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Ghosh S, Krege W, Doerr B, Mischnik M, Pragst I, Dickneite G, Herzog E. Evaluation of the prothrombotic potential of four-factor prothrombin complex concentrate (4F-PCC) in animal models. PLoS One 2021; 16:e0258192. [PMID: 34614035 PMCID: PMC8494364 DOI: 10.1371/journal.pone.0258192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/21/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Acquired coagulopathy may be associated with bleeding risk. Approaches to restore haemostasis include administration of coagulation factor concentrates, but there are concerns regarding potential prothrombotic risk. The present study assessed the prothrombotic potential of four-factor prothrombin complex concentrate (4F-PCC) versus activated PCC (aPCC) and recombinant factor VIIa (rFVIIa), using three preclinical animal models. METHODS The first model was a modified Wessler model of venous stasis-induced thrombosis in rabbit, focusing on dilutional coagulopathy; the second model employed the same system but focused on direct oral anticoagulant reversal (i.e. edoxaban). The third model assessed the prothrombotic impact of 4F-PCC, aPCC and rFVIIa in a rat model of ferric chloride-induced arterial thrombosis. RESULTS In the first model, thrombi were observed at aPCC doses ≥10 IU/kg (therapeutic dose 100 IU/kg) and rFVIIa doses ≥50 μg/kg (therapeutic dose 90 μg/kg), but not 4F-PCC 50 IU/kg (therapeutic dose 50 IU/kg). The impact of 4F-PCC (up to 300 IU/kg) on thrombus formation was evident from 10 minutes post-administration, but not at 24 hours post-administration; this did not change with addition of tranexamic acid and/or fibrinogen concentrate. 4F-PCC-induced thrombus formation was lower after haemodilution versus non-haemodilution. In the second model, no prothrombotic effect was confirmed at 4F-PCC 50 IU/kg. The third model showed lower incidence of thrombus formation for 4F-PCC 50 IU/kg versus aPCC (50 U/kg) and rFVIIa (90 μg/kg). CONCLUSIONS These results suggest that 4F-PCC has a low thrombotic potential versus aPCC or rFVIIa, supporting the clinical use of 4F-PCC for the treatment of coagulopathy-mediated bleeding.
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Affiliation(s)
- Subhajit Ghosh
- Department of Pharmacology and Toxicology, CSL Behring GmbH, Marburg, Germany
| | - Wilfred Krege
- Department of Pharmacology and Toxicology, CSL Behring GmbH, Marburg, Germany
| | - Baerbel Doerr
- Department of Pharmacology and Toxicology, CSL Behring GmbH, Marburg, Germany
| | - Marcel Mischnik
- Department of Pharmacology and Toxicology, CSL Behring GmbH, Marburg, Germany
| | - Ingo Pragst
- Department of Clinical Research and Development, CSL Behring GmbH, Marburg, Germany
| | - Gerhard Dickneite
- Department of Pharmacology and Toxicology, CSL Behring GmbH, Marburg, Germany
| | - Eva Herzog
- Department of Pharmacology and Toxicology, CSL Behring GmbH, Marburg, Germany
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Doerr B, Boobis A. The UK Committee on Toxicity (COT) and on Carcinogenicity (COC) of Chemicals in Food, Consumer Products and the Environment: Guidance for synthesising and integration of epidemiological and toxicological evidence. Toxicol Lett 2021. [DOI: 10.1016/s0378-4274(21)00751-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Herrmann S, Doerr B, May F, Kuehnemuth B, Cherpokova D, Herzog E, Dickneite G, Nolte MW. Tissue distribution of rIX-FP after intravenous application to rodents. J Thromb Haemost 2020; 18:3194-3202. [PMID: 32810892 DOI: 10.1111/jth.15069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/30/2020] [Accepted: 08/11/2020] [Indexed: 08/31/2023]
Abstract
BACKGROUND Hemophilia B is caused by coagulation factor IX (FIX) deficiency. Recombinant fusion protein linking coagulation FIX with recombinant albumin (rIX-FP; Idelvion® ) is used for replacement therapy with an extended half-life. A previous quantitative whole-body autoradiography (QWBA) study investigating the biodistribution of rIX-FP indicated equal biodistribution, but more prolonged tissue retention compared with a marketed recombinant FIX product. OBJECTIVES To complete and confirm the QWBA study data by directly measuring rIX-FP protein and activity levels in tissues following intravenous (i.v.) administration to normal rats and FIX-deficient (hemophilia B) mice. METHODS After i.v. administration of rIX-FP at a dose of 2000 IU/kg, animals were euthanized at specific time points up to 72 hours postdosing. Subsequently, plasma and various tissues, which were selected based on the previous QWBA results, were harvested and analyzed for FIX antigen levels using an ELISA (both species) or an immunohistochemistry method (mice only), as well as for FIX activity levels (mice only) using a chromogenic assay. RESULTS In rats, rIX-FP distributed extravascularly into all tissues analyzed (ie, liver, kidney, skin and knee) with peak antigen levels reached between 1 and 7 hours postdosing. In hemophilia B mice, rIX-FP tissue distribution was comparable to rats. FIX antigen levels correlated well with FIX activity readouts. CONCLUSIONS Our results confirm QWBA data showing that rIX-FP distributes into relevant target tissues. Importantly, it was demonstrated that rIX-FP available in tissues retains its functional activity and can thus facilitate its therapeutic activity at sites of potential injury.
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Affiliation(s)
| | - Baerbel Doerr
- Research Marburg, CSL Behring GmbH, Marburg, Germany
| | - Frauke May
- Research Marburg, CSL Behring GmbH, Marburg, Germany
| | | | | | - Eva Herzog
- Research Marburg, CSL Behring GmbH, Marburg, Germany
| | | | - Marc W Nolte
- Research Marburg, CSL Behring GmbH, Marburg, Germany
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Herzog E, Kaspereit F, Krege W, Doerr B, Mischnik M, Pragst I, Dickneite G. 1504: 4F-PCC DEMONSTRATES FAVORABLE SAFETY PROFILE IN A RABBIT MODEL OF VENOUS THROMBOSIS. Crit Care Med 2016. [DOI: 10.1097/01.ccm.0000510178.74007.c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Herzog E, Kaspereit F, Krege W, Mueller-Cohrs J, Doerr B, Niebl P, Dickneite G. Four-factor prothrombin complex concentrate reverses apixaban-associated bleeding in a rabbit model of acute hemorrhage. J Thromb Haemost 2015; 13:2220-6. [PMID: 26447393 PMCID: PMC4738416 DOI: 10.1111/jth.13165] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/26/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Apixaban is a direct factor Xa inhibitor approved for the treatment and prevention of thromboembolic disease. There is a lack of data regarding its reversal in cases of acute bleeding or prior to emergency surgery that needs addressing. OBJECTIVES This study assessed whether a four-factor prothrombin complex concentrate (4F-PCC; Beriplex(®) /Kcentra(®) , CSL Behring) can effectively reverse apixaban-associated bleeding in an in vivo rabbit model and evaluated the correlations between in vivo hemostasis and in vitro coagulation parameters. METHODS For dose-finding purposes, anesthetized rabbits were treated with a single intravenous dose of apixaban (800-1600 μg kg(-1) ) and, following a standardized kidney incision, volume of blood loss and time to hemostasis were measured. In a subsequent study phase, anesthetized rabbits were treated with apixaban 1200 μg kg(-1) followed by 4F-PCC (6.25-100 IU kg(-1) ), and the effects on the same bleeding parameters were assessed. In parallel, coagulation parameters were monitored. RESULTS Dose-dependent increases in time to hemostasis and total blood loss were observed post apixaban administration. Preincision treatment with 4F-PCC resulted in a statistically significant reversal in bleeding time (all doses) and volume (doses ≥ 12.5 IU kg(-1) ). Of the coagulation parameters measured, thrombin generation initiated using the RD reagent (phospholipids only) was the most sensitive to in vivo measures of 4F-PCC's hemostatic efficacy, although some correlations were also observed for prothrombin time and whole blood clotting time. CONCLUSIONS In this rabbit model of acute hemorrhage, 4F-PCC showed potential for reversing the bleeding effects of apixaban. Clinical data in apixaban-treated patients are needed to confirm these results.
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Affiliation(s)
- E Herzog
- Research, CSL Behring GmbH, Marburg, Germany
| | - F Kaspereit
- Research, CSL Behring GmbH, Marburg, Germany
| | - W Krege
- Research, CSL Behring GmbH, Marburg, Germany
| | | | - B Doerr
- Research, CSL Behring GmbH, Marburg, Germany
| | - P Niebl
- Research, CSL Behring GmbH, Marburg, Germany
| | - G Dickneite
- Research, CSL Behring GmbH, Marburg, Germany
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Herzog E, Kaspereit F, Krege W, Mueller-Cohrs J, Doerr B, Niebl P, Dickneite G. Correlation of Coagulation Markers and 4F-PCC-Mediated Reversal of Rivaroxaban in a Rabbit Model of Acute Bleeding. Thromb Res 2015; 135:554-60. [DOI: 10.1016/j.thromres.2015.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/08/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
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Herzog E, Kaspereit FJ, Krege W, Doerr B, van Ryn J, Dickneite G, Pragst I. Thrombotic safety of prothrombin complex concentrate (Beriplex P/N) for dabigatran reversal in a rabbit model. Thromb Res 2014; 134:729-36. [DOI: 10.1016/j.thromres.2014.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 07/03/2014] [Accepted: 07/05/2014] [Indexed: 01/23/2023]
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Pragst I, Zeitler SH, Doerr B, Kaspereit FJ, Herzog E, Dickneite G, van Ryn J. Reversal of dabigatran anticoagulation by prothrombin complex concentrate (Beriplex P/N) in a rabbit model. J Thromb Haemost 2012; 10:1841-8. [PMID: 22812619 DOI: 10.1111/j.1538-7836.2012.04859.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND One limitation of the direct thrombin inhibitor dabigatran is the lack of specific antidotes that allow acute bleeding events to be managed or urgent interventional procedures performed. Prothrombin complex concentrates (PCCs) have served as a standard treatment for the reversal of coumarin anticoagulation. OBJECTIVES This study was designed to determine in an animal model whether a PCC (Beriplex P/N) can effectively reverse the effects of dabigatran. An additional objective was to evaluate markers of dabigatran-associated bleeding diathesis. METHODS Anesthetized rabbits were treated with 0.4 mg kg(-1) dabigatran followed by PCC doses of 20, 35 or 50 IU kg(-1) or placebo. After a standardized kidney incision, volume of blood loss and time to hemostasis were determined. RESULTS From an initial mean of 29 mL, blood loss progressively declined by 5.44 mL with a 95% confidence interval (CI) of 2.21-8.67 mL per 10 IU kg(-1) increment in PCC dose (P = 0.002). At a PCC dose of 50 IU kg(-1) blood loss was fully normalized. Increasing PCC doses shortened the median time to hemostasis from 20.0 to 5.7 min (P < 0.001). The rate of hemostasis was nearly trebled with each 10 IU kg(-1) increment in PCC dose (rate ratio, 2.89; CI, 1.64-5.09). CONCLUSIONS In this animal study, PCC showed potential as an agent for reversing the effects of dabigatran. Further investigation is warranted.
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Affiliation(s)
- I Pragst
- CSL Behring GmbH, Marburg Boehringer Ingelheim Pharma GmbH & Co KG, Biberach, Germany.
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Pragst I, Doerr B, Kaspereit F, Krege W, Raquet E, Dickneite G. Acquired bleeding model induced by dilutional coagulopathy in the rabbit. Crit Care 2009. [PMCID: PMC4084323 DOI: 10.1186/cc7601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Dickneite G, Doerr B, Kaspereit F. Characterization of the Coagulation Deficit in Porcine Dilutional Coagulopathy and Substitution with a Prothrombin Complex Concentrate. Anesth Analg 2008; 106:1070-7, table of contents. [DOI: 10.1213/ane.0b013e318165dfbb] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Disseminated intravascular coagulation is a disorder that affects the function of the clotting system and is frequently associated with sepsis or septic shock. One of its leading symptoms is the decrease in circulating fibrinogen. We investigated the effect of fibrinogen concentrate (Haemocomplettan P) on fibrinogen plasma levels, coagulation parameters and mortality in a rat model of sepsis-induced disseminated intravascular coagulation. The disseminated intravascular coagulation was characterized by elevated thrombin-antithrombin complex and a sharp drop in circulating fibrinogen. Coagulation abnormalities were evaluated by thrombelastography. Plasma fibrinogen levels decreased from 2.06 +/- 0.2 to 0.16 +/- 0.1 g/l following administration of bacterial lipopolysaccharide. Thrombelastographic measurements revealed a concurrent decrease in maximum amplitude and an increase in reaction time. Treatment with fibrinogen concentrate (Haemocomplettan P, 25-200 mg/kg body weight intravenously) resulted in a statistically significant dose-dependent increase in fibrinogen plasma levels and amelioration of the measured coagulation abnormalities. Fibrinogen plasma concentrations were restored to normal levels when 200 mg/kg body weight fibrinogen concentrate was administered. A significant decrease in sepsis-induced mortality was observed in animals treated with Haemocomplettan P.
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Affiliation(s)
- Franz Kaspereit
- Aventis Behring GmbH, Pharmacology/Toxicology, Marburg, Germany
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Doerr B, Sheil E, Baisch MJ, Forbes S, Howe CJ, Johnson M, Vogtsberger C. Beyond community assessment into the real world of learning aggregate practice. Nurs Health Care Perspect 1998; 19:214-9. [PMID: 10446564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
One certainty for nursing, and therefore for nursing education, is that nurses of the 21st century will be called upon to deliver aggregate-based care. Faculty, seeking ways to prepare students for this challenge, often use community assessment as a strategy to help develop skills required to implement care at the aggregate level. In this unique program, community projects completed during an undergraduate community and family health nursing course are expanded in scope to include community diagnosis, planning, intervention, and outcome evaluation. Projects offer immediate benefit to the agency and may continue for several semesters, involving students in various phases of the nursing process.
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Affiliation(s)
- B Doerr
- School of Nursing, University of Wisconsin-Milwaukee, USA
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Girten B, Doerr B, Kanabus EW, Herola AJ. ALTERATIONS IN PROSTAGLANDIN PRODUCTION FROM RABBIT AORTA AFTER SHORT- AND LONG-TERM EXERCISE TRAINING. Med Sci Sports Exerc 1986. [DOI: 10.1249/00005768-198604001-00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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