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Cheng J, Zeng H, Chen H, Fan L, Xu C, Huang H, Tang T, Li M. Current knowledge of thrombocytopenia in sepsis and COVID-19. Front Immunol 2023; 14:1213510. [PMID: 37841241 PMCID: PMC10568455 DOI: 10.3389/fimmu.2023.1213510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Thrombocytopenia, characterized by a decrease in platelet count, is commonly observed in sepsis and COVID-19. In sepsis, thrombocytopenia can result from various mechanisms, including impaired platelet production in the bone marrow, accelerated platelet destruction due to increased inflammation, sequestration of platelets in the spleen, immune-mediated platelet destruction, or dysregulated host responses. Similarly, thrombocytopenia has been reported in COVID-19 patients, but the immune-related mechanisms underlying this association remain unclear. Notably, interventions targeting thrombocytopenia have shown potential for improving outcomes in both sepsis and COVID-19 patients. Understanding these mechanisms is crucial for developing effective treatments.
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Affiliation(s)
- Junjie Cheng
- Intensive Care Unit, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Hanhai Zeng
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huaijun Chen
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linfeng Fan
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chaoran Xu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huaping Huang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tianchi Tang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Min Li
- Intensive Care Unit, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
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2
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Zhao Y, Cao LY, Zhao YX, Wang F, Xie LL, Xing HY, Wang Q. Medical record data-enabled machine learning can enhance prediction of left atrial appendage thrombosis in nonvalvular atrial fibrillation. Thromb Res 2023; 223:174-183. [PMID: 36764084 DOI: 10.1016/j.thromres.2023.01.001] [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: 10/11/2022] [Revised: 11/16/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND As a major complication of non-valvular atrial fibrillation (NVAF), left atrial appendage (LAA) thrombosis is associated with cerebral ischemic strokes, as well as high morbidity. Due to insufficient incorporation of risk factors, most current scoring methods are limited to the analysis of relationships between clinical characteristics and LAA thrombosis rather than detecting potential risk. Therefore, this study proposes a clinical data-driven machine learning method to predict LAA thrombosis of NVAF. METHODS Patients with NVAF from January 2014 to June 2022 were enrolled from Southwest Hospital. We selected 40 variables for analysis, including demographic data, medical history records, laboratory results, and the structure of LAA. Three machine learning algorithms were adopted to construct classifiers for the prediction of LAA thrombosis risk. The most important variables related to LAA thrombosis and their influences were recognized by SHapley Addictive exPlanations method. In addition, we compared our model with CHADS2 and CHADS2-VASc scoring methods. RESULTS A total of 713 participants were recruited, including 127 patients with LAA thrombosis and 586 patients with no obvious thrombosis. The consensus models based on Random Forest and eXtreme Gradient Boosting LAA thrombosis prediction (RXTP) achieved the best accuracy of 0.865, significantly outperforming CHADS2 score and CHA2DS2-VASc score (0.757 and 0.754, respectively). The SHAP results showed that B-type natriuretic peptide, left atrial appendage width, C-reactive protein, Fibrinogen and estimated glomerular filtration rate are closely related to the risk of LAA thrombosis in nonvalvular atrial fibrillation. CONCLUSIONS The RXTP-NVAF model is the most effective model with the greatest ROC value and recall rate. The summarized risk factors obtained from SHAP enable the optimization of the treatment strategy, thereby preventing thromboembolism events and the occurrence of cardiogenic ischemic stroke.
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Affiliation(s)
- Yue Zhao
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University),Chongqing, China
| | - Li-Ya Cao
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University),Chongqing, China
| | - Ying-Xin Zhao
- Department of Pharmacy, Army Medical Center, Army Medical University (Third Military Medical University),Chongqing, China
| | - Fei Wang
- Medical Big Data and Artificial Intelligence Center, the First Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
| | - Lin-Li Xie
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University),Chongqing, China
| | - Hai-Yan Xing
- Department of Pharmacy, Army Medical Center, Army Medical University (Third Military Medical University),Chongqing, China.
| | - Qian Wang
- Department of Pharmacy, the First Affiliated Hospital of Army Medical University (Third Military Medical University),Chongqing, China.
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Zhu LC, Wu W, Zou B, Gan DK, Lin X, Zhou W, Xiong ML. Efficacy predictors of third-generation cephalosporins in treating spontaneous bacterial peritonitis. Medicine (Baltimore) 2022; 101:e30164. [PMID: 36221348 PMCID: PMC9542963 DOI: 10.1097/md.0000000000030164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Third-generation cephalosporins (3rd GCs) have recently become controversial as the first-line strategy for empirical spontaneous bacterial peritonitis (SBP) treatment. This study aimed to identify SBP treatment efficacy predictors of 3rd GCs. METHODS In this retrospective cohort study, 279 cirrhosis patients with SBP who received 3rd GC monotherapy for initial empirical treatment from 2013 to 2019 were included. Nonresponse was defined as a decreased ascites polymorphonuclear (PMN) count < 25% from baseline after 48 hours of antibacterial treatment. Multivariate regression analysis was used to identify efficacy predictors of 3rd GCs in treating SBP. Kaplan-Meier analysis was used to evaluate survival data. RESULTS The nonresponder group included 120 patients with no response, and the responder group included 159 patients with responses. The response rate to 3rd GCs was 57.0% among all patients. The common pathogens were Escherichia coli (40.6%), Staphylococcus (15.6%), Klebsiella pneumonia (12.5%), and Streptococcus (12.5%) in 32 ascites culture isolates. Nosocomial SBP (NSBP) (odds ratio [OR]: 2.371, 95% confidence interval [CI]: 1.323-4.249, P = .004), pneumonia (OR: 11.561, 95% CI: 1.876-71.257, P = .008), recurrent SBP (OR: 3.386, 95% CI: 1.804-6.357, P < .001), platelet count (≥113.5 × 109/L) (OR: 3.515, 95% CI: 1.973-6.263, P < .001), and ascites PMN count (≤0.760 × 109/L) (OR: 4.967, 95% CI: 2.553-9.663, P < .001) were independent predictors of nonresponse to 3rd GCs against SBP. Survival plot analysis at 30 days showed worse survival for the nonresponders (P = .003). CONCLUSION NSBP, pneumonia, recurrent SBP, increased platelet count, and lower ascites PMN count were independent predictors of nonresponse to 3rd GC in treating SBP. Nonresponse to initial antibiotic treatment was associated with worse survival.
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Affiliation(s)
- Long-Chuan Zhu
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
- *Correspondence: Long-Chuan Zhu, Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, 330002, China. (e-mail: )
| | - Wei Wu
- Department of Digestion, Children’s Hospital of Jiangxi Province, Nanchang, Jiangxi, China
| | - Bo Zou
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Da-Kai Gan
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Xue Lin
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Wei Zhou
- Department of Information Technology, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
| | - Mo-Long Xiong
- Department of Liver Disease, The Ninth Hospital of Nanchang, Nanchang, Jiangxi, China
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Chen X, Wei F, Zhang D, Tian S. Platelet index on admission as a predictor of bacteremia in acute cholangitis: a 7-year retrospective observational study. Platelets 2022; 33:1279-1286. [PMID: 36120827 DOI: 10.1080/09537104.2022.2123466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Bacteremia frequently occurs in patients with acute cholangitis, which could increase the risk of mortality. This single-center retrospective observational study was conducted from July 2013 to July 2020 to evaluate the predictive value of platelet index for bacteremia at admission for acute cholecystitis. A total of 285 patients with acute cholangitis were divided into bacteremia group and non-bacteremia group. The incidence of bacteremia in acute cholangitis was 48.42%. The bacteremia group had more grade III patients, higher 30d mortality rate [17(12.32%) vs 8(5.44%), p = .040] and higher incidence of thrombocytopenia [76(55.07%) vs 35(23.81%), p < .001]. Platelet counts and plateletcrit were significantly lower in the bacteremia group [84.5(60, 180) vs 162(102,225) ×109/L and 0.10(0.07, 0.21)% vs 0.18(0.12, 0.25) %, both p < .001]. ROC analysis indicated a high predictive value of platelet count and plateletcrit for bacteremia in patients with acute cholangitis and the area under the ROC curve (AUC) were 0.649 and 0.655, respectively. These results support the value of platelet count and plateletcrit in early prediction of bacteremia at admission for acute cholangitis.
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Affiliation(s)
- XiaoYing Chen
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Fu Wei
- Department of Intensive Care Unit, Xi'an People's Hospital(Xi'an Forth Hospital), Xi'an, PR China
| | - Dan Zhang
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Shijing Tian
- Department of Emergency, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
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Mandel J, Casari M, Stepanyan M, Martyanov A, Deppermann C. Beyond Hemostasis: Platelet Innate Immune Interactions and Thromboinflammation. Int J Mol Sci 2022; 23:ijms23073868. [PMID: 35409226 PMCID: PMC8998935 DOI: 10.3390/ijms23073868] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023] Open
Abstract
There is accumulating evidence that platelets play roles beyond their traditional functions in thrombosis and hemostasis, e.g., in inflammatory processes, infection and cancer, and that they interact, stimulate and regulate cells of the innate immune system such as neutrophils, monocytes and macrophages. In this review, we will focus on platelet activation in hemostatic and inflammatory processes, as well as platelet interactions with neutrophils and monocytes/macrophages. We take a closer look at the contributions of major platelet receptors GPIb, αIIbβ3, TLT-1, CLEC-2 and Toll-like receptors (TLRs) as well as secretions from platelet granules on platelet-neutrophil aggregate and neutrophil extracellular trap (NET) formation in atherosclerosis, transfusion-related acute lung injury (TRALI) and COVID-19. Further, we will address platelet-monocyte and macrophage interactions during cancer metastasis, infection, sepsis and platelet clearance.
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Affiliation(s)
- Jonathan Mandel
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany; (J.M.); (M.C.); (M.S.)
| | - Martina Casari
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany; (J.M.); (M.C.); (M.S.)
| | - Maria Stepanyan
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany; (J.M.); (M.C.); (M.S.)
- Center For Theoretical Problems of Physico-Chemical Pharmacology, 109029 Moscow, Russia;
- Physics Faculty, Lomonosov Moscow State University, 119991 Moscow, Russia
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology Immunology Ministry of Healthcare of Russian Federation, 117198 Moscow, Russia
| | - Alexey Martyanov
- Center For Theoretical Problems of Physico-Chemical Pharmacology, 109029 Moscow, Russia;
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology Immunology Ministry of Healthcare of Russian Federation, 117198 Moscow, Russia
- N.M. Emanuel Institute of Biochemical Physics RAS (IBCP RAS), 119334 Moscow, Russia
| | - Carsten Deppermann
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, 55131 Mainz, Germany; (J.M.); (M.C.); (M.S.)
- Correspondence:
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Di Bella S, Luzzati R, Principe L, Zerbato V, Meroni E, Giuffrè M, Crocè LS, Merlo M, Perotto M, Dolso E, Maurel C, Lovecchio A, Dal Bo E, Lagatolla C, Marini B, Ippodrino R, Sanson G. Aspirin and Infection: A Narrative Review. Biomedicines 2022; 10:biomedicines10020263. [PMID: 35203473 PMCID: PMC8868581 DOI: 10.3390/biomedicines10020263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
Acetylsalicylic acid (ASA) is one of the most commonly used drugs in the world. It derives from the extract of white willow bark, whose therapeutic potential was known in Egypt since 1534 BC. ASA’s pharmacological effects are historically considered secondary to its anti-inflammatory, platelet-inhibiting properties; however, human studies demonstrating a pro-inflammatory effect of ASA exist. It is likely that we are aware of only part of ASA’s mechanisms of action; moreover, the clinical effect is largely dependent on dosages. During the past few decades, evidence of the anti-infective properties of ASA has emerged. We performed a review of such research in order to provide a comprehensive overview of ASA and viral, bacterial, fungal and parasitic infections, as well as ASA’s antibiofilm properties.
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Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, “S. Giovanni di Dio” Hospital, 88900 Crotone, Italy;
| | - Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital, 34149 Trieste, Italy; (V.Z.); (E.D.); (C.M.); (A.L.)
| | - Elisa Meroni
- Clinical Microbiology and Virology Unit, “A. Manzoni” Hospital, 23900 Lecco, Italy;
| | - Mauro Giuffrè
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
- Correspondence: ; Tel.: +39-040-3994-305
| | - Lory Saveria Crocè
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
| | - Marco Merlo
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
| | - Maria Perotto
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
| | - Elisabetta Dolso
- Infectious Diseases Unit, Trieste University Hospital, 34149 Trieste, Italy; (V.Z.); (E.D.); (C.M.); (A.L.)
| | - Cristina Maurel
- Infectious Diseases Unit, Trieste University Hospital, 34149 Trieste, Italy; (V.Z.); (E.D.); (C.M.); (A.L.)
| | - Antonio Lovecchio
- Infectious Diseases Unit, Trieste University Hospital, 34149 Trieste, Italy; (V.Z.); (E.D.); (C.M.); (A.L.)
| | - Eugenia Dal Bo
- Cardiothoracic-Vascular Department, Azienda Sanitaria Universitaria Integrata, Cattinara University Hospital, 34149 Trieste, Italy;
| | - Cristina Lagatolla
- Department of Life Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Bruna Marini
- Ulisse BioMed Labs, Area Science Park, 34149 Trieste, Italy; (B.M.); (R.I.)
| | - Rudy Ippodrino
- Ulisse BioMed Labs, Area Science Park, 34149 Trieste, Italy; (B.M.); (R.I.)
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (S.D.B.); (R.L.); (L.S.C.); (M.M.); (M.P.); (G.S.)
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Ngamsri KC, Putri RA, Jans C, Schindler K, Fuhr A, Zhang Y, Gamper-Tsigaras J, Ehnert S, Konrad FM. CXCR4 and CXCR7 Inhibition Ameliorates the Formation of Platelet-Neutrophil Complexes and Neutrophil Extracellular Traps through Adora2b Signaling. Int J Mol Sci 2021; 22:13576. [PMID: 34948374 PMCID: PMC8709064 DOI: 10.3390/ijms222413576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 12/16/2022] Open
Abstract
Peritonitis and peritonitis-associated sepsis are characterized by an increased formation of platelet-neutrophil complexes (PNCs), which contribute to an excessive migration of polymorphonuclear neutrophils (PMN) into the inflamed tissue. An important neutrophilic mechanism to capture and kill invading pathogens is the formation of neutrophil extracellular traps (NETs). Formation of PNCs and NETs are essential to eliminate pathogens, but also lead to aggravated tissue damage. The chemokine receptors CXCR4 and CXCR7 on platelets and PMNs have been shown to play a pivotal role in inflammation. Thereby, CXCR4 and CXCR7 were linked with functional adenosine A2B receptor (Adora2b) signaling. We evaluated the effects of selective CXCR4 and CXCR7 inhibition on PNCs and NETs in zymosan- and fecal-induced sepsis. We determined the formation of PNCs in the blood and, in addition, their infiltration into various organs in wild-type and Adora2b-/- mice by flow cytometry and histological methods. Further, we evaluated NET formation in both mouse lines and the impact of Adora2b signaling on it. We hypothesized that the protective effects of CXCR4 and CXCR7 antagonism on PNC and NET formation are linked with Adora2b signaling. We observed an elevated CXCR4 and CXCR7 expression in circulating platelets and PMNs during acute inflammation. Specific CXCR4 and CXCR7 inhibition reduced PNC formation in the blood, respectively, in the peritoneal, lung, and liver tissue in wild-type mice, while no protective anti-inflammatory effects were observed in Adora2b-/- animals. In vitro, CXCR4 and CXCR7 antagonism dampened PNC and NET formation with human platelets and PMNs, confirming our in vivo data. In conclusion, our study reveals new protective aspects of the pharmacological modulation of CXCR4 and CXCR7 on PNC and NET formation during acute inflammation.
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Affiliation(s)
- Kristian-Christos Ngamsri
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; (K.-C.N.); (R.A.P.); (C.J.); (K.S.); (A.F.); (Y.Z.); (J.G.-T.)
| | - Rizki A. Putri
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; (K.-C.N.); (R.A.P.); (C.J.); (K.S.); (A.F.); (Y.Z.); (J.G.-T.)
| | - Christoph Jans
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; (K.-C.N.); (R.A.P.); (C.J.); (K.S.); (A.F.); (Y.Z.); (J.G.-T.)
| | - Katharina Schindler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; (K.-C.N.); (R.A.P.); (C.J.); (K.S.); (A.F.); (Y.Z.); (J.G.-T.)
| | - Anika Fuhr
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; (K.-C.N.); (R.A.P.); (C.J.); (K.S.); (A.F.); (Y.Z.); (J.G.-T.)
| | - Yi Zhang
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; (K.-C.N.); (R.A.P.); (C.J.); (K.S.); (A.F.); (Y.Z.); (J.G.-T.)
| | - Jutta Gamper-Tsigaras
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; (K.-C.N.); (R.A.P.); (C.J.); (K.S.); (A.F.); (Y.Z.); (J.G.-T.)
| | - Sabrina Ehnert
- Siegfried Weller Research Institute, BG Trauma Center Tübingen, Department of Trauma and Reconstructive Surgery, University of Tübingen, Schnarrenbergstr. 95, D-72076 Tübingen, Germany;
| | - Franziska M. Konrad
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; (K.-C.N.); (R.A.P.); (C.J.); (K.S.); (A.F.); (Y.Z.); (J.G.-T.)
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8
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Mutthineni RB, Ramishetty A, Gojja P, Muralidaran G, Burle VVA. Platelet Indices be a New Biomarker for Periodontal Disease. Contemp Clin Dent 2021; 12:289-293. [PMID: 34759687 PMCID: PMC8525805 DOI: 10.4103/ccd.ccd_461_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/01/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Platelets play an important role in inflammation and hemostasis. Periodontitis, a chronic inflammatory disease, is linked to an increase in platelet activation leading to increased risk for atherosclerosis and cardiovascular diseases. Aim: The aim was to evaluate whether platelet indices (mean platelet volume [MPV], platelet distribution width [PDW], and plateletcrit [PCT]) can be a biomarker for determining the severity of periodontal disease and to assess the relation between platelet indices in patients with periodontitis and healthy controls. Materials and Methods: The study included 3 groups – moderate periodontitis, severe periodontitis, and systemically healthy controls without periodontitis. Clinical parameters recorded were clinical attachment level and probing pocket depth and venous blood samples were drawn for the analysis of MPV, PDW, and PCT. Results: ANOVA test with post hoc Tukey's test was used to compare among 3 groups. Statistical analysis of platelet indices was done using sample t-test. The mean values of MPV, PDW, and PCT gradually increased from normal to severe periodontitis. Conclusion: Periodontitis, a chronic inflammatory process, causes not only increase in the quantity of platelets but also causes platelet activation which leads to change in platelet size, platelet shape, and platelet aggregation. As periodontitis causing platelet activation which seems to be a contributing factor in the development of cardiovascular diseases.
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Affiliation(s)
| | - Arpita Ramishetty
- Department of Periodontics, Mamata Dental College, Khammam, Telangana, India
| | - Prathibha Gojja
- Department of Periodontics, Mamata Dental College, Khammam, Telangana, India
| | | | - V V Alekya Burle
- Department of Periodontics, Mamata Dental College, Khammam, Telangana, India
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9
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Raineri EJM, Altulea D, van Dijl JM. Staphylococcal trafficking and infection - from 'nose to gut' and back. FEMS Microbiol Rev 2021; 46:6321165. [PMID: 34259843 PMCID: PMC8767451 DOI: 10.1093/femsre/fuab041] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/11/2021] [Indexed: 12/12/2022] Open
Abstract
Staphylococcus aureus is an opportunistic human pathogen, which is a leading cause of infections worldwide. The challenge in treating S. aureus infection is linked to the development of multidrug-resistant strains and the mechanisms employed by this pathogen to evade the human immune defenses. In addition, S. aureus can hide asymptomatically in particular ‘protective’ niches of the human body for prolonged periods of time. In the present review, we highlight recently gained insights in the role of the human gut as an endogenous S. aureus reservoir next to the nasopharynx and oral cavity. In addition, we address the contribution of these ecological niches to staphylococcal transmission, including the roles of particular triggers as modulators of the bacterial dissemination. In this context, we present recent advances concerning the interactions between S. aureus and immune cells to understand their possible roles as vehicles of dissemination from the gut to other body sites. Lastly, we discuss the factors that contribute to the switch from colonization to infection. Altogether, we conclude that an important key to uncovering the pathogenesis of S. aureus infection lies hidden in the endogenous staphylococcal reservoirs, the trafficking of this bacterium through the human body and the subsequent immune responses.
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Affiliation(s)
- Elisa J M Raineri
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dania Altulea
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Maarten van Dijl
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Giustozzi M, Ehrlinder H, Bongiovanni D, Borovac JA, Guerreiro RA, Gąsecka A, Papakonstantinou PE, Parker WAE. Coagulopathy and sepsis: Pathophysiology, clinical manifestations and treatment. Blood Rev 2021; 50:100864. [PMID: 34217531 DOI: 10.1016/j.blre.2021.100864] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/31/2021] [Accepted: 06/22/2021] [Indexed: 12/13/2022]
Abstract
Sepsis is a complex syndrome with a high incidence, increasing by 8.7% annually over the last 20 years. Coagulopathy is a leading factor associated with mortality in patients with sepsis and range from slight thrombocytopenia to fatal disorders, such as disseminated intravascular coagulation (DIC). Platelet reactivity increases during sepsis but prospective trials of antiplatelet therapy during sepsis have been disappointing. Thrombocytopenia is a known predictor of worse prognosis during sepsis. The mechanisms underlying thrombocytopenia in sepsis have yet to be fully understood but likely involves decreased platelet production, platelet sequestration and increased consumption. DIC is an acquired thrombohemorrhagic syndrome, resulting in intravascular fibrin formation, microangiopathic thrombosis, and subsequent depletion of coagulation factors and platelets. DIC can be resolved with treatment of the underlying disorder, which is considered the cornerstone in the management of this syndrome. This review presents the current knowledge on the pathophysiology, diagnosis, and treatment of sepsis-associated coagulopathies.
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Affiliation(s)
- Michela Giustozzi
- Internal Vascular and Emergency Medicine and Stroke Unit, University of Perugia, Perugia, Italy.
| | - Hanne Ehrlinder
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Dario Bongiovanni
- Technical University of Munich, School of Medicine, University hospital rechts der Isar, Department of Internal Medicine I, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Germany; Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS and Humanitas University, Rozzano, Milan, Italy
| | - Josip A Borovac
- Department of Pathophysiology, University of Split School of Medicine, Split, Croatia; Clinic for Cardiovascular Diseases, University Hospital of Split (KBC Split), Split, Croatia
| | | | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Panteleimon E Papakonstantinou
- Second Cardiology Department, Evangelismos Hospital, Athens, Greece; Hypertension Unit "ESH Excellence Centre", First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - William A E Parker
- Cardiovascular Research Unit, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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11
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Ghimire S, Ravi S, Budhathoki R, Arjyal L, Hamal S, Bista A, Khadka S, Uprety D. Current understanding and future implications of sepsis-induced thrombocytopenia. Eur J Haematol 2020; 106:301-305. [PMID: 33191517 DOI: 10.1111/ejh.13549] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023]
Abstract
Sepsis is a global health burden that needs intensive medical care. Thrombocytopenia in sepsis is well known to increase morbidity as well as mortality. Several studies have been performed both in animal models and in humans to understand the mechanism by which sepsis causes thrombocytopenia. Recent studies have shown that inhibiting thrombocytopenia improves outcomes in sepsis patients. Understanding these mechanisms to identify targets in use of newer treatment modalities besides using resuscitation measures, antibiotics and removal of thrombocytopenia inducing agent could potentially help us improve outcomes in sepsis.
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Affiliation(s)
- Subash Ghimire
- Department of Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Swapna Ravi
- Department of Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Rasmita Budhathoki
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Lubina Arjyal
- Department of Medicine, Gundersen Lutheran Medical Center, La Crosse, WI, USA
| | - Savyata Hamal
- Zainul Haque Sikder Women's Medical College, Bangladesh
| | - Amir Bista
- Department of Hematology-Oncology, Gundersen Lutheran Medical Center, LA Crosse, WI, USA
| | - Sushmita Khadka
- Department of Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA
| | - Dipesh Uprety
- Department of Hematology-Oncology, Gundersen Lutheran Medical Center, LA Crosse, WI, USA
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12
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Gautam I, Storad Z, Filipiak L, Huss C, Meikle CK, Worth RG, Wuescher LM. From Classical to Unconventional: The Immune Receptors Facilitating Platelet Responses to Infection and Inflammation. BIOLOGY 2020; 9:E343. [PMID: 33092021 PMCID: PMC7589078 DOI: 10.3390/biology9100343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 12/14/2022]
Abstract
Platelets have long been recognized for their role in maintaining the balance between hemostasis and thrombosis. While their contributions to blood clotting have been well established, it has been increasingly evident that their roles extend to both innate and adaptive immune functions during infection and inflammation. In this comprehensive review, we describe the various ways in which platelets interact with different microbes and elicit immune responses either directly, or through modulation of leukocyte behaviors.
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Affiliation(s)
| | | | | | | | | | | | - Leah M. Wuescher
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA; (I.G.); (Z.S.); (L.F.); (C.H.); (C.K.M.); (R.G.W.)
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13
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Braxton AM, Chalmin AL, Najarro KM, Brockhurst JK, Johnson KT, Lyons CE, Daly B, Cryer CG, Vijay S, Cyphers G, Guerrero-Martin SM, Aston SA, McGee K, Su YP, Arav-Boger R, Metcalf Pate KA. Platelet-endothelial associations may promote cytomegalovirus replication in the salivary gland in mice. Platelets 2020; 31:860-868. [PMID: 31726921 PMCID: PMC7220825 DOI: 10.1080/09537104.2019.1689383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/24/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
Platelet decline is a feature of many acute viral infections, including cytomegalovirus (CMV) infection in humans and mice. Platelet sequestration in association with other cells, including endothelium and circulating leukocytes, can contribute to this decline and influence the immune response to and pathogenesis of viral infection. We sought to determine if platelet-endothelial associations (PEAs) contribute to platelet decline during acute murine CMV (mCMV) infection, and if these associations affect viral load and production. Male BALB/c mice were infected with mCMV (Smith strain), euthanized at timepoints throughout acute infection and compared to uninfected controls. An increase in PEA formation was confirmed in the salivary gland at all post-inoculation timepoints using immunohistochemistry for CD41+ platelets co-localizing with CD34+ vessels. Platelet depletion did not change amount of viral DNA or timecourse of infection, as measured by qPCR. However, platelet depletion reduced viral titer of mCMV in the salivary glands while undepleted controls demonstrated robust replication in the tissue by plaque assay. Thus, platelet associations with endothelium may enhance the ability of mCMV to replicate within the salivary gland. Further work is needed to determine the mechanisms behind this effect and if pharmacologic inhibition of PEAs may reduce CMV production in acutely infected patients.
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Affiliation(s)
- Alicia M. Braxton
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Alyssa L. Chalmin
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kevin M. Najarro
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jacqueline K. Brockhurst
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, USA
| | - Karl T. Johnson
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Claire E. Lyons
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Brenna Daly
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
- Cummings School of Veterinary Medicine, Tufts University, North Grafton, USA
| | - Catherine G. Cryer
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, USA
| | - Shefali Vijay
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Griffin Cyphers
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Selena M. Guerrero-Martin
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - S. Andrew Aston
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
- Department of Psychiatry of Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kirstin McGee
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Yu-Pin Su
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ravit Arav-Boger
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA
| | - Kelly A. Metcalf Pate
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, USA
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14
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Hannachi N, Lepidi H, Fontanini A, Takakura T, Bou-Khalil J, Gouriet F, Habib G, Raoult D, Camoin-Jau L, Baudoin JP. A Novel Approach for Detecting Unique Variations among Infectious Bacterial Species in Endocarditic Cardiac Valve Vegetation. Cells 2020; 9:cells9081899. [PMID: 32823780 PMCID: PMC7464176 DOI: 10.3390/cells9081899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/25/2022] Open
Abstract
Infectious endocarditis (IE) remains one of the deadliest heart diseases with a high death rate, generally following thrombo-embolic events. Today, therapy is based on surgery and antibiotic therapy. When thromboembolic complications in IE patients persist, this is often due to our lack of knowledge regarding the pathophysiological development and organization of cells in the vegetation, most notably the primordial role of platelets and further triggered hemostasis, which is related to the diversity of infectious microorganisms involved. Our objective was to study the organization of IE vegetations due to different bacteria species in order to understand the related pathophysiological mechanism of vegetation development. We present an approach for ultrastructural analysis of whole-infected heart valve tissue based on scanning electron microscopy and energy-dispersive X-ray spectroscopy. Our approach allowed us to detect differences in cell organization between the analyzed vegetations and revealed a distinct chemical feature in viridans Streptococci ones. Our results illustrate the benefits that such an approach may bring for guiding therapy, considering the germ involved for each IE patient.
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Affiliation(s)
- Nadji Hannachi
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France; (N.H.); (A.F.); (J.B.-K.); (F.G.); (D.R.); (L.C.-J.)
| | - Hubert Lepidi
- Laboratoire D’anatomie et de Cytologie Pathologique, Hôpital de la Timone, AP-HM, boulevard Jean-Moulin, 13005 Marseille, France;
| | - Anthony Fontanini
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France; (N.H.); (A.F.); (J.B.-K.); (F.G.); (D.R.); (L.C.-J.)
| | - Tatsuki Takakura
- Hitachi High-Tech Corporation, Analytical & Medical Solution Business Group 882 Ichige, Hitachinaka-shi, Ibaraki-ken 312-8504, Japan;
| | - Jacques Bou-Khalil
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France; (N.H.); (A.F.); (J.B.-K.); (F.G.); (D.R.); (L.C.-J.)
| | - Frédérique Gouriet
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France; (N.H.); (A.F.); (J.B.-K.); (F.G.); (D.R.); (L.C.-J.)
| | - Gilbert Habib
- Département de Cardiologie, Hôpital de la Timone, AP-HM, Boulevard Jean-Moulin, 13005 Marseille, France;
| | - Didier Raoult
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France; (N.H.); (A.F.); (J.B.-K.); (F.G.); (D.R.); (L.C.-J.)
| | - Laurence Camoin-Jau
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France; (N.H.); (A.F.); (J.B.-K.); (F.G.); (D.R.); (L.C.-J.)
- Laboratoire D’Hématologie, Hôpital de la Timone, APHM, Boulevard Jean- Moulin, 13005 Marseille, France
| | - Jean-Pierre Baudoin
- Aix Marseille Univ, IRD, APHM, MEPHI, IHU Méditerranée Infection, 13005 Marseille, France; (N.H.); (A.F.); (J.B.-K.); (F.G.); (D.R.); (L.C.-J.)
- Correspondence: ; Tel.: +33-4-1373-2401; Fax: +33-4-1373-2402
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15
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Lichota A, Gwozdzinski K, Szewczyk EM. Microbial Modulation of Coagulation Disorders in Venous Thromboembolism. J Inflamm Res 2020; 13:387-400. [PMID: 32801832 PMCID: PMC7406375 DOI: 10.2147/jir.s258839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022] Open
Abstract
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third leading cause of cardiovascular death in the world. Important risk factors of thrombosis include bed restraint, surgery, major trauma, long journeys, inflammation, pregnancy, and oral contraceptives, previous venous thromboembolism, cancer, and bacterial infections. Sepsis increases the risk of blood clot formation 2–20 times. In this review, we discussed various mechanisms related to the role of bacteria in venous thrombosis also taking into consideration the role of the human microbiome. Many known bacteria, such as Helicobacter pylori, Chlamydia pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli, causing infections may increase the risk of thrombotic complications through platelet activation or may lead to an inflammatory reaction involving the fibrinolytic system. Additionally, the bacteria participate in the production of factors causing or increasing the risk of cardiovascular diseases. An example can be trimethylamine N-oxide (TMAO) but also uremic toxins (indoxyl sulfate), short-chain fatty acids (SCFA) phytoestrogens, and bile acids. Finally, we presented the involvement of many bacteria in the development of venous thromboembolism and other cardiovascular diseases.
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Affiliation(s)
- Anna Lichota
- Department of Pharmaceutical Microbiology and Microbiological Diagnostics, Faculty of Pharmacy, Medical University of Lodz, Lodz, Poland
| | - Krzysztof Gwozdzinski
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
| | - Eligia M Szewczyk
- Department of Pharmaceutical Microbiology and Microbiological Diagnostics, Faculty of Pharmacy, Medical University of Lodz, Lodz, Poland
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16
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Byakika S, Mukisa IM, Byaruhanga YB, Muyanja C. A Review of Criteria and Methods for Evaluating the Probiotic Potential of Microorganisms. FOOD REVIEWS INTERNATIONAL 2019. [DOI: 10.1080/87559129.2019.1584815] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Stellah Byakika
- Department of Food Technology and Nutrition, School of Food Technology Nutrition and Bioengineering, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Ivan Muzira Mukisa
- Department of Food Technology and Nutrition, School of Food Technology Nutrition and Bioengineering, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Yusuf Byenkya Byaruhanga
- Department of Food Technology and Nutrition, School of Food Technology Nutrition and Bioengineering, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
| | - Charles Muyanja
- Department of Food Technology and Nutrition, School of Food Technology Nutrition and Bioengineering, College of Agricultural and Environmental Sciences, Makerere University, Kampala, Uganda
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17
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Koga Y, Meguro H, Fujieda H, Ueno Y, Miwa K, Kainoh M. A new hydrophilic polysulfone hemodialysis membrane can prevent platelet-neutrophil interactions and successive neutrophil activation. Int J Artif Organs 2019; 42:175-181. [PMID: 30638104 PMCID: PMC6421590 DOI: 10.1177/0391398818823767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE: Microaggregates have often been observed during hemodialysis and are clearly associated with complications of hemodialysis therapy. In this study, we aimed to clarify the effects of two polysulfone membranes, with different abilities to activate blood cells, on the formation of these microaggregates; we also investigated their molecular mechanisms. METHODS: Human whole blood was circulated through a mini-module dialyzer using the membranes in vitro; platelet-neutrophil complexes in blood were determined by flow cytometry. Isolated human neutrophils were incubated with the membranes in plasma, in the presence or absence of platelets, followed by flow cytometric analysis of intracellular reactive oxygen species and cell-surface activated CD11b on neutrophils. RESULTS: CX-U, a conventional polysulfone membrane with remarkable cell activation, induced the formation of platelet-neutrophil complexes; however, NV-U, a new hydrophilic polysulfone membrane with slight or no cell activation, did not cause complex formation. Moreover, CX-U-induced reactive oxygen species production and the increase in activated CD11b expression on neutrophils were enhanced by platelets. On the other hand, NV-U hardly affected neutrophil activation, regardless of whether platelets were present or not. The enhancement of CX-U-induced neutrophil activations by platelets was greatly inhibited by anti-CD62P antibody. CONCLUSION: The ability of polysulfone membranes to activate blood cells is closely related to platelet-neutrophil interaction. Therefore, a biocompatible membrane, like NV-U, can be expected to prevent microaggregate formation during hemodialysis and avoid subsequent cell activation.
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Affiliation(s)
- Yoko Koga
- 1 Pharmaceutical Research Laboratories, Toray Industries, Inc., Kamakura, Japan
| | - Hiroyuki Meguro
- 1 Pharmaceutical Research Laboratories, Toray Industries, Inc., Kamakura, Japan
| | - Hiroaki Fujieda
- 2 Advanced Material Research Laboratories, Toray Industries, Inc., Otsu, Japan
| | - Yoshiyuki Ueno
- 2 Advanced Material Research Laboratories, Toray Industries, Inc., Otsu, Japan
| | - Keishi Miwa
- 2 Advanced Material Research Laboratories, Toray Industries, Inc., Otsu, Japan
| | - Mie Kainoh
- 1 Pharmaceutical Research Laboratories, Toray Industries, Inc., Kamakura, Japan
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18
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Abdillahi SM, Maaß T, Kasetty G, Strömstedt AA, Baumgarten M, Tati R, Nordin SL, Walse B, Wagener R, Schmidtchen A, Mörgelin M. Collagen VI Contains Multiple Host Defense Peptides with Potent In Vivo Activity. THE JOURNAL OF IMMUNOLOGY 2018; 201:1007-1020. [PMID: 29925677 DOI: 10.4049/jimmunol.1700602] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/01/2018] [Indexed: 11/19/2022]
Abstract
Collagen VI is a ubiquitous extracellular matrix component that forms extensive microfibrillar networks in most connective tissues. In this study, we describe for the first time, to our knowledge, that the collagen VI von Willebrand factor type A-like domains exhibit a broad-spectrum antimicrobial activity against Gram-positive and Gram-negative bacteria in human skin infections in vivo. In silico sequence and structural analysis of VWA domains revealed that they contain cationic and amphipathic peptide sequence motifs, which might explain the antimicrobial nature of collagen VI. In vitro and in vivo studies show that these peptides exhibited significant antibacterial activity against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa through membrane disruption. Our findings shed new light on the role of collagen VI-derived peptides in innate host defense and provide templates for development of peptide-based antibacterial therapies.
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Affiliation(s)
- Suado M Abdillahi
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden;
| | - Tobias Maaß
- Center for Biochemistry, Medical Faculty, Center for Molecular Medicine Cologne, University of Cologne, 50931 Cologne, Germany
| | - Gopinath Kasetty
- Division of Respiratory Medicine and Allergology, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden
| | - Adam A Strömstedt
- Pharmacognosy, Department of Medicinal Chemistry, Uppsala University, 751 23 Uppsala, Sweden
| | - Maria Baumgarten
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden
| | - Ramesh Tati
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden
| | - Sara L Nordin
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden
| | - Björn Walse
- Saromics Biostructures AB, 223 63 Lund, Sweden
| | - Raimund Wagener
- Center for Biochemistry, Medical Faculty, Center for Molecular Medicine Cologne, University of Cologne, 50931 Cologne, Germany
| | - Artur Schmidtchen
- Division of Dermatology and Venereology, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden.,Copenhagen Wound Healing Center, Bispebjerg Hospital, Department of Biomedical Sciences, University of Copenhagen, 2400 Copenhagen, Denmark and
| | - Matthias Mörgelin
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden.,Colzyx AB, 223 81 Lund, Sweden
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19
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Abstract
Thrombocytopenia is common in patients with invasive bacterial infections. Bacteria can activate platelets, but it is unclear if this affects platelet count. The aim of this study was to examine whether bacteraemia with Staphylococcus aureus, which readily activate human platelets, was more likely to be complicated by thrombocytopenia than bacteraemia with Escherichia coli or Streptococcus pneumoniae with different abilities to activate platelets.We compared information from 600 adult patients with community-acquired bacteraemia with S. aureus (n = 140), E. coli (n = 420) and S. pneumoniae (n = 40) in Southern Sweden, 2012, linking information on positive blood cultures from microbiological databases and medical charts. The proportion of patients with thrombocytopenia (platelet count <150 × 109/ml) was calculated. Logistic regression was used to estimate the odds ratios (OR) for thrombocytopenia according to bacterial species adjusted for confounders.The proportion of thrombocytopenia was 29% in S. aureus, 28% in E. coli and 20% in S. pneumonia bacteraemia (P = 0.50), corresponding to an OR of 1.2 (95% confidence interval 0.7-1.9) for thrombocytopenia for S. aureus as compared with E. coli or S. pneumoniae, adjusted for confounders.This study indicates that platelet activation by bacteria is not a major causative mechanism in sepsis-associated thrombocytopenia.
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20
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Larkin CM, Hante NK, Breen EP, Tomaszewski KA, Eisele S, Radomski MW, Ryan TA, Santos-Martinez MJ. Role of matrix metalloproteinases 2 and 9, toll-like receptor 4 and platelet-leukocyte aggregate formation in sepsis-associated thrombocytopenia. PLoS One 2018; 13:e0196478. [PMID: 29734352 PMCID: PMC5937753 DOI: 10.1371/journal.pone.0196478] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/14/2018] [Indexed: 12/15/2022] Open
Abstract
Background The development of thrombocytopenia in sepsis is a poor prognostic indicator associated with a significantly increased mortality risk. Mechanisms underlying this phenomenon remain to be clearly elucidated. Matrix metalloproteinases (MMPs) are enzymes that regulate the turnover of the extra-cellular matrix. MMP-2 is recognised as a platelet agonist with MMP-9 proposed as an inhibitor of platelet activation. The existence of MMP-9 in platelets is a subject of debate. There is limited evidence thus far to suggest that toll-like receptor 4 (TLR-4) and platelet-leukocyte aggregate (PLA) formation may be implicated in the development of sepsis-associated thrombocytopenia. Objectives To investigate whether MMP -2/-9, toll-like receptor 4 (TLR-4) or platelet-leukocyte aggregate (PLA) formation are implicated in a decline in platelet numbers during septic shock. Methods This was an observational study which recruited healthy controls, non-thrombocytopenic septic donors and thrombocytopenic septic donors. MMP-2, MMP-9 and TLR-4 platelet surface expression as well as PLA formation was examined using flow cytometry. In addition MMP-2 and MMP-9 were examined by gelatin zymography and enzyme-linked immunosorbent assay (ELISA) using a 3 compartment model (plasma, intraplatelet and platelet membrane). Results There was no difference found in MMP-2, MMP-9 or TLR-4 levels between non-thrombocytopenic and thrombocytopenic septic donors. PLA formation was increased in thrombocytopenic patients. MMP-9 was detected in platelets using flow cytometry, gelatin zymography and ELISA techniques. Conclusions Platelet consumption into PLAs may account for the development of thrombocytopenia in septic shock. MMP-9 is found in platelets and it is upregulated during septic shock.
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Affiliation(s)
- Caroline M. Larkin
- Department of Anaesthesia and Intensive Care Medicine, St James’s Hospital, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- * E-mail:
| | - Nadhim Kamil Hante
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- College of Pharmacy, University of Kufa, Najaf, Iraq
| | - Eamon P. Breen
- Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Krzysztof A. Tomaszewski
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Simon Eisele
- Department of Pharmacy, Ludwig Maximilian University, Munich, Germany
| | - Marek W. Radomski
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- School of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Thomas A. Ryan
- Department of Anaesthesia and Intensive Care Medicine, St James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Maria-Jose Santos-Martinez
- School of Pharmacy and Pharmaceutical Sciences and Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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21
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Petersson F, Kilsgård O, Shannon O, Lood R. Platelet activation and aggregation by the opportunistic pathogen Cutibacterium (Propionibacterium) acnes. PLoS One 2018; 13:e0192051. [PMID: 29385206 PMCID: PMC5792000 DOI: 10.1371/journal.pone.0192051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/16/2018] [Indexed: 11/19/2022] Open
Abstract
Cutibacterium (Propionibacterium) acnes, considered a part of the skin microbiota, is one of the most commonly isolated anaerobic bacteria from medical implants in contact with plasma. However, the precise interaction of C. acnes with blood cells and plasma proteins has not been fully elucidated. Herein, we have investigated the molecular interaction of C. acnes with platelets and plasma proteins. We report that the ability of C. acnes to aggregate platelets is dependent on phylotype, with a significantly lower ability amongst type IB isolates, and the interaction of specific donor-dependent plasma proteins (or concentrations thereof) with C. acnes. Pretreatment of C. acnes with plasma reduces the lag time before aggregation demonstrating that pre-deposition of plasma proteins on C. acnes is an important step in platelet aggregation. Using mass spectrometry we identified several plasma proteins deposited on C. acnes, including IgG, fibrinogen and complement factors. Inhibition of IgG, fibrinogen or complement decreased C. acnes-mediated platelet aggregation, demonstrating the importance of these plasma proteins for aggregation. The interaction of C. acnes and platelets was visualized using fluorescence microscopy, verifying the presence of IgG and fibrinogen as components of the aggregates, and co-localization of C. acnes and platelets in the aggregates. Here, we have demonstrated the ability of C. acnes to activate and aggregate platelets in a bacterium and donor-specific fashion, as well as added mechanistic insights into this interaction.
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Affiliation(s)
- Frida Petersson
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ola Kilsgård
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Immunotechnology, Faculty of Engineering Lund, Lund University, Lund, Sweden
| | - Oonagh Shannon
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Rolf Lood
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- * E-mail:
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Platelet reactivity in sepsis syndrome: results from the PRESS study. Eur J Clin Microbiol Infect Dis 2017; 36:2503-2512. [PMID: 28840345 DOI: 10.1007/s10096-017-3093-6] [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: 07/12/2017] [Accepted: 08/10/2017] [Indexed: 01/02/2023]
Abstract
Platelet activation mediates systemic inflammatory response during infection. However, data on platelet reactivity (PR) varies among different settings. We assessed PR along different stages of sepsis and tried to predict for determinants of its variance. In parallel, we evaluated it as an early bedside diagnostic biomarker. This was an observational prospective cohort study. Incoming patients were assorted to distinct groups of uncomplicated infection, sepsis, and severe sepsis/septic shock. A control group of healthy volunteers was used as comparison. PR was assessed using the bedside point-of-care VerifyNow assay, in P2Y12 reaction units (PRU) alongside with levels of major inflammatory markers and whole blood parameters. A total of 101 patients and 27 healthy volunteers were enrolled. PR significantly and reversibly increases during sepsis compared to uncomplicated infection and healthy controls (244 ± 66.7 vs 187.33 ± 60.98, p < 0.001 and 192.17 ± 47.51, p < 0.001, respectively). In severe sepsis, PR did not significantly differ compared to other groups. Sepsis stage uniquely accounts for 15.5% of PR in a linear regression prediction model accounting for 30% of the variance of PR (F = 8.836, p < 0.001). PRU >253 had specificity of 91.2% and sensitivity of 40.8% in discriminating septic from non-septic patients. The addition of PRU to SOFA and qSOFA scores significantly increased their c-statistic (AUC SOFA + PRU, 0.867 vs SOFA, 0.824, p < 0.003 and AUC qSOFA + PRU, 0.842 vs qSOFA, 0.739, p < 0.001), making them comparable (AUC SOFA + PRU vs qSOFA + PRU, p = 0.4). PR significantly and reversibly increases early in sepsis, but seems to exhaust while disease progresses. Bedside assessment of PR can provide robust discriminative accuracy in the early diagnosis of septic patients.
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Acetylsalicylic acid differentially limits the activation and expression of cell death markers in human platelets exposed to Staphylococcus aureus strains. Sci Rep 2017; 7:5610. [PMID: 28717145 PMCID: PMC5514152 DOI: 10.1038/s41598-017-06024-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/07/2017] [Indexed: 12/14/2022] Open
Abstract
Beyond their hemostatic functions, platelets alter their inflammatory response according to the bacterial stimulus. Staphylococcus aureus is associated with exacerbated inflammation and thrombocytopenia, which is associated with poor prognosis during sepsis. Acetylsalicylic acid and statins prevent platelet aggregation and decrease the mortality rate during sepsis. Therefore, we assessed whether these two molecules could reduce in vitro platelet activation and the inflammatory response to S. aureus. Platelets were exposed to clinical strains of S. aureus in the presence or absence of acetylsalicylic acid or fluvastatin. Platelet activation, aggregation, and release of soluble sCD62P, sCD40 Ligand, RANTES and GROα were assessed. Platelet cell death was evaluated by analyzing the mitochondrial membrane potential, phosphatidylserine exposure, platelet microparticle release and caspase-3 activation. All S. aureus strains induced platelet activation but not aggregation and decreased the platelet count, the expression of cell death markers and the release of RANTES and GROα. Acetylsalicylic acid but not fluvastatin limited platelet activation and inflammatory factor release and restored the platelet count by protecting platelets from Staphylococcus-induced expression of cell death markers. This study demonstrates that acetylsalicylic acid limits S. aureus-induced effects on platelets by reducing cell death, revealing new strategies to reduce the platelet contribution to bacteremia-associated inflammation.
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24
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Thachil J, Warkentin TE. How do we approach thrombocytopenia in critically ill patients? Br J Haematol 2016; 177:27-38. [PMID: 27982413 DOI: 10.1111/bjh.14482] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A low platelet count is a frequently encountered haematological abnormality in patients treated in intensive treatment units (ITUs). Although severe thrombocytopenia (platelet count <20 × 109 /l) can be associated with bleeding, even moderate-degree thrombocytopenia is associated with organ failure and adverse prognosis. The aetiology for thrombocytopenia in ITU is often multifactorial and correcting one aetiology may not normalise the low platelet count. The classical view for thrombocytopenia in this setting is consumption associated with thrombin-mediated platelet activation, but other concepts, including platelet adhesion to endothelial cells and leucocytes, platelet aggregation by increased von Willebrand factor release, red cell damage and histone release, and platelet destruction by the complement system, have recently been described. The management of severe thrombocytopenia is platelet transfusion in the presence of active bleeding or invasive procedure, but the risk-benefit of prophylactic platelet transfusions in this setting is uncertain. In this review, the incidence and mechanisms of thrombocytopenia in patients with ITU, its prognostic significance and the impact on organ function is discussed. A practical approach based on the authors' experience is described to guide management of a critically ill patient who develops thrombocytopenia.
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Affiliation(s)
- Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Theodore E Warkentin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton Regional Laboratory Medicine Program, Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
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25
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Doni A, Garlanda C, Mantovani A. Innate immunity, hemostasis and matrix remodeling: PTX3 as a link. Semin Immunol 2016; 28:570-577. [PMID: 27881292 DOI: 10.1016/j.smim.2016.10.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 12/20/2022]
Abstract
Innate immunity is evolutionarily connected with hemostasis. PTX3 is an essential fluid-phase pattern recognition molecule of the innate immune system that acts as a functional ancestor of antibodies. PTX3 by interacting with defense collagens and fibrinogens amplifies effector functions of the innate immune system. At wound sites, PTX3 regulates the injury-induced thrombotic response and promotes wound healing by favoring timely fibrinolysis. Therefore, PTX3 interacts with ancestral domains conserved in innate immunity, hemostasis and extracellular matrix and exerts functions related to both antimicrobial resistance and tissue repair. These findings strengthen the connection between innate immune system and hemostasis, and suggest that recognition of microbes and extracellular matrix are evolutionarily conserved and integrated functions of the innate immune system.
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Affiliation(s)
- Andrea Doni
- Istituto Clinico Humanitas IRCCS, via Manzoni 113, 20089 Rozzano, Italy.
| | - Cecilia Garlanda
- Istituto Clinico Humanitas IRCCS, via Manzoni 113, 20089 Rozzano, Italy; Humanitas University, via Manzoni 113, 20089 Rozzano, Italy
| | - Alberto Mantovani
- Istituto Clinico Humanitas IRCCS, via Manzoni 113, 20089 Rozzano, Italy; Humanitas University, via Manzoni 113, 20089 Rozzano, Italy
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Hurley SM, Lutay N, Holmqvist B, Shannon O. The Dynamics of Platelet Activation during the Progression of Streptococcal Sepsis. PLoS One 2016; 11:e0163531. [PMID: 27656898 PMCID: PMC5033464 DOI: 10.1371/journal.pone.0163531] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 09/09/2016] [Indexed: 01/11/2023] Open
Abstract
Platelets contribute to inflammation however, the role of platelet activation during the pathophysiological response to invasive bacterial infection and sepsis is not clear. Herein, we have investigated platelet activation in a mouse model of invasive Streptococcus pyogenes infection at 5, 12, and 18 hours post infection and correlated this to parameters of infection. The platelet population in ex-vivo blood samples showed no increased integrin activation or surface presentation of CD62P, however platelet-neutrophil complex formation and plasma levels of CD62P were increased during bacterial dissemination and the progression of sepsis, indicating that platelet activation had occurred in vivo. Platelet-neutrophil complex formation was the most discriminatory marker of platelet activation. Platelet-neutrophil complexes were increased above baseline levels during early sepsis but decreased to significantly lower levels than baseline during late sepsis. The removal of these complexes from the circulation coincided with a significant increase in organ damage and the accumulation of platelets in the liver sinusoids, suggesting that platelet activation in the circulation precedes accumulation of platelets in damaged organs. The results demonstrate that monitoring platelet activation using complementary methods may provide prognostic information during the pathogenesis of invasive S. pyogenes infection.
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Affiliation(s)
- Sinead M. Hurley
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, SE- 22184 Lund, Sweden
| | | | - Bo Holmqvist
- Imagene-iT AB, Medicon Village, SE22381 Lund, Sweden
| | - Oonagh Shannon
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, SE- 22184 Lund, Sweden
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A Dysregulated Balance of Proinflammatory and Anti-Inflammatory Host Cytokine Response Early During Therapy Predicts Persistence and Mortality in Staphylococcus aureus Bacteremia. Crit Care Med 2016; 44:671-9. [PMID: 26540400 DOI: 10.1097/ccm.0000000000001465] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The contribution of individual immune response to Staphylococcus aureus bacteremia on outcome has not been well studied. The objective was to relate the host cytokine response to outcome of Staphylococcus aureus bacteremia. DESIGN Prospective observational study. SETTING Three U.S. university-affiliated medical centers. PATIENTS Adult patients infected with Staphylococcus aureus bacteremia hospitalized between July 2012 and August 2014. INTERVENTIONS Blood specimens were obtained at Staphylococcus aureus bacteremia onset and 72 hours after therapy initiation. Levels of tissue necrosis factor, interleukin-6, interleukin-8, interleukin-17A, and interleukin-10 were measured by enzyme-linked immunosorbent assay at each time point and compared between those with persistent bacteremia (≥ 4 d) and resolving bacteremia. Primary outcome was persistent bacteremia after 4 days of effective therapy. Secondary outcomes were 30-day mortality and 30-day recurrence. MEASUREMENTS AND MAIN RESULTS A total of 196 patients were included (mean age, 59 yr); of them, 33% had methicillin-resistant Staphylococcus aureus bacteremia. Forty-seven percent of the methicillin-resistant Staphylococcus aureus strains were staphylococcal cassette chromosome mec IV. Persistent bacteremia occurred in 24% of patients (47/196); they were more likely to die than resolving bacteremia group (28% vs 5%; p < 0.001). Compared with resolving bacteremia group, persistent bacteremia patients had higher initial median levels of tissue necrosis factor (44.73 vs 21.68 pg/mL; p < 0.001), interleukin-8 (124.76 vs 47.48 pg/mL; p = 0.028), and interleukin-10 (104.31 vs 29.72 pg/mL; p < 0.001). Despite 72 hours of treatment, levels remained higher for the persistent bacteremia group than for the resolving bacteremia group (tissue necrosis factor: 26.95 vs 18.38 pg/mL, p = 0.02; interleukin-8: 70.75 vs 27.86 pg/mL, p = 0.002; interleukin-6: 67.50 vs 21.81 pg/mL, p = 0.005; and interleukin-10: 30.98 vs 12.60 pg/mL, p < 0.001). Interleukin-17A levels were similar between groups at both time points. After controlling for confounding variables by multivariate analysis, interleukin-10/tissue necrosis factor ratio at 72 hours most significantly predicted persistence (odds ratio, 2.98; 95% CI, 1.39-6.39; p = 0.005) and mortality (odds ratio, 9.87; 95% CI, 2.64-36.91; p < 0.001) at values more than 1.00 and more than 2.56, respectively. CONCLUSIONS Sustained elevation of interleukin-10/tissue necrosis factor ratio at 72 hours suggests a dysregulated immune response and may be used to guide management to improve outcomes.
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28
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Middleton EA, Weyrich AS, Zimmerman GA. Platelets in Pulmonary Immune Responses and Inflammatory Lung Diseases. Physiol Rev 2016; 96:1211-59. [PMID: 27489307 DOI: 10.1152/physrev.00038.2015] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Platelets are essential for physiological hemostasis and are central in pathological thrombosis. These are their traditional and best known activities in health and disease. In addition, however, platelets have specializations that broaden their functional repertoire considerably. These functional capabilities, some of which are recently discovered, include the ability to sense and respond to infectious and immune signals and to act as inflammatory effector cells. Human platelets and platelets from mice and other experimental animals can link the innate and adaptive limbs of the immune system and act across the immune continuum, often also linking immune and hemostatic functions. Traditional and newly recognized facets of the biology of platelets are relevant to defensive, physiological immune responses of the lungs and to inflammatory lung diseases. The emerging view of platelets as blood cells that are much more diverse and versatile than previously thought further predicts that additional features of the biology of platelets and of megakaryocytes, the precursors of platelets, will be discovered and that some of these will also influence pulmonary immune defenses and inflammatory injury.
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Affiliation(s)
- Elizabeth A Middleton
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and the Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Andrew S Weyrich
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and the Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Guy A Zimmerman
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, and the Program in Molecular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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29
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Larkin CM, Santos-Martinez MJ, Ryan T, Radomski MW. Sepsis-associated thrombocytopenia. Thromb Res 2016; 141:11-6. [PMID: 26953822 DOI: 10.1016/j.thromres.2016.02.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/08/2016] [Accepted: 02/19/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Caroline M Larkin
- Department of Anaesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland; School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland.
| | | | - Thomas Ryan
- Department of Anaesthesia and Intensive Care Medicine, St James's Hospital, Dublin, Ireland; Department of Clinical Medicine, Trinity College Dublin, Ireland
| | - Marek W Radomski
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Ireland
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30
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Mauler M, Seyfert J, Haenel D, Seeba H, Guenther J, Stallmann D, Schoenichen C, Hilgendorf I, Bode C, Ahrens I, Duerschmied D. Platelet-neutrophil complex formation-a detailed in vitro analysis of murine and human blood samples. J Leukoc Biol 2015; 99:781-9. [PMID: 26578648 DOI: 10.1189/jlb.3ta0315-082r] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 10/28/2015] [Indexed: 12/13/2022] Open
Abstract
Platelets form complexes with neutrophils during inflammatory processes. These aggregates migrate into affected tissues and also circulate within the organism. Several studies have evaluated platelet-neutrophil complexes as a marker of cardiovascular diseases in human and mouse. Although multiple publications have reported platelet-neutrophil complex counts, we noticed that different methods were used to analyze platelet-neutrophil complex formation, resulting in significant differences, even in baseline values. We established a protocol for platelet-neutrophil complex measurement with flow cytometry in murine and human whole blood samples. In vitro platelet-neutrophil complex formation was stimulated with ADP or PMA. We tested the effect of different sample preparation steps and cytometer settings on platelet-neutrophil complex detection and noticed false-positive counts with increasing acquisition speed. Platelet-neutrophil complex formation depends on platelet P-selectin expression, and antibody blocking of P-selectin consequently prevented ADP-induced platelet-neutrophil complex formation. These findings may help generating more comparable data among different research groups that examine platelet-neutrophil complexes as a marker for cardiovascular disease and novel therapeutic interventions.
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Affiliation(s)
- Maximilian Mauler
- Faculty of Biology, Heart Center, University of Freiburg, Germany and Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
| | - Julia Seyfert
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
| | - David Haenel
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
| | - Hannah Seeba
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
| | - Janine Guenther
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
| | - Daniela Stallmann
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
| | - Claudia Schoenichen
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
| | - Ingo Hilgendorf
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
| | - Ingo Ahrens
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
| | - Daniel Duerschmied
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany
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31
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Svensson L, Frick IM, Shannon O. Group G streptococci mediate fibrinogen-dependent platelet aggregation leading to transient entrapment in platelet aggregates. MICROBIOLOGY-SGM 2015; 162:117-126. [PMID: 26511072 DOI: 10.1099/mic.0.000203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Platelets have been reported to become activated in response to bacteria and this is proposed to contribute to the acute response to bacterial infection. In the present study, we investigated platelet aggregation in response to group G streptococci (GGS) in vitro in healthy human donors and in vivo in a mouse model of streptococcal sepsis. Platelet aggregation by GGS was dependent on the bacterial surface protein FOG and engagement of the platelet fibrinogen receptor; however, it was independent of IgG and the platelet Fc receptor. Platelets exerted no antibacterial effects on the bacteria, and aggregates formed were markedly unstable, allowing bacteria to rapidly return to the plasma and grow post-aggregation. Thrombocytopenia and platelet activation occurred during invasive infection with GGS, and platelets were demonstrated to contribute to bacterial dissemination during infection. These findings reveal an important role for bacteria-platelet interactions during the pathogenesis of streptococcal infection.
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Affiliation(s)
- Lisbeth Svensson
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, SE-22184 Lund, Sweden
| | - Inga-Maria Frick
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, SE-22184 Lund, Sweden
| | - Oonagh Shannon
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, SE-22184 Lund, Sweden
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32
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Cognasse F, Nguyen KA, Damien P, McNicol A, Pozzetto B, Hamzeh-Cognasse H, Garraud O. The Inflammatory Role of Platelets via Their TLRs and Siglec Receptors. Front Immunol 2015; 6:83. [PMID: 25784910 PMCID: PMC4345914 DOI: 10.3389/fimmu.2015.00083] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/12/2015] [Indexed: 12/16/2022] Open
Abstract
Platelets are non-nucleated cells that play central roles in the processes of hemostasis, innate immunity, and inflammation; however, several reports show that these distinct functions are more closely linked than initially thought. Platelets express numerous receptors and contain hundreds of secretory products. These receptors and secretory products are instrumental to the platelet functional responses. The capacity of platelets to secrete copious amounts of cytokines, chemokines, and related molecules appears intimately related to the role of the platelet in inflammation. Platelets exhibit non-self-infectious danger detection molecules on their surfaces, including those belonging to the “toll-like receptor” family, as well as pathogen sensors of other natures (Ig- or complement receptors, etc.). These receptors permit platelets to both bind infectious agents and deliver differential signals leading to the secretion of cytokines/chemokines, under the control of specific intracellular regulatory pathways. In contrast, dysfunctional receptors or dysregulation of the intracellular pathway may increase the susceptibility to pathological inflammation. Physiological vs. pathological inflammation is tightly controlled by the sensors of danger expressed in resting, as well as in activated, platelets. These sensors, referred to as pathogen recognition receptors, primarily sense danger signals termed pathogen associated molecular patterns. As platelets are found in inflamed tissues and are involved in auto-immune disorders, it is possible that they can also be stimulated by internal pathogens. In such cases, platelets can also sense danger signals using damage associated molecular patterns (DAMPs). Some of the most significant DAMP family members are the alarmins, to which the Siglec family of molecules belongs. This review examines the role of platelets in anti-infection immunity via their TLRs and Siglec receptors.
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Affiliation(s)
- Fabrice Cognasse
- Etablissement Français du Sang Auvergne-Loire , Saint-Etienne , France ; GIMAP-EA3064, Université de Lyon , Saint Etienne , France
| | - Kim Anh Nguyen
- GIMAP-EA3064, Université de Lyon , Saint Etienne , France
| | - Pauline Damien
- GIMAP-EA3064, Université de Lyon , Saint Etienne , France
| | - Archibald McNicol
- Faculty of Health Sciences, Colleges of Pharmacy and Medicine, University of Manitoba , Winnipeg, MB , Canada
| | - Bruno Pozzetto
- GIMAP-EA3064, Université de Lyon , Saint Etienne , France
| | | | - Olivier Garraud
- GIMAP-EA3064, Université de Lyon , Saint Etienne , France ; Institut National de Transfusion Sanguine (INTS) , Paris , France
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33
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Hamzeh-Cognasse H, Damien P, Chabert A, Pozzetto B, Cognasse F, Garraud O. Platelets and infections - complex interactions with bacteria. Front Immunol 2015; 6:82. [PMID: 25767472 PMCID: PMC4341565 DOI: 10.3389/fimmu.2015.00082] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/11/2015] [Indexed: 12/29/2022] Open
Abstract
Platelets can be considered sentinels of vascular system due to their high number in the circulation and to the range of functional immunoreceptors they express. Platelets express a wide range of potential bacterial receptors, including complement receptors, FcγRII, Toll-like receptors but also integrins conventionally described in the hemostatic response, such as GPIIb–IIIa or GPIb. Bacteria bind these receptors either directly, or indirectly via fibrinogen, fibronectin, the first complement C1q, the von Willebrand Factor, etc. The fate of platelet-bound bacteria is questioned. Several studies reported the ability of activated platelets to internalize bacteria such as Staphylococcus aureus or Porphyromonas gingivalis, though there is no clue on what happens thereafter. Are they sheltered from the immune system in the cytoplasm of platelets or are they lysed? Indeed, while the presence of phagolysosome has not been demonstrated in platelets, they contain antimicrobial peptides that were shown to be efficient on S. aureus. Besides, the fact that bacteria can bind to platelets via receptors involved in hemostasis suggests that they may induce aggregation; this has indeed been described for Streptococcus sanguinis, S. epidermidis, or C. pneumoniae. On the other hand, platelets are able to display an inflammatory response to an infectious triggering. We, and others, have shown that platelet release soluble immunomodulatory factors upon stimulation by bacterial components. Moreover, interactions between bacteria and platelets are not limited to only these two partners. Indeed, platelets are also essential for the formation of neutrophil extracellular traps by neutrophils, resulting in bacterial clearance by trapping bacteria and concentrating antibacterial factors but in enhancing thrombosis. In conclusion, the platelet–bacteria interplay is a complex game; its fine analysis is complicated by the fact that the inflammatory component adds to the aggregation response.
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Affiliation(s)
| | - Pauline Damien
- GIMAP-EA3064, Université de Lyon , Saint-Etienne , France
| | - Adrien Chabert
- GIMAP-EA3064, Université de Lyon , Saint-Etienne , France
| | - Bruno Pozzetto
- GIMAP-EA3064, Université de Lyon , Saint-Etienne , France
| | - Fabrice Cognasse
- GIMAP-EA3064, Université de Lyon , Saint-Etienne , France ; Etablissement Français du Sang Auvergne-Loire , Saint-Etienne , France
| | - Olivier Garraud
- GIMAP-EA3064, Université de Lyon , Saint-Etienne , France ; Institut National de la Transfusion Sanguine , Paris , France
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Garraud O, Cognasse F. Are Platelets Cells? And if Yes, are They Immune Cells? Front Immunol 2015; 6:70. [PMID: 25750642 PMCID: PMC4335469 DOI: 10.3389/fimmu.2015.00070] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/03/2015] [Indexed: 02/06/2023] Open
Abstract
Small fragments circulating in the blood were formally identified by the end of the nineteenth century, and it was suggested that they assisted coagulation via interactions with vessel endothelia. Wright, at the beginning of the twentieth century, identified their bone-marrow origin. For long, platelets have been considered sticky assistants of hemostasis and pollutants of blood or tissue samples; they were just cell fragments. As such, however, they were acknowledged as immunizing (to specific HPA and HLA markers): the platelet’s dark face. The enlightened face showed that besides hemostasis, platelets contained factors involved in healing. As early as 1930s, platelets entered the arsenal of medicines were transfused, and were soon manipulated to become a kind of glue to repair damaged tissues. Some gladly categorized platelets as cells but they were certainly not fully licensed as such for cell physiologists. Actually, platelets possess almost every characteristic of cells, apart from being capable of organizing their genes: they have neither a nucleus nor genes. This view prevailed until it became evident that platelets play a role in homeostasis and interact with cells other than with vascular endothelial cells; then began the era of physiological and also pathological inflammation. Platelets have now entered the field of immunity as inflammatory cells. Does assistance to immune cells itself suffice to license a cell as an “immune cell”? Platelets prove capable of sensing different types of signals and organizing an appropriate response. Many cells can do that. However, platelets can use a complete signalosome (apart from the last transcription step, though it is likely that this step can be circumvented by retrotranscribing RNA messages). The question has also arisen as to whether platelets can present antigen via their abundantly expressed MHC class I molecules. In combination, these properties argue in favor of allowing platelets the title of immune cells.
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Affiliation(s)
- Olivier Garraud
- Institut National de la Transfusion Sanguine , Paris , France ; EA3064, Université de Lyon , Saint-Etienne , France
| | - Fabrice Cognasse
- EA3064, Université de Lyon , Saint-Etienne , France ; Etablissement Français du Sang Auvergne-Loire , Saint-Etienne , France
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Santos-Gallego CG, Badimon JJ. The sum of two evils: pneumonia and myocardial infarction: is platelet activation the missing link? J Am Coll Cardiol 2014; 64:1926-8. [PMID: 25444148 DOI: 10.1016/j.jacc.2014.08.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 08/19/2014] [Accepted: 08/26/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos G Santos-Gallego
- Atherothrombosis Research Unit, Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Juan J Badimon
- Atherothrombosis Research Unit, Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Violi F, Cangemi R, Calvieri C. Pneumonia, thrombosis and vascular disease. J Thromb Haemost 2014; 12:1391-400. [PMID: 24954194 DOI: 10.1111/jth.12646] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Indexed: 02/06/2023]
Abstract
SUMMARY An enhanced risk of cardiovascular mortality has been observed after pneumonia. Epidemiological studies have shown that respiratory tract infections are associated with an increased risk of thrombotic-related vascular disease such as myocardial infarction, ischemic stroke and venous thrombosis. Myocardial infarction and stroke have been detected essentially in the early phase of the disease (i.e. within 48 h from hospital admission), with an incidence ranging from as low as 1% to as high as 11%. Age, previous cardiovascular events and high pneumonia severity index were independent predictors of myocardial infarction; clinical predictors of stroke were not identified. Deep venous thrombosis and pulmonary embolism may also occur after pneumonia but incidence and clinical predictors must be defined. The biological plausibility of such an association may be deduced by experimental and clinical studies, showing that lung infection is complicated by platelet aggregation and clotting system activation, as documented by up-regulation of tissue factor and down-regulation of activated protein C. The effect of antithrombotic drugs has been examined in experimental and clinical studies but results are still inconclusive.
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Affiliation(s)
- F Violi
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
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Platelet activation by Streptococcus pyogenes leads to entrapment in platelet aggregates, from which bacteria subsequently escape. Infect Immun 2014; 82:4307-14. [PMID: 25069984 DOI: 10.1128/iai.02020-14] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Platelet activation and aggregation have been reported to occur in response to a number of Gram-positive pathogens. Here, we show that platelet aggregates induced by Streptococcus pyogenes were unstable and that viable bacteria escaped from the aggregates over time. This was not due to differential activation in response to the bacteria compared with physiological activators. All the bacterial isolates induced significant platelet activation, including integrin activation and alpha and dense-granule release, at levels equivalent to those induced by potent physiological platelet activators that induced stable aggregates. The ability to escape the aggregates and to resist the antibacterial effects of platelets was dependent on active protein synthesis by the bacteria within the aggregate. We conclude that S. pyogenes bacteria can temporarily cover themselves with activated platelets, and we propose that this may facilitate survival of the bacteria in the presence of platelets.
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Abstract
Platelets play crucial functions in hemostasis and the prevention of bleeding. During H1N1 influenza A virus infection, platelets display activation markers. The platelet activation triggers during H1N1 infection remain elusive. We observed that H1N1 induces surface receptor activation, lipid mediator synthesis, and release of microparticles from platelets. These activation processes require the presence of serum/plasma, pointing to the contribution of soluble factor(s). Considering that immune complexes in the H1N1 pandemic were reported to play a pathogenic role, we assessed their contribution in H1N1-induced platelet activation. In influenza-immunized subjects, we observed that the virus scaffolds with immunoglobulin G (IgG) to form immune complexes that promote platelet activation. Mechanistically, this activation occurs through stimulation of low-affinity type 2 receptor for Fc portion of IgG (FcγRIIA), a receptor for immune complexes, independently of thrombin. Using a combination of in vitro and in vivo approaches, we found that the antibodies from H3N2-immunized mice activate transgenic mouse platelets that express FcγRIIA when put in the presence of H1N1, suggesting that cross-reacting influenza antibodies suffice. Alternatively, H1N1 can activate platelets via thrombin formation, independently of complement and FcγRIIA. These observations identify both the adaptive immune response and the innate response against pathogens as 2 intertwined processes that activate platelets during influenza infections.
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40
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Use of antiplatelet agents in sepsis: A glimpse into the future. Thromb Res 2014; 133:131-8. [DOI: 10.1016/j.thromres.2013.07.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 11/21/2022]
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41
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Koch A, Meesters MI, Scheller B, Boer C, Zacharowski K. Systemic endotoxin activity correlates with clot formation: an observational study in patients with early systemic inflammation and sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R198. [PMID: 24025340 PMCID: PMC4057518 DOI: 10.1186/cc12892] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/11/2013] [Indexed: 01/08/2023]
Abstract
Introduction Inflammation and coagulation are closely linked, and both can be triggered by endotoxin. Thrombelastometry and impedance aggregometry are of diagnostic and predictive value in critically ill patients. In this observational study we investigated the correlation of endotoxin activity with thrombelasometric and aggregometric variables in patients with systemic inflammation. Methods Based on a daily screening on a tertiary academic surgical ICU, patients, as soon as they fulfilled two or more criteria for systemic inflammatory response syndrome (SIRS), were included. In whole blood we performed endotoxin activity (EA) assay, thrombelastometry (ROTEM®) and impendance aggregometry (Multiplate®). Results In total, 49 patients were included with a broad spread of EA levels of (median (minimum to maximum)) 0.27 (0.01 to 0.72), allowing expedient correlative analysis. Clot formation time (CFT) (263 s (60 to 1,438 s)) and clotting time (CT) (1,008 s (53 to 1,481 s)) showed a significant negative correlation with EA level (r = -0.38 (P < 0.005) and r = -0.29 (P < 0.05)). Positive correlations were found for alpha-angle (50° (17 to 78°), r = 0.40 (P < 0.005)) and maximum clot firmness (MCF) (55 mm (5/76), r = 0.27 (P < 0.05)). No significant correlations were found between Lysis Index at 60 minutes (LI60) and EA levels. There was no correlation between EA level and aggregometric values, or classical coagulation parameters. Conclusions In patients with systemic inflammation, increasing endotoxin concentrations correlate with increased clot formation.
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Page C, Pitchford S. Neutrophil and platelet complexes and their relevance to neutrophil recruitment and activation. Int Immunopharmacol 2013; 17:1176-84. [PMID: 23810443 DOI: 10.1016/j.intimp.2013.06.004] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 09/20/2012] [Accepted: 06/09/2013] [Indexed: 12/29/2022]
Abstract
The manifestation of platelet 'satallitism' around neutrophils in whole blood is a long acknowledged phenomenon [1]. Circulating platelet-neutrophil complexes (PNC) occur in a diverse range of inflammatory disorders and infections that affect numerous organs of the body. Animal models have revealed that the formation of PNC is required for the recruitment of neutrophils to inflamed tissue, since platelets 'prime' neutrophils for efficient adhesion to vascular endothelium via the up-regulation of integrins and enhanced responsiveness to chemokines (Fig. 1). Perhaps surprisingly, the surface contact between platelets and neutrophils additionally enhances other neutrophil functions, such as chemotaxis that is required for migration into tissues, trans-cellular production of eicosanoids, phagocytosis and trapping of pathogens, increased respiratory burst leading to the production of reactive oxygen species (ROS), and modulation of neutrophil apoptosis (Fig. 1). Platelet P-selectin appears to have a particular role in enhancing the majority of these activities, and the influence of platelet P-selectin is not therefore confined to the initial rolling events in the process of neutrophil extravasation.
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Affiliation(s)
- Clive Page
- Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, Kings College London, London SE1 9NH, UK
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Bacillus anthracis peptidoglycan activates human platelets through FcγRII and complement. Blood 2013; 122:571-9. [PMID: 23733338 DOI: 10.1182/blood-2013-02-486613] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Platelet activation frequently accompanies sepsis and contributes to the sepsis-associated vascular leakage and coagulation dysfunction. Our previous work has implicated peptidoglycan (PGN) as an agent causing systemic inflammation in gram-positive sepsis. We used flow cytometry and fluorescent microscopy to define the effects of PGN on the activation of human platelets. PGN induced platelet aggregation, expression of the activated form of integrin αIIbβ3, and exposure of phosphatidylserine (PS). These changes were dependent on immunoglobulin G and were attenuated by the Fcγ receptor IIa-blocking antibody IV.3, suggesting they are mediated by PGN-anti-PGN immune complexes signaling through Fcγ receptor IIa. PS exposure was not blocked by IV.3 but was sensitive to inhibitors of complement activation. PGN was a potent activator of the complement cascade in human plasma and caused deposition of C5b-9 on the platelet surface. Platelets with exposed PS had greatly accelerated prothrombinase activity. We conclude that PGN derived from gram-positive bacteria is a potent platelet agonist when complexed with anti-PGN antibody and could contribute to the coagulation dysfunction accompanying gram-positive infections.
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van den Berg S, Laman JD, Boon L, ten Kate MT, de Knegt GJ, Verdijk RM, Verbrugh HA, Nouwen JL, Bakker-Woudenberg IAJM. Distinctive cytokines as biomarkers predicting fatal outcome of severe Staphylococcus aureus bacteremia in mice. PLoS One 2013; 8:e59107. [PMID: 23520553 PMCID: PMC3592822 DOI: 10.1371/journal.pone.0059107] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 02/11/2013] [Indexed: 11/26/2022] Open
Abstract
Invasive Staphylococcus aureus infections are frequently associated with bacteraemia. To support clinical decisions on antibiotic therapy, there is an urgent need for reliable markers as predictors of infection outcome. In the present study in mice, bacteraemia was established by intravenous inoculation of a clinical S. aureus isolate at the LD50 inoculum. As potential biomarkers for fatal outcome, blood culture (qualitative and quantitative), serum levels of C-reactive protein (CRP), as well as 31 selected cytokines and chemokines were assessed during the first three days of infection. A positive S. aureus blood culture, the quantitative blood culture, CRP levels, and levels of eight cytokines were indicative for the presence of S. aureus bacteraemia. However, only tumor necrosis factor (TNF) α, interleukin (IL) 1α, and keratinocyte chemoattractant (KC; a functional homologue of human IL-8) were each significantly elevated in eventually non-surviving infected mice versus eventually surviving infected mice. In severe S. aureus bacteraemia in mice, TNF-α, IL-1α, and KC are biomarkers predicting fatal outcome of infection. KC was a biomarker elevated irrespective the progression of infection, which is very interesting regarding clinical application in view of the heterogeneity of patients experiencing bacteraemia in this respect.
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Affiliation(s)
- Sanne van den Berg
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Adamzik M, Görlinger K, Peters J, Hartmann M. Whole blood impedance aggregometry as a biomarker for the diagnosis and prognosis of severe sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R204. [PMID: 23088388 PMCID: PMC3682307 DOI: 10.1186/cc11816] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 10/03/2012] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Sepsis leads to an activation of the immune system and hemostatis. However, studies on platelet aggregation in severe sepsis using impedance aggregometry have not been performed and the diagnostic and prognostic capabilities are unknown. In the present study we hypothesized that impedance aggregometry findings might serve as a biomarker for the diagnosis and prognosis of severe sepsis. METHODS Eighty patients with severe sepsis and 50 postoperative patients were included in the prospective observational study. Platelet function was determined at the first day of severe sepsis and surgery, respectively, using impedance aggregometry (Multiplate®). Moreover, platelet count, procalcitonin, interleukin 6, C-reactive protein and 30-day mortality were determined. RESULTS Compared to postoperative patients, platelet aggregation was significantly reduced in patients with severe sepsis (collagen-test: 70.8 (44.4, 83.2) arbitrary units (A.U.) vs. 26.8 (12.7, 45.8) A.U.; P <0.001; median and quartiles). Furthermore, marked differences in platelet function were observed in survivors and non-survivors of severe sepsis (collagen-test: 33.4 (10.9, 48.8) A.U. vs. 12.4 (6.5, 25.0) A.U.; P = 0.001). Kaplan-Meier analysis demonstrated that higher platelet function was associated with a mortality of 10%, while mortality was 40% when platelet function was low (collagen-test; P = 0.002). The odds ratio was 6.0. In both univariate and multivariate analyses (including procalcitonin, IL6, C-reactive protein and platelet count) impedance aggregometry using collagen as the activator proved to be the best and an independent predictor for the diagnosis and prognosis of severe sepsis in critical illness. CONCLUSIONS In severe sepsis, impedance aggregometry allows better prediction of diagnosis and survival than conventional biomarkers and platelet count.
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Otto GP, Sossdorf M, Boettel J, Kabisch B, Breuel H, Winning J, Lösche W. Effects of low-dose acetylsalicylic acid and atherosclerotic vascular diseases on the outcome in patients with severe sepsis or septic shock. Platelets 2012; 24:480-5. [PMID: 22994591 DOI: 10.3109/09537104.2012.724482] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sepsis and its sequelae of multiple organ failure is one of the leading causes of death in the industrial countries. Several studies have shown that patients who are treated with low-dose acetyl salicylic acid (ASA) for secondary prevention of atherothrombosis may have a lower risk to develop organ failure in the case of critical illness. The benefit of ASA is probably due to an inhibition of platelet activation as well as an increase in the formation of anti-inflammatory lipoxin A4. On the other hand, the effect of ASA could be - at least partially - an indirect one, caused by atherosclerotic vascular diseases as the cause of ASA treatment. Atherosclerosis is considered as a moderate systemic inflammation and we hypothesise that this chronic condition could have an impact on the outcome in sepsis. To get more information on the benefit of ASA in critically ill patients and on possible interference with atherosclerotic vascular diseases, we analysed the medical records of 886 septic patients who were admitted to the surgical intensive care unit (ICU) of a university hospital. Logistic regression analysis indicated that patients who were treated during the ICU stay with ASA (100 mg/d) had a significantly lower mortality. Odds ratios (ORs; with 95% confidential intervals) of 0.56 (0.37-0.84) and 0.57 (0.39-0.83) were calculated for ICU and hospital mortality, respectively. In contrast, statin treatment did not have significant effect on mortality. Diagnosis of atherosclerotic vascular diseases according to ICD classification did not influence ICU mortality but lowered hospital mortality (OR = 0.71 (0.52-0.99)). Subgroup analysis provided preliminary evidence that clopidogrel when given as only anti-platelet drug may have a similar benefit as ASA, but the combination of ASA and clopidogrel failed to improve the outcome. The time course of plasma fibrinogen and procalcitonin levels indicate that ASA seems to reduce the activation of haemostasis and increase the resolution of inflammation. It is concluded that prospective interventional studies should be done to test the use of ASA as novel therapeutic approach in critically ill patients.
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Affiliation(s)
- Gordon Philipp Otto
- Clinic for Anaesthesiology and Intensive Care Medicine, University Hospital Jena, Jena, Germany
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Huang HS, Chang HH. Platelets in inflammation and immune modulations: functions beyond hemostasis. Arch Immunol Ther Exp (Warsz) 2012; 60:443-51. [PMID: 22940877 DOI: 10.1007/s00005-012-0193-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 02/29/2012] [Indexed: 12/13/2022]
Abstract
Platelets play central roles for maintaining the homeostasis of the blood coagulation. As they are also involved in immune responses and host defenses, increasing evidences have suggested that platelets exert other roles beyond their well-recognized function in preventing bleeding. This review is focused on inflammation, allergy and immune modulations of platelets. Platelets conduct immunoregulation through secretion of functional mediators, interaction with various immune cells, endothelial cells and beneficial for the leukocyte infiltration to inflamed/allergic tissues. In these regulations, the leukocytes are influenced by and receiving the signals from platelets. In contrast, rare attentions were focused on platelet regulations by immune system. An intriguingly example in the intravenous immunoglobulin (IVIg) treatment is discussed, in which dendritic cells exert anti-inflammatory effect through platelets. This further suggests that coagulant and immune systems are tightly associated rather than separate entities. The cross-talks between these two systems implicate that platelet therapy may have application beyond thrombosis, and immune interventions may have potentials to treat thrombosis diseases.
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Affiliation(s)
- Hsuan-Shun Huang
- Department of Molecular Biology and Human Genetics, Tzu Chi University, 701 Sec. 3, Chung Yang Rd, Hualien, 970, Taiwan, ROC
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Abstract
PURPOSE OF REVIEW Sepsis is an inflammatory condition associated with significant morbidity and mortality. Given the lack of specific therapies for the condition, prevention has garnered significant interest and increased importance. The article reviews the current literature regarding the use of aspirin and statins for the prevention of sepsis. RECENT FINDINGS Aspirin and statins have been integral in the prevention of atherosclerotic disease. Additionally, statins have proven beneficial in the prevention of nonatherosclerotic conditions secondary to their pleiotropic effects. In animal models, this pleiotropism modulates many inflammatory pathways of sepsis. The platelet also plays an integral role in this inflammatory cascade of sepsis. Scientific data indicates that antiplatelet therapy, including aspirin, may attenuate these undesirable effects of platelets. Finally, observational studies have shown that patients taking statins have a decreased incidence of sepsis and septic shock, and aspirin may potentiate these benefits. SUMMARY Sepsis is a deadly and costly condition with no available, specific treatment options. The statins and aspirin are well tolerated and widely used for prevention of cardiovascular disease. Because of their effects on the immune system and inflammatory pathways, they may present viable medical options for the prevention of sepsis.
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Shannon O, Herwald H, Oehmcke S. Modulation of the coagulation system during severe streptococcal disease. Curr Top Microbiol Immunol 2012; 368:189-205. [PMID: 23224709 DOI: 10.1007/82_2012_283] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Haemostasis is maintained by a tightly regulated coagulation system that comprises platelets, procoagulant proteins, and anticoagulant proteins. During the local and systemic response to bacterial infection, the coagulation system becomes activated, and contributes to the pathophysiological response to infection. The significant human pathogen, Streptococcus pyogenes has multiple strategies to modulate coagulation. This can range from systemic activation of the intrinsic and extrinsic pathway of coagulation to local stimulation of fibrinolysis. Such diverse effects on this host system imply a finely tuned host-bacteria interaction. The molecular mechanisms that underlie this modulation of the coagulation system are discussed in this review.
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Affiliation(s)
- Oonagh Shannon
- Division of Infection Medicine, Department of Clinical Sciences, Biomedical Centre, B14, Lund University, Sweden.
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