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The Impact of the Eculizumab on the Thrombogenicity Induced by Extracellular Vesicles in Paroxysmal Nocturnal Hemoglobinuria Patients


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University of Namur

The Impact of the Eculizumab on the Thrombogenicity Induced by Extracellular

Vesicles in Paroxysmal Nocturnal Hemoglobinuria Patients

Wannez, Adeline; Devalet, Bérangère; Bouvy, Céline; Bihin, Benoît; Douxfils, Jonathan;

Dogne, Jean-Michel; Mullier, François

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Research and practice in thrombosis and haemostasis

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Citation for pulished version (HARVARD):

Wannez, A, Devalet, B, Bouvy, C, Bihin, B, Douxfils, J, Dogne, J-M & Mullier, F 2017, The Impact of the

Eculizumab on the Thrombogenicity Induced by Extracellular Vesicles in Paroxysmal Nocturnal Hemoglobinuria

Patients. in Research and practice in thrombosis and haemostasis: Abstracts of the XXVI Congress of the

International Society on Thrombosis and Haemostasis, July 8–13, 2017. vol. 1, pp. 1083, XXVI Congress of the

International Society on Thrombosis and Haemostasis, Berlin, Germany, 8/07/17.

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Methods: Advanced CRC patients receiving 5-fluorouracil based ChTx

were eligible. The number of EV was assessed by flow cytometry in fresh platelet poor plasma obtained from venous blood collected im-mediately before ChTx. EV were defined by size (forward scatter, < 1 μm) and annexin V binding and labeled using antibodies (anti-CD41a: platelet positive EV [PLT+EV]; anti-CD142: TF positive EV [TF+EV]). D-Dimer was assessed by ELISA. The paired t-test was used to com-pare baseline (BL) levels with levels obtained before ChTx. Data are given in absolute numbers (median [quartiles]) if not otherwise stated.

Results: 41 patients (mean age 64 years, 68% men) were included and

35 patients completed 3 cycles of ChTx. Table 1 shows the number of EV, the levels of D-dimer and CEA at BL and before 2nd and 3rd ChTx,

respectively. EV significantly decreased from 429 (288; 664)x103 mL-1

at BL to 255 (181; 474)x103 mL-1 before the 3rd cycle. PLT+EV

signifi-cantly decreased from 216 (129; 287)x103 mL-1 at BL to 119 (74; 210)

x103 mL-1 before the 3rd cycle. The proportion of PLT+EV ranged from

45%-50% throughout ChTx. Number and proportion of TF+EV were small at all time points. D-dimer levels were 0.99 (0.48; 2.52) μg mL-1

at BL and did not decrease over the course of ChTx. D-dimer levels did not correlate with the number of EV.

Conclusions: In patients with advanced CRC, ChTx attenuates

coagu-lation activation as indicated by a decline of the number of EV.

PB 676 

| The Impact of the Eculizumab on

the Thrombogenicity Induced by Extracellular

Vesicles in Paroxysmal Nocturnal Hemoglobinuria


A. Wannez1,2, B. Devalet2, C. Bouvy1, B. Bihin2, J. Douxfils1,

J.-M. Dogné1, F. Mullier2

1University of Namur, Pharmacy Department, Namur, Belgium, 2Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium

Background: Paroxysmal nocturnal hemoglobinuria (PNH) is

charac-terized by a complement-mediated hemolysis. Complement attack in-duces extracellular vesicles (EV) production. These EV can be implied in thrombus formation, the leading cause of death in PNH patients. Eculizumab, an anti-C5 monoclonal antibody, decreases the thrombo-sis frequency in PNH.

Aims: We wanted to assess the impact of eculizumab on the EV

quan-tification and on their procoagulant activity. The purpose is to check, if the antithrombotic activity of the eculizumab could be, in part, ex-plained by its interaction with the EV.

Methods: We recruited 6 PNH patients. Informed consents were

obtained for each patient. The study was led according to the dec-laration of Helsinki and approved by the local Ethic Committee. We collected platelet free plasma (PFP) for each patient before the start of eculizumab, after 4 weeks and after 11 weeks of treatment. We as-sessed the amount of platelets EV (flow cytometry), the procoagulant activity on PFP (Thrombin generation-TGA), provided by phospholip-ids (STA®-Procoag-PPL) and by isolated EV (TGA). We used mixed-effects linear regression (R 3.1.2 with nlme package) with logarithmic transformation for flow cytometry results.

Results: We compared the results obtained after 4 weeks or after

11 weeks of treatment compared to the value before the start of the treatment. The results on the patient‘s PFP show a decrease in the amount of platelet EV with the treatment. About the procoagulant activity of the EV, we observed a decrease in the procoagulant profile (PL and EV-induced) with the eculizumab.

Conclusions: Eculizumab can play its anti-thrombotic role by an action on

the EV. With a bigger cohort, we could estimate a threshold value of the procoagulant activity induced by the EV. The purpose will be to measure the EV activity by STA®-Procoag PPL or TGA on isolated EV in order to assess the thrombotic risk of PNH patients treated with eculizumab.

PB 677 

| Magnetic Capture of Extracellular

Vesicles: A Quantitative Flow Cytometry Study

A. Brisson1, R. Linares1, Y. Boucaud1, C. Gounou1, S. Tan1,

L. Adumeau2, S. Mornet2

1University of Bordeaux, UMR-CBMN, Pessac, France, 2UPR-ICMCB, CNRS, Pessac, France

Background: Cells release small membrane vesicles, called

micropar-ticles, exosomes or extracellular vesicles (EV), which attract interest for their diverse properties and potential applications. However, EV found in body fluids are heterogeneous, and there is yet no reliable method allowing the isolation of selected EV populations.

T A B L E 1   Number of extracellular vesicles (EV), levels of D-dimer and CEA in venous blood of colorectal cancer patients before and during chemotherapy

Before 1st ChTx (baseline) Before 2nd ChTx p-value 1st vs 2nd Before 3rd ChTx p-value 1st vs 3rd

n 41 40 35 EV (x 103 mL-1) 429 (288; 664) 376 (225; 584) 0.13 255 (181; 474) 0.007 PLT+EV (x 103 mL-1) 216 (129; 287) 171 (104;248) 0.056 119 (74; 210) 0.001 % of EV 50 45 47 TF+EV (x 103 mL-1) 19 (10; 38) 20 (9; 32) 0.58 15 (9; 29) 0.101 % of EV 6 7 6 D-Dimer (μg mL-1) 0.99 (0.48; 2.52) 0.69 (0.50; 3.06) 0.95 0.99 (0.52; 2.17) 0.95 CEA (μg L-1) 9.4 (1.9; 42.8) 9.7 (2.6; 70.6) 0.086 9.4 (3.0; 54.9) 0.39


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