1
|
Launois A, Valade S, Mariotte E, Galicier L, Azoulay E, Roose E, Vanhoorelbeke K, Veyradier A, Joly BS. Hemophagocytic lymphohistiocytosis is associated with deficiency and closed conformation of ADAMTS-13. Res Pract Thromb Haemost 2024; 8:102292. [PMID: 38371335 PMCID: PMC10869956 DOI: 10.1016/j.rpth.2023.102292] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 02/20/2024] Open
Abstract
Background A disintegrin and metalloprotease with thrombospondin type 1 repeats, member 13 (ADAMTS-13) is the specific von Willebrand factor-cleaving protease and circulates in a closed and latent conformation due to a spacer/CUB1 domain interaction. ADAMTS-13 is allosterically activated after binding of its substrate or antibodies, inducing an open conformation. Recently, we suggested a potential role of plasmin (fibrinolysin) in hemostasis disorders reported in most patients with hemophagocytic lymphohistiocytosis (HLH), a rare and life-threatening condition related to a severe systemic inflammatory state. Most patients with HLH had a partial ADAMTS-13 deficiency, and plasmin could induce a truncation of the C-terminal part of ADAMTS-13 and thus an open conformation. Objectives To understand the effect of plasmin on ADAMTS-13, our study aimed to investigate ADAMTS-13 conformation in patients with HLH. Methods Forty-five critically ill patients with HLH were prospectively enrolled between April 2015 and December 2018. ADAMTS-13 activity was measured by fluorescent resonance energy transfer-VWF73 assay, ADAMTS-13 antigen, and conformation with our homemade 3H9-enzyme-linked immunosorbent assay and 1C4-enzyme-linked immunosorbent assay. Results ADAMTS-13 activity ranged from <10 to 65 IU/dL, and 41 of the 45 patients had a quantitative deficiency in ADAMTS-13 (activity <50 IU/dL). Twenty patients had a severe ADAMTS-13 deficiency (activity <20 IU/dL). ADAMTS-13 conformation was folded in all patients under normal conditions. Surprisingly, the switch of ADAMTS-13 conformation expected with the monoclonal antibody 17G2 (anti-CUB1) was disturbed in 6 patients (activity <20 IU/dL). Conclusion Our study reported that ADAMTS-13 conformation is closed in HLH and provides an indirect proof that plasmin is not able to massively degrade ADAMTS-13. Further studies on glycosylation and citrullination profiles of ADAMTS-13 are needed to understand their role in HLH.
Collapse
Affiliation(s)
- Amélie Launois
- Service d’Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, Paris, France
- Equipe d'Accueil 3518, Institut de Recherche Saint-Louis, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Sandrine Valade
- Service de Réanimation médicale, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, Paris, France
| | - Eric Mariotte
- Service de Réanimation médicale, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, Paris, France
| | - Lionel Galicier
- Service d’Immunologie clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, Paris, France
| | - Elie Azoulay
- Service de Réanimation médicale, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, Paris, France
| | - Elien Roose
- Laboratory for Thrombosis Research, Interdisciplinarity Research Facility Life Sciences, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, Interdisciplinarity Research Facility Life Sciences, Katholieke Universiteit Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Agnès Veyradier
- Service d’Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, Paris, France
- Equipe d'Accueil 3518, Institut de Recherche Saint-Louis, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Bérangère S. Joly
- Service d’Hématologie biologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris Nord, Université Paris Cité, Paris, France
- Equipe d'Accueil 3518, Institut de Recherche Saint-Louis, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| |
Collapse
|
2
|
Launois A, Chahabi SZ, Devaux F, Amouroux I, Flaujac C. Commercial human frozen plasmas for local, cross-site and long-term comparability of coagulation analysers. Blood Coagul Fibrinolysis 2024; 35:14-22. [PMID: 38051662 DOI: 10.1097/mbc.0000000000001268] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Laboratory compliance implies to correlate instruments for coagulation parameter with a wide range of measure using patient samples or commercialized sets of frozen plasmas. The aim of this study was to evaluate the intra, inter-reproducibility and long-term stability of ExpertCor Routine (ECR) plasma sets (Stago) on different parameters. The study was realized in two laboratories on four different instruments. Inter-site and intra-site correlation of ECR sets for PT, aPTT, Fibrinogen, INR, factor V (FV) UFH and LMWH anti-Xa and intra-reproducibility of DDimer (DDI), factor VIII (FVIII:C) and antithrombin (AT) assays were tested. To evaluate ECR long-term stability, samples were tested until 180 after delivery in one laboratory. Intra-site evaluation correlation coefficients is around 1. All predefined criteria to fulfil good comparability between inter-site instruments are met with Passing slopes between 0.9 and 1.1 and intercepts ranging from -0.62 to 2.83%. Long-term stability evaluation does not show any deviation over 180 days for aPTT, fibrinogen, DDI, UFH, LMWH but a drift for FV with STA-NeoPTimal reagent. On contrary, AT and FVIII:C are not stable. PT in second has an excellent stability unlike PT in percentage. Our study validates the use of ECR sets for correlation between instruments and inter-sites agreement, as for parameters claimed on the products than for factor V and FVIII:C. The evaluation of stability confirming the possible extension of use for 180 days after delivery except for FVIII:C and AT. These plasmas sets are an excellent alternative to local plasma patient use to perform instrument comparison.
Collapse
Affiliation(s)
- Amélie Launois
- Laboratoire de Biologie Médicale (secteur hémostase), Hôpital André Mignot - Versailles, Le Chesnay
| | - Sara Zia Chahabi
- Laboratoire de Biologie Médicale (secteur hémostase), Hôpital André Mignot - Versailles, Le Chesnay
| | - Floriane Devaux
- Laboratoire de Biologie Médicale (secteur hémostase), Hôpital André Mignot - Versailles, Le Chesnay
| | - Isabelle Amouroux
- Laboratoire de Biologie Médicale, Centre hospitalier de Rambouillet, France
| | - Claire Flaujac
- Laboratoire de Biologie Médicale (secteur hémostase), Hôpital André Mignot - Versailles, Le Chesnay
| |
Collapse
|
3
|
Launois A, De Raucourt E, Martin-Toutain I, Samdjee F, Le Dore S, Ferre E, Flaujac C. Emicizumab assays evaluations with four different reagents in severe haemophilia A patients: Concentration from baseline to maintenance therapy. Haemophilia 2023; 29:374-376. [PMID: 36446748 DOI: 10.1111/hae.14703] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Amélie Launois
- Laboratoire de Biologie Médicale (Secteur Hémostase), C.H. de Versailles André Mignot, Le Chesnay, France
| | - Emmanuelle De Raucourt
- Centre de Ressources et Compétences Maladies Hémorragiques, C.H. de Versailles André Mignot, Le Chesnay, France
| | - Isabelle Martin-Toutain
- Centre de Ressources et Compétences Maladies Hémorragiques, C.H. de Versailles André Mignot, Le Chesnay, France
| | - Farahna Samdjee
- Pharmacie, C.H. de Versailles André Mignot, Le Chesnay, France
| | - Sophie Le Dore
- Centre de Ressources et Compétences Maladies Hémorragiques, C.H. de Versailles André Mignot, Le Chesnay, France
| | - Emmanuelle Ferre
- Centre de Ressources et Compétences Maladies Hémorragiques, C.H. de Versailles André Mignot, Le Chesnay, France
| | - Claire Flaujac
- Laboratoire de Biologie Médicale (Secteur Hémostase), C.H. de Versailles André Mignot, Le Chesnay, France
| |
Collapse
|
4
|
Valade S, Joly BS, Veyradier A, Fadlallah J, Zafrani L, Lemiale V, Launois A, Stepanian A, Galicier L, Fieschi C, Mirouse A, Tudesq JJ, Lepretre AC, Azoulay E, Darmon M, Mariotte E. Coagulation disorders in patients with severe hemophagocytic lymphohistiocytosis. PLoS One 2021; 16:e0251216. [PMID: 34343182 PMCID: PMC8330932 DOI: 10.1371/journal.pone.0251216] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/14/2021] [Indexed: 01/13/2023] Open
Abstract
Background Coagulation disorders are common in patients with hemophagocytic lymphohistiocytosis (HLH), associated with an increased risk of bleeding and death. We aim to investigate coagulation disorders and their outcome implications in critically ill patients with HLH. Methods We prospectively evaluated 47 critically ill patients with HLH (median age of 54 years [42–67]) between April 2015 and December 2018. Coagulation assessments were performed at day 1. Abnormal standard coagulation was defined as prothrombin time (PT) <50% and/or fibrinogen <2g/L. HLH aetiology was mostly ascribed to haematological malignancies (74% of patients). Results Coagulation disorders and severe bleeding events were frequent, occurring in 30 (64%) and 11 (23%) patients respectively. At day 1, median fibrinogen level was 2∙65g/L [1.61–5.66]. Fibrinolytic activity was high as suggested by increased median levels of D-dimers, fibrin monomers, PAI-1 (plasminogen activator inhibitor) and tPA (tissue plasminogen activator). Forty-one (91%) patients had a decreased ADAMTS13 activity (A Disintegrin-like And Metalloproteinase with ThromboSpondin type 1 repeats, member 13). By multivariable analysis, the occurrence of a severe bleeding (OR 3.215 [1.194–8.653], p = 0∙021) and SOFA score (Sepsis-Related Organ Failure Assessment) at day 1 (OR 1.305 per point [1.146–1.485], p<0∙001) were independently associated with hospital mortality. No early biological marker was associated with severe bleeding. Conclusions Hyperfibrinolysis may be the primary mechanism responsible for hypofibrinogenemia and may also participate in ADAMTS13 degradation. Targeting the plasmin system appears as a promising approach in severe HLH-related coagulation disorders.
Collapse
Affiliation(s)
- Sandrine Valade
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
- * E-mail:
| | - Bérangère S. Joly
- EA3518, Université de Paris, Paris, France
- Hematology Biology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Agnès Veyradier
- EA3518, Université de Paris, Paris, France
- Hematology Biology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Jehane Fadlallah
- EA3518, Université de Paris, Paris, France
- Department of Clinical Immunology, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Lara Zafrani
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Virginie Lemiale
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Amélie Launois
- EA3518, Université de Paris, Paris, France
- Hematology Biology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Alain Stepanian
- EA3518, Université de Paris, Paris, France
- Hematology Biology Department, AP-HP, Hôpital Lariboisière, Paris, France
| | - Lionel Galicier
- EA3518, Université de Paris, Paris, France
- Department of Clinical Immunology, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Claire Fieschi
- EA3518, Université de Paris, Paris, France
- Department of Clinical Immunology, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Adrien Mirouse
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Jean Jacques Tudesq
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Anne-Claire Lepretre
- Transfusion Department, Etablissement Français Du Sang, Hôpital Saint-Louis, Paris, France
| | - Elie Azoulay
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Michael Darmon
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| | - Eric Mariotte
- AP-HP, Medical ICU, Hôpital Saint-Louis, Paris, France
- EA3518, Université de Paris, Paris, France
| |
Collapse
|
5
|
Atsou S, Furlan F, Duchemin J, Ellouze S, Sourdeau É, Launois A, Roussel-Robert V, Stieltjes N, Combe S, Fontenay M, Curis E, Jourdi G. Pharmacodynamics of eftrenonacog-alfa (rFIX-Fc) in severe hemophilia B patients: A real-life study. Eur J Pharmacol 2020; 891:173764. [PMID: 33249076 DOI: 10.1016/j.ejphar.2020.173764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/04/2020] [Accepted: 11/06/2020] [Indexed: 01/26/2023]
Abstract
Eftrenonacog-alfa is a recombinant factor IX-Fc fusion protein increasingly prescribed in hemophilia B patients. We aimed to assess its pharmacodynamics (PD) in real-life setting via FIX activity measurement and thrombin generation assay (TGA). Sixty samples from 15 severe hemophilia B treated patients were collected at different time points. FIX activity was measured using product-specific one-stage clotting assay (reference method) and two chromogenic assays (CSA) (Biophen FIX and Rox FIX). TGA was triggered with 1 pM tissue factor. Five parameters were analyzed: lag time (LT), time to peak (TTP), peak height (PH), endogenous thrombin potential (ETP), and velocity. PD models were built to characterize their relationships with FIX activity, using mixed effects models. Mean trough FIX level was estimated at 4.64 (±1.50) IU/dl with a recovery at 0.78 (±0.16) IU/dl per 1 IU/kg injected dose. FIX activity ranged between 1 and 86 IU/dl with 21.5 IU/dl median value. Biophen FIX and Rox FIX allowed reliable measurements except in samples with FIX <20 IU/dl in which values were underestimated (delta >30%). PD models revealed that velocity was the most sensitive TGA parameter to FIX activity followed by PH, ETP, TTP and finally LT. Following FIX activity peak after eftrenonacog-alfa injection, velocity decreased first, followed by PH then ETP. Both CSA failed to accurately measure FIX in severe hemophilia B patients receiving eftrenonacog-alfa throughout the measuring range. TGA could be an additional valuable tool to evaluate hemostasis balance in treated patients.
Collapse
Affiliation(s)
- Senade Atsou
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Fiona Furlan
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Jérôme Duchemin
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Syrine Ellouze
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Élise Sourdeau
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Amélie Launois
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Valérie Roussel-Robert
- Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Natalie Stieltjes
- Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Sophie Combe
- Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France
| | - Michaela Fontenay
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France; Université de Paris, Faculté de Santé, F-75006, Paris, France
| | - Emmanuel Curis
- Laboratoire de Biomathématiques, EA 7537, Faculté de Pharmacie, Université de Paris, France; Service de Biostatistiques et Informatique Médicale SBIM, Hôpital Saint Louis, AP-HP, Paris, France
| | - Georges Jourdi
- Service D'Hématologie Biologique, AP-HP.Centre-Université de Paris, Hôpital Cochin, F-75014, Paris, France; Université de Paris, Innovative Therapies in Haemostasis, INSERM UMR-S1140, F-75006, Paris, France.
| |
Collapse
|
6
|
Le LMM, Reitter D, He S, Bonle FT, Launois A, Martinez D, Prognon P, Caudron E. Safety analysis of occupational exposure of healthcare workers to residual contaminations of cytotoxic drugs using FMECA security approach. Sci Total Environ 2017; 599-600:1939-1944. [PMID: 28549369 DOI: 10.1016/j.scitotenv.2017.05.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/06/2017] [Accepted: 05/07/2017] [Indexed: 06/07/2023]
Abstract
Handling cytotoxic drugs is associated with chemical contamination of workplace surfaces. The potential mutagenic, teratogenic and oncogenic properties of those drugs create a risk of occupational exposure for healthcare workers, from reception of starting materials to the preparation and administration of cytotoxic therapies. The Security Failure Mode Effects and Criticality Analysis (FMECA) was used as a proactive method to assess the risks involved in the chemotherapy compounding process. FMECA was carried out by a multidisciplinary team from 2011 to 2016. Potential failure modes of the process were identified based on the Risk Priority Number (RPN) that prioritizes corrective actions. Twenty-five potential failure modes were identified. Based on RPN results, the corrective actions plan was revised annually to reduce the risk of exposure and improve practices. Since 2011, 16 specific measures were implemented successively. In six years, a cumulative RPN reduction of 626 was observed, with a decrease from 912 to 286 (-69%) despite an increase of cytotoxic compounding activity of around 23.2%. In order to anticipate and prevent occupational exposure, FMECA is a valuable tool to identify, prioritize and eliminate potential failure modes for operators involved in the cytotoxic drug preparation process before the failures occur.
Collapse
Affiliation(s)
- Laetitia Minh Mai Le
- Pharmacy Department, European Georges Pompidou Hospital, Paris, France; Lip(Sys)(2) Chimie analytique Pharmaceutique, Université Paris Sud, Univ. Paris Saclay, Chatenay-Malabry, France.
| | - Delphine Reitter
- Pharmacy Department, European Georges Pompidou Hospital, Paris, France
| | - Sophie He
- Pharmacy Department, European Georges Pompidou Hospital, Paris, France
| | - Franck Té Bonle
- Pharmacy Department, European Georges Pompidou Hospital, Paris, France
| | - Amélie Launois
- Pharmacy Department, European Georges Pompidou Hospital, Paris, France
| | - Diane Martinez
- Risk Management Department, European Georges Pompidou Hospital, Paris, France
| | - Patrice Prognon
- Pharmacy Department, European Georges Pompidou Hospital, Paris, France; Lip(Sys)(2) Chimie analytique Pharmaceutique, Université Paris Sud, Univ. Paris Saclay, Chatenay-Malabry, France
| | - Eric Caudron
- Pharmacy Department, European Georges Pompidou Hospital, Paris, France; Lip(Sys)(2) Chimie analytique Pharmaceutique, Université Paris Sud, Univ. Paris Saclay, Chatenay-Malabry, France
| |
Collapse
|