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Harrison OJ, Cagampang F, Ohri SK, Torrens C, Salhiyyah K, Modi A, Moorjani N, Whetton AD, Townsend PA. Candidate plasma biomarkers for predicting ascending aortic aneurysm in bicuspid aortic valve disease. J Cardiothorac Surg 2018; 13:76. [PMID: 29929532 PMCID: PMC6013884 DOI: 10.1186/s13019-018-0762-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Bicuspid aortic valve (BAV) disease is the most common congenital cardiac abnormality affecting 1–2% of the population and is associated with a significantly increased risk of ascending aortic aneurysm. However, predicting which patients will develop aneurysms remains a challenge. This pilot study aimed to identify candidate plasma biomarkers for monitoring ascending aortic diameter and predicting risk of future aneurysm in BAV patients. Methods Plasma samples were collected pre-operatively from BAV patients undergoing aortic valve surgery. Maximum ascending aortic diameter was measured on pre-operative transoesophageal echocardiography. Maximum diameter ≥ 45 mm was classified as aneurysmal. Sequential Window Acquisition of all THeoretical Mass Spectra (SWATH-MS), an advanced mass spectrometry technique, was used to identify and quantify all proteins within the samples. Protein abundance and aortic diameter were correlated using logistic regression. Levene’s test was used to identify proteins demonstrating low abundance variability in the aneurysmal patients (consistent expression in disease), and high variability in the non-aneurysmal patients (differential expression between ‘at risk’ and not ‘at risk’ patients). Results Fifteen plasma samples were collected (seven non-aneurysmal and 8 aneurysmal BAV patients). The mean age of the patients was 55.5 years and the majority were female (10/15, 67%). Four proteins (haemoglobin subunits alpha, beta and delta and mannan-binding lectin serine protease) correlated significantly with maximal ascending aortic diameter (p < 0.05, r = 0.5–0.6). Five plasma proteins demonstrated significantly lower variability in the aneurysmal group and may indicate increased risk of aneurysm in non-aneurysmal patients (DNA-dependent protein kinase catalytic subunit, lumican, tetranectin, gelsolin and cartilage acidic protein 1). A further 7 proteins were identified only in the aneurysmal group (matrin-3, glucose-6-phosphate isomerase, coactosin-like protein, peptidyl-prolyl cis-trans isomerase A, golgin subfamily B member 1, myeloperoxidase and 2′-deoxynucleoside 5′-phosphate N-hydrolase 1). Conclusions This study is the first to identify candidate plasma biomarkers for predicting aortic diameter and risk of future aneurysm in BAV patients. It provides valuable pilot data and proof of principle that could be used to design a large-scale prospective investigation. Ultimately, a more affordable ‘off-the-shelf’ follow-on blood assay could then be developed in place of SWATH-MS, for use in the healthcare setting. Electronic supplementary material The online version of this article (10.1186/s13019-018-0762-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oliver J Harrison
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK. .,Department of Cardiac Surgery, University Hospital Southampton, Southampton General Hospital, Tremona Road, D-level, North Wing (MP 46), Southampton, UK.
| | - Felino Cagampang
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sunil K Ohri
- Department of Cardiac Surgery, University Hospital Southampton, Southampton General Hospital, Tremona Road, D-level, North Wing (MP 46), Southampton, UK
| | - Christopher Torrens
- Institute of Developmental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kareem Salhiyyah
- Department of Cardiac Surgery, University Hospital Southampton, Southampton General Hospital, Tremona Road, D-level, North Wing (MP 46), Southampton, UK
| | | | - Narain Moorjani
- Department of Cardiac Surgery, Papworth Hospital NHS Foundation Trust, University of Cambridge, Cambridge, UK
| | - Anthony D Whetton
- Stoller Biomarker Discovery Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Paul A Townsend
- Stoller Biomarker Discovery Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Diener JL, Daniel Lagassé HA, Duerschmied D, Merhi Y, Tanguay JF, Hutabarat R, Gilbert J, Wagner DD, Schaub R. Inhibition of von Willebrand factor-mediated platelet activation and thrombosis by the anti-von Willebrand factor A1-domain aptamer ARC1779. J Thromb Haemost 2009; 7:1155-62. [PMID: 19422452 DOI: 10.1111/j.1538-7836.2009.03459.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND von Willebrand factor (VWF) has a role in both hemostasis and thrombosis. Platelets adhere to damaged arteries by interactions between the VWF A1-domain and glycoprotein Ib receptors under conditions of high shear. This initial platelet binding event stimulates platelet activation, recruitment, and activation of the clotting cascade, promoting thrombus formation. OBJECTIVE To characterize the inhibitory activity of a VWF inhibitory aptamer. METHODS Using in vitro selection, aptamer stabilization, and conjugation to a 20-kDa poly(ethylene glycol), we generated a nuclease-resistant aptamer, ARC1779, that binds to the VWF A1-domain with high affinity (K(D) approximately 2 nM). The aptamer was assessed for inhibition of VWF-induced platelet aggregation. In vitro inhibition of platelet adhesion was assessed on collagen-coated slides and injured pig aortic segments. In vivo activity was assessed in a cynomolgus monkey carotid electrical injury thrombosis model. RESULTS AND CONCLUSION ARC1779 inhibited botrocetin-induced platelet aggregation (IC90 approximately 300 nM) and shear force-induced platelet aggregation (IC95 approximately 400 nM). It reduced adhesion of platelets to collagen-coated matrices and formation of platelet thrombi on denuded porcine arteries. ARC1779 also inhibited the formation of occlusive thrombi in cynomolgus monkeys. We have discovered a novel anti-VWF aptamer that could have therapeutic use as an anti-VWF agent in the setting of VWF-mediated thrombosis.
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Affiliation(s)
- J L Diener
- Immune Disease Institute and Department of Pathology, Harvard Medical School, Boston, MA, USA
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Gilbert JC, DeFeo-Fraulini T, Hutabarat RM, Horvath CJ, Merlino PG, Marsh HN, Healy JM, Boufakhreddine S, Holohan TV, Schaub RG. First-in-human evaluation of anti von Willebrand factor therapeutic aptamer ARC1779 in healthy volunteers. Circulation 2007; 116:2678-86. [PMID: 18025536 DOI: 10.1161/circulationaha.107.724864] [Citation(s) in RCA: 190] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND ARC1779 is a therapeutic aptamer antagonist of the A1 domain of von Willebrand Factor (vWF), the ligand for receptor glycoprotein 1b on platelets. ARC1779 is being developed as a novel antithrombotic agent for use in patients with acute coronary syndromes. METHODS AND RESULTS This was a randomized, double-blind, placebo-controlled study in 47 healthy volunteers of doses of ARC1779 from 0.05 to 1.0 mg/kg. Pharmacodynamic effects were measured by an ELISA for free vWF A1 binding sites and by a platelet function analyzer. In terms of pharmacokinetics, the concentration-time profile of ARC1779 appeared monophasic. The observed concentration and area under the curve were dose proportional. The mean apparent elimination half-life was approximately 2 hours, and mean residence time was approximately 3 hours. The mean apparent volumes of distribution (at steady state and during terminal phase) were approximately one half the blood volume, suggesting that ARC1779 distribution is in the central compartment. The mean clearance ranged from approximately 10% to approximately 21% of the glomerular filtration rate, suggesting that renal filtration may not be a major mechanism of clearance of ARC1779. Inhibition of vWF A1 binding activity was achieved with an EC(90) value of 2.0 mug/mL (151 nmol/L) and of platelet function with an EC(90) value of 2.6 mug/mL (196 nmol/L). ARC1779 was generally well tolerated, and no bleeding was observed. Adverse events tended to be minor and not dose related. CONCLUSIONS This is the first-in-human evaluation of a novel aptamer antagonist of vWF. ARC1779 produced dose- and concentration-dependent inhibition of vWF activity and platelet function with duration of effect suitable for the intended clinical use in acute coronary syndromes.
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