Mechanisms of action of an investigational new freeze-dried platelet-derived hemostatic product.

BACKGROUND: A safe and efficacious hemostatic product with a long shelf-life is needed to reduce mortality from hemorrhage due to trauma and improve surgical outcomes for persons with platelet deficiency or dysfunction. Thrombosomes, a trehalose-stabilized, leukoreduced, pooled blood group-O freeze-dried platelet-derived hemostatic (FPH) with a 3-year shelf-life, may satisfy this need. OBJECTIVES: To characterize the mechanism of action of FPH. METHODS: FPH's ability to adhere to collagen, aggregate with and without platelets, and form clots was evaluated in vitro. Nonobese diabetic-severe combined immunodeficiency mouse models were used to assess circulation persistence and hemostatic efficacy. RESULTS: FPH displays the morphology and surface proteins of activated platelets. FPH adheres to collagen, aggregates, and promotes clots, producing an insoluble fibrin mesh. FPH is rapidly cleared from circulation, has hemostatic efficacy comparable to apheresis platelets in a murine tail-cut, and acts in a dose-dependent manner. CONCLUSION: FPH is a first-in-class investigational treatment and shows strong potential as a hemostatic agent that is capable of binding exposed collagen, coaggregating with endogenous platelets, and promoting the coagulation cascade. These properties may be exploited to treat active platelet-related or diffuse vascular bleeding. FPH has the potential to fulfill a large unmet patient need as an acute hemostatic treatment in severe bleeding, such as surgery and trauma.

Clinical Inquiries: How can we keep impaired glucose tolerance and impaired fasting glucose from progressing to diabetes?

Lifestyle changes and some drugs can help. Lifestyle interventions aimed at weight loss of 5% to 10% of body weight along with moderate aerobic exercise such as brisk walking for 150 minutes a week are the most effective means to prevent impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) from progressing to diabetes (strength of recommendation [SOR]: A, several meta-analyses, including a recent Cochrane review).