1
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Offiah C, Tierney S, Egan B, Collins RD, Ryan DJ, McCarthy AJ, Smith DR, Mahon J, Boyle E, Delaney H, O 'Donohoe R, Hurley A, Walsh RA, Murphy SM, Bogdanova-Mihaylova P, O 'Dowd S, Kelly MJ, Omer T, Coughlan T, O'Neill D, Martin M, Murphy SJX, McCabe DJH. Frequency of inter-specialty consensus decisions and adherence to advice following discussion at a weekly neurovascular multidisciplinary meeting. Ir J Med Sci 2023; 192:3051-3062. [PMID: 37081289 PMCID: PMC10119010 DOI: 10.1007/s11845-023-03319-4] [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: 12/02/2022] [Accepted: 02/13/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND/AIMS Data are limited on the frequency of 'consensus decisions' between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses and post-MDM 'adherence' to such advice. METHODS This prospective audit/quality improvement project collated prospectively-recorded data from a weekly Neurovascular/Stroke Centre MDM documenting the proportion of extracranial carotid/vertebral stenosis patients in whom 'consensus management decisions' were reached by neurologists, vascular surgeons, stroke physicians-geriatricians and neuroradiologists. Adherence to MDM advice was analysed in asymptomatic carotid stenosis (ACS), symptomatic carotid stenosis (SCS), 'indeterminate symptomatic status stenosis' (ISS) and vertebral artery stenosis (VAS) patients, including intervals between index event to MDM + / - intervention. RESULTS One hundred fifteen patients were discussed: 108 with carotid stenosis and 7 with VAS. Consensus regarding management was noted in 96.5% (111/115): 100% with ACS and VAS, 96.2% with SCS and 92.9% with ISS. Adherence to MDM management advice was 96.4% (107/111): 100% in ACS, ISS and VAS patients; 92% (46/50) in SCS patients. The median interval from index symptoms to revascularisation in 50-99% SCS patients was 12.5 days (IQR: 9-18.3 days; N = 26), with a median interval from MDM to revascularisation of 5.5 days (IQR: 1-7 days). Thirty patients underwent revascularisation. Two out of twenty-nine patients (6.9%) with either SCS or ISS had a peri-procedural ipsilateral ischaemic stroke, with no further strokes/deaths during 3-months follow-up. CONCLUSIONS The high frequency of inter-specialty consensus regarding management and adherence to proposed treatment supports a collaborative/multidisciplinary model of care in patients with extracranial arterial stenoses. Service development should aim to shorten times between MDM discussion-intervention and optimise prevention of stroke/death.
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Grants
- Meath Foundation, Vascular Neurology Research Foundation,
- The Adelaide Health Foundation Ireland, Enterprise Ireland-Innovation Partnership Programme
- Trinity College Dublin Innovation Bursary, The Meath Foundation, Ireland, Joint Irish Institute of Clinical Neuroscience/Merck Serono Fellowship in Neuroscience Grant, The Vascular Neurology Research Foundation Ireland, Bayer HealthCare, Ireland and Verum
- The Meath Foundation, Ireland; The Adelaide Health Foundation, Ireland; The Vascular Neurology Research Foundation Ireland; the Enterprise Ireland-Innovation Partnership Programme (co-funded by the European Regional Development Fund); and by unrestricted e
- University of Dublin, Trinity College
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Affiliation(s)
- Chika Offiah
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Sean Tierney
- Dept. of Vascular Surgery, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Bridget Egan
- Dept. of Vascular Surgery, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Ronán D Collins
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Daniel J Ryan
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Allan J McCarthy
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Deirdre R Smith
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Vascular Neurology Research Foundation, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - James Mahon
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Emily Boyle
- Dept. of Vascular Surgery, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Holly Delaney
- Dept. of Radiology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Rory O 'Donohoe
- Dept. of Radiology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Alison Hurley
- Dept. of Radiology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Richard A Walsh
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Sinead M Murphy
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Petya Bogdanova-Mihaylova
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Sean O 'Dowd
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Mark J Kelly
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Taha Omer
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Tara Coughlan
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Desmond O'Neill
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Mary Martin
- Dept. of Geriatric and Stroke Medicine, Naas General Hospital, Naas, Ireland
| | - Stephen J X Murphy
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland
| | - Dominick J H McCabe
- Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
- Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
- Vascular Neurology Research Foundation, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
- Dept. of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK.
- Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
- Vascular Neurology Research Foundation, c/o Department of Neurology, Tallaght University Hospital /AMNCH, Tallaght, Dublin, 24, Ireland.
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2
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Van Bael J, Vandenbulcke A, Ahmed-Belkacem A, Guichou JF, Pawlotsky JM, Samyn J, Barendrecht AD, Maas C, De Meyer SF, Vanhoorelbeke K, Tersteeg C. Small-Molecule Cyclophilin Inhibitors Potently Reduce Platelet Procoagulant Activity. Int J Mol Sci 2023; 24:ijms24087163. [PMID: 37108326 PMCID: PMC10139176 DOI: 10.3390/ijms24087163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Procoagulant platelets are associated with an increased risk for thrombosis. Procoagulant platelet formation is mediated via Cyclophilin D (CypD) mediated opening of the mitochondrial permeability transition pore. Inhibiting CypD activity could therefore be an interesting approach to limiting thrombosis. In this study, we investigated the potential of two novel, non-immunosuppressive, non-peptidic small-molecule cyclophilin inhibitors (SMCypIs) to limit thrombosis in vitro, in comparison with the cyclophilin inhibitor and immunosuppressant Cyclosporin A (CsA). Both cyclophilin inhibitors significantly decreased procoagulant platelet formation upon dual-agonist stimulation, shown by a decreased phosphatidylserine (PS) exposure, as well as a reduction in the loss of mitochondrial membrane potential. Furthermore, the SMCypIs potently reduced procoagulant platelet-dependent clotting time, as well as fibrin formation under flow, comparable to CsA. No effect was observed on agonist-induced platelet activation measured by P-selectin expression, as well as CypA-mediated integrin αIIbβ3 activation. Importantly, whereas CsA increased Adenosine 5'-diphosphate (ADP)-induced platelet aggregation, this was unaffected in the presence of the SMCypIs. We here demonstrate specific cyclophilin inhibition does not affect normal platelet function, while a clear reduction in procoagulant platelets is observed. Reducing platelet procoagulant activity by inhibiting cyclophilins with SMCypIs forms a promising strategy to limit thrombosis.
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Affiliation(s)
- Jens Van Bael
- Laboratory for Thrombosis Research, KU Leuven Kulak Kortrijk Campus, 8500 Kortrijk, Belgium
| | - Aline Vandenbulcke
- Laboratory for Thrombosis Research, KU Leuven Kulak Kortrijk Campus, 8500 Kortrijk, Belgium
| | | | - Jean-François Guichou
- Centre de Biologie Structurale (CBS), INSERM U1054, CNRS UMR5048, Université de Montpellier, 34090 Montpellier, France
| | - Jean-Michel Pawlotsky
- Team Viruses, Hepatology Cancer, INSERM U955, 94000 Creteil, France
- National Reference Center for Viral Hepatitis B, C and Delta, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, 94000 Creteil, France
| | - Jelle Samyn
- Laboratory for Thrombosis Research, KU Leuven Kulak Kortrijk Campus, 8500 Kortrijk, Belgium
| | - Arjan D Barendrecht
- Diagnostic Laboratory Research, UMC Utrecht, 3584 CX Utrecht, The Netherlands
| | - Coen Maas
- Diagnostic Laboratory Research, UMC Utrecht, 3584 CX Utrecht, The Netherlands
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Kulak Kortrijk Campus, 8500 Kortrijk, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, KU Leuven Kulak Kortrijk Campus, 8500 Kortrijk, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, KU Leuven Kulak Kortrijk Campus, 8500 Kortrijk, Belgium
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Denorme F, Campbell RA. Procoagulant platelets: novel players in thromboinflammation. Am J Physiol Cell Physiol 2022; 323:C951-C958. [PMID: 35993516 PMCID: PMC9484986 DOI: 10.1152/ajpcell.00252.2022] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022]
Abstract
Platelets play a key role in maintaining hemostasis. However, dysregulated platelet activation can lead to pathological thrombosis or bleeding. Once a platelet gets activated, it will either become an aggregatory platelet or eventually a procoagulant platelet with both types playing distinct roles in thrombosis and hemostasis. Although aggregatory platelets have been extensively studied, procoagulant platelets have only recently come into the spotlight. Procoagulant platelets are a subpopulation of highly activated platelets that express phosphatidylserine and P-selectin on their surface, allowing for coagulation factors to bind and thrombin to be generated. In recent years, novel roles for procoagulant platelets have been identified and they have increasingly been implicated in thromboinflammatory diseases. Here, we provide an up-to-date review on the mechanisms resulting in the formation of procoagulant platelets and how they contribute to hemostasis, thrombosis, and thromboinflammation.
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Affiliation(s)
- Frederik Denorme
- University of Utah Molecular Medicine Program in Molecular Medicine, Salt Lake City, Utah
| | - Robert A Campbell
- University of Utah Molecular Medicine Program in Molecular Medicine, Salt Lake City, Utah
- Division of Microbiology and Pathology, Department of Pathology, University of Utah, Salt Lake City, Utah
- Division of General Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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4
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Subramanian A, Delaney S, Murphy SJX, Smith DR, Offiah C, McMahon J, de Borst GJ, Naylor AR, Hamilton G, Kinsella JA, McCabe DJH. Platelet Biomarkers in Patients with Atherosclerotic Extracranial Carotid Artery Stenosis: A Systematic Review. Eur J Vasc Endovasc Surg 2022; 63:379-389. [PMID: 35181225 DOI: 10.1016/j.ejvs.2021.10.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim was to enhance understanding of the role of platelet biomarkers in the pathogenesis of vascular events and risk stratifying patients with asymptomatic or symptomatic atherosclerotic carotid stenosis. DATA SOURCES Systematic review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. REVIEW METHODS A systematic review collated data from 1975 to 2020 on ex vivo platelet activation and platelet function/reactivity in patients with atherosclerotic carotid stenosis. RESULTS Forty-three studies met the inclusion criteria; the majority included patients on antiplatelet therapy. Five studies showed increased platelet biomarkers in patients with ≥ 30% asymptomatic carotid stenosis (ACS) vs. controls, with one neutral study. Preliminary data from one study suggested that quantification of "coated platelets" in combination with stenosis severity may aid risk stratification in patients with ≥ 50% - 99% ACS. Platelets were excessively activated in patients with ≥ 30% symptomatic carotid stenosis (SCS) vs. controls (≥ 11 positive studies and one neutral study). Antiplatelet-High on Treatment Platelet Reactivity (HTPR), previously called "antiplatelet resistance", was observed in 23% - 57% of patients on aspirin, with clopidogrel-HTPR in 25% - 100% of patients with ≥ 50% - 99% ACS. Aspirin-HTPR was noted in 9.5% - 64% and clopidogrel-HTPR in 0 - 83% of patients with ≥ 50% SCS. However, the data do not currently support the use of ex vivo platelet function/reactivity testing to tailor antiplatelet therapy outside of a research setting. Platelets are excessively activated (n = 5), with increased platelet counts (n = 3) in recently symptomatic vs. asymptomatic patients, including those without micro-emboli on transcranial Doppler (TCD) monitoring (n = 2). Most available studies (n = 7) showed that platelets become more reactive or activated following carotid endarterectomy or stenting, either as an acute phase response to intervention or peri-procedural treatment. CONCLUSION Platelets are excessively activated in patients with carotid stenosis vs. controls, in recently symptomatic vs. asymptomatic patients, and may become activated/hyper-reactive following carotid interventions despite commonly prescribed antiplatelet regimens. Further prospective multicentre studies are required to determine whether models combining clinical, neurovascular imaging, and platelet biomarker data can facilitate optimised antiplatelet therapy in individual patients with carotid stenosis.
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Affiliation(s)
- Arun Subramanian
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Stroke Service, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Siobhan Delaney
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Stroke Service, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Stephen J X Murphy
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Stroke Service, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Deirdre R Smith
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Vascular Neurology Research Foundation, Tallaght University Hospital/ Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Chika Offiah
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Stroke Service, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Jean McMahon
- Tallaght University Hospital Library, Tallaght University Hospital/ Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Netherlands
| | - A Ross Naylor
- The Leicester Vascular Institute, Glenfield Hospital, Leicester, UK
| | - George Hamilton
- Department of Vascular Surgery, University Department of Surgery, Royal Free Hampstead NHS Trust, London, UK
| | - Justin A Kinsella
- Department of Neurology, St Vincent's University Hospital/University College Dublin, Ireland
| | - Dominick J H McCabe
- Department of Neurology, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Stroke Service, Tallaght University Hospital/Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Vascular Neurology Research Foundation, Tallaght University Hospital/ Adelaide and Meath Hospital, Dublin, Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland; Department of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK; Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
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5
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Veninga A, Baaten CCFMJ, De Simone I, Tullemans BME, Kuijpers MJE, Heemskerk JWM, van der Meijden PEJ. Effects of Platelet Agonists and Priming on the Formation of Platelet Populations. Thromb Haemost 2021; 122:726-738. [PMID: 34689320 PMCID: PMC9197595 DOI: 10.1055/s-0041-1735972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Platelets from healthy donors display heterogeneity in responsiveness to agonists. The response thresholds of platelets are controlled by multiple bioactive molecules, acting as negatively or positively priming substances. Higher circulating levels of priming substances adenosine and succinate, as well as the occurrence of hypercoagulability, have been described for patients with ischaemic heart disease. Here, we present an improved methodology of flow cytometric analyses of platelet activation and the characterisation of platelet populations following activation and priming by automated clustering analysis.Platelets were treated with adenosine, succinate, or coagulated plasma before stimulation with CRP-XL, 2-MeSADP, or TRAP6 and labelled for activated integrin αIIbβ3 (PAC1), CD62P, TLT1, CD63, and GPIX. The Super-Enhanced Dmax subtraction algorithm and 2% marker (quadrant) setting were applied to identify populations, which were further defined by state-of-the-art clustering techniques (tSNE, FlowSOM).Following activation, five platelet populations were identified: resting, aggregating (PAC1 + ), secreting (α- and dense-granules; CD62P + , TLT1 + , CD63 + ), aggregating plus α-granule secreting (PAC1 + , CD62P + , TLT1 + ), and fully active platelet populations. The type of agonist determined the distribution of platelet populations. Adenosine in a dose-dependent way suppressed the fraction of fully activated platelets (TRAP6 > 2-MeSADP > CRP-XL), whereas succinate and coagulated plasma increased this fraction (CRP-XL > TRAP6 > 2-MeSADP). Interestingly, a subset of platelets showed a constant response (aggregating, secreting, or aggregating plus α-granule secreting), which was hardly affected by the stimulus strength or priming substances.
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Affiliation(s)
- Alicia Veninga
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Constance C F M J Baaten
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.,Institute for Molecular Cardiovascular Research, University Hospital Aachen, RWTH Aachen University, Germany
| | - Ilaria De Simone
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.,Institute for Cardiovascular and Metabolic Research, University of Reading, Reading, United Kingdom
| | - Bibian M E Tullemans
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Marijke J E Kuijpers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.,Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johan W M Heemskerk
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands
| | - Paola E J van der Meijden
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, The Netherlands.,Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
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6
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Dave RG, Geevar T, Aaron S, Ninan Benjamin R, Mammen J, Kumar S, Vijayan R, Gowri M, C Nair S. Diagnostic utility of flow cytometry based coated-platelets assay as a biomarker to predict thrombotic or hemorrhagic phenotype in acute stroke. CYTOMETRY PART B-CLINICAL CYTOMETRY 2021; 102:246-253. [PMID: 34152689 DOI: 10.1002/cyto.b.22026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coated-platelets are sub-population of platelets "coated" with highly procoagulant proteins and phosphatidylserine that sustains thrombin generation. They are produced upon dual agonist stimulation by collagen and thrombin. This study was conducted to assess if there was any difference in the levels of coated-platelets in patients with primary intracranial hemorrhage (PICH) and ischemic stroke due to large artery atherosclerosis (LAA) as compared to healthy controls, and to see if coated-platelet levels had any influence on the hemorrhagic transformation (HT) of ischemic stroke. METHODS Coated-platelet levels were determined by flow cytometry using fluorescently tagged Annexin V antibody to identify phosphatidylserine exposed on the surface of platelets activated by dual agonists (convulxin and thrombin) in cross-sectional cohort of 75 patients with stroke and 34 controls. RESULTS Patients with PICH (n = 35) had significantly lower coated-platelets than the controls (adjusted mean ± SE, 21.0 ± 1.9% vs. 36.1 ± 1.7%, p < 0.001), while patients with LAA (n = 30) had significantly higher coated-platelets than controls (adjusted mean ± SE, 51.9 ± 1.5% vs. 36.1 ± 1.7%, p < 0.001). Patients with subsequent HT of ischemic stroke (n = 10) had significantly lower coated-platelet levels at admission compared to those without HT (adjusted mean ± SE, 18.1 ± 2.6% vs. 51.9 ± 1.5%, p < 0.001). CONCLUSIONS Coated-platelet levels are significantly different in patients with hemorrhagic and ischemic stroke as compared with controls. Lower levels of coated-platelets measured by flow cytometry may be earliest predictor of subsequent HT in patients with ischemic stroke even before the radiological changes suggestive of HT are visualized.
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Affiliation(s)
- Rutvi Gautam Dave
- Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tulasi Geevar
- Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sanjith Aaron
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Joy Mammen
- Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Snehil Kumar
- Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramya Vijayan
- Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sukesh C Nair
- Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India
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7
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Increased procoagulant platelet levels are predictive of death in COVID-19. GeroScience 2021; 43:2055-2065. [PMID: 34109507 PMCID: PMC8189550 DOI: 10.1007/s11357-021-00385-3] [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: 04/19/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
Prior research has identified abnormal platelet procoagulant responses in COVID-19. Coated-platelets, a form of procoagulant platelets, support thrombin formation and are elevated in ischemic stroke patients with increased risk for recurrent infarction. Our goal was to examine changes in coated-platelet levels over the course of COVID-19 infection and determine their association with disease severity, thrombosis, and death. Coated-platelet levels were assayed after admission and repeated weekly in COVID-19 patients, and in COVID-19 negative controls. Receiver operator characteristic (ROC) analysis was used to calculate area under the curve (AUC) values for a model including baseline coated-platelets to predict death. Kaplan–Meier and Cox proportional hazards analysis was used to predict risk for death at 90 days. We enrolled 33 patients (22 with moderate and 11 with severe infection) and 20 controls. Baseline coated-platelet levels were lower among moderate (mean ± SD; 21.3 ± 9.8%) and severe COVID-19 patients (28.5 ± 11.9%) compared to controls (38.1 ± 10.4%, p < 0.0001). Coated-platelet levels increased during follow-up in COVID-19 patients by 7% (relative) per day from symptom onset (95% CI 2–12%, p = 0.007). A cut-off of 33.9% for coated-platelet levels yielded 80% sensitivity and 96% specificity for death at 90 days, with resulting AUC of 0.880 (95% CI 0.680–1.0, p = 0.0002). The adjusted hazard ratio for death in patients with coated-platelet levels > 33.9% was 40.99 when compared to those with levels ≤ 33.9% (p < 0.0001). Platelet procoagulant potential is transiently decreased in most patients during COVID-19; however, increased baseline platelet procoagulant levels predict death. Defining the mechanisms involved and potential links with aging may yield novel treatment targets.
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Yanofsky R, Sancho C, Gasbarrino K, Zheng H, Doonan RJ, Jaunet F, Steinmetz-Wood S, Veinot JP, Lai C, Daskalopoulou SS. Expression of Resistin, Chemerin, and Chemerin's Receptor in the Unstable Carotid Atherosclerotic Plaque. Stroke 2021; 52:2537-2546. [PMID: 33980047 DOI: 10.1161/strokeaha.120.030228] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Russell Yanofsky
- Division of Internal Medicine, Department of Medicine (R.Y.), McGill University, Montreal, Canada
| | | | - Karina Gasbarrino
- Division of Experimental Medicine, Department of Medicine, Research Institute of McGill University Health Centre (K.G., H.Z., S.S.D.), McGill University, Montreal, Canada
| | - Huaien Zheng
- Division of Experimental Medicine, Department of Medicine, Research Institute of McGill University Health Centre (K.G., H.Z., S.S.D.), McGill University, Montreal, Canada
| | - Robert J Doonan
- Department of Vascular Surgery (R.J.D.), McGill University, Montreal, Canada
| | - Fanny Jaunet
- Department of Biological Engineering, Polytech Nice-Sophia, Biot, France (F.J.)
| | - Samantha Steinmetz-Wood
- Division of Internal Medicine, Department of Medicine, University of Vermont Medical Center, Burlington (S.S.-W.)
| | - John P Veinot
- Department of Pathology and Laboratory Medicine, University of Ottawa Heart Institute, Canada (J.P.V., C.L.)
| | - Chi Lai
- Department of Pathology and Laboratory Medicine, University of Ottawa Heart Institute, Canada (J.P.V., C.L.)
| | - Stella S Daskalopoulou
- Division of Experimental Medicine, Department of Medicine, Research Institute of McGill University Health Centre (K.G., H.Z., S.S.D.), McGill University, Montreal, Canada
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9
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Podoplelova NA, Nechipurenko DY, Ignatova AA, Sveshnikova AN, Panteleev MA. Procoagulant Platelets: Mechanisms of Generation and Action. Hamostaseologie 2021; 41:146-153. [PMID: 33860522 DOI: 10.1055/a-1401-2706] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
During the past decades, it has been increasingly recognized that the major function of accelerating membrane-dependent reactions of blood coagulation is predominantly implemented by a subset of activated platelets. These procoagulant platelets (also called collagen- and thrombin-activated or COAT, coated, necrotic, although there could be subtle differences between these definitions) are uniquely characterized by both procoagulant activity and, at the same time, inactivated integrins and profibrinolytic properties. The mechanisms of their generation both in vitro and in situ have been increasingly becoming clear, suggesting unique and multidirectional roles in hemostasis and thrombosis. In this mini-review, we shall highlight the existing concepts and challenges in this field.
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Affiliation(s)
- N A Podoplelova
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, Moscow, Russia.,National Medical Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russia
| | - D Y Nechipurenko
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, Moscow, Russia.,National Medical Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russia.,Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
| | - A A Ignatova
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, Moscow, Russia.,National Medical Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russia
| | - A N Sveshnikova
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, Moscow, Russia.,National Medical Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russia.,Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
| | - M A Panteleev
- Center for Theoretical Problems of Physicochemical Pharmacology, Russian Academy of Sciences, Moscow, Russia.,National Medical Research Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russia.,Faculty of Physics, Lomonosov Moscow State University, Moscow, Russia
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10
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Aliotta A, Bertaggia Calderara D, Zermatten MG, Marchetti M, Alberio L. Thrombocytopathies: Not Just Aggregation Defects-The Clinical Relevance of Procoagulant Platelets. J Clin Med 2021; 10:jcm10050894. [PMID: 33668091 PMCID: PMC7956450 DOI: 10.3390/jcm10050894] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/31/2021] [Accepted: 02/12/2021] [Indexed: 01/08/2023] Open
Abstract
Platelets are active key players in haemostasis. Qualitative platelet dysfunctions result in thrombocytopathies variously characterized by defects of their adhesive and procoagulant activation endpoints. In this review, we summarize the traditional platelet defects in adhesion, secretion, and aggregation. In addition, we review the current knowledge about procoagulant platelets, focusing on their role in bleeding or thrombotic pathologies and their pharmaceutical modulation. Procoagulant activity is an important feature of platelet activation, which should be specifically evaluated during the investigation of a suspected thrombocytopathy.
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Affiliation(s)
- Alessandro Aliotta
- Hemostasis and Platelet Research Laboratory, Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1010 Lausanne, Switzerland; (A.A.); (D.B.C.); (M.G.Z.); (M.M.)
| | - Debora Bertaggia Calderara
- Hemostasis and Platelet Research Laboratory, Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1010 Lausanne, Switzerland; (A.A.); (D.B.C.); (M.G.Z.); (M.M.)
| | - Maxime G. Zermatten
- Hemostasis and Platelet Research Laboratory, Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1010 Lausanne, Switzerland; (A.A.); (D.B.C.); (M.G.Z.); (M.M.)
| | - Matteo Marchetti
- Hemostasis and Platelet Research Laboratory, Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1010 Lausanne, Switzerland; (A.A.); (D.B.C.); (M.G.Z.); (M.M.)
- Service de Médecine Interne, Hôpital de Nyon, CH-1260 Nyon, Switzerland
| | - Lorenzo Alberio
- Hemostasis and Platelet Research Laboratory, Division of Hematology and Central Hematology Laboratory, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), CH-1010 Lausanne, Switzerland; (A.A.); (D.B.C.); (M.G.Z.); (M.M.)
- Correspondence:
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11
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Kholmukhamedov A. Procoagulant Platelets. Platelets 2020. [DOI: 10.5772/intechopen.92638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There are two well-known subpopulations of activated platelets: pro-aggregatory and procoagulant. Procoagulant platelets represent a subpopulation of activated platelets, which are morphologically and functionally distinct from pro-aggregatory ones. Although various names have been used to describe these platelets in the literature (CoaT, CoaTed, highly activated, ballooned, capped, etc.), there is a consensus on their phenotypic features including exposure of high levels of phosphatidylserine (PSer) on the surface; decreased aggregatory and adhesive properties; support of active tenase and prothrombinase complexes; maximal generation by co-stimulation of glycoprotein VI (GPVI) and protease-activated receptors (PAR). In this chapter, morphologic and functional features of procoagulant platelets, as well as the mechanisms of their formation, will be discussed.
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12
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Murphy SJ, Lim ST, Kinsella JA, Tierney S, Egan B, Feeley TM, Dooley C, Kelly J, Murphy SM, Walsh RA, Collins R, Coughlan T, O'Neill D, Harbison JA, Madhavan P, O'Neill SM, Colgan MP, Meaney JF, Hamilton G, McCabe DJ. Simultaneous assessment of plaque morphology, cerebral micro-embolic signal status and platelet biomarkers in patients with recently symptomatic and asymptomatic carotid stenosis. J Cereb Blood Flow Metab 2020; 40:2201-2214. [PMID: 31711341 PMCID: PMC7585923 DOI: 10.1177/0271678x19884427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The relationship between plaque morphology, cerebral micro-embolic signals (MES) and platelet biomarkers in carotid stenosis patients warrants investigation.We combined data from two prospective, observational studies to assess carotid plaque morphology and relationship with cerebral MES and platelet biomarkers in patients with recently symptomatic (≤4 weeks of transient ischaemic attack (TIA)/ischaemic stroke) versus asymptomatic carotid stenosis. Plaque morphology on ultrasound was graded with Grey-Scale Median (GSM) and Gray-Weale (GW) scoring. Bilateral transcranial Doppler ultrasound classified patients as 'MES+ve' or 'MES-ve'. Full blood counts were analysed and flow cytometry quantified CD62P and CD63 expression, leucocyte-platelet complexes and reticulated platelets.Data from 42 recently symptomatic carotid stenosis patients were compared with those from 36 asymptomatic patients. There were no differences in median GSM scores between symptomatic and asymptomatic patients (25 vs. 30; P = 0.31) or between MES+ve vs. MES-ve symptomatic patients (36 vs. 25; P = 0.09). Symptomatic patients with GSM-echodense plaques (GSM ≥25) had higher platelet counts (228 vs. 191 × 109/L), neutrophil-platelet (3.3 vs. 2.7%), monocyte-platelet (6.3 vs. 4.55%) and lymphocyte-platelet complexes (2.91 vs. 2.53%) than 'asymptomatic patients with GSM-echodense plaques' (P ≤ 0.03).Recently, symptomatic carotid stenosis patients with 'GSM-echodense plaques' have enhanced platelet production/secretion/activation compared with their asymptomatic counterparts. Simultaneous assessment with neurovascular imaging and platelet biomarkers may aid risk-stratification in carotid stenosis.
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Affiliation(s)
- Stephen J Murphy
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland
| | - Soon T Lim
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland
| | - Justin A Kinsella
- Department of Neurology, St Vincent's University Hospital, University College Dublin, Dublin, Ireland
| | - Sean Tierney
- Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland
| | - Bridget Egan
- Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland
| | - Tim M Feeley
- Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Dublin Midlands Hospital Group, Dublin, Ireland
| | - Clare Dooley
- Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland
| | - James Kelly
- Department of Vascular Surgery, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland
| | - Sinead M Murphy
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland
| | - Richard A Walsh
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland
| | - Ronan Collins
- Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland
| | - Tara Coughlan
- Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Department of Medicine for the Elderly/Stroke Service, St James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - Desmond O'Neill
- Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Age-Related Health Care Department, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland
| | - Joseph A Harbison
- Department of Medicine for the Elderly/Stroke Service, St James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - Prakash Madhavan
- Department of Vascular Surgery, St James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - Sean M O'Neill
- Department of Vascular Surgery, St James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - Mary P Colgan
- Centre for Advanced Medical Imaging, Department of Radiology, St James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - Jim F Meaney
- Centre for Advanced Medical Imaging, Department of Radiology, St James's Hospital/Trinity College Dublin, Dublin, Ireland
| | - George Hamilton
- Department of Vascular Surgery, University Department of Surgery, Royal Free Hampstead NHS Trust, London, UK
| | - Dominick Jh McCabe
- Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Stroke Service, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Department of Clinical Neurosciences, Royal Free Campus, UCL Institute of Neurology, London, UK.,Vascular Neurology Research Foundation c/o Department of Neurology, The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital/Tallaght University Hospital, Dublin, Ireland.,Irish Centre for Vascular Biology, Dublin, Ireland.,Stroke Clinical Trials Network Ireland, Dublin, Ireland
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13
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Reddy EC, Rand ML. Procoagulant Phosphatidylserine-Exposing Platelets in vitro and in vivo. Front Cardiovasc Med 2020; 7:15. [PMID: 32195268 PMCID: PMC7062866 DOI: 10.3389/fcvm.2020.00015] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/30/2020] [Indexed: 12/11/2022] Open
Abstract
The physiological heterogeneity of platelets leads to diverse responses and the formation of discrete subpopulations upon platelet stimulation. Procoagulant platelets are an example of such subpopulations, a key characteristic of which is exposure either of the anionic aminophospholipid phosphatidylserine (PS) or of tissue factor on the activated platelet surface. This review focuses on the former, in which PS exposure on a subpopulation of platelets facilitates assembly of the intrinsic tenase and prothrombinase complexes, thereby accelerating thrombin generation on the activated platelet surface, contributing importantly to the hemostatic process. Mechanisms involved in platelet PS exposure, and accompanying events, induced by physiologically relevant agonists are considered then contrasted with PS exposure resulting from intrinsic pathway-mediated apoptosis in platelets. Pathologies of PS exposure, both inherited and acquired, are described. A consideration of platelet PS exposure as an antithrombotic target concludes the review.
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Affiliation(s)
- Emily C Reddy
- Developmental and Stem Cell Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Margaret L Rand
- Division of Haematology/Oncology, Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Departments of Laboratory Medicine & Pathobiology, Biochemistry, and Paediatrics, University of Toronto, Toronto, ON, Canada
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14
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Kirkpatrick AC, Vincent AS, Dale GL, Prodan CI. Increased platelet procoagulant potential predicts recurrent stroke and TIA after lacunar infarction. J Thromb Haemost 2020; 18:660-668. [PMID: 31858724 DOI: 10.1111/jth.14714] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/05/2019] [Accepted: 12/12/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mean levels of coated-platelets, a subset of highly procoagulant platelets, are decreased in patients with lacunar as compared to those with non-lacunar stroke. Elevated coated-platelets are associated with increased risk for recurrent infarction in non-lacunar stroke and predict incident stroke after transient ischemic attack (TIA). OBJECTIVE We investigated if coated-platelet levels are predictive of recurrent cerebral ischemia following lacunar stroke. METHODS Coated-platelet levels were assayed in consecutive patients with acute lacunar stroke, who were followed for up to 12 months. Cox proportional hazards regression analysis was used to estimate the combined risk of stroke and TIA at 12 months according to initial coated-platelet levels. RESULTS We enrolled a total of 109 lacunar stroke patients. Eight events were recorded over a mean follow-up period of 10.8 months. A cut-off of 42.6% for coated-platelet levels yielded a sensitivity of 0.75 (0.35-0.97; 95% confidence interval [CI]), specificity of 0.92 (0.85-0.97), positive predictive value of 0.43 (0.26-0.62), and a negative predictive value of 0.98 (0.93-0.99) for recurrent stroke/TIA. The adjusted hazard ratio for recurrent stroke/TIA in patients with coated-platelet levels ≥ 42.6% was 23.9 (95% CI: 4.26-134.4) when compared to those with levels < 42.6%. CONCLUSIONS Identification of increased platelet procoagulant potential may improve our ability to identify patients at higher risk of recurrent stroke/TIA following a lacunar stroke. Further study of mechanisms involved is warranted and may yield novel targets for prevention and treatment.
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Affiliation(s)
- Angelia C Kirkpatrick
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Andrea S Vincent
- Cognitive Science Research Center, University of Oklahoma, Norman, OK, USA
| | - George L Dale
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin I Prodan
- Veterans Affairs Medical Center, Oklahoma City, OK, USA
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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15
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Lesyk G, Jurasz P. Advances in Platelet Subpopulation Research. Front Cardiovasc Med 2019; 6:138. [PMID: 31572733 PMCID: PMC6753372 DOI: 10.3389/fcvm.2019.00138] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/29/2019] [Indexed: 01/01/2023] Open
Abstract
Although lacking a nucleus, platelets are increasingly recognized not only for their complexity, but also for their diversity. Some 50 years ago platelet subpopulations were characterized by size and density, and these characteristics were thought to reflect platelet aging. Since, our knowledge of platelet heterogeneity has grown to recognize that differences in platelet biochemistry and function exist. This includes the identification of vanguard and follower platelets, platelets with differing procoagulant ability including "COAT-platelets" which enhance procoagulant protein retention on their surface, and most recently, the identification of platelet subpopulations with a differential ability to generate and respond to nitric oxide. Hence, in this mini-review, we summarize the current knowledge of platelet subpopulation diversity focusing on their physical, biochemical, and functional heterogeneity. In addition, we review how platelet subpopulations may change between health and disease and how differences among platelets may influence response to anti-platelet therapy. Finally, we look forward and discuss some of the future directions and challenges for this growing field of platelet research.
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Affiliation(s)
- Gabriela Lesyk
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.,Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada
| | - Paul Jurasz
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada.,Cardiovascular Research Centre, University of Alberta, Edmonton, AB, Canada.,Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB, Canada
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16
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Kirkpatrick AC, Stoner JA, Dale GL, Rabadi M, Prodan CI. Higher Coated-Platelet Levels in Acute Stroke are Associated with Lower Cognitive Scores at Three Months Post Infarction. J Stroke Cerebrovasc Dis 2019; 28:2398-2406. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/14/2019] [Accepted: 06/24/2019] [Indexed: 12/24/2022] Open
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17
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Kirkpatrick AC, Vincent AS, Dale GL, Prodan CI. Clopidogrel use and smoking cessation result in lower coated-platelet levels after stroke. Platelets 2019; 31:236-241. [PMID: 31043107 DOI: 10.1080/09537104.2019.1609661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Coated-platelets are a subset of highly procoagulant platelets elevated in patients with non-lacunar ischemic stroke and associated with stroke recurrence. Cross-sectional studies in controls have shown that smoking is associated with higher coated-platelet levels while chronic use of serotonin reuptake inhibitors (SSRIs), statins or aspirin is associated with lower coated-platelet levels. We now investigate if initiation of treatment with SSRIs, statins, clopidogrel, aspirin or oral anticoagulants and smoking cessation impacts coated-platelet levels at 90 days after ischemic stroke. Coated-platelet levels, reported as percent of cells converted to coated-platelets, were measured in 87 consecutive patients with stroke at baseline and repeated at 90 days. Repeated-measure ANOVA was used to determine if initiation of treatment with individual medications or smoking cessation impacted coated-platelet levels. Decreased coated-platelets levels at 90 days as compared to baseline were observed after initiation of treatment with clopidogrel (p = .0001, partial η2 = 0.17) and smoking cessation (p = .014, partial η2 = 0.10). Initiation of treatment with SSRIs, statins, aspirin or oral anticoagulants did not result in significant changes in coated-platelet potential. These novel longitudinal data suggest that clopidogrel therapy and smoking cessation attenuate coated-platelet potential at 90 days after ischemic stroke.
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Affiliation(s)
- Angelia C Kirkpatrick
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Veterans Affairs Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andrea S Vincent
- Cognitive Science Research Center, University of Oklahoma, Norman, OK, USA
| | - George L Dale
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin I Prodan
- Veterans Affairs Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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18
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Guo L, Zhou D, Wu D, Ding J, He X, Shi J, Duan Y, Yang T, Ding Y, Ji X, Meng R. Short-term remote ischemic conditioning may protect monkeys after ischemic stroke. Ann Clin Transl Neurol 2019; 6:310-323. [PMID: 30847363 PMCID: PMC6389742 DOI: 10.1002/acn3.705] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/01/2018] [Accepted: 11/07/2018] [Indexed: 12/20/2022] Open
Abstract
Objective We aimed to evaluate the safety and effectiveness of short-term remote ischemic postconditioning (RIPC) in acute stroke monkey models. Methods Acute stroke monkeys were allocated to four groups based on the number of limbs exposed to RIPC. RIPC was initiated by 5-min cuff inflation/deflation cycles of the target limb(s) for 5-10 bouts. Vital signs, skin integrity, brain MRI, and serum levels of cardiac enzymes (myoglobin, creatine kinase [CK], CK-muscle/brain [CK-MB]), one inflammatory marker (high-sensitivity C-reactive protein [hsCRP], and one endothelial injury marker (von Willebrand factor [vWF]) were assessed. Spetzler scores were used to assess neurological function. Results No significant differences in vital signs or local skin integrity were found. Short-term RIPC did not reduce infarct volume under any condition at the 24th hour after stroke. However, neurological function improved in multi-limb RIPC compared with sham and single-limb RIPC at the 30th day follow-up after stroke. Myoglobin, CK, and CK-MB levels were reduced after multi-limb RIPC, regardless of the number of bouts. Moreover, multi-limb RIPC produced a greater diminution in CK-MB levels, whereas two-limb RIPC was more effective in reducing serum CK levels at the 24th hour after stroke. hsCRP increased after 5 bouts of multi-limb RIPC before decreasing below baseline and single-limb RIPC levels. Serum vWF was decreased at later time points after RIPC in all RIPC groups. Conclusions Stroke monkeys in hyperacute stage may benefit from short-term RIPC; however, whether this intervention can be translated into clinical use in patients with acute ischemic stroke warrants further study.
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Affiliation(s)
- Linlin Guo
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China.,Beijing Geriatric Hospital Beijing China.,China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China.,Center of Stroke Beijing Institute for Brain Disorders Beijing China
| | - Da Zhou
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China.,China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China.,Center of Stroke Beijing Institute for Brain Disorders Beijing China
| | - Di Wu
- China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China.,Center of Stroke Beijing Institute for Brain Disorders Beijing China
| | - Jiayue Ding
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China.,China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China.,Center of Stroke Beijing Institute for Brain Disorders Beijing China
| | - Xiaoduo He
- China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China
| | - Jingfei Shi
- China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China
| | - Yunxia Duan
- China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China
| | - Tingting Yang
- China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China.,Center of Stroke Beijing Institute for Brain Disorders Beijing China
| | - Yuchuan Ding
- China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China.,Center of Stroke Beijing Institute for Brain Disorders Beijing China.,Department of Neurosurgery Wayne State University School of Medicine Detroit Michigan
| | - Xunming Ji
- China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China.,Center of Stroke Beijing Institute for Brain Disorders Beijing China.,Department of Neurosurgery Xuanwu Hospital Capital Medical University Beijing China
| | - Ran Meng
- Department of Neurology Xuanwu Hospital Capital Medical University Beijing China.,China-America Institute of Neuroscience Xuanwu Hospital Capital Medical University Beijing China.,Center of Stroke Beijing Institute for Brain Disorders Beijing China
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19
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Nechipurenko DY, Receveur N, Yakimenko AO, Shepelyuk TO, Yakusheva AA, Kerimov RR, Obydennyy SI, Eckly A, Léon C, Gachet C, Grishchuk EL, Ataullakhanov FI, Mangin PH, Panteleev MA. Clot Contraction Drives the Translocation of Procoagulant Platelets to Thrombus Surface. Arterioscler Thromb Vasc Biol 2019; 39:37-47. [DOI: 10.1161/atvbaha.118.311390] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
After activation at the site of vascular injury, platelets differentiate into 2 subpopulations, exhibiting either proaggregatory or procoagulant phenotype. Although the functional role of proaggregatory platelets is well established, the physiological significance of procoagulant platelets, the dynamics of their formation, and spatial distribution in thrombus remain elusive.
Approach and Results—
Using transmission electron microscopy and fluorescence microscopy of arterial thrombi formed in vivo after ferric chloride–induced injury of carotid artery or mechanical injury of abdominal aorta in mice, we demonstrate that procoagulant platelets are located at the periphery of the formed thrombi. Real-time cell tracking during thrombus formation ex vivo revealed that procoagulant platelets originate from different locations within the thrombus and subsequently translocate towards its periphery. Such redistribution of procoagulant platelets was followed by generation of fibrin at thrombus surface. Using in silico model, we show that the outward translocation of procoagulant platelets can be driven by the contraction of the forming thrombi, which mechanically expels these nonaggregating cells to thrombus periphery. In line with the suggested mechanism, procoagulant platelets failed to translocate and remained inside the thrombi formed ex vivo in blood derived from nonmuscle myosin (
MYH9
)-deficient mice. Ring-like distribution of procoagulant platelets and fibrin around the thrombus observed with blood of humans and wild-type mice was not present in thrombi of
MYH9
-knockout mice, confirming a major role of thrombus contraction in this phenomenon.
Conclusions—
Contraction of arterial thrombus is responsible for the mechanical extrusion of procoagulant platelets to its periphery, leading to heterogeneous structure of thrombus exterior.
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Affiliation(s)
- Dmitry Y. Nechipurenko
- From the Department of Physics, Lomonosov Moscow State University, Russia (D.Y.N., R.R.K., F.I.A., M.A.P.)
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
| | - Nicolas Receveur
- INSERM, Etablissement Français du Sang-Grand Est, UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France (N.R., A.E., C.L., C.G., P.H.M.)
| | - Alena O. Yakimenko
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
| | - Taisiya O. Shepelyuk
- Faculty of Basic Medicine, Lomonosov Moscow State University, Russia (T.O.S.)
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
| | - Alexandra A. Yakusheva
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
| | - Roman R. Kerimov
- From the Department of Physics, Lomonosov Moscow State University, Russia (D.Y.N., R.R.K., F.I.A., M.A.P.)
| | - Sergei I. Obydennyy
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
| | - Anita Eckly
- INSERM, Etablissement Français du Sang-Grand Est, UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France (N.R., A.E., C.L., C.G., P.H.M.)
| | - Catherine Léon
- INSERM, Etablissement Français du Sang-Grand Est, UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France (N.R., A.E., C.L., C.G., P.H.M.)
| | - Christian Gachet
- INSERM, Etablissement Français du Sang-Grand Est, UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France (N.R., A.E., C.L., C.G., P.H.M.)
| | - Ekaterina L. Grishchuk
- Department of Physiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (E.L.G.)
| | - Fazoil I. Ataullakhanov
- From the Department of Physics, Lomonosov Moscow State University, Russia (D.Y.N., R.R.K., F.I.A., M.A.P.)
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Department of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia (F.I.A., M.A.P.)
| | - Pierre H. Mangin
- INSERM, Etablissement Français du Sang-Grand Est, UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, France (N.R., A.E., C.L., C.G., P.H.M.)
| | - Mikhail A. Panteleev
- From the Department of Physics, Lomonosov Moscow State University, Russia (D.Y.N., R.R.K., F.I.A., M.A.P.)
- Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology, and Immunology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia (D.Y.N., A.O.Y., T.O.S., A.A.Y., S.I.O., F.I.A., M.A.P.)
- Department of Biological and Medical Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia (F.I.A., M.A.P.)
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20
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Mezei G, Debreceni IB, Kerenyi A, Remenyi G, Szasz R, Illes A, Kappelmayer J, Batar P. Dasatinib inhibits coated-platelet generation in patients with chronic myeloid leukemia. Platelets 2018; 30:836-843. [DOI: 10.1080/09537104.2018.1501470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gabriella Mezei
- Department of Hematology, University of Debrecen, Debrecen, Hungary
| | - Ildiko Beke Debreceni
- Clinical Center, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Adrienne Kerenyi
- Clinical Center, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Gyula Remenyi
- Department of Hematology, University of Debrecen, Debrecen, Hungary
| | - Robert Szasz
- Department of Hematology, University of Debrecen, Debrecen, Hungary
| | - Arpad Illes
- Department of Hematology, University of Debrecen, Debrecen, Hungary
| | - Janos Kappelmayer
- Clinical Center, Department of Laboratory Medicine, University of Debrecen, Debrecen, Hungary
| | - Peter Batar
- Department of Hematology, University of Debrecen, Debrecen, Hungary
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21
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Tafur AJ, Fuentes H, Caprini JA, Rivas A, Uresandi F, Duce R, Lopez-Reyes R, Visona A, Merah A, Monreal M. Predictors of Early Mortality in Cancer-Associated Thrombosis: Analysis of the RIETE Database. TH OPEN 2018; 2:e158-e166. [PMID: 31249939 PMCID: PMC6524871 DOI: 10.1055/s-0038-1642022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/13/2018] [Indexed: 12/13/2022] Open
Abstract
Cancer-associated thrombosis (CT) carries a high, heterogeneous, and poorly predicted likelihood of mortality. Thus, we aimed to define predictors of 30-day mortality in 10,025 patients with CT. In a randomly selected derivation cohort, we used recursive partitioning analysis to detect variables that select for a risk of mortality within 30 days. In a validation cohort, we evaluated our results using Cochran–Armitage test. The most common types of cancer were lung (16%), breast (14%), and colorectal (14%); median age was 69 years (range, 14–101); most had metastatic disease (63%); 13% of patients died within 30 days. In the derivation cohort (
n
= 6,660), a white blood cell (WBC) count in the highest quartile predicted early mortality (odds ratio, 7.8; 95% confidence interval [CI], 4.6–13.1); and the presence of metastatic disease, pulmonary embolism (PE), and immobility defined the risk of those with normal WBC count. We defined death risk according four sequential questions: (1) Does the patient have an elevated WBC count? (Yes, group D). (2) If no, does the patient have metastasis? (No, group A). (3) If yes, is the patient immobile? (Yes, group D). (4) If no, does the patient have a PE? (Yes, group C; no, group B). In the validation cohort (
n
= 3,365), the 30-day risk of death was 2.9% in group A (95% CI, 1.9–4.3), compared with 25% in group D (95% CI, 22.5–27.5), and there was a rate escalation between groups (
p
for trend < 0.01). In conclusion, with four sequential questions, the risk of death in CT can be easily stratified. An elevated WBC count at baseline predicted 30-day mortality better than metastases, PE, or immobility.
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Affiliation(s)
- Alfonso J Tafur
- NorthShore University HealthSystem, Evanston, Illinois, United States
| | - Harry Fuentes
- John Stroger Cook County Hospital, Chicago, Illinois, United States
| | - Joseph A Caprini
- NorthShore University HealthSystem, Evanston, Illinois, United States
| | | | - F Uresandi
- Hospital de Cruces, Barakaldo, Vizcaya, Spain
| | | | | | - Adriana Visona
- Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
| | - Adel Merah
- Université Jean-Monnet, Service de Medecine Vasculaire et Therapeutique, CHU de Saint Etienne, Saint-Etienne, France
| | - Manuel Monreal
- Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Barcelona, Spain
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22
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Mattheij NJA, Swieringa F, Mastenbroek TG, Berny-Lang MA, May F, Baaten CCFMJ, van der Meijden PEJ, Henskens YMC, Beckers EAM, Suylen DPL, Nolte MW, Hackeng TM, McCarty OJT, Heemskerk JWM, Cosemans JMEM. Coated platelets function in platelet-dependent fibrin formation via integrin αIIbβ3 and transglutaminase factor XIII. Haematologica 2015; 101:427-36. [PMID: 26721892 DOI: 10.3324/haematol.2015.131441] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 12/23/2015] [Indexed: 11/09/2022] Open
Abstract
Coated platelets, formed by collagen and thrombin activation, have been characterized in different ways: i) by the formation of a protein coat of α-granular proteins; ii) by exposure of procoagulant phosphatidylserine; or iii) by high fibrinogen binding. Yet, their functional role has remained unclear. Here we used a novel transglutaminase probe, Rhod-A14, to identify a subpopulation of platelets with a cross-linked protein coat, and compared this with other platelet subpopulations using a panel of functional assays. Platelet stimulation with convulxin/thrombin resulted in initial integrin α(IIb)β3 activation, the appearance of a platelet population with high fibrinogen binding, (independently of active integrins, but dependent on the presence of thrombin) followed by phosphatidylserine exposure and binding of coagulation factors Va and Xa. A subpopulation of phosphatidylserine-exposing platelets bound Rhod-A14 both in suspension and in thrombi generated on a collagen surface. In suspension, high fibrinogen and Rhod-A14 binding were antagonized by combined inhibition of transglutaminase activity and integrin α(IIb)β3 Markedly, in thrombi from mice deficient in transglutaminase factor XIII, platelet-driven fibrin formation and Rhod-A14 binding were abolished by blockage of integrin α(IIb)β3. Vice versa, star-like fibrin formation from platelets of a patient with deficiency in α(IIb)β3(Glanzmann thrombasthenia) was abolished upon blockage of transglutaminase activity. We conclude that coated platelets, with initial α(IIb)β3 activation and high fibrinogen binding, form a subpopulation of phosphatidylserine-exposing platelets, and function in platelet-dependent star-like fibrin fiber formation via transglutaminase factor XIII and integrin α(IIb)β3.
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Affiliation(s)
- Nadine J A Mattheij
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
| | - Frauke Swieringa
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
| | - Tom G Mastenbroek
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
| | - Michelle A Berny-Lang
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | | | - Constance C F M J Baaten
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
| | - Paola E J van der Meijden
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
| | - Yvonne M C Henskens
- Central Diagnostic Laboratory, Maastricht University Medical Center, The Netherlands
| | - Erik A M Beckers
- Department of Internal Medicine, Maastricht University Medical Center, The Netherlands
| | - Dennis P L Suylen
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
| | | | - Tilman M Hackeng
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
| | - Owen J T McCarty
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Johan W M Heemskerk
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
| | - Judith M E M Cosemans
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands
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23
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Tafur AJ, Dale G, Cherry M, Wren JD, Mansfield AS, Comp P, Rathbun S, Stoner JA. Prospective evaluation of protein C and factor VIII in prediction of cancer-associated thrombosis. Thromb Res 2015; 136:1120-5. [PMID: 26475410 PMCID: PMC4679511 DOI: 10.1016/j.thromres.2015.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/02/2015] [Accepted: 10/04/2015] [Indexed: 12/12/2022]
Abstract
Venous thromboembolism (VTE) is a preventable disease, yet it is one of the leading causes of death among patients with cancer. Improving risk stratification mechanisms will allow us to personalize thrombo-prophylaxis strategies. We sought to evaluate Collagen and Thrombin Activated Platelets (COAT-platelets) as well as protein C and factor VIII as biomarkers predictive of cancer-associated thrombosis in a prospective cohort of patients with cancer. Protein C was selected as a candidate based on bioinformatics prediction. Blood samples were collected before chemotherapy. All specimen processing was blinded to clinical data. Surveillance and adjudication of the main outcome of VTE was performed for up to 1 year. We used Cox proportional hazard regression to measure the association of biomarkers and incident events using SAS 9.2 for all statistical analysis. Death was modeled as a competing event. Among 241 patients followed for an average of 10.4 months, 15% died and 13% developed a VTE. COAT-platelets were not predictive of VTE. Low levels of pre-chemotherapy protein C (<118%) (HR 2.5; 95% CI 1.1-5.5) and high baseline factor VIII (>261% I) (HR 3.0; 95% CI 1.1-8.0) were predictive of VTE after adjusting for age, Khorana prediction risk, metastatic disease and D dimer. In addition, low protein C was predictive of overall mortality independent of age, metastatic disease and functional status (HR 2.8; 95% CI 1.3-6.0). Addition of these biomarkers to cancer-VTE risk prediction models may add to risk stratification and patient selection to optimize thrombo-prophylaxis.
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Affiliation(s)
- A J Tafur
- Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States.
| | - G Dale
- Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States
| | - M Cherry
- Department of Medicine - Hematology-Oncology section, University of Oklahoma Health Sciences Center, United States
| | - J D Wren
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, United States
| | - A S Mansfield
- Department of Oncology, Division of Medical Oncology, Mayo Clinic Rochester, United States
| | - P Comp
- Department of Medicine - Hematology-Oncology section, University of Oklahoma Health Sciences Center, United States
| | - S Rathbun
- Department of Medicine - Cardiology-Vascular Section, University of Oklahoma Health Sciences Center, United States
| | - J A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, United States
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24
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Sabour S. Letter by Sabour regarding article, "coated-platelets improve prediction of stroke and transient ischemic attack in asymptomatic internal carotid artery stenosis". Stroke 2014; 46:e46. [PMID: 25503554 DOI: 10.1161/strokeaha.114.007780] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Siamak Sabour
- Safety Promotion and Injury Prevention Research Center, and Department of Clinical Epidemiology, School of Health, Shahid Beheshti University of Medical Sciences, Tehran, I.R. Iran
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25
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Kirkpatrick AC, Tafur AJ, Prodan CI. Response to letter regarding article, "coated-platelets improve prediction of stroke and transient ischemic attack in asymptomatic internal carotid artery stenosis". Stroke 2014; 46:e47. [PMID: 25503548 DOI: 10.1161/strokeaha.114.007864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Alfonso J Tafur
- Department of Medicine, University of Oklahoma Health Sciences Center
| | - Calin I Prodan
- Department of Neurology, University of Oklahoma Health Sciences Center
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