1
|
Joncour AL, Cacoub P, Boulaftali Y, Saadoun D. Neutrophil, NETs and Behçet's disease: A review. Clin Immunol 2023; 250:109318. [PMID: 37019424 DOI: 10.1016/j.clim.2023.109318] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
Behçet's disease (BD) is a chronic systemic vasculitis characterized by recurrent oral and genital ulcers, skin lesions, articular, neurological, vascular and sight-threatening ocular inflammation. BD is thought to share both autoimmune and autoinflammatory disease features. BD is triggered by environmental factors such as infectious agents in genetically predisposed subjects. Neutrophils seem to play an instrumental role in BD and recent works regarding the role of neutrophils extracellular traps (NETs) provides new insight in the pathophysiology of BD and the mechanisms involved in immune thrombosis. This review provides a recent overview on the role of neutrophils and NETs in the pathogenesis of BD.
Collapse
|
2
|
Bettiol A, Alibaz-Oner F, Direskeneli H, Hatemi G, Saadoun D, Seyahi E, Prisco D, Emmi G. Vascular Behçet syndrome: from pathogenesis to treatment. Nat Rev Rheumatol 2023; 19:111-126. [PMID: 36544027 DOI: 10.1038/s41584-022-00880-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Behçet syndrome is a rare, chronic inflammatory disease of unknown aetiopathogenesis, most commonly presenting with mucocutaneous and ocular manifestations. Vascular involvement, most frequently superficial vein and deep vein thrombosis, can occur in up to 50% of patients with Behçet syndrome. Venous thrombosis at atypical sites (inferior and superior vena cava, suprahepatic veins with Budd-Chiari syndrome, portal vein, cerebral sinuses and right atrium and/or ventricle) and arterial involvement (mostly in situ thrombosis and aneurysms of the pulmonary arteries, as well as aneurysms of the abdominal aorta, and peripheral and visceral arteries) are also unique features of Behçet syndrome. Behçet syndrome is considered a natural model of inflammation-induced thrombosis in humans, with an impaired immune-inflammatory response rather than traditional cardiovascular risk factors contributing to thrombogenesis. Specifically, neutrophil hyperactivation and neutrophil-mediated mechanisms of damage directly promote endothelial dysfunction, platelet activation and thrombogenesis in Behçet syndrome. This unusual pathogenesis directly determines the treatment approach, which relies mostly on immunosuppressants rather than anticoagulants for treatment of thrombosis and for secondary prevention. This Review discusses the main histopathological, pathogenetic and clinical aspects of vascular Behçet syndrome, addressing their implications for therapeutic management. Future perspectives in terms of pathogenetic studies, disease monitoring and treatment strategies are also discussed.
Collapse
Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Fatma Alibaz-Oner
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Haner Direskeneli
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - David Saadoun
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitie-Salpetriere, AP-HP, Paris, France
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy. .,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy. .,Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
| |
Collapse
|
3
|
Rewald E, Jaksic JC. Behçet's syndrome treated with high-dose intravenous IgG and low-dose aspirin. J R Soc Med 2018; 83:652-3. [PMID: 2286970 PMCID: PMC1292866 DOI: 10.1177/014107689008301021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- E Rewald
- Fundación Hematológica, Mardel Plata, Argentina
| | | |
Collapse
|
4
|
Fernández-Bello I, López-Longo FJ, Arias-Salgado EG, Jiménez-Yuste V, Butta NV. Behçet's disease: new insight into the relationship between procoagulant state, endothelial activation/damage and disease activity. Orphanet J Rare Dis 2013; 8:81. [PMID: 23711081 PMCID: PMC3669042 DOI: 10.1186/1750-1172-8-81] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/21/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Behçet disease (BD) is associated with a prothrombotic state of unknown origin that may lead to life-threatening events. Calibrated Automated Thrombogram (CAT) and Rotational Thromboelastometry (ROTEM) are two global haemostasis assays that may reveal new insights into the physiopathological mechanisms of the disease and its procoagulant condition. METHODS 23 BD patients who had no signs or symptoms of current thrombosis and 33 age- and sex-matched controls were included in the study. We performed ROTEM and CAT tests and assessed erythrocyte count, platelet count, platelet contribution to clot formation and plasma levels of tissue-type plasminogen activator, plasminogen activator inhibitor type 1 (PAI-1), fibrinogen, C-reactive protein (CRP), thrombin-antithrombin III complex (TAT), D-dimer and E-selectin (ES). RESULTS Both ROTEM and CAT tests showed a hypercoagulable state in the BD patients. Plasma levels of PAI-1, fibrinogen, TAT, CRP and ES were significantly increased in this group compared to controls. The disease activity (DA) was significantly correlated with levels of ES and the maximum clot firmness, and this last one, in turn, correlated with rising levels of ES, PAI-1, CRP and fibrinogen. CAT parameters did not correlate with DA or ES. CONCLUSIONS Both ROTEM and CAT tests reveal that patients with BD have a procoagulant state even in the absence of thrombosis. ROTEM test indicates that increased levels of fibrinogen and PAI-1 may be involved in the prothrombotic state of this pathology, while platelets do not significantly contribute. Moreover, CAT assay demonstrate that plasma from BD patients is able to generate more thrombin than controls in response to the same stimulus and that this effect is independent of the DA and the endothelial impairment suggesting the involvement of another factor in the hypercoagulable state observed in BD patients. This study also shows that endothelium activation/damage may be a contributing factor in both the procoagulant and clinical conditions of BD, as shown by the direct correlation between ES levels, ROTEM parameters and DA.
Collapse
|
5
|
La Regina M, Gasparyan AY, Orlandini F, Prisco D. Behçet's Disease as a Model of Venous Thrombosis. Open Cardiovasc Med J 2010; 4:71-7. [PMID: 20360979 PMCID: PMC2847254 DOI: 10.2174/1874192401004020071] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 11/23/2009] [Accepted: 12/12/2009] [Indexed: 01/11/2023] Open
Abstract
Behçet's disease (BD) is a chronic inflammatory disease of unknown aetiology characterized by recurrent oral, genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in BD. The frequency of vascular lesions in BD, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%. In this review, various factors of thrombogenesis in BD, particularly pro- and antithrombotic endothelial and non-endothelial factors, factors of coagulation, platelet activation and rheological changes are presented and discussed from positions of Virchow's triad of venous thrombosis. Despite advances in understanding of thrombogenesis in BD, still many issues of diagnosis and targeted preventive and therapeutic measures remain unresolved. Further studies are needed to clarify the pathobiology of BD-related thrombosis and to provide the clinicians with recommendations over the utility, safety and effectiveness of the antithrombotic therapy in BD.
Collapse
Affiliation(s)
- Micaela La Regina
- Department of Internal Medicine, Periodic Fevers Research Centre, Catholic University, Rome, Italy
| | | | | | - Domenico Prisco
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| |
Collapse
|
6
|
Regina ML, Gasparyan AY, Orlandini F, Prisco D. Behçet’s Disease as a Model of Venous Thrombosis. Open Cardiovasc Med J 2010. [DOI: 10.2174/1874192401004010071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Behçet’s disease (BD) is a chronic inflammatory disease of unknown aetiology characterized by recurrent oral, genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in BD. The frequency of vascular lesions in BD, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%.
In this review, various factors of thrombogenesis in BD, particularly pro- and antithrombotic endothelial and non-endothelial factors, factors of coagulation, platelet activation and rheological changes are presented and discussed from positions of Virchow’s triad of venous thrombosis.
Despite advances in understanding of thrombogenesis in BD, still many issues of diagnosis and targeted preventive and therapeutic measures remain unresolved. Further studies are needed to clarify the pathobiology of BD-related thrombosis and to provide the clinicians with recommendations over the utility, safety and effectiveness of the antithrombotic therapy in BD.
Collapse
|
7
|
Acikgoz N, Karincaoglu Y, Ermis N, Yagmur J, Atas H, Kurtoglu E, Cansel M, Barutcu I, Pekdemir H, Özdemir R. Response: Is Mean Platelet Volume Increased in Behcet's Disease with Thrombosis? TOHOKU J EXP MED 2010. [DOI: 10.1620/tjem.222.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nusret Acikgoz
- Inonu University Faculty of Medicine, Department of Cardiology
| | | | - Necip Ermis
- Inonu University Faculty of Medicine, Department of Cardiology
| | - Jülide Yagmur
- Inonu University Faculty of Medicine, Department of Cardiology
| | - Halil Atas
- Inonu University Faculty of Medicine, Department of Cardiology
| | | | - Mehmet Cansel
- Inonu University Faculty of Medicine, Department of Cardiology
| | | | - Hasan Pekdemir
- Inonu University Faculty of Medicine, Department of Cardiology
| | - Ramazan Özdemir
- Inonu University Faculty of Medicine, Department of Cardiology
| |
Collapse
|
8
|
Maladie de Behçet et recommandations de l’EULAR : médecine fondée sur les preuves ou sur l’expérience clinique. Rev Med Interne 2009; 30:939-41. [DOI: 10.1016/j.revmed.2009.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
9
|
Martínez M, Ricart J, Ruiz-Aja S, Rus A, Todolí J, Calvo J, Vayá A. Platelet Activation and Red Blood Cell Phosphatidylserine Exposure Evaluated by Flow Cytometry in Patients with Behçet’s Disease: Are They Related to Thrombotic Events? PATHOPHYSIOLOGY OF HAEMOSTASIS AND THROMBOSIS 2008; 36:18-22. [DOI: 10.1159/000112635] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 07/26/2007] [Indexed: 12/21/2022]
|
10
|
Akar S, Ozcan MA, Ateş H, Gürler O, Alacacioglu I, Ozsan GH, Akkoç N, Ozkan S, Demirkan F, Onen F. Circulated activated platelets and increased platelet reactivity in patients with Behçet's disease. Clin Appl Thromb Hemost 2006; 12:451-7. [PMID: 17000890 DOI: 10.1177/1076029606293430] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Behçet's disease (BD) is a multisystem disorder. Venous as well as arterial thrombosis is a common complication of BD but exact pathogenetic mechanism of the thrombotic tendency is not well known. This study aimed to evaluate circulating activated platelets and platelet reactivity in Behçet's patients. Twenty-two Behçet's patients (4 female, 18 male; mean age 38.6 +/- 10.9 years) and 20 control subjects (8 female, 12 male; mean age 38.8 +/- 9.4 years) were included. Those patients who had hypertension, hyperlipidemia, peripheral or coronary artery disease, hepatic or renal function abnormality, and who were using aspirin and other platelet-active drugs were excluded. Platelet activity and reactivity to adenosine diphosphate (ADP) were measured by whole blood flow cytometry. We assessed markers of platelet degranulation (P-selectin; CD62P) and the activated glycoprotein IIb/IIIa receptor (PAC1 binding to fibrinogen binding site) before and after stimulation with ADP. Platelet P-selectin expression was not significantly different between patients and control subjects both at baseline (p=0.420) and after stimulation (p=0.56). Baseline (p=0.001) and ADP-stimulated (p=0.003) PAC1 binding was significantly higher in Behçet's patients than in the control group. Clinical activity has no effect on P-selectin expression and PAC1 binding. There is evidence of platelet activity and hyperreactivity in patients with BD and this may contribute to a prothrombotic state. In addition to aspirin, other antiplatelet drugs may be useful in the prevention and treatment of thrombosis in Behçet's patients.
Collapse
Affiliation(s)
- Servet Akar
- Department of Internal Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Yapişlar H, Aydogan S, Borlu M, Ascioglu O. Decreased nitric oxide and increased platelet aggregation levels in patients with Behçet's disease. Thromb Res 2006; 119:461-5. [PMID: 16806408 DOI: 10.1016/j.thromres.2006.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 02/20/2006] [Accepted: 02/20/2006] [Indexed: 11/19/2022]
Affiliation(s)
- Hande Yapişlar
- Erciyes University, Medical Faculty, Department of Physiology, 38039-Kayseri, Turkey.
| | | | | | | |
Collapse
|
12
|
Anfossi G, Russo I, Massucco P, Mattiello L, Doronzo G, De Salve A, Trovati M. Impaired synthesis and action of antiaggregating cyclic nucleotides in platelets from obese subjects: possible role in platelet hyperactivation in obesity. Eur J Clin Invest 2004; 34:482-9. [PMID: 15255785 DOI: 10.1111/j.1365-2362.2004.01370.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Subjects with central obesity exhibit platelet hyperactivity, which is involved in the atherosclerotic process and therefore can account for the increased risk of cardiovascular morbidity and mortality. The aim of the study was to evaluate whether alterations of platelet function in obesity involve synthesis and/or action of the two antiaggregating cyclic nucleotides adenosine 3',5'-cyclic monophosphate (cAMP) and guanosine 3',5'-cyclic monophosphate (cGMP). MATERIALS AND METHODS In platelets from 16 obese and 15 control subjects we investigated the influence on platelet responses to the Adenosine-5-diphosphate sodium salt (ADP) exerted by (i) prostacyclin analogue Iloprost (0.31-5 nmol L(-1)) and the cAMP analogue 8-bromo-cAMP (10-500 micro mol L(-1)); and by (ii) nitric oxide (NO) donor sodium nitroprusside (SNP) (5-100 micro mol L(-1)) and the cGMP analogue 8-bromo-cGMP (10-500 micro mol L(-1)). IC(50) (minimal concentration of each inhibitor necessary to reduce platelet response to ADP by half) was determined. Iloprost and SNP ability to increase cyclic nucleotides was also measured. RESULTS Significantly greater IC(50) were observed in obese subjects than in healthy controls (1.59 +/- 0.16 vs. 0.80 +/- 0.08 nmol L(-1), P = 0.0001 for Iloprost, and 27.6 +/- 6.5 vs. 7.0 +/- 1.7 micro mol L(-1), P = 0.006, for SNP); when data from control and obese subjects were pooled together, IC(50) of Iloprost and SNP correlated with the homeostasis model assessment (HOMA IR), which is a parameter used to measure the insulin resistance (r = 0.588, P = 0.029 and r = 0.640, P = 0.006, respectively). Also the antiaggregating effect of 8-Br-cAMP and 8-Br-cGMP was smaller in the obese subjects. Finally, the ability of Iloprost to increase platelet cAMP and the ability of SNP to increase both cGMP and cAMP were reduced in obese subjects. CONCLUSIONS Platelet resistance to the antiaggregating effects of prostacyclin and NO in obesity is attributable to impairment of cyclic nucleotide synthesis and action. As cyclic nucleotides are the main effectors of platelet antiaggregation, the resistance to them can account for platelet hyperactivity in obesity.
Collapse
Affiliation(s)
- G Anfossi
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
| | | | | | | | | | | | | |
Collapse
|
13
|
Nakano H, Oka H, Matsuda T, Ooka S, Suzuki N, Hayashi J, Ishida S, Suzuki T, Hirota K, Ozaki S. Spontaneous platelet aggregation in patients with Behçet's disease by using laser-light scattering aggregometer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2003; 528:437-41. [PMID: 12918740 DOI: 10.1007/0-306-48382-3_89] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- H Nakano
- Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Affiliation(s)
- M Leiba
- Department of Medicine C, Sheba Medical Centre, Tel-Hashomer, Israel
| | | | | | | | | |
Collapse
|
15
|
Watanabe T, Kishi Y, Numano F, Isobe M. Enhanced platelet sensitivity to prostacyclin in patients in an active stage of Takayasu arteritis. Thromb Res 2001; 104:77-83. [PMID: 11672751 DOI: 10.1016/s0049-3848(01)00349-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Patients in an active stage of Takayasu arteritis are often complicated with thrombosis in the affected vessels. We investigated whether alteration of platelet sensitivity to prostacyclin is involved in platelet function in these patients. Twelve female patients in an active stage (48.3+/-11.8 years, mean+/-S.D.), diagnosed clinically by a persistently elevated erythrocyte sedimentation rate (>40 mm/h) with typical symptoms, along with 10 gender- and age-matched patients in an inactive stage and 12 control subjects were enrolled. Half-maximal concentration (EC(50)) for platelet aggregation to collagen was determined in the presence and absence of 1 nM iloprost, a stable prostacyclin analog. Sensitivity of platelets to prostacyclin was quantified by the ratio of EC(50) (R) in the presence of iloprost to that in its absence. Patients in an active stage exhibited enhanced platelet aggregation, as demonstrated by significantly lower EC(50) to collagen and increased plasma thromboxane B(2) concentration. However, R values in these patients were significantly higher (4.00+/-1.05; P<.001) than those in the inactive patients or controls (2.58+/-0.62 and 2.43+/-0.68, respectively), suggesting enhanced sensitivity to prostacyclin in patients with active disease. Plasma 6-keto-PGF1 alpha levels were lower in the active patients than those in other groups of subjects. We conclude that platelets in an active stage of TA may be sensitive not only to collagen but also to prostacyclin. The increase in sensitivity of the platelets to prostacyclin could be a compensatory mechanism against a decrease in the prostanoid production, presumably associated with endothelial dysfunction.
Collapse
Affiliation(s)
- T Watanabe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | | | | | | |
Collapse
|
16
|
Demirer S, Sengül N, Yerdel MA, Tüzüner A, Ulus AT, Gürler A, Bergqvist D, Siegbahn A, Karacagil S. Haemostasis in patients with Behçet's disease. Eur J Vasc Endovasc Surg 2000; 19:570-4. [PMID: 10873722 DOI: 10.1053/ejvs.2000.1091] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM to determine whether Behçet's disease affects haemostatic function. SETTING University Hospital, Turkey. PATIENTS one hundred and twenty-seven consecutive patients with Behçet's disease, 34 of whom with a history of vascular involvement. METHODS prothrombin fragment 1+2 tissue plasminogen activator, protein S and C, antithrombin, fibrinogen, von Willebrand factor, thrombomodulin and prothrombin time (PT) were measured in patient plasma. RESULTS soluble thrombomodulin was significantly lower and von Willebrand factor (vWF) and tissue plasminogen activator (tPA) significantly higher in Behçet's patients. Patients with vascular involvement showed the highest levels of vWF and tPA. There was no activation of coagulation, not even in patients with an active disease at the time of sampling. CONCLUSION there were indirect signs of endothelial activity or damage, particularly in patients with vascular involvement. Coagulation was not activated.
Collapse
Affiliation(s)
- S Demirer
- Department of Surgery, Ankara University Hospital, Turkey
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
Behçet's disease is an uncommon condition that is managed primarily by medical therapy. Nevertheless, the widespread manifestations of the disease mean that surgeons from many different subspecialties may be involved in the care of patients. This is especially so for the treatment of life-threatening complications. For this reason the surgeon needs to consider Behçet's disease in the differential diagnosis of many conditions and to be aware of the general principles underlying the surgical care of affected patients.
Collapse
Affiliation(s)
- A W Bradbury
- University Department of Surgery, Royal Infirmary, Edinburgh, UK
| | | | | |
Collapse
|
18
|
Wright SD, Tuddenham EG. Myeloproliferative and metabolic causes. BAILLIERE'S CLINICAL HAEMATOLOGY 1994; 7:591-635. [PMID: 7841603 DOI: 10.1016/s0950-3536(05)80101-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- S D Wright
- Department of Haematology, St. Mary's Hospital, London, UK
| | | |
Collapse
|
19
|
Abstract
Behçet's disease is an inflammatory disorder of unknown etiology, characterized by recurrent oral and genital aphthous ulcers, ocular inflammation, and skin lesions of erythema nodosum and acneiform eruptions. Selenium (Se) affects all components of the immune system, i.e., the development and expression of nonspecific, humoral, and cell-mediated responses. In general, a deficiency in Se appears to result in immunosuppression, whereas supplementation with low doses of Se appears to result in augmentation and/or restoration of immunologic functions. In this study, the distribution of Se and IgG, IgM in serum were compared in samples from healthy adult control and Behçet's disease patients. The serum Se levels were measured by AA-30-40 Varian Spectra, and immunoglobulins were measured by immunodiffusion technique. The mean (SD) serum Se level of 54.24 +/- 8.06 ng/mL among Behçet's disease subjects was significantly different (P less than 0.01) from that in the control subjects (90.01 +/- 9.94 ng/mL). We also measured IgG and IgM as 10.01 +/- 2.74 mg/mL and 1.26 +/- 0.29 mg/mL, respectively for patients, and 15.08 +/- 4.73 mg/mL and 1.58 +/- 0.43 mg/mL for controls. The mean values of IgG and IgM for patients were significantly (P less than 0.05) different from the values of controls. It seems, therefore, that a deficiency in selenium impedes the humoral immune response.
Collapse
Affiliation(s)
- E Delilbaşi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|