Methods of identifying critically ill patients at increased risk of development of organ failure and compounds for the treatment hereof
The present invention relates to compounds for treatment that protects the endothelium, prevents pathologic thrombus formation in the microcirculation and preserves platelet number and function and thus may be related to minimizing or preventing development of organ failure, including multiple organ failure (MOF), and, hence, death in critically ill patients by administration of agent(s) limiting the platelets ability to aggregate and form clots and/or by agents modulating/preserving endothelial integrity and/or by agent(s) increasing the rate of thrombus lysis, and Another aspect of the invention related to by a cell-based whole blood viscoelastical haemostatic assay identifying critically ill patients at increased risk of development of organ failure, including multiple organ failure (MOF) and death.
1. A method of treating or reducing risk of systemic inflammation and/or severe infection, in a patient suffering from systemic inflammation and/or severe infection characterized by purpura fulminans; comprising administering to a patient in need thereof a combination of (1) one or more compounds selected from the group consisting of platelet inhibitors, wherein the platelet inhibitor is capable of inhibiting the GPIIb/IIIa receptor and (2) one or more compounds capable of modulating/preserving the endothelial integrity wherein the compound capable of modulating/preserving the endothelial integrity is selected from the group consisting of PGI2, PGX, and prostacyclin or a variant thereof, thereby treating or preventing organ failure in said patient.
2. The method of claim 1 , wherein the platelet inhibitor is capable of inhibiting the GPIIb/IIIa receptor and the compound capable of modulating/preserving the endothelial integrity is PGI2 or a variant thereof.
3. The method of claim 1 , wherein the platelet inhibitor is selected from the group consisting of abciximab, eptifibatide, tirofiban, orbofiban, xemilofiban, lamifiban, XJ757, DUP728 and XR299.
4. The method of claim 1 , wherein the platelet inhibitor has a half time of less than 3 hours.
5. The method of claim 1 , wherein the prostacyclin variant is selected from the group consisting of beraprost sodium, epoprostenol sodium, iloprost, iloprost in combination with bosentan, iloprost in combination with sildenafil citrate, treprostinil, pegylated treprostinil, treprostinil diethanolamine and treprostinil sodium, 2- {4-[(5,6-diphenylpyrazin-2-yl)(isopropyl)amino]butoxy}-N-(methylsulfonyl)acetamide, {4-[(5 ,6-diphenylpyrazin-2-yl)(isopropyl)amino]butoxylacetic acid, 8-[1,4,5-triphenyl-1H-imidazol-2-yl-oxy]octanoic acid, isocarbacyclin, cicaprost, [4-[2-(1,1-Diphenylethylsulfanyl)-ethyl]-3,4-dihydro-2H-benzo[1,4] oxazin-8-yloxy]-acetic acid N-Methyl-d-glucamine, 7,8-dihydro-5-(2-(1-phenyl-1-pyrid-3-yl-methiminoxy)-ethyl)-a-naphthyloxyacetic acid, (5-(2-diphenylmethyl aminocarboxy)-ethyl)-a-naphthyloxyaceticacid, 2-[3-[2-(4,5-diphenyl-2-oxazoly)ethyl]phenoxy]acetic acid, [3-[4-(4,5-diphenyl-2-oxazolyl)-5-oxazolyl]phenoxy]acetic acid, bosentan, 17[alpha], 20-dimethyl-[DELTA]6,6a-6a-carba PGI1, 15-deoxy-16[alpha]-hydroxy-16[beta],20-dimethyl-[DELTA]6,6a-6a-carba PGI1 and pentoxifylline (1- {5-oxohexyl}-3,7-dimethylxanthine).
6. The method of claim 1 , wherein the compound capable of modulating/preserving the endothelial integrity has a half-life of less than 4 hours.
7. A method for the preservation of platelet number and/or function in a patient suffering from systemic inflammation and/or severe infection characterized by purpura fulminans comprising administering to a patient in need thereof a combination of (1) one or more compounds selected from the group consisting of platelet inhibitors, wherein the platelet inhibitor is capable of inhibiting the GPIIb/IIIa receptor, and (2) one or more compounds capable of modulating/preserving the endothelial integrity wherein the compound capable of modulating/preserving the endothelial integrity is selected from the group consisting of PGI2, PGX, nitrogen oxide, and prostacyclin or a variant thereof, thereby treating or reducing risk of purpura fulminans in said patient.
8. The method of claim 7 , wherein the platelet inhibitor is capable of inhibiting the GPIIb/IIIa receptor and the compound capable of modulating/preserving the endothelial integrity is PGI2 or a variant thereof.
9. The method of claim 7 , wherein the platelet inhibitor is selected from the group consisting of abciximab, eptifibatide, tirofiban, orbofiban, xemilofiban, lamifiban, XJ757, DUP728 and XR299.
10. The method of claim 7 , wherein the platelet inhibitor has a half time of less than 3 hours.
11. The method of claim 7 , wherein the prostacyclin variant is selected from the group consisting of beraprost sodium, epoprostenol sodium, iloprost, iloprost in combination with bosentan, iloprost in combination with sildenafil citrate, treprostinil, pegylated treprostinil, treprostinil diethanolamine and treprostinil sodium, 2-{4-[(5,6-diphenylpyrazin-2-yl)(isopropyl)amino]butoxyl}-N-(methylsulfonyl)acetamide, {4-[(5,6-diphenylpyrazin-2-yl)(isopropyl)amino]butoxyl acetic acid, 8-[1,4,5-triphenyl-1H-imidazol-2-yl-oxy]octanoic acid, isocarbacyclin, cicaprost, [4-[2-(1,1-Diphenylethylsulfanyl)-ethyl]-3,4-dihydro-2H-benzo[1,4]oxazin-8-yloxy]-acetic acid N-Methyl-d-glucamine, 7,8-dihydro-5-(2-(1-phenyl-1-pyrid-3-yl-methiminoxy)-ethyp-a-naphthyloxyacetic acid, (5-(2-diphenylmethyl aminocarboxy)-ethyl)-a-naphthyloxyaceticacid, 2-[3[-(4,5-diphenyl-2-oxazolypethyl]phenoxy]acetic acid, [3-[4-(4,5-diphenyl-2-oxazolyl)-5-oxazolyl]phenoxy]acetic acid, bosentan, 17[alpha], 20-dimethyl-[DELTA]6,6a-6a-carba PGI1, 15- deoxy-16[alpha]-hydroxy-16[beta],20-dimethyl-[DELTA]6,6a-6a-carba PGI1 and pentoxifylline (1-{5-oxohexyl}-3,7-dimethylxanthine).
12. The method of claim 7 , wherein the compound capable of modulating/preserving the endothelial integrity has a half-life of less than 4 hours.
13. A method of treating or reducing risk of purpura fulminans, in a patient suffering from systemic inflammation and/or severe infection; comprising administering to a patient in need thereof a combination of (1) one or more compounds selected from the group consisting of platelet inhibitors, wherein the platelet inhibitor is capable of inhibiting the GPIIb/IIIa receptor and (2) one or more compounds capable of modulating/preserving the endothelial integrity wherein the compound capable of modulating/preserving the endothelial integrity is selected from the group consisting of PGI2, PGX, and prostacyclin or a variant thereof, thereby treating or preventing organ failure in said patient.