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Lin F, Yu SB, Liu YY, Liu CZ, Lu S, Cao J, Qi QY, Zhou W, Li X, Liu Y, Tian J, Li ZT. Porous Polymers as Universal Reversal Agents for Heparin Anticoagulants through an Inclusion-Sequestration Mechanism. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2200549. [PMID: 35499202 DOI: 10.1002/adma.202200549] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Heparins are widely used anticoagulants for surgical procedures and extracorporeal therapies. However, all of them have bleeding risks. Protamine sulfate, the only clinically approved antidote for unfractionated heparin (UFH), has adverse effects. Moreover, protamine can only partially neutralize low-molecular-weight heparins (LMWHs) and is not effective for fondaparinux. Here, an inclusion-sequestration strategy for efficient neutralization of heparin anticoagulants by cationic porous supramolecular organic frameworks (SOFs) and porous organic polymers (POPs) is reported. Isothermal titration calorimetric and fluorescence experiments show strong binding affinities of these porous polymers toward heparins, whereas dynamic light scattering and zeta potential analysis confirm that the heparin sequences are adsorbed into the interior of the porous hosts. Activated partial thromboplastin time, anti-FXa, and thromboelastography assays indicate that their neutralization efficacies are higher than or as high as that of protamine for UFH and generally superior to protamine for LMWHs and fondaparinux, which is further confirmed by tail-transection model in mice and ex vivo aPTT or anti-FXa analysis in rats. Acute toxicity evaluations reveal that one of the SOFs displays outstanding biocompatibility. This work suggests that porous polymers can supply safe and rapid reversal of clinically used heparins, as protamine surrogates, providing an improved approach for their neutralization.
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Affiliation(s)
- Furong Lin
- Key Laboratory of Synthetic and Self-Assembly Chemistry for Organic Functional Molecules, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, 345 Lingling Road, Shanghai, 200032, P. R. China
| | - Shang-Bo Yu
- Key Laboratory of Synthetic and Self-Assembly Chemistry for Organic Functional Molecules, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, 345 Lingling Road, Shanghai, 200032, P. R. China
| | - Yue-Yang Liu
- Department of Chemistry, Fudan University, 2205 Songhu Road, Shanghai, 200438, P. R. China
| | - Chuan-Zhi Liu
- Department of Chemistry, Fudan University, 2205 Songhu Road, Shanghai, 200438, P. R. China
| | - Shuai Lu
- College of Chemistry and Environmental Engineering, Shenzhen University, Shenzhen, 518055, P. R. China
| | - Jin Cao
- Key Laboratory of Synthetic and Self-Assembly Chemistry for Organic Functional Molecules, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, 345 Lingling Road, Shanghai, 200032, P. R. China
| | - Qiao-Yan Qi
- Key Laboratory of Synthetic and Self-Assembly Chemistry for Organic Functional Molecules, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, 345 Lingling Road, Shanghai, 200032, P. R. China
| | - Wei Zhou
- Department of Chemistry, Fudan University, 2205 Songhu Road, Shanghai, 200438, P. R. China
| | - Xiaopeng Li
- College of Chemistry and Environmental Engineering, Shenzhen University, Shenzhen, 518055, P. R. China
| | - Yi Liu
- The Molecular Foundry, Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA
| | - Jia Tian
- Key Laboratory of Synthetic and Self-Assembly Chemistry for Organic Functional Molecules, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, 345 Lingling Road, Shanghai, 200032, P. R. China
| | - Zhan-Ting Li
- Key Laboratory of Synthetic and Self-Assembly Chemistry for Organic Functional Molecules, Shanghai Institute of Organic Chemistry, Chinese Academy of Sciences, 345 Lingling Road, Shanghai, 200032, P. R. China
- Department of Chemistry, Fudan University, 2205 Songhu Road, Shanghai, 200438, P. R. China
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Kamiński K, Kałaska B, Koczurkiewicz P, Michalik M, Szczubiałka K, Mogielnicki A, Buczko W, Nowakowska M. New arginine substituted derivative of poly(allylamine hydrochloride) for heparin reversal. MEDCHEMCOMM 2014. [DOI: 10.1039/c3md00374d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Harr JN, Moore EE, Wohlauer MV, Fragoso M, Gamboni F, Liang X, Banerjee A, Silliman CC. Activated platelets in heparinized shed blood: the "second hit" of acute lung injury in trauma/hemorrhagic shock models. Shock 2011; 36:595-603. [PMID: 21841533 PMCID: PMC3220733 DOI: 10.1097/shk.0b013e318231ee76] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The return of heparinized shed blood (SB) in trauma/hemorrhagic shock (T/HS) models remains controversial because of potential anti-inflammatory properties. Although ubiquitous as an anticoagulant, heparin is ineffective on cellular coagulation as an antithrombotic agent. Therefore, we hypothesized that returning heparinized SB would paradoxically enhance acute lung injury (ALI) after T/HS because of the infusion of activated platelets. Sprague-Dawley rats, anesthetized with pentobarbital, underwent laparotomy and hemorrhage-induced shock (MAP of 30 mmHg × 45 min). Animals were resuscitated with a combination of normal saline and returned SB. Shed blood was collected in either 80 U/kg of heparin, 800 U/kg of heparin, or citrate or diluted 1:8 with normal saline. An additional group of animals were pretreated with a platelet P2Y12 receptor antagonist (clopidogrel) before T/HS. Bronchoalveolar lavage, lung myeloperoxidase assays, pulmonary immunofluorescence, and blood smears were conducted. Bronchoalveolar lavage protein increased in animals resuscitated with heparinized SB (T/HS + 80 U/kg Hep 1.62 ± 0.29, T/HS + 800 U/kg Hep 1.30 ± 0.15 vs. T/SS 0.51 ± 0.16 and T/HS Citrate 0.7 ± 0.09) (P < 0.0001). Blood smears and platelet function assays revealed platelet aggregates and increased platelet activation. Animals pretreated with a platelet P2Y12 receptor antagonist were protected from postinjury ALI (P < 0.0001). Animals with return of SB had increased pulmonary polymorphonuclear leukocyte sequestration (P < 0.0001). Pulmonary immunofluorescence demonstrated microthrombi only in the T/HS group receiving heparinized SB (P < 0.0001). The return of heparinized SB functions as a "second hit" to enhance ALI, with activated platelets propagating microthrombi and pulmonary polymorphonuclear leukocyte recruitment.
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Affiliation(s)
- Jeffrey N. Harr
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Ernest E. Moore
- Department of Surgery, University of Colorado Denver, Aurora, CO
- Department of Surgery, Denver Health Medical Center, Denver, CO
- Trauma Research Center, University of Colorado Denver, Aurora, CO
| | - Max V. Wohlauer
- Department of Surgery, University of Colorado Denver, Aurora, CO
| | - Miguel Fragoso
- Department of Surgery, Denver Health Medical Center, Denver, CO
| | - Fabia Gamboni
- Trauma Research Center, University of Colorado Denver, Aurora, CO
| | - Xiayuan Liang
- Department of Pathology, University of Colorado Denver, Aurora, CO
| | - Anirban Banerjee
- Trauma Research Center, University of Colorado Denver, Aurora, CO
| | - Christopher C. Silliman
- Trauma Research Center, University of Colorado Denver, Aurora, CO
- Department of Pediatrics, University of Colorado Denver, Aurora, CO
- Research Department, Bonfils Blood Center, Denver, CO
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Nuthall G, Skippen P, Daoust C, Al-Jofan F, Seear M. Citrate anticoagulation in a piglet model of pediatric continuous renal replacement therapy. Crit Care Med 2002; 30:900-3. [PMID: 11940766 DOI: 10.1097/00003246-200204000-00031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop pediatric guidelines for the use of citrate as a regional anticoagulant for continuous renal replacement therapy (CRRT) using a neonatal piglet model. DESIGN Prospective observational study. SETTING Animal laboratory in the research center of a tertiary-level children's hospital. SUBJECTS Ten neonatal piglets. INTERVENTIONS AND MEASUREMENTS Using a venovenous CRRT circuit and filter, we randomly altered the filter blood flow rate, replacement flow rate, and citrate flow rate over conventional pediatric ranges. Measured end points were prefilter serum ionized calcium and citrate levels. MAIN RESULTS A prefilter serum citrate concentration of 6 mmol/L is required to maintain the prefilter ionized calcium < or =0.4 mmol/L. Using multiple regression analysis on collected data, we derived a formula to predict prefilter serum citrate for combinations of replacement flow rate, blood flow rate, and citrate flow rate. CONCLUSIONS The available literature and our past experience indicate that a prefilter ionized calcium < or =0.4 mmol/L is required to anticoagulate a CRRT circuit; a prefilter serum citrate concentration of 6 mmol/L is required to achieve this. Our multiple regression analysis can be expressed graphically to allow easy calculation of the required citrate flow rate, given the knowledge of the replacement flow rate and blood flow rate. Our results provide the first guidelines for the use of citrate as a regional anticoagulant in a pediatric-size model of CRRT.
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Affiliation(s)
- Gabrielle Nuthall
- Pediatric Intensive Care Unit, Children's and Women's Health Centre of British Columbia, University of British Columbia, Vancouver, BC, Canada
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