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Antidote-mediated control of an anticoagulant aptamer in vivo


Patient safety and treatment outcome could be improved if physicians could rapidly control the activity of therapeutic agents in their patients. Antidote control is the safest way to regulate drug activity, because unlike rapidly clearing drugs, control of the drug activity is independent of underlying patient physiology and co-morbidities. Until recently, however, there was no general method to discover antidote-controlled drugs. Here we demonstrate that the activity and side effects of a specific class of drugs, called aptamers, can be controlled by matched antidotes in vivo. The drug, an anticoagulant aptamer, systemically induces anticoagulation in pigs and inhibits thrombosis in murine models. The antidote rapidly reverses anticoagulation engendered by the drug, and prevents drug-induced bleeding in surgically challenged animals. These results demonstrate that rationally designed drug-antidote pairs can be generated to provide control over drug activities in animals.

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Figure 1: Anticoagulant activity and antidote neutralization of Ch-9.3t in human and animal plasmas.
Figure 2: In vivo drug and antidote activity in swine.
Figure 3: Aptamer Ch-9.3t is an antithrombotic in mice.
Figure 4: Antidote prevents bleeding induced by drug treatment and surgical trauma.


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We thank K.A. High for plasma from factor IX-deficient mice. We thank B. Harrington, R. Califf, J. Alexander and B. Anderson for their continued intellectual support of the development of antidote-controlled anticoagulant and antithrombotic agents. This work was supported by grants from the American Heart Association to C.P.R. and the National Institutes of Health to B.A.S. and W.P.F.

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Correspondence to Christopher P Rusconi or Bruce A Sullenger.

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C.P.R. and B.A.S. have equity in Regado Biosciences, Inc., a biotechnology company spun out of Duke University to commercialize drug-antidote pairs.

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Rusconi, C., Roberts, J., Pitoc, G. et al. Antidote-mediated control of an anticoagulant aptamer in vivo. Nat Biotechnol 22, 1423–1428 (2004).

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