Bioavailability and relative tissue distribution of [125I]-recombinant human thrombin following intravenous or subcutaneous administration to non-human primates

BACKGROUND

Recombinant human thrombin (rhThrombin) is being developed as a general adjunct to hemostasis. Endogenous thrombin is rapidly inactivated by complex formation with antithrombin III and other inhibitors. It follows that these inhibitors will also inactivate any rhThrombin that reaches the systemic circulation.

OBJECTIVES

Study goals were to determine the pharmacokinetic characteristics of [(125)I]-rhThrombin and [(125)I]-rhThrombin complexed to endogenous inhibitors, and the tissue distribution of rhThrombin-associated radioactivity in non-human primates. Hematology, serum chemistry and coagulation status were also monitored.

METHODS

[(125)I]-rhThrombin was administered intravenously (i.v.; 3.5 U kg(-1)) or subcutaneously (s.c.; 350 U kg(-1)) to male cynomolgus monkeys. Plasma was analyzed for rhThrombin-associated radioactivity and non-compartmental analysis was used to determine the corresponding pharmacokinetic parameters. A size exclusion-high pressure liquid chromatography (SE-HPLC) method was used to quantitate rhThrombin complexes, non-complexed rhThrombin, and free [(125)I]. Whole-body gamma scintigraphy was used to follow radioactivity localization up to 72 h postdose.

RESULTS

No adverse events were observed following [(125)I]-rhThrombin administration. The pharmacokinetic profile of rhThrombin-associated radioactivity following i.v. injection was multi-exponential with an initial half-life of approximately 10 min. Following both i.v. and s.c. dosing, the terminal half-life was approximately 15 h. SE-HPLC analysis revealed that rhThrombin was rapidly complexed to antithrombin III and other inhibitors in the systemic circulation following i.v. administration. Thus, rhThrombin-associated radioactivity in the blood was complexed and presumed inactive. [(125)I]-rhThrombin inhibitor complexes accumulated and were eliminated in the liver following both routes of administration.

CONCLUSIONS

These data suggest that rhThrombin rapidly binds to endogenous inhibitors following either i.v. or s.c. administration.

Identification of a mammalian angiopoietin-related protein expressed specifically in liver

Based on searches of EST databases for signal sequences and amphipathic helices, we have identified and cloned an angiopoietin-like gene, ANGPTL3. Multiple tissue Northern blots show that ANGPTL3 is expressed principally in the liver. ANGPTL3 is expressed early during liver development, and expression is maintained in adult liver. Human ANGPTL3 is a 460-amino-acid polypeptide with the characteristic structure of angiopoietins: a signal peptide, an extended helical domain predicted to form dimeric or trimeric coiled-coils, a short linker peptide, and a globular fibrinogen homology domain (FHD). Murine ANGPTL3 is a 455-acid polypeptide encoded by seven exons on mouse chromosome 4, spanning about 11 kb of DNA. ANGPTL3 contains the four conserved cysteines implicated in the intramolecular disulfide bonds within the FHD, but it does not contain two other cysteines that are found within the FHD of angiopoietins 1, 2, and 4. ANGPTL3 also does not contain the characteristic calcium binding motif found in the other angiopoietins. By radiation hybrid mapping and the use of surrounding genes, human ANGPTL3 maps to the 1p31 region.

Crosslinking kinetics of the human transglutaminase, factor XIII[A2], acting on fibrin gels and gamma-chain peptides

Factor XIII is the terminal enzyme of the coagulation cascade which serves to rapidly crosslink the adjacent gamma-chain C-termini of fibrin clots. In vivo, this process is initiated by the proteolytic action of thrombin which simultaneously converts both soluble fibrinogen to fibrin and activates zymogen FXIII; fibrin then spontaneously polymerizes to form a gel which activated FXIII stabilizes through crosslinking. Due to the kinetic complexity and the difficulty of investigating gel phase reactions, methods employing pre-activation of recombinant human Factor XIII (rFXIII[A'2]) were developed to effectively decouple these reactions. By utilizing these methods, the kinetic parameters of gamma-chain crosslinking in fibrin gels could be determined by both initial rate and integrated rate techniques under physiologically relevant conditions. The crosslinking of the gamma-chain of fibrin gels could be described by apparent Michaelis kinetics with K(m)(app) = 6.2 microM, kcat = 1872 min-1, and Ksp = 302 min-1 microM-1 for a fibrin gamma-chain monomer of M(r) = 170000 Da. In contrast, both the crosslinking rates of alpha-chains within fibrin gels (Ksp = 0.38 min-1 microM-1: Bishop et al. (1993)) and the crosslinking of a soluble synthetic peptide containing the unique gamma-chain fibrin crosslinking site (Ksp = 0.030 min-1 microM-1) could not be shown to saturate and gave apparent first-order rates with respect to rFXIII[A'2]. These observations coupled with the large differences in the turnover rates (approximately 10(4)) suggest two likely mechanisms for FXIII[A'2]-substrate interactions: (1) random (or independent) binding of non- or weakly interacting substrate pairs imposes a high entropic barrier (i. e., delta Gbinding) to the formation of a productive catalytic complex, e.g., for soluble gamma-chain peptides and the flexible alpha-chains within fibrin, and (2) binding to an oriented substrate pair effectively lowers the entropic barrier to formation of a Michaelis complex and thus greatly enhances the rate of catalysis, e.g., for gamma-chain pairs within the fibrin fibrils.

Effect of polyol type on the surface structure of sulfonate-containing polyurethanes

Polyurethanes based upon polytetramethylene oxide (PTMO) as the polyol and derivatized with propyl sulfonate functionality pendant from the urethane nitrogen have previously been shown to possess good blood-contacting properties. Other investigators have shown that sulfonated polyurethanes containing polyethylene oxide (PEO) as the soft segment are much more thrombogenic than those containing PTMO as the soft segment. In this article, the surface properties of sulfonated polyurethanes based upon either PTMO or PEO are compared. Dynamic contact angle measurements show a significant decrease in the receding angles of the sulfonated PTMO-containing polyurethane as compared to its nonsulfonated precursor polymer. No significant difference is seen between the receding contact angles of either the sulfonated PEO-based polyurethane or its nonsulfonated analog. Variable-angle electron spectroscopy for chemical analysis (ESCA) studies of sulfonated PTMO-based polyurethane performed at room temperature show that there is a significant decrease in sulfur content at the surface. In contrast, the sulfonated PEO-based polyurethane showed little change in sulfur content with take-off angle. Finally, ESCA studies of freeze-dried surfaces show a significant increase in sulfur near the surface of the sulfonated PTMO-based polymer as compared to vacuum-dried samples but show no such increase for the sulfonated PEO-based polyurethane. It is suggested that the ability of the sulfonate functionality to be expressed at the surface may explain the observed differences in blood compatibility between the sulfonated polyurethanes based upon polyols of varying hydrophilicity.

Surface properties of RGD-peptide grafted polyurethane block copolymers: variable take-off angle and cold-stage ESCA studies

Variable take-off angle and cold-stage ESCA measurements were utilized to analyze the surface composition of five polyurethane block copolymers. The polymers studied included a PTMO-polyurethane control, a carboxylated version of the control polyurethane, and three different peptide grafted (GRGESY, GRGDSY, and GRGDVY) polyurethanes. On dry samples the nitrogen signal detected using ESCA decreased with increasing take-off angle (i.e. as the specimen was probed closer to the surface) for all five polymers. This was believed to be due to the depletion of nitrogen-containing urethane hard segments at the surface. For all five polymers, the surface nitrogen concentration, associated with the hard segment, increased upon hydration. A greater increase of nitrogen concentration was observed for the peptide grafted polymers which suggests that grafting of the hydrophilic peptides to the polyurethane augments the hard segment enrichment at the surface upon hydration. Upon dehydration, the nitrogen concentration decreased for all five polymers suggesting migration of the more hydrophobic PTMO soft segment to the surface. In vitro endothelial cell adhesion showed an increase of cell attachment on prehydrated RGD-containing peptide grafted polyurethanes, but not on the other polymers. This result suggests an enhancement of peptide density at the aqueous interface, in good agreement with the ESCA studies.

The Johns Hopkins rechargeable pacemaker. Historical aspect

Several groups have attempted to develop a clinically usable rechargeable cardiac pacemaker. Because of the technical problems, of the 11 reported efforts, only one has met with success, the unit developed at the Johns Hopkins University. A brief review of rechargeable pacemakers is given, along with a discussion of technical problems that required solution before the rechargeable pacemaker could be used clinically. The rechargeable pacemaker, because of its size, should minimize patient problems of discomfort, cosmesis, and skin erosion. The anticipated life of the rechargeable power cell should eliminate the need for pulse generator replacement during the patients's lifetime.

Pulmonary arterial pulse wave velocity and impedance in man

The differential pressure method of Womersley and McDonald was used to measure instantaneous blood flow in the main pulmonary artery in ten human subjects. Three subjects had normal pulmonary arterial pressures and flows, seven had mitral stenosis and pulmonary hypertension. The spectrum of input impedance versus frequency was similar to that previously reported for the dog and rabbit, with the modulus decreasing from relatively high values at zero frequency to a minimum between 2 and 5 cycles/sec. Characteristic impedance and phase velocity were lower in the normal subjects than in those with pulmonary hypertension (averages, 23 dyne sec cm -5 and 1.68 m/sec in the normals; 46 dyne sec cm -5 and 4.77 m/sec in the hypertensives). Hydraulic energy dissipated per unit time by pulsations in the pulmonary bed was usually higher in the hypertensive than in the normal cases, because of the greater stiffness of the pulmonary arteries in the subjects with pulmonary hypertension. The elasticity of the pulmonary arterial tree appears to be as important as the state of the arterioles and capillaries in determining the energy required for pulsatile pulmonary blood flow.

Prolapse of the mitral valve: clinical and cine-angiocardiographic findings

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Anomalous left coronary artery arising from the pulmonary artery in an adult. A review of the therapeutic problem

The 29-year-old woman with anomalous left coronary artery arising from the pulmonary trunk whose case is presented is at the time of writing, the oldest patient on record in whom this condition has been diagnosed during life. The diagnosis was made by aortic cineangiography and confirmed by selective injection of contrast material into the right coronary artery. The collateral pathways between the right and the anomalous left coronary artery were thus defined. Vectorcardiographic and electrocardiographic patterns of anterolateral myocardial infarction with periinfarction block have not been observed in any of the previously reported adults with this type of rare congenital anomaly.

The 27 cases of ligation of the aberrant left coronary artery arising from the pulmonary artery reported in the literature have been reviewed and the results of this operation discussed.

Diagnosis of the anomalous left coronary artery in adult life is possible if it is considered in patients presenting with a continuous murmur at the base and electrocardiographic evidence of myocardial infarction.