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Manoharan A, Gemmell R, Cavanaugh L, Shadood N. Thrombosis in Myeloproliferative Neoplasms: A Single Center Experience of Using Whole Blood Platelet Aggregation Studies for Risk Assessment and Thromboprophylaxis. Clin Appl Thromb Hemost 2022; 28:10760296221117482. [PMID: 35898172 PMCID: PMC9340402 DOI: 10.1177/10760296221117482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Thromboembolic complications are the most common causes of morbidity and
mortality in patients with Philadelphia chromosome-negative myeloproliferative
neoplasms (MPN); and prevention of these complications remains a significant
clinical challenge. Effective thromboprophylaxis in MPN patients generally
requires use of anti-platelet therapy, commonly aspirin; however, there are no
standardized or universally accepted guidelines regarding the dose of aspirin.
This study evaluates the usefulness of whole blood platelet aggregation (WBPA)
studies to identify patients at risk for thrombosis and to achieve safe and
effective long term thromboprophylaxis. One hundred and thirty-two consecutive
patients were enrolled into this study. WBPA studies were performed at diagnosis
in 125 patients to identify those with platelet hyperactivity (deemed to be at
risk for thrombosis) and repeated 4 weeks after commencement of anti-platelet
therapy to ascertain the efficacy. In patients with incomplete drug effect,
treatment was revised and the study repeated until optimum effect was achieved.
Results of the WBPA studies and anti-platelet therapy requirements were
correlated with the underlying driver mutations and various international
prognostic score of thrombosis for essential thrombocythemia (IPSET- Thrombosis)
sub-groups. WBPA studies showed varying degrees of platelet hyper-activity in
115 patients. Based on these results, the patients were commenced on
anti-platelet therapy comprising aspirin (dose ranging from 100mg twice or
thrice weekly to 400mg daily) and clopidogrel (75mg daily) alone or in
combination with aspirin or odorless garlic. None of the patients developed
thrombosis during the follow up period ranging from 1-23 years (median 8yrs),
while on the prescribed, individualized anti-platelet therapy. No significant
differences were noted in terms of aspirin dose requirements between the JAK-2
positive and CALR or MPL positive patients, and, among the four IPSET-Thrombosis
sub-groups. Patients with normal (9) or hypo (1) – activity were not given any
anti-platelet therapy at diagnosis.
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Affiliation(s)
- Arumugam Manoharan
- Southern Sydney Haematology, St George Private Hosipital, Sydney, Australia.,Faculty of Health, Medicine & Applied Sciences, 8691University of Wollongong, Wollongong, New South Wales, Australia
| | - Rosalie Gemmell
- Department of Haematology, ST. George Hospital, Sydney, Australia
| | - Lauren Cavanaugh
- Department of Haematology, ST. George Hospital, Sydney, Australia
| | - Noor Shadood
- Department of Haematology, ST. George Hospital, Sydney, Australia
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Badar S, Azarkan M, Mekkawy AH, Akhter J, Pillai K, El Mahyaoui R, Ke K, Cavanaugh L, Morris DL. Comparison of proteolytic, cytotoxic and anticoagulant properties of chromatographically fractionated bromelain to un-fractionated bromelain. Am J Transl Res 2021; 13:4309-4321. [PMID: 34150016 PMCID: PMC8205729] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
Bromelain consisting of a number of proteolytic enzymes possess anticancer and thrombotic properties. Hence, four chromatically separated fractions were examined for their proteolytic, anticancer and antithrombotic activity. Bromelain fractions were separated using ion-exchange column chromatography. Proteolytic properties were assessed using standard azocasein assay. Anticancer properties were first assessed using four different cell lines PANC-1, HEP 2B, HEP 3G and OVCAR-3 on cells grown in 96 well plates. Subsequently, fraction 2 and fraction 3 combined with gemcitabine were tested in ASPC-1 cells. Then cytotoxicity of fraction 3 was compared to bromelain in combination with doxorubicin and N-acetylcysteine on HEP G2 and HEP 3B cells. Finally, the anticoagulation effect of fraction 3 or bromelain combined with N-acetylcysteine was evaluated using human blood. Fraction 3 showed the highest proteolytic activity (5% greater than standard bromelain) whilst others were less active. Cytotoxicity as assessed by IC50 indicated fraction 3 to be the most potent whilst the others did not follow their proteolytic potency order. OVCAR-3 was the most sensitive amongst the cell lines. Fraction 3 showed higher potency in combination with gemcitabine in ASPC-1 cells compared to fraction 2. Similarly, fraction 3 in combination with doxorubicin showed higher toxicity when compared to bromelain. Fraction 3 or bromelain only showed thrombolytic activity in combination with N-acetylcysteine. Fraction 3 may be developed for clinical use since it showed better cytotoxicity compared to bromelain.
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Affiliation(s)
- Samina Badar
- Department of Surgery, University of New South Wales, St. George HospitalKogarah, NSW, Australia
| | - Mohamed Azarkan
- Service de Chimie Générale I (CP 609), Protein Chemistry Unit, Faculty of Medicine, Université Libre de Bruxelles (ULB)Brussels, Belgium
| | - Ahmed H Mekkawy
- Department of Surgery, University of New South Wales, St. George HospitalKogarah, NSW, Australia
- Mucpharm Pty LtdAustralia
| | - Javed Akhter
- Department of Surgery, University of New South Wales, St. George HospitalKogarah, NSW, Australia
- Mucpharm Pty LtdAustralia
| | - Krishna Pillai
- Department of Surgery, University of New South Wales, St. George HospitalKogarah, NSW, Australia
- Mucpharm Pty LtdAustralia
| | - Rachida El Mahyaoui
- Service de Chimie Générale I (CP 609), Protein Chemistry Unit, Faculty of Medicine, Université Libre de Bruxelles (ULB)Brussels, Belgium
| | - Kevin Ke
- Department of Surgery, University of New South Wales, St. George HospitalKogarah, NSW, Australia
| | - Lauren Cavanaugh
- Haematology Department, St. George HospitalKogarah, NSW, Australia
| | - David L Morris
- Department of Surgery, University of New South Wales, St. George HospitalKogarah, NSW, Australia
- Mucpharm Pty LtdAustralia
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Favaloro EJ, Mohammed S, Donikian D, Kondo M, Duncan E, Yacoub O, Zebeljan D, Ng S, Malan E, Yuen A, Beggs J, Moosavi S, Coleman R, Klose N, Chapman K, Cavanaugh L, Pasalic L, Motum P, Tan CW, Brighton T. A multicentre assessment of contemporary laboratory assays for heparin induced thrombocytopenia. Pathology 2020; 53:247-256. [PMID: 33032809 DOI: 10.1016/j.pathol.2020.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 03/03/2020] [Revised: 06/25/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022]
Abstract
Heparin induced thrombocytopenia (HIT) is a rare but potentially fatal complication of heparin therapy. In some patients, HIT causes platelet activation and thrombosis (sometimes abbreviated HITT), which leads to adverse clinical sequalae ('pathological HIT'). The likelihood of HIT is initially assessed clinically, typically using a scoring system, of which the 4T score is that most utilised. Subsequent laboratory testing to confirm or exclude HIT facilitates exclusion or diagnosis and management. The current investigation comprises a multicentre (n=9) assessment of contemporary laboratory testing for HIT, as performed over the past 1-3 years in each site and comprising testing of over 1200 samples. The primary laboratory test used by study participants (n=8) comprised a chemiluminescence procedure (HIT-IgG(PF4-H)) performed on an AcuStar instrument. Additional immunological testing performed by study sites included lateral flow (STiC, Stago), enzyme linked immunosorbent assay (ELISA), Asserachrom (HPIA IgG), PaGIA (BioRad), plus functional assays, primarily serotonin release assay (SRA) or platelet aggregation methods. The chemiluminescence procedure yielded a highly sensitive screening method for identifying functional HIT, given high area under the curve (AUC, generally ≥0.9) in a receiver operator characteristic (ROC) analysis against SRA as gold standard. ELISA testing resulted in lower ROC AUC scores (<0.8) and higher levels of false positives. Although there is clear association with the likelihood of HIT, the 4T score had less utility than literature suggests, and was comparable to a previous study reported by some of the authors.
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Affiliation(s)
- Emmanuel J Favaloro
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia; NSW Health Pathology, NSW, Australia; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia.
| | - Soma Mohammed
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia; NSW Health Pathology, NSW, Australia
| | - Dea Donikian
- NSW Health Pathology, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia
| | - Mayuko Kondo
- NSW Health Pathology, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia
| | | | | | - Diane Zebeljan
- NSW Health Pathology, NSW, Australia; Liverpool Hospital, Liverpool, NSW, Australia
| | - Sara Ng
- NSW Health Pathology, NSW, Australia; Liverpool Hospital, Liverpool, NSW, Australia
| | | | - Agnes Yuen
- Monash Health, Melbourne, Vic, Australia
| | | | | | - Robyn Coleman
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Nathan Klose
- Sullivan Nicolaides Pathology, Brisbane, Qld, Australia
| | - Kent Chapman
- NSW Health Pathology, NSW, Australia; John Hunter Hospital, Newcastle, NSW, Australia
| | - Lauren Cavanaugh
- NSW Health Pathology, NSW, Australia; St George Hospital, Kogarah, NSW, Australia
| | - Leonardo Pasalic
- Department of Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), Sydney Centres for Thrombosis and Haemostasis, Westmead Hospital, Westmead, NSW, Australia; NSW Health Pathology, NSW, Australia; School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Penelope Motum
- NSW Health Pathology, NSW, Australia; Liverpool Hospital, Liverpool, NSW, Australia
| | - Chee Wee Tan
- South Australia Pathology, Adelaide, SA, Australia; Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Timothy Brighton
- NSW Health Pathology, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia
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Lee KH, Cavanaugh L, Leung H, Yan F, Ahmadi Z, Chong BH, Passam F. Quantification of NETs-associated markers by flow cytometry and serum assays in patients with thrombosis and sepsis. Int J Lab Hematol 2018. [PMID: 29520957 DOI: 10.1111/ijlh.12800] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Neutrophil extracellular traps (NETs) are networks of extracellular fibres produced from neutrophil DNA with a pathogenic role in infection, thrombosis and other conditions. Reliable assays for measuring NETs are desirable as novel treatments targeting NETs are being explored for the treatment of these conditions. We compare a whole blood flow cytometry method with serum assays to measure NETs-associated markers in patients with sepsis and thrombosis. METHODS Patients with deep venous thrombosis (n = 25), sepsis (n = 21) and healthy controls (n = 23) were included in the study. Neutrophil surface NETs markers were determined by flow cytometry on whole blood samples by gating of neutrophils stained for surface citrullinated histone (H3cit) and myeloperoxidase (MPO). Serum double-stranded (ds) DNA, MPO, myeloid-related protein, nucleosomes, DNAse, elastase, human high-mobility group box 1 and MPO-DNA complexes were quantified as circulating markers of NETs. RESULTS Neutrophil NETs markers by flow cytometry and serum NETs markers were significantly higher in patients with thrombosis and sepsis compared with healthy controls. Neutrophil NETs markers significantly correlated with the serum marker dsDNA. CONCLUSION Flow cytometry detection of neutrophil NETs markers is feasible in whole blood and correlates with serum markers of NETs. We propose the flow cytometry detection of MPO/H3cit positive neutrophils and serum dsDNA as simple methods to quantify cellular and extracellular NET markers in patients with thrombosis and sepsis.
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Affiliation(s)
- K H Lee
- Department of Haematology, St George Hospital, Kogarah, NSW, Australia.,Department of Medicine, St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - L Cavanaugh
- Department of Haematology, St George Hospital, Kogarah, NSW, Australia
| | - H Leung
- Department of Medicine, St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - F Yan
- Department of Medicine, St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Z Ahmadi
- Department of Medicine, St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - B H Chong
- Department of Haematology, St George Hospital, Kogarah, NSW, Australia.,Department of Medicine, St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - F Passam
- Department of Haematology, St George Hospital, Kogarah, NSW, Australia.,Department of Medicine, St George Clinical School, University of New South Wales, Kogarah, NSW, Australia
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