The challenge of managing hemophilia A and STEC-induced hemolytic uremic syndrome

Item does not contain fulltextBACKGROUND: The hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy leading to acute kidney injury in children. In most cases it is triggered by an infection caused by Shiga-like toxin-producing Escherichia coli (STEC). Endothelial damage plays a central role in the pathogenesis of disease. Hemophilia A is a genetic disorder leading to factor VIII (FVIII) deficiency, an important factor in the coagulation system. CASE: Here we describe a hemophilia A patient who developed HUS due to a STEC O26 infection. The patient developed not only acute kidney injury, but also severe gastro-intestinal and neurological complications. Increased amounts of recombinant FVIII (rFVIII) had to be administered during the acute phase of the disease to reach acceptable blood levels of FVIII, in order to control the hemorrhagic colitis and to prevent severe neurological complications. CONCLUSION: The patient's treatment schedule of rFVIII during the HUS period was a serious challenge, and we cannot exclude that it contributed to the severity of the HUS by enhancing the thrombotic microangiopathic process. The role of factor VIII administration in the severe outcome of this disease is discussed

A unified theory of calcium alternans in ventricular myocytes

Intracellular calcium (Ca(2+)) alternans is a dynamical phenomenon in ventricular myocytes, which is linked to the genesis of lethal arrhythmias. Iterated map models of intracellular Ca(2+) cycling dynamics in ventricular myocytes under periodic pacing have been developed to study the mechanisms of Ca(2+) alternans. Two mechanisms of Ca(2+) alternans have been demonstrated in these models: one relies mainly on fractional sarcoplasmic reticulum Ca(2+) release and uptake, and the other on refractoriness and other properties of Ca(2+) sparks. Each of the two mechanisms can partially explain the experimental observations, but both have their inconsistencies with the experimental results. Here we developed an iterated map model that is composed of two coupled iterated maps, which unifies the two mechanisms into a single cohesive mathematical framework. The unified theory can consistently explain the seemingly contradictory experimental observations and shows that the two mechanisms work synergistically to promote Ca(2+) alternans. Predictions of the theory were examined in a physiologically-detailed spatial Ca(2+) cycling model of ventricular myocytes