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Sanfilippo F, Currò JM, La Via L, Dezio V, Martucci G, Brancati S, Murabito P, Pappalardo F, Astuto M. Use of nafamostat mesilate for anticoagulation during extracorporeal membrane oxygenation: A systematic review. Artif Organs 2022; 46:2371-2381. [PMID: 35531906 DOI: 10.1111/aor.14276] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/10/2022] [Accepted: 04/18/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) represents an advanced option for supporting refractory respiratory and/or cardiac failure. Systemic anticoagulation with unfractionated heparin (UFH) is routinely used. However, patients with bleeding risk and/or heparin-related side effects may necessitate alternative strategies: among these, nafamostat mesilate (NM) has been reported. METHODS We conducted a systematic literature search (PubMed and EMBASE, updated 12/08/2021), including all studies reporting NM anticoagulation for ECMO. We focused on reasons for starting NM, its dose and the anticoagulation monitoring approach, the incidence of bleeding/thrombosis complications, the NM-related side effects, ECMO weaning, and mortality. RESULTS The search revealed 11 relevant findings, all with retrospective design. Of these, three large studies reported a control group receiving UFH, the other were case series (n = 3) or case reports (n = 5). The main reason reported for NM use was an ongoing or high risk of bleeding. The NM dose varied largely as did the anticoagulation monitoring approach. The average NM dose ranged from 0.46 to 0.67 mg/kg/h, but two groups of authors reported larger doses when monitoring anticoagulation with ACT. Conflicting findings were found on bleeding and thrombosis. The only NM-related side effect was hyperkalemia (n = 2 studies) with an incidence of 15%-18% in patients anticoagulated with NM. Weaning and survival varied across studies. CONCLUSION Anticoagulation with NM in ECMO has not been prospectively studied. While several centers have experience with this approach in high-risk patients, prospective studies are warranted to establish the optimal space of this approach in ECMO.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Jessica Marika Currò
- School of Anaesthesia and Intensive Care, University "Magna Graecia", Catanzaro, Italy
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Veronica Dezio
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT, UPMC Italy, Palermo, Italy
| | - Serena Brancati
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Paolo Murabito
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Federico Pappalardo
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.,CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marinella Astuto
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco", Catania, Italy.,Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Bashant KR, Toepfner N, Day CJ, Mehta NN, Kaplan MJ, Summers C, Guck J, Chilvers ER. The mechanics of myeloid cells. Biol Cell 2020; 112:103-112. [DOI: 10.1111/boc.201900084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/18/2019] [Accepted: 01/03/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Kathleen R Bashant
- Department of MedicineUniversity of Cambridge Cambridge UK
- Systemic Autoimmunity BranchNational Institute of Arthritis and Musculoskeletal and Skin DiseasesNational Institutes of Health Bethesda Maryland USA
| | - Nicole Toepfner
- Center for Molecular and Cellular BioengineeringBiotechnology Center, Technische Universität Dresden Dresden Germany
- Department of PediatricsUniversity Clinic Carl Gustav Carus, Technische Universität Dresden Dresden Germany
| | | | - Nehal N Mehta
- National Heart Lung and Blood InstituteNational Institutes of Health Bethesda MD USA
| | - Mariana J Kaplan
- Systemic Autoimmunity BranchNational Institute of Arthritis and Musculoskeletal and Skin DiseasesNational Institutes of Health Bethesda Maryland USA
| | | | - Jochen Guck
- Max‐Planck‐Institut für die Physik des Lichts & Max‐Planck‐Zentrum für Physik und Medizin Erlangen Germany
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Bashant KR, Vassallo A, Herold C, Berner R, Menschner L, Subburayalu J, Kaplan MJ, Summers C, Guck J, Chilvers ER, Toepfner N. Real-time deformability cytometry reveals sequential contraction and expansion during neutrophil priming. J Leukoc Biol 2019; 105:1143-1153. [PMID: 30835869 PMCID: PMC7587463 DOI: 10.1002/jlb.ma0718-295rr] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 02/08/2019] [Accepted: 02/14/2019] [Indexed: 12/19/2022] Open
Abstract
It has become increasingly apparent that the biomechanical properties of neutrophils impact on their trafficking through the circulation and in particularly through the pulmonary capillary bed. The retention of polarized or shape-changed neutrophils in the lungs was recently proposed to contribute to acute respiratory distress syndrome pathogenesis. Accordingly, this study tested the hypothesis that neutrophil priming is coupled to morpho-rheological (MORE) changes capable of altering cell function. We employ real-time deformability cytometry (RT-DC), a recently developed, rapid, and sensitive way to assess the distribution of size, shape, and deformability of thousands of cells within seconds. During RT-DC analysis, neutrophils can be easily identified within anticoagulated "whole blood" due to their unique granularity and size, thus avoiding the need for further isolation techniques, which affect biomechanical cell properties. Hence, RT-DC is uniquely suited to describe the kinetics of MORE cell changes. We reveal that, following activation or priming, neutrophils undergo a short period of cell shrinking and stiffening, followed by a phase of cell expansion and softening. In some contexts, neutrophils ultimately recover their un-primed mechanical phenotype. The mechanism(s) underlying changes in human neutrophil size are shown to be Na+ /H+ antiport-dependent and are predicted to have profound implications for neutrophil movement through the vascular system in health and disease.
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Affiliation(s)
- Kathleen R Bashant
- Department of Medicine, University of Cambridge, Cambridge, UK
- National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Reinhard Berner
- Department of Pediatrics, University Clinic Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Leonhard Menschner
- Department of Pediatrics, University Clinic Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | | | | | | | - Jochen Guck
- Center for Molecular and Cellular Bioengineering, Biotechnology Center, Technische Universität Dresden, Dresden, Germany
| | | | - Nicole Toepfner
- Department of Pediatrics, University Clinic Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Center for Molecular and Cellular Bioengineering, Biotechnology Center, Technische Universität Dresden, Dresden, Germany
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Ekpenyong AE, Toepfner N, Fiddler C, Herbig M, Li W, Cojoc G, Summers C, Guck J, Chilvers ER. Mechanical deformation induces depolarization of neutrophils. SCIENCE ADVANCES 2017; 3:e1602536. [PMID: 28630905 PMCID: PMC5470826 DOI: 10.1126/sciadv.1602536] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The transition of neutrophils from a resting state to a primed state is an essential requirement for their function as competent immune cells. This transition can be caused not only by chemical signals but also by mechanical perturbation. After cessation of either, these cells gradually revert to a quiescent state over 40 to 120 min. We use two biophysical tools, an optical stretcher and a novel microcirculation mimetic, to effect physiologically relevant mechanical deformations of single nonadherent human neutrophils. We establish quantitative morphological analysis and mechanical phenotyping as label-free markers of neutrophil priming. We show that continued mechanical deformation of primed cells can cause active depolarization, which occurs two orders of magnitude faster than by spontaneous depriming. This work provides a cellular-level mechanism that potentially explains recent clinical studies demonstrating the potential importance, and physiological role, of neutrophil depriming in vivo and the pathophysiological implications when this deactivation is impaired, especially in disorders such as acute lung injury.
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Affiliation(s)
- Andrew E. Ekpenyong
- Cavendish Laboratory, Department of Physics, University of Cambridge, Cambridge CB3 0HE, UK
- Biotechnology Center for Molecular and Cellular Bioengineering, Technische Universität Dresden, 01307 Dresden, Germany
- Department of Physics, Creighton University, Omaha, NE 68178, USA
| | - Nicole Toepfner
- Klinik und Poliklinik für Kinder-und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Department of Medicine, Addenbrooke’s and Papworth Hospitals, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Christine Fiddler
- Department of Medicine, Addenbrooke’s and Papworth Hospitals, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Maik Herbig
- Biotechnology Center for Molecular and Cellular Bioengineering, Technische Universität Dresden, 01307 Dresden, Germany
| | - Wenhong Li
- Biotechnology Center for Molecular and Cellular Bioengineering, Technische Universität Dresden, 01307 Dresden, Germany
| | - Gheorghe Cojoc
- Biotechnology Center for Molecular and Cellular Bioengineering, Technische Universität Dresden, 01307 Dresden, Germany
| | - Charlotte Summers
- Department of Medicine, Addenbrooke’s and Papworth Hospitals, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Jochen Guck
- Cavendish Laboratory, Department of Physics, University of Cambridge, Cambridge CB3 0HE, UK
- Biotechnology Center for Molecular and Cellular Bioengineering, Technische Universität Dresden, 01307 Dresden, Germany
- Corresponding author.
| | - Edwin R. Chilvers
- Department of Medicine, Addenbrooke’s and Papworth Hospitals, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
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Lim JY, Kim JB, Choo SJ, Chung CH, Lee JW, Jung SH. Anticoagulation During Extracorporeal Membrane Oxygenation; Nafamostat Mesilate Versus Heparin. Ann Thorac Surg 2016; 102:534-9. [DOI: 10.1016/j.athoracsur.2016.01.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/05/2016] [Accepted: 01/11/2016] [Indexed: 10/21/2022]
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Morizumi S, Hiramatsu Y, Matsuzaki K, Goto Y, Sato S, Abe M, Kato H, Matsubara M, Sakakibara Y. Early Heparin Administration Attenuates Tissue Factor-Mediated Thrombin Generation During Simulated Cardiopulmonary Bypass. J Card Surg 2013; 29:35-40. [DOI: 10.1111/jocs.12254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sei Morizumi
- Department of Cardiovascular Surgery; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Kanji Matsuzaki
- Department of Cardiovascular Surgery; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Yukinobu Goto
- Department of Cardiovascular Surgery; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Shoko Sato
- Department of Cardiovascular Surgery; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Masakazu Abe
- Department of Cardiovascular Surgery; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Hideyuki Kato
- Department of Cardiovascular Surgery; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Muneaki Matsubara
- Department of Cardiovascular Surgery; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Yuzuru Sakakibara
- Department of Cardiovascular Surgery; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
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Tang M, Zhao XG, Gu YJ, Chen CZ. An in vitro model for studying neutrophil activation during cardiopulmonary bypass by using a polymerase chain reaction thermocycler. Altern Lab Anim 2010; 38:213-9. [PMID: 20602537 DOI: 10.1177/026119291003800307] [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
The accurate temperature control of a polymerase chain reaction (PCR) thermocycler was exploited in developing an in vitro model to study neutrophil activation during cardiopulmonary bypass. Neutrophils from 12 volunteers underwent temperature changes in a PCR thermocycler (37 degrees C for 30 minutes, 28 degrees C for 60 minutes, and then 37 degrees C for 90 minutes). Different co-incubates were applied to neutrophils, as follows: Group A: phosphate-buffered saline solution; Group B: platelet activating factor (PAF) ; Group C: platelet-depleted plasma; Group D: platelet-depleted plasma + PAF; and Group E: platelet-rich plasma. Membrane-bound elastase (MBE) activity was measured every 30 minutes throughout the experiment. MBE activity decreased significantly after hypothermia, compared with the baseline level (p < 0.001), and it resumed an increase after re-warming. Among all co-incubates, platelet-rich plasma was the most potent pro-inflammatory stimulus to neutrophils. A linear correlation was found between MBE and platelet count in platelet-rich plasma (p = 0.004). A novel in vitro model involving a PCR thermocycler has been proved to be reliable in the study of neutrophil activation during cardiopulmonary bypass. The model could possibly be used as an alternative to animals in the development of new drugs to combat neutrophil damage to tissues and organs during cardiopulmonary bypass in cardiac surgery.
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Affiliation(s)
- Min Tang
- Department of Cardiothoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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9
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Serine protease inhibitor nafamostat given before reperfusion reduces inflammatory myocardial injury by complement and neutrophil inhibition. J Cardiovasc Pharmacol 2008; 52:151-60. [PMID: 18670364 DOI: 10.1097/fjc.0b013e318180188b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Animal data strongly support a role for inflammation in myocardial ischemia reperfusion injury. Attempts at cardioprotection by immunomodulation (such as with the specific C5 antibody pexelizumab) in humans have been disappointing. We hypothesized that a broader spectrum antiinflammatory agent might yield successful cardioprotection. The serine protease inhibitor nafamostat (FUT-175), which is already in clinical use, is a potent antiinflammatory synthetic serine protease inhibitor with anticomplement activity that we tested in a well-established rabbit model of 1 hour of myocardial ischemia followed by 3 hours of reperfusion. Compared to vehicle-treated animals, nafamostat (1 mg/kg of body weight) administered 5 minutes before reperfusion significantly reduced myocardial injury assessed by plasma creatine kinase activity (38.1 +/- 6.0 versus 57.9 +/- 3.7I U/g protein; P < 0.05) and myocardial necrosis (23.6 +/- 3.1% versus 35.7 +/- 1.0%; P < 0.05) as well as myocardial leukocyte accumulation (P < 0.05). In parallel in vitro studies, Nafamostat was a significantly more potent broad spectrum complement suppressor than C1 inhibitor. Nafamostat appears to have capability as an inhibitor of both complement pathways and as a broad-spectrum antiinflammatory agent by virtue of its serine protease inhibition. Administration of nafamostat before myocardial reperfusion after ischemia produced significant, dose-dependent cardioprotection. Reduced leukocyte accumulation and complement activity seem involved in the mechanism of this cardioprotective effect.
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Fukunaga K, Fukuda Y, Yokoyama Y, Ohnishi K, Kusaka T, Kosaka T, Hida N, Ohda Y, Miwa H, Matsumoto T. Activated platelets as a possible early marker to predict clinical efficacy of leukocytapheresis in severe ulcerative colitis patients. J Gastroenterol 2006; 41:524-32. [PMID: 16868799 DOI: 10.1007/s00535-006-1789-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 01/31/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Leukocytapheresis (LCAP) is an effective adjunct for patients with active ulcerative colitis (UC). Because LCAP may have the potential to remove and modulate not only leukocytes but also platelets, we evaluated the correlation between activated platelets and the therapeutic response to LCAP. METHODS Fourteen patients with severe UC received weekly LCAP for 5 consecutive weeks. Their average clinical activity index (CAI) and endoscopic index (EI) were 9.6 +/- 3.4 and 10.9 +/- 1.0, respectively. Their peripheral blood was sampled before and after every LCAP and stained with fluorescent antibodies to the activation-dependent surface antigens of platelets (CD63, CD62-P) prior to flow cytometry. Endoscopic evaluations were performed after the last LCAP. RESULTS Clinical remission (CAI < 4) was induced in 50% of the patients (7/14) after 5 weeks, and there were no significant differences observed in clinical background between the responder group (RG) and the nonresponder group (NG). In the RG, the populations of CD63(+) (P < 0.03) and CD62-P(+) (P < 0.05) platelets were significantly decreased after the first LCAP, and their reduction ratio decreased gradually with repeated LCAP. A significant improvement of the EI score, especially mucosal damage, was achieved in RG (P < 0.04) but not in NG. CONCLUSIONS These results indicate that the therapeutic responses to LCAP were reflected in modulations of population and/or platelet functions, especially after the first session. The decrease of such activated platelets immediately after the first LCAP may be an early marker for predicting the response in patients with severe UC.
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Affiliation(s)
- Ken Fukunaga
- Division of Lower Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, 663-8501, Japan
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