Publications by authors named "Iwona Prajs"

13 Publications

  • Page 1 of 1

Platelet Reactivity and Response to Aspirin and Clopidogrel in Patients with Platelet Count Disorders.

Cardiol Res Pract 2021 17;2021:6637799. Epub 2021 Apr 17.

Department of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland.

Background: Platelet reactivity and response to antiplatelet drugs, acetylsalicylic acid (ASA) and clopidogrel, in patients with thrombocytopenia and thrombocythemia can have a potentially important effect on the outcome. The effectiveness and safety of antiplatelet drugs in such patients has not been well examined. Measuring the effect of ASA and clopidogrel on platelets could help guide the therapy. Nevertheless, platelet response to antiplatelet drugs is not routinely measured in platelet count disorders and relevant evidence is scarce.

Aims: The study aimed to measure platelet reactivity and response to ASA and clopidogrel in patients with platelet count disorders.

Materials And Methods: This was a cross-sectional study of consecutive patients hospitalized in cardiology and hematology departments in the years 2018-2019. The study included patients with thrombocytopenia (PLT < 150 G/L) and thrombocythemia (PLT > 450 G/L) on ASA or dual antiplatelet therapy (DAPT; ASA plus clopidogrel). Controls included patients on antiplatelet drugs with normal platelet count. Platelet reactivity was measured in whole blood (Multiplate aggregometer, Roche, Switzerland) using arachidonic acid (AA), adenosine-5'-diphosphate (ADP), and thrombin receptor agonist peptide-6 (TRAP) as agonists. Platelet aggregation was expressed in arbitrary units (AU). AA-induced aggregation was used as a measure of response to ASA with a cut-off above 30 AU showing high on-treatment platelet reactivity to ASA (HTPR-A). ADP-induced aggregation measured response to clopidogrel with a cut-off above 48 AU for high on-treatment platelet reactivity to clopidogrel (HTPR-C). TRAP-induced aggregation measured baseline platelet reactivity not affected by oral antiplatelet drugs.

Results: The study included 174 patients. There were 64 patients with thrombocytopenia, 30 patients with chronic thrombocythemia, and 80 controls. All patients were on 75 mg of ASA and 32% of them additionally on 75 mg of clopidogrel due to a history of recent coronary artery angioplasty. AA- and ADP-induced aggregation was comparable between thrombocytopenic patients and controls (median (IQR) 19 (7-28) vs. 23 (15-38) for AA AU and 32 (16-44) vs. 50 (32-71) for ADP AU, respectively), while it was significantly higher in thrombocythemic patients (median (IQR) 80 (79-118) for AA AU and 124 (89-139) for ADP AU). TRAP-induced aggregation showed significantly lowest aggregation in thrombocytopenic (median (IQR) 41 (34-60) for TRAP AU) and highest in thrombocythemic patients (median (IQR) 137 (120-180) for TRAP AU). HTPR-A was frequent in thrombocythemic patients in comparison with thrombocytopenic patients and controls (60% vs. 4% vs. 15%, respectively; < 0.0002). HTPR-C was highly common in thrombocythemic patients and least common in thrombocytopenic ones in comparison with controls (80% vs. 8% vs. 40%, respectively; < 0.001).

Conclusion: Chronic thrombocytopenia does not significantly affect platelet reactivity and response to ASA and clopidogrel in comparison with controls. Thrombocytosis significantly increases platelet reactivity and attenuates response to both ASA and clopidogrel.
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http://dx.doi.org/10.1155/2021/6637799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8068533PMC
April 2021

Fecal microbiota transplantation in the treatment of intestinal steroid-resistant graft-versus-host disease: two case reports and a review of the literature.

J Int Med Res 2020 Jun;48(6):300060520925693

Department and Clinic of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland.

Acute graft-versus-host disease (aGvHD) reduces the efficiency and safety of allogeneic hematopoietic stem cell transplantation (allo-HSCT). In recent years, attempts have been made to transplant fecal microbiota from healthy donors to treat intestinal GvHD. This study presented two cases of patients undergoing allo-HSCT who were later selected for fecal microbiota transplantation (FMT). In the first patient, FMT resulted in the complete resolution of symptoms, whereas therapeutic efficacy was not achieved in the second patient. FMT eliminated drug-resistant pathogens, namely very drug-resistant spp., but not multidrug-resistant or spp. Further research is needed, particularly on the safety of FMT in patients with intestinal steroid-resistant GvHD and on the distant impact of transplanted microflora on the outcomes of allo-HSCT. FMT appears promising for the treatment of patients with steroid-resistant GvHD.
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http://dx.doi.org/10.1177/0300060520925693DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294377PMC
June 2020

Higher efficacy of intermediate dose cytarabine + G-CSF compared to cyclophosphamide + G-CSF in hematopoietic stem cell mobilization in patients with multiple myeloma.

J Clin Apher 2020 Aug 16;35(4):246-254. Epub 2020 Apr 16.

Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland.

Background: There are several regimens used in hematopoietic stem cell (HSC) mobilization in multiple myeloma (MM). Cyclophosphamide (Cy) is one of the most commonly used agents, although it does not always result in collecting adequate number of CD34+ cells. Recently, cytarabine (Ara-C) has been proposed as potentially efficient and safe option.

Aims: Since the data regarding Ara-C in HSC mobilization is limited, the aim of our study was to compare retrospectively the efficiency and toxicity of G-CSF combined with either Ara-C or Cy in MM patients.

Materials & Methods: Of a total of 89 patients, 43 received low or intermediate doses of Cy, and 46 were treated with 800 mg/m /day of Ara-C administered for two days.

Results: The mean peak of CD34+ cells/ul in peripheral blood was 132 (range, 84-202) in Ara-C and 51 (range, 29-69) in Cy cohort (p < 0.001). The median number of collected CD34+ cells (×106/kg) was 10.3 (range, 4.2-17.9) vs 4.5 (range, 2.7-8.9), respectively (p < 0.001). Mobilization failure was observed in one patient in Ara-C cohort (2%) and in 8 patients treated with Cy (19%) (p = 0.013). In the Ara-C group 98% of patients obtained more than 4×106 CD34+ cells/kg required for tandem transplantation. Moreover, we observed a trend toward increased paraprotein levels measured at transplant compared to before HSC mobilization in Ara-C cohort and significantly higher transfusion rates in that group.

Conclusion: Our findings confirm higher HSC mobilization efficacy of Ara-C compared to Cy in MM patients. However, lower transfusions rate and better disease control of Cy may justify its use in some cases.
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http://dx.doi.org/10.1002/jca.21784DOI Listing
August 2020

The comparison of effectiveness and safety between different biosimilars of G-CSF in the mobilization of peripheral blood stem cells (PBSCs) for autologous transplantation (autologous peripheral blood stem cell transplantation, auto-PBSCT).

J Clin Apher 2020 Jan 30;35(1):4-8. Epub 2019 Oct 30.

Department of Hematology, Blood Cancer and Bone Marrow Transplantation, Wroclaw University Hospital, Wroclaw, Lower Silesia, Poland.

Background: Autologous peripheral blood marrow stem cell transplantation (auto-PBSCT) preceded by high-dose chemotherapy is a well-known method of treatment for patients with hematological cancers. Performing the procedure entails obtaining from the patient their own stem cells from peripheral blood using G-CSF. Currently, various filgrastim biosimilars are widely used.

Aim Of The Study: The purpose of this study is to compare the efficacy and safety of three different biosimilars of filgrastim in PBSC mobilization in patients with hematological malignancies.

Materials And Methods: This is a retrospective analysis of 282 patients (118 women and 164 men) who underwent stem cells mobilization for auto-PBSCT in the Department of Hematology in Wroclaw in 2012-2014. Three filgrastim biosimilars were used: Tevagrastim (95), Nivestim (92), and Zarzio (95). Ninety patients (32%) were diagnosed with multiple myeloma, 55 (19%) with Hodgkin's lymphoma, 90 (32%) with NHLs, 20 (7%) with acute myeloid leukemia, and 27 (10%) with another hematological cancer.

Results: The mean number of CD34+ cells collected during the first leukapheresis was 5.95 × 10 /kg for Tevagrastim, 7.08 × 10 /kg for Nivestim, and 6.8 × 10 /kg for Zarzio (P > .05). The necessary number of leukapheresis for patients receiving Zarzio, Nivestim, and Tevagrastim was 1.32, 1.37, and 1.66, respectively (P > .05). The percentage of effective mobilizations was 88.2% for Zarzio, 86.2% for Nivestim, and 84.9% for Tevagrastim. The side effects included bone pain and headache.

Conclusion: All tested biosimilars demonstrated similar effectiveness and safety profiles in patients with hematological tumors undergoing PBSC mobilization; therefore, they can be used interchangeably.
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http://dx.doi.org/10.1002/jca.21750DOI Listing
January 2020

Elevated serum concentrations of metalloproteinases (MMP-2, MMP-9) and their inhibitors (TIMP-1, TIMP-2) in patients with Graves' orbitopathy.

Adv Clin Exp Med 2018 Jan;27(1):99-103

Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland.

Background: Graves' orbitopathy (GO), also known as thyroid-associated ophthalmopathy, is characterized by dramatic tissue reactivity. Both inflammation and tissue remodeling characterize the clinical course of GO. Some data has been found regarding the association of MMPs and TIMPs in GO.

Material And Methods: Serum concentrations of MMP-9, MMP-2, TIMP-1, and TIMP-2 were determined by ELISA method.

Objectives: Forty-eight patients (34 females, 14 males, with median age 51.5 years) with GD and hyperthyroidism were enrolled in the study. In 28 patients, active, moderate-to-severe grade orbitopathy was diagnosed. The aim of this study was to assess the serum concentrations of MMP-2, MMP-9, TIMP-1, and TIMP-2 in patients with Graves' disease (GD), with and without GO, and their relationship with disease severity, as well as to evaluate how these concentrations change after successful treatment.

Results: Median serum concentrations of MMP-2 and MMP-9 were significantly higher in all patients with GD as well as in the subgroup with GO than in the control group. Median serum concentrations of TIMP-1 and TIMP-2 were significantly higher in all patients with GD than in controls. The same significant differences were observed in the subgroups with and without GO in comparison with controls. The GO subgroup showed a significant positive correlation between the MMP-9 concentration and the serum level of TSHRAb antibodies, and a clinical activity score ≥4 according to EUGOGO.

Conclusions: In our study we found that only MMP-9 differentiates the patients with and without GO, and may be used as a marker of the disease severity in patients with this manifestation of GD.
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http://dx.doi.org/10.17219/acem/68991DOI Listing
January 2018

Predictive factors of thrombosis for patients with essential thrombocythaemia: A single center study.

Adv Clin Exp Med 2017 Jan-Feb;26(1):115-121

Department and Clinic of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Poland.

Background: Thrombotembolic complications are the leading cause of mortality in essential thrombocythemia (ET), but the definition of thrombotic risk remains far from clear.

Objectives: The aim of this study was to evaluate the prognostic markers for thrombosis to identify ET patients at risk.

Material And Methods: Forty-five consecutive patients with ET were studied. This group was divided into two subgroups ET patients with (A) and without (B) history of thrombosis. Each patient has been tested for complete blood count, fibrinogen, factor VIII, D-dimer, protein C, APCR, TAT and F1+2. JAK2 mutation was assessed by RT-PCR. Factor V Leiden and prothrombin genes mutations were screened by DNA sequencing.

Results: The median age of ET patients was 62.0 years. JAK2 mutation was found in 24 patients, 21 of them had a history of thrombotic events, and 17/21 were JAK2 positive. Compared to controls, ET patients had a significantly higher WBC and PLT counts, and higher mean platelet volume (MPV), but not Hgb level or RBC count. In ET subgroup A, apart from changes seen in the whole ET, the Hgb level, RBC count, and Hct were also significantly elevated. Interestingly, the MPV was significantly larger in subgroup A, but not in B. Fibrinogen and D-dimers levels were significantly higher in ET group than in controls, but not F1+F2 or TAT. The results of hemostatic tests did not markedly differ between subgroups A and B. APCR was found in 5/45 patients with ET, and 2 out of 5 had a factor V Leiden heterozygous mutation. No prothrombin gene mutation was observed.

Conclusions: Our results suggest that MPV can serve as a simple test for assessing the hypercoagulable state in ET patients. It has been confirmed that JAK2 mutation and leukocytosis are independent predictors for thrombotic events in ET patients.
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http://dx.doi.org/10.17219/acem/68578DOI Listing
June 2017

Increased expression of metalloproteinase-2 and -9 (MMP-2, MMP-9), tissue inhibitor of metalloproteinase-1 and -2 (TIMP-1, TIMP-2), and EMMPRIN (CD147) in multiple myeloma.

Hematology 2016 Jan 13;21(1):26-33. Epub 2015 Aug 13.

Introduction: Activity of metalloproteinases (MMP) is controlled both by specific tissue inhibitors (TIMP) and activators (extracellular matrix metalloproteinase inducer, EMMPRIN). There are few data available concerning concentration the bone marrow of MMP-2, MMP-9, TIMP-1, and TIMP-2, or EMMPRIM expression by bone marrow mesenchymal stromal cells (BMSCs) in patients with multiple myeloma (MM).

Patients And Methods: We studied 40 newly diagnosed, untreated patients: 18 males and 22 females with de novo MM and 11 healthy controls. Bone marrow was collected prior to therapy. BMSCs were derived by culturing bone marrow cells on MesenCult. Protein concentrations were determined in bone marrow plasma and culture supernatants by ELISA. EMMPRIN expression by BMSCs was assessed by flow cytometry.

Results: The median concentrations of MMP-9, TIMP-1, and TIMP-2 in both marrow plasma and culture supernatants were significantly higher in MM patients than controls.

Conclusion: EMMPRIN expression and ratios MMP-9/TIMP-1 and MMP-2/TIMP-2 were higher in MM patients, our results demonstrate that in MM patients MMP-2 and MMP-9 are secreted in higher amounts and are not balanced by inhibitors.
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http://dx.doi.org/10.1179/1607845415Y.0000000043DOI Listing
January 2016

The role of soluble HLA-G and HLA-G receptors in patients with hematological malignancies after allogeneic stem cell transplantation.

Med Oncol 2015 Aug 18;32(8):219. Epub 2015 Jul 18.

Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, ul. Pasteura 4, 50-367, Wroclaw, Poland.

HLA-G is a non-classical MHC class I molecule whose suppressive activity on immune effector cells is exerted due to interactions with receptors ILT2, ILT4 and KIR2DL4. These receptors are expressed mainly on NK cells and monocytes, and their intensity of expression changes depending on HLA-G level. HLA-G plays an important role in the development of tolerance following organ transplantations and bone marrow stem cell transplantations. HLA-G also participates in the modulation of the immune response during cancerogenesis. The aim of this study was to assess HLA-G level in blood serum, the percentage of NK cells and monocytes with expression of receptors for HLA-G (ILT2, ILT4, KIR2DL4 and NKG2D) in patients who received allogeneic stem cell transplantations, and their influence on the occurrence of graft-versus-host reaction. The study included 32 patients with bone marrow diseases (acute leukemias, myelodysplastic syndrome, chronic myeloid leukemia, paroxysmal nocturnal hemoglobinuria) who received allogeneic stem cell transplantations. We assessed the expression of receptors ILT2, ILT4, KIR2DL4 and NKG2D on monocytes and NK cells, as well as the level of HLA-G in blood serum in patients before conditioning, in the transplant hematopoietic reconstitution period following allogeneic bone marrow stem cell transplantation. The percentage of NK cells with expression of KIR2DL4, ILT2 and ILT4 receptors was higher in patients with 0-I grade GVHD than in patients with II-IV grade GVHD. The percentage of monocytes with expression of ILT4 and ILT2 receptors was higher in patients with 0-I grade GVHD than in patients with II-IV grade GVHD. The level of HLA-G in patients' blood serum was higher after the stem cell transplantation compared with the period before transplantation. HLA-G level and HLA-G receptors are related to intensity of GVHD and may play the role of a prognostic factor for the development of GVHD and the clinical course of this reaction.
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http://dx.doi.org/10.1007/s12032-015-0664-1DOI Listing
August 2015

Endothelial progenitor cells and left ventricle function in patients with acute myocardial infarction: potential therapeutic considertions.

Am J Ther 2012 Jan;19(1):44-50

Department of Cardiology, Wroclaw Medical University, Wroclaw, Poland.

Endothelial progenitor cells (EPCs) play a key role in angiogenesis and vascular repair, although their exact functions are still disputable. The impact of EPC on left ventricular ejection fraction (LVEF) during acute myocardial infarction (MI) in patients treated with primary percutaneous coronary intervention (PCI) is also under investigation. The aim of this study was to assess the impact of different populations of EPC on LVEF during and 6 months after acute MI treated with primary PCI. The study included 34 patients with documented acute anterior wall MI. The control group consisted of 19 apparently healthy subjects. Blood for EPC assessments was obtained during the first 24 hours after MI and at 7 days and 6 months after PCI. CD34⁺/CD133⁺/CD45⁻, CD34⁺/CD31⁺/CD45⁻, CD34⁺/CD105⁺/CD45⁻, and CD31⁺/CD133⁺/CD45⁻ cell types were studied by flow cytometry. Echocardiography has been performed simultaneously with the EPC measurements. We observed a significant elevation of CD34⁺/CD133⁺/CD45⁻, CD34⁺/CD105⁺/CD45⁻, and CD31⁺/CD133⁺/CD45⁻ EPC at 7 days after PCI in comparison with 24 hours and 6 months after the MI. Patients with preserved LVEF at 7 days after PCI had also higher levels of CD31⁺/CD133⁺/CD45⁻. Acute anterior wall MI treated with primary PCI is followed by enhanced mobilization of EPC among which a high level of CD31⁺/CD133⁺/CD45⁻ subtype was strongly associated with the most preserved LVEF for up to 6 months after the index event. These data may provide some insight for future therapeutic strategies.
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http://dx.doi.org/10.1097/MJT.0b013e3181e0cab3DOI Listing
January 2012

Vasculitis in systemic lupus erythematosus (SLE)--assessment of peripheral blood mononuclear cell activation and the degree of endothelial dysfunction: initial report.

Postepy Hig Med Dosw (Online) 2007 Dec 3;61:725-35. Epub 2007 Dec 3.

Department of Angiology, Arterial Hypertension, and Diabetology, Wrocław Medical University, Wrocław, Poland.

Background: Inflammatory-immune changes in the vascular endothelium are one of the main factors initiating vessel wall damage. Enhanced expression of endothelial adhesion molecules and their receptors on the surface of circulating leukocytes seems to play an important role in the pathogenesis of vasculitis. Increasing evidence indicates endothelial cell activation/damage in SLE. In patients with SLE complicated by vasculitis, enhanced expression of integrin activation markers on the surface of peripheral blood mononuclear cells (PBMCs) has been reported. It seems relevant to assess the mechanisms of inflammatory response involving PBMCs and endothelial cells at particular stages of SLE microangiopathy.

Aim: The main aim was to assess the surface expressions of the integrin adhesion molecules VLA-4 (CD49d) and LFA-1 (CD11a) on PBMCs as well as the number of circulating endothelial cells (CECs) in patients with SLE and complications related to inflammatory microangiopathy and to determine whether these parameters vary depending on disease activity.

Patients: Twenty-nine women with SLE (mean age: 38.72+/-10.23 years) were divided into subgroup I: those with severe disease activity according to the modified disease activity index SLEDAI, characterized by the presence of inflammatory microangiopathy-related complications such as systemic central nervous system affection and/or vasculitis and/or nephritis (15 women, mean age: 38.33+/-11.02 years), and subgroup II: patients with mild or moderate disease activity according to SLEDAI and without vascular complications (14 women, mean age: 39.14+/-9.72 years).

Methods: Expressions of VLA-4 and LFA-1 on the surface of peripheral blood lymphocytes and monocytes were assessed by flow cytometry using monoclonal antibodies. CECs (a marker of endothelial damage) were isolated from peripheral blood with anti-CD146(S-Endo 1)-coated immunomagnetic Dynabeads. Tests for the lupus anticoagulant, antinuclear antibody, anti-dsDNA, and anticardiolipin antibody were performed in every study subject by ELISA. Erythrocyte sedimentation rate and serum levels of fibrinogen, C-reactive protein, the complement components C3 and C4, urea, creatinine, and uric acid were determined by standard methods. Peripheral blood counts and a general urinalysis were also performed.

Results: The mean CEC count was significantly higher in SLE patients than in the control group (15.29+/-12.10 vs. 3.08+/-1.46 cells/ml, p<0.001). CEC counts was notably elevated in patient subgroup II compared with the control group (9.14+/-5.16 vs. 3.08+/-1.46 cells/ml, p<0.05) and in subgroup I compared with subgroup II (21.03+/-13.96 vs. 9.14+/-5.19 cell/ml, p<0.05). In patients with severe SLE flares, CEC count visibly correlated with disease activity assessed by SLEDAI score (R=0.92, p<0.001). The expressions of VLA-4 and LFA-1 on peripheral blood lymphocytes in both patient subgroups were significantly higher than in the control group (subgroup I vs. controls: 1.70+/-1.56 vs. 0.39+/-0.26%, p<0.05, and 1.97+/-2.60 vs. 0.67+/-0.83%, p<0.05; subgroup II vs. controls: 1.71+/-1.04 vs. 0.39+/-0.26%, p<0.001, and 3.32+/-2.48 vs. 0.67+/-0.83%, p<0.05, for VLA-4 and LFA-1, respectively). There was no significant difference between the two subgroups of patients (1.70+/-1.56 vs. 1.71+/-1.04%, p>0.05, and 1.97+/-2.60 vs. 3.32+/-2.48%, p>0.05, respectively). Similarly, the surface expression of LFA-1 on circulating monocytes in patients in both subgroups was notably enhanced over that of the control group (91.44+/-16.00 vs. 84.95+/-19.86%, p<0.05, and 90.11+/-10.34 vs. 84.95+/-19.86%, p<0.05, in subgroups I and II respectively) and was comparable in both subgroups of patients (91.44+/-16.00 vs. 90.11+/-10.33%, p>0.05). The surface expression of VLA-4 on peripheral blood monocytes was considerably higher in patients with severe disease activity than in the control group and in patients with less active disease (77.10+/-13.56 vs. 64.90+/-19.13%, p<0.05, and 77.10+/-13.56 vs. 63.40+/-20.95%, p<0.05, respectively). However, there was no significant difference between patients with mild or moderate disease activity and the control group (63.40+/-20.95 vs. 64.90+/-19.13%, p>0.05).

Conclusions: 1) The number of CECs increases in the course of SLE and correlates with disease activity, indicating progressive endothelial damage.2) The expressions of VLA-4 and LFA-1 on the surface of peripheral blood lymphocytes as well as that of LFA-1 on circulating monocytes are enhanced in SLE patients regardless of disease activity. 3) The expression of VLA-4 on the surface of circulating monocytes is enhanced only in patients with severe disease activity, characterized by the presence of complications connected with inflammatory microangiopathy, which may indicate that the upregulation of VLA-4 expression in monocytes plays a leading role in the pathogenesis of vasculitis in SLE.
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December 2007

Platelet aggregation and P-selectin levels during exercise treadmill test in patients with ischaemic heart disease.

Kardiol Pol 2006 Oct;64(10):1094-100; discussion 1101

Katedra i Klinika Kardiologii Akademii Medycznej, ul. Pasteura 4, 50-367 Wrocław.

Introduction: Coronary artery disease (CAD) is associated with higher platelet activation sometimes despite aspirin use. There are conflicting data concerning platelet activation course during physical exercise in patients on aspirin with CAD.

Aim: To assess platelet activation pattern during physical exercise in patients with CAD.

Methods: The study included 35 patients (20 men, 15 women) aged 64.7+/-10 years with CAD (CCS II) on aspirin treatment (75 mg daily) and a control group of 10 healthy subjects adjusted for age and gender. Treadmill testing was performed using the Bruce protocol. Platelet aggregation was measured with optical aggregation with the agonists ADP (10 microM), collagen (2 microg/ml) and arachidonic acid (0.5 mg/ml) before and at peak exercise; P-selectin platelet and soluble expression (basal and after stimulation with thrombin) was assessed with cytofluorometry before, at peak exercise and 1 hour after.

Results: There were no differences in collagen and ADP aggregation between patients and the control group. There was a significant increase of ADP aggregation at peak exercise in the control group (p <0.05). There was a positive correlation between platelet aggregation before exercise and at peak exercise with ADP (r=+0.86) and with collagen (r=+0.61). There was no difference in soluble P-selectin concentration between patients and the control group. Platelet P-selectin expression without stimulation with thrombin 1 hour after exercise was significantly higher in patients than in the control group (p <0.05).

Conclusions: 1. Physical exercise does not intensify platelet aggregation in patients with CAD on 75 mg aspirin daily. 2. Despite taking aspirin, platelet activation measured with the expression of platelet P-selectin increases and there is further intensification during exercise testing. 3. The concentration of soluble P-selectin in patients with CAD does not reflect the expression of platelet P-selectin.
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October 2006

Aspirin failure course during exercise and its connection with soluble CD40L.

Thromb Res 2007 14;119(6):679-86. Epub 2006 Jun 14.

Department of Cardiology, Wroclaw Medical University, Pasteur 4 Street, 50-367 Wroclaw, Poland.

Introduction: The aspirin failure (resistance) is a still discussed and highly studied problem. This phenomenon is observed in rest, but could be precipitated by an exercise. The aspirin resistance was also linked with the inflammatory process which is a key event for the atherosclerosis development. Platelets seem to play an important role also in that setting, probably by the CD40-CD40L axis. The aim of the study was to assess the frequency of the aspirin failure induced by the exercise and the role of sCD40L in that regard.

Materials And Methods: The study included 40 patients with established coronary artery disease. The control group consisted of 10 patients without coronary artery disease matched for age. All patients and controls were on 75 mg of aspirin for at least 30 days and had treadmill testing and blood collected for measurement of sCD40L and optical platelet aggregation with ADP, collagen and arachidonic acid. Aspirin resistance was defined as a maximal aggregation with ADP and collagen exceeding 70%.

Results: There were 15 aspirin-resistant patients in the studied group (37%). There were significantly higher concentration of sCD40L (ng/ml) in aspirin-resistant patients in comparison with aspirin-sensitive ones before testing (7,9 +/- 2,5 vs. 5,1 +/- 3,5, p < 0,05) and on the top of it (8,1 +/- 2,9 vs. 4,5 +/- 3,9, p < 0,05). There were 3 persons who become resistant on the top of the exercise which was connected with the significant increase of sCD40L concentration in that group (from 7,6 +/- 1,9 before exercise to 10,1 +/- 2,9 on the top of the exercise, p < 0,05). There was also a positive correlation between the sCD40L level before and on the top of the exercise in an aspirin-resistant group (r = 0,48 for both, p < 0,05). Patients who were aspirin-resistant at rest had also significant elevation of platelet aggregation on the top of the exercise (ADP (%) from 90,5 +/- 8,6 to 95,0 +/- 6,5, p < 0,05 and collagen (%) from 87,8 +/- 8,7 to 92,1 +/- 8,0, p < 0,05).

Conclusions: 1. Aspirin resistance phenomenon is present in about 37% patients on 75 mg aspirin daily.2. Aspirin-resistant patients have higher platelet aggregation during the exercise.3. Moderate physical exercise provokes 12% increase in the aspirin resistance phenomenon occurrence.4. Aspirin resistance is connected with higher sCD40L level at rest and exercise provoked aspirin resistance is connected with the sCD40L concentration increase.
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http://dx.doi.org/10.1016/j.thromres.2006.05.003DOI Listing
June 2007

31P MRS analysis of the phospholipid composition of normal human peripheral blood mononuclear cells (PBMC).

Cell Mol Biol Lett 2005 ;10(3):373-82

Department of Hematology, Wrocław Medical University, Poland.

The aim of this investigation was to characterize the phospholipid composition of normal human blood mononuclear cells using 31P NMR spectroscopy. Mononuclear cells of peripheral blood were obtained from 10 volunteers. Phospholipid extracts were prepared from 60x10(6) cells according to modified Folch's method. An AMX 300 Bruker spectrometer 7.05 T was used. The 31P spectrum of phospholipid extracts from normal human PBMC consisted of 9 peaks, with one each for phosphatidylcholine (PC), plasmalogen of phosphatidylcholine (CPLAS), lysophosphatidylcholine (LPC), sphingomyelin (SM), phosphatidylethanolamine (PE), phosphatidylinositol (PI), phosphatidylserine (PS) and cardiolipin (CL), and another one due to the external reference substance, methylenediphosphonic acid (MDPA). The concentrations of these phospholipids (PL), based on the integral intensities, were as follows: 0.398 +/- 0.078 mmole/l for PC; 0.033 +/- 0.019 mmole/l for CPLAS; 0.155 +/- 0.043 mmole/l for SM; 0.266 +/- 0.104 mmole/l for PI+PE; 0.101 +/- 0.040 mmole/l for PS, and 0.026 +/- 0.033 mmole/l for CL. The results of this study confirmed that 31P MRS is a convenient tool for measuring the phospholipid concentrations of biological samples.
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December 2005