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Krug J, Bochenek ML, Gogiraju R, Laubert-Reh D, Lackner KJ, Münzel T, Wild PS, Espinola-Klein C, Schäfer K. Circulating Soluble EPCR Levels Are Reduced in Patients with Ischemic Peripheral Artery Disease and Associated with Markers of Endothelial and Vascular Function. Biomedicines 2023; 11:2459. [PMID: 37760900 PMCID: PMC10526050 DOI: 10.3390/biomedicines11092459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Endothelial dysfunction initiates cardiovascular pathologies, including peripheral artery disease (PAD). The pathophysiology of impaired new vessel formation in the presence of angiogenic stimuli, such as ischemia and inflammation, is unknown. We have recently shown in mice that reduced endothelial protein C receptor (EPCR) expression results in defective angiogenesis following experimental hindlimb ischemia. (2) Purpose: To determine soluble (s)EPCR levels in the plasma of patients with PAD and to compare them with the protein C activity and biomarkers of endothelial function, inflammation, and angiogenesis. (3) Methods and Results: Clinical tests of vascular function and immunoassays of plasma from patients with PAD stage II were compared to age- and sex-matched individuals with and without cardiovascular risk factors or PAD stage III/IV patients. sEPCR levels were significantly lower in PAD stage II patients compared to subjects with risk factors, but no PAD, and further decreased in PAD stage III/IV patients. Plasma protein C activity or levels of ADAM17, a mediator of EPCR shedding, did not differ. Significant associations between sEPCR and the ankle-brachial index (p = 0.0359), age (p = 0.0488), body mass index (p = 0.0110), and plasma sE-selectin levels (p = 0.0327) were observed. High-sensitive CRP levels and white blood cell counts were significantly elevated in PAD patients and associated with serum glucose levels, but not sEPCR. In contrast, plasma TNFα or IL1β levels did not differ. Circulating levels of VEGF were significantly elevated in PAD stage II patients (p = 0.0198), but not associated with molecular (sE-selectin) or functional (ankle-brachial index) markers of vascular health. (4) Conclusions: Our findings suggest that circulating sEPCR levels may be useful as biomarkers of endothelial dysfunction, including angiogenesis, in persons older than 35 years and that progressive loss of endothelial protein C receptors might be involved in the development and progression of PAD.
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Affiliation(s)
- Janina Krug
- Department of Cardiology, Cardiology I, University Medical Center Mainz, 55131 Mainz, Germany (M.L.B.); (R.G.); (D.L.-R.); (T.M.); (P.S.W.)
| | - Magdalena L. Bochenek
- Department of Cardiology, Cardiology I, University Medical Center Mainz, 55131 Mainz, Germany (M.L.B.); (R.G.); (D.L.-R.); (T.M.); (P.S.W.)
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, 55131 Mainz, Germany
| | - Rajinikanth Gogiraju
- Department of Cardiology, Cardiology I, University Medical Center Mainz, 55131 Mainz, Germany (M.L.B.); (R.G.); (D.L.-R.); (T.M.); (P.S.W.)
| | - Dagmar Laubert-Reh
- Department of Cardiology, Cardiology I, University Medical Center Mainz, 55131 Mainz, Germany (M.L.B.); (R.G.); (D.L.-R.); (T.M.); (P.S.W.)
| | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Thomas Münzel
- Department of Cardiology, Cardiology I, University Medical Center Mainz, 55131 Mainz, Germany (M.L.B.); (R.G.); (D.L.-R.); (T.M.); (P.S.W.)
| | - Philipp S. Wild
- Department of Cardiology, Cardiology I, University Medical Center Mainz, 55131 Mainz, Germany (M.L.B.); (R.G.); (D.L.-R.); (T.M.); (P.S.W.)
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, 55131 Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, Cardiology III, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Katrin Schäfer
- Department of Cardiology, Cardiology I, University Medical Center Mainz, 55131 Mainz, Germany (M.L.B.); (R.G.); (D.L.-R.); (T.M.); (P.S.W.)
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Impact of Laparoscopic Sleeve Gastrectomy on Thrombomodulin Concentration and Early Markers of Atherosclerosis. J Interv Cardiol 2022; 2022:6152571. [PMID: 35855391 PMCID: PMC9286949 DOI: 10.1155/2022/6152571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background Thrombomodulin, an integral membrane protein functioning as a cofactor in the anticoagulant pathways, has recently emerged as a marker of endothelial dysfunction. This study aimed to investigate the impact of laparoscopic sleeve gastrectomy (LSG) on thrombomodulin concentration and early markers of atherosclerosis. Methods Forty-four subjects undergoing LSG were prospectively examined. The change in thrombomodulin concentration from baseline (preoperative) to the sixth postoperative month following the LSG and the relationship between the change in thrombomodulin concentration and BMI, CIMT, ABI, and blood lipids were examined. Results The medical records were available for 44 patients (mean age: 37.2 ± 10.9 years, 65.9% male). LSG led to significant reductions in total body weight and body mass index (BMI) at postoperative six months (37.0 ± 5.6 kg/m2 vs. 47.1 ± 5.8 kg/m2, p < 0.001). Markers of early atherosclerotic events, including carotid intima-media thickness (CIMT) and ABI, improved. The change in thrombomodulin concentration (Δ TMD) was significantly correlated with the change in Δ BMI (r = 0.500, p=0.011), Δ LDL (r = 0.389, p=0.032), Δ systolic blood pressure (r = 0.384, p=0.012), and Δ CIMT (r = 0.327, p=0.012) and was negatively correlated with Δ HDL (r = −0.344, p=0.020) and Δ ABI (r = −0.357, p=0.020). Conclusion LSG leads to significant improvements in blood lipids, systolic and diastolic blood pressure, and in surrogate markers of atherosclerotic burden and endothelial function, including thrombomodulin, ABI, and CIMT, at postoperative six months. LSG might prevent or reduce atherogenesis in the early stages by stopping endothelial dysfunction.
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Endothelial Dysfunction in the Pathogenesis of Abdominal Aortic Aneurysm. Biomolecules 2022; 12:biom12040509. [PMID: 35454098 PMCID: PMC9030795 DOI: 10.3390/biom12040509] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 12/25/2022] Open
Abstract
Abdominal aortic aneurysm (AAA), defined as a focal dilation of the abdominal aorta beyond 50% of its normal diameter, is a common and potentially life-threatening vascular disease. The molecular and cellular mechanisms underlying AAA pathogenesis remain unclear. Healthy endothelial cells (ECs) play a critical role in maintaining vascular homeostasis by regulating vascular tone and maintaining an anti-inflammatory, anti-thrombotic local environment. Increasing evidence indicates that endothelial dysfunction is an early pathologic event in AAA formation, contributing to both oxidative stress and inflammation in the degenerating arterial wall. Recent studies utilizing single-cell RNA sequencing revealed heterogeneous EC sub-populations, as determined by their transcriptional profiles, in aortic aneurysm tissue. This review summarizes recent findings, including clinical evidence of endothelial dysfunction in AAA, the impact of biomechanical stress on EC in AAA, the role of endothelial nitric oxide synthase (eNOS) uncoupling in AAA, and EC heterogeneity in AAA. These studies help to improve our understanding of AAA pathogenesis and ultimately may lead to the generation of EC-targeted therapeutics to treat or prevent this deadly disease.
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Nakayama H, Inada H, Inukai T, Kondo K, Hirai K, Tsutsumi T, Adachi Y, Nagi-Miura N, Ohno N, Suzuki K. Recombinant Human Soluble Thrombomodulin Suppresses Arteritis in a Mouse Model of Kawasaki Disease. J Vasc Res 2021; 59:176-188. [PMID: 34929700 DOI: 10.1159/000520717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Kawasaki disease (KD) is associated with diffuse and systemic vasculitis of unknown aetiology and primarily affects infants and children. Intravenous immunoglobulin (IVIG) treatment reduces the risk of developing coronary aneurysms, but some children have IVIG-resistant KD, which increases their risk of developing coronary artery injury. Here, we investigated the effect of recombinant human soluble thrombomodulin (rTM), which has anticoagulant, anti-inflammatory, and cytoprotective properties on the development of coronary arteritis in a mouse model of vasculitis. METHODS An animal model of KD-like vasculitis was created by injecting mice with Candida albicans water-soluble fraction (CAWS). This model was used to investigate the mRNA expression of interleukin (IL)-10, tumour necrosis factor alpha (TNF-α), and tissue factor (TF), in addition to histopathology of heart tissues. RESULTS rTM treatment significantly reduces cardiac vascular endothelium hypertrophy by 34 days after CAWS treatment. In addition, mRNA expression analysis revealed that rTM administration increased cardiac IL-10 expression until day 27, whereas expression of TNF-α was unaffected. Moreover, in the spleen, rTM treatment restores IL-10 and TF expression to normal levels. CONCLUSION These findings suggest that rTM suppresses CAWS-induced vasculitis by upregulating IL-10. Therefore, rTM may be an effective treatment for KD.
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Affiliation(s)
- Hironobu Nakayama
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Hiroyasu Inada
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Tatsuya Inukai
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan.,Department of Microbiology, Tokyo Medical University, Shinjuku-ku, Japan
| | - Kenta Kondo
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan.,Medicine Department, Suzuka Kaisei Hospital, Suzuka, Japan
| | - Kazuyuki Hirai
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Tomonari Tsutsumi
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan
| | - Yoshiyuki Adachi
- School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Noriko Nagi-Miura
- School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Naohito Ohno
- School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, Hachioji, Japan
| | - Koji Suzuki
- Faculty of Pharmaceutical Science, Suzuka University of Medical Science, Suzuka, Japan
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Kondo T, Takahashi M, Yamasaki G, Sugimoto M, Kuse A, Morichika M, Nakagawa K, Sakurada M, Asano M, Ueno Y. Immunohistochemical analysis of thrombomodulin expression in myocardial tissue from autopsy cases of ischemic heart disease. Leg Med (Tokyo) 2021; 51:101897. [PMID: 33940278 DOI: 10.1016/j.legalmed.2021.101897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/07/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
Thrombomodulin is a transmembrane glycoprotein that is ubiquitously expressed on the surface of vascular endothelial cells. Thrombomodulin exerts its anticoagulant effects by combining with thrombin, activating protein C, and inactivating the coagulation factors FVa and FVIIIa. Clinically, thrombomodulin is also known as a marker of vascular injury because it circulates freely in response to endothelial injury. In this study, myocardial tissue from cases of ischemic heart disease was subjected to immunohistochemistry by thrombomodulin. We examined 40 neutral-formalin-fixed, paraffin-embedded myocardial tissue samples from autopsy cases that were diagnosed with ischemic heart disease (within 48 h postmortem). Thrombomodulin expression was observed in vascular endothelial cells between myocardial cells and in mesothelial cells of the epicardium. In necrotic myocardium, diffusion of thrombomodulin, which reflected endothelial injury, was observed. Upregulated thrombomodulin expression was observed around myocardial cells under ongoing remodeling, which suggested endothelial proliferation in these locations. Completed fibrotic foci of the myocardium did not show upregulated thrombomodulin expression. In a mouse model of acute myocardial infarction, the same phenomena as that found in human samples were observed by immunohistochemistry of thrombomodulin. Immunostaining of thrombomodulin, as a marker for endothelial injury or myocardial remodeling, may be useful for supplementing conventional staining techniques in the diagnosis of ischemic heart disease in forensic pathology.
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Affiliation(s)
- Takeshi Kondo
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Motonori Takahashi
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Gentaro Yamasaki
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Marie Sugimoto
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Azumi Kuse
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mai Morichika
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kanako Nakagawa
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Sakurada
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan; Forensic Science Laboratory, Hyogo Prefectural Police Headquarters, Kobe, Japan
| | - Migiwa Asano
- Department of Legal Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yasuhiro Ueno
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan
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6
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Zamzam A, Syed MH, Rand ML, Singh K, Hussain MA, Jain S, Khan H, Verma S, Al-Omran M, Abdin R, Qadura M. Altered coagulation profile in peripheral artery disease patients. Vascular 2020; 28:368-377. [PMID: 32252612 DOI: 10.1177/1708538120915997] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Peripheral artery disease patients have been shown to be more susceptible to thrombotic events compared to non-peripheral artery disease patients. Therefore, the aim of this study was to investigate the coagulation profile in peripheral artery disease patients with chronic limb threatening ischemia, moderate peripheral artery disease patients with claudication, and non-peripheral artery disease controls. METHODS Chronic limb threatening ischemia patients were matched to peripheral artery disease patients with claudication and non-peripheral artery disease controls in a 1:1:1 ratio. Each patient had their cytokines, markers of thrombin generation, coagulation factors, natural anti-coagulants, fibrinolysis, and endothelial injury markers assessed. RESULTS Markers of thrombin activation, thrombin Fragments F1 + 2 (Frag 1 + 2), and thrombin-anti-thrombin complex were found to be significantly elevated in all peripheral artery disease and chronic limb threatening ischemia patients relative to non-peripheral artery disease controls. Similarly, relative to non-peripheral artery disease controls, inflammatory markers including C-reactive protein, soluble platelet factor 4, and neutrophil gelatinase-associated lipocalin were also found to be significantly upregulated in chronic limb threatening ischemia patients, but not in peripheral artery disease patients with claudication. Furthermore, our data demonstrated significant increases in markers of endothelial injury in chronic limb threatening ischemia patients relative to non-peripheral artery disease controls. Finally, decreases in natural anti-coagulants (protein C and protein S) and coagulation factors FIX, FXI, and FXII were also observed in chronic limb threatening ischemia patients when compared with non-peripheral artery disease controls. CONCLUSIONS Our data suggest that in relation to non-peripheral artery disease controls, chronic limb threatening ischemia patients are more hypercoagulable. However, peripheral artery disease patients with claudication appear to have similar levels of circulating procoagulant markers as non-peripheral artery disease patients. This may explain the increased risk of thrombotic events observed in chronic limb threatening ischemia patients.
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Affiliation(s)
- Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Muzammil H Syed
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Margaret L Rand
- Department of Laboratory Medicine and Pathobiology, Biochemistry and Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Haematology/Oncology & Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Krishna Singh
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Mohamad A Hussain
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shubha Jain
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hamzah Khan
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rawand Abdin
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
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7
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Amiral J. Measurement of blood activation markers applied to the early diagnosis of cardiovascular alterations. Expert Rev Mol Diagn 2019; 20:85-98. [DOI: 10.1080/14737159.2020.1704258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jean Amiral
- Scientific-Hemostasis-Consulting, Scientific Director and Consultant in Thrombosis-Hemostasis, Andrésy, France
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Revisiting the activated protein C-protein S-thrombomodulin ternary pathway: Impact of new understanding on its laboratory investigation. Transfus Apher Sci 2019; 58:538-544. [PMID: 31256946 DOI: 10.1016/j.transci.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although suspected conceptually in the 60 s, Protein C and Protein S activities in hemostasis were investigated and reported from the mid-80 s, followed by the discovery of Thrombomodulin, an endothelial cell membrane associated protein, playing the most important heamostatic role. These 3 proteins act in regulating thrombogenesis and protecting against thrombo-embolic events. When blood is activated, any trace of circulating thrombin is captured by Thrombomodulin in the microcirculation, making thrombin become an anticoagulant through its capacity to activate Protein C to Activated Protein C, which operates as a sentinel in blood coagulation, in the form of a complex with free Protein S, to block any new blood activation site, and more especially circulating activated Factors V and VIII. Protein S not only acts as the Activated Protein C cofactor, but also as the cofactor of Tissue Factor Pathway Inhibitor. In addition, it has some functions in the complement pathway through its binding to C4b-BP. Another capability of activated protein C is to lower fibrinolytic activity, as the Activated Protein C Inhibitor is also known as Plasminogen Activator Inhibitor 3. The Protein C-Protein S system becomes less efficient in the presence of mutated Factor V (Factor V-Leiden or other variants), which is resistant to its inactivating effect. Other pathologies linked to this system concern the development of allo- or auto-antibodies to Protein S or to thrombin, which can generate severe thrombotic complications in affected patients. Some antithrombotic drugs have originated from this regulatory system. Protein C or Protein S concentrates are used for treating deficient patients. Activated Protein C (especially in patients with sepsis) or Thrombomodulin are proposed as antithrombotic medications. Most importantly, congenital or acquired Protein C or Protein S deficiencies are associated with severe recurrent thrombotic events. From the clinical standpoint most of the patients are heterozygous, as homozygosity is almost incompatible with life in the absence of a continuous and efficient treatment. Laboratory investigation of this highly complex system involves many different specialized assays for measuring these 3 proteins' activities, their antigenic content or their genetic sequence. The Protein S in-vitro anticoagulant activity is weak and contrasts with its high antithrombotic role in-vivo, showing that diagnostic assays have not yet succeeded in reproducing all the natural mechanisms for evidencing the anticoagulant role of Protein S. This paradoxal notion is discussed and illustrated in this manuscript as well is a revisit of the major characteristics and pathophysiological functions of the Protein C-Protein S-Thrombomodulin system; the associated pathologies; and the main laboratory tools available for clinical diagnosis. In respect to future perspectives, we also focused on developing more significant and relevant assays, especially for Protein S, thanks to the understanding of its biological roles.
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Kosaki R, Minoura Y, Ogura K, Oishi Y, Tanaka L, Arai K, Nomura K, Sakai K, Sekimoto T, Nisikura T, Tsujita H, Kondo S, Tsukamoto S, Hamazaki Y, Kobayashi Y. Thrombomodulin can predict the incidence of second events in patients with acute coronary syndrome: Single-center, retrospective cohort study. J Cardiol 2018; 72:494-500. [DOI: 10.1016/j.jjcc.2018.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 01/29/2023]
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10
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Tani S, Matsuo R, Hirayama A. Does administration of eicosapentaenoic acid increase soluble thrombomodulin level in statin-treated patients with stable coronary artery disease? Heart Vessels 2018; 34:368-374. [PMID: 30143885 DOI: 10.1007/s00380-018-1240-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/17/2018] [Indexed: 12/13/2022]
Abstract
Interventions targeting the serum eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio could be useful for the prevention of coronary artery disease (CAD). Few data exist regarding the effects of administration of EPA on the serum levels of soluble thrombomodulin (sTM) as a marker of endothelial damage, or on the relationship between the sTM and EPA/AA ratio in patients with CAD receiving statin treatment. We assigned stable CAD patients already receiving statin therapy to an EPA group (1800 mg/day: n = 50) or control group (n = 50). A significant increase of the sTM level was observed in the EPA group as compared to that in the control group 0.40 (0.10/0.70) FU/mL vs. 0.20 (0/0.40) FU/mL, p = 0.004 at the 6-month follow-up examination. Multivariate regression analysis after adjustments for coronary risk factors and changes of the serum lipid levels identified an increased EPA/AA ratio as an independent predictor of increased serum sTM level (β = 0.244, p = 0.02). The results suggest that an increased sTM level caused by additional administration of EPA to statin might be associated with an increased EPA/AA ratio. The increase of the serum sTM after administration of EPA might reflect an increase of the TM expression on the endothelial surface rather than endothelial damage in CAD patients under statin treatment.Clinical Trial Registration Information UMIN ( http://www.umin.ac.jp/ ), Study ID: UMIN000010452.
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Affiliation(s)
- Shigemasa Tani
- Department of Health Planning Center, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan. .,Department of Cardiology, Nihon University Hospital, Tokyo, Japan. .,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Rei Matsuo
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan.,Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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11
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Lindberg-Larsen V, Ostrowski SR, Lindberg-Larsen M, Rovsing ML, Johansson PI, Kehlet H. The effect of pre-operative methylprednisolone on early endothelial damage after total knee arthroplasty: a randomised, double-blind, placebo-controlled trial. Anaesthesia 2017; 72:1217-1224. [DOI: 10.1111/anae.13983] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 12/24/2022]
Affiliation(s)
- V. Lindberg-Larsen
- Section for Surgical Pathophysiology; The Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - S. R. Ostrowski
- Section for Transfusion Medicine; Capital Region Blood Bank; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - M. Lindberg-Larsen
- Department of Orthopaedic Surgery; Copenhagen University Hospital, Bispebjerg and Frederiksberg; Denmark
| | - M. L. Rovsing
- Department of Anaesthesiology and Intensive Care Medicine; Copenhagen University Hospital, Bispebjerg and Frederiksberg; Denmark
| | - P. I. Johansson
- Section for Transfusion Medicine; Capital Region Blood Bank; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
- Department of Surgery; University of Texas Health Sciences; Houston Texas USA
| | - H. Kehlet
- Section for Surgical Pathophysiology; The Lundbeck Foundation Centre for Fast-Track Hip and Knee Arthroplasty; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
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12
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Hasibuzzaman MM, Hossain S, Islam MS, Rahman A, Anjum A, Hossain F, Mohanto NC, Karim MR, Hoque MM, Saud ZA, Miyataka H, Himeno S, Hossain K. Association between arsenic exposure and soluble thrombomodulin: A cross sectional study in Bangladesh. PLoS One 2017; 12:e0175154. [PMID: 28399171 PMCID: PMC5388467 DOI: 10.1371/journal.pone.0175154] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 03/21/2017] [Indexed: 11/19/2022] Open
Abstract
Chronic exposure to arsenic is associated with increased morbidity and mortality from cardiovascular disease (CVD); however, plausible biomarker for early prediction and the underlying mechanism of arsenic-related CVD have not yet been clearly understood. Endothelial dysfunction plays a central role in the development of CVD. We hypothesized that endothelial damage or dysfunction is an important aspect and may be an early event of arsenic-related CVD. Soluble thrombomodulin (sTM) in serum is thought to be a specific and stable marker for endothelial damage or dysfunction. This study was designed to evaluate the association between chronic exposure to arsenic and sTM among human subjects in arsenic-endemic and non-endemic rural areas in Bangladesh. A total of 321 study subjects (217 from arsenic-endemic areas and 104 from a non-endemic area) were recruited. Subjects' arsenic exposure levels (i.e., drinking water, hair and nail arsenic concentrations) were measured by Inductively Coupled Plasma Mass Spectroscopy. The subjects' serum sTM levels were quantified by immunoassay kit. The average sTM levels of the subjects in arsenic-endemic and non-endemic areas were 4.58 ± 2.20 and 2.84 ± 1.29 (ng mL-1) respectively, and the difference was significant (p<0.001). Arsenic exposure levels showed a significant (water arsenic: rs = 0.339, p<0.001, hair arsenic: rs = 0.352, p<0.001 and nail arsenic: rs = 0.308, p<0.001) positive associations with sTM levels. Soluble TM levels were higher in the higher exposure gradients if we stratified the subjects into tertile groups (low, medium and high) based on the arsenic concentrations of the subjects' drinking water, hair and nails. Finally, increased levels of sTM were negatively correlated with high density lipoprotein cholesterol (HDL-C), and positively correlated with intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1). Results of this study show that chronic exposure to arsenic has mild to moderate association with sTM levels.
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Affiliation(s)
- M. M. Hasibuzzaman
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Shakhawoat Hossain
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Shofikul Islam
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
| | - Atiqur Rahman
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Adiba Anjum
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Faruk Hossain
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Nayan Chandra Mohanto
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Md. Rezaul Karim
- Department of Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
| | - Md. Mominul Hoque
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Zahangir Alam Saud
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
| | - Hideki Miyataka
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima, Japan
| | - Seiichiro Himeno
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical Sciences, Tokushima Bunri University, Tokushima, Japan
| | - Khaled Hossain
- Department of Biochemistry and Molecular Biology, University of Rajshahi, Rajshahi, Bangladesh
- * E-mail:
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13
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Cimmino G, Ciuffreda LP, Ciccarelli G, Calabrò P, Ferraiolo FAV, Rivellino A, De Palma R, Golino P, Rossi F, Cirillo P, Berrino L. Upregulation of TH/IL-17 Pathway-Related Genes in Human Coronary Endothelial Cells Stimulated with Serum of Patients with Acute Coronary Syndromes. Front Cardiovasc Med 2017; 4:1. [PMID: 28224128 PMCID: PMC5293806 DOI: 10.3389/fcvm.2017.00001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/11/2017] [Indexed: 12/14/2022] Open
Abstract
Background Inflammation plays an essential role in the development and complications of atherosclerosis plaques, including acute coronary syndromes (ACS). Indeed, previous reports have shown that within the coronary circulation of ACS patients, several soluble mediators are released. Moreover, it has been demonstrated that endothelial dysfunction might play an important role in atherosclerosis as well as ACS pathophysiology. However, the mechanisms by which these soluble mediators might affect endothelial functions are still largely unknown. We have evaluated whether soluble mediators contained in serum from coronary circulation of ACS patients might promote changes of gene profile in human coronary endothelial cells (HCAECs). Methods HCAECs were stimulated in vitro for 12 h with serum obtained from the coronary sinus (CS) and the aorta (Ao) of ACS patients; stable angina (SA) patients served as controls. Gene expression profiles of stimulated cells were evaluated by microarray and real-time PCR. Results HCAECs stimulated with serum from CS of ACS patients showed a significant change (upregulation and downregulation) in gene expression profile as compared with cells stimulated with serum from CS of SA patients. Moreover, ad hoc sub analysis indicated the upregulation of Th-17/IL-17 pathway-related genes. Conclusion This study demonstrates that, in ACS patients, the chemical mediators released in the coronary circulation might be able to perturb coronary endothelial cells (ECs) modifying their gene profile. These modified ECs, through downregulation of protective gene and, mainly, through upregulation of gene able to modulate the Th-17/IL-17 pathway, might play a key role in progression of coronary atherosclerosis and in developing future acute events.
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Affiliation(s)
- Giovanni Cimmino
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Loreta Pia Ciuffreda
- Department of Experimental Medicine, Section of Pharmacology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Giovanni Ciccarelli
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Paolo Calabrò
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | | | - Alessia Rivellino
- Department of Experimental Medicine, Section of Pharmacology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Raffaele De Palma
- Department of Clinical and Experimental Medicine, Section of Immunology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Paolo Golino
- Department of Cardio-Thoracic and Respiratory Sciences, Section of Cardiology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology, University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Section of Cardiology, University of Naples, "Federico II" , Naples , Italy
| | - Liberato Berrino
- Department of Experimental Medicine, Section of Pharmacology, University of Campania "Luigi Vanvitelli" , Naples , Italy
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Swampillai J, Doshi S, Fraser AG, Goodfellow J, Jones CJ. Review: Clinical assessment of endothelial function — an update. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/14746514050050020401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endothelial dysfunction precedes clinically detectable vascular disease, suggesting its early detection may allow the targeting of treatment to improve endothelial function and thus inhibit progression of disease.1,2 Although the evidence for a preventive strategy remains circumstantial, there is worldwide interest in the measurement of endothelial function in relation to risk factors and treatment of atherosclerotic vascular disease. Unfortunately, a widely applicable clinical measurement of endothelial function does not yet exist; those that are available remain tools for research. The ideal clinical test of endothelial function should be specific, sensitive and reproducible, as well as simple to perform, painless, and inexpensive. In this review we outline the relative merits and disadvantages of the techniques that are available.
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Affiliation(s)
- Janice Swampillai
- Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff, CF14 4XN, UK,
| | - Sagar Doshi
- Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - Alan G Fraser
- Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - Jonathan Goodfellow
- Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - Christopher Jh Jones
- Wales Heart Research Institute, University of Wales College of Medicine, Heath Park, Cardiff, CF14 4XN, UK
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15
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Goeijenbier M, Gasem MH, Meijers JC, Hartskeerl RA, Ahmed A, Goris MG, Isbandrio B, Schuller SS, Osterhaus AD, Martina BE, van Gorp EC, Nally JE, Wagenaar JF. Markers of endothelial cell activation and immune activation are increased in patients with severe leptospirosis and associated with disease severity. J Infect 2015; 71:437-46. [DOI: 10.1016/j.jinf.2015.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/28/2015] [Accepted: 05/18/2015] [Indexed: 01/06/2023]
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16
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Thrombomodulin gene proximal promoter polymorphisms in premature acute coronary syndrome patients in Bahrain. Blood Coagul Fibrinolysis 2015; 26:919-24. [PMID: 26226255 DOI: 10.1097/mbc.0000000000000361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Thrombomodulin is expressed on endothelial cells and monocytes (mTM) where it has an anticoagulant function. Enzymatic cleavage from the cell surface produces soluble thrombomodulin (sTM) in plasma. Abnormal levels of sTM and mutations in the thrombomodulin gene (THBD) are linked to cardiovascular disease. The aim of this study was to investigate THBD proximal promoter mutations and levels of sTM and mTM in men presenting with premature acute coronary syndrome (ACS). This prospective cross-sectional study included 100 adult men with premature ACS (age <55 years) and 60 healthy age-matched controls. Plasma sTM was assayed by ELISA. mTM expression was assessed by flow cytometry with CD141 antibody. The -33 G/A polymorphism was identified by PCR-restriction fragment length polymorphism analysis and the THBD proximal promoter region was sequenced. Significantly lower sTM (P < 0.001) and higher mTM (P < 0.001) were seen in ACS patients. Heterozygous THBD promoter polymorphisms -33 G/A and -9/-10 GG/AT were found in eight patients and five control individuals. In patients and control individuals, allele frequencies of A were 0.02 and 0.025, and that of AT were 0.025 and 0.017, respectively. There were no significant associations of these polymorphisms with ACS, sTM levels or mTM expression. THBD polymorphisms -33 G/A and -9/-10 GG/AT are present in low frequency in our patient population, and are more frequent in the South Asians as compared to the Arabs. The frequency of -33 G/A is lower, whereas that of -9/-10 GG/AT is higher than that reported in the Orientals. The presence of THBD proximal promoter polymorphisms do not explain variations in levels of sTM and mTM in this patient population.
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Liu KL, Lee KT, Chang CH, Chen YC, Lin SM, Chu PH. Elevated plasma thrombomodulin and angiopoietin-2 predict the development of acute kidney injury in patients with acute myocardial infarction. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R100. [PMID: 24886544 PMCID: PMC4075148 DOI: 10.1186/cc13876] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 05/02/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Acute kidney injury (AKI) following acute myocardial infarction (AMI) is associated with unfavorable prognosis. Endothelial activation and injury were found to play a critical role in the development of both AKI and AMI. This pilot study aimed to determine whether the plasma markers of endothelial injury and activation could serve as independent predictors for AKI in patients with AMI. METHODS This prospective study was conducted from March 2010 to July 2012 and enrolled consecutive 132 patients with AMI receiving percutaneous coronary intervention (PCI). Plasma levels of thrombomodulin (TM), von Willebrand factor (vWF), angiopoietin (Ang)-1, Ang-2, Tie-2, and vascular endothelial growth factor (VEGF) were measured on day 1 of AMI. AKI was defined as elevation of serum creatinine of more than 0.3 mg/dL within 48 hours. RESULTS In total, 13 out of 132 (9.8%) patients with AMI developed AKI within 48 hours. Compared with patients without AKI, patients with AKI had increased plasma levels of Ang-2 (6338.28 ± 5862.77 versus 2412.03 ± 1256.58 pg/mL, P = 0.033) and sTM (7.6 ± 2.26 versus 5.34 ± 2.0 ng/mL, P < 0.001), and lower estimated glomerular filtration rate (eGFR) (46.5 ± 20.2 versus 92.5 ± 25.5 mL/min/1.73 m2, P < 0.001). Furthermore, the areas under the receiver operating curves demonstrated that plasma thrombomodulin (TM) and Ang-2 levels on day 1 of AMI had modest discriminative powers for predicting AKI development following AMI (0.796, P <0.001; 0.833, P <0.001; respectively). CONCLUSIONS Endothelial activation, quantified by plasma levels of TM and Ang-2 may play an important role in development of AKI in patients with AMI.
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18
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Association of n-3 polyunsaturated fatty acids with soluble thrombomodulin as a marker of endothelial damage: a cross-sectional pilot study. J Cardiol 2014; 64:312-7. [PMID: 24679942 DOI: 10.1016/j.jjcc.2014.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 12/06/2013] [Accepted: 02/03/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Soluble thrombomodulin (sTM) is a useful marker of vascular endothelial damage. Although n-3 polyunsaturated fatty acids (n-3 PUFAs) (eicosapentaenoic acid: EPA; docosahexaenoic acid: DHA) have various cardiovascular protective effects, their effect in preventing vascular endothelial damage remains unclear. Furthermore, little is known about the association of EPA and DHA with sTM using the cross-sectional study method. METHODS AND RESULTS This pilot study was designed as a hospital-based cross-sectional study to investigate the relationships between serum n-3 PUFA levels and sTM level in patients with the presence of one or more risk factors for atherosclerosis. Of the 534 sequential patients who had routinely been registered to a study cohort of our institute, 324 patients without chronic kidney disease (because sTM is eliminated by renal excretion and the serum sTM level is increased by renal dysfunction) were enrolled in this study. In a multivariate analysis after adjustment for atherosclerotic risk factors, elevated EPA+DHA level was an independent variable of decreased sTM level (β=-0.183, p=0.0006). The serum levels of EPA and DHA showed a strong correlation (r=0.736, p<0.0001); however, multivariate analysis including EPA and DHA revealed that serum DHA (β=-0.243, p=0.003), but not serum EPA (β=0.049, p=0.538), was identified as an independent negative determinant of sTM level. CONCLUSION Although there are numerous unresolved issues in regard to the differences in the cardiovascular protective effects between EPA and DHA, DHA may be associated with a decrease in sTM. A large-scale trial would be warranted to demonstrate whether the beneficial effect of n3-PUFAs therapy on endothelial damage and improvement of endothelial function might also result in fewer clinical cardiovascular events.
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19
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Freestone B, Krishnamoorthy S, Lip GYH. Assessment of endothelial dysfunction. Expert Rev Cardiovasc Ther 2014; 8:557-71. [DOI: 10.1586/erc.09.184] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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20
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Vaverkova H, Karasek D, Novotny D, Kovarova D, Halenka M, Slavik L, Frohlich J. Positive association of adiponectin with soluble thrombomodulin, von Willebrand factor and soluble VCAM-1 in dyslipidemic subjects. Clin Biochem 2013; 46:766-71. [DOI: 10.1016/j.clinbiochem.2013.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 01/29/2013] [Accepted: 02/22/2013] [Indexed: 11/26/2022]
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21
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Zhang Q, Zeng C, Fu Y, Cheng Z, Zhang J, Liu Z. Biomarkers of endothelial dysfunction in patients with primary focal segmental glomerulosclerosis. Nephrology (Carlton) 2012; 17:338-45. [PMID: 22295953 DOI: 10.1111/j.1440-1797.2012.01575.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM Endothelial dysfunction occurs in nephrotic syndrome (NS) and may constitute a link between NS and vascular complications. Focal segmental glomerulosclerosis (FSGS) is a common cause of NS. This study aimed to assess endothelial markers at different stages of FSGS and define whether they were associated with thromboembolic complications and disease activity. METHODS Forty-four patients with nephrotic-range proteinuria and biopsy-proven primary FSGS were included in this study. Nine of them had concurrent thromboembolisms. Thirty-two sex- and age- matched healthy volunteers served as controls. Endothelial markers including circulating endothelial cells (CECs), soluble thrombomodulin (sTM), von Willebrand factor (vWf), soluble vascular cell adhesion molecule-1 (sVCAM-1) and sE-selectin were assessed at the commencement of the study in all participants and were repeated at 2, 6 and 12 months of follow-up in patients without thromboembolisms. RESULTS Patients with FSGS during active stage showed significantly higher levels of CECs, sTM, vWf, sVCAM-1 and sE-selectin when compared with controls. Moreover, patients with thromboembolisms had higher CECs and vWf than those without thromboembolisms. In patients without thromboembolisms, endothelial markers except sE-selectin had inverse correlations with serum albumin and were positively related to cholesterol. Multiple analyses showed that cholesterol and serum albumin were independent predictors of CECs and sTM, and vWf and sVCAM-1, respectively. At follow-up, these markers systematically decreased as the disease went into remission, but the increase in vWf and sVCAM-1 persisted even in patients obtaining complete remission for nearly a year. In patients with no response, levels of endothelial markers exhibited no obvious change. CONCLUSION Patients with FSGS had elevated markers of endothelial dysfunction, which were largely related to the activity of the disease. Meanwhile, levels of CECs and vWf were higher in patients concurrent with thromboembolisms.
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Affiliation(s)
- Qingyan Zhang
- Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
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Bossola M, Rosa F, Tazza L, de Curtis A, Costanzo S, Vulpio C, Iacoviello L. P-selectin, E-selectin, and CD40L over time in chronic hemodialysis patients. Hemodial Int 2012; 16:38-46. [PMID: 22099468 DOI: 10.1111/j.1542-4758.2011.00579.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to measure P-selectin, E-selectin, and CD-4L levels over time in chronic hemodialysis (HD) patients. Thirty stable patients with end-stage renal failure undergoing chronic HD were included in the study. Blood samples were obtained before HD for measurement of P-selectin, E-selectin, and CD-40L. Measurements were performed at month 0 (T0), 3 (T2), 8 (T3), and 13 (T4). The levels of P-selectin, E-selectin, and CD40L were also analyzed according to the occurrence of cardiovascular disease (CVD) and to CVD-related mortality. The levels of CD40L and P-selectin changed significantly over time, decreasing at month 3 and 6 and returning at the T0 levels at month 13. Conversely, E-selectin levels did not. The levels of CD40L, P-selectin and E-selectin over time did not differ significantly between patients with age ≤ 65 or > 65 years, between patients with or without CVD, or between patients who died or who survived during the follow-up. In end-stage renal failure patients undergoing chronic HD, CD40L and P-selectin, but not E-selectin, showed a transient decrease over time, and the serum levels of these molecules were not associated with CVD or with CVD-related mortality.
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Affiliation(s)
- Maurizio Bossola
- Hemodialysis Service, Department of Surgery, Catholic University, Rome, Italy.
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23
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Dogra R, Das R, Ahluwalia J, Kumar RM, Talwar KK. Association of thrombomodulin gene polymorphisms and plasma thrombomodulin levels with acute myocardial infarction in north Indian patients. Clin Appl Thromb Hemost 2012; 19:637-43. [PMID: 22734102 DOI: 10.1177/1076029612449900] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This is the first study from north India that investigated the association of thrombomodulin (TM) polymorphisms with acute myocardial infarction (AMI) in 350 patients (≤ 40 years, n = 184 and ≥ 60 years, n = 166) and 350 matched-controls. The TM polymorphisms were determined by polymerase chain reaction-single-stranded conformational polymorphism and DNA sequencing. The TM 1418TT genotype (odds ratio [OR] 2.8; 95% confidence interval [CI] 1.3-6.4; P = .012) was independent risk predictor of young AMI as were hypertension (OR 3.3; 95% CI 1.8-5.9; P < .001), diabetes mellitus (OR 14.3; 95% CI 2.9-44.6; P = .001), smoking (OR 13.8; 95% CI 7.7-24.7; P < .001), family history (OR 1.8; 95% CI 1.1-3.3; P = .045), high body mass index (OR 2.2; 95% CI 1.3-3.6; P = .002), and high waist-hip ratio (OR 4.1; 95% CI 2.4-7.1; P < .001). Mean plasma TM also showed association with young AMI (P < .001). Smoking carriers of TM 1418CT + TT genotype had significantly higher risk of AMI (OR 12.8; 95% CI 6.0-27.3; P < .001) when compared with nonsmoking noncarriers. In conclusion, TM 1418C/T polymorphism is independent predictor of AMI and synergies with smoking.
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Affiliation(s)
- Rupinder Dogra
- 1Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Papadopoulos D, Mourouzis I, Kotrotsou A, Papazachou U, Sanidas E, Tsioufis K, Makris T. Hemostasis Parameters Disturbances in Healthy Individuals with Prehypertension. Clin Exp Hypertens 2012; 34:385-8. [DOI: 10.3109/10641963.2011.631650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Plasma thrombomodulin activity, tissue factor activity and high levels of circulating procoagulant phospholipid as prognostic factors for acute myocardial infarction. Blood Coagul Fibrinolysis 2010; 20:635-41. [PMID: 19809306 DOI: 10.1097/mbc.0b013e32832e05dd] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several studies have indicated an association between haemostatic markers and acute myocardial infarction, but few or no studies refer to their activity. We studied plasma levels of 10 coagulation factors (fibrinogen, protein C, protein S, von Willebrand factor, D-dimers, factor VIIa, free tissue factor pathway inhibitor, tissue-type plasminogen activator, plasminogen activator inhibitor-1, thrombomodulin) and using new specific assays analysed the activity of plasma tissue factor (TFa), thrombomodulin (TMa), and procoagulant phospholipid in 46 consecutive patients with acute myocardial infarction at the time of hospital admission, and compared them with 34 healthy normal volunteers. Plasma levels of TFa, TMa, and procoagulant phospholipid were significantly higher in cases than in control patients (P < 0.001). In addition the ratio of TFa/free tissue factor pathway inhibitor was higher in patients than in controls, whereas the tissue-type plasminogen activator (t-PA)/plasminogen activator inhibitor-1 ratio was lower in patients. Interestingly, patients with an unfavourable outcome during a 2-month follow-up had higher levels of TFa, TMa, procoagulant phospholipid, a higher ratio of TFa/free tissue factor pathway inhibitor and a lower ratio of t-PA/plasminogen activator inhibitor-1 than patients who recovered. The combination of these different parameters reveals an increase in procoagulant activity as well as impaired fibrinolytic activity during the acute phase of an acute myocardial infarction. The association of the level of the activity of these three factors may provide a new tool to assess the prognosis of acute myocardial infarction. Further studies are needed to support our findings and to elucidate the clinical interest of measuring these factors.
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Yavuz BB, Dede DS, Yavuz B, Cankurtaran M, Halil M, Ulger Z, Cankurtaran ES, Aytemir K, Kabakci G, Haznedaroglu IC, Ariogul S. Potential biomarkers for vascular damage in Alzheimer's disease: thrombomodulin and von Willebrand factor. J Nutr Health Aging 2010; 14:439-41. [PMID: 20617285 DOI: 10.1007/s12603-010-0043-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Evidence regarding the vascular basis of Alzheimer's disease (AD) is growing. In vascular damage thrombomodulin tears of the cell wall and its level increases in the plasma. von Willebrand factor (vWF) is also thought to be a biomarker for vascular damage. The aim of this study was to examine the levels of vWF and thrombomodulin in AD as possible markers for vascular damage and to test their utility as an early biomarker in AD. DESIGN Case-control study. SETTING Geriatric medicine outpatient clinic of a university hospital. PARTICIPANTS Twenty Alzheimer's disease patients free from vascular risk factors and 20 controls were enrolled in the study. MEASUREMENTS Thrombomodulin and VWF levels of 20 AD patients and 20 controls were analyzed by commercial kits. RESULTS Thrombomodulin levels were not different between Alzheimer's disease and control groups [median (range) = 4.25 (2.27-37.00) ng/ml in Alzheimer's disease and 3.55 (2.27-14.00) in control group, p=0.15]. Von Willebrand Factor antigen (%) levels were 188.5 (96-306) in Alzheimer's disease, and 181 (112- 284) in control group (p=0.74). CONCLUSION Although vascular damage is thought to play role in the pathogenesis of AD, vWF and thrombomodulin failed to demonstrate the vascular damage in AD. Their utility to be used as early biomarkers of AD could not be shown.
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Affiliation(s)
- B B Yavuz
- Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Geriatric Medicine, Sihhiye, 06100, Ankara, Turkey.
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Kynurenines and oxidative status are independently associated with thrombomodulin and von Willebrand factor levels in patients with end-stage renal disease. Thromb Res 2009; 124:452-7. [DOI: 10.1016/j.thromres.2009.04.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/06/2009] [Accepted: 04/22/2009] [Indexed: 12/18/2022]
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28
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Ushida Y, Koshy G, Kawashima Y, Kiji M, Umeda M, Nitta H, Nagasawa T, Ishikawa I, Izumi Y. Changes in serum interleukin-6, C-reactive protein and thrombomodulin levels under periodontal ultrasonic debridement. J Clin Periodontol 2009; 35:969-75. [PMID: 18976393 DOI: 10.1111/j.1600-051x.2008.01316.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to compare the effect of single-visit full-mouth mechanical debridement (FMD) and quadrant-wise mechanical debridement (QMD) on the levels of serum interleukin (IL)-6, C-reactive protein (CRP) and soluble thrombomodulin. MATERIAL AND METHODS Thirty-six subjects with chronic periodontitis were randomly allocated to three groups: undergoing QMD, single-visit FMD with povidone iodine or with water. Serum IL-6 and soluble thrombomodulin were measured by enzyme-linked immunosorbent assay, and serum CRP was measured by the latex-enhanced nephelometric method. RESULTS Serum IL-6 level increased significantly immediately after debridement in all the three groups, with this increase being greatest in the full-mouth groups. However, the increase in the full-mouth groups was not significantly higher than that of quadrant-wise group. In the quadrant-wise group, serum IL-6 level decreased significantly 1 month after debridement compared with baseline. Serum-soluble thrombomodulin decreased significantly in the full-mouth groups but not in the quadrant-wise group. Changes in CRP level were not significant at baseline or after debridement in all the three groups. CONCLUSIONS FMD increased serum IL-6 and reduced serum-soluble thrombomodulin to a greater extent than QMD, suggesting that the former technique has stronger transient effects on systemic vascular endothelial functions than the latter.
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Affiliation(s)
- Yuka Ushida
- Department of Hard Tissue Engineering, Section of Periodontology, Graduate School, Tokyo, Japan.
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Abstract
Atrial fibrillation (AF) is associated with an increased risk of mortality and morbidity from stroke and thromboembolism. Endothelial damage or dysfunction may contribute to this increased risk of thromboembolism via the mediation of a prothrombotic or hypercoagulable state. However, the precise pathophysiological mechanism(s) relating endothelial (dys)function to AF and thromboembolism are yet to be fully elucidated. This review article aims to provide a comprehensive overview of endothelial (dys)function and AF, as well as the merits and limitations of the different methods used to assess endothelial function in AF.
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Affiliation(s)
- Suresh Krishnamoorthy
- University of Birmingham Centre for Cardiovascular Science, City Hospital, Birmingham, B18 7QH, UK
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30
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Karásek D, Vaverková H, Halenka M, Slavík L, Novotný D. Endothelial haemostatic markers in members of families with familial combined hyperlipidemia. Thromb Res 2009; 123:466-75. [DOI: 10.1016/j.thromres.2008.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 12/04/2007] [Accepted: 02/12/2008] [Indexed: 11/17/2022]
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Assessment of coronary heart disease risk by combined analysis of coagulation factors. Atherosclerosis 2008; 198:294-300. [PMID: 18342864 DOI: 10.1016/j.atherosclerosis.2007.12.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 12/11/2007] [Accepted: 12/21/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Prospective studies have reported a positive association of coagulation factors with risk of coronary heart disease (CHD). It is unclear whether these coagulation factors interact. METHODS AND RESULTS Using a prospective case-cohort design, we analyzed by Cox proportional hazard regression interactions between soluble thrombomodulin (sTM) and fibrinogen, factor VIII (FVIII), FVII, or plasminogen activator inhibitor-1 (PAI-1) in 410 CHD cases and 721 non-cases from the Atherosclerosis Risk in Communities (ARIC). There was a significant interaction between sTM and fibrinogen (p=0.027). We next assessed risk ratios (RR) by combined tertile analysis. Combined analysis revealed that being in the upper sTM tertile counteracted the CHD risk imposed by higher fibrinogen whereas being in the lower sTM tertile amplified the CHD risk of higher fibrinogen. sTM and fibrinogen mutually influenced CHD incidence in a concentration-dependent manner. When analyzed as single factors by tertiles, FVIII, FVII and PAI-1 were not associated with CHD. However, when analyzed together with sTM, FVIII and PAI-1 were both positively associated with CHD for those in the lower sTM tertile. CONCLUSION There is a complex interaction between sTM and prothrombotic coagulation factors. Combined analysis improves CHD risk assessment.
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Malatino LS, Stancanelli B, Cataliotti A, Bellanuova I, Fatuzzo P, Rapisarda F, Leonardis D, Tripepi G, Mallamaci F, Zoccali C. Circulating E-selectin as a risk marker in patients with end-stage renal disease. J Intern Med 2007; 262:479-87. [PMID: 17875185 DOI: 10.1111/j.1365-2796.2007.01841.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND E-selectin is a key adhesion molecule which plays a fundamental role in endothelial progenitor cell-dependent reparative mechanisms in experimental ischaemia and it serves to anchor leucocytes to the endothelium in inflammatory processes. Inflammation is one of the strongest risk factors for death and cardiovascular (CV) events in end-stage renal disease (ESRD). OBJECTIVE The objective of the current study was to evaluate whether E-selectin is a useful biomarker of clinical outcome in ESRD patients. We tested the prediction power of circulating E-selectin for mortality and CV events in a cohort of 265 ESRD patients. RESULTS During the follow-up, 59 patients died and 58 had CV events. All-cause mortality was inversely related to serum E-selectin, the risk of death being the lowest in patients in the third E-selectin tertile (HR: 1, reference group), intermediate in those in the second tertile (HR: 1.30) and the highest in patients in the first tertile (HR: 2.02, P = 0.01). Similarly, the risk of fatal and nonfatal CV events followed an inverse pattern being lowest in the third tertile (reference group) and highest in the first tertile (HR: 1.73, P = 0.03). The prediction power of E-selectin for death and CV events was confirmed in a Cox regression analysis where E-selectin emerged as an inverse predictor of these outcomes, particularly so in patients with severe inflammation. CONCLUSIONS These data are in keeping with the hypothesis that in systemic inflammation altered E-selectin shedding may play a role in arterial damage and implicates this adhesion molecule in atherosclerotic complications in a high-risk condition like ESRD.
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Affiliation(s)
- L S Malatino
- Division of Internal Medicine, Department of Medicine and Systemic Disease, Hypertension Centre, University of Catania, Ragusa, Italy.
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Zhang X, Hu Y, Hong M, Guo T, Wei W, Song S. Plasma thrombomodulin, fibrinogen, and activity of tissue factor as risk factors for acute cerebral infarction. Am J Clin Pathol 2007; 128:287-92. [PMID: 17638664 DOI: 10.1309/hb6ab1yr4dqut5au] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Several studies have indicated association between hematologic markers and increased risks of cerebrovascular disease, but few reports referred to their roles together. We studied plasma levels of 16 hematologic markers in 50 cases diagnosed as acute cerebral infarction (ACI) and 54 hospital control subjects. Plasma levels of thrombomodulin, fibrinogen, and activity of tissue factor (aTF) were significantly higher in cases than in control subjects (P < .001, P < .01, and P < .05, respectively). Multivariate logistic regression analysis showed that hypertension and high plasma levels of thrombomodulin, fibrinogen, and aTF were significantly associated with presence of ACI (odds ratio [OR], 143.74, P < .001; OR, 2.05, P < .05; OR, 2.09, P < .05; OR, 1.02, P < .05, respectively). Our findings indicate that hypertension and elevation of plasma thrombomodulin, fibrinogen, and aTF are independent risk factors for ACI.
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Affiliation(s)
- Xiaoping Zhang
- Institute of Hematology, Affiliated Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Constans J, Conri C. Circulating markers of endothelial function in cardiovascular disease. Clin Chim Acta 2006; 368:33-47. [PMID: 16530177 DOI: 10.1016/j.cca.2005.12.030] [Citation(s) in RCA: 187] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 12/15/2005] [Accepted: 12/23/2005] [Indexed: 02/06/2023]
Abstract
Endothelial dysfunction is a key event in cardiovascular disease. Measurement of endothelial dysfunction in vivo presents a major challenge, but has important implications since it may identify the clinical need for therapeutic intervention, specifically in primary prevention. Several biological markers have been used as indicators of endothelial dysfunction. The soluble adhesion molecules sICAM-1 and sVCAM-1 lack specificity and are increased in inflammatory processes. Both markers are increased in coronary artery disease. sICAM-1 level predicts the risk for cardiovascular disease or diabetes mellitus in healthy individuals. sE-selectin is specific for the endothelium and is increased in coronary artery disease and diabetes mellitus. sE-selectin is also associated with diabetic risk. The endothelium-specific marker, soluble thrombomodulin, is associated with severity of coronary artery disease, stroke or peripheral occlusive arterial disease and is not increased in healthy or asymptomatic subjects. Interestingly, thrombomodulin decreases during treatment of hypercholesterolemia or hyperhomocysteinemia. In contrast, von Willebrand factor is the best endothelial biomarker and predicts risk for ischemic heart disease or stroke.
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Affiliation(s)
- Joël Constans
- Service de Médecine Interne et Médecine Vasculaire, Hôpital Saint-André, 1 rue Jean Burguet, 33075 Bordeaux And EA 3670, Université Victor Segalen-Bordeaux II, 146 rue Léo Saignat, 33000 Bordeaux, France.
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35
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The Endothelium. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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36
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Nagasaki T, Inaba M, Hiura Y, Tahara H, Kumeda Y, Shirakawa K, Onoda N, Ishikawa T, Ishimura E, Nishizawa Y. Plasma levels of adiponectin and soluble thrombomodulin in hypothyroid patients with normal thyroid function following levothyroxine replacement therapy. Biomed Pharmacother 2005; 59:571-7. [PMID: 16202556 DOI: 10.1016/j.biopha.2005.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2005] [Accepted: 03/04/2005] [Indexed: 11/27/2022] Open
Abstract
Hypothyroidism is associated with increased morbidity from cardiovascular disease, and adiponectin (ApN) is a newly-identified adipocytokine, which is expressed in human adipose cells and may have a protective effect against the development of coronary artery disease. The aim of the study was to evaluate the involvement of ApN secretion in hypothyroid patients with normal thyroid function following levothyroxine (L-T(4)) replacement therapy, and to associate plasma ApN levels with intima-media thickness (IMT) in the common carotid artery (CCA), an indicator of early atherosclerosis, and cardiovascular parameters including soluble thrombomodulin (sTM), a plasma endothelial injury marker. The CCA IMT and plasma levels of ApN and sTM were measured in 52 hypothyroid patients and in age-, sex- and body mass index (BMI)-matched normal control subjects. Thirty-six of the hypothyroid patients were further monitored for changes in these markers during 1 year in a euthyroid state induced by L-T(4) replacement therapy. Although the basal CCA IMT was significantly higher in hypothyroid patients [0.633 +/- 0.018 mm (mean +/- S.E.)] than in control subjects (0.552 +/- 0.022 mm, P < 0.005), both groups had similar baseline ApN and sTM levels [10.23 +/- 0.76 vs. 10.10 +/- 0.93 microg/ml: NS; and 2.58 +/- 0.14 vs. 2.68 +/- 0.20 ng/ml: NS, respectively]. Simple regression analysis revealed that plasma ApN was significantly correlated in a positive manner with age (r = 0.339, P = 0.015), HDL-cholesterol (r = 0.295, P = 0.048), and sTM (r = 0.490, P = 0.0005), but not with CCA IMT (r = 0.059, P = 0.742). In multivariate analysis, the plasma ApN level was significantly associated with that of sTM (r = 0.546, P = 0.0001) and with serum high-density lipoprotein (HDL)-cholesterol levels (r = 0.291, P = 0.029) in hypothyroid patients. During 1 year of L-T(4) replacement therapy, hypothyroid patients showed a significant decrease in CCA IMT, to 0.553 +/- 0.016 mm (P < 0.0001), a level comparable to normal controls, but no significant change in ApN (from 10.79 +/- 1.07 to 10.6 9+/- 1.14 microg/ml, NS) or sTM (from 2.59 +/- 0.15 to 2.74 +/- 0.18 ng/ml, NS). Hence, we provide evidence that ApN and sTM might not contribute to enhanced atherosclerosis, as reflected by increased CCA IMT in hypothyroid patients. However, this is the first report to demonstrate a positive and significant association of sTM with ApN. These data support the hypothesis that sTM is one of the determinant of ApN and thus suggest the presence of an sTM-associated regulatory mechanism for ApN secretion in hypothyroid patients.
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Affiliation(s)
- Toshiki Nagasaki
- Department of Metabolism, Endocrinology and Molecular Medicine, Internal Medicine, 1-4-3, Asahi-machi, Osaka 545-8585, Japan
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Chan SH, Chen JH, Li YH, Lin LJ, Tsai LM. Increasing post-event plasma thrombomodulin level associates with worse outcome in survival of acute coronary syndrome. Int J Cardiol 2005; 111:280-5. [PMID: 16307806 DOI: 10.1016/j.ijcard.2005.09.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2005] [Revised: 09/04/2005] [Accepted: 09/18/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We seek to evaluate the association of serial plasma soluble thrombomodulin (TM) change and outcome in survivals of acute coronary syndrome (ACS). BACKGROUND Plasma TM is a marker of endothelial damage. Elevated cross-sectional TM level has been found to be associated with worse outcome in survivals of acute myocardial infarction (MI). However, the association of serial TM change with ACS is not clear. METHODS In 47 survivals of ACS [39 males; age, 64.7+/-9.3 years; 15 unstable angina (UA), 32 acute MI], plasma soluble TM and serum high sensitivity C-reactive protein (hs-CRP) levels are measured at index ACS and at 3-month follow-up. Using hierarchical cluster analysis, patients are classified into ascending (n=29) and descending group (n=18) according to the change in TM level. Composite study end-point is recurrent UA, MI and sudden cardiac death (SCD). RESULTS The magnitude of change of plasma soluble TM is not related to demographic characteristics, diagnosis and pattern of revascularization. The change of TM level in ascending and descending group is 1.80+/-1.13 and -1.73+/-0.48 ng/ml (p<0.001), respectively. There is no significantly difference in demographic characteristics, diagnosis and pattern of revascularization between both groups. The mean hs-CRP levels at index ACS and at 3-months follow-up are also not statistically different between two groups. At 6-month follow-up, 6 patients in ascending group reach end-point (1 SCD, 1 UA, and 4 MIs), however, no patient in descending group suffers from subsequent event (p=0.044). After a mean follow-up of 317 days (range, 60 to 541 days), 9 (19%) patients reach end-point. Kaplan-Meier survival analysis reveals that increasing plasma TM predicts worse clinical outcome (hazard ratio=0.13, log-transformed 95% confidence interval 0.03 to 0.48, p=0.0224 by the log-rank test). CONCLUSION Increasing plasma TM level associates with worse outcome in patients surviving ACS.
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Affiliation(s)
- Shih-Hung Chan
- Cardiovascular Division, Department of Internal Medicine, National Cheng-Kung University Medical Center, 138 Sheng Li Road, 70428, Tainan City, Taiwan, ROC.
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Anderson L. Candidate-based proteomics in the search for biomarkers of cardiovascular disease. J Physiol 2005; 563:23-60. [PMID: 15611012 PMCID: PMC1665562 DOI: 10.1113/jphysiol.2004.080473] [Citation(s) in RCA: 266] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Accepted: 12/16/2004] [Indexed: 11/08/2022] Open
Abstract
The key concept of proteomics (looking at many proteins at once) opens new avenues in the search for clinically useful biomarkers of disease, treatment response and ageing. As the number of proteins that can be detected in plasma or serum (the primary clinical diagnostic samples) increases towards 1000, a paradoxical decline has occurred in the number of new protein markers approved for diagnostic use in clinical laboratories. This review explores the limitations of current proteomics protein discovery platforms, and proposes an alternative approach, applicable to a range of biological/physiological problems, in which quantitative mass spectrometric methods developed for analytical chemistry are employed to measure limited sets of candidate markers in large sets of clinical samples. A set of 177 candidate biomarker proteins with reported associations to cardiovascular disease and stroke are presented as a starting point for such a 'directed proteomics' approach.
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Blann AD. Assessment of Endothelial Dysfunction: Focus on Atherothrombotic Disease. PATHOPHYSIOLOGY OF HAEMOSTASIS AND THROMBOSIS 2005; 33:256-61. [PMID: 15692226 DOI: 10.1159/000083811] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
As the endothelium is crucial to cardiovascular disease, the accurate assessment of this organ is a valuable tool, especially if such assessments are clinically relevant. As functions of the endothelium focus on haemostasis and the maintenance of correct vascular tone, and dysfunction results in changes that promote thrombosis and hypertension, thus assessment of endothelial function therefore follows these processes. Foremost in the plasma markers of vascular function is von Willebrand factor, a molecule that interacts with platelets. Lack of nitric oxide results in poor blood pressure control that can be quantified by impaired flow mediated dilatation. More recently, increased numbers of circulating endothelial cells have been described that indicate severe damage to the endothelium. Unsurprisingly, these three markers correlate with each other and former two predict adverse outcome in long-term follow up studies. The assessment of vascular damage is becoming recognised as having an increasingly prominent part in the pathophysiology of cardiovascular disease.
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Affiliation(s)
- Andrew D Blann
- Haemostasis, Thrombosis, and Vascular Biology Unit, University Department of Medicine City Hospital, Birmingham, United Kingdom.
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40
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Chao T, Li Y, Tsai W, Chen J, Liu P, Tsai L. Elevation of the soluble thrombomodulin levels is associated with inflammation after percutaneous coronary interventions. Clin Cardiol 2004; 27:407-10. [PMID: 15298041 PMCID: PMC6654447 DOI: 10.1002/clc.4960270708] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Thrombomodulin (TM) is an endothelial cell surface thrombin-binding protein with anticoagulation ability by thrombin-mediated activation of protein C. An increase of plasma soluble TM level is reported to be associated with severity and worse outcome of coronary artery disease. HYPOTHESIS This prospective study investigated the relation of the elevated levels of plasma soluble TM and inflammatory and myonecrotic markers in patients undergoing percutaneous coronary intervention (PCI). METHODS Plasma levels of soluble TM, C-reactive protein (CRP), and creatine kinase and its MB isoenzyme were measured before and after PCI in 100 patients undergoing PCIs. RESULTS Peak TM levels after PCIs were significantly higher than baseline (3.39 +/- 1.63 vs. 2.90 +/- 1.57 ng/ml, p < 0.001). The peak TM levels after PCIs correlated significantly with the peak CRP and MB levels, and the maximal inflation duration (r = 0.423, p < 0.001; r = 0.212, p = 0.034; r = 0.307, p= 0.002, respectively). CONCLUSIONS Soluble TM levels increase significantly after PCI. The elevation of the soluble TM after PCI shows better correlation with inflammation than myocardial injury, indicating an endothelial origin. Measurement of soluble TM could be useful and calls for further studies on the prognostic effects of this marker in this clinical condition.
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Affiliation(s)
- Ting‐Hsing Chao
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi‐Heng Li
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei‐Chuan Tsai
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jyh‐Hong Chen
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping‐Yen Liu
- Department of Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Liang‐Miin Tsai
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Lim HS, Lip GYH. Impaired fasting glycaemia vs. impaired glucose tolerance: two sides of the same coin with implications for cardiovascular risk. Diabet Med 2004; 21:303-4. [PMID: 15049929 DOI: 10.1111/j.1464-5491.2004.01232.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gerdes VEA, Kremer Hovinga JA, Ten Cate H, Brandjes DPM, Büller HR. Soluble thrombomodulin in patients with established atherosclerosis. J Thromb Haemost 2004; 2:200-1. [PMID: 14717989 DOI: 10.1111/j.1538-7836.2004.0562f.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chou ET, Schulman SP, Thiemann DR, Sohn RH, Bellantoni MF, Rade JJ. Effect of short-term estrogen with and without progesterone therapy on circulating markers of endothelial activation and injury in postmenopausal women with unstable angina pectoris. Am J Cardiol 2003; 91:1240-2. [PMID: 12745110 DOI: 10.1016/s0002-9149(03)00273-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Eric T Chou
- Division of Cardiology, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA
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Chong AY, Blann AD, Lip GYH. Assessment of endothelial damage and dysfunction: observations in relation to heart failure. QJM 2003; 96:253-67. [PMID: 12651970 DOI: 10.1093/qjmed/hcg037] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- A-Y Chong
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK
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Saigo K, Jiang M, Tanaka C, Fujimoto K, Kobayashi A, Nozu K, Iijima K, Ryo R, Sugimoto T, Imoto S, Kumagai S. Usefulness of automatic detection of fragmented red cells using a hematology analyzer for diagnosis of thrombotic microangiopathy. CLINICAL AND LABORATORY HAEMATOLOGY 2002; 24:347-51. [PMID: 12452815 DOI: 10.1046/j.1365-2257.2002.00473.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We previously reported an automatic method for quantitative analysis of schistocytes or fragmented red cells using an automatic hematology analyzer, XE-2100. In the study reported here, we evaluated the accuracy of this detection method in patients with thrombotic microangiopathy (TMA). A follow-up study was performed on 14 patients with two types of TMA, thrombotic thrombocytopenic purpura or hemolytic uremic syndrome. Schistocyte percent was evaluated both with an automatic counter and by means of microscopic observation. Total activity and isoenzyme pattern of lactate dehydrogenase (LD) were also determined. In these patients, schistocyte percent determined by automatic counting correlated highly with that determined by manual counting under microscopic observation (r = 0.852, P < 0.0001). Schistocyte percent was shown to correlate significantly with isoenzyme fractions 1 and 2 of LD (r = 0.732, P < 0.02), reflecting hemolysis. Nine of 11 patients tested had high concentrations of LD isoenzyme five without distinct liver damage, and schistocyte percent did not relate to fraction 5 of LD. Automatic detection of schistocyte percent using a hematology analyzer was useful for an accurate diagnosis and follow-up of thrombotic microangiopathy. The origin of LD fraction 5 remains to be determined.
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Affiliation(s)
- K Saigo
- Blood Transfusion Division, Kobe University Hospital, Kobe, Japan.
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Kozuka K, Kohriyama T, Nomura E, Ikeda J, Kajikawa H, Nakamura S. Endothelial markers and adhesion molecules in acute ischemic stroke--sequential change and differences in stroke subtype. Atherosclerosis 2002; 161:161-8. [PMID: 11882328 DOI: 10.1016/s0021-9150(01)00635-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The progress of a stroke concerns the activation of endothelial cells and platelets. We measured the plasma activities of von Willebrand factor (vWf) and the serum levels of soluble thrombomodulin (sTM) as endothelial markers, and the plasma concentrations of soluble P-selectin (sP-selectin) and soluble E-selectin (sE-selectin) as adhesion molecules during the acute (within 48 h from onset) and subacute (after 1 month from the onset) phases of 52 consecutive patients with acute ischemic stroke and 86 age-matched control subjects. The plasma vWf activities and levels of sP-and sE-selectins in stroke patients were significantly elevated compared with those in controls during both the acute and subacute phases. The serum levels of sTM in stroke patients were significantly higher than those in controls only during the subacute phase. In atherothrombotic infarction, the vWf activities and the levels of sP-selectin, markers for endothelial and platelet activation, remained higher until the subacute phase compared with controls, and the concentrations of sTM, a marker for endothelial injury, were increased during the subacute phase compared with during the acute phase. In lacunar infarction, the levels of sTM and sE-selectin of patients were higher only during the acute phase than controls. These findings suggest that the endothelial cell damage might be maintained until the subacute phase in atherothrombotic infarction, whereas it is remarkable only during the acute phase in lacunar infarction. The evaluation of endothelial markers and adhesion molecules would represent the pathophysiological states of stroke and may provide useful information for the treatment of the ischemic infarction.
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Affiliation(s)
- Kazuko Kozuka
- Third Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3, Kasumi, Minami-Ku, Hiroshima City 734-8551, Japan
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Scott DA, Palmer RM. The influence of tobacco smoking on adhesion molecule profiles. Tob Induc Dis 2002; 1:7-25. [PMID: 19570245 PMCID: PMC2671531 DOI: 10.1186/1617-9625-1-1-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2001] [Revised: 02/18/2002] [Accepted: 02/19/2002] [Indexed: 12/02/2022] Open
Abstract
Sequential interactions between several adhesion molecules and their ligands regulate lymphocyte circulation and leukocyte recruitment to inflammatory foci. Adhesion molecules are, therefore, central and critical components of the immune and inflammatory system. We review the evidence that tobacco smoking dysregulates specific components of the adhesion cascade, which may be a common factor in several smoking-induced diseases. Smoking causes inappropriate leukocyte activation, leukocyte-endothelial adhesion, and neutrophil entrapment in the microvasculature, which may help initiate local tissue destruction. Appropriate inflammatory reactions may thus be compromised. In addition to smoke-induced alterations to membrane bound endothelial and leukocyte adhesion molecule expression, which may help explain the above phenomena, smoking has a profound influence on circulating adhesion molecule profiles, most notably sICAM-1 and specific sCD44 variants. Elevated concentrations of soluble adhesion molecules may simply reflect ongoing inflammatory processes. However, increasing evidence suggests that specific soluble adhesion molecules are immunomodulatory, and that alterations to soluble adhesion molecule profiles may represent a significant risk factor for several diverse diseases. This evidence is discussed herein.
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Affiliation(s)
- D A Scott
- Department of Oral Biology, Faculty of Dentistry, University of Manitoba, 780 Bannatyne Ave, Winnipeg, MB, R3E 0W2, Canada.
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Li YH, Chen CH, Yeh PS, Lin HJ, Chang BI, Lin JC, Guo HR, Wu HL, Shi GY, Lai ML, Chen JH. Functional mutation in the promoter region of thrombomodulin gene in relation to carotid atherosclerosis. Atherosclerosis 2001; 154:713-9. [PMID: 11257274 DOI: 10.1016/s0021-9150(00)00639-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thrombomodulin is an important endothelial anticoagulant protein that decreases thrombin activity and activates protein C. Our recent study has shown that the G-33A promoter mutation of thrombomodulin gene is associated with coronary artery disease. This study was conducted to determine whether the G-33A mutation in the promoter region of thrombomodulin gene is a genetic risk factor for ischemic stroke or carotid atherosclerosis. The functional significance of this mutation was also evaluated. We recruited 333 patients (mean age 64 years, 59% male) with ischemic stroke and 257 age- and sex-matched controls. In all study participants, carotid atherosclerosis was assessed by Duplex scanning, and thrombomodulin G-33A promoter mutation was detected by single-strand conformation polymorphism. Luciferase reporter gene assay was used to assess the influence of this mutation on thrombomodulin promoter activity. There was no significant difference in the thrombomodulin G-33A mutation frequency (GA+AA genotypes) between the stroke and the control groups (18.3 vs. 24. 1%, P=0.105). The G-33A mutation frequency was also similar between the study participants with and without carotid atherosclerosis (22.2 vs. 19.8%, P=0.550). When only younger subjects (age </=60 years) were included in the analysis, however, we found the mutation occurred more frequently in participants with carotid atherosclerosis (33.3 vs. 17.3%, odds ratio [OR]=2.38, 95% confidence interval [CI]=1.16-4.90, P=0.027). Multiple logistic regression analyses showed that only diabetes mellitus (OR=3.11, 95% CI=1.33-7.30, P=0.009) and G-33A mutation (OR=2.46, 95% CI=1.14-5.29, P=0.021) were associated independently with carotid atherosclerosis in younger subjects. As assessed by luciferase reporter gene assays, the contructs bearing the G-33A mutation showed a significant decrease (36+/-12%) in transcriptional activity in comparison with the wild type constructs. Our findings suggest that G-33A mutation reduces the thrombomodulin promoter activity and is associated with carotid atherosclerosis in younger subjects.
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Affiliation(s)
- Y H Li
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, 70428, Tainan, Taiwan, ROC
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Blann AD, Lip GY. Virchow's triad revisited: the importance of soluble coagulation factors, the endothelium, and platelets. Thromb Res 2001; 101:321-7. [PMID: 11320984 DOI: 10.1016/s0049-3848(00)00419-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Li YH, Chen JH, Wu HL, Shi GY, Huang HC, Chao TH, Tsai WC, Tsai LM, Guo HR, Wu WS, Chen ZC. G-33A mutation in the promoter region of thrombomodulin gene and its association with coronary artery disease and plasma soluble thrombomodulin levels. Am J Cardiol 2000; 85:8-12. [PMID: 11078228 DOI: 10.1016/s0002-9149(99)00597-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thrombomodulin is an endothelial glycoprotein that decreases thrombin activity and activates protein C. A recent study has shown that G-33A promoter mutation of the thrombomodulin gene occurs particularly in Asians. In this study, we analyzed the distribution of G-33A mutation in the promoter region of the thrombomodulin gene in the Chinese population and determined whether the mutation might be a risk for coronary artery disease (CAD). In addition, the influence of this mutation on plasma soluble thrombomodulin levels in patients with CAD was also examined. We studied 320 consecutive patients (mean age 63 years; 73% men) with CAD and 200 age- and sex-matched control subjects. Screening for thrombomodulin G-33A promoter mutation was conducted using polymerase chain reaction, single-strand conformation polymorphism, and direct deoxyribonucleic acid sequencing. The frequency of the G-33A mutation (GA+AA genotypes) was significantly higher in the CAD group (23.8% vs 15.5%, odds ratio [OR] 1.70, p = 0.031). Multiple logistic regression analysis showed that the mutation was an independent risk factor (OR 1.81, p = 0.016) for CAD, as was hypertension (OR 1.44, p = 0.040), diabetes mellitus (OR 2.50, p <0.001), and smoking (OR 2.15, p <0.001). In CAD patients with GG genotype, the soluble thrombomodulin level increased with the extent of CAD (36 +/- 15 vs 47 +/- 18 vs 55 +/- 36 ng/ml in 1-, 2-, or 3-vessel CAD, p <0.001). However, in CAD patients with G-33A mutation, there was no difference between the levels of soluble thrombomodulin (39 +/- 17 vs 37 +/- 15 vs 42 +/- 18 ng/ml, p = NS) in 1-, 2-, or 3-vessel CAD. Our observations suggest that there is a significant association of the G-33A mutation in thrombomodulin gene with CAD, and this mutation may influence the soluble thrombomodulin levels in patients with CAD.
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Affiliation(s)
- Y H Li
- Department of Internal Medicine, College of Medicine, National Cheng Kung Univeristy, Tainan, Taiwan
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