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Siddiqui F, Hoppensteadt D, Jeske W, Ramacciotti E, Tafur A, Fareed J. Andexanet Alfa Neutralizes the Anticoagulant Effects of Unfractionated Heparin of Bovine, Ovine and Porcine Origin Almost as Protamine Sulfate. Clin Appl Thromb Hemost 2024; 30:10760296241247558. [PMID: 38656136 PMCID: PMC11044804 DOI: 10.1177/10760296241247558] [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: 02/23/2024] [Revised: 03/21/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Andexanet alfa (AA) - zhzo, recombinant coagulation factor Xa, is an approved antidote for oral Xa inhibitors (apixaban and rivaroxaban). Unfractionated heparin (UFH) is commonly used for therapeutic, interventional, and surgical indications. Protamine sulfate (PrSO4) is frequently used to neutralize UFH. This study aimed to investigate the comparative neutralization profiles of AA and PrSO4 for heparins of bovine, ovine, and porcine origin. MATERIALS AND METHODS The neutralization effect of PrSO4 at 25 µg/ml and AA at 100 µg/ml was studied on an approximate surgical/interventional concentration of heparin by supplementing whole blood with each of the heparins at 25 µg/ml. For the clotting profile (activated partial thromboplastin time: aPTT), amidolytic (anti-Xa and anti-IIa), and thrombin generation assay each of the heparin were supplemented from -10-0.62 µg/ml. RESULTS In the whole blood ACT studies, all three heparins produced strong anti-coagulant effects (400-450 seconds) compared to saline (130-150 seconds). Both AA and PrSO4 almost fully neutralized the anti-coagulant effects of heparins (140-160 seconds). Both antidotes completely reversed the anticoagulant effects of all three heparins in the aPTT and thrombin generation assay. However, PrSO4 was more effective in neutralizing the anti-Xa, and anti-IIa effects than AA, which only partially neutralized these effects. CONCLUSION Andexanet alfa at 100 µg/ml effectively neutralizes the therapeutic and surgical/interventional concentrations of heparins in in-vitro settings. While differences in the anti-Xa, and anti-IIa effects between heparins were noted, anti-coagulant effect of these agents in the aPTT assay were comparable. A similar neutralization profile was observed in the ACT and thrombin generation assays by both agents.
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Affiliation(s)
- Fakiha Siddiqui
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
- Program in Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Debra Hoppensteadt
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Walter Jeske
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Eduardo Ramacciotti
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
- Science Valley Research Institute, São Paulo, SP, Brazil
- Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo Andre, SP, Brazil
| | - Alfonso Tafur
- Northshore Cardiovascular Institute, NorthShore University Health Systems, Evanston, IL, USA
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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Olson G, Jeske W, Iqbal O, Krupa E, Farooqui A, Siddiqui F, Hoppensteadt D, Kouta A, Fareed J. Potency Adjusted Blended Heparin of Bovine, Ovine, and Porcine Heparin Exhibit Comparable Biologic Effects to Referenced Single-Sourced Porcine Heparin. Clin Appl Thromb Hemost 2023; 29:10760296231163251. [PMID: 36908199 PMCID: PMC10014986 DOI: 10.1177/10760296231163251] [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] [Indexed: 03/14/2023] Open
Abstract
Introduction: Bovine and ovine mucosa represent alternate anticoagulants to porcine mucosa for production of unfractionated heparin (UFH). Standardized heparins from various sources can be blended and potency adjusted, blended heparins exhibit comparable effects as single-sourced porcine UFH. This study evaluated the pharmacologic profile of blended heparin and compared their activities to that of single sourced porcine, ovine, and bovine heparins. Methods: The anticoagulant effects of gravimetric and potency-adjusted heparins were evaluated with aPTT, TT, anti-Xa, anti-IIa, ACT, and TGA studies. Protamine sulfate studies were used for neutralization potential of each of the individual heparins. Results: The potency-adjusted heparins demonstrated comparable aPTT, TT, anti-Xa, anti-IIa, and ACT values at all concentrations (U/mL). However, in gravimetric studies, bovine heparin consistently showed lower values with the exception of thrombin generation inhibition studies. The protamine sulfate neutralization studies demonstrated complete neutralization at all concentrations for the potency-adjusted heparins. However, at gravimetric concentrations, minor differences were noted in the neutralization profile in each of these heparins. Conclusion: These studies support the hypothesis that blended heparin from bovine, ovine, and porcine tissue, when standardized in unit-equivalent proportions, exhibits a comparable anticoagulant profile to the single species derived heparins.
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Affiliation(s)
- Guy Olson
- Cardiovascular Research Institute, Section of Hemostasis and Thrombosis, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Walter Jeske
- Cardiovascular Research Institute, Section of Hemostasis and Thrombosis, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Omer Iqbal
- Cardiovascular Research Institute, Section of Hemostasis and Thrombosis, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Emily Krupa
- Cardiovascular Research Institute, Section of Hemostasis and Thrombosis, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Amber Farooqui
- Cardiovascular Research Institute, Section of Hemostasis and Thrombosis, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Fakiha Siddiqui
- Cardiovascular Research Institute, Section of Hemostasis and Thrombosis, 25815Loyola University Medical Center, Maywood, IL, USA.,Program in Health Sciences, 16728UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Debra Hoppensteadt
- Cardiovascular Research Institute, Section of Hemostasis and Thrombosis, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Ahmed Kouta
- Cardiovascular Research Institute, Section of Hemostasis and Thrombosis, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, Section of Hemostasis and Thrombosis, 25815Loyola University Medical Center, Maywood, IL, USA
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Allen M, Bansal V, Siddiqui F, Hoppensteadt D, Krupa E, Fareed J, Kantarcioglu B. The Relevance of Thrombo-Inflammatory Biomarkers and Their Relationship with Circulating Glycosaminoglycans in End-Stage Renal Disease Patients. Clin Appl Thromb Hemost 2023; 29:10760296231169512. [PMID: 37062946 PMCID: PMC10116011 DOI: 10.1177/10760296231169512] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
En-stage renal disease (ESRD) is a growing public health problem. The atherosclerotic cardiovascular complications are the leading causes of mortality and morbidity in the ESRD. In this study, we sought to quantify the levels of thrombo-inflammatory biomarkers in an ESRD patients in comparison to healthy controls to determine their relevance in thrombo-inflammation and adverse outcomes. The levels of D-Dimer, C-reactive protein (CRP), plasminogen activator inhibitor 1 (PAI-1) antigen, functional PAI-1, thrombin activatable fibrinolysis inhibitor, tissue plasminogen activator, von Willebrand factor, and anti-PF4 IgG and microparticle (MP) activity were quantified by using commercially available ELISA immunoassays for each of the ESRD (n = 73) and control plasma samples (n = 10). The levels of endogenous glycosaminoglycans (GAGs) were quantified by utilizing a Heparin Red Probe (Redprobes UG, Germany). The collected data were analyzed to demonstrate the relationship between various parameters. All the tested biomarkers were increased in ESRD patients in comparison to healthy controls (p < 0.05). These biomarkers have shown significant correlations within each other except for anti-PF4 Ig G and MPs. The CRP levels were significantly higher in patients who had coronary artery disease (CAD) (p < 0.05), but there was no significant difference in other biomarkers according to the cardiovascular outcomes. In the multivariate analysis, the CRP (odds ratio: 1.19; 95% confidence interval: 1.01-1.41; p: 0.03) value was an independent predictor of CAD. In this study, we demonstrated increased levels of 10 different biomarkers in ESRD patients. The CRP levels can be a good predictor of CAD in ESRD patients.
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Affiliation(s)
- Madeline Allen
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Vinod Bansal
- Department of Nephrology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
- Program in Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Emily Krupa
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Bulent Kantarcioglu
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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Brailovsky Y, Lakhter V, Newman J, Allen S, Elkaryoni A, Desai P, Masic D, Bechara CF, Bontekoe E, Hoppensteadt D, Lopez JJ, Siddiqui F, Iqbal O, Fareed J, Darki A. Fibrinolytic Status and Risk of Death After Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2023; 29:10760296231162079. [PMID: 36911974 PMCID: PMC10014973 DOI: 10.1177/10760296231162079] [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] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Acute pulmonary embolism (PE) is a heterogeneous disease process with variable presentation and outcomes. The endogenous fibrinolytic system is a complex framework of regulatory pathways that maintains homeostasis by dissolving overabundant thrombi. We sought to investigate phenotypic profiles of the endogenous fibrinolytic system among patients presenting with acute PE and their impact on mortality. METHODS We enrolled all consecutive patients with acute PE in our institutional Pulmonary Embolism Response Team registry. We collected blood samples at the time of PE diagnosis and analyzed concentrations of plasminogen activator inhibitor 1 (PAI-1), thrombin-activatable fibrinolysis inhibitor (TAFI), and alpha-2-antiplasmin (A2A). We assessed the association of concentration of fibrinolytic inhibitors and 1-year all-cause mortality and various echocardiographic markers of right ventricular (RV) dysfunction. RESULTS There is significant variability of PAI-1, A2A, and TAFI concentrations across the spectrum of PE risk profiles with high PAI-1, low TAFI, and low A2A (herein referred to as a high-risk biomarker profile) correlating with worse PE severity. High-risk biomarker profile correlated with high-risk echocardiographic features of RV dysfunction, including increased RV/left ventricular (LV) ratio, low tricuspid annular plane systolic excursion, and low right ventricular outflow tract velocity time integral. Higher-risk biomarker profile was able to discriminate and independently identify patients at high risk of all-cause mortality (Group 2 HR 6 95% CI 1.3-27.8, Group 3 HR 12, 95% CI 1.7-86). CONCLUSIONS Further studies are needed to assess the exact pathophysiological link between fibrinolytic status and poor outcome after acute PE and to ascertain the impact of anti-inhibitors of the fibrinolytic system on response to therapy and outcomes after acute PE.
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Affiliation(s)
- Yevgeniy Brailovsky
- Jefferson Heart Institute, Sidney Kimmel School of Medicine, 23217Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Joshua Newman
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Sorcha Allen
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Ahmed Elkaryoni
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Parth Desai
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Dalila Masic
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Carlos F Bechara
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Emily Bontekoe
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Debra Hoppensteadt
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - John J Lopez
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Fakiha Siddiqui
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Omer Iqbal
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Jawed Fareed
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Amir Darki
- 12248Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
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Odeh A, Dungan GD, Hoppensteadt D, Siddiqui F, Kantarcioglu B, Darki A, Fareed J, Syed MA. Interrelationship Between Inflammatory Biomarkers and Collagen Remodeling Proteins in Atrial Fibrillation. Clin Appl Thromb Hemost 2023; 29:10760296231165055. [PMID: 36941787 PMCID: PMC10034319 DOI: 10.1177/10760296231165055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Atrial Fibrillation (AF) is the most prevalent cardiac arrhythmia worldwide. Inflammation and structural remodeling of the left atrium are thought to be involved in the pathogenesis of AF. This study explores collagen remodeling and inflammatory biomarkers in AF patients compared to healthy controls to discern their role in AF. MATERIALS AND METHODS Plasma samples were collected from AF patients undergoing first AF ablation (n = 72) and compared with commercially available human plasma samples from healthy subjects (n = 62). The collagen remodeling biomarkers and inflammatory biomarkers in the AF patients and control population were quantified using sandwich ELISA kits. GraphPad prism was used to perform statistical analyses. RESULTS There was a statistically significant elevation in all the collagen remodeling biomarkers and inflammatory biomarkers in the AF patients compared to healthy controls. Spearman correlation analysis demonstrated significant correlations between inflammatory and collagen remodeling biomarkers, and among the collagen biomarkers. Of note, CRP was found to be correlated with TIMP-1, ICTP and PIIINP. IL6 and TIMP-1 were also found to be intercorrelated. Furthermore, correlations were noted among the different collagen remodeling peptides, and between TNFα and IL6, two of the inflammatory markers explored in this study. CONCLUSIONS The elevation of the inflammatory biomarkers and collagen remodeling proteins in AF patients is suggestive of inflammation and increased collagen turnover. The association between inflammatory biomarkers and collagen remodeling proteins may contribute to their regulation and role in the remodeling process.
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Affiliation(s)
- Ameer Odeh
- Stritch School of Medicine, 2456Loyola University Chicago, Maywood, IL, USA
| | - Gabriel D Dungan
- Stritch School of Medicine, 2456Loyola University Chicago, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Fakiha Siddiqui
- Department of Pathology, 25815Loyola University Medical Center, Maywood, IL, USA
- Program in Health Sciences, UCAM- 16728Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Bulent Kantarcioglu
- Department of Pathology, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Amir Darki
- Department of Medicine, Division of Cardiology, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Mushabbar A Syed
- Department of Medicine, Division of Cardiology, 25815Loyola University Medical Center, Maywood, IL, USA
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O'Hara A, Pozin J, Darki A, Siddiqui F, Hoppensteadt D, Walenga J, Fareed J, Kantarcioglu B. Glycemic Control and Plasma Levels of Pro-Inflammatory and Pro-Thrombotic Biomarkers in Diabetic Patients Presenting with Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2023; 29:10760296231165058. [PMID: 36941804 PMCID: PMC10034284 DOI: 10.1177/10760296231165058] [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] [Indexed: 03/23/2023] Open
Abstract
Type I and type II diabetes are closely associated with a pro-inflammatory state and to a pro-thrombotic state. The role of glycemic control in pulmonary embolism (PE) is poorly understood and requires additional investigation. The aim of this study is to investigate the relationship between glycemic control and thrombo-inflammatory biomarkers in a PE patient cohort compared to normal samples. Demographic and clinical information for 86 diabetic patients and 106 non-diabetic patients presenting with acute PE was collected via retrospective chart review. Plasma levels of pro-inflammatory (C-reactive protein [CRP], tumor necrosis factor-alpha [TNF-α], interleukin-6 [IL-6]) and pro-thrombotic (d-dimer, plasminogen activator inhibitor-1 [PAI-1], tissue plasminogen activator [tPA], thrombin activatable fibrinolysis inhibitor [TAFI], von-Willebrand factor [vWF], endogenous glycosaminoglycans [GAGs]) biomarkers were drawn within 24 hours of diagnosis of acute PE. Data was also obtained for a population of healthy adult controls. All the pro-inflammatory and pro-thrombotic biomarkers were elevated in diabetic PE patients in comparison to healthy controls. None of the biomarkers were elevated in diabetic PE patients when compared to non-diabetic PE patients. There was no difference in the levels of the pro-inflammatory biomarkers according to glycemic control. The plasma level of TAFI was elevated in diabetic patients with poor glycemic control. Diabetic patients were more likely to have a more severe PE. These studies demonstrate that thrombo-inflammatory biomarkers are elevated in diabetic PE patients with associated comorbidities in comparison to normal individuals. However, there is no difference between the PE cohort alone in comparison to PE with diabetes. The role of TAFI within the continuum of diabetic vascular disease warrants additional investigation.
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Affiliation(s)
- Alexander O'Hara
- Stritch School of Medicine, 2456Loyola University Chicago, Maywood, IL, USA
| | - Jacob Pozin
- Stritch School of Medicine, 2456Loyola University Chicago, Maywood, IL, USA
| | - Amir Darki
- Department of Cardiology, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
- Program in Health Sciences, UCAM-Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jeanine Walenga
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Bulent Kantarcioglu
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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Odeh A, Dungan GD, Darki A, Hoppensteadt D, Siddiqui F, Kantarcioglu B, Fareed J, Syed MA. Collagen Remodeling and Fatty Acid Regulation Biomarkers in Understanding the Molecular Pathogenesis of Atrial Fibrillation. Clin Appl Thromb Hemost 2022; 28:10760296221145181. [PMID: 36514257 PMCID: PMC9756370 DOI: 10.1177/10760296221145181] [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] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Atrial Fibrillation (AF) is the most common cardiac arrythmia in the world. Structural remodeling and fatty acid metabolism dysregulation are believed to play a role in the development of AF. This study explored different biomarkers in the blood of AF patients and a control population to determine if there was a significant difference between the two groups. MATERIAL AND METHODS Plasma samples were collected from 73 patients with confirmed diagnosis of AF from Loyola University Clinic. Control group represented commercially available plasma (n = 50). Sandwich ELISA kits were used to quantify the collagen remodeling proteins and liver type fatty acid binding protein (L-FABP) in the AF population and the control population. Non-esterified fatty acids (NEFAs) were measured using an enzymatic colorimetric kit from Wako Diagnostics. Statistical analyses were performed using GraphPad Prism. RESULTS All the collagen remodeling biomarkers were significantly higher in AF patients compared to the control group. The fatty acid dysregulation biomarkers were elevated in the AF patients. Spearman correlation analyses yielded significant correlations between L-FABP and TIMP-1 (r = 0.47, P < 0.001), NEFA and TIMP-2 (r = 0.41, P = 0.002), NEFA and ICTP (r = 0.41, P =0 .002), and NEFA and PIIINP (r = 0.61, P < 0.0001). SUMMARY AND CONCLUSIONS The elevation of collagen remodeling biomarkers suggests an upregulation of these biomarkers and their potential role in AF, which may contribute to atrial fibrosis. L-FABP and NEFAs were elevated in AF patients. The correlations between the collagen remodeling and fatty acid dysregulation biomarkers may be due to their involvement in structural remodeling of the atria.
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Affiliation(s)
- Ameer Odeh
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA,Ameer Odeh, Stritch School of Medicine, Loyola University Chicago, 2160 S First Avenue, Maywood, IL 60153, USA.
| | - Gabriel D. Dungan
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Amir Darki
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Fakiha Siddiqui
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | | | - Jawed Fareed
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Mushabbar A. Syed
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
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Mehrotra S, Hoppensteadt D, Jeske W, Siddiqui F, Iqbal O, Tafur A, Lewis B, Jaradeh M, Kantarcioglu B, Fareed J. Differential Neutralization of Apixaban, Betrixaban, Edoxaban, and Rivaroxaban by Andexanet Alfa as Measured by Whole Blood Thromboelastographic Analysis. Clin Appl Thromb Hemost 2022; 28:10760296221138297. [PMID: 36476125 PMCID: PMC9742582 DOI: 10.1177/10760296221138297] [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] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The available oral anti-Xa agents are routinely used for the management of thrombotic disorders. A molecularly modified recombinant coagulation FXa, also known as Andexanet Alfa (AA), that has been developed as an antidote to neutralize the bleeding effects of oral FXa inhibitors, such as Apixaban and Rivaroxaban. MATERIALS AND METHODS This study utilized thromboelastography (TEG 5000 Hemostasis System), to investigate the neutralizing effects of AA at different concentrations of oral FXa inhibitors measuring such parameters as R-Time, K-Time, Angle, and Max Amplitude (MA). Apixaban, Betrixaban, Edoxaban, and Rivaroxaban were obtained commercially in powdered form. Each of these drugs was supplemented with freshly drawn whole citrated blood at a concentration of 1 μg/mL. And subsequently mixed with AA at 50 or 100 μg/mL. RESULTS At a concentration of 1 μg/mL, all FXa inhibitors produced variable anticoagulant effects in the order of Edoxaban > Betrixaban > Rivaroxaban > Apixaban. AA at 100 μg/mL produced a complete neutralization of these inhibitors whereas at 50 μg/mL relatively weaker neutralization as measured by various parameters. CONCLUSION These results suggest that regardless of the variable anticoagulant effects exhibited by the FXa Inhibitors, AA at FC = 100 μg/mL fully neutralized these agents as measured by the TEG parameters. AA was shown to be more effective in neutralizing Betrixaban and least effective in Apixaban. The neutralization of various FXa inhibitors was dose and donor-dependent warranting dosage adjustment for optimal outcomes.
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Affiliation(s)
- Siddharth Mehrotra
- Department of Molecular Pharmacology & Neuroscience, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Molecular Pharmacology & Neuroscience, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA,Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Walter Jeske
- Department of Molecular Pharmacology & Neuroscience, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA,Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA,Program in Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Omer Iqbal
- Department of Molecular Pharmacology & Neuroscience, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Alfonso Tafur
- Department of Vascular Medicine, Northshore Cardiovascular Institute, NorthShore University Health Systems, Skokie, IL, USA,Department of Internal Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Bruce Lewis
- Department of Internal Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Mark Jaradeh
- Department of Molecular Pharmacology & Neuroscience, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Bulent Kantarcioglu
- Department of Molecular Pharmacology & Neuroscience, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Department of Molecular Pharmacology & Neuroscience, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA,Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA,Jawed Fareed, Department of Molecular Pharmacology & Neuroscience, Loyola University Health System, 2160 S First Avenue Bldg 115, Rm 432 Maywood, IL 60153, USA.
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Kantarcioglu B, Mehrotra S, Papineni C, Siddiqui F, Kouta A, Hoppensteadt D, Bansal V, Darki A, Van Thiel DH, Fareed J. Endogenous Glycosaminoglycans in Various Pathologic Plasma Samples as Measured by a Fluorescent Quenching Method. Clin Appl Thromb Hemost 2022; 28:10760296221144047. [PMID: 36474353 PMCID: PMC9732799 DOI: 10.1177/10760296221144047] [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] [Indexed: 12/13/2022] Open
Abstract
Endogenous glycosaminoglycans (GAGs) with a similar structure to heparin are widely distributed in various tissues. A fluorescence probe, namely Heparin Red, can detect polyanionic GAGs in plasma samples. The purpose of this study is to measure endogenous GAGs in various plasma samples obtained from different pathologic states in comparison to healthy controls utilizing this method. Plasma samples were obtained from patient groups including atrial fibrillation (AF), end-stage-renal-disease (ESRD), diabetes mellitus (DM), sepsis, cancer, liver disease (LD), and pulmonary embolism (PE). Normal human plasma (NHP) was used as healthy controls. The Heparin Red kit from Red Probes (Münster, Germany) was used for the quantification of endogenous GAGs in each sample before and after heparinase I degradation. All results were compiled as group means ± SD for comparison. NHP was found to have relatively low levels of endogenous GAGs with a mean concentration of 0.06 μg/mL. The AF, ESRD, DM, and sepsis patient samples had a mean endogenous GAG concentration of 0.55, 0.72, 0.92, and 0.94 μg/mL, respectively. The levels of endogenous GAGs were highest in cancer, LD, and PE patient plasma samples with a mean concentration of 1.95, 2.78, and 2.83 μg/mL, respectively. Heparinase I degradation resulted in a decline in GAG levels in plasma samples. These results clearly show that detectable Heparin Red sensitive endogenous GAGs are present in circulating plasma at varying levels in various patient groups. Additional studies are necessary to understand this complex pathophysiology.
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Affiliation(s)
- Bulent Kantarcioglu
- Department of Pathology and Laboratory Medicine, Cardiovascular
Research Institute, Loyola
University Chicago, Health Sciences
Division, Maywood, IL, USA,Bulent Kantarcioglu, Department of
Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola
University Chicago, Health Sciences Division, Maywood, IL 60153, USA.
| | - Siddharth Mehrotra
- Department of Pathology and Laboratory Medicine, Cardiovascular
Research Institute, Loyola
University Chicago, Health Sciences
Division, Maywood, IL, USA
| | - Charulatha Papineni
- Department of Pathology and Laboratory Medicine, Cardiovascular
Research Institute, Loyola
University Chicago, Health Sciences
Division, Maywood, IL, USA,Department of Molecular Pharmacology and Neuroscience,
Loyola
University Chicago, Maywood, IL, USA
| | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular
Research Institute, Loyola
University Chicago, Health Sciences
Division, Maywood, IL, USA,Program in Health Sciences, UCAM - Universidad Católica San Antonio de
Murcia, Murcia, Spain
| | - Ahmed Kouta
- Department of Pathology and Laboratory Medicine, Cardiovascular
Research Institute, Loyola
University Chicago, Health Sciences
Division, Maywood, IL, USA,Department of Molecular Pharmacology and Neuroscience,
Loyola
University Chicago, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular
Research Institute, Loyola
University Chicago, Health Sciences
Division, Maywood, IL, USA
| | - Vinod Bansal
- Department of Internal Medicine, Nephrology,
Loyola
University Medical Center, Maywood, IL,
USA
| | - Amir Darki
- Cardiology Department, Loyola University Medical
Center, Maywood, IL, USA
| | - David H. Van Thiel
- Division of Gastroenterology and Hepatology,
Rush Oak Park
Hospital, Oak Park, Illinois and Rush
University Medical Center, Chicago, IL, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Cardiovascular
Research Institute, Loyola
University Chicago, Health Sciences
Division, Maywood, IL, USA
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10
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Costa R, Fatourou E, Hoppensteadt D, Fareed J, Halaris A. Cardiolipin Antibody: A Potential Biomarker for Depression. J Pers Med 2022; 12:jpm12111759. [PMID: 36573728 PMCID: PMC9697829 DOI: 10.3390/jpm12111759] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Inflammation plays a pivotal role in the etiopathology of Major Depressive Disorder (MDD), at least in a subset of patients. It is crucial to first establish which specific inflammatory biomarkers are of clinical utility. Anti-cardiolipin antibody (aCL IgM) is an inflammatory marker that has the potential to be such a candidate but there are insufficient studies to confirm this potential. Objective: To investigate the baseline titer level and the longitudinal progression of plasma titers of aCL IgM in MDD subjects receiving antidepressant therapy in comparison to healthy control (HC) subjects; to determine if changes in aCL IgM plasma titers correlate to changes in depressive symptoms; and, to ascertain if baseline aCL IgM plasma titers could predict treatment response. Methods: Forty-eight medically healthy outpatients diagnosed with MDD were enrolled in one of two groups in two sequentially conducted clinical trials. In Group-E, patients received a 12-week regimen of escitalopram (n = 20). Those in Group-Q received a 12-week regimen of quetiapine (n = 28). The main outcome measure was plasma aCL IgM titers, the Hamilton Rating Scale for Depression (HAM-D17) and the Hamilton Rating Scale for Anxiety (HAM-A). There were 16 HC subjects. Results: When Group-Q and Group-E participants were grouped together (n = 48), MDD subjects had an elevated baseline aCL IgM (19.9 μg/mL) compared to HC subjects (8.32 μg/mL) (p = 0.006). aCL IgM correlated significantly with HAM-D17 scores at baseline in MDD subjects (p = 0.0185, r = 0.296). Examining the individual groups, Group-Q MDD patients had a significantly elevated baseline aCL IgM (p = 0.008) while Group-E's MDD patients did not. On the other hand, only Group-E MDD patients showed a significant correlation at baseline between aCL IgM and HAM-A score (p = 0.0392, r = 0.4327); they also showed a significant inverse correlation between week 12 HAMD-17 Item #10 (Anxiety, Psychic) and week 12 aCL IgM titer (p = 0.0268, r = -0.5516). Conclusions: MDD patients had significantly higher plasma titers of aCL IgM when compared to HC subjects. Moreover, at baseline, the higher the aCL IgM titer, the higher the depression severity, as measured by HAMD-17 score. However, this study did not demonstrate that aCL IgM titers changed significantly throughout a 12-week course of antidepressant treatment and revealed no correlation between changes in depressive symptoms and changes in aCL IgM titers. Baseline aCL IgM could not predict treatment response. We conclude that, despite lacking predictive ability as regards treatment response, plasma titers of aCL IgM have a diagnostic potential in MDD that necessitates further exploration.
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Affiliation(s)
- Renzo Costa
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
| | - Evangelia Fatourou
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai/Elmhurst Hospital Center, New York, NY 10029, USA
| | - Debra Hoppensteadt
- Department of Pathology, Laboratory Medicine, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Jawed Fareed
- Department of Pathology, Laboratory Medicine, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Angelos Halaris
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
- Correspondence:
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11
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Baig N, Kouta A, Jaradeh M, Hoppensteadt D, Jeske W, Fareed J. Comparative Studies on the Interaction of Heparins from Various Origins with Heparin Cofactor II and Antithrombin. FASEB J 2022. [PMID: 35559558 DOI: 10.1096/fasebj.2022.36.s1.l8122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Unfractionated heparins (UFH) of mucosal origin are currently obtained from bovine, ovine, and porcine sources. In the USP potency assays, bovine mucosal heparin (BMH) exhibit much lower activities (140 U/mg) in comparison to porcine mucosal heparin (PMH; 195 U/mg) and ovine mucosal heparin (OMH; 200 U/mg). Besides molecular and structural differences, these heparins have differential interactions with serpins such as antithrombin (AT) and heparin cofactor II (HCII). The purpose of this study is to compare the inhibitory profiles of various heparins in systems enriched with AT and HCII. MATERIALS AND METHODS The active pharmaceutical ingredients (API) of BMH, OMH, and PMH were obtained from Kin Master (Brazil), Ronssi (China), and Medefil (USA). Bovine (B.LMWH), ovine (O.LMWH), and porcine (P.LMWH) derived low-molecular-weight heparins (LMWH, enoxaparin) were obtained from Ronssi (China). Purified human AT, HCII, and thrombin (IIa) were obtained from Enzyme Research (USA). All heparins (UFH's and LMWH's) were supplemented to AT and HCII enriched buffer systems at various gravimetric and potency equated concentrations. The relative inhibition of IIa was measured in terms of percent inhibition using an amidolytic method employing IIa specific substrates. Percent inhibition was calculated for each concentration in both systems for each of the three heparins. Inhibitory concentrations required to inhibit 50% of thrombin (IC-50) was calculated for each UFH and LMWH in terms of µg/mL and U/mL. RESULTS In the AT supplemented system using gravimetric concentrations of various UFH's, PMH and OMH showed comparable values, whereas BMH exhibited much higher IC-50's. However, the LMWH's of various origins showed comparable IC-50 values. In this same system, the USP potency adjusted heparins exhibited comparable results for all UFH's (Figure 1). In the HCII supplemented system, UFH's of various origins exhibited similar IC-50 values in both gravimetric and USP potency adjusted studies. Similarly, the LMWH's when compared in gravimetric amounts demonstrated similar IC-50 values (Figure 2). The relative IC-50 values of the LMWH's in both the AT and HCII enriched systems were higher than the UFH's. CONCLUSION These results show that potency adjusted UFH's exhibit comparable inhibition of IIa in AT and HCII enriched systems. The differing BMH results observed in these two systems at gravimetric concentrations may partly be due to differences in charge density and AT-binding consensus sequences. The depolymerized enoxaparin of different origins did not reveal any significant differences in the IC-50 values. This may be due to the chemical modifications that occur during the manufacturing of these agents. Future studies may be warranted to further investigate these cofactors and their impacts on the function of various heparins.
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Affiliation(s)
- Nausheen Baig
- Pathology and Pharmacology, Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Ahmed Kouta
- Pathology and Pharmacology, Loyola University Chicago Health Sciences Division, Maywood, IL
| | - Mark Jaradeh
- Pathology and Pharmacology, Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | | | - Walter Jeske
- Loyola University Chicago Health Sciences Division, Maywood, IL
| | - Jawed Fareed
- Pathology and Pharmacology, Loyola University Chicago Health Sciences Division, Maywood, IL
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12
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Shetye P, Dungan G, Syed M, Hoppensteadt D, Siddiqui F, Laddu A, Fareed J. Molecular and cellular pathogenesis of endothelial lining in atrial fibrillation. FASEB J 2022. [PMID: 35554928 DOI: 10.1096/fasebj.2022.36.s1.r3875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Atrial Fibrillation (AF) is a cardiac arrhythmia that is caused by a miscoordination between the heart's upper and lower chambers. von Willebrand Factor (vWF) is a glycoprotein that aids the formation of blood clots by helping platelets adhere to the blood vessels and to one another. Once a blood clot begins to break down, it releases a protein fragment known as D-Dimer. Due to the nature of its production, D-Dimer levels can often be used as an indicator for the presence of a blood clot in the circulatory system. Interleukin-6 (IL-6) is a cytokine that helps regulate immune response. It is produced by monocytes and macrophages in response to an infection or a tissue injury. PURPOSE The aim of this research was to analyze how levels of biomarkers of inflammation and thrombosis vary between AF patients and a normal human plasma group (NHP). HYPOTHESIS Biomarkers of inflammation and thrombosis are present at higher levels in AF patients when compared to an NHP group. MATERIALS AND METHODS The AF samples (n=53) were collected following the IRB protocols at Loyola University Medical Center and Loyola Heart & Vascular clinics, while the NHP group blood samples (n=48) were obtained from a centralized blood bank known as George King Biomedical (Overland Park, Kansas). vWF, D-Dimer, and IL-6 levels were measured in both the AF group and the NHP using commercially available sandwich ELISA kits. STATISTICAL ANALYSIS The biomarker levels were analyzed using PRISM GraphPad, IBM Statistical Package for Social Sciences (SPSS), and Microsoft Excel for important statistical characteristics, including mean, median, mode, standard error of the mean (SEM), standard deviation, minimum, maximum, and interquartile range. In addition, tests for normal distribution, quartile analysis, unpaired t-tests, skewness, correlation analysis, and Mann-Whitney tests were conducted. Lastly, the data was broken down into every tenth percentile to assess the distribution of the data. RESULTS The data was organized using the following format: Mean ± SEM. When all the biomarkers were compared, there was no significant correlation between the three (all correlations were positive with r-values below 0.2); however, they all showed an upregulation in the AF group when compared to the NHP group. For vWF, there was a 6663.785% increase in the AF group (AF 4796.200 ± 286.155 vs. NHP 70.910 ± 7.268). For D-Dimer there was a 386.549% increase in the AF group (AF 913.379 ± 125.634 vs. NHP 187.726 ± 31.320). Lastly, for IL-6 there was a 253.002% increase in the AF group (AF 4.409 ± 1.125 vs. NHP 1.249 ± 0.178). Furthermore, when the statistical significances between the biomarkers and the NHP group were analyzed, it was found that all three data groups held a p-value less than 0.05 (<0.001 for vWF, <0.001 for D-Dimer, and 0.0087 for IL-6), deeming the data statistically significant and thus the null hypothesis is rejected for all three data sets. CONCLUSION The above research supports the hypothesis that there will be an upregulation in biomarkers of inflammation and thrombosis (vWF, D-Dimer, IL-6) in AF patients.
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13
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Hoppensteadt D, Jeske W, Farooqui A, Kouta A, Iqbal O, Kantarcioglu B, Kraemer R, Bansal V, Fareed J. Bio‐equivalence of Potency Adjusted Approved Heparin Solutions Compared to a Newly Developed Heparin Solution. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r4995] [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] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Omer Iqbal
- Loyola University Medical CenterMaywoodIL
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14
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Jaradeh M, Baig N, Kouta A, Duff R, Cera L, Jeske W, Hoppensteadt D, Fareed J. Quantitative TFPI Antigen Release and Functionality After Intravenous Administration of Heparins Sourced From Various Species in Non‐human Primates. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.l7833] [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] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Ahmed Kouta
- Loyola University Medical CenterBrookfieldIL
| | | | - Lee Cera
- Loyola University Medical CenterBrookfieldIL
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15
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Sharma R, Sridharan D, Bansal V, Hoppensteadt D, Siddiqui F, Iqbal O, Laddu A, Fareed J. Oxidative Stress Biomarkers in Patients with End Stage Renal Disease. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3956] [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] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | - Omer Iqbal
- Loyola University Medical CenterMaywoodIL
| | - Atul Laddu
- Loyola University Medical CenterMaywoodIL
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16
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Bhate A, Karumanchi P, Bansal V, Siddiqui F, Iqbal O, Hoppensteadt D, Fareed J. Thrombo‐inflammatory Biomarkers in Patients with End‐Stage Renal Disease. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3917] [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] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Omer Iqbal
- Loyola University Medical CenterMaywoodIL
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17
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Olson G, Kouta A, Baig N, Jeske W, Hoppensteadt D, Iacobelli M, Iqbal O, Bakhos M, Cera L, Bansal V, Fareed J. USP Potency Adjusted Bovine Mucosal Heparins are Comparable to Porcine Mucosal Heparin and May be Interchangeable for Anticoagulation. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r5143] [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] [Indexed: 11/11/2022]
Affiliation(s)
- Guy Olson
- Loyola University Medical CenterMaywoodIL
| | | | | | | | | | | | - Omer Iqbal
- Loyola University Medical CenterMaywoodIL
| | | | - Lee Cera
- Loyola University Medical CenterMaywoodIL
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18
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Gavankar S, Odeh A, Syed M, Hoppensteadt D, Siddiqui F, Laddu A, Fareed J. Collagen Remodeling Proteins, Inflammatory Biomarkers and FABP Regulation in Understanding the Pathogenesis of Atrial Fibrillation. FASEB J 2022. [DOI: 10.1096/fasebj.2022.36.s1.r3780] [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] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ameer Odeh
- Loyola University Medical CenterMaywoodIL
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19
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Kantarcioglu B, Darki A, Siddiqui F, Hoppensteadt D, Lewis J, Krämer R, Adiguzel C, Fareed J. The Relevance of Anti-PF4 Antibody Isotypes and Endogenous Glycosaminoglycans and their Relationship with Inflammatory Biomarkers in Pulmonary Embolism Patients. Clin Appl Thromb Hemost 2022; 28:10760296221091770. [PMID: 35360982 PMCID: PMC8980416 DOI: 10.1177/10760296221091770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction Previous studies have shown that inflammation may contribute to the interplay of endogenous glycosaminoglycans (GAGs) and anti-PF4 antibodies. In this study, we quantified the levels of anti-PF4 antibody isotypes and endogenous GAGs together with inflammatory biomarkers in pulmonary embolism (PE) patients to determine whether there is a relationship in between. Identification of this relationship may provide insight to the complex pathophysiology of PE and HIT and may also be useful for development of potential prognostic, diagnostic and therapeutic interventions. Materials and Methods Plasma samples from PE patients (n: 210) were analyzed for anti-PF4 antibody isotypes and various thrombo-inflammatory cytokines utilizing commercially available biochip array and ELISA methods. The endogenous GAG levels in PE patients’ plasma were quantified using a fluorescence quenching method. The collected data analyzed to demonstrate the relationship between various parameters. Results The endogenous GAG levels were increased in the PE group (P < .05). The levels of anti-PF4 antibody isotypes were higher in varying levels in comparison to the normal group (P < .05). Inflammatory cytokines have shown varying levels of increase with IL-6, IL-8 and IL-10 showing the most pronounced values. Mortality outcome was related to increased GAGs and some of the cytokines. Conclusion In this study, we demonstrated increased levels of anti-PF4 antibody isotypes, endogenous GAGs, and inflammatory biomarkers in a large patient cohort in PE. The levels of the endogenous GAGs and inflammatory biomarkers were associated with PE severity and mortality. More studies are needed to understand this complex pathophysiology.
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Affiliation(s)
- Bulent Kantarcioglu
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, Loyola University Chicago, Maywood, IL, USA
| | - Amir Darki
- Division of Cardiovascular Disease, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, IL, USA
- Department of Internal Medicine, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, IL, USA
| | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, Loyola University Chicago, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, Loyola University Chicago, Maywood, IL, USA
| | - Joseph Lewis
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, Loyola University Chicago, Maywood, IL, USA
| | - Roland Krämer
- Institute of Inorganic Chemistry, Heidelberg University, Heidelberg, Germany
| | - Cafer Adiguzel
- Department of Internal Medicine, Division of Hematology, Bahcesehir University, Istanbul, Turkey
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, Loyola University Chicago, Maywood, IL, USA
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20
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Darwish I, Fareed J, Brailovsky Y, Hoppensteadt D, Slajus B, Bontekoe E, De Stefano F, Reed T, Darki A. Dysregulation of Biomarkers of Hemostatic Activation and Inflammatory Processes are Associated with Adverse Outcomes in Pulmonary Embolism. Clin Appl Thromb Hemost 2022; 28:10760296211064898. [PMID: 35043658 PMCID: PMC8796112 DOI: 10.1177/10760296211064898] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The pathophysiology of pulmonary embolism (PE) represents complex, multifactorial processes involving blood cells, vascular endothelium, and the activation of inflammatory pathways. Platelet (P), endothelial (E), and leukocyte (L)-selectin molecules may play an important role in PE pathophysiology. We aimed to profile the biomarkers of inflammation, including selectins in PE patients, and compare them to healthy individuals. Materials and methods 100 acute PE patients and 50 controls were included in this case control study. ELISA methods were used to quantify levels of selectins, inflammatory, and hemostatic biomarkers. Results In PE patients, levels of selectin molecules as compared to controls convey increased P-selectin levels (95 ng/mL vs 40 ng/mL, p < .0001) and decreased L-selectin levels (1468 ng/mL vs 1934 ng/mL, p < .0001). Significant correlations were found between selectins and Plasminogen Activating Inhibitor-1 (PAI-1), Tumor Necrosis Factor-a (TNFa), and D-dimer. Fold change between selectins and controls is compared to other biomarkers, illustrating degrees of change comparable to TNFa, alpha-2-antiplasmin, and microparticles. L-selectin levels are inversely associated with all-cause-mortality in PE patients, (p = .040). Conclusion These studies suggest that various thrombo-inflammatory biomarkers are elevated in PE patients. Furthermore, L-selectin levels are inversely associated with mortality outcomes.
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Affiliation(s)
- Iman Darwish
- 12248Stritch School of Medicine, 550858Loyola University Chicago, Maywood, IL, USA
| | - Jawed Fareed
- Center for Translational Research and Education, Maywood, IL, USA
| | | | | | - Brett Slajus
- Center for Translational Research and Education, Maywood, IL, USA
| | - Emily Bontekoe
- Center for Translational Research and Education, Maywood, IL, USA
| | - Frank De Stefano
- Center for Translational Research and Education, Maywood, IL, USA
| | - Trent Reed
- 25815Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Amir Darki
- 25815Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
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21
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Goldstein J, Dieter RS, Bansal V, Wieschhaus K, Dieter RS, Bontekoe E, Hoppensteadt D, Fareed J. Arterial-renal Syndrome in Patients with ESRD, a New Disease Paradigm. Clin Appl Thromb Hemost 2022; 28:10760296211072820. [PMID: 35018865 PMCID: PMC8761876 DOI: 10.1177/10760296211072820] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Patients with end-stage renal disease (ESRD) often present with an increased risk of cardiovascular disease. Conditions of compromised cardiovascular health such as atrial fibrillation (AFIB) and peripheral arterial disease (PAD) may alter biomarker levels in a way that reflects worsening ESRD. This study profiled biomarkers and laboratory parameters of endothelium dysfunction in patients with ESRD, categorized by additional AFIB and PAD conditions. Methods Citrated blood samples were collected from 95 patients with ESRD. Biomarker levels were measured from plasma samples using sandwich ELISAs, including tissue plasminogen activator (tPA), D-dimer, and nitrotyrosine. Lab parameters, including BUN, calcium, creatinine, parathyroid hormone, phosphate, alkaline phosphatase, ferritin, transferrin, and total iron capacity, and patient comorbidities were obtained from patient medical records. The comorbidities were determined through provider notes, and evidence of applicable testing. Results 14.89% of patients were found to have atrial fibrillation (n = 14), 30.85% of patients were found to have peripheral arterial disease (n = 29), and 6.38% of patients were found to have both peripheral arterial disease and atrial fibrillation (n = 6). When compared to patients with only ESRD, patients with ESRD and PAD showed elevated levels of D-Dimer (p = .0314) and nitrotyrosine (p = .0330). When compared to patients with only ESRD, patients with atrial fibrillation showed elevated levels of D-Dimer (p = .0372), nitrotyrosine (p = .0322), and tPA (p = .0198). Conclusion When compared to patients with just ESRD, patients with concomitant PAD had elevated levels of Nitrotyrosine and D-dimer; while patients with concomitant Afib had elevated levels of nitrotyrosine, D-dimer, as well as tPA.
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Affiliation(s)
- Jake Goldstein
- Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Robert S Dieter
- Loyola University Medical Center, Department of Cardiovascular Medicine Maywood, IL, USA
| | - Vinod Bansal
- Loyola University Medical Center, Department of Nephrology, Maywood, IL, USA
| | | | - Robert S Dieter
- Northwestern's McCormick School of Engineering, Evanston, IL, USA
| | - Emily Bontekoe
- Loyola University Medical Center, Department of Pathology and Pharmacology Maywood, IL, USA
| | - Debra Hoppensteadt
- Loyola University Medical Center, Department of Pathology and Pharmacology Maywood, IL, USA
| | - Jawed Fareed
- Loyola University Medical Center, Department of Pathology and Pharmacology Maywood, IL, USA
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Kantarcioglu B, Darki A, Siddiqui F, Krupa E, Vural M, Kacmaz M, Hoppensteadt D, Iqbal O, Jeske W, Walenga J, Adiguzel C, Fareed J. Predictive Role of Blood Cellular Indices and Their Relationship with Endogenous Glycosaminoglycans as Determinants of Inflammatory Biomarkers in Pulmonary Embolism. Clin Appl Thromb Hemost 2022; 28:10760296221104801. [PMID: 35733366 PMCID: PMC9234831 DOI: 10.1177/10760296221104801] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In this study, we profiled the levels of blood cellular indices, endogenous glycosaminoglycans (GAGs) and inflammatory biomarkers in a cohort comprised of pulmonary embolism (PE) patients, to determine their inter-relationships. Identification of this relationship may provide insight to the complex pathophysiology of PE and the predictive role of blood cellular indices in acute PE patients. MATERIALS AND METHODS Plasma samples from PE patients and healthy controls were analyzed for thrombo-inflammatory biomarkers (IL-2, IL-4, IL-6, IL-8, IL-10, VEGF, IFN-ɣ, TNF-α, IL-1α, IL-1β, MCP-1, EGF, D-dimer, CRP and MMP-9) using biochip array and ELISA methods. The endogenous GAG levels were quantified using a fluorescence quenching method. The data regarding the blood cellular indices were collected through the review of patient medical records and analyzed to demonstrate their relationship. RESULTS The levels of inflammatory biomarkers and endogenous GAGs were elevated in acute PE patients compared to controls (P < .05). Most of the blood cellular indices have shown significant differences in acute PE patients compared to controls (P < .05). The levels of inflammatory biomarkers, endogenous GAGs and the blood cellular indices have shown significant associations in correlation and multivariable analysis. While NLR, PLR and SII were significantly predicting the 30-day mortality, PNR, ELR and EMR were not sufficient to predict 30-day mortality in acute PE. CONCLUSION Our results show that the increased thrombo-inflammatory response is associated with the release of GAGs and the changes in blood cellular indices. The predictive role of the blood cellular indices for mortality is dependent on their relationship with the inflammatory response.
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Affiliation(s)
- Bulent Kantarcioglu
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Amir Darki
- Division of Cardiovascular Disease, Loyola Stritch School of Medicine, 25815Loyola University Medical Center, Maywood, Illinois, USA
| | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA.,Program in Health Sciences. UCAM - Universidad Católica San Antonio de Murcia, Spain
| | - Emily Krupa
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Mehmet Vural
- Department of Internal Medicine, Loyola Stritch School of Medicine, 25815Loyola University Medical Center, Maywood, Illinois, USA.,Department of Internal Medicine, 24558Weiss Memorial Hospital, Chicago, USA
| | - Murat Kacmaz
- Department of Internal Medicine, Division of Hematology, 52987Hatay Mustafa Kemal University, Hatay, Turkey
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Omer Iqbal
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Walter Jeske
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Jeanine Walenga
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
| | - Cafer Adiguzel
- Department of Internal Medicine, Division of Hematology, Bahcesehir University, Istanbul, Turkey
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, 2456Loyola University Chicago, Maywood, IL, USA
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Lewis J, Iqbal O, Jeske W, Hoppensteadt D, Siddiqui F, Fareed J. Differential Neutralization of Unfractionated Heparin and Enoxaparin by Andexanet Alfa. Clin Appl Thromb Hemost 2022; 28:10760296221099934. [PMID: 35535398 PMCID: PMC9096191 DOI: 10.1177/10760296221099934] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Andexanet alfa (andexanet) is an approved antidote used to reverse the bleeding effects of Direct Oral Anticoagulant (Direct-Xa agents) agents because it reverses anti-Xa activity. Unfractionated heparin (UFH) and low molecular weight heparins (LMWHs) exhibit anti-Xa activity. The purpose is to investigate the neutralization of UFH and LMWH by andexanet in activated clotting time (ACT), thrombelastography (TEG), and anti-Xa due to the protamine sulfate shortage. METHODS UFH and LMWH were studied with andexanet, PS, or saline as potential reversal agents/controls at varying concentrations in ACT, TEG, and anti-Xa and compared to each other. RESULTS Andexanet partially neutralized both drugs several TEG parameters at high andexanet concentrations, but it was not as effective as protamine sulfate in any of the assays used. Most TEG parameters were correlated with andexanet concentration. In ACT, significant neutralization was demonstrated at many andexanet concentrations for UFH, but not LMWH. UFH was completely neutralized by PS in ACT, while LMWH was partially neutralized by PS in ACT. Andexanet alfa was a less effective neutralization agent than the protamine sulfate as it only partially neutralized UFH in ACT and was ineffective at neutralizing LMWH when tested at the same concentration as PS (10 ug/mL). CONCLUSION Andexanet partially neutralized UFH and LMWH with variability between assays, necessitating investigation into assay-dependent differences.
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Affiliation(s)
- Joseph Lewis
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Omer Iqbal
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Walter Jeske
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Debra Hoppensteadt
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Fakiha Siddiqui
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
- Program in Health Science, Universidad Católica de Murcia, Spain
| | - Jawed Fareed
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
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24
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DeVon HA, Uwizeye G, Cai HY, Shroff AR, Briller JE, Ardati A, Hoppensteadt D, Rountree L, Schlaeger JM. Feasibility and preliminary efficacy of acupuncture for angina in an underserved diverse population. Acupunct Med 2021; 40:152-159. [PMID: 34856826 DOI: 10.1177/09645284211055754] [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] [Indexed: 11/16/2022]
Abstract
PURPOSE Stable angina is ischemic chest pain on exertion or with emotional stress. Despite guideline-directed therapy, up to 30% of patients have suboptimal pain relief. The aims of this study were to: (1) determine the feasibility and acceptability of a randomized controlled trial (RCT) of acupuncture; and (2) evaluate preliminary efficacy of acupuncture with respect to reduction of pain and increased functional status and health-related quality of life (HRQoL). METHODS Participants with stable angina for ⩾1 month received either a standardized acupuncture protocol, twice per week for 5 weeks, or an attention control protocol. Measures included the McGill Pain Questionnaire (average pain intensity (API), pain now) and the Seattle Angina Questionnaire-7 (functional status, symptoms, and HRQoL). Feasibility was defined as ⩾80% recruitment, ⩾75% retention following enrollment, and ⩾80% completion. Descriptive statistics and mixed-effects linear regression were used for analysis. RESULTS The sample (n = 24) had a mean age of 59 ± 12 years, was predominantly female (63%), and represented minority groups (8% White, 52% Black, 33% Hispanic, and 8% Other). Feasibility was supported by 79% retention and 89% completion rates. The recruitment rate (68%) was slightly lower than expected. Acceptability scores were 87.9% for the acupuncture group and 51.7% for the control group. Outcomes were significantly better for the acupuncture versus control groups (API, b = -2.1 (1.1), p = 0.047; functional status, b = 27.6 (7.2), p < 0.001; and HRQoL, b = 38.8 (11.9), p = 0.001). CONCLUSIONS AND IMPLICATIONS Acupuncture was feasible and acceptable in our diverse sample. We were slightly under the recruitment target of 80%, but participants who started the study had a high likelihood of completing it. Acupuncture shows promise for stable angina, but its effectiveness needs to be confirmed by a larger, adequately powered RCT. TRIAL REGISTRATION NUMBER NCT02914834 (ClinicalTrials.gov).
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Affiliation(s)
- Holli A DeVon
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Glorieuse Uwizeye
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Hui Yan Cai
- Department of Acupuncture and Oriental Medicine, National University of Health Sciences, Lombard, IL, USA
| | - Adhir R Shroff
- Department of Cardiology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Joan E Briller
- Department of Cardiology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Amer Ardati
- Department of Cardiology, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Lauren Rountree
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
| | - Judith M Schlaeger
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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25
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Jaradeh M, Baig N, Bontekoe E, Mitrovic M, Antic D, Hoppensteadt D, Kantarcioglu B, Fareed J. The Relationship Between Thrombo-Inflammatory Biomarkers and Cellular Indices of Inflammation in Lymphoma Patients. Clin Appl Thromb Hemost 2021; 27:10760296211050358. [PMID: 34713728 PMCID: PMC8558596 DOI: 10.1177/10760296211050358] [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] [Indexed: 11/16/2022] Open
Abstract
Introduction Thrombo-inflammatory biomarkers play an important role in the pathogenesis of lymphoma. We aimed to characterize the interrelationship of thrombo-inflammatory biomarkers and blood cellular indices in lymphoma patients. Materials and Methods Ninety-eight lymphoma patient samples were collected from Lymphoma Center of Clinic of Hematology, University of Belgrade, Serbia. Normal controls (n = 50) represented plasma from healthy individuals. Plasminogen activator inhibitor (PAI-1), D-Dimer, factor XIII, C-reactive protein (CRP), microparticles (Mp), Von Willebrand factor (vWF), total protein S, urokinase-type plasminogen activator (uPA), tumor necrosis factor (TNFα), β2-glycoprotein I (β2GPI), and fibronectin levels were measured utilizing commercially-available ELISA methods. Thrombin generation profile (TGA) was measured using a fluorometric kinetic assay. Platelets, leukocytes, lymphocytes, and neutrophils were measured in conjunction with the complete blood profile. Results Statistically significant differences were noted in levels of PAI-1, D-Dimer, factor XIII, CRP, microparticles, vWF, uPA, TNFα, β2GPI, fibronectin, and TGA when compared to normal (all P values < .001). Platelet to leukocyte ratio (PLA) correlated to TNFα and fibronectin (R = −0.31 and −0.53, respectively) and the platelet to neutrophil ratio (PNR) correlated to factor XIII and β2GPI (R = 0.40 and 0.40, respectively). Conclusion Plasma samples from lymphoma patients demonstrated a significantly altered thrombo-inflammatory biomarker profile that has notable correlations to blood cellular indices.
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Affiliation(s)
- Mark Jaradeh
- 25815Loyola University Medical Center, Maywood, IL, USA
| | - Nausheen Baig
- 25815Loyola University Medical Center, Maywood, IL, USA
| | | | | | - Darko Antic
- 54801University of Belgrade, Belgrade, Serbia
| | | | | | - Jawed Fareed
- 25815Loyola University Medical Center, Maywood, IL, USA
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26
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Slovacek H, Khanna R, Poredos P, Jezovnik M, Hoppensteadt D, Fareed J, Hopkinson W. Interrelationship of Osteopontin, MMP-9 and ADAMTS4 in Patients With Osteoarthritis Undergoing Total Joint Arthroplasty. Clin Appl Thromb Hemost 2021; 26:1076029620964864. [PMID: 33350314 PMCID: PMC7758646 DOI: 10.1177/1076029620964864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 01/30/2023] Open
Abstract
Osteoarthritis (OA) is a degenerative joint disease characterized by loss of articular cartilage, inflammation and pain, which sometimes necessitates total joint arthroplasty (TJA). Profiling biomarkers of cartilage degradation and inflammation is a promising area of research to understand the pathogenesis of OA. This study aims to report the post-operative fluctuations of 3 biomarkers of OA, osteopontin (OPN), matrix metalloproteinase-9 (MMP-9), and ADAMTS4 (a disintegrin and metalloproteinase with thrombospondin motifs 4), in patients undergoing TJA to further define the interaction among these biomarkers and delineate their role in OA pathogenesis. OPN is an extracellular matrix (ECM) glycoprotein with increased activity in OA and joint damage and is upregulated by either inflammation or cleavage by MMPs and thrombin. MMP-9 is known to cleave OPN and is upregulated by inflammatory markers, such as IL-1, IL-6 and CRP. ADAMTS4 is an enzyme that degrades aggrecan, a major component of cartilage. These biomarkers were measured in deidentified blood samples collected on the day of surgery, 1 day post-operatively, and day 5-7 post-operatively. MMP-9 and OPN levels were significantly elevated at all times, and ADAMTS4 was significantly decreased at baseline versus controls. OPN and ADAMTS4 inversely fluctuated post-operatively, indicating an interrelation between these 2 biomarkers. This study suggests that the upregulation of MMP-9 and therefore OPN then results in the downregulation of ADAMTS4. The relationship between OPN and thrombin also highlights the importance of monitoring for thrombotic complications. These biomarkers, along with thrombin-mediated cleavage products, may be helpful in the prognostic management of OA patients.
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Affiliation(s)
- Hannah Slovacek
- Department of Pathology and Laboratory Medicine, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Rajan Khanna
- Department of Pathology and Laboratory Medicine, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Pavel Poredos
- Medical Clinic Division of Vascular Medicine, 37663Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Mateja Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - William Hopkinson
- Health Sciences Division, Orthopaedic Surgery and Rehabilitation Department, 2456Loyola University Chicago, Maywood, IL, USA
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27
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Siddiqui F, Antic D, Tafur A, Bontekoe E, Hoppensteadt D, Gerotziafas G, Elalamy I, Fareed J. Thrombin Generation Profile in Various Lymphoma Sub-Groups and Its Augmentation by Andexanet Alfa. Clin Appl Thromb Hemost 2021; 26:1076029620983466. [PMID: 33372544 PMCID: PMC7783880 DOI: 10.1177/1076029620983466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 12/21/2022] Open
Abstract
The prevalence of thrombosis in lymphoma patients is reportedly high and ranges
from 3-10%. Vascular malfunction and inflammatory processes further contribute
to the thrombotic activation process in these patients. Andexanet alfa (AA) is
an antidote for factor Xa inhibitors and its usage has been reported with
thrombotic complications. This study was designed to compare the effect of AA on
the thrombin generation (TG) potential. Blood samples from 78 patients with
confirmed diagnosis of non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL) and
Chronic lymphocytic leukemia (CLL) were collected from the University of
Belgrade Clinic, Serbia. Normal human plasma (NHP) was used for referencing
purposes. Individual samples were supplemented with AA at 100 ug/ml. TG studies
were carried out using a commercially available fluorogenic substrate method. TG
parameters such as peak thrombin (PT), lag time (LT) and area under the curve
(AUC) were compiled. Cumulatively, lymphoma patients showed an increase in LT
compared to NHP which decreases with AA. The PT and AUC levels were decreased
compared to NHP and increases with AA. Upon sub-grouping of lymphoma patients,
PT levels for all sub-groups were increased with AA. The AUC values increased
for HL and NHL and decreased for CLL with AA. Variations in lag time were noted
in all 3 sub-groups. Lymphoma represents a heterogenous group of patients where
both the hypercoagulable state and inflammatory responses simultaneously occur.
Increased thrombin generation in post AA supplemented samples suggest that the
use of this agent may potentially be associated with thrombotic
complications.
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Affiliation(s)
- Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Darko Antic
- Head of Intensive care unit, Lymphoma Centre, Clinic for Hematology, Clinical Center Serbia, University of Belgrade, Belgrade, Serbia.,Department of Internal Medicine, University of Belgrade, Belgrade, Serbia
| | - Alfonso Tafur
- Northshore Cardiovascular Institute, NorthShore University Health Systems, Skokie, IL, USA
| | - Emily Bontekoe
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine and Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Grigoris Gerotziafas
- Head of Thrombosis and Haemostasis Unit, Co-Chair of Thrombosis Center, Service d'Hématologie Biologique, Tenon, University Hospital, France.,Cancer Biology and Therapeutics, Centre de Recherche Saint-Antoine, INSERM U938 and Université Pierre et Marie Curie, Paris, France
| | - Ismail Elalamy
- Service d'Hématologie Biologique, Hôpital Tenon UPMC EA3499, Paris, France
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine and Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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Kouta A, Hoppensteadt D, Bontekoe E, Jeske W, Duff R, Cera L, Fareed J. Studies on Tissue Factor Pathway Inhibitor Antigen Release by Bovine, Ovine and Porcine Heparins Following Intravenous Administration to Non-Human Primates. Clin Appl Thromb Hemost 2021; 26:1076029620951851. [PMID: 33034200 PMCID: PMC7549172 DOI: 10.1177/1076029620951851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/23/2022] Open
Abstract
Unfractionated heparin (UFH) is a sulfated glycosaminoglycan that
consists of repeating disaccharides, containing iduronic acid (or
glucuronic acid) and glucosamine, exhibiting variable degrees of
sulfation. UFHs release tissue factor pathway inhibitor (TFPI) which
inhibits the extrinsic pathway of coagulation by inactivating factor
Xa and the factor VIIa/TF complex. Most heparins used clinically are
derived from porcine intestinal mucosa however, heparins can also be
derived from tissues of bovine and ovine origin. Currently there are
some concerns about the shortage of the porcine heparins as they are
widely used in the manufacturing of the low molecular weight heparins
(LMWHs). Moreover, due to cultural and religious reasons in some
countries, alternative sources of heparins are needed. Bovine mucosal
heparins (BMH) are currently being developed for re-introduction to
the US market for both medical and surgical indications. Compared to
porcine mucosal heparin (PMH), BMH exhibits a somewhat weaker
anti-coagulant activity. In this study, we determined the TFPI antigen
level following administration of various dosages of UFHs from
different origins. These studies demonstrated that IV administration
of equigravemetric dosages of PMH and ovine mucosal heparin (OMH) to
non-human primates resulted in comparable TFPI antigen release from
endothelial cells. In addition, the levels of TFPI were significantly
higher than TFPI antigen levels observed after BMH administration.
Potency adjusted dosing resulted in comparable TFPI release profiles
for all 3 heparins. Therefore, such dosing may provide uniform levels
of anticoagulation for the parenteral indications for UFHs. These
observations warrant further clinical validation in specific
indications.
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Affiliation(s)
- Ahmed Kouta
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Debra Hoppensteadt
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Emily Bontekoe
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Walter Jeske
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Richard Duff
- Comparative Medicine Facility, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Lee Cera
- Comparative Medicine Facility, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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29
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Qneibi D, Ramacciotti E, Macedo AS, Caffaro RA, Agati LB, Siddiqui F, Kouta A, Hoppensteadt D, Fareed J, Carter CA. Comparative Studies on the Anticoagulant Profile of Branded Enoxaparin and a New Biosimilar Version. Clin Appl Thromb Hemost 2021; 26:1076029620960820. [PMID: 32996340 PMCID: PMC7533927 DOI: 10.1177/1076029620960820] [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] [Indexed: 12/02/2022] Open
Abstract
Low molecular weight heparins (LMWH) represent depolymerized heparin prepared by various methods that exhibit differential, biochemical and pharmacological profiles. Enoxaparin is prepared by benzylation followed by alkaline depolymerization of porcine heparin. Upon the expiration of its patent, several biosimilar versions of enoxaparin have become available. Heparinox (Sodic enoxaparine; Cristália Produtos Químicos Farmacêuticos LTDA, Sao Paulo, Brazil) is a new biosimilar form of enoxaparin. We assessed the molecular weight and the biochemical profile of Heparinox and compared its properties to the original branded enoxaparin (Lovenox; Sanofi, Paris, France). Clotting profiles compared included activated clotting time, activated partial thromboplastin time (aPTT), and thrombin time (TT). Anti-protease assays included anti-factor Xa and anti-factor IIa activities. Thrombin generation was measured using a calibrated automated thrombogram and thrombokinetic profile included peak thrombin, lag time and area under the curve. USP potency was determined using commercially available assay kits. Molecular weight profiling was determined using high performance liquid chromatography. We determined that Heparinox and Lovenox were comparable in their molecular weight profile. Th anticoagulant profile of the branded and biosimilar version were also similar in the clot based aPTT and TT. Similarly, the anti-Xa and anti-IIa activities were comparable in the products. No differences were noted in the thrombin generation inhibitory profile of the branded and biosimilar versions of enoxaparin. Our studies suggest that Heparinox is bioequivalent to the original branded enoxaparin based upon in vitro tests however will require further in vivo studies in animal models and humans to determine their clinical bioequivalence.
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Affiliation(s)
- Dalia Qneibi
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Eduardo Ramacciotti
- Department of Pathology and Laboratory Medicines, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | | | | | | | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Ahmed Kouta
- Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.,Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA.,Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, 25815Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Charles A Carter
- Department of Clinical Research, College of Pharmacy & Health Sciences, 2078Campbell University, Buies Creek, NC, USA
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30
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Nichols JH, Brandler ES, Fantz CR, Fisher K, Goodman MD, Headden G, Hoppensteadt D, Matika R, Peacock WF, Rodrigo J, Schützenmeister A, Swanson JR, Canada-Vilalta C, Miles G, Tran N. A Multicenter Evaluation of a Point-of-Care Blood Glucose Meter System in Critically Ill Patients. J Appl Lab Med 2021; 6:820-833. [PMID: 33837390 DOI: 10.1093/jalm/jfab005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/04/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Our purpose was to evaluate the performance of the ACCU-CHEK® Inform II blood glucose monitoring system (Roche Diagnostics GmbH) compared with the perchloric acid hexokinase (PCA-HK) comparator method on the cobas® 6000 analyzer (Roche Diagnostics International Ltd) in critically ill patients. METHODS Overall, 476 arterial (376 pediatric/adult, 100 neonate), 375 venous, and 100 neonatal heel-stick whole-blood samples were collected and evaluated from critical care settings at 10 US hospitals, including the emergency department, medical and surgical intensive care units (ICUs), and neonatal and pediatric ICUs. The ACCU-CHEK Inform II system was evaluated at 2 cutoff boundaries: boundary 1 was ≥95% of results within ±12 mg/dL of the reference (samples with blood glucose <75 mg/dL) or ±12% of the reference (glucose ≥75 mg/dL), and boundary 2 was ≥98% of results within ±15 mg/dL or ±15% of the reference. Clinical performance was assessed by evaluating sample data using Parkes error grid, Monte Carlo simulation, and sensitivity and specificity analyses to estimate clinical accuracy and implications for insulin dosing when using the ACCU-CHEK Inform II system. RESULTS Proportions of results within evaluation boundaries 1 and 2, respectively, were 96% and 98% for venous samples, 94% and 97% for pediatric and adult arterial samples, 84% and 98% for neonatal arterial samples, and 96% and 100% for neonatal heel-stick samples. Clinical evaluation demonstrated high specificity and sensitivity, with low risk of potential insulin-dosing errors. CONCLUSIONS The ACCU-CHEK Inform II system demonstrated clinically acceptable performance against the PCA-HK reference method for blood glucose monitoring in a diverse population of critically ill patients in US care settings.
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Affiliation(s)
- James H Nichols
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Corinne R Fantz
- Roche Diagnostics Corporation, US Medical and Scientific Affairs, Indianapolis, IN, USA
| | | | | | - Gary Headden
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Ryan Matika
- University of Arizona Medical Center, Tucson, AZ, USA
| | | | | | | | | | | | - Gabrielle Miles
- Roche Diagnostics Operations US, Biostatistics and Data Science, Indianapolis, IN, USA
| | - Nam Tran
- UC Davis Health, Sacramento, CA, USA
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Patel D, Darki A, Hoppensteadt D, Darwish I, Syed M, Brailovsky Y, Fareed J. Biomarkers of Thrombo-Inflammatory Responses in Pulmonary Embolism Patients With Pre-Existing Versus New-Onset Atrial Fibrillation. Clin Appl Thromb Hemost 2021; 27:10760296211014964. [PMID: 34013785 PMCID: PMC8142239 DOI: 10.1177/10760296211014964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/15/2022] Open
Abstract
Pulmonary embolism (PE) patients have an increased prevalence and incidence of
atrial fibrillation (AF). Because comorbid AF increases risk of morbidity and
mortality, we sought to investigate the role of thrombo-inflammatory biomarkers
in risk stratifying patients who experience an acute PE episode. Study
participants were enrolled from a Pulmonary Embolism Response Team (PERT)
registry between March 2016 and March 2019 at Loyola University Medical Center
and Gottlieb Memorial Hospital. This cohort was divided into 3 groups: PE
patients with a prior diagnosis of AF (n = 8), PE patients with a subsequent
diagnosis of AF (n = 11), and PE patients who do not develop AF (n = 71).
D-dimer, CRP, PAI-1, TAFIa, FXIIIa, A2A, MP, and TFPI were profiled using the
ELISA method. All biomarkers were significantly different between controls and
PE patients (P < 0.05). Furthermore, TFPI was significantly
elevated in PE patients who subsequently developed AF compared to PE patients
who did not develop AF (157.7 ± 19.0 ng/mL vs. 129.0 ± 9.3 ng/mL,
P = 0.0386). This study suggests that thrombo-inflammatory
biomarkers may be helpful in indicating an acute PE episode. Also, elevated TFPI
levels may be associated with an increased risk of developing AF after a PE.
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Affiliation(s)
- Dimpi Patel
- 2456Loyola University of Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Amir Darki
- Department of Cardiology, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Debra Hoppensteadt
- Hemostasis and Thrombosis Laboratories, Center of Translational Research and Education, Maywood, IL, USA
| | - Iman Darwish
- Hemostasis and Thrombosis Laboratories, Center of Translational Research and Education, Maywood, IL, USA
| | - Mushabbar Syed
- Department of Cardiology, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Yevgeniy Brailovsky
- epartment of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jawed Fareed
- Hemostasis and Thrombosis Laboratories, Center of Translational Research and Education, Maywood, IL, USA
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32
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Khanna R, Slovacek H, Liles J, Haddad S, Poredos P, Bontekoe E, Jezovnik M, Hoppensteadt D, Fareed J, Hopkinson W. Regulation of Cortisol in Patients Undergoing Total Joint Arthoplasty. Clin Appl Thromb Hemost 2021; 27:1076029621987614. [PMID: 34000837 PMCID: PMC8135205 DOI: 10.1177/1076029621987614] [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] [Indexed: 11/17/2022] Open
Abstract
Osteoarthritis is a condition in which joint cartilage and bone degenerate progressively over time. Total joint arthroplasty is a definitive treatment. Cortisol is a hormone that is associated with pain and inflammation. This study aims to investigate the cortisol levels in patients undergoing total joint arthroplasty. Plasma samples were collected from 71 total joint arthroplasty (TJA) patients at baseline (pre-surgery), 24 hours post-operation, and 5 days post-operation. Cortisol levels were measured in each sample using a commercially available ELISA kit. All results were compiled as group means ± SD. The plasma cortisol level at baseline were 218.5 ± 12 ng/mL. The 24-hour post-surgical samples showed a marked increase in cortisol levels 240.7 ± 15 ng/mL. The blood samples drawn at the 5th day after surgery showed a downward trend (74 ± 12 ng/mL). At 5 days post-operation, cortisol levels were significantly lower than at baseline or 24 hours post-operation. These results point to the fact that prior to surgery, the patient’s emotional stress contributes to increased serum cortisol levels. The higher level of cortisol persists at 24 hours post-operation due to inflammation from the procedure. This data also suggests that at 5 days post-operation, the inflammatory response from the surgery and emotional stress subside, resulting in a near normalization of the cortisol levels. Cortisol is a hormone that plays a major role in the body’s response to surgery. The relevance between cortisol and different points in the surgical timeline has the potential to prognosticate and improve recovery measures.
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Affiliation(s)
- Rajan Khanna
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Hannah Slovacek
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Jeffrey Liles
- Department of Orthopedic Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Sandra Haddad
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Pavel Poredos
- Medical Clinic Division of Vascular Medicine, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Emily Bontekoe
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Mateja Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - William Hopkinson
- Orthopaedic Surgery and Rehabilitation Department, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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33
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Bontekoe E, Brailovsky Y, Hoppensteadt D, Bontekoe J, Siddiqui F, Newman J, Iqbal O, Reed T, Fareed J, Darki A. Upregulation of Inflammatory Cytokines in Pulmonary Embolism Using Biochip-Array Profiling. Clin Appl Thromb Hemost 2021; 27:10760296211013107. [PMID: 33969714 PMCID: PMC8113361 DOI: 10.1177/10760296211013107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 12/16/2022] Open
Abstract
The complex pathophysiology of pulmonary embolism (PE) involves hemostatic activation, inflammatory processes, cellular dysfunction, and hemodynamic derangements. Due to the heterogeneity of this disease, risk stratification and diagnosis remains challenging. Biochip-array technology provides an integrated high throughput method for analyzing blood plasma samples for the simultaneous measurement of multiple biomarkers for potential risk stratification. Using biochip-array method, this study aimed to quantify the inflammatory biomarkers such as interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and epidermal growth factor (EGF) in 109 clinically confirmed PE patients in comparison to the control group comprised of plasma samples collected from 48 healthy subjects. Cytokines IL-4, IL-6, IL-8, IL-10, IL-1β, and MCP-1 demonstrated varying level of significant increase (P < 0.05) in massive-risk PE patients compared to submassive- and low-risk PE patients. The upregulation of inflammatory cytokines in PE patients observed in this study suggest that inflammation plays an important role in the overall pathophysiology of this disease. The application of biochip-array technology may provide a useful approach to evaluate these biomarkers to understand the pathogenesis and risk stratification of PE patients.
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Affiliation(s)
- Emily Bontekoe
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Medical Center, Health Sciences Division, Maywood, IL, USA
| | - Yevgeniy Brailovsky
- Advanced Heart Failure, Mechanical Circulatory Support, Heart Transplant, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine and Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jack Bontekoe
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Medical Center, Health Sciences Division, Maywood, IL, USA
| | - Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Medical Center, Health Sciences Division, Maywood, IL, USA
| | - Joshua Newman
- Division of Cardiovascular Medicine, Department of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Omer Iqbal
- Department of Pathology and Laboratory Medicine and Department of Ophthalmology, Cardiovascular Research Institute, Loyola University Medical Center, Maywood, IL, USA
| | - Trent Reed
- Department of Emergency Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine and Department of Pharmacology and Neuroscience, Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Amir Darki
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
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34
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Kulkarni A, Farooqui A, Hoppensteadt D, Van Thiel D, Siddiqui F, Fareed J. Biomarkers, inflammation, and thrombosis in Hepatocellular Carcinoma. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.03754] [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] [Indexed: 11/11/2022]
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35
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Siddiqui F, Syed M, Bontekoe E, Hoppensteadt D, Darki A, Wieschhaus K, Iqbal O, Liles J, Fareed J. ENDOGENOUS ACTIVATION OF THROMBIN GENERATION IN ATRIAL FIBRILLATION AND ITS RELEVANCE TO PROTHROMBIN FRAGMENT 1.2 AND D-DIMER. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03174-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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36
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Wieschhaus K, Patel D, Bontekoe E, Goldstein J, Hoppensteadt D, Steen L, Fareed J, Syed M. COLLAGEN TURNOVER BIOMARKERS IN ATRIAL FIBRILLATION AND THEIR USE IN CLINICAL MANAGEMENT AND THE STUDY OF INFLAMMATORY PATHOGENESIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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37
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Bontekoe E, Siddiqui F, Hoppensteadt D, Kouta A, Kraemer R, Fareed J. Comparison of Functional Methods with Absolute Quantitation of Heparin Levels in Clinical Samples as measured by Heparin Red Assay. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.02550] [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] [Indexed: 11/11/2022]
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38
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Nimkar S, Siddiqui F, Hoppensteadt D, Amour M, Liles J, Fareed J. Biomarkers of Inflammation and Thrombosis in Patients Undergoing Total Joint Replacement. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.04117] [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] [Indexed: 11/11/2022]
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39
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Jeske W, Kouta A, Bontekoe E, Siddiqui F, Hoppensteadt D, Fareed J, Kraemer R. Quantification of Bovine and Porcine Heparins Utilizing the Heparin Red Assay, Applications in the Study of Pharmacokinetics and Pharmacodynamics. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.02163] [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] [Indexed: 11/11/2022]
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40
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Kouta A, Jeske W, Cera L, Farshid A, Duff R, Hoppensteadt D, Fareed J. Protamine Sulfate Neutralization Profile of Various Dosages of Bovine, Ovine and Porcine UFHs and Their Depolymerized Derivatives in Non-Human Primates. Clin Appl Thromb Hemost 2021; 27:10760296211005544. [PMID: 33926250 PMCID: PMC8114756 DOI: 10.1177/10760296211005544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Currently used unfractionated heparins (UFHs) and low molecular weight heparins (LMWHs) are derived from porcine intestinal mucosa. However, heparins have also been manufactured from tissues of other mammalian species such as cow (Bovine) and sheep (Ovine). Protamine sulphate (PS) is an effective inhibitor of heparin and is used clinically to neutralize both LMWH and UFH. In this study, we determined the PS neutralization profile of these agents in non-human primate model using anti-Xa and anti-IIa methods. MATERIAL AND METHODS UFHs obtained from bovine, ovine and porcine mucosal tissues and their respective depolymerized LMWHs were administered at both, gravimetric (0.5 mg/kg) and potency adjusted (100 U/kg) dosages regimen intravenously to individual groups of primates in cross over studies. PS was administered at a fixed dosage and the relative neutralization of these anticoagulants was measured utilizing amidolytic anti-Xa and anti-IIa methods. RESULTS These studies have demonstrated that, the equi-gravimetric dosages of BMH, PMH and OMH have comparable PS neutralization profiles. At potency adjusted dosages, all UFHs were completely neutralized by PS. Although comparable, the LMWHs were not fully neutralized by PS in both the anti-Xa and anti-IIa assays. PS was more efficient in neutralizing the anti-IIa effects of LMWHs. CONCLUSION Heparins of diverse origins showed comparable neutralization profiles by PS in the amidolytic anti-Xa and anti-IIa assays.
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Affiliation(s)
- Ahmed Kouta
- Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Walter Jeske
- Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Lee Cera
- Comparative Medical Facility, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Azarfrooz Farshid
- Comparative Medical Facility, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Richard Duff
- Comparative Medical Facility, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Debra Hoppensteadt
- Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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41
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Bansal V, Siddiqui F, Bontekoe E, Hoppensteadt D, Fareed J. POS-790 CIRCULATING HEPARIN AND ITS RELEVANCE TO THROMBIN GENERATION PROFILE IN ESRD PATIENTS UNDERGOING MAINTENANCE HEMODIALYSIS. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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42
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Murata S, Murphy M, Khanna R, Hoppensteadt D, Fareed J, Halaris A. Elevated salivary cortisol predicts response to adjunctive immune modulation in treatment-resistant bipolar depression. Journal of Affective Disorders Reports 2021. [DOI: 10.1016/j.jadr.2021.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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43
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Bansal V, Bontekoe E, Siddiqui F, Bontekoe J, Hoppensteadt D, Jawed F. POS-561 PERSISTENT COAGULATION ABNORMALITIES IN END-STAGE RENAL DISEASE AFTER 1-YEAR OF FOLLOW UP. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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44
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Slovacek H, Khanna R, Poredos P, Poredos P, Jezovnik M, Hoppensteadt D, Fareed J, Hopkinson W. Interrelationship of MMP-9, Proteoglycan-4, and Inflammation in Osteoarthritis Patients Undergoing Total Hip Arthroplasty. Clin Appl Thromb Hemost 2021; 27:1076029621995569. [PMID: 33754883 PMCID: PMC7995300 DOI: 10.1177/1076029621995569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/16/2022] Open
Abstract
Osteoarthritis (OA) is a chronic condition marked by joint pain, inflammation and loss of articular cartilage, that can be treated with total joint arthroplasty (TJA) at end stages. TJA is marked by post-operative inflammation, which directly effects levels of cartilage degradation biomarkers, proteoglycan-4 (PRG4) and matrix metalloproteinase-9 (MMP-9). PRG4 is a protective glycoprotein that is decreased in individuals with OA. MMP-9 is a matrix metalloproteinase that contributes to articular cartilage loss and is elevated in OA patients. It is upregulated by pro-inflammatory markers, such as IL-1, IL-6 and CRP. This study aims to elucidate the immediate post-operative changes in levels of PRG4, MMP-9, IL-6, CRP, and WBC in patients undergoing TJA to clarify the role of inflammation in recovery after surgery and in the overall pathogenesis of OA. Blood was collected at 3 time points (day 0, day 1 post-operatively, and days 5-7 post-operatively), from 63 patients undergoing TJA due to OA, and levels of these biomarkers were quantified. IL-6, CRP, WBC and MMP-9 were lowest at day 0, highest at day 1, and stabilized at an intermediate level at days 5-7. Meanwhile, PRG4 followed the opposite trend. These studies suggest that IL-6, CRP and WBC showed predictable fluctuations, with pro-inflammatory biomarkers upregulating MMP-9 and downregulating PRG4. Measuring these biomarkers may help expose the role of inflammation in the post-surgical recovery of TJA patients and in long-term pathogenesis of OA. These levels may help risk stratify patients pre-operatively and help develop individualized post-surgical plans.
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Affiliation(s)
- Hannah Slovacek
- Department of Pathology and Laboratory Medicine, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Rajan Khanna
- Department of Pathology and Laboratory Medicine, 25815Loyola University Medical Center, Maywood, IL, USA
| | - Pavel Poredos
- Medical Clinic Division of Vascular Medicine, University Medical Centre Ljubljana, Slovenia
| | - Peter Poredos
- Department of Anesthesiology and Perioperative Intensive Care, University Medical Centre Ljubljana, Slovenia
| | - Mateja Jezovnik
- Department of Advanced Cardiopulmonary Therapies and Transplantation, 12340University of Texas Health Science Center at Houston, TX, USA
| | - Debra Hoppensteadt
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - William Hopkinson
- Orthopaedic Surgery and Rehabilitation Department, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
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45
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Wegrzyn G, Walborn A, Rondina M, Fareed J, Hoppensteadt D. Biomarkers of Platelet Activation and Their Prognostic Value in Patients With Sepsis-Associated Disseminated Intravascular Coagulopathy. Clin Appl Thromb Hemost 2021; 27:1076029620943300. [PMID: 33586482 PMCID: PMC7894689 DOI: 10.1177/1076029620943300] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 12/15/2022] Open
Abstract
Sepsis-associated disseminated intravascular coagulation (DIC) is related to marked hemostatic changes such as transient thrombocytopenia secondary to the endogenous activation and consumption of platelets. This study measured markers of platelet function in 103 adult ICU patients with clinically established sepsis-associated DIC to determine the biomarker association with disease severity. Patients were categorized as having no DIC, nonovert DIC, or overt DIC using the International Society of Thrombosis and Hemostasis scoring system. Plasma levels of CD40L, platelet factor 4 (PF4), platelet-derived microparticles, and microparticle-associated tissue factor were quantified. Markers of platelet activation were significantly elevated in patients with DIC compared to healthy individuals. This increase was independent of platelet count. Levels of PF4 differed based on the severity of DIC and differentiated nonsurvivors and survivors. These findings suggest that the markers of platelet activation in DIC may not be regulated by the number of circulating platelets and may be independent of the factors leading to their consumption.
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Affiliation(s)
- Gracelene Wegrzyn
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA.,Department of Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Amanda Walborn
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA.,Department of Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew Rondina
- Department of Internal Medicine and the Molecular Medicine Program, University of Utah and the GRECC, George E. Wahlen VAMC, Salt Lake City, UT, USA
| | - Jawed Fareed
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA.,Department of Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA.,Department of Pharmacology, Loyola University Medical Center, Maywood, IL, USA
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46
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Sadek M, Iqbal O, Siddiqui F, Till S, Mazariegos M, Campbell E, Mudaliar K, Speiser J, Bontekoe E, Kouta A, Farooqui A, Daravath B, Qneibi D, Sadek R, Hoppensteadt D, Fareed J, Bouchard C. The Role of IL-13, IL-15 and Granulysin in the Pathogenesis of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Clin Appl Thromb Hemost 2021; 27:1076029620950831. [PMID: 33560872 PMCID: PMC7876748 DOI: 10.1177/1076029620950831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 12/17/2022] Open
Abstract
Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are Severe
Cutaneous Adverse Reactions (SCARS) characterized by fever and mucocutaneous
lesions leading to necrosis and sloughing of the epidermis. Conjunctival lesions
are reported in 85% of patients. The pathogenesis of SJS/TEN/SCARS is not
completely understood. It is hypothesized that IL-13, IL-15 and Granulysin
expressed in plasma and skin may play a role. We measured the circulating levels
of these cytokines in the plasma using ELISA and their expression in the skin
using immunofluorescence microscopy. A total of 12 SJS/TEN skin biopsy samples
(8 SJS, 2 SJS/TEN overlap and 2 TEN) were analyzed. Biopsy samples from patients
with Lichen Planus (an inflammatory condition of the skin and mucous membranes)
served as controls. Studies were also performed in human corneal epithelial
cells where expression of these cytokines were measured following a challenge
with TNF-α (0, 1, 10 and 100 ng/ml). The intensity of immunofluorescence was
measured Using Imaris® software. The results showed significantly increased
expression of these cytokines in the skin biopsy samples as measured by the
average intensities of IL-13 (6.1 x 133.0 ± 4.231 x 10^8), and Granulysin (4.2 x
123.0 ± 4.231 x 10^8) compared to Lichen planus control (3.0 x 123.0 ±1.62 x
10^5). Increased expression of IL-13 and IL-15 were noted in cell culture
studies and in the plasma samples when compared to Normal Human Plasma as
controls. It is concluded that IL-13, IL-15 and Granulysin play a role in the
pathogenesis of SJS/TEN.
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Affiliation(s)
- Michael Sadek
- Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Omer Iqbal
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Fakiha Siddiqui
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Sean Till
- Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Melissa Mazariegos
- Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Edward Campbell
- Department of Microbiology and Immunology, Loyola University Medical Center, Maywood, IL, USA
| | - Kumaran Mudaliar
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Jodi Speiser
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Emily Bontekoe
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Ahmed Kouta
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Ambar Farooqui
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Bharathi Daravath
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Dalia Qneibi
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Ramy Sadek
- Department of Medicine, University of California Los Angles, Olive View, Maywood, IL, USA
| | - Debra Hoppensteadt
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, Loyola University Chicago, Health Sciences Divisions, Maywood, IL, USA
| | - Charles Bouchard
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL, USA
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Bontekoe J, Bansal V, Lee J, Syed M, Hoppensteadt D, Maia P, Walborn A, Liles J, Vasaiwala S, Fareed J. Procalcitonin as a Marker of Comorbid Atrial Fibrillation in Chronic Kidney Disease and History of Sepsis. Clin Appl Thromb Hemost 2021; 26:1076029620932228. [PMID: 32539447 PMCID: PMC7427007 DOI: 10.1177/1076029620932228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 01/02/2023] Open
Abstract
Cardiovascular disease and infection are the leading causes of mortality in patients with stage 5 chronic kidney disease on hemodialysis (CKD5-HD). Inflammation is a large component in the pathogenesis of both atrial fibrillation (AF) and sepsis and may link these conditions in CKD5-HD. Procalcitonin (PCT) is an inflammatory biomarker elevated in systemic infection and CKD5-HD, yet its value with regard to comorbid AF has not been thoroughly investigated. The aim of this study sought to evaluate circulating inflammatory markers, including PCT, Angiopoietin-1, Angiopoetin-2, CD40-L, C-reactive protein, d-dimer, and von Willebrand factor in relation to these conditions. Plasma levels of inflammatory markers were measured by enzyme linked immunosorbent assay method in CKD5-HD (n = 97) patients and controls (n = 50). Procalcitonin levels were significantly elevated (P = .0270) in CKD5-HD with comorbid AF compared to those without AF. Further analysis of patients with a history of sepsis demonstrated significantly elevated levels of PCT (P = .0405) in those with comorbid AF (160.7 ± 39.5 pg/mL) compared to those without AF (117.4 ± 25.3 pg/mL). This study demonstrates that the inflammatory biomarker PCT is further elevated in the presence of both AF and a history of sepsis in hemodialysis patients and suggests that underlying chronic inflammation following sepsis resolution may place these patients at greater risk of developing AF.
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Affiliation(s)
- Jack Bontekoe
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Vinod Bansal
- Department of Nephrology, Loyola University Medical Center, Maywood, IL, USA
| | - Justin Lee
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Mushabbar Syed
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Paula Maia
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Amanda Walborn
- Department of Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Jeffrey Liles
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Smit Vasaiwala
- Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
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48
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Walborn A, Rondina M, Fareed J, Hoppensteadt D. Development of an Algorithm to Predict Mortality in Patients With Sepsis and Coagulopathy. Clin Appl Thromb Hemost 2020; 26:1076029620902849. [PMID: 32129085 PMCID: PMC7288806 DOI: 10.1177/1076029620902849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Indexed: 12/14/2022] Open
Abstract
Sepsis is a systemic response to infection with a high rate of mortality and
complex pathophysiology involving inflammation, infection response, hemostasis,
endothelium, and platelets. The purpose of this study was to develop an equation
incorporating biomarker levels at intensive care unit (ICU) admission to predict
mortality in patients with sepsis, based on the hypothesis that a combination of
biomarkers representative of multiple physiological systems would provide
improved predictive value. Plasma samples and clinical data were collected from
103 adult patients with sepsis at the time of ICU admission. Biomarker levels
were measured using commercially available methods. A 28-day mortality was used
as the primary end point. Stepwise linear regression modeling was performed to
generate a predictive equation for mortality. Differences in biomarker levels
between survivors were quantified using the Mann-Whitney test and the area under
the receiver operating curve (AUC) was used to describe predictive ability.
Significant differences (P < .05) were observed between
survivors and nonsurvivors for plasminogen activator inhibitor 1 (AUC = 0.70),
procalcitonin (AUC = 0.77), high mobility group box 1 (AUC = 0.67), interleukin
(IL) 6 (AUC = 0.70), IL-8 (AUC = 0.70), protein C (AUC = 0.71), angiopoietin-2
(AUC = 0.76), endocan (AUC = 0.58), and platelet factor 4 (AUC = 0.70). A
predictive equation for mortality was generated using stepwise linear regression
modeling, which incorporated procalcitonin, vascular endothelial growth factor,
the IL-6:IL-10 ratio, endocan, and platelet factor 4, and demonstrated a better
predictive value for patient outcome than any individual biomarker (AUC = 0.87).
The use of mathematical modeling resulted in the development of a predictive
equation for sepsis-associated mortality with performance than any individual
biomarker or clinical scoring system which incorporated biomarkers
representative of multiple systems.
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Affiliation(s)
- Amanda Walborn
- Departments of Pathology, Loyola University Medical Center, Maywood, IL, USA.,Departments of Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew Rondina
- Department of Internal Medicine and the Molecular Medicine Program, University of Utah and the GRECC, George E. Wahlen VAMC, Salt Lake City, UT, USA
| | - Jawed Fareed
- Departments of Pathology, Loyola University Medical Center, Maywood, IL, USA.,Departments of Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Debra Hoppensteadt
- Departments of Pathology, Loyola University Medical Center, Maywood, IL, USA.,Departments of Pharmacology, Loyola University Medical Center, Maywood, IL, USA
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49
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Patel D, Darki A, Hoppensteadt D, Darwish I, Fareed J, Syed M, Brailovsky Y. BIOMARKER PROFILING IN PULMONARY EMBOLISM PATIENTS WITH PRE-EXISTING VS NEW-ONSET ATRIAL FIBRILLATION. Chest 2020. [DOI: 10.1016/j.chest.2020.08.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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50
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Siddiqui F, Bontekoe E, Hoppensteadt D, Farooqui A, Iqbal O, Brailovsky Y, Fareed J, Darki A. ENDOGENOUS THROMBIN GENERATION POTENTIAL IN PATIENTS WITH PULMONARY EMBOLISM AND ITS RELEVANCE TO THROMBOTIC AND INFLAMMATORY BIOMARKERS. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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