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Kell DB, Lip GYH, Pretorius E. Fibrinaloid Microclots and Atrial Fibrillation. Biomedicines 2024; 12:891. [PMID: 38672245 PMCID: PMC11048249 DOI: 10.3390/biomedicines12040891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Atrial fibrillation (AF) is a comorbidity of a variety of other chronic, inflammatory diseases for which fibrinaloid microclots are a known accompaniment (and in some cases, a cause, with a mechanistic basis). Clots are, of course, a well-known consequence of atrial fibrillation. We here ask the question whether the fibrinaloid microclots seen in plasma or serum may in fact also be a cause of (or contributor to) the development of AF. We consider known 'risk factors' for AF, and in particular, exogenous stimuli such as infection and air pollution by particulates, both of which are known to cause AF. The external accompaniments of both bacterial (lipopolysaccharide and lipoteichoic acids) and viral (SARS-CoV-2 spike protein) infections are known to stimulate fibrinaloid microclots when added in vitro, and fibrinaloid microclots, as with other amyloid proteins, can be cytotoxic, both by inducing hypoxia/reperfusion and by other means. Strokes and thromboembolisms are also common consequences of AF. Consequently, taking a systems approach, we review the considerable evidence in detail, which leads us to suggest that it is likely that microclots may well have an aetiological role in the development of AF. This has significant mechanistic and therapeutic implications.
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Affiliation(s)
- Douglas B. Kell
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- The Novo Nordisk Foundation Center for Biosustainability, Technical University of Denmark, Søltofts Plads, Building 220, 2800 Kongens Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool L7 8TX, UK;
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Etheresia Pretorius
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
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Kell DB, Khan MA, Kane B, Lip GYH, Pretorius E. Possible Role of Fibrinaloid Microclots in Postural Orthostatic Tachycardia Syndrome (POTS): Focus on Long COVID. J Pers Med 2024; 14:170. [PMID: 38392604 PMCID: PMC10890060 DOI: 10.3390/jpm14020170] [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: 12/11/2023] [Revised: 01/16/2024] [Accepted: 01/27/2024] [Indexed: 02/24/2024] Open
Abstract
Postural orthostatic tachycardia syndrome (POTS) is a common accompaniment of a variety of chronic, inflammatory diseases, including long COVID, as are small, insoluble, 'fibrinaloid' microclots. We here develop the argument, with accompanying evidence, that fibrinaloid microclots, through their ability to block the flow of blood through microcapillaries and thus cause tissue hypoxia, are not simply correlated with but in fact, by preceding it, may be a chief intermediary cause of POTS, in which tachycardia is simply the body's exaggerated 'physiological' response to hypoxia. Similar reasoning accounts for the symptoms bundled under the term 'fatigue'. Amyloids are known to be membrane disruptors, and when their targets are nerve membranes, this can explain neurotoxicity and hence the autonomic nervous system dysfunction that contributes to POTS. Taken together as a system view, we indicate that fibrinaloid microclots can serve to link POTS and fatigue in long COVID in a manner that is at once both mechanistic and explanatory. This has clear implications for the treatment of such diseases.
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Affiliation(s)
- Douglas B Kell
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- The Novo Nordisk Foundation Centre for Biosustainability, Building 220, Chemitorvet 200, Technical University of Denmark, 2800 Kongens Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1, Matieland 7602, South Africa
| | - Muhammed Asad Khan
- Directorate of Respiratory Medicine, Manchester University Hospitals, Wythenshawe Hospital, Manchester M23 9LT, UK
| | - Binita Kane
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- Manchester University Foundation Trust and School of Biological Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Etheresia Pretorius
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1, Matieland 7602, South Africa
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Petrone P, Fortunato M, Paccagnini E, Gentile M, De Felice C, Lupetti P. A novel mini-invasive finger-prick protocol for preparing blood micro-samples for morphological analysis of human erythrocytes by scanning electron microscopy. Tissue Cell 2023; 84:102189. [PMID: 37549512 DOI: 10.1016/j.tice.2023.102189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
Here we describe the development and optimization of a new protocol for the preparation and surface imaging by scanning electron microscope of human erythrocytes from blood micro-samples obtained by finger prick. By testing several key pre-analytical conditions for blood sampling, erythrocyte preservation, storage and imaging, we designed a rapid new minimally-invasive reproducible method for obtaining uniform deposition of an adequate number of erythrocytes with well-preserved morphology on a substrate. The possibility of obtaining reliable reproducible high resolution morphometric data on peripheral erythrocytes makes this protocol valuable for diagnostic and basic research purposes.
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Affiliation(s)
- Paola Petrone
- Department of Life Sciences, University of Siena, Siena, Italy.
| | | | | | | | - Claudio De Felice
- Neonatal Intensive Care Unit, University Hospital, Azienda Ospedaliera Universitaria Senese (AOUS), Siena, Italy
| | - Pietro Lupetti
- Department of Life Sciences, University of Siena, Siena, Italy
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Kell DB, Pretorius E. Are fibrinaloid microclots a cause of autoimmunity in Long Covid and other post-infection diseases? Biochem J 2023; 480:1217-1240. [PMID: 37584410 DOI: 10.1042/bcj20230241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023]
Abstract
It is now well established that the blood-clotting protein fibrinogen can polymerise into an anomalous form of fibrin that is amyloid in character; the resultant clots and microclots entrap many other molecules, stain with fluorogenic amyloid stains, are rather resistant to fibrinolysis, can block up microcapillaries, are implicated in a variety of diseases including Long COVID, and have been referred to as fibrinaloids. A necessary corollary of this anomalous polymerisation is the generation of novel epitopes in proteins that would normally be seen as 'self', and otherwise immunologically silent. The precise conformation of the resulting fibrinaloid clots (that, as with prions and classical amyloid proteins, can adopt multiple, stable conformations) must depend on the existing small molecules and metal ions that the fibrinogen may (and is some cases is known to) have bound before polymerisation. Any such novel epitopes, however, are likely to lead to the generation of autoantibodies. A convergent phenomenology, including distinct conformations and seeding of the anomalous form for initiation and propagation, is emerging to link knowledge in prions, prionoids, amyloids and now fibrinaloids. We here summarise the evidence for the above reasoning, which has substantial implications for our understanding of the genesis of autoimmunity (and the possible prevention thereof) based on the primary process of fibrinaloid formation.
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Affiliation(s)
- Douglas B Kell
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, U.K
- The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kemitorvet 200, 2800 Kgs Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
| | - Etheresia Pretorius
- Department of Biochemistry, Cell and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, U.K
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1 Matieland, Stellenbosch 7602, South Africa
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Williams A, Bissinger R, Shamaa H, Patel S, Bourne L, Artunc F, Qadri SM. Pathophysiology of Red Blood Cell Dysfunction in Diabetes and Its Complications. PATHOPHYSIOLOGY 2023; 30:327-345. [PMID: 37606388 PMCID: PMC10443300 DOI: 10.3390/pathophysiology30030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
Diabetes Mellitus (DM) is a complex metabolic disorder associated with multiple microvascular complications leading to nephropathy, retinopathy, and neuropathy. Mounting evidence suggests that red blood cell (RBC) alterations are both a cause and consequence of disturbances related to DM-associated complications. Importantly, a significant proportion of DM patients develop varying degrees of anemia of confounding etiology, leading to increased morbidity. In chronic hyperglycemia, RBCs display morphological, enzymatic, and biophysical changes, which in turn prime them for swift phagocytic clearance from circulation. A multitude of endogenous factors, such as oxidative and dicarbonyl stress, uremic toxins, extracellular hypertonicity, sorbitol accumulation, and deranged nitric oxide metabolism, have been implicated in pathological RBC changes in DM. This review collates clinical laboratory findings of changes in hematology indices in DM patients and discusses recent reports on the putative mechanisms underpinning shortened RBC survival and disturbed cell membrane architecture within the diabetic milieu. Specifically, RBC cell death signaling, RBC metabolism, procoagulant RBC phenotype, RBC-triggered endothelial cell dysfunction, and changes in RBC deformability and aggregation in the context of DM are discussed. Understanding the mechanisms of RBC alterations in DM provides valuable insights into the clinical significance of the crosstalk between RBCs and microangiopathy in DM.
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Affiliation(s)
- Alyssa Williams
- Faculty of Science, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, ON L8S 4M1, Canada
| | - Rosi Bissinger
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Hala Shamaa
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Shivani Patel
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Lavern Bourne
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
| | - Ferruh Artunc
- Division of Endocrinology, Diabetology and Nephrology, Department of Internal Medicine, University Hospital Tübingen, 72076 Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, 72076 Tübingen, Germany
- German Center for Diabetes Research at the University of Tübingen, 72076 Tübingen, Germany
| | - Syed M. Qadri
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
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Arkew M, Asmerom H, Gemechu K, Tesfa T. Global Prevalence of Anemia Among Type 2 Diabetic Adult Patients: A Systematic Review and Meta-Analysis. Diabetes Metab Syndr Obes 2023; 16:2243-2254. [PMID: 37545742 PMCID: PMC10402722 DOI: 10.2147/dmso.s421851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023] Open
Abstract
Background Anemia is a common and often overlooked hematological change observed in patients with diabetes mellitus. However, there is no global survey or health registry that estimates the pooled prevalence of anemia in patients with type 2 diabetes. Therefore, this study aimed to determine the global pooled prevalence of anemia among adult patients with type 2 diabetes. Methods This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The study protocol was registered on PROSPERO with the reference number (CRD42022327135), and the link provided (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022327135) display the published methodology. Previously published articles were searched in PubMed/Medline, Cochrane Library, WHO Global Index Medicus, African Journals Online, ScienceDirect, Google Scholar, and Google from October 26 to November 09, 2022. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal tool. Random-effects model was used to estimate the pooled prevalence of anemia. The degree of heterogeneity among the included studies was assessed using I2 statistics. Publication bias was detected using funnel plot symmetry analysis supplemented by Egger's and Begg's tests. Results Twenty-four studies with a total number of 19,118 participants were included in this systematic review and meta-analysis. The overall pooled prevalence of anemia among type 2 diabetic adult patients was 27.0% (95% CI: 24.0, 31.0, I2 = 96.45%; P< 0.001). Geographical and time-based subgroup analysis showed that higher prevalence of anemia was observed in Africa region 28.0% (95% CI: 17.0, 39.0) and from 2015 to 2022, 28.0% (95% CI: 24.0, 33.0), respectively. Conclusion Anemia is a moderate public health problem among adult patients with type 2 diabetes. Nearly one in four patients with type 2 diabetes develops anemia. Therefore, considering the negative impact of anemia, it is important to include anemia screening in the routine assessment of diabetes-related complications.
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Affiliation(s)
- Mesay Arkew
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haftu Asmerom
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kabtamu Gemechu
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewodros Tesfa
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Montoya-Navarrete AL, Guerrero-Barrera AL, Quezada-Tristán T, Valdivia-Flores AG, Cano-Rábano MJ. Red blood cells morphology and morphometry in adult, senior, and geriatricians dogs by optical and scanning electron microscopy. Front Vet Sci 2022; 9:998438. [PMID: 36439358 PMCID: PMC9685804 DOI: 10.3389/fvets.2022.998438] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/28/2022] [Indexed: 10/10/2023] Open
Abstract
Red blood cells (RBC) morphologic evaluation through microscopy optical (OM) and SEM, provides information to forecast, evaluate, and monitor the functioning of many organs. Factors, such aging and diseases affect RBC morphology in both, human and animals. SEM is useful to evaluate RBC morphology, although its use in diagnosis and evaluation in dogs is limited, due to the availability and cost. The aim of this research was to assess the normal RBC morphology in adult, senior and geriatrician dogs, clinically healthy by OM and SEM. In addition to evaluating the age effect, sex, body size, and their interaction on erythrocyte morphometry. To carry out the research 152 blood samples were evaluated from dogs of different sexes and body sizes (small, medium, and large). Three groups were made based on dogs age: group I adults (1-7.9 years old), group II senior (8-11.9 years old), and group III geriatricians (>12 years old). Erythrocyte parameters were evaluated by OM (diameter, height, and axial ratio). Per each dog, the parameters of 20 erythrocytes were measured. A total of 2,600 cells were scanned with the AmScope™ Software scale. In addition, the RBC morphology was evaluated by SEM. Statistical analyses used analysis of variance and a general linear model, which allows the comparison of multiple factors at two or more levels (p < 0.05). The results of this study showed that diameter and height were lower in adult dogs than in senior and geriatrician dogs (p < 0.05). Whereas, sex, body size, and the interaction did not show a significant effect (p > 0.05). Additionally, some images of anisocytosis, polychromasia, and poikilocytosis (echinocytes, acanthocytes, codocytes, spherocytes, stomatocytes, dacryocytes quatrefoil, and elliptocytes) were obtained by OM and SEM. Our study provides information about the morphological and morphometry alterations of adult, senior, and geriatrician dogs RBC. This work contributes to future investigations and the diagnosing diseases, where it is necessary to evaluate the morphology of RBC.
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Affiliation(s)
- Ana Luisa Montoya-Navarrete
- Morphology Department, Basic Sciences Center, Autonomous University of Aguascalientes, Aguascalientes, Mexico
| | | | - Teódulo Quezada-Tristán
- Veterinary Sciences Department, Agricultural Sciences Center, Autonomous University of Aguascalientes, Aguascalientes, Mexico
| | - Arturo G. Valdivia-Flores
- Veterinary Sciences Department, Agricultural Sciences Center, Autonomous University of Aguascalientes, Aguascalientes, Mexico
| | - María J. Cano-Rábano
- Department of Veterinary Medicine, Surgery and Anatomy, Faculty of Veterinary Medicine, University of León, León, Spain
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8
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Arkew M, Asmerom H, Tesfa T, Tsegaye S, Gemechu K, Bete T, Haile K. Red Blood Cell Parameters and Their Correlation with Glycemic Control Among Type 2 Diabetic Adult Patients in Eastern Ethiopia: A Comparative Cross-Sectional Study. Diabetes Metab Syndr Obes 2022; 15:3499-3507. [PMID: 36388065 PMCID: PMC9656327 DOI: 10.2147/dmso.s386093] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022] Open
Abstract
Background Diabetes has been proposed to inflict an insult on the hematopoietic milieu marked by changes in hematological indices including red blood cell parameters. Thus, this study aimed to assess the red blood cell parameters and their correlation with glycemic control in type 2 diabetic adult patients in comparison with apparently healthy individuals. Methods A comparative cross-sectional study was conducted at the chronic illness clinic of Hiwot Fana Comprehensive Specialized University Hospital from May 20 to July 10, 2022. A total of 220 (110 type 2 diabetic patients and 110 controls) study participants were selected by a simple random sampling technique. Five milliliters of venous blood were collected by the vacutainer blood collection technique. Red blood cell parameters and blood glucose levels were determined using UniCel DxH 800 and Biosystems A25 analyzers, respectively. Independent sample t-test and Pearson correlation test were used for the data analysis. P-value <0.05 was considered statistically significant. Results Statistically significant difference was observed in RBC parameters of T2DM patients and the control group. The mean RBC count, Hgb, Hct (P < 0.001), and MCHC (P = 0.002) in patients with type 2 diabetes was significantly lower than in the control group. However, the mean of RDW was significantly increased in type 2 diabetic patient groups than in the control group (P < 0.001). The mean RBC count, Hct, and Hgb in patients with good glycemic control were significantly higher than the patients with poor glycemic control. Besides, a statistically significant negative correlation was observed between glycemic control and RBC count, Hgb, and Hct level in diabetic patients. Conclusion In this study, a statistically significant difference was observed in red blood cell parameters of type 2 diabetic patients compared to the control group. A significant negative correlation was noted between glycemic control and RBC parameters in type 2 diabetic patients. Therefore, evaluation of RBC parameters should be considered for better management of patients with type 2 diabetes mellitus.
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Affiliation(s)
- Mesay Arkew
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haftu Asmerom
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewodros Tesfa
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Setegn Tsegaye
- College of Health and Medical Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Kabtamu Gemechu
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Bete
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kassahun Haile
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
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Grobbelaar LM, Kruger A, Venter C, Burger EM, Laubscher GJ, Maponga TG, Kotze MJ, Kwaan HC, Miller JB, Fulkerson D, Huff W, Chang E, Wiarda G, Bunch CM, Walsh MM, Raza S, Zamlut M, Moore HB, Moore EE, Neal MD, Kell DB, Pretorius E. Relative Hypercoagulopathy of the SARS-CoV-2 Beta and Delta Variants when Compared to the Less Severe Omicron Variants Is Related to TEG Parameters, the Extent of Fibrin Amyloid Microclots, and the Severity of Clinical Illness. Semin Thromb Hemost 2022; 48:858-868. [PMID: 36174604 DOI: 10.1055/s-0042-1756306] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Earlier variants of SARS-CoV-2 have been associated with plasma hypercoagulability (as judged by thromboelastography) and an extensive formation of fibrin amyloid microclots, which are considered to contribute to the pathology of the coronavirus 2019 disease (COVID-19). The newer Omicron variants appear to be far more transmissible, but less virulent, even when taking immunity acquired from previous infections or vaccination into account. We here show that while the clotting parameters associated with Omicron variants are significantly raised over those of healthy, matched controls, they are only raised to levels significantly lower than those seen with more severe variants such as beta and delta. We also observed that individuals infected with omicron variants manifested less extensive microclot formation in platelet-poor plasma compared with those harboring the more virulent variants. The measurement of clotting effects between the different variants acts as a kind of "internal control" that demonstrates the relationship between the extent of coagulopathies and the virulence of the variant of interest. This adds to the evidence that microclots may play an important role in reflecting the severity of symptoms observed in COVID-19.
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Affiliation(s)
- Lize M Grobbelaar
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Matieland, South Africa
| | - Arneaux Kruger
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Matieland, South Africa
| | - Chantelle Venter
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Matieland, South Africa
| | | | | | - Tongai G Maponga
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Maritha J Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Hau C Kwaan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joseph B Miller
- Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Daniel Fulkerson
- Department of Neurosurgery, St. Joseph Regional Medical Center, Mishawaka, Indiana
| | - Wei Huff
- Department of Neurosurgery, St. Joseph Regional Medical Center, Mishawaka, Indiana
| | - Eric Chang
- Indiana University School of Medicine - South Bend, Notre Dame, Indiana
| | - Grant Wiarda
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Connor M Bunch
- Departments of Emergency Medicine and Internal Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Mark M Walsh
- Indiana University School of Medicine - South Bend, Notre Dame, Indiana.,Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana.,Department of Emergency Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Syed Raza
- Department of Critical Care Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Mahmud Zamlut
- Department of Critical Care Medicine, Saint Joseph Regional Medical Center, Mishawaka, Indiana
| | - Hunter B Moore
- Division of Transplant Surgery, Department of Surgery, Denver Health and University of Colorado Health Sciences Center, Denver, Colorado
| | - Ernest E Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health and University of Colorado Health Sciences Center, Denver, Colorado
| | - Matthew D Neal
- Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Douglas B Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Matieland, South Africa.,Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, England, United Kingdom.,The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Lyngby, Denmark
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Matieland, South Africa.,The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Lyngby, Denmark
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10
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Nardini M, Ciasca G, Lauria A, Rossi C, Di Giacinto F, Romanò S, Di Santo R, Papi M, Palmieri V, Perini G, Basile U, Alcaro FD, Di Stasio E, Bizzarro A, Masullo C, De Spirito M. Sensing red blood cell nano-mechanics: Toward a novel blood biomarker for Alzheimer's disease. Front Aging Neurosci 2022; 14:932354. [PMID: 36204549 PMCID: PMC9530048 DOI: 10.3389/fnagi.2022.932354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Red blood cells (RBCs) are characterized by a remarkable elasticity, which allows them to undergo very large deformation when passing through small vessels and capillaries. This extreme deformability is altered in various clinical conditions, suggesting that the analysis of red blood cell (RBC) mechanics has potential applications in the search for non-invasive and cost-effective blood biomarkers. Here, we provide a comparative study of the mechanical response of RBCs in patients with Alzheimer's disease (AD) and healthy subjects. For this purpose, RBC viscoelastic response was investigated using atomic force microscopy (AFM) in the force spectroscopy mode. Two types of analyses were performed: (i) a conventional analysis of AFM force-distance (FD) curves, which allowed us to retrieve the apparent Young's modulus, E; and (ii) a more in-depth analysis of time-dependent relaxation curves in the framework of the standard linear solid (SLS) model, which allowed us to estimate cell viscosity and elasticity, independently. Our data demonstrate that, while conventional analysis of AFM FD curves fails in distinguishing the two groups, the mechanical parameters obtained with the SLS model show a very good classification ability. The diagnostic performance of mechanical parameters was assessed using receiving operator characteristic (ROC) curves, showing very large areas under the curves (AUC) for selected biomarkers (AUC > 0.9). Taken all together, the data presented here demonstrate that RBC mechanics are significantly altered in AD, also highlighting the key role played by viscous forces. These RBC abnormalities in AD, which include both a modified elasticity and viscosity, could be considered a potential source of plasmatic biomarkers in the field of liquid biopsy to be used in combination with more established indicators of the pathology.
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Affiliation(s)
- Matteo Nardini
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriele Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Lauria
- Unitá Operativa Complessa Neuroriabilitazione ad Alta Intensitá, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Rossi
- Department of Laboratory Diagnostic and Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Flavio Di Giacinto
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sabrina Romanò
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Riccardo Di Santo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimiliano Papi
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Palmieri
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Istituto dei Sistemi Complessi (ISC), Consiglio Nazionale delle Ricerche (CNR), Rome, Italy
| | - Giordano Perini
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Umberto Basile
- Department of Laboratory Diagnostic and Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesca D. Alcaro
- Department of Laboratory Diagnostic and Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Enrico Di Stasio
- Department of Laboratory Diagnostic and Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Bizzarro
- Unitáă Operativa Complessa Continuità assistenziale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carlo Masullo
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Sezione di Neurologia, Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco De Spirito
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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11
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Pretorius E, Venter C, Laubscher GJ, Kotze MJ, Oladejo SO, Watson LR, Rajaratnam K, Watson BW, Kell DB. Prevalence of symptoms, comorbidities, fibrin amyloid microclots and platelet pathology in individuals with Long COVID/Post-Acute Sequelae of COVID-19 (PASC). Cardiovasc Diabetol 2022; 21:148. [PMID: 35933347 PMCID: PMC9356426 DOI: 10.1186/s12933-022-01579-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/16/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fibrin(ogen) amyloid microclots and platelet hyperactivation previously reported as a novel finding in South African patients with the coronavirus 2019 disease (COVID-19) and Long COVID/Post-Acute Sequelae of COVID-19 (PASC), might form a suitable set of foci for the clinical treatment of the symptoms of Long COVID/PASC. A Long COVID/PASC Registry was subsequently established as an online platform where patients can report Long COVID/PASC symptoms and previous comorbidities. METHODS In this study, we report on the comorbidities and persistent symptoms, using data obtained from 845 South African Long COVID/PASC patients. By using a previously published scoring system for fibrin amyloid microclots and platelet pathology, we also analysed blood samples from 80 patients, and report the presence of significant fibrin amyloid microclots and platelet pathology in all cases. RESULTS Hypertension, high cholesterol levels (dyslipidaemia), cardiovascular disease and type 2 diabetes mellitus (T2DM) were found to be the most important comorbidities. The gender balance (70% female) and the most commonly reported Long COVID/PASC symptoms (fatigue, brain fog, loss of concentration and forgetfulness, shortness of breath, as well as joint and muscle pains) were comparable to those reported elsewhere. These findings confirmed that our sample was not atypical. Microclot and platelet pathologies were associated with Long COVID/PASC symptoms that persisted after the recovery from acute COVID-19. CONCLUSIONS Fibrin amyloid microclots that block capillaries and inhibit the transport of O2 to tissues, accompanied by platelet hyperactivation, provide a ready explanation for the symptoms of Long COVID/PASC. Removal and reversal of these underlying endotheliopathies provide an important treatment option that urgently warrants controlled clinical studies to determine efficacy in patients with a diversity of comorbidities impacting on SARS-CoV-2 infection and COVID-19 severity. We suggest that our platelet and clotting grading system provides a simple and cost-effective diagnostic method for early detection of Long COVID/PASC as a major determinant of effective treatment, including those focusing on reducing clot burden and platelet hyperactivation.
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Affiliation(s)
- Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa. .,Department of Biochemistry and Systems Biology, Faculty of Health and Life Sciences, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK.
| | - Chantelle Venter
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa
| | | | - Maritha J Kotze
- Division of Chemical Pathology, Department of Pathology, National Health Laboratory Service, Tygerberg Hospital & Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Sunday O Oladejo
- Centre for AI Research, School for Data-Science & Computational Thinking, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Liam R Watson
- Centre for AI Research, School for Data-Science & Computational Thinking, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Kanshu Rajaratnam
- Centre for AI Research, School for Data-Science & Computational Thinking, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Bruce W Watson
- Centre for AI Research, School for Data-Science & Computational Thinking, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Douglas B Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa. .,Department of Biochemistry and Systems Biology, Faculty of Health and Life Sciences, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK. .,The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kemitorvet 200, 2800, Kgs Lyngby, Denmark.
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12
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Zajda A, Sikora J, Huttunen KM, Markowicz-Piasecka M. Structural Comparison of Sulfonamide-Based Derivatives That Can Improve Anti-Coagulation Properties of Metformin. Int J Mol Sci 2022; 23:ijms23084132. [PMID: 35456961 PMCID: PMC9029893 DOI: 10.3390/ijms23084132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 01/13/2023] Open
Abstract
Due to its high efficiency, good safety profile, and potential cardio-protective properties, metformin, a dimethyl biguanide, is the first-line medication in antihyperglycemic treatment for type 2 diabetic patients. The aim of our present study was to assess the effects of eight new sulfonamide-based derivatives of metformin on selected plasma parameters and vascular hemostasis, as well as on endothelial and smooth muscle cell function. The compounds with an alkyl chain (1–3), trifluoromethyl substituent (4), or acetyl group (5) significantly elevated glucose utilization in human umbilical endothelial cells (HUVECs), similarly to metformin. Our novel findings showed that metformin analogues 1–3 presented the most beneficial properties because of their greatest safety profile in the WST-1 cell viability assay, which was also proved in the further HUVEC integrity studies using RTCA DP. Compounds 1–3 did not affect either HUVEC or aortal smooth muscle cell (AoSMC) viability up to 3.0 mM. Importantly, these compounds beneficially affected some of the coagulation parameters, including factor X and antithrombin III activity. In contrast to the above-mentioned metformin analogues, derivatives 4 and 5 exerted more profound anticoagulation effects; however, they were also more cytotoxic towards HUVECs, as IC50 values were 1.0–1.5 mM. In conclusion, the chemical modification of a metformin scaffold into sulfonamides possessing alkyl substituents results in the formation of novel derivatives with potential bi-directional activity including anti-hyperglycemic properties and highly desirable anti-coagulant activity.
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Affiliation(s)
- Agnieszka Zajda
- Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego1, 90-151 Lodz, Poland;
| | - Joanna Sikora
- Department of Bioinorganic Chemistry, Medical University of Lodz, ul. Muszyńskiego1, 90-151 Lodz, Poland;
| | - Kristiina M. Huttunen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1C, P.O. Box 1627, 70211 Kuopio, Finland;
| | - Magdalena Markowicz-Piasecka
- Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego1, 90-151 Lodz, Poland;
- Correspondence: ; Tel.: +48-42-677-92-50
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13
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Sha T, Zhang Y, Li C, Lei G, Wu J, Li X, Yang Z, Zeng C, Wei J. Association of Metformin Use With Risk of Venous Thromboembolism in Adults With Type 2 Diabetes: A General-Population-Based Cohort Study. Am J Epidemiol 2022; 191:856-866. [PMID: 34999759 DOI: 10.1093/aje/kwab291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/06/2021] [Accepted: 12/21/2021] [Indexed: 11/14/2022] Open
Abstract
Metformin is hypothesized to protect against the risk of venous thromboembolism (VTE); however, there is a paucity of data supporting this hypothesis. Among individuals aged 40-90 years with a diagnosis of type 2 diabetes in the Health Improvement Network database (2000-2019), we compared the risks of incident VTE, pulmonary embolism, and deep vein thrombosis among metformin initiators with those among sulfonylurea initiators. Individuals were followed from their first prescription refill to an incident VTE, drug discontinuation, switching or augmenting, plan disenrollment, or the end of the study, whichever occurred first. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox model, adjusting for confounders using inverse probability of treatment weighting. Among 117,472 initiators of metformin and 13,835 initiators of sulfonylureas, 555 (1.3/1,000 person-years) and 75 (2.1/1,000 person-years) VTE cases occurred in each group, respectively. The multivariable-adjusted HR was 0.65 (95% CI: 0.51, 0.84). The corresponding risks for pulmonary embolism (adjusted HR = 0.71, 95% CI: 0.50, 1.01) and deep vein thrombosis (adjusted HR = 0.64, 95% CI: 0.48, 0.87) were also lower in metformin initiators than in sulfonylurea initiators. Our study provided empirical evidence to support a lower risk of VTE after initiation of metformin as compared with sulfonylureas among patients with type 2 diabetes.
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14
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Kell DB, Laubscher GJ, Pretorius E. A central role for amyloid fibrin microclots in long COVID/PASC: origins and therapeutic implications. Biochem J 2022; 479:537-559. [PMID: 35195253 PMCID: PMC8883497 DOI: 10.1042/bcj20220016] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 12/15/2022]
Abstract
Post-acute sequelae of COVID (PASC), usually referred to as 'Long COVID' (a phenotype of COVID-19), is a relatively frequent consequence of SARS-CoV-2 infection, in which symptoms such as breathlessness, fatigue, 'brain fog', tissue damage, inflammation, and coagulopathies (dysfunctions of the blood coagulation system) persist long after the initial infection. It bears similarities to other post-viral syndromes, and to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Many regulatory health bodies still do not recognize this syndrome as a separate disease entity, and refer to it under the broad terminology of 'COVID', although its demographics are quite different from those of acute COVID-19. A few years ago, we discovered that fibrinogen in blood can clot into an anomalous 'amyloid' form of fibrin that (like other β-rich amyloids and prions) is relatively resistant to proteolysis (fibrinolysis). The result, as is strongly manifested in platelet-poor plasma (PPP) of individuals with Long COVID, is extensive fibrin amyloid microclots that can persist, can entrap other proteins, and that may lead to the production of various autoantibodies. These microclots are more-or-less easily measured in PPP with the stain thioflavin T and a simple fluorescence microscope. Although the symptoms of Long COVID are multifarious, we here argue that the ability of these fibrin amyloid microclots (fibrinaloids) to block up capillaries, and thus to limit the passage of red blood cells and hence O2 exchange, can actually underpin the majority of these symptoms. Consistent with this, in a preliminary report, it has been shown that suitable and closely monitored 'triple' anticoagulant therapy that leads to the removal of the microclots also removes the other symptoms. Fibrin amyloid microclots represent a novel and potentially important target for both the understanding and treatment of Long COVID and related disorders.
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Affiliation(s)
- Douglas B. Kell
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, U.K
- The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kemitorvet 200, 2800 Kgs Lyngby, Denmark
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, 7602, South Africa
| | | | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, 7602, South Africa
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15
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Brun JF, Varlet-Marie E, Myzia J, Raynaud de Mauverger E, Pretorius E. Metabolic Influences Modulating Erythrocyte Deformability and Eryptosis. Metabolites 2021; 12:4. [PMID: 35050126 PMCID: PMC8778269 DOI: 10.3390/metabo12010004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 12/17/2022] Open
Abstract
Many factors in the surrounding environment have been reported to influence erythrocyte deformability. It is likely that some influences represent reversible changes in erythrocyte rigidity that may be involved in physiological regulation, while others represent the early stages of eryptosis, i.e., the red cell self-programmed death. For example, erythrocyte rigidification during exercise is probably a reversible physiological mechanism, while the alterations of red blood cells (RBCs) observed in pathological conditions (inflammation, type 2 diabetes, and sickle-cell disease) are more likely to lead to eryptosis. The splenic clearance of rigid erythrocytes is the major regulator of RBC deformability. The physicochemical characteristics of the surrounding environment (thermal injury, pH, osmolality, oxidative stress, and plasma protein profile) also play a major role. However, there are many other factors that influence RBC deformability and eryptosis. In this comprehensive review, we discuss the various elements and circulating molecules that might influence RBCs and modify their deformability: purinergic signaling, gasotransmitters such as nitric oxide (NO), divalent cations (magnesium, zinc, and Fe2+), lactate, ketone bodies, blood lipids, and several circulating hormones. Meal composition (caloric and carbohydrate intake) also modifies RBC deformability. Therefore, RBC deformability appears to be under the influence of many factors. This suggests that several homeostatic regulatory loops adapt the red cell rigidity to the physiological conditions in order to cope with the need for oxygen or fuel delivery to tissues. Furthermore, many conditions appear to irreversibly damage red cells, resulting in their destruction and removal from the blood. These two categories of modifications to erythrocyte deformability should thus be differentiated.
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Affiliation(s)
- Jean-Frédéric Brun
- UMR CNRS 9214-Inserm U1046 Physiologie et Médecine Expérimentale du Cœur et des Muscles-PHYMEDEXP, Unité D’explorations Métaboliques (CERAMM), Département de Physiologie Clinique, Université de Montpellier, Hôpital Lapeyronie-CHRU de Montpellier, 34295 Montpellier, France; (J.M.); (E.R.d.M.)
| | - Emmanuelle Varlet-Marie
- UMR CNRS 5247-Institut des Biomolécules Max Mousseron (IBMM), Laboratoire du Département de Physicochimie et Biophysique, UFR des Sciences Pharmaceutiques et Biologiques, Université de Montpellier, 34090 Montpellier, France;
| | - Justine Myzia
- UMR CNRS 9214-Inserm U1046 Physiologie et Médecine Expérimentale du Cœur et des Muscles-PHYMEDEXP, Unité D’explorations Métaboliques (CERAMM), Département de Physiologie Clinique, Université de Montpellier, Hôpital Lapeyronie-CHRU de Montpellier, 34295 Montpellier, France; (J.M.); (E.R.d.M.)
| | - Eric Raynaud de Mauverger
- UMR CNRS 9214-Inserm U1046 Physiologie et Médecine Expérimentale du Cœur et des Muscles-PHYMEDEXP, Unité D’explorations Métaboliques (CERAMM), Département de Physiologie Clinique, Université de Montpellier, Hôpital Lapeyronie-CHRU de Montpellier, 34295 Montpellier, France; (J.M.); (E.R.d.M.)
| | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Private Bag X1 MATIELAND, Stellenbosch 7602, South Africa;
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16
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In vitro effect of high glucose concentrations on erythrocyte morphology assessed by scanning electron microscopy. Micron 2021; 154:103179. [PMID: 34895961 DOI: 10.1016/j.micron.2021.103179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022]
Abstract
AIMS To evaluate the in vitro effect of different glucose concentrations and the time series in erythrocyte cell viability and morphology parameters. METHODS Different glucose concentrations were assessed, from a normal physiological glucose concentration (5 mM) to a diabetes scenario (100 mM). Cell viability was obtained by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) assay. The erythrocyte morphology (diameter, height, and axial ratio) was assessed by scanning electron microscopy (SEM). RESULTS A significant decrease in cell viability was observed in erythrocytes with higher glucose concentration (100 mM). There was also a significant increase in the cells' diameter and height exposed to 100 mM, vs. those cultured with 5, 20, and 45 mM glucose, but only at 24 and 48 h. When comparing the same glucose concentration by a time series, it was observed that erythrocytes from the culture with 45 and 100 mM of glucose had a significant continuous decrease (approximately -0.40 μm) in diameter and height (24, 48, and 72 h), but there was no difference in the axial ratio observed. CONCLUSION Continuous exposure to high glucose concentrations in diabetes models produced less cell viability and changes in erythrocyte morphology (larger and scrambled cells), which in vivo might impact in microvascular complications.
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17
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HGF can reduce accumulation of inflammation and regulate glucose homeostasis in T2D mice. J Physiol Biochem 2021; 77:613-624. [PMID: 34363605 DOI: 10.1007/s13105-021-00828-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
Hepatocyte growth factor (HGF) has been studied as a protective factor for the survival of islet β cells and regulatory glucose transport and metabolism in many studies. The addition of exogenous HGF to cells or mice is the most common way to study HGF, but the persistence and stability of the administered HGF are unclear. In this experiment, wild-type C57BL6 (WT) mice and HGF-overexpressing transgenic (HGF-Tg) mice were divided into a normal diet (ND) group and an HFD group. The HGF protein level in the liver, kidney, spleen, pancreas, and VAT of HGF-Tg-ND mice was upregulated compared to that of WT-ND mice, and it was also upregulated in HGF-Tg-HFD mice compared to that in WT-HFD mice. In the ND group, though the HGF-Tg-ND mice showed higher fasted blood glucose levels and larger integrated density (IOD) of glucagon-positive cells than WT-ND mice, we found that HGF-Tg-ND mice can still maintain normal glucose tolerance based on an intraperitoneal glucose tolerance test (IPGTT) and an intraperitoneal insulin tolerance test (IPITT). In the HFD group, the HGF-Tg-HFD mice showed insulin sensitivity in IPGTT and IPITT and had larger areas and higher IOD values of islet β cells and smaller areas and IOD values of islet α cells than the WT-HFD mice. HGF-Tg-HFD mice had lower level of serum insulin than WT-HFD mice. The HGF-Tg-HFD mice showed inhibited accumulation of CD4+ T cells, CD8+ T cells, Ly6G+ neutrophils, and F4/80+ macrophages in the blood and tissues and protected liver and kidney functions. Oil Red O-stained liver sections revealed that WT-HFD mice had larger areas and higher IOD values of Oil Red O-positive cells than HGF-Tg-HFD mice, and WT-HFD mice had higher score of NASH. PAS-stained kidney sections found WT-HFD has higher mesangial area/glomerular area × 100% than HGF-Tg-HFD mice. Comparative analyses demonstrated that HGF reduces the proportions of inflammatory cells in the blood and tissues, and protects liver and kidney tissues by regulating glucose homeostasis of type 2 diabetic mice.
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18
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Wilson JM, Farley KX, Broida SE, Bradbury TL, Guild GN. Metformin Use Is Associated with Fewer Complications in Patients with Type-2 Diabetes Undergoing Total Knee Arthroplasty: A Propensity Score-Matched Analysis. J Bone Joint Surg Am 2021; 103:601-608. [PMID: 33787554 DOI: 10.2106/jbjs.20.01535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Diabetes is a well-established risk factor for complications following total knee arthroplasty (TKA), and the incidence of type-2 diabetes is increasing. Metformin is considered first-line therapy for type-2 diabetes and has been shown to reduce all-cause mortality and to possess anti-inflammatory properties. The impact of metformin use as it relates to outcomes following TKA is unknown. The purpose of this study was to investigate this relationship. METHODS This is a retrospective cohort study using the Truven MarketScan database. Adult patients undergoing unilateral, primary TKA were identified. We included only patients with a preoperative diagnosis of type-2 diabetes and established 2 cohorts based on metformin status. Propensity score matching was performed to match patients who used metformin to those who did not (1-to-1). Patients were matched on factors including age, sex, insulin status, other diabetic medications, comorbidities, complexity of diabetes, and smoking status. Regression analysis was then performed on matched cohorts to examine 90-day outcomes. A subgroup analysis was performed on 1-year revision rates. RESULTS After matching, there were 32,186 patients in both the metformin group and the no-metformin group, resulting in a total of 64,372 included patients. Baseline characteristics were similar between groups. Regression analysis, performed on matched cohorts, demonstrated that the no-metformin group had increased odds of readmission (odds ratio [OR], 1.09 [95% confidence interval (CI), 1.04 to 1.15]; p < 0.001), emergency department presentation (OR, 1.09 [95% CI, 1.04 to 1.14]; p < 0.001), extended length of stay (OR, 1.12 [95% CI, 1.06 to 1.15]; p < 0.001), periprosthetic joint infection (OR, 1.30 [95% CI, 1.13 to 1.50]; p < 0.001), deep vein thrombosis (OR, 1.17 [95% CI, 1.09 to 1.26]; p < 0.001), acute kidney injury (OR, 1.21 [95% CI, 1.09 to 1.33]; p < 0.001), hypoglycemic events (OR, 1.25 [95% CI, 1.01 to 1.54]; p = 0.039), and 1-year revision (OR, 1.16 [95% CI, 1.01 to 1.33]; p = 0.033). CONCLUSIONS Metformin use in patients with type-2 diabetes undergoing TKA appears to be associated with lower odds of multiple complications and resource utilization parameters, including periprosthetic joint infection and 1-year revision rates. Given the frequency with which TKA is performed in patients with type-2 diabetes, this knowledge has the potential to improve optimization protocols and outcomes in this group of patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopaedic Surgery, Emory University , Atlanta , Georgia
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19
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Loyola-Leyva A, Loyola-Rodríguez JP, Terán-Figueroa Y, Camacho-Lopez S, González FJ, Barquera S. Application of atomic force microscopy to assess erythrocytes morphology in early stages of diabetes. A pilot study. Micron 2020; 141:102982. [PMID: 33227627 DOI: 10.1016/j.micron.2020.102982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
The study aim was to assess the application of atomic force microscopy (AFM) to evaluate erythrocyte morphology in early stages of type 2 diabetes mellitus, and the association with biochemical, anthropometric, diet, and physical activity indicators. This was a pilot cross-sectional study with four groups: healthy individuals, people with prediabetes (PDG), metabolic syndrome (MSG), and diabetes mellitus group (DMG). Blood samples were obtained to assess the erythrocyte morphology and biochemical parameters. Anthropometrical measurements were taken. Besides, a diet and a physical activity questionnaire were applied. The evaluation of the erythrocyte morphology through the AFM showed quantitative and qualitative alterations in the cell's form and size. Compared to the healthy group, the PDG had a reduction in height (-0.80 μm, p < 0.05), and an increase in axial ratio (-0.09 μm, p < 0.05); the MSG had lower concave depth (-0.19 μm, p < 0.05); and the DMG had a decreased height (-0.46 μm, p < 0.05) and concave depth (-0.29 μm, p < 0.05), and higher axial ratio (+0.08 μm) and thickness (+0.32 μm, p < 0.05). The PDG vs. DMG had a statistically significant difference in concave depth (+0.23 μm, p < 0.05) and thickness (-0.26 μm, p < 0.05). The MSG was different than the DMG in variables like axial ratio (-0.05 μm) and thickness (-0.25 μm). Besides, higher values of age, HbA1c, triglycerides, body mass index, waist-to-hip ratio, and physical inactivity were associated with altered erythrocyte morphology. AFM is a promising instrument to assess early but subtle changes in erythrocyte morphology (height, axial ratio, concave depth, thickness) before significant pathological conditions, such as type 2 diabetes mellitus. HbA1c might have a major effect in altered morphology, vs. metabolic parameters like high triglycerides, body mass index, waist, and physical inactivity.
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Affiliation(s)
- Alejandra Loyola-Leyva
- Coordination for Innovation and Application of Science and Technology (Coordinación para la Innovación y Aplicación de la Ciencia y Tecnología, CIACyT), Avenida Sierra Leona 550, Lomas 2ª sección, 78210, San Luis Potosí, S.L.P, Mexico.
| | - Juan Pablo Loyola-Rodríguez
- Faculty of Dentistry, Popular Autonomous University of the State of Puebla, 21 sur 1103, Barrio de Santiago, 72410, Puebla, Puebla, Mexico.
| | - Yolanda Terán-Figueroa
- Faculty of Nursing and Nutrition, Autonomous University of San Luis Potosí (Universidad Autónoma de San Luis Potosí), Lateral Av. Salvador Nava, Lomas, 78290, San Luis Potosí, S.L.P, Mexico.
| | - Santiago Camacho-Lopez
- Department of Optics, Center for Scientific Research and Higher Education of Ensenada (Centro de Investigación Científica y de Educación Superior de Ensenada, CICESE), Carretera Ensenada-Tijuana 3918. Zona Playitas, Ensenada, Baja California, Mexico.
| | - Francisco Javier González
- Coordination for Innovation and Application of Science and Technology (Coordinación para la Innovación y Aplicación de la Ciencia y Tecnología, CIACyT), Avenida Sierra Leona 550, Lomas 2ª sección, 78210, San Luis Potosí, S.L.P, Mexico.
| | - Simón Barquera
- Center for Nutrition and Health Research. National Institute of Public Health. Address: Av. Universidad No.655 Col Sta. Ma. Ahuacatitlán. Cuernavaca, Morelos, Mexico.
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20
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Pretorius E, Venter C, Laubscher GJ, Lourens PJ, Steenkamp J, Kell DB. Prevalence of readily detected amyloid blood clots in 'unclotted' Type 2 Diabetes Mellitus and COVID-19 plasma: a preliminary report. Cardiovasc Diabetol 2020; 19:193. [PMID: 33203441 PMCID: PMC7670290 DOI: 10.1186/s12933-020-01165-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background Type 2 Diabetes Mellitus (T2DM) is a well-known comorbidity to COVID-19 and coagulopathies are a common accompaniment to both T2DM and COVID-19. In addition, patients with COVID-19 are known to develop micro-clots within the lungs. The rapid detection of COVID-19 uses genotypic testing for the presence of SARS-Cov-2 virus in nasopharyngeal swabs, but it can have a poor sensitivity. A rapid, host-based physiological test that indicated clotting severity and the extent of clotting pathologies in the individual who was infected or not would be highly desirable. Methods Platelet poor plasma (PPP) was collected and frozen. On the day of analysis, PPP samples were thawed and analysed. We show here that microclots can be detected in the native plasma of twenty COVID-19, as well as ten T2DM patients, without the addition of any clotting agent, and in particular that such clots are amyloid in nature as judged by a standard fluorogenic stain. Results were compared to ten healthy age-matched individuals. Results In COVID-19 plasma these microclots are significantly increased when compared to the levels in T2DM. Conclusions This fluorogenic test may provide a rapid and convenient test with 100% sensitivity (P < 0.0001) and is consistent with the recognition that the early detection and prevention of such clotting can have an important role in therapy.
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Affiliation(s)
- Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland, 7602, South Africa.
| | - Chantelle Venter
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland, 7602, South Africa
| | - Gert Jacobus Laubscher
- Mediclinic Stellenbosch, Suite 104, 1 Elsie du Toit Street, Stellenbosch, 7600, South Africa
| | - Petrus Johannes Lourens
- Mediclinic Stellenbosch, Suite 104, 1 Elsie du Toit Street, Stellenbosch, 7600, South Africa
| | - Janami Steenkamp
- PathCare Laboratories, PathCare Business Centre, Neels Bothma Street, N1 City, 7460, South Africa
| | - Douglas B Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1, Matieland, 7602, South Africa. .,Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool, L69 7ZB, UK. .,The Novo Nordisk Foundation Centre for Biosustainability, Building 220, Kemitorvet, Technical University of Denmark, 2800, Kongens Lyngby, Denmark.
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21
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Di Giacinto F, Tartaglione L, Nardini M, Mazzini A, Romanò S, Rizzo GE, Papi M, De Spirito M, Pitocco D, Ciasca G. Searching for the Mechanical Fingerprint of Pre-diabetes in T1DM: A Case Report Study. Front Bioeng Biotechnol 2020; 8:569978. [PMID: 33117782 PMCID: PMC7552738 DOI: 10.3389/fbioe.2020.569978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/27/2020] [Indexed: 01/11/2023] Open
Abstract
We report the case of a 38 year-old Caucasian man enrolled in a study aimed at investigating the physical properties of red blood cells (RBCs) using advanced microscopy techniques, including Atomic Force Microscopy (AFM). At the time of his first enrolment in the study, he had normal Fasting Plasma Glucose (FPG) values, a BMI of 24.1, and no other symptoms of diabetes, including fatigue, high triglycerides, low HDL cholesterol, and altered inflammatory and corpuscular RBC indices. The subject reported no family history of diabetes, obesity, and cardiovascular diseases. Despite his apparently healthy conditions, the biomechanics of his RBCs was altered, showing increased values of stiffness and viscosity. More than 1 year after the mechanical measurements, the subject was admitted to the Operational Unit of Diabetology of the Policlinico Gemelli Hospital with high blood glucose and glycosylated hemoglobin (HbA1c) levels and diagnosed with type 1 diabetes (T1DM). Here, we show these data, and we discuss the hypothesis that RBC mechanical properties could be sensitive to changes occurring during the pre-diabetic phase of T1DM.
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Affiliation(s)
- Flavio Di Giacinto
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Linda Tartaglione
- Diabetes Care Unit, Catholic University School of Medicine and Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Matteo Nardini
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Alberto Mazzini
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Sabrina Romanò
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Gaetano Emanuele Rizzo
- Diabetes Care Unit, Catholic University School of Medicine and Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Massimiliano Papi
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Marco De Spirito
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Catholic University School of Medicine and Fondazione Policlinico Universitario “A. Gemelli” Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Gabriele Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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22
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Functional Mammalian Amyloids and Amyloid-Like Proteins. Life (Basel) 2020; 10:life10090156. [PMID: 32825636 PMCID: PMC7555005 DOI: 10.3390/life10090156] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/12/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023] Open
Abstract
Amyloids are highly ordered fibrous cross-β protein aggregates that are notorious primarily because of association with a variety of incurable human and animal diseases (termed amyloidoses), including Alzheimer’s disease (AD), Parkinson’s disease (PD), type 2 diabetes (T2D), and prion diseases. Some amyloid-associated diseases, in particular T2D and AD, are widespread and affect hundreds of millions of people all over the world. However, recently it has become evident that many amyloids, termed “functional amyloids,” are involved in various activities that are beneficial to organisms. Functional amyloids were discovered in diverse taxa, ranging from bacteria to mammals. These amyloids are involved in vital biological functions such as long-term memory, storage of peptide hormones and scaffolding melanin polymerization in animals, substrate attachment, and biofilm formation in bacteria and fungi, etc. Thus, amyloids undoubtedly are playing important roles in biological and pathological processes. This review is focused on functional amyloids in mammals and summarizes approaches used for identifying new potentially amyloidogenic proteins and domains.
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23
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Grobler C, Maphumulo SC, Grobbelaar LM, Bredenkamp JC, Laubscher GJ, Lourens PJ, Steenkamp J, Kell DB, Pretorius E. Covid-19: The Rollercoaster of Fibrin(Ogen), D-Dimer, Von Willebrand Factor, P-Selectin and Their Interactions with Endothelial Cells, Platelets and Erythrocytes. Int J Mol Sci 2020; 21:ijms21145168. [PMID: 32708334 PMCID: PMC7403995 DOI: 10.3390/ijms21145168] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), also known as coronavirus disease 2019 (COVID-19)-induced infection, is strongly associated with various coagulopathies that may result in either bleeding and thrombocytopenia or hypercoagulation and thrombosis. Thrombotic and bleeding or thrombotic pathologies are significant accompaniments to acute respiratory syndrome and lung complications in COVID-19. Thrombotic events and bleeding often occur in subjects with weak constitutions, multiple risk factors and comorbidities. Of particular interest are the various circulating inflammatory coagulation biomarkers involved directly in clotting, with specific focus on fibrin(ogen), D-dimer, P-selectin and von Willebrand Factor (VWF). Central to the activity of these biomarkers are their receptors and signalling pathways on endothelial cells, platelets and erythrocytes. In this review, we discuss vascular implications of COVID-19 and relate this to circulating biomarker, endothelial, erythrocyte and platelet dysfunction. During the progression of the disease, these markers may either be within healthy levels, upregulated or eventually depleted. Most significant is that patients need to be treated early in the disease progression, when high levels of VWF, P-selectin and fibrinogen are present, with normal or slightly increased levels of D-dimer (however, D-dimer levels will rapidly increase as the disease progresses). Progression to VWF and fibrinogen depletion with high D-dimer levels and even higher P-selectin levels, followed by the cytokine storm, will be indicative of a poor prognosis. We conclude by looking at point-of-care devices and methodologies in COVID-19 management and suggest that a personalized medicine approach should be considered in the treatment of patients.
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Affiliation(s)
- Corlia Grobler
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch 7602, South Africa; (C.G.); (S.C.M.); (L.M.G.); (J.C.B.)
| | - Siphosethu C. Maphumulo
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch 7602, South Africa; (C.G.); (S.C.M.); (L.M.G.); (J.C.B.)
| | - L. Mireille Grobbelaar
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch 7602, South Africa; (C.G.); (S.C.M.); (L.M.G.); (J.C.B.)
| | - Jhade C. Bredenkamp
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch 7602, South Africa; (C.G.); (S.C.M.); (L.M.G.); (J.C.B.)
| | - Gert J. Laubscher
- Elsie du Toit Street, Stellenbosch MediClinic, Stellenbosch 7600, South Africa; (G.J.L.); (P.J.L.)
| | - Petrus J. Lourens
- Elsie du Toit Street, Stellenbosch MediClinic, Stellenbosch 7600, South Africa; (G.J.L.); (P.J.L.)
| | - Janami Steenkamp
- PathCare Laboratories, PathCare Business Centre, Neels Bothma Street, N1 City, Cape Town 7460, South Africa;
| | - Douglas B. Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch 7602, South Africa; (C.G.); (S.C.M.); (L.M.G.); (J.C.B.)
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool L69 7ZB, UK
- The Novo Nordisk Foundation Centre for Biosustainability, Building 220, Kemitorve Technical University of Denmark, 2800 Kongens Lyngby, Denmark
- Correspondence: (D.B.K.); (E.P.)
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch 7602, South Africa; (C.G.); (S.C.M.); (L.M.G.); (J.C.B.)
- Correspondence: (D.B.K.); (E.P.)
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24
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Jackson BS, Nunes Goncalves J, Pretorius E. Comparison of pathological clotting using haematological, functional and morphological investigations in HIV-positive and HIV-negative patients with deep vein thrombosis. Retrovirology 2020; 17:14. [PMID: 32571345 PMCID: PMC7310079 DOI: 10.1186/s12977-020-00523-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/16/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Patients infected with the human immunodeficiency virus (HIV) are more prone to systemic inflammation and pathological clotting, and many may develop deep vein thrombosis (DVT) as a result of this dysregulated inflammatory profile. Coagulation tests are not routinely performed unless there is a specific reason. METHODS We recruited ten healthy control subjects, 35 HIV negative patients with deep vein thrombosis (HIV negative-DVT), and 13 HIV patients with DVT (HIV positive-DVT) on the primary antiretroviral therapy (ARV) regimen-emtricitabine, tenofovir and efavirenz. Serum inflammatory markers, haematological results, viscoelastic properties using thromboelastography (TEG) and scanning electron microscopy (SEM) of whole blood (WB) were used to compare the groups. RESULTS The DVT patients (HIV positive and HIV negative) had raised inflammatory markers. The HIV positive-DVT group had anaemia in keeping with anaemia of chronic disorders. DVT patients had a hypercoagulable profile on the TEG but no significant difference between HIV negative-DVT and HIV positive-DVT groups. The TEG analysis compared well and supported our ultrastructural results. Scanning electron microscopy of DVT patient's red blood cells (RBCs) and platelets demonstrated inflammatory changes including abnormal cell shapes, irregular membranes and microparticle formation. All the ultrastructural changes were more prominent in the HIV positive-DVT patients. CONCLUSIONS Although there were trends that HIV-positive patients were more hypercoagulable on functional tests (viscoelastic profile) compared to HIV-negative patients, there were no significant differences between the 2 groups. The sample size was, however, small in number. Morphologically there were inflammatory changes in patients with DVT. These ultrastructural changes, specifically with regard to platelets, appear more pronounced in HIV-positive patients which may contribute to increased risk for hypercoagulability and deep vein thrombosis.
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Affiliation(s)
- Brandon S Jackson
- Department of Surgery, University of Pretoria, Pretoria, 0007, South Africa
| | | | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa.
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25
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Markowicz-Piasecka M, Sadkowska A, Huttunen KM, Podsiedlik M, Mikiciuk-Olasik E, Sikora J. An investigation into the pleiotropic activity of metformin. A glimpse of haemostasis. Eur J Pharmacol 2020; 872:172984. [PMID: 32017937 DOI: 10.1016/j.ejphar.2020.172984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/08/2020] [Accepted: 01/31/2020] [Indexed: 02/07/2023]
Abstract
The most characteristic features of type 2 diabetes mellitus (T2DM) are hyperglycaemia and insulin resistance, however, patients with T2DM are at higher risk of cardiovascular disease (CVD) and atherosclerosis. Diabetes, frequently related to metabolic and vascular impairments, is also associated with thrombosis, increased blood coagulation and an imbalance between coagulation and fibrinolysis. Metformin is the most often used oral glucose-lowering agent; its beneficial properties include lowering insulin resistance, weight reduction and cardioprotection. Available data suggest that the advantageous properties of metformin stem from its favourable effects on endothelium, and anti-oxidative and anti-inflammatory properties. This paper reviews the favourable impact of metformin on endothelial function, with particular emphasis on the release of endogenous molecules modulating the state of the vascular endothelium and coagulation. It also summarizes the present knowledge on the influence of metformin on platelet activity and plasma haemostasis, including clot formation, stabilization and fibrinolysis. Its findings confirm that metformin should constitute first line therapy of T2DM subjects; however, more comprehensive methodical studies are required to discover the full potential of this drug.
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Affiliation(s)
- Magdalena Markowicz-Piasecka
- Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego 1, 90-151, Lodz, Poland.
| | - Adrianna Sadkowska
- Students Research Group, Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego 1, 90-151, Lodz, Poland.
| | - Kristiina M Huttunen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1C, POB 1627, 70211, Kuopio, Finland.
| | - Maria Podsiedlik
- Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego 1, 90-151, Lodz, Poland.
| | - Elżbieta Mikiciuk-Olasik
- Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego 1, 90-151, Lodz, Poland.
| | - Joanna Sikora
- Laboratory of Bioanalysis, Department of Pharmaceutical Chemistry, Drug Analysis and Radiopharmacy, Medical University of Lodz, ul. Muszyńskiego 1, 90-151, Lodz, Poland.
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26
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Visser MJ, Pretorius E. Atomic Force Microscopy: The Characterisation of Amyloid Protein Structure in Pathology. Curr Top Med Chem 2020; 19:2958-2973. [DOI: 10.2174/1568026619666191121143240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/24/2019] [Accepted: 09/27/2019] [Indexed: 12/28/2022]
Abstract
:
Proteins are versatile macromolecules that perform a variety of functions and participate in
virtually all cellular processes. The functionality of a protein greatly depends on its structure and alterations
may result in the development of diseases. Most well-known of these are protein misfolding disorders,
which include Alzheimer’s and Parkinson’s diseases as well as type 2 diabetes mellitus, where
soluble proteins transition into insoluble amyloid fibrils. Atomic Force Microscopy (AFM) is capable of
providing a topographical map of the protein and/or its aggregates, as well as probing the nanomechanical
properties of a sample. Moreover, AFM requires relatively simple sample preparation, which presents
the possibility of combining this technique with other research modalities, such as confocal laser
scanning microscopy, Raman spectroscopy and stimulated emission depletion microscopy. In this review,
the basic principles of AFM are discussed, followed by a brief overview of how it has been applied
in biological research. Finally, we focus specifically on its use as a characterisation method to
study protein structure at the nanoscale in pathophysiological conditions, considering both molecules
implicated in disease pathogenesis and the plasma protein fibrinogen. In conclusion, AFM is a userfriendly
tool that supplies multi-parametric data, rendering it a most valuable technique.
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Affiliation(s)
- Maria J.E. Visser
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa
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27
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Sheremet'ev YA, Popovicheva AN, Rogozin MM, Levin GY. Red blood cell aggregation, disaggregation and aggregate morphology in autologous plasma and serum in diabetic foot disease. Clin Hemorheol Microcirc 2019; 72:221-227. [PMID: 30909193 DOI: 10.3233/ch-180405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetes mellitus is frequently associated with microcirculation pathology and hemorheological disorders. METHODS 24 patients with diabetic foot and 22 healthy subjects were recruited. RBC aggregation, disaggregation and morphology of aggregates were determined in autologous plasma and serum. RESULTS The RBC aggregation in patients with diabetic foot increased in autologous plasma and serum. Increased red blood cell aggregate strength in these patients was observed only in autologous plasma. Microscopic images of RBC aggregates of patients with diabetic foot show the formation of pathologic globular structures of aggregates in autologous plasma and serum. CONCLUSION The RBC aggregation in autologous plasma and autologous serum in patients with diabetic foot is significantly higher than in healthy subjects. Increase in strength of RBC aggregates in diabetic foot patients was observed only in autologous plasma. The microscopic images of RBC aggregates in patients with diabetic foot indicate the formation of globular (pathologic) structures of aggregates in autologous plasma and serum. The differences in the morphology of RBC aggregates in autologous plasma and serum between healthy subjects and diabetic foot patients, obtained by microscopic image analysis with high magnification light microscope, can be used as an additional diagnostic tool in medical practice.
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28
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Impaired Glucose Tolerance is Associated with Enhanced Platelet-Monocyte Aggregation in Short-Term High-Fat Diet-Fed Mice. Nutrients 2019; 11:nu11112695. [PMID: 31703365 PMCID: PMC6893711 DOI: 10.3390/nu11112695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 01/21/2023] Open
Abstract
High-fat diet (HFD) feeding is known to induce metabolic dysregulation, however, less is known on its impact in promoting the hypercoagulable state. This current study aimed to evaluate platelet-monocyte aggregate (PMA) formation following short-term HFD feeding. This is particularly important for understanding the link between inflammation and the hypercoagulable state during the early onset of metabolic dysregulation. To explore such a hypothesis, mice were fed a HFD for 8 weeks, with body weights as well as insulin and blood glucose levels monitored on a weekly basis during this period. Basal hematological measurements were determined and the levels of spontaneous peripheral blood PMAs were assessed using whole blood flow cytometry. The results showed that although there were no significant differences in body weights, mice on HFD displayed impaired glucose tolerance and markedly raised insulin levels. These metabolic abnormalities were accompanied by elevated baseline PMA levels as an indication of hypercoagulation. Importantly, it was evident that baseline levels of monocytes, measured using the CD14 monocyte marker, were significantly decreased in HFD-fed mice when compared to controls. In summary, the current evidence shows that in addition to causing glucose intolerance, such as that identified in a prediabetic state, HFD-feeding can promote undesirable hypercoagulation, the major consequence implicated in the development of cardiovascular complications.
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29
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Pretorius E, Page MJ, Hendricks L, Nkosi NB, Benson SR, Kell DB. Both lipopolysaccharide and lipoteichoic acids potently induce anomalous fibrin amyloid formation: assessment with novel Amytracker™ stains. J R Soc Interface 2019; 15:rsif.2017.0941. [PMID: 29445039 PMCID: PMC5832738 DOI: 10.1098/rsif.2017.0941] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/24/2018] [Indexed: 12/11/2022] Open
Abstract
In recent work, we discovered that the presence of highly substoichiometric amounts (10−8 molar ratio) of lipopolysaccharide (LPS) from Gram-negative bacteria caused fibrinogen clotting to lead to the formation of an amyloid form of fibrin. We here show that the broadly equivalent lipoteichoic acids (LTAs) from two species of Gram-positive bacteria have similarly (if not more) potent effects. Using thioflavin T fluorescence to detect amyloid as before, the addition of low concentrations of free ferric ion is found to have similar effects. Luminescent conjugated oligothiophene dyes (LCOs), marketed under the trade name Amytracker™, also stain classical amyloid structures. We here show that they too give very large fluorescence enhancements when clotting is initiated in the presence of the four amyloidogens (LPS, ferric ions and two LTA types). The staining patterns differ significantly as a function of both the amyloidogens and the dyes used to assess them, indicating clearly that the nature of the clots formed is different. This is also the case when clotting is measured viscometrically using thromboelastography. Overall, the data provide further evidence for an important role of bacterial cell wall products in the various coagulopathies that are observable in chronic, inflammatory diseases. The assays may have potential in both diagnostics and therapeutics.
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Affiliation(s)
- Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Matieland 7602, South Africa
| | - Martin J Page
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Matieland 7602, South Africa
| | - Lisa Hendricks
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Matieland 7602, South Africa
| | - Nondumiso B Nkosi
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Matieland 7602, South Africa
| | - Sven R Benson
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Matieland 7602, South Africa
| | - Douglas B Kell
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Matieland 7602, South Africa .,School of Chemistry, The University of Manchester, 131 Princess Street, Manchester, Lancs M1 7DN, UK.,The Manchester Institute of Biotechnology, The University of Manchester, 131 Princess Street, Manchester, Lancs M1 7DN, UK.,Centre for Synthetic Biology of Fine and Speciality Chemicals, The University of Manchester, 131 Princess Street, Manchester, Lancs M1 7DN, UK
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30
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Randeria SN, Thomson GJA, Nell TA, Roberts T, Pretorius E. Inflammatory cytokines in type 2 diabetes mellitus as facilitators of hypercoagulation and abnormal clot formation. Cardiovasc Diabetol 2019; 18:72. [PMID: 31164120 PMCID: PMC6549308 DOI: 10.1186/s12933-019-0870-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The global burden of type 2 diabetes mellitus (T2DM), together with the presence of cardiovascular risk in this population, is reaching pandemic levels. A prominent feature of T2DM is chronic and systemic inflammation, with the accompanying presence of circulating and dysregulated inflammatory biomarkers; which in turn is associated with abnormal clot formation. METHODS Here, we investigate the correlation between abnormal blood clotting, using thromboelastography (TEG), clot ultrastructure using scanning electron microscopy (SEM) and the presence of a dysregulated inflammatory cytokine profile, by examining various circulating biomarkers. RESULTS Our results show that many biomarkers, across TEG, cytokine and lipid groups, were greatly dysregulated in the T2DM sample. Furthermore, our T2DM sample's coagulation profiles were significantly more hypercoagulable when compared to our heathy sample, and ultrastructural analysis confirmed a matted and denser clot structure in the T2DM sample. CONCLUSIONS We suggest that dysregulated circulating molecules may in part be responsible for a hypercoagulable state and vascular dysfunction in the T2DM sample. We propose further that a personalized approach could be of great value when planning treatment and tracking the patient health status after embarking on a treatment regimes, and that looking to novel inflammatory and vascular biomarkers might be crucial.
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Affiliation(s)
- Shehan N Randeria
- Department of Physiological Sciences, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Greig J A Thomson
- Department of Physiological Sciences, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Theo A Nell
- Department of Physiological Sciences, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Timothy Roberts
- Department of Physiological Sciences, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
- Department of Biochemistry, Institute of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Crown St, Liverpool, L69 7ZB, UK.
| | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
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Loyola-Leyva A, Loyola-Rodríguez JP, Terán Figueroa Y, González FJ, Atzori M, Barquera Cervera S. Altered erythrocyte morphology in Mexican adults with prediabetes and type 2 diabetes mellitus evaluated by scanning electron microscope. Microscopy (Oxf) 2019; 68:261-270. [PMID: 30860262 DOI: 10.1093/jmicro/dfz011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/15/2019] [Accepted: 02/08/2019] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the erythrocyte morphology in people with prediabetes, T2DM and healthy subjects in a Mexican population and its association with biochemical parameters. METHODS Cross-sectional study consisted of three groups: healthy (HG), people with prediabetes (PG) and with T2DM (DMG). A blood sample was obtained from all participants to assess the erythrocyte morphology, and levels of HbA1c, glucose and lipid profile. Anthropometrical parameters were also evaluated. RESULTS It was observed that compared with healthy individuals, people with prediabetes presented a significant decrease in the diameter (-0.08 μm, P = 0.014) and height (-0.07 μm, P = 0.004), as well as people with T2DM (-0.33 μm, P < 0.001 in diameter; and -0.36 μm, P < 0.001 in height). Besides, it was found a significant difference in diameter (-0.25 μm, P < 0.001) and height (-0.29 μm, P < 0.001) between the PG and DMG. No significant differences in the axial ratio between groups. Also, HbA1c, glucose, triglycerides, cholesterol, LDL cholesterol, systolic blood pressure, weight, BMI, waist and hip circumference were significantly associated with diameter and height. CONCLUSIONS Erythrocyte morphological alterations can serve as an indicator of early diagnosis of T2DM and a factor implicated in the course of the clinical condition, so the correction of these alterations could serve as a treatment for prediabetes and T2DM. It is essential to promote constantly checkups of biochemical and anthropometrical parameters, as well as erythrocyte morphological alterations to prevent the onset of prediabetes and T2DM and possible clinical complications.
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Affiliation(s)
- Alejandra Loyola-Leyva
- School of Medicine, Autonomous University of San Luis Potosí (Universidad Autónoma de San Luis Potosí), Avenida Venustiano Carranza 2405, Los Filtros, 78210, San Luis Potosí, S.L.P, Mexico
| | - Juan Pablo Loyola-Rodríguez
- Laboratory of Nanobiotechnology, Faculty of Medicine, Autonomous University of Guerrero (Universidad Autónoma de Guerrero), Acapulco, Guerrero, Mexico
| | - Yolanda Terán Figueroa
- Faculty of Nursing and Nutrition, Autonomous University of San Luis Potosí (Universidad Autónoma de San Luis Potosí), Av. Niño Artillero 130. Zona Universitaria, 78240, San Luis Potosí, S.L.P, México
| | - Francisco Javier González
- Coordination for Innovation and Application of Science and Technology (CIACyT), Avenida Sierra Leona 550, Lomas 2ª sección, 78210, San Luis Potosí, S.L.P, México
| | - Marco Atzori
- Faculty of Sciences, Autonomous University of San Luis Potosí (Universidad Autónoma de San Luis Potosí), Lateral Av. Salvador Nava, Lomas, 78290, San Luis Potosí, S.L.P, México
| | - Simón Barquera Cervera
- National Institute of Public Health (Instituto Nacional de Salud Pública), Av. Universidad No.655 Col Sta. Ma. Ahuacatitlán. Cuernavaca, Morelos, México
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32
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Red blood cell membrane cholesterol in type 2 diabetes mellitus. Thromb Res 2019; 178:91-98. [DOI: 10.1016/j.thromres.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 02/07/2023]
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33
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Phasha MAN, Soma P, Pretorius E, Phulukdaree A. Coagulopathy in Type 2 Diabetes Mellitus: Pathological Mechanisms and the Role of Factor XIII-A Single Nucleotide Polymorphisms. Curr Diabetes Rev 2019; 15:446-455. [PMID: 30706822 DOI: 10.2174/1573399815666190130113328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/18/2018] [Accepted: 01/21/2019] [Indexed: 12/29/2022]
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) has quadrupled within three decades since 1980, affecting 422 million adults in 2016. It remains one of the most common noncommunicable chronic diseases and the underlying risk factor for cardiovascular diseases worldwide. There are different underlying mechanisms that play a role in the development of pathologies associated with the disease such as hyperglycaemia, oxidative stress, obesity, inflammation and hypercoagulation; each of which are interlinked. Hyperglycaemia, oxidative stress and obesity play a huge role in the activation of inflammation and coagulation. Activation of inflammatory pathways increases the production of thrombin which predisposes the development of thrombotic related diseases. One of the factors that contribute to the increase of thrombin is the impairment of the fibrinolysis process due to decreased expression of tissue-plasminogen activator (tPA) by increased levels of plasminogen activator inhibitor-1 (PAI-1). Coagulation factor XIII (FXIII), a transglutaminase that is composed of subunits A and B (FXIII-A2B2), is essential for the last step of fibrin clot formation in the coagulation pathway. Genetic variation of FXIII-A in the form of single nucleotide polymorphisms (SNPs) alters the activity of FXIII, altering clot properties which influence disease outcomes. This review discusses the link between underlying mechanisms of T2DM, well known FXIII-A variants and coagulation.
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Affiliation(s)
- Marry-Ann Ntanyane Phasha
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Prashilla Soma
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Etheresia Pretorius
- Department of Physiological Science, Faculty of Sciences, Stellenbosch University, Pretoria, South Africa
| | - Alia Phulukdaree
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Gajos G, Siniarski A, Natorska J, Ząbczyk M, Siudut J, Malinowski KP, Gołębiowska-Wiatrak R, Rostoff P, Undas A. Polyhedrocytes in blood clots of type 2 diabetic patients with high cardiovascular risk: association with glycemia, oxidative stress and platelet activation. Cardiovasc Diabetol 2018; 17:146. [PMID: 30466424 PMCID: PMC6251112 DOI: 10.1186/s12933-018-0789-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/14/2018] [Indexed: 01/14/2023] Open
Abstract
Background Little is known about factors that affect the composition of contracted blood clots in specific diseases. We investigated the content of polyhedral erythrocytes (polyhedrocytes) formed in blood clots and its determinants in type 2 diabetes (T2D) patients. Methods In 97 patients with long-standing T2D [median HbA1c, 6.4% (interquartile range 5.9–7.8)], we measured in vitro the composition of blood clots, including a clot area covered by polyhedrocytes using scanning electron microscopy and the erythrocyte compression index (ECI), defined as a ratio of the mean polyhedrocyte area to the mean native erythrocyte area. Moreover, plasma fibrin clot permeability (Ks), clot lysis time (CLT), thrombin generation, oxidative stress [total protein carbonyl (total PC), total antioxidant capacity and thiobarbituric acid reactive substances (TBARS)], and platelet activation markers were determined. The impact of glucose concentration on polyhedrocytes formation was assessed in vitro. Results Polyhedrocytes content in contracted clots was positively correlated with glucose (r = 0.24, p = 0.028), glycated hemoglobin (r = 0.40, p = 0.024), total cholesterol (r = 0.22, p = 0.044), TBARS (r = 0.60, p = 0.0027), P-selectin (r = 0.54, p = 0.0078) and platelet factor-4, PF4 (r = 0.59, p = 0.0032), but not with thrombin generation, platelet count, Ks or CLT. Patients who formed more polyhedrocytes (≥ 10th percentile) (n = 83, 85.6%) had higher glucose (+ 15.7%, p = 0.018), fibrinogen (+ 16.6%, p = 0.004), lower red blood cell distribution width (RDW, − 8.8%, p = 0.034), reduced plasma clot density (− 21.8% Ks, p = 0.011) and impaired fibrinolysis (+ 6.5% CLT, p = 0.037) when compared to patients with lesser amount of polyhedrocytes (< 10th percentile). ECI and the content of polyhedrocytes were strongly associated with total PC (r = 0.79, p = 0.036 and r = 0.67, p = 0.0004, respectively). In vitro an increase of glucose concentration by 10 mmol/L was associated with 94% higher polyhedrocytes content (p = 0.033) when compared to the baseline (7.1 mM). After adjustment for age, sex and fibrinogen, multiple regression analysis showed that RDW was the only independent predictor of polyhedrocytes content in T2D (OR = 0.61, 95% CI 0.39–0.92). Conclusions Poor glycemic control, together with enhanced platelet activation and oxidative stress, increase the content of polyhedrocytes in blood clots generated in T2D patients. Electronic supplementary material The online version of this article (10.1186/s12933-018-0789-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Grzegorz Gajos
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Prądnicka 80 St., 31-202, Kraków, Poland. .,John Paul II Hospital, Prądnicka 80 St., Kraków, Poland.
| | - Aleksander Siniarski
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Prądnicka 80 St., 31-202, Kraków, Poland.,John Paul II Hospital, Prądnicka 80 St., Kraków, Poland
| | - Joanna Natorska
- Institute of Cardiology, Jagiellonian University Medical College, Prądnicka 80 St., Kraków, Poland.,John Paul II Hospital, Prądnicka 80 St., Kraków, Poland
| | - Michał Ząbczyk
- Institute of Cardiology, Jagiellonian University Medical College, Prądnicka 80 St., Kraków, Poland
| | - Jakub Siudut
- Institute of Cardiology, Jagiellonian University Medical College, Prądnicka 80 St., Kraków, Poland.,John Paul II Hospital, Prądnicka 80 St., Kraków, Poland
| | - Krzysztof Piotr Malinowski
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Grzegórzecka 20 St., Kraków, Poland
| | - Renata Gołębiowska-Wiatrak
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Prądnicka 80 St., 31-202, Kraków, Poland.,John Paul II Hospital, Prądnicka 80 St., Kraków, Poland
| | - Paweł Rostoff
- Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Prądnicka 80 St., 31-202, Kraków, Poland.,John Paul II Hospital, Prądnicka 80 St., Kraków, Poland
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Prądnicka 80 St., Kraków, Poland.,John Paul II Hospital, Prądnicka 80 St., Kraków, Poland
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35
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de Waal GM, Engelbrecht L, Davis T, de Villiers WJS, Kell DB, Pretorius E. Correlative Light-Electron Microscopy detects lipopolysaccharide and its association with fibrin fibres in Parkinson's Disease, Alzheimer's Disease and Type 2 Diabetes Mellitus. Sci Rep 2018; 8:16798. [PMID: 30429533 PMCID: PMC6235901 DOI: 10.1038/s41598-018-35009-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/27/2018] [Indexed: 02/06/2023] Open
Abstract
Many chronic diseases, including those classified as cardiovascular, neurodegenerative, or autoimmune, are characterized by persistent inflammation. The origin of this inflammation is mostly unclear, but it is typically mediated by inflammatory biomarkers, such as cytokines, and affected by both environmental and genetic factors. Recently circulating bacterial inflammagens such as lipopolysaccharide (LPS) have been implicated. We used a highly selective mouse monoclonal antibody to detect bacterial LPS in whole blood and/or platelet poor plasma of individuals with Parkinson’s Disease, Alzheimer’s type dementia, or Type 2 Diabetes Mellitus. Our results showed that staining is significantly enhanced (P < 0.0001) compared to healthy controls. Aberrant blood clots in these patient groups are characterized by amyloid formation as shown by the amyloid-selective stains thioflavin T and Amytracker™ 480 or 680. Correlative Light-Electron Microscopy (CLEM) illustrated that the LPS antibody staining is located in the same places as where amyloid fibrils may be observed. These data are consistent with the Iron Dysregulation and Dormant Microbes (IDDM) hypothesis in which bacterial inflammagens such as LPS are responsible for anomalous blood clotting as part of the aetiology of these chronic inflammatory diseases.
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Affiliation(s)
- Greta M de Waal
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa
| | - Lize Engelbrecht
- Central Analytical Facilities, Fluorescence Microscopy Unit, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa
| | - Tanja Davis
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa
| | - Willem J S de Villiers
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa.,Department of Internal Medicine, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa
| | - Douglas B Kell
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa.,School of Chemistry, The University of Manchester, 131 Princess St, Manchester, Lancs, M1 7DN, UK.,Manchester Institute of Biotechnology, The University of Manchester, 131 Princess St, Manchester, Lancs, M1 7DN, UK
| | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, 7602, South Africa.
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36
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Pretorius L, Thomson GJA, Adams RCM, Nell TA, Laubscher WA, Pretorius E. Platelet activity and hypercoagulation in type 2 diabetes. Cardiovasc Diabetol 2018; 17:141. [PMID: 30388964 PMCID: PMC6214175 DOI: 10.1186/s12933-018-0783-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023] Open
Abstract
Background A strong correlation exists between type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), with CVD and the presence of atherosclerosis being the prevailing cause of morbidity and mortality in diabetic populations. T2DM is accompanied by various coagulopathies, including anomalous clot formation or amyloid fibrin(ogen), the presence of dysregulated inflammatory molecules. Platelets are intimately involved in thrombus formation and particularly vulnerable to inflammatory cytokines. Methods The aim of this current study was therefore to assess whole blood (hyper)coagulability, platelet ultrastructure and receptor expression, as well as the levels of IL-1β, IL-6, IL-8 and sP-selectin in healthy and diabetic individuals. Platelet morphology was assessed through scanning electron microscopy (SEM), while assessment of GPIIb/IIIa receptor expression was performed with confocal microscopy and flow cytometry with the addition of FITC-PAC-1 and CD41-PE antibodies. IL-1β, IL-6 and IL-8 and sP-selectin levels were assessed using a multiplex assay. Results In T2DM there is significant upregulation of circulating inflammatory markers, hypercoagulation and platelet activation, with increased GPIIb/IIIa receptor expression, as seen with flow cytometry and confocal microscopy. Analyses showed that these receptors were additionally shed onto microparticles, which was confirmed with SEM. Conclusions Cumulatively, this provides mechanistic evidence that pathological states of platelets together with amyloid fibrin(ogen) in T2DM, might underpin an increased risk for cardiovascular events.
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Affiliation(s)
- Lesha Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Stellenbosch, 7602, South Africa
| | - Greig J A Thomson
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Stellenbosch, 7602, South Africa
| | - Rozanne C M Adams
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Stellenbosch, 7602, South Africa.,Central Analytical Facilities, Fluorescence Imaging Unit Stellenbosch University, Stellenbosch Private Bag X1, Stellenbosch, 7602, South Africa
| | - Theo A Nell
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Stellenbosch, 7602, South Africa
| | - Willem A Laubscher
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Stellenbosch, 7602, South Africa.,Department of Electronic and Electric Engineering, Faculty of Engineering, Stellenbosch University, Stellenbosch Private Bag X1, Stellenbosch, 7602, South Africa
| | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1, Stellenbosch, 7602, South Africa.
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DiNicolantonio JJ, Mangan D, O'Keefe JH. Copper deficiency may be a leading cause of ischaemic heart disease. Open Heart 2018; 5:e000784. [PMID: 30364437 PMCID: PMC6196933 DOI: 10.1136/openhrt-2018-000784] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 01/23/2023] Open
Affiliation(s)
| | | | - James H O'Keefe
- Department of Preventive Cardiology, University of Missouri-Kansas City, Saint Lukes Mid America Heart Institute, Kansas City, Missouri, USA
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38
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Pretorius E. Erythrocyte deformability and eryptosis during inflammation, and impaired blood rheology. Clin Hemorheol Microcirc 2018; 69:545-550. [PMID: 29710698 DOI: 10.3233/ch-189205] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This review focusses on the erythrocytes (RBCs) and their structural changes during inflammation and impaired blood rheology. We discuss systemic inflammation and the effects of dysregulated inflammatory molecules. These pro-inflammatory molecules directly affect the haematological system, and particularly the RBCs, platelets and plasma proteins. We focus on the three main changes; increased RBC eryptosis (programmed cell death, similar to apoptosis) and pathological deformability, platelet hyperreactivity and anomalous blood clotting, due to pathological changes to fibrin(ogen) protein structure. This pro-inflammatory haematological system directly affects blood rheology. In turn, hemorheological parameters such as RBC deformability are important parameters in hypercoagulation, which is a hallmark of inflammation. For RBC deformation to happen during blood flow, the RBC membrane needs to be elastic to elongate sufficiently to squeeze through small capillaries. However, of greater importance is that the cell must return to its original biconcave shape after exiting the small diameter capillaries. CONCLUSION Hemorheological parameters such as RBC deformability are of great importance clinically, to both identify the presence and extent of inflammation, and to study these parameters during intervention therapies. RBC rheology and deformability may therefore be a useful cell model for pharmaceutical testing.
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Affiliation(s)
- E Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, Private Bag X1 Matieland, South Africa
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Kell DB, Pretorius E. No effects without causes: the Iron Dysregulation and Dormant Microbes hypothesis for chronic, inflammatory diseases. Biol Rev Camb Philos Soc 2018; 93:1518-1557. [PMID: 29575574 PMCID: PMC6055827 DOI: 10.1111/brv.12407] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 12/11/2022]
Abstract
Since the successful conquest of many acute, communicable (infectious) diseases through the use of vaccines and antibiotics, the currently most prevalent diseases are chronic and progressive in nature, and are all accompanied by inflammation. These diseases include neurodegenerative (e.g. Alzheimer's, Parkinson's), vascular (e.g. atherosclerosis, pre-eclampsia, type 2 diabetes) and autoimmune (e.g. rheumatoid arthritis and multiple sclerosis) diseases that may appear to have little in common. In fact they all share significant features, in particular chronic inflammation and its attendant inflammatory cytokines. Such effects do not happen without underlying and initially 'external' causes, and it is of interest to seek these causes. Taking a systems approach, we argue that these causes include (i) stress-induced iron dysregulation, and (ii) its ability to awaken dormant, non-replicating microbes with which the host has become infected. Other external causes may be dietary. Such microbes are capable of shedding small, but functionally significant amounts of highly inflammagenic molecules such as lipopolysaccharide and lipoteichoic acid. Sequelae include significant coagulopathies, not least the recently discovered amyloidogenic clotting of blood, leading to cell death and the release of further inflammagens. The extensive evidence discussed here implies, as was found with ulcers, that almost all chronic, infectious diseases do in fact harbour a microbial component. What differs is simply the microbes and the anatomical location from and at which they exert damage. This analysis offers novel avenues for diagnosis and treatment.
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Affiliation(s)
- Douglas B. Kell
- School of ChemistryThe University of Manchester, 131 Princess StreetManchesterLancsM1 7DNU.K.
- The Manchester Institute of BiotechnologyThe University of Manchester, 131 Princess StreetManchesterLancsM1 7DNU.K.
- Department of Physiological SciencesStellenbosch University, Stellenbosch Private Bag X1Matieland7602South Africa
| | - Etheresia Pretorius
- Department of Physiological SciencesStellenbosch University, Stellenbosch Private Bag X1Matieland7602South Africa
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40
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Markowicz-Piasecka M, Huttunen KM, Mateusiak Ł, Mikiciuk-Olasik E, Sikora J. Sulfenamide and sulfonamide derivatives of metformin can exert anticoagulant and profibrinolytic properties. Chem Biol Interact 2018; 284:126-136. [DOI: 10.1016/j.cbi.2018.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/15/2018] [Accepted: 02/12/2018] [Indexed: 01/07/2023]
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Pretorius E, Page MJ, Mbotwe S, Kell DB. Lipopolysaccharide-binding protein (LBP) can reverse the amyloid state of fibrin seen or induced in Parkinson's disease. PLoS One 2018; 13:e0192121. [PMID: 29494603 PMCID: PMC5832207 DOI: 10.1371/journal.pone.0192121] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/18/2018] [Indexed: 01/13/2023] Open
Abstract
The thrombin-induced polymerisation of fibrinogen to form fibrin is well established as a late stage of blood clotting. It is known that Parkinson's Disease (PD) is accompanied by dysregulation in blood clotting, but it is less widely known as a coagulopathy. In recent work, we showed that the presence of tiny amounts of bacterial lipopolysaccharide (LPS) in healthy individuals could cause clots to adopt an amyloid form, and this could be observed via scanning electron microscopy (SEM) or via the fluorescence of thioflavin-T. This could be prevented by the prior addition of lipopolysaccharide-binding protein (LBP). We had also observed by SEM this unusual clotting in the blood of patients with Parkinson's Disease. We hypothesised, and here show, that this too can be prevented by LBP in the context of PD. This adds further evidence implicating inflammatory microbial cell wall products as an accompaniment to the disease, and may be part of its aetiology. This may lead to novel treatment strategies in PD designed to target microbes and their products.
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Affiliation(s)
- Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Martin J. Page
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Sthembile Mbotwe
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Douglas B. Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
- School of Chemistry, The University of Manchester, Manchester, Lancs, United Kingdom
- The Manchester Institute of Biotechnology, The University of Manchester, Manchester, Lancs, United Kingdom
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Viscoelasticity as a measurement of clot structure in poorly controlled type 2 diabetes patients: towards a precision and personalized medicine approach. Oncotarget 2018; 7:50895-50907. [PMID: 27447972 PMCID: PMC5239445 DOI: 10.18632/oncotarget.10618] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/30/2016] [Indexed: 12/14/2022] Open
Abstract
Objectives Type 2 diabetes patients (T2D) have a considerably higher cardiovascularrisk, which is closely associated with systemic inflammation, and an accompanying pathologic coagulation system. Due to the complexity of the diabetic profile, we suggest that we need to look at each patient individually and particularly at his or her clotting profile; as the healthiness of the coagulation system gives us an indication of the success of clinical intervention. Results T2D coagulability varied markedly, although there were no clear difference in medication use and the standards of HbA1c levels. Research design and methods Our sample consisted of 90 poorly controlled T2D and 71 healthy individuals. We investigated the medication use and standards of HbA1c levels of T2D and we used thromboelastography (TEG) and scanning electron microscopy (SEM) to study their clot formation. Conclusion The latest NIH guidelines suggest that clinical medicine should focus on precision medicine, and the current broad understanding is that precision medicine may in future, provide personalized targets for preventative and therapeutic interventions. Here we suggest a practical example where TEG can be used as an easily accessible point-of-care tool to establish a comprehensive clotting profile analysis for T2D patients; and additionally may provide valuable information that may be used in the envisaged precision medicine approach. Only by closely following each individual patient's progress and healthiness and thereby managing systemic inflammation, will we be able to reduce this pandemic.
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Biocompatible sulfenamide and sulfonamide derivatives of metformin can exert beneficial effects on plasma haemostasis. Chem Biol Interact 2017; 280:15-27. [PMID: 29217384 DOI: 10.1016/j.cbi.2017.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/13/2017] [Accepted: 12/01/2017] [Indexed: 01/03/2023]
Abstract
As the pharmacokinetic properties of metformin are unfavourable, several analogues and prodrugs have been synthesised to improve its bioavailability. The aim of this study was to assess the plasma stability of sulfenamide and sulfonamide derivatives of metformin and establish their effects on plasma haemostasis and integrity of red blood cells (RBCs). The overall haemostasis potential was evaluated spectrophotometrically by clot formation and lysis test (CL-test). PT (Prothrombin Time) and APTT (Activated Partial Tromboplastin Time) were used to evaluate the effects if the compounds on the extrinsic and intrinsic coagulation pathway. Haemolysis assay, microscopy and flow cytometry studies were conducted to determine the effect of the compounds on RBCs. Two sulfonamide and one sulfenamide derivatives of metformin were associated with a statistically significant decrease in the overall potential of clot formation and fibrinolysis (↓ CLAUC), suggesting that these compounds may exert beneficial effects regarding plasma haemostasis, which is frequently impaired in diabetic patients. p- and o-Nitrobenzene sulfonamides contributed to the beneficial change in kinetic parameters of clot formation and fibrinolysis. o-Nitrobenzene sulfonamide significantly increased thrombin generation time (↑ TGt) and was also found to prolong both APTT and PT. All compounds did not exert any effects on the integrity of RBCs over the concentration range 0.006-0.6 μmol/mL which constitutes the expected therapeutic concentration. In conclusion, sulfonamide derivatives of metformin present potentially beneficial properties in terms of plasma haemostasis which is frequently impaired in T2DM patients. Therefore, metformin sulfonamides may become a prototype for further design and synthesis of novel metformin analogues and prodrugs with improved pharmacokinetic properties.
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Page MJ, Bester J, Pretorius E. Interleukin-12 and its procoagulant effect on erythrocytes, platelets and fibrin(ogen): the lesser known side of inflammation. Br J Haematol 2017; 180:110-117. [PMID: 29143311 DOI: 10.1111/bjh.15020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 09/19/2017] [Indexed: 01/21/2023]
Abstract
Inflammation, with its associated inflammatory molecules, is integral to most chronic diseases, including the various cardiovascular diseases. Interleukin 12 (IL12) is one of the inflammatory cytokines that is upregulated during inflammation; however, we know very little about its exact effect on red blood cells (RBCs), platelets and fibrin(ogen). IL12 is an important pleiotropic cytokine in early inflammatory responses and has potent immunomodulatory, antitumour and anti-infection activity. Here we investigate how low levels of circulating IL12, comparable to levels found during chronic inflammation, affect coagulation parameters, platelets and RBCs. We used thromboelastography, scanning electron microscopy, refractometery and wide-field microscopy. Our results show that IL12 caused hypercoagulation, platelet activation and spreading, as well as RBC agglutination. This phenomenon has far-reaching implications for treatment of the plethora of conditions where IL12 is upregulated, since it suggests aberrant haemorheology as agglutination affects blood flow. This information might be used in future to target the lowering of IL12 in inflammatory conditions, as well as address RBC agglutination.
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Affiliation(s)
- Martin J Page
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Janette Bester
- Department of Physiology, University of Pretoria, Pretoria, South Africa
| | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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Morphological changes in erythrocytes of people with type 2 diabetes mellitus evaluated with atomic force microscopy: A brief review. Micron 2017; 105:11-17. [PMID: 29145008 DOI: 10.1016/j.micron.2017.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 12/31/2022]
Abstract
Prevalence of type 2 diabetes mellitus (T2DM) has been increasing worldwide. Cardiovascular diseases are one of the main causes of death among people with T2DM. Morphological changes in erythrocytes have been associated with higher risk of cardiovascular diseases. Atomic force microscopy (AFM) is a new technique that allows non-invasive imaging of cells and the evaluation of changes in mechanical properties. AIM To evaluate by AFM the erythrocytes morphological changes of people with T2DM METHODS: Search was conducted from in PubMed, ScienceDirect, Scielo, and Lilacs. Erythrocyte, type 2 Diabetes Mellitus and, Microscopy, Atomic Force were the keywords used for the search. Papers included were cross-sectional studies performed in humans. RESULTS Five of seven articles fulfilled the inclusion criteria. Compared with healthy cells, the erythrocytes from individuals affected by T2DM had morphological changes such as a decreased concave depth, diameter, height and a deformation index, while axial ratio, stiffness, adhesive force, aggregation, and rigidity index were increased. The results regarding the erythrocyte roughness were inconclusive. CONCLUSIONS The AFM is an excellent instrument to study the altered erythrocytes of subjects affected by T2DM. Morphology changes in erythrocytes could lead to cardiovascular events, which are major complications in people living with this disease.
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Pretorius E, Page MJ, Engelbrecht L, Ellis GC, Kell DB. Substantial fibrin amyloidogenesis in type 2 diabetes assessed using amyloid-selective fluorescent stains. Cardiovasc Diabetol 2017; 16:141. [PMID: 29096623 PMCID: PMC5668975 DOI: 10.1186/s12933-017-0624-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/23/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND We have previously shown that many chronic, inflammatory diseases are accompanied, and possibly partly caused or exacerbated, by various coagulopathies, manifested as anomalous clots in the form of 'dense matted deposits'. More recently, we have shown that these clots can be amyloid in nature, and that the plasma of healthy controls can be induced to form such clots by the addition of tiny amounts of bacterial lipopolysaccharide or lipoteichoic acid. Type 2 diabetes (T2D) is also accompanied by raised levels of LPS. METHODS We use superresolution and confocal microscopies to investigate the amyloid nature of clots from healthy and T2D individuals. RESULTS We show here, with the established stain thioflavin T and the novel stains Amytracker™ 480 and 680, that the clotting of plasma from type 2 diabetics is also amyloid in nature, and that this may be prevented by the addition of suitable concentrations of LPS-binding protein. CONCLUSION This implies strongly that there is indeed a microbial component to the development of type 2 diabetes, and suggests that LBP might be used as treatment for it and its sequelae.
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Affiliation(s)
- Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, Stellenbosh, 7602, South Africa.
| | - Martin J Page
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, Stellenbosh, 7602, South Africa
| | - Lize Engelbrecht
- Central Analytical Facility, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, Stellenbosh, 7602, South Africa
| | - Graham C Ellis
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, Stellenbosh, 7602, South Africa.,Synexus Helderberg Clinical Research Centre, Helderberg Synexus South Africa, 7G&H Arun Place, Somerset West, 7130, South Africa
| | - Douglas B Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch Private Bag X1 Matieland, Stellenbosh, 7602, South Africa. .,School of Chemistry and Manchester Institute of Biotechnology, The University of Manchester, 131 Princess St, Manchester, M1 7DN, Lancs, UK.
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Pretorius E, Mbotwe S, Kell DB. Lipopolysaccharide-binding protein (LBP) reverses the amyloid state of fibrin seen in plasma of type 2 diabetics with cardiovascular co-morbidities. Sci Rep 2017; 7:9680. [PMID: 28851981 PMCID: PMC5574907 DOI: 10.1038/s41598-017-09860-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 07/31/2017] [Indexed: 12/22/2022] Open
Abstract
Type 2 diabetes (T2D) has many cardiovascular complications, including a thrombotic propensity. Many such chronic, inflammatory diseases are accompanied (and may be exacerbated, and possibly even largely caused) by amyloid fibril formation. Recognising that there are few strong genetic associations underpinning T2D, but that amyloidogenesis of amylin is closely involved, we have been seeking to understand what might trigger the disease. Serum levels of bacterial lipopolysaccharide are raised in T2D, and we recently showed that fibrin(ogen) polymerisation during blood clotting can be affected strongly by LPS. The selectivity was indicated by the regularisation of clotting by lipopolysaccharide-binding protein (LBP). Since coagulopathies are a hallmark of T2D, we wondered whether they might too be caused by LPS (and reversed by LBP). We show here, using SEM and confocal microscopy, that platelet-poor-plasma from subjects with T2D had a much greater propensity for hypercoagulability and for amyloidogenesis, and that these could both be reversed by LBP. These data imply that coagulopathies are an important feature of T2D, and may be driven by ‘hidden’ LPS. Given the prevalence of amyloid formation in the sequelae of diabetes, this opens up novel strategies for both the prevention and treatment of T2D.
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Affiliation(s)
- Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch Private Bag X1 MATIELAND, 7602, Stellenbosch, South Africa.
| | - Sthembile Mbotwe
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Arcadia, 0007, South Africa
| | - Douglas B Kell
- School of Chemistry, The University of Manchester, 131 Princess St, MANCHESTER M1 7DN, Lancs, UK. .,Manchester Institute of Biotechnology, The University of Manchester, 131 Princess St, MANCHESTER M1 7DN, Lancs, UK. .,Centre for Synthetic Biology of Fine and Speciality Chemicals, The University of Manchester, 131 Princess St, MANCHESTER M1 7DN, Lancs, UK.
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Kell DB, Pretorius E. To What Extent Are the Terminal Stages of Sepsis, Septic Shock, Systemic Inflammatory Response Syndrome, and Multiple Organ Dysfunction Syndrome Actually Driven by a Prion/Amyloid Form of Fibrin? Semin Thromb Hemost 2017; 44:224-238. [PMID: 28778104 PMCID: PMC6193370 DOI: 10.1055/s-0037-1604108] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A well-established development of increasing disease severity leads from sepsis through systemic inflammatory response syndrome, septic shock, multiple organ dysfunction syndrome, and cellular and organismal death. Less commonly discussed are the equally well-established coagulopathies that accompany this. We argue that a lipopolysaccharide-initiated (often disseminated intravascular) coagulation is accompanied by a proteolysis of fibrinogen such that formed fibrin is both inflammatory and resistant to fibrinolysis. In particular, we argue that the form of fibrin generated is amyloid in nature because much of its normal α-helical content is transformed to β-sheets, as occurs with other proteins in established amyloidogenic and prion diseases. We hypothesize that these processes of amyloidogenic clotting and the attendant coagulopathies play a role in the passage along the aforementioned pathways to organismal death, and that their inhibition would be of significant therapeutic value, a claim for which there is considerable emerging evidence.
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Affiliation(s)
- Douglas B Kell
- School of Chemistry, The University of Manchester, Manchester, United Kingdom.,Manchester Institute of Biotechnology, The University of Manchester, Manchester, United Kingdom.,Centre for Synthetic Biology of Fine and Speciality Chemicals, The University of Manchester, Manchester, United Kingdom
| | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Matieland, South Africa
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Xanthopoulos A, Giamouzis G, Melidonis A, Kitai T, Paraskevopoulou E, Paraskevopoulou P, Patsilinakos S, Triposkiadis F, Skoularigis J. Red blood cell distribution width as a prognostic marker in patients with heart failure and diabetes mellitus. Cardiovasc Diabetol 2017; 16:81. [PMID: 28683798 PMCID: PMC5501451 DOI: 10.1186/s12933-017-0563-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/20/2017] [Indexed: 02/08/2023] Open
Abstract
Background Red blood cell distribution width (RDW) is an established prognostic marker in acute and chronic heart failure (HF). Recent studies have pointed out a link among RDW, diabetes mellitus (DM) and inflammation. We sought to investigate the prognostic value and longitudinal pattern of RDW in patients with concomitant HF and DM, which remains unknown. Methods A total of 218 patients (71 diabetics) who presented with acute HF had RDW measured at admission, discharge and 4, 8 and 12 months post-discharge. The study endpoint was all-cause mortality or rehospitalization for HF during 1-year follow-up. Results The study endpoint was met in 33 patients (46.5%) with DM and in 54 patients (36.7%) without DM. RDW at admission was associated with higher event rate both in HF patients with and without DM (adjusted HR: 1.349, p = 0.002, 95% CI 1.120–1.624 and adjusted HR: 1.142, p = 0.033, 95% CI 1.011–1.291 respectively). In addition, a significant interaction was found between diabetes and RDW longitudinal changes (βinteraction = −0.002; SE = 0.001; p = 0.042). Conclusions Despite the similar prognostic significance of RDW in diabetic and non-diabetic HF patients regarding the study endpoint, longitudinal changes were found to be significantly different between these two groups of HF patients. This might be due to the higher inflammatory burden that diabetic HF patients carry and may provide new insights to the pathophysiological mechanism of RDW increase in HF, which remains unknown.
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Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, P.O. Box 1425, 411 10, Larissa, Greece.
| | - Gregory Giamouzis
- Department of Cardiology, University General Hospital of Larissa, P.O. Box 1425, 411 10, Larissa, Greece
| | | | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | | | | | - Filippos Triposkiadis
- Department of Cardiology, University General Hospital of Larissa, P.O. Box 1425, 411 10, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, P.O. Box 1425, 411 10, Larissa, Greece
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Qadri SM, Bissinger R, Solh Z, Oldenborg PA. Eryptosis in health and disease: A paradigm shift towards understanding the (patho)physiological implications of programmed cell death of erythrocytes. Blood Rev 2017; 31:349-361. [PMID: 28669393 DOI: 10.1016/j.blre.2017.06.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/05/2017] [Accepted: 06/15/2017] [Indexed: 12/19/2022]
Abstract
During the course of their natural ageing and upon injury, anucleate erythrocytes can undergo an unconventional apoptosis-like cell death, termed eryptosis. Eryptotic erythrocytes display a plethora of morphological alterations including volume reduction, membrane blebbing and breakdown of the membrane phospholipid asymmetry resulting in phosphatidylserine externalization which, in turn, mediates their phagocytic recognition and clearance from the circulation. Overall, the eryptosis machinery is tightly orchestrated by a wide array of endogenous mediators, ion channels, membrane receptors, and a host of intracellular signaling proteins. Enhanced eryptosis shortens the lifespan of circulating erythrocytes and confers a procoagulant phenotype; this phenomenon has been tangibly implicated in the pathogenesis of anemia, deranged microcirculation, and increased prothrombotic risk associated with a multitude of clinical conditions. Herein, we reviewed the molecular mechanisms dictating eryptosis and erythrophagocytosis and critically analyzed the current evidence leading to the pathophysiological ramifications of eryptotic cell death in the context of human disease.
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Affiliation(s)
- Syed M Qadri
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Centre for Innovation, Canadian Blood Services, Hamilton, ON, Canada.
| | - Rosi Bissinger
- Department of Internal Medicine, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Ziad Solh
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Medical Services and Innovation, Canadian Blood Services, Hamilton, ON, Canada
| | - Per-Arne Oldenborg
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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