1
|
Hollestelle MJ, Kristoffersen AH, Idema RN, Meijer P, Sandberg S, de Maat MPM, Aarsand AK. Systematic review and meta-analysis of within-subject and between-subject biological variation data of coagulation and fibrinolytic measurands. Clin Chem Lab Med 2023; 61:1470-1480. [PMID: 36810291 DOI: 10.1515/cclm-2022-1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES The diagnosis and monitoring of bleeding and thrombotic disorders depend on correct haemostatic measurements. The availability of high-quality biological variation (BV) data is important in this context. Many studies have reported BV data for these measurands, but results are varied. The present study aims to deliver global within-subject (CVI) and between-subject (CVG) BV estimates for haemostasis measurands by meta-analyses of eligible studies, by assessment with the Biological Variation Data Critical Appraisal Checklist (BIVAC). METHODS Relevant BV studies were graded by the BIVAC. Weighted estimates for CVI and CVG were obtained via meta-analysis of the BV data derived from BIVAC-compliant studies (graded A-C; whereby A represents optimal study design) performed in healthy adults. RESULTS In 26 studies BV data were reported for 35 haemostasis measurands. For 9 measurands, only one eligible publication was identified and meta-analysis could not be performed. 74% of the publications were graded as BIVAC C. The CVI and CVG varied extensively between the haemostasis measurands. The highest estimates were observed for PAI-1 antigen (CVI 48.6%; CVG 59.8%) and activity (CVI 34.9%; CVG 90.2%), while the lowest were observed for activated protein C resistance ratio (CVI 1.5%; CVG 4.5%). CONCLUSIONS This study provides updated BV estimates of CVI and CVG with 95% confidence intervals for a wide range of haemostasis measurands. These estimates can be used to form the basis for analytical performance specifications for haemostasis tests used in the diagnostic work-up required in bleeding- and thrombosis events and for risk assessment.
Collapse
Affiliation(s)
- Martine J Hollestelle
- ECAT Foundation (External Quality Control for Assays and Tests), Voorschoten, The Netherlands
| | - Ann Helen Kristoffersen
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - René N Idema
- Result Laboratory, Amphia Hospital, Breda, The Netherlands
| | - Piet Meijer
- ECAT Foundation (External Quality Control for Assays and Tests), Voorschoten, The Netherlands
| | - Sverre Sandberg
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group on Biological Variation and Task Group for the Biological Variation Database, Milan, Italy
| | - Moniek P M de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aasne K Aarsand
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group on Biological Variation and Task Group for the Biological Variation Database, Milan, Italy
| |
Collapse
|
2
|
Ziemba YC, Abdulrehman J, Hollestelle MJ, Meijer P, Plumhoff E, Hsu P, Selby R. Diagnostic Testing for von Willebrand Disease: Trends and Insights from North American Laboratories over the Last Decade. Semin Thromb Hemost 2022; 48:700-710. [PMID: 36122573 DOI: 10.1055/s-0042-1754332] [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: 10/14/2022]
Abstract
Accurate diagnosis of von Willebrand disease (VWD) depends on the quality, precision, and variability of the laboratory assays. The North American Specialized Coagulation Laboratory Association (NASCOLA) is a provider of external quality assessment (EQA) for approximately 60 specialized coagulation laboratories in North America. In this report, NASCOLA EQA data from 2010 to 2021 are reviewed for trends in methodology and precision among various assays. In particular, recent ASH ISTH NHF WFH (American Society of Hematology, International Society on Thrombosis and Haemostasis, National Hemophilia Foundation, and World Hemophilia Federation) guidelines for diagnosis of VWD are reviewed in light of EQA data. In contrast to other geographic regions, laboratories in North America predominantly use three-assay screening panels (antigen, platelet-binding activity, and factor VIII [FVIII] activity) rather than four-assay panels (antigen, platelet-binding activity, FVIII activity, and collagen-binding activity). They also use latex immunoassays rather than chemiluminescence immunoassays, and the classic ristocetin cofactor (VWF:RCo) assay and monoclonal antibody (VWF:Ab) assay to assess VWF platelet-binding activity over newer recommended assays (VWF:GPIbM and VWF:GPIbR). Factors that may be influencing these North American practice patterns include lack of Food and Drug Administration approval of the VWF:GPIbM, VWF:GPIbR, collagen binding assays, and chemiluminescence methodologies, and the influence of the 2008 National Heart, Lung, and Blood Institute guidelines on laboratory practice. Lastly, systems-based solutions are urgently needed to improve the overall accuracy of laboratory testing for VWD by minimizing preanalytical variables and adopting assay standardization.
Collapse
Affiliation(s)
- Yonah C Ziemba
- Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York
| | | | | | - Piet Meijer
- ECAT Foundation, Voorschoten, the Netherlands
| | - Elizabeth Plumhoff
- North American Specialized Coagulation Laboratory Association, Rochester, Minnesota
| | - Peihong Hsu
- Department of Pathology and Laboratory Medicine, Northwell Health, New York, New York
| | - Rita Selby
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,North American Specialized Coagulation Laboratory Association, Rochester, Minnesota.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Hollestelle MJ, Meijers JCM, Meijer P. How Do Laboratories Perform von Willebrand Disease Diagnostics and Classification of von Willebrand Disease Patients? Results from External Quality Data and an International Survey. Semin Thromb Hemost 2022. [PMID: 36063849 DOI: 10.1055/s-0042-1757137] [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: 10/14/2022]
Abstract
BACKGROUND Reduced or dysfunctional von Willebrand factor (VWF) may lead to von Willebrand disease (VWD), which is a common inherited bleeding disorder. VWD is classified into three major types: type 1 is a partial quantitative deficiency of VWF, type 3 is a complete quantitative deficiency of VWF, and type 2 consists of qualitative abnormalities of VWF. To arrive at a correct VWD diagnosis, multiple tests and a correct interpretation of these tests are needed. AIM The aim of the present study was to gain insight into the approach of laboratories toward VWD diagnosis. METHODS Data from four samples of the external quality assessment (EQA) VWF surveys of the ECAT (External Quality Control for Assays and Tests) were evaluated. Furthermore, results were analyzed of a questionnaire that was sent to hemostasis laboratories about VWD diagnostic approaches. RESULTS For most EQA samples, the majority of participants indicated the correct classification. However, 6 to 60% indicated another classification. For all samples, significant differences in VWF results were observed between the correct and incorrect classifications. The questionnaire demonstrated that the testing approach varied between the laboratories, especially for parameters that were essential for discrimination between VWD type 1 and healthy individuals, as well as the cutoff values used to discriminate VWD types 1 and 2. CONCLUSIONS Diagnosis of VWD is heterogeneous in diagnostic approach, guidelines, and cutoff values within large ranges of VWF results between laboratories. Harmonization of approaches and increased accuracy of VWF measurements may help to establish a correct diagnosis.
Collapse
Affiliation(s)
- Martine J Hollestelle
- External Quality Control for Assays and Tests (ECAT) Foundation, Voorschoten, the Netherlands
| | - Joost C M Meijers
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Department of Molecular Hematology, Sanquin Research, Amsterdam, the Netherlands
| | - Piet Meijer
- External Quality Control for Assays and Tests (ECAT) Foundation, Voorschoten, the Netherlands
| |
Collapse
|
4
|
Hollestelle MJ, Meijers JCM, Meijer P. How Do Laboratories Perform von Willebrand Disease Diagnostics and Classification of von Willebrand Disease Patients? Results from External Quality Data and an International Survey. Semin Thromb Hemost 2022; 48:739-749. [DOI: 10.1055/s-0042-1758163] [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: 11/06/2022]
Abstract
Abstract
Background Reduced or dysfunctional von Willebrand factor (VWF) may lead to von Willebrand disease (VWD), which is a common inherited bleeding disorder. VWD is classified into three major types: type 1 is a partial quantitative deficiency of VWF, type 3 is a complete quantitative deficiency of VWF, and type 2 consists of qualitative abnormalities of VWF. To arrive at a correct VWD diagnosis, multiple tests and a correct interpretation of these tests are needed.
Aim The aim of the present study was to gain insight into the approach of laboratories toward VWD diagnosis.
Methods Data from four samples of the external quality assessment (EQA) VWF surveys of the ECAT (External Quality Control for Assays and Tests) were evaluated. Furthermore, results were analyzed of a questionnaire that was sent to hemostasis laboratories about VWD diagnostic approaches.
Results For most EQA samples, the majority of participants indicated the correct classification. However, 6 to 60% indicated another classification. For all samples, significant differences in VWF results were observed between the correct and incorrect classifications. The questionnaire demonstrated that the testing approach varied between the laboratories, especially for parameters that were essential for discrimination between VWD type 1 and healthy individuals, as well as the cutoff values used to discriminate VWD types 1 and 2.
Conclusions Diagnosis of VWD is heterogeneous in diagnostic approach, guidelines, and cutoff values within large ranges of VWF results between laboratories. Harmonization of approaches and increased accuracy of VWF measurements may help to establish a correct diagnosis.
Collapse
Affiliation(s)
- Martine J. Hollestelle
- External Quality Control for Assays and Tests (ECAT) Foundation, Voorschoten, the Netherlands
| | - Joost C. M. Meijers
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Molecular Hematology, Sanquin Research, Amsterdam, the Netherlands
| | - Piet Meijer
- External Quality Control for Assays and Tests (ECAT) Foundation, Voorschoten, the Netherlands
| |
Collapse
|
5
|
Hollestelle MJ, Meijers JCM, Meijer P. How Do Laboratories Perform von Willebrand Disease Diagnostics and Classification of von Willebrand Disease Patients? Results from External Quality Data and an International Survey. Semin Thromb Hemost 2022; 48:739-749. [PMID: 36055267 DOI: 10.1055/s-0042-1754354] [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: 10/14/2022]
Abstract
BACKGROUND Reduced or dysfunctional von Willebrand factor (VWF) may lead to von Willebrand disease (VWD), which is a common inherited bleeding disorder. VWD is classified into three major types: type 1 is a partial quantitative deficiency of VWF, type 3 is a complete quantitative deficiency of VWF, and type 2 consists of qualitative abnormalities of VWF. To arrive at a correct VWD diagnosis, multiple tests and a correct interpretation of these tests are needed. AIM The aim of the present study was to gain insight into the approach of laboratories toward VWD diagnosis. METHODS Data from four samples of the external quality assessment (EQA) VWF surveys of the ECAT (External Quality Control for Assays and Tests) were evaluated. Furthermore, results were analyzed of a questionnaire that was sent to hemostasis laboratories about VWD diagnostic approaches. RESULTS For most EQA samples, the majority of participants indicated the correct classification. However, 6 to 60% indicated another classification. For all samples, significant differences in VWF results were observed between the correct and incorrect classifications. The questionnaire demonstrated that the testing approach varied between the laboratories, especially for parameters that were essential for discrimination between VWD type 1 and healthy individuals, as well as the cutoff values used to discriminate VWD types 1 and 2. CONCLUSIONS Diagnosis of VWD is heterogeneous in diagnostic approach, guidelines, and cutoff values within large ranges of VWF results between laboratories. Harmonization of approaches and increased accuracy of VWF measurements may help to establish a correct diagnosis.
Collapse
Affiliation(s)
- Martine J Hollestelle
- External Quality Control for Assays and Tests (ECAT) Foundation, Voorschoten, the Netherlands
| | - Joost C M Meijers
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Molecular Hematology, Sanquin Research, Amsterdam, the Netherlands
| | - Piet Meijer
- External Quality Control for Assays and Tests (ECAT) Foundation, Voorschoten, the Netherlands
| |
Collapse
|
6
|
Arisz RA, Meijer P, Péquériaux NCV, van de Leur SJ, Lukens MV, de Maat MPM, Hollestelle MJ. Impact of COVID-19 pandemic on the quality of test output in haemostasis laboratories. Int J Lab Hematol 2021; 44:407-413. [PMID: 34806301 PMCID: PMC9011814 DOI: 10.1111/ijlh.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022]
Abstract
Introduction The high incidence of thrombotic events in patients with COVID‐19 affects health care worldwide and results in an increased workload in haemostasis laboratories due to more frequent testing of D‐dimer, haemostatic parameters and anti‐Xa tests. However, the impact of this increase in assay requests on the quality of performance in haemostasis laboratories remains unclear. In this study, the impact of the COVID‐19 pandemic on the quality of performance and management of haemostasis laboratories was evaluated. Methods The impact on the quality of performance was studied using external quality assessment data from 2019 to 2020 derived from ECAT surveys. A questionnaire was sent to Dutch haemostasis laboratories to identify challenges and management strategies. Furthermore, the number of assays performed in 2019 and 2020 was supplied by four Dutch hospitals, located in regions with different disease incidence. Results No differences in response rate nor the quality of the measurements were observed between the EQA surveys in 2019 and 2020. The questionnaire results showed a large increase of >25% in the number of test requests for anti‐Xa, D‐dimer and fibrinogen assays in 2020 compared to 2019. Extreme peaks in test requests were also observed in the four evaluated hospitals. Additionally, 84% of the respondents indicated that they had experienced increased work pressure, and increased sick leave was observed in 71% of the participating laboratories. Conclusions The enormous increase in test requests, especially for D‐dimer assays and anti‐Xa activity, did not affect the quality of performance within haemostatic laboratories during the COVID‐19 pandemic.
Collapse
Affiliation(s)
- Ryanne A Arisz
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Piet Meijer
- ECAT Foundation (External quality Control for Assays and Tests), Voorschoten, Netherlands
| | - Nathalie C V Péquériaux
- Department of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | | | - Michaël V Lukens
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Martine J Hollestelle
- ECAT Foundation (External quality Control for Assays and Tests), Voorschoten, Netherlands
| |
Collapse
|
7
|
Abdulrehman J, Ziemba YC, Hsu P, Van Cott EM, Plumhoff EA, Meijer P, Hollestelle MJ, Selby R. Diagnosis of von Willebrand disease: An assessment of the quality of testing in North American laboratories. Haemophilia 2021; 27:e713-e720. [PMID: 34455654 DOI: 10.1111/hae.14397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Laboratory diagnosis of von Willebrand Disease (VWD) is complex. Reliance on laboratory testing can be problematic as different VWD screening panels, assays and methodologies can produce analytic variability in test results. OBJECTIVES To compare the degree of imprecision among the VWD assays and within the platelet binding activity (PBA) assays, to determine the consensus among the VWD assays for correct classification of sample results, and to determine consensus among laboratories' von Willebrand factor (VWF) multimer interpretations and final interpretations of the VWD panels. PATIENTS/METHODS Proficiency testing results from the North American Specialized Coagulation Laboratory Association (NASCOLA) submitted by laboratories from 2010 to 2019 for all normal, type (T) 1 VWD and T2 VWD samples were analysed. RESULTS AND CONCLUSIONS Imprecision was lowest for VWF antigen and highest for collagen binding activity (CBA) with median coefficient of variation (CV) of 12% (interquartile range (IQR) 7%) and 23% (IQR 21%) respectively. Within the VWF PBA assays, the gain-of-function mutant GP1b binding (VWF: GP1bM) methods had the least imprecision (CV 9%, IQR 10%). All assays, including the various PBA methods had excellent consensus. The majority of laboratories agreed that normal (median consensus-82%, IQR 16%) and T1 VWD (median consensus-100%, IQR 9%) samples had normal multimer distribution. Consensus among laboratories for final interpretations was excellent for normal samples (median 81%, IQR 8%), good for T1 VWD samples (median 59%, IQR 9%), and fair for T2 VWD samples (median 44%, IQR 21%). Consensus on final interpretation decreased as sample complexity increased.
Collapse
Affiliation(s)
- Jameel Abdulrehman
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Yonah C Ziemba
- Department of Pathology and Laboratory Medicine, Northwell Health, Hempstead, NY, USA
| | - Peihong Hsu
- Department of Pathology and Laboratory Medicine, Northwell Health, Hempstead, NY, USA
| | | | | | - Piet Meijer
- ECAT Foundation, Voorschoten, the Netherlands
| | | | - Rita Selby
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
Hollestelle MJ, van der Meer FJM, Meijer P. Quality performance for indirect Xa inhibitor monitoring in patients using international external quality data. Clin Chem Lab Med 2021; 58:1921-1930. [PMID: 32441664 DOI: 10.1515/cclm-2020-0130] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/30/2020] [Indexed: 01/20/2023]
Abstract
Objectives Chromogenic anti-activated factor X (FXa) assays are currently the "gold standard" for monitoring indirect anticoagulants. However, anti-FXa has been shown to vary according to the choice of reagents. In the present study, the performance of anti-FXa measurement was evaluated in order to gain more insight into the clinical applications. Furthermore, the longitudinal coefficient of variation (CV) was studied to investigate whether there is improvement over time. Methods Laboratory tests results were evaluated for samples spiked with unfractionated heparin (UFH), low-molecular-weight-heparin (LMWH), fondaparinux and danaparoid sodium. External quality assessment (EQA) data from multiple years were used from more than 100 laboratories. Results Comparison of the results for all methods showed significant differences in measured values between the frequently used methods (ANOVA: p < 0.001). The largest differences were observed for LMWH and UFH measurements. These differences may be caused by differences in method composition, such as the addition of dextran sulphate. Substantial interlaboratory variation in anti-FXa monitoring was observed for all parameters, particularly at low concentrations. Our results showed that below 0.35 IU/mL, the CVs for UFH and LMWH increase dramatically and results below this limit should be used with caution. Conclusions Our study demonstrates that the choice of the anti-FXa method is particularly important for UFH and LMWH measurement. The variation in measurements may have an effect on clinical implications, such as therapeutic ranges. Furthermore, the longitudinal EQA data demonstrated a constant performance and, in at least 50% of the cases, improvement in the CV% of the anti-Xa results over time.
Collapse
Affiliation(s)
- Martine J Hollestelle
- External Quality Control for Assays and Tests (ECAT) Foundation, Voorschoten, The Netherlands
| | - Felix J M van der Meer
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Piet Meijer
- External Quality Control for Assays and Tests (ECAT) Foundation, Voorschoten, The Netherlands
| |
Collapse
|
9
|
Smahi M, De Pooter N, Hollestelle MJ, Toulon P. Monitoring unfractionated heparin therapy: Lack of standardization of anti-Xa activity reagents. J Thromb Haemost 2020; 18:2613-2621. [PMID: 32573889 DOI: 10.1111/jth.14969] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/14/2020] [Revised: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION One of the main advantages of using anti-Xa instead of activated partial thromboplastin time in monitoring of unfractionated heparin (UFH) therapy relies on its hypothesized standardization, with a unique therapeutic range defined to be 0.30 to 0.70 IU/mL. The aim of the present study was to compare the inter-reagent agreement of anti-Xa activity. METHODS Citrate tubes were obtained from 104 inpatients on UFH. Plasma samples were stored frozen in aliquots at -70°C before being shipped to three accredited coagulation laboratories to be evaluated for anti-Xa activity using their routine assay(s). Pooled normal plasmas spiked with dilutions of the 6th International Standard of UFH to achieve anti-Xa activities up to 1.0 IU/mL were evaluated using the same techniques. RESULTS In the plasmas from patients on UFH, the median anti-Xa activity ranged from 0.37 IU/mL with one reagent to 0.57 IU/mL with another; results were in between (0.45 IU/mL) using two other reagents. Comparisons of results obtained using the different reagents demonstrated unacceptable bias up to 0.24 IU/mL between some reagents (41% difference). The concordance as whether anti-Xa activities measured using different reagents were within or outside the therapeutic range was between 0.411 and 0.939 (kappa). Similar discrepancy was demonstrated for anti-Xa activities when evaluating normal plasma spiked with the International Standard. A discrepancy of the same order of magnitude was demonstrated in the 2017 External Quality Assessment Program provided by the External Quality Control in Assays and Tests exercises. CONCLUSIONS The reported discrepancy between test results obtained using different anti-Xa assays clearly suggests a lack of standardization of that assay with potentially significant impact on the patients' anticoagulation.
Collapse
Affiliation(s)
- Motalib Smahi
- Hematology Department, Simone Veil Hospital, Eaubonne, France
| | | | - Martine J Hollestelle
- External quality Control for Assays and Tests (ECAT) Foundation, Voorschoten, The Netherlands
| | - Pierre Toulon
- Hematology Department, Université Côte d'Azur, CHU Nice, Nice, France
| |
Collapse
|
10
|
Hollestelle MJ, Meijer P. International external quality assessment for measurements of direct oral anticoagulants: results and recommendations. Br J Haematol 2019; 188:460-464. [DOI: 10.1111/bjh.16179] [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: 05/11/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Martine J. Hollestelle
- External quality Control for Assays and Tests (ECAT) Foundation Voorschoten The Netherlands
| | - Piet Meijer
- External quality Control for Assays and Tests (ECAT) Foundation Voorschoten The Netherlands
| |
Collapse
|
11
|
Hollestelle MJ, Ruinemans-Koerts J, Idema RN, Meijer P, de Maat MP. Determination of sigma score based on biological variation for haemostasis assays: fit-for-purpose for daily practice? ACTA ACUST UNITED AC 2019; 57:1235-1241. [DOI: 10.1515/cclm-2018-0934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/14/2018] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Internal quality control (QC) rules for laboratory tests can be derived from analytical performance specifications (APS) using the six-sigma method. We tested the applicability of this paradigm to routine haemostasis measurements.
Methods
Three laboratories using different instruments and reagents calculated sigma scores for their prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen and antithrombin (AT) measurements. Sigma scores were calculated using biological variation (BV) data from the literature in combination with internal and external QC data.
Results
Wide ranges in sigma scores for the PT (0.1–6.8), APTT (0.0–4.3), fibrinogen (1.5–8.3) and AT (0.1–2.4) were observed when QC data was combined with the minimum, median and maximum value of BV data, due in particular to a large variation in within-subject and between-subjects coefficients of variation. When the median BV values were applied, most sigma scores were below 3.0, for internal QC data; 75% and for external QC data; 92%.
Conclusions
Our findings demonstrate that: (1) The sigma scores for common haemostasis parameters are relatively low, and (2) The application of the six-sigma method to BV-derived APS is hampered by the large variation in published BV data. As the six-sigma concept is based on requirements for monitoring, and many haemostasis tests are only designed for diagnostic purposes, a fit-for-purpose APS is needed to achieve clinically relevant quality goals.
Collapse
|
12
|
Favaloro EJ, Bonar R, Hollestelle MJ, Jennings I, Mohammed S, Meijer P, Woods T, Meiring M. Differential sensitivity of von Willebrand factor activity assays to reduced VWF molecular weight forms: A large international cross-laboratory study. Thromb Res 2018; 166:96-105. [DOI: 10.1016/j.thromres.2018.04.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/22/2018] [Accepted: 04/16/2018] [Indexed: 12/17/2022]
|
13
|
Matysiak S, Hellmuth K, El-Sagheer AH, Shivalingam A, Ariyurek Y, de Jong M, Hollestelle MJ, Out R, Brown T. Searching for avidity by chemical ligation of combinatorially self-assembled DNA-encoded ligand libraries. Org Biomol Chem 2018; 16:48-52. [DOI: 10.1039/c7ob02119d] [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: 11/21/2022]
Abstract
DNA encoded ligands are self-assembled into bivalent complexes and chemically ligated to link their identities.
Collapse
Affiliation(s)
| | | | - Afaf H. El-Sagheer
- Department of Chemistry
- University of Oxford
- Chemistry Research Laboratory
- Oxford
- UK
| | - Arun Shivalingam
- Department of Chemistry
- University of Oxford
- Chemistry Research Laboratory
- Oxford
- UK
| | - Yavuz Ariyurek
- Leiden Genome Technology Center
- Leiden University Medical Center
- Leiden
- The Netherlands
| | | | - Martine J. Hollestelle
- Dep. Immunophathology and Blood Coagulation
- Sanquin Diagnostic Services
- Amsterdam
- The Netherlands
| | - Ruud Out
- Piculet-Biosciences BV
- 2333BD Leiden
- The Netherlands
| | - Tom Brown
- Department of Chemistry
- University of Oxford
- Chemistry Research Laboratory
- Oxford
- UK
| |
Collapse
|
14
|
van den Besselaar AM, van Rijn CJ, Cobbaert CM, Reijnierse GLA, Hollestelle MJ, Niessen RW, Hudig F. Fibrinogen determination according to Clauss: commutability assessment of International and commercial standards and quality control samples. ACTA ACUST UNITED AC 2017; 55:1761-1769. [DOI: 10.1515/cclm-2016-1088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/14/2017] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Many clinical laboratories use a clotting rate assay according to Clauss for the determination of fibrinogen in citrated plasma. The aim of the present study was to assess the commutability of the current International Standard for fibrinogen (coded 09/264), three commercial fibrinogen standards, and 10 freeze-dried plasma quality control samples from various sources.Methods:Clotting rate assays according to Clauss were performed on three automated instruments (Sysmex CA1500, STA-Rack Evolution and ACL-Top 700), using three commercial thrombin reagents (Siemens, Stago, and Instrumentation Laboratory). Relationships between the results obtained with the three instruments were determined with 25 fresh-frozen plasma samples obtained from patients. The deviations of the assay results obtained with the freeze-dried samples were compared with the deviations obtained with the fresh-frozen samples, according to approved CLSI guideline C53A.Results:Freezing and thawing had no influence on the assay results. There were significant differences in the mean assay results (fibrinogen, g/L) for the fresh-frozen plasma samples between the three automated instruments: 2.51 (STA-Rack Evolution), 2.25 (ACL-Top 700) and 2.20 (Sysmex CA1500). Similar differences were observed for several freeze-dried plasma samples. Some freeze-dried plasma samples, including the International Standard, were out of the 95% confidence interval for the relationship between STA-Rack Evolution and Sysmex CA1500.Conclusions:Some freeze-dried plasmas including the international standard for fibrinogen are not commutable among automated instruments for fibrinogen clotting rate assays according to Clauss. Our results have consequences for all interested parties in the traceability chain (WHO, industry, external quality assessment schemes, clinical laboratories).
Collapse
|
15
|
van der Land V, Mutsaerts HJMM, Engelen M, Heijboer H, Roest M, Hollestelle MJ, Kuijpers TW, Nederkoorn PJ, Cnossen MH, Majoie CBLM, Nederveen AJ, Fijnvandraat K. Risk factor analysis of cerebral white matter hyperintensities in children with sickle cell disease. Br J Haematol 2015; 172:274-84. [PMID: 26492630 DOI: 10.1111/bjh.13819] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 09/07/2015] [Indexed: 11/26/2022]
Abstract
Sickle cell disease (SCD) is complicated by silent cerebral infarcts, visible as white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI). Both local vaso-occlusion, elicited by endothelial dysfunction, and insufficiency of cerebral blood flow (CBF) have been proposed to be involved in the aetiology. We performed an explorative study to investigate the associations between WMHs and markers of endothelial dysfunction and CBF by quantifying WMH volume on 3.0 Tesla MRI. We included 40 children with HbSS or HbSβ(0) thalassaemia, with a mean age of 12.1 ± 2.6 years. Boys demonstrated an increased risk for WMHs (odds ratio 4.5, 95% confidence interval 1.2-17.4), unrelated to glucose-6-phosphate dehydrogenase deficiency. In patients with WMHs, lower fetal haemoglobin (HbF) was associated with a larger WMH volume (regression coefficient = -0.62, R2 = 0.5, P = 0.04). Lower ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) levels were associated with lower CBF in the white matter (regression coefficient = 0.07, R2 = 0.15, P = 0.03), suggesting that endothelial dysfunction could potentially hamper CBF. The findings of our explorative study suggest that a high level of HbF may be protective for WMHs and that endothelial dysfunction may contribute to the development of WMHs by reducing CBF.
Collapse
Affiliation(s)
- Veronica van der Land
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | | | - Marc Engelen
- Department of Paediatric Neurology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Harriët Heijboer
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Mark Roest
- Department of Clinical Chemistry and Haematology, University Medical Centre, Utrecht, The Netherlands
| | - Martine J Hollestelle
- Department Immunopathology and Blood Coagulation, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Paediatric Oncology and Haematology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Aart J Nederveen
- Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Karin Fijnvandraat
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Meenhuis A, van Vliet R, Hudig F, Ypma PF, Schipperus MR, Hollestelle MJ. Successful treatment of a noninhibitory antibody-mediated acquired factor X deficiency in a patient with marginal-zone lymphoma. Clin Case Rep 2015; 3:587-93. [PMID: 26273448 PMCID: PMC4527802 DOI: 10.1002/ccr3.294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/03/2015] [Accepted: 04/16/2015] [Indexed: 11/09/2022] Open
Abstract
Prolonged clotting times were observed in a patient with spontaneous hemorrhage. Analysis showed severe factor X deficiency due to clearance by a noninhibitory antibody. Lymphadenopathy identified on imaging led to diagnosis of marginal B-cell lymphoma. Treatment of lymphoma with rituximab and chlorambucil resulted in complete disappearance of the bleeding disorder.
Collapse
Affiliation(s)
| | - Rianne van Vliet
- Department of Haematology, Haga Teaching Hospital The Hague, The Netherlands
| | | | - Paula F Ypma
- Department of Haematology, Haga Teaching Hospital The Hague, The Netherlands
| | - Martin R Schipperus
- Department of Haematology, Haga Teaching Hospital The Hague, The Netherlands
| | - Martine J Hollestelle
- Department of Immunopathology and Blood Coagulation, Sanquin Diagnostic Services Amsterdam, The Netherlands
| |
Collapse
|
17
|
Chen SF, Xia ZL, Han JJ, Wang YT, Wang JY, Pan SD, Wu YP, Zhang B, Li GY, Du JW, Gao HQ, de Groot PG, de Laat B, Hollestelle MJ. Increased active von Willebrand factor during disease development in the aging diabetic patient population. Age (Dordr) 2013; 35:171-177. [PMID: 22120183 PMCID: PMC3543747 DOI: 10.1007/s11357-011-9335-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 10/25/2011] [Indexed: 05/31/2023]
Abstract
Type 2 diabetes is known to cause endothelial activation resulting in the secretion of von Willebrand factor (VWF). We have shown that levels of VWF in a glycoprotein Ib-binding conformation are increased in specific clinical settings. The aim of the current study is to investigate whether active VWF levels increase during aging and the development of diabetes within the population of patients suffering from type 2 diabetes. Patients and controls were divided into two groups based on age: older and younger than 60 years of age. VWF antigen, VWF propeptide, VWF activation factor and total active VWF were measured. Patients older than 60 years of age had increased levels of total active VWF, VWF activation factor and VWF propeptide compared to younger patients and controls. All measured VWF parameters were associated with age in diabetic patients. Total active VWF and VWF propeptide correlated with the period of being diagnosed with diabetes. Regression analyses showed that especially the VWF activation factor was strongly associated with diabetes in patients older than 60 years of age. In conclusion, we found that the conformation of VWF could be involved in the disease process of diabetes and that the VWF in a glycoprotein Ib-binding conformation could play a role as risk marker during the development of diabetes in combination with an increase in age. Our study shows that the active quality of VWF was more important than the quantity.
Collapse
Affiliation(s)
- Shuang Feng Chen
- SPKLOMHNMB and Central Laboratory, Liaocheng People’ Hospital, Taishan Medical University, Liaocheng, Shandong China
| | - Zuo Li Xia
- SPKLOMHNMB and Central Laboratory, Liaocheng People’ Hospital, Taishan Medical University, Liaocheng, Shandong China
- Department of Aging Medicine, Taishan Medical University, Taian, Shandong China
| | - Ji Ju Han
- Institute of Arthrosclerosis, Taishan Medical University, Taian, Shandong China
| | - Yi Ting Wang
- SPKLOMHNMB and Central Laboratory, Liaocheng People’ Hospital, Taishan Medical University, Liaocheng, Shandong China
| | - Ji Yue Wang
- SPKLOMHNMB and Central Laboratory, Liaocheng People’ Hospital, Taishan Medical University, Liaocheng, Shandong China
| | - Shao Dong Pan
- SPKLOMHNMB and Central Laboratory, Liaocheng People’ Hospital, Taishan Medical University, Liaocheng, Shandong China
| | - Ya Ping Wu
- SPKLOMHNMB and Central Laboratory, Liaocheng People’ Hospital, Taishan Medical University, Liaocheng, Shandong China
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, G03.550, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Bin Zhang
- SPKLOMHNMB and Central Laboratory, Liaocheng People’ Hospital, Taishan Medical University, Liaocheng, Shandong China
| | - Guang Yao Li
- SPKLOMHNMB and Central Laboratory, Liaocheng People’ Hospital, Taishan Medical University, Liaocheng, Shandong China
| | - Jing Wei Du
- SPKLOMHNMB and Central Laboratory, Liaocheng People’ Hospital, Taishan Medical University, Liaocheng, Shandong China
| | - Hen Qiang Gao
- SPKLOMHNMB and Central Laboratory, Liaocheng People’ Hospital, Taishan Medical University, Liaocheng, Shandong China
| | - Philip G. de Groot
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, G03.550, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Bas de Laat
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, G03.550, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Martine J. Hollestelle
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, G03.550, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
18
|
Lotta LA, Lombardi R, Mariani M, Lancellotti S, De Cristofaro R, Hollestelle MJ, Canciani MT, Mannucci PM, Peyvandi F. Platelet reactive conformation and multimeric pattern of von Willebrand factor in acquired thrombotic thrombocytopenic purpura during acute disease and remission. J Thromb Haemost 2011; 9:1744-51. [PMID: 21726405 DOI: 10.1111/j.1538-7836.2011.04428.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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: 11/29/2022]
Abstract
BACKGROUND Binding of von Willebrand factor (VWF) multimers of ultra-large size to platelets is considered the triggering mechanism of microvascular thrombosis in thrombotic thrombocytopenic purpura (TTP). OBJECTIVE To assess the potential of VWF-related measurements as markers of disease activity and severity in TTP. METHODS VWF antigen (VWF:Ag), platelet glycoprotein-Ib-α binding-conformation (GPIb-α/BC) and multimeric pattern were investigated in 74 patients with acquired TTP during acute disease, remission or both and 73 healthy controls. In patients with both acute and remission samples available, VWF ristocetin co-factor activity (VWF:RCo) and collagen binding (VWF:CB) were also measured. The relationships of study measurements with the presence of acute disease and remission and with markers of disease severity were assessed. RESULTS VWF:Ag and VWF-GPIb-α/BC were higher in TTP patients than controls (P < 0.001 and 0.004). However, there was no statistically significant difference in VWF-GPIb-α/BC between samples obtained during acute TTP and remission. Larger VWF multimers were frequently lacking in acute TTP patients, who displayed ultra-large multimers at remission. The degree of loss of larger VWF multimers correlated with the degree of abnormality of hemoglobin, platelet counts and serum lactate dehydrogenase (LDH) and was associated with low levels of both VWF:RCo/Ag and VWF:CB/Ag ratios. CONCLUSIONS In TTP the platelet-binding conformation of VWF is not exclusively present in acute disease, nor is it associated with its clinical and laboratory severity. The loss of larger VWF multimers, accompanied by low VWF:RCo/Ag and VWF:CB/Ag ratio values, represents an index of disease activity and severity of acute TTP in patients with severe ADAMTS-13 deficiency.
Collapse
Affiliation(s)
- L A Lotta
- UOS Dipartimentale per la Diagnosi e la Terapia delle Coagulopatie, Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre and Scientific Direction, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Fondazione Luigi Villa, Università degli Studi di Milano, Milan, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Hollestelle MJ, Lai KW, van Deuren M, Lenting PJ, de Groot PG, Sprong T, Bovenschen N. Cleavage of von Willebrand factor by granzyme M destroys its factor VIII binding capacity. PLoS One 2011; 6:e24216. [PMID: 21909423 PMCID: PMC3164717 DOI: 10.1371/journal.pone.0024216] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 08/03/2011] [Indexed: 12/27/2022] Open
Abstract
Von Willebrand factor (VWF) is a pro-hemostatic multimeric plasma protein that promotes platelet aggregation and stabilizes coagulation factor VIII (FVIII) in plasma. The metalloproteinase ADAMTS13 regulates the platelet aggregation function of VWF via proteolysis. Severe deficiency of ADAMTS13 is associated with thrombotic thrombocytopenic purpura, but does not always correlate with its clinical course. Therefore, other proteases could also be important in regulating VWF activity. In the present study, we demonstrate that VWF is cleaved by the cytotoxic lymphocyte granule component granzyme M (GrM). GrM cleaved both denaturated and soluble plasma-derived VWF after Leu at position 276 in the D3 domain. GrM is unique in that it did not affect the multimeric size and pro-hemostatic platelet aggregation ability of VWF, but instead destroyed the binding of VWF to FVIII in vitro. In meningococcal sepsis patients, we found increased plasma GrM levels that positively correlated with an increased plasma VWF/FVIII ratio in vivo. We conclude that, next to its intracellular role in triggering apoptosis, GrM also exists extracellularly in plasma where it could play a physiological role in controlling blood coagulation by determining plasma FVIII levels via proteolytic processing of its carrier VWF.
Collapse
Affiliation(s)
- Martine J Hollestelle
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
20
|
Hollestelle MJ, Loots CM, Squizzato A, Renné T, Bouma BJ, de Groot PG, Lenting PJ, Meijers JCM, Gerdes VEA. Decreased active von Willebrand factor level owing to shear stress in aortic stenosis patients. J Thromb Haemost 2011; 9:953-8. [PMID: 21352469 DOI: 10.1111/j.1538-7836.2011.04247.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [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: 11/29/2022]
Abstract
BACKGROUND Aortic stenosis patients often show bleeding complications. Previously, a prolonged platelet function analyzer (PFA-100) closure time was observed with plasma of severe aortic stenosis patients. To elucidate a possible role of circulating preactivated von Willebrand factor (VWF), we determined the level of VWF in its active, platelet-binding conformation in plasma of patients with aortic stenosis. PATIENTS/METHODS Sixty-two aortic stenosis patients were included in this study. VWF and related parameters were measured, and the results were related to severity of aortic stenosis. RESULTS VWF activation factor, indicating the proportion of circulating VWF able to bind to platelets, correlated negatively with peak transvalvular gradient and PFA-100 closure time. No correlation was observed between ADAMTS13 activity and peak transvalvular gradient or PFA-100 closure time. Both VWF antigen and VWF propeptide levels were significantly higher in patients with mild and moderate aortic stenosis, but not in those with severe stenosis. CONCLUSIONS Our data demonstrate that the aortic pressure gradient is inversely associated with VWF activation factor, but not with VWF antigen or VWF multimerization in patients with aortic stenosis. These findings might have implications for the bleeding observed in patients with aortic stenosis.
Collapse
Affiliation(s)
- M J Hollestelle
- Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Peyvandi F, Hollestelle MJ, Palla R, Merlini PA, Feys HB, Vanhoorelbeke K, Lenting PJ, Mannucci PM. Active platelet-binding conformation of plasma von Willebrand factor in young women with acute myocardial infarction. J Thromb Haemost 2010; 8:1653-6. [PMID: 20456747 DOI: 10.1111/j.1538-7836.2010.03896.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
van Schie MC, DE Maat MPM, Dippel DWJ, de Groot PG, Lenting PJ, Leebeek FWG, Hollestelle MJ. von Willebrand factor propeptide and the occurrence of a first ischemic stroke. J Thromb Haemost 2010; 8:1424-6. [PMID: 20345720 DOI: 10.1111/j.1538-7836.2010.03863.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
23
|
Hollestelle MJ, Sprong T, Bovenschen N, de Mast Q, van der Ven AJ, Joosten LAB, Neeleman C, Hyseni A, Lenting PJ, de Groot PG, van Deuren M. von Willebrand factor activation, granzyme-B and thrombocytopenia in meningococcal disease. J Thromb Haemost 2010; 8:1098-106. [PMID: 20158601 DOI: 10.1111/j.1538-7836.2010.03811.x] [Citation(s) in RCA: 7] [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: 11/28/2022]
Abstract
SUMMARY BACKGROUND During invasive meningococcal disease, severe thrombocytopenia is strongly associated with a poor outcome. OBJECTIVES In order to elucidate the pathophysiological mechanism behind the development of thrombocytopenia, we studied the role of von Willebrand factor (VWF) in meningococcal disease. PATIENTS/METHODS Thirty-two children with severe meningococcal disease admitted to our university hospital were included in this study. VWF and related parameters were measured and results were correlated with the development of shock and thrombocytopenia. RESULTS At admission, all patients had increased levels of (active) VWF and VWF propeptide. The highest VWF propeptide levels were observed in patients with shock, indicating acute endothelial activation. Although VWF propeptide levels in patients with shock, with or without thrombocytopenia, were similar, increased active VWF was significantly lower in patients with thrombocytopenia as compared with patients without thrombocytopenia. ADAMTS13 was moderately decreased. However, the VWF multimeric pattern was minimally increased. We assume that these findings are explained by VWF consumption and perhaps by granzyme B (GrB). In vitro experiments showed that GrB is able to cleave VWF multimers in plasma, whereas GrB was high in patients with shock, who developed thrombocytopenia. CONCLUSIONS Our results demonstrate that consumption of VWF, derived from endothelial cells, could be a key feature of meningococcal disease and primary to the development of thrombocytopenia during shock.
Collapse
Affiliation(s)
- M J Hollestelle
- Department of Clinical Chemistry and Haematology, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Timmerman P, Barderas R, Desmet J, Altschuh D, Shochat S, Hollestelle MJ, Höppener JWM, Monasterio A, Casal JI, Meloen RH. A combinatorial approach for the design of complementarity-determining region-derived peptidomimetics with in vitro anti-tumoral activity. J Biol Chem 2009; 284:34126-34. [PMID: 19808684 DOI: 10.1074/jbc.m109.041459] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The great success of therapeutic monoclonal antibodies has fueled research toward mimicry of their binding sites and the development of new strategies for peptide-based mimetics production. Here, we describe a new combinatorial approach for the production of peptidomimetics using the complementarity-determining regions (CDRs) from gastrin17 (pyroEGPWLEEEEEAYGWMDF-NH(2)) antibodies as starting material for cyclic peptide synthesis in a microarray format. Gastrin17 is a trophic factor in gastrointestinal tumors, including pancreatic cancer, which makes it an interesting target for development of therapeutic antibodies. Screening of microarrays containing bicyclic peptidomimetics identified a high number of gastrin binders. A strong correlation was observed between gastrin binding and overall charge of the peptidomimetic. Most of the best gastrin binders proceeded from CDRs containing charged residues. In contrast, CDRs from high affinity antibodies containing mostly neutral residues failed to yield good binders. Our experiments revealed essential differences in the mode of antigen binding between CDR-derived peptidomimetics (K(d) values in micromolar range) and the parental monoclonal antibodies (K(d) values in nanomolar range). However, chemically derived peptidomimetics from gastrin binders were very effective in gastrin neutralization studies using cell-based assays, yielding a neutralizing activity in pancreatic tumoral cell lines comparable with that of gastrin-specific monoclonal antibodies. These data support the use of combinatorial CDR-peptide microarrays as a tool for the development of a new generation of chemically synthesized cyclic peptidomimetics with functional activity.
Collapse
Affiliation(s)
- Peter Timmerman
- Pepscan Therapeutics B.V., Zuidersluisweg 2, 8243 RC Lelystad, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
van Schie MC, de Maat MPM, de Groot PG, Hyseni A, Dippel DWJ, Lenting PJ, Leebeek FWG, Hollestelle MJ. Active von Willebrand factor and the risk of stroke. Atherosclerosis 2009; 208:322-3. [PMID: 19732894 DOI: 10.1016/j.atherosclerosis.2009.07.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 07/27/2009] [Indexed: 10/20/2022]
|
26
|
Barderas R, Shochat S, Timmerman P, Hollestelle MJ, Martínez-Torrecuadrada JL, Höppener JWM, Altschuh D, Meloen R, Casal JI. Designing antibodies for the inhibition of gastrin activity in tumoral cell lines. Int J Cancer 2008; 122:2351-9. [PMID: 18224686 DOI: 10.1002/ijc.23395] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Gastrin and its derivatives are becoming important targets for immunotherapy of pancreatic, gastric and colorectal tumors. This study was conducted to design antibodies able to block gastrin binding to the gastrin/cholecystokinin-2 (CCK-2) receptor in order to delay tumor growth. The authors have used different gastrin molecules, combined with the diphtheria toxoid, to generate and select human single chain variable fragments (scFvs) as well as mouse monoclonal antibodies and scFvs against different regions of gastrin. There was a remarkable conservation in the antibody repertoire against gastrin, independently of the approach and the species. The germlines most frequently used in gastrin antibody formation were identified. Three different epitopes were identified in the gastrin molecule. The resulting mouse monoclonal antibodies and scFvs were analyzed for gastrin neutralization using Colo 320 WT cells, which overexpress the CCK-2 receptor. The gastrin neutralizing activity assay showed that N-terminal specific mouse monoclonal antibodies were more efficient to inhibit proliferation of Colo 320 WT cells than the anti-C terminal antibodies. Moreover, the human antigastrin scFvs obtained in this study inhibited significantly the proliferation of Colo 320 tumoral cells. These findings should contribute to a more rational design of antibody-based antigastrin therapies in cancer, including passive administration of human antibodies with blocking activity.
Collapse
Affiliation(s)
- Rodrigo Barderas
- Protein Technology Unit, Biotechnology Program, Spanish National Cancer Research Center (CNIO), Madrid, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Hollestelle MJ, Timmerman P, Meloen RH, Höppener JWM. Characterization of gastrin-cholecystokinin 2 receptor interaction in relation to c-fos induction. Endocr Relat Cancer 2008; 15:301-9. [PMID: 18310296 DOI: 10.1677/erc-07-0206] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The interaction of gastrin with the cholecystokinin 2 (CCK2)/gastrin receptor has been studied extensively in relation to gastric acid secretion. However, not much is known about the contribution of individual amino acids of gastrin interacting with the CCK2 receptor, when gastrin is acting as a tumor growth factor. The purpose of the present study was to determine the significance of each individual amino acid residue of human gastrin-17 with respect to CCK2 receptor-mediated cell proliferation. Activation of this receptor was assessed using an in vitro bioassay based on gastrin-induced expression of a c-fos-luciferase reporter, transfected in AR42JB13 and Colo 320 cells, a rat pancreatic and human colorectal cell line respectively. Gastrin-17 dose dependently increased c-fos induction in both cancer cell lines. L365,260, a known CCK2 receptor antagonist, completely blocked the gastrin signal, demonstrating the specificity of this assay. We demonstrated for the first time that four carboxy-terminal amino acids of gastrin-17 are essential for activation of the CCK2 receptor with respect to c-fos induction. Also other residues of gastrin-17, notably glycine-2 for the rat CCK2 receptor and glutamic acid 8-10 and tyrosine-12 for the human receptor, were found to be important, although to a lesser extent. Alanine-substitution variants of each of the four carboxy-terminal amino acids of gastrin-17 showed strongly reduced receptor activation but did not act as competitive inhibitors of gastrin-17. Identification of the essential role of the carboxy-terminal tetrapeptide of gastrin-17 in CCK2 receptor-mediated c-fos induction indicates that gastrin inhibitory therapeutic strategies should mainly be targeted toward this region of gastrin.
Collapse
Affiliation(s)
- Martine J Hollestelle
- Department of Metabolic and Endocrine Diseases, University Medical Center Utrecht, Lundlaan 6, Utrecht, The Netherlands.
| | | | | | | |
Collapse
|
28
|
Hollestelle MJ, Donkor C, Mantey EA, Chakravorty SJ, Craig A, Akoto AO, O'Donnell J, van Mourik JA, Bunn J. von Willebrand factor propeptide in malaria: evidence of acute endothelial cell activation. Br J Haematol 2006; 133:562-9. [PMID: 16681646 DOI: 10.1111/j.1365-2141.2006.06067.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The pathogenicity of Plasmodium falciparum is thought to relate to the unique ability of infected erythrocytes to adhere to and subsequently activate the vascular endothelium. To study the state of endothelial activation during falciparum malaria, we measured plasma levels of both von Willebrand factor (VWF) and its propeptide, indices of chronic and acute endothelial cell perturbation, respectively. Results were correlated with clinical and biochemical markers of disease severity, including plasma lactate. Our data show that acute endothelial cell activation is a hallmark of malaria in children, indicated by a significant rise in VWF and VWF propeptide. The highest VWF and propeptide levels were seen in cerebral and non-cerebral severe malaria, and associations found between VWF propeptide level and lactate (P < 0.001). Mean VWF propeptide levels (nmol/l) were in cerebral malaria 33.4, non-cerebral severe malaria 26.3, mild malaria 22.1, non-malaria febrile illness 10.2, and controls 10.1. Differences between patient and control groups were highly significant (P < 0.005). Follow-up of 26 cerebral malaria cases showed that levels of VWF propeptide, but not VWF fell by 24 h, following the clinical course of disease and recovery. These novel findings potentially implicate acute, regulated exocytosis of endothelial cell Weibel-Palade bodies in the pathogenesis of Plasmodium falciparum malaria.
Collapse
|
29
|
Bril WS, van Helden PMW, Hausl C, Zuurveld MG, Ahmad RU, Hollestelle MJ, Reitsma PH, Fijnvandraat K, van Lier RAW, Schwarz HP, Mertens K, Reipert BM, Voorberg J. Tolerance to factor VIII in a transgenic mouse expressing human factor VIII cDNA carrying an Arg(593) to Cys substitution. Thromb Haemost 2006; 95:341-7. [PMID: 16493498 DOI: 10.1160/th05-08-0559] [Citation(s) in RCA: 19] [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: 11/05/2022]
Abstract
Inhibitory antibodies develop in approximately 25% of patients with severe hemophilia. A following treatment with factorVIII. In E-16KO or E-17KO mice, in which the factor VIII gene has been inactivated by insertion of a neo cassette, inhibitors develop following administration of factor VIII. Here, we describe the generation of transgenic mice expressing human factor VIII-R593C (huFVIII-R593C). Human factor VIII-R593C cDNA under control of a mouse albumin enhancer/promoter was injected into fertilized oocytes. Analysis of transgenic mice revealed that human factor VIII-R593C was expressed in the liver. Transgenic mice were crossed with factor VIII-deficient mice (E-16KO mice). In plasma of E-16KO mice antibodies were detected after five serial intravenous injections of factor VIII, while plasma of huFVIII-R593C/E-16KO mice did not contain detectable levels of antibodies. No antibody secreting cells were observed in either spleen or bone marrow of huFVIII-R593C/E-16KO mice. Also, factor VIII-specific memory B cells were not observed in the spleen of huFVIII-R593C/E-16KO mice. Analysis of T cell responses revealed that splenocytes derived of E-16KO mice secreted IL-10 and IFN-gamma following restimulation with factor VIII in vitro. In contrast, no factor VIII-specific T cell responses were observed in huFVIII-R593C/E-16KO mice. These results indicate that huFVIII-R593C/E-16KO mice are tolerant to intravenously administered factor VIII. It is anticipated that this model may prove useful for studying immune responses in the context of factor VIII gene therapy.
Collapse
Affiliation(s)
- Wendy S Bril
- Department of Plasma Proteins, Sanquin Research at CLB, Plesmanlaan 125, 1066 CX Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
In humans, fulminant hepatic failure (FHF) is frequently associated with increased factor VIII (FVIII) levels, despite widespread liver cell death. The mechanisms leading to increased FVIII levels and cellular sites of this enhanced FVIII production are poorly understood. We studied the effect of total hepatectomy in pigs, a large-animal model of FHF, on the expression of plasma and tissue FVIII during 24-hour follow-up. Tissue FVIII expression was determined before and 24 h after hepatectomy, both at the mRNA level and immunohistochemically. The expression of plasma and tissue von Willebrand factor (VWF), the natural stabilizing carrier protein of FVIII, was also measured. Total hepatectomy elicited a gradual and sustained twofold elevation of circulating FVIII, whereas FVIII mRNA levels in various organs did not increase after hepatectomy. The half-life of FVIII increased from 7.7 to 10.3 h and VWF levels were also elevated in anhepatic pigs. The increase in the half-life of FVIII and increased levels of VWF were not sufficient to explain the rise in plasma FVIII levels. At the protein level, prominent changes in the cellular distribution of FVIII were seen in spleen and kidney. These observations suggest that in this model of FHF the lack of hepatic FVIII synthesis is adequately compensated by other organs, notably spleen and kidneys.
Collapse
Affiliation(s)
- M J Hollestelle
- Department of Plasma Proteins, Sanquin Research, Amsterdam, the Netherlands
| | | | | | | | | | | |
Collapse
|
31
|
Schooten CJ, Tjernberg P, Westein E, Terraube V, Castaman G, Mourik JA, Hollestelle MJ, Vos HL, Bertina RM, Berg HM, Eikenboom JCJ, Lenting PJ, Denis CV. Cysteine-mutations in von Willebrand factor associated with increased clearance. J Thromb Haemost 2005; 3:2228-37. [PMID: 16194200 DOI: 10.1111/j.1538-7836.2005.01571.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [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: 11/28/2022]
Abstract
BACKGROUND von Willebrand disease (VWD) is a bleeding disorder caused by the decrease of functional von Willebrand factor (VWF). Low levels of VWF can result from decreased synthesis, impaired secretion, increased clearance or combinations thereof. Several mutations lead to impaired synthesis or secretion of VWF, however, little is known about the survival of VWF in the circulation. OBJECTIVES To evaluate the effect of several VWF mutations on VWF clearance. PATIENTS/METHODS The effect of three cysteine-mutations (C1130F, C1149R or C2671Y) on the in vivo survival of VWF was studied in patients carrying these mutations and in a VWF-deficient mice model. RESULTS In patients carrying these mutations, we observed increased propeptide/mature VWF ratios and rapid disappearance of VWF from the circulation after desmopressin treatment. Detailed analysis of in vivo clearance of recombinant VWF in a VWF-deficient mice model revealed a fourfold increased clearance rate of the mutants. The mutations C1130F, C1149R and C2671Y are each associated with reduced survival of VWF in the circulation. Detailed analysis of the recombinant mutant VWF demonstrated that increased clearance was not due to increased proteolysis by ADAMTS-13. We did not identify functional or structural characteristics that the mutant proteins have in common and could be associated with the phenomenon of increased clearance. CONCLUSIONS Cysteine-mutations in VWF may result in reduced in vivo survival. The observation that various mutations are associated with increased in vivo clearance may have major implications for the therapeutic strategies that rely on the rise of endogenous VWF after desmopressin administration.
Collapse
Affiliation(s)
- C J Schooten
- Department of Haematology, Laboratory for Thrombosis and Haemostasis, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
Liver disease is associated with markedly elevated plasma factor VIII (FVIII) levels, whereas the synthesis of many other coagulation factors and proteins is reduced. In order to define the mechanism of FVIII increase, we have determined the expression levels of FVIII, both at mRNA and protein level, in patients with liver disease who underwent partial liver resection. In addition, the expression of von Willebrand factor (VWF) and low density lipoprotein receptor-related protein (LRP), proteins known for their ability to modulate FVIII plasma levels, were examined. Tissue samples for RNA extraction were obtained from 4 patients with cirrhosis, 9 patients with liver failure without cirrhosis and 6 patients with liver metastasis of a colon or rectum carcinoma (control group). In patients with liver cirrhosis hepatic FVIII and LRP mRNA levels were significantly lower than controls (p < or = 0.010), while VWF mRNA was significantly higher (p < or = 0.050). Immunohistochemical analysis revealed that cellular VWF protein distribution was also increased in cirrhotic livers compared to liver tissue from patients with non-cirrhotic liver disease. In cirrhotic tissue enlarged portal veins appeared to overgrow FVIII producing sinusoidal endothelial cells. Similarly, the number of LRP-producing cells appeared to be lower in cirrhotic tissue than in controls. The plasma concentration of both FVIII and VWF was significantly higher in patients with cirrhosis than control subjects (p = 0.038 and 0.010 respectively). These results demonstrate that elevated plasma FVIII levels in liver cirrhosis are associated with increased hepatic biosynthesis of VWF and decreased expression of LRP, rather than increased FVIII synthesis.
Collapse
|
33
|
Hollestelle MJ, Thinnes T, Crain K, Stiko A, Kruijt JK, van Berkel TJ, Loskutoff DJ, van Mourik JA. Tissue distribution of factor VIII gene expression in vivo--a closer look. Thromb Haemost 2001; 86:855-61. [PMID: 11583319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Previous studies have shown that factor VIII (FVIII) is expressed by multiple tissues. However, little is known about its cellular origin or its level of expression in different organs. In the present study, we examined FVIII gene expression in different tissues on a quantitative basis. Most of the tissues, especially liver and kidney, expressed high levels of FVIII mRNA compared to their level of expression of other hemostatic proteins, including von Willebrand factor (VWF). This was unexpected since FVIII is a trace protein. In situ hybridization analysis confirmed that liver and kidney were rich in FVIII mRNA. In the liver, a clear hybridization signal was detected in cells lining the sinusoids. FVIII mRNA analysis of purified liver cells confirmed the expression of FVIII mRNA by sinusoidal endothelial cells and Kupffer cells. Low but significant levels of FVIII mRNA were also detected in the hepatocytes. VWF mRNA was not detectable in these cells. Similarly, immunohistochemical staining of liver tissue revealed that FVIII protein is primarily associated with sinusoidal cells. VWF protein was predominantly located in the endothelium of larger vessels. In the kidney, FVIII synthesis was localized to the glomeruli and to tubular epithelial cells. Taken together, these results suggest that besides hepatocytes, non-parenchymal cells (e.g. sinusoidal endothelial cells) contribute to FVIII synthesis. VWF synthesis is primarily confined to extra-hepatic tissues.
Collapse
Affiliation(s)
- M J Hollestelle
- Department of Blood Coagulation, CLB, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
In this paper a flux-coupling model of photosynthesis is presented. By requiring minimum entropy production, it is found that the photosynthetic efficiency is essentially given by the square root of D/lambda. D and lambda are the diffusion coefficient and thermal conductivity of the rate-limiting processes in the chloroplast, respectively. For experimental values of D and lambda, the efficiency is found to be 2.4-7.5%, with a likely value of 6.1%, whereas C4-plants are known to have an efficiency of 6.2%. We conclude that the process of photosynthesis is in quantitative agreement with the principle of minimum entropy production.
Collapse
Affiliation(s)
- C D Andriesse
- Faculty of Physics and Astronomy, Utrecht University, The Netherlands.
| | | |
Collapse
|