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Bucciol R, Othman M. Tissue factor positive microparticles as a biomarker for increased risk of breast cancer-associated thrombosis: a mini review. Curr Opin Hematol 2023; 30:180-185. [PMID: 37522480 DOI: 10.1097/moh.0000000000000774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
PURPOSE OF REVIEW Cancer-associated thrombosis (CAT), such as venous thromboembolism (VTE), is a frequent complication in cancer patients, resulting in poor prognosis. Breast cancer is not highly thrombogenic but is highly prevalent, resulting in increased VTE cases. Many cancers express tissue factor (TF), a glycoprotein that triggers coagulation. The cancer cells were shown to express and release substantial amounts of TF-positive microparticles (MPTF), associated with a prothrombotic state. This narrative review evaluated the current use of the procoagulant MPTF as a biomarker for thrombosis risk in breast cancer. RECENT FINDINGS Tumors of epithelial origin with elevated TF expression have been associated with increased VTE incidence. Thus, studies have affirmed the use of MPTF biomarkers for VTE risk in many cancers. Patients with metastatic breast cancer and CAT were found to exhibit elevated procoagulant microparticles in vitro, due to TF expression. The silencing of TF was associated with decreased microparticle release in breast carcinoma cell lines, associated with decreased coagulation. SUMMARY CAT is a multifactorial condition, with several various underlying diseases. It is proposed that MPTF may be an effective biomarker for thrombosis risk in breast cancer patients but requires a more systemic evaluation utilizing standardized quantification methods.
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Affiliation(s)
- Regan Bucciol
- Department of Biomedical and Molecular Sciences, Queen's University
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, Queen's University
- School of Baccalaureate Nursing, St Lawrence College, Kingston, Ontario, Canada
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Thaler J, Prager G, Pabinger I, Ay C. Plasma Clot Properties in Patients with Pancreatic Cancer. Cancers (Basel) 2023; 15:4030. [PMID: 37627058 PMCID: PMC10452192 DOI: 10.3390/cancers15164030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Pancreatic cancer is one of the most prothrombotic malignancies. Plasma clot properties may be altered in patients with pancreatic cancer, and circulating tissue factor (TF) may play an important role. We applied a modified plasma clot formation assay (only CaCl2 and phospholipids were added to initiate clotting) and a standard clotting assay (lipidated TF was also added) to investigate whether plasma clot properties are altered in pancreatic cancer patients (n = 40, 23 female) compared to sex-matched healthy controls. The modified assay was also performed in the presence of a TF blocking antibody. With this modified assay, we detected an increased plasma clot formation rate (Vmax) and an increased delta absorbance (ΔAbs, indicating fibrin fiber thickness) in patients compared to controls. These differences were not detected with the standard clotting assay. Following addition of a TF blocking antibody in in our modified assay, Vmax decreased significantly in patients only, ΔAbs significantly decreased in patients and in healthy controls, the lag phase did not change, and the time to peak fibrin generation increased in patients only. Taken together, these findings indicate the presence of a prothrombotic state in pancreatic cancer patients, which depends on TF and is detectable with our modified assay but not with a standard clotting assay.
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Affiliation(s)
- Johannes Thaler
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria; (I.P.); (C.A.)
| | - Gerald Prager
- Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria;
| | - Ingrid Pabinger
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria; (I.P.); (C.A.)
| | - Cihan Ay
- Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria; (I.P.); (C.A.)
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Meyer AD, Hughes TB, Rishmawi AR, Heard P, Shah S, Aune GJ. A cohort study on blood coagulation in childhood cancer survivors. Thromb Res 2023; 226:100-106. [PMID: 37141794 DOI: 10.1016/j.thromres.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/22/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
Cancer survivors are at an increased risk of thromboembolism compared to the general pediatric population. Anticoagulant therapy decreases the risk of thromboembolism in cancer patients. We hypothesized that pediatric cancer survivors are in a chronically hypercoagulable state compared to healthy controls. Children who survived for more than five years from cancer diagnosis at the UT Health Science Center at San Antonio Cancer Survivorship Clinic were compared to healthy controls. The exclusion criteria were recent NSAID use or a history of coagulopathy. Coagulation analysis included platelet count, thrombin-antithrombin complexes (TAT), plasminogen activator inhibitor (PAI), routine coagulation assays, and thrombin generation with and without thrombomodulin. We enrolled 47 pediatric cancer survivors and 37 healthy controls. Platelet count was significantly lower in cancer survivors at a mean of 254 × 109/L (95%CI: 234-273 × 109/L) compared at 307 × 109/L (283-331 × 109/L) in healthy controls (p < 0.001), although not outside the normal range. Routine coagulation assays showed no differences, except for a significantly lower prothrombin time (PT) in cancer survivors (p < 0.004). Cancer survivors has significantly elevated biomarkers of the procoagulant state, such as TAT and PAI, compared to healthy controls (p < 0.001). A multiple logistic regression model controlling for age, BMI, gender, and race/ethnicity documented that a low platelet count, short prothrombin clot time, and higher procoagulant biomarkers (TAT and PAI) were significantly associated with past cancer therapy. Survivors of childhood cancer have a persistent procoagulant imbalance for more than five years after diagnosis. Further studies are needed to establish whether procoagulant imbalance increases the risk of thromboembolism in childhood cancer survivors.
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Affiliation(s)
- Andrew D Meyer
- Division of Critical Care, Department of Pediatrics, Long School of Medicine at The University of Texas Health Science Center, San Antonio, TX, United States of America.
| | - Tyler B Hughes
- Division of Critical Care, Department of Pediatrics, Long School of Medicine at The University of Texas Health Science Center, San Antonio, TX, United States of America.
| | - Anjana R Rishmawi
- Division of Critical Care, Department of Pediatrics, Long School of Medicine at The University of Texas Health Science Center, San Antonio, TX, United States of America
| | - Patty Heard
- Division of Critical Care, Department of Pediatrics, Long School of Medicine at The University of Texas Health Science Center, San Antonio, TX, United States of America.
| | - Shafqat Shah
- Division of Hematology/Oncology, Department of Pediatrics, Long School of Medicine at The University of Texas Health Science Center, San Antonio, TX, United States of America.
| | - Gregory J Aune
- Division of Hematology/Oncology, Department of Pediatrics, Long School of Medicine at The University of Texas Health Science Center, San Antonio, TX, United States of America; Greehey Children's Cancer Research Institute, San Antonio, TX, United States of America.
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Tawil N, Rak J. Blood coagulation and cancer genes. Best Pract Res Clin Haematol 2022; 35:101349. [DOI: 10.1016/j.beha.2022.101349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
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Serum Pharmacochemistry Combining Network Pharmacology to Discover the Active Constituents and Effect of Xijiao Dihuang Tang Prescription for Treatment of Blood-Heat and Blood-Stasis Syndrome-Related Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:6934812. [PMID: 35178159 PMCID: PMC8845118 DOI: 10.1155/2022/6934812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/08/2022] [Accepted: 01/19/2022] [Indexed: 02/05/2023]
Abstract
Xijiao Dihuang Tang (XDT), a classic TCM prescription, has been used to clinically treat blood-heat and blood-stasis syndrome- (BHSS-) related diseases, including hemorrhagic stroke and sepsis. However, the active constituents and mechanism of XDT in the treatment of BHSS-related diseases have not been elucidated due to the lack of appropriate methodologies. In this study, serum pharmacochemistry and network pharmacology were used to explore the active constituents and the mechanism of XDT in the treatment of BHSS-related diseases. The effects of XDT were evaluated using dry yeast-induced rats as rat models with BHSS, which demonstrated the antipyretic and anticoagulant properties of XDT. The HPLC-QTOF/MS/MS assay was used to identify 60 serum constituents of XDT (SCXDT). Then, 338 targets of 60 SCXDT were predicted by integrating multiple databases and the MACCS fingerprint similarity prediction method. The degree of topological properties with targets of 19 key active constituents in SCXDT was identified and evaluated in glutamate-induced PC12 cells. Subsequently, 338 targets of 60 SCXDT were mainly involved in biological processes such as inflammation, coagulation, cell proliferation, and apoptosis, as well as oxidative contingencies via compound-target-disease network analysis. The core targets including IL-1β, IL-6, TNF, NOS3, and MAPK1 were identified using protein-protein interaction network analysis, whereas dozens of signaling pathways such as the p38MAPK signaling pathway were identified using functional pathway enrichment analysis. The results indicated that XDT has broad therapeutic and neuroprotective effects on inflammation, coagulation, oxidative stress, cell proliferation, and apoptosis in dry yeast-induced rats with BHSS and glutamate-induced PC12 cells by regulating the p38MAPK signaling pathway. This study not only discovered the active constituents of XDT but also elaborated its mechanisms in the treatment of BHSS-related diseases by intervening in a series of targets, signaling pathways, and biological processes such as inflammation, coagulation, oxidative stress, neuroprotection. The findings in this study provide a novel strategy for exploring the therapeutic efficacy of TCM prescriptions.
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Phosphate and Endothelial Function: How Sensing of Elevated Inorganic Phosphate Concentration Generates Signals in Endothelial Cells. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1362:85-98. [DOI: 10.1007/978-3-030-91623-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wurtzel JGT, Lazar S, Sikder S, Cai KQ, Astsaturov I, Weyrich AS, Rowley JW, Goldfinger LE. Platelet microRNAs inhibit primary tumor growth via broad modulation of tumor cell mRNA expression in ectopic pancreatic cancer in mice. PLoS One 2021; 16:e0261633. [PMID: 34936674 PMCID: PMC8694476 DOI: 10.1371/journal.pone.0261633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Abstract
We investigated the contributions of platelet microRNAs (miRNAs) to the rate of growth and regulation of gene expression in primary ectopic tumors using mouse models. We previously identified an inhibitory role for platelets in solid tumor growth, mediated by tumor infiltration of platelet microvesicles (microparticles) which are enriched in platelet-derived miRNAs. To investigate the specific roles of platelet miRNAs in tumor growth models, we implanted pancreatic ductal adenocarcinoma cells as a bolus into mice with megakaryocyte-/platelet-specific depletion of mature miRNAs. We observed an ~50% increase in the rate of growth of ectopic primary tumors in these mice compared to controls including at early stages, associated with reduced apoptosis in the tumors, in particular in tumor cells associated with platelet microvesicles-which were depleted of platelet-enriched miRNAs-demonstrating a specific role for platelet miRNAs in modulation of primary tumor growth. Differential expression RNA sequencing of tumor cells isolated from advanced primary tumors revealed a broad cohort of mRNAs modulated in the tumor cells as a function of host platelet miRNAs. Altered genes comprised 548 up-regulated transcripts and 43 down-regulated transcripts, mostly mRNAs altogether spanning a variety of growth signaling pathways-notably pathways related to epithelial-mesenchymal transition-in tumor cells from platelet miRNA-deleted mice compared with those from control mice. Tumors in platelet miRNA-depleted mice showed more sarcomatoid growth and more advanced tumor grade, indicating roles for host platelet miRNAs in tumor plasticity. We further validated increased protein expression of selected genes associated with increased cognate mRNAs in the tumors due to platelet miRNA depletion in the host animals, providing proof of principle of widespread effects of platelet miRNAs on tumor cell functional gene expression in primary tumors in vivo. Together, these data demonstrate that platelet-derived miRNAs modulate solid tumor growth in vivo by broad-spectrum restructuring of the tumor cell transcriptome.
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Affiliation(s)
- Jeremy G. T. Wurtzel
- Division of Hematology, Department of Medicine, Cardeza Center for Hemostasis, Thrombosis, and Vascular Biology, Cardeza Foundation for Hematologic Research, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Sophia Lazar
- Division of Hematology, Department of Medicine, Cardeza Center for Hemostasis, Thrombosis, and Vascular Biology, Cardeza Foundation for Hematologic Research, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Sonali Sikder
- Molecular Therapeutics Program and The Marvin & Concetta Greenberg Pancreatic Cancer Institute, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Kathy Q. Cai
- Cancer Biology Program and Histopathology Facility, Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Igor Astsaturov
- Molecular Therapeutics Program and The Marvin & Concetta Greenberg Pancreatic Cancer Institute, Fox Chase Cancer Center, Philadelphia, PA, United States of America
| | - Andrew S. Weyrich
- Molecular Medicine Program, Pathology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Jesse W. Rowley
- Molecular Medicine Program, Pulmonary Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Lawrence E. Goldfinger
- Division of Hematology, Department of Medicine, Cardeza Center for Hemostasis, Thrombosis, and Vascular Biology, Cardeza Foundation for Hematologic Research, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America
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8
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Platelets and extracellular vesicles and their cross talk with cancer. Blood 2021; 137:3192-3200. [PMID: 33940593 DOI: 10.1182/blood.2019004119] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
Platelets play significant and varied roles in cancer progression, as detailed throughout this review series, via direct interactions with cancer cells and by long-range indirect interactions mediated by platelet releasates. Microvesicles (MVs; also referred to as microparticles) released from activated platelets have emerged as major contributors to the platelet-cancer nexus. Interactions of platelet-derived MVs (PMVs) with cancer cells can promote disease progression through multiple mechanisms, but PMVs also harbor antitumor functions. This complex relationship derives from PMVs' binding to both cancer cells and nontransformed cells in the tumor microenvironment and transferring platelet-derived contents to the target cell, each of which can have stimulatory or modulatory effects. MVs are extracellular vesicles of heterogeneous size, ranging from 100 nm to 1 µm in diameter, shed by living cells during the outward budding of the plasma membrane, entrapping local cytosolic contents in an apparently stochastic manner. Hence, PMVs are encapsulated by a lipid bilayer harboring surface proteins and lipids mirroring the platelet exterior, with internal components including platelet-derived mature messenger RNAs, pre-mRNAs, microRNAs, and other noncoding RNAs, proteins, second messengers, and mitochondria. Each of these elements engages in established and putative PMV functions in cancer. In addition, PMVs contribute to cancer comorbidities because of their roles in coagulation and thrombosis and via interactions with inflammatory cells. However, separating the effects of PMVs from those of platelets in cancer contexts continues to be a major hurdle. This review summarizes our emerging understanding of the complex roles of PMVs in the development and progression of cancer and cancer comorbidities.
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Antiplatelet Therapy Combined with Anastrozole Induces Features of Partial EMT in Breast Cancer Cells and Fails to Mitigate Breast-Cancer Induced Hypercoagulation. Int J Mol Sci 2021; 22:ijms22084153. [PMID: 33923802 PMCID: PMC8074114 DOI: 10.3390/ijms22084153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022] Open
Abstract
Thromboembolic complications are a leading cause of morbidity and mortality in cancer patients. Cancer patients often present with an increased risk for thrombosis including hypercoagulation, so the application of antiplatelet strategies to oncology warrants further investigation. This study investigated the effects of anastrozole and antiplatelet therapy (aspirin/clopidogrel cocktail or atopaxar) treatment on the tumour responses of luminal phenotype breast cancer cells and induced hypercoagulation. Ethical clearance was obtained (M150263). Blood was co-cultured with breast cancer cell lines (MCF7 and T47D) pre-treated with anastrozole and/or antiplatelet drugs for 24 h. Hypercoagulation was indicated by thrombin production and platelet activation (morphological and molecular). Gene expression associated with the epithelial-to-mesenchymal transition (EMT) was assessed in breast cancer cells, and secreted cytokines associated with tumour progression were evaluated. Data were analysed with the PAST3 software. Our findings showed that antiplatelet therapies (aspirin/clopidogrel cocktail and atopaxar) combined with anastrozole failed to prevent hypercoagulation and induced evidence of a partial EMT. Differences in tumour responses that modulate tumour aggression were noted between breast cancer cell lines, and this may be an important consideration in the clinical management of subphenotypes of luminal phenotype breast cancer. Further investigation is needed before this treatment modality (combined hormone and antiplatelet therapy) can be considered for managing tumour associated-thromboembolic disorder.
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The Abnormal Expression of miR-205-5p, miR-195-5p, and VEGF-A in Human Cervical Cancer Is Related to the Treatment of Venous Thromboembolism. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3929435. [PMID: 32851067 PMCID: PMC7436339 DOI: 10.1155/2020/3929435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/14/2020] [Accepted: 05/13/2020] [Indexed: 12/11/2022]
Abstract
Background Low molecular heparin (LWMH) therapy can prevent the occurrence of VTE in tumor patients and may have a direct antitumor effect. However, the expression pattern of VEGF-A and microRNAs was less reported in cervical cancer subjects who received concurrent chemoradiotherapy (CCRT) or received anticoagulant treatment with low molecular weight heparin (LWMH) after CCRT (CCRT+LWMH). Methods In this study, 30 cervical cancer subjects treated with CCRT and 30 cervical cancer patients treated with CCRT+LWMH were enrolled. We screened five miRNAs (miR-15a-5p, miR-16-5p, miR-29a-3p, miR-195-5p, and miR-205-5p), which have multiple binding sites with VEGF-A and are highly expressed in serum of patients with cervical cancer, by RT-qPCR. The expression level of VEGF-A was also detected by RT-qPCR and ELISA. Statistical methods were used for difference and correlation analyses. Results We observed the curative effect in the two treatment methods. In the CCRT group, the total effective rate was 60.00%, and in the CCRT+LWMT group, the total effective rate was 83.33% (P = 0.013, χ2 = 6.129). Additionally, the serum levels of VEGF-A in the CCRT+LWMH group were downregulated, relative to the CCRT group (P < 0.05), and VEGF-A in serum was significantly positively correlated with venous thromboembolism (VTE) (r = 2.134, P = 0.035). Only miR-205-5p and miR-195-5p were upregulated in CCRT+LWMH, relative to CCRT (P < 0.05). In serum of patients with cervical cancer after CCRT+LWMH treatment, there was no significant correlation between VEGF-A and miR-15a-5p (r = −0.132, P = 0.209), miR-16-5p (r = −0.205, P = 0.311), or miR-29a-3p (r = −0.029, P = 0.662), but VEGF-A was significantly negatively correlated with miR-195-5p (r = −0.396, P = 0.040) and miR-205-5p (r = −0.315, P = 0.032). Furthermore, VTE was also significantly negatively correlated with miR-195-5p (r = −0.412, P = 0.031) and miR-205-5p (r = −0.123, P = 0.044). Conclusion These data revealed roles for VEGF-A and these miRNAs as potential biomarkers in cervical cancer patients with VTE, which exhibited usage potential in the treatment of venous thromboembolism.
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Xia Q, Zhang X, Chen Q, Chen X, Teng J, Wang C, Li M, Fan L. Down-regulation of tissue factor inhibits invasion and metastasis of non-small cell lung cancer. J Cancer 2020; 11:1195-1202. [PMID: 31956365 PMCID: PMC6959078 DOI: 10.7150/jca.37321] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/03/2019] [Indexed: 02/05/2023] Open
Abstract
Objective: Tissue factor (TF) is clinically identified as a marker for the detection of various types of cancer as well as the prediction of prognosis for cancer patients. This present study aims to explore the possibility and feasibility to use plasma TF as a biomarker for the prediction of prognosis of patients with non-small cell lung cancer (NSCLC). Methods: A total of 100 patients with NSCLC at stage I to IV was included in the study, in whom the expression of plasma TF was detected. The Cox proportional-hazards regression model was then used to analyze the collected information, attempting to identify how patients' overall survival (OS) was associated with the expression of plasma TF. To verify the function of TF in invasion and metastasis, the expression of plasma TF was downregulated by SiRNA both in vivo and in vitro. Results: The expression of plasma TF in NSCLC patients was related to the diagnosis age of the patient. It was noted that patients with high TF expression levels tended to have worse OS performance, which implied that TF could be used as a marker for patients with stage I-IV NSCLC (HR = 2.030, 95% CI = 1.21-3.398, P = 0.007). TF down-regulation inhibited the growth of tumor in vitro as well as the metastasis and invasion of NSCLC cells in vivo. Conclusion: Both in vivo and in vitro, the invasion and migration of NSCLC cells are suppressed by TF knockdown. TF has the potential to become an effective biomarker for the prediction of prognosis of patients with stage I-IV NSCLC.
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Affiliation(s)
- Qing Xia
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China.,Institute of Energy Metabolism and Health, Tongji University School of Medicine, Shanghai, China.,Institute of Development and Research of Holistic Integrative Medicine, Tongji University, Shanghai, China
| | - Xu Zhang
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China.,Institute of Energy Metabolism and Health, Tongji University School of Medicine, Shanghai, China.,Institute of Development and Research of Holistic Integrative Medicine, Tongji University, Shanghai, China
| | - Qianqian Chen
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China.,Institute of Energy Metabolism and Health, Tongji University School of Medicine, Shanghai, China.,Institute of Development and Research of Holistic Integrative Medicine, Tongji University, Shanghai, China
| | - Xiangyun Chen
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China.,Institute of Energy Metabolism and Health, Tongji University School of Medicine, Shanghai, China.,Institute of Development and Research of Holistic Integrative Medicine, Tongji University, Shanghai, China
| | - Junliang Teng
- School of information management and engineering, Shanghai University of Finance and Economics, Shanghai, China
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China
| | - Ming Li
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China.,Institute of Energy Metabolism and Health, Tongji University School of Medicine, Shanghai, China.,Institute of Development and Research of Holistic Integrative Medicine, Tongji University, Shanghai, China
| | - Lihong Fan
- Department of Respiratory Medicine, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China.,Institute of Energy Metabolism and Health, Tongji University School of Medicine, Shanghai, China.,Institute of Development and Research of Holistic Integrative Medicine, Tongji University, Shanghai, China
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Isolated tumour microparticles induce endothelial microparticle release in vitro. Blood Coagul Fibrinolysis 2019; 31:35-42. [PMID: 31789658 DOI: 10.1097/mbc.0000000000000876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Cancer induces a hypercoagulable state, resulting in an increased risk of venous thromboembolism. One of the mechanisms driving this is tissue factor (TF) production by the tumour, released in small lipid bound microparticles. We have previously demonstrated that tumour cell line media-induced procoagulant changes in HUVEC. The aim of this study was to investigate the effect of tumour microparticles and recombinant human TF (rhTF) on the endothelium. Procoagulant microparticles from the PANC-1 cell line were harvested by ultrafiltration. HUVEC were then incubated with these procoagulant microparticles or rhTF. Flow cytometry was used to investigate the effect of endothelial cell surface protein expression and microparticle release. Microparticles but not soluble TF was responsible for the procoagulant activity of cell-free tumour media. We also demonstrated an increase in endothelial microparticle release with exposure to tumour microparticles, with a positive linear relationship observed (R = 0.6630 P ≤ 0.0001). rhTF did not induce any of the changes observed with microparticles. Here we demonstrate that procoagulant activity of tumour cell line media is dependent on microparticles, and that exposure of endothelial cells to these microparticles results in an increase in microparticle release from HUVEC. This suggests a mechanism of transfer of procoagulant potential from the cancer to the remote endothelium.
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Wimmer K, Sachet M, Oehler R. Circulating biomarkers of cell death. Clin Chim Acta 2019; 500:87-97. [PMID: 31655053 DOI: 10.1016/j.cca.2019.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 12/15/2022]
Abstract
Numerous disease states are associated with cell death. For many decades, apoptosis and accidental necrosis have been assumed to be the two ways how a cell can die. The recent discovery of additional cell death processes such as necroptosis, ferroptosis or pyroptosis revealed a complex interplay between cell death mechanisms and diseases. Depending on the particular cell death pathway, cells secrete distinct molecular patterns, which differ between cell death types. This review focusses on released molecules, detectable in the blood flow, and their potential role as circulating biomarkers of cell death. We elucidate the molecular background of different biomarkers and give an overview on their correlation with disease stage, therapy response and prognosis in patients.
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Affiliation(s)
- Kerstin Wimmer
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Monika Sachet
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Rudolf Oehler
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Haen P, Mege D, Crescence L, Dignat-George F, Dubois C, Panicot-Dubois L. Thrombosis Risk Associated with Head and Neck Cancer: A Review. Int J Mol Sci 2019; 20:ijms20112838. [PMID: 31212608 PMCID: PMC6600456 DOI: 10.3390/ijms20112838] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 12/12/2022] Open
Abstract
Venous thromboembolism (VTE) is a common complication for cancer patients. VTE-associated risk varies according to the type of tumor disease. Head and neck cancer is a common cancer worldwide, and most tumors are squamous cell carcinomas due to tobacco and alcohol abuse. The risk of VTE associated with head and neck (H&N) cancer is considered empirically low, but despite the high incidence of H&N cancer, few data are available on this cancer; thus, it is difficult to state the risk of VTE. Our review aims to clarify this situation and tries to assess the real VTE risk associated with H&N cancer. We report that most clinical studies have concluded that there is a very low thrombosis risk associated with H&N cancer. Even with the biases that often exist, this clinical review seems to confirm that the risk of VTE was empirically hypothesized. Furthermore, we highlight that H&N cancer has all the biological features of a cancer associated with a high thrombosis risk, including a strong expression of procoagulant proteins, modified thrombosis/fibrinolysis mechanisms, and secretions of procoagulant microparticles and procoagulant cytokines. Thus, this is a paradoxical situation, and some undiscovered mechanisms that could explain this clinical biological ambivalence might exist.
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Affiliation(s)
- Pierre Haen
- Aix Marseille Univ, INSERM 1263, INRA, Center for CardioVascular and Nutrition Research (C2VN), 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Department of Maxillo-Facial Surgery, Army Training Hospital, Laveran, 13013 Marseille, France.
| | - Diane Mege
- Aix Marseille Univ, INSERM 1263, INRA, Center for CardioVascular and Nutrition Research (C2VN), 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Department of Digestive Surgery, Timone University Hospital, AP-HM, 13005 Marseille, France.
| | - Lydie Crescence
- Aix Marseille Univ, INSERM 1263, INRA, Center for CardioVascular and Nutrition Research (C2VN), 27 Boulevard Jean Moulin, 13385 Marseille, France.
| | - Françoise Dignat-George
- Aix Marseille Univ, INSERM 1263, INRA, Center for CardioVascular and Nutrition Research (C2VN), 27 Boulevard Jean Moulin, 13385 Marseille, France.
- Laboratoire d'Hématologie, Centre Hospitalo-Universitaire Conception, 385 Boulevard Baille, 13385 Marseille, France.
| | - Christophe Dubois
- Aix Marseille Univ, INSERM 1263, INRA, Center for CardioVascular and Nutrition Research (C2VN), 27 Boulevard Jean Moulin, 13385 Marseille, France.
| | - Laurence Panicot-Dubois
- Aix Marseille Univ, INSERM 1263, INRA, Center for CardioVascular and Nutrition Research (C2VN), 27 Boulevard Jean Moulin, 13385 Marseille, France.
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15
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Madkhali Y, Featherby S, Collier ME, Maraveyas A, Greenman J, Ettelaie C. The Ratio of Factor VIIa:Tissue Factor Content within Microvesicles Determines the Differential Influence on Endothelial Cells. TH OPEN 2019; 3:e132-e145. [PMID: 31259295 PMCID: PMC6598090 DOI: 10.1055/s-0039-1688934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/10/2019] [Indexed: 02/07/2023] Open
Abstract
Tissue factor (TF)-positive microvesicles from various sources can promote cellular proliferation or alternatively induce apoptosis, but the determining factors are unknown. In this study the hypothesis that the ratio of fVIIa:TF within microvesicles determines this outcome was examined. Microvesicles were isolated from HepG2, BxPC-3, 786-O, MDA-MB-231, and MCF-7 cell lines and microvesicle-associated fVIIa and TF antigen and activity levels were measured. Human coronary artery endothelial cells (HCAECs) were incubated with these purified microvesicles, or with combinations of fVIIa-recombinant TF, and cell proliferation/apoptosis was measured. Additionally, by expressing mCherry-PAR2 on HCAEC surface, PAR2 activation was quantified. Finally, the activation of PAR2 on HCAEC or the activities of TF and fVIIa in microvesicles were blocked prior to addition of microvesicles to cells. The purified microvesicles exhibited a range of fVIIa:TF ratios with HepG2 and 786-O cells having the highest (54:1) and lowest (10:1) ratios, respectively. The reversal from proapoptotic to proliferative was estimated to occur at a fVIIa:TF molar ratio of 15:1, but HCAEC could not be rescued at higher TF concentrations. The purified microvesicles induced HCAEC proliferation or apoptosis according to this ruling. Blocking PAR2 activation on HCAEC, or inhibiting fVIIa or TF-procoagulant function on microvesicles prevented the influence on HCAEC. Finally, incubation of HCAEC with recombinant TF resulted in increased surface exposure of fVII. The induction of cell proliferation or apoptosis by TF-positive microvesicles is dependent on the ratio of fVIIa:TF and involves the activation of PAR2. At lower TF concentrations, fVIIa can counteract the proapoptotic stimulus and induce proliferation.
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Affiliation(s)
- Yahya Madkhali
- Department of Biomedical Sciences, University of Hull, Hull, United Kingdom.,Department of Medical Laboratories, College of Applied Medical Sciences, Majmaah University, KSA, Al Majmaah, Saudi Arabia
| | - Sophie Featherby
- Department of Biomedical Sciences, University of Hull, Hull, United Kingdom
| | - Mary E Collier
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
| | - Anthony Maraveyas
- Division of Cancer-Hull York Medical School, University of Hull, Hull, United Kingdom
| | - John Greenman
- Department of Biomedical Sciences, University of Hull, Hull, United Kingdom
| | - Camille Ettelaie
- Department of Biomedical Sciences, University of Hull, Hull, United Kingdom
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16
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Asghar S, Parvaiz F, Manzoor S. Multifaceted role of cancer educated platelets in survival of cancer cells. Thromb Res 2019; 177:42-50. [PMID: 30849514 DOI: 10.1016/j.thromres.2019.02.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/24/2019] [Accepted: 02/22/2019] [Indexed: 11/20/2022]
Abstract
Platelets, the derivatives of megakaryocytes, pose dynamic biological functions such as homeostasis and wound healing. The mechanisms involved in these processes are utilized by cancerous cells for proliferation and metastasis. Platelets through their activation establish an aggregate termed as Tumor cell induced platelet aggregation (TCIPA) that aids in establishing a niche for the primary tumor at secondary site while recruiting granulocytes and monocytes. The study of these close interactions between the tumor and the platelets can be exploited as biomarkers in liquid biopsy for early cancer detection, thereby increasing the life expectancy of cancer patients.
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Affiliation(s)
- Sidra Asghar
- Atta-ur -Rahman School of Applied Biosciences, National University of Sciences and Technology, Pakistan
| | - Fahed Parvaiz
- Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Sobia Manzoor
- Atta-ur-Rahman School of Applied Biosciences, National University of Sciences and Technology, H12, 44000 Islamabad, Pakistan.
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17
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Ünlü B, Versteeg HH. Cancer-associated thrombosis: The search for the holy grail continues. Res Pract Thromb Haemost 2018; 2:622-629. [PMID: 30349879 PMCID: PMC6178660 DOI: 10.1002/rth2.12143] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/24/2018] [Indexed: 02/06/2023] Open
Abstract
Cancer patients have an increased risk of developing venous thromboembolism (VTE), a condition that is associated with increased morbidity and mortality. Although risk assessment tools have been developed, it is still very challenging to predict which cancer patients will suffer from VTE. The scope of this review is to summarize and discuss studies focusing on the link between genetic alterations and risk of cancer-associated thrombosis (CAT). Thus far, classical risk factors that contribute to VTE have been tried as risk factors of CAT, with low success. In support, hypercoagulant plasma profiles in patients with CAT differ from those with only VTE, indicating other risk factors that contribute to VTE in cancer. As germline mutations do not significantly contribute to elevated risk of VTE, somatic mutations in tumors may significantly associate with and contribute to CAT. As it is very time-consuming to investigate each and every mutation, an unbiased approach is warranted. In this light we discuss our own recent unbiased proof-of-principle study using RNA sequencing in isolated colorectal cancer cells. Our work has uncovered candidate genes that associate with VTE in colorectal cancer, and these gene profiles associated with VTE more significantly than classical parameters such as platelet counts, D-dimer, and P-selectin levels. Genes associated with VTE could be linked to pathways being involved in coagulation, inflammation and methionine degradation. We conclude that tumor cell-specific gene expression profiles and/or mutational status has superior potential as predictors of VTE in cancer patients.
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Affiliation(s)
- Betül Ünlü
- Department of Internal MedicineEinthoven Laboratory for Experimental Vascular MedicineLeiden University Medical CenterLeidenThe Netherlands
| | - Henri H. Versteeg
- Department of Internal MedicineEinthoven Laboratory for Experimental Vascular MedicineLeiden University Medical CenterLeidenThe Netherlands
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18
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Muhsin-Sharafaldine MR, McLellan AD. Apoptotic vesicles: deathly players in cancer-associated coagulation. Immunol Cell Biol 2018; 96:723-732. [PMID: 29738615 DOI: 10.1111/imcb.12162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/01/2018] [Accepted: 05/02/2018] [Indexed: 12/27/2022]
Abstract
Although cancer is associated with coagulation disorders, it is still unclear how the combination of tumor cell and host factors enhance the hypercoagulable state of cancer patients. Emerging evidence points to a central role for tumor endosomal and plasma membrane-derived vesicular components in the pathogenesis of cancer-related thrombosis. In particular, tumor cell membranes and extracellular vesicles (EV) harbor lipids and proteinaceous coagulation factors able to initiate multiple points within the coagulation matrix. The impact of chemotherapy upon a host already burdened with a hypercoagulable state increases the risk of pathological coagulation. We argue that chemotherapy-induced EV harbor the most active components for cancer related thrombosis and discuss how membrane components of the host and tumor act to initiate coagulation to enhance thrombotic risk in cancer patients.
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19
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Muhsin-Sharafaldine MR, McLellan AD. Tumor-Derived Apoptotic Vesicles: With Death They Do Part. Front Immunol 2018; 9:957. [PMID: 29780392 PMCID: PMC5952256 DOI: 10.3389/fimmu.2018.00957] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/17/2018] [Indexed: 12/21/2022] Open
Abstract
Tumor cells release lipid particles known as extracellular vesicles (EV) that contribute to cancer metastasis, to the immune response, and to thrombosis. When tumors are exposed to radiation or chemotherapy, apoptotic vesicles (ApoVs) are released in abundance as the plasma membrane delaminates from the cytoskeleton. Recent studies have suggested that ApoVs are distinct from the EVs released from living cells, such as exosomes or microvesicles. Depending on their treatment conditions, tumor-released ApoV have been suggested to either enhance or suppress anti-cancer immunity. In addition, tumor-derived ApoV possess procoagulant activity that could increase the thrombotic state in cancer patients undergoing chemotherapy or radiotherapy. Since ApoVs are one of the least appreciated type of EVs, we focus in this review on the distinctive characterization of tumor ApoVs and their proposed mechanistic effects on cancer immunity, coagulation, and metastasis.
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Affiliation(s)
| | - Alexander D McLellan
- Department of Microbiology and Immunology, University of Otago, Dunedin, New Zealand
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20
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Stark K, Schubert I, Joshi U, Kilani B, Hoseinpour P, Thakur M, Grünauer P, Pfeiler S, Schmidergall T, Stockhausen S, Bäumer M, Chandraratne S, von Brühl ML, Lorenz M, Coletti R, Reese S, Laitinen I, Wörmann SM, Algül H, Bruns CJ, Ware J, Mackman N, Engelmann B, Massberg S. Distinct Pathogenesis of Pancreatic Cancer Microvesicle-Associated Venous Thrombosis Identifies New Antithrombotic Targets In Vivo. Arterioscler Thromb Vasc Biol 2018; 38:772-786. [PMID: 29419408 DOI: 10.1161/atvbaha.117.310262] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/17/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Cancer patients are at high risk of developing deep venous thrombosis (DVT) and venous thromboembolism, a leading cause of mortality in this population. However, it is largely unclear how malignant tumors drive the prothrombotic cascade culminating in DVT. APPROACH AND RESULTS Here, we addressed the pathophysiology of malignant DVT compared with nonmalignant DVT and focused on the role of tumor microvesicles as potential targets to prevent cancer-associated DVT. We show that microvesicles released by pancreatic adenocarcinoma cells (pancreatic tumor-derived microvesicles [pcMV]) boost thrombus formation in a model of flow restriction of the mouse vena cava. This depends on the synergistic activation of coagulation by pcMV and host tissue factor. Unlike nonmalignant DVT, which is initiated and propagated by innate immune cells, thrombosis triggered by pcMV was largely independent of myeloid leukocytes or platelets. Instead, we identified externalization of the phospholipid phosphatidylethanolamine as a major mechanism controlling the prothrombotic activity of pcMV. Disrupting phosphatidylethanolamine-dependent activation of factor X suppressed pcMV-induced DVT without causing changes in hemostasis. CONCLUSIONS Together, we show here that the pathophysiology of pcMV-associated experimental DVT differs markedly from innate immune cell-promoted nonmalignant DVT and is therefore amenable to distinct antithrombotic strategies. Targeting phosphatidylethanolamine on tumor microvesicles could be a new strategy for prevention of cancer-associated DVT without causing bleeding complications.
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Affiliation(s)
- Konstantin Stark
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.).
| | - Irene Schubert
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Urjita Joshi
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Badr Kilani
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Parandis Hoseinpour
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Manovriti Thakur
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Petra Grünauer
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Susanne Pfeiler
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Tobias Schmidergall
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Sven Stockhausen
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Markus Bäumer
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Sue Chandraratne
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Marie-Luise von Brühl
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Michael Lorenz
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Raffaele Coletti
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Sven Reese
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Iina Laitinen
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Sonja Maria Wörmann
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Hana Algül
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Christiane J Bruns
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Jerry Ware
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Nigel Mackman
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Bernd Engelmann
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
| | - Steffen Massberg
- From the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Munich, Germany (K.S., I.S., B.K., P.H., T.S., S.S., S.C., M.-L.v.B., M.L., R.C., S.M.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (K.S., S.M.); Institut für Laboratoriumsmedizin (U.J., M.T., P.G., S.P., M.B., B.E.) and Lehrstuhl für Anatomie, Histologie und Embryologie, Department of Veterinary Medicine (S.R.), Ludwig-Maximilians-Universität, Munich, Germany; Nuklearmedizinische Klinik und Poliklinik (I.L.) and II. Medizinische Klinik und Poliklinik (S.M.W., H.A.), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Klinik und Poliklinik für Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinik Köln, Cologne, Germany (C.J.B.); Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock (J.W.); and Department of Medicine, University of North Carolina at Chapel Hill (N.M.)
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Review of the Association between Splenectomy and Chronic Thromboembolic Pulmonary Hypertension. Ann Am Thorac Soc 2018; 13:945-54. [PMID: 27058013 DOI: 10.1513/annalsats.201512-826fr] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Recent evidence suggests that there may be a link between splenectomy and the later development of pulmonary hypertension, in particular World Health Organization group IV pulmonary hypertension (chronic thromboembolic pulmonary hypertension). Epidemiological studies have demonstrated an odds ratio as high as 18 for the development of chronic thromboembolic pulmonary hypertension after splenectomy in comparison with matched control subjects who have not undergone splenectomy. The mechanisms governing the association between removal of the spleen and the subsequent development of chronic thromboembolic pulmonary hypertension remain incompletely understood; however, recent advances in understanding of coagulation homeostasis have shed some light on this association. Splenectomy increases the risk of venous thromboembolic disease, a necessary precursor of chronic thromboembolic pulmonary hypertension, by generating a prothrombotic state. This prothrombotic state likely results from a reduction in the removal of circulating procoagulant factors from the bloodstream after splenectomy. Although much is to be learned, circulating microparticles have emerged as the most likely mediator for the development of thrombosis after splenectomy. Apparently because of a reduction in reticuloendothelial cell clearance, microparticle levels are elevated in patients after splenectomy. Elevated circulating microparticle levels have been linked to thromboembolism and pulmonary hypertension in a dose-dependent fashion. It is important for health care providers to be aware of the link between splenectomy and chronic thromboembolic pulmonary hypertension. We are optimistic that clarification of the exact mechanisms that govern this association will yield clinical guidelines and potential treatments.
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Hernández C, Orbe J, Roncal C, Alvarez-Hernandez M, de Lizarrondo SM, Alves MT, Mata JG, Páramo JA. Tissue factor expressed by microparticles is associated with mortality but not with thrombosis in cancer patients. Thromb Haemost 2017; 110:598-608. [DOI: 10.1160/th13-02-0122] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/07/2013] [Indexed: 01/08/2023]
Abstract
SummaryA prothrombotic state is one of the hallmarks of malignancy and a major contributor to morbidity and mortality in cancer patients. Tissue factor (TF) is often overexpressed in malignancy and is a prime candidate in predicting the hypercoagulable state. Moreover, increased number of TF-exposing microparticles (MPs) in cancer patients may contribute to venous thromboembolism (VTE). We have conducted a prospective cohort study to determine whether elevated TF antigen, TF activity and TF associated to MPs (MPs-TF) are predictive of VTE and mortality in cancer patients. The studied population consisted of 252 cancer patients and 36 healthy controls. TF antigen and activity and MPs-TF were determined by ELISA and chromogenic assays. During a median follow-up of 10 months, 40 thrombotic events were recorded in 34 patients (13.5%), and 73 patients (28.9%) died. TF antigen and activity were significantly higher in patients than in controls (p<0.01) mainly in patients with advanced stages, whereas no differences were observed for TF activity of isolated MPs. We did not find a statistically significant association of TF variables with the risk of VTE. Multivariate analysis adjusting for age, sex, type of cancer and other confounding variables showed that TF activity (p<0.01) and MPs-TF activity (p<0.05) were independently associated with mortality. In conclusion, while TF variables were not associated with future VTE in cancer patients, we found a strong association of TF and MPs-TF activity with mortality, thus suggesting they might be good prognostic markers in cancer patients.
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23
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The potential role of platelets in the consensus molecular subtypes of colorectal cancer. Cancer Metastasis Rev 2017; 36:273-288. [DOI: 10.1007/s10555-017-9678-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Gran OV, Braekkan SK, Paulsen B, Skille H, Rosendaal FR, Hansen JB. Occult cancer-related first venous thromboembolism is associated with an increased risk of recurrent venous thromboembolism. J Thromb Haemost 2017; 15:1361-1367. [PMID: 28440069 DOI: 10.1111/jth.13714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Indexed: 12/21/2022]
Abstract
Essentials Recurrence risk after an occult cancer-related incident venous thromboembolism (VTE) is unknown. We compared the risk of VTE recurrence in occult-, overt- and non-cancer related first VTE. Patients with occult-cancer related first VTE had the highest risk of VTE recurrence. The high recurrence risk in occult cancer is likely due to the advanced cancers. SUMMARY Background Although venous thromboembolism (VTE) is associated with a high recurrence rate, the absolute recurrence rates for cancer-related VTE, particularly occult cancer, are not well known. Objectives To investigate the risk of VTE recurrence in patients with occult and overt cancer-related VTE. Methods Incident VTE events among participants of the first to sixth Tromsø surveys occurring in the period 1994-2012 were included. Occult cancer was defined as cancer diagnosed within a year following a VTE, and overt cancer was defined as cancer diagnosed within the 2 years before a VTE. Results Among 733 patients with incident VTE, 110 had overt cancer and 40 had occult cancer. There were 95 recurrent VTE events during a median of 3.2 years of follow-up. The 1-year cumulative incidence of VTE recurrence was 38.6% in subjects with occult cancer, 15.5% in subjects with overt cancer, and 3.8% in non-cancer subjects. The 1-year risk of recurrence was 12-fold (hazard ratio [HR] 12.4, 95% confidence interval [CI] 5.9-26.3) higher in subjects with occult cancer and four-fold (HR 4.3, 95% CI 2.0-9.2) higher in subjects with overt cancer than in non-cancer subjects. The occult cancers associated with VTE recurrence were typically located at prothrombotic sites (i.e. lung and gastrointestinal) and presented at advanced stages. The majority (69%) of recurrences in subjects with occult cancer occurred before or shortly after cancer diagnosis, and were therefore not treatment-related. Conclusion Our findings suggest that the increased risk of recurrence in patients with occult cancer is mainly attributable to the advanced cancers in these patients.
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Affiliation(s)
- O V Gran
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway, Tromsø, Norway
| | - S K Braekkan
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - B Paulsen
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway, Tromsø, Norway
| | - H Skille
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway, Tromsø, Norway
| | - F R Rosendaal
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - J-B Hansen
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT - The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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25
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Cohen JG, Prendergast E, Geddings JE, Walts AE, Agadjanian H, Hisada Y, Karlan BY, Mackman N, Walsh CS. Evaluation of venous thrombosis and tissue factor in epithelial ovarian cancer. Gynecol Oncol 2017; 146:146-152. [PMID: 28501328 DOI: 10.1016/j.ygyno.2017.04.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Ovarian clear cell carcinoma (OCCC) and high grade serous ovarian cancer (HGSOC) are associated with the highest risk of VTE among patients with epithelial ovarian cancer (EOC). Tissue factor (TF) is a transmembrane glycoprotein which can trigger thrombosis. We sought to evaluate if there is an association between VTE and tumor expression of tissue factor (TF), plasma TF, and microvesicle TF (MV TF) activity in this high-risk population. METHODS We performed a case-control study of OCCC and HGSOC patients with and without VTE. 105 patients who underwent surgery at a tertiary care center between January 1995 and October 2013 were included. Plasma TF was measured with an enzyme-linked immunosorbent assay. A TF-dependent Factor Xa generation assay was used to measure MV TF activity. Immunohistochemical (IHC) analysis was performed to evaluate tumor expression of TF. RESULTS 35 women with OCCC or HGSOC diagnosed with VTE within 9months of surgery were included in the case group. Those with VTE had a worse OS, p<0.0001, with a greater than three-fold increase in risk of death, HR 3.33 (CI 1.75-6.35). There was no significant difference in median plasma TF level or MV TF activity level between patients with and without VTE. OCCC patients had greater expression of TF in their tumors than patients with HGSOC, p<0.0001. CONCLUSIONS TFMV activity and plasma TF level were not predictive of VTE in this patient population. Given the extensive expression of TF in OCCC tumors, it is unlikely IHC expression will be useful in risk stratification for VTE in this population.
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Affiliation(s)
- Joshua G Cohen
- Division of Gynecologic Oncology, University of California, Los Angeles, 200 Medical Plaza, Suite 220, Los Angeles, CA 90095, USA
| | - Emily Prendergast
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Julia E Geddings
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, 2312 MBRB, 111 Mason Farm Rd, CB#7126, Chapel Hill, NC 27599, USA
| | - Ann E Walts
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - Hasmik Agadjanian
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Yohei Hisada
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, 2312 MBRB, 111 Mason Farm Rd, CB#7126, Chapel Hill, NC 27599, USA; K.G. Jebsen TREC, The Faculty of Health Sciences, UiT- The Arctic University of Tromsø, 9037 Tromsø, Norway
| | - Beth Y Karlan
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Nigel Mackman
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, 2312 MBRB, 111 Mason Farm Rd, CB#7126, Chapel Hill, NC 27599, USA; K.G. Jebsen TREC, The Faculty of Health Sciences, UiT- The Arctic University of Tromsø, 9037 Tromsø, Norway
| | - Christine S Walsh
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA.
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Tsunaka M, Shinki H, Koyama T. Cell-based evaluation of changes in coagulation activity induced by antineoplastic drugs for the treatment of acute myeloid leukemia. PLoS One 2017; 12:e0175765. [PMID: 28406995 PMCID: PMC5391104 DOI: 10.1371/journal.pone.0175765] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/30/2017] [Indexed: 11/30/2022] Open
Abstract
Idarubicin (IDR), cytarabine (AraC), and tamibarotene (Am80) are effective for treatment of acute myeloid leukemia (AML). In acute leukemia, the incidence of venous thromboembolism or disseminated intravascular coagulation is associated with induction chemotherapy. Procoagulant effects of IDR, AraC, and Am80 were investigated in a vascular endothelial cell line EAhy926 and AML cell lines HL60 (AML M2), NB4 (AML M3, APL), and U937 (AML M5), focusing on tissue factor (TF), phosphatidylserine (PS), and thrombomodulin (TM). IDR induced procoagulant activity on the surface of vascular endothelial and AML cell lines. Expression of TF antigen, TM antigen, and PS were induced by IDR on the surface of each cell line, whereas expression of TF and TM mRNAs were unchanged. Conversely, Am80 decreased TF exposure and procoagulant activity, and increased TM exposure on NB4 cells. In NB4 cells, we observed downregulation of TF mRNA and upregulation of TM mRNA. These data suggest IDR may induce procoagulant activity in vessels by apoptosis through PS exposure and/or TF expression on vascular endothelial and AML cell lines. Am80 may suppress blood coagulation through downregulation of TF expression and induction of TM expression. Our methods could be useful to investigate changes in procoagulant activity induced by antineoplastic drugs.
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Affiliation(s)
- Misae Tsunaka
- Laboratory Molecular Genetics of Hematology, Field of Applied Laboratory Science, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Haruka Shinki
- Laboratory Molecular Genetics of Hematology, Field of Applied Laboratory Science, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takatoshi Koyama
- Laboratory Molecular Genetics of Hematology, Field of Applied Laboratory Science, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- * E-mail:
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Procoagulant effects of lung cancer chemotherapy: impact on microparticles and cell-free DNA. Blood Coagul Fibrinolysis 2017; 28:72-82. [PMID: 26919453 DOI: 10.1097/mbc.0000000000000546] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is the second leading type of cancer, with venous thromboembolism being the second leading cause of death. Studies have shown increased levels of microparticles and cell-free DNA (CFDNA) in cancer patients, which can activate coagulation through extrinsic and intrinsic pathways, respectively. However, the impact of lung cancer chemotherapy on microparticle and/or CFDNA generation is not completely understood. The aim of the study was to study the effects of platinum-based chemotherapeutic agents on generation of procoagulant microparticles and CFDNA in vitro and in vivo. Microparticles were isolated from chemotherapy-treated monocytes, human umbilical vein endothelial cells, or cancer cells. Tissue factor (TF) and phosphatidylserine levels were characterized and thrombin/factor Xa generation assays were used to determine microparticle procoagulant activity. CFDNA levels were isolated from cell supernatants and plasma. A murine xenograft model of human lung carcinoma was used to study the procoagulant effects of TF microparticles and CFDNA in vivo. In vitro, platinum-based chemotherapy induced TF/phosphatidylserine microparticle shedding from A549 and A427 lung cancers cells, which enhanced thrombin generation in plasma in a FVII-dependent manner. CFDNA levels were increased in supernatants of chemotherapy-treated neutrophils and plasma of chemotherapy-treated mice. TF microparticles were elevated in plasma of chemotherapy-treated tumour-bearing mice. Plasma CFDNA levels are increased in chemotherapy-treated tumour-free mice and correlate with increased thrombin generation. In tumour-bearing mice, chemotherapy increases plasma levels of CFDNA and TF/phosphatidylserine microparticles. Platinum-based chemotherapy induces the shedding of TF/phosphatidylserine microparticles from tumour cells and the release of CFDNA from host neutrophils.
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Meikle CKS, Kelly CA, Garg P, Wuescher LM, Ali RA, Worth RG. Cancer and Thrombosis: The Platelet Perspective. Front Cell Dev Biol 2017; 4:147. [PMID: 28105409 PMCID: PMC5214375 DOI: 10.3389/fcell.2016.00147] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/12/2016] [Indexed: 01/03/2023] Open
Abstract
Platelets are critical to hemostatic and immunological function, and are key players in cancer progression, metastasis, and cancer-related thrombosis. Platelets interact with immune cells to stimulate anti-tumor responses and can be activated by immune cells and tumor cells. Platelet activation can lead to complex interactions between platelets and tumor cells. Platelets facilitate cancer progression and metastasis by: (1) forming aggregates with tumor cells; (2) inducing tumor growth, epithelial-mesenchymal transition, and invasion; (3) shielding circulating tumor cells from immune surveillance and killing; (4) facilitating tethering and arrest of circulating tumor cells; and (5) promoting angiogenesis and tumor cell establishment at distant sites. Tumor cell-activated platelets also predispose cancer patients to thrombotic events. Tumor cells and tumor-derived microparticles lead to thrombosis by secreting procoagulant factors, resulting in platelet activation and clotting. Platelets play a critical role in cancer progression and thrombosis, and markers of platelet-tumor cell interaction are candidates as biomarkers for cancer progression and thrombosis risk.
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Affiliation(s)
- Claire K S Meikle
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
| | - Clare A Kelly
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
| | - Priyanka Garg
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
| | - Leah M Wuescher
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
| | - Ramadan A Ali
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
| | - Randall G Worth
- Department of Medical Microbiology and Immunology, University of Toledo College of Medicine and Life Sciences Toledo, OH, USA
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Jeffery U, Staber J, LeVine D. Using the laboratory to predict thrombosis in dogs: An achievable goal? Vet J 2016; 215:10-20. [DOI: 10.1016/j.tvjl.2016.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 01/09/2023]
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Bang OY, Chung JW, Lee MJ, Kim SJ, Cho YH, Kim GM, Chung CS, Lee KH, Ahn MJ, Moon GJ. Cancer Cell-Derived Extracellular Vesicles Are Associated with Coagulopathy Causing Ischemic Stroke via Tissue Factor-Independent Way: The OASIS-CANCER Study. PLoS One 2016; 11:e0159170. [PMID: 27427978 PMCID: PMC4948859 DOI: 10.1371/journal.pone.0159170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/28/2016] [Indexed: 12/18/2022] Open
Abstract
Background Cancer and stroke, which are known to be associated with one another, are the most common causes of death in the elderly. However, the pathomechanisms that lead to stroke in cancer patients are not well known. Circulating extracellular vesicles (EVs) play a role in cancer-associated thrombosis and tumor progression. Therefore, we hypothesized that cancer cell-derived EVs cause cancer-related coagulopathy resulting in ischemic stroke. Methods Serum levels of D-dimer and EVs expressing markers for cancer cells (epithelial cell adhesion molecule [CD326]), tissue factor (TF [CD142]), endothelial cells (CD31+CD42b-), and platelets (CD62P) were measured using flow cytometry in (a) 155 patients with ischemic stroke and active cancer (116 − cancer-related, 39 − conventional stroke mechanisms), (b) 25 patients with ischemic stroke without cancer, (c) 32 cancer patients without stroke, and (d) 101 healthy subjects. Results The levels of cancer cell-derived EVs correlated with the levels of D-dimer and TF+ EVs. The levels of cancer cell-derived EVs (CD326+ and CD326+CD142+) were higher in cancer-related stroke than in other groups (P<0.05 in all the cases). Path analysis showed that cancer cell-derived EVs are related to stroke via coagulopathy as measured by D-dimer levels. Poor correlation was observed between TF+ EV and D-dimer, and path analysis demonstrated that cancer cell-derived EVs may cause cancer-related coagulopathy independent of the levels of TF+ EVs. Conclusions Our findings suggest that cancer cell-derived EVs mediate coagulopathy resulting in ischemic stroke via TF-independent mechanisms.
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Affiliation(s)
- Oh Young Bang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Translational and Stem Cell Research Laboratory on Stroke, Samsung Medical Center, Seoul, Republic of Korea
- * E-mail:
| | - Jong-Won Chung
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Translational and Stem Cell Research Laboratory on Stroke, Samsung Medical Center, Seoul, Republic of Korea
| | - Mi Ji Lee
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suk Jae Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Hee Cho
- Translational and Stem Cell Research Laboratory on Stroke, Samsung Medical Center, Seoul, Republic of Korea
- Clinical Research Center, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Gyeong-Moon Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chin-Sang Chung
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwang Ho Lee
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Departments of Hemato-oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyeong Joon Moon
- Translational and Stem Cell Research Laboratory on Stroke, Samsung Medical Center, Seoul, Republic of Korea
- Clinical Research Center, Samsung Biomedical Research Institute, Seoul, Republic of Korea
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Salla E, Dimakakos EP, Tsagkouli S, Giozos I, Charpidou A, Kainis E, Syrigos KN. Venous Thromboembolism in Patients Diagnosed With Lung Cancer. Angiology 2015; 67:709-24. [PMID: 26553057 DOI: 10.1177/0003319715614945] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Considering the high prevalence of lung cancer, our purpose was to summarize the existing literature to identify the several factors that contribute to the increased risk of venous thromboembolism (VTE) in patients with lung cancer and to analyze the current recommendations for thromboprophylaxis and treatment of VTE in those patients. METHODS We searched the Medline and EMBASE databases from February 1985 to February 2014 to identify retrospective and prospective randomized controlled studies that investigate one or more risk factors for VTEs in patients with lung cancer. RESULTS A VTE is a major complication for patients diagnosed with lung cancer. The risk factors for VTE events in patients with lung cancer consist of cancer-related (histological type and stage of cancer), treatment-related (surgery, chemotherapy, angiogenic agents, and supportive care agents), and patient-related factors (comorbidities, immobility, performance status, and prior thrombosis). Low-molecular-weight heparins are recommended for long-term treatment of cancer-associated thrombosis. Duration of anticoagulant therapy beyond 6 months should be based on individual clinical evaluation. Thromboprophylaxis for patients with lung cancer during hospitalization and immediate postoperative period is well established. CONCLUSIONS Efforts to assess thrombotic risk in patients with lung cancer may improve therapeutic and preventive strategies in the future, with final goal to minimize the burden and consequences of thrombotic events in patients with lung cancer.
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Affiliation(s)
- E Salla
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - Evangelos P Dimakakos
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - S Tsagkouli
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - I Giozos
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - A Charpidou
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - E Kainis
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece
| | - K N Syrigos
- Oncology Unit GPP, Sotiria General Hospital Athens School of Medicine, Athens, Greece Yale School of Medicine, New Haven, CT, USA
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Nomura S, Niki M, Nisizawa T, Tamaki T, Shimizu M. Microparticles as Biomarkers of Blood Coagulation in Cancer. BIOMARKERS IN CANCER 2015; 7:51-6. [PMID: 26462252 PMCID: PMC4592056 DOI: 10.4137/bic.s30347] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/05/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
Cancer is associated with hypercoagulopathy and increased risk of thrombosis. This negatively influences patient morbidity and mortality. Cancer is also frequently complicated by the development of venous thromboembolism (VTE). Tumor-derived tissue factor (TF)-bearing microparticles (MPs) are associated with VTE events in malignancy. MPs are small membrane vesicles released from many different cell types by exocytic budding of the plasma membrane in response to cellular activation or apoptosis. MPs may also be involved in clinical diseases through expression of procoagulative phospholipids. The detection of TF-expressing MPs in cancer patients may be clinically useful. In lung and breast cancer patients, MPs induce metastasis and angiogenesis and may be indicators of vascular complications. Additionally, MPs in patients with various types of cancer possess adhesion proteins and bind target cells to promoting cancer progression or metastasis. Overexpression of TF by cancer cells is closely associated with tumor progression, and shedding of TF-expressing MPs by cancer cells correlates with the genetic status of cancer. Consequently, TF-expressing MPs represent important markers to consider in the prevention of and therapy for VTE complications in cancer patients.
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Affiliation(s)
- Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Maiko Niki
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tohru Nisizawa
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takeshi Tamaki
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Michiomi Shimizu
- First Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan
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Simulated Thrombin Generation in the Presence of Surface-Bound Heparin and Circulating Tissue Factor. Ann Biomed Eng 2015; 44:1072-84. [PMID: 26168717 DOI: 10.1007/s10439-015-1377-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 06/24/2015] [Indexed: 10/23/2022]
Abstract
An expanded computational model of surface induced thrombin generation was developed that includes hemodynamic effects, 22 biochemical reactions and 44 distinct chemical species. Surface binding of factors V, VIII, IX, and X was included in order to more accurately simulate the formation of the surface complexes tenase and prothrombinase. In order to model these reactions, the non-activated, activated and inactivated forms were all considered. This model was used to investigate the impact of surface bound heparin on thrombin generation with and without the additive effects of thrombomodulin (TM). In total, 104 heparin/TM pairings were evaluated (52 under venous conditions, 52 under arterial conditions), the results demonstrating the synergistic ability of heparin and TM to reduce thrombin generation. Additionally, the role of circulating tissue factor (TF(p)) was investigated and compared to that of surface-bound tissue factor (TF(s)). The numerical results suggest that circulating TF has the power to amplify thrombin generation once the coagulation cascade is already initiated by surface-bound TF. TF(p) concentrations as low as 0.01 nM were found to have a significant impact on total thrombin generation.
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Chistiakov DA, Orekhov AN, Bobryshev YV. Extracellular vesicles and atherosclerotic disease. Cell Mol Life Sci 2015; 72:2697-708. [PMID: 25894694 PMCID: PMC11113133 DOI: 10.1007/s00018-015-1906-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 12/14/2022]
Abstract
Circulating extracellular vesicles (EVs) comprise a heterogeneous population of vesicular structures. According to the current paradigm, there are three types of EVs, including exosomes, microvesicles and apoptotic bodies, that are differentiated in their size, formation, and release mechanisms. EVs were shown to act as a 'post service' that serves a long-distance delivery of complex cellular messages. The cargo of EVs consists of a variety of biomolecules including proteins, DNA, mRNA, and non-coding RNA. In normal or pathological conditions, EVs deliver various molecules to the recipient cells. Those molecules greatly vary depending on the microenvironmental stimuli. In proinflammatory conditions such as atherosclerosis and other cardiovascular diseases, EVs derived from vascular endothelial cells, vascular smooth muscle cells, macrophages, and other circulating immune cells mainly possess proinflammatory properties. However, the capacity of circulating EVs to stably maintain and deliver a variety of biomolecules makes these microparticles to be a promising therapeutic tool for treatment of cardiovascular pathology. To date, circulating EVs were evaluated to be as a source of valuable diagnostic and prognostic biomarkers such as microRNA. Circulating EVs keep a great therapeutic potential to serve as vehicles for targeted therapy of cardiovascular diseases.
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Affiliation(s)
- Dimitry A. Chistiakov
- The Mount Sinai Community Clinical Oncology Program, Mount Sinai Comprehensive Cancer Center, Mount Sinai Medical Center, Miami Beach, FL 33140 USA
- Division of Laboratory Medicine, Department of Molecular Genetic Diagnostics and Cell Biology, Institute of Pediatrics, Research Center for Children’s Health, Moscow, 119991 Russia
| | - Alexander N. Orekhov
- Laboratory of Angiopathology, Institute of General Pathology and Pathophysiology, Russian Academy of Sciences, Moscow, 125315 Russia
- Department of Biophysics, Faculty of Biology, Lomonosov Moscow State University, Moscow, 119991 Russia
| | - Yuri V. Bobryshev
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, NSW 2052 Australia
- School of Medicine, University of Western Sydney, Campbelltown, NSW 2560 Australia
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Ünlü B, Versteeg HH. Effects of tumor-expressed coagulation factors on cancer progression and venous thrombosis: is there a key factor? Thromb Res 2014; 133 Suppl 2:S76-84. [DOI: 10.1016/s0049-3848(14)50013-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Phan M, John S, Casanegra AI, Rathbun S, Mansfield A, Stoner JA, Tafur AJ. Primary venous thromboembolism prophylaxis in patients with solid tumors: a meta-analysis. J Thromb Thrombolysis 2014; 38:241-9. [PMID: 24233387 PMCID: PMC4427894 DOI: 10.1007/s11239-013-1014-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Venous thromboembolism (VTE) is a leading cause of death among outpatient chemotherapy patients. However the VTE preventive measures for outpatients are not widely advocated. We did a meta-analysis to evaluate the outpatient VTE prevention's effectiveness and safety. We searched electronic databases until the end of December 2012 and reviewed the abstracts and manuscripts following the PRISMA guidelines. Occurrence of first VTE event was the efficacy outcome. The safety end point was major bleeding. We calculated Q statistic and a homogeneity formal test. The odds ratio (OR) estimates were pooled by using the Mantel-Haenszel fixed-effects method in the absence of heterogeneity. Data were analyzed using the R META package). We identified 1,485 articles and reviewed 37 articles based on initial screening. The number of patients included in 11 selected trials was 7,805. The odds of VTE was lower in the prophylaxis group (OR 0.56; 95% CI 0.45-0.71) and improved when heparin-based prevention was analyzed (OR 0.53; 95% CI 0.41-0.70). We found strong prevention among patients with lung cancer (OR 0.46; 95% CI 0.29-0.74) and pancreatic cancer (OR 0.33; 95% CI 0.16-0.67). Major bleeding events were frequent in the intervention group (OR 1.65; 95% CI 1.12-2.44). Thromboprophylaxis reduced VTE episodes. The VTE events were reduced by 47% in heparin-based prophylaxis trials compared to placebo. The patients receiving heparin-based prophylaxis had a 60% increase in bleeding events. Improving risk stratification tools to personalize prevention strategies may enhance the VTE prevention applicability in cancer patients.
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Affiliation(s)
- Minh Phan
- Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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TLR4 is essential for dendritic cell activation and anti-tumor T-cell response enhancement by DAMPs released from chemically stressed cancer cells. Cell Mol Immunol 2013; 11:150-9. [PMID: 24362470 DOI: 10.1038/cmi.2013.59] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 11/02/2013] [Accepted: 11/03/2013] [Indexed: 12/17/2022] Open
Abstract
The combination of immunotherapy and chemotherapy is regarded as a promising approach for the treatment of certain types of cancer. However, the underlying mechanisms need to be fully investigated to guide the design of more efficient protocols for cancer chemoimmunotherapy. It is well known that danger-associated molecular patterns (DAMPs) can activate immune cells, including dendritic cells (DCs), via Toll-like receptors (TLRs); however, the role of DAMPs released from chemical drug-treated tumor cells in the activation of the immune response needs to be further elucidated. Here, we found that colorectal cancer (CRC) cells treated with oxaliplatin (OXA) and/or 5-fluorouracil (5-Fu) released high levels of high-mobility group box 1 (HMGB1) and heat shock protein 70 (HSP70). After OXA/5-Fu therapy, the sera of CRC patients also exhibited increased levels of HMGB1 and HSP70, both of which are well-known DAMPs. The supernatants of dying CRC cells treated with OXA/5-Fu promoted mouse and human DC maturation, with upregulation of HLA-DR, CD80 and CD86 expression and enhancement of IL-1β, TNF-α, MIP-1α, MIP-1β, RANTES and IP-10 production. Vaccines composed of DCs pulsed with the supernatants of chemically stressed CRC cells induced a more significant IFN-γ-producing Th1 response both in vitro and in vivo. However, the supernatants of chemically stressed CRC cells failed to induce phenotypic maturation and cytokine production in TLR4-deficient DCs, indicating an essential role of TLR4 in DAMP-induced DC maturation and activation. Furthermore, pulsing with the supernatants of chemically stressed CRC cells did not efficiently induce an IFN-γ-producing Th1 response in TLR4-deficient DCs. Collectively, these results demonstrate that DAMPs released from chemically stressed cancer cells can activate DCs via TLR4 and enhance the induction of an anti-tumor T-cell immune response, delineating a clinically relevant immuno-adjuvant pathway triggered by DAMPs.
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Blix K, Jensvoll H, Brækkan SK, Hansen JB. White blood cell count measured prior to cancer development is associated with future risk of venous thromboembolism--the Tromsø study. PLoS One 2013; 8:e73447. [PMID: 24023876 PMCID: PMC3762748 DOI: 10.1371/journal.pone.0073447] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/21/2013] [Indexed: 12/21/2022] Open
Abstract
Background Elevated white blood cell (WBC) count is associated with risk of venous thromboembolism (VTE) in cancer patients initiating chemotherapy. It is not known whether the risk of VTE by WBC count in cancer patients is causal or merely a consequence of the malignant disease. To address this question, we studied the association between WBC count, measured prior to cancer development, and risk of VTE in subjects who did and did not develop cancer during follow-up in a prospective population-based study. Methods Baseline characteristics, including WBC and neutrophil counts, were measured in 24304 initially cancer-free subjects who participated in the Tromsø Study in 1994-1995. Incident cancer diagnosis and VTE events were registered up to September 1, 2007. In the cancer cohort, WBC and neutrophil counts were measured in average 7.1 years before cancer development. Cox-regression models were used to calculate hazard ratios (HRs) for VTE by WBC and neutrophil counts as categorized variables (<40th, 40-80th, and >80th percentile) with 95% confidence intervals (CIs). Results During follow-up, 1720 subjects developed cancer and there were 388 VTE events, of which 116 occurred in the cancer-group (6.9 per 1000 person-years) and 272 in the cancer-free group (1.1 per 1000 person-years). In those who developed cancer, WBC count above the 80th percentile (≥8.6x109 cells/L) was associated with a 2.4-fold higher risk (HR 2.36, 95% CI: 1.44-3.87) of VTE compared to WBC count below the 40th percentile (<6.4x109 cells/L). No association was found between WBC count and VTE in those who stayed cancer-free (HR 0.94, 95% CI 0.65-1.36). Similar findings were observed for neutrophils. Comment Pre-cancer WBC count was associated with risk of VTE in cancer patients, but not in cancer-free subjects. Our findings suggest that leukocytes may play a causal role in cancer-related VTE rather than only reflecting the low-grade inflammation associated with cancer.
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Affiliation(s)
- Kristine Blix
- Hematological Research Group, Department of Clinical Medicine, University of Tromsø and Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Hilde Jensvoll
- Hematological Research Group, Department of Clinical Medicine, University of Tromsø and Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- * E-mail:
| | - Sigrid K. Brækkan
- Hematological Research Group, Department of Clinical Medicine, University of Tromsø and Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - John-Bjarne Hansen
- Hematological Research Group, Department of Clinical Medicine, University of Tromsø and Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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Lacroix R, Dubois C, Leroyer AS, Sabatier F, Dignat-George F. Revisited role of microparticles in arterial and venous thrombosis. J Thromb Haemost 2013; 11 Suppl 1:24-35. [PMID: 23809108 DOI: 10.1111/jth.12268] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Microparticles (MPs) represent a heterogeneous population of submicronic vesicles that are released in response to cell activation or apoptosis. MPs harbor a large repertoire of cell surface receptors and mRNA and biological activities representative of their parent cells and related to their involvement in many biological functions. Although MP generation is a physiological response, a dramatic increase in circulating MPs is detectable in a variety of thrombosis-associated disorders compared with healthy individuals. In this review, we will discuss a new vision of MPs as complex and ambivalent structures that express both activators and inhibitors of coagulation but also convey fibrinolytic properties. After summarizing our current knowledge about the role of MPs in venous and arterial thrombosis, this review will explore how this new vision of MPs influences their definition as emergent biomarkers in thrombotic diseases. Among the studies that have aimed to establish a link between thrombosis and MPs, a few studies have demonstrated a predictive value of MPs. So far, it is unclear whether this limited causative association is the result of current technical concerns and limited standardization or has to be integrated into a more complex vision of the role of MPs as key systems for regulating the balance between coagulation and fibrinolysis.
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Affiliation(s)
- R Lacroix
- VRCM, UMR_S1076, UFR de Pharmacie, Aix Marseille Université, INSERM, Marseille, France
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