51
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Al-Samkari H, Croteau SE. Shifting Landscape of Hemophilia Therapy: Implications for Current Clinical Laboratory Coagulation Assays. Am J Hematol 2018; 93:1082-1090. [PMID: 29884997 DOI: 10.1002/ajh.25153] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/16/2018] [Accepted: 05/20/2018] [Indexed: 01/27/2023]
Abstract
Clinical coagulation assays are an integral part of diagnosing and managing patients with hemophilia; however, in this new era of bioengineered factor products and non-factor therapeutics, problems have arisen with use of traditional coagulation tests for the quantification of several of these new products. Discussion over the use of one-stage clotting assays versus chromogenic substrate assays for clinical decision making and potency labeling has been ongoing for many years. Emerging factor concentrates have heightened concern over assay selection and availability. Emicizumab interferes with all aPTT based assays, rendering them unreliable and potentially falsely reassuring to the unaware provider. This review explores considerations for coagulation assays in the clinical setting and highlights how awareness of institutional coagulation assays and potential limitations have never been more critical for providers caring for patients with bleeding disorders. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hanny Al-Samkari
- Center for Hematology, Massachusetts General Hospital Cancer Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Stacy E Croteau
- Boston Children's Hospital, Boston Hemophilia Center, Boston, MA
- Harvard Medical School, Boston, MA
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52
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Dargaud Y, Negrier C, Rusen L, Windyga J, Georgiev P, Bichler J, Solomon C, Knaub S, Lissitchkov T, Klamroth R. Individual thrombin generation and spontaneous bleeding rate during personalized prophylaxis with Nuwiq®(human-cl rhFVIII) in previously treated patients with severe haemophilia A. Haemophilia 2018; 24:619-627. [DOI: 10.1111/hae.13493] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Dargaud
- Hopital Cardiologique Louis Pradel; University of Lyon; Lyon France
| | - C. Negrier
- Hopital Cardiologique Louis Pradel; University of Lyon; Lyon France
| | | | - J. Windyga
- Department of Disorders of Haemostasis and Internal Medicine; Institute of Haematology and Transfusion Medicine; Warsaw Poland
| | - P. Georgiev
- Clinic of Haematology; University Multiprofile Hospital for Active Treatment “Sveti Georgi” and Medical University; Plovdiv Bulgaria
| | | | - C. Solomon
- Octapharma AG; Lachen Switzerland
- Department of Anesthesiology; Perioperative Care and General Intensive Care; Salzburg University Hospital; Paracelsus Medical University; Salzburg Austria
| | - S. Knaub
- Octapharma AG; Lachen Switzerland
| | - T. Lissitchkov
- Department of Clinical Haematology in Haemorrhagic Diathesis and Anaemia; Specialized Hospital for Active Treatment “Joan Pavel”; Sofia Bulgaria
| | - R. Klamroth
- Vivantes Klinikum im Friedrichshain; Berlin Germany
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53
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Evaluation of recombinant factor VIII Fc (Eloctate) activity by thromboelastometry in a multicenter phase 3 clinical trial and correlation with bleeding phenotype. Blood Coagul Fibrinolysis 2018; 28:540-550. [PMID: 28486277 PMCID: PMC5642334 DOI: 10.1097/mbc.0000000000000638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The aim of this study was to compare the hemostatic efficacy of recombinant factor VIII Fc (rFVIIIFc) (Eloctate) and Advate by ex-vivo rotation thromboelastometry (ROTEM) of whole blood and to explore potential ROTEM parameters that may be more predictive of a patient's bleeding tendency than plasma FVIII activity. Thirteen clinical sites were selected to perform ROTEM on freshly collected blood samples from 44 patients in the phase 3 study for rFVIIIFc, including 16 patients undergoing sequential pharmacokinetic assessment of Advate and rFVIIIFc. Equivalent hemostatic activity was observed for rFVIIIFc and Advate in postinfusion samples, followed by improvements for rFVIIIFc in clotting time, clot formation time and alpha angle (α) for a longer duration than Advate, consistent with the pharmacokinetic improvements reported previously for rFVIIIFc. Our study did not demonstrate a statistical correlation between a patient's ROTEM activity at baseline or at trough and the occurrence of spontaneous bleeds while on prophylactic therapy. However, an association was observed between postinfusion clotting time and the occurrence of one or more spontaneous bleeds vs. no bleeds over a follow-up period of 1 year (P = 0.003). How well a patient's whole blood clotting deficiency is corrected after a dose of FVIII may be an indicator of subsequent bleeding tendency in patients with otherwise equivalent FVIII peak and trough levels. The technical challenges of standardizing the ROTEM, largely overcome in the current study, may however preclude the use of this method for widespread assessment of global hemostasis unless additional assay controls or normalization procedures prove to be effective.
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54
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Thrombin generation estimates the anticoagulation effect of direct oral anticoagulants with significant interindividual variability observed. Blood Coagul Fibrinolysis 2018; 29:148-154. [DOI: 10.1097/mbc.0000000000000678] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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55
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56
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Desborough MJR, Naeem H, Baker P, Curry N. Factor XIa-triggered thrombin generation in severe haemophilia A. Br J Haematol 2018; 184:637-640. [PMID: 29468639 DOI: 10.1111/bjh.15126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michael J R Desborough
- Oxford National Institute for Health Research Biomedical Research Centre, Blood Theme, Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford, UK.,Oxford Clinical Research in Transfusion Medicine, Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Hassan Naeem
- Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford, UK
| | - Peter Baker
- Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford, UK
| | - Nicola Curry
- Oxford National Institute for Health Research Biomedical Research Centre, Blood Theme, Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford, UK
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57
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Pai M. Laboratory Evaluation of Hemostatic and Thrombotic Disorders. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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58
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Gaston E, Fraser JF, Xu ZP, Ta HT. Nano- and micro-materials in the treatment of internal bleeding and uncontrolled hemorrhage. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 14:507-519. [PMID: 29162534 DOI: 10.1016/j.nano.2017.11.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 11/01/2017] [Accepted: 11/05/2017] [Indexed: 12/14/2022]
Abstract
Internal bleeding is defined as the loss of blood that occurs inside of a body cavity. After a traumatic injury, hemorrhage accounts for over 35% of pre-hospital deaths and 40% of deaths within the first 24 hours. Coagulopathy, a disorder in which the blood is not able to properly form clots, typically develops after traumatic injury and results in a higher rate of mortality. The current methods to treat internal bleeding and coagulopathy are inadequate due to the requirement of extensive medical equipment that is typically not available at the site of injury. To discover a potential route for future research, several current and novel treatment methods have been reviewed and analyzed. The aim of investigating different potential treatment options is to expand available knowledge, while also call attention to the importance of research in the field of treatment for internal bleeding and hemorrhage due to trauma.
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Affiliation(s)
- Elizabeth Gaston
- Australian Institute for Bioengineering and Nanotechnology, the University of Queensland, Brisbane, QLD, Australia; Department of Bioengineering, Clemson University, Clemson, SC, USA
| | - John F Fraser
- Faculty of Medicine, Critical Care Research Group, Prince Charles Hospital and the University of Queensland, Brisbane, Brisbane, QLD, Australia
| | - Zhi Ping Xu
- Australian Institute for Bioengineering and Nanotechnology, the University of Queensland, Brisbane, QLD, Australia
| | - Hang T Ta
- Australian Institute for Bioengineering and Nanotechnology, the University of Queensland, Brisbane, QLD, Australia.
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59
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Blaine KP, Sakai T. Viscoelastic Monitoring to Guide Hemostatic Resuscitation in Liver Transplantation Surgery. Semin Cardiothorac Vasc Anesth 2017; 22:150-163. [PMID: 29099334 DOI: 10.1177/1089253217739121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Coagulopathic bleeding must be anticipated during liver transplantation (LT) surgery. Patients with end-stage liver disease (ESLD) often present with disease-related hematologic disturbances, including the loss of hepatic procoagulant and anticoagulant clotting factors and thrombocytopenia. Transplantation surgery itself presents additional hemostatic changes, including hyperfibrinolysis. Viscoelastic monitoring (VEM) is often used to provide targeted, personalized hemostatic therapies for complex bleeding states including cardiac surgery and major trauma. The use in these coagulopathic conditions led to its application to LT, although the mechanisms of coagulopathy in these patients are quite different. While VEM is often used during transplant surgeries in Europe and North America, evidence supporting its use is limited to a few small clinical studies. The theoretical and clinical applications of the standard and specialized VEM assays are discussed in the setting of LT and ESLD.
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Affiliation(s)
- Kevin P Blaine
- 1 Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Tetsuro Sakai
- 2 University of Pittsburgh Medical Center Health System, Pittsburgh, PA, USA
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60
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In-vitro assessment of the effect of dabigatran on thrombosis of adult and neonatal plasma. Blood Coagul Fibrinolysis 2017; 28:551-557. [DOI: 10.1097/mbc.0000000000000639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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61
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Sevenet PO, Depasse F. Clot waveform analysis: Where do we stand in 2017? Int J Lab Hematol 2017; 39:561-568. [PMID: 28876509 DOI: 10.1111/ijlh.12724] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/11/2017] [Indexed: 11/27/2022]
Abstract
Analysis of the optical waveform generated during global coagulation assays, such as activated partial thromboplastin time and prothrombin time, can provide much precious information on the global coagulation state of the plasma sample tested, in addition to a single clotting time. Many studies have been published concerning patient diagnosis and management in haemophilia A, and in the early diagnosis and prognosis of disseminated intravascular coagulation and sepsis. However, many other works have also been published on further potential clinical applications such as lupus anticoagulant diagnosis and anticoagulant monitoring. Altogether, these publications have demonstrated the ability for clot waveform analysis (CWA) to improve patient management, especially as this tool is inexpensive, rapid and readily available on coagulation analysers with optical detection systems. By an extensive review of the literature related to studies performed on CWA, this publication aims at providing a review of current knowledge in this specific field, ranging from research data to potential clinical applications and future trends.
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Affiliation(s)
- P O Sevenet
- Diagnostica Stago S.A.S, Asnières sur Seine, France
| | - F Depasse
- Diagnostica Stago S.A.S, Asnières sur Seine, France
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62
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Fernández-Bello I, Stenmo C, Butta N, Lind V, Ezban M, Jiménez-Yuste V. The pharmacokinetics and pharmacodynamics of single-dose and multiple-dose recombinant activated factor VII in patients with haemophilia A or B. Haemophilia 2017; 23:868-876. [DOI: 10.1111/hae.13312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - N. Butta
- University Hospital La Paz-IdiPaz; Madrid Spain
| | - V. Lind
- Novo Nordisk A/S; Måløv Denmark
| | | | - V. Jiménez-Yuste
- University Hospital La Paz-IdiPaz; Madrid Spain
- Autonoma University; Madrid Spain
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63
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Jardim LL, Chaves DG, Silveira-Cassette ACO, Simões e Silva AC, Santana MP, Cerqueira MH, Prezotti A, Lorenzato C, Franco V, van der Bom JG, Rezende SM. Immune status of patients with haemophilia A before exposure to factor VIII: first results from the HEMFIL study. Br J Haematol 2017; 178:971-978. [DOI: 10.1111/bjh.14799] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/01/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Letícia L. Jardim
- Faculty of Medicine; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | | | | | | | | | - Monica H. Cerqueira
- Instituto de Hematologia Arthur de Siqueira Cavalcanti (HEMORIO); Rio de Janeiro Brazil
| | - Alessandra Prezotti
- Centro de Hematologia e Hemoterapia do Espírito Santo (HEMOES); Vitória Espírito Santo Brazil
| | - Claudia Lorenzato
- Centro de Hematologia e Hemoterapia do Paraná (HEMEPAR); Curitiba Paraná Brazil
| | - Vivian Franco
- Centro de Hematologia e Hemoterapia de Santa Catarina (HEMOSC); Florianópolis Santa Catarina Brazil
| | - Johanna G. van der Bom
- Centre for Clinical Transfusion Research; Sanquin & Department of Clinical Epidemiology; Leiden University Medical Centre (LUMC); Leiden the Netherlands
| | - Suely M. Rezende
- Faculty of Medicine; Universidade Federal de Minas Gerais; Belo Horizonte Minas Gerais Brazil
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64
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Hudák R, Székely EG, Kovács KR, Nagy A, Hofgárt G, Berényi E, Csiba L, Kappelmayer J, Bagoly Z. Low thrombin generation predicts poor prognosis in ischemic stroke patients after thrombolysis. PLoS One 2017; 12:e0180477. [PMID: 28692682 PMCID: PMC5503253 DOI: 10.1371/journal.pone.0180477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 06/15/2017] [Indexed: 11/25/2022] Open
Abstract
Thrombolysis by intravenous recombinant tissue plasminogen activator (rt-PA) is an effective therapy in acute ischemic stroke (AIS). Thrombin generation test (TGT) is a global hemostasis test providing information about the speed and amount of generated thrombin in plasma. Here we aimed to find out whether results of this test before the initiation of thrombolysis might predict outcomes. Study population included 120 consecutive AIS patients, all within 4.5 hours of their symptom onset, who underwent thrombolysis by rt-PA. Blood samples were collected from all patients upon admission and TGT was performed using platelet poor plasma. Clinical data of patients including the NIHSS were registered at admission, day 1 and 7 after therapy. The ASPECT score was assessed using CT images taken before and 24 hours after thrombolysis. Long-term functional outcome was defined 3 months after the event by the modified Rankin Scale. Endogenous Thrombin Potential (ETP) and Peak Thrombin were significantly lower in patients with cardioembolic IS. Symptomatic intracranial hemorrhage (SICH) was found in 6 patients and was significantly associated with low ETP and Peak Thrombin levels. A multiple logistic regression model revealed that an ETP result in the lower quartile is an independent predictor of mortality within the first two weeks (OR: 6.03; 95%CI: 1.2–30.16, p<0.05) and three months after the event (OR: 5.28; 95%CI: 1.27–21.86, p<0.05). Low levels of ETP and Peak Thrombin parameters increase the risk of therapy associated SICH. A low ETP result is an independent predictor of short- and long-term mortality following thrombolysis.
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Affiliation(s)
- Renáta Hudák
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Edina G. Székely
- Department of Laboratory Medicine, Division of Clinical Laboratory Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin R. Kovács
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gergely Hofgárt
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ervin Berényi
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Csiba
- Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - János Kappelmayer
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsa Bagoly
- Department of Laboratory Medicine, Division of Clinical Laboratory Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- * E-mail:
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65
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Gringeri A, Steinitz-Trost K, Doralt J. Current and future approaches to overcoming the challenges of hemophilia treatment personalization. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1334551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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66
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Tan AYJ, Macachor JD, Hee HI. Managing the marginally raised aPTT-looking beyond the absolute number. Paediatr Anaesth 2017; 27:779-780. [PMID: 28585400 DOI: 10.1111/pan.13152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Angela Y J Tan
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore
| | - Joselo D Macachor
- Department of Anaesthesia and Intensive Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Hwan Ing Hee
- Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.,Duke- NUS Graduate Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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67
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Livnat T, Budnik I, Levy-Mendelovich S, Avishai E, Misgav M, Barg AA, Lubetsky A, Brutman-Barazani T, Kenet G. Combination of hemostatic therapies for treatment of patients with hemophilia A and inhibitors. Blood Cells Mol Dis 2017; 66:1-5. [PMID: 28689155 DOI: 10.1016/j.bcmd.2017.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/24/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Therapy application and monitoring of patients with hemophilia A (HA) and inhibitors are challenging. In the current study, combined FVIII - bypass therapy was implemented for a cohort of severe HA patients with inhibitors. METHODS Plasma of 15 HA patients with inhibitors was spiked ex vivo with FVIII, rFVIIa, FEIBA and their combinations and thrombin generation (TG) was studied. Some patients who experienced hemarthroses or required minor surgeries were treated by a combined concomitant administration of FVIII+FEIBA as IV bolus doses. RESULTS TG spiking studies showed individual responses not correlated to inhibitor titer. Combinations of agents augmented TG as compared to any single agent, while combined FVIII+FEIBA yielded the highest TG, supporting it as a potential treatment. Following emergent successful surgery of child treated by concomitant FVIII+FEIBA, a total of 396 episodes in 7/15 patients were treated with concomitant FVIII+FEIBA. Five patients were treated for bleeding episodes only, whereas 2 were children undergoing immune tolerance induction (ITI) with FEIBA prophylaxis. Four minor surgeries were performed on FVIII+FEIBA repeated infusions. Neither thrombosis nor any other adverse events were documented. CONCLUSION A combination of FVIII+FEIBA may be effective and safe as an alternative treatment option for some high-responding inhibitor patients.
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Affiliation(s)
- Tami Livnat
- Sackler School of Medicine, Tel Aviv University, Israel; The Israeli National Hemophilia Center, Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Ivan Budnik
- Department of Pathophysiology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sarina Levy-Mendelovich
- Sackler School of Medicine, Tel Aviv University, Israel; The Israeli National Hemophilia Center, Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Einat Avishai
- The Israeli National Hemophilia Center, Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Mudi Misgav
- Sackler School of Medicine, Tel Aviv University, Israel; The Israeli National Hemophilia Center, Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Assaf Arie Barg
- Sackler School of Medicine, Tel Aviv University, Israel; The Israeli National Hemophilia Center, Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Aharon Lubetsky
- Sackler School of Medicine, Tel Aviv University, Israel; The Israeli National Hemophilia Center, Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Tami Brutman-Barazani
- The Israeli National Hemophilia Center, Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - Gili Kenet
- Sackler School of Medicine, Tel Aviv University, Israel; The Israeli National Hemophilia Center, Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Israel.
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68
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Chevreux G, Tilly N, Leblanc Y, Ramon C, Faid V, Martin M, Dhainaut F, Bihoreau N. Biochemical characterization of LR769, a new recombinant factor VIIa bypassing agent produced in the milk of transgenic rabbits. Haemophilia 2017; 23:e324-e334. [PMID: 28594467 DOI: 10.1111/hae.13253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The bypassing agent factor VII (FVIIa) is a first-line therapy for the treatment of acute bleeding episodes in patients with haemophilia and high-titre inhibitors. FVIIa is a highly post-translationally modified protein that requires eukaryotic expression systems to produce a fully active molecule. A recombinant FVIIa was produced in the milk of transgenic rabbits to increase expression and provide an efficient, safe and affordable product after purification to homogeneity (LR769). AIM To present the biochemical and functional in vitro characteristics of LR769. RESULTS Mass spectrometric analyses of the intact protein and of heavy and light chains revealed a fully activated, mature and properly post-translationally modified protein notably regarding N/O-glycosylations and γ-carboxylation. Primary structure analysis, performed by peptide mapping, confirmed 100% of the sequence and the low level or absence of product-derived impurities such as oxidized, deamidated and glycated forms. Low levels of aggregates and fragments were observed by different chromatographic methods. Higher order structure investigated by circular dichroism showed appropriate secondary/tertiary structures and conformational change in the presence of Ca2+ ions. Finally, activated partial thromboplastin time and thrombin generation assays showed the ability of LR769 to decrease coagulation time and to generate thrombin in haemophiliac-A-plasmas, even in the presence of inhibitors. CONCLUSION The innovative expression system used to produce LR769 yields a new safe and effective rhFVIIa for the treatment of haemophilia A or B patients with inhibitors.
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Affiliation(s)
- G Chevreux
- LFB Biotechnologies, Courtaboeuf, France
| | - N Tilly
- LFB Biotechnologies, Courtaboeuf, France
| | - Y Leblanc
- LFB Biotechnologies, Courtaboeuf, France
| | - C Ramon
- LFB Biotechnologies, Courtaboeuf, France
| | - V Faid
- LFB Biotechnologies, Courtaboeuf, France
| | - M Martin
- LFB Biotechnologies, Courtaboeuf, France
| | - F Dhainaut
- LFB Biotechnologies, Courtaboeuf, France
| | - N Bihoreau
- LFB Biotechnologies, Courtaboeuf, France
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69
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70
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Temporal changes in clot lysis and clot stability following tranexamic acid in cardiac surgery. Blood Coagul Fibrinolysis 2017; 28:295-302. [DOI: 10.1097/mbc.0000000000000595] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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71
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Payam AF, Trewby W, Voïtchovsky K. Simultaneous viscosity and density measurement of small volumes of liquids using a vibrating microcantilever. Analyst 2017; 142:1492-1498. [PMID: 28352874 PMCID: PMC5450008 DOI: 10.1039/c6an02674e] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 03/18/2017] [Indexed: 11/21/2022]
Abstract
Many industrial and technological applications require precise determination of the viscosity and density of liquids. Such measurements can be time consuming and often require sampling substantial amounts of the liquid. These problems can partly be overcome with the use of microcantilevers but most existing methods depend on the specific geometry and properties of the cantilever, which renders simple, accurate measurement difficult. Here we present a new approach able to simultaneously quantify both the density and the viscosity of microliters of liquids. The method, based solely on the measurement of two characteristic frequencies of an immersed microcantilever, is completely independent of the choice of a cantilever. We derive analytical expressions for the liquid's density and viscosity and validate our approach with several simple liquids and different cantilevers. Application of our model to non-Newtonian fluids shows that the calculated viscosities are remarkably robust when compared to measurements obtained from a standard rheometer. However, the results become increasingly dependent on the cantilever geometry as the frequency-dependent nature of the liquid's viscosity becomes more significant.
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Affiliation(s)
- A. F. Payam
- Department of Physics , Durham University , Durham , UK .
| | - W. Trewby
- Department of Physics , Durham University , Durham , UK .
| | - K. Voïtchovsky
- Department of Physics , Durham University , Durham , UK .
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72
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Șerban M, Poenaru D, Cernat L, Savescu D, Pătrașcu J, Schramm W, Ursu E, Mihailov D, Jinca C, Ioniță I, Arghirescu S. Global clotting assays - monitoring the effect of by-passing agents in haemophilia patients with inhibitors. REV ROMANA MED LAB 2017. [DOI: 10.1515/rrlm-2017-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
The development of FVIII/FIX inhibitor alloantibodies represents a severe complication requiring specific laboratory evaluation for establishing a life-saving therapy regimen. Our preliminary study aimed at elaborating a laboratory strategy for monitoring the effectiveness of Activated Prothrombin Complex Concentrate (APCC) and recombinant activated factor VII (rFVIIa) in haemophiliacs with inhibitors, by checking the reliability and clinical value of three complementary assays: clotting-time based coagulometry, thrombelastography (TEG) and thrombin generation assay (TGA). The investigations were performed on 7 patients with severe haemophilia A with high titer inhibitors treated for 12 episodes of severe bleedings, 5 of them for surgical interventions. After the administration of bypassing agents (BPAs) the clotting-time based assay brought changes only on prothrombin (p<0.01), potentially signaling a thrombotic risk, without any impact on the global hemostasis. TEG displayed prompt significant improvement only after rFVIIa (90μg/kg). TGA revealed significantly improved values for peak and velocity index, time to peak and start tail after both BPAs. Despite some disparities between biological hemostatic phenotype and clinical response to therapy, we concluded that TEG and TGA are the only current exploratory assays, expressing the quality of haemostatic control, representing a real support for a personalized, adapted therapy in hemophilia with inhibitors.
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Affiliation(s)
- Margit Șerban
- Department of Onco-hematology, Emergency Children Hospital “Louis Turcanu” Timișoara, 2nd Dr. Iosif Nemoianu , Timisoara , Romania
| | - Dan Poenaru
- Romanian Academy of Medical Science, Timisoara University of Medicine and Pharmacy “Victor Babes” , Timisoara , Romania
| | - Laura Cernat
- Emergency Children Hospital “Louis Turcanu” , Timisoara , Romania
| | - Delia Savescu
- Emergency Children Hospital “Louis Turcanu” , Timisoara , Romania
| | - Jenel Pătrașcu
- University of Medicine and Pharmacy “Victor Babes” , Timisoara , Romania
| | | | - Emilia Ursu
- Emergency Children Hospital “Louis Turcanu” , Timisoara , Romania
| | - Delia Mihailov
- University of Medicine and Pharmacy “Victor Babes” , Timisoara , Romania
| | - Cristian Jinca
- University of Medicine and Pharmacy “Victor Babes” , Timisoara , Romania
| | - Ioana Ioniță
- University of Medicine and Pharmacy “Victor Babes” , Timisoara , Romania
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Nummi V, Jouppila A, Lassila R. Monitoring once-weekly recombinant factor IX prophylaxis in hemophilia B with thrombin generation assay and factor IX activity. Int J Lab Hematol 2017; 39:359-368. [DOI: 10.1111/ijlh.12634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/07/2017] [Indexed: 01/30/2023]
Affiliation(s)
- V. Nummi
- Faculty of Medicine; University of Helsinki; Helsinki Finland
- Coagulation Disorders Unit; Department of Hematology and Comprehensive Cancer Center; Laboratory Services; Helsinki University Hospital; Helsinki Finland
| | - A. Jouppila
- Helsinki University Hospital Research Institute; Helsinki Finland
| | - R. Lassila
- Faculty of Medicine; University of Helsinki; Helsinki Finland
- Coagulation Disorders Unit; Department of Hematology and Comprehensive Cancer Center; Laboratory Services; Helsinki University Hospital; Helsinki Finland
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74
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Odonkor P, Srinivas A, Strauss E, Williams B, Mazzeffi M, Tanaka KA. Perioperative Coagulation Management of a Hemophilia A Patient During Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2017; 21:312-320. [DOI: 10.1177/1089253217702747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Perioperative management of cardiovascular surgical procedures requiring cardiopulmonary bypass (CPB) in patients with hemophilia A poses a clinical challenge in coagulation management. Use of CPB requires the administration of an anticoagulant, usually unfractionated heparin, and also causes dilutional coagulopathy, platelet dysfunction or platelet consumption coagulopathy. Hypothermia and activation of the inflammatory cascade also affect coagulation. The effects of CPB on circulating levels of factor VIII have not been clearly defined. In this review, the effects of CPB and hemodilution on FVIII are shown in a case presentation, and perioperative laboratory testing in patients with hemophilia A having cardiac surgery is discussed along with perioperative and postoperative coagulation management.
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Affiliation(s)
| | | | - Erik Strauss
- University of Maryland Medical System, Baltimore, MD, USA
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Moorlag M, Schurgers E, Krishnamoorthy G, Bouwhuis A, Lindhout T, Kelchtermans H, Lance MD, de Laat B. Near-Patient Thrombin Generation in Patients Undergoing Elective Cardiac Surgery. ACTA ACUST UNITED AC 2017; 1:613-625. [DOI: 10.1373/jalm.2016.022335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/05/2017] [Indexed: 11/06/2022]
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76
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Rare bleeding disorders-old diseases in the era of novel options for therapy. Blood Cells Mol Dis 2017; 67:63-68. [PMID: 28222949 DOI: 10.1016/j.bcmd.2017.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 02/12/2017] [Indexed: 12/20/2022]
Abstract
Rare diseases are defined as life-threatening or chronically debilitating diseases with a prevalence of less than one per 2000 according to the European Union or one per 1250 according to the USA. Congenital rare bleeding disorders RBD are reported in most populations, with incidence varying from 1 in 5000 (Hemophilia A), 1:30,000 (Hemophilia B) to much rarer (1:500,000 for FVII deficiency, 1-3 million for Prothrombin or FXIII deficiency). Acquired Hemophilia A is also a rare bleeding disorder with estimated frequency of 1 in million. Most RBDs are inherited as autosomal recessive (AR); however, heterozygous carriers with varying degrees of corresponding factor deficiency may render an unpredictable propensity for bleeding. In patients with bleeding symptoms, laboratory assessment and especially molecular techniques currently enable accurate diagnosis and may provide tools for prenatal and family counseling. Currently hemostasis control is mainly based upon replacement of the missing coagulation factors (unless presence of inhibitors renders it impossible), however future gene therapy and disruptive, non-replacement alternatives may be promising for patients with RBD.
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77
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Erickson A, Waldhaus K, David T, Huang N, Rico S, Corash L, Mufti N, Benjamin RJ. Plasma treated with amotosalen and ultraviolet A light retains activity for hemostasis after 5 days post-thaw storage at 1 to 6oC. Transfusion 2017; 57:997-1006. [DOI: 10.1111/trf.13973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/29/2022]
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Myers DR, Qiu Y, Fay ME, Tennenbaum M, Chester D, Cuadrado J, Sakurai Y, Baek J, Tran R, Ciciliano J, Ahn B, Mannino R, Bunting S, Bennett C, Briones M, Fernandez-Nieves A, Smith ML, Brown AC, Sulchek T, Lam WA. Single-platelet nanomechanics measured by high-throughput cytometry. NATURE MATERIALS 2017; 16:230-235. [PMID: 27723740 PMCID: PMC5266633 DOI: 10.1038/nmat4772] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 09/12/2016] [Indexed: 05/20/2023]
Abstract
Haemostasis occurs at sites of vascular injury, where flowing blood forms a clot, a dynamic and heterogeneous fibrin-based biomaterial. Paramount in the clot's capability to stem haemorrhage are its changing mechanical properties, the major drivers of which are the contractile forces exerted by platelets against the fibrin scaffold. However, how platelets transduce microenvironmental cues to mediate contraction and alter clot mechanics is unknown. This is clinically relevant, as overly softened and stiffened clots are associated with bleeding and thrombotic disorders. Here, we report a high-throughput hydrogel-based platelet-contraction cytometer that quantifies single-platelet contraction forces in different clot microenvironments. We also show that platelets, via the Rho/ROCK pathway, synergistically couple mechanical and biochemical inputs to mediate contraction. Moreover, highly contractile platelet subpopulations present in healthy controls are conspicuously absent in a subset of patients with undiagnosed bleeding disorders, and therefore may function as a clinical diagnostic biophysical biomarker.
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Affiliation(s)
- David R. Myers
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, 30332
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332
| | - Yongzhi Qiu
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, 30332
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332
| | - Meredith E. Fay
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, 30332
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332
| | | | - Daniel Chester
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, NC 27695
- Comparative Medicine Institute at North Carolina State University, Raleigh, NC 27695
| | - Jonas Cuadrado
- School of Physics, Georgia Institute of Technology, Atlanta, GA, 30332
| | - Yumiko Sakurai
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, 30332
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332
| | - Jong Baek
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, 30332
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332
| | - Reginald Tran
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, 30332
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332
| | - Jordan Ciciliano
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, 30332
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332
| | - Byungwook Ahn
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, 30332
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332
| | - Robert Mannino
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, 30332
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332
| | - Silvia Bunting
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322
| | - Carolyn Bennett
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
| | - Michael Briones
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
| | - Alberto Fernandez-Nieves
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- School of Physics, Georgia Institute of Technology, Atlanta, GA, 30332
| | - Michael L. Smith
- Department of Biomedical Engineering, Boston University, Boston, MA, 02215
| | - Ashley C. Brown
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, Raleigh, NC 27695
- Comparative Medicine Institute at North Carolina State University, Raleigh, NC 27695
| | - Todd Sulchek
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332
| | - Wilbur A. Lam
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Aflac Cancer Center and Blood Disorders Service of Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30322
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, 30332
- Winship Cancer Institute of Emory University, Atlanta, GA, 30322
- Parker H. Petit Institute of Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA 30332
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332
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79
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Ljungkvist M, Lövdahl S, Zetterberg E, Berntorp E. Low agreement between fresh and frozen-thawed platelet-rich plasma in the calibrated automated thrombogram assay. Haemophilia 2017; 23:e214-e218. [DOI: 10.1111/hae.13180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M. Ljungkvist
- Department of Translational Medicine; Clinical Coagulation Research Unit; Skåne University Hospital; Lund University; Malmö Sweden
| | - S. Lövdahl
- Department of Translational Medicine; Clinical Coagulation Research Unit; Skåne University Hospital; Lund University; Malmö Sweden
| | - E. Zetterberg
- Department of Translational Medicine; Clinical Coagulation Research Unit; Skåne University Hospital; Lund University; Malmö Sweden
| | - E. Berntorp
- Department of Translational Medicine; Clinical Coagulation Research Unit; Skåne University Hospital; Lund University; Malmö Sweden
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Abstract
Thromboelastography (TEG) has been used for decades to guide transfusion therapy during cardiac and hepatic surgeries. Renewed interest and improved technology have led to wider applications of TEG in other areas of hemostasis. To correctly interpret the data generated and to validate outcomes, it is important to improve the understanding of the differences in the currently available assay procedures, the issues related to sample activation, and the importance of the use of appropriate controls. Current TEG assays use a variety of samples and can vary slightly in the procedures. In this chapter, we very briefly review TEG applications and discuss interpretations, normal ranges, and reference controls, and we explain the method of TEG run using standard citrated native blood samples. We provide detailed technical steps and tips. We discuss precautions and issues related to the assay, which we hope can guide toward better application and data interpretation.
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81
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Nogami K. The utility of thromboelastography in inherited and acquired bleeding disorders. Br J Haematol 2016; 174:503-14. [PMID: 27264484 DOI: 10.1111/bjh.14148] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/30/2016] [Indexed: 01/08/2023]
Abstract
Thromboelastography (TEG) was first described by Hartert in 1948, and was designed to monitor viscoelastic clot strength in whole blood in real time. The current TEG method and Rotational Thromboelastometry (ROTEM) were subsequently developed from the original principles. Both of the modern methods provide data by measuring changes in the viscoelastic strength of a small sample of clotting blood in response to a constant rotational force. The important advantage of these techniques is to visually observe and quantify blood coagulation including the propagation, stabilization and dissolution phases of clot formation under low shear conditions. Analysis of the results provides detailed kinetic data on fibrin generation, clot strength and fibrinolysis. These TEG/ROTEM analyses therefore enable evaluation of global clotting function and the monitoring of haemostatic treatment in various clinical situations, not only in patients with genetic bleeding disorders, such as haemophilia, but also in patients undergoing cardiac surgery, liver transplantation or suffering from traumatic injury. Some evidence suggests that haemostatic management using TEG/ROTEM leads to a reduction in total transfusions of whole blood or clotting factors. Wider clinical application of this technology seems likely.
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Affiliation(s)
- Keiji Nogami
- Department of Paediatrics, Nara Medical University, Kashihara, Nara, Japan
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82
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Heger A, Janisch S, Pock K, Römisch J. Comparative biochemical studies of fresh frozen plasma and pooled solvent/detergent-treated plasma (octaplasLG ® ) with focus on protein S and its impact in different thrombin generation assay set-ups. Vox Sang 2016; 111:266-273. [PMID: 27232115 DOI: 10.1111/vox.12420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/24/2016] [Accepted: 04/27/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The solvent/detergent treatment enables effective and robust inactivation of all lipid-enveloped viruses, but also inactivates partly sensitive plasma proteins such as protein S. The aim of this study was to investigate the thrombin generation capacity of octaplasLG® , in particular focusing on the function of protein S in thrombin generation assay and the impact of assay settings. MATERIALS AND METHODS Sixteen octaplasLG® batches and 32 units of single donor fresh frozen plasma (FFP) were investigated. For protein S, both functional activity and free antigen levels were measured. Thrombin generation assay was performed using two fluorogenic tests with different triggers. Finally, rotational thromboelastometry was performed. RESULTS Mean protein S levels were lower in octaplasLG® , but a wider range of values was found for FFP. Clotting parameters and thrombin generation capacities overlapped between the two plasma groups as demonstrated using both thrombin generation assays and different triggers. Spiking studies with protein S-depleted plasma, human purified protein S or antibodies against protein S confirmed a correlation between protein S and thrombin generation capacity under specific assay conditions, especially in an assay with low tissue factor concentration. CONCLUSION Correlation between protein S and thrombin generation capacity was demonstrated in the TGA. Due to higher variability in protein S content in the FFP group, overlapping haemostatic potentials of the two plasma groups were found.
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Affiliation(s)
- A Heger
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria.
| | - S Janisch
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria
| | - K Pock
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria
| | - J Römisch
- Octapharma Pharmazeutika Produktiosges.m.b.H, Research & Development, Vienna, Austria
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83
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Challenges of diagnosing and managing the adolescent with heavy menstrual bleeding. Thromb Res 2016; 143:91-100. [PMID: 27208978 DOI: 10.1016/j.thromres.2016.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/26/2016] [Accepted: 05/01/2016] [Indexed: 11/20/2022]
Abstract
Unpredictable, prolonged or heavy menstrual bleeding (HMB) may be expected for many adolescents soon after menarche. A decade of clinical experience and research has now established firmly that bleeding disorders (BD) are common in adolescents with HMB. Despite these advances, many questions remain, and several aspects of the diagnosis and management of BDs in adolescents are not supported by rigorous clinical trials. In this overview, four major areas will be discussed. First, we will discuss the frequency of BDs in young women with HMB. Up to 20% of older females with HMB are thought to have an underlying BD. Estimates from retrospective studies in adolescents suggest a prevalence that varies anywhere from 10 to 62%. Prospective studies with uniform hemostatic evaluation are needed to answer this question definitively. Second, we will review existing tools that help screen and diagnose adolescents with HMB with an underlying BD. Although identification of an underlying BD in older women with HMB is relatively straight forward, uncertainties remain for adolescents. Heavy menstrual bleeding in this age group may have different pathophysiological underpinnings than those in older women and may often be disregarded as anovulatory. There is an urgent need to develop novel tools, and evaluate existing diagnostic strategies in adolescents. Third, we will discuss the optimal medical management of HMB in young adolescents. As direct evidence is largely lacking, these areas are also subject to extrapolation from older women. Lastly, an important area- prediction, and management of future bleeding in those adolescents who are diagnosed with a mild BD-will be discussed. Throughout, areas of controversy and opportunities for further research are highlighted.
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84
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Jha NK, Shestopal SA, Gourley MJ, Woodle SA, Liang Y, Sarafanov AG, Weinstein M, Ovanesov MV. Optimization of the thrombin generation test components to measure potency of factor VIII concentrates. Haemophilia 2016; 22:780-9. [DOI: 10.1111/hae.12943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 02/06/2023]
Affiliation(s)
- N. K. Jha
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MDUSA
- Department of Physics George Washington University Washington DC USA
| | - S. A. Shestopal
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MDUSA
| | - M. J. Gourley
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MDUSA
| | - S. A. Woodle
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MDUSA
| | - Y. Liang
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MDUSA
| | - A. G. Sarafanov
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MDUSA
| | - M. Weinstein
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MDUSA
| | - M. V. Ovanesov
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MDUSA
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85
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Zavyalova E, Kopylov A. Exploring potential anticoagulant drug formulations using thrombin generation test. Biochem Biophys Rep 2016; 5:111-119. [PMID: 28955812 PMCID: PMC5600416 DOI: 10.1016/j.bbrep.2015.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/05/2015] [Accepted: 11/13/2015] [Indexed: 01/20/2023] Open
Abstract
Many anticoagulant drugs inhibiting proteins of the coagulation cascade have been developed. The main targets of anticoagulant drugs are thrombin and factor Xa; inhibiting these factors delays thrombus growth, thus preventing thrombosis while increasing bleeding risk. A balance between thrombosis and bleeding is ensured in the ‘therapeutic window’ of the anticoagulant drug concentration range. Novel anticoagulant drugs and combinations thereof are being developed. We rank coagulation factors as potential anticoagulant drug targets in combination with thrombin inhibitors, aptamer HD1 and bivalirudin, providing a background for several promising dual target treatment strategies. The thrombin generation test was used to assess the whole coagulation cascade in normal and factor-deficient human blood plasma. Potential therapeutic windows were estimated for coagulation factors, ranking them as targets for anticoagulant drugs. Thrombin and factor Xa have been revealed as the most promising targets, which fully agrees with the current drug development strategy. Inhibitors of factors Va and VIIa are expected to have narrow therapeutic windows. Inhibitors of factors VIIIa and IXa are expected to have a moderate anticoagulant effect. Factors XI and XII are poor targets for anticoagulant drugs. Compared with plasma that is deficient in factor II, the thrombin inhibitors bivalirudin and aptamer HD1 had increased activity. Both inhibitors were tested in deficient plasma providing a model of potential drug combination. The most promising combinations were anti-thrombin with anti-V/Va and also anti-thrombin with anti-IX/IXa. Each combination had an incremental dose-effect dependence that is promising from the standpoint of the therapeutic window. Coagulation factors are ranked as anticoagulant targets. Several promising combinations of anticoagulant and thrombin inhibitor are proposed. The most promising combinations are anti-thrombin with anti-V/Va or anti-IX/IXa.
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Affiliation(s)
- Elena Zavyalova
- Chemistry Department of Lomonosov Moscow State University, 'Apto-Pharm' LTD, Moscow, Russian Federation
| | - Alexey Kopylov
- Chemistry Department of Lomonosov Moscow State University, 'Apto-Pharm' LTD, Moscow, Russian Federation
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86
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Epithelial and Erythrocyte Microvesicles From Bronchoalveolar Lavage Fluid Are Elevated and Associated With Outcome in Chronic Lung Allograft Dysfunction. Transplantation 2016; 99:2394-400. [PMID: 26451527 DOI: 10.1097/tp.0000000000000881] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic lung allograft dysfunction (CLAD) is the major outcome limitation for lung transplant recipients (LTR) after the first year, and therapies targeting immunological pathways show only limited success. Because microvesicles (MV) are biomarkers of endothelial dysfunction and coagulation but are also involved in immunological responses, we hypothesized that MV, found in bronchoalveolar lavage (BAL) fluids (BALF) of LTR at CLAD diagnosis, are elevated and potential prognostic biomarkers. METHODS The BALF was collected from 37 LTR at time point of CLAD diagnosis and 37 LTR without any complication at routinely performed BAL. The MV concentration and origin were determined by flow cytometry by detection of different antigens. Patient- and transplant-related risk factors were included in a retrospective statistical analysis. RESULTS The BALF-MV levels of epithelial and red blood cell (RBC) origin were significantly higher in CLAD patients (mean: 1533/μL and 158/μL) compared to controls (436/μL, 57/μL). The LTR with high levels of epithelial MV >580/μL showed a significantly shorter overall survival at 4 years after BAL (39.5%) compared to patients with low MV (66.4%) and this proofed to be an independent prognostic factor in multivariate Cox analysis (hazards ratio = 3.05). Furthermore, LTR with high levels of RBC MV ≥225/μL were also associated with worse disease-specific survival, with probabilities at 4 years after BAL of 85.8% vs. 36.0%. CONCLUSIONS Epithelial and RBC BALF-MV are elevated at CLAD diagnosis, have a potential as biomarkers, and support the hypothesis of a pathway, including activation of coagulation and complement, endothelial barrier dysfunction, and microangiopathy.
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Carcao M, Hilliard P, Escobar MA, Solimeno L, Mahlangu J, Santagostino E. Optimising musculoskeletal care for patients with haemophilia. Eur J Haematol 2015; 95 Suppl 81:11-21. [DOI: 10.1111/ejh.12581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Manuel Carcao
- Division of Haematology/Oncology and Child Health Evaluative Sciences; Research Institute; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Pamela Hilliard
- Department of Rehabilitation; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Miguel A. Escobar
- Gulf States Hemophilia and Thrombophilia Center; Department of Hematology; University of Texas Health Science Center; Houston TX USA
| | - Luigi Solimeno
- Ortho Trauma Unit; Emergency Department; IRCCS Cà Granda Foundation; Maggiore Hospital; Milan Italy
| | - Johnny Mahlangu
- Haemophilia Comprehensive Care Centre; Faculty of Health Sciences; University of the Witwatersrand and National Health Laboratory Service; Johannesburg South Africa
| | - Elena Santagostino
- Hemophilia and Thrombosis Center ‘A. Bianchi Bonomi’; IRCCS Cà Granda Foundation; Maggiore Hospital; Milan Italy
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88
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Baumgartner CK, Zhang G, Kuether EL, Weiler H, Shi Q, Montgomery RR. Comparison of platelet-derived and plasma factor VIII efficacy using a novel native whole blood thrombin generation assay. J Thromb Haemost 2015; 13:2210-9. [PMID: 26453193 PMCID: PMC4715732 DOI: 10.1111/jth.13169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/30/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND We have recently developed a successful gene therapy approach for hemophilia A in which factor VIII (FVIII) expression is targeted to platelets by the αIIb promoter. Levels of platelet-expressed FVIII (2bF8) achieved by gene therapy may vary between individuals due to differences in ex vivo transduction and gene expression efficiency. Accurate assays to evaluate 2bF8 efficacy are desirable. OBJECTIVE To compare the hemostatic efficacy of 2bF8 with replacement therapy over a wide therapeutic dose range. METHODS Efficacy of 2bF8 was assessed using a new transgenic mouse model expressing high 2bF8 levels (LV18(tg) ). Blood from LV18(tg) mice or FVIII(null) mice infused with recombinant FVIII was mixed with FVIII(null) blood at different ratios ex vivo to achieve several concentrations of 2bF8 or plasma FVIII. Samples were evaluated with a novel native whole blood thrombin generation assay that uses recalcified whole blood without the addition of tissue factor to initiate coagulation. RESULTS FVIII dose dependency was observed in all five thrombin generation parameters. While the total amount of thrombin generated was similar, 2bF8 significantly accelerated thrombin generation compared with plasma FVIII. Remarkably, a 10-fold lower dose of 2bF8 than plasma FVIII (0.2% vs. 2%) significantly shortened the onset and peak of thrombin generation compared with FVIII(null) blood. CONCLUSION Using a new transgenic mouse model, we showed that the novel native whole blood thrombin generation assay established here can be used to monitor platelet targeted FVIII gene therapy. The higher therapeutic efficacy of 2bF8 compared with factor replacement therapy seemed to be due to acceleration of thrombin generation.
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Affiliation(s)
- C K Baumgartner
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - G Zhang
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - E L Kuether
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - H Weiler
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - Q Shi
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - R R Montgomery
- Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, WI, USA
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
- Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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89
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Brown SA, Phillips J, Barnes C, Curtin J, McRae S, Ockelford P, Rowell J, Smith MP, Dunkley S. Challenges in hemophilia care in Australia and New Zealand. Curr Med Res Opin 2015; 31:1985-91. [PMID: 26296234 DOI: 10.1185/03007995.2015.1082990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Health and life expectancy for people with hemophilia have improved significantly in recent years, but we face new challenges, especially in the context of resource-constrained health services. AIM This paper aims to highlight such challenges and propose practical solutions. METHODS Nine hemophilia specialists from Australia and New Zealand reached consensus on areas of greatest need for improvement in hemophilia care in these countries, based on clinical experience and published data, and agreed on how to address these. RESULTS Demography, optimizing treatment and assessing treatment success were identified as broad areas of challenge which included: comorbidities in ageing patients; transitioning from pediatric to adult care; equity of care for remote populations; weight-based dosing in obese patients; tailoring prophylaxis; accurate diagnosis of acute joint pain; managing chronic arthropathy; providing psychosocial support; consistency in definitions and assessment; and quantifiable outcome measures. Practice points included increased cross-specialty coordination and including psychologists and rheumatologists as part of comprehensive care teams; close collaboration between pediatric and adult centers to facilitate transition of care; systems such as telehealth that ensure continuity of care for remote populations; using pharmacokinetic data to tailor therapy; rapid and accurate diagnosis of acute joint pain; using data from bleeding registries to assess treatment effects and help with service planning; and ensuring consistency through benchmarking and standardization of HTCs. SUMMARY Achieving treatment equity, optimal outcomes and cost savings may be possible through investing in national governance structures, expanding the comprehensive model of care and implementing innovative solutions tailored to local needs.
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Affiliation(s)
- S A Brown
- a a Royal Children's Hospital Haematology , Brisbane , Queensland , Australia
- b b Pathology Queensland , Brisbane , Queensland , Australia
| | - J Phillips
- c c Haematology Department , Wellington Hospital , Wellington , New Zealand
| | - C Barnes
- d d Haemophilia Treatment Centre, Royal Children's Hospital , Parkville , Victoria , Australia
| | - J Curtin
- e e Haematology Department , The Children's Hospital at Westmead , Westmead , New South Wales , Australia
| | - S McRae
- f f Adult Haemophilia Treatment Centre, Royal Adelaide Hospital , Adelaide , South Australia , Australia
| | - P Ockelford
- g g Adult Haemophilia Treatment Centre, Auckland Hospital , Auckland , New Zealand
| | - J Rowell
- h h Haemophilia Treatment Centre, Royal Brisbane and Women's Hospital , Brisbane , Queensland , Australia
| | - M P Smith
- i i Canterbury District Health Board, Christchurch Hospital , Christchurch , New Zealand
| | - S Dunkley
- j j Haemophilia Treatment Centre, Royal Prince Alfred Hospital , Camperdown , New South Wales , Australia
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90
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Chitlur M, Young G. Global assays in hemophilia. Semin Hematol 2015; 53:40-5. [PMID: 26805906 DOI: 10.1053/j.seminhematol.2015.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Revised: 11/05/2004] [Accepted: 12/01/2005] [Indexed: 11/11/2022]
Abstract
The quest for the ideal method to study hemostasis in the evaluation and management of patients with bleeding disorders such as hemophilia is an ongoing effort. With the rapid evolution of biotechnology and the emergence of several new products for treatment of patients with hemophilia with and without inhibitors, there is a great need for tests that can be used to reliably evaluate and monitor our interventions. Global assays in coagulation allow the study of the interaction between the components involved in the process of hemostasis and are therefore considered by many to be more reflective of the in vivo hemostatic mechanism. Here we provide a brief review of the most widely used global assays in hemostasis (thrombin generation and thromboelastography) and their utility in the evaluation and management of hemophilia.
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Affiliation(s)
- Meera Chitlur
- Carman and Ann Adams Department of Pediatrics, Division of Hematology/Oncology, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
| | - Guy Young
- Department of Pediatrics, Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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91
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Espitia O, Fouassier M. Le test de génération de thrombine. Rev Med Interne 2015; 36:690-3. [DOI: 10.1016/j.revmed.2015.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/29/2015] [Indexed: 01/06/2023]
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92
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Joly B, d'Oiron R, Desconclois C, Bendelac L, Rafowicz A, Meyzer C, Labrune P, Veyradier A. [Mild hemophilia A fortuitously discovered during Henoch-Schönlein purpura]. Arch Pediatr 2015; 22:1167-70. [PMID: 26412326 DOI: 10.1016/j.arcped.2015.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/07/2015] [Accepted: 07/29/2015] [Indexed: 11/15/2022]
Abstract
Henoch-Schönlein purpura is a common form of immunological vasculitis in children. Hemophilia A is a genetic disorder, inherited in a X-linked recessive pattern, and characterized by spontaneous hemorrhage or prolonged bleeding due to factor VIII deficiency. The clinical signs depend on the severity of factor VIII deficiency. We herein report the case of a 4-year-old boy admitted to the emergency room for typical rheumatoid purpura, associated with a lengthening of aPTT, whose exploration had uncovered mild hemophilia A. Laboratory assays should explore lengthening of aPTT: firstly the presence of lupus anticoagulant without bleeding risk, in an inflammatory context; secondly a deficiency of VWF and one of the factors involved in the extrinsic coagulation pathway associated with bleeding risk.
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Affiliation(s)
- B Joly
- Service d'hématologie biologique, hôpital Antoine-Béclère, université Paris 11, Assistance publique-Hôpitaux de Paris, 157, avenue de la Porte-de-Trivaux, 92140 Clamart, France
| | - R d'Oiron
- Centre régional de traitement de l'hémophilie et des maladies hémorragiques (CRTH), hôpital Bicêtre, université Paris 11, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - C Desconclois
- Service d'hématologie biologique, hôpital Bicêtre, université Paris 11, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - L Bendelac
- Service d'hématologie biologique, hôpital Bicêtre, université Paris 11, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - A Rafowicz
- Centre régional de traitement de l'hémophilie et des maladies hémorragiques (CRTH), hôpital Bicêtre, université Paris 11, Assistance publique-Hôpitaux de Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - C Meyzer
- Service de pédiatrie générale, hôpital Antoine-Béclère, université Paris 11, Assistance publique-Hôpitaux de Paris, 157, avenue de la Porte-de-Trivaux, 92140 Clamart, France
| | - P Labrune
- Service de pédiatrie générale, hôpital Antoine-Béclère, université Paris 11, Assistance publique-Hôpitaux de Paris, 157, avenue de la Porte-de-Trivaux, 92140 Clamart, France
| | - A Veyradier
- Service d'hématologie biologique, hôpital Antoine-Béclère, université Paris 11, Assistance publique-Hôpitaux de Paris, 157, avenue de la Porte-de-Trivaux, 92140 Clamart, France.
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93
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Hermans C, Dolan G, Jennings I, Windyga J, Lobet S, Rodríguez-Merchán EC, Di Minno MND, Jiménez-Yuste V, O'Mahony B. Managing Haemophilia for Life: 5th Haemophilia Global Summit. Eur J Haematol 2015; 95 Suppl 78:1-25. [PMID: 26350039 DOI: 10.1111/ejh.12617] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The 5th Haemophilia Global Summit was held in Barcelona, Spain, in September 2014. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and explored issues relevant to the practical management of haemophilia, as well as key opportunities and challenges for care in the future. The topics outlined in this supplement were selected by the Scientific Steering Committee for their relevance to improving haemophilia care globally. In this supplement from the meeting, Gerry Dolan explores pharmacokinetics and dynamics in haemophilia, and Gerry Dolan and Ian Jennings jointly address the role of the laboratory in haemophilia care. The potential benefits of low-dose prophylaxis regimens for people with haemophilia in the developing world are reviewed by Jerzy Windyga, and the question of whether 'Future haemophilia research should be undertaken in the developing world' is debated by Jerzy Windyga and Cedric Hermans. Management strategies for ankle arthropathy are discussed by Sébastien Lobet and E. Carlos Rodríguez-Merchán, and the use of ultrasound for the early detection of haemophilic arthropathy is addressed by Matteo Nicola Dario Di Minno and Víctor Jiménez-Yuste. Finally, the role of patients in the future of haemophilia care is reviewed by Brian O'Mahony.
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Affiliation(s)
| | | | - Ian Jennings
- UK National External Quality Assessment Service, Sheffield, UK
| | - Jerzy Windyga
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
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94
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George LA, Thalji NK, Raffini LJ, Gimotty PA, Camire RM. Correction of human hemophilia A whole blood abnormalities with a novel bypass agent: zymogen-like FXa(I16L). J Thromb Haemost 2015; 13:1694-8. [PMID: 26190406 DOI: 10.1111/jth.13059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Approximately 30% of hemophilia A (HA) and 5% of hemophilia B patients develop inhibitors to protein replacement therapy, and this is the major cause of disease-related morbidity in the developed world. We previously developed zymogen-like factor Xa (FXa) molecules with impaired active site maturation, enabling a greater half-life than wild-type FXa while maintaining full procoagulant function in the prothrombinase complex. Here we evaluated the ability of zymogen-like FXa(I16L) to correct whole blood thromboelastometry abnormalities of severe HA subjects with and without inhibitors. METHODS Fourteen severe HA subjects without and five with inhibitors were enrolled at baseline ( FVIII C < 1%) > 5 half-lives from factor or bypass therapy. The subjects' whole blood was evaluated by thromboelastography (ROTEM(®) ) using INTEM analysis with two concentrations of FXa(I16L) or recombinant factor VIIa (rFVIIa). RESULTS With 0.1 nm FXa(I16L) , clot time (CT, in minutes [min]) among HA subjects without and with inhibitors (mean = 2.87 min, 95% CI = 2.58-3.15 min, and mean = 2.9 min, 95% CI = 2.07-3.73 min, respectively) did not significantly differ from control CT (mean = 2.73 min, 95% CI = 2.62-2.85 min). Addition of 20 nm rFVIIa, simulating a 90-μg/kg dose, resulted in significantly prolonged CTs for HA subjects without and with inhibitors (mean = 5.43 min, 95% CI = 4.53-6.35 min, and mean = 4.25 min, 95% CI = 3.32-5.17 min, respectively) relative to controls. CONCLUSIONS FXa(I16L) restored thromboelastometry CT to control values in severe HA subjects with and without inhibitors. The findings corroborate previous animal data and demonstrate the first evidence of zymogen-like FXa(I16L) correcting human HA subjects' whole-blood abnormalities and support the use of FXa(I16L) as a novel hemostatic agent.
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Affiliation(s)
- L A George
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Cellular and Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N K Thalji
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Cellular and Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - L J Raffini
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - P A Gimotty
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - R M Camire
- Division of Hematology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Cellular and Molecular Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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95
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The impact of thrombin generation and rotation thromboelastometry on assessment of severity of factor XI deficiency. Thromb Res 2015; 136:465-73. [DOI: 10.1016/j.thromres.2015.06.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/28/2015] [Accepted: 06/17/2015] [Indexed: 11/22/2022]
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96
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Nayak S, Lee D, Patel-Hett S, Pittman DD, Martin SW, Heatherington AC, Vicini P, Hua F. Using a Systems Pharmacology Model of the Blood Coagulation Network to Predict the Effects of Various Therapies on Biomarkers. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2015; 4:396-405. [PMID: 26312163 PMCID: PMC4544053 DOI: 10.1002/psp4.50] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/23/2015] [Indexed: 01/09/2023]
Abstract
A number of therapeutics have been developed or are under development aiming to modulate the coagulation network to treat various diseases. We used a systems model to better understand the effect of modulating various components on blood coagulation. A computational model of the coagulation network was built to match in-house in vitro thrombin generation and activated Partial Thromboplastin Time (aPTT) data with various concentrations of recombinant factor VIIa (FVIIa) or factor Xa added to normal human plasma or factor VIII-deficient plasma. Sensitivity analysis applied to the model revealed that lag time, peak thrombin concentration, area under the curve (AUC) of the thrombin generation profile, and aPTT show different sensitivity to changes in coagulation factors' concentrations and type of plasma used (normal or factor VIII-deficient). We also used the model to explore how variability in concentrations of the proteins in coagulation network can impact the response to FVIIa treatment.
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Affiliation(s)
- S Nayak
- Pharmacometrics, Global Innovative Pharma Business (GIPB), Pfizer Inc. Cambridge, Massachusetts, USA
| | - D Lee
- Quantitative Clinical Sciences, PharmaTherapeutics Clinical R&D, Pfizer Inc. Cambridge, Massachusetts, USA
| | - S Patel-Hett
- Rare Disease Research Unit Pfizer Inc. Cambridge, Massachusetts, USA
| | - D D Pittman
- Rare Disease Research Unit Pfizer Inc. Cambridge, Massachusetts, USA
| | - S W Martin
- Pharmacometrics, Global Innovative Pharma Business (GIPB), Pfizer Inc. Cambridge, Massachusetts, USA
| | - A C Heatherington
- Quantitative Clinical Sciences, PharmaTherapeutics Clinical R&D, Pfizer Inc. Cambridge, Massachusetts, USA
| | - P Vicini
- Pharmacokinetics, Dynamics and Metabolism, New Biological Entities, Pfizer Inc. Cambridge, Massachusetts, USA
| | - F Hua
- Quantitative Clinical Sciences, PharmaTherapeutics Clinical R&D, Pfizer Inc. Cambridge, Massachusetts, USA
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97
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98
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Leissinger CA, Konkle BA, Antunes SV. Prevention of bleeding in hemophilia patients with high-titer inhibitors. Expert Rev Hematol 2015; 8:375-82. [DOI: 10.1586/17474086.2015.1036733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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99
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Kerlin BA, Waller AP, Sharma R, Chanley MA, Nieman MT, Smoyer WE. Disease Severity Correlates with Thrombotic Capacity in Experimental Nephrotic Syndrome. J Am Soc Nephrol 2015; 26:3009-19. [PMID: 25855774 DOI: 10.1681/asn.2014111097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/08/2015] [Indexed: 11/03/2022] Open
Abstract
Thrombotic disease, a major life-threatening complication of nephrotic syndrome, has been associated with proteinuria and hypoalbuminemia severity. However, it is not fully understood how disease severity correlates with severity of the acquired hypercoagulopathy of nephrotic syndrome. Without this knowledge, the utility of proteinuria and/or hypoalbuminemia as biomarkers of thrombotic risk remains limited. Here, we show that two well established ex vivo hypercoagulopathy assays, thrombin generation and rotational thromboelastometry, are highly correlated with proteinuria and hypoalbuminemia in the puromycin aminonucleoside and adriamycin rat models of nephrotic syndrome. Notably, in the puromycin aminonucleoside model, hyperfibrinogenemia and antithrombin deficiency were also correlated with proteinuria severity, consistent with reports in human nephrotic syndrome. Importantly, although coagulation was not spontaneously activated in vivo with increasing proteinuria, vascular injury induced a more robust thrombotic response in nephrotic animals. In conclusion, hypercoagulopathy is highly correlated with nephrotic disease severity, but overt thrombosis may require an initiating insult, such as vascular injury. Our results suggest that proteinuria and/or hypoalbuminemia could be developed as clinically meaningful surrogate biomarkers of hypercoagulopathy to identify patients with nephrotic syndrome at highest risk for thrombotic disease and potentially target them for anticoagulant pharmacoprophylaxis.
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Affiliation(s)
- Bryce A Kerlin
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio; Divisions of Hematology/Oncology/Blood & Marrow Transplantation and
| | - Amanda P Waller
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio
| | - Ruchika Sharma
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio; Divisions of Hematology/Oncology/Blood & Marrow Transplantation and
| | - Melinda A Chanley
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio
| | - Marvin T Nieman
- Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio
| | - William E Smoyer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's, Columbus, Ohio; Nephrology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; and
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100
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Abstract
PURPOSE OF REVIEW There exists an imbalance between our understanding of the physiology of the blood coagulation process and the translation of this understanding into useful assays for clinical application. As technology advances, the capabilities for merging the two areas have become more attainable. Global assays have advanced our understanding of the dynamics of the blood coagulation process beyond end point assays and are at the forefront of implementation in the clinic. RECENT FINDINGS We will review recent advances in the main global assays with a focus on thrombin generation that have potential for clinical utility. These assays include direct (thrombogram, whole blood, purified systems) and indirect empirical measures of thrombin generation (thromboelastography) and mechanism-based computational models that use plasma composition data from individuals to generate thrombin generation profiles. SUMMARY Empirical thrombin generation assays (direct and indirect) and computational modeling of thrombin generation have greatly advanced our understanding of the hemostatic balance. Implementation of these types of assays and visualization approaches in the clinic will potentially provide a basis for the development of individualized patient care. Advances in both empirical and computational global assays have made the goal of predicting precrisis changes in an individual's hemostatic state one step closer.
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