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Vorobev A, Bitsadze V, Yagubova F, Khizroeva J, Solopova A, Tretyakova M, Gashimova N, Grigoreva K, Einullaeva S, Drozhzhina M, Hajiyeva A, Khalilulina E, Cherepanov A, Kapanadze D, Egorova E, Kuneshko N, Gris JC, Elalamy I, Ay C, Makatsariya A. The Phenomenon of Thrombotic Microangiopathy in Cancer Patients. Int J Mol Sci 2024; 25:9055. [PMID: 39201740 PMCID: PMC11354439 DOI: 10.3390/ijms25169055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/19/2024] [Accepted: 08/15/2024] [Indexed: 09/03/2024] Open
Abstract
Thrombotic microangiopathy (TMA) encompasses a range of disorders characterized by blood clotting in small blood vessels, leading to organ damage. It can manifest as various syndromes, including thrombotic thrombocytopenic purpura (TTP), hemolytic-uremic syndrome (HUS), and others, each with distinct causes and pathophysiology. Thrombo-inflammation plays a significant role in TMA pathogenesis: inflammatory mediators induce endothelial injury and activation of platelet and coagulation cascade, contributing to microvascular thrombosis. Primary TMA, such as TTP, is primarily caused by deficient ADAMTS13 metalloproteinase activity, either due to antibody-mediated inhibition or intrinsic enzyme synthesis defects. In cancer patients, a significant reduction in ADAMTS13 levels and a corresponding increase in VWF levels is observed. Chemotherapy further decreased ADAMTS13 levels and increased VWF levels, leading to an elevated VWF/ADAMTS13 ratio and increased thrombotic risk. Drug-induced TMA (DITMA) can result from immune-mediated or non-immune-mediated mechanisms. Severe cases of COVID-19 may lead to a convergence of syndromes, including disseminated intravascular coagulation (DIC), systemic inflammatory response syndrome (SIRS), and TMA. Treatment of TMA involves identifying the underlying cause, implementing therapies to inhibit complement activation, and providing supportive care to manage complications. Plasmapheresis may be beneficial in conditions like TTP. Prompt diagnosis and treatment are crucial to prevent serious complications and improve outcomes.
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Affiliation(s)
- Alexander Vorobev
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Victoria Bitsadze
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Fidan Yagubova
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Jamilya Khizroeva
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Antonina Solopova
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Maria Tretyakova
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Nilufar Gashimova
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Kristina Grigoreva
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Sabina Einullaeva
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Maria Drozhzhina
- Faculty of General Medicine, Russian University of Medicine, 4th Dolgorukovskaya Str., 127006 Moscow, Russia;
| | - Aygun Hajiyeva
- Faculty of General Medicine, I.M. Sechenov First State Moscow Medical University Baku Branch, Huseyn Javid, Yasamal, Baku AZ1141, Azerbaijan;
| | - Emilia Khalilulina
- Faculty of General Medicine, Pirogov Russian National Research Medical University, Ulitsa Ostrovityanova 1, 117997 Moscow, Russia;
| | - Alexander Cherepanov
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Daredzhan Kapanadze
- Center of Pathology of Pregnancy and Hemostasis «Medlabi», 340112 Tbilisi, Georgia;
| | - Elena Egorova
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
| | - Nart Kuneshko
- Moscow’s Region Odintsovo Maternity Hospital, 143003 Odintsovo, Russia;
| | - Jean-Christophe Gris
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
- Faculty of Pharmaceutical and Biological Sciences, Montpellier University, 34093 Montpellier, France
| | - Ismail Elalamy
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
- Department Hematology and Thrombosis Center, Medicine Sorbonne University, 75012 Paris, France
- Hospital Tenon, 4 Rue de la Chine, 75020 Paris, France
| | - Cihan Ay
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
- Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, 1080 Vienna, Austria
| | - Alexander Makatsariya
- Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia; (A.V.); (V.B.); (F.Y.); (J.K.); (A.S.); (M.T.); (K.G.); (S.E.); (A.C.); (E.E.); (J.-C.G.); (I.E.); (C.A.); (A.M.)
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Aigner C, Schmidt A, Gaggl M, Sunder-Plassmann G. An updated classification of thrombotic microangiopathies and treatment of complement gene variant-mediated thrombotic microangiopathy. Clin Kidney J 2019; 12:333-337. [PMID: 31198225 PMCID: PMC6543965 DOI: 10.1093/ckj/sfz040] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Indexed: 12/21/2022] Open
Abstract
Conditions presenting with signs of thrombotic microangiopathies (TMAs) comprise a wide spectrum of different diseases. While pathological hallmarks are thrombosis of arterioles and capillaries, clinical signs are mechanical haemolysis, thrombocytopenia and acute renal injury or neurological manifestations. The current classification of various syndromes of TMA is heterogeneous and often does not take the underlying pathophysiology into consideration. Therefore we propose a simplified classification based on the aetiology of different syndromes leading to TMA. We propose to categorize different TMA syndromes in hereditary and acquired forms and classify them based on the genetic background or underlying conditions. Of course, this classification is not always distinctly applicable in each case and from time to time reassessment of the established diagnosis is strongly recommended. The recommended treatment of TMA in the past was plasma exchange (PE). However, recently, the terminal complement inhibitor eculizumab became commercially available and has shown promising results in different open-label studies and case series. In our centre, first-line therapy is PE; however, patients are instantly switched to complement inhibitory therapy in case of treatment failure or intolerance.
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Affiliation(s)
- Christof Aigner
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Alice Schmidt
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Martina Gaggl
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Gere Sunder-Plassmann
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
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