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Yan W, Sheng M, Yu W, Shen L, Qi J, Zhou H, Hu T, Zhao L. Hydroxyethyl Starch-Bovine Hemoglobin Conjugate as an Effective Oxygen Carrier with the Ability to Expand Plasma. ACS OMEGA 2023; 8:11447-11456. [PMID: 37008107 PMCID: PMC10061510 DOI: 10.1021/acsomega.3c00275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/08/2023] [Indexed: 06/19/2023]
Abstract
Hemorrhagic shock leads to intravasal volume deficiency, tissue hypoxia, and cellular anaerobic metabolism. Hemoglobin (Hb) could deliver oxygen for hypoxic tissues but is unable to expand plasma. Hydroxyethyl starch (HES) could compensate for the intravasal volume deficiency but cannot deliver oxygen. Thus, bovine Hb (bHb) was conjugated with HES (130 kDa and 200 kDa) to develop an oxygen carrier with the ability to expand plasma. Conjugation with HES increased the hydrodynamic volume, colloidal osmotic pressure, and viscosity of bHb. It slightly perturbed the quaternary structure and heme environment of bHb. The partial oxygen pressures at 50% saturation (P 50) of the two conjugates (bHb-HES130 and bHb-HES200) were 15.1 and 13.9 mmHg, respectively. The two conjugates showed no apparent side effects on the morphology and rigidity, hemolysis, and platelet aggregation of red blood cells of Wistar rats. Thus, bHb-HES130 and bHb-HES200 were expected to function as an effective oxygen carrier with the ability to expand plasma.
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Affiliation(s)
- Wenying Yan
- State
Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
- University
of Chinese Academy of Sciences, Beijing 100190, China
| | - Ming Sheng
- Institute
of Health Service and Transfusion Medicine, Academy of Military Medical Sciences, Beijing 100850, China
| | - Weili Yu
- State
Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
| | - Lijuan Shen
- State
Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
| | - Jinming Qi
- State
Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
| | - Hong Zhou
- Institute
of Health Service and Transfusion Medicine, Academy of Military Medical Sciences, Beijing 100850, China
| | - Tao Hu
- State
Key Laboratory of Biochemical Engineering, Institute of Process Engineering, Chinese Academy of Sciences, Beijing 100190, China
| | - Lian Zhao
- Institute
of Health Service and Transfusion Medicine, Academy of Military Medical Sciences, Beijing 100850, China
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2
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Dyer WB, Simonova G, Chiaretti S, Bouquet M, Wellburn R, Heinsar S, Ainola C, Wildi K, Sato K, Livingstone S, Suen JY, Irving DO, Tung JP, Li Bassi G, Fraser JF. Recovery of organ-specific tissue oxygen delivery at restrictive transfusion thresholds after fluid treatment in ovine haemorrhagic shock. Intensive Care Med Exp 2022; 10:12. [PMID: 35377109 PMCID: PMC8980119 DOI: 10.1186/s40635-022-00439-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Fluid resuscitation is the standard treatment to restore circulating blood volume and pressure after massive haemorrhage and shock. Packed red blood cells (PRBC) are transfused to restore haemoglobin levels. Restoration of microcirculatory flow and tissue oxygen delivery is critical for organ and patient survival, but these parameters are infrequently measured. Patient Blood Management is a multidisciplinary approach to manage and conserve a patient’s own blood, directing treatment options based on broad clinical assessment beyond haemoglobin alone, for which tissue perfusion and oxygenation could be useful. Our aim was to assess utility of non-invasive tissue-specific measures to compare PRBC transfusion with novel crystalloid treatments for haemorrhagic shock. Methods A model of severe haemorrhagic shock was developed in an intensive care setting, with controlled haemorrhage in sheep according to pressure (mean arterial pressure 30–40 mmHg) and oxygen debt (lactate > 4 mM) targets. We compared PRBC transfusion to fluid resuscitation with either PlasmaLyte or a novel crystalloid. Efficacy was assessed according to recovery of haemodynamic parameters and non-invasive measures of sublingual microcirculatory flow, regional tissue oxygen saturation, repayment of oxygen debt (arterial lactate), and a panel of inflammatory and organ function markers. Invasive measurements of tissue perfusion, oxygen tension and lactate levels were performed in brain, kidney, liver, and skeletal muscle. Outcomes were assessed during 4 h treatment and post-mortem, and analysed by one- and two-way ANOVA. Results Each treatment restored haemodynamic and tissue oxygen delivery parameters equivalently (p > 0.05), despite haemodilution after crystalloid infusion to haemoglobin concentrations below 70 g/L (p < 0.001). Recovery of vital organ-specific perfusion and oxygen tension commenced shortly before non-invasive measures improved. Lactate declined in all tissues and correlated with arterial lactate levels (p < 0.0001). The novel crystalloid supported rapid peripheral vasodilation (p = 0.014) and tended to achieve tissue oxygen delivery targets earlier. PRBC supported earlier renal oxygen delivery (p = 0.012) but delayed peripheral perfusion (p = 0.034). Conclusions Crystalloids supported vital organ oxygen delivery after massive haemorrhage, despite haemodilution to < 70 g/L, confirming that restrictive transfusion thresholds are appropriate to support oxygen delivery. Non-invasive tissue perfusion and oximetry technologies merit further clinical appraisal to guide treatment for massive haemorrhage in the context of Patient Blood Management. Supplementary Information The online version contains supplementary material available at 10.1186/s40635-022-00439-6.
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Affiliation(s)
- Wayne B Dyer
- Australian Red Cross Lifeblood, Sydney, Australia.
| | - Gabriela Simonova
- Australian Red Cross Lifeblood, Brisbane, Australia.,Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Mahe Bouquet
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | | | - Silver Heinsar
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Carmen Ainola
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Karin Wildi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Cardiovascular Research Institute, Basel, Switzerland
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | | | - Jacky Y Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - David O Irving
- Australian Red Cross Lifeblood, Sydney, Australia.,Faculty of Health, University of Technology, Sydney, Australia
| | - John-Paul Tung
- Australian Red Cross Lifeblood, Brisbane, Australia.,Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Medical Engineering Research Facility, Queensland University of Technology, Brisbane, Australia.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
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3
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Li W, Tsai AG, Intaglietta M, Tartakovsky DM. A model of anemic tissue perfusion after blood transfusion shows critical role of endothelial response to shear stress stimuli. J Appl Physiol (1985) 2021; 131:1815-1823. [PMID: 34647829 DOI: 10.1152/japplphysiol.00524.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although some of the cardiovascular responses to changes in hematocrit (Hct) are not fully quantified experimentally, available information is sufficient to build a mathematical model of the consequences of treating anemia by introducing RBCs into the circulation via blood transfusion. We present such a model, which describes how the treatment of normovolemic anemia with blood transfusion impacts oxygen (O2) delivery (DO2, the product of blood O2 content and arterial blood flow) by the microcirculation. Our analysis accounts for the differential response of the endothelium to the wall shear stress (WSS) stimulus, changes in nitric oxide (NO) production due to modification of blood viscosity caused by alterations of both hematocrit (Hct) and cell free layer thickness, as well as for their combined effects on microvascular blood flow and DO2. Our model shows that transfusions of 1- and 2-unit of blood have a minimal effect on DO2 if the microcirculation is unresponsive to the WSS stimulus for NO production that causes vasodilatation increasing blood flow and DO2. Conversely, in a fully WSS responsive organism, blood transfusion significantly enhances blood flow and DO2, because increased viscosity stimulates endothelial NO production causing vasodilatation. This finding suggests that evaluation of a patients' pretransfusion endothelial WSS responsiveness should be beneficial in determining the optimal transfusion requirements for treating patients with anemia.NEW & NOTEWORTHY Transfusion of 1 or 2 units of blood accounts for about 3/4 of the world blood consumption of 119 million units per year, whereas a current world demand deficit is on the order of 100 million units. Therefore, factors supporting the practice of transfusing 1 unit instead of 2 are of interest, given their potential to expand the number of interventions without increasing blood availability. Our mathematical model provides a physiological support for this practice.
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Affiliation(s)
- Weiyu Li
- Department of Energy Resources Engineering, Stanford University, Stanford, California
| | - Amy G Tsai
- Department of Bioengineering, University of California, San Diego, California
| | - Marcos Intaglietta
- Department of Bioengineering, University of California, San Diego, California
| | - Daniel M Tartakovsky
- Department of Energy Resources Engineering, Stanford University, Stanford, California
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4
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Munoz C, Aletti F, Govender K, Cabrales P, Kistler EB. Resuscitation After Hemorrhagic Shock in the Microcirculation: Targeting Optimal Oxygen Delivery in the Design of Artificial Blood Substitutes. Front Med (Lausanne) 2020; 7:585638. [PMID: 33195342 PMCID: PMC7652927 DOI: 10.3389/fmed.2020.585638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022] Open
Abstract
Microcirculatory preservation is essential for patient recovery from hemorrhagic shock. In hemorrhagic shock, microcirculatory flow and pressure are greatly reduced, creating an oxygen debt that may eventually become irreversible. During shock, tissues become hypoxic, cellular respiration turns to anaerobic metabolism, and the microcirculation rapidly begins to fail. This condition requires immediate fluid resuscitation to promote tissue reperfusion. The choice of fluid for resuscitation is whole blood; however, this may not be readily available and, on a larger scale, may be globally insufficient. Thus, extensive research on viable alternatives to blood has been undertaken in an effort to develop a clinically deployable blood substitute. This has not, as of yet, achieved fruition, in part due to an incomplete understanding of the complexities of the function of blood in the microcirculation. Hemodynamic resuscitation is acknowledged to be contingent on a number of factors other than volume expansion. The circulation of whole blood is carefully regulated to optimize oxygen delivery to the tissues via shear stress modulation through blood viscosity, inherent oxygen-carrying capacity, cell-free layer variation, and myogenic response, among other variables. Although plasma expanders can address a number of these issues, hemoglobin-based oxygen carriers (HBOCs) introduce a method of replenishing the intrinsic oxygen-carrying capacity of blood. There continue to be a number of issues related to HBOCs, but recent advances in the next-generation HBOCs show promise in the preservation of microcirculatory function and limiting toxicities. The development of HBOCs is now focused on viscosity and the degree of microvascular shear stress achieved in order to optimize vasoactive and oxygen delivery responses by leveraging the restoration and maintenance of physiological responses to blood flow in the microcirculation. Blood substitutes with higher viscous properties tend to improve oxygen delivery compared to those with lower viscosities. This review details current concepts in blood substitutes, particularly as they relate to trauma/hemorrhagic shock, with a specific focus on their complex interactions in the microcirculation.
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Affiliation(s)
- Carlos Munoz
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Federico Aletti
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Krianthan Govender
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Pedro Cabrales
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Erik B Kistler
- Department of Anesthesiology and Critical Care, University of California, San Diego, La Jolla, CA, United States.,Department of Anesthesiology and Critical Care, Veterans Affairs San Diego Healthcare System, San Diego, CA, United States
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5
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Chan YL, Han ST, Li CH, Wu CC, Chen KF. Transfusion of Red Blood Cells to Patients with Sepsis. Int J Mol Sci 2017; 18:ijms18091946. [PMID: 28891973 PMCID: PMC5618595 DOI: 10.3390/ijms18091946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/26/2017] [Accepted: 09/08/2017] [Indexed: 12/14/2022] Open
Abstract
Sepsis is one of the major causes of death worldwide, and is the host response to infection which renders our organs malfunctioning. Insufficient tissue perfusion and oxygen delivery have been implicated in the pathogenesis of sepsis-related organ dysfunction, making transfusion of packed red blood cells (pRBCs) a reasonable treatment modality. However, clinical trials have generated controversial results. Even the notion that transfused pRBCs increase the oxygen-carrying capacity of blood has been challenged. Meanwhile, during sepsis, the ability of our tissues to utilize oxygen may also be reduced, and the increased blood concentrations of lactate may be the results of strong inflammation and excessive catecholamine release, rather than impaired cell respiration. Leukodepleted pRBCs more consistently demonstrated improvement in microcirculation, and the increase in blood viscosity brought about by pRBC transfusion helps maintain functional capillary density. A restrictive strategy of pRBC transfusion is recommended in treating septic patients.
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Affiliation(s)
- Yi-Ling Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Taoyuan 330, Taiwan.
| | - Shih-Tsung Han
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Taoyuan 330, Taiwan.
| | - Chih-Huang Li
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Taoyuan 330, Taiwan.
| | - Chin-Chieh Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital Keelung, Keelung 204, Taiwan.
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou, Taoyuan 330, Taiwan.
- Department of Emergency Medicine, Chang Gung Memorial Hospital Keelung, Keelung 204, Taiwan.
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 330, Taiwan.
- Community Medicine Research Center, Chang Gung Memorial Hospital Keelung, Keelung 204, Taiwan.
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Rodriguez-Brotons A, Bietiger W, Peronet C, Langlois A, Magisson J, Mura C, Sookhareea C, Polard V, Jeandidier N, Zal F, Pinget M, Sigrist S, Maillard E. Comparison of Perfluorodecalin and HEMOXCell as Oxygen Carriers for Islet Oxygenation in an In Vitro Model of Encapsulation. Tissue Eng Part A 2016; 22:1327-1336. [PMID: 27796164 DOI: 10.1089/ten.tea.2016.0064] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transplantation of encapsulated islets in a bioartificial pancreas is a promising alternative to free islet cell therapy to avoid immunosuppressive regimens. However, hypoxia, which can induce a rapid loss of islets, is a major limiting factor. The efficiency of oxygen delivery in an in vitro model of bioartificial pancreas involving hypoxia and confined conditions has never been investigated. Oxygen carriers such as perfluorocarbons and hemoglobin might improve oxygenation. To verify this hypothesis, this study aimed to identify the best candidate of perfluorodecalin (PFD) or HEMOXCell® to reduce cellular hypoxia in a bioartificial pancreas in an in vitro model of encapsulation ex vivo. The survival, hypoxia, and inflammation markers and function of rat islets seeded at 600 islet equivalents (IEQ)/cm2 and under 2% pO2 were assessed in the presence of 50 μg/mL of HEMOXCell or 10% PFD with or without adenosine. Both PFD and HEMOXCell increased the cell viability and decreased markers of hypoxia (hypoxia-inducible factor mRNA and protein). In these culture conditions, adenosine had deleterious effects, including an increase in cyclooxygenase-2 and interleukin-6, in correlation with unregulated proinsulin release. Despite the effectiveness of PFD in decreasing hypoxia, no restoration of function was observed and only HEMOXCell had the capacity to restore insulin secretion to a normal level. Thus, it appeared that the decrease in cell hypoxia as well as the intrinsic superoxide dismutase activity of HEMOXCell were both mandatory to maintain islet function under hypoxia and confinement. In the context of islet encapsulation in a bioartificial pancreas, HEMOXCell is the candidate of choice for application in vivo.
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Affiliation(s)
| | - William Bietiger
- 1 Université de Strasbourg, Centre Européen d'Etude du Diabète, Strasbourg, France
| | - Claude Peronet
- 1 Université de Strasbourg, Centre Européen d'Etude du Diabète, Strasbourg, France
| | - Allan Langlois
- 1 Université de Strasbourg, Centre Européen d'Etude du Diabète, Strasbourg, France
| | | | - Carole Mura
- 1 Université de Strasbourg, Centre Européen d'Etude du Diabète, Strasbourg, France
| | - Cynthia Sookhareea
- 1 Université de Strasbourg, Centre Européen d'Etude du Diabète, Strasbourg, France
| | - Valerie Polard
- 4 HEMARINA Aéropôle Centre , Biotechnopôle, Morlaix, France
| | - Nathalie Jeandidier
- 1 Université de Strasbourg, Centre Européen d'Etude du Diabète, Strasbourg, France .,2 Structure d'Endocrinologie, Diabète-Nutrition et Addictologie, Pôle NUDE, Hôpitaux Universitaires de Strasbourg (HUS) , Strasbourg, France
| | - Franck Zal
- 4 HEMARINA Aéropôle Centre , Biotechnopôle, Morlaix, France
| | - Michel Pinget
- 1 Université de Strasbourg, Centre Européen d'Etude du Diabète, Strasbourg, France .,2 Structure d'Endocrinologie, Diabète-Nutrition et Addictologie, Pôle NUDE, Hôpitaux Universitaires de Strasbourg (HUS) , Strasbourg, France
| | - Séverine Sigrist
- 1 Université de Strasbourg, Centre Européen d'Etude du Diabète, Strasbourg, France
| | - Elisa Maillard
- 1 Université de Strasbourg, Centre Européen d'Etude du Diabète, Strasbourg, France
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