Diss. (sammanfattning) Linköping : Linköpings universitet, 2008. / Härtill 5 uppsatser.

Magister Chirurgiae Dentium - MChD (Oral Medicine and Periodontics) / In recent years, the development and use of autologous platelet rich concentrates (PC's) has gained traction within the rapidly progressive, multidisciplinary field of regenerative medicine. A PC subtype, marketed as advanced platelet rich fibrin (A- PRF), is a recent advancement of the original PRF protocol and promoted as a "blood concentrate" containing platelets, leukocytes, circulating stem cells and endothelial cells. A-PRF in the form of membranes, plugs, or even shredded particulates are increasingly being used as surgical adjuncts in areas of previous infection or left exposed within the microbial rich oral environment. Although recent literature has noted the biologic benefits of this material within the context of wound healing and regeneration, the antimicrobial potential of APRF has remained unexplored. The aim of this investigation is to determine if A-PRF displays antimicrobial activity against microbes of the oral cavity with a null hypothesis that its activity is no different to a clot of unprocessed venous blood. Methodology: A-PRF and whole blood samples were obtained from consenting individuals and utilised to conduct an in-vitro agar disk diffusion investigation to determine their antimicrobial activity. Standardised samples of A-PRF, unprocessed clotted blood and 0.2% chlorhexidine gluconate (CHX) were tested against organisms cultured from fresh oral rinse samples and pure cultures of candida albicans, streptococcus mutans, staphylococcus aureus and enterococcus faecalis. The antimicrobial activity was assessed in accordance to the established principles of the agar disk diffusion method and measurement of inhibition zones. Results: A-PRF displayed antimicrobial activity against all of the individual organisms tested within this study following a 24 hour incubation period. However, no significant differences were noted between A-PRF and a natural clot of blood when tested against cultures of the oral rinse sample. Finally, the antimicrobial activity of A-PRF is significantly inferior to an equal volume of the CHX preparation. Conclusion: Although A-PRF displays antimicrobial activity; its strength, spectrum and biologic activity within a polymicrobial environment requires further investigation.

Os hemoderivados têm sido utilizados com frequência cada vez maior na medicina equina, sendo caracterizados como um produto autólogo, com maior quantidade de fatores de crescimento e que melhora a capacidade de cicatrização de tecidos com pouco aporte sanguíneo, como tendões e articulações, diminuindo o tempo de recuperação do animal. Sabe-se que os fatores de crescimento são derivados das plaquetas, porém a correlação positiva entre o aumento na contagem plaquetária e a maior concentração de fatores de crescimento ainda é motivo de discussão entre os autores. Com o intuito de se obter um produto final com maior contagem plaquetária, é frequente o aumento da velocidade ou número de centrifugações na metodologia empregada, aumentando o risco de agregação plaquetária precoce. O objetivo do presente trabalho é estudar o efeito da dupla centrifugação no preparo de PRP, por meio da comparação entre contagens plaquetárias, concentrações de fator de crescimento TGF-β1, e grau de ativação plaquetária por meio da porcentagem de agregação. Foram utilizados 12 equinos, machos, de 3 a 5 anos, clinicamente sadios. Para tanto foram realizados dois protocolos distintos: um com centrifugação única e o outro com dupla centrifugação. No primeiro, o sangue com anticoagulante foi centrifugado a 141G/12 minutos; enquanto no segundo a primeira centrifugação foi de 300G/5 minutos seguida de 700G/15 minutos, com repouso entre as mesmas e após. Os produtos obtidos após cada centrifugação foram submetidos à contagem plaquetária, teste de agregação e quantificação de TGF--β1 por meio de kit ELISA. Os resultados obtidos demonstraram maior concentração plaquetária quando utilizado protocolo de dupla centrifugação. Agregometria evidenciou maior ativação das plaquetas durante o preparo do PRP quando submetidas a maiores velocidades de centrifugação (força gravitacional) e não ao fato das amostras serem centrifugadas duas vezes. A quantificação do TGF--β1 não mostrou diferença quando realizado em amostras com apenas uma centrifugação, mas demonstrou valores maiores no produto final da segunda centrifugação. A avaliação por meio de coeficiente de determinação e coeficiente de correlação de Pearson evidenciou correlação positiva entre contagem plaquetária e de TGF--β1. O protocolo com dupla centrifugação se mostrou mais eficaz em concentrar plaquetas e TGF--β1, não sendo prejudicado pela ativação precoce dessas plaquetas durante o preparo. / Blood derived products have been used in equine medicine with increasing frequency, being characterized as an autologous product, with greater amount of growth factors and be capable of improvement the healing capacity in tissues with poor blood supply, such as tendons and joints, reducing the time of recovery of the animal. It is known that the growth factors are derived from platelets, but the positive correlation between the increase in platelet count and the higher concentration of growth factors is still a reason for discussion among the authors. In order to obtain a final product with a higher platelet count, it is frequent to increase the speed or number of centrifugations in the methodology employed, increasing the risk of early platelet aggregation. The aim of the present study is to verify the effect of double centrifugation in PRP preparation by comparing platelet counts, TGF-β1 growth factor concentrations, and degree of platelet activation through percentage of aggregation. Twelve horses, male, aged 3 to 5 years-old, clinically healthy were subjected. Two different protocols were performed: one with single centrifugation and the other with double centrifugation. In the first one, the anticoagulated blood was centrifugated at 141G/12 minutes; while in the second one the first centrifugation was 300G/5 minutes followed by 700G/15 minutes, with rest between them and after. The products obtained after each centrifugation were submitted to platelet counting, aggregation test and measurement of TGF-β1 by ELISA kit. The results showed a higher platelet concentration when double centrifugation protocol was used. The aggregometry test evidenced a greater activation of the platelets during the preparation of PRP when submitted to higher centrifugation velocities (times g), and not to double centrifugation. Quantification of TGF-β1 showed no difference when performed on samples with only one centrifugation, but was higher values in the final product of the second centrifugation. The determination coefficient and Pearsons correlation coefficient showed a positive correlation between the platelet count and TGF-β1 concentration. The double centrifugation protocol proved to be more effective at concentrating platelets and consequently higher amounts of TGF-β1, not being impaired by early activation during obtainment.

No description available.

Heparin is an anticoagulant widely administered to patients undergoing major orthopedic or cardiac surgery. Though heparin is effective at preventing thrombosis, it is paradoxically associated with the development of heparin-induced thrombocytopenia (HIT). HIT is strongly associated with thrombotic complications and is an adverse drug reaction that occurs when heparin binds to the self-protein, platelet factor 4 (PF4) and forms immunogenic multimolecular complexes. As a result, anti-PF4/heparin antibodies are formed, which bind to these complexes, and can cross-linking Fc receptors on platelets and monocytes causing intense platelet activation, thrombocytopenia, and thrombosis. Patients who receive heparin frequently form antibodies against these PF4/heparin complexes; however, most of these antibodies do not cause HIT. Over-diagnosis of HIT is common due to the detection of clinically insignificant non-pathogenic anti-PF4/heparin antibodies. Current enzyme immunoassays (EIAs) cannot distinguish between pathogenic and non-pathogenic anti-PF4/heparin antibodies and will give a false positive result in the presence of the clinically insignificant non-pathogenic anti-PF4/heparin antibodies. Further functional testing is required to identify samples containing the pathogenic anti-PF4/heparin antibodies that will lead to HIT; however, these tests are not readily available in most centres, and delay timely diagnosis. There is little known about the differences between pathogenic and non-pathogenic HIT antibodies. The identification of antigenic determinations of pathogenic HIT antibodies binding to PF4 from this project will have direct implications for patient care. We will be able to accurately and rapidly identify “true” HIT patients from learning more about the pathogenic HIT antibody epitope. / Dissertation / Doctor of Science (PhD) / At least 30% of patients admitted into the hospital will be exposed to the anticoagulant, heparin. 1-3% of these patients develop heparin-induced thrombocytopenia (HIT): an adverse drug reaction. HIT is a major cause of morbidity and mortality in patients receiving heparin if not diagnosed and treated in a timely manner. HIT occurs when patients form antibodies against the platelet protein, platelet factor 4, in complex with heparin leading to an immune response. However, most heparin-exposed patients produce these antibodies but do not have HIT. Current rapid and available diagnostics tools cannot distinguish between antibodies that can or cannot cause the disease. To improve HIT diagnosis, we will identify the molecular differences between the antibodies that cause HIT and those that do not. From this, we can develop a new diagnostic assay that will be able to dictate whether the antibodies found in patients are specific for HIT.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25175号 / 医博第5061号 / 京都大学大学院医学研究科医学専攻 / (主査)教授 江藤 浩之, 教授 長尾 美紀, 教授 大鶴 繁 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Depression is highly prevalent in coronary artery disease (CAD) and confers an increased risk of morbidity and mortality, yet mechanisms are unknown. Platelet activating factor (PAF) lipids are associated not only with CAD but also with inflammation, oxidative/nitrosative stress, vascular endothelial dysfunction and platelet reactivity which are proposed etiopathological mechanisms for depression. This study investigated the relationship between PAF species and depressive symptoms in 20 CAD patients. Plasma analyses were performed using electrospray ionization mass spectrometry (precursor ion scan). Primary analysis revealed no association between the potent pro-inflammatory PAF PC(O-16:0/2:0) and depressive symptoms measured by the Hamilton Depression Rating Scale [HAM-D] (F=0.405, p=0.533) or Beck Depression Inventory [BDI]-II (F=0.120, p=0.733) in a linear regression. Exploratory analyses revealed potential associations between greater PC(O-18:1/0:0) and greater HAM-D score and greater PC(O-22:6/2:0) concentrations with a greater BDI-II score. This study suggests that specific PAFs might be biomarkers for depressive symptoms in CAD patients.

Depression is highly prevalent in coronary artery disease (CAD) and confers an increased risk of morbidity and mortality, yet mechanisms are unknown. Platelet activating factor (PAF) lipids are associated not only with CAD but also with inflammation, oxidative/nitrosative stress, vascular endothelial dysfunction and platelet reactivity which are proposed etiopathological mechanisms for depression. This study investigated the relationship between PAF species and depressive symptoms in 20 CAD patients. Plasma analyses were performed using electrospray ionization mass spectrometry (precursor ion scan). Primary analysis revealed no association between the potent pro-inflammatory PAF PC(O-16:0/2:0) and depressive symptoms measured by the Hamilton Depression Rating Scale [HAM-D] (F=0.405, p=0.533) or Beck Depression Inventory [BDI]-II (F=0.120, p=0.733) in a linear regression. Exploratory analyses revealed potential associations between greater PC(O-18:1/0:0) and greater HAM-D score and greater PC(O-22:6/2:0) concentrations with a greater BDI-II score. This study suggests that specific PAFs might be biomarkers for depressive symptoms in CAD patients.

Class of 2009 Abstract / OBJECTIVES: An estimated 26.3 million Americans have Diabetes Mellitus (DM). Currently six classes of agents are approved for the treatments of Type 2 DM. Problems with current options have led to searches for new medications and adjunctive therapy. Prickly pear (Opuntia species) has been traditionally used by Mexicans and Pima Indians for the treatment of DM. This is a retrospective analysis of data obtained from a randomized placebo-controlled prospective experiment in 28 Type 2 DM rodents (ZDF). There were 2 negative control groups which consisted of non-DM rodents and ZDFs; each receiving water. The positive control group consisted of ZDFs who received rosiglitazone 4.75 mg/kg/day. The treatment group consisted of ZDFs who received 5-10 mL/kg/dose of Opuntia ficus indica (Jugo De Nopal) liquid, given twice daily. Weight, blood glucose and platelet aggregation were recorded and analyzed. At baseline, there were no significant differences in weight or blood glucose among ZDF groups. The lean control rodents had significantly lower blood glucose compared to the ZDF rodents (p<0.001). Treatment with Jugo de Nopal resulted in a statistically significant reduction in blood glucose (p<0.001), with a mean decrease in blood glucose of 7%. All treatment groups demonstrated a significant weight gain, however, the prickly pear group had significantly less weight gain than the rosiglitazone group (p=0.028). CONCLUSIONS: There was not a significant difference among the treatment groups with regard to platelet responsiveness. Further studies are necessary to determine the efficacy of prickly pear as a blood glucose lowering agent.

Platelets play a crucial role for blood hemostasis, the process that prevents bleeding. In addition, platelets have been demonstrated to promote cancer progression and cancer related complications like metastasis and thrombosis. Platelets can affect cancer related diseases either directly or by interacting with other blood cells or molecules in the circulation of individuals with cancer. The current thesis addresses the role of platelets in tumor progression and tumor-induced systemic effects of cancer, with a special focus on the effects on the vasculature. In the first paper, the role of platelets in tumor progression in histidine-rich glycoprotein (HRG)-deficient mice was addressed. We report that HRG-deficient mice show enhanced tumor growth, epithelial to mesenchymal transition (EMT) and metastasis. The enhanced platelet activity in the absence of HRG is responsible for the accelerated tumor progression. In the second paper, we demonstrate that platelet-derived PDGFB is a central player to keep the tumor vessels functional. Moreover, in a pancreatic neuroendocrine carcinoma model with PDGFB-deficient platelets, spontaneous liver metastasis was enhanced. With this finding we identify a previously unknown role of platelet derived PDGFB. In the third paper, we found that TBK1 mediates platelet-induced EMT by activation of NF-kB signaling, which suggest that TBK1 contributes to tumor invasiveness in mammary epithelial tumors. In the last paper, we report that the vascular function in organs that are neither affected by the primary tumor, nor represent metastatic sites, is impaired in mice with cancer. We show that tumor-induced formation of intravascular neutrophil extracellular traps (NETs), a fibril matrix consisting of neutrophils with externalized DNA and histones, granule proteases and platelets, are responsible for the impaired peripheral vessel function.