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Casini A, Undas A, Palla R, Thachil J, de Moerloose P. Diagnosis and classification of congenital fibrinogen disorders: communication from the SSC of the ISTH. J Thromb Haemost 2018; 16:1887-1890. [PMID: 30076675 DOI: 10.1111/jth.14216] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Indexed: 12/17/2022]
Affiliation(s)
- A Casini
- Division of Angiology and Haemostasis, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - A Undas
- Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Cracow, Poland
| | - R Palla
- Department of Medicine and Medical Specialities, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milan, IRCCS Maggiore Hospital, Milan, Italy
| | - J Thachil
- Department of Haematology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - P de Moerloose
- Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Tsakiris DA, Kappos L, Reber G, Marbet GA, Le Floch-Rohr J, Roux E, de Moerloose P. Lack of Association Between Antiphospholipid Antibodies and Migraine. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1651625] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryWe prospectively studied the prevalence of lupus anticoagulant, anticardiolipin antibodies (aCL) and various haemostatic parameters in 71 patients with migraine and compared the results with a control group of 32 subjects with back pain never having experienced migraine. The patients with migraine were divided into two groups: group I with migraine without (n = 18) and with aura lasting less than 60 min (n = 24) and group II with migraine with prolonged aura or migrainous infarction (complicated migraine, n = 29). The following results were obtained: a) no difference in aCL positivity was noted between migrainous patients and controls and between common migraine and complicated migraine patients and b) no statistically significant difference in haemostatic parameters (except for thrombin-antithrombin III complexes) was found between the two groups of migraine and between aCL positive and negative migrainous patients. These data suggest that anticardiolipin antibodies are not involved in the pathogenesis of migraine complications.
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Affiliation(s)
- D A Tsakiris
- The Coagulation and Fibrinolysis Laboratory, University Hospital of Basel, Switzerland
| | - L Kappos
- Department of Neurology, University Hospital of Basel, Switzerland
| | - G Reber
- Haemostasis Unit, University Cantonal Hospital, Geneva, Switzerland
| | - G A Marbet
- The Coagulation and Fibrinolysis Laboratory, University Hospital of Basel, Switzerland
| | - J Le Floch-Rohr
- Department of Neurology, University Cantonal Hospital, Geneva, Switzerland
| | - E Roux
- Division of Rheumatology, University Cantonal Hospital, Geneva, Switzerland
| | - P de Moerloose
- Haemostasis Unit, University Cantonal Hospital, Geneva, Switzerland
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3
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Bounameaux H, de Moerloose P, Perrier A, Reber G. Plasma Measurement of D-Dimer as Diagnostic Aid in Suspected Venous Thromboembolism: An Overview. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642375] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThis paper reviews the published experience with plasma measurement of D-dimer (DD), a specific degradation product of crosslinked fibrin, in the diagnostic approach of venous thromboembolism (VTE). Pooling 11 studies (with weighting of the figures according to sample size) with a total of 1337 patients clinically suspected of deep venous thrombosis (DVT) (prevalence of DVT 35%) disclosed an average weighted sensitivity of 96.8% (95% CI: 95.2–98.4) and specificity of 35.2% (95% Cl: 32.0–38.4) for the presence of DVT when the ELISA technique was used. In 908 patients suspected of pulmonary embolism (PE) from 9 trials (prevalence of PE 38%), the ELISA technique was associated with a weighted sensitivity of 96.8% (95% Cl: 95.0–98.6) and specificity of 45.1% (95% Cl: 40.8–49.4) for the disease. Figures obtained with latex assays were definitely lower, precluding their use in the diagnostic approach of VTE.These results show that a low concentration of plasma DD measured by the ELISA technique (usually less than 500 μg/1) might be used to rule out VTE in clinically suspected patients. Increased plasma concentrations are of no utility because of the low specificity of this test result.The clinical usefulness of the DD ELISA test should now be assessed in management trials under routine conditions, in the frame of clinical decision-making diagnostic processes. Lastly, the promising data obtained in a small number of asymptomatic, postoperative patients at risk of VTE deserve confirmation before the test can be recommended for initial screening in thrombo-prophylactic trials.
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Affiliation(s)
- H Bounameaux
- The Division of Angiology and Haemostasis, University Hospital of Geneva, Geneva, Switzerland
| | - P de Moerloose
- The Division of Angiology and Haemostasis, University Hospital of Geneva, Geneva, Switzerland
| | - A Perrier
- Division of Pneumology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - G Reber
- The Division of Angiology and Haemostasis, University Hospital of Geneva, Geneva, Switzerland
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de Moerloose P, Minazio P, Reber G, Perrier A, Bounameaux H. D-Dimer Determination to Exclude Pulmonary Embolism: a Two-Step Approach Using Latex Assay as a Screening Tool. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648817] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryD-dimer (DD), when measured by a quantitative enzyme-linked immunosorbent assay (ELISA), is a valuable test to exclude venous thromboembolism (VTE). However, DD ELISA technique is not appropriate for emergency use and the available agglutination latex assays are not sensitive enough to be used as an alternative to rule out the diagnosis of VTE. Latex assays could still be used as screening tests. We tested this hypothesis by comparing DD levels measured by ELISA and latex assays in 334 patients suspected of pulmonary embolism. All but one patient with a positive (DD ≥500 ng/ml) latex assay had DD levels higher than 500 ng/ml with the ELISA assay. Accordingly, ELISA technique could be restricted to patients with a negative result in latex assay. This two-step approach would have spared about 50% of ELISA in our cohort. In conclusion, our data indicate that a latex test can be used as a first diagnostic step to rule out pulmonary embolism provided a negative result is confirmed by ELISA and the performance of the latex assay used has been assessed properly.
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Affiliation(s)
- P de Moerloose
- Division of Angiology and Haemostasis, Department of Medicine, University Cantonal Hospital of Geneva, Switzerland
| | - Ph Minazio
- Division of Angiology and Haemostasis, Department of Medicine, University Cantonal Hospital of Geneva, Switzerland
| | - G Reber
- Division of Angiology and Haemostasis, Department of Medicine, University Cantonal Hospital of Geneva, Switzerland
| | - A Perrier
- Division of Pneumology, Department of Medicine, University Cantonal Hospital of Geneva, Switzerland
| | - H Bounameaux
- Division of Angiology and Haemostasis, Department of Medicine, University Cantonal Hospital of Geneva, Switzerland
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5
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Reber G, Arvieux J, Comby E, Degenne D, de Moerloose P, Sanmarco M, Potron G. Multicenter Evaluation of Nine Commercial Kits for the Quantitation of Anticardiolipin Antibodies. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1653795] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe performances of nine commercial kits and an in-house method (HM) for the quantitation of anticardiolipin antibodies (ACA) have been evaluated in a multicenter study. Ninety control and patient samples and six standards from Louisville University were run with kits and with the HM. Marked differences in positivity rate between kits were observed, ranging from 31 to 60% for IgG and 6 to 50% for IgM. Concordance between kits occurred in 59 and 51% of samples for IgG and IgM respectively. Concordance coefficients (kappa) ranged from 0.13 to 0.92. Slopes of regression lines between the declared units of Louisville standards and the units measured from the calibrators of the kits showed great diversity and ranged from 0.159 to 0.931 for IgG and from 0.236 to 0.836 for IgM. The β2-glycoprotein I (β2-GPI) content of the dilution buffers and the wells supplied with the kits revealed noticeable differences. However samples containing anti-(β2-GPI antibodies were classified similarly by all but one kit. In contrast the ability to measure samples devoid of anti-β2-GPI antibodies differed markedly between the kits.This study shows that differences in positivity rates between the commercial kits may contribute to the differences in ACA prevalence rate found in the literature. The choice of cut-off levels may partly explain the moderate concordance between the kits. In addition some samples behave very differently depending on the kits. In spite of the expression of results in PL units, standardization of ACA assays has not been achieved.
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Affiliation(s)
- G Reber
- The Haemostasis Unit, Geneva University Hospital, Switzerland
| | - J Arvieux
- The Centre de Transfusion Sanguine, Grenoble, France
| | - E Comby
- The Centre Hospitalier Universitaire, Caen, France
| | - D Degenne
- The Centre Hospitalier Universitaire, Tours, France
| | - P de Moerloose
- The Haemostasis Unit, Geneva University Hospital, Switzerland
| | - M Sanmarco
- The Faculté de Médecine, Université d’Aix-Marseille II, France
| | - G Potron
- The Centre Hospitalier Universitaire, Reims, France
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6
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Affiliation(s)
- G Reber
- Haemostasis Unit, University Hospital, Geneva, Switzerland
| | - P de Moerloose
- Haemostasis Unit, University Hospital, Geneva, Switzerland
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De Benedetti E, Reber G, Miescher PA, de Moerloose P. No Increase of β2-Glycoprotein I Levels in Patients with Antiphospholipid Antibodies. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646331] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E De Benedetti
- Haemostasis Unit, University Hospital Geneva, Switzerland
| | - G Reber
- Haemostasis Unit, University Hospital Geneva, Switzerland
| | - P A Miescher
- Haematology Division, University Hospital Geneva, Switzerland
| | - P de Moerloose
- Haemostasis Unit, University Hospital Geneva, Switzerland
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8
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Bounameaux H, Khabiri E, Huber O, Schneider PA, Didier D, Moerloose PD, Reber G. Value of Liquid Crystal Contact Thermography and Plasma Level of D-Dimer for Screening of Deep Venous Thrombosis Following General Abdominal Surgery. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648508] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryBecause the use of radioactive fibrinogen uptake test (FUT) has become questionable both for ethical (risk of virus transmission) and technical (lack of sensitivity) reasons, we investigated the potential value of two alternative methods for screening of asymptomatic deep venous thrombosis following elective digestive surgery: liquid crystal contact thermography (LCCT) and measurement of plasma concentration of D-dimer (DD), as compared with bilateral ascending phlebography. Out of 194 patients, 185 underwent phlebography on the 8th (0-19, median and range) postoperative day. Despite prophylaxis with low-molecular-weight heparin and elastic stockings, DVT was detected on phlebography in 58 legs of 45 patients. Sensitivity of LCCT with respect to the presence of DVT was 55% (n = 184 patients) or 28% (n = 368 legs) with a specificity of 67% and 82%, respectively. These poor performances were obtained despite a good interobserver agreement for the LCCT assessments (overall kappa coefficient of 0.66 between three experts). The most accurate cut-off of DD for discriminating patients with or without DVT was 3,000 pg/1, as determined by ROC curve analysis. Sensitivity of a DD level of more than 3,000 pg/1 for the presence of phlebographically documented DVT on the 8th postoperative day was 89% for a specificity of 48%.Thus, LCCT cannot be used for screening of postoperative, mainly asymptomatic DVT following general surgery. On the other hand, measurement of plasma DD may be useful for initial screening, a negative result (level less than 3,000 pg/1) allowing to exclude DVT (negative predictive value of 93%) and a positive result (positive predictive value of 35%) requiring confirmation by phlebography. This sequential approach might be useful in studies of the efficacy of antithrombotic regimens for prophylaxis of DVT in patients at risk.
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Affiliation(s)
- H Bounameaux
- The Units of Angiology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - E Khabiri
- The Units of Angiology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - O Huber
- Clinic of Digestive Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - P-A Schneider
- Division of Radiodiagnostics, Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - D Didier
- Division of Radiodiagnostics, Department of Radiology, University Hospital of Geneva, Geneva, Switzerland
| | - P de Moerloose
- Hemostasis, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - G Reber
- Hemostasis, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
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Affiliation(s)
- O Bongard
- Unit of Haemostasis and Unit of Angiology, University Hospital of Geneva, Switzerland
| | - G Reber
- Unit of Haemostasis and Unit of Angiology, University Hospital of Geneva, Switzerland
| | - H Bounameaux
- Unit of Haemostasis and Unit of Angiology, University Hospital of Geneva, Switzerland
| | - P de Moerloose
- Unit of Haemostasis and Unit of Angiology, University Hospital of Geneva, Switzerland
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Abstract
The effects on hemostasis of two high-flux membranes in hollow-fiber configuration, polyamide (PAM) and polyacrylonitrile (AN69), were analyzed in a cross-over study involving ten chronic hemodialyzed patients. Blood samples were obtained at arterial and venous sites of the extracorporeal circuit before dialysis and at 15, 30 and 180 min. Primary hemostasis: PAM induced an early significant drop in platelet counts, but at 180 min there was no longer any difference between membranes. Beta-thromboglobulin release by PAM was significantly higher at all time points. Coagulation: thrombin-antihrombin III complexes (TAT) and fibrinopeptide A increased significantly, the highest values being found with AN69. With both membranes the arteriovenous differences in TAT levels were negative throughout the sessions. Fibrinolysis: no significant differences were observed. In conclusion, both membranes induced hemostatic changes. Although these two hollow-fiber dialyzers look relatively similar, the changes observed were different, polyamide acting mainly on primary hemostasis and polyacrylonitrile on coagulation.
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Affiliation(s)
- G. Reber
- Hemostasis Unit and Division of Nephrology Geneva - Switzerland
| | - C. Stoermann
- Department of Medicine, University Cantonal Hospital, Geneva - Switzerland
| | - P. de Moerloose
- Hemostasis Unit and Division of Nephrology Geneva - Switzerland
| | - P. Ruedin
- Department of Medicine, University Cantonal Hospital, Geneva - Switzerland
| | - M. Leski
- Department of Medicine, University Cantonal Hospital, Geneva - Switzerland
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Dunoyer-Geindre S, Kruithof EKO, Rochemonteix GD, Rosnoblet C, Gruenberg J, Reber G, de Moerloose P. Localization of β2-Glycoprotein 1 in Late Endosomes of Human Endothelial Cells. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615766] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryAntiphospholipid antibodies (APLA) are associated with thrombophilia and recurrent pregnancy loss. Different mechanisms have been proposed to explain their pathogenic effects and among them, we have previously shown that APLA accumulate in late endosomes of human umbilical vein endothelial cells (HUVEC) leading to a redistribution of the cation-independent mannose-6-phosphate receptor (CI-M6PR). Because many APLA are directed towards β2-glycoprotein 1 (β2GP1)-phospholipid complexes, we investigated the localisation of β2GP1 in HUVEC. By immunofluorescence analysis, using monoclonal and polyclonal anti- β2GP1 antibodies, we detected β2GP1 at the cell surface and in late endosomes. Incubation of HUVEC with anti- β2GP1 antibodies resulted in antibody accumulation at the cell surface and within late endosomes and in a redistribution of the CI-M6PR from the Golgi apparatus to late endosomes. The anti- β2GP1 antibodies remained detectable in late endosomes even after several days of incubation in antibody-free medium. The accumulation of anti- β2GP1 antibodies in late endosomes of endothelial cells and the resulting modification of intracellular protein trafficking may contribute to the pathogenic effects of these antibodies.
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Abstract
SummaryD-dimer measurement has proven to be very useful to rule out deep vein thrombosis (DVT) and pulmonary embolism (PE) in symptomatic outpatients (1). The problem faced by many physicians is the choice and the position of the D-Dimer tests in the diagnostic work-up of patients suspected of venous thromboembolism (VTE). In the last and present issues of Thrombosis and Haemostasis, two very interesting studies addressing these questions were published.In the first paper (2), de Groot and colleagues evaluated, in a management study, the clinical utility of incorporating the SimpliRED assay in the diagnostic work-up of patients with suspected PE. Of the 245 study subjects, 59 did not receive anticoagulant therapy on the basis of a nondiagnostic lung scan, a normal D-dimer and a non-high clinical probability of PE. In the follow-up, only one patient experienced a thromboembolic event (which can be compared with the 6% of subsequent rate of VTE in the follow-up of the 54 patients with a normal perfusion lung scan). However, if SimpliRED D-dimer would have been used alone as a first exclusion step, 6 of 61 patients with proven PE had been missed (9.8%, 95% CI 3.7-20.2).
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Amri Y, Jouini H, Becheur M, Dabboubi R, Mahjoub B, Messaoud T, Sfar MT, Casini A, de Moerloose P, Toumi NEH. Fibrinogen Mahdia: A congenitally abnormal fibrinogen characterized by defective fibrin polymerization. Haemophilia 2017; 23:e340-e347. [DOI: 10.1111/hae.13268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Y. Amri
- Hematology Laboratory; Bechir Hamza Children's Hospital; Tunis Tunisia
| | - H. Jouini
- Hematology Laboratory; Bechir Hamza Children's Hospital; Tunis Tunisia
| | - M. Becheur
- Hematology Laboratory; Bechir Hamza Children's Hospital; Tunis Tunisia
| | - R. Dabboubi
- Biochemistry Laboratory; Bechir Hamza Children's Hospital; Tunis Tunisia
| | - B. Mahjoub
- Department of Pediatrics; Tahar Sfar University Hospital; Mahdia Tunisia
| | - T. Messaoud
- Biochemistry Laboratory; Bechir Hamza Children's Hospital; Tunis Tunisia
| | - M. T. Sfar
- Department of Pediatrics; Tahar Sfar University Hospital; Mahdia Tunisia
| | - A. Casini
- Division of Angiology and Haemostasis; University Hospitals and Faculty of Medicine of Geneva; Geneva Switzerland
| | - P. de Moerloose
- Division of Angiology and Haemostasis; University Hospitals and Faculty of Medicine of Geneva; Geneva Switzerland
| | - N. E. H. Toumi
- Hematology Laboratory; Bechir Hamza Children's Hospital; Tunis Tunisia
- Department of Clinical Biology A; Faculty of Pharmacy; Monastir Tunisia
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14
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Casini A, Brungs T, Lavenu-Bombled C, Vilar R, Neerman-Arbez M, de Moerloose P. Genetics, diagnosis and clinical features of congenital hypodysfibrinogenemia: a systematic literature review and report of a novel mutation. J Thromb Haemost 2017; 15:876-888. [PMID: 28211264 DOI: 10.1111/jth.13655] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Indexed: 12/14/2022]
Abstract
Essentials Hypodysfibrinogenemia is rarely reported among the congenital fibrinogen disorders. This first systematic literature review led to identification of 51 hypodysfibrinogenemic cases. Diagnosis based only on functional/antigenic fibrinogen ratio may be insufficient. Family studies show an incomplete segregation of mutation with the clinical phenotypes. SUMMARY Background Hypodysfibrinogenemia is a rare disease characterized by decreased levels of a dysfunctional fibrinogen. It shares features with both hypo- and dysfibrinogenemia, although with specific molecular patterns and clinical phenotypes. Objectives To better define the genetics, the diagnosis and the clinical features of hypodysfibrinogenemia. Patients/Methods A systematic literature search led to 167 records. After removal of duplicates, abstract screening and full-text reviewing, 56 molecular and/or clinical studies were analyzed, including a novel FGB missense mutation in a woman with a mild bleeding phenotype. Results A total of 32 single causative mutations were reported, mainly in the COOH-terminal region of the γ or Aα chains at heterozygous or homozygous state. Seven additional hypodysfibrinogenemias were due to compound heterozygosity. The hypofibrinogenemic phenotypes were a result of an impaired assembly or secretion or an increased clearance of the fibrinogen variant, whereas the dysfibrinogenemic phenotype was mainly a result of a defective fibrin polymerization and an abnormal calcium or tPA binding. Among 51 identified index cases, a functional/antigenic fibrinogen ratio < 0.7 had a sensitivity of 86% for the diagnosis of hypodysfibrinogenemia. Eleven patients (22%) were asymptomatic at time of diagnosis, 23 (45%) had a mild bleeding phenotype with mainly obstetrical or gynecologic-related hemorrhage and 22 (43%) had experienced at least one thrombotic event, including 23 venous and eight arterial thromboses. Conclusions This first systematic review on hypodysfibrinogenemia shows the heterogeneity of causative mutations and that misdiagnosis could occur in relation to the functional and antigenic fibrinogen levels. Family studies reveal an incomplete segregation of the mutation with the clinical phenotype.
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Affiliation(s)
- A Casini
- Division of Angiology and Haemostasis, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - T Brungs
- Service d'Hématologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - C Lavenu-Bombled
- Service d'Hématologie Biologique, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - R Vilar
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - M Neerman-Arbez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - P de Moerloose
- Division of Angiology and Haemostasis, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
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15
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Casini A, Vilar R, Beauverd Y, Aslan D, Devreese K, Mondelaers V, Alberio L, Gubert C, de Moerloose P, Neerman-Arbez M. Protein modelling to understandFGBmutations leading to congenital hypofibrinogenaemia. Haemophilia 2017; 23:583-589. [DOI: 10.1111/hae.13190] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2017] [Indexed: 12/17/2022]
Affiliation(s)
- A. Casini
- Division of Angiology and Haemostasis; Faculty of Medicine; Geneva University Hospitals; Geneva Switzerland
| | - R. Vilar
- Department of Genetic Medicine and Development; University Medical School of Geneva; Geneva Switzerland
| | - Y. Beauverd
- Haematology Division; Faculty of Medicine; Geneva University Hospitals; Geneva Switzerland
| | - D. Aslan
- Pediatric Hematology Unit; Faculty of Medicine; Gazi University; Ankara Turkey
| | - K. Devreese
- Coagulation Laboratory; Ghent University Hospital; Ghent Belgium
| | - V. Mondelaers
- Department of Pediatric Hemato-oncology and Stem Cell Transplantation; Ghent University Hospital; Ghent Belgium
| | - L. Alberio
- Service et Laboratoire central d'Hématologie; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - C. Gubert
- Department of Genetic Medicine and Development; University Medical School of Geneva; Geneva Switzerland
| | - P. de Moerloose
- Division of Angiology and Haemostasis; Faculty of Medicine; Geneva University Hospitals; Geneva Switzerland
| | - M. Neerman-Arbez
- Department of Genetic Medicine and Development; University Medical School of Geneva; Geneva Switzerland
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16
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Devreese KM, Poncet A, Lindhoff-Last E, Musial J, de Moerloose P, Fontana P. A multicenter study to assess the reproducibility of antiphospholipid antibody results produced by an automated system. J Thromb Haemost 2017; 15:91-95. [PMID: 27813343 DOI: 10.1111/jth.13560] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/24/2016] [Indexed: 12/01/2022]
Abstract
Essentials Inter-lab variation studies for antiphospholipid antibodies (aPL) with the same assay are lacking. We carried out an assessment of repeatability and reproducibility of an automated aPL assay. High intra-center repeatability for anticardiolipin and aβ2 GPI makes duplicate testing unnecessary. Inter-lab reproducibility was high except for aβ2GPI IgG. SUMMARY Background Inter-assay variability is a well-known problem in antiphospholipid antibody testing, because of the lack of standardization. Inter-laboratory reproducibility for the same assay is similarly important. Objectives Testing repeatability and reproducibility of HemosIL® AcuStar for anticardiolipin (aCL) and antiβ2-glycoprotein I antibodies (aβ2GPI) IgG and IgM. Patients/Methods In this observational study, out of 420 samples from the thrombophilia centers of Ghent and Geneva, 100 samples were randomly selected and successively analyzed in three centers: Ghent (C1, in duplicate for repeatability evaluation), Geneva (C2) and Frankfurt (C3). Results Results from 99 samples were available, including 25 from patients with antiphospholipid syndrome (APS) and 74 from non-APS patients. The intra-center repeatability expressed as intra-class correlation coefficient (ICC) was higher than 0.99 for each parameter. Differences between two measurements rarely exceeded 1 U mL-1 for values below 100 U mL-1 , except for aβ2GPI IgG, where differences varied from -4 to 4 U mL-1 . The inter-center ICCs were higher than 0.99, except for aCL IgM (ICC = 0.961). These ICCs remained high even when considering values below 100 U mL-1 (0.943, 0.964 and 0.977 for aCL IgG, aCL gM and aβ2GPI IgM, respectively), except for aβ2GPI IgG (ICC = 0.652). Qualitative comparison showed less than 5% discordant classification between centers, with somewhat more discordant results for aβ2GPI IgG. Conclusions In terms of discriminating properties, the HemosIL® AcuStar has excellent intra-center repeatability and a good inter-center reproducibility for aCL IgG, aCL IgM and aβ2GPI IgM. Some concern may arise for aβ2GPI IgG.
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Affiliation(s)
- K M Devreese
- Coagulation Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University Hospital, Ghent, Belgium
| | - A Poncet
- CRC and Division of Clinical-Epidemiology, Department of Health and Community Medicine, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - E Lindhoff-Last
- Cardiology Angiology Center Bethanien (CCB) Vascular Center-Coagulation Center, Frankfurt, Germany
| | - J Musial
- Department of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - P de Moerloose
- Division of Angiology and Haemostasis, Faculty of Medicine, University Hospitals of Geneva and Geneva Platelet Group, Geneva, Switzerland
| | - P Fontana
- Division of Angiology and Haemostasis, Faculty of Medicine, University Hospitals of Geneva and Geneva Platelet Group, Geneva, Switzerland
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Hermans C, Klamroth R, Richards M, de Moerloose P, Garrido RP. Outcome measures in European patients with haemophilia: Survey of implementation in routine clinical practice, perception of relevance and recommendations by European treaters in the EHTSB. Haemophilia 2016; 23:222-229. [PMID: 27790841 DOI: 10.1111/hae.13085] [Citation(s) in RCA: 6] [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] [Accepted: 07/29/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study was conducted to evaluate the current implementation of outcome measures in routine clinical haemophilia practice and to explore and appreciate the perception of the relevance of such measures by treaters. METHODS A survey was completed by 19 of the 26 physicians involved in the European Haemophilia Therapy Strategy Board (EHTSB). Employing an extensive inventory of outcome measures used in patients with haemophilia, information was collected about the frequency of data collection and the subjective appreciation of their importance during clinic review. RESULTS The survey revealed that most treaters currently collect data that are mainly related to the haemostatic treatment (consumption of concentrates) and the bleeding symptoms (number and location of bleeds) in a non-uniform and non-standardized way. By contrast, functional, physical and quality of life scorings are rarely used and show considerable heterogeneity between treaters. Also, many disparities emerged between practice and perception, in particular quality of life data that are perceived as being important but for most of the time are not collected. CONCLUSIONS This survey represents, in our view, the first attempt to evaluate the actual utilization of outcome measures in haemophilia care. While the value of outcome measures is appreciated, they are not assessed regularly. Therefore, there is a need to include appropriate performance indicators (outcome measures) of haemophilia care in routine clinical practice. Consensus recommendations to provide a framework for achieving this aim are provided.
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Affiliation(s)
- C Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium
| | - R Klamroth
- Klinik für Innere Medizin, Hämophiliezentrum, Vivantes-Klinikum in Friedrichhain, Berlin, Germany
| | - M Richards
- Paediatric Haematology Department, Children's Day Hospital, St James University Hospital, Leeds, UK
| | - P de Moerloose
- Départment de Medicine Interne, Unité d'Hémostase, Hôpital Cantonal, Geneva, Switzerland
| | - R P Garrido
- Unidad de Hemofilia, Hospital Virgen del Rocio, Seville, Spain
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18
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Abstract
INTRODUCTION No evidence-based guidelines for the management of patients suffering from afibrinogenaemia and hypofibrinogenaemia are available. AIM AND METHOD The aim of this study was to harmonize patient's care among invited haemophilia experts from Belgium, France and Switzerland. A Delphi-like methodology was used to reach a consensus on: prophylaxis, bleeding, surgery, pregnancy and thrombosis management. RESULTS The main final statements are as follows: (i) a secondary fibrinogen prophylaxis should be started after a first life-threatening bleeding in patients with afibrinogenaemia; (ii) during prophylaxis the target trough fibrinogen level should be 0.5 g L-1 ; (iii) if an adaptation of dosage is required, the frequency of infusions rather than the fibrinogen amount should be modified; (iv) afibrinogenaemic patients undergoing a surgery at high bleeding risk should receive fibrinogen concentrates regardless of the personal or family history of bleeding; (v) moderate hypofibrinogenaemic patients (i.e. ≥0.5 g L-1 ) without previous bleeding (despite haemostatic challenges) undergoing a surgery at low bleeding risk may not receive fibrinogen concentrates as prophylaxis; (vi) monitoring the trough fibrinogen levels should be performed at least once a month throughout the pregnancy and a foetal growth and placenta development close monitoring by ultrasound is recommended; (vii) fibrinogen replacement should be started concomitantly to the introduction of anticoagulation in afibrinogenaemic patients suffering from a venous thromboembolic event; and (viii) low-molecular-weight heparin is the anticoagulant of choice in case of venous thromboembolism. CONCLUSION The results of this initiative should help clinicians in the difficult management of patients with congenital fibrinogen disorders.
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Affiliation(s)
- A Casini
- Division of Angiology and Haemostasis, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P de Moerloose
- Division of Angiology and Haemostasis, University Hospitals and Faculty of Medicine, Geneva, Switzerland
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19
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de Moerloose P, Schved JF, Nugent D. Rare coagulation disorders: fibrinogen, factor VII and factor XIII. Haemophilia 2016; 22 Suppl 5:61-5. [DOI: 10.1111/hae.12965] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 12/17/2022]
Affiliation(s)
- P. de Moerloose
- Division of Angiology and Haemostasis; University Hospitals and Faculty of Medicine; Geneva Switzerland
| | | | - D. Nugent
- Department of Hematology; Children's Hospital of Orange County; Orange CA USA
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20
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Abstract
Congenital fibrinogen disorders are rare diseases affecting either the quantity (afibrinogenaemia and hypofibrinogenaemia) or the quality (dysfibrinogenaemia) or both (hypodysfibrinogenaemia) of fibrinogen. In addition to bleeding, unexpected thrombosis, spontaneous spleen ruptures, painful bone cysts and intrahepatic inclusions can complicate the clinical course of patients with quantitative fibrinogen disorders. Clinical manifestations of dysfibrinogenaemia include absence of symptoms, major bleeding or thrombosis as well as systemic amyloidosis. Although the diagnosis of any type of congenital fibrinogen disorders is usually not too difficult with the help of conventional laboratory tests completed by genetic studies, the correlation between all available tests and the clinical manifestations is more problematic in many cases. Improving accuracy of diagnosis, performing genotype, analysing function of fibrinogen variants and carefully investigating the personal and familial histories may lead to a better assessment of patients' phenotype and therefore help in identifying patients at increased risk of adverse clinical outcomes. This review provides an update of various tests (conventional and global assays, molecular testing, fibrin clot analysis) and clinical features, which may help to better predict the phenotype of the different types of congenital fibrinogen disorders.
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Affiliation(s)
- A Casini
- Division of Angiology and Haemostasis, University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - P de Moerloose
- Division of Angiology and Haemostasis, University Hospitals and Faculty of Medicine, Geneva, Switzerland
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21
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Marchetti T, de Moerloose P, Gris JC. Antiphospholipid antibodies and the risk of severe and non-severe pre-eclampsia: the NOHA case-control study. J Thromb Haemost 2016; 14:675-84. [PMID: 26782635 DOI: 10.1111/jth.13257] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 11/25/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND pre-eclampsia (PEecl) can be defined as non-severe (NS-PEecl) or severe (S-PEecl). Our study aimed to determine the incidence of antiphospholipid antibodies (aPLs) in women with a past history of NS-PEecl or S-PEecl. PATIENTS AND METHODS This case-control study includes 195 control women, 199 NS-PEecl patients and 143 S-PEecl patients whose plasma samples were collected 6 months after their first delivery. Each plasma was tested for lupus anticoagulant (LA), anticardiolipin (aCL) and antiβ2GP1 antibodies, as well as antibodies against phosphatidylserine/prothrombin complex (aPS/PT) and domain I of the β2GP1. RESULTS When compared with the control group no significant associations were found for the NS-PEecl group after adjustment of confounding variables. For the S-PEecl group, there was an association with antiβ2GP1 immunoglobulin G (IgG) (OR 16.91, 95% CI 3.71-77.06), as well as age, obesity, smoking and multiparity. Antiβ2GP1-domain I IgG was associated with aCL, antiβ2GP1 and aPS/PT IgG in the three groups. aPS/PT IgG was associated with aCL IgG, and aPS/PT IgM was associated with aCL and antiβ2GP1 IgM in the three groups. CONCLUSION S-PEecl is a distinct entity from NS-PEecl and is mainly associated with the presence of antiβ2GP1 IgG. Antiβ2GP1 domain I correlates with other aPL IgG tests, and aPS/PT may be promising in patients for whom LA tests cannot be interpreted.
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Affiliation(s)
- T Marchetti
- Haemostasis Unit, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - P de Moerloose
- Haemostasis Unit, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - J C Gris
- Laboratoire et Consultations d'Hématologie, CHU Nîmes, Nîmes, France
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22
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Holme PA, Combescure C, Tait R, Berntorp E, Rauchensteiner S, de Moerloose P. Hypertension, haematuria and renal functioning in haemophilia - a cross-sectional study in Europe. Haemophilia 2015; 22:248-255. [DOI: 10.1111/hae.12847] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 01/17/2023]
Affiliation(s)
- P. A. Holme
- Department of Haematology; Oslo University Hospital and Institute of Clinical Medicine University of Oslo; Oslo Norway
| | - C. Combescure
- University Hospital and Faculty of Medicine of Geneva; Geneva Switzerland
| | | | | | | | - P. de Moerloose
- University Hospital and Faculty of Medicine of Geneva; Geneva Switzerland
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23
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Casini A, Neerman-Arbez M, Ariëns RA, de Moerloose P. Dysfibrinogenemia: from molecular anomalies to clinical manifestations and management. J Thromb Haemost 2015; 13:909-19. [PMID: 25816717 DOI: 10.1111/jth.12916] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [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: 01/19/2015] [Indexed: 12/14/2022]
Abstract
Congenital dysfibrinogenemia is a qualitative congenital fibrinogen disorder characterized by normal antigen levels of a dysfunctional fibrinogen. The diagnosis is usually based on discrepancies between fibrinogen activity and antigen levels, but could require more specialized techniques for the assessment of fibrinogen function, owing to some limitations in routine assays. Molecular abnormalities, which are frequently heterozygous missense mutations localized in exon 2 of FGA and exon 8 of FGG, lead to defects in one or more phases of fibrinogen to fibrin conversion, fibrin network formation, and other important functions of fibrinogen. The clinical phenotype is highly heterogeneous, from no manifestations to bleeding and/or thrombotic events. Asymptomatic propositi and relatives with the predisposing genotype are at risk of developing adverse outcomes during the natural course of the disease. Correlations between genotype and phenotype have not yet been clearly established, with the exception of some abnormal fibrinogens that severely increase the risk of thrombosis. Functional analysis of polymerization and fibrinolysis, structural studies of the fibrin network and the viscoelastic properties of fibrin clot could help to predict the phenotype of congenital dysfibrinogenemia, but have not yet been evaluated in detail. The management is essentially based on personal and family history; however, even individuals who are still asymptomatic and without a family history should be carefully assessed and monitored. Particular situations, such as pregnancy, delivery, and surgery, require a multidisciplinary approach.
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Affiliation(s)
- A Casini
- Angiology and Hemostasis Division, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M Neerman-Arbez
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - R A Ariëns
- Theme Thrombosis, Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine and Multidisciplinary Cardiovascular Research Centre, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - P de Moerloose
- Angiology and Hemostasis Division, University Hospitals and Faculty of Medicine, Geneva, Switzerland
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24
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Casini A, Sokollik C, Lukowski SW, Lurz E, Rieubland C, de Moerloose P, Neerman-Arbez M. Hypofibrinogenemia and liver disease: a new case of Aguadilla fibrinogen and review of the literature. Haemophilia 2015; 21:820-7. [PMID: 25990487 DOI: 10.1111/hae.12719] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Fibrinogen storage disease (FSD) is characterized by hypofibrinogenemia and hepatic inclusions due to impaired release of mutant fibrinogen which accumulates and aggregates in the hepatocellular endoplasmic reticulum. Liver disease is variable. AIM We studied a new Swiss family with fibrinogen Aguadilla. In order to understand the molecular peculiarity of FSD mutations, fibrinogen Aguadilla and the three other causative mutations, all located in the γD domain, were modelled. METHOD The proband is a Swiss girl aged 4 investigated because of fatigue and elevated liver enzymes. Protein structure models were prepared using the Swiss-PdbViewer and POV-Ray software. RESULTS The proband was found to be heterozygous for fibrinogen Aguadilla: FGG Arg375Trp. Familial screening revealed that her mother and maternal grandmother were also affected and, in addition, respectively heterozygous and homozygous for the hereditary haemochromatosis mutation HFE C282Y. Models of backbone and side-chain interactions for fibrinogen Aguadilla in a 10-angstrom region revealed the loss of five H-bonds and the gain of one H-bond between structurally important amino acids. The structure predicted for fibrinogen Angers showed a novel helical structure in place of hole 'a' on the outer edge of γD likely to have a negative impact on fibrinogen assembly and secretion. CONCLUSION The mechanism by which FSD mutations generate hepatic intracellular inclusions is still not clearly established although the promotion of aberrant intermolecular strand insertions is emerging as a likely cause. Reporting new cases is essential in the light of novel opportunities of treatment offered by increasing knowledge of the degradation pathway and autophagy.
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Affiliation(s)
- A Casini
- Angiology and Haemostasis, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - C Sokollik
- Paediatric Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - S W Lukowski
- Department of Genetic Medicine and Development, University Medical School of Geneva, Geneva, Switzerland
| | - E Lurz
- Paediatric Gastroenterology, Hepatology and Nutrition, University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - C Rieubland
- Division of Human Genetics, Department of Paediatrics, Inselspital, Bern, Switzerland
| | - P de Moerloose
- Angiology and Haemostasis, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - M Neerman-Arbez
- Angiology and Haemostasis, University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland.,Department of Genetic Medicine and Development, University Medical School of Geneva, Geneva, Switzerland
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25
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Lavigne-Lissalde G, Aya AG, Mercier FJ, Roger-Christoph S, Chauleur C, Morau E, Ducloy-Bouthors AS, Mignon A, Raucoules M, Bongain A, Boehlen F, de Moerloose P, Bouvet S, Fabbro-Peray P, Gris JC. Recombinant human FVIIa for reducing the need for invasive second-line therapies in severe refractory postpartum hemorrhage: a multicenter, randomized, open controlled trial. J Thromb Haemost 2015; 13:520-9. [PMID: 25594352 DOI: 10.1111/jth.12844] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 12/31/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Case reports on recombinant human factor VIIa (rhuFVIIa) use in women with severe postpartum hemorrhage (PPH) showed encouraging results, but no randomized controlled trial (RCT) is available. PATIENTS AND METHODS Eighty-four women with severe PPH unresponsive to uterotonics were randomized to receive one early single rhuFVIIa infusion (n = 42) or standard care (no rhuFVIIa; n = 42). The primary efficacy outcome measure was the reduction of the need for specific second-line therapies, such as interventional hemostatic procedures, for blood loss and transfusions. The primary safety outcome measure was the number of deaths and thrombotic events during the 5 days following rhuFVIIa infusion. RESULTS rhuFVIIa was associated with a reduction in the number of patients who needed second-line therapies compared with controls (standard care). Specifically, 39/42 (93%) patients in the standard care arm received second-line therapies and 22/42 (52%) patients in the rhuFVIIa arm (absolute difference, 41%; range, 18-63%; relative risk RR, 0.56 [0.42-0.76]). The delivery mode (vaginal or Cesarean section) did not affect the primary outcome. No death occurred. Two venous thrombotic events were recorded in the rhuFVIIa arm: one ovarian vein thrombosis and one deep vein thrombosis with a non-severe pulmonary embolism. CONCLUSION This open RCT in women with severe PPH refractory to uterotonics shows that rhuFVIIa reduces the need for specific second-line therapies in about one in three patients, with the occurrence of non-fatal venous thrombotic events in one in 20 patients.
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Affiliation(s)
- G Lavigne-Lissalde
- Laboratory of Hematology, Carémeau University Hospital, Nîmes, France; Research group EA2992, Montpellier University, Nîmes, France
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26
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Pavlova A, Preisler B, Driesen J, de Moerloose P, Zieger B, Hütker S, Dengler K, Harbrecht U, Oldenburg J. Congenital combined deficiency of coagulation factors VII and X--different genetic mechanisms. Haemophilia 2015; 21:386-391. [PMID: 25582404 DOI: 10.1111/hae.12604] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 11/28/2022]
Abstract
Combined coagulation factor VII (FVII) and factor X (FX) deficiency (combined FVII/FX deficiency) belongs to the group of bleeding disorders in which both factors show reduced plasma activity. It may arise from coincidental inheritance of separate coagulation factor deficiencies or a common cause as large deletions comprising both gene loci. The F7 and F10 genes are located on the long arm of chromosome 13. Here, we describe 10 cases with combined FVII/FX deficiency representing both genetic mechanisms of occurrence. Genetic analyses included direct sequencing of the F7 and F10 genes and MLPA (multiplex ligation-dependent probe amplification) for detection of heterozygous large deletions. In four patients, the combined deficiency was due to a large deletion within the terminal end of chromosome 13. In the remaining six cases the deficiency resulted from coincidental inheritance of different genetic alterations affecting both genes independently. In most cases, the genetic defects were heterozygous, presenting with prolonged PT, normal aPTT and mild or no bleeding symptoms. Only in one case compound heterozygous mutations were detected in the F10, resulting in prolonged aPTT and a more severe bleeding phenotype. To avoid a misdiagnosis of combined FVII/FX deficiency, analyses of single factor activities have to be performed in all cases with prolonged PT even if aPTT is normal. Genetic analyses are substantial for correct prediction of an inheritance pattern and a proper genetic counselling.
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Affiliation(s)
- A Pavlova
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
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27
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Abstract
The primary major issue in haemophilia treatment remains the development of inhibitors. Recently two novel bypassing products have been developed. First, a humanized bispecific antibody against FIXa and FX, termed hBS23, was produced utilizing these two molecules placed into a spatially appropriate position to mimic FVIIIa, and recently this mimetic activity and the pharmacokinetics of the original antibody were improved by engineering the charge properties of the variable region within the immunoglobulin. Using the new antibody, termed ACE910, a phase 1 study in 64 Japanese and Caucasian healthy adults was performed and data from this trial suggested that the product had medically acceptable safety and tolerability profiles. The other new bypassing agent is named MC710, and consists of a mixture of plasma-derived FVIIa and FX. Preclinical studies using in vitro and in vivo haemophilia B inhibitor monkey models indicated that the haemostatic effects of FVIIa and FX were enhanced by simultaneous administration. Results from phase I and II clinical studies suggested that MC710 had equal or greater pharmacokinetic (PK), pharmacodynamic (PD), efficacy and safety profiles than conventional bypassing agents in the treatment of joint bleeding in haemophilia patients with inhibitors. Another significant current issue in this context is the increased medical cost of conventional treatment due to the higher consumption of concentrates. Biosimilar products may offer advantages in these circumstances and may offer a less expensive alternative. Regulatory issues, however, together with acceptability of biosimilar materials and reimbursement policies as well as supply and demand incentives remain to be considered. Rare bleeding disorders (RBDs) have attracted less attention from the pharmaceutical industry than haemophilia or von Willebrand disease due to the limited number of patients involved. Many cases of this type have been treated, therefore, using fresh frozen plasma (FFP) or prothrombin complex concentrates (PCCs) which carry serious risks of infections, allergic reactions and fluid overload. Several specific plasma-derived or recombinant products including fibrinogen, FVIIa, FXI and FXIII have now become available, however, and a phase III clinical study of recombinant FXIIIa has recently been completed demonstrating safety and efficacy of substances of this nature.
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Affiliation(s)
- M Shima
- Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan
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28
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Lebreton A, Casini A, Alhayek R, Kouteich KL, Neerman-Arbez M, de Moerloose P. Successful pregnancy under fibrinogen substitution in a woman with congenital afibrinogenaemia complicated by a postpartum venous thrombosis. Haemophilia 2014; 21:e108-10. [DOI: 10.1111/hae.12584] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. Lebreton
- Division of Angiology and Haemostasis; University Hospitals and Faculty of Medicine; Geneva Switzerland
- Haematology Department; CHU Clermont-Ferrand; Clermont-Ferrand France
| | - A. Casini
- Division of Angiology and Haemostasis; University Hospitals and Faculty of Medicine; Geneva Switzerland
| | - R. Alhayek
- Urology Department; Dubai Hospital; Dubai United Arab Emirates
| | - K. L. Kouteich
- Gynaecology Department; Saudi German Hospital; Dubai United Arab Emirates
| | - M. Neerman-Arbez
- Division of Angiology and Haemostasis; University Hospitals and Faculty of Medicine; Geneva Switzerland
- Department of Genetic Medicine and Development; Faculty of Medicine; University of Geneva; Geneva Switzerland
| | - P. de Moerloose
- Division of Angiology and Haemostasis; University Hospitals and Faculty of Medicine; Geneva Switzerland
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29
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Fontana P, Poncet A, Lindhoff-Last E, de Moerloose P, Devreese KM. Refinement of the cutoff values of the HemosIL AcuStar assay for the detection of anticardiolipin and anti-beta2 glycoprotein-1 antibodies. J Thromb Haemost 2014; 12:2034-7. [PMID: 25244443 DOI: 10.1111/jth.12732] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 09/15/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The HemosIL AcuStar antiphospholipid assay (Instrumentation Laboratory, Bedford, MA, USA) is a fully automated assay using chemiluminescent technology for the detection of anticardiolipin and anti-beta2 glycoprotein-1 antibodies. This assay showed excellent agreement between results of different laboratories. The cutoff values to define positivity were calculated in 250 healthy blood bank donors but were associated with large confidence intervals (CIs). OBJECTIVE The objective of this study was to more precisely determine the cutoff values of the HemosIL AcuStar antiphospholipid assay by increasing the number of healthy blood bank donors through a multicenter study and by applying a normalization procedure of the distribution of each antibody. METHODS Five laboratories participated to this study, allowing the inclusion of 626 samples. We used a Box-Cox power transformation method to normalize the distribution and calculate the 99th percentile and the corresponding 95%CI for each antibody. RESULTS The revised cutoff values were overall lower than those initially calculated with more stringent CIs and yielded a 4.2% increase in sensitivity with a 2.7% decrease in specificity regarding thrombotic events or obstetric complications. CONCLUSIONS We provide refined cutoff values for the detection of anticardiolipin and anti-beta2 glycoprotein-1 antibodies with the HemosIL AcuStar Antiphospholipid assay that should be preferred for routine use.
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Affiliation(s)
- P Fontana
- Division of Angiology and Haemostasis, University Hospitals of Geneva and Geneva Platelet Group, Faculty of Medicine, Geneva, Switzerland
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30
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Marchetti T, Ruffatti A, Wuillemin C, de Moerloose P, Cohen M. Hydroxychloroquine restores trophoblast fusion affected by antiphospholipid antibodies. J Thromb Haemost 2014; 12:910-20. [PMID: 24656088 DOI: 10.1111/jth.12570] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/13/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Obstetric antiphospholipid syndrome (APS) is defined by pregnancy complications associated with antiphospholipid antibodies (aPL). The mechanisms of the pathogenic effects of aPL in pregnancy are poorly understood. Toll-like receptors (TLR) have been implicated previously in APS. OBJECTIVES The aims of our study were (1) to determine aPL effects on trophoblastic cell fusion and differentiation, (2) to identify which TLR is involved in this process, and (3) to evaluate the efficacy of hydroxychloroquine (HCQ) to counteract the effects of aPL. METHODS BeWo cells are a model for trophoblast fusion and differentiation. Fusion index was assessed by immunocytochemical examination, and biochemical differentiation by using ELISA-measured β-human choronic gonadotropin hormone (β-hCG) secretion. We used three types of aPL to study their effect on cell fusion and differentiation: aPL derived from obstetric APS patients and affinity purified and polyclonal rabbit anti-β2-glycoprotein-1 (anti-β2GP1) antibodies. Experiments on fusion were confirmed using primary cytotrophoblastic cells. RESULTS All of the types of aPL used decreased the fusion index in BeWo and primary trophoblastic cells (64%, 52%, and 41% for BeWo cells and 67% and 62% for primary cells, respectively), and anti-β2GP1 antibodies decreased hCG secretion in BeWo cells (41%). To block TLR4 antibodies or to abolish TLR4 cell surface expression restored fusion index in both cell types and β-human choronic gonadotropin hormone excretion in BeWo cells. HCQ treatment induced the same effect and decreased TLR4 mRNA (40% and 35%, respectively) and protein expressions (62% and 42%, respectively) in BeWo cells. CONCLUSION Anti-β2GP1 antibodies decrease trophoblastic differentiation via TLR4. This effect is restored by HCQ, suggesting its therapeutic interest in APS pregnancies.
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Affiliation(s)
- T Marchetti
- Laboratory of Hormonology, Maternity, Geneva University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland; Angiology and Haemostasis Division, Geneva University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
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31
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Bolton-Maggs P, Goudemand J, Hermans C, Makris M, de Moerloose P. FXI concentrate use and risk of thrombosis. Haemophilia 2014; 20:e349-51. [PMID: 24785157 DOI: 10.1111/hae.12457] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/29/2022]
Affiliation(s)
- P Bolton-Maggs
- SHOT Office, Manchester Blood Centre, Plymouth Grove, Manchester, UK
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32
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Brandt KJ, Fickentscher C, Boehlen F, Kruithof EKO, de Moerloose P. NF-κB is activated from endosomal compartments in antiphospholipid antibodies-treated human monocytes. J Thromb Haemost 2014; 12:779-91. [PMID: 24612386 DOI: 10.1111/jth.12536] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 02/12/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND The antiphospholipid antibody syndrome (APS) is an autoimmune disease associated with arterial or venous thrombosis and/or recurrent fetal loss and is caused by pathogenic antiphospholipid antibodies (aPLA). We recently demonstrated that Toll-like receptor 2 (TLR2) and CD14 contribute to monocyte activation of aPLA. OBJECTIVE To study the mechanisms of cell activation by aPLA, leading to pro-coagulant and pro-inflammatory responses. METHODS AND RESULTS For this study, we used purified antibodies from the plasmas of 10 different patients with APS and healthy donors. We demonstrate that aPLA, but not control IgG, co-localizes with TLR2 and TLR1 or TLR6 on human monocytes. Blocking antibodies to TLR2, TLR1 or TLR6, but not to TLR4, decreased TNF and tissue factor (TF) responses to aPLA. Pharmacological and siRNA approaches revealed the importance of the clathrin/dynamin-dependent endocytic pathway in cell activation by aPLA. In addition, soluble aPLA induced NF-κB activation, while bead-immobilized aPLA beads, which cannot be internalized, were unable to activate NF-κB. Internalization of aPLA in monocytes and NF-κB activation were dependent on the presence of CD14. CONCLUSION We show that TLR2 and its co-receptors, TLR1 and TLR6, contribute to the pathogenicity of aPLA, that aPLA are internalized via clathrin- and CD14-dependent endocytosis and that endocytosis is required for NF-κB activation. Our results contribute to a better understanding of the APS and provide a possible therapeutic approach.
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Affiliation(s)
- K J Brandt
- Division of Angiology and Hemostasis, University Hospital of Geneva and Faculty of Medicine, Geneva, Switzerland
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Casini A, Lukowski S, Quintard VL, Crutu A, Zak M, Regazzoni S, de Moerloose P, Neerman-Arbez M. FGB mutations leading to congenital quantitative fibrinogen deficiencies: an update and report of four novel mutations. Thromb Res 2014; 133:868-74. [PMID: 24560896 DOI: 10.1016/j.thromres.2014.01.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/16/2014] [Accepted: 01/20/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Causative mutations leading to congenital quantitative fibrinogen are frequently clustered in FGA encoding the fibrinogen Aα-chain. Mutations of FGB encoding the Bβ-chain are less common and of interest since the Bβ-chain is considered the rate-limiting factor in the hepatic production of the fibrinogen hexamer. METHOD Four novel FGB mutations were identified in two afibrinogenemic (one new-born and one 30 years old male) and hypofibrinogenemic (a 49 years old female) patient, with heterogeneous thrombotic and bleeding phenotype. The human fibrinogen beta chain precursor protein sequence (P02675) was obtained from the UniProt database. The resulting models were analysed in SwissPdbViewer 4.1 and POV-Ray 3.7. RESULTS The FGB c.895T>C p.Y299H (numbering from the initiator Met) and the FGB c.1415G>T p.G472V were predicted to be deleterious by SIFT analysis. The first replaces an uncharged aromatic amino acid side chain by a positively charged side chain modifying the balance in the distribution of hydrophobic and hydrophilic of the 10 Å neighbourhood residues. The second replaces one non-charged aliphatic side chain by another without any changes for the 10 Å surrounding region. The FGB c.352C>T p.Q118X leads to a severe premature termination codon and the FGB intron 4: IVS4-1G>C (c719-1G>C) leads to skipping of exon 5 or usage of a cryptic acceptor site located upstream or downstream of the normal site. CONCLUSIONS The continuous characterization of novel molecular defects responsible for fibrinogen deficiency combined with modelling of mutant proteins will continue to provide a better comprehension of the complexity of fibrinogen synthesis and physiology.
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Affiliation(s)
- A Casini
- Division of Angiology and Haemostasis, University Hospitals of Geneva, Switzerland
| | - S Lukowski
- Department of Genetic Medicine and Development, University Medical School of Geneva, Switzerland
| | - V Louvain Quintard
- Haemostasis Laboratory, Surgical Center Marie Lannelongue, Le Plessis Robinson, France
| | - A Crutu
- Haemostasis Laboratory, Surgical Center Marie Lannelongue, Le Plessis Robinson, France
| | - M Zak
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S Regazzoni
- Division of Haematology, Regional Hospital of Lugano, Lugano, Switzerland
| | - P de Moerloose
- Division of Angiology and Haemostasis, University Hospitals of Geneva, Switzerland.
| | - M Neerman-Arbez
- Division of Angiology and Haemostasis, University Hospitals of Geneva, Switzerland; Department of Genetic Medicine and Development, University Medical School of Geneva, Switzerland
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Hermans C, de Moerloose P, Dolan G. Clinical management of older persons with haemophilia. Crit Rev Oncol Hematol 2013; 89:197-206. [PMID: 23953685 DOI: 10.1016/j.critrevonc.2013.07.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 03/24/2013] [Revised: 06/23/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022] Open
Abstract
Life expectancy for people with haemophilia (PWH) has improved and is now approaching that of the general population. The growing population of elderly PWH will therefore increasingly face the age-related morbidities such as cardiovascular diseases, malignant disease, liver disease, and bone and joint related diseases, as well as the lifestyle and psychosocial factors that accompany many of these conditions. For many PWH, frequent contact with haemophilia specialists within the comprehensive care centres supplants the relationship that individuals in the general population have with their general practitioners. As a result, there is a risk that elderly PWH may miss the chronic disease screening opportunities offered to the general population. This review focuses on the screening tests and examinations recommended for age-related comorbidities in the general population that may be applicable to the growing population of older people with haemophilia.
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Affiliation(s)
- C Hermans
- Haemostasis-Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - P de Moerloose
- Hemostasis Unit, University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - G Dolan
- Nottingham Haemophilia Comprehensive Care Centre, Nottingham University Hospitals, Queens Medical Center, Nottingham, UK
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Biron-Andreani C, de Moerloose P, D'oiron R, Chambost H, Schved JF, Hermans C. Cancer detection and management in patients with haemophilia: a retrospective European multicentre study. Haemophilia 2013; 20:78-82. [DOI: 10.1111/hae.12250] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 12/29/2022]
Affiliation(s)
- C. Biron-Andreani
- Haemophilia Treatment Centre; Saint-Eloi University Hospital Montpellier; Montpellier France
| | - P. de Moerloose
- Haemophilia Treatment Centre; University Hospital and Faculty of Medicine; Geneva Switzerland
| | - R. D'oiron
- Haemophilia Treatment Centre; Paris-Le Kremlin Bicêtre; Bicêtre APHP University Hospital; Le Kremlin Bicêtre France
| | - H. Chambost
- Haemophilia Treatment Centre; La Timone Hospital APHM; Aix Marseille University; Marseille France
| | - J.-F. Schved
- Haemophilia Treatment Centre; Saint-Eloi University Hospital Montpellier; Montpellier France
| | - C. Hermans
- Haemophilia Treatment Centre; St-Luc University Hospital Brussels; Brussels Belgium
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Staritz P, de Moerloose P, Schutgens R, Dolan G. Applicability of the European Society of Cardiology guidelines on management of acute coronary syndromes to people with haemophilia - an assessment by the ADVANCE Working Group. Haemophilia 2013; 19:833-40. [PMID: 23710576 DOI: 10.1111/hae.12189] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2013] [Indexed: 12/11/2022]
Abstract
There are no evidence-based guidelines for antithrombotic management in people with haemophilia (PWH) presenting with acute coronary syndrome (ACS). The aim of the study was to review the current European Society of Cardiology guidelines, and to consider how best they should be adapted for PWH. Structured communication techniques based on a Delphi-like methodology were used to achieve expert consensus on key aspects of clinical management. The main final statements are as follows: (i) ACS and myocardial revascularization should be managed promptly by a multidisciplinary team that includes a haemophilia expert, (ii) each comprehensive care centre for adult PWH should have a formal clinical referral pathway with a cardiology centre with an emergency unit and 24 h availability of percutaneous coronary intervention (PCI), (iii) PCI should be performed as soon as possible under adequate clotting factor protection, (iv) bare metal stents are preferred to drug-eluting stents, (v) anticoagulants should only be used in PWH after replacement therapy, (vi) minimum trough levels should not fall below 5-15% in PWH on dual antiplatelet therapy, (vii) the duration of dual antiplatelet therapy after ACS and PCI should be limited to a minimum, (viii) the use of GPIIb-IIIa inhibitors is not recommended in PWH other than in exceptional circumstances, (ix) the use of fibrinolysis may be justified in PWH when primary PCI (within 90 min) is not available ideally under adequate clotting factor management. It is hoped that the results of this initiative will help to guide optimal management of ACS in PWH.
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Affiliation(s)
- P Staritz
- Department of Internal Medicine, Hemophilia Care Center Heidelberg, SRH Kurpfalzkrankenhaus, Heidelberg, Germany
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Bonhomme F, Schved JF, Giansily-Blaizot M, Samama CM, de Moerloose P. Déficits rares de la coagulation et gestes invasifs. ACTA ACUST UNITED AC 2013; 32:198-205. [DOI: 10.1016/j.annfar.2013.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/21/2013] [Indexed: 12/20/2022]
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Casini A, Boehlen F, Lecompte T, de Moerloose P. [Thrombotic risk in myeloproliferative neoplasms: what the general practitioner needs to know]. Rev Med Suisse 2013; 9:315-320. [PMID: 23469399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Polycythaemia vera, essential thrombocythemia and primary myelofibrosis are stem cell-derived clonal haemopathies classified in the group of myeloproliferative neoplasms. Their clinical course may be complicated by both arterial and venous (sometimes in unusual sites) thrombotic events. Although general risk factors contribute to the prevalence of thrombotic events in this population, some other risk factors are specifically associated with the myeloproliferative neoplasms. The treatment options are aspirin, anticoagulation, cytoreduction and phlebotomies.
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Affiliation(s)
- A Casini
- Service d'angiologie et d'hémostase HUG et Faculté de médecine de Geneve, 1211 Geneve 14.
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Righini M, Mazzolai L, de Moerloose P. [Which anticoagulant agent for which patient?]. Rev Med Suisse 2013; 9:299-300. [PMID: 23469395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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de Moerloose P, Casini A, Boehlen F, Fontana P. [New oral anticoagulants: from theory to practice]. Rev Med Suisse 2013; 9:104-107. [PMID: 23409645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Physicians are confronted with many new antithrombotic drugs, either antiplatelet agents or new oral anticoagulants (NOAC). Targets of NOAC are specific (either anti-IIa or antiXa) and clinical studies have shown that NOAC are as efficacious and as safe as "old" anticoagulants (heparin, low molecular weight heparin, vitamin K antagonists); moreover they present some advantages. Indeed, NOAC have a wide therapeutic window and do not require laboratory monitoring. Therefore, it is very tempting to prescribe them on a large scale basis in patients at risk or having thromboembolic diseases. However, things are not so simple in the day-to-day practice and this review aims at answering in a brief and simplified manner to some questions.
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Affiliation(s)
- P de Moerloose
- Service d'angiologie et d'hémostase HUG, 1211 Genève 14.
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Pagano S, Satta N, Werling D, Offord V, de Moerloose P, Charbonney E, Hochstrasser D, Roux-Lombard P, Vuilleumier N. Anti-apolipoprotein A-1 IgG in patients with myocardial infarction promotes inflammation through TLR2/CD14 complex. J Intern Med 2012; 272:344-57. [PMID: 22329401 DOI: 10.1111/j.1365-2796.2012.02530.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Toll-like receptor (TLR)-mediated vascular inflammation, inducible by - amongst other factors - auto-antibodies, is increasingly recognized as a potential mediator of cardiovascular disease. We investigated whether anti-apolipoprotein (Apo)A-1 IgG was associated with a pro-inflammatory cytokine profile in myocardial infarction (MI) patients and whether anti-ApoA-1 IgG elicited a pro-inflammatory response by activating TLRs. METHODS As surrogate markers of atherosclerotic plaque vulnerability, interleukin (IL)-6, tumour necrosis factor (TNF)-α, matrix metalloproteinase (MMP)-9 and MMP-3 levels were assessed in 221 consecutive MI patients. Using human monocyte-derived macrophages (HMDMs) we investigated (i) the anti-ApoA-1 IgG interaction with TLRs using proximity ligation assay and (ii) anti-ApoA-1 IgG-dependent IL-6/TNF-α production. TLR involvement was further confirmed using HEK293-Blue TLR-2/-4 cells and by computational docking simulations. RESULTS In MI patients, anti-ApoA-1 IgG positivity was associated with higher levels of IL-6, TNF-α and MMP-9, but lower MMP-3 levels. In in vitro experiments, anti-ApoA-1 antibodies bound to HDMDs in a TLR2-dependent manner, resulting in nuclear translocation of NFκB and a significant increase in TNF-α and IL-6 production. Subsequent functional studies highlighted the importance of CD14 as co-receptor in the anti-ApoA-1 IgG-TLR2-induced cytokine production. Additional bioinformatic studies identified structural homologies between TLR2 and ApoA-1, which may explain the observed cross-reactivity between antibodies against these two molecules. CONCLUSIONS Anti-ApoA-1 IgG positivity in MI is associated with a high-risk cytokine profile. These auto-antibodies promote inflammation by stimulating the TLR2/CD14 receptor complex, probably because of molecular mimicry, which may contribute to atherosclerosis-related complications in patients.
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Affiliation(s)
- S Pagano
- Division of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospital, Geneva, Switzerland
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Brandt K, Fickentscher C, de Lamotte GF, Boehlen F, Reber G, Kruithof E, de Moerloose P. P146 TLR2-ligands induce NF-κB activation exclusively from endosomal compartments. Cytokine 2012. [DOI: 10.1016/j.cyto.2012.06.246] [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: 11/27/2022]
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Mansouri Taleghani B, Boehlen F, Chizzolini C, Kössler T, Matthes T, Ortner E, Blondon M, Tirefort Y, Reber G, de Moerloose P. 57 Acquired factor XIII inhibitor: multimodal therapeutic approach with finally including immunoadsorption. Transfus Apher Sci 2010. [DOI: 10.1016/s1473-0502(10)70034-3] [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: 11/29/2022]
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Boehlen F, Tirefort-Dimitrova Y, de Moerloose P, Fontana P. [Update on new antithrombotic treatments]. Rev Med Suisse 2010; 6:109-112. [PMID: 20170027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Update on new antithrombotic treatments Antithrombotic treatments are frequently prescribed in different clinical situations. Classical anticoagulants have some disadvantages. New anticoagulants have emerged recently. Fondaparinux is now prescribed for both prophylaxis and treatment of venous thromboembolism. Two drugs are particularly interesting: rivaroxaban and dabigatran. Concerning the new antiplatelet agents, many molecules such as prasugrel, ticagrelor, cangrelor, SCH530348 or terutroban have appeared recently. They are directed either to the P2Y12 receptor or to other original targets. Studies have shown an increased bleeding risk for some of them as well as unexpected side effects. In the next future, these new molecules could allow a more individualised prescription of antithrombotic agents.
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Affiliation(s)
- F Boehlen
- Unité D'Hémostase Service, d'angiologie et d'hémostase, Département de médicine interne, HUG, Genève.
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Klamroth R, von Depka M, Richards M, de Moerloose P, Fischer K, Lambert T, Lavigne-Lissalde G, Perez R, Dolan G, Hermans C, Holstein K. Management of acute haemarthrosis in haemophilia A. Hamostaseologie 2010. [DOI: 10.1055/s-0037-1619070] [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: 10/17/2022] Open
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Reny JL, Bonvini R, Barazer I, Berdagué P, de Moerloose P, Schved JF, Gris JC, Fontana P. Le concept de « résistance » à l’aspirine : mécanismes et pertinence clinique. Rev Med Interne 2009; 30:1020-9. [DOI: 10.1016/j.revmed.2009.02.028] [Citation(s) in RCA: 2] [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] [Received: 09/16/2008] [Revised: 02/03/2009] [Accepted: 02/15/2009] [Indexed: 11/29/2022]
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de Laat B, Pengo V, Pabinger I, Musial J, Voskuyl AE, Bultink IEM, Ruffatti A, Rozman B, Kveder T, de Moerloose P, Boehlen F, Rand J, Ulcova-Gallova Z, Mertens K, de Groot PG. The association between circulating antibodies against domain I of beta2-glycoprotein I and thrombosis: an international multicenter study. J Thromb Haemost 2009; 7:1767-73. [PMID: 19694946 DOI: 10.1111/j.1538-7836.2009.03588.x] [Citation(s) in RCA: 212] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Diagnosis of the antiphospholipid syndrome (APS) is difficult as a result of limited specificity of existing assays for detecting clinically relevant antiphospholipid antibodies. Anti-beta2-glycoprotein I (beta 2GPI) antibodies play a central role in the disease process of APS. OBJECTIVES We have investigated the relation between antiphospholipid antibodies with specificity for domain I of beta 2GPI and thrombosis/pregnancy morbidity in an international multicenter study. PATIENTS/METHODS Four hundred and seventy-seven patients derived from nine different centres met the inclusion criterion of having anti-beta 2GPI antibodies in their plasma/serum. Clinical data and results of tests for lupus anticoagulant, anti-cardiolipin antibodies and anti-beta 2GPI antibodies were established at the different centres of inclusion. After being re-tested for the presence of IgG and/or IgM anti-beta 2GPI antibodies, the samples were tested for the presence of IgG-directed against domain I of beta 2GPI and results were correlated with the thrombotic and obstetric history. RESULTS Re-testing for the presence of anti-beta 2GPI antibodies resulted in inclusion of 442/477 patients. IgG class anti-domain I antibodies were present in plasma of 243/442 patients (55%). 201/243 (83%) had a history of thrombosis. This resulted in an odds ratio of 3.5 (2.3-5.4, 95% confidence interval) for thrombosis. Anti-domain I IgG antibodies were also significantly correlated with obstetric complications [odds ratio: 2.4 (1.4-4.3, 95% confidence interval)]. CONCLUSION In this multicenter study, the detection of IgG antibodies that are directed against domain I of beta 2GPI proved to be more strongly associated with thrombosis and obstetric complications than those detected using the standard anti-beta 2GPI antibody assay.
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Affiliation(s)
- B de Laat
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands.
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Astermark J, Negrier C, Hermans C, Holme PA, Klamroth R, Kotsi P, de Moerloose P, Pasi J, Rocino A, von Depka M, Windyga J, Ludlam CA. European curriculum for thrombosis and haemostasis. Haemophilia 2009; 15:337-44. [PMID: 19149857 DOI: 10.1111/j.1365-2516.2008.01836.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Astermark
- Department for Coagulation Disorders, Malmö University Hospital, Malmö, Sweden.
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