1
|
Joly BS, Darmon M, Dekimpe C, Dupont T, Dumas G, Yvin E, Beranger N, Vanhoorelbeke K, Azoulay E, Veyradier A. Imbalance of von Willebrand factor and ADAMTS13 axis is rather a biomarker of strong inflammation and endothelial damage than a cause of thrombotic process in critically ill COVID-19 patients. J Thromb Haemost 2021; 19:2193-2198. [PMID: 34219357 PMCID: PMC8420340 DOI: 10.1111/jth.15445] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 05/20/2021] [Revised: 06/11/2021] [Accepted: 07/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Critically ill patients with coronavirus disease 2019 (COVID-19) are prone to developing macrothrombosis and microthrombosis. COVID-19 has been reported to be rarely associated with thrombotic microangiopathies. A disintegrin and metalloprotease with thrombospondin type I repeats, member 13 (ADAMTS13) severe deficiency, the hallmark of thrombotic thrombocytopenic purpura (TTP), induces the formation of platelet, unusually large von Willebrand factor (VWF) multimer microthrombi. In immune-mediated TTP, ADAMTS13 adopts specifically an open conformation. The VWF/ADAMTS13 couple may contribute to the microthrombi formation in pulmonary alveolar capillaries in COVID-19. OBJECTIVE To investigate clinical features, hemostatic laboratory parameters, VWF/ADAMTS13 axis, and ADAMTS13 conformation in critically ill COVID-19 patients at admission. METHODS Fifty three critically ill COVID-19 patients were enrolled between March 18 and May 9 2020 in a monocentric hospital. RESULTS The median age was 59 years and the male-to-female ratio was 2.8/1. We reported seven pulmonary embolisms and 15 deaths. Biological investigations showed increased fibrinogen and factor V levels, and strongly increased D-dimers correlated with mortality. No patient presented severe thrombocytopenia nor microangiopathic hemolytic anemia. An imbalance between high VWF antigen levels and normal or slightly decreased ADAMTS13 activity levels (strongly elevated VWF/ADAMTS13 ratio) was correlated with mortality. Three patients had a partial quantitative deficiency in ADAMTS13. We also reported a closed conformation of ADAMTS13 in all patients, reinforcing the specificity of an open conformation of ADAMTS13 as a hallmark of TTP. CONCLUSION We suggest that slightly decreased or normal ADAMTS13 activity and highly elevated VWF are rather biomarkers reflecting both the strong inflammation and the endothelial damage rather than drivers of the thrombotic process of COVID-19.
Collapse
Affiliation(s)
- Bérangère S Joly
- Service d'Hématologie biologique, Hôpital Lariboisière, AP-HP.Nord, Université de Paris, Paris, France
- EA3518 Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Michael Darmon
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris, France
| | - Charlotte Dekimpe
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Thibault Dupont
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris, France
| | - Guillaume Dumas
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris, France
| | - Elise Yvin
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris, France
| | - Nicolas Beranger
- Service d'Hématologie biologique, Hôpital Lariboisière, AP-HP.Nord, Université de Paris, Paris, France
- EA3518 Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Karen Vanhoorelbeke
- Laboratory for Thrombosis Research, IRF Life Sciences, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Elie Azoulay
- Service de Réanimation médicale, Hôpital Saint-Louis, AP-HP.Nord, Université de Paris, Paris, France
| | - Agnès Veyradier
- Service d'Hématologie biologique, Hôpital Lariboisière, AP-HP.Nord, Université de Paris, Paris, France
- EA3518 Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| |
Collapse
|
2
|
Beranger N, Benghezal S, Joly BS, Capdenat S, Delton A, Stepanian A, Coppo P, Veyradier A. Diagnosis and follow-up of thrombotic thrombocytopenic purpura with an automated chemiluminescent ADAMTS13 activity immunoassay. Res Pract Thromb Haemost 2021; 5:81-93. [PMID: 33537532 PMCID: PMC7845081 DOI: 10.1002/rth2.12461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/24/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Thrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathy (TMA) caused by a severe functional deficiency in ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type I repeats-13), the specific von Willebrand factor (VWF) cleaving protease. ADAMTS13 activity is essential to diagnose TTP but remains challenging to assess, as reference ADAMTS13 activity assays are manual and time consuming. Current techniques also lack robustness in low detectable ADAMTS13 activity range, which could prove problematic for therapy-driven monitoring. OBJECTIVES The HemosIL AcuStar ADAMTS13 activity assay is a fast, automated chemiluminescent assay, the performance of which remains to be evaluated prospectively on very large cohorts of patients with TMA and in real-life conditions. PATIENTS AND METHODS Our study was conducted over two successive sequences: a retrospective evaluation followed by a "real-life" prospective evaluation. Overall, we evaluated the HemosIL AcuStar ADAMTS13 activity assay on 539 citrated plasma samples. We extensively studied linearity, limit of detection, contamination, intra-assay and interassay precisions with a specific focus on levels < 25 IU/dL. Diagnostic performances for the detection of < 10 IU/dL ADAMTS13 activity and overall method comparison were conducted with the fluorescence resonance energy transfer (FRETS)-VWF73 assay as the reference method. RESULTS Technical performance proved excellent. Robustness in low detectable ADAMTS13 activity range was good, potentially qualifying this assay for therapy-driven monitoring. Comparison with the FRETS-VWF73 assay was satisfactory (r 2 = .83, P < .0001) as were the diagnostic performances for acute-phase TTP (specificity, 99.7%; positive predictive value, 99.2%). CONCLUSION The HemosIL AcuStar ADAMTS13 activity assay is a fast, reliable, automated technique well adapted as a first-line ADAMTS13 activity assay for TTP diagnosis and follow-up.
Collapse
Affiliation(s)
- Nicolas Beranger
- Service d’hématologie BiologiqueHôpital Lariboisière, AP‐HP.Nord and EA3518Institut de Recherche Saint‐LouisUniversité de ParisParisFrance
- French National Reference Centre for Thrombotic MicroangiopathiesAssistance Publique – Hôpitaux de ParisFrance
| | - Sandrine Benghezal
- Service d’hématologie BiologiqueHôpital Lariboisière, AP‐HP.Nord and EA3518Institut de Recherche Saint‐LouisUniversité de ParisParisFrance
- French National Reference Centre for Thrombotic MicroangiopathiesAssistance Publique – Hôpitaux de ParisFrance
| | - Bérangère S. Joly
- Service d’hématologie BiologiqueHôpital Lariboisière, AP‐HP.Nord and EA3518Institut de Recherche Saint‐LouisUniversité de ParisParisFrance
- French National Reference Centre for Thrombotic MicroangiopathiesAssistance Publique – Hôpitaux de ParisFrance
| | - Sophie Capdenat
- Service d’hématologie BiologiqueHôpital Lariboisière, AP‐HP.Nord and EA3518Institut de Recherche Saint‐LouisUniversité de ParisParisFrance
- French National Reference Centre for Thrombotic MicroangiopathiesAssistance Publique – Hôpitaux de ParisFrance
| | - Adeline Delton
- Service d’hématologie BiologiqueHôpital Lariboisière, AP‐HP.Nord and EA3518Institut de Recherche Saint‐LouisUniversité de ParisParisFrance
- French National Reference Centre for Thrombotic MicroangiopathiesAssistance Publique – Hôpitaux de ParisFrance
| | - Alain Stepanian
- Service d’hématologie BiologiqueHôpital Lariboisière, AP‐HP.Nord and EA3518Institut de Recherche Saint‐LouisUniversité de ParisParisFrance
- French National Reference Centre for Thrombotic MicroangiopathiesAssistance Publique – Hôpitaux de ParisFrance
| | - Paul Coppo
- French National Reference Centre for Thrombotic MicroangiopathiesAssistance Publique – Hôpitaux de ParisFrance
- Département d’hématologie cliniqueHôpital Saint AntoineUniversité Pierre et Marie CurieParisFrance
| | - Agnès Veyradier
- Service d’hématologie BiologiqueHôpital Lariboisière, AP‐HP.Nord and EA3518Institut de Recherche Saint‐LouisUniversité de ParisParisFrance
- French National Reference Centre for Thrombotic MicroangiopathiesAssistance Publique – Hôpitaux de ParisFrance
| |
Collapse
|
3
|
Delrue M, Siguret V, Neuwirth M, Joly B, Beranger N, Sène D, Chousterman BG, Voicu S, Bonnin P, Mégarbane B, Stépanian A. von Willebrand factor/ADAMTS13 axis and venous thromboembolism in moderate-to-severe COVID-19 patients. Br J Haematol 2020; 192:1097-1100. [PMID: 33368196 DOI: 10.1111/bjh.17216] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Maxime Delrue
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,EA 3518, Paris University, Paris, France
| | - Virginie Siguret
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,INSERM, UMRS 1140, Paris University, Paris, France
| | - Marie Neuwirth
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,INSERM, UMRS 1140, Paris University, Paris, France
| | - Bérangère Joly
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,EA 3518, Paris University, Paris, France
| | - Nicolas Beranger
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,EA 3518, Paris University, Paris, France
| | - Damien Sène
- Department of Internal Medicine, Lariboisière Hospital, Paris University, Paris, France
| | - Benjamin G Chousterman
- Department of Anesthesiology and Critical Care, Lariboisière Hospital, Paris University, Paris, France.,INSERM, UMRS 942, Université de Paris, Paris, France
| | - Sebastian Voicu
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris University, Paris, France.,INSERM, UMRS 1144, Paris University, Paris, France
| | - Philippe Bonnin
- Department of Clinical Physiology, Lariboisière Hospital, Paris University, Paris, France.,INSERM U1265, INSERM, Université de Paris, Paris, France.,INSERM U1148-Laboratory for Vascular and Translational Science, Université de Paris, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris University, Paris, France.,INSERM, UMRS 1144, Paris University, Paris, France
| | - Alain Stépanian
- Department of Hematology, Lariboisière Hospital, Paris University, Paris, France.,EA 3518, Paris University, Paris, France
| |
Collapse
|