Blood clotting research on the Alps

In Body
Written by  Loek Kusiak Wednesday, 06 November 2013 14:37
Oxygen deficiency increases the risk of thrombosis – at least, this was the suspicion. Now, thanks to a spectacular research expedition to the thin air atop an Alpine summit, there is certainty. The research leader Bas de Laat from Synapse, a spin-off company of Maastricht University, used a new testing method that can predict thrombosis early.
 
Does oxygen deficiency really cause blood clotting and an increased risk of thrombosis? To find out, De Laat and his team took a finger prick of blood from 30 test participants at a 4100 metre peak in the Alps. Only a mountaineer – like De Laat himself –could come up with such an idea for a research expedition, which took place last summer. De Laat is director of Synapse BV, a company that studies methods for predicting haemorrhages and thrombosis. Synapse is a spin-off of the research institute CARIM, and originated from UM’s Department of Biochemistry led by emeritus professor Coen Hemker (79), who still advises Synapse.
 
“Thrombosis is a silent killer”, says De Laat. “Suddenly it’s just there.” The condition often begins in the legs. A blood clot in a vein causes venous thrombosis, which can lead to a stroke or – if it enters the artery to the lungs – a pulmonary embolism. “Doctors knew that patients who’ve had a stroke or lung problems often suffer from thrombosis and oxygen deficiency. But it wasn’t clear exactly how far the blood clotting and the risk of thrombosis could be attributed to oxygen deficiency. So doctors also don’t know how much oxygen to administer to prevent thrombosis.”
 

New testing method

Where better than at high altitude in the mountains, with oxygen-depleted air, to identify once and for all the link between blood clotting, thrombosis and oxygen deficiency? De Laat knew that clotting research on mountaintops was not new in itself. However, earlier studies had used the wrong blood-taking technique, resulting in contradictory findings. “We were able to avoid this with the new blood clotting test developed by Synapse, the measurement instrument POC-TG, which at present only exists as a demonstration model. This test can establish the exact clotting values using blood taken only from a finger prick.”
 
Clotting is also affected by whether the test participant is sitting still or on the move. “So one group of 15 volunteers walked and climbed their way to the top, while the other group went by funicular. Finding volunteers was easy. What was difficult was convincing the medical ethics committees and organising the permits. The €200,000 we needed to fund the expedition was almost completely covered by sponsors.”
 

Slower blood cells

Mont Blanc was the initial destination, but due to poor weather the expedition was moved at the last moment to the Breithorn, a 4164 metre peak in the Swiss Alps. Six guides led the way. With every 1000 metre increase, a medical team took blood from the volunteers. Six days after their departure on 5 June, the group reached the summit.
 
“We discovered conclusively that oxygen deficiency causes an increase in certain clotting proteins. This can trigger a blood clot in the veins, or venous thrombosis”, says De Laat. “But we also saw that the higher you go, the slower the blood cells in the body behave. And the slower they move, the less chance you have of arterial thrombosis, such as a heart attack. This is a new discovery. So we confirmed that oxygen deficiency can increase the risk of venous thrombosis, but contrary to our initial assumption, this does not apply to the risk of a heart attack.”
 
De Laat and his group are now writing up their findings for the journal Science. Meanwhile, demand among hospitals and laboratories for the TOC-PG has exploded. “In operating theatres and intensive care units it will soon be possible to determine exactly how great the chance of thrombosis is, whether someone should be given blood thinners, and how much oxygen to administer. What’s more, our test can also be used to screen women to see if they should take a different contraceptive pill. After all, we know there’s a link between the pill and thrombosis. So this test will also reach GP's offices.”
 

Air travel

De Laat now plans to study the effects of oxygen deficiency in aeroplanes. “One in 5000 flyers develops thrombosis. Is that caused by sitting still for a long time, which makes the blood circulation stagnate? Or is it caused by the low air pressure and less oxygen in the air? We’ll find out with test participants who are both active and passive during the flight.”
 
The biggest bonus of the expedition, according to De Laat, is the increased attention for clotting research. Particularly when it comes to funding, thrombosis research is often overlooked in favour of research into other diseases, such as cancer. “Yet, preventing thrombosis would mean reducing or even erasing half of all health problems. Thanks to the expedition, interest in this research has grown at the Dutch Heart Foundation too.”
 

Bas de Laat (1976) studied medicine in Utrecht and did his PhD research on the causes of thrombosis. He is a former head of the blood clotting department at the Sanquin Blood Supply Foundation. Since 2010, he has been general director of Synapse and principal researcher at the UM Department of Biochemistry, guest researcher at the Utrecht UMC and visiting professor at a research institute in La Jolla (USA). 

 
 
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