Intestinal thrombotic microangiopathy: a distinct entity in the spectrum of graft-versus-host disease

Gavriilaki, Eleni; Karafoulidou, Ioanna; Pasteli, Nikoleta; Batsis, Ioannis; Mallouri, Despina; Lazaridou, Andriana; Iskas, Michalis; Vardi, Anna; Papalexandri, Apostolia; Tsompanakou, Aliki; Papaemmanouil, Styliani; Ilias, A.; Anagnostopoulos, Achilles

doi:10.1007/s12185-019-02750-7

Cited by 14 publications

(10 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Strikingly similar histological pictures have recently been reported in Covid-19 patients with diffuse severe endotheliitis of the submucosal vessels in the small bowel [41] . In a way, this kind of endothelial injury is similar to that commonly reported in intestinal transplant-associated thrombotic microangiopathy, which is observed after hematopoietic stem cell transplant [42] . Indeed, in these cases ischemic enterocolitis presents with abdominal pain and gastrointestinal bleeding.…”

Section: Endotheliitis As An Effector Of Gastrointestinal Tract Damagsupporting

confidence: 81%

Intestinal permeability changes with bacterial translocation as key events modulating systemic host immune response to SARS-CoV-2: A working hypothesis

Cardinale

Capurso

Ianiro

et al. 2020

Digestive and Liver Disease

View full text Add to dashboard Cite

The microbiota-gut-liver-lung axis plays a bidirectional role in the pathophysiology of a number of infectious diseases. During the course of severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and 2 (SARS-CoV-2) infection, this pathway is unbalanced due to intestinal involvement and systemic inflammatory response. Moreover, there is convincing preliminary evidence linking microbiota-gut-liver axis perturbations, proinflammatory status, and endothelial damage in noncommunicable preventable diseases with coronavirus disease 2019 (Covid-19) severity. Intestinal damage due to SARS-CoV-2 infection, systemic inflammation-induced dysfunction, and IL-6-mediated diffuse vascular damage may increase intestinal permeability and precipitate bacterial translocation. The systemic release of damage- and pathogen-associated molecular patterns (e.g. lipopolysaccharides) and consequent immune-activation may in turn auto-fuel vicious cycles of systemic inflammation and tissue damage. Thus, intestinal bacterial translocation may play an additive/synergistic role in the cytokine release syndrome in Covid-19. This review provides evidence on gut-liver axis involvement in Covid-19 as well as insights into the hypothesis that intestinal endotheliitis and permeability changes with bacterial translocation are key pathophysiologic events modulating systemic inflammatory response. Moreover, it presents an overview of readily applicable measures for the modulation of the gut-liver axis and microbiota in clinical practice.

show abstract

Section: Endotheliitis As An Effector Of Gastrointestinal Tract Damagsupporting

confidence: 81%

Intestinal permeability changes with bacterial translocation as key events modulating systemic host immune response to SARS-CoV-2: A working hypothesis

Cardinale

Capurso

Ianiro

et al. 2020

Digestive and Liver Disease

View full text Add to dashboard Cite

show abstract

“…Histologic studies show both intrarenal and extrarenal microthrombi suggesting that TA-TMA is a multisystem disorder [51,59]. iTMA is an increasingly recognized manifestation and is associated with high-risk features [15,[59][60][61][62]. iTMA presents with a constellation of signs and symptoms including severe abdominal pain, diarrhea, vomiting, ascites, and intestinal bleeding, which are similar to that of GI GVHD, infectious colitis, or drug-induced colitis.…”

Section: Gastrointestinal Tractmentioning

confidence: 99%

Transplant-associated thrombotic microangiopathy: theoretical considerations and a practical approach to an unrefined diagnosis

Young

Pallas

Knovich

2021

Bone Marrow Transplant

View full text Add to dashboard Cite

Transplant-associated thrombotic microangiopathy (TA-TMA) is an increasingly recognized complication of hematopoietic stem cell transplant (HSCT) with high morbidity and mortality. The triad of endothelial cell activation, complement dysregulation, and microvascular hemolytic anemia has the potential to cause end organ dysfunction, multiple organ dysfunction syndrome and death, but clinical features mimic other disorders following HSCT, delaying diagnosis. Recent advances have implicated complement as a major contributor and the therapeutic potential of complement inhibition has been explored. Eculizumab has emerged as an effective therapy and narsoplimab (OMS721) has been granted priority review by the FDA. Large studies performed mostly in pediatric patients suggest that earlier recognition and treatment may lead to improved outcomes. Here we present a clinically focused summary of recently published literature and propose a diagnostic and treatment algorithm.

show abstract

“…Because the sample size was too small (only three patients), this result should mainly serve as an indication pointing towards future research. However, the aforementioned condition is rare and the patient's survival from this condition even rarer [45,46]. In this sense we reckon that this finding should be highlighted keeping in mind of course the above limitation.…”

Section: Discussionmentioning

confidence: 92%

Assessment of Endothelial Injury and Pro-Coagulant Activity Using Circulating Microvesicles in Survivors of Allogeneic Hematopoietic Cell Transplantation

Gavriilaki

Sakellari

Anyfanti

et al. 2020

IJMS

Self Cite

View full text Add to dashboard Cite

(1) Background: survivors of allogeneic hematopoietic cell transplantation (alloHCT) suffer from morbidity and mortality due to cardiovascular events. We hypothesized that vascular injury and pro-coagulant activity are evident in alloHCT survivors without existing alloHCT complications or relapse. (2) Methods: we enrolled consecutive adult alloHCT survivors without established cardiovascular disease and control individuals matched for traditional cardiovascular risk factors (January–December 2019). Circulating microvesicles (MVs) of different cellular origins (platelet, erythrocyte, and endothelial) were measured by a standardized flow cytometry protocol as novel markers of vascular injury and pro-coagulant activity. (3) Results: we recruited 45 survivors after a median of 2.3 (range 1.1–13.2) years from alloHCT, and 45 controls. The majority of patients suffered from acute (44%) and/or chronic (66%) graft-versus-host disease (GVHD). Although the two groups were matched for traditional cardiovascular risk factors, alloHCT survivors showed significantly increased platelet and erythrocyte MVs compared to controls. Within alloHCT survivors, erythrocyte MVs were significantly increased in patients with a previous history of thrombotic microangiopathy. Interestingly, endothelial MVs were significantly increased only in alloHCT recipients of a myeloablative conditioning. Furthermore, MVs of different origins showed a positive association with each other. (4) Conclusions: endothelial dysfunction and increased thrombotic risk are evident in alloHCT recipients long after alloHCT, independently of traditional cardiovascular risk factors. An apparent synergism of these pathophysiological processes may be strongly involved in the subsequent establishment of cardiovascular disease.

show abstract

Intestinal thrombotic microangiopathy: a distinct entity in the spectrum of graft-versus-host disease

Cited by 14 publications

References 14 publications

Intestinal permeability changes with bacterial translocation as key events modulating systemic host immune response to SARS-CoV-2: A working hypothesis

Intestinal permeability changes with bacterial translocation as key events modulating systemic host immune response to SARS-CoV-2: A working hypothesis

Transplant-associated thrombotic microangiopathy: theoretical considerations and a practical approach to an unrefined diagnosis

Assessment of Endothelial Injury and Pro-Coagulant Activity Using Circulating Microvesicles in Survivors of Allogeneic Hematopoietic Cell Transplantation

Contact Info

Product

Resources

About