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Duellberg C, Hannappel A, Kistner S, Maneg O. Biochemical Characterization of a New 10% IVIG Preparation [IgG Next Generation (BT595)/Yimmugo ®] Obtained from a Manufacturing Process Preserving IgA/IgM Potential of Human Plasma. Drugs R D 2023; 23:245-255. [PMID: 37466834 PMCID: PMC10439088 DOI: 10.1007/s40268-023-00430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Human plasma is used for the generation of several life-saving drugs and contains valuable antibodies from the immunoglobulin classes IgG, IgM and IgA. Purified intravenous IgG solutions (IVIGs) form the majority of plasma-derived medicine to treat patients with various forms of immunodeficiencies. In conventional IVIG manufacturing processes, immunoglobulin classes IgM and IgA are often discarded as contaminants, but these antibody classes have been proven to be effective for the treatment of acute bacterial infections. Considering the increase in demand for human plasma-derived products and the ethical value of the raw material, a more resource-saving usage of human plasma is needed. Intensive research over the last decades showed that adverse reactions to IVIGs depend on the presence of thrombogenic factors, partially unfolded proteins, non-specific activation of the complement system, and blood group specific antibodies. Therefore, new IVIG preparations with reduced risks of adverse reactions are desirable. METHOD A new manufacturing process that yields two biologics was established and quality attributes of the new IVIG solution (Yimmugo®) obtained from this process are presented. RESULTS Here, we provide a biochemical characterization of Yimmugo®, a new 10% IVIG preparation. It is derived from human blood plasma by a combined manufacturing process, where IgM and IgA are retained for the production of a new biologic (trimodulin, currently under investigation in phase III clinical trials). Several improvements have been implemented in the manufacturing of Yimmugo® to reduce the risk of adverse reactions. Gentle and efficient mixing by vibration (called "vibromixing") during a process step where proteins are at risk to aggregate was implemented to potentially minimize protein damage. In addition, a dedicated process step for the removal of the complement system activator properdin was implemented, which resulted in very low anticomplementary activity levels. The absence of measurable thrombogenic activity in combination with a very high degree of functional monomeric antibodies predict excellent efficacy and tolerability. CONCLUSION Yimmugo® constitutes a new high quality IVIG preparation derived from a novel manufacturing process that takes advantage of the full therapeutic immunoglobulin potential of human plasma.
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Affiliation(s)
| | | | | | - Oliver Maneg
- Biotest AG, Landsteinerstr.5, Dreieich, Germany.
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2
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Niemann G, Germer M, Hauf M, Poelsler G, Röder J, Schüttrumpf J. Hyperimmunplasma: Gewinnung, Verarbeitung und therapeutische
Anwendungen. TRANSFUSIONSMEDIZIN 2023. [DOI: 10.1055/a-1894-1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
ZusammenfassungDas Prinzip der passiven Immunisierung ist seit dem 19. Jahrhundert bekannt und
wird auch bei aktuellen Pandemien als Ansatz zur Prophylaxe und Therapie
eingesetzt. Der Schutz wird hierbei übertragen durch Blut, Serum oder
Plasma, welche Immunglobuline gegen spezifische Krankheitserreger,
Bakterientoxine oder sonstige Antigene enthalten, sowie durch aus Humanplasma
industriell aufgereinigte Immunglobuline. Die aktuell verwendeten
Reinigungsverfahren für Immunglobuline aus Humanplasma beruhen auf der
von Edwin J. Cohn entwickelten Fraktionierung von Plasma. Zur Gewinnung von
Immunglobulinen mit hohen Antikörpertitern gegen spezifische Antigene,
sogenannte Hyperimmunglobuline, muss zunächst Hyperimmunplasma gezielt
von ausgewählten Spendern gewonnen werden. Diese Spender haben
erhöhte Antikörpertiter gegen spezifische Krankheitserreger,
Bakterientoxine oder sonstige Antigene, wenn sie im Rahmen einer vorangegangenen
Infektion natürlich immunisiert wurden, einen zugelassenen Impfstoff zur
Immunisierung erhalten haben oder gezielt zum Zweck der Plasmaspende immunisiert
wurden. Aktuell sind in Deutschland, Österreich und der Schweiz
Hyperimmunglobulinprodukte für verschiedene Anwendungen im Patienten
zugelassen, von denen die meisten aus humanem Blutplasma gewonnen werden. Um die
Herstellung der Produkte und damit letztlich die Behandlung der Patienten
gewährleisten zu können, werden resiliente Lieferketten
benötigt. Hierzu bedarf es unter anderem Änderungen in den
Rahmenbedingungen für die Spenderimmunisierung in Deutschland.
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Burnouf T, Gathof B, Bloch EM, Bazin R, de Angelis V, Patidar GK, Rastvorceva RMG, Oreh A, Goel R, Rahimi-Levene N, Hindawi S, Al-Riyami AZ, So-Osman C. Production and Quality Assurance of Human Polyclonal Hyperimmune Immunoglobulins against SARS-CoV-2. Transfus Med Rev 2022; 36:125-132. [PMID: 35879213 PMCID: PMC9183240 DOI: 10.1016/j.tmrv.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Thierry Burnouf
- College of Biomedical Engineering, Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, Taipei, Taiwan; International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
| | - Birgit Gathof
- Department of Transfusion Medicine, University Hospital of Cologne, Köln, Germany.
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Renée Bazin
- Héma-Québec, Medical Affairs and Innovation, Québec, Canada
| | | | - Gopal Kumar Patidar
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rada M Grubovic Rastvorceva
- Institute for Transfusion Medicine of RNM, Skopje, North Macedonia; Faculty of Medical Sciences, University Goce Delcev, Štip, North Macedonia
| | - Adaeze Oreh
- Department of Planning, Research and Statistics, National Blood Service Commission, Federal Ministry of Health, Abuja, Nigeria
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Hematology/Oncology, Simmons Cancer Institute at SIU School of Medicine and ImpactLife Blood Center, Springfield, IL, USA
| | | | - Salwa Hindawi
- Haematology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
| | - Cynthia So-Osman
- Department of Haematology, Erasmus Medical Centre, Rotterdam, The Netherlands; Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
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Keating SM, Mizrahi RA, Adams MS, Asensio MA, Benzie E, Carter KP, Chiang Y, Edgar RC, Gautam BK, Gras A, Leong J, Leong R, Lim YW, Manickam VA, Medina-Cucurella AV, Niedecken AR, Saini J, Simons JF, Spindler MJ, Stadtmiller K, Tinsley B, Wagner EK, Wayham N, Tracy L, Lundberg CV, Büscher D, Terencio JV, Roalfe L, Pearce E, Richardson H, Goldblatt D, Ramjag AT, Carrington CVF, Simmons G, Muench MO, Chamow SM, Monroe B, Olson C, Oguin TH, Lynch H, Jeanfreau R, Mosher RA, Walch MJ, Bartley CR, Ross CA, Meyer EH, Adler AS, Johnson DS. Generation of recombinant hyperimmune globulins from diverse B-cell repertoires. Nat Biotechnol 2021; 39:989-999. [PMID: 33859400 PMCID: PMC8355030 DOI: 10.1038/s41587-021-00894-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
Plasma-derived polyclonal antibody therapeutics, such as intravenous immunoglobulin, have multiple drawbacks, including low potency, impurities, insufficient supply and batch-to-batch variation. Here we describe a microfluidics and molecular genomics strategy for capturing diverse mammalian antibody repertoires to create recombinant multivalent hyperimmune globulins. Our method generates of diverse mixtures of thousands of recombinant antibodies, enriched for specificity and activity against therapeutic targets. Each hyperimmune globulin product comprised thousands to tens of thousands of antibodies derived from convalescent or vaccinated human donors or from immunized mice. Using this approach, we generated hyperimmune globulins with potent neutralizing activity against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in under 3 months, Fc-engineered hyperimmune globulins specific for Zika virus that lacked antibody-dependent enhancement of disease, and hyperimmune globulins specific for lung pathogens present in patients with primary immune deficiency. To address the limitations of rabbit-derived anti-thymocyte globulin, we generated a recombinant human version and demonstrated its efficacy in mice against graft-versus-host disease.
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Affiliation(s)
| | | | - Matthew S Adams
- GigaGen Inc., South San Francisco, CA, USA
- Department of Molecular, Cell, and Developmental Biology, University of California, Santa Cruz, Santa Cruz, CA, USA
| | | | | | | | - Yao Chiang
- GigaGen Inc., South San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lucy Roalfe
- Immunobiology Section, Great Ormond Street Institute of Child Health, University College London, London, England
| | - Emma Pearce
- Immunobiology Section, Great Ormond Street Institute of Child Health, University College London, London, England
| | - Hayley Richardson
- Immunobiology Section, Great Ormond Street Institute of Child Health, University College London, London, England
| | - David Goldblatt
- Immunobiology Section, Great Ormond Street Institute of Child Health, University College London, London, England
| | - Anushka T Ramjag
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Christine V F Carrington
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | | | | | | | | | | | - Thomas H Oguin
- Regional Biocontainment Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Heather Lynch
- Regional Biocontainment Laboratory, Duke University Medical Center, Durham, NC, USA
| | | | - Rachel A Mosher
- Waisman Biomanufacturing, University of Wisconsin, Madison, WI, USA
| | - Matthew J Walch
- Waisman Biomanufacturing, University of Wisconsin, Madison, WI, USA
| | | | - Carl A Ross
- Waisman Biomanufacturing, University of Wisconsin, Madison, WI, USA
| | - Everett H Meyer
- Stanford Diabetes Research Center, Stanford University Medical Center, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University Medical Center, Stanford, CA, USA
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5
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Focosi D, Tuccori M, Franchini M. The Road towards Polyclonal Anti-SARS-CoV-2 Immunoglobulins (Hyperimmune Serum) for Passive Immunization in COVID-19. Life (Basel) 2021; 11:144. [PMID: 33671893 PMCID: PMC7918959 DOI: 10.3390/life11020144] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
Effective treatments specific for COVID-19 are still lacking. In the setting of passive immunotherapies based on neutralizing antibodies (nAbs), randomized controlled trials of COVID-19 convalescent plasma (CCP) anti-SARS-CoV-2 Spike protein monoclonal antibodies (mAb), which have been granted emergency use authorization, have suggested benefit in early disease course (less than 72 hours from symptoms and seronegative). Meanwhile, polyclonal immunoglobulins (i.e., hyperimmune serum), derived either from CCP donations or from animals immunized with SARS-CoV-2 antigens, are likely to become the next nAb-derived candidate. We here discuss the pros and cons of hyperimmune serum versus CCP and mAb, and summarize the ongoing clinical trials of COVID-19 hyperimmune sera.
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Affiliation(s)
- Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, 56124 Pisa, Italy
| | - Marco Tuccori
- Division of Pharmacology and Pharmacovigilance, University of Pisa, 56126 Pisa, Italy;
- Unit of Adverse Drug reaction Monitoring, Pisa University Hospital, 56124 Pisa, Italy
| | - Massimo Franchini
- Department of Hematology and Transfusion Medicine, Carlo Poma Hospital, 46100 Mantua, Italy;
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6
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Liang Y, Jackson JW, Woodle SA, Surov SS, Parunov LA, Scott DE, Weinstein M, Lee TK, Ovanesov MV. Detecting factor XIa in immune globulin products: Commutability of international reference materials for traditional and global hemostasis assays. Res Pract Thromb Haemost 2021; 5:211-222. [PMID: 33537546 PMCID: PMC7845073 DOI: 10.1002/rth2.12467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/21/2020] [Accepted: 11/03/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Activated coagulation factor XIa (FXIa) is an impurity and primary source of procoagulant activity in thrombosis-implicated immune globulin (IG) products. Several assays, of varying quality and precision are used to assess FXIa-like procoagulant activity in units relevant to their respective principles. OBJECTIVES To advance unified reporting, we sought to employ the World Health Organization reference reagents (RRs) to present the results of differing methodologies in units of FXIa activity and rank the sensitivity and robustness of these methodologies. METHODS RR 11/236 served as a calibrator in several FXIa-sensitive blood coagulation tests: two commercial chromogenic FXIa assays (CAs); a nonactivated partial thromboplastin time (NaPTT); an in-house fibrin generation (FG) assay; an in-house thrombin generation (TG) assay; and an assay for FXIa- and kallikrein-like proteolytic activities based on cleavage of substrate SN13a. Some assays were tested in either normal or FXI-deficient plasma. RESULTS Each method demonstrated a sigmoidal dose-response to RRs. NaPTT was the least sensitive to FXIa and the least precise; our in-house TG was the most sensitive; and the two CAs were the most precise. All methods, except for SN13a, which is less specific for thrombotic impurities, gave comparable (within 20% difference) FXIa activity assignments for IG lots. CONCLUSIONS Purified FXIa reference standards support quantitation of FXIa levels in IG products in all tested assay methodologies. This should help to standardize the measurement of thrombotic potentials in IG products and prevent products exhibiting high procoagulant activity from distribution for patient use. Further research is needed to address the effect of IG product-specific matrixes on assay performance.
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Affiliation(s)
- Yideng Liang
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Joseph W. Jackson
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Samuel A. Woodle
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Stepan S. Surov
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Leonid A. Parunov
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Dorothy E. Scott
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Mark Weinstein
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Timothy K. Lee
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
| | - Mikhail V. Ovanesov
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationSilver SpringMDUSA
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7
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Wilmot HV, Gray E. Enabling accurate measurement of activated factor XI (FXIa) in therapeutic immunoglobulin products. Vox Sang 2020; 116:656-664. [PMID: 33277936 PMCID: PMC8359487 DOI: 10.1111/vox.13046] [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: 09/14/2020] [Revised: 11/05/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Abstract
Background and objectives In 2010, an intravenous immunoglobulin (IVIG) product was removed from the market due to an association with serious thromboembolic events. Investigations revealed that factor XIa (FXIa) was present as a process‐related impurity. This study investigated the ability of two commercial FXIa assays to measure FXIa in immunoglobulin preparations and conducted a survey of FXIa activity in marketed immunoglobulin products. Materials and methods Factor XIa assays were modified to include spiking of samples with FXIa before testing. An immunoglobulin product and its excipient were used to assess the ability of the assays to recover the spiked FXIa levels. Results The Biophen FXIa assay required a high pre‐dilution of the sample to obtain statistically valid results and complete FXIa recovery. The ROX FXIa assay was more sensitive, giving statistically valid results at a lower sample pre‐dilution and FXIa spike level. This modified ROX FXIa assay was used to assay 17 lots of immunoglobulin products for FXIa. Two product lots had measurable FXIa levels without the need for spiking. A further 3 lots produced detectable but not statistically valid FXIa results when left unspiked. Spiking produced statistically valid assays and recoveries above 100%, demonstrating inherent FXIa. Conclusion This study shows marketed immunoglobulin products can contain detectable levels of FXIa. Spiking brings the FXIa levels into the quantifiable range of the assay, allowing measurement of inherent FXIa. Accurate measurement is important to inform on ‘safe’ levels of FXIa in these products and allow future safety guidelines to be set.
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Affiliation(s)
- Helen V Wilmot
- Haemostasis Section, Biotherapeutics, National Institute for Biological Standards and Control (NIBSC), South Mimms, Hertfordshire, UK
| | - Elaine Gray
- Haemostasis Section, Biotherapeutics, National Institute for Biological Standards and Control (NIBSC), South Mimms, Hertfordshire, UK
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8
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Delila L, Wu YW, Nebie O, Widyaningrum R, Chou ML, Devos D, Burnouf T. Extensive characterization of the composition and functional activities of five preparations of human platelet lysates for dedicated clinical uses. Platelets 2020; 32:259-272. [PMID: 33245683 DOI: 10.1080/09537104.2020.1849603] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Human platelet lysates (HPLs), rich in various growth factors and cell growth-promoting molecules, encompass a new range of blood products that are being used for regenerative medicine, cell therapies, and tissue engineering. Well-characterized dedicated preparations, tailor-made to best fit specific therapeutic applications, are needed for optimal clinical efficacy and safety. Here, five types of HPL were prepared from the same platelet concentrates and extensively characterized to determine and compare their proteins, growth factors, cytokines, biochemical profiles, thrombin-generating capacities, thrombin-associated proteolytic activities, phospholipid-associated procoagulant potential, contents of extracellular vesicles expressing phosphatidylserine and tissue factor, and antioxidative properties. Our results revealed that all five HPL preparations contained detectable supraphysiological levels, in the ca. 0.1 ~ 350-ng/ml range, of all growth factors assessed, except insulin-like growth factor-1 detected only in HPL containing plasma. There were significant differences observed among these HPLs in total protein content, fibrinogen, complement components C3 and C4, albumin, and immunoglobulin G, and, most importantly, in their functional coagulant and procoagulant activities and antioxidative capacities. Our data revealed that the biochemical and functional properties of HPL preparations greatly vary depending upon their mode of production, with potential impacts on the safety and efficacy for certain clinical indications. Modes of preparation of HPLs should be carefully designed, and the product properties carefully evaluated based on the intended therapeutic use to ensure optimal clinical outcomes.
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Affiliation(s)
- Liling Delila
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Yu-Wen Wu
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Ouada Nebie
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Rifa Widyaningrum
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ming-Li Chou
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - David Devos
- Univ. Lille, CHU-Lille, Inserm, U1172, Lille Neuroscience & Cognition, France
| | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,Research Center of Biomedical Devices, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,International PhD Program in Cell Therapy and Regeneration Medicine, College of Medicine Taipei Medical University, Taipei, Taiwan.,PhD Program in Graduate Institute of Mind Brain and Consciousness, College of Humanities and Social Sciences, Taipei Medical University, Taipei, Taiwan
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9
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Xu Y, Liang Y, Parunov L, Despres D, Eckhaus M, Scott D, Ovanesov M, Struble EB. Combined thrombogenic effects of vessel injury, pregnancy and procoagulant immune globulin administration in mice. Thromb J 2020; 18:32. [PMID: 33292285 PMCID: PMC7648396 DOI: 10.1186/s12959-020-00245-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background Pregnant women are at increased risk of thrombotic adverse events. Plasma derived immune globulin (IG) products, which are used in pregnancy for various indications, may contain procoagulant impurity activated coagulation factor XI (FXIa). Procoagulant IG products have been associated with increased thrombogenicity but their effect in pregnancy is unknown. Methods Late pregnant (gestation days 17–20) or early lactation (days 1–3) and control female mice were treated with IGs supplemented with human FXIa then subjected to ferric chloride (FeCl3) vessel injury. Occlusion of blood vessel was assessed by recording blood velocity in the femoral vein for 20 min using doppler ultrasound laser imaging. FXIa dose was selected by the ability to increase thrombin generation in mouse plasma in vitro. Results FXIa produced robust thrombin generation in mouse plasma ex vivo. Following FeCl3 injury, pregnant and non-pregnant mice receiving IG + FXIa exhibited faster reduction of blood velocity in femoral vein compared to IG alone or untreated controls. In vitro, thrombin generation in plasma samples collected after thrombosis in FXIa-treated animals was elevated and could be reduced by anti-FXI antibody. Conclusions Our results suggest that intravenously-administered FXIa may contribute to thrombosis at the site of vascular injury in both pregnant and non-pregnant animals. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12959-020-00245-8.
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Affiliation(s)
- Yanqun Xu
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993-0002, USA
| | - Yideng Liang
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993-0002, USA
| | - Leonid Parunov
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993-0002, USA
| | - Daryl Despres
- Mouse Imaging Facility, National Institutes of Health, Bethesda, MD, USA
| | - Michael Eckhaus
- Pathology Service, Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Dorothy Scott
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993-0002, USA
| | - Mikhail Ovanesov
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993-0002, USA.
| | - Evi B Struble
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993-0002, USA.
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10
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Roberts G, Fox B, Longstaff C. Development of an updated assay for prekallikrein activator in albumin and immunoglobulin therapeutics. Vox Sang 2020; 116:99-105. [PMID: 32986885 PMCID: PMC7891625 DOI: 10.1111/vox.12980] [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: 02/29/2020] [Revised: 05/27/2020] [Accepted: 07/01/2020] [Indexed: 12/02/2022]
Abstract
Background Prekallikrein activator (PKA) is a contaminating enzyme found in therapeutic albumin and immunoglobulin products. The level is commonly measured using methods such as that defined by the European Pharmacopoeia (Ph Eur) with traceability to the WHO International Standard for PKA. This method generally works well, but problems are sometimes observed. Materials and methods A simplified one‐step method has been developed to replace the existing Ph Eur two‐step method which consists of kallikrein generation followed by kallikrein measurement using a chromogenic substrate. Analysis of data from the one‐stage method is simplified by the use of a dedicated online app. Results The one‐stage method was validated against the current Ph Eur method using batches of albumin and immunoglobulins. Problem batches of immunoglobulins were investigated using the one‐stage method. Improved methodology using true initial rate determinations and use of acid‐treated prekallikrein substrate (PKS) helped understand and reduce artefactual results. Conclusions The one‐stage method and associated app streamline real‐time determination of PKA and promote good principles of enzyme assays to limit substrate depletion, while also conserving expensive PKS. Blanking steps and reproducibility are simplified.
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Affiliation(s)
- Graham Roberts
- Biotherapeutics Division, National Institute for Biological Standards and Control, South Mimms, UK
| | - Bernard Fox
- Biotherapeutics Division, National Institute for Biological Standards and Control, South Mimms, UK
| | - Colin Longstaff
- Biotherapeutics Division, National Institute for Biological Standards and Control, South Mimms, UK
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11
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Nair PM, Rendo MJ, Reddoch-Cardenas KM, Burris JK, Meledeo MA, Cap AP. Recent advances in use of fresh frozen plasma, cryoprecipitate, immunoglobulins, and clotting factors for transfusion support in patients with hematologic disease. Semin Hematol 2020; 57:73-82. [PMID: 32892846 PMCID: PMC7384412 DOI: 10.1053/j.seminhematol.2020.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Indexed: 02/07/2023]
Abstract
Hematologic diseases include a broad range of acquired and congenital disorders, many of which affect plasma proteins that control hemostasis and immune responses. Therapeutic interventions for these disorders include transfusion of plasma, cryoprecipitate, immunoglobulins, or convalescent plasma-containing therapeutic antibodies from patients recovering from infectious diseases, as well as concentrated pro- or anticoagulant factors. This review will focus on recent advances in the uses of plasma and its derivatives for patients with acquired and congenital hematologic disorders.
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Affiliation(s)
- Prajeeda M. Nair
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Matthew J. Rendo
- San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, USA
| | | | - Jason K. Burris
- San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, USA
| | - Michael A. Meledeo
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA
| | - Andrew P. Cap
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, USA,Uniformed Services University, Bethesda, MD, USA,Corresponding author. Andrew P. Cap, MD, PhD, United States Army Institute of Surgical Research, 3650 Chambers Pass, JBSA Fort Sam Houston, TX 78234. Tel.: +1-210-539-4858 (office), +1-210-323-6908 (mobile)
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Davenport MT, Dickson JA, Johnson MR, Chamberland S. Total Synthesis of Clavatadine B. JOURNAL OF NATURAL PRODUCTS 2019; 82:3191-3195. [PMID: 31692341 DOI: 10.1021/acs.jnatprod.9b00813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The first total synthesis of clavatadine B (2), a natural product found to be a selective human blood coagulation factor XIa inhibitor, is described. A convergent approach that exemplifies the advantages of direct, early stage guanidinylation provided an immediate clavatadine B precursor, which was assembled in an efficient manner using known synthetic precursors of the structurally related natural product clavatadine A (1). Global deprotection cleanly provided clavatadine B in only four steps from a known derivative of homogentisic acid lactone (longest linear sequence, 75% overall yield).
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Affiliation(s)
- Michael T Davenport
- Department of Chemistry , Utah Valley University , 800 West University Parkway , Orem , Utah 84058 , United States
| | - Jordan A Dickson
- Department of Chemistry , Utah Valley University , 800 West University Parkway , Orem , Utah 84058 , United States
| | - Matthew R Johnson
- Department of Chemistry , Utah Valley University , 800 West University Parkway , Orem , Utah 84058 , United States
| | - Stephen Chamberland
- Department of Chemistry , Utah Valley University , 800 West University Parkway , Orem , Utah 84058 , United States
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Intravenous immunoglobulins for rheumatic disorders and thromboembolic events—a case series and review of the literature. Immunol Res 2018; 66:668-674. [DOI: 10.1007/s12026-018-9047-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Limonier F, Willems S, Waeterloos G, Sneyers M, Dhaenens M, Deforce D. Estimating the Reliability of Low-Abundant Signals and Limited Replicate Measurements through MS2 Peak Area in SWATH. Proteomics 2018; 18:e1800186. [PMID: 30387297 DOI: 10.1002/pmic.201800186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/25/2018] [Indexed: 12/26/2022]
Abstract
Sequential windows acquisition of all theoretical fragment ions mass spectrometry (SWATH-MS) provides large-scale protein quantification with high accuracy and selectivity. Nevertheless, reliable quantification of low-abundant signals in complex samples remains challenging, as recently illustrated in a multicenter benchmark study of different label-free software tools. Here, the SWATH Replicates Analysis 2.0 template from Sciex is used to highlight that the relationship between the MS2 peak area and the variability can be described by a function. This functional relationship appears to be largely insensitive to variation in samples or acquisition conditions, suggesting a device-intrinsic property. By using a power regression, it is shown that the MS2 peak area can be used to predict the quantification repeatability without relying on replicate injections, thus contributing to high-throughput confident quantification of low-abundant signals with SWATH-MS.
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Affiliation(s)
- Franck Limonier
- Sciensano, Juliette Wytsman 14, B-1050 Brussels, Belgium.,Laboratory of Pharmaceutical Biotechnology, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
| | - Sander Willems
- Laboratory of Pharmaceutical Biotechnology, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
| | | | - Myriam Sneyers
- Sciensano, Juliette Wytsman 14, B-1050 Brussels, Belgium
| | - Maarten Dhaenens
- Laboratory of Pharmaceutical Biotechnology, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
| | - Dieter Deforce
- Laboratory of Pharmaceutical Biotechnology, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, B-9000 Ghent, Belgium
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Hong J, Bang SM, Mun YC, Yhim HY, Lee J, Lim HS, Oh D. Efficacy and Safety of a New 10% Intravenous Immunoglobulin Product in Patients with Primary Immune Thrombocytopenia (ITP). J Korean Med Sci 2018; 33:e142. [PMID: 29736158 PMCID: PMC5934518 DOI: 10.3346/jkms.2018.33.e142] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/15/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In the current study, we aimed to investigate the efficacy and safety of intravenous immunoglobulin (IVIg)-SN 10%, a new 10% IVIg formulation, in adult patients with severe primary immune thrombocytopenia (ITP; platelet count < 20 × 109/L). METHODS Patients diagnosed as primary ITP, aged 19 years old or more, and had a platelet count of < 20 × 109/L by screening complete blood cell count performed within 2 weeks of study commencement were eligible. Patients received IVIg-SN 10% at a dose of 1 g/kg/day for two consecutive days. Response was defined as the achievement of a platelet count of ≥ 50 × 109/L at day 8. RESULTS Out of 81 eligible patients, 31 patients were newly diagnosed, 7 patients had persistent ITP, and 43 patients had chronic ITP. In intent-to-treat analysis, 61.3 patients (75.7%) achieved response and satisfied the pre-defined non-inferiority condition. Median time to response was 2 days and mean duration of maintaining response after the completion of IVIg therapy was 9.13 ± 8.40 days. Response rates were not found to be dependent on the phase of ITP or previous treatment for ITP. The drug was well tolerated and the frequency of mucocutaneous bleeding decreased during the study period. CONCLUSION In summary, IVIg-SN 10% formulation was found to be safe and effective in adult ITP patients (Trial registry at ClinicalTrials.gov, NCT02063789).
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Affiliation(s)
- Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Mee Bang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ho-Young Yhim
- Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | | | - Hyeong-Seok Lim
- Department of Clinical Pharmacology and Therapeutics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Doyeun Oh
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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Sridhar G, Ekezue BF, Izurieta HS, Forshee RA, Selvam N, Mintz PD, Anderson SA, Menis MD. Occurrence of hemolytic reactions on the same day as immune globulin product administrations during 2008 to 2014. Transfusion 2017; 58:70-80. [DOI: 10.1111/trf.14384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/24/2017] [Accepted: 08/24/2017] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Hector S. Izurieta
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | - Richard A. Forshee
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | | | - Paul D. Mintz
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | - Steven A. Anderson
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
| | - Mikhail D. Menis
- Center for Biologics Evaluation and Research, U.S. Food and Drug Administration; Silver Spring Maryland
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17
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Peljhan S, Jakop T, Šček D, Skvarča V, Goričar B, Žabar R, Mencin N. HPLC fingerprinting approach for raw material assessment and unit operation tracking for IVIG production from Cohn I+II+III fraction. Electrophoresis 2017; 38:2880-2885. [DOI: 10.1002/elps.201700212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 01/05/2023]
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18
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Wietek S, Svorc D, Debes A, Svae TE. Tolerability and safety of the intravenous immunoglobulin octagam® 10% in patients with immune thrombocytopenia: a post-authorisation safety analysis of two non-interventional phase IV trials. Hematology 2017; 23:242-247. [DOI: 10.1080/10245332.2017.1385892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Stefan Wietek
- Octapharma Pharmazeutika Produktionsges.m.b.H., Vienna, Austria
| | - Daniel Svorc
- Octapharma Pharmazeutika Produktionsges.m.b.H., Vienna, Austria
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Limonier F, Van Steendam K, Waeterloos G, Brusselmans K, Sneyers M, Deforce D. An application of mass spectrometry for quality control of biologicals: Highly sensitive profiling of plasma residuals in human plasma-derived immunoglobulin. J Proteomics 2017; 152:312-320. [DOI: 10.1016/j.jprot.2016.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/04/2016] [Accepted: 11/10/2016] [Indexed: 01/02/2023]
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20
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Leiderman K, Chang WC, Ovanesov M, Fogelson AL. Synergy Between Tissue Factor and Exogenous Factor XIa in Initiating Coagulation. Arterioscler Thromb Vasc Biol 2016; 36:2334-2345. [PMID: 27789475 PMCID: PMC5167573 DOI: 10.1161/atvbaha.116.308186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 10/11/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Recent evidence suggests involvement of coagulation factor XIa (FXIa) in thrombotic event development. This study was conducted to explore possible synergies between tissue factor (TF) and exogenous FXIa (E-FXIa) in thrombin generation. APPROACH AND RESULTS In thrombin generation assays, for increasing concentrations of E-FXIa with low, but not with high TF concentrations, peak thrombin significantly increased whereas lag time and time to peak significantly decreased. Similar dependencies of lag times and rates of thrombin generation were found in mathematical model simulations. In both in vitro and in silico experiments that included E-FXIa, thrombin bursts were seen for TF levels much lower than those required without E-FXIa. For in silico thrombin bursts initiated by the synergistic action of TF and E-FXIa, the mechanisms leading to the burst differed substantially from those for bursts initiated by high TF alone. For the synergistic case, sustained activation of platelet-bound FIX by E-FXIa, along with the feedback-enhanced activation of platelet-bound FVIIIa and FXa, was needed to elicit a thrombin burst. Furthermore, the initiation of thrombin bursts by high TF levels relied on different platelet FIX/FIXa binding sites than those involved in bursts initiated by low TF levels with E-FXIa. CONCLUSIONS Low concentrations of TF and exogenous FXIa, each too low to elicit a burst in thrombin production alone, act synergistically when in combination to cause substantial thrombin production. The observation about FIX/FIXa binding sites may have therapeutic implications.
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Affiliation(s)
- Karin Leiderman
- From the Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden (K.L.); Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD (W.C.C., M.O.); and Departments of Mathematics and Bioengineering, University of Utah, Salt Lake City (A.L.F.)
| | - William C Chang
- From the Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden (K.L.); Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD (W.C.C., M.O.); and Departments of Mathematics and Bioengineering, University of Utah, Salt Lake City (A.L.F.)
| | - Mikhail Ovanesov
- From the Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden (K.L.); Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD (W.C.C., M.O.); and Departments of Mathematics and Bioengineering, University of Utah, Salt Lake City (A.L.F.)
| | - Aaron L Fogelson
- From the Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden (K.L.); Office of Blood Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD (W.C.C., M.O.); and Departments of Mathematics and Bioengineering, University of Utah, Salt Lake City (A.L.F.).
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Backholer L, Green L, Huish S, Platton S, Wiltshire M, Doughty H, Curnow E, Cardigan R. A paired comparison of thawed and liquid plasma. Transfusion 2016; 57:881-889. [DOI: 10.1111/trf.13915] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 01/01/2023]
Affiliation(s)
| | - Laura Green
- NHS Blood and Transplant
- Barts Health NHS Trust UK
- Blizzard Institute; Queen Mary University of London; London UK
| | | | | | | | | | | | - Rebecca Cardigan
- NHS Blood and Transplant; Cambridge UK
- Department of Haematology; University of Cambridge; Cambridge UK
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22
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Park DH, Kang GB, Kang DE, Hong JW, Lee MG, Kim KY, Han JW. A new manufacturing process to remove thrombogenic factors (II, VII, IX, X, and XI) from intravenous immunoglobulin gamma preparations. Biologicals 2016; 45:1-8. [PMID: 27876270 DOI: 10.1016/j.biologicals.2016.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 10/24/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022] Open
Abstract
Coagulation factors (II, VII, IX, X, and particularly XIa) remaining in high concentrations in intravenous immunoglobulin (IVIG) preparations can form thrombi, causing thromboembolic events, and in serious cases, result in death. Therefore, manufacturers of biological products must investigate the ability of their production processes to remove procoagulant activities. Previously, we were able to remove coagulation factors II, VII, IX, and X from our IVIG preparation through ethanol precipitation, but factor XIa, which plays an important role in thrombosis, remained in the intermediate products. Here, we used a chromatographic process using a new resin that binds with high capacity to IgG and removes procoagulant activities. The procoagulant activities were reduced to low levels as determined by the thrombin generation assay: <1.56 mIU/mL, chromogenic FXIa assay: <0.16 mIU/mL, non-activated partial thromboplastin time (NaPTT): >250 s, FXI/FXIa ELISA: <0.31 ng/mL. Even after spiking with FXIa at a concentration 32.5 times higher than the concentration in normal specimens, the procoagulant activities were below the detection limit (<0.31 ng/mL). These results demonstrate the ability of our manufacturing process to remove procoagulant activities to below the detection limit (except by NaPTT), suggesting a reduced risk of thromboembolic events that maybe potentially caused by our IVIG preparation.
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Affiliation(s)
- Dong Hwarn Park
- Green Cross Corp., Ihyeon-ro 30 beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Gil Bu Kang
- Green Cross Corp., Ihyeon-ro 30 beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Dae Eun Kang
- Green Cross Corp., Ihyeon-ro 30 beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Jeung Woon Hong
- Green Cross Corp., Ihyeon-ro 30 beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea
| | - Min Gyu Lee
- Research Center for Epigenome Regulation, School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Ki Yong Kim
- Green Cross Corp., Ihyeon-ro 30 beon-gil, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea.
| | - Jeung Whan Han
- Research Center for Epigenome Regulation, School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea.
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23
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Ammann EM, Jones MP, Link BK, Carnahan RM, Winiecki SK, Torner JC, McDowell BD, Fireman BH, Chrischilles EA. Intravenous immune globulin and thromboembolic adverse events in patients with hematologic malignancy. Blood 2016; 127:200-7. [PMID: 26443622 PMCID: PMC4713161 DOI: 10.1182/blood-2015-05-647552] [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: 05/28/2015] [Accepted: 10/02/2015] [Indexed: 01/25/2023] Open
Abstract
In patients with hypogammaglobulinemia secondary to chronic lymphocytic leukemia (CLL) or multiple myeloma (MM), intravenous immune globulin (IVIg) may be administered to reduce the risk of infection. Since 2013, IVIg products have carried a boxed safety warning about the risk of thromboembolic events (TEEs), with TEEs reported in 0.5% to 15% of patients treated with IVIg. In this retrospective cohort study of older patients with CLL or MM identified from the Surveillance, Epidemiology, and End Results-Medicare Linked Database, we assessed rates of clinically serious TEEs in 2724 new users of IVIg and a propensity-matched comparison group of 8035 nonusers. For the primary end point, arterial TEE, we observed a transient increased risk of TEE during the day of an IVIg infusion and the day afterward (hazard ration = 3.40; 95% confidence interval [CI]: 1.25, 9.25); this risk declined over the remainder of the 30-day treatment cycle. When considered in terms of absolute risk averaged over a 1-year treatment period, the increase in risk attributable to IVIg was estimated to be 0.7% (95% CI: -0.2%, 2.0%) compared with a baseline risk of 1.8% for the arterial TEE end point. A statistically nonsignificant risk increase of 0.3% (95% CI: -0.4%, 1.5%) compared with a baseline risk of 1.1% was observed for the venous TEE end point. Further research is needed to establish the generalizability of these results to patients receiving higher doses of IVIg for other indications.
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Affiliation(s)
| | - Michael P Jones
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, IA
| | - Brian K Link
- Division of Hematology, Oncology and Blood & Marrow Transplantation, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA
| | | | - Scott K Winiecki
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation & Research, US Food and Drug Administration, Silver Spring, MD
| | | | - Bradley D McDowell
- Population Research Core, Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA; and
| | - Bruce H Fireman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Elizabeth A Chrischilles
- Department of Epidemiology and Population Research Core, Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, IA; and
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Management of adverse events in the treatment of patients with immunoglobulin therapy: A review of evidence. Autoimmun Rev 2015; 15:71-81. [PMID: 26384525 DOI: 10.1016/j.autrev.2015.09.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/08/2015] [Indexed: 12/12/2022]
Abstract
Immunoglobulin (IG) therapy is actually used for a broad range of diseases including primary and secondary immunodeficiency disorders, and autoimmune diseases. This therapy is available for intravenous (IV) and subcutaneous (SC) administration. The efficacy of the IG therapy has been demonstrated in numerous studies and across different diseases. Generally, IG infusions are well tolerated; however some well-known adverse reactions, ranging from mild to severe, are associated with the therapy. The most common adverse reactions including headache, nausea, myalgia, fever, chills, chest discomfort, skin and anaphylactic reactions, could arise immediately during or after the infusion. Delayed events could be more severe and include migraine headaches, aseptic meningitis, haemolysis renal impairment and thrombotic events. This paper reviews all the potential adverse events related to IG therapy and establishes a comprehensive guideline for the management of these events. Moreover it resumes the opinions and clinical experience of expert endorsers on the utilization of the treatment. Published data were classified into levels of evidence and the strength of the recommendation was given for each intervention according to the GRADE system.
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Vieths S, Seitz R. [Official experimental testing of biomedical products. Regulatory frame and importance of for quality, safety and efficacy]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 57:1133-8. [PMID: 25123139 DOI: 10.1007/s00103-014-2028-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The official experimental testing of biomedicinal products provides a very significant contribution to ensuring quality, safety and efficacy of these indispensable medicines. Already in the prelicensing phase or to elucidate clusters of increased adverse effects, official medicinal control laboratories are committed to perform experimental testing. The official batch release can be seen as external quality control of the manufacturer's release testing. For proficient performance in these tasks, scientific research is required, in particular on the development and refinement of test methods, and considering the continuous development of innovative biomedicinal products. This article is aimed at introducing the present thematic issue and in particular the regulatory basis of experimental product testing, and illustrates by means of several examples its great importance for the sake of the patients.
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Affiliation(s)
- S Vieths
- Paul-Ehrlich-Institut, Bundesinstitut für Impfstoffe und biomedizinische Arzneimittel, Paul-Ehrlich-Straße 51-59, 63225, Langen, Deutschland,
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Reshef A, Zanichelli A, Longhurst H, Relan A, Hack CE. Elevated D-dimers in attacks of hereditary angioedema are not associated with increased thrombotic risk. Allergy 2015; 70:506-13. [PMID: 25640891 PMCID: PMC4409094 DOI: 10.1111/all.12587] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 12/23/2022]
Abstract
Background Recommended management of attacks of hereditary angioedema (HAE) due to C1 esterase inhibitor (C1-INH) deficiency (C1-INH-HAE) includes therapy with exogenous C1INH. Thrombotic/thromboembolic events (TEE) have been reported with plasma-derived C1INH, but so far none with recombinant human C1INH (rhC1INH). This phase III, randomized, placebo (saline)-controlled study evaluated the safety of rhC1INH 50 IU/kg for the treatment of acute attacks in 74 patients with C1-INH-HAE. Methods Monitoring for TEE and assessment of risk of deep vein thrombosis (DVT) by the Wells prediction rule were performed, and levels of fibrin degradation products (plasma D-dimers) were assessed before study drug administration (baseline), 2 h, and 7 days posttreatment. Results Plasma D-dimer levels were elevated in 80% of the patients (median [25th–75th percentiles]: 2149 [480–5105] μg/l; normal ≤250 μg/l) and were higher in patients with submucosal (abdominal, oropharyngeal–laryngeal) attacks (3095 [890–10000] μg/l; n = 29) compared with subcutaneous (peripheral, facial) attacks (960 [450–4060] μg/l; n = 35). Median plasma D-dimer levels were comparable across treatment groups at baseline (1874 [475–4568] μg/l rhC1INH; 2259 [586–7533] μg/l saline) and 2 h postinfusion (2389 [760–4974] μg/l rhC1INH; 2550 [310–8410] μg/l saline); median plasma D-dimer levels were decreased by Day 7 in both groups (425 [232–3240] μg/l rhC1INH; 418 [246–2318] μg/l saline). No increased risk of DVT was identified, nor any TEE reported in rhC1INH treated or controls. Conclusion Elevated plasma D-dimer levels were associated with acute C1-INH-HAE attacks, particularly with submucosal involvement. However, rhC1INH therapy was not associated with thrombotic events.
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Affiliation(s)
- A. Reshef
- Sheba Medical Center University of Tel Aviv Tel‐Hashomer Israel
| | - A. Zanichelli
- Department of Biomedical & Clinical Sciences Ospedale Luigi Sacco University of Milan Milan Italy
| | | | - A. Relan
- Pharming Technologies BV Leiden The Netherlands
| | - C. E. Hack
- Laboratory for Translational Immunology University Medical Center Utrecht Utrecht The Netherlands
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28
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Cardigan R, Green L. Thawed and liquid plasma--what do we know? Vox Sang 2015; 109:1-10. [PMID: 25833464 DOI: 10.1111/vox.12251] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 12/16/2014] [Accepted: 12/16/2014] [Indexed: 12/21/2022]
Abstract
There is increasing interest in the use of liquid or frozen plasma thawed and stored for extended periods (>24 h) to reduce wastage and to improve rapid availability of plasma in massive transfusion protocols advocating the early use of plasma in trauma by some centres. There is now a body of studies that have assessed individual coagulation factors during storage of thawed plasma. These show that factor VIII (FVIII) is the worst affected factor and that its activity is mainly lost during the first 24 h following thawing. However, for most factors studied, there is a continual decline during further storage. The few studies that have assessed thrombin generation in thawed plasma have shown variable results. Extended storage of plasma is associated with an increase in levels of DEHP in the component and could theoretically increase the risk of bacterial contamination, although the latter does not appear to have been an issue in countries that have adopted the use of thawed plasma. There are no clinical studies relating to the efficacy of extended-thawed plasma, and therefore, the potential reduction in its efficacy must be balanced with the clinical need for the component.
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Affiliation(s)
| | - L Green
- NHS Blood & Transplant, and Barts Health NHS Trust and Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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29
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Bonilla FA. Adverse effects of immunoglobulin G therapy: thromboembolism and haemolysis. Clin Exp Immunol 2015; 178 Suppl 1:72-4. [PMID: 25546769 DOI: 10.1111/cei.12518] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Roberts PL, Dolan T, Paddick M, Stagg S, More JE. Development of an intravenous immunoglobulin with improved safety and functional activity. Biologicals 2014; 43:123-9. [PMID: 25498751 DOI: 10.1016/j.biologicals.2014.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/24/2022] Open
Abstract
The development and properties of a liquid intravenous immunoglobulin (Gammaplex(®)), of high purity, stability and functional activity, is described. Virus and TSE reduction by specific steps in the process were evaluated by spiking studies using small-scale models. The removal of procoagulant activity was determined using immunochemical and functional activity assays. Neutralisation and opsonic activity were used to demonstrate the functional activity of the IgG. The final low pH formulated product was stable at room temperature and was of high purity and functional activity. Three dedicated virus inactivation steps, i.e. solvent detergent, low pH and virus filtration, were shown to be effective. When combined with the B + I ethanol precipitation step, this gave a total reduction of >21 to >24 log for the enveloped and >10 to >13 log for the non-enveloped viruses tested. Several steps in the process were shown to contribute to TSE removal using scrapie. Potential procoagulant activity including Factor XI/XIa, was reduced to very low/undetectable levels in the final product. A new high purity liquid IVIG product has been developed, of high purity and good functional activity and stability. The process includes various steps for the removal of pathogens and procoagulant activity.
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Affiliation(s)
- Peter L Roberts
- Bio Products Laboratory, Dagger Lane, Elstree, Hertfordshire WD6 3BX, UK.
| | - Tara Dolan
- Bio Products Laboratory, Dagger Lane, Elstree, Hertfordshire WD6 3BX, UK
| | - Martyn Paddick
- Bio Products Laboratory, Dagger Lane, Elstree, Hertfordshire WD6 3BX, UK
| | - Shirley Stagg
- Bio Products Laboratory, Dagger Lane, Elstree, Hertfordshire WD6 3BX, UK
| | - John E More
- Bio Products Laboratory, Dagger Lane, Elstree, Hertfordshire WD6 3BX, UK
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31
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Vargas M, Segura Á, Wu YW, Herrera M, Chou ML, Villalta M, León G, Burnouf T. Human plasma-derived immunoglobulin G fractionated by an aqueous two-phase system, caprylic acid precipitation, and membrane chromatography has a high purity level and is free of detectable in vitro thrombogenic activity. Vox Sang 2014; 108:169-77. [PMID: 25469648 DOI: 10.1111/vox.12209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Instituto Clodomiro Picado has developed an immunoglobulin G (IgG) plasma fractionation process combining a polyethylene glycol/phosphate aqueous two-phase system (ATPS), caprylic acid precipitation and anion-exchange membrane chromatography. We evaluated the purity and in vitro thrombogenicity of such IgG, in line with current international requirements. MATERIALS AND METHODS Contributions of the different production steps to reduce thrombogenicity were assessed at 0·2 l-scale, and then the methodology was scaled-up to a 10 l-scale and final products (n = 3) were analysed. Purity, immunoglobulin composition, and subclass distribution were determined by electrophoretic and immunochemical methods. The in vitro thrombogenic potential was determined by a thrombin generation assay (TGA) using a Technothrombin fluorogenic substrate. Prekallikrein activator (PKA), plasmin, factor Xa, thrombin and thrombin-like activities were assessed using S-2302, S-2251, S-2222, S-2238 and S-2288 chromogenic substrates, respectively, and FXI by an ELISA. RESULTS The thrombogenicity markers were reduced mostly during the ATPS step and were found to segregate mostly into the discarded liquid upper phase. The caprylic acid precipitation eliminated the residual procoagulant activity. The IgG preparations made from the 10 l-batches contained 100% gamma proteins, low residual IgA and undetectable IgM. The IgG subclass distribution was not substantially affected by the process. TGA and amidolytic activities revealed an undetectable in vitro thrombogenic risk and the absence of proteolytic enzymes in the final product. CONCLUSIONS Fractionating human plasma by an ATPS combined with caprylic acid and membrane chromatography resulted in an IgG preparation of high purity and free of a detectable in vitro thrombogenic risk.
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Affiliation(s)
- M Vargas
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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32
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Germishuizen WA, Gyure DC, Stubbings D, Burnouf T. Quantifying the thrombogenic potential of human plasma-derived immunoglobulin products. Biologicals 2014; 42:260-70. [PMID: 25096922 DOI: 10.1016/j.biologicals.2014.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/24/2014] [Accepted: 04/29/2014] [Indexed: 12/27/2022] Open
Abstract
Polyvalent immunoglobulin G (IgG) products obtained by fractionation of human plasma are used to treat a broad range of conditions, including immunodeficiency syndromes and autoimmune, inflammatory, and infectious diseases. Recent incidences of increased thromboembolic events (TEEs) associated with intravenous (IV) IgG (IVIG) led to recalls of some products and increased regulatory oversight of manufacturing processes in order to ensure that products are essentially free of procoagulant/thrombogenic plasma protein contaminants. Laboratory investigations have now identified activated factor XI (FXIa) as the likely causative agent of IVIG-related TEEs. Quantification of the thrombogenic potential is becoming a requirement made to fractionators (a) to validate the capacity of IVIG and subcutaneous IgG manufacturing processes to remove procoagulant contaminants and (b) to establish the safety of the final products. However, in the absence of a recommended test by the main regulatory authorities, several analytical approaches have been evaluated by fractionators, regulators, and university groups. This review focuses on the scientific rationale, merits, and applications of several analytical methods of quantifying the thrombogenic potential of IgG products and intermediates to meet the latest regulatory requirements.
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Affiliation(s)
| | - D C Gyure
- National Bioproducts Institute, Pinetown, South Africa
| | - D Stubbings
- National Bioproducts Institute, Pinetown, South Africa
| | - T Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, Taipei Medical University, 250 Wuxing St., Taipei City 110, Taiwan.
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33
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Sridhar G, Ekezue BF, Izurieta HS, Selvam N, Ovanesov MV, Divan HA, Liang Y, Golding B, Forshee RA, Anderson SA, Menis M. Immune globulins and same-day thrombotic events as recorded in a large health care database during 2008 to 2012. Transfusion 2014; 54:2553-65. [DOI: 10.1111/trf.12663] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/03/2014] [Accepted: 02/25/2014] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Hector S. Izurieta
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | | | - Mikhail V. Ovanesov
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | | | - Yideng Liang
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Basil Golding
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Richard A. Forshee
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Steven A. Anderson
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
| | - Mikhail Menis
- Center for Biologics Evaluation and Research; US Food and Drug Administration; Rockville Maryland
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34
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de Maat S, Tersteeg C, Herczenik E, Maas C. Tracking down contact activation - from coagulationin vitroto inflammationin vivo. Int J Lab Hematol 2014; 36:374-81. [DOI: 10.1111/ijlh.12222] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/28/2014] [Indexed: 02/07/2023]
Affiliation(s)
- S. de Maat
- Department of Clinical Chemistry and Haematology; University Medical Center Utrecht; Utrecht the Netherlands
| | - C. Tersteeg
- Department of Clinical Chemistry and Haematology; University Medical Center Utrecht; Utrecht the Netherlands
| | - E. Herczenik
- Department of Clinical Chemistry and Haematology; University Medical Center Utrecht; Utrecht the Netherlands
| | - C. Maas
- Department of Clinical Chemistry and Haematology; University Medical Center Utrecht; Utrecht the Netherlands
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35
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Significance of platelet and monocyte activation for therapeutic immunoglobulin-induced thromboembolism. Thromb Res 2014; 133:244-53. [DOI: 10.1016/j.thromres.2013.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/04/2013] [Accepted: 11/26/2013] [Indexed: 11/23/2022]
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36
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A glance on recent progresses in diagnosis and treatment of primary immunodeficiencies/ Progrese recente în diagnosticul şi tratamentul imunodeficienţelor primare. REV ROMANA MED LAB 2014. [DOI: 10.2478/rrlm-2014-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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37
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Komenda M, Stadler D, Malinas T, Moses M, Pragst I, Herzog E, Schmutz P, Minnig K, El Menyawi I. Assessment of the ability of the Privigen®purification process to deplete thrombogenic factor XIa from plasma. Vox Sang 2013; 107:26-36. [DOI: 10.1111/vox.12119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/04/2013] [Accepted: 11/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M. Komenda
- Research and Development; CSL Behring AG; Bern Switzerland
| | - D. Stadler
- Research and Development; CSL Behring AG; Bern Switzerland
| | - T. Malinas
- Research and Development; CSL Behring; Broadmeadows Vic. Australia
| | - M. Moses
- Preclinical Research and Development; CSL Behring GmbH; Marburg Germany
| | - I. Pragst
- Preclinical Research and Development; CSL Behring GmbH; Marburg Germany
| | - E. Herzog
- Preclinical Research and Development; CSL Behring GmbH; Marburg Germany
| | - P. Schmutz
- Quality Control; CSL Behring AG; Bern Switzerland
| | - K. Minnig
- Quality Control; CSL Behring AG; Bern Switzerland
| | - I. El Menyawi
- Research and Development; CSL Behring AG; Bern Switzerland
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38
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Matafonov A, Cheng Q, Geng Y, Verhamme IM, Umunakwe O, Tucker EI, Sun MF, Serebrov V, Gruber A, Gailani D. Evidence for factor IX-independent roles for factor XIa in blood coagulation. J Thromb Haemost 2013; 11:2118-27. [PMID: 24152424 PMCID: PMC3947433 DOI: 10.1111/jth.12435] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/15/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Factor XIa is traditionally assigned a role in FIX activation during coagulation. However, recent evidence suggests this protease may have additional plasma substrates. OBJECTIVE To determine whether FXIa promotes thrombin generation and coagulation in plasma in the absence of FIX, and to determine whether FXI-deficiency produces an antithrombotic effect in mice independently of FIX. METHODS FXIa, FXIa variants and anti-FXIa antibodies were tested for their effects on plasma coagulation and thrombin generation in the absence of FIX, and for their effects on the activation of purified coagulation factors. Mice with combined FIX and FXI deficiency were compared with mice lacking either FIX or FXI in an arterial thrombosis model. RESULTS In FIX-deficient plasma, FXIa induced thrombin generation, and anti-FXIa antibodies prolonged clotting times. This process involved FXIa-mediated conversion of FX and FV to their active forms. Activation of FV by FXIa required the A3 domain on the FXIa heavy chain, whereas activation of FX did not. FX activation by FXIa, unlike FIX activation, was not a calcium-dependent process. Mice lacking both FIX and FXI were more resistant to ferric chloride-induced carotid artery occlusion than FXI-deficient or FIX-deficient mice. CONCLUSION In addition to its predominant role as an activator of FIX, FXIa may contribute to coagulation by activating FX and FV. As the latter reactions do not require calcium, they may make important contributions to in vitro clotting triggered by contact activation. The reactions may be relevant to FXIa's roles in hemostasis and in promoting thrombosis.
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Affiliation(s)
- Anton Matafonov
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN
- Department of Bioengineering and Organic Chemistry, Tomsk Polytechnic University, Tomsk, Russia
| | - Qiufang Cheng
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN
| | - Yipeng Geng
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN
| | - Ingrid M. Verhamme
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN
| | - Obi Umunakwe
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN
| | - Erik I. Tucker
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR
| | - Mao-fu Sun
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN
| | - Vladimir Serebrov
- Department of Biochemistry and Molecular Biology, Siberian State Medical University, Tomsk, Russia
| | - Andras Gruber
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR
| | - David Gailani
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN
- Department of Medicine, Vanderbilt University, Nashville, TN
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39
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Menis M, Sridhar G, Selvam N, Ovanesov MV, Divan HA, Liang Y, Scott D, Golding B, Forshee R, Ball R, Anderson SA, Izurieta HS. Hyperimmune globulins and same-day thrombotic adverse events as recorded in a large healthcare database during 2008-2011. Am J Hematol 2013; 88:1035-40. [PMID: 23907744 DOI: 10.1002/ajh.23559] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 06/28/2013] [Accepted: 07/22/2013] [Indexed: 11/09/2022]
Abstract
Thrombotic events (TEs) are rare serious complications following administration of hyperimmune globulin (HIG) products. Our retrospective claims-based study assessed occurrence of same-day TEs following administration of HIGs during 2008-2011 and examined potential risk factors using HealthCore's Integrated Research Database (HIRD(SM) ) and laboratory testing of products' procoagulant Factor XIa activity by U.S. Food and Drug Administration. Multivariable regression was used to estimate same-day TE risk for different products. Of 101,956 individuals exposed to 23 different HIG product groups, 86 (0.84 per 1,000 persons) had a TE diagnosis code (DC) recorded on the same day as HIG administration. Unadjusted same-day TE DC rates (per 1,000 persons) ranged from 0.4 to 148.9 for different products. GamaSTAN S/D IG >10 cc had statistically significantly higher same-day TE DC risk compared to Tetanus IG (OR = 57.57; 95% CI = 19.72-168.10). Increased TE risk was also observed with older age (≥45 years), prior thrombotic events, and hypercoagulable state(s). Laboratory investigation identified elevated Factor XIa activity for GamaSTAN S/D, HepaGam B, HyperHep B S/D, WinRho SDF, HyperRHO S/D full dose, and HyperTET S/D. Our study, for the first time, identified increase in the same-day TE DC risk with GamaSTAN S/D IG >10 cc and suggests potentially elevated TE risk with other HIGs.
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Affiliation(s)
- Mikhail Menis
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | | | | | - Mikhail V. Ovanesov
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | | | - Yideng Liang
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Dorothy Scott
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Basil Golding
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Richard Forshee
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Robert Ball
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Steven A. Anderson
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
| | - Hector S. Izurieta
- Center for Biologics Evaluation and ResearchU.S. Food and Drug AdministrationRockville Maryland
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40
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Lackner F, Beck G, Eichmeir S, Gemeiner M, Hummel K, Pullirsch D, Razzazi-Fazeli E, Seifner A, Miller I. Contamination of therapeutic human immunoglobulin preparations with apolipoprotein H (β2-glycoprotein I). Electrophoresis 2013; 35:515-21. [PMID: 24132587 DOI: 10.1002/elps.201300319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/10/2013] [Accepted: 10/02/2013] [Indexed: 12/20/2022]
Abstract
Polyclonal immunoglobulin (Ig) concentrates are important biological medicinal products and the assurance of their quality and safety is crucial. In our present approach we used proteomic methods to check the purity of commercial Ig products of different origin. The experimental setup included nonreducing 2DE or DIGE combined with MALDI-TOF and the thrombin generation assay, a routine safety test for pharmaceutical Ig preparations, and was complemented by a specific immunoassay. 2DE patterns displayed contaminations with trace amounts of human apolipoprotein H (Apo-H), transferrin, albumin, and its fragments. In contrast to the latter, Apo-H is a protein that is active in the coagulation cascade, and thus a potential involvement in thromboembolic events in vivo cannot be excluded. It was found by 2DE and MALDI-TOF to be a contaminant of several Ig preparations. Spiking experiments of Ig preparations with pure Apo-H demonstrated an Apo-H concentration dependent increase in thrombin generation assay values. Traces of Apo-H are possibly also contributing to unwanted side effects, as already known for factor XIa. The significance of Apo-H contaminations for these side effects might be verified by detailed analyses of pharmacovigilance data.
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41
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José M, Marzo N, Pons B, Herrerias A, López L, Faro M, López M, Jorquera JI. Flebogamma® DIF (intravenous immunoglobulin) purification process effectively eliminates procoagulant activities. Biologicals 2013; 41:393-9. [DOI: 10.1016/j.biologicals.2013.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/22/2013] [Accepted: 08/11/2013] [Indexed: 11/27/2022] Open
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42
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Darnige L, Lillo-Le Louët A. [Treatments with immunoglobulin and thrombotic adverse events]. Rev Med Interne 2013; 35:39-44. [PMID: 24011913 DOI: 10.1016/j.revmed.2013.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/24/2013] [Accepted: 07/20/2013] [Indexed: 02/06/2023]
Abstract
Treatments with intravenous or subcutaneous immunoglobulin (Ig) are used in a broad variety of disorders. Tolerance of Ig is usually good but adverse events, including some serious ones, have been reported and may differ among different Ig preparations. Thrombotic complications occur in 0.6 to 13% of cases and can involve arterial or venous circulation, rarely both. Deep venous thrombosis with or without pulmonary embolism, stroke or myocardial infarction remained the most frequent thrombotic complications. Some risk factors have been identified, mainly old age, multiple cardiovascular risk factors, and past history of thrombo-embolic manifestations. Several mechanisms are suggested to explain this increased risk of thrombotic complications. Indeed, Ig treatments increase the plasma viscosity, increase and activate platelets, can trigger the coagulation cascade through the presence of activated factor XI in some Ig preparations, and release vasoactive molecules responsible for vasospasm. Patients have to be carefully monitored and risk factors to be identified as soon as possible. The role of antiplatelets or anticoagulation is not well determined but should probably be proposed to patients with high risk.
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Affiliation(s)
- L Darnige
- Service d'hématologie biologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France.
| | - A Lillo-Le Louët
- Centre régional de pharmacovigilance, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France
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43
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In vitro evaluation of residual procoagulants in human intravenous immunoglobulins from 11 Chinese blood fractionation companies. Thromb Res 2013; 132:381-5. [DOI: 10.1016/j.thromres.2013.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/04/2013] [Accepted: 07/25/2013] [Indexed: 11/21/2022]
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44
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Seifner A, Beck G, Bayer P, Eichmeir S, Lackner F, Rögelsperger O, Weber K, Wollein G. Assessment of immunoglobulin concentrates on thrombogenic activity by thrombin generation assay, prekallikrein activator assay, and size-exclusion chromatography. Transfusion 2013; 54:376-83. [DOI: 10.1111/trf.12280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 04/19/2013] [Accepted: 04/21/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Alexandra Seifner
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Gerhard Beck
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Patrick Bayer
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Stephanie Eichmeir
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Friedrich Lackner
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Olga Rögelsperger
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Katharina Weber
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
| | - Gabriele Wollein
- Austrian Medicines and Medical Devices Agency; AGES-Austrian Agency for Health and Food Safety; Vienna; Austria
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45
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Wu YW, Champagne J, Toueille M, Gantier R, Burnouf T. Dedicated removal of immunoglobulin (Ig)A, IgM, and Factor (F)XI/activated FXI from human plasma IgG. Transfusion 2013; 54:169-78. [DOI: 10.1111/trf.12243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 03/30/2013] [Accepted: 03/30/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Yu-Wen Wu
- Institute of Medical Biomaterials and Tissue Engineering, College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Research and Development, Chromatography Applications; Pall Life Sciences; Cergy France
- Pall Life Sciences; Northborough Massachusetts
- Human Protein Process Sciences (HPPS); Lille France
| | - Jérôme Champagne
- Institute of Medical Biomaterials and Tissue Engineering, College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Research and Development, Chromatography Applications; Pall Life Sciences; Cergy France
- Pall Life Sciences; Northborough Massachusetts
- Human Protein Process Sciences (HPPS); Lille France
| | - Magali Toueille
- Institute of Medical Biomaterials and Tissue Engineering, College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Research and Development, Chromatography Applications; Pall Life Sciences; Cergy France
- Pall Life Sciences; Northborough Massachusetts
- Human Protein Process Sciences (HPPS); Lille France
| | - René Gantier
- Institute of Medical Biomaterials and Tissue Engineering, College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Research and Development, Chromatography Applications; Pall Life Sciences; Cergy France
- Pall Life Sciences; Northborough Massachusetts
- Human Protein Process Sciences (HPPS); Lille France
| | - Thierry Burnouf
- Institute of Medical Biomaterials and Tissue Engineering, College of Oral Medicine; Taipei Medical University; Taipei Taiwan
- Research and Development, Chromatography Applications; Pall Life Sciences; Cergy France
- Pall Life Sciences; Northborough Massachusetts
- Human Protein Process Sciences (HPPS); Lille France
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46
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Funk MB, Gross N, Gross S, Hunfeld A, Lohmann A, Guenay S, Hanschmann KM, Keller-Stanislawski B. Thromboembolic events associated with immunoglobulin treatment. Vox Sang 2013; 105:54-64. [DOI: 10.1111/vox.12025] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 12/10/2012] [Accepted: 12/13/2012] [Indexed: 11/26/2022]
Affiliation(s)
- M. B. Funk
- Department of Safety of Medicinal Products and Medical Devices; Paul-Ehrlich-Institut; Langen; Germany
| | - N. Gross
- Department of Immunology; Paul-Ehrlich-Institut; Langen; Germany
| | - S. Gross
- Department of Immunology; Paul-Ehrlich-Institut; Langen; Germany
| | - A. Hunfeld
- Department of Haematology/Transfusion Medicine; Paul-Ehrlich-Institut; Langen; Germany
| | - A. Lohmann
- Department of Safety of Medicinal Products and Medical Devices; Paul-Ehrlich-Institut; Langen; Germany
| | - S. Guenay
- Department of Safety of Medicinal Products and Medical Devices; Paul-Ehrlich-Institut; Langen; Germany
| | - K. M. Hanschmann
- Department of Biostatistics; Paul-Ehrlich-Institut; Langen; Germany
| | - B. Keller-Stanislawski
- Department of Safety of Medicinal Products and Medical Devices; Paul-Ehrlich-Institut; Langen; Germany
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47
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Dhainaut F, Guillaumat PO, Dib H, Perret G, Sauger A, de Coupade C, Beaudet M, Elzaabi M, Mouthon L. In vitro and in vivo properties differ among liquid intravenous immunoglobulin preparations. Vox Sang 2012; 104:115-26. [PMID: 23003576 PMCID: PMC3580880 DOI: 10.1111/j.1423-0410.2012.01648.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective To compare in vitro and in vivo biological and biochemical properties of five liquid intravenous immunoglobulin (IVIg) preparations licensed for therapeutic use in Europe. Methods ClairYg® was compared in a blinded manner to four other liquid IVIg preparations licensed in Europe (Octagam®, Kiovig®, Gamunex®, Privigen®). Three batches of each preparation were tested, except for the IgG repertoires and the animal model. Results Levels of anti-A and anti-B antibodies were lower in ClairYg® (0·11/0·11) relative to a positive EDQM standard and Octagam® (0·11/0·08) than in other preparations (0·33–0·69/0·42–0·46). IgG in ClairYg® recognized 365 and 416 protein spots in HEp-2 cell and Escherichia coli protein extracts vs. 230–330 and 402–842 protein spots, respectively, for IgG in other preparations. IgA content (301 vs. 165–820 ng/mg of IgG), Factor XI and Factor XII antigen (0·46 vs. 0·85–2·40 mU/mg of IgG and 7·8 vs. 20·0–46·2 lU/mg of IgG) C1q binding (0·42 vs. 0·67–1·89 arbitrary units) and C5a uptake (0·41 vs. 0·45–0·66% of activation) were lower in ClairYg® than in other preparations. Finally, intravenous infusion of ClairYg®, Gamunex® and Privigen® had no major effect on arterial blood pressure in spontaneously hypertensive rats. Conclusions Our results evidence some differences in the biological and biochemical properties among licensed liquid IVIg preparations.
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Affiliation(s)
- F Dhainaut
- LFB Biotechnologies, Courtaboeuf, France Université Paris Descartes, Faculté de Médecine, Institut Cochin, INSERM U1016, Paris, France
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Daniel GW, Menis M, Sridhar G, Scott D, Wallace AE, Ovanesov MV, Golding B, Anderson SA, Epstein J, Martin D, Ball R, Izurieta HS. Immune globulins and thrombotic adverse events as recorded in a large administrative database in 2008 through 2010. Transfusion 2012; 52:2113-21. [DOI: 10.1111/j.1537-2995.2012.03589.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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