TY - JOUR A1 - Navarro, Stefano A1 - Stegner, David A1 - Nieswandt, Bernhard A1 - Heemskerk, Johan W. M. A1 - Kuijpers, Marijke J. E. T1 - Temporal roles of platelet and coagulation pathways in collagen- and tissue factor-induced thrombus formation JF - International Journal of Molecular Sciences N2 - In hemostasis and thrombosis, the complex process of thrombus formation involves different molecular pathways of platelet and coagulation activation. These pathways are considered as operating together at the same time, but this has not been investigated. The objective of our study was to elucidate the time-dependency of key pathways of thrombus and clot formation, initiated by collagen and tissue factor surfaces, where coagulation is triggered via the extrinsic route. Therefore, we adapted a microfluidics whole-blood assay with the Maastricht flow chamber to acutely block molecular pathways by pharmacological intervention at desired time points. Application of the technique revealed crucial roles of glycoprotein VI (GPVI)-induced platelet signaling via Syk kinase as well as factor VIIa-induced thrombin generation, which were confined to the first minutes of thrombus buildup. A novel anti-GPVI Fab EMF-1 was used for this purpose. In addition, platelet activation with the protease-activating receptors 1/4 (PAR1/4) and integrin αIIbβ3 appeared to be prolongedly active and extended to later stages of thrombus and clot formation. This work thereby revealed a more persistent contribution of thrombin receptor-induced platelet activation than of collagen receptor-induced platelet activation to the thrombotic process. KW - coagulation KW - fibrin KW - glycoprotein VI KW - platelet receptors KW - spatiotemporal thrombus KW - thrombin Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284219 SN - 1422-0067 VL - 23 IS - 1 ER - TY - JOUR A1 - Rohmann, Jessica L. A1 - Huo, Shufan A1 - Sperber, Pia S. A1 - Piper, Sophie K. A1 - Rosendaal, Frits R. A1 - Heuschmann, Peter U. A1 - Endres, Matthias A1 - Liman, Thomas G. A1 - Siegerink, Bob T1 - Coagulation factor XII, XI, and VIII activity levels and secondary events after first ischemic stroke JF - Journal of Thrombosis and Haemostasis N2 - Background Though risk for recurrent vascular events is high following ischemic stroke, little knowledge about risk factors for secondary events post‐stroke exists. Objectives Coagulation factors XII, XI, and VIII (FXII, FXI, and FVIII) have been implicated in first thrombotic events, and our aim was to estimate their effects on vascular outcomes within 3 years after first stroke. Patients/Methods In the Prospective Cohort with Incident Stroke Berlin (PROSCIS‐B) study, we followed participants aged 18 and older for 3 years after first mild to moderate ischemic stroke event or until occurrence of recurrent stroke, myocardial infarction, or all‐cause mortality. We compared high coagulation factor activity levels to normal and low levels and also analyzed activities as continuous variables. We used Cox proportional hazards models adjusted for age, sex, and cardiovascular risk factors to estimate hazard ratios (HRs) for the combined endpoint. Results In total, 94 events occurred in 576 included participants, resulting in an absolute rate of 6.6 events per 100 person‐years. After confounding adjustment, high FVIII activity showed the strongest relationship with the combined endpoint (HR = 2.05, 95% confidence interval [CI] 1.28–3.29). High FXI activity was also associated with a higher hazard (HR = 1.80, 95% CI 1.09–2.98), though high FXII activity was not (HR = 0.86, 95% CI 0.49–1.51). Continuous analyses yielded similar results. Conclusions In our study of mild to moderate ischemic stroke patients, high activity levels of FXI and FVIII but not FXII were associated with worse vascular outcomes in the 3‐year period after first ischemic stroke. KW - coagulation KW - factor VIII KW - factor XI KW - factor XII KW - ischemic stroke Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-217877 VL - 18 IS - 12 SP - 3316 EP - 3324 ER - TY - JOUR A1 - Dorsch, Oliver A1 - Krieter, Detlef H. A1 - Lemke, Horst-Dieter A1 - Fischer, Stefan A1 - Melzer, Nima A1 - Sieder, Christian A1 - Bramlage, Peter A1 - Harenberg, Job T1 - A multi-center, prospective, open-label, 8-week study of certoparin for anticoagulation during maintenance hemodialysis - the membrane study JF - BMC Nephrology N2 - Background: Adequate anticoagulation is prerequisite for effective hemodialysis to prevent clotting in the extracorporeal circuit. We aimed providing first data on the efficacy and safety of the low-molecular-weight heparin certoparin in this setting. Methods: Multicenter, open-label, 8-week trial. Patients received a single dose of 3,000 IU certoparin i.v. with additional titration steps of 600 IU and/or continuous infusion if necessary. Results: 120 patients were screened, 109 enrolled (median age 71; range 26-90 years) and 106 available for efficacy analyses. The percentage of unsatisfactory dialysis results at 8 weeks due to clotting or bleeding, was 1.9% (n = 2/106; 95% confidence interval [CI] 0.23-6.65%); no major bleeding. 1.9% had moderate/severe clotting in the lines/bubble catcher and 2.8% in the dialyser at week 8.15.7 +/- 14.3% of the dialysis filters' visual surface area was showing redness. In subgroups of patients receiving median doses of 3000 +/- 0, 3000 (2400-6000) and 4200 (3000-6600) IU, plasma aXa levels at baseline, 4 and 8 weeks were 0.24 [ 95% CI 0.21-0.27], 0.33 [0.27-0.40] and 0.38 [0.33-0.45] aXa IU/ml at 2 h. C-48h was 0.01 [0.01-0.02] aXa IU at all visits. At baseline and 4 weeks AUC(0-48h) was 2.66 [2.19-3.24] and 3.66 [3.00-4.45] aXa IU*h/ml. In 3.0% of dialyses (n = 83/2724) prolonged fistula compression times were documented. Eight patients (7.34%) had at least one episode of minor bleeding. 4) 85.3% of patients had any adverse event, 9.2% were serious without suspected drug relation; and in 32 patients a drug-relation was suspected. Conclusions: Certoparin appears effective and safe for anticoagulation in patients undergoing maintenance hemodialysis. KW - XA KW - low molecular weight KW - severe renal insufficiency KW - unfractionated heparin KW - standard heparin KW - enoxaparin KW - metaanalysis KW - coagulation KW - fragmin KW - sodium Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-134845 VL - 13 IS - 50 ER - TY - JOUR A1 - Kraft, Peter A1 - De Meyer, Simon F. A1 - Kleinschnitz, Christoph T1 - Next-Generation Antithrombotics in Ischemic Stroke: Preclinical Perspective on ‘Bleeding-Free Antithrombosis’ JF - Journal of Cerebral Blood Flow and Metabolism N2 - The present antithrombotic drugs used to treat or prevent ischemic stroke have significant limitations: either they show only moderate efficacy (platelet inhibitors), or they significantly increase the risk for hemorrhages (thrombolytics, anticoagulants). Although most strokes are caused by thrombotic or embolic vessel occlusions, the pathophysiological role of platelets and coagulation is largely unclear. The introduction of novel transgenic mouse models and specific coagulation inhibitors facilitated a detailed analysis of molecular pathways mediating thrombus formation in models of acute ischemic stroke. Prevention of early platelet adhesion to the damaged vessel wall by blocking platelet surface receptors glycoprotein Ib alpha (GPIbα) or glycoprotein VI (GPVI) protects from stroke without provoking bleeding complications. In addition, downstream signaling of GPIbα and GPVI has a key role in platelet calcium homeostasis and activation. Finally, the intrinsic coagulation cascade, activated by coagulation factor XII (FXII), has only recently been identified as another important mediator of thrombosis in cerebrovascular disease, thereby disproving established concepts. This review summarizes the latest insights into the pathophysiology of thrombus formation in the ischemic brain. Potential clinical merits of novel platelet inhibitors and anticoagulants as powerful and safe tools to combat ischemic stroke are discussed. KW - von Willebrand factor KW - platelets KW - glycoprotein Ib KW - FXII KW - coagulation KW - Stim Y1 - 2012 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-126538 VL - 32 IS - 10 ER - TY - JOUR A1 - Borges, Alvaro H. A1 - O'Connor, Jemma L. A1 - Phillips, Andrew N. A1 - Baker, Jason V. A1 - Vjecha, Michael J. A1 - Losso, Marcelo H. A1 - Klinker, Hartwig A1 - Lopardo, Gustavo A1 - Williams, Ian A1 - Lundgren, Jens D. T1 - Factors Associated with D-Dimer Levels in HIV-Infected Individuals JF - PLOS ONE N2 - Background: Higher plasma D-dimer levels are strong predictors of mortality in HIV+ individuals. The factors associated with D-dimer levels during HIV infection, however, remain poorly understood. Methods: In this cross-sectional study, participants in three randomized controlled trials with measured D-dimer levels were included (N = 9,848). Factors associated with D-dimer were identified by linear regression. Covariates investigated were: age, gender, race, body mass index, nadir and baseline CD4(+) count, plasma HIV RNA levels, markers of inflammation (C-reactive protein [CRP], interleukin-6 [IL-6]), antiretroviral therapy (ART) use, ART regimens, co-morbidities (hepatitis B/C, diabetes mellitus, prior cardiovascular disease), smoking, renal function (estimated glomerular filtration rate [eGFR] and cystatin C) and cholesterol. Results: Women from all age groups had higher D-dimer levels than men, though a steeper increase of D-dimer with age occurred in men. Hepatitis B/C co-infection was the only co-morbidity associated with higher D-dimer levels. In this subgroup, the degree of hepatic fibrosis, as demonstrated by higher hyaluronic acid levels, but not viral load of hepatitis viruses, was positively correlated with D-dimer. Other factors independently associated with higher D-dimer levels were black race, higher plasma HIV RNA levels, being off ART at baseline, and increased levels of CRP, IL-6 and cystatin C. In contrast, higher baseline CD4+ counts and higher high-density lipoprotein cholesterol were negatively correlated with D-dimer levels. Conclusions: D-dimer levels increase with age in HIV+ men, but are already elevated in women at an early age due to reasons other than a higher burden of concomitant diseases. In hepatitis B/C co-infected individuals, hepatic fibrosis, but not hepatitis viral load, was associated with higher D-dimer levels. KW - fibrin D-dimer KW - all-cause mortality KW - antiretroviral therapy KW - plasma D-dimer KW - elderly persons KW - coagulation KW - biomarkers KW - disease KW - interleukin-6 KW - adults Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-117094 VL - 9 IS - 3 ER - TY - THES A1 - Strehl, Amrei T1 - Studies on regulation and signaling of the platelet glycoproteins GPV and GPVI T1 - Studien zur Regulation und Signaltransduktion der Plättchenglykoproteine GPV und GPVI N2 - Bei Verletzung einer Gefäßwand kommen Blutplättchen in Kontakt mit den Substanzen des Subendothels; Die Plättchen werden dadurch aktiviert, sie aggregieren und verschließen die Wunde, wodurch ein hoher Blutverlust verhindert wird. Unter pathologischen Bedingungen, bei Aufbrechen eines artherosklerotischen Plaques an der Gefäßwand, können sich jedoch große Plättchenaggregate, die Thromben, formen, die das Gefäß verschließen, den Blutfluss stoppen und somit zu Schlaganfall und Herzinfarkt führen können. Die kontrollierte Regulation und Signaltransduktion von bzw. durch Plättchenoberflächenrezeptoren ist wesentlich für das Funktionieren der Zellen und die intakte Balance zwischen physiologischer Plättchen-Aktivierung und der pathologischen Bildung eines Thrombus. In der vorliegenden Arbeit wird über wichtige Aspekte dieser Signalwege, die in drei Unterprojekten untersucht worden sind, berichtet. In dem ersten Unterprojekt wurde die Regulation von Plättchenoberflächenrezeptoren, den Glykoproteinen (GP) V und VI, bei Mäusen analysiert. Hier wird beschrieben, dass GPV und GPVI von der Plättchenoberfläche durch Metalloproteinasen geschnitten werden. Während physiologischer Stress, wie das Entkoppeln der oxidativen Phosphorylierung in den Mitochondrien, das Schneiden von GPVI durch eine unbekannte Proteinase auslöst, verursacht die Aktivierung von Plättchen mit bestimmten Agonisten das Schneiden von GPV. Die dafür verantwortliche Metalloproteinase wurde als ADAM17 identifiziert. In dem zweiten Unterprojekt wurde die Rolle der Protein Kinase C (PKC) in der Plättchenaktivierung einerseits und in der Plättchen pro-koagulanten Aktivität andereseits untersucht. Die Konformationsänderung/Aktivierung von alphaIIbeta3-Integrinen und Sekretion von Granula sind charakteristisch für die Plättchenaktivierung. Calcium-(Ca2+)-abhängige Phosphatidylserin (PS)- Expression auf der Plättchenoberfläche hingegen ist kennzeichnend für die pro-koagulante Aktivität. Der Beitrag von PKC zu den beschriebenen Plättchenzuständen war bisher unklar. In diesem Projekt wurde zum ersten Mal gezeigt, dass PKC eine doppelte Funktion in den Plättchen besitzt: einerseits fördert PKC die Plättchen-Aktivierung und –Aggregation, andererseits unterdrückt PKC die pro-koagulant Aktivität. In dem dritten Unterprojekt wurde die Rolle der kleinen GTPase Rac1 in der Plättchen- Aktivierung und -Aggregation in vitro und in vivo an konditionalen Rac1 Mäusen analysiert. Es wird berichtet, dass Rac1 für die GPVI abhängige Aktivierung von alphaIIbbeta3-Integrinen und dem Freisetzen von Ca2+ in der Zelle, notwendig ist, sowie für GPVI abhängige Plättchen-Aggregation und Thrombus Bildung. Hiermit wird die GTPase Rac1 zum ersten Mal in den Signalweg unterhalb von GPVI eingeordnet und ihr zudem dort eine essentielle Rolle zugeteilt. N2 - Platelets are crucial to inhibit extensive blood loss at sites of vascular injury. However, under pathological conditions such as rupture of an atherosclerotic plaque, activated platelets form aggregates that may occlude the vessel. This can lead to heart attack and stroke. Various and complex signaling pathways in the cell are involved in the steps of platelet adhesion, activation and aggregation. Single aspects of these processes were studied in three different subprojects in this work. The Glycoprotein (GP) Ib-V-IX complex is responsible for the first contact of platelets with the vessel wall. Subsequently, GPVI can bind to collagen of the subendothelium, which initiates a signaling cascade leading to platelet activation, aggregation, characterized by integrin activation and granule secretion and platelet procoagulant activity. The latter is characterized by exposed phosphatidylserine (PS) on the platelet surface, which enhances thrombin generation and thereby the coagulation cascade. A controlled regulation of GP receptors on the platelet surface is vital for an intact response of the cell to platelet agonists. In the first subproject described here the regulation of GPV and GPVI on mouse platelets was investigated and it was found that both receptors are shed from the platelet surface in a metalloproteinase dependent manner. However, GPVI is shed upon mitochondrial injury, while GPV cleavage could be observed upon platelet stimulation. The metalloproteinase responsible for GPVI shedding remains unknown whereas the metallproteinase that sheds GPV was identified in this work as being ADAM17. This shows that the expression of both receptors underlies a controlled mechanism regulated through distinct metalloproteinases. In the second subproject the role of protein kinase C (PKC) in platelet activation and procoagulant response was investigated using PKC specific inhibitors. It was found that PKC blockage reduced platelet activation but enhanced platelet procoagulant activity. This is the first time that a dual role in platelet activation and procoagulant activity is defined for PKC. In the third project the role of the small GTPase Rac1 in platelet signaling was studied using conditional Rac1 knock out mice. It is reported here that Rac1 lies downstream of GPVI and is involved in integrin activation and cytsolic Ca2+ changes in vitro and platelet adhesion and thrombus formation in vivo. This is the first time that Rac1 is demonstrated to have a pivotal role in GPVI signaling and furthermore points to a novel, unknown pathway downstream of GPVI. KW - Thrombozyt KW - Membranglykoproteine KW - Proteinkinase C KW - Signaltransduktion KW - Blutplättchen KW - Glykoprotein-Shedding KW - Protein Kinase C KW - Koagulation KW - Rac1 KW - platelets KW - glycoprotein-shedding KW - protein kinase C KW - coagulation KW - Rac1 Y1 - 2006 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-22283 ER -