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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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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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Kohl K, Herzog E, Dickneite G, Pestel S. Evaluation of urinary biomarkers for early detection of acute kidney injury in a rat nephropathy model. J Pharmacol Toxicol Methods 2020; 105:106901. [DOI: 10.1016/j.vascn.2020.106901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022]
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Dickneite G, Czech J. Combination of Antibiotic Treatment with the Thrombin Inhibitor Recombinant Hirudin for the Therapy of Experimental Klebsiella pneumoniae Sepsis. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1642520] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryRats which were infected with the gramnegative pathogen Klebsiella pneumoniae develop disseminated intravascular coagulation (DIC), multi-organ failure (MOF) and finally die in a septic shock. We investigated the therapeutic effect of antibiotic (tobramycin) treatment combined with the infusion of the highly specific thrombin inhibitor rec. hirudin. Although administration of 2 mg/kg tobramycin alone leads to a decrease of the bacterial burden, DIC could not be prevented. Infusion of rec. hirudin (0.25 mg/kg x h) for 4 h (start of treatment 1 h post infection), in addition to a bolus administration of tobramycin, led to an amelioration of DIC parameters as fibrinogen, thrombin-antithrombin complex (TAT) and platelets. Serum transaminase levels (GOT, GPT) as a marker of MOF were significantly improved by rec. hirudin, the T50 value increased from 17 h in the tobramycin group to 42 h in the tobramycin + rec. hirudin giuup, muilality rates were 90% or 60%, respectively. Combination of heparin (10011/kg x h) and tobramycin was not effective on survival.
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Affiliation(s)
| | - Jörg Czech
- The Research Laboratories of Behringwerke AG, Marburg, Germany
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Abstract
SummaryExperimental gram-negative sepsis was induced in the rat by Klebsiella pneumoniae. Although bacteria are susceptible to the treatment with the antibiotic Tobramycin, DIC could not be prevented. DIC was manifested by a leuko- and thrombocytopenia, decreases in fibrinogen and AT III and an increase of the aPTT. In this model the therapeutic treatment with human AT III was evaluated. To determine the optimal concentration of AT III a prestudy in a LPS induced DIC in the rat was performed. It was shown that a bolus i. v. injection of 500 U/kg improved survival and DIC, and was thus chosen for the Klebsiella sepsis model. The infectious load was adjusted to yield a mortality rate of 90-100% in the untreated Klebsiella group and a reduction to about 40-50% of the mortality rate by Tobramycin. It was found that AT III reduced mortality in the Klebsiella induced sepsis not only when given prophylactically but was effective even when administrated in a late stage of the DIC, i. e. 3 or 5 h post infection.
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Affiliation(s)
| | - Eric-Paul Pâques
- The Research Laboratories of Behringwerke AG, Marburg/Lahn, Germany
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Lauer P, Metzner H, Zettlmeißl G, Li M, Smith A, Lathe R, Dickneite G. Targeted Inactivation of the Mouse Locus Encoding Coagulation Factor XIII-A: Hemostatic Abnormalities in Mutant Mice and Characterization of the Coagulation Deficit. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1613342] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryBlood coagulation factor XIII (FXIII) promotes cross-linking of fibrin during blood coagulation; impaired clot stabilization in human genetic deficiency is associated with marked pathologies of major clinical impact, including bleeding symptoms and deficient wound healing. To investigate the role of FXIII we employed homologous recombination to generate a targeted deletion of the inferred exon 7 of the FXIII-A gene. FXIII transglutaminase activity in plasma was reduced to about 50% in mice heterozygous for the mutant allele, and was abolished in homozygous null mice. Plasma fibrin γ-dimerization was also indetectable in the homozygous deficient animals, confirming the absence of activatable FXIII. Homozygous mutant mice were fertile, although reproduction was impaired. Bleeding episodes, hematothorax, hematoperitoneum and subcutaneous hemorrhage in mutant mice were associated with reduced survival. Arrest of tail-tip bleeding in FXIII-A deficient mice was markedly and significantly delayed; replacement of mutant mice with human plasma FXIII (Fibrogammin® P) restored bleeding time to within the normal range. Thrombelastography (TEG) experiments demonstrated impaired clot stabilization in FXIII-A mutant mice, replacement with human FXIII led to dose-dependent TEG normalization. The mutant mice thus reiterate some key features of the human genetic disorder: they will be valuable in assessing the role of FXIII in other associated pathologies and the development of new therapies.
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Nicolay U, Friesen HJ, Reers M, Dickneite G. Development of an Anti-Bleeding Agent for Recombinant Hirudin Induced Skin Bleeding in the Pig. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryRecombinant hirudin (rH) is a highly specific thrombin inhibitor which is under clinical investigation for various thrombotic disorders. However, one of its potential risks during clinical use might be hemorrhage, especially when combined with other agents interfering with the coagulation system like antiplatelet or fibrinolytic agents. In this experimental study we investigated whether Haemate, a von Willebrand Factor (vWF) and factor VIII containing product, could correct rH/aspirin induced bleeding in an experimental pig study. Skin bleeding time was evaluated in three open, placebo-controlled, randomized studies following comparable designs. A total of 62 animals were given a short-term infusion of aspirin (20 mg/kg) followed by a three-hour infusion of a high or low dose (0.3 or 0.5 mg/kg/h) of rH. At cessation of rH infusion, animals were allocated to treatment with either Haemate (30 FVIII U/kg) or the recombinant factor VIII, Helixate, which is devoid of vWF. The skin bleeding time (SBT, given as times of baseline) as measured four hours after the start of the rH infusion was defined as the prospective endpoint.In study 1 (low dose rH + Haemate) 4 h SBT was 2.18 (placebo) and 1.61 (Haemate, p = 0.0111). In study No. 2 (high dose rH + Haemate) SBT was 2.58 in placebo and 1.73 in Haemate (p = 0.0001). No significant difference between placebo and treatment were detected in study No. 3 (low dose rH + Helixate). Haemate but not Helixate significantly decreased bleeding time as compared to placebo at termination of the study (7 hours) which was defined as the secondary endpoint. No effect on either aPTT nor rH plasma levels were observed with any of the study drugs. It was concluded that Haemate decreases excess bleeding induced by rH/aspirin treatment without altering rH’s anticoagulant effect.
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Dardik R, Leor J, Skutelsky E, Castel D, Holbova R, Schiby G, Shaish A, Dickneite G, Loscalzo J, Inbal A. Evaluation of the pro-angiogenic effect of factor XIII in heterotopic mouse heart allografts and FXIII-deficient mice. Thromb Haemost 2017; 95:546-50. [PMID: 16525585 DOI: 10.1160/th05-06-0409] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 11/05/2022]
Abstract
SummaryThrombin-activated Factor XIII (FXIIIa),a plasma transglutaminase, stabilizes fibrin clots by crosslinking fibrin chains. FXIIIa was previously shown by us to exhibit proangiogenic activity associated with downregulation of thrombospondin-1, phosphorylation of vascular endothelial growth factor receptor 2 (VEGFR-2), and upregulation of c-Jun. In the current study, we evaluated the proangiogenic effect of FXIIIa in two murine models: a neonatal heterotopic cardiac allograft model in normal mice, and a Matrigel plug model in FXIII-deficient mice. In the neonatal cardiac allograft model, the number of new vessels as well as graft viability (contractile performance) was significantly higher in FXIIIa-injected animals than in controls. A significant increase in the level of c-Jun mRNA and a significant decrease in the level of TSP-1 mRNA were observed in heart allografts treated with FXIIIa. A marked decrease in TSP-1 protein expression was observed within the endothelial cells of hearts treated with FXIIIa. In the Matrigel plug model, FXIII-deficient mice showed a significantly decreased number of new vessels compared to that of the control mice,and the number of vessels almost reached normal levels following addition of FXIIIa. The results of this study provide substantial in vivo evidence for the proangiogenic activity of FXIIIa.
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Affiliation(s)
- Rima Dardik
- Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
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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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Abstract
This pre-clinical study was performed to investigate the ability of the haemostatic fleece TachoComb® to prevent adhesion formation following uterine surgery. Thirty rabbits were randomized to receive TachoComb® or no intervention following incision to the right uterine horn. After 14 days, the animals were killed and examined for the presence of adhesion. The lengths of any adhesions were measured and the severity was recorded as a score (0, no adhesion; 1, adhesion easy to lyse; 2, adhesion lysed with traction; 3, adhesion separated by sharp dissection). The incidence of adhesions was 100% in the control group compared with 33% in the TachoComb®-treated animals. The mean adhesion score was significantly lower (0.7 versus 2.2) and the mean adhesion length category was significantly shorter (0.4 versus 2.0) with TachoComb® than in the control group. This study indicates that TachoComb® is a well-tolerated and effective means of preventing adhesion following gynaecological surgery.
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Deicke C, Chakrakodi B, Pils MC, Dickneite G, Johansson L, Medina E, Loof TG. Local activation of coagulation factor XIII reduces systemic complications and improves the survival of mice after Streptococcus pyogenes M1 skin infection. Int J Med Microbiol 2016; 306:572-579. [PMID: 27338836 DOI: 10.1016/j.ijmm.2016.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 01/28/2023] Open
Abstract
Coagulation is a mechanism for wound healing after injury. Several recent studies delineate an additional role of the intrinsic pathway of coagulation, also known as the contact system, in the early innate immune response against bacterial infections. In this study, we investigated the role of factor XIII (FXIII), which is activated upon coagulation induction, during Streptococcus pyogenes-mediated skin and soft tissue infections. FXIII has previously been shown to be responsible for the immobilization of bacteria within a fibrin network which may prevent systemic bacterial dissemination. In order to investigate if the FXIII-mediated entrapment of S. pyogenes also influences the disease outcome we used a murine S. pyogenes M1 skin and soft tissue infection model. Here, we demonstrate that a lack of FXIII leads to prolonged clotting times, increased signs of inflammation, and elevated bacterial dissemination. Moreover, FXIII-deficient mice show an impaired survival when compared with wildtype animals. Additionally, local reconstitution of FXIII-deficient mice with a human FXIII-concentrate (Fibrogammin®P) could reduce the systemic complications, suggesting a protective role for FXIII during early S. pyogenes skin infection. FXIII therefore might be a possible therapeutically application to support the early innate immune response during skin infections caused by S. pyogenes.
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Affiliation(s)
- Christin Deicke
- Infection Immunology Research Group, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, D-38124 Braunschweig, Germany
| | - Bhavya Chakrakodi
- Center for Infectious Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, S-14186 Stockholm, Sweden
| | - Marina C Pils
- Mouse-pathology, Animal Experimental Unit, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, D-38124 Braunschweig, Germany
| | - Gerhard Dickneite
- Department of Preclinical Research and Development, CSL Behring GmbH, Emil-von-Behring-Strasse 76, D-35041 Marburg, Germany
| | - Linda Johansson
- Center for Infectious Medicine, Department of Medicine, Karolinska Institute, Karolinska University Hospital Huddinge, S-14186 Stockholm, Sweden
| | - Eva Medina
- Infection Immunology Research Group, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, D-38124 Braunschweig, Germany
| | - Torsten G Loof
- Infection Immunology Research Group, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, D-38124 Braunschweig, Germany.
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May F, Krupka J, Fries M, Thielmann I, Pragst I, Weimer T, Panousis C, Nieswandt B, Stoll G, Dickneite G, Schulte S, Nolte MW. FXIIa inhibitor rHA-Infestin-4: Safe thromboprotection in experimental venous, arterial and foreign surface-induced thrombosis. Br J Haematol 2016; 173:769-78. [DOI: 10.1111/bjh.13990] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/04/2015] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | - Ina Thielmann
- Chair of Vascular Medicine; University Hospital Wuerzburg and Rudolf Virchow Centre for Experimental Biomedicine; Wuerzburg Germany
| | | | | | - Con Panousis
- CSL Limited; Bio21 Institute; Parkville Victoria Australia
| | - Bernhard Nieswandt
- Chair of Vascular Medicine; University Hospital Wuerzburg and Rudolf Virchow Centre for Experimental Biomedicine; Wuerzburg Germany
| | - Guido Stoll
- Department of Neurology; University Hospital Wuerzburg; Wuerzburg Germany
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Beyerle A, Solomon C, Dickneite G, Herzog E. Nonclinical analysis of the safety, pharmacodynamics, and pharmacokinetics of plasma-derived human FXIII concentrate in animals. Pharmacol Res Perspect 2016; 4:e00227. [PMID: 27069637 PMCID: PMC4804322 DOI: 10.1002/prp2.227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 11/18/2022] Open
Abstract
Factor XIII (FXIII) is a coagulation protein which plays a major role in hemostasis by covalently cross‐linking fibrin molecules, thereby stabilizing the blood clot and increasing resistance to fibrinolysis. FXIII deficiency, either congenital or acquired, is associated with spontaneous bleeding, increased bleeding time, and poor wound healing. Purified plasma‐derived human FXIII concentrate (pd hFXIII) has been available since 1993 for therapeutic use in congenital FXIII deficiency. This set of nonclinical investigations aimed to evaluate the pharmacodynamic effects and assess the safety profile of pd hFXIII. The efficacy and safety of pd hFXIII were evaluated by pharmacodynamic, pharmacokinetic, and toxicity studies in mice and rats, safety pharmacology studies in dogs, neoantigenicity study, local tolerance, and thrombogenicity tests in rabbits. Administration of pd hFXIII resulted in the correction of deficits in clot formation kinetics and strength as measured by thromboelastometry, and was not associated with thrombus formation up to 350 IU/kg in FXIII knockout mice. There was no production of neoantigens resulting from the viral elimination manufacturing steps detected, and no adverse reactions were observed in toxicity studies with single doses up to 3550 IU/kg in mice and 1420 IU/kg in rats; nor from repeat doses of 350 IU/kg in rats. In addition, local tolerance tests revealed a good tolerability profile in rabbits. Overall, this data showed that pd hFXIII was well tolerated and pharmacodynamically active in preclinical animal models, supporting pd hFXIII as a therapy for FXIII deficiency.
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Affiliation(s)
- Andrea Beyerle
- CSL Behring GmbH Preclinical Research and Development Marburg Germany
| | - Cristina Solomon
- CSL Behring GmbH Medical Affairs Acquired Bleeding Disorders Marburg Germany
| | - Gerhard Dickneite
- CSL Behring GmbH Preclinical Research and Development Marburg Germany
| | - Eva Herzog
- CSL Behring GmbH Preclinical Research and Development Marburg Germany
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Krupka J, May F, Weimer T, Pragst I, Kleinschnitz C, Stoll G, Panousis C, Dickneite G, Nolte MW. The Coagulation Factor XIIa Inhibitor rHA-Infestin-4 Improves Outcome after Cerebral Ischemia/Reperfusion Injury in Rats. PLoS One 2016; 11:e0146783. [PMID: 26815580 PMCID: PMC4731395 DOI: 10.1371/journal.pone.0146783] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/22/2015] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Ischemic stroke provokes severe brain damage and remains a predominant disease in industrialized countries. The coagulation factor XII (FXII)-driven contact activation system plays a central, but not yet fully defined pathogenic role in stroke development. Here, we investigated the efficacy of the FXIIa inhibitor rHA-Infestin-4 in a rat model of ischemic stroke using both a prophylactic and a therapeutic approach. Methods For prophylactic treatment, animals were treated intravenously with 100 mg/kg rHA-Infestin-4 or an equal volume of saline 15 min prior to transient middle cerebral artery occlusion (tMCAO) of 90 min. For therapeutic treatment, 100 mg/kg rHA-Infestin-4, or an equal volume of saline, was administered directly after the start of reperfusion. At 24 h after tMCAO, rats were tested for neurological deficits and blood was drawn for coagulation assays. Finally, brains were removed and analyzed for infarct area and edema formation. Results Within prophylactic rHA-Infestin-4 treatment, infarct areas and brain edema formation were reduced accompanied by better neurological scores and survival compared to controls. Following therapeutic treatment, neurological outcome and survival were still improved although overall effects were less pronounced compared to prophylaxis. Conclusions With regard to the central role of the FXII-driven contact activation system in ischemic stroke, inhibition of FXIIa may represent a new and promising treatment approach to prevent cerebral ischemia/reperfusion injury.
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Affiliation(s)
| | | | | | | | | | - Guido Stoll
- University of Würzburg, Department of Neurology, Würzburg, Germany
| | - Con Panousis
- CSL Limited, Bio21 Institute, Parkville, Victoria, Australia
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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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Dickneite G, Herwald H, Korte W, Allanore Y, Denton CP, Matucci Cerinic M. Coagulation factor XIII: a multifunctional transglutaminase with clinical potential in a range of conditions. Thromb Haemost 2015; 113:686-97. [PMID: 25652913 DOI: 10.1160/th14-07-0625] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/27/2014] [Indexed: 12/28/2022]
Abstract
Coagulation factor XIII (FXIII), a plasma transglutaminase, is best known as the final enzyme in the coagulation cascade, where it is responsible for cross-linking of fibrin. However, a growing body of evidence has demonstrated that FXIII targets a wide range of additional substrates that have important roles in health and disease. These include antifibrinolytic proteins, with cross-linking of α2-antiplasmin to fibrin, and potentially fibrinogen, being the principal mechanism(s) whereby plasmin-mediated clot degradation is minimised. FXIII also acts on endothelial cell VEGFR-2 and αvβ3 integrin, which ultimately leads to downregulation of the antiangiogenic protein thrombospondin-1, promoting angiogenesis and neovascularisation. Under infectious disease conditions, FXIII cross-links bacterial surface proteins to fibrinogen, resulting in immobilisation and killing, while during wound healing, FXIII induces cross-linking of the provisional matrix. The latter process has been shown to influence the interaction of leukocytes with the provisional extracellular matrix and promote wound healing. Through these actions, there are good rationales for evaluating the therapeutic potential of FXIII in diseases in which tissue repair is dysregulated or perturbed, including systemic sclerosis (scleroderma), invasive bacterial infections, and tissue repair, for instance healing of venous leg ulcers or myocardial injuries. Adequate levels of FXIII are also required in patients undergoing surgery to prevent or treat perioperative bleeding, and its augmentation in patients with/at risk for perioperative bleeding may also have potential clinical benefit. While there are preclinical and/or clinical data to support the use of FXIII in a range of settings, further clinical evaluation in these underexplored applications is warranted.
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Affiliation(s)
- Gerhard Dickneite
- Prof. Dr Gerhard Dickneite, Preclinical R&D, CSL Behring, PO Box 1230, 35002 Marburg, Germany, Tel.: +49 6421 392306, Fax: +49 6421 394663, E-mail:
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Herzog E, Kaspereit F, Krege W, Niebl P, Dickneite G. Four-factor prothrombin complex concentrate (Beriplex® P/N) is superior to three-factor prothrombin complex concentrate for reversal of coumarin anticoagulation. Crit Care 2015. [PMCID: PMC4471522 DOI: 10.1186/cc14427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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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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Schürmann D, Herzog E, Raquet E, Nolte MW, May F, Müller-Cohrs J, Björkqvist J, Dickneite G, Pragst I. C1-esterase inhibitor treatment: preclinical safety aspects on the potential prothrombotic risk. Thromb Haemost 2014; 112:960-71. [PMID: 25103795 DOI: 10.1160/th13-06-0469] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/16/2014] [Indexed: 11/05/2022]
Abstract
Human plasma-derived C1-esterase inhibitor (C1-INH) is an efficacious and safe treatment for hereditary angioedema. However, thrombotic events in subjects treated with C1-INH at recommended or off-label, high doses have been reported. In this study, we addressed the potential prothrombotic risk of C1-INH treatment in high doses using a non-clinical rabbit model. Following intravenous infusion of C1-INH to rabbits at doses up to 800 IU/kg, the exposure and the pharmacodynamic efficacy of C1-INH in rabbits were confirmed by activity measurements of C1-esterase, and coagulation factors XIa and XIIa, respectively. Potential prothrombotic effects were assessed following induction of venous and arterial thrombosis using in vivo models of venous and arterial stasis, complemented by various in vitro assays of coagulation markers. Administration of C1-INH at doses up to 800 IU/kg did not potentiate thrombus formation during venous stasis. In contrast, inhibition of arterial occlusion was observed upon C1-INH administration when compared with isotonic saline treatment, indicating antithrombotic rather than prothrombotic activity of high dose C1-INH treatment in vivo. This was further confirmed in vitro by decreased thrombin generation, increased activated partial thromboplastin time, clotting time and clot formation time, and inhibition of platelet aggregation. No relevant changes in fibrinolysis or in the levels of thrombin-antithrombin complexes, and prothrombin fragment 1+2 were observed upon high dose C1-INH treatment. The data suggest that treatment of healthy rabbits with high doses of C1-INH could potentially inhibit coagulation and thrombus formation rather than induce a prothrombotic risk.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ingo Pragst
- Dr. Ingo Pragst, CSL Behring GmbH, Marburg, Emil-von-Behring Straße 76, 35041 Marburg, Germany, Tel.: +49 6421 39 2799, Fax: +49 6421 39 5310, E-mail:
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Beyerle A, Nolte MW, Solomon C, Herzog E, Dickneite G. Analysis of the safety and pharmacodynamics of human fibrinogen concentrate in animals. Toxicol Appl Pharmacol 2014; 280:70-7. [PMID: 25102310 DOI: 10.1016/j.taap.2014.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/15/2014] [Accepted: 07/24/2014] [Indexed: 12/30/2022]
Abstract
Fibrinogen, a soluble 340kDa plasma glycoprotein, is critical in achieving and maintaining hemostasis. Reduced fibrinogen levels are associated with an increased risk of bleeding and recent research has investigated the efficacy of fibrinogen concentrate for controlling perioperative bleeding. European guidelines on the management of perioperative bleeding recommend the use of fibrinogen concentrate if significant bleeding is accompanied by plasma fibrinogen levels less than 1.5-2.0g/l. Plasma-derived human fibrinogen concentrate has been available for therapeutic use since 1956. The overall aim of the comprehensive series of non-clinical investigations presented was to evaluate i) the pharmacodynamic and pharmacokinetic characteristics and ii) the safety and tolerability profile of human fibrinogen concentrate Haemocomplettan P® (RiaSTAP®). Pharmacodynamic characteristics were assessed in rabbits, pharmacokinetic parameters were determined in rabbits and rats and a safety pharmacology study was performed in beagle dogs. Additional toxicology tests included: single-dose toxicity tests in mice and rats; local tolerance tests in rabbits; and neoantigenicity tests in rabbits and guinea pigs following the introduction of pasteurization in the manufacturing process. Human fibrinogen concentrate was shown to be pharmacodynamically active in rabbits and dogs and well tolerated, with no adverse events and no influence on circulation, respiration or hematological parameters in rabbits, mice, rats and dogs. In these non-clinical investigations, human fibrinogen concentrate showed a good safety profile. This data adds to the safety information available to date, strengthening the current body of knowledge regarding this hemostatic agent.
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Affiliation(s)
- Andrea Beyerle
- CSL Behring GmbH, Preclinical Research and Development, Marburg, Germany.
| | - Marc W Nolte
- CSL Behring GmbH, Preclinical Research and Development, Marburg, Germany
| | - Cristina Solomon
- CSL Behring GmbH, Medical Affairs, Marburg, Germany; Department of Anaesthesiology, Perioperative Medicine and General Intensive Care, Paracelsus Medical University, Salzburg, Austria
| | - Eva Herzog
- CSL Behring GmbH, Preclinical Research and Development, Marburg, Germany
| | - Gerhard Dickneite
- CSL Behring GmbH, Preclinical Research and Development, Marburg, Germany
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Herzog E, Harris S, Henson C, McEwen A, Schenk S, Nolte MW, Pragst I, Dickneite G, Schulte S, Zollner S. Biodistribution of the recombinant fusion protein linking coagulation factor IX with albumin (rIX-FP) in rats. Thromb Res 2014; 133:900-7. [DOI: 10.1016/j.thromres.2014.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/22/2014] [Accepted: 02/13/2014] [Indexed: 01/19/2023]
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Zollner S, Raquet E, Claar P, Müller-Cohrs J, Metzner HJ, Weimer T, Pragst I, Dickneite G, Schulte S. Non-clinical pharmacokinetics and pharmacodynamics of rVIII-SingleChain, a novel recombinant single-chain factor VIII. Thromb Res 2014; 134:125-31. [PMID: 24814969 DOI: 10.1016/j.thromres.2014.03.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/06/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION rVIII-SingleChain (CSL627), a novel recombinant coagulation factor VIII (FVIII), is under investigation in a phase I/III clinical programme (AFFINITY) for the treatment of haemophilia A. Non-clinical studies were conducted to investigate the pharmacokinetic/pharmacodynamic profile of rVIII-SingleChain in comparison with full-length recombinant FVIII. MATERIALS AND METHODS Binding affinity of rVIII-SingleChain for von Willebrand factor was investigated by surface plasmon resonance analysis. The pharmacokinetic profile of rVIII-SingleChain was compared with a marketed full-length recombinant FVIII concentrate (Advate(®)) in haemophilia A mice, von Willebrand factor knock-out mice, Crl:CD (SD) rats, rabbits and cynomolgus monkeys. Systemic FVIII activity or antigen levels were recorded. Procoagulant activity was measured in an FeCl3-induced arterial occlusion model and by recording thrombin generation activity (ex vivo) after administration of 200-250 IU/kg rVIII-SingleChain or full-length FVIII to haemophilia A mice. RESULTS rVIII-SingleChain displayed a high affinity for von Willebrand factor (KD=44 pM vs. 139 pM for full-length recombinant FVIII). In all animal species tested, rVIII-SingleChain had more favourable pharmacokinetic properties than full-length recombinant FVIII: clearance was decreased and area under the curve and terminal half-life were enhanced vs. full-length recombinant FVIII, while in vivo recovery and volume of distribution were equivalent. rVIII-SingleChain showed a prolonged thrombin generation potential and prolonged procoagulant activity vs. full-length recombinant FVIII in an FeCl3-induced arterial occlusion model. CONCLUSIONS rVIII-SingleChain had a higher affinity for von Willebrand factor than full-length recombinant FVIII and displayed favourable pharmacokinetic/pharmacodynamic properties in non-clinical models.
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Affiliation(s)
- Sabine Zollner
- Product Development, CSL Behring AG, CH-3000 Bern, Switzerland.
| | - Elmar Raquet
- Preclinical Research and Development, CSL Behring GmbH, 35041 Marburg, Germany
| | - Philipp Claar
- Preclinical Research and Development, CSL Behring GmbH, 35041 Marburg, Germany
| | - Jochen Müller-Cohrs
- Preclinical Research and Development, CSL Behring GmbH, 35041 Marburg, Germany
| | - Hubert J Metzner
- Preclinical Research and Development, CSL Behring GmbH, 35041 Marburg, Germany
| | - Thomas Weimer
- Preclinical Research and Development, CSL Behring GmbH, 35041 Marburg, Germany
| | - Ingo Pragst
- Preclinical Research and Development, CSL Behring GmbH, 35041 Marburg, Germany
| | - Gerhard Dickneite
- Preclinical Research and Development, CSL Behring GmbH, 35041 Marburg, Germany
| | - Stefan Schulte
- Preclinical Research and Development, CSL Behring GmbH, 35041 Marburg, Germany
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Larsson M, Rayzman V, Nolte MW, Nickel KF, Bjorkqvist J, Jamsa A, Hardy MP, Fries M, Schmidbauer S, Hedenqvist P, Broome M, Pragst I, Dickneite G, Wilson MJ, Nash AD, Panousis C, Renne T. A Factor XIIa Inhibitory Antibody Provides Thromboprotection in Extracorporeal Circulation Without Increasing Bleeding Risk. Sci Transl Med 2014; 6:222ra17. [DOI: 10.1126/scitranslmed.3006804] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Zollner S, Schuermann D, Raquet E, Mueller-Cohrs J, Weimer T, Pragst I, Dickneite G, Schulte S. Pharmacological characteristics of a novel, recombinant fusion protein linking coagulation factor VIIa with albumin (rVIIa-FP). J Thromb Haemost 2014; 12:220-8. [PMID: 24641308 PMCID: PMC4166693 DOI: 10.1111/jth.12477] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 09/03/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Recombinant factor VIIa (rFVIIa) is approved for use in controlling bleeding episodes in people with hemophilia who have developed inhibitors to replacement therapy. Due to its short half-life (t½), frequent injections are required, limiting its use as a prophylactic treatment. A novel, recombinant fusion protein linking coagulation factor VIIa with albumin (rVIIa-FP) has been developed to extend the t(½) of rFVIIa. OBJECTIVES The aim of our studies was to investigate the pharmacokinetic/pharmacodynamic characteristics of rVIIa-FP in preclinical animal species. METHODS Pharmacokinetic (PK) parameters were derived after single intravenous dosing in hemophilia A mice, rats, rabbits and monkeys. PK analysis was based on human FVII plasma levels determined by measuring FVII antigen levels by ELISA in mice and rats, and FVIIa activity using STACLOT® VIIa-rTF in rabbits and monkeys. Induction of thrombin generation was investigated in mice, while hemostatic activity was assessed by thrombus formation in rabbits. RESULTS Compared with rFVIIa, rVIIa-FP displayed a prolonged t(½), enhanced in vivo recovery and reduced clearance in all species investigated. In mice, 16 h after treatment with rVIIa-FP, thrombin levels were quantifiable, indicating prolonged efficacy, whereas values had approached baseline at this time after treatment with rFVIIa. After 12 h, hemostatic efficacy was negligible in rFVIIa-treated rabbits, but sustained in animals receiving rVIIa-FP. CONCLUSIONS These studies indicate that the longer t(½) of rVIIa-FP compared with rFVIIa translates into extended activity. These findings suggest that rVIIa-FP has the potential to be administered less frequently than rFVIIa-containing concentrates in clinical use.
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Dickneite G, Hoffman M. Reversing the new oral anticoagulants with prothrombin complex concentrates (PCCs): what is the evidence? Thromb Haemost 2013; 111:189-98. [PMID: 24136202 DOI: 10.1160/th13-05-0431] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 09/19/2013] [Indexed: 11/05/2022]
Abstract
Newer oral anticoagulants offer several advantages over traditional agents (e.g. warfarin), but they are still associated with a bleeding risk and currently there is no validated reversal treatment for them. While there is little support for the use of fresh frozen plasma, and limited data available on the effects of activated recombinant factor VII, preclinical data suggest that prothrombin complex concentrates (PCCs) may have potential in this setting. PCCs are currently used to successfully reverse warfarin-induced anticoagulation; however, clinical evidence for their use with new oral anticoagulants is lacking, with most of the available data coming from preclinical animal studies. Furthermore, there appears to be variation in the ability of different PCCs to reverse the coagulopathy induced by the new anticoagulants, and a lack of correlation between the reversal of laboratory test results and the reversal of anticoagulant-induced bleeding. Although there have been encouraging results, care must be taken in generalising findings from animal models and nonbleeding human subjects to the situation in bleeding patients. Ultimately, more evidence supporting anticoagulation reversal for new anticoagulants is needed, particularly regarding the treatment of bleeding in human patients in a clinical setting. According to the current evidence, use of PCCs may be considered a reasonable approach in dire clinical situations; however, a consensus has not yet been reached regarding PCC use or dosing, due to lack of clinical data.
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Affiliation(s)
- Gerhard Dickneite
- Prof. Dr. Gerhard Dickneite, Preclinical R&D, CSL Behring, PO Box 1230, 35002 Marburg, Germany, Tel.: +49 6421 39 2306, Fax: +49 6421 39 4663, E-mail:
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Zollner SB, Raquet E, Müller-Cohrs J, Metzner HJ, Weimer T, Pragst I, Dickneite G, Schulte S. Preclinical efficacy and safety of rVIII-SingleChain (CSL627), a novel recombinant single-chain factor VIII. Thromb Res 2013; 132:280-7. [PMID: 23830969 DOI: 10.1016/j.thromres.2013.06.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 06/13/2013] [Accepted: 06/16/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The preclinical efficacy and safety of rVIII-SingleChain (CSL627), a novel recombinant single-chain factor VIII, was assessed in a series of animal studies. MATERIALS AND METHODS In the tail-clip bleeding model, hemophilia A mice were injected with escalating doses (1-150 IU/kg) of rVIII-SingleChain, B-domain deleted (BDD) rFVIII (ReFacto AF(®)), or full-length rFVIII products (Advate(®), Helixate(®)). Total blood loss and the percentage of animals in which hemostasis occurred were assessed in this observer-blinded, randomized study. In a second non-randomized study in hemophilia A mice, thromboelastographic analysis, thrombin generation, and activated partial thromboplastin time assays were performed. General safety and toxicity were assessed in three animal species, including determination of the prothrombotic potential of rVIII-SingleChain in a rabbit venous thrombosis model. RESULTS Under acute bleeding conditions, the effect of rVIII-SingleChain on total blood loss and hemostasis was indistinguishable from BDD and full-length rFVIII. rVIII-SingleChain and full-length rFVIII (both 20 IU/kg) corrected thromboelastographic parameters, activated partial thromboplastin time, and thrombin generation to a similar degree in hemophilia A mice. In a thrombosis model, the effect of rVIII-SingleChain on thrombus incidence was non-significant and comparable to BDD rFVIII at doses up to 500 IU/kg. Treatment with rVIII-SingleChain did not cause anaphylactic reaction or local intolerance in safety and toxicity studies, and demonstrated an excellent overall safety profile. CONCLUSIONS rVIII-SingleChain showed convincing hemostatic efficacy and excellent tolerability in animal studies, warranting continued investigation in human Phase I/III trials (AFFINITY).
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Affiliation(s)
- Sabine B Zollner
- Preclinical Research and Development, CSL Behring GmbH, 35041 Marburg, Germany.
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Chen JW, Figueiredo JL, Wojtkiewicz GR, Siegel C, Iwamoto Y, Kim DE, Nolte MW, Dickneite G, Weissleder R, Nahrendorf M. Selective factor XIIa inhibition attenuates silent brain ischemia: application of molecular imaging targeting coagulation pathway. JACC Cardiovasc Imaging 2013; 5:1127-38. [PMID: 23153913 DOI: 10.1016/j.jcmg.2012.01.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 01/17/2012] [Accepted: 01/26/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The purpose of this study was use molecular imaging targeting coagulation pathway and inflammation to better understand the pathophysiology of silent brain ischemia (SBI) and monitor the effects of factor XIIa inhibition. BACKGROUND SBI can be observed in patients who undergo invasive vascular procedures. Unlike acute stroke, the diffuse nature of SBI and its less tangible clinical symptoms make this disease difficult to diagnose and treat. METHODS We induced SBI in mice by intra-arterial injection of fluorescently labeled microbeads or fractionated clot into the carotid artery. After SBI induction, diffusion-weighted magnetic resonance imaging was performed to confirm the presence of microinfarcts in asymptomatic mice. Molecular imaging targeting the downstream factor XIII activity (single-photon emission computed tomography/computed tomography) at 3 h and myeloperoxidase activity (magnetic resonance imaging) on day 3 after SBI induction were performed, without and with the intravenous administration of a recombinant selective factor XIIa inhibitor derived from the hematophagous insect Triatoma infestans (rHA-Infestin-4). Statistical comparisons between 2 groups were evaluated by the Student t test or Mann-Whitney U test. RESULTS In SBI-induced mice, we found abnormal activation of the coagulation cascade (factor XIII activity) and increased inflammation (myeloperoxidase activity) close to where emboli lodge in the brain. rHA-Infestin-4 administration significantly reduced ischemic damage (53% to 85% reduction of infarct volume, p < 0.05) and pathological coagulation (35% to 39% reduction of factor XIII activity, p < 0.05) without increasing hemorrhagic frequency. Myeloperoxidase activity, when normalized to the infarct volume, did not significantly change with rHA-Infestin-4 treatment, suggesting that this treatment does not further decrease inflammation other than that resulting from the reduction in infarct volume. CONCLUSIONS Focal intracerebral clotting and inflammatory activity are part of the pathophysiology underlying SBI. Inhibiting factor XIIa with rHA-Infestin-4 may present a safe and effective treatment to decrease the morbidity of SBI.
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Affiliation(s)
- John W Chen
- Center for Systems Biology, Boston, Massachusetts 02114, USA
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Majmudar MD, Keliher EJ, Heidt T, Leuschner F, Truelove J, Sena BF, Gorbatov R, Iwamoto Y, Dutta P, Wojtkiewicz G, Courties G, Sebas M, Borodovsky A, Fitzgerald K, Nolte MW, Dickneite G, Chen JW, Anderson DG, Swirski FK, Weissleder R, Nahrendorf M. Monocyte-directed RNAi targeting CCR2 improves infarct healing in atherosclerosis-prone mice. Circulation 2013; 127:2038-46. [PMID: 23616627 DOI: 10.1161/circulationaha.112.000116] [Citation(s) in RCA: 215] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exaggerated and prolonged inflammation after myocardial infarction (MI) accelerates left ventricular remodeling. Inflammatory pathways may present a therapeutic target to prevent post-MI heart failure. However, the appropriate magnitude and timing of interventions are largely unknown, in part because noninvasive monitoring tools are lacking. Here, we used nanoparticle-facilitated silencing of CCR2, the chemokine receptor that governs inflammatory Ly-6C(high) monocyte subset traffic, to reduce infarct inflammation in apolipoprotein E-deficient (apoE(-/-)) mice after MI. We used dual-target positron emission tomography/magnetic resonance imaging of transglutaminase factor XIII (FXIII) and myeloperoxidase (MPO) activity to monitor how monocyte subset-targeted RNAi altered infarct inflammation and healing. METHODS AND RESULTS Flow cytometry, gene expression analysis, and histology revealed reduced monocyte numbers and enhanced resolution of inflammation in infarcted hearts of apoE(-/-) mice that were treated with nanoparticle-encapsulated siRNA. To follow extracellular matrix cross-linking noninvasively, we developed a fluorine-18-labeled positron emission tomography agent ((18)F-FXIII). Recruitment of MPO-rich inflammatory leukocytes was imaged with a molecular magnetic resonance imaging sensor of MPO activity (MPO-Gd). Positron emission tomography/magnetic resonance imaging detected anti-inflammatory effects of intravenous nanoparticle-facilitated siRNA therapy (75% decrease of MPO-Gd signal; P<0.05), whereas (18)F-FXIII positron emission tomography reflected unimpeded matrix cross-linking in the infarct. Silencing of CCR2 during the first week after MI improved ejection fraction on day 21 after MI from 29% to 35% (P<0.05). CONCLUSION CCR2-targeted RNAi reduced recruitment of Ly-6C(high) monocytes, attenuated infarct inflammation, and curbed post-MI left ventricular remodeling.
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Affiliation(s)
- Maulik D Majmudar
- Center for Systems Biology, Massachusetts General Hospital, 185 Cambridge St, Boston, MA 02114, USA.
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Heydenreich N, Nolte MW, Göb E, Langhauser F, Hofmeister M, Kraft P, Albert-Weissenberger C, Brede M, Varallyay C, Göbel K, Meuth SG, Nieswandt B, Dickneite G, Stoll G, Kleinschnitz C. C1-Inhibitor Protects From Brain Ischemia-Reperfusion Injury by Combined Antiinflammatory and Antithrombotic Mechanisms. Stroke 2012; 43:2457-67. [DOI: 10.1161/strokeaha.112.660340] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nadine Heydenreich
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Marc W. Nolte
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Eva Göb
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Friederike Langhauser
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Marion Hofmeister
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Peter Kraft
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Christiane Albert-Weissenberger
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Marc Brede
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Csanad Varallyay
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Kerstin Göbel
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Sven G. Meuth
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Bernhard Nieswandt
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Gerhard Dickneite
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Guido Stoll
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
| | - Christoph Kleinschnitz
- From the Department of Neurology (N.H., E.G., F.L., P.K., C.A.W., G.S., C.K.), University of Würzburg, Würzburg, Germany; CSL Behring GmbH (M.W.N., M.H., G.D.), Marburg, Germany; Department of Anesthesiology and Critical Care (M.B.), University of Würzburg, Würzburg, Germany; Department of Neuroradiology (C.V.), University of Würzburg, Würzburg, Germany; Department of Neurology–Inflammatory Disorders of the Nervous System and Neurooncology (K.G., S.G.M.), University of Münster, Münster, Germany
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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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Nolte MW, Nichols TC, Mueller-Cohrs J, Merricks EP, Pragst I, Zollner S, Dickneite G. Improved kinetics of rIX-FP, a recombinant fusion protein linking factor IX with albumin, in cynomolgus monkeys and hemophilia B dogs. J Thromb Haemost 2012; 10:1591-9. [PMID: 22726310 PMCID: PMC3928127 DOI: 10.1111/j.1538-7836.2012.04826.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prophylaxis of hemophilia B, at present, requires multiple infusions of human factor (F)IX concentrates per week. A FIX molecule with a prolonged half-life has the potential to greatly improve the convenience of, and adherence to, prophylaxis. OBJECTIVES The aim of our studies was to investigate the pharmacokinetic (PK) and pharmacodynamic (PD) profile of a recombinant fusion protein linking coagulation FIX with albumin (rIX-FP). METHODS Cynomolgus monkeys and hemophilia B dogs received single intravenous doses of rIX-FP (50-500 IU kg(-1)). rIX-FP plasma levels were determined by an activity-based assay (dogs only) and anti-FIX ELISA methods. Additionally, activated partial thromboplastin time (APTT) was determined in hemophilia B dogs. Data were compared with a direct study comparator (recombinant FIX [rFIX]) or previously published data. RESULTS The terminal half-life of rIX-FP was prolonged in both species compared with FIX reference data. In hemophilia B dogs, human FIX antigen levels remained above 0.05 IU mL(-1) more than three times longer after rIX-FP (7.3 days) compared with rFIX (2.3 days), whereas respective calculations based on activity levels confirmed the observed superior profile. Prolonged PDs of rIX-FP were demonstrated with APTT<60 s sustained around four times longer with rIX-FP (5.9 days) than rFIX (1.5 days). CONCLUSIONS These studies indicate that the recombinant albumin fusion technology successfully improves the PK profile of FIX. Clinical studies will test whether the improved kinetics result in a significant half-life extension in patients with hemophilia B.
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Affiliation(s)
- M W Nolte
- Preclinical Research and Development, CSL Behring GmbH, Marburg, Germany.
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Tsujimoto I, Moriya K, Sakai K, Dickneite G, Sakai T. Critical role of factor XIII in the initial stages of carbon tetrachloride-induced adult liver remodeling. Am J Pathol 2011; 179:3011-9. [PMID: 22019897 PMCID: PMC3260829 DOI: 10.1016/j.ajpath.2011.08.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 08/05/2011] [Accepted: 08/24/2011] [Indexed: 12/29/2022]
Abstract
The transglutaminase-mediated, covalent cross-linking of proteins is an essential step in tissue remodeling after injury. This process provides tissues with extra rigidity and resistance against proteolytic degradation. Plasma coagulation factor XIII (FXIII) is a transglutaminase that promotes cross-linking of the extracellular matrix (ECM) components fibrin and fibronectin to form a provisional matrix in response to tissue damage. However, the functional requirement for this FXIII-mediated cross-linked provisional matrix in adult tissue remodeling remains to be defined. Although it has been proposed that the formation FXIII-mediated fibrin-fibronectin provisional matrix is a critical step for ECM remodeling, we show in an FXIII subunit A-deficient murine model of acute liver injury that the lack of FXIII subunit A did not interfere with collagen reconstruction and resolution after liver injury. Furthermore, FXIIIA deficiency caused significantly increased hepatocyte apoptosis and a delay in hepatocyte regeneration after injury, which were accompanied by a significantly high induction of p53 expression. These findings suggest novel functions of FXIII that the FXIII-mediated covalently cross-linked matrix could promote survival signals for hepatocytes in adult tissue remodeling.
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Affiliation(s)
- Ikuko Tsujimoto
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Raquet E, Stockschläder M, Dickneite G. Repeated infusions of VWF/FVIII concentrate: impact of VWF:FVIII ratio on FVIII trough and peak levels in a rabbit model. Haemophilia 2011; 17:808-14. [PMID: 21726357 DOI: 10.1111/j.1365-2516.2011.02603.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The ratio of von Willebrand factor (VWF) to FVIII differs among available VWF/FVIII concentrates. Repeated infusions of concentrates with a low VWF:FVIII ratio may expose patients with von Willebrand disease to supranormal FVIII levels. The aim of this study was to determine the effects of repeated infusions with two VWF/FVIII concentrates differing in VWF:FVIII ratio on attained FVIII trough and peak levels as well as other pharmacokinetic parameters. Rabbits were randomized to receive multiple 150 IU kg⁻¹ VWF:RCo infusions at 4 h intervals with VWF/FVIII concentrates of a high (Haemate® P/Humate-P®) or low (Wilate®) VWF:FVIII ratio. Trough plasma FVIII and VWF levels were measured after each infusion. Pharmacokinetic analysis was performed using samples collected frequently after infusion. Mean FVIII trough level after the first Wilate infusion was 50.6 IU dL⁻¹ with a 95% confidence interval (CI) of 43.1-58.2 IU dL⁻¹, compared with 31.8 IU dL⁻¹ (CI, 24.4-39.1 IU dL⁻¹) for Haemate P (P<0.001). Trough levels progressively increased over the 24 h treatment period in both groups. After the final infusion, mean trough FVIII remained significantly higher (P = 0.002) in recipients of Wilate. Mean peak FVIII concentration after infusion was 67% higher in the Wilate group (167 vs. 100 IU dL⁻¹ , respectively; P = 0.002). Mean cumulative exposure to FVIII, as measured by area under the curve, was 84% greater in Wilate-treated animals. Half-life did not differ between the two concentrates. Animal model data suggest that exposure to elevated FVIII levels can be reduced through use of VWF/FVIII concentrates with higher VWF:FVIII ratios.
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Affiliation(s)
- E Raquet
- Departments of Preclinical Research and Development Medical Affairs, Commercial Development Coagulation, CSL Behring GmbH, Marburg, Germany
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Kaspereit F, Hoffmann S, Pragst I, Dickneite G. Prothrombin complex concentrate mitigates diffuse bleeding after cardiopulmonary bypass in a porcine model. Br J Anaesth 2010; 105:576-82. [PMID: 20716565 PMCID: PMC2955534 DOI: 10.1093/bja/aeq216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Extracorporeal circuit priming and intravascular volume expansion during cardiopulmonary bypass (CPB) may lead to dilutional coagulopathy and excessive diffuse postoperative bleeding. Prothrombin complex concentrate (PCC) containing clotting factors II (FII), VII (FVII), IX (FIX), and X (FX) could be of potential value in correcting dilutional coagulopathy and reducing blood loss. Methods Anaesthetized pigs underwent CPB with hypothermia for 2 h at 25°C followed by 1 h of normothermia. Approximately 1 h after CPB, animals randomly received either isotonic saline 1 ml kg−1 or PCC 30 IU kg−1 in a volume of 1 ml kg−1. Diffuse coagulopathic bleeding was assessed as suture hole blood loss from a Gore-Tex patch placed over a full-thickness incision in the left carotid artery. Results After CPB, levels of FII, FVII, FIX, and FX declined from baseline by 32% to 48%, and PCC fully or partially reversed those deficits. Median suture hole blood loss after administration of saline placebo was 74 ml. PCC reduced suture hole bleeding by a median of 54 ml with a 95% confidence interval of 6–112 ml (P=0.026) compared with saline. PCC, but not saline, normalized skin bleeding time. Peak thrombin generation markedly decreased after CPB, but then returned in PCC-treated animals to a level higher than baseline by 28.7 nM (14.5–41.1 nM; P=0.031). Conclusions PCC was effective in correcting dilutional coagulopathy and reducing diffuse bleeding in an in vivo large-animal CPB model. Further research is warranted on PCC as a haemostatic agent in CPB.
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Affiliation(s)
- F Kaspereit
- Department of Preclinical Research and Development, CSL Behring GmbH, Marburg, Germany
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Hagedorn I, Schmidbauer S, Pleines I, Kleinschnitz C, Kronthaler U, Stoll G, Dickneite G, Nieswandt B. Factor XIIa Inhibitor Recombinant Human Albumin Infestin-4 Abolishes Occlusive Arterial Thrombus Formation Without Affecting Bleeding. Circulation 2010; 121:1510-7. [DOI: 10.1161/circulationaha.109.924761] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ina Hagedorn
- From the University Clinic, University of Würzburg, and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg (I.H., I.P., B.N.); CSL-Behring GmbH, Marburg (S.S., G.D.); Department of Neurology, University Clinic, Würzburg (C.K., G.S.); and Wehracker 13, Marburg/Michelbach (U.K.), Germany
| | - Stefan Schmidbauer
- From the University Clinic, University of Würzburg, and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg (I.H., I.P., B.N.); CSL-Behring GmbH, Marburg (S.S., G.D.); Department of Neurology, University Clinic, Würzburg (C.K., G.S.); and Wehracker 13, Marburg/Michelbach (U.K.), Germany
| | - Irina Pleines
- From the University Clinic, University of Würzburg, and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg (I.H., I.P., B.N.); CSL-Behring GmbH, Marburg (S.S., G.D.); Department of Neurology, University Clinic, Würzburg (C.K., G.S.); and Wehracker 13, Marburg/Michelbach (U.K.), Germany
| | - Christoph Kleinschnitz
- From the University Clinic, University of Würzburg, and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg (I.H., I.P., B.N.); CSL-Behring GmbH, Marburg (S.S., G.D.); Department of Neurology, University Clinic, Würzburg (C.K., G.S.); and Wehracker 13, Marburg/Michelbach (U.K.), Germany
| | - Ulrich Kronthaler
- From the University Clinic, University of Würzburg, and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg (I.H., I.P., B.N.); CSL-Behring GmbH, Marburg (S.S., G.D.); Department of Neurology, University Clinic, Würzburg (C.K., G.S.); and Wehracker 13, Marburg/Michelbach (U.K.), Germany
| | - Guido Stoll
- From the University Clinic, University of Würzburg, and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg (I.H., I.P., B.N.); CSL-Behring GmbH, Marburg (S.S., G.D.); Department of Neurology, University Clinic, Würzburg (C.K., G.S.); and Wehracker 13, Marburg/Michelbach (U.K.), Germany
| | - Gerhard Dickneite
- From the University Clinic, University of Würzburg, and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg (I.H., I.P., B.N.); CSL-Behring GmbH, Marburg (S.S., G.D.); Department of Neurology, University Clinic, Würzburg (C.K., G.S.); and Wehracker 13, Marburg/Michelbach (U.K.), Germany
| | - Bernhard Nieswandt
- From the University Clinic, University of Würzburg, and Rudolf Virchow Center, DFG Research Center for Experimental Biomedicine, Würzburg (I.H., I.P., B.N.); CSL-Behring GmbH, Marburg (S.S., G.D.); Department of Neurology, University Clinic, Würzburg (C.K., G.S.); and Wehracker 13, Marburg/Michelbach (U.K.), Germany
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Kaspereit F, Hoffman S, Pragst I, Dickneite G. Treatment of the coagulation deficit during extracorporeal circulation in a porcine model by a prothrombin complex concentrate. Crit Care 2010. [PMCID: PMC2934462 DOI: 10.1186/cc8600] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Dickneite G, Friesen HJ, Kumpe G, Reers M. Reduction of r-hirudin induced bleeding in pigs by the administration of von Willebrand factor. Platelets 2009; 7:283-90. [DOI: 10.3109/09537109609023590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Dickneite G, Pragst I. Prothrombin complex concentrate vs fresh frozen plasma for reversal of dilutional coagulopathy in a porcine trauma model. Br J Anaesth 2009; 102:345-54. [PMID: 19168856 PMCID: PMC2642652 DOI: 10.1093/bja/aen391] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Fluid resuscitation following traumatic injury causes haemodilution and can contribute to coagulopathy. Coagulation factor replacement may be necessary to prevent bleeding complications of dilutional coagulopathy. Compared with fresh frozen plasma (FFP), prothrombin complex concentrate (PCC) may potentially offer a more rapid and effective means of normalizing coagulation factor levels. Methods In anaesthetized mildly hypothermic pigs, 65–70% of total blood volume was substituted in phases with hydroxyethyl starch and red cells. Animals were then treated with 15 ml kg−1 isotonic saline placebo, 25 IU kg−1 PCC, or 15 ml kg−1 FFP. Immediately thereafter, either a standardized femur or spleen injury was inflicted, and coagulation function, including thrombin generation, and bleeding were assessed. An additional group received high-dose FFP (40 ml kg−1) before femur injury. Results Haemodilution markedly prolonged prothrombin time and reduced peak thrombin generation. PCC, but not FFP, fully reversed those effects. Compared with 15 ml kg−1 FFP, PCC shortened the time to haemostasis after either bone (P=0.001) or spleen (P=0.028) trauma and reduced the volume of blood lost (P<0.001 and P=0.015, respectively). Subsequent to bone injury, PCC also accelerated haemostasis (P=0.003) and diminished blood loss (P=0.006) vs 40 ml kg−1 FFP. Conclusions PCC was effective in correcting dilutional coagulopathy and controlling bleeding in an in vivo large-animal trauma model. In light of its suitability for more rapid administration than FFP, PCC merits further investigation as a therapy for dilutional coagulopathy in trauma and surgery.
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Affiliation(s)
- G Dickneite
- Department of Pharmacology and Toxicology, CSL Behring GmbH, Marburg, 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. A comparison of the pharmacokinetics of antithrombin derived from human plasma and from transgenic goats and the prevention of sepsis in an animal model. Biopharm Drug Dispos 2008; 29:356-65. [DOI: 10.1002/bdd.623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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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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Dickneite G. Prothrombin complex concentrate versus recombinant factor VIIa for reversal of coumarin anticoagulation. Thromb Res 2007; 119:643-51. [PMID: 16842841 DOI: 10.1016/j.thromres.2006.05.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 05/12/2006] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Prothrombin complex concentrate (PCC) is recommended for emergency reversal of oral coumarin anticoagulation. Recently, recombinant factor VIIa (rFVIIa) has also been investigated for this purpose, although no direct comparison of PCC and rFVIIa has been reported. This study was designed to compare the effectiveness of PCC and rFVIIa for reversal of both acute and sustained coumarin anticoagulation. MATERIALS AND METHODS In the acute model, rats received 2.5 mg.kg(-1) phenprocoumon, and reversal of anticoagulation by 4.88 mL.kg(-1) saline, 100 microg.kg(-1) rFVIIa (NovoSeven) or 50 U.kg(-1) PCC (Beriplex P/N) was assessed at 16 h. For the sustained model, a second phenprocoumon dose was administered at 24 h and anticoagulation reversal evaluated at 48 h. Study endpoints were activated partial thromboplastin time (aPTT), prothrombin time (PT) and tail tip bleeding. RESULTS Acute anticoagulation raised median PT to 4.3 fold the normal level. This elevation was nearly completely reversed both by rFVIIa and PCC. aPTT increase was minor. Effects of sustained anticoagulation were more severe and pervasive, with aPTT, PT and blood loss increasing to 7.7, 51 and 30 fold the control levels, respectively. In the sustained model, rFVIIa substantially reduced and PCC fully normalized PT. In this model, PCC also diminished aPTT (p<0.01), fully normalized blood loss (p<0.01) and shortened bleeding time (p=0.008), while rFVIIa was without significant effect on these endpoints. CONCLUSIONS In a sustained anticoagulation animal model designed to simulate standard long-term oral coumarin therapy in patients, PCC was more effective than rFVIIa in restoring hemostatic function.
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Nahrendorf M, Hu K, Frantz S, Jaffer FA, Tung CH, Hiller KH, Voll S, Nordbeck P, Sosnovik D, Gattenlöhner S, Novikov M, Dickneite G, Reed GL, Jakob P, Rosenzweig A, Bauer WR, Weissleder R, Ertl G. Factor XIII deficiency causes cardiac rupture, impairs wound healing, and aggravates cardiac remodeling in mice with myocardial infarction. Circulation 2006; 113:1196-202. [PMID: 16505171 PMCID: PMC4066325 DOI: 10.1161/circulationaha.105.602094] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Identification of key molecular players in myocardial healing could lead to improved therapies, reduction of scar formation, and heart failure after myocardial infarction (MI). We hypothesized that clotting factor XIII (FXIII), a transglutaminase involved in wound healing, may play an important role in MI given prior clinical and mouse model data. METHODS AND RESULTS To determine whether a truly causative relationship existed between FXIII activity and myocardial healing, we prospectively studied myocardial repair in FXIII-deficient mice. All FXIII(-/-) and FXIII(-)(/+) (FXIII activity <5% and 70%) mice died within 5 days after MI from left ventricular rupture. In contradistinction, FXIII(-/-) mice that received 5 days of intravenous FXIII replacement therapy had normal survival rates; however, cardiac MRI demonstrated worse left ventricular remodeling in these reconstituted FXIII(-/-) mice. Using a FXIII-sensitive molecular imaging agent, we found significantly greater FXIII activity in wild-type mice and FXIII(-/-) mice receiving supplemental FXIII than in FXIII(-/-) mice (P<0.05). In FXIII(-/-) but not in reconstituted FXIII(-/-) mice, histology revealed diminished neutrophil migration into the MI. Reverse transcriptase-polymerase chain reaction studies suggested that the impaired inflammatory response in FXIII(-/-) mice was independent of intercellular adhesion molecule and lipopolysaccharide-induced CXC chemokine, both important for cell migration. After MI, expression of matrix metalloproteinase-9 was 650% higher and collagen-1 was 53% lower in FXIII(-/-) mice, establishing an imbalance in extracellular matrix turnover and providing a possible mechanism for the observed cardiac rupture in the FXIII(-/-) mice. CONCLUSIONS These data suggest that FXIII has an important role in murine myocardial healing after infarction.
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Affiliation(s)
- Matthias Nahrendorf
- Medizinische Klinik und Poliklinik I, Universität Würzburg, Würzburg, Germany
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Kroez M, Lang W, Dickneite G. Wound healing and degradation of the fibrin sealant Beriplast P following partial liver resection in rabbits. Wound Repair Regen 2005; 13:318-23. [PMID: 15953052 DOI: 10.1111/j.1067-1927.2005.130315.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective of this study was to investigate the degradation kinetics of the fibrin sealant (FS) Beriplast P in an experimental liver surgery model in rabbits. A partial liver resection was performed in 21 rabbits, and the wound area covered with Beriplast P to ensure hemostasis. Wound healing of the resection sites was evaluated morphologically over 11 weeks. Degradation of the FS was evaluated by measuring the thickness of the remaining fibrin layer. Plasma samples were analyzed for antibodies against fibrinogen, albumin, thrombin, fibrin, and factor XIII. No postoperative hemorrhage was observed, indicating successful hemostasis throughout. The FS was degraded with a half-life of about 25 days postapplication and was completely replaced by granulation tissue within 9 weeks. The FS degradation and tissue development followed the general stages of wound healing: inflammation and resorption, proliferation, organization and production of collagen, maturation, and scarring. An immune reaction was elicited against the main four human proteins of the FS. The antibody titers peaked on day 14, with a gradual decrease thereafter. We conclude that the FS accomplished hemostasis, facilitated healing in accordance with natural processes, and was completely degraded over time. In humans, the reduced immunogenicity of the FS would potentially increase its degradation half-life.
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Abstract
Platelet activation in response to dual stimulation with collagen and thrombin results in the formation of a subpopulation of activated platelets known as coated platelets. Coated platelets are characterized by high surface levels of alpha-granule proteins and phosphatidylserine, which support the assembly of procoagulant protein complexes. Using murine models, we tested the hypothesis that the collagen receptor-associated molecule FcRgamma and the transglutaminase factor XIIIA are required for the formation of coated platelets. Following dual stimulation with the collagen receptor agonist convulxin and thrombin, 68% of platelets from C57BL/6 mice acquired the coated platelet phenotype, defined by high surface levels of fibrinogen and von Willebrand factor and decreased binding of the alphaIIbbeta3 activation-dependent antibody PE-JON/A. In FcRgamma-/- mice, only 10% of platelets became "coated" after dual stimulation with convulxin plus thrombin (P < .05 vs C57BL/6 platelets). Decreased coated platelet formation in FcRgamma-/- platelets was accompanied by decreased annexin V binding (P < .01) and decreased platelet procoagulant activity (P < .05). Platelets from FXIIIA-/- mice did not differ from control platelets in coated platelet formation or annexin V binding. We conclude that FcRgamma, but not factor XIIIA, is essential for formation of highly procoagulant coated platelets following dual stimulation with collagen and thrombin.
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Affiliation(s)
- Shawn M Jobe
- Department of Pediatrics, University of Iowa College of Medicine, Iowa City, IA 52242, USA
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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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Koseki-Kuno S, Yamakawa M, Dickneite G, Ichinose A. Factor XIII A subunit-deficient mice developed severe uterine bleeding events and subsequent spontaneous miscarriages. Blood 2003; 102:4410-2. [PMID: 12933578 DOI: 10.1182/blood-2003-05-1467] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [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: 11/20/2022] Open
Abstract
To understand the molecular pathology of factor XIII (FXIII) deficiency in vivo, its A subunit (FXIIIA)-knockout (KO) mice were functionally analyzed. Although homozygous FXIIIA female KO mice were capable of becoming pregnant, most of them died due to excessive vaginal bleeding during gestation. Abdominal incisions revealed that the uteri of the dead mice were filled with blood and that some embryos were much smaller than others within a single uterus. A series of histologic examinations of the pregnant animals suggested that massive placental hemorrhage and subsequent necrosis developed in the uteri of the FXIIIA KO mice on day 10 of gestation. This was true regardless of the genotypes of fetuses. These results are reminiscent of spontaneous miscarriage in pregnant humans with FXIII deficiency and indicate that maternal FXIII plays a critical role in uterine hemostasis and maintenance of the placenta during gestation.
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Affiliation(s)
- Shiori Koseki-Kuno
- Department of Molecular Patho-Biochemistry and Patho-Biology, Yamagata University School of Medicine, Iida-Nishi 2-2-2, Yamagata 990-9585 Japan.
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Abstract
Therapy with intravenous immunoglobulin preparations has been used effectively in a wide range of conditions. Although generally well tolerated, intravenous immunoglobulin preparations may be associated with transient hypotension in some patients. This study examined the role of different immunoglobulin G fractions in the development of intravenous immunoglobulin-induced hypotension in an anaesthetized rat model and assessed the effects of a new liquid immunoglobulin prepared at a low pH on both the formation of immunoglobulin G dimers and the development of hypotension. The effects of this new preparation in an experimental autoimmune encephalomyelitis model were also evaluated. Results from the haemodynamic studies indicated that immunoglobulin G dimers in polyclonal immunoglobulin G are responsible for the hypotensive events associated with some immunoglobulin preparations. They also showed that adjustment to an acidic pH results in the rapid dissociation of immunoglobulin G dimers and prevents the development of hypotension. Additional experiments demonstrated that only immunoglobulin G dimers with a functional Fc fragment can bind to Fcgamma receptors on macrophages to induce the release of blood pressure-lowering mediators. Moreover, essentially monomeric Fc fragments can block the blood pressure-lowering effects of immunoglobulin G dimers. Preparation of a new liquid intravenous immunoglobulin with the pH adjusted to 4.3 prevents the formation of immunoglobulin G dimers even over long-term storage and does not significantly affect blood pressure in a rat model. This preparation is as effective as other intravenous immunoglobulin preparations in ameliorating symptoms of experimental autoimmune encephalomyelitis. These results, like those from previous studies, indicate that preparation of intravenous immunoglobulin at a low pH substantially reduces immunoglobulin G dimerization; this effect significantly decreases the potential for intravenous immunoglobulin to induce hypotension without reducing its clinically relevant biological activity.
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MESH Headings
- Animals
- Antibodies, Anti-Idiotypic/chemistry
- Biological Products/chemistry
- Biological Products/isolation & purification
- Biological Products/toxicity
- Blood Pressure/drug effects
- Dimerization
- Encephalomyelitis, Autoimmune, Experimental/physiopathology
- Encephalomyelitis, Autoimmune, Experimental/therapy
- Female
- Humans
- Hydrogen-Ion Concentration
- Hypotension/etiology
- Hypotension/immunology
- Hypotension/prevention & control
- Immunoglobulin Fc Fragments/chemistry
- Immunoglobulin Idiotypes/chemistry
- Immunoglobulins, Intravenous/chemistry
- Immunoglobulins, Intravenous/isolation & purification
- Immunoglobulins, Intravenous/toxicity
- Rats
- Rats, Inbred Lew
- Rats, Sprague-Dawley
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Affiliation(s)
- Monika Kroez
- Aventis Behring GmbH, Emil von Behring Strasse 76, 35041, Marburg, Germany
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