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Borba-Junior IT, Lima F, Sidarta-Oliveira D, Moraes CRP, Annichino-Bizzacchi JM, Bombassaro B, Palma AC, Costa FTM, Moretti ML, Mansour E, Velloso LA, Orsi FA, De Paula EV. Podoplanin and CLEC-2 levels in patients with COVID-19. Res Pract Thromb Haemost 2023; 7:100282. [PMID: 37361399 PMCID: PMC10284445 DOI: 10.1016/j.rpth.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Podoplanin (PDPN gene) and CLEC-2 are involved in inflammatory hemostasis and have also been related with the pathogenesis of thrombosis. Emerging evidence also suggest that podoplanin can exert protective effects in sepsis and in acute lung injury. In lungs, podoplanin is co-expressed with ACE2, which is the main entry receptor for SARS-CoV-2. Aim To explore the role of podoplanin and CLEC-2 in COVID-19. Methods Circulating levels of podoplanin and CLEC-2 were measured in 30 consecutive COVID-19 patients admitted due to hypoxia, and in 30 age- and sex-matched healthy individuals. Podoplanin expression in lungs from patients who died of COVID-19 was obtained from two independent public databases of single-cell RNAseq from which data from control lungs were also available. Results Circulating podoplanin levels were lower in COVID-19, while no difference was observed in CLEC-2 levels. Podoplanin levels were significantly inversely correlated with markers of coagulation, fibrinolysis and innate immunity. scRNAseq data confirmed that PDPN is co-expressed with ACE2 in pneumocytes, and showed that PDPN expression is lower in this cell compartment in lungs from patients with COVID-19. Conclusion Circulating levels of podoplanin are lower in COVID-19, and the magnitude of this reduction is correlated with hemostasis activation. We also demonstrate the downregulation of PDPN at the transcription level in pneumocytes. Together, our exploratory study questions whether an acquired podoplanin deficiency could be involved in the pathogenesis of acute lung injury in COVID-19, and warrant additional studies to confirm and refine these findings.
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Affiliation(s)
| | - Franciele Lima
- School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | - Joyce M. Annichino-Bizzacchi
- School of Medical Sciences, University of Campinas, Campinas, Brazil
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
| | - Bruna Bombassaro
- School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - André C. Palma
- School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | | | - Eli Mansour
- School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Lício Augusto Velloso
- School of Medical Sciences, University of Campinas, Campinas, Brazil
- Obesity and Comorbidities Center, University of Campinas, Campinas, Brazil
| | - Fernanda Andrade Orsi
- School of Medical Sciences, University of Campinas, Campinas, Brazil
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
| | - Erich Vinicius De Paula
- School of Medical Sciences, University of Campinas, Campinas, Brazil
- Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
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de Lima F, Moraes CRP, Barbosa MS, Bombassaro B, Palma AC, Dertkigil SSJ, Moretti ML, Orsi FA, Annichino-Bizzacchi JM, Mansour E, Velloso LA, De Paula EV. Association of heme-oxygenase 1, hemopexin, and heme levels with markers of disease severity in COVID-19. Exp Biol Med (Maywood) 2023; 248:309-316. [PMID: 36740756 PMCID: PMC9902789 DOI: 10.1177/15353702221139185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Heme-oxygenase 1 (HO-1) is an enzyme with well-known anti-inflammatory and antioxidant properties, whose levels have been previously associated with disease severity in the context of sterile and infectious diseases. Moreover, the heme/HO-1 pathway has been associated with prothrombotic changes in other diseases. Accordingly, the potential of modulating HO-1 levels for the treatment of COVID-19 was extensively speculated during the COVID-19 pandemic, but very few actual data were generated. The aim of our study was to explore the association of HO-1, heme, and hemopexin (HPX) levels with COVID-19 severity and with markers of inflammation and coagulation activation. The study was conducted in 30 consecutive patients with COVID-19 admitted due to hypoxemia, and 30 healthy volunteers matched by sex, age, and geographic region. HO-1 and HPX levels were measured by enzyme immunoassay (ELISA) and heme levels were measured by a colorimetric method. A comprehensive panel of coagulation and fibrinolysis activation was also used. Patients with COVID-19 presented increased levels of HO-1 when compared to controls (5741 ± 2696 vs 1953 ± 612 pg/mL, respectively, P < 0.0001), as well as a trend toward increased levels of HPX (3.724 ± 0.880 vs 3.254 ± 1.022 mg/mL, respectively; P = 0.06). In addition, HO-1 and HPX levels reduced from admission to day + 4. HO-1 levels were associated with duration of intensive care unit stay and with several markers of coagulation activation. In conclusion, modulation of HO-1 could be associated with the prothrombotic state observed in COVID-19, and HO-1 could also represent a relevant biomarker for COVID-19. New independent studies are warranted to explore and expand these findings.
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Affiliation(s)
- Franciele de Lima
- School of Medical Sciences, University of Campinas, Campinas 13083-887, Brazil,Franciele de Lima.
| | | | - Mayck Silva Barbosa
- School of Medical Sciences, University of Campinas, Campinas 13083-887, Brazil
| | - Bruna Bombassaro
- Obesity and Comorbidities Research Center, University of Campinas, Campinas 13083-864, Brazil
| | - André C Palma
- School of Medical Sciences, University of Campinas, Campinas 13083-887, Brazil
| | | | - Maria Luiza Moretti
- School of Medical Sciences, University of Campinas, Campinas 13083-887, Brazil
| | | | - Joyce M Annichino-Bizzacchi
- School of Medical Sciences, University of Campinas, Campinas 13083-887, Brazil,Hematology and Hemotherapy Center, University of Campinas, Campinas 13083-878, Brazil
| | - Eli Mansour
- School of Medical Sciences, University of Campinas, Campinas 13083-887, Brazil
| | - Licio A Velloso
- School of Medical Sciences, University of Campinas, Campinas 13083-887, Brazil,Obesity and Comorbidities Research Center, University of Campinas, Campinas 13083-864, Brazil
| | - Erich Vinicius De Paula
- School of Medical Sciences, University of Campinas, Campinas 13083-887, Brazil,Hematology and Hemotherapy Center, University of Campinas, Campinas 13083-878, Brazil
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Moraes CRP, Borba-Junior IT, De Lima F, Silva JRA, Bombassaro B, Palma AC, Mansour E, Velloso LA, Orsi FA, Costa FTM, De Paula EV. Association of Ang/Tie2 pathway mediators with endothelial barrier integrity and disease severity in COVID-19. Front Physiol 2023; 14:1113968. [PMID: 36895630 PMCID: PMC9988918 DOI: 10.3389/fphys.2023.1113968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/07/2023] [Indexed: 02/25/2023] Open
Abstract
Endothelial barrier (EB) disruption contributes to acute lung injury in COVID-19, and levels of both VEGF-A and Ang-2, which are mediators of EB integrity, have been associated with COVID-19 severity. Here we explored the participation of additional mediators of barrier integrity in this process, as well as the potential of serum from COVID-19 patients to induce EB disruption in cell monolayers. In a cohort from a clinical trial consisting of thirty patients with COVID-19 that required hospital admission due to hypoxia we demonstrate that i) levels of soluble Tie2 were increase, and of soluble VE-cadherin were decreased when compared to healthy individuals; ii) sera from these patients induce barrier disruption in monolayers of endothelial cells; and iii) that the magnitude of this effect is proportional to disease severity and to circulating levels of VEGF-A and Ang-2. Our study confirms and extends previous findings on the pathogenesis of acute lung injury in COVID-19, reinforcing the concept that EB is a relevant component of this disease. Our results pave the way for future studies that can refine our understanding of the pathogenesis of acute lung injury in viral respiratory disorders, and contribute to the identification of new biomarkers and therapeutic targets for these conditions.
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Affiliation(s)
| | | | - Franciele De Lima
- School of Medical Sciences, University of Campinas, Campinas, Brazil
| | | | - Bruna Bombassaro
- Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil
| | - André C Palma
- School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Eli Mansour
- School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Lício Augusto Velloso
- School of Medical Sciences, University of Campinas, Campinas, Brazil.,Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil
| | | | | | - Erich Vinicius De Paula
- School of Medical Sciences, University of Campinas, Campinas, Brazil.,Hematology and Hemotherapy Center, University of Campinas, Campinas, Brazil
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Hounkpe BW, Moraes CRP, Lanaro C, Santos MNN, Costa FF, De Paula EV. Evaluation of the mechanisms of heme-induced tissue factor activation: Contribution of innate immune pathways. Exp Biol Med (Maywood) 2022; 247:1542-1547. [PMID: 35775605 PMCID: PMC9554166 DOI: 10.1177/15353702221106475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Hemolytic diseases such as Sickle Cell Disease (SCD) are characterized by a natural propensity for both arterial and venous thrombosis. The ability of heme to induce tissue factor (TF) activation has been shown both in animal models of SCD, and in human endothelial cells and monocytes. Moreover, it was recently demonstrated that heme can induce coagulation activation in the whole blood of healthy volunteers in a TF-dependent fashion. Herein, we aim to further explore the cellular mechanisms by which heme induces TF-coagulation activation, using human mononuclear cells, which have been shown to be relevant to in vivo hemostasis. TF mRNA expression was evaluated by qPCR and TF procoagulant activity was evaluated using a 2-stage assay based on the generation of activated factor X (FXa). Heme was capable of inducing both TF expression and activation in a TLR4-dependent pathway. This activity was further amplified after TNF-α-priming. Our results provide additional details on the mechanisms by which heme is involved in the pathogenesis of hypercoagulability in hemolytic diseases.
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Affiliation(s)
| | | | - Carolina Lanaro
- Hematology and Hemotherapy Center, University of Campinas, CEP 13083-970 Campinas, Brazil
| | | | - Fernando Ferreira Costa
- School of Medical Sciences, University of Campinas, CEP 13083-894 Campinas, Brazil,Hematology and Hemotherapy Center, University of Campinas, CEP 13083-970 Campinas, Brazil
| | - Erich Vinicius De Paula
- School of Medical Sciences, University of Campinas, CEP 13083-894 Campinas, Brazil,Hematology and Hemotherapy Center, University of Campinas, CEP 13083-970 Campinas, Brazil,Erich Vinicius De Paula.
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Borba-Junior IT, Moraes CRP, Lima F, Barbosa MS, Annichino-Bizzacchi JM, Mansour E, Velloso LA, Costa FTM, Orsi FA, Paula EV. AVALIAÇÃO DA INTEGRIDADE DA BARREIRA ENDOTELIAL E SUA RELAÇÃO COM AS MANIFESTAÇÕES CLÍNICAS E LABORATORIAIS NA COVID-19. Hematol Transfus Cell Ther 2021. [PMCID: PMC8530677 DOI: 10.1016/j.htct.2021.10.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objetivos Os mecanismos fisiopatológicos que determinam a gravidade da Covid-19 estão associados a ativação da hemostasia e da imunidade inata, em um processo coletivamente referido como imunotrombose, e que envolve ativação plaquetária, geração de NETs (do inglês, Nucleo extracelular traps), expressão de fator tecidual, ativação do complemento e ativação endotelial. Um elemento importante da ativação endotelial é a quebra da barreira endotelial (BE), que ocorre para facilitar o acesso de leucócitos aos tecidos, onde contribuem para erradicação dos patógenos. No entanto, a avaliação da integridade da BE é desafiadora, exigindo o uso de modelos celulares. O objetivo desse estudo foi avaliar o efeito do soro de pacientes com Covid-19 sobre a integridade da BE em monocamadas de células endoteliais, e sua correlação com características clínicas da doença. Materiais e métodos A população do estudo consistiu em 30 pacientes com Covid-19 que apresentavam comprometimento pulmonar confirmado por tomografia de tórax, e necessidade de internação hospitalar por hipoxemia e 30 controles saudáveis pareados por sexo e idade. Os pacientes recrutados fizeram parte de um estudo clínico (REBEC: U1111-1250-1843), e as amostras utilizadas nesta avaliação foram obtidas no momento da internação, antes de qualquer intervenção. Monocamadas de células endoteliais de duas fontes (HUVECs: células de cordão umbilical; HULECs: células endoteliais pulmonares) foram estimuladas com soro de pacientes e indivíduos saudáveis (diluição 15% em meio de cultura) e a integridade da BE foi avaliada por um sensor de impedância celular (ECIS; Eletric Cell-substrate Impedance Sensing System) continuamente por 36 horas. Biomarcadores de gravidade e relacionados à ativação da hemostasia foram avaliados por kits comerciais. Dados clínicos foram obtidos a partir dos prontuários digitais. Resultados O soro de pacientes com Covid-19 induziu quebra de BE significativamente mais acentuada que o de indivíduos saudáveis em HUVECs nos tempos 15 min (p < 0,01); 30 min (p ≤ 0,001); 1h (p ≤ 0,0001); 2h (p ≤ 0,0001); 3h (p ≤ 0,0001); 4h (p ≤ 0,01) e 5h (p ≤ 0,05). Estes resultados foram confirmados no modelo de células endoteliais pulmonares (HULECs). A magnitude da quebra apresentou correlação significativa com desfechos clínicos relevantes como tempo de internação total (RS até 0.57) e tempo de UTI (RS = 0,47). Em relação a biomarcadores de interesse na Covid-19, a quebra da BE apresentou correlação significativa com neutrofilia, relação neutrófilo/linfócito, fator de Von Willebrand, fatores IX e XI, fibrinogênio, D-dímero e uPAR (Receptor de Uroquinase). Discussão Através de um método considerado padrão-ouro para avaliação in vitro da integridade da BE nós demonstramos que componentes presentes no soro de pacientes com Covid-19 são capazes de promover a quebra da BE, e que a magnitude deste processo está relacionada à gravidade desta doença. A correlação com outros marcadores inflamatórios corrobora a conexão entre os mecanismos envolvidos na imunotrombose em pacientes com Covid-19. Conclusão nossos resultados apontam a quebra da BE como um alvo terapêutico atrativo nestes pacientes.
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Moraes CRP, Lima F, Borba-Junior IT, Barbosa MS, Huber SC, Mansour E, Annichino-Bizzacchi JM, Velloso LA, Orsi FA, Paula EV. AVALIAÇÃO DOS NÍVEIS CIRCULANTES DE MEDIADORES DA INTEGRIDADE DA BARREIRA ENDOTELIAL NA COVID-19 E SUA RELAÇÃO COM A ATIVAÇÃO DA HEMOSTASIA. Hematol Transfus Cell Ther 2021. [PMCID: PMC8530648 DOI: 10.1016/j.htct.2021.10.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objetivos a imunotrombose consiste no processo que envolve a ativação concomitante da imunidade inata, hemostasia e endotélio como parte da resposta a patógenos, e vem sendo colocada no centro da fisiopatologia da Covid-19. Um elemento menos explorado da imunotrombose é a ruptura da barreira endotelial (BE), que permite o acesso dos leucócitos aos tecidos inflamados. Entre os reguladores da integridade da BE destacam-se as vias que envolvem a angiopoietina (Ang) 1 e 2 e seu receptor Tie2, e a via do VEGF-A/VE-caderina (VEC). Além deste papel, foi recentemente demonstrado que a ativação da via Ang/Tie2 inibe a ativação endotelial e a expressão de fator tecidual, estabilizando o endotélio no estado quiescente. Neste estudo determinamos os níveis circulantes de mediadores da integridade da BE na Covid-19, e exploramos sua associação com a gravidade da doença, assim como com a ativação da hemostasia através de um painel abrangente de biomarcadores. Materiais e métodos as amostras foram obtidas de 30 pacientes internados por Covid-19 devido à hipoxemia e achados tomográficos típicos, e recrutados para um estudo clínico (REBEC: U1111-1250-1843). As amostras foram coletadas em até 24h do diagnóstico, antes de qualquer intervenção terapêutica. Os níveis de reguladores da BE foram medidos por métodos imunológicos (Elisa ou multiplex), e o de biomarcadores da hemostasia por kits comerciais específicos. Um grupo de 30 indivíduos saudáveis pareados por idade e sexo foram utilizados como controle. Dados clínicos e laboratoriais foram obtidos dos prontuários digitais. Resultados o tempo médio de internação foi de 12,9 ± 9,8 dias, e 12 pacientes (40%) necessitaram de UTI. O dímero D médio foi de 3.609 ± 14.440 ng/mL. Os níveis circulantes de todos reguladores da integridade da BE encontraram-se aumentados em pacientes, quando comparado com controles (Ang1: 463.2 ± 194.6 vs 237.4 ± 104.9 pg/mL, p < 0.0001; Ang2: 1.926 (1.275-3.134) vs 1.215 (9-1.444) pg/mL, p < 0.0001; Tie2: 10.753 ± 2.377 vs 8.603 ± 1.851 pg/mL, p < 0.0001 e VEGF-A: 94.7 (73.4-116.0) vs 45.9 (39.7-57.0), p < 0.0001. Além disso, os níveis de alguns destes reguladores se associaram significativamente a desfechos de relevância clínica, a saber: (i) extensão da lesão pulmonar na tomografia: Ang2 e VEGF-A; (ii) tempo de internação em UTI: VEGF-A. Interessantemente, observamos correlações consistentes e significativas entre os níveis de reguladores da BE a proteínas envolvidas na ativação da hemostasia (fibrinogênio, VWF: Ag, uPAR, PAI-1 e P-selectina). Discussão o interesse no estudo de reguladores da integridade da BE na Covid-19 já se justifica pelo fato de a doença envolver tanto o comprometimento da barreira alvéolo-capilar quanto a ativação da angiogênese, como demonstrado por outros autores. Nossos resultados reforçam a relevância destas vias através da associação observada com desfechos clínicos. Além disso, os resultados mostram pela primeira vez uma associação entre mediadores da integridade da BE e um painel amplo de biomarcadores da ativação da hemostasia, sugerindo um crosstalk entre estas vias na Covid-19, como demonstrado recentemente no contexto da sepse. Conclusões nossos resultados apontam que a via Ang/Tie2 deve ser considerada um alvo terapêutico atrativo na Covid-19, por representar um elemento central da imunotrombose nestes pacientes.
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Lima F, Moraes CRP, Barbosa MS, Borba-Júnior IT, Mansour E, Velloso LA, Paula EV. AVALIAÇÃO DOS NÍVEIS DE MARCADORES DA VIA HEME/HEMOPEXINA/HEME-OXIGENASE 1 E SUA ASSOCIAÇÃO COM PARÂMETROS CLÍNICOS E LABORATORIAIS NA COVID-19. Hematol Transfus Cell Ther 2021. [PMCID: PMC8530620 DOI: 10.1016/j.htct.2021.10.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objetivos Material e métodos Resultados Discussão Conclusão
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