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van der Sluijs KM, Bakker EA, Schuijt TJ, Joseph J, Kavousi M, Geersing GJ, Rutten FH, Hartman YAW, Thijssen DHJ, Eijsvogels TMH. Long-term cardiovascular health status and physical functioning of nonhospitalized patients with COVID-19 compared with non-COVID-19 controls. Am J Physiol Heart Circ Physiol 2023; 324:H47-H56. [PMID: 36459448 PMCID: PMC9870581 DOI: 10.1152/ajpheart.00335.2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is reported to have long-term effects on cardiovascular health and physical functioning, even in the nonhospitalized population. The physiological mechanisms underlying these long-term consequences are however less well described. We compared cardiovascular risk factors, arterial stiffness, and physical functioning in nonhospitalized patients with COVID-19, at a median of 6 mo postinfection, versus age- and sex-matched controls. Cardiovascular risk was assessed using blood pressure and biomarker concentrations (amino-terminal pro-B-type-natriuretic-peptide, high-sensitive cardiac troponin I, C-reactive protein), and arterial stiffness was assessed using carotid-femoral pulse wave velocity. Physical functioning was evaluated using accelerometry, handgrip strength, gait speed and questionnaires on fatigue, perceived general health status, and health-related quality of life (hrQoL). We included 101 former patients with COVID-19 (aged 59 [interquartile range, 55-65] yr, 58% male) and 101 controls. At 175 [126-235] days postinfection, 32% of the COVID-19 group reported residual symptoms, notably fatigue, and 7% required post-COVID-19 care. We found no differences in blood pressure, biomarker concentrations, or arterial stiffness between both groups. Former patients with COVID-19 showed a higher handgrip strength (43 [33-52] vs. 38 [30-48] kg, P = 0.004) and less sleeping time (8.8 [7.7-9.4] vs. 9.8 [8.9-10.3] h/day, P < 0.001) and reported fatigue more often than controls. Accelerometry-based habitual physical activity levels, gait speed, perception of general health status, and hrQoL were not different between groups. In conclusion, one in three nonhospitalized patients with COVID-19 reports residual symptoms at a median of 6 mo postinfection, but we were unable to relate these symptoms to increases in cardiovascular risk factors, arterial stiffness, or physical dysfunction.NEW & NOTEWORTHY We examined cardiovascular and physical functioning outcomes in nonhospitalized patients with COVID-19, at a median of 6 mo postinfection. When compared with matched controls, minor differences in physical functioning were found, but objective measures of cardiovascular risk and arterial stiffness did not differ between groups. However, one in three former patients with COVID-19 reported residual symptoms, notably fatigue. Follow-up studies should investigate the origins of residual symptoms and their long-term consequences in former, nonhospitalized patients with COVID-19.
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Affiliation(s)
- Koen M. van der Sluijs
- 1Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Esmée A. Bakker
- 1Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim J. Schuijt
- 2Clinical Chemistry and Hematology Laboratory, Hospital Gelderse Vallei Ede, Ede, The Netherlands
| | - Jayaraj Joseph
- 3Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, India
| | - Maryam Kavousi
- 4Department of Epidemiology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Geert-Jan Geersing
- 5Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H. Rutten
- 5Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Yvonne A. W. Hartman
- 1Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dick H. J. Thijssen
- 1Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thijs M. H. Eijsvogels
- 1Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Van Der Sluijs KM, Bakker EA, Schuijt TJ, Joseph J, Thijssen DHJ, Eijsvogels TMH. Long-term cardiovascular health and physical functioning of non-hospitalised ex-COVID-19 patients: a case-control study. Eur J Prev Cardiol 2022. [PMCID: PMC9384083 DOI: 10.1093/eurjpc/zwac056.167] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation (Nederlandse Hartstichting) Background/Introduction SARS-CoV-2 and the associated coronavirus disease 2019 (COVID-19) has substantial acute effects on cardiovascular health and physical functioning, but the long-term effects are less clear, especially in individuals that recover from COVID-19 at home, representing ~95% of all cases. Purpose We compared cardiovascular health and physical functioning of non-hospitalised ex-COVID-19 patients versus age- and sex-matched healthy peers. Methods We recruited non-hospitalised adults with PCR-proven COVID-19 and age- and sex-matched controls for this case-control study. Duration of COVID-19 illness and presence of residual complaints were inquired. Cardiovascular health status and physical functioning were assessed through a series of measurements: blood pressure, blood biomarkers (NT-proBNP, high-sensitive cardiac troponin I, C-reactive protein), carotid-femoral pulse wave velocity (ARTSENS), handgrip strength, 4-metre gait speed, habitual physical activity (days per week with at least 30 minutes of moderate physical activity) and quality of life based on the 12-item short form. Results We included 101 ex-COVID-19 patients (median age 59.0 [54.5-65.5], 59 (58.4%) male) at a median of 5.0 [4.0-7.0] months post-infection and 101 age- and sex-matched controls (median age 58.0 [54.0-64.5], 58 (57.4%) male). Median duration of COVID-19 illness was 8.0 days [6.0-14.0] and 32.3% of the cases reported residual complaints at the time of inclusion. We found no differences between ex-COVID-19 patients and controls in blood pressure (134-81 vs. 133-81 mmHg, p=0.40 and p=0.30 for systolic and diastolic pressures respectively), concentrations of NT-proBNP (8.50 vs. 7.00 pmol/L, p=0.22), high-sensitive cardiac troponin I (4.11 vs. 3.38 ng/L, p=0.06), C-reactive protein (4.00 vs. 4.00 mg/L, p=0.93) and carotid-femoral pulse wave velocity (6.63 vs. 7.01 m/s, p=0.30). Ex-COVID-19 patients showed higher handgrip strength compared to controls (43 kg vs. 38 kg, p=0.004), but 4-metre gait speed (2.62 vs. 2.56 s, p=0.33), habitual physical activity levels (6.0 vs. 6.0 days, p=0.16) and reported quality of life (86.4% vs. 88.6%, p=0.10) were not different between groups. Conclusion(s) Cardiovascular health and physical functioning parameters were not different between non-hospitalised ex-COVID-19 patients and age- and sex-matched controls at five months post-infection. This suggests that individuals who recovered from COVID-19 at home do not have an increased cardiovascular risk or impaired physical functioning in the long-term.
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Affiliation(s)
- KM Van Der Sluijs
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - EA Bakker
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - TJ Schuijt
- Gelderse Vallei Hospital, Clinical Chemistry and Hematology Laboratory, Ede, Netherlands (The)
| | - J Joseph
- Indian Institute of Technology (IIT) Madras, Department of Electrical Engineering, Chennai, India
| | - DHJ Thijssen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands (The)
| | - TMH Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, Netherlands (The)
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Maag A, van Rein N, Schuijt TJ, Kopatz WF, Kruijswijk D, Thomassen S, Hackeng TM, Camire RM, van der Poll T, Meijers JCM, Bos MHA, van ’t Veer C. Major bleeding during oral anticoagulant therapy associated with factor V activation by factor Xa. J Thromb Haemost 2022; 20:328-338. [PMID: 34773381 PMCID: PMC9299225 DOI: 10.1111/jth.15589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Plasma thrombin generation (TG) provides important information on coagulation status; however, current TG output parameters do not predict major bleeding of patients on anticoagulants. We recently reported that factor V (FV) activation by factor X (FX)a contributes importantly to the initiation phase of TG. Here we investigated how this pathway varies in the normal population and whether FXa-mediated activation of FV is associated with major bleeding in patients on anticoagulant therapy. APPROACH We employed TIX-5, a specific inhibitor of FV activation by FXa, to estimate the contribution of FXa-mediated FV activation to tissue factor (TF)-initiated TG. RESULTS We show that the contribution of this pathway to plasma TG varies considerably in the normal population, as measured by the time needed to form the first traces of thrombin (TG lag time; mean prolongation by TIX-5 40%, range 0%-116%). Comparing patients on vitamin K antagonists (VKA) of the BLEED study (263 patients with and 538 patients without major bleeding), showed a marked prolongation in the median TG lag time in the presence of TIX-5 in cases (12.83 versus 11.00 minutes, P = 0.0030), while the TG lag time without TIX-5 only showed a minor although significant difference (5.83 vs. 5.67 minutes, P = 0.0198). The TIX-5 sensitivity (lag time + TIX-5/lag time + vehicle) in the upper quartile was associated with a 1.62-fold (95% confidence interval 1.04-2.52) increased risk of major bleeding compared to the lowest quartile. CONCLUSION A greater dependence on FXa-mediated activation of FV of TG is associated with increased risk of major bleeding during VKA therapy.
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Affiliation(s)
- Anja Maag
- Center for Experimental and Molecular MedicineAmsterdam Infection and Immunity Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Division of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
| | - Nienke van Rein
- Division of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of Clinical Pharmacy and ToxicologyLeiden University Medical CenterLeidenthe Netherlands
| | - Tim J. Schuijt
- Clinical Chemistry and Hematology LaboratoryHospital Gelderse Vallei EdeEdethe Netherlands
| | - Wil F. Kopatz
- Department of Experimental Vascular MedicineAmsterdam Cardiovascular Sciences, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Danielle Kruijswijk
- Center for Experimental and Molecular MedicineAmsterdam Infection and Immunity Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Stella Thomassen
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtthe Netherlands
| | - Tilman M. Hackeng
- Department of BiochemistryCardiovascular Research Institute MaastrichtMaastricht UniversityMaastrichtthe Netherlands
| | - Rodney M. Camire
- Division of Hematology and the Perelman Center for Cellular and Molecular TherapeuticsChildren’s Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
- Department of PediatricsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Tom van der Poll
- Center for Experimental and Molecular MedicineAmsterdam Infection and Immunity Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
| | - Joost C. M. Meijers
- Department of Experimental Vascular MedicineAmsterdam Cardiovascular Sciences, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
- Department of Molecular and Cellular HemostasisSanquin ResearchAmsterdamthe Netherlands
| | - Mettine H. A. Bos
- Division of Thrombosis and HemostasisLeiden University Medical CenterLeidenthe Netherlands
| | - Cornelis van ’t Veer
- Center for Experimental and Molecular MedicineAmsterdam Infection and Immunity Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamthe Netherlands
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Maag A, Sharma P, Schuijt TJ, Kopatz WF, Kruijswijk D, Marquart JA, van der Poll T, Hackeng TM, Nicolaes GAF, Meijers JCM, Bos MHA, van ’t Veer C. Structure-function of anticoagulant TIX-5, the inhibitor of factor Xa-mediated FV activation. J Thromb Haemost 2021; 19:1697-1708. [PMID: 33829620 PMCID: PMC8360041 DOI: 10.1111/jth.15329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/05/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND The prothrombinase complex consists of factors Xa (FXa) and Va (FVa) on an anionic phospholipid surface and converts prothrombin into thrombin. Both coagulation factors require activation before complex assembly. We recently identified TIX-5, a unique anticoagulant tick protein that specifically inhibits FXa-mediated activation of FV. Because TIX-5 inhibited thrombin generation in blood plasma, it was concluded that FV activation by FXa contributes importantly to coagulation. OBJECTIVE We aimed to unravel the structure-function relationships of TIX-5. METHOD We used a structure model generated based on homology with the allergen Der F7. RESULTS Tick inhibitor of factor Xa toward FV was predicted to consist of a single rod formed by several beta sheets wrapped around a central C-terminal alpha helix. By mutagenesis we could show that two hydrophobic loops at one end of the rod mediate the phospholipid binding of TIX-5. On the other end of the rod an FV interaction region was identified on one side, whereas on the other side an EGK sequence was identified that could potentially form a pseudosubstrate of FXa. All three interaction sites were important for the anticoagulant properties of TIX-5 in a tissue factor-initiated thrombin generation assay as well as in the inhibition of FV activation by FXa in a purified system. CONCLUSION The structure-function properties of TIX-5 are in perfect agreement with a protein that inhibits the FXa-mediated activation on a phospholipid surface. The present elucidation of the mechanism of action of TIX-5 will aid in deciphering the processes involved in the initiation phase of blood coagulation.
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Affiliation(s)
- Anja Maag
- Amsterdam UMCUniversity of AmsterdamCenter for Experimental and Molecular MedicineAmsterdam Infection and Immunity InstituteAmsterdamThe Netherlands
- Division of Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Priyanka Sharma
- Amsterdam UMCUniversity of AmsterdamCenter for Experimental and Molecular MedicineAmsterdam Infection and Immunity InstituteAmsterdamThe Netherlands
| | - Tim J. Schuijt
- Hospital Gelderse Vallei EdeClinical Chemistry and Hematology LaboratoryEdeThe Netherlands
| | - Wil F. Kopatz
- Department of Experimental Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Daniëlle Kruijswijk
- Amsterdam UMCUniversity of AmsterdamCenter for Experimental and Molecular MedicineAmsterdam Infection and Immunity InstituteAmsterdamThe Netherlands
| | - J. Arnoud Marquart
- Department of Molecular and Cellular HemostasisSanquin ResearchAmsterdamThe Netherlands
| | - Tom van der Poll
- Amsterdam UMCUniversity of AmsterdamCenter for Experimental and Molecular MedicineAmsterdam Infection and Immunity InstituteAmsterdamThe Netherlands
| | - Tilman M. Hackeng
- Department of BiochemistryCardiovascular Research Institute Maastricht (CARIM) Maastricht UniversityMaastrichtThe Netherlands
| | - Gerry A. F. Nicolaes
- Department of BiochemistryCardiovascular Research Institute Maastricht (CARIM) Maastricht UniversityMaastrichtThe Netherlands
| | - Joost C. M. Meijers
- Department of Experimental Vascular MedicineAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Department of Molecular and Cellular HemostasisSanquin ResearchAmsterdamThe Netherlands
| | - Mettine H. A. Bos
- Division of Thrombosis and HemostasisLeiden University Medical CenterLeidenThe Netherlands
| | - Cornelis van ’t Veer
- Amsterdam UMCUniversity of AmsterdamCenter for Experimental and Molecular MedicineAmsterdam Infection and Immunity InstituteAmsterdamThe Netherlands
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Zegers SAM, Smit Y, Saes JL, van Duren C, Schuijt TJ, van Heerde WL, Schols SEM. Diagnostic work up of patients with increased bleeding tendency. Haemophilia 2019; 26:269-277. [PMID: 31886943 PMCID: PMC7155060 DOI: 10.1111/hae.13922] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/30/2019] [Accepted: 12/06/2019] [Indexed: 12/13/2022]
Abstract
Introduction The diagnostic trajectory of patients with increased bleeding tendency can be very costly and time‐consuming. In addition, previous studies have shown that half of these patients remain without final diagnosis despite all efforts. Aim This study aimed to improve insight into the current diagnostic process of these patients. Methods A total of 117 adult patients, referred to an academic hospital because of being suspected to have an increased bleeding tendency, were included. Different parameters were compared between patients receiving final diagnosis, patients without final diagnosis but a high Tosetto bleeding assessment tool (BAT) score (classified as bleeding of unknown cause, or BUC) and a control group consisting of patients without final diagnosis and a low BAT score. Results The BAT score was significantly higher in patients in the BUC group as compared to patients reaching final diagnosis (8.1 vs 4.9). Interestingly, the two subcategories most prevalently increased were surgery and post‐partum haemorrhage‐associated bleeding (surgery: 2.1 vs 1.1; post‐partum haemorrhage: 0.7 vs 0.0). Laboratory screening results were more often abnormal in patients reaching final diagnosis compared to patients remaining without diagnosis and a high BAT score (n = 32 (78%) vs n = 14 (46%), 95% CI 1.5‐12), especially concerning the PFA (=27 (66%) vs n = 10 (33%), 95% CI 1.4‐10) and von Willebrand factor activity levels (n = 11 (27%) vs n = 1 (3%), 95% CI 1.3‐91). Conclusion Isolated high bleeding score on surgical or post‐partum bleeding correlates with a lower chance of receiving final diagnosis. Withholding extensive haemostatic testing should be considered. Better screening and confirmative haemostatic assays are still needed.
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Affiliation(s)
- Suzanne A M Zegers
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yolba Smit
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joline L Saes
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands.,Haemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Clint van Duren
- Department of Laboratory Medicine, Laboratory of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim J Schuijt
- Department of Laboratory Medicine, Laboratory of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Waander L van Heerde
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands.,Haemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Radboud University Medical Center, Nijmegen, The Netherlands.,Enzyre BV, Novio Tech Campus, Nijmegen, The Netherlands
| | - Saskia E M Schols
- Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands.,Haemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Radboud University Medical Center, Nijmegen, The Netherlands
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Schuijt TJ, Boss DS, Musson REA, Demir AY. Influence of point-of-care C-reactive protein testing on antibiotic prescription habits in primary care in the Netherlands. Fam Pract 2018; 35:179-185. [PMID: 28973636 DOI: 10.1093/fampra/cmx081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bacterial resistance to antibiotics represents a serious global challenge that is associated with high morbidity and mortality. One of the most important causes of this threat is antibiotic overuse. The Dutch College of General Practitioners (DCGP) recommends the use of point-of-care (POC) testing for C-reactive protein (CRP) in two guidelines ('Acute Cough' and 'Diverticulitis') to achieve a more sensible prescription pattern of antibiotics. OBJECTIVE To evaluate the use of POC-CRP testing in light of the DCGP guidelines and the effect of CRP measurements on antibiotic prescription policy in primary care. METHODS In a prospective observational study, which included 1756 patients, general practitioners (GPs) were asked to complete a questionnaire after every POC-CRP testing, stating the indication for performing the test, the CRP result and their decision whether or not to prescribe antibiotics. Indications were verified against the DCGP guidelines and categorized. Antibiotic prescription was evaluated in relation to CRP concentrations. RESULTS AND CONCLUSION Indications to perform POC-CRP test and the prescription pattern of antibiotics based on CRP value varied considerably between GPs. Differences in antibiotic prescription rate were most obvious in patients who presented with CRP values between 20 and 100 mg/l, and could in part be explained by the indication for performing POC-CRP test and patient age. Most GPs followed the DCGP guidelines and used low CRP values to underpin their decision to refrain from antibiotic prescription. Peer-based reflection on differences in POC-CRP usage and antibiotic prescription rate amongst GPs may further nourish a more critical approach to prescription of antibiotics.
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Affiliation(s)
- Tim J Schuijt
- Laboratory for Clinical Chemistry and Haematology, Meander Medical Center, Amersfoort, The Netherlands
| | - David S Boss
- Laboratory for Clinical Chemistry and Haematology, Meander Medical Center, Amersfoort, The Netherlands.,SALTRO, Diagnostic Center for Primary Care, Utrecht, The Netherlands
| | - Ruben E A Musson
- Laboratory for Clinical Chemistry and Haematology, Meander Medical Center, Amersfoort, The Netherlands.,Laboratory for Clinical Chemistry and Haematology, University Medical Center, Utrecht, The Netherlands
| | - Ayse Y Demir
- Laboratory for Clinical Chemistry and Haematology, Meander Medical Center, Amersfoort, The Netherlands
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Narasimhan S, Schuijt TJ, Abraham NM, Rajeevan N, Coumou J, Graham M, Robson A, Wu MJ, Daffre S, Hovius JW, Fikrig E. Modulation of the tick gut milieu by a secreted tick protein favors Borrelia burgdorferi colonization. Nat Commun 2017; 8:184. [PMID: 28775250 PMCID: PMC5543126 DOI: 10.1038/s41467-017-00208-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 06/12/2017] [Indexed: 01/07/2023] Open
Abstract
The Lyme disease agent, Borrelia burgdorferi, colonizes the gut of the tick Ixodes scapularis, which transmits the pathogen to vertebrate hosts including humans. Here we show that B. burgdorferi colonization increases the expression of several tick gut genes including pixr, encoding a secreted gut protein with a Reeler domain. RNA interference-mediated silencing of pixr, or immunity against PIXR in mice, impairs the ability of B. burgdorferi to colonize the tick gut. PIXR inhibits bacterial biofilm formation in vitro and in vivo. Abrogation of PIXR function in vivo results in alterations in the gut microbiome, metabolome and immune responses. These alterations influence the spirochete entering the tick gut in multiple ways. PIXR abrogation also impairs larval molting, indicative of its role in tick biology. This study highlights the role of the tick gut in actively managing its microbiome, and how this impacts B. burgdorferi colonization of its arthropod vector. Borrelia burgdorferi, the causative agent of Lyme disease, is transmitted by the tick Ixodes scapularis. Here, the authors show that a tick secreted protein (PIXR) modulates the tick gut microbiota and facilitates B. burgdorferi colonization.
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Affiliation(s)
- Sukanya Narasimhan
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06420, USA.
| | - Tim J Schuijt
- Department of Internal Medicine, Division of Infectious Diseases, Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, AZ, 1105, The Netherlands
| | - Nabil M Abraham
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06420, USA.,Howard Hughes Medical Institute, Chevy Chase, MD, 20815, USA
| | - Nallakkandi Rajeevan
- Yale Centre for Medical Informatics, 300 George Street, New Haven, CT, 06511, USA.,Clinical Epidemiology Research Centre, VA Cooperative Studies Program, West Haven, CT, 06516, USA
| | - Jeroen Coumou
- Department of Internal Medicine, Division of Infectious Diseases, Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, AZ, 1105, The Netherlands
| | - Morven Graham
- Yale Centre for Cellular and Molecular Imaging, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Andrew Robson
- Program in Vertebrate Developmental Biology, Departments of Pediatrics and Genetics, Yale University School of Medicine, New Haven, CT, 06420, USA
| | - Ming-Jie Wu
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06420, USA
| | - Sirlei Daffre
- Departamento de Parasitologia, Universidade de São Paulo, São Paulo, 05508-900, Brazil
| | - Joppe W Hovius
- Department of Internal Medicine, Division of Infectious Diseases, Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, AZ, 1105, The Netherlands
| | - Erol Fikrig
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06420, USA. .,Howard Hughes Medical Institute, Chevy Chase, MD, 20815, USA.
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8
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Affiliation(s)
- Jacqueline M Lankelma
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tim J Schuijt
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - W Joost Wiersinga
- Department of Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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9
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Schuijt TJ, Lankelma JM, Scicluna BP, de Sousa e Melo F, Roelofs JJTH, de Boer JD, Hoogendijk AJ, de Beer R, de Vos A, Belzer C, de Vos WM, van der Poll T, Wiersinga WJ. The gut microbiota plays a protective role in the host defence against pneumococcal pneumonia. Gut 2016. [PMID: 26511795 DOI: 10.1136/gutjnl- 2015-309728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Pneumonia accounts for more deaths than any other infectious disease worldwide. The intestinal microbiota supports local mucosal immunity and is increasingly recognised as an important modulator of the systemic immune system. The precise role of the gut microbiota in bacterial pneumonia, however, is unknown. Here, we investigate the function of the gut microbiota in the host defence against Streptococcus pneumoniae infections. DESIGN We depleted the gut microbiota in C57BL/6 mice and subsequently infected them intranasally with S. pneumoniae. We then performed survival and faecal microbiota transplantation (FMT) experiments and measured parameters of inflammation and alveolar macrophage whole-genome responses. RESULTS We found that the gut microbiota protects the host during pneumococcal pneumonia, as reflected by increased bacterial dissemination, inflammation, organ damage and mortality in microbiota-depleted mice compared with controls. FMT in gut microbiota-depleted mice led to a normalisation of pulmonary bacterial counts and tumour necrosis factor-α and interleukin-10 levels 6 h after pneumococcal infection. Whole-genome mapping of alveolar macrophages showed upregulation of metabolic pathways in the absence of a healthy gut microbiota. This upregulation correlated with an altered cellular responsiveness, reflected by a reduced responsiveness to lipopolysaccharide and lipoteichoic acid. Compared with controls, alveolar macrophages derived from gut microbiota-depleted mice showed a diminished capacity to phagocytose S. pneumoniae. CONCLUSIONS This study identifies the intestinal microbiota as a protective mediator during pneumococcal pneumonia. The gut microbiota enhances primary alveolar macrophage function. Novel therapeutic strategies could exploit the gut-lung axis in bacterial infections.
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Affiliation(s)
- Tim J Schuijt
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Clinical Chemistry, Hematology and Immunology, Diakonessenhuis Utrecht, The Netherlands
| | - Jacqueline M Lankelma
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Brendon P Scicluna
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Felipe de Sousa e Melo
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J Daan de Boer
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arjan J Hoogendijk
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Regina de Beer
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Alex de Vos
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Clara Belzer
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
| | - Willem M de Vos
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands Department of Bacteriology & Immunology, Helsinki University, Helsinki, Finland
| | - Tom van der Poll
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Schuijt TJ, Lankelma JM, Scicluna BP, de Sousa e Melo F, Roelofs JJTH, de Boer JD, Hoogendijk AJ, de Beer R, de Vos A, Belzer C, de Vos WM, van der Poll T, Wiersinga WJ. The gut microbiota plays a protective role in the host defence against pneumococcal pneumonia. Gut 2016; 65:575-83. [PMID: 26511795 PMCID: PMC4819612 DOI: 10.1136/gutjnl-2015-309728] [Citation(s) in RCA: 500] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/20/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Pneumonia accounts for more deaths than any other infectious disease worldwide. The intestinal microbiota supports local mucosal immunity and is increasingly recognised as an important modulator of the systemic immune system. The precise role of the gut microbiota in bacterial pneumonia, however, is unknown. Here, we investigate the function of the gut microbiota in the host defence against Streptococcus pneumoniae infections. DESIGN We depleted the gut microbiota in C57BL/6 mice and subsequently infected them intranasally with S. pneumoniae. We then performed survival and faecal microbiota transplantation (FMT) experiments and measured parameters of inflammation and alveolar macrophage whole-genome responses. RESULTS We found that the gut microbiota protects the host during pneumococcal pneumonia, as reflected by increased bacterial dissemination, inflammation, organ damage and mortality in microbiota-depleted mice compared with controls. FMT in gut microbiota-depleted mice led to a normalisation of pulmonary bacterial counts and tumour necrosis factor-α and interleukin-10 levels 6 h after pneumococcal infection. Whole-genome mapping of alveolar macrophages showed upregulation of metabolic pathways in the absence of a healthy gut microbiota. This upregulation correlated with an altered cellular responsiveness, reflected by a reduced responsiveness to lipopolysaccharide and lipoteichoic acid. Compared with controls, alveolar macrophages derived from gut microbiota-depleted mice showed a diminished capacity to phagocytose S. pneumoniae. CONCLUSIONS This study identifies the intestinal microbiota as a protective mediator during pneumococcal pneumonia. The gut microbiota enhances primary alveolar macrophage function. Novel therapeutic strategies could exploit the gut-lung axis in bacterial infections.
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Affiliation(s)
- Tim J Schuijt
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Clinical Chemistry, Hematology and Immunology, Diakonessenhuis Utrecht, The Netherlands
| | - Jacqueline M Lankelma
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Brendon P Scicluna
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Felipe de Sousa e Melo
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J Daan de Boer
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arjan J Hoogendijk
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Regina de Beer
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Alex de Vos
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Clara Belzer
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands
| | - Willem M de Vos
- Laboratory of Microbiology, Wageningen University, Wageningen, The Netherlands,Department of Bacteriology & Immunology, Helsinki University, Helsinki, Finland
| | - Tom van der Poll
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Medicine, Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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11
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Wagemakers A, Coumou J, Schuijt TJ, Oei A, Nijhof AM, van 't Veer C, van der Poll T, Bins AD, Hovius JWR. An Ixodes ricinus Tick Salivary Lectin Pathway Inhibitor Protects Borrelia burgdorferi sensu lato from Human Complement. Vector Borne Zoonotic Dis 2016; 16:223-8. [PMID: 26901751 DOI: 10.1089/vbz.2015.1901] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We previously identified tick salivary lectin pathway inhibitor (TSLPI) in Ixodes scapularis, a vector for Borrelia burgdorferi sensu stricto (s.s.) in North America. TSLPI is a salivary protein facilitating B. burgdorferi s.s. transmission and acquisition by inhibiting the host lectin complement pathway through interference with mannose binding lectin (MBL) activity. Since Ixodes ricinus is the predominant vector for Lyme borreliosis in Europe and transmits several complement sensitive B. burgdorferi sensu lato (s.l.) strains, we aimed to identify, describe, and characterize the I. ricinus ortholog of TSLPI. METHODS We performed (q)PCRs on I. ricinus salivary gland cDNA to identify a TSLPI ortholog. Next, we generated recombinant (r)TSLPI in a Drosophila expression system and examined inhibition of the MBL complement pathway and complement-mediated killing of B. burgdorferi s.l. in vitro. RESULTS We identified a TSLPI ortholog in I. ricinus salivary glands with 93% homology at the RNA and 89% at the protein level compared to I. scapularis TSLPI, which was upregulated during tick feeding. In silico analysis revealed that TSLPI appears to be part of a larger family of Ixodes salivary proteins among which I. persulcatus basic tail salivary proteins and I. scapularis TSLPI and Salp14. I. ricinus rTSLPI inhibited the MBL complement pathway and protected B. burgdorferi s.s. and Borrelia garinii from complement-mediated killing. CONCLUSION We have identified a TSLPI ortholog, which protects B. burgdorferi s.l. from complement-mediated killing in I. ricinus, the major vector for tick-borne diseases in Europe.
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Affiliation(s)
- Alex Wagemakers
- 1 Center for Experimental and Molecular Medicine, Academic Medical Center , Amsterdam, the Netherlands
| | - Jeroen Coumou
- 1 Center for Experimental and Molecular Medicine, Academic Medical Center , Amsterdam, the Netherlands
| | - Tim J Schuijt
- 1 Center for Experimental and Molecular Medicine, Academic Medical Center , Amsterdam, the Netherlands
| | - Anneke Oei
- 2 Department of Medical Microbiology, Academic Medical Center , Amsterdam, the Netherlands
| | - Ard M Nijhof
- 3 Institute of Parasitology and Tropical Veterinary Medicine , Berlin, Germany
| | - Cornelis van 't Veer
- 1 Center for Experimental and Molecular Medicine, Academic Medical Center , Amsterdam, the Netherlands
| | - Tom van der Poll
- 1 Center for Experimental and Molecular Medicine, Academic Medical Center , Amsterdam, the Netherlands
| | - Adriaan D Bins
- 1 Center for Experimental and Molecular Medicine, Academic Medical Center , Amsterdam, the Netherlands
| | - Joppe W R Hovius
- 1 Center for Experimental and Molecular Medicine, Academic Medical Center , Amsterdam, the Netherlands
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12
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Jongerius I, Schuijt TJ, Mooi FR, Pinelli E. Complement evasion by Bordetella pertussis: implications for improving current vaccines. J Mol Med (Berl) 2015; 93:395-402. [PMID: 25686752 PMCID: PMC4366546 DOI: 10.1007/s00109-015-1259-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/19/2015] [Accepted: 01/27/2015] [Indexed: 12/17/2022]
Abstract
Bordetella pertussis causes whooping cough or pertussis, a highly contagious disease of the respiratory tract. Despite high vaccination coverage, reported cases of pertussis are rising worldwide and it has become clear that the current vaccines must be improved. In addition to the well-known protective role of antibodies and T cells during B. pertussis infection, innate immune responses such as the complement system play an essential role in B. pertussis killing. In order to evade this complement activation and colonize the human host, B. pertussis expresses several molecules that inhibit complement activation. Interestingly, one of the known complement evasion proteins, autotransporter Vag8, is highly expressed in the recently emerged B. pertussis isolates. Here, we describe the current knowledge on how B. pertussis evades complement-mediated killing. In addition, we compare this to complement evasion strategies used by other bacterial species. Finally, we discuss the consequences of complement evasion by B. pertussis on adaptive immunity and how identification of the bacterial molecules and the mechanisms involved in complement evasion might help improve pertussis vaccines.
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Affiliation(s)
- Ilse Jongerius
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
- Present Address: Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Tim J. Schuijt
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
- Present Address: Department of Clinical Chemistry, Hematology and Immunology, Diakonessenhuis, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands
| | - Frits R. Mooi
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Elena Pinelli
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
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13
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Schuijt TJ, Bakhtiari K, Daffre S, Deponte K, Wielders SJH, Marquart JA, Hovius JW, van der Poll T, Fikrig E, Bunce MW, Camire RM, Nicolaes GAF, Meijers JCM, van 't Veer C. Factor Xa activation of factor V is of paramount importance in initiating the coagulation system: lessons from a tick salivary protein. Circulation 2013; 128:254-66. [PMID: 23817575 DOI: 10.1161/circulationaha.113.003191] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Generation of active procoagulant cofactor factor Va (FVa) and its subsequent association with the enzyme activated factor X (FXa) to form the prothrombinase complex is a pivotal initial event in blood coagulation and has been the subject of investigative effort, speculation, and controversy. The current paradigm assumes that FV activation is initiated by limited proteolysis by traces of (meizo) thrombin. METHODS AND RESULTS Recombinant tick salivary protein TIX-5 was produced and anticoagulant properties were studied with the use of plasma, whole blood, and purified systems. Here, we report that TIX-5 specifically inhibits FXa-mediated FV activation involving the B domain of FV and show that FXa activation of FV is pivotal for plasma and blood clotting. Accordingly, tick feeding is impaired on TIX-5 immune rabbits, displaying the in vivo importance of TIX-5. CONCLUSIONS Our data elucidate a unique molecular mechanism by which ticks inhibit the host's coagulation system. From our data, we propose a revised blood coagulation scheme in which direct FXa-mediated FV activation occurs in the initiation phase during which thrombin-mediated FV activation is restrained by fibrinogen and inhibitors.
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Affiliation(s)
- Tim J Schuijt
- Center for Experimental and Molecular Medicine, University of Amsterdam, Meibergdreef 9, Room L01-145, 1105 AZ, Amsterdam, The Netherlands.
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14
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Schuijt TJ, van der Poll T, de Vos WM, Wiersinga WJ. The intestinal microbiota and host immune interactions in the critically ill. Trends Microbiol 2013; 21:221-9. [PMID: 23454077 DOI: 10.1016/j.tim.2013.02.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/28/2013] [Accepted: 02/01/2013] [Indexed: 12/12/2022]
Abstract
The gastrointestinal tract harbors a complex population of microbes that play a fundamental role in the development of the immune system and human health. Besides an important local contribution in the host defense against infections, it has become increasingly clear that intestinal bacteria also modulate immune responses at systemic sites. These new insights can be of profound clinical relevance especially for intensive care medicine where the majority of patients are treated with antibiotics, which have pervasive and long-term effects on the intestinal microbiota. Moreover, considerable progress has been made in defining the role of the intestinal microbiota in both health and disease. In this review, we highlight these aspects and focus on recent key findings addressing the role of intestinal microbiota in antimicrobial defense mechanisms and its impact on intestinal homeostasis in the critically ill.
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Affiliation(s)
- Tim J Schuijt
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
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15
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Schuijt TJ, Coumou J, Narasimhan S, Dai J, Deponte K, Wouters D, Brouwer M, Oei A, Roelofs JJTH, van Dam AP, van der Poll T, Van't Veer C, Hovius JW, Fikrig E. A tick mannose-binding lectin inhibitor interferes with the vertebrate complement cascade to enhance transmission of the lyme disease agent. Cell Host Microbe 2011; 10:136-46. [PMID: 21843870 DOI: 10.1016/j.chom.2011.06.010] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [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: 03/30/2011] [Revised: 05/27/2011] [Accepted: 06/27/2011] [Indexed: 11/18/2022]
Abstract
The Lyme disease agent Borrelia burgdorferi is primarily transmitted to vertebrates by Ixodes ticks. The classical and alternative complement pathways are important in Borrelia eradication by the vertebrate host. We recently identified a tick salivary protein, designated P8, which reduced complement-mediated killing of Borrelia. We now discover that P8 interferes with the human lectin complement cascade, resulting in impaired neutrophil phagocytosis and chemotaxis and diminished Borrelia lysis. Therefore, P8 was renamed the tick salivary lectin pathway inhibitor (TSLPI). TSLPI-silenced ticks, or ticks exposed to TSLPI-immune mice, were hampered in Borrelia transmission. Moreover, Borrelia acquisition and persistence in tick midguts was impaired in ticks feeding on TSLPI-immunized, B. burgdorferi-infected mice. Together, our findings suggest an essential role for the lectin complement cascade in Borrelia eradication and demonstrate how a vector-borne pathogen co-opts a vector protein to facilitate early mammalian infection and vector colonization.
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Affiliation(s)
- Tim J Schuijt
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06420, USA.
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16
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Schuijt TJ, Narasimhan S, Daffre S, DePonte K, Hovius JWR, Van't Veer C, van der Poll T, Bakhtiari K, Meijers JCM, Boder ET, van Dam AP, Fikrig E. Identification and characterization of Ixodes scapularis antigens that elicit tick immunity using yeast surface display. PLoS One 2011; 6:e15926. [PMID: 21246036 PMCID: PMC3016337 DOI: 10.1371/journal.pone.0015926] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 12/02/2010] [Indexed: 11/30/2022] Open
Abstract
Repeated exposure of rabbits and other animals to ticks results in acquired resistance or immunity to subsequent tick bites and is partially elicited by antibodies directed against tick antigens. In this study we demonstrate the utility of a yeast surface display approach to identify tick salivary antigens that react with tick-immune serum. We constructed an Ixodes scapularis nymphal salivary gland yeast surface display library and screened the library with nymph-immune rabbit sera and identified five salivary antigens. Four of these proteins, designated P8, P19, P23 and P32, had a predicted signal sequence. We generated recombinant (r) P8, P19 and P23 in a Drosophila expression system for functional and immunization studies. rP8 showed anti-complement activity and rP23 demonstrated anti-coagulant activity. Ixodes scapularis feeding was significantly impaired when nymphs were fed on rabbits immunized with a cocktail of rP8, rP19 and rP23, a hall mark of tick-immunity. These studies also suggest that these antigens may serve as potential vaccine candidates to thwart tick feeding.
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Affiliation(s)
- Tim J Schuijt
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America.
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Schuijt TJ, Hovius JW, van der Poll T, van Dam AP, Fikrig E. Lyme borreliosis vaccination: the facts, the challenge, the future. Trends Parasitol 2010; 27:40-7. [PMID: 20594913 DOI: 10.1016/j.pt.2010.06.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 05/31/2010] [Accepted: 06/02/2010] [Indexed: 11/26/2022]
Abstract
Lyme disease, or Lyme borreliosis, the most prevalent arthropod-borne disease in the Western world, is caused by spirochetes belonging to the Borrelia burgdorferi sensu lato group and is predominantly transmitted through Ixodes ticks. There is currently no vaccine available to prevent Lyme borreliosis in humans. Borrelia outer membrane proteins are reviewed which have been investigated as vaccine candidates. In addition, several tick proteins are discussed, on which anti-tick vaccines have been based, or are interesting future candidates, to prevent transmission of the spirochete from the tick vector to the mammalian host. Finally, novel vaccination strategies to prevent Lyme borreliosis are proposed, based on multiple Borrelia antigens, tick antigens or a combination of both Borrelia as well as tick antigens.
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Affiliation(s)
- T J Schuijt
- Academic Medical Center, University of Amsterdam, Center for Experimental and Molecular Medicine, Amsterdam, The Netherlands
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18
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van Burgel ND, Kraiczy P, Schuijt TJ, Zipfel PF, van Dam AP. Identification and functional characterisation of Complement Regulator Acquiring Surface Protein-1 of serum resistant Borrelia garinii OspA serotype 4. BMC Microbiol 2010; 10:43. [PMID: 20146822 PMCID: PMC2833144 DOI: 10.1186/1471-2180-10-43] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 02/10/2010] [Indexed: 11/29/2022] Open
Abstract
Background B. burgdorferi sensu lato (sl) is the etiological agent of Lyme borreliosis in humans. Spirochetes have adapted themselves to the human immune system in many distinct ways. One important immune escape mechanism for evading complement activation is the binding of complement regulators Factor H (CFH) or Factor H-like protein1 (FHL-1) to Complement Regulator-Acquiring Surface Proteins (CRASPs). Results We demonstrate that B. garinii OspA serotype 4 (ST4) PBi resist complement-mediated killing by binding of FHL-1. To identify the primary ligands of FHL-1 four CspA orthologs from B. garinii ST4 PBi were cloned and tested for binding to human CFH and FHL-1. Orthologs BGA66 and BGA71 were found to be able to bind both complement regulators but with different intensities. In addition, all CspA orthologs were tested for binding to mammalian and avian CFH. Distinct orthologs were able to bind to CFH of different animal origins. Conclusions B. garinii ST4 PBi is able to evade complement killing and it can bind FHL-1 to membrane expressed proteins. Recombinant proteins BGA66 can bind FHL-1 and human CFH, while BGA71 can bind only FHL-1. All recombinant CspA orthologs from B. garinii ST4 PBi can bind CFH from different animal origins. This partly explains the wide variety of animals that can be infected by B. garinii.
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Affiliation(s)
- Nathalie D van Burgel
- Department of Medical Microbiology, Centre of Infectious Diseases, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, the Netherlands.
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Hovius JW, Schuijt TJ, de Groot KA, Roelofs JJTH, Oei GA, Marquart JA, de Beer R, van 't Veer C, van der Poll T, Ramamoorthi N, Fikrig E, van Dam AP. Preferential protection of Borrelia burgdorferi sensu stricto by a Salp15 homologue in Ixodes ricinus saliva. J Infect Dis 2008; 198:1189-97. [PMID: 18752445 DOI: 10.1086/591917] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Ixodes ticks are the main vectors for Borrelia burgdorferi sensu lato. In the United States, B. burgdorferi is the sole causative agent of Lyme borreliosis and is transmitted by Ixodes scapularis. In Europe, 3 Borrelia species-B. burgdorferi, B. garinii, and B. afzelii-are prevalent, which are transmitted by Ixodes ricinus. The I. scapularis salivary protein Salp15 has been shown to bind to B. burgdorferi outer surface protein (Osp) C, protecting the spirochete from antibody-mediated killing. METHODS AND RESULTS We recently identified a Salp15 homologue in I. ricinus, Salp15 Iric-1. Here, we have demonstrated, by solid-phase overlays, enzyme-linked immunosorbent assay, and surface plasmon resonance, that Salp15 Iric-1 binds to B. burgdorferi OspC. Importantly, this binding protected the spirochete from antibody-mediated killing in vitro and in vivo; immune mice rechallenged with B. burgdorferi preincubated with Salp15 Iric-1 displayed significantly higher Borrelia numbers and more severe carditis, compared with control mice. Furthermore, Salp15 Iric-1 was capable of binding to OspC from B. garinii and B. afzelii, but these Borrelia species were not protected from antibody-mediated killing. CONCLUSIONS Salp15 Iric-1 interacts with all European Borrelia species but differentially protects B. burgdorferi from antibody-mediated killing, putatively giving this Borrelia species a survival advantage in nature.
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Affiliation(s)
- J W Hovius
- Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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