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Review

The Phenomenon of Thrombotic Microangiopathy in Cancer Patients

by
Alexander Vorobev
1,
Victoria Bitsadze
1,
Fidan Yagubova
1,
Jamilya Khizroeva
1,
Antonina Solopova
1,
Maria Tretyakova
1,
Nilufar Gashimova
1,*,
Kristina Grigoreva
1,
Sabina Einullaeva
1,
Maria Drozhzhina
2,
Aygun Hajiyeva
3,
Emilia Khalilulina
4,
Alexander Cherepanov
1,
Daredzhan Kapanadze
5,
Elena Egorova
1,
Nart Kuneshko
6,
Jean-Christophe Gris
1,7,
Ismail Elalamy
1,8,9,
Cihan Ay
1,10 and
Alexander Makatsariya
1
1
Department of Obstetrics, Gynecology and Perinatal Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str. 8-2, 119991 Moscow, Russia
2
Faculty of General Medicine, Russian University of Medicine, 4th Dolgorukovskaya Str., 127006 Moscow, Russia
3
Faculty of General Medicine, I.M. Sechenov First State Moscow Medical University Baku Branch, Huseyn Javid, Yasamal, Baku AZ1141, Azerbaijan
4
Faculty of General Medicine, Pirogov Russian National Research Medical University, Ulitsa Ostrovityanova 1, 117997 Moscow, Russia
5
Center of Pathology of Pregnancy and Hemostasis «Medlabi», 340112 Tbilisi, Georgia
6
Moscow’s Region Odintsovo Maternity Hospital, 143003 Odintsovo, Russia
7
Faculty of Pharmaceutical and Biological Sciences, Montpellier University, 34093 Montpellier, France
8
Department Hematology and Thrombosis Center, Medicine Sorbonne University, 75012 Paris, France
9
Hospital Tenon, 4 Rue de la Chine, 75020 Paris, France
10
Department of Medicine I, Clinical Division of Hematology and Hemostaseology, Medical University of Vienna, 1080 Vienna, Austria
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2024, 25(16), 9055; https://doi.org/10.3390/ijms25169055
Submission received: 13 May 2024 / Revised: 19 June 2024 / Accepted: 15 August 2024 / Published: 21 August 2024
(This article belongs to the Section Molecular Pathology, Diagnostics, and Therapeutics)
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Abstract

Thrombotic microangiopathy (TMA) encompasses a range of disorders characterized by blood clotting in small blood vessels, leading to organ damage. It can manifest as various syndromes, including thrombotic thrombocytopenic purpura (TTP), hemolytic-uremic syndrome (HUS), and others, each with distinct causes and pathophysiology. Thrombo-inflammation plays a significant role in TMA pathogenesis: inflammatory mediators induce endothelial injury and activation of platelet and coagulation cascade, contributing to microvascular thrombosis. Primary TMA, such as TTP, is primarily caused by deficient ADAMTS13 metalloproteinase activity, either due to antibody-mediated inhibition or intrinsic enzyme synthesis defects. In cancer patients, a significant reduction in ADAMTS13 levels and a corresponding increase in VWF levels is observed. Chemotherapy further decreased ADAMTS13 levels and increased VWF levels, leading to an elevated VWF/ADAMTS13 ratio and increased thrombotic risk. Drug-induced TMA (DITMA) can result from immune-mediated or non-immune-mediated mechanisms. Severe cases of COVID-19 may lead to a convergence of syndromes, including disseminated intravascular coagulation (DIC), systemic inflammatory response syndrome (SIRS), and TMA. Treatment of TMA involves identifying the underlying cause, implementing therapies to inhibit complement activation, and providing supportive care to manage complications. Plasmapheresis may be beneficial in conditions like TTP. Prompt diagnosis and treatment are crucial to prevent serious complications and improve outcomes.
Keywords: thrombotic microangiopathy; cancer patients; thrombotic thrombocytopenic purpura; thrombo-inflammation; ADAMTS13; drug-induced TMA; COVID-19; microangiopathic hemolytic anemia; chemotherapy-induced TMA thrombotic microangiopathy; cancer patients; thrombotic thrombocytopenic purpura; thrombo-inflammation; ADAMTS13; drug-induced TMA; COVID-19; microangiopathic hemolytic anemia; chemotherapy-induced TMA

Share and Cite

MDPI and ACS Style

Vorobev, A.; Bitsadze, V.; Yagubova, F.; Khizroeva, J.; Solopova, A.; Tretyakova, M.; Gashimova, N.; Grigoreva, K.; Einullaeva, S.; Drozhzhina, M.; et al. The Phenomenon of Thrombotic Microangiopathy in Cancer Patients. Int. J. Mol. Sci. 2024, 25, 9055. https://doi.org/10.3390/ijms25169055

AMA Style

Vorobev A, Bitsadze V, Yagubova F, Khizroeva J, Solopova A, Tretyakova M, Gashimova N, Grigoreva K, Einullaeva S, Drozhzhina M, et al. The Phenomenon of Thrombotic Microangiopathy in Cancer Patients. International Journal of Molecular Sciences. 2024; 25(16):9055. https://doi.org/10.3390/ijms25169055

Chicago/Turabian Style

Vorobev, Alexander, Victoria Bitsadze, Fidan Yagubova, Jamilya Khizroeva, Antonina Solopova, Maria Tretyakova, Nilufar Gashimova, Kristina Grigoreva, Sabina Einullaeva, Maria Drozhzhina, and et al. 2024. "The Phenomenon of Thrombotic Microangiopathy in Cancer Patients" International Journal of Molecular Sciences 25, no. 16: 9055. https://doi.org/10.3390/ijms25169055

APA Style

Vorobev, A., Bitsadze, V., Yagubova, F., Khizroeva, J., Solopova, A., Tretyakova, M., Gashimova, N., Grigoreva, K., Einullaeva, S., Drozhzhina, M., Hajiyeva, A., Khalilulina, E., Cherepanov, A., Kapanadze, D., Egorova, E., Kuneshko, N., Gris, J.-C., Elalamy, I., Ay, C., & Makatsariya, A. (2024). The Phenomenon of Thrombotic Microangiopathy in Cancer Patients. International Journal of Molecular Sciences, 25(16), 9055. https://doi.org/10.3390/ijms25169055

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