1
|
Ahmed S, Odumade OA, van Zalm P, Fatou B, Hansen R, Martin CR, Angelidou A, Steen H. Proteomics-Based Mapping of Bronchopulmonary Dysplasia-Associated Changes in Noninvasively Accessible Oral Secretions. J Pediatr 2024; 270:113774. [PMID: 37839510 PMCID: PMC11014893 DOI: 10.1016/j.jpeds.2023.113774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/18/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To determine if oral secretions (OS) can be used as a noninvasively collected body fluid, in lieu of tracheal aspirates (TA), to track respiratory status and predict bronchopulmonary dysplasia (BPD) development in infants born <32 weeks. STUDY DESIGN This was a retrospective, single center cohort study that included data and convenience samples from week-of-life (WoL) 3 from 2 independent preterm infant cohorts. Using previously banked samples, we applied our sample-sparing, high-throughput proteomics technology to compare OS and TA proteomes in infants born <32 weeks admitted to the Neonatal Intensive Care Unit (NICU) (Cohort 1; n = 23 infants). In a separate similar cohort, we mapped the BPD-associated changes in the OS proteome (Cohort 2; n = 17 infants including 8 with BPD). RESULTS In samples collected during the first month of life, we identified 607 proteins unique to OS, 327 proteins unique to TA, and 687 overlapping proteins belonging to pathways involved in immune effector processes, neutrophil degranulation, leukocyte mediated immunity, and metabolic processes. Furthermore, we identified 37 OS proteins that showed significantly differential abundance between BPD cases and controls: 13 were associated with metabolic and immune dysregulation, 10 of which (eg, SERPINC1, CSTA, BPI) have been linked to BPD or other prematurity-related lung disease based on blood or TA investigations, but not OS. CONCLUSIONS OS are a noninvasive, easily accessible alternative to TA and amenable to high-throughput proteomic analysis in preterm newborns. OS samples hold promise to yield actionable biomarkers of BPD development, particularly for prospective categorization and timely tailored treatment of at-risk infants with novel therapies.
Collapse
Affiliation(s)
- Saima Ahmed
- Department of Pathology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Oludare A Odumade
- Harvard Medical School, Boston, MA; Division of Neonatology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Precision Vaccines Program, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Patrick van Zalm
- Department of Pathology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Benoit Fatou
- Department of Pathology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Precision Vaccines Program, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Rachel Hansen
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Asimenia Angelidou
- Harvard Medical School, Boston, MA; Precision Vaccines Program, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Hanno Steen
- Department of Pathology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Precision Vaccines Program, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
2
|
Meli A, De Falco S, Novembrino C, Boscolo Anzoletti M, Arcadipane A, Panarello G, Occhipinti G, Grasselli G, Panigada M. The role of inflammation and antithrombin supplementation on thromboelastographic parameters during veno-venous ECMO for respiratory failure. Perfusion 2024; 39:66S-76S. [PMID: 38651578 DOI: 10.1177/02676591241237637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) may act as a driver or propagator of systemic inflammation. In turn, cytokine release can modify thromboelastographic (TEG) tests which are commonly used for anticoagulation monitoring. In this context, antithrombin (AT) supplementation might further modify TEG. METHODS This is a pre-specified sub-study of the "Randomized Controlled Trial of Antithrombin Supplementation During Extracorporeal Membrane Oxygenation" study (investigator-initiated, randomized, single-blind, two-arm trial) conducted in two Italian ECMO referral ICUs. Adult patients requiring vv-ECMO for respiratory failure and undergoing unfractioned heparin (UFH) administration were enrolled and randomized whether to receive AT supplementation. Plasma samples for cytokine assay (IL-8, IL-10, IL-6, IL-1β, TNF-α and Pro-ADM) and heparinase TEG were collected from every patient before ECMO start, 24 h and 72 h after ECMO start, before ECMO removal, and 7 days after ECMO removal or upon ICU discharge whichever happened first. AT concentration, coagulation and clinical data were collected before ECMO start and at pre-fixed time points. RESULTS Thirty-nine patients were enrolled (21 treatments, 18 controls). TEG-R had a weak-to-moderate positive correlation with IL-8, IL-6, IL-10 and TNF-α and a moderate positive correlation with Pro-ADM. TEG-ANG showed a weak negative correlation with IL-8, IL-6 and TNF-α, while TEG-MA negatively correlated with IL-8, TNF-α and Pro-ADM. AT supplementation seemed to modify the association between TEG-MA and IL-8, IL-10 and Pro-ADM; conversely, AT did not affect the relationship among TEG-R or TEG-ANG and the studied cytokines. CONCLUSIONS High concentrations of systemic cytokines correlated with longer reaction times and decreased angle and amplitude at TEG, suggesting that an increase in inflammation is related with hypocoagulability as revealed by thromboelastography.
Collapse
Affiliation(s)
- Andrea Meli
- Department of Anesthesiology, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano De Falco
- Department of Anesthesiology, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Novembrino
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Boscolo Anzoletti
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Arcadipane
- Department of Anesthesia and Intensive Care, IRCCS, UPMC, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC Palermo, Italy
| | - Giovanna Panarello
- Department of Anesthesia and Intensive Care, IRCCS, UPMC, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC Palermo, Italy
| | - Giovanna Occhipinti
- Department of Anesthesia and Intensive Care, IRCCS, UPMC, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), UPMC Palermo, Italy
| | - Giacomo Grasselli
- Department of Anesthesiology, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Mauro Panigada
- Department of Anesthesiology, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
3
|
Grover SP, Mackman N. Anticoagulant SERPINs: Endogenous Regulators of Hemostasis and Thrombosis. Front Cardiovasc Med 2022; 9:878199. [PMID: 35592395 PMCID: PMC9110684 DOI: 10.3389/fcvm.2022.878199] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022] Open
Abstract
Appropriate activation of coagulation requires a balance between procoagulant and anticoagulant proteins in blood. Loss in this balance leads to hemorrhage and thrombosis. A number of endogenous anticoagulant proteins, such as antithrombin and heparin cofactor II, are members of the serine protease inhibitor (SERPIN) family. These SERPIN anticoagulants function by forming irreversible inhibitory complexes with target coagulation proteases. Mutations in SERPIN family members, such as antithrombin, can cause hereditary thrombophilias. In addition, low plasma levels of SERPINs have been associated with an increased risk of thrombosis. Here, we review the biological activities of the different anticoagulant SERPINs. We further consider the clinical consequences of SERPIN deficiencies and insights gained from preclinical disease models. Finally, we discuss the potential utility of engineered SERPINs as novel therapies for the treatment of thrombotic pathologies.
Collapse
|
4
|
A botanical medicine dragon's blood exhibited clinical antithrombosis efficacy similar to low molecular weight heparin. SCIENCE CHINA-LIFE SCIENCES 2021; 64:1691-1701. [PMID: 33521854 DOI: 10.1007/s11427-020-1848-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/09/2020] [Indexed: 12/14/2022]
Abstract
Deep vein thrombosis (DVT) is a common complication following traumatic fracture with a 0.5%-1% annual incidence. Low molecular weight heparin (LMWH) is the most commonly used anticoagulation drug for DVT prevention, but treatment with LMWH is invasive. Our aim is to compare the antithrombotic effect of dragon's blood, an oral botanical anticoagulant medicine approved by the Chinese FDA, with LMWH in patients undergoing hip fracture surgery and to explore the molecular mechanisms of anticoagulation treatment. Our study recruited patients and divided them into LMWH and dragon's blood treatment group. Coagulation index tests, Doppler ultrasound and mRNA sequencing were performed before and after anticoagulation therapy. There was no significant difference in postoperative DVT incidence between the two groups (23.1% versus 15.4%, P=0.694). D-dimer (D-D) and fibrinogen degradation product (FDP) showed significant reductions in both groups after anticoagulation treatments. We identified SLC4A1, PROS1, PRKAR2B and seven other genes as being differentially expressed during anticoagulation therapy in both groups. Genes correlated with coagulation indexes were also identified. Dragon's blood and LMWH showed similar effects on DVT and produced similar gene expression changes in patients undergoing hip fracture surgery, indicating that dragon's blood is a more convenient antithrombosis medicine (oral) than LMWH (hypodermic injection).
Collapse
|
5
|
Yagi Y, Okazaki A, Endo M, Yanagisawa K, Fukuda J, Nishimura K, Yamazaki K. A Comparison of the Oligosaccharide Structures of Antithrombin Derived from Plasma and Recombinant Using POTELLIGENT ® Technology. ANAL SCI 2019; 35:1333-1340. [PMID: 31423004 DOI: 10.2116/analsci.19p181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Human antithrombin (AT) has two isoforms of which the predominant α-form is glycosylated on all four possible glycosylation sites and the lower abundant β-isoform lacks the oligosaccharide on Asn135. The main oligosaccharide structure of human AT consists of biantennary complex-type oligosaccharides lacking a core fucose. Generally, Chinese hamster ovary (CHO) cells produce recombinant human AT (rhAT) with core-fucosylated oligosaccharides. However, rhAT lacking core-fucose oligosaccharides can be produced by POTELLIGENT® technology, which uses FUT8 knockout CHO cells in production. The rhAT has more variable glycan structures, such as tetra-antennary complex type, high-mannose type, and mannose 6-phosphate species as minor components compared to plasma-derived human AT (phAT). In addition, the site-specific glycan profile was different between two ATs. We evaluated the effect of these properties on efficacy and safety based on a comparison of rhAT made by that technology with phAT in terms of their respective oligosaccharide structures, site-specific oligosaccharide profiles, and the ratio of α- and β-forms. Although some structural differences were found between the rhAT and phAT, we concluded that these differences have no significant effect on the efficacy and safety of rhAT.
Collapse
Affiliation(s)
- Yuki Yagi
- Bio Process Research and Development Laboratories, Production Division, Kyowa Kirin Co., Ltd
| | - Akira Okazaki
- Takasaki Plant, Production Division, Kyowa Kirin Co., Ltd
| | - Megumi Endo
- Bio Process Research and Development Laboratories, Production Division, Kyowa Kirin Co., Ltd
| | - Kumi Yanagisawa
- Bio Process Research and Development Laboratories, Production Division, Kyowa Kirin Co., Ltd
| | - Jun Fukuda
- Corporate Strategy & Planning Department, Kyowa Kirin Co., Ltd
| | - Koichiro Nishimura
- Bio Process Research and Development Laboratories, Production Division, Kyowa Kirin Co., Ltd
| | - Katsuyoshi Yamazaki
- Bio Process Research and Development Laboratories, Production Division, Kyowa Kirin Co., Ltd
| |
Collapse
|
6
|
Setaka T, Hirano K, Moriya K, Kaneko T, Morita S, Shinkai T, Morishita E, Ichida T. Portal Vein Thrombosis in a Patient with Hereditary Antithrombin Deficiency. Intern Med 2019; 58:1733-1737. [PMID: 30799362 PMCID: PMC6630136 DOI: 10.2169/internalmedicine.2295-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Portal vein thrombosis (PVT) has been reported in many patients with and without liver cirrhosis. The portal vein is a rare site of thrombosis, and various conditions can predispose an individual to PVT. Among those conditions, hereditary thrombophilia has been increasingly reported recently. We herein report the case of a non-cirrhotic 30-year-old man who developed acute PVT with hereditary antithrombin deficiency. Antithrombin (AT) replacement therapy was required along with heparin. Given our experience with this case, we believe that a screening test for prothrombotic disorders, such as AT deficiency, should be considered in cases of PVT.
Collapse
Affiliation(s)
- Tamao Setaka
- Department of Internal Medicine, Shonan East General Hospital, Japan
| | - Katsuharu Hirano
- Department of Internal Medicine, Shonan East General Hospital, Japan
| | - Keiichi Moriya
- Department of Internal Medicine, Shonan East General Hospital, Japan
| | - Tougen Kaneko
- Department of Internal Medicine, Shonan East General Hospital, Japan
| | - Seie Morita
- Department of Internal Medicine, Shonan East General Hospital, Japan
| | - Tetsu Shinkai
- Department of Internal Medicine, Shonan East General Hospital, Japan
| | - Eriko Morishita
- Department of Clinical Laboratory Sciences, Graduate School of Medical Science, Kanazawa University, Japan
| | - Takafumi Ichida
- Department of Internal Medicine, Shonan East General Hospital, Japan
| |
Collapse
|
7
|
Sugihara T, Fujiwara S, Ishioka S, Urakubo T, Suzawa T. Isolation of recombinant human antithrombin isoforms by Cellufine Sulfate affinity chromatography. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1095:198-203. [DOI: 10.1016/j.jchromb.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/29/2018] [Accepted: 07/01/2018] [Indexed: 11/16/2022]
|
8
|
Ling G, Nathwani AC, Tuddenham EGD. Recent advances in developing specific therapies for haemophilia. Br J Haematol 2018; 181:161-172. [DOI: 10.1111/bjh.15084] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Gavin Ling
- Katherine Dormandy Haemophilia and Thrombosis Centre; Royal Free London NHS Foundation Trust; London UK
| | - Amit C. Nathwani
- Katherine Dormandy Haemophilia and Thrombosis Centre; Royal Free London NHS Foundation Trust; London UK
| | - Edward G. D. Tuddenham
- Katherine Dormandy Haemophilia and Thrombosis Centre; Royal Free London NHS Foundation Trust; London UK
| |
Collapse
|
9
|
Yamada T, Kanda Y, Takayama M, Hashimoto A, Sugihara T, Satoh-Kubota A, Suzuki-Takanami E, Yano K, Iida S, Satoh M. Comparison of biological activities of human antithrombins with high-mannose or complex-type nonfucosylated N-linked oligosaccharides. Glycobiology 2016; 26:482-92. [PMID: 26747427 PMCID: PMC4813732 DOI: 10.1093/glycob/cww001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 12/31/2015] [Indexed: 01/30/2023] Open
Abstract
The structure of the N-linked oligosaccharides attached to antithrombin (AT) has been shown to affect its anticoagulant activity and pharmacokinetics. Human AT has biantennary complex-type oligosaccharides with the unique feature of lacking a core fucose, which affects its biological activities by changing its heparin-binding affinity. In human plasma, AT circulates as a mixture of the α-form bearing four oligosaccharides and the β-form lacking an oligosaccharide at Asn135. However, it remains unclear how the immature high-mannose-type oligosaccharides produced by mammalian cells affect biological activities of AT. Here, we succeeded in directly comparing the activities between the high-mannose and complex types. Interestingly, although there were no substantial differences in thrombin inhibitory activity, the high-mannose type showed higher heparin-binding affinity. The anticoagulant activities were increased by heparin and correlated with the heparin-binding affinity, resulting in the strongest anticoagulant activity being displayed in the β-form with the high-mannose type. In pharmacokinetic profiling, the high-mannose type showed a much shorter plasma half-life than the complex type. The β-form was found to have a prolonged plasma half-life compared with the α-form for the high-mannose type; conversely, the α-form showed a longer half-life than the β-form for the complex-type. The present study highlights that AT physiological activities are strictly controlled not only by a core fucose at the reducing end but also by the high-mannose-type structures at the nonreducing end. The β-form with the immature high-mannose type appears to function as a more potent anticoagulant than the AT typically found in human plasma, once it emerges in the blood.
Collapse
Affiliation(s)
- Tsuyoshi Yamada
- Bio Process Research and Development Laboratories, Production Division, Kyowa Hakko Kirin Co., Ltd., Takasaki-shi, Gunma 370-0013, Japan
| | - Yutaka Kanda
- Fuji Research Park, R&D Division, Kyowa Hakko Kirin Co., Ltd., Suntou-gun, Shizuoka 411-8731, Japan
| | - Makoto Takayama
- Fuji Research Park, R&D Division, Kyowa Hakko Kirin Co., Ltd., Suntou-gun, Shizuoka 411-8731, Japan
| | - Akitoshi Hashimoto
- Fuji Research Park, R&D Division, Kyowa Hakko Kirin Co., Ltd., Suntou-gun, Shizuoka 411-8731, Japan
| | - Tsutomu Sugihara
- Bio Process Research and Development Laboratories, Production Division, Kyowa Hakko Kirin Co., Ltd., Takasaki-shi, Gunma 370-0013, Japan
| | - Ai Satoh-Kubota
- Tokyo Research Park, R&D Division, Kyowa Hakko Kirin Co., Ltd., Machida-shi, Tokyo 194-8533, Japan
| | - Eri Suzuki-Takanami
- Tokyo Research Park, R&D Division, Kyowa Hakko Kirin Co., Ltd., Machida-shi, Tokyo 194-8533, Japan
| | | | - Shigeru Iida
- Tokyo Research Park, R&D Division, Kyowa Hakko Kirin Co., Ltd., Machida-shi, Tokyo 194-8533, Japan
| | - Mitsuo Satoh
- Immunology & Allergy R&D Unit, R&D Division, Kyowa Hakko Kirin Co., Ltd., Chiyoda-ku, Tokyo 100-8185, Japan
| |
Collapse
|
10
|
Ornaghi S, Mueller M, Barnea ER, Paidas MJ. Thrombosis during pregnancy: Risks, prevention, and treatment for mother and fetus-harvesting the power of omic technology, biomarkers and in vitro or in vivo models to facilitate the treatment of thrombosis. ACTA ACUST UNITED AC 2015; 105:209-25. [DOI: 10.1002/bdrc.21103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Sara Ornaghi
- Department of Obstetrics and Gynecology; University of Milan-Bicocca; Monza Italy
- Department of Obstetrics, Gynecology and Reproductive Sciences; Yale Women and Children's Center for Blood Disorders and Preeclampsia Advancement, Yale University School of Medicine; New Haven Connecticut
| | - Martin Mueller
- Department of Obstetrics, Gynecology and Reproductive Sciences; Yale Women and Children's Center for Blood Disorders and Preeclampsia Advancement, Yale University School of Medicine; New Haven Connecticut
- Department of Obstetrics and Gynecology; University Hospital Bern; Bern Switzerland
| | - Eytan R. Barnea
- Society for the Investigation of Early Pregnancy; Cherry Hill New Jersey
- BioIncept LLC; Cherry Hill New Jersey
| | - Michael J. Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences; Yale Women and Children's Center for Blood Disorders and Preeclampsia Advancement, Yale University School of Medicine; New Haven Connecticut
| |
Collapse
|
11
|
Ornaghi S, Barnhart KT, Frieling J, Streisand J, Paidas MJ. Clinical syndromes associated with acquired antithrombin deficiency via microvascular leakage and the related risk of thrombosis. Thromb Res 2014; 133:972-84. [PMID: 24593911 DOI: 10.1016/j.thromres.2014.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/25/2014] [Accepted: 02/11/2014] [Indexed: 12/17/2022]
Abstract
Antithrombin (AT) is a 65kDa glycoprotein belonging to a group of inhibitory factors known as serpins (serine protease inhibitors). It plays a critical role in the inhibition of coagulation and inflammation processes within the environment of the vascular endothelium. Inadequate levels of functional AT in plasma results in an increased risk of thrombotic events, both venous and arterial. AT deficiency can be inherited or acquired. Congenital AT deficiency is the most severe inherited thrombophilic condition with an odds ratio of 20 for the increased risk of venous thrombosis. Acquired AT deficiency occurs in a variety of physiologic and pathologic medical conditions with similar risks of increased thrombosis. In this article, we review clinical settings characterized by an acquired AT deficiency largely or partly subsequent to protein microvascular leakage. Other different mechanisms of AT depletion are implied in some clinical conditions together with endothelial loss, and, therefore, outlined. In addition, we provide a description of the current knowledge on the specific mechanisms underlying endothelial AT leakage and on the consequences of this protein decrease, specifically looking at thrombosis. We identify potential directions of research that might prove useful in patients with acquired AT deficiency.
Collapse
Affiliation(s)
- Sara Ornaghi
- Yale Women and Children's Center For Blood Disorders, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, USA; Department of Obstetrics and Gynecology, University of Milan-Bicocca, via Pergolesi 33, Monza, MB, Italy.
| | - Kurt T Barnhart
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - Johan Frieling
- rEVO Biologics 175 Crossing Boulevard, Framingham, MA 01702, USA
| | - James Streisand
- rEVO Biologics 175 Crossing Boulevard, Framingham, MA 01702, USA
| | - Michael J Paidas
- Yale Women and Children's Center For Blood Disorders, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, USA
| |
Collapse
|
12
|
Chevreux G, Faid V, Scohyers JM, Bihoreau N. N-/O-glycosylation analysis of human FVIIa produced in the milk of transgenic rabbits. Glycobiology 2013; 23:1531-46. [PMID: 24092837 PMCID: PMC3816631 DOI: 10.1093/glycob/cwt085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Human coagulation factor VIIa is a glycoprotein that promotes haemostasis through activation of the coagulation cascade extrinsic pathway. Most haemophilia A/B patients with inhibitors are treated by injection of plasma-derived or recombinant FVIIa. The use of recombinant products raises questions about the ability of the host cell to produce efficiently post-translationally modified proteins. Glycosylation is especially critical considering that it can modulate protein safety and efficacy. The present paper reports the N-/O-glycosylation pattern of a new recombinant human factor VIIa expressed in the mammary glands of transgenic rabbits. Glycosylation was investigated by chromatography and advanced mass spectrometry techniques for glycan identification and quantitation. Mass spectrometry (MS)/MS analyses were performed to confirm the glycan structures as well as the position and branching of specific monosaccharides or substituents. The two N-glycosylation sites were found to be fully occupied mostly by mono- and bi-sialylated biantennary complex-type structures, the major form being A2G2S1. Some oligomannose/hybrid structures were retrieved in lower abundance, the major ones being GlcNAcα1,O-phosphorylated at the C6-position of a Man residue (Man-6-(GlcNAcα1,O-)phosphate motif) as commonly observed on lysosomal proteins. No immunogenic glycotopes such as Galili (Galα1,3Gal) and HD antigens (N-glycolylneuraminic acid (NeuGc)) were detected. Concerning O-glycosylation, the product exhibited O-fucose and O-glucose-(xylose)0, 1, 2 motifs as expected. The N-glycosylation consistency was also investigated by varying production parameters such as the period of lactation, the number of consecutive lactations and rabbit generations. Results show that the transgenesis technology is suitable for the long-term production of rhFVIIa with a reproducible glycosylation pattern.
Collapse
Affiliation(s)
- Guillaume Chevreux
- Analytical Department, LFB Biotechnologies, 3 Avenue des Tropiques, Les Ulis, 91942 Courtaboeuf, France
| | | | | | | |
Collapse
|
13
|
Kim KA, Lim YY, Kim SH, Park JY. Bioequivalence of two intravenous formulations of antithrombin III: a two-way crossover study in healthy Korean subjects. Clin Ther 2013; 35:1752-61. [PMID: 24094463 DOI: 10.1016/j.clinthera.2013.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/03/2013] [Accepted: 08/31/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treatment with antithrombin (AT)-III is indicated for patients with sepsis or hereditary AT deficiency. OBJECTIVE The purpose of this study was to compare the pharmacokinetic and pharmacodynamic characteristics of 2 AT-III formulations in healthy Korean volunteers to satisfy the regulatory requirements for bioequivalence for marketing purposes. METHODS A single-center, single-dose, open-label, randomized, 2-period, 2-sequence crossover study was conducted in healthy Korean volunteers. Blood samples for the drug analysis were collected for up to 216 hours after drug administration. Participants received either the test or reference formulation of AT-III 100 U/kg IV for 20 minutes in the first period and the alternative formulation in the second period. Both the AT-III activity and antigen (Ag) were measured for the analysis of pharmacokinetic properties, and the prothrombin time and the activated partial thromboplastin time were assessed for the analysis of pharmacodynamic properties. Because AT-III is an endogenous compound, the analysis used data corrected from baseline values. The tolerability of the 2 formulations was also assessed based on physical examinations including vital sign measurements, laboratory tests, and 12-lead ECG. RESULTS Of the 20 subjects enrolled (mean [SD] age, height, and weight, 25.3 [2.3] years, 175.3 [4.5] cm, and 67.4 [6.3] kg, respectively), 19 completed both treatment periods; 1 subject withdrew consent for personal reasons. The observed mean (SD) Cmax, AUClast, and AUC0-∞ of AT-III activity were, respectively, 279.24% (35.92), 14,364.10 (2325.25) %·h, and 17,526.38 (3150.81) %·h with the test formulation and 249.75% (31.96), 12,962.95 (1897.52) %·h, and 15,957.67 (3189.21) %·h with the reference formulation. The observed mean (SD) Cmax, AUClast, and AUC0-∞ of AT-III Ag were 62.58 (5.66) mg/dL, 3051.94 (401.87) mg/dL·h, and 3639.80 (726.01) mg/dL·h, respectively, with the test formulation and 58.63 (5.27) mg/dL, 2805.08 (272.38) mg/dL·h, and 3340.00 (428.46) mg/dL·h with the reference formulation. The geometric mean ratios (90% CI) of the log-transformed data for AT-III activity between the 2 formulations were 1.11494 (1.08994-1.14053) for Cmax, 1.11305 (1.05435-1.17503) for AUClast, and 1.11527 (1.03754-1.19889) for AUC0-∞; corresponding values for AT-III Ag were 1.08802 (1.06258-1.11405), 1.10905 (1.05804-1.16242), and 1.11460 (1.02058-1.21726). During the study period, 8 adverse events were reported, and all were transient, mild, and resolved completely during the treatment period. CONCLUSION The results of the present study showed that these 2 AT-III formulations met the regulatory criteria for pharmacokinetic bioequivalence with respect to AT-III activity and Ag in these healthy Korean subjects. ClinicalTrials.gov identifier: NCT00846274.
Collapse
Affiliation(s)
- Kyoung-Ah Kim
- Department of Clinical Pharmacology and Toxicology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | | | | | | |
Collapse
|
14
|
Abstract
The mechanisms of vascular control of thrombotic events remain unclear. The vasculature possesses essential anticoagulant factors that regulate coagulation. Because the endothelium-to-blood ratios are much higher in the microcirculation, it is likely that stasis contributes to thrombotic risk, due in large part to failure to rapidly access the microcirculation and to gain access to this highly anticoagulant environment. Inflammation can potentiate thrombosis in part through downregulation of the vascular anticoagulants, a process that appears to be exacerbated in aging, a well-known risk factor for thrombosis. Surgery and trauma, two major risk factors for thrombosis, result in the release of a variety of cellular components that trigger coagulation through separate mechanisms.
Collapse
Affiliation(s)
- Charles T Esmon
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, 73104, USA.
| | | |
Collapse
|
15
|
Pal N, Kertai MD, Lakshminarasimhachar A, Avidan MS. Pharmacology and clinical applications of human recombinant antithrombin. Expert Opin Biol Ther 2010; 10:1155-68. [DOI: 10.1517/14712598.2010.495713] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
16
|
Yang H, Li QW, Han ZS, Hu JH, Li WY, Liu ZB. Recombinant human antithrombin expressed in the milk of non-transgenic goats exhibits high efficiency on rat DIC model. J Thromb Thrombolysis 2009; 28:449-57. [DOI: 10.1007/s11239-009-0347-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 04/30/2009] [Indexed: 01/03/2023]
|
17
|
Abstract
Perioperative bleeding is a major challenge particularly because of increasing clinical use of potent antithrombotic drugs. Understanding current concepts of coagulation is important in determining the preoperative bleeding risk of patients, and in managing hemostatic therapy perioperatively. The serine protease thrombin plays pivotal roles in the activation of additional serine protease zymogens (inactive enzymatic precursors), cofactors, and cell-surface receptors. Thrombin generation is closely regulated to locally achieve rapid hemostasis after injury without causing uncontrolled systemic thrombosis. During surgery, there are major disturbances in coagulation and inflammatory systems because of hemorrhage/hemodilution, blood transfusion, and surgical stresses. Postoperative bleeding often requires allogeneic blood transfusions, which support thrombin generation and hemostasis. However, procoagulant activity and inflammation are increased postoperatively; thus, antithrombotic therapy may be required to prevent perioperative thrombotic complications. There have been significant advances in the management of perioperative hemostasis and thrombosis because of the introduction of novel hemostatic and antithrombotic drugs. However, a limitation of current treatment is that conventional clotting tests do not reflect the entire physiological processes of coagulation making optimal pharmacologic therapy difficult. Understanding the in vivo regulatory mechanisms and pharmacologic modulation of thrombin generation may help control bleeding without potentially increasing prothrombotic risks. In this review, we focus on the regulatory mechanisms of hemostasis and thrombin generation using multiple, simplified models of coagulation.
Collapse
Affiliation(s)
- Kenichi A Tanaka
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Emory University School of Medicine, Atlanta, GA 30322, USA.
| | | | | |
Collapse
|
18
|
Drozd NN, Makarov VA, Miftakhova NT, Dereza TL, Azhigirova MA. Antithrombotic activity of Russian antithrombin III preparation on the model of induced venous thrombosis. Bull Exp Biol Med 2007; 142:66-8. [PMID: 17369905 DOI: 10.1007/s10517-006-0293-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Antithrombotic activity of Russian preparation Antithrombin III was studied on rat model of induced venous thrombosis. Optimal doses of antithrombin and heparin preventing thrombus growth were determined.
Collapse
Affiliation(s)
- N N Drozd
- Laboratory of Pathology and Pharmacology of Hemostasis, Laboratory for Fractionation of Plasma Proteins, Hematology Research Center, Russian Academy of Medical Sciences, Moscow.
| | | | | | | | | |
Collapse
|
19
|
Mochizuki S, Miyano K, Kondo M, Hirose M, Masaki A, Ohi H. Purification and characterization of recombinant human antithrombin containing the prelatent form in Chinese hamster ovary cells. Protein Expr Purif 2005; 41:323-31. [PMID: 15866718 DOI: 10.1016/j.pep.2005.03.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2004] [Revised: 03/07/2005] [Indexed: 11/17/2022]
Abstract
Antithrombin (AT) is a serine proteinase inhibitor and a major regulator of the blood coagulation cascade. AT in human plasma has two isoforms, a predominant alpha-isoform and a minor beta-isoform; the latter lacks N-glycosylation at Asn 135 and has a higher heparin affinity. From the difference in its folding states, the AT molecule can be separated into three forms: a native form, a denatured and inactive form known as the latent form, and a partially denatured form called the prelatent form. In this study, we purified and characterized recombinant human AT (rAT) containing the prelatent form produced by Chinese hamster ovary (CHO) cells. When rAT was purified at physiological pH, its specific activity was lower than that of plasma-derived human AT (pAT). The latent and prelatent forms were detected in rAT by using hydrophobic interaction chromatography analysis. However, when rAT was purified at alkaline pH, the prelatent form was reversibly folded to the native form and the inhibitory activity of rAT increased to a value similar to that of pAT. Highly purified rAT was analyzed and compared with pAT by using sodium dodecyl sulfate-polyacrylamide gel electrophoresis, circular dichroism spectroscopy, amino acid composition, N-terminal sequence, monosaccharide composition, peptide mapping, and heparin-binding affinity. From these analyses, rAT was found to be structurally identical to pAT, except for carbohydrate side-chains. rAT in CHO cells had a high beta-isoform content and it caused a higher heparin affinity than by pAT and also pH-dependent reversible inhibitory activity.
Collapse
Affiliation(s)
- Shinobu Mochizuki
- Protein Research Laboratory, Pharmaceuticals Research Unit, Research and Development Division, Mitsubishi Pharma Corporation, 2-25-1 Shodai-ohtani, Hirakata, Osaka 573-1153, Japan.
| | | | | | | | | | | |
Collapse
|
20
|
Karlsson G, Winge S. Separation between the alpha and beta forms of human antithrombin by hydroxyapatite high-performance liquid chromatography. Protein Expr Purif 2003; 28:196-201. [PMID: 12651125 DOI: 10.1016/s1046-5928(02)00678-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Human antithrombin (AT) inhibits several proteases in the coagulation system, including thrombin and factor Xa, and thus, plays an important role in the regulation of blood coagulation. The predominant form of AT in plasma is ATalpha, which contains four glycosylated asparagine residues, and the minor form is ATbeta, which lacks the Asn-135 glycosylation. In this study, hydroxyapatite high-performance liquid chromatography, using a segmented sodium phosphate gradient, was utilized for the high-resolution separation of ATalpha and ATbeta. The detection limit (signal-to-noise ratio of 3) for ATbeta was 30 microg/mL, corresponding to 0.5% of the injected concentration of AT. Two analyzed commercial AT products both contained about 2% ATbeta. This method is suitable for the determination of ATbeta in pure samples of native AT.
Collapse
Affiliation(s)
- Göran Karlsson
- Plasma R & D, Octapharma AB, SE-11275 Stockholm, Sweden.
| | | |
Collapse
|
21
|
Lynch TJ. Biotechnology: alternatives to human plasma-derived therapeutic proteins. Best Pract Res Clin Haematol 2000; 13:669-88. [PMID: 11102283 DOI: 10.1053/beha.2000.0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Proteins derived from human plasma have become critically important therapeutic products since their introduction in the 1940s. In the last 20 years, the tools of molecular biology have provided alternatives to the administration of the natural products. Recombinant analogues of Factor VIII and Factor IX are commercially available, and recombinant forms of other plasma proteins are under development. Genetic engineering also provides the opportunity to modify a natural protein to improve the efficiency with which it can be produced in vitro, or to change its therapeutic profile. More efficient production systems, such as transgenic plants or animals, may yield less costly therapies and a wider availability of products that are now in limited supply. Finally, gene therapy offers the prospect of permanently correcting conditions arising from deficiencies in any one of several plasma proteins, freeing individuals from the need to undergo periodic treatments with exogenous proteins.
Collapse
Affiliation(s)
- T J Lynch
- Division of Hematology, U.S. Food and Drug Administration, Rockville, MD, USA
| |
Collapse
|
22
|
Schorr M, Siebeck M, Zügel N, Welcker K, Gippner-Steppert C, Czwienzek E, Gröschler M, Jochum M. Antithrombin III and local serum application: adjuvant therapy in peritonitis. Eur J Clin Invest 2000; 30:359-66. [PMID: 10759886 DOI: 10.1046/j.1365-2362.2000.00630.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with diffuse peritonitis show an overall mortality of about 20%, probably caused by the breakdown of local defence mechanisms combined with a systemic outspread of bacteria and toxins, which often results in sepsis syndrome. DESIGN In a prospective, randomized, controlled study 50 patients with diffuse secondary peritonitis were included. Patients in the therapy group were treated with an adjuvant medication consisting of a continuous intravenous infusion of antithrombin III and two intraperitoneal instillations of fresh frozen human donor serum. The aim of the study was the reduction of mortality and incidence of multiple organ failure. RESULTS Mean antithrombin III plasma levels in the therapy group were raised above 140% for 4 days and were significantly higher than in the control group. With the intraperitoneal application of fresh frozen serum and antithrombin III opsonic capacity as well as thrombin, inhibitory activity in the exudate could be significantly elevated over 2 days. The 90-day-mortality rate was 6/26 (23%) in the control group and 6/24 (25%) in the therapy group. Although no improvement of mortality was achieved, a slight but not significant reduction of the severity of the multiple organ failure was seen. CONCLUSIONS The chosen therapeutic approach was feasible and showed no side-effects. Yet, neither mortality nor multiple organ failure were significantly improved by the applied short-term adjuvant therapy. Thus, for future trials in severely-ill patients a longer treatment period and/or combinations of antithrombin III with other anti-inflammatory agents should be considered.
Collapse
Affiliation(s)
- M Schorr
- Ludwig-Maximilians-Universität München, Munich; Zentralklinikum Augsburg, Augsburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Rossi M, Martinelli L, Storti S, Corrado M, Marra R, Varano C, Schiavello R. The role of antithrombin III in the perioperative management of the patient with unstable angina. Ann Thorac Surg 1999; 68:2231-6. [PMID: 10617008 DOI: 10.1016/s0003-4975(99)00864-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate the effectiveness of intraoperative administration of antithrombin III (AT III) to improve anticoagulation and preserve the hemostatic mechanisms during cardiopulmonary bypass (CPB) in patients with unstable angina under heparin treatment. METHODS We divided 22 patients, scheduled for coronary artery bypass grafting, into two groups. Group A (11 patients) received 3000 International Units (IU) of AT III concentrates plus heparin before aortic cannulation. Group B (11 patients) received only heparin. Blood drainage, allogeneic blood transfusions, and intraoperative activated coagulation time were recorded. Also, AT III, thrombin-antithrombin complex (TAT), fragment 1.2 (F 1.2), and D-dimers were measured during the operation and the first postoperative day. RESULTS Group A patients had fewer transfusions and had less chest-tube drainage. In group A, AT III levels increased after AT III concentrates administration and were always higher than in group B. In group B, F 1.2 and TAT increased significantly more after CPB and at the end of operation. Differences in D-dimers between the groups were not significant. CONCLUSIONS Intraoperative administration of AT III concentrates allowed adequate anticoagulation during CPB and attenuated the coagulative cascade activation and the consequent consumptive coagulopathy.
Collapse
Affiliation(s)
- M Rossi
- Department of Anesthesia and Critical Care, Catholic University of the Sacred Heart, Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
25
|
Dickneite G, Leithäuser B. Influence of antithrombin III on coagulation and inflammation in porcine septic shock. Arterioscler Thromb Vasc Biol 1999; 19:1566-72. [PMID: 10364091 DOI: 10.1161/01.atv.19.6.1566] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The physiological inhibitor of thrombin, antithrombin III (ATIII, Kybernin P) was investigated for its antiinflammatory and anticoagulant effects in a pig model of septic shock. Pigs were infused with a dose of 0.25 microgram. kg-1. h-1 of lipopolysaccharide (LPS) over a period of 3 hours. Animals developed systemic inflammation, disseminated intravascular coagulation (DIC), organ failure and cardiovascular abnormalities, namely pulmonary hypertension and systemic hypotension. Twenty septic pigs were allocated to 2 study groups, treated either with ATIII (n=10) or placebo (n=10). ATIII was administered as a 250-U/kg IV bolus infusion for 30 minutes (-60 to -30 minutes) followed by a single IV bolus of 125 U/kg (t=0) and a second 30-minute infusion of 250 U/kg (120 to 150 minutes). ATIII significantly prevented the development of a DIC; the increase in fibrin monomers (placebo, 11.4+/-9.1 reciprocal titers, at 6 hours) was completely overcome by ATIII (P<0. 05). ATIII significantly prevented the increase in thromboxane (TXB2) levels, which were 809+/-287 pg/mL in the placebo and 420+/-174 pg/mL in the verum group after 6 hours (P<0.02). On the other hand, ATIII had no influence on TNF levels. In a lethal study with an increased dose of LPS (0.5 microgram. kg-1. h-1). A significant reduction in mortality was observed in the ATIII group (0 of 7) compared with the placebo group (4 of 6) (P<0.05, chi2 test) a significant reduction of pulmonary hypertension (placebo, 42.0+/-11. 1 mm Hg; ATIII, 23.6+/-7.5 mm Hg, P<0.05), but no effect on systemic hypotension, was noted in the ATIII group. It was thus concluded that modulation of the procoagulatory state by substitution of ATIII results in a late beneficial antiinflammatory effect in this model of septic shock.
Collapse
Affiliation(s)
- G Dickneite
- Centeon Pharma GmbH, 35002 Marburg Medical Clinic, Justus-Liebig-University, 35385 Giebetaen, Germany.
| | | |
Collapse
|
26
|
Kok V, Slacmeulder M, Jochmans K, Ninane J. [Antithrombin deficiency and thrombosis in a young child]. Arch Pediatr 1999; 6:279-82. [PMID: 10191894 DOI: 10.1016/s0929-693x(99)80265-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Thromboses represent a rare event in children and may be due to a deficiency of antithrombin. CASE REPORT A 10-year-old boy developed thrombosis due to a congenital quantitative deficiency in antithrombin, confirmed by molecular biology. His father was diagnosed with the same deficiency. The child was first treated with heparin and is now on antivitamin K. He is well 26 months after diagnosis. CONCLUSION When a young patient presents with a thrombotic event, a congenital deficiency in one of the inhibitors of coagulation, one of which is antithrombin, should be looked for and the condition treated as soon as possible.
Collapse
Affiliation(s)
- V Kok
- Service de pédiatrie, clinique Notre-Dame-de-Grâce, Gosselies, Belgique
| | | | | | | |
Collapse
|
27
|
Thiagarajan P, Wu KK. Mechanisms of antithrombotic drugs. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 1999; 46:297-324. [PMID: 10332506 DOI: 10.1016/s1054-3589(08)60474-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- P Thiagarajan
- Division of Hematology and Vascular Biology Research Center, University of Texas-Houston Medical School 77030, USA
| | | |
Collapse
|
28
|
Weisinger AS, Levy JH. Current Hematologic Issues in Cardiac Surgery and Cardiopulmonary Bypass. Semin Cardiothorac Vasc Anesth 1998. [DOI: 10.1177/108925329800200402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recently, new attempts have been made to fight old problems of coagulation and hemostasis as they relate to cardiac surgery. These discoveries are timely because the practice of both internists and surgeons has begun to change. Newer and more potent medications are being used by cardiologists in an effort to exert better control over hemostatic mechanisms with the hope that this may eventually improve the chances for sur vival of patients with coronary artery disease. In addi tion, cardiac surgeons have been more aggressive in voicing their concerns that cardiopulmonary bypass (CPB) is nothing more than a necessary evil. More and more surgeons are performing coronary artery bypass surgery (CABG) without the use of a CPB machine when possible. Cardiac anesthesiologists are expected to take patients from the emergency room (where they may have received thrombolytics), from the catheterization laboratory (where they may have received antiplatelet agents), and from the intensive care unit (where they may have received heparin) to the operating room, where they will undergo further anticoagulation therapy and then have their blood exposed to a thrombogenic surface for up to several hours. It is even more impor tant to ensure that this is all reversed at the end of surgery. The answers to these problems are not entirely available yet; however, one piece of the puzzle has been found. What follows is a review of hemostatic balance in patients who present for cardiac surgery and how this relates to thrombin, the center of the coagulation universe. It is believed that by better control of the generation of thrombin during CPB, patients may have better results from anticoagulation therapy during sur gery and have fewer problems with bleeding after surgery. A discussion on the newest attempt at this, antithrombin III, follows.
Collapse
Affiliation(s)
- Andrew S. Weisinger
- Department of Anesthesiology, Emory University School of Medicine, Division of Cardiothoracic Anesthesiology and Critical Care, TheEmory Clinic, Atlanta, GA
| | - Jerrold H. Levy
- Department of Anesthesiology, Emory University School of Medicine, Division of Cardiothoracic Anesthesiology and Critical Care, TheEmory Clinic, Atlanta, GA
| |
Collapse
|
29
|
Transgenically Produced Human Antithrombin: Structural and Functional Comparison to Human Plasma–Derived Antithrombin. Blood 1998. [DOI: 10.1182/blood.v91.12.4561] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractRecombinant human antithrombin (rhAT) produced in transgenic goat milk was purified to greater than 99%. The specific activity of the rhAT was identical to human plasma–derived AT (phAT) in an in vitro thrombin inhibition assay. However, rhAT had a fourfold higher affinity for heparin than phAT. The rhAT was analyzed and compared with phAT by reverse phase high-performance liquid chromatography, circular dichroism, fluorophore-assisted carbohydrate electrophoresis (FACE), amino acid sequence, and liquid chromatography/mass spectrography peptide mapping. Based on these analyses, rhAT was determined to be structurally identical to phAT except for differences in glycosylation. Oligomannose structures were found on the Asn 155 site of the transgenic protein, whereas only complex structures were observed on the plasma protein. RhAT contained a GalNAc for galactose substitution on some N-linked oligosaccharides, as well as a high degree of fucosylation. RhAT was less sialylated than phAT and contained both N-acetylneuraminic and N-glycolylneuraminic acid. We postulate that the increase in affinity for heparin found with rhAT resulted from the presence of oligomannose-type structures on the Asn 155 glycosylation site and differences in sialylation.
Collapse
|
30
|
Transgenically Produced Human Antithrombin: Structural and Functional Comparison to Human Plasma–Derived Antithrombin. Blood 1998. [DOI: 10.1182/blood.v91.12.4561.412k21_4561_4571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recombinant human antithrombin (rhAT) produced in transgenic goat milk was purified to greater than 99%. The specific activity of the rhAT was identical to human plasma–derived AT (phAT) in an in vitro thrombin inhibition assay. However, rhAT had a fourfold higher affinity for heparin than phAT. The rhAT was analyzed and compared with phAT by reverse phase high-performance liquid chromatography, circular dichroism, fluorophore-assisted carbohydrate electrophoresis (FACE), amino acid sequence, and liquid chromatography/mass spectrography peptide mapping. Based on these analyses, rhAT was determined to be structurally identical to phAT except for differences in glycosylation. Oligomannose structures were found on the Asn 155 site of the transgenic protein, whereas only complex structures were observed on the plasma protein. RhAT contained a GalNAc for galactose substitution on some N-linked oligosaccharides, as well as a high degree of fucosylation. RhAT was less sialylated than phAT and contained both N-acetylneuraminic and N-glycolylneuraminic acid. We postulate that the increase in affinity for heparin found with rhAT resulted from the presence of oligomannose-type structures on the Asn 155 glycosylation site and differences in sialylation.
Collapse
|
31
|
Van Norman GA, Gernsheimer T, Chandler WL, Cochran RP, Spiess BD. Indicators of fibrinolysis during cardiopulmonary bypass after exogenous antithrombin-III administration for acquired antithrombin III deficiency. J Cardiothorac Vasc Anesth 1997; 11:760-3. [PMID: 9327320 DOI: 10.1016/s1053-0770(97)90172-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- G A Van Norman
- Department of Anesthesiology, University of Washington, Seattle 98195, USA
| | | | | | | | | |
Collapse
|
32
|
Sánchez J, Velasco F, Alvarez R, Román J, Torres A. Aortic thrombosis in a neonate with hereditary antithrombin III deficiency: successful outcome with thrombolytic and replacement treatment. Acta Paediatr 1996; 85:245-7. [PMID: 8640060 DOI: 10.1111/j.1651-2227.1996.tb14003.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We report the case of a newborn male who presented an aortic thrombosis during the neonatal period and was subsequently diagnosed as having antithrombin III (AT III) hereditary deficiency type I. This hypercoagulable condition is known to predispose young adults to venous thrombosis, but in our patient the primary thrombotic incident affected the arterial vessels within the first few days of life. Combined treatment with thrombolytic agents and AT III concentrates recovered aortic permeability, suggesting that the use of AT III may be beneficial for the treatment of thrombotic complications during the first few days of life.
Collapse
Affiliation(s)
- J Sánchez
- Haematology Department, University Hospital Reina Sofia, Córdoba, Spain
| | | | | | | | | |
Collapse
|
33
|
Rowbottom SJ. Epidural caesarean section in a patient with congenital antithrombin III deficiency. Anaesth Intensive Care 1995; 23:493-5. [PMID: 7485945 DOI: 10.1177/0310057x9502300416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
34
|
Lebing WR, Hammond DJ, Wydick JE, Baumbach GA. A highly purified antithrombin III concentrate prepared from human plasma fraction IV-1 by affinity chromatography. Vox Sang 1994; 67:117-24. [PMID: 7801599 DOI: 10.1111/j.1423-0410.1994.tb01645.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We describe an improved method for large-scale purification of antithrombin III (AT-III) from human plasma involving heparin affinity chromatography of redissolved fraction IV-1 paste, viral inactivation by heating, followed by a second heparin affinity column. The characteristics of a new heparin affinity resin and the ability to extrapolate process behavior from small-scale (20 ml) to large-scale (40 liter) columns are described. This supports the use of the small-scale column for process optimization and validation studies in compliance with current regulatory requirements for biological products. The process has been characterized by analytical techniques including sodium dodecyl sulfate (SDS), reducing SDS, and nondenaturing polyacrylamide gel electrophoresis; laser desorption time-of-flight mass spectroscopy, and electrospray mass spectroscopy. These results demonstrate that greater than 95% of the protein in the final products is AT-III, which is greater than 95% active as defined by thrombin inhibition.
Collapse
Affiliation(s)
- W R Lebing
- Plasma Manufacturing Technology, Miles Inc., Clayton, N.C. 27520
| | | | | | | |
Collapse
|
35
|
|