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Ling CW, Sud K, Patel R, Peterson G, Wanandy T, Yeoh SF, Van C, Castelino R. Culture-directed antibiotics in peritoneal dialysis solutions: a systematic review focused on stability and compatibility. J Nephrol 2023; 36:1841-1859. [PMID: 37548827 PMCID: PMC10543841 DOI: 10.1007/s40620-023-01716-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND This systematic review summarises the stability of less commonly prescribed antibiotics in different peritoneal dialysis solutions that could be used for culture-directed therapy of peritonitis, which would be especially useful in regions with a high prevalence of multidrug antibiotic-resistant strains. METHODS A literature search of Medline, Scopus, Embase and Google Scholar for articles published from inception to 25 January, 2023 was conducted. Only antibiotic stability studies conducted in vitro and not recently reviewed by So et al. were included. The main outcomes were chemical, physical, antimicrobial and microbial stability. This protocol was registered in PROSPERO (registration number CRD42023393366). RESULTS We screened 1254 abstracts, and 28 articles were included in the study. In addition to those discussed in a recent systematic review (So et al., Clin Kidney J 15(6):1071-1078, 2022), we identified 18 antimicrobial agents. Of these, 9 have intraperitoneal dosing recommendations in the recent International Society for Peritoneal Dialysis (ISPD) peritonitis guidelines, and 7 of the 9 had stability data applicable to clinical practice. They were cefotaxime, ceftriaxone, daptomycin, ofloxacin, and teicoplanin in glucose-based solutions, tobramycin in Extraneal solution only and fosfomycin in Extraneal, Nutrineal, Physioneal 1.36% and 2.27% glucose solutions. CONCLUSIONS Physicochemical stability has not been demonstrated for all antibiotics with intraperitoneal dosing recommendations in the ISPD peritonitis guidelines. Further studies are required to determine the stability of antibiotics, especially in icodextrin-based and low-glucose degradation products, pH-neutral solutions.
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Affiliation(s)
- Chau Wei Ling
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Kamal Sud
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, NSW, Australia
- Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Sydney, NSW, Australia
| | - Rahul Patel
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Gregory Peterson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Troy Wanandy
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
- Department of Pharmacy, Royal Hobart Hospital, Hobart, TAS, Australia
- Department of Clinical Immunology and Allergy, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Siang Fei Yeoh
- Department of Pharmacy, National University Hospital, Singapore, Singapore
| | - Connie Van
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Ronald Castelino
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
- Department of Pharmacy, Blacktown Hospital, Blacktown, NSW, Australia
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Hemocompatibility Evaluation of Thai Bombyx mori Silk Fibroin and Its Improvement with Low Molecular Weight Heparin Immobilization. Polymers (Basel) 2022; 14:polym14142943. [PMID: 35890719 PMCID: PMC9319666 DOI: 10.3390/polym14142943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
Bombyx mori silk fibroin (SF), from Nangnoi Srisaket 1 Thai strain, has shown potential for various biomedical applications such as wound dressing, a vascular patch, bone substitutes, and controlled release systems. The hemocompatibility of this SF is one of the important characteristics that have impacts on such applications. In this study, the hemocompatibility of Thai SF was investigated and its improvement by low molecular weight heparin (LMWH) immobilization was demonstrated. Endothelial cell proliferation on the SF and LMWH immobilized SF (Hep/SF) samples with or without fibroblast growth factor-2 (FGF-2) was also evaluated. According to hemocompatibility evaluation, Thai SF did not accelerate clotting time, excess stimulate complement and leukocyte activation, and was considered a non-hemolysis material compared to the negative control PTFE sheet. Platelet adhesion of SF film was comparable to that of the PTFE sheet. For hemocompatibility enhancement, LMWH was immobilized successfully and could improve the surface hydrophilicity of SF films. The Hep/SF films demonstrated prolonged clotting time and slightly lower complement and leukocyte activation. However, the Hep/SF films could not suppress platelet adhesion. The Hep/SF films demonstrated endothelial cell proliferation enhancement, particularly with FGF-2 addition. This study provides fundamental information for the further development of Thai SF as a hemocompatible biomaterial.
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Plasma levels of enoxaparin oligosaccharides, antifactor-Xa and thrombin generation in patients undergoing haemodialysis. Blood Coagul Fibrinolysis 2020; 31:152-159. [PMID: 31990754 DOI: 10.1097/mbc.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
: Low molecular weight heparins are used during haemodialysis for thromboprophylaxis of the dialysis circuit, with plasma antifactor-Xa (anti-Xa) activity used as a surrogate measure for effective anticoagulation. However, this pharmacokinetic parameter does not always correlate with pharmacodynamic effects in patients. The aim of this study was to investigate the relationship between actual plasma levels of the low molecular weight heparins enoxaparin, anti-Xa activity, and global coagulation measurement of thrombin generation during haemodialysis. Blood was analysed from 16 adult patients with end-stage kidney disease at 0, 2, 4 h, and at completion of 31 dialysis sessions where single fixed doses of 20 (n = 3), 40 (n = 16), 60 (n = 6), or 80 (n = 6) mg of enoxaparin (equating to 0.23-1.07 mg/kg) were used as thromboprophylaxis. Plasma enoxaparin oligosaccharides [degree of polymerization (dp)6-dp16] were measured by high-performance size exclusion chromatography, anti-Xa activity by colourimetric assay, and thrombin generation by calibrated automated thrombogram. Plasma enoxaparin fragments were undetectable at the beginning of each dialysis, peaked at 2 h to levels that correlated with dose (r = 0.68, P < 0.001) then remained relatively stable. In contrast, therapeutic anti-Xa levels achieved at 2 h in 18 cases (58%) quickly dropped to only six cases (19%) at the end of dialysis, by which time thrombin generation had also recovered in 81% of patients. Statistical modelling revealed a threshold value of anti-Xa at 0.53 IU/ml that supressed thrombin generation to 15.28% of baseline (P < 0.001). Despite loss of anticoagulant activity in the majority of patients, plasma levels of enoxaparin oligosaccharides remained detectable and relatively unchanged throughout dialysis.
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Patel RP, Shastri MD, Ming LC, Zaidi STR, Peterson GM. Therapeutic Potential of Enoxaparin in Lichen Planus: Exploring Reasons for Inconsistent Reports. Front Pharmacol 2018; 9:586. [PMID: 29922163 PMCID: PMC5996198 DOI: 10.3389/fphar.2018.00586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 05/16/2018] [Indexed: 12/16/2022] Open
Abstract
Lichen planus (LP) is an uncommon mucocutaneous inflammatory condition, that is immunologically mediated, typically pruritic and often recurs. The currently advocated therapies are either not highly effective or associated with severe side effects. Enoxaparin, a widely used anticoagulant, is composed of both anticoagulant and non-anticoagulant fragments. Enoxaparin is reported to have anti-inflammatory properties and it was found to be effective in LP. However, the results from clinical studies have varied substantially and, therefore, the clinical role of enoxaparin in LP remains uncertain. This review focuses on potential reasons for the reported inconsistent outcomes, as well as proposing solutions; these include identifying batch-to-batch inconsistency in the composition of enoxaparin. The potential therapeutic value of enoxaparin in LP must be explored using well-designed clinical trials, combined with experimental studies that focus on identifying the anti-inflammatory fragments of enoxaparin and elucidating the mechanism of action of these non-anticoagulant fragments.
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Affiliation(s)
- Rahul P. Patel
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Madhur D. Shastri
- School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | - Long Chiau Ming
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
- School of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia
- Vector-borne Diseases Research Group (VERDI), Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA, Shah Alam, Malaysia
| | | | - Gregory M. Peterson
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
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Kandel S, Zaidi STR, Wanandy ST, Ming LC, Castelino RL, Sud K, Patel RP. Stability of Ceftazidime and Heparin in Four Different Types of Peritoneal Dialysis Solutions. ARCH ESP UROL 2017; 38:49-56. [PMID: 29162678 DOI: 10.3747/pdi.2017.00115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/28/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intraperitoneal (IP) administration of ceftazidime is recommended for the treatment of peritoneal dialysis-associated peritonitis (PDAP) from Pseudomonas. Patients with PDAP may also need IP heparin to overcome problems with drainage of turbid peritoneal dialysis (PD) fluids and blockage of catheters with fibrin. Physico-chemical stability of ceftazidime and heparin, and biological stability of heparin in many types of PD solutions is unknown. Therefore, we investigated the stability of ceftazidime and heparin in 4 types of PD solutions. METHODS A total of 12 PD bags (3 for each type of solution) containing ceftazidime and heparin were prepared and stored at 4°C for 120 hours, and then at 25°C for 6 hours, and finally at 37°C for 12 hours. An aliquot was withdrawn after predefined time points and analyzed for the concentration of ceftazidime and heparin using high-performance liquid-chromatography (HPLC). Samples were assessed for pH, color changes, particle content, and anticoagulant activity of heparin. RESULTS Ceftazidime and heparin retained more than 91% of their initial concentration when stored at 4°C for 120 hours followed by storage at 25°C for 6 hours and then at 37°C for 12 hours. Heparin retained more than 95% of its initial activity throughout the study period. Particle formation was not detected at any time under the storage conditions. The pH and color remained essentially unchanged throughout the study. CONCLUSIONS Ceftazidime-heparin admixture retains its stability over long periods of storage at different temperatures, allowing its potential use for PDAP treatment in outpatient and remote settings.
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Affiliation(s)
- Surendra Kandel
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Syed Tabish R Zaidi
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - S Troy Wanandy
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,Department of Pharmacy, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Long C Ming
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.,School of Pharmacy, KPJ Healthcare University College, Nilai, Negeri Sembilan, Malaysia
| | - Ronald L Castelino
- School of Nursing, University of Sydney, New South Wales, Australia.,Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Kamal Sud
- Peritoneal Dialysis Unit, Regional Dialysis Centre, Blacktown Hospital, Blacktown, New South Wales, Australia.,Department of Renal Medicine, Nepean Hospital and Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia
| | - Rahul P Patel
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Lean QY, Gueven N, Eri RD, Bhatia R, Sohal SS, Stewart N, Peterson GM, Patel RP. Heparins in ulcerative colitis: proposed mechanisms of action and potential reasons for inconsistent clinical outcomes. Expert Rev Clin Pharmacol 2015; 8:795-811. [PMID: 26308504 DOI: 10.1586/17512433.2015.1082425] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Current drug therapies for ulcerative colitis (UC) are not completely effective in managing moderate-to-severe UC and approximately 20% of patients with severe UC require surgical interventions. Heparins, polydisperse mixtures of non-anticoagulant and anticoagulant oligosaccharides, are widely used as anticoagulants. However, heparins are also reported to have anti-inflammatory properties. Unfractionated heparin was initially used in patients with UC for the treatment of rectal microthrombi. Surprisingly, it was found to be effective in reducing UC-associated symptoms. Since then, several pre-clinical and clinical studies have reported promising outcomes of heparins in UC. In contrast, some controlled clinical trials demonstrated no or only limited benefits, thus the potential of heparins for the treatment of UC remains uncertain. This review discusses potential mechanisms of action of heparins, as well as proposed reasons for their contradictory clinical effectiveness in the treatment of UC.
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Affiliation(s)
- Qi Ying Lean
- a 1 Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia.,b 2 Faculty of Pharmacy, University of Technology MARA, Puncak Alam , Selangor, Malaysia
| | - Nuri Gueven
- a 1 Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia
| | - Rajaraman D Eri
- c 3 School of Health Sciences, Faculty of Health, University of Tasmania, Launceston , Tasmania, Australia
| | - Rajesh Bhatia
- d 4 Royal Hobart Hospital , Hobart, Tasmania, Australia
| | - Sukhwinder Singh Sohal
- c 3 School of Health Sciences, Faculty of Health, University of Tasmania, Launceston , Tasmania, Australia.,e 5 Breathe Well Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia
| | - Niall Stewart
- a 1 Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia
| | - Gregory M Peterson
- a 1 Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia.,e 5 Breathe Well Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia.,f 6 Health Services Innovation Tasmania, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia
| | - Rahul P Patel
- a 1 Division of Pharmacy, School of Medicine, Faculty of Health, University of Tasmania , Hobart, Tasmania, Australia
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Shastri MD, Stewart N, Horne J, Peterson GM, Gueven N, Sohal SS, Patel RP. In-vitro suppression of IL-6 and IL-8 release from human pulmonary epithelial cells by non-anticoagulant fraction of enoxaparin. PLoS One 2015; 10:e0126763. [PMID: 25961885 PMCID: PMC4427328 DOI: 10.1371/journal.pone.0126763] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/07/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Enoxaparin, a mixture of anticoagulant and non-anticoagulant fractions, is widely used as an anticoagulant agent. However, it is also reported to possess anti-inflammatory properties. Our study indicated that enoxaparin inhibits the release of IL-6 and IL-8 from A549 pulmonary epithelial cells. Their release causes extensive lung tissue damage. The use of enoxaparin as an anti-inflammatory agent is hampered due to the risk of bleeding associated with its anticoagulant fractions. Therefore, we aimed to identify the fraction responsible for the observed anti-inflammatory effect of enoxaparin and to determine the relationship between its structure and biological activities. METHODS A549 pulmonary epithelial cells were pre-treated in the presence of enoxaparin and its fractions. The levels of IL-6 and IL-8 released from the trypsin-stimulated cells were measured by ELISA. The anticoagulant activity of the fraction responsible for the effect of enoxaparin was determined using an anti-factor-Xa assay. The fraction was structurally characterised using nuclear magnetic resonance. The fraction was 2-O, 6-O or N-desulfated to determine the position of sulfate groups required for the inhibition of interleukins. High-performance size-exclusion chromatography was performed to rule out that the observed effect was due to the interaction between the fraction and trypsin or interleukins. RESULTS Enoxaparin (60 μg/mL) inhibited the release of IL-6 and IL-8 by >30%. The fraction responsible for this effect of enoxaparin was found to be a disaccharide composed of α-L-iduronic-acid and α-D-glucosamine-6-sulfate. It (15 μg/mL) inhibited the release of interleukins by >70%. The 6-O sulphate groups were responsible for its anti-inflammatory effect. The fraction did not bind to trypsin or interleukins, suggesting the effect was not due to an artefact of the experimental model. CONCLUSION The identified disaccharide has no anticoagulant activity and therefore eliminates the risk of bleeding associated with enoxaparin. Future in-vivo studies should be designed to validate findings of the current study.
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Affiliation(s)
- Madhur D. Shastri
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Niall Stewart
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - James Horne
- Central Science Laboratory, University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M. Peterson
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
- Health Services Innovation Tasmania, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
- Breathe Well Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Nuri Gueven
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Sukhwinder S. Sohal
- Breathe Well Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
- School of Health Sciences, Faculty of Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Rahul P. Patel
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
- * E-mail:
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Opposing effects of low molecular weight heparins on the release of inflammatory cytokines from peripheral blood mononuclear cells of asthmatics. PLoS One 2015; 10:e0118798. [PMID: 25738575 PMCID: PMC4349593 DOI: 10.1371/journal.pone.0118798] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/08/2015] [Indexed: 12/24/2022] Open
Abstract
Background T-cell-mediated inflammatory cytokines, such as interleukin (IL)-4, IL-5, IL-13 and tumor necrosis factor-alpha (TNF-α), play an important role in the initiation and progression of inflammatory airways diseases. Low-molecular-weight heparins (LMWHs), widely used anticoagulants, possess anti-inflammatory properties making them potential treatment options for inflammatory diseases, including asthma. In the current study, we investigated the modulating effects of two LMWHs (enoxaparin and dalteparin) on the release of cytokines from stimulated peripheral blood mononuclear cells (PBMCs) of asthmatic subjects to identify the specific components responsible for the effects. Methods PBMCs from asthmatic subjects (consist of ~75% of T-cells) were isolated from blood taken from ten asthmatic subjects. The PBMCs were pre-treated in the presence or absence of different concentrations of LMWHs, and were then stimulated by phytohaemagglutinin for the release of IL-4, IL-5, IL-13 and TNF-α. LMWHs were completely or selectively desulfated and their anticoagulant effect, as well as the ability to modulate cytokine release, was determined. LMWHs were chromatographically fractionated and each fraction was tested for molecular weight determination along with an assessment of anticoagulant potency and effect on cytokine release. Results Enoxaparin inhibited cytokine release by more than 48%, whereas dalteparin increased their release by more than 25%. The observed anti-inflammatory effects of enoxaparin were independent of their anticoagulant activities. Smaller fractions, in particular dp4 (four saccharide units), were responsible for the inhibitory effect of enoxaparin. Whereas, the larger fractions, in particular dp22 (twenty two saccharide units), were associated with the stimulatory effect of dalteparin. Conclusion Enoxaparin and dalteparin demonstrated opposing effects on inflammatory markers. These observed effects could be due to the presence of structurally different components in the two LMWHs arising from different methods of depolymerisation. This study provides a platform for further studies investigating the usefulness of enoxaparin in various inflammatory diseases.
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Ingle RG, Agarwal AS. A world of low molecular weight heparins (LMWHs) enoxaparin as a promising moiety—A review. Carbohydr Polym 2014; 106:148-53. [DOI: 10.1016/j.carbpol.2014.01.100] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 01/21/2014] [Accepted: 01/30/2014] [Indexed: 12/23/2022]
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Shastri MD, Peterson GM, Stewart N, Sohal SS, Patel RP. Non-anticoagulant derivatives of heparin for the management of asthma: distant dream or close reality? Expert Opin Investig Drugs 2014; 23:357-73. [PMID: 24387080 DOI: 10.1517/13543784.2014.866092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Approximately 300 million people worldwide are currently affected by asthma. Improvements in the understanding of the mechanisms involved in such inflammatory airway disorders has led to the recognition of new therapeutic approaches. Heparin, a widely used anticoagulant, has been shown to be beneficial in the management of asthma. It belongs to the family of highly sulphated polysaccharides referred to as glycosaminoglycans, containing a heterogeneous mixture of both anticoagulant and non-anticoagulant polysaccharides. Experimental findings have suggested that heparin has potential anti-asthmatic properties owing to the ability of its non-anticoagulant oligosaccharides to bind and modulate the activity of a wide range of biological molecules involved in the inflammatory process. AREAS COVERED This review focuses on the potential mechanisms of action and clinical application of heparin as an anti-inflammatory agent for the management of asthma. EXPERT OPINION Heparin may play a significant role in the management of asthma. However, these properties are often hindered by the presence of anticoagulant oligosaccharides, which possess a significant risk of bleeding. Therefore, its therapeutic potential must be explored using well-designed clinical studies that focus on identifying and isolating the anti-inflammatory oligosaccharides of heparin and further elucidating the structure and mechanisms of actions of these non-anticoagulant oligosaccharides.
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Affiliation(s)
- Madhur D Shastri
- University of Tasmania, School of Pharmacy , Private Bag 26, Hobart, Tasmania , Australia +61 3 6226 1079 ; +61 3 6226 2870 ;
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Ion exchange chromatographic separation and isolation of oligosaccharides of intact low-molecular-weight heparin for the determination of their anticoagulant and anti-inflammatory properties. Anal Bioanal Chem 2013; 405:6043-52. [PMID: 23712644 DOI: 10.1007/s00216-013-6996-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
Abstract
It is well known that enoxaparin, a widely used anticoagulant and low-molecular-weight heparin containing a large number of oligosaccharides, possesses anti-inflammatory activity. Whilst enoxaparin has shown promising results in various inflammatory disorders, some of its oligosaccharides have anti-inflammatory properties and others increase the risk of bleeding due to their anticoagulant effects. The aim of this study was to develop an effective ion exchange chromatographic (IC) technique which allows the separation, isolation and, consequently, the identification of different oligosaccharides of enoxaparin with or without anticoagulant activity. The developed method utilises a semi-preparative CarboPac PA100 (9 × 250 mm) ion exchange column with sodium chloride gradient elution and UV detection at 232 nm. The method successfully resolved enoxaparin into more than 30 different peaks. IC-derived oligosaccharides with high, moderate, low or no anticoagulant activity were identified using an anti-factor Xa assay. The anti-inflammatory activity of selected oligosaccharides was investigated using the Griess assay. Using this technique, the oligosaccharides of enoxaparin with low or no anticoagulant activity, whilst exhibiting significant anti-inflammatory activity, could be fractionated. This technique can provide a platform to identify the oligosaccharides which are devoid of significant anticoagulant activity and are responsible for the therapeutic effects of enoxaparin that have been observed in various inflammatory conditions.
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Effective reversed-phase ion pair high-performance liquid chromatography method for the separation and characterization of intact low-molecular-weight heparins. Anal Biochem 2009; 387:113-21. [DOI: 10.1016/j.ab.2009.01.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 01/01/2009] [Accepted: 01/04/2009] [Indexed: 11/21/2022]
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13
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Patel RP, Narkowicz C, Jacobson GA. In vitro stability of enoxaparin solutions (20 mg/mL) diluted in 4% glucose. Clin Ther 2008; 30:1880-5. [DOI: 10.1016/j.clinthera.2008.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2008] [Indexed: 11/24/2022]
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