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Cooper F, Carakushansky M, Johnson CM, Gurnurkar S. Deep Vein Thrombosis as the Presenting Sign in an Adolescent With New-Onset Type 2 Diabetes. JCEM CASE REPORTS 2024; 2:luae038. [PMID: 38495393 PMCID: PMC10941296 DOI: 10.1210/jcemcr/luae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Indexed: 03/19/2024]
Abstract
Prothrombin G20210A mutation occurs in only 2% to 3% of the population, but usually does not become apparent unless the individual exhibits another risk factor for clotting. A risk factor such as hyperglycemia in the setting of diabetes mellitus may accelerate this clotting process, even at a very young age. In this case report, we discuss a 15-year-old boy presenting with left calf swelling and pain, found to have extensive deep vein thrombosis in the setting of hyperglycemia and a newly discovered prothrombin G20210A mutation. Venous thromboembolism in the setting of type 2 diabetes mellitus has not been described in children.
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Affiliation(s)
- Felicia Cooper
- Department of Endocrinology, Nemours Children's Health Florida, Orlando, FL 32827, USA
| | - Mauri Carakushansky
- Department of Endocrinology, Nemours Children's Health Florida, Orlando, FL 32827, USA
| | - Craig M Johnson
- Department of Interventional Radiology, Nemours Children's Health Florida, Orlando, FL 32827, USA
| | - Shilpa Gurnurkar
- Department of Endocrinology, Nemours Children's Health Florida, Orlando, FL 32827, USA
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2
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The role of plasminogen activator inhibitor-1 in gynecological and obstetrical diseases: an update review. J Reprod Immunol 2022; 150:103490. [DOI: 10.1016/j.jri.2022.103490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 11/21/2022]
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3
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Diabetes drugs in the fight against Alzheimer's disease. Ageing Res Rev 2019; 54:100936. [PMID: 31330313 DOI: 10.1016/j.arr.2019.100936] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/20/2019] [Accepted: 07/17/2019] [Indexed: 01/10/2023]
Abstract
Alzheimer's disease (AD) is the most prevalent form of dementia, particularly in old age subjects. Hyperinsulinemia and insulin resistance, which are known as pathophysiological features of Type 2 Diabetes Mellitus (T2DM), have also been demonstrated to have a significant impact on cognitive impairment. Studies have shown that an altered insulin pathway may interact with amyloid-β protein deposition and tau protein phosphorylation, both leading factors for AD development. Drugs used for T2DM treatment from insulin and metformin through dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists may represent a promising approach to fight AD. With this review from animal to human studies, we aim at responding to the reasons why drugs for diabetes may represent potential treatments for AD.
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de Vries PS, van Herpt TTW, Ligthart S, Hofman A, Ikram MA, van Hoek M, Sijbrands EJG, Franco OH, de Maat MPM, Leebeek FWG, Dehghan A. ADAMTS13 activity as a novel risk factor for incident type 2 diabetes mellitus: a population-based cohort study. Diabetologia 2017; 60:280-286. [PMID: 27787621 PMCID: PMC6518068 DOI: 10.1007/s00125-016-4139-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/26/2016] [Indexed: 01/01/2023]
Abstract
AIMS/HYPOTHESIS ADAMTS13 is a protease that breaks down von Willebrand factor (VWF) multimers into smaller, less active particles. VWF has been associated with an increased risk of incident type 2 diabetes mellitus. Here, we determine whether ADAMTS13 activity and VWF antigen are associated with incident diabetes. METHODS This study included 5176 participants from the Rotterdam Study, a prospective population-based cohort study. Participants were free of diabetes at baseline and followed up for more than 20 years. Cox proportional hazards models were used to examine the association of ADAMTS13 activity and VWF antigen with incident diabetes. RESULTS ADAMTS13 activity was associated with an increased risk of incident diabetes (HR 1.17 [95% CI 1.08, 1.27]) after adjustment for known risk factors and VWF antigen levels. Although ADAMTS13 activity was positively associated with fasting glucose and insulin, the association with incident diabetes did not change when we adjusted for these covariates. ADAMTS13 activity was also associated with incident prediabetes (defined on the basis of both fasting and non-fasting blood glucose) after adjustment for known risk factors (HR 1.11 [95% CI 1.03, 1.19]), while the VWF antigen level was not. VWF antigen was associated with incident diabetes, but this association was attenuated after adjustment for known risk factors. CONCLUSIONS/INTERPRETATION ADAMTS13 activity appears to be an independent risk factor for incident prediabetes and type 2 diabetes. As the association between ADAMTS13 and diabetes did not appear to be explained by its cleavage of VWF, ADAMTS13 may have an independent role in the development of diabetes.
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Affiliation(s)
- Paul S de Vries
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Human Genetics Center, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thijs T W van Herpt
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Symen Ligthart
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mandy van Hoek
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eric J G Sijbrands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
- Department of Epidemiology and Biostatistics, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK.
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Dietrich K, Ball GDC, Mitchell LG. Increased plasminogen activator inhibitor results in a hypofibrinolytic state in adolescents with obesity: in vivo and ex vivo evidence. Br J Haematol 2016; 175:300-307. [PMID: 27434823 DOI: 10.1111/bjh.14238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/25/2016] [Indexed: 12/14/2022]
Abstract
Obesity in adolescents increases their risk for deep vein thrombosis. The objectives of this study were to determine potential mechanisms for thrombotic risk by investigating the fibrinolytic pathway in a sample of adolescents with and without obesity. Thirty-seven adolescents with obesity and 16 normal weight age-matched controls were recruited. Plasma levels of components of the fibrinolytic system were measured in addition to a Global Haemostasis Potential assay (GHP), which assesses plasma capacity to generate and lyse a fibrin clot. Levels of plasminogen activator inhibitor (PAI) and tissue plasminogen activator (tPA)/PAI complexes were increased in adolescents with obesity when compared to normal weight controls. There was a significant inverse association of increasing PAI with a decrease in plasmin-antiplasmin complexes. The GHP in obese adolescents displayed a hypofibrinolytic response with a markedly increased t½ clot lysis time, as well as an increase in fibrin clot density as indicated by increased absorbance at maximum peak height. In the obese group, immunodepletion of PAI decreased both t½ lysis time and absorbance at maximum peak height. We have shown in vivo and ex vivo there is a hypofibrinolytic state in obese adolescents and have established the hypofibrinolytic state is due to increased PAI levels.
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Affiliation(s)
| | - Geoff D C Ball
- University of Alberta, Edmonton, AB, Canada.,Stollery Children's Hospital, Edmonton, AB, Canada
| | - Lesley G Mitchell
- University of Alberta, Edmonton, AB, Canada. .,Stollery Children's Hospital, Edmonton, AB, Canada.
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Hess K. The vulnerable blood. Coagulation and clot structure in diabetes mellitus. Hamostaseologie 2014; 35:25-33. [PMID: 25418205 DOI: 10.5482/hamo-14-09-0039] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/11/2014] [Indexed: 01/04/2023] Open
Abstract
Patients with diabetes are at increased risk of cardiovascular morbidity and mortality. While arteriosclerotic lesions have long been recognized as the underlying cause more recent studies suggest that alterations of the blood are also critically involved. Following plaque rupture, adherence of platelets is followed by the formation of a cross-linked fibrin clot. Patients with diabetes exhibit a prothrombotic milieu consisting of hyper reactive platelets, a tight and rigid clot structure which is due to up-regulation of coagulation factors and prolongation of clot lysis. Metabolic alterations as well as inflammatory processes, which are up-regulated in diabetes, are thought to be the main underlying causes. More recently, the complement cascade has emerged as a potential new player in this context with several complement components directly influencing both platelet function and coagulation. This review provides an overview concerning the changes that lead to alterations of platelet function and clot structure in diabetes.
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Affiliation(s)
- K Hess
- Dr. Katharina Hess, Department of Internal Medicine I, University Hospital Pauwelsstr. 30, 52074 Aachen, Germany, Tel. +49/(0)241/803 71 28, Fax +49/(0)241/808 25 45, E-mail:
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Ota K, Yamagishi SI, Kim M, Dambaeva S, Gilman-Sachs A, Beaman K, Kwak-Kim J. Elevation of soluble form of receptor for advanced glycation end products (sRAGE) in recurrent pregnancy losses (RPL): possible participation of RAGE in RPL. Fertil Steril 2014; 102:782-9. [PMID: 25044082 DOI: 10.1016/j.fertnstert.2014.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/03/2014] [Accepted: 06/03/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine whether the soluble receptor for advanced glycation end products (sRAGE) and immune inflammatory markers are associated with recurrent pregnancy losses (RPL). DESIGN Prospective case-control study. SETTING University clinic. PATIENT(S) A total of 93 women (age 35.8±4.6 years) were enrolled including 63 women with three or more recurrent pregnancy losses (RPL), and age-matched fertile controls with a history of at least one live birth and no history of pregnancy losses (n=30). INTERVENTION(S) Peripheral blood collection. MAIN OUTCOME MEASURE(S) Assessment of anthropometric, metabolic, and inflammatory immune variables. RESULT(S) Levels of sRAGE were statistically significantly higher in RPL patients than in control patients (1,528.9±704.5 vs. 1,149.9±447.4 pg/mL). In the multivariate analysis, the levels of insulin, plasminogen activator inhibitor-1, the resistance index of the uterine radial artery, and the ratio of tumor necrosis factor-α/interleukin-10 producing T helper cells were statistically significantly associated with the serum sRAGE level. CONCLUSION(S) Elevated levels of serum sRAGE are associated with RPL. The soluble receptor for advanced glycation end products might contribute to RPL by reducing uterine blood flow and subsequently causing ischemia in the fetus via inflammatory and thrombotic reactions.
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Affiliation(s)
- Kuniaki Ota
- Reproductive Medicine, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, Illinois; Department of Microbiology and Immunology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Sho-ichi Yamagishi
- Department of Pathophysiology and Therapeutics of Diabetic Vascular Complications, Kurume University School of Medicine, Kurume, Japan
| | - Michael Kim
- Department of Microbiology and Immunology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Svetlana Dambaeva
- Department of Microbiology and Immunology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Alice Gilman-Sachs
- Department of Microbiology and Immunology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Kenneth Beaman
- Department of Microbiology and Immunology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Joanne Kwak-Kim
- Reproductive Medicine, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, Illinois; Department of Microbiology and Immunology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.
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Tosur Z, Green D, De Chavez PJ, Knutson KL, Goldberger JJ, Zee P, Liu K, Kim KY, Carnethon MR. The association between sleep characteristics and prothrombotic markers in a population-based sample: Chicago Area Sleep Study. Sleep Med 2014; 15:973-8. [PMID: 24924657 DOI: 10.1016/j.sleep.2014.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/21/2014] [Accepted: 04/14/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Short sleep duration and poor quality sleep are associated with coronary heart disease (CHD) mortality; however, the underlying pathophysiologic process remains unclear. Sleep apnea may confound the association because of its relationship with formation of thrombi, the vascular occlusive process in CHD. We tested whether sleep duration and quality were associated with prothrombotic biomarkers in adults with a low probability of apnea. METHODS We included adults aged 35-64 years recruited from the community and who had an apnea hypopnea index <15 after one night of screening (n=506). Sleep duration and maintenance were determined from 7 days of wrist actigraphy; daytime sleepiness was estimated using the Epworth Sleepiness Scale. Factor VIII (FVIII), von Willebrand factor (vWF), thrombin antithrombin (TAT) complexes, and plasminogen activator inhibitor-1 (PAI-1) were measured in fasting blood. RESULTS Sleep duration, maintenance, and daytime sleepiness were not associated with FVIII, vWf, or TAT. Sleep maintenance was modestly inversely associated with higher levels of log-transformed PAI-1 (β = -0.07, standard error (SE)=0.03 per 4.8%, p=0.04) following adjustment for demographic characteristics, cardiovascular risk factors, and body mass index (BMI). CONCLUSIONS Mild impairment in sleep was modestly associated with activation of coagulation; further study is needed to evaluate the role of fibrinolytic factors in sleep-mediated coronary thrombosis.
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Affiliation(s)
- Zehra Tosur
- Division of Hematology/Oncology, Department of Medicine, Chicago, IL, USA
| | - David Green
- Division of Hematology/Oncology, Department of Medicine, Chicago, IL, USA
| | - Peter John De Chavez
- Department of Preventive Medicine, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | | | - Jeffrey J Goldberger
- Department of Preventive Medicine, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Phyllis Zee
- Department of Preventive Medicine, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Kwang-Youn Kim
- Department of Preventive Medicine, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine of Northwestern University, Chicago, IL, USA.
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