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Platelet hyperaggregability is associated with decreased ADAMTS13 activity and enhanced endotoxemia in patients with acute cholangitis
Author(s) -
Takaya Hiroaki,
Kawaratani Hideto,
Kubo Takuya,
Seki Kenichiro,
Sawada Yasuhiko,
Kaji Kosuke,
Okura Yasushi,
Takeda Kosuke,
Kitade Mitsuteru,
Moriya Kei,
Namisaki Tadashi,
Mitoro Akira,
Matsumoto Masanori,
Fukui Hiroshi,
Yoshiji Hitoshi
Publication year - 2018
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12926
Subject(s) - medicine , platelet , gastroenterology
Aim Insufficient ADAMTS13 activity (ADAMTS13:AC) leads to increased levels of unusually large von Willebrand factor (VWF) multimers and causes microcirculatory disturbance and multiple organ failure (MOF). Endotoxin (Et) triggers the activation of coagulation and cytokine cascades, leading to MOF in severe inflammatory response syndrome. Here, we investigated the potential role of endotoxemia‐related ADAMTS13 in acute cholangitis. Methods Twenty‐four patients with acute cholangitis, including 7 with severe acute cholangitis, were recruited in this study. The levels of ADAMTS13:AC, VWF antigen (VWF:Ag), interleukin (IL)‐6, IL‐8, and tumor necrosis factor (TNF)‐α in each patient were determined by enzyme‐linked immunosorbent assay, whereas Et levels were determined by Et activity assay (EAA) analysis. Results The ADAMTS13:AC and VWF:Ag levels were significantly lower and higher, respectively, in patients with acute cholangitis than in controls. The EAA levels were higher in patients with acute cholangitis than in controls, and were inversely correlated with that of ADAMTS13:AC. Patients with severe acute cholangitis had significantly lower ADAMTS13:AC and higher VWF:Ag levels than those with mild to moderate cholangitis. Notably, ADMTS13:AC was directly correlated with platelet counts and inversely correlated with IL‐6 levels, and the VWF:Ag/ADAMTS13:AC ratio was directly correlated with IL‐8 and TNF‐α levels. Conclusions Imbalance of ADAMTS13:AC and VWF:Ag levels might be associated with severe acute cholangitis, reflecting platelet hyperaggregability. Severe acute cholangitis has severe pathophysiological features and is complicated by endotoxemia and MOF. Notably, this is the first report indicating an association between the levels of ADAMTS13:AC and VWF:Ag and those of EAA and cytokines in acute cholangitis.