ATP-adenosine-glutathione cross-linked hemoglobin as clinically useful oxygen carrier

To attenuate hemoglobin's (Hb) intrinsic toxicity, Texas Tech University scientists developed a novel concept of "pharmacologic cross-linking" to formulate an effective oxygen carrier, HemoTech, which consists of purified bovine Hb cross-linked intramolecularly with ATP and intermolecularly with adenosine, and conjugated with reduced glutathione (GSH). In this composition, while ATP prevents Hb dimerization, adenosine permits the formation of homogeneous polymers. ATP also serves as a regulator of blood vessel tone via activation of the P2Y receptor, whereas adenosine counteracts the vasoconstrictive and pro-inflammatory properties of Hb via stimulation of adenosine A2 and A3 receptors. GSH introduces electronegative charge onto the Hb surface that blocks Hb's transglomerular and transendothelial passage. Besides, GSH shields heme from nitric oxide and reactive oxygen species, thus enhancing vasodilation and lowering Hb prooxidative potential. HemoTech underwent favorable initial pre-clinical testing and proof of medical concept, and is under commercial development by HemoBioTech Inc. HemoTech has entered the regulatory process in the US. Several mandated requirements have already been met, including viral/transmissible spongiform encephalopathy (TSE) clearance validation studies and various pre-clinical pharmacological, pharmacokinetic, toxicological, genotoxicity and efficacy tests. These studies provided further evidence that "pharmacologic cross-linking" of the Hb molecule with ATP, adenosine and GSH, is useful for designing a viable Hb-based oxygen carrier.