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Fields AT, Andraska EA, Kaltenmeier C, Matthay ZA, Herrera K, Nuñez-Garcia B, Jones CM, Wick KD, Liu S, Luo JH, Yu YP, Matthay MA, Hendrickson CM, Bainton RJ, Barrett TJ, Berger JS, Neal MD, Kornblith LZ. Effects of the circulating environment of COVID-19 on platelet and neutrophil behavior. Front Immunol 2023; 14:1130288. [PMID: 36999030 PMCID: PMC10043426 DOI: 10.3389/fimmu.2023.1130288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/23/2023] [Indexed: 04/01/2023] Open
Abstract
Introduction Thromboinflammatory complications are well described sequalae of Coronavirus Disease 2019 (COVID-19), and there is evidence of both hyperreactive platelet and inflammatory neutrophil biology that contributes to the thromoinflammatory milieu. It has been demonstrated in other thromboinflammatory diseases that the circulating environment may affect cellular behavior, but what role this environment exerts on platelets and neutrophils in COVID-19 remains unknown. We tested the hypotheses that 1) plasma from COVID-19 patients can induce a prothrombotic platelet functional phenotype, and 2) contents released from platelets (platelet releasate) from COVID-19 patients can induce a proinflammatory neutrophil phenotype. Methods We treated platelets with COVID-19 patient and disease control plasma, and measured their aggregation response to collagen and adhesion in a microfluidic parallel plate flow chamber coated with collagen and thromboplastin. We exposed healthy neutrophils to platelet releasate from COVID-19 patients and disease controls and measured neutrophil extracellular trap formation and performed RNA sequencing. Results We found that COVID-19 patient plasma promoted auto-aggregation, thereby reducing response to further stimulation ex-vivo. Neither disease condition increased the number of platelets adhered to a collagen and thromboplastin coated parallel plate flow chamber, but both markedly reduced platelet size. COVID-19 patient platelet releasate increased myeloperoxidasedeoxyribonucleic acid complexes and induced changes to neutrophil gene expression. Discussion Together these results suggest aspects of the soluble environment circulating platelets, and that the contents released from those neutrophil behavior independent of direct cellular contact.
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Affiliation(s)
- Alexander T. Fields
- Department of Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Elizabeth A. Andraska
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Christof Kaltenmeier
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Zachary A. Matthay
- Department of Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Kimberly Herrera
- Department of Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Brenda Nuñez-Garcia
- Department of Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
| | - Chayse M. Jones
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine D. Wick
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Silvia Liu
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jian-Hua Luo
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yan-Ping Yu
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael A. Matthay
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Carolyn M. Hendrickson
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Roland J. Bainton
- Department of Anesthesia and Perioperative Care, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Tessa J. Barrett
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Jeffrey S. Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, NY, United States
- New York University (NYU) Center for the Prevention of Cardiovascular Disease, New York University (NYU) Langone Health, New York, NY, United States
- Division of Vascular Surgery, Department of Surgery, New York University (NYU) Grossman School of Medicine, New York, NY, United States
| | - Matthew D. Neal
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Lucy Z. Kornblith
- Department of Surgery, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- *Correspondence: Lucy Z. Kornblith,
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Song YK, Yuan HX, Jian YP, Chen YT, Liang KF, Liu XJ, Ou ZJ, Liu JS, Li Y, Ou JS. Pentraxin 3 in Circulating Microvesicles: a Potential Biomarker for Acute Heart Failure After Cardiac Surgery with Cardiopulmonary Bypass. J Cardiovasc Transl Res 2022; 15:1414-1423. [PMID: 35879589 DOI: 10.1007/s12265-022-10253-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 10/16/2022]
Abstract
The aim of this study was to investigate whether pentraxin 3 (PTX3) in microvesicles (MVs) can be a valuable biomarker for the prediction of acute heart failure (AHF) after cardiac surgery with cardiopulmonary bypass (CPB). One hundred and twenty-four patients undergoing cardiac surgery with CPB were included and analyzed (29 with AHF and 95 without AHF). The concentrations of PTX3 in MVs isolated from plasma were measured by ELISA kits before, 12 h, and 3 days after surgery. Patients' demographics, medical history, surgical data, and laboratory results were collected. The levels of PTX3 in MVs were significantly elevated during perioperative surgery, which was increased more in the AHF group. The concentrations of PTX3 in MVs at postoperative 12 h were independent risk factors for AHF with the area under the ROC curve of 0.920. The concentration of PTX3 in MVs may be a novel biomarker for prediction of AHF after cardiac surgery.
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Affiliation(s)
- Yuan-Kai Song
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Hao-Xiang Yuan
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Yu-Peng Jian
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Ya-Ting Chen
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Kai-Feng Liang
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Xiao-Jun Liu
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Zhi-Jun Ou
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- Division of Hypertension and Vascular Diseases, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jia-Sheng Liu
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Yan Li
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China.
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China.
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
| | - Jing-Song Ou
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China.
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China.
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Brain Function and Disease, Guangzhou, China.
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Matthay ZA, Hellmann ZJ, Nunez-Garcia B, Fields AT, Cuschieri J, Neal MD, Berger JS, Luttrell-Williams E, Knudson MM, Cohen MJ, Callcut RA, Kornblith LZ. Postinjury platelet aggregation and venous thromboembolism. J Trauma Acute Care Surg 2022; 93:604-612. [PMID: 35444156 PMCID: PMC9585095 DOI: 10.1097/ta.0000000000003655] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Posttraumatic venous thromboembolism (VTE) remains prevalent in severely injured patients despite chemoprophylaxis. Importantly, although platelets are central to thrombosis, they are not routinely targeted in prevention of posttraumatic VTE. Furthermore, platelets from injured patients show ex vivo evidence of increased activation yet impaired aggregation, consistent with functional exhaustion. However, the relationship of this platelet functional phenotype with development of posttraumatic VTE is unknown. We hypothesized that, following injury, impaired ex vivo platelet aggregation (PA) is associated with the development of posttraumatic VTE. METHODS We performed a secondary analysis of 133 severely injured patients from a prospective observational study investigating coagulation and inflammation (2011-2019). Platelet aggregation in response to stimulation with adenosine diphosphate (ADP), collagen, and thrombin was measured at presentation (preresuscitation) and 24 hours (postresuscitation). Viscoelastic clot strength and lysis were measured in parallel by thromboelastography. Multivariable regression examined relationships between PA at presentation, 24 hours, and the change (δ) in PA between presentation and 24 hours with development of VTE. RESULTS The 133 patients were severely injured (median Injury Severity Score, 25), and 14% developed VTE (all >48 hours after admission). At presentation, platelet count and PA were not significantly different between those with and without incident VTE. However, at 24 hours, those who subsequently developed VTE had significantly lower platelet counts (126 × 10 9 /L vs. 164 × 10 9 /L, p = 0.01) and lower PA in response to ADP ( p < 0.05), collagen ( p < 0.05), and thrombin ( p = 0.06). Importantly, the magnitude of decrease in PA (δ) from presentation to 24 hours was independently associated with development of VTE (adjusted odds ratios per 10 aggregation unit decrease: δ-ADP, 1.31 [ p = 0.03]; δ-collagen, 1.36 [ p = 0.01]; δ-thrombin, 1.41 [ p < 0.01]). CONCLUSION Severely injured patients with decreasing ex vivo measures of PA despite resuscitation have an increased risk of developing VTE. This may have implications for predicting development of VTE and for studying platelet targeted chemoprophylaxis regimens. LEVEL OF EVIDENCE Prognostic/Epidemiological; Level III.
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Affiliation(s)
- Zachary A. Matthay
- Department of Surgery, Zuckerberg San Francisco General Hospital/University of California San Francisco, San Francisco, CA
| | | | - Brenda Nunez-Garcia
- Department of Surgery, Zuckerberg San Francisco General Hospital/University of California San Francisco, San Francisco, CA
| | - Alexander T. Fields
- Department of Surgery, Zuckerberg San Francisco General Hospital/University of California San Francisco, San Francisco, CA
| | - Joseph Cuschieri
- Department of Surgery, Zuckerberg San Francisco General Hospital/University of California San Francisco, San Francisco, CA
| | - Matthew D. Neal
- Department of Surgery, University of Pittsburg, Pittsburg, PA
| | - Jeffrey S. Berger
- Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | | | - M. Margaret Knudson
- Department of Surgery, Zuckerberg San Francisco General Hospital/University of California San Francisco, San Francisco, CA
| | | | | | - Lucy Z. Kornblith
- Department of Surgery, Zuckerberg San Francisco General Hospital/University of California San Francisco, San Francisco, CA
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Abstract
PURPOSE OF REVIEW The collection of shed blood and its reinfusion has been termed 'cell salvage' or 'autotransfusion'. This review will summarize the historical foundation of cell salvage and summarize recent literature associated with cell salvage use in trauma. RECENT FINDINGS There have been no publications on cell salvage in trauma during the last 2 years. This is based on a PubMed search using the key words, 'cell salvage', 'autologous blood transfusion' and 'operative blood salvage'. Although the wars in Iraq and Afghanistan were ongoing, publications focused upon autotranfusion of unwashed blood from the hemothorax and on the resuscitation of the injured in remote settings. SUMMARY Autotransfusion or cell salvage is markedly under utilized in trauma. Opportunities exist for significant blood savings if it is used more frequently. More research is clearly needed to assess the safety of autotransfusion in the traumatized patient.
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Fields AT, Matthay ZA, Nunez-Garcia B, Matthay EC, Bainton RJ, Callcut RA, Kornblith LZ. Good Platelets Gone Bad: The Effects of Trauma Patient Plasma on Healthy Platelet Aggregation. Shock 2021; 55:189-197. [PMID: 32694397 PMCID: PMC8547718 DOI: 10.1097/shk.0000000000001622] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Altered postinjury platelet behavior is recognized in the pathophysiology of trauma-induced coagulopathy (TIC), but the mechanisms remain largely undefined. Studies suggest that soluble factors released by injury may inhibit signaling pathways and induce structural changes in circulating platelets. Given this, we sought to examine the impact of treating healthy platelets with plasma from injured patients. We hypothesized that healthy platelets treated ex-vivo with plasma from injured patients with shock would impair platelet aggregation, while treatment with plasma from injured patients with significant injury burden, but without shock, would enhance platelet aggregation. METHODS Plasma samples were isolated from injured patients (pretransfusion) and healthy donors at a Level I trauma center and stored at -80°C. Plasma samples from four separate patients in each of the following stratified clinical groups were used: mild injury/no shock (injury severity score [ISS] 2-15, base excess [BE]>-6), mild injury/with shock (ISS 2-15, BE≤-6), severe injury/no shock (ISS>25, BE>-6), severe injury/with shock (ISS>25, BE≤-6), minimal injury (ISS 0/1, BE>-6), and healthy. Platelets were isolated from three healthy adult males and were treated with plasma for 30 min. Aggregation was stimulated with a thrombin receptor agonist and measured via multiple-electrode platelet aggregometry. Data were normalized to HEPES Tyrode's (HT) buffer-only treated platelets. Associations of plasma treatment groups with platelet aggregation measures were tested with Mann-Whitney U tests. RESULTS Platelets treated with plasma from patients with shock (regardless of degree of injury) had significantly impaired thrombin-stimulated aggregation compared with platelets treated with plasma from patients without shock (P = 0.002). Conversely, platelets treated with plasma from patients with severe injury, but without shock, had amplified thrombin-stimulated aggregation (P = 0.030). CONCLUSION Shock-mediated soluble factors impair platelet aggregation, and tissue injury-mediated soluble factors amplify platelet aggregation. Future characterization of these soluble factors will support development of novel treatments of TIC.
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Affiliation(s)
| | | | | | - Ellicott C. Matthay
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Roland J. Bainton
- Department of Anesthesia and Perioperative Care, University of California, San Francisco
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Protein Compositions Changes of Circulating Microparticles in Patients With Valvular Heart Disease Subjected to Cardiac Surgery Contribute to Systemic Inflammatory Response and Disorder of Coagulation. Shock 2020; 52:487-496. [PMID: 30601407 DOI: 10.1097/shk.0000000000001309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We recently demonstrated that circulating microparticles (MPs) from patients with valvular heart diseases (VHD) subjected to cardiac surgery impaired endothelial function and vasodilation. However, it is unknown whether or not the protein composition of these circulating MPs actually changes in response to the disease and the surgery. Circulating MPs were isolated from age-matched control subjects (n = 50) and patients (n = 50) with VHD before and 72 h after cardiac surgery. Proteomics study was performed by liquid chromatography and mass spectrometry combined with isobaric tags for relative and absolute quantification technique. The differential proteins were identified by ProteinPilot, some of which were validated by Western blotting. Bio-informatic analysis of differential proteins was carried out. A total of 849 proteins were identified and 453 proteins were found in all three groups. Meanwhile, 165, 39, and 80 proteins were unique in the control, pre-operation, and postoperation groups respectively. The unique proteins were different in localization, molecular function, and biological process. The pro-inflammatory proteins were increased in VHD patients and more so postoperatively. Proteins related to coagulation were dramatically changed before and after surgery. The protein composition of circulating MPs was changed in patients with VHD undergoing cardiac surgery, which may lead to activation of the systemic inflammatory response and disorders of coagulation.
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Platelet dysfunction during trauma involves diverse signaling pathways and an inhibitory activity in patient-derived plasma. J Trauma Acute Care Surg 2020; 86:250-259. [PMID: 30531331 DOI: 10.1097/ta.0000000000002140] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Trauma-induced coagulopathy occurs in about 25% of injured patients and accounts for about 10% of deaths worldwide. Upon injury, hemostatic function may decline due to vascular dysfunction, clotting factor deficiencies, hyperfibrinolysis, and/or platelet dysfunction. We investigated agonist-induced calcium signaling in platelets obtained over time from trauma patients. METHODS Platelets from trauma patients and healthy donors were monitored via intracellular calcium mobilization and flow cytometry markers (α2bβ3 activation, P-selectin display, and phosphatidylserine exposure) following stimulation with a panel of agonists (adenosine 5'-diphosphate sodium salt, U46619, convulxin, PAR-1/4 activating peptides, iloprost) used in isolation or in pairwise tests. Furthermore, healthy donor platelets were tested in heterologous plasma isolated from healthy subjects and trauma patients. RESULTS When exposed to agonists over the first 24 hours postinjury, trauma patient platelets mobilized less calcium in comparison to healthy platelets. Partial recovery of platelet activity was observed in about a third of patients after 120 hours, although not fully obtaining healthy baseline function. Flow cytometry markers of trauma platelets were similar to healthy platelets prior to stimulation, but were depressed in trauma platelets stimulated with adenosine 5'-diphosphate sodium salt or convulxin. Also, washed healthy platelets showed a significant reduction in calcium mobilization when reconstituted in plasma from trauma patients, relative to healthy plasma, at all plasma doses tested. CONCLUSION Platelet dysfunction in trauma patients included poor response to multiple agonists relevant to hemostatic function. Furthermore, the inhibitor effect of patient plasma on healthy platelets suggests that soluble plasma species may downregulate endogenous or transfused platelets during trauma.
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Cagliani J, Yang WL, Brenner M, Wang P. Deoxyribonuclease Reduces Tissue Injury and Improves Survival After Hemorrhagic Shock. J Surg Res 2020; 249:104-113. [PMID: 31926397 DOI: 10.1016/j.jss.2019.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/16/2019] [Accepted: 11/23/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hemorrhagic shock (HS) caused by rapid loss of a large amount of blood is the leading cause of early death after severe injury. When cells are damaged during HS, many intracellular components including DNA are released into the circulation and function as endogenous damage-associated molecular patterns (DAMPs) that can trigger excessive inflammatory response and subsequently multiple organ dysfunction. We hypothesized that the administration of deoxyribonuclease I (DNase I) could reduce cell-free DNA and attenuate tissue damage in HS. METHODS Eight-week-old male C57BL/6 mice underwent HS by controlled bleeding from the femoral artery for 90 min, followed by resuscitation with Ringer's lactate solution (vehicle) or DNase I (10 mg/kg BW). RESULTS At 20 h after HS, serum levels of cell-free DNA were increased by 7.6-fold in the vehicle-treated HS mice compared with sham, while DNase I reduced its levels by 47% compared with the vehicle group. Serum levels of tissue injury markers (lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase) and proinflammatory cytokine interleukin 6 were significantly reduced in the DNase I-treated mice. In the lungs, messenger RNA levels of proinflammatory cytokines (interleukin 6 and interleukin 1 β), chemoattractant macrophage inflammatory protein - 2, and myeloperoxidase activity were significantly decreased in HS mice after DNase I. Finally, DNase I significantly improved the 10-day survival rate in HS mice. CONCLUSIONS Administration of DNase I attenuates tissue damage and systemic and lung inflammation, leading to improvement of survival in HS mice. Thus, DNase I may potentially serve as an adjunct therapy for managing patients with HS.
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Affiliation(s)
- Joaquin Cagliani
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York; Center for Immunology and Inflammation, Feinstein Institutes for Medical Research, Manhasset, New York; Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York; Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Weng-Lang Yang
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York; Center for Immunology and Inflammation, Feinstein Institutes for Medical Research, Manhasset, New York; Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York; Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York
| | - Max Brenner
- Center for Immunology and Inflammation, Feinstein Institutes for Medical Research, Manhasset, New York; Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Ping Wang
- Elmezzi Graduate School of Molecular Medicine, Manhasset, New York; Center for Immunology and Inflammation, Feinstein Institutes for Medical Research, Manhasset, New York; Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York.
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9
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Sowy S, Rutter CR, Jeffery U. Extracellular vesicle concentration and procoagulant activity of canine haemoperitoneum fluid and packed red blood cells. J Small Anim Pract 2019; 60:423-429. [PMID: 31025382 DOI: 10.1111/jsap.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/23/2019] [Accepted: 02/19/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To compare the concentration of phosphatidylserine-positive extracellular vesicles and phosphatidylserine-derived procoagulant activity of canine haemoperitoneum fluids and packed red blood cell units. MATERIALS AND METHODS Ten dogs with haemoperitoneum (neoplasia = 7; trauma = 1; other = 2) were recruited, and five non-leukoreduced packed red blood cell units purchased. Supernatants were collected from haemoperitoneum samples and packed red blood cell units using a consistent centrifugation protocol. Phosphatidylserine-positive extracellular vesicle concentrations were measured by flow cytometry and phosphatidylserine-mediated procoagulant activity by a commercial thrombin generation assay. RESULTS Phosphatidylserine-mediated procoagulant activity was significantly higher for supernatants collected from packed red blood cell units (median 54 nM, range 53 to 60 nM) than haemoperitoneum samples (median 43 nM; range 7 to 51 nM; P = 0.0007). By flow cytometry, the concentration of phosphatidylserine-positive extracellular vesicles was not significantly different between packed red blood cell (median: 415/μL, range 173 to 1331/μL) and haemoperitoneum samples (median: 314/μL, range 132 to 3880/μL; P = 0.77). CLINICAL SIGNIFICANCE This study does not suggest that shed abdominal blood contains more extracellular vesicles with phosphatidylserine-mediated procoagulant activity than donor packed red blood cell units. Clinical studies to compare the effects of autologous transfusion of shed abdominal blood and packed red blood cell units on coagulation status and clinical outcome are required.
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Affiliation(s)
- S Sowy
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas 77843, USA
| | - C R Rutter
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas 77843, USA
| | - U Jeffery
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas 77843, USA
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Slichter SJ, Fitzpatrick L, Osborne B, Christoffel T, Gettinger I, Pellham E, Bailey SL, Jones MK, Herzig MC, Cap AP. Platelets stored in whole blood at 4°C: in vivo posttransfusion platelet recoveries and survivals and in vitro hemostatic function. Transfusion 2019; 59:2084-2092. [PMID: 30977914 DOI: 10.1111/trf.15302] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/24/2019] [Accepted: 01/30/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Ordinarily, whole blood (WB) is separated into components before storage. We assessed the posttransfusion viability and function of platelets (PLTs) if they were stored within WB at 4°C. STUDY DESIGN AND METHODS Whole blood was obtained from 30 normal subjects and stored at 4°C without agitation for 12 days and for 10, 15, or 22 days with agitation. After WB storage, a PLT concentrate was prepared, and a fresh PLT sample was obtained from each donor. The stored PLTs were labeled with 111 In and the fresh with 51 Cr, and both were simultaneously transfused into their donor. Blood samples were obtained after transfusion to determine PLT recoveries and survivals. PLT samples from WB before and after storage were also assayed for PLT function and biochemistry. RESULTS After storage for 12 days without WB rotation, poststorage PLT counts averaged only 49 ± 12% of baseline values. After storage for 10, 15, or 22 days with end-over-end WB rotation, PLT counts averaged 76 ± 14% of baseline values. Fifteen-day poststorage radiolabeled PLT recoveries averaged 27 ± 11% (49 ± 16% of fresh), and survivals averaged 1.2 ± 0.4 days (16 ± 6% of fresh). in vitro assays demonstrated marked PLT activation after any storage time, and although PLT function decreased over time, stored PLTs were still considered acceptable. CONCLUSION These data suggest that, during rotated WB storage at 4°C for up to 15 days, PLT yields, poststorage PLT recoveries and survivals, and PLT function should be sufficient to support the short-term hemostatic needs of traumatized patients.
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Affiliation(s)
- Sherrill J Slichter
- Research Institute, Bloodworks Northwest, Seattle, Washington.,University of Washington School of Medicine, Seattle, Washington
| | | | - Barbara Osborne
- Research Institute, Bloodworks Northwest, Seattle, Washington
| | | | - Irena Gettinger
- Research Institute, Bloodworks Northwest, Seattle, Washington
| | - Esther Pellham
- Research Institute, Bloodworks Northwest, Seattle, Washington
| | | | - Mary Kay Jones
- Research Institute, Bloodworks Northwest, Seattle, Washington
| | | | - Andrew P Cap
- U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
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11
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Abstract
Trauma can affect any individual at any location and at any time over a lifespan. The disruption of macrobarriers and microbarriers induces instant activation of innate immunity. The subsequent complex response, designed to limit further damage and induce healing, also represents a major driver of complications and fatal outcome after injury. This Review aims to provide basic concepts about the posttraumatic response and is focused on the interactive events of innate immunity at frequent sites of injury: the endothelium at large, and sites within the lungs, inside and outside the brain and at the gut barrier.
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Brenner M, Wang P. What'S New in SHOCK, June 2017? Shock 2017; 47:661-665. [PMID: 28505019 DOI: 10.1097/shk.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Max Brenner
- Center for Immunology and Inflammation, The Feinstein Institute for Medical Research, Manhasset, New York
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