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Kusudo E, Murata Y, Kawamoto S, Egi M. Variant-derived SARS-CoV-2 spike protein does not directly cause platelet activation or hypercoagulability. Clin Exp Med 2023; 23:3701-3708. [PMID: 37208552 PMCID: PMC10198021 DOI: 10.1007/s10238-023-01091-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/11/2023] [Indexed: 05/21/2023]
Abstract
Thrombosis has been associated with severity and mortality in COVID-19. SARS-CoV-2 infects the host via its spike protein. However, direct effects of spike proteins from SARS-CoV-2 variants on platelet activity and coagulability have not been examined. An ethically approved ex vivo study was performed under a preplanned power analysis. Venous blood was collected from 6 healthy subjects who gave prior written consent. The samples were divided into 5 groups: without spike proteins (group N) and with spike proteins derived from alpha, beta, gamma, and delta SARS-CoV-2 variants (groups A, B, C, and D, respectively). Platelet aggregability, P-selectin expression, platelet-associated complement-1 (PAC-1) binding, platelet count, and mean platelet volume (MPV) were measured in all 5 groups, and thromboelastography (TEG) parameters were measured in groups N and D. The % change in each parameter in groups A to D was calculated relative to the value in group N. Data were analyzed by Friedman test, except for TEG parameters, which were evaluated by Wilcoxon matched pairs test. P < 0.05 was considered significant. This study included 6 participants based on a power analysis. There were no significant differences in platelet aggregability under stimulation with adenosine diphosphate 5 µg/ml, collagen 0.2 or 0.5 µg/ml, and Ser-Phe-Leu-Leu-Arg-Asn-amide trifluoroacetate salt (SFLLRN) 0.5 or 1 µM in groups A-D compared to group N. There were also no significant differences in P-selectin expression and PAC-1 binding under basal conditions or SFLLRN stimulation, and no significant differences in platelet count, MPV and TEG parameters. Platelet hyperactivity and blood hypercoagulability have been reported in COVID-19 patients, but spike proteins at 5 µg/ml from SARS-CoV-2 variants (alpha, beta, gamma, delta) did not directly cause these effects in an ex vivo study. This study was approved by the Ethics Committee of Kyoto University Hospital (R0978-1) on March 06, 2020.
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Affiliation(s)
- Eriko Kusudo
- Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yutaka Murata
- Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Anesthesia, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Shuji Kawamoto
- Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Moritoki Egi
- Department of Anesthesia, Kyoto University Hospital, 54 Shogoin-kawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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Kusudo E, Murata Y, Matsumoto T, Kawamoto S, Egi M. Platelet function of whole blood after short-term cold storage: A prospective in vitro observational study. Transfusion 2023; 63:384-392. [PMID: 36477860 DOI: 10.1111/trf.17216] [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: 10/28/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is no standardized storage temperature of whole blood for acute normovolemic hemodilution (ANH). STUDY DESIGN AND METHODS We conducted a prospective observational study to examine the difference in platelet function between short-term whole blood storage at 4 and 22°C. Venous blood (40 ml) was collected from seven healthy subjects who gave prior written consent. The samples were divided into three groups: before storage (group Pre), cold (4°C) storage (group C), and room temperature (22°C) storage (group R). Groups C and R were tested after 6 h of blood storage. Platelet aggregability, platelet factor 4 (PF4), β-thromboglobulin (β-TG), P-selectin expression, pH, PO2 , PCO2 , glucose, lactate, blood count, and thromboelastography (TEG) parameters were measured. The percentage change in each parameter in groups C and R was calculated using the value in group Pre as a reference. These data were then compared between groups C and R using a Wilcoxon matched pairs test. p < 0.05 was considered to be statistically significant. RESULTS Compared with group R, group C showed significantly higher platelet aggregability with adenosine diphosphate (ADP) 2, 4, and 6 μM (all p = 0.016) and collagen 1 μg/ml (p = 0.047) stimulation, and significantly lower PF4 and β-TG elevation (both p = 0.031), glucose consumption (p = 0.031), and lactate production (p = 0.016). The ADP channel in TEG showed a significant increase in platelet aggregation rate in group C compared to group R. DISCUSSION Cold storage of whole blood in ANH may provide improved storage conditions for platelets and contribute to improved hemostasis compared to room temperature storage.
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Affiliation(s)
- Eriko Kusudo
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Yutaka Murata
- Department of Anesthesia, Kitano Hospital, Osaka, Japan
| | | | - Shuji Kawamoto
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Moritoki Egi
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
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Kawamoto S, Kusudo E, Fukuda K. Use of argatroban in combination with nafamostat mesilate in open-heart surgery for a pediatric patient with heparin-induced thrombocytopenia type II: a case report. JA Clin Rep 2020; 6:3. [PMID: 32026037 PMCID: PMC6966733 DOI: 10.1186/s40981-020-0310-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/22/2019] [Accepted: 01/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Heparin-induced thrombocytopenia type II (HIT II) is a rare, immune-mediated complication of heparin therapy and can cause life-threatening thromboembolism. However, perioperative anticoagulation therapy for patients with a complication of HIT II has not been established. Case presentation A 6-year-old boy with tetralogy of Fallot underwent radical intracardiac repair with administration of argatroban at 1 year old due to positive HIT antibody. Reoperation was scheduled for pulmonary valve insufficiency, using argatroban and nafamostat mesilate as anticoagulants. Argatroban has a long onset time and the activated coagulation time (ACT) requires 7–26 h to return to the preadministration level, making hemorrhage control difficult, while half-life of nafamostat mesilate is shorter than that of argatroban. Celite ACT reflects the effects of both argatroban and nafamostat mesilate, but kaolin ACT reflects only the effect of argatroban. Due to the early termination of argatroban administration based on Celite and kaolin ACTs, ACT recovered to ≤ 200 s at 5 h after the end of argatroban administration. Conclusion Celite and kaolin ACTs can be used as markers to obtain close control of the required dose of argatroban in combination with nafamostat mesilate for the management of HIT II patients.
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Affiliation(s)
- Shuji Kawamoto
- Department of Anesthesia, Kyoto University Hospital, 54, Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Eriko Kusudo
- Department of Anesthesia, Kyoto University Hospital, 54, Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazuhiko Fukuda
- Department of Anesthesia, Kyoto University Hospital, 54, Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Hirotsu A, Kusudo E, Mori N, Miyai Y, Suzuki K, Kawamoto S, Fukuda K. Successful perioperative management of living-donor liver transplantation for a patient with severe methylmalonic acidemia: a case report. JA Clin Rep 2018; 4:83. [PMID: 32026114 PMCID: PMC6967269 DOI: 10.1186/s40981-018-0221-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/08/2018] [Accepted: 12/17/2018] [Indexed: 12/19/2022] Open
Abstract
Background Methylmalonic acidemia (MMAemia) is a rare hereditary disease affecting organic acid metabolism. It causes recurrent metabolic acidosis and secondary mitochondrial dysfunction, resulting in a poor prognosis. Liver transplantation (LT) has been performed to facilitate the metabolism of organic acids and improve the prognosis of MMAemia. However, there have been few reports on perioperative management of LT. Case presentation A 22-month-old female with severe MMAemia was scheduled to receive LT to relieve recurrent metabolic acidosis despite dietary and pharmacological treatment. General anesthesia was maintained without propofol or nitrous oxide, which can worsen MMAemia-induced metabolic acidosis during anesthesia for LT. Strict metabolic and respiratory management enabled the operation to be successfully performed without metabolic acidosis. Conclusion Perioperative management of LT for MMAemia is challenging for anesthesiologists because of the possibility of serious metabolic acidosis. We succeeded in preventing metabolic decompensation by avoiding the use of propofol and nitrous oxide.
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Affiliation(s)
- Akiko Hirotsu
- Department of Anesthesia, Kyoto University Hospital, 54, Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Eriko Kusudo
- Department of Anesthesia, Osaka Red Cross Hospital, 5-30, Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555, Japan
| | - Natsumi Mori
- Department of Anesthesia, Osaka Red Cross Hospital, 5-30, Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555, Japan
| | - Yoshimitsu Miyai
- Department of Anesthesia, Kyoto University Hospital, 54, Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kengo Suzuki
- Department of Anesthesia, Kyoto University Hospital, 54, Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shuji Kawamoto
- Department of Anesthesia, Kyoto University Hospital, 54, Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazuhiko Fukuda
- Department of Anesthesia, Kyoto University Hospital, 54, Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Kusudo E, Endo Y, Kitayama N, Ishida Y, Fujisawa A, Dainichi T, Kabashima K. Pemphigus foliaceus developed in a patient with long-term erosion on the genital skin. J Dermatol 2017; 44:e126-e127. [PMID: 28150338 DOI: 10.1111/1346-8138.13772] [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] [Indexed: 11/30/2022]
Affiliation(s)
- Eriko Kusudo
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuichiro Endo
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naomi Kitayama
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshihiro Ishida
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Fujisawa
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Teruki Dainichi
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Singapore Immunology Network (SIgN) and Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore.,PRESTO, Japan Science and Technology Agency, Kawaguchi, Japan
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