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Watanabe E, Takasu O, Teratake Y, Sakamoto T, Ikeda T, Kotani J, Kitamura N, Ohmori M, Teratani A, Honda G, Hatano M, Mayer B, Schneider EM, Oda S. A Thrombomodulin Promoter Gene Polymorphism, rs2239562, Influences Both Susceptibility to and Outcome of Sepsis. Front Med (Lausanne) 2022; 8:762198. [PMID: 35083232 PMCID: PMC8785550 DOI: 10.3389/fmed.2021.762198] [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: 08/21/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Disseminated intravascular coagulation plays a key role in the pathophysiology of sepsis. Thrombomodulin is essential in the protein C system of coagulation cascade, and functional polymorphisms influence the human thrombomodulin gene (THBD). Therefore, we conducted a multicenter study to evaluate the influence of such polymorphisms on the pathophysiology of sepsis. Methods: A collaborative case-control study in the intensive care unit (ICU) of each of five tertiary emergency centers. The study included 259 patients (of whom 125 displayed severe sepsis), who were admitted to the ICU of Chiba University Hospital, Chiba, Japan between October 2001 and September 2008 (discovery cohort) and 793 patients (of whom 271 patients displayed severe sepsis), who were admitted to the five ICUs between October 2008 and September 2012 (multicenter validation cohort). To assess the susceptibility to severe sepsis, we further selected 222 critically ill patients from the validation cohort matched for age, gender, morbidity, and severity with the patients with severe sepsis, but without any evidence of sepsis. Results: We examined whether the eight THBD single nucleotide polymorphisms (SNPs) were associated with susceptibility to and/or mortality of sepsis. Higher mortality on severe sepsis in the discovery and combined cohorts was significantly associated with the CC genotype in a THBD promoter SNP (-1920*C/G; rs2239562) [odds ratio [OR] 2.709 (1.067-6.877), P = 0.033 and OR 1.768 (1.060-2.949), P = 0.028]. Furthermore, rs2239562 SNP was associated with susceptibility to severe sepsis [OR 1.593 (1.086-2.338), P = 0.017]. Conclusions: The data demonstrate that rs2239562, the THBD promoter SNP influences both the outcome and susceptibility to severe sepsis.
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Affiliation(s)
- Eizo Watanabe
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.,General Medical Science, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Osamu Takasu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Japan
| | | | - Teruo Sakamoto
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Toshiaki Ikeda
- Division of Critical Care and Emergency Medicine, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan
| | - Joji Kotani
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Masaaki Ohmori
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ayako Teratani
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Goichi Honda
- Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan
| | | | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry, Ulm Universtiy, Ulm, Germany
| | - E Marion Schneider
- Division of Experimental Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - Shigeto Oda
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Arishima T, Ito T, Yasuda T, Yashima N, Furubeppu H, Kamikokuryo C, Futatsuki T, Madokoro Y, Miyamoto S, Eguchi T, Haraura H, Maruyama I, Kakihana Y. Circulating activated protein C levels are not increased in septic patients treated with recombinant human soluble thrombomodulin. Thromb J 2018; 16:24. [PMID: 30275773 PMCID: PMC6161343 DOI: 10.1186/s12959-018-0178-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/24/2018] [Indexed: 01/01/2023] Open
Abstract
Background Recombinant human soluble thrombomodulin (rTM) has been used for the treatment of disseminated intravascular coagulation in Japan, and an international phase III clinical trial for rTM is currently in progress. rTM mainly exerts its anticoagulant effects through an activated protein C (APC)-dependent mechanism, but the circulating APC levels after rTM treatment have not been clarified. This prospective observational study investigated plasma APC levels after rTM treatment. Methods Plasma levels of soluble thrombomodulin, thrombin-antithrombin complex (TAT), protein C, and APC were measured in eight septic patients treated with rTM. APC generation in vitro was assessed in the presence or absence of rTM. Results rTM significantly increased thrombin-mediated APC generation in vitro. In septic patients, soluble thrombomodulin levels were significantly increased during a 30–60-min period of rTM treatment and TAT levels were decreased. However, APC activity was not increased during the treatment period. Conclusions Plasma APC activity is not increased in septic patients treated with rTM. It is possible that APC acts locally and does not circulate systemically. Electronic supplementary material The online version of this article (10.1186/s12959-018-0178-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takuro Arishima
- 1Emergency and Critical Care Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Takashi Ito
- 1Emergency and Critical Care Center, Kagoshima University Hospital, Kagoshima, Japan.,2Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544 Japan
| | - Tomotsugu Yasuda
- 1Emergency and Critical Care Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Nozomi Yashima
- 3Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroaki Furubeppu
- 1Emergency and Critical Care Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Chinatsu Kamikokuryo
- 3Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takahiro Futatsuki
- 1Emergency and Critical Care Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Yutaro Madokoro
- 1Emergency and Critical Care Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Shotaro Miyamoto
- 1Emergency and Critical Care Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Tomohiro Eguchi
- 1Emergency and Critical Care Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Hiroyuki Haraura
- 1Emergency and Critical Care Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Ikuro Maruyama
- 2Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544 Japan
| | - Yasuyuki Kakihana
- 1Emergency and Critical Care Center, Kagoshima University Hospital, Kagoshima, Japan.,3Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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