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Sun X, Peng Y, He P, Cheng H, Li D, Liu H, Lin H, Liu G. Repurposing indocyanine green: exploring the potential of an old drug in modern medicine. NANOSCALE 2024; 16:11411-11428. [PMID: 38860512 DOI: 10.1039/d4nr00283k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
The repurposing of existing drugs, referred to as theranostics, has made profound impacts on precision medicine. Indocyanine green (ICG), a well-established and clinical dye, has continued to be a star agent, described as a multifunctional molecule with concurrent photo- or sono-sensitiveness capabilities and co-delivery accessibility, showing remarkable potential in the area of unimodal or multimodal imaging-guided therapy of various diseases, leading to the extensive consideration of immediate clinical translations. In this review, we strive to bring the understanding of repurposing performance assessment for ICG into practice by clarifying the relationships between its features and applicability. Specifically, we address the obstacles encountered in the process of developing an ICG repurposing strategy, as well as the noteworthy advancements made in the field of ICG repurposing. We also go into detail about the structure-function correlations of drugs containing ICG and how different structural groups significantly affect the physicochemical properties.
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Affiliation(s)
- Xinfei Sun
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China.
| | - Yisheng Peng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China.
| | - Pan He
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China.
| | - Hongwei Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China.
| | - Dong Li
- College of Ocean Food and Biological Engineering, Jimei University, Xiamen 361021, China
| | - Huanhuan Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China.
| | - Huirong Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China.
| | - Gang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen 361102, China.
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Leerson J, Tulloh A, Lopez FT, Gregory S, Buscher H, Rosengarten G. Detecting Oxygenator Thrombosis in ECMO: A Review of Current Techniques and an Exploration of Future Directions. Semin Thromb Hemost 2024; 50:253-270. [PMID: 37640048 DOI: 10.1055/s-0043-1772843] [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: 08/31/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a life-support technique used to treat cardiac and pulmonary failure, including severe cases of COVID-19 (coronavirus disease 2019) involving acute respiratory distress syndrome. Blood clot formation in the circuit is one of the most common complications in ECMO, having potentially harmful and even fatal consequences. It is therefore essential to regularly monitor for clots within the circuit and take appropriate measures to prevent or treat them. A review of the various methods used by hospital units for detecting blood clots is presented. The benefits and limitations of each method are discussed, specifically concerning detecting blood clots in the oxygenator, as it is concluded that this is the most critical and challenging ECMO component to assess. We investigate the feasibility of solutions proposed in the surrounding literature and explore two areas that hold promise for future research: the analysis of small-scale pressure fluctuations in the circuit, and real-time imaging of the oxygenator. It is concluded that the current methods of detecting blood clots cannot reliably predict clot volume, and their inability to predict clot location puts patients at risk of thromboembolism. It is posited that a more in-depth analysis of pressure readings using machine learning could better provide this information, and that purpose-built imaging could allow for accurate, real-time clotting analysis in ECMO components.
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Affiliation(s)
- Jack Leerson
- Department is Manufacturing, Materials and Mechatronics Engineering, School of Engineering, RMIT University, Melbourne, Victoria, Australia
- Department of Manufacturing, CSIRO, Research Way, Clayton, Victoria, Australia
| | - Andrew Tulloh
- Department of Manufacturing, CSIRO, Research Way, Clayton, Victoria, Australia
| | - Francisco Tovar Lopez
- Department is Manufacturing, Materials and Mechatronics Engineering, School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Shaun Gregory
- Department of Mechanical and Aerospace Engineering, Cardiorespiratory Engineering and Technology Laboratory, Monash University, Melbourne, Victoria, Australia
| | - Hergen Buscher
- Department of Intensive Care Medicine, St Vincent's Hospital, Sydney, Australia
| | - Gary Rosengarten
- Department is Manufacturing, Materials and Mechatronics Engineering, School of Engineering, RMIT University, Melbourne, Victoria, Australia
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Fu X, Su Z, Wang Y, Sun A, Wang L, Deng X, Chen Z, Fan Y. Comparison of hemodynamic features and thrombosis risk of membrane oxygenators with different structures: A numerical study. Comput Biol Med 2023; 159:106907. [PMID: 37075599 DOI: 10.1016/j.compbiomed.2023.106907] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE The geometric structure of the membrane oxygenator can exert an impact on its hemodynamic features, which contribute to the development of thrombosis, thereby affecting the clinical efficacy of ECMO treatment. The purpose of this study is to investigate the impact of varying geometric structures on hemodynamic features and thrombosis risk of membrane oxygenators with different designs. METHODS Five oxygenator models with different structures, including different number and location of blood inlet and outlet, as well as variations in blood flow path, were established for investigation. These models are referred to as Model 1 (Quadrox-i Adult Oxygenator), Model 2 (HLS Module Advanced 7.0 Oxygenator), Model 3 (Nautilus ECMO Oxygenator), Model 4 (OxiaACF Oxygenator) and Model 5 (New design oxygenator). The hemodynamic features of these models were numerically analyzed using the Euler method combined with computational fluid dynamics (CFD). The accumulated residence time (ART) and coagulation factor concentrations (C[i], where i represents different coagulation factors) were calculated by solving the convection diffusion equation. The resulting relationships between these factors and the development of thrombosis in the oxygenator were then investigated. RESULTS Our results show that the geometric structure of the membrane oxygenator, including the location of the blood inlet and outlet as well as the design of the flow path, has a significant impact on the hemodynamic surroundings within the oxygenator. In comparison to Model 4, which had the inlet and outlet located in the center position, Model 1 and Model 3, which had the inlet and outlet at the edge of the blood flow field, exhibited a more uneven distribution of blood flow within the oxygenator, particularly in areas distant from the inlet and outlet, which was accompanied with lower flow velocity and higher values of ART and C[i], leading to the formation of flow dead zones and an elevated risk of thrombosis. The oxygenator of Model 5 is designed with a structure that features multiple inlets and outlets, which greatly improves the hemodynamic environment inside the oxygenator. This results in a more even distribution of blood flow within the oxygenator, reducing areas with high values of ART and C[i], and ultimately lowering the risk of thrombosis. The oxygenator of Model 3 with circular flow path section shows better hemodynamic performance compared to the oxygenator of Model 1 with square circular flow path. The overall ranking of hemodynamic performance for all five oxygenators is as follows: Model 5 > Model 4 > Model 2 > Model 3 > Model 1, indicating that Model 1 has the highest thrombosis risk while Model 5 has the lowest. CONCLUSION The study reveals that the different structures can affect the hemodynamic characteristics inside membrane oxygenators. The design of multiple inlets and outlets can improve the hemodynamic performance and reduce the thrombosis risk in membrane oxygenators. These findings of this study can be used to guide the optimization design of membrane oxygenators for improving hemodynamic surroundings and reducing thrombosis risk.
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Affiliation(s)
- Xingji Fu
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Zihua Su
- Beijing Aerospace Changfeng Co., Ltd., Beijing, 100854, China
| | - Yawei Wang
- Beijing Aerospace Changfeng Co., Ltd., Beijing, 100854, China
| | - Anqiang Sun
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Lizhen Wang
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Xiaoyan Deng
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Zengsheng Chen
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.
| | - Yubo Fan
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China.
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Hatakenaka K, Hijikata W, Fujiwara T, Ohuchi K, Inoue Y. Prevention of thrombus formation in blood pump by mechanical circular orbital excitation of impeller in magnetically levitated centrifugal pump. Artif Organs 2023; 47:425-431. [PMID: 36305737 PMCID: PMC10098525 DOI: 10.1111/aor.14443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/22/2022] [Accepted: 10/15/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mechanical circulatory support devices, such as left ventricular assist devices, have recently been used in patients with heart failure as destination therapy but the formation of thrombus in blood pumps remains a critical problem. In this study, we propose a mechanical antithrombogenic method by impeller excitation using a magnetically levitated (Maglev) centrifugal pump. Previous studies have shown that one-directional excitation prevents thrombus; however, it is effective in only one direction. In this study, we aimed to obtain a better effect by vibrating it in a circular orbit to induce uniform changes in the shear-rate field entirely around the impeller. METHODS The blood coagulation time was compared using porcine blood. (1) The flow rate was set to 1 L/min, and applied excitation was at a frequency of 280 Hz and amplitude of 3 μm. (2) Moreover, the effect was compared by varying the frequency, amplitude, and direction of the excitation. In this experiment, the flow rate was set to 0.3 L/min. RESULTS (1) The thrombus formation time was 77 min without excitation and 133 min with excitation, which was 1.7 times longer. (2) The results showed no difference between (280 Hz, 3 μm) and (50 Hz, 16 μm) circular orbital excitations, and no directional difference, with thrombus formation of 2.5 times longer under all conditions than that without excitation. CONCLUSION In the case of simple reciprocating excitation, the time was approximately 1.2 times longer. This indicated that the circular orbital excitation is more effective.
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Affiliation(s)
- Kohei Hatakenaka
- School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Wataru Hijikata
- School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsuhiro Ohuchi
- Center for Experimental Animals, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Inoue
- Advanced Medical Engineering Research Center, Asahikawa Medical University, Asahikawa, Japan
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Sakurai H, Fujiwara T, Ohuchi K, Hijikata W, Inoue Y, Maruyama O, Tahara T, Yokota S, Tanaka Y, Takewa Y, Mizuno T, Arai H. Innovative experimental animal models for real-time comparison of antithrombogenicity between two oxygenators using dual extracorporeal circulation circuits and indocyanine green fluorescence imaging. Artif Organs 2023; 47:77-87. [PMID: 35957489 DOI: 10.1111/aor.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/08/2022] [Accepted: 08/02/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Antithrombogenicity of extracorporeal membrane oxygenation (ECMO) devices, particularly oxygenators, is a current problem, with numerous studies and developments underway. However, there has been limited progress in developing methods to accurately compare the antithrombogenicity of oxygenators. Animal experiments are commonly conducted to evaluate the antithrombogenicity of devices; however, it is challenging to maintain a steady experimental environment. We propose an innovative experimental animal model to evaluate different devices in a constant experimental environment in real-time. METHODS This model uses two venous-arterial ECMO circuits attached to one animal (one by jugular vein and carotid artery, one by femoral vein and artery) and real-time assessment of thrombus formation in the oxygenator by indocyanine green (ICG) fluorescence imaging. Comparison studies were conducted using three pigs: one to compare different oxygenators (MERA vs. CAPIOX) (Case 1), and two to compare antithrombotic properties of the oxygenator (QUADROX) when used under different hydrodynamic conditions (continuous flow vs. pulsatile flow) (Cases 2 and 3). RESULTS Thrombi, visualized using ICG imaging, appeared as black dots on a white background in each oxygenator. In Case 1, differences in the site of thrombus formation and rate of thrombus growth were observed in real-time in two oxygenators. In Case 2 and 3, the thrombus region was smaller in pulsatile than in continuous conditions. CONCLUSIONS We devised an innovative experimental animal model for comparison of antithrombogenicity in ECMO circuits. This model enabled simultaneous evaluation of two different ECMO circuits under the same biological conditions and reduced the number of sacrificed experimental animals.
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Affiliation(s)
- Hironobu Sakurai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsuhiro Ohuchi
- Center for Experimental Animals, Tokyo Medical and Dental University, Tokyo, Japan
| | - Wataru Hijikata
- School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Yusuke Inoue
- Advanced Medical Engineering Research Center, Asahikawa Medical University, Asahikawa, Japan
| | - Osamu Maruyama
- Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Tomoki Tahara
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sachie Yokota
- Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yui Tanaka
- School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Yoshiaki Takewa
- Advanced Medical Engineering Research Center, Asahikawa Medical University, Asahikawa, Japan
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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