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Maltepe E, Smith M, Boehme J, Datar SA, Hutchings RS, Vento CA, Manzoor H, Loucks A, Winger JA, Fineman JR. OMX: A NOVEL OXYGEN DELIVERY BIOTHERAPEUTIC IMPROVES OUTCOMES IN AN OVINE MODEL OF CONTROLLED HEMORRHAGIC SHOCK. Shock 2024; 62:103-110. [PMID: 38662597 DOI: 10.1097/shk.0000000000002356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
ABSTRACT Hemorrhagic shock is a major source of morbidity and mortality worldwide. While whole blood or blood product transfusion is a first-line treatment, maintaining robust supplies presents significant logistical challenges, particularly in austere environments. OMX is a novel nonhemoglobin (Hb)-based oxygen carrier derived from the H-NOX (heme-nitric oxide/oxygen binding) protein family. Because of their engineered oxygen (O 2 ) affinities, OMX proteins only deliver O 2 to severely hypoxic tissues. Additionally, unlike Hb-based oxygen carriers, OMX proteins do not scavenge nitric oxide in the vasculature. To determine the safety and efficacy of OMX in supporting tissue oxygen delivery and cardiovascular function in a large animal model of controlled hemorrhage, 2-3-week-old lambs were anesthetized, intubated, and mechanically ventilated. Hypovolemic shock was induced by acute hemorrhage to obtain a 50% reduction over 30 min. Vehicle (n = 16) or 400 mg/kg OMX (n = 13) treatment was administered over 15 min. Hemodynamics, arterial blood gases, and laboratory values were monitored throughout the 6-h study. Comparisons between groups were made using t tests, Wilcoxon rank sum test, and Fisher's exact test. Survival was assessed using Kaplan-Meier curves and the log-rank test. We found that OMX was well-tolerated and significantly improved lactate and base deficit trends, and hemodynamic indices ( P < 0.05). Median survival time was greater in the OMX-treated group (4.7 vs. 6.0 h, P < 0.003), and overall survival was significantly increased in the OMX-treated group (25% vs. 85%, P = 0.004). We conclude that OMX is well-tolerated and improves metabolic, hemodynamic, and survival outcomes in an ovine model of controlled hemorrhagic shock.
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Affiliation(s)
| | | | - Jason Boehme
- Department of Pediatrics, UCSF, San Francisco, CA
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Correia JJ, Stafford WF, Erlandsen H, Cole JL, Premathilaka SH, Isailovic D, Dignam JD. Hydrodynamic and thermodynamic analysis of PEGylated human serum albumin. Biophys J 2024:S0006-3495(24)00412-0. [PMID: 38898654 DOI: 10.1016/j.bpj.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/31/2024] [Accepted: 06/17/2024] [Indexed: 06/21/2024] Open
Abstract
Covalent labeling of therapeutic drugs and proteins with polyethylene glycol (PEGylation) is an important modification for improving stability, solubility, and half-life. PEGylation alters protein solution behavior through its impact on thermodynamic nonideality by increasing the excluded volume, and on hydrodynamic nonideality by increasing the frictional drag. To understand PEGylation's impact, we investigated the thermodynamic and hydrodynamic properties of a model system consisting of PEGylated human serum albumin derivatives using analytical ultracentrifugation (AUC) and dynamic light scattering (DLS). We constructed PEGylated human serum albumin derivatives of single, linear 5K, 10K, 20K, and 40K PEG chains and a single branched-chain PEG of 40K (2 × 20K). Sedimentation velocity (SV) experiments were analyzed using SEDANAL direct boundary fitting to extract ideal sedimentation coefficients so, hydrodynamic nonideality ks, and thermodynamic nonideality 2BM1SV terms. These quantities allow the determination of the Stokes radius Rs, the frictional ratio f/fo, and the swollen or entrained volume Vs/v, which measure size, shape, and solvent interaction. We performed sedimentation equilibrium experiments to obtain independent measurements of thermodynamic nonideality 2BM1SE. From DLS measurements, we determined the interaction parameter, kD, the concentration dependence of the apparent diffusion coefficient, D, and from extrapolation of D to c = 0 a second estimate of Rs. Rs values derived from SV and DLS measurements and ensemble model calculations (see complementary study) are then used to show that ks + kD = theoretical 2B22M1. In contrast, experimental BM1 values from SV and sedimentation equilibrium data collectively allow for similar analysis for protein-PEG conjugates and show that ks + kD = 1.02-1.07∗BM1, rather than the widely used ks + kD = 2BM1 developed for hard spheres. The random coil behavior of PEG dominates the colloidal properties of PEG-protein conjugates and exceeds the sum of a random coil and hard-sphere volume due to excess entrained water.
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Affiliation(s)
- John J Correia
- Department of Cell & Molecular Biology, University of Miss Medical Center, Jackson, Mississippi.
| | - Walter F Stafford
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts
| | - Heidi Erlandsen
- Center for Open Research Resources and Equipment, University of Connecticut, Storrs, Connecticut
| | - James L Cole
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, Connecticut
| | | | - Dragan Isailovic
- Department of Chemistry and Biochemistry, University of Toledo, Toledo, Ohio
| | - John David Dignam
- Department of Chemistry and Biochemistry, University of Toledo, Toledo, Ohio
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Wrobeln A, Jägers J, Quinting T, Schreiber T, Kirsch M, Fandrey J, Ferenz KB. Albumin-derived perfluorocarbon-based artificial oxygen carriers can avoid hypoxic tissue damage in massive hemodilution. Sci Rep 2020; 10:11950. [PMID: 32686717 PMCID: PMC7371727 DOI: 10.1038/s41598-020-68701-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/26/2020] [Indexed: 12/29/2022] Open
Abstract
Artificial blood for clinical use is not yet available therefore, we previously developed artificial oxygen carriers (capsules) and showed their functionality in vitro and biocompatibility in vivo. Herein, we assessed the functionality of the capsules in vivo in a normovolemic hemodilution rat-model. We stepwise exchanged the blood of male Wistar-rats with medium either in the presence of capsules (treatment) or in their absence (control). We investigated tissue hypoxia thoroughly through online biomonitoring, determination of enzyme activity and pancreatic hormones in plasma, histochemical and immunohistochemical staining of small intestine, heart, liver and spleen as well as in situ hybridization of kidneys. After hemodilution, treated animals show higher arterial blood pressure and have a stable body temperature. Additionally, they show a more stable pH, a higher oxygen partial pressure (pO2), and a lower carbon dioxide partial pressure (pCO2). Interestingly, blood-glucose-levels drop severely in treated animals, presumably due to glucose consumption. Creatine kinase values in these animals are increased and isoenzyme analysis indicates the spleen as origin. Moreover, the small intestine of treated animals show reduced hypoxic injury compared to controls and the kidneys have reduced expression of the hypoxia-inducible erythropoietin mRNA. In conclusion, our capsules can prevent hypoxic tissue damage. The results provide a proof of concept for capsules as adequate erythrocyte substitute.
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Affiliation(s)
- Anna Wrobeln
- Institute of Physiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Johannes Jägers
- Institute of Physiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Theresa Quinting
- Institute of Physiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Timm Schreiber
- Institute of Physiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Michael Kirsch
- Institute of Physiological Chemistry, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Joachim Fandrey
- Institute of Physiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Katja B Ferenz
- Institute of Physiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany. .,CeNIDE (Center for Nanointegration Duisburg-Essen) University of Duisburg-Essen, Carl-Benz-Strasse 199, 47057, Duisburg, Germany.
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Liu H, Yan C, Yan K, Zhu W, Shen Y, Yang B, Chen C, Zhu H. Study of the effects of polymerized porcine hemoglobin (pPolyHb) in an acute anemia rat model. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2016; 45:694-700. [DOI: 10.1080/21691401.2016.1228665] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Huifang Liu
- College of Life Science, Northwest University, Xi’an, PR China
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, PR China
| | - Chengbin Yan
- College of Life Science, Northwest University, Xi’an, PR China
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, PR China
| | - Kunping Yan
- College of Life Science, Northwest University, Xi’an, PR China
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, PR China
| | - Wenjin Zhu
- School of public health, The First Affiliated Hospital of Xi’ an Jiaotong University, Xi’an, PR China
| | - Yuesheng Shen
- College of Life Science, Northwest University, Xi’an, PR China
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, PR China
| | - Bo Yang
- College of Life Science, Northwest University, Xi’an, PR China
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, PR China
| | - Chao Chen
- College of Life Science, Northwest University, Xi’an, PR China
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, PR China
| | - Hongli Zhu
- College of Life Science, Northwest University, Xi’an, PR China
- National Engineering Research Center for Miniaturized Detection Systems, Northwest University, Xi’an, PR China
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Terraneo L, Bianciardi P, Malavalli A, Mkrtchyan G, Spann SN, Lohman J, Samaja M, Vandegriff KD. Hemoglobin extravasation in the brain of rats exchange-transfused with hemoglobin-based oxygen carriers. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2016; 45:710-716. [PMID: 27908199 DOI: 10.1080/21691401.2016.1263640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Haemoglobin (Hb)-based oxygen carriers are under consideration as oxygen therapeutics. Their effect on apoptosis is critical, because the onset of pro-apoptotic pathways may lead to tissue damage. MP4OX, a polyethylene glycol-conjugated human Hb preserves the baseline level of neuron apoptosis with respect to sham. Here we develop a method for measuring Hb extravasation in brain. We exchange transfused rats by haemorrhaging 50% of their blood with simultaneous, isovolemic replacement with Hextend (negative control), MP4OX, or αα-cross-linked Hb. Animals were sacrificed 2 h after transfusion, brain tissue was harvested and processed for double-staining immunofluorescence, whereby Hb ? chain and NeuN (a neuron protein) were stained and quantitated. Whereas Hextend did not induce Hb extravasation, in both MP4OX and ??Hb brains Hb molecules were detected outside neurons. The level of extravasated Hb chains was > 3-fold higher in Hb compared to MP4OX. Western blot analysis revealed that the expression levels of protein related to redox imbalance (e.g., Nrf2, iNOS and ERK phosphorylation) were higher in ααHb than MP4OX. In conclusions, higher Hb extravasation in ααHb than MP4OX induces redox imbalance, which causes higher anti-oxidant response. Whereas Nrf2 response may be considered protective, iNOS response appears damaging.
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Affiliation(s)
- Laura Terraneo
- a Department of Health Science , University of Milan , Milan , Italy
| | - Paola Bianciardi
- a Department of Health Science , University of Milan , Milan , Italy
| | - Ashok Malavalli
- b NovoSang, Inc. , San Diego , CA , USA.,c Sangart Inc. , San Diego , CA , USA
| | | | | | | | - Michele Samaja
- a Department of Health Science , University of Milan , Milan , Italy
| | - Kim D Vandegriff
- b NovoSang, Inc. , San Diego , CA , USA.,c Sangart Inc. , San Diego , CA , USA
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Weiskopf RB, Beliaev AM, Shander A, Guinn NR, Cap AP, Ness PM, Silverman TA. Addressing the unmet need of life-threatening anemia with hemoglobin-based oxygen carriers. Transfusion 2016; 57:207-214. [PMID: 27859328 DOI: 10.1111/trf.13923] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/22/2016] [Accepted: 10/02/2016] [Indexed: 01/02/2023]
Affiliation(s)
| | - Andrei M Beliaev
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Aryeh Shander
- Department of Anesthesiology, Center for Blood Conservation, Duke University Medical Center, Durham, North Carolina
| | - Nicole R Guinn
- Department of Anesthesiology, Critical Care Medicine, Pain Management and Hyperbaric Medicine, Englewood Hospital & Medical Center, Englewood, New Jersey.,Medicine & Surgery, Icahn School of Medicine Mount Sinai, New York, New York
| | - Andrew P Cap
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas
| | - Paul M Ness
- Pathology, Medicine, Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland
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Vandegriff KD, Malavalli A, Lohman J, Young MA, Terraneo L, Virgili E, Bianciardi P, Caretti A, Samaja M. Impact of acellular hemoglobin-based oxygen carriers on brain apoptosis in rats. Transfusion 2014; 54:2045-54. [PMID: 24673504 DOI: 10.1111/trf.12643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/23/2013] [Accepted: 12/26/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Extracellular hemoglobin (Hb)-based oxygen carriers (HBOCs) are under extensive consideration as oxygen therapeutics. Their effects on cellular mechanisms related to apoptosis are of particular interest, because the onset of proapoptotic pathways may give rise to tissue damage. STUDY DESIGN AND METHODS The objective was to assess whether the properties of the Hb that replaces blood during an isovolemic hemodilution would modulate apoptotic-response mechanisms in rat brain and whether such signaling favors cytoprotection or damage. We exposed rats to exchange transfusion (ET; 50% blood volume and isovolemic replacement with Hextend [negative colloid control], MP4OX [PEGylated HBOC with high oxygen affinity], and ααHb [αα-cross-linked HBOC with low oxygen affinity; n=4-6/group]). Sham rats acted as control. Animals were euthanized at 2, 6, and 12 hours after ET; brain tissue was harvested and processed for analysis. RESULTS In MP4OX animals, the number of neurons that overexpressed the hypoxia-inducible factor (HIF)-1α was higher than in ααHb, particularly at the early time points. In addition, MP4OX was associated with greater phosphorylation of protein kinase B (Akt), a well-known cytoprotective factor. Indeed, the degree of apoptosis, measured as terminal deoxynucleotidyl transferase-positive neurons and caspase-3 cleavage, ranked in order of MP4OX < Hextend < ααHb. CONCLUSION Even though both HBOCs showed increased levels of HIF-1α compared to shams or Hextend-treated animals, differences in signaling events resulted in very different outcomes for the two HBOCs. ααHb-treated brain tissue showed significant neuronal damage, measured as apoptosis. This was in stark contrast to the protection seen with MP4OX, apparently due to recruitment of Akt and neuronal specific HIF-1α pathways.
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van der Linden P, Gazdzik TS, Jahoda D, Heylen RJ, Skowronski JC, Pellar D, Kofranek I, Górecki AZ, Fagrell B, Keipert PE, Hardiman YJ, Levy H. A Double-Blind, Randomized, Multicenter Study of MP4OX for Treatment of Perioperative Hypotension in Patients Undergoing Primary Hip Arthroplasty Under Spinal Anesthesia. Anesth Analg 2011; 112:759-73. [PMID: 21317165 DOI: 10.1213/ane.0b013e31820c7b5f] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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