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author:("pragati, I.")
2.  Improved kinetics of rIX-FP, a recombinant fusion protein linking factor IX with albumin, in cynomolgus monkeys and hemophilia B dogs 
Background
Prophylaxis of hemophilia B, at present, requires multiple infusions of human factor IX (FIX) concentrates per week. A FIX molecule with a prolonged half-life has the potential to greatly improve convenience of, and adherence to, prophylaxis.
Objectives
The aim of our studies was to investigate the pharmacokinetic and pharmacodynamic profile of a recombinant fusion protein linking coagulation factor IX with albumin (rIX-FP).
Methods
Cynomolgus monkeys and hemophilia B dogs received single intravenous doses of rIX-FP (50–500 IU kg−1). rIX-FP plasma levels were determined by an activity-based assay (dogs only) and anti-FIX enzyme-linked immunosorbent assay methods. Additionally, activated partial thromboplastin time (aPTT) was determined in hemophilia B dogs. Data were compared with a direct study comparator (recombinant FIX [rFIX]) or previously published data.
Results
Terminal half-life of rIX-FP was prolonged in both species compared with FIX reference data. In hemophilia B dogs, human FIX antigen levels remained above 0.05 IU mL−1 more than three times longer following rIX-FP (7.3 days) compared with rFIX (2.3 days), whereas respective calculations based on activity levels confirmed observed superior profile. Prolonged pharmacodynamics of rIX-FP was demonstrated with aPTT <60 seconds sustained around four times longer with rIX-FP (5.9 days) than rFIX (1.5 days).
Conclusions
These studies indicate that the recombinant albumin fusion technology successfully improves the pharmacokinetic profile of FIX. Clinical studies will test whether the improved kinetics result in a significant half-life extension in patients with hemophilia B.
doi:10.1111/j.1538-7836.2012.04826.x
PMCID: PMC3928127  PMID: 22726310
factor IX; fusion protein; hemophilia B; rIX-FP; hemophilia B dog; cynomolgus monkey
3.  Prothrombin complex concentrate mitigates diffuse bleeding after cardiopulmonary bypass in a porcine model 
BJA: British Journal of Anaesthesia  2010;105(5):576-582.
Background
Extracorporeal circuit priming and intravascular volume expansion during cardiopulmonary bypass (CPB) may lead to dilutional coagulopathy and excessive diffuse postoperative bleeding. Prothrombin complex concentrate (PCC) containing clotting factors II (FII), VII (FVII), IX (FIX), and X (FX) could be of potential value in correcting dilutional coagulopathy and reducing blood loss.
Methods
Anaesthetized pigs underwent CPB with hypothermia for 2 h at 25°C followed by 1 h of normothermia. Approximately 1 h after CPB, animals randomly received either isotonic saline 1 ml kg−1 or PCC 30 IU kg−1 in a volume of 1 ml kg−1. Diffuse coagulopathic bleeding was assessed as suture hole blood loss from a Gore-Tex patch placed over a full-thickness incision in the left carotid artery.
Results
After CPB, levels of FII, FVII, FIX, and FX declined from baseline by 32% to 48%, and PCC fully or partially reversed those deficits. Median suture hole blood loss after administration of saline placebo was 74 ml. PCC reduced suture hole bleeding by a median of 54 ml with a 95% confidence interval of 6–112 ml (P=0.026) compared with saline. PCC, but not saline, normalized skin bleeding time. Peak thrombin generation markedly decreased after CPB, but then returned in PCC-treated animals to a level higher than baseline by 28.7 nM (14.5–41.1 nM; P=0.031).
Conclusions
PCC was effective in correcting dilutional coagulopathy and reducing diffuse bleeding in an in vivo large-animal CPB model. Further research is warranted on PCC as a haemostatic agent in CPB.
doi:10.1093/bja/aeq216
PMCID: PMC2955534  PMID: 20716565
blood coagulation disorders; cardiopulmonary bypass; haemodilution; haemorrhage; prothrombin complex concentrates
5.  Prothrombin complex concentrate vs fresh frozen plasma for reversal of dilutional coagulopathy in a porcine trauma model 
BJA: British Journal of Anaesthesia  2009;102(3):345-354.
Background
Fluid resuscitation following traumatic injury causes haemodilution and can contribute to coagulopathy. Coagulation factor replacement may be necessary to prevent bleeding complications of dilutional coagulopathy. Compared with fresh frozen plasma (FFP), prothrombin complex concentrate (PCC) may potentially offer a more rapid and effective means of normalizing coagulation factor levels.
Methods
In anaesthetized mildly hypothermic pigs, 65–70% of total blood volume was substituted in phases with hydroxyethyl starch and red cells. Animals were then treated with 15 ml kg−1 isotonic saline placebo, 25 IU kg−1 PCC, or 15 ml kg−1 FFP. Immediately thereafter, either a standardized femur or spleen injury was inflicted, and coagulation function, including thrombin generation, and bleeding were assessed. An additional group received high-dose FFP (40 ml kg−1) before femur injury.
Results
Haemodilution markedly prolonged prothrombin time and reduced peak thrombin generation. PCC, but not FFP, fully reversed those effects. Compared with 15 ml kg−1 FFP, PCC shortened the time to haemostasis after either bone (P=0.001) or spleen (P=0.028) trauma and reduced the volume of blood lost (P<0.001 and P=0.015, respectively). Subsequent to bone injury, PCC also accelerated haemostasis (P=0.003) and diminished blood loss (P=0.006) vs 40 ml kg−1 FFP.
Conclusions
PCC was effective in correcting dilutional coagulopathy and controlling bleeding in an in vivo large-animal trauma model. In light of its suitability for more rapid administration than FFP, PCC merits further investigation as a therapy for dilutional coagulopathy in trauma and surgery.
doi:10.1093/bja/aen391
PMCID: PMC2642652  PMID: 19168856
blood, haemodilution; complications, haemorrhagic disorder; complications, trauma; fresh frozen plasma; prothrombin complex concentrate

Results 1-5 (5)