Management of Cerebral Venous Thrombosis Due to Adenoviral COVID-19 Vaccination

Objective Cerebral venous thrombosis (CVT) caused by vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare adverse effect of adenovirus-based severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) vaccines. In March 2021, after autoimmune pathogenesis of VITT was discovered, treatment recommendations were developed. These comprised immunomodulation, non-heparin anticoagulants, and avoidance of platelet transfusion. The aim of this study was to evaluate adherence to these recommendations and its association with mortality. Methods We used data from an international prospective registry of patients with CVT after the adenovirus-based SARS-CoV-2 vaccination. We analyzed possible, probable, or definite VITT-CVT cases included until January 18, 2022. Immunomodulation entailed administration of intravenous immunoglobulins and/or plasmapheresis. Results Ninety-nine patients with VITT-CVT from 71 hospitals in 17 countries were analyzed. Five of 38 (13%), 11 of 24 (46%), and 28 of 37 (76%) of the patients diagnosed in March, April, and from May onward, respectively, were treated in-line with VITT recommendations (p < 0.001). Overall, treatment according to recommendations had no statistically significant influence on mortality (14/44 [32%] vs 29/55 [52%], adjusted odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.16-1.19). However, patients who received immunomodulation had lower mortality (19/65 [29%] vs 24/34 [70%], adjusted OR = 0.19, 95% CI = 0.06-0.58). Treatment with non-heparin anticoagulants instead of heparins was not associated with lower mortality (17/51 [33%] vs 13/35 [37%], adjusted OR = 0.70, 95% CI = 0.24-2.04). Mortality was also not significantly influenced by platelet transfusion (17/27 [63%] vs 26/72 [36%], adjusted OR = 2.19, 95% CI = 0.74-6.54). Conclusions In patients with VITT-CVT, adherence to VITT treatment recommendations improved over time. Immunomodulation seems crucial for reducing mortality of VITT-CVT. ANN NEUROL 2022Peer reviewe

Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries

Background: Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. Aims: We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. Methods: We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). Results: Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20–37) versus 47 (IQR 32–58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11–40]) than in HICs (44/102 [43%, 95% CI 34–53], p = 0.039). Conclusions: The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.</p

Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19

Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28–54) vs 45 (28–56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28–79) vs 68 (30–125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19–62) vs 53 (20–92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.</p

Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19

Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28–54) vs 45 (28–56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28–79) vs 68 (30–125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19–62) vs 53 (20–92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.</p

Effets athéroprotecteurs de la curcumine et d’extraits riches en polyphénols d’Antirhea borbonica et de Doratoxylon apetalum

Cardiovascular diseases are the leading cause of death in France with an even higher prevalence in Reunion. Most deaths are due to ischemic heart disease because of atherosclerotic plaque rupture and thrombus formation leading to cardiac ischemia. The oxidation of low density lipoproteins (LDL) and endothelial dysfunction represent important steps in the destabilization of plaque, hence the interest of a treatment capable of reducing the oxidation of LDL or of protecting endothelial cells from their cytotoxic effects. Polyphenols are antioxidant molecules very present in the plant kingdom. Preliminary studies on human adipocytes have shown that polyphenol-rich extracts of Antirhea borbonica and Doratoxylon apetalum, respectively endemic and indigenous species of Reunion Island, had antioxidant and anti-inflammatory properties (Marimoutou , M et al., 2015). The aim of this thesis was, first, to test the antioxidant and cytoprotective capacities of polyphenol rich extracts of these two species on endothelial cells. Then in a second time we tested the extract of Doratoxylon apetalum on a murine model of atherosclerosis (ApoE KO mice) to evaluate its anti-inflammatory effect on atheroma plaques.Les maladies cardiovasculaires représentent la première cause de mortalité en France avec une prévalence encore plus importante à La Réunion. La plupart des décès sont attribuables aux cardiopathies ischémiques due à la rupture d'une plaque d'athérosclérose et à la formation d'un caillot entrainant une ischémie cardiaque. L'oxydation des lipoprotéines de basse densité (LDL) et la dysfonction de l'endothélium représentent des étapes importantes dans la déstabilisation de la plaque, d'où l’intérêt de rechercher un traitement capable de diminuer l'oxydation des LDL ou de protéger les cellules endothéliales de leurs effets cytotoxiques. Les polyphénols sont des molécules antioxydantes très présentes dans le règne végétal. Des études préliminaires du laboratoire sur des adipocytes humain on montré que des extraits riches en polyphénols d'Antirhea borbonica et de Doratoxylon apetalum, deux espèces respectivement endémique et indigène de l'Île de La Réunion, possédaient des propriétés antioxydantes et anti-inflammatoires (Marimoutou, M et al. 2015). Le But de cette thèse était, dans un premier temps, de tester les capacités antioxydantes et cytoprotectrices d'extraits riches en polyphénols de ces deux espèces sur des cellules endothéliales. Puis dans un second temps nous avons testé l'extrait de Doratoxylon apetalum sur un modèle murin d'athérosclérose (souris ApoE KO) pour évaluer son effet anti-inflammatoire sur les plaques d'athérome

Atheroprotective effects of curcumin and polyphenol rich extracts of Antirhea borbonica and Doratoxylon apetalum

Les maladies cardiovasculaires représentent la première cause de mortalité en France avec une prévalence encore plus importante à La Réunion. La plupart des décès sont attribuables aux cardiopathies ischémiques due à la rupture d'une plaque d'athérosclérose et à la formation d'un caillot entrainant une ischémie cardiaque. L'oxydation des lipoprotéines de basse densité (LDL) et la dysfonction de l'endothélium représentent des étapes importantes dans la déstabilisation de la plaque, d'où l’intérêt de rechercher un traitement capable de diminuer l'oxydation des LDL ou de protéger les cellules endothéliales de leurs effets cytotoxiques. Les polyphénols sont des molécules antioxydantes très présentes dans le règne végétal. Des études préliminaires du laboratoire sur des adipocytes humain on montré que des extraits riches en polyphénols d'Antirhea borbonica et de Doratoxylon apetalum, deux espèces respectivement endémique et indigène de l'Île de La Réunion, possédaient des propriétés antioxydantes et anti-inflammatoires (Marimoutou, M et al. 2015). Le But de cette thèse était, dans un premier temps, de tester les capacités antioxydantes et cytoprotectrices d'extraits riches en polyphénols de ces deux espèces sur des cellules endothéliales. Puis dans un second temps nous avons testé l'extrait de Doratoxylon apetalum sur un modèle murin d'athérosclérose (souris ApoE KO) pour évaluer son effet anti-inflammatoire sur les plaques d'athérome.Cardiovascular diseases are the leading cause of death in France with an even higher prevalence in Reunion. Most deaths are due to ischemic heart disease because of atherosclerotic plaque rupture and thrombus formation leading to cardiac ischemia. The oxidation of low density lipoproteins (LDL) and endothelial dysfunction represent important steps in the destabilization of plaque, hence the interest of a treatment capable of reducing the oxidation of LDL or of protecting endothelial cells from their cytotoxic effects. Polyphenols are antioxidant molecules very present in the plant kingdom. Preliminary studies on human adipocytes have shown that polyphenol-rich extracts of Antirhea borbonica and Doratoxylon apetalum, respectively endemic and indigenous species of Reunion Island, had antioxidant and anti-inflammatory properties (Marimoutou , M et al., 2015). The aim of this thesis was, first, to test the antioxidant and cytoprotective capacities of polyphenol rich extracts of these two species on endothelial cells. Then in a second time we tested the extract of Doratoxylon apetalum on a murine model of atherosclerosis (ApoE KO mice) to evaluate its anti-inflammatory effect on atheroma plaques

Constraining global-scale weathering models through nano-scale ectomycorrhiza-mineral interactions.

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Ectomycorrhizal weathering, a matter of size ?

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Numerical Modelling of Nano-Scale Mineral Dissolution and Simulation of Mycelial Growth Dynamics to Couple Observations of Mycorrhizal Weathering at Single-Hypha and Whole-Plant Scales

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Hydroxyapatite weathering by pine mycorrhizas-The role of oxalic acid.

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