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Helms J, Curtiaud A, Severac F, Tschirhart M, Merdji H, Bourdin M, Contant G, Depasse F, Abou Rjeily R, Sattler L, Meziani F, Angles-Cano E. Fibrinolysis as a Causative Mechanism for Bleeding Complications on Extracorporeal Membrane Oxygenation: A Pilot Observational Prospective Study. Anesthesiology 2024; 141:75-86. [PMID: 38502917 DOI: 10.1097/aln.0000000000004980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is associated with a high risk of bleeding complications. The specific impact of ECMO on fibrinolysis remains unexplored. The objective of the current pilot observational prospective study was to investigate the longitudinal dynamics of fibrinolytic markers-i.e., changes over time-in the context of bleeding events in patients on ECMO. METHODS Longitudinal dynamics of contact phase components (kininogen and bradykinin) and fibrinolysis markers (tissue plasminogen activator [tPA], plasminogen activator inhibitor-1 [PAI-1], their complexes [tPA•PAI-1], plasmin-antiplasmin complexes, plasminogen, and D-dimer) were measured in patients undergoing venovenous and venoarterial ECMO, before implantation, at 0, 6, and 12 h after implantation, and daily thereafter. RESULTS The cohort consisted of 30 patients (214 ECMO days). The concentrations of tPA, D-dimer, plasmin-antiplasmin complexes, PAI-1, and tPA•PAI-1 complexes were increased, whereas plasminogen decreased compared to normal values. A noteworthy divergence was observed between hemorrhagic and nonhemorrhagic patients: in bleeding patients, D-dimer, plasmin-antiplasmin, tPA, PAI-1, and tPA•PAI-1 followed an increasing kinetics before hemorrhage and then decreased to their baseline level; conversely, nonbleeding patients showed a decreasing kinetics in these markers. Also, D-dimer and tPA followed an increasing kinetics in bleeding patients compared to nonbleeding patients (median values for D-dimer dynamics: 1,080 vs. -440 ng/ml, P = 0.05; tPA dynamics: 0.130 vs. 0.100 nM, P = 0.038), and both markers significantly increased the day before hemorrhage. A tPA concentration above 0.304 nM was associated with bleeding events (odds ratio, 4.92; 95% CI, 1.01 to 24.08; P = 0.049). CONCLUSIONS Contact activation induces fibrinolysis in ECMO patients, especially in patients experiencing bleeding. This finding supports the role of this mechanism as a possible causal factor for hemorrhages during ECMO and open new avenues for novel therapeutic perspectives. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Julie Helms
- Strasbourg University (UNISTRA); Strasbourg University Hospital, Medical Intensive Care Unit (NHC), Strasbourg, France; INSERM (French National Institute of Health and Medical Research), Unit 1260, Regenerative Nanomedicine, Medicine Federation of Strasbourg, Strasbourg, France
| | - Anaïs Curtiaud
- Strasbourg University (UNISTRA); Strasbourg University Hospital, Medical Intensive Care Unit (NHC), Strasbourg, France; INSERM (French National Institute of Health and Medical Research), Unit 1260, Regenerative Nanomedicine, Medicine Federation of Strasbourg, Strasbourg, France
| | - François Severac
- Strasbourg University Hospital, Clinical Research Methods Group (GMRC), Strasbourg, France
| | - Marine Tschirhart
- INSERM (French National Institute of Health and Medical Research), Unit 1260, Regenerative Nanomedicine, Medicine Federation of Strasbourg, Strasbourg, France
| | - Hamid Merdji
- Strasbourg University (UNISTRA); Strasbourg University Hospital, Medical Intensive Care Unit (NHC), Strasbourg, France; INSERM (French National Institute of Health and Medical Research), Unit 1260, Regenerative Nanomedicine, Medicine Federation of Strasbourg, Strasbourg, France
| | - Matthieu Bourdin
- Diagnostica Stago, Prospective Research Department, Gennevilliers, France
| | - Geneviève Contant
- Diagnostica Stago, Prospective Research Department, Gennevilliers, France
| | - François Depasse
- Diagnostica Stago, Clinical Development, Asnières sur Seine, France
| | - Ramy Abou Rjeily
- Paris Cite University-INSERM U-1140, Innovative Therapies in Haemostasis, Paris, France
| | - Laurent Sattler
- Strasbourg University Hospital, Laboratory of Hematology, Hautepierre, Strasbourg, France
| | - Ferhat Meziani
- Strasbourg University (UNISTRA); Strasbourg University Hospital, Medical Intensive Care Unit (NHC), Strasbourg, France; INSERM (French National Institute of Health and Medical Research), Unit 1260, Regenerative Nanomedicine, Medicine Federation of Strasbourg, Strasbourg, France
| | - Eduardo Angles-Cano
- Paris Cite University-INSERM U-1140, Innovative Therapies in Haemostasis, Paris, France
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Nash J, Meah MN, Whittington B, Debono S, Raftis J, Miller MR, Sorbie A, Mills NL, Nespoux J, Bruce L, Duffin R, Dhaun N, Brittan M, Chao L, Merali S, Kim M, Wang Z, Zhang Y, Jin S, Wang B, Kozinn M, Newby DE. PAR4 Antagonism in Patients With Coronary Artery Disease Receiving Antiplatelet Therapies. Arterioscler Thromb Vasc Biol 2024; 44:987-996. [PMID: 38357820 DOI: 10.1161/atvbaha.123.320448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND BMS-986141 is a novel potent highly selective antagonist of PAR (protease-activated receptor) type 4. PAR4 antagonism has been demonstrated to reduce thrombus formation in isolation and in combination with factor Xa inhibition in high shear conditions in healthy people. We sought to determine whether PAR4 antagonism had additive antithrombotic effects in patients with coronary artery disease who were receiving antiplatelet therapy. METHODS Forty-five patients with stable coronary heart disease and 10 healthy volunteers completed a phase 2a open-label 4-arm single-center study. Patients were allocated to 1 of 3 treatment arms for 7 days: (1) ticagrelor (90 mg BID), (2) aspirin (75 mg QD), or (3) the combination of ticagrelor and aspirin. Agonist-induced platelet aggregation, platelet activation, and ex vivo thrombus formation were measured before and 2 and 24 hours after a single oral 4-mg dose of BMS-986141 on the first study visit day in all participants. RESULTS BMS-986141 demonstrated highly selective inhibition of PAR4-AP (agonist peptide)-induced platelet aggregation, P-selectin expression, and platelet-monocyte aggregate expression (P≤0.001 for all), which were unaffected by concomitant antiplatelet therapies. PAR4 antagonism reduced ex vivo thrombus area in high shear conditions in healthy volunteers (-21%; P=0.001) and in patients receiving ticagrelor alone (-28%; P=0.001), aspirin alone (-23%; P=0.018), or both in combination (-24%; P≤0.001). Plasma concentration of BMS-986141 correlated with PAR4-AP-induced platelet responses (P≤0.001 for all) and total thrombus area under high shear stress conditions (P≤0.01 for all). CONCLUSIONS PAR4 antagonism has additive antithrombotic effects when used in addition to ticagrelor, aspirin, or their combination, in patients with stable coronary heart disease. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05093790.
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Affiliation(s)
- Jennifer Nash
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Mohammed N Meah
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Beth Whittington
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
- WorldWide Patient Safety (B.W.), Bristol Myers Squibb, Lawrenceville, NJ
| | - Samuel Debono
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Jennifer Raftis
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Mark R Miller
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Andrew Sorbie
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Nicholas L Mills
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Josselin Nespoux
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Lorraine Bruce
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Rodger Duffin
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Neeraj Dhaun
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Mairi Brittan
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Longfei Chao
- Clinical Pharmacology and Pharmacometrics (L.C., S.M.), Bristol Myers Squibb, Lawrenceville, NJ
| | - Samira Merali
- Clinical Pharmacology and Pharmacometrics (L.C., S.M.), Bristol Myers Squibb, Lawrenceville, NJ
| | - Minji Kim
- Translational Medicine (M.K., Z.W.), Bristol Myers Squibb, Lawrenceville, NJ
- Early Cardiovascular Clinical Development, R&D (M.K.), Bristol Myers Squibb, Lawrenceville, NJ
| | - Zhaoqing Wang
- Translational Medicine (M.K., Z.W.), Bristol Myers Squibb, Lawrenceville, NJ
| | - Yue Zhang
- Global Biometrics and Data Sciences (Y.Z., S.J.), Bristol Myers Squibb, Lawrenceville, NJ
| | - Shiqiang Jin
- Global Biometrics and Data Sciences (Y.Z., S.J.), Bristol Myers Squibb, Lawrenceville, NJ
| | - Beqing Wang
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
| | - Marc Kozinn
- Translational Medicine (M.K., Z.W.), Bristol Myers Squibb, Lawrenceville, NJ
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (J.N., M.N.M., B.W., S.D., J.R., M.R.M., A.S., N.L.M., J.N., L.B., R.D., N.D., M.B., D.E.N.)
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Whyte CS, Mutch NJ. "Going with the flow" in modeling fibrinolysis. Front Cardiovasc Med 2022; 9:1054541. [PMID: 36531720 PMCID: PMC9755328 DOI: 10.3389/fcvm.2022.1054541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/18/2022] [Indexed: 09/10/2024] Open
Abstract
The formation of thrombi is shaped by intravascular shear stress, influencing both fibrin architecture and the cellular composition which has downstream implications in terms of stability against mechanical and fibrinolytic forces. There have been many advancements in the development of models that incorporate flow rates akin to those found in vivo. Both thrombus formation and breakdown are simultaneous processes, the balance of which dictates the size, persistence and resolution of thrombi. Therefore, there is a requirement to have models which mimic the physiological shear experienced within the vasculature which in turn influences the fibrinolytic degradation of the thrombus. Here, we discuss various assays for fibrinolysis and importantly the development of novel models that incorporate physiological shear rates. These models are essential tools to untangle the molecular and cellular processes which govern fibrinolysis and can recreate the conditions within normal and diseased vessels to determine how these processes become perturbed in a pathophysiological setting. They also have utility to assess novel drug targets and antithrombotic drugs that influence thrombus stability.
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Affiliation(s)
- Claire S. Whyte
- Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
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Wang K, Wang W, Lei L, Lan Y, Liu Q, Ren L, Wu S. Association between short-term exposure to ambient air pollution and biomarkers of coagulation: A systematic review and meta-analysis. ENVIRONMENTAL RESEARCH 2022; 215:114210. [PMID: 36030918 DOI: 10.1016/j.envres.2022.114210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/17/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Ambient air pollution is one of the major global risk factors for cardiovascular health, and coagulation changes have been proposed to mediate this risk. Plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF), soluble P-selectin (sP-selectin) and tissue plasminogen activator (t-PA) are major coagulation biomarkers. However, there has been no systematic meta-analysis to summarize associations of ambient air pollution with these coagulation biomarkers. To assess the overall associations between ambient particulate matter (PM2.5, PM10), ozone (O3), nitrogen dioxide (NO2), carbon monoxide (CO) and major coagulation biomarkers including PAI-1, vWF, sP-selectin and t-PA based on the existing epidemiological research. We performed a systematic literature search of publications reporting the associations of ambient air pollutants (PM2.5, PM10, O3, NO2, and CO) with coagulation biomarkers (PAI-1, vWF, sP-selectin and t-PA) in PubMed, Web of Science, EMBASE, and Scopus databases as of April 5, 2022. Then, we performed a random-effect meta-analysis, which included 27 articles, and then identified the potential sources of heterogeneity. The pooled percent changes of coagulation biomarkers per 10 μg/m3 increase in short-term exposure to ambient PM2.5 were 2.43% (95% CI: 0.59%, 4.29%) in PAI-1, 1.08% (95% CI: 0.21%, 1.96%) in vWF and 1.14% (95% CI: 0.59%, 1.68%) in sP-selectin, respectively. We also found significant associations of short-term exposure to ambient O3 with PAI-1 (1.62%, 95% CI: 0.01%, 3.25%), sP-selectin (9.59%, 95% CI:2.78%, 16.86%) and t-PA (0.45%, 95% CI: 0.02%, 0.88%), respectively. Short-term exposures to ambient PM10, NO2 and CO were not significantly associated with changes in coagulation biomarkers. In conclusion, short-term exposures to PM2.5 and O3 are associated with significant increases in coagulation biomarkers, suggesting an activated coagulation state upon air pollution exposure.
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Affiliation(s)
- Kai Wang
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China
| | - Wanzhou Wang
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Lei Lei
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China
| | - Yang Lan
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China
| | - Qisijing Liu
- Research Institute of Public Health, School of Medicine, Nankai University, Tianjin, China
| | - Lihua Ren
- School of Nursing, Peking University, Beijing, China
| | - Shaowei Wu
- Department of Occupational and Environmental Health, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China; Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China; Key Laboratory of Trace Elements and Endemic Diseases in Ministry of Health, Xi'an, Shaanxi, China.
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Role of Shear Stress and tPA Concentration in the Fibrinolytic Potential of Thrombi. Int J Mol Sci 2021; 22:ijms22042115. [PMID: 33672724 PMCID: PMC7924342 DOI: 10.3390/ijms22042115] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 11/16/2022] Open
Abstract
The resolution of arterial thrombi is critically dependent on the endogenous fibrinolytic system. Using well-established and complementary whole blood models, we investigated the endogenous fibrinolytic potential of the tissue-type plasminogen activator (tPA) and the intra-thrombus distribution of fibrinolytic proteins, formed ex vivo under shear. tPA was present at physiologically relevant concentrations and fibrinolysis was monitored using an FITC-labelled fibrinogen tracer. Thrombi were formed from anticoagulated blood using a Chandler Loop and from non-anticoagulated blood perfused over specially-prepared porcine aorta strips under low (212 s−1) and high shear (1690 s−1) conditions in a Badimon Chamber. Plasminogen, tPA and plasminogen activator inhibitor-1 (PAI-1) concentrations were measured by ELISA. The tPA–PAI-1 complex was abundant in Chandler model thrombi serum. In contrast, free tPA was evident in the head of thrombi and correlated with fibrinolytic activity. Badimon thrombi formed under high shear conditions were more resistant to fibrinolysis than those formed at low shear. Plasminogen and tPA concentrations were elevated in thrombi formed at low shear, while PAI-1 concentrations were augmented at high shear rates. In conclusion, tPA primarily localises to the thrombus head in a free and active form. Thrombi formed at high shear incorporate less tPA and plasminogen and increased PAI-1, thereby enhancing resistance to degradation.
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Meah MN, Raftis J, Wilson SJ, Perera V, Garonzik SM, Murthy B, Everlof JG, Aronson R, Luettgen J, Newby DE. Antithrombotic Effects of Combined PAR (Protease-Activated Receptor)-4 Antagonism and Factor Xa Inhibition. Arterioscler Thromb Vasc Biol 2020; 40:2678-2685. [PMID: 32907366 PMCID: PMC7571844 DOI: 10.1161/atvbaha.120.314960] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/22/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE PAR (protease-activated receptor)-4 antagonism has antiplatelet effects under conditions of high shear stress. We aimed to establish whether PAR4 antagonism had additive antithrombotic activity in the presence of factor Xa inhibition in an ex vivo model of acute arterial injury. Approach and Results: Fifteen healthy volunteers (29±6 years, 7 women) completed a phase zero double-blind randomized controlled crossover trial. Ex vivo platelet activation, platelet aggregation, and thrombus formation were measured following blood perfusion of low shear and high shear stress chambers. Upstream of the chambers, extracorporeal blood was admixed with (1) vehicle, (2) low-dose apixaban (20 ng/mL), (3) high-dose apixaban (80 ng/mL), (4) BMS-986141 (400 ng/mL), (5) BMS-968141 and low-dose apixaban, or (6) BMS-968141 and high-dose apixaban in 6 sequential studies performed in random order. Compared with vehicle, BMS-986141 demonstrated selective inhibition of PAR4-AP (agonist peptide)-stimulated platelet aggregation, platelet-monocyte aggregates, and P-selectin expression (P≤0.01 for all). Total thrombus area was reduced under both low shear and high shear stress conditions for all drug infusions (P<0.0001 for all versus vehicle). BMS-968141 reduced total (≤44.4%) and platelet-rich (≤39.3%) thrombus area, whereas apixaban reduced total (≤42.9%) and fibrin-rich (≤31.6%) thrombus area. Combination of BMS-986141 with apixaban caused a further modest reduction in total thrombus area (9.6%-12.4%), especially under conditions of high shear stress (P≤0.027). CONCLUSIONS In the presence of factor Xa inhibition, PAR4 antagonism with BMS-986141 further reduces thrombus formation, especially under conditions of high shear stress. This suggests the potential for additive efficacy of combination PAR4 antagonism and factor Xa inhibition in the prevention of atherothrombotic events.
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Affiliation(s)
- Mohammed N. Meah
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (M.N.M., J.R., S.J.W., D.E.N.)
| | - Jennifer Raftis
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (M.N.M., J.R., S.J.W., D.E.N.)
| | - Simon J. Wilson
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (M.N.M., J.R., S.J.W., D.E.N.)
| | - Vidya Perera
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (M.N.M., J.R., S.J.W., D.E.N.)
| | - Samira M. Garonzik
- Bristol-Myers Squibb, Princeton Pike Facility, NJ (V.P., S.M.G., B.M., R.A.)
| | - Bindu Murthy
- Bristol-Myers Squibb, Princeton Pike Facility, NJ (V.P., S.M.G., B.M., R.A.)
| | - J. Gerry Everlof
- Brisol-Myers Squibb, Lawrenceville Facility, Princeton, NJ (J.G.E., J.L.)
| | - Ronald Aronson
- Bristol-Myers Squibb, Princeton Pike Facility, NJ (V.P., S.M.G., B.M., R.A.)
| | - Joseph Luettgen
- Brisol-Myers Squibb, Lawrenceville Facility, Princeton, NJ (J.G.E., J.L.)
| | - David E. Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, United Kingdom (M.N.M., J.R., S.J.W., D.E.N.)
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Andrews JPM, Portal C, Walton T, Macaskill MG, Hadoke PWF, Alcaide Corral C, Lucatelli C, Wilson S, Wilson I, MacNaught G, Dweck MR, Newby DE, Tavares AAS. Non-invasive in vivo imaging of acute thrombosis: development of a novel factor XIIIa radiotracer. Eur Heart J Cardiovasc Imaging 2020; 21:673-682. [PMID: 31408105 PMCID: PMC7237957 DOI: 10.1093/ehjci/jez207] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/01/2019] [Accepted: 08/07/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS Cardiovascular thrombosis is responsible a quarter of deaths annually worldwide. Current imaging methods for cardiovascular thrombosis focus on anatomical identification of thrombus but cannot determine thrombus age or activity. Molecular imaging techniques hold promise for identification and quantification of thrombosis in vivo. Our objective was to assess a novel optical and positron-emitting probe targeting Factor XIIIa (ENC2015) as biomarker of active thrombus formation. METHODS AND RESULTS Optical and positron-emitting ENC2015 probes were assessed ex vivo using blood drawn from human volunteers and passed through perfusion chambers containing denuded porcine aorta as a model of arterial injury. Specificity of ENC2015 was established with co-infusion of a factor XIIIa inhibitor. In vivo18F-ENC2015 biodistribution, kinetics, radiometabolism, and thrombus binding were characterized in rats. Both Cy5 and fluorine-18 labelled ENC2015 rapidly and specifically bound to thrombi. Thrombus uptake was inhibited by a factor XIIIa inhibitor. 18F-ENC2015 remained unmetabolized over 8 h when incubated in ex vivo human blood. In vivo, 42% of parent radiotracer remained in blood 60 min post-administration. Biodistribution studies demonstrated rapid clearance from tissues with elimination via the urinary system. In vivo,18F-ENC2015 uptake was markedly increased in the thrombosed carotid artery compared to the contralateral patent artery (mean standard uptake value ratio of 2.40 vs. 0.74, P < 0.0001). CONCLUSION ENC2015 rapidly and selectively binds to acute thrombus in both an ex vivo human translational model and an in vivo rodent model of arterial thrombosis. This probe holds promise for the non-invasive identification of thrombus formation in cardiovascular disease.
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Affiliation(s)
- Jack P M Andrews
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK, Corresponding author. Tel: +44 (77) 6688 5010; Fax: +131 242 6379. E-mail:
| | - Christophe Portal
- Edinburgh Molecular Imaging Ltd., 9 Little France Road, Edinburgh, UK
| | - Tashfeen Walton
- Edinburgh Imaging facility QMRI, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Mark G Macaskill
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - Patrick W F Hadoke
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - Carlos Alcaide Corral
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - Christophe Lucatelli
- Edinburgh Imaging facility QMRI, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Simon Wilson
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - Ian Wilson
- ImaginAb, Inc. U.S. 43 Hindry Avenue, Suite D, Inglewood, California, USA
| | - Gillian MacNaught
- Edinburgh Imaging facility QMRI, University of Edinburgh, 47 Little France Crescent, Edinburgh, UK
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
| | - Adriana A S Tavares
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, UK
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Storch AS, Rocha HNM, Garcia VP, Batista GMDS, Mattos JD, Campos MO, Fuly AL, Nóbrega ACLD, Fernandes IA, Rocha NG. Oscillatory shear stress induces hemostatic imbalance in healthy men. Thromb Res 2018; 170:119-125. [DOI: 10.1016/j.thromres.2018.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/28/2018] [Accepted: 08/24/2018] [Indexed: 01/27/2023]
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9
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Jin Z, Choi H, Park J, Jung C, Ko SY, Park JO, Park S. Feasibility Study of Extracorporeal Shock Wave Lithotripsy for Chronic Total Occlusion Therapy. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0130-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Regoli D, Gobeil F. Critical insights into the beneficial and protective actions of the kallikrein-kinin system. Vascul Pharmacol 2015; 64:1-10. [PMID: 25579779 DOI: 10.1016/j.vph.2014.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/26/2014] [Indexed: 12/20/2022]
Abstract
Hypertension is characterized by an imbalance between the renin-angiotensin system (RAS) and the kallikrein-kinin system (KKS). Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II AT-1 receptor antagonists (also known as sartans or ARBs) are potent modulators of these systems and are highly effective as first-line treatments for hypertension, diabetic nephropathies, and diseases of the brain and coronary arteries. However, these agents are mechanistically distinct and should not be considered interchangeable. In this mini-review, we provide novel insights into the often neglected roles of the KKS in the beneficial, protective, and reparative actions of ACEIs. Indeed, ACEIs are the only antihypertensive drugs that properly reduce the imbalance between the RAS and the KKS, thereby restoring optimal cardiovascular homeostasis and significantly reducing morbidity and the risk of all-cause mortality among individuals affected by hypertension and other cardiovascular diseases.
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Affiliation(s)
- Domenico Regoli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Fernand Gobeil
- Department of Pharmacology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada, J1H 5N4.
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Diehl KJ, Weil BR, Greiner JJ, Wright KP, Stauffer BL, DeSouza CA. Impaired endogenous fibrinolytic capacity in prehypertensive men. J Hum Hypertens 2015; 29:468-72. [PMID: 25566873 PMCID: PMC4762274 DOI: 10.1038/jhh.2014.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/29/2014] [Accepted: 11/04/2014] [Indexed: 12/14/2022]
Abstract
Prehypertension (BP 120–139/80–89 mmHg) is associated with an increased risk for future atherothrombotic events. Although the mechanisms underlying this elevated risk are not completely understood, one possibility is that prehypertension is associated with impaired endothelial fibrinolytic capacity. We tested the hypothesis that vascular endothelial release of t-PA is impaired in prehypertensive men. Net endothelial release of t-PA was determined, in vivo, in response to intrabrachial infusions of bradykinin (12.5, 25, 50 ng/100 mL tissue/min) and sodium nitroprusside at (1.0, 2.0, 4.0 µg/100 mL tissue/min) in 42 middle-age and older men: 16 normotensive (BP range: 100–119/57–79 mmHg); 16 prehypertensive (BP range: 120–139/76–89 mmHg); and 10 hypertensive (BP range: 140–150/74–100 mmHg). Net release of t-PA antigen was ~25% lower (P < 0.05) in the prehypertensive (−0.9 ± 0.8 to 42.4 ± 5.3 ng/100 mL tissue/min) compared with the normotensive (0.5 ± 1.0 to 53.9 ± 6.5 ng/100 mL tissue/min) men. There was no significant difference in t-PA release between the hypertensive (−1.8±1.6 to 40.8±6.6 ng/100 mL tissue/min) and prehypertensive groups. Sodium nitroprusside did not significantly alter t-PA release in any group. These data indicate that endothelial t-PA release is diminished in prehypertensive men. Further, the level of impairment in t-PA release seen with clinical hypertension is already apparent in the prehypertensive state. Impaired endothelial fibrinolytic function may underlie the increased atherothrombotic risk associated with blood pressure in the prehypertensive range.
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Affiliation(s)
- K J Diehl
- Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA
| | - B R Weil
- Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA
| | - J J Greiner
- Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA
| | - K P Wright
- Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA
| | - B L Stauffer
- 1] Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA [2] Department of Medicine, University of Colorado, Denver, CO, USA [3] Denver Health Medical Center, Denver, CO, USA
| | - C A DeSouza
- 1] Department of Integrative Physiology, Integrative Vascular Biology Laboratory, University of Colorado, Boulder, CO, USA [2] Department of Medicine, University of Colorado, Denver, CO, USA
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Effect of Three Dimensional Culture of Porcine Endometrial Cells on Their Plasminogen Activity and Pre-implantation Embryo Development after Co-culture. JOURNAL OF ANIMAL REPRODUCTION AND BIOTECHNOLOGY 2014. [DOI: 10.12750/jet.2014.29.2.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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