CU-2010 and CU-2020

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CU-2010 and CU-2020 are synthetic compounds that act as serine protease inhibitors. [1] These were developed in 2010 to replace the use of aprotinin during and after cardiac surgery, including surgeries with cardiopulmonary bypass which cause blood loss and hemorrhagic complications. [2] CU-2010 and CU-2020 were developed to avoid many issues associated with the use of aprotinin, including the risk of an allergic reaction and infection. Since the isolation of aprotinin is expensive, a drug with a simpler synthesis was desired. [3]

Contents

Chemistry

CU-2010 has a molecular weight of 700 Da and binds to the active site of serine proteases, like a substrate, due to its peptide-like properties.

Pharmacology

After intravenous infusion, CU-2010 is quickly cleared as it has a half-life of about 20 minutes (in rats and dogs). Polymerization and covalent attachment of polymer chains of polyethylene glycol (PEG) or pegylation results in the formation of CU-2020, which has a longer half-life of 45 minutes. The advantage of the short half-life of CU-2010 is that it allows it to work in an “on-off” mode, hence being able to adapt to the haemostatic situation of the moment.

CU-2010 and CU-2020 have the ability to inhibit plasmin to a similar extent as aprotinin, but they are 100,000 times better at inhibiting factor Xa and factor Xia. These inhibitory properties as well as their inhibition of plasma kallikrein and thrombin, reduces the production of thrombin and coagulation time. In vitro studies confirmed the fibrinolysis inhibition capacity of CU-2010 when present at concentrations between 100 and 1000 nM. [4]

The prolongation of coagulation (or prothrombin time, PT) occurs following either tissue factor or contact-phase stimulation and is dose-dependent. CU-2010 acts as an effective contact-phase inhibitor at antifibrinolytic concentrations. Further, when CU-2010 and CU-2020 are continuously infused, the greater inhibition of factors Xa and XIa compared to that by aprotinin prevent early thrombosis, providing an anti-coagulatory effect in patients, and prolonging activated partial thromboplastin time (aPTT). [5] Prolonged time for lysis further displays the anti-fibrinolytic characteristics of these drugs. Together, the anti-coagulatory and anti-fibrinolytic effects reduce the chance of thrombo-embolic complications.

CU-2010 and CU-2020 possess anti inflammatory effects due to their inhibition on plasma–kallikrein. CU-2010 and CU-2020 reduce leukocyte-endothelial interaction, migration of leukocytes, adhesion molecules expression, rate of apoptosis, inflammatory genes expression (especially TNF-α) and protein synthesis, all events which normally occur after myocardial ischemia/reperfusion. These anti-inflammatory effects of the serine protease inhibitors result in a reduced amount of free radicals and less lipid peroxidation with the amount of malonaldehyde in the heart tissue being reduced. However, the activation of neutrophils does not seem to be altered. CU-2010 and CU-2020 improve coronary endothelial function similarly to aprotinin. Unlike aprotinin, at high doses, their anti-inflammatory properties allow for the improvement in the recovery of contractility in the left ventricle after ischemic conditions, and increase the protection of the myocardium. [6] Moreover, CU-2010 and CU-2020 do not compromise clot strength, and do not affect the function of vascular smooth muscle.

Related Research Articles

<span class="mw-page-title-main">Coagulation</span> Process by which blood changes from liquid into a gel, forming blood clots

Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The mechanism of coagulation involves activation, adhesion and aggregation of platelets, as well as deposition and maturation of fibrin.

<span class="mw-page-title-main">Thrombin</span> Enzyme involved in blood coagulation in humans

Thrombin is a serine protease, an enzyme that, in humans, is encoded by the F2 gene. Prothrombin is proteolytically cleaved to form thrombin in the clotting process. Thrombin in turn acts as a serine protease that converts soluble fibrinogen into insoluble strands of fibrin, as well as catalyzing many other coagulation-related reactions.

Fibrinolysis is a process that prevents blood clots from growing and becoming problematic. Primary fibrinolysis is a normal body process, while secondary fibrinolysis is the breakdown of clots due to a medicine, a medical disorder, or some other cause.

<span class="mw-page-title-main">Antithrombin</span> Mammalian protein found in Homo sapiens

Antithrombin (AT) is a small glycoprotein that inactivates several enzymes of the coagulation system. It is a 432-amino-acid protein produced by the liver. It contains three disulfide bonds and a total of four possible glycosylation sites. α-Antithrombin is the dominant form of antithrombin found in blood plasma and has an oligosaccharide occupying each of its four glycosylation sites. A single glycosylation site remains consistently un-occupied in the minor form of antithrombin, β-antithrombin. Its activity is increased manyfold by the anticoagulant drug heparin, which enhances the binding of antithrombin to factor IIa (prothrombin) and factor Xa.

Low-molecular-weight heparin (LMWH) is a class of anticoagulant medications. They are used in the prevention of blood clots and treatment of venous thromboembolism and in the treatment of myocardial infarction.

The kinin–kallikrein system or simply kinin system is a poorly understood hormonal system with limited available research. It consists of blood proteins that play a role in inflammation, blood pressure control, coagulation and pain. Its important mediators bradykinin and kallidin are vasodilators and act on many cell types. Clinical symptoms include marked weakness, tachycardia, fever, leukocytosis and acceleration of ESR.

<span class="mw-page-title-main">Protein C</span> Mammalian protein found in Homo sapiens

Protein C, also known as autoprothrombin IIA and blood coagulation factor XIX, is a zymogen, that is, an inactive enzyme. The activated form plays an important role in regulating anticoagulation, inflammation, and cell death and maintaining the permeability of blood vessel walls in humans and other animals. Activated protein C (APC) performs these operations primarily by proteolytically inactivating proteins Factor Va and Factor VIIIa. APC is classified as a serine protease since it contains a residue of serine in its active site. In humans, protein C is encoded by the PROC gene, which is found on chromosome 2.

Protease-activated receptors(PAR) are a subfamily of related G protein-coupled receptors that are activated by cleavage of part of their extracellular domain. They are highly expressed in platelets, and also on endothelial cells, myocytes and neurons.

<span class="mw-page-title-main">Tissue factor</span> Protein involved in blood coagulation

Tissue factor, also called platelet tissue factor, factor III, or CD142, is a protein encoded by the F3 gene, present in subendothelial tissue and leukocytes. Its role in the clotting process is the initiation of thrombin formation from the zymogen prothrombin. Thromboplastin defines the cascade that leads to the activation of factor X—the tissue factor pathway. In doing so, it has replaced the previously named extrinsic pathway in order to eliminate ambiguity.

<span class="mw-page-title-main">Aprotinin</span> Antifibrinolytic molecule

The drug aprotinin, is a small protein bovine pancreatic trypsin inhibitor (BPTI), or basic trypsin inhibitor of bovine pancreas, which is an antifibrinolytic molecule that inhibits trypsin and related proteolytic enzymes. Under the trade name Trasylol, aprotinin was used as a medication administered by injection to reduce bleeding during complex surgery, such as heart and liver surgery. Its main effect is the slowing down of fibrinolysis, the process that leads to the breakdown of blood clots. The aim in its use was to decrease the need for blood transfusions during surgery, as well as end-organ damage due to hypotension as a result of marked blood loss. The drug was temporarily withdrawn worldwide in 2007 after studies suggested that its use increased the risk of complications or death; this was confirmed by follow-up studies. Trasylol sales were suspended in May 2008, except for very restricted research use. In February 2012 the European Medicines Agency (EMA) scientific committee reverted its previous standpoint regarding aprotinin, and has recommended that the suspension be lifted. Nordic became distributor of aprotinin in 2012.

Kininogens are precursor proteins for kinins, biologically active polypeptides involved in blood coagulation, vasodilation, smooth muscle contraction, inflammatory regulation, and the regulation of the cardiovascular and renal systems.

<span class="mw-page-title-main">Heparin cofactor II</span>

Heparin cofactor II (HCII), a protein encoded by the SERPIND1 gene, is a coagulation factor that inhibits IIa, and is a cofactor for heparin and dermatan sulfate.

<span class="mw-page-title-main">Batroxobin</span>

Batroxobin, also known as reptilase, is a snake venom enzyme with Venombin A activity produced by Bothrops atrox and Bothrops moojeni, venomous species of pit viper found east of the Andes in South America. It is a hemotoxin which acts as a serine protease similarly to thrombin, and has been the subject of many medical studies as a replacement of thrombin. Different enzymes, isolated from different species of Bothrops, have been called batroxobin, but unless stated otherwise, this article covers the batroxobin produced by B. moojeni, as this is the most studied variety.

<span class="mw-page-title-main">Oxygenator</span> Medical equipment

An oxygenator is a medical device that is capable of exchanging oxygen and carbon dioxide in the blood of human patient during surgical procedures that may necessitate the interruption or cessation of blood flow in the body, a critical organ or great blood vessel. These organs can be the heart, lungs or liver, while the great vessels can be the aorta, pulmonary artery, pulmonary veins or vena cava.

<span class="mw-page-title-main">Coagulation factor II receptor</span> Mammalian protein found in Homo sapiens

Proteinase-activated receptor 1 (PAR1) also known as protease-activated receptor 1 or coagulation factor II (thrombin) receptor is a protein that in humans is encoded by the F2R gene. PAR1 is a G protein-coupled receptor and one of four protease-activated receptors involved in the regulation of thrombotic response. Highly expressed in platelets and endothelial cells, PAR1 plays a key role in mediating the interplay between coagulation and inflammation, which is important in the pathogenesis of inflammatory and fibrotic lung diseases. It is also involved both in disruption and maintenance of endothelial barrier integrity, through interaction with either thrombin or activated protein C, respectively.

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<span class="mw-page-title-main">Camostat</span> Serine protease inhibitor

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The fibrinolysis system is responsible for removing blood clots. Hyperfibrinolysis describes a situation with markedly enhanced fibrinolytic activity, resulting in increased, sometimes catastrophic bleeding. Hyperfibrinolysis can be caused by acquired or congenital reasons. Among the congenital conditions for hyperfibrinolysis, deficiency of alpha-2-antiplasmin or plasminogen activator inhibitor type 1 (PAI-1) are very rare. The affected individuals show a hemophilia-like bleeding phenotype. Acquired hyperfibrinolysis is found in liver disease, in patients with severe trauma, during major surgical procedures, and other conditions. A special situation with temporarily enhanced fibrinolysis is thrombolytic therapy with drugs which activate plasminogen, e.g. for use in acute ischemic events or in patients with stroke. In patients with severe trauma, hyperfibrinolysis is associated with poor outcome. Moreover, hyperfibrinolysis may be associated with blood brain barrier impairment, a plasmin-dependent effect due to an increased generation of bradykinin.

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References

  1. Szabó, Gábor, et al. "The Novel Synthetic Serine Protease Inhibitor CU-2010 Dose-Dependently Reduces Postoperative Blood Loss and Improves Postischemic Recovery After Cardiac Surgery in a Canine Model." The Journal of Thoracic and Cardiovascular Surgery 139.3 (2010): 732-40. Biological Sciences.
  2. "Event Brief of the Medicines Company Acquires CU-2010 and Curacyte Discovery GmbH - Final." Fair Disclosure WireAug 06 2008. ABI/INFORM Trade & Industry.
  3. Mangano, Dennis T., Iulia C. Tudor, and Cynthia Dietzel. "The Risk Associated with Aprotinin in Cardiac Surgery." The New England Journal of Medicine 354.4 (2006): 353-65. ProQuest Psychology Journals.
  4. Dietrich, Wulf, et al. "CU-2010--a Novel Small Molecule Protease Inhibitor with Antifibrinolytic and Anticoagulant Properties."Anesthesiology 110.1 (2009): 123-30. Biological Sciences.
  5. Szabó, Gábor, et al. "Effects of Novel Synthetic Serine Protease Inhibitors on Postoperative Blood Loss, Coagulation Parameters, and Vascular Relaxation After Cardiac Surgery." The Journal of Thoracic and Cardiovascular Surgery 139.1 (2010): 181,8; discussion 188. Biological Sciences.
  6. Veres, Gabor. "New Drug Therapies Reduce Bleeding in Cardiac Surgery." Semmelweis Egyetem (Hungary), 2010. Hungary:ProQuest Dissertations & Theses A&I.