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Zapponi KCS, Orsi FA, Cunha JLR, de Brito IR, Romano AVC, Bittar LF, De Paula EV, Penteado CF, Montalvão S, Annichino-Bizzacchi JM. Neutrophil activation and circulating neutrophil extracellular traps are increased in venous thromboembolism patients for at least one year after the clinical event. J Thromb Thrombolysis 2021; 53:30-42. [PMID: 34449018 PMCID: PMC8791881 DOI: 10.1007/s11239-021-02526-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 12/23/2022]
Abstract
Neutrophil activation and neutrophil extracellular traps (NETs) have been associated with the pathogenesis of venous thromboembolism (VTE). Considering VTE-associated chronic sequelae, which suggest that some pathological mechanisms remain after the acute episode, we investigated whether neutrophil activation is increased in patients with a prior VTE at least one year before this investigation. Thirty-seven patients with prior VTE and 37 individuals with no history of VTE were included. Neutrophil activity was evaluated by the expression of the adhesive molecule activation-specific epitopes LFA-1 (CD11a) and MAC-1 (CD11b), chemotaxis, reactive oxygen species (ROS) and by MPO-DNA complexes as markers of NETs. The adhesive molecules sICAM-1 and sVCAM-1, involved in the cross talk between neutrophil and endothelial cells, were also evaluated. Patient neutrophils presented increased CD11a expression before and after TNF-α stimulus, whereas increased CD11b expression was observed only after TNF-α stimulus, as compared to controls. Neutrophil chemotaxis on both, basal state and after IL-8 stimulus, on circulating levels of sICAM-1 and sVCAM-1, and on MPO-DNA complexes were also increased in VTE patients. ROS release was similar between patients and controls. This is, to our knowledge, the first study to investigate neutrophil inflammatory activity in VTE patients a long period after an acute event (approximately 2 years). The results showed altered neutrophil activation patterns in these patients. While activated neutrophils can cause endothelial activation and injury, the activated endothelium can induce the release of NETs with consequent endothelial cytotoxicity, creating a vicious cycle of activation between neutrophils and endothelium that can lead to thrombosis.
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Affiliation(s)
- Kiara C. S. Zapponi
- Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas street, 480, Campinas, 13083878 Brazil
| | - Fernanda A. Orsi
- Department of Clinical Pathology, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
- Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - José Luiz R. Cunha
- Department of Clinical Pathology, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Ingrid R. de Brito
- Department of Clinical Pathology, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Anna Virginia C. Romano
- Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas street, 480, Campinas, 13083878 Brazil
| | - Luis Fernando Bittar
- Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas street, 480, Campinas, 13083878 Brazil
- Department of Clinical Pathology, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | - Erich Vinicius De Paula
- Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas street, 480, Campinas, 13083878 Brazil
| | - Carla F. Penteado
- Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas street, 480, Campinas, 13083878 Brazil
| | - Silmara Montalvão
- Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas street, 480, Campinas, 13083878 Brazil
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Shan X, Liu Z, Wulasihan M, Ma S. Edoxaban improves atrial fibrillation and thromboembolism through regulation of the Wnt-β-induced PI3K/ATK-activated protein C system. Exp Ther Med 2019; 17:3509-3517. [PMID: 30988731 PMCID: PMC6447810 DOI: 10.3892/etm.2019.7379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 04/20/2018] [Indexed: 11/24/2022] Open
Abstract
Thromboembolism is a commonly observed condition in geriatrics that is caused by vascular endothelial injury, platelet activation, physiological coagulation processes, reduction of anticoagulant activity, decreased fibrinolytic activity and abnormal flow in the heart chamber, artery or vein. The protein C anticoagulant system serves a crucial role in anticoagulant therapy for the treatment of thromboembolism. Previous findings have suggested that edoxaban is an efficient oral anticoagulant in the acute treatment of venous thromboembolism. In the present study, the efficacy of edoxaban on thromboembolism induced by atrial fibrillation was investigated in a mouse model. Inflammatory factors interleukin (IL)-1, −4, −8 and tumor necrosis factor (TNF)-α were analyzed in the sera of mice with fibrillation induced by thromboembolism. Expression and activity of thymic stromal lymphopoietin (TSLP) and activated protein C resistance were investigated in platelets and vascular endothelial cells (VECs). TSLP-induced platelet viability, Wnt-β phosphorylation and integrin expression were analyzed in platelets. Furthermore, Wnt-β expression and the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway in VECs were analyzed. Results demonstrated that the expression levels of IL-1, −4, −8 and TNF-α were significantly downregulated in the sera of mice with fibrillation and thromboembolism following treatment with edoxaban (P<0.01). Furthermore, the expression levels of prostacyclin (PGI2), prostaglandin (PG)E2, PGD2 and PGF2α were significantly increased in the sera of experimental mice that received edoxaban therapy (P<0.01). Results also indicated that edoxaban significantly stimulated the protein expression of TSLP and activated Wnt-β phosphorylation and integrin expression in platelets (P<0.01). In addition, edoxaban therapy significantly upregulated the expression levels of PI3K and AKT, and subsequently increased the activity of protein C and S in VECs (P<0.01). Notably, edoxaban treatment improved atrial fibrillation and thromboembolism, as determined by pathological analysis. In conclusion, these results suggested that edoxaban elicited beneficial effects for mice with atrial fibrillation induced by thromboembolism through the regulation of the Wnt-β-induced PI3K/ATK-activated protein C system.
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Affiliation(s)
- Xuefeng Shan
- Department of Pediatric Surgery, The First Affiliated Hospital, Xinjiang Medical University, Urumchi, Xinjiang 830054, P.R. China
| | - Zhiqiang Liu
- Comprehensive Heart Internal Medicine, Heart Center of The First Affiliated Hospital, Xinjiang Medical University, Urumchi, Xinjiang 830054, P.R. China
| | - Muhuyati Wulasihan
- Comprehensive Heart Internal Medicine, Heart Center of The First Affiliated Hospital, Xinjiang Medical University, Urumchi, Xinjiang 830054, P.R. China
| | - Songfeng Ma
- Department of Pediatric Surgery, The First Affiliated Hospital, Xinjiang Medical University, Urumchi, Xinjiang 830054, P.R. China
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