Pharmacokinetics of Inter-Alpha Inhibitor Proteins and Effects on Hemostasis After Hypoxic-Ischemic Brain Injury in Neonatal Rats

Page: [3997 - 4006] Pages: 10

  • * (Excluding Mailing and Handling)

Abstract

Background: Hypoxic-ischemic (HI) brain injury is a leading cause of long-term neurodevelopmental morbidities in neonates. Human plasma-derived Inter-Alpha Inhibitor Proteins (hIAIPs) are neuroprotective after HI brain injury in neonatal rats. The light chain (bikunin) of hIAIPs inhibits proteases involved in the coagulation of blood. Newborns exposed to HI can be at risk for significant bleeding in the brain and other organs.

Objective: The objectives of the present study were to assess the pharmacokinetics (PK) and the duration of bleeding after intraperitoneal (IP) administration of hIAIPs in HI-exposed male and female neonatal rats.

Methods: HI was induced with the Rice-Vannucci method in postnatal (P) day-7 rats. After the right common carotid artery ligation, rats were exposed to 90 min of 8% oxygen. hIAIPs (30 mg/kg, IP) were given immediately after Sham or HI exposure in the PK study and serum was collected 1, 6, 12, 24, or 36 h after the injections. Serum hIAIP concentrations were measured with a competitive ELISA. ADAPT5 software was used to fit the pooled PK data considering first-order absorption and disposition. hIAIPs (60 mg/kg, IP) were given in the bleeding time studies at 0, 24 and 48 h after HI with tail bleeding times measured 72 h after HI.

Results: IP administration yielded significant systemic exposure to hIAIPs with PK being affected markedly including primarily faster absorption and reduced elimination as a result of HI and modestly of sex-related differences. hIAIP administration did not affect bleeding times after HI.

Conclusion: These results will help to inform hIAIP dosing regimen schedules in studies of neuroprotection in neonates exposed to HI.

Keywords: Pharmacokinetics, inter-alpha-inhibitor proteins, hypoxic-ischemic brain injury, coagulation, sex, neonates.

[1]
Barrett RD, Bennet L, Davidson J, et al. Destruction and reconstruction: Hypoxia and the developing brain. Birth Defects Res C Embryo Today 2007; 81(3): 163-76.
[http://dx.doi.org/10.1002/bdrc.20095] [PMID: 17963273]
[2]
Scafidi J, Fagel DM, Ment LR, Vaccarino FM. Modeling premature brain injury and recovery. Int J Dev Neurosci 2009; 27(8): 863-71.
[http://dx.doi.org/10.1016/j.ijdevneu.2009.05.009] [PMID: 19482072]
[3]
Perrone S, Stazzoni G, Tataranno ML, Buonocore G. New pharmacologic and therapeutic approaches for hypoxic-ischemic encephalopathy in the newborn. J Matern Fetal Neonatal Med 2012; 25(Suppl. 1): 83-8.
[http://dx.doi.org/10.3109/14767058.2012.663168] [PMID: 22309153]
[4]
Shankaran S, Pappas A, McDonald SA, et al. Eunice Kennedy Shriver NICHD Neonatal Research Network. Childhood outcomes after hypothermia for neonatal encephalopathy. N Engl J Med 2012; 366(22): 2085-92.
[http://dx.doi.org/10.1056/NEJMoa1112066] [PMID: 22646631]
[5]
McAdams RM, Juul SE. Neonatal Encephalopathy: Update on therapeutic hypothermia and other novel therapeutics. Clin Perinatol 2016; 43(3): 485-500.
[http://dx.doi.org/10.1016/j.clp.2016.04.007] [PMID: 27524449]
[6]
Ferriero DM. Neonatal brain injury. N Engl J Med 2004; 351(19): 1985-95.
[http://dx.doi.org/10.1056/NEJMra041996] [PMID: 15525724]
[7]
Leviton A, Allred EN, Fichorova RN, Kuban KC, Michael O’Shea T, Dammann O. ELGAN study investigators. Systemic inflammation on postnatal days 21 and 28 and indicators of brain dysfunction 2years later among children born before the 28th week of gestation. Early Hum Dev 2016; 93: 25-32.
[http://dx.doi.org/10.1016/j.earlhumdev.2015.11.004] [PMID: 26735345]
[8]
Leviton A, Dammann O, Allred EN, et al. Neonatal systemic inflammation and the risk of low scores on measures of reading and mathematics achievement at age 10 years among children born extremely preterm. Int J Dev Neurosci 2018; 66: 45-53.
[http://dx.doi.org/10.1016/j.ijdevneu.2018.01.001] [PMID: 29413878]
[9]
Marlow N, Wolke D, Bracewell MA, Samara M, Group EPS. EPICure Study Group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005; 352(1): 9-19.
[http://dx.doi.org/10.1056/NEJMoa041367] [PMID: 15635108]
[10]
Hill CA, Fitch RH. Sex differences in mechanisms and outcome of neonatal hypoxia-ischemia in rodent models: implications for sex-specific neuroprotection in clinical neonatal practice. Neurol Res Int 2012; 2012867531
[http://dx.doi.org/10.1155/2012/867531] [PMID: 22474588]
[11]
Smith AL, Alexander M, Rosenkrantz TS, Sadek ML, Fitch RH. Sex differences in behavioral outcome following neonatal hypoxia ischemia: insights from a clinical meta-analysis and a rodent model of induced hypoxic ischemic brain injury. Exp Neurol 2014; 254: 54-67.
[http://dx.doi.org/10.1016/j.expneurol.2014.01.003] [PMID: 24434477]
[12]
Gandhi M, Aweeka F, Greenblatt RM, Blaschke TF. Sex differences in pharmacokinetics and pharmacodynamics. Annu Rev Pharmacol Toxicol 2004; 44: 499-523.
[http://dx.doi.org/10.1146/annurev.pharmtox.44.101802.121453] [PMID: 14744256]
[13]
Yano T, Anraku S, Nakayama R, Ushijima K. Neuroprotective effect of urinary trypsin inhibitor against focal cerebral ischemia-reperfusion injury in rats. Anesthesiology 2003; 98(2): 465-73.
[http://dx.doi.org/10.1097/00000542-200302000-00028] [PMID: 12552207]
[14]
Threlkeld SW, Gaudet CM, La Rue ME, et al. Effects of inter-alpha inhibitor proteins on neonatal brain injury: Age, task and treatment dependent neurobehavioral outcomes. Exp Neurol 2014; 261: 424-33.
[http://dx.doi.org/10.1016/j.expneurol.2014.07.012] [PMID: 25084519]
[15]
Singh K, Zhang LX, Bendelja K, et al. Inter-alpha inhibitor protein administration improves survival from neonatal sepsis in mice. Pediatr Res 2010; 68(3): 242-7.
[http://dx.doi.org/10.1203/PDR.0b013e3181e9fdf0] [PMID: 20520583]
[16]
Lim YP. ProThera Biologics, Inc.: a novel immunomodulator and biomarker for life-threatening diseases. R I Med J (2013) 2013; 96(2): 16-8..
[PMID: 23641420]
[17]
Koga Y, Fujita M, Tsuruta R, et al. Urinary trypsin inhibitor suppresses excessive superoxide anion radical generation in blood, oxidative stress, early inflammation, and endothelial injury in forebrain ischemia/reperfusion rats. Neurol Res 2010; 32(9): 925-32.
[http://dx.doi.org/10.1179/016164110X12645013515133] [PMID: 20223106]
[18]
Shu Y, Yang Y, Qiu W, et al. Neuroprotection by ulinastatin in experimental autoimmune encephalomyelitis. Neurochem Res 2011; 36(11): 1969-77.
[http://dx.doi.org/10.1007/s11064-011-0520-4] [PMID: 21667278]
[19]
Gaudet CM, Lim YP, Stonestreet BS, Threlkeld SW. Effects of age, experience and inter-alpha inhibitor proteins on working memory and neuronal plasticity after neonatal hypoxia-ischemia. Behav Brain Res 2016; 302: 88-99.
[http://dx.doi.org/10.1016/j.bbr.2016.01.016] [PMID: 26778784]
[20]
Threlkeld SW, Lim YP, La Rue M, Gaudet C, Stonestreet BS. Immuno-modulator inter-alpha inhibitor proteins ameliorate complex auditory processing deficits in rats with neonatal hypoxic-ischemic brain injury. Brain Behav Immun 2017; 64: 173-9.
[http://dx.doi.org/10.1016/j.bbi.2017.03.004] [PMID: 28286301]
[21]
Barrios-Anderson A, Chen X, Nakada S, Chen R, Lim YP, Stonestreet BS. Immuno-modulator inter-alpha inhibitor proteins ameliorate complex auditory processing deficits in rats with neonatal hypoxic-ischemic brain injury. Brain Behav Immun 2017; 64: 173-9
[http://dx.doi.org/10.1093/jnen/nlz051] [PMID: 31274164]
[22]
Chen X, Nakada S, Donahue JE, et al. Neuroprotective effects of inter-alpha inhibitor proteins after hypoxic-ischemic brain injury in neonatal rats. Exp Neurol 2019; 317: 244-59.
[http://dx.doi.org/10.1016/j.expneurol.2019.03.013] [PMID: 30914159]
[23]
Jessen TE, Faarvang KL, Ploug M. Carbohydrate as covalent crosslink in human inter-alpha-trypsin inhibitor: a novel plasma protein structure. FEBS Lett 1988; 230(1-2): 195-200.
[http://dx.doi.org/10.1016/0014-5793(88)80670-7] [PMID: 2450785]
[24]
Potempa J, Kwon K, Chawla R, Travis J. Inter-alpha-trypsin inhibitor. Inhibition spectrum of native and derived forms. J Biol Chem 1989; 264(25): 15109-14.
[PMID: 2475494]
[25]
Zhu L, Zhuo L, Watanabe H, Kimata K. Equivalent involvement of inter-alpha-trypsin inhibitor heavy chain isoforms in forming covalent complexes with hyaluronan. Connect Tissue Res 2008; 49(1): 48-55.
[http://dx.doi.org/10.1080/03008200701820955] [PMID: 18293178]
[26]
Zhuo L, Kimata K. Structure and function of inter-alpha-trypsin inhibitor heavy chains. Connect Tissue Res 2008; 49(5): 311-20.
[http://dx.doi.org/10.1080/03008200802325458] [PMID: 18991084]
[27]
Fries E, Blom AM. Bikunin--not just a plasma proteinase inhibitor. Int J Biochem Cell Biol 2000; 32(2): 125-37.
[http://dx.doi.org/10.1016/S1357-2725(99)00125-9] [PMID: 10687949]
[28]
Morishita H, Yamakawa T, Matsusue T, et al. Novel factor Xa and plasma kallikrein inhibitory-activities of the second Kunitz-type inhibitory domain of urinary trypsin inhibitor. Thromb Res 1994; 73(3-4): 193-204.
[http://dx.doi.org/10.1016/0049-3848(94)90098-1] [PMID: 8191413]
[29]
Rice JE III, Vannucci RC, Brierley JB. The influence of immaturity on hypoxic-ischemic brain damage in the rat. Ann Neurol 1981; 9(2): 131-41.
[http://dx.doi.org/10.1002/ana.410090206] [PMID: 7235629]
[30]
Fries E, Kaczmarczyk A. Inter-alpha-inhibitor, hyaluronan and inflammation. Acta Biochim Pol 2003; 50(3): 735-42.
[http://dx.doi.org/10.18388/abp.2003_3664] [PMID: 14515153]
[31]
Opal SM, Lim YP, Cristofaro P, et al. Inter-α inhibitor proteins: a novel therapeutic strategy for experimental anthrax infection. Shock 2011; 35(1): 42-4.
[http://dx.doi.org/10.1097/SHK.0b013e3181e83204] [PMID: 20523269]
[32]
Spasova MS, Sadowska GB, Threlkeld SW, Lim YP, Stonestreet BS. Ontogeny of inter-alpha inhibitor proteins in ovine brain and somatic tissues. Exp Biol Med (Maywood) 2014; 239(6): 724-36.
[http://dx.doi.org/10.1177/1535370213519195] [PMID: 24728724]
[33]
Lim YP, Josic D, Callanan H, Brown J, Hixson DC. Affinity purification and enzymatic cleavage of inter-alpha inhibitor proteins using antibody and elastase immobilized on CIM monolithic disks. J Chromatogr A 2005; 1065(1): 39-43.
[http://dx.doi.org/10.1016/j.chroma.2004.11.006] [PMID: 15782948]
[34]
Vannucci SJ, Hagberg H. Hypoxia-ischemia in the immature brain. J Exp Biol 2004; 207(Pt 18): 3149-54.
[http://dx.doi.org/10.1242/jeb.01064] [PMID: 15299036]
[35]
Towfighi J, Mauger D, Vannucci RC, Vannucci SJ. Influence of age on the cerebral lesions in an immature rat model of cerebral hypoxia-ischemia: a light microscopic study. Brain Res Dev Brain Res 1997; 100(2): 149-60.
[http://dx.doi.org/10.1016/S0165-3806(97)00036-9] [PMID: 9205806]
[36]
Thoresen M, Bågenholm R, Løberg EM, Apriccna F. The stress of being restrained reduces brain damage after a hypoxic-ischaemic insult in the 7-day-old rat. Neuroreport 1996; 7(2): 481-4.
[http://dx.doi.org/10.1097/00001756-199601310-00025] [PMID: 8730810]
[37]
Thoresen M, Hobbs CE, Wood T, Chakkarapani E, Dingley J. Cooling combined with immediate or delayed xenon inhalation provides equivalent long-term neuroprotection after neonatal hypoxia-ischemia. J Cereb Blood Flow Metab 2009; 29(4): 707-14.
[http://dx.doi.org/10.1038/jcbfm.2008.163] [PMID: 19142190]
[38]
Dingley J, Tooley J, Porter H, Thoresen M. Xenon provides short-term neuroprotection in neonatal rats when administered after hypoxia-ischemia. Stroke 2006; 37(2): 501-6.
[http://dx.doi.org/10.1161/01.STR.0000198867.31134.ac] [PMID: 16373643]
[39]
Thoresen M, Bågenholm R, Løberg EM, Apricena F, Kjellmer I. Posthypoxic cooling of neonatal rats provides protection against brain injury. Arch Dis Child Fetal Neonatal Ed 1996; 74(1): F3-9.
[http://dx.doi.org/10.1136/fn.74.1.F3] [PMID: 8653432]
[40]
Osredkar D, Thoresen M, Maes E, Flatebø T, Elstad M, Sabir H. Hypothermia is not neuroprotective after infection-sensitized neonatal hypoxic-ischemic brain injury. Resuscitation 2014; 85(4): 567-72.
[http://dx.doi.org/10.1016/j.resuscitation.2013.12.006] [PMID: 24361672]
[41]
Bona E, Hagberg H, Løberg EM, Bågenholm R, Thoresen M. Protective effects of moderate hypothermia after neonatal hypoxia-ischemia: short- and long-term outcome. Pediatr Res 1998; 43(6): 738-45.
[http://dx.doi.org/10.1203/00006450-199806000-00005] [PMID: 9621982]
[42]
Ma D, Hossain M, Chow A, et al. Xenon and hypothermia combine to provide neuroprotection from neonatal asphyxia. Ann Neurol 2005; 58(2): 182-93.
[http://dx.doi.org/10.1002/ana.20547] [PMID: 16049939]
[43]
Turner PV, Brabb T, Pekow C, Vasbinder MA. Administration of substances to laboratory animals: routes of administration and factors to consider. J Am Assoc Lab Anim Sci 2011; 50(5): 600-13.
[PMID: 22330705]
[44]
Alapati D, Rong M, Chen S, et al. Connective tissue growth factor antibody therapy attenuates hyperoxia-induced lung injury in neonatal rats. Am J Respir Cell Mol Biol 2011; 45(6): 1169-77.
[http://dx.doi.org/10.1165/rcmb.2011-0023OC] [PMID: 21659659]
[45]
Disdier C, Zhang J, Fukunaga Y, et al. Alterations in inter-alpha inhibitor protein expression after hypoxic-ischemic brain injury in neonatal rats. Int J Dev Neurosci 2018; 65: 54-60.
[http://dx.doi.org/10.1016/j.ijdevneu.2017.10.008] [PMID: 29079121]
[46]
Nagy A, Gertsenstein M, Vintersten K, Behringer R. Preparation of rat serum. CSH Protoc 2006 2006.
[http://dx.doi.org/10.1101/pdb.prot4372]
[47]
Lim YP, Bendelja K, Opal SM, Siryaporn E, Hixson DC, Palardy JE. Correlation between mortality and the levels of inter-alpha inhibitors in the plasma of patients with severe sepsis. J Infect Dis 2003; 188(6): 919-26.
[http://dx.doi.org/10.1086/377642] [PMID: 12964125]
[48]
Chaaban H, Keshari RS, Silasi-Mansat R, et al. Inter-α inhibitor protein and its associated glycosaminoglycans protect against histone-induced injury. Blood 2015; 125(14): 2286-96.
[http://dx.doi.org/10.1182/blood-2014-06-582759] [PMID: 25631771]
[49]
Liu Y, Jennings NL, Dart AM, Du XJ. Standardizing a simpler, more sensitive and accurate tail bleeding assay in mice. World J Exp Med 2012; 2(2): 30-6.
[http://dx.doi.org/10.5493/wjem.v2.i2.30] [PMID: 24520531]
[50]
Fadiran EO, Zhang L. Effects of sex differences in the pharmacokinetics of drugs and their impact on the safety of medicines in womenmedicines for womenSpringer International Publishing Cham 2015; 41-68.
[http://dx.doi.org/10.1007/978-3-319-12406-3_2]
[51]
Chen X, DuBois DC, Almon RR, Jusko WJ. Interrelationships between infliximab and recombinant tumor necrosis factor-α in plasma using minimal physiologically based pharmacokinetic models. Drug Metab Dispos 2017; 45(7): 790-7.
[http://dx.doi.org/10.1124/dmd.116.074807] [PMID: 28411280]
[52]
Wilson RB. Hypoxia, cytokines and stromal recruitment: parallels between pathophysiology of encapsulating peritoneal sclerosis, endometriosis and peritoneal metastasis. Pleura Peritoneum 2018; 3(1)20180103
[http://dx.doi.org/10.1515/pp-2018-0103] [PMID: 30911653]
[53]
Hsu YC, Chang YC, Lin YC, Sze CI, Huang CC, Ho CJ. Cerebral microvascular damage occurs early after hypoxia-ischemia via nNOS activation in the neonatal brain. J Cereb Blood Flow Metab 2014; 34(4): 668-76.
[http://dx.doi.org/10.1038/jcbfm.2013.244] [PMID: 24398931]
[54]
Page S, Munsell A, Al-Ahmad AJ. Cerebral hypoxia/ischemia selectively disrupts tight junctions complexes in stem cell-derived human brain microvascular endothelial cells. Fluids Barriers CNS 2016; 13(1): 16.
[http://dx.doi.org/10.1186/s12987-016-0042-1] [PMID: 27724968]
[55]
Castillo-Melendez M, Baburamani AA, Cabalag C, et al. Experimental modelling of the consequences of brief late gestation asphyxia on newborn lamb behaviour and brain structure. PLoS One 2013; 8(11)e77377
[http://dx.doi.org/10.1371/journal.pone.0077377] [PMID: 24223120]
[56]
Goasdoue K, Chand KK, Miller SM, et al. Seizures are associated with blood-brain barrier disruption in a piglet model of neonatal hypoxic-ischaemic encephalopathy. Dev Neurosci 2019; 1-16.
[PMID: 31048585]
[57]
Lee HB, Blaufox MD. Blood volume in the rat. J Nucl Med 1985; 26(1): 72-6.
[PMID: 3965655]
[58]
Chaaban H, Shin M, Sirya E, Lim YP, Caplan M, Padbury JF. Inter-alpha inhibitor protein level in neonates predicts necrotizing enterocolitis. J Pediatr 2010; 157(5): 757-61.
[http://dx.doi.org/10.1016/j.jpeds.2010.04.075] [PMID: 20955849]
[59]
Chaaban H, Singh K, Huang J, Siryaporn E, Lim YP, Padbury JF. The role of inter-alpha inhibitor proteins in the diagnosis of neonatal sepsis. J Pediatr 2009; 154: 620-22 e1.
[60]
Sjöberg EM, Blom A, Larsson BS, Alston-Smith J, Sjöquist M, Fries E. Plasma clearance of rat bikunin: evidence for receptor-mediated uptake. Biochem J 1995; 308(Pt 3): 881-7.
[http://dx.doi.org/10.1042/bj3080881] [PMID: 8948446]
[61]
Anderson BJ, Holford NH. Mechanism-based concepts of size and maturity in pharmacokinetics. Annu Rev Pharmacol Toxicol 2008; 48: 303-32.
[http://dx.doi.org/10.1146/annurev.pharmtox.48.113006.094708] [PMID: 17914927]
[62]
Balduini W, De Angelis V, Mazzoni E, Cimino M. Simvastatin protects against long-lasting behavioral and morphological consequences of neonatal hypoxic/ischemic brain injury. Stroke 2001; 32(9): 2185-91.
[http://dx.doi.org/10.1161/hs0901.094287] [PMID: 11546915]
[63]
Fan LW, Lin S, Pang Y, et al. Hypoxia-ischemia induced neurological dysfunction and brain injury in the neonatal rat. Behav Brain Res 2005; 165(1): 80-90.
[http://dx.doi.org/10.1016/j.bbr.2005.06.033] [PMID: 16140403]
[64]
Forman KR, Diab Y, Wong EC, Baumgart S, Luban NL, Massaro AN. Coagulopathy in newborns with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia: a retrospective case-control study. BMC Pediatr 2014; 14: 277.
[http://dx.doi.org/10.1186/1471-2431-14-277] [PMID: 25367591]
[65]
Bauman ME, Cheung PY, Massicotte MP. Hemostasis and platelet dysfunction in asphyxiated neonates. J Pediatr 2011; 158(2)(Suppl.): e35-9.
[http://dx.doi.org/10.1016/j.jpeds.2010.11.011] [PMID: 21238709]
[66]
Delaria KA, Muller DK, Marlor CW, et al. Characterization of placental bikunin, a novel human serine protease inhibitor. J Biol Chem 1997; 272(18): 12209-14.
[http://dx.doi.org/10.1074/jbc.272.18.12209] [PMID: 9115295]