Treatment of acute myocardial infarction with recombinant tissue-type plasminogen activator

In Ireland, to date, coronary thrombolytic therapy has been confined almost exclusively to the use of streptokinase. However, a large body of evidence suggests that, in comparison to streptokinase, the agent recombinant tissue-type plasminogen activator (rt-PA) may be more effective in lysing coronary thrombi and achieving coronary reperfusion and causes fewer disturbances of the coagulation system. With these considerations in mind, we undertook a study to explore the future potential role of rt-PA in our particular clinical practice. Sixteen patients presenting to our centre with clinical and ECG features suggestive of acute myocardial infarction were treated with rt-PA and heparin infusion within 3.8 +/- 1.3 (mean +/- SD) [range 0.6 - 5.3] hours of the onset of their symptoms. Reperfusion, as assessed by clinical, electrocardiographic and biochemical criteria, was achieved in 15 of these 16 patients. One patient developed reocclusion that was successfully treated with repeat thrombolytic therapy. Follow up coronary angiography, performed in eight patients, confirmed successful reperfusion in seven. One patient developed an intracranial haemorrhage. The result of this pilot study highlight the importance of considering thrombolytic therapy in all patients presenting with suspected acute myocardial infarction (AMI). Our observations also suggest that rt-PA is very effective in restoring myocardial perfusion in patients with AMI who present at an early stage. As with all thrombolytic agents, it may be associated with haemorrhagic complications. Determination of the precise role of rt-PA, as opposed to other thrombolytic agents, awaits the results of ongoing clinical trials.     

Effect of recombinant tissue-type plasminogen activator on ten platelet membrane glycoproteins

Recombinant tissue-type plasminogen activator (rt-PA) did not modify densities of nine platelet membrane glycoproteins: collagen receptor subunit GP Ia; fibrinogen receptor GP IIb IIIa; thrombospondin receptor GP IV; von Willebrand factor receptor GP Ib and associated GP IX; thrombospondin; activation glycoprotein GMP 140; vitronectin receptor subunit VNR α and GP Ha. rt-PA induced slight decrease of GP 24 (CD9) density on platelet membrane. Antigen densities were determined after incubation of platelet-rich plasma with therapeutic doses of rt-PA (from 0.5-4 μg/ml) by a quantitative cytofluorometric method. Addition of fibrin did not modify the effect of rt-PA. These results suggest that incubation of platelet-rich plasma with therapeutic doses of rt-PA neither modify glycoproteins involved in platelet adhesion and aggregation nor markedly activate platelets.     

Localisation of fluorescence-labelled recombinant tissue-type plasminogen activator (rt-PA) on thrombi in vitro

Recombinant tissue-type plasminogen activator exhibits a high specific affinity for fibrin and is therefore of great value as a thrombolytic agent. However, its distribution after binding to a thrombus has not yet been demonstrated. In this study the binding of fluorescence-labelled rt-PA to human whole blood thrombi in vitro was investigated.After labelling with dichlorotriazinylaminofluorescein (DTAF) rt-PA retained fibrin affinity as well as enzymatic activity. Aged thrombi were incubated with increased concentrations of DTAF-rt-PA. Fluorescence in cryosections of the clots, as visualised by incidence microscopy, was observed only at the thrombus surface. The following control experiments confirmed that the fluorescence was specifically derived from the labelled protein: 1. after incubation of thrombi with DTAF alone no fluorescence could be observed in cryosections prepared from these thrombi; 2. incubation of a thrombus, exhibiting DTAF-rt-PA derived surface fluorescence, with unlabelled rt-PA resulted in the complete loss of surface fluorescence; 3. the fluorescence was randomly distributed throughout the whole cryosection if DTAF-rt-PA was present during thrombus formation.The findings suggest that during clot lysis, rt-PA binds initially to the thrombus surface but does not penetrate into the body of the clot. Thrombolysis is, therefore, likely to proceed via successive fibrin removal from the clot surface.     

Levels of tissue-type plasminogen activator and plasminogen activator inhibitor 1 in disseminated intravascular coagulation syndrome

Since disseminated intravascular coagulation (DIC) may directly reflect the abnormal regulation of the fibrinolytic system by endothelial cells, we have measured the levels of tissue-type plasminogen activator (t-PA), type 1 PA inhibitor (PAI-1) and t-PA . PAI-1 complex which is formed as a result of interaction on the two factors, in the plasma of patients with DIC (n = 51) and healthy controls (n = 42). Antigens of t-PA, PAI-1 and t-PA . PAI-1 complex were significantly increased in the DIC plasma (36.4 +/- 25.1, 106.8 +/- 54.7 and 46.6 +/- 34.5 ng/ml, respectively) compared with those in normal plasma (8.5 +/- 4.3, 54.4 +/- 21.2 and 8.6 +/- 3.5 ng/ml, respectively). The molar ratio of t-PA to PAI-1 was much higher in the DIC plasma (1:3) than in normal plasma (1:6), which caused enhancement of the whole fibrinolytic activity in the DIC plasma. These changes resulted in significant consumption of plasminogen, alpha 2-plasmin inhibitor (alpha 2-PI) and a significant increase of plasmin . alpha 2-PI complex (PPI) and D-dimer. These results suggest that t-PA and its specific inhibitor PAI-1 both of which are secreted from endothelial cells into blood, play an important role on the progress of DIC.     

组织型纤溶酶原激活物基因的DNA改组

目的：探索利用DNA改组（DNAshuffling)技术，获得更高活性tPA的可能性。方法：以人，恒河猴及大白鼠tPAcDNA为一组基因，进行tPA的DNA改组（DNAfamily shuffling)。以改组后构建的tPA多样性文库转染CHO细胞并进行克隆和筛选。结果：得到了两株有意义的克隆；t9和t17，其中t9克隆表达的tPA活性略高于人tPA，初步的比活性测定结果表明，活性约提高4倍。t17克隆表达的tPA虽然有88个氨基酸的缺失，但仍表现出与人tPA相同的活性，两株克隆经测序证明，为改组后的基因，其序列以人和恒河猴的tPAcDNA序列为主，少数序列来源于大白鼠tPAcDNA。结论：这一探索性结果将为后续几轮的tPADNA改组探明道路，为最终从改组后tPA多样性基因库中筛选到比较理想的重组体打下基础。     

Leukocyte tissue-type plasminogen activator activity in dialysis patients

Plasma fibrinopeptide B beta 15-42 was significantly high in undialyzed and hemodialyzed chronic renal failure (CRF) patients, indicating that the fibrinolytic system as well as the coagulation system is stimulated. There are two kinds of plasminogen activators (PA) for the fibrinolytic system: urokinase (UK) and tissue-type PA (t-PA). PA activity of peripheral leukocytes from healthy volunteers, continuous ambulatory peritoneal dialysis (CAPD) patients and hemodialysis (HD) patients was measured and compared. Peripheral leukocyte PA in the euglobulin fraction was purified using zinc-chelate-Sepharose 6B column and Concanavalin A-Sepharose column chromatography. The different PA activity was quantitatively identified by electrophoretic enzymography and was confirmed using antibody against UK and t-PA. PA activity of peripheral leukocytes was significantly higher in HD patients on the cupro-ammonium processing membrane dialyzer than in CAPD patients and healthy volunteers. All PA activity in the three groups was UK, and t-PA was not detected. This suggested that the inflammatory response was continuously induced in HD patients, resulting in the induction of PA activity of the leukocytes and plasma, and that different mechanisms were involved for the synthesis or secretion of UK and t-PA.     

The influence of recombinant tissue-type plasminogen activator and plasmin on platelet aggregation: a quenched-flow study

Our study was designed to investigate the influence of human recombinant tissue-type plasminogen activator (rt-PA) and plasmin on platelet aggregation kinetics. Quenched-flow aggregometry coupled to single-particle counting was used with washed human platelets, which were pre-incubated for 5 min at 37°C with physiological and pharmacological doses of rt-PA (0.14–70 nM). Aggregation induced by adenosine diphosphate (ADP) under physiological flow conditions was followed over 15s. Depending on donor and reaction time, potentiation (one third of subjects), inhibition (one third of subjects), and no effect on ADP-induced (10 μM) aggregation were noted within the first 5s, while from 5.0 to 15.O s no influence was seen. On the other hand, using 2.5 μM ADP, aggregation was inhibited in all sensitive donors. Pre-incubation of platelets with plasmin (10nM, 100 nM) for 5 min at 37°C elicited a biphasic response to ADP. Depending on concentration and reaction time, plasmin potentiated or inhibited ADP-induced (10 μM) aggregation. Our data reveal that some individuals are susceptible for potentiation of platelet aggregation by both rt-PA and plasmin. Such susceptibility may contribute to the phenomenon of early reocclusion observed during thrombolytic therapy with rt-PA.     

Hormonal regulation of tissue-type plasminogen activator and plasminogen activator inhibitor type-1 in cultured monkey Sertoli cells

Sertoli cells play a central role in the control and maintenanceof spermatogenesis. Isolated Sertoli cells of mouse and rattestes have been shown to secrete plasminogen activator (PA)and a plasminogen activator inhibitor type-1 (PAI-1) in culture.In this study, we have investigated the hormonal regulationof PA and PAI-1 activities in cultured monkey Sertoli cells.Sertoli cells (5x10⁵ cells/well) isolated from infant rhesusmonkey testes were preincubated at 35°C for 16 h in 24-wellplates precoated with poly(D-lysine) (5 µg/cm²) in 0.5ml McCoy's 5a medium containing 5% of fetal calf serum and furtherincubated for 48 h in 0.5 ml serum-free medium with or withoutvarious hormones or other compounds. PA as well as PAI-1 activitiesin the conditioned media were assayed by fibrin overlay andreverse fibrin autography techniques respectively. The Sertolicells in vitro secreted only tissue-type PA (tPA), no detectableamount of urokinase-type PA (uPA) could be observed. MonkeySertoli cells were also capable of secreting PAI-1. Immunocytochemicalstudies indicated that both tPA and PAI-1 positive staininglocalized in the Sertoli cells, spermatids and residual bodiesof the seminiferous epithelium; Northern blot analysis furtherconfirmed the presence of both tPA and PAI-1 mRNA in monkeySertoli cells. Addition of follicle-stimulating hormone (FSH)or cyclic adenosine monophosphate (cAMP) derivatives or cAMP-generatingagents and gonadotrophin-releasing hormone (GnRH) agonist orphorbol ester (PMA) to the cell culture significantly increasedtPA activity. PAI-1 activity in the culture was also enhancedby these reagents except 8-bromo-dibutyryl-cAMP, forskolin and3-isobutyl-1-methylxanthin (MIX) which greatly stimulated tPAactivity, whereas decreased PAI-1 activity, implying that neutralizationof PAI-1 activity by the high level of tPA in the conditionedmedia may occur. These data suggest that increased intracellularsignals which activate protein kinase A (PKA), or protein kinaseC (PKC) can modulate Sertoli cell tPA and PAI-1 activities.The concomitant induction of PA and PAI-1 by the same reagentsin the Sertoli cells may reflect a finely tuned regulatory mechanismin which PAI-1 could limit the excession of the proteolysis. plasminogen activator inhibitor type-1/Rhesus monkey/Sertoli cells/tissue-type plasminogen activator     

人脐静脉内皮细胞分泌组织型纤溶酶原激活物及其抑制剂1对醒脑静干预的反应

背景：前期研究发现醒脑静能有效抑制兔心肌缺血再灌注模型的炎症递质及促纤溶作用,但是影响纤溶系统活性的作用机制未完全明确。目的：观察醒脑静对重组人肿瘤坏死因子α介导人脐静脉内皮细胞分泌组织型纤溶酶原激活物和纤溶酶原激活物抑制剂1及其基因表达的影响。方法：取3-5 代人脐静脉内皮细胞,在培养基中添加10 μg/L 重组人肿瘤坏死因子α介导人脐静脉内皮细胞分泌组织型纤溶酶原激活物和纤溶酶原激活物抑制剂1及其基因表达,醒脑静组加入不同浓度(5,10,20 mL/L)的醒脑静干预,阳性对照组添加氟伐他汀(1 μmol/L),并设立单纯人脐静脉内皮细胞培养的空白对照组。培育24 h后采用酶联免疫吸附双抗体夹心法(ELISA)检测细胞上清液组织型纤溶酶原激活物和纤溶酶原激活物抑制剂1水平;采用反转录聚合酶链反应检测人脐静脉内皮细胞的组织型纤溶酶原激活物和纤溶酶原激活物抑制剂1的mRNA表达。结果与结论：重组人肿瘤坏死因子α组纤溶酶原激活物抑制剂1分泌和mRNA表达较空白对照组显著升高 (P < 0.05),组织型纤溶酶原激活物分泌和mRNA表达较空白对照组显著降低(P < 0.05)。不同浓度醒脑静组纤溶酶原激活物抑制剂1分泌和mRNA表达均较重组人肿瘤坏死因子α组显著降低(P < 0.05),而组织型纤溶酶原激活物分泌和mRNA表达均较重组人肿瘤坏死因子α组显著升高(P < 0.05),且呈剂量依赖关系。结果证实,醒脑静作用可逆转重组人肿瘤坏死因子α所致的人脐静脉内皮细胞的纤溶活性。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Interaction of tissue-type plasminogen activator with fibronectin and fibronectin fragments

In this paper we present data on the interaction, in solution, of the tissue-type plasminogen activator (t-PA) with fibronectin (FN) and its degradation products (FNdp). A cross radial caseinolytic assay (CRACA) was developed for the evaluation of the effect of the FN and/or FNdp on t-PA and urokinase plasminogen activator (u-PA) activity. A directional caseinolysis was observed when t-PA or u-PA were tested in the proximity of FNdp; no directionality was observed when intact FN or BSA were used. After incubation of t-PA, but not u-PA, with FNdp, PA activity at 170, 150, 100 and 30 kDa was detected by SDS-PAGE followed by zymography. The incubation of intact FN with t-PA gives rise to two forms of 500 and 150 kDa after prolonged incubation of the zymograms; no higher MW forms appear when u-PA substitutes t-PA.The immunoblotting analysis of the mixtures of t-PA and FN or FNdp with anti-t-PA or anti-FN sera showed that intact FN and some of its fragments interact with t-PA, giving rise to complexes recognized by both antisera and resistant to SDS-PAGE. Similar complexes are also evident, in vivo, in biological fluids like human plasma cryoprecipitates (cryos).     

Efficacy and tolerance of recombinant tissue-type plasminogen activator in patients with thrombotic or embolic occlusions of leg-arteries

Summary The efficacy and safety of recombinant tissue-type plasminogen activator (rt-PA) was evaluated in 46 patients with thrombembolic arterial occlusions in leg arteries. rt-PA was given over 1–4 h with a maximum dose of 18 mg. The effect of rt-PA treatment was determined as patency of the occluded arteries in 44 different patients 14 days after treatment. In 41 patients at least one artery was recanalized (93%) by rt-PA, and in almost half of these patients (48%) no residual stenosis were detected after the lytic treatment. A slight residual stenosis was detected in 29% of the patients and a severe residual stenosis in 21%. An additional treatment with percutaneous transluminal angioplasty was performed in 23 of the 44 patients and successful in 21 (91%). In 8 patients an addition catheter-embolectomy was performed. No difference in patency rate was detected between patients with thrombotic and those with embolic occlusions. The age of the occlusion influenced the patency rate; occlusions under the age of 5 weeks showed a patency rate of 96% compared to 82% in older occlusions. The length of the occlusion did not have any influence on the outcome of the rt-PA treatment. From the results of this open study we conclude that a dose of up to 18 mg of rt-PA is both safe and effective in the treatment of thromboembolic occlusions in leg arteries.Abbreviations rt-PA recombinant tissue-type plasminogen activator - GGT gamma-glutamyltransferase - SGOT aspartate aminotransferase - SGPT alanine aminotransferase - LDH lactate dehydrogenase - PTA percutaneous transluminal angioplasty Dedicated to Prof. Dr. N. Zöllner on the occasion of his 70th birthday     

Amyloid-beta-stimulated plasminogen activation by tissue-type plasminogen activator results in processing of neuroendocrine factors

Alzheimer's disease brain is characterized by the abundant presence of amyloid deposits. Accumulation of the major constituent of these deposits, amyloid-beta (Abeta), has been associated with decreased neurotransmission, increased neuronal cell death, and with cognitive decline. The mechanisms underlying these phenomena have not yet been fully elucidated. We have previously shown that amyloid peptides like Abeta bind tissue-type plasminogen activator (tPA) and cause enhanced plasmin production. Here we describe the identification of five major neuronal cell-produced Abeta-associated proteins and how Abeta-stimulated plasmin formation affects their processing. These five proteins are all neuroendocrine factors (NEFs): chromogranins A, B and C; truncated chromogranin B; and VGF. Plasminogen caused processing of Abeta-bound (but not soluble) tPA, chromogranin B and VGF and the degradation products were released from Abeta. Processing of the neuroendocrine factors was dependent on tPA as it was largely abrogated in tPA-/- cells or in the presence of a specific tPA-inhibitor. If plasmin indeed produces NEF-derived peptides in vivo, some of these peptides may have biological activity, for instance in regulating neurotransmitter release that may affect the pathology of Alzheimer's disease.     

Secretion of tissue-type plasminogen activator and plasminogen activator inhibitor by Rickettsia conorii- and Rickettsia rickettsii-infected cultured endothelial cells.

Hemostasis abnormalities have been described in patients with Mediterranean spotted fever and Rocky Mountain spotted fever. Evidence of the activation of the fibrinolytic system has been obtained in both diseases. After experimental Rocky Mountain spotted fever, an elevated level of fibrinogen was found in parallel with the activation of the fibrinolytic system and transient elevation of the tissue-type plasminogen activator. Later protein is mainly synthesized by endothelial cells. The ability to culture human endothelial cells in vitro provides a unique system to study the secretion of tissue-type plasminogen activator and of plasminogen activator inhibitor after rickettsial infection. Human vascular endothelial cells derived from the umbilical vein, when infected with Rickettsia conorii or Rickettsia rickettsii, secreted as much tissue-type plasminogen activator as control cells. The activity of plasminogen activator inhibitor however, was higher in the supernatants of infected cells than in those of control cells. This rickettsia-induced imbalance of the tissue-type plasminogen activator-inhibitor pair was a very early event after in vitro infection. The involvement of this system during Mediterranean spotted fever and Rocky Mountain spotted fever remains to be demonstrated.