Solulin is a soluble form of thrombomodulin that is resistant to proteolysis and oxidation. It has been shown to increase the clot lysis time in factor VIII (fVIII)-deficient plasma by an activated thrombinactivatable fibrinolysis inhibitor (TAFIa)-dependent mechanism. In the present study, blood was drawn from humans and dogs with hemophilia, and thromboelastography was used to measure tissue factor-initiated fibrin formation and tissueplasminogen activator-induced fibrinolysis. The kinetics of TAFI and protein C activation by the thrombin-Solulin complex were determined to describe the relative extent of anticoagulation and antifibrinolysis. In severe hemophilia A, clot stability increased by > 4-fold in the presence of Solulin while minimally affecting clot lysis time. Patients receiving fVIII/fIX prophylaxis showed a similar trend of increased clot stability in the presence of Solulin. The catalytic efficiencies of TAFI and protein C activation by the thrombinSolulin complex were determined to be 1.53 and 0.02/M/s, respectively, explaining its preference for antifibrinolysis over anticoagulation at low concentrations. Finally, hemophilic dogs given Solulin had improved clot strength in thromboelastography assays. In conclusion, the antifibrinolytic properties of Solulin are exhibited in hemophilic human (in vitro) and dog (in vivo/ex vivo) blood at low concentrations. Our findings suggest the therapeutic utility of Solulin at a range of very low doses. (Blood. 2012;119(15): 3622-3628)
IntroductionPatients with hemophilia A have a bleeding diathesis that is usually predicted by their factor VIII (fVIII) activity level (fVIII:C). 1,2 The primary form of treatment for severe hemophilia A is replacement therapy, which involves administration of recombinant or plasmaderived fVIII. FVIII can be given either on demand or by prophylaxis, 3 and the amount needed can vary drastically depending on the treatment schedule and the type and severity of the bleed in the case of on-demand treatment. 4 The treatment developments to date have greatly improved both mortality and morbidity for individuals with hemophilia 5,6 ; however, current treatments are not 100% effective, are expensive, and are often considered inconvenient. Because single bleeding events can have devastating consequences, it is important to continue to strive for maximally effective treatments. The recent improvements in mortality and morbidity have only been observed in developed countries with the resources to fund treatment. It is currently estimated that 80% of the world's hemophilia population has little or no access to therapy 7 ; therefore, the development of costeffective alternate treatment strategies or effective factor-sparing regimes to treat bleeding is clearly necessary.Many new and adjunctive therapeutic options have been explored, including platelet infusion, 8 tranexamic acid, 9 ⑀-amino caproic acid, 10 molecules that block tissue factor pathway inhibitor, 11,12 and a combination of phospholipid and fXa 13 and fXIII. 14 Solulin is a recom...