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Abstract
Patients with the severe form of coronavirus disease 2019 (COVID-19) have been frequently found to suffer from both arterial and venous thrombotic events due to the perpetuation of a hypercoagulable state. This phenomenon, termed COVID-19-associated coagulopathy, is now considered a major component of the pathophysiology of this novel infectious disease, leading to widespread thrombosis. While at first, the vascular insults may be limited to the pulmonary microvasculature, as the disease progresses, systemic involvement occurs, culminating in distant organ thrombosis and multiorgan dysfunction syndrome. In this review article, we discuss recent insights into the pathophysiologic mechanisms of COVID-19-associated coagulopathy and review the clinical, histopathologic, and laboratory evidence, which leads us to conclude that COVID-19 is both a pulmonary and vascular disorder.
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Key Words
- ace2, angiotensin-converting enzyme 2
- ards, acute respiratory distress syndrome
- cc, coronavirus 2019–associated coagulopathy
- covid-19, coronavirus disease 2019
- dic, disseminated intravascular coagulation
- dvt, deep vein thrombosis
- icu, intensive care unit
- il, interleukin
- ly30, lysis at 30 minutes
- no, nitric oxide
- pai-1, plasminogen activator inhibitor 1
- pe, pulmonary embolism
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- tf, tissue factor
- tma, thrombotic microangiopathy
- tpa, tissue plasminogen activator
- vte, venous thromboembolism
- vwf, von willebrand factor
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Fabian Sanchis-Gomar
- Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia, Spain.
| | - Emmanuel J Favaloro
- Haematology, Sydney Centers for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Brandon M Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, Ohio, USA
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Visveswaran GK, Morparia K, Narang S, Sturt C, Divita M, Voigt B, Hawatmeh A, McQueen D, Cohen M. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Thrombosis: Phlegmasia Cerulea Dolens Presenting with Venous Gangrene in a Child. J Pediatr 2020; 226:281-284.e1. [PMID: 32673617 DOI: 10.1016/j.jpeds.2020.07.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022]
Abstract
A 12-year-old girl with severe acute respiratory syndrome coronavirus 2 infection presented as phlegmasia cerulea dolens with venous gangrene. Emergent mechanical thrombectomy was complicated by a massive pulmonary embolism and cardiac arrest, for which extracorporeal cardiopulmonary resuscitation and therapeutic hypothermia were used. Staged ultrasound-assisted catheter-directed thrombolysis was used for treatment of bilateral pulmonary emboli and the extensive lower extremity deep vein thrombosis while the patient received extracorporeal membrane oxygenation support. We highlight the need for heightened suspicion for occult severe acute respiratory syndrome coronavirus 2 infection among children presenting with unusual thrombotic complications.
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Key Words
- apla, antiphospholipid antibodies
- aps, antiphospholipid syndrome
- covid-19, coronavirus disease 19
- dic, disseminated intravascular coagulation
- ecmo, extracorporeal membrane oxygenation
- ivc, inferior vena cava
- pcd, phlegmasia cerulea dolens
- pe, pulmonary embolism
- rv, right ventricular
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- tpa, tissue plasminogen activator
- ucdt, ultrasound-assisted catheter-directed thrombolysis
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Shuster KA, Wrobleski SK, Hawley AE, Lucchesi BR, Sorenson DR, Bergin IL, Sigler RE, Guire KE, Nowland MH, Wakefield TW, Myers DD. Prothrombotic effects of thrombolytic therapy in a rat (Rattus norvegicus) model of venous thrombolysis. Comp Med 2013; 63:244-251. [PMID: 23759527 PMCID: PMC3690430] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/16/2012] [Accepted: 12/03/2012] [Indexed: 06/02/2023]
Abstract
The use of thrombolytic agents has greatly improved patient outcomes, but the prothrombotic response to these drugs in vivo is unknown. Approximately 24 h after we induced thrombosis in male Sprague-Dawley rats, we placed an infusion line in the inferior vena cava and administered either saline or a thrombolytic agent (tissue plasminogen activator [tPA] or plasmin) for 30 min. Blood was drawn immediately after infusion; rats were euthanized 24 h after infusion for collection of blood and tissue (inferior vena cava and thrombus). Thrombus size was decreased in the tPA-treated rats but not in those that received saline or plasmin; this change correlated with the significant rise in D-dimer levels noted immediately after infusion in the tPA-treated rats. Plasma soluble P-selectin, a prothrombotic marker, was elevated at 24 h in the plasmin group compared with the other treatment groups. There were no significant differences in plasma C3a, C5a, or C5b9 levels or in thrombus C3 levels between groups. According to ultrastructural analysis, thrombus structure and vein wall effects did not differ between groups. Local tPA did not induce a prothrombotic state during acute DVT or after thrombolytic therapy in a rodent model of venous thrombolysis. Conversely, levels of the prothrombotic marker plasma soluble P-selectin increased when plasmin was administered.
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Kaur M, Rai A, Bhatnagar R. Rabies DNA vaccine: no impact of MHC class I and class II targeting sequences on immune response and protection against lethal challenge. Vaccine 2009; 27:2128-37. [PMID: 19356616 PMCID: PMC7115670 DOI: 10.1016/j.vaccine.2009.01.128] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 01/24/2009] [Accepted: 01/29/2009] [Indexed: 11/23/2022]
Abstract
Rabies is progressive fatal encephalitis. WHO estimates 55,000 rabies deaths and more than 10 million PEP every year world-wide. A variety of cell-culture derived vaccines are available for prophylaxis against rabies. However, their high cost restricts their usage in developing countries, where such cases are most often encountered. This is driving the quest for newer vaccine formulations; DNA vaccines being most promising amongst them. Here, we explored strategies of antigen trafficking to various cellular compartments aiming at improving both humoral and cellular immunity. These strategies include use of signal sequences namely Tissue Plasminogen Activator (TPA), Ubiquitin (UQ) and Lysosomal-Associated Membrane Protein-1 (LAMP-1). TPA, LAMP-1 and their combination were aimed at enhancing the CD4(+) T cell and antibody response. In contrast, the UQ tag was utilized for enhancing CD8(+) response. The potency of modified DNA vaccines assessed by total antibody response, antibody isotypes, cytokine profile, neutralizing antibody titer and protection conferred against in vivo challenge; was enhanced in comparison to native unmodified vaccine, but the response elicited did not pertain to the type of target sequence and the directed arm of immunity. Interestingly, the DNA vaccines that had been designed to generate different type of immune responses yielded in effect similar response. In conclusion, our data indicate that the directing target sequence is not the exclusive deciding factor for type and extent of immune response elicited and emphasizes on the antigen dependence of immune enhancement strategies.
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Key Words
- ab, antibody
- ig, immunoglobulin
- elisa, enzyme linked immunosorbent assay
- gp, glycoprotein
- lamp-1, lysosomal-associated membrane protein-1
- mhc, major histocompatibility complex
- mq, milli quartz water
- pmsf, phenyl methyl sulphonyl fluoride
- ripa, radioimmunoprecipitation assay buffer
- rffit, rapid fluorescence focus inhibition test
- tm, transmembrane
- tpa, tissue plasminogen activator
- tris, tris(hydroxymethyl) aminomethane
- uq, ubiquitin
- targeting sequence
- rabies virus-neutralizing antibody (rvna)
- survival
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Affiliation(s)
- Manpreet Kaur
- Laboratory Of Molecular Biology And Genetic Engineering, School Of Biotechnology, Jawaharlal Nehru University, New Delhi 110067, Delhi, India
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Ishigami S, Sandkvist M, Tsui F, Moore E, Coleman T, Lawrence D. Identification of a novel targeting sequence for regulated secretion in the serine protease inhibitor neuroserpin. Biochem J 2007; 402:25-34. [PMID: 17040209 PMCID: PMC1783992 DOI: 10.1042/bj20061170] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 10/09/2006] [Accepted: 10/16/2006] [Indexed: 11/17/2022]
Abstract
Ns (neuroserpin) is a member of the serpin (serine protease inhibitor) gene family that is primarily expressed within the central nervous system. Its principal target protease is tPA (tissue plasminogen activator), which is thought to contribute to synaptic plasticity and to be secreted in a stimulus-dependent manner. In the present study, we demonstrate in primary neuronal cultures that Ns co-localizes in LDCVs (large dense core vesicles) with the regulated secretory protein chromogranin B. We also show that Ns secretion is regulated and can be specifically induced 4-fold by secretagogue treatment. A novel 13-amino-acid sorting signal located at the C-terminus of Ns is identified that is both necessary and sufficient to target Ns to the regulated secretion pathway. Its deletion renders Ns no longer responsive to secretagogue stimulation, whereas PAI-Ns [Ns (neuroserpin)-PAI-1 (plasminogen activator inhibitor-1) chimaera appending the last 13 residues of Ns sequence to the C-terminus of PAI-1] shifts PAI-1 secretion into a regulated secretory pathway.
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Key Words
- immunohistochemistry
- large dense-core vesicle
- neuron
- neuroserpin
- serpin
- tissue plasminogen activator (tpa)
- anp, atrial natriuretic peptide
- bip, immunoglobulin heavy-chain-binding protein
- ccd camera, charge-coupled device camera
- cns, central nervous system
- dapi, 4′,6-diamidino-2-phenylindole
- dmem, dulbecco's modified eagle's medium
- dpbs, dulbecco's pbs
- e15, embryonic day 15
- er, endoplasmic reticulum
- fbs, fetal bovine serum
- hrp, horseradish peroxidase
- hsp47, heat-shock protein 47
- ldcv, large dense core vesicle
- nbm, neurobasal medium
- nmda, n-methyl-d-aspartate
- ns, neuroserpin
- pai-1, plasminogen activator inhibitor-1
- pai-ns, ns–pai-1 chimaera appending the last 13 residues of ns sequence to the c-terminus of pai-1
- rrx, rhodamine red-x
- serpin, serine protease inhibitor
- tpa, tissue plasminogen activator
- wtns, wild-type ns
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Affiliation(s)
- Shoji Ishigami
- *Center for Vascular and Inflammatory Diseases, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, U.S.A
| | - Maria Sandkvist
- †Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, U.S.A
| | - Foon Tsui
- ‡Department of Biochemistry, J.H. Holland Laboratory, American Red Cross, 15601 Crabbs Branch Way, Rockville, MD 20855, U.S.A
| | - Elizabeth Moore
- *Center for Vascular and Inflammatory Diseases, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, U.S.A
| | | | - Daniel A. Lawrence
- ∥Department of Internal Medicine, University of Michigan School of Medicine, 7301 MSRB III, 1150 W. Medical Center Drive, Ann Arbor, MI, U.S.A
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Beattie J, Allan GJ, Lochrie JD, Flint DJ. Insulin-like growth factor-binding protein-5 (IGFBP-5): a critical member of the IGF axis. Biochem J 2006; 395:1-19. [PMID: 16526944 PMCID: PMC1409685 DOI: 10.1042/bj20060086] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Accepted: 01/30/2006] [Indexed: 11/17/2022]
Abstract
The six members of the insulin-like growth factor-binding protein family (IGFBP-1-6) are important components of the IGF (insulin-like growth factor) axis. In this capacity, they serve to regulate the activity of both IGF-I and -II polypeptide growth factors. The IGFBPs are able to enhance or inhibit the activity of IGFs in a cell- and tissue-specific manner. One of these proteins, IGFBP-5, also has an important role in controlling cell survival, differentiation and apoptosis. In this review, we report on the structural and functional features of the protein which are important for these effects. We also examine the regulation of IGFBP-5 expression and comment on its potential role in tumour biology, with special reference to work with breast cancer cells.
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Key Words
- extracellular matrix (ecm)
- glycosaminoglycan
- insulin-like growth factor-i (igf-i)
- insulin-like growth factor-binding protein 5 (igfbp-5)
- mammary gland
- proteolysis
- adam, adisintegrin and metalloprotease
- ap-2, activator protein 2
- cat, chloramphenicol acetyltransferase
- cbp-4, c-terminus of insulin-like growth factor-binding protein 4 (residues 151–232)
- c/ebp, ccaat/enhancer-binding protein
- ecm, extracellular matrix
- er, oestrogen receptor
- erk1/2, extracellular-signal-regulated protein kinase 1/2
- fhl-2, four-and-a-half lim domain 2
- gag, glycosaminoglycan
- gh, growth hormone
- igf, insulin-like growth factor
- igfbp, igf-binding protein
- igf-ir, igf-i receptor
- igf-iir, igf-ii receptor
- ir, insulin receptor
- irs, ir substrate
- mapk, mitogen-activated protein kinase
- nbp-4, n-terminus of igfbp-4 (residues 3–82)
- oe2, oestradiol
- op-1, osteogenic protein-1
- opn, osteopontin
- pai-1, plasminogen activator inhibitor-1
- papp, pregnancy-associated plasma protease
- pge2, prostaglandin e2
- psmc, porcine smooth-muscle cell
- ra, retinoic acid
- rassf1c, isoform c of the ras association family 1 protein group
- rt, reverse transcription
- spr, surface plasmon resonance
- tpa, tissue plasminogen activator
- tsp-1, thrombospondin-1
- vn, vitronectin
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Affiliation(s)
- James Beattie
- Hannah Research Institute, Ayr KA6 5HL, Scotland, UK.
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