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Bonnez Q, Dekimpe C, Bekaert T, Tellier E, Kaplanski G, Joly BS, Veyradier A, Coppo P, Lammertyn J, Tersteeg C, De Meyer SF, Vanhoorelbeke K. Diagnosis of thrombotic thrombocytopenic purpura: Easy-to-use fiber-optic surface plasmon resonance immunoassays for automated ADAMTS13 antigen and conformation evaluation. J Thromb Haemost 2024:S1538-7836(24)00170-3. [PMID: 38554935 DOI: 10.1016/j.jtha.2024.03.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Laboratory diagnosis of immune-mediated thrombotic thrombocytopenic purpura (iTTP) remains challenging when ADAMTS13 activity ranges between 10-20%. To prevent misdiagnosis, open ADAMTS13 conformation gained clinical attention as a novel biomarker especially to diagnose acute iTTP in patient with diagnostic undecisive ADAMTS13 activity. Plasma ADAMTS13 conformation analysis corrects for ADAMTS13 antigen with both parameters being characterized in enzyme-linked immunosorbent assay (ELISA)-based reference assays requiring expert technicians. OBJECTIVES To design ADAMTS13 antigen and conformation assays on automated, easy-to-use fiber-optic surface plasmon resonance (FO-SPR) technology to promote assay accessibility and diagnose challenging iTTP patients. PATIENTS/METHODS ADAMTS13 antigen and conformation assays were designed on FO-SPR technology. Plasma of twenty healthy donors and twenty acute iTTP patients were quantified and data from FO-SPR and ELISA reference assays were compared. RESULTS Following assay design, both antigen and conformation FO-SPR assays were optimized and characterized presenting strong analytical sensitivity (detection limit of 0.001 μg/mL) and repeatability (inter-assay variation of 14.4%). Comparative analysis suggests positive correlation (Spearman r of 0.92) and good agreement between FO-SPR and ELISA assays. As expected, FO-SPR assays showed a closed or open ADAMTS13 conformation in healthy donors and acute iTTP patients respectively. CONCLUSIONS Both ADAMTS13 antigen and conformation assays were transferred onto automated, easy-to-use FO-SPR technology displaying potent analytical sensitivity and reproducibility. ADAMTS13 antigen and conformation were determined for healthy donors and acute iTTP patients showing strong correlation with ELISA reference. Introducing FO-SPR technology in clinical context could support routine diagnosis of acute iTTP patients, notably when ADAMTS13 activity fluctuates between 10-20%.
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Affiliation(s)
- Quintijn Bonnez
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Tim Bekaert
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Edwige Tellier
- Aix-Marseille University, Institut National de la Santé et de la Recherche Médicale, INRAE, C2VN, Marseille, France
| | - Gilles Kaplanski
- Aix-Marseille University, Institut National de la Santé et de la Recherche Médicale, INRAE, C2VN, Marseille, France; Service de Médecine Interne et Immunologie Clinique, CHU Conception, Aix-Marseille University, APHM, Marseille, France
| | - Bérangère S Joly
- Service d'Hématologie Biologique Hôpital Lariboisière, AP-HP and EA3518, IRSL, Université Paris Cité, Paris France
| | - Agnès Veyradier
- Service d'Hématologie Biologique Hôpital Lariboisière, AP-HP and EA3518, IRSL, Université Paris Cité, Paris France; Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT) AP-HP Paris France
| | - Paul Coppo
- Department of Hematology, Reference Center for Thrombotic Microangiopathies (CNR-MAT), Saint-Antoine University Hospital, AP-HP, Paris, France
| | - Jeroen Lammertyn
- Department of Biosystems, Biosensors Group, KU Leuven, Leuven, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
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Falter T, Rossmann H, de Waele L, Dekimpe C, von Auer C, Müller-Calleja N, Häuser F, Degreif A, Marandiuc D, Messmer X, Sprinzl M, Lackner KJ, Jurk K, Vanhoorelbeke K, Lämmle B. A novel von Willebrand factor multimer ratio as marker of disease activity in thrombotic thrombocytopenic purpura. Blood Adv 2023; 7:5091-5102. [PMID: 37399489 PMCID: PMC10471935 DOI: 10.1182/bloodadvances.2023010028] [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] [Received: 02/21/2023] [Revised: 06/02/2023] [Accepted: 06/02/2023] [Indexed: 07/05/2023] Open
Abstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP), an autoantibody-mediated severe ADAMTS13 deficiency, is caused by insufficient proteolytic processing of von Willebrand factor (VWF) multimers (MMs) and microvascular thrombi. Recurrence of acute iTTP is associated with persistence or reappearance of ADAMTS13 deficiency. Some patients remain in remission despite recurring or persisting severe ADAMTS13 deficiency. In a prospective 2-year observational study, we investigated VWF MM patterns and ADAMTS13 in patients with iTTP in remission and at acute episodes. Of the 83 patients with iTTP, 16 suffered 22 acute episodes whereas 67 remained in clinical remission during follow-up, including 13 with ADAMTS13 <10% and 54 with ADAMTS13 ≥10%. High -molecular weight to low-molecular weight VWF MM ratio based on sodium dodecyl sulfate-agarose gel electrophoresis was compared with ADAMTS13 activity. VWF MM ratio was significantly higher in patients in remission with <10% compared with ≥10% ADAMTS13 activity. Fourteen samples obtained from 13 to 50 days (interquartile range; median, 39) before acute iTTP onset (ADAMTS13 <10% in 9 patients and 10%-26% in 5) showed VWF MM ratios significantly higher than those from 13 patients remaining in remission with ADAMTS13 <10%. At acute iTTP onset, VWF MM ratio decreased significantly and was low in all patients despite <10% ADAMTS13. The VWF MM ratio does not depend exclusively on ADAMTS13 activity. The disappearance of high molecular weight VWF MMs resulting in low VWF MM ratio at iTTP onset may be explained by consumption of larger VWF MMs in the microcirculation. The very high VWF MM ratio preceding acute iTTP recurrence suggests that VWF processing is hampered more than in patients remaining in remission.
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Affiliation(s)
- Tanja Falter
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Heidi Rossmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Laure de Waele
- Laboratory for Thrombosis Research, Interdisciplinary Research Facility, KU Leuven Campus Kortrijk, Kortrijk, Belgium
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, Interdisciplinary Research Facility, KU Leuven Campus Kortrijk, Kortrijk, Belgium
| | - Charis von Auer
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- Department of Hematology, Oncology and Pneumology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Nadine Müller-Calleja
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Friederike Häuser
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Adriana Degreif
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Dana Marandiuc
- Transfusion Center, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Xavier Messmer
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Martin Sprinzl
- Medical Department I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Karl J. Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Kerstin Jurk
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, Interdisciplinary Research Facility, KU Leuven Campus Kortrijk, Kortrijk, Belgium
| | - Bernhard Lämmle
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
- University Clinic of Hematology & Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bonnez Q, Dekimpe C, Tellier E, Kaplanski G, Verhamme P, Tersteeg C, De Meyer SF, Lammertyn J, Joly B, Coppo P, Veyradier A, Vanhoorelbeke K. Measuring ADAMTS-13 activity to diagnose thrombotic thrombocytopenic purpura: a novel, fast fiber-optic surface plasmon resonance immunoassay. Res Pract Thromb Haemost 2023; 7:102171. [PMID: 37711907 PMCID: PMC10497779 DOI: 10.1016/j.rpth.2023.102171] [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: 06/15/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 09/16/2023] Open
Abstract
Background Thrombotic thrombocytopenic purpura (TTP) is characterized by severe ADAMTS-13 activity deficiency (<10%). Diagnostic testing is challenging because of unavailability, high cost, and expert technician requirement of ADAMTS-13 enzyme assays. Cost-effective, automated fiber-optic surface plasmon resonance (FO-SPR) platforms show potential for developing diagnostic tests. Yet, FO-SPR has never been explored to measure enzymatic activities. Objectives To develop an easy-to-use ADAMTS-13 activity assay utilizing optical fibers to rapidly diagnose TTP. Methods The ADAMTS-13 activity assay was designed and optimized using FO-SPR technology based on a previously described enzyme-linked immunosorbent assay setup. A calibration curve was generated to quantify ADAMTS-13 activity in plasma of healthy donors and patients with acute immune-mediated TTP (iTTP), hemolytic uremic syndrome, or sepsis. ADAMTS-13 activity data from FO-SPR and fluorescence resonance energy transfer-based strategies (FRETS)-VWF73 reference assays were compared. Results After initial assay development, optimization improved read-out magnitude and signal-to-noise ratio and reduced variation. Further characterization demonstrated a detection limit (6.8%) and inter-assay variation (Coefficient of variation, 7.2%) that showed good analytical sensitivity and repeatability. From diverse plasma samples, only plasma from patients with acute iTTP showed ADAMTS-13 activities below 10%. Strong Pearson correlation (r = 0.854) between FO-SPR and reference FRETS-VWF73 assays were observed for all measured samples. Conclusions A fast ADAMTS-13 activity assay was designed onto automated FO-SPR technology. Optimization resulted in sensitive ADAMTS-13 activity measurements with a detection limit enabling clinical diagnosis of TTP within 3 hours. The FO-SPR assay proved strong correlation with the reference FRETS-VWF73 assay. For the first time, this assay demonstrated the capacity of FO-SPR technology to measure enzymatic activity in pre-clinical context.
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Affiliation(s)
- Quintijn Bonnez
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Edwige Tellier
- Aix-Marseille University, Institut National de la Santé et de la Recherche Médicale, INRAE, C2VN, Marseille, France
| | - Gilles Kaplanski
- Aix-Marseille University, Institut National de la Santé et de la Recherche Médicale, INRAE, C2VN, Marseille, France
- Service de Médecine Interne et Immunologie Clinique, CHU Conception, Aix-Marseille University, APHM, Marseille, France
| | - Peter Verhamme
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Simon F. De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Jeroen Lammertyn
- Department of Biosystems, Biosensors Group, KU Leuven, Leuven, Belgium
| | - Bérangère Joly
- Service d'Hématologie Biologique Hôpital Lariboisière, AP-HP and EA3518, IRSL, Université Paris Cité, Paris France
| | - Paul Coppo
- Department of Hematology, Reference Center for Thrombotic Microangiopathies (CNR-MAT), Saint-Antoine University Hospital, AP-HP, Paris, France
| | - Agnès Veyradier
- Service d'Hématologie Biologique Hôpital Lariboisière, AP-HP and EA3518, IRSL, Université Paris Cité, Paris France
- Centre de Référence des Microangiopathies Thrombotiques (CNR-MAT) AP-HP Paris France
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Dekimpe C, Roose E, Sakai K, Tersteeg C, De Meyer SF, Vanhoorelbeke K. Toward gene therapy for congenital thrombotic thrombocytopenic purpura. J Thromb Haemost 2022; 21:1090-1099. [PMID: 36696190 DOI: 10.1016/j.jtha.2022.12.018] [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] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/17/2023]
Abstract
Congenital thrombotic thrombocytopenic purpura (cTTP) is caused by a severe deficiency in the plasma metalloprotease ADAMTS-13. The current management of cTTP is dependent on the prophylactic administration of ADAMTS-13 via plasma infusion. This is a demanding therapy for patients because transfusions are lifelong and time-consuming and allergic reactions frequently occur. Although current management of cTTP controls acute episodes, it does not provide a long-lasting cure for this disease. The endogenous expression of ADAMTS-13 after gene transfer would provide a curative therapy and ongoing research explores various preclinical gene therapeutic approaches for cTTP. This review focuses on the current state of the literature regarding preclinical gene therapy studies for cTTP and on the challenges of developing a gene therapy medicinal product for cTTP.
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Affiliation(s)
- Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Elien Roose
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Kazuya Sakai
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium.
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Kangro K, Roose E, Dekimpe C, Vandenbulcke A, Graça NAG, Voorberg J, Ustav M, Männik A, Vanhoorelbeke K. Improvement of recombinant ADAMTS13 production through a more optimal signal peptide or an N-terminal fusion protein. J Thromb Haemost 2022; 20:2379-2385. [PMID: 35841209 DOI: 10.1111/jth.15819] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/26/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recombinant human ADAMTS13 (rADAMTS13) is a key protein in fundamental research for investigating its mode of action and the pathophysiology of thrombotic thrombocytopenic purpura (TTP). However, the expression of rADAMTS13 is quite low in mammalian cells, which makes the production of the protein time-consuming and labor-intensive. OBJECTIVES We aimed at increasing the yield of rADAMTS13 by (1) using a more optimal signal peptide (SP) and (2) constructing an N-terminal fusion protein of ADAMTS13 with human serum albumin domain 1 (AD1-ADAMTS13). METHODS Six SPs were investigated to select the most optimal SP. Expression plasmids containing the most optimal SP and ADAMTS13 cDNA or the fusion construct AD1-ADAMTS13 were generated and transiently transfected into CHOEBNALT85 cell-line. Expression levels of rADAMTS13 in expression medium were analyzed and compared with the expression level of rADAMTS13 with native SP (nat-SP). RESULTS Expression of rADAMTS13 with coagulation factor VII (FVII) SP was 3-fold higher (16.00 μg/ml) compared with the expression with nat-SP (5.03 μg/ml). The highest yields were obtained with AD1-ADAMTS13 protein with a 15-fold higher concentration (78.22 μg/ml) compared with the expression with nat-SP. The rADAMTS13 expressed with FVII-SP retained its activity (104.0%) to cleave von Willebrand factor, whereas AD1-ADAMTS13 demonstrated even higher activity (144.3%). CONCLUSION We succeeded in generating expression vectors that yield (1) rADAMTS13 at higher levels because of more optimal FVII-SP and (2) high levels of AD1-ADAMTS13 N-terminal fusion protein. The highest expression levels were obtained with AD1-ADAMTS13 N-terminal fusion protein, which is paving the way for highly efficient protein production.
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Affiliation(s)
- Kadri Kangro
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
- Icosagen Cell Factory OÜ, Õssu, Kambja vald, Estonia
| | - Elien Roose
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Aline Vandenbulcke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Nuno A G Graça
- Icosagen Cell Factory OÜ, Õssu, Kambja vald, Estonia
- Department of Molecular Hematology, Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Jan Voorberg
- Department of Molecular Hematology, Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, The Netherlands
- Department of Experimental Vascular Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mart Ustav
- Icosagen Cell Factory OÜ, Õssu, Kambja vald, Estonia
| | - Andres Männik
- Icosagen Cell Factory OÜ, Õssu, Kambja vald, Estonia
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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Joly BS, Darmon M, Dekimpe C, Dupont T, Dumas G, Yvin E, Beranger N, Vanhoorelbeke K, Azoulay E, Veyradier A. Imbalance of von Willebrand factor and ADAMTS13 axis is rather a biomarker of strong inflammation and endothelial damage than a cause of thrombotic process in critically ill COVID-19 patients. J Thromb Haemost 2021; 19:2193-2198. [PMID: 34219357 PMCID: PMC8420340 DOI: 10.1111/jth.15445] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/11/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Critically ill patients with coronavirus disease 2019 (COVID-19) are prone to developing macrothrombosis and microthrombosis. COVID-19 has been reported to be rarely associated with thrombotic microangiopathies. A disintegrin and metalloprotease with thrombospondin type I repeats, member 13 (ADAMTS13) severe deficiency, the hallmark of thrombotic thrombocytopenic purpura (TTP), induces the formation of platelet, unusually large von Willebrand factor (VWF) multimer microthrombi. In immune-mediated TTP, ADAMTS13 adopts specifically an open conformation. The VWF/ADAMTS13 couple may contribute to the microthrombi formation in pulmonary alveolar capillaries in COVID-19. OBJECTIVE To investigate clinical features, hemostatic laboratory parameters, VWF/ADAMTS13 axis, and ADAMTS13 conformation in critically ill COVID-19 patients at admission. METHODS Fifty three critically ill COVID-19 patients were enrolled between March 18 and May 9 2020 in a monocentric hospital. RESULTS The median age was 59 years and the male-to-female ratio was 2.8/1. We reported seven pulmonary embolisms and 15 deaths. Biological investigations showed increased fibrinogen and factor V levels, and strongly increased D-dimers correlated with mortality. No patient presented severe thrombocytopenia nor microangiopathic hemolytic anemia. An imbalance between high VWF antigen levels and normal or slightly decreased ADAMTS13 activity levels (strongly elevated VWF/ADAMTS13 ratio) was correlated with mortality. Three patients had a partial quantitative deficiency in ADAMTS13. We also reported a closed conformation of ADAMTS13 in all patients, reinforcing the specificity of an open conformation of ADAMTS13 as a hallmark of TTP. CONCLUSION We suggest that slightly decreased or normal ADAMTS13 activity and highly elevated VWF are rather biomarkers reflecting both the strong inflammation and the endothelial damage rather than drivers of the thrombotic process of COVID-19.
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Affiliation(s)
- Bérangère S Joly
- Service d'Hématologie biologique, Hôpital Lariboisière, AP-HP.Nord, Université de Paris, Paris, France
- EA3518 Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Michael Darmon
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris, France
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Thibault Dupont
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris, France
| | - Guillaume Dumas
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris, France
| | - Elise Yvin
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris, France
| | - Nicolas Beranger
- Service d'Hématologie biologique, Hôpital Lariboisière, AP-HP.Nord, Université de Paris, Paris, France
- EA3518 Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Elie Azoulay
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris, France
| | - Agnès Veyradier
- Service d'Hématologie biologique, Hôpital Lariboisière, AP-HP.Nord, Université de Paris, Paris, France
- EA3518 Institut de Recherche Saint-Louis, Université de Paris, Paris, France
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Dekimpe C, Roose E, Kangro K, Bonnez Q, Vandenbulcke A, Tellier E, Kaplanski G, Feys HB, Tersteeg C, Männik A, De Meyer SF, Vanhoorelbeke K. Determination of anti-ADAMTS-13 autoantibody titers in ELISA: Influence of ADAMTS-13 presentation and autoantibody detection. J Thromb Haemost 2021; 19:2248-2255. [PMID: 33728786 DOI: 10.1111/jth.15297] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is caused by inhibitory and/or clearing anti-ADAMTS-13 (A Disintegrin and Metalloprotease with ThromboSpondin type 1 repeats, member 13) autoantibodies. To determine the presence and total level of anti-ADAMTS-13 autoantibodies, commercial and in-house developed ELISAs are performed. However, different ELISA methods vary in relation to the presentation of recombinant (r)ADAMTS-13 and the detection method of the anti-ADAMTS-13 autoantibodies. Currently, the influence of those different approaches on anti-ADAMTS-13 autoantibody titers is not known. OBJECTIVES To assess the influence of different ADAMTS-13 presentation- and autoantibody detection methods on anti-ADAMTS-13 autoantibody titers in ELISA. MATERIALS/METHODS Anti-ADAMTS-13 autoantibody titers from 18 iTTP patients were determined using four different set-ups of anti-ADAMTS-13 autoantibody ELISAs. The ELISAs varied in the used presentation of rADAMTS-13 (directly coated full-length rADAMTS-13, directly coated rMDTCS and rT2C2, or antibody-captured full-length rADAMTS-13) and the detection antibodies (polyclonal anti-human IgG or monoclonal anti-human IgG1-4 antibodies). RESULTS Strong correlations between the different anti-ADAMTS-13 autoantibody ELISA approaches were observed, when using polyclonal anti-human IgG detection antibodies recognizing all IgG subclasses similarly, independent of the method of rADAMTS-13 presentation. Anti-ADAMTS-13 autoantibody titers correlated less when using a mixture of monoclonal anti-human IgG1-4 , because not all IgG subclasses were recognized with similar affinities. CONCLUSION Anti-ADAMTS-13 autoantibody levels using different methods of rADAMTS-13 presentation strongly correlate. However, the levels of anti-ADAMTS-13 autoantibodies are highly dependent on the detection antibody used, which should detect all IgG subclasses (IgG1-4 ) equally well.
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Affiliation(s)
- Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Elien Roose
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Kadri Kangro
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
- Icosagen Cell Factory OÜ, Kambja vald, Tartumaa, Estonia
| | - Quintijn Bonnez
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Aline Vandenbulcke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Edwige Tellier
- C2VN, INSERM, INRAE, Aix Marseille Universite, Marseille, France
| | - Gilles Kaplanski
- C2VN, INSERM, INRAE, Aix Marseille Universite, Marseille, France
- Hôpital de la Conception, Service de médecine interne, APHM, C2VN, INSERM, INRAE, Aix Marseille Universite, Marseille, France
| | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Andres Männik
- Icosagen Cell Factory OÜ, Kambja vald, Tartumaa, Estonia
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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8
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van Manen L, van Hezel ME, Boshuizen M, Straat M, de Man AME, Dekimpe C, Vanhoorelbeke K, van Bruggen R, Juffermans NP. Effect of red blood cell transfusion on inflammation, endothelial cell activation and coagulation in the critically ill. Vox Sang 2021; 117:64-70. [PMID: 34196412 PMCID: PMC9291904 DOI: 10.1111/vox.13125] [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: 01/03/2021] [Revised: 04/14/2021] [Accepted: 04/14/2021] [Indexed: 01/28/2023]
Abstract
Background and Objectives Red blood cell (RBC) transfusion is a frequently applied intervention in an intensive care unit. However, transfusion is associated with adverse outcomes including organ failure and thrombo‐embolic events. Mechanisms of these effects are not known but may be related to activation of the endothelium or of the coagulation or inflammatory system. We hypothesized that a RBC transfusion in the critically ill would result in further activation of these systems. Materials and Methods In 74 non‐bleeding critically ill patients receiving one RBC unit, markers of inflammation, endothelial cell activation and coagulation were measured before transfusion, at 1 h after transfusion and 24 h after transfusion. The impact of disease severity of the recipient on these changes was assessed by comparing septic and non‐septic patients (according to sepsis‐3 definition) and by correlation of biomarkers with the sequential organ failure assessment (SOFA) score. Results Levels of von Willebrand Factor (vWF), soluble ICAM‐1, soluble thrombomodulin, fibrinogen and d‐dimer were already high at baseline, whereas ADAMTS13 levels were low. VWF levels increased significantly 24 h after RBC transfusion (median 478% (338–597) vs. 526% (395–623), p = 0.009). The other biomarkers did not change significantly. Post transfusion change was not dependent on the presence of sepsis and was not correlated with SOFA score. Conclusion RBC transfusion in critically ill patients was associated with an increase in circulating vWF levels, suggesting a further increase in activation of the endothelium, a finding that was independent of the presence of sepsis or organ injury level.
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Affiliation(s)
- Lisa van Manen
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Location VUmc, University of Amsterdam, Amsterdam, The Netherlands.,Department of Blood Cell Research, Sanquin research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Maike E van Hezel
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Location VUmc, University of Amsterdam, Amsterdam, The Netherlands.,Department of Blood Cell Research, Sanquin research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Margit Boshuizen
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Location VUmc, University of Amsterdam, Amsterdam, The Netherlands.,Department of Blood Cell Research, Sanquin research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen Straat
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Location VUmc, University of Amsterdam, Amsterdam, The Netherlands
| | - Angelique M E de Man
- Department of Intensive Care Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Robin van Bruggen
- Department of Blood Cell Research, Sanquin research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care Medicine and Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, Location VUmc, University of Amsterdam, Amsterdam, The Netherlands.,Department of Intensive Care Medicine, OLVG Hospital, Amsterdam, The Netherlands
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9
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Horta S, Qu JH, Dekimpe C, Bonnez Q, Vandenbulcke A, Tellier E, Kaplanski G, Delport F, Geukens N, Lammertyn J, Vanhoorelbeke K. Co(III)-NTA Mediated Antigen Immobilization on a Fiber Optic-SPR Biosensor for Detection of Autoantibodies in Autoimmune Diseases: Application in Immune-Mediated Thrombotic Thrombocytopenic Purpura. Anal Chem 2020; 92:13880-13887. [DOI: 10.1021/acs.analchem.0c02586] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sara Horta
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
- Department of Biosystems, Biosensors Group, KU Leuven, Willem De Croylaan 42, Heverlee B-3001, Belgium
| | - Jia-Huan Qu
- Department of Biosystems, Biosensors Group, KU Leuven, Willem De Croylaan 42, Heverlee B-3001, Belgium
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
| | - Quintijn Bonnez
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
| | - Aline Vandenbulcke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
| | - Edwige Tellier
- INSERM, INRAE, C2VN, Jardin du Pharo, Aix Marseille Univ, 58 Boulevard Charles Livon, 13007 Marseille , France
| | - Gilles Kaplanski
- INSERM, INRAE, C2VN, Jardin du Pharo, Aix Marseille Univ, 58 Boulevard Charles Livon, 13007 Marseille , France
- APHM, INSERM, INRAE, C2VN, Hôpital de la Conception, Service de médecine interne, Aix Marseille Univ, 147 Boulevard Baille, 13005 Marseille, France
| | - Filip Delport
- FOx Biosystems NV, Bioville, Agoralaan Abis, Diepenbeek 3590, Belgium
| | - Nick Geukens
- PharmAbs, The KU Leuven Antibody Center, KU Leuven, Herestraat 49, Leuven 3000, Belgium
| | - Jeroen Lammertyn
- Department of Biosystems, Biosensors Group, KU Leuven, Willem De Croylaan 42, Heverlee B-3001, Belgium
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
- PharmAbs, The KU Leuven Antibody Center, KU Leuven, Herestraat 49, Leuven 3000, Belgium
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10
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Dekimpe C, Roose E, Tersteeg C, Joly BS, Dewaele A, Horta S, Pareyn I, Vandenbulcke A, Deckmyn H, Feys HB, Tellier E, Kaplanski G, Scully M, Coppo P, De Meyer SF, Veyradier A, Vanhoorelbeke K. Anti-ADAMTS13 autoantibodies in immune-mediated thrombotic thrombocytopenic purpura do not hamper ELISA-based quantification of ADAMTS13 antigen. J Thromb Haemost 2020; 18:985-990. [PMID: 31989742 DOI: 10.1111/jth.14747] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The biological diagnosis of immune-mediated thrombotic thrombocytopenic purpura (iTTP) is based on determination of ADAMTS13 activity (<10%) and anti-ADAMTS13 autoantibodies. ADAMTS13 antigen levels are not routinely measured in iTTP patients, but studies have shown that antigen levels are a valuable prognostic factor. OBJECTIVES To (a) report the validation of our in-house developed ADAMTS13 antigen enzyme-linked immunosorbent assay (ELISA) and determine ADAMTS13 antigen in a large cohort of healthy donor and iTTP patient plasma samples; and (b) to investigate whether ADAMTS13 antigen determination is not disturbed by the presence of anti-ADAMTS13 autoantibodies. METHODS Our in-house ADAMTS13 antigen ELISA was validated in terms of sensitivity, repeatability, and reproducibility. ADAMTS13 antigen levels were determined in plasma samples from 423 healthy donors and 112 acute iTTP patients. Purified IgGs from iTTP patients were added to normal human plasma to determine whether anti-ADAMTS13 autoantibodies hampered ADAMTS13 antigen determination. RESULTS Our in-house ADAMTS13 antigen ELISA has a detection limit of 3% and low intra-assay (coefficient of variation, %CV < 10%) and inter-assay (%CV < 18%) variability. ADAMTS13 antigen levels were significantly reduced (P < .0001) in acute iTTP patients (15 ± 18%) compared to healthy donors (101 ± 18%). The anti-ADAMTS13 autoantibodies in plasma of iTTP patients did not impede ADAMTS13 antigen determinations using our in-house ELISA. CONCLUSIONS Our in-house ADAMT13 antigen ELISA is a powerful tool to correctly determine ADAMTS13 antigen levels in iTTP patients, which supports routine ADAMTS13 antigen measurements in these patients to have better insight into disease prognosis.
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Affiliation(s)
- Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Elien Roose
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Claudia Tersteeg
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Bérangère S Joly
- Université de Paris, AP-HP Nord, hôpital Lariboisière, Service d'hématologie biologique, Paris, France
- Université de Paris, EA3518 Institut de Recherche Saint-Louis, Paris, France
| | - Aurélie Dewaele
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Sara Horta
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Inge Pareyn
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Aline Vandenbulcke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Hans Deckmyn
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Hendrik B Feys
- Transfusion Research Center, Belgian Red Cross-Flanders, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Edwige Tellier
- Aix-Marseille Université, INSERM, INRA, C2VN, Marseille, France
| | - Gilles Kaplanski
- Aix-Marseille Université, INSERM, INRA, C2VN, Marseille, France
- Aix Marseille Université, APHM, INSERM, INRA, C2VN, Service de médecine interne, Marseille, France
| | - Marie Scully
- Department of Haematology, University College London Hospital, and National Institute for Health Research Cardiometabolic Programme, UCLH/UCL BRC, London, UK
| | - Paul Coppo
- Département d'Hématologie Clinique, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Agnès Veyradier
- Université de Paris, AP-HP Nord, hôpital Lariboisière, Service d'hématologie biologique, Paris, France
- Université de Paris, EA3518 Institut de Recherche Saint-Louis, Paris, France
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
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11
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Zafrani L, Dekimpe C, Joly BS, Roose E, Fieux F, Azoulay E, Peraldi MN, Durrbach A, Coppo P, Vanhoorelbeke K, Veyradier A. Transfer of ADAMTS13 antibody-mediated thrombotic thrombocytopenic purpura via kidney transplantation. Haematologica 2019; 104:e277-e280. [PMID: 30819908 DOI: 10.3324/haematol.2019.219063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Lara Zafrani
- Service de Réanimation Médicale, Hôpital Saint Louis, Assistance Publique - Hôpitaux de Paris, (AP-HP), Université Paris Diderot, Paris, France.,French Reference Center for Thrombotic Microangiopathies, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Bérangère S Joly
- French Reference Center for Thrombotic Microangiopathies, Hôpital Saint Antoine, AP-HP, Paris, France.,Service d'Hématologie biologique and EA3518 Université Paris Diderot, Groupe Hospitalier Saint Louis - Lariboisière, AP-HP, Paris, France
| | - Elien Roose
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Fabienne Fieux
- Service de Réanimation Chirurgicale, Hôpital Saint Louis, AP-HP, Université Paris Diderot, Paris, France
| | - Elie Azoulay
- Service de Réanimation Médicale, Hôpital Saint Louis, Assistance Publique - Hôpitaux de Paris, (AP-HP), Université Paris Diderot, Paris, France.,French Reference Center for Thrombotic Microangiopathies, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Marie-Noëlle Peraldi
- Service de Néphrologie et Transplantation Rénale, Hôpital Saint Louis, AP-HP, Université Paris Diderot, Paris, France
| | - Antoine Durrbach
- Service de Néphrologie-Transplantation Rénale, Hôpital de Bicêtre, AP-HP, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Paul Coppo
- French Reference Center for Thrombotic Microangiopathies, Hôpital Saint Antoine, AP-HP, Paris, France.,Département d'Hématologie Clinique, Hôpital Saint Antoine, AP-HP, Université Pierre et Marie Curie, Paris, France
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Agnès Veyradier
- French Reference Center for Thrombotic Microangiopathies, Hôpital Saint Antoine, AP-HP, Paris, France .,Service d'Hématologie biologique and EA3518 Université Paris Diderot, Groupe Hospitalier Saint Louis - Lariboisière, AP-HP, Paris, France
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