Abstract
Though protamine sulfate is the only approved antidote of unfractionated heparin (UFH), yet may produce life threatening side effects such as systemic hypotension, catastrophic pulmonary vasoconstriction or allergic reactions. We have described 40 kDa dextrans (Dex40) substituted with glycidyltrimethylammonium chloride (GTMAC) as effective, immunogenically and hemodynamically neutral inhibitors of UFH. The aim of the present study was to evaluate in mice and rats toxicokinetic profile of the most promising polymer—Dex40-GTMAC3. Polymer was rapidly eliminated with a half-time of 12.5 ± 3.0 min in Wistar rats, and was mainly distributed to the kidneys and liver in mice. The safety studies included the measurement of blood count and blood biochemistry, erythrocyte osmotic fragility and the evaluation of the histological alterations in kidneys, liver and lungs of mice and rats in acute and chronic experiments. We found that Dex40-GTMAC3 is not only effective but also very well tolerated. Additionally, we found that protamine may cause overt hemolysis with appearance of permanent changes in the liver and kidneys. In summary, fast renal clearance behavior and generally low tissue accumulation of Dex40-GTMAC3 is likely to contribute to its superior to protamine biocompatibility. Intravenous administration of therapeutic doses to living animals does not result in the immunogenic, hemodynamic, blood, and organ toxicity. Dex40-GTMAC3 seems to be a promising effective and safe candidate for further clinical development as new UFH reversal agent.
Highlights
Unfractionated heparin (UFH) is mainly utilized in hospitals during the treatment and prevention of thrombosis, but is associated with an increased risk of bleeding and other adverse effects
We found a signal of fluorescein-labeled Dex40GTMAC3 in liver (1st rat = 38.90, 2nd rat = 13.34 and 3rd rat = 40.12) and kidneys (1st rat = 32.57, 2nd rat = 15.34 and 3rd rat = 61.34)
During the past six decades dextrans have been extensively used as plasma volume expanders because of their high biocompatibility and biological inertness resulting from their uncommon poly-(α-D-1,6-glucose) linkage
Summary
Unfractionated heparin (UFH) is mainly utilized in hospitals during the treatment and prevention of thrombosis, but is associated with an increased risk of bleeding and other adverse effects. The use of UFH and protamine is essential during many cardiovascular procedures, such as coronary artery bypass, heart transplant, cardiac valve repair or repair of congenital heart problems; their number increased by 28% from 5, 939, 000 in 2000 to 7, 588, 000 in 2010 in USA (Mozzaffarian et al, 2015). Surgical procedures like aortic aneurysm repair, arteriovenous fistula grafts for hemodialysis, carotid endarterectomy, complex vascular reconstruction or femoral popliteal bypass often require co-administration of UFH and protamine (Mahan, 2014)
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