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Pfeffer MA, Kohs TC, Vu HH, Jordan KR, Wang JSH, Lorentz CU, Tucker EI, Puy C, Olson SR, DeLoughery TG, Hinds MT, Keshari RS, Gailani D, Lupu F, McCarty OJ, Shatzel JJ. Factor XI Inhibition for the Prevention of Catheter-Associated Thrombosis in Patients With Cancer Undergoing Central Line Placement: A Phase 2 Clinical Trial. Arterioscler Thromb Vasc Biol 2024; 44:290-299. [PMID: 37970718 PMCID: PMC10877270 DOI: 10.1161/atvbaha.123.319692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/24/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Despite the ubiquitous utilization of central venous catheters in clinical practice, their use commonly provokes thromboembolism. No prophylactic strategy has shown sufficient efficacy to justify routine use. Coagulation factors FXI (factor XI) and FXII (factor XII) represent novel targets for device-associated thrombosis, which may mitigate bleeding risk. Our objective was to evaluate the safety and efficacy of an anti-FXI mAb (monoclonal antibody), gruticibart (AB023), in a prospective, single-arm study of patients with cancer receiving central line placement. METHODS We enrolled ambulatory cancer patients undergoing central line placement to receive a single dose of gruticibart (2 mg/kg) administered through the venous catheter within 24 hours of placement and a follow-up surveillance ultrasound at day 14 for evaluation of catheter thrombosis. A parallel, noninterventional study was used as a comparator. RESULTS In total, 22 subjects (n=11 per study) were enrolled. The overall incidence of catheter-associated thrombosis was 12.5% in the interventional study and 40.0% in the control study. The anti-FXI mAb, gruticibart, significantly prolonged the activated partial thromboplastin time in all subjects on day 14 compared with baseline (P<0.001). Gruticibart was well tolerated and without infusion reactions, drug-related adverse events, or clinically relevant bleeding. Platelet flow cytometry demonstrated no difference in platelet activation following administration of gruticibart. T (thrombin)-AT (antithrombin) and activated FXI-AT complexes increased following central line placement in the control study, which was not demonstrated in our intervention study. CRP (C-reactive protein) did not significantly increase on day 14 in those who received gruticibart, but it did significantly increase in the noninterventional study. CONCLUSIONS FXI inhibition with gruticibart was well tolerated without any significant adverse or bleeding-related events and resulted in a lower incidence of catheter-associated thrombosis on surveillance ultrasound compared with the published literature and our internal control study. These findings suggest that targeting FXI could represent a safe intervention to prevent catheter thrombosis. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04465760.
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Affiliation(s)
- Michael A. Pfeffer
- Division of Hematology and Medical Oncology, Oregon Health
& Science University, Portland, OR
| | - Tia C.L. Kohs
- Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR
| | - Helen H. Vu
- Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR
| | - Kelley R. Jordan
- Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR
| | - Jenny Si Han Wang
- Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR
| | - Christina U. Lorentz
- Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR
- Aronora, Inc., Portland, OR
| | - Erik I. Tucker
- Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR
- Aronora, Inc., Portland, OR
| | - Cristina Puy
- Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR
| | - Sven R. Olson
- Division of Hematology and Medical Oncology, Oregon Health
& Science University, Portland, OR
| | - Thomas G. DeLoughery
- Division of Hematology and Medical Oncology, Oregon Health
& Science University, Portland, OR
| | - Monica T. Hinds
- Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR
| | - Ravi S. Keshari
- Cardiovascular Biology Research Program, Oklahoma Medical
Research Foundation, Oklahoma City, OK
| | - David Gailani
- Department of Pathology, Microbiology and Immunology,
Vanderbilt University Medical Center, Nashville, TN
| | - Florea Lupu
- Cardiovascular Biology Research Program, Oklahoma Medical
Research Foundation, Oklahoma City, OK
| | - Owen J.T. McCarty
- Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR
| | - Joseph J. Shatzel
- Division of Hematology and Medical Oncology, Oregon Health
& Science University, Portland, OR
- Department of Biomedical Engineering, Oregon Health &
Science University, Portland, OR
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Lan J, Zeng T, Liu S, Lan J, Qian L. Noonan syndrome with RAF1 gene mutations in a newborn with cerebral haemorrhage. Eur J Med Res 2022; 27:146. [PMID: 35953836 PMCID: PMC9367063 DOI: 10.1186/s40001-022-00772-2] [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: 05/10/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022] Open
Abstract
Background Noonan syndrome is an autosomal dominant genetic disorder that can occur in men and women and has a sporadic or family history. NS can lead to abnormal bleeding, but cerebral haemorrhage is rare. This is the first case of cerebral haemorrhage with a RAF1 gene mutation that originated in the neonatal period. Case presentation This case presents a newborn with a RAF1 gene mutation resulting in NS complicated with an abnormality of chromosome 46, X, del (Y) (q12). In the course of treatment, the baby's breathing suddenly increased. After an MRI examination of the skull, haemorrhaging was found in multiple parts of the brain. Conclusions After symptomatic treatment, the baby recovered well, but the main cause of cerebral haemorrhage was not found.
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Affiliation(s)
- Junwei Lan
- Neonatology Department, Research Group in Lishui Municipal Central Hospital of Zhejiang Province, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - Tianbao Zeng
- Neonatology Department, Research Group in Lishui Municipal Central Hospital of Zhejiang Province, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - Sheng Liu
- Neonatology Department, Research Group in Lishui Municipal Central Hospital of Zhejiang Province, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - Juhong Lan
- Neonatology Department, Research Group in Lishui Municipal Central Hospital of Zhejiang Province, Lishui Hospital of Zhejiang University, Lishui, 323000, China
| | - Lijun Qian
- Neonatology Department, Research Group in Lishui Municipal Central Hospital of Zhejiang Province, Lishui Hospital of Zhejiang University, Lishui, 323000, China.
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Murray NP, Guzman E, Del Prado M. Transient acquired factor XII deficiency associated with moderately severe Covid-19 pneumonia. Hematol Transfus Cell Ther 2021; 43:515-517. [PMID: 34514334 PMCID: PMC8416650 DOI: 10.1016/j.htct.2021.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nigel P Murray
- Faculty of Medicine, University Finis Terrae, Providencia, Chile; Hospital de Carabineros de Chile, Ñuñoa, Chile.
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Alqahtany FS, Algahtani FH, Alshebly MM, Albegamy TS, Alghamdi ES, Alnakhli MA, Madkhaly FM, Alharbi AA, Alqahtani NA. Factor XII deficiency in asymptomatic Saudi population: A retrospective cohort study. Saudi J Biol Sci 2021; 28:2004-2006. [PMID: 33732086 PMCID: PMC7938109 DOI: 10.1016/j.sjbs.2021.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 11/26/2022] Open
Abstract
Factor XII (FXII) deficiency is a rare genetic blood disorder. It can lead to a higher risk of developing deep vein thrombosis or acquired thrombotic disorders than the general population. This retrospective study evaluated patients who opted for surgery and were found to have abnormal clotting profiles and clotting factors on preoperative routine blood. Patients were included regardless of whether they were symptomatic or asymptomatic. The cohort comprised 115 patients with a mean FXII level of 128.04 ± 36.93%. Two (1.79%) patients, both of whom were women, had FXII levels <60%. The mean FXII level was 58 ± 1.41 (range, 57–59%) in this group. The present study shows the prevalence of FXII in the asymptomatic Saudi population. The results provide the normal range for FXII. The findings of our study provide the basis for diagnosing F XII deficiency in the asymptomatic Saudi population.
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Affiliation(s)
- Fatmah S Alqahtany
- Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Farjah H Algahtani
- Department of Medicine, Division of Oncology/Hematology, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mashael M Alshebly
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Thamer S Albegamy
- Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Essam S Alghamdi
- Heamatopathology & Blood Transfusion Consultant, Ministry of Health, Riyadh, Saudi Arabia
| | - Mohammed A Alnakhli
- Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fatimah M Madkhaly
- Department of Pathology, Hematopathology Unit, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah A Alharbi
- College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nawaf A Alqahtani
- College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia
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