Thromb Haemost 2017; 117(01): 44-56
DOI: 10.1160/TH16-05-0416
Coagulation and Fibrinolysis
Schattauer GmbH

A novel hirudin derivative inhibiting thrombin without bleeding for subcutaneous injection

Bing Zhao
1   Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Fudan University, Shanghai, China
2   Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
,
Yanling Zhang
1   Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Fudan University, Shanghai, China
2   Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
,
Yinong Huang
1   Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Fudan University, Shanghai, China
2   Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
,
Jinchao Yu
1   Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Fudan University, Shanghai, China
2   Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
,
Yaran Li
1   Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Fudan University, Shanghai, China
2   Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
,
Qi Wang
2   Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
,
Yixin Ma
2   Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
,
Hou-Yan Song
1   Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Fudan University, Shanghai, China
2   Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
3   Collaborative Innovation Center for Biotherapy, Sichuan University, Huaxi Campus, Chengdu, China
,
Min Yu
1   Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Fudan University, Shanghai, China
2   Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
,
Wei Mo
1   Key Laboratory of Metabolism and Molecular Medicine, Ministry of Education, Fudan University, Shanghai, China
2   Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
› Author Affiliations
Financial support: This study was supported by the National Natural Science Foundation of China (NSFC 81673498) and the Science and Technology Commission of Shanghai Municipality (STCSM 16431904600).
Further Information

Publication History

Received: 28 May 2016

Accepted after major revision: 17 September 2016

Publication Date:
14 November 2017 (online)

Summary

Currently, anticoagulants would be used to prevent thrombosis. Thrombin is an effector enzyme for haemostasis and thrombosis. We designed a direct thrombin inhibitor peptide (DTIP) using molecular simulation and homology modelling and demonstrated that the C-terminus of DTIP interacts with exosite I, and N-terminus with the activity site of thrombin, respectively. DTIP interfered with thrombin-mediated coagulation in human, rat and mouse plasma (n=10 per group) and blocked clotting in human whole blood in vitro. When administered subcutaneously, DTIP showed potent and dose-dependent extension of aPTT, PT, TT and CT in rats (n=10 per group). The antithrombotic dose of DTIP induced significantly less bleeding than bivalirudin determined by transecting distal tail assay in rats. Furthermore, DTIP reached peak blood concentration in 0.5–1 hour and did not cause increased bleeding after five days of dosing compared to dabigatran etexilate. The antithrombotic effect of DTIP was evaluated in mice using lethal pulmonary thromboembolism model and FeCl3-induced mesenteric arteriole thrombus model. DTIP (1.0 mg/kg, sc) prevented deep venous thrombosis and increased the survival rate associated with pulmonary thromboembolism from 30 % to 80 %. Intravital microscopy showed that DTIP (1.0 mg/kg, sc) decelerated mesenteric arteriole thrombosis caused by FeCl3 injury. These data establish that DTIP is a novel antithrombotic agent that could be used to prevent thrombosis without conferring an increased bleeding risk.

Supplementary Material to this article is available at www.thrombosis-online.com.

 
  • References

  • 1 Larsson M, Rayzman V, Nolte MW. et al. A factor XIIa inhibitory antibody provides thromboprotection in extracorporeal circulation without increasing bleeding risk. Sci Transl Med 2014; 06: 222ra217.
  • 2 Weitz JI. A novel approach to thrombin inhibition. Thromb Res 2003; 109 (Suppl. 01) S17-22.
  • 3 Sheng GH, Aronowitz P. The lesser known side-effect of warfarin: warfarin-induced venous limb gangrene. Mayo Clin Proc 2014; 89: e47.
  • 4 Warkentin TE, Elavathil LJ, Hayward CP. et al. The pathogenesis of venous limb gangrene associated with heparin-induced thrombocytopenia. Ann Intern Med 1997; 127: 804-812.
  • 5 Chang YT, Hu YF, Liao JN. et al. The assessment of anticoagulant activity to predict bleeding outcome in atrial fibrillation patients receiving dabigatran etexilate. Blood Coagul Fibrinolysis 2016; 27: 389-395.
  • 6 Riley TR, Gauthier-Lewis ML, Sanchez CK. et al. Evaluation of Bleeding Events Requiring Hospitalisation in Patients With Atrial Fibrillation Receiving Dabigatran, Warfarin, or Antiplatelet Therapy. J Pharm Pract 2016 Epub ahead of print
  • 7 Ruff CT, Giugliano RP, Braunwald E. et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014; 383: 955-962.
  • 8 Leung TS, Law EH. Differential benefit risk assessment of DOACs in the treatment of venous thromboembolism: focus on dabigatran. Drug Des Devel Ther 2015; 09: 3557-3569.
  • 9 Thorne K, Dee S, Jayathissa S. Prescriber compliance with renal function monitoring in patients taking dabigatran (Pradaxa). N Z Med J 2015; 128: 83-88.
  • 10 Kubitza D, Roth A, Becka M. et al. Effect of hepatic impairment on the pharmacokinetics and pharmacodynamics of a single dose of rivaroxaban, an oral, direct Factor Xa inhibitor. Br J Clin Pharmacol 2013; 76: 89-98.
  • 11 Warkentin TE. Bivalent direct thrombin inhibitors: hirudin and bivalirudin. Best Pract Res Clin Haematol 2004; 17: 105-125.
  • 12 Fenton 2nd JW, Witting JI, Pouliott C. et al. Thrombin anion-binding exosite interactions with heparin and various polyanions. Ann NY Acad Sci 1989; 556: 158-165.
  • 13 Maraganore JM, Bourdon P, Jablonski J. et al. Design and characterisation of hirulogs: a novel class of bivalent peptide inhibitors of thrombin. Biochemistry 1990; 29: 7095-7101.
  • 14 Coppens M, Eikelboom JW, Gustafsson D. et al. Translational success stories: development of direct thrombin inhibitors. Circ Res 2012; 111: 920-929.
  • 15 Mo W, Zhang YL, Chen HS. et al. A novel hirudin derivative characterized with anti-platelet aggregations and thrombin inhibition. J Thromb Thrombolysis 2009; 28: 230-237.
  • 16 Lu WF, Mo W, Liu Z. et al. The antithrombotic effect of a novel hirudin derivative after reconstruction of carotid artery in rabbits. Thromb Res 2010; 126: e339-343.
  • 17 Lee CJ, Ansell JE. Direct thrombin inhibitors. Br J Clin Pharmacol 2011; 72: 581-592.
  • 18 Shenoi RA, Kalathottukaren MT, Travers RJ. et al. Affinity-based design of a synthetic universal reversal agent for heparin anticoagulants. Sci Transl Med 2014; 06: 260ra150.
  • 19 Huang Y, Zhang Y, Wu Y. et al. Expression, purification, and mass spectrometric analysis of 15N, 13C–labelled RGD-hirudin, expressed in Pichia pastoris, for NMR studies. PLoS One 2012; 07: e42207.
  • 20 Huang Y, Zhang Y, Zhao B. et al. Structural basis of RGD-hirudin binding to thrombin: Tyr 3 and five C-terminal residues are crucial for inhibiting thrombin activity. BMC Struct Biol 2014; 14: 26
  • 21 Greinacher A, Warkentin TE. The direct thrombin inhibitor hirudin. Thromb Haemost 2008; 99: 819-829.
  • 22 Laskowski RA, Rullmannn JA, MacArthur MW. et al. AQUA and PROCHECK-NMR: programs for checking the quality of protein structures solved by NMR. J Biomol NMR 1996; 08: 477-486.
  • 23 Markwardt F, Walsmann P. [Purification and analysis of the thrombin inhibitor hirudin]. Hoppe Seylers Z Physiol Chem 1967; 348: 1381-1386.
  • 24 Shenoi RA, Kalathottukaren MT, Travers RJ. et al. Affinity-based design of a synthetic universal reversal agent for heparin anticoagulants. Sci Transl Med 2014; 06: 260ra150.
  • 25 Naik S, Kumru OS, Cullom M. et al. Probing structurally altered and aggregated states of therapeutically relevant proteins using GroEL coupled to bio-layer interferometry. Protein Sci 2014; 23: 1461-1478.
  • 26 Liang Y, Fu Y, Qi RM. et al. Cartilage oligomeric matrix protein is a natural inhibitor of thrombin. Blood 2015; 126: 905-914.
  • 27 Stolla M, Stefanini L, Roden RC. et al. The kinetics of alphaIIbbeta3 activation determines the size and stability of thrombi in mice: implications for antiplatelet therapy. Blood 2011; 117: 1005-1013.
  • 28 Angelillo-Scherrer A, Burnier L, Flores N. et al. Role of Gas6 receptors in platelet signaling during thrombus stabilisation and implications for antithrombotic therapy. J Clin Invest 2005; 115: 237-246.
  • 29 Shen B, Zhao X, O’Brien KA. et al. A directional switch of integrin signalling and a new antithrombotic strategy. Nature 2013; 503: 131-135.
  • 30 Vu TT, Zhou J, Leslie BA. et al. Arterial thrombosis is accelerated in mice deficient in histidine-rich glycoprotein. Blood 2015; 125: 2712-2719.
  • 31 Hu L, Fan Z, Du H. et al. BF061, a novel antiplatelet and antithrombotic agent targeting P2Y12 and PDE. Thromb Haemost 2011; 09: 49-50.
  • 32 Song X, Mo W, Liu X. et al. The NMR solution structure of recombinant RGD-hirudin. Biochem Biophys Res Commun 2007; 360: 103-108.
  • 33 Majeed A, Schulman S. Bleeding and antidotes in new oral anticoagulants. Best Pract Res Clin Haematol 2013; 26: 191-202.
  • 34 Schulman S, Beyth RJ, Kearon C. et al. Hemorrhagic complications of anticoagulant and thrombolytic treatment. Chest 2008; 133: 257s-298s.
  • 35 Petros S. Lepirudin in the management of patients with heparin-induced thrombocytopenia. Biologics 2008; 02: 481-490.
  • 36 Graetz TJ, Tellor BR, Smith JR. et al. Desirudin: a review of the pharmacology and clinical application for the prevention of deep vein thrombosis. Expert Rev Cardiovasc Ther 2011; 09: 1101-1109.
  • 37 Galasso G, Mirra M, De Luca G. et al. Bivalirudin in Patients Undergoing PCI: State of Art and Future Perspectives. Transl Med UniSa 2016; 14: 54-63.
  • 38 Izadpanah M, Khalili H, Mohammadi M. Comparing safety of heparin as continuous intravenous infusion and multiple subcutaneous injections. J Comp Eff Res 2016; 05: 31-38.
  • 39 Baglin TP, Langdown J, Frasson R. et al. Discovery and characterisation of an antibody directed against exosite I of thrombin. J Thromb Haemost 2015; 14: 137-142.
  • 40 Brommer EJ, Meijer P. Thrombin generation induced by the intrinsic or extrinsic coagulation pathway is accelerated by streptokinase, independently of plasminogen. Thromb Haemost 1993; 70: 995-997.
  • 41 Kobsar A, Koessler J, Kehrer L. et al. The thrombin inhibitors hirudin and Refludan((R)) activate the soluble guanylyl cyclase and the cGMP pathway in washed human platelets. Thromb Haemost 2012; 107: 521-529.
  • 42 Basu D, Gallus A, Hirsh J. et al. A prospective study of the value of monitoring heparin treatment with the activated partial thromboplastin time. N Engl J Med 1972; 287: 324-327.
  • 43 Shahzad A, Kemp I, Mars C. et al. Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial. Lancet 2014; 384: 1849-1858.
  • 44 Antman EM. Hirudin in acute myocardial infarction - Thrombolysis and thrombin inhibition in myocardial infarction (TIMI) 9B trial. Circulation 1996; 94: 911-921.
  • 45 Luo X, Zhang F, Zhang C. et al. [Risk factors associated with the severity of PE in patients with acute deep venous thrombosis of lower extremities]. Zhonghua Wai Ke Za Zhi 2015; 53: 580-583.
  • 46 Robertson L, Kesteven P, McCaslin JE. Oral direct thrombin inhibitors or oral factor Xa inhibitors for the treatment of PE. Cochrane Database Syst Rev 2015; 12: CD010957.
  • 47 Barr JD, Chauhan AK, Schaeffer GV. et al. Red blood cells mediate the onset of thrombosis in the ferric chloride murine modell. Blood 2013; 121: 3733-3741.
  • 48 Lenain N, Freund M, Leon C. et al. Inhibition of localized thrombosis in P2Y1-deficient mice and rodents treated with MRS2179, a P2Y1 receptor antagonist. J Thromb Haemost 2003; 01: 1144-1149.
  • 49 Orlowski E, Chand R, Yip J. et al. A platelet tetraspanin superfamily member, CD151, is required for regulation of thrombus growth and stability in vivo. Thromb Haemost 2009; 07: 2074-2084.
  • 50 Zhang S, Zhang SH, Hu L. et al. Nucleotide-Binding Oligomerisation Domain 2 Receptor Is Expressed in Platelets and Enhances Platelet Activation and Thrombosis. Circulation 2015; 131: 1160-1170.
  • 51 Stangier J, Rathgen K, Stahle H. et al. The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects. Br J Clin Pharmacol 2007; 64: 292-303.
  • 52 Henrikson KP, Salazar SL, Fenton 2nd JW. et al. Role of thrombin receptor in breast cancer invasiveness. Br J Cancer 1999; 79: 401-406.
  • 53 Wojtukiewicz MZ, Tang DG, Ciarelli JJ. et al. Thrombin increases the metastatic potential of tumor cells. Int J Cancer 1993; 54: 793-806.
  • 54 Schulze EB, Hedley BD, Goodale D. et al. The thrombin inhibitor Argatroban reduces breast cancer malignancy and metastasis via osteopontin-dependent and osteopontin-independent mechanisms. Breast Cancer Res Treat 2008; 112: 243-254.
  • 55 Li J, Yu S, Qian D. et al. Bivalirudin Anticoagulant Therapy With or Without Platelet Glycoprotein IIb/IIIa Inhibitors During Transcatheter Coronary Interventional Procedures: A Meta-Analysis. Medicine 2015; 94: e1067.