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Liaptsi E, Merkouris E, Polatidou E, Tsiptsios D, Gkantzios A, Kokkotis C, Petridis F, Christidi F, Karatzetzou S, Karaoglanis C, Tsagkalidi AM, Chouliaras N, Tsamakis K, Protopapa M, Pantazis-Pergaminelis D, Skendros P, Aggelousis N, Vadikolias K. Targeting Neutrophil Extracellular Traps for Stroke Prognosis: A Promising Path. Neurol Int 2023; 15:1212-1226. [PMID: 37873833 PMCID: PMC10594510 DOI: 10.3390/neurolint15040076] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
Stroke has become the first cause of functional disability and one of the leading causes of mortality worldwide. Therefore, it is of crucial importance to develop accurate biomarkers to assess stroke risk and prognosis. Emerging evidence suggests that neutrophil extracellular trap (NET) levels may serve as a valuable biomarker to predict stroke occurrence and functional outcome. NETs are known to create a procoagulant state by serving as a scaffold for tissue factor (TF) and platelets inducing thrombosis by activating coagulation pathways and endothelium. A literature search was conducted in two databases (MEDLINE and Scopus) to trace all relevant studies published between 1 January 2016 and 31 December 2022, addressing the potential utility of NETs as a stroke biomarker. Only full-text articles in English were included. The current review includes thirty-three papers. Elevated NET levels in plasma and thrombi seem to be associated with increased mortality and worse functional outcomes in stroke, with all acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage included. Additionally, higher NET levels seem to correlate with worse outcomes after recanalization therapies and are more frequently found in strokes of cardioembolic or cryptogenic origin. Additionally, total neutrophil count in plasma seems also to correlate with stroke severity. Overall, NETs may be a promising predictive tool to assess stroke severity, functional outcome, and response to recanalization therapies.
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Affiliation(s)
- Eirini Liaptsi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
| | - Ermis Merkouris
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
| | - Efthymia Polatidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
| | - Aimilios Gkantzios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.P.); (D.P.-P.); (N.A.)
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
| | - Stella Karatzetzou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
| | - Christos Karaoglanis
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
| | - Anna-Maria Tsagkalidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
| | - Nikolaos Chouliaras
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
| | - Konstantinos Tsamakis
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, UK;
| | - Maria Protopapa
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.P.); (D.P.-P.); (N.A.)
| | - Dimitrios Pantazis-Pergaminelis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.P.); (D.P.-P.); (N.A.)
| | - Panagiotis Skendros
- First Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.P.); (D.P.-P.); (N.A.)
| | - Konstantinos Vadikolias
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.L.); (E.M.); (E.P.); (A.G.); (F.C.); (S.K.); (C.K.); (A.-M.T.); (N.C.); (K.V.)
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Ngo ATP, Gollomp K. Building a better
NET
: Neutrophil extracellular trap targeted therapeutics in the treatment of infectious and inflammatory disorders. Res Pract Thromb Haemost 2022. [DOI: 10.1002/rth2.12808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Anh T. P. Ngo
- Division of Hematology Children's Hospital of Philadelphia Philadelphia Pennsylvania USA
| | - Kandace Gollomp
- Division of Hematology Children's Hospital of Philadelphia Philadelphia Pennsylvania USA
- Department of Pediatrics, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
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de Castro JTDS, Appenzeller S, Colella MP, Yamaguti-Hayakawa G, Paula EVD, Annichinno-Bizzachi J, Cendes F, Fabiano R, Orsi FA. Neurological manifestations in thrombotic microangiopathy: Imaging features, risk factors and clinical course. PLoS One 2022; 17:e0272290. [PMID: 36129939 PMCID: PMC9491546 DOI: 10.1371/journal.pone.0272290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background and purpose Thrombotic microangiopathy (TMA) is a group of microvascular occlusive disorders that presents with neurological involvement in up to 87% of the cases. Although the central nervous system (CNS) is an important target organ in TMA, the role of neurological manifestations in the disease clinical course is not well established. In this study, we described the neurological manifestations and CNS radiological aspects in patients with a first, acute TMA event. We also examined the association between severe neurological involvement and adverse clinical outcomes in TMA. Methods A cohort of patients diagnosed with a first TMA event between 1995 and 2016 was included, their medical charts and imaging tests were retrospectively evaluated. Results A total of 49 patients were included, 85.7% were women and the mean age was 36.5 years-old (SD 13.0). Neurological manifestations were described in 85.7% of the patients, most of them (88%) were considered severe and consisted of confusion, compromised sensorimotor function, stupor, seizures, and personality change. Imaging tests were performed in 62% of the patients with neurological manifestations and detected acute CNS lesions, such as posterior reversible encephalopathy syndrome, hemorrhagic and ischemic stroke were observed, in 7 (27%) of them. While the need for intensive care unit admission was greater and longer among patients with severe neurological manifestations, the number of plasma exchange sessions, the total duration of hospitalization and in-hospital death were similar between groups. Conclusions Severe neurological manifestations are common in first TMA events and are responsible for a worse disease presentation at admission. While the effect of neurological manifestations on acute TMA clinical course seems to be modest, these manifestations may have an important impact on the development of chronic cognitive impairment, which highlights the need for proper diagnosis and treatment.
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Affiliation(s)
- José Thiago de Souza de Castro
- School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
- Department of Radiology, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
- * E-mail:
| | - Simone Appenzeller
- Rheumatology Unit, School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
| | - Marina Pereira Colella
- Thrombosis and Hemostasis Unit, Hematology and Hemotherapy Center, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - Gabriela Yamaguti-Hayakawa
- Thrombosis and Hemostasis Unit, Hematology and Hemotherapy Center, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - Erich Vinícius De Paula
- Thrombosis and Hemostasis Unit, Hematology and Hemotherapy Center, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
- Discipline of Hematology and Hemotherapy, Department of Internal Medicine, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - Joyce Annichinno-Bizzachi
- Thrombosis and Hemostasis Unit, Hematology and Hemotherapy Center, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
- Discipline of Hematology and Hemotherapy, Department of Internal Medicine, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - Fernando Cendes
- Department of Neurology, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil
| | - Reis Fabiano
- School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
- Department of Radiology, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
| | - Fernanda Andrade Orsi
- Department of Clinical Pathology, School of Medical Sciences, University of Campinas, (UNICAMP), Campinas, São Paulo, Brazil
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Kong W, Wang Y, Wang H, Zhou Q, Chen J, Han F. Systemic sclerosis complicated with renal thrombotic microangiopathy: a case report and literature review. BMC Nephrol 2022; 23:22. [PMID: 35012481 PMCID: PMC8751341 DOI: 10.1186/s12882-021-02639-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background Systemic sclerosis (SSc) may overlap with other connective tissue diseases, which is named overlap syndrome. Scleroderma renal crisis (SRC) is a rare but severe complication of SSc. SSc related thrombotic microangiopathy (SSc-TMA) is an infrequent pathology type of SRC, while SSc-TMA accompanied by overlap syndrome is very rare. Case presentation This study reported a case of acute kidney injury (AKI) accompanied with overlap syndrome of SSc, systemic lupus erythematosus (SLE) and polymyositis (PM). The renal pathology supported the diagnosis of SSc-TMA but not SLE or PM-related renal injury, characterized by renal arteriolar thrombosis, endothelial cells edema, little cast in tubules and mild immune complex deposition. The primary TMA related factors (ADAMTS13 and complement H factor) were normal. Thus, this case was diagnosed as secondary TMA associated with SSc. The patient was treated with renin angiotensin system inhibitors, sildenafil, supportive plasma exchange/dialysis, and rituximab combined with glucocorticoids. After 2 months of peritoneal dialysis treatment, her renal function recovered and dialysis was stopped. Conclusion This study presented a case of SSc-TMA with overlap syndrome. Rituximab can be used as a treatment option in patients with high SRC risk or already manifesting SRC.
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Affiliation(s)
- Weiwei Kong
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, No.79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Yaomin Wang
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, No.79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Huiping Wang
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, No.79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Qin Zhou
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, No.79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Jianghua Chen
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, No.79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Fei Han
- Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province; National Key Clinical Department of Kidney Diseases; Institute of Nephrology, Zhejiang University; Zhejiang Clinical Research Center of Kidney and Urinary System Disease, No.79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, China.
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Zheng XL. The standard of care for immune thrombotic thrombocytopenic purpura today. J Thromb Haemost 2021; 19:1864-1871. [PMID: 34060225 PMCID: PMC8324529 DOI: 10.1111/jth.15406] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/30/2021] [Accepted: 05/20/2021] [Indexed: 12/20/2022]
Abstract
Targeted therapy of immune thrombotic thrombocytopenic purpura (iTTP) requires acurate and prompt diagnosis and differentiation from complement-mediated hemolytic uremic syndrome and other causes of thrombotic microangiopathy. ADAMTS-13 (A Disintegrin And Metalloprotease with ThromboSpondin-1 Domain, member 13) evaluation (activity and inhibitors or anti-ADAMTS-13 IgG) is the key for diagnosis and further management of patients with suspected iTTP during acute episode and in clinical response or remission. Clinical trial results and real-world data have demonstrated the efficacy and safety of the triple therapy consisting of therapeutic plasma exchange, caplacizumab, and immunosuppressives (e.g., corticosteroids and rituximab) for acute iTTP. Such a therapeutic strategy has significantly accelerated the normalization of platelet counts, decreased the length of stays in the intensive care unit and the hospital, but most importantly reduced the mortality rate. The present review highlights some of the important advancements for the diagnosis and management of iTTP and proposes triple therapy as the standard of care for acute iTTP today.
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Affiliation(s)
- X Long Zheng
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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