| Transportadores de oxígeno basados en hemoglobina: investigación y realidad hacia una alternativa de las trasfusiones de sangre |
Haemoglobin-based oxygen carriers: research and reality towards an alternative to blood transfusions.
Mozzarelli A, Ronda L, Faggiano S, Bettati S, Bruno S.
Department of Biochemistry and Molecular Biology, University of Parma, Parma, Italy. andrea.mozzarelli@unipr.it
Blood Transfus. 2010 Jun;8 Suppl 3:s59-68.
Blood transfusion is the key life-saving treatment in many traumatic emergencies, chronic or acute pathologies, and during or upon surgical interventions. The primary goal of blood transfusion is the fast recovery of oxygen delivery to organs, especially the brain. Furthermore, circulation volume is restored, thus maintaining the blood pressure at levels that guarantee an efficient blood flux. Whereas this secondary need can be fulfilled to some extent by blood expanders, such as colloid- and crystalloid-based solutions, up to now no approved alternative to red cells is available for oxygen supply. The main transfusion active principle, red blood cells, is derived from the voluntary action of blood donors. Transfusions can be and are considered a very safe and effective oxygen-based therapy, provided that detailed guidelines are followed1. This evaluation has been somewhat challenged in recent years.
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| Transportadores de oxígeno basados en hemoglobina: estado actual y futuras direcciones |
Hemoglobin-based oxygen carriers: current status and future directions.
Silverman TA, Weiskopf RB; Planning Committee and the Speakers.
Collaborators (53)
Alayash A, Buehler P, Epstein J, Fratantoni J, Gladwin M, Goldkind S, Goldsmith J, Holmberg J, Klein H, Nemo G, Schechter A, Silverman T, Weiskopf R, Fratantoni J, Alayash A, Biro GP, Bunn HF, Schechter A, Alving B, Silverman TA, Goldkind S, Keipert P, Gould SA, Abuchowski A, Greenburg AG, Estep T, DeAngelo J, Klein H, Cohn S, Demetriades D, Fink MP, Freilich D, Holcomb JB, Natanson C, Norris EJ, Sloan EP, Vlahakes GJ, Weiskopf RB, Baines A, Gladwin M, Parrillo JE, Regan RF, Waltier DC, Biro G, Carson JL, Cavagnaro J, Emanuel E, Fleming T, Intaglietta M, Olson J, Schaer D, Vlahakes G, Warltier D.
Office of Blood Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland 20852, USA. toby.silverman@fda.hhs.gov
Anesthesiology. 2009 Nov;111(5):946-63.
SEMISYNTHETIC or synthetic preparations of hemoglobin, now termed hemoglobin-based oxygen carriers (HBOCs), have been in development as an alternative to erythrocytes for several decades. Nonclinical and clinical studies of HBOCs have raised questions about their safety. Similarity of the serious adverse event profiles among these products has raised questions regarding the possibility of common underlying mechanism(s) of toxicity despite differences among these molecular preparations. The observed serious adverse events have presented an obstacle to development because they raise concerns about the relative benefit/risk of these biologics.http://journals.lww.com/anesthesiology/Fulltext/2009/11000/Hemoglobin_based_Oxygen_Carriers__Current_Status.8.aspx |
| Transportadores de oxígeno en cirugía cardíaca |
Francisco Javier Molina Méndez
Archivos de Cardiología México Vol. 76 Supl. 2/Abril-Junio 2006:S2, 100-106
Resumen
Los transportadores de oxígeno pueden ser agrupados en dos categorías: Soluciones basadas en hemoglobina y emulsiones basadas en perfluoroquímicos. La transfusión de eritrocitos alogénicos representa un recurso limitado y está asociada con eventos adversos como reacciones de transfusión aguda, transmisión de enfermedades infecciosas, inmunosupresión e infecciones postoperatorias. Aunque la "sangre artificial" no es una realidad clínica, algunos "transportadores artificiales de oxígeno" están en un estadio clínico en desarrollo.http://www.scielo.org.mx/pdf/acm/v76s2/v76s2a11.pdf |
La disfunción endotelial aumenta la vasoconstricción debido a la recolección de residuos de óxido nítrico por transportadores de oxígeno basados en hemoglobina |
Endothelial dysfunction enhances vasoconstriction due to scavenging of nitric oxide by a hemoglobin-based oxygen carrier.
Yu B, Shahid M, Egorina EM, Sovershaev MA, Raher MJ, Lei C, Wu MX, Bloch KD, Zapol WM.
Anesthesia Center for Critical Care Research, Department of Anesthesia, Wellman Center of Photomedicine, Boston, Massachusetts, USA.
Anesthesiology. 2010 Mar;112(3):586-94.
Abstract
BACKGROUND: To date, there is no safe and effective hemoglobin-based oxygen carrier (HBOC) to substitute for erythrocyte transfusion. It is uncertain whether a deficiency of endothelial nitric oxide bioavailability (endothelial dysfunction) prevents or augments HBOC-induced vasoconstriction. METHODS: Hemodynamic effects of infusion of PolyHeme (1.08 g hemoglobin/kg; Northfield Laboratories, Evanston, IL) or murine tetrameric hemoglobin (0.48 g hemoglobin/kg) were determined in awake healthy lambs, awake mice, and anesthetized mice. In vitro, a cumulative dose-tension response was obtained by sequential addition of PolyHeme or tetrameric hemoglobin to phenylephrine-precontracted murine aortic rings. RESULTS: Infusion of PolyHeme did not cause systemic hypertension in awake lambs but produced acute systemic and pulmonary vasoconstriction. Infusion of PolyHeme did not cause systemic hypertension in healthy wild-type mice but induced severe systemic vasoconstriction in mice with endothelial dysfunction (either db/db mice or high-fat fed wild-type mice for 4-6 weeks). The db/db mice were more sensitive to systemic vasoconstriction than wild-type mice after the infusion of either tetrameric hemoglobin or PolyHeme. Murine aortic ring studies confirmed that db/db mice have an impaired response to an endothelial-dependent vasodilator and an enhanced vasoconstrictor response to HBOC. CONCLUSIONS: Reduction in low molecular weight hemoglobin concentrations to less than 1% is insufficient to abrogate the vasoconstrictor effects of HBOC infusion in healthy awake sheep or in mice with reduced vascular nitric oxide levels associated with endothelial dysfunction. These findings suggest that testing HBOCs in animals with endothelial dysfunction can provide a more sensitive indication of their potential vasoconstrictor effects.http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2010&issue=03000&article=00017&type=abstract
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