Premium
A quantitative systems pharmacology model of blood coagulation network describes in vivo biomarker changes in non‐bleeding subjects
Author(s) -
Lee D.,
Nayak S.,
Martin S. W.,
Heatherington A. C.,
Vicini P.,
Hua F.
Publication year - 2016
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13515
Subject(s) - in vivo , coagulation , pharmacokinetics , biomarker , pharmacology , prothrombin time , medicine , pharmacodynamics , tissue factor , d dimer , chemistry , biochemistry , biology , microbiology and biotechnology
Essentials Baseline coagulation activity can be detected in non‐bleeding state by in vivo biomarker levels. A detailed mathematical model of coagulation was developed to describe the non‐bleeding state. Optimized model described in vivo biomarkers with recombinant activated factor VII treatment. Sensitivity analysis predicted prothrombin fragment 1 + 2 and D‐dimer are regulated differently.Summary Background Prothrombin fragment 1 + 2 ( F 1 + 2 ), thrombin–antithrombin III complex ( TAT ) and D‐dimer can be detected in plasma from non‐bleeding hemostatically normal subjects or hemophilic patients. They are often used as safety or pharmacodynamic biomarkers for hemostatis‐modulating therapies in the clinic, and provide insights into in vivo coagulation activity. Objectives To develop a quantitative systems pharmacology ( QSP ) model of the blood coagulation network to describe in vivo biomarkers, including F 1 + 2 , TAT , and D‐dimer, under non‐bleeding conditions. Methods The QSP model included intrinsic and extrinsic coagulation pathways, platelet activation state‐dependent kinetics, and a two‐compartment pharmacokinetics model for recombinant activated factor VII ( rFVII a). Literature data on F 1 + 2 and D‐dimer at baseline and changes with rFVII a treatment were used for parameter optimization. Multiparametric sensitivity analysis ( MPSA ) was used to understand key proteins that regulate F 1 + 2 , TAT and D‐dimer levels. Results The model was able to describe tissue factor ( TF )‐dependent baseline levels of F 1 + 2 , TAT and D‐dimer in a non‐bleeding state, and their increases in hemostatically normal subjects and hemophilic patients treated with different doses of rFVII a. The amount of TF required is predicted to be very low in a non‐bleeding state. The model also predicts that these biomarker levels will be similar in hemostatically normal subjects and hemophilic patients. MPSA revealed that F 1 + 2 and TAT levels are highly correlated, and that D‐dimer is more sensitive to the perturbation of coagulation protein concentrations. Conclusions A QSP model for non‐bleeding baseline coagulation activity was established with data from clinically relevant in vivo biomarkers at baseline and changes in response to rFVII a treatment. This model will provide future mechanistic insights into this system.