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TABLE 4 Summary of Baseline Plasma Levels of α -Acid Glycoprotein (*AGP) (also called Orosomucoid) in Mouse, Rat, Pig and Human.

Adult Species μg/mL Relative to Human Comment Reference
Mouse 100 ~20% ➝ 20 times during acute phase activation Smith and Waters (2019) 43
Sprague-Dawley 230–320 48% ➝ up to 10 times during surgery, stress, injury, and Smith and Waters (2019) 43
rat (275) inflammation
Pig 1,000–3,000 3.5-fold higher Strongly age dependent. Newborn basal levels 2–6 Heegaard et al. (2013) 42
(2,000) times ➝ than adults. Adult AGP after infection and
➝
opposite to other species.
Human 390–740 — ➝ 2–4 times during heart attack, major surgery, Smith and Waters (2019) 43
(565) burns, and trauma
*AGP, an important constituent of human and animal plasma, is a major positive acute-phase protein (except pigs) with drug-binding, anti-in-
flammatory, and immunomodulatory properties. AGP can bind >300 drugs.

forward use of blood products (i.e., person-to-person, prehos- 6. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
pital blood banking, freeze-dried plasma/ and platelets) and (2001–2011): implications for the future of combat casualty care.
may have a broad-spectrum public purpose for prehospital ci- J Trauma Acute Care Surg. 2012;73(6 suppl 5):S431–437.
vilian trauma and aeromedical retrieval. Notwithstanding our 7. Cap AP, Pidcoke HF, DePasquale M, et al. Blood far forward:
progress in ALM development, it is important to emphasize Time to get moving! J Trauma Acute Care Surg. 2015;78(6 suppl
1):S2–S6.
that more ALM translational studies and trials are required 8. Dobson GP. On being the right size: heart design, mitochon-
before safe field use is possible. drial efficiency, and lifespan potential. Clin Exp Pharm Physiol.
2003;30(8):590–597.
Acknowledgments 9. Dobson GP. Organ arrest, protection and preservation: natural
The authors would particularly like to thank the US Depart- hibernation to cardiac surgery: a review. Comp Biochem Physiol
Part B. 2004;139:469–485.
ment of Defense for their continued support of our work 10. Dobson GP, Letson HL. Adenosine, lidocaine and Mg (ALM):
2+
and the College of Medicine and Dentistry at James Cook from cardiac surgery to combat casualty care: teaching old drugs
University. new tricks. J Trauma Acute Care Surg. 2016;80(1):135–145.
11. Dobson GP, Faggian G, Onorati F, et al.. Hyperkalemic cardio-
Author Contributions plegia in adult and pediatric cardiac surgery: end of an era? Front
G.P.D. and H.L.L. contributed equally to literature search, Clin Transl Physiol. 2013;4(Aug 28):1–28.
study design, data interpretation, and writing of the manuscript. 12. Dobson GP, Jones MW. Adenosine and lignocaine: a new concept
in non-depolarising surgical arrest, protection and preservation. J
Thorac Cardiovasc Surg. 2004;127(3):794–805.
Conflict of Interest Statement 13. Dobson GP. Membrane polarity: a target for myocardial pro-
G.P.D. is the sole inventor of the ALM concept for cardiac sur- tection and reduced inflammation in adult and pediatric car-
gery, trauma, sepsis, and cardioplegia. H.L.L. has no conflicts diothoracic surgery (Editorial). J Thorac Cardiovasc Surg.
to declare. 2010;140(December):1213–1217.
14. Onorati F, Santini F, Dandale R, et al. “Polarizing” microplegia
improves cardiac cycle efficiency after CABG for unstable angina.
Funding Int J Cardiol. 2013;167(6):2739–2746.
This work was supported by USSOCOM, IACUC protocol 15. Onorati F, Dobson GP, San Biagio L, et al. Superior myocardial
A2118 and A2296, USAMRMC proposal SO150053 under protection using ‘polarizing’ adenosine, lidocaine, and Mg
2+
Award No. W81XWH-USSOCOM-BAA-15-1. The opinions, (ALM) cardioplegia in humans. J Am Coll Cardiol. 2016;67(14):
interpretations, and conclusions are those of the authors and 1751–1753.
2+
are not necessarily endorsed by the US Department of Defense. 16. Letson HL, Dobson GP. Ultra-small IV bolus of 7.5% NaCl/Mg
with adenosine and lidocaine (ALM) improves early resuscitation
outcome in the rat following severe hemorrhagic shock in vivo. J
Availability of Data and Materials Trauma. 2011;71(3):708–719.
The datasets supporting the conclusions of this manuscript 17. Letson HL, Dobson GP. Small-volume 7.5% NaCl with 6% dex-
can be made available by emailing the authors. tran-70 or 6% and 10% Hetastarch are associated with arrhyth-
mias and death following 60 min of severe hemorrhagic shock in
the rat in vivo. J Trauma. 2011;70(June 6):1444–1452.
References 18. Canyon SJ, Dobson GP. Protection against ventricular arrhyth-
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