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Manuel Carcao, Katsuyuki Fukutake, Aida Inbal, Bryce Kerlin, Riitta Lassila, Johannes Oldenburg, May-Lill Garly, Diane Nugent
Congenital factor XIII (FXIII) deficiency is a rare, autosomal recessive bleeding disorder with potentially life-threatening consequences. FXIII is composed of two subunits (A and B), and a deficiency or dysfunction of either can result in FXIII deficiency. Traditionally, FXIII deficiency has been managed by infusing plasma-derived products containing FXIII (fresh frozen plasma, cryoprecipitate, and plasma-derived FXIII concentrates), all of which contain both subunits. Despite the increased safety of plasma-derived products, concern remains regarding potential viral safety issues...
August 24, 2016: Seminars in Thrombosis and Hemostasis
Michael Desborough, Lise J Estcourt, Anna Chaimani, Carolyn Doree, Sally Hopewell, Marialena Trivella, Andreas V Hadjinicolaou, Paresh Vyas, Simon J Stanworth
This is the protocol for a review and there is no abstract. The objectives are as follows: To compare the relative efficacy of different treatments for thrombocytopenia (artificial platelet substitutes, platelet-poor plasma, fibrinogen, rFVIIa, rFXIII, thrombopoietin mimetics, antifibrinolytic drugs or platelet transfusions) in patients with chronic bone marrow failure and to derive a hierarchy of potential alternate treatments to platelet transfusions.
January 26, 2016: Cochrane Database of Systematic Reviews
B Brand-Staufer, M Carcao, B A Kerlin, A Will, M Williams, C W Tornøe, M Sandberg Lundblad, D Nugent
Three trials investigated the pharmacokinetics (PK) of recombinant factor XIII (rFXIII) A-subunit. To compare the PK characteristics of rFXIII among trials and different age groups of patients. Dosing with rFXIII 35 IU kg(-1) every 4th week. Blood samples for PK assessments were collected regularly throughout the dosing interval from a total of 68 individual patients with FXIII congenital deficiency. The mean PK parameters were similar across the three age groups, and for the three trials, as well as constant over time based on results from patients participating in both mentor 1 and mentor 2 trials...
May 2015: Haemophilia: the Official Journal of the World Federation of Hemophilia
B Kerlin, B Brand, A Inbal, S Halimeh, D Nugent, M Lundblad, R Tehranchi
BACKGROUND: The use of monthly recombinant factor XIII (rFXIII) recently demonstrated favorable safety and efficacy for congenital FXIII A-subunit deficiency patients aged ≥ 6 years (mentor(™) 1 trial), although the pharmacokinetics (PK) were not fully evaluated. OBJECTIVES: To comprehensively evaluate the steady-state PK of rFXIII in patients aged ≥ 6 years with congenital FXIII A-subunit deficiency. PATIENTS/METHODS: mentor(™) 2 is an ongoing, multinational safety and efficacy trial in which patients are receiving monthly rFXIII (35 IU kg(-1) ) for ≥ 52 weeks...
December 2014: Journal of Thrombosis and Haemostasis: JTH
Wolfgang Korte
Circulating factor XIII (FXIII) consists of two active (A) and two carrier (B) subunits in tetrameric form. Congenital FXIII deficiency is a rare autosomal-recessive trait that mostly results from an FXIII A-subunit deficiency. Classic coagulation assays, such as prothrombin time or activated partial thromboplastin time, are not sensitive to FXIII; therefore, specific FXIII assays are necessary to detect the deficiency. The clinical picture of congenital FXIII deficiency comprises abortions, umbilical cord bleeding, increased surgical bleeding, intracerebral hemorrhage (which can, unfortunately, be the very first sign of severe FXIII deficiency), menorrhagia, and wound-healing disorders...
2014: Journal of Blood Medicine
M Williams, A Will, C Stenmo, A Rosholm, R Tehranchi
Congenital factor XIII (FXIII) deficiency is a rare bleeding disorder, which in its severe form is associated with a significant bleeding phenotype, requiring regular prophylactic therapy. A recently developed recombinant FXIII (rFXIII) has demonstrated safety and efficacy in children aged ≥6 years and adults (mentor1 trial). This article describes the mentor4 trial, which has assessed the pharmacokinetics (PK) and safety of rFXIII in younger children (1 to <6 years) with congenital FXIII deficiency, and compares extrapolated PK parameters with the mentor1 trial...
January 2014: Haemophilia: the Official Journal of the World Federation of Hemophilia
Johannes Dodt, Peter Volkers, Rainer Seitz
Triggering the extrinsic coagulation pathway in plasma and using a fluorogenic factor XIIIa (FXIIIa) substrate for continuously monitoring FXIIIa activity, an FXIIIa generation curve is obtained. The parameters area under the curve (AUC), time to peak (TTP), and concentration at peak (CP) were calculated. In dilutions of normal plasma in FXIII-deficient plasma, AUC and CP showed linear dose-response relationships, whereas TTP increased from 9.9 min for 25% FXIII to 11.6 min for 100% FXIII. Three FXIII-A preparations (rFXIII, rFXIII(V34L), and cellular FXIII [cFXIII]) showed a linear dose response for AUC and CP...
August 15, 2013: Analytical Biochemistry
Aida Inbal, Johannes Oldenburg, Manuel Carcao, Anders Rosholm, Ramin Tehranchi, Diane Nugent
Congenital factor XIII (FXIII) deficiency is a rare, autosomal-recessive disorder, with most patients having an A-subunit (FXIII-A) deficiency. Patients experience life-threatening bleeds, impaired wound healing, and spontaneous abortions. In many countries, only plasma or cryoprecipitate treatments are available, but these carry a risk for allergic reactions and infection with blood-borne pathogens. The present study was a multinational, open-label, single-arm, phase 3 prophylaxis trial evaluating the efficacy and safety of a novel recombinant FXIII (rFXIII) in congenital FXIII-A subunit deficiency...
May 31, 2012: Blood
Sergey B Zaets, Da-Zhong Xu, Qi Lu, Eleonora Feketova, Tamara L Berezina, Inga V Malinina, Edwin A Deitch, Eva H Olsen
BACKGROUND: Plasma factor XIII (FXIII) is responsible for stabilization of fibrin clot at the final stage of blood coagulation. Since FXIII has also been shown to modulate inflammation, endothelial permeability, as well as diminish multiple organ dysfunction (MOD) after gut ischemia-reperfusion injury, we hypothesized that FXIII would reduce MOD caused by trauma-hemorrhagic shock (THS). MATERIALS AND METHODS: Rats were subjected to a 90 min THS or trauma sham shock (TSS) and treated with either recombinant human FXIII A(2) subunit (rFXIII) or placebo immediately after resuscitation with shed blood or at the end of the TSS period...
April 2011: Journal of Surgical Research
Gunhild Klarskov Kristiansen, Mette Dahl Andersen
Factor XIII (FXIII) is a pro-transglutaminase found in the plasma as well as intracellularly in platelets and macrophages. Plasma FXIII is activated by thrombin cleavage (FXIIIa*) and acts in the final stages of blood coagulation cascade. In contrast, the function and activation of cellular FXIII are less characterized. Cellular FXIII relies on a conformational activation of the protein. The nonproteolytic activation of FXIII to FXIIIa° induced by Ca(2+) alone is well known, but up until now it has been discussed under which conditions the process can be induced and whether it can be reversed...
March 18, 2011: Journal of Biological Chemistry
Kerrie A Smith, Penelope J Adamson, Richard J Pease, Jane M Brown, Anthony J Balmforth, Paul A Cordell, Robert A S Ariëns, Helen Philippou, Peter J Grant
Fibrinogen αC residues 242-424 have been shown to have a major regulatory role in the activation of factor XIII-A(2)B(2) (FXIII-A(2)B(2)); however, the interactions underpinning this enhancing effect have not been determined. Here, we have characterized the binding of recombinant (r)FXIII-A subunit and FXIII-A(2)B(2) with fibrin(ogen) and fibrin αC residues 233-425. Using recombinant truncations of the fibrin αC region 233-425 and surface plasmon resonance, we found that activated rFXIII-A bound αC 233-425 (K(d) of 2...
March 24, 2011: Blood
Jerrold H Levy, Ravi Gill, Nancy A Nussmeier, Peter Skov Olsen, Henning F Andersen, Frank V McL Booth, Christian M Jespersen
Bleeding following cardiac surgery involving cardiopulmonary bypass (CPB) remains a major concern. Coagulation factor XIII (FXIII) functions as a clot-stabilising factor by cross-linking fibrin. Low post-operative levels of FXIII correlate with increased post-operative blood loss. To evaluate preliminary safety and pharmacokinetics of recombinant FXIII (rFXIII-A(2)) in cardiac surgery, patients scheduled for coronary artery bypass grafting were randomised to receive a single dose of either rFXIII-A(2) (11.9, 25, 35 or 50 IU/kg) or placebo in a 4:1 ratio...
October 2009: Thrombosis and Haemostasis
Pär I Johansson, Niels Jacobsen, Dorthe Viuff, Eva H N Olsen, Rasmus Rojkjaer, Søren Andersen, Lars C Petersen, Marianne Kjalke
The haemostatic effect of recombinant activated factor VII (rFVIIa;NovoSeven) in thrombocytopenic patients has been a matter of controversy. Haemostasis by rFVIIa occurs via FVIIa-mediated thrombin generation in a platelet-dependent manner and may therefore be suboptimal in patients without functional platelets. Under such conditions, a clot-stabilizing agent, such as factor XIII (FXIII), may supplement the effect ofrFVIIa and improve haemostasis. Recombinant factor XIII (rFXIII-A2) is produced as an A2 homodimer of the FXIII A subunit and is equivalent to cellular FXIII normally found in platelets...
November 2008: British Journal of Haematology
Sergey B Zaets, Da-Zhong Xu, Qi Lu, Eleonora Feketova, Tamara L Berezina, Maryann Gruda, Inga V Malinina, Edwin A Deitch, Eva H N Olsen
Plasma factor XIII (FXIII) is responsible for stabilization of fibrin clot at the final stage of blood coagulation. Because FXIII has also been shown to modulate inflammation and endothelial permeability, we hypothesized that FXIII diminishes multiple organ dysfunction caused by gut I/R injury. A model of superior mesenteric artery occlusion (SMAO) was used to induce gut I/R injury. Rats were subjected to 45-min SMAO or sham SMAO and treated with recombinant human FXIII A2 subunit (rFXIII) or placebo at the beginning of the reperfusion period...
June 2009: Shock
Masayoshi Souri, Hiroshi Kaetsu, Akitada Ichinose
Factor XIII (FXIII) is a heterotetramer composed of two catalytic A subunits (FXIII-A) and two B subunits (FXIII-B). FXIII-B has 10 Sushi domains. To explore the structure-function relationship of FXIII-B, we looked for domains in FXIII-B responsible for its homodimer and heterotetramer assembly with FXIII-A. Full-length recombinant human FXIII-B (rFXIII-B) and truncated rFXIII-Bs with various numbers of Sushi domains (rFXIII-B x- y ) were expressed in a baculovirus expression system. rFXIII-B was indistinguishable from purified human plasma FXIII-B, in terms of the molecular weight (after being deglycosylated by glycosidases) and the ability to form complexes between the two subunits...
August 19, 2008: Biochemistry
Masayoshi Souri, Shiori Koseki-Kuno, Naoki Takeda, Jay L Degen, Akitada Ichinose
Factor XIII (FXIII) is a proenzyme of plasma transglutaminase consisting of enzymatic A (FXIII-A) and noncatalytic B subunits (FXIII-B), and acts in hemostasis and wound healing. We freshly generated mice lacking either FXIII-A or FXIII-B to investigate the physiological functions of FXIII in vivo. Mice carrying the disrupted allele were born at the expected Mendelian ratios, and the homozygous mice were viable and fertile under specific pathogen-free conditions. Although all homozygous and heterozygous mice showed no marked difference from the wild-type animals in general appearance, homozygous mice of either FXIII-A- or FXIII-B-deficiency did have prolonged bleeding times...
January 2008: International Journal of Hematology
R Schaal-Jensen, B Kiehr, H T Boesen, J S Krabbe, C Sommer, H Jacobsen, M B Oleksiewicz
BACKGROUND: In cynomolgus monkeys, suprapharmacological doses of clotting recombinant factor XIII (rFXIII) cause a generalized coagulopathy, associated with formation of circulating high molecular weight protein complexes (HMEX). HMEX consist of plasma protein substrates cross-linked by FXIII transglutaminase activity. OBJECTIVE: To characterize HMEX, with a view to develop safety biomarker assays. METHODS: Cynomolgus monkeys received single i...
October 2007: Journal of Thrombosis and Haemostasis: JTH
M B Oleksiewicz, R Schaal-Jensen, B Kiehr, J Steenbuch Krabbe, C Sommer
Combination treatment with the clotting factors recombinant activated factor VII (rFVIIa), serine protease, and recombinant factor XIII (rFXIII), protransglutaminase, is being explored for haemostatic therapy. We performed a single-dose toxicology study in the cynomolgus monkey, with four dose groups receiving 0.1 + 0.34 mg kg(-1) (group 1), 0.33 + 1.12 mg kg(-1) (group 2), 1.67 + 5.60 mg kg(-1) (group 3) and 5.00 + 16.80 mg kg(-1) (group 4) of a rFVIIa + rFXIII combination. In the three lower dose groups, no clinical, histopathological or blood chemistry changes were observed...
July 2007: Biomarkers: Biochemical Indicators of Exposure, Response, and Susceptibility to Chemicals
Amy E Lovejoy, Tom C Reynolds, Jennifer E Visich, Michael D Butine, Guy Young, Melissa A Belvedere, Rachelle C Blain, Susan M Pederson, Laura M Ishak, Diane J Nugent
Congenital factor XIII (FXIII) deficiency is associated with a tendency for severe bleeding, a risk for spontaneous abortion, and a high rate of spontaneous intracranial hemorrhage. This phase 1 escalating-dose study was developed to evaluate the safety and pharmacokinetics of a single administration of human recombinant FXIII-A2 (rFXIII-A2) homodimer in adults with congenital FXIII deficiency. Pharmacokinetics and activity of rXIII and changes in endogenous B subunit levels were assessed. Recombinant FXIII-A2 homodimer were complexed with endogenous FXIII-B subunits to form an FXIII-A2B2 heterotetramer with a half-life of 8...
July 1, 2006: Blood
Jennifer E Visich, Linda A Zuckerman, Michael D Butine, Kulasiri A Gunewardena, Richard Wild, Kirsten M Morton, Thomas C Reynolds
Factor XIII (FXIII) is a plasma transglutaminase that covalently cross-links fibrin proteins to one another and to other proteins, increasing the mechanical strength of blood clots. Endogenous FXIII is the final enzyme in the clotting cascade and circulates as a heterotetramer comprising 2 FXIII-A subunits and 2 FXIII-B subunits. Recombinant human FXIII A2 (rFXIII) homodimer is produced in Saccharomyces cerevisiae. Upon injection, rFXIII combines with the free FXIIIB subunit that circulates in excess to form the rA2B2 tetramer...
October 2005: Thrombosis and Haemostasis
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