Unfractionated heparin dosing for therapeutic anticoagulation in critically ill obese adults

PURPOSE

Research evaluating unfractionated heparin (UFH) dosing in obese critically ill populations is limited. This study aimed to determine optimal weight-based and total therapeutic infusion rates of UFH in this population.

METHODS

This retrospective cohort study compared adults on UFH infusions in intensive care units from May 2011 through October 2013 across 3 weight strata: 95 to 104 kg (control), 105 to 129 kg (high weight), and greater than or equal to 130 kg (higher weight). Primary outcomes included total and weight-based infusion rates for therapeutic anticoagulation.

RESULTS

To achieve therapeutic activated partial thromboplastin times, higher weight patients had higher mean infusion rates compared with control (2017 vs 1582 U/h; P = .002). Mean weight-based therapeutic infusion rate was lower in the higher weight group compared with control (13.1 vs 15.8 U kg(-1) h(-1); P = .008). Post hoc analyses indicated mean weight-based infusion rate to achieve therapeutic anticoagulation was 15 U kg(-1) h(-1) in patients less than 165 kg and 13 U kg(-1) h(-1) in patients greater than 165 kg.

CONCLUSIONS

Patients greater than or equal to 130 kg have lower weight-based heparin requirements compared with patients 95 to 104 kg. This difference appears to be driven by patients greater than 165 kg. Patients greater than 165 kg have lower weight-based heparin requirements, whereas patients from 105 to 164 kg have weight-based requirements similar to a normal-weight patient population. Initiating heparin at appropriate weight-based doses for obese patients may optimize anticoagulation.

The chemokine receptor Cxcr3 is not essential for acute cardiac allograft rejection in mice and rats

Chemokine receptors have gained attention as potential targets for novel therapeutic strategies. We investigated the mechanisms of allograft rejection in chemokine receptor Cxcr3-deficient mice using a model of acute heart allograft rejection in the strain combination BALB/c to C57BL/6. Allograft survival was minimally prolonged in Cxcr3-deficient mice compared to wild-type (wt) animals (8 vs. 7 days) and treatment with a subtherapeutic dose of cyclosporine A (CsA) led to similar survival in Cxcr3-deficient and wt recipients (13 vs. 12 days). At rejection grafts were histologically indistinguishable. Microarray analysis revealed that besides Cxcr3 only few genes were differentially expressed in grafts or in spleens from transplanted or untransplanted animals. Transcript analysis by quantitative RT-PCR of selected cytokines, chemokines, or chemokine receptors or serum levels of selected cytokines and chemokines showed similar levels between the two groups. Furthermore, in a rat heart allograft transplantation model treatment with a small molecule CXCR3 antagonist did not prolong survival despite full blockade of Cxcr3 in vivo. In summary, Cxcr3 deficiency or pharmacologic blockade does not diminish graft infiltration, tempo and severity of rejection. Thus, Cxcr3 does not appear to play a pivotal role in the allograft rejection models described here.

Von Willebrand factor-cleaving protease activity and proteolysis of von Willebrand factor in bone marrow transplant-associated thrombotic microangiopathy

INTRODUCTION

Thrombotic microangiopathy (TM) of the fulminant type occurring in patients following bone marrow transplant (BMT) has clinical manifestations that are similar to thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome, but the outcome is generally fatal despite conventional therapy. Idiopathic acquired TTP has been associated with IgG inhibitors to the cleaving protease of von Willebrand factor (vWF) in plasma. In this study, we investigated the role of the vWF protease and vWF proteolysis in the pathogenesis of BMT-associated TM of the fulminant type.

METHODS

vWF antigen level, vWF multimeric pattern, and vWF metalloprotease activity were investigated in the plasma samples of six consecutive patients with acute BMT-associated TM. Histologic and immunohistochemical studies were also performed on autopsy kidney specimens from four of the patients. All six patients had the fulminant type of the disorder with a fatal outcome and none of the patients responded to plasma infusion.

RESULTS

The vWF-cleaving protease activity in plasma was normal in all patients. However, analysis of the vWF multimeric pattern showed a decrease of high molecular weight multimers. The decrease of large multimers may be caused by vWF-platelet binding as well as shear enhanced proteolysis of vWF. In the four patients who had an autopsy, a pattern of arteriolar thrombosis, distinct from that of TTP, was detected in the kidneys.

CONCLUSION

These findings suggest that BMT-associated TM of the fulminant type is a heterogeneous process and distinct from TTP in pathogenesis. Analysis of vWF protease and vWF multimeric distribution are valuable tools in making the distinction between BMT-associated TM and TTP.

On the preparative use of recombinant pig alpha(1-3)galactosyl-transferase

A series of non-natural N-acyl derivatives of lactosamine is incubated with recombinant alpha(1-3)galactosyl-transferase and UDP-galactose. The enzyme shows a high promiscuity towards the non-natural acceptors. It selectively transfers a galactose unit onto the 3-OH group of the terminal beta-linked galactose in an alpha-mode to give an array of linear-B trisaccharides.

Enzymatic synthesis of sialyl-Lewis(a)-libraries with two non-natural monosaccharide units

A series of sialylated type-I sugars, which have the natural N-acetyl group of the glucosamine moiety replaced by a wide range of amides, is incubated with recombinant fucosyl-transferase III and non-natural guanosine-diphosphate activated donor-sugars. Surprisingly, the enzyme tolerates the simultaneous alterations on the donor and acceptor to form a wide array of sialyl-Lewis(a)-analogues.

On the preparative use of recombinant beta(1-3)galactosyl-transferase

A number of non-natural N-acyl derivatives of glucosamine is incubated with a recombinant beta(1-3)galactosyl-transferase and UDP-galactose. Surprisingly, the enzyme recognizes the non-natural acceptors as substrates and transfers galactose onto the 3-OH group in a beta-mode to give a series of Lewis(c)-(type 1) disaccharides.

Immunocytochemical localization of alpha2,3(N)-sialyltransferase (ST3Gal III) in cell lines and rat kidney tissue sections: evidence for golgi and post-golgi localization

Sialylation is a biosynthetic process occurring in the trans compartments of the Golgi apparatus. Corresponding evidence is based on localization and biochemical studies of alpha2, 6(N)-sialyltransferase (ST6Gal I) as previously reported. Here we describe generation and characterization of polyclonal antibodies to recombinant rat alpha2,3(N)-sialyltransferase (ST3Gal III) expressed as a soluble enzyme in Sf9 cells or as a beta-galactosidase-human-ST3Gal III fusion-protein from E.coli , respectively. These antibodies were used to localize ST3Gal III by immunofluorescence in various cell lines and rat kidney tissue sections. In transiently transfected COS cells the antibodies directed to soluble sialyltransferase or the sialyltransferase portion of the fusion-protein only recognized the recombinant antigen retained in the endoplasmic reticulum. However, an antibody fraction crossreactive with beta-galactosidase recognized natively expressed ST3Gal III which was found to be colocalized with beta1, 4-galactosyltransferase in the Golgi apparatus of several cultured cell lines. Antibodies affinity purified on the beta-galactosidase-ST3Gal III fusion-protein column derived from both antisera have then been used to localize the enzyme in perfusion-fixed rat kidney sections. We found strong staining of the Golgi apparatus of tubular epithelia and a brush-border-associated staining which colocalized with cytochemical staining of the H+ATPase. This subcellular localization was not observed for ST6Gal I which localized to the Golgi apparatus. These data show colocalization in the Golgi apparatus and different post-Golgi distributions of the two sialyltransferases.

Enzymatic fucosylations of non-natural sialylated type-I trisaccharides with recombinant fucosyl-transferase-III

Recombinant fucosyl-transferase-III (Lewis type enzyme) is used to prepare a series of non-natural sialyl-Lewis derivatives on a preparative scale. The enzyme tolerates a wide range of acceptors which have the natural N-acetyl group of the glucosamine moiety replaced by substituted aromatic and heteroaromatic amides.

Enzymatic alpha(2-3)sialylation of non-natural type-I (Lewisc) disaccharides with recombinant sialyl-transferase

Recombinant alpha(2-3)sialyl-transferase from rat liver is used to sialylate a series of type-I (Lewisc) disaccharides on a preparative scale. The enzyme tolerates a broad array of N-acetyl replacements of the N-glucosamine subunit ranging from small and large lipophilic groups to charged and heterocyclic amides.

Sequence relations among the IncY plasmid p15B, P1, and P7 prophages

Electron microscopic analysis of heteroduplex molecules between the 94-kb plasmid p15B and the 92-kb phage P1 genome revealed nine regions of nonhomology, eight substitutions, and two neighboring insertions. Overall, the homologous segments correspond to 83% of the P1 genome and 81% of p15B. Heteroduplex molecules between p15B and the 99-kb phage P7 genome showed nonhomology in eight of the same nine regions; in addition, two new nonhomologous segments are present and P7 carries a 5-kb insertion representing Tn902. The DNA homology between those two genomes amounts to 79% of P7 DNA and 83% of p15B. Plasmid p15B contains two stem-loop structures. One of them has no equivalent structure on P1 and P7 DNA. The other substitutes the invertible C segments of P1 and P7 and their flanking sequences including cin, the gene for the site-specific recombinase mediating inversion.