Fig. 4From: Chloroquine reduces hypercoagulability in pancreatic cancer through inhibition of neutrophil extracellular trapsCQ inhibition of NETs reverses platelet aggregation and decreases tissue factor. In vitro treatment of whole blood with CQ led to a significant reduction in platelet aggregation in blood harvested from tumor bearing mice (a, AUC 50 ± 2.4 vs. 68.1 ± 8.8, n = 4, p < 0.05). Treatment of mice with CQ led to a decrease in aggregation in tumor bearing animals with no change in sham (b, AUC 52.6 ± 5.3 vs. 68.1 ± 8.8, n = 4, p < 0.05). Importantly, CQ had minimal effects in PAD4KO mice, suggesting that it decreases platelet aggregation through inhibition of NETs (c). CQ treatment led to a decrease in circulating tissue factor in tumor bearing mice (d, 186.9 ± 5.6 vs. 228.2 ± 21 pg/mL, p < 0.05). Hydroxychloroquine treatment resulted in significant reduction in tissue factor levels in patients with elevated preoperative serum tissue factor compared to control, with a mean response to treatment of − 240 ± 120 versus − 8.74 ± 26 pg/mL (p < 0.05, n = 10 gem/nab-paclitaxel, n = 7 HCQ). Waterfall plot demonstrating individual treatment response to gemcitabine/nab-paclitaxel with and without hydroxychloroquine in patients with elevated preoperative levels (e)Back to article page