Hb-based Oxygen Carriers Research Articles

Polymerized Hemoglobin Maintains Cardiac Function After Extreme Anemia

BackgroundBlood transfusion as a treatment for anemia is vital in ensuring oxygen (O2) carrying capacity. However, fears of blood shortages and adverse reactions to stored blood transfusion have driven the development of oxygen carrying alternatives to blood. One class of alternatives to blood for transfusion medicine are hemoglobin (Hb) based oxygen carriers (HBOCs), which have been in development for decades. A recent advancement in the development of HBOCs is the discovery that their O2 affinity can be tightly regulated by locking Hb in the T state (low O2 affinity), or R state (high O2 affinity). By regulating O2 affinity, O2 extraction by tissues can be controlled, and targeted O2 delivery to hypoxic tissues is made possible. As the heart is one of the most sensitive organs to changes in oxygenation due to its high metabolic rate, the objective of this study was to test the efficacy of high and low O2 affinity HBOCs in maintaining cardiac function and systemic O2 delivery during severe anemia.MethodsPolymerized hemoglobin (PolyHb), the most scalable method of producing HBOCs, was synthesized in the high and low O2 affinity state (R and T, respectively) with glutaraldehyde and then subjected to 8–9 cycles of diafiltration as previously described. This resulted in a PolyHb solution containing only polymerized Hb molecules > 500kDa suspended in Lactated Ringers solution. Rats were instrumented with a pressure‐volume catheter to monitor cardiac function. Severe anemia was induced via a 50% isovolumic hemodilution with 5% human serum albumin. Rats were then resuscitated by a 40% isovolumic infusion of a 10 g/dL solution of R PolyHb, T PolyHb, or fresh blood (drawn from the animal during the first exchange).ResultsSevere anemia resulted in impaired cardiac function and O2 delivery. Transfusion of fresh blood, T PolyHb, and R PolyHb restored vascular resistance, blood pressure, and cardiac contractility. T PolyHb also promoted increased O2 extraction and myocardial energy utilization. Severe anemia did not cause significant changes in blood electrolytes relative to baseline. Severe anemia resulted in blood acidification that only recovered for animals resuscitated with T PolyHb. Furthermore, resuscitation with T PolyHb resulted in higher arterial pO2 and lower pCO2 than other groups. R PolyHb increased lactate and glucose, suggesting that the high O2 affinity prevented proper O2 release to some tissues, despite maintaining cardiac function.ConclusionsBoth T and R PolyHb maintain myocardial O2 extraction compared to fresh blood. T PolyHb appears to be the optimal molecule for increasing O2 delivery during anemic conditions. Although R PolyHb apparently decreased systemic O2 extraction during anemia, it can be potentially useful to increase O2 uptake in the lungs during hypoxic‐hypoxia. This study indicates that PolyHb is as efficacious as fresh blood in restoring cardiac function and oxygenation in rats during severe anemia.Support or Funding InformationThis work was supported by the NIH Heart Lung and Blood Institute under Grants T32‐HL105373, R01‐HL126945, and R01‐HL138116.

Cardiovascular effects of polymerized hemoglobin in a dyslipidemia model

The need for alternatives to allogeneic red blood cells (RBCs) for transfusion medicine has been recognized for more than a century. Large molecular size polymerized human hemoglobin (Hb) (PolyhHb) is a Hb based oxygen (O2) carrier (HBOC) recently evaluated with promising results in efficient O2 delivery and minimal toxicity. Despite significant commercial development, late stage clinical results of HBOC solutions hampered development. To evaluate the safety of PolyhHb as an O2 therapeutic agent in a vulnerable population, the present study was performed in a guinea pigs subjected to a high fat and high sucrose diet (HDHS). This model mimics human dyslipidemia and potentially induces endothelial dysfunction (ED). The objective of this study was to evaluate the impact of large molecular size PolyhHb on cardiovascular function in guinea pigs with dyslipidemia. Animals weighing between 150–200 g were fed a HDHS for 12 weeks. The metabolic characterization of the model included glucose tolerance testing (GTT) and measurement of the lipid profile. After metabolic characterization, the carotid artery and jugular vein were catheterized and catheters were exteriorized dorsally. Then, PolyhHb (n = 5) was subjected to a 20% blood volume (BV) exchange‐transfusion (BV estimated as 7.5% of body weight) with PolyhHb at 10 g/dL. Sham (n = 5) was subjected to the same procedure, but no exchange transfusion was performed. Post exchange, the animals were allowed to recover for 24 hours, after which blood pressure (BP) and heart rate (HR) were recorded, and BP and HR variability (HRV) were evaluated by spectral analysis. Animals were subjected to a sequence of vasoactive drugs to evaluate their baroreflex (phenylephrine, sodium nitroprusside, 1 and 2 ug), endothelial function (acethocoline (ACH), 2 and 4 ug), and nitric oxide response (Nitro‐L‐arginine methyl ester (L‐NAME), 12 mg/kg). Animals presented glucose intolerance and dyslipidemia. PolyhHb induced an 18% increase in MAP 24 hours after exchange‐transfusion. PolyhHb showed a decreased response to L‐NAME, suggesting a deficiency in nitric oxide (NO) dependent regulation of vascular tone, a known consequence of acellular Hb NO scavenging. There were no differences in baroreflex between groups nor significant endothelial dysfunction for the PolyhHb group compared to the Sham group. An increase in HRV and in sympathetic nervous system (SNS) modulation of the heart (low frequency band, LF) was observed in the PolyhHb group compared to Sham. On the other hand, parasympathetic modulation of the heart (high frequency band, HF) was decreased for the PolyhHb group compared to Sham, culminating in a 2‐fold increase in sympathetic vagal balance. Moreover, BP variability as well as blood vessel SNS modulation was increased for PolyhHb compared to Sham. In conclusion, PolyhHb transfusion impaired the autonomic nervous system in guinea pigs with dyslipidemia. Our results suggest that dyslipidemic patients might be more vulnerable to PolyhHb transfusion side effects.Support or Funding InformationThis work was supported by the NIH Heart Lung and Blood Institute under Grants T32‐HL105373, R01‐HL126945, and the DOD DMRDP under Grant W81XWH‐18‐1‐0059

Resuscitation From Hemorrhagic Shock With Fresh and Stored Blood and Polymerized Hemoglobin.

Hemoglobin (Hb)-based oxygen carriers (HBOCs) have been proposed as alternatives to blood for decades. Previous studies demonstrated that large molecular diameter HBOCs based on polymerized bovine Hb (PolybHb) attenuate Hb side-effects and toxicity. The objective of this study was to test the safety and efficacy of tense state PolybHb after long-term storage. PolybHb was subjected to diafiltration to remove low molecular weight (< 500 kDa) species and stored for 2 years. PolybHb was studied in parallel with blood, collected from rats and stored leukodepleted under blood bank conditions for 3 weeks. Rats were hemorrhaged and resuscitated to 90% of the blood pressure before the hemorrhage with fresh blood, stored blood, fresh PolybHb, or 2-year-stored PolybHb. Hemorrhagic shock impaired oxygen delivery and cardiac function. Resuscitation restored blood pressure and cardiac function, but stored blood required a significantly larger transfusion volume to recover from shock compared with fresh blood and PolybHb (fresh and stored). Stored blood transfusion elevated markers of organ damage compared with all other groups. These studies indicate that large molecular diameter PolybHb is as efficacious as fresh blood in restoring cardiac function and confirm the lack of degradation of PolybHb's safety or efficacy during long-term storage.

Low-Fouling Electrosprayed Hemoglobin Nanoparticles with Antioxidant Protection as Promising Oxygen Carriers.

Despite all the attempts to create advanced hemoglobin (Hb)-based oxygen carriers (HBOCs) employing an encapsulation platform, major challenges including attaining a high Hb loading and long circulation times still need to be overcome. Herein, the fabrication, for the first time, of nanoparticles fully made of Hb (Hb-NPs) employing the electrospray technique is reported. The Hb-NPs are then coated by antioxidant and self-polymerized poly(dopamine) (PDA) to minimize the conversion of Hb into nonfunctional methemoglobin (metHb). The PDA shell is further functionalized with poly(ethylene glycol) (PEG) to achieve stealth properties. The results demonstrate that the as-prepared Hb-NPs are hemo- and biocompatible while offering antioxidant protection and decreasing the formation of metHb. Additionally, decoration with PEG results in decreased protein adsorption onto the Hb-NPs surface, suggesting a prolonged retention time within the body. Finally, the Hb-NPs also preserve the reversible oxygen-binding and releasing properties of Hb. All in all, within this study, a novel HBOCs with high Hb content is fabricated and its potential as an artificial blood substitute is evaluated.

Bio-Inspired Artificial Red Blood Cell: Design, Pre-Clinical Results and Novel Indications

In blood, the primary role of RBCs is to transport oxygen and to regulate regional blood flow distribution, via highly regulated mechanisms. In the setting of exsanguinating haemorrhage or severe anemia, RBC loss may critically restrict tissue oxygenation and result in morbidity and mortality. In such cases, transfusion of whole blood or RBCs can significantly improve survival. However, blood products including RBCs have limited availability and portability and present additional challenges related to type matching, pathogenic contamination risks, and short shelf-life. These issues lead to substantial logistical barriers to their pre-hospital use or in austere battlefield and remote civilian conditions. To date, efforts to develop hemoglobin (Hb) based oxygen carriers (HBOCs) have failed, because of design flaws which do not preserve physiologic interactions of Hb with: O2 (they capture O2 in lungs, but do not release O2 effectively to tissue) and nitric oxide (NO) (they trap NO, causing vasoconstriction). While robust efforts are underway to resolve these issues, recent research breakthroughs have led to bio-inspired engineering of RBC surrogates, using various cross-linked, polymeric and encapsulated Hb in the form of 'bio-synthetic RBC surrogates'. These 'next-generation' Hb-based oxygen carriers (HBOCs) can potentially provide therapeutic oxygenation when whole blood or RBC are not available. This talk will comprehensively review both historical and new HBOC designs, including current state-of-the-art and novel bio-inspired artificial RBC designs in development, along with a critical discussion of successes and challenges in this field. Disclosures Doctor: Biogen: Membership on an entity's Board of Directors or advisory committees; Fresenius Kabi: Honoraria; KaloCyte, Inc.: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Patents &amp; Royalties; Etiometry: Membership on an entity's Board of Directors or advisory committees.

Hemoglobin-based Oxygen Carriers: Current State-of-the-art and Novel Molecules.

In blood, the primary role of red blood cells (RBCs) is to transport oxygen via highly regulated mechanisms involving hemoglobin (Hb). Hb is a tetrameric porphyrin protein comprising of two α- and two β-polypeptide chains, each containing an iron-containing heme group capable of binding one oxygen molecule. In military as well as civilian traumatic exsanguinating hemorrhage, rapid loss of RBCs can lead to suboptimal tissue oxygenation and subsequent morbidity and mortality. In such cases, transfusion of whole blood or RBCs can significantly improve survival. However, blood products including RBCs present issues of limited availability and portability, need for type matching, pathogenic contamination risks, and short shelf-life, causing substantial logistical barriers to their prehospital use in austere battlefield and remote civilian conditions. While robust research is being directed to resolve these issues, parallel research efforts have emerged toward bioengineering of semisynthetic and synthetic surrogates of RBCs, using various cross-linked, polymeric, and encapsulated forms of Hb. These Hb-based oxygen carriers (HBOCs) can potentially provide therapeutic oxygenation when blood or RBCs are not available. Several of these HBOCs have undergone rigorous preclinical and clinical evaluation, but have not yet received clinical approval in the USA for human use. While these designs are being optimized for clinical translations, several new HBOC designs and molecules have been reported in recent years, with unique properties. The current article will provide a comprehensive review of such HBOC designs, including current state-of-the-art and novel molecules in development, along with a critical discussion of successes and challenges in this field.

Engineering tyrosine residues into hemoglobin enhances heme reduction, decreases oxidative stress and increases vascular retention of a hemoglobin based blood substitute

Hemoglobin (Hb)-based oxygen carriers (HBOC) are modified extracellular proteins, designed to replace or augment the oxygen-carrying capacity of erythrocytes. However, clinical results have generally been disappointing due to adverse side effects, in part linked to the intrinsic oxidative toxicity of Hb. Previously a redox-active tyrosine residue was engineered into the Hb β subunit (βF41Y) to facilitate electron transfer between endogenous antioxidants such as ascorbate and the oxidative ferryl heme species, converting the highly oxidizing ferryl species into the less reactive ferric (met) form. We inserted different single tyrosine mutations into the α and β subunits of Hb to determine if this effect of βF41Y was unique. Every mutation that was inserted within electron transfer range of the protein surface and the heme increased the rate of ferryl reduction. However, surprisingly, three of the mutations (βT84Y, αL91Y and βF85Y) also increased the rate of ascorbate reduction of ferric(met) Hb to ferrous(oxy) Hb. The rate enhancement was most evident at ascorbate concentrations equivalent to that found in plasma (< 100 μM), suggesting that it might be of benefit in decreasing oxidative stress in vivo. The most promising mutant (βT84Y) was stable with no increase in autoxidation or heme loss. A decrease in membrane damage following Hb addition to HEK cells correlated with the ability of βT84Y to maintain the protein in its oxygenated form. When PEGylated and injected into mice, βT84Y was shown to have an increased vascular half time compared to wild type PEGylated Hb. βT84Y represents a new class of mutations with the ability to enhance reduction of both ferryl and ferric Hb, and thus has potential to decrease adverse side effects as one component of a final HBOC product.

Kinetic studies on oxygen releasing of HBOC and red blood cells as fluids and factors affecting the process

Red blood cells (RBCs) possess intact cyto-architectures while haemoglobin (Hb) is a cell-free, homogeneous solution. Both RBCs and Hb are generalized oxygen carriers. In this paper, kinetic studies on oxygen-releasing of high concentration of Hb and RBCs under various conditions were carried out regarding Hb and RBCs as fluids. Among them, Hb under specific conditions was seen as the simplest Hb-based oxygen carrier (HBOC), Also, factors affecting the oxygen releasing of Hb and RBCs, including osmotic pressure, viscosity and allosteric agent, have been well studied. Analysis of the results from the measurement above showed that kinetics of oxygen releasing of either pure Hb or the simplest HBOCs was obviously different from that of RBCs. The oxygen-releasing time of Hb was shorter and the oxygen-releasing rates of Hb were quicker than those of RBCs under various conditions. Therefore, as fluids, only by changing the milieus it exists in, Hb could not achieve the expected oxygen-releasing effect on the microcirculation so well as RBCs do in the same system, irrespective of the interaction between the fluids and blood vessels. Furthermore, kinetic properties of HBOCs must be considered and matched with those of RBCs in the study of HBOCs.

Resuscitation from Hemorrhagic Shock with High Molecular Weight Polymerized Hemoglobin

BackgroundHemoglobin (Hb) based oxygen carriers (HBOCs) have been proposed as an alternative to red blood cells (RBCs) for transfusion medicine. Lack of mechanistic analysis lead to clinical evaluation of low molecular weight (MW) HBOCs, which failed in phase III clinical trials due to a myriad of side effects not seen in pre‐clinical trials. Increasing the MW of HBOCs can decrease these side effects by confining HBOCs to the vascular space and increasing nitric oxide generation. HBOCs are advantageous to blood due to their non‐immunogenic properties and potential to use non‐human hb sources, among others. In this study we compare the efficacy of fresh blood, freshly synthesized polymerized bovine hb (PolybHb), and PolybHb stored for 2 years in restoring cardiac function after hemorrhagic shock.MethodsPolybHb was synthesized in the low oxygen affinity (T) state with a 35:1 ratio of glutaraldehyde to bovine Hb, and then subjected to 8–9 cycles of diafiltration. This resulted in a PolybHb solution containing only polymerized Hb molecules &lt; 0.2 uM and &gt;500kDa. PolybHb was then frozen at −80°C and stored until used. Fresh red blood cells were prepared from the blood removed during hemorrhage by centrifugation at 1000g for 7 minutes, removal of the buffy coat, hemoconcentration to a hematocrit of 50%. Rats (200–250g) were hemorrhaged for 50% of their blood volume, held in hypovolemia for 30 minutes, and resuscitated to recover blood pressure to 90% pre‐hemorrhage with fresh autologous blood (fresh blood), PolybHb generated within 3 months of the study (PolybHb 2017), or PolybHb generated two years prior to the study (PolybHb 2015).ResultsShock resulted in impaired oxygen delivery and cardiac function. Resuscitation with fresh blood, PolybHb 2017, and PolybHb 2015 restored cardiac function and systemic vascular resistance. Slightly more PolybHb was infused before restoration of 90% pre‐hemorrhage MAP was achieved, but the volume was not statistically significant. Likely as a result of the higher resuscitation volume, stroke volume and stroke work increased more in animals resuscitated with PolybHb than fresh autologous blood. PolybHb did not impair cardiac contractility nor cause excessive vasoconstriction.ConclusionsStudies indicate that PolybHb is as efficacious as fresh autologous blood in restoring cardiac function in rats after hemorrhagic shock. Additionally, PolybHb can be safely stored at −80°C for two years and retain efficacy, unlike red blood cells.Support or Funding InformationNIH Grants from the National Heart Lung and Blood Institute, T32‐HL105373, P01‐HL110900, R01‐HL126945This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Revisiting the putative role of heme as a trigger of inflammation.

Activation of the innate immune system by free heme has been proposed as one of the principal consequences of cell‐free hemoglobin (Hb) exposure. Nonetheless, in the absence of infection, heme exposures within a hematoma, during hemolysis, or upon systemic administration of Hb (eg, as a Hb‐based oxygen carrier) are typically not accompanied by uncontrolled inflammation, challenging the assumption that heme is a major proinflammatory mediator in vivo. Because of its hydrophobic nature, heme liberated from oxidized hemoglobin is rapidly transferred to alternative protein‐binding sites (eg, albumin) or to hydrophobic lipid compartments minimizing protein‐free heme under in vivo equilibrium conditions. We demonstrate that the capacity of heme to activate human neutrophil granulocytes strictly depends on the availability of non protein‐associated heme. In human endothelial cells as well as in mouse macrophage cell cultures and in mouse models of local and systemic heme exposure, protein‐associated heme or Hb do not induce inflammatory gene expression over a broad range of exposure conditions. Only experiments in protein‐free culture medium demonstrated a weak capacity of heme‐solutions to induce toll‐like receptor‐(TLR4) dependent TNF‐alpha expression in macrophages. Our data suggests that the equilibrium‐state of free and protein‐associated heme critically determines the proinflammatory capacity of the metallo‐porphyrin. Based on these data it appears unlikely that inflammation‐promoting equilibrium conditions could ever occur in vivo.

Comprehensive Biochemical and Biophysical Characterization of Hemoglobin-Based Oxygen Carrier Therapeutics: All HBOCs Are Not Created Equally.

The development of hemoglobin (Hb)-based oxygen carriers (HBOCs) has been hampered because of safety concerns in humans. Chemical and/or genetic modifications of the Hb introduce varied structural and conformational constraint on the molecule that resulted in proteins with diverse allosteric responses, nitrosative and oxidative side reactions. Here, we present for the first time a comprehensive biochemical and biophysical comparison of human, bovine, and genetically engineered HBOCs that have been tested in humans. We evaluate oxygen equilibrium and ligand binding kinetics under different experimental conditions as well as their autoxidation kinetics, redox reactions, and heme release. We determined the effects of HBOCs on cellular redox states and mitochondrial respiration. Taken together, these experiments provide a better understanding of the relationship between the structure-function and oxidative reactivity of these proteins. One can therefore select independently among these diverse properties to engineer a safe and effective HBOC with improved biochemical/biophysical characteristics.

Ferulic acid modification enhances the anti-oxidation activity of natural Hb in vitro

During the development of artificial red blood cell (RBC) substitutes, oxidation side reaction is one of the major factors that hinder the application of haemoglobin (Hb)-based oxygen carriers (HBOCs). In order to avoid oxidation toxicity, we designed and prepared natural Hb conjugated with ferulic acid (FA) via simple chemical modification. In addition, the thiol groups on Hb surface were increased via the reaction of Hb with 2-iminothiolane (2-IT) and then modified with FA for the study of anti-oxidant ability. It was showed that Hb modified with FA (FA-Hb) had similar oxygen-binding capacity to natural Hb. Moreover, the anti-oxidant ability of FA-Hb in vitro in different systems was superior to natural Hb and in proportion to the degree of modification of FA. The results indicate that FA-Hb might have the potential to serve as a novel oxygen carrier with the capacity to reduce oxidative side reaction.

Glutaraldehyde inactivation of enveloped DNA viruses in the preparation of haemoglobin-based oxygen carriers

Glutaraldehyde (GA), used medically as a disinfectant and as a crosslinker for haemoglobin (Hb)-based oxygen carriers (HBOCs), was investigated for its ability to inactivate viruses during the preparation of these artificial blood substitutes. Porcine parvovirus (PPV; a non-enveloped DNA virus) and porcine pseudorabies virus (PRV; an enveloped DNA virus) were used as the virus indicators. Upon treatment with 0.1 mM GA, the titer of PRV decreased from 9.62 log10 to 2.62 log10 within 0.5 h, whereas that of PPV decreased from 7.00 log10 to 2.30 log10 in 5 h. Following treatment with 1.0 mM GA, the titer of PRV decreased from 11.00 log10 to 1.97 log10 within 0.5 h, whereas that of PPV decreased from 7.50 log10 to 3.43 log10 in 4.5 h. During the polymerization of Hb with GA, the GA concentration decreased to 1.0 and 0.1 mM within 30 and 50 min, respectively, at a GA:Hb molar ratio of 10:1, whereas at a GA:Hb molar ratio of 30:1, GA decreased to those same concentrations in 1.5 and 2.5 h, respectively. This rapid decrease in GA concentration during its polymerization with Hb indicates that GA must be added into the Hb solution in a short time in order to get as high a initial concentration as possible. In this study, the GA can only inactivate PRV effectively, given that a longer time (4.5 h) was required for it to inactivate the PPV titer. This study therefore demonstrates that GA inactivates the enveloped DNA virus only during the preparation of HBOCs.

Construction of biconcave hemoglobin-based microcapsules and electrochemical evaluation for its ability of oxygen carry

Hemoglobin (Hb)-based oxygen carriers (HBOCs) have been investigated intensively. Enhancing the loading content of Hb in a red-blood-cell (RBC) like structure and seeking effective method to evaluate their oxygen-carrying capability have been the significant challenges. Here, we present unique biconcave Hb-Ca(OH)2 microcapsules of around 6.5μm with high oxygen affinity using a facile and controllable method. Dextran introduced in the co-precipitation process can not only adjust the morphology of Ca(OH)2 particles but also improve the biocompatibility of the obtained microcapsules. The Hb entrapment efficiency in the microcapsules corresponded to 68% of the Hb content in one native RBC. The dynamic process of carrying-releasing oxygen of Hb-Ca(OH)2 microcapsules was investigated using electrochemical techniques. Hb in microcapsules on the surface of electrode maintained its naturally biological activity and exhibited a high ability to carry oxygen reversibly. The oxygen releasing of oxyHb-Ca(OH)2 microcapsules can be retained during at least 2400s. The results demonstrate that Hb-Ca(OH)2 microcapsules with highly loaded content possessed excellent function of oxygen-binding and releasing, which make it promising for applications in artificial oxygen carriers and other biomedical fields.

Naturalegg whitemicrospheres for controlled drug release

As a hemoglobin (Hb)-based oxygen carrier (HBOC), Hb suffers from the disadvantages of short half-life, renal toxicity and vasoactivity. Because dextran is a macromolecule that can be easily derivatized with various chemical moieties, conjugation of Hb with dextran can effectively increase the size of Hb and overcome the disadvantages of Hb. Thus, a dextran-bovine Hb (bHb) conjugate (dex-bHb) was prepared by conjugation of bHb with periodate-oxidized dextran here. As an important functional amino acid residue of bHb, Cys-93(β) was reversibly protected by 4,4′-dithiodipyridine to avoid reaction with periodate-oxidized dextran. Dex-bHb showed significantly higher hydrodynamic volume and higher viscosity than bHb. Conjugation with dextran stabilized the R state of bHb and slightly altered the heme environment of bHb. Conjugation with dextran decreased the P50 of bHb, lowered the sensitivity to the allosteric effectors and slightly decreased the autoxidation rate of bHb. Thus, dex-bHb was expected to act as a potent HBOC with low oxidative toxicity.

Structural, functional and physiochemical properties of dextran-bovine hemoglobin conjugate as a hemoglobin-based oxygen carrier

Abstract As a hemoglobin (Hb)-based oxygen carrier (HBOC), Hb suffers from the disadvantages of short half-life, renal toxicity and vasoactivity. Because dextran is a macromolecule that can be easily derivatized with various chemical moieties, conjugation of Hb with dextran can effectively increase the size of Hb and overcome the disadvantages of Hb. Thus, a dextran-bovine Hb (bHb) conjugate (dex-bHb) was prepared by conjugation of bHb with periodate-oxidized dextran here. As an important functional amino acid residue of bHb, Cys-93(β) was reversibly protected by 4,4′-dithiodipyridine to avoid reaction with periodate-oxidized dextran. Dex-bHb showed significantly higher hydrodynamic volume and higher viscosity than bHb. Conjugation with dextran stabilized the R state of bHb and slightly altered the heme environment of bHb. Conjugation with dextran decreased the P50 of bHb, lowered the sensitivity to the allosteric effectors and slightly decreased the autoxidation rate of bHb. Thus, dex-bHb was expected to act as a potent HBOC with low oxidative toxicity.

Comparison of the Pharmacokinetic Properties of Hemoglobin-Based Oxygen Carriers.

Hemoglobin (Hb) is an ideal material for use in the development of an oxygen carrier in view of its innate biological properties. However, the vascular retention of free Hb is too short to permit a full therapeutic effect because Hb is rapidly cleared from the kidney via glomerular filtration or from the liver via the haptogloblin-CD 163 pathway when free Hb is administered in the blood circulation. Attempts have been made to develop alternate acellular and cellular types of Hb based oxygen carriers (HBOCs), in which Hb is processed via various routes in order to regulate its pharmacokinetic properties. These HBOCs have been demonstrated to have superior pharmacokinetic properties including a longer half-life than the Hb molecule in preclinical and clinical trials. The present review summarizes and compares the pharmacokinetic properties of acellular and cellular type HBOCs that have been developed through different approaches, such as polymerization, PEGylation, cross-linking, and encapsulation.

Hemoglobin-Based Blood Substitutes and the Treatment of Sickle Cell Disease: More Harm than Help?

Intense efforts have been made by both industry and academia over the last three decades to produce viable hemoglobin (Hb)-based oxygen carriers (HBOCs), also known as “blood substitutes”. Human trials conducted so far by several manufactures in a variety of clinical indications, including trauma, and elective surgeries have failed and no product has gained the Food and Drug Administration approval for human use. Safety concerns due to frequent incidences of hemodynamic, cardiac events, and even death led to the termination of some of these trials. Several second generation HBOC products that have been chemically and/or genetically modified (or in some cases ligated with carbon monoxide (CO)) found a new clinical application in conditions as complex as sickle cell disease (SCD). By virtue of higher oxygen affinity (P50) (R-state), and smaller size, HBOCs may be able to reach the microvasculature unload of oxygen to reverse the cycles of sickling/unsickling of the deoxy-sickle cell Hb (HbS) (T-state), thus preventing vaso-occlusion, a central event in SCD pathophysiology. However, biochemically, it is thought that outside the red blood cell (due to frequent hemolysis), free HbS or infused HBOCs are capable of interfering with a number of oxidative and signaling pathways and may, thus, negate any benefit that HBOCs may provide. This review discusses the advantages and disadvantages of using HBOCs in SCD.

Erythromer (EM), a Nanoscale Bio-Synthetic Artificial Red Cell: Proof of Concept and In Vivo Efficacy Results

▪BACKGROUND: There is need for an artificial oxygen (O2) carrier for use when: stored blood is unavailable or undesirable. To date, efforts to develop hemoglobin (Hb) based oxygen carriers (HBOCs) have failed, because of design flaws which do not preserve physiologic interactions of Hb with: O2 (they capture O2 in lungs, but do not release O2 effectively to tissue) and nitric oxide (NO) (they trap NO, causing vasoconstriction). EM design surmounts these weaknesses by: encapsulating Hb, controlling O2 capture/release with a novel 2,3-DPG shuttle and attenuating NO uptake through shell properties.METHODS: The EM prototype and its lyophilized form were analyzed: (1) structurally (dynamic light scattering (DLS), transmission electron microscopy (TEM) and atomic force microscopy (AFM)), as well as for: (2) payload retention (Drabkin), (3) biocompatibility (ex vivo complement activation), (4) O2 affinity (p50, Hill n, Adair), (5) rheology (cone and plate viscometer in rabbit plasma), (6) NO consumption (chemiluminescence), (7) pharmacokinetic (PK) profile (tracking 99mTc-labeled EM in rats), and (8) in vivo O2 delivery (two rodent models: hemorrhagic shock [rats, instrumented for tissue pO2] and hemodilution [bioluminescent HIF-1α reporter mice]).RESULTS: EM was structurally stable (size: 175±10 nm; polydispersity: 0.26±0.0 by DLS, confirmed by TEM and AFM; zeta potential: 12±2 mV). After 3 months storage, we observed nominal change (<10%) in size, zeta potential, or polydispersity. CH50 (complement activation) results were indistinguishable from negative controls and we observed no impact on plasma viscosity (1:10 and 1:5 dilution). p50 was calculated to be 21.46±2.75 Torr (control RBC p50: 23.63±1.84); EM Hill & Adair also similar to control RBC. Two compartment PK modeling in rats resulted in good fit, with distribution t1/2=26.2±3.6 min and elimination t1/2=300±12 min (R2>0.96); which is likely to translate to a t1/2 in humans of ~ 3h. EM NO sequestration varied as a function of shell crosslinking and was below the rate observed for RBCs. In our hemorrhagic shock model in fully instrumented SD Rats (400g), 40% blood volume was removed; animals were then resuscitated with an equal volume of EM (N=6) or normal saline (N=6). EM was suspended at 40 wt/vol%, [Hb]=4mM. EM infusion rapidly stabilized hemodynamics. During the 1st hour, we observed resolution of both lactic acidosis (3.2±1.5 v 8.2±2.1 mM) [for EM and NS, respectively, throughout] and elevated AV O2 difference (24±11 v 67±23%) as well as improved brain pO2 (30.5±1.4 v 17.2±1.3 Torr); p<0.05, RMANOVA, for all. Hemodilution model:Un-instrumented, HIF-1α (ODD) luciferase mice underwent hemodilution (70% v/v) with pentastarch, fresh blood (autotransfusion controls), or EM [N=6, all groups];Hb target nadir was reached (5 mg/dL). To detect whole body luciferase expression, D-luciferin (50 mg/kg, IP) was injected, then serial images were obtained (IVIS, Living Image). HIF-luc radiance was significantly higher in the HES group than in autotransfusion and EM groups, which did not differ (p<0.01, RMANOVA).CONCLUSIONS: The ErythroMer prototype has passed rigorous initial ex vivo and in vivo "proof of concept" testing and bench testing, which suggests this design surmounts prior challenges (by HBOCs) in emulating normal RBC physiologic interactions with O2 and NO. In models of major bleeding/anemia, EM reconstitutes normal hemodynamics and O2 delivery, observed at the system, tissue, and cellular level. EM potential for extended ambient dry storage has significant implications for portability and use. Next steps include formulation scaling, detailed study of pharmacokinetics, biodistribution and safety, as well as evaluation in large animal models of hemorrhagic shock. DisclosuresPan:KaloCyte, Inc.: Equity Ownership; Children's Discovery Institute: Research Funding; National Institutes of Health: Research Funding. Spinella:KaloCyte, Inc.: Equity Ownership; Children's Discovery Institute: Research Funding; National Institutes of Health: Research Funding. Hare:Children's Discovery Institute: Research Funding. Lanza:KaloCyte, Inc.: Membership on an entity's Board of Directors or advisory committees; National Institutes of Health: Research Funding. Doctor:KaloCyte, Inc.: Equity Ownership; Children's Discovery Institute: Research Funding; National Institutes of Health: Research Funding.

A PEGylated bovine hemoglobin as a potent hemoglobin-based oxygen carrier.

Hemoglobin (Hb)-based oxygen carriers (HBOCs) have been used as blood substitutes in surgery medicine and oxygen therapeutics for ischemic stroke. As a potent HBOC, the PEGylated Hb has received much attention for its oxygen delivery and plasma expanding ability. Two PEGylated Hbs, Euro-Hb, and MP4 have been developed for clinical trials, using human adult hemoglobin (HbA) as the original substrate. However, HbA was obtained from outdated human blood and its quantity available from this source may not be sufficient for mass production of PEGylated HbA. In contrast, bovine Hb (bHb) has no quantity constraints for its ample resource. Thus, bHb is of potential to function as an alternative substrate to obtain a PEGylated bHb (bHb-PEG). bHb-PEG was prepared under the same reaction condition as HbA-PEG, using maleimide chemistry. The structural, functional, solution and physiological properties of bHb-PEG were determined and compared with those of HbA-PEG. bHb-PEG showed higher hydrodynamic volume, colloidal osmotic pressure, viscosity and P50 than HbA-PEG. The high P50 of bHb can partially compensate the PEGylation-induced perturbation in the R to T state transition of HbA. bHb-PEG was non-vasoactive and could efficiently recover the mean arterial pressure of mice suffering from hemorrhagic shock. Thus, bHb-PEG is expected to function as a potent HBOC for its high oxygen delivery and strong plasma expanding ability. © 2016 American Institute of Chemical Engineers Biotechnol. Prog., 33:252-260, 2017.