Hypertrophic osteoarthropathy: Endothelium and platelet function

Abstract

Hypertrophic osteoarthropathy (HOA) is characterized by finger clubbing, periostosis and arthritis. The pathogenesis of hypertrophic osteoarthropathy is still uncertain. Earlier studies have been focused on the potential role of platelet and endothelium in the pathogenesis of HOA. The aim of this study was to evaluate the circulating levels of endothelin-1 (ET-1), beta-thromboglobulin (beta-TG) and platelet-derived growth factor (PDGF) in 21 HOA patients. The circulating levels of ET-1, beta-TG were significantly higher in HOA patients vs healthy controls, but not vs controls with lung diseases. On the contrary, PDGF was significantly higher in HOA patients vs healthy controls and vs subjects with lung diseases. These findings suggest that "endothelium/platelet unit" may play a role in the pathogenesis of HOA, and PDGF could induce the changes observed in HOA.

Clubbing: An update on diagnosis, differential diagnosis, pathophysiology, and clinical relevance

“…63 Patients with primary and secondary HOA had greater PDGF levels than control subjects and patients with lung disease without HOA. 64 Another platelet-derived, growth-promoting cytokine, vascular endothelial growth factor, is elevated in the serum of patients with lung cancer and secondary HOA compared with patients with lung cancer without HOA, and likely contributes to the vascular hyperplasia seen in clubbing pathology. 65 Finally, immunohistochemical studies of the stroma of clubbed digits show greater PDGF and vascular endothelial growth factor positivity than that of control subjects; researchers suggest that vascular endothelial growth factor and PDGF are released after platelet impaction and expression is enhanced by hypoxia in the stroma after capillary occlusion.…”

Hypertrophische Osteoarthropathie und Thrombozytopenie bei Bronchialkarzinom

“…In der Literatur wird die Hypothese beschrieben, dass aus dem Knochenmark ausgeschwemmte Thrombozytenaggregate bei der Passage durch die Lungenstrombahn mechanisch weiter fragmentiert werden [22]. Shunts würden das vermehrte Auftreten abnormer, größerer Thrombozyten im Körperkreislauf ermöglichen, so daß die Plättchendegradation nun in der peripheren Strombahn erfolgt, was lokal zur Freisetzung eines Wachstumsfaktors (platelet derived growth factor, PDGF) und dadurch zur Hypertrophie (Endglieder der Extremitäten, Periost) führt [4,9,10,15,16]. Die Ausprägung des Rechts-links-Shunts ist im Rahmen pulmonaler Erkrankungen offensichtlich, kann aber auch bei extrapulmonalen Krankheiten durch Mediatoren vermittelt werden.…”

Using microscopy to improve a diagnosis: an isolated case of tuberculosis‐induced hypertrophic osteopathy in archaeological dog remains

“…Its ultimate effect for those suffering from this condition is severe disability from tissue swellings. Hypertrophic osteopathy is actually a secondary response, possibly due to an increased peripheral blood circulation of growth factors (Lenehan & Fetter, 1985;Silveri et al, 1996;Silveira et al, 2000), caused by the presence of either pulmonary (e.g. tuberculosis, chronic bronchopneumonia, pleural neoplasia) or non-pulmonary (e.g.…”