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Myers D, Lester P, Adili R, Hawley A, Durham L, Dunivant V, Reynolds G, Crego K, Zimmerman Z, Sood S, Sigler R, Fogler W, Magnani J, Holinstat M, Wakefield T. A new way to treat proximal deep venous thrombosis using E-selectin inhibition. J Vasc Surg Venous Lymphat Disord 2020; 8:268-278. [PMID: 32067728 PMCID: PMC9006622 DOI: 10.1016/j.jvsv.2019.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/16/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE There is an inter-relationship between thrombosis and inflammation. Previously, we have shown the importance of P-selectin in thrombogenesis and thrombus resolution in many preclinical animal models. The role of E-selectin has been explored in rodent models and in a small pilot study of clinical calf vein deep venous thrombosis. The purpose of this study was to determine the role of E-selectin in thrombosis in a primate model of proximal iliac vein thrombosis, a model close to the human condition. METHODS Iliac vein thrombosis was induced with a well-characterized primate model. Through a transplant incision, the hypogastric vein and iliac vein branches were ligated. Thrombus was induced by balloon occlusion of the proximal and distal iliac vein for 6 hours. The balloons were then deflated, and the primates recovered. Starting on postocclusion day 2, animals were treated with the E-selectin inhibitor GMI-1271, 25 mg/kg subcutaneously, once daily until day 21 (n = 4). Nontreated control animals received no treatment (n = 5). All animals were evaluated by magnetic resonance venography (MRV); evaluation of vessel area by ultrasound, protein analysis, hematology (complete blood count), and coagulation tests (bleeding time, prothrombin time, activated partial thromboplastin time, fibrinogen, and thromboelastography) were performed at baseline, day 2, day 7, day 14, and day 21 with euthanasia. In addition, platelet function and CD44 expression on leukocytes were determined. RESULTS E-selectin inhibition by GMI-1271 significantly increased vein recanalization by MRV vs control animals on day 14 (P < .05) and day 21 (P < .0001). GMI-1271 significantly decreased vein wall inflammation by MRV with gadolinium vein wall enhancement vs control also on day 14 (P < .0001) and day 21 (P < .0001). The thromboelastographic measure of clot strength (maximum amplitude) showed significant decreases in animals treated with GMI-1271 vs controls at day 2 (P < .05) and day 7 (P < .05). Animals treated with GMI-1271 had significant vessel area increase by day 21 vs controls (P < .05) by ultrasound. Vein wall intimal thickening (P < .001) and intimal fibrosis (P < .05) scores were significantly decreased in GMI-1271-treated animals vs controls. Importantly, no significant differences in hematology or coagulation test results were noted between all groups, suggesting that E-selectin inhibition carries no bleeding potential. GMI-1271 did not affect platelet function or aggregation or CD44 expression on leukocytes. In addition, no episodes of bleeding were noted in either group. CONCLUSIONS This study suggests that E-selectin modulates venous thrombus progression and that its inhibition will increase thrombus recanalization and decrease vein wall inflammation, without affecting coagulation. The use of an E-selectin inhibitor such as GMI-1271 could potentially change how we treat deep venous thrombosis.
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Affiliation(s)
- Daniel Myers
- Conrad Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich; Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Mich.
| | - Patrick Lester
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Mich
| | - Reheman Adili
- Department of Pharmacology, University of Michigan, Ann Arbor, Mich
| | - Angela Hawley
- Conrad Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich
| | - Laura Durham
- Conrad Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich
| | - Veronica Dunivant
- Conrad Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich
| | - Garrett Reynolds
- Conrad Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich
| | - Kiley Crego
- Conrad Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich
| | - Zoe Zimmerman
- Department of Pharmacology, University of Michigan, Ann Arbor, Mich
| | - Suman Sood
- Division of Hematology/Oncology, University of Michigan, Ann Arbor, Mich
| | - Robert Sigler
- Unit for Laboratory Animal Medicine, University of Michigan, Ann Arbor, Mich
| | | | | | | | - Thomas Wakefield
- Conrad Jobst Vascular Research Laboratories, Section of Vascular Surgery, University of Michigan, Ann Arbor, Mich
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Jagadeeswaran P, Cooley BC, Gross PL, Mackman N. Animal Models of Thrombosis From Zebrafish to Nonhuman Primates: Use in the Elucidation of New Pathologic Pathways and the Development of Antithrombotic Drugs. Circ Res 2017; 118:1363-79. [PMID: 27126647 DOI: 10.1161/circresaha.115.306823] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/30/2015] [Indexed: 12/23/2022]
Abstract
Thrombosis is a leading cause of morbidity and mortality worldwide. Animal models are used to understand the pathological pathways involved in thrombosis and to test the efficacy and safety of new antithrombotic drugs. In this review, we will first describe the central role a variety of animal models of thrombosis and hemostasis has played in the development of new antiplatelet and anticoagulant drugs. These include the widely used P2Y12 antagonists and the recently developed orally available anticoagulants that directly target factor Xa or thrombin. Next, we will describe the new players, such as polyphosphate, neutrophil extracellular traps, and microparticles, which have been shown to contribute to thrombosis in mouse models, particularly venous thrombosis models. Other mouse studies have demonstrated roles for the factor XIIa and factor XIa in thrombosis. This has spurred the development of strategies to reduce their levels or activities as a new approach for preventing thrombosis. Finally, we will discuss the emergence of zebrafish as a model to study thrombosis and its potential use in the discovery of novel factors involved in thrombosis and hemostasis. Animal models of thrombosis from zebrafish to nonhuman primates are vital in identifying pathological pathways of thrombosis that can be safely targeted with a minimal effect on hemostasis. Future studies should focus on understanding the different triggers of thrombosis and the best drugs to prevent each type of thrombotic event.
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Affiliation(s)
- Pudur Jagadeeswaran
- From the Department of Biological Sciences, University of North Texas, Denton (P.J.); Department of Pathology and Laboratory Medicine (B.C.C.), and Department of Medicine (N.M.), University of North Carolina, Chapel Hill; and Department of Medicine, McMaster University, Hamilton, Ontario, Canada (P.L.G.).
| | - Brian C Cooley
- From the Department of Biological Sciences, University of North Texas, Denton (P.J.); Department of Pathology and Laboratory Medicine (B.C.C.), and Department of Medicine (N.M.), University of North Carolina, Chapel Hill; and Department of Medicine, McMaster University, Hamilton, Ontario, Canada (P.L.G.)
| | - Peter L Gross
- From the Department of Biological Sciences, University of North Texas, Denton (P.J.); Department of Pathology and Laboratory Medicine (B.C.C.), and Department of Medicine (N.M.), University of North Carolina, Chapel Hill; and Department of Medicine, McMaster University, Hamilton, Ontario, Canada (P.L.G.)
| | - Nigel Mackman
- From the Department of Biological Sciences, University of North Texas, Denton (P.J.); Department of Pathology and Laboratory Medicine (B.C.C.), and Department of Medicine (N.M.), University of North Carolina, Chapel Hill; and Department of Medicine, McMaster University, Hamilton, Ontario, Canada (P.L.G.)
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Wolberg AS, Rosendaal FR, Weitz JI, Jaffer IH, Agnelli G, Baglin T, Mackman N. Venous thrombosis. Nat Rev Dis Primers 2015; 1:15006. [PMID: 27189130 DOI: 10.1038/nrdp.2015.6] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Venous thromboembolism (VTE) encompasses deep-vein thrombosis (DVT) and pulmonary embolism. VTE is the leading cause of lost disability-adjusted life years and the third leading cause of cardiovascular death in the world. DVT leads to post-thrombotic syndrome, whereas pulmonary embolism can cause chronic pulmonary hypertension, both of which reduce quality of life. Genetic and acquired risk factors for thrombosis include non-O blood groups, factor V Leiden mutation, oral contraceptive use, hormone replacement therapy, advanced age, surgery, hospitalization and long-haul travel. A combination of blood stasis, plasma hypercoagulability and endothelial dysfunction is thought to trigger thrombosis, which starts most often in the valve pockets of large veins. Animal studies have revealed pathogenic roles for leukocytes, platelets, tissue factor-positive microvesicles, neutrophil extracellular traps and factors XI and XII. Diagnosis of VTE requires testing and exclusion of other pathologies, and typically involves laboratory measures (such as D-dimer) and diagnostic imaging. VTE is treated with anticoagulants and occasionally with thrombolytics to prevent thrombus extension and to reduce thrombus size. Anticoagulants are also used to reduce recurrence. New therapies with improved safety profiles are needed to prevent and treat venous thrombosis. For an illustrated summary of this Primer, visit: http://go.nature.com/8ZyCuY.
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Affiliation(s)
- Alisa S Wolberg
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, 819 Brinkhous-Bullitt Building, Chapel Hill, North Carolina 27599-7525, USA.,McAllister Heart Institute, University of North Carolina at Chapel Hill, USA
| | - Frits R Rosendaal
- Department of Clinical Epidemiology and Department of Thrombosis and Hemostasis, Leiden University Medical Center, The Netherlands.,K.G. Jensen Thrombosis Research and Expertise Center, University of Tromsø, Norway
| | - Jeffrey I Weitz
- Department of Medicine and Department of Biochemistry and Biomedical Sciences, McMaster University, and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Iqbal H Jaffer
- Department of Medicine and Department of Biochemistry and Biomedical Sciences, McMaster University, and Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada
| | - Giancarlo Agnelli
- Division of Internal and Cardiovascular Medicine, Stroke Unit, University of Perugia, Italy
| | - Trevor Baglin
- Department of Haematology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Nigel Mackman
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, 819 Brinkhous-Bullitt Building, Chapel Hill, North Carolina 27599-7525, USA.,McAllister Heart Institute, University of North Carolina at Chapel Hill, USA.,K.G. Jensen Thrombosis Research and Expertise Center, University of Tromsø, Norway.,Department of Medicine, University of North Carolina at Chapel Hill, USA
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Diaz JA, Wrobleski SK, Alvarado CM, Hawley AE, Doornbos NK, Lester PA, Lowe SE, Gabriel JE, Roelofs KJ, Henke PK, Schaub RG, Wakefield TW, Myers DD. P-selectin inhibition therapeutically promotes thrombus resolution and prevents vein wall fibrosis better than enoxaparin and an inhibitor to von Willebrand factor. Arterioscler Thromb Vasc Biol 2015; 35:829-37. [PMID: 25657307 DOI: 10.1161/atvbaha.114.304457] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Aptamers are oligonucleotides targeting protein-protein interactions with pharmacokinetic profiles and activity reversal options. Although P-selectin and von Willebrand factor (vWF) have been implicated in the development of venous thrombosis (VT), no studies have directly compared aptamer efficacy with standard of care in VT. In this study, ARC5692, an anti-P-selectin aptamer, and ARC15105, an anti-vWF aptamer, were compared with low-molecular-weight heparin, enoxaparin, to test the efficacy of P-selectin or vWF inhibition in promoting thrombus resolution and preventing vein wall fibrosis, in a baboon model of VT. APPROACH AND RESULTS Groups were as follows: treatment arm: animals received P-selectin or vWF aptamer inhibitors or enoxaparin (n=3 per group). Controls received no treatment (n=3). Prophylactic arm: animals received P-selectin inhibitor (n=4) or vWF inhibitor (n=3). Treatment arm: P-selectin-inhibitor demonstrated a significant improvement in vein recanalization by magnetic resonance venography (73% at day 21), and significantly decreased vein wall collagen, compared with all groups. Anti-P-selectin equaled enoxaparin in maintaining valve competency by ultrasound. All control animals had compromised valve competency post thrombosis. Prophylactic arm: animals receiving P-selectin and vWF inhibitors demonstrated improved vein recanalization by magnetic resonance venography versus controls (80% and 85%, respectively, at day 21). Anti-P-selectin protected iliac valve function better than anti-vWF, and both improved valve function versus controls. No adverse bleeding events were observed. CONCLUSIONS The P-selectin inhibitor aptamer promoted iliac vein recanalization, preserved valve competency, and decreased vein wall fibrosis. The results of this work suggest that P-selectin inhibition maybe an ideal target in the treatment and prophylaxis of deep VT, warranting clinical trials.
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Affiliation(s)
- Jose A Diaz
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.).
| | - Shirley K Wrobleski
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Christine M Alvarado
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Angela E Hawley
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Nichole K Doornbos
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Patrick A Lester
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Suzan E Lowe
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Joy E Gabriel
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Karen J Roelofs
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Peter K Henke
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Robert G Schaub
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Thomas W Wakefield
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
| | - Daniel D Myers
- From the Section of Vascular Surgery, Department of Surgery, Conrad Jobst Vascular Research Laboratories (J.A.D., S.K.W., C.M.A., A.E.H., N.K.D., J.E.G., K.J.R., P.K.H., T.W.W., D.D.M.), Unit for Laboratory Animal Medicine (C.M.A., P.A.L., D.D.M.), and Department of Radiology (S.E.L.), University of Michigan, Ann Arbor; and Research and Development, Archemix Corporation, Cambridge, MA (R.G.S.)
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