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Perfluorocarbon-based oxygen carriers: from physics to physiology. Pflugers Arch 2020; 473:139-150. [PMID: 33141239 PMCID: PMC7607370 DOI: 10.1007/s00424-020-02482-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/29/2022]
Abstract
Developing biocompatible, synthetic oxygen carriers is a consistently challenging task that researchers have been pursuing for decades. Perfluorocarbons (PFC) are fascinating compounds with a huge capacity to dissolve gases, where the respiratory gases are of special interest for current investigations. Although largely chemically and biologically inert, pure PFCs are not suitable for injection into the vascular system. Extensive research created stable PFC nano-emulsions that avoid (i) fast clearance from the blood and (ii) long organ retention time, which leads to undesired transient side effects. PFC-based oxygen carriers (PFOCs) show a variety of application fields, which are worthwhile to investigate. To understand the difficulties that challenge researchers in creating formulations for clinical applications, this review provides the physical background of PFCs’ properties and then illuminates the reasons for instabilities of PFC emulsions. By linking the unique properties of PFCs and PFOCs to physiology, it elaborates on the response, processing and dysregulation, which the body experiences through intravascular PFOCs. Thereby the reader will receive a scientific and easily comprehensible overview why PFOCs are precious tools for so many diverse application areas from cancer therapeutics to blood substitutes up to organ preservation and diving disease.
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2
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Peng Y, Kheir JN, Polizzotti BD. Injectable Oxygen: Interfacing Materials Chemistry with Resuscitative Science. Chemistry 2018; 24:18820-18829. [DOI: 10.1002/chem.201802054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/11/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Yifeng Peng
- Translational Research Laboratory, Department of Cardiology; Boston Children's Hospital; Boston MA 02115 USA
- Department of Pediatrics; Harvard Medical School; Boston MA 02115 USA
| | - John N. Kheir
- Translational Research Laboratory, Department of Cardiology; Boston Children's Hospital; Boston MA 02115 USA
- Department of Pediatrics; Harvard Medical School; Boston MA 02115 USA
| | - Brian D. Polizzotti
- Translational Research Laboratory, Department of Cardiology; Boston Children's Hospital; Boston MA 02115 USA
- Department of Pediatrics; Harvard Medical School; Boston MA 02115 USA
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3
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Smith MD, Smirthwaite AD, Cairns DE, Cousins RB, Gaylor JD. Techniques for Measurement of Oxygen Consumption Rates of Hepatocytes during Attachment and Post-Attachment. Int J Artif Organs 2018. [DOI: 10.1177/039139889601900106] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Three techniques for measuring oxygen consumption rate (OCR) of cultured cells relevant to the development of bioartificial liver devices are reported. In an oxystat apparatus, HepG2 cells immobilised on Cytodex 3 microcarriers at a concentration of 106 cells ml-1 had a mean OCR of 0.7 nmol s-1/106 cells. The OCR decreased with increasing cell density, a characteristic previously reported for other cell lines. Rat hepatocytes immobilised on single collagen layers in a flow cell and challenged with ammonia had a mean OCR of 0.59 nmol s-1/106 cells. A novel two-compartment oxystat system was used to determine the OCR of rat hepatocytes during the attachment phase. OCR declined from 1.0 nmol s-1/106 immediately after seeding to 0.7 nmol s-1/106 cells at nine hours. The low OCR for HepG2 reflects loss of certain oxygen dependent metabolic pathways. The OCR measured for rat hepatocytes during and post-attachment are significantly higher than those reported elsewhere and have major implications for the development of bioartificial liver devices.
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Affiliation(s)
- M. D. Smith
- Department of Bioengineering Unit University of Strathclyde, Glasgow, Scotland - UK
| | - A. D. Smirthwaite
- Department of Bioengineering Unit University of Strathclyde, Glasgow, Scotland - UK
| | - D. E. Cairns
- Department of Chemical & Process Engineering, University of Strathclyde, Glasgow, Scotland - UK
| | - R. B. Cousins
- Department of Chemical & Process Engineering, University of Strathclyde, Glasgow, Scotland - UK
| | - J. D. Gaylor
- Department of Bioengineering Unit University of Strathclyde, Glasgow, Scotland - UK
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Riess JG. Oxygen carriers ("blood substitutes")--raison d'etre, chemistry, and some physiology. Chem Rev 2001; 101:2797-920. [PMID: 11749396 DOI: 10.1021/cr970143c] [Citation(s) in RCA: 544] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- J G Riess
- MRI Institute, University of California at San Diego, San Diego, CA 92103, USA.
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Riess JG. [Perspectives for the use of oxygen carriers as erythrocyte substitutes in surgery]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1995; 14 Suppl 1:107-17. [PMID: 7486312 DOI: 10.1016/s0750-7658(05)81809-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- J G Riess
- Laboratoire de Chimie Moléculaire, Unité Associée au CNRS, Université de Nice-Sophia Antipolis, Faculté des Sciences
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Millard RW. Oxygen solubility, rheology and hemodynamics of perfluorocarbon emulsion blood substitutes. ARTIFICIAL CELLS, BLOOD SUBSTITUTES, AND IMMOBILIZATION BIOTECHNOLOGY 1994; 22:235-44. [PMID: 8087245 DOI: 10.3109/10731199409117417] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Perfluorocarbon-based blood substitute emulsions have been under development for more than a quarter century. The first generation emulsions have provided confirmation that the physical principals of high gas solubility and low viscosity can effectively support organ and organism respiration and metabolism. Clinical trials led the US FDA in 1990 to be the first to approve a 20 w/v % perfluorocarbon emulsion for human use as coronary angioplasty adjuvant therapy. Hemodynamic responses to hemodilution with intravascular perfluorocarbon emulsions have varied with species and the mechanisms for adverse reactions are better understood now as second generation emulsions containing up to 100 w/v % perfluorocarbon are under development as blood substitutes, imaging agents, and for other therapeutic applications. This report describes the evolution of perfluorocarbon emulsions as blood substitutes by emphasizing oxygen solubility, rheology and hemodynamic aspects of the emulsions as they have been applied in experimental laboratory animal and human clinical settings.
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Affiliation(s)
- R W Millard
- College of Medicine, University of Cincinnati, Ohio 45267-0575
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7
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Abstract
In this review the current status of what commonly are termed "blood substitutes" is discussed. The term blood substitute is a misnomer because the formulations under development at this time transport respiratory gases but do not perform the metabolic, regulatory, and protective functions of blood. Either hemoglobin or a perfluorochemical form the base to transport oxygen; the advantages and disadvantages of each base are discussed. The availability of a blood substitute in the U.S. will require approval by the Food and Drug Administration (FDA) and, by law, both its efficacy and safety must be demonstrated prior to approval. Showing efficacy of any blood substitute is complicated by the oxygen reserve and the compensatory mechanisms to acute blood loss in man. The challenge is to prove that the administration of these formulations offer clinical advantages compared with replacement of volume alone. Several efficacy models, the most attractive among them being perioperative hemodilution, should provide data that would bring these formulations into clinical practice. When hemoglobin is not within the favorable environment of the red cell, whether the hemoglobin is derived from expression vectors developed through recombinant biotechnology or from lysed human red cells, it acquires a left-shifted oxygen disassociation curve. Further, because the tetramer disassociates when injected intravenously and the resulting dimers are cleared rapidly from the circulation by the kidneys, intravascular dwell time is brief. Hemoglobins have been modified chemically and linked intramolecularly, intermolecularly, and to macromolecules to correct these problems. While these manipulations have normalized the p50 and extended the dwell time significantly, some toxicity problems remain unresolved. The binding of nitric oxide to hemoglobin preparations and the presumably resultant systemic and pulmonary hypertension observed in animals may be the most difficult to overcome, although the implications of these reactions in man is poorly understood. Perfluorochemicals (PFC) provide a fundamentally different and simpler approach to oxygen transport than hemoglobin formulations. Typically, the PFCs used are liquids composed of 8 to 10 carbon atoms that dissolve oxygen and obey Henry's law. Thus, the recipient's inspired oxygen and cardiac output assume importance. Because they are insoluble in water, PFCs are administered as emulsions, that is, as small droplets about 0.1 to 0.2 microns in diameter. In this respect, they are very similar to the lipid emulsions widely used for parenteral nutrition. Egg yolk phospholipid and poloxamers are most commonly used as emulsifiers. PFCs are not metabolized and are excreted unchanged by the lungs, following temporary storage by the monocyte-macrophage system (MMS).(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- T F Zuck
- Hoxworth Blood Center, University of Cincinnati, Ohio
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8
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Abstract
The approval of Fluosol, a fluorocarbon emulsion for oxygenating the myocardium during the transluminal coronary angioplasty procedure, is a landmark in the field of injectable oxygen carriers, the so-called blood substitutes. This review discusses the advances made since this first emulsion was initially developed about 12 years ago. Attention is focused on the progress achieved in the preparation and selection of new, better-defined and faster-excreted fluorocarbons, and better surfactants, improved emulsions, knowledge of structure/property relationships along with an improved understanding of the physiologic response to their administration. These advances have led to the development of a second generation of highly concentrated, fluid and stable injectable oxygen carriers suitable for a broad range of clinical applications. Prospects for further progress and future generations of emulsions are also outlined.
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Affiliation(s)
- J G Riess
- Laboratoire de Chimie Moléculaire, Associé au CNRS, Université de Nice-Sophia Antipolis, France
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Bowers W, Daum P, Blaha M, Stevens C, Castro I, Leav I. Calcium antagonists and heat-induced hepatic injury. VIRCHOWS ARCHIV. B, CELL PATHOLOGY INCLUDING MOLECULAR PATHOLOGY 1987; 53:235-42. [PMID: 2890236 DOI: 10.1007/bf02890248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Several laboratories have demonstrated the value of the isolated perfused rat liver as a suitable model for heat-induced hepatic injury in vivo. Membrane changes caused by perfusion of rat livers at 42 degrees C for 90 min were similar to those induced by toxic chemicals or hypoxia. In an evaluation of several categories of drugs reported to reduce cell injury, calcium antagonists (nifedipine, dantrolene, and verapamil), were evaluated for their therapeutic potential for heat injury. Isolated rat livers were perfused at 42 degrees C for 90 min with and without calcium antagonists. Livers were also perfused at 37 degrees C. Potassium and transaminase leakage, bile production and ultrastructure were used to evaluate their responses. Neither of the three calcium antagonists significantly improved any of the functional parameters measured. However, dantrolene produced dilated or vesicular rough endoplasmic reticulum in the heated livers. These changes suggest selective intracellular action on endoplasmic reticulum of heated livers. Ring-shaped mitochondria and vesicular endoplasmic reticulum were observed in the heated, verapamil-treated livers, but these could not be quantitatively distinguished from controls. Nifedipine did not appear to alter intracellular membranes, but did increase bile production.
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Affiliation(s)
- W Bowers
- U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts 01760-5007
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Lutz J, Stark M. Half life and changes in the composition of a perfluorochemical emulsion within the vascular system of rats. Pflugers Arch 1987; 410:181-4. [PMID: 3684504 DOI: 10.1007/bf00581913] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The decline of the concentration of perfluorochemicals (PFC) after a single injection of three different doses was studied in the circulation of rats. The doses used amounted to 4.4, 10 and 14 g/kg body weight of Fluosol-DA, an emulsion of 7 parts of perfluorodecalin (FDC) and 3 parts of perfluorotripropylamine (FTPA). This also allowed testing of the composition of the emulsion remaining in the circulation and of that found in the liver. After two days a decrease of the half life from 34.0 +/- 0.7 to 17.1 +/- 4.3 h was found within the circulation at the highest dose. At the same time a change in the composition of the emulsion in the blood stream occurred, favouring the fraction of FTPA. FTPA increased from 28.3 +/- 1.4 to 54.4 +/- 8.1% on the fourth day. Whereas in the cells of the liver PFC droplets may be broken up, freed from their surfactant layer and handled according to their individual components, for PFC in the blood stream an unchanged composition should be assumed. Both results, the decreasing half life and the change in composition of the circulating emulsion may best be explained by a shrinking and instability of the emulgator film, showing the necessity for development of a superior surfactant.
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Affiliation(s)
- J Lutz
- Physiologisches Institut der Universität Würzburg, Federal Republic of Germany
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Mueller-Klieser W, Vaupel P. Improvement of tumor spheroid oxygenation by tetrachlorodecaoxide. Int J Radiat Oncol Biol Phys 1987; 13:49-54. [PMID: 3804815 DOI: 10.1016/0360-3016(87)90259-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The benefit of Tetrachlorodecaoxide (TCDO) in improving tumor tissue oxygenation has been tested using multicellular tumor spheroids. Measurements of oxygen tension (PO2) values with O2-sensitive microelectrodes revealed a distinct enhancement of the spheroid oxygenation after both, bolus injection or continuous infusion of TCDO into the medium surrounding the spheroids. The effect of TCDO on local oxygenation appeared to be less pronounced in spheroid regions with low initial PO2 values compared to well-oxygenated areas of these cellular aggregates. By continuously infusing TCDO into the measuring system, a sustained increase of local PO2 was obtained which was proportional to the local steady state concentration of TCDO in the medium surrounding the tumor spheroids. During experiments with TCDO in vivo, this substance should, therefore, be tested for its potential of improving the oxygenation status of solid tumors, and hence, of sensitizing tumors to classical treatments, such as radiotherapy.
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12
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Lowe KC. Perfluorocarbons as oxygen-transport fluids. COMPARATIVE BIOCHEMISTRY AND PHYSIOLOGY. A, COMPARATIVE PHYSIOLOGY 1987; 87:825-38. [PMID: 2887381 DOI: 10.1016/0300-9629(87)90001-6] [Citation(s) in RCA: 86] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
1. An overview of the proposed biological applications of perfluorocarbons and their emulsions as oxygen-transport fluids is presented. 2. Aspects of the properties, preparation, composition and physiological assessment of perfluorocarbon emulsions are discussed. 3. The experimental basis for some of the potential therapeutic uses of PFCs in liquid ventilation, treatment of decompression sickness, organ perfusion, oxygenation of ischaemic and malignant tissues, and as contrast media for NMR imaging is described. 4. The extent to which emulsified perfluorocarbons may have value as substitutes for red blood cells is discussed in detail. Data from both animal and human studies with such emulsions is reviewed. Brief consideration is also given to the possible use of native and modified haemoglobin in blood replacement together with recent work on the preparation of so-called "synthetic red cells".
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13
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Mueller-Klieser W, Vaupel P. Tetrachlorodecaoxide improves the oxygenation status of multicellular tumor spheroids. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1986; 200:623-32. [PMID: 3799354 DOI: 10.1007/978-1-4684-5188-7_75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The benefit of Tetrachlorodecaoxide (TCDO) in improving tumor tissue oxygenation has been tested using multicellular tumor spheroids. Measurements of PO2 values with O2-sensitive microelectrodes revealed a distinct enhancement of the spheroid oxygenation after bolus injection of TCDO into the medium around the spheroid (peak concentration: 0.7 mM). Small spheroids exhibited a uniform, transient rise in PO2 at different locations within the spheroid. Larger spheroids showed a smaller, yet still significant increase in PO2 in inner parts compared to the spheroid periphery. The increase in PO2 after TCDO injection appeared to be less in spheroid areas with low initial PO2 values versus well-oxygenated spheroid regions. Continuous infusion of TCDO for 15 minutes at steady state concentrations in the medium of 33 microM resulted in a substantial and persistent elevation of the local PO2 within spheroids. The PO2 returned to the control level 20 minutes after the stoppage of the infusion.
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14
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Reindorf CA, Kurantsin-Mills J, Allotey JB, Castro O. Perfluorocarbon compounds: effects on the rheological properties of sickle erythrocytes in vitro. Am J Hematol 1985; 19:229-36. [PMID: 4014223 DOI: 10.1002/ajh.2830190304] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The effects of oxygenated perfluorotributylamine (Fluosol-43) on the rheological properties of sickle (HbSS) erythrocytes have been determined by means of microviscometry and positive pressure cell filtration. Incubation of deoxygenated sickled erythrocytes (pO2 congruent to 30 mmHg) with oxygenated Fluosol-43 reduced the percentage of sickled erythrocytes from about 63 to 33%. Deoxygenation of 40% suspension of sickle erythrocytes in autologous plasma increased the viscosity by about 160% at shear rate of 1.15 sec-1. Incubation of the deoxygenated sickled erythrocytes with oxygenated Fluosol-43 significantly reduced the viscosity at the low shear rates. Filtration of 0.2% suspension of deoxygenated sickle erythrocytes through capillary-sized Nuclepore filters showed high resistance at low flow rates. Oxygenated Fluosol-43 increased the deformability of HbSS erythrocytes and thereby reduced the resistance at flow rates less than 1 ml/min. These data suggest that perfluorocarbons may be useful in reducing the propensity of hemoglobin S polymerization and sickling and thereby prevent tissue infarction in vaso-occlusive crisis. Therefore, the concept of examining the potential application of perfluorochemicals for alleviating severe vaso-occlusive events may be useful.
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Lutz J, Metzenauer P. Effects of potential blood substitutes (perfluorochemicals) on rat liver and spleen. Pflugers Arch 1980; 387:175-81. [PMID: 7191980 DOI: 10.1007/bf00584269] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The effect of an emulsion of perfluorochemicals (PFC) (7 parts perfluorodecalin and 3 parts perfluorotripropylamine, 4.4 g PFC/kg body weight) on organ function was determined. Whereas maximal storage of PFC was reached in the spleen as early as 12 h after PFC administration, the liver attained a maximal PFC content only after 2 days. The increase in weight also differed: a maximum occurred in the spleen on the 4th day, in the liver on the 8th day. Indocyanine green (ICG) clearance showed a small decrease, statistically significant after 12 and 24 h. Colloidal carbon clearance, used as a measure of the function of the reticuloendothelial system (RES) decreased instantly after PFC to less than half the control value; after full recovery a second decrease was seen which lasted till the 4th day after PFC. Pretreatment with C 48/80 or with increasing doses of E. coli endotoxin could largely obviate the depressive effect of PFC-loading on carbon clearance. Serum transaminases increased to about twice the control levels but were normal by the 2nd day, and thereafter. Alkaline phosphatase showed a 2.5 fold increase but returned to control level after the 2nd day. It is concluded that while a severe disturbance of liver function did not occur, the reduction in the capacity of the RES can become a serious factor in the defence against a simultaneously appearing infection if not compensated by activating the RES.
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