Pulsed cavitational therapy using high-frequency ultrasound for the treatment of deep vein thrombosis in an in vitro model of human blood clot.

Post-thrombotic syndrome, a frequent complication of deep venous thrombosis, can be reduced with early vein recanalization. Pulsed cavitational therapy (PCT) using ultrasound is a recent non-invasive approach. We propose to test the efficacy and safety of high-frequency focused PCT for drug-free thrombolysis (thrombotripsy) in a realistic in vitro model of venous thrombosis. To reproduce venous thrombosis conditions, human whole blood was allowed to clot by stasis in silicone tubes (6 mm internal diameter) at a 30 cm H2O pressure, maintained during the whole experiment. We engineered an ultrasound device composed of dual 2.25 MHz transducers centered around a 6 MHz imaging probe. A therapeutic focus was generated at a 3.2 cm depth from the probe. Thrombotripsy was performed by longitudinally scanning the thrombus at three different speeds: 1 mm s-1 (n = 6); 2 mm s-1 (n = 6); 3 mm s-1 (n = 12). Restored outflow was measured every three passages. Filters were placed to evaluate the debris size. Twenty-four occlusive thrombi, of 2.5 cm mean length and 4.4 kPa mean stiffness, were studied. Flow restoration was systematically obtained by nine subsequent passages (4.5 min maximum). By varying the device's speed, we found an optimal speed of 1 mm s-1 to be efficient for effective recanalization with 90 s (three passages). Within 90 s, flow restoration was of 80, 62 and 74% at respectively 1, 2 and 3 mm s-1. For all groups, cavitation cloud drilled a 1.7 mm mean diameter channel throughout the clot. Debris analysis showed 92% of debris <10 µm, with no fragment > 200 µm.

Osteoprotegerin, a new actor in vasculogenesis, stimulates endothelial colony-forming cells properties.

BACKGROUND: Osteoprotegerin (OPG), a soluble receptor of the tumour necrosis factor family, and its ligand, the receptor activator of nuclear factor-κB ligand (RANKL), are emerging as important regulators of vascular pathophysiology. OBJECTIVES: We evaluated their effects on vasculogenesis induced by endothelial colony-forming cells (ECFC) and on neovessel formation in vivo. METHODS: Effects of OPG and RANKL on in vitro angiogenesis were evaluated after ECFC incubation with OPG or RANKL (0-50 ng mL(-1)). Effects on microvessel formation were evaluated with an in vivo murin Matrigel plug assay. Vascularization was evaluated by measuring plug hemoglobin and vascular endothelial growth factor (VEGF)-R2 content 14 days after implantation. RESULTS: We found that ECFC expressed OPG and RANK but not RANKL mRNA. Treatment of ECFC with VEGF or stromal cell-derived factor-1 (SDF-1) upregulated OPG mRNA expression. OPG stimulated ECFC migration (P < 0.05), chemotaxis (P < 0.05) and vascular cord formation on Matrigel(®) (P < 0.01). These effects were correlated with SDF-1 mRNA overexpression, which was 30-fold higher after 4 h of OPG stimulation (P < 0.01). OPG-mediated angiogenesis involved the MAPK signaling pathway as well as Akt or mTOR cascades. RANKL also showed pro-vasculogenic effects in vitro. OPG combined with FGF-2 promoted neovessel formation in vivo, whereas RANKL had no effect. CONCLUSIONS: OPG induces ECFC activation and is a positive regulator of microvessel formation in vivo. Our results suggest that the OPG/RANK/RANKL axis may be involved in vasculogenesis and strongly support a modulatory role in tissue revascularization.

Neoangiogenesis induced by progenitor endothelial cells: effect of fucoidan from marine algae.

Fucoidans--sulphated polysaccharides extracted from brown algae--could be beneficial in patients with ischemic diseases. Their antithrombotic and proangiogenic properties promote in animals, neovascularization and angiogenesis which prevent necrosis of ischemic tissue. In 1997, endothelial progenitor cells were first identified in human peripheral blood. They are recruited from bone marrow and contribute to neovascularization after ischemic injury. Mobilization of these cells in ischemic sites is an important step in new vessel formation. It is thought that the progenitors interact with endothelial cells, then extravasate and reach ischemic sites, where they proliferate and differentiate into new blood vessels. Although chemokines, cytokines and adhesion molecules are thought to be involved, the precise mechanism of progenitor mobilization is not fully understood. Recent studies suggest that stromal-derived factor 1 plays a critical role at several steps of progenitor mobilization. Given the role of proteoglycans within bone marrow, at the endothelium surface, and in growth factor and chemokine binding, fucoidans might influence the mobilization of endothelial progenitor cells and their incorporation in ischemic tissue. This review provides an update on circulating endothelial progenitors and their role in neovascularization. It focuses on recent advances in our understanding of interactions between these progenitor cells and exogenous sulphated polysaccharides, and their implications for understanding the fucoidan mechanism of action.

Polystyrene derivatives as candidates for extracorporeal adsorption of Factor VIII antibodies in the management of haemophiliac patients.

BACKGROUND AND OBJECTIVES: This article presents a new approach for removing the Factor VIII inhibitors (anti-FVIII) in haemophiliac patients by immunoadsorption using an affinity matrix. MATERIALS AND METHODS: Ten blood samples from haemophiliac patients with anti-FVIII were assayed for antibodies, total immunoglobulins, procoagulant proteins and complement C3 protein after circulation over one or two columns filled with the polymers under investigation. RESULTS: These new synthetic sorbents are able to remove in vitro 90% of anti-FVIII from haemophiliac plasma with inhibitors (up to 540 Bethesda Units/ml). Neither coagulation factor adsorption nor effects on complement system activation were observed. CONCLUSIONS: The data presented clearly show that these polymers allow a rapid and efficient reduction of inhibitor titre. In view of the parameters studied, these polymers fulfil the requirements for use in a blood purification process to decrease high inhibitor titres without losing essential proteins.

Inactivation of thrombin by a fucosylated chondroitin sulfate from echinoderm.

A polysaccharide extracted from the sea cucumber body wall has the same backbone structure as the mammalian chondroitin sulfate, but some of the glucuronic acid residues display sulfated fucose branches. These branches confer high anticoagulant activity to the polysaccharide. Since the sea cucumber chondroitin sulfate has analogy in structure with mammalian glycosaminoglycans and sulfated fucans from brown algae, we compared its anticoagulant action with that of heparin and of a homopolymeric sulfated fucan with approximately the same level of sulfation as the sulfated fucose branches found in the sea cucumber polysaccharide. These various compounds differ not only in their anticoagulant potencies but also in the mechanisms of thrombin inhibition. Fucosylated chondroitin sulfate, like heparin, requires antithrombin or heparin cofactor II for thrombin inhibition. Sulfated fucans from brown algae have an antithrombin effect mediated by antithrombin and heparin cofactor II, plus a direct antithrombin effect more pronounced for some fractions. But even in the case of these two polysaccharides, we observed some differences. In contrast with heparin, total inhibition of thrombin in the presence of antithrombin is not achieved with fucosylated chondroitin sulfate, possibly reflecting a less specific interaction. Fucosylated chondroitin sulfate is able to inhibit thrombin generation after stimulation by both contact-activated and thromboplastin-activated systems. It delayed only the contact-induced thrombin generation, as expected for an anticoagulant without direct thrombin inhibition. Overall, the specific spatial array of the sulfated fucose branches in the fucosylated chondroitin sulfate not only confer high anticoagulant activity to the polysaccharide but also determine differences in the way it inhibits thrombin.

Analysis of the in vitro inhibition of mammary adenocarcinoma cell adhesion by sulphated polysaccharides.

Evidence is mounting that changes in the ability of cancer cells to adhere to extracellular matrices (ECM) play a decisive role in metastasis spread. We have investigated the effect of different sulphated polysaccharides on the adhesion of MCF7 and MDA-MB231 adenocarcinoma breast cells to different substrata: a reconstituted basement membrane (Matrigel) and various adhesion-mediating proteins (fibronectin, laminin, type IV collagen). Most of them inhibited cell adhesion and the most active component is a galactose rich units polysaccharide, carrageenan iota. Taken together, the results suggest that this inhibitory activity depends on the charge density related to sulphate groups, the molecular weight and also the carbohydrate structure. These products very likely unstabilize the interaction between the glucosaminoglycan portion of proteoglycans and the ECM proteins and then block the ability of these adhesive proteins to bind to cells.

Relationship between sulfate groups and biological activities of fucans.

The anticoagulant and antiproliferative effects of low molecular weight fucans with different sulfate content were examined. The anticoagulant activity was determined by activated partial thromboplastin time and the antiproliferative one was achieved in vitro on CCL39 fibroblast cell line. The results showed that inhibitory effects of fucans on both coagulation and cell proliferation are dependent on their sulfation degree. Decreased sulfation diminishes the two activities not in the same manner: some low molecular weight fucan fractions with no anticoagulant activity retain their ability to inhibit cell growth.

Further data on the structure of brown seaweed fucans: relationships with anticoagulant activity.

The composition, molecular weight (MW), anticoagulant activity and nuclear magnetic resonance spectra of various low-molecular-weight fucans (LMWFs) obtained by partial hydrolysis or radical depolymerization of a crude fucoidan extracted from the brown seaweed Ascophyllum nodosum are compared. Fucose units were found mainly sulfated at O-2, to a lesser extent at O-3, and only slightly at O-4, contrary to previously published results for fucoidans from other brown seaweeds, and fucose 2, 3-O-disulfate residues were observed for the first time. As the sulfation pattern excluded an alpha-(1-->2)-linked fucose backbone and a high proportion of alpha-(1-->4) linkages was found, it would appear that the concept of fucoidan structure needs to be revised. Anticoagulant activity is apparently related not only to MW and sulfation content, as previously determined, but also (and more precisely) to 2-O-sulfation and 2,3-O-disulfation levels.

Antithrombotic and anticoagulant activities of a low molecular weight fucoidan by the subcutaneous route.

Fucoidans (high-molecular-weight sulfated polysaccharides extracted from brown seaweeds) have anticoagulant and antithrombotic effects. They inhibit thrombin by catalyzing both serpins (antithrombin and heparin cofactor II) according to their chemical structures and origins. In this study, a low-molecular-weight (LMW) fucoidan of 8 kDa was obtained by chemical degradation of a high-molecular-weight fraction. The antithrombotic and anticoagulant activities of this new compound were compared to those of a low-molecular-weight heparin (LMWH), dalteparin, following subcutaneous administration to rabbits. This LMW fucoidan exhibited dose-related venous antithrombotic activity, with an ED80 of about 20 mg/kg, 2 h after a single subcutaneous injection. Its activity was comparable to that of dalteparin (close to 200 anti-Xa IU/kg) and was maximal 30 min after a single subcutaneous injection. The activity remained stable (about 70%) from 1 to 4 h after injection, but disappeared by 8 h. The antithrombotic activity was not associated with either a prolongation of the thrombin clotting time (TCT) or an increase in anti-Xa activity, contrary to dalteparin. A slight prolongation of APTT occurred with both compounds. This venous antithrombotic activity was associated with a decrease in ex vivo thrombin generation and with a significant increase in the lag phase in a thrombin generation test. LMW fucoidan thus has potent antithrombotic activity and a potentially weaker haemorrhagic effect (i.e. a smaller effect on coagulation tests and a smaller prolongation of the bleeding time) than dalteparin.

Adsorption of immunoglobulin G and anti-factor VIII inhibitory antibody from haemophiliac plasma to derivatized polystyrenes.

Modified polystyrene resins containing sulphonate groups and tyrosyl sulphamide or tyrosyl methyl ester sulphamide groups have been investigated with respect to their potential for selective binding of anti-Factor VIII inhibitory antibodies from plasma. Adsorption of total immunoglobulin G and of a monoclonal antibody to Factor VIII was measured following addition of the radioiodinated proteins to normal plasma, plasma depleted of Factor VIII by adsorption on a resin coupled to anti-Factor VIII antibody, and haemophiliac plasma containing various levels of inhibitory anti-Factor VIII antibody. Depletion of anti-Factor VIII antibody from the haemophiliac plasmas by incubation with the resins was also measured by Bethesda assay. The modified resins and their corresponding unmodified "controls' showed similar binding of total immunoglobulin G. However, only resins containing either sulphonate or a combination of sulphonate and tyrosyl sulphamide groups showed evidence of selective adsorption of anti-Factor VIII antibody from plasma.

Fucans, sulfated polysaccharides extracted from brown seaweeds, inhibit vascular smooth muscle cell proliferation. II. Degradation and molecular weight effect.

Fucan, a sulfated polysaccharide extracted from brown seaweeds, inhibits smooth muscle cell (SMC) proliferation with a higher antiproliferative activity than heparin (Logeart et al., Eur. J. Cell Biol. 74, 1997, this issue). In order to investigate the structure-activity relationship of fucan on SMC growth, we have prepared by size exclusion chromatography fucan fractions of various molecular masses ranging from 5.5 to 556 kDa. Our experiments showed that the antiproliferative activity is dependent on the molecular weight of the polysaccharide. The molecular weight threshold indicated that about 30 saccharidic units on fucan were necessary to give the antiproliferative activity on SMCs. A kinetics study of DNA synthesis using tritiated thymidine uptake was also performed with different molecular weight fucan fractions. Although all tested fractions acted as soon as the cells enter the first cell cycle, the duration and potency of action varied. Moreover, displacement experiments of iodinated fucan revealed that the low molecular fucan fraction interacted weakly with the binding sites. Finally, gel permeation chromatography of internalized radiolabeled heparin and fucans was performed with SMCs. A rapid degradation of internalized heparin was observed, whereas only low molecular weight fucan fractions were partially degraded by SMCs. Together, these results indicate the significance of molecular weight on the antiproliferative activity of fucans on SMCs, and might help to understand their mechanism of action. In addition, the degradation experiments with internalized heparin and fucans ruled out a direct link between polysaccharide degradation and the antiproliferative effect on SMCs.

Affinity of human anti-factor VIII antibodies for functional polystyrene supports.

Human anti-factor VIII antibodies (anti-FVIII) neutralize Factor VIII (FVIII) procoagulant activity. These antibodies appear in about 5-15 per cent of severely affected patients with haemophilia A treated with FVIII concentrates (Mannucci, 1993). In order to obtain non-thrombogenic materials able to interact specifically with anti-FVIII, amino acids residues that mimic part of the FVIII molecule recognized by anti-FVIII have been grafted. Several cross-linked polystyrenes were functionalized with sulphonate and tyrosine sulphamide groups or tyrosine derivatives sulphamide groups such as methyl ester tyrosine, or the peptides aspartic acid methyl amide tyrosine, tyrosine aspatic acid methyl amide or aspartic acid aspatic acid methyl amide tyrosine. The in vitro removal of anti-FVIII from haemophilic A plasma was performed on different supports. These polymers exhibit strong and selective affinity for the anti-FVIII. The amount of adsorbed anti-FVIII varies with the composition of the polymer and a maximum is achieved for 15-35 per cent of amino acid sulphamide groups. The influence of different chemical groups on the surface of the polymeric solid supports on the adsorption of anti-FVIII was also studied.

Synthetic sorbents for removal of factor VIII inhibitors from haemophilic A plasma.

Human factor VIII (FVIII) is a protein of the blood coagulation system that is absent or defective in patients with haemophilia A. A most serious complication following replacement therapy in 10-15% of patients treated with available FVIII concentrate is the development of inhibitors of FVIII (anti-FVIII). Some polymers functionalized with suitable chemical substituents which mimic part of the epitope of FVIII recognized by the inhibitors might be used in extracorporeal circulation to reduce the concentration of antibodies to FVIII. For this purpose, insoluble polystyrene bearing sulfonate and L-tyrosine methyl ester sulfamide groups have been synthesized. The in vitro removal of anti-FVIII inhibitors from plasmas of patients with haemophilia A was performed. Different chromatographic parameters were studied and optimized.

Inhibition of complement activation by natural sulfated polysaccharides (fucans) from brown seaweed.

In the present study, we demonstrate that natural sulfated polysaccharides (fucans) isolated from brown seaweed are potent inhibitors of human complement activation. A fucan fraction of chromatographic molecular weight 22,600, termed BS8, was found to inhibit classical and alternative pathway activation in whole serum in a dose-dependent fashion. Fucan BS8 inhibited formation of the classical pathway C3 convertase by interfering with C1 activation or by inhibiting C4 cleavage and the interaction between C4b and C2. The fucan also inhibited formation/function of the alternative pathway C3 convertase by suppressing the binding of B to C3b and by interfering with the stabilizing function of Properdin. The inhibitory effect of fucans on formation of the C3 convertases was dependent on the molecular weight of the polysaccharide for compounds of chromatographic molecular weight below 16,600. Fucan had no effect on the function of the terminal complex. Since fucans were more efficient than heparin in inhibiting activation of the classical pathway in whole serum and exhibited a lesser specific anticoagulant activity on a molar basis, our results suggest that these natural sulfated polysaccharides have a potential for use as anti-complementary and anti-inflammatory agents.

Tyrosyl sulfamide derivatives as ligands for affinity adsorption of anti FVIII antibodies.

Human anti factor VIII (anti FVIII) antibodies neutralize factor VIII procoagulant activity. These antibodies appear in about 5-10% of severely affected haemophiliac A patients treated with FVIII concentrates. In order to obtain non-thrombogenic materials able to interact specifically with anti FVIII, we have grafted amino acid residues which mimic part of the epitope of the FVIII molecule recognized by the anti FVIII. For this purpose, crosslinked polystyrenes functionalized with sulfonate and tyrosyl or methyl ester tyrosyl sulfamide groups have been synthesized and characterized. The in vitro removal of anti FVIII from haemophiliac patient plasma with antibodies, was performed on these different active supports. These polymers exhibit strong and selective affinity for the anti FVIII. The adsorption of the antibodies vary with the percentage of units bearing methyl ester tyrosyl sulfamide groups and present a maximum at 25% grafting rate. For the more efficient resin, the affinity constant, determined for the adsorption isotherm for the anti FVIII is about 10(9) M-1, whereas the affinity constant for the IgG in the same experimental conditions, is low (10(5) M-1). The influence of different chemical groups on the polymeric phase, on their affinity for the inhibitors was also studied. The most active resins can be selected and used in an extracorporeal circulation to reduce the concentration of anti FVIII in a blood epuration process.

Antitumor activity of low molecular weight fucans extracted from brown seaweed Ascophyllum nodosum.

The effect of low molecular weight fucans (LMW fucans) has been examined on the proliferation of tumour cells. These LMW fucans are not active on all tumour cell lines. They are not cytotoxic and inhibit CCL39 fibroblast cells and human colon adenocarcinoma Colo320DM proliferation (85% and 50% of inhibition respectively). The active concentration of sulphated polysaccharide is about 10 micrograms/mL for CCL39 cells and 100 micrograms/mL for COLO 320 DM. This inhibitory effect is fetal calf serum concentration and cell density dependent. Furthermore, fucans are internalized into CCL39 cells within the first hours of incubation. They are distributed into the cytoplasmic compartment but not in the nucleus, and are not excreted after one week of contact. In the case of COLO 320 DM cells, the same fluorescent fucan is not internalized after one week of contact, but remains strongly fixed on the cytoplasmic membrane. This inhibitory effect is not accompanied by any modifications of the cell distribution in the various phases of the cell cycle. There are no significant differences in the antitumor effect either between the various LMW fucan or with the crude extract.

Interactions of proteins in human plasma with modified polystyrene resins.

Investigations are reported on the composition of protein layers adsorbed from plasma to various modified polystyrene resins. As well as polystyrene itself, polystyrene bearing sulfonate groups in the benzene rings, and polystyrene sulfonate in which the sulfonate groups were converted to amino acid sulfamide, were investigated. Some of these resins were shown in previous work to have anticoagulant properties. To study the adsorption of proteins from plasma, the resins were exposed to citrate anticoagulated human plasma for 3 h. Adsorbed proteins were then eluted sequentially by 1M Tris buffer and 4% SDS solution, and examined by SDS-PAGE. The gel patterns were similar on all resins except polystyrene. From the MWs of the gel bands, the major protein component appeared to be fibrinogen. Smaller amounts of plasminogen, transferrin, albumin, and IgG were also present. In addition, Ouchterlony immunoassay of the eluates from one resin gave positive identification of complement C3, fibronectin, IgG, and IgM. Many other minor gel bands remain unidentified. A consistent finding for all resins was the presence of plasmin-type fibrinogen degradation products though the amounts varied with resin type. It is concluded from this (and from experiments showing FDP formation when fibrinogen was absorbed to the resins, from buffer containing a trace of plasminogen) that the functional groups in these materials promote the adsorption of plasminogen and its activation to a plasmin-like molecule. It appears from the substantial quantities of fibrinogen adsorbed to these materials after 3 h exposure to plasma that the Vroman effect (giving transient adsorption of fibrinogen) is not operative on these materials. It is hypothesized that specific interactions occur between fibrinogen and sulfonate groups.