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Barbosa da Cruz D, Helms J, Aquino LR, Stiel L, Cougourdan L, Broussard C, Chafey P, Riès-Kautt M, Meziani F, Toti F, Gaussem P, Anglés-Cano E. DNA-bound elastase of neutrophil extracellular traps degrades plasminogen, reduces plasmin formation, and decreases fibrinolysis: proof of concept in septic shock plasma. FASEB J 2019; 33:14270-14280. [PMID: 31682515 DOI: 10.1096/fj.201901363rrr] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Activation of platelets and neutrophils in septic shock results in the formation of microvascular clots containing an intricate scaffold of fibrin with neutrophil extracellular traps (NETs) DNA. NETs contain multiple components that might impact endogenous fibrinolysis, resulting in failure to lyse clots in the microcirculation and residual systemic microthrombosis. We propose herein that the reservoir of human neutrophil elastase (HNE) on NETs may directly interfere with the fibrinolytic mechanism via a plasminogen proteolytic pathway. To investigate this mechanism, we constructed fibrin-NETs matrices by seeding and activating neutrophils onto a fibrin surface and monitored plasminogen activation or degradation. We demonstrate that the elastase activity of HNE-DNA complexes is protected from inhibition by plasma antiproteases and sustains its ability to degrade plasminogen. Using mass spectrometry proteomic analysis, we identified plasminogen fragments composed of kringle (K) domains (K1+2+3, k1+2+3+4) and the serine protease (SP) region (K5-SP). We further demonstrate that patients with septic shock with disseminated intravascular coagulation have circulating HNE-DNA complexes, HNE-derived plasminogen fragments, a low plasminogen concentration, and a reduced capacity to generate plasmin onto fibrin. In conclusion, we show that NETs bearing active HNE-DNA complexes reduce plasminogen into fragments, thus impairing fibrinolysis by decreasing the local plasminogen concentration, plasminogen binding to fibrin, and localized plasmin formation.-Barbosa da Cruz, D., Helms, J., Aquino, L. R., Stiel, L., Cougourdan, L., Broussard, C., Chafey, P., Riès-Kautt, M., Meziani, F., Toti, F., Gaussem, P., Anglés-Cano, E. DNA-bound elastase of neutrophil extracellular traps degrades plasminogen, reduces plasmin formation, and decreases fibrinolysis: proof of concept in septic shock plasma.
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Affiliation(s)
- Dayana Barbosa da Cruz
- Innovative Therapies in Haemostasis, INSERM Unité Mixte de Recherche (UMR)_S 1140, Université de Paris, Paris, France
| | - Julie Helms
- Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,ImmunoRhumatologie Moléculaire, INSERM UMR_S 1109, Fédération de Médecine Translationnelle de Strasbourg, Faculté de Médecine, Université de Strasbourg, Strasbourg, France
| | - Lluvia Ramírez Aquino
- Innovative Therapies in Haemostasis, INSERM Unité Mixte de Recherche (UMR)_S 1140, Université de Paris, Paris, France
| | - Laure Stiel
- Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Regenerative Nanomedicine, INSERM UMR_S 1260, Université de Strasbourg, Strasbourg, France
| | - Lucas Cougourdan
- Innovative Therapies in Haemostasis, INSERM Unité Mixte de Recherche (UMR)_S 1140, Université de Paris, Paris, France
| | - Cedric Broussard
- Plateforme Protéomique 3P5, Université de Paris, Paris, France.,Institut Cochin, INSERM, Centre National de la Recherche Scientifique (CNRS), Université de Paris, Paris, France
| | - Philippe Chafey
- Plateforme Protéomique 3P5, Université de Paris, Paris, France.,Institut Cochin, INSERM, Centre National de la Recherche Scientifique (CNRS), Université de Paris, Paris, France
| | - Madeleine Riès-Kautt
- Plateforme Protéomique 3P5, Université de Paris, Paris, France.,Institut Cochin, INSERM, Centre National de la Recherche Scientifique (CNRS), Université de Paris, Paris, France
| | - Ferhat Meziani
- Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Regenerative Nanomedicine, INSERM UMR_S 1260, Université de Strasbourg, Strasbourg, France
| | - Florence Toti
- Regenerative Nanomedicine, INSERM UMR_S 1260, Université de Strasbourg, Strasbourg, France
| | - Pascale Gaussem
- Innovative Therapies in Haemostasis, INSERM Unité Mixte de Recherche (UMR)_S 1140, Université de Paris, Paris, France.,Assistance Publique-Hôpitaux de Paris, Service d'Hématologie Biologique, Hôpital Européen Georges Pompidou, Paris, France
| | - Eduardo Anglés-Cano
- Innovative Therapies in Haemostasis, INSERM Unité Mixte de Recherche (UMR)_S 1140, Université de Paris, Paris, France
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Katsafadou AI, Tsangaris GT, Anagnostopoulos AK, Billinis C, Barbagianni MS, Vasileiou NGC, Spanos SA, Mavrogianni VS, Fthenakis GC. Differential quantitative proteomics study of experimental Mannheimia haemolytica mastitis in sheep. J Proteomics 2019; 205:103393. [PMID: 31154024 DOI: 10.1016/j.jprot.2019.103393] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 02/08/2023]
Abstract
Objective was the differential quantitative proteomics study of ovine mastitis induced by Mannheimia haemolytica; clinical, microbiological, cytological and histopathological methods were employed for confirmation and monitoring. Proteins were separated by two-dimensional gel electrophoresis (2-DE) for all samples and differentially abundant proteins were identified by mass spectrometry; comparisons were performed with pre- (blood, milk) and post- (milk of contralateral gland) inoculation findings. Animals developed mastitis, confirmed by isolation of challenge strain and increase of neutrophils in milk and by histopathological evidence. In blood plasma, 33 differentially abundant proteins (compared to findings before challenge) were identified: 6 with decrease, 13 with new appearance and 14 with varying abundance. In a post-challenge milk whey protein reference map, 65 proteins were identified; actin cytoplasmic-1, beta-lactoglobulin-1/B, cathelicidin-1 predominated. Further, 89 differentially abundant proteins (compared to findings before challenge) were identified: 18 with decrease, 53 with new appearance, 3 with increase and 15 with varying abundance; 15 proteins showed status changes in blood plasma and milk whey. Differential abundance from inoculated and contralateral glands revealed 74 proteins only from the inoculated gland. Most differentially abundant proteins in milk whey were involved in cell organisation and biogenesis (n = 17) or in inflammatory and defence response (n = 13). SIGNIFICANCE: The proteomes of blood and milk from ewes with experimental mastitis caused by Mannheimia haemolytica and the differential proteomics in sequential samples after challenge are presented for the first time. This is the first detailed proteomics study in M. haemolytica-associated mastitis in ewes. An experimental model fully simulating natural mastitis has been used. Use of experimentally induced mastitis minimised potential variations and allowed consistency of results. The study included evaluation of changes in blood plasma and milk whey. Protein patterns have been studied, indicating with great accuracy changes that had occurred as part of the disease process and development, during the acute phase of infection. Relevant protein-protein interactions were studied. The entirety of proteomics findings has suggested that affected ewes had mounted a defence response that had been regulated by many proteins (e.g., cathelicidins, haptoglobin, serum amyloid A) and through various pathways (e.g., acute phase response, binding and transporting significant ions and molecules); these were interdependent at various points. Potential biomarkers have been indicated for use in diagnostic assays of mastitis.
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Affiliation(s)
- Angeliki I Katsafadou
- Veterinary Faculty, University of Thessaly, 43100 Karditsa, Greece; Proteomics Research Unit, Biomedical Research Foundation of Academy of Athens, 11527 Athens, Greece
| | - George Th Tsangaris
- Proteomics Research Unit, Biomedical Research Foundation of Academy of Athens, 11527 Athens, Greece
| | | | | | | | | | - Stavros A Spanos
- Veterinary Faculty, University of Thessaly, 43100 Karditsa, Greece
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Fabian E, Bogner M, Elmadfa I. Age-related modification of antioxidant enzyme activities in relation to cardiovascular risk factors. Eur J Clin Invest 2012; 42:42-8. [PMID: 21722101 DOI: 10.1111/j.1365-2362.2011.02554.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Since oxidative stress might cause and promote cardiovascular risk factors such as oxidized low-density lipoproteins (oxLDL), apolipoprotein(a) [apo(a)], asymmetric dimethylarginine (ADMA) and fetuin A, we investigated antioxidant enzyme activities in relation to the vascular redox balance and these risk factors in elderly people. MATERIALS AND METHODS For this observational study, a total of 102 subjects were recruited and divided into three groups: A (70-74 years/n = 48), B (75-79 years/n = 35) and C (≥ 80 years/n = 19). Activities of the erythrocyte antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) were determined photometrically oxLDL, apo(a), ADMA and fetuin A by ELISA. Plasma concentrations of the lipid peroxidation products malondialdehyde (MDA) and conjugated dienes (CD) were analysed with HPLC. RESULTS There were no significant age-associated alterations in apo(a) levels, but there was a significant age-related decrease in activities of SOD (A>C, B>C: P < 0·01), CAT (A>C: P < 0·05) and GSH-Px (A>C: P < 0·05), accompanied by a significant increase in oxLDL (A<C: P < 0·001; B<C: P < 0·05), ADMA (A<B: P < 0·05; A<C: P < 0·001), MDA (A<C, B<C: P < 0·01) and CD (A<C, B<C: P < 0·01), and a significant decrease in fetuin A (A>C: P < 0·01; B>C: P < 0·05). Consequently, all groups showed significant negative age-associated correlations between CAT and MDA (A, B, C: P < 0·05), GSH-Px and CD (A, C: P < 0·01; B: P < 0·05), SOD and oxLDL (A, B: P < 0·05; C: P < 0·01), and fetuin A and MDA (A: P < 0·01; B, C: P < 0·05), and a significant positive correlation between oxLDL and ADMA (A, B: P < 0·05; C: P < 0·01). CONCLUSIONS This study indicates a significant age-related decrease in antioxidant enzyme activities accompanied by significantly increased systemic oxidative stress, which promotes the cardiovascular risk factors oxLDL, ADMA and fetuin A in elderly people.
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Affiliation(s)
- Elisabeth Fabian
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria.
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Baños-González M, Peña-Duque M, Anglés-Cano E, Martinez-Rios M, Bahena A, Valente-Acosta B, Cardoso-Saldaña G, Angulo-Ortíz J, de la Peña-Díaz A. Apo(a) phenotyping and long-term prognosis for coronary artery disease. Clin Biochem 2010; 43:640-4. [DOI: 10.1016/j.clinbiochem.2010.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 01/26/2010] [Accepted: 01/27/2010] [Indexed: 11/16/2022]
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Hoover-Plow J, Hart E, Gong Y, Shchurin A, Schneeman T. A physiological function for apolipoprotein(a): a natural regulator of the inflammatory response. Exp Biol Med (Maywood) 2008; 234:28-34. [PMID: 18997104 DOI: 10.3181/0804-rm-136] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Structural similarities between apolipoprotein(a) (apo(a)), the unique apoprotein of lipoprotein(a), and plasminogen, the zymogen of plasmin, can interfere with functions of plasmin (ogen) in vitro. The purpose of this study was to evaluate the role of apo(a) in inflammation in vivo using apo(a) transgenic mice and to determine if effects are plasminogen-dependent using backgrounds that are either plasminogen-replete or plasminogen-deficient. After administration of peritoneal inflammatory stimuli, thioglycollate, bioimplants or lipopolysaccharide, the number of responding peritoneal neutrophils and macrophages were quantified. Apo(a), in either wild-type or plasminogen deficient backgrounds, inhibited neutrophil recruitment but had no effect on plasminogen-dependent macrophage recruitment. Macrophage-inflammatory protein-2, a neutrophil chemokine, was reduced in apo(a) mice, and injection of this chemokine prior to thioglycollate restored neutrophil recruitment in apo(a) transgenic mice. In the lipopolysaccharide model, mice with apo(a), unlike mice without apo(a), did not increase neutrophil recruitment in response to the stimulus. In the bioimplant model, neutrophil recruitment and neutrophil cytokines were reduced in apo(a)tg mice but only in a plasminogen-deficient background. These results indicate for the first time that apo(a), independent of plasminogen interaction, inhibits neutrophil recruitment in vivo in diverse peritoneal inflammatory models. Hence, apo(a) may function as a cell specific suppressor of the inflammatory response.
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Affiliation(s)
- Jane Hoover-Plow
- Department of Molecular Cardiology, NB50, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Lacroix R, Sabatier F, Mialhe A, Basire A, Pannell R, Borghi H, Robert S, Lamy E, Plawinski L, Camoin-Jau L, Gurewich V, Angles-Cano E, Dignat-George F. Activation of plasminogen into plasmin at the surface of endothelial microparticles: a mechanism that modulates angiogenic properties of endothelial progenitor cells in vitro. Blood 2007; 110:2432-9. [PMID: 17606760 PMCID: PMC2495018 DOI: 10.1182/blood-2007-02-069997] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The regulation of plasmin generation on cell surfaces is of critical importance in the control of vascular homeostasis. Cell-derived microparticles participate in the dissemination of biological activities. However, their capacity to promote plasmin generation has not been documented. In this study, we show that endothelial microparticles (EMPs) from tumor necrosis factor alpha (TNFalpha)-stimulated endothelial cells served as a surface for the generation of plasmin. The generation of plasmin involved expression of urokinase-type plasminogen activator (uPA) and its receptor (uPAR) at the surface of EMPs and was further increased by their ability to bind exogenous uPA on uPAR. Plasminogen was activated at the surface of EMPs in a dose-dependent, saturable, and specific manner as indicated by the inhibition of plasmin formation by epsilon-amino-caproic acid (epsilon-ACA) and carboxypeptidase B. EMP-induced plasmin generation affects tube formation mediated by endothelial progenitor cells. However, low amounts of EMPs increased tube formation, whereas higher concentrations inhibited it. Prevention of these effects by inhibitors of either uPA or plasmin underscore the key role of EMP-induced plasmin generation. In conclusion, we demonstrated that EMPs act as vectors supporting efficient plasmin generation and dissemination, a new pathway in the regulation of endothelial proteolytic activities with potential involvement in inflammation, angiogenesis, and atherosclerosis.
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Affiliation(s)
- Romaric Lacroix
- Physiopathologie de l'Endothelium
INSERM : U608Université de la Méditerranée - Aix-Marseille IIFaculte de Pharmacie MARSEILLE
27, Boulevard Jean Moulin
13385 MARSEILLE CEDEX 05,FR
| | - Florence Sabatier
- Physiopathologie de l'Endothelium
INSERM : U608Université de la Méditerranée - Aix-Marseille IIFaculte de Pharmacie MARSEILLE
27, Boulevard Jean Moulin
13385 MARSEILLE CEDEX 05,FR
| | - Agnes Mialhe
- Physiopathologie de l'Endothelium
INSERM : U608Université de la Méditerranée - Aix-Marseille IIFaculte de Pharmacie MARSEILLE
27, Boulevard Jean Moulin
13385 MARSEILLE CEDEX 05,FR
| | - Agnes Basire
- Physiopathologie de l'Endothelium
INSERM : U608Université de la Méditerranée - Aix-Marseille IIFaculte de Pharmacie MARSEILLE
27, Boulevard Jean Moulin
13385 MARSEILLE CEDEX 05,FR
| | - Ralph Pannell
- Vascular Research Laboratory
Beth Israel Deaconess - Harvard Medical SchoolBoston, MA,US
| | - Helene Borghi
- Service de Microscopie Electronique, UFR de Médecine
Université de la Méditerranée - Aix-Marseille IIMarseille,FR
| | - Stephane Robert
- Physiopathologie de l'Endothelium
INSERM : U608Université de la Méditerranée - Aix-Marseille IIFaculte de Pharmacie MARSEILLE
27, Boulevard Jean Moulin
13385 MARSEILLE CEDEX 05,FR
| | - Edouard Lamy
- Physiopathologie de l'Endothelium
INSERM : U608Université de la Méditerranée - Aix-Marseille IIFaculte de Pharmacie MARSEILLE
27, Boulevard Jean Moulin
13385 MARSEILLE CEDEX 05,FR
| | - Laurent Plawinski
- Sérine protéases et physiopathologie de l'unité neurovasculaire
INSERM : U919Université de CaenGIP Cyceron/Bd Henri Becquerel
14074-cdx, Caen, France,FR
| | - Laurence Camoin-Jau
- Physiopathologie de l'Endothelium
INSERM : U608Université de la Méditerranée - Aix-Marseille IIFaculte de Pharmacie MARSEILLE
27, Boulevard Jean Moulin
13385 MARSEILLE CEDEX 05,FR
| | - Victor Gurewich
- Vascular Research Laboratory
Beth Israel Deaconess - Harvard Medical SchoolBoston, MA,US
| | - Eduardo Angles-Cano
- Sérine protéases et physiopathologie de l'unité neurovasculaire
INSERM : U919Université de CaenGIP Cyceron/Bd Henri Becquerel
14074-cdx, Caen, France,FR
- * Correspondence should be adressed to: Eduardo Angles-Cano
| | - Francoise Dignat-George
- Physiopathologie de l'Endothelium
INSERM : U608Université de la Méditerranée - Aix-Marseille IIFaculte de Pharmacie MARSEILLE
27, Boulevard Jean Moulin
13385 MARSEILLE CEDEX 05,FR
- * Correspondence should be adressed to: Francoise Dignat-George
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Pepe G, Chimienti G, Liuzzi GM, Lamanuzzi BL, Nardulli M, Lolli F, Anglés-Cano E, Matà S. Lipoprotein(a) in the cerebrospinal fluid of neurological patients with blood-cerebrospinal fluid barrier dysfunction. Clin Chem 2006; 52:2043-8. [PMID: 16990412 DOI: 10.1373/clinchem.2006.073544] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is a recognized pathogenic particle in human plasma, but its presence in the cerebrospinal fluid and its possible role in the central nervous system have not been documented. We tested the hypothesis that apolipoprotein(a) [apo(a)], free or as a component of the Lp(a) particle, can cross the blood-cerebrospinal fluid barrier and be found in the cerebrospinal fluid of patients affected by neurologic pathologies. METHODS We studied paired cerebrospinal fluid/serum samples from 77 patients with inflammatory (n=20) or noninflammatory (n=34) blood-cerebrospinal fluid barrier dysfunction and without blood-cerebrospinal fluid barrier dysfunction (n=23). We used ELISA to measure Lp(a) concentrations and Western blot and immunodetection to analyze apo(a) isoforms in native and reducing conditions. RESULTS Entire Lp(a) with either small or large apo(a) isoforms was present in the cerebrospinal fluid of patients with blood-cerebrospinal fluid barrier dysfunction, regardless of its pathogenesis. Multiple linear regression analysis showed that both serum Lp(a) concentration (P=0.003) and cerebrospinal fluid/serum albumin ratio (P<0.001) were predictors of the Lp(a) concentration in cerebrospinal fluid. CONCLUSIONS Our results demonstrate that Lp(a) can cross a dysfunctional blood-cerebrospinal fluid barrier. The unusual presence of Lp(a) in the cerebrospinal fluid could extend some of its known pathogenic effects to the central nervous system.
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Affiliation(s)
- Gabriella Pepe
- Department of Biochemistry and Molecular Biology, University of Bari, Italy.
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Ohnishi T, Kakimoto K, Bandow K, Lowenstein CJ, Daikuhara Y, Matsuguchi T. Mature Hepatocyte Growth Factor/Scatter Factor on the Surface of Human Granulocytes Is Released by a Mechanism Involving Activated Factor Xa. THE JOURNAL OF IMMUNOLOGY 2006; 176:6945-53. [PMID: 16709855 DOI: 10.4049/jimmunol.176.11.6945] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Serum hepatocyte growth factor (HGF) is rapidly increased in patients suffering from various tissue injuries including arterial occlusive diseases. However, the cellular sources of the HGF increase remain largely unknown. In the present study, we showed that bioactive mature HGF is constitutively present on the surface of granulocytes in human peripheral blood. Exogenously added 125I-labeled iodo-HGF efficiently bound to granulocyte surface, whereas only a scarce amount of HGF mRNA was detected in granulocytes, indicating that the mature HGF on granulocytes is likely to be derived from other cell types. Interestingly, treatment of granulocytes with human serum rapidly induced the release of the cell surface-associated HGF. In vivo, thromboplastin injection into mice increased HGF release from transplanted human granulocytes, which was inhibited by the pretreatment with DX9065a, a specific inhibitor of factor Xa. Furthermore, DX9065a also inhibited the serum-induced HGF release from human granulocytes in vitro, suggesting that the HGF-releasing factor(s) in serum is associated with factor Xa activation. Thus, human granulocytes may function as a transporter of HGF in the peripheral blood, releasing HGF at the injured sites caused by blood coagulation, where HGF may promote tissue repair.
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Affiliation(s)
- Tomokazu Ohnishi
- Division of Biochemistry and Molecular Dentistry, Department of Developmental Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan
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Katsouras CS, Tsironis LD, Elisaf M, Goodevenos JA, Michalis LK, Tselepis AD. Lipoprotein(a) as a cardiovascular risk factor. Future Cardiol 2005; 1:509-17. [DOI: 10.2217/14796678.1.4.509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Evidence for the role of lipoprotein(a) (Lp[a]) in atherosclerosis and thrombosis has considerably increased over the past few years. Therefore, Lp(a) is currently classified as an emerging lipid risk factor for cardiovascular disease. High Lp(a) plasma levels carried in particles with small-sized apolipoprotein(a) isoforms are associated with preclinical vascular changes, cardiovascular disease and the mode of presentation of coronary artery disease (acute coronary syndromes). However, randomized clinical trials with an emphasis on agents that specifically lower plasma Lp(a) do not exist. At present, screening for increases in Lp(a) in the general population is not recommended. The measurement of Lp(a) may be of value in individuals with an increased risk of cardiovascular disease, particularly in patients with high low-density lipoprotein cholesterol plasma levels, since a high Lp(a) concentration in such subjects further increases the risk of coronary heart disease.
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Affiliation(s)
| | - Loukas D Tsironis
- University of Ioannina, Laboratory of Biochemistry, Department of Chemistry, 45100 Ioannina, Greece
| | - Moses Elisaf
- University of Ioannina, Department of Internal Medicine, 45110 Ioannina, Greece
| | - John A Goodevenos
- University of Ioannina, Department of Cardiology, 45110 Ioannina, Greece
| | - Lampros K Michalis
- University of Ioannina, Department of Cardiology, 45110 Ioannina, Greece
| | - Alexandros D Tselepis
- University of Ioannina, Laboratory of Biochemistry, Department of Chemistry, 45110 Ioannina, Greece
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