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Platelet-Neutrophil Crosstalk in Thrombosis. Int J Mol Sci 2023; 24:ijms24021266. [PMID: 36674781 PMCID: PMC9861587 DOI: 10.3390/ijms24021266] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Platelets are essential for the formation of a haemostatic plug to prevent bleeding, while neutrophils are the guardians of our immune defences against invading pathogens. The interplay between platelets and innate immunity, and subsequent triggering of the activation of coagulation is part of the host system to prevent systemic spread of pathogen in the blood stream. Aberrant immunothrombosis and excessive inflammation can however, contribute to the thrombotic burden observed in many cardiovascular diseases. In this review, we highlight how platelets and neutrophils interact with each other and how their crosstalk is central to both arterial and venous thrombosis and in COVID-19. While targeting platelets and coagulation enables efficient antithrombotic treatments, they are often accompanied with a bleeding risk. We also discuss how novel approaches to reduce platelet-mediated recruitment of neutrophils could represent promising therapies to treat thrombosis without affecting haemostasis.
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The Role of Neutrophils in Lower Limb Peripheral Artery Disease: State of the Art and Future Perspectives. Int J Mol Sci 2023; 24:ijms24021169. [PMID: 36674682 PMCID: PMC9866688 DOI: 10.3390/ijms24021169] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023] Open
Abstract
In recent years, increasing attention has been paid to the role of neutrophils in cardiovascular (CV) disease (CVD) with evidence supporting their role in the initiation, progression, and rupture of atherosclerotic plaque. Although these cells have long been considered as terminally differentiated cells with a relatively limited spectrum of action, recent research has revealed intriguing novel cellular functions, including neutrophil extracellular trap (NET) generation and inflammasome activation, which have been linked to several human diseases, including CVD. While most research to date has focused on the role of neutrophils in coronary artery and cerebrovascular diseases, much less information is available on lower limb peripheral artery disease (PAD). PAD is a widespread condition associated with great morbidity and mortality, though physician and patient awareness of the disease remains low. To date, several studies have produced some evidence on the role of certain biomarkers of neutrophil activation in this clinical setting. However, the etiopathogenetic role of neutrophils, and in particular of some of the newly discovered mechanisms, has yet to be fully elucidated. In the future, complementary assessment of neutrophil activity should improve CV risk stratification and provide personalized treatments to patients with PAD. This review aims to summarize the basic principles and recent advances in the understanding of neutrophil biology, current knowledge about the role of neutrophils in atherosclerosis, as well as available evidence on their role of PAD.
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Varjú I, Tóth E, Farkas ÁZ, Farkas VJ, Komorowicz E, Feller T, Kiss B, Kellermayer MZ, Szabó L, Wacha A, Bóta A, Longstaff C, Kolev K. Citrullinated fibrinogen forms densely packed clots with decreased permeability. J Thromb Haemost 2022; 20:2862-2872. [PMID: 36083779 PMCID: PMC9828116 DOI: 10.1111/jth.15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/17/2022] [Accepted: 09/07/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Fibrin, the main scaffold of thrombi, is susceptible to citrullination by PAD (peptidyl arginine deiminase) 4, secreted from neutrophils during the formation of neutrophil extracellular traps. Citrullinated fibrinogen (citFg) has been detected in human plasma as well as in murine venous thrombi, and it decreases the lysability and mechanical resistance of fibrin clots. OBJECTIVE To investigate the effect of fibrinogen citrullination on the structure of fibrin clots. METHODS Fibrinogen was citrullinated with PAD4 and clotted with thrombin. Scanning electron microscopy (SEM) and atomic force microscopy (AFM) were used to measure fiber thickness, fiber height/width ratio, and fiber persistence length in clots containing citFg. Fiber density was measured with laser scanning microscopy (LSM) and permeability measurements were carried out to estimate the porosity of the clots. The intra-fiber structure of fibrin was analyzed with small-angle X-ray scattering (SAXS). RESULTS SEM images revealed a decrease in the median fiber diameter that correlated with the fraction of citFg in the clot, while the fiber width/length ratio remained unchanged according to AFM. With SAXS we observed that citrullination resulted in the formation of denser clots in line with increased fiber density shown by LSM. The permeability constant of citrullinated fibrin decreased more than 3-fold indicating significantly decreased porosity. SAXS also showed largely preserved periodicity in the longitudinal assembly of fibrin monomers. CONCLUSION The current observations of thin fibers combined with dense packing and low porosity in the presence of citFg can provide a structural framework for the mechanical fragility and lytic resistance of citrullinated fibrin.
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Affiliation(s)
- Imre Varjú
- Program in Cellular and Molecular MedicineBoston Children's HospitalBostonMassachusettsUSA
- Department of PediatricsHarvard Medical SchoolBostonMassachusettsUSA
- Department of Biochemistry, Institute of Biochemistry and Molecular BiologySemmelweis UniversityBudapestHungary
- Department of Sociomedical Sciences, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Erzsébet Tóth
- Department of Biochemistry, Institute of Biochemistry and Molecular BiologySemmelweis UniversityBudapestHungary
| | - Ádám Z. Farkas
- Department of Biochemistry, Institute of Biochemistry and Molecular BiologySemmelweis UniversityBudapestHungary
| | - Veronika J. Farkas
- Department of Biochemistry, Institute of Biochemistry and Molecular BiologySemmelweis UniversityBudapestHungary
| | - Erzsébet Komorowicz
- Department of Biochemistry, Institute of Biochemistry and Molecular BiologySemmelweis UniversityBudapestHungary
| | - Tímea Feller
- Department of Biophysics and Radiation BiologySemmelweis UniversityBudapestHungary
| | - Balázs Kiss
- Department of Biophysics and Radiation BiologySemmelweis UniversityBudapestHungary
| | | | - László Szabó
- Department of Biochemistry, Institute of Biochemistry and Molecular BiologySemmelweis UniversityBudapestHungary
- Department of Functional and Structural Materials, Institute of Materials and Environmental Chemistry, Research Centre for Natural SciencesHungarian Academy of SciencesBudapestHungary
| | - András Wacha
- Biological Nanochemistry Research Group, Institute of Materials and Environmental Chemistry, Centre for Natural SciencesHungarian Academy of SciencesBudapestHungary
| | - Attila Bóta
- Biological Nanochemistry Research Group, Institute of Materials and Environmental Chemistry, Centre for Natural SciencesHungarian Academy of SciencesBudapestHungary
| | - Colin Longstaff
- National Institute for Biological Standards and ControlSouth MimmsUK
| | - Krasimir Kolev
- Department of Biochemistry, Institute of Biochemistry and Molecular BiologySemmelweis UniversityBudapestHungary
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Chen D, Liu P, Liu Y, Wang Z, Zhou Y, Jiang L, Yuan C, Li Y, Lin W, Huang M. A Clot-Homing Near-Infrared Probe for In Vivo Imaging of Murine Thromboembolic Models. Adv Healthc Mater 2022; 11:e2102213. [PMID: 34994110 DOI: 10.1002/adhm.202102213] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/16/2021] [Indexed: 11/09/2022]
Abstract
Direct thrombus imaging contributes to early detection of thrombosis, and animal models with clinical relevance are vital in the development of new thrombolytics. Here, a facile clot-homing strategy is developed based on the finding that blood clot is negatively charged. Positively charged pentalysine moiety is coupled with phthalocyanine-based fluorophore , and its applications in murine thromboembolic models are described. The probe efficiently stains the cryosection of intracranial thrombi retrieved from patients with cardioembolic stroke. In vitro, the fibrin-rich clot is labeled by the probe at sub-nanomolar concentration. The probe-labeled clot is formed into microparticles (1-5 µm) and intravenously injected into mice for pulmonary embolism modeling. In vivo imaging demonstrates fast accumulation and retention of fluorescent clot microparticles in pulmonary vessels. Recombinant tissue-type plasminogen activator (rtPA) administration greatly reduces near-infrared signal in the lungs in a time-dependent manner. This probe is also tested in a stroke model. Middle cerebral artery is occluded by autologous thrombi formed under electric stimulation. In vivo imaging shows that the probe efficiently homes to thrombus at early stage. Hence, this probe has great potential in real-time imaging of thromboembolism in clinically relevant models, promoting bench-to-bedside translation. This clot-homing principle can be used in other applications.
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Affiliation(s)
- Dan Chen
- College of Chemistry Fuzhou University No. 2 Wulongjiang North Avenue Fuzhou 350108 P. R. China
| | - Peiwen Liu
- College of Chemistry Fuzhou University No. 2 Wulongjiang North Avenue Fuzhou 350108 P. R. China
| | - Yurong Liu
- College of Chemistry Fuzhou University No. 2 Wulongjiang North Avenue Fuzhou 350108 P. R. China
| | - Zhiyou Wang
- College of Chemistry Fuzhou University No. 2 Wulongjiang North Avenue Fuzhou 350108 P. R. China
| | - Yang Zhou
- College of Chemistry Fuzhou University No. 2 Wulongjiang North Avenue Fuzhou 350108 P. R. China
| | - Longguang Jiang
- College of Chemistry Fuzhou University No. 2 Wulongjiang North Avenue Fuzhou 350108 P. R. China
| | - Cai Yuan
- College of Chemistry Fuzhou University No. 2 Wulongjiang North Avenue Fuzhou 350108 P. R. China
| | - Yongkun Li
- Department of Neurology Fujian Provincial Hospital, Shengli Clinical College of Fujian Medical University No. 134 Dong Street Fuzhou Fujian 350001 P. R. China
| | - Wei Lin
- Fujian Institute of integrated traditional Chinese and Western Medicine Fujian University of Traditionial Chinese Medicine No. 1 Qiuyang Road, Minhou District Fuzhou 350122 P. R. China
| | - Mingdong Huang
- College of Chemistry Fuzhou University No. 2 Wulongjiang North Avenue Fuzhou 350108 P. R. China
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5
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Early Plasma Nuclear DNA, Mitochondrial DNA, and Nucleosome Concentrations Are Associated With Acute Kidney Injury in Critically Ill Trauma Patients. Crit Care Explor 2022; 4:e0663. [PMID: 35372847 PMCID: PMC8963825 DOI: 10.1097/cce.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Circulating nucleic acids, alone and in complex with histones as nucleosomes, have been proposed to link systemic inflammation and coagulation after trauma to acute kidney injury (AKI). We sought to determine the association of circulating nucleic acids measured at multiple time points after trauma with AKI risk.
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Pérez-Olivares L, Soehnlein O. Contemporary Lifestyle and Neutrophil Extracellular Traps: An Emerging Link in Atherosclerosis Disease. Cells 2021; 10:1985. [PMID: 34440753 PMCID: PMC8394440 DOI: 10.3390/cells10081985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Neutrophil extracellular traps (NETs) are networks of extracellular genetic material decorated with proteins of nuclear, granular and cytosolic origin that activated neutrophils expel under pathogenic inflammatory conditions. NETs are part of the host's innate immune defense system against invading pathogens. Interestingly, these extracellular structures can also be released in response to sterile inflammatory stimuli (e.g., shear stress, lipidic molecules, pro-thrombotic factors, aggregated platelets, or pro-inflammatory cytokines), as in atherosclerosis disease. Indeed, NETs have been identified in the intimal surface of diseased arteries under cardiovascular disease conditions, where they sustain inflammation via NET-mediated cell-adhesion mechanisms and promote cellular dysfunction and tissue damage via NET-associated cytotoxicity. This review will focus on (1) the active role of neutrophils and NETs as underestimated players of the inflammatory process during atherogenesis and lesion progression; (2) how these extracellular structures communicate with the main cell types present in the atherosclerotic lesion in the arterial wall; and (3) how these neutrophil effector functions interplay with lifestyle-derived risk factors such as an unbalanced diet, physical inactivity, smoking or lack of sleep quality, which represent major elements in the development of cardiovascular disease.
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Affiliation(s)
- Laura Pérez-Olivares
- Center for Molecular Biology of Inflammation (ZMBE), Institute for Experimental Pathology (ExPat), Westfälische Wilhelms-Universität (WWU), 48149 Münster, Germany;
| | - Oliver Soehnlein
- Center for Molecular Biology of Inflammation (ZMBE), Institute for Experimental Pathology (ExPat), Westfälische Wilhelms-Universität (WWU), 48149 Münster, Germany;
- Department of Physiology and Pharmacology (FyFa), Karolinska Institute, 17165 Stockholm, Sweden
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7
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The Neutrophil Secretome as a Crucial Link between Inflammation and Thrombosis. Int J Mol Sci 2021; 22:ijms22084170. [PMID: 33920656 PMCID: PMC8073391 DOI: 10.3390/ijms22084170] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular diseases are a leading cause of death. Blood–cell interactions and endothelial dysfunction are fundamental in thrombus formation, and so further knowledge of the pathways involved in such cellular crosstalk could lead to new therapeutical approaches. Neutrophils are secretory cells that release well-known soluble inflammatory signaling mediators and other complex cellular structures whose role is not fully understood. Studies have reported that neutrophil extracellular vesicles (EVs) and neutrophil extracellular traps (NETs) contribute to thrombosis. The objective of this review is to study the role of EVs and NETs as key factors in the transition from inflammation to thrombosis. The neutrophil secretome can promote thrombosis due to the presence of different factors in the EVs bilayer that can trigger blood clotting, and to the release of soluble mediators that induce platelet activation or aggregation. On the other hand, one of the main pathways by which NETs induce thrombosis is through the creation of a scaffold to which platelets and other blood cells adhere. In this context, platelet activation has been associated with the induction of NETs release. Hence, the structure and composition of EVs and NETs, as well as the feedback mechanism between the two processes that causes pathological thrombus formation, require exhaustive analysis to clarify their role in thrombosis.
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8
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Weisel JW, Litvinov RI. Visualizing thrombosis to improve thrombus resolution. Res Pract Thromb Haemost 2021; 5:38-50. [PMID: 33537528 PMCID: PMC7845077 DOI: 10.1002/rth2.12469] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/05/2020] [Accepted: 11/15/2020] [Indexed: 12/12/2022] Open
Abstract
The severity, course, and outcomes of thrombosis are determined mainly by the size and location of the thrombus, but studying thrombus structure and composition has been an important but challenging task. The substantial progress in determination of thrombus morphology has become possible due to new intravital imaging methodologies in combination with mechanical thrombectomy, which allows extraction of a fresh thrombus from a patient followed by microscopy. Thrombi have been found to contain various structural forms of fibrin along with platelet aggregates, leukocytes, and red blood cells, many of which acquire a polyhedral shape (polyhedrocytes) as a result of intravital platelet-driven contraction. The relative volume fractions of thrombus components and their structural forms vary substantially, depending on the clinical and pathogenic characteristics. This review summarizes recent research that describes quantitative and qualitative morphologic characteristics of arterial and venous thrombi that are relevant for the pathogenesis, prophylaxis, diagnosis, and treatment of thrombosis.
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Affiliation(s)
- John W. Weisel
- Department of Cell and Developmental BiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Rustem I. Litvinov
- Department of Cell and Developmental BiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
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9
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Kim SW, Lee JK. Role of HMGB1 in the Interplay between NETosis and Thrombosis in Ischemic Stroke: A Review. Cells 2020; 9:cells9081794. [PMID: 32731558 PMCID: PMC7464684 DOI: 10.3390/cells9081794] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 12/17/2022] Open
Abstract
Neutrophil extracellular traps (NETs) comprise decondensed chromatin, histones and neutrophil granular proteins and are involved in the response to infectious as well as non-infectious diseases. The prothrombotic activity of NETs has been reported in various thrombus-related diseases; this activity can be attributed to the fact that the NETs serve as a scaffold for cells and numerous coagulation factors and stimulate fibrin deposition. A crosstalk between NETs and thrombosis has been indicated to play a role in numerous thrombosis-related conditions including stroke. In cerebral ischemia, neutrophils are the first group of cells to infiltrate the damaged brain tissue, where they produce NETs in the brain parenchyma and within blood vessels, thereby aggravating inflammation. Increasing evidences suggest the connection between NETosis and thrombosis as a possible cause of “tPA resistance”, a problem encountered during the treatment of stroke patients. Several damage-associated molecular pattern molecules have been proven to induce NETosis and thrombosis, with high mobility group box 1 (HMGB1) playing a critical role. This review discusses NETosis and thrombosis and their crosstalk in various thrombosis-related diseases, focusing on the role of HMGB1 as a mediator in stroke. We also addresses the function of peptidylarginine deiminase 4 with respect to the interplay with HMGB1 in NET-induced thrombosis.
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Affiliation(s)
- Seung-Woo Kim
- Department of Biomedical Sciences, Inha University School of Medicine, Inchon 22212, Korea;
- Medical Research Center, Inha University School of Medicine, Inchon 22212, Korea
| | - Ja-Kyeong Lee
- Medical Research Center, Inha University School of Medicine, Inchon 22212, Korea
- Department of Anatomy, Inha University School of Medicine, Inchon 22212, Korea
- Correspondence: ; Tel.: +82-32-860-9893; Fax: +82-32-884-2105
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10
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Neutrophil extracellular traps and NETosis: a report of two autopsies and review of literature. Blood Coagul Fibrinolysis 2019; 31:92-96. [PMID: 31789662 DOI: 10.1097/mbc.0000000000000872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Recent studies reveal that neutrophil extracellular traps (NETs) play a significant role in platelet entrapment and consequent activation of the coagulation cascade. Herein we present two autopsy cases of NETosis. The first case is a 76-year-old man, with metastatic squamous cell carcinoma of the lung who expired 5 days post admission. Autopsy revealed extensively necrotic poorly differentiated squamous cell carcinoma of the right lung. A 30-cm cylindrical thrombus was identified, extending from the left ventricle to the thoracic aorta, composed of numerous neutrophils enmeshed in abundant fibrin representing a NET. The second case is a 73-year-old man who suffered a cardiopulmonary arrest of unknown cause and expired 2 days post admission. Autopsy revealed a 5-cm mural thrombus with numerous neutrophils in the descending aorta consistent with NET, bilateral bronchopneumonia and infarcted bowel. These two autopsies highlight the pathogenic role of NET in causing thrombosis.
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11
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Thålin C, Hisada Y, Lundström S, Mackman N, Wallén H. Neutrophil Extracellular Traps: Villains and Targets in Arterial, Venous, and Cancer-Associated Thrombosis. Arterioscler Thromb Vasc Biol 2019; 39:1724-1738. [PMID: 31315434 DOI: 10.1161/atvbaha.119.312463] [Citation(s) in RCA: 238] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Recent studies have demonstrated a role of neutrophils in both venous and arterial thrombosis. A key prothrombotic feature of neutrophils is their ability to release web-like structures composed of DNA filaments coated with histones and granule proteins referred to as neutrophil extracellular traps (NETs). NETs were discovered over a decade ago as part of our first line of host defense against invading microorganisms. Although NETs have a protective role against pathogens, recent data suggest that an uncontrolled and excessive NET formation within the vasculature may contribute to pathological thrombotic disorders. In vitro studies suggest that NETs promote vessel occlusion by providing a scaffold for platelets, red blood cells, extracellular vesicles, and procoagulant molecules, such as von Willebrand factor and tissue factor. In addition, NET components enhance coagulation by both activating the intrinsic pathway and degrading an inhibitor of the extrinsic pathway (tissue factor pathway inhibitor). NET formation has, therefore, been proposed to contribute to thrombus formation and propagation in arterial, venous, and cancer-associated thrombosis. This review will describe animal and human studies suggesting a role of NETs in the pathogenesis of various thrombotic disorders. Targeting NETs may be a novel approach to reduce thrombosis without affecting hemostasis.
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Affiliation(s)
- Charlotte Thålin
- From the Division of Internal Medicine, Department of Clinical Sciences, Danderyd Hospital (C.T.), Karolinska Institutet, Stockholm, Sweden
| | - Yohei Hisada
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill (Y.H., N.M.)
| | - Staffan Lundström
- Department of Oncology-Pathology (S.L.), Karolinska Institutet, Stockholm, Sweden.,Palliative Care Services and R&D-Unit, Stockholms Sjukhem Foundation, Sweden (S.L.)
| | - Nigel Mackman
- Division of Hematology and Oncology, Department of Medicine, University of North Carolina at Chapel Hill (Y.H., N.M.)
| | - Håkan Wallén
- Division of Cardiovascular Medicine (H.W.), Karolinska Institutet, Stockholm, Sweden
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12
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Neutrophils: back in the thrombosis spotlight. Blood 2019; 133:2186-2197. [PMID: 30898858 DOI: 10.1182/blood-2018-10-862243] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022] Open
Abstract
Reactive and clonal neutrophil expansion has been associated with thrombosis, suggesting that neutrophils play a role in this process. However, although there is no doubt that activated monocytes trigger coagulation in a tissue factor-dependent manner, it remains uncertain whether stimulated neutrophils can also directly activate coagulation. After more than a decade of debate, it is now largely accepted that normal human neutrophils do not synthetize tissue factor, the initiator of the extrinsic pathway of coagulation. However, neutrophils may passively acquire tissue factor from monocytes. Recently, the contact system, which initiates coagulation via the intrinsic pathway, has been implicated in the pathogenesis of thrombosis. After the recent description of neutrophil extracellular trap (NET) release by activated neutrophils, some animal models of thrombosis have demonstrated that coagulation may be enhanced by direct NET-dependent activation of the contact system. However, there is currently no consensus on how to assess or quantify NETosis in vivo, and other experimental animal models have failed to demonstrate a role for neutrophils in thrombogenesis. Nevertheless, it is likely that NETs can serve to localize other circulating coagulation components and can also promote vessel occlusion independent of fibrin formation. This article provides a critical appraisal of the possible roles of neutrophils in thrombosis and highlights some existing knowledge gaps regarding the procoagulant activities of neutrophil-derived extracellular chromatin and its molecular components. A better understanding of these mechanisms could guide future approaches to prevent and/or treat thrombosis.
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Prochazka V, Jonszta T, Czerny D, Krajca J, Roubec M, Macak J, Kovar P, Kovarova P, Pulcer M, Zoubkova R, Lochman I, Svachova V, Pavliska L, Vrtkova A, Kasprak D, Gumulec J, Weisel JW. The Role of von Willebrand Factor, ADAMTS13, and Cerebral Artery Thrombus Composition in Patient Outcome Following Mechanical Thrombectomy for Acute Ischemic Stroke. Med Sci Monit 2018; 24:3929-3945. [PMID: 29887594 PMCID: PMC6029516 DOI: 10.12659/msm.908441] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The aim of the study was to investigate the role of von Willebrand factor (vWF), the vWF-cleaving protease, ADAMTS13, the composition of thrombus, and patient outcome following mechanical cerebral artery thrombectomy in patients with acute ischemic stroke. Material/Methods A prospective cohort study included 131 patients with ischemic stroke (<6 hours) with or without intravenous thrombolysis. Interventional procedure parameters, hemocoagulation markers, vWF, ADAMTS13, and histological examination of the extracted thrombi were performed. The National Institutes of Health Stroke Scale (NIHSS) score was used on hospital admission, after 24 hours, at day 7; the three-month modified Rankin Scale score was used. Results Mechanical thrombectomy resulted in a Treatment in Cerebral Ischemia (TICI) score of 2–3, with recanalization in 89% of patients. Intravenous thrombolysis was used in 101 (78%). Patients with and without intravenous thrombolysis therapy had a good clinical outcome (score 0–2) in 47% of cases (P=0.459) using the three-month modified Rankin Scale. Patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥15 had significantly increased vWF levels (P=0.003), and a significantly increased vWF: ADAMTS13 ratio (P=0.038) on hospital admission. Significant correlation coefficients were found for plasma vWF and thrombo-embolus vWF (r=0.32), platelet (r=0.24), and fibrin (r=0.26) levels. In the removed thrombus, vWF levels were significantly correlated with platelet count (r=0.53), CD31-positive cells (r=0.38), and fibrin (r=0.48). Conclusions In patients with acute ischemic stroke, mechanical cerebral artery thrombectomy resulted in a good clinical outcome in 47% of cases, with and without intravenous thrombolysis therapy.
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Affiliation(s)
- Vaclav Prochazka
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Tomas Jonszta
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Daniel Czerny
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jan Krajca
- Department of Radiology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Roubec
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jirka Macak
- Department of Pathology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Petr Kovar
- Department of Pathology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Petra Kovarova
- Blood Centre, University Hospital Ostrava, Ostrava, Czech Republic
| | - Martin Pulcer
- Department of Clinical Hematology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Renata Zoubkova
- Department of Anesthesiology, Resuscitation and Intensive Medicine Clinic, University Hospital Ostrava, Ostrava, Czech Republic
| | | | | | - Lubomir Pavliska
- Department of Deputy Director of Science and Research, University Hospital Ostrava, Ostrava, Czech Republic
| | - Adela Vrtkova
- Department of Applied Mathematics , VŠB-Technical University of Ostrava, Ostrava, Czech Republic
| | - David Kasprak
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jaromir Gumulec
- Department of Hematooncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - John W Weisel
- Department of Cell and Developmental Biology, University of Pensylvania School of Medicine, Philadelphia, PA, USA
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14
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Hangge P, Stone J, Albadawi H, Zhang YS, Khademhosseini A, Oklu R. Hemostasis and nanotechnology. Cardiovasc Diagn Ther 2017; 7:S267-S275. [PMID: 29399530 DOI: 10.21037/cdt.2017.08.07] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hemorrhage accounts for significant morbidity and mortality. Various techniques have been employed to augment hemostasis from simple tourniquets to self-assembling nanoparticles. A growing understanding of the natural clotting cascade has allowed agents to become more targeted for potential use in different clinical scenarios. This review discusses current and developing hemostatic techniques, including matrix agents, external agents, biologically inspired agents, and synthetic and cell-derived nanoparticles.
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Affiliation(s)
- Patrick Hangge
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Jonathan Stone
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Hassan Albadawi
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Yu Shrike Zhang
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Rahmi Oklu
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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15
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Czaplicki C, Albadawi H, Partovi S, Gandhi RT, Quencer K, Deipolyi AR, Oklu R. Can thrombus age guide thrombolytic therapy? Cardiovasc Diagn Ther 2017; 7:S186-S196. [PMID: 29399522 DOI: 10.21037/cdt.2017.11.05] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Venous thrombosis (VT) is a common yet complex clinical condition that has shown minimal alteration in clinical management for decades. It is well known that thrombus evolves structurally over time, with complex changes resulting from the interplay between coagulation factors, cytokines, leukocytes and a myriad of other factors. Our current treatment options are most effective in the acute thrombus, which is composed predominantly of a loose mesh of fibrin and red blood cells (RBCs), making current anticoagulation therapies and thrombolytics quite effective in treatment. Later stages of thrombus are more cellular containing leukocytes, and develop a fibrotic collagenous framework that is more resistant to our current treatments. Understanding the biology of an evolving thrombus will allow us to tailor our treatment and optimize outcomes, as well as focus on novel therapies for the treatment of chronic thrombus. Given the morbidity and mortality of both post thrombotic syndrome (PTS) in patients with deep VT, as well as chronic thromboembolic pulmonary hypertension (CTEPH) in patients with pulmonary embolism (PE), new and innovative therapies must continue to be explored to help prevent these potentially devastating conditions.
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Affiliation(s)
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Sasan Partovi
- University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ripal T Gandhi
- Miami Cardiac and Vascular Institute, University of South Florida College of Medicine, Kendall, FL, USA
| | - Keith Quencer
- Department of Radiology, University of California San Diego Medical Center, San Diego, CA, USA
| | - Amy R Deipolyi
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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16
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Oklu R, Sheth RA, Wong KHK, Jahromi AH, Albadawi H. Neutrophil extracellular traps are increased in cancer patients but does not associate with venous thrombosis. Cardiovasc Diagn Ther 2017; 7:S140-S149. [PMID: 29399517 DOI: 10.21037/cdt.2017.08.01] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background A single center, prospective tissue-based study was conducted to investigate an association between neutrophil extracellular traps (NETs) and venous thromboembolic disease in patients with malignancy. Methods Plasma was collected from 65 patients in which 27 were cancer patients and 38 were age-matched non-cancer patients. Plasma NETs, circulating free DNA (cfDNA), DNase-1, endonuclease-G, endonuclease activity and thrombin-antithrombin III (TAT) complex levels was quantified. Laboratory values were also compared. Additionally, NETs detection and quantification was performed with fluorescent immunohistochemistry (IHC) in tissue-banked tumor sections and fresh human venous thrombus derived from cancer patients. Results Plasma samples from cancer patients contained higher levels of nucleosomes (P=0.0009) and cfDNA (P=0.0008) compared to the non-cancer group. Western blot analysis revealed significantly lower DNase-1 protein levels (P=0.016) that paralleled lower nuclease activity (P=0.03) in plasma samples from cancer patients compared to non-cancer patients. Thrombus tissue from cancer patients and tumor tissue from liver and lung cancer also showed marked levels of NETs. However, increased levels of NETs in cancer patients did not correlate with TAT complex activation or prevalence of venous thrombosis in cancer patients. Conclusions Further studies are warranted to determine the role of NETs as a procoagulant in human thrombosis.
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Affiliation(s)
- Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, TX, USA
| | - Keith H K Wong
- Center for Engineering in Medicine & Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Amin H Jahromi
- Department of Radiology, University of California San Diego Medical Center, San Diego, CA, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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17
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Sheth RA, Niekamp A, Quencer KB, Shamoun F, Knuttinen MG, Naidu S, Oklu R. Thrombosis in cancer patients: etiology, incidence, and management. Cardiovasc Diagn Ther 2017; 7:S178-S185. [PMID: 29399521 DOI: 10.21037/cdt.2017.11.02] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Venous thromboembolism (VTE) is the second most common cause of mortality in cancer patients. The mechanisms of cancer-associated thrombosis (CAT), much like cancer itself, are multi-factorial and incompletely understood. Cancer type, stage, tumor-derived factors and genetics all affect CAT risk. Furthermore, cancer therapies as well as the indwelling vascular devices through which these therapies are delivered can increase the risk for CAT. In this review, we summarize mechanisms of hypercoagulability in cancer patients, patterns of thrombosis associated with cancer, current guidelines for the diagnosis and management of CAT, and important considerations regarding the placement of implantable vascular devices in the care of cancer patients with VTE.
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Affiliation(s)
- Rahul A Sheth
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Niekamp
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keith B Quencer
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Fadi Shamoun
- Division of Vascular Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Sailendra Naidu
- Division of Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahmi Oklu
- Division of Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA
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18
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Wallace A, Albadawi H, Patel N, Khademhosseini A, Zhang YS, Naidu S, Knuttinen G, Oklu R. Anti-fouling strategies for central venous catheters. Cardiovasc Diagn Ther 2017; 7:S246-S257. [PMID: 29399528 DOI: 10.21037/cdt.2017.09.18] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Central venous catheters (CVCs) are ubiquitous in the healthcare industry and carry two common complications, catheter related infections and occlusion, particularly by thrombus. Catheter-related bloodstream infections (CRBSI) are an important cause of nosocomial infections that increase patient morbidity, mortality, and hospital cost. Innovative design strategies for intravenous catheters can help reduce these preventable infections. Antimicrobial coatings can play a major role in preventing disease. These coatings can be divided into two major categories: drug eluting and non-drug eluting. Much of these catheter designs are targeted at preventing the formation of microbial biofilms that make treatment of CRBSI nearly impossible without removal of the intravenous device. Exciting developments in catheter impregnation with antibiotics as well as nanoscale surface design promise innovative changes in the way that physicians manage intravenous catheters. Occlusion of a catheter renders the catheter unusable and is often treated by tissue plasminogen activator administration or replacement of the line. Prevention of this complication requires a thorough understanding of the mechanisms of platelet aggregation, signaling and cross-linking. This article will look at the advances in biomaterial design specifically drug eluting, non-drug eluting, lubricious coatings and micropatterning as well as some of the characteristics of each as they relate to CVCs.
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Affiliation(s)
- Alex Wallace
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Nikasha Patel
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Ali Khademhosseini
- Department of Bioengineering, Department of Chemical and Biomolecular Engineering, Henry Samueli School of Engineering and Applied Sciences, University of California-Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Radiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA.,Center for Minimally Invasive Therapeutics (C-MIT), University of California-Los Angeles, Los Angeles, CA, USA.,California NanoSystems Institute (CNSI), University of California-Los Angeles (UCLA), Los Angeles, CA, USA
| | - Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Sailendra Naidu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Grace Knuttinen
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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19
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Zhang YS, Oklu R, Albadawi H. Bioengineered in vitro models of thrombosis: methods and techniques. Cardiovasc Diagn Ther 2017; 7:S329-S335. [PMID: 29399537 DOI: 10.21037/cdt.2017.08.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Thrombosis is a prevailing vascular disorder that has been historically studied in vivo with conventional animal models. Here we review recent advances in methods and techniques that allow for engineering of biomimetic in vitro models of thrombosis, usually combined with microfluidic devices, termed thrombosis-on-a-chip systems, to reproduce such vascular pathology outside living organisms. These human cell-based thrombosis-on-a-chip platforms recapitulate the important characteristics of native thrombosis in terms of vascular structures, extracellular matrix properties, cellular composition, and pathophysiology, making them enabling in vitro models to study this important class of vascular disorders as well as to develop personalized treatment regimens.
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Affiliation(s)
- Yu Shrike Zhang
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA
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20
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Fleck D, Albadawi H, Shamoun F, Knuttinen G, Naidu S, Oklu R. Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Ther 2017; 7:S228-S237. [PMID: 29399526 DOI: 10.21037/cdt.2017.09.15] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Deep vein thrombosis (DVT) is a major health problem worldwide. The risk of pulmonary embolism following DVT is well established, but the long-term vascular sequelae of DVT are often underappreciated, costly to manage, and can have extremely detrimental effects on quality of life. Treatment of DVT classically involves oral anticoagulation, which reduces the risk of pulmonary embolism but does not remove the clot. Anticoagulation therefore does little to prevent the venous damage and scarring that occurs following DVT, leaving the patient at risk for permanent venous insufficiency and development of post-thrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) is a minimally invasive endovascular treatment that is used as an adjunct to anticoagulation. CDT lowers the risk of PTS by reducing clot burden and protecting against valvular damage. A catheter is advanced directly to the site of thrombosis under fluoroscopy followed by a slow, prolonged infusion of a relatively low dose of thrombolytic agent. CDT restores venous patency faster than anticoagulation, which hastens the relief of acute symptoms. Adjunctive CDT modalities have become increasingly popular among interventional radiologists, allowing for additional mechanical thrombectomy or ultrasound-enhanced thrombolysis at the time of catheter placement. These pharmacomechanical CDT (PCDT) techniques have the potential to reduce treatment time and associated healthcare costs. Numerous observational and retrospective studies have consistently shown a benefit of CDT plus anticoagulation over anticoagulation alone for prevention of PTS. Patients with long life expectancy and acute thrombosis involving the iliac and proximal femoral veins (iliofemoral DVT) have the greatest benefit from CDT, which may decrease the risk of PTS and/or decrease the severity of PTS symptoms if they do occur. Randomized controlled trials remain limited but generally support the observational data. CDT also plays an important role in those with acute limb-threatening venous occlusion or severe symptoms from DVT. Although adverse outcomes are rare, a potential devastating outcome is intracranial bleeding. While the available literature suggests the risk of serious morbidity from bleeding is quite rare, the absolute risk of bleeding is not clear and will require outcomes data from randomized trials. Future studies should also examine the cost-effectiveness of CDT for PTS prevention, particularly with respect to quality-adjusted life years, and compare the effectiveness of available PCDT devices.
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Affiliation(s)
- Drew Fleck
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Hassan Albadawi
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Fadi Shamoun
- Division of Vascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Grace Knuttinen
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Sailendra Naidu
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Rahmi Oklu
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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21
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Stone J, Hangge P, Albadawi H, Wallace A, Shamoun F, Knuttien MG, Naidu S, Oklu R. Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther 2017; 7:S276-S284. [PMID: 29399531 DOI: 10.21037/cdt.2017.09.01] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide. Venous thromboembolism (VTE), which includes DVT and pulmonary embolism (PE), affects an estimated 1 per 1,000 people and contributes to 60,000-100,000 deaths annually. Normal blood physiology hinges on a delicate balance between pro- and anti-coagulant factors. Virchow's Triad distills the multitude of risk factors for DVT into three basic elements favoring thrombus formation: venous stasis, vascular injury, and hypercoagulability. Clinical, biochemical, and radiological tests are used to increase the sensitivity and specificity for diagnosing DVT. Anticoagulation therapy is essential for the treatment of DVT. With few exceptions, the standard therapy for DVT has been vitamin K-antagonists (VKAs) such as warfarin with heparin or fractionated heparin bridging. More recently, a number of large-scale clinical trials have validated the use of direct oral anticoagulants (DOACs) in place of warfarin in select cases. In this review, we summarize the pathogenesis, diagnosis, and medical management of DVT, with particular emphasis on anticoagulation therapy and the role of DOACs in the current treatment algorithm.
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Affiliation(s)
- Jonathan Stone
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Patrick Hangge
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Hassan Albadawi
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Alex Wallace
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Fadi Shamoun
- Division of Cardiovascular Diseases, Mayo Clinic, Phoenix, AZ, USA
| | - M Grace Knuttien
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Sailendra Naidu
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
| | - Rahmi Oklu
- Division of Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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22
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Laridan E, Denorme F, Desender L, François O, Andersson T, Deckmyn H, Vanhoorelbeke K, De Meyer SF. Neutrophil extracellular traps in ischemic stroke thrombi. Ann Neurol 2017; 82:223-232. [PMID: 28696508 DOI: 10.1002/ana.24993] [Citation(s) in RCA: 314] [Impact Index Per Article: 44.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Neutrophil extracellular traps (NETs) have been shown to promote thrombus formation. Little is known about the exact composition of thrombi that cause ischemic stroke. In particular, no information is yet available on the presence of NETs in cerebral occlusions. Such information is, however, essential to improve current thrombolytic therapy with tissue plasminogen activator (t-PA). This study aimed at investigating the presence of neutrophils and more specifically NETs in ischemic stroke thrombi. METHODS Sixty-eight thrombi retrieved from ischemic stroke patients undergoing endovascular treatment were characterized by immunostaining using neutrophil markers (CD66b and neutrophil elastase) and NET markers (citrullinated histone H3 [H3Cit] and extracellular DNA). Neutrophils and NETs were quantified. In addition, extracellular DNA was targeted by performing ex vivo lysis of retrieved thrombi with DNase 1 and t-PA. RESULTS Neutrophils were detected extensively throughout all thrombi. H3Cit, a hallmark of NETs, was observed in almost all thrombi. H3Cit-positive area varied up to 13.45% of total thrombus area. Colocalization of H3Cit with extracellular DNA released from neutrophils confirmed the specific presence of NETs. H3Cit was more abundant in thrombi of cardioembolic origin compared to other etiologies. Older thrombi contained significantly more neutrophils and H3Cit compared to fresh thrombi. Interestingly, ex vivo lysis of patient thrombi was more successful when adding DNase 1 to standard t-PA. INTERPRETATION Neutrophils and NETs form important constituents of cerebral thrombi. Targeting of NETs with DNase 1 might have prothrombolytic potential in treatment of acute ischemic stroke. Ann Neurol 2017;82:223-232.
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Affiliation(s)
- Elodie Laridan
- Laboratory for Thrombosis Research, KU Leuven, Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Frederik Denorme
- Laboratory for Thrombosis Research, KU Leuven, Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Linda Desender
- Laboratory for Thrombosis Research, KU Leuven, Campus Kulak Kortrijk, Kortrijk, Belgium
| | | | - Tommy Andersson
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Hans Deckmyn
- Laboratory for Thrombosis Research, KU Leuven, Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, KU Leuven, Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven, Campus Kulak Kortrijk, Kortrijk, Belgium
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23
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Qi H, Yang S, Zhang L. Neutrophil Extracellular Traps and Endothelial Dysfunction in Atherosclerosis and Thrombosis. Front Immunol 2017; 8:928. [PMID: 28824648 PMCID: PMC5545592 DOI: 10.3389/fimmu.2017.00928] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/20/2017] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular diseases are a leading cause of mortality and morbidity worldwide. Neutrophils are a component of the innate immune system which protect against pathogen invasion; however, the contribution of neutrophils to cardiovascular disease has been underestimated, despite infiltration of leukocyte subsets being a known driving force of atherosclerosis and thrombosis. In addition to their function as phagocytes, neutrophils can release their extracellular chromatin, nuclear protein, and serine proteases to form net-like fiber structures, termed neutrophil extracellular traps (NETs). NETs can entrap pathogens, induce endothelial activation, and trigger coagulation, and have been detected in atherosclerotic and thrombotic lesions in both humans and mice. Moreover, NETs can induce endothelial dysfunction and trigger proinflammatory immune responses. Overall, current data indicate that NETs are not only present in plaques and thrombi but also have causative roles in triggering formation of atherosclerotic plaques and venous thrombi. This review is focused on published findings regarding NET-associated endothelial dysfunction during atherosclerosis, atherothrombosis, and venous thrombosis pathogenesis. The NET structure is a novel discovery that will find its appropriate place in our new understanding of cardiovascular disease. In addition, NETs have high potential to be further explored toward much better treatment of atherosclerosis and venous thromboembolism in clinic.
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Affiliation(s)
- Haozhe Qi
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuofei Yang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lan Zhang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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24
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Abstract
Beyond its role in hemostasis, von Willebrand factor (VWF) is an emerging mediator of vascular inflammation. Recent studies highlight the involvement of VWF and its regulator, ADAMTS13, in mechanisms that underlie vascular inflammation and immunothrombosis, like leukocyte rolling, adhesion, and extravasation; vascular permeability; ischemia/reperfusion injury; complements activation; and NETosis. The VWF/ADAMTS13 axis is implicated in the pathogenesis of atherosclerosis, promoting plaque formation and inflammation through macrophage and neutrophil recruitment in inflamed lesions. Moreover, VWF and ADAMTS13 have been recently proposed as prognostic biomarkers in cardiovascular, metabolic, and inflammatory diseases, such as diabetes, stroke, myocardial infarction, and sepsis. All these features make VWF an attractive therapeutic target in thromboinflammation. Several lines of research have recently investigated “tailor-made” inhibitors of VWF. Results from animal models and clinical studies support the potent anti-inflammatory and antithrombotic effect of VWF antagonism, providing reassuring data on its safety profile. This review describes the role of VWF in vascular inflammation “from bench to bedside” and provides an updated overview of the drugs that can directly interfere with the VWF/ADAMTS13 axis.
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25
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Döring Y, Soehnlein O, Weber C. Neutrophil Extracellular Traps in Atherosclerosis and Atherothrombosis. Circ Res 2017; 120:736-743. [PMID: 28209798 DOI: 10.1161/circresaha.116.309692] [Citation(s) in RCA: 299] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/13/2016] [Accepted: 01/16/2016] [Indexed: 12/17/2022]
Abstract
Neutrophil extracellular traps expelled from suicidal neutrophils comprise a complex structure of nuclear chromatin and proteins of nuclear, granular, and cytosolic origin. These net-like structures have also been detected in atherosclerotic lesions and arterial thrombi in humans and mice. Functionally, neutrophil extracellular traps have been shown to induce activation of endothelial cells, antigen-presenting cells, and platelets, resulting in a proinflammatory immune response. Overall, this suggests that they are not only present in plaques and thrombi but also they may play a causative role in triggering atherosclerotic plaque formation and arterial thrombosis. This review will focus on current findings of the involvement of neutrophil extracellular traps in atherogenesis and atherothrombosis.
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Affiliation(s)
- Yvonne Döring
- From the Institute for Cardiovascular Prevention (IPEK), Department of Medicine, LMU Munich, Germany (Y.D., O.S., C.W.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany (O.S., C.W.); Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (O.S.); and Department of Biochemistry, Cardiovascular Research Institute (CARIM), Maastricht University, The Netherlands (C.W.).
| | - Oliver Soehnlein
- From the Institute for Cardiovascular Prevention (IPEK), Department of Medicine, LMU Munich, Germany (Y.D., O.S., C.W.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany (O.S., C.W.); Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (O.S.); and Department of Biochemistry, Cardiovascular Research Institute (CARIM), Maastricht University, The Netherlands (C.W.)
| | - Christian Weber
- From the Institute for Cardiovascular Prevention (IPEK), Department of Medicine, LMU Munich, Germany (Y.D., O.S., C.W.); DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany (O.S., C.W.); Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands (O.S.); and Department of Biochemistry, Cardiovascular Research Institute (CARIM), Maastricht University, The Netherlands (C.W.).
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26
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Zhang YS, Davoudi F, Walch P, Manbachi A, Luo X, Dell'Erba V, Miri AK, Albadawi H, Arneri A, Li X, Wang X, Dokmeci MR, Khademhosseini A, Oklu R. Bioprinted thrombosis-on-a-chip. LAB ON A CHIP 2016; 16:4097-4105. [PMID: 27722710 PMCID: PMC5072176 DOI: 10.1039/c6lc00380j] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Pathologic thrombosis kills more people than cancer and trauma combined; it is associated with significant disability and morbidity, and represents a major healthcare burden. Despite advancements in medical therapies and imaging, there is often incomplete resolution of the thrombus. The residual thrombus can undergo fibrotic changes over time through infiltration of fibroblasts from the surrounding tissues and eventually transform into a permanent clot often associated with post-thrombotic syndrome. In order to understand the importance of cellular interactions and the impact of potential therapeutics to treat thrombosis, an in vitro platform using human cells and blood components would be beneficial. Towards achieving this aim, there have been studies utilizing the capabilities of microdevices to study the hemodynamics associated with thrombosis. In this work, we further exploited the utilization of 3D bioprinting technology, for the construction of a highly biomimetic thrombosis-on-a-chip model. The model consisted of microchannels coated with a layer of confluent human endothelium embedded in a gelatin methacryloyl (GelMA) hydrogel, where human whole blood was infused and induced to form thrombi. Continuous perfusion with tissue plasmin activator led to dissolution of non-fibrotic clots, revealing clinical relevance of the model. Further encapsulating fibroblasts in the GelMA matrix demonstrated the potential migration of these cells into the clot and subsequent deposition of collagen type I over time, facilitating fibrosis remodeling that resembled the in vivo scenario. Our study suggests that in vitro 3D bioprinted blood coagulation models can be used to study the pathology of fibrosis, and particularly, in thrombosis. This versatile platform may be conveniently extended to other vascularized fibrotic disease models.
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Affiliation(s)
- Yu Shrike Zhang
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Farideh Davoudi
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Philipp Walch
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Institute of Pharmacy and Molecular Biotechnology, Heidelberg University, Im Neuenheimer Feld 364, D-69120, Germany
| | - Amir Manbachi
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xuan Luo
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Sorbonne Universités, Université de Technologie de Compiègne, UMR CNRS 7338, BMBI, Compiègne, France
| | - Valeria Dell'Erba
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Department of Biomedical Engineering, Politecnico di Torino, 10129 Torino, Italy
| | - Amir K Miri
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hassan Albadawi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Andrea Arneri
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xiaoyun Li
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and State Key Laboratory of Pulp and Paper Engineering, South China University of Technology, Guangzhou, 510640, PR China
| | - Xiaoying Wang
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and State Key Laboratory of Pulp and Paper Engineering, South China University of Technology, Guangzhou, 510640, PR China
| | - Mehmet Remzi Dokmeci
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA and Department of Bioindustrial Technologies, College of Animal Bioscience and Technology, Konkuk University, Hwayang-dong, Gwangjin-gu, Seoul 143-701, Republic of Korea and Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia
| | - Rahmi Oklu
- Biomaterials Innovation Research Center, Division of Engineering in Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. and Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA and Division of Vascular & Interventional Radiology, Mayo Clinic, Scottsdale, AZ 85259, USA.
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Kimball AS, Obi AT, Diaz JA, Henke PK. The Emerging Role of NETs in Venous Thrombosis and Immunothrombosis. Front Immunol 2016; 7:236. [PMID: 27446071 PMCID: PMC4921471 DOI: 10.3389/fimmu.2016.00236] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/02/2016] [Indexed: 12/11/2022] Open
Abstract
Venous thrombosis (VT), a leading cause of morbidity and mortality worldwide, has recently been linked to neutrophil activation and release of neutrophil extracellular traps (NETs) via a process called NETosis. The use of various in vivo thrombosis models and genetically modified mice has more precisely defined the exact role of NETosis in the pathogenesis of VT. Translational large animal VT models and human studies have confirmed the presence of NETs in pathologic VT. Activation of neutrophils, with subsequent NETosis, has also been linked to acute infection. This innate immune response, while effective for bacterial clearance from the host by formation of an intravascular bactericidal "net," also triggers thrombosis. Intravascular thrombosis related to such innate immune mechanisms has been coined immunothrombosis. Dysregulated immunothrombosis has been proposed as a mechanism of pathologic micro- and macrovascular thrombosis in sepsis and autoimmune disease. In this focused review, we will address the dual role of NETs in the pathogenesis of VT and immunothrombosis.
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Affiliation(s)
- Andrew S Kimball
- Section of Vascular Surgery, Conrad Jobst Vascular Research Laboratories, Department of Surgery, University of Michigan , Ann Arbor, MI , USA
| | - Andrea T Obi
- Section of Vascular Surgery, Conrad Jobst Vascular Research Laboratories, Department of Surgery, University of Michigan , Ann Arbor, MI , USA
| | - Jose A Diaz
- Section of Vascular Surgery, Conrad Jobst Vascular Research Laboratories, Department of Surgery, University of Michigan , Ann Arbor, MI , USA
| | - Peter K Henke
- Section of Vascular Surgery, Conrad Jobst Vascular Research Laboratories, Department of Surgery, University of Michigan , Ann Arbor, MI , USA
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Albadawi H, Oklu R, Raacke Malley RE, O'Keefe RM, Uong TP, Cormier NR, Watkins MT. Effect of DNase I treatment and neutrophil depletion on acute limb ischemia-reperfusion injury in mice. J Vasc Surg 2015; 64:484-493. [PMID: 26704988 DOI: 10.1016/j.jvs.2015.01.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/18/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Extracellular traps (ETs) consisting of DNA-protein complexes formed after tissue injury contribute to the inflammatory and thrombosis cascades, thereby exacerbating injury. Exogenous DNase I has been suggested as a therapeutic strategy to limit injury in the brain and myocardium. These studies were designed to evaluate the effects of exogenous DNase I treatment on skeletal muscle injury after acute hindlimb ischemia-reperfusion (IR) injury in mice and to determine whether neutrophils are a major source of ETs in postischemic muscle tissue. METHODS C57BL6 mice were subjected to 1.5 hours of tourniquet ischemia and 24 hours of reperfusion with and without human recombinant DNase I treatment. A separate set of mice was subjected to neutrophil depletion (ND), followed by the same intervals of IR. Laser Doppler imaging and tissue harvesting were done at 24 hours for assessment of limb perfusion, muscle fiber injury, adenosine triphosphate (ATP) level, markers of inflammation, thrombosis, and formation of ETs. RESULTS DNase I treatment significantly reduced detection of ETs in postischemic muscle but did not alter skeletal muscle fiber injury, levels of proinflammatory molecules, or ATP level. DNase I treatment did enhance postischemic hindlimb perfusion, decreased infiltrating inflammatory cells, and reduced the expression of thrombin-antithrombin III. ND resulted in a significant yet small reduction in ETs in the postischemic muscle. ND did not alter skeletal muscle fiber injury, hindlimb perfusion, or ATP levels. CONCLUSIONS These data suggest that neither DNase I treatment nor ND was protective against IR injury, even though both decreased detection of ETs in skeletal muscle after IR. Neutrophils are not the only source of ETs after IR.
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Affiliation(s)
- Hassan Albadawi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Rahmi Oklu
- Department of Radiology, Division of Vascular Imaging and Intervention, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Rita Elise Raacke Malley
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Ryan M O'Keefe
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Thuy P Uong
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Nicholas R Cormier
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass
| | - Michael T Watkins
- Department of Surgery, Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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29
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Gould TJ, Lysov Z, Liaw PC. Extracellular DNA and histones: double-edged swords in immunothrombosis. J Thromb Haemost 2015; 13 Suppl 1:S82-91. [PMID: 26149054 DOI: 10.1111/jth.12977] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The existence of extracellular DNA in human plasma, also known as cell-free DNA (cfDNA), was first described in the 1940s. In recent years, there has been a resurgence of interest in the functional significance of cfDNA, particularly in the context of neutrophil extracellular traps (NETs). cfDNA and histones are key components of NETs that aid in the host response to infection and inflammation. However, cfDNA and histones may also exert harmful effects by triggering coagulation, inflammation, and cell death and by impairing fibrinolysis. In this article, we will review the pathologic nature of cfDNA and histones in macrovascular and microvascular thrombosis, including venous thromboembolism, cancer, sepsis, and trauma. We will also discuss the prognostic value of cfDNA and histones in these disease states. Understanding the molecular and cellular pathways regulated by cfDNA and histones may provide novel insights to prevent pathological thrombus formation and vascular occlusion.
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Affiliation(s)
- T J Gould
- Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
- Thrombosis and Atherosclerosis Research Institute (TaARI), McMaster University, Hamilton, ON, Canada
| | - Z Lysov
- Department of Medical Sciences, McMaster University, Hamilton, ON, Canada
- Thrombosis and Atherosclerosis Research Institute (TaARI), McMaster University, Hamilton, ON, Canada
| | - P C Liaw
- Thrombosis and Atherosclerosis Research Institute (TaARI), McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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30
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Mangold A, Alias S, Scherz T, Hofbauer T, Jakowitsch J, Panzenböck A, Simon D, Laimer D, Bangert C, Kammerlander A, Mascherbauer J, Winter MP, Distelmaier K, Adlbrecht C, Preissner KT, Lang IM. Coronary neutrophil extracellular trap burden and deoxyribonuclease activity in ST-elevation acute coronary syndrome are predictors of ST-segment resolution and infarct size. Circ Res 2014; 116:1182-92. [PMID: 25547404 DOI: 10.1161/circresaha.116.304944] [Citation(s) in RCA: 316] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Mechanisms of coronary occlusion in ST-elevation acute coronary syndrome are poorly understood. We have previously reported that neutrophil (polymorphonuclear cells [PMNs]) accumulation in culprit lesion site (CLS) thrombus is a predictor of cardiovascular outcomes. OBJECTIVE The goal of this study was to characterize PMN activation at the CLS. We examined the relationships between CLS neutrophil extracellular traps (NETs), bacterial components as triggers of NETosis, activity of endogenous deoxyribonuclease, ST-segment resolution, and infarct size. METHODS AND RESULTS We analyzed coronary thrombectomies from 111 patients with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention. Thrombi were characterized by immunostaining, flow cytometry, bacterial profiling, and immunometric and enzymatic assays. Compared with femoral PMNs, CLS PMNs were highly activated and formed aggregates with platelets. Nucleosomes, double-stranded DNA, neutrophil elastase, myeloperoxidase, and myeloid-related protein 8/14 were increased in CLS plasma, and NETs contributed to the scaffolds of particulate coronary thrombi. Copy numbers of Streptococcus species correlated positively with dsDNA. Thrombus NET burden correlated positively with infarct size and negatively with ST-segment resolution, whereas CLS deoxyribonuclease activity correlated negatively with infarct size and positively with ST-segment resolution. Recombinant deoxyribonuclease accelerated the lysis of coronary thrombi ex vivo. CONCLUSIONS PMNs are highly activated in ST-elevation acute coronary syndrome and undergo NETosis at the CLS. Coronary NET burden and deoxyribonuclease activity are predictors of ST-segment resolution and myocardial infarct size.
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Affiliation(s)
- Andreas Mangold
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Sherin Alias
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Thomas Scherz
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Thomas Hofbauer
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Johannes Jakowitsch
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Adelheid Panzenböck
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Daniel Simon
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Daniela Laimer
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Christine Bangert
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Andreas Kammerlander
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Julia Mascherbauer
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Max-Paul Winter
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Klaus Distelmaier
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Christopher Adlbrecht
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Klaus T Preissner
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.)
| | - Irene M Lang
- From the Division of Cardiology, Department of Internal Medicine II (A.M., S.A., T.S., T.H., J.J., A.P., D.S., A.K., J.M., M.-P.W., K.D., C.A., I.M.L.), Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology (D.L., C.B.), Vienna General Hospital, Medical University of Vienna, Austria; and Institute for Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany (K.T.P.).
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31
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Ge L, Zhou X, Ji WJ, Lu RY, Zhang Y, Zhang YD, Ma YQ, Zhao JH, Li YM. Neutrophil extracellular traps in ischemia-reperfusion injury-induced myocardial no-reflow: therapeutic potential of DNase-based reperfusion strategy. Am J Physiol Heart Circ Physiol 2014; 308:H500-9. [PMID: 25527775 DOI: 10.1152/ajpheart.00381.2014] [Citation(s) in RCA: 157] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Emerging evidence suggests a potential role of neutrophil extracellular traps (NETs) in linking sterile inflammation and thrombosis. We hypothesized that NETs would be induced during myocardial ischemia-reperfusion (I/R), and NET-mediated microthrombosis may contribute to myocardial "no-reflow". Male Wistar rats were randomly divided into I/R control, DNase (DNase I, 20 μg/rat), recombinant tissue-type plasminogen activator (rt-PA, 420 μg/rat), DNase + rt-PA, and sham control groups after 45-min myocardial ischemia. In situ NET formation, the anatomic "no re-flow" area, and infarct size were evaluated immediately after 3 h of reperfusion. Long-term left ventricular (LV) functional and histological analyses were performed 45 days after operation. Compared with the I/R controls, the DNase + rt-PA group exhibited reduced NET density [8.38 ± 1.98 vs. 26.86 ± 3.07 (per 200 × field), P < 0.001] and "no-flow" area (15.22 ± 0.06 vs. 34.6 ± 0.05%, P < 0.05) in the ischemic region, as well as reduced infarct size (38.39 ± 0.05 vs. 71.00 ± 0.03%, P < 0.001). Additionally, compared with the I/R controls, DNase + rt-PA treatment significantly ameliorated I/R injury-induced LV remodeling (LV ejection fraction: 64.22 ± 3.37 vs. 33.81 ± 2.98%, P < 0.05; LV maximal slope of the LV systolic pressure increment: 3,785 ± 216 vs. 2,596 ± 299 mmHg/s, P < 0.05). The beneficial effect was not observed in rats treated with DNase I or rt-PA alone. Our study provides evidence for the existence of NETs in I/R-challenged myocardium and confirms the long-term benefit of a novel DNase-based reperfusion strategy (DNase I + rt-PA), which might be a promising option for the treatment of myocardial I/R injury and coronary no-reflow.
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Affiliation(s)
- Lan Ge
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Institute of Cardiovascular Disease and Heart Center, Pingjin Hospital, Logistics University of the Chinese People's Armed Police Forces, Tianjin, China; and
| | - Xin Zhou
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Institute of Cardiovascular Disease and Heart Center, Pingjin Hospital, Logistics University of the Chinese People's Armed Police Forces, Tianjin, China; and
| | - Wen-Jie Ji
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Institute of Cardiovascular Disease and Heart Center, Pingjin Hospital, Logistics University of the Chinese People's Armed Police Forces, Tianjin, China; and
| | - Rui-Yi Lu
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Institute of Cardiovascular Disease and Heart Center, Pingjin Hospital, Logistics University of the Chinese People's Armed Police Forces, Tianjin, China; and
| | - Yan Zhang
- Institute of Molecular Medicine, Peking University, Peking, China
| | - Yi-Dan Zhang
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Institute of Cardiovascular Disease and Heart Center, Pingjin Hospital, Logistics University of the Chinese People's Armed Police Forces, Tianjin, China; and
| | - Yong-Qiang Ma
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Institute of Cardiovascular Disease and Heart Center, Pingjin Hospital, Logistics University of the Chinese People's Armed Police Forces, Tianjin, China; and
| | - Ji-Hong Zhao
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Institute of Cardiovascular Disease and Heart Center, Pingjin Hospital, Logistics University of the Chinese People's Armed Police Forces, Tianjin, China; and
| | - Yu-Ming Li
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Institute of Cardiovascular Disease and Heart Center, Pingjin Hospital, Logistics University of the Chinese People's Armed Police Forces, Tianjin, China; and
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Semeraro F, Ammollo CT, Esmon NL, Esmon CT. Histones induce phosphatidylserine exposure and a procoagulant phenotype in human red blood cells. J Thromb Haemost 2014; 12:1697-702. [PMID: 25069624 PMCID: PMC4194154 DOI: 10.1111/jth.12677] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Extracellular histones exert part of their prothrombotic activity through the stimulation of blood cells. Besides platelets, histones can bind to red blood cells (RBCs), which are important contributors to thrombogenesis, but little is known about the functional consequences of this interaction. OBJECTIVES To evaluate the effect of histones on the procoagulant potential of human RBCs with particular regard to the expression of surface phosphatidylserine (PS). METHODS PS exposure on human RBCs treated with a natural mixture of histones or recombinant individual histones was evaluated with fluorescein isothiocyanate-annexin-V binding and measured with flow cytometry. Calcium influx in RBCs loaded with the calcium-sensitive fluorophore Fluo-4 AM was assessed with flow cytometry. The procoagulant potential of histone-treated RBCs was evaluated with a purified prothrombinase assay and a one-stage plasma recalcification clotting test. RESULTS Natural histones induced PS exposure on RBCs in a dose-dependent manner, and neutralization or cleavage of histones by heparin or activated protein C, respectively, abolished PS externalization. H4 was mainly responsible for the stimulating activity of histones, whereas the other subtypes were almost ineffective. Similarly, natural histones and H4 induced influx of calcium into RBCs, whereas the other individual histones did not. Histone-induced exposure of PS on RBCs translated into increased prothrombinase complex-mediated prothrombin activation and accelerated fibrin formation in plasma. CONCLUSIONS Histones induce RBCs to express a procoagulant phenotype through the externalization of PS. This finding provides new insights into the prothrombotic activity of extracellular histones.
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Affiliation(s)
- F Semeraro
- Coagulation Biology Laboratory, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
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Savchenko AS, Martinod K, Seidman MA, Wong SL, Borissoff JI, Piazza G, Libby P, Goldhaber SZ, Mitchell RN, Wagner DD. Neutrophil extracellular traps form predominantly during the organizing stage of human venous thromboembolism development. J Thromb Haemost 2014; 12:860-70. [PMID: 24674135 PMCID: PMC4055516 DOI: 10.1111/jth.12571] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/21/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND A growing health problem, venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), requires refined diagnostic and therapeutic approaches. Neutrophils contribute to thrombus initiation and development in experimental DVT. Recent animal studies recognized neutrophil extracellular traps (NETs) as an important scaffold supporting thrombus stability. However, the hypothesis that human venous thrombi involve NETs has not undergone rigorous testing. OBJECTIVE To explore the cellular composition and the presence of NETs within human venous thrombi at different stages of development. PATIENTS AND METHODS We examined 16 thrombi obtained from 11 patients during surgery or at autopsy using histomorphological, immunohistochemical and immunofluorescence analyses. RESULTS We classified thrombus regions as unorganized, organizing and organized according to their morphological characteristics. We then evaluated them, focusing on neutrophil and platelet deposition as well as micro-vascularization of the thrombus body. We observed evidence of NET accumulation, including the presence of citrullinated histone H3 (H3Cit)-positive cells. NETs, defined as extracellular diffuse H3Cit areas associated with myeloperoxidase and DNA, localized predominantly during the phase of organization in human venous thrombi. CONCLUSIONS NETs are present in organizing thrombi in patients with VTE. They are associated with thrombus maturation in humans. Dissolution of NETs might thus facilitate thrombolysis. This finding provides new insights into the clinical development and pathology of thrombosis and provides new perspectives for therapeutic advances.
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Affiliation(s)
- A S Savchenko
- Program in Cellular and Molecular Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Oklu R, Stone JR, Albadawi H, Watkins MT. Extracellular traps in lipid-rich lesions of carotid atherosclerotic plaques: implications for lipoprotein retention and lesion progression. J Vasc Interv Radiol 2014; 25:631-4. [PMID: 24581730 DOI: 10.1016/j.jvir.2013.12.567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 12/18/2013] [Accepted: 12/22/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To investigate the presence and location of extracellular traps (ETs) in atherosclerotic plaques and to determine whether they are spatially associated with inflammatory cells and the lipid core. MATERIALS AND METHODS Human carotid atherosclerotic plaques were collected from seven patients after surgical endarterectomy. Sequential tissue sections were stained with hematoxylin-eosin or subjected to immunohistochemistry to detect ETs, neutrophils and macrophages or apolipoprotein B (ApoB). To demonstrate the specificity of the antibody used to detect ETs, the adjacent tissue section was pretreated with deoxyribonuclease-1 (DNase-1) before immunostaining for ETs. RESULTS All seven carotid plaques demonstrated advanced atherosclerotic lesions. Extensive ET and ApoB immunostaining was detected predominantly within the acellular lipid core. Along the edges of the lipid core, confocal microscopy revealed areas suggestive of active release of ETs from MPO-positive cells. Pretreatment of tissue sections with DNase-1 abolished ET signal in the extracellular matrix, but not the signal within the cells along the margins of the core. CONCLUSIONS The localization of ETs to the lipid core suggests a possible binding site for lipoproteins, which may further promote lesion progression and inflammation.
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Affiliation(s)
- Rahmi Oklu
- Department of Imaging, Division of Vascular Imaging and Intervention, Massachusetts General Hospital, 290 Gray/Bigelow, 55 Fruit Street, Boston, MA 02114; Harvard Medical School, Boston, Massachusetts.
| | - James R Stone
- Department of Pathology and Center for Systems Biology, Massachusetts General Hospital, 290 Gray/Bigelow, 55 Fruit Street, Boston, MA 02114; Harvard Medical School, Boston, Massachusetts
| | - Hassan Albadawi
- Department of Surgery, Division of Vascular Surgery, Massachusetts General Hospital, 290 Gray/Bigelow, 55 Fruit Street, Boston, MA 02114; Harvard Medical School, Boston, Massachusetts
| | - Michael T Watkins
- Department of Surgery, Division of Vascular Surgery, Massachusetts General Hospital, 290 Gray/Bigelow, 55 Fruit Street, Boston, MA 02114; Harvard Medical School, Boston, Massachusetts
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Abstract
The contributions by blood cells to pathological venous thrombosis were only recently appreciated. Both platelets and neutrophils are now recognized as crucial for thrombus initiation and progression. Here we review the most recent findings regarding the role of neutrophil extracellular traps (NETs) in thrombosis. We describe the biological process of NET formation (NETosis) and how the extracellular release of DNA and protein components of NETs, such as histones and serine proteases, contributes to coagulation and platelet aggregation. Animal models have unveiled conditions in which NETs form and their relation to thrombogenesis. Genetically engineered mice enable further elucidation of the pathways contributing to NETosis at the molecular level. Peptidylarginine deiminase 4, an enzyme that mediates chromatin decondensation, was identified to regulate both NETosis and pathological thrombosis. A growing body of evidence reveals that NETs also form in human thrombosis and that NET biomarkers in plasma reflect disease activity. The cell biology of NETosis is still being actively characterized and may provide novel insights for the design of specific inhibitory therapeutics. After a review of the relevant literature, we propose new ways to approach thrombolysis and suggest potential prophylactic and therapeutic agents for thrombosis.
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Sillesen M, Jin G, Oklu R, Albadawi H, Imam AM, Jepsen CH, Hwabejire JO, Ostrowski SR, Johansson PI, Rasmussen LS, Alam HB. Fresh-frozen plasma resuscitation after traumatic brain injury and shock attenuates extracellular nucleosome levels and deoxyribonuclease 1 depletion. Surgery 2013; 154:197-205. [PMID: 23889948 DOI: 10.1016/j.surg.2013.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 04/03/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Traumatic brain injury and shock are among the leading causes of trauma-related mortality. We have previously shown that fresh-frozen plasma (FFP) resuscitation reduces the size of brain lesion and associated swelling compared with crystalloids. We hypothesized that this effect would be associated with an attenuation of circulating nucleosome levels, a biomarker of injury with cytotoxic potential, through reconstitution of circulating deoxyribonuclease-1 (DNAse1), an enzyme identified as critical in nucleosome clearance from the circulation. METHODS Twelve swine underwent a protocol of traumatic brain injury followed by 40% volume-controlled hemorrhage. Animals were left in shock (mean arterial pressure of 35 mmHg) for 2 hours before they were resuscitated with normal saline (NS) or FFP. Circulating levels of nucleosomes and DNAse1 were measured whereas extracellular nucleosomes were quantified on brain histology. Lesion size and brain swelling were also quantified. RESULTS Nucleosome levels were significantly greater in the NS group 6 hours after resuscitation (0.32 mU vs 0.15 mU, P = .030) whereas DNAse1 levels were substantially greater in the FFP group (9.82 ng/mL vs 4.54 ng/mL, P = .010). Circulating nucleosomes levels correlated with lesion size (rho = 0.79, P = .002) as well as brain swelling (rho = 0.89, P < .001) whereas DNAse1 levels correlated with brain swelling (rho = -0.61, P = .036) but not lesion size (rho = -0.47, P = .124). Brain staining revealed nucleosome extracellularization in both groups, but this appeared more frequent in the NS-resuscitated animals. CONCLUSION Our results show that resuscitation with FFP attenuates circulating nucleosome levels and prevents DNAse1 depletion. These factors may play a role in the neuroprotective effects observed during early resuscitation with FFP.
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Affiliation(s)
- Martin Sillesen
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Oklu R, Deipolyi AR, Wicky S, Ergul E, Deik AA, Chen JW, Hirsch JA, Wojtkiewicz GR, Clish CB. Identification of small compound biomarkers of pituitary adenoma: a bilateral inferior petrosal sinus sampling study. J Neurointerv Surg 2013; 6:541-6. [PMID: 24005126 DOI: 10.1136/neurintsurg-2013-010821] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Evaluation of the pathogenic mechanisms underlying Cushing disease (CD) is limited partly by the inaccessibility of the pituitary gland for biopsy. We used bilateral inferior petrosal sinus sampling (BIPSS), the gold standard in diagnosing pituitary sources of CD, to obtain central blood samples for in vivo metabolomic analysis of pathways involved in pituitary adenomas. We evaluated 16 samples from eight patients who underwent BIPSS to measure adrenocorticotropic hormone (ACTH) levels in the inferior petrosal sinus (IPS) bilaterally. Seven patients had CD with concordant BIPSS, surgical, and pathologic findings. Samples from the IPS contralateral to histologically proven lesions were used as controls. BIPSS of the eighth patient revealed no central pituitary ACTH source, and these samples were also included as controls. Plasma samples were profiled using a combination of three liquid chromatography tandem mass spectrometry methods, which assessed 259 metabolites. Following Bonferroni correction for multiple comparisons, three small compound biomarkers of CD (pyridoxate, deoxycholic acid, and 3-methyladipate) were identified to be significantly altered in pituitary adenomas. The pathway most significantly impacted in CD samples is one previously shown to be upregulated in other cancers. Exploiting the BIPSS technique, we showed a complete metabolite and lipid profile of pituitary adenomas in CD. These potential biomarkers of CD may elucidate tumor biology and suggest possible diagnostic molecular imaging probes as well as therapeutic targets in patients with recurrent disease after surgery.
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Affiliation(s)
- Rahmi Oklu
- Division of Vascular Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy R Deipolyi
- Division of Vascular Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephan Wicky
- Division of Vascular Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emel Ergul
- Division of Vascular Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amy A Deik
- Division of Metabolite Profiling, Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - John W Chen
- Division of Neuroradiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA Center for Systems Biology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua A Hirsch
- Division of Interventional Neuroradiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory R Wojtkiewicz
- Center for Systems Biology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Clary B Clish
- Division of Metabolite Profiling, Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
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Oklu R, Albadawi H, Jones JE, Yoo HJ, Watkins MT. Reduced hind limb ischemia-reperfusion injury in Toll-like receptor-4 mutant mice is associated with decreased neutrophil extracellular traps. J Vasc Surg 2013; 58:1627-36. [PMID: 23683381 DOI: 10.1016/j.jvs.2013.02.241] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/13/2013] [Accepted: 02/21/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Ischemia-reperfusion (IR) injury is a significant problem in the management of patients with acute limb ischemia. Despite rapid restoration of blood flow after technically successful open and endovascular revascularization, complications secondary to IR injury continue to occur and limit clinical success. Our aim was to create a murine model of hind limb IR injury to examine the role of Toll-like receptor-4 (TLR4) and to determine whether inactive TLR4 led to a decrease in the detection of neutrophil extracellular traps (NETs), which are known to be highly thrombogenic and may mediate microvascular injury. METHODS A calibrated tension tourniquet was applied to unilateral hind limb of wild-type (WT) and TLR4 receptor mutant (TLR4m) mice for 1.5 hours to induce ischemia and then removed to initiate reperfusion. At the end of 48 hours of reperfusion, mice were euthanized and hind limb tissue and serum specimens were collected for analysis. Hematoxylin and eosin-stained sections of hind limb skeletal muscle tissue were examined for fiber injury. For immunohistochemistry, mouse monoclonal antihistone H2A/H2B/DNA complex antibody to detect NETs and rabbit polyclonal antimyeloperoxidase antibody were used to identify infiltrating cells containing myeloperoxidase. Muscle adenosine triphosphate levels, nuclear factor (NF)-κB activity, the α-subunit of inhibitor of NF-κB light polypeptide gene enhancer, poly (adenosine diphosphate-ribose) polymerase activity, and inducible nitric oxide synthase expression were measured. Systemic levels of keratinocyte-derived chemokine, monocyte chemotactic protein-1, and vascular endothelial growth factor in the serum samples were also examined. RESULTS IR injury in the hind limb of WT mice demonstrated significant levels of muscle fiber injury, decreased energy substrates, increased NF-κB activation, decreased levels of α-subunit of inhibitor of NF-κB light polypeptide gene enhancer, increased inducible nitric oxide synthase expression, and increased poly (adenosine diphosphate-ribose) polymerase activity levels compared with the TLR4m samples. Additionally, there was marked decrease in the level of neutrophil and monocyte infiltration in the TLR4m mice, which corresponded to similar levels of decreased NET detection in the interstitial space and in microvascular thrombi. In situ nuclease treatment of WT tissue sections significantly diminished the level of NET immunostaining, demonstrating the specificity of the antibody to detect NETs and suggesting a potential role for nuclease treatment in IR injury. CONCLUSIONS These results suggest a pivotal role for TLR4 in mediating hind limb IR injury and suggest that NETs may contribute to muscle fiber injury.
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Affiliation(s)
- Rahmi Oklu
- Division of Vascular Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Boston, Mass
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Cho H, Guo Y, Sosnovik DE, Josephson L. Imaging DNA with fluorochrome bearing metals. Inorg Chem 2013; 52:12216-22. [PMID: 23646914 DOI: 10.1021/ic400404g] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Molecules that fluoresce upon binding DNA are widely used in assaying and visualizing DNA in cells and tissues. However, using light to visualize DNA in animals is limited by the attenuation of light transmission by biological tissues. Moreover, it is now clear that DNA is an important mediator of dead cell clearance, coagulation reactions, and an immunogen in autoimmune lupus. Attaching metals (e.g., superparamagnetic nanoparticles, gadolinium ions, radioactive metal ions) to DNA-binding fluorochromes provides a way of imaging DNA in whole animals, and potentially humans, without light. Imaging metal-bearing, DNA-binding fluorochromes and their target DNA by magnetic resonance imaging may shed light on the many key roles of DNA in health and disease beyond the storage of genetic information.
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Affiliation(s)
- Hoonsung Cho
- Center for Translational Nuclear Medicine and Molecular Imaging, ‡Martinos Center for Biomedical Imaging, Department of Radiology, and §Cardiovascular Research Center, Cardiology Division, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts 02114, United States
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