Adjunctive dabigatran therapy improves outcome of experimental left-sided Staphylococcus aureus endocarditis.

Authors:
Lars J Christophersen
Lars J Christophersen
Copenhagen University Hospital
Denmark
Jens Peter Goetze
Jens Peter Goetze
University of Copenhagen
Denmark
Kim Thomsen
Kim Thomsen
Copenhagen University Hospital
Denmark
Christian Enevold
Christian Enevold
Institute for Inflammation Research
Denmark

PLoS One 2019 19;14(4):e0215333. Epub 2019 Apr 19.

Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.

Background: Staphylococcus aureus is the most frequent and fatal cause of left-sided infective endocarditis (IE). New treatment strategies are needed to improve the outcome. S. aureus coagulase promotes clot and fibrin formation. We hypothesized that dabigatran, could reduce valve vegetations and inflammation in S. aureus IE.

Methods: We used a rat model of severe aortic valve S. aureus IE. All infected animals were randomized to receive adjunctive dabigatran (10 mg/kg b.i.d., n = 12) or saline (controls, n = 11) in combination with gentamicin. Valve vegetation size, bacterial load, cytokine, cell integrins expression and peripheral platelets and neutrophils were assessed 3 days post-infection.

Results: Adjunctive dabigatran treatment significantly reduced valve vegetation size compared to controls (p< 0.0001). A significant reduction of the bacterial load in aortic valves was seen in dabigatran group compared to controls (p = 0.02), as well as expression of key pro-inflammatory markers keratinocyte-derived chemokine, IL-6, ICAM-1, TIMP-1, L-selectin (p< 0.04). Moreover, the dabigatran group had a 2.5-fold increase of circulating platelets compared to controls and a higher expression of functional and activated platelets (CD62p+) unbound to neutrophils.

Conclusion: Adjunctive dabigatran reduced the vegetation size, bacterial load, and inflammation in experimental S. aureus IE.

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Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215333PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474597PMC
April 2019

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