Defibrotide Interferes With Several Steps of the Coagulation-Inflammation Cycle and Exhibits Therapeutic Potential to Treat Severe Malaria

Objective-The coagulation-inflammation cycle has been implicated as a critical component in malaria pathogenesis. Defibrotide (DF), a mixture of DNA aptamers, displays anticoagulant, anti-inflammatory, and endothelial cell (EC)-protective activities and has been successfully used to treat comatose children with veno-occlusive disease. DF was investigated here as a drug to treat cerebral malaria. Methods and Results-DF blocks tissue factor expression by ECs incubated with parasitized red blood cells and attenuates prothrombinase activity, platelet aggregation, and complement activation. In contrast, it does not affect nitric oxide bioavailability. We also demonstrated that Plasmodium falciparum glycosylphosphatidylinositol (Pf-GPI) induces tissue factor expression in ECs and cytokine production by dendritic cells. Notably, dendritic cells, known to modulate coagulation and inflammation systemically, were identified as a novel target for DF. Accordingly, DF inhibits Toll-like receptor ligand-dependent dendritic cells activation by a mechanism that is blocked by adenosine receptor antagonist (8-p-sulfophenyltheophylline) but not reproduced by synthetic poly-A, -C, -T, and -G. These results imply that aptameric sequences and adenosine receptor mediate dendritic cells responses to the drug. DF also prevents rosetting formation, red blood cells invasion by P. falciparum and abolishes oocysts development in Anopheles gambiae. In a murine model of cerebral malaria, DF affected parasitemia, decreased IFN-gamma levels, and ameliorated clinical score (day 5) with a trend for increased survival. Conclusion-Therapeutic use of DF in malaria is proposed. (Arterioscler Thromb Vasc Biol. 2012; 32:786-798.)

Factor Xa activation of factor V is of paramount importance in initiating the coagulation system: lessons from a tick salivary protein

BACKGROUND: Generation of active procoagulant cofactor factor Va (FVa) and its subsequent association with the enzyme activated factor X (FXa) to form the prothrombinase complex is a pivotal initial event in blood coagulation and has been the subject of investigative effort, speculation, and controversy. The current paradigm assumes that FV activation is initiated by limited proteolysis by traces of (meizo) thrombin. METHODS AND RESULTS: Recombinant tick salivary protein TIX-5 was produced and anticoagulant properties were studied with the use of plasma, whole blood, and purified systems. Here, we report that TIX-5 specifically inhibits FXa-mediated FV activation involving the B domain of FV and show that FXa activation of FV is pivotal for plasma and blood clotting. Accordingly, tick feeding is impaired on TIX-5 immune rabbits, displaying the in vivo importance of TIX-5. CONCLUSIONS: Our data elucidate a unique molecular mechanism by which ticks inhibit the host's coagulation system. From our data, we propose a revised blood coagulation scheme in which direct FXa-mediated FV activation occurs in the initiation phase during which thrombin-mediated FV activation is restrained by fibrinogen and inhibitors.

Microwave-Mediated Hetero Diels-Alder reaction: Synthesis of biologically active compounds

Heterocyclic compounds represent almost two-thirds of all the known organic compounds: they are widely distributed in nature and play a key role in a huge number of biologically important molecules including some of the most significant for human beings. A powerful tool for the synthesis of such compounds is the hetero Diels-Alder reaction (HDA), that involve a [4+2] cycloaddition reaction between heterodienes and suitable dienophiles. Among heterodienes to be used in such six-membered heterocyclic construction strategy, 3-trialkylsilyloxy-2-aza-1,3-dienes (Fig 1) has been demonstrated particularly attractive. In this thesis work, HDA reactions between 2-azadienes and carbonylic and/or olefinic dienophiles, are described. Moreover, substitution of conventional heating by the corresponding dielectric heating as been explored in the frame of Microwave-Assisted-Organic-Synthesis (MAOS) which constitutes an up-to-grade research field of great interest both from an academic and industrial point of view. Reaction of the azadiene 1 (Fig 1) will be described using as dienophiles carbonyl compounds as aldehyde and ketones. The six-membered adducts thus obtained (Scheme 1) have been elaborated to biologically active compounds like 1,3-aminols which constitutes the scaffold for a wide range of drugs (Prozac®, Duloxetine, Venlafaxine) with large applications in the treatment of severe diseases of nervous central system (NCS). Scheme 1 The reaction provides the formation of three new stereogenic centres (C-2; C-5; C-6). The diastereoselective outcome of these reactions has been deeply investigated by the use of various combination of achiral and chiral azadienes and aliphatic, aromatic or heteroaromatic aldehydes. The same approach, basically, has been used in the synthesis of piperidin-2-one scaffold substituting the carbonyl dienophile with an electron poor olefin. Scheme 2 As a matter of fact, this scaffold is present in a very large number of natural substances and, more interesting, is a required scaffold for an huge variety of biologically active compounds. Activated olefins bearing one or two sulfone groups, were choose as dienophiles both for the intrinsic characteristic flexibility of the “sulfone group” which may be easily removed or elaborated to more complex decorations of the heterocyclic ring, and for the electron poor property of this dienophiles which makes the resulting HDA reaction of the type “normal electron demand”. Synthesis of natural compounds like racemic (±)-Anabasine (alkaloid of Tobacco’s leaves) and (R)- and (S)-Conhydrine (alkaloid of Conium Maculatum’s seeds and leaves) and its congeners, are described (Fig 2).

Numerical simulation of interdigitated back contact hetero-junction solar cells

The goal of this thesis is the application of an opto-electronic numerical simulation to heterojunction silicon solar cells featuring an all back contact architecture (Interdigitated Back Contact Hetero-Junction IBC-HJ). The studied structure exhibits both metal contacts, emitter and base, at the back surface of the cell with the objective to reduce the optical losses due to the shadowing by front contact of conventional photovoltaic devices. Overall, IBC-HJ are promising low-cost alternatives to monocrystalline wafer-based solar cells featuring front and back contact schemes, in fact, for IBC-HJ the high concentration doping diffusions are replaced by low-temperature deposition processes of thin amorphous silicon layers. Furthermore, another advantage of IBC solar cells with reference to conventional architectures is the possibility to enable a low-cost assembling of photovoltaic modules, being all contacts on the same side. A preliminary extensive literature survey has been helpful to highlight the specific critical aspects of IBC-HJ solar cells as well as the state-of-the-art of their modeling, processing and performance of practical devices. In order to perform the analysis of IBC-HJ devices, a two-dimensional (2-D) numerical simulation flow has been set up. A commercial device simulator based on finite-difference method to solve numerically the whole set of equations governing the electrical transport in semiconductor materials (Sentuarus Device by Synopsys) has been adopted. The first activity carried out during this work has been the definition of a 2-D geometry corresponding to the simulation domain and the specification of the electrical and optical properties of materials. In order to calculate the main figures of merit of the investigated solar cells, the spatially resolved photon absorption rate map has been calculated by means of an optical simulator. Optical simulations have been performed by using two different methods depending upon the geometrical features of the front interface of the solar cell: the transfer matrix method (TMM) and the raytracing (RT). The first method allows to model light prop-agation by plane waves within one-dimensional spatial domains under the assumption of devices exhibiting stacks of parallel layers with planar interfaces. In addition, TMM is suitable for the simulation of thin multi-layer anti reflection coating layers for the reduction of the amount of reflected light at the front interface. Raytracing is required for three-dimensional optical simulations of upright pyramidal textured surfaces which are widely adopted to significantly reduce the reflection at the front surface. The optical generation profiles are interpolated onto the electrical grid adopted by the device simulator which solves the carriers transport equations coupled with Poisson and continuity equations in a self-consistent way. The main figures of merit are calculated by means of a postprocessing of the output data from device simulation. After the validation of the simulation methodology by means of comparison of the simulation result with literature data, the ultimate efficiency of the IBC-HJ architecture has been calculated. By accounting for all optical losses, IBC-HJ solar cells result in a theoretical maximum efficiency above 23.5% (without texturing at front interface) higher than that of both standard homojunction crystalline silicon (Homogeneous Emitter HE) and front contact heterojuction (Heterojunction with Intrinsic Thin layer HIT) solar cells. However it is clear that the criticalities of this structure are mainly due to the defects density and to the poor carriers transport mobility in the amorphous silicon layers. Lastly, the influence of the most critical geometrical and physical parameters on the main figures of merit have been investigated by applying the numerical simulation tool set-up during the first part of the present thesis. Simulations have highlighted that carrier mobility and defects level in amorphous silicon may lead to a potentially significant reduction of the conversion efficiency.

Manufacturing and characterization of amorphous silicon alloys passivation layers for silicon hetero-junction solar cells

Nel presente lavoro di tesi magistrale sono stati depositati e caratterizzati film sottili (circa 10 nm) di silicio amorfo idrogenato (a-Si:H), studiando in particolare leghe a basso contenuto di ossigeno e carbonio. Tali layer andranno ad essere implementati come strati di passivazione per wafer di Si monocristallino in celle solari ad eterogiunzione HIT (heterojunctions with intrinsic thin layer), con le quali recentemente è stato raggiunto il record di efficienza pari a 24.7% . La deposizione è avvenuta mediante PECVD (plasma enhanced chemical vapour deposition). Tecniche di spettroscopia ottica, come FT-IR (Fourier transform infrared spectroscopy) e SE (spettroscopic ellipsometry) sono state utilizzate per analizzare le configurazioni di legami eteronucleari (Si-H, Si-O, Si-C) e le proprietà strutturali dei film sottili: un nuovo metodo è stato implementato per calcolare i contenuti atomici di H, O e C da misure ottiche. In tal modo è stato possibile osservare come una bassa incorporazione (< 10%) di ossigeno e carbonio sia sufficiente ad aumentare la porosità ed il grado di disordine a lungo raggio del materiale: relativamente a quest’ultimo aspetto, è stata sviluppata una nuova tecnica per determinare dagli spettri ellisometrici l’energia di Urbach, che esprime la coda esponenziale interna al gap in semiconduttori amorfi e fornisce una stima degli stati elettronici in presenza di disordine reticolare. Nella seconda parte della tesi sono stati sviluppati esperimenti di annealing isocrono, in modo da studiare i processi di cristallizzazione e di effusione dell’idrogeno, correlandoli con la degradazione delle proprietà optoelettroniche. L’analisi dei differenti risultati ottenuti studiando queste particolari leghe (a-SiOx e a-SiCy) ha permesso di concludere che solo con una bassa percentuale di ossigeno o carbonio, i.e. < 3.5 %, è possibile migliorare la risposta termica dello specifico layer, ritardando i fenomeni di degradazione di circa 50°C.

Coagulation factor XIII activation peptide and subunit levels in patients with acute ischaemic stroke: a pilot study

We have recently shown that FXIII activation peptide (AP-FXIII) can be measured in plasma. The objective of this pilot study was to investigate for the first time if AP-FXIII can be detected in plasma from patients with acute ischaemic stroke.

Identification of eight novel coagulation factor XIII subunit A mutations: implied consequences for structure and function

Severe hereditary coagulation factor XIII deficiency is a rare homozygous bleeding disorder affecting one person in every two million individuals. In contrast, heterozygous factor XIII deficiency is more common, but usually not associated with severe hemorrhage such as intracranial bleeding or hemarthrosis. In most cases, the disease is caused by F13A gene mutations. Causative mutations associated with the F13B gene are rarer.

Autotransfusion system or integrated automatic suction device in minimized extracorporeal circulation: influence on coagulation and inflammatory response

To measure surrogate markers of coagulation activation as well as of the systemic inflammatory response in patients undergoing primary elective coronary artery bypass grafting (CABG) using either the so-called Smart suction device or a continuous autotransfusion system (C.A.T.S.®).

Changes of coagulation parameters during high altitude expedition

Data on changes of haemostatic parameters at altitudes above 5000 m are very limited. So far it is unknown, whether altered coagulation could contribute to the development of acute mountain sickness.

[Proteins influencing the blood coagulation]

This review describes some natural proteins, which can be employed, either as factor concentrates derived from human plasma or as recombinant drug, to modulate the coagulation system. I will address some biochemical characteristics and the physiological role of von Willebrand factor, the coagulation factors of the extrinsic and intrinsic pathways, and the physiological anticoagulant protein C. In addition, I will detail the pharmacological compounds, which are available for influencing or substituting the coagulation proteins: desmopressin (DDAVP), single coagulation factor concentrates, prothrombin complex concentrates, and protein C concentrate. In particular, I will address some treatment topics of general medical interest, such as the treatment of massive bleeding, the correction of the coagulopathy induced by vitamin K-antagonists in patients with cerebral haemorrhage, and of the coagulopathy of meningococcemia. Finally, I will describe some properties and practical clinical applications of the recombinant anticoagulans lepirudin and bivalirudin, which are derived from hirudin, the natural anticoagulant of the medical leech.

Rivaroxaban: Quantification by anti-FXa assay and influence on coagulation tests A study in 9 Swiss laboratories

INTRODUCTION: Rivaroxaban (RXA) is licensed for prophylaxis of venous thromboembolism after major orthopaedic surgery of the lower limbs. Currently, no test to quantify RXA in plasma has been validated in an inter-laboratory setting. Our study had three aims: to assess i) the feasibility of RXA quantification with a commercial anti-FXa assay, ii) its accuracy and precision in an inter-laboratory setting, and iii) the influence of 10mg of RXA on routine coagulation tests. METHODS: The same chromogenic anti-FXa assay (Hyphen BioMed) was used in all participating laboratories. RXA calibrators and sets of blinded probes (aim ii.) were prepared in vitro by spiking normal plasma. The precise RXA content was assessed by high-pressure liquid chromatography-tandem mass spectrometry. For ex-vivo studies (aim iii), plasma samples from 20 healthy volunteers taken before and 2 - 3hours after ingestion of 10mg of RXA were analyzed by participating laboratories. RESULTS: RXA can be assayed chromogenically. Among the participating laboratories, the mean accuracy and the mean coefficient of variation for precision of RXA quantification were 7.0% and 8.8%, respectively. Mean RXA concentration was 114±43?g/L .RXA significantly altered prothrombin time, activated partial thromboplastin time, factor analysis for intrinsic and extrinsic factors. Determinations of thrombin time, fibrinogen, FXIII and D-Dimer levels were not affected. CONCLUSIONS: RXA plasma levels can be quantified accurately and precisely by a chromogenic anti-FXa assay on different coagulometers in different laboratories. Ingestion of 10mg RXA results in significant alterations of both PT- and aPTT-based coagulation assays.

Comparison of porcine and human coagulation by thrombelastometry

Although the pig is a standard model for the evaluation of various diseases in humans, including coagulopathy, it is not clear whether results in animals can be extrapolated to man.

Stress-induced alterations in coagulation: assessment of a new hemoconcentration correction technique

For the examination of psychological stress effects on coagulation, the Dill and Costill correction (DCC) for hemoconcentration effects has been used to adjust for stress-induced plasma volume changes. Although the correction is appropriate for adjusting concentrations of various large blood constituents, it may be inappropriate for time-dependent or functional coagulation assays. Two new plasma reconstitution techniques for correcting hemoconcentration effects on stress-induced changes in coagulation were compared with the DCC.

[Laboratory diagnostic with regard to new anticoagulants - monitoring and influence on coagulation tests]

New oral anticoagulants promise to overcome essential drawbacks of traditional substances. They have a predictable therapeutic effect, a wide therapeutic window, only limited interaction with food and drugs and can be administered p.o. with a fixed dose. On the other hand, knowledge on the laboratory management of new anticoagulants is limited. In the present article we discuss possible indications and available assays for monitoring of Rivaroxaban, Apixaban and Dabigatran. Furthermore, we discuss interpretation of routine coagulation tests during therapy with these new drugs.