A low molecular weight heparin compared with unfractionated heparin

A 6000 daltons low molecular weight heparin (LMWH) was compared with unfractionated mucosal heparin in vitro and in vivo. Despite unimpressive specifications by clotting assays in vitro, the LMWH gave high and sustained activity in vivo by anti-Factor Xa assays, following subcutaneous injection. However, activity measured by APTT and calcium thrombin time assays was at least as high as occurred following unfractionated heparin. On the basis of clotting assays, there seems no reason to expect a lower incidence of haemorrhagic side-effects following the clinical use of this LMWH. The study also strikingly demonstrates the inadequacy of in vitro clotting assays for assessing the in vivo behaviour of LMWH.

Standardization of prekallikrein activator (PKA): the 1st British reference preparation for PKA

A collaborative study on prekallikrein activator (PKA) has been carried out involving four laboratories for the purpose of establishing a British reference preparation for PKA. Samples of two plasma protein fractions (PPF) were assayed against participants' own supplies of the Bureau of Biologics Reference Preparation No. 2 (BoB 2). There was good agreement on the relative PKA activities of the two preparations. One of the preparations, coded 79/572, was established as the 1st British Reference Preparation for Prekallikrein Activator, with an assigned potency of 78.9 units/ml.

Effects of heparin oligosaccharides with high affinity for antithrombin III in experimental venous thrombosis

The in vitro and in vivo characteristics of two oligosaccharide heparin fragments have been compared to those of unfractionated mucosal heparin. A decasaccharide fragment had essentially no activity by APTT or calcium thrombin time assays in vitro, but possessed very high specific activity by anti-Factor Xa assays. When injected into rabbits at doses of up to 80 microgram/kg, this fragment was relatively ineffective in impairing stasis thrombosis despite producing high blood levels by anti-Xa assays. A 16-18 monosaccharide fragment had even higher specific activity (almost 2000 iu/mg) by chromogenic substrate anti-Xa assay, with minimal activity by APTT. When injected in vivo, this fragment gave low blood levels by APTT, very high anti-Xa levels, and was more effective in preventing thrombosis than the decasaccharide fragment. However, in comparison with unfractionated heparin, the 16-18 monosaccharide fragment was only partially effective in preventing thrombosis, despite producing much higher blood levels by anti-Xa assays. It is concluded that the high-affinity binding of a heparin fragment to antithrombin III does not by itself impair venous thrombogenesis, and that the anti-Factor Xa activity of heparin is only a partial expression of its therapeutic potential.

Assessment of osteodystrophy in patients with chronic renal failure

Nine patients with chronic renal failure were followed for more than one year by serial bone biopsies which were assessed by quantitative histological techniques. All patients had evidence of bone disease; this progressed during the interbiopsy period in eight. Patients who had the most advanced histologic disease at initial biopsy showed the most progression in resorption and demineralization, but with greater progression of hyperparathyroid bone disease than osteomalacia. The type of bone disease and its rate of progression could only be accurately assessed histologically. No predictive parameters of early bone disease were found from clinical history, biochemistry or radiology. Raised serum alkaline phosphatase occurred only in advanced hyperparathyroid bone disease. Minor radiological abnormalities in magnified views of the hands were indicative of histologically advanced asymptomatic hyperparathyroidism.

Resistance of normal endothelium to damage by thrombin

We examined the effect of locally infused thrombin on rabbit neck veins, using autologous [111In]indium-labeled platelets on the vessel wall. However, when the animals were pre-treated with aspirin (10 mg/kg), there was a marked change in the ratio of radioactive counts between control and treated segments, consistent with platelet deposition on the walls of thrombin-treated segments. Thrombin-treated and control veins were also examined by transmission and scanning electronmicroscopy. Although occasional clumps of platelets were seen adhering to the vessel wall in both control and treated segments, the endothelium was essentially intact. There was no evidence of substantial denudation of the endothelium, and overall there was little morphological difference between control and treated segments. It is concluded that normal endothelium is not damaged by thrombin, and that venous thrombi develop by a direct effect of thrombin on platelets and fibrinogen, and not by thrombin-mediated damage to the vein wall.

A comparison of pentosan polysulphate and heparin. II: Effects of subcutaneous injection

A comparison has been made between the effects of pentosan polysulphate (SP54) and mucosal heparin following subcutaneous injection in man. Unlike heparin, pentosan polysulphate has relatively little effect in vivo as measured by anti-factor Xa clotting assay and none by an anti-Xa amidolytic assay (S-2222). However, pentosan polysulphate is at least as potent as heparin on a weight basis in producing activation of lipoprotein lipase, shortening of the euglobulin clot lysis time and impairing the generation of factor Xa. Our data indicate that pentosan polysulphate has more marked effects in vivo than in vitro, that the action of the drug on clotting is mediated mainly via an At III-independent pathway, and that its effects are not confined to the coagulation system.

A comparison of pentosan polysulphate (SP54) and heparin. I: Mechanism of action on blood coagulation

The effects of SP54 on inhibition of thrombin, factor Xa and factor IXa, in the presence and absence of antithrombin III (At III), have been examined and compared to those of heparin. SP54 potentiated inhibition of thrombin and Xa by purified At III, but crossed immunoelectrophoresis data indicated that these effects were mediated by binding to the enzyme, rather than to At III. Relatively high concentrations of SP54 were required for inhibition of thrombin and Xa in plasma, but at concentrations less than 2 micrograms/ml there was a marked suppression of the intrinsic activation of factor X. This effect was shown to be independent of At III, and to be due largely to inhibition of factor IXa. Prothrombin activation by factor Xa and phospholipid was also suppressed by SP54 in the absence of At III, and its effect on the APTT was also shown to be independent of At III. It is concluded that a relatively low concentrations the anticoagulant actions of SP54 are mainly due to these At III-independent pathways.

Fluid shifts from myofibrillar to sarcoplasmic space in the myocardium of exhausted rats

Integrity of the myocardium following a swim to exhaustion (STE) was assessed by quantitative light and electron microscopy in young adult female rats. Myocardial fiber diameter and mitochondrial (MITO) number, size, and volume fraction (VF) were unaffected by the STE, Also, the STE did not alter ventricular water content. In contrast, myofibrillar (MYO) VF was reduced and sarcoplasmic (SARCO) VF elevated (both P less than 0.05) at exhaustion. As both cell and MITO absolute volume were apparently unchanged at exhaustion, an intracellular fluid shift from MYO to SARCO space must have occurred, without affecting MITO volume. Neither swim training nor low-protein diet modified these exhaustion-induced changes. These data provide a possible explanation at the ultrastructural level for the documented reduction in performance of the heart in the exhausted state.

Studies in man and experimental animals of a low molecular weight heparin fraction

In vitro and in vivo studies were carried out on a commercially prepared low molecular weight heparin fraction. By APTT assay the fraction had a specific activity of half that of unfractionated mucosal heparin, yet retained full potency by anti-Xa assay (both clotting and chromogenic substrate). When administered intravenously to human volunteers, the anti-Xa/APTT ratio remained the same as it was in vitro. However, after subcutaneous injection, the ratio increased and anti-Xa activity could not be fully neutralized ex vivo by PF4. The fraction was as effective as unfractionated heparin in preventing experimental serum-induced thrombosis, suggesting that a heparin fraction with high specific activity by anti-Factor Xa assay compared to APTT activity may be an effective drug for the prophylaxis of venous thrombosis.

Cardiorespiratory and metabolic responses to treadmill exercise in the horse

The purpose of this study was to measure cardiovascular, respiratory, and metabolic responses to graded treadmill exercise in the horse. A five-stage treadmill test up to 90% of predicted maximal heart rate was administered to five sedentary horses. The highest measured level of exercise produced a sixfold increase in cardiac output and a 41% elevation of stroke volume over standing values. Left ventricular, arterial, and right atrial pressures as well as the maximal time derivative of left ventricular pressure were all elevated during exercise. Under the same two conditions hematocrit (Hct) increased from 33 +/- 2 to 47 +/- 1%, oxygen uptake (VO2) from 1.1 +/- 0.1 to 32.7 +/0 2.1 1.min-1, and respiratory exchange ratio (RQ) increased from 0.83 +/- 0.02 to 0.96 +/- 0.01. In addition, three of the horses were willing to trot at a sixth stage (14 km.h-1, 11.5% grade), which elicited a VO2 of 39.8 +/- 0.31.min-1 and an RQ of 0.98 +/- 0.01. In response to the sympathetic stimulation of exercise, the horse is able to elevate Hct, hemoglobin, and oxygen-carrying capacity by emptying the spleen, thus increasing total circulating red blood cells by as much as 50%. This enabled three of the five horses used in the present study to increase aerobic metabolism almost 40-fold above resting or twice that seen in humans. Therefore, in the horse "blood-boosting" is an efficient mechanism for increasing aerobic metabolism. This finding lends further support to the view that the oxygen transport system limits maximal aerobic capacity in humans.

Electromagnetic measurement of cardiac output during exercise in the horse

Aortic root blood flow was measured with an electromagnetic (EM) flow meter in unanesthetized horses during rest and exercise. The cardiac output response to exercise, as determined by the EM technique, was compared with the response reported by others who used indicator dilution techniques with good agreement. The EM method will allow making measurement of cardiovascular responses to exercise in the horse, not obtainable with other techniques.

Cardiorespiratory adjustments to tethered-swimming in the horse

The cardiorespiratory and metabolic responses to various levels of tethered-swimming were evaluated in 5 sedentary horses. Cardiac output (Q) and heart rate (HR) correlated highly (r = 0.89 and 0.94 respectively) with work effort (WE) expressed as kg pulled . kg body wt-1 . 10-2. While swimming, stroke volume (SV) was reduced at the lowest workloads, but increased with increasing WE so that at the highest workloads it had returned to the on-land standing SV. Pressures in the pulmonic as well as on both sides of the systemic circulation were considerably elevated by this form of exercise, although only mean carotid artery pressure (CAP) correlated highly (r = 0.83) with WE. During tethered-swimming plasma lactic acid (LA) rose exponentially from 1 to 10 mmol . 1-1 with increasing HR over the range 150-200 beats . min-1. Oxygen uptake (VO2) increased linearly (r = 0.95) from 25-112 ml . kg-1. min-1 over the We range of 3.0-7.8 kg pulled . kg body wt-1. 10-2. The aerobic capacity of the equine species would appear to be twice that of man. The greater increase in VO2 in the exercising horse cannot be explained solely on the basis of increases in Q. Therefore alterations in hematocrit, hemoglobin and oxygen extraction appear to play a more important role in the horse during exercise than they do in man.