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Petito E, Gresele P. Immune attack on megakaryocytes in immune thrombocytopenia. Res Pract Thromb Haemost 2024; 8:102345. [PMID: 38525349 PMCID: PMC10960061 DOI: 10.1016/j.rpth.2024.102345] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 03/26/2024] Open
Abstract
A State of the Art lecture titled "Immune Attack on Megakaryocytes in ITP: The Role of Megakaryocyte Impairment" was presented at the International Society on Thrombosis and Haemostasis Congress in 2023. Immune thrombocytopenia (ITP) is an acquired autoimmune disorder caused by autoantibodies against platelet surface glycoproteins that provoke increased clearance of circulating platelets, leading to reduced platelet number. However, there is also evidence of a direct effect of antiplatelet autoantibodies on bone marrow megakaryocytes. Indeed, immunologic cells responsible for autoantibody production reside in the bone marrow; megakaryocytes progressively express during their maturation the same glycoproteins against which ITP autoantibodies are directed, and platelet autoantibodies have been detected in the bone marrow of patients with ITP. In vitro studies using ITP sera or monoclonal antibodies against platelet and megakaryocyte surface glycoproteins have shown an impairment of many steps of megakaryopoiesis and thrombopoiesis, such as megakaryocyte differentiation and maturation, migration from the osteoblastic to the vascular niche, adhesion to extracellular matrix proteins, and proplatelet formation, resulting in impaired and ectopic platelet production in the bone marrow and diminished platelet release in the bloodstream. Moreover, cytotoxic T cells may target bone marrow megakaryocytes, resulting in megakaryocyte destruction. Altogether, these findings suggest that antiplatelet autoantibodies and cellular immunity against bone marrow megakaryocytes may significantly contribute to thrombocytopenia in some patients with ITP. Finally, we summarize relevant new data on this topic presented during the 2023 International Society on Thrombosis and Haemostasis Congress. The complete unraveling of the mechanisms of immune attack-induced impairment of megakaryopoiesis and thrombopoiesis may open the way to new therapeutic approaches.
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Affiliation(s)
- Eleonora Petito
- Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Paolo Gresele
- Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Goracci L, Petito E, Di Veroli A, Falcinelli E, Bencivenga C, Giglio E, Becattini C, De Robertis E, Vaudo G, Gresele P. A platelet lipidomics signature in patients with COVID-19. Platelets 2023; 34:2200847. [PMID: 37114418 DOI: 10.1080/09537104.2023.2200847] [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] [Indexed: 04/29/2023]
Abstract
Ischemic cardiovascular and venous thromboembolic events are a frequent cause of death in severe COVID-19 patients. Platelet activation plays a key role in these complications, however platelet lipidomics have not been studied yet. The aim of our pilot investigation was to perform a preliminary study of platelet lipidomics in COVID-19 patients compared to healthy subjects. Lipid extraction and identification of ultrapurified platelets from eight hospitalized COVID-19 patients and eight age- and sex-matched healthy controls showed a lipidomic pattern almost completely separating COVID-19 patients from healthy controls. In particular, a significant decrease of ether phospholipids and increased levels of ganglioside GM3 were observed in platelets from COVID-19 patients. In conclusion, our study shows for the first time that platelets from COVID-19 patients display a different lipidomics signature distinguishing them from healthy controls, and suggests that altered platelet lipid metabolism may play a role in viral spreading and in the thrombotic complications of COVID-19.
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Affiliation(s)
- Laura Goracci
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - Eleonora Petito
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Alessandra Di Veroli
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Caterina Bencivenga
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - Elisa Giglio
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Cecilia Becattini
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Edoardo De Robertis
- Division of Anaesthesia, Analgesia, and Intensive Care, University of Perugia, Perugia, Italy
| | - Gaetano Vaudo
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
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Petito E, Gresele P. VITT two years later: should it still be in the scientific agenda? Thromb Haemost 2023. [PMID: 37285904 DOI: 10.1055/a-2107-0891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Vaccine-induced immune thrombotic thrombocytopenia (VITT) was recognized around two years ago, at the beginning of the anti-SARS-CoV-2 vaccination campaign, as a rare but life-threatening complication of adenoviral vector vaccines. Two years later the COVID-19 pandemic has been tamed, although not defeated, and the vaccines provoking VITT have been abandoned in most high-income countries, thus why should we still speak about VITT? Because a significant fraction of the world population has not been vaccinated yet, especially in low/middle-income countries that can only afford adenoviral vector-based vaccines, because the adenoviral vector platform is being used for the development of a large series of new vaccines for other transmissible diseases, and lastly because there are some clues suggesting that VITT may not be exclusive to anti-SARS-CoV-2 vaccines. Therefore a deep understanding of this new syndrome is highly warranted as well as the awareness that we still miss some crucial insight into its pathophysiology and on some aspects of its management. This snapshot review aims to portray our knowledge on VITT, focusing on its clinical presentation, pathophysiological insight, diagnostic and management strategies and to pinpoint the main unmet needs, highlighting the aspects on which research should focus in the near future.
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Affiliation(s)
- Eleonora Petito
- Department of Medicine and Surgery - Section of Internal and Cardiovascular Medicine, University of Perugia Department of Medicine and Surgery, Perugia, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery - Section of Internal and Cardiovascular Medicine, University of Perugia Department of Medicine and Surgery, Perugia, Italy
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Petito E, Franco L, Falcinelli E, Guglielmini G, Conti C, Vaudo G, Paliani U, Becattini C, Mencacci A, Tondi F, Gresele P. COVID-19 infection-associated platelet and neutrophil activation is blunted by previous anti-SARS-CoV-2 vaccination. Br J Haematol 2023; 201:851-856. [PMID: 36883298 DOI: 10.1111/bjh.18726] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/22/2022] [Revised: 02/03/2023] [Accepted: 02/18/2023] [Indexed: 03/09/2023]
Abstract
The effectiveness of vaccination against SARS-CoV-2 in preventing COVID-19 or in reducing severe illness in subjects hospitalized for COVID-19 despite vaccination has been unequivocally shown. However, no studies so far have assessed if subjects who get COVID-19 despite vaccination are protected from SARS-CoV-2-induced platelet, neutrophil and endothelial activation, biomarkers associated with thrombosis and worse outcome. In this pilot study, we show that previous vaccination blunts COVID-19-associated platelet activation, assessed by circulating platelet-derived microvesicles and soluble P-selectin, and neutrophil activation, assessed by circulating neutrophil extracellular trap (NET) biomarkers and matrix metalloproteinase-9, and reduces COVID-19-associated thrombotic events, hospitalization in intensive-care units and death.
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Affiliation(s)
- Eleonora Petito
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Laura Franco
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Giuseppe Guglielmini
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Chiara Conti
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Gaetano Vaudo
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Ugo Paliani
- Division of Internal Medicine, USL Umbria 1, Pantalla, Italy
| | - Cecilia Becattini
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Antonella Mencacci
- Department of Medicine and Surgery, Microbiology and Clinical Microbiology, University of Perugia, Perugia, Italy
| | - Francesca Tondi
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
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Abstract
INTRODUCTION COVID-19 is associated to an increased risk of thrombosis, as a result of a complex process that involves the activation of vascular and circulating cells, the release of soluble inflammatory and thrombotic mediators and blood clotting activation. AREAS COVERED This article reviews the pathophysiological role of platelets, neutrophils and the endothelium, and of their interactions, in the thrombotic complications of COVID-19 patients, and the current and future therapeutic approaches targeting these cell types. EXPERT OPINION Virus-induced platelet, neutrophil and endothelial cell changes are crucial triggers of the thrombotic complications and of the adverse evolution of COVID-19. Both the direct interaction with the virus and the associated cytokine storm concur to trigger cell activation in a classical thromboinflammatory vicious circle. Although heparin has proven to be an effective prophylactic and therapeutic weapon for the prevention and treatment of COVID-19-associated thrombosis, it acts downstream of the cascade of events triggered by SARS-CoV-2. The identification of specific molecular targets interrupting the thromboinflammatory cascade upstream, and more specifically acting either on the interaction of SARS-CoV-2 with blood and vascular cells or on the specific signalling mechanisms associated with their COVID-19-associated activation, might theoretically offer greater protection with potentially lesser side effects.
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Affiliation(s)
- E Falcinelli
- Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - E Petito
- Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - P Gresele
- Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Petito E, Colonna E, Falcinelli E, Mezzasoma AM, Cesari E, Giglio E, Fiordi T, Almerigogna F, Villa A, Gresele P. Anti-severe acute respiratory syndrome coronavirus-2 adenoviral-vector vaccines trigger subclinical antiplatelet autoimmunity and increase of soluble platelet activation markers. Br J Haematol 2022; 198:257-266. [PMID: 35577507 DOI: 10.1111/bjh.18245] [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] [Received: 02/10/2022] [Revised: 04/21/2022] [Accepted: 05/01/2022] [Indexed: 12/16/2022]
Abstract
To slow down the coronavirus disease 2019 (COVID-19) pandemic an unequalled vaccination campaign was initiated. Despite proven efficacy and safety, a rare but potentially fatal complication of adenoviral-vector vaccines, called vaccine-induced immune thrombotic thrombocytopenia (VITT), has emerged the pathogenesis of which seems to be related to the development of platelet-activating anti-platelet factor 4 (PF4) antibodies. While a few studies have evaluated the incidence of anti-PF4 positivity in anti-severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccine recipients, to date no studies have assessed whether an antiplatelet immunological response develops and if this associates with platelet and blood clotting activation. We carried out a prospective study in healthy subjects who received the first dose of ChAdOx1 or Ad26.COV2.S or BNT162b2 vaccines to evaluate platelet-specific and non-specific immune response and in vivo platelet activation and blood clotting activation. Individuals receiving ChAdOx1 and, less so, Ad26.COV2.S developed with high frequency auto- or alloantiplatelet antibodies, increased circulating platelet-derived microvesicles and soluble P-selectin associated with mild blood clotting activation. Our study shows that an immunological reaction involving platelets is not uncommon in individuals receiving anti-SARS-CoV-2 vaccination, especially after ChAdOx1 and Ad26.COV2.S, and that it associates with in vivo platelet and blood clotting activation.
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Affiliation(s)
- Eleonora Petito
- Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Elisabetta Colonna
- Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Anna Maria Mezzasoma
- Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Enrica Cesari
- Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Elisa Giglio
- Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Tiziana Fiordi
- Section of Occupational Medicine and Toxicology, University of Perugia, Perugia, Italy
| | - Fabio Almerigogna
- Unit of Allergology and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Alfredo Villa
- Central Clinical Chemistry Laboratory, S.M. della Misericordia Hospital, Perugia, Italy
| | - Paolo Gresele
- Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
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Paciullo F, Petito E, Falcinelli E, Gresele P, Momi S. Pleiotropic effects of PCSK9-inhibition on hemostasis: Anti-PCSK9 reduce FVIII levels by enhancing LRP1 expression. Thromb Res 2022; 213:170-172. [DOI: 10.1016/j.thromres.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
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Cafaro G, Petito E, Bistoni O, Falcinelli E, Cipriani S, Borghi MC, Bonifacio AF, Giglio E, Alunno A, Perricone C, Gerli R, Gresele P, Bartoloni E. Methotrexate improves endothelial function in early rheumatoid arthritis patients after 3 months of treatment. Arthritis Res Ther 2022; 24:236. [PMID: 36280849 PMCID: PMC9590167 DOI: 10.1186/s13075-022-02930-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Endothelial dysfunction contributes to increased cardiovascular (CV) disease in rheumatoid arthritis (RA). Angiogenic T cells (Tang) are a key regulator of vascular function via their interaction with endothelial progenitor cells (EPCs). Methotrexate (MTX) has been associated to reduced CV disease risk, but its effects on endothelial homeostasis have been poorly explored. We investigated MTX effects on endothelial homeostasis in early, treatment-naïve RA patients. Methods Fifteen untreated, early RA patients and matched healthy controls (HC) were enrolled. RA patients with long-standing disease in remission or low disease activity treated with MTX for at least 6 months were selected as controls. Circulating CD28+ and CD28null Tang cell, endothelial microparticle (EMP), EPC and soluble vascular cell adhesion molecule (sVCAM)-1 levels were measured. Results Tang percentage was higher in early RA than in HCs and significantly increased after 3-month MTX treatment. Tang cells in RA were characterized by higher percentage of CD28null and lower CD28-positive cells than HCs. MTX restored a Tang cell phenotype similar to HCs. Altered sVCAM-1, EMP and EPC were restored to levels similar to HCs after a 3-month MTX. Biomarker levels after 3 months of MTX were not different to those of patients with long-standing treatment. Conclusions MTX has a positive effect on Tang, sVCAM-1, EPCs and EMPs in RA. Restoration of imbalance between CD28 + and CD28null Tang by MTX may be one of the mechanisms underlying its favourable effects on endothelial dysfunction. These effects seem to be long-lasting and independent from systemic inflammation reduction, suggesting a direct effect of MTX on the endothelium.
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Affiliation(s)
- Giacomo Cafaro
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Eleonora Petito
- grid.9027.c0000 0004 1757 3630Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Onelia Bistoni
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- grid.9027.c0000 0004 1757 3630Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Sabrina Cipriani
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Maria Chiara Borghi
- grid.9027.c0000 0004 1757 3630Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Angelo F. Bonifacio
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Elisa Giglio
- grid.9027.c0000 0004 1757 3630Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alessia Alunno
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy ,grid.158820.60000 0004 1757 2611Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Carlo Perricone
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Roberto Gerli
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
| | - Paolo Gresele
- grid.9027.c0000 0004 1757 3630Section of Internal and Cardiovascular Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- grid.9027.c0000 0004 1757 3630Rheumatology Unit, University of Perugia, Perugia, Italy
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Momi S, Falcinelli E, Petito E, Ciarrocca Taranta G, Ossoli A, Gresele P. Matrix metalloproteinase-2 on activated platelets triggers endothelial PAR-1 initiating atherosclerosis. Eur Heart J 2021; 43:504-514. [PMID: 34529782 DOI: 10.1093/eurheartj/ehab631] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/02/2021] [Accepted: 09/09/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Platelets participate in atherogenesis with mechanisms not yet fully clarified. Vascular wall MMP-2 is involved in the arterial remodelling accompanying atherosclerosis. Platelets contain and release MMP-2 but no informations are available on its role in atherosclerotic lesion formation. METHODS AND RESULTS We generated double knockout mice lacking the LDL receptor and MMP-2 only in circulating blood cells showing that they develop significantly lesser femoral intima thickening after photochemical-induced arterial damage and atherosclerotic lesions in the aorta, measured by the en face method, after 4 months of atherogenic diet. Moreover, repeated transfusions of autologous-activated platelets in LDLR-/- mice on atherogenic diet significantly enhanced the extension of aortic atherosclerotic lesions while transfusion of activated platelets from MMP-2-/- mice did not. In vitro coincubation studies showed that platelet-derived MMP-2 plays a pivotal role in the development and progression of atherosclerosis through a complex cross-talk between activated platelets, monocyte/macrophages, and endothelial cells. Translational studies in patients with CAD and chronic HIV infection showed that platelet surface expression of MMP-2 highly significantly correlated with the degree of carotid artery stenosis. CONCLUSION We show a previously unknown mechanism of the pathway through which platelets expressing MMP-2 trigger the initial phases of atherosclerosis and provide a mechanism showing that they activate endothelial PAR-1 triggering endothelial p38MAPK signalling and the expression of adhesion molecules. The development of drugs blocking selectively platelet MMP-2 or its expression may represent a new approach to the prevention of atherosclerosis.
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Affiliation(s)
- Stefania Momi
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Strada Vicinale Via delle Corse, Perugia 06132, Italy
| | - Emanuela Falcinelli
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Strada Vicinale Via delle Corse, Perugia 06132, Italy
| | - Eleonora Petito
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Strada Vicinale Via delle Corse, Perugia 06132, Italy
| | - Giulia Ciarrocca Taranta
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Strada Vicinale Via delle Corse, Perugia 06132, Italy
| | - Alice Ossoli
- Center E. Grossi Paoletti, Department of Pharmacologic and Biomolecular Science, University of Milan, via delle Corse, Milan 06132, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Strada Vicinale Via delle Corse, Perugia 06132, Italy
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Gresele P, Falcinelli E, Momi S, Petito E, Sebastiano M. Platelets and Matrix Metalloproteinases: A Bidirectional Interaction with Multiple Pathophysiologic Implications. Hamostaseologie 2021; 41:136-145. [PMID: 33860521 DOI: 10.1055/a-1393-8339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Platelets contain and release several matrix metalloproteinases (MMPs), a highly conserved protein family with multiple functions in organism defense and repair. Platelet-released MMPs as well as MMPs generated by other cells within the cardiovascular system modulate platelet function in health and disease. In particular, a normal hemostatic platelet response to vessel wall injury may be transformed into pathological thrombus formation by platelet-released and/or by locally generated MMPs. However, it is becoming increasingly clear that platelets play a role not only in hemostasis but also in immune response, inflammation and allergy, atherosclerosis, and cancer development, and MMPs seem to contribute importantly to this role. A deeper understanding of these mechanisms may open the way to novel therapeutic approaches to the inhibition of their pathogenic effects and lead to significant advances in the treatment of cardiovascular, inflammatory, and neoplastic disorders.
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Affiliation(s)
- P Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - E Falcinelli
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - S Momi
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - E Petito
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - M Sebastiano
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
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Petito E, Falcinelli E, Paliani U, Cesari E, Vaudo G, Sebastiano M, Cerotto V, Guglielmini G, Gori F, Malvestiti M, Becattini C, Paciullo F, De Robertis E, Bury L, Lazzarini T, Gresele P. Association of Neutrophil Activation, More Than Platelet Activation, With Thrombotic Complications in Coronavirus Disease 2019. J Infect Dis 2021; 223:933-944. [PMID: 33280009 PMCID: PMC7798977 DOI: 10.1093/infdis/jiaa756] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/03/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 infection is associated with hypercoagulability, which predisposes to venous thromboembolism (VTE). We analyzed platelet and neutrophil activation in patients with coronavirus disease 2019 (COVID-19) and their association with VTE. METHODS Hospitalized patients with COVID-19 and age- and sex-matched healthy controls were studied. Platelet and leukocyte activation, neutrophil extracellular traps (NETs), and matrix metalloproteinase 9, a neutrophil-released enzyme, were measured. Four patients were restudied after recovery. The activating effect of plasma from patients with COVID-19 on control platelets and leukocytes and the inhibiting activity of common antithrombotic agents on it were studied. RESULTS A total of 36 patients with COVID-19 and 31 healthy controls were studied; VTE developed in 8 of 36 patients with COVID-19 (22.2%). Platelets and neutrophils were activated in patients with COVID-19. NET, but not platelet activation, biomarkers correlated with disease severity and were associated with thrombosis. Plasmatic matrix metalloproteinase 9 was significantly increased in patients with COVID-19. Platelet and neutrophil activation markers, but less so NETs, normalized after recovery. In vitro, plasma from patients with COVID-19 triggered platelet and neutrophil activation and NET formation, the latter blocked by therapeutic-dose low-molecular-weight heparin, but not by aspirin or dypiridamole. CONCLUSIONS Platelet and neutrophil activation are key features of patients with COVID-19. NET biomarkers may help to predict clinical worsening and VTE and may guide low-molecular-weight heparin treatment.
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Affiliation(s)
- Eleonora Petito
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Ugo Paliani
- Division of Internal Medicine, ASL 1 Umbria, Città di Castello, Italy
| | - Enrica Cesari
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Gaetano Vaudo
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Manuela Sebastiano
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Vittorio Cerotto
- Section of Anesthesia, Intensive Care and Pain Medicine, Department of Emergency and Urgency, Città di Castello Hospital, Città di Castello, Italy
| | - Giuseppe Guglielmini
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Fabio Gori
- Section of Anesthesia, Intensive Care, and Pain Medicine, Azienda Ospedaliera-Universitaria Santa Maria della Misericordia, Perugia, Italy
| | - Marco Malvestiti
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Cecilia Becattini
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Francesco Paciullo
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Edoardo De Robertis
- Department of Surgical and Biomedical Sciences, Division of Anaesthesia, Analgesia, and Intensive Care, University of Perugia, Perugia, Italy
| | - Loredana Bury
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Teseo Lazzarini
- Section of Anesthesia and Intensive Care, Presidio Alto Chiascio, USL Umbria 1, Gubbio, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
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12
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Bury L, Camilloni B, Castronari R, Piselli E, Malvestiti M, Borghi M, KuchiBotla H, Falcinelli E, Petito E, Amato F, Paliani U, Vaudo G, Cerotto V, Gori F, Becattini C, De Robertis E, Lazzarini T, Castaldo G, Mencacci A, Gresele P. Search for SARS-CoV-2 RNA in platelets from COVID-19 patients. Platelets 2020; 32:284-287. [PMID: 33349108 DOI: 10.1080/09537104.2020.1859104] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 12/25/2022]
Abstract
The frequent finding of thrombocytopenia in patients with severe SARS-CoV-2 infection (COVID-19) and previous evidence that several viruses enter platelets suggest that SARS-CoV-2 might be internalized by platelets of COVID-19. Aim of our study was to assess the presence of SARS-CoV-2 RNA in platelets from hospitalized patients with aconfirmed diagnosis of COVID-19. RNA was extracted from platelets, leukocytes and serum from 24 COVID-19 patients and 3 healthy controls, real-time PCR and ddPCR for viral genes were carried out. SARS-CoV-2 RNA was not detected in any of the samples analyzed nor in healthy controls, by either RT-PCR or ddPCR, while RNA samples from nasopharyngeal swabs of COVID-19 patients were correctly identified. Viral RNA was not detected independently of viral load, of positive nasopharyngeal swabs, or viremia, the last detected in only one patient (4.1%). SARS-CoV-2 entry in platelets is not acommon phenomenon in COVID-19 patients, differently from other viral infections.
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Affiliation(s)
- Loredana Bury
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Barbara Camilloni
- Department of Medicine and Surgery, Microbiology Unit, University of Perugia, Perugia, Italy
| | - Roberto Castronari
- Department of Medicine and Surgery, Microbiology Unit, University of Perugia, Perugia, Italy
| | - Elisa Piselli
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Marco Malvestiti
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Mariachiara Borghi
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Haripriya KuchiBotla
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Eleonora Petito
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Felice Amato
- Università Di Napoli Federico II, Naples, Italy.,CEINGE-Biotecnologie Avanzate, Naples, Italy
| | - Ugo Paliani
- Division of Internal Medicine, ASL 1 Umbria, Città Di Castello, Italy
| | - Gaetano Vaudo
- Unit of Internal Medicine, Terni University Hospital, Terni, Italy
| | - Vittorio Cerotto
- Section of Anesthesia, Intensive Care and Pain Medicine, Department of Emergency and Urgency, Città Di Castello Hospital, Città Di Castello, Italy
| | - Fabio Gori
- Section of Anesthesia, Intensive Care, and Pain Medicine, Azienda Ospedaliera-Universitaria Santa Maria Della Misericordia, Perugia, Italy
| | - Cecilia Becattini
- Internal Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy
| | - Edoardo De Robertis
- Department of Medicine and Surgery, Division of Anaesthesia, Analgesia, and Intensive Care, University of Perugia, Perugia, Italy
| | - Teseo Lazzarini
- Section of Anesthesia and Intensive Care, Presidio Alto Chiascio, USL Umbria 1, Gubbio, Italy
| | | | - Antonella Mencacci
- Department of Medicine and Surgery, Microbiology Unit, University of Perugia, Perugia, Italy
| | - Paolo Gresele
- Department of Medicine and Surgery, Section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
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13
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Falcinelli E, Giordan N, Luccioli F, Piselli E, La Paglia G, Momi S, Mirabelli G, Petito E, Alunno A, Gresele P, Gerli R. Randomized Trial of Hymovis® versus Synvisc® on Matrix Metalloproteinases in Knee Osteoarthritis. Muscles Ligaments Tendons J 2020. [DOI: 10.32098/mltj.04.2020.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- E. Falcinelli
- Section of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - N. Giordan
- Clinical Research Department, Fidia Farmaceutici SpA, Abano Terme, Italy
| | - F. Luccioli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - E. Piselli
- Section of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - G.M.C. La Paglia
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - S. Momi
- Section of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - G. Mirabelli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - E. Petito
- Section of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - A. Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - P. Gresele
- Section of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - R. Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
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14
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Bury L, Malara A, Momi S, Petito E, Balduini A, Gresele P. Mechanisms of thrombocytopenia in platelet-type von Willebrand disease. Haematologica 2019; 104:1473-1481. [PMID: 30655369 PMCID: PMC6601082 DOI: 10.3324/haematol.2018.200378] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 01/11/2019] [Indexed: 11/09/2022] Open
Abstract
Platelet-type von Willebrand disease is an inherited platelet disorder characterized by thrombocytopenia with large platelets caused by gain-of-function variants in GP1BA leading to enhanced GPIbα-von Willebrand factor (vWF) interaction. GPIbα and vWF play a role in megakaryocytopoiesis, thus we aimed to investigate megakaryocyte differentiation and proplatelet-formation in platelet-type von Willebrand disease using megakaryocytes from a patient carrying the Met239Val variant and from mice carrying the Gly233Val variant. Platelet-type von Willebrand disease megakaryocytes bound vWF at an early differentiation stage and generated proplatelets with a decreased number of enlarged tips compared to control megakaryocytes. Moreover, they formed proplatelets upon contact with collagen, differently from normal megakaryocytes. Similarly, collagen triggered megakaryocytes showed defective activation of the RhoA-MLC2 axis, which prevents proplatelet formation, and increased phosphorylation of Lyn, which acts as a negative regulator of GPVI signaling, thus preventing ectopic proplatelet-formation on collagen. Consistently, human and murine bone marrow contained an increased number of extravascular platelets compared to controls. In addition, platelet survival of mutant mice was shortened compared to control mice, and the administration of desmopressin, raising circulating vWF, caused a marked drop in platelet count. Taken together, these results show for the first time that thrombocytopenia in platelet-type von Willebrand disease is due to the combination of different pathogenic mechanisms, i.e. the formation of a reduced number of platelets by megakaryocytes, the ectopic release of platelets in the bone marrow, and the increased clearance of platelet/vWF complexes.
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Affiliation(s)
- Loredana Bury
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia
| | - Alessandro Malara
- Department of Molecular Medicine, University of Pavia.,Biotechnology Research Laboratories, IRCCS San Matteo Foundation, Pavia, Italy
| | - Stefania Momi
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia
| | - Eleonora Petito
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia
| | - Alessandra Balduini
- Department of Molecular Medicine, University of Pavia.,Biotechnology Research Laboratories, IRCCS San Matteo Foundation, Pavia, Italy
| | - Paolo Gresele
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia
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15
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Alunno A, Falcinelli E, Luccioli F, Petito E, Bartoloni E, Momi S, Mirabelli G, Mancini GB, Gerli R, Gresele P. Platelets Contribute to the Accumulation of Matrix Metalloproteinase Type 2 in Synovial Fluid in Osteoarthritis. Thromb Haemost 2017; 117:2116-2124. [PMID: 28981555 DOI: 10.1160/th17-06-0379] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inflammation plays a role in the initiation and progression of osteoarthritis (OA), a chronic degenerative joint disorder. Platelets are inflammatory cells, contain and release matrix metalloproteinases (MMPs) and favour the release of these enzymes, key effectors of cartilage and subchondral bone degradation, by other cells; however, their role in OA has not been investigated yet. Our aims were (1) to assess the presence of platelets and of MMP-2 in synovial fluid (SF) of OA patients; (2) to evaluate the contribution of platelets to MMP-2 release by fibroblast-like synoviocytes (FLS); and (3) to investigate if hyaluronic acid (HA) interferes with these processes. SF was collected from 27 OA patients before and after treatment with intra-articular HA (20 mg/2 mL). Moreover, FLS were co-cultured with platelets, and the release of MMP-2 in supernatants was measured. Our results show that platelets are present in OA SF and show markers of activation. OA SF also contains relevant amounts of MMP-2. Co-incubation of platelets with FLS favours the release of MMP-2 by the interaction of platelet surface P-selectin with FLS CD44 by a mechanism involving the activation of pAkt and pSrc in FLS. Administration of HA to OA patients decreased the infiltration of platelets in SF and reduced the levels of MMP-2. The addition of HA in vitro inhibited the release of MMP-2 by FLS triggered by the interaction with platelets. In conclusion, our data show that platelets may contribute to joint degeneration in OA by favouring the accumulation of MMP-2 in SF.
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Affiliation(s)
- Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- Division of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Filippo Luccioli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Eleonora Petito
- Division of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Stefania Momi
- Division of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy
| | - Giulia Mirabelli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Giovanni B Mancini
- Division of Orthopedics and Traumatology, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Paolo Gresele
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy.,Division of Internal and Cardiovascular Medicine, Department of Medicine, University of Perugia, Perugia, Italy
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16
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Falcinelli E, Cosmi B, Filippini M, Petito E, Legnani C, Cini M, Guglielmini G, Migliacci R, Palareti G, Gresele P. Endothelial activation in patients with superficial vein thrombosis (SVT) of the lower limbs. Thromb Res 2017; 157:20-22. [PMID: 28679113 DOI: 10.1016/j.thromres.2017.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/14/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Emanuela Falcinelli
- Section of Internal and Cardiovascular Medicine, Dept. of Internal Medicine, University of Perugia, Italy
| | - Benilde Cosmi
- Cardiovascular Diseases, University of Bologna, Bologna, Italy
| | | | - Eleonora Petito
- Section of Internal and Cardiovascular Medicine, Dept. of Internal Medicine, University of Perugia, Italy
| | | | - Michela Cini
- Cardiovascular Diseases, University of Bologna, Bologna, Italy
| | - Giuseppe Guglielmini
- Section of Internal and Cardiovascular Medicine, Dept. of Internal Medicine, University of Perugia, Italy
| | - Rino Migliacci
- Division of Internal Medicine, Ospedale della Valdichiana "S. Margherita", Cortona, Italy
| | | | - Paolo Gresele
- Section of Internal and Cardiovascular Medicine, Dept. of Internal Medicine, University of Perugia, Italy.
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17
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Alunno A, Petito E, Mirabelli G, Falcinelli E, Luccioli F, Momi S, Bartoloni E, Santoboni G, Bistoni O, Caterbi S, Gresele P, Gerli R. THU0194 Role of Platelets in the Pathogenesis of Osteoarthritis and Biological Effects of Hyaluronic Acid: in Vivo and in Vitro Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Francisci D, Falcinelli E, Baroncelli S, Petito E, Cecchini E, Weimer LE, Floridia M, Gresele P, Baldelli F. Potential anti-inflammatory effects of maraviroc in HIV-positive patients: a pilot study of inflammation, endothelial dysfunction, and coagulation markers. ACTA ACUST UNITED AC 2014; 46:466-70. [PMID: 24738757 DOI: 10.3109/00365548.2014.898332] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 11/13/2022]
Abstract
Persistent immune activation and chronic inflammation significantly contribute to non-AIDS morbidity in HIV-infected patients. The HIV inhibitor maraviroc (MVC) targets the cellular chemokine CCR5 HIV co-receptor, which is involved in important inflammatory pathways. MVC could have significant anti-inflammatory and anti-atherosclerotic effects, also reducing immune activation. We designed a pilot study to determine which plasma biomarkers of inflammation, endothelial dysfunction, and hypercoagulability were modified by MVC in 2 groups of 10 patients starting MVC-free or MVC-containing regimens. Ten age- and gender-matched healthy controls were also included. We found higher levels of all inflammatory biomarkers in HIV-infected patients compared to healthy controls. Both groups showed decreasing levels of interleukin (IL)-17, IL-10, and macrophage inflammatory protein (MIP)-1a following the achievement of viral suppression. Vascular cell adhesion molecule (VCAM)-1 levels were decreased in the MVC group and increased in the MVC-free group. In conclusion, some inflammatory biomarkers tend to decrease with the salvage regimen; MVC was not associated with a better impact on these measured markers.
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Affiliation(s)
- Daniela Francisci
- From the 1 Division of Infectious Diseases, University of Perugia , Perugia
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19
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Alunno A, Luccioli F, Falcinelli E, Santoboni G, Momi S, Bartoloni E, Petito E, Bistoni O, Mirabelli G, Gresele P, Gerli R. AB0952 Intra-articular low molecular weight hyaluronate reduces platelet influx and matrix metalloproteinase-2 levels in synovial fluid of patients with knee osteoarthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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20
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Falcinelli E, Francisci D, Belfiori B, Petito E, Guglielmini G, Malincarne L, Mezzasoma A, Sebastiano M, Conti V, Giannini S, Bonora S, Baldelli F, Gresele P. In vivo platelet activation and platelet hyperreactivity in abacavir-treated HIV-infected patients. Thromb Haemost 2013; 110:349-57. [PMID: 23703656 DOI: 10.1160/th12-07-0504] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 04/30/2013] [Indexed: 12/30/2022]
Abstract
Abacavir (ABC) has been associated with ischaemic cardiovascular events in HIV-infected patients, but the pathogenic mechanisms are unknown. Aim of our study was to assess whether ABC induces in vivo platelet activation and ex vivo platelet hyper-reactivity. In a retrospective, case-control study, in vivo platelet activation markers were measured in 69 HIV-infected patients, before starting therapy and after 6-12 months of either ABC (n=35) or tenofovir (TDF) (n=34), and compared with those from 20 untreated HIV-infected patients. A subgroup of patients was restudied after 28-34 months for ex vivo platelet reactivity. In vivo platelet activation markers were assessed by ELISA or flow cytometry, ex vivo platelet reactivity by light transmission aggregometry (LTA) and PFA-100®. Thein vitro effects of the ABC metabolite, carbovir triphosphate, on aggregation and intra-platelet cGMP were also studied. sPLA2, sPsel and sGPV increased significantly 6-12 months after the beginning of ABC, but not of TDF or of no treatment. Ex vivo platelet function studies showed enhanced LTA, shorter PFA-100® C/ADP closure time and enhanced platelet expression of P-sel and CD40L in the ABC group. The intake of ABC blunted the increase of intraplatelet cGMP induced by nitric oxide (NO) and acutely enhanced collagen-induced aggregation. Preincubation of control platelets with carbovir triphosphate in vitro enhanced platelet aggregation and blunted NO-induced cGMP elevation. In conclusion, treatment with ABC enhances in vivo platelet activation and induces platelet hyperreactivity by blunting the inhibitory effects of NO on platelets. These effects may lead to an increase of ischaemic cardiovascular events.
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Affiliation(s)
- Emanuela Falcinelli
- Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Via E. dal Pozzo, Perugia, Italy
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21
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Francisci D, Falcinelli E, Belfiori B, Petito E, Fierro T, Baldelli F, Gresele P. Impact of tenofovir versus abacavir on HIV-related endothelial dysfunction. AIDS Patient Care STDS 2011; 25:567-9. [PMID: 21851265 DOI: 10.1089/apc.2011.0184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Daniela Francisci
- Division of Infectious Diseases, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Emanuela Falcinelli
- Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - Barbara Belfiori
- Division of Infectious Diseases, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Eleonora Petito
- Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - Tiziana Fierro
- Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - Franco Baldelli
- Division of Infectious Diseases, Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | - Paolo Gresele
- Division of Internal and Cardiovascular Medicine, Department of Internal Medicine, University of Perugia, Perugia, Italy
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Ahmed SR, Cosgrove D, Ball D, Donehower RC, Nelkin B, Petito E, Downs M, Chen HX, Doyle A, Scardina A, Carducci MA, Azad NS. A phase I, single-institution open-label, dose-escalation trial with an expansion cohort evaluating the safety and tolerability of AZD6244 and IMC-A12 in subjects with advanced solid malignancies. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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23
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Francisci D, Falcinelli E, Belfiori B, Petito E, Mezzasoma M, Baldelli F, Gresele P. Role of platelet activation in the cardiovascular complications associated with HIV infection: differential effect of abacavir versus tenofovir. J Int AIDS Soc 2010. [PMCID: PMC3113067 DOI: 10.1186/1758-2652-13-s4-p62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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