Thrombosis in small and medium-sized pulmonary arteries in Wegener's granulomatosis: a confocal laser scanning
Alfredo Nicodemos Cruz Santana1, Alexandre Muxfeldt Ab'Saber, Walcy Rosolio Teodoro
1Faculdade de Medicina da Universidade de São Paulo, University of São Paulo School of Medicine, Hospital das Clínicas, São Paulo, Brazil. alfredonicodemos@hotmail.com
Objective:
Wegener's granulomatosis (WG) can cause endothelial cell damage and thromboembolic events. Nevertheless, there have been few studies on the pulmonary microcirculation--small and medium-sized pulmonary arteries (SMSPA)--in patients with WG. The objective of this study was to quantify fibrin thrombi in the SMSPA of patients with WG.
Methods:
We analyzed 24 SMSPA samples collected from six patients with WG and 16 SMSPA samples collected from four patients without WG. In all samples, we used the endothelial cell marker CD34 and confocal laser scanning microscopy in order to detect intravascular fibrin thrombi. We calculated the total vessel area, the free lumen area, and the thrombotic area.
Results:
The mean total vessel area was similar in the WG and control groups (32,604 µm² vs. 32,970 µm², p = 0.8793). Thrombi were present in 22 (91.67%) of the 24 WG group samples and in none of the control group samples (p < 0.0001; OR = 297; 95% CI: 13.34-6,612). The mean thrombotic area was greater in the WG group samples than in the control group samples (10,068 µm² vs. 0.000 µm²; p < 0.0001). In contrast, the mean free lumen area was smaller in the WG group samples than in the control group samples (6,116 µm² vs. 24,707 µm²; p < 0.0001).
Conclusions:
Confocal laser scanning microscopy revealed a significant association between pulmonary microvascular thrombosis and WG. This suggests a possible role of microvascular thrombosis in the pathophysiology of pulmonary WG, evoking the potential benefits of anticoagulation therapy in pulmonary WG. However, further studies are needed in order to confirm our findings, and randomized clinical trials should be conducted in order to test the role of anticoagulation therapy in the treatment of patients with pulmonary WG.
Insights
Pulmonary microvascular thrombosis is significantly associated with Wegener's granulomatosis (WG). This finding suggests anticoagulation therapy may benefit patients with pulmonary WG, warranting further clinical trials.
Area of Science:
- Pulmonary Medicine
- Vascular Biology
- Rheumatology
Background:
- Wegener's granulomatosis (WG) can lead to endothelial damage and thromboembolic events.
- Pulmonary microcirculation involvement in WG is understudied.
- Small and medium-sized pulmonary arteries (SMSPA) are key areas of investigation.
Purpose of the Study:
- To quantify fibrin thrombi in the SMSPA of WG patients.
- To investigate the association between WG and pulmonary microvascular thrombosis.
Main Methods:
- Analysis of 24 WG and 4 control SMSPA samples.
- Utilized CD34 marker and confocal laser scanning microscopy.
- Quantified total vessel area, free lumen area, and thrombotic area.
Main Results:
- Fibrin thrombi found in 91.67% of WG samples, none in controls.
- Significantly larger thrombotic area in WG samples (p < 0.0001).
- Significantly smaller free lumen area in WG samples (p < 0.0001).
Conclusions:
- Pulmonary microvascular thrombosis is significantly associated with WG.
- Microvascular thrombosis may play a role in pulmonary WG pathophysiology.
- Anticoagulation therapy warrants investigation for pulmonary WG treatment.
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