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Brown M, Kuhn B, Moskowitz KA, Amos S, Mays EL, Alexander WA, Fitzpatrick GM. Characterization of a canine freeze-dried platelet-derived hemostatic agent: A preclinical model for surgical and traumatic hemorrhage. Thromb Res 2024; 238:67-77. [PMID: 38678865 DOI: 10.1016/j.thromres.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/26/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION A freeze-dried, platelet-derived hemostatic agent (FPH) was developed for acute hemorrhage. The canine product (cFPH) was developed for use in preclinical models supporting human product (hFPH) investigations. MATERIALS AND METHODS A carotid artery bypass graft (CABG) study in dogs compared 3 dosages of cFPH to canine liquid stored platelets (cLSP) and vehicle (VEH) control groups. Histopathological analysis and blood loss assessments were completed. A separate ex-vivo synthetic graft study assessed thrombogenicity via blood from human and canine donors that was combined with species-specific FPH or apheresis platelets. Characterization of cFPH and hFPH included thrombin generation, total thrombus formation, and scanning electron microscopy. RESULTS Blood loss was reduced in CABG dogs receiving standard of care (cLSP) or cFPH treatment compared to VEH control; a cFPH dose effect signal was observed. Further, cFPH dosing up to 5 × 109 cells/kg was not associated with increased mortality or occlusion of the anastomosis sites, and histopathologic evidence of off-target thrombosis was not detected. When passed through a synthetic graft (ex vivo), whole blood combined with species-specific FPH did not result in thrombosis beyond that of whole blood control. In vitro testing and imaging of cFPH and FPH were comparable. CONCLUSIONS A single dose of cFPH or cLSP reduced blood loss in a pilot surgical study and was well tolerated with no related adverse events. Further, the hemostatic activity and characteristics of cFPH are comparable to that of hFPH, suggesting that research findings from the canine product are likely to inform the development of the human product.
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Affiliation(s)
- Meredith Brown
- Cellphire Therapeutics, Inc., 9430 Key West Ave, Rockville, MD 20850, USA.
| | - Benjamin Kuhn
- Cellphire Therapeutics, Inc., 9430 Key West Ave, Rockville, MD 20850, USA.
| | - Keith A Moskowitz
- Cellphire Therapeutics, Inc., 9430 Key West Ave, Rockville, MD 20850, USA.
| | - Stephen Amos
- Cellphire Therapeutics, Inc., 9430 Key West Ave, Rockville, MD 20850, USA.
| | - Erin Long Mays
- Cellphire Therapeutics, Inc., 9430 Key West Ave, Rockville, MD 20850, USA.
| | - W Allan Alexander
- Cellphire Therapeutics, Inc., 9430 Key West Ave, Rockville, MD 20850, USA.
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Kim MY, Han HJ. Dose-dependent effect of canine lyophilized platelet on an in vitro hemodilution model. BMC Vet Res 2023; 19:61. [PMID: 36932415 PMCID: PMC10022049 DOI: 10.1186/s12917-023-03614-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
The transfusion of stored platelets has emerged as an efficient method for treating dogs with thrombocytopenia. However, the availability of fresh platelets is limited in veterinary medicine due to demanding storage conditions. Lyophilized platelets have long shelf lives and can be easily stored, increasing their accessibility for thrombocytopenic dogs. Due to the lack of research and information on the dose effect, canine lyophilized platelets are used at a clinical dosage without research-based evidence. This study was to evaluate the dose effect of lyophilized canine platelets on blood coagulability. Three different concentrations of lyophilized canine platelets were added to in vitro hemodilution blood model, increasing the platelet count by 25, 50, and 100 × 106/ml and coagulation profiles were analyzed. The coagulability was evaluated via the plasma fibrinogen concentration, coagulation time, thromboelastography (TEG), and platelet function analyzer (PFA). Higher concentrations of lyophilized platelets showed dose-dependent association with decreased aPTT and R-time of TEG and increased alpha angle and MA of TEG. These results showed the potential that the higher dose of canine lyophilized platelets better improve blood coagulability than the standard dose and provided the basis for further safety and clinical studies.
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Affiliation(s)
- Mu-Young Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, 05029, Seoul, Republic of Korea
| | - Hyun-Jung Han
- Department of Veterinary Emergency and Critical Care, College of Veterinary Medicine, Konkuk University, 05029, Seoul, Republic of Korea.
- KU Center for Animal Blood Medical Science, Konkuk University, 05029, Seoul, Republic of Korea.
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Cho JH, Wool GD, Tjota MY, Gutierrez J, Mikrut K, Miller JL. Functional Assessment of Platelet Dense Granule ATP Release. Am J Clin Pathol 2021; 155:863-872. [PMID: 33386737 DOI: 10.1093/ajcp/aqaa196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study was undertaken to explore the feasibility of assessing platelet dense granule release in response to platelet stimuli, using less than 1 mL of whole blood (WB). METHODS Optimization of the luciferin-luciferase (LL) assay for ATP release, together with additional modifications, was applied to 1:10 diluted WB. RESULTS LL assay optimization using nonstirred 1:10 diluted WB resulted in dense granule ATP release in response to thrombin receptor-activating peptide (TRAP) of similar magnitude to that observed using stirred platelet-rich plasma. Stirring of the 1:10 diluted WB restored collagen-induced dense granule secretion. Addition of lyophilized, formalin-fixed platelets, together with stirring, restored dense granule secretion responsiveness to ADP. TRAP, ADP, and collagen all stimulated ATP release in 1:10 diluted WB under the optimized conditions of this study at levels close to those observed using platelet-rich plasma. Blood sample reconstitution experiments offer hope that this assay may prove robust down to WB platelet counts as low as 50 × 103/μL. CONCLUSIONS Platelet dense granule release in response to a number of classic stimuli, including ADP, was accomplished from less than 1 mL WB with minimal specimen processing, using widely available reagents and instrumentation.
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Affiliation(s)
- Joseph H Cho
- Department of Pathology, University of Chicago, Chicago, IL
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Bynum JA, Meledeo MA, Peltier GC, McIntosh CS, Taylor AS, Montgomery RK, Reddoch-Cardenas KM, Getz TM, Fitzpatrick MG, Cap AP. Evaluation of a lyophilized platelet-derived hemostatic product. Transfusion 2019; 59:1490-1498. [PMID: 30980737 DOI: 10.1111/trf.15167] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Current limitations of platelet shelf life to 5 days have led to an increasingly greater demand for hemostatic agents with greater longevity. The objective of this study was to evaluate the function of a lyophilized platelet-derived hemostatic product (thrombosome [TS]) as a potential alternative to fresh platelets. METHODS Platelets were collected from whole blood from healthy donors. TSs were reconstituted with water and added to various configurations of reassembled whole blood (platelets, plasma, and RBCs); measures included rotational thromboelastometry (ROTEM), optical aggregometry, mitochondrial function, calibrated automated thrombogram, collagen adhesion under flow (shear flow assay), and flow cytometry. RESULTS In ROTEM, no differences were observed between maximum clot formation values for contact pathway activation thromboelastometry tests with TSs or platelet samples. Significantly decreased aggregation was observed in the TSs versus platelets (p < 0.001 for all agonists). Flow cytometry measures demonstrated significant decreases in glycoprotein Ib expression and increases in phosphatidylserine expression in the TS group (p < 0.01). The calibrated automated thrombogram assay was suggestive (lag time and peak thrombin) that the TSs might have some thrombogenic properties. Measurements of mitochondrial function revealed that TSs had no functional mitochondria. CONCLUSION In this study, TSs were shown to have nonfunctional mitochondria. ROTEM measures revealed that the TSs had no impact on clot strength. Likewise, compared to platelets, the TSs displayed minimal aggregation, had significantly more phosphatidylserine (measure of activation status), but had the ability to adhere to a collagen surface under flow conditions and contribute to clot formation and induced greater thrombin generation.
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Affiliation(s)
- James A Bynum
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Michael A Meledeo
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Grantham C Peltier
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Colby S McIntosh
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Ashley S Taylor
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Robbie K Montgomery
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Kristin M Reddoch-Cardenas
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | | | | | - Andrew P Cap
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
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Cancelas JA. Future of platelet formulations with improved clotting profile: a short review on human safety and efficacy data. Transfusion 2019; 59:1467-1473. [DOI: 10.1111/trf.15163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Jose A. Cancelas
- Hoxworth Blood CenterUniversity of Cincinnati Academic Health Center Cincinnati Ohio
- Division of Experimental Hematology and Cancer BiologyCincinnati Children's Hospital Medical Center Cincinnati Ohio
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Michael Fitzpatrick G. Novel platelet products under development for the treatment of thrombocytopenia or acute hemorrhage. Transfus Apher Sci 2018; 58:7-11. [PMID: 30718153 DOI: 10.1016/j.transci.2018.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Controlling hemorrhage has been a focus of survival since man recognized that the loss of blood led to death. Papyri from 1600 BCE describe methods for hemorrhage control including; direct pressure, ligature and the use of sutures. Multiple studies have demonstrated the survival advantage of early transfusion of whole blood or red cells and plasma. The added survival impact of early transfusion of platelets was recently reported in a substudy of the prospective Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial. Early transfusion of platelets demonstrated a statistically significant survival benefit at 24 h and 30 days post-injury. [1] Platelet availability is limited due to the short shelf life (5-7 days) and storage requirements (room temperature with constant agitation). Providing platelets or platelet derived products for prehospital treatment and to rural and some urban hospitals is an unmet medical need. The interest in novel and alternative platelet products has grown over the past decade and the status of novel platelet products is presented herein. Development, approval, and distribution of hemostatically effective approved platelet products for prehospital use and routine stockage in rural and urban centers could significantly increase survival rates in bleeding patients.
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Hickman DA, Pawlowski CL, Sekhon UDS, Marks J, Gupta AS. Biomaterials and Advanced Technologies for Hemostatic Management of Bleeding. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2018; 30:10.1002/adma.201700859. [PMID: 29164804 PMCID: PMC5831165 DOI: 10.1002/adma.201700859] [Citation(s) in RCA: 260] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/18/2017] [Indexed: 05/03/2023]
Abstract
Bleeding complications arising from trauma, surgery, and as congenital, disease-associated, or drug-induced blood disorders can cause significant morbidities and mortalities in civilian and military populations. Therefore, stoppage of bleeding (hemostasis) is of paramount clinical significance in prophylactic, surgical, and emergency scenarios. For externally accessible injuries, a variety of natural and synthetic biomaterials have undergone robust research, leading to hemostatic technologies including glues, bandages, tamponades, tourniquets, dressings, and procoagulant powders. In contrast, treatment of internal noncompressible hemorrhage still heavily depends on transfusion of whole blood or blood's hemostatic components (platelets, fibrinogen, and coagulation factors). Transfusion of platelets poses significant challenges of limited availability, high cost, contamination risks, short shelf-life, low portability, performance variability, and immunological side effects, while use of fibrinogen or coagulation factors provides only partial mechanisms for hemostasis. With such considerations, significant interdisciplinary research endeavors have been focused on developing materials and technologies that can be manufactured conveniently, sterilized to minimize contamination and enhance shelf-life, and administered intravenously to mimic, leverage, and amplify physiological hemostatic mechanisms. Here, a comprehensive review regarding the various topical, intracavitary, and intravenous hemostatic technologies in terms of materials, mechanisms, and state-of-art is provided, and challenges and opportunities to help advancement of the field are discussed.
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Affiliation(s)
- DaShawn A Hickman
- Case Western Reserve University School of Medicine, Department of Pathology, Cleveland, Ohio 44106, USA
| | - Christa L Pawlowski
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
| | - Ujjal D S Sekhon
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
| | - Joyann Marks
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
| | - Anirban Sen Gupta
- Case Western Reserve University, Department of Biomedical Engineering, Cleveland, Ohio 44106, USA
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Raftis J, Lucking A, Hunter A, Millar M, Fitzpatrick M, Feuerstein G, Newby D, Joshi N. Lyophilised reconstituted human platelets increase thrombus formation in a clinical ex vivo model of deep arterial injury. Thromb Haemost 2017; 108:176-82. [DOI: 10.1160/th12-02-0059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/01/2012] [Indexed: 11/05/2022]
Abstract
SummaryPlatelets are the principal component of the innate haemostatic system that protect from traumatic bleeding. We investigated whether lyophilised human platelets (LHPs) could enhance clot formation within platelet-free and whole blood environments using an ex vivo model of deep arterial injury. Lyophilised human platelets were produced from stored human platelets and characterised using conventional, fluorescent and electron microscopic techniques. LHPs were resuspended in platelet-free plasma (PFP) obtained from citrated whole human blood to form final concentrations of 0,20 and 200 × 109 LHPs/L. LHPs with recalcified PFP or whole blood were perfused through the chamber at low (212 s-1) and high (1,690 s-1) shear rates with porcine aortic tunica media as thrombogenic substrate. LHPs shared morphological characteristics with native human platelets and were incorporated into clot generated from PFP or whole blood. Histomorphometrically measured mean thrombus area increased in a dose-dependent manner following the addition of LHPs to PFP under conditions of high shear [704 μm2 ± 186 μm2 (mean ± SEM), 1,511 μm2 ± 320 μm2 and 2,378 μm2 ± 315 μm2, for LHPs at 0, 20 and 200 × 109 /l, respectively (p= 0.012)]. Lyophil-ised human platelets retain haemostatic properties when reconstituted in both PFP and whole blood, and enhance thrombus formation in a model of deep arterial injury. These data suggest that LHPs have the potential to serve as a therapeutic intervention during haemorrhage under circumstances of trauma, and platelet depletion or dysfunction.
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Abstract
Blood transfusion refers to the perioperative administration of blood and blood components. Adherence to proper indications for blood component therapy is essential because of its potential adverse effects and costs of transfusion. Over the years, the significance of blood components in treating certain diseases or conditions has been recognized. In this article, the most commonly used blood components along with the new developments in component therapy have been discussed. Recommendations by different academic and clinical trials and studies have been presented for quick reference. The individual coagulation factors are discussed in brief.
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Affiliation(s)
- Rajesh Chand Arya
- Department of Cardiac Anesthesiology, Hero DMC Heart Institute, Ludhiana
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10
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Davidow EB, Brainard B, Martin LG, Beal MW, Bode A, Ford MJ, Ramsey N, Fagella A, Jutkowitz A. Use of fresh platelet concentrate or lyophilized platelets in thrombocytopenic dogs with clinical signs of hemorrhage: a preliminary trial in 37 dogs. J Vet Emerg Crit Care (San Antonio) 2013; 22:116-25. [PMID: 23016747 DOI: 10.1111/j.1476-4431.2011.00710.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To examine the safety and feasibility of using lyophilized platelets (LYO) and fresh platelet concentrate (FRESH) in bleeding thrombocytopenic dogs. DESIGN Preliminary prospective randomized clinical trial. SETTING Two private referral centers and 3 university teaching hospitals. ANIMALS Thirty-seven dogs with a complaint of hemorrhage associated with thrombocytopenia (platelet count <70 × 10(9) /L [70,000/μL], a hematocrit >15%, and that had received neither vincristine nor platelet-containing transfusions within 72 h of enrollment were studied. INTERVENTIONS Animals were randomized to receive LYO or FRESH, dosed according to weight. Physical examination, complete blood counts, and coagulation testing (prothrombin time and activated partial thromboplastin time) were performed at enrollment. Physical examinations were also performed immediately post transfusion, and at 1 and 24 h after transfusion. Complete blood counts were repeated immediately post transfusion and at 24 h. Collected data included bleeding score (BLS), response to transfusion, adverse reactions, hospitalization time, need for additional transfusions, survival to discharge, and 28-d survival. MEASUREMENTS AND MAIN RESULTS Twenty-two dogs received LYO and 15 received FRESH. There was no difference between groups in age, weight, BLS, platelet count, white blood cell count, hematocrit, or presence of melena. There was no difference between groups in transfusion reaction rates, the need for additional transfusions, 24-h BLS, hospitalization time, survival to discharge, or 28-d survival. CONCLUSIONS Transfusion of LYO was feasible and associated with a low transfusion reaction rate in this limited study of thrombocytopenic canine patients presenting with mild-to-severe hemorrhage. LYO were easy to use and provided storage advantages over FRESH. Further study of this product, including examination of efficacy and platelet life span, is warranted.
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Hux BD, Martin LG. Platelet transfusions: treatment options for hemorrhage secondary to thrombocytopenia. J Vet Emerg Crit Care (San Antonio) 2012; 22:73-80. [DOI: 10.1111/j.1476-4431.2011.00706.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Xu MJ, Chen GM, Fan JL, Liu JH, Xu XG, Zhang SZ. Moisture sorption characteristics of freeze-dried human platelets. J Zhejiang Univ Sci B 2011; 12:210-8. [PMID: 21370506 DOI: 10.1631/jzus.b1010199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Freeze-drying is a promising method for a long-term storage of human platelets. The moisture sorption characteristics of freeze-dried human platelets (FDHPs) were studied in this paper. The moisture sorption isotherms of FDHPs and freeze-dried lyophilization buffer (FDLB) were measured at 4, 25, and 37 °C. The experimental data were fitted to Brunauer-Emmett-Teller (BET) and Guggenheim-Anderson-de Boer (GAB) equations. There were no significant statistical differences (P>0.05) between the sorption characteristics of FDHPs and FDLB at 4 and 25 °C, while FDHPs absorbed more water at 37 °C. The net isosteric heat of sorption was derived. The heat for FDHPs showed an abnormal negative value at low moisture contents when 25 and 37 °C data were used. Dynamic sorption experiments were carried out at 25 °C with environmental water activity controlled at 0.75, 0.85, and 0.90. The moisture diffusion coefficient was fitted to be 8.24×10(-12) m(2)/s when experimental data at initial time were used. These results would be helpful in choosing prehydration and storage condition for FDHPs.
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Affiliation(s)
- Meng-jie Xu
- Institute of Refrigeration and Cryogenics, Zhejiang University, Hangzhou 310027, China
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Magnetic and contrast properties of labeled platelets for magnetomotive optical coherence tomography. Biophys J 2011; 99:2374-83. [PMID: 20923673 DOI: 10.1016/j.bpj.2010.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 07/29/2010] [Accepted: 08/05/2010] [Indexed: 01/22/2023] Open
Abstract
This article introduces a new functional imaging paradigm that uses optical coherence tomography (OCT) to detect rehydrated, lyophilized platelets (RL platelets) that are in the preclinical trial stage and contain superparamagnetic iron oxides (SPIOs) approved by the U.S. Food and Drug Administration. Platelets are highly functional blood cells that detect and adhere to sites of vascular endothelial damage by forming primary hemostatic plugs. By applying magnetic gradient forces, induced nanoscale displacements (magnetomotion) of the SPIO-RL platelets are detected as optical phase shifts in OCT. In this article, we characterize the iron content and magnetic properties of SPIO-RL platelets, construct a model to predict their magnetomotion in a tissue medium, and demonstrate OCT imaging in tissue phantoms and ex vivo pig arteries. Tissue phantoms containing SPIO-RL platelets exhibited >3 dB contrast/noise ratio at ≥1.5 × 10(9) platelets/cm(3). OCT imaging was performed on ex vivo porcine arteries after infusion of SPIO-RL platelets, and specific contrast was obtained on an artery that was surface-damaged (P < 10(-6)). This may enable new technologies for in vivo monitoring of the adherence of SPIO-RL platelets to sites of bleeding and vascular damage, which is broadly applicable for assessing trauma and cardiovascular diseases.
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Hawksworth JS, Elster EA, Fryer D, Sheppard F, Morthole V, Krishnamurthy G, Tomori T, Brown TS, Tadaki DK. Evaluation of lyophilized platelets as an infusible hemostatic agent in experimental non-compressible hemorrhage in swine. J Thromb Haemost 2009; 7:1663-71. [PMID: 19656278 DOI: 10.1111/j.1538-7836.2009.03562.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Human lyophilized platelets hold promise as a novel hemostatic infusion agent for the control of traumatic hemorrhage. Rehydrated, lyophilized platelets (Stasix) were investigated as an infusible hemostatic agent in experimental non-compressible hemorrhage, using a porcine liver injury model. METHODS Yorkshire swine underwent a grade III liver injury and uncontrolled bleeding. After 15 min, animals were infused with Stasix (n = 10) or normal saline vehicle (n = 10). At 2 h, the liver was repaired, and the animals were monitored for another4 h. Resuscitation, including blood transfusion, was administered during the hospital phase. Laboratory data, including arterial blood gas, complete blood count, thromboelastography (TEG), and coagulation parameters, were collected. All animals underwent necropsy with complete histopathologic examination. RESULTS Overall survival in the Stasix group [8/10 (80%)] was significantly higher than in the control group [2/10 (20%)] (P = 0.023). Mean total blood loss index (g kg(-1)) was lower in Stasix-treated animals (22.2 +/- 3.5) than in control animals (34.7 +/- 3.4) (P = 0.019). Hemodynamic parameters were improved in the Stasix group, and a trend towards higher hemoglobin and lower lactate was observed. Coagulation and TEG parameters were not different between the groups. One surviving animal in the Stasix group had evidence of thrombi on necropsy. CONCLUSIONS This is the first reported study to evaluate rehydrated, lyophilized platelets as an infusible hemostatic agent for non-compressible hemorrhage. Stasix improved survival and reduced blood loss in a liver injury porcine model. However, evidence of thrombotic complications warrants further investigation prior to human use in the setting of traumatic hemorrhage.
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Affiliation(s)
- J S Hawksworth
- Combat Casualty Care, Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD 20910, USA
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Bode AP, Lust RM, Read MS, Fischer TH. Correction of the Bleeding Time With Lyophilized Platelet Infusions in Dogs on Cardiopulmonary Bypass. Clin Appl Thromb Hemost 2008; 14:38-54. [DOI: 10.1177/1076029607304746] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lyophilized canine platelets were infused in a single large bolus dose into splenectomized dogs after 2 hours' perfusion on cardiopulmonary bypass to test their possible efficacy in restoring hemostasis after compromise of platelet function. The vessel bleeding time (VBT) was monitored by venipuncture of the exposed jugular vein. During cardiopulmonary bypass, platelet counts fell quickly and the VBTs became prolonged over baseline. Infusion of lyophilized platelets reconstituted in normal saline occurred just before or immediately after weaning from the cardiopulmonary bypass pump. The results showed consistent and persistent lowering of the VBTs by the infused lyophilized platelets. Controls showed continuously prolonged VBTs. The weighted average VBT in infused subjects was significantly lower than the average in controls: 3 minutes 10 seconds versus 6 minutes 59 seconds, respectively ( t test, P = .01). These results in this setting indicate the possible effectiveness of similar human lyophilized platelet preparations in reducing postoperative bleeding in open heart surgery.
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Affiliation(s)
- Arthur P. Bode
- Department of Pathology and Laboratory Medicine, East Carolina University School of Medicine, Greenville, North Carolina,
| | - Robert M. Lust
- Department of Physiology East Carolina University School of Medicine, Greenville, North Carolina
| | - Marjorie S. Read
- Department of Pathology The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Thomas H. Fischer
- Department of Pathology The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Hoshi R, Murata S, Matsuo R, Myronovych A, Hashimoto I, Ikeda H, Ohkohchi N. Freeze-dried platelets promote hepatocyte proliferation in mice. Cryobiology 2007; 55:255-60. [PMID: 17936259 DOI: 10.1016/j.cryobiol.2007.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 08/22/2007] [Accepted: 08/22/2007] [Indexed: 02/06/2023]
Abstract
In recent years, platelets are reported to promote liver, as well as bone regeneration and dermal wound healing. Platelets are required not only for thrombocytopenia treating but also for regenerative therapy. Platelets cannot be stored beyond three days, therefore, shortage of fresh platelets sometimes occurs. To preserve platelets for a long duration without degrading growth factors, a freeze-dried technique is required. We report here that platelets can be preserved by freeze-drying, using a programmed freezing method to avoid intracellular ice crystal formation. Freeze-dried platelets kept their morphological countenance and response with the agonist of thrombin was well maintained. Freeze-dried platelets stored adenine nucleotides, PDGF, and IGF-1 the same as those of fresh platelets. Freeze dried platelets also preserved their proliferative effect on hepatocytes identical to that of fresh platelets. These results of our study suggest that freeze dried platelets will obviate the storage problem of fresh platelets.
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Affiliation(s)
- Reiko Hoshi
- Department of Surgery, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan
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Campbell RA, Fischer TH, Wolberg AS. A novel approach to improving recombinant factor VIIa activity with a preserved platelet preparation. Br J Haematol 2007; 138:82-93. [PMID: 17555451 DOI: 10.1111/j.1365-2141.2007.06617.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recombinant activated factor VII (NovoSeven, rFVIIa) is used to abrogate bleeding in haemophiliacs with inhibitors and is hypothesised to work by increasing activated factor X generation on the platelet surface. We hypothesised that rFVIIa activity could be increased by the co-addition of platelet procoagulant surface. This study characterised the ability of a rehydrated, lyophilised (RL) platelet preparation to increase rFVIIa activity in haemophilic conditions. RL platelets supported thrombin generation in the presence of factors VIII and IX but, in the absence of factors VIII and IX, thrombin generation was significantly reduced. RL platelets supported rFVIIa-mediated thrombin generation in a rFVIIa-concentration dependent manner. In a cell-based in vitro model of haemophilia, the presence of RL platelets increased the rFVIIa-dependent thrombin generation rate 2.8-fold compared with rFVIIa alone. Similarly, the addition of RL platelets plus rFVIIa to the in vitro model of haemophilia and to haemophilic platelet-rich plasma shortened the onset of clot formation and increased clot stability in a fibrinolytic environment versus rFVIIa alone. These results suggest that RL platelets can support rFVIIa-mediated thrombin generation, and that co-administration of RL platelets with rFVIIa may increase the efficacy of rFVIIa in some patients.
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Affiliation(s)
- Robert A Campbell
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27599-7525, USA
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Abstract
Ever since platelet transfusions were shown to reduce mortality from haemorrhage in patients with acute leukaemia in the 1950s, the use of this therapy has steadily grown to become an essential part of the treatment of cancer, haematological malignancies, marrow failure, and haematopoietic stem cell transplantation. Today, more than 1.5 million platelet products are transfused in the USA each year, 2.9 million products in Europe. However, platelet transfusion can transmit infections and trigger serious immune reactions and they can be rendered ineffective by alloimmunisation. There are several types of platelet components and all can be modified to reduce the chances of many of the complications of platelet transfusion. Transfusion practices, including indications for transfusion, dose of platelets transfused, and methods of treating alloimmunised recipients vary between countries, and even within countries. We review commonly used platelet components, product modifications, transfusion practices, and adverse consequences of platelet transfusions.
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Affiliation(s)
- David F Stroncek
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892-1184, USA.
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Affiliation(s)
- Tamir Kanias
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Research and Development, Canadian Blood Services, Alberta, Canada
| | - Jason P. Acker
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Research and Development, Canadian Blood Services, Alberta, Canada
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Fischer TH, Robbins ME, Bode AP, Nichols TC, Bellinger DE, Schoenfisch MH. Evidence that rehydrated, lyophilized red blood cells are sufficiently deformable for normal microcirculation transit. Microsc Res Tech 2005; 65:62-71. [PMID: 15570582 DOI: 10.1002/jemt.20106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A method was developed for the preparation of rehydratable lyophilized red blood cells (RL RBCs) that hold promise as cell-based oxygen carriers for transfusion medicine. The maintenance of normal cellular deformability is essential for the successful development of cell-based oxygen delivery systems. Improper deformability of RBCs can lead to hemolysis if too fragile or microvascular occlusion if too rigid. We developed an aldehyde stabilization method that is based on the use of paraformaldehyde polymers that complement the function of spectrin as a structural unit with conformational flexibility. Three types of in vitro deformability studies (filter transit, pipette aspiration, and atomic force microscopy) and in vivo intravital microscopy were performed to characterize the deformability of RL RBCs. When considered with safety data from previously reported studies in dogs, the results of these studies indicate that paraformaldehyde-modified RL RBCs have visco-elastic deformability properties that are in the nonpathological range.
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Affiliation(s)
- Thomas H Fischer
- Department of Pathology and Laboratory Medicine, Francis Owen Blood Research Laboratory, 350 S. Old Fayetteville Rd., University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.
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Bakaltcheva I, Reid T. Effects of blood product storage protectants on blood coagulation1 1The opinions expressed herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense. Transfus Med Rev 2003; 17:263-71. [PMID: 14571394 DOI: 10.1016/s0887-7963(03)00040-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The ever-increasing demand for blood products challenges scientists to develop new and more effective techniques for their preservation. The progress of these novel preservation technologies uses a wide variety of cryoprotectant, lyoprotectant, and other preservatives, which will need to be explored and assessed for their biological effects during blood product formulation. The leading factor in protectant selection is for their ability to provide superior preservation for a particular blood product. We believe that such protectants used in blood product development should also be evaluated for their ability to preserve normal hemostasic mechanisms. In this review, high-molecular-weight cryoprotectants, lyoprotectants, polyols, amino acids, antioxidants, and surfactants, used because of their protective properties, were evaluated for their possible role in relation to their effect on normal hemostatic mechanisms.
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Affiliation(s)
- Irina Bakaltcheva
- Blood Research, Walter Reed Army Institute, Silver Spring, MD 20910, USA.
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Fischer TH, Merricks EP, Bode AP, Bellinger DA, Russell K, Reddick R, Sanders WE, Nichols TC, Read MS. Thrombus formation with rehydrated, lyophilized platelets. Hematology 2002; 7:359-69. [PMID: 12475741 DOI: 10.1080/1024533021000047954] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Stored human platelets are frequently used in hemorrhagic emergencies, but have limited immediate utility for controlling bleeding due to storage lesion and are frequently contaminated with microorganisms. The development of paraformaldehyde-treated, lyophilized and rehydrated (RL) platelets, which are sterile and have a prolonged shelf life (years), ameliorate the efficacy and sterility problems with stored platelets. RL platelets have been shown to have many native functions of fresh platelets in vitro and to mediate hemostasis in vivo in large animal models of hemorrhagic shock and cardiopulmonary bypass induced platelet dysfunction. To further evaluate the functional properties of this transfusion product, we studied the role of RL platelets in three aspects of thrombus formation and lysis. First, the interaction between RL platelets and fibrinogen was investigated. The surface density of unligated GPIIb-IIIa on RL and fresh platelets were, respectively 30000 and 70000 molecules per cell as detected with the monoclonal antibody 10E-5. Freezing, lyophilization and rehydration steps in the preparation of RL platelets resulted in the surface presentation of 120000 molecules of fibrinogen per cell from alpha granule sources. After ADP activation, RL platelets bound exogenous 125I-labeled fibrinogen in a dose-dependent manner with an affinity that is similar to that of fresh platelets and was inhibited by RGD peptides. 125I-Labeled fibrinogen binding to RL and fresh platelets, respectively, saturated at 14000 and 32000 molecules per cell. Scanning electron microscopic ultrastructural analysis showed that fibrin strands interacted with the surface of RL platelets in a normal manner. The second set of studies investigated the ability of RL platelets to catalyze and amplify the clot formation process in an activation-dependent manner. We showed that RL platelets undergo degranulation in fibrin in clots and functioned as thrombogenic surfaces for the generation of activated coagulation factors and fibrin generation. A final set of studies was performed to investigate fibrin of clots that contained RL platelets. RL platelet clots were lysed in the presence of tissue plasminogen activator with a similar time course as clots without platelets, and lysis occurred faster than when fresh platelets were included in the fibrin mass. The results of these three studies demonstrate that RL platelets are capable of mediating thrombus formation and do not inhibit lysis. Our results help explain how RL platelets restore hemostasis in vivo, and indicate that these cells might be a viable alternative to fresh stored platelets in transfusion medicine.
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Affiliation(s)
- Thomas H Fischer
- Department of Pathology, 350 Old Fayetteville Road, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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Fischer TH, Merricks E, Bellinger DA, Hayes PM, Smith RS, Raymer RA, Read MS, Nichols TC, Bode AP. Splenic clearance mechanisms of rehydrated, lyophilized platelets. ARTIFICIAL CELLS, BLOOD SUBSTITUTES, AND IMMOBILIZATION BIOTECHNOLOGY 2001; 29:439-51. [PMID: 11795630 DOI: 10.1081/bio-100108549] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A variety of platelet substitutes (e.g., rehydrated, lyophilized (RL) platelets, thromboerythrocytes, plateletsomes, infusible platelet membranes, synthocytes, fibrinogen-coated microcapules) are potentially useful as hemostatic agents in transfusion medicine. However, as "foreign" particles, platelet substitutes interact to varying extents with elements of the reticulo-endothelial system for clearance, reducing hemostatic efficacy. Experiments were performed to better understand the interaction of RL platelets with elements of the innate and acquired immune systems. The infusion of heterologous RL platelets into rats resulted in rapid clearance from the free circulation with half-life values of minutes. The clearance of RL platelets was inhibited when macrophages were rendered apoptotic with gadolinium. Transmission EM analysis of splenic tissue after infusion of lyophilized cells, as well as in vitro mixing studies with splenic macrophages and RL platelets, indicated that macrophage-mediated phagocytosis mechanisms were operant in RL platelet clearance by the reticulo-endothelial system. Studies with IV IgG, as a competitive inhibitor of the macrophage Fc receptor, provides evidence that RL platelet destruction is in part mediated by platelet surface bound IgG. This hypothesis was further supported by the finding that RL platelets react with IgG class antibodies that are pre-existing in naïve animals. These studies provide a rational basis for prolonging the circulation time of RL platelets and other platelet substitutes.
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Affiliation(s)
- T H Fischer
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, USA
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Hermida G, Manjón R, Casanova F, Rodriguez-Salazar M. Oral vaccination with autologous platelets in chronic autoimmune thrombocytopenic purpura. Med Hypotheses 2001; 57:612-5. [PMID: 11735321 DOI: 10.1054/mehy.2001.1427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Idiopathic thrombocytopenic purpura (ITP) is a common disease of autoimmune mechanism in which nearly 40% of patients need a third-line treatment after steroids and splenectomy failure. Due to the variable results of the multiple therapeutic modalities in refractory patients it is necessary to develop a more effective treatment. Following previous assays of immunotolerance with the administration of "oral vaccines", we propose a therapeutic protocol in chronic ITP patients with autologous cryopreserved or liophilized platelets administered in enteric capsules. The procedure is theoretically feasible and technically easy and does not need the isolation of the specific antigen target of the autoantibodies in each particular case.
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Affiliation(s)
- G Hermida
- Servicio de Hematología, Hospital General Yague, Avenida del Cid 96, (09005) Burgos, Spain.
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