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Research Article|Articles in Press

The role of platelets in heat-related illness and heat-induced coagulopathy

  • Toshiaki Iba
    Correspondence
    Corresponding author at: Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo 113-8421, Japan.
    Affiliations
    Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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  • Julie Helms
    Affiliations
    Strasbourg University (UNISTRA), Strasbourg, France

    Strasbourg University Hospital, Medical Intensive Care Unit - NHC, Strasbourg, France

    INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France
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  • Marcel Levi
    Affiliations
    Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands

    Department of Medicine, University College London Hospitals NHS Foundation Trust, and Cardio-metabolic Programme-NIHR UCLH/UCL BRC, London, UK
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  • Jerrold H. Levy
    Affiliations
    Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA
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      Abstract

      Heat-related illness is becoming more problematic due to ongoing global warming. Heat-related injury causes systemic inflammation and coagulopathy, due to leukocyte, platelet, and vascular endothelial cell activation and injury. Hyperthermia directly modulates platelet function and can induce cellular damage. Meanwhile, heat also affects platelet function via activated coagulation, excess inflammation, production of cytokines, and heat shock proteins. Aberrant hyperthermia-induced interactions between leukocytes and endothelial cells are also involved in platelet regulation. Heat-induced coagulopathy commonly progresses to disseminated intravascular coagulation (DIC), leading to multiple organ failure and in some cases enhanced bleeding. Consequently, platelet count, prothrombin time, and DIC score are useful for evaluating the severity of heat-related illness in addition to other organ damage markers such as Glasgow Coma Scale, creatinine, and bilirubin. Despite the increasing risk, therapeutic modalities targeting platelets are limited and no established therapy exists. In this review, we summarize the current knowledge about the role of platelets in the pathogenesis, diagnosis, and management of heat-related illness.

      Keywords

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      References

        • Young S.S.
        • Young J.S.
        Overall warming with reduced seasonality: temperature change in New England, USA, 1900–2020.
        Climate. 2021; 9: 176
        • Hemmelgarn C.
        • Gannon K.
        Heatstroke: thermoregulation, pathophysiology, and predisposing factors.
        Compend, Contin. Educ. Vet. 2013; 35E4
        • Huisse M.G.
        • Pease S.
        • Hurtado-Nedelec M.
        Leukocyte activation: the link between inflammation and coagulation during heatstroke. A study of patients during the 2003 heat wave in Paris.
        Crit. Care Med. 2008; 36: 2288-2295
        • Hifumi T.
        • Kondo Y.
        • Shimazaki J.
        • et al.
        Prognostic significance of disseminated intravascular coagulation in patients with heat stroke in a nationwide registry.
        J. Crit. Care. 2018; 44: 306-311
        • Bouchama A.
        • Abuyassin B.
        • Lehe C.
        • et al.
        Classic and exertional heatstroke.
        Nat. Rev. Dis. Primers. 2022; 8: 8
        • Iba T.
        • Connors J.M.
        • Levi M.
        • Levy J.H.
        Heatstroke-induced coagulopathy: biomarkers, mechanistic insights, and patient management.
        EClinicalMedicine. 2022; 44101276
        • Rao G.H.
        • Smith II, C.M.
        • Escolar G.
        • White J.G.
        Influence of heat on platelet biochemistry, structure, and function.
        J. Lab. Clin. Med. 1993; 122: 455-464
        • Gader A.M.
        • Al-Mashhadani S.A.
        • Al-Harthy S.S.
        Direct activation of platelets by heat is the possible trigger of the coagulopathy of heat stroke.
        Br. J. Haematol. 1990; 74: 86-92
        • Al-Mashhadani S.A.
        • Gader A.M.
        • Al Harthi S.
        The role of platelets in the coagulopathy of heatstroke- a study of platelet aggregation in heatstroke patients during the Makkah pilgrimage (Haj) to Makkah.
        Platelets. 1997; 8: 37-42
        • White J.G.
        Effects of heat on platelet structure and function.
        Blood. 1968; 32: 324-335
        • Gader A.G.
        • Ghumlas A.K.
        • Hussain M.F.
        • et al.
        The ultrastructure of camel blood platelets: a comparative study with human, bovine, and equine cells.
        Platelets. 2008; 19: 51-58
        • Al Ghumlas A.K.
        • Abdel Gader A.G.
        • Hussein M.F.
        • et al.
        Effects of heat on camel platelet structure and function-a comparative study with humans.
        Platelets. 2008; 19: 163-171
        • Wang Z.
        • Shi Q.
        • Li S.
        • et al.
        Hyperthermia induces platelet apoptosis and glycoprotein ibalpha ectodomain shedding.
        Platelets. 2010; 21: 229-237
        • Polanowska-Grabowska R.
        • Gear A.R.
        Heat-shock proteins and platelet function.
        Platelets. 2000; 11: 6-22
        • Kozawa O.
        • Matsuno H.
        • Niwa M.
        • et al.
        HSP20, low-molecular-weight heat shock-related protein, acts extracellularly as a regulator of platelet functions: a novel defense mechanism.
        Life Sci. 2002; 72: 113-124
        • Suzuki H.
        • Kosuge Y.
        • Kobayashi K.
        • et al.
        Heat-shock protein 72 promotes platelet aggregation induced by various platelet activators in rats.
        Biomed. Res. 2017; 38: 175-182
        • Rigg R.A.
        • Healy L.D.
        • Nowak M.S.
        • et al.
        Heat shock protein 70 regulates platelet integrin activation, granule secretion and aggregation.
        Am. J. Physiol. Cell Physiol. 2016; 310: C568-C575
        • Jackson J.W.
        • Rivera-Marquez G.M.
        • Beebe K.
        • et al.
        Pharmacologic dissection of the overlapping impact of heat shock protein family members on platelet function.
        J. Thromb. Haemost. 2020; 18: 1197-1209
        • Hoter A.
        • Rizk S.
        • Naim H.Y.
        Cellular and molecular adaptation of arabian camel to heat stress.
        Front. Genet. 2019; 10: 588
        • Li F.
        • Xiao H.
        • Zhou F.
        • et al.
        Study of HSPB6: insights into the properties of the multifunctional protective agent.
        Cell. Physiol. Biochem. 2017; 44: 314-332
        • Niwa M.
        • Kozawa O.
        • Matsuno H.
        • et al.
        Small molecular weight heat shock-related protein, HSP20, exhibits an anti-platelet activity by inhibiting receptor-mediated calcium influx.
        Life Sci. 2000; 66 (PL7-12)
        • McLemore E.C.
        • Tessier D.J.
        • Flynn C.R.
        • et al.
        Transducible recombinant small heat shock-related protein, HSP20, inhibits vasospasm and platelet aggregation.
        Surgery. 2004; 136: 573-578
        • Lang D.
        • Dohle F.
        • Terstesse M.
        • et al.
        Down-regulation of monocyte apoptosis by phagocytosis of platelets: involvement of a caspase-9, caspase-3, and heat shock protein 70-dependent pathway.
        J. Immunol. 2002; 168: 6152-6158
        • Espersen G.T.
        • Elbaek A.
        • Ernst E.
        • et al.
        Effect of physical exercise on cytokines and lymphocyte subpopulations in human peripheral blood.
        APMIS. 1990; 98: 395-400
        • Robins H.I.
        • Kutz M.
        • Wiedemann G.J.
        • et al.
        Cytokine induction in humans by 41.8 degrees C whole body hyperthermia.
        Cancer Lett. 1995; 97: 195-201
        • Camus G.
        • Nys M.
        • Poortmans J.R.
        • et al.
        Endotoxaemia, production of tumour necrosis factor alpha and polymorphonuclear neutrophil activation following strenuous exercise in humans.
        Eur. J. Appl. Physiol. Occup. Physiol. 1998; 79: 62-68
        • Geng Y.
        • Ma Q.
        • Liu Y.N.
        • et al.
        Heatstroke induces liver injury via IL-1β and HMGB1-induced pyroptosis.
        J. Hepatol. 2015; 63: 622-633
        • Dehbi M.
        • Uzzaman T.
        • Baturcam E.
        • et al.
        Toll-like receptor 4 and high-mobility group box 1 are critical mediators of tissue injury and survival in a mouse model for heatstroke.
        PLoS One. 2012; 7e44100
        • Oishi S.
        • Tsukiji N.
        • Otake S.
        • et al.
        Heme activates platelets and exacerbates rhabdomyolysis-induced acute kidney injury via CLEC-2 and GPVI/FcRγ.
        Blood Adv. 2021; 5: 2017-2026
        • Shields A.M.
        • Panayi G.S.
        • Corrigall V.M.
        A new-age for biologic therapies: long-term drug-free therapy with BiP?.
        Front. Immunol. 2012; 3: 17
        • Eisinger F.
        • Patzelt J.
        • Langer H.F.
        The platelet response to tissue injury.
        Front. Med. 2018; 5: 317
        • Tong H.
        • Wan P.
        • Zhang X.
        • et al.
        Vascular endothelial cell injury partly induced by mesenteric lymph in heat stroke.
        Inflammation. 2014; 37: 27-34
        • Bouchama A.
        • Hammami M.M.
        • Haq A.
        • et al.
        Evidence for endothelial cell activation/injury in heatstroke.
        Crit. Care Med. 1996; 24: 1173-1178
        • Shieh S.D.
        • Shiang J.C.
        • Lin Y.F.
        • et al.
        Circulating angiotensin-converting enzyme, von willebrand factor antigen and thrombomodulin in exertional heat stroke.
        Clin. Sci. 1995; 89: 261-265
        • Selak M.A.
        Neutrophil-platelet interactions in inflammation.
        Receptor. 1994; 4: 3-7
        • Sylman J.L.
        • Artzer D.T.
        • Rana K.
        • Neeves K.B.
        A vascular injury model using focal heat-induced activation of endothelial cells.
        Integr. Biol. 2015; 7: 801-814
        • Roberts G.T.
        • Ghebeh H.
        • Chishti M.A.
        • et al.
        Microvascular injury, thrombosis, inflammation, and apoptosis in the pathogenesis of heatstroke: a study in baboon model.
        Arterioscler. Thromb. Vasc. Biol. 2008; 28: 1130-1136
        • Wilhelm E.N.
        • González-Alonso J.
        • Chiesa S.T.
        • et al.
        Whole-body heat stress and exercise stimulate the appearance of platelet microvesicles in plasma with limited influence of vascular shear stress.
        Physiol. Rep. 2017; 5e13496
        • Joop K.
        • Berckmans R.J.
        • Nieuwland R.
        • et al.
        Microparticles from patients with multiple organ dysfunction syndrome and sepsis support coagulation through multiple mechanisms.
        Thromb. Haemost. 2001; 85: 810-820
        • Chao T.C.
        • Sinniah R.
        • Pakiam J.E.
        Acute heat stroke deaths.
        Pathology. 1981; 13: 145-156
        • Charan N.B.
        • Robinson W.A.
        • Mathew M.
        Heat stroke, disseminated intravascular coagulation and death in a long distance runner.
        J. Assoc. Physicians India. 1975; 23: 917-919
        • Larcan A.
        • Lambert H.
        • Laprevote-Heully M.C.
        • et al.
        Heat stroke and disseminated intravascular coagulation. Apropos of 2 cases.
        Sem. Hop. 1978; 54: 603-619
        • Mustafa K.Y.
        • Omer O.
        • Khogali M.
        • et al.
        Blood coagulation and fibrinolysis in heat stroke.
        Br. J. Haematol. 1985; 61: 517-523
        • Zhou Y.
        • Li L.
        • Liu L.
        • et al.
        Heat stroke deaths caused by electric blankets: case report and review of the literature.
        Am J Forensic Med Pathol. 2006; 27: 324-327
        • Sohal R.S.
        • Sun S.C.
        • Colcolough H.L.
        • Burch G.E.
        Heat stroke. An electron microscopic study of endothelial cell damage and disseminated intravascular coagulation.
        Arch. Intern. Med. 1968; 122: 43-47
        • Proctor E.A.
        • Dineen S.M.
        • van Nostrand S.C.
        • et al.
        Coagulopathy signature precedes and predicts severity of end-organ heat stroke pathology in a mouse model.
        J. Thromb. Haemost. 2020; 18: 1900-1910
        • Yamamoto T.
        • Fujita M.
        • Oda M.Y.
        • et al.
        Evaluation of a novel classification of heat-related illnesses: a multicentre observational study (Heat Stroke STUDY 2012).
        Int. J. Environ. Res. Public Health. 2018; 15: 1962
        • Shimazaki J.
        • Hifumi T.
        • Shimizu K.
        • et al.
        Clinical characteristics, prognostic factors, and outcomes of heat-related illness (Heatstroke study 2017–2018).
        Acute Med. Surg. 2020; 7e516
        • Hifumi T.
        • Kondo Y.
        • Shimazaki J.
        • et al.
        Prognostic significance of disseminated intravascular coagulation in patients with heat stroke in a nationwide registry.
        J. Crit. Care. 2018; 44: 306-311
        • Xing L.
        • Liu S.Y.
        • Mao H.D.
        • et al.
        The prognostic value of routine coagulation tests for patients with heat stroke.
        Am. J. Emerg. Med. 2021; 44: 366-372
        • Zhong L.
        • Wu M.
        • Ji J.
        • et al.
        Association between platelet levels on admission and 90-day mortality in patients with exertional heatstroke, a 10 years cohort study.
        Front. Med. 2021; 8716058
        • Min J.
        • Wan P.
        • Liu G.
        • et al.
        Sonoclot signature analysis: a new point-of-care testing method for defining heat stroke-induced coagulopathy.
        Int. J. Gen. Med. 2021; 14: 6925-6933
        • Jin H.
        • Li Z.
        • Guo X.
        • et al.
        Microcirculatory disorders and protective role of antioxidant in severe heat stroke: a rat study.
        Shock. 2016; 46: 688-695
        • El-Sabban F.
        • Fahim M.A.
        Treatments with lead expedite hyperthermia-induced thromboembolism in mouse pial microvessels.
        Int. J. Hyperth. 1998; 14: 319-329
        • Iba T.
        • Umemura Y.
        • Wada H.
        • Levy J.H.
        Roles of coagulation abnormalities and microthrombosis in sepsis: pathophysiology, diagnosis, and treatment.
        Arch. Med. Res. 2021; 52: 788-797
        • Asakura H.
        Classifying types of disseminated intravascular coagulation: clinical and animal models.
        J. Intensive Care. 2014; 2: 20
        • Moore H.B.
        • Gando S.
        • Iba T.
        • et al.
        Defining trauma-induced coagulopathy with respect to future implications for patient management: communication from the SSC of the ISTH.
        J. Thromb. Haemost. 2020; 18: 740-747
        • Barbosa da Cruz D.
        • Helms J.
        • Aquino L.R.
        • et al.
        DNA-bound elastase of neutrophil extracellular traps degrades plasminogen, reduces plasmin formation, and decreases fibrinolysis: proof of concept in septic shock plasma.
        FASEB J. 2019; 33: 14270-14280
        • Iba T.
        • Warkentin T.E.
        • Connors J.M.
        • Levy J.H.
        Therapeutic strategies in patients with coagulopathy and disseminated intravascular coagulation: awareness of the phase-dependent characteristics.
        Minerva Med. 2021; 112: 701-712
        • Matsumoto H.
        • Takeba J.
        • Umakoshi K.
        • et al.
        Successful treatment for disseminated intravascular coagulation (DIC) corresponding to phenotype changes in a heat stroke patient.
        J. Intensive Care. 2019; 7: 2
        • Chen A.H.
        • Song X.D.
        • Luo B.D.
        • Zou F.
        Protective and anti-fatigue effects of aspirin against heatstroke in rats.
        Sheng Li Xue Bao. 2005; 57: 446-452
        • Pennings G.J.
        • Reddel C.J.
        • Traini M.
        • et al.
        Rapid release of interleukin-1β from human platelets is independent of NLRP3 and caspase.
        Thromb. Haemost. 2021 Jun 25; https://doi.org/10.1055/s-0041-1731288
        • Kobayashi K.
        • Mimuro S.
        • Sato T.
        • et al.
        Dexmedetomidine preserves the endothelial glycocalyx and improves survival in a rat heatstroke model.
        J. Anesth. 2018; 32: 880-885
        • Shi Y.
        • Jiang X.
        • Zhang L.
        • et al.
        Endothelium-targeted overexpression of heat shock protein 27 ameliorates blood-brain barrier disruption after ischemic brain injury.
        Proc. Natl. Acad. Sci. U. S. A. 2017; 114: E1243-E1252