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Platelet activation and neutrophil extracellular trap (NET) formation in immune thrombocytopenia: is there an association?

Authors
  • Lozano, Maria L1, 2
  • Garabet, Lamya3, 4, 5
  • Fernandez-Perez, Maria Piedad1
  • De Los Reyes-García, Ascension M1
  • Diaz-Lozano, Pedro1
  • Garcia-Barbera, Nuria1
  • Aguila, Sonia1
  • Vicente, Vicente1, 2
  • Ghanima, Waleed5, 6, 7
  • Martinez, Constantino1
  • Gonzalez-Conejero, Rocio1
  • 1 Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación, Servicio de Hematología y Oncología Médica, Universidad de Murcia , Murcia, Spain. , (Spain)
  • 2 Grupo de investigación CB15/00055 del Centro de Investigacion Biomedica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII) , Madrid, Spain. , (Spain)
  • 3 Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital , Lørenskog, Norway. , (Norway)
  • 4 Center for Laboratory Medicine, Østfold Hospital Trust , Grålum, Norway. , (Norway)
  • 5 Institute of Clinical Medicine, University of Oslo , Oslo, Norway. , (Norway)
  • 6 Department of Research, Østfold Hospital Trust , Grålum, Norway. , (Norway)
  • 7 Department of Medicine, Østfold Hospital Trus , Grålum, Norway. , (Norway)
Type
Published Article
Journal
Platelets
Publisher
Informa UK (Taylor & Francis)
Publication Date
Oct 02, 2020
Volume
31
Issue
7
Pages
906–912
Identifiers
DOI: 10.1080/09537104.2019.1696456
PMID: 31762368
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

No biological predictors for the increased risk of thrombosis in patients with immune thrombocytopenia (ITP) have been identified. The aim of the study was to investigate platelet and neutrophil activation as well neutrophil extracellular trap (NET) formation in 63 ITP patients and 30 healthy volunteers. Platelet and neutrophil activation was assessed during steady state using flow cytometry analysis, and NETs were evaluated by quantitation of cell free DNA (cfDNA), and citrullinated histone-3-DNA (CitH3-DNA). Patient platelets and neutrophils showed increased CD62 and CD11b expression compared to controls (p = .038, and p = .022, respectively). In patients, platelet activation inversely correlated with platelet count and platelet size (p < .001), and positively correlated with neutrophil degranulation (p = .024). More NET formation, both CitH3-DNA (p = .025) and cfDNA(p < .001), were present in ITP patients compared to controls. CitH3-DNA inversely correlated with CD62 expression on platelets (p = .042), but higher levels of cfDNA were observed in individuals with classical cardiovascular risk factors for thrombosis, and in those with a previous history of thrombotic events. In this disease, the increased platelet activation and plasma NET levels seem to be separable processes that associate (either positively or inversely in the case of CitH3-DNA or platelet degranulation, respectively) to platelet mass.

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