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Sheppard FR, Mitchell TA, Macko AR, Fryer DM, Schaub LJ, Ozuna KM, Glaser JJ. Whole blood and Hextend: Bookends of modern tactical combat casualty care field resuscitation and starting point for multifunctional resuscitation fluid development. J Trauma Acute Care Surg 2018; 85:S33-S38. [PMID: 29261592 DOI: 10.1097/ta.0000000000001772] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hemorrhage is the leading cause of preventable death in traumatically injured civilian and military populations. Prehospital resuscitation largely relies on crystalloid and colloid intravascular expansion, as whole blood and component blood therapy are logistically arduous. In this experiment, we evaluated the bookends of Tactical Combat Casualty Care Guidelines recommendations of prehospital resuscitation with Hextend and whole blood in a controlled hemorrhagic shock model within non-human primates, as means of a multifunctional resuscitative fluid development. METHODS In the nonhuman primate, a multiple injuries model was used, consisting of a musculoskeletal injury (femur fracture), soft tissue injury (15-cm laparotomy), and controlled hemorrhage to a mean arterial pressure of 20 mm Hg, demarcating the beginning of the shock period. Animals were randomized to prehospital interventions of whole blood or Hextend at T = 0 minutes, and at T = 90 minutes definitive surgical interventions and balanced sanguineous damage control resuscitation could be implemented. All animals were euthanized at T = 480 minutes. Data are expressed as mean ± SEM; significance, p < 0.05. RESULTS No significant differences in survival (83% vs. 100%; p = 0.3), tissue perfusion (EtCO2 and StO2) or endpoints of resuscitation (base deficit, lactate, pH) between Hextend and whole blood were identified. Second, whole blood compared with Hextend demonstrated significantly earlier normalization of clot formation time, maximal clot firmness, and α angle. CONCLUSION A future multifunctional resuscitative fluid including an asanguineous, oncotic, non-oxygen-carrying component to facilitate intravascular volume expansion, and a component with synthetic coagulation factors and fibrinogen to deter coagulopathy may show equivalence to whole blood. LEVEL OF EVIDENCE N/A: Study type: translational animal model.
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Affiliation(s)
- Forest R Sheppard
- From the Department of Trauma and Expeditionary Medicine, Naval Medical Research Unit San Antonio (F.R.S., A.R.M., D.M.F., L.J.S., K.M.O., J.J.G.), JBSA-Ft. Sam Houston; Department of Surgery, San Antonio Military Medical Center (T.A.M., J.J.G.), JBSA-Ft. Sam Houston, Texas; and Washington University in St. Louis (F.R.S.), St. Louis, Missouri
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Nonhuman Primate (Rhesus Macaque) Models of Severe Pressure-Targeted Hemorrhagic and Polytraumatic Hemorrhagic Shock. Shock 2018; 49:174-186. [DOI: 10.1097/shk.0000000000000910] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nonhuman primate model of polytraumatic hemorrhagic shock recapitulates early platelet dysfunction observed following severe injury in humans. J Trauma Acute Care Surg 2017; 82:461-469. [PMID: 28225526 DOI: 10.1097/ta.0000000000001343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Platelet dysfunction has been described as an early component of trauma-induced coagulopathy. The platelet component of trauma-induced coagulopathy remains to be fully elucidated and translatable animal models are required to facilitate mechanistic investigations. We sought to determine if the early platelet dysfunction described in trauma patients could be recapitulated in a nonhuman primate model of polytraumatic hemorrhagic shock. METHODS Twenty-four male rhesus macaques weighting 7 to 14 kg were subjected to 60 minutes (min) of severe pressure-targeted controlled hemorrhagic shock (HS) with and without other injuries. After 60 min, resuscitation with 0.9% NaCl and whole blood was initiated. Platelet counts and platelet aggregation assays were performed at baseline (BSLN), end of shock (EOS; T = 60 min), end of resuscitation (EOR; T = 180 min), and T = 360 min on overall cohort. Results are reported as mean ± standard deviation (SD) or median (interquartile range). Statistical analysis was conducted using Spearmen correlation, one-way analysis of variance, two-way repeated-measures analysis of variance, paired t-test or Wilcoxon nonparametric test, with p < 0.05 considered significant. RESULTS Platelet count in all injury cohorts decreased over time, but no animals developed thrombocytopenia. Correlations were observed between platelet aggregation and platelet count for all agonists: adenosine diphosphate, thrombin recognition-activating peptide-6, collagen, and arachidonic acid. Overall, compared to BSLN, platelet aggregation decreased for all agonist at EOS, EOR, and T = 360 min. When normalized to platelet count, platelet aggregation in response to agonist thrombin recognition-activating peptide-6 demonstrated no change from BSLN at subsequent time points. Aggregation to adenosine diphosphate was significantly less at EOR but not EOS or T = 360 min compared to BSLN. Platelet aggregation to collagen and arachidonic acid was not significantly different at EOS compared to BSLN but was significantly less at EOR and T = 360 min. CONCLUSION Nonhuman primates manifest early platelet dysfunction in response to polytraumatic hemorrhagic shock, consistent with that reported in severely injured human patients. Nonhuman primate models potentially are translationally valuable for understanding the mechanisms and pathophysiology of trauma-induced platelet dysfunction.
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Lee SC, Lee H, Oh KB, Hwang IS, Yang H, Park MR, Ock SA, Woo JS, Im GS, Hwang S. Production and Breeding of Transgenic Cloned Pigs Expressing Human CD73. Dev Reprod 2017; 21:157-165. [PMID: 28785737 PMCID: PMC5532308 DOI: 10.12717/dr.2017.21.2.157] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 11/17/2022]
Abstract
One of the reasons to causing blood coagulation in the tissue of xenografted
organs was known to incompatibility of the blood coagulation and
anti-coagulation regulatory system between TG pigs and primates. Thus,
overexpression of human CD73 (hCD73) in the pig endothelial cells is considered
as a method to reduce coagulopathy after pig-to-non-human-primate
xenotransplantation. This study was performed to produce and breed transgenic
pigs expressing hCD73 for the studies immune rejection responses and could
provide a successful application of xenotransplantation. The transgenic cells
were constructed an hCD73 expression vector under control porcine Icam2 promoter
(pIcam2-hCD73) and established donor cell lines expressing hCD73. The numbers of
transferred reconstructed embryos were 127 ± 18.9. The pregnancy and delivery
rate of surrogates were 8/18 (44%) and 3/18 (16%). The total number of delivered
cloned pigs were 10 (2 alive, 7 mummy, and 1 died after birth). Among them,
three live hCD73-pigs were successfully delivered by Caesarean section, but one
was dead after birth. The two hCD73 TG cloned pigs had normal reproductive
ability. They mated with wild type (WT) MGH (Massachusetts General Hospital)
female sows and produced totally 16 piglets. Among them, 5 piglets were
identified as hCD73 TG pigs. In conclusion, we successfully generated the hCD73
transgenic cloned pigs and produced their litters by natural mating. It can be
possible to use a mate for the production of multiple transgenic pigs such as
α-1,3-galactosyltransferase knock-out /hCD46 for xenotransplantation.
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Affiliation(s)
- Seung-Chan Lee
- Animal Biotechnology Division, National Institute of Animal Science, RDA, Wanju 55365, Republic of Korea
| | - Haesun Lee
- Animal Biotechnology Division, National Institute of Animal Science, RDA, Wanju 55365, Republic of Korea
| | - Keon Bong Oh
- Animal Biotechnology Division, National Institute of Animal Science, RDA, Wanju 55365, Republic of Korea
| | - In-Sul Hwang
- Animal Biotechnology Division, National Institute of Animal Science, RDA, Wanju 55365, Republic of Korea
| | - Hyeon Yang
- Animal Biotechnology Division, National Institute of Animal Science, RDA, Wanju 55365, Republic of Korea
| | - Mi-Ryung Park
- Animal Biotechnology Division, National Institute of Animal Science, RDA, Wanju 55365, Republic of Korea
| | - Sun-A Ock
- Animal Biotechnology Division, National Institute of Animal Science, RDA, Wanju 55365, Republic of Korea
| | - Jae-Seok Woo
- Animal Biotechnology Division, National Institute of Animal Science, RDA, Wanju 55365, Republic of Korea
| | - Gi-Sun Im
- Animal Biotechnology Division, National Institute of Animal Science, RDA, Wanju 55365, Republic of Korea
| | - Seongsoo Hwang
- Animal Biotechnology Division, National Institute of Animal Science, RDA, Wanju 55365, Republic of Korea
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Choi K, Shim J, Ko N, Eom H, Kim J, Lee JW, Jin DI, Kim H. Production of heterozygous alpha 1,3-galactosyltransferase (GGTA1) knock-out transgenic miniature pigs expressing human CD39. Transgenic Res 2016; 26:209-224. [PMID: 27830476 DOI: 10.1007/s11248-016-9996-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 11/02/2016] [Indexed: 12/21/2022]
Abstract
Production of transgenic pigs for use as xenotransplant donors is a solution to the severe shortage of human organs for transplantation. The first barrier to successful xenotransplantation is hyperacute rejection, a rapid, massive humoral immune response directed against the pig carbohydrate GGTA1 epitope. Platelet activation, adherence, and clumping, all major features of thrombotic microangiopathy, are inevitable results of immune-mediated transplant rejection. Human CD39 rapidly hydrolyzes ATP and ADP to AMP; AMP is hydrolyzed by ecto-5'-nucleotidase (CD73) to adenosine, an anti-thrombotic and cardiovascular protective mediator. In this study, we developed a vector-based strategy for ablation of GGTA1 function and concurrent expression of human CD39 (hCD39). An hCD39 expression cassette was constructed to target exon 4 of GGTA1. We established heterozygous GGTA1 knock-out cell lines expressing hCD39 from pig ear fibroblasts for somatic cell nuclear transfer (SCNT). We also described production of heterozygous GGTA1 knock-out piglets expressing hCD39 and analyzed expression and function of the transgene. Human CD39 was expressed in heart, kidney and aorta. Human CD39 knock-in heterozygous ear fibroblast from transgenic cloned pigs, but not in non-transgenic pig's cells. Expression of GGTA1 gene was lower in the knock-in heterozygous ear fibroblast from transgenic pigs compared to the non-transgenic pig's cell. The peripheral blood mononuclear cells (PBMC) from the transgenic pigs were more resistant to lysis by pooled complement-preserved normal human serum than that from wild type (WT) pig. Accordingly, GGTA1 mutated piglets expressing hCD39 will provide a new organ source for xenotransplantation research.
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Affiliation(s)
- Kimyung Choi
- Optipharm Inc., 63, Osongsaengmyeong 6-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Joohyun Shim
- Optipharm Inc., 63, Osongsaengmyeong 6-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Nayoung Ko
- Optipharm Inc., 63, Osongsaengmyeong 6-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Heejong Eom
- Optipharm Inc., 63, Osongsaengmyeong 6-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Jiho Kim
- Optipharm Inc., 63, Osongsaengmyeong 6-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Jeong-Woong Lee
- Functional Genomics Research Center, Korea Research Institute of Bioscience and Biotechnology, Daejeon, Republic of Korea
| | - Dong-Il Jin
- Department of Animal Science and Biotechnology, Chungnam National University, Daejeon, Republic of Korea
| | - Hyunil Kim
- Optipharm Inc., 63, Osongsaengmyeong 6-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do, Republic of Korea.
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Control of severe intra-abdominal hemorrhage with an infusible platelet-derived hemostatic agent in a nonhuman primate (rhesus macaque) model. J Trauma Acute Care Surg 2016; 80:617-24. [PMID: 26808038 DOI: 10.1097/ta.0000000000000964] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hemorrhage remains the leading cause of potentially survivable trauma mortality. Recent reports indicate that injuries sustained in noncompressible anatomic locations (i.e., truncal and junctional) account for 86.5% of hemorrhage-related deaths. Infusible human platelet-derived hemostatic agents (hPDHAs) represent a promising strategy to reduce blood loss from noncompressible injuries. Here, we evaluate the hemostatic efficacy of a lyophilized hPDHA in a rhesus macaque model of severe, uncontrolled hemorrhage. METHODS Hemorrhage was induced via laparoscopic 60% left-lobe hepatectomy in anesthetized rhesus macaques (T = 0 minute). Treatment infusion began with an 11-mL bolus (T = 5-6 minutes) of either 5% albumin solution (control; n = 8) or hPDHA (1.2 × 10(10) platelet equivalents, n = 8), followed by 2.8-mL/min 0.9% normal saline at T = 6-20 minutes. Resuscitation continued with normal saline (0.22 mL/kg/min) to a total volume of 20 mL/kg at T = 120 minutes, at which time surgical hemostasis was achieved and percent blood loss quantified. Animals were monitored until T = 480 minutes and then euthanized, and necropsy was performed with emphasis on intravascular and end-organ thrombi. Data are expressed as mean ± SEM; significance, p < 0.05. RESULTS Both groups exhibited a ∼70% decrease in mean arterial pressure (MAP) from T = 0-5 minutes. Percent blood loss was 44.2 ± 3.9% in hPDHA animals, and 44.3 ± 3.3% in controls. Survival rates were 4 of 8 for hPDHA animals and 7 of 8 for controls. Regardless of treatment, percent blood loss was greater (p < 0.02) in nonsurviving animals (55 ± 2%, n = 5) compared with surviving animals (42% ± 3%, n = 11). No pathologic intravascular thrombi were observed in either group. CONCLUSION The isolated administration of hPDHA did not significantly reduce blood loss; however, thrombocytopenia was not present in the model, and clinically, platelets would be administered in combination with plasma. Mortality was not statistically different between groups (p = 0.14) but was related to blood loss. Future studies should consider the use of hPDHA in combination with additional therapeutics (e.g., factors) and a model that incorporates thrombocytopenia or platelet dysfunction.
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Development of a Nonhuman Primate (Rhesus Macaque) Model of Uncontrolled Traumatic Liver Hemorrhage. Shock 2015; 44 Suppl 1:114-22. [DOI: 10.1097/shk.0000000000000335] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
INTRODUCTION Lyophilization may facilitate production of a safe, portable, easily storable, and transportable source of platelets for bleeding patients. The objective of this study was to examine the impact of lyophilized human and porcine platelets in a swine liver injury model of nonsurgical hemorrhage. METHODS Anesthetized pigs (40 kg) had a controlled 35% total blood volume bleed from the right jugular vein followed by cooling to 35°C and resuscitation with Ringer's lactate to achieve a 3:1 blood withdrawal resuscitation. Through a midline laparotomy, the liver was injured with two standardized 5 × 5-cm grids with lacerations 1 cm apart and 0.5 cm deep. After 2 min of uncontrolled hemorrhage, the animals were treated with placebo (n = 5), lyophilized human (n = 5, HP), or swine platelets (n = 5, SP). At 15 min, shed blood was calculated. The animals then underwent abdominal closure. At 48 h, the animals were killed for histopathologic evaluation of the lung, kidney, and heart. RESULTS Intraoperative blood loss at 15 min was significantly higher in the HP arm (SP: 4.9 ± 2.9 mL/kg, HP: 12.3 ± 4.7 mL/kg, and control: 6.1 ± 2.5 mL/kg; P = 0.013). Mortality at 48 h was 20% in all three arms, due to uncontrolled intra-abdominal bleeding. At the time the animals were killed, SP animals had a significantly higher hematocrit (SP: 22.0% ± 3.0%, HP: 15.1% ± 4.9%, and control: 13.9% ± 0.6%; P = 0.026). No significant difference was found in platelet count (SP: 319.3 ± 62.1 × 10(3)/µL, HP:361.5 ± 133.6 × 10(3)/µL, and control: 242.7 ± 42.5 × 10(3)/µL; P = 0.259). Histopathology of kidneys, lungs, and heart demonstrated no evidence of thromboembolic complications. CONCLUSION In this swine model of liver injury, human lyophilized platelets increased intraoperative blood loss. With the use of species-specific lyophilized platelets, however, this effect was abolished, with a decrease in blood loss at 48 h after injury.
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Gock H, Nottle M, Lew AM, d'Apice AJ, Cowan P. Genetic modification of pigs for solid organ xenotransplantation. Transplant Rev (Orlando) 2011; 25:9-20. [DOI: 10.1016/j.trre.2010.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 08/13/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
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Interrelation between peripheral platelet count and platelet activation during and after liver surgery in pigs. Blood Coagul Fibrinolysis 2010; 21:237-41. [DOI: 10.1097/mbc.0b013e3283358149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Current world literature. Curr Opin Organ Transplant 2009; 14:211-7. [PMID: 19307967 DOI: 10.1097/mot.0b013e32832ad721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baertschiger RM, Buhler LH. Xenotransplantation literature update January-February, 2008. Xenotransplantation 2008; 15:200-4. [PMID: 18611229 DOI: 10.1111/j.1399-3089.2008.00473.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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Baertschiger RM, Buhler LH. Xenotransplantation literature update May-August, 2007. Xenotransplantation 2007; 14:642-52. [PMID: 17991153 DOI: 10.1111/j.1399-3089.2007.00431.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Reto M Baertschiger
- Surgical Research Unit, Department of Surgery, University Hospital Geneva, Geneva, Switzerland
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