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Okamoto W, Hasegawa M, Usui T, Kashima T, Sakata S, Hamano T, Onozawa H, Hashimoto R, Iwazaki M, Kohno M, Komatsu T. Hemoglobin-albumin clusters as an artificial O 2 carrier: Physicochemical properties and resuscitation from hemorrhagic shock in rats. J Biomed Mater Res B Appl Biomater 2022; 110:1827-1838. [PMID: 35191606 DOI: 10.1002/jbm.b.35040] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/30/2021] [Accepted: 02/09/2022] [Indexed: 01/10/2023]
Abstract
A bovine hemoglobin (HbBv) or human adult hemoglobin (HbA) wrapped covalently by human serum albumins (HSAs), hemoglobin-albumin clusters (HbBv-HSA3 and HbA-HSA3 ), are artificial O2 carriers used as a red blood cell substitute. This article describes the physicochemical properties of the HbBv-HSA3 and HbA-HSA3 solutions, and their abilities to restore the systemic condition after resuscitation from hemorrhagic shock in anesthetized rats. The HbBv-HSA3 and HbA-HSA3 , which have high colloid osmotic activity, showed equivalent solution characteristics and O2 binding parameters. Shock was induced by 50% blood withdrawal. Rats exhibited hypotension and significant metabolic acidosis. After 15 min, the rats were administered shed autologous blood (SAB), HbBv-HSA3 , HbA-HSA3 , or Ringer's lactate (RL) solution. Survival rates, circulation parameters, hematological parameters, and blood gas parameters were monitored during the hemorrhagic shock and for 6 h after administration. All rats in the SAB, HbBv-HSA3 , and HbA-HSA3 groups survived for 6 h. The HbBv-HSA3 and HbA-HSA3 groups restored mean arterial pressure after the resuscitation. No remarkable difference was observed in the time courses of blood gas parameters in any resuscitated group except for the RL group. Serum biochemical tests showed increases in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the HbBv-HSA3 and HbA-HSA3 groups compared to the SAB group. Therefore, we observed other rats awakened after resuscitation with HbA-HSA3 for 7 days. The blood cell count, AST, and ALT recovered to the baseline values by 7 days. All the results implied that HbBv-HSA3 and HbA-HSA3 clusters provide restoration from hemorrhagic shock as an alternative material for SAB transfusion.
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Affiliation(s)
- Wataru Okamoto
- Department of Applied Chemistry, Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Mai Hasegawa
- Department of Applied Chemistry, Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Tomone Usui
- Department of Applied Chemistry, Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Tomonori Kashima
- Department of Applied Chemistry, Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Sho Sakata
- Department of Applied Chemistry, Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Tatsuhiko Hamano
- Department of Applied Chemistry, Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Hiroto Onozawa
- Department of General Thoracic Surgery, School of Medicine, Tokai University, Kanagawa, Japan
| | - Ryo Hashimoto
- Department of General Thoracic Surgery, School of Medicine, Tokai University, Kanagawa, Japan
| | - Masayuki Iwazaki
- Department of General Thoracic Surgery, School of Medicine, Tokai University, Kanagawa, Japan
| | - Mitsutomo Kohno
- Department of General Thoracic Surgery, School of Medicine, Tokai University, Kanagawa, Japan.,Department of General Thoracic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Teruyuki Komatsu
- Department of Applied Chemistry, Faculty of Science and Engineering, Chuo University, Tokyo, Japan
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Faggiano S, Ronda L, Bruno S, Abbruzzetti S, Viappiani C, Bettati S, Mozzarelli A. From hemoglobin allostery to hemoglobin-based oxygen carriers. Mol Aspects Med 2021; 84:101050. [PMID: 34776270 DOI: 10.1016/j.mam.2021.101050] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/18/2022]
Abstract
Hemoglobin (Hb) plays its vital role through structural and functional properties evolutionarily optimized to work within red blood cells, i.e., the tetrameric assembly, well-defined oxygen affinity, positive cooperativity, and heterotropic allosteric regulation by protons, chloride and 2,3-diphosphoglycerate. Outside red blood cells, the Hb tetramer dissociates into dimers, which exhibit high oxygen affinity and neither cooperativity nor allosteric regulation. They are prone to extravasate, thus scavenging endothelial NO and causing hypertension, and cause nephrotoxicity. In addition, they are more prone to autoxidation, generating radicals. The need to overcome the adverse effects associated with cell-free Hb has always been a major hurdle in the development of substitutes of allogeneic blood transfusions for all clinical situations where blood is unavailable or cannot be used due to, for example, religious objections. This class of therapeutics, indicated as hemoglobin-based oxygen carriers (HBOCs), is formed by genetically and/or chemically modified Hbs. Many efforts were devoted to the exploitation of the wealth of biochemical and biophysical information available on Hb structure, function, and dynamics to design safe HBOCs, overcoming the negative effects of free plasma Hb. Unfortunately, so far, no HBOC has been approved by FDA and EMA, except for compassionate use. However, the unmet clinical needs that triggered intensive investigations more than fifty years ago are still awaiting an answer. Recently, HBOCs "repositioning" has led to their successful application in organ perfusion fluids.
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Affiliation(s)
- Serena Faggiano
- Department of Food and Drug, University of Parma, Parma, Italy; Institute of Biophysics, National Research Council, Pisa, Italy
| | - Luca Ronda
- Institute of Biophysics, National Research Council, Pisa, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefano Bruno
- Department of Food and Drug, University of Parma, Parma, Italy
| | - Stefania Abbruzzetti
- Department of Mathematical, Physical and Computer Sciences, University of Parma, Parma, Italy
| | - Cristiano Viappiani
- Department of Mathematical, Physical and Computer Sciences, University of Parma, Parma, Italy
| | - Stefano Bettati
- Institute of Biophysics, National Research Council, Pisa, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy; National Institute of Biostructures and Biosystems, Rome, Italy
| | - Andrea Mozzarelli
- Department of Food and Drug, University of Parma, Parma, Italy; Institute of Biophysics, National Research Council, Pisa, Italy.
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Savla C, Palmer AF. Structural Stability and Biophysical Properties of the Mega-Protein Erythrocruorin Are Regulated by Polyethylene Glycol Surface Coverage. Biomacromolecules 2021; 22:2081-2093. [PMID: 33821616 DOI: 10.1021/acs.biomac.1c00196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A wide variety of hemoglobin-based oxygen carriers (HBOCs) have been designed for use as red blood cell (RBC) substitutes in transfusion medicine, ex vivo organ perfusion, oxygen delivery to hypoxic tissues, and a myriad of other applications. However, hemoglobin (Hb) derived from annelids (erythrocruorins [Ecs]) comprise a natural class of HBOC, since they are larger in size (30 nm in diameter) and contain more heme groups per molecule (144 heme groups) compared to human Hb (hHb; 5 nm in diameter and 4 heme groups). The larger size of Ec compared to hHb reduces tissue extravasation from the vascular space, thus, reducing vasoconstriction, systemic hypertension, and tissue oxidative injury when used as an RBC substitute. In addition, prior research has shown that Ecs possess slower auto-oxidation rates than hHb at physiological temperature, thus, making them attractive candidates for use as RBC substitutes. Unfortunately, it was also observed that Ecs have a much lower circulatory half-life in vivo compared to other HBOCs. Hence, conjugating polyethylene glycol (PEG) to the surface of Ec was proposed as a simple strategy to increase Ec circulatory half-life. Therefore, in order to inform future in vivo studies with PEGylated Ec, we decided to investigate the structural stability and biophysical properties of variable PEG surface coverage on Ec compared to native Ec. We observed an increase in PEG-Ec diameter and molecular weight (MW) and changes to the quaternary structure, secondary structure, and surface hydrophobicity after PEGylation. There was also an increase in oxygen binding affinity, reduction in oxygen offloading rate, and increase in auto-oxidation rate for increasing PEGylation ratios. Weak dissociation of Ec was also observed after dense PEGylation caused by steric repulsion of the conjugated PEG chains. Hence, we determined an optimum Ec PEGylation ratio that resulted in a substantial size and MW increase along with preservation of oxygen binding properties. In future studies, these materials will be tested in animal models to evaluate pharmacodynamics, pharmacokinetics, tissue oxygenation, microcirculatory responses, and overall safety.
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Affiliation(s)
- Chintan Savla
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, United States
| | - Andre F Palmer
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, United States
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Pires IS, Savla C, Palmer AF. Poly(ethylene glycol) Surface-Conjugated Apohemoglobin as a Synthetic Heme Scavenger. Biomacromolecules 2020; 21:2155-2164. [DOI: 10.1021/acs.biomac.0c00141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Ivan S. Pires
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, United States
| | - Chintan Savla
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, United States
| | - Andre F. Palmer
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, Ohio 43210, United States
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Polydopamine-based surface modification of hemoglobin particles for stability enhancement of oxygen carriers. J Colloid Interface Sci 2020; 571:326-336. [PMID: 32208203 DOI: 10.1016/j.jcis.2020.03.046] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/20/2020] [Accepted: 03/11/2020] [Indexed: 11/22/2022]
Abstract
Templated assembly techniques have been extensively used to develop various types of hemoglobin (Hb) loaded particles with improved performance. However, several instability issues must still be solved, including Hb exposure, enhanced Hb auto-oxidation, and the relatively weak binding of Hb to cross-linkers. Herein, to meet the stability requirements for novel hemoglobin-based oxygen carriers (HBOCs), hemoglobin-polydopamine particles (Hb-PDA) were fabricated using a mild process that combines the co-precipitation of Hb and an inorganic template with the spontaneous adhesion of PDA. The Hb-PDA showed uniform size distribution, chemical integrity of both Hb and PDA, high biocompatibility, and robust oxygen delivery. Our results demonstrated that the use of polydopamine as a biocompatible coating material reduced Hb leakage from the particles under both static and flow conditions, thus mitigating the toxicity associated with free Hb and strengthening the stability of Hb particles. In addition, Hb-PDA reduced HUVEC (Human Umbilical Vein Cells) oxidative injury and scavenged 85% of the available hydroxyl radicals, exhibiting its potential to act as an antioxidant for encapsulated Hb. Hb-PDA therefore shows significant promise as a cell-like structurally and functionally stable HBOCs.
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Reassessment of the Need for an Oxygen Carrier for the Treatment of Traumatic Hemorrhage When Blood is not an Option. Shock 2019; 52:55-59. [DOI: 10.1097/shk.0000000000001417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Estep TN. Haemoglobin-based oxygen carriers and myocardial infarction. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:593-601. [PMID: 30849245 DOI: 10.1080/21691401.2019.1573181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The incidence of investigator diagnosed myocardial infarction (MI) is greater in patients treated with haemoglobin-based oxygen carriers (HBOCs) than controls. Clinical trials and literature pertaining to possible HBOC toxicity mechanisms have been analyzed in order to identify possible reasons for this imbalance. MI diagnosis is hampered by potential interference of troponin assays by haemoglobin, haemolysis and bilirubin. Nevertheless, insofar as the reported incidence correlates with actual occurrence, there is a positive relationship between MI and HBOC dose and size. Preclinical and clinical data suggest that direct cardiac toxicity and coronary vasoconstriction are unlikely. More probable are detrimental intravascular interactions between HBOCs and components of the coagulation cascade, particularly dysfunctional endothelium. Elucidation of mechanisms is impeded by a lack of clinical data. Measurement of relevant biomarkers would be extremely useful in this regard and in improving patient selection criteria. Conduct of clinical trials in carefully selected patient populations after the development of improved protocols for MI diagnosis, along with concomitant biomarker data collection, is recommended.
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Recent and prominent examples of nano- and microarchitectures as hemoglobin-based oxygen carriers. Adv Colloid Interface Sci 2018; 260:65-84. [PMID: 30177214 DOI: 10.1016/j.cis.2018.08.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/16/2022]
Abstract
Blood transfusions, which usually consist in the administration of isolated red blood cells (RBCs), are crucial in traumatic injuries, pre-surgical conditions and anemias. Although RBCs transfusion from donors is a safe procedure, donor RBCs can only be stored for a maximum of 42 days under refrigerated conditions and, therefore, stockpiles of RBCs for use in acute disasters do not exist. With a worldwide shortage of donor blood that is expected to increase over time, the creation of oxygen-carriers with long storage life and compatibility without typing and cross-matching, persists as one of the foremost important challenges in biomedicine. However, research has so far failed to produce FDA approved RBCs substitutes (RBCSs) for human usage. As such, due to unacceptable toxicities, the first generation of oxygen-carriers has been withdrawn from the market. Being hemoglobin (Hb) the main component of RBCs, a lot of effort is being devoted in assembling semi-synthetic RBCS utilizing Hb as the oxygen-carrier component, the so-called Hb-based oxygen carriers (HBOCs). However, a native RBC also contains a multi-enzyme system to prevent the conversion of Hb into non-functional methemoglobin (metHb). Thus, the challenge for the fabrication of next-generation HBOCs relies in creating a system that takes advantage of the excellent oxygen-carrying capabilities of Hb, while preserving the redox environment of native RBCs that prevents or reverts the conversion of Hb into metHb. In this review, we feature the most recent advances in the assembly of the new generation of HBOCs with emphasis in two main approaches: the chemical modification of Hb either by cross-linking strategies or by conjugation to other polymers, and the Hb encapsulation strategies, usually in the form of lipidic or polymeric capsules. The applications of the aforementioned HBOCs as blood substitutes or for oxygen-delivery in tissue engineering are highlighted, followed by a discussion of successes, challenges and future trends in this field.
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9
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Comparison of the Pharmacokinetic Properties of Hemoglobin-Based Oxygen Carriers. J Funct Biomater 2017; 8:jfb8010011. [PMID: 28335469 PMCID: PMC5371884 DOI: 10.3390/jfb8010011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 12/23/2022] Open
Abstract
Hemoglobin (Hb) is an ideal material for use in the development of an oxygen carrier in view of its innate biological properties. However, the vascular retention of free Hb is too short to permit a full therapeutic effect because Hb is rapidly cleared from the kidney via glomerular filtration or from the liver via the haptogloblin-CD 163 pathway when free Hb is administered in the blood circulation. Attempts have been made to develop alternate acellular and cellular types of Hb based oxygen carriers (HBOCs), in which Hb is processed via various routes in order to regulate its pharmacokinetic properties. These HBOCs have been demonstrated to have superior pharmacokinetic properties including a longer half-life than the Hb molecule in preclinical and clinical trials. The present review summarizes and compares the pharmacokinetic properties of acellular and cellular type HBOCs that have been developed through different approaches, such as polymerization, PEGylation, cross-linking, and encapsulation.
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10
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Azarov I, Wang L, Rose JJ, Xu Q, Huang XN, Belanger A, Wang Y, Guo L, Liu C, Ucer KB, McTiernan CF, O'Donnell CP, Shiva S, Tejero J, Kim-Shapiro DB, Gladwin MT. Five-coordinate H64Q neuroglobin as a ligand-trap antidote for carbon monoxide poisoning. Sci Transl Med 2016; 8:368ra173. [PMID: 27928027 PMCID: PMC5206801 DOI: 10.1126/scitranslmed.aah6571] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/16/2016] [Indexed: 12/11/2022]
Abstract
Carbon monoxide (CO) is a leading cause of poisoning deaths worldwide, with no available antidotal therapy. We introduce a potential treatment paradigm for CO poisoning, based on near-irreversible binding of CO by an engineered human neuroglobin (Ngb). Ngb is a six-coordinate hemoprotein, with the heme iron coordinated by two histidine residues. We mutated the distal histidine to glutamine (H64Q) and substituted three surface cysteines with less reactive amino acids to form a five-coordinate heme protein (Ngb-H64Q-CCC). This molecule exhibited an unusually high affinity for gaseous ligands, with a P50 (partial pressure of O2 at which hemoglobin is half-saturated) value for oxygen of 0.015 mmHg. Ngb-H64Q-CCC bound CO about 500 times more strongly than did hemoglobin. Incubation of Ngb-H64Q-CCC with 100% CO-saturated hemoglobin, either cell-free or encapsulated in human red blood cells, reduced the half-life of carboxyhemoglobin to 0.11 and 0.41 min, respectively, from ≥200 min when the hemoglobin or red blood cells were exposed only to air. Infusion of Ngb-H64Q-CCC to CO-poisoned mice enhanced CO removal from red blood cells, restored heart rate and blood pressure, increased survival, and was followed by rapid renal elimination of CO-bound Ngb-H64Q-CCC. Heme-based scavenger molecules with very high CO binding affinity, such as our mutant five-coordinate Ngb, are potential antidotes for CO poisoning by virtue of their ability to bind and eliminate CO.
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Affiliation(s)
- Ivan Azarov
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Ling Wang
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Jason J Rose
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Qinzi Xu
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Xueyin N Huang
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Andrea Belanger
- Department of Physics, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Ying Wang
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Lanping Guo
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Chen Liu
- Department of Physics, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Kamil B Ucer
- Department of Physics, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Charles F McTiernan
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Christopher P O'Donnell
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Sruti Shiva
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Center for Metabolism and Mitochondrial Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Jesús Tejero
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Daniel B Kim-Shapiro
- Department of Physics, Wake Forest University, Winston-Salem, NC 27109, USA
- Translational Science Center, Wake Forest University, Winston-Salem, NC 27109, USA
| | - Mark T Gladwin
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA.
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
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Abstract
Carbon monoxide (CO) has long been considered an environmental pollutant and a poison. Exogenous exposure to amounts of CO beyond the physiologic level of the body can result in a protective or adaptive response. However, as a gasotransmitter, endogenous CO is important for multiple physiologic functions. To date, at least seven distinct methods of delivering CO have been utilized in animal and clinical studies. In this mini-review, we summarize the exogenous CO delivery methods and compare their advantages and disadvantages.
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Affiliation(s)
- Hui-Jun Hu
- Department of Navy Aeromedicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China; Department of Hyperbaric Oxygen, Navy General Hospital, Beijing, China
| | - Qiang Sun
- Department of Hyperbaric Oxygen, Navy General Hospital, Beijing, China
| | - Zhou-Heng Ye
- Department of Navy Aeromedicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
| | - Xue-Jun Sun
- Department of Navy Aeromedicine, Faculty of Naval Medicine, Second Military Medical University, Shanghai, China
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Tao Z, Ghoroghchian PP. Microparticle, nanoparticle, and stem cell-based oxygen carriers as advanced blood substitutes. Trends Biotechnol 2014; 32:466-73. [DOI: 10.1016/j.tibtech.2014.05.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/22/2014] [Accepted: 05/05/2014] [Indexed: 12/29/2022]
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Leal-Noval SR, Muñoz M, Asuero M, Contreras E, García-Erce JA, Llau JV, Moral V, Páramo JA, Quintana M, Basora M, Bautista-Paloma FJ, Bisbe E, Bóveda JL, Castillo-Muñoz A, Colomina MJ, Fernández C, Fernández-Mondéjar E, Ferrándiz C, García de Lorenzo A, Gomar C, Gómez-Luque A, Izuel M, Jiménez-Yuste V, López-Briz E, López-Fernández ML, Martín-Conde JA, Montoro-Ronsano B, Paniagua C, Romero-Garrido JA, Ruiz JC, Salinas-Argente R, Sánchez C, Torrabadella P, Arellano V, Candela A, Fernández JA, Fernández-Hinojosa E, Puppo A. [The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document]. Med Intensiva 2013; 37:259-83. [PMID: 23507335 DOI: 10.1016/j.medin.2012.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 12/12/2012] [Accepted: 12/19/2012] [Indexed: 02/06/2023]
Abstract
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: « Does this particular AABT reduce the transfusion rate or not?» All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.
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Affiliation(s)
- S R Leal-Noval
- Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias.
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15
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Leal-Noval SR, Muñoz M, Asuero M, Contreras E, García-Erce JA, Llau JV, Moral V, Páramo JA, Quintana M, Basora M, Bautista-Paloma FJ, Bisbe E, Bóveda JL, Castillo-Muñoz A, Colomina MJ, Fernández C, Fernández-Mondéjar E, Ferrándiz C, García de Lorenzo A, Gomar C, Gómez-Luque A, Izuel M, Jiménez-Yuste V, López-Briz E, López-Fernández ML, Martín-Conde JA, Montoro-Ronsano B, Paniagua C, Romero-Garrido JA, Ruiz JC, Salinas-Argente R, Sánchez C, Torrabadella P, Arellano V, Candela A, Fernández JA, Fernández-Hinojosa E, Puppo A. [The 2013 Seville Consensus Document on alternatives to allogenic blood transfusion. An update on the Seville Document]. ACTA ACUST UNITED AC 2013; 60:263.e1-263.e25. [PMID: 23415109 DOI: 10.1016/j.redar.2012.12.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/12/2012] [Indexed: 12/21/2022]
Abstract
Since allogeneic blood transfusion (ABT) is not harmless, multiple alternatives to ABT (AABT) have emerged, though there is great variability in their indications and appropriate use. This variability results from the interaction of a number of factors, including the specialty of the physician, knowledge and preferences, the degree of anemia, transfusion policy, and AABT availability. Since AABTs are not harmless and may not meet cost-effectiveness criteria, such variability is unacceptable. The Spanish Societies of Anesthesiology (SEDAR), Hematology and Hemotherapy (SEHH), Hospital Pharmacy (SEFH), Critical Care Medicine (SEMICYUC), Thrombosis and Hemostasis (SETH) and Blood Transfusion (SETS) have developed a Consensus Document for the proper use of AABTs. A panel of experts convened by these 6 Societies have conducted a systematic review of the medical literature and have developed the 2013 Seville Consensus Document on Alternatives to Allogeneic Blood Transfusion, which only considers those AABT aimed at decreasing the transfusion of packed red cells. AABTs are defined as any pharmacological or non-pharmacological measure aimed at decreasing the transfusion of red blood cell concentrates, while preserving patient safety. For each AABT, the main question formulated, positively or negatively, is: "Does this particular AABT reduce the transfusion rate or not?" All the recommendations on the use of AABTs were formulated according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) methodology.
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Affiliation(s)
- S R Leal-Noval
- Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC).
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Galvagno SM, Mackenzie CF. New and future resuscitation fluids for trauma patients using hemoglobin and hypertonic saline. Anesthesiol Clin 2012; 31:1-19. [PMID: 23351531 DOI: 10.1016/j.anclin.2012.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hemoglobin-based oxygen carriers (HBOC) and hypertonic saline solutions (HSS) are used for resuscitation of trauma patients with hemorrhagic shock. In this review, the clinical application, dosing, administration, and side effects of these solutions are discussed. Although HBOC and HSS are not ideal resuscitation fluids, until rapidly thawed universal donor frozen blood and blood component therapy becomes widely available in North America, these fluids should to be considered immediately after injury and throughout the spectrum of care for patients with hemorrhagic shock, until blood and blood components become available.
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Affiliation(s)
- Samuel M Galvagno
- Division of Trauma Anesthesiology (Program in Trauma, R Adams Cowley Shock Trauma Center), Department of Anesthesiology, Shock Trauma Anesthesia Organized Research Center (STAR ORC), University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Wei L, Wu RB, Yang CM, Zheng SY, Yu XY. Cardioprotective effect of a hemoglobin-based oxygen carrier on cold ischemia/reperfusion injury. Cardiology 2011; 120:73-83. [PMID: 22143256 DOI: 10.1159/000333106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 09/07/2011] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The etiology of myocardial ischemia/reperfusion (I/R) injury is multifactorial, but activation of the innate immune system and the resulting inflammatory response are important components of I/R injury. The aim of this study was to investigate the protective effect of a hemoglobin-based oxygen carrier (HBOC) on cold I/R heart and to explore the underlying mechanisms. METHODS Isolated Sprague-Dawley rat hearts were perfused in the Langendorff mode. After 30 min of basal perfusion, rat hearts were arrested with histidine-tryptophan-ketoglutarate solution (HTKs) with or without an HBOC and hypothermically stored (4°C) for 9 or 14 h, followed by 2 h of reperfusion. RESULTS Compared with HTKs alone, the HBOC in HTKs greatly improved heart contraction and decreased infarct size, necrosis and apoptosis, which was related to the reduced expression of Toll-like receptor 2 (TLR 2), TLR 4, TNF-α, IL-1β and nuclear factor-κB (NF-κB) activation. CONCLUSIONS Our results demonstrated that the HBOC protected isolated rat heart from cold I/R injury and this protection was associated with attenuation of the expression of the TLR 2 and TLR 4/NF-κB signaling pathway, which may down-regulate the inflammatory response.
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Affiliation(s)
- Li Wei
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Wei L, Wu RB, Yang CM, Zheng SY, Yu XY. Polymerised placenta haemoglobin attenuates cold ischaemia/reperfusion injury in isolated rat heart. Microvasc Res 2011; 82:430-8. [PMID: 21907723 DOI: 10.1016/j.mvr.2011.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 07/28/2011] [Accepted: 08/25/2011] [Indexed: 12/14/2022]
Abstract
Ischaemia/reperfusion (I/R) injury is harmful to the cardiovascular system and is responsible for the inflammatory response, which, in turn, aggravates cardiac dysfunction. This study was designed to investigate the protective effect and potential mechanism of a haemoglobin-based oxygen carrier on cold I/R-injured hearts. Isolated Sprague-Dawley rat hearts were perfused in Langendorff mode. After a 30-min basal perfusion, rat hearts were arrested and hypothermically stored at 4°C for 12h followed by a 2-h reperfusion. Compared with histidine-tryptophan-ketoglutarate solution (HTKs), polymerised placenta haemoglobin (PolyPHb) in HTKs greatly improved heart contraction and decreased infarction size, necrosis, and apoptosis, which was related to reduced expression of TLR2, TLR4, TNF-α, and IL-1β, and NF-κB activation. Our results demonstrate the cardioprotective effect of PolyPHb on cold I/R-injured hearts and revealed that this protection was mediated in large part by attenuation of TLR2 and -4/NF-κB signalling pathway and could possibly down-regulate the inflammatory response.
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Affiliation(s)
- Li Wei
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510080, China
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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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Diaspirin cross-linked hemoglobin infusion did not influence base deficit and lactic acid levels in two clinical trials of traumatic hemorrhagic shock patient resuscitation. ACTA ACUST UNITED AC 2010; 68:1158-71. [PMID: 20145575 DOI: 10.1097/ta.0b013e3181bbfaac] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diaspirin cross-linked hemoglobin (DCLHb) has demonstrated a pressor effect that could adversely affect traumatic hemorrhagic shock patients through diminished perfusion to vital organs, causing base deficit (BD) and lactate abnormalities. METHODS Data from two parallel, multicenter traumatic hemorrhagic shock clinical trials from 17 US Emergency Departments and 27 European Union prehospital services using DCLHb, a hemoglobin-based resuscitation fluid. RESULTS In the 219 patients, the mean age was 37.3 years, 64% of the patients sustained a blunt injury, 48% received DCLHb resuscitation, and the overall 28-day mortality rate was 36.5%. BD data did not differ by treatment group (DCLHb vs. normal saline [NS]) at any time point. Study entry BD was higher in patients who died when compared with survivors in both studies (US: -14.7 vs. -9.3 and European Union: -11.1 vs. -4.1 mEq/L, p < 0.003) and at the first three time points after resuscitation. No differences in BD based on treatment group were observed in either those who survived or those who died from the hemorrhagic shock. US lactate data did not differ by treatment group (DCLHb vs. NS) at any time point. Study entry lactates were higher in US patients who ultimately died when compared with survivors (82.4 vs. 56.1 mmol/L, p < 0.003) and at all five postresuscitation time points. No lactate differences were observed between DCLHb and NS survivors or in those who died based on treatment group. CONCLUSIONS Although patients who died had more greatly altered perfusion than those who survived, DCLHb treatment of traumatic hemorrhagic shock patients was not associated with BD or lactate abnormalities that would indicate poor perfusion.
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22
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The lack of consistent diaspirin cross-linked hemoglobin infusion blood pressure effects in the US and EU traumatic hemorrhagic shock clinical trials. Shock 2010; 33:123-33. [PMID: 20092028 DOI: 10.1097/shk.0b013e3181ac482b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hemoglobin solutions have demonstrated a pressor effect that could adversely affect hemorrhagic shock patient resuscitation through accelerated hemorrhage, diminished perfusion, or inadequate resuscitation. Data from two parallel, multicenter traumatic hemorrhagic shock clinical trials in 17 US emergency departments and in 27 EU prehospital systems using diaspirin cross-linked hemoglobin (DCLHb), a hemoglobin-based resuscitation fluid. In the 219 patients, patients were 37 years old, 64% sustained blunt injury, 48% received DCLHb, and 36% expired. Although mean systolic blood pressure (SBP) and diastolic blood pressure values differed at 2 of the 10 measured time points, blood pressure (BP) curve analysis showed no SBP, diastolic blood pressure, or MAP differences based on treatment. Although SBP values 160 and 120 mmHg or greater were 2.2x and 2.6x more frequently noted in survivors, they were not more common with DCLHb use or in DCLHb patients who expired in US study nonsurvivors or in any EU study patients. Systolic blood pressure values 160 and 120 mmHg or greater were 2.8x and 1.3x more frequently noted in DCLHb survivors as compared with normal saline survivors. Only 3% of the BP variation noted could be attributed to DCLHb use, and as expected, injury severity and baseline physiologic status were stronger predictors. In the United States alone, treatment group was not correlated by regression with BP at any time point. Neither mean BP readings nor elevated BP readings were correlated with DCLHb treatment of traumatic hemorrhagic shock patients. As such, no clinically demonstrable DCLHb pressor effect could be directly related to the adverse mortality outcome observed in the US study.
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Weiskopf RB. Hemoglobin-Based Oxygen Carriers: Compassionate Use and Compassionate Clinical Trials. Anesth Analg 2010; 110:659-62. [DOI: 10.1213/ane.0b013e3181c85255] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Silverman TA, Weiskopf RB. Hemoglobin-based oxygen carriers: current status and future directions. Transfusion 2009; 49:2495-515. [DOI: 10.1111/j.1537-2995.2009.02356.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fronticelli C, Koehler RC. Design of recombinant hemoglobins for use in transfusion fluids. Crit Care Clin 2009; 25:357-71, Table of Contents. [PMID: 19341913 DOI: 10.1016/j.ccc.2008.12.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Molecular biology has been applied to the development of hemoglobin-based oxygen carrier (HBOC) proteins that can be expressed in bacteria or yeast. The transformation of the hemoglobin molecule into an HBOC requires a variety of modifications for rendering the acellular molecule of hemoglobin physiologically acceptable when transfused in circulation. Hemoglobins with different oxygen affinities can be obtained by introducing mutations at the heme pocket, the site of oxygen binding, or by introducing surface mutations that stabilize the hemoglobin molecule in the low-oxygen-affinity state. Modification of the size of the heme pocket is also used to hinder nitric oxide depletion and associated vasoconstriction. Introduction of cysteine residues on the hemoglobin surface allows formation of intermolecular bonds and formation of polymeric HBOCs. These polymers of recombinant hemoglobin have the characteristics of molecular size, molecular stability, and oxygen delivery to hypoxic tissue suitable for an HBOC.
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Affiliation(s)
- Clara Fronticelli
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Blalock, Baltimore, MD 21287, USA.
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Caccia D, Ronda L, Frassi R, Perrella M, Del Favero E, Bruno S, Pioselli B, Abbruzzetti S, Viappiani C, Mozzarelli A. PEGylation Promotes Hemoglobin Tetramer Dissociation. Bioconjug Chem 2009; 20:1356-66. [DOI: 10.1021/bc900130f] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Dario Caccia
- Dipartimento di Scienze e Tecnologie Biomediche, Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università degli Studi di Milano, and LITA (Laboratorio Interdisciplinare di Tecnologie Avanzate), 20090 Segrate, Milano, Italy, and Dipartimento di Biochimica e Biologia Molecolare, Dipartimento di Fisica, Università di Parma, and NEST CNR-INFM, Istituto Nazionale di Biostrutture e Biosistemi, 43100 Parma, Italy
| | - Luca Ronda
- Dipartimento di Scienze e Tecnologie Biomediche, Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università degli Studi di Milano, and LITA (Laboratorio Interdisciplinare di Tecnologie Avanzate), 20090 Segrate, Milano, Italy, and Dipartimento di Biochimica e Biologia Molecolare, Dipartimento di Fisica, Università di Parma, and NEST CNR-INFM, Istituto Nazionale di Biostrutture e Biosistemi, 43100 Parma, Italy
| | - Raffaella Frassi
- Dipartimento di Scienze e Tecnologie Biomediche, Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università degli Studi di Milano, and LITA (Laboratorio Interdisciplinare di Tecnologie Avanzate), 20090 Segrate, Milano, Italy, and Dipartimento di Biochimica e Biologia Molecolare, Dipartimento di Fisica, Università di Parma, and NEST CNR-INFM, Istituto Nazionale di Biostrutture e Biosistemi, 43100 Parma, Italy
| | - Michele Perrella
- Dipartimento di Scienze e Tecnologie Biomediche, Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università degli Studi di Milano, and LITA (Laboratorio Interdisciplinare di Tecnologie Avanzate), 20090 Segrate, Milano, Italy, and Dipartimento di Biochimica e Biologia Molecolare, Dipartimento di Fisica, Università di Parma, and NEST CNR-INFM, Istituto Nazionale di Biostrutture e Biosistemi, 43100 Parma, Italy
| | - Elena Del Favero
- Dipartimento di Scienze e Tecnologie Biomediche, Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università degli Studi di Milano, and LITA (Laboratorio Interdisciplinare di Tecnologie Avanzate), 20090 Segrate, Milano, Italy, and Dipartimento di Biochimica e Biologia Molecolare, Dipartimento di Fisica, Università di Parma, and NEST CNR-INFM, Istituto Nazionale di Biostrutture e Biosistemi, 43100 Parma, Italy
| | - Stefano Bruno
- Dipartimento di Scienze e Tecnologie Biomediche, Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università degli Studi di Milano, and LITA (Laboratorio Interdisciplinare di Tecnologie Avanzate), 20090 Segrate, Milano, Italy, and Dipartimento di Biochimica e Biologia Molecolare, Dipartimento di Fisica, Università di Parma, and NEST CNR-INFM, Istituto Nazionale di Biostrutture e Biosistemi, 43100 Parma, Italy
| | - Barbara Pioselli
- Dipartimento di Scienze e Tecnologie Biomediche, Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università degli Studi di Milano, and LITA (Laboratorio Interdisciplinare di Tecnologie Avanzate), 20090 Segrate, Milano, Italy, and Dipartimento di Biochimica e Biologia Molecolare, Dipartimento di Fisica, Università di Parma, and NEST CNR-INFM, Istituto Nazionale di Biostrutture e Biosistemi, 43100 Parma, Italy
| | - Stefania Abbruzzetti
- Dipartimento di Scienze e Tecnologie Biomediche, Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università degli Studi di Milano, and LITA (Laboratorio Interdisciplinare di Tecnologie Avanzate), 20090 Segrate, Milano, Italy, and Dipartimento di Biochimica e Biologia Molecolare, Dipartimento di Fisica, Università di Parma, and NEST CNR-INFM, Istituto Nazionale di Biostrutture e Biosistemi, 43100 Parma, Italy
| | - Cristiano Viappiani
- Dipartimento di Scienze e Tecnologie Biomediche, Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università degli Studi di Milano, and LITA (Laboratorio Interdisciplinare di Tecnologie Avanzate), 20090 Segrate, Milano, Italy, and Dipartimento di Biochimica e Biologia Molecolare, Dipartimento di Fisica, Università di Parma, and NEST CNR-INFM, Istituto Nazionale di Biostrutture e Biosistemi, 43100 Parma, Italy
| | - Andrea Mozzarelli
- Dipartimento di Scienze e Tecnologie Biomediche, Dipartimento di Chimica, Biochimica e Biotecnologie per la Medicina, Università degli Studi di Milano, and LITA (Laboratorio Interdisciplinare di Tecnologie Avanzate), 20090 Segrate, Milano, Italy, and Dipartimento di Biochimica e Biologia Molecolare, Dipartimento di Fisica, Università di Parma, and NEST CNR-INFM, Istituto Nazionale di Biostrutture e Biosistemi, 43100 Parma, Italy
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Young MA, Lohman J, Malavalli A, Vandegriff KD, Winslow RM. Hemospan Improves Outcome in a Model of Perioperative Hemodilution and Blood Loss in the Rat: Comparison With Hydroxyethyl Starch. J Cardiothorac Vasc Anesth 2009; 23:339-47. [DOI: 10.1053/j.jvca.2008.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Indexed: 11/11/2022]
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Hemoglobin-based Oxygen Carriers: First, Second or Third Generation? Human or Bovine? Where are we Now? Crit Care Clin 2009; 25:279-301, Table of Contents. [DOI: 10.1016/j.ccc.2009.01.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cameron SJ, Gerhardt G, Engelstad M, Young MA, Norris EJ, Sokoll LJ. Interference in clinical chemistry assays by the hemoglobin-based oxygen carrier, Hemospan. Clin Biochem 2008; 42:221-4. [PMID: 19028481 DOI: 10.1016/j.clinbiochem.2008.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 10/20/2008] [Accepted: 10/24/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate interference by the hemoglobin-based oxygen carrier Hemospan on clinical laboratory assays. DESIGN AND METHODS Interfering Hemospan concentrations were determined for general chemistry and cardiac marker analytes in pooled serum and the corresponding hemolysis index was calculated. RESULTS Hemospan did not interfere with 20 of 35 analytes. Hemospan produced a negative interference in serum creatinine, amylase, alkaline phosphatase, uric acid, and GGT assays and a positive interference in serum phosphate, LDH, iron, triglycerides, total protein, AST, cholesterol, magnesium, and albumin assays, and appeared to positively bias the serum cardiac troponin I (cTnI) assay only when cTnI is present in the sample. CONCLUSIONS We present a report of assays affected by Hemospan and the threshold concentrations for interference. This study highlights the importance of interference studies in understanding the effects of hemoglobin-based oxygen carriers on results reported by the clinical laboratory.
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Affiliation(s)
- Scott J Cameron
- Department of Pathology, Clinical Chemistry Division, Johns Hopkins Medical Institutions, Meyer B-125 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Vandegriff KD, Young MA, Lohman J, Bellelli A, Samaja M, Malavalli A, Winslow RM. CO-MP4, a polyethylene glycol-conjugated haemoglobin derivative and carbon monoxide carrier that reduces myocardial infarct size in rats. Br J Pharmacol 2008; 154:1649-61. [PMID: 18536756 DOI: 10.1038/bjp.2008.219] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND PURPOSE MP4 (Hemospan) is a Hb-based oxygen therapeutic agent, based on polyethylene-glycol (PEG) conjugation to Hb, undergoing clinical trials as an oxygen carrier. This study describes the functional interaction between MP4 and carbon monoxide (CO), as a CO delivery agent, and the effects of CO-MP4 on myocardial infarct size following ischaemia and reperfusion in rats. EXPERIMENTAL APPROACH Kinetic measurements of CO-MP4 binding were used to evaluate the effects of PEG modification on Hb subunit structure/function and to calculate CO-MP4 equilibrium constants. CO transport by CO-MP4 was shown by ligand (O2/CO) partitioning between MP4 and red blood cell (RBC)-Hb. Pharmacological effects of CO-MP4 were studied on myocardial infarction in rats. KEY RESULTS CO binding kinetics show primary structural/functional effects on beta chains in MP4, with alpha chains maintaining the ability to undergo tertiary conformational transition. CO confers long-term, room-temperature stability and is able to rapidly re-equilibrate between MP4 and RBCs. In a rat model of myocardial infarct, in contrast to oxy-MP4, CO-MP4 reduced infarct size when administered prior to the induction of ischaemia. CONCLUSIONS AND IMPLICATIONS MP4 PEGylation chemistry modifies the individual function of Hb subunits, but results in an overall CO equilibrium constant similar to that for unmodified Hb. CO-MP4 is able to deliver CO to the circulation and reduces ischaemia/reperfusion injury in rats, providing the first evidence for this drug as a CO therapeutic agent.
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Cell-free oxygen carriers: scientific foundations, clinical development, and new directions. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2008; 1784:1382-6. [PMID: 18555029 DOI: 10.1016/j.bbapap.2008.04.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/16/2008] [Accepted: 04/22/2008] [Indexed: 11/23/2022]
Abstract
The most significant hurdle to the development of a safe and effective hemoglobin-based oxygen carrier ("blood substitute") is generally thought to be its propensity to cause vasoconstriction in the microcirculation and hypertension. Two theories for this effect are currently being studied: in one, scavenging NO by hemoglobin reduces vasorelaxation; in the other, cell-free hemoglobin oversupplies O2 (a known vasoconstrictor) to vascular walls by facilitated diffusion. While both mechanisms might lead to reduction of local NO concentration, the important distinction between the two is that if the NO scavenging theory is correct, it greatly diminishes the prospects to develop any solution based on free hemoglobin. However, if the O2-oversupply theory is correct, modifications to the hemoglobin molecule can be envisioned that can prevent oversupply and reduce toxicity. This review summarizes the development of Hemospan, a novel modification of human hemoglobin whose design is based on the O2-oversupply theory. Because of its low P50 and increased molecular size, the release of O2 in resistance vessels (arterioles) by Hemospan is restricted, and vasoconstriction is greatly reduced.
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