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Meijer K, van Heerde W, Gomez K. Diagnosis of rare bleeding disorders. Haemophilia 2022; 28 Suppl 4:119-124. [PMID: 35521730 DOI: 10.1111/hae.14561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022]
Abstract
Rare bleeding disorders result in significant morbidity but are globally underdiagnosed. Advances in genomic testing and specialist laboratory assays have greatly increased the diagnostic armamentarium. This has resulted in the discovery of new genetic causes for rare diseases and a better understanding of the underlying molecular pathology.
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Affiliation(s)
- Karina Meijer
- Division of Thrombosis and Haemostasis, Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Waander van Heerde
- Radboud University Medical Center, Hemophilia Treatment Centre, Nijmegen-Eindhoven-Maastricht, Nijmegen, The Netherlands.,Enzyre, Nijmegen, The Netherlands
| | - Keith Gomez
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
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Gorkom BLV, Holme PA, Joch C, Rogosch T, Feussner A, McKeand W, Roberts J, van Heerde W. Pharmacokinetics and pharmacodynamics of a recombinant fusion protein linking activated coagulation factor VII with human albumin (rVIIa-FP) in patients with congenital FVII deficiency. ACTA ACUST UNITED AC 2020; 25:17-25. [PMID: 31852380 DOI: 10.1080/16078454.2019.1700329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Recombinant fusion protein linking activated factor VIIa to human albumin (rVIIa-FP) is a therapeutic option designed to prevent and treat bleeding events in patients with congenital FVII deficiency with reduced infusion frequency compared to current FVII treatments. This study characterized the pharmacokinetics (PK) and pharmacodynamics (PD) of rVIIa-FP.Methods: A phase I multicenter, randomized, open-label, parallel-arm, single-dose study (NCT02470871) was conducted in nine patients with severe congenital FVII deficiency. Patients received their routine FVII product (30 IU/kg plasma-derived FVII [pdFVII] or 25 μg/kg recombinant activated FVII (rFVIIa) [eptacog alfa]), and were then randomly assigned to receive 100 or 300 μg/kg of rVIIa-FP. Blood samples for PK and PD assessments were drawn up to 48 hr after administration. FVIIa activity was determined using a one-stage clotting assay. PD parameters were derived from thrombin generation testing, using the Nijmegen hemostasis assay.Results: rVIIa-FP showed improved PK compared to rFVIIa, with 2- to 3-fold longer t1/2 and 4- to 8-fold lower clearance. Analysis of PD data showed a sustained suppression of lag time below 4.5 min (upper limit of healthy people) for rVIIa-FP compared to rFVIIa. AUEC and ECmax were similar across the two dose groups of rVIIa-FP and rFVIIa.Discussion: rVIIa-FP was well tolerated in patients with congenital FVII deficiency, showed a longer half-life and lower clearance compared to rFVIIa, and lag time remaining within healthy ranges for ≥8 hr.Conclusion: These results warrant further investigation into the efficacy of rVIIa-FP to control and prevent bleeding in patients with FVII deficiency.
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Affiliation(s)
- Britta Laros-van Gorkom
- Department of Hematology and Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pål André Holme
- Department of Hematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Waander van Heerde
- Department of Hematology and Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Hematology Laboratory, Radboud University Medical Center, Nijmegen, Netherlands.,Enzyre, Novio Tech Campus, Nijmegen, The Netherlands
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Meijer K, van Heerde W, Gomez K. Diagnosis of rare bleeding disorders. Haemophilia 2020; 27 Suppl 3:60-65. [PMID: 32578312 DOI: 10.1111/hae.14049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/27/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 11/27/2022]
Abstract
Rare bleeding disorders result in significant morbidity but are globally underdiagnosed. Advances in genomic testing and specialist laboratory assays have greatly increased the diagnostic armamentarium. This has resulted in the discovery of new genetic causes for rare diseases and a better understanding of the underlying molecular pathology.
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Affiliation(s)
- Karina Meijer
- Division of Thrombosis and Haemostasis, Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Waander van Heerde
- Radboud University Medical Center, Hemophilia Treatment Centre, Nijmegen-Eindhoven-Maastricht, Nijmegen, The Netherlands.,Enzyre, Nijmegen, The Netherlands
| | - Keith Gomez
- Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
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4
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Maas D, Laros-van Gorkom B, Gianotten S, Cruijsen M, van Heerde W, Nijziel M. Acquired von Willebrand Disease Associated with Mantle Cell Lymphoma. Case Rep Hematol 2018; 2018:7973297. [PMID: 29651351 PMCID: PMC5830951 DOI: 10.1155/2018/7973297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 12/26/2017] [Accepted: 12/28/2017] [Indexed: 11/18/2022] Open
Abstract
We present a rare case of acquired von Willebrand syndrome (AVWS) caused by a mantle cell lymphoma. A 61-year-old male suffered from recurrent bleeding symptoms since a few months. Initially, physical examination was normal. von Willebrand factor antigen (VWF:Ag) level and factor VIII activity (FVIII:C) were low (0.31 IU/ml and 0.43 IU/ml, resp.). Ristocetin cofactor activity (VWF:RCo) was 0.09 IU/ml, and collagen binding activity (VWF:CB) was 0.10 IU/ml. VWF:RCo/VWF:Ag ratio was 0.29, and RIPA value was normal. Highest molecular weight VWF multimers were absent. A diagnosis of von Willebrand Disease (VWD) type 2A was made. However, no genetic mutation was found. No inhibitory antibodies against VWF or factor VIII were detected. A few months later, cervical, axillary, and inguinal lymphadenopathy was found on physical examination. A CT scan confirmed multiple enlarged lymph nodes, and a clonal B-cell population matching a mantle cell lymphoma was detected in the bone marrow. Chemoimmunotherapy resulted in a very good partial remission and concomitantly in a rapid decrease of bleeding problems and complete normalization of FVIII:C and VWF:Ag. The diagnosis of AVWS cannot be rejected by negative mixing studies due to difficulties in the detection of autoantibodies and because of a highly heterogeneous pathogenesis of AVWS. When the suspicion of AVWS is high, an extensive investigation should be performed to find the underlying cause.
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Affiliation(s)
- Dominique Maas
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
- Hemophilia Treatment Center, Radboud University Medical Center, Nijmegen, Netherlands
| | - Britta Laros-van Gorkom
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
- Hemophilia Treatment Center, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sanne Gianotten
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marjan Cruijsen
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Waander van Heerde
- Hemophilia Treatment Center, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Laboratory Medicine, Laboratory for Hematology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marten Nijziel
- Department of Hematology, Radboud University Medical Center, Nijmegen, Netherlands
- Hemophilia Treatment Center, Radboud University Medical Center, Nijmegen, Netherlands
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van Heerde W, Novákovà I, Lillicrap D, Giles A, Verbruggen B. A 4% Solution of Bovine Serum Albumin May Be Used in Place of Factor VIII:C Deficient Plasma in the Control Sample in the Nijmegen Modification of the Bethesda Factor VIII:C Inhibitor Assay. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613214] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kienhorst LBE, van Lochem E, Kievit W, Dalbeth N, Merriman ME, Phipps-Green A, Loof A, van Heerde W, Vermeulen S, Stamp LK, van Koolwijk E, de Graaf J, Holzinger D, Roth J, Janssens HJEM, Merriman TR, Broen JCA, Janssen M, Radstake TRDJ. Gout Is a Chronic Inflammatory Disease in Which High Levels of Interleukin-8 (CXCL8), Myeloid-Related Protein 8/Myeloid-Related Protein 14 Complex, and an Altered Proteome Are Associated With Diabetes Mellitus and Cardiovascular Disease. Arthritis Rheumatol 2016; 67:3303-13. [PMID: 26248007 DOI: 10.1002/art.39318] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 07/30/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The frequent association of gout with metabolic syndrome and cardiovascular disease (CVD) suggests that it has a systemic component. Our objective was to study whether circulating proinflammatory cytokines are associated with comorbidities in gout patients. METHODS We studied 330 gout patients from 3 independent cohorts and compared them with 144 healthy individuals and 276 disease controls. We measured circulating levels of interleukin-8 (IL-8)/CXCL8, IL-1β, IL-6, IL-10, IL-12, and tumor necrosis factor, after which we performed proteome-wide analysis in a selection of samples to identify proteins that were possibly prognostic for the development of comorbidities. Replication analysis was performed specifically for myeloid-related protein 8 (MRP-8)/MRP-14 complex. RESULTS Compared to healthy controls and disease control patients, patients with gouty arthritis (n = 48) had significantly higher mean levels of CXCL8 (P < 0.001), while other cytokines were almost undetectable. Similarly, patients with intercritical gout showed high levels of CXCL8. CXCL8 was independently associated with diabetes mellitus in patients with intercritical gout (P < 0.0001). Proteome-wide analysis in gouty arthritis (n = 18) and intercritical gout (n = 39) revealed MRP-8 and MRP-14 as the proteins with the greatest differential expression between low and high levels of CXCL8 and also showed a positive correlation of MRP8/MRP14 complex with CXCL8 levels (R(2) = 0.49, P < 0.001). These findings were replicated in an independent cohort. The proteome of gout patients with high levels of CXCL8 was associated with diabetes mellitus (odds ratio 16.5 [95% confidence interval 2.8-96.6]) and CVD (odds ratio 3.9 [95% confidence interval 1.0-15.3]). CONCLUSION Circulating levels of CXCL8 are increased during both the acute and intercritical phases of gout, and they coincide with a specific circulating proteome that is associated with risk of diabetes mellitus and CVD. Further research focused on the roles of CXCL8 and MRP8/MRP14 complex in patients with gout is warranted.
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Affiliation(s)
| | | | - Wietske Kievit
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Arnoud Loof
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Sita Vermeulen
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | | | | | - Hein J E M Janssens
- Radboud University Medical Center, Nijmegen, The Netherlands, and Rijnstate Hospital, Arnhem, The Netherlands
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van Poppel PCM, Breedveld P, Abbink EJ, Roelofs H, van Heerde W, Smits P, Lin W, Tan AH, Russel FG, Donders R, Tack CJ, Rongen GA. Salvia Miltiorrhiza Root Water-Extract (Danshen) Has No Beneficial Effect on Cardiovascular Risk Factors. A Randomized Double-Blind Cross-Over Trial. PLoS One 2015; 10:e0128695. [PMID: 26192328 PMCID: PMC4508048 DOI: 10.1371/journal.pone.0128695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/22/2015] [Indexed: 01/06/2023] Open
Abstract
Purpose Danshen is the dried root extract of the plant Salvia Miltiorrhiza and it is used as traditional Chinese medicinal herbal product to prevent and treat atherosclerosis. However, its efficacy has not been thoroughly investigated. This study evaluates the effect of Danshen on hyperlipidemia and hypertension, two well known risk factors for the development of atherosclerosis. Methods This was a randomized, placebo-controlled, double-blind crossover study performed at a tertiary referral center. Participants were recruited by newspaper advertisement and randomized to treatment with Danshen (water-extract of the Salvia Miltiorrhiza root) or placebo for 4 consecutive weeks. There was a wash out period of 4 weeks. Of the 20 analysed participants, 11 received placebo first. Inclusion criteria were: age 40-70 years, hyperlipidemia and hypertension. At the end of each treatment period, plasma lipids were determined (primary outcome), 24 hours ambulant blood pressure measurement (ABPM) was performed, and vasodilator endothelial function was assessed in the forearm. Results LDL cholesterol levels were 3.82±0.14 mmol/l after Danshen and 3.52±0.16 mmol/l after placebo treatment (mean±SE; p<0.05 for treatment effect corrected for baseline). Danshen treatment had no effect on blood pressure (ABPM 138/84 after Danshen and 136/87 after placebo treatment). These results were further substantiated by the observation that Danshen had neither an effect on endothelial function nor on markers of inflammation, oxidative stress, glucose metabolism, hemostasis and blood viscosity. Conclusion Four weeks of treatment with Danshen (water-extract) slightly increased LDL-cholesterol without affecting a wide variety of other risk markers. These observations do not support the use of Danshen to prevent or treat atherosclerosis. Trial Registration ClinicalTrials.gov NCT01563770
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Affiliation(s)
- Pleun C. M. van Poppel
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Pauline Breedveld
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
| | - Evertine J. Abbink
- Clinical Research Centre Nijmegen, Radboud university medical center, Nijmegen, The Netherlands
| | - Hennie Roelofs
- Department of Gastro-Enterology, Radboud university medical center, Nijmegen, The Netherlands
| | - Waander van Heerde
- Department of Clinical Chemistry, Radboud university medical center, Nijmegen, The Netherlands
| | - Paul Smits
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
| | - Wenzhi Lin
- Medical Center Balans, The Hague, The Netherlands
| | - Aaitje H. Tan
- Practice for acupuncture and member of the Dutch Association of Acupuncture Medicine, Amsterdam, The Netherlands
| | - Frans G. Russel
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
| | - Rogier Donders
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Cees J. Tack
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Gerard A. Rongen
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
- Department of Pharmacology and Toxicology, Radboud university medical center, Nijmegen, The Netherlands
- * E-mail:
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van Bon L, Affandi AJ, Broen J, Christmann RB, Marijnissen RJ, Stawski L, Farina GA, Stifano G, Mathes AL, Cossu M, York M, Collins C, Wenink M, Huijbens R, Hesselstrand R, Saxne T, DiMarzio M, Wuttge D, Agarwal SK, Reveille JD, Assassi S, Mayes M, Deng Y, Drenth JPH, de Graaf J, den Heijer M, Kallenberg CGM, Bijl M, Loof A, van den Berg WB, Joosten LAB, Smith V, de Keyser F, Scorza R, Lunardi C, van Riel PLCM, Vonk M, van Heerde W, Meller S, Homey B, Beretta L, Roest M, Trojanowska M, Lafyatis R, Radstake TRDJ. Proteome-wide analysis and CXCL4 as a biomarker in systemic sclerosis. N Engl J Med 2014; 370:433-43. [PMID: 24350901 PMCID: PMC4040466 DOI: 10.1056/nejmoa1114576] [Citation(s) in RCA: 301] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Plasmacytoid dendritic cells have been implicated in the pathogenesis of systemic sclerosis through mechanisms beyond the previously suggested production of type I interferon. METHODS We isolated plasmacytoid dendritic cells from healthy persons and from patients with systemic sclerosis who had distinct clinical phenotypes. We then performed proteome-wide analysis and validated these observations in five large cohorts of patients with systemic sclerosis. Next, we compared the results with those in patients with systemic lupus erythematosus, ankylosing spondylitis, and hepatic fibrosis. We correlated plasma levels of CXCL4 protein with features of systemic sclerosis and studied the direct effects of CXCL4 in vitro and in vivo. RESULTS Proteome-wide analysis and validation showed that CXCL4 is the predominant protein secreted by plasmacytoid dendritic cells in systemic sclerosis, both in circulation and in skin. The mean (±SD) level of CXCL4 in patients with systemic sclerosis was 25,624±2652 pg per milliliter, which was significantly higher than the level in controls (92.5±77.9 pg per milliliter) and than the level in patients with systemic lupus erythematosus (1346±1011 pg per milliliter), ankylosing spondylitis (1368±1162 pg per milliliter), or liver fibrosis (1668±1263 pg per milliliter). CXCL4 levels correlated with skin and lung fibrosis and with pulmonary arterial hypertension. Among chemokines, only CXCL4 predicted the risk and progression of systemic sclerosis. In vitro, CXCL4 down-regulated expression of transcription factor FLI1, induced markers of endothelial-cell activation, and potentiated responses of toll-like receptors. In vivo, CXCL4 induced the influx of inflammatory cells and skin transcriptome changes, as in systemic sclerosis. CONCLUSIONS Levels of CXCL4 were elevated in patients with systemic sclerosis and correlated with the presence and progression of complications, such as lung fibrosis and pulmonary arterial hypertension. (Funded by the Dutch Arthritis Association and others.).
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Affiliation(s)
- Lenny van Bon
- The authors' affiliations are listed in the Appendix
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Lappegård KT, Pop-Purceleanu M, van Heerde W, Sexton J, Tendolkar I, Pop G. Improved neurocognitive functions correlate with reduced inflammatory burden in atrial fibrillation patients treated with intensive cholesterol lowering therapy. J Neuroinflammation 2013; 10:78. [PMID: 23809138 PMCID: PMC3699385 DOI: 10.1186/1742-2094-10-78] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 06/12/2013] [Indexed: 11/30/2022] Open
Abstract
Background Atrial fibrillation (AF) is associated with increased mortality and morbidity, including risk for cerebral macro- and microinfarctions and cognitive decline, even in the presence of adequate oral anticoagulation. AF is strongly related to increased inflammatory activity whereby anti-inflammatory agents can reduce the risk of new or recurrent AF. However, it is not known whether anti-inflammatory therapy can also modify the deterioration of neurocognitive function in older patients with AF. In the present study, older patients with AF were treated with intensive lipid-lowering therapy with atorvastatin 40 mg and ezetimibe 10 mg, or placebo. We examined the relationship between neurocognitive functions and inflammatory burden. Findings Analysis of inflammatory markers revealed significant reductions in high sensitivity C-reactive protein (hs-CRP), fibroblast growth factor (FGF), granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-1 receptor antagonist (IL-1RA), interleukin (IL)-9, IL-13 and IL-17, and interferon-γ (IFNγ) in the treatment group compared to placebo. Reduction in plasma concentration of IL-1RA, IL-2, IL-9 and IL-12, and macrophage inflammatory protein-1β (MIP-1β) correlated significantly with improvement in the neurocognitive functions memory and speed. Loss of volume in amygdala and hippocampus, as determined by magnetic resonance imaging (MRI), was reduced in the treatment arm, statistically significant for left amygdala. Conclusions Anti-inflammatory therapy through intensive lipid-lowering treatment with atorvastatin 40 mg and ezetimibe 10 mg can modify the deterioration of neurocognitive function, and the loss of volume in certain cerebral areas in older patients with AF. Trial registration Clinical Trials.gov NCT00449410
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Affiliation(s)
- Knut Tore Lappegård
- Divison of Internal Medicine, Nordland Hospital, Norway and University of Tromsø, Bodø, Norway.
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Verbruggen B, van Heerde W, Laros-van Gorkom B. Improvements in Factor VIII Inhibitor Detection: From Bethesda to Nijmegen. Semin Thromb Hemost 2010; 35:752-9. [DOI: 10.1055/s-0029-1245107] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wiefferink AE, Weerwind PW, van Heerde W, Teerenstra S, Noyez L, de Pauw BE, Brouwer RM. Autotransfusion management during and after cardiopulmonary bypass alters fibrin degradation and transfusion requirements. J Extra Corpor Technol 2007; 39:66-70. [PMID: 17672185 PMCID: PMC4680668] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
UNLABELLED The coagulation-fibrinolytic profile during cardiopulmonary bypass (CPB) has been widely documented. However, less information is available on the possible persistence of these alterations when autotransfusion is used in management of perioperative blood loss. This study was designed to explore the influence of autotransfusion management on intravascular fibrin degradation and postoperative transfusions. Thirty patients, undergoing elective primary isolated coronary bypass grafting, were randomly allocated either to a control group (group A; n=15) or an intervention group (group B; n=15) in which mediastinal and residual CPB blood was collected and processed by a continuous autotransfusion system before re-infusion. Intravascular fibrin degradation as indicated by D-dimer generation was measured at five specific intervals and corrected for hemodilution. In addition, chest tube drainage and need for homologous blood were monitored. D-dimer generation increased significantly during CPB in group A, from 312 to 633 vs. 291 to 356 ng/mL in group B (p = .001). The unprocessed residual blood (group A) revealed an unequivocal D-dimer elevation, 4131 +/- 1063 vs. 279 +/- 103 ng/mL for the processed residual in group B (p < .001). Consequently, in the first post-CPB period, the intravascular fibrin degradation was significantly elevated in group A compared with group B (p = .001). Twenty hours postoperatively, no significant difference in D-dimer levels was detected between both groups. However, a significant intra-group D-dimer elevation pre- vs. postoperative was noticed from 312 to 828 ng/mL in group A and from 291 to 588 ng/mL in group B (p < .01 for both). Postoperative chest tube drainage was higher in the patients from group A, which also had the highest postoperative D-dimer levels. Patients in group A perceived a higher need for transfusions of red cells suspensions postoperatively. These data clearly indicate that autotransfusion management during and after CPB suppresses early postoperative fibrin degradation. KEYWORDS cardiopulmonary bypass, cardiotomy suction, coronary surgery, autotransfusion, fibrin degradation.
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Affiliation(s)
- Alice E.C.M. Wiefferink
- Department of Extra-Corporeal Circulation, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Patrick W. Weerwind
- Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Waander van Heerde
- Department of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Steven Teerenstra
- Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Luc Noyez
- Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Ben E. de Pauw
- Department of Bloodtransfusion and Transplantation Immunology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - René M.H.J. Brouwer
- Department of Cardiothoracic Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Abstract
In this study, large-scale profiling of salivary proteins and peptides ranging from 2 to 100 kDa was demonstrated using surface-enhanced laser desorption/ionization-time of flight-mass spectrometry (SELDI-TOF-MS). Results show that chip surface type and sample type critically affect the amount and composition of detected salivary proteins. Delayed processing time resulted in both increase and decrease of peak numbers consistent with proteolysis. SELDI-TOF-MS profiles also changed, depending on storage temperature, although sample processing by centrifugation and numbers of freeze-thaw cycles had a minimal impact. In conclusion, SELDI-TOF-MS offers a simple, rapid, high-throughput technique for profiling low-mass (<10 kDa) saliva proteins/peptides. We wish to use this technique to gain insight into the human saliva proteome composition and its changes over time in response to food consumption.
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Affiliation(s)
- Raymond Schipper
- Wageningen Centre for Food Sciences, TI Food and Nutrition, Laboratory of Food Chemistry, Wageningen University, the Netherlands.
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Schipper R, Loof A, de Groot J, Harthoorn L, Dransfield E, van Heerde W. SELDI-TOF-MS of saliva: Methodology and pre-treatment effects. J Chromatogr B Analyt Technol Biomed Life Sci 2007; 847:45-53. [PMID: 17070117 DOI: 10.1016/j.jchromb.2006.10.005] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 09/28/2006] [Accepted: 10/08/2006] [Indexed: 10/24/2022]
Abstract
Interest in saliva as a diagnostic fluid for monitoring general health and for early diagnosis of disease has increased in the last few years. In particular, efforts have focused on the generation of protein maps of saliva using advanced proteomics technology. Surface-enhanced laser-desorption/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) is a novel high throughput and extremely sensitive proteomic approach that allows protein expression profiling of large sets of complex biological specimens. In this study, large scale profiling of salivary proteins and peptides, ranging from 2 to 100kDa was demonstrated using SELDI-TOF-MS. Various methodological aspects and pre-analytical variables were analysed with respect to their effects on saliva SELDI-TOF-MS profiling. Results show that chip surface type and sample type (unstimulated versus stimulated) critically affect the amount and composition of detected salivary proteins. Factors that influenced normal saliva protein profiling were matrix composition, sample dilution and binding buffer properties. Delayed processing time experiments show certain new peptides evolving 3h post-saliva donation, and quantitative analyses indicate relative intensity of other proteins and peptides changing with time. The addition of protease inhibitors partly counteracted the destabilization of certain protein/peptide mass spectra over time suggesting that some proteins in saliva are subject to digestion by intrinsic salivary proteases. SELDI-TOF-MS profiles also changed by varying storage time and storage temperature whereas centrifugation speed and freeze-thaw cycles had minimal impact. In conclusion, SELDI-TOF-MS offers a high throughput platform for saliva protein and peptide profiling, however, (pre-)analytical conditions must be taken into account for valid interpretation of the acquired data.
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Affiliation(s)
- Raymond Schipper
- Wageningen Centre for Food Sciences, P.O. Box 557, 6700 AN Wageningen, The Netherlands.
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Bodar EJ, van der Hilst JCH, van Heerde W, van der Meer JWM, Drenth JPH, Simon A. Defective apoptosis of peripheral-blood lymphocytes in hyper-IgD and periodic fever syndrome. Blood 2006; 109:2416-8. [PMID: 17138829 DOI: 10.1182/blood-2005-10-039578] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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: 11/20/2022] Open
Abstract
Hereditary periodic fever syndromes are characterized by incapacitating attacks of fever and generalized inflammation. While the mutated genes for the major syndromes in this group are known, the pathogenesis remains unclear. The aim of this study was to investigate apoptosis in patients with periodic fever as a possible pathogenic factor. We measured anisomycin-induced apoptosis with annexin-V flow cytometry and caspase-3/7 activity in peripheral-blood lymphocytes from symptom-free patients with hyper-IgD and periodic fever syndrome (HIDS; n = 10), TNF-receptor-associated periodic syndrome (TRAPS; n = 7), and familial Mediterranean fever (FMF; n = 2). HIDS lymphocytes showed a decreased percentage of apoptosis during remission by both methods compared with controls (17.8% vs 55.4%), whereas no difference was observed in TRAPS or FMF lymphocytes. This defective apoptosis of lymphocytes may be a central pathogenic mechanism in HIDS, since dysfunction of one of the inhibitory mechanisms to curtail the immunologic response could cause an unbridled generalized inflammation after a trivial stimulus.
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Affiliation(s)
- Evelien J Bodar
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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15
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van Tits L, de Graaf J, Toenhake H, van Heerde W, Stalenhoef A. C-Reactive Protein and Annexin A5 Bind to Distinct Sites of Negatively Charged Phospholipids Present in Oxidized Low-Density Lipoprotein. Arterioscler Thromb Vasc Biol 2005; 25:717-22. [PMID: 15692104 DOI: 10.1161/01.atv.0000157979.51673.2c] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [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: 11/16/2022]
Abstract
Objective—
To investigate binding of C-reactive protein (CRP) and annexin A5, 2 proteins with high affinity for negatively charged phospholipids, to oxidized low-density lipoprotein (LDL) and the consequences of these interactions for subsequent binding of oxidized LDL to monocyte/macrophage-like U937 cells.
Methods and Results—
We found that CRP and annexin A5 at physiological concentrations bind Ca
++
dependently to oxidized phosphatidylcholine present in oxidized LDL but not to native LDL. Binding of CRP to oxidized LDL did not interfere with binding of annexin A5, and vice versa. In the presence of 2 to 10 mg/L CRP, binding of
125
I-labeled oxidized LDL to undifferentiated U937 cells increased 50% to 100%. This effect was independent of the presence of complement and could be inhibited by irrelevant IgG and by antibodies to CD64 but not by annexin A5. Annexin A5 alone had no effect on binding of oxidized LDL to the cells.
Conclusions—
These findings suggest that: (1) CRP and annexin A5 at physiological concentrations bind to distinct sites of negatively charged phospholipids present in oxidized LDL; (2) CRP enhances binding of oxidized LDL to monocytic/macrophage-like cells via Fcγ receptors; and (3) annexin A5 does not antagonize the CRP-induced enhanced binding of oxidized LDL to U937 cells.
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Affiliation(s)
- Lambertus van Tits
- Department of Medicine, Radboud University Nijmegen Medical Centre, Nijmegen,The Netherlands.
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16
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Verbruggen B, van Heerde W, Novákovà I, Lillicrap D, Giles A. A 4% solution of bovine serum albumin may be used in place of factor VIII:C deficient plasma in the control sample in the Nijmegen Modification of the Bethesda factor VIII:C inhibitor assay. Thromb Haemost 2002; 88:362-4. [PMID: 12195715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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