Thrombocytopenia (TCP) may cause severe and life-threatening bleeding. While this may be prevented by platelet transfusions, transfusions are associated with potential complications, do not always work (platelet refractory) and are not always available. There is an urgent need for a synthetic alternative. We evaluated the ability of fibrinogen-coated nanospheres (FCNs) to prevent TCP-related bleeding. FCNs are made of human albumin polymerized into a 100-nm sphere and coated with fibrinogen. We hypothesized that FCNs would bind to platelets through fibrinogen-GPIIb/IIIa interactions, contributing to hemostasis in the setting of TCP. We used two murine models to test these effects: in the first model, BALB/c mice received 7.25 Gy total-body irradiation (TBI); in the second model, lower dose TBI (7.0 Gy) was combined with an anti-platelet antibody (anti-CD41) to induce severe TCP. Deaths in both models were due to gastrointestinal or intracranial bleeding. Addition of antiplatelet antibody to 7.0 Gy TBI significantly worsened TCP and increased mortality compared to 7.0 Gy TBI alone. FCNs significantly improved survival compared to saline control in both models, suggesting it ameliorated TCP-related bleeding. Additionally, in a saphenous vein bleeding model of antibody-induced TCP, FCNs shortened bleeding times. There were no clinical or histological findings of thrombosis or laboratory findings of disseminated intravascular coagulation after FCN treatment. In support of safety, fluorescence microscopy suggests that FCNs bind to platelets only upon platelet activation with collagen, limiting activity to areas of endothelial damage. To our knowledge, this is the first biosynthetic agent to demonstrate a survival advantage in TCP-related bleeding.
Fibrinogen-Coated Albumin Nanospheres Prevent Thrombocytopenia-Related Bleeding
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Anthony D. Sung, Richard C. Yen, Yiqun Jiao, Alyssa Bernanke, Deborah A. Lewis, Sara E. Miller, Zhiguo Li, Joel R. Ross, Alexandra Artica, Sadhna Piryani, Dunhua Zhou, Yang Liu, Tuan Vo-Dinh, Maureane Hoffman, Thomas L. Ortel, Nelson J. Chao, Benny J. Chen; Fibrinogen-Coated Albumin Nanospheres Prevent Thrombocytopenia-Related Bleeding. Radiat Res 1 August 2020; 194 (2): 162–172. doi: https://doi.org/10.1667/RADE-20-00016
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