institute of Technology Ladkrabang, Bangkok 10520, Thailand
| | - Sri Charan Bindu Bavisetty
- Department of Fermentation Technology, Faculty of Food-Industry, King Mongkut's Institute of Technology Ladkrabang, Bangkok 10520, Thailand.
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Johnson TE, Wells RJ, Bell A, Nielsen VG, Olver CS. Carbon monoxide releasing molecule enhances coagulation and decreases fibrinolysis in canine plasma exposed to Crotalus viridis venom in vitro and in vivo. Basic Clin Pharmacol Toxicol 2019; 125:328-336. [PMID: 31059181 DOI: 10.1111/bcpt.13242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 04/24/2019] [Indexed: 11/30/2022]
Abstract
Carbon monoxide releasing molecule-2 (CORM-2), an emerging therapeutic in human medicine, enhances plasmatic coagulation and attenuates fibrinolysis in vitro in human, rabbit and horse plasma and ameliorates hypocoagulation and hyperfibrinolysis secondary to venom exposure in human plasma in vitro. Fibrinogenases in rattlesnake venom cause decreased clot strength, and in the presence of tissue plasminogen activator (tPA) in vitro, a markedly increased rate of clot lysis. CO interacts with a haem group on fibrinogen, changing its configuration so that the fibrin clot is strengthened and more resistant to fibrinolysis. We hypothesized that CORM-2 enhances coagulation and attenuates fibrinolysis in canine plasma exposed to C viridis venom. We measured the effects of C viridis venom on clot strength, rates of coagulation and fibrinolysis in both pooled canine plasma and plasma from individual naturally envenomed dogs, with and without CORM-2, using thromboelastography (TEG). We tested venom effects on coagulation using tissue factor (TF) activated TEG and on both coagulation and fibrinolysis using TF-activated TEG with added tPA. We found that 17.9 µg/mL of venom causes a mean 26.4% decrease in clot strength, a 61.8% decrease in maximum rate of thrombus generation, 75% faster clot lysis, a 226% increase in maximum rate of lysis and a 92% decrease in total clot life span (CLS). CORM-2 ameliorated these effects, increasing CLS in the presence of venom by 603%. Additionally, we showed that CORM-2 has similar effects in vitro on plasma from naturally envenomed dogs, showing promise as an adjunct therapy for snake envenomation.
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Affiliation(s)
- Tyler E Johnson
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, North Carolina
| | - Raegan J Wells
- Phoenix Veterinary Referral and Emergency, Phoenix, Arizona
| | - Amy Bell
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - Vance G Nielsen
- Department of Anesthesia, University of Arizona College of Medicine, Tucson, Arizona
| | - Christine S Olver
- Department of Microbiology, Immunology and Pathology, Clinical Pathology Section, Colorado State University, Fort Collins, Colorado
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Novel Fibrinolytic Protease Producing Streptomyces radiopugnans VITSD8 from Marine Sponges. Mar Drugs 2019; 17:md17030164. [PMID: 30871149 PMCID: PMC6471097 DOI: 10.3390/md17030164] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022] Open
Abstract
Fibrinolytic enzymes have received more attention due to their medicinal potential for thrombolytic diseases. The aim of this study is to characterize the in vitro fibrinolytic nature of purified protease producing Streptomyces radiopugnans VITSD8 from marine brown tube sponges Agelas conifera. Three varieties of sponge were collected from the Rameshwaram Sea coast, Tamil Nadu, India. The fibrinolytic activity of Streptomyces sp. was screened and determined by casein plasminogen plate and fibrin plate methods respectively. The crude caseinolytic protease was purified using ammonium sulfate fractionation, affinity and ion-exchange chromatography. Based on the morphological, biochemical, and molecular characterization, the isolate VITSD8 was confirmed as Streptomyces radiopugnans. Maltose and peptone were found to be the best carbon and nitrogen sources for the production of fibrinolytic protease. The carbon and nitrogen source peptone showed (781 U/mL) enzyme activity. The optimum pH and temperature for fibrinolytic protease production was found to be 7.0 and 33 °C respectively. The purified enzyme showed a maximum specific activity of 3891 U. The blood clot lysis activity was compared with the standard, and it was concluded that a minimum of 0.18 U (10 µL) of purified protease was required to dissolve the blood clot. This is the first report which exploits the fibrinolytic protease activity of Streptomyces radiopugnans VITSD8 extracted from a marine sponge. Hence the investigation suggests a potential benefit of purified fibrinolytic protease which will serve as an excellent clot buster alternative.
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Bourcier R, Legrand L, Soize S, Labreuche J, Beaumont M, Desal H, Derraz I, Bracard S, Oppenheim C, Naggara O. Validation of overestimation ratio and TL-SVS as imaging biomarker of cardioembolic stroke and time from onset to MRI. Eur Radiol 2018; 29:2624-2631. [PMID: 30421018 DOI: 10.1007/s00330-018-5835-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/17/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aimed to determine in the "THRACE" trial, the clinical and MRI technical parameters associated with the two-layered susceptibility vessel sign (TL-SVS) and the overestimation ratio (overR). MATERIALS AND METHODS Patients with pre-treatment brain gradient echo (GRE) sequence and an etiological work-up were identified. Two readers reviewed TL-SVS, i.e., a SVS with a linear low-intense signal core surrounded by a higher intensity and measured the overR as the width of SVS divided by the width of the artery. Binomial and ordinal logistic regression respectively tested the association between TL-SVS and quartiles of overR with patient characteristics, cardioembolic stroke (CES), time from onset to imaging, and GRE sequence parameters (inter slice gap, slice thickness, echo time, flip angle, voxel size, and field strength). RESULTS Among 258 included patients, 102 patients were examined by 3 Tesla MRI and 156 by 1.5 Tesla MRI. Intra- and inter-reader agreements for quartiles of overR and TL-SVS were good to excellent. The median overR was 1.59 (IQR, 1.30 to 1.86). TL-SVS was present in 101 patients (39.2%, 95%CI, 33.1 to 45.1%). In multivariate analysis, only CES was associated with overR quartiles (OR, 1.83; 95%CI, 1.11 to 2.99), and every 60 min increase from onset to MRI time was associated with TL-SVS (OR, 1.72; 95%CI, 1.10 to 2.67). MRI technical parameters were statistically associated with neither overR nor TL-SVS. CONCLUSION Independent of GRE sequence parameters, an increased overR was associated to CES, while the TL-SVS is independently related to a longer time from onset to MRI. KEY POINTS • An imaging biomarker would be useful to predict the etiology of stroke in order to adapt secondary prevention of stroke. • The two-layered susceptibility vessel sign and the overestimation ratio are paramagnetic effect derived markers that vary according to the MRI machines and sequence parameters. • Independent of sequence parameters, an increased overestimation ratio was associated to cardioembolic stroke, while the two-layered susceptibility vessel sign is independently related to a longer time from onset to MRI.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.
| | - Laurence Legrand
- Department of Neuroradiology, Université Paris-Descartes. INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Sébastien Soize
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Reims, Reims, France.,INSERM UMR-S 1237 Physiopathology and imaging of neurological disorders, Université Caen Normandie, Caen, France
| | - Julien Labreuche
- Centre Hospitalier Regional Universitaire de Lille, Biostatistics, Lille, Hauts-de-France, France
| | - Marine Beaumont
- CIC1433, INSERM, IADI, U1254, Université de Lorraine, INSERM, CHRU de Nancy CIC-IT Nancy, Nancy, France
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Imad Derraz
- Department of Diagnostic and Interventional Neuroradiology, Hopital Gui de Chauillac, Montpellier, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Université Paris-Descartes. INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Olivier Naggara
- Department of Neuroradiology, Université Paris-Descartes. INSERM U894, Sainte-Anne Hospital, Paris, France.,Pediatric Radiology Department, Necker Enfants Malades, Paris, France
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Bourcier R, Derraz I, Delasalle B, Beaumont M, Soize S, Legrand L, Desal H, Bracard S, Naggara O, Oppenheim C. Susceptibility Vessel Sign and Cardioembolic Etiology in the THRACE Trial. Clin Neuroradiol 2018; 29:685-692. [PMID: 29947813 DOI: 10.1007/s00062-018-0699-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 05/28/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE The susceptibility vessel sign (SVS) has been described on gradient echo (GRE) magnetic resonance imaging (MRI) in acute ischemic stroke patients by large vessel occlusion. The presence of SVS (SVS+) was associated with treatment outcome and stroke etiology with conflicting results. Based on multicenter data from the THRombectomie des Artères CErebrales (THRACE) study, we aimed to determine if the association between SVS and cardioembolic etiology (CE) was independent of GRE sequence parameters. MATERIAL AND METHODS Patients with a pretreatment brain GRE sequence were identified. Logistic regression tested the association between SVS+, CE, time from onset to imaging and GRE sequence parameters (e.g. echo time, voxel size, field strength). We calculated the sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the SVS to predict a stroke from a CE. RESULTS An SVS+ was observed in 237 out of 287 (83%) patients. In the univariate analysis, there was a significant association between SVS+ and a CE with an odds ratio (OR) and 95% confidence interval (95% CI) of 2.10 (1.02-4.29), respectively (p = 0.04) but not with GRE sequence parameters. In multivariate analysis, there was an independent relationship between SVS+ and CE (OR [95% CI]: 2.14 [1.02-4.45], p = 0.04). Sensitivity and specificity of SVS+ to predict CE were 0.89 and 0.21, respectively. The PPV and NPV of SVS+ were 0.44 and 0.78, respectively. CONCLUSION The presence of SVS is associated to CE, independent of GRE sequence parameters. While the specificity and the PPV of the sign were low, CE seems less likely in the absence of an SVS.
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Affiliation(s)
- Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France.
| | - Imad Derraz
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France
| | - Béatrice Delasalle
- L'institut du thorax, Centre Hospitalier Universitaire Nantes, Nantes, France.,UMR1087, Institut National de la Santé et de la Recherche Médicale, Nantes, France
| | - Marine Beaumont
- CIC1433, INSERM, Université de Lorraine, Nancy, France.,IADI, U1254, Université de Lorraine, Nancy, France.,CHRU de Nancy CIC-IT, INSERM, Nancy, France
| | - Sebastien Soize
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Reims, Reims, France.,INSERM UMR-S 1237 Physiopathology and imaging of neurological disorders, Université Caen Normandie, Caen, France
| | - Laurence Legrand
- Department of Neuroradiology, Université Paris-Descartes, Paris, France.,INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Guillaume et René Laennec University Hospital, Nantes, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Montpellier, Montpellier, France
| | - Olivier Naggara
- Department of Neuroradiology, Université Paris-Descartes, Paris, France.,Pediatric Radiology Department, Necker Enfants Malades, Paris, France.,INSERM U894, Sainte-Anne Hospital, Paris, France
| | - Catherine Oppenheim
- Department of Neuroradiology, Université Paris-Descartes, Paris, France.,INSERM U894, Sainte-Anne Hospital, Paris, France
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Donaghy D, Yoo S, Johnson T, Nielsen V, Olver C. Carbon Monoxide-Releasing Molecule Enhances Coagulation and Decreases Fibrinolysis in Normal Canine Plasma. Basic Clin Pharmacol Toxicol 2018; 123:257-262. [PMID: 29577635 DOI: 10.1111/bcpt.13015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/16/2018] [Indexed: 01/17/2023]
Abstract
The dog is an important companion animal and also purpose-bred for research studies. Coagulopathies in dogs are common, although the availability of blood products for therapy is inconsistent throughout the profession. A pro-coagulant therapeutic that is readily available and easily stored would be useful for the treatment of coagulopathies. Tricarbonyldichlororuthenium (II) dimer [Carbon monoxide-releasing molecule-2 (CORM-2)] acts as a prothrombotic agent in plasma by increasing the velocity of clot formation and clot strength, and by decreasing the clot's vulnerability to fibrinolysis. We sought to test CORM-2's effect on coagulation and fibrinolysis in vitro in canine plasma using thromboelastography. Measures of the rate of clot formation and clot strength in plasma without CORM-2 were highly correlated with fibrinogen concentration. We found that CORM-2 significantly enhanced the rate of clot formation and clot strength and significantly reduced the rate of fibrinolysis and the clot lysis time. The per cent change in rate of clot formation and clot strength was not significantly correlated with fibrinogen concentration, indicating that CORM-2's pro-coagulant effect is not dependent on fibrinogen concentration. This study corroborates studies in other species that show that CORM-2 is pro-coagulant in plasma, and lays the groundwork for developing CORM-2 as a therapeutic agent for canine coagulopathies. Future studies will evaluate the effect of CORM-2 on whole blood both in vitro and in vivo.
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Affiliation(s)
- Dillon Donaghy
- Department of Microbiology, Immunology and Pathology, Clinical Pathology Section, Colorado State University, Fort Collins, CO, USA
| | - Seung Yoo
- Seattle Veterinary Specialists, Kirkland, WA, USA
| | - Tyler Johnson
- Department of Microbiology, Immunology and Pathology, Clinical Pathology Section, Colorado State University, Fort Collins, CO, USA
| | - Vance Nielsen
- Department of Anesthesia, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Christine Olver
- Department of Microbiology, Immunology and Pathology, Clinical Pathology Section, Colorado State University, Fort Collins, CO, USA
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de Villiers S, Swanepoel A, Bester J, Pretorius E. Novel Diagnostic and Monitoring Tools in Stroke: an Individualized Patient-Centered Precision Medicine Approach. J Atheroscler Thromb 2015; 23:493-504. [PMID: 26686739 DOI: 10.5551/jat.32748] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Central to the pathogenesis of ischaemic stroke are the normally protective processes of platelet adhesion and activation. Experimental evidence has shown that the ligand-receptor interactions in ischaemic stroke represent a thrombo-inflammatory cascade, which presents research opportunities into new treatment. However, as anti-platelet drugs have the potential to cause severe side effects in ischaemic stroke patients (as well as other vascular disease patients), it is important to carefully monitor the risk of bleeding and risk of thrombus in patients receiving treatment. Because thrombo-embolic ischaemic stroke is a major health issue, we suggest that the answer to adequate treatment is based on an individualized patient-centered approach, inline with the latest NIH precision medicine approach. A combination of viscoelastic methodologies may be used in a personalized patient-centered regime, including thromboelastography (TEG®) and the lesser used scanning electron microscopy approach (SEM). Thromboelastography provides a dynamic measure of clot formation, strength, and lysis, whereas SEM is a visual structural tool to study patient fibrin structure in great detail. Therefore, we consider the evidence for TEG® and SEM as unique means to confirm stroke diagnosis, screen at-risk patients, and monitor treatment efficacy. Here we argue that the current approach to stroke treatment needs to be restructured and new innovative thought patterns need to be applied, as even approved therapies require close patient monitoring to determine efficacy, match treatment regimens to each patient's individual needs, and assess the risk of dangerous adverse effects. TEG® and SEM have the potential to be a useful tool and could potentially alter the clinical approach to managing ischaemic stroke. As envisaged in the NIH precision medicine approach, this will involve a number of role players and innovative new research ideas, with benefits that will ultimately only be realized in a few years. Therefore, with this ultimate goal in mind, we suggest that an individualized patient-orientated approach is now available and therefore already within our ability to use.
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Affiliation(s)
- Sulette de Villiers
- Department of Physiology, Faculty of Health Sciences, University of Pretoria
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Yan S, Liu K, Tong L, Yu Y, Zhang S, Lou M. Different risk factors for poor outcome between patients with positive and negative susceptibility vessel sign. J Neurointerv Surg 2015; 8:1001-5. [DOI: 10.1136/neurintsurg-2015-011999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/04/2015] [Indexed: 11/04/2022]
Abstract
PurposeThe absence of the susceptibility vessel sign (negative SVS) on gradient-recalled echo or susceptibility-weighted imaging (SWI) in thrombolytic therapy has not been well studied. Since positive and negative SVS may have different components, we aimed to investigate the difference in risk factors for clinical outcome between patients with positive and negative SVS.MethodsWe retrospectively examined clinical and imaging data from 85 consecutive patients with acute ischemic stroke with middle cerebral artery occlusion who underwent SWI before intravenous thrombolysis (IVT). We then examined the predictors of negative SVS and the risk factors for a poor outcome (defined as modified Rankin Scale score ≥3) 3 months after IVT in subgroup analysis.ResultsMultivariate regression analysis indicated that previous antiplatelet use (OR 0.076; 95% CI 0.007 to 0.847; p=0.036) and shorter time from onset to treatment (OR 1.051; 95% CI 1.003 to 1.102; p=0.037) were inversely associated with poor outcome in patients with negative SVS, while higher baseline National Institutes of Health Stroke Scale (NIHSS) score was associated with poor outcome in patients with positive SVS (OR 1.222; 95% CI 1.084 to 1.377; p=0.001).ConclusionsThe risk factors for clinical outcome after IVT in patients with negative SVS may differ from those with positive SVS.
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Kell DB, Pretorius E. The simultaneous occurrence of both hypercoagulability and hypofibrinolysis in blood and serum during systemic inflammation, and the roles of iron and fibrin(ogen). Integr Biol (Camb) 2015; 7:24-52. [PMID: 25335120 DOI: 10.1039/c4ib00173g] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although the two phenomena are usually studied separately, we summarise a considerable body of literature to the effect that a great many diseases involve (or are accompanied by) both an increased tendency for blood to clot (hypercoagulability) and the resistance of the clots so formed (hypofibrinolysis) to the typical, 'healthy' or physiological lysis. We concentrate here on the terminal stages of fibrin formation from fibrinogen, as catalysed by thrombin. Hypercoagulability goes hand in hand with inflammation, and is strongly influenced by the fibrinogen concentration (and vice versa); this can be mediated via interleukin-6. Poorly liganded iron is a significant feature of inflammatory diseases, and hypofibrinolysis may change as a result of changes in the structure and morphology of the clot, which may be mimicked in vitro, and may be caused in vivo, by the presence of unliganded iron interacting with fibrin(ogen) during clot formation. Many of these phenomena are probably caused by electrostatic changes in the iron-fibrinogen system, though hydroxyl radical (OH˙) formation can also contribute under both acute and (more especially) chronic conditions. Many substances are known to affect the nature of fibrin polymerised from fibrinogen, such that this might be seen as a kind of bellwether for human or plasma health. Overall, our analysis demonstrates the commonalities underpinning a variety of pathologies as seen in both hypercoagulability and hypofibrinolysis, and offers opportunities for both diagnostics and therapies.
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Affiliation(s)
- Douglas B Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester, 131, Princess St, Manchester M1 7DN, Lancs, UK.
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Wasowicz M, McCluskey SA, Wijeysundera DN, Yau TM, Meinri M, Beattie WS, Karkouti K. The Incremental Value of Thrombelastography for Prediction of Excessive Blood Loss After Cardiac Surgery. Anesth Analg 2010; 111:331-8. [DOI: 10.1213/ane.0b013e3181e456c1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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