Direct Amplification of Tissue Factor:Factor VIIa Procoagulant Activity by Bile Acids Drives Intrahepatic Coagulation

The association of serum total bile acids and deep venous thrombosis

BACKGROUND AND AIM

Bile acid metabolism plays a crucial role in maintaining the delicate balance between coagulation and anticoagulation processes. However, there is a paucity of research exploring the relationship between serum total bile acids (TBA) levels and the risk of deep venous thrombosis (DVT) in Chinese individuals. The primary objective of this study is to investigate the association between TBA levels and DVT occurrence in this population.

METHODS AND RESULTS

A cross-sectional study was conducted involving 4522 patients with suspected DVT, recruited from June 2018 to October 2023, at the First Affiliated Hospital of Xi'an Jiaotong University. After rigorous screening, 3165 patients were included in the final analysis. Participants were categorized into three TBA level groups: low-level (TBA < 2.3 umol/L), moderate-level (2.3 ≤ TBA < 4.3 umol/L), and high-level (TBA ≥ 4.3 umol/L). Logistic regression analysis was utilized to assess the relationship between TBA levels and DVT risk, adjusting for potential confounders. The median age of the study population was 63 years, with a median TBA level of 3.2 (1.9-5.3) umol/L. The findings revealed that, compared to the low-level TBA group, the moderate and high-level TBA groups had significantly higher odds ratios (ORs) for DVT, with ORs of 1.47 (95% CI: 1.21 to 1.78, P < 0.001) and 1.91 (95% CI: 1.58 to 2.32, P < 0.001), respectively. Interestingly, higher TBA levels were also associated with reduced odds of bleeding risk, with ORs of 0.81 (95% CI: 0.63 to 1.03, P < 0.001) and 0.64 (95% CI: 0.5 to 0.81, P < 0.001), respectively.

CONCLUSIONS

Our study provides evidence that serum TBA levels may serve as a risk factor for DVT in Chinese individuals, with higher levels conferring an increased risk. Additionally, unexpectedly, higher TBA levels were found to be associated with a reduced risk of bleeding complications. These findings have significant implications for understanding the complex interplay between bile acid metabolism and deep venous thrombosis, and warrant further investigation.

Multi-omics Analysis to Identify Key Immune Genes for Osteoporosis based on Machine Learning and Single-cell Analysis

OBJECTIVE

Osteoporosis is a severe bone disease with a complex pathogenesis involving various immune processes. With the in-depth understanding of bone immune mechanisms, discovering new therapeutic targets is crucial for the prevention and treatment of osteoporosis. This study aims to explore novel bone immune markers related to osteoporosis based on single-cell and transcriptome data, utilizing bioinformatics and machine learning methods, in order to provide novel strategies for the diagnosis and treatment of the disease.

METHODS

Single cell and transcriptome data sets were acquired from Gene Expression Omnibus (GEO). The data was then subjected to cell communication analysis, pseudotime analysis, and high dimensional WGCNA (hdWGCNA) analysis to identify key immune cell subpopulations and module genes. Subsequently, ConsensusClusterPlus analysis was performed on the key module genes to identify different diseased subgroups in the osteoporosis (OP) training set samples. The immune characteristics between subgroups were evaluated using Cibersort, EPIC, and MCP counter algorithms. OP's hub genes were screened using 10 machine learning algorithms and 113 algorithm combinations. The relationship between hub genes and immunity and pathways was established by evaluating the immune and pathway scores of the training set samples through the ESTIMATE, MCP-counter, and ssGSEA algorithms. Real-time fluorescence quantitative PCR (RT-qPCR) testing was conducted on serum samples collected from osteoporosis patients and healthy adults.

RESULTS

In OP samples, the proportions of bone marrow-derived mesenchymal stem cells (BM-MSCs) and neutrophils increased significantly by 6.73% (from 24.01% to 30.74%) and 6.36% (from 26.82% to 33.18%), respectively. We found 16 intersection genes and four hub genes (DND1, HIRA, SH3GLB2, and F7). RT-qPCR results showed reduced expression levels of DND1, HIRA, and SH3GLB2 in clinical blood samples of OP patients. Moreover, the four hub genes showed positive correlations with neutrophils (0.65-0.90), immature B cells (0.76-0.92), and endothelial cells (0.79-0.87), while showing negative correlations with myeloid-derived suppressor cells (negative 0.54-0.73), T follicular helper cells (negative 0.71-0.86), and natural killer T cells (negative 0.75-0.85).

CONCLUSION

Neutrophils play a crucial role in the occurrence and development of osteoporosis. The four hub genes potentially inhibit metabolic activities and trigger inflammation by interacting with other immune cells, thereby significantly contributing to the onset and diagnosis of OP.

Neutrophil extracellular traps induce intrahepatic thrombotic tendency and liver damage in cholestatic liver disease

BACKGROUND

Cholestatic liver diseases induce local and systemic hypercoagulation, with neutrophil extracellular traps (NETs) serving as major drivers. These NETs have been linked to decreased liver function in patients with obstructive jaundice. However, the impact of NETs on liver hypercoagulation in cholestatic liver disease remains unknown.

METHODS

We utilized bile duct ligation to create experimental mice and analyzed NETs formation in the liver. Fibrin deposition, tissue factor expression, and inflammation in the liver were visualized through western blot and immunohistochemical techniques. LSECs were incubated with isolated NETs, and we detected endothelial procoagulant activity using coagulation protein production assays and measuring endothelial permeability. In both in vivo and in vitro settings, DNase I was applied to clarify the effect of NETs on intrahepatic hypercoagulability, hepatotoxicity, LSEC, and macrophage activation or injury.

RESULTS

Bile duct ligation mice exhibited significantly increased levels of NETs in liver tissue, accompanied by neutrophil infiltration, tissue necrosis, fibrin deposition, and thrombophilia compared to sham mice. Notably, NETs resulted in phosphatidylserine and tissue factor exposure on LSEC, enhancing coagulation Factor Xa and thrombin production. The enhanced procoagulant activity could be reversed by degrading NETs with DNase I. Additionally, NETs-induced permeability changes in LSECs, characterized by increased VE-cadherin expression and F-actin retraction, which could be rescued by DNase I. Meanwhile, NET formation is associated with KC activation and the formation of inflammatory factors.

CONCLUSIONS

NETs promote intrahepatic activation of coagulation and inflammation, leading to liver tissue injury. Strategies targeting NET formation may offer a potential therapeutic approach for treating cholestatic liver disease.

Application Value of Combined Detection of Anti-β2-GPI, ACL, and Lupus Anticoagulant in the Diagnosis of Patients with Antiphospholipid Syndrome

Objective

To investigate the application value of combined detection of anti-beta 2-glycoprotein I antibody (anti-β2-GPI), anti-cardiolipin antibody (ACL), and lupus anticoagulant (LA) in the diagnosis of patients with antiphospholipid syndrome (APS).

Methods

30 APS patients in our hospital between Jan. 2020 and Jan. 2021 were chosen as the experimental group, and 30 healthy persons with normal physical examination during the same period were selected as the control group The anti-β2-GPI and ACL indexes of both groups were detected by enzyme-linked immunosorbent assay (ELISA), with the LA levels tested by modified dilute Russell's viper venom time (dRVVT) and LA ratio calculated. The diagnostic efficacy of single detection and combined detection was analyzed by plotting the receiver operating characteristic (ROC) curve.

Results

The serum indexes in the experimental group were remarkably higher than those in the control group (P < 0.001). ROC curve analysis suggested that in the diagnosis of APS, the area under the ROC curve by detecting anti-β2-GPI, ACL, LA ratio alone and simultaneously were 0.517, 0.583, 0.683, and 0.817 respectively, and the combined detection of the three had remarkably higher sensitivity and specificity than those of each single detection.

Conclusion

The indexes of anti-β2-GPI, ACL, and LA ratio were highly expressed in APS patients, and the combined detection of the three has high diagnostic value and can effectively screen and assist the diagnosis of APS.

Plasma metabolomics in a deep vein thrombosis rat model based on ultra-high performance liquid chromatography-electrostatic field orbitrap high resolution mass spectrometry

深静脉血栓(DVT)是一种血栓栓塞性疾病,具有高发病率、高死亡率和高后遗症3大特点。采用左股静脉不完全结扎加高渗盐水刺激建立DVT大鼠模型,使用超高效液相色谱-静电场轨道阱高分辨质谱(UHPLC-Orbitrap HRMS)检测假手术组与DVT模型组的血浆代谢谱,用主成分分析(PCA)及正交偏最小二乘-判别分析(OPLS-DA)对代谢组数据进行多元统计分析,观察两组间的代谢表型差异,将多变量模型分析中的变量重要性值(VIP>1)以及代谢物在模型组中的变化倍数(FC≤0.5或FC≥2,且P<0.05)作为差异代谢物筛选条件。最终在DVT模型组与假手术组间筛选得到27种差异代谢物,这些代谢物反映了DVT大鼠的代谢紊乱情况。具体表现为与假手术组相比,DVT模型组中三甲基胺氮氧化物(TMAO)、维生素K、鹅去氧胆酸、牛磺酸、1-甲基烟酰胺、7-酮胆固醇、反式十六烷基-2-烯醇肉碱、乙烯基乙酰甘氨酸、丙酰脯氨酸、咪唑乙酸、咪唑乙酸核糖苷、1,3,7-三甲基尿酸、1-丁胺、2-羟基异丙酸、吡哆醛、5α-四氢皮质酮、苯乳酸的水平显著升高;而3-脱氢肉碱、磷脂酰胆碱22∶6/20∶2(PC 22∶6/20∶2)、甘油二酯18∶3/20∶4(DG 18∶3/20∶4)、溶血磷脂酰胆碱20∶2(LysoPC 20∶2)、波维酸、鹅肌肽、L-肌肽、辛酸、羟基丙酮酸、3-羟基癸酸的水平显著降低。基于京都基因与基因组百科全书数据库(KEGG)代谢通路的差异丰度(DA)分析显示DVT模型大鼠与假手术组的代谢通路差异主要集中在初级胆汁酸生物合成、胆汁分泌、组氨酸代谢、亚油酸代谢、甘油磷脂代谢和β-丙氨酸代谢。紊乱的代谢物和代谢途径可为进一步深入理解DVT的病理机制、寻找诊断标志物及药物作用靶点提供参考。

Risk factors, hematological and biochemical profile associated with colic in Delman horses in Gresik, Indonesia

Background: Horses are herd animals that have been domesticated in the last century. In several countries, an overview of risk factors and clinical evaluation in horses with colic has not been well‐described. This study aimed to evaluate risk factors and hematological profiles in horses associated with colic in Gresik, East Java, Indonesia.

Methods: A cross-sectional study was performed during April - October 2019. A total of 115 horses were diagnosed based on physical examination, clinical symptoms, and rectal examination. A questionnaire was asked to the horse-owners to analyze the risk factors while the clinical examination was performed and blood samples were collected for pre-treatment and 14 days post-treatment. Hematological profile was evaluated from a whole blood sample. Serum cortisol, plasma epinephrine, and norepinephrine concentrations were also evaluated after separating the aliquots. 

Results: Of the 115 horses, 96 were diagnosed with colic. The horses with colic showed a significant association between cases with gender (p<0.021), breed (p<0.000), wheat bran feeding (p<0.015), concentrate feeding (p<0.003), anthelmintics administration (p<0.000), gastrointestinal parasites (p<0.000), dental diseases (p<0.024), previous exposure to colic (p<0.000), body condition score (p<0.000), and access to water per day (p<0.000). Based on whole blood and serum evaluation, there were ameliorated significantly on the hematological profile (p<0.01), serum cortisol (p<0.05), and plasma epinephrine (p<0.01) at 14 days post-treatment.

Conclusion: This study has identified factors associated with colic in Delman horses. The study provides crucial information to investigate cases of colic and to contribute the development of healthcare strategies during treatment and clinical evaluation.

Linking liver metabolic and vascular disease via bile acid signaling

Non-alcoholic fatty liver disease (NAFLD) is a metabolic disorder affecting over one quarter of the global population. Liver fat accumulation in NAFLD is promoted by increased de novo lipogenesis leading to the development of a proatherosclerotic lipid profile and atherosclerotic cardiovascular disease (CVD). The CVD component of NAFLD is the main determinant of patient outcome. The farnesoid X receptor (FXR) and the G protein bile acid-activated receptor 1 (GPBAR1) are bile acid-activated receptors that modulate inflammation and lipid and glucose metabolism in the liver and CV system, and are thus potential therapeutic targets. We review bile acid signaling in liver, metabolic tissues, and the CV system, and we propose the development of dual FXR/GPBAR1 ligands, intestine-restricted FXR ligands, or statin combinations to limit side effects and effectively manage the liver and CV components of NAFLD.

Bile acid-induced tissue factor activity in hepatocytes correlates with activation of farnesoid X receptor

Bile acids (BA) have been found to promote coagulation by increasing tissue factor (TF) activity. The contribution of elevated BA levels and cholestasis to TF decryption within the liver parenchyma and the role of farnesoid X receptor (FXR) in this process remain unclear. We investigated the effects of BA on TF activity and thrombin generation in hepatocytes and correlated these effects with activation of FXR-dependent signaling and apoptosis. HepG2 cells and primary hepatocytes were incubated with chenodeoxycholic acid (CDCA), glycochenodeoxycholic acid (GCDCA), ursodeoxycholic acid (UCDA), or the synthetic FXR agonist GW4064 for 24 h. MTT tests demonstrated cell viability throughout experiments. TF activity was tested via factor Xa generation and thrombin generation was measured by calibrated automated thrombography. Increased TF activity alongside enhanced thrombin generation was observed with CDCA and GW4064 but not with GCDCA and UDCA. TF activity was substantially reduced when FXR activation was blocked with the antagonist DY 268. Quantitative polymerase chain reaction revealed upregulation of FXR target genes only by CDCA and GW4064. Western blot analysis and fluorescence microscopy showed no TF overexpression arguing for TF decryption. Caspase 3 activity measurements and flow cytometric analysis of Annexin V binding showed no signs of apoptosis. Long-term exposure of hepatocytes to nontoxic BA may cause intracellular FXR overstimulation, triggering TF decryption irrespective of the amphiphilic properties of BA. The effect of BA on TF activation correlates with the molecule's ability to enter the cells and activate FXR. TF decryption occurs independently of apoptotic mechanisms.

Neutrophil extracellular traps enhance procoagulant activity and thrombotic tendency in patients with obstructive jaundice

BACKGROUND & AIMS

Patients with obstructive jaundice (OJ) are considered to be prothrombotic with increased risk of thromboembolism complications. The role of neutrophil extracellular traps (NETs) in procoagulant activity (PCA) and thrombosis risk in patients with OJ is unclear. In this study, we investigated NETs formation in OJ patients and the role of elevated unconjugated bilirubin (UCB) in inducing NETs, resulting in enhanced PCA and endothelial injury.

METHODS

NETs of OJ patients and healthy controls were measured. NETs PCA was assessed via coagulation time (CT), fibrin formation and purified coagulation complex production assays. Visualization of NETs and mitochondrial reactive oxygen species (MitoROS) were performed with a fluorescence microscope. We further used confocal microscopy to quantify the exposure of phosphatidylserine (PS), fibrin strands and FVa/Xa on Human umbilical vein endothelial cells (HUVECs).

RESULTS

Assessment of NETs components levels revealed greater NETs production in OJ patients than in healthy controls. Importantly, OJ-NETs were responsible for enhanced PCA. UCB induced NETs formation via MitoROS accumulation and mitochondrial mobilization. HUVECs cocultured with OJ NETs lost their cell-cell junctions and consequently converted to a procoagulant phenotype. The PCA was attenuated by using DNase I alone or in combination with lactadherin.

CONCLUSIONS

Our results suggest that UCB-induced NETs play a prominent role in promoting the hypercoagulable and prothrombotic state in OJ patients. The increased MitoROS accumulation in neutrophils initiated NETosis. NETs are promising targets for indicating or improving coagulation disorders in OJ patients.