Avaliação do papel do fator de Von Willebrand em pacientes portadores de Doença Pulmonar Obstrutiva Crônica (DPOC)

A doença pulmonar obstrutiva crônica é uma doença que leva à obstrução pulmonar geralmente irreversível e está intimamente relacionada com o hábito de fumar. Ao longo dos anos, ocorre destruição dos septos alveolares com a degradação das fibras elásticas e depósito do colágeno que compõe estes septos. Muito tem se discutido sobre a existência de inflamação sistêmica no paciente com DPOC e sobre as suas possíveis manifestações extra-pulmonares . O processo de aterosclerose pode fazer parte deste espectro inflamatório a partir da presença de dano endotelial. O fator de Von Willebrand é um marcador de dano endotelial e pode ser dosado de forma quantitativa e qualitativa. Este trabalho demonstra uma diferença estatisticamente significativa, qualitativa e quantitativamente, entre os níveis de fator de Von Willebrand em tabagistas e em pacientes com DPOC, quando comparados ao grupo controle. Ao analisarmos os pacientes com DPOC dividindo-os em subgrupos considerando quatro classificações distintas: GOLD 2006 (Anexo A), GOLD 2011 (Anexo B), grau de sintomatologia a partir da escala de dispneia MRC modificada (Anexo C) e número de exacerbações no último ano. Observamos uma diferença estatisticamente significativa, em relação ao nível qualitativo do fator de von Willebrand, apenas quando comparamos pacientes com DPOC sintomáticos e não sintomáticos. Demonstramos ainda uma correlação inversa entre o percentual predito de volume expiratório forçado no primeiro segundo (VEF1%) com os níveis qualitativos de fator de von Willebrand. Desta forma, o fator de von Willebrand está aumentado no paciente com DPOC, sendo um possível marcador sérico de sintomatologia relacionado a esta doença. Apesar de não se conseguir definir gravidade dos pacientes com DPOC pelo GOLD, o fator de von Willebrand estabelece uma correlação inversa com os níveis de VEF1%, sugerindo algum tipo de participação na progressão da doença.

Fator de Von Willebrand no adenocarcinoma colorretal

O adenocarcinoma colorretal é um dos tumores sólidos mais prevalentes no mundo, ocupando a terceira posição em ambos os sexos, precedido pelo carcinoma de pulmão e estômago em homens, e pelo carcinoma de mama e cérvix em mulheres. No Brasil, o adenocarcinoma colorretal está entre as cinco neoplasias mais freqüentes, ocupando a quinta posição em mortalidade. A sobrevida global dos pacientes está em torno de 40% em 5 anos, tendo havido pequena elevação deste índice nas últimas quatro décadas. O estadiamento clínico-patológico permanece como o mais importante indicador prognóstico para o adenocarcinoma colorretal, sendo a sobrevida em 5 anos dos pacientes portadores de metástases à distância menor que 5%. Estas lesões são encontradas em 75% dos indivíduos que morrem da doença e representam, na maioria das vezes, um evento terminal. O processo de metastatização segue uma série de etapas interligadas que devem ser completadas pela célula tumoral para que se produza uma lesão clinicamente evidente. O primeiro passo desta seqüência se dá através de um fenômeno conhecido como angiogênese. Este consiste na proliferação endotelial acelerada com formação de novos vasos, que irão permitir que o tumor cresça e envie células neoplásicas à circulação. Esta neovascularização leva à maior produção de uma glicoproteína plasmática essencial para o processo de hemostasia primária, o fator de von Willebrand. Esta proteína é liberada pelas células endoteliais e pelas plaquetas e seus níveis estão elevados em situações clínicas em que há proliferação ou dano endotelial. Nos pacientes com câncer, o fator de von Willebrand, além de servir como potencial marcador da angiogênese, contribui diretamente para a formação das metástases, promovendo a ligação das células tumorais às plaquetas. Esta interação faz com que se formem agregados celulares heterotípicos que não são reconhecidos pelo sistema imunológico e têm maior capacidade de adesão aos leitos capilares dos órgãos alcançados. A associação entre aumento nos níveis plasmáticos do fator de von Willebrand e a progressão neoplásica foi demonstrada em pacientes com tumores de cabeça e pescoço e colo uterino, não havendo dados na literatura sobre a correlação deste fator com o câncer colorretal. No presente estudo foram comparados as concentrações desta proteína em 75 pacientes com adenocarcinoma colorretal e em 88 controles saudáveis, sendo estes valores correlacionados com os principais indicadores prognósticos da doença. Este é o primeiro estudo a ser publicado que documenta o comportamento do fator de von Willebrand em pacientes com adenocarcinoma colorretal. Os resultados deste estudo demonstraram que os pacientes com câncer colorretal apresentaram níveis de fator de von Willebrand significativamente superiores aos controles (P < 0.0001). Houve associação significativa entre as concentrações do fator de von Willebrand e o estadiamento tumoral (P < 0.0001), a invasão de estruturas anatômicas adjacentes (P < 0.009) e a presença de metástases à distância (P < 0.02). Os dados aqui apresentados sugerem que os níveis plasmáticos do fator de von Willebrand nos pacientes com adenocarcinoma colorretal possam ser indicadores do comportamento biológico deste tumor. Portanto, a definição do papel desta proteína no processo de disseminação neoplásica merece estudos complementares.

Estabilidade do fator de von Willebrand e fator VIII no crioprecipitado canino em diferentes protocolos de armazenamento

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Determinação do teste padrão para o diagnóstico de cães com doença de von willebrand

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Doença de von Willebrand em cães: estudo da prevalência e caracterização da doença em cães normais e fêmeas durante o ciclo estral, gestação e lactação

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Basement membrane and provisional matrix components (collagen type IV, laminins and von Willebrand factor) in rheumatoid arthritis and Sjögren s syndrome

The aim of this study was twofold- Firstly, to determine the composition of the type IV collagen which are the major components of the basement membrane (BM), in the synovial lining of the rheumatoid arthritis (RA) patient and in the BM in the labial salivary gland of the Sjögrens syndrome (SS) patient. Secondly, this thesis aimed to investigate the role of the BM component laminin α4 and laminin α5 in the migration of neutrophils from the blood vessels thorough the synovial lining layer into synovial fluid and the presence of vWF in the microvasculature of labial salivary gland in SS. Our studies showed that certain α chains type IV collagen are low in RA compared to control synovial linings, while laminin α5 exhibited a pattern of low expression regions at the synovial lining interface towards the joint cavity and fluid. Also, high numbers of macrophage-like lining cells containing MMP-9 were found in the lining. MMP-9 was also found in the synovial fluid. Collagen α1/2 (IV) mRNA was found to be present in high amount compared to the other α(IV) chains and also showed intense labelling in immunohistochemical staining in normal and SS patients. In healthy glands α5(IV) and α6(IV) chains were found to be continuous around ducts but discontinuous around acini. The α5(IV) and α6(IV) mRNAs were present in LSG explants and HSG cell line, while in SS these chains seemed to be absent or appear only in patches around the ductal BM and tended to be absent around acini in immunohistochemical staining, indicating that their synthesis and/or degradation seemed to be locally regulated around acinar cells. The provisional matrix component vWF serves as a marker of vascular damage. Microvasculature in SS showed signs of focal damage which in turn might impair arteriolar feeding, capillary transudation and venular drainage of blood. However, capillary density was not decreased but rather increased, perhaps as a result of angiogenesis compensatory to microvascular damage. Microvascular involvement of LSG may contribute to the pathogenesis of this syndrome. This twofold approach allows us to understand the intricate relation between the ECM components and the immunopathological changes that occur during the pathogenesis of these inflammatory rheumatic disease processes. Also notably this study highlights the importance of maintaining a healthy ECM to prevent the progression or possibly allow reversal of the disease to a considerable level. Furthermore, it can be speculated that a healthy BM could quarantine the inflamed region or in case of cancer cells barricade the movement of malignant cells thereby preventing further spread to the surrounding areas. This understanding can be further applied to design appropriate drugs which act specifically to maintain a proper BM/BM like intercellular matrix composition.

Endothelial microparticles released in thrombotic thrombocytopenic purpura express von Willebrand factor and markers of endothelial activation

It has been suggested that endothelial apoptosis is a primary lesion in the pathogenesis of thrombotic thrombocytopenic purpura (TTP). We tested this hypothesis by examining the phenotypic signatures of endothelial microparticles (EMP) in TTP patients. In addition, the effect of TTP plasma on microvascular endothelial cells (MVEC) in culture was further delineated. EMP released by endothelial cells (EC) express markers of the parent EC; EMP released in activation carry predominantly CD54 and CD62E, while those in apoptosis CD31 and CD105. We investigated EMP release in vitro and in TTP patients. Following incubation of MVEC with TTP plasma, EMP and EC were analysed by flow cytometry for the expression of CD31, CD51, CD54, CD62E, CD105, CD106 and von Willebrand factor (VWF) antigen. EMP were also analysed in 12 TTP patients. In both EC and EMP, CD62E and CD54 expression were increased 3- to 10-fold and 8- to 10-fold respectively. However, CD31 and CD105 were reduced 40-60% in EC but increased twofold in EMP. VWF expression was found in 55 +/- 15% of CD62E(+) EMP. Markers of apoptosis were negative. In TTP patients, CD62E(+) and CD31(+)/CD42b(-) EMP were markedly elevated, and preceded and correlated well with a rise in platelet counts and a fall in lactate dehydrogenase. CD62E(+) EMP (60 +/- 20%) co-expressed VWF and CD62E. The ratio of CD31(+)/42b(-) to CD62E(+) EMP exhibited a pattern consistent with activation. In conclusion, our studies indicate endothelial activation in TTP. EMP that co-express VWF and CD62E could play a role in the pathogenesis of TTP.

Fluid Shear Induces Conformation Change in Human Blood Protein von Willebrand Factor in Solution

Many of the physiological functions of von Willebrand Factor (VWF), including its binding interaction with blood platelets, are regulated by the magnitude of applied fluid/hydrodynamic stress. We applied two complementary strategies to study the effect of fluid forces on the solution structure of VWF. First, small-angle neutron scattering was used to measure protein conformation changes in response to laminar shear rates (G) up to 3000/s. Here, purified VWF was sheared in a quartz Couette cell and protein conformation was measured in real time over length scales from 2-140 nm. Second, changes in VWF structure up to 9600/s were quantified by measuring the binding of a fluorescent probe 1,1'-bis(anilino)-4-,4'-bis(naphtalene)-8,8'-disulfonate (bis-ANS) to hydrophobic pockets exposed in the sheared protein. Small angle neutron scattering studies, coupled with quantitative modeling, showed that VWF undergoes structural changes at G < 3000/s. These changes were most prominent at length scales <10 nm (scattering vector (q) range >0.6/nm). A mathematical model attributes these changes to the rearrangement of domain level features within the globular section of the protein. Studies with bis-ANS demonstrated marked increase in bis-ANS binding at G > 2300/s. Together, the data suggest that local rearrangements at the domain level may precede changes at larger-length scales that accompany exposure of protein hydrophobic pockets. Changes in VWF conformation reported here likely regulate protein function in response to fluid shear.

Régulation de la fonction plaquettaire par un aptamère dirigé contre le domaine A1 du facteur Von-Willebrand

Drs Dandachli and Arzamendi contributed equally to this work.

Platelet endothelial cell adhesion molecule-1 inhibits platelet response to thrombin and von Willebrand factor by regulating the internalization of glycoprotein Ib via AKT/glycogen synthase kinase-3/dynamin and integrin αIIbβ3

OBJECTIVE: Platelet endothelial cell adhesion molecule-1 (PECAM-1) regulates platelet response to multiple agonists. How this immunoreceptor tyrosine-based inhibitory motif-containing receptor inhibits G protein-coupled receptor-mediated thrombin-induced activation of platelets is unknown. APPROACH AND RESULTS: Here, we show that the activation of PECAM-1 inhibits fibrinogen binding to integrin αIIbβ3 and P-selectin surface expression in response to thrombin (0.1-3 U/mL) but not thrombin receptor-activating peptides SFLLRN (3×10(-7)-1×10(-5) mol/L) and GYPGQV (3×10(-6)-1×10(-4) mol/L). We hypothesized a role for PECAM-1 in reducing the tethering of thrombin to glycoprotein Ibα (GPIbα) on the platelet surface. We show that PECAM-1 signaling regulates the binding of fluorescein isothiocyanate-labeled thrombin to the platelet surface and reduces the levels of cell surface GPIbα by promoting its internalization, while concomitantly reducing the binding of platelets to von Willebrand factor under flow in vitro. PECAM-1-mediated internalization of GPIbα was reduced in the presence of both EGTA and cytochalasin D or latrunculin, but not either individually, and was reduced in mice in which tyrosines 747 and 759 of the cytoplasmic tail of β3 integrin were mutated to phenylalanine. Furthermore, PECAM-1 cross-linking led to a significant reduction in the phosphorylation of glycogen synthase kinase-3β Ser(9), but interestingly an increase in glycogen synthase kinase-3α pSer(21). PECAM-1-mediated internalization of GPIbα was reduced by inhibitors of dynamin (Dynasore) and glycogen synthase kinase-3 (CHIR99021), an effect that was enhanced in the presence of EGTA. CONCLUSIONS: PECAM-1 mediates internalization of GPIbα in platelets through dual AKT/protein kinase B/glycogen synthase kinase-3/dynamin-dependent and αIIbβ3-dependent mechanisms. These findings expand our understanding of how PECAM-1 regulates nonimmunoreceptor signaling pathways and helps to explains how PECAM-1 regulates thrombosis.

Prevalence of von Willebrand disease in dogs from São Paulo State, Brazil

The aims of the current study were to assess the prevalence of von Willebrand disease (vWD) in dogs from the region of Botucatu, São Paulo State, Brazil, and to evaluate laboratory tests to diagnose this disease. The study included 350 dogs of various ages, different breeds, and both sexes. Dogs included in the study had no historical or clinical evidence of abnormal bleeding. von Willebrand factor antigen (vWF:Ag), buccal mucosal bleeding time, activated partial thromboplastin time, and factor VIII activity were evaluated in their ability to diagnose vWD. The prevalence of vWD in dogs was 1.43% in the Botucatu region of Brazil. Determination of vWF:Ag was the best laboratory test to diagnose vWD.

Ligature of external carotid artery as an optional technique in a patient with von Willebrand disease

The von Willebrand disease (vWD) is a hereditary coagulopathy. There is no gender predilection. Clinically characterized by mucocutaneous bleeding, especially nose bleeding, menorrhagia and bleeding after trauma. This article reports a case of a 52-year-old Caucasian male patient with vWD, who presented with extensive bleeding in the tongue after a lacerating injury caused by accidental biting, and describes some clinical, pathological and treatment aspects of vWD. After repeated attempts to suture the wound and replace clotting factors, a decision was made to perform the ligature of the external carotid artery ipsilateral to the injury. There was favorable resolution of the case, with a good aspect of the scar 2 months after ligation. This case reinforces that it is extremely important to make a thorough review of medical history of all patients, searching for possible bleeding disorders or previous family history.

Evaluation of von willebrand factor during pregnancy, lactation and oestrous cycle in bitches affected and unaffected by von willebrand disease

Plasmatic concentrations of von Willebrand Factor (vWF) increase during pregnancy in humans and dogs; however the mechanism of such increase is still not well defined. The aims of this study were: (i) to evaluate changes in vWF concentration during pregnancy and during the subsequent oestrous cycle in bitches affected and unaffected by von Willebrand Disease (vWD); (ii) to correlate the vWF levels and cortisol levels in both groups. Seven vWD affected (GI) and nine unaffected (GII) bitches were used. The animals were assessed during pregnancy, parturition, lactation and non-gestational oestrous cycle in 11 moments (Pregnancy 1, Pregnancy 2, Parturition, Lactation 1, Lactation 2, Lactation 3, Anestrus, Proestrus, Oestrus, Diestrus 1, and Diestrus 2). The following tests were performed; measurement of von Willebrand factor antigen (vWF:Ag), albumin and cortisol. In both groups, vWF concentration remained stable during the non-gestational oestrous cycle, but increased during pregnancy, with the highest value observed at parturition. Increases of 70% and 124% in vWF were seen in GI and GII, respectively, compared to anestrus. No correlation was found between vWF and cortisol. Values of vWF:Ag changed during pregnancy, with a peak at parturition, both in vWD affected and unaffected animals. Values of vWF were not altered in the different phases of the oestrous cycle following pregnancy in both groups. Evaluation of vWF during pregnancy can cause false negative results for vWD, but assessment can be performed at any point in the oestrous cycle of non-pregnant bitches. © 2012 Blackwell Verlag GmbH.

von Willebrand factor-mediated platelet adhesion is critical for deep vein thrombosis in mouse models

Deep vein thrombosis (DVT) and its complication, pulmonary embolism, are frequent causes of disability and mortality. Although blood flow disturbance is considered an important triggering factor, the mechanism of DVT initiation remains elusive. Here we show that 48-hour flow restriction in the inferior vena cava (IVC) results in the development of thrombi structurally similar to human deep vein thrombi. von Willebrand factor (VWF)-deficient mice were protected from thrombosis induced by complete (stasis) or partial (stenosis) flow restriction in the IVC. Mice with half normal VWF levels were also protected in the stenosis model. Besides promoting platelet adhesion, VWF carries Factor VIII. Repeated infusions of recombinant Factor VIII did not rescue thrombosis in VWF(-/-) mice, indicating that impaired coagulation was not the primary reason for the absence of DVT in VWF(-/-) mice. Infusion of GPG-290, a mutant glycoprotein Ib?-immunoglobulin chimera that specifically inhibits interaction of the VWF A1 domain with platelets, prevented thrombosis in wild-type mice. Intravital microscopy showed that platelet and leukocyte recruitment in the early stages of DVT was dramatically higher in wild-type than in VWF(-/-) IVC. Our results demonstrate a pathogenetic role for VWF-platelet interaction in flow disturbance-induced venous thrombosis.