1
|
Al-Ghafry M, Abou-Ismail MY, Acharya SS. Inherited Disorders of the Fibrinolytic Pathway: Pathogenic Phenotypes and Diagnostic Considerations of Extremely Rare Disorders. Semin Thromb Hemost 2024. [PMID: 39299257 DOI: 10.1055/s-0044-1789596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
Fibrinolysis is initiated by the activation of plasminogen to plasmin via tissue-plasminogen activator (tPA) and urokinase-plasminogen activator (uPA); plasmin then converts fibrin to fibrin degradation products (FDPs). The antifibrinolytics counterbalancing this system include plasminogen activator inhibitor-1 (PAI-1), which inhibits tPA and uPA, α-2 antiplasmin (α2AP), which inhibits plasmin, and thrombin activatable fibrinolysis inhibitor, which inhibits the conversion of fibrin to FDP. Inherited disorders of the fibrinolytic pathway are rare and primarily have hemorrhagic phenotypes in humans: PAI-1 deficiency, α2AP deficiency, and Quebec platelet disorder. Patients with these disorders are usually treated for bleeds or receive prophylaxis to prevent bleeds in the surgical setting, with pharmacological antifibrinolytics such as aminocaproic acid and tranexamic acid. Disorders of the fibrinolytic pathway with fibrin deposition are extremely rare, mostly noted in patients with plasminogen deficiency, who have more recently benefited from advances in human plasma-derived plasminogen concentrates administered intravenously or locally. These disorders can be very difficult to diagnose using conventional or even specialized coagulation testing, as testing can be nonspecific or have low sensitivity. Testing of the corresponding protein's activity and antigen (where applicable) can be obtained in specialized centres, and routine laboratory measures are not diagnostic. Genetic testing of the pathogenic mutations is recommended in patients with a high suspicion of an inherited disorder of the fibrinolytic pathway.
Collapse
Affiliation(s)
- Maha Al-Ghafry
- Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Mouhamed Yazan Abou-Ismail
- Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Suchitra S Acharya
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant - Cohen Children's Medical Center, New Hyde Park, New York
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| |
Collapse
|
2
|
Sharma S, Jamwal M, Uppal V, Senee HK, Jindal M, Ahluwalia J, Das R, Varma N, Malhotra P, Kumar N. Plasminogen Activator Inhibitor-1 4G/5G Promoter Polymorphism in Indian Patients with Deep Vein Thrombosis. Indian J Hematol Blood Transfus 2024; 40:331-334. [PMID: 38708166 PMCID: PMC11065813 DOI: 10.1007/s12288-023-01660-3] [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: 09/05/2022] [Accepted: 04/17/2023] [Indexed: 05/07/2024] Open
Abstract
A single guanosine deletion/insertion (4G/5G) polymorphism in the promoter region of plasminogen activator inhibitor-1 (PAI-1) gene encoding PAI-1 protein has been investigated in deep vein thrombosis (DVT) patients. The association between PAI-1 4G/5G polymorphism and increased risk of DVT has been reported in some studies, while others have reported a lack of association. The present study aimed to investigate if the PAI-1 4G/5G polymorphism is associated with an increased risk of DVT in the Indian population and to assess its association with thrombophilic risk factors. Fifty-two adult patients with a history of chronic or recurrent DVT and 52 healthy adult controls were genotyped for PAI-1 4G/5G polymorphism. Plasma levels of PAI-1 and other thrombophilic risk factors were also measured. PAI-1 4G/5G polymorphism was not significantly associated with an increased risk of DVT. Protein C deficiency was significantly associated with the 4G/4G genotype. Patients with the 4G/4G genotype had significantly reduced PAI-1 levels as compared to the controls. PAI-1 4G/5G polymorphism did not significantly contribute to an increased risk of DVT in the Indian population. However, in the presence of thrombophilic risk factor abnormalities, the risk of DVT is increased in individuals with the 4G/4G genotype in the Indian cohort. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-023-01660-3.
Collapse
Affiliation(s)
- Saniya Sharma
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Manu Jamwal
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Varun Uppal
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Hari Kishan Senee
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Manav Jindal
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Jasmina Ahluwalia
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Reena Das
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Neelam Varma
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| | - Narender Kumar
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012 India
| |
Collapse
|
3
|
Reda S, Schwarz N, Müller J, McRae HL, Oldenburg J, Pötzsch B, Rühl H. Fibrinolysis biomarker, thrombin, and activated protein C level alterations after coagulation activation depend on type of thrombophilia and clinical phenotype. Res Pract Thromb Haemost 2024; 8:102351. [PMID: 38487678 PMCID: PMC10937968 DOI: 10.1016/j.rpth.2024.102351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/14/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024] Open
Abstract
Background Recently, we have shown alterations in the anticoagulant response to recombinant activated factor VII (rFVIIa)-induced coagulation activation in patients with thrombophilia. Objectives This study aimed to extend this in vivo model to fibrinolysis biomarkers. Methods This interventional in vivo study included 56 patients with thrombophilia and previous venous thromboembolism (VTE+), 38 without VTE (VTE-), and 35 healthy controls. Plasma levels of D-dimer, plasmin-α2-antiplasmin (PAP) complex, and plasminogen activator inhibitor-1 (PAI-1) were monitored for over 8 hours after rFVIIa infusion (15 μg/kg) along with thrombin markers and activated protein C (APC). Results Throughout cohorts, median PAP increased by 40% to 52% (P < 3.9 × 10-10) and PAI-1 decreased by 59% to 79% (P < 3.5 × 10-8). In contrast to thrombin-antithrombin (TAT) complex, which also increased temporarily (44% to 115%, P < 3.6 × 10-6), changes in PAP and PAI-1 did not reverse during the observation period. The area under the measurement-time curves (AUCs) of PAP and TAT, which are measures of plasmin and thrombin formation, respectively, were each greater in the VTE+ cohort than in healthy controls (median PAP-AUC = 0.48 vs 0.27 ng·h/L [P = .003], TAT-AUC = 0.12 vs 0.03 nmol·h/L [P = 2.5 × 10-4]) and were correlated with one another (r = 0.554). As evidenced by the respective AUCs, asymptomatic factor (F)V Leiden carriers showed less PAP formation (0.22 vs 0.41 ng·h/L, P = 9 × 10-4), more pronounced PAI-1 decline (0.10 vs 0.18 ng·h/L, P = .01), and increased APC formation (28.7 vs 15.4 pmol·h/L, P = .02) than those within the VTE+ group (n = 19 each). Conclusion rFVIIa-induced thrombin formation is associated with fibrinolysis parameter changes outlasting the concomitant anticoagulant response. Both correlate with thrombosis history in FV Leiden and might help explain its variable clinical expressivity.
Collapse
Affiliation(s)
- Sara Reda
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Nadine Schwarz
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Jens Müller
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Hannah L. McRae
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Bernd Pötzsch
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Heiko Rühl
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
4
|
Morrow GB, Mutch NJ. Past, Present, and Future Perspectives of Plasminogen Activator Inhibitor 1 (PAI-1). Semin Thromb Hemost 2023; 49:305-313. [PMID: 36522166 DOI: 10.1055/s-0042-1758791] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Plasminogen activator inhibitor 1 (PAI-1), a SERPIN inhibitor, is primarily known for its regulation of fibrinolysis. However, it is now known that this inhibitor functions and contributes to many (patho)physiological processes including inflammation, wound healing, cell adhesion, and tumor progression.This review discusses the past, present, and future roles of PAI-1, with a particular focus on the discovery of this inhibitor in the 1970s and subsequent characterization in health and disease. Throughout the past few decades diverse functions of this serpin have unraveled and it is now considered an important player in many disease processes. PAI-1 is expressed by numerous cell types, including megakaryocytes and platelets, adipocytes, endothelial cells, hepatocytes, and smooth muscle cells. In the circulation PAI-1 exists in two pools, within plasma itself and in platelet α-granules. Platelet PAI-1 is secreted following activation with retention of the inhibitor on the activated platelet membrane. Furthermore, these anucleate cells contain PAI-1 messenger ribonucleic acid to allow de novo synthesis.Outside of the traditional role of PAI-1 in fibrinolysis, this serpin has also been identified to play important roles in metabolic syndrome, obesity, diabetes, and most recently, acute respiratory distress syndrome, including coronavirus disease 2019 disease. This review highlights the complexity of PAI-1 and the requirement to ascertain a better understanding on how this complex serpin functions in (patho)physiological processes.
Collapse
Affiliation(s)
- Gael B Morrow
- Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicola J Mutch
- Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| |
Collapse
|
5
|
Sánchez LM, Snarr BS, Soni H, Lee-Kim Y, Cohen CT. Arterial thrombosis in a newborn with homozygous plasminogen activator inhibitor-1 4G/4G polymorphism. Pediatr Blood Cancer 2022; 69:e29586. [PMID: 35147281 DOI: 10.1002/pbc.29586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/02/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Luisanna M Sánchez
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Brian S Snarr
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Heather Soni
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - YoungNa Lee-Kim
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Clay T Cohen
- Department of Pediatrics, Section of Hematology-Oncology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
6
|
Cutaneous Ulcer Caused by Apixaban Treatment Is Resolved after Replacement with Dabigatran. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58050691. [PMID: 35630109 PMCID: PMC9146744 DOI: 10.3390/medicina58050691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022]
Abstract
Nowadays, novel oral anticoagulants (NOACs) have shown improved safety profile and efficacy compared to vitamin K antagonists in the prevention of thromboembolic events occurring during different pathological conditions. However, there are concerns and safety issues, mostly related to adverse events following interactions with other drugs, in real-world practice. We report the case of an 83-year-old woman who developed a non-bleeding leg ulcer not caused by trauma or other evident pathological conditions after 10 days of treatment with apixaban 5 mg/q.d. She was switched from apixaban to dabigatran and the leg ulcer rapidly improved and completely cicatrized in 40 days. The resolution of the ulcer and the toleration of dabigatran therapy suggest an apixaban-specific reaction; however, the pathological mechanism of ulcer onset is currently unclear. Careful evaluation of hospital databases of Molise region (Southern Italy) hospitals identified two similar cases between 2019 and 2021. These cases underline the necessity of careful post-marketing surveillance, considering the rapidly increasing number of patients treated with NOACs and patient’s risk factors such as old age, high polypharmacy rate, co-morbidities, and peculiar genetic background related to NOACs pharmacokinetic features.
Collapse
|
7
|
Kollabathula A, Sharma S, Kumar N, Ahluwalia J, Das R, Varma N, Rana SS. Plasminogen Activator Inhibitor-1 4G/5G Promoter Polymorphism in Adults with Splanchnic Vein Thrombosis: A Case-Control Study. Indian J Hematol Blood Transfus 2022; 38:169-172. [PMID: 35125725 PMCID: PMC8804071 DOI: 10.1007/s12288-021-01454-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/03/2021] [Indexed: 01/03/2023] Open
Abstract
The role of PAI-1 4G/5G polymorphism in venous thrombosis is unclear. PAI-1 4G/4G genotype is associated with elevated levels of PAI-1 resulting in a hypofibrinolytic state and hence increased thrombotic risk. In this study, we assessed the role of PAI-1 4G/5G promoter polymorphism in adult patients with splanchnic vein thrombosis. A total of 40 cases (portal vein thrombosis and Budd-Chiari syndrome) and 40 healthy controls were evaluated for the PAI-1 4G/5G polymorphism by amplification refractory mutation system polymerase chain reaction along with thrombophilia workup. The frequency of PAI-1 4G/4G homozygous, 4G/5G heterozygous and 5G/5G homozygous genotypes were 17.5%, 42.5% and 40%, respectively among cases and 22.5%, 50% and 27.5%, respectively among controls and the difference was not statistically significant (p = 0.61). The PAI-1 4G/4G genotype was significantly associated with the cases with deranged thrombophilic risk factor (both inherited and acquired) (p = 0.02). SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12288-021-01454-5.
Collapse
Affiliation(s)
- Arpitha Kollabathula
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Saniya Sharma
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Narender Kumar
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Jasmina Ahluwalia
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Reena Das
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Neelam Varma
- Department of Hematology, Level 5, Research Block A, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh, 160012 India
| |
Collapse
|
8
|
Assessment of fibrinolytic markers in patients with deep vein thrombosis. Blood Coagul Fibrinolysis 2021; 33:113-118. [DOI: 10.1097/mbc.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
Williams PT. Quantile-specific heritability of plasminogen activator inhibitor type-1 (PAI-1, aka SERPINE1) and other hemostatic factors. J Thromb Haemost 2021; 19:2559-2571. [PMID: 34273240 DOI: 10.1111/jth.15468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/07/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Plasminogen activator inhibitor type-1 (PAI-1, aka SERPINE1) is a moderately heritable glycoprotein that regulates fibrin clot dissolution (fibrinolysis). OBJECTIVES Test whether the heritabilities (h2 ) of PAI-1 and other hemostatic factors are constant throughout their distribution or whether they are quantile-specific (i.e., a larger or smaller h2 depending on whether their concentrations are high or low). METHODS Quantile regression was applied to 5606 parent-offspring pairs and 5310 full siblings of the Framingham Heart Study. Quantile-specific heritability was estimated from the parent-offspring regression slope (βPO , h2 = 2βPO /(1+rspouse )) and the full-sib regression slope (βFS , h2 = {(1+8rspouse βFS )0.5 -1}/(2rspouse )). RESULTS Heritability (h2 ± SE) increased significantly with increasing percentiles of the offspring's age- and sex-adjusted PAI-1 distribution when estimated from βPO (plinear trend = 0.0001): 0.09 ± 0.02 at the 10th, 0.09 ± 0.02 at the 25th, 0.16 ± 0.02 at the 50th, 0.29 ± 0.04 at the 75th, and 0.26 ± 0.08 at the 90th percentile of the PAI-1 distribution, and when estimated from βFS (plinear trend = 6.5x10-7 ). There was no significant evidence for quantile-specific heritability for factor VII (plinear trend = 0.35), D-dimer (plinear trend = 0.08), tPA (plinear trend = 0.74), or von Willebrand factor (plinear trend = 0.79). CONCLUSION Higher mean plasma PAI-1 antigen concentrations tend to accentuate genetic effects (quantile-dependent expressivity), which is consistent with the greater reported differences in PAI-1 concentrations between rs1799889 SERPINE1 (4G/5G) genotypes in patients with osteonecrosis, meningococcal sepsis, obesity, prior myocardial infarction, deep vein thrombosis, and polycystic ovarian syndrome than in healthy controls. It is also consistent with the greater increases in PAI-1 concentrations in 4G-allele carriers than 5G/5G homozygotes following fibrinolytic treatment, low-salt intake, and high saturated fat intake.
Collapse
Affiliation(s)
- Paul T Williams
- Lawrence Berkeley National Laboratory, Molecular Biophysics & Integrated Bioimaging Division, Berkeley, CA, USA
| |
Collapse
|
10
|
Genotype Variations and Association between PAI-1 Promoter Region (4G/5G and -844G/A) and Susceptibility to Acute Myocardial Infarction and Chronic Stable Angina. Cardiol Res Pract 2021; 2021:5551031. [PMID: 34258054 PMCID: PMC8257367 DOI: 10.1155/2021/5551031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/28/2021] [Accepted: 05/30/2021] [Indexed: 11/29/2022] Open
Abstract
The present study aimed at investigating the 4G/5G and -844G/A polymorphisms and plasma concentration of PAI-1 in patients with acute myocardial infarction (AMI) and chronic stable angina (CSA) in Indian population. It included 100 patients with AMI and stable angina and 100 healthy controls. All study subjects were typed for two PAI polymorphisms (4G/5G and -844G/A) through PCR-RFLP and level of PAI through ELISA. The comparison of AMI and CSA independently with control in terms of PAI-1 level was statistically significant but not between AMI and CSA. The frequency of 4G/4G and 4G/5G genotype and 4G allele was significantly higher in AMI cases than in control and was found to increase the risk of AMI. There was a significant relationship between 4G/5G polymorphism and AMI risk under the dominant and codominant genotype. The frequency of 4G/4G genotype and 4G allele was significantly higher in CSA cases than in control group and increases the risk of CSA. There was no significant association between 4G/5G polymorphism and CSA risk under recessive, dominant, and codominant models. The genotype and allelic frequencies difference between the cases (AMI and CSA) and control with regard to -844G/A polymorphisms were statistically nonsignificant. Also, we did not detect any significant association of -844G/A polymorphism with AMI and CSA in recessive, dominant, and codominant models. Along with the traditional risk factors, the 4G/5G allele polymorphism is an independent risk factor for the development of AMI. The detection of 4G/5G allele may therefore be helpful in primary prevention. Patients who carry the 4G/5G allele polymorphism have high concentrations of PAI-1, which might be involved in incidents leading to AMI. The present study for the first time revealed significant association of 4G/5G allele polymorphism with high risk of AMI in Indian population and will be helpful in identifying the genetic risk factors associated with AMI and CSA and for better management of diagnostic measures.
Collapse
|
11
|
Morrow GB, Whyte CS, Mutch NJ. A Serpin With a Finger in Many PAIs: PAI-1's Central Function in Thromboinflammation and Cardiovascular Disease. Front Cardiovasc Med 2021; 8:653655. [PMID: 33937363 PMCID: PMC8085275 DOI: 10.3389/fcvm.2021.653655] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/23/2021] [Indexed: 12/27/2022] Open
Abstract
Plasminogen activator inhibitor 1 (PAI-1) is a member of the serine protease inhibitor (serpin) superfamily. PAI-1 is the principal inhibitor of the plasminogen activators, tissue plasminogen activator (tPA), and urokinase-type plasminogen activator (uPA). Turbulence in the levels of PAI-1 tilts the balance of the hemostatic system resulting in bleeding or thrombotic complications. Not surprisingly, there is strong evidence that documents the role of PAI-1 in cardiovascular disease. The more recent uncovering of the coalition between the hemostatic and inflammatory pathways has exposed a distinct role for PAI-1. The storm of proinflammatory cytokines liberated during inflammation, including IL-6 and TNF-α, directly influence PAI-1 synthesis and increase circulating levels of this serpin. Consequently, elevated levels of PAI-1 are commonplace during infection and are frequently associated with a hypofibrinolytic state and thrombotic complications. Elevated PAI-1 levels are also a feature of metabolic syndrome, which is defined by a cluster of abnormalities including obesity, type 2 diabetes, hypertension, and elevated triglyceride. Metabolic syndrome is in itself defined as a proinflammatory state associated with elevated levels of cytokines. In addition, insulin has a direct impact on PAI-1 synthesis bridging these pathways. This review describes the key physiological functions of PAI-1 and how these become perturbed during disease processes. We focus on the direct relationship between PAI-1 and inflammation and the repercussion in terms of an ensuing hypofibrinolytic state and thromboembolic complications. Collectively, these observations strengthen the utility of PAI-1 as a viable drug target for the treatment of various diseases.
Collapse
Affiliation(s)
- Gael B Morrow
- Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.,Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Claire S Whyte
- Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Nicola J Mutch
- Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| |
Collapse
|
12
|
Barinotti A, Radin M, Cecchi I, Foddai SG, Rubini E, Roccatello D, Sciascia S, Menegatti E. Genetic Factors in Antiphospholipid Syndrome: Preliminary Experience with Whole Exome Sequencing. Int J Mol Sci 2020; 21:E9551. [PMID: 33333988 PMCID: PMC7765384 DOI: 10.3390/ijms21249551] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 12/18/2022] Open
Abstract
As in many autoimmune diseases, the pathogenesis of the antiphospholipid syndrome (APS) is the result of a complex interplay between predisposing genes and triggering environmental factors, leading to a loss of self-tolerance and immune-mediated tissue damage. While the first genetic studies in APS focused primarily on the human leukocytes antigen system (HLA) region, more recent data highlighted the role of other genes in APS susceptibility, including those involved in the immune response and in the hemostatic process. In order to join this intriguing debate, we analyzed the single-nucleotide polymorphisms (SNPs) derived from the whole exome sequencing (WES) of two siblings affected by APS and compared our findings with the available literature. We identified genes encoding proteins involved in the hemostatic process, the immune response, and the phospholipid metabolism (PLA2G6, HSPG2, BCL3, ZFAT, ATP2B2, CRTC3, and ADCY3) of potential interest when debating the pathogenesis of the syndrome. The study of the selected SNPs in a larger cohort of APS patients and the integration of WES results with the network-based approaches will help decipher the genetic risk factors involved in the diverse clinical features of APS.
Collapse
Affiliation(s)
- Alice Barinotti
- Center of Research of Immunopathology and Rare Diseases—Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, 10154 Turin, Italy; (A.B.); (M.R.); (I.C.); (S.G.F.); (E.R.); (D.R.); (E.M.)
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10125 Turin, Italy
| | - Massimo Radin
- Center of Research of Immunopathology and Rare Diseases—Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, 10154 Turin, Italy; (A.B.); (M.R.); (I.C.); (S.G.F.); (E.R.); (D.R.); (E.M.)
| | - Irene Cecchi
- Center of Research of Immunopathology and Rare Diseases—Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, 10154 Turin, Italy; (A.B.); (M.R.); (I.C.); (S.G.F.); (E.R.); (D.R.); (E.M.)
| | - Silvia Grazietta Foddai
- Center of Research of Immunopathology and Rare Diseases—Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, 10154 Turin, Italy; (A.B.); (M.R.); (I.C.); (S.G.F.); (E.R.); (D.R.); (E.M.)
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10125 Turin, Italy
| | - Elena Rubini
- Center of Research of Immunopathology and Rare Diseases—Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, 10154 Turin, Italy; (A.B.); (M.R.); (I.C.); (S.G.F.); (E.R.); (D.R.); (E.M.)
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases—Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, 10154 Turin, Italy; (A.B.); (M.R.); (I.C.); (S.G.F.); (E.R.); (D.R.); (E.M.)
- Nephrology and Dialysis, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital and University of Turin, 10154 Turin, Italy
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases—Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, 10154 Turin, Italy; (A.B.); (M.R.); (I.C.); (S.G.F.); (E.R.); (D.R.); (E.M.)
- Nephrology and Dialysis, Department of Clinical and Biological Sciences, S. Giovanni Bosco Hospital and University of Turin, 10154 Turin, Italy
| | - Elisa Menegatti
- Center of Research of Immunopathology and Rare Diseases—Coordinating Center of Piemonte and Aosta Valley Network for Rare Diseases, S. Giovanni Bosco Hospital, Department of Clinical and Biological Sciences, University of Turin, 10154 Turin, Italy; (A.B.); (M.R.); (I.C.); (S.G.F.); (E.R.); (D.R.); (E.M.)
- Department of Clinical and Biological Sciences, School of Specialization of Clinical Pathology, University of Turin, 10125 Turin, Italy
| |
Collapse
|
13
|
Stewart LK, Kline JA. Fibrinolytics for the treatment of pulmonary embolism. Transl Res 2020; 225:82-94. [PMID: 32434005 PMCID: PMC7487055 DOI: 10.1016/j.trsl.2020.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/07/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
The use of fibrinolytic agents in acute pulmonary embolism (PE), first described over 50 years ago, hastens the resolution of RV stain, leading to earlier hemodynamic improvement. However, this benefit comes at the increased risk of bleeding. The strongest indication for fibrinolysis is in high-risk PE, or that characterized by sustained hypotension, while its use in patients with intermediate-risk PE remains controversial. Fibrinolysis is generally not recommended for routine use in intermediate-risk PE, although most guidelines advise that it may be considered in patients with signs of acute decompensation and an overall low bleeding risk. The efficacy of fibrinolysis often varies significantly between patients, which may be at least partially explained by several factors found to promote resistance to fibrinolysis. Ultimately, treatment decisions should carefully weigh the risks and benefits of the individual clinical scenario at hand, including the overall severity, the patient's bleeding risk, and the presence of factors known to promote resistance to fibrinolysis. This review aims to further explore the use of fibrinolytic agents in the treatment of PE including specific indications, outcomes, and special considerations.
Collapse
Affiliation(s)
- Lauren K Stewart
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Jeffrey A Kline
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
14
|
Chiu D, Weinberger J. Cerebral Venous Sinus Thrombosis and Acute Myocardial Infarction in a Patient with PAI-1 4G/4G Homozygosity. J Stroke Cerebrovasc Dis 2020; 29:105250. [PMID: 33066907 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/09/2020] [Accepted: 08/11/2020] [Indexed: 11/28/2022] Open
Abstract
The plasminogen activator inhibitor-1 (PAI-1) 4G/4G homozygous genotype represents a genetic thrombophilia that has been associated with enhanced risk of arterial and venous thrombotic events. The optimal anticoagulation strategy for PAI-1 4G homozygous patients is unclear. Herein we present a case of a patient with PAI-1 4G/4G homozygosity who was placed on dabigatran after developing cerebral venous sinus thrombosis (CVST), but who then suffered an acute myocardial infarction several weeks later. We seek to highlight the relationship between the PAI-1 4G/4G genotype and risk of CVST, as well as discuss our management strategy in the aftermath of dabigatran failure.
Collapse
Affiliation(s)
- Daniel Chiu
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1137, New York, NY 10029; Department of Neurology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029.
| | - Jesse Weinberger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029
| |
Collapse
|
15
|
Hussein TM, Abd Elmoaty Elneily D, Mohamed Abdelfattah Elsayed F, El-Attar LM. Genetic risk factors for venous thromboembolism among infertile men with Klinefelter syndrome. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2020; 20:100228. [PMID: 32577403 PMCID: PMC7303976 DOI: 10.1016/j.jcte.2020.100228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 11/13/2022]
Abstract
Infertile males with KS have sex-chromosome abnormalities, endocrinal disturbances and other health problems. Hereditary thrombophilia may exacerbate tendency to thrombosis in KS patients. Genotype and allele frequency of thrombophilic gene variants were remarkably high in men with KS. The coexistence of different mutant alleles was evident in infertile KS males.
Background Klinefelter syndrome (KS) is one of the commonest sex chromosome disorders. Affected males become infertile and highly susceptible to several health problems, including vascular thromboembolism (VTE). The risk of VTE may be exacerbated by an underlying genetically inherited thrombophilia. In this study, we aimed to investigate the genotype and allele frequencies of common gene polymorphisms related to hereditary thrombophilia in infertile males with KS compared to normal, fertile men. Methods Eighty-five infertile males with KS and 75 healthy control males were included in this case-control study. Genetic testing was done using an extended thrombophilia gene panel by Multiplex PCR reverse hybridization method. Results There was an increased frequency of mutant alleles and heterozygous genotypes of FV Leiden, FV H 1299R, Pro G20210A, MTHFR C677T and PAI-1 4G/5G thrombophilic gene polymorphisms in KS patients compared to the control group. It was shown that 10.7% of KS patients had the A3 haplotype of the EPCR gene in comparison to 5.3% of control patients. The A3/A3 genotype was found only in KS patients (7.1%). Carriers of more than one mutant allele in KS patients exceeded the control (p < 0.001). Conclusion A high prevalence of thrombophilic gene polymorphisms and the coexistence of different mutant alleles were evident in infertile KS males. These data highlight the importance of conducting further studies to understand the role of hereditary thrombophilia in predicting venous thrombosis in patients with Klinefelter syndrome.
Collapse
Key Words
- APC, activated protein C
- Allele frequency
- BMI, Body mass index
- EPCR, Endothelial protein C receptor
- FSH, Follicle stimulating hormone
- FV Leiden, Factor V leiden
- Genotype
- HDL, High density lipoprotein
- Hereditary thrombophilia
- Klinefelter syndrome
- LDL, Low density lipoprotein
- LH, Luteinizing hormone
- MAF, Minor Allele Frequency
- MTHFR, 5, 10-methylene tetrahydrofolate reductase
- PAI-1, plasminogen activator inhibitor 1
- PROCR, Protein C receptor gene
- PTH, Prothrombin
- Polymorphism
- SNP, Single Nucleotide Polymorphism
- VTE, Venous thromboembolism
- VTE, thrombosis
Collapse
Affiliation(s)
- Tarek M Hussein
- Dermatology and Andrology Department, Alexandria University, Alexandria, Egypt
| | - Dalia Abd Elmoaty Elneily
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Lama M El-Attar
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| |
Collapse
|
16
|
Geng B, Li S, Zhou J, Feng G. Correlation between PAI-1 rs1799889 polymorphism and venous thromboembolism: A meta-analysis of 48 case-control studies. Phlebology 2020; 35:472-479. [PMID: 31948344 DOI: 10.1177/0268355519897552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND We performed this meta-analysis to better assess the relationship between plasminogen activator inhibitor-1 (PAI-1) rs1799889 polymorphism and the risk of venous thromboembolism. METHOD Eligible studies were searched in PubMed, Medline, Embase, Web of Science and CNKI. Odds ratios with 95% confidence intervals were calculated. RESULT A total of 48 studies with 14,806 participants were analyzed. No positive results were detected in overall analyses. Further subgroup analyses revealed that the PAI-1 rs1799889 polymorphism was significantly associated with the risk of venous thromboembolism in Caucasians and East Asians. When we stratified available data according to type of disease, we found that the PAI-1 rs1799889 polymorphism was significantly correlated with the risk of DVT. No any other positive results were observed in overall and subgroup analyses. CONCLUSION Our findings indicate that the PAI-1 rs1799889 polymorphism may serve as a potential biological marker for venous thromboembolism in Caucasians and East Asians.
Collapse
Affiliation(s)
- Baoyu Geng
- Department of Cardiology, Taixing People's Hospital of Jiangsu Province, Taixing, China
| | - Shenghui Li
- Department of Cardiology, Taixing People's Hospital of Jiangsu Province, Taixing, China
| | - Jungao Zhou
- Department of Cardiology, Taixing People's Hospital of Jiangsu Province, Taixing, China
| | - Guangzhi Feng
- Department of Cardiology, Taixing People's Hospital of Jiangsu Province, Taixing, China
| |
Collapse
|
17
|
Javanshir E, Sadat-Ebrahimi SR, Parvizi R, Toufan M, Sate H. Giant mass but small symptoms; huge thrombosis in the right atrium originating from the superior vena cava and protruding to the right ventricle: a case report. J Med Case Rep 2019; 13:312. [PMID: 31627731 PMCID: PMC6800504 DOI: 10.1186/s13256-019-2240-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/21/2019] [Indexed: 11/24/2022] Open
Abstract
Background Thrombosis of the superior vena cava with propagation to the right heart chambers can be seen in the presence of chronic indwelling catheters. Moreover, the idiopathic right atrial thrombi may become entrapped in Chiari’s networks, and idiopathic thrombosis of the superior vena cava may occur rarely because of the underlying coagulation disorders or malignancies. Case presentation A 43-year-old Iranian (Persian) woman was admitted to our hospital with palpitation of 2 years’ duration and mild to moderate dyspnea of 10 days’ duration. Her past medical history, basic laboratory test results, and cardiac enzyme measurements were unremarkable. Imaging studies revealed a 1.4-cm × 7.4-cm multilobulated, hypermobile mass in the right atrium, extending into the right ventricle, that appeared to be emanating from the superior vena cava. Moreover, partial filling defects were visible in the distal parts of both right and left pulmonary arteries extending to their branches, suggesting massive pulmonary emboli. The patient’s huge mass and emboli were removed by surgery, and pathologic evaluations confirmed that all of the specimens were thrombosis. A number of mutations known as risk factors of thrombosis were detected during genetic evaluations. However, mild symptoms of the patient along with a huge mass in the right atrium, thrombosis in the superior vena cava, and massive thromboembolism remained unexplained. Conclusion Huge and dangerous thrombosis inside the heart and superior vena cava can evolve without expected considerable symptoms. Also, detecting the underlying causes of these thromboses sometimes is not feasible by only checking the prevalent known risk factors. Therefore, comprehensive evaluations should be carried out in these patients.
Collapse
Affiliation(s)
- Elnaz Javanshir
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyyed-Reza Sadat-Ebrahimi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. .,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Rezayat Parvizi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrnoosh Toufan
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hosein Sate
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
18
|
Dugalic S, Petronijevic M, Stefanovic A, Stefanovic K, Perovic M, Pantic I, Vrzic Petronijevic S, Stanisavljevic D, Zaric M. Perinatal complications related to inherited thrombophilia: review of evidence in different regions of the world. J Matern Fetal Neonatal Med 2019; 34:2567-2576. [PMID: 31547728 DOI: 10.1080/14767058.2019.1669017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The term thrombophilia describes disorders associated with an increased predisposition of developing venous thromboembolism (VTE). It may be acquired, like in those with antiphospholipid syndrome or inherited. The aim of this review was to compare the complications and outcomes of pregnancies in women with inherited thrombophilia between different populations, including the population of our country where the results of the research are scarce. The review of literature included all papers indexed on PubMed and Medline in the last 20 years, with different study design, including other reviews of literature, systematic reviews with meta-analysis and several case-control studies and population-based cohort studies. We aimed to cover as many geographic regions as possible with the aim to show the differences in the different parts of the world and including our country. Our analysis showed that types of thrombophilia differ in different geographic regions. Also, the differences exist between one particular type of thrombophilia in different regions. Nevertheless, no matter what the differences are between prevalence, all authors investigated the association between inherited thrombophilia and poor pregnancy outcome and managed to find some kind of association. The case with our own country is similar. Although we lack in studies with this issue and the design of published studies is not powerful enough, we may conclude that in our samples, women with thrombophilia are in potential risk of several poor pregnancy outcomes. Further and better analyses are necessary to prove this hypothesis not only on the level of study sample but also on general population. Given the fact that thrombophilia certainly affects the pregnancy and its outcome, the urge to perform screening tests in every woman suspected to have this kind of disorder and with respect to differences that exist in different world regions is inevitable.
Collapse
Affiliation(s)
- Stefan Dugalic
- Clinical Centre of Serbia, Clinic for Gynecology and Obstetrics, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milos Petronijevic
- Clinical Centre of Serbia, Clinic for Gynecology and Obstetrics, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Stefanovic
- Clinical Centre of Serbia, Clinic for Gynecology and Obstetrics, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Katarina Stefanovic
- Clinical Centre of Serbia, Clinic for Gynecology and Obstetrics, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milan Perovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Gynecology and Obstetrics "Narodni front", Belgrade, Serbia
| | - Igor Pantic
- Laboratory for Cellular Physiology, Institute of Medical Physiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,University of Haifa, Haifa, Israel
| | - Svetlana Vrzic Petronijevic
- Clinical Centre of Serbia, Clinic for Gynecology and Obstetrics, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dejana Stanisavljevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milica Zaric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
19
|
Alotaibi FT, Peng B, Klausen C, Lee AF, Abdelkareem AO, Orr NL, Noga H, Bedaiwy MA, Yong PJ. Plasminogen activator inhibitor-1 (PAI-1) expression in endometriosis. PLoS One 2019; 14:e0219064. [PMID: 31315131 PMCID: PMC6637014 DOI: 10.1371/journal.pone.0219064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/14/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose Deep infiltrating endometriosis (DIE) is defined as an endometriotic lesion penetrating to a depth of >5 mm and is associated with pelvic pain, but the underlying mechanisms are unclear. Our objective is to investigate whether plasminogen activator inhibitor-1 expression (PAI-1) in endometriotic tissues is increased in women with DIE. Methods In this blinded in vitro study, immunohistochemistry and Histoscore were used to examine the expression of PAI-1 in glandular epithelium (GECs) and stroma (SCs) in a total of 62 women: deep infiltrating uterosacral/rectovaginal endometriosis (DIE; n = 13), ovarian endometrioma (OMA; n = 14), superficial peritoneal uterosacral/cul-de-sac endometriosis (SUP; n = 23), uterine (eutopic) endometrium from women with endometriosis (UE; n = 6), and non-endometriosis eutopic endometrium (UC; n = 6). The following patient characteristics were also collected: age, American Fertility Society stage, hormonal suppression, phase of menstrual cycle, dysmenorrhea score and deep dyspareunia score. Results PAI-1 expression in GECs and SCs of the DIE group was significantly higher than that of SUP group (p = 0.01, p = 0.01, respectively) and UE group (p = 0.03, p = 0.04, respectively). Interestingly, increased PAI-1 expression in GECs and SCs was also significantly correlated with increased dysmenorrhea (r = 0.38, p = 0.01; r = 0.34, p = 0.02, respectively). Conclusions We found higher expression of PAI-1 in DIE, and an association between PAI-1 and worse dysmenorrhea.
Collapse
Affiliation(s)
- Fahad T. Alotaibi
- Department of Obstetrics & Gynaecology, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, Canada
| | - Bo Peng
- Department of Obstetrics & Gynaecology, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, Canada
| | - Christian Klausen
- Department of Obstetrics & Gynaecology, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, Canada
| | - Anna F. Lee
- Department of Obstetrics & Gynaecology, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, Canada
| | - Amr O. Abdelkareem
- Department of Obstetrics & Gynaecology, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, Canada
| | - Natasha L. Orr
- Department of Obstetrics & Gynaecology, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, Canada
| | - Heather Noga
- Department of Obstetrics & Gynaecology, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, Canada
| | - Mohamed A. Bedaiwy
- Department of Obstetrics & Gynaecology, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, Canada
| | - Paul J. Yong
- Department of Obstetrics & Gynaecology, BC Children’s Hospital Research Institute, The University of British Columbia, Vancouver, Canada
- * E-mail:
| |
Collapse
|
20
|
Adler G, Mahmutbegovic E, Valjevac A, Adler MA, Mahmutbegovic N, Safranow K, Czerska E, Pawinska-Matecka A, Ciechanowicz I, Marjanovic D. Association Between - 675 ID, 4G/5G PAI-1 Gene Polymorphism and Pregnancy Loss: A Systematic Review. Acta Inform Med 2018; 26:156-159. [PMID: 30515004 PMCID: PMC6195400 DOI: 10.5455/aim.2018.26.156-159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Several analysis for different population conclude that endothelial plasminogen activator inhibitor 1 gene polymorphism, -675 ID, 4G/5G PAI-1 (ref SNP ID: rs1799889, also described as rs34857375, has merged into rs1799762) may increase risk of pregnancy loss (PL). However, there is a disagreement as to the association 4G allele with pregnancy loss. Aim Therefore, we decided to investigate the -675 ID, 4G/5G PAI-1 as a potential genetic factor linked to PL in European and worldwide populations. A systematic review of the scientific literature was conducted with the use of the PubMed and Scopus electronic databases (1991-present), using the following search terms: pregnancy loss, miscarriage, genetic risk of thrombophilia, rs1799889 PAI-1 gen, 4G/5G PAI-1 gene polymorphism, PAI-1 gene locus 4G/5G polymorphism. Results Among European populations, the statistically significant association between 4G allele and recurrent PL only in Czechs and Bulgarian women was found (p<0.002 and p=0.018, respectively); while, among populations outside Europe in Iranian, Tunisian and Turkish women (each p<0.001). Conclusions We concluded, that both in Europe and elsewhere in the world, the high frequency of 4G allele in population, is not unambiguously linked with the risk of pregnancy loss.
Collapse
Affiliation(s)
- Grazyna Adler
- Department of Studies in Antropogenetics and Biogerontology, Pomeranian Medical University, Szczecin, Poland
| | - Emir Mahmutbegovic
- Institution of Health Protection of Women and Motherhood Canton Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amina Valjevac
- Laboratory for Molecular Medicine, Center for Genetics, Medical Faculty, University of Sarajevo, Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Nevena Mahmutbegovic
- Neurology Clinic, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Polandl
| | - Ewa Czerska
- Central Laboratory, Regional Hospital, Szczecin, Poland
| | | | | | - Damir Marjanovic
- International Burch University, Bosnia and Herzegovina.,Institute for Anthropological Research, Zagreb, Croatia
| |
Collapse
|
21
|
Proprotein convertase subtilisin/kexin type 9 (PCSK9) Deficiency is Protective Against Venous Thrombosis in Mice. Sci Rep 2017; 7:14360. [PMID: 29084995 PMCID: PMC5662614 DOI: 10.1038/s41598-017-14307-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/09/2017] [Indexed: 12/13/2022] Open
Abstract
The effect of lipid lowering on the incidence of deep venous thrombosis (DVT) is controversial. The purpose of this study was to determine the effect of proprotein convertase subtilisin/kexin type 9 (PCSK9) deficiency on development of DVT in mice. Pcsk9 deficient (pcsk9 -/-) and wild-type (WT) littermates underwent partial inferior vena cava (IVC) ligation to induce venous thrombosis. 48 hours following IVC ligation, IVC thrombosis was evident in 60% of WT mice and 25% of pcsk9 -/- mice (p < 0.05). Analysis of IVC thrombosis revealed greater thrombus weight, length, myeloid cell recruitment, and more neutrophil extracellular trap formation (NETs) in WT compared to pcsk9 -/- mice. Intravital microscopy performed two hours following partial IVC ligation revealed that leukocyte firm attachment was increased in WT mice compared to mice undergoing a sham operation, however leukocyte attachment was reduced in pcsk9 -/- mice compared to WT mice. In conclusion, deficiency of PCSK9 is associated with protection from venous thrombosis. This protection is associated with reduced leukocyte recruitment and NET formation at the site of thrombosis.
Collapse
|
22
|
Prabhudesai A, Shetty S, Ghosh K, Kulkarni B. Investigation of Plasminogen Activator Inhibitor-1 (PAI-1) 4G/5G promoter polymorphism in Indian venous thrombosis patients: A case-control study. Eur J Haematol 2017; 99:249-254. [PMID: 28561456 DOI: 10.1111/ejh.12912] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of PAI-1 4G/5G polymorphism in venous thrombosis has been contradictory. PAI-1 4G/4G genotype is associated with elevated levels of PAI-1 resulting in a hypofibrinolytic state and a higher thrombotic risk. OBJECTIVE In this study, the distribution of genotypes and frequency of alleles of the 4G/5G polymorphism of PAI-1 gene in Indian patients with different types of venous thrombosis was investigated for its role in development of thrombosis. METHOD A total of 87 portal vein thrombosis (PVT), 71 Budd-Chiari syndrome (BCS), 156 cerebral vein thrombosis (CVT), and 163 deep vein thrombosis (DVT) patients were studied alongside 251 healthy controls for the PAI-1 4G/5G polymorphism by allele-specific PCR. RESULTS Frequency of 4G/4G genotype was higher in all groups in comparison with controls. 4G/4G was associated with PVT risk (OR=2.51, 95% CI=1.29-4.96, P=.0075), BCS risk (OR=5.98, 95% CI=2.68-13.42, P<.0001), and DVT risk (OR=1.75, 95% CI=0.98-3.02, P=.0225). This is the first case-control study from India establishing PAI-1 4G/4G as a strong risk factor for abdominal thrombosis (PVT and BCS). Statistically significant association was not found between 4G/4G genotype and CVT risk. CONCLUSION PAI-1 4G/4G is a strong risk factor for venous thrombosis in Indian patients and should be included in laboratory testing panel of thrombophilia.
Collapse
Affiliation(s)
- Aniket Prabhudesai
- Department of Thrombosis and Haemostasis, KEM Hospital, National Institute of Immunohaematology (ICMR), Parel, Mumbai, India
| | - Shrimati Shetty
- Department of Thrombosis and Haemostasis, KEM Hospital, National Institute of Immunohaematology (ICMR), Parel, Mumbai, India
| | - Kanjaksha Ghosh
- Surat Raktadan Kendra & Research Centre, Regional Blood Transfusion Centre, Surat, Gujarat, India
| | - Bipin Kulkarni
- Department of Thrombosis and Haemostasis, KEM Hospital, National Institute of Immunohaematology (ICMR), Parel, Mumbai, India
| |
Collapse
|
23
|
Plasminogen activator inhibitor-1 4G/5G genotype and residual venous occlusion following acute unprovoked deep vein thrombosis of the lower limb: A prospective cohort study. Thromb Res 2017; 153:71-75. [DOI: 10.1016/j.thromres.2017.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 12/27/2022]
|
24
|
Nair V, Yanamandra U, Kumud R, Ghosh K. PAI-1 polymorphism as a cause of severe high altitude associated arteriovenous thrombosis. BMJ Case Rep 2016; 2016:bcr-2016-217361. [PMID: 27881587 DOI: 10.1136/bcr-2016-217361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a 34-year-old man who developed disseminated intra-arterial and venous thrombosis following exposure to extreme high altitude. On evaluation, the patient was found to have thrombosis involving the aorta, bilateral iliac arteries and middle cerebral artery. On detailed evaluation for the cause of recurrent seizures, he was also found to have cerebral venous thrombosis of the superior sagittal sinus. The patient underwent amputation of 3 limbs due to gangrene. Procoagulant work up revealed increased plasminogen activator inhibitor-1 activity with 4G/4G polymorphism. This case highlights the life-threatening and limb-threatening thrombosis secondary to a rare inherited thrombophilia on exposure to extreme high altitude.
Collapse
Affiliation(s)
- Velu Nair
- Armed Forces Medical Services, Army Medical Corps (Indian Army), New Delhi, India
| | - Uday Yanamandra
- Department of Internal Medicine, Armed Forces Medical College, Pune, Maharashtra, India.,Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Rai Kumud
- Department of Vascular Surgery, Max Super Specialty Hospital, New Delhi, Delhi, India
| | - Kanjakya Ghosh
- Department of Immunohematology & Hematopathology, Surat Raktadan Kendra & Research Centre, Surat, Gujarat, India
| |
Collapse
|
25
|
Glueck CJ, Goldenberg N, Wang P, Aregawi D. Ramifications of Four Concurrent Thrombophilic Mutations and One Hypofibrinolytic Mutation. Clin Appl Thromb Hemost 2016; 10:365-71. [PMID: 15497023 DOI: 10.1177/107602960401000409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A kindred was examined in which the 48-year-old white female proband with three deep venous thrombosis-pulmonary emboli events had four thrombophilic and one hypofibrinolytic mutations, and in which her 14-year-old asymptomatic daughter had four thrombophilic mutations. The proband was heterozygous for the G1691A factor V Leiden, G20210A prothrombin, and platelet glycoprotein IIIa PL A1/A2 mutations, had high factor VIII (221%), and was homozygous for the 4G4G plasminogen activator inhibitor-1 gene mutation, with high plasminogen activator inhibitor activity (23.7 U/mL). Her 14-year-old daughter was homozygous for the G1691A factor V Leiden and platelet glycoprotein IIb-IIIa PL A2/A2 mutations, compound heterozygous for the C677T and A1298C methylenetetrahydrofolate reductase (MTHFR) mutations, and heterozygous for the G20210A prothrombin mutation, a combination with an estimated likelihood of 1.6 × 10-7. In 247 white healthy controls, there was no V Leiden homozygosity and no V Leiden-prothrombin gene compound heterozygosity. Heterozygosity for the V Leiden and prothrombin gene mutations was 3.2% and 4.1%, respectively. Homozygosity for the platelet glycoprotein IIb-IIIa PL A2A2, PAI-1 gene 4G4G, and C677T MTHFR mutations was 3.2%, 22.7%, and 12%, respectively. The proband will receive anticoagulation therapy for life. Beyond aspirin, avoidance of exogenous estrogens, and enoxaparin prophylaxis during pregnancy, it is not known whether the proband’s daughter should have lifelong anticoagulation therapy, or only after her first thrombotic event.
Collapse
|
26
|
Seheult JN, Chibisov I. A Case of Unexplained Cerebral Sinus Thrombosis in a 22-Year-Old Obese Caucasian Woman. Lab Med 2016; 47:233-40. [PMID: 27287941 DOI: 10.1093/labmed/lmw023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Herein, we present the case of a 22-year old obese Caucasian woman female with no acquired thrombophilic risk factors who was diagnosed with extensive cerebral sinus thrombosis. A detailed thrombophilia workup demonstrated persistently elevated plasminogen activator inhibitor 1 (PAI-1) activity levels, with an elevated PAI-1 antigen concentration and homozygosity for the PAI-1 4G allele (4G/4G genotype). The patient was treated with indefinite warfarin anticoagulation medication due to the unprovoked nature of her thrombotic event. Disturbances in the fibrinolytic system, in particular PAI-1, have been related to an increased risk of arterial and venous thrombosis. In this article, we discuss the pathophysiology of hypofibrinolysis associated with elevated PAI-1 levels and the PAI-1 4G/5G polymorphism.
Collapse
Affiliation(s)
- Jansen N Seheult
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA,
| | - Irina Chibisov
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, Institute for Transfusion Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, PA
| |
Collapse
|
27
|
Zilio M, Mazzai L, Sartori MT, Barbot M, Ceccato F, Daidone V, Casonato A, Saggiorato G, Noventa F, Trementino L, Prandoni P, Boscaro M, Arnaldi G, Scaroni C. A venous thromboembolism risk assessment model for patients with Cushing's syndrome. Endocrine 2016; 52:322-32. [PMID: 26113424 DOI: 10.1007/s12020-015-0665-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/12/2015] [Indexed: 11/28/2022]
Abstract
Cushing's syndrome (CS) is associated with an incidence of venous thromboembolism (VTE) about ten times higher than in the normal population. The aim of our study was to develop a model for identifying CS patients at higher risk of VTE. We considered clinical, hormonal, and coagulation data from 176 active CS patients and used a forward stepwise logistic multivariate regression analysis to select the major independent risk factors for thrombosis. The risk of VTE was calculated as a 'CS-VTE score' from the sum of points of present risk factors. VTE developed in 20 patients (4 pulmonary embolism). The group of CS patients with VTE were older (p < 0.001) and had more cardiovascular events (p < 0.05), infections and reduced mobility (both p < 0.001), higher midnight plasma cortisol levels (p < 0.05), and shorter APTT (p < 0.01) than those without. We identified six major independent risk factors for VTE: age ≥69 years and reduced mobility were given two points each, whereas acute severe infections, previous cardiovascular events, midnight plasma cortisol level >3.15 times the normality and shortened APTT were given one point each. A CS-VTE score <2 anticipated no risk of VTE; a CS-VTE score of two mild risk (10 %); a CS-VTE score of three moderate risk (46 %); a CS-VTE score ≥4 high risk (85 %). Considering a score ≥3 as predictive of VTE, 94 % of the patients were correctly classified. A simple score helps stratify the VTE risk in CS patients and identify those who could benefit from thromboprophylaxis.
Collapse
Affiliation(s)
- Marialuisa Zilio
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy.
| | - Linda Mazzai
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy
| | - Maria Teresa Sartori
- Clinical Medicine II, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Padua, Italy
| | - Mattia Barbot
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy
| | - Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy
| | - Viviana Daidone
- Clinical Medicine II, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Padua, Italy
| | - Alessandra Casonato
- Clinical Medicine II, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Padua, Italy
| | - Graziella Saggiorato
- Clinical Medicine II, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Padua, Italy
| | - Franco Noventa
- Clinical Medicine V, Department of Medicine DIMED, University-Hospital of Padova, Padua, Italy
| | - Laura Trementino
- Endocrinology Unit, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Prandoni
- Clinical Medicine II, Department of Cardiac, Thoracic and Vascular Sciences, University-Hospital of Padova, Padua, Italy
| | - Marco Boscaro
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy
| | - Giorgio Arnaldi
- Endocrinology Unit, Polytechnic University of Marche, Ancona, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale, 105 35128, Padua, Italy
| |
Collapse
|
28
|
Hampton BM, Schwartz SG, Brantley MA, Flynn HW. Update on genetics and diabetic retinopathy. Clin Ophthalmol 2015; 9:2175-93. [PMID: 26648684 PMCID: PMC4664538 DOI: 10.2147/opth.s94508] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Clinical risk factors for diabetic retinopathy (DR), such as duration of disease and degree of glucose control, do not adequately predict disease progression in individual patients, suggesting the presence of a genetic component. Multiple smaller studies have investigated genotype–phenotype correlations in genes encoding vascular endothelial growth factor, aldose reductase, the receptor for advanced glycation end products, and many others. In general, reported results have been conflicting, due to factors including small sample sizes, variations in study design, differences in clinical end points, and underlying genetic differences between study groups. At this time, there is no confirmed association with any risk allele reported. As we continue to collect data from additional studies, the role of genetics in DR may become more apparent.
Collapse
Affiliation(s)
- Blake M Hampton
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen G Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Milam A Brantley
- Department of Ophthalmology, Vanderbilt Eye Institute, Nashville, TN, USA
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
29
|
Sundquist K, Wang X, Svensson PJ, Sundquist J, Hedelius A, Larsson Lönn S, Zöller B, Memon AA. Plasminogen activator inhibitor-1 4G/5G polymorphism, factor V Leiden, prothrombin mutations and the risk of VTE recurrence. Thromb Haemost 2015; 114:1156-64. [PMID: 26245493 DOI: 10.1160/th15-01-0031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/29/2015] [Indexed: 12/31/2022]
Abstract
Plasminogen-activator inhibitor (PAI)-1 is an important inhibitor of the plasminogen/plasmin system. PAI-1 levels are influenced by the 4G/5G polymorphism in the PAI-1 promoter. We investigated the relationship between the PAI-1 polymorphism and VTE recurrence, and its possible modification by factor V Leiden (FVL) and prothrombin (PTM) mutations. Patients (n=1,069) from the Malmö Thrombophilia Study were followed from discontinuation of anticoagulant treatment until diagnosis of VTE recurrence or the end of the study (maximum follow-up 9.8 years). One hundred twenty-seven patients (11.9 %) had VTE recurrence. PAI-1 was genotyped by TaqMan PCR. Cox regression analysis adjusted for age, sex and acquired risk factors of VTE showed no evidence of an association between PAI-1 genotype and risk of VTE recurrence in the study population as a whole. However, by including an interaction term in the analysis we showed that FVL but not PTM modified the effect of PAI-1 genotype: patients with the 4G allele plus FVL had a higher risk of VTE recurrence [hazard ratio (HR) =2.3, 95 % confidence interval (CI) =1.5-3.3] compared to patients with the 4G allele but no FVL (reference group) or FVL irrespective of PAI-1 genotype (HR=1.8, 95 % CI=1.3-2.5). Compared to reference group, 5G allele irrespective of FVL was associated with lower risk of VTE recurrence only when compared with 4G allele together with FVL. In conclusion, FVL has a modifying effect on PAI-1 polymorphism in relation to risk of VTE recurrence. The role of PAI-1 polymorphism as a risk factor of recurrent VTE may be FVL dependent.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Ashfaque A Memon
- Ashfaque A. Memon, Center for Primary Health Care Research, Wallenberg Laboratory, 6th floor, Inga Marie Nilssons gata 53, Skåne University Hospital, S-205 02 Malmö, Sweden, Tel.: +46 40331465, Fax: +46 40391370, E-mail:
| |
Collapse
|
30
|
Wang J, Wang C, Chen N, Shu C, Guo X, He Y, Zhou Y. Association between the plasminogen activator inhibitor-1 4G/5G polymorphism and risk of venous thromboembolism: a meta-analysis. Thromb Res 2014; 134:1241-8. [PMID: 25450536 DOI: 10.1016/j.thromres.2014.09.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/02/2014] [Accepted: 09/25/2014] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism was considered to be associated with risk of venous thromboembolism (VTE), while evidence remains inadequate. To provide a more accurate estimation of this relationship, we performed an updated meta-analysis of all eligible studies. MATERIALS AND METHODS A systematical search was performed in PubMed, EMBASE, Wanfang, China National Knowledge Infrastructure (CNKI) and Cqvip databases to identify relevant studies published before March 6(th) 2014. The odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the fixed/random-effects model using Review Manager 5.1 and STATA 12.0. RESULTS A total of 34 studies with 3561 cases and 5693 controls were analyzed. Overall, significant association between the PAI-1 4G/5G variant and VTE risk in total population (dominant model: OR=1.32, 95%CI: 1.13-1.54) was observed. And this variant was also related to the deep vein thrombosis risk (dominant model: OR=1.60, 95%CI: 1.24-2.06, P=0.0003). In the subgroup analyses on ethnicity, significant results were obtained in both Asians (dominant model: OR=2.08, 95%CI: 1.29-3.35, P=0.003) and Caucasians (dominant model: OR=1.31, 95%CI: 1.10-1.56, P=0.003). However, no significant association was found in patients with provoked VTE. In terms of subgroup analyses on co-existence of other thrombotic risk factors, the PAI-1 4G/5G polymorphism was significantly associated with VTE risk in patients with factor V Leiden mutation (dominant model: OR=1.72, 95%CI: 1.17-2.53), but not in patients with cancer or surgery. CONCLUSION Our findings demonstrate the role of PAI-1 4G/5G polymorphism being a risk candidate locus for VTE susceptibility, especially in patients with other genetic thrombophilic disorders.
Collapse
Affiliation(s)
- Jiarong Wang
- West China Medical School of Sichuan University, Chengdu, Sichuan Province, China
| | - Chengdi Wang
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Nan Chen
- West China Medical School of Sichuan University, Chengdu, Sichuan Province, China
| | - Chi Shu
- West China Medical School of Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaojiang Guo
- West China Medical School of Sichuan University, Chengdu, Sichuan Province, China
| | - Yazhou He
- West China Medical School of Sichuan University, Chengdu, Sichuan Province, China; Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yanhong Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, P.R China.
| |
Collapse
|
31
|
Farajzadeh M, Bargahi N, Poursadegh Zonouzi A, Farajzadeh D, Pouladi N. Polymorphisms in thrombophilic genes are associated with deep venous thromboembolism in an Iranian population. Meta Gene 2014; 2:505-13. [PMID: 25606434 PMCID: PMC4287852 DOI: 10.1016/j.mgene.2014.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 06/07/2014] [Accepted: 06/19/2014] [Indexed: 11/19/2022] Open
Abstract
It has been revealed that the inherited thrombophilia increases the risk of thrombosis in the venous system. To study the association of factor V G1691A, factor V HR2 (4070A/G), prothrombin G20210A, and PAI-1 (- 675 I/D, 5G/4G) polymorphisms with deep venous thromboembolism (DVT), these polymorphisms were investigated. A total of 193 patients who presented clinical symptoms of deep venous thromboembolism including 103 men and 90 women, and 500 healthy individuals without both personal and family histories of thromboembolic disorders including 275 men and 225 women were recruited into the study. Genotyping was carried out using the amplification refractory mutation system-polymerase chain reaction (ARMS-PCR) technique. Our results showed that the genotype distribution for FV (G1691A and A4070G) and PAI-1 4G/5G polymorphisms in DVT patients were significantly higher than healthy control (P < 0.05). Also, the mutant allele frequencies for all studied polymorphisms differed significantly between the case and control groups (P < 0.05). We concluded that the prevalence of FV (G1691A and A4070G) and PAI-1 4G/5G polymorphisms increased the risk of DVT occurrence in subjects. These findings provide additional evidence to support the hypothesis that thrombophilic gene polymorphisms are involved in vascular thromboembolism.
Collapse
Affiliation(s)
- Malak Farajzadeh
- Department of Genetic, Biotechnology Research Center, Research & Development Complex, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nasrin Bargahi
- Department of Genetic, Biotechnology Research Center, Research & Development Complex, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Poursadegh Zonouzi
- Department of Cellular and Molecular Biology, Biological Science Faculty, Azarbaijan Shahid Madani University, Tabriz, Iran
| | - Davoud Farajzadeh
- Department of Genetic, Biotechnology Research Center, Research & Development Complex, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Cellular and Molecular Biology, Biological Science Faculty, Azarbaijan Shahid Madani University, Tabriz, Iran
- Corresponding author at: Department of Genetic, Biotechnology Research Center, Research & Development Complex, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Cellular and Molecular Biology, Biological Science Faculty, Azarbaijan Shahid Madani University, Tabriz, Iran. Tel./fax: + 98 412 4327541.
| | - Nasser Pouladi
- Department of Cellular and Molecular Biology, Biological Science Faculty, Azarbaijan Shahid Madani University, Tabriz, Iran
| |
Collapse
|
32
|
Koutroumpi S, Spiezia L, Albiger N, Barbot M, Bon M, Maggiolo S, Gavasso S, Simioni P, Frigo A, Mantero F, Scaroni C. Thrombin generation in Cushing's Syndrome: do the conventional clotting indices tell the whole truth? Pituitary 2014; 17:68-75. [PMID: 23408210 DOI: 10.1007/s11102-013-0467-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cushing's Syndrome (CS) is associated with an increased mortality, where hypercoagulability seems to have a crucial role in both arterial and venous thrombosis. Parameters of in vitro thrombin generation (TG) such as lag time, peak thrombin and endogenous thrombin potential (ETP), that describe the time until thrombin burst, the peak amount of TG and the total amount of thrombin generated, respectively as well as classical clotting markers were evaluated in 33 CS patients compared to both a group of 28 patients matched for the features of Metabolic Syndrome (MetS) and 31 healthy individuals. CS and MetS patients had shorter lag time (p < 0.0001), higher peak and ETP (p < 0.0001) than healthy controls, though lag time was less shortened in CS (p < 0.0001) respect to MetS group. Prothrombin time (PT) was increased (p < 0.0001) in both CS and MetS patients, while partial thromboplastin time (PTT) was shorter (p < 0.0001) in CS compared to both MetS and healthy group (p < 0.0001). Factor VIII (FVIII), Antithrombin (AT), protein C and S were increased only in CS patients (p < 0.0001). lag time, AT and FVIII correlated to night salivary cortisol (r = + 0.59; p = 0.0005, r = + 0.40; p = 0.003, r = + 0.40; p = 0.04, respectively); PTT correlated inversely to urinary free cortisol (r = -0.45; p = 0.009). BMI correlated negatively to lag time (r = -0.40; p = 0.0001) and positively to peak and ETP (r = + 0.34; p = 0.001, r = + 0.28; p = 0.008, respectively). Obese and diabetic patients had shorter lag time (p = 0.0005; p = 0.0002, respectively), higher ETP (p = 0.0006; p = 0.007, respectively) and peak (p = 0.0003; p = 0.0005, respectively) as well as a more prolonged PT (p = 0.04; p = 0.009, respectively). Hypertensive individuals had higher ETP (p = 0.004), peak (p = 0.0008) and FVIII (p = 0.001). Our findings confirm a prothrombotic state in both CS and MetS patients, though lag time was less shortened in CS. The high levels of endogenous physiological anticoagulants, could possibly represent a protective mechanism against hypercoagulability seen in CS patients.
Collapse
Affiliation(s)
- S Koutroumpi
- Endocrinology Unit, Department of Medicine-DIMED, University of Padua, Via Ospedale, 105, 35128, Padua, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Karaca M, Hismi B, Ozgul RK, Karaca S, Yilmaz DY, Coskun T, Sivri HS, Tokatli A, Dursun A. High prevalence of cerebral venous sinus thrombosis (CVST) as presentation of cystathionine beta-synthase deficiency in childhood: molecular and clinical findings of Turkish probands. Gene 2013; 534:197-203. [PMID: 24211323 DOI: 10.1016/j.gene.2013.10.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/07/2013] [Accepted: 10/24/2013] [Indexed: 11/26/2022]
Abstract
Classical homocystinuria is the most commonly inherited disorder of sulfur metabolism, caused by the genetic alterations in human cystathionine beta-synthase (CBS) gene. In this study, we present comprehensive clinical findings and the genetic basis of homocystinuria in a cohort of Turkish patients. Excluding some CBS mutations, detailed genotype-phenotype correlation for different CBS mutations has not been established in literature. We aimed to make clinical subgroups according to main clinical symptoms and discussed these data together with mutational analysis results from our patients. Totally, 16 different mutations were identified; twelve of which had already been reported, and four are novel (p.N93Y, p.L251P, p.D281V and c.829-2A>T). The probands were classified into three major groups according to the clinical symptoms caused by these mutations. A psychomotor delay was the most common diagnostic symptom (n=12, 46.2% neurological presentation), followed by thromboembolic events (n=6, 23.1% vascular presentation) and lens ectopia, myopia or marfanoid features (n=5, 19.2% connective tissue presentation). Pyridoxine responsiveness was 7.7%; however, with partial responsive probands, the ratio was 53.9%. In addition, five thrombophilic nucleotide changes including MTHFR c.677 C>T and c.1298 A>C, Factor V c.1691 G>A, Factor II c.20210 G>A, and SERPINE1 4G/5G were investigated to assess their contributions to the clinical spectrum. We suggest that the effect of these polymorphisms on clinical phenotype of CBS is not very clear since the distribution of thrombophilic polymorphisms does not differ among specific groups. This study provides molecular findings of 26 Turkish probands with homocystinuria and discusses the clinical presentations and putative effects of the CBS mutations.
Collapse
Affiliation(s)
- Mehmet Karaca
- Aksaray University, Faculty of Science and Arts, Department of Biology, Aksaray, Turkey
| | - Burcu Hismi
- Hacettepe University, Faculty of Medicine, Pediatrics Department, Unit of Metabolism, Ankara, Turkey
| | - Riza Koksal Ozgul
- Hacettepe University, Faculty of Medicine, Pediatrics Department, Unit of Metabolism, Ankara, Turkey; Hacettepe University, Institute of Child Health, Ankara, Turkey
| | - Sefayet Karaca
- Aksaray University, School of Health Science, Aksaray, Turkey
| | - Didem Yucel Yilmaz
- Hacettepe University, Faculty of Medicine, Pediatrics Department, Unit of Metabolism, Ankara, Turkey
| | - Turgay Coskun
- Hacettepe University, Faculty of Medicine, Pediatrics Department, Unit of Metabolism, Ankara, Turkey
| | - Hatice Serap Sivri
- Hacettepe University, Faculty of Medicine, Pediatrics Department, Unit of Metabolism, Ankara, Turkey
| | - Aysegul Tokatli
- Hacettepe University, Faculty of Medicine, Pediatrics Department, Unit of Metabolism, Ankara, Turkey
| | - Ali Dursun
- Hacettepe University, Faculty of Medicine, Pediatrics Department, Unit of Metabolism, Ankara, Turkey.
| |
Collapse
|
34
|
Koutroumpi S, Daidone V, Sartori MT, Cattini MG, Albiger NM, Occhi G, Ferasin S, Frigo A, Mantero F, Casonato A, Scaroni C. Venous thromboembolism in patients with Cushing's syndrome: need of a careful investigation of the prothrombotic risk profile. Pituitary 2013; 16:175-81. [PMID: 22585010 DOI: 10.1007/s11102-012-0398-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A high incidence of venous thromboembolic (VTE) complications has been reported in Cushing's syndrome (CS), mostly post-operatively and attributable to hypercoagulability. The prevalence of symptomatic VTE was investigated retrospectively in 58 consecutive CS patients in relation to acquired and genetic thrombotic risk factors. Eight CS patients (14 %) developed VTE (group A), 3 of them related and 5 unrelated to surgery. These patients had higher urinary free cortisol (p = 0.01) and VWF levels (p = 0.02) than the 50 patients without VTE (group B), as well an increase in the hemostatically more efficient, high-molecular-weight VWF multimers (p = 0.002). Factor V Leiden and the prothrombin gene 20210A variants (the most common inherited thrombophilic defects) were more represented in group A than in group B, as was the genotype GCAG/GCAG of the VWF gene promoter, known to hyperinduce VWF upregulation under cortisol excess. All but one of the patients with VTE unrelated to surgery had at least four acquired and at least one inherited risk factor. Severe hypercortisolism and VWF levels with increased haemostatic activity are strongly associated with VTE in CS. VTE episodes unrelated to surgery are attributable to the synergistic action of acquired and inherited thrombotic risk factors. Based on these observations, we believe that severely affected CS patients should be screened for coagulation disorders and receive antithrombotic prophylaxis whenever they have concomitant prothrombotic risk factors.
Collapse
Affiliation(s)
- S Koutroumpi
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Padua Medical School, Via Ospedale 105, 35128 Padua, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Wang S, Cao Q, Wang X, Li B, Tang M, Yuan W, Fang J, Qian J, Qin C, Zhang W. PAI-1 4G/5G polymorphism contributes to cancer susceptibility: evidence from meta-analysis. PLoS One 2013; 8:e56797. [PMID: 23437240 PMCID: PMC3577655 DOI: 10.1371/journal.pone.0056797] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/15/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The plasminogen activator inhibitor-1 (PAI-1) is expressed in many cancer cell types and allows the modulation of cancer growth, invasion and angiogenesis. To date, studies investigated the association between a functional polymorphism in PAI-1 (4G/5G) and risk of cancer have shown inclusive results. METHODS A meta-analysis based on 25 case-control studies was performed to address this issue. Odds ratios (OR) with corresponding 95% confidence intervals (CIs) were used to assess the association. The statistical heterogeneity across studies was examined with I(2) test. RESULTS Overall, a significant increased risk of cancer was associated with the PAI-1 4G/4G polymorphism for the allele contrast (4G vs. 5G: OR = 1.10, CI = 1.03-1.18, I(2) = 49.5%), the additive genetic model (4G/4G vs. 5G/5G: OR = 1.21, CI = 1.06-1.39, I(2) = 51.9%), the recessive genetic model (4G/4G vs. 4G/5G+5G/5G: OR = 1.11, CI = 1.04-1.18, I(2) = 20.8%). In the subgroup analysis by ethnicity, the results indicated that individuals with 4G/4G genotype had a significantly higher cancer risk among Caucasians (4G/4G vs. 5G/5G: OR = 1.31, 95%CI = 1.09-1.59, I(2) = 59.6%; 4G/4G vs. 4G/5G: OR = 1.12, 95%CI = 1.04-1.21, I(2) = 3.6%; recessive model: OR = 1.12, 95%CI = 1.05-1.21, I(2) = 25.3%). CONCLUSIONS The results of the present meta-analysis support an association between the PAI-1 4G/5G polymorphism and increasing cancer risk, especially among Caucasians, and those with 4G allele have a high risk to develop colorectal cancer and endometrial cancer.
Collapse
Affiliation(s)
- Shangqian Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoxiang Wang
- Department of Urology, Yangzhou No.1 People’s Hospital, Yangzhou, China
| | - Bingjie Li
- Division of Epidemiology, University of Texas Health Science Center, Houston, Texas, United States of America
| | - Min Tang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wanqing Yuan
- Department of Orthopedics, The Affiliated Hospital of Medical College, Qingdao University, Qingdao, China
| | - Jianzheng Fang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Qian
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Qin
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail: (WZ); (CQ)
| | - Wei Zhang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- * E-mail: (WZ); (CQ)
| |
Collapse
|
36
|
Mehtap O, Ateşoğlu EB, Tarkun P, Gönüllü E, Keski H, Topçu Y, Uzülmez N, Sünnetçi D, Hacıhanefioğlu A. The association between gene polymorphisms and leukocytosis with thrombotic complications in patients with essential thrombocythemia and polycythemia vera. Turk J Haematol 2012; 29:162-9. [PMID: 24744648 PMCID: PMC3986955 DOI: 10.5505/tjh.2012.03780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 08/10/2011] [Indexed: 11/08/2022] Open
Abstract
Objective: Vascular events are a common complication in patients with polycythemia vera (PV) and essential thrombocythemia (ET). This study aimed to analyze the association between PAI-1 4G/5G and ACE I/D gene polymorphisms, and leukocytosis with thrombosis in patients with PV and ET. Material and Methods: In total, 64 patients with ET and PV were evaluated. Arterial or venous thrombosis, such as cerebral transient ischemic attack, ischemic stroke, myocardial infarction, peripheral arterial thrombosis, deep venous thrombosis, and pulmonary embolism, were defined as a vascular event. DNA samples were screened for mutations via reverse hybridization strip assay. Results: In terms of PAI-1 gene polymorphism, the frequency of the 4G and 5G allele was 48.5% and 51.5%, respectively. The ACE allele frequency was 51.2% and 48.8% for D and I, respectively. There wasn’t an association between occurrence of vascular events and the frequency of any allele. In terms of occurrence of vascular events, there weren’t any significance differences between the patients that were carrying the ACE D/D homozygous allele to ACE I/D and those that carried the I/I allele (P = 0.93). There wasn’t a significant difference in occurrence of vascular events between the PAI-1 5G/5G homozygote allele carriers, and the 4G/5G and 4G/4G allele carriers (P = 0.97). Vascular events were significantly more common in the patients with leukocytosis (leukocyte count >10 × 109 L–1) than in those without leukocytosis (leukocyte count ≤10 × 109 L–1) (P = 0.00). Age >60 years was also a significant risk factor for occurrence of vascular events(P = 0.008). Conclusion: PAI-1 and ACE gene polymorphisms were not considered new risk factors for thrombosis in PV and ET patients. On the other hand, leukocytosis at diagnosis was associated with the occurrence of vascular events in the patients with ET and PV.
Collapse
Affiliation(s)
- Ozgür Mehtap
- Kocaeli University, School of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Elif Birtaş Ateşoğlu
- Kocaeli University, School of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Pınar Tarkun
- Kocaeli University, School of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Emel Gönüllü
- Kocaeli University, School of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Hakan Keski
- Kocaeli University, School of Medicine, Department of Hematology, Kocaeli, Turkey
| | - Yıldıray Topçu
- Kocaeli University, School of Medicine, Department of Internal Medicine, Kocaeli, Turkey
| | - Nilüfer Uzülmez
- Kocaeli University, School of Medicine, Department of Medical Genetic, Kocaeli, Turkey
| | - Deniz Sünnetçi
- Kocaeli University, School of Medicine, Department of Medical Genetic, Kocaeli, Turkey
| | | |
Collapse
|
37
|
Ringelstein M, Jung A, Berger K, Stoll M, Madlener K, Klötzsch C, Schlachetzki F, Stolz E. Promotor polymorphisms of plasminogen activator inhibitor-1 and other thrombophilic genotypes in cerebral venous thrombosis: a case-control study in adults. J Neurol 2012; 259:2287-92. [DOI: 10.1007/s00415-012-6477-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 03/04/2012] [Accepted: 03/05/2012] [Indexed: 01/21/2023]
|
38
|
Abstract
Venous thromboembolic disease continues to be a major source of morbidity and mortality, with obese patients who are critically ill presenting some of the most at-risk patients. As the literature evolves, it has become clear that there is a complex relationship between obesity and thrombosis and atherogenesis. It is true that many of these conditions are reversible with weight loss; however, obesity remains on the rise. Management of obese patients must incorporate and consider these intricate changes in an attempt to improve patient outcomes.
Collapse
|
39
|
Bern MM, McCarthy N. Failure to lyse venous thrombi because of elevated plasminogen activator Inhibitor 1 (PAI-1) and 4G polymorphism of its promotor genome (The PAI-1/4G Syndrome). Clin Appl Thromb Hemost 2011; 16:574-8. [PMID: 20724304 DOI: 10.1177/1076029610361334] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Plasminogen activator Inhibitor 1 (PAI-1) inhibits plasminogen activators leading to decreased fibrinolysis and increased risk of thromboembolic disease (TED). Shifts in PAI-1 promoter genome from normal 5G>5G to 4G>5G or 4G>4G alleles are associated with overexpression of PAI-1. In this study patients with residual venous thrombi were observed to have increased PAI-1 levels and more frequent shifts to 4G alleles. Of the 26, 20 (76.9%) patients with unresolved thrombus had elevated PAI-1 values. 4G genomic shifts were found in 92.9% patients studied. Normal PAI-1 levels were found in 5 patients with 4G polymorphisms. Thus, PAI-1 is often elevated among patients with residual thrombus, with an unexpectedly high prevalence of the 4G polymorphism of the promoter genome. Patients with persistent thrombus should be considered at risk of having constituently increased PAI-1 due to genomic changes in the PAI-1 promoter genome. Hypotheses are proposed to explain those with normal PAI-1, despite having 4G polymorphisms.
Collapse
Affiliation(s)
- Murray M Bern
- Department of Medicine, Division of Research, New England Baptist Hospital, Harvard Medical School, Boston, MA, USA.
| | | |
Collapse
|
40
|
Katrancioglu N, Manduz S, Ozen F, Yilmaz MB, Karahan O, Ozdemir O, Berkan O. Type I plasminogen activator inhibitor 4G allele frequency is associated with chronic venous insufficiency. J Int Med Res 2010; 38:1513-8. [PMID: 20926026 DOI: 10.1177/147323001003800435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Chronic venous insufficiency (CVI) is a common disease associated with poor quality of life. Genetic polymorphisms causing coagulation abnormalities may account for some of the CVI pathogenesis. Type I plasminogen activator inhibitor (PAI-1) is responsible for fibrinolytic system regulation, and plasma levels of PAI-1 are strongly correlated with PAI-1 4G/5G gene polymorphism. The association between PAI-1 4G/5G gene polymorphism and CVI was investigated. In 34 consecutive patients with clinically overt CVI, the PAI-1 4G/4G polymorphism was detected in three cases (8.8%); the 4G/5G polymorphism was detected in 28 (82.4%). In 34 age- and sex-matched controls, the PAI-1 4G/4G polymorphism was detected in one case (2.9%) and the 4G/5G polymorphism was detected in 14 cases (41.2%). The PAI-1 4G allele was found significantly more frequently in CVI patients than in controls. The 4G allele was associated with a 3.25-fold increase in CVI risk. Thus, a relationship between CVI and the PAI-1 4G allele is apparent.
Collapse
Affiliation(s)
- N Katrancioglu
- Department of Cardiovascular Surgery, Heart Centre Building, Cumhuriyet University School of Medicine, Main Street, Sivas, Turkey.
| | | | | | | | | | | | | |
Collapse
|
41
|
Ringwald J, Berger A, Adler W, Kraus C, Pitto RP. Genetic polymorphisms in venous thrombosis and pulmonary embolism after total hip arthroplasty: a pilot study. Clin Orthop Relat Res 2009; 467:1507-15. [PMID: 18800213 PMCID: PMC2674155 DOI: 10.1007/s11999-008-0498-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 08/22/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Deep venous thrombosis (DVT) after major orthopaedic surgery is a substantial concern. We asked whether the single or combined presence of thrombophilic genetic polymorphisms might further increase the already high risk for venous thrombosis and pulmonary embolism (PE) after THA. We therefore compared the prevalence of factor V Leiden, prothrombin G20210A, methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C, and plasminogen activator inhibitor 4G/5G polymorphisms between 50 patients with symptomatic DVT within 3 weeks after elective THA and an asymptomatic control group of 85 patients. We found no major difference for the presence of a single mutation between the groups. Factor V Leiden and homozygous MTHFR C667T mutations were of borderline significance with odds ratios (95% confidence intervals) of 3.73 (0.89-15.63) and 2.93 (0.92-9.29), respectively. Patients with homozygous or combined heterozygous status of MTHFR C677T and A1298C mutation had a higher frequency of DVT after elective THA (odds ratio, 2.86; 95% confidence interval, 1.32-6.35) than those with wild-type. The presence of a single mutation may not further increase the already high risk for symptomatic DVT after THA, whereas combinations of mutations of distinct polymorphisms might be important. However, prospective studies with a larger number of patients are needed before we would recommend preoperative screening. LEVEL OF EVIDENCE Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Juergen Ringwald
- Department of Transfusion Medicine and Haemostaseology, University Hospital of Erlangen, Krankenhausstraße 12, 91054 Erlangen, Germany
| | - Annika Berger
- Center for Neurological Imaging, Brigham and Women’s Hospital, Harvard University, Boston, MA USA
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Cornelia Kraus
- Institute of Human Genetics, University Hospital of Erlangen, Erlangen, Germany
| | - Rocco P. Pitto
- Department of Orthopaedic Surgery, Middlemore Hospital, University of Auckland, Auckland, New Zealand
| |
Collapse
|
42
|
Akhter MS, Biswas A, Ranjan R, Meena A, Yadav BK, Sharma A, Saxena R. Plasminogen activator inhibitor-1 (PAI-1) gene 4G/5G promoter polymorphism is seen in higher frequency in the Indian patients with deep vein thrombosis. Clin Appl Thromb Hemost 2009; 16:184-8. [PMID: 19419975 DOI: 10.1177/1076029609333673] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION A number of prothrombotic and fibrinolytic disorders may lead to venous thrombosis. A 4G/5G polymorphism located in the promoter region of plasminogen activator inhibitor-1 (PAI-1) gene has been found to be commonly associated with the levels of PAI-1 and might be a risk factor for deep vein thrombosis (DVT). The aim of this study was to look for the potential association of this polymorphism with DVT in the Asian Indian population. MATERIAL AND METHODS A total of 110 consecutive patients (M:F = 62:48) with idiopathic DVT and equal number of age- and sex-matched healthy controls were the study participants. All study participants were typed for the PAI-1 4G/ 5G polymorphism, factor V Leiden, factor V Hong Kong/Cambridge mutations, and HR2 haplotype. RESULT The variant allele for the PAI-1 4G/5G polymorphism showed both genotypic (P = .0013, chi(2) = 10.303; odds ratio [OR] = 3.75) as well as allelic association (P = .0004, chi(2) = 12.273; OR = 1.99) with DVT. Factor V Leiden and factor V HR2 haplotype were observed in 10 (9.0%) and 13 (11.8%) patients, respectively. None of the study participants showed the factor V Hong Kong Cambridge mutations. CONCLUSION Our study shows the association of 4G allele with DVT in Asian Indian population. The higher prevalence of 4G polymorphism in patients with DVT (compared with controls) seen in our study is in concordance with previous reports from the Caucasian population.
Collapse
|
43
|
Tsakiris DA, Tichelli A. Thrombotic complications after haematopoietic stem cell transplantation: early and late effects. Best Pract Res Clin Haematol 2009; 22:137-45. [DOI: 10.1016/j.beha.2008.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
44
|
Coulam CB, Jeyendran RS. Thrombophilic gene polymorphisms are risk factors for unexplained infertility. Fertil Steril 2008; 91:1516-7. [PMID: 18930220 DOI: 10.1016/j.fertnstert.2008.07.1782] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 07/28/2008] [Accepted: 07/29/2008] [Indexed: 10/21/2022]
Abstract
Earlier studies have shown inherited thrombophilia to be a risk factor for recurrent implantation failure, raising the question of whether this risk is related to the underlying cause of unexplained infertility or to the mechanisms involved in the implantation process. When nine thrombophilic gene polymorphisms were compared among 92 women with the diagnosis of unexplained infertility and 60 fertile control women, women with a history of unexplained infertility displayed a higher prevalence of MTHFR C677T polymorphisms than control women.
Collapse
Affiliation(s)
- Carolyn B Coulam
- Pregnancy Success Center and Rinehart Center for Reproductive Medicine, Chicago, Illinois, USA.
| | | |
Collapse
|
45
|
Coulam CB, Wallis D, Weinstein J, DasGupta DS, Jeyendran RS. ORIGINAL ARTICLE: Comparison of Thrombophilic Gene Mutations Among Patients Experiencing Recurrent Miscarriage and Deep Vein Thrombosis. Am J Reprod Immunol 2008; 60:426-31. [DOI: 10.1111/j.1600-0897.2008.00640.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
46
|
Rask O, Nilsson KO, Berntorp E. Oestrogen treatment of constitutional tall stature in girls: is there a risk of thrombosis or bleeding? Acta Paediatr 2008; 97:342-7. [PMID: 18298783 DOI: 10.1111/j.1651-2227.2007.00635.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To evaluate haemostatic effects and clinical outcome of oestrogen treatment of constitutionally tall stature in girls. METHODS We conducted a single-centre cohort study, 63 girls referred over a period of 15 years were investigated. The girls were given oestrogen treatment for constitutional tall stature at a median initial dose of 300 ug ethinyl estradiol/day and were consecutively examined for changes in coagulation. Medical records were retrospectively reviewed, additional data were collected at follow-up by blood sampling and interviews. RESULTS After 1 year of treatment, levels of antithrombin and von Willebrand factor (VWF) were significantly decreased (p<0.001 and p=0.015, respectively), whereas there was no significant change in levels of plasminogen inhibitor type 1. No venous thromboembolism (VTE) or major side effects were observed. Genetic risk factors for thrombosis were present, as was expected. The mean height reduction was 5.5 cm. The height-reducing effect was inversely correlated with chronological age (r=-0.44, p<0.01) and bone age (r=-0.61, p<0.01). CONCLUSIONS Changes in coagulation parameters occurred both towards pro- and anticoagulation. Treatment with high-dose ethinyl estradiol can successfully limit final height, and it is most effective when started at a younger bone age.
Collapse
Affiliation(s)
- Olof Rask
- Department of Pediatrics, Centre for Thrombosis and Hemostasis, Malmö University Hospital, Malmö, Sweden.
| | | | | |
Collapse
|
47
|
Tsantes AE, Nikolopoulos GK, Bagos PG, Bonovas S, Kopterides P, Vaiopoulos G. The effect of the plasminogen activator inhibitor-1 4G/5G polymorphism on the thrombotic risk. Thromb Res 2007; 122:736-42. [PMID: 17949795 DOI: 10.1016/j.thromres.2007.09.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 08/15/2007] [Accepted: 09/14/2007] [Indexed: 11/29/2022]
Abstract
Plasminogen activator inhibitor (PAI-1), is the central component of the fibrinolytic system. A deletion/insertion (4G/5G) polymorphism in the promoter region of the PAI-1 gene has been correlated with levels of plasma PAI-1. The 4G allele is associated with higher levels of PAI-1, and might increase the risk for intravascular thrombosis. However, the contribution of this genetic variant to the risk for thrombosis, both arterial and venous, has not been clearly established. A broad spectrum of findings regarding the effect of the 4G allele on thrombotic risk in different target organs has been reported. Our aim is to summarize the variable influence of this polymorphism on thrombotic events in different tissues or organs and explain the underlying mechanisms accounting for these differences.
Collapse
Affiliation(s)
- Argirios E Tsantes
- Laboratory of Hematology & Blood Bank Unit, Attikon General Hospital, School of Medicine, University of Athens, Greece.
| | | | | | | | | | | |
Collapse
|
48
|
Shammaa DMR, Sabbagh AS, Taher AT, Zaatari GS, Mahfouz RAR. Plasminogen Activator Inhibitor-1 (PAI-1) gene 4G/5G alleles frequency distribution in the Lebanese population. Mol Biol Rep 2007; 35:453-7. [PMID: 17578681 DOI: 10.1007/s11033-007-9106-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Accepted: 05/30/2007] [Indexed: 12/31/2022]
Abstract
Plasminogen activator inhibitor-1 (PAI-1) is an inhibitor of fibrinolysis. Increased plasma PAI-1 levels play an essential role in the pathogenesis of cardiovascular risk and other diseases associated with thrombosis. The 4G/5G polymorphism of the PAI-1 promoter region has been extensively studied in different populations. We studied 160 healthy unrelated Lebanese individuals using a reverse hybridization PCR assay to detect the 5G/5G, 4G/5G and, 4G/4G genotypes of the PAI-1 gene and the frequencies of the 4G and 5G alleles. We found that 4G/5G genotype was the most prevalent (45.6%) followed by 5G/5G (36.9%) and 4G/4G (17.5%). The frequencies of the 4G and 5G alleles were calculated to be 0.403 and 0.597, respectively. Compared to other ethnic communities, the Lebanese population was found to harbour a relatively high prevalence of the rare 4G allele. This, in turn, may predispose this population to develop cardiovascular diseases and other thrombotic clinical conditions. This study aids to enhance our understanding of the genetic features of the Lebanese population.
Collapse
Affiliation(s)
- Dina M R Shammaa
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | | | | | | | | |
Collapse
|
49
|
Duggan E, O'Dwyer MJ, Caraher E, Diviney D, McGovern E, Kelleher D, McManus R, Ryan T. Coagulopathy after cardiac surgery may be influenced by a functional plasminogen activator inhibitor polymorphism. Anesth Analg 2007; 104:1343-7, table of contents. [PMID: 17513622 DOI: 10.1213/01.ane.0000261267.28891.00] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cytokine-mediated inflammation and coagulopathy may occur after cardiac surgery. In this study we investigated the temporal pattern of plasminogen activator inhibitor-1 (PAI-1) gene expression after cardiac surgery and its relation with PAI genotype, and obtained preliminary data regarding its relation to perioperative morbidity. METHODS The relative change in PAI-1 mRNA 1, 6, and 24 h after cardiopulmonary bypass (CPB) was measured from mononuclear cells in 82 patients undergoing elective cardiac surgery. DNA was analyzed for carriage of the 4G/5G PAI-1 polymorphism. RESULTS PAI-1 gene expression decreased after CPB in all patients. A larger reduction in PAI-1 gene expression was observed in homozygous carriers of the 5G allele. Homozygous carriers of the 5G allele were also more likely to receive transfusion of coagulation blood products. There was no relation between change in PAI-1 gene expression and duration of CPB. CONCLUSIONS PAI-1 gene expression decreased over time after CPB. We found a link between PAI-1 genotype, PAI gene expression, and transfusion of coagulation products after cardiac surgery.
Collapse
Affiliation(s)
- Edel Duggan
- Department of Anaesthesia, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Eroglu A, Ulu A, Akar N. Plasminogen activator inhibitor-1 gene 4G/5G polymorphism in cancer patients with and without thrombosis. J Thromb Thrombolysis 2006; 22:111-2. [PMID: 17008976 DOI: 10.1007/s11239-006-9054-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Aydan Eroglu
- Department of Surgery and Surgical Oncology, Numune State Hospital, Konya, Turkey
| | | | | |
Collapse
|