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Trunfio M, Tang B, Okwuegbuna O, Iudicello JE, Bharti A, Moore DJ, Gelman BB, Morgello S, Patel PB, Rubin LH, Ances BM, Gianella S, Heaton RK, Ellis RJ, Letendre SL. Longitudinal analysis of CSF HIV RNA in untreated people with HIV: Identification of CSF controllers. J Med Virol 2024; 96:e29550. [PMID: 38511593 PMCID: PMC11139255 DOI: 10.1002/jmv.29550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
Interindividual variation of human immunodeficiency virus (HIV) RNA setpoint in cerebrospinal fluid (CSF) and its determinants are poorly understood, but relevant for HIV neuropathology, brain reservoirs, viral escape, and reseeding after antiretroviral interruptions. Longitudinal multicentric study on demographic, clinical, and laboratory correlates of CSF HIV RNA in 2000 follow-up visits from 597 people with HIV (PWH) off antiretroviral therapy (ART) and with plasma HIV RNA > the lower limit of quantification (LLQ). Factors associated with CSF control (CSFC; CSF HIV RNA < LLQ while plasma HIV RNA > LLQ) and with CSF/plasma discordance (CSF > plasma HIV RNA > LLQ) were also assessed through mixed-effects models. Posthoc and sensitivity analyses were performed for persistent CSFC and ART-naïve participants, respectively. Over a median follow-up of 2.1 years, CSF HIV RNA was associated with CD4+ and CD8+ T cells, CSF leukocytes, blood-brain barrier (BBB) integrity, biomarkers of iron and lipid metabolism, serum globulins, past exposure to lamivudine, and plasma HIV RNA (model p < 0.0001). CSFC (persistent in 7.7% over 3 years) and CSF/plasma discordance (persistent in <0.01% over 1 year) were variably associated with the same parameters (model p < 0.001). Sensitivity analyses confirmed most of the previous associations in participants never exposed to ART. Persistent CSFC was associated with higher CD4+ T-cell count nadir (p < 0.001), lower serum globulins (p = 0.003), and lower CSF leukocytes (p < 0.001). Without ART, one in 13 PWH had persistently undetectable CSF HIV RNA, while persistent CSF/plasma discordance was extremely rare over years. Immune responses, inflammation, BBB permeability, and iron and lipid metabolism were all associated with HIV replication in CSF.
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Affiliation(s)
- Mattia Trunfio
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Bin Tang
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Oluwakemi Okwuegbuna
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Jennifer E. Iudicello
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Ajay Bharti
- Division of Infectious Diseases and Global Health, University of California San Diego, San Diego, California, USA
| | - David J. Moore
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Benjamin B. Gelman
- Department of Pathology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Susan Morgello
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Payal B. Patel
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Leah H. Rubin
- Department of Neurology, Psychiatry and Behavioral Sciences, Molecular and Cellular Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Beau M. Ances
- Department of Neurology, Washington University, St Louis, Missouri, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Health, University of California San Diego, San Diego, California, USA
| | - Robert K. Heaton
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Ronald J. Ellis
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
| | - Scott L. Letendre
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, University of California San Diego, San Diego, California, USA
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Ningtyas DC, Leitner F, Sohail H, Thong YL, Hicks SM, Ali S, Drew M, Javed K, Lee J, Kenangalem E, Poespoprodjo JR, Anstey NM, Rug M, Choi PYI, Kho S, Gardiner EE, McMorran BJ. Platelets mediate the clearance of senescent red blood cells by forming prophagocytic platelet-cell complexes. Blood 2024; 143:535-547. [PMID: 37992231 PMCID: PMC10934294 DOI: 10.1182/blood.2023021611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023] Open
Abstract
ABSTRACT In humans, ∼0.1% to 0.3% of circulating red blood cells (RBCs) are present as platelet-RBC (P-RBC) complexes, and it is 1% to 2% in mice. Excessive P-RBC complexes are found in diseases that compromise RBC health (eg, sickle cell disease and malaria) and contribute to pathogenesis. However, the physiological role of P-RBC complexes in healthy blood is unknown. As a result of damage accumulated over their lifetime, RBCs nearing senescence exhibit physiological and molecular changes akin to those in platelet-binding RBCs in sickle cell disease and malaria. Therefore, we hypothesized that RBCs nearing senescence are targets for platelet binding and P-RBC formation. Confirming this hypothesis, pulse-chase labeling studies in mice revealed an approximately tenfold increase in P-RBC complexes in the most chronologically aged RBC population compared with younger cells. When reintroduced into mice, these complexes were selectively cleared from the bloodstream (in preference to platelet-free RBC) through the reticuloendothelial system and erythrophagocytes in the spleen. As a corollary, patients without a spleen had higher levels of complexes in their bloodstream. When the platelet supply was artificially reduced in mice, fewer RBC complexes were formed, fewer erythrophagocytes were generated, and more senescent RBCs remained in circulation. Similar imbalances in complex levels and senescent RBC burden were observed in humans with immune thrombocytopenia (ITP). These findings indicate that platelets are important for binding and clearing senescent RBCs, and disruptions in platelet count or complex formation and clearance may negatively affect RBC homeostasis and may contribute to the known risk of thrombosis in ITP and after splenectomy.
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Affiliation(s)
- Dian C. Ningtyas
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Florentina Leitner
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- Medical University of Vienna, Vienna, Austria
| | - Huma Sohail
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Yee Lin Thong
- Division of Genome Science and Cancer, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- The National Platelet Research and Referral Centre, Australian National University, Canberra, ACT, Australia
| | - Sarah M. Hicks
- Division of Genome Science and Cancer, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- The National Platelet Research and Referral Centre, Australian National University, Canberra, ACT, Australia
| | - Sidra Ali
- Division of Genome Science and Cancer, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- The National Platelet Research and Referral Centre, Australian National University, Canberra, ACT, Australia
| | - Megan Drew
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Kiran Javed
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Jiwon Lee
- Centre for Advanced Microscopy, Australian National University, Canberra, ACT, Australia
| | - Enny Kenangalem
- Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
| | - Jeanne R. Poespoprodjo
- Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Department of Pediatrics, Gadjah Mada University, Yogyakarta, Indonesia
| | - Nicholas M. Anstey
- Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Melanie Rug
- Centre for Advanced Microscopy, Australian National University, Canberra, ACT, Australia
| | - Philip Y.-I. Choi
- Division of Genome Science and Cancer, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- The National Platelet Research and Referral Centre, Australian National University, Canberra, ACT, Australia
- Department of Clinical Haematology, The Canberra Hospital, Garran, ACT, Australia
| | - Steven Kho
- Papuan Health and Community Development Foundation, Timika, Papua, Indonesia
- Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
| | - Elizabeth E. Gardiner
- Division of Genome Science and Cancer, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- The National Platelet Research and Referral Centre, Australian National University, Canberra, ACT, Australia
| | - Brendan J. McMorran
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
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An O, Deppermann C. Platelet lifespan and mechanisms for clearance. Curr Opin Hematol 2024; 31:6-15. [PMID: 37905750 DOI: 10.1097/moh.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
PURPOSE OF REVIEW Activated or aged platelets are removed from circulation under (patho)physiologic conditions, the exact mechanism of platelet clearance under such conditions remains unclear and are currently being investigated. This review focuses on recent findings and controversies regarding platelet clearance and the disruption of platelet life cycle. RECENT FINDINGS The platelet life span is determined by glycosylation of platelet surface receptors with sialic acid. Recently, it was shown that platelet activation and granule release leads to desialylation of glycans and accelerated clearance of platelets under pathological conditions. This phenomenon was demonstrated to be a main reason for thrombocytopenia being a complication in several infections and immune disorders. SUMMARY Although we have recently gained some insight into how aged platelets are cleared from circulation, we are still not seeing the full picture. Further investigations of the platelet clearance pathways under pathophysiologic conditions are needed as well as studies to unravel the connection between platelet clearance and platelet production.
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Affiliation(s)
- Olga An
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Wang Q, Zhao H, Tong Y, Qin J, Zhou M, Xu L. Aspartate Aminotransferase/Platelet Ratio Index Upon Admission Predicts 24-Week Mortality in Patients With HIV-Associated Talaromyces marneffei. Open Forum Infect Dis 2023; 10:ofad593. [PMID: 38107017 PMCID: PMC10721445 DOI: 10.1093/ofid/ofad593] [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: 07/31/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
Background A high aspartate aminotransferase/platelet ratio index (APRI) predicts mortality in patients with severe infection. This study aims to assess the potential of APRI as a predictor for mortality in patients with HIV-associated Talaromyces marneffei (HTM). Methods Associations between APRI and CD4 count, white blood cell count, C-reactive protein (CRP) level, procalcitonin (PCT) level, and cytokines were assessed in 119 patients. Univariate and multivariate Cox regression models were used to predict APRI on 24-week mortality. Results APRI was positively associated with CRP (r = 0.190, P = .039), PCT (r = 0.220, P = .018), interleukin 6 (r = 0.723, P < .001), interleukin 10 (r = 0.416, P = .006), and tumor necrosis factor α (r = 0.575, P < .001) and negatively associated with CD4 count (r = -0.234, P = .011). In total, 20.2% (24/119) of patients died within the 24-week follow-up. The 24-week survival rate was 88.0% for patients with APRI <5.6% and 61.1% for those with APRI ≥5.6 (log-rank P < .001). After adjustment for sex, age, body mass index, and CD4 count, as well as serum levels of hemoglobin, APRI ≥5.6 (adjusted hazard ratio [95% CI]; 3.0 [1.2-7.1], P = .015), PCT ≥1.7 ng/mL (3.7 [1.5-9.6], P = .006), and non-amphotericin B deoxycholate treatment (2.8 [1.2-6.6], P = .018) were independent risk factors for 24-week mortality. Conclusions For patients with HTM, APRI is associated with severity and is an independent risk factor for 24-week mortality.
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Affiliation(s)
- Qi Wang
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Infectious Diseases, Huzhou Central Hospital of Zhejiang University, Huzhou, China
| | - Handan Zhao
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Yong Tong
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Infectious Diseases, Huzhou Central Hospital of Zhejiang University, Huzhou, China
| | - Jiaying Qin
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Minghan Zhou
- College of Medicine, Zhejiang University, Hangzhou, China
| | - Lijun Xu
- National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Awamura T, Nakasone ES, Gangcuangco LM, Subia NT, Bali AJ, Chow DC, Shikuma CM, Park J. Platelet and HIV Interactions and Their Contribution to Non-AIDS Comorbidities. Biomolecules 2023; 13:1608. [PMID: 38002289 PMCID: PMC10669125 DOI: 10.3390/biom13111608] [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: 10/05/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Platelets are anucleate cytoplasmic cell fragments that circulate in the blood, where they are involved in regulating hemostasis. Beyond their normal physiologic role, platelets have emerged as versatile effectors of immune response. During an infection, cell surface receptors enable platelets to recognize viruses, resulting in their activation. Activated platelets release biologically active molecules that further trigger host immune responses to protect the body against infection. Their impact on the immune response is also associated with the recruitment of circulating leukocytes to the site of infection. They can also aggregate with leukocytes, including lymphocytes, monocytes, and neutrophils, to immobilize pathogens and prevent viral dissemination. Despite their host protective role, platelets have also been shown to be associated with various pathophysiological processes. In this review, we will summarize platelet and HIV interactions during infection. We will also highlight and discuss platelet and platelet-derived mediators, how they interact with immune cells, and the multifaceted responsibilities of platelets in HIV infection. Furthermore, we will give an overview of non-AIDS comorbidities linked to platelet dysfunction and the impact of antiretroviral therapy on platelet function.
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Affiliation(s)
- Thomas Awamura
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (T.A.); (N.T.S.); (A.-J.B.)
| | - Elizabeth S. Nakasone
- University of Hawai‘i Cancer Center, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA;
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA;
| | - Louie Mar Gangcuangco
- Hawai‘i Center for AIDS, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (L.M.G.); (C.M.S.)
| | - Natalie T. Subia
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (T.A.); (N.T.S.); (A.-J.B.)
| | - Aeron-Justin Bali
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (T.A.); (N.T.S.); (A.-J.B.)
| | - Dominic C. Chow
- Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA;
- Hawai‘i Center for AIDS, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (L.M.G.); (C.M.S.)
| | - Cecilia M. Shikuma
- Hawai‘i Center for AIDS, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (L.M.G.); (C.M.S.)
| | - Juwon Park
- Department of Tropical Medicine, Medical Microbiology, and Pharmacology, John A. Burns School Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (T.A.); (N.T.S.); (A.-J.B.)
- Hawai‘i Center for AIDS, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI 96813, USA; (L.M.G.); (C.M.S.)
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Schulze AB, Mohr M, Sackarnd J, Schmidt LH, Tepasse PR, Rosenow F, Evers G. Risk Factors in HIV-1 Positive Patients on the Intensive Care Unit: A Single Center Experience from a Tertiary Care Hospital. Viruses 2023; 15:v15051164. [PMID: 37243250 DOI: 10.3390/v15051164] [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: 04/29/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
HIV-positive patients with acquired immunodeficiency syndrome (AIDS) often require treatment on intensive care units (ICUs). We aimed to present data from a German, low-incidence region cohort, and subsequently evaluate factors measured during the first 24 h of ICU stay to predict short- and long-term survival, and compare with data from high-incidence regions. We documented 62 patient courses between 2009 and 2019, treated on a non-operative ICU of a tertiary care hospital, mostly due to respiratory deterioration and co-infections. Of these, 54 patients required ventilatory support within the first 24 h with either nasal cannula/mask (n = 12), non-invasive ventilation (n = 16), or invasive ventilation (n = 26). Overall survival at day 30 was 77.4%. While ventilatory parameters (all p < 0.05), pH level (c/o 7.31, p = 0.001), and platelet count (c/o 164,000/µL, p = 0.002) were significant univariate predictors of 30-day and 60-day survival, different ICU scoring systems, such as SOFA score, APACHE II, and SAPS 2 predicted overall survival (all p < 0.001). Next to the presence or history of solid neoplasia (p = 0.026), platelet count (HR 6.7 for <164,000/µL, p = 0.020) and pH level (HR 5.8 for <7.31, p = 0.009) remained independently associated with 30-day and 60-day survival in multivariable Cox regression. However, ventilation parameters did not predict survival multivariably.
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Affiliation(s)
- Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Jan Sackarnd
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Lars Henning Schmidt
- Medical Department IV, Pneumology, Respiratory Medicine and Thoracic Oncology, Klinikum Ingolstadt, 85049 Ingolstadt, Germany
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Phil-Robin Tepasse
- Department of Medicine B, Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology, University Hospital Münster, 48149 Münster, Germany
| | - Felix Rosenow
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Münster, 48149 Münster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany
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Suan MAM, Chan HK, Sem X, Shilton S, Hassan MRA. Diagnostic performance of two non-invasive biomarkers used individually and in sequential combination for cirrhosis associated with hepatitis C virus infection. Sci Rep 2022; 12:20153. [PMID: 36418369 PMCID: PMC9684447 DOI: 10.1038/s41598-022-24612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
Abstract
This cross-sectional study evaluated the performance of the Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) and the Fibrosis-4 (FIB-4) Index when they were used individually and in sequential combination to diagnose cirrhosis associated with hepatitis C virus infection. The final evaluation involved 906 people living with hepatitis C. The diagnostic performance of individual biomarkers at cut-off scores of 1.5 and 2.0 for the APRI and at 3.25 for the FIB-4 index was assessed. For the sequential combination method, the cirrhosis status of individuals with an APRI score between 1.0 and 1.5 were reassessed using the FIB-4. Transient elastography (TE) was used as the reference standard for diagnosing cirrhosis. The APRI, at a cut-off score of 1.5, showed a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 44.9%, 97.6%, 91.1% and 76.3%, respectively. Increasing the cut-off score to 2.0 produced a much lower sensitivity (29.6%) and NPV (71.9%). The FIB-4, at a cut-off score of 3.25, yielded a sensitivity, specificity, PPV and NPV of 40.8%, 97.3%, 89.1% and 75.0%, respectively. The sequential combination method demonstrated a much more optimal diagnostic performance (50.2% sensitivity, 96.6% specificity, 89.0% PPV and 77.9% NPV). Overall, the APRI and FIB-4 Index performed better in diagnosing cirrhosis associated with hepatitis C when they were used in sequential combination.
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Affiliation(s)
- Mohd Azri Mohd Suan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health, Alor Setar, Kedah, Malaysia
| | - Huan Keat Chan
- Clinical Research Centre, Hospital Sultanah Bahiyah, Ministry of Health, Alor Setar, Kedah, Malaysia
| | - Xiaohui Sem
- grid.452485.a0000 0001 1507 3147FIND, Geneva, Switzerland
| | | | - Muhammad Radzi Abu Hassan
- grid.415759.b0000 0001 0690 5255Office of Deputy Director General, Ministry of Health Malaysia, Putrajaya, Malaysia
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The potential role of ischaemia-reperfusion injury in chronic, relapsing diseases such as rheumatoid arthritis, Long COVID, and ME/CFS: evidence, mechanisms, and therapeutic implications. Biochem J 2022; 479:1653-1708. [PMID: 36043493 PMCID: PMC9484810 DOI: 10.1042/bcj20220154] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 02/07/2023]
Abstract
Ischaemia–reperfusion (I–R) injury, initiated via bursts of reactive oxygen species produced during the reoxygenation phase following hypoxia, is well known in a variety of acute circumstances. We argue here that I–R injury also underpins elements of the pathology of a variety of chronic, inflammatory diseases, including rheumatoid arthritis, ME/CFS and, our chief focus and most proximally, Long COVID. Ischaemia may be initiated via fibrin amyloid microclot blockage of capillaries, for instance as exercise is started; reperfusion is a necessary corollary when it finishes. We rehearse the mechanistic evidence for these occurrences here, in terms of their manifestation as oxidative stress, hyperinflammation, mast cell activation, the production of marker metabolites and related activities. Such microclot-based phenomena can explain both the breathlessness/fatigue and the post-exertional malaise that may be observed in these conditions, as well as many other observables. The recognition of these processes implies, mechanistically, that therapeutic benefit is potentially to be had from antioxidants, from anti-inflammatories, from iron chelators, and via suitable, safe fibrinolytics, and/or anti-clotting agents. We review the considerable existing evidence that is consistent with this, and with the biochemical mechanisms involved.
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Pretorius E, Venter C, Laubscher GJ, Kotze MJ, Oladejo SO, Watson LR, Rajaratnam K, Watson BW, Kell DB. Prevalence of symptoms, comorbidities, fibrin amyloid microclots and platelet pathology in individuals with Long COVID/Post-Acute Sequelae of COVID-19 (PASC). Cardiovasc Diabetol 2022; 21:148. [PMID: 35933347 PMCID: PMC9356426 DOI: 10.1186/s12933-022-01579-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/16/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Fibrin(ogen) amyloid microclots and platelet hyperactivation previously reported as a novel finding in South African patients with the coronavirus 2019 disease (COVID-19) and Long COVID/Post-Acute Sequelae of COVID-19 (PASC), might form a suitable set of foci for the clinical treatment of the symptoms of Long COVID/PASC. A Long COVID/PASC Registry was subsequently established as an online platform where patients can report Long COVID/PASC symptoms and previous comorbidities. METHODS In this study, we report on the comorbidities and persistent symptoms, using data obtained from 845 South African Long COVID/PASC patients. By using a previously published scoring system for fibrin amyloid microclots and platelet pathology, we also analysed blood samples from 80 patients, and report the presence of significant fibrin amyloid microclots and platelet pathology in all cases. RESULTS Hypertension, high cholesterol levels (dyslipidaemia), cardiovascular disease and type 2 diabetes mellitus (T2DM) were found to be the most important comorbidities. The gender balance (70% female) and the most commonly reported Long COVID/PASC symptoms (fatigue, brain fog, loss of concentration and forgetfulness, shortness of breath, as well as joint and muscle pains) were comparable to those reported elsewhere. These findings confirmed that our sample was not atypical. Microclot and platelet pathologies were associated with Long COVID/PASC symptoms that persisted after the recovery from acute COVID-19. CONCLUSIONS Fibrin amyloid microclots that block capillaries and inhibit the transport of O2 to tissues, accompanied by platelet hyperactivation, provide a ready explanation for the symptoms of Long COVID/PASC. Removal and reversal of these underlying endotheliopathies provide an important treatment option that urgently warrants controlled clinical studies to determine efficacy in patients with a diversity of comorbidities impacting on SARS-CoV-2 infection and COVID-19 severity. We suggest that our platelet and clotting grading system provides a simple and cost-effective diagnostic method for early detection of Long COVID/PASC as a major determinant of effective treatment, including those focusing on reducing clot burden and platelet hyperactivation.
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Affiliation(s)
- Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa. .,Department of Biochemistry and Systems Biology, Faculty of Health and Life Sciences, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK.
| | - Chantelle Venter
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa
| | | | - Maritha J Kotze
- Division of Chemical Pathology, Department of Pathology, National Health Laboratory Service, Tygerberg Hospital & Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Sunday O Oladejo
- Centre for AI Research, School for Data-Science & Computational Thinking, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Liam R Watson
- Centre for AI Research, School for Data-Science & Computational Thinking, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Kanshu Rajaratnam
- Centre for AI Research, School for Data-Science & Computational Thinking, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Bruce W Watson
- Centre for AI Research, School for Data-Science & Computational Thinking, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Douglas B Kell
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Private Bag X1, Matieland, Stellenbosch, 7602, South Africa. .,Department of Biochemistry and Systems Biology, Faculty of Health and Life Sciences, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, L69 7ZB, UK. .,The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kemitorvet 200, 2800, Kgs Lyngby, Denmark.
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10
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Infection of lung megakaryocytes and platelets by SARS-CoV-2 anticipate fatal COVID-19. Cell Mol Life Sci 2022; 79:365. [PMID: 35708858 PMCID: PMC9201269 DOI: 10.1007/s00018-022-04318-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 12/11/2022]
Abstract
SARS-CoV-2, although not being a circulatory virus, spread from the respiratory tract resulting in multiorgan failures and thrombotic complications, the hallmarks of fatal COVID-19. A convergent contributor could be platelets that beyond hemostatic functions can carry infectious viruses. Here, we profiled 52 patients with severe COVID-19 and demonstrated that circulating platelets of 19 out 20 non-survivor patients contain SARS-CoV-2 in robust correlation with fatal outcome. Platelets containing SARS-CoV-2 might originate from bone marrow and lung megakaryocytes (MKs), the platelet precursors, which were found infected by SARS-CoV-2 in COVID-19 autopsies. Accordingly, MKs undergoing shortened differentiation and expressing anti-viral IFITM1 and IFITM3 RNA as a sign of viral sensing were enriched in the circulation of deadly COVID-19. Infected MKs reach the lung concomitant with a specific MK-related cytokine storm rich in VEGF, PDGF and inflammatory molecules, anticipating fatal outcome. Lung macrophages capture SARS-CoV-2-containing platelets in vivo. The virus contained by platelets is infectious as capture of platelets carrying SARS-CoV-2 propagates infection to macrophages in vitro, in a process blocked by an anti-GPIIbIIIa drug. Altogether, platelets containing infectious SARS-CoV-2 alter COVID-19 pathogenesis and provide a powerful fatality marker. Clinical targeting of platelets might prevent viral spread, thrombus formation and exacerbated inflammation at once and increase survival in COVID-19.
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11
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McCutcheon K, Manga P. Human Immunodeficiency Virus and Cardiovascular Disease: Revisiting the Inflammation-Thrombosis Axis. Thromb Haemost 2022; 122:476-479. [PMID: 34689321 DOI: 10.1055/s-0041-1736445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Keir McCutcheon
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Pravin Manga
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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12
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Whiteheart SW. Platelet-HIV: interactions and their implications. Platelets 2022; 33:208-211. [PMID: 35086429 PMCID: PMC8881393 DOI: 10.1080/09537104.2021.2019695] [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: 10/19/2022]
Abstract
While it is clear that platelets interact with viruses, the ramifications and mechanisms of those interactions are still being defined for each type of viral infection. HIV/AIDS+ represents a potentially unique example of how viremia affects platelets since the increasing efficacy of antiretroviral therapeutics (ART) has made it a chronic disease that increases the risk of cardiovascular disease. In this opinion article, we discuss some of the open questions about how platelets interact with HIV. What happens to a virion once it binds a platelet? What is the nature of virus-induced platelet activation? Are platelets a normal part of the immune response to viremia that has been co-opted to increase the spread of HIV? The answers to these and similar questions will help define how platelet-directed therapeutics might be used in treating HIV/AIDS+ patients.
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Affiliation(s)
- Sidney W. Whiteheart
- Dept. of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, Lexington KY, USA,Lexington VA Medical Center, Lexington, KY, USA,To whom correspondence should be directed: Sidney W. Whiteheart, Ph.D., Department of Molecular and Cellular Biochemistry, University of Kentucky College of Medicine, B361 BBSRB, 741 S Limestone, Lexington, KY 40536, USA, Tel: 859-257-4882, Fax: 859-257-2283,
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