1
|
Barletta JF, Erstad BL. Dosing Medications for Coagulopathy Reversal in Patients with Extreme Obesity. J Emerg Med 2022; 63:541-550. [PMID: 35906122 DOI: 10.1016/j.jemermed.2022.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/22/2022] [Accepted: 04/23/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND The reversal of anticoagulant or antiplatelet medications is a priority in the management of patients with severe injury with the goal of minimizing further bleeding without thrombotic complications. There are few studies, however, evaluating the dosing of reversal agents in the setting of trauma specific to patients with extreme obesity. Nevertheless, clinicians must still make decisions, balancing concerns of ongoing bleeding with excessive thrombosis. OBJECTIVES We describe the literature pertaining to dosing of medications used for the reversal of both drug-induced and trauma-related coagulopathy with the intent of providing a framework for clinicians to make dosing decisions in this challenging population. DISCUSSION Obesity is known to impact both the volume of distribution and the clearance of medications, but these changes are not usually linear with size nor are they uniform across drugs. Current strategies for dosing reversal agents in obesity include a capped dose (e.g., prothrombin complex concentrates), fixed dosages (e.g., andexanet alfa, idarucizumab, and tranexamic acid), and weight-based dosing (e.g., desmopressin). Extreme obesity, however, was not highly prevalent in the studies that have validated these dosing strategies. In fact, many of the clinical studies fail to report the average weight of the patients included. CONCLUSION Future studies should make efforts to increase reporting of patients with obesity included in clinical trials along with results stratified by weight class. In the meantime, doses listed in product labels should be used. Desmopressin should be dosed using either ideal body weight or a dose-capping strategy.
Collapse
Affiliation(s)
- Jeffrey F Barletta
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale
| | - Brian L Erstad
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, Arizona
| |
Collapse
|
2
|
Yokota Y, Inatomi O, Nakagawa M, Kakuda K, Hiroe K, Sakai S, Osaki R, Iwasa M, Kawahara M, Kito K, Andoh A, Bamba H. Acquired Coagulation Factor V Inhibitor That Was Successfully Treated with Oral Corticosteroid Therapy. Intern Med 2021; 60:2663-2666. [PMID: 34121013 PMCID: PMC8429299 DOI: 10.2169/internalmedicine.7453-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Acquired coagulation factor V (FV) inhibitors are rare disorders in which antibodies against FV develop under various conditions. We herein report the case of a 71-year-old woman with FV inhibitor during radiochemotherapy for pancreatic cancer. Multiple purpuras suddenly appeared on her bilateral upper limbs with prolonged coagulation data (APTT 97.3 seconds). The FV activity was less than 3% and the FV inhibitor was positive (1.7 B.U./mL). Oral prednisolone induced a rapid normalization of the coagulation data and FV activity and a rapid disappearance of FV inhibitor within 7 days. Early diagnosis and treatment may therefore be important in cases of FV inhibitor.
Collapse
Affiliation(s)
- Yoshihiro Yokota
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| | - Osamu Inatomi
- Department of Medicine, Shiga University of Medical Science, Japan
| | - Minami Nakagawa
- Department of Clinical Laboratory Medicine, Nagahama Red Cross Hospital, Japan
| | - Kazuki Kakuda
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| | - Kousuke Hiroe
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| | - Shigeki Sakai
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| | - Rie Osaki
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| | - Masaki Iwasa
- Department of Medicine, Shiga University of Medical Science, Japan
| | | | - Katsuyuki Kito
- Department of Medicine, Shiga University of Medical Science, Japan
| | - Akira Andoh
- Department of Medicine, Shiga University of Medical Science, Japan
| | - Hiromichi Bamba
- Department of Gastroenterology, Nagahama Red Cross Hospital, Japan
| |
Collapse
|
3
|
Désage S, Chamouard V, Meunier S, Enjolras N, Sobas F, Négrier C, Le Quellec S. Management of intracranial haemorrhage in a newborn with inherited factor VII deficiency with the use of rFVIIa aliquots. Haemophilia 2020; 27:e487-e490. [PMID: 33215792 DOI: 10.1111/hae.14199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/17/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Stéphanie Désage
- Unité d'hémostase clinique, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Valérie Chamouard
- Unité d'hémostase clinique, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Sandrine Meunier
- Unité d'hémostase clinique, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Nathalie Enjolras
- EA 4609 Hémostase et cancer, Université Claude Bernard Lyon 1, Lyon, France
| | - Frédéric Sobas
- Service d'hématologie biologique, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Claude Négrier
- Unité d'hémostase clinique, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France.,EA 4609 Hémostase et cancer, Université Claude Bernard Lyon 1, Lyon, France.,Service d'hématologie biologique, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Sandra Le Quellec
- Unité d'hémostase clinique, Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, Lyon, France.,EA 4609 Hémostase et cancer, Université Claude Bernard Lyon 1, Lyon, France.,Service d'hématologie biologique, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
4
|
Gorkom BLV, Holme PA, Joch C, Rogosch T, Feussner A, McKeand W, Roberts J, van Heerde W. Pharmacokinetics and pharmacodynamics of a recombinant fusion protein linking activated coagulation factor VII with human albumin (rVIIa-FP) in patients with congenital FVII deficiency. ACTA ACUST UNITED AC 2020; 25:17-25. [PMID: 31852380 DOI: 10.1080/16078454.2019.1700329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Recombinant fusion protein linking activated factor VIIa to human albumin (rVIIa-FP) is a therapeutic option designed to prevent and treat bleeding events in patients with congenital FVII deficiency with reduced infusion frequency compared to current FVII treatments. This study characterized the pharmacokinetics (PK) and pharmacodynamics (PD) of rVIIa-FP.Methods: A phase I multicenter, randomized, open-label, parallel-arm, single-dose study (NCT02470871) was conducted in nine patients with severe congenital FVII deficiency. Patients received their routine FVII product (30 IU/kg plasma-derived FVII [pdFVII] or 25 μg/kg recombinant activated FVII (rFVIIa) [eptacog alfa]), and were then randomly assigned to receive 100 or 300 μg/kg of rVIIa-FP. Blood samples for PK and PD assessments were drawn up to 48 hr after administration. FVIIa activity was determined using a one-stage clotting assay. PD parameters were derived from thrombin generation testing, using the Nijmegen hemostasis assay.Results: rVIIa-FP showed improved PK compared to rFVIIa, with 2- to 3-fold longer t1/2 and 4- to 8-fold lower clearance. Analysis of PD data showed a sustained suppression of lag time below 4.5 min (upper limit of healthy people) for rVIIa-FP compared to rFVIIa. AUEC and ECmax were similar across the two dose groups of rVIIa-FP and rFVIIa.Discussion: rVIIa-FP was well tolerated in patients with congenital FVII deficiency, showed a longer half-life and lower clearance compared to rFVIIa, and lag time remaining within healthy ranges for ≥8 hr.Conclusion: These results warrant further investigation into the efficacy of rVIIa-FP to control and prevent bleeding in patients with FVII deficiency.
Collapse
Affiliation(s)
- Britta Laros-van Gorkom
- Department of Hematology and Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pål André Holme
- Department of Hematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | | | | | | | | | - Waander van Heerde
- Department of Hematology and Hemophilia Treatment Center Nijmegen-Eindhoven-Maastricht, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Laboratory Medicine, Hematology Laboratory, Radboud University Medical Center, Nijmegen, Netherlands.,Enzyre, Novio Tech Campus, Nijmegen, The Netherlands
| |
Collapse
|
5
|
Factor VIIa. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
6
|
Giuffrida G, Nicolosi D, Giuffrida A, Rapisarda C, Calafiore V, Giuffrida A, Di Raimondo F. Successful coronary artery bypass graft surgery in severe congenital factor VII deficiency: Perioperative treatment with pd-factor VII concentrate. Haemophilia 2018; 25:e135-e137. [PMID: 30589157 DOI: 10.1111/hae.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- G Giuffrida
- Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - D Nicolosi
- Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - A Giuffrida
- UOC Diagnostics Imaging and Radiotherapy, University of Naples Federico II, Naples, Italy
| | - C Rapisarda
- Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - V Calafiore
- Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - A Giuffrida
- UOC Cardiac Surgery, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - F Di Raimondo
- Division of Haematology, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| |
Collapse
|
7
|
Cattivelli K, Distefano C, Bonetti L, Testa S, Siboni SM, Plebani A, Poggiani C. Recurrent Bleedings in Newborn: A Factor VII Deficiency Case Report. Transfus Med Hemother 2018; 45:104-106. [PMID: 29765293 DOI: 10.1159/000481993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/29/2017] [Indexed: 11/19/2022] Open
Abstract
Background: Major hemorrhages in newborns can be caused by several conditions, and knowledge of the differential diagnosis is essential in order to ensure prompt recognition and appropriate treatment. Case Report: We describe the case of a male newborn experiencing recurrent hemorrhages from the first days of life. Laboratory findings showed normal platelet count, hepatic function, and C-reactive protein. Coagulation tests detected an isolated prothrombin time (PT) prolongation and severe factor VII (FVII) deficiency. Conclusion: Inherited FVII deficiency is a rare autosomal recessive bleeding disorder. Clinical presentation is heterogeneous, and bleeding severity is not directly related to FVII levels. Acute bleeding episodes can be treated with human plasma-derived FVII (pdFVII) or recombinant activated FVII (rFVIIa). In case of severe deficiency, prophylaxis must be evaluated. Awareness of this condition is crucial in order to establish prompt diagnosis and treatment.
Collapse
Affiliation(s)
- Kim Cattivelli
- Pediatrics Clinic, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Distefano
- Pediatrics Clinic, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Lorenza Bonetti
- Pediatrics Department, Istituti Ospedalieri di Cremona, Cremona, Italy
| | - Sophie Testa
- Hemostasis and Thrombosis Center, Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Simona Maria Siboni
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Plebani
- Pediatrics Clinic, University of Brescia, Spedali Civili di Brescia, Brescia, Italy
| | - Carlo Poggiani
- Neonatal Intensive Care Unit, Istituti Ospedalieri di Cremona, Cremona, Italy
| |
Collapse
|
8
|
Strauss E, Mazzeffi M, Williams B, Key N, Tanaka K. Perioperative management of rare coagulation factor deficiency states in cardiac surgery. Br J Anaesth 2017; 119:354-368. [DOI: 10.1093/bja/aex198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2017] [Indexed: 01/21/2023] Open
|
9
|
Hansen CE, Myers DR, Baldwin WH, Sakurai Y, Meeks SL, Lyon LA, Lam WA. Platelet-Microcapsule Hybrids Leverage Contractile Force for Targeted Delivery of Hemostatic Agents. ACS NANO 2017; 11:5579-5589. [PMID: 28541681 DOI: 10.1021/acsnano.7b00929] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report a cell-mediated, targeted drug delivery system utilizing polyelectrolyte multilayer capsules that hybridize with the patient's own platelets upon intravenous administration. The hybridized platelets function as the sensor and actuator for targeted drug delivery and controlled release in our system. These capsules are biochemically and mechanically tuned to enable platelet adhesion and capsule rupture upon platelet activation and contraction, enabling the targeted and controlled "burst" release of an encapsulated biotherapeutic. As platelets are the "first responders" in the blood clot formation process, this platelet-hybridized system is ideal for the targeted delivery of clot-augmenting biotherapeutics wherein immediate therapeutic efficacy is required. As proof-of-concept, we tailored this system to deliver the pro-clotting biotherapeutic factor VIII for hemophilia A patients that have developed inhibitory antifactor VIII antibodies. The polyelectrolyte multilayer capsules physically shield the encapsulated factor VIII from the patient's inhibitors during circulation, preserving its bioactivity until it is delivered at the target site via platelet contractile force. Using an in vitro microfluidic vascular injury model with factor VIII-inhibited blood, we demonstrate a 3.8× increase in induced fibrin formation using capsules loaded with factor VIII at a concentration an order of magnitude lower than that used in systemic delivery. We further demonstrate that clot formation occurs 18 min faster when factor VIII loaded capsules are used compared to systemic delivery at the same concentration. Because platelets are integral in the pathophysiology of thrombotic disorders, cancer, and innate immunity, this paradigm-shifting smart drug delivery system can be similarly applied to these diseases.
Collapse
Affiliation(s)
- Caroline E Hansen
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine , Atlanta, Georgia 30322, United States
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University , Atlanta, Georgia 30332, United States
| | - David R Myers
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine , Atlanta, Georgia 30322, United States
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University , Atlanta, Georgia 30332, United States
| | - W Hunter Baldwin
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine , Atlanta, Georgia 30322, United States
| | - Yumiko Sakurai
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine , Atlanta, Georgia 30322, United States
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University , Atlanta, Georgia 30332, United States
| | - Shannon L Meeks
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine , Atlanta, Georgia 30322, United States
| | - L Andrew Lyon
- Schmid College of Science and Technology, Chapman University , Orange, California 92866, United States
| | - Wilbur A Lam
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Children's Healthcare of Atlanta/Emory University School of Medicine , Atlanta, Georgia 30322, United States
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University , Atlanta, Georgia 30332, United States
| |
Collapse
|
10
|
Fazavana JG, Muczynski V, Proulle V, Wohner N, Christophe OD, Lenting PJ, Denis CV. LDL receptor-related protein 1 contributes to the clearance of the activated factor VII-antithrombin complex. J Thromb Haemost 2016; 14:2458-2470. [PMID: 27614059 DOI: 10.1111/jth.13502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Abstract
Essentials Factor VIIa is cleared principally as a complex with antithrombin. Enzyme/serpin complexes are preferred ligands for the scavenger-receptor LRP1. Factor VIIa/antithrombin but not factor VIIa alone is a ligand for LRP1. Macrophage-expressed LRP1 contributes to the clearance of factor VIIa/antithrombin. SUMMARY Background Recent findings point to activated factor VII (FVIIa) being cleared predominantly (± 65% of the injected protein) as part of a complex with the serpin antithrombin. FVIIa-antithrombin complexes are targeted to hepatocytes and liver macrophages. Both cells lines abundantly express LDL receptor-related protein 1 (LRP1), a scavenger receptor mediating the clearance of protease-serpin complexes. Objectives To investigate whether FVIIa-antithrombin is a ligand for LRP1. Methods Binding of FVIIa and pre-formed FVIIa-antithrombin to purified LRP1 Fc-tagged cluster IV (rLRP1-cIV/Fc) and to human and murine macrophages was analyzed. FVIIa clearance was determined in macrophage LRP1 (macLRP1)-deficient mice. Results Solid-phase binding assays showed that FVIIa-antithrombin bound in a specific, dose-dependent and saturable manner to rLRP1-cIV/Fc. Competition experiments with human THP1 macrophages indicated that binding of FVIIa but not of FVIIa-antithrombin was reduced in the presence of annexin-V or anti-tissue factor antibodies, whereas binding of FVIIa-antithrombin but not FVIIa was inhibited by the LRP1-antagonist GST-RAP. Additional experiments revealed binding of both FVIIa and FVIIa-antithrombin to murine control macrophages. In contrast, no binding of FVIIa-antithrombin to macrophages derived from macLRP1-deficient mice could be detected. Clearance of FVIIa-antithrombin but not of active site-blocked FVIIa was delayed 1.5-fold (mean residence time of 3.3 ± 0.1 h versus 2.4 ± 0.2 h) in macLRP1-deficient mice. The circulatory presence of FVIIa was prolonged to a similar extent in macLRP1-deficient mice and in control mice. Conclusions Our data show that FVIIa-antithrombin but not FVIIa is a ligand for LRP1, and that LRP1 contributes to the clearance of FVIIa-antithrombin in vivo.
Collapse
Affiliation(s)
- J G Fazavana
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1176, Universitaires Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - V Muczynski
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1176, Universitaires Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - V Proulle
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1176, Universitaires Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Department of Biological Hematology, CHU Bicetre, Hôpitaux Universitaires Paris Sud, AP-HP, Paris, France
| | - N Wohner
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1176, Universitaires Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - O D Christophe
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1176, Universitaires Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - P J Lenting
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1176, Universitaires Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - C V Denis
- Institut National de la Santé et de la Recherche Médicale, UMR_S 1176, Universitaires Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| |
Collapse
|
11
|
The Use of Gene Ontology Term and KEGG Pathway Enrichment for Analysis of Drug Half-Life. PLoS One 2016; 11:e0165496. [PMID: 27780226 PMCID: PMC5079577 DOI: 10.1371/journal.pone.0165496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/12/2016] [Indexed: 02/07/2023] Open
Abstract
A drug's biological half-life is defined as the time required for the human body to metabolize or eliminate 50% of the initial drug dosage. Correctly measuring the half-life of a given drug is helpful for the safe and accurate usage of the drug. In this study, we investigated which gene ontology (GO) terms and biological pathways were highly related to the determination of drug half-life. The investigated drugs, with known half-lives, were analyzed based on their enrichment scores for associated GO terms and KEGG pathways. These scores indicate which GO terms or KEGG pathways the drug targets. The feature selection method, minimum redundancy maximum relevance, was used to analyze these GO terms and KEGG pathways and to identify important GO terms and pathways, such as sodium-independent organic anion transmembrane transporter activity (GO:0015347), monoamine transmembrane transporter activity (GO:0008504), negative regulation of synaptic transmission (GO:0050805), neuroactive ligand-receptor interaction (hsa04080), serotonergic synapse (hsa04726), and linoleic acid metabolism (hsa00591), among others. This analysis confirmed our results and may show evidence for a new method in studying drug half-lives and building effective computational methods for the prediction of drug half-lives.
Collapse
|
12
|
Ghadimi K, Levy JH, Welsby IJ. Prothrombin Complex Concentrates for Bleeding in the Perioperative Setting. Anesth Analg 2016; 122:1287-300. [PMID: 26983050 DOI: 10.1213/ane.0000000000001188] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Prothrombin complex concentrates (PCCs) contain vitamin K-dependent clotting factors (II, VII, IX, and X) and are marketed as 3 or 4 factor-PCC formulations depending on the concentrations of factor VII. PCCs rapidly restore deficient coagulation factor concentrations to achieve hemostasis, but like with all procoagulants, the effect is balanced against thromboembolic risk. The latter is dependent on both the dose of PCCs and the individual patient prothrombotic predisposition. PCCs are approved by the US Food and Drug Administration for the reversal of vitamin K antagonists in the setting of coagulopathy or bleeding and, therefore, can be administered when urgent surgery is required in patients taking warfarin. However, there is growing experience with the off-label use of PCCs to treat patients with surgical coagulopathic bleeding. Despite their increasing use, there are limited prospective data related to the safety, efficacy, and dosing of PCCs for this indication. PCC administration in the perioperative setting may be tailored to the individual patient based on the laboratory and clinical variables, including point-of-care coagulation testing, to balance hemostatic benefits while minimizing the prothrombotic risk. Importantly, in patients with perioperative bleeding, other considerations should include treating additional sources of coagulopathy such as hypofibrinogenemia, thrombocytopenia, and platelet disorders or surgical sources of bleeding. Thromboembolic risk from excessive PCC dosing may be present well into the postoperative period after hemostasis is achieved owing to the relatively long half-life of prothrombin (factor II, 60-72 hours). The integration of PCCs into comprehensive perioperative coagulation treatment algorithms for refractory bleeding is increasingly reported, but further studies are needed to better evaluate the safe and effective administration of these factor concentrates.
Collapse
Affiliation(s)
- Kamrouz Ghadimi
- From the Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
| | | | | |
Collapse
|
13
|
Abstract
Glanzmann's thrombasthenia (GT) and congenital factor VII deficiency (FVII CD) are rare autosomal recessive bleeding disorders: GT is the most frequent congenital platelet function disorder, and FVII CD is the most common factor-deficiency disease after haemophilia. The frequency of these disorders in the general population ranges from 1:500,000 to 1:2,000,000. Because GT and FVII CD are both rare, registries are the only approach possible to allow the collection and analysis of sufficient observational data. Recombinant activated factor VII (rFVIIa, eptacog alfa activated) is indicated for the treatment of acute bleeding episodes and for surgery coverage in patients with GT who are refractory to platelets and have antiplatelet or anti-human leukocyte antigen (HLA) antibodies, and for the prevention and treatment of bleeding in patients with FVII CD. This article summarises published data on the mechanism of action and use of rFVIIa in these disorders from two international, prospective, observational registries: the Glanzmann's Thrombasthenia Registry (GTR) for GT; and the Seven Treatment Evaluation Registry (STER) for FVII CD. Haemostatic effectiveness rates with rFVIIa were high across all patients with GT and those with FVII CD, and treatment with rFVIIa in the GTR and STER registries was well tolerated. The GTR and the STER are the largest collections of data in GT and FVII CD, respectively, and have expanded our knowledge of the management of these two rare bleeding disorders.
Collapse
|
14
|
Casini A, de Moerloose P. Factor concentrates for rare congenital coagulation disorders: where are we now? Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2016.1108188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
15
|
Böhm E, Seyfried BK, Dockal M, Graninger M, Hasslacher M, Neurath M, Konetschny C, Matthiessen P, Mitterer A, Scheiflinger F. Differences in N-glycosylation of recombinant human coagulation factor VII derived from BHK, CHO, and HEK293 cells. BMC Biotechnol 2015; 15:87. [PMID: 26382581 PMCID: PMC4574471 DOI: 10.1186/s12896-015-0205-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 09/09/2015] [Indexed: 04/16/2023] Open
Abstract
UNLABELLED BACKGROUND & METHODS Recombinant factor VII (rFVII), the precursor molecule for recombinant activated FVII (rFVIIa), is, due to its need for complex post translational modifications, produced in mammalian cells. To evaluate the suitability of a human cell line in order to produce rFVII with post-translational modifications as close as possible to pdFVII, we compared the biochemical properties of rFVII synthesized in human embryonic kidney-derived (HEK)293 cells (HEK293rFVII) with those of rFVII expressed in Chinese hamster ovary (CHO, CHOrFVII) and baby hamster kidney (BHK, BHKrFVII) cells, and also with those of plasma derived FVII (pdFVII), using various analytical methods. rFVII was purified from selected production clones derived from BHK, CHO, and HEK293 cells after stable transfection, and rFVII isolates were analyzed for protein activity, impurities and post-translational modifications. RESULTS & DISCUSSION The analytical results showed no apparent gross differences between the various FVII proteins, except in their N-linked glycosylation pattern. Most N-glycans found on rFVII produced in HEK293 cells were not detected on rFVII from CHO and BHK cells, or, somewhat unexpectedly, on pdFVII; all other protein features were similar. HEK293rFVII glycans were mainly characterized by a higher structural variety and a lower degree of terminal sialylation, and a high amount of terminal N-acetyl galactosamines (GalNAc). All HEK293rFVII oligosaccharides contained one or more fucoses (Fuc), as well as hybrid and high mannose (Man) structures. CONCLUSIONS From all rFVII isolates investigated, CHOrFVII contained the highest degree of sialylation and no terminal GalNAc, and CHO cells were therefore assumed to be the best option for the production of rFVII.
Collapse
Affiliation(s)
- Ernst Böhm
- Baxalta Innovations GmbH, Uferstraße 15, A-2304, Orth/Donau, Austria.
| | - Birgit K Seyfried
- Baxalta Innovations GmbH, Uferstraße 15, A-2304, Orth/Donau, Austria.
| | - Michael Dockal
- Baxalta Innovations GmbH, Uferstraße 15, A-2304, Orth/Donau, Austria.
| | - Michael Graninger
- Baxalta Innovations GmbH, Uferstraße 15, A-2304, Orth/Donau, Austria.
| | | | - Marianne Neurath
- Baxalta Innovations GmbH, Uferstraße 15, A-2304, Orth/Donau, Austria.
| | | | - Peter Matthiessen
- BaxaltaInnovations GmbH, Industriestraße 72, A-1220, Vienna, Austria.
| | - Artur Mitterer
- Baxalta Innovations GmbH, Uferstraße 15, A-2304, Orth/Donau, Austria.
| | | |
Collapse
|
16
|
Siboni SM, Biguzzi E, Mistretta C, Garagiola I, Peyvandi F. Long-term prophylaxis in severe factor VII deficiency. Haemophilia 2015; 21:812-9. [DOI: 10.1111/hae.12702] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 12/19/2022]
Affiliation(s)
- S. M. Siboni
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Dipartimento delle Units Multispecialistiche e dei Trapianti; Unità Operativa Complessa di Ematologia non Tumorale e Coagulopatie; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - E. Biguzzi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Dipartimento delle Units Multispecialistiche e dei Trapianti; Unità Operativa Complessa di Ematologia non Tumorale e Coagulopatie; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - C. Mistretta
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Dipartimento delle Units Multispecialistiche e dei Trapianti; Unità Operativa Complessa di Ematologia non Tumorale e Coagulopatie; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - I. Garagiola
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Dipartimento delle Units Multispecialistiche e dei Trapianti; Unità Operativa Complessa di Ematologia non Tumorale e Coagulopatie; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - F. Peyvandi
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center; Dipartimento delle Units Multispecialistiche e dei Trapianti; Unità Operativa Complessa di Ematologia non Tumorale e Coagulopatie; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| |
Collapse
|
17
|
Mumford AD, Ackroyd S, Alikhan R, Bowles L, Chowdary P, Grainger J, Mainwaring J, Mathias M, O'Connell N. Guideline for the diagnosis and management of the rare coagulation disorders: a United Kingdom Haemophilia Centre Doctors' Organization guideline on behalf of the British Committee for Standards in Haematology. Br J Haematol 2014; 167:304-26. [PMID: 25100430 DOI: 10.1111/bjh.13058] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Andrew D Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Promising coagulation factor VIII bypassing strategies for patients with haemophilia A. Blood Coagul Fibrinolysis 2014; 25:539-52. [DOI: 10.1097/mbc.0000000000000098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
19
|
Morfini M, Batorova A, Mariani G, Auerswald G, Bernardi F, Di Minno G, Dolce A, Fede C, Giansily-Blaizot M, Ingerslev J, Martinowitz U, Napolitano M, Pinotti M, Schved JF. Pharmacokinetic properties of recombinant FVIIa in inherited FVII deficiency account for a large volume of distribution at steady state and a prolonged pharmacodynamic effect. Thromb Haemost 2014; 112:424-5. [PMID: 24763923 DOI: 10.1160/th13-12-1045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 03/11/2014] [Indexed: 12/17/2022]
Affiliation(s)
- M Morfini
- Massimo Morfini, Agency for Hemophilia and Regional Reference Center for Inherited Bleeding Disorders, Azienda Ospedalieriero, Universitaria Careggi, Florence, Italy, Tel.: +39 055 7947587, Fax: +39 055 7947794, E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Vestergaard B, Appa RS, Lykkesfeldt J, Agersø H. The kidneys play an important role in the clearance of rFVIIa in rats. Thromb Res 2014; 133:1124-9. [PMID: 24731563 DOI: 10.1016/j.thromres.2014.03.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 02/10/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Previous distribution and histological studies have indicated that the kidneys and renal proximal tubular cells play a role in clearance of rFVIIa. However, the relative importance of the kidneys in clearance of rFVIIa has not previously been addressed. The objective of the present study was to evaluate the importance of the kidneys in the clearance process of rFVIIa after iv administration to rats using a nephrectomy model. MATERIALS AND METHODS A nephrectomized rat model was established and validated using inulin, a compound primarily cleared by the kidneys, as a test substance and several physiological parameters were monitored to ensure viability and robustness of the model. The model was then used for pharmacokinetic evaluation of renal clearance of rFVIIa. The pharmacokinetic parameters for rFVIIa were evaluated both by use of standard non-compartmental methods and by use of mixed effects methods, where a pharmacokinetic model was used to simultaneously model all data from healthy, sham operated, and nephrectomized rats. RESULTS Nephrectomized animals showed stable rectal temperature, SpO2 and pulse and as expected, clearance of inulin was essentially abolished compared to control animals (p<0.001). For rFVIIa, nephrectomy resulted in a clearance and terminal half-life of 34mL/h/kg and 2.8h compared to 68mL/h/kg and1.9h in rats exposed to sham surgery (p<0.0001 for both parameters). CONCLUSION The present data show that about 50% of the total clearance of rFVIIa from circulation in rats under isoflurane anaesthesia is due to renal clearance.
Collapse
Affiliation(s)
- Bill Vestergaard
- Biopharmaceuticals Research Unit, Novo Nordisk A/S, Måløv, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Rupa S Appa
- Biopharmaceuticals Research Unit, Novo Nordisk A/S, Måløv, Denmark
| | - Jens Lykkesfeldt
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik Agersø
- Biopharmaceuticals Research Unit, Novo Nordisk A/S, Måløv, Denmark
| |
Collapse
|