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Cuddington C, Greenfield A, Lee YG, Kim JL, Lamb D, Buehler PW, Black SM, Palmer AF, Whitson BA. Polymerized Human Hemoglobin-Based Oxygen Carrier Preserves Lung Allograft Function During Normothermic Ex Vivo Lung Perfusion. ASAIO J 2024; 70:442-450. [PMID: 38266069 PMCID: PMC11062835 DOI: 10.1097/mat.0000000000002118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Normothermic ex vivo lung perfusion (EVLP) can resuscitate marginal lung allografts to increase organs available for transplantation. During normothermic perfusion, cellular metabolism is more active compared with subnormothermic perfusion, creating a need for an oxygen (O 2 ) carrier in the perfusate. As an O 2 carrier, red blood cells (RBCs) are a scarce resource and are susceptible to hemolysis in perfusion circuits, thus releasing cell-free hemoglobin (Hb), which can extravasate into the tissue space, thus promoting scavenging of nitric oxide (NO) and oxidative tissue damage. Fortunately, polymerized human Hb (PolyhHb) represents a synthetic O 2 carrier with a larger molecular diameter compared with Hb, preventing extravasation, and limiting adverse reactions. In this study, a next-generation PolyhHb-based perfusate was compared to both RBC and asanguinous perfusates in a rat EVLP model. During EVLP, the pulmonary arterial pressure and pulmonary vascular resistance were both significantly higher in lungs perfused with RBCs, which is consistent with RBC hemolysis. Lungs perfused with PolyhHb demonstrated greater oxygenation than those perfused with RBCs. Post-EVLP analysis revealed that the PolyhHb perfusate elicited less cellular damage, extravasation, iron tissue deposition, and edema than either RBCs or colloid control. These results show promise for a next-generation PolyhHb to maintain lung function throughout EVLP.
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Affiliation(s)
- Clayton Cuddington
- William G. Lowrie Department of Chemical and Biomolecular Engineering, College of Engineering, The Ohio State University
| | - Alisyn Greenfield
- William G. Lowrie Department of Chemical and Biomolecular Engineering, College of Engineering, The Ohio State University
| | - Yong Gyu Lee
- Department of Surgery, The Ohio State University Wexner Medical Center
- The Collaboration for Organ Perfusion, Preservation, Engineering and Regeneration (COPPER) Laboratory
| | - Jung Lye Kim
- Department of Surgery, The Ohio State University Wexner Medical Center
- The Collaboration for Organ Perfusion, Preservation, Engineering and Regeneration (COPPER) Laboratory
| | - Derek Lamb
- Departments of Pathology and Pediatrics, Center for Blood Oxygen Transport Hemostasis, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
| | - Paul W. Buehler
- Departments of Pathology and Pediatrics, Center for Blood Oxygen Transport Hemostasis, University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA
| | - Sylvester M. Black
- Department of Surgery, The Ohio State University Wexner Medical Center
- The Collaboration for Organ Perfusion, Preservation, Engineering and Regeneration (COPPER) Laboratory
| | - Andre F. Palmer
- William G. Lowrie Department of Chemical and Biomolecular Engineering, College of Engineering, The Ohio State University
| | - Bryan A. Whitson
- Department of Surgery, The Ohio State University Wexner Medical Center
- The Collaboration for Organ Perfusion, Preservation, Engineering and Regeneration (COPPER) Laboratory
- The Davis Heart and Lung Research Institute at The Ohio State University Wexner Medical, College of Medicine
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Cooper CE, Bird M, Sheng X, Choi JW, Silkstone GGA, Simons M, Syrett N, Piano R, Ronda L, Bettati S, Paredi G, Mozzarelli A, Reeder BJ. Stability of Maleimide-PEG and Mono-Sulfone-PEG Conjugation to a Novel Engineered Cysteine in the Human Hemoglobin Alpha Subunit. Front Chem 2021; 9:707797. [PMID: 34381760 PMCID: PMC8350135 DOI: 10.3389/fchem.2021.707797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022] Open
Abstract
In order to use a Hemoglobin Based Oxygen Carrier as an oxygen therapeutic or blood substitute, it is necessary to increase the size of the hemoglobin molecule to prevent rapid renal clearance. A common method uses maleimide PEGylation of sulfhydryls created by the reaction of 2-iminothiolane at surface lysines. However, this creates highly heterogenous mixtures of molecules. We recently engineered a hemoglobin with a single novel, reactive cysteine residue on the surface of the alpha subunit creating a single PEGylation site (βCys93Ala/αAla19Cys). This enabled homogenous PEGylation by maleimide-PEG with >80% efficiency and no discernible effect on protein function. However, maleimide-PEG adducts are subject to deconjugation via retro-Michael reactions and cross-conjugation to endogenous thiol species in vivo. We therefore compared our maleimide-PEG adduct with one created using a mono-sulfone-PEG less susceptible to deconjugation. Mono-sulfone-PEG underwent reaction at αAla19Cys hemoglobin with > 80% efficiency, although some side reactions were observed at higher PEG:hemoglobin ratios; the adduct bound oxygen with similar affinity and cooperativity as wild type hemoglobin. When directly compared to maleimide-PEG, the mono-sulfone-PEG adduct was significantly more stable when incubated at 37°C for seven days in the presence of 1 mM reduced glutathione. Hemoglobin treated with mono-sulfone-PEG retained > 90% of its conjugation, whereas for maleimide-PEG < 70% of the maleimide-PEG conjugate remained intact. Although maleimide-PEGylation is certainly stable enough for acute therapeutic use as an oxygen therapeutic, for pharmaceuticals intended for longer vascular retention (weeks-months), reagents such as mono-sulfone-PEG may be more appropriate.
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Affiliation(s)
- Chris E Cooper
- School of Life Sciences, University of Essex, Colchester, United Kingdom
| | | | | | | | - Gary G A Silkstone
- School of Life Sciences, University of Essex, Colchester, United Kingdom
| | - Michelle Simons
- School of Life Sciences, University of Essex, Colchester, United Kingdom
| | - Natalie Syrett
- School of Life Sciences, University of Essex, Colchester, United Kingdom
| | - Riccardo Piano
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Luca Ronda
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Institute of Biophysics, National Research Council, Pisa, Italy
| | - Stefano Bettati
- Department of Medicine and Surgery, University of Parma, Parma, Italy.,Institute of Biophysics, National Research Council, Pisa, Italy
| | | | - Andrea Mozzarelli
- Institute of Biophysics, National Research Council, Pisa, Italy.,Department of Food and Drug, University of Parma, Parma, Italy
| | - Brandon J Reeder
- School of Life Sciences, University of Essex, Colchester, United Kingdom
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