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  • 1
    In: Blood Journal, American Society of Hematology, ( 2023-05-22)
    Abstract: Immune TTP (iTTP) survivors have increased risk of cardiovascular disease including stroke, and report persistent cognitive difficulties during remission. We conducted this prospective study of iTTP survivors in clinical remission to determine the prevalence of silent cerebral infarction (SCI), defined as magnetic resonance imaging (MRI) evidence of brain infarction without corresponding overt neuro-deficits, during clinical remission. We also tested the hypothesis that SCI is associated with cognitive impairment assessed using the NIH ToolBox cognition battery. We used fully corrected T scores adjusted for age, sex, race, and education. Based on DSM-5 criteria, we defined mild and major cognitive impairment as T-scores that are 1-2 SD and & gt; 2 SD below the mean on at least one test, respectively. Forty-two patients have been enrolled, with 36 completing MRI.SCI was present in 50% (18) , of which 8 (44.4%) had prior overt stroke including during acute iTTP. Patients with SCI had higher rates of cognitive impairment (66.7% vs. 27.7%, P=0.026) including major cognitive impairment (50% vs. 5.6%, P=0.010). In separate logistic regression models, SCI was associated with any (mild or major) cognitive impairment [OR 10.5 (95% CI 1.45 - 76.63); P = 0.020] and major cognitive impairment [OR 7.98 (95% CI 1.11 - 57.27); P = 0.039] after adjusting for history of stroke and Beck depression inventory scores. In summary, MRI evidence of brain infarction is common in iTTP survivors; the strong association of SCI with impaired cognition suggests that these 'silent' infarcts are neither silent nor innocuous.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2023
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  • 2
    In: Blood, American Society of Hematology, ( 2023-03-22)
    Abstract: Inhibitors of complement and coagulation are present in the saliva of a variety of blood feeding arthropods that transmit parasitic and viral pathogens. Here we describe the structure and mechanism of action of the sand fly salivary protein lufaxin, which inhibits formation of the central alternative C3 convertase (C3bBb) and inhibits coagulation factor Xa (fXa). Surface plasmon resonance experiments show that lufaxin stabilizes the binding of the serine protease factor B (FB) to C3b but does not detectably bind either C3b or FB alone. The crystal structure of the inhibitor reveals a novel all β-sheet fold containing two domains. A structure of the lufaxin-C3bB complex obtained by cryo-electron microscopy shows that lufaxin binds via its N-terminal domain at an interface containing elements of both C3b and FB. By occupying this spot, the inhibitor locks FB into a closed conformation where proteolytic activation of FB by FD cannot occur. C3bB-bound lufaxin binds fXa at a separate site in its C-terminal domain. In the cryo-EM structure of a C3bB-lufaxin-fXa complex the inhibitor binds both targets simultaneously and lufaxin inhibits fXa through substrate-like binding of a C-terminal peptide at the active site as well as other interactions in this region. Lufaxin inhibits complement activation in ex vivo models of atypical hemolytic uremic syndrome (aHUS) and paroxysmal nocturnal hemoglobinuria (PNH) as well as thrombin generation in plasma, providing rationale for the development of a bispecific inhibitor to treat complement-related diseases in which thrombosis is a prominent manifestation.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2023
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  • 3
    Online Resource
    Online Resource
    Springer Science and Business Media LLC ; 2023
    In:  Journal of Clinical Immunology Vol. 43, No. 6 ( 2023-08), p. 1134-1136
    In: Journal of Clinical Immunology, Springer Science and Business Media LLC, Vol. 43, No. 6 ( 2023-08), p. 1134-1136
    Type of Medium: Online Resource
    ISSN: 0271-9142 , 1573-2592
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    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 2016755-6
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  • 4
    Online Resource
    Online Resource
    American Society of Hematology ; 2021
    In:  The Hematologist Vol. 18, No. 5 ( 2021-09-01)
    In: The Hematologist, American Society of Hematology, Vol. 18, No. 5 ( 2021-09-01)
    Type of Medium: Online Resource
    ISSN: 1551-8779
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2021
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  • 5
    Online Resource
    Online Resource
    Ferrata Storti Foundation (Haematologica) ; 2021
    In:  Haematologica Vol. 107, No. 5 ( 2021-07-22), p. 1095-1105
    In: Haematologica, Ferrata Storti Foundation (Haematologica), Vol. 107, No. 5 ( 2021-07-22), p. 1095-1105
    Abstract: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may manifest as thrombosis, stroke, renal failure, myocardial infarction, and thrombocytopenia, reminiscent of other complement- mediated diseases. Multiple clinical and preclinical studies have implicated complement in the pathogenesis of COVID-19 illness. We previously found that the SARS-CoV-2 spike protein activates the alternative pathway of complement (APC) in vitro through interfering with the function of complement factor H, a key negative regulator of APC. Here, we demonstrated that serum from 58 COVID-19 patients (32 patients with minimal oxygen requirement, 7 on high flow oxygen, 17 requiring mechanical ventilation and 2 deaths) can induce complementmediated cell death in a functional assay (the modified Ham test) and increase membrane attack complex (C5b-9) deposition on the cell surface. A positive modified Ham assay ( 〉 20% cell-killing) was present in 41.2% COVID-19 patients requiring intubation (n=7/17) and only 6.3% in COVID-19 patients requiring minimal oxygen support (n=2/32). C5 and factor D inhibition effectively mitigated the complement amplification induced by COVID-19 patient serum. Increased serum factor Bb level was associated with disease severity in COVID-19 patients, suggesting that APC dysregulation plays an important role. Moreover, SARS-CoV-2 spike proteins directly block complement factor H from binding to heparin, which may lead to complement dysregulation on the cell surface. Taken together, our data suggest that complement dysregulation contributes to the pathogenesis of COVID-19 and may be a marker of disease severity.
    Type of Medium: Online Resource
    ISSN: 1592-8721 , 0390-6078
    Language: Unknown
    Publisher: Ferrata Storti Foundation (Haematologica)
    Publication Date: 2021
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  • 6
    In: Proceedings of the National Academy of Sciences, Proceedings of the National Academy of Sciences, Vol. 119, No. 47 ( 2022-11-22)
    Abstract: Severe COVID-19 is characterized by a prothrombotic state associated with thrombocytopenia, with microvascular thrombosis being almost invariably present in the lung and other organs at postmortem examination. We evaluated the presence of antibodies to platelet factor 4 (PF4)–polyanion complexes using a clinically validated immunoassay in 100 hospitalized patients with COVID-19 with moderate or severe disease (World Health Organization score, 4 to 10), 25 patients with acute COVID-19 visiting the emergency department, and 65 convalescent individuals. Anti-PF4 antibodies were detected in 95 of 100 hospitalized patients with COVID-19 (95.0%) irrespective of prior heparin treatment, with a mean optical density value of 0.871 ± 0.405 SD (range, 0.177 to 2.706). In contrast, patients hospitalized for severe acute respiratory disease unrelated to COVID-19 had markedly lower levels of the antibodies. In a high proportion of patients with COVID-19, levels of all three immunoglobulin (Ig) isotypes tested (IgG, IgM, and IgA) were simultaneously elevated. Antibody levels were higher in male than in female patients and higher in African Americans and Hispanics than in White patients. Anti-PF4 antibody levels were correlated with the maximum disease severity score and with significant reductions in circulating platelet counts during hospitalization. In individuals convalescent from COVID-19, the antibody levels returned to near-normal values. Sera from patients with COVID-19 induced higher levels of platelet activation than did sera from healthy blood donors, but the results were not correlated with the levels of anti-PF4 antibodies. These results demonstrate that the vast majority of patients with severe COVID-19 develop anti-PF4 antibodies, which may play a role in the clinical complications of COVID-19.
    Type of Medium: Online Resource
    ISSN: 0027-8424 , 1091-6490
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    Language: English
    Publisher: Proceedings of the National Academy of Sciences
    Publication Date: 2022
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  • 7
    Online Resource
    Online Resource
    Proceedings of the National Academy of Sciences ; 2012
    In:  Proceedings of the National Academy of Sciences Vol. 109, No. 10 ( 2012-03-06)
    In: Proceedings of the National Academy of Sciences, Proceedings of the National Academy of Sciences, Vol. 109, No. 10 ( 2012-03-06)
    Abstract: Thus, in summary, these findings show the existence of a mechanism of cell death in Drosophila other than developmental apoptosis and suggest its transcriptional control by NF-κB. These results also assign roles in addition to immunity to previously characterized genes of the immune signaling pathway. They also provide a basis for exploring NF-κB signaling as a therapeutic target in retinal degeneration. To understand further the role played by Relish in cell death, we asked if this prodeath signal could be attributed to its transcriptional activity (i.e., its effects on DNA in the nucleus) or to as-yet-unknown functions it has in the cell fluid (cytosol) outside the nucleus. To answer this question, we carried out gain-of-function studies by expressing certain parts of the Relish protein: ( i ) its transcriptionally active N-terminal region (domain) or ( ii ) the cytosol-localized C-terminal domain. Expression of the N-terminal domain in a variety of tissues proved detrimental ( Fig. P1 D – F ). However, overexpressed C-terminal domain or full-length Relish did not have any effects. These data suggest that Relish exerts a toxic effect via its transcriptional activity. We next examined the role played by genes that act downstream of Dredd during immune responses. The immune response pathway in Drosophila relies on the expression of antimicrobial peptides by enhancing the transcription of their genes. In this case, the transcription is activated via a transcription factor protein, NF-κB. During infection by Gram-negative bacteria, the immune response is mediated by the NF-κB homolog Relish. We observed that mutations in the gene relish completely prevented photoreceptor cell death Fig. P1 ( A – C ). We also observed that Relish was transcriptionally active specifically in light-treated norpA flies but not in wild-type (nonmutated) flies. Furthermore, mutations that block Relish activation rescue photoreceptor degeneration as well. These results all indicate its key role in retinal degeneration. To identify the players involved in photoreceptor cell death, we undertook a candidate gene approach. We reasoned that activation of effector caspases must rely on apical (initiator) caspases. Surprisingly, a mutation in the caspase-8 homolog, Dredd, rescued the light-induced cell death but had no adverse effects on retinal development, indicating that Dredd plays a crucial role in retinal degeneration but is dispensable during developmental apoptosis. Dredd is known to play a key role in the activation of the innate immune response against certain bacterial infections (Gram-negative bacteria). Interestingly, the upstream activators of Dredd in immune response were not involved in retinal degeneration in norpA flies. Thus, alternative and yet-uncharacterized mechanisms also can activate Dredd. We investigated the cell death signaling pathway activated in norpA flies. Previous analysis of norpA retinal degeneration suggested a marginal role for apoptotic players usually involved in developmental processes ( 5 ), indicating that the photoreceptor cell death might involve an alternative mechanism. Our data further clarify that the machinery in place for activating the major initiator caspase in this familiar apoptotic pathway, Dronc, is not engaged during retinal degeneration. The data presented here also suggest that effector caspases are involved, although only to a marginal extent. Caspases are enzymes that in general play a central role in apoptotic pathways. To model retinal degeneration, we used a Drosophila mutant, no receptor potential A ( norpA ). These flies lack a functional eye-specific protein, phospholipase C, which is the effector enzyme of the visual transduction pathway. Hence, these flies are defective in generating a response to light. The photoreceptors of these flies are viable when flies are reared in the dark but rapidly undergo cell death when the flies are exposed to light. Previous work on norpA mutants has revealed that exposure to light leads to massive endocytosis (internalization from the plasma membrane into the cell body) of rhodopsin, the light-sensing molecule ( 2 ). This internalized rhodopsin accumulates in the cell body and fails to undergo timely degradation ( 3 ). Preventing rhodopsin endocytosis or its accumulation rescues the photoreceptors from death ( 3 , 4 ). Retinal degeneration causes irreversible loss of vision in humans. In most cases, the cells affected are the neurons in the retina. The death of the retinal neurons and an inability to replace them causes permanent vision loss. Among the retinal neuronal cell types, photoreceptors seem to be especially susceptible to damage causing retinal degeneration ( 1 ) In most cases, the precise mechanism of photoreceptor death is not understood completely. We investigated the cell death (apoptosis) signaling pathways behind photoreceptor cell death and found that they involve players different from those of the known apoptotic pathways—specifically, the gene Relish , which is involved in immune responses.
    Type of Medium: Online Resource
    ISSN: 0027-8424 , 1091-6490
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    Language: English
    Publisher: Proceedings of the National Academy of Sciences
    Publication Date: 2012
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    SSG: 11
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  • 8
    In: eJHaem, Wiley, Vol. 4, No. 2 ( 2023-05), p. 324-338
    Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection results in coagulation activation although it is usually not associated with consumption coagulopathy. D‐dimers are also commonly elevated despite systemic hypofibrinolysis. To understand these unusual features of coronavirus disease 2019 (COVID‐19) coagulopathy, 64 adult patients with SARS‐CoV‐2 infection (36 moderate and 28 severe) and 16 controls were studied. We evaluated the repertoire of plasma protease inhibitors (Serpins, Kunitz, Kazal, Cystatin‐like) targeting the fibrinolytic system: Plasminogen Activator Inhibitor‐1 (PAI‐1), Tissue Plasminogen Activator/Plasminogen Activator Inhibitor‐1 complex (t‐PA/PAI‐1), α‐2‐Antiplasmin, Plasmin‐α2‐Antiplasmin Complex, Thrombin‐activatable Fibrinolysis Inhibitor (TAFI)/TAFIa, Protease Nexin‐1 (PN‐1), and Neuroserpin (the main t‐PA inhibitor of the central nervous system). Inhibitors of the common (Antithrombin, Thrombin‐antithrombin complex, Protein Z [PZ]/PZ inhibitor, Heparin Cofactor II, and α2‐Macroglobulin), Protein C ([PC] , Protein C inhibitor, and Protein S), contact (Kallistatin, Protease Nexin‐2/Amyloid Beta Precursor Protein, and α‐1‐Antitrypsin), and complement (C1‐Inhibitor) pathways, in addition to Factor XIII, Histidine‐rich glycoprotein (HRG) and Vaspin were also investigated by enzyme‐linked immunosorbent assay. The association of these markers with disease severity was evaluated by logistic regression. Pulmonary expression of PAI‐1 and Neuroserpin in the lungs from eight post‐mortem cases was assessed by immunohistochemistry. Results show that six patients (10%) developed thrombotic events, and mortality was 11%. There was no significant reduction in plasma anticoagulants, in keeping with a compensated state. However, an increase in fibrinolysis inhibitors (PAI‐1, Neuroserpin, PN‐1, PAP, and t‐PA/PAI‐1) was consistently observed, while HRG was reduced. Furthermore, these markers were associated with moderate and/or severe disease. Notably, immunostains demonstrated overexpression of PAI‐1 in epithelial cells, macrophages, and endothelial cells of fatal COVID‐19, while Neuroserpin was found in intraalveolar macrophages only. These results imply that the lungs in SARS‐CoV‐2 infection provide anti‐fibrinolytic activity resulting in a shift toward a local and systemic hypofibrinolytic state predisposing to (immuno)thrombosis, often in a background of compensated disseminated intravascular coagulation.
    Type of Medium: Online Resource
    ISSN: 2688-6146 , 2688-6146
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 3021452-X
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  • 9
    Online Resource
    Online Resource
    American Society of Hematology ; 2022
    In:  Blood Vol. 139, No. 23 ( 2022-06-09), p. 3361-3365
    In: Blood, American Society of Hematology, Vol. 139, No. 23 ( 2022-06-09), p. 3361-3365
    Abstract: Approximately a third of patients with paroxysmal nocturnal hemoglobinuria (PNH) remain transfusion dependent or have symptomatic anemia despite treatment with a C5 inhibitor. Pegcetacoplan inhibits complement proximally at the level of C3 and is highly effective in treating persistent anemia resulting from C3-mediated extravascular hemolysis. We describe the rationale for C3 inhibition in the treatment of PNH and discuss preclinical and clinical studies using pegcetacoplan and other compstatin derivatives. We propose an approach for sequencing complement inhibitors in PNH.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 10
    Online Resource
    Online Resource
    American Society of Hematology ; 2021
    In:  Hematology Vol. 2021, No. 1 ( 2021-12-10), p. 614-620
    In: Hematology, American Society of Hematology, Vol. 2021, No. 1 ( 2021-12-10), p. 614-620
    Abstract: COVID-19 is frequently associated with abnormalities on coagulation testing and a coagulopathy driven by inflammation, intravascular coagulation activation, and microvascular thrombosis. Elevated D-dimer is the most common finding and is a predictor of adverse outcomes including thrombosis, critical illness, and death. Although COVID-19-associated coagulopathy has some similarities to disseminated intravascular coagulation, the platelet count is usually preserved, coagulation times are usually normal or minimally prolonged, and thrombosis is more common than bleeding, at least in noncritically ill patients. Bleeding is uncommon but may be a significant problem in critically ill patients, including those who may develop a consumptive coagulopathy with frank disseminated intravascular coagulation and those on extracorporeal membrane oxygenation. Blood product support to correct coagulopathy is reserved for bleeding patients or those requiring invasive procedures. Current recommendations suggest that all hospitalized patients should receive at least a prophylactic dose of anticoagulation. Results from a multiplatform randomized clinical trial suggest that therapeutically dosed anticoagulation may improve outcomes, including the need for organ support and mortality in moderately ill patients but not in those requiring critical care. The results of ongoing trials evaluating the impact of different antithrombotic strategies (therapeutic agents and intensity) on COVID-19 outcomes are eagerly awaited and are expected to have important implications for patient management. We also discuss COVID-19 vaccine-associated cytopenias and bleeding as well as vaccine-induced thrombotic thrombocytopenia, in which thrombosis is associated with thrombocytopenia, elevated D-dimer, and, frequently, hypofibrinogenemia.
    Type of Medium: Online Resource
    ISSN: 1520-4391 , 1520-4383
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2021
    detail.hit.zdb_id: 2084287-9
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