Efectos de la estimulación mecánica en la comunicación entre células óseas / Effects of mechanical stimulation oncommunication between bone cells

La fuerza mecánica es importante para el modelado, el remodelado y la regeneración ósea; estimula a los osteocitos provocando una alteración en la producción y secreción de moléculas de señalización que regulan la actividad de los osteoblastos y los osteoclastos. El objetivo del presente estudio fue evaluar el efecto del medio condicionado de células osteocíticas de ratón estimuladas mecánicamente sobre la capacidad proliferativa y migratoria de células mesenquimales y células óseas. Para ello, se analizó la proliferación y migración de las células preosteoblásticas de ratón, células mesenquimales preadiposas humanas y macrófagos de ratón en presencia del medio condicionado de las células osteocíticas, tras 6 y 24 horas después de ser sometidas a un estrés mecánico de 10 dinas/cm2 por flujo de fluido (FF) durante 10 minutos. Se encontró que la migración de células preosteoblásticas aumentó significativamente en presencia de medios condicionados de células osteocíticas con respecto al grupo control estático (SC) (SC=12,63±5,44; FF6h=23,03±11,57; FF24h=29,72±15,76; p<0,0001). De la misma manera, las células preadiposas también incrementaron significativamente su migración en presencia de dichos medios condicionados (SC=11,48±4,75; FF6h=18,43±9,94; FF24h=18,80±10,03; p≤0,0007). Sin embargo, la migración de los macrófagos disminuyó en presencia del medio condicionado recogido a las 24 horas con respecto al grupo control estático (SC=69±22,71; FF24h=26,57±5,47; p<0,0001). Estos efectos se asociaron con la disminución de la expresión proteica de ciertas quimioquinas, como la proteína quimiotáctica de monocitos de tipo I (SC=0,25±0,06; FF24h=0,09±0,005; p=0,0262), la proteína del grupo I de alta movilidad (SC=0,25±0,04; FF24h=0,15±0,05; p=0,0159) y la proteína reguladora de la activación de linfocitos T y monocitos (SC=3,29±0,88; FF6h=1,33±1,09; FF24h=0,97±0,66; p≤0,0314), por parte de los osteocitos en presencia de estímulo mecánico con respecto al grupo control estático. En conclusión, este estudio in vitro demuestra que la mecanotransducción de los osteocitos potencia el reclutamiento de osteoblastos y células mesenquimales preadiposas mientras que reduce la migración de los macrófagos

Mechanical force is important for modeling, remodeling and bone regeneration. It stimulates the osteocytes, causingan alteration in the production and secretion of signaling molecules that regulate osteoblast and osteoclast activity.The present study aims to evaluate the effect of the conditioned medium of mechanically stimulated mouse osteocyticcells on the proliferative and migratory capacity of mesenchymal cells and bone cells. For this, the proliferation andmigration of mouse pre‐osteoblastic cells, human pre‐adult mesenchymal cells and mouse macrophages in the pre‐sence of the conditioned medium of osteocytic cells were analyzed, after 6 and 24 hours after being subjected to amechanical stress of 10 dynes/cm2by fluid flow (FF) for 10 minutes. The migration of pre‐osteoblastic cells has beenfound to increase significantly in the presence of conditioned media of osteocytic cells compared to the static controlgroup (SC)(SC=12.63±5.44, FF6h=23.03±11.57, FF24h=29.72±15.76, p<0.0001). In the same way, the pre‐adipose cellsalso significantly increased their migration in the presence of this conditioned media (SC=11.48±4.75, FF6h=18.43±9.94,FF24h=18.80±10.03; p≤0.0007). However, macrophage migration decreased in the presence of the conditioned mediumcollected at 24 hours with respect to the static control group (SC=69±22.71, FF24h=26.57±5.47, p<0.0001). Theseeffects were associated with decreased protein expression of certain chemokines, such as the monocyte chemotacticprotein type I (SC=0.25±0.06, FF24h=0.09±0.005, p=0.0262), the protein of group I of high mobility (SC=0.25±0.04,FF24h=0.15±0.05, p=0.0159) and the regulatory protein of the activation of T lymphocytes and monocytes(SC=3.29±0.88, FF6h=1.33±1.09, FF24h=0.97±0.66, p≤0.0314), by the osteocytes in the presence of mechanical stimu‐lation with respect to the static control group. In conclusion, this in vitro study demonstrates that osteocyte mechano‐transduction enhances recruitment of osteoblasts and pre‐adipose mesenchymal cells while reducing the migration ofmacrophages

Risk of ischemic stroke associated with functional thrombin-activatable fibrinolysis inhibitor plasma levels.

BACKGROUND AND PURPOSE: Recently, a novel procarboxypeptidase B-like proenzyme, called thrombin-activatable fibrinolysis inhibitor (TAFI), has been described. It plays an important role in the delicate balance between coagulation and fibrinolysis. TAFI leads to potent inhibition of tissue plasminogen activator-induced fibrinolysis. The relevance of TAFI in thromboembolic disease is unclear. We have investigated the risk of ischemic stroke (IS) in relation to plasma levels of functional TAFI. METHODS: In a case-control study, we enrolled 264 individuals; 114 had IS, and 150 were recruited as controls who were age and sex matched and had no history of arterial disease. The individuals supplied information on their personal and family histories of cardiovascular diseases and conventional cardiovascular risk factors. Functional TAFI assays were performed by use of a method based on the activation of TAFI with thrombin-thrombomodulin and the measure of the TAFI activity generated. Other hemostatic parameters assayed were factor VIIIc, anti-phospholipid antibodies,fibrinogen, factor V Leiden, and the prothrombin gene G20210A mutations (PT20210A). RESULTS: Functional TAFI levels were significantly higher in patients with IS (113.7+/-25%; range, 57% to 209%) than in controls (102.6+/-19%). The odds ratio for IS in patients with functional TAFI levels >120% was 5.7 (95% confidence interval, 2.3 to 14.1). CONCLUSIONS: We found that functional TAFI levels in plasma (>120%) increased the risk of IS approximately 6-fold. Further studies should elucidate the physiological role of TAFI in arterial disease and possibly provide clues to therapeutic approaches.

Contribution of prothrombin 20210A allele and factor V Leiden mutation to thrombosis risk in thrombophilic families with other hemostatic deficiencies.

BACKGROUND AND OBJECTIVES: The aims of this study were to compare the lifetime probability of developing thrombosis in 722 relatives of 132 thrombophilic families of symptomatic probands with recognized thrombophilic defects and to determine the prevalence of the factor V Leiden (FVL) mutation and the 20210A allele of the prothrombin gene (PT20210A) in these families. DESIGN AND METHODS: The study included 722 members belonging to 132 unrelated families. The propositi were patients who had been referred to our Thrombosis Unit. The families were selected through a symptomatic proband. Once a patient with a deficiency or mutation was identified, family members were screened for the same defect. RESULTS: The prevalence of FVL and PT20210A in families with other thrombophilic defects was higher than expected. Compared with non-deficient individuals, the risk of venous thrombosis was increased in subjects with antithrombin (AT), protein S (PS) and protein C (PC) deficiencies, and in carriers of FVL and PT20210A mutations. The risk of thrombosis was significantly increased for individuals with combined genetic defects (PC-FVL, PS-FVL, PS-PT20210A and FVL-PT20210A). The ages at the time of 50% thrombosis-free survival were as follows: 34 years for AT deficiency, (19 years with FVL, 21 years with PT20210A), 62 years for PC deficiency (33 years with FVL, 44 years with PT20210A), 37 years for PS deficiency (24 years with FVL, 36 years with PT20210A), 50 years for the FVL mutation (52 years with PT20210A), and 65 years for the PT20210A mutation. As for clinical characteristics, no differences were observed except for the higher frequency of oral contraceptive-related thrombosis in women who were carriers of PT20210A or FVL. INTERPRETATION AND CONCLUSIONS: Based on these results, screening for FVL and PT20210A mutation is recommended in patients with other thrombophilic defects. To the best of our knowledge, this is the first family study, including the PT20210A mutation, that compares genetic risk factors for thrombosis and the lifelong probability of developing thrombosis.

Risk of thrombosis associated with oral contraceptives of women from 97 families with inherited thrombophilia: high risk of thrombosis in carriers of the G20210A mutation of the prothrombin gene.

BACKGROUND AND OBJECTIVES: Oral contraceptives (OC) and inherited thrombophilia are well-known risk factors associated with venous thromboembolism (VTE). However, there are only few studies on the risk of VTE in women with inherited thrombophilia who use oral contraceptives. DESIGN AND METHODS: We performed a retrospective family cohort study of 325 women belonging to 97 families with inherited thrombophilia, including antithrombin, protein S and C deficiencies, the factor V Leiden mutation (FVL) and the G20210A mutation of the prothrombin gene (PT20210A) to determine the risk of VTE associated with OC intake. RESULTS: For carriers of the PT20210A mutation, the risk of VTE in OC users was 3-fold higher (95% CI 1.3-6.8) than that in non-carriers. Carriers of FVL mutation taking OC showed an OR of 1.4 (95% CI 0.6-3.3), indicating a tendency to increase the risk of VTE. INTERPRETATION AND CONCLUSIONS: Because of the high prevalence of the PT20210A (6.5%) and FVL (2%) mutations in the general Spanish population and the increased risk of VTE associated with OC intake, genetic screening for these mutations should be considered in potential OC users belonging to families with thrombophilia.

Linkage analysis demonstrates that the prothrombin G20210A mutation jointly influences plasma prothrombin levels and risk of thrombosis.

Association studies suggest that the G20210A mutation (G to A substitution at nucleotide position 20210) in the prothrombin gene (PT) is associated with increased plasma prothrombin activity and with increased risk for venous thromboembolism. To test directly for linkage between this PT variant and plasma prothrombin activity we performed a family-based study. The G20210A genotypes and plasma prothrombin activity levels were determined in 435 individuals belonging to 22 extended Spanish families. The sample was composed of 388 homozygous (G/G) normal individuals and 43 heterozygote (G/A) and 4 homozygote (A/A) carriers for the G20210A mutation. The results of variance-component linkage analysis yielded a highly significant lod score of 3.6 (P = 2.4 x 10(-5)) between this mutation and a quantitative trait locus (QTL) that influences prothrombin activity. Importantly, a conditional linkage analysis that simultaneously accounted for association with the G20210A variant completely eliminated the linkage signal, which indicates that this mutation affects the function of the prothrombin gene. Additionally, a bivariate linkage analysis of plasma prothrombin activity and thrombosis significantly improved the linkage signal for prothrombin activity (lod score = 4.7; P = 1.5 x 10(-6)) and provided strong evidence that this QTL has a pleiotropic effect on the risk of thrombosis (lod score = 2.43; P =.0004). These results represent the first direct genetic evidence that a QTL in the PT gene influences prothrombin activity levels and susceptibility to thrombosis and strongly support the conclusion that G20210A is a functional polymorphism. (Blood. 2000;95:2780-2785)

Protein S gene analysis reveals the presence of a cosegregating mutation in most pedigrees with type I but not type III PS deficiency.

DNA sequence analysis of the protein S gene (PROS1) in 22 Spanish probands with type I or III PS deficiency, has allowed the identification of 10 different mutations and 2 new sequence variants in 15 probands. Nine of the mutations, 8 of which are novel, cosegregate with type I or quantitative PS deficiency in 12 of the 13 pedigrees analyzed. One of these mutations (Q238X) also cosegregates with both type I and III PS-deficient phenotypes coexisting in a type I/III pedigree. Another mutation identified in a pedigree with these two PS phenotypes is the missense mutation R520G, present in the homozygous form in the type I propositus and in the heterozygous form in his type III relatives. By contrast, no cosegregating PROS1 mutation has been found in any of the six families with only type III phenotypes. Three of these families, as well as the two families with type I and I/III phenotypes where no other PROS1 mutation has been identified, segregate the P allele of the S460P variant, although this allele does not always cosegregate with the deficient phenotype. From these results we conclude that while mutations in PROS1 are the main cause of type I PS deficiency, the molecular basis of the type III phenotype is probably more complex, with many cases not being explained by a PROS1 mutation.

Incidence and clinical manifestations of activated protein C resistance and factor V Leiden in young patients with venous thromboembolic disease in Spain.

In order to evaluate the actual incidence and clinical repercussion of activated protein C resistance (APCR) in our area, we performed a coagulation and thrombophillic study on 65 young patients diagnosed with deep vein thrombosis and 53 controls. Family and genetic study was carried out in APC-resistant patients. We found APCR in 26.15% of patients and the 77.7% of these and their relative were heterozygous for factor V Leiden. There's a clear relationship between phenotype APCR and thrombosis, and also between factor V Leiden and thrombosis.

Absence of linkage between type III protein S deficiency and the PROS1 and C4BP genes in families carrying the protein S Heerlen allele.

To elucidate the molecular basis of hereditary protein S (PS) deficiency and, in particular, type III or free PS deficiency, the allelic distribution and segregation patterns of the PS gene (PROS1) polymorphisms P626A/G and S460P (PS Heerlen) have been analyzed in a group of 45 proposita suffering from type I or type III PS deficiency. No differences between patients and controls were found in the frequency of the P626A/G alleles. By contrast, the frequency of the PS Heerlen allele in the group of patients with type III PS deficiency (9 of 46 chromosomes, P = .196) was significantly higher (P < .001) than in the control group (1 of 300 chromosomes, P = .003). The A allele of P626A/G was always associated with the P allele of S460P. However, this haplotype did not co-segregate with the type III PS-deficient phenotype in 3 of the families. Furthermore, multipoint linkage analysis excluded the whole PROS1 gene in 1 of these families, which is in agreement with the absence of mutations in the PROS1 gene, as determined by sequence analysis. Finally, linkage analysis with 4 microsatellite markers linked to the C4BPB and C4BPA loci also excluded these two genes. From these results we conclude that, at least in some families, the molecular basis of type III PS deficiency is not due to the Mendelian inheritance of a single defect in the PROS1 or in the C4BP genes.

Abnormal polymerization and normal binding of plasminogen and t-PA in three new dysfibrinogenaemias: Barcelona III and IV (gamma Arg 275-->His) and Villajoyosa (gamma Arg 275-->Cys).

Congenital dysfibrinogenaemia was found in three non-related patients. None of them had a haemorrhagic tendency, but one gave a thrombotic history. When their fibrinogens were treated with thrombin, they released fibrinopeptides A and B at normal rates, but the resultant fibrin monomers produced exhibited abnormal polymerization curves. This abnormality was more marked in fibrinogen Villajoyosa than in Barcelonas III and IV. Plasminogen and t-PA binding to fibrin monomers from the three dysfibrinogenaemias was similar to that of normal fibrin monomers. The gamma chain was purified from the three fibrinogens, treated with CNBr and the peptides produced were separated by reversed-phase HPLC. Chromatograms of digested fibrinogens showed an abnormal peak that was not present in the normal gamma chain. Amino acid sequence analysis of abnormal peptides and genomic DNA sequencing revealed that the gamma arginine 275 had been changed in the three fibrinogens; in two cases it was substituted by histidine, and in the third by cysteine. The altered properties observed in fibrin monomers produced from fibrinogen with the gamma Arg 275-->His or gamma Arg 275-->Cys substitution, suggests that this amino acid is important in maintaining the protein structure necessary for normal polymerization, but is not essential for the binding of t-PA or plasminogen to fibrin. It also suggests that the change Arg-->Cys produces more severe alterations in the functions of fibrinogen than the substitution Arg-->His.

[Cervical lymphangioma]. / Linfangioma cervical.

Reporting a cervical Lymphangioma with satisfactory postoperative recovery. Bibliographic survey relating to the several approaches to diagnosis as well as schedules of treatment.

[Markers of hypercoagulability during pregnancy: thrombin-antithrombin-III complexes and D dimer]. / Marcadores de hipercoagulabilidad durante el embarazo: complejos trombina-antitrombina-III y dímero D.

Pregnancy can be regarded as a secondary hyper-coagulability state. The development of thrombin-anti-thrombin complexes (TATC), D dimer and anti-thrombin III (AT III) was analysed in the present work on 33 pregnant women. A significant increase of the TATC records was found between the first and third trimesters and between the second and third trimesters (p = 0.005 and p = 0.02, respectively). The AT III values were within the normal range. The values of the D dimer increased progressively during pregnancy, but only the figures achieved in the third trimester were statistically significant with respect to the control group (p = 0.14). The increase of TATC and D dimer during pregnancy are considered as hypercoagulability.