CONTROL OF BLOOD ACTIVATION BY SYNTHETIC SURFACES

肝素化血液与心肺合成表面的接触 机器在体内启动复杂的化学和细胞反应 导致血栓形成和出血问题的血液 身体炎症反应。“这项建议寻求识别和 选择性地抑制最初的反应和激活的激动剂 凝血、纤溶和免疫化学防御机制 在体外循环(CPB)期间。该提案将利用几个 新开发的免疫化学分析方法可用于破译 血小板、中性粒细胞、补体、纤溶和接触系统 在CPB期间，蛋白质被激活，在我们成熟的 体外模拟体外循环(SECC)模型及一种新的 恒河猴活体模型。新研制的鼠抗因子抗体 XII、前激肽释放酶和高分子量激肽原，以及特异性 多肽，如硼精氨酸激肽释放酶抑制剂，将首先 在我们的体外模型中进行了测试，然后在狒狒身上进行了测试。该项目还 寻找肝素的替代品，如水飞蓟素和硼精氨酸肽， 和鱼精蛋白，如血小板因子4，因为肝素和鱼精蛋白 是已知的血液激动剂。纤溶酶和纤溶酶在纤溶系统中的作用 CPB期间和术后中性粒细胞弹性蛋白酶的研究将使用新的 纤维蛋白和纤维蛋白原片段的特异性分析。纤溶 抑制剂-转换酸、己酸和非质子酸- 将在病人和狒狒身上进行评估。该项目试图利用 可逆性阻断的特定多肽和组合策略 中性粒细胞和血小板活化。将对患者进行研究， 发现并量化接触系统和纤溶系统的激活 系统蛋白、血小板和中性粒细胞。未经批准的药品， 特定的多肽和单克隆抗生素将在体外进行研究， 首先是用人血，然后是在狒狒身上，因为大多数人类 免疫化学检测与狒狒血液发生交叉反应。的最新进展 血液学和免疫化学提供了现实的前景 抑制表面激活的血液成分可以实现和 在非常年轻和非常年长的人中，CPB的发病率和死亡率 可以减少。

Contact of heparinized blood with synthetic surfaces of the heart-lung machine initiates complex chemical and cellular reactions within the blood that result in thrombotic and bleeding problems and in a "whole body inflammatory response." This proposal seeks to identify and to selectively inhibit the initial reactions and agonists that activate blood coagulation, fibrinolysis and immunochemical defense mechanisms during cardiopulmonary bypass (CPB). The proposal will utilize several newly developed immunochemical assays to decipher the mechanisms whereby platelets$ neutrophils and complement and fibrinolytic and contact system proteins are activated during CPB in patients, in our well-established in vitro model of simulated extracorporeal circulation (SECC) and in a new in vivo baboon model. Newly developed murine antibodies against Factor XII, prekallikrein and high molecular weight kininogen, and specific peptides such as a boroarginine kallikrein inhibitor, will first be tested in our in vitro model and then in the baboon. The project also seeks alternatives to heparin, such as hirudin and boroarginine peptides, and to protamine, such as platelet factor 4, since heparin and protamine are known blood agonists. The role of fibrinolysis by both plasmin and neutrophil elastase during and after CPB will be studied using new specific assays for fibrin and fibrinogen fragments. Fibrinolytic inhibitors - tranexemic acid, epsilon amino caproic acid and aprotonin - will be evaluated in patients and baboons. The project seeks to use specific peptides and combination strategies to reversibly block neutrophil and platelet activation. Patient studies will be done to, discover and quantitate activation of contact system and fibrinolytic system proteins, and platelets and neutrophils. Unapproved drugs, specific peptides and monoclonal antibiotics will be studied in vitro, first using human blood and then in baboons, since most human immunochemical assays cross-react with baboon blood. Recent advances in hematology and immunochemistry offer realistic prospects that selective inhibition of surface-activated blood constituents can be achieved and that the morbidity and mortality of CPB in the very young and very old can be reduced.