thromboplastin and Graft-vs-Host-Disease

There is compelling evidence that blood-borne tissue factor that is predominantly found on circulating microparticles (MPs) plays an important role in both, cancer biology and organ and stem-cell transplantation (SCT). Therefore, we hypothesized that numbers of tissue factor bearing MPs might be associated with complications and outcome in allogeneic SCT (allo-SCT).. In a prospective study, we enumerated total, platelet, endothelial, and tissue factor bearing MPs in plasma samples obtained from up to 60 patients with hematologic diseases at different time-points during the course of allo-SCT by flow cytometry. Patient- and transplant-related risk factors were included in statistical analysis.. Mean follow-up time was 968 days (0-1981 days). Thirty-four (56.7%) patients died, 17 due to transplant-related mortality (28.3%). High numbers of tissue factor positive MPs more than 500/μL before conditioning were predictive for shorter overall survival (P=0.017, hazard ratio=4.5) in multivariate analysis. This was mainly caused by an increase in transplant-related mortality (P=0.010, hazard ratio=11.0) with cumulative incidences at 1 year of 68.8% compared with patients with lower values (20.1%; P=0.002).. Tissue factor bearing MPs might be useful biomarkers for risk stratification in allo-SCT patients and further studies should investigate their origin, functional properties, and optimal cut-off values.

Topics: Adolescent; Adult; Aged; Biomarkers; Blood Platelets; Cell-Derived Microparticles; Endothelium, Vascular; Female; Flow Cytometry; Graft vs Host Disease; Hematologic Diseases; Humans; Incidence; Male; Middle Aged; Mucositis; Predictive Value of Tests; Prospective Studies; Recurrence; Risk Factors; Stem Cell Transplantation; Thromboembolism; Thromboplastin; Transplantation, Homologous; Young Adult

While therapeutic mesenchymal stromal/stem cells (MSCs) have usually been obtained from bone marrow, perinatal tissues have emerged as promising new sources of cells for stromal cell therapy. In this study, we present a first safety follow-up on our clinical experience with placenta-derived decidual stromal cells (DSCs), used as supportive immunomodulatory and regenerative therapy for patients with severe complications after allogeneic hematopoietic stem cell transplantation (HSCT). We found that DSCs are smaller, almost half the volume of MSCs, which may favor microvascular passage. DSCs also show different hemocompatibility, with increased triggering of the clotting cascade after exposure to human blood and plasma in vitro. After infusion of DSCs in HSCT patients, we observed a weak activation of the fibrinolytic system, but the other blood activation markers remained stable, excluding major adverse events. Expression profiling identified differential levels of key factors implicated in regulation of hemostasis, such as a lack of prostacyclin synthase and increased tissue factor expression in DSCs, suggesting that these cells have intrinsic blood-activating properties. The stronger triggering of the clotting cascade by DSCs could be antagonized by optimizing the cell graft reconstitution before infusion, for example, by use of low-dose heparin anticoagulant in the cell infusion buffer. We conclude that DSCs are smaller and have stronger hemostatic properties than MSCs, thus triggering stronger activation of the clotting system, which can be antagonized by optimizing the cell graft preparation before infusion. Our results highlight the importance of hemocompatibility safety testing for every novel cell therapy product before clinical use, when applied using systemic delivery.

Topics: Adolescent; Adult; Anticoagulants; Blood Coagulation; Bone Marrow Cells; Child; Child, Preschool; Cytochrome P-450 Enzyme System; Decidua; Female; Gene Expression; Graft vs Host Disease; Heparin; Humans; Infant; Infant, Newborn; Intramolecular Oxidoreductases; Male; Mesenchymal Stem Cell Transplantation; Mesenchymal Stem Cells; Middle Aged; Placenta; Pregnancy; Reverse Transcriptase Polymerase Chain Reaction; Thromboplastin; Treatment Outcome

This study was purposed to detect the expression level of human endothelial cell tissue factor (hECTF) and concentration of IL-2, and to investigate the alterations of hECTF and IL-2 after using immunosuppressive agent (cyclosporin, CsA) and explore the significance of endothelial cell (EC) lesion and abnormal expression of tissue factor (TF) in GVHD. Human endothelial cells and allogeneic lymphocytes were mixed and cultured as well as were cocultured with CsA for 4-6 hours in vitro, then the expression level of hECTF was detected by flow cytometry and RT-PCR, the concentration of IL-2 in supernatant was assayed by ELISA. The experiment was divided into 4 groups: 1st group--non-mixed-cultured group (negative control group), 2nd group - mixed-cultured group (positive control group), 3rd group - mixed-cocultured group with 1 µg/ml CsA and 4th group--mixed-cocultured group with 2 µg/ml CsA. The results showed that as compared with non-mixed-cultured group (negative control group), the expression level of hECTF and concentration of IL-2 in another 3 groups significantly increased (p<0.01), while as compared with positive control group, the expression level of hECTF and concentration of IL-2 in cocultured groups with CsA both decreased (p<0.01). It is concluded that the lesion of EC and abnormal expression of TF play a crucial role in GVHD, among which the high expression of TF after being stimulated by donor's lymphocytes may be the key step for occurrence and progression of GVHD.

Topics: Cells, Cultured; Coculture Techniques; Cyclosporine; Endothelial Cells; Graft vs Host Disease; Humans; Interleukin-2; Lymphocytes; Thromboplastin

To study the pathogenetic role of tissue factor (TF) in endothelial-injury in GVHD.. Gene and protein expressions of TF in the organs of allogenic hematopoietic stem cell transplantation (allo-HSCT) and autologous HSCT (auto-HSCT) mice were determined by real-time PCR and Western blot. The effect of allogeneic T lymphocytes on the expression of TF and other cytokines and activation of MAPKs in human umbilical vein endothelial cells (HUVECs) was detected by flow cytometry, real-time PCR or Western blot. The influence of TF antibodies (SB203580 and SP600125) on allogeneic T lymphocytes-induced cytokines expression was also tested.. (1) TF gene and protein expression in the liver, skin, small intestine and stomach of allo-HSCT mice was significantly elevated about 15.1+/-2.1, 5.5+/-1.4, 9.7+/-2.3, 14.2+/-2.9 folds and 13.5+/-2.7, 6.2+/-0.9, 7.9+/-1.6, 15.3+/-3.2 folds respectively compared with that of auto-HSCT mice. (2) Allogeneic CD4+ CD8+ T lymphocytes significantly enhanced TF, VCAM-1, TNF-alpha, IFN-gamma and IL-6 expression in TNF-alpha prestimulated HUVECs. (3) Allogeneic T lymphocytes enhanced p38MAPK and JNK phosphorylation in HUVECs, but did not affect ERK phosphorylation. p38 MAPK JNK inhibitors SB203580 and SP600125 reduced allogeneic T lymphocytes-induced TF expression in HUVECs. (4) SB203580 and SP600125 down-regulated allogeneic T lymphocytes-induced VCAM-1, TNF-alpha, IFN-gamma, IL-6 expression in HUVECs.. TF mediates vascular endothelial-injury and activation in GVHD via phosphorylation of p38MAPK and JNK.

Topics: Animals; Anthracenes; Cells, Cultured; Disease Models, Animal; Endothelial Cells; Endothelium; Endothelium, Vascular; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Imidazoles; Interferon-gamma; Interleukin-6; Mice; Mitogen-Activated Protein Kinases; Pyridines; T-Lymphocytes; Thromboplastin; Tumor Necrosis Factor-alpha

This study examined the expressions of human serum tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in patients with acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and their clinical significance. The serum TF and TFPI levels were detected by ELISA in 28 allo-HSCT recipients before and after the transplantation and the changes of TF and TFPI levels were dynamically monitored at different phases of the disease. No significant differences in the serum TF and TFPI levels were found in allo-HSCT recipients in the absence of aGVHD or with grade I aGVHD before and after the transplantation. The levels of serum TF and TFPI were substantially increased in the patients with gradeII aGVHD at the peak of aGVHD (P<0.05) and they were even higher in the patients with grade III-IV aGVHD (P<0.01). When the conditions became stable after treatment with immunosuppressive agents, the serum TFPI level was decreased to the baseline level (P>0.05) and the TF level was lowered but still higher than the baseline level (P<0.05). It was concluded that the levels of serum TF and TFPI were increased significantly in the patients with grade II-IV aGVHD after allo-HSCT and decreased markedly after the treatment. Monitoring the levels of serum TF and TFPI in the patients with allo-HSCT is important to predict the occurrence, outcome and prognosis of aGVHD.

Topics: Acute Disease; Adolescent; Adult; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Leukemia; Lipoproteins; Male; Middle Aged; Prognosis; Thromboplastin; Transplantation, Homologous; Young Adult