title: Platelet ligands and ADAMTS13 during Puumala hantavirus infection and associated thrombocytopenia.
abstract: We aimed here to elucidate the role of adhesive platelet ligands and endothelial involvement during the acute phase of Puumala hantavirus (PUUV) infection. Nineteen hospital-treated patients with serologically confirmed diagnosis of acute PUUV infection were included. Patient charts were reviewed for clinical and basic laboratory data. Plasma levels of von Willebrand factor antigen (VWF:Ag), ristocetin cofactor (VWF:RCo), factor VIII (FVIII:C) and a disintegrin and metalloproteinase with a thrombospondin type 1 domain 13 (ADAMTS13) activities as well as fibrinogen and fibronectin were measured three times acutely and once during the recovery phase. VWF:Ag and VWF:RCo were nearly three-fold higher acutely compared with recovery (median 252 vs. 88%, and mean 267 vs. 98%, respectively; P<0.001 for both), whereas FVIII:C was only slightly elevated (median 118 vs. 88%, P=0.002) and remarkably failed to show association with VWF in the acute phase. ADAMTS13 activity and fibronectin concentration were lower in the acute compared with the recovery phase (median 56 vs. 63%, P=0.003, and median 221 vs. 330 μmol/l, P=0.001, respectively). Fibrinogen raised acutely (mean 5.0 vs. 3.3 g/l, P<0.001), negatively correlating with the platelet count (r=-0.468, P=0.043). Markedly upregulated fibrinogen and VWF together with decreased levels of ADAMTS13 activity and fibronectin were observed during acute PUUV infection. VWF and FVIII:C did not associate during the acute phase, whereas thrombocytopenia correlated negatively with fibrinogen. These findings imply several rearranged interactions between platelets and their ligands.
authors.affiliation: Department of Internal Medicine, University Hospital, University of Tampere, Tampere, Finland. outi.k.laine@fimnet.fi
authors.forename: Outi
authors.initials: O
authors.lastname: Laine
authors.forename: Satu
authors.initials: S
authors.lastname: Mäkelä
authors.forename: Jukka
authors.initials: J
authors.lastname: Mustonen
authors.forename: Mika
authors.initials: M
authors.lastname: Helminen
authors.forename: Antti
authors.initials: A
authors.lastname: Vaheri
authors.forename: Riitta
authors.initials: R
authors.lastname: Lassila
authors.forename: Lotta
authors.initials: L
authors.lastname: Joutsi-Korhonen
mesh_terms: D051722:ADAM Proteins / Q000032:analysis; D000071120:ADAMTS13 Protein; D000210:Acute-Phase Reaction / Q000097:blood* / Q000276:immunology / Q000473:pathology / Q000821:virology; D000328:Adult; D001780:Blood Coagulation Tests; D001792:Blood Platelets / Q000166:cytology / Q000378:metabolism*; D003289:Convalescence; D005169:Factor VIII / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D005353:Fibronectins / Q000032:analysis; D005387:Finland; D006480:Hemorrhagic Fever with Renal Syndrome / Q000097:blood* / Q000150:complications / Q000276:immunology / Q000473:pathology / Q000821:virology; D006801:Humans; D007120:Immunochemistry; D008024:Ligands; D008297:Male; D008875:Middle Aged; D015539:Platelet Activation / Q000276:immunology; D010973:Platelet Adhesiveness; D029262:Puumala virus / Q000254:growth & development; D012310:Ristocetin / Q000032:analysis; D013921:Thrombocytopenia / Q000097:blood* / Q000150:complications / Q000276:immunology / Q000473:pathology / Q000821:virology; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D005353:Fibronectins; D008024:Ligands; D014841:von Willebrand Factor; D012310:Ristocetin; D005169:Factor VIII; D005340:Fibrinogen; D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human