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Chest pain with increased troponin level; not always a cardiology issue. ACTA ACUST UNITED AC 2020; 57:201-204. [PMID: 30447150 DOI: 10.2478/rjim-2018-0037] [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: 09/02/2018] [Indexed: 11/21/2022]
Abstract
Thrombotic Thrombocytopenic Purpura (TTP) is a thrombotic microangiopathy syndrome resulting from decrease or absence of "a disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13" (ADAMTS13). TTP has been characterized by the classical pentad of thrombocytopenia, hemolysis, fever, renal injury and neurological deficits, yet the patient may present with any atypical symptom related to microthrombi formation in the microcirculation. Here we present a rare case of a young patient with retrosternal chest pain and myocardial injury as the first manifestation of TTP.
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2
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Graham SM, Chen J, Le J, Ling M, Chung DW, Liles WC, López JA. Von Willebrand Factor Adhesive Activity and ADAMTS13 Protease Activity in HIV-1-Infected Men. Int J Med Sci 2019; 16:276-284. [PMID: 30745808 PMCID: PMC6367531 DOI: 10.7150/ijms.28110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Endothelial activation caused by HIV-1 infection leads to release of von Willebrand factor (VWF), which enters the circulation or attaches to vessel walls and self-assembles into strings and fibers, enabling platelet adhesion; this adhesive activity is regulated by the VWF-cleaving protease ADAMTS13. Our objective was to assess VWF adhesive activity and ADAMTS13 protease activity in HIV-1 infection. Methods: We measured levels of VWF antigen, VWF activation factor (a measure of adhesive activity), ADAMTS13 antigen, ADAMTS13 activity, and apolipoprotein A1 (which interferes with VWF self-association) in serum samples from HIV-1-infected men whose infections were acute (n=10), chronic untreated (n=10), or chronic treated (n=10), compared to uninfected controls (n=10). Means across groups were compared using analysis of variance with contrasts, and Pearson correlations were calculated. Results: Plasma viral load was positively correlated with VWF adhesive activity, which was elevated in acute relative to chronic treated HIV-1 infection. ADAMTS13 antigen and activity were both positively correlated with plasma viral load, and ADAMTS13 activity was significantly higher in men with acute HIV infection than in uninfected controls, and in both acute and chronic untreated HIV infection relative to chronic treated infection. Conclusion: These findings suggest that even in the setting of increased ADAMTS13 protease activity, VWF in HIV-1 infection is hyperadhesive, which may favor development of microvascular and arterial thromboses and thereby contribute to increased cardiovascular risk in HIV-1-infected individuals.
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Affiliation(s)
- Susan M Graham
- Department of Medicine, University of Washington, Seattle, WA USA.,Department of Global Health, University of Washington, Seattle, WA USA.,Department of Epidemiology, University of Washington, Seattle, WA USA
| | - Junmei Chen
- Bloodworks Research Institute, Seattle, WA, USA
| | - Jennie Le
- Bloodworks Research Institute, Seattle, WA, USA
| | - Minhua Ling
- Bloodworks Research Institute, Seattle, WA, USA
| | | | - W Conrad Liles
- Department of Medicine, University of Washington, Seattle, WA USA.,Department of Global Health, University of Washington, Seattle, WA USA.,Department of Pathology, University of Washington, Seattle, WA USA.,Department of Pharmacology, University of Washington, Seattle, WA, USA
| | - José A López
- Department of Medicine, University of Washington, Seattle, WA USA.,Bloodworks Research Institute, Seattle, WA, USA.,Department of Biochemistry, University of Washington, Seattle, WA USA.,Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
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3
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Mietsch M, Sauermann U, Mätz-Rensing K, Klippert A, Daskalaki M, Stolte-Leeb N, Stahl-Hennig C. Revisiting a quarter of a century of simian immunodeficiency virus (SIV)-associated cardiovascular diseases at the German Primate Center. Primate Biol 2017; 4:107-115. [PMID: 32110698 PMCID: PMC7041533 DOI: 10.5194/pb-4-107-2017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/04/2017] [Indexed: 01/08/2023] Open
Abstract
Human immunodeficiency virus (HIV) comorbidities have become
clinically more important due to antiretroviral therapy. Although therapy
increases life expectancy, it does not completely suppress immune activation
and its associated complications. The simian immunodeficiency virus
(SIV)-infected rhesus macaque (Macaca mulatta) represents a valuable
model for the investigation of SIV-associated diseases. Although
cardiovascular (CV) changes are common in HIV-infected patients, there are
only a few reports on the incidence of CV findings in SIV-infected animals.
In addition, potential associations between pathohistological findings and
hematological parameters are still unclear. We therefore conducted a retrospective analysis of 195 SIV-infected rhesus
macaques that were euthanized with AIDS-related symptoms at the German
Primate Center, Goettingen, over a 25-year period. Pathological findings
were correlated with hematological data. The main findings included myocarditis (12.8 %), endocarditis
(9.7 %),
and arteriopathy (10.3 %) in various organs. Thrombocytopenia occurred
more frequently in macaques with endocarditis or arteriopathy than in
macaques without CV disease (80 % in animals with endocarditis, 60 %
in animals with arteriopathy, p<0.0001 and p=0.0016, respectively). Further investigations of the interaction between coagulation markers,
proinflammatory cytokines, and biomarkers associated with endothelial
dysfunction (e.g., D-dimers) and histological data (vascular wall structure)
may unravel the mechanisms underlying HIV/SIV-associated CV comorbidities.
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Affiliation(s)
- Matthias Mietsch
- Unit of Infection Models, German Primate Center, 37077 Goettingen, Germany.,These authors contributed equally to this work
| | - Ulrike Sauermann
- Unit of Infection Models, German Primate Center, 37077 Goettingen, Germany.,These authors contributed equally to this work
| | | | - Antonina Klippert
- Unit of Infection Models, German Primate Center, 37077 Goettingen, Germany
| | - Maria Daskalaki
- Unit of Infection Models, German Primate Center, 37077 Goettingen, Germany
| | - Nicole Stolte-Leeb
- Unit of Infection Models, German Primate Center, 37077 Goettingen, Germany
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4
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Warner NC, Vaughan LB, Wenzel RP. Human immunodeficiency virus associated thrombotic thrombocytopenic purpura, a clinical conundrum. J Clin Apher 2016; 32:567-570. [DOI: 10.1002/jca.21514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/02/2016] [Accepted: 09/19/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Nathaniel C. Warner
- Department of Internal Medicine; Virginia Commonwealth University; 5017 Caledonia Rd, Richmond Virginia 23225
| | - Leroy B. Vaughan
- Division of Infectious Diseases; Virginia Commonwealth University; Richmond Virginia
| | - Richard P. Wenzel
- Division of Infectious Diseases; Virginia Commonwealth University; Richmond Virginia
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5
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Tasaki T, Yamada S, Nabeshima A, Noguchi H, Nawata A, Hisaoka M, Sasaguri Y, Nakayama T. An autopsy case of myocardial infarction due to idiopathic thrombotic thrombocytopenic purpura. Diagn Pathol 2015; 10:52. [PMID: 26022055 PMCID: PMC4446843 DOI: 10.1186/s13000-015-0285-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/22/2015] [Indexed: 01/16/2023] Open
Abstract
UNLABELLED Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder characterized by systemic platelet-von Willebrand factor aggregation, organ ischemia and profound thrombocytopenia. In this report, we describe an autopsy case of a 77-year-old Japanese man diagnosed with idiopathic TTP. He had no history of cardiovascular disease symptoms, such as chest pain, ST segment elevation, and elevation of cardiac enzyme levels, except arrhythmia. The patient suddenly died despite receiving many treatments. On autopsy, macroscopically and microscopically, acute and chronic myocardial infarction manifested as petechiae and fibrotic foci and covered a wide area in the myocardium, including the area near the atrioventricular node. The microthrombi in the small arterioles and capillaries were platelet thrombi, which showed positive results for periodic acid-Schiff stain and factor VIII on immunohistochemical staining. The cause of the sudden death was suspected to be myocardial infarction, including a cardiac conduction system disorder due to multiple platelet microthrombi. Asymptomatic myocardial infarction is an important cause of death in TTP. Therefore, the heart tissue, including the sinus-atrial node and the atrioventricular node, should be microscopically examined more closely in autopsy cases of patients with TTP who experienced sudden death of TTP. This report is a critical teaching case considering that its cause of sudden death may be arrhythmia due to a myocardial infarction including cardiac conduction system disorder by platelet microthrombi. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2113354005156739.
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Affiliation(s)
- Takashi Tasaki
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Sohsuke Yamada
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Atsunori Nabeshima
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Hirotsugu Noguchi
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Aya Nawata
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
| | - Masanori Hisaoka
- Pathology and Oncology, University of Occupational and Environmental Health, Kitakyusyu, Japan.
| | | | - Toshiyuki Nakayama
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
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van den Berg K, Murphy EL, Pretorius L, Louw VJ. The impact of HIV-associated anaemia on the incidence of red blood cell transfusion: implications for blood services in HIV-endemic countries. Transfus Apher Sci 2014; 51:10-8. [PMID: 25457008 DOI: 10.1016/j.transci.2014.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cytopaenias, especially anaemia, are common in the HIV-infected population. The causes of HIV related cytopaenias are multi-factorial and often overlapping. In addition, many of the drugs used in the management of HIV-positive individuals are myelosuppresive and can both cause and exacerbate anaemia. Even though blood and blood products are still the cornerstone in the management of severe cytopaenias, how HIV may affect blood utilisation is not well understood. The impact of HIV/AIDS on blood collections has been well documented. As the threat posed by HIV on the safety of the blood supply became clearer, South Africa introduced progressively more stringent donor selection criteria, based on the HIV risk profile of the donor cohort from which the blood collected. The implementation of new testing technology in 2008 which significantly improved the safety of the blood supply enabled the removal of what was perceived by many as a racially based donor risk model. However, this new technology had a significant and sustained impact on the cost of blood and blood products in South Africa. In contrast, it would appear little is known of how HIV influences the utilisation of blood and blood products. Considering the high prevalence of HIV among hospitalised patients and the significant risk for anaemia among this group, there would be an expectation that the transfusion requirements of an HIV-infected patient would be higher than that of an HIV-negative patient. However, very little published data is available on this topic which emphasises the need for further large-scale studies to evaluate the impact of HIV/AIDS on the utilisation of blood and blood products and how the large-scale roll-out of ARV programs may in future play a role in determining the country's blood needs.
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Affiliation(s)
- Karin van den Berg
- South African National Blood Service, Port Elizabeth, South Africa; Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa.
| | - Edward L Murphy
- University of California, San Francisco, United States; Blood Systems Research Institute, San Francisco, United States
| | - Lelanie Pretorius
- Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa; Ampath Laboratories, Bloemfontein, South Africa
| | - Vernon J Louw
- Division Clinical Haematology, Department of Internal Medicine, University of the Free State, Bloemfontein, South Africa
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Humane-Immundefizienz-Virus-assoziierte thrombotisch-thrombozytopenische Purpura. Rechtsmedizin (Berl) 2013. [DOI: 10.1007/s00194-013-0917-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Protective anti-inflammatory effect of ADAMTS13 on myocardial ischemia/reperfusion injury in mice. Blood 2012; 120:5217-23. [PMID: 22915644 DOI: 10.1182/blood-2012-06-439935] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Coronary heart disease is a major cause of death in the western world. Although essential for successful recovery, reperfusion of ischemic myocardium is inevitably associated with reperfusion injury. To investigate a potential protective role of ADAMTS13, a protease cleaving von Willebrand factor multimers, during myocardial ischemia/reperfusion, we used a mouse model of acute myocardial infarction. We found that Adamts13(-/-) mice developed larger myocardial infarctions than wild-type control mice, whereas treatment of wild-type mice with recombinant human ADAMTS13 (rhADAMTS13) led to smaller infarctions. The protective effect of ADAMTS13 was further confirmed by a significant reduction of cardiac troponin-I release and less myocardial apoptosis in mice that received rhADAMTS13 compared with controls. Platelets adherent to the blood vessel wall were observed in few areas in the heart samples from mice treated with vehicle and were not detected in samples from mice treated with rhADAMTS13. However, we observed a 9-fold reduction in number of neutrophils infiltrating ischemic myocardium in mice that were treated with rhADAMTS13, suggesting a potent anti-inflammatory effect of ADAMTS13 during heart injury. Our data show that ADAMTS13 reduces myocardial ischemia/reperfusion injury in mice and indicate that rhADAMTS13 could be of therapeutic value to limit myocardial ischemia/reperfusion injury.
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