Immune heparin-induced thrombocytopenia (HIT) is a potentially serious complication of heparin therapy and is associated with antibodies directed against a complex of platelet factor 4 (PF4) and heparin. Early diagnosis of HIT is important to reduce morbidity and mortality. I developed an enzyme immunoassay that detects the binding of HIT IgG to PF4-heparin in the fluid phase. This required techniques to purify and biotinylate PF4. The fluid phase assay produces consistently low background and can detect low levels of anti-PF4-heparin. It is suited to testing alternative anticoagulants because, unlike in an ELISA, a clearly defined amount of antigen is available for antibody binding. I was able to detect anti-PF4-heparin IgG in 93% of HIT patients. I also investigated cross-reactivity of anti-PF4-heparin antibodies with PF4 complexed to alternative heparin-like anticoagulants. Low molecular weight heparins cross-reacted with 88% of the sera from HIT patients while half of the HIT sera weakly cross-reacted with PF4-danaparoid (Orgaran). The thrombocytopenia and thrombosis of most of these patients resolved during danaparoid therapy, indicating that detection of low affinity antibodies to PF4-danaparoid by immunoassay may not be an absolute contraindication for danaparoid administration. While HIT patients possess antibodies to PF4-heparin, I observed that HIT antibodies will also bind to PF4 alone adsorbed on polystyrene ELISA wells but not to soluble PF4 in the absence of heparin. Having developed a technique to affinity-purify anti-PF4-heparin HIT IgG, I provide the first estimates of the avidity of HIT IgG. HIT IgG displayed relatively high functional affinity for both PF4-heparin (Kd=7-30nM) and polystyrene adsorbed PF4 alone (Kd=20-70nM). Furthermore, agarose beads coated with PF4 alone were almost as effective as beads coated with PF4 plus heparin in depleting HIT plasmas of anti-PF4-heparin antibodies. I conclude that the HIT antibodies which bind to polystyrene adsorbed PF4 without heparin are largely the same IgG molecules that bind PF4-heparin and thus most HIT antibodies bind epitope(s) on PF4 and not epitope(s) formed by part of a PF4 molecule and part of a heparin molecule. Binding of PF4 to heparin (optimal) or polystyrene/agarose (sub-optimal) promotes recognition of this epitope. Under conditions that are more physiological and sensitive than previous studies, I observed that affinity-purified HIT IgG will cause platelet aggregation upon the addition of heparin. Platelets activated with HIT IgG increased their release and surface expression of PF4. I quantitated the binding of affinity-purified HIT 125I-IgG to platelets as they activate in a plasma milieu. Binding of the HIT IgG was dependent upon heparin and some degree of platelet activation. Blocking the platelet Fc??? receptor-II with the monoclonal antibody IV.3 did not prevent HIT IgG binding to activated platelets. I conclude that anti-PF4-heparin IgG is the only component specific to HIT plasma that is required to induce platelet aggregation. The Fab region of HIT IgG binds to PF4-heparin that is on the surface of activated platelets. I propose that only then does the Fc portion of the bound IgG activate other platelets via the Fc receptor. My data support a dynamic model of platelet activation where released PF4 enhances further antibody binding and more release.

Immune heparin-induced thrombocytopenia (HIT) is a potentially serious complication of heparin therapy and is associated with antibodies directed against a complex of platelet factor 4 (PF4) and heparin. Early diagnosis of HIT is important to reduce morbidity and mortality. I developed an enzyme immunoassay that detects the binding of HIT IgG to PF4-heparin in the fluid phase. This required techniques to purify and biotinylate PF4. The fluid phase assay produces consistently low background and can detect low levels of anti-PF4-heparin. It is suited to testing alternative anticoagulants because, unlike in an ELISA, a clearly defined amount of antigen is available for antibody binding. I was able to detect anti-PF4-heparin IgG in 93% of HIT patients. I also investigated cross-reactivity of anti-PF4-heparin antibodies with PF4 complexed to alternative heparin-like anticoagulants. Low molecular weight heparins cross-reacted with 88% of the sera from HIT patients while half of the HIT sera weakly cross-reacted with PF4-danaparoid (Orgaran). The thrombocytopenia and thrombosis of most of these patients resolved during danaparoid therapy, indicating that detection of low affinity antibodies to PF4-danaparoid by immunoassay may not be an absolute contraindication for danaparoid administration. While HIT patients possess antibodies to PF4-heparin, I observed that HIT antibodies will also bind to PF4 alone adsorbed on polystyrene ELISA wells but not to soluble PF4 in the absence of heparin. Having developed a technique to affinity-purify anti-PF4-heparin HIT IgG, I provide the first estimates of the avidity of HIT IgG. HIT IgG displayed relatively high functional affinity for both PF4-heparin (Kd=7-30nM) and polystyrene adsorbed PF4 alone (Kd=20-70nM). Furthermore, agarose beads coated with PF4 alone were almost as effective as beads coated with PF4 plus heparin in depleting HIT plasmas of anti-PF4-heparin antibodies. I conclude that the HIT antibodies which bind to polystyrene adsorbed PF4 without heparin are largely the same IgG molecules that bind PF4-heparin and thus most HIT antibodies bind epitope(s) on PF4 and not epitope(s) formed by part of a PF4 molecule and part of a heparin molecule. Binding of PF4 to heparin (optimal) or polystyrene/agarose (sub-optimal) promotes recognition of this epitope. Under conditions that are more physiological and sensitive than previous studies, I observed that affinity-purified HIT IgG will cause platelet aggregation upon the addition of heparin. Platelets activated with HIT IgG increased their release and surface expression of PF4. I quantitated the binding of affinity-purified HIT 125I-IgG to platelets as they activate in a plasma milieu. Binding of the HIT IgG was dependent upon heparin and some degree of platelet activation. Blocking the platelet Fc??? receptor-II with the monoclonal antibody IV.3 did not prevent HIT IgG binding to activated platelets. I conclude that anti-PF4-heparin IgG is the only component specific to HIT plasma that is required to induce platelet aggregation. The Fab region of HIT IgG binds to PF4-heparin that is on the surface of activated platelets. I propose that only then does the Fc portion of the bound IgG activate other platelets via the Fc receptor. My data support a dynamic model of platelet activation where released PF4 enhances further antibody binding and more release.

Made available in DSpace on 2014-12-17T14:03:42Z (GMT). No. of bitstreams: 1 LucianaFC_DISSERT.pdf: 1219461 bytes, checksum: 86df41deecc523bb278b7a9bc3b86ec9 (MD5) Previous issue date: 2013-03-04 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / In recent years the heparin has been the subject of several studies that aim to expand its use as a therapeutic agent, due to its ability to modulate the activity of various proteins that play important roles in the regulation of pathophysiological processes. In several experiments and preclinical trials, heparin has demonstrated an anti-inflammatory role. However, its clinical use is limited, due to its strong anticoagulant activity and hemorrhagic complications. For this reason, considerable efforts have been employed in discovery of heparin analogous (heparinoid) with reduced side effects, that retain the anti-inflammatory properties of heparin. In this context, a heparinoid obtained from the head of Litopenaeus vannamei shrimp, which presents a structural similarity to heparin, showed, in previous studies, anti-inflammatory activity in a model of acute peritonitis with reduced anticoagulant effect in vitro and low hemorrhagic activity. Thus, the present work had as objective to evaluate the effect the heparinoid of the cephalothorax of gray shrimp on the acute inflammatory response in different times (3 or 6 hours after the induction of inflammatory stimulus), using the model of acute peritonitis induced in mice. It was also analyzed the HL effect over the activity of elastase, an enzyme involved in leukocyte recruitment. Furthermore to check if the different doses of heparin and heparinoid change the hemostatic balance in vivo, was assessed the effect of these compounds on the plasma clotting time in animals submitted to inflammation. The results show that in 3 hours, all doses of heparinoid were able to prevent efficiently in the acute inflammatory process without any anticoagulant effects, unlike the extrapolation dose of heparin, which has induced a large hemorrhage due its high anticoagulant activity. However, 6 hours after induction of inflammation, only the dosages of 0.1 and 1.0 μg/Kg of heparin and 1.0 μg/Kg of heparinoid kept anti-migratory effect, without changing of the hemostatic balance. These results indicate that the anti-migratory effect of theses compounds depends on the dosage and time of inflammatory stimulus. The HL and heparin were also able to inhibit the activity of the enzyme elastase. The discovery of this bioactive compound in the cephalothorax of shrimps can arouse great interest in biotechnology, since this compound could be useful as a structural model interesting for the development of new therapeutic agents for peritonitis / Nos ?ltimos anos a heparina tem sido alvo de diversos estudos que visam ampliar seu uso como agente terap?utico, devido ? sua habilidade de modular a atividade de v?rias prote?nas que desempenham pap?is importantes na regula??o de processos fisiopatol?gicos. Em diversos experimentos e ensaios pr?-cl?nicos, a heparina tem demonstrado papel anti-inflamat?rio. Entretanto, seu uso cl?nico ? limitado, devido ? sua forte atividade anticoagulante e complica??es hemorr?gicas. Por essa raz?o, consider?vel esfor?o tem sido empregado na descoberta de an?logos da heparina (heparin?ide) com reduzidos efeitos colaterais, que retenham as propriedades anti-inflamat?rias da heparina. Nesse contexto, um heparin?ide (HL) obtido da cabe?a do camar?o Litopenaeus vannamei, de semelhan?a estrutural ? heparina, apresentou em estudos pr?vios atividade anti-inflamat?ria em modelo de peritonite aguda, com reduzido efeito anticoagulante in vitro e baixa atividade hemorr?gica. Assim, o presente trabalho teve como objetivo avaliar o efeito deste heparin?ide sobre a resposta inflamat?ria aguda em diferentes tempos (3 ou 6 horas ap?s a indu??o do est?mulo inflamat?rio), utilizando o modelo de peritonite aguda induzida em camundongos. Foi analisado tamb?m o efeito do HL sobre a atividade da elastase, uma enzima envolvida no recrutamento de leuc?citos. Al?m disso, para verificar se as diferentes doses do heparin?ide e da heparina alteram o equil?brio hemost?tico in vivo, foi avaliado o efeito desses compostos sobre o tempo de coagula??o do plasma nos animais submetidos ? inflama??o. Os resultados revelam que em 3 horas, todas as doses do heparin?ide foram capazes de interferir de forma eficiente no processo inflamat?rio agudo sem apresentar efeito anticoagulante e interfer?ncia no equil?brio hemost?tico, ao contr?rio da dose de extrapola??o da heparina que induziu forte hemorragia, al?m de apresentar alta atividade anticoagulante. Entretanto, no tempo de 6 horas ap?s a indu??o da inflama??o, apenas as doses de 0,1 e 1,0 μg/Kg da heparina e 1,0 μg/Kg do heparin?ide mantiveram o efeito antimigrat?rio, sem alterar o equil?brio hemost?tico. Esses resultados indicam que o efeito antimigrat?rio depende do tempo e da dose administrada. O HL e a heparina tamb?m foram capazes de inibir a atividade da enzima elastase. A descoberta desse composto bioativo no cefalot?rax do camar?o poder? despertar grande interesse biotecnol?gico, pois este composto poderia servir como um modelo estrutural interessante para o desenvolvimento de novos agentes terap?uticos espec?ficos para a peritonite

<p>Heparan sulfate proteoglycans are proteins with long, unbranched heparan sulfate (HS) polysaccharide chains attached to them. They are found on cell surfaces and in basement membranes where they exert their action by interacting with a wide range of enzymes and signaling molecules and are thereby involved in a range of various processes both during embryonic development and in adult physiology.</p><p>A great part of the biological functionality of proteoglycans can be directly related to the polysaccharide part. HS chains display very variable sulfation patterns where highly sulfated regions are responsible for a large part of the biological activity. The biosynthesis of HS is a complex process in which a number of enzymes are involved. Better comprehension of how this process is regulated could reveal clues to how formation of HS sulfation patterns occurs, and thereby how HS functionality is controlled.</p><p>This thesis is focusing on regulation of one of the enzymes responsible for HS sulfation, glucosaminyl N-deacetylase/N-sulfotransferase (NDST), in an attempt to understand these mechanisms better. Different aspects of NDST regulation were studied in three projects:</p><p>I) “Heparin/heparan sulfate biosynthesis: Processive formation of N-sulfated domains”, where the sulfate donor PAPS is shown to influence the manner in which NDST modifies the substrate, affecting the domain structure of the polysaccharide.</p><p>II) “Heparan sulfate biosynthesis: Characterization of an NDST1 splice variant”, where a splice variant of NDST1 which appears to influence NDST1 protein levels and affect HS structure is described.</p><p>III) “Heparan sulfate biosynthesis in zebrafish: Five NDST genes with distinct expression patterns during embryonic development”, in which five zebrafish NDSTs were cloned and shown to be expressed in a temporally and spatially regulated manner.</p>

Heparin is a complex mixture of sulfated polysaccharides derived from animals and one of the oldest drugs in use. While an efficacious anticoagulant, heparin is beset by side effects and pharmacokinetic difficulties. Low molecular weight heparins (LMWH) are made by depolymerizing unfractionated heparin (UFH) and present improvements in these areas. However, they still retain a phenomenally high level of complexity due to their polydispersity and the introduction of non-native structural features. This makes the structural characterization LMWHs a daunting task. This work details the development of a novel capillary electrophoretic (CE) method for fingerprinting LMWHs. Since their complexity normally results in a nearly featureless electropherogram, polyalkylamines were used as a resolving agents to yield highly resolved and reproducible fingerprints characteristic of the LMWH being investigated. Linear polyamines of resolved LMWH in a manner dependent on chain length and charge density, while cyclic polyamines were incapable of resolution. Longer length glycosaminoglycans such as UFH and chondroitin sulfate were not successfully fingerprinted as they lacked run to run consistency. Further investigation into the mode of polyamine binding showed that they bound to LMWH via a two site binding model, indicating the presence of specific sites on LMWH that tightly bind polyamines. Upon the saturation of these sites, the polyamines continue to interact via general electrostatic binding. Pentaethylenehexamine was also able to separate the known contaminant oversulfated chondroitin sulfate from UFH. In July of 2010, the US food and drug administration approved a generic for the widely used LMWH enoxaparin, a questionable move due to the difficulties of proving the equivalence of such a complex mixture. A comparison of the brand and generic batches of enoxaparin using the fingerprinting method revealed striking similarities, bolstering the generic’s claim of equivalency and providing a protocol for the evaluation of other biosimilar LMWHs. This is the first work utilizing CE in developing high resolution fingerprints of LMWH. It presents a noteworthy method for quality assessment of LMWH and provides the basis for designing other small molecule probes for the analysis of complex glycosaminoglycans.

Thrombin is a key enzyme of the coagulation cascade exhibiting important roles in both pro-coagulation and anti-coagulation processes. Most clinically used anticoagulant drugs, including polymeric heparin, warfarin, hirudin, argatroban and the recently approved dabigatran, aim to reduce thrombin activity. There are several binding domains on thrombin including the active site, anion-binding exosites I and II, and the sodium binding site. We hypothesized that thrombin may be better regulated through an allosteric process mediated by small molecules binding to either exosite I or II. An appropriately designed allosteric regulator that reduces the procoagulant signal in a finely tuned manner may maintain a delicate balance between procoagulant and anticoagulant signals in blood resulting reduced bleeding complications. In this work, we synthesized and studied a library of potent, small, aromatic molecules as allosteric inhibitors of thrombin. Of the 28 potential inhibitors, 11 molecules inhibited thrombin with reasonable potency. Structure activity relationship studies showed that sulfation at the 5-position of the benzofuran scaffold was essential for targeting thrombin. Michaelis-Menten kinetic studies indicated a non-competitive, allosteric mechanism of inhibition. Site-directed mutagenesis, competitive binding and molecular modeling studies led to the identification of the most plausible binding pose for a potent sulfated dimer. To further improve the potency, a small library of sulfated benzofuran trimers was synthesized and studied for thrombin inhibition. Further, to find new scaffold to inhibit thrombin allosterically, docking-based virtual screening approach was used. All these molecules were found to be moderately potent thrombin inhibitors and can serve as lead to develop allosteric inhibitor. Overall, this work presents the first small, synthetic, sulfated aromatic molecules as potent allosteric modulators of thrombin. Finally, this work also highlights the opportunity of exploring allosteric modulators of other coagulation enzymes, e.g., factors Xa, IXa and XIa, based on the sulfated benzofuran scaffold.

Unfractionated heparin, which is a widely used anticoagulant, is frequently replaced with low-molecular-mass species. They are used due to their more predictable anticoagulant effect with less bleeding complications and also they have prolonged anticoagulant effect. For monitoring of low-molecular-mass heparin levels, anti-factor Xa assay is used, which has some significant drawbacks. This work is dedicated to determination of low-molecular-mass heparin, namely Fraxiparine, using affinity capillary electrophoresis. Heparin is a polysaccharide which does not exhibit a significant UV absorption; therefore, its indirect detection method was used. Fraxiparine forms a stable complex with protamine. Protamine is an arginine-rich, positively charged peptide which is used to suppress heparin anticoagulant effect. Because protamine has a complex, not precisely defined structure, it was replaced by well-defined tetraarginine. The method uses phosphoric acid of 9 mmol L-1 concentration with addition of 0.1% (w/v) hydroxyethylcellulose as the background electrolyte. The samples are injected hydrodynamically into the capillary by a pressure of 5 kPa. First, the zone of Fraxiparine was injected, followed by the zone of tetraarginine (5 s). After that, 30 kV voltage was applied for 30 s. During this time the...

Das Ziel der vorliegenden Arbeit war die Klärung der Fragestellung, ob sich die quantitative NMR-Spektroskopie zur Bestimmung von Identität, Reinheit und Gehalt von Arzneistoffen eignet, und wie sich Präzision und Empfindlichkeit dieser Methode im Vergleich zu etablierten chromatographischen Verfahren verhalten. Die quantitative Untersuchung der drei strukturell jeweils verwandten Mehrkomponentengemische Codergocrinmesilat, Clomifencitrat und Flupentixoldihydrochlorid bewies eindrucksvoll die Eignung der 1H-NMR-Spektroskopie als orthogonale, analytische Messmethode im Vergleich zu validierten HPLC-Arzneibuchmethoden. Die im Rahmen einer Validierung der 1H-NMR-Methode ermittelten Ergebnisse erfüllten bezüglich Präzision und Richtigkeit die an eine im pharmazeutischen Bereich eingesetzte analytische Methode gestellten Anforderungen; zudem wurden weitere Prüfparameter wie Selektivität, Linearität, Robustheit und Stabilität verifiziert. Externe-Standard-Experimente wie "Zwei-Röhrchen-Methode" und ERETIC-Verfahren bestätigten die quantitativen Ergebnisse der Internen Standardisierung; jedoch wurde hier -- insbesondere für die ERETIC-Technik -- eine höhere Fehleranfälligkeit und somit eine größere Streuung der Einzelergebnisse beobachtet. Am Beispiel von Codergocrinmesilat und Flupentixoldihydrochlorid konnte zudem die Eignung anderer NMR-aktiver Kerne wie 13C und 19F für die quantitative Analyse von komplexen Substanzgemischen aufgezeigt werden. Das Potential der 1H-NMR-Spektroskopie für die Reinheitsprüfung von Arzneistoffen wurde am Beispiel der Aminosäure L-Alanin aufgezeigt. Die zu erwartenden Verunreinigungen Glutamin-, Asparagin-, Äpfel- und Fumarsäure konnten im Gegensatz zu den "veralteten" Prüfmethoden des Europäischen Arzneibuches eindeutig identifiziert und quantifiziert werden; mit einer Bestimmungsgrenze von <= 0.03% wurden die Vorgaben der ICH-Richtlinie Q3A(R2) erfüllt. Die deutliche Übereinstimmung der NMR-spektroskopisch ermittelten Ergebnisse einer quantitativ untersuchten Alanin-Modellmischung mit einer für den Routinebetrieb geeigneten HPLC-Methode unter Einsatz verschiedener Detektoren wie CAD, NQAD, ELSD und MS, sowie der Vergleich wichtiger Prüfparameter wie Linearität und Nachweisgrenze bestätigten die Eignung der 1H-NMR-Spektroskopie im Rahmen der routinemäßig durchgeführten Qualitätskontrolle. Die Aufdeckung von Arzneimittelfälschungen mit Hilfe der NMR-Spektroskopie wurde im Rahmen dieser Arbeit anhand der zwei aktuellen Fallbeispiele Heparin und Glycerin näher untersucht. Die in Zusammenhang mit dem Heparin-Skandal verantwortliche Kontaminante OSCS konnte neben Dermatansulfat und weiteren natürlich vorkommenden Glykosaminoglykan-Verunreinigungen im 1H-NMR-Spektrum eindeutig identifiziert und auf 0.1% OSCS bzw. 0.5% Dermatansulfat begrenzt werden. Eine präzise und richtige quantitative Bestimmung der beiden Glykosaminoglykane wurde über die N-Acetyl-Resonanzen mit Hilfe der Signalhöhenbestimmung und dem Standard-Additionsverfahren ermöglicht; deutliche Abweichungen vom "wahren" Gehalt wurden hingegen, bedingt durch starke Signalüberlagerungen, nach Flächenvergleich beobachtet. Weitere Verunreinigungen, insbesondere Lösungsmittelrückstände, die während des Extraktions- und Reinigungsprozesses des Heparins eingesetzt werden, konnten ebenfalls über charakteristische Resonanzen identifiziert und mit Hilfe der Internen-Standard-Methode quantitativ erfasst werden. Eine umfangreiche Untersuchung von 145 Heparin-API-Mustern mittels NMR-Spektroskopie und weiteren, neuentwickelten Verfahren wie HPLC, CE, IR- und Raman-Spektroskopie konnte die Eignung der entwickelten 1H-NMR-Methode bestätigen. Potentielle Glycerin-Kontaminanten wie Diethylenglycol und Ethylenglycol konnten ebenso wie eine weitere, natürlich vorkommende Verunreinigung, Propylenglycol, mittels 1H- und 13C-NMR-Spektroskopie identifiziert und quantifiziert werden. Beide Methoden erfüllten die in der USP beschriebenen Anforderungen, die für pharmazeutisch eingesetztes Glycerin jeweils höchstens 0.1% Diethylenglycol bzw. Ethylenglycol erlaubt. Während die quantitative Reinheitsprüfung beim Einsatz der 1H-NMR-Spektroskopie mit einer Messdauer im Bereich von etwa 30 min für den Routineeinsatz geeignet ist, ist die entwickelte quantitative 13C-NMR-Methode beim Einsatz von Spektrometern geringer Magnetfeldstärke aufgrund einer geringen Nachweisempfindlichkeit und der NOE-Problematik für den Routinebetrieb nur bedingt anwendbar. Abschließend kann zusammengefasst werden, dass die untersuchten Beispiele die NMR-Spektroskopie als in hohem Maße geeignet für die quantitative Analyse von Arzneimitteln ausweisen. / The main objective of the present thesis was the investigation of the suitability of quantitative NMR spectroscopy for identification, purity assay, and quantification of a given drug, as well as a comparison of precision and sensitivity of this method with well-established chromatographic routines. The quantitative analysis of the three multi-component drug mixtures codergocrine mesylate, clomiphene citrate, and flupentixol dihydrochloride strikingly demonstrates the suitability of the 1H NMR spectroscopy as an independent analytical measurement technique in comparison to validated HPLC methods of international pharmacopoeias. Concerning precision and accuracy, the results obtained from validation of the 1H NMR method met the requirements that are made on an analytical routine for pharmaceutical purposes; additionally, further validation parameters such as selectivity, linearity, robustness, and stability have been verified. Experiments like the "twin tube" and ERETIC techniques utilizing external standards confirm these results; however, in this context an increased error rate and therefore larger variance was observed, especially in the case of ERETIC. By means of codergocrine mesylate and flupentixol dihydrochloride, additionally the suitability of other NMR active nuclei as 13C or 19F for quantification of complex mixtures was shown. The potential of the 1H NMR spectroscopy for purity assays was demonstrated for the example of the amino acid L-alanin. Identification and quantification of the expected impurities glutamic acid, aspartic acid, malic acid, and fumaric acid was possible, in contrast to "out-dated" test methods of the European Pharmacopoeia; achieving a limit of quantification <= 0.03%, the demands of the ICH guideline Q3A(R2) have been met. Concerning the quantification of an alanine model mixture, the clear agreement between the results obtained by means of NMR spectroscopy and a HPLC method using various detectors like CAD, NQAD, ELSD, and MS, suited for routine analysis, as well as the comparison of various relevant parameters such as linearity and limit of quantification confirmed the qualification of 1H NMR spectroscopy in the field of routine quality assurance. Within the scope of this work, the disclosure of counterfeit drugs by means of NMR spectroscopy was investigated in detail utilizing two current case studies, namely heparin and glycerin. Besides dermatan sulfate and other natural occurrences of glycosaminoglycan impurities, the contaminant OSCS revealed in connection with the recent heparin affair was clearly identified in the 1H NMR spectrum and these contaminants could be limited to 0.1% OSCS and 0.5% dermatan sulfate, respectively. A precise and accurate quantification of these two glycosaminoglycanes was achieved using signal height and standard addition methods applied to the N-acetyl resonances; comparison of signal areas however yielded considerable deviations from the "true" content, which are due to strong signal overlap. Further contaminants, especially solvent residues originating from the extraction and purification processes of heparin, have been able to be identified with the help of characteristic resonances; their quantification was possible. An extensive study of 145 heparin API samples by means of NMR spectroscopy and other novel techniques such as HPLC, capillary electrophoresis, IR and Raman spectroscopy confirmed the qualification of the developed 1H NMR method. Potential contaminants in glycerin such as diethylene glycol and ethylene glycol have been able to be identified as well as quantified by means of 1H and 13C NMR spectroscopy, as was the case for propylene glycol, which is naturally present. Both methods met the requirements of the USP, limiting the amount of diethylene glycol and ethylene glycol for pharmaceutical purposes to 0.1%, respectively. While 1H NMR spectroscopy with a measurement time of about 30 min is well suited for routine application, the applicability of the 13C NMR method is limited due to the NOE effect and the low sensitivity at low field strengths. In conclusion, each of the attended topics showed, that NMR spectroscopy is a powerful tool within the framework of quantitative drug analysis.

Medicamentos biológicos são obtidos a partir de fluidos biológicos ou tecidos de origem animal por procedimentos biotecnológicos e, a partir do vencimento das suas patentes, surge a possibilidade da produção de suas cópias, os chamados biossimilares. Este tema, além de polêmico, por ainda apresentar divergências de entendimento da classe científica, também engloba 4 das 5 classes terapêuticas de medicamentos mais vendidas, e apresenta evolução crescente no mercado farmacêutico. Com o aumento da demanda, cresce o interesse na produção de medicamentos biológicos de alta qualidade, com a mesma eficácia, porém a preços mais baixos. Dessa forma, é possível entender a responsabilidade das regulamentações, principalmente no que diz respeito aos biossimilares, a fim de que eles respeitem os requisitos mínimos necessários para serem comparáveis ao seu medicamento biológico novo. Assim, este trabalho teve como objetivo avaliar questões técnico-regulatórias e os requisitos de qualidade para registro de medicamentos biológicos e biossimilares humanos frente a diferentes Autoridades Sanitárias mundiais. A análise foi baseada em três moléculas biológicas, sendo a clássica heparina e moléculas novas, filgrastim e infliximabe. Foi constatado que na teoria, a legislação brasileira é baseada em regulamentos internacionais, especialmente da Federal and Drug Administration (FDA) e European Medicines Agency (EMA), e que na prática, o Brasil tem se mostrado mais conservador na extrapolação de indicação e na aprovação dos biossimilares. Ainda, foi possível notar que independente do país, as Farmacopeias ainda necessitam de aprimoramento com relação a este tema, pois em sua maioria, não existe padronização dos parâmetros e testes a serem realizados. Pesquisa demonstrou que o conhecimento sobre biossimilares ainda não está consolidado entre profissionais médicos e que, portanto, há necessidade de programas para esclarecimentos, com a finalidade de estimular seu uso, quando possível e com custos mais interessantes. / Biological drugs are obtained from biological fluids or animals tissues by biotechnological procedures and, from the expiration of their patents, the possibility of producing their \"copies\", the so-called biosimilars, arises. In addition to being a controversial subject, as it still presents divergences of understanding by the scientific class, it also encompasses 4 of the 5 therapeutic classes of best-selling drugs, and it presents an increasing evolution in the pharmaceutical market. As demand increases, interest in the production of high-quality biological drugs with the same effectiveness, but at lower prices, also increases. In this way, it is possible to understand the responsibility of regulations, especially with regard to biosimilars, so that they comply with the minimum requirements needed to be comparable to their reference biological medicine. Thus, the objective of this project was to evaluate technical and regulatory topics, as well as quality requirements for the registration of human biological and biosimilar medicines under the perspective of different Health Authorities around the world. The analysis was based on three biological molecules, being the classic heparin and new molecules, filgrastim and infliximab. It was found that in theory, Brazilian regulation is based on international regulations, especially the Federal and Drug Administration (FDA) and the European Medicines Agency (EMA), and that in practice, Brazil has been more conservative in the extrapolation of indication and approval of biosimilars. Also, it was possible to note that, regardless the country, Pharmacopoeias still need to be improved for this topic, since in general, there is no standardization of the parameters and tests to be performed. Research showed that the knowledge about biosimilars is not yet consolidated among doctors and that, therefore, there is a need for clarification programs, with the purpose of stimulating their use, when possible and at lower costs.

Les héparines regroupant les héparines standards (HNF), les héparines de bas poids moléculaire(HBPM), et le fondaparinux, sont des médicaments anticoagulants. Ils potentialisent l’antithrombine (AT) : un inhibiteur physiologique de la coagulation. Leur utilisation en thérapeutique est associée à un risque hémorragique majeur. Actuellement, le sulfate de protamine est le seul antidote disponible vis-à-vis des HNF. Il est partiellement efficace vis-à-vis des HBPM, et n’a aucun effet contre le fondaparinux, qui n’a pas d’antidote jusqu’à présent. C’est dans ce contexte que nous proposons des AT modifiées inactives, mais capables de se lier aux molécules d’héparines. Ces AT déplaceraient les molécules d’héparines de l’AT plasmatique, et neutraliseraient leur effet anticoagulant. Pour produire de telles AT, nous avons choisi une approche recombinante et une approche chimique. Dans la première approche, nous avons exprimé le variant AT-N135Q-Pro394. Ce variant possède une activité anti-Xa ou anti-IIa inférieure à 0,02% en présence de dérivés hépariniques, et une affinité à l’héparine 3 fois meilleure, comparée à l’AT plasmatique. En revanche, dans l’approche chimique, nous avons modifié l’AT plasmatique par la 2,3-butanedione (AT-BD), un réactif chimique de caractérisation des arginines. Contrairement au variant, cette AT-BD a une perte d’activité anticoagulante modérée, puis une affinité à l’héparine 20 fois meilleure, comparée à l’AT plasmatique. Malgré ces différences de propriétés biochimiques, ces 2 AT modifiées neutralisent d’une façon similaire les héparines in vitro et sur un modèle murin. Par ailleurs, à l’inverse du sulfate de protamine, nos antidotes n’ont pas d’activité anticoagulante propre sur un test de céphaline activée. Ainsi, ce travail de thèse a permis non seulement de proposer les premiers et les seuls antidotes spécifiques au fondaparinux décrits, mais aussi des antidotes alternatifs pour tous les anticoagulants hépariniques. / Unfractionnated heparin (UFH), low molecular weight heparins (LMWH), and fondaparinux are used therapeutically as anticoagulants. They potentiate antithrombin (AT): a physiological inhibitor of coagulation. Their therapeutic use is associated with a major risk of bleeding. Currently, protamine sulfate is the only antidote available for UFH. It is partially effective for LMWH, and has no effect against fondaparinux, which has no antidote. So, we propose modified inactive AT, but able to bind heparin molecules as antidote of these heparins. These molecules would compete with plasmatic AT for binding to heparins, and neutralize their anticoagulant effect. To produce that AT, we realized a genetic approach and a chemical approach. In the first approach, we expressed the variant AT-N135Q-Pro394 that had an anti-Xa or anti-IIa activity below 0.02% in the presence of heparins, and heparin affinity three times higher, compared to the plasmatic AT. In the chemical approach, we modified the plasmatic AT by 2,3-butanedione (AT-BD), a chemical reagent for arginin’s characterization. The AT-BD had a moderate loss of anticoagulant activity, and a heparin affinity 20 times higher, compared to the plasmatic AT. Despite these differences in biochemical properties, these two modified AT neutralize similarly heparins in vitro and in a mouse model. Moreover, unlike protamine sulfate, our antidotes had not an intrinsic anticoagulant effect in activated partial thromboplastin test. Thus, this PhD-work offers the first and the only specific antidote described to fondaparinux, and it can be used too alternatively for all anticoagulant heparins.