DIASPIRIN CROSS-LINKED HEMOGLOBIN IMPROVES NEUROLOGICAL OUTCOME FOLLOWING REVERSIBLE BUT NOT IRREVERSIBLE CNS ISCHEMIA IN RABBITS

Background and Purpose Hemodilution using modified hemoglobin solutions may reduce ischemic central nervous system injury. Purified diaspirin cross-linked hemoglobin (DCLHb) is a cell-free hemoglobin that is intramolecularly cross-linked between the two alpha Subunits, resulting in enhanced oxygen offloading to tissues and increased half-life. In the present experiments, we evaluated the ability of DCLHb to reduce neurological damage in two rabbit stroke models. Methods In a reversible spinal cord ischemia model, ischemia of the caudal lumbar spinal cord was produced by temporary occlusion of the abdominal aorta. In an irreversible model of cerebral ischemia, plastic microspheres (50 mu m) were injected into the internal carotid artery and lodged in the cerebral microvasculature. DCLHb was administered 5 minutes after initiation of ischemia as either a 10-mL/kg infusion, 10-mL/kg exchange transfusion, or a 20-mL/kg infusion. Control animals received human serum albumin that was oncotically matched to the DCLHb. Results In the spinal cord model, DCLHb significantly increased the duration of ischemia required to produce permanent paralysis from 27.33+/-8.71 minutes (mean+/-SD) in controls to 42.59+/-10.10 minutes in the 10-mL/kg exchange transfusion group and to 40.82+/-18.16 minutes in the 20-mL/kg infusion condition (P<.05). DCLHb did not significantly reduce neurological damage in the microsphere embolization model. Conclusions These data suggest that cross-linked hemoglobin reduces neurological damage after reversible central nervous system ischemia and that this is not attributable to hemodilution or hypervolemia only.