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Wiszniewska M, Włodarczyk U, Sury M, Słomka A, Piekuś-Słomka N, Żdanowicz A, Żekanowska E. The Usefulness of Factor XIII Concentration Assessment in Patients in the Acute Phase of Ischaemic Stroke Treated with Thrombolysis. Neurol Int 2024; 16:551-560. [PMID: 38804480 PMCID: PMC11130863 DOI: 10.3390/neurolint16030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND AND AIMS In recent years, there has been a growing interest in factor XIII in ischaemic stroke. The study's main aim was to assess the usefulness of factor XIII concentration determination in patients with acute ischaemic stroke (AIS) treated with thrombolysis with recombinant tissue plasminogen activator (t-PA). METHODS The study was conducted in two groups of 84 patients with AIS: group I-with thrombolytic therapy and group II-without thrombolysis. A physical examination, neurological status (using the National Institutes of Health Stroke Scale, NIHSS), daily patients' activities measured with the Barthel Index and Modified Rankin Scale (mRS), and blood parameters were conducted on day 1 and day 7. The following parameters were assessed: highly sensitive C-reaction protein (CRP), fibrinogen, D-dimers (DD), neutrophil-lymphocyte ratio (NLR index), and the concentration of factor XIII-A. RESULTS In group I, the concentration of XIII-A decreased significantly between day 1 and 7 (p < 0.001). In group I, the concentration of XIII-A on day 7 in Total Anterior Circulation Infarct (TACI) was significantly lower than in non-TACI stroke. XIII-A concentration in group I was significantly lower in patients < 31 points with Acute Stroke Registry and Analysis of Lausanne (ASTRAL). A greater decrease in XIII-A between the first sampling on day 1 and the second sampling on day 7 was associated with a worse patient neurological state in group I. CONCLUSIONS In patients with AIS treated with t-PA, factor XIII concentrations decrease in the acute phase of stroke, and the largest decrease occurs in the TACI stroke. Determination of factor XIII concentration in patients with AIS can be used in clinical practice as an additional parameter supporting the assessment of stroke severity and may play a role in the prognosis; lower factor XIII-A activity may be a predictor of a worse prognosis.
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Affiliation(s)
- Małgorzata Wiszniewska
- Emergency Medical Services, University of Applied Sciences, 64-920 Piła, Poland
- Neurological Department with Stroke Unit, Specialist Hospital, 64-920 Piła, Poland
| | - Urszula Włodarczyk
- Neurological Department with Stroke Unit, Specialist Hospital, 64-920 Piła, Poland
| | - Magdalena Sury
- Neurological Department with Stroke Unit, Specialist Hospital, 64-920 Piła, Poland
| | - Artur Słomka
- Department of Pathophysiology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum, Faculty of Pharmacy, 85-067 Bydgoszcz, Poland; (A.S.)
| | - Natalia Piekuś-Słomka
- Department of Inorganic and Analytical Chemistry, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, 85-067 Bydgoszcz, Poland;
| | - Anna Żdanowicz
- Department of Nursing, Stanislaw Staszic State University of Applied Science, 64-920 Piła, Poland
| | - Ewa Żekanowska
- Department of Pathophysiology, Nicolaus Copernicus University in Torun, Ludwik Rydygier Collegium Medicum, Faculty of Pharmacy, 85-067 Bydgoszcz, Poland; (A.S.)
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2
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Marta-Enguita J, Navarro-Oviedo M, Machado FJDM, Bermejo R, Aymerich N, Herrera M, Zandio B, Pagola J, Juega J, Marta-Moreno J, Rodriguez JA, Páramo JA, Roncal C, Muñoz R, Orbe J. Role of factor XIII in ischemic stroke: a key molecule promoting thrombus stabilization and resistance to lysis. J Thromb Haemost 2024; 22:1080-1093. [PMID: 38160727 DOI: 10.1016/j.jtha.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Active coagulation factor XIII (FXIII) catalyzing crosslinking of fibrin and other hemostatic factors plays a key role in clot stability and lysis. OBJECTIVES To evaluate the effect of FXIII inhibition in a mouse model of ischemic stroke (IS) and the role of activated FXIII (FXIIIa) in clot formation and lysis in patients with IS. METHODS A ferric chloride IS murine model was performed before and after administration of a FXIIIa inhibitor (FXIIIinh). Thromboelastometry in human and mice blood was used to evaluate thrombus stiffness and lysis with FXIIIinh. FXIIIa-dependent fibrin crosslinking and lysis with fibrinolytic drugs (tissue plasminogen activator and tenecteplase) were studied on fibrin plates and on thrombi and clotted plasma of patients with IS. Finally, circulating and thrombus FXIIIa were measured in 85 patients with IS. RESULTS FXIIIinh administration before stroke induction reduced infarct size, α2-antiplasmin (α2AP) crosslinking, and local microthrombosis, improving motor coordination and fibrinolysis without intracranial bleeds (24 hours). Interestingly, FXIII blockade after stroke also reduced brain damage and neurologic deficit. Thromboelastometry in human/mice blood with FXIIIinh showed delayed clot formation, reduced clot firmness, and shortened tissue plasminogen activator lysis time. FXIIIa fibrin crosslinking increased fibrin density and lysis resistance, which increased further after α2AP addition. FXIIIinh enhanced ex vivo lysis in stroke thrombi and fibrin plates. In patients with IS, thrombus FXIII and α2AP were associated with inflammatory and hemostatic components, and plasma FXIIIa correlated with thrombus α2AP and fibrin. CONCLUSION Our results suggest a key role of FXIIIa in thrombus stabilization, α2AP crosslinking, and lysis resistance, with a protective effect of FXIIIinh in an IS experimental model.
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Affiliation(s)
- Juan Marta-Enguita
- Atherothrombosis Laboratory, Cardiovascular Diseases Program, Centro de Investigacion Medica Aplicada (CIMA), Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona Spain; Neurology Department, Hospital Universitario Navarra, Pamplona, Spain; Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS)-Ictus Instituto de Salud Carlos III (ISCIII), Madrid, Spain. https://twitter.com/jmartaen
| | - Manuel Navarro-Oviedo
- Atherothrombosis Laboratory, Cardiovascular Diseases Program, Centro de Investigacion Medica Aplicada (CIMA), Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona Spain
| | - Florencio J D M Machado
- Atherothrombosis Laboratory, Cardiovascular Diseases Program, Centro de Investigacion Medica Aplicada (CIMA), Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona Spain
| | - Rebeca Bermejo
- Neurointervencionist Radiology, Hospital Universitario Navarra, Pamplona, Spain
| | - Nuria Aymerich
- Neurology Department, Hospital Universitario Navarra, Pamplona, Spain; Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS)-Ictus Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Maria Herrera
- Neurology Department, Hospital Universitario Navarra, Pamplona, Spain; Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS)-Ictus Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Beatriz Zandio
- Neurology Department, Hospital Universitario Navarra, Pamplona, Spain; Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS)-Ictus Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jorge Pagola
- Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS)-Ictus Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Stroke Unit, Vall d'Hebron Instituto de Investigación (VHIR), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Jesús Juega
- Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS)-Ictus Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Stroke Unit, Vall d'Hebron Instituto de Investigación (VHIR), Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Javier Marta-Moreno
- Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS)-Ictus Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Neurology Department, Hospital Universitario Miguel Servet, IIS-Aragon, Zaragoza, Spain
| | - Jose-Antonio Rodriguez
- Atherothrombosis Laboratory, Cardiovascular Diseases Program, Centro de Investigacion Medica Aplicada (CIMA), Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, Madrid, Spain
| | - Jose-Antonio Páramo
- Atherothrombosis Laboratory, Cardiovascular Diseases Program, Centro de Investigacion Medica Aplicada (CIMA), Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, Madrid, Spain; Hematology Department, Clinica Universidad Navarra, Pamplona, Spain
| | - Carmen Roncal
- Atherothrombosis Laboratory, Cardiovascular Diseases Program, Centro de Investigacion Medica Aplicada (CIMA), Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), ISCIII, Madrid, Spain
| | - Roberto Muñoz
- Neurology Department, Hospital Universitario Navarra, Pamplona, Spain; Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS)-Ictus Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Josune Orbe
- Atherothrombosis Laboratory, Cardiovascular Diseases Program, Centro de Investigacion Medica Aplicada (CIMA), Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona Spain; Red de Investigación Cooperativa Orientada a Resultados en Salud (RICORS)-Ictus Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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Crochemore T, Görlinger K, Lance MD. Early Goal-Directed Hemostatic Therapy for Severe Acute Bleeding Management in the Intensive Care Unit: A Narrative Review. Anesth Analg 2024; 138:499-513. [PMID: 37977195 PMCID: PMC10852045 DOI: 10.1213/ane.0000000000006756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 11/19/2023]
Abstract
This is a narrative review of the published evidence for bleeding management in critically ill patients in different clinical settings in the intensive care unit (ICU). We aimed to describe "The Ten Steps" approach to early goal-directed hemostatic therapy (EGDHT) using point-of-care testing (POCT), coagulation factor concentrates, and hemostatic drugs, according to the individual needs of each patient. We searched National Library of Medicine, MEDLINE for publications relevant to management of critical ill bleeding patients in different settings in the ICU. Bibliographies of included articles were also searched to identify additional relevant studies. English-language systematic reviews, meta-analyses, randomized trials, observational studies, and case reports were reviewed. Data related to study methodology, patient population, bleeding management strategy, and clinical outcomes were qualitatively evaluated. According to systematic reviews and meta-analyses, EGDHT guided by viscoelastic testing (VET) has been associated with a reduction in transfusion utilization, improved morbidity and outcome in patients with active bleeding. Furthermore, literature data showed an increased risk of severe adverse events and poor clinical outcomes with inappropriate prophylactic uses of blood components to correct altered conventional coagulation tests (CCTs). Finally, prospective, randomized, controlled trials point to the role of goal-directed fibrinogen substitution to reduce bleeding and the amount of red blood cell (RBC) transfusion with the potential to decrease mortality. In conclusion, severe acute bleeding management in the ICU is still a major challenge for intensive care physicians. The organized and sequential approach to the bleeding patient, guided by POCT allows for rapid and effective bleeding control, through the rational use of blood components and hemostatic drugs, since VET can identify specific coagulation disorders in real time, guiding hemostatic therapy with coagulation factor concentrates and hemostatic drugs with individual goals.
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Affiliation(s)
- Tomaz Crochemore
- From the Department of Critical Care, Hospital Vila Nova Star, São Paulo, Brazil
- Department of Critical Care, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Werfen LATAM, São Paulo, Brazil
| | - Klaus Görlinger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Germany
- TEM Innovations GmbH/Werfen PBM, Munich, Germany
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Moore HB. Fibrinolysis Shutdown and Hypofibrinolysis Are Not Synonymous Terms: The Clinical Significance of Differentiating Low Fibrinolytic States. Semin Thromb Hemost 2023; 49:433-443. [PMID: 36318960 PMCID: PMC10366941 DOI: 10.1055/s-0042-1758057] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Low fibrinolytic activity has been associated with pathologic thrombosis and multiple-organ failure. Low fibrinolytic activity has two commonly associated terms, hypofibrinolysis and fibrinolysis shutdown. Hypofibrinolysis is a chronic state of lack of ability to generate an appropriate fibrinolytic response when anticipated. Fibrinolysis shutdown is the shutdown of fibrinolysis after systemic activation of the fibrinolytic system. There has been interchanging of these terms to describe critically ill patients in multiple settings. This is problematic in understanding the pathophysiology of disease processes related to these conditions. There is also a lack of research on the cellular mediators of these processes. The purpose of this article is to review the on and off mechanisms of fibrinolysis in the context of low fibrinolytic states to define the importance in differentiating hypofibrinolysis from fibrinolysis shutdown. In many clinical scenarios, the etiology of a low fibrinolytic state cannot be determined due to ambiguity if a preceding fibrinolytic activation event occurred. In this scenario, the term "low fibrinolytic activity" or "fibrinolysis resistance" is a more appropriate descriptor, rather than using assumptive of hypofibrinolysis and fibrinolysis shutdown, particularly in the acute setting of infection, injury, and surgery.
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Affiliation(s)
- Hunter B. Moore
- Division of Transplant Surgery, Department of Surgery, University of Colorado Denver, Aurora, Colorado Semin Thromb Hemost
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5
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Coupland LA, Rabbolini DJ, Schoenecker JG, Crispin PJ, Miller JJ, Ghent T, Medcalf RL, Aneman AE. Point-of-care diagnosis and monitoring of fibrinolysis resistance in the critically ill: results from a feasibility study. Crit Care 2023; 27:55. [PMID: 36765421 PMCID: PMC9912243 DOI: 10.1186/s13054-023-04329-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/22/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Fibrinolysisis is essential for vascular blood flow maintenance and is triggered by endothelial and platelet release of tissue plasminogen activator (t-PA). In certain critical conditions, e.g. sepsis, acute respiratory failure (ARF) and trauma, the fibrinolytic response is reduced and may lead to widespread thrombosis and multi-organ failure. The mechanisms underpinning fibrinolysis resistance include reduced t-PA expression and/or release, reduced t-PA and/or plasmin effect due to elevated inhibitor levels, increased consumption and/or clearance. This study in critically ill patients with fibrinolysis resistance aimed to evaluate the ability of t-PA and plasminogen supplementation to restore fibrinolysis with assessment using point-of-care ClotPro viscoelastic testing (VET). METHODS In prospective, observational studies, whole-blood ClotPro VET evaluation was carried out in 105 critically ill patients. In 32 of 58 patients identified as fibrinolysis-resistant (clot lysis time > 300 s on the TPA-test: tissue factor activated coagulation with t-PA accelerated fibrinolysis), consecutive experimental whole-blood VET was carried out with repeat TPA-tests spiked with additional t-PA and/or plasminogen and the effect on lysis time determined. In an interventional study in a patient with ARF and fibrinolysis resistance, the impact of a 24 h intravenous low-dose alteplase infusion on coagulation and fibrinolysis was prospectively monitored using standard ClotPro VET. RESULTS Distinct response groups emerged in the ex vivo experimental VET, with increased fibrinolysis observed following supplementation with (i) t-PA only or (ii) plasminogen and t-PA. A baseline TPA-test lysis time of > 1000 s was associated with the latter group. In the interventional study, a gradual reduction (25%) in serial TPA-test lysis times was observed during the 24 h low-dose alteplase infusion. CONCLUSIONS ClotPro viscoelastic testing, the associated TPA-test and the novel experimental assays may be utilised to (i) investigate the potential mechanisms of fibrinolysis resistance, (ii) guide corrective treatment and (iii) monitor in real-time the treatment effect. Such a precision medicine and personalised treatment approach to the management of fibrinolysis resistance has the potential to increase treatment benefit, while minimising adverse events in critically ill patients. TRIAL REGISTRATION VETtiPAT-ARF, a clinical trial evaluating ClotPro-guided t-PA (alteplase) administration in fibrinolysis-resistant patients with ARF, is ongoing (ClinicalTrials.gov NCT05540834 ; retrospectively registered September 15th 2022).
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Affiliation(s)
- Lucy A. Coupland
- grid.415994.40000 0004 0527 9653Intensive Care Unit, Liverpool Hospital, Liverpool, Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170 Australia
| | - David J. Rabbolini
- grid.1013.30000 0004 1936 834XKolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia ,grid.410556.30000 0001 0440 1440Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jonathan G. Schoenecker
- grid.412807.80000 0004 1936 9916Department of Orthopaedics and Pharmacology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Philip J. Crispin
- grid.413314.00000 0000 9984 5644Haematology Department, The Canberra Hospital, Canberra, Australia ,grid.1001.00000 0001 2180 7477The Australian National University Medical School, Canberra, Australia
| | - Jennene J. Miller
- grid.415994.40000 0004 0527 9653Intensive Care Unit, Liverpool Hospital, Liverpool, Australia
| | - Tony Ghent
- grid.413154.60000 0004 0625 9072Intensive Care Unit, Gold Coast University Hospital, South Port, Australia
| | - Robert L. Medcalf
- grid.1002.30000 0004 1936 7857Australian Centre for Blood Diseases, Monash University, Melbourne, Australia
| | - Anders E. Aneman
- grid.415994.40000 0004 0527 9653Intensive Care Unit, Liverpool Hospital, Liverpool, Australia ,grid.429098.eIngham Institute for Applied Medical Research, 1 Campbell St, Liverpool, NSW 2170 Australia
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Risman RA, Kirby NC, Bannish BE, Hudson NE, Tutwiler V. Fibrinolysis: an illustrated review. Res Pract Thromb Haemost 2023; 7:100081. [PMID: 36942151 PMCID: PMC10024051 DOI: 10.1016/j.rpth.2023.100081] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
In response to vessel injury (or other pathological conditions), the hemostatic process is activated, resulting in a fibrous, cellular-rich structure commonly referred to as a blood clot. Succeeding the clot's function in wound healing, it must be resolved. This illustrated review focuses on fibrinolysis-the degradation of blood clots or thrombi. Fibrin is the main mechanical and structural component of a blood clot, which encases the cellular components of the clot, including platelets and red blood cells. Fibrinolysis is the proteolytic degradation of the fibrin network that results in the release of the cellular components into the bloodstream. In the case of thrombosis, fibrinolysis is required for restoration of blood flow, which is accomplished clinically through exogenously delivered lytic factors in a process called external lysis. Fibrinolysis is regulated by plasminogen activators (tissue-type and urokinase-type) that convert plasminogen into plasmin to initiate fiber lysis and lytic inhibitors that impede this lysis (plasminogen activator inhibitors, alpha 2-antiplasmin, and thrombin activatable fibrinolysis inhibitor). Furthermore, the network structure has been shown to regulate lysis: thinner fibers and coarser clots lyse faster than thicker fibers and finer clots. Clot contraction, a result of platelets pulling on fibers, results in densely packed red blood cells (polyhedrocytes), reduced permeability to fibrinolytic factors, and increased fiber tension. Extensive research in the field has allowed for critical advancements leading to improved thrombolytic agents. In this review, we summarize the state of the field, highlight gaps in knowledge, and propose future research questions.
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Affiliation(s)
| | - Nicholas C Kirby
- Department of Chemistry, East Carolina University, Greenville, North Carolina, USA
| | | | - Nathan E Hudson
- Department of Physics, East Carolina University Greenville, North Carolina, USA
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Litvinov RI, Weisel JW. Blood clot contraction: Mechanisms, pathophysiology, and disease. Res Pract Thromb Haemost 2023; 7:100023. [PMID: 36760777 PMCID: PMC9903854 DOI: 10.1016/j.rpth.2022.100023] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/09/2022] [Accepted: 11/17/2022] [Indexed: 01/18/2023] Open
Abstract
A State of the Art lecture titled "Blood Clot Contraction: Mechanisms, Pathophysiology, and Disease" was presented at the International Society on Thrombosis and Haemostasis (ISTH) Congress in 2022. This was a systematic description of blood clot contraction or retraction, driven by activated platelets and causing compaction of the fibrin network along with compression of the embedded erythrocytes. The consequences of clot contraction include redistribution of the fibrin-platelet meshwork toward the periphery of the clot and condensation of erythrocytes in the core, followed by their deformation from the biconcave shape into polyhedral cells (polyhedrocytes). These structural signatures of contraction have been found in ex vivo thrombi derived from various locations, which indicated that clots undergo intravital contraction within the blood vessels. In hemostatic clots, tightly packed polyhedrocytes make a nearly impermeable seal that stems bleeding and is impaired in hemorrhagic disorders. In thrombosis, contraction facilitates the local blood flow by decreasing thrombus obstructiveness, reducing permeability, and changing susceptibility to fibrinolytic enzymes. However, in (pro)thrombotic conditions, continuous background platelet activation is followed by platelet exhaustion, refractoriness, and impaired intravital clot contraction, which is associated with weaker thrombi predisposed to embolization. Therefore, assays that detect imperfect in vitro clot contraction have potential diagnostic and prognostic values for imminent or ongoing thrombosis and thrombotic embolism. Collectively, the contraction of blood clots and thrombi is an underappreciated and understudied process that has a pathogenic and clinical significance in bleeding and thrombosis of various etiologies. Finally, we have summarized relevant new data on this topic presented during the 2022 ISTH Congress.
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Affiliation(s)
- Rustem I Litvinov
- Department of Cell and Developmental Biology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John W Weisel
- Department of Cell and Developmental Biology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Lu H, Xiao L, Wang W, Li X, Ma Y, Zhang Y, Wang X. Fibrinolysis Regulation: A Promising Approach to Promote Osteogenesis. TISSUE ENGINEERING. PART B, REVIEWS 2022; 28:1192-1208. [PMID: 35442086 DOI: 10.1089/ten.teb.2021.0222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Soon after bone fracture, the initiation of the coagulation cascade results in the formation of a blood clot, which acts as a natural material to facilitate cell migration and osteogenic differentiation at the fracture site. The existence of hematoma is important in early stage of bone healing, but the persistence of hematoma is considered harmful for bone regeneration. Fibrinolysis is recently regarded as a period of critical transition in angiogenic-osteogenic coupling, it thereby is vital for the complete healing of the bone. Moreover, the enhanced fibrinolysis is proposed to boost bone regeneration through promoting the formation of blood vessels, and fibrinolysis system as well as the products of fibrinolysis also play crucial roles in the bone healing process. Therefore, the purpose of this review is to elucidate the fibrinolysis-derived effects on osteogenesis and summarize the potential approaches-improving bone healing by regulating fibrinolysis, with the purpose to further understand the integral roles of fibrinolysis in bone regeneration and to provide theoretical knowledge for potential fibrinolysis-related osteogenesis strategies. Impact statement Fibrinolysis emerging as a new and viable therapeutic intervention to be contained within osteogenesis strategies, however to now, there have been no review articles which collates the information between fibrinolysis and osteogenesis. This review, therefore, focusses on the effects that fibrinolysis exerts on bone healing, with a purpose to provide theoretical reference to develop new strategies to modulate fibrinolysis to accelerate fibrinolysis thus enhancing bone healing.
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Affiliation(s)
- Haiping Lu
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Lan Xiao
- School of Mechanical, Medical and Process Engineering, Center for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia.,The Australia-China Center for Tissue Engineering and Regenerative Medicine, Kelvin Grove, Brisbane, Queensland, Australia
| | - Weiqun Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xuyan Li
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yaping Ma
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yi Zhang
- Department of Hygiene Toxicology, School of Public Health, Zunyi Medical University, Zunyi, Guizhou, China
| | - Xin Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.,School of Mechanical, Medical and Process Engineering, Center for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia.,The Australia-China Center for Tissue Engineering and Regenerative Medicine, Kelvin Grove, Brisbane, Queensland, Australia
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9
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VanZweden E, Tolsma R, Hung V, Awad P, Sawyer R, Li Y. The advances of blood clots used as biomaterials in regenerative medicine. Regen Med 2022; 17:957-969. [DOI: 10.2217/rme-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The physiologic process of blood clot formation is well understood and occurs naturally in the setting of tissue injury to achieve hemostasis and begin the process of wound healing. While the investigation of blood clots as a biomaterial is still in the early stages, there has been some research with similar biomaterials made of the components of blood clots that support the innovative idea of using an autologous blood clot as a scaffold or delivery method for therapeutic agents. Here, we review the physiology of blood clots in wound healing and how using blood clots as a biomaterial and delivery system can potentially promote wound healing, provide targeted therapeutic agent delivery and use it as an innovative tool in regenerative medicine.
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Affiliation(s)
| | - Rachael Tolsma
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Victor Hung
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Peter Awad
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Robert Sawyer
- Department of General Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Yong Li
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
- Department of Orthopaedic Surgery, Biomedical Engineering, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
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10
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Javed H, Singh S, Urs SUR, Oldenburg J, Biswas A. Genetic landscape in coagulation factor XIII associated defects – Advances in coagulation and beyond. Blood Rev 2022; 59:101032. [PMID: 36372609 DOI: 10.1016/j.blre.2022.101032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
Coagulation factor XIII (FXIII) acts as a fine fulcrum in blood plasma that maintains the balance between bleeding and thrombosis by covalently crosslinking the pre-formed fibrin clot into an insoluble one that is resistant to premature fibrinolysis. In plasma, FXIII circulates as a pro-transglutaminase complex composed of the dimeric catalytic FXIII-A encoded by the F13A1 gene and dimeric carrier/regulatory FXIII-B subunits encoded by the F13B gene. Growing evidence accumulated over decades of exhaustive research shows that not only does FXIII play major roles in both pathological extremes of hemostasis i.e. bleeding and thrombosis, but that it is, in fact, a pleiotropic protein with physiological roles beyond coagulation. However, the current FXIII genetic-epidemiological literature is overwhelmingly derived from the bleeding pathology associated with its deficiency. In this article we review the current clinical, functional, and molecular understanding of this fascinating multifaceted protein, especially putting into the same perspective its genetic landscape.
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Matveeva VG, Senokosova EA, Sevostianova VV, Khanova MY, Glushkova TV, Akentieva TN, Antonova LV, Barbarash LS. Advantages of Fibrin Polymerization Method without the Use of Exogenous Thrombin for Vascular Tissue Engineering Applications. Biomedicines 2022; 10:biomedicines10040789. [PMID: 35453539 PMCID: PMC9026760 DOI: 10.3390/biomedicines10040789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 01/01/2023] Open
Abstract
Fibrin is widely used in vascular tissue engineering. Typically, fibrin polymerization is initiated by adding exogenous thrombin. In this study, we proposed a protocol for the preparation of completely autologous fibrin without the use of endogenous thrombin and compared the properties of the prepared fibrin matrix with that obtained by the traditional method. Fibrinogen was obtained by ethanol precipitation followed by fibrin polymerization by adding either exogenous thrombin and calcium chloride (ExThr), or only calcium chloride (EnThr). We examined the structure, mechanical properties, thrombogenicity, degradation rate and cytocompatibility of fibrin matrices. Factor XIII (FXIII) quantitative assay was performed by ELISA, and FXIII activity was assessed by SDS-PAGE detection of γ-γ cross-links. The results show that network structure of EnThr fibrin was characterized by thinner fibers. The EnThr fibrin matrices had higher strength, stiffness and resistance to proteolytic degradation compared to ExThr fibrin. EnThr fibrin matrices exhibited less thrombogenicity in vitro than ExThr, and retained high cytocompatibility. Thus, the proposed approach has several advantages over the traditional method, namely the fabrication of a completely autologous coating material that has better mechanical properties, higher resistance to proteolysis and lower thrombogenicity.
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Rehman S, Song J, Faisal M, Alatar AA, Akhter F, Ahmad S, Hu B. The Neoepitopes on Methylglyoxal- (MG-) Glycated Fibrinogen Generate Autoimmune Response: Its Role in Diabetes, Atherosclerosis, and Diabetic Atherosclerosis Subjects. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6621568. [PMID: 34970417 PMCID: PMC8714332 DOI: 10.1155/2021/6621568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES In diabetes mellitus, hyperglycemia-mediated nonenzymatic glycosylation of fibrinogen protein plays a crucial role in the pathogenesis of micro- and macrovascular complications especially atherosclerosis via the generation of advanced glycation end products (AGEs). Methylglyoxal (MG) induces glycation of fibrinogen, resulting in structural alterations that lead to autoimmune response via the generation of neoepitopes on protein molecules. The present study was designed to probe the prevalence of autoantibodies against MG-glycated fibrinogen (MG-Fib) in type 2 diabetes mellitus (T2DM), atherosclerosis (ATH), and diabetic atherosclerosis (T2DM-ATH) patients. Design and Methods. The binding affinity of autoantibodies in patients' sera (T2DM, n = 100; ATH, n = 100; and T2DM-ATH, n = 100) and isolated immunoglobulin G (IgG) against native fibrinogen (N-Fib) and MG-Fib to healthy subjects (HS, n = 50) was accessed by direct binding ELISA. The results of direct binding were further validated by competitive/inhibition ELISA. Moreover, AGE detection, ketoamines, protein carbonyls, hydroxymethylfurfural (HMF), thiobarbituric acid reactive substances (TBARS), and carboxymethyllysine (CML) concentrations in patients' sera were also determined. Furthermore, free lysine and free arginine residues were also estimated. RESULTS The high binding affinity was observed in 54% of T2DM, 33% of ATH, and 65% of T2DM-ATH patients' samples with respect to healthy subjects against MG-Fib antigen in comparison to N-Fib (p < 0.05 to p < 0.0001). HS sera showed nonsignificant binding (p > 0.05) with N-Fib and MG-Fib. Other biochemical parameters were also found to be significant (p < 0.05) in the patient groups with respect to the HS group. CONCLUSIONS These findings in the future might pave a way to authenticate fibrinogen as a biomarker for the early detection of diabetes-associated micro- and macrovascular complications.
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Affiliation(s)
- Shahnawaz Rehman
- Department of Biochemistry, Sir Syed Faculty of Science, Mohammad Ali Jauhar University, Rampur, U.P., India
| | - Jiantao Song
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Mohammad Faisal
- Department of Botany & Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Abdulrahman A. Alatar
- Department of Botany & Microbiology, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Firoz Akhter
- Department of Biomedical Engineering, Stony Brook University, New York, USA
| | - Saheem Ahmad
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, University of Hail, 2440, Saudi Arabia
| | - Bo Hu
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
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Joundi RA, Menon BK. Thrombus Composition, Imaging, and Outcome Prediction in Acute Ischemic Stroke. Neurology 2021; 97:S68-S78. [PMID: 34785606 DOI: 10.1212/wnl.0000000000012796] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES New imaging techniques have advanced our ability to capture thrombus characteristics and burden in real time. An improved understanding of recanalization rates with thrombolysis and endovascular thrombectomy based on thrombus characteristics has spurred interest in new therapies for acute stroke. METHODS AND RESULTS This article reviews the biochemical, structural, and imaging characteristics of intracranial thrombi in acute ischemic stroke; the relationship between thrombus composition and response to lytic and endovascular therapies; and current and future directions for improving outcomes in patients with acute stroke based on thrombus characteristics. DISCUSSION Thrombus composition, size, location, and timing from stroke onset correlate with imaging findings in acute ischemic stroke and are associated with clinical outcome. Further research across multiple domains could assist in better applying our knowledge of thrombi to patient selection and individualization of acute therapies.
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Affiliation(s)
- Raed A Joundi
- From the Department of Neurosciences and Community Health Sciences, Calgary Stroke Program (R.J.), and Department of Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute (B.K.M.), Cumming School of Medicine, University of Calgary, Canada
| | - Bijoy K Menon
- From the Department of Neurosciences and Community Health Sciences, Calgary Stroke Program (R.J.), and Department of Neurosciences, Radiology, and Community Health Sciences, Hotchkiss Brain Institute (B.K.M.), Cumming School of Medicine, University of Calgary, Canada.
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14
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Brinjikji W, Madalina Mereuta O, Dai D, Kallmes DF, Savastano L, Liu Y, Nimjee SM, Nogueira RG, Abbasi M, Kadirvel R. Mechanisms of fibrinolysis resistance and potential targets for thrombolysis in acute ischaemic stroke: lessons from retrieved stroke emboli. Stroke Vasc Neurol 2021; 6:658-667. [PMID: 34312319 PMCID: PMC8717785 DOI: 10.1136/svn-2021-001032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022] Open
Abstract
There has been growing interest and insight into the histological composition of retrieved stroke emboli. One of the main focuses of the stroke clot analysis literature has been the implications of clot composition on mechanical thrombectomy procedures. However, the holy grail of clot analysis may not be in the field of clot–device interaction, but rather, in understanding mechanisms of fibrinolysis resistance. The mechanisms underlying the low response to fibrinolytic therapy, even with the newer, more powerful agents, remain poorly understood. While factors such as embolus size, location and collateral status influence alteplase delivery and recanalisation rates; compositional analyses focused on histological and ultrastructural characteristics offer unique insights into mechanisms of alteplase resistance. In this review, we strive to provide comprehensive review of current knowledge on clot composition and ultrastructural analyses that help explain resistance to fibrinolysis.
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Affiliation(s)
- Waleed Brinjikji
- Radiology, Mayo Clinic, Rochester, Minnesota, USA .,Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Daying Dai
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Yang Liu
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahid M Nimjee
- Neurosurgery, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Raul G Nogueira
- Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mehdi Abbasi
- Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Schneck E, Muelich M, Markmann M, Edinger F, Cooper N, Moeller A, Bein G, Hecker A, Koch C, Sander M, Wolff M. Combined Administration of Fibrinogen and Factor XIII Concentrate Does Not Improve Dilutional Coagulopathy Superiorly Than Sole Fibrinogen Therapy: Results of an In-Vitro Thrombelastographic Study. J Clin Med 2021; 10:jcm10102068. [PMID: 34065924 PMCID: PMC8150940 DOI: 10.3390/jcm10102068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/04/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
The early administration of fibrinogen has gained wide acceptance for the treatment of major hemorrhage, whereas the substitution of coagulation factor XIII (FXIII) is only supported by a low level of evidence. This study aimed to answer the question of whether a combined therapy of fibrinogen/FXIII substitution performs superiorly to sole fibrinogen administration in the treatment of dilutional coagulopathy. An in-vitro model of massive transfusion was used to compare the effect of combined fibrinogen/FXIII administration to that of sole fibrinogen therapy for the treatment of dilutional coagulopathy. For this purpose, the blood of red blood cell concentrates, fresh frozen plasma, and platelet concentrates were reconstituted in a ratio of 4:4:1, and then diluted with gelatin by 20% and 40%, respectively. Clot formation and stability were analyzed by thrombelastography. Both sole fibrinogen therapy (equivalent to 50 mg/kg) and the combined administration of fibrinogen (equivalent to 50 mg/kg) and FXIII (equivalent to 75 International Units (IU)/kg) increased fibrinogen-dependent mean clot firmness independently of the degree of dilution (20% dilution: 7 (6.3–7.8) mm; 20% dilution fibrinogen: 13.5 (13–17.3) mm; 20% dilution fibrinogen/FXIII: 16.5 (15.3–18.8) mm; 40% dilution: 3 (2–3.8) mm; 40% dilution fibrinogen: 8 (7–11.3) mm; 40% dilution fibrinogen/FXIII: 10 (8.3–11.8) mm; all p < 0.01). However, no differences were identified between the two treatment arms. Compared to fibrinogen therapy, no beneficial effect of the combined administration of fibrinogen and FXIII for the treatment of dilutional coagulopathy was detected in this in-vitro massive transfusion model. The result was independent of the degree of dilution.
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Affiliation(s)
- Emmanuel Schneck
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany; (M.M.); (M.M.); (F.E.); (C.K.); (M.S.); (M.W.)
- Correspondence: ; Tel.: +49-641-985-44401
| | - Marcus Muelich
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany; (M.M.); (M.M.); (F.E.); (C.K.); (M.S.); (M.W.)
| | - Melanie Markmann
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany; (M.M.); (M.M.); (F.E.); (C.K.); (M.S.); (M.W.)
| | - Fabian Edinger
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany; (M.M.); (M.M.); (F.E.); (C.K.); (M.S.); (M.W.)
| | - Nina Cooper
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, 35392 Giessen, Germany; (N.C.); (A.M.); (G.B.)
| | - Annette Moeller
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, 35392 Giessen, Germany; (N.C.); (A.M.); (G.B.)
| | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, 35392 Giessen, Germany; (N.C.); (A.M.); (G.B.)
| | - Andreas Hecker
- Department of General & Thoracic Surgery, University Hospital of Giessen, 35392 Giessen, Germany;
| | - Christian Koch
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany; (M.M.); (M.M.); (F.E.); (C.K.); (M.S.); (M.W.)
| | - Michael Sander
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany; (M.M.); (M.M.); (F.E.); (C.K.); (M.S.); (M.W.)
| | - Matthias Wolff
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, 35392 Giessen, Germany; (M.M.); (M.M.); (F.E.); (C.K.); (M.S.); (M.W.)
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Mohammed BAB. Alpha 2-antiplasmin deficiency in a Sudanese child: a case report. J Med Case Rep 2021; 15:238. [PMID: 33957960 PMCID: PMC8103643 DOI: 10.1186/s13256-021-02813-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background The plasma serine protease inhibitor alpha 2-antiplasmin (α2-AP, otherwise known as α2-plasmin inhibitor) is a rapid-acting plasmin inhibitor recently found in human plasma, which seems to have a significant role in the regulation of in vivo fibrinolysis. Congenital deficiency of α2-AP is extremely uncommon. Case presentation We report here a case of absolute deficiency of α2-AP in an 11-year-old Sudanese boy, who had a lifelong intermittent hemorrhagic tendency (gum bleeding, epistaxis, and exaggerated bleeding after trauma). Coagulation tests including prothrombin time, partial thromboplastin time, thrombin time, bleeding time, platelet count, clot retraction test, antithrombin, and factor VIII levels were within normal limits. Hepatic function tests and complete blood count were also normal. The main interesting finding in this patient was that the whole blood clot lysis was extremely fast, completed within 5–8 hours. The second abnormal finding is that the euglobulin clot lysis time was short. Nevertheless, the concentration of α2-AP in the patient's plasma was 0.2 IU/ml (reference range is 0.80–1.20 IU/ml). The addition of pooled plasma (with normal α2-AP) to the patient's whole blood corrected the accelerated fibrinolysis. Conclusion The study showed that α2-AP deficiency resulted in uninhibited fibrinolysis that caused the hemorrhagic tendency in this patient. Thus, this report demonstrates the significant role of α2-AP in coagulation.
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17
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Bronić A, Ferenčak G, Bernat R, Leniček-Krleža J, Dumić J, Dabelić S. Association of fibrinogen and plasmin inhibitor, but not coagulation factor XIII gene polymorphisms with coronary artery disease. J Med Biochem 2021; 40:138-149. [PMID: 33776563 PMCID: PMC7982289 DOI: 10.5937/jomb0-26839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/26/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In the final phase of clot formation, fibrinogen constitutes frame, whereas factor XIII (FXIII) active form is responsible for the covalent cross-linking of fibrin fibres and plasmin inhibitor (PI), thus contributing to clot stability. It could be expected that any change of coagulation factors' structure affects the clot formation and modulates the atherothrombotic risk. The aim was to determine the frequency of four single nucleotide polymorphisms: (i) A > G in codon 312 of the fibrinogen α-chain gene (rs6050, Thr312AlaFGA), (ii) C > T at position 10034 of the 3 - untranslated region in the fibrinogen γ-chain gene (rs2066865, 10034C > T FGG), (iii) C > T in codon 564 of the FXIII-A subunit gene (rs5982, Pro564LeuFXIII-A), and (iv) C > T in codon 6 of the plasmin inhibitor gene (rs2070863, Arg6TrpPI) in Croatian patients and their association with coronary artery disease (CAD). METHODS We performed the unrelated case-control association study on the consecutive sample of patients 18 years old, who had undergone coronary angiography for investigation of chest pain and suspected CAD. The cases were patients with confirmed CAD (N=201), and the controls were the subjects with no CAD (N=119). Samples were genotyped using PCR-RFLP analysis. RESULTS Observed frequencies of the rare alleles of Thr312Ala FGA, 10034C > T FGG, Leu564Pro FXIII-A and Arg6Trp PI polymorphisms were 21%, 17%, 14%, 20%, respectively. Patients with 10034C > T FGG CC genotype had 3.5 times (95% CI 1.02-12.03) higher adjusted odds for CAD than patients with 10034C > T FGG TT genotype. Patients with Arg6Trp PI CC genotype had 3.86 times (95% CI 1.23-12.12) higher odds for CAD than patients with Arg6Trp PI TT genotype. It seems that those genotype-related higher odds are also male-gender related. No difference was observed regarding any other investigated polymorphism. CONCLUSIONS Our finding suggests that 10034C > T FGG and Arg6Trp PI are associated with CAD.
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Affiliation(s)
- Ana Bronić
- Sestre Milosrdnice University Hospital Centre, Clinical Institute of Chemistry, Department for Laboratory Diagnostics in Traumatology and Orthopaedics, Zagreb, Croatia
| | - Goran Ferenčak
- Medicol Outpatients Clinic, Department of Laboratory Diagnostics, Zagreb, Croatia
| | - Robert Bernat
- Westpfalz-Klinikum GmbH, Department of Internal Medicine 2, Kaiserslautern, Germany
| | - Jasna Leniček-Krleža
- Children's Hospital Zagreb, Department of Laboratory Diagnostics, Zagreb, Croatia
| | - Jerka Dumić
- University of Zagreb, Faculty of Pharmacy and Biochemistry, Department of Biochemistry and Molecular Biology, Zagreb, Croatia
| | - Sanja Dabelić
- University of Zagreb, Faculty of Pharmacy and Biochemistry, Department of Biochemistry and Molecular Biology, Zagreb, Croatia
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18
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Bikov A, Meszaros M, Schwarz EI. Coagulation and Fibrinolysis in Obstructive Sleep Apnoea. Int J Mol Sci 2021; 22:ijms22062834. [PMID: 33799528 PMCID: PMC8000922 DOI: 10.3390/ijms22062834] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 12/29/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is a common disease which is characterised by repetitive collapse of the upper airways during sleep resulting in chronic intermittent hypoxaemia and frequent microarousals, consequently leading to sympathetic overflow, enhanced oxidative stress, systemic inflammation, and metabolic disturbances. OSA is associated with increased risk for cardiovascular morbidity and mortality, and accelerated coagulation, platelet activation, and impaired fibrinolysis serve the link between OSA and cardiovascular disease. In this article we briefly describe physiological coagulation and fibrinolysis focusing on processes which could be altered in OSA. Then, we discuss how OSA-associated disturbances, such as hypoxaemia, sympathetic system activation, and systemic inflammation, affect these processes. Finally, we critically review the literature on OSA-related changes in markers of coagulation and fibrinolysis, discuss potential reasons for discrepancies, and comment on the clinical implications and future research needs.
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Affiliation(s)
- Andras Bikov
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M13 9MT, UK
- Correspondence: ; Tel.: +44-161-291-2493; Fax: +44-161-291-5730
| | - Martina Meszaros
- Department of Pulmonology, Semmelweis University, 1083 Budapest, Hungary;
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, 8006 Zurich, Switzerland;
| | - Esther Irene Schwarz
- Department of Pulmonology and Sleep Disorders Centre, University Hospital Zurich, 8006 Zurich, Switzerland;
- Centre of Competence Sleep & Health Zurich, University of Zurich, 8091 Zurich, Switzerland
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19
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Memtsas VP, Arachchillage DRJ, Gorog DA. Role, Laboratory Assessment and Clinical Relevance of Fibrin, Factor XIII and Endogenous Fibrinolysis in Arterial and Venous Thrombosis. Int J Mol Sci 2021; 22:ijms22031472. [PMID: 33540604 PMCID: PMC7867291 DOI: 10.3390/ijms22031472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Diseases such as myocardial infarction, ischaemic stroke, peripheral vascular disease and venous thromboembolism are major contributors to morbidity and mortality. Procoagulant, anticoagulant and fibrinolytic pathways are finely regulated in healthy individuals and dysregulated procoagulant, anticoagulant and fibrinolytic pathways lead to arterial and venous thrombosis. In this review article, we discuss the (patho)physiological role and laboratory assessment of fibrin, factor XIII and endogenous fibrinolysis, which are key players in the terminal phase of the coagulation cascade and fibrinolysis. Finally, we present the most up-to-date evidence for their involvement in various disease states and assessment of cardiovascular risk.
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Affiliation(s)
- Vassilios P. Memtsas
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire SG1 4AB, UK;
| | - Deepa R. J. Arachchillage
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London SW7 2AZ, UK;
- Department of Haematology, Imperial College Healthcare NHS Trust, London W2 1NY, UK
- Department of Haematology, Royal Brompton Hospital, London SW3 6NP, UK
| | - Diana A. Gorog
- Cardiology Department, East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire SG1 4AB, UK;
- School of Life and Medical Sciences, Postgraduate Medical School, University of Hertfordshire, Hertfordshire AL10 9AB, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London SW3 6LY, UK
- Correspondence: ; Tel.: +44-207-0348841
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20
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Vasilyeva AD, Yurina LV, Bugrova AE, Indeykina MI, Kononikhin AS, Schegolikhin AN, Ivanov VS, Nikolaev EN, Rosenfeld MA. The Nature of Resistance of the Coagulation Factor XIII Structure to Hypochlorite-Induced Oxidation. DOKL BIOCHEM BIOPHYS 2020; 495:276-281. [PMID: 33368034 DOI: 10.1134/s1607672920050117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/22/2022]
Abstract
The damage to blood coagulation factor XIII (FXIII) at different stages of its enzymatic activation under the action of various physiological amounts of hypochlorite ion was studied. The results obtained by HPLC-MS/MS, SDS-PAGE, and colorimetry showed that, during the conversion of FXIII to FXIIIa, the vulnerability of FXIII to hypochlorite-induced oxidation increased. FXIII oxidized with 150 μM hypochlorite completely retained its enzymatic activity inherent to the intact protein, whereas FXIIIa treated with 50 μM hypochlorite showed sharply reduced enzymatic activity. It was shown that a number of methionine and cysteine residues on the catalytic subunit can perform antioxidant function; additionally, the regulatory subunits of FXIII-B contribute to the antioxidant protection of the catalytic center of the FXIII-A subunit, which, together with the tight packing of the tetrameric structure of the FXIII proenzyme, are the three factors that provide high protein resistance to the oxidizing agent.
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Affiliation(s)
- A D Vasilyeva
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russia.
| | - L V Yurina
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - A E Bugrova
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - M I Indeykina
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russia.,Moscow Institute of Physics and Technology, Dolgoprudny, Moscow, Russia
| | - A S Kononikhin
- Talrose Institute for Energy Problems of Chemical Physics, Semenov Federal Center of Chemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - A N Schegolikhin
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - V S Ivanov
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
| | - E N Nikolaev
- Skolkovo Institute of Science and Technology, Skolkovo, Moscow oblast, Russia
| | - M A Rosenfeld
- Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, Moscow, Russia
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21
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Singh S, Saleem S, Reed GL. Alpha2-Antiplasmin: The Devil You Don't Know in Cerebrovascular and Cardiovascular Disease. Front Cardiovasc Med 2020; 7:608899. [PMID: 33426005 PMCID: PMC7785519 DOI: 10.3389/fcvm.2020.608899] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/02/2020] [Indexed: 01/23/2023] Open
Abstract
Alpha2-antiplasmin (α2AP), the fast-reacting, serine protease inhibitor (serpin) of plasmin, was originally thought to play a key role in protection against uncontrolled, plasmin-mediated proteolysis of coagulation factors and other molecules. However, studies of humans and mice with genetic deficiency of α2AP have expanded our understanding of this serpin, particularly in disease states. Epidemiology studies have shown an association between high α2AP levels and increased risk or poor outcome in cardiovascular diseases. Mechanistic studies in disease models indicate that α2AP stops the body's own fibrinolytic system from dissolving pathologic thrombi that cause venous thrombosis, pulmonary embolism, arterial thrombosis, and ischemic stroke. In addition, α2AP fosters the development of microvascular thrombosis and enhances matrix metalloproteinase-9 expression. Through these mechanisms and others, α2AP contributes to brain injury, hemorrhage and swelling in experimental ischemic stroke. Recent studies also show that α2AP is required for the development of stasis thrombosis by inhibiting the early activation of effective fibrinolysis. In this review, we will discuss the key role played by α2AP in controlling thrombosis and fibrinolysis and, we will consider its potential value as a therapeutic target in cardiovascular diseases and ischemic stroke.
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Affiliation(s)
- Satish Singh
- Department of Medicine, University of Arizona-College of Medicine, Phoenix, AZ, United States
| | - Sofiyan Saleem
- Department of Medicine, University of Arizona-College of Medicine, Phoenix, AZ, United States
| | - Guy L Reed
- Department of Medicine, University of Arizona-College of Medicine, Phoenix, AZ, United States
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22
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Sidelmann JJ, Gram JB, Rasmussen JJ, Kistorp C. Anabolic-Androgenic Steroid Abuse Impairs Fibrin Clot Lysis. Semin Thromb Hemost 2020; 47:11-17. [PMID: 33017849 DOI: 10.1055/s-0040-1714398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abuse of anabolic-androgenic steroids (AASs) is suspected to increase the risk of cardiovascular disease (CVD) and cardiovascular mortality in otherwise healthy individuals. AAS abuse may increase the incidence of CVD by altering the hemostatic balance toward a procoagulant state. Studies on the effect of AAS abuse on the fibrinolytic system, however, have either demonstrated a profibrinolytic effect or no effect of AAS abuse, but the overall effect of AAS on fibrinolysis has not been addressed so far. This cross-sectional study investigated the effect of AAS on fibrin clot lysis, fibrin structure, and the hemostatic proteins, potentially affecting these measures in current and former AAS abusers and healthy age-matched controls. The study population consisted of 37 current and 33 former AAS abusers, along with 30 healthy age-matched controls. Fibrin clot lysis, fibrin structure properties, fibrinogen, coagulation factor XIII (FXIII) plasminogen, plasmin inhibitor, plasminogen activator inhibitor-1 (PAI-1), and thrombin activatable fibrinolysis inhibitor (TAFI) were determined. Fibrin clot lysis was significantly reduced in participants abusing AAS compared with former abusers and controls (p < 0.001). Plasma fibrinogen, plasminogen, and plasmin inhibitor were significantly increased in current abusers (p < 0.05). No significant differences were observed with respect to measures of fibrin structure properties, PAI-1, and TAFI (p > 0.05). In conclusion, AAS abuse depresses fibrin clot lysis. This effect is not associated with alterations in fibrin structure but is rather caused by increased plasma concentrations of fibrinogen, FXIII, and plasmin inhibitor. These findings suggest that AAS abuse may be associated with increased thrombotic disease.
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Affiliation(s)
- Johannes Jakobsen Sidelmann
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.,Unit for Thrombosis Research, Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jørgen Brodersen Gram
- Unit for Thrombosis Research, Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.,Unit for Thrombosis Research, Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jon J Rasmussen
- Department of Endocrinology and Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Internal Medicine, Holbæk Hospital, Region Zealand, Denmark
| | - Caroline Kistorp
- Department of Endocrinology and Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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23
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Urano T, Suzuki Y, Iwaki T, Sano H, Honkura N, Castellino FJ. Recognition of Plasminogen Activator Inhibitor Type 1 as the Primary Regulator of Fibrinolysis. Curr Drug Targets 2020; 20:1695-1701. [PMID: 31309890 DOI: 10.2174/1389450120666190715102510] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/17/2019] [Accepted: 06/24/2019] [Indexed: 01/12/2023]
Abstract
The fibrinolytic system consists of a balance between rates of plasminogen activation and fibrin degradation, both of which are finely regulated by spatio-temporal mechanisms. Three distinct inhibitors of the fibrinolytic system that differently regulate these two steps are plasminogen activator inhibitor type-1 (PAI-1), α2-antiplasmin, and thrombin activatable fibrinolysis inhibitor (TAFI). In this review, we focus on the mechanisms by which PAI-1 governs total fibrinolytic activity to provide its essential role in many hemostatic disorders, including fibrinolytic shutdown after trauma. PAI-1 is a member of the serine protease inhibitor (SERPIN) superfamily and inhibits the protease activities of plasminogen activators (PAs) by forming complexes with PAs, thereby regulating fibrinolysis. The major PA in the vasculature is tissue-type PA (tPA) which is secreted from vascular endothelial cells (VECs) as an active enzyme and is retained on the surface of VECs. PAI-1, existing in molar excess to tPA in plasma, regulates the amount of free active tPA in plasma and on the surface of VECs by forming a tPA-PAI-1 complex. Thus, high plasma levels of PAI-1 are directly related to attenuated fibrinolysis and increased risk for thrombosis. Since plasma PAI-1 levels are highly elevated under a variety of pathological conditions, including infection and inflammation, the fibrinolytic potential in plasma and on VECs is readily suppressed to induce fibrinolytic shutdown. A congenital deficiency of PAI-1 in humans, in turn, leads to life-threatening bleeding. These considerations support the contention that PAI-1 is the primary regulator of the initial step of fibrinolysis and governs total fibrinolytic activity.
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Affiliation(s)
- Tetsumei Urano
- Department of Medical Physiology, Hamamatsu University School of Medicine, 1-20-1, Handa-yama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Yuko Suzuki
- Department of Medical Physiology, Hamamatsu University School of Medicine, 1-20-1, Handa-yama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Takayuki Iwaki
- Department of Pharmacology, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Hideto Sano
- Department of Medical Physiology, Hamamatsu University School of Medicine, 1-20-1, Handa-yama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Naoki Honkura
- Department of Medical Physiology, Hamamatsu University School of Medicine, 1-20-1, Handa-yama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Francis J Castellino
- W.M. Keck Center for Transgene Research, Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, Indiana, USA
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24
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Vasilyeva A, Yurina L, Shchegolikhin A, Indeykina M, Bugrova A, Kononikhin A, Nikolaev E, Rosenfeld M. The Structure of Blood Coagulation Factor XIII Is Adapted to Oxidation. Biomolecules 2020; 10:E914. [PMID: 32560304 PMCID: PMC7355775 DOI: 10.3390/biom10060914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022] Open
Abstract
The blood coagulation factor XIII (FXIII) plays a critical role in supporting coagulation and fibrinolysis due to both the covalent crosslinking of fibrin polymers, rendering them resistant to plasmin lysis, and the crosslinking of fibrin to proteins of the fibrinolytic system. The hypochlorite-mediated oxidation of the blood coagulation factor XIII (FXIII) at the different stages of its enzymatic activation is studied for the first time in this paper. The consolidated results obtained with the aid of MS/MS, electrophoresis, and colorimetry demonstrate that in the process of FXIII's conversion into FXIIIa, the vulnerability of FXIII to hypochlorite-induced oxidation increased as follows: native FXIII < FXIII + Ca2+ << FXIII + Ca2+/thrombin. The modification sites were detected among all the structural regions of the catalytic FXIII-A subunit, except for the activation peptide, and embraced several sushi domains of the FXIII-B subunit. Oxidized amino acid residues belonging to FXIII-A are surface-exposed residues and can perform an antioxidant role. The regulatory FXIII-B subunits additionally contribute to the antioxidant defense of the catalytic center of the FXIII-A subunits. Taken together, the present data along with the data from previous studies demonstrate that the FXIII proenzyme structure is adapted to oxidation.
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Affiliation(s)
- Alexandra Vasilyeva
- N. M. Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia; (L.Y.); (A.S.); (M.I.); (A.B.); (M.R.)
| | - Lyubov Yurina
- N. M. Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia; (L.Y.); (A.S.); (M.I.); (A.B.); (M.R.)
| | - Alexander Shchegolikhin
- N. M. Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia; (L.Y.); (A.S.); (M.I.); (A.B.); (M.R.)
| | - Maria Indeykina
- N. M. Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia; (L.Y.); (A.S.); (M.I.); (A.B.); (M.R.)
- V.L. Talrose Institute for Energy Problems of Chemical Physics, N.N. Semenov Federal Center of Chemical Physics, Russian Academy of Sciences, Chernogolovka, 142432 Moscow, Russia
| | - Anna Bugrova
- N. M. Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia; (L.Y.); (A.S.); (M.I.); (A.B.); (M.R.)
| | - Alexey Kononikhin
- Moscow Institute of Physics and Technology (State University), Dolgoprudny, 141701 Moscow, Russia
- Skolkovo Institute of Science and Technology, 121205 Moscow, Russia;
| | - Eugene Nikolaev
- Skolkovo Institute of Science and Technology, 121205 Moscow, Russia;
| | - Mark Rosenfeld
- N. M. Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 119334 Moscow, Russia; (L.Y.); (A.S.); (M.I.); (A.B.); (M.R.)
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25
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Godtfredsen ACM, Sidelmann JJ, Gram JB, Andersen M, Glintborg D. Fibrin lysability is associated with central obesity and inflammation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2020; 99:1078-1084. [PMID: 32048272 DOI: 10.1111/aogs.13825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/03/2020] [Accepted: 02/07/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is characterized by increased central fat mass (CFM), hyper-inflammation, and hemostatic alterations; the risk of cardiovascular disease may also be increased. Reduced fibrin lysability is a risk factor for cardiovascular disease. The present study assessed fibrin lysability in women with PCOS and controls of similar age and body mass index. MATERIAL AND METHODS Ninety women with PCOS and 35 controls of comparable age and body mass index were included. Hemostatic markers (fibrin lysability, fibrinogen, coagulation factor XIII, plasminogen, plasminogen activator inhibitor 1 [PAI-1], plasmin inhibitor, thrombin activatable fibrinolysis inhibitor (TAFI), D-dimer), C-reactive protein (CRP), body mass index, waist-to-hip ratio, CFM determined by Dual-energy X-ray absorptiometry scan, and sex hormones (testosterone estradiol, and sex hormone binding globulin) were determined. RESULTS TAFI and CRP were higher in women with PCOS, than controls. In women with PCOS, fibrin lysability correlated with CFM, waist-to-hip ratio, CRP, fibrinogen, and all hemostatic variables (P ≤ .004) except TAFI and D-dimer. CFM correlated with fibrinogen, CRP, coagulation factor XIII, waist-to-hip ratio, plasminogen, PAI-1, plasmin inhibitor, and TAFI (P < .02). In controls, fibrin lysability correlated with CFM, fibrinogen, coagulation factor XIII, and plasmin inhibitor (P ≤ .02). CFM correlated with PAI-1, plasmin inhibitor, coagulation factor XIII, fibrinogen, and CRP (P ≤ .05). Stepwise regression analysis revealed that fibrin lysability was associated with CFM, fibrinogen and CRP in women with PCOS (r2 = .46, P ≤ .001), but only with CFM in controls (r2 = .28, P < .001). CONCLUSIONS Fibrin lysability was comparable in women with PCOS and controls. Fibrin lysability was associated with CFM and hyper-inflammation in women with PCOS, but only with CFM in controls. These findings suggest that obese women with PCOS and augmented inflammation could have an increased risk of cardiovascular disease.
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Affiliation(s)
- Anne C M Godtfredsen
- Unit for Thrombosis Research, Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Esbjerg, Denmark.,Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Obstetrics and Gynecology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Johannes J Sidelmann
- Unit for Thrombosis Research, Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Esbjerg, Denmark.,Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jørgen B Gram
- Unit for Thrombosis Research, Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Esbjerg, Denmark.,Department of Clinical Biochemistry, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Marianne Andersen
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
| | - Dorte Glintborg
- Department of Endocrinology and Metabolism, Odense University Hospital, Odense, Denmark
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26
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Roberts IV, Bukhary D, Valdivieso CYL, Tirelli N. Fibrin Matrices as (Injectable) Biomaterials: Formation, Clinical Use, and Molecular Engineering. Macromol Biosci 2019; 20:e1900283. [PMID: 31769933 DOI: 10.1002/mabi.201900283] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/14/2019] [Indexed: 12/19/2022]
Abstract
This review focuses on fibrin, starting from biological mechanisms (its production from fibrinogen and its enzymatic degradation), through its use as a medical device and as a biomaterial, and finally discussing the techniques used to add biological functions and/or improve its mechanical performance through its molecular engineering. Fibrin is a material of biological (human, and even patient's own) origin, injectable, adhesive, and remodellable by cells; further, it is nature's most common choice for an in situ forming, provisional matrix. Its widespread use in the clinic and in research is therefore completely unsurprising. There are, however, areas where its biomedical performance can be improved, namely achieving a better control over mechanical properties (and possibly higher modulus), slowing down degradation or incorporating cell-instructive functions (e.g., controlled delivery of growth factors). The authors here specifically review the efforts made in the last 20 years to achieve these aims via biomimetic reactions or self-assembly, as much via formation of hybrid materials.
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Affiliation(s)
- Iwan Vaughan Roberts
- Division of Pharmacy and Optometry, School of Health Science, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Deena Bukhary
- Division of Pharmacy and Optometry, School of Health Science, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.,Department of Pharmaceutical Science, Faculty of Pharmacy, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | | | - Nicola Tirelli
- Division of Pharmacy and Optometry, School of Health Science, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.,Laboratory of Polymers and Biomaterials, Fondazione Istituto Italiano di Tecnologia, via Morego 30, 16163, Genova, Italy
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27
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Di Meglio L, Desilles JP, Ollivier V, Nomenjanahary MS, Di Meglio S, Deschildre C, Loyau S, Olivot JM, Blanc R, Piotin M, Bouton MC, Michel JB, Jandrot-Perrus M, Ho-Tin-Noé B, Mazighi M. Acute ischemic stroke thrombi have an outer shell that impairs fibrinolysis. Neurology 2019; 93:e1686-e1698. [PMID: 31541014 DOI: 10.1212/wnl.0000000000008395] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/29/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Thrombi responsible for large vessel occlusion (LVO) in the setting of acute ischemic stroke (AIS) are characterized by a low recanalization rate after IV thrombolysis. To test whether AIS thrombi have inherent common features that limit their susceptibility to thrombolysis, we analyzed the composition and ultrastructural organization of AIS thrombi causing LVO. METHODS A total of 199 endovascular thrombectomy-retrieved thrombi were analyzed by immunohistology and scanning electron microscopy (SEM) and subjected to ex vivo thrombolysis assay. The relationship between thrombus organization and thrombolysis resistance was further investigated in vitro using thrombus produced by recalcification of citrated whole blood. RESULTS SEM and immunohistology analyses revealed that, although AIS thrombus composition and organization was highly heterogeneous, AIS thrombi shared a common remarkable structural feature in the form of an outer shell made of densely compacted thrombus components including fibrin, von Willebrand factor, and aggregated platelets. In vitro thrombosis experiments using human blood indicated that platelets were essential to the formation of the thrombus outer shell. Finally, in both AIS and in vitro thrombi, the thrombus outer shell showed a decreased susceptibility to tissue plasminogen activator-mediated thrombolysis as compared to the thrombus inner core. INTERPRETATION Irrespective of their etiology and despite their heterogeneity, intracranial thrombi causing LVO have a core shell structure that influences their susceptibility to thrombolysis.
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Affiliation(s)
- Lucas Di Meglio
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Jean-Philippe Desilles
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Véronique Ollivier
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Mialitiana Solo Nomenjanahary
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Sara Di Meglio
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Catherine Deschildre
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Stéphane Loyau
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Jean-Marc Olivot
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Raphaël Blanc
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Michel Piotin
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Marie-Christine Bouton
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Jean-Baptiste Michel
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Martine Jandrot-Perrus
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
| | - Benoît Ho-Tin-Noé
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France.
| | - Mikael Mazighi
- From U1148 Institut National de la Santé et de la Recherche Médicale (INSERM) (L.D.M., J.-P.D., V.O., M.S.N., S.D.M., C.D., S.L., M.-C.B., J.-B.M., M.J.-P., B.H.-T.-N., M.M.), Laboratory of Vascular Translational Science, Sorbonne Paris Cité, Université Paris Diderot; Department of Interventional Neuroradiology (J.-P.D., R.B., M.P., M.M.), Rothschild Foundation Hospital, Paris; and Toulouse University Medical Center (J.-M.O.), France
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28
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Misztal T, Golaszewska A, Tomasiak-Lozowska MM, Iwanicka M, Marcinczyk N, Leszczynska A, Chabielska E, Rusak T. The myeloperoxidase product, hypochlorous acid, reduces thrombus formation under flow and attenuates clot retraction and fibrinolysis in human blood. Free Radic Biol Med 2019; 141:426-437. [PMID: 31279970 DOI: 10.1016/j.freeradbiomed.2019.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/24/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
Hypochlorite (HOCl), a strong oxidant and antimicrobial agent, has been proposed to be associated with hemostatic abnormalities during inflammatory response. However, its complex impact on hemostasis is not completely understood. In this report we studied the effect of clinically relevant (micromolar) HOCl concentrations on thrombus formation under flow, kinetics of platelet-fibrin clot formation, its architecture, retraction, and lysis. We found that HOCl (up to 500 µM) did not affect kinetics of coagulation measured in whole blood. HOCl (500-1000 µM) markedly diminished thrombus formation under flow. Clot retraction rate was reduced by HOCl dose-dependently (50-500 µM). HOCl (125-500 µM) inhibited fibrinolysis in whole blood and in platelet-depleted plasma, dose-dependently. Activity of plasmin was reduced by HOCl at concentrations started from 500 µM. HOCl (up to 500 µM) did not reduce plasminogen binding to fibrin under flow. HOCl (125-500 µM) modulated architecture of fibrin- and platelet-fibrin clots towards structures made of thin and densely packed fibers. Exposure of pure fibrinogen to HOCl (10-1000 µM) resulted in formation of dityrosine and was associated with altered fibrin structure derived from such modified fibrinogen. HOCl-altered fibrin net structure was not related with modulation of platelet procoagulant response, thrombin generation, and factor XIII activity. We conclude that, in human blood, clinically relevant HOCl concentrations may inhibit thrombus formation under flow, clot retraction and fibrinolysis. Fibrinolysis and clot retraction seem to be the most sensitive to HOCl-evoked inhibition. HOCl-modified fibrinogen and altered clot structure associated with it are likely to be primary sources of attenuated fibrinolysis.
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Affiliation(s)
- Tomasz Misztal
- Department of Physical Chemistry, Medical University of Bialystok, Kilinskiego 1, 15-089, Bialystok, Poland.
| | - Agata Golaszewska
- Department of Physical Chemistry, Medical University of Bialystok, Kilinskiego 1, 15-089, Bialystok, Poland.
| | | | - Marta Iwanicka
- Department of Physical Chemistry, Medical University of Bialystok, Kilinskiego 1, 15-089, Bialystok, Poland.
| | - Natalia Marcinczyk
- Department of Biopharmacy, Medical University of Bialystok, Kilinskiego 1, 15-089, Bialystok, Poland.
| | - Agnieszka Leszczynska
- Department of Biopharmacy, Medical University of Bialystok, Kilinskiego 1, 15-089, Bialystok, Poland.
| | - Ewa Chabielska
- Department of Biopharmacy, Medical University of Bialystok, Kilinskiego 1, 15-089, Bialystok, Poland.
| | - Tomasz Rusak
- Department of Physical Chemistry, Medical University of Bialystok, Kilinskiego 1, 15-089, Bialystok, Poland.
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29
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Feller T, Hársfalvi J, Csányi C, Kiss B, Kellermayer M. Plasmin-driven fibrinolysis in a quasi-two-dimensional nanoscale fibrin matrix. J Struct Biol 2018; 203:273-280. [DOI: 10.1016/j.jsb.2018.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 11/28/2022]
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30
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Thromboelastometry Identified Alteration of Clot Stabilization and Factor XIII Supplementation Need in a Patient with Decompensated Liver Disease Undergoing Liver Biopsy. Case Rep Gastrointest Med 2018; 2018:6360543. [PMID: 30228917 PMCID: PMC6136510 DOI: 10.1155/2018/6360543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/05/2018] [Accepted: 07/31/2018] [Indexed: 11/17/2022] Open
Abstract
Liver disease has been considered the prototype of hemorrhagic disease. Disorder in any component of coagulation system can lead to hemorrhage. Deficiency of factor XIII may impair clot strength and clot stabilization and can be accessed by thromboelastometry. We report a case of a patient with a rapid evolution of liver disease who underwent a liver biopsy. Thromboelastometry was performed, evidencing impairment of clot stability. This clotting disorder was corrected with factor XIII concentrate after unsuccessful administration of antifibrinolytic drugs and hepatic biopsy was performed without hemorrhagic complications. Case Presentation. We report the case of a previously healthy 38-year-old man, who presented to our emergency department with clinical signs of rapid progression of acute liver failure. The laboratory tests revealed platelets of 142x103/mm3, plasma fibrinogen concentration of 221 mg/dl, increased international nationalized ratio (INR 1.9), total bilirubin of 3.9mg/dl, direct bilirubin of 2.3mg/dl, ALT 751U/l, and AST 540U/l without acute bleeding. A liver biopsy was indicated. Based on the results of the thromboelastometry, Tranexamic Acid was administered to correct hyperfibrinolysis followed by factor XIII concentrate to correct factor XIII deficiency. Thromboelastometry was normal despite conventional coagulation tests were still altered. So, liver biopsy was performed with no signs of bleeding and without need of further transfusion. Conclusion. Thromboelastometry may be considered a useful, feasible, and safe tool to monitor and manage coagulopathy in patients with liver disease, with the potential advantage of helping avoid unnecessary transfusion in such patients.
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31
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Pryzdial ELG, Lee FMH, Lin BH, Carter RLR, Tegegn TZ, Belletrutti MJ. Blood coagulation dissected. Transfus Apher Sci 2018; 57:449-457. [PMID: 30049564 DOI: 10.1016/j.transci.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hemostasis is the physiological control of bleeding and is initiated by subendothelial exposure. Platelets form the primary vascular seal in three stages (localization, stimulation and aggregation), which are triggered by specific interactions between platelet surface receptors and constituents of the subendothelial matrix. As a secondary hemostatic plug, fibrin clot formation is initiated and feedback-amplified to advance the seal and stabilize platelet aggregates comprising the primary plug. Once blood leakage has been halted, the fibrinolytic pathway is initiated to dissolve the clot and restore normal blood flow. Constitutive and induced anticoagulant and antifibrinolytic pathways create a physiological balance between too much and too little clot production. Hemostatic imbalance is a major burden to global healthcare, resulting in thrombosis or hemorrhage.
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Affiliation(s)
- Edward L G Pryzdial
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada; Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Frank M H Lee
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bryan H Lin
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rolinda L R Carter
- Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tseday Z Tegegn
- Centre for Innovation, Canadian Blood Services, Ottawa, ON, Canada; Centre for Blood Research, University of British Columbia, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mark J Belletrutti
- Pediatric Hematology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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32
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Uitte de Willige S, Malfliet JJ, Abdul S, Leebeek FW, Rijken DC. The level of circulating fibroblast activation protein correlates with incorporation of alpha-2-antiplasmin into the fibrin clot. Thromb Res 2018; 166:19-21. [DOI: 10.1016/j.thromres.2018.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/20/2018] [Accepted: 03/26/2018] [Indexed: 01/20/2023]
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33
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Urano T, Castellino FJ, Suzuki Y. Regulation of plasminogen activation on cell surfaces and fibrin. J Thromb Haemost 2018; 16:S1538-7836(22)02204-8. [PMID: 29779246 PMCID: PMC6099326 DOI: 10.1111/jth.14157] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Indexed: 01/27/2023]
Abstract
The fibrinolytic system dissolves fibrin and maintains vascular patency. Recent advances in imaging analyses allowed visualization of the spatiotemporal regulatory mechanism of fibrinolysis, as well as its regulation by other plasma hemostasis cofactors. Vascular endothelial cells (VECs) retain tissue-type plasminogen activator (tPA) after secretion and maintain high plasminogen (plg) activation potential on their surfaces. As in plasma, the serpin, plasminogen activator inhibitor type 1 (PAI-1), regulates fibrinolytic potential via inhibition of the VEC surface-bound plg activator, tPA. Once fibrin is formed, plg activation by tPA is initiated and effectively amplified on the surface of fibrin, and fibrin is rapidly degraded. The specific binding of plg and tPA to lytic edges of partly degraded fibrin via newly generated C-terminal lysine residues, which amplifies fibrin digestion, is a central aspect of this pathophysiological mechanism. Thrombomodulin (TM) plays a role in the attenuation of plg binding on fibrin and the associated fibrinolysis, which is reversed by a carboxypeptidase B inhibitor. This suggests that the plasma procarboxypeptidase B, thrombin-activatable fibrinolysis inhibitor (TAFI), which is activated by thrombin bound to TM on VECs, is a critical aspect of the regulation of plg activation on VECs and subsequent fibrinolysis. Platelets also contain PAI-1, TAFI, TM, and the fibrin cross-linking enzyme, factor (F) XIIIa, and either secrete or expose these agents upon activation in order to regulate fibrinolysis. In this review, the native machinery of plg activation and fibrinolysis, as well as their spatiotemporal regulatory mechanisms, as revealed by imaging analyses, are discussed.
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Affiliation(s)
- T. Urano
- Department of Medical PhysiologyHamamatsu University School of MedicineHamamatsuJapan
| | - F. J. Castellino
- W.M. Keck Center for Transgene ResearchUniversity of Notre DameUniversity of Notre DameNotre DameINUSA
| | - Y. Suzuki
- Department of Medical PhysiologyHamamatsu University School of MedicineHamamatsuJapan
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Andreotti F, Navarese EP, Crea F. Prolonged endogenous fibrinolysis predicts reduced survival after acute coronary syndromes. Eur Heart J 2018; 39:1086-1088. [DOI: 10.1093/eurheartj/ehy118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Filippo Crea
- Institute of Cardiology, Catholic University Hospital, Rome, Italy
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35
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Xu Z, Zhang Y, Liu W, Liu Y, Su Y, Xing Q, He X, Wei Z, Cao Y, Xiang H. Polymorphisms of F2, PROC, PROZ, and F13A1 Genes are Associated With Recurrent Spontaneous Abortion in Chinese Han Women. Clin Appl Thromb Hemost 2018; 24:894-900. [PMID: 29363996 PMCID: PMC6714729 DOI: 10.1177/1076029617750487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mutations of hemostasis/coagulation-related genes have been speculated to cause recurrent spontaneous abortion (RSA). This study investigated the genetic association between the polymorphisms of factor V (F5), factor II (F2), antithrombin (SERPINC1), protein C (PROC), protein S (PROS1), protein Z (PROZ), factor XIII (F13A1), and carboxypeptidase B2 (CPB2) genes and RSA. The 426 patients with RSA and 444 controls were recruited in this study, and single-nucleotide polymorphisms (SNPs) were analyzed by using SNPscan technology. Genotype and allele frequencies of rs3136520 in F2, rs3024731 in PROZ, and rs1050782 in F13A1 showed statistically significant differences between the 2 groups. TT genotype of rs3136520 (P = .031, odds ratio [OR] = 0.986, 95% confidence interval [CI] = 0.976-0.997) and AA genotype of rs2069906 in PROC (P = .021, OR = 0.114, 95% CI = 0.014-0.902) in their recessive models and AG + GG variants of rs1050782 (P = .007, OR = 0.681, 95% CI = 0.516-0.899) in the dominant model might be associated with the reduced risk of RSA. AT + TT variants of rs3024731 (P = .010, OR = 1.479, 95% CI = 1.098-1.994) may increase disease susceptibility in dominant model. Haplotype analysis of rs3024731 and rs3024735 in PROZ displayed that the AA and TG haplotype were inclined to decrease and increase the risk of RSA, respectively. These results suggested that rs3136520, rs2069906, rs3024731, and rs1050782 may have a significant association with the genetic susceptibility of RSA in Chinese Han women.
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Affiliation(s)
- Zuying Xu
- 1 Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China.,3 Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Ying Zhang
- 1 Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China.,3 Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Wei Liu
- 4 Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yunyun Liu
- 1 Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China.,3 Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Yezhou Su
- 1 Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China.,3 Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Qiong Xing
- 1 Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China.,3 Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Xiaojin He
- 1 Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China.,3 Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Zhaolian Wei
- 1 Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China.,3 Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Yunxia Cao
- 1 Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China.,3 Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Huifen Xiang
- 1 Department of Obstetrics and Gynecology, Reproductive Medicine Center, the First Affiliated Hospital of Anhui Medical University, Hefei, China.,2 Anhui Province Key Laboratory of Reproductive Health and Genetics, Anhui Medical University, Hefei, China.,3 Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
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36
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Factor XIII in plasma, but not in platelets, mediates red blood cell retention in clots and venous thrombus size in mice. Blood Adv 2018; 2:25-35. [PMID: 29344582 DOI: 10.1182/bloodadvances.2017011890] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/29/2017] [Indexed: 01/08/2023] Open
Abstract
The transglutaminase factor XIII (FXIII) stabilizes clots against mechanical and biochemical disruption and is essential for hemostasis. In vitro and in vivo models of venous thrombosis demonstrate that FXIII mediates clot size by promoting red blood cell (RBC) retention. However, the key source of FXIII and whether FXIII activity can be reduced to suppress thrombosis without imposing deleterious hemostatic consequences are 2 critical unresolved questions. FXIII is present in multiple compartments, including plasma (FXIIIplasma) as a heterotetramer of A2 and B2 subunits and platelets (FXIIIplt) as an A2 homodimer. We determined the role of the FXIII compartment and level in clot contraction, composition, and size in vitro and using in vivo models of hemostasis and venous thrombosis. Reducing overall FXIII levels decreased whole blood clot weight but did not alter thrombin generation or contraction of platelet-rich plasma clots. In reconstituted platelet-rich plasma and whole blood clot contraction assays, FXIIIplasma, but not FXIIIplt, produced high-molecular-weight fibrin crosslinks, promoted RBC retention, and increased clot weights. Genetically imposed reduction of FXIII delayed FXIII activation and fibrin crosslinking, suggesting FXIII levels mediate the kinetics of FXIII activation and activity and that the timing of these processes is a critical determinant of RBC retention during clot formation and contraction. A 50% reduction in FXIIIplasma produced significantly smaller venous thrombi but did not increase bleeding in tail transection or saphenous vein puncture models in vivo. Collectively, these findings suggest that partial FXIII reduction may be a therapeutic strategy for reducing venous thrombosis.
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