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Chen L, Yang Z, Liu H. Hemoglobin-Based Oxygen Carriers: Where Are We Now in 2023? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020396. [PMID: 36837597 PMCID: PMC9962799 DOI: 10.3390/medicina59020396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/03/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
The pursuit for blood a substitute has spanned over a century, but a majority of the efforts have been disappointing. As of today, there is no widely accepted product used as an alternative to human blood in clinical settings with severe anemic condition(s). Blood substitutes are currently also termed oxygen therapeutics. There are two major categories of oxygen therapeutics, hemoglobin-based and perfluorocarbon-based products. In this article, we reviewed the most developed but failed products and products still in active clinical research in the category of hemoglobin-based oxygen carriers. Among all of the discussed hemoglobin-based oxygen therapeutics, HemAssist, PolyHeme, Hemolink, Hemospan, and Hemoximer were discontinued. Hemopure is in clinical use in South Africa and Russia. Oxyglobin, the sister product of Hemopure, has been approved for veterinary use in the European Union and the United States. HemO2life has recently been approved for organ preservation in organ transplantation in the European Union. OxyVita and Sanguinate are still undergoing active clinical studies. The field of oxygen therapeutics seems to be entering a phase of rapid growth in the coming 10-20 years.
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Affiliation(s)
- Lin Chen
- Department of Anesthesiology, Hubei Women & Children’s Hospital, 745 Wuluo Road, Hongshan, Wuhan 430070, China
| | - Zeyong Yang
- Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai Key Laboratory of Embryogenic Disease, Shanghai Municipal Key Clinical Specialty, 1961 Huashan Road, Shanghai 200030, China
| | - Henry Liu
- Department of Anesthesiology & Critical Care, Perelman School of Medicine, The University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
- Correspondence:
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2
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Mohanto N, Park YJ, Jee JP. Current perspectives of artificial oxygen carriers as red blood cell substitutes: a review of old to cutting-edge technologies using in vitro and in vivo assessments. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2023; 53:153-190. [PMID: 35935469 PMCID: PMC9344254 DOI: 10.1007/s40005-022-00590-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/02/2022] [Indexed: 01/06/2023]
Abstract
Background Several circumstances such as accidents, surgery, traumatic hemorrhagic shock, and other causalities cause major blood loss. Allogenic blood transfusion can be resuscitative for such conditions; however, it has numerous ambivalent effects, including supply shortage, needs for more time, cost for blood grouping, the possibility of spreading an infection, and short shelf-life. Hypoxia or ischemia causes heart failure, neurological problems, and organ damage in many patients. To address this emergent medical need for resuscitation and to treat hypoxic conditions as well as to enhance oxygen transportation, researchers aspire to achieve a robust technology aimed to develop safe and feasible red blood cell substitutes for effective oxygen transport. Area covered This review article provides an overview of the formulation, storage, shelf-life, clinical application, side effects, and current perspectives of artificial oxygen carriers (AOCs) as red blood cell substitutes. Moreover, the pre-clinical (in vitro and in vivo) assessments for the evaluation of the efficacy and safety of oxygen transport through AOCs are key considerations in this study. With the most significant technologies, hemoglobin- and perfluorocarbon-based oxygen carriers as well as other modern technologies, such as synthetically produced porphyrin-based AOCs and oxygen-carrying micro/nanobubbles, have also been elucidated. Expert opinion Both hemoglobin- and perfluorocarbon-based oxygen carriers are significant, despite having the latter acting as safeguards; they are cost-effective, facile formulations which penetrate small blood vessels and remove arterial blockages due to their nano-size. They also show better biocompatibility and longer half-life circulation than other similar technologies.
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Affiliation(s)
- Nijaya Mohanto
- College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452 Republic of Korea
| | - Young-Joon Park
- College of Pharmacy, Ajou University, Suwon, Gyeonggi, Republic of Korea
| | - Jun-Pil Jee
- College of Pharmacy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju, 61452 Republic of Korea
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Abutarboush R, Gu M, Kawoos U, Mullah SH, Chen Y, Goodrich SY, Lashof-Sullivan M, McCarron RM, Statz JK, Bell RS, Stone JR, Ahlers ST. Exposure to Blast Overpressure Impairs Cerebral Microvascular Responses and Alters Vascular and Astrocytic Structure. J Neurotrauma 2019; 36:3138-3157. [PMID: 31210096 PMCID: PMC6818492 DOI: 10.1089/neu.2019.6423] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Exposure to blast overpressure may result in cerebrovascular impairment, including cerebral vasospasm. The mechanisms contributing to this vascular response are unclear. The aim of this study was to evaluate the relationship between blast and functional alterations of the cerebral microcirculation and to investigate potential underlying changes in vascular microstructure. Cerebrovascular responses were assessed in sham- and blast-exposed male rats at multiple time points from 2 h through 28 days after a single 130-kPa (18.9-psi) exposure. Pial microcirculation was assessed through a cranial window created in the parietal bone of anesthetized rats. Pial arteriolar reactivity was evaluated in vivo using hypercapnia, barium chloride, and serotonin. We found that exposure to blast leads to impairment of arteriolar reactivity >24 h after blast exposure, suggesting delayed injury mechanisms that are not simply attributed to direct mechanical deformation. Observed vascular impairment included a reduction in hypercapnia-induced vasodilation, increase in barium-induced constriction, and reversal of the serotonin effect from constriction to dilation. A reduction in vascular smooth muscle contractile proteins consistent with vascular wall proliferation was observed, as well as delayed reduction in nitric oxide synthase and increase in endothelin-1 B receptors, mainly in astrocytes. Collectively, the data show that exposure to blast results in delayed and prolonged alterations in cerebrovascular reactivity that are associated with changes in the microarchitecture of the vessel wall and astrocytes. These changes may contribute to long-term pathologies involving dysfunction of the neurovascular unit, including cerebral vasospasm.
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Affiliation(s)
- Rania Abutarboush
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Ming Gu
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Usmah Kawoos
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Saad H Mullah
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Ye Chen
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Samantha Y Goodrich
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Margaret Lashof-Sullivan
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Richard M McCarron
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Jonathan K Statz
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland.,The Henry M. Jackson Foundation for the Advancement of Military Medicine Inc., Bethesda, Maryland
| | - Randy S Bell
- Neurosurgery Department, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - James R Stone
- Department of Radiology and Medical Imaging, University of Virginia Medical Center, Charlottesville, Virginia
| | - Stephen T Ahlers
- Neurotrauma Department, Naval Medical Research Center, Silver Spring, Maryland
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Abutarboush R, Mullah SH, Saha BK, Haque A, Walker PB, Aligbe C, Pappas G, Tran Ho LTV, Arnaud FG, Auker CR, McCarron RM, Scultetus AH, Moon-Massat P. Brain oxygenation with a non-vasoactive perfluorocarbon emulsion in a rat model of traumatic brain injury. Microcirculation 2018; 25:e12441. [DOI: 10.1111/micc.12441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 01/12/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Rania Abutarboush
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Saad H. Mullah
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Biswajit K. Saha
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Ashraful Haque
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Peter B. Walker
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Chioma Aligbe
- Department of Surgery; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Georgina Pappas
- Department of Surgery; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | | | - Francoise G. Arnaud
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
- Department of Surgery; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Charles R. Auker
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
| | - Richard M. McCarron
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
- Department of Surgery; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Anke H. Scultetus
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
- Department of Surgery; Uniformed Services University of the Health Sciences; Bethesda MD USA
| | - Paula Moon-Massat
- NeuroTrauma Department; Naval Medical Research Center; Silver Spring MD USA
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Zhao J, Yan C, Xu L, Yan K, Feng B, Zhao M, Niu G, Wu M, Chen C, Zhu H. The effect of pPolyHb on hemodynamic stability and mesenteric microcirculation in a rat model of hemorrhagic shock. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2017; 45:677-685. [PMID: 28129711 DOI: 10.1080/21691401.2017.1282869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The effects of polymerized porcine hemoglobin (pPolyHb) on hemodynamic stability and maintenance of mesenteric microvascular function were explored in a rat model of hemorrhagic shock (HS). Following controlled hemorrhage, rats were infused with equal volumes of either pPolyHb, hetastarch (HES), or red blood cell (RBC). The results showed that pPolyHb was superior to HES and RBC in restoring hemodynamic stability and reversing anaerobic metabolism. We observed a reduction in the diameter of mesenteric microvasculature after HS. Resuscitation with pPolyHb and RBC was able to restore the diameters of the venules and arterioles, whereas HES failed to restore the diameters during the observation period.
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Affiliation(s)
- Jing Zhao
- a College of Life Science, Northwest University , Xi'an , P. R. China.,d Department of Anesthesiology , Xijing Hospital, Fourth Military Medical University , Xi'an , P. R. China
| | - Chengbin Yan
- a College of Life Science, Northwest University , Xi'an , P. R. China
| | - Lijuan Xu
- a College of Life Science, Northwest University , Xi'an , P. R. China
| | - Kunping Yan
- a College of Life Science, Northwest University , Xi'an , P. R. China
| | - Bao Feng
- c Shaanxi Lifegen Co. Ltd , Xi'an , P. R. China
| | - Mengye Zhao
- a College of Life Science, Northwest University , Xi'an , P. R. China
| | - Geng Niu
- a College of Life Science, Northwest University , Xi'an , P. R. China
| | - Mengdi Wu
- a College of Life Science, Northwest University , Xi'an , P. R. China
| | - Chao Chen
- a College of Life Science, Northwest University , Xi'an , P. R. China.,b National Engineering Research Center for Miniaturized Detection Systems, Northwest University , Xi'an , P. R. China
| | - Hongli Zhu
- a College of Life Science, Northwest University , Xi'an , P. R. China.,b National Engineering Research Center for Miniaturized Detection Systems, Northwest University , Xi'an , P. R. China
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Oxygen Carriers: Are They Enough for Cellular Support? SPRINGER SERIES IN TRANSLATIONAL STROKE RESEARCH 2017. [DOI: 10.1007/978-3-319-45345-3_26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abutarboush R, Saha BK, Mullah SH, Arnaud FG, Haque A, Aligbe C, Pappas G, Auker CR, McCarron RM, Moon-Massat PF, Scultetus AH. Cerebral Microvascular and Systemic Effects Following Intravenous Administration of the Perfluorocarbon Emulsion Perftoran. J Funct Biomater 2016; 7:jfb7040029. [PMID: 27869709 PMCID: PMC5197988 DOI: 10.3390/jfb7040029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 12/02/2022] Open
Abstract
Oxygen-carrying perfluorocarbon (PFC) fluids have the potential to increase tissue oxygenation during hypoxic states and to reduce ischemic cell death. Regulatory approval of oxygen therapeutics was halted due to concerns over vasoconstrictive side effects. The goal of this study was to assess the potential vasoactive properties of Perftoran by measuring brain pial arteriolar diameters in a healthy rat model. Perftoran, crystalloid (saline) or colloid (Hextend) solutions were administered as four sequential 30 min intravenous (IV) infusions, thus allowing an evaluation of cumulative dose-dependent effects. There were no overall changes in diameters of small-sized (<50 μm) pial arterioles within the Perftoran group, while both saline and Hextend groups exhibited vasoconstriction. Medium-sized arterioles (50–100 μm) showed minor (~8–9%) vasoconstriction within saline and Hextend groups and only ~5% vasoconstriction within the Perftoran group. For small- and medium-sized pial arterioles, the mean percent change in vessel diameters was not different among the groups. Although there was a tendency for arterial blood pressures to increase with Perftoran, pressures were not different from the other two groups. These data show that Perftoran, when administered to healthy anesthetized rats, does not cause additional vasoconstriction in cerebral pial arterioles or increase systemic blood pressure compared with saline or Hextend.
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Affiliation(s)
- Rania Abutarboush
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
| | - Biswajit K Saha
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
| | - Saad H Mullah
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
| | - Francoise G Arnaud
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20895, USA.
| | - Ashraful Haque
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
| | - Chioma Aligbe
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
| | - Georgina Pappas
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
| | - Charles R Auker
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
| | - Richard M McCarron
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20895, USA.
| | - Paula F Moon-Massat
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
| | - Anke H Scultetus
- NeuroTrauma Department, Naval Medical Research Center (NMRC), Silver Spring, MD 20910, USA.
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20895, USA.
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Arnaud F, Higgins A, McCarron R, Moon-Massat PF. Determination of methemoglobin and hemoglobin levels in small volume samples. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2016; 45:58-62. [DOI: 10.3109/21691401.2016.1138490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Francoise Arnaud
- NeuroTrauma Department, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Adam Higgins
- NeuroTrauma Department, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
| | - Richard McCarron
- NeuroTrauma Department, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Paula F. Moon-Massat
- NeuroTrauma Department, Operational and Undersea Medicine Directorate, Naval Medical Research Center, Silver Spring, MD, USA
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