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Isik E, Aydinok Y, Albayrak C, Durmus B, Karakas Z, Orhan MF, Sarper N, Aydın S, Unal S, Oymak Y, Karadas N, Turedi A, Albayrak D, Tayfun F, Tugcu D, Karaman S, Tobu M, Unal E, Ozcan A, Unal S, Aksu T, Unuvar A, Bilici M, Azik F, Ay Y, Gelen SA, Zengin E, Albudak E, Eker I, Karakaya T, Cogulu O, Ozkinay F, Atik T. Identification of the molecular etiology in rare congenital hemolytic anemias using next-generation sequencing with exome-based copy number variant analysis. Eur J Haematol 2024. [PMID: 38556258 DOI: 10.1111/ejh.14194] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/29/2024] [Accepted: 03/09/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES In congenital hemolytic anemias (CHA), it is not always possible to determine the specific diagnosis by evaluating clinical findings and conventional laboratory tests. The aim of this study is to evaluate the utility of next-generation sequencing (NGS) and clinical-exome-based copy number variant (CNV) analysis in patients with CHA. METHODS One hundred and forty-three CHA cases from 115 unrelated families referred for molecular analysis were enrolled in the study. Molecular analysis was performed using two different clinical exome panels in 130 patients, and whole-exome sequencing in nine patients. Exome-based CNV calling was incorporated into the traditional single-nucleotide variant and small insertion/deletion analysis pipeline for NGS data in 92 cases. In four patients from the same family, the PK Gypsy variant was investigated using long-range polymerase chain reaction. RESULTS Molecular diagnosis was established in 86% of the study group. The most frequently mutated genes were SPTB (31.7%) and PKLR (28.5%). CNV analysis of 92 cases revealed that three patients had different sizes of large deletions in the SPTB and six patients had a deletion in the PKLR. CONCLUSIONS In this study, NGS provided a high molecular diagnostic rate in cases with rare CHA. Analysis of the CNVs contributed to the diagnostic success.
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Affiliation(s)
- Esra Isik
- Division of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Yesim Aydinok
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Canan Albayrak
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Basak Durmus
- Division of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Zeynep Karakas
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Fatih Orhan
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Nazan Sarper
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Sultan Aydın
- Division of Pediatric Hematology and Oncology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Selma Unal
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Yesim Oymak
- Division of Pediatric Hematology, Dr. Behcet Uz Children's Hospital, Izmir, Turkey
| | - Nihal Karadas
- Division of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Aysen Turedi
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Davut Albayrak
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Medical Park Samsun Hospital, Samsun, Turkey
| | - Funda Tayfun
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Deniz Tugcu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Serap Karaman
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mahmut Tobu
- Department of Hematology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ekrem Unal
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Alper Ozcan
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sule Unal
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tekin Aksu
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Aysegul Unuvar
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Bilici
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatih Azik
- Department of Pediatrics, Division of Pediatric Hematology, Faculty of Medicine, Muğla Sıtkı Koçman University, Mugla, Turkey
| | - Yilmaz Ay
- Division of Pediatric Hematology and Oncology, Kartal Dr Lütfi Kırdar Training and Research Hospital, Istanbul, Turkey
| | - Sema Aylan Gelen
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Emine Zengin
- Division of Pediatric Hematology, Department of Pediatrics, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Esin Albudak
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ibrahim Eker
- Department of Pediatric Hematology and Oncology and Pediatric Hematopoietic Stem Cell Transplantation Unit, Afyonkarahisar Health Science University Faculty of Medicine, Afyon, Turkey
| | - Taner Karakaya
- Department of Medical Genetics, Samsun Education and Research Hospital, Samsun, Turkey
| | - Ozgur Cogulu
- Division of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ferda Ozkinay
- Division of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Tahir Atik
- Division of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
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Tas MD, Devebacak A, Gunes A, Tobu M, Barut Selver O. Clinical approach to corneal microcyst formation through cytarabine-related corneal toxicity. Clin Exp Optom 2024; 107:95-96. [PMID: 36690335 DOI: 10.1080/08164622.2022.2156774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 12/05/2022] [Indexed: 01/25/2023] Open
Affiliation(s)
- Muhammed Dara Tas
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ali Devebacak
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ajda Gunes
- Department of Hematology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Mahmut Tobu
- Department of Hematology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ozlem Barut Selver
- Department of Ophthalmology, Ege University Faculty of Medicine, Izmir, Turkey
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3
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Gokalp C, Karadag FK, Braunisch MC, Schmaderer C, Gunay E, Kiper HD, Tobu M, Ustün C, Demirci MS, Ozkahya M. In Vitro Closure Times (PFA-100) Are Different Between Peritoneal Dialysis and Hemodialysis. Hamostaseologie 2020; 40:671-678. [PMID: 32717750 DOI: 10.1055/a-1171-0499] [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: 10/23/2022] Open
Abstract
INTRODUCTION Platelet dysfunction is not uncommon in patients with end-stage renal disease (ESRD). Type of renal replacement therapy may have an effect on platelet functions, which has not been well investigated. We evaluated in vitro closure time (CT) differences between peritoneal dialysis (PD) and hemodialysis (HD) patients using platelet function analyzer (PFA-100)and observed a significant difference between these renal replacement therapies. METHODS Patients with ESRD undergoing PD (n = 24) or HD (n = 23) for more than 6 months were included. Blood samples for collagen/epinephrine (Col/EPI) and collagen/adenosine diphosphate (Col/ADP) measurements were obtained before HD at a mid-week session for HD patients and at an outpatient control time for PD patients. RESULTS Three of 24 (12.5%) PD patients and 16 of 23 (69.5%) HD patients had prolonged PFA-100 Col/EPI, p< 0.001. Likewise, 4.2% of PD patients and 87.0% of HD patients had prolonged PFA-100 Col/ADP, p< 0.001. Moreover, the median times of PFA-Col/EPI and PFA-100 Col/ADP were significantly lower in PD patients compared with those of HD patients (p< 0.001). Multivariate analysis showed that the type of renal replacement was a risk factor for both elevated PFA-100 Col/ADP and PFA-100 Col/EPI after adjusted for platelets, hematocrit, and urea (p< 0.001). CONCLUSIONS The type of renal replacement therapy may have an effect on in vitro CTs; therefore, studies including more patients with long-term follow-up are needed to investigate if the difference has any impact on clinical outcomes.
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Affiliation(s)
- Cenk Gokalp
- Department of Nephrology, Ege University, İzmir, Turkey
| | | | - Matthias Christoph Braunisch
- Department of Nephrology, KlinikumRechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Christoph Schmaderer
- Department of Nephrology, KlinikumRechts der Isar, School of Medicine, Technical University Munich, Munich, Germany
| | - Emrah Gunay
- Department of Nephrology, Ege University, İzmir, Turkey
| | | | - Mahmut Tobu
- Department of Hematology, Ege University, İzmir, Turkey
| | - Celalettin Ustün
- Department of Hematology, University of Minnesota, Minnesota, United States
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Korkmaz S, Solmaz Medeni S, Demirkan F, Kalayoglu Besisik S, Altay Dadin S, Akgun Cagliyan G, Kabukcu Hacioglu S, Sari I, Goren Sahin D, Arat M, Dagdas S, Ozet G, Kutlu N, Karaagac Akyol T, Ozcebe OI, Uskudar Teke H, Kiper Unal D, Guner N, Tombak A, Celik H, Bay I, Kiki I, Ozgur G, Erkurt MA, Ozatli D, Meletli O, Demircioglu S, Demir C, Kurtoglu E, Vural F, Tobu M, Karakus A, Ayyildiz O, Dal MS, Afacan Ozturk B, Albayrak M, Ocakci S, Bolaman Z, Sonmez M, Karakus V, Gokmen Sevindik O, Berber I, Dogu MH, Gulturk E, Ulas T, Payzin B, Kuku I, Cagirgan S, Altuntas F. The Turkish experience with therapeutic plasma exchange: A national survey. Transfus Apher Sci 2019; 58:287-292. [DOI: 10.1016/j.transci.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Dogan EE, Uslu M, Comert Ozkan M, Kiper Unal HD, Saydam G, Ogut MF, Tobu M. The effect of polycythemia vera on hearing functions: Evaluation of twenty-one patients. Clin Otolaryngol 2019; 44:434-437. [PMID: 30735002 DOI: 10.1111/coa.13303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 11/20/2018] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Esma E Dogan
- Department of Hematology, Ege University Medicine Faculty, Izmir, Turkey
| | - Mustafa Uslu
- Department of Otorhinolaryngology, Ege University Medicine Faculty, Izmir, Turkey
| | - Melda Comert Ozkan
- Department of Hematology, Ege University Medicine Faculty, Izmir, Turkey
| | | | - Guray Saydam
- Department of Hematology, Ege University Medicine Faculty, Izmir, Turkey
| | - Mehmet F Ogut
- Department of Otorhinolaryngology, Ege University Medicine Faculty, Izmir, Turkey
| | - Mahmut Tobu
- Department of Hematology, Ege University Medicine Faculty, Izmir, Turkey
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6
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Patir P, Soyer N, Durusoy IR, Sahin F, Saydam G, Tobu M, Tombuloglu M, Vural F. A Retrospective Comparison of TECAM and BEAM Conditioning Regimens Before Autologous Hematopoietic Stem Cell Transplant in Lymphoma Patients: Efficacy and Toxicity. EXP CLIN TRANSPLANT 2018. [PMID: 29969082 DOI: 10.6002/ect.2017.0274] [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: 11/05/2022]
Abstract
OBJECTIVES The aim of our study was to evaluate the efficacy and toxicity of TECAM (thiotepa, etoposide, cyclophosphamide, cytarabine, and melphalan) and BEAM (carmustine, etoposide, cytarabine, and melphalan) conditioning regimens before autologous hematopoietic stem cell transplant in patients with lymphoma. MATERIALS AND METHODS We retrospectively analyzed 108 relapsed/refractory lymphoma patients who had high-dose treatments followed by autologous hematopoietic stem cell transplant between October 2012 and February 2017. RESULTS At a median follow-up period of 16 months, the estimated 2-year progression-free survival rates for the TECAM and BEAM groups were 55.7% and 52.9%, respectively (P = .811). The estimated 2-year overall survival rate in the TECAM group (55.9%) was relatively inferior to that shown in the BEAM group (67%), but the differences were not significant (P = .238). No differences were observed for time to hematopoietic recovery and duration of hospitalization. Incidences of transplant-related infectious and noninfectious complications were similar for each conditioning regimen. CONCLUSIONS Our experience shows that the TECAM regimen is an effective high-dose chemotherapy for lymphoma patients before autologous hematopoietic stem cell transplant.
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Affiliation(s)
- Pusem Patir
- From the Department of Hematology, Ege University, Faculty of Medicine, Izmir, Turkey
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7
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Sahin F, Akay OM, Ayer M, Dal MS, Ertop S, Ilhan O, Karakus V, Ozcan MA, Ozkocaman V, Ozsan H, Salim O, Tobu M, Tombak A, Tuglular TF, Yilmaz M, Unal A, Yenerel MN, Saydam G. Pesg PNH diagnosis, follow-up and treatment guidelines. Am J Blood Res 2016; 6:19-27. [PMID: 27570707 PMCID: PMC4981648] [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] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/28/2016] [Indexed: 06/06/2023]
Abstract
PNH Education and Study Group (PESG) have been established in December 2013 as a non-profit, independent, medical organization www.pesg.org. Paroxysmal Nocturnal Hemoglobinuria (PNH) is a multi-systemic disease that should be treated with a multidisciplinary approach. Patients may apply to the clinics other than the hematology due to variability and diversity of clinical findings which lower the rate of diagnosis due to low awareness about PNH. PNH might be overlooked and diagnosis might be delayed. Regarding these, PESG was established with the collaboration of Immunology, Cardiology, Thorax Diseases (Pulmonology), Neurology, Gastroenterology, General Surgery and Urology specialists in addition to hematologists dealing with PNH. The PESG study group aims to increase the awareness about PNH, including training activities about PNH, strengthening the relations between clinics and planning of clinical studies as a goal. It is the first professional organization focusing on PNH, in Turkey.In this guideline, we want to facilitate the diagnosis attributes of physicians from all specializations that deal with PNH and its systemic complications. One can perceive this as a tailor made guideline of international guidelines but not a compilation.
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Affiliation(s)
- Fahri Sahin
- Department of Hematology, Ege UniversityIzmir, Turkey
| | | | - Mesut Ayer
- Department of Hematology, Haseki Training and Research HospitalIstanbul, Turkey
| | - Mehmet Sinan Dal
- Department of Hematology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research HospitalAnkara, Turkey
| | - Sehmus Ertop
- Department of Hematology, Bulent Ecevit UniversityZonguldak, Turkey
| | - Osman Ilhan
- Department of Hematology, Ankara UniversityAnkara, Turkey
| | - Volkan Karakus
- Department of Hematology, Mugla Sıtkı Kocman UniversityMugla, Turkey
| | | | | | - Hayri Ozsan
- Department of Hematology, Dokuz Eylul UniversityIzmir, Turkey
| | - Ozan Salim
- Department of Hematology, Akdeniz UniversityAntalya, Turkey
| | - Mahmut Tobu
- Department of Hematology, Ege UniversityIzmir, Turkey
| | - Anil Tombak
- Department of Hematology, Mersin UniversityMersin, Turkey
| | | | - Mehmet Yilmaz
- Department of Hematology, Gaziantep UniversityGaziantep, Turkey
| | - Ali Unal
- Department of Hematology, Erciyes UniversityKayseri, Turkey
| | | | - Guray Saydam
- Department of Hematology, Ege UniversityIzmir, Turkey
- On behalf of PNH Education and Study Group (PESG)
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8
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Tobu M, Iqbal O, Messmore HL, Ma Q, Hoppensteadt DA, Fareed J. Influence of Different Anticoagulant Agents on Fibrinopeptide A Generation. Clin Appl Thromb Hemost 2016; 9:273-92. [PMID: 14653437 DOI: 10.1177/107602960300900403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to determine the in vitro effects of different anticoagulant drugs on fibrinopeptide A (FPA) generation inhibition and to identify whether there is any correlation between FPA generation, Hemochron ACT, global clotting as says, and chromogenic assays. Unfractionated heparin is a conventionally used anticoagulant. New anticoagulant drugs such as low molecular weight heparins (LMWHs), pentasaccharide, and antithrombin drugs are now approved for various indications. Anti-Xa drugs are in various phases of clinical development. The influence of different anticoagulant agents has been studied on fibrinopeptide A generation, Hemochron celite ACT, global clotting assays, and chromogenic anti-Xa and anti-Ila assays. Different LMWHs (Clivarin, Dalteparin, Enoxaparin, and Tinzaparin), anti-Xa agents (Pentasaccharide, DX-9065a and unfractionated heparin), and anti-Ila agents (PEG-Hirudin, Hirudin, Efegatran and Argatroban) were studied. The blood from healthy volunteers (n=4) was drawn for each drug. Imuclone FPA enzyme-linked immunosorbent kit assay, Hemochron celite ACT assay, global clotting assays (PT, APTT, Heptest-HI, thrombin time), and Loyola chromogenic anti-Xa and anti-Ila assays were studied. Pentasaccharide demonstrated minimal effects on the whole blood clotting time such as ACT and on inhibition of FPA generation (IC50 > 25 /g/mL). DX-9065a exhibited a significant prolongation of ACT and marked inhibition of FPA generation (IC50 = 4.12 Ag/mL). Unfractionated heparin showed a marked inhibition of FPA generation (IC,, = 5.16 Aog/mL). Pentasaccharide, DX-9065a and UFH showed a marked correlation between ACT and inhibition of FPA generation. LMWHs demonstrated concentrationdependent inhibition of FPA generation. LMWHs studied showed good correlation between FPA generation inhibition and ACT test. Similar correlation was seen between FPA generation inhibition and the APTT, anti Xa (heptest-HI assay) and anti-IIa activity. Anti-IIa drugs demonstrated concentration-dependent inhibition of FPA generation. Their FPA generation inhibition potency is correlated with the ACT assay. A strong correlation between Hemochron ACT and FPA generation inhibition was observed. Based on this significant correlation, the FPA generation inhibition can be predicted by point-of-care ACT assay.
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Affiliation(s)
- M Tobu
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, Illinois 60153, USA
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9
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Fareed D, Iqbal O, Tobu M, Hoppensteadt DA, Fareed J. Blood Levels of Nitric Oxide, C-Reactive Protein, and Tumor Necrosis Factor-α Are Upregulated in Patients with Malignancy-Associated Hypercoagulable State: Pathophysiologic Implications. Clin Appl Thromb Hemost 2016; 10:357-64. [PMID: 15497022 DOI: 10.1177/107602960401000408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Endogenous generation of nitric oxide (NO) plays an important role in the regulation of cardiovascular and inflammatory responses. This mediator is synthesized by a family of enzymes collectively known as NO synthase. Several isoforms of this enzyme have been identified and can be grouped as constitutive or inducible. Increased production of NO is reported in several inflammatory disorders, such as sepsis, arthritis, thrombotic thrombocytopenic purpura (TTP), and antiphospholipid syndrome. In addition, NO upregulates cyclo-oxygenase-2 and synthesis of several other inflammatory cytokines. Inflammation and thrombotic complications are usually associated with malignancy. Earlier reports indicate the upregulation of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and tissue factor (TF) in patients with malignancy. To determine the relationship between inflammatory cytokines and NO in cancer patients with hypercoagulable states, baseline plasma samples from 160 patients with confirmed malignancy and hypercoagulable state were analyzed for NO levels. A chemical method based on a chemiluminescent reaction between NO and ozone using a highly sensitive gas phase NO analyzer was used. CRP, TF, and TNF-α were measured using enzyme-linked immunosorbent assay methods. Of the 160 patients who were plasma tested, the baseline NO levels ranged from 13.7 to 98.6 μM (63.1±15.9 μM, mean±SD) in contrast to age-matched control, which ranged from 9.1 to 34.6 μM (19.8±6.2 μM, mean±SD, n=138). Cancer patients also showed marked variations in the NO levels. Eighteen of 60 cancer patients exhibited greater than 60 μM NO levels. The CRP, TNF-α and TF were also significantly elevated. A correlation between CRP (r2=0.73) and NO levels was noted in cancer patients with hypercoagulable state. These data suggest that the pathogenesis associated with malignancy/hypercoagulable state is associated with an inflammatory component. In addition, the observed hemodynamic changes in some of the cancer patients may be due to increased NO production.
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Affiliation(s)
- D Fareed
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, Illinois, USA.
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Tobu M, Iqbal O, Hoppensteadt D, Neville B, Messmore HL, Fareed J. Anti-Xa and Anti-IIa Drugs Alter International Normalized Ratio Measurements: Potential Problems in the Monitoring of Oral Anticoagulants. Clin Appl Thromb Hemost 2016; 10:301-9. [PMID: 15497016 DOI: 10.1177/107602960401000402] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Several of the newly developed anti-Xa and anti-IIa agents have been shown to influence the International Normalized Ratio (INR) values. During phase I trials with normal healthy volunters and phase II study patients who were given warfarin and concomitant anti-IIa or anti-Xa agents, it has been reported that INR values were falsely elevated. It is of critical importance to know of the effects of these agents on INR to avoid dosage errors. To study the influence of these agents on INR, we used several anti-IIa agents (argatroban, recombinant hirudin, efegatran, and PEG-hirudin) and anti-Xa drugs (pentasaccharides such as fondaparinux and idraparinux, DX-9065a and JTV-803). The anti-IIa drugs were supplemented in citrated plasma at a concentration of 0 to 1 μg/mL level and anti-Xa drugs in the range of 0 to 25 μg/mL. The IC50 values for each of these agents were calculated. Four different commercially available prothrombin time (PT) reagents were used to perform the PT assays and to calculate the relative INR values. Direct synthetic factor IIa and Xa inhibitors exhibited a concentration-dependent increase in the INR values. Hirudin, efegatran, and PEG-hirudin showed a weaker effect, whereas argatroban showed a much higher elevation of the INR values. Synthetic indirect anti-Xa agents such as the pentasaccharide did not show any effect on the INR values. Furthermore, prothrombin time reagents with high ISI values exhibited disproportionally higher INR values for both the direct anti-Xa and anti-IIa agents. Elevation of INR values has therapeutic implications when non-oral anticoagulant drugs are used in combination with drugs such as warfarin. Because of the false elevation of INR values with some of the non-oral anticoagulant drugs, patients who are on concomitant warfarin therapy should be carefully evaluated for their corresponding INR values for proper dosing. To avoid dosing errors it is best not to use the INR values in the therapeutic monitoring of anti-Xa and anti-IIa agents either in the monotherapeutic or polytherapeutic modalities. These data also warrant the development clinically relevant methods for the monitoring of the concomitant use of newly developed anti-Xa and anti-IIa drugs with oral anticoagulants.
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Affiliation(s)
- Mahmut Tobu
- Loyola University Medical Center, Department of Pathology, Maywood, Illinois, USA
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Tobu M, Iqbal O, Fareed D, Chatha M, Hoppensteadt D, Bansal V, Fareed J. Erythropoietin-Induced Thrombosis as a Result of Increased Inflammation and Thrombin Activatable Fibrinolytic Inhibitor. Clin Appl Thromb Hemost 2016; 10:225-32. [PMID: 15247979 DOI: 10.1177/107602960401000304] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic inflammation is a major cause of morbidity and mortality in end-stage renal disease. The associated anemia in these patients due to renal cortical atrophy and erythropoietin deficiency is treated with recombinant erythropoietin. Recent reports suggest a growing incidence of symptomatic venous thrombosis in cancer patients treated with recombinant erythropoietin. Several investigators have reported on different mechanisms of thrombosis in these patients. We hypothesize that thrombosis in patients with end-stage renal disease due to increased expression of C-reactive protein (CRP) as a result of chronic inflammation promotes the release of thrombin activatable fibrinolytic inhibitor causing fibrinolytic deficit and eventually thrombosis. Furthermore, because endothelial nitric oxide is responsible for the maintenance of the normal vascular function, the decreased levels of nitric oxide in chronic inflammation cause endothelial damage and result in thrombosis. To test this hypothesis, blood samples were collected from 106 patients (49 male and 57 female, aged 59.8±15.7 years) with end-stage renal disease undergoing hemodialysis and treated with recombinant erythropoietin at a mean dose of 201.8 U/kg/week. Blood samples were drawn in 5-mL tubes containing 3.2% sodium citrate just before the hemodialysis procedure. These blood samples were immediately centrifuged to obtain platelet-poor plasma, which was aliquoted and frozen at -70°C until further analysis. Erytropoietin antibodies were measured using an anti-EPO enzyme-linked immunosorbent assay (ELISA) method developed in our laboratory. Nitric oxide was measured using a NO analyzer (Sievers 280I, Ionics, Boulder, CO). Plasma CRP levels were measured with a highly sensitive ELISA method IMUNOCLONE CRP ELISA (American Diagnostica, Greenwich, CT). TAFI antigen levels in plasma were analyzed with an IMUCLONE TAFI ELISA kit (American Diagnostica, Greenwich, CT). TAFI functional activity was assayed with an ACTICHROME TAFI activity kit. The measured levels of nitric oxide, CRP, TAFI antigen, and TAFI functional were 37.36±36.8 (normal value, 37.49±18.96; range, 19.3-102 μM), 12.27±10.6 (normal value, < 1 μg/mL), 146.9±28.4% NHP (normal, 100% NHP), and 102.55±37% NHP (normal range, 22.3-165.7; mean, 89.5% NHP), respectively. The erythropoietin antibody was detected in 9.4% of the patient group. While 20% of the erythropoietin antibody-positive and 27.1% of the erythropoietin antibody-negative patients experienced chest pain, thrombotic events developed in 9.4% of the erythropoietin antibody-negative patients. These data provide the rationale for a novel mechanism of thrombosis through increased activity of CRP, nitric oxide, and TAFI, leading to fibrinolytic deficit and thrombosis in patients treated with erythropoietin.
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Affiliation(s)
- Mahmut Tobu
- Department of Pathology, Loyola University Medical Center, Maywood, Illinois 60153, USA
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Comert M, Gursoy S, Tobu M. Pleural effusion formation in the course of myeloma. Arch Bronconeumol 2015; 51:418-9. [PMID: 25619415 DOI: 10.1016/j.arbres.2014.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/15/2014] [Accepted: 05/15/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Melda Comert
- Departamento de Hematología, Facultad de Medicina, Universidad Ege, Esmirna, Turquía.
| | - Soner Gursoy
- Departamento de Cirugía Torácica, Hospital de Investigación Suat Seren, Esmirna, Turquía.
| | - Mahmut Tobu
- Departamento de Hematología, Facultad de Medicina, Universidad Ege, Esmirna, Turquía.
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Tobu M, Demir M, Iqbal O, Lietz H, Hoppensteadt D, Walenga J, Fareed J. The irrelevance of International Normalized Ratio in the monitoring of anti-IIa and anti-Xa drugs. J Thromb Haemost 2014. [DOI: 10.1111/j.1538-7836.2003.tb05643.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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14
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Cetinkalp S, Tobu M, Karadeniz M, Buyukkeçeci F, Yilmaz C. The effect of hormone replacement treatment on thrombin-activatable fibrinolysis inhibitor activity levels in patients with Hashimoto thyroiditis. Intern Med 2009; 48:281-5. [PMID: 19252348 DOI: 10.2169/internalmedicine.48.1758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Hypothyroid patients have increased risk of cardiovascular diseases, and several mechanisms have been considered responsible in these patients. Although, a few studies demonstrated fibrinolytic system changes in hypothyroid patients, there is no study demonstrating TAFI activity in hypothyroid Hashimoto's thyroiditis patients. The aim of this study was to evaluate TAFI activity status and the effect of L thyroxin hormone replacement treatment on fibrinolytic system in this patient group. METHODS Thirty patients with hypothyroid Hashimoto thyroiditis (all were female and the mean age was 44.3+/-14.6 years, ranging between 17-68 years) were enrolled to study. Their TSH levels were high (27.2+/-5.2 mU/L) and Free T3 and Free T4 hormone levels were below than normal. In this study, euthyroid 20 healthy volunteers (mean age 32.5+/-4.9 years, range 26-42 years) were adopted. L-thyroxin treatment before and after TAFI activity levels were measured in patients. RESULTS In the control group, TAFI activity levels were 9.6+/-0.4 microg/mL. In patients with L-thyroxin before and after treatment there were high levels of TAFI activity value of 14.2+/-0.9 and 12.9+/-0.8 microg/mL, respectively. In the patient group, after L-thyroxin treatment TAFI activity levels were decreased but they were not statistically significant (p=0.187). When compared to the control group, high levels of TAFI activity were observed in the patient group (p<0.0001). CONCLUSION Our data demonstrated that in Hashimoto thyroiditis, patients have high levels of TAFI activity compared to controls. A high level of TAFI activity suggests fibrinolytic deficit or thrombotic tendency in hypothyroid patients and this deficit is persistent after L-thyroxine replacement.
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Affiliation(s)
- Sevki Cetinkalp
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ege University Hospital, Izmir, Turkey
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Samikkannu M, Hoppensteadt D, Adiguzel C, Cunanan J, Iqbal O, Tobu M, Fareed J. Effect of Heparin and Low Molecular Weight Heparin on the Regulation of Microparticle in Atrial Fibrillation. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.1118.3] [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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Wahi R, Hoppensteadt D, Tobu M, Iqbal O, Walenga J, Demir M, Fareed D, Fareed J. COMPARATIVE STUDY ON THE ANTICOAGULANT EFFECTS OF UNFRACTIONATED AND LOW MOLECULAR WEIGHT HEPARINS, LOWER LOW MOLECULAR WEIGHT HEPARINS AND PENTASACCAHRIDE AS MEASURED BY WHOLE BLOOD ACT, ANTI-XA AND A NEWLY DEVELOPED PROTHROMBINASE INDUCED CLOTTING TIME. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb00781.x] [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: 11/30/2022]
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17
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Fareed J, Ciftci A, Demir M, Hoppensteadt D, Altiay G, Tobu M, Iqbal O, Fareed D, Bick R, Sheikh A. Up-regulation of inflammatory and thrombotic mediators in lung cancer and their modulation by oral anticoagulantion. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7705] [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: 11/20/2022] Open
Abstract
7705 Background: Venous thromboembolic events (VTE) are associated with lung cancer and significantly contributes to the increased mortality in these patients. While the increased prevalence of VTE is fully recognized in lung cancer, its pathogenesis is not fully understood at this time. Even the patients undergoing therapeutic interventions are at high risk to develop VTE. Profiling of surrogate markers of thrombosis and inflammation provides an opportunity to understand the pathogenesis of thrombosis in these patients. Methods: In a prospective, randomized, controlled study patients with inoperable lung cancer (n=100) were randomized to receive chemotherapy, radiation and warfarin (INR 1.5–2.5) or chemotherapy, radiation without warfarin (n=50). Blood samples were drawn prior to and after the second treatment cycle with warfarin. All samples were analyzed for such inflammation markers as the tumor necrosis factor alpha (TNF a), CD 40 ligand (CD 40L), C-reactive protein (CRP), interleukin 1 beta (IL-1β), asymmetric dimethylarginine (ADMA) and nitric oxide (NO). In addition, prothrombin fragment F1.2 (F1.2) and thrombin antithrombin complex (TAT) were also measured. Results: The results are summarized in the following table . All of the surrogate markers of inflammation showed a decreased trend (13–50%) in the warfarin treated group, whereas the non-warfarin treated group exhibited an increase (18–46%) in all markers except CRP and ADMA. The markers of thrombin generation were down regulated in the warfarin treated group. Conclusions: The levels of various inflammatory markers are upregulated in lung cancer suggesting a pathogenic role of this process in lung cancer. Warfarin down regulated the inflammatory and thrombogenic processes in contrast to the non-warfarin treated group. The clinical relevance of these observations require additional analysis. No significant financial relationships to disclose. [Table: see text]
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Affiliation(s)
- J. Fareed
- Loyola Univ Medcl Ctr, Maywood, IL; Trakya University School of Medicne, Edirne, Turkey; Loyola University Medical Center, Maywood, IL
| | - A. Ciftci
- Loyola Univ Medcl Ctr, Maywood, IL; Trakya University School of Medicne, Edirne, Turkey; Loyola University Medical Center, Maywood, IL
| | - M. Demir
- Loyola Univ Medcl Ctr, Maywood, IL; Trakya University School of Medicne, Edirne, Turkey; Loyola University Medical Center, Maywood, IL
| | - D. Hoppensteadt
- Loyola Univ Medcl Ctr, Maywood, IL; Trakya University School of Medicne, Edirne, Turkey; Loyola University Medical Center, Maywood, IL
| | - G. Altiay
- Loyola Univ Medcl Ctr, Maywood, IL; Trakya University School of Medicne, Edirne, Turkey; Loyola University Medical Center, Maywood, IL
| | - M. Tobu
- Loyola Univ Medcl Ctr, Maywood, IL; Trakya University School of Medicne, Edirne, Turkey; Loyola University Medical Center, Maywood, IL
| | - O. Iqbal
- Loyola Univ Medcl Ctr, Maywood, IL; Trakya University School of Medicne, Edirne, Turkey; Loyola University Medical Center, Maywood, IL
| | - D. Fareed
- Loyola Univ Medcl Ctr, Maywood, IL; Trakya University School of Medicne, Edirne, Turkey; Loyola University Medical Center, Maywood, IL
| | - R. Bick
- Loyola Univ Medcl Ctr, Maywood, IL; Trakya University School of Medicne, Edirne, Turkey; Loyola University Medical Center, Maywood, IL
| | - A. Sheikh
- Loyola Univ Medcl Ctr, Maywood, IL; Trakya University School of Medicne, Edirne, Turkey; Loyola University Medical Center, Maywood, IL
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Ma Q, Tobu M, Schultz C, Jeske W, Hoppensteadt D, Walenga J, Cornelli U, Lee J, Linhardt R, Hanin I, Fareed J. Molecular weight dependent tissue factor pathway inhibitor release by heparin and heparin oligosaccharides. Thromb Res 2006; 119:653-61. [PMID: 16824584 PMCID: PMC4142645 DOI: 10.1016/j.thromres.2006.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Revised: 05/01/2006] [Accepted: 05/09/2006] [Indexed: 11/28/2022]
Abstract
Heparin and low molecular weight heparins exert their vascular effects by mobilizing tissue factor pathway inhibitor (TFPI) from the vascular endothelium into the blood circulation. We compared the influence of molecular weight on the TFPI release by heparin and its fractions in a non-human primate model. Primates were treated with unfractionated heparin, a low molecular weight heparin (gammaparin), or a heparin-derived oligosaccharide mixture (C3). Endothelial TFPI release was determined using both immunologic and functional assays. After intravenous administration, all agents significantly increased TFPI levels (p<0.05) in a dose dependent manner. The increase produced by unfractionated heparin and gammaparin was greater than that by C3 at an equal dosage (p<0.05). With subcutaneous injection, all agents produced less TFPI release. Repeated administration of heparin-derived oligosaccharides gradually increased TFPI release. A 1.89 fold increase in TFPI levels was observed 4 days after C3 treatment (2.5 mg/kg). Our findings indicated that TFPI release is dependent on the molecular weight of heparin and its derivatives. Heparin oligosaccharides exert their vascular effects through increased TFPI release after long-term repeated administration.
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Affiliation(s)
- Qing Ma
- Department of Pharmacology and Experimental Therapeutics, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
- Corresponding authors. Ma is to be contacted at Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14260, United States. Tel.: +1 716 645 2828x243. Fareed, Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States. Tel.: +1 708 216 3262. (Q. Ma), (J. Fareed)
| | - Mahmut Tobu
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
| | - Christopher Schultz
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
| | - Walter Jeske
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
| | - Debra Hoppensteadt
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
| | - Jeanine Walenga
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
| | - Umberto Cornelli
- Department of Pharmacology and Experimental Therapeutics, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
| | - John Lee
- Department of Pharmacology and Experimental Therapeutics, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
| | - Robert Linhardt
- Department of Chemistry and Chemical Biology, Rensselaer Polytechnic Institute, Troy, NY 12180, United States
| | - Israel Hanin
- Department of Pharmacology and Experimental Therapeutics, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
| | - Jawed Fareed
- Department of Pharmacology and Experimental Therapeutics, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
- Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States
- Corresponding authors. Ma is to be contacted at Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14260, United States. Tel.: +1 716 645 2828x243. Fareed, Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, United States. Tel.: +1 708 216 3262. (Q. Ma), (J. Fareed)
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Hoppensteadt DA, Ciftci A, Demir M, Altiay G, Tobu M, Iqbal O, Fareed D, Bick R, Fareed J. Increased levels of inflammatory mediators in lung cancer and their modulation by oral anticoagulant treatment. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17050] [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: 11/20/2022] Open
Abstract
17050 Background: Venous thromboembolic events (VTE) are associated with lung cancer and significantly contributes to the increased mortality in these patients. While the increased prevalence of VTE is fully recognized in lung cancer, its pathogenesis is not fully understood. Even the patients undergoing therapeutic interventions are at high risk to develop VTE. These patients provide a unique clinical setting to investigate the pathogenesis of lung cancer associated thrombosis. Methods: In a prospective, randomized, controlled study patients with inoperable lung cancer (n = 100) were randomized to receive chemotherapy, radiation and warfarin (INR 1.5–2.5) or chemotherapy, radiation without warfarin (n = 50). Blood samples were drawn prior to and after the second treatment cycle with warfarin. All samples were analyzed for tumor necrosis factor alpha (TNF α), CD 40 ligand (CD 40L), C-reactive protein (CRP), interleukin 1 beta (IL-1β), asymmetric dimethylarginine (ADMA) and nitric oxide (NO). Results: Summarized in the table given below. All of the surrogate markers of inflammation showed a decreased trend (13–50%) in the warfarin treated group, whereas the non-warfarin treated group exhibited an increase (18–46%) in all markers except CRP and ADMA. Conclusions: The levels of various inflammatory markers are upregulated in lung cancer suggesting a pathogenic role of this process in lung cancer. Warfarin down regulated the inflammatory process in contrast to the non-warfarin treated group. The clinical relevance of these observations require additional analysis. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- D. A. Hoppensteadt
- Loyola University Chicago, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; Loyola University Medical Center, Maywood, IL; University of Texas Southwestern Medical School, Dallas, TX
| | - A. Ciftci
- Loyola University Chicago, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; Loyola University Medical Center, Maywood, IL; University of Texas Southwestern Medical School, Dallas, TX
| | - M. Demir
- Loyola University Chicago, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; Loyola University Medical Center, Maywood, IL; University of Texas Southwestern Medical School, Dallas, TX
| | - G. Altiay
- Loyola University Chicago, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; Loyola University Medical Center, Maywood, IL; University of Texas Southwestern Medical School, Dallas, TX
| | - M. Tobu
- Loyola University Chicago, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; Loyola University Medical Center, Maywood, IL; University of Texas Southwestern Medical School, Dallas, TX
| | - O. Iqbal
- Loyola University Chicago, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; Loyola University Medical Center, Maywood, IL; University of Texas Southwestern Medical School, Dallas, TX
| | - D. Fareed
- Loyola University Chicago, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; Loyola University Medical Center, Maywood, IL; University of Texas Southwestern Medical School, Dallas, TX
| | - R. Bick
- Loyola University Chicago, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; Loyola University Medical Center, Maywood, IL; University of Texas Southwestern Medical School, Dallas, TX
| | - J. Fareed
- Loyola University Chicago, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; Loyola University Medical Center, Maywood, IL; University of Texas Southwestern Medical School, Dallas, TX
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20
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Fareed J, Hoppensteadt DA, Demir M, Iqbal O, Jeske W, Tobu M, Bick R. Nitric oxide and asymmetric dimethylarginine (ADMA) in malignancy associated thrombosis and their modulation by anticoagulants. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10573] [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: 11/20/2022] Open
Abstract
10573 Background: Cancer associated thrombotic complications are primarily due to endothelial dysfunction and upregulation of inflammatory processes. Nitric oxide (NO) represents one of the major endothelial derived vasoactive mediators. Asymmetric dimethylarginine (ADMA) is an endogenous competitive inhibitor of NO synthase which inhibits NO production at pathophysiologic levels. Plasma ADMA levels are upregulated in atherosclerosis, hypertension, end stage renal disease, chronic heart failure and microangiopathy. Methods: To test the hypothesis that endothelial dysfunction in cancer patients may result in increased ADMA levels, plasma samples were retrospectively analyzed from an open label, multidose, active comparator designed study in which all patients (n = 110) were initially treated with low molecular weight heparin, enoxaparin (E) at 1–1.5 mg/kg sc for 5 days and further subdivided into group E which continued to receive E and warfarin (W) group which was given oral anticoagulants for a period of up to 12 weeks. Baseline blood samples (BL), 5 days post E (IPE) and 4–6 week samples from the E and W were analyzed for ADMA and NO levels by ELISA methods. Results: Both the ADMA and NO levels were markedly elevated in cancer patients. The E treated group showed a marked decrease in the ADMA levels which persisted throughout the treatment period. However, in the W converted group the ADMA levels rebounded to an increased level indicating that E differentially regulated ADMA in these patients. The down regulation pattern of NO was similar for both E and W. Conclusions: These results suggest that patients with cancer and thrombosis exhibit simultaneous upregulation of ADMA and NO. While E and W show a differential regulation of ADMA both result in downregulation of NO. The fact that E regulates ADMA is highly suggestive of its role in iNOS regulation which may be involved in the inflammatory response in cancer patients. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- J. Fareed
- Loyola University, Maywood, IL; Loyola University Medical Center, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; University of Texas Southwestern Medical School, Dallas, TX
| | - D. A. Hoppensteadt
- Loyola University, Maywood, IL; Loyola University Medical Center, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; University of Texas Southwestern Medical School, Dallas, TX
| | - M. Demir
- Loyola University, Maywood, IL; Loyola University Medical Center, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; University of Texas Southwestern Medical School, Dallas, TX
| | - O. Iqbal
- Loyola University, Maywood, IL; Loyola University Medical Center, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; University of Texas Southwestern Medical School, Dallas, TX
| | - W. Jeske
- Loyola University, Maywood, IL; Loyola University Medical Center, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; University of Texas Southwestern Medical School, Dallas, TX
| | - M. Tobu
- Loyola University, Maywood, IL; Loyola University Medical Center, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; University of Texas Southwestern Medical School, Dallas, TX
| | - R. Bick
- Loyola University, Maywood, IL; Loyola University Medical Center, Maywood, IL; Trakya University School of Medicine, Edirne, Turkey; Ege University, Izmir, Turkey; University of Texas Southwestern Medical School, Dallas, TX
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Tobu M, Ma Q, Iqbal O, Schultz C, Jeske W, Hoppensteadt DA, Fareed J. Comparative tissue factor pathway inhibitor release potential of heparins. Clin Appl Thromb Hemost 2005; 11:37-47. [PMID: 15678271 DOI: 10.1177/107602960501100104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tissue factor pathway inhibitor (TFPI) is released following the administration of unfractionated heparin, low-molecular-weight heparins, defibrotide and PI-88. In this study, the comparative effects of heparin, a low-molecular-weight heparin-gammaparin and a heparin-derived oligosaccharide mixture-subeparin (C3) were studied on functional and immunologic tissue factor pathway inhibitor activity levels in a non-human primate (Macaca mulatta) model. The dose-dependent effect was studied following intravenous and subcutaneous administration. Following the administration of 1 mg/kg of heparin, gammaparin, and C3, the functional levels of TFPI at 5 minutes were 2.40, 2.56, and 1.08 U/mL and the corresponding TFPI immunologic levels were 4.3-, 4.0-, and 2.1-fold, increased, respectively, over the baseline value. From these results, it can be concluded that heparin and gammaparin produced similar levels of TFPI release. Hence, gammaparin and heparin have similar TFPI release potential despite their differences in molecular weight. The influence of molecular weight, charge density, and interactions with heparin cofactor II on TFPI release are also discussed.
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Affiliation(s)
- M Tobu
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, Illinois 60153, USA
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Hoppensteadt D, Tobu M, Iqbal O, Cunanan J, Fareed J, Deitcher S. Hyperhomocysteinemia in cancer patients with thrombosis is not associated with methylene tetrahydrofolate reductase (MTHFR) gene mutations is down regulated by low molecular weight heparin (LMWHs) treatment. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2056] [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: 11/20/2022] Open
Affiliation(s)
| | - M. Tobu
- Loyola Univ Chicago, Maywood, IL; Nuvelo, Sunnyvale, CA
| | - O. Iqbal
- Loyola Univ Chicago, Maywood, IL; Nuvelo, Sunnyvale, CA
| | - J. Cunanan
- Loyola Univ Chicago, Maywood, IL; Nuvelo, Sunnyvale, CA
| | - J. Fareed
- Loyola Univ Chicago, Maywood, IL; Nuvelo, Sunnyvale, CA
| | - S. Deitcher
- Loyola Univ Chicago, Maywood, IL; Nuvelo, Sunnyvale, CA
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Iqbal O, Tobu M, Bansal V, Hoppensteadt D, Patel C, Wahi R, Fareed J. Enhanced Inflammatory response in cancer patients with end stage renal disease. Implications in thrombotic risk stratification. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8238] [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: 11/20/2022] Open
Affiliation(s)
- O. Iqbal
- Loyola Univ Medcl Ctr, Maywood, IL
| | - M. Tobu
- Loyola Univ Medcl Ctr, Maywood, IL
| | | | | | - C. Patel
- Loyola Univ Medcl Ctr, Maywood, IL
| | - R. Wahi
- Loyola Univ Medcl Ctr, Maywood, IL
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Fareed J, Hoppensteadt D, Cort S, Iqbal O, Bacher P, Fareed D, Tobu M, Deitcher S. Enoxaparin (E) and warfarin (W) differentially regulate tissue factor (TF), tissue factor pathway inhibitor (TFPI) and thrombin activatable fibrinolytic inhibitor (TAFI) in cancer patients with thrombosis. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.2057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Fareed
- Loyola Univ Medcl Ctr, Maywood, IL; Sanofi Aventis, Bridgewater, NJ; Ege Universitesi Tip Fakultesi Hastanesi, Izmir, Turkey; Nuvelo, Sunnyvale, CA
| | - D. Hoppensteadt
- Loyola Univ Medcl Ctr, Maywood, IL; Sanofi Aventis, Bridgewater, NJ; Ege Universitesi Tip Fakultesi Hastanesi, Izmir, Turkey; Nuvelo, Sunnyvale, CA
| | - S. Cort
- Loyola Univ Medcl Ctr, Maywood, IL; Sanofi Aventis, Bridgewater, NJ; Ege Universitesi Tip Fakultesi Hastanesi, Izmir, Turkey; Nuvelo, Sunnyvale, CA
| | - O. Iqbal
- Loyola Univ Medcl Ctr, Maywood, IL; Sanofi Aventis, Bridgewater, NJ; Ege Universitesi Tip Fakultesi Hastanesi, Izmir, Turkey; Nuvelo, Sunnyvale, CA
| | - P. Bacher
- Loyola Univ Medcl Ctr, Maywood, IL; Sanofi Aventis, Bridgewater, NJ; Ege Universitesi Tip Fakultesi Hastanesi, Izmir, Turkey; Nuvelo, Sunnyvale, CA
| | - D. Fareed
- Loyola Univ Medcl Ctr, Maywood, IL; Sanofi Aventis, Bridgewater, NJ; Ege Universitesi Tip Fakultesi Hastanesi, Izmir, Turkey; Nuvelo, Sunnyvale, CA
| | - M. Tobu
- Loyola Univ Medcl Ctr, Maywood, IL; Sanofi Aventis, Bridgewater, NJ; Ege Universitesi Tip Fakultesi Hastanesi, Izmir, Turkey; Nuvelo, Sunnyvale, CA
| | - S. Deitcher
- Loyola Univ Medcl Ctr, Maywood, IL; Sanofi Aventis, Bridgewater, NJ; Ege Universitesi Tip Fakultesi Hastanesi, Izmir, Turkey; Nuvelo, Sunnyvale, CA
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Ravindranath TM, Goto M, Demir M, Tobu M, Kujawski MF, Hoppensteadt D, Samonte V, Iqbal O, Sayeed MM, Fareed J. Tissue factor pathway inhibitor and thrombin activatable fibrinolytic inhibitor plasma levels following burn and septic injuries in rats. Clin Appl Thromb Hemost 2005; 10:379-85. [PMID: 15497025 DOI: 10.1177/107602960401000411] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Burn and septic injuries induce profound changes in coagulation status. This study examined the changes in plasma tissue factor pathway inhibitor (TFPI) and thrombin activatable fibrinolytic inhibitor (TAFI) levels in a rat model of burn and septic injuries. Rats underwent 30% TBSA cutaneous scald burn injury and septic insult was induced by caecal ligation and puncture (CLP). CLP was superimposed on burn injury to mimic the clinical model of sepsis complicating burn injury. Rats were pretreated with Cprofloxacin orally to colonize their gut with Enterococcus faecalis. TFPI and TAFI plasma levels were measured using functional activity assay kit with a chromogenic method at 24 and 72 hours following the injuries. TFPI levels decreased significantly at 24 hours in burn, CLP, and burn+CLP groups, followed by incomplete rebound recovery at 72 hours in all three groups. On the other hand, TAFI levels increased significantly at 24- and 72-hour time points in all three groups. These results suggest that burn, septic, and their combined injuries perturb coagulation cascade and thrombotic process toward the procoagulant pathway by impairing fibrinolysis.
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26
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Iqbal O, Messmore H, Fareed J, Ahmad S, Hoppensteadt D, Hazar S, Tobu M, Aziz S, Wehrmacher W. Antithrombotic agents in the treatment of severe sepsis. Expert Opin Emerg Drugs 2005; 7:111-39. [PMID: 15989540 DOI: 10.1517/14728214.7.1.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sepsis, a systemic inflammatory syndrome, is a response to infection and when associated with multiple organ dysfunction is termed severe sepsis. It remains a leading cause of mortality in the critically ill. The response to the invading microorganisms may be considered as a balance between a pro-inflammatory and an anti-inflammatory reaction. While an inadequate pro-inflammatory reaction and a strong anti-inflammatory response could lead to overwhelming infection and the death of the patient, a strong and uncontrolled pro-inflammatory response, manifested by the release of pro-inflammatory mediators may lead to microvascular thrombosis and multiple organ failure. Endotoxin triggers sepsis via the release of various mediators such as tumour necrosis factor-alpha and interleukin-1 (IL-1). These cytokines activate the complement and coagulation systems, release adhesion molecules, prostaglandins, leukotrienes, reactive oxygen species and nitric oxide. Other mediators involved in the sepsis syndrome include IL-1, -6 and -8; arachidonic acid metabolites; platelet activating factor; histamine; bradykinin; angiotensin; complement components and vasoactive intestinal peptide. These pro-inflammatory responses are counteracted by IL-10. Most of the trials targeting the different mediators of the pro-inflammatory response have failed due to a lack of correct definition of sepsis. Understanding the exact pathophysiology of the disease will enable more advanced treatment options. Targeting the coagulation system with various anticoagulant agents including, activated protein C, and tissue factor pathway inhibitor (TFPI) is a rational approach. Many clinical trials have been conducted to evaluate these agents in severe sepsis. While trials on antithrombin and TFPI were not so successful, the double-blind, placebo-controlled, Phase III trial of recombinant human activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) was successful, creating a significant decrease in mortality when compared to the placebo group. A better understanding of the pathophysiologic mechanism of severe sepsis will provide better treatment options, and combination antithrombotic treatment may provide a multipronged approach for the treatment of severe sepsis.
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Affiliation(s)
- Omer Iqbal
- Loyola University Medical Center, Maywood, Illinois 60153, USA
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27
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Iqbal O, Tobu M, Aziz S, Gerdisch M, Da Valle M, Demir M, Hoppensteadt DA, Ahmad S, Walenga JM, Fareed J. Successful Use of Recombinant Hirudin and Its Monitoring by Ecarin Clotting Time in Patients with Heparin-Induced Thrombocytopenia Undergoing Off-Pump Coronary Artery Revascularization. J Card Surg 2005; 20:42-51. [PMID: 15673409 DOI: 10.1111/j.0886-0440.2005.200316.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Refludan (lepirudin-rDNA for injection) is the first direct thrombin inhibitor approved by the United States FDA for anticoagulation to patients with heparin-induced thrombocytopenia (HIT). It was monitored by ecarin clotting time (ECT) assay in patients with HIT. Case histories and clotting parameters for three patients undergoing off-pump coronary artery revascularization procedure are discussed. The first patient received r-hirudin at a dose of 0.2 mg/kg intravenous (IV) bolus followed by 0.15 mg/kg/hour infusion. The second patient received 0.4 mg/kg IV bolus followed by infusion of 0.15 mg/kg/hour infusion. The third patient with renal failure received 0.2 mg/kg IV bolus followed by an infusion of 0.02 mg/kg/hour. Blood samples were drawn at baseline, 5 minutes post bolus and every 15 minutes during the coronary artery revascularization procedure. ECT was performed immediately on the citrated whole blood samples using the ECT cards in conjunction with the point-of-care, the thrombolytic assessment system (TAS) Analyzer (Pharmanetics, Raleigh, NC). The plasma samples were then analyzed for APTT and liquid ECT assay performed on a kinetic centrifugal analyzer (ACL 300 Plus). The ECT by cards was ideally maintained above 600 seconds during the surgical procedure. Additional boluses of Refludan were given as and when necessary (ECT < 600 sec) in order to maintain adequate anticoagulation. The calculated circulating concentrations of Refludan, following a bolus administration, based on the ECT cards, liquid ECT and APTT were 3.20 +/- 1.3, 3.51 +/- 1.35 and 2.02 +/- 1.19 microg/mL, respectively.
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Affiliation(s)
- O Iqbal
- Department of Pathology, Loyola University Medical Center, 2160 S. First Ave., Building 102, Room 2646, Maywood, IL 60153, USA.
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Florian-Kujawski MR, Hoppensteadt D, Iqbal O, Demir M, Tobu M, Fareed D, Fareed J. Role of PAI-1 and TAFI in the mediation of fibrinolytic deficit in cancer patients. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.9727] [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: 11/20/2022] Open
Affiliation(s)
- M. R. Florian-Kujawski
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey
| | - D. Hoppensteadt
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey
| | - O. Iqbal
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey
| | - M. Demir
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey
| | - M. Tobu
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey
| | - D. Fareed
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey
| | - J. Fareed
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey
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Fareed J, Iqbal O, Tobu M, Hoppensteadt DA, Cunanan J, Cort S, Deitcher S. Increased blood levels of inflammatory cytokines CRP, TNF-α, CD40L, MCP-1 and Nitric Oxide in malignancy-associated thrombosis and their modulation by a low molecular weight heparin, Enoxaparin. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6077] [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: 11/20/2022] Open
Affiliation(s)
- J. Fareed
- Loyola University, Maywood, IL; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - O. Iqbal
- Loyola University, Maywood, IL; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - M. Tobu
- Loyola University, Maywood, IL; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - D. A. Hoppensteadt
- Loyola University, Maywood, IL; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - J. Cunanan
- Loyola University, Maywood, IL; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - S. Cort
- Loyola University, Maywood, IL; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - S. Deitcher
- Loyola University, Maywood, IL; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
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Tobu M, Hoppensteadt DA, Cunanan J, Iqbal O, Demir MA, Fareed J, Deitcher S. Hyperhomocysteinemia in cancer patients with thrombosis is independent of methylene tetrahydrofolate reductase gene mutation. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6152] [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: 11/20/2022] Open
Affiliation(s)
- M. Tobu
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Cleveland Clinic, Cleveland, OH
| | - D. A. Hoppensteadt
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Cleveland Clinic, Cleveland, OH
| | - J. Cunanan
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Cleveland Clinic, Cleveland, OH
| | - O. Iqbal
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Cleveland Clinic, Cleveland, OH
| | - M. A. Demir
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Cleveland Clinic, Cleveland, OH
| | - J. Fareed
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Cleveland Clinic, Cleveland, OH
| | - S. Deitcher
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Cleveland Clinic, Cleveland, OH
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Iqbal O, Tobu M, Demir MA, Hoppensteadt D, Fareed J, Cort S, Deitcher S. Upregulation of monocyte chemotactic protein-1 and CD40 ligand in cancer patients and their modulation by subcutaneous enoxaparin-results from the ONCENOX study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6069] [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: 11/20/2022] Open
Affiliation(s)
- O. Iqbal
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - M. Tobu
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - M. A. Demir
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - D. Hoppensteadt
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - J. Fareed
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - S. Cort
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
| | - S. Deitcher
- Loyola University Medical Center, Maywood, IL; Trakya University Medical School, Edirne, Turkey; Aventis Pharmaceutical, Bridgewater, NJ; Cleveland Clinic, Cleveland, OH
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Omay SB, Saydam G, Aydın HH, Selvi N, Öktem G, Sanlı UA, Tobu M, Büyükkeçec F. Potential Involvement of Calcineurin in Regulating the State of Differentiation and Apoptosis of HL-60 Cells During Methylprednisolone-Treatment. Turk J Haematol 2003; 20:143-151. [PMID: 27265572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
To evaluate the role of calcineurin (protein phosphatase type 2B, PP2B) in methylprednisolone-induced differentiation and apoptosis of leukaemic cells, we have investigated the induction of apoptosis, calcineurin specific protein phosphatase activity and expression of regulatory and catalytic subunits of calcineurin and calmodulin after induction of HL-60 leukaemic cells with methylprednisolone. The cells underwent differentiation and apoptosis within 72 hours time period after methylprednisolone added to cell culture media. Before apoptosis occurred, the specific calcineurin enzyme activity revealed gradual increase during the differentiation process. However, immunoblots of catalytic and regulatory subunits of calcineurin showed no amplification in the amount of these cellular signaling mediators during methylprednisolone-induced differentiation and apoptosis but calmodulin expression gradually increased during the process. Significant increase in the specific calcineurin enzyme activity during differentiation and apoptosis might be crucial to the posttranslational modifications of calcineurin during methylprednisolone-induced differentiation.
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Tobu M, Florian-Kujawski MR, Hoppensteadt DA, Iqbal GMO, Bacher P, Fareed J. Considerations in the standardization of the functional and immunologic assays for human procarboxypeptidase U. Diagnostic implications. J Thromb Haemost 2003. [DOI: 10.1111/j.1538-7836.2003.tb04420.x] [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: 11/29/2022]
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Florian-Kujawski M, Hoppensteadt DA, Tobu M, Kereiakes DJ, Lewis B, Leya F, Fareed J. Plasma procarboxypeptidase U is up-regulated in patients undergoing percutaneous intervention: effects of anticoagulant dosage of low molecular weight heparins. J Thromb Haemost 2003. [DOI: 10.1111/j.1538-7836.2003.tb04435.x] [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]
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35
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Schultz C, Iqbal O, Hoppensteadt D, Ma Q, Tobu M, Florian-Kujawski M, Fareed D. Heparinase I digestion of tinzaparin: a novel approach to neutralize the anti-coagulant and potential hemorrhagic effects of low molecular weight heparin. J Thromb Haemost 2003. [DOI: 10.1111/j.1538-7836.2003.tb05405.x] [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: 11/26/2022]
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Abstract
Long-distance air travel is increasing and cases of venous thromboembolism (VTE) following air travel have attracted both considerable public attention and legal claims against airlines. VTE is a common disorder worldwide with a notably high incidence in older individuals. Many biochemical factors that lead to, or accentuate, thrombus formation are associated with increased risk of VTE. These factors include thrombophilia, activated protein C resistance and factor V Leiden, prothrombin gene mutation, antiphospholipid antibodies, protein S and protein C deficiencies, and methylene tetrahydrofolate reductase polymorphism and homocysteinemia. Individual physical characteristics including age, weight and height are significant for personal risk of VTE as are other factors such as use of oral contraceptives in women. In the case of air travel-related venous thrombosis, superimposed upon these individual factors are the environmental factors directly related to air travel. Travel-related factors include stasis associated with prolonged periods of immobility, physiological stresses resulting from exposure to the cabin environment (low humidity and hypoxia) in long-haul flight and other in-flight factors. It is suggested that passenger behavior (movement, avoidance of dehydration and of alcohol) and appropriate pharmacological prophylaxis for high-risk travelers can reduce the likelihood of VTE. Physical prophylaxis (use of compression stockings or in-flight exercise devices) may also be of general benefit to passengers. It is recommended that airlines become more proactive in educating passengers concerning the dangers of VTE and in promoting passenger actions that can reduce risk. Airlines should also work to avoid cramped seating conditions (seat size and pitch) that contribute to prolonged immobility. Governments and regulatory authorities should mandate the provision of adequate seating conditions and a good cabin environment and should support studies that will define risks and determine the efficacy of protocols to minimize dangers of VTE. Increased long-haul air traffic and an aging population suggest that travel-related VTE may present a growing healthcare threat and has highlighted a need for additional biomedical research into the causes and potential solutions to this problem.
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Affiliation(s)
- Omer Iqbal
- Department of Pathology, Loyola University Medical Center, Maywood, Ill 60153, USA.
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Tobu M, Iqbal O, Ma Q, Schultz C, Jeske W, Hoppensteadt D, Lewis B, Fareed D, Fareed J. Global anticoagulant effects of a synthetic anti-factor Xa inhibitor (DX-9065a): implications for interventional use. Clin Appl Thromb Hemost 2003; 9:1-17. [PMID: 12643318 DOI: 10.1177/107602960300900101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Heparin has been conventionally used as an anticoagulant for medical and surgical indications. Because factor Xa is an essential component of the prothrombinase complex and leads to the generation of thrombin, its inhibition has become a focus of newer antithrombotic drug development. The in vitro anticoagulant profile of DX-9065a, a synthetic direct factor Xa inhibitor, was studied using activated clotting time assay, thrombelastography, and global clotting tests, such as prothrombin time (PT), activated partial thromboplastin time (aPTT), diluted aPTT, Heptest, Heptest-HI, dilute Russell's viper venom time (dRVVT), thrombin time, ecarin clotting time, and amidolytic anti-Xa assay. In addition, the effect of DX-9065a on platelet aggregation and inhibition of thrombin generation markers (FPA, F1+2, and TAT) were studied. The pharmacokinetic and pharmacodynamic profiles of DX-9065a were also studied in a non-human primate (Macaca mulatta) model. DX-9065a produced a concentration-dependent increase in the Hemochron celite ACT and HemoTec ACT. Clotting times of 538 +/- 19 and 401 +/- 12, respectively, were reached at a concentration of 25 microg/mL signifying that DX-9065a may be useful in interventional cardiological procedures. DX-9065a prolonged the r-time on thrombelastography. DX-9065a did not show any effect on adenosine diphosphate (ADP)-, collagen-, epinephrine-, and arachidonic acid-induced platelet aggregation at concentrations up to 10 microgram/mL. DX-9065a exhibited a concentration-dependent prolongation of the PT, aPTT, diluted aPTT, Heptest, dRVVT, and reached the clotting times of 51.6, 132, 193, 47.9, 129.9 seconds, respectively, at a final concentration of 12.5 microgram/mL; compared to a control value of 10.6, 30.2, 41.9, 14, 32.2 seconds, respectively. DX-9065a did not affect the ecarin clotting time and thrombin time at concentrations up to 12.5 microgram/mL. Because DX-9065a prolonged the dRVVT, this may impact diagnostic screening of patients with systemic lupus erythematosus.
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Affiliation(s)
- Mahmut Tobu
- Department of Pathology and Pharmacology, Loyola University, Maywood, Illinois, USA
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38
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Tobu M, Iqbal O, Hoppensteadt DA, Shultz C, Jeske W, Fareed J. Effects of a synthetic factor Xa inhibitor (JTV-803) on various laboratory tests. Clin Appl Thromb Hemost 2002; 8:325-36. [PMID: 12516682 DOI: 10.1177/107602960200800404] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Synthetic direct inhibitors of factor Xa are capable of prolonging the global anticoagulant assay times in a concentration-dependent fashion. The relative degree of thrombin generation inhibition at an equivalent prolongation is not similar to the results observed with heparins and oral anticoagulant drugs. In addition, the direct factor Xa inhibitors prolong the Russell's viper venom test (RWT) and Heptest clotting times. Ecarin clotting time (ECT) and thrombin time (TT) remain unaffected. The kinetics of factor Xa inhibition are markedly different than those observed with pentasaccharide and heparins. Therefore, the methods developed for heparins and pentasaccharides may not be applicable for the monitoring of factor Xa inhibitors. To test the feasibility of using the prothrombin time (PT), International Normalized Ratio (INR), activated partial thromboplastin time (aPTT), Heptest, thrombin time, RVVT, ECT, and a modified anti-Xa amidolytic assay, to monitor a synthetic factor Xa inhibitor, normal human pool plasma samples were spiked with a synthetic factor Xa inhibitor in the concentration range of 0 to 1 microg/mL and 0 to 25 microg/mL. Different laboratory tests were performed and INR and other ratios were calculated. The anticoagulant effects on whole blood were measured using the activated clotting time (ACT). Further studies on the effect of factor Xa inhibitor on platelet aggregation; factor II, VII, and X functional levels; and fibrinopeptide A (FPA) generation were carried out at equivalent INR levels in comparison to oral anticoagulant and antithrombin agents. FPA generation at equivalent anticoagulant level in comparison to heparin (twice the baseline) was also carried out. Factor Xa inhibitor produced a concentration-dependent prolongation of the ACT. ACT was doubled at a concentration of 4 to 5 microg/mL. There was a marked difference in the prolongation of the PT by a synthetic factor Xa inhibitor dependent on the ISI of the PT reagent used. When the results were calculated to determine INR, marked variations were noted between the recombinant thromboplastin and rabbit brain thromboplastin. The rabbit brain thromboplastin reagent gave markedly high INR values. Similar results were observed when different aPTT reagents were studied. In the anti-Xa assay, modification of the incubation time was employed to extend the proper sensitivity range. These studies warrant further investigation to understand the mechanism of action of factor Xa inhibitors.
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Affiliation(s)
- Mahmut Tobu
- Loyola University Medical Center, Maywood, Illinois 60153, USA
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Iqbal O, Tobu M, Hoppenstead D, Aziz S, Messmore H, Fareed J. Antithrombotic Agents in the Management of Sepsis. Turk J Haematol 2002; 19:349-389. [PMID: 27264974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Sepsis, a systemic inflammatory syndrome, is a response to infection and when associated with multiple organ dysfunction is termed, severe sepsis. It remains a leading cause of mortality in the critically ill. The response to the invading bacteria may be considered as a balance between proinflammatory and antiinflammatory reaction. While an inadequate proinflammatory reaction and a strong antiinflammatory response could lead to overwhelming infection and death of the patient, a strong and uncontrolled proinflammatory response, manifested by the release of proinflammatory mediators may lead to microvascular thrombosis and multiple organ failure. Endotoxin triggers sepsis by releasing various mediators including tumor necrosis factor-alpha and interleukin-1(IL-1). These cytokines activate the complement and coagulation systems, release adhesion molecules, prostaglandins, leukotrienes, reactive oxygen species and nitric oxide (NO). Other mediators involved in the sepsis syndrome include IL-1, IL-6 and IL-8; arachidonic acid metabolites; platelet activating factor (PAF); histamine; bradykinin; angiotensin; complement components and vasoactive intestinal peptide. These proinflammatory responses are counteracted by IL-10. Most of the trials targeting the different mediators of proinflammatory response have failed due a lack of correct definition of sepsis. Understanding the exact pathophysiology of the disease will enable better treatment options. Targeting the coagulation system with various anticoagulant agents including antithrombin, activated protein C (APC), tissue factor pathway inhibitor (TFPI) is a rational approach. Many clinical trials have been conducted to evaluate these agents in severe sepsis. While trials on antithrombin and TFPI were not so successful, the double-blind, placebo-controlled, phase III trial of recombinant human activated protein C worldwide evaluation in severe sepsis (PROWESS) was successful, significantly decreasing mortality when compared to the placebo group. Better understanding of the pathophysiologic mechanism of severe sepsis will provide better treatment options. Combination antithrombotic therapy may provide a multipronged approach for the treatment of severe sepsis.
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Ahmad S, Iqbal O, Tobu M, Demir M. Immunobiology and Pathophysiology of Heparin-Induced Thrombocytopenia/ Thrombosis Syndrome-An Update. Turk J Haematol 2002; 19:127-131. [PMID: 27264753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Heparin-induced thrombocytopenia (HIT) syndrome is one of the more frequent and dangerous autoimmune complications of heparin therapy in clinical setting. It is now widely accepted that heparins are capable of complexing with endogenous chemokines and modify at molecular level to trigger the HIT-associated antibodies responsible for pathogenesis. Newer evidence suggests a functional heterogeneity in the HIT antibodies. Besides platelet factor IV (PF IV), there are several endogenous factors, which are responsible for the upregulation of HIT antibodies in various prophylactic and therapeutic regimens. While the pathophysiology and the mechanisms of action in HIT are rather complex, the role of IgG subtype antibodies is clearly established in mediating the pathogenesis. Currently available antithrombin drugs seem to be promising therapeutic modalities to combat the severe thrombotic episode and platelet activation associated with HIT. The clinical relevance of the pathologically nonfunctional HIT antibodies and the mechanism(s) of their formation, in terms of both correlative evidence and causal relationships, need further investigation.
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Iqbal O, Tobu M, Demir M, Fareed J, Aziz S, Messmore H. The Role of Thrombolytic Drugs in the Management of Acute Myocardial Infarction and Stroke. Turk J Haematol 2002; 19:151-177. [PMID: 27264756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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Aydin HH, Selvi N, Saydam G, Tobu M, Uzunoglu S, Uslu R, Buyukkececi F, Omay SB. Up-regulation of serine/threonine protein phosphatase type 2A regulatory subunits during methylprednisolone-induced differentiation of leukaemic HL-60 cells. Clin Lab Haematol 2000; 22:271-4. [PMID: 11122267 DOI: 10.1046/j.1365-2257.2000.00326.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Serine/threonine protein phosphatase 2A (PP2A) may play a role in leukaemic cell differentiation of the HL-60 myeloid leukaemic cell-line after methylprednisolone induction. We have investigated the specific enzyme activity and expression of catalytic and regulatory subunits of PP2A. The resulting specific enzyme activity and immunoblots showed an increase in enzyme activity and the expression of regulatory subunits after methylprednisolone treatment. There was no change in the expression of PP2A catalytic subunits. It is suggested that the effect of methylprednisolone on leukaemic differentiation may be the result of PP2A upregulation.
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Affiliation(s)
- H H Aydin
- Ege University School of Medicine Department of Biochemistry, Bornova 35100, Izmir, Turkey
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Uzunoglu S, Uslu R, Tobu M, Saydam G, Terzioglu E, Buyukkececi F, Omay SB. Augmentation of methylprednisolone-induced differentiation of myeloid leukemia cells by serine/threonine protein phosphatase inhibitors. Leuk Res 1999; 23:507-12. [PMID: 10374865 DOI: 10.1016/s0145-2126(99)00040-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To elucidate the roles of serine/threonine protein phosphatases type 1 (PP1) and type 2A (PP2A) in methylprednisolone-induced differentiation of HL60 cells into granulocytes and K562 cells into monocytes, we examined the effect of serine/threonine protein phosphatase inhibitors, okadaic acid and Cal-A on the proliferation/differentiation of HL60 and K562 cells. Okadaic acid and Cal-A augmented methylprednisolone induced granulocytic differentiation and cell death of HL60 cells and monocytic differentiation and cell death of K562 cells in different dose ranges, respectively. These data suggest an important role of PP1 and PP2A in the mechanism leading to differentiation of leukemic cells.
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Affiliation(s)
- S Uzunoglu
- Department of Molecular Biology, Celal Bayar University, Faculty of Science and Arts, Manisa, Turkey
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Ok E, Kursat S, Alev M, Tobu M, Tokat Y, Akcicek F, Hoscoskun C, Basci A. Further evidence of favorable effects of gemfibrozil on the lipid profile in renal allograft recipients. Nephron Clin Pract 1996; 73:491-2. [PMID: 8832618 DOI: 10.1159/000189121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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