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Capece GE, Luyendyk JP, Poole LG. Fibrinolysis-Mediated Pathways in Acute Liver Injury. Semin Thromb Hemost 2024; 50:638-647. [PMID: 38395065 DOI: 10.1055/s-0044-1779738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Acute liver injury (ALI), that is, the development of reduced liver function in patients without preexisting liver disease, can result from a wide range of causes, such as viral or bacterial infection, autoimmune disease, or adverse reaction to prescription and over-the-counter medications. ALI patients present with a complex coagulopathy, characterized by both hypercoagulable and hypocoagulable features. Similarly, ALI patients display a profound dysregulation of the fibrinolytic system with the vast majority of patients presenting with a hypofibrinolytic phenotype. Decades of research in experimental acute liver injury in mice suggest that fibrinolytic proteins, including plasmin(ogen), plasminogen activators, fibrinolysis inhibitors, and fibrin(ogen), can contribute to initial hepatotoxicity and/or stimulate liver repair. This review summarizes major experimental findings regarding the role of fibrinolytic factors in ALI from the last approximately 30 years and identifies unanswered questions, as well as highlighting areas for future research.
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Affiliation(s)
- Gina E Capece
- Department of Pharmacology, Rutgers University Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - James P Luyendyk
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, Michigan
| | - Lauren G Poole
- Department of Pharmacology, Rutgers University Robert Wood Johnson Medical School, Piscataway, New Jersey
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2
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Risman RA, Belcher HA, Ramanujam RK, Weisel JW, Hudson NE, Tutwiler V. Comprehensive Analysis of the Role of Fibrinogen and Thrombin in Clot Formation and Structure for Plasma and Purified Fibrinogen. Biomolecules 2024; 14:230. [PMID: 38397467 PMCID: PMC10886591 DOI: 10.3390/biom14020230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
Altered properties of fibrin clots have been associated with bleeding and thrombotic disorders, including hemophilia or trauma and heart attack or stroke. Clotting factors, such as thrombin and tissue factor, or blood plasma proteins, such as fibrinogen, play critical roles in fibrin network polymerization. The concentrations and combinations of these proteins affect the structure and stability of clots, which can lead to downstream complications. The present work includes clots made from plasma and purified fibrinogen and shows how varying fibrinogen and activation factor concentrations affect the fibrin properties under both conditions. We used a combination of scanning electron microscopy, confocal microscopy, and turbidimetry to analyze clot/fiber structure and polymerization. We quantified the structural and polymerization features and found similar trends with increasing/decreasing fibrinogen and thrombin concentrations for both purified fibrinogen and plasma clots. Using our compiled results, we were able to generate multiple linear regressions that predict structural and polymerization features using various fibrinogen and clotting agent concentrations. This study provides an analysis of structural and polymerization features of clots made with purified fibrinogen or plasma at various fibrinogen and clotting agent concentrations. Our results could be utilized to aid in interpreting results, designing future experiments, or developing relevant mathematical models.
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Affiliation(s)
- Rebecca A. Risman
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA; (R.A.R.); (R.K.R.)
| | - Heather A. Belcher
- Department of Physics, East Carolina University, Greenville, NC 27858, USA; (H.A.B.); (N.E.H.)
| | - Ranjini K. Ramanujam
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA; (R.A.R.); (R.K.R.)
| | - John W. Weisel
- Department of Cell and Developmental Biology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Nathan E. Hudson
- Department of Physics, East Carolina University, Greenville, NC 27858, USA; (H.A.B.); (N.E.H.)
| | - Valerie Tutwiler
- Department of Biomedical Engineering, Rutgers University, Piscataway, NJ 08854, USA; (R.A.R.); (R.K.R.)
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3
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Chen R, Huang M, Xu P. Polyphosphate as an antithrombotic target and hemostatic agent. J Mater Chem B 2023; 11:7855-7872. [PMID: 37534776 DOI: 10.1039/d3tb01152f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Polyphosphate (PolyP) is a polymer comprised of linear phosphate units connected by phosphate anhydride bonds. PolyP exists in a diverse range of eukaryotes and prokaryotes with varied chain lengths ranging from six to thousands of phosphate units. Upon activation, human platelets and neutrophils release short-chain PolyP, along with other components, to initiate the coagulation pathway. Long-chain PolyP derived from cellular or bacterial organelles exhibits higher proinflammatory and procoagulant effects compared to short-chain PolyP. Notably, PolyP has been identified as a low-hemorrhagic antithrombotic target since neutralizing plasma PolyP suppresses the thrombotic process without impairing the hemostatic functions. As an inorganic polymer without uniform steric configuration, PolyP is typically targeted by cationic polymers or recombinant polyphosphatases rather than conventional antibodies, small-molecule compounds, or peptides. Additionally, because of its procoagulant property, PolyP has been incorporated in wound-dressing materials to facilitate blood hemostasis. This review summarizes current studies on PolyP as a low-hemorrhagic antithrombotic target and the development of hemostatic materials based on PolyP.
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Affiliation(s)
- Ruoyu Chen
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, P. R. China.
| | - Mingdong Huang
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, P. R. China.
- College of Chemistry, Fuzhou University, Fuzhou, Fujian, 350108, P. R. China
| | - Peng Xu
- College of Biological Science and Engineering, Fuzhou University, Fuzhou, Fujian, 350108, P. R. China.
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4
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Risman RA, Kirby NC, Bannish BE, Hudson NE, Tutwiler V. Fibrinolysis: an illustrated review. Res Pract Thromb Haemost 2023; 7:100081. [PMID: 36942151 PMCID: PMC10024051 DOI: 10.1016/j.rpth.2023.100081] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
In response to vessel injury (or other pathological conditions), the hemostatic process is activated, resulting in a fibrous, cellular-rich structure commonly referred to as a blood clot. Succeeding the clot's function in wound healing, it must be resolved. This illustrated review focuses on fibrinolysis-the degradation of blood clots or thrombi. Fibrin is the main mechanical and structural component of a blood clot, which encases the cellular components of the clot, including platelets and red blood cells. Fibrinolysis is the proteolytic degradation of the fibrin network that results in the release of the cellular components into the bloodstream. In the case of thrombosis, fibrinolysis is required for restoration of blood flow, which is accomplished clinically through exogenously delivered lytic factors in a process called external lysis. Fibrinolysis is regulated by plasminogen activators (tissue-type and urokinase-type) that convert plasminogen into plasmin to initiate fiber lysis and lytic inhibitors that impede this lysis (plasminogen activator inhibitors, alpha 2-antiplasmin, and thrombin activatable fibrinolysis inhibitor). Furthermore, the network structure has been shown to regulate lysis: thinner fibers and coarser clots lyse faster than thicker fibers and finer clots. Clot contraction, a result of platelets pulling on fibers, results in densely packed red blood cells (polyhedrocytes), reduced permeability to fibrinolytic factors, and increased fiber tension. Extensive research in the field has allowed for critical advancements leading to improved thrombolytic agents. In this review, we summarize the state of the field, highlight gaps in knowledge, and propose future research questions.
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Affiliation(s)
| | - Nicholas C Kirby
- Department of Chemistry, East Carolina University, Greenville, North Carolina, USA
| | | | - Nathan E Hudson
- Department of Physics, East Carolina University Greenville, North Carolina, USA
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Belcher HA, Litwa K, Guthold M, Hudson NE. The Applicability of Current Turbidimetric Approaches for Analyzing Fibrin Fibers and Other Filamentous Networks. Biomolecules 2022; 12:biom12060807. [PMID: 35740932 PMCID: PMC9221518 DOI: 10.3390/biom12060807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 12/07/2022] Open
Abstract
Turbidimetry is an experimental technique often used to study the structure of filamentous networks. To extract structural properties such as filament diameter from turbidimetric data, simplifications to light scattering theory must be employed. In this work, we evaluate the applicability of three commonly utilized turbidimetric analysis approaches, each using slightly different simplifications. We make a specific application towards analyzing fibrin fibers, which form the structural scaffold of blood clots, but the results are generalizable. Numerical simulations were utilized to assess the applicability of each approach across a range of fiber lengths and diameters. Simulation results indicated that all three turbidimetric approaches commonly underestimate fiber diameter, and that the “Carr-Hermans” approach, utilizing wavelengths in the range of 500−800 nm, provided <10% error for the largest number of diameter/length combinations. These theoretical results were confirmed, under select conditions, via the comparison of fiber diameters extracted from experimental turbidimetric data, with diameters obtained using super-resolution microscopy.
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Affiliation(s)
- Heather A. Belcher
- Department of Physics, East Carolina University, Greenville, NC 27858, USA;
| | - Karen Litwa
- Department of Anatomy & Cell Biology, East Carolina University, Greenville, NC 27858, USA;
| | - Martin Guthold
- Department of Physics, Wake Forest University, Winston-Salem, NC 27109, USA;
| | - Nathan E. Hudson
- Department of Physics, East Carolina University, Greenville, NC 27858, USA;
- Correspondence: ; Tel.: +1-252-737-5349
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Milyaeva OY, Rafikova AR. Effect of Low Concentrations of Thrombin on the Dynamic Surface Properties of Fibrinogen Solutions. COLLOID JOURNAL 2022. [DOI: 10.1134/s1061933x22010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cardenas JC. Thrombin Generation Following Severe Trauma: Mechanisms, Modulators, and Implications for Hemostasis and Thrombosis. Shock 2021; 56:682-690. [PMID: 33660669 DOI: 10.1097/shk.0000000000001773] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Thrombin is the central coagulation enzyme that catalyzes the conversion of fibrinogen to form insoluble fibrin blood clots. In vivo, thrombin production results from the concerted effort of plasma enzymatic reactions with essential contributions from circulating and vessel wall cells. The relative amount of thrombin produced directly dictates the structure and stability of fibrin clots; therefore, sufficient thrombin generation is essential for normal hemostasis to occur. Examination of thrombin generation phenotypes among severely injury trauma patients reveals important relationships between the potential for generating thrombin and risks of bleeding and thrombotic complications. Thus, understanding determinants of thrombin generation following traumatic injury is of high clinical importance. This review will focus on patterns and mechanisms of thrombin generation in severely injured patients, the role of fluid resuscitation in modulating thrombin generation and implications for outcomes.
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Affiliation(s)
- Jessica C Cardenas
- Division of Acute Care Surgery and Center for Translationssal Injury Research, Department of Surgery, McGovern School of Medicine, The University of Texas Health Science Center, Houston, Texas
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Vocetkova K, Sovkova V, Buzgo M, Lukasova V, Divin R, Rampichova M, Blazek P, Zikmund T, Kaiser J, Karpisek Z, Amler E, Filova E. A Simple Drug Delivery System for Platelet-Derived Bioactive Molecules, to Improve Melanocyte Stimulation in Vitiligo Treatment. NANOMATERIALS 2020; 10:nano10091801. [PMID: 32927642 PMCID: PMC7559479 DOI: 10.3390/nano10091801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Abstract
Vitiligo is the most common depigmentation disorder of the skin. Currently, its therapy focuses on the halting of the immune response and stimulation of the regenerative processes, leading to the restoration of normal melanocyte function. Platelet-rich plasma (PRP) represents a safe and cheap regenerative therapy option, as it delivers a wide spectrum of native growth factors, cytokines and other bioactive molecules. The aim of this study was to develop a simple delivery system to prolong the effects of the bioactive molecules released from platelets. The surface of electrospun and centrifugally spun poly-ε-caprolactone (PCL) fibrous scaffolds was functionalized with various concentrations of platelets; the influence of the morphology of the scaffolds and the concentration of the released platelet-derived bioactive molecules on melanocytes, was then assessed. An almost two-fold increase in the amount of the released bioactive molecules was detected on the centrifugally spun vs. electrospun scaffolds, and a sustained 14-day release of the bioactive molecules was demonstrated. A strong concentration-dependent response of melanocyte to the bioactive molecules was observed; higher concentrations of bioactive molecules resulted in improved metabolic activity and proliferation of melanocytes. This simple system improves melanocyte viability, offers on-site preparation and is suitable for prolonged topical PRP administration.
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Affiliation(s)
- Karolina Vocetkova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
- Correspondence:
| | - Vera Sovkova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Matej Buzgo
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Vera Lukasova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Radek Divin
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Michala Rampichova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
| | - Pavel Blazek
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 616 00 Brno, Czech Republic; (P.B.); (T.Z.); (J.K.)
| | - Tomas Zikmund
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 616 00 Brno, Czech Republic; (P.B.); (T.Z.); (J.K.)
| | - Jozef Kaiser
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 616 00 Brno, Czech Republic; (P.B.); (T.Z.); (J.K.)
| | - Zdenek Karpisek
- Institute of Mathematics, Faculty of Mechanical Engineering, Brno University of Technology, Technicka 2, 616 69 Brno, Czech Republic;
| | - Evzen Amler
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Eva Filova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
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Sun J, Lv X. Why Does Large Venous Pouch Thrombose after Cerebral Arteriovenous Shunts Embolization? Ann Indian Acad Neurol 2020; 23:553-555. [PMID: 33223680 PMCID: PMC7657283 DOI: 10.4103/aian.aian_448_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/29/2018] [Accepted: 12/12/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Jidian Sun
- Department of Neurosurgery, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- Address for correspondence: Dr. Xianli Lv, Litang Road 168, Changping, Beijing, 102218, P.R. China. E-mail:
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Aβ peptide and fibrinogen weave a web of destruction in cerebral amyloid angiopathy. Proc Natl Acad Sci U S A 2020; 117:15391-15393. [PMID: 32576699 DOI: 10.1073/pnas.2009999117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Zhao Z, Zhao Z, Zheng X, Li X, Li X, Huang C, Shan Y, Nyame L, Ibrahim M, Gao X, Liang H, Hu J, Zou J. The association between smoking and unfavorable outcomes in
acute ischemic stroke patients with mechanical thrombectomy. Tob Induc Dis 2020; 18:31. [PMID: 32336969 PMCID: PMC7177386 DOI: 10.18332/tid/119229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Little is known about the relationship between smoking and clinical outcomes in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT). The outcomes could depend on different stroke subtypes. The aim of this study was to investigate whether smoking affected differently the outcomes in patients with different stroke subtypes who received MT. METHODS AIS patients who underwent MT were prospectively enrolled from three hospitals between January 2014 and December 2018. Smokers were defined as current users of cigarettes. The stroke subtypes were classified according to TOAST criteria. Outcome measurements included treatment effects, intracerebral hemorrhage (ICH), and functional outcomes at 3 months. The effects of smoking on outcomes were assessed by logistic regression analysis. RESULTS A total of 128 AIS patients with MT were enrolled, including 64 smokers and 64 non-smokers. Logistic regression analysis indicated that smoking was related to higher risk of In-hospital ICH (OR=4.31; 95% CI: 1.10–16.96; p=0.036) in patients with cardioembolism subtype. Furthermore, smoking was also associated with lower rates of mild stroke at discharge (OR=0.07; 95% CI: 0.02–0.31; p<0.001) and functional independence (OR=0.13; 95% CI: 0.03–0.56; p=0.006) in patients with cardioembolism subtype. CONCLUSIONS In AIS patients undergoing MT, smoking could be related to a higher risk of In-hospital ICH and lower rates of mild stroke at discharge and functional independence if their stroke subtype is cardioembolism.
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Affiliation(s)
- Zhihong Zhao
- Department of Neurology, The First Affiliated Hospital (People’s Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Zheng Zhao
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiaohan Zheng
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiang Li
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xuemei Li
- Department of Neurology, The First Affiliated Hospital (People’s Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Chaoping Huang
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - Yajie Shan
- Department of Neurology, The First Affiliated Hospital (People’s Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Linda Nyame
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Mako Ibrahim
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xiaoping Gao
- Department of Neurology, The First Affiliated Hospital (People’s Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Hui Liang
- Department of Neurology, The First Affiliated Hospital (People’s Hospital of Hunan Province), Hunan Normal University, Changsha, China
| | - Jue Hu
- Department of Neurology, Changsha Central Hospital, Changsha, China
| | - JianJun Zou
- Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
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Atypical antipsychotic clozapine binds fibrinogen and affects fibrin formation. Int J Biol Macromol 2020; 154:142-149. [PMID: 32184141 DOI: 10.1016/j.ijbiomac.2020.03.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 12/18/2022]
Abstract
Clozapine is an atypical antipsychotic used for the treatment of schizophrenia. The prescribed target daily doses may reach 900 mg. Literature studies report a connection between clozapine usage and thrombosis development. Our in vitro study aimed to provide insight into molecular bases of this observation, investigating clozapine binding to fibrinogen, the main plasma protein involved in hemostasis. Fibrinogen/clozapine interaction was confirmed by protein fluorescence quenching, with an affinity constant of 1.7 × 105 M-1. Direct interactions did not affect the structure of fibrinogen, nor fibrinogen melting temperature. Clozapine binding affected fibrin formation by reducing coagulation speed and thickness of fibrin fibers suggesting that in the presence of clozapine, fibrinogen may acquire thrombogenic characteristics. Although no difference in fibrin gel porosity was detected, other factors present in the blood may act synergistically with altered fibrin formation to modify fibrin clot, thus increasing the risk for development of thrombosis in patients on clozapine treatment. ORAC and HORAC assays showed that clozapine reduced free radical-induced oxidation of fibrinogen. All observed effects of clozapine on fibrinogen are dose-dependent, with the effect on fibrin formation being more pronounced.
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Censi R, Casadidio C, Deng S, Gigliobianco MR, Sabbieti MG, Agas D, Laus F, Di Martino P. Interpenetrating Hydrogel Networks Enhance Mechanical Stability, Rheological Properties, Release Behavior and Adhesiveness of Platelet-Rich Plasma. Int J Mol Sci 2020; 21:E1399. [PMID: 32092976 PMCID: PMC7073123 DOI: 10.3390/ijms21041399] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022] Open
Abstract
Platelet-rich plasma (PRP) has attracted much attention for the treatment of articular cartilage defects or wounds due to its intrinsic content of growth factors relevant for tissue repair. However, the short residence time of PRP in vivo, due to the action of lytic enzymes, its weak mechanical properties and the consequent short-term release of bioactive factors has restricted its application and efficacy. The present work aimed at designing new formulation strategies for PRP, based on the use of platelet concentrate (PC)-loaded hydrogels or interpenetrating polymer networks, directed at improving mechanical stability and sustaining the release of bioactive growth factors over a prolonged time-span. The interpenetrating hydrogels comprised two polymer networks interlaced on a molecular scale: (a) a first covalent network of thermosensitive and biodegradable vinyl sulfone bearing p(hydroxypropyl methacrylamide-lacate)-polyethylene glycol triblock copolymers, tandem cross-linked by thermal gelation and Michael addition when combined with thiolated hyaluronic acid, and (b) a second network composed of cross-linked fibrin. The PC-loaded hydrogels, instead, was formed only by network (a). All the designed and successfully synthesized formulations greatly increased the stability of PRP in vitro, leading to significant increase in degradation time and storage modulus of PRP gel. The resulting viscoelastic networks showed the ability to controllably release platelet derived growth factor and transforming growth factr β1, and to improve the tissue adhesiveness of PRP. The newly developed hydrogels show great potential for application in the field of wound healing, cartilage repair and beyond.
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Affiliation(s)
- Roberta Censi
- School of Pharmacy, University of Camerino, Via. S. Agostino 1, 62032 Camerino (MC), Italy; (C.C.); (S.D.); (M.R.G.); (P.D.M.)
| | - Cristina Casadidio
- School of Pharmacy, University of Camerino, Via. S. Agostino 1, 62032 Camerino (MC), Italy; (C.C.); (S.D.); (M.R.G.); (P.D.M.)
| | - Siyuan Deng
- School of Pharmacy, University of Camerino, Via. S. Agostino 1, 62032 Camerino (MC), Italy; (C.C.); (S.D.); (M.R.G.); (P.D.M.)
| | - Maria Rosa Gigliobianco
- School of Pharmacy, University of Camerino, Via. S. Agostino 1, 62032 Camerino (MC), Italy; (C.C.); (S.D.); (M.R.G.); (P.D.M.)
| | - Maria Giovanna Sabbieti
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Gentile III da Varano, 62032 Camerino (MC), Italy; (M.G.S.); (D.A.)
| | - Dimitrios Agas
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Gentile III da Varano, 62032 Camerino (MC), Italy; (M.G.S.); (D.A.)
| | - Fulvio Laus
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Matelica (MC), Italy;
| | - Piera Di Martino
- School of Pharmacy, University of Camerino, Via. S. Agostino 1, 62032 Camerino (MC), Italy; (C.C.); (S.D.); (M.R.G.); (P.D.M.)
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Ex vivo properties of plasma clot formation and lysis in patients with cancer at risk for venous thromboembolism, arterial thrombosis, and death. Transl Res 2020; 215:41-56. [PMID: 31525325 PMCID: PMC7332340 DOI: 10.1016/j.trsl.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/05/2019] [Accepted: 08/26/2019] [Indexed: 01/05/2023]
Abstract
A prothrombotic state is frequently observed in patients with cancer and contributes to the risks of venous thromboembolism (VTE), arterial thromboembolism (ATE), tumor progression, and death. Altered ex vivo properties of plasma clot formation and lysis have been observed in patients with cancer. The aim of this prospective study was to comprehensively characterize the relationship between plasma clot properties, inflammation, hypercoagulability, thrombotic complications, and mortality in patients with cancer using a tissue-factor-based turbidimetric assay of clot formation and lysis. Turbidity parameters were determined in 815 patients with newly-diagnosed or recurrent cancer and 97 healthy controls. Patients were followed-up for 2 years and rates of VTE (n = 72 events), ATE (n = 21 events), and death (n = 304 events) were assessed. Compared to controls, cancer patients' turbidity profiles showed an increased clot formation potential and higher resistance toward fibrinolysis. Elevated biomarkers of inflammation and hemostasis, such as C-reactive protein, FVIII, and thrombin generation explained substantial amounts of variation in turbidity parameters. In a prospective analysis, altered parameters of clot formation identified cancer patients at high risk of ATE (Hazard ratio [HR] per doubling of peak absorbance: 4.43, 95% CI: 1.50-13.07, P = 0.007) and death (HR per doubling of peak absorbance: 2.73, 2.00-3.72, P< 0.0001); these findings were independent of other prognostic covariates. Contrarily, turbidity parameters were not associated with risk of VTE (HR per doubling of peak absorbance: 1.15, 0.66-2.01, P = 0.62). We conclude that patients with cancer have altered ex vivo properties of clot formation which predict risks of ATE and mortality but not VTE.
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15
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Effect of tannic acid on blood components and functions. Colloids Surf B Biointerfaces 2019; 184:110505. [DOI: 10.1016/j.colsurfb.2019.110505] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/06/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023]
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16
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Beckman JD, Wolberg AS. Mechanistic rationale for factor XIII cotreatment in haemophilia. Haemophilia 2019; 25:e377-e378. [PMID: 31577382 DOI: 10.1111/hae.13855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/03/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Joan D Beckman
- Department of Medicine, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Alisa S Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Absence of functional compensation between coagulation factor VIII and plasminogen in double-knockout mice. Blood Adv 2019; 2:3126-3136. [PMID: 30459211 DOI: 10.1182/bloodadvances.2018024851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022] Open
Abstract
Plasminogen deficiency is associated with severely compromised fibrinolysis and extravascular deposition of fibrin. In contrast, coagulation factor VIII (FVIII) deficiency leads to prolonged and excessive bleeding. Based on opposing biological functions of plasminogen and FVIII deficiencies, we hypothesized that genetic elimination of FVIII would alleviate the systemic formation of fibrin deposits associated with plasminogen deficiency and, in turn, elimination of plasminogen would limit bleeding symptoms associated with FVIII deficiency. Mice with single and combined deficiencies of FVIII (F8-/-) and plasminogen (Plg-/-) were evaluated for phenotypic characteristics of plasminogen deficiency, including wasting disease, shortened lifespan, rectal prolapse, and multiorgan fibrin deposition. Conversely, to specifically examine the role of plasmin-mediated fibrinolysis on bleeding caused by FVIII deficiency, F8-/- and F8-/-/Plg-/- mice were subjected to a bleeding challenge. Mice with a combined deficiency in FVIII and plasminogen displayed no phenotypic differences relative to mice with single FVIII or plasminogen deficiency. Plg-/- and F8-/-/Plg-/- mice exhibited the same penetrance and severity of wasting disease, rectal prolapse, extravascular fibrin deposits, and reduced viability. Furthermore, following a tail vein-bleeding challenge, no significant differences in bleeding times or total blood loss could be detected between F8-/- and F8-/-/Plg-/- mice. Moreover, F8-/- and F8-/-/Plg-/- mice responded similarly to recombinant FVIII (rFVIII) therapy. In summary, the pathological phenotype of Plg-/- mice developed independently of FVIII-dependent coagulation, and elimination of plasmin-driven fibrinolysis did not play a significant role in a nonmucosal bleeding model in hemophilia A mice.
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18
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Nogami K, Matsumoto T, Sasai K, Ogiwara K, Arai N, Shima M. A novel simultaneous clot‐fibrinolysis waveform analysis for assessing fibrin formation and clot lysis in haemorrhagic disorders. Br J Haematol 2019; 187:518-529. [DOI: 10.1111/bjh.16111] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/11/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Keiji Nogami
- Department of Paediatrics Nara Medical University Kashihara Nara Japan
| | - Tomoko Matsumoto
- Course of Haemophilia Treatment & Pathology Nara Medical University Kashihara Nara Japan
- Tenri Medical and School Tenri Japan
| | - Kana Sasai
- Department of Paediatrics Nara Medical University Kashihara Nara Japan
| | - Kenichi Ogiwara
- Department of Paediatrics Nara Medical University Kashihara Nara Japan
| | - Nobuo Arai
- Engineering Division Sysmex Corporation Kobe Japan
| | - Midori Shima
- Department of Paediatrics Nara Medical University Kashihara Nara Japan
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19
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Heubel-Moenen FCJI, Henskens YMC, Verhezen PWM, Wetzels RJH, Schouten HC, Beckers EAM. Fibrinolysis in patients with chemotherapy-induced thrombocytopenia and the effect of platelet transfusion. J Thromb Haemost 2019; 17:1073-1084. [PMID: 31033178 DOI: 10.1111/jth.14465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 01/11/2023]
Abstract
Essentials Bleeding in chemotherapy induced thrombocytopenia (CIT) might be influenced by hyperfibrinolysis. t-PA-thromboelastography is a fast and reliable assay for hyperfibrinolysis in CIT patients. Clots of CIT patients are more susceptible to t-PA induced lysis compared to healthy individuals. Besides platelets, other factors are likely to influence clot lysis in CIT patients. BACKGROUND Bleeding events in chemotherapy-induced thrombocytopenic (CIT) patients with similar platelet counts might be influenced by changes in clot lysis potential. OBJECTIVES To investigate, in an observational study, thromboelastographic lysis parameters, alterations in clot strength and susceptibility to clot lysis in CIT patients. To identify factors associated with fibrinolytic profiles, and to evaluate the effects of platelet transfusions. METHODS Independent determinants of tissue-type plasminogen activator (t-PA)-ROTEM lysis parameters were identified with multivariable linear regression. Clot formation, strength and lysis parameters were compared with the results of healthy individuals. Characteristics of CIT patients with and without hyperfibrinolytic profiles were compared. t-PA-ROTEM results before, 1 hour after and 24 hours after platelet transfusion were compared. RESULTS A total of 72 consecutive CIT patients were included. t-PA-ROTEM lysis parameters correlated with changes in fibrinolytic proteins. Clot formation time was longer, maximum clot firmness was weaker and lysis times were shorter than in healthy individuals. CIT patients had low plasminogen activator inhibitor-1 and thrombin-activatable fibrinolysis inhibitor levels, and 40% showed hyperfibrinolytic profiles. Platelet transfusions resulted in less hyperfibrinolytic profiles in many, but not all CIT patients. Patients without hyperfibrinolytic profiles had higher fibrinogen, factor VIII and α2 -antiplasmin levels. CONCLUSIONS t-PA-ROTEM can be used as a fast and reliable assay to detect hyperfibrinolytic profiles in CIT patients. CIT patients have weaker clots, which are more susceptible to clot lysis, than healthy individuals. Besides platelets, other factors are likely to influence clot susceptibility to fibrinolysis in CIT patients. The impact of a hyperfibrinolytic t-PA-ROTEM profile on bleeding remains to be investigated.
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Affiliation(s)
- Floor C J I Heubel-Moenen
- Department of Hematology, Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Yvonne M C Henskens
- Central Diagnostic Laboratory, Unit for Hemostasis and Transfusion, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Paul W M Verhezen
- Central Diagnostic Laboratory, Unit for Hemostasis and Transfusion, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Rick J H Wetzels
- Central Diagnostic Laboratory, Unit for Hemostasis and Transfusion, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Harry C Schouten
- Department of Hematology, Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Erik A M Beckers
- Department of Hematology, Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
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20
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Negrier C, Shima M, Hoffman M. The central role of thrombin in bleeding disorders. Blood Rev 2019; 38:100582. [PMID: 31164248 DOI: 10.1016/j.blre.2019.05.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 05/10/2019] [Accepted: 05/20/2019] [Indexed: 01/25/2023]
Abstract
Maintaining normal hemostasis relies on a regulated system of procoagulant and anticoagulant pathways, and disruption of these processes leads to the loss of hemostatic control, with the potential for excessive bleeding or thrombosis. Evaluation of bleeding disorders has conventionally been achieved by laboratory assays that measure the activity of individual coagulation factors. While such assays have proven effective for detecting abnormalities of the coagulation system and aiding diagnosis, inherent limitations prevent them from capturing a complete picture of hemostatic function. An improved understanding of thrombin activity and its central role in hemostasis and bleeding disorders has led to the clinical development of global assays that are more physiologically relevant than traditional assays; furthermore, these global assays are able to monitor responses to therapy. In this review, we provide an overview of the role of thrombin in hemostasis, and describe the clinical benefits of thrombin monitoring in patients with bleeding disorders. Moreover, we discuss recent advances in thrombin-targeting therapeutic strategies that aim to correct thrombin deficiency and prevent bleeding in patients with hemophilia and other rare bleeding disorders.
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Affiliation(s)
- Claude Negrier
- Haematology Department, Louis Pradel University Hospital, University Claude Bernard, Lyon, France
| | - Midori Shima
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
| | - Maureane Hoffman
- Department of Pathology, Duke University Medical Center, Durham, NC, USA.
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21
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Wang X, Luo Y, Yang Y, Zheng B, Yan F, Wei F, Friis TE, Crawford RW, Xiao Y. Alteration of clot architecture using bone substitute biomaterials (beta-tricalcium phosphate) significantly delays the early bone healing process. J Mater Chem B 2018; 6:8204-8213. [PMID: 32254940 DOI: 10.1039/c8tb01747f] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
When a bone substitute biomaterial is implanted into the body, the material's surface comes into contact with circulating blood, which results in the formation of a peri-implant hematoma or blood clot. Although hematoma formation is vital for the early bone healing process, knowledge concerning the biomaterial-induced structural properties of blood clots is limited. Here, we report that implantation of beta-tricalcium phosphate (β-TCP) in a bone defect healing model in rats resulted in significantly delayed early bone healing compared to empty controls (natural healing). In vitro studies showed that β-TCP had a profound effect on the overall structure of hematomas, as was observed by fibrin turbidity, scanning electron microscopy (SEM), compaction assays, and fibrinolysis. Under the influence of β-TCP, clot formation had a significantly shortened lag time and there was enhanced lateral fibrin aggregation during the clot polymerization, which resulted in clots composed of thinner fibers. Furthermore, fibrin clots that formed around β-TCP exhibited reduced compaction and increased resistance to fibrinolysis. Together, these results provide a plausible mechanism for how implanted bone-substitute materials may impact the structural properties of the hematoma, thereby altering the early bone healing processes, such as cell infiltration, growth factor release and angiogenesis.
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Affiliation(s)
- Xin Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
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22
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An ATF6-tPA pathway in hepatocytes contributes to systemic fibrinolysis and is repressed by DACH1. Blood 2018; 133:743-753. [PMID: 30504459 DOI: 10.1182/blood-2018-07-864843] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/13/2018] [Indexed: 01/18/2023] Open
Abstract
Tissue-type plasminogen activator (tPA) is a major mediator of fibrinolysis and, thereby, prevents excessive coagulation without compromising hemostasis. Studies on tPA regulation have focused on its acute local release by vascular cells in response to injury or other stimuli. However, very little is known about sources, regulation, and fibrinolytic function of noninjury-induced systemic plasma tPA. We explore the role and regulation of hepatocyte-derived tPA as a source of basal plasma tPA activity and as a contributor to fibrinolysis after vascular injury. We show that hepatocyte tPA is downregulated by a pathway in which the corepressor DACH1 represses ATF6, which is an inducer of the tPA gene Plat Hepatocyte-DACH1-knockout mice show increases in liver Plat, circulating tPA, fibrinolytic activity, bleeding time, and time to thrombosis, which are reversed by silencing hepatocyte Plat Conversely, hepatocyte-ATF6-knockout mice show decreases in these parameters. The inverse correlation between DACH1 and ATF6/PLAT is conserved in human liver. These findings reveal a regulated pathway in hepatocytes that contributes to basal circulating levels of tPA and to fibrinolysis after vascular injury.
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23
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Macrae FL, Duval C, Papareddy P, Baker SR, Yuldasheva N, Kearney KJ, McPherson HR, Asquith N, Konings J, Casini A, Degen JL, Connell SD, Philippou H, Wolberg AS, Herwald H, Ariëns RA. A fibrin biofilm covers blood clots and protects from microbial invasion. J Clin Invest 2018; 128:3356-3368. [PMID: 29723163 PMCID: PMC6063501 DOI: 10.1172/jci98734] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/01/2018] [Indexed: 01/28/2023] Open
Abstract
Hemostasis requires conversion of fibrinogen to fibrin fibers that generate a characteristic network, interact with blood cells, and initiate tissue repair. The fibrin network is porous and highly permeable, but the spatial arrangement of the external clot face is unknown. Here we show that fibrin transitioned to the blood-air interface through Langmuir film formation, producing a protective film confining clots in human and mouse models. We demonstrated that only fibrin is required for formation of the film, and that it occurred in vitro and in vivo. The fibrin film connected to the underlying clot network through tethering fibers. It was digested by plasmin, and formation of the film was prevented with surfactants. Functionally, the film retained blood cells and protected against penetration by bacterial pathogens in a murine model of dermal infection. Our data show a remarkable aspect of blood clotting in which fibrin forms a protective film covering the external surface of the clot, defending the organism against microbial invasion.
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Affiliation(s)
- Fraser L Macrae
- Thrombosis and Tissue Repair Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Cédric Duval
- Thrombosis and Tissue Repair Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Praveen Papareddy
- Division of Infection Medicine, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stephen R Baker
- Thrombosis and Tissue Repair Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Nadira Yuldasheva
- Thrombosis and Tissue Repair Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Katherine J Kearney
- Population and Clinical Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Helen R McPherson
- Thrombosis and Tissue Repair Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Nathan Asquith
- Thrombosis and Tissue Repair Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Joke Konings
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, School of Medicine, and.,Synapse Research Institute, CARIM, University of Maastricht, Maastricht, Netherlands
| | - Alessandro Casini
- Division of Angiology and Haemostasis, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jay L Degen
- Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - Simon D Connell
- Molecular and Nanoscale Physics Group, School of Physics and Astronomy, University of Leeds, Leeds, United Kingdom
| | - Helen Philippou
- Thrombosis and Tissue Repair Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Alisa S Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Heiko Herwald
- Division of Infection Medicine, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Robert As Ariëns
- Thrombosis and Tissue Repair Group, Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom.,Department of Biochemistry, Cardiovascular Research Institute Maastricht, School of Medicine, and
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24
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Grant AL, Letson HL, Morris JL, McEwen P, Hazratwala K, Wilkinson M, Dobson GP. Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study. J Orthop Surg Res 2018; 13:149. [PMID: 29914535 PMCID: PMC6006687 DOI: 10.1186/s13018-018-0855-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/05/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce excessive bleeding and transfusion requirements. Our aim was to examine if TXA was required in all osteoarthritis patients undergoing TKA surgery, and its possible effects on systemic inflammation and coagulation properties. METHODS Twenty-three patients (Oxford Score 22-29) were recruited consecutively; 12 patients received TXA before (IV, 1.2 g/90 kg) and immediately after surgery (intra-articular, 1.4 g/90 kg). Inflammatory mediators and ROTEM parameters were measured in blood at baseline, after the first bone-cut, immediately after surgery, and postoperative days 1 and 2. RESULTS After the bone cut and surgery, TXA significantly increased MCP-1, TNF-α, IL-1β and IL-6 levels compared to non-TXA patients, which was further amplified postoperatively. During surgery, TXA significantly prolonged EXTEM clot times, indicating a thrombin-slowing effect, despite little or no change in clot amplitude or fibrinogen. TXA was associated with three- to fivefold increases in FIBTEM maximum lysis (ML), a finding counter to TXA's antifibrinolytic effect. Maximum lysis for extrinsic and intrinsic pathways was < 8%, indicating little or no hyperfibrinolysis. No significant differences were found in postoperative hemoglobin between the two groups. CONCLUSIONS TXA was associated with increased systemic inflammation during surgery compared to non-TXA patients, with further amplification on postoperative days 1 and 2. On the basis of little or no change in viscoelastic clot strength, fibrinogen or clot lysis, there appeared to be no clinical justification for TXA in our group of patients. Larger prospective, randomized trials are required to investigate a possible proinflammatory effect in TKA patients.
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Affiliation(s)
- Andrea L Grant
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, Townsville, Queensland, 4812, Australia.,Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia
| | - Hayley L Letson
- Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia
| | - Jodie L Morris
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, Townsville, Queensland, 4812, Australia.,Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia
| | - Peter McEwen
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, Townsville, Queensland, 4812, Australia.,Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia
| | - Kaushik Hazratwala
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, Townsville, Queensland, 4812, Australia.,Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia
| | - Matthew Wilkinson
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico, Townsville, Queensland, 4812, Australia.,Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia
| | - Geoffrey P Dobson
- Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville, Queensland, 4811, Australia.
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25
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Mechanical and Biochemical Role of Fibrin Within a Venous Thrombus. Eur J Vasc Endovasc Surg 2018; 55:417-424. [DOI: 10.1016/j.ejvs.2017.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/03/2017] [Indexed: 12/13/2022]
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26
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27
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Gorog DA, Fayad ZA, Fuster V. Arterial Thrombus Stability. J Am Coll Cardiol 2017; 70:2036-2047. [DOI: 10.1016/j.jacc.2017.08.065] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/15/2017] [Accepted: 08/31/2017] [Indexed: 01/27/2023]
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28
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Swanepoel AC, Emmerson O, Pretorius E. Effect of Progesterone and Synthetic Progestins on Whole Blood Clot Formation and Erythrocyte Structure. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2017; 23:607-617. [PMID: 28480839 DOI: 10.1017/s1431927617000484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Combined oral contraceptive (COC) use is a risk factor for venous thrombosis (VT) and related to the specific type of progestin used. VT is accompanied by inflammation and pathophysiological clot formation, that includes aberrant erythrocytes and fibrin(ogen) interactions. In this paper, we aim to determine the influence of progesterone and different synthetic progestins found in COCs on the viscoelasticity of whole blood clots, as well as erythrocyte morphology and membrane ultrastructure, in an in vitro laboratory study. Thromboelastography (TEG), light microscopy, and scanning electron microscopy were our chosen methods. Our results point out that progestins influence the rate of whole blood clot formation. Alterations to erythrocyte morphology and membrane ultrastructure suggest the presence of eryptosis. We also note increased rouleaux formation, erythrocyte aggregation, and spontaneous fibrin formation in whole blood which may explain the increased risk of VT associated with COC use. Although not all COC users will experience a thrombotic event, individuals with a thrombotic predisposition, due to inflammatory or hematological illness, should be closely monitored to prevent pathological thrombosis.
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29
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Hudson NE. Biophysical Mechanisms Mediating Fibrin Fiber Lysis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2748340. [PMID: 28630861 PMCID: PMC5467299 DOI: 10.1155/2017/2748340] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/30/2017] [Indexed: 01/19/2023]
Abstract
The formation and dissolution of blood clots is both a biochemical and a biomechanical process. While much of the chemistry has been worked out for both processes, the influence of biophysical properties is less well understood. This review considers the impact of several structural and mechanical parameters on lytic rates of fibrin fibers. The influences of fiber and network architecture, fiber strain, FXIIIa cross-linking, and particle transport phenomena will be assessed. The importance of the mechanical aspects of fibrinolysis is emphasized, and future research avenues are discussed.
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Affiliation(s)
- Nathan E. Hudson
- Department of Physics, East Carolina University, N304 Howell Science Complex, Greenville, NC 27858, USA
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30
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Jansohn E, Bengzon J, Kander T, Schött U. A pilot study on the applicability of thromboelastometry in detecting brain tumour-induced hypercoagulation. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:289-294. [DOI: 10.1080/00365513.2017.1306877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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31
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Afosah DK, Al-Horani RA, Sankaranarayanan NV, Desai UR. Potent, Selective, Allosteric Inhibition of Human Plasmin by Sulfated Non-Saccharide Glycosaminoglycan Mimetics. J Med Chem 2017; 60:641-657. [DOI: 10.1021/acs.jmedchem.6b01474] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Daniel K. Afosah
- Department of Medicinal Chemistry,
and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia 23219, United States
| | - Rami A. Al-Horani
- Department of Medicinal Chemistry,
and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia 23219, United States
| | - Nehru Viji Sankaranarayanan
- Department of Medicinal Chemistry,
and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia 23219, United States
| | - Umesh R. Desai
- Department of Medicinal Chemistry,
and Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, Virginia 23219, United States
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32
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Abstract
Fibrinogen and fibrin are essential for hemostasis and are major factors in thrombosis, wound healing, and several other biological functions and pathological conditions. The X-ray crystallographic structure of major parts of fibrin(ogen), together with computational reconstructions of missing portions and numerous biochemical and biophysical studies, have provided a wealth of data to interpret molecular mechanisms of fibrin formation, its organization, and properties. On cleavage of fibrinopeptides by thrombin, fibrinogen is converted to fibrin monomers, which interact via knobs exposed by fibrinopeptide removal in the central region, with holes always exposed at the ends of the molecules. The resulting half-staggered, double-stranded oligomers lengthen into protofibrils, which aggregate laterally to make fibers, which then branch to yield a three-dimensional network. Much is now known about the structural origins of clot mechanical properties, including changes in fiber orientation, stretching and buckling, and forced unfolding of molecular domains. Studies of congenital fibrinogen variants and post-translational modifications have increased our understanding of the structure and functions of fibrin(ogen). The fibrinolytic system, with the zymogen plasminogen binding to fibrin together with tissue-type plasminogen activator to promote activation to the active proteolytic enzyme, plasmin, results in digestion of fibrin at specific lysine residues. In spite of a great increase in our knowledge of all these interconnected processes, much about the molecular mechanisms of the biological functions of fibrin(ogen) remains unknown, including some basic aspects of clotting, fibrinolysis, and molecular origins of fibrin mechanical properties. Even less is known concerning more complex (patho)physiological implications of fibrinogen and fibrin.
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Affiliation(s)
- John W Weisel
- Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - Rustem I Litvinov
- Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Tanka-Salamon A, Komorowicz E, Szabó L, Tenekedjiev K, Kolev K. Free Fatty Acids Modulate Thrombin Mediated Fibrin Generation Resulting in Less Stable Clots. PLoS One 2016; 11:e0167806. [PMID: 27942000 PMCID: PMC5152833 DOI: 10.1371/journal.pone.0167806] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/21/2016] [Indexed: 12/19/2022] Open
Abstract
Upon platelet activation, free fatty acids are released at the stage of thrombus formation, but their effects on fibrin formation are largely unexplored. Our objective was to characterize the kinetic effects of fatty acids on thrombin activity, as well as the structural and mechanical properties of the resultant fibrin clots. Thrombin activity on fibrinogen was followed by turbidimetry and detailed kinetic characterization was performed using a fluorogenic short peptide substrate. The viscoelastic properties of fibrin were measured with rotatory oscillation rheometer, whereas its structure was analyzed with scanning electron microscopy (SEM). In turbidimetric assays of fibrin generation, oleate and stearate at physiologically relevant concentrations (60–600 μM) produced a bell-shaped inhibitory dose response, increasing 10- to 30-fold the time to half-maximal clotting. Oleate inhibited thrombin activity on a short peptide substrate according to a mixed-type inhibitor pattern (a 9-fold increase of the Michaelis constant, Km and a 20% decrease of the catalytic constant), whereas stearate resulted in only a minor (15%) drop in the catalytic constant without any change in the Km. Morphometric analysis of SEM images showed a 73% increase in the median fiber diameter in the presence of stearate and a 20% decrease in the presence of oleate. Concerning the viscoelastic parameters of the clots, storage and loss moduli, maximal viscosity and critical shear stress decreased by 32–65% in the presence of oleate or stearate, but loss tangent did not change indicating decreased rigidity, higher deformability and decreased internal resistance to shear stress. Our study provides evidence that free fatty acids (at concentrations comparable to those reported in thrombi) reduce the mechanical stability of fibrin through modulation of thrombin activity and the pattern of fibrin assembly.
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Affiliation(s)
- Anna Tanka-Salamon
- Department of Medical Biochemistry, Semmelweis University, Budapest, Hungary
| | - Erzsébet Komorowicz
- Department of Medical Biochemistry, Semmelweis University, Budapest, Hungary
| | - László Szabó
- IMEC, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Kiril Tenekedjiev
- Nikola Vaptsarov Naval Academy, Varna, Bulgaria
- Australian Maritime College, University of Tasmania, Newnham, Australia
| | - Krasimir Kolev
- Department of Medical Biochemistry, Semmelweis University, Budapest, Hungary
- * E-mail:
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Hugenholtz GCG, Macrae F, Adelmeijer J, Dulfer S, Porte RJ, Lisman T, Ariëns RAS. Procoagulant changes in fibrin clot structure in patients with cirrhosis are associated with oxidative modifications of fibrinogen. J Thromb Haemost 2016; 14:1054-66. [PMID: 26833718 DOI: 10.1111/jth.13278] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 01/12/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Essentials Patients with cirrhosis have hemostatic changes, which may contribute to a risk of thrombosis. This in vitro study compares clot formation and structure between patients and healthy subjects. Clot formation is delayed in patients; ultimately, however, clot permeability is decreased. The thrombogenic structure of fibrin clots may contribute to the thrombotic risk in cirrhosis. ABSTRACT Background and Objectives Patients with cirrhosis can be at risk of thrombotic complications due to an imbalance between hemostatic components. However, little is known on how the disease affects clot generation or how alterations in the structure of fibrin clots may affect the hemostatic function of these patients. Methods We investigated the formation and structure of clots generated with plasma and purified fibrinogen of 42 patients with cirrhosis. Clots generated with plasma and fibrinogen of 29 healthy volunteers were studied for comparison. Clot formation and structure were assessed by turbidity, permeation studies, confocal laser and scanning electron microscopy (SEM). The extent of fibrinogen oxidation was assessed by measuring the carbonyl content of purified fibrinogen samples. Results Tissue factor and thrombin-induced clotting of plasma was delayed in patients. The clotting rate was also decreased, but change in turbidity, fibrin density and fiber thickness were largely comparable to healthy volunteers. Conversely, clot permeability was significantly decreased in patients. When clots were generated with purified fibrinogen, differences in clot formation and structure similar to those in plasma were found. The carbonyl content was increased in patient fibrinogen and correlated with disease severity and clot permeability. Conclusions Delayed clot formation in cirrhosis ultimately results in decreased clot permeability. Similar alterations in clots generated with purified fibrinogen suggest that modifications of the molecule are (partly) responsible. Taken together, these findings are indicative of hypercoagulable features of clots of patients with cirrhosis, which may explain the increased risk of thrombosis associated with this condition.
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Affiliation(s)
- G C G Hugenholtz
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - F Macrae
- Thrombosis Research Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - J Adelmeijer
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S Dulfer
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R J Porte
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T Lisman
- Surgical Research Laboratory, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R A S Ariëns
- Thrombosis Research Group, Division of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
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Ząbczyk M, Majewski J, Karkowski G, Malinowski KP, Undas A. Vitamin K antagonists favourably modulate fibrin clot properties in patients with atrial fibrillation as early as after 3days of treatment: Relation to coagulation factors and thrombin generation. Thromb Res 2015; 136:832-8. [DOI: 10.1016/j.thromres.2015.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/31/2015] [Accepted: 08/12/2015] [Indexed: 11/26/2022]
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Morfini M. Rapid rFVIIa enhanced on-demand dosing in haemophilia inhibitor patients. Eur J Haematol 2015; 96:111-8. [PMID: 26172449 DOI: 10.1111/ejh.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2015] [Indexed: 01/19/2023]
Abstract
Recombinant factor VII activated (rFVIIa) is a bypassing agent widely used in haemophilia A and B patients with antibodies against coagulation factors VIII or IX. When used according to the correct doses, rFVIIa may control bleeding, subclinical bleeding and rebleeding, avoiding the effect of neutralising inhibitors. Because of the fast action of the rFVIIa, haemostasis occurs promptly and enables a fast bleeding control with on-demand treatment in home or in surgical setting. Rapidity is also a distinguishing feature in preparation and injection of rFVIIa to cope the restraining times of busy patients and parents. The effective haemostatic activity of rFVIIa enables a sustained bleeding control, which is implemented with every other day (eod) administration and suited for enhanced on-demand therapy and short-term repeated infusions use of rFVIIa to prevent microhaemorrhages or rebleeding. Comprehensive appreciation of these pharmacological and pharmacodynamic' characteristics will likely be a further stimulus to the wider enhanced on-demand use of rFVIIa.
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Affiliation(s)
- Massimo Morfini
- Past President of Italian Association of Haemophilia Centers (AICE), Florence, Italy
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van Rooy MJ, Duim W, Ehlers R, Buys AV, Pretorius E. Platelet hyperactivity and fibrin clot structure in transient ischemic attack individuals in the presence of metabolic syndrome: a microscopy and thromboelastography study. Cardiovasc Diabetol 2015; 14:86. [PMID: 26140921 PMCID: PMC4542104 DOI: 10.1186/s12933-015-0249-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 06/18/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Strokes are commonly preceded by transient ischemic attacks (TIAs). TIA is often associated with metabolic syndrome (causing chronic inflammation), resulting in a proinflammatory- and procoagulant-environment. The aim of this study was to determine whether platelet- and fibrin network-morphology or coagulation profiles of individuals that suffered a TIA in the presence of metabolic syndrome was altered when compared to healthy individuals. MATERIALS AND METHODS The study consisted of 40 voluntary participants. Twenty individuals that suffered a TIA in the previous 48 h with at least two metabolic syndrome risk factors present and twenty healthy age-matched controls. Scanning electron- and atomic force microscopy was used to study platelet- and fibrin-morphology, atomic force microscopy was used to study platelet- and fibrin fiber-elasticity and thromboelastography for the study of coagulation profiles. Statistical analysis was performed to compare the two groups. In all cases a p-value of less than 0.05 was considered statistically significant. RESULTS Platelets of the control group appeared spherical with few pseudopodia present while the platelets of the TIA individuals presented with numerous pseudopodia and spreading, indicating activation. Platelet aggregation was also present. The fibrin networks of the healthy individuals consist of thick and thin fibers that form an organized network of fibers. The fibrin networks of the TIA individuals appeared less organized with less taut fibers. Fibrin fiber thickness was found to be significantly increased in the TIA group (p-value <0.001) when compared to healthy controls. The thicker fibers formed irregular networks with thick masses of fibrin fibers. Platelet and fibrin fiber elasticity was found to be significantly lower in the experimental group (p-value 0.0042 and p-value 0.0007 respectively). The hemostatic profiles of the diseased individuals did not differ significantly (p-value > 0.05) from the healthy controls, indicating a normal functioning coagulation cascade. CONCLUSION The findings indicate that pathological clot formation is not caused by alterations in the coagulation cascade but rather by the premature activation of platelets (as a result of chronic inflammation) that in turn causes altered fibrin formation.
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Affiliation(s)
- Mia-Jeanne van Rooy
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia, 0007, South Africa
| | - Wiebren Duim
- Department of Neurology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
| | - Rene Ehlers
- Department of Statistics, Faculty of Natural Sciences, University of Pretoria, Arcadia, 0007, South Africa
| | - Antoinette V Buys
- Unit of Microscopy and Microanalysis, Faculty of Natural Sciences, Arcadia, 0007, South Africa
| | - Etheresia Pretorius
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Private Bag x323, Arcadia, 0007, South Africa.
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Plasma clot properties in patients with a mild-to-moderate bleeding tendency of unknown cause. Ann Hematol 2015; 94:1301-10. [DOI: 10.1007/s00277-015-2399-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/17/2015] [Indexed: 11/26/2022]
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Smith SA, Morrissey JH. 2013 scientific sessions Sol Sherry distinguished lecture in thrombosis: polyphosphate: a novel modulator of hemostasis and thrombosis. Arterioscler Thromb Vasc Biol 2015; 35:1298-305. [PMID: 25908762 DOI: 10.1161/atvbaha.115.301927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/10/2015] [Indexed: 11/16/2022]
Abstract
Polyphosphate is a highly anionic, linear polymer of inorganic phosphates that is found throughout biology, including in many infectious microorganisms. Recently, polyphosphate was discovered to be stored in a subset of the secretory granules of human platelets and mast cells, and to be secreted on activation of these cells. Work from our laboratory and others has now shown that polyphosphate is a novel, potent modulator of the blood clotting and complement systems that likely plays roles in hemostasis, thrombosis, inflammation, and host responses to pathogens. Therapeutics targeting polyphosphate may have the potential to limit thrombosis with fewer hemorrhagic complications than conventional anticoagulant drugs that target essential proteases of the blood clotting cascade.
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Affiliation(s)
- Stephanie A Smith
- From the Department of Biochemistry, University of Illinois at Urbana-Champaign
| | - James H Morrissey
- From the Department of Biochemistry, University of Illinois at Urbana-Champaign.
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Martin AC, Gouin-Thibault I, Siguret V, Mordohay A, Samama CM, Gaussem P, Le Bonniec B, Godier A. Multimodal assessment of non-specific hemostatic agents for apixaban reversal. J Thromb Haemost 2015; 13:426-36. [PMID: 25630710 DOI: 10.1111/jth.12830] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 12/07/2014] [Indexed: 08/31/2023]
Abstract
BACKGROUND Non-specific hemostatic agents, namely activated prothrombin complex concentrate (aPCC), PCC and recombinant activated factor (F) VII (rFVIIa), can be used, off-label, to reverse the effects of FXa inhibitors in the rare cases of severe hemorrhages, as no approved specific antidote is available. We have evaluated the ability of aPCC, PCC and rFVIIa to reverse apixaban. METHODS Healthy volunteer whole blood was spiked with therapeutic or supra-therapeutic apixaban concentrations and two doses of aPCC, PCC or rFVIIa. Tests performed included a turbidimetry assay for fibrin polymerization kinetics analysis, scanning electron microscopy for fibrin network structure observation, thrombin generation assay (TGA), thromboelastometry, prothrombin time and activated partial thromboplastin time. RESULTS aPCC generated a dense clot constituting thin and branched fibers similar to those of a control without apixaban, increased fibrin polymerization velocity and improved quantitative (endogenous thrombin potential and peak height) as well as latency (clotting and lag times) parameters. Adding PCC also improved the fibrin and increased quantitative parameters, but fibrin polymerization kinetics and latency parameters were not corrected. Finally, rFVIIa improved latency parameters but failed to restore the fibrin network structure, fibrin polymerization velocity and quantitative parameters. CONCLUSION aPCC was more effective than PCC or rFVIIa in reversing in vitro the effects of apixaban. aPCC rapidly triggered the development of an apparently normal fibrin network and corrected latency and quantitative parameters, whereas PCC or rFVIIa had only a partial effect.
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Affiliation(s)
- A-C Martin
- Faculté de Pharmacie, Inserm UMR-S1140, Paris, France; Sorbonne Paris Cité, Université Paris Descartes, Paris, France; Service de Cardiologie, Hôpital du Val de Grâce, Paris, France
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Brinkman HJM. Global assays and the management of oral anticoagulation. Thromb J 2015; 13:9. [PMID: 25762867 PMCID: PMC4355453 DOI: 10.1186/s12959-015-0037-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/12/2015] [Indexed: 12/12/2022] Open
Abstract
Coagulation tests range from global or overall tests to assays specific to individual clotting factors and their inhibitors. Whether a particular test is influenced by an oral anticoagulant depends on the principle of the test and the type of oral anticoagulant. Knowledge on coagulation tests applicable in monitoring status and reversal of oral anticoagulation is a prerequisite when studying potential reversal agents or when managing anticoagulation in a clinical setting. Specialty tests based on the measurement of residual activated factor X (Xa) or thrombin activity, e.g., are highly effective for determining the concentration of the new generation direct factor Xa- and thrombin inhibitors, but these tests are unsuitable for the assessment of anticoagulation reversal by non-specific prohemostatic agents like prothrombin complex concentrate (PCC) and recombinant factor VIIa (FVIIa). Global coagulation assays, in this respect, seem more appropriate. This review evaluates the current status on the applicability of the global coagulation assays PT, APTT, thrombin generation and thromboelastography in the management of oral anticoagulation by vitamin K antagonists and the direct factor Xa and thrombin inhibitors. Although all global tests are influenced by both types of anticoagulants, not all tests are useful for monitoring anticoagulation and reversal thereof. Many (pre)analytical conditions are of influence on the assay readout, including the oral anticoagulant itself, the concentration of assay reagents and the presence of other elements like platelets and blood cells. Assay standardization, therefore, remains an issue of importance.
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Affiliation(s)
- Herm Jan M Brinkman
- Department of Plasma Proteins, Sanquin Research, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands
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Alamelu J, Bevan D, Sorensen B, Rangarajan S. Pharmacokinetic and pharmacodynamic properties of plasma-derived vs. recombinant factor IX in patients with hemophilia B: a prospective crossover study. J Thromb Haemost 2014; 12:2044-8. [PMID: 25315324 DOI: 10.1111/jth.12756] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 10/12/2014] [Indexed: 08/31/2023]
Abstract
BACKGROUND Effective treatment of acute bleeding episodes in patients with hemophilia B relies on factor IX recovery, with higher levels being more desirable, whereas prevention of bleeds with a prophylactic regimen depends on the half-life of the product. Lower recovery values have been reported following administration of recombinant FIX (rFIX) than following administration of plasma-derived FIX (pdFIX). OBJECTIVES To compare the pharmacokinetic and pharmacodynamic properties of rFIX and pdFIX in patients with hemophilia B. METHODS A prospective crossover study of nine patients with moderate to severe hemophilia B was performed. Following a washout period, 50 U kg(-1) FIX was administered, and blood samples were taken as per protocol up to 48 h postinfusion. Paired data were analyzed with the Wilcoxon signed rank test. RESULTS Mean peak recovery at 10 min postinfusion was 62.14 IU dL(-1) with pdFIX and 52.7 IU dL(-1) with rFIX (P = 0.08). Mean half-life was 16.6 h with pdFIX and 17.5 h with rFIX (P = 0.55). Maximum peak thrombin generation (PTG) was 35.9 nm with pdFIX and 28.9 nm with rFIX (P = 0.21). Administration of rFIX resulted in early PTG, whereas administration of pdFIX resulted in slightly later and sustained PTG. At 48 h, PTG was similar with pdFIX (19.0 nm) and rFIX (19.4 nm) (P = 0.91). CONCLUSIONS Patients experienced better recovery with pdFIX than with rFIX. pdFIX and rFIX had similar half-lives. Maximum PTG was higher for pdFIX; however, this difference did not reach statistical significance. The clinical impact of the slightly increased, delayed and sustained PTG with pdFIX requires further investigation.
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Affiliation(s)
- J Alamelu
- Centre for Haemostasis and Thrombosis, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Alonso-Orgaz S, Moreno-Luna R, López JA, Gil-Dones F, Padial LR, Moreu J, de la Cuesta F, Barderas MG. Proteomic characterization of human coronary thrombus in patients with ST-segment elevation acute myocardial infarction. J Proteomics 2014; 109:368-81. [DOI: 10.1016/j.jprot.2014.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 01/04/2023]
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Shiu HT, Goss B, Lutton C, Crawford R, Xiao Y. Formation of blood clot on biomaterial implants influences bone healing. TISSUE ENGINEERING PART B-REVIEWS 2014; 20:697-712. [PMID: 24906469 DOI: 10.1089/ten.teb.2013.0709] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The first step in bone healing is forming a blood clot at injured bones. During bone implantation, biomaterials unavoidably come into direct contact with blood, leading to a blood clot formation on its surface prior to bone regeneration. Despite both situations being similar in forming a blood clot at the defect site, most research in bone tissue engineering virtually ignores the important role of a blood clot in supporting healing. Dental implantology has long demonstrated that the fibrin structure and cellular content of a peri-implant clot can greatly affect osteoconduction and de novo bone formation on implant surfaces. This article reviews the formation of a blood clot during bone healing in relation to the use of platelet-rich plasma (PRP) gels. It is implicated that PRP gels are dramatically altered from a normal clot in healing, resulting in conflicting effect on bone regeneration. These results indicate that the effect of clots on bone regeneration depends on how the clots are formed. Factors that influence blood clot structure and properties in relation to bone healing are also highlighted. Such knowledge is essential for developing strategies to optimally control blood clot formation, which ultimately alter the healing microenvironment of bone. Of particular interest are modification of surface chemistry of biomaterials, which displays functional groups at varied composition for the purpose of tailoring blood coagulation activation, resultant clot fibrin architecture, rigidity, susceptibility to lysis, and growth factor release. This opens new scope of in situ blood clot modification as a promising approach in accelerating and controlling bone regeneration.
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Affiliation(s)
- Hoi Ting Shiu
- 1 Science and Engineering Faculty, Institute of Health and Biomedical Innovation, Queensland University of Technology , Brisbane, Australia
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Swanepoel AC, Lindeque BG, Swart PJ, Abdool Z, Pretorius E. Part 2: Ultrastructural changes of fibrin networks during three phases of pregnancy: A qualitative investigation. Microsc Res Tech 2014; 77:602-8. [DOI: 10.1002/jemt.22385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 05/03/2014] [Accepted: 05/15/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Albe C. Swanepoel
- Department of Physiology, School of Medicine, Faculty of Health Sciences; University of Pretoria; Arcadia 0007 South Africa
| | - Barend G. Lindeque
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, School of Medicine; University of Pretoria; Arcadia 0007 South Africa
| | - Paul J. Swart
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, School of Medicine; University of Pretoria; Arcadia 0007 South Africa
| | - Zeelha Abdool
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, School of Medicine; University of Pretoria; Arcadia 0007 South Africa
| | - Etheresia Pretorius
- Department of Physiology, School of Medicine, Faculty of Health Sciences; University of Pretoria; Arcadia 0007 South Africa
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Vikerfors A, Svenungsson E, Ågren A, Mobarrez F, Bremme K, Holmström M, Eelde A, Bruzelius M, Elgue G, Wallén H, Antovic A. Studies of fibrin formation and fibrinolytic function in patients with the antiphospholipid syndrome. Thromb Res 2014; 133:936-44. [DOI: 10.1016/j.thromres.2014.02.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/10/2014] [Accepted: 02/24/2014] [Indexed: 12/01/2022]
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Djabir Y, Letson HL, Dobson GP. Adenosine, lidocaine, and Mg2+ (ALM™) increases survival and corrects coagulopathy after eight-minute asphyxial cardiac arrest in the rat. Shock 2014; 40:222-32. [PMID: 23846412 DOI: 10.1097/shk.0b013e3182a03566] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION No drug therapy has demonstrated improved survival following cardiac arrest (CA) of cardiac or noncardiac origin. In an effort to translate the cardiorescue properties of Adenocaine (adenosine and lidocaine) and magnesium sulfate (ALM) from cardiac surgery and hemorrhagic shock to resuscitation, we examined the effect of ALM on hemodynamic rescue and coagulopathy following asphyxial-induced CA in the rat. METHODS Nonheparinized animals (400-500 g, n = 39) were randomly assigned to 0.9% saline (n = 12) and 0.9% saline ALM (n = 10) groups. After baseline data were acquired, the animal was surface cooled (33°C-34°C) and the ventilator line clamped for 8 min inducing CA; 0.5 mL of solution was injected intravenously followed by 60-s chest compressions (300/min), and rats were rewarmed. Return of spontaneous circulation (ROSC), mean arterial pressure, heart rate, and rectal temperature were recorded for 2 h. Additional rats were randomized for rotation thromboelastometry measurements (n = 17). RESULTS Rats treated with ALM had a significant survival benefit (100% ALM vs. 67% controls achieved ROSC) and generated a higher mean arterial pressure than did controls after 75 min (81 vs. 72 mmHg at 120 min, P < 0.05). In all rats, rotation thromboelastometry lysis index decreased during CA, implying hyperfibrinolysis. Control ROSC survivors displayed hypocoagulopathy (prolonged EXTEM/INTEM clotting time, clot formation time, prothrombin time, activated partial thromboplastin time), decreased maximal clot firmness, lowered elasticity, and lowered clot amplitudes but no change in lysis index. These coagulation abnormalities were corrected by ALM at 120 min after ROSC. CONCLUSIONS Small bolus of 0.9% NaCl ALM improved survival and hemodynamics following nonhemorrhagic, asphyxial CA and corrected prolonged clot times and clot retraction compared with controls.
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Affiliation(s)
- Yulia Djabir
- Heart and Trauma Research Laboratory, Physiology and Pharmacology, James Cook University, Queensland, Australia
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Lai BF, Zou Y, Yang X, Yu X, Kizhakkedathu JN. Abnormal blood clot formation induced by temperature responsive polymers by altered fibrin polymerization and platelet binding. Biomaterials 2014; 35:2518-28. [DOI: 10.1016/j.biomaterials.2013.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/08/2013] [Indexed: 12/25/2022]
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Meseguer E, Labreuche J, Gonzalez-Valcarcel J, Sirimarco G, Guidoux C, Cabrejo L, Lavallee PC, Klein IF, Amarenco P, Mazighi M. The smoking paradox: impact of smoking on recanalization in the setting of intra-arterial thrombolysis. Cerebrovasc Dis Extra 2014; 4:84-91. [PMID: 24926305 PMCID: PMC4035683 DOI: 10.1159/000357218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The smoking paradox refers to a better outcome in smokers eligible for thrombolytic treatment in myocardial infarction or ischemic stroke. Recent findings suggest that current smokers may present higher recanalization rates after intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA). We evaluated the impact of smoking in a consecutive series of patients treated with intra-arterial (IA) rt-PA. METHODS We analyzed data collected between April 2007 and December 2012 in our prospective registry. All acute ischemic stroke patients with an arterial occlusion treated by IA rt-PA (± IV, ± thrombectomy) were included. Arterial status was monitored with conventional angiography during the IA procedure. The primary study outcome was a complete recanalization achieved immediately after termination of IA rt-PA infusion. Secondary outcomes included complete recanalization after the end of the endovascular therapy (including complete recanalization achieved after adjunctive thrombectomy), favorable outcome (90-day modified Rankin Score ≤2), 90-day all-cause mortality, and any intracerebral hemorrhage. RESULTS Among the 227 included patients, 18.5% (n = 42) were current smokers and 16.7% (n = 38) former smokers. Compared with nonsmokers, current smokers were younger, more often men, had less frequently hypertension, and cardioembolic etiology, whereas former smokers were more often men and had more frequently hypercholesterolemia. The rate of complete recanalization was 30% (n = 68) after IA rt-PA infusion and 49% after adjunctive thrombectomy. A higher complete recanalization rate was found both in current smokers (45.2%) and former smokers (42.1%) compared to nonsmokers (22.5%). After adjustment for potential confounders, the adjusted odds ratio (OR) for complete recanalization associated with ever-smokers was 2.51 [95% confidence interval (CI) 1.26-4.99; p = 0.009]. A similar adjusted OR was found when the complete recanalization achieved after thrombectomy was included (OR 2.18, 95% CI 1.13-4.19; p = 0.019). However, smoking status was not independently associated with favorable outcome (adjusted OR 1.41, 95% CI 0.62-3.22 for former smokers, and adjusted OR 1.35, 95% CI 0.59-3.05 for current smokers), 90-day all-cause mortality (adjusted OR 0.68, 95% CI 0.25-1.81 for former smokers, and adjusted OR 1.55, 95% CI 0.54-4.48 for current smokers) or intracerebral hemorrhage (adjusted OR 0.72, 95% CI 0.29-1.76 for former smokers, and adjusted OR 0.80, 95% CI 0.32-1.96 for current smokers). CONCLUSIONS IA rt-PA administration was more effective to achieve complete arterial recanalization in current as well as former smokers. The characterization of the smoking paradox pathophysiology may lead to the identification of a patient-target population with a favorable response to rt-PA therapy. However, the smoking paradox should not be misinterpreted and not be used to promote smoking.
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Affiliation(s)
- Elena Meseguer
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | | | - Jaime Gonzalez-Valcarcel
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Gaia Sirimarco
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Céline Guidoux
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Lucie Cabrejo
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Philippa C. Lavallee
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Isabelle F. Klein
- Department of Radiology, Bichat University Hospital, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Pierre Amarenco
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
| | - Mikaël Mazighi
- Department of Neurology and Stroke Centre, Paris, France
- INSERM U-698 and Paris-Diderot University, Paris, France
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Vanegas-Acosta JC, Garzón-Alvarado DA, Lancellotti V. Numerical investigation into blood clotting at the bone-dental implant interface in the presence of an electrical stimulus. Comput Biol Med 2013; 43:2079-88. [PMID: 24290924 DOI: 10.1016/j.compbiomed.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/05/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
Abstract
The insertion of a dental implant activates a sequence of wound healing events ending with bone formation and implant osseointegration. This sequence starts with the blood coagulation process and the formation of a fibrin network that detains spilt blood. Fibrin formation can be simplified as the kinetic reaction between thrombin and fibrinogen preceding the conversion of fibrinogen into fibrin. Based on experimental observations of the electrical properties of these molecules, we present a hypothesis for the mechanism of a static electrical stimulus in controlling the formation of the blood clot. Specifically, the electrical stimulus increases the fibrin network formation in such a way that a preferential region of higher fibrin density is obtained. This hypothesis is validated by means of a numerical model for the blood clot formation at the bone-dental implant interface. Numerical results compare favorably to experimental observations for blood clotting with and without the static electrical stimulus. It is concluded that the density of the fibrin network depends on the strength of the static electrical stimulus, and that the blood clot formation has a preferential direction of formation in the presence of the electrical signal.
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Affiliation(s)
- J C Vanegas-Acosta
- Grupo de Modelado Matemático y Métodos Numéricos GNUM-UN, Departamento de Ingeniería Mecánica y Mecatrónica, Universidad Nacional de Colombia, Ciudad Universitaria, Bogotá, Colombia; Electromagnetics Group, Department of Electrical Engineering, Eindhoven University of Technology, 5612AZ Eindhoven, The Netherlands.
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