C‐reactive protein induces expression of tissue factor and plasminogen activator inhibitor‐1 and promotes fibrin accumulation in vein grafts

Ji, Yan; Fish, Philip; Strawn, Tammy L; Lohman, Alexander W.; Wu, Jianbo; Szalai, Alexander J.; Fay, William P.

doi:10.1111/jth.12680

Cited by 19 publications

(15 citation statements)

References 38 publications

(57 reference statements)

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“…CRP can bind to surface receptors on monocytes, endothelial cells and platelets thereby altering their function to propagate hypercoagulable conditions (73,74). The ability of CRP and SAA to induce TF expression has been demonstrated in various cell types (13,14,22,71,72,(75)(76)(77)(78)(79)(80)(81) and by in vivo studies (82,83). Additionally, acute phase reactants can also suppress fibrinolysis by promoting expression of plasminogen activator inbibitor-1 (PAI-1) (82) and inhibiting TF pathway inhibitor (TFPI) expression (81,83).…”

Section: Discussionmentioning

confidence: 99%

The Atypical Fibrin Fibre Network in Rheumatoid Arthritis and its Relation to Autoimmunity, Inflammation and Thrombosis

Bezuidenhout

Venter

Roberts

et al. 2020

Preprint

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Objective. The risk of cardiovascular events in patients with RA is disproportionately heightened as a result of systemic inflammation. The relative effect of autoimmuneassociated citrullination on the structure and thrombotic potential of fibrin(ogen) remains unknown. We therefore compared indices of vascular function, inflammation, coagulation and fibrin clot composition in RA patients with healthy controls and evaluated inter-parameter relationships. Methods. Blood samples were collected from 30 RA patients and 25 age-and gender-matched healthy volunteers.Levels of SAA, CRP, ICAM-1 and VCAM-1 was measured using a sandwich immunoassay. Whole blood coagulation was assessed using Thromboelastography. Fibrin clot networks and fiber structure was investigated using Scanning Electron Microscopy. The detection and quantification of citrullination in formed fibrin clots were performed using a fluorescently labeled Citrulline monoclonal antibody with Confocal Microscopy. Results. Concentrations of SAA, CRP and ICAM-1 were significantly elevated in RA patients compared to controls. TEG parameters relating to coagulation initiation (R and K), rate of fibrin cross-linking (α-Angle), and time to reach maximum thrombus generation (TMRTG) were attenuated in RA patients. Parameters relating to clot strength (MA, MRTG, TGG) did not statistically differ between RA and controls. Logistic regression modelling revealed stronger association between acute phase reactants (CRP, SAA) with TEG parameters than endothelial function markers. Microscopic analysis revealed denser networks of thicker fibrin fibers in RA patients compared to controls [median (interquartile range) 214 (170-285) vs 120 (100-144) nm respectively, p<0.0001, Odds ratio=22.7). Detection of multiple citrullinated regions within fibrin clot structures in RA patients, which was less prevalent in control samples (p<0.05, OR=2.2). Conclusion.Patients with active RA display a coagulation profile that is dissimilar to general findings associated with other inflammatory conditions. The alteration of protein structures by autoimmune linked citrullination could play a role in determining the structure of fibrin and the potential of conferring a heightened thrombotic risk in RA patients.

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Section: Discussionmentioning

confidence: 99%

The Atypical Fibrin Fibre Network in Rheumatoid Arthritis and its Relation to Autoimmunity, Inflammation and Thrombosis

Bezuidenhout

Venter

Roberts

et al. 2020

Preprint

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“…Inflammation has been increasingly recognized as a key contributor to the pathophysiology of cerebrovascular diseases [ 11 ]. In particular in LVO, the inflammatory response may trigger events in the coagulation cascade intravascularly [ 12 , 13 ]. This seems to be the case in our patients.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Thrombectomy of COVID-19 positive acute ischemic stroke patient: a case report and call for preparedness

2020

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Background The novel coronavirus (COVID-19) global pandemic is associated with an increased incidence of acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). The treatment of these patients poses unique and significant challenges to health care providers requiring changes in existing protocols. Case presentation A 54-year-old COVID-19 positive patient developed sudden onset left hemiparesis secondary to an acute right middle cerebral artery occlusion (National Institutes of Health Stroke Scale (NIHSS) score = 11). Mechanical thrombectomy (MT) was performed under a new protocol specifically designed to maximize protective measures for the team involved in the care of the patient. Mechanical Thrombectomy was performed successfully under general anesthesia resulting in TICI 3 recanalization. With regards to time metrics, time from door to reperfusion was 60 mins. The 24-h NIHSS score decreased to 2. Patient was discharged after 19 days after improvement of her pulmonary status with modified Rankin Scale = 1. Conclusion Patients infected by COVID-19 can develop LVO that is multifactorial in etiology. Mechanical thrombectomy in a COVID-19 confirmed patient presenting with AIS due to LVO is feasible with current mechanical thrombectomy devices. A change in stroke workflow and protocols is now necessary in order to deliver the appropriate life-saving therapy for COVID-19 positive patients while protecting medical providers.

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“…8 In addition, C-reactive protein increases plasminogen activator inhibitor-1 (PAI-1) levels. 17 PAI-1 inhibits the enzyme tissue plasminogen activator (important for blood clot dissolution); thus, it plays an important role in the regulation of fibrinolytic activity. 18 A systemic inflammatory state may activate clotting pathways, leading to atherosclerotic plaque instability and rupture resulting in acute coronary syndrome.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Obstructive Sleep Apnea Hypopnea Syndrome and Inflammatory Markers and Quality of Life in Subjects With Acute Coronary Syndrome

Yuan

Wang

et al. 2016

Respir Care

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BACKGROUND: The objective of this work was to examine the relationship between obstructive sleep apnea (OSA) and inflammatory markers and quality of life in patients with acute coronary syndrome, especially undergoing percutaneous coronary intervention. METHODS: One hundred eighteen subjects were admitted with acute coronary syndrome over 1 y who had symptoms of OSA and positive polysomnography on admission. Of these subjects, 53 underwent primary percutaneous coronary intervention during their admission, and 65 had medical management. We then compared inflammatory markers by OSA status. We also assessed cardiac symptoms using the Seattle Angina Questionnaire and sleep symptoms using the Epworth Sleepiness Scale. RESULTS: Subjects in the percutaneous coronary intervention group had a higher oxygen desaturation index (ODI) (P ‫؍‬ .02) and apnea-hypopnea index (AHI) (P ‫؍‬ .048) compared with those in the medical management group. In percutaneous coronary intervention subjects, the moderate-severe OSA group (AHI > 15/h) had a higher hematocrit (P ‫؍‬ .047), homocysteine (P ‫؍‬ .01), and highsensitivity C-reactive protein (P ‫؍‬ .045) compared with those with no or mild OSA (AHI < 15/h). There was a significant correlation between high-sensitivity C-reactive protein and both AHI (r ‫؍‬ 0.46, P ‫؍‬ .001) and ODI (r ‫؍‬ 0.47, P < .001). Those with moderate-severe OSA had higher Epworth Sleepiness Scale (P ‫؍‬ .002), greater physical limitation (P ‫؍‬ .01), and lower treatment satisfaction and disease perception (P ‫؍‬ .007), as judged by subscales of the Seattle Angina Questionnaire, compared with those with no or mild OSA. Finally, subjects undergoing percutaneous coronary intervention with lower AHI (r ‫؍‬ 0.48, P < .001) and ODI (r ‫؍‬ 0.49, P < .001) reported higher treatment satisfaction. CONCLUSIONS: Subjects with acute coronary syndrome undergoing percutaneous coronary intervention who had moderate-severe OSA showed higher levels of inflammatory mediators and lower treatment satisfaction and disease perception. These factors may increase the risk of adverse sequelae by increasing the systemic inflammatory response.

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C‐reactive protein induces expression of tissue factor and plasminogen activator inhibitor‐1 and promotes fibrin accumulation in vein grafts

Cited by 19 publications

References 38 publications

The Atypical Fibrin Fibre Network in Rheumatoid Arthritis and its Relation to Autoimmunity, Inflammation and Thrombosis

The Atypical Fibrin Fibre Network in Rheumatoid Arthritis and its Relation to Autoimmunity, Inflammation and Thrombosis

Mechanical Thrombectomy of COVID-19 positive acute ischemic stroke patient: a case report and call for preparedness

The Relationship Between Obstructive Sleep Apnea Hypopnea Syndrome and Inflammatory Markers and Quality of Life in Subjects With Acute Coronary Syndrome

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