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Haemoglobin-based oxygen carriers and myocardial infarction
1a Chart Biotech Consulting, LLC , Erie , CO , USA.
Artificial Cells, Nanomedicine, and Biotechnology
|March 9, 2019
Summary
Patients using hemoglobin-based oxygen carriers (HBOCs) show higher myocardial infarction (MI) rates. Further research is needed to understand HBOC toxicity and improve patient safety.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Toxicology
Background:
- Hemoglobin-based oxygen carriers (HBOCs) are investigated as blood substitutes.
- An increased incidence of myocardial infarction (MI) has been observed in patients receiving HBOCs compared to controls.
Purpose of the Study:
- To analyze clinical trials and literature to identify potential mechanisms for HBOC-associated MI.
- To evaluate the relationship between HBOCs, dose, size, and MI occurrence.
Main Methods:
- Review of clinical trials and scientific literature on HBOC toxicity.
- Analysis of potential interferences in myocardial infarction diagnostic assays (e.g., troponin).
Main Results:
- Myocardial infarction diagnosis can be complicated by assay interferences from hemoglobin, hemolysis, and bilirubin.
- A positive correlation exists between HBOC dose/size and reported MI incidence.
- Direct cardiac toxicity and coronary vasoconstriction are unlikely mechanisms.
Conclusions:
- Detrimental intravascular interactions between HBOCs and the coagulation cascade, especially with dysfunctional endothelium, are probable causes of MI.
- Lack of clinical data impedes mechanism elucidation.
- Improved diagnostic protocols, biomarker measurement, and trials in selected populations are recommended.
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