Alzheimer’s disease (AD) is a significant source of morbidity and mortality for millions of
people worldwide, and multiple potential etiologies have been postulated to contribute to AD. Among
these, spontaneous cerebral emboli and increased cerebral and circulating heme oxygenase (Hmox)
activity in AD patients are of particular interest, as two of the products of Hmox activity, carbon monoxide
(CO) and iron enhance plasmatic coagulation and modify the ultrastructure of thrombi. We hypothesized
that patients afflicted with AD would have coagulation kinetics modulated by CO and iron. Using
viscoelastic assessments of coagulation, it was determined with a small cohort (n=11) of AD patients that all had
enhancement of coagulation by CO, iron, or both. In a complementary fashion, it was determined that a separate cohort
(n=12) of AD patients had thrombi with ultrastructural features consistent with iron and CO exposure as assessed with
scanning electron microscopy. Further, when stratified by normal or abnormally increased serum ferritin concentrations
(which can be increased by Hmox), the AD patients with abnormal ferritin concentrations had significantly thinner fibrin
fiber diameters, not unlike that noted when normal plasma is mixed with iron or CO. In sum, AD patients were noted to
have plasmatic coagulation kinetic and thrombus ultrastructural changes consistent with exposure to CO and iron. Future
investigation of CO and iron in the pathogenesis of Alzheimer’s disease is warranted.
Keywords: Alzheimer’s disease, carbon monoxide, iron, heme oxygenase, scanning electron microscopy, thrombelastography.
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