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Weaver AJ, McIntosh CS, Kelly SG, Barrera GD, Lizarraga S, Hildreth KE, Williams CE, Grantham L, Yoshida T, Omert L, Bynum JA, Meledeo MA, Reddoch-Cardenas KM. Evaluating the effects of hypoxic storage on platelet function and health using a novel storage system. Transfusion 2024; 64:693-704. [PMID: 38511850 DOI: 10.1111/trf.17784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/16/2023] [Revised: 01/14/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Thousands of units of whole blood (WB) and blood components are transfused daily to treat trauma patients. Improved methods for blood storage are critical to support trauma-related care. The Hemanext ONE® system offers a unique method for hypoxic storage of WB, with successfully demonstrated storage of clinically viable RBCs. This work evaluated the system for the storage of WB, focusing on platelet health and function. STUDY DESIGN AND METHODS WB was collected from healthy donors and processed through the Hemanext ONE® system. Hemoglobin oxygen saturation (HbSO2) levels of WB were depleted to 10%, 20%, or 30% of total HbSO2 and then stored in PVC bags sealed in oxygen-impermeable bags (except for normoxic control) with samples collected on days 1, 7, and 14 post-processing. Flow cytometry assessed the activation and apoptosis of platelets. Clot dynamics were assessed based on aggregometry and thromboelastography assays, as well as thrombin generation using a calibrated-automated thrombogram method. RESULTS Hypoxic storage conditions were maintained throughout the storage period. Hypoxia triggered increased lactate production, but pH changes were negligible compared to normoxic control. Storage at 10% HbSO2 had a significant impact on platelet function, resulting in increased activation and reduced clot formation and aggregation. These effects were less significant at 20% and 30% HbSO2. DISCUSSION This study indicates that platelets are sensitive to hypoxic storage and suffer significant metabolic and functional deterioration when stored at or below 10% HbSO2.
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Affiliation(s)
- A J Weaver
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - C S McIntosh
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - S G Kelly
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - G D Barrera
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - S Lizarraga
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - K E Hildreth
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - C E Williams
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - L Grantham
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - T Yoshida
- Hemanext Inc., Lexington, Massachusetts, USA
| | - L Omert
- Hemanext Inc., Lexington, Massachusetts, USA
| | | | - M A Meledeo
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
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Wu X, Cap AP, Bynum JA, Chance TC, Darlington DN, Meledeo MA. Prolyl hydroxylase domain inhibitor is an effective pre-hospital pharmaceutical intervention for trauma and hemorrhagic shock. Sci Rep 2024; 14:3874. [PMID: 38365865 PMCID: PMC10873291 DOI: 10.1038/s41598-024-53945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 10/04/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024] Open
Abstract
Pre-hospital potentially preventable trauma related deaths are mainly due to hypoperfusion-induced tissue hypoxia leading to irreversible organ dysfunction at or near the point of injury or during transportation prior to receiving definitive therapy. The prolyl hydroxylase domain (PHD) is an oxygen sensor that regulates tissue adaptation to hypoxia by stabilizing hypoxia inducible factor (HIF). The benefit of PHD inhibitors (PHDi) in the treatment of anemia and lactatemia arises from HIF stabilization, which stimulates endogenous production of erythropoietin and activates lactate recycling through gluconeogenesis. The results of this study provide insight into the therapeutic roles of MK-8617, a pan-inhibitor of PHD-1, 2, and 3, in the mitigation of lactatemia in anesthetized rats with polytrauma and hemorrhagic shock. Additionally, in an anesthetized rat model of lethal decompensated hemorrhagic shock, acute administration of MK-8617 significantly improves one-hour survival and maintains survival at least until 4 h following limited resuscitation with whole blood (20% EBV) at one hour after hemorrhage. This study suggests that pharmaceutical interventions to inhibit prolyl hydroxylase activity can be used as a potential pre-hospital countermeasure for trauma and hemorrhage at or near the point of injury.
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Affiliation(s)
- Xiaowu Wu
- Blood and Shock Resuscitation, USA Army Institute of Surgical Research, 3698 Chambers Pass, Bldg 3610, JBSA Fort Sam Houston, TX, 78234-7767, USA.
| | - Andrew P Cap
- Blood and Shock Resuscitation, USA Army Institute of Surgical Research, 3698 Chambers Pass, Bldg 3610, JBSA Fort Sam Houston, TX, 78234-7767, USA
| | - James A Bynum
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Tiffani C Chance
- Department of Health and Human Services, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, 20993, USA
| | - Daniel N Darlington
- Blood and Shock Resuscitation, USA Army Institute of Surgical Research, 3698 Chambers Pass, Bldg 3610, JBSA Fort Sam Houston, TX, 78234-7767, USA
| | - Michael A Meledeo
- Blood and Shock Resuscitation, USA Army Institute of Surgical Research, 3698 Chambers Pass, Bldg 3610, JBSA Fort Sam Houston, TX, 78234-7767, USA
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Edwards TH, Meledeo MA, Peltier GC, Henderson AF, Pompa LA, Bynum JA. In vitro evaluation of hyperosmotic canine plasma suitable for infusion. J Vet Emerg Crit Care (San Antonio) 2024; 34:63-68. [PMID: 37966879 DOI: 10.1111/vec.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 05/13/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To determine the characteristics of canine freeze-dried plasma (cFDP) as it is serially diluted with sterile water. DESIGN In vitro experimental study. SETTING Government blood and coagulation research laboratory. ANIMALS cFDP from a commercial manufacturer. INTERVENTIONS Ten units of cFDP were reconstituted to 100%, 90%, 80%, 70%, 60%, 50%, and 40% of the recommended volume with sterile water. The resultant solutions were analyzed for coagulation factor activity (factors II, V, VII, VIII, IX, X, and XII as well as antithrombin), fibrinogen concentration, prothrombin time, activated partial thromboplastin time, viscosity, osmolality, and kaolin-activated thromboelastography. MEASUREMENTS AND MAIN RESULTS Viscosity, osmolality, and turbidity properties of plasma were increased in a reconstitution volume-dependent manner, with the 40% suggested volume generating approximately 2-fold increases in each. Similarly, factor activity levels and fibrinogen concentration increased by approximately 2-fold over this range in a concentration-dependent manner. Prothrombin time declined from 11.4 seconds at 100% volume to 10.9 seconds at 70% before increasing to 11.9 seconds at 40%. Activated partial thromboplastin time increased exponentially from 21.8 seconds at 100% rehydration to 100.0 seconds at 40%. R-time on TEG increased from 3.1 to 13.9 minutes at 50% rehydration, while alpha angle declined from 61.3° to 24.7° over the same range, and the maximum amplitude initially increased from 13.2 mm at 100% water to 18.6 mm at 70% water before dropping back down to 14.6 mm at 50% water. No clotting was observed with 40% rehydration. CONCLUSIONS The creation of hyperosmotic plasma from cFDP appears feasible with preservation of concentrated coagulation factors, although there are some unexplained effects that happen to coagulation functions at the highest concentrations tested using only 40%-50% of recommended rehydration volume. Further studies are needed to evaluate the hyperosmotic product in vivo.
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Affiliation(s)
- Thomas H Edwards
- US Army Institute of Surgical Research, San Antonio, Texas, USA
- BluePearl Veterinary Specialists, San Antonio, Texas, USA
- College of Veterinary Medicine, Lincoln Memorial University, Harrogate, Tennessee, USA
| | | | | | | | - Luis A Pompa
- US Army Institute of Surgical Research, San Antonio, Texas, USA
| | - James A Bynum
- US Army Institute of Surgical Research, San Antonio, Texas, USA
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Muraoka WT, Nair PM, Darlington DN, Wu X, Bynum JA, Cap AP. A novel, quantitative clot retraction assay to evaluate platelet function. Platelets 2023; 34:2254403. [PMID: 37700390 DOI: 10.1080/09537104.2023.2254403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/06/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023]
Abstract
Blood platelets are crucial to prevent excessive bleeding following injury to blood vessels. Platelets are crucial for the formation of clots and for clot strength. Platelet activation involves aggregation, attachment to fibrin and clot retraction. Most assays that address platelet function measure platelet aggregation, not clot retraction. Here, we describe a 96-well-based clot retraction assay that requires a relatively short runtime and small sample volume. The assay involves continuous optical density monitoring of platelet-rich plasma that is activated with thrombin. The data can be analyzed using time-series analytical tools to generate quantitative information about different phases of clot formation and clot retraction. The assay demonstrated good repeatability and reproducibility and was robust to different calcium concentrations. Impairment of platelet bioenergetics, actin polymerization, fibrin interaction, and signaling significantly affected clot retraction and was detected and showed good agreement with light transmission aggregometry, suggesting that clot retraction is predictive of platelet function. Using this microplate clot retraction assay, we showed a significant difference in platelets stored in autologous plasma compared with platelet additive solution after 7 days of room temperature storage.
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Affiliation(s)
- Wayne T Muraoka
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Prajeeda M Nair
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
| | - Daniel N Darlington
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
- The Department of Surgery, University of Texas Health, San Antonio, TX, USA
| | - Xiaowu Wu
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
- The Department of Surgery, University of Texas Health, San Antonio, TX, USA
| | - James A Bynum
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
- The Department of Surgery, University of Texas Health, San Antonio, TX, USA
| | - Andrew P Cap
- U.S. Army Institute of Surgical Research, Fort Sam Houston, TX, USA
- The Department of Surgery, University of Texas Health, San Antonio, TX, USA
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Herzig MC, Christy BA, Montgomery RK, Cantu-Garza C, Barrera GD, Lee JH, Mucha N, Talackine JR, Abaasah IA, Bynum JA, Cap AP. Short-term assays for mesenchymal stromal cell immunosuppression of T-lymphocytes. Front Immunol 2023; 14:1225047. [PMID: 37822938 PMCID: PMC10562633 DOI: 10.3389/fimmu.2023.1225047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction Trauma patients are susceptible to coagulopathy and dysfunctional immune responses. Mesenchymal stromal cells (MSCs) are at the forefront of the cellular therapy revolution with profound immunomodulatory, regenerative, and therapeutic potential. Routine assays to assess immunomodulation activity examine MSC effects on proliferation of peripheral blood mononuclear cells (PBMCs) and take 3-7 days. Assays that could be done in a shorter period of time would be beneficial to allow more rapid comparison of different MSC donors. The studies presented here focused on assays for MSC suppression of mitogen-stimulated PBMC activation in time frames of 24 h or less. Methods Three potential assays were examined-assays of apoptosis focusing on caspase activation, assays of phosphatidyl serine externalization (PS+) on PBMCs, and measurement of tumor necrosis factor alpha (TNFα) levels using rapid ELISA methods. All assays used the same initial experimental conditions: cryopreserved PBMCs from 8 to 10 pooled donors, co-culture with and without MSCs in 96-well plates, and PBMC stimulation with mitogen for 2-72 h. Results Suppression of caspase activity in activated PBMCs by incubation with MSCs was not robust and was only significant at times after 24 h. Monitoring PS+ of live CD3+ or live CD4+/CD3+ mitogen-activated PBMCs was dose dependent, reproducible, robust, and evident at the earliest time point taken, 2 h, although no increase in the percentage of PS+ cells was seen with time. The ability of MSC in co-culture to suppress PBMC PS+ externalization compared favorably to two concomitant assays for MSC co-culture suppression of PBMC proliferation, at 72 h by ATP assay, or at 96 h by fluorescently labeled protein signal dilution. TNFα release by mitogen-activated PBMCs was dose dependent, reproducible, robust, and evident at the earliest time point taken, with accumulating signal over time. However, suppression levels with MSC co-culture was reliably seen only after 24 h. Discussion Takeaways from these studies are as follows: (1) while early measures of PBMC activation is evident at 2-6 h, immunosuppression was only reliably detected at 24 h; (2) PS externalization at 24 h is a surrogate assay for MSC immunomodulation; and (3) rapid ELISA assay detection of TNFα release by PBMCs is a robust and sensitive assay for MSC immunomodulation at 24 h.
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Affiliation(s)
- Maryanne C. Herzig
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Barbara A. Christy
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Robbie K. Montgomery
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Carolina Cantu-Garza
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Gema D. Barrera
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Ji H. Lee
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Nicholas Mucha
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Jennifer R. Talackine
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - Isaac A. Abaasah
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
| | - James A. Bynum
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
- Department of Surgery, University of Texas, Health Science Center, San Antonio, TX, United States
| | - Andrew P. Cap
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, TX, United States
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Christy BA, Herzig MC, Abaasah IE, Heard TC, Cap AP, Bynum JA. Refrigerated human mesenchymal stromal cells as an alternative to cryostorage for use in clinical investigation. Transfusion 2023. [PMID: 37293980 DOI: 10.1111/trf.17454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mesenchymal stromal cells (MSCs) and other therapeutic cells show efficacy for cardiac damage, neurological disease, chronic lung disease, pediatric graft versus host disease, and several inflammatory conditions. Based on their anti-inflammatory and immune-modulatory activities, responsiveness, and secretion of beneficial factors, cellular therapeutics may provide benefits in acute and chronic traumatic injury. However, the use of live cells presents logistical challenges, especially for military trauma. MSCs are generally shipped and stored frozen but require sterile handling before infusion. This requires skilled personnel and equipment not readily available in a forward medical treatment facility or even a small community hospital. METHODS Commercial human bone marrow- and adipose-derived MSCs from multiple donors were cultured under standard conditions, harvested and stored at 4°C in solution for up to 21 days. Cell viability, ATP content, apoptosis, proliferation capability, immunomodulation activity, and responsiveness were assessed after different amounts of time. RESULTS Human MSCs can be stored at 4°C in MSC culture medium for 14 days while maintaining a reasonable level of viability and function. Both viability and function are reduced when MSCs are stored in crystalloid solutions. CONCLUSIONS This approach makes it feasible to prepare cellular therapeutic agents in a laboratory or commercial facility and ship them under refrigerated conditions. Once they reach their destination, they can be stored at 4°C under conditions similar to blood products. Cells prepared and stored this way could also be used directly with minimal handling, making them more practical for both civilian and military trauma.
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Affiliation(s)
- Barbara A Christy
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
- Department of Molecular Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Maryanne C Herzig
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Isaac E Abaasah
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Tiffany C Heard
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
- Research Directorate, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - James A Bynum
- Blood and Shock Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
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Reddoch-Cardenas KM, McIntosh C, Barrera G, Bynum JA. Cold storage of whole blood in an additive solution containing apoptotic and necrotic inhibitors. Transfusion 2023; 63 Suppl 3:S189-S198. [PMID: 37102617 DOI: 10.1111/trf.17355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Whole blood (WB) reigns superior to component therapy for the treatment of hemorrhagic shock on the battlefield. Though cold storage of WB offers a shelf life of 21 to 35 days, storage lesions and the potential for blood wastage remain. Storing WB in an additive solution (AS) containing apoptotic inhibitors may help preserve blood cell viability and improve blood quality over extended cold storage. STUDY DESIGN AND METHODS Non-leukoreduced WB was obtained from healthy individuals and dosed with: AS, AS+Necrostatin-1 (AS+N1), AS+Boc-D-fmk (AS+B; apoptosis inhibitor), AS+Q-VD-OPh (AS+Q; apoptosis inhibitor), and Control (0.9% saline). Blood bags were kept refrigerated (1°-6°C) for 21 days. Bags were tested on days 0, 7, 14, and 21 for complete blood count, metabolism, clot formation, aggregation function, platelet activation, and red blood cell quality. RESULTS Platelet count was better preserved in all AS-containing samples. All groups displayed increased glucose consumption and lactate production with storage. Furthermore, all groups displayed a similar decline in clot strength (max amplitude) over the 21-day storage period. Bags that received AS displayed greater preservation of GPIIb expression and lower phosphatidylserine exposure. P-selectin expression was increased in all AS groups. DISCUSSION Treatment of hemorrhagic shock with WB transfusion is logistically simpler than component therapy. Results from our study suggest that refrigerated WB stored with an AS containing apoptotic and necrotic inhibitors helps better preserve platelet count but does not improve platelet function. The future development of WB ASs is warranted to optimize both platelet quality and hemostatic function.
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Affiliation(s)
| | - Colby McIntosh
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Gema Barrera
- Blood and Shock Resuscitation, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
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Thomas KA, Srinivasan AJ, McIntosh C, Rahn K, Kelly S, McGough L, Clayton S, Smith A, Vavro L, Musgrove J, Hill R, Mdaki KS, Bynum JA, Meledeo MA, Cap AP, Spinella PC, Reddoch-Cardenas KM, Shea SM. Comparison of Platelet Quality and Function Across Apheresis Collection Platforms. Transfusion 2023; 63 Suppl 3:S146-S158. [PMID: 37070399 DOI: 10.1111/trf.17370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Platelet concentrates (PLT) can be manufactured using a combination of apheresis collection devices and suspension media (plasma or platelet additive solution (PAS)). It is unclear how platelet quality and hemostatic function differ across the current in-use manufacturing methods in the United States. The objective of this study was therefore to compare baseline function of PLT collected using different apheresis collection platforms and storage media. STUDY DESIGN AND METHODS PLT were collected at two sites with identical protocols(N=5 per site, N=10 total per group) on the MCS®+ 9000 (Haemonetics; "MCS"), the Trima Accel® 7 (Terumo; "Trima"), and the Amicus Cell Separator (Fresenius Kabi, "Amicus"). MCS PLT were collected into plasma while Trima and Amicus PLT were collected into plasma or PAS (Trima into Isoplate and Amicus into InterSol; yielding groups "TP", "TI" and "AP", "AI", respectively). PLT units were sampled 1 hour after collection and assayed to compare cellular counts, biochemistry, and hemostatic function. RESULTS Differences in biochemistry were most evident between plasma and PAS groups, as anticipated. MCS and TP had the highest clot strength as assessed by viscoelastometry. AI had the lowest thrombin generation capacity. Both TP and TI had the highest responses on platelet aggregometry. AI had the greatest number of microparticles. DISCUSSION Platelet quality and function differs among collection platforms at baseline. MCS and Trima platelets overall appear to trend towards higher hemostatic function. Future investigations will assess how these differences change throughout storage, and if these in vitro measures are clinically relevant. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Amudan J Srinivasan
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Colby McIntosh
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, TX, USA
| | - Katelin Rahn
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Kelly
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, TX, USA
| | - Lilian McGough
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Skye Clayton
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alexandra Smith
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa Vavro
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Javonn Musgrove
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ronnie Hill
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, TX, USA
| | - Kennedy S Mdaki
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, TX, USA
| | - James A Bynum
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - M Adam Meledeo
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, TX, USA
| | - Andrew P Cap
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, TX, USA
| | - Philip C Spinella
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Critical Care, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Susan M Shea
- Trauma and Transfusion Medicine Research Center, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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Thompson P, Ciaraglia A, Handspiker E, Bjerkvig C, Bynum JA, Glassberg E, Gurney JM, Hudson AJ, Jenkins DH, Nicholson SE, Strandenes G, Braverman MA. Risk of Harm in Needle Decompression for Tension Pneumothorax. J Spec Oper Med 2023:ZU1D-3DL9. [PMID: 37036785 DOI: 10.55460/zu1d-3dl9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Tension pneumothorax (TPX) is the third most common cause of preventable death in trauma. Needle decompression at the fifth intercostal space at anterior axillary line (5th ICS AAL) is recommended by Tactical Combat Casualty Care (TCCC) with an 83-mm needle catheter unit (NCU). We sought to determine the risk of cardiac injury at this site. METHODS Institutional data sets from two trauma centers were queried for 200 patients with CT chest. Inclusion criteria include body mass index of =30 and age 18-40 years. Measurements were taken at 2nd ICS mid clavicular line (MCL), 5th ICS AAL and distance from the skin to pericardium at 5th ICS AAL. Groups were compared using Mann-Whitney U and chi-squared tests. RESULTS The median age was 27 years with median BMI of 23.8 kg/m2. The cohort was 69.5% male. Mean chest wall thickness at 2nd ICS MCL was 38-mm (interquartile range (IQR) 32-45). At 5th ICS AAL, the median chest wall thickness was 30-mm (IQR 21-40) and the distance from skin to pericardium was 66-mm (IQR 54-79). CONCLUSION The distance from skin to pericardium for 75% of patients falls within the length of the recommended needle catheter unit (83-mm). The current TCCC recommendation to "hub" the 83mm needle catheter unit has potential risk of cardiac injury.
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Becerra SC, Christy BA, Herzig MC, Bynum JA, Darlington DN. Metabolic effects of radiation on red blood cells from cold stored whole blood. Transfusion 2023; 63 Suppl 3:S199-S207. [PMID: 37029665 DOI: 10.1111/trf.17345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/24/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND The risk of military and civilian radiation exposure is increasing, and determining the effects of exposure is a high priority. Irradiation of the nearby blood supply after a nuclear event may impede mobilization of blood products for resuscitation at a time of great need. RBCs are administered to patients with trauma and hemorrhage to transport and deliver oxygen and avoid tissue hypoxia. Here we determine the effects of ionizing radiation on the energy metabolome of RBCs isolated from cold stored whole blood to determine if their stability is compromised by radiation exposure. STUDY DESIGN AND METHODS Whole blood from healthy volunteers was subjected to 0, 25, or 75 Gy of X-irradiation, and stored at 4°C. RBCs were isolated from stored WB at 0, 1, 7, 14, and 21 days of storage. The levels of extracted Krebs cycle intermediates, nicotinamide adenine dinucleotides, and phosphorylated derivatives of adenosine and guanosine were determined by tandem mass spectroscopy. RESULTS Irradiation at either 25Gy or 75Gy had no significant effect on any parameter measured compared to control (0Gy). However, there was a significant change over time in storage for ATP, GDP, and guanosine. DISCUSSION Irradiation at doses up to 75Gy had no effect on the energy metabolome of RBCs prepared from blood stored at 4°C for up to 21 days, suggesting that the RBC energy metabolome is not affected by radiation exposure and the blood can still be used for resuscitation in trauma patients.
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Affiliation(s)
- Sandra C Becerra
- Pathology, Epidemiology and Biostatistics, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, 78234, USA
| | - Barbara A Christy
- Blood and Shock Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, 78234, USA
- Department of Molecular Medicine, UT Health San Antonio, San Antonio, Texas, 78229, USA
| | - Maryanne C Herzig
- Blood and Shock Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, 78234, USA
| | - James A Bynum
- Blood and Shock Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, 78234, USA
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, 78229, USA
| | - Daniel N Darlington
- Blood and Shock Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, 78234, USA
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, 78229, USA
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11
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Becerra SC, Christy BA, Herzig MC, Bynum JA, Darlington DN. Effects of Radiation Exposure and Storage on the Energy Metabolome of Platelets in Whole Blood. Transfusion 2023; 63 Suppl 3:S138-S145. [PMID: 36971034 DOI: 10.1111/trf.17332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Exposure to radiation through battlefield use of nuclear weapons, terrorist attacks or accidents at nuclear power plants is a current concern for the military. Beyond the risk of exposure to personnel is the intentional or accidental irradiation of our blood banking supply system. It is unknown how large doses of ionizing radiation affect storage of blood and blood products, including platelets. The major function of platelets is clot formation which includes aggregation, shape change, vesicle release, and fibrinogen attachment; these tasks require a significant amount of energy. Here, we determine whether the ionizing radiation effects the energy metabolome of platelets in storage. STUDY DESIGN AND METHODS Fresh whole blood from healthy volunteers was subjected to 0, 25, or 75Gy of X-irradiation, and stored at 4°C. Platelets were isolated from stored WB at 0, 1, 7, 14, and 21 days of storage. Krebs cycle intermediates, nicotinamide adenine dinucleotides, and the tri-, di, and mono- phosphorylated versions of adenosine and guanosine were extracted and measured by tandem mass spectroscopy. RESULTS Irradiation at either 25Gy or 75Gy had no significant effect on the amount of any metabolite measured compared to control (0Gy). However, there was a significant fall over time in storage for most of the metabolites measured. DISCUSSION These data show that irradiation at high doses has no effect on the concentration of the energy metabolome of platelets derived from whole blood stored in 4°C for up to 21 days and suggests that platelets can maintain their metabolome even after radiation exposure.
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Affiliation(s)
- Sandra C Becerra
- Pathology, Epidemiology, and Biostatistics, US Army Institute of Surgical Research, Joint Base, San Antonio, Fort Sam Houston, Texas, USA
- Translational Science PhD Program, UT Health-San Antonio, San Antonio, Texas, USA
| | - Barbara A Christy
- Translational Science PhD Program, UT Health-San Antonio, San Antonio, Texas, USA
- Blood and Shock Research, US Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, Texas, USA
- Department of Molecular Medicine, UT Health-San Antonio, San Antonio, Texas, USA
| | - Maryanne C Herzig
- Blood and Shock Research, US Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, Texas, USA
| | - James A Bynum
- Blood and Shock Research, US Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, Texas, USA
- Department of Surgery, UT Health-San Antonio, San Antonio, Texas, USA
| | - Daniel N Darlington
- Blood and Shock Research, US Army Institute of Surgical Research, Joint Base San Antonio, Fort Sam Houston, Texas, USA
- Department of Surgery, UT Health-San Antonio, San Antonio, Texas, USA
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12
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Wheeler LR, Edwards TH, Heinz JA, Scott LLF, Grantham LE, Keesee JD, Henderson AF, Gerardo AC, Hoareau G, Bynum JA. Comparison of assessment of coagulation in healthy dogs by the TEG 6s and TEG 5000 viscoelastic analyzers. J Vet Diagn Invest 2022; 34:780-788. [PMID: 35854673 PMCID: PMC9446302 DOI: 10.1177/10406387221112638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/16/2022] Open
Abstract
The TEG 6s (Haemonetics) point-of-care viscoelastic analyzer is portable, compact, simple to use, and has the potential for rapid viscoelastic analysis that can guide the treatment of veterinary patients at the site of care. Although approved for use in people, the TEG 6s has yet to be evaluated for hemostatic analysis in veterinary medicine. Citrated whole blood (CWB) was collected from 27 healthy dogs. An aliquot of CWB from each dog was diluted by 33% with an isotonic crystalloid, representing an in vitro model of hemodilution. Unaltered and diluted CWB samples were analyzed using 2 TEG 6s and 6 TEG 5000 (Haemonetics) analyzers. The 6 TEG 5000 analyzers ran duplicate analyses of either unaltered or diluted samples using 1 of 3 reagents (Haemonetics): Kaolin TEG, RapidTEG, or TEG Functional Fibrinogen. Duplicate TEG 5000 analyses were averaged and compared with a single TEG 6s analysis. Lin concordance correlation coefficient and Bland-Altman plots were used to evaluate agreement of reaction time, kinetic time, alpha angle, maximum amplitude (MA), and G value (G) for samples activated with Kaolin TEG, and agreement of MA for samples activated with RapidTEG between the 2 machines. Overall, agreement between the TEG 6s and TEG 5000 analyzers was poor. Viscoelastic measurements by the TEG 6s and TEG 5000 in healthy dogs were not all interchangeable. Agreement was satisfactory only for MA and G measurements of diluted blood samples activated with Kaolin TEG, and MA measurements for both unaltered and diluted blood samples activated with RapidTEG.
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Affiliation(s)
- Lance R. Wheeler
- College of Veterinary Medicine, Texas A&M
University, College Station, TX, USA
| | - Thomas H. Edwards
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
- BluePearl Veterinary Specialists and the
College of Veterinary Medicine, Lincoln Memorial University, Harrogate, TN,
USA
| | - Justin A. Heinz
- College of Veterinary Medicine, Texas A&M
University, College Station, TX, USA
| | - Laura L. F. Scott
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
| | - Lonnie E. Grantham
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
- Oak Ridge Institute for Science and Education,
Oak Ridge, TN, USA
| | - Jeffrey D. Keesee
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
| | - Alice F. Henderson
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
| | - Angelina C. Gerardo
- Department of Defense Military Working Dog
Veterinary Service, JBSA Lackland Air Force Base, TX, USA
| | - Guillaume Hoareau
- Department of Surgery, University of Utah
Health, Salt Lake City, UT, USA
| | - James A. Bynum
- U.S. Army Institute of Surgical Research, JBSA
Fort Sam Houston, TX, USA
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13
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McDonough MM, Keyloun J, Orfeo T, Brummel-Zeidins K, Bynum JA, Wu X, Darlington DN, Shupp JW, Burmeister DM. A Natural History Study of Coagulopathy in a Porcine 40% Total Body Surface Area Burn Model Reveals the Time-Dependent Significance of Functional Assays. Burns 2022; 48:1805-1815. [DOI: 10.1016/j.burns.2022.08.016] [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] [Received: 06/14/2022] [Revised: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
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14
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Braverman MA, Smith AA, Ciaraglia AV, Radowsky JS, Schauer SG, Sams VG, Greebon LJ, Shiels MD, Jonas RB, Ngamsuntikul S, Waltman E, Epley E, Rose T, Bynum JA, Cap AP, Eastridge BJ, Stewart RM, Jenkins DH, Nicholson SE. The regional whole blood program in San Antonio, TX: A 3-year update on prehospital and in-hospital transfusion practices for traumatic and non-traumatic hemorrhage. Transfusion 2022; 62 Suppl 1:S80-S89. [PMID: 35748675 DOI: 10.1111/trf.16964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/06/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Abstract
Low titer type O Rh-D + whole blood (LTO + WB) has become a first-line resuscitation medium for hemorrhagic shock in many centers around the World. Showing early effectiveness on the battlefield, LTO + WB is used in both the pre-hospital and in-hospital settings for traumatic and non-traumatic hemorrhage resuscitation. Starting in 2018, the San Antonio Whole Blood Collaborative has worked to provide LTO + WB across Southwest Texas, initially in the form of remote damage control resuscitation followed by in-hospital trauma resuscitation. This program has since expanded to include pediatric trauma resuscitation, obstetric hemorrhage, females of childbearing potential, and non-traumatic hemorrhage. The objective of this manuscript is to provide a three-year update on the successes and expansion of this system and outline resuscitation challenges in special populations.
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Affiliation(s)
| | - Allison A Smith
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | | | - Jason S Radowsky
- Department of Trauma and Acute Care Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Steven G Schauer
- Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, USA.,United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Valerie G Sams
- Department of Trauma and Acute Care Surgery, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Leslie J Greebon
- Department of Pathology, UT Health San Antonio, San Antonio, Texas, USA
| | | | | | | | | | - Eric Epley
- Southwest Texas Regional Advisory Council, San Antonio, Texas, USA
| | - Tracee Rose
- Southwest Texas Regional Advisory Council, San Antonio, Texas, USA
| | - James A Bynum
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Andre P Cap
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Brian J Eastridge
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Ronald M Stewart
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
| | - Donald H Jenkins
- Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
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15
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Escandon MA, Tapia AD, Fisher AD, Shackelford SA, Bebarta VS, Wright FL, Nicholson SE, Hill R, Bynum JA, Schauer SG. An Analysis of the Incidence of Hypocalcemia in Wartime Trauma Casualties. Med J (Ft Sam Houst Tex) 2022:17-21. [PMID: 35373316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Background: Massive transfusion protocols implement the use of blood products to restore homeostasis. Citrated blood products are required for massive transfusions and can induce hypocalcemia, resulting in decreased cardiac contractility. Recent data suggests that major trauma alone is associated with hypocalcemia. This phenomenon remains poorly described. We seek to characterize the incidence and risk factors for early hypocalcemia in the setting of combat trauma. MATERIALS AND METHODS This is a secondary analysis of previously described data from the Department of Defense Trauma Registry from January 2007 to March 2020. In this sub-analysis, we selected only casualties that had at least one ionized calcium measurement. We defined hypocalcemia as an ionized calcium level of less than 1.2mmol/L. RESULTS Within our study database, there were 142 adult casualties that met inclusion with at least one calcium value documented. We found 72 (51%) experienced at least one episode of hypocalcemia. Median composite injury severity score (ISS) was significantly lower in the control cohort compared to those with hypocalcemia (9 versus 15, p=0.010). Survival was similar between the two groups (97% versus 90%, p=0.166). On multivariable analysis when evaluating serious injuries by body region, only serious injuries to the extremities were significantly associated with developing hypocalcemia (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.00-2.21). When comparing prehospital interventions, only intravenous (IV) fluid administration was associated with high proportions experiencing hypocalcemia (25% versus 43%, p=0.029). In the multivariable model adjusted for ISS, mechanism of injury, and patient category, IV fluids were associated with the development of hypocalcemia (OR 2.48, 95% CI 1.03-5.94). When comparing vital signs, only respiratory rates were noted to be higher in the hypocalcemia cohort (18.6 versus 20.4, p=0.048). CONCLUSIONS Approximately half of combat casualties with available ionized calcium (iCa) level were hypocalcemic. Prehospital IV fluid use was associated with the development of hypocalcemia. Our study has implications for forward-staged medical teams with limited laboratory analysis capabilities. Additional research is needed to determine whether calcium replacement improves survival from traumatic injury and to identify the specific indications and timing for calcium replacement. This study will help inform a clinical study intended to aid in the development of clinical practice guidelines for deployed medical personnel.
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Affiliation(s)
| | - Ashley D Tapia
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX
| | - Andrew D Fisher
- Texas Army National Guard, Austin, TX; and University of New Mexico School of Medicine, Albuquerque, NM
| | | | - Vikhyat S Bebarta
- Center for COMBAT Research, University of Colorado Anschutz Medical Campus, Aurora, CO; and 59th Medical Wing, JBSA Lackland, TX
| | - Franklin L Wright
- Center for COMBAT Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Ronnie Hill
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX
| | - James A Bynum
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX
| | - Steven G Schauer
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX; Brooke Army Medical Center, JBSA Fort Sam Houston, TX; and Uniformed Services University of the Health Sciences, Bethesda, MD
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16
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Wu X, Darlington DN, Christy BA, Liu B, Keesee JD, Salgado CL, Bynum JA, Cap AP. Intravenous administration of mesenchymal stromal cells leads to a dose-dependent coagulopathy and is unable to attenuate acute traumatic coagulopathy in rats. J Trauma Acute Care Surg 2022; 92:542-552. [PMID: 34797814 PMCID: PMC8860226 DOI: 10.1097/ta.0000000000003476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mesenchymal stromal cells (MSCs) express surface tissue factor (TF), which may affect hemostasis and detract from therapeutic outcomes of MSCs if administered intravenously. In this study, we determine a safe dose of MSCs for intravenous (IV) administration and further demonstrate the impact of IV-MSC on acute traumatic coagulopathy (ATC) in rats. METHODS Tissue factor expression of rat bone marrow-derived mesenchymal stromal cell (BMSC) or adipose-derived mesenchymal stromal cell (AMSC) was detected by immunohistochemistry and enzyme-linked immunosorbent assay. The coagulation properties were measured in MSC-treated rat whole blood, and blood samples were collected from rats after IV administration of MSCs. Acute traumatic coagulopathy rats underwent polytrauma and 40% hemorrhage, followed by IV administration of 5 or 10 million/kg BMSCs (BMSC-5, BMSC-10), or vehicle at 1 hour after trauma. RESULTS Rat MSCs expressed TF, and incubation of rat BMSCs or AMSCs with whole blood in vitro led to a significantly shortened clotting time. However, a dose-dependent prolongation of prothrombin time with reduction in platelet counts and fibrinogen was found in healthy rat treated with IV-MSCs. Bone marrow-derived mesenchymal stromal cells at 5 million/kg or less led to minimal effect on hemostasis. Mesenchymal stromal cells were not found in circulation but in the lungs after IV administration regardless of the dosage. Acute traumatic coagulopathy with prolonged prothrombin time was not significantly affected by 5 or 10 million/kg BMSCs. Intravenous administration of 10 million/kg BMSCs led to significantly lower fibrinogen and platelet counts, while significantly higher levels of lactate, wet/dry weight ratio, and leukocyte infiltration in the lung were present compared with BMSC-5 or vehicle. No differences were seen in immune or inflammatory profiles with BMSC treatment in ATC rats, at least in the acute timeframe. CONCLUSION Intravenous administration of MSCs leads to a risk of coagulopathy associated with a dose-dependent reduction in platelet counts and fibrinogen and is incapable of restoring hemostasis of rats with ATC after polytrauma and hemorrhagic shock.
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17
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Edwards TH, Meledeo MA, Peltier GC, Henderson AF, Hammill RM, McIntosh CS, Bynum JA. Hemoglobin-Based Oxygen Carrier for the Reconstitution of Canine Freeze-Dried Plasma in an In Vitro Model of Resuscitation. J Spec Oper Med 2022; 22:111-114. [PMID: 35278326 DOI: 10.55460/yeym-xu23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
Military working dogs (MWDs) are force multipliers that are at risk for severe trauma when employed on the battlefield. When in severe hemorrhagic shock, MWDs require both oxygen- carrying capacity and replacement of vascular volume and coagulation factors. The objective of this study was to evaluate the hemostatic capacity of canine freeze-dried plasma (cFDP) with a Food and Drug Administration (FDA)-approved hemoglobin- based oxygen carrier (HBOC) in an in vitro model of resuscitation. Whole blood (WB) was collected from 10 MWDs, and these samples were diluted by 10%, 25%, or 40% with either cFDP (reconstituted with water), HBOC, cFDP (reconstituted with HBOC), or an equal volume of a 1:1 ratio of cFDP (reconstituted with water) and HBOC. Hemostatic parameters were minimally changed based on evaluation of prothrombin time, activated partial thromboplastin time, fibrinogen and thromboelastography at the 10% and 25% dilutions, and parameters consistent with a hypocoagulability were seen at dilutions of 40%. Based on the results of this study, additional research is warranted to determine if cFDP reconstituted with HBOC is a viable resuscitation product in canine trauma.
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18
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Clarke EE, Hamm J, Fisher AD, April MD, Long BJ, Mdaki KS, Hill R, Bynum JA, Schauer SG. Trends in Prehospital Blood, Crystalloid, and Colloid Administration in Accordance With Changes in Tactical Combat Casualty Care Guidelines. Mil Med 2021; 187:e1265-e1270. [PMID: 34935982 DOI: 10.1093/milmed/usab461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/12/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Hemorrhage is the leading threat to the survival of battlefield casualties. This study aims to investigate the types of fluids and blood products administered in prehospital trauma encounters to discover the effectiveness of Tactical Combat Casualty Care (TCCC) recommendations. MATERIALS AND METHODS This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry with a focus on prehospital fluid and blood administration in conjunction with changes in the TCCC guidelines. We collected demographic information on each patient. We categorized receipt of each fluid type and blood product as a binary variable for each casualty and evaluated trends over 2007-2020 both unadjusted and controlling for injury severity and mechanism of injury. RESULTS Our original dataset comprised 25,897 adult casualties from January 1, 2007 through March 17, 2020. Most (97.3%) of the casualties were male with a median age of 25. Most (95.5%) survived to hospital discharge, and 12.2% of the dataset received fluids of any kind. Medical personnel used crystalloids in 7.4% of encounters, packed red blood cells in 2.0%, and whole blood in 0.5% with very few receiving platelets or freeze-dried plasma. In the adjusted model, we noted significant year-to-year increases in intravenous fluid administration from 2014 to 2015 and 2018 to 2019, with significant decreases noted in 2008-2009, 2010-2012, and 2015-2016. We noted no significant increases in Hextend used, but we did note significant decreases in 2010-2012. For any blood product, we noted significant increases from 2016 to 2017, with decreases noted in 2009-2013, 2015-2016, and 2017-2018. Overall, we noted a general spike in all uses in 2011-2012 that rapidly dropped off 2012-2013. Crystalloids consistently outpaced the use of blood products. We noted a small upward trend in all blood products from 2017 to 2019. CONCLUSIONS Changes in TCCC guidelines did not immediately translate into changes in prehospital fluid administration practices. Crystalloid fluids continue to dominate as the most commonly administered fluid even after the 2014 TCCC guidelines changed to use of blood products over crystalloids. There should be future studies to investigate the reasons for delay in guideline implementation and efforts to improve adherence.
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Affiliation(s)
| | - James Hamm
- Soldier Recovery Brigade, National Capital Region, Walter Reed, MD, USA
| | - Andrew D Fisher
- University of New Mexico School of Medicine, Albuquerque, NM 87106, USA.,Texas Army National Guard, Austin, TX, USA
| | - Michael D April
- 40th FRSD, Forward Resuscitative Surgical Team, Fort Carson, CO 80193, USA.,Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Brit J Long
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA
| | - Kennedy S Mdaki
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
| | - Ronnie Hill
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
| | - James A Bynum
- US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
| | - Steven G Schauer
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA.,US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX 78234, USA
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19
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Nair PM, Meledeo MA, Wells AR, Wu X, Bynum JA, Leung KP, Liu B, Cheeniyil A, Ramasubramanian AK, Weisel JW, Cap AP. Cold-stored platelets have better preserved contractile function in comparison with room temperature-stored platelets over 21 days. Transfusion 2021; 61 Suppl 1:S68-S79. [PMID: 34269433 DOI: 10.1111/trf.16530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/18/2020] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 01/04/2023]
Abstract
Although it is well established that transfusion of platelets in cases of severe bleeding reduces mortality, the availability of platelets is hampered by harsh restrictions on shelf life due to elevated risks of microbial contamination and functional losses with room temperature-stored platelets (RTP) kept at 22°C. In contrast, many recent studies have shown that 4°C cold-stored platelets (CSP) are able to overcome these shortcomings leading to the recent Food and Drug Administration licensure for 14-day stored CSP when conventional platelets are unavailable. This work expands the evidence supporting superiority of CSP function by assaying the less explored platelet-mediated clot retraction of RTP and CSP in either autologous plasma (AP) or platelet additive solution (PAS) for up to 21 days. The results demonstrate that CSP have better preservation of contractile function, exhibiting retraction for up to 21 days in both AP and PAS and forming highly ordered fibrin scaffolds similar to those of fresh platelets. In contrast, RTP stored in AP showed impaired contractile function by Day 5 with no retraction after 10 days, whereas PAS-stored RTP retained contractile function for up to 21 days. Collectively, these findings support extended storage of CSP and suggest that storage in PAS can mitigate functional losses in RTP.
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Affiliation(s)
- Prajeeda M Nair
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Michael A Meledeo
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Adrienne R Wells
- Severe Burns Research Department, Combat Wound Repair Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Xiaowu Wu
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - James A Bynum
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Kai P Leung
- Severe Burns Research Department, Combat Wound Repair Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Bin Liu
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Aswathi Cheeniyil
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Anand K Ramasubramanian
- Department of Biomedical Engineering, University of Texas at San Antonio, San Antonio, Texas, USA.,Department of Chemical and Materials Engineering, San Jose State University, San Jose, California, USA
| | - John W Weisel
- Department of Cell and Developmental Biology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Andrew P Cap
- Blood and Coagulation Research Department, Combat Mortality Prevention Division, United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
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20
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Meledeo MA, Peltier GC, McIntosh CS, Bynum JA, Corley JB, Cap AP. Coagulation function of never frozen liquid plasma stored for 40 days. Transfusion 2021; 61 Suppl 1:S111-S118. [PMID: 34269464 DOI: 10.1111/trf.16526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/26/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Never frozen liquid plasma (LP) has limited shelf life versus fresh frozen plasma (FFP) or plasma frozen within 24 h (PF24). Previous studies showed decreasing factor activities after Day (D)14 in thawed FFP but no differences between LP and FFP until D10. This study examined LP function through D40. STUDY DESIGN AND METHODS FFP and PF24 were stored at -20°C until assaying. LP was assayed on D5 then stored (4°C) for testing through D40. A clinical coagulation analyzer measured Factor (F)V, FVIII, fibrinogen, prothrombin time (PT), and activated partial thromboplastin time (aPTT). Thromboelastography (TEG) and thrombogram measured functional coagulation. Ristocetin cofactor assay quantified von Willebrand factor (vWF) activity. Residual platelets were counted. RESULTS FV/FVIII showed diminished activity over time in LP, while PT and aPTT both increased over time. LP vWF declined significantly by D7. Fibrinogen remained high through D40. Thrombin lagtime was delayed in LP but consistent to D40, while peak thrombin was significantly lower in LP but did not significantly decline over time. TEG R-time and angle remained constant. LP and PF24 (with residual platelets) had initially higher TEG maximum amplitudes (MA), but by D14 LP was similar to FFP. CONCLUSION Despite significant declines in some factors in D40 LP, fibrinogen concentration and TEG MA were stable suggesting stored LP provides fibrinogen similarly to frozen plasmas even at D40. LP is easier to store and prepare for prehospital transfusion, important benefits when the alternative is crystalloid.
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Affiliation(s)
| | - Grantham C Peltier
- U.S. Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas, USA
| | - Colby S McIntosh
- U.S. Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas, USA
| | - James A Bynum
- U.S. Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas, USA
| | - Jason B Corley
- Armed Services Blood Program, JBSA-Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- U.S. Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas, USA
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21
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Chance TC, Wu X, Keesee JD, Garcia-Marcano J, Salgado CL, Liu B, Moseley JJ, Peck KA, R-Borlado L, Atai NA, Gould SJ, Marban LS, Cap AP, Rathbone CR, Bynum JA. Extracellular vesicles derived from cardiosphere-derived cells as a potential antishock therapeutic. J Trauma Acute Care Surg 2021; 91:S81-S88. [PMID: 34108422 DOI: 10.1097/ta.0000000000003218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/09/2023]
Abstract
BACKGROUND Extracellular vesicles (EVs) isolated from cardiosphere-derived cells (CDC-EVs) are coming to light as a unique cell-free therapeutic. Because of their novelty, however, there still exist prominent gaps in knowledge regarding their therapeutic potential. Herein the therapeutic potential of CDC-EVs in a rat model of acute traumatic coagulopathy induced by multiple injuries and hemorrhagic shock is outlined. METHODS Extracellular vesicle surface expression of procoagulant molecules (tissue factor and phosphatidylserine) was evaluated by flow cytometry. Extracellular vesicle thrombogenicity was tested using calibrated thrombogram, and clotting parameters were assessed using a flow-based adhesion model simulating blood flow over a collagen-expressing surface. The therapeutic efficacy of EVs was then determined in a rat model of acute traumatic coagulopathy induced by multiple injuries and hemorrhagic shock. RESULTS Extracellular vesicles isolated from cardiosphere-derived cells are not functionally procoagulant and do not interfere with platelet function. In a rat model of multiple injuries and hemorrhagic shock, early administration of EVs significantly reduced the elevation of lactate and creatinine and did not significantly enhance coagulopathy in rats with acute traumatic coagulopathy. CONCLUSION The results of this study are of great relevance to the development of EV products for use in combat casualty care, as our studies show that CDC-EVs have the potential to be an antishock therapeutic if administered early. These results demonstrate that research using CDC-EVs in trauma care needs to be considered and expanded beyond their reported cardioprotective benefits.
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Affiliation(s)
- Tiffani C Chance
- From the Coagulation and Blood Research (Blood) (T.C.C., X.W., J.D.K., J.G.-M., C.L.S., B.L., A.P.C., J.A.B.), United States Army Institute of Surgical Research, San Antonio, Texas; Capricor Therapeutics Institute (J.J.M., K.A.P., L.R.-B., N.A.A., L.S.M.), Beverly Hills, California; Department of Biological Chemistry (S.J.G.), Johns Hopkins, Baltimore, Maryland; and Department of Biomedical Engineering (C.R.R.), The University of Texas at San Antonio, San Antonio, Texas
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22
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Reddoch-Cardenas KM, Cheppudira BP, Garza T, Hopkins CD, Bunker KD, Slee DH, Cap AP, Bynum JA, Christy RJ. Evaluation of KP-1199: a novel acetaminophen analog for hemostatic function and antinociceptive effects. Transfusion 2021; 61 Suppl 1:S234-S242. [PMID: 34269435 DOI: 10.1111/trf.16497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/31/2020] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acetaminophen (APAP) is a widely self-prescribed analgesic for mild to moderate pain, but overdose or repeat doses can lead to liver injury and death. Kalyra Pharmaceuticals has developed a novel APAP analog, KP-1199, currently in Phase 1 clinical studies, which lacks hepatotoxicity. In this study, the authors evaluated the antinociceptive effect of KP-1199 on thermal injury-induced nociceptive behaviors as well as hemostatic parameters using human blood samples. METHODS Full-thickness thermal injury was induced in anesthetized adult male Sprague-Dawley rats. On day 7 post-injury, KP-1199 (30 and 60 mg/kg) or APAP (60 mg/kg) was administered orally. Antinociception of KP-1199 and APAP were assessed at multiple time points using Hargreaves' test. In separate experiments, human whole blood was collected and treated with either KP-1199, APAP, or Vehicle (citrate buffer) at 1× (214 μg/ml) and 10× (2140 μg/ml) concentrations. The treated blood samples were assessed for: clotting function, thrombin generation, and platelet activation. RESULTS APAP did not produce antinociceptive activity. KP-1199 treatment significantly increased the nociceptive threshold, and the antinociceptive activity persisted up to 3 h post-treatment. In human samples, 10× APAP caused significantly prolonged clotting times and increased platelet activation, whereas KP-1199 had caused no negative effects on either parameter tested. CONCLUSION These results suggest that KP-1199 possesses antinociceptive activity in a rat model of thermal injury. Since KP-1199 does not induce platelet activation or inhibit coagulation, it presents an attractive alternative to APAP for analgesia, especially for battlefield or surgical scenarios where blood loss and blood clotting are of concern.
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Affiliation(s)
| | - Bopaiah P Cheppudira
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Thomas Garza
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Chad D Hopkins
- Kalyra Pharmaceuticals, Inc., San Diego, California, USA
| | - Kevin D Bunker
- Kalyra Pharmaceuticals, Inc., San Diego, California, USA
| | | | - Andrew P Cap
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - James A Bynum
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Robert J Christy
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, Texas, USA
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23
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Heard TC, Gómez BI, Saathoff ME, Duarte J, Dubick MA, Bynum JA, Christy RJ, Burmeister DM. Minimal Effects of Intravenous Administration of Xenogeneic Adipose Derived Stem Cells on Organ Function in a Porcine 40%TBSA Burn Model. J Burn Care Res 2021; 42:870-879. [PMID: 34057993 DOI: 10.1093/jbcr/irab094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adipose stem cells (ASCs) have shown therapeutic promise for various conditions, including burn injury. While ASCs have immunomodulatory properties, concerns exist over pro-coagulant activity after intravenous (IV) administration. In the present study, we examined IV human ASC delivery in terms of coagulation, organ function, and inflammation in a 40% total body surface area (TBSA) swine burn model. Anesthetized female Yorkshire swine were burned and randomized to receive 15ml/kg Lactated Ringer's containing: no ASCs; a low dose (5x10 5 ASCs/kg), or a high dose (5x10 6 ASCs/kg). For biochemical analysis, blood was collected at baseline (BL), 3, 6, 12, and 24 hours post-burn, while kidney and liver tissue was collected post-euthanasia. A significant, but transient, effect of ASCs was seen on prothrombin times and INR, wherein low doses revealed slight hypercoagulation. Burns increased partial thromboplastin time, fibrinogen, and d-dimer levels, which was unchanged with ASC administration. ASCs tended to exacerbate increases in bilirubin at 3 hours, but this didn't reach statistical significance. A significant effect of ASCs on creatinine and BUN was seen, wherein low doses elevated levels at 24 hours (creatinine, p=0.0012; BUN, p=0.0195). Hepatic and renal TUNEL staining were similar for all groups. A dose-dependent decrease in IL-8 was observed, while low doses significantly increased IL-1RA at 3 (p=0.050), IL-12 at 12 (p=0.021) and IL-6 at 24 hours post-burn (p=0.035). IV administration of xenogeneic ASCs slightly increased coagulation, but effects on burn-induced renal and hepatic dysfunction effects were minimal. Despite some significant immunomodulation, organ dysfunction effects were modest. Collectively, this study provides evidence to be skeptical about xenogeneic ASC administration in regards to burn.
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Affiliation(s)
- Tiffany C Heard
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - Belinda I Gómez
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - Micaela E Saathoff
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - Jamila Duarte
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - Michael A Dubick
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - James A Bynum
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - Robert J Christy
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America
| | - David M Burmeister
- Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America
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24
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Edwards TH, Pusateri AE, Mays EL, Bynum JA, Cap AP. Lessons Learned From the Battlefield and Applicability to Veterinary Medicine - Part 2: Transfusion Advances. Front Vet Sci 2021; 8:571370. [PMID: 34026881 PMCID: PMC8138582 DOI: 10.3389/fvets.2021.571370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Since the inception of recent conflicts in Afghanistan and Iraq, transfusion practices in human military medicine have advanced considerably. Today, US military physicians recognize the need to replace the functionality of lost blood in traumatic hemorrhagic shock and whole blood is now the trauma resuscitation product of choice on the battlefield. Building on wartime experiences, military medicine is now one of the country's strongest advocates for the principle of hemostatic resuscitation using whole blood or balanced blood components as the primary means of resuscitation as early as possibly following severe trauma. Based on strong evidence to support this practice in human combat casualties and in civilian trauma care, military veterinarians strive to practice similar hemostatic resuscitation for injured Military Working Dogs. To this end, canine whole blood has become increasingly available in forward environments, and non-traditional storage options for canine blood and blood components are being explored for use in canine trauma. Blood products with improved shelf-life and ease of use are not only useful for military applications, but may also enable civilian general and specialty practices to more easily incorporate hemostatic resuscitation approaches to canine trauma care.
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Affiliation(s)
- Thomas H Edwards
- U.S. Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
| | - Anthony E Pusateri
- U.S. Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
| | - Erin Long Mays
- Veterinary Specialty Services, Manchester, MO, United States
| | - James A Bynum
- U.S. Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
| | - Andrew P Cap
- U.S. Army Institute of Surgical Research, Joint Base San Antonio, San Antonio, TX, United States
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25
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Nowadly CD, Fisher AD, Borgman MA, Mdaki KS, Hill RL, Nicholson SE, Bynum JA, Schauer SG. The Use of Whole Blood Transfusion During Non-Traumatic Resuscitation. Mil Med 2021; 187:e821-e825. [PMID: 33856481 DOI: 10.1093/milmed/usab128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence from military populations showed that resuscitation using whole blood (WB), as opposed to component therapies, may provide additional survival benefits to traumatically injured patients. However, there is a paucity of data available for the use of WB in uninjured patients requiring transfusion. We sought to describe the use of WB in non-trauma patients at Brooke Army Medical Center (BAMC). MATERIALS AND METHODS Between January and December 2019, the BAMC ClinComp electronic medical record system was reviewed for all patients admitted to the hospital who received at least one unit of WB during this time period. Patients were sorted based on their primary admission diagnosis. Patients with a primary trauma-based admission were excluded. RESULTS One hundred patients were identified who received at least one unit of WB with a primary non-trauma admission diagnosis. Patients, on average, received 1,064 mL (750-2,458 mL) of WB but received higher volumes of component therapy. Obstetric/gynecologic (OBGYN) indications represented the largest percentage of non-trauma patients who received WB (23%), followed by hematologic/oncologic indications (16%). CONCLUSION In this retrospective study, WB was most commonly used for OBGYN-associated bleeding. As WB becomes more widespread across the USA for use in traumatically injured patients, it is likely that WB will be more commonly used for non-trauma patients. More outcome data are required to safely expand the indications for WB use beyond trauma.
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Affiliation(s)
- Craig D Nowadly
- Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
| | - Andrew D Fisher
- Medical Command, Texas Army National Guard, Austin, TX 78703, USA.,Department of Surgery, UNM School of Medicine, Albuquerque, NM 87131, USA
| | - Matthew A Borgman
- Department of pediatric, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA.,Uniformed Services Univeristy of the Health Sciences, Bethesda, Maryland 20814, USA
| | - Kennedy S Mdaki
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
| | - Ronnie L Hill
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
| | - Susannah E Nicholson
- Department of Surgery, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - James A Bynum
- United States Army Institute of Surgical Research, JBSA Fort Sam Houston, San Antonio, TX 78234, USA
| | - Steven G Schauer
- Department of Emergency Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX 78234, USA.,Uniformed Services Univeristy of the Health Sciences, Bethesda, Maryland 20814, USA
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26
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Herzig MC, Christy BA, Montgomery RK, Delavan CP, Jensen KJ, Lovelace SE, Cantu C, Salgado CL, Cap AP, Bynum JA. Interactions of human mesenchymal stromal cells with peripheral blood mononuclear cells in a Mitogenic proliferation assay. J Immunol Methods 2021; 492:113000. [PMID: 33609532 DOI: 10.1016/j.jim.2021.113000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/05/2020] [Accepted: 02/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Immunomodulation by mesenchymal stromal cells (MSCs) is a potentially important therapeutic modality. MSCs suppress peripheral blood mononuclear cell (PBMC) proliferation in vitro, suggesting a mechanism for suppressing inflammatory responses in vivo. This study details the interactions of PBMCs and MSCs. METHODS Pooled human PBMCs and MSCs were co-cultured at different MSC:PBMC ratios and harvested from 0 to 120 h, with and without phytohaemagglutin A (PHA) stimulation. Proliferation of adherent MSCs and non-adherent PBMCs was assessed by quantitation of ATP levels. PBMC surface marker expression was analyzed by flow cytometry. Indoleamine 2,3-dioxygenase (IDO) activity was determined by kynurenine assay and IDO mRNA by RT-PCR. Cytokine release was measured by ELISA. Immunofluorescent microscopy detected MSC, PBMC, monocyte (CD14+) and apoptotic events. RESULTS PBMC proliferation in response to PHA gave a robust ATP signal by 72 h, which was suppressed by co-culture with densely plated MSCs. Very low level MSC seeding densities relative to PBMC number reproducibly stimulated PBMC proliferation. The CD4+/CD3+ population significantly decreased over time while the CD8+/CD3+ population significantly increased. No change in CD4+/CD8+ ratio is seen with high density MSC co-culture; very low density MSCs augment the changes seen in PHA stimulated PBMCs alone. IDO activity in MSCs co-cultured with PBMCs correlated with PBMC suppression. MSCs increased the secretion of IL-10 and IL-6 from stimulated co-cultures and decreased TNF-α secretion. In stimulated co-culture, low density MSCs decreased in number; fluorescence immunomicroscopy detected association of PBMC with MSC and phosphatidyl serine externalization in both cell populations. CONCLUSIONS A bidirectional interaction between MSCs and PBMCs occurs during co-culture. High numbers of MSCs inhibit PHA-stimulated PBMC proliferation and the PBMC response to stimulation; low numbers of MSCs augment these responses. Low density MSCs are susceptible to attrition, apparently by PBMC-induced apoptosis. These results may have direct application when considering therapeutic dosing of patients; low MSC doses may have unintended detrimental consequences.
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Affiliation(s)
- Maryanne C Herzig
- Blood and Coagulation Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America.
| | - Barbara A Christy
- Blood and Coagulation Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America; Department of Molecular Medicine, UT Health San Antonio, San Antonio, TX, United States of America.
| | - Robbie K Montgomery
- Blood and Coagulation Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America.
| | - Christopher P Delavan
- Blood and Coagulation Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America.
| | - Katherine J Jensen
- Blood and Coagulation Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America.
| | - Sarah E Lovelace
- Blood and Coagulation Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America.
| | - Carolina Cantu
- Blood and Coagulation Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America.
| | - Christi L Salgado
- Blood and Coagulation Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America.
| | - Andrew P Cap
- Blood and Coagulation Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America; Department of Surgery, UT Health San Antonio, San Antonio, TX, United States of America.
| | - James A Bynum
- Blood and Coagulation Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX, United States of America.
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27
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O'Rourke B, Nguyen S, Tilles AW, Bynum JA, Cap AP, Parekkadan B, Barcia RN. Mesenchymal stromal cell delivery via an ex vivo bioreactor preclinical test system attenuates clot formation for intravascular application. Stem Cells Transl Med 2021; 10:883-894. [PMID: 33527780 PMCID: PMC8133341 DOI: 10.1002/sctm.20-0454] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/08/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
While mesenchymal stromal cells are an appealing therapeutic option for a range of clinical applications, their potential to induce clotting when used systemically remains a safety concern, particularly in hypercoagulable conditions, such as in patients with severe COVID‐19, trauma, or cancers. Here, we tested a novel preclinical approach aimed at improving the safety of mesenchymal stromal cell (MSC) systemic administration by use of a bioreactor. In this system, MSCs are seeded on the exterior of a hollow‐fiber filter, sequestering them behind a hemocompatible semipermeable membrane with defined pore‐size and permeability to allow for a molecularly defined cross talk between the therapeutic cells and the whole blood environment, including blood cells and signaling molecules. The potential for these bioreactor MSCs to induce clots in coagulable plasma was compared against directly injected “free” MSCs, a model of systemic administration. Our results showed that restricting MSCs exposure to plasma via a bioreactor extends the time necessary for clot formation to occur when compared with “free” MSCs. Measurement of cell surface data indicates the presence of known clot inducing factors, namely tissue factor and phosphatidylserine. Results also showed that recovering cells and flushing the bioreactor prior to use further prolonged clot formation time. Furthermore, application of this technology in two in vivo models did not require additional heparin in fully anticoagulated experimental animals to maintain target activated clotting time levels relative to heparin anticoagulated controls. Taken together the clinical use of bioreactor housed MSCs could offer a novel method to control systemic MSC exposure and prolong clot formation time.
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Affiliation(s)
- Brian O'Rourke
- Sentien Biotechnologies, Inc, Lexington, Massachusetts, USA
| | - Sunny Nguyen
- Sentien Biotechnologies, Inc, Lexington, Massachusetts, USA
| | - Arno W Tilles
- Sentien Biotechnologies, Inc, Lexington, Massachusetts, USA
| | - James A Bynum
- Blood and Coagulation Research Program, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- Blood and Coagulation Research Program, US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Biju Parekkadan
- Sentien Biotechnologies, Inc, Lexington, Massachusetts, USA.,Department of Surgery, Center for Surgery, Innovation, and Bioengineering, Massachusetts General Hospital, Harvard Medical School and Shriners Hospitals for Children, Boston, Massachusetts, USA.,Harvard Stem Cell Institute, Cambridge, Massachusetts, USA.,Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA
| | - Rita N Barcia
- Sentien Biotechnologies, Inc, Lexington, Massachusetts, USA
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28
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Schauer SG, Naylor JF, Fisher AD, Hyams DG, Carius BM, Escandon MA, Linscomb CD, McDonald H, Cap AP, Bynum JA. Blood Product Administration During Transport Throughout the US Africa Command Theater of Operation. J Spec Oper Med 2021; 21:66-70. [PMID: 34529808 DOI: 10.55460/4si5-9irh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND United States Africa Command (US AFRICOM) is one of six US Defense Department's geographic combatant commands and is responsible to the Secretary of Defense for military relations with African nations, the African Union, and African regional security organizations. A full-spectrum combatant command, US AFRICOM is responsible for all US Department of Defense operations, exercises, and security cooperation on the African continent, its island nations, and surrounding waters. We seek to characterize blood product administration within AFRICOM using the in-transit visibility tracking tool known as TRAC2ES (TRANSCOM Regulating and Command & Control Evacuation System). METHODS We performed a retrospective review of TRAC2ES medical evacuations from the AFRICOM theater of operations conducted between 1 January 2008 and 31 December 2018. RESULTS During this time, there were 963 cases recorded in TRAC2ES originating within AFRICOM, of which 10 (1%) cases received blood products. All patients were males. One was a Department of State employee, one was a military working dog, and the remainder were military personnel. Of the ten humans, seven were the result of trauma, most by way of gunshot wound, and three were due to medical causes. Among human subjects receiving blood products for traumatic injuries, a total of 5 units of type O negative whole blood, 29 units of packed red blood cells (pRBCs), and 9 units of fresh frozen plasma (FFP) were transfused. No subjects underwent massive transfusion of blood products, and only one subject received pRBCs and FFP in 1:1 fashion. All subjects survived until evacuation. CONCLUSIONS Within the TRAC2ES database, blood product administration within AFRICOM was infrequent, with some cases highlighting lack of access to adequate blood products. Furthermore, the limitations within this database highlight the need for systems designed to capture medical care performance improvement, as this database is not designed to support such analyses. A mandate for performance improvement within AFRICOM that is similar to that of the US Central Command would be beneficial if major improvements are to occur.
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29
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Reddoch-Cardenas KM, Peltier GC, Chance TC, Nair PM, Meledeo MA, Ramasubramanian AK, Cap AP, Bynum JA. Cold storage of platelets in platelet additive solution maintains mitochondrial integrity by limiting initiation of apoptosis-mediated pathways. Transfusion 2020; 61:178-190. [PMID: 33294977 DOI: 10.1111/trf.16185] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 12/06/2019] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cold storage of platelets in plasma maintains hemostatic function and is an attractive alternative to room temperature platelets (RTPs). We have recently shown that functional differences between cold-stored platelets (CSPs) and RTPs after 5-day storage are associated with mitochondrial respiration and that CSPs in platelet (PLT) additive solution (PAS) can maintain hemostatic function for at least 15 days. STUDY DESIGN AND METHODS This study tested the hypothesis that cold storage in PAS preserves mitochondrial integrity by reducing PLT apoptosis. CSPs and RTPs in plasma or PAS were stored and assayed for up to 15 days for mitochondrial function and integrity, mitochondrial-associated mRNA transcript expression, apoptotic proteins, and apoptotic flow cytometry metrics. RESULTS CSP preserved mitochondria-associated mRNA comparable to baseline levels, improved mitochondrial respiration, and minimized depolarization to Day 15. Additionally, CSPs had minimal induction of caspases, preservation of plasma membrane integrity, and low expression of pro-apoptotic Bax. Storage in PAS appeared to be protective for RTPs in some parameters and enhanced the effects of CSPs. CONCLUSION Mitochondrial function and molecular analyses defined CSP priming as distinctly different from the well-documented RTP storage lesion. While current blood bank storage at room temperature is limited to 5 to 7 days, refrigeration and storage in PAS for up to 15 days may represent an opportunity to enhance inventories and access to PLT hemostatic support for bleeding patients.
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Affiliation(s)
| | - Grant C Peltier
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, Texas, USA
| | | | - Prajeeda M Nair
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, Texas, USA
| | - Michael A Meledeo
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, Texas, USA
| | | | - Andrew P Cap
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, Texas, USA
| | - James A Bynum
- US Army Institute of Surgical Research, JBSA-Fort Sam Houston, Sam Houston, Texas, USA
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30
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Zaar M, Herzig MC, Fedyk CG, Montgomery RK, Prat N, Parida BK, Hinojosa-Laborde C, Muniz GW, Shade RE, Bauer C, Delacruz W, Bynum JA, Convertino VA, Cap AP, Pidcoke HF. Similar hemostatic responses to hypovolemia induced by hemorrhage and lower body negative pressure reveal a hyperfibrinolytic subset of non-human primates. PLoS One 2020; 15:e0234844. [PMID: 32579572 PMCID: PMC7314422 DOI: 10.1371/journal.pone.0234844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/30/2019] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To study central hypovolemia in humans, lower body negative pressure (LBNP) is a recognized alternative to blood removal (HEM). While LBNP mimics the cardiovascular responses of HEM in baboons, similarities in hemostatic responses to LBNP and HEM remain unknown in this species. METHODS Thirteen anesthetized baboons were exposed to progressive hypovolemia by HEM and, four weeks later, by LBNP. Hemostatic activity was evaluated by plasma markers, thromboelastography (TEG), flow cytometry, and platelet aggregometry at baseline (BL), during and after hypovolemia. RESULTS BL values were indistinguishable for most parameters although platelet count, maximal clot strength (MA), protein C, thrombin anti-thrombin complex (TAT), thrombin activatable fibrinolysis inhibitor (TAFI) activity significantly differed between HEM and LBNP. Central hypovolemia induced by either method activated coagulation; TEG R-time decreased and MA increased during and after hypovolemia compared to BL. Platelets displayed activation by flow cytometry; platelet count and functional aggregometry were unchanged. TAFI activity and protein, Factors V and VIII, vWF, Proteins C and S all demonstrated hemodilution during HEM and hemoconcentration during LBNP, whereas tissue plasminogen activator (tPA), plasmin/anti-plasmin complex, and plasminogen activator inhibitor-1 did not. Fibrinolysis (TEG LY30) was unchanged by either method; however, at BL, fibrinolysis varied greatly. Post-hoc analysis separated baboons into low-lysis (LY30 <2%) or high-lysis (LY30 >2%) whose fibrinolytic state matched at both HEM and LBNP BL. In high-lysis, BL tPA and LY30 correlated strongly (r = 0.95; P<0.001), but this was absent in low-lysis. In low-lysis, BL TAFI activity and tPA correlated (r = 0.88; P<0.050), but this was absent in high-lysis. CONCLUSIONS Central hypovolemia induced by either LBNP or HEM resulted in activation of coagulation; thus, LBNP is an adjunct to study hemorrhage-induced pro-coagulation in baboons. Furthermore, this study revealed a subset of baboons with baseline hyperfibrinolysis, which was strongly coupled to tPA and uncoupled from TAFI activity.
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Affiliation(s)
- Morten Zaar
- Center for Human Integrative Physiology, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Maryanne C. Herzig
- Coagulation and Blood Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
- * E-mail:
| | - Chriselda G. Fedyk
- Coagulation and Blood Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Robbie K. Montgomery
- Coagulation and Blood Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Nicolas Prat
- Coagulation and Blood Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge, France
| | - Bijaya K. Parida
- Coagulation and Blood Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Carmen Hinojosa-Laborde
- Center for Human Integrative Physiology, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Gary W. Muniz
- Center for Human Integrative Physiology, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Robert E. Shade
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Cassondra Bauer
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, Texas, United States of America
| | - Wilfred Delacruz
- Center for Human Integrative Physiology, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - James A. Bynum
- Coagulation and Blood Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Victor A. Convertino
- Center for Human Integrative Physiology, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Andrew P. Cap
- Coagulation and Blood Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
| | - Heather F. Pidcoke
- Coagulation and Blood Research, United States Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America
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31
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Herzig MC, Fedyk CG, Montgomery RK, Schaffer BS, Bynum JA, Pidcoke HF, Cap AP. Blood component separation of pathogen-reduced whole blood by the PRP method produces acceptable red cells but platelet yields and function are diminished. Transfusion 2020; 60 Suppl 3:S124-S133. [PMID: 32478864 DOI: 10.1111/trf.15766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study evaluated blood components processed by the platelet rich plasma (PRP) method from fresh whole blood (FWB) treated with a pathogen reduction technology (PRT). The effects of storage temperature on PRT treated platelet concentrates (PCs) were also examined. STUDY DESIGN AND METHODS PRT was performed using riboflavin and ultraviolet light on FWB in citrate phosphate dextrose anticoagulant. Following PRT, red blood cells (RBCs), PCs, and plasma for fresh frozen plasma (FFP), were isolated by sequential centrifugation. RBCs were stored at 4°C, FFP at -80°C, and PC at 22°C or at 4°C. Components were assayed throughout their storage times for blood gases, chemistry and CBC, hemostatic function as well as platelet (PLT) and RBC integrity. RESULTS Component processing following PRT resulted in a significant drop in platelet recovery. Most PRT-PC bags fell below AABB guidelines for platelet count. PRT-PC also showed a decrease in clot strength and decreased aggregometry response. Platelet caspases were activated by PRT. Storage at 4°C improved platelet function. In PRT-FFP, prothrombin time and partial thromboplastin time (PT and aPTT) were prolonged; factors V, VII, VIII, and XI, protein C, and fibrinogen were significantly decreased. Free hemoglobin was elevated two-fold in PRT-RBC. CONCLUSION Blood components isolated by the PRP method from PRT-treated WB result in a high percentage of PC that fail to meet AABB guidelines. FFP also shows diminished coagulation capacity. However, PRT-RBC are comparable to control-RBC. PRT-WB retains acceptable hemostatic function but alternatives to the PRP method of component separation may be more suitable.
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Affiliation(s)
- Maryanne C Herzig
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Chriselda G Fedyk
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Robbie K Montgomery
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Beverly S Schaffer
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - James A Bynum
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA.,Institute of Biomedical Studies, Baylor University, Waco, Texas, USA.,Joint Interdisciplinary Biomedical Engineering Program, UT San Antonio & UT Health San Antonio, San Antonio, Texas, USA
| | - Heather F Pidcoke
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA.,Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
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32
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Meledeo MA, Peltier GC, McIntosh CS, Corley JB, Bynum JA, Cap AP. Field‐expedient thawing of fresh‐frozen plasma. Transfusion 2020; 60 Suppl 3:S87-S95. [DOI: 10.1111/trf.15652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Jason B. Corley
- US Army Institute of Surgical Research JBSA Fort Sam Houston Texas
| | - James A. Bynum
- US Army Institute of Surgical Research JBSA Fort Sam Houston Texas
| | - Andrew P. Cap
- US Army Institute of Surgical Research JBSA Fort Sam Houston Texas
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33
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Reddoch-Cardenas KM, Sharma U, Salgado CL, Cantu C, Darlington DN, Pidcoke HF, Bynum JA, Cap AP. Use of Specialized Pro-Resolving Mediators to Alleviate Cold Platelet Storage Lesion. Transfusion 2020; 60 Suppl 3:S112-S118. [PMID: 32478925 DOI: 10.1111/trf.15750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cold-stored platelets are an attractive option for treatment of actively bleeding patients due to a reduced risk of septic complications and preserved hemostatic function compared to conventional room temperature-stored platelets. However, refrigeration causes increased platelet activation and aggregate formation. Specialized pro-resolving mediators (SPMs), cell signaling mediators biosynthesized from essential fatty acids, have been shown to modulate platelet function and activation. In this study, we sought to determine if SPMs could be used to inhibit cold-stored platelet activation. METHODS Platelets were collected from healthy donors (n = 4-7) and treated with SPMs (resolvin E1 [RvE1], maresin 1 [MaR1], and resolvin D2 [RvD2]) or vehicle (VEH; 0.1% EtOH). Platelets were stored without agitation in the cold and assayed on Days 0 and 7 of storage for platelet activation levels using flow cytometry, platelet count, aggregation response using impedance aggregometry, and nucleotide content using mass spectrometry. RESULTS Compared to VEH, SPM treatment inhibited GPIb shedding (all compounds), significantly reduced both PS exposure and activation of GPIIb/IIIa receptor (RvD2, MaR1), and preserved aggregation response to TRAP (RvD2, MaR1) after 7 days of storage. Similar to untreated cold-stored platelets, SPM-treated samples did not preserve platelet counts or block the release of P-Selectin. Nucleotide content was unaffected by SPM treatment in cold-stored platelets. CONCLUSIONS SPM treatment, particularly Mar1 and RvD2, led to reduced platelet activation and preserved platelet function after 7 days of storage in the cold. Future work is warranted to better elucidate the mechanism of action of SPMs on cold platelet function and activation.
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Affiliation(s)
- Kristin M Reddoch-Cardenas
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Umang Sharma
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Christi L Salgado
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Carolina Cantu
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Daniel N Darlington
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Heather F Pidcoke
- Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA
| | - James A Bynum
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - Andrew P Cap
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
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34
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Meledeo MA, Peltier GC, McIntosh CS, Bynum JA, Cap AP. Optimizing whole blood storage: hemostatic function of 35-day stored product in CPD, CP2D, and CPDA-1 anticoagulants. Transfusion 2019; 59:1549-1559. [PMID: 30980756 DOI: 10.1111/trf.15164] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Transitioning from whole blood (WB) to components developed from efforts to maximize donor yield. Components are advantageous for specific derangements, but treating hemorrhage with components requires significantly more volume to provide similar effects to WB. Because storage lesion and waste remain problematic, this study examined hemostatic function of refrigerated WB stored for 35 days in anticoagulants citrate-phosphate-dextrose-adenosine (CPDA-1), citrate-phosphate-dextrose (CPD), or citrate-phosphate-double dextrose (CP2D). METHODS Refrigerated WB units from healthy donors were sampled over 35 days. Global hemostatic parameters were measured by thromboelastometry, thrombogram, platelet aggregometry, and platelet adhesion to collagen under shear conditions. The effects of transfusion filtration and mixing 35-day stored product with fresh WB were evaluated. RESULTS Countable platelets declined as aggregation clusters appeared in microscopy. While gross platelet agonist-induced aggregation declined over time, normalization revealed aggregation responses in remaining platelets. Peak thrombin generation increased over time. Clot strength diminished over storage in tissue factor-activated samples (normalized by filtration of aggregates). Functional fibrinogen responses remained consistent throughout. Filtration was necessary to maintain consistent platelet adhesion to collagen beyond collection day. Few differences were observed between anticoagulants, and stored/fresh mixing studies normalized coagulation parameters. CONCLUSIONS WB is easier to collect, store, and transfuse. WB provides platelets, an oft-neglected, critical resuscitation component, but their individual numbers decline as aggregates appear, resulting in diminished coagulation response. WB has better performance in these assays when examined at earlier time points, but expirations designated to specific anticoagulants appear arbitrary for hemostatic functionality, as little changes beyond 21 days regardless of anticoagulant.
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Affiliation(s)
| | - Grantham C Peltier
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas
| | - Colby S McIntosh
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas
| | - James A Bynum
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas
| | - Andrew P Cap
- United States Army Institute of Surgical Research, JBSA-Fort Sam Houston, Texas
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35
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Bynum JA, Meledeo MA, Peltier GC, McIntosh CS, Taylor AS, Montgomery RK, Reddoch-Cardenas KM, Getz TM, Fitzpatrick MG, Cap AP. Evaluation of a lyophilized platelet-derived hemostatic product. Transfusion 2019; 59:1490-1498. [PMID: 30980737 DOI: 10.1111/trf.15167] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Current limitations of platelet shelf life to 5 days have led to an increasingly greater demand for hemostatic agents with greater longevity. The objective of this study was to evaluate the function of a lyophilized platelet-derived hemostatic product (thrombosome [TS]) as a potential alternative to fresh platelets. METHODS Platelets were collected from whole blood from healthy donors. TSs were reconstituted with water and added to various configurations of reassembled whole blood (platelets, plasma, and RBCs); measures included rotational thromboelastometry (ROTEM), optical aggregometry, mitochondrial function, calibrated automated thrombogram, collagen adhesion under flow (shear flow assay), and flow cytometry. RESULTS In ROTEM, no differences were observed between maximum clot formation values for contact pathway activation thromboelastometry tests with TSs or platelet samples. Significantly decreased aggregation was observed in the TSs versus platelets (p < 0.001 for all agonists). Flow cytometry measures demonstrated significant decreases in glycoprotein Ib expression and increases in phosphatidylserine expression in the TS group (p < 0.01). The calibrated automated thrombogram assay was suggestive (lag time and peak thrombin) that the TSs might have some thrombogenic properties. Measurements of mitochondrial function revealed that TSs had no functional mitochondria. CONCLUSION In this study, TSs were shown to have nonfunctional mitochondria. ROTEM measures revealed that the TSs had no impact on clot strength. Likewise, compared to platelets, the TSs displayed minimal aggregation, had significantly more phosphatidylserine (measure of activation status), but had the ability to adhere to a collagen surface under flow conditions and contribute to clot formation and induced greater thrombin generation.
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Affiliation(s)
- James A Bynum
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Michael A Meledeo
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Grantham C Peltier
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Colby S McIntosh
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Ashley S Taylor
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Robbie K Montgomery
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Kristin M Reddoch-Cardenas
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
| | | | | | - Andrew P Cap
- Coagulation and Blood Research Program, U.S. Army Institute of Surgical Research, Fort Sam Houston, Texas
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36
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Christy BA, Herzig MC, Delavan C, Cantu C, Salgado C, Bynum JA, Cap AP. Human primary fibroblasts perform similarly to MSCs in assays used to evaluate MSC safety and potency. Transfusion 2019; 59:1593-1600. [PMID: 30980752 DOI: 10.1111/trf.15187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/18/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cellular therapeutic agents may benefit trauma patients by modulating the immune response to injury, and by reducing inflammation and vascular leakage. Administration of allogeneic mesenchymal stromal cells (MSCs) shows some benefit in preclinical and clinical trials, but less testing has been performed with other cell types. Human primary fibroblasts (FBs) were compared to MSCs in assays designed to evaluate MSCs to determine if these assays actually evaluate properties unique to MSCs or whether related cell types perform similarly. STUDY DESIGN AND METHODS MSC-related surface marker expression, tissue factor, and human leukocyte antigen-D related were evaluated by flow cytometry, and in vitro adipogenic and osteogenic differentiation potential were determined. Procoagulant activity was determined by thromboelastography. Two potency assays correlated with immunomodulation potential were utilized: the mixed lymphocyte reaction and indoleamine 2,3-dioxygenase enzyme activity assays. RESULTS Human primary FBs performed similarly to MSCs in assays designed to evaluate MSC characteristics and potency. Although similar for MSC-positive cell surface marker expression, FBs did not show robust adipose differentiation and expressed some level of markers not expected on MSCs. CONCLUSIONS Human primary FBs are very similar to human MSCs, at least in assays currently used to evaluate MSC potency. Preclinical and clinical testing are required to determine if FBs show similar activity to MSCs in vivo. If FBs show inferior activity in vivo, development of new MSC-specific potency assays will be necessary to evaluate properties relevant to their unique clinical benefits.
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Affiliation(s)
- Barbara A Christy
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas.,Department of Molecular Medicine, UT Health San Antonio, San Antonio, Texas
| | - Maryanne C Herzig
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Christopher Delavan
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Carolina Cantu
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - Christi Salgado
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas
| | - James A Bynum
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas.,Institute of Biomedical Studies, Baylor University, Waco, Texas.,Joint Interdisciplinary Biomedical Engineering Program, UT San Antonio & UT Health San Antonio, San Antonio, Texas
| | - Andrew P Cap
- Coagulation & Blood Research, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas.,Department of Surgery, UT Health San Antonio, San Antonio, Texas
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37
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Meledeo MA, Liu QP, Peltier GC, Carney RC, McIntosh CS, Taylor AS, Bynum JA, Pusateri AE, Cap AP. Spray‐dried plasma deficient in high‐molecular‐weight multimers of von Willebrand factor retains hemostatic properties. Transfusion 2018; 59:714-722. [DOI: 10.1111/trf.15038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Adam Meledeo
- JBSA‐Fort Sam HoustonUnited States Army Institute of Surgical Research San Antonio Texas
| | | | - Grantham C. Peltier
- JBSA‐Fort Sam HoustonUnited States Army Institute of Surgical Research San Antonio Texas
| | | | - Colby S. McIntosh
- JBSA‐Fort Sam HoustonUnited States Army Institute of Surgical Research San Antonio Texas
| | - Ashley S. Taylor
- JBSA‐Fort Sam HoustonUnited States Army Institute of Surgical Research San Antonio Texas
| | - James A. Bynum
- JBSA‐Fort Sam HoustonUnited States Army Institute of Surgical Research San Antonio Texas
| | - Anthony E. Pusateri
- JBSA‐Fort Sam HoustonUnited States Army Institute of Surgical Research San Antonio Texas
| | - Andrew P. Cap
- JBSA‐Fort Sam HoustonUnited States Army Institute of Surgical Research San Antonio Texas
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38
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Reddoch-Cardenas KM, Montgomery RK, Lafleur CB, Peltier GC, Bynum JA, Cap AP. Cold storage of platelets in platelet additive solution: an in vitro comparison of two Food and Drug Administration-approved collection and storage systems. Transfusion 2018; 58:1682-1688. [PMID: 29603238 DOI: 10.1111/trf.14603] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/08/2018] [Accepted: 02/11/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Refrigeration of platelets (PLTs) in a PLT additive solution (PAS) reduces PLT activation compared to storage in plasma and preserves function for at least 15 days. Currently only two PASs are licensed by the Food and Drug Administration, each for use with only one apheresis platform. In this study, we compared the metabolic, functional, and activation status of PLTs collected on a Trima apheresis collection system and stored refrigerated in Isoplate (ISO) PAS to PLTs collected on an Amicus collection system and stored refrigerated in Intersol (INT) PAS. STUDY DESIGN AND METHODS Apheresis PLTs (n = 4-7 donors) were collected on a Trima in ISO PAS or on an Amicus in INT PAS. PLTs were stored in a walk-in refrigerator (1-6°C) without agitation for long-term storage. Bags were assayed at Days 1, 5, 10, and 15 of storage. Measurements included PLT counts, pH, aggregation response, rotational thromboelastometry, and activation markers. RESULTS Cold-stored Trima-collected PLTs in ISO were slightly more hemostatic than Amicus-collected PLTs in INT and displayed better adhesion to collagen under flow conditions. Amicus-collected PLTs in INT showed increased microaggregate formation on Days 5 and 10 and a significant decrease in PLT count over storage. Trima-collected PLTs in ISO displayed better clot strength than Amicus-collected PLTs in INT. CONCLUSION Compared to cold-stored Amicus PLTs in INT, Trima PLTs in ISO display superior in vitro function and may be better suited for treatment of bleeding patients. Clinical studies are warranted to confirm these findings.
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Affiliation(s)
| | - Robbie K Montgomery
- Coagulation and Blood Research Program, US Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Crystal B Lafleur
- Kirksville College of Osteopathic Medicine, A.T. Still University, Kirksville, Missouri
| | - Grantham C Peltier
- Coagulation and Blood Research Program, US Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - James A Bynum
- Coagulation and Blood Research Program, US Army Institute of Surgical Research, Fort Sam Houston, Texas
| | - Andrew P Cap
- Coagulation and Blood Research Program, US Army Institute of Surgical Research, Fort Sam Houston, Texas
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39
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Leone R, Jensen KJ, Abijay C, Dolmetsch T, Koons N, Darlington DN, Cap AP, Wu X, Delavan CP, Herzig MC, Christy BA, Kempski KM, Blackburn AN, De Lorenzo RA, Blackburn MB, Donald MC, Klemcke HG, Harrington BK, He CJ, Gómez BI, Chao T, Little JS, Heard TC, Dubick MA, Burmeister DM, Xu A, III KW, Mohammadipoor A, Rodriguez L, Roberts T, Batchinsky A, Cancio L, Antebi B, Walford RA, McIntosh CS, Peltier GC, Sharma U, Montgomery RK, Meledeo MA, Bynum JA, Lovelace S, Estlack L, Jensen K, Kazen L, Mangum LC, Garcia GR, Akers KS. Proceedings of the 5th Annual United States Army Institute of Surgical Research Summer Undergraduate Research Internship Program 2017. J Transl Med 2017. [PMCID: PMC5773900 DOI: 10.1186/s12967-017-1316-3] [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: 11/10/2022] Open
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40
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Meledeo MA, Herzig MC, Bynum JA, Wu X, Ramasubramanian AK, Darlington DN, Reddoch KM, Cap AP. Acute traumatic coagulopathy. J Trauma Acute Care Surg 2017; 82:S33-S40. [DOI: 10.1097/ta.0000000000001431] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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41
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Bynum JA, Wang X, Stavchansky SA, Bowman PD. Time Course Expression Analysis of 1[2-cyano-3,12-dioxooleana-1,9(11)-dien-28-oyl]imidazole Induction of Cytoprotection in Human Endothelial Cells. Gene Regul Syst Bio 2017; 11:1177625017701106. [PMID: 28469413 PMCID: PMC5398299 DOI: 10.1177/1177625017701106] [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] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/04/2017] [Indexed: 12/12/2022]
Abstract
1[2-cyano-3,12-dioxooleana-1,9(11)-dien-28-oyl]imidazole (CDDO-Im), a synthetic derivative of oleanolic acid that exhibits antioxidant and anti-inflammatory activity in several animal and in vitro models, has been shown to be beneficial if given after injury. Although induction of heme oxygenase 1 appears to be a major effector of cytoprotection, the mechanism by which the overall effect is mediated is largely unknown. This study evaluated temporal gene expression profiles to better characterize the early transcriptional events and their relationship to the dynamics of the cytoprotective response in human umbilical vein endothelial cells (HUVEC) to CDDO-Im. Time-course gene expression profiling was performed on HUVEC treated with CDDO-Im for 0.5, 1, 3, 6, and 24 hours. More than 10 000 genes were statistically altered in their expression in at least 1 time point across the time course. Large alterations in immediate-early gene expression were readily detectable within 0.5 hour after administration of CDDO-Im.
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Affiliation(s)
- James A Bynum
- U.S. Army Institute of Surgical Research, San Antonio, TX, USA.,Division of Pharmaceutics, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - Xinyu Wang
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine-Georgia Campus, Suwanee, GA, USA
| | - Salomon A Stavchansky
- Division of Pharmaceutics, College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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42
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Clifford JL, Yang R, Bowman PD, Bynum JA, Wenke JC, Hammamieh R. Gene Expression Profile During the Repair Process in a Rat Calvarial Bone Critical Size Defect. FASEB J 2017. [DOI: 10.1096/fasebj.31.1_supplement.979.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John L Clifford
- Integrative Systems BiologyUS Army Center for Environmental Health ResearchFort DetrickMD
| | - Ruoting Yang
- Integrative Systems BiologyUS Army Center for Environmental Health ResearchFort DetrickMD
| | | | | | | | - Rasha Hammamieh
- Integrative Systems BiologyUS Army Center for Environmental Health ResearchFort DetrickMD
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43
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Bynum JA, Adam Meledeo M, Getz TM, Rodriguez AC, Aden JK, Cap AP, Pidcoke HF. Bioenergetic profiling of platelet mitochondria during storage: 4°C storage extends platelet mitochondrial function and viability. Transfusion 2016; 56 Suppl 1:S76-84. [DOI: 10.1111/trf.13337] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- James A. Bynum
- US Army Institute of Surgical Research; JBSA-Fort Sam Houston Texas
| | - M. Adam Meledeo
- US Army Institute of Surgical Research; JBSA-Fort Sam Houston Texas
| | - Todd M. Getz
- US Army Institute of Surgical Research; JBSA-Fort Sam Houston Texas
| | | | - James K. Aden
- US Army Institute of Surgical Research; JBSA-Fort Sam Houston Texas
| | - Andrew P. Cap
- US Army Institute of Surgical Research; JBSA-Fort Sam Houston Texas
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44
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Getz TM, Montgomery RK, Bynum JA, Aden JK, Pidcoke HF, Cap AP. Storage of platelets at 4°C in platelet additive solutions prevents aggregate formation and preserves platelet functional responses. Transfusion 2016; 56:1320-8. [DOI: 10.1111/trf.13511] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [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] [Revised: 12/02/2015] [Accepted: 12/28/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Todd M. Getz
- US Army Institute of Surgical Research; Fort Sam Houston, San Antonio Texas
| | | | - James A. Bynum
- US Army Institute of Surgical Research; Fort Sam Houston, San Antonio Texas
| | - James K. Aden
- US Army Institute of Surgical Research; Fort Sam Houston, San Antonio Texas
| | - Heather F. Pidcoke
- US Army Institute of Surgical Research; Fort Sam Houston, San Antonio Texas
| | - Andrew P. Cap
- US Army Institute of Surgical Research; Fort Sam Houston, San Antonio Texas
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Bynum JA, Rastogi A, Stavchansky SA, Bowman PD. Cytoprotection of human endothelial cells from oxidant stress with CDDO derivatives: network analysis of genes responsible for cytoprotection. Pharmacology 2015; 95:181-92. [PMID: 25926128 DOI: 10.1159/000381188] [Citation(s) in RCA: 2] [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] [Received: 11/03/2014] [Accepted: 02/24/2015] [Indexed: 11/19/2022]
Abstract
AIM To identify drugs that may reduce the impact of oxidant stress on cell viability. METHODS Human umbilical vein endothelial cells were treated with 200 nmol/l CDDO-Im (imidazole) and CDDO-Me (methyl) after exposure to menadione and compared to vehicle-treated cells. Cell viability and cytotoxicity were assessed, and gene expression profiling was performed. RESULTS CDDO-Im was significantly more cytoprotective and less cytotoxic (p < 0.001) than CDDO-Me. Although both provided cytoprotection by induction of gene transcription, CDDO-Im induced more genes. In addition to a higher induction of the key cytoprotective gene heme oxygenase-1 (38.9-fold increase for CDDO-Im and 26.5-fold increase for CDDO-Me), CDDO-Im also induced greater expression of heat shock proteins (5.5-fold increase compared to 2.8-fold for CDDO-Me). CONCLUSIONS Both compounds showed good induction of heme oxygenase, which largely accounted for their cytoprotective effect. Differences were detected in cytotoxicity at higher doses, indicating that CDDO-Me was more cytotoxic than CDDO-Im. Significant differences were detected in the ability of CDDO-Im and CDDO-Me to affect differential gene transcription. CDDO-Im induced more genes than did CDDO-Me. The source of the differences in gene expression patterns between CDDO-Im and CDDO-Me was not determined but may be important in long-term use of this class of drugs.
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Affiliation(s)
- James A Bynum
- US Army Institute of Surgical Research, Fort Sam Houston, San Antonio, Tex., USA
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Wang X, Bynum JA, Stavchansky S, Bowman PD. Cytoprotection of human endothelial cells against oxidative stress by 1-[2-cyano-3,12-dioxooleana-1,9(11)-dien-28-oyl]imidazole (CDDO-Im): application of systems biology to understand the mechanism of action. Eur J Pharmacol 2014; 734:122-31. [PMID: 24703885 DOI: 10.1016/j.ejphar.2014.03.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 12/13/2013] [Revised: 03/18/2014] [Accepted: 03/24/2014] [Indexed: 12/15/2022]
Abstract
Cellular damage from oxidative stress, in particular following ischemic injury, occurs during heart attack, stroke, or traumatic injury, and is potentially reducible with appropriate drug treatment. We previously reported that caffeic acid phenethyl ester (CAPE), a plant-derived polyphenolic compound, protected human umbilical vein endothelial cells (HUVEC) from menadione-induced oxidative stress and that this cytoprotective effect was correlated with the capacity to induce heme oxygenase-1 (HMOX1) and its protein product, a phase II cytoprotective enzyme. To further improve this cytoprotective effect, we studied a synthetic triterpenoid, 1-[2-cyano-3,12-dioxooleana-1,9(11)-dien-28-oyl]imidazole (CDDO-Im), which is known as a potent phase II enzyme inducer with antitumor and anti-inflammatory activities, and compared it to CAPE. CDDO-Im at 200nM provided more protection to HUVEC against oxidative stress than 20μM CAPE. We explored the mechanism of CDDO-Im cytoprotection with gene expression profiling and pathway analysis and compared to that of CAPE. In addition to potent up-regulation of HMOX1, heat shock proteins (HSP) were also found to be highly induced by CDDO-Im in HUVEC. Pathway analysis results showed that transcription factor Nrf2-mediated oxidative stress response was among the top canonical pathways commonly activated by both CDDO-Im and CAPE. Compared to CAPE, CDDO-Im up-regulated more HSP and some of them to a much higher extent. In addition, CDDO-Im treatment affected Nrf2 pathway more significantly. These findings may provide an explanation why CDDO-Im is a more potent cytoprotectant than CAPE against oxidative stress in HUVEC.
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Affiliation(s)
- Xinyu Wang
- Department of Pharmaceutical Sciences, School of Pharmacy, Philadelphia College of Osteopathic Medicine-Georgia Campus, 625 Old Peachtree Road NW, Suwanee, GA 30024-2937, USA.
| | - James A Bynum
- US Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA; Division of Pharmaceutics, College of Pharmacy, University of Texas at Austin, TX 77812, USA
| | - Solomon Stavchansky
- Division of Pharmaceutics, College of Pharmacy, University of Texas at Austin, TX 77812, USA
| | - Phillip D Bowman
- US Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA.
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Bowman P, Bynum JA, McFaul SJ. The genetic response of human endothelial cells to exposure to varying oxygen concentration. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.717.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Phillip Bowman
- DCRUS Army Institute of Surgical ResearchFort Sam HoustonTX
| | - James A Bynum
- DCRUS Army Institute of Surgical ResearchFort Sam HoustonTX
| | - Steve J McFaul
- DCRUS Army Institute of Surgical ResearchFort Sam HoustonTX
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Bowman P, Bynum JA, McFaul SJ. An In Vitro Hypoxia/Reoxygenation Model of Ischemia/Reperfusion Injury with Glucose Oxidase And Catalase. FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.717.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Phillip Bowman
- DCRUS Army Institute of Surgical ResearchFort Sam HoustonTX
| | - James A Bynum
- DCRUS Army Institute of Surgical ResearchFort Sam HoustonTX
| | - Steve J McFaul
- DCRUS Army Institute of Surgical ResearchFort Sam HoustonTX
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Meledeo MA, Bynum JA, Sondeen JL, Bowman PD. Endothelial cell responses to laminar flow: changes in gene expression, protein, and glycocalyx. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.1129.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - James A Bynum
- DCRUS Army Institute of Surgical ResearchFt Sam HoustonTX
| | - Jill L Sondeen
- DCRUS Army Institute of Surgical ResearchFt Sam HoustonTX
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Bowman PD, Bynum JA, Craig T, Meledeo MA, Darlington DN. Temporal gene expression profiling of the hypothalamus following trauma. FASEB J 2012. [DOI: 10.1096/fasebj.26.1_supplement.lb673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Teresa Craig
- Department of SurgeryUniversity of Texas Health Science Center San AntonioSan AntonioTX
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