Factor V Heterozygous
This mutation is consistent with an increase in thrombosis meaning the problem with this is an increase in clotting.
Pentosan Polysulfate (PPS)
It is important to note that pentosan and polysulfate WITH heparin share a high degree of sulfonation. The compound pentosan polysulfate (PPS) is low in anticoagulant activity BUT it does share some of the properties of heparin. With respect to this patient this could be of benefit as it is a low-grade anticoagulant.
The typical dose when using Pentosan to treat arthritis is 0.5mL sub q once/week, sometimes twice/week for the first 6 weeks. After the first 6 weeks you can potentially space it out to once/month. This is a very low dose meaning even if the patient is already on an anticoagulant for Factor V Heterozygous mutation this should not affect the anticoagulant therapy. You should have a lot of leeway in absolutely utilizing something like this for this particular patient. ALSO, if the patient is not on any anticoagulants this has beneficial features of the low anticoagulant activity.
Pentosan polysulfate has other beneficial properties that can be of importance. PPS regulates systemic iron availability and has significant properties in reducing a Hepcidin (a peptide hormone produced by the liver). A hepcidin dysregulation can cause disorders both with iron overload (i.e. Iron Refractory Iron Deficient Anemia) and iron deficiency (i.e. Anemia of chronic disease (ACD) or Anemia of inflammation (AI).
The two pathways known for hepcidin expression are:
-BMP/SMAD signaling pathway (iron-mediated)
-Inflammatory cytokine IL-6 and JAK/STAT3
Attached is an article discussing how Pentosan polysulfate can be used to control hepcidin. Asperti, Michela, Andrea Denardo, Magdalena Gryzik, Annalisa Castagna, Domenico Girelli, Annamaria Naggi, Paolo Arosio, and Maura Poli. “Pentosan Polysulfate to Control Hepcidin Expression in Vitro and in Vivo.” Biochemical Pharmacology 175 (May 2020): 113867. https://doi.org/10.1016/j.bcp.2020.113867.
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