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Wahlund CJ, Çaglayan S, Czarnewski P, Hansen JB, Snir O. Sustained and intermittent hypoxia differentially modulate primary monocyte immunothrombotic responses to IL-1β stimulation. Front Immunol 2023; 14:1240597. [PMID: 37753073 PMCID: PMC10518394 DOI: 10.3389/fimmu.2023.1240597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Venous thromboembolism (VTE) is a leading cause of preventable deaths in hospitals, and its incidence is not decreasing despite extensive efforts in clinical and laboratory research. Venous thrombi are primarily formed in the valve pockets of deep veins, where activated monocytes play a crucial role in bridging innate immune activation and hemostatic pathways through the production of inflammatory cytokines, chemokines, and tissue factor (TF) - a principal initiator of coagulation. In the valve pocket inflammation and hypoxia (sustained/intermittent) coexist, however their combined effects on immunothrombotic processes are poorly understood. Inflammation is strongly associated with VTE, while the additional contribution of hypoxia remains largely unexplored. To investigate this, we modelled the intricate conditions of the venous valve pocket using a state-of-the-art hypoxia chamber with software-controlled oxygen cycling. We comprehensively studied the effects of sustained and intermittent hypoxia alone, and in combination with VTE-associated inflammatory stimuli on primary monocytes. TF expression and activity was measured in monocytes subjected to sustained and intermittent hypoxia alone, or in combination with IL-1β. Monocyte responses were further analyzed in detailed by RNA sequencing and validated by ELISA. Stimulation with IL-1β alone promoted both transcription and activity of TF. Interestingly, the stimulatory effect of IL-1β on TF was attenuated by sustained hypoxia, but not by intermittent hypoxia. Our transcriptome analysis further confirmed that sustained hypoxia limited the pro-inflammatory response induced by IL-1β, and triggered a metabolic shift in monocytes. Intermittent hypoxia alone had a modest effect on monocyte transcript. However, in combination with IL-1β intermittent hypoxia significantly altered the expression of 2207 genes and enhanced the IL-1β-stimulatory effects on several chemokine and interleukin genes (e.g., IL-19, IL-24, IL-32, MIF), as well as genes involved in coagulation (thrombomodulin) and fibrinolysis (VEGFA, MMP9, MMP14 and PAI-1). Increased production of CCL2, IL-6 and TNF following stimulation with intermittent hypoxia and IL-1β was confirmed by ELISA. Our findings provide valuable insights into how the different hypoxic profiles shape the immunothrombotic response of monocytes and shed new light on the early events in the pathogenesis of venous thrombosis.
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Affiliation(s)
- Casper J.E. Wahlund
- Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Safak Çaglayan
- Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Paulo Czarnewski
- Science for Life Laboratory, Department of Gene Technology, KTH Royal Institute of Technology, Stockholm, Sweden
- Science for Life Laboratory, Department of Biochemistry and Biophysics, National Bioinformatics Infrastructure Sweden, Stockholm University, Stockholm, Sweden
| | - John-Bjarne Hansen
- Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Omri Snir
- Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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2
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Portugal C, Fang MC, Go AS, Zhou H, Chang J, Prasad P, Fan D, Garcia EA, Sung SH, Reynolds K. The anticoagulation length of therapy and risk of new adverse events in venous thromboembolism (ALTERNATIVE) study: Design and survey results. PLoS One 2022; 17:e0277961. [PMID: 36480548 PMCID: PMC9731472 DOI: 10.1371/journal.pone.0277961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
The Anticoagulation Length of Therapy and Risk of New Adverse Events In Venous Thromboembolism (ALTERNATIVE) study was designed to compare the benefits and harms of different treatment options for extended treatment of venous thromboembolism (VTE). In this paper, we describe the study cohort, survey data collection, and preliminary results. We identified 39,605 adult patients (age ≥ 18 years) from two large integrated health care delivery systems who were diagnosed with incident VTE and received initial anticoagulation therapy of 3 months or longer. A subset of the cohort (12,737) was invited to participate in a survey. Surveys were completed in English, Spanish or Mandarin via a mailed questionnaire, an online secure web link, or telephone. The survey domains included demographics, personal medical history, anticoagulant treatment history, anticoagulant treatment satisfaction, health-related quality of life and health literacy. A total of 5,017 patients participated in the survey for an overall response rate of 39.4%. The mean (SD) age of the survey respondents was 63.0 (14.5) years and self-reported race was 76.0% White/European, 11.1% Black/African American, and 3.8% Asian/Pacific Islander and 14.0% reported Hispanic ethnicity. Sixty percent of respondents completed the web survey, while 29.0% completed the mail-in paper survey, and 11.0% completed the survey via telephone. The ALTERNATIVE Study will address knowledge gaps by comparing several treatment alternatives for the extended management of VTE so that this information could be used by patients and clinicians to make more informed, patient-centered treatment choices.
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Affiliation(s)
- Cecilia Portugal
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Margaret C. Fang
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
- Department of Medicine and Department of Epidemiology, and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
- Departments of Medicine, Stanford University, Palo Alto, CA, United States of America
| | - Hui Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
| | - John Chang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
| | - Priya Prasad
- Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Dongjie Fan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Elisha A. Garcia
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States of America
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States of America
- * E-mail:
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3
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Yang M, Chen L, Zhang M, Huang X, Zhao W, Wang H. Evidence-Based Nursing Model in Interventional Thrombolysis for Acute Lower Extremity Arterial Embolism. Contrast Media Mol Imaging 2022; 2022:4488797. [PMID: 35677027 DOI: 10.1155/2022/4488797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/02/2022]
Abstract
Acute lower extremity arterial embolism (AE) is a serious clinical emergency, and, if not treated in time, it can easily lead to limb ischemia and necrosis and eventually facing amputation, which seriously damages patients' physical and mental health. In the past, the conventional drug thrombolytic therapy had slow and limited efficacy, and the best time for treatment is easily delayed, while arterial dissection and thrombectomy treatment, although fast, is traumatic and has many complications, which is not easily accepted by patients. The aim of this study was to investigate the value of evidence-based care model in the application of interventional thrombolysis for acute lower limb arterial embolism. Seventy-two patients with acute lower limb arterial embolism who underwent interventional thrombolysis treatment received by the Department of Vascular Surgery of our hospital from July 2016 to December 2021 were randomly divided into a control group (given conventional nursing services) and a quality group (given full quality nursing services) to compare the effect of nursing services in the two groups. The results showed that the postoperative psychological status of patients in the quality group was significantly better than that of patients in the control group (P < 0.05). The total incidence of postoperative adverse events and the total treatment efficiency of the quality group were better than those of the control group (P < 0.05). The efficacy of quality nursing care in patients with acute lower extremity arterial embolism is more desirable than conventional nursing care and is recommended. The site of vascular occlusion after bypass surgery can be clarified when angiography is performed after thrombolytic therapy, which can help secondary surgical intervention to prolong the time to patency. The efficacy of quality nursing care in patients with acute lower extremity arterial embolism is more desirable than that of conventional nursing care and is recommended.
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Soudet S, Jedraszak G, Evrard O, Marolleau JP, Garcon L, Pietri MAS. Is Hematopoietic Clonality of Indetermined Potential a Risk Factor for Pulmonary Embolism? TH Open 2021; 5:e338-e342. [PMID: 34414354 PMCID: PMC8370792 DOI: 10.1055/s-0041-1733856] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background
Unprovoked pulmonary embolism (uPE) is a severe and frequent condition. Identification of new risk factors is mandatory to identify patients that would benefit from a long-term treatment. Clonal hematopoiesis of indeterminate potential (CHIP) is defined by the acquisition of somatic mutations that drive clonal expansion in the absence of cytopenia. Its prevalence is estimated of 5% in the population above 65 years. Since inflammation and endothelial dysfunction may share a pathophysiological pathway(1), we hypothesized that CHIP, may be a risk factor for uPE.
Methods
We conducted a pilot retrospective observational study. Patients with iPE between 18 to 65 years old were included. PE was considered as unprovoked, when no transient nor persistant risk factor was present and when thrombophilia testing was negative. We excluded documented atherosclerosis, personal or familial history of VTE and presence of cytopenias. CHIP proportion in uPE patients were analyzed using next generation sequencing of the coding sequence of a custom panel composed by
DNMT3A, ASXL1, SF3B1, TET2
and
TP 53
.
Results
Upon 61 patients with uPE consecutively included, a total of 19 somatic mutations were found in 12 patients (20%) IC95% [10 - 20]. 15 mutations were found in
DNMT3A
gene, 3 in
ASXL1
and one in
TET2
. There was no diference in terms of age, PE location, DVT presence and risk stratification in CHIP carriers and non carriers.
Conclusion
We report for the first time, the presence of high rates of CHIP in patients presenting with uPE. Thus, CHIP may be a new risk factor for VTE. These results need to be confirmed in an ongoing prospective case-control study including more patients and using a more diverse gene panel to better determine CHIP incidence in uPE.
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Affiliation(s)
- S Soudet
- Department of Vascular Medicine, CHU Amiens Picardie, Amiens, France.,EA 7516 CHIMERE, Université Picardie Jules Verne, Amiens, France
| | - G Jedraszak
- Department of Genetic, CHU Amiens Picardie, Amiens, France.,EA 4666 HEMATIM, Université Picardie Jules Verne, Amiens, France
| | - O Evrard
- Department of Genetic, CHU Amiens Picardie, Amiens, France.,EA 4666 HEMATIM, Université Picardie Jules Verne, Amiens, France
| | - J P Marolleau
- Department of Genetic, CHU Amiens Picardie, Amiens, France.,EA 4666 HEMATIM, Université Picardie Jules Verne, Amiens, France
| | - L Garcon
- Department of Genetic, CHU Amiens Picardie, Amiens, France.,EA 4666 HEMATIM, Université Picardie Jules Verne, Amiens, France
| | - M A Sevestre Pietri
- Department of Vascular Medicine, CHU Amiens Picardie, Amiens, France.,EA 7516 CHIMERE, Université Picardie Jules Verne, Amiens, France
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Højen AA, Søgaard M, Seddon K, Noble S. Patient public involvement and engagement in thrombosis research: Not just for the intrepid. Res Pract Thromb Haemost 2021; 5:245-246. [PMID: 33537550 PMCID: PMC7845071 DOI: 10.1002/rth2.12451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Anette Arbjerg Højen
- Aalborg Thrombosis Research Unit Department of Clinical Medicine Faculty of Health Aalborg University Aalborg Denmark.,Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - Mette Søgaard
- Aalborg Thrombosis Research Unit Department of Clinical Medicine Faculty of Health Aalborg University Aalborg Denmark.,Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - Kathy Seddon
- Marie Curie, Expert Patient Voices Division of Population Medicine Cardiff University Cardiff UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre Cardiff University Cardiff UK
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Barnes GD, Cushman M. Response: Patient and caregiver engagement in venous thromboembolism research. Res Pract Thromb Haemost 2020; 5:247. [PMID: 33537551 PMCID: PMC7845054 DOI: 10.1002/rth2.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Geoffrey D Barnes
- Department of Internal Medicine Frankel Cardiovascular Center University of Michigan Ann Arbor MI USA
| | - Mary Cushman
- Department of Medicine Department of Pathology & Laboratory Medicine Larner College of Medicine at the University of Vermont Burlington VT USA
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