The effects of aprotinin on chromogenic peptide substrate and other assays for components of the coagulation,fibrinolysis and plasma kallikrein systems

Plasma samples containing a range of aprotinin levels (0–400 KIU/ml) were tested in chromogenic peptide substrate assays for antithrombin III, protein C, plasma kallikrein inhibition, plasminogen, antiplasmin, tissue plasminogen activator and plasminogen activator inhibitor. No effect on the antithrombin III assay was seen. Aprotinin produced significantly reduced values in the assays for protein C, plasminogen and tissue plasminogen activator, and significantly increased values for kallikrein inhibition, antiplasmin and plasminogen activator inhibitor. Immunochemical assays for plasminogen activator including a new assay (BIA-t-PA) and plasminogen activator inhibitor were not affected by aprotinin. When plasma samples from patients undergoing cardiopulmonary bypass, with and without high dose aprotinin therapy, were tested in the chromogenic substrate assay for plasminogen activator inhibitor, markedly elevated apparent inhibitor levels were found in the aprotinin group.     

Inhibition of the fibrinolytic and fibrinogenolytic activity of plasminogen activators in vitro by the antidotes ϵ-aminocaproic acid,tranexamic acid and aprotinin

The effects of the potential antifibrinolytic antidotes EACA, AMCA and aprotinin on the pharmacological activity of SK, u-PAs, APSAC and t-PA (alteplase) were compared in vitro. Both the initiation of human plasma clot lysis and ongoing clot lysis in the presence of SK and APSAC were effectively inhibited by concentrations of EACA (1 mM) and aprotinin (50 KIU/ml) equivalent to those found at steady state conditions during the standard therapeutic regimens. The actions of tcu-PA and scu-PA were also inhibited, at least initially, although some fibrinolytic activity appeared on extended incubation with tcu-PA. EACA (1 mM) was only moderately inhibitory to t-PA, and aprotinin (50 KIU/ml) was not an effective antidote. Ongoing fibrinogenolysis was generally less readily inhibited than fibrinolysis. A higher concentration of EACA (12 mM, equivalent to the initial peak level achieved therapeutically) effectively inhibited fibrinolytic activity for all thrombolytic agents but the higher concentration of aprotinin (500 KIU/ml) failed to inhibit t-PA completely. Inhibition by AMCA, at concentrations equivalent to those used therapeutically, was similar to the maximum effect achieved by EACA.In conclusion, aprotinin and EACA/AMCA represent useful antidotes for those rare occasions when it is necessary to terminate the action of SK, APSAC and u-PA—even when plasma levels of thrombolytic agent are high, as after the standard administration of APSAC as a short injection. Concentrations of aprotinin and EACA/AMCA achievable by current dosage regimens are relatively less able to inhibit t-PA.     

Role of kinins and sensory neurons in the rat pleural leukocyte migration induced by Phoneutria nigriventer spider venom.

The leukocyte migration induced by Phoneutria nigriventer spider venom (PNV) has been investigated in rats using the pleurisy model. Intrapleural injection of PNV (10-100 microg/cavity) caused a dose- and time-dependent leukocyte accumulation. The bradykinin B(2) receptor antagonist Hoe 140 (0.5 mg/kg) substantially inhibited PNV-induced cell accumulation, whereas the angiotensin-converting enzyme inhibitor captopril (2 mg/kg) potentiated by 80% this effect. The non-specific kallikrein inhibitor aprotinin and the plasma kallikrein inhibitor soybean trypsin inhibitor greatly reduced PNV-induced leukocyte migration, whereas the selective tissue kallikrein inhibitor P(ac)-F-S-R-EDDnp failed to affect PNV-induced responses. Treatment of rats with capsaicin (50 mg/kg) at the neonatal stage resulted in 67% inhibition of the PNV-induced cell migration. The neurokinin NK(1) receptor antagonist SR140333, but not the NK(2) receptor antagonist SR48968, reduced by 55% venom-induced cell accumulation. We conclude that bradykinin generation is involved in the PNV-induced pleural leukocyte migration in rats, where it can directly activate sensory nerves contributing to a neurogenic inflammatory mechanism.     

Kallikrein inhibition and C1-esterase inhibitor levels in patients with the lupus inhibitor

It has been suggested that kallikrein inhibition may predispose patients with the lupus inhibitor to thrombosis by interfering with the Factor XII-mediated activation of plasminogen. To further investigate this suggestion, the authors measured kallikrein inhibition in 19 patients with the lupus inhibitor. They found that kallikrein inhibition was greater than 100% of that of a normal plasma pool in all patients and greater than 125% in 11 of 19. Kallikrein inhibition was significantly correlated with C1-esterase inhibitor (C1S-INH) concentration, which they measured by rocket immunoelectrophoresis (r = +0.55, P less than 0.05). In three patients the C1S-INH was more than 30% greater than the kallikrein inhibition. Crossed immunoelectrophoresis for C1S-INH in these patients' plasma revealed an electrophoretic mobility identical with that of the normal plasma pool. The authors suggest that C1S-INH-mediated kallikrein inhibition, in conjunction with other coagulation abnormalities, predisposes patients with the lupus inhibitor to thrombosis.     

Characterisation of rt-PA I276G,a recombinant human tissue-type plasminogen activator mutant with altered plasmin cleavage site

rt-PA I276G, a mutant of recombinant human tissue-type plasminogen activator (rt-PA) with altered plasmin cleavage site, was obtained by site-directed mutagenesis of Ile²⁷⁶ to Gly. rt-PA I276G, purified to homogeneity from the conditioned medium of transfected Chinese hamster ovary cells, was obtained as a single chain molecule, which was quantitatively converted to a two chain moiety by cleavage of the Lys²⁷⁷-Gly²⁷⁸ peptide bond with plasmin. The specific activities on fibrin films of the single chain and two chain forms of rt-PA I276G were 8900 and 15000 IU/mg respectively, as compared to 210000 and 130000 IU/mg respectively for the single chain and two chain forms of wild-type rt-PA obtained in the same expression system. The amidolytic activity of the rt-PA I276G moieties was 3- to 5-fold lower and their catalytic efficiency for plasminogen activation 20- to 50-fold lower than those of the wild-type rt-PA moieties. Both single chain and two chain rt-PA I276G induced concentration-dependent lysis of a ¹²⁵I-fibrin labelled plasma clot submersed in human plasma; equi-effective concentrations (causing 50% clot lysis in 2 h) were 0.55 and 1.40 μg/ml respectively, as compared to 0.36 and 0.60 μg/ml for single chain or two chain wild-type rt-PA respectively. Continuous infusion over 60 min of single chain rt-PA 1276G or wild-type rt-PA in hamsters with a pulmonary embolus, revealed an approximately 2-fold lower thrombolytic potency (clot lysis versus dose) for the mutant, but a comparable specific thrombolytic activity (clot lysis versus steady state plasma antigen level). It is concluded that replacement of Ile²⁷⁶ by Gly in single chain rt-PA significantly reduces the intrinsic enzymatic activity in purified systems. In a plasma milieu in the presence of fibrin the fibrinolytic potential of the mutant is, however, only 2-fold lower than that of wild-type rt-PA obtained in the same expression system.     

Production of the modified form of human plasminogen by alpha 2-macroglobulin-plasmin complexes

It has been speculated that the modified form of plasminogen, a precursor of proteolytic enzyme plasmin in plasma, plays an important role in fibrinolysis in the blood. The present study was undertaken to examine the production by alpha 2-macroglobulin-plasmin complexes. alpha 2-Macroglobulin-plasmin complexes were purified from urokinase-activated plasma by affinity chromatography on lysine-Sepharose and gel filtration on Ultrogel AcA 22. The plasmin complex converted native plasminogen into the modified form more easily in the presence of epsilon-aminocaproic acid. The modification of native plasminogen by alpha 2-macroglobulin-bound plasmin was completely inhibited by aprotinin, and partly by soybean trypsin inhibitor. alpha 2-macroglobulin-bound plasmin produced modified plasminogen in human plasma where potent plasmin inhibitors exist, though the degree of production was small. The present results support the speculation of the important role of the modified form in vivo.     

Inhibition of short-circuit current in toad urinary bladder by inhibitors of glandular kallikrein

Aprotinin, a reversible inhibitor, and D-Phe-Phe-Arg-chloromethyl ketone (DPPA), an irreversible inhibitor of mammalian glandular kallikreins, decreased short-circuit current (SCC) in the isolated toad urinary bladder. Both were more potent and rapidly acting on the mucosal than serosal surface. The maximal inhibition in basal SCC was 29% for aprotinin and 41% for DPPA at concentrations of 7.0 X 10(-6) and 1.0 X 10(-5) M, respectively. SCC inhibition with mucosal aprotinin was reversed by rinsing, whereas inhibition with mucosal DPPA was not reversible. The presence of either agent in the mucosal bath inhibited the SCC increase to serosal vasopressin, but neither modified this response when present in the serosal bath. Neither agent affected basal or vasopressin-stimulated osmotic water permeability. Aprotinin did not prevent aldosterone-induced increases in SCC. Soybean trypsin inhibitor, an inhibitor of plasma but not glandular kallikrein, did not affect SCC. We postulate that these inhibitors of mammalian glandular kallikreins act upon some accessible serine proteinase(s) to reduce short-circuit current. This protein(s) might be an amphibian homologue of mammalian renal kallikrein.     

Cleavage of surfactant-incorporating fibrin by different fibrinolytic agents. Kinetics of lysis and rescue of surface activity

Incorporation of surfactant into polymerizing fibrin causes loss of surface activity and marked retardation of clot lysis by plasmin (Günther and colleagues, Am. J. Physiol. 1994;267:L618-L624). We compared the efficacy of tissue-type plasminogen activator (t-PA), urokinase-type plasminogen activator (u-PA), activated anisoylated streptokinase-plasminogen activator complex (APSAC), and plasmin to dissolve surfactant-incorporating fibrin. Alveofact was employed as a natural surfactant source, and plasminogen was coincorporated into the fibrin matrix at a physiologic ratio to fibrin. Fibrinolysis was quantified by the release of tracer from (125)I-labeled fibrin, and the pattern of split products was characterized by sodium dodecyl sulfate polyacrylamide gel electrophoresis. In addition, we investigated the fibrinolysis-related restoration of surface activity by measurement in the pulsating bubble surfactometer. Concentrations of all fibrinolytic agents were chosen to effect approximately 40% lysis of clot material in the absence of surfactant (control). When incorporated into the fibrin matrix, but not when admixed after clot formation, surfactant inhibited the cleavage of fibrin by all fibrinolytic agents in a dose-dependent manner. Interestingly, t-PA and u-PA were significantly less inhibited than was plasmin or APSAC. The pattern of arising fibrin scission products was identical for all fibrinolytic approaches and was independent of surfactant incorporation. Adsorption and minimum surface tension-lowering properties of Alveofact were almost completely lost upon incorporation into fibrin, but surface activity was fully restored upon sustained clot lysis with all fibrinolytic agents. We conclude that the fibrinolytic capacity of all agents investigated is markedly inhibited by surfactant incorporation in fibrin, but this inhibition is significantly less pronounced in the agents employing preincorporated plasminogen (t-PA and u-PA), as compared with plasmin and APSAC. The plasminogen activators may thus proffer to "rescue" pulmonary surfactant function by induction of fibrinolysis in the alveolar compartment.     

Reactive oxygen species as regulators of human neutrophil and fibroblast interstitial collagenases.

The effects of various reactive oxygen species on latent human neutrophil and fibroblast-type interstitial collagenases were studied. Latent human neutrophil collagenases (proMMP-8) was efficiently activated by hypochlorous acid and hydrogen peroxide and less efficiently by the serine proteinases trypsin and chymotrypsin. Human plasmin and plasma kallikrein did not activate latent human neutrophil collagenase. The activation of latent human neutrophil collagenase by hypochlorous acid and hydrogen peroxide corresponded to the activation obtained with the other known non-proteolytic activators phenylmercuric chloride and gold thioglucose. The activation by hydrogen peroxide was inhibited by mannitol and desferoxamine, suggesting a localized Fenton-type reaction to be responsible for the generation of hydroxyl radical and/or hydroxyl radical-like reactive oxygen pathway of neutrophil procollagenase does not involve plasmin and plasma kallikrein, which are efficient proteolytic activators of latent fibroblast-type procollagenase (proMMP-1). Fibroblast procollagenase was also slightly activated by hypochlorous acid and gold thioglucose. Thus neutrophil procollagenase seems to prefer non-proteolytic means of activation and reactive oxygen species can be regarded as potent activators in vivo. Synovial-fluid neutrophils from rheumatoid arthritis patients were found to release collagenase in 30% active form when compared to same patients' peripheral blood neutrophils, which released collagenase in completely latent form. This may indicate that the triggering of neutrophil at the site of inflammation in vivo involves initial oxidative activation of collagenase upon the degranulation process.     

Effects of the venom of the rhinoceros horned viper (Bitis nasicornis) on blood coagulation, platelet aggregation, and fibrinolysis

The venom of the rhinoceros horned viper (Bitis nasicornis) has been studied in vitro and has been shown to be anticoagulant. This action appeared to be due to an effect on both the extrinsic and intrinsic blood thromboplastin mechanisms. The venom was also proteolytic and in purified caseinolytic systems activated plasminogen, enhanced the activation of plasminogen by streptokinase, and potentiated the action of plasmin. In the euglobulin clot lysis system high concentrations of venom produced inhibition. The crude venom increased platelet adhesiveness but in high concentrations delayed the snowstorm effect in the Chandler's tube system and inhibited platelet adenosine diphosphate reactivity. Passage through carboxymethylcellulose yielded six fractions. One possessed anticoagulant activity, inhibited plasmin, and increased the optical density of platelet-rich plasma. The other five fractions shortened the plasma recalcification time but had no effect on plasmin activity. Four fractions aggregated platelets and enhanced platelet adenosine diphosphate reactivity.     

Inhibitory action of protein kinase Cbeta inhibitor on tetrodotoxin-resistant Na+ current in small dorsal root ganglion neurons in diabetic rats

Experimental evidence has been presented to suggest that protein kinase Cbeta isoform-selective inhibitor LY333531 is effective at alleviating diabetic hyperalgesia. In the present study, we isolated small (< or =25 microm in soma diameter) dorsal root ganglion (DRG) neurons from control and streptozocin (STZ)-induced diabetic rats, and examined the acute action of LY333531 (1-1000 nM) on the tetrodotoxin-resistant Na(+) current (TTX-R I(Na)), which plays an essential role in transmitting nociceptive impulses, using the whole-cell patch-clamp method. TTX-R I(Na) in diabetic DRG neurons was enhanced in amplitude (71.5+/-3.6pA/pF, n=10 versus 41.2+/-3.3pA/pF, n=8) and was activated at more negative potentials (V(1/2), -15.1+/-1.3 mV versus -9.6+/-1.4 mV), compared with that in control neurons. Bath application of LY333531 acutely inhibited TTX-R I(Na) in both control and diabetic DRG neurons, and the degree of inhibition by the drug at concentrations of 1, 10 and 100 nM was significantly greater in diabetic DRG neurons than in control DRG neurons. Thus, TTX-R I(Na), which is upregulated in the diabetic state, is likely to be more potently inhibited by submicromolar concentrations of LY333531. These results suggest that an acute inhibition of TTX-R I(Na) by LY333531 attenuates the exaggerated excitability of DRG neurons in the diabetic state, which appears to be related at least partly to anti-hyperalgesic actions of the drug in diabetic neuropathy.     

The production of fibrinolysis inhibitors as a parameter of the activation state in murine macrophages.

Macrophages from peritoneal exudates which had been induced by various irritants were cultured, and the supernatants were tested for inhibitors of fibrinolysis using the plasmin-dependent lysis of ¹²⁵I-labeled fibrinogen as assay. Washout macrophages and casein or proteose peptone-elicited macrophages were found to release fibrinolysis inhibitors in contrast to lipopolysaccharide or thioglycollate-induced macrophages. The molecular weight of inhibitors was determined at 60 000, 45 000 and 15 000 by Sephadex chromatography. Whereas the inhibitors at 15 000 and 45 000 could be detected in all experiments, the inhibitor at mol. wt. 60 000 was not present in all preparations. The isoelectric point of inhibitor I (mol. wt. 15 000) and inhibitor II (mol. wt. 45 000) was determined at 4.15. The proteolytic and esterolytic activity of trypsin and chymotrypsin were both inhibited by each of the two inhibitors. On the other hand, only the proteolytic activity of plasmin could be inhibited. Evidence for the active synthesis of inhibitors by macrophages came from several experiments. Macrophages in serum-free cultures continued to release inhibitors for at least 48 h; normal mouse serum did not contain inhibitors of the same molecular size, and [³H]leucine was incorporated into the inhibitors which were specifically detected by the absorption of plasmin inhibitor complexes to lysyl-Sepharose. Since inhibitors and plasminogen activator could not be detected in the same macrophage culture supernatants, it appears that the production of inhibitors and plasminogen activator by the same macrophage population is mutually exclusive.     

Kinetics of activation of variant plasminogens in a noncrosslinked fibrin clot: Abnormal plasmin generation with the plasminogen.Streptokinase complex,urokinase and tissue plasminogen activator

A purified clot lysis system (noncrosslinked) was developed to evaluate and study variant plasminogens from patients with a history of thrombophilia. Plasmin generation was studied in the soluble phase and in the clot lysis system with different activators, streptokinase and its derivatives, urokinase and tissue plasminogen activator. Five of the variant plasminogens (Dl, D2, K, S, and F) generated low levels of plasmin in the soluble phase, whereas two (M and Y) generated near normal levels of plasmin. Plasmin generation in the clot lysis system divided the variants into three groups: one variant (Dl) had a very prolonged lysis time or a negligible plasmin generation rate with three direct activators, three variants (D2, K and S) had moderately prolonged lysis times or low plasmin generation rates with these activators, and three variants (F, M, and Y) had normal lysis times and normal plasmin generation rates with these activators. Kinetics of activation parameters with three direct plasminogen activators were determined from a non-linear regression analysis of plots of velocity versus plasminogen concentration and were verified by Lineweaver-Buck plots where possible. With plasminogen.streptokinase, the four variants with prolonged lysis times, had normal apparent Michaelis constants and low catalytic rate constants. Three variants with normal lysis times had high apparent Michaelis constants showing decreased affinity for the plasminogen.streptokinase activator complex, and high catalytic rate constants. With urokinase, the variant with the longest clot lysis time had a high apparent Michaelis constant and a low catalytic rate constant, three variants with prolonged lysis times gave low catalytic rate constants; two of them gave normal apparent Michaelis constants and one gave a high apparent Michaelis constant. Of the three variants with normal lysis times, one gave normal kinetic constants and two had high apparent Michaelis constants with high catalytic rate constants. With tissue plasminogen activator, the variant with the longest clot lysis time gave a high apparent Michaelis constant and a high catalytic rate constant. The three variants with prolonged lysis times gave variable results, one had a slightly higher apparent Michaelis constant with a low catalytic rate constant, the second one had a very low apparent Michaelis constant with a low catalytic rate constant and the third one had a high apparent Michaelis constant with a normal catalytic rate constant. Three variants with normal lysis times had slightly higher Michaelis constants and near normal catalytic rate constants. With the noncrosslinked fibrin substrate, all of the variant plasminogens have lowered catalytic efficiencies with two or three plasminogen activators. The theoretical aspects of these plasmin generation data are discussed.     

Effect of antiphospholipid antibodies on the formation and lysis of fibrin network in patients with recurrent miscarriage

The present work was intended to study the process of fibrin formation and lysis and plasmin generation in a group of patients with recurrent miscarriage (RM), due to the presence of antiphospholipid antibodies (N = 10); as well as in women with RM without the antiphospholipid syndrome (APS) (N = 6), compared with those of a group of healthy women (N= 8). In the group of patients with APS, nine were positive for antibodies against cardiolipin (aCL), five for anti-beta2-glycoprotein I (anti-beta2GPI), four for both antibodies, and one for antibodies against prothrombin (aPT) and lupus anticoagulant (LA). Fibrin formation and lysis was followed by turbidity and plasmin generation using chromogenic substrate S2251. The polymerization curves from RM patients without APS and the LA patient showed an increased slope and maximum turbidity compared to those of the control group. The speed of lysis was higher in the LA patient (21 +/- 0) 10(-4) deltaOD/seg and the RM patients without APS (19.6 +/- 5.7) 10(-4) deltaDO/seg, compared to that of the control group (14.5 +/- 2.8) 10(-4) deltaDO/seg. Plasmin generation increased only in RM patients without APS (85 +/- 24%) against the control group (52 +/- 3%), p = 0.005. The changes observed in the fibrin polymerization and lysis process of women with RM without APS and LA seem to be related to their higher fibrinogen levels, while the increased plasmin generation was related to the patients' morbidity.     

Highly stable plasminogen activator inhibitor type one (VLHL PAI-1) protects fibrin clots from tissue plasminogen activator-mediated fibrinolysis

Plasminogen activator inhibitor-1 (PAI-1) is the major specific inhibitor of tissue-type plasminogen activator (tPA) which mediates fibrin clot lysis through activation of plasminogen. Wild-type-PAI-1 (wPAI-1) is rapidly converted to the latent form (half-life of approximately 2 h) and loses its ability to inhibit tPA. We developed a very long half-life PAI-1 (VLHL PAI-1), a recombinant protein with a half-life >700 h compared with wPAI-1. In this study, VLHL PAI-1 was assessed for its ability to inhibit clot lysis in vitro. Clot formation was initiated in normal plasma supplemented with tPA by the addition of either tissue factor or human recombinant FVIIa. Clot lysis time, monitored turbidimetrically in a microtiter plate reader, was determined at various concentrations of wPAI-1 and VLHL PAI-1. Both wPAI-1 and VLHL PAI-1 caused a significant increase in clot lysis time, although the latter was somewhat less effective at lower concentrations. The VLHL PAI-1, but not wPAI-1, maintained its anti-fibrinolytic activity after preincubation overnight at 37 degrees. These studies demonstrate that VLHL PAI-1 is an effective inhibitor of fibrin clot degradation. Due to the high stability of VLHL PAI-1 compared with wPAI-1, this novel inhibitor of tPA-mediated fibrinolysis may have therapeutic applications for treating surgical and trauma patients when used directly or in conjunction with the procoagulant recombinant FVIIa.     

Plasmin-catalysed cleavage of single chain tissue-type plasminogen activator in fibrin clots

The activity of single chain t-PA in the presence of fibrin was investigated and compared to that of its twochain counterpart. A plasmin resistant t-PA analogue in which Arg-275 is replaced by Gly was included in this study in order to avoid the complications caused by concomitant two chain generation during plasminogen activation experiments. Substantial plasminogen activation of single chain t-PA was observed during fibrin clot dissolution, still the clot lysis activity of two chain t-PA was found to be about 20% higher than that of the single chain form. Plasmin-catalysed cleavage of single chain t 25I-t-PA was studied in the presence and absence of fibrin. This reaction was not enhanced by fibrin, rather a small inhibition was observed. In addition to the primary cleavage site at Arg-275 Ile-276 secondary plasmin-catalysed cleavage resulting in a 30 000 Da fragment was observed. Appearance of this fragment took place roughly at the same time as a decline in clot lysis activity (but not in amidolytic activity) was observed. Secondary plasmin cleavage was not observed when fibrin was present.     

A comparison of the rates of clot lysis in a plasma milieu induced by tissue plasminogen activator (t-PA) and rec-pro-urokinase: Evidence that t-PA has a more restricted mode of action

Tissue plasminogen activator (t-PA) and pro-urokinase (pro-UK) were previously found to have distinct and complementary mechanisms of action in a plasma milieu. The t-PA activated primarily plasminogen bound to intact fibrin (internal lysine-bound), whereas pro-UK activated plasminogen bound to partially degraded fibrin (C-terminal lysine-bound). These observations therefore suggested that each of these activators was restricted in its fibrin-dependent lytic effect. At least this is true at activator concentrations where activation of plasminogen is strictly fibrin dependent; at some high concentration all plasminogen is activated including free plasminogen in the ambient plasma. However, since some pro-UK is converted to UK at the plasmin rich fibrin surface during the course of lysis and since UK is a non-selective plasminogen activator, the pro-UK/UK system should not be similarly restricted. The present study was therefore designed to examine whether this is the case by determining the highest rates of lysis achievable at the threshold of specificity for t-PA and for pro-UK/UK respectively. Maximal rates of clot lysis by t-PA (0.1–5 μg/ml) and by rec-pro-UK (0.5–5 μg/ml) were determined and correlated with the degree of preservation of fibrinogen. The highest rate of clot lysis induced by a fibrin-specific (<10% fibrinogen degradation) dose of rec-pro-UK was 80%/h. A similar rate could not be induced by t-PA without causing >80% fibrinogen degradation. The highest fibrin-specific rate of lysis achievable with t-PA was only 42%/h. When a small amount of t-PA was added at intervals during clot lysis induced by rec-pro-UK, the t-PA significantly foreshortened the lag phase, but it did not enhance the maximal rate of clot lysis. By contrast, when rec-pro-UK was added during the course of clot lysis induced by a large, but fibrin-specific amount of t-PA, rec-pro-UK accelerated the rate of lysis thereby demonstrating the presence of some fibrin-bound plasminogen not activated by t-PA. The study indicates that in a plasma milieu t-PA is more restricted in its action and activates only about half the fibrin-bound plasminogen which is activated by rec-pro-UK/UK.     

Assay of glycated fibrinogen in plasma as an indicator of blood glucose control

A method of assay for glycated fibrinogen (C-Fbg) in plasma has been developed. This method is based on the measurement of 1-deoxy-1-morpholino-D-fructose (DMF) in the fibrinogen (Fbg) solution separated from plasma and redissolved. Twenty five NIH units of thrombin was added to 600 microliters of plasma. After incubation, the fibrin clot was separated and washed. The fibrin clot was redissolved with Owren's veronal buffer contained urokinase. After incubation, DMF was measured using a Fructosamine Kit. G-Fbg measured by this method correlated significantly with the amount of furosine that was a specific product by hydrolysis of glycated lysine residue. In this method, the CV for intraday assay ranged from 2.0 to 3.6% and that for interday assay was 3.9%. The average of G-Fbg values in 78 diabetic patients (23.8 +/- 10.7 mumol DMF/g Fbg) was significantly higher than in 26 normal subjects (9.2 +/- 3.8 mumol DMF/g Fbg). The G-Fbg value correlated with blood glucose at the same time or one day earlier than 1-2 weeks or 1 month earlier. These results suggest that assay of G-Fbg by this method may be useful in monitoring short-term control of blood glucose in diabetic patients.     

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.     

Acquisition of plasmin activity by Fusobacterium nucleatum subsp. nucleatum and potential contribution to tissue destruction during periodontitis

Fusobacterium nucleatum subsp. nucleatum has been associated with a variety of oral and nonoral infections such as periodontitis, pericarditis, bone infections, and brain abscesses. Several studies have shown the role of plasmin, a plasma serine protease, in increasing the invasive capacity of microorganisms. In this study, we investigated the binding of human plasminogen to F. nucleatum subsp. nucleatum, and its subsequent activation into plasmin. Plasminogen-binding activity of bacterial cells was demonstrated by a solid-phase dot blot assay using an anti-plasminogen antibody. The binding activity was heat resistant and involved cell-surface lysine residues since it was abolished in the presence of the lysine analog epsilon-aminocaproic acid. Activation of plasminogen-coated bacteria occurred following incubation with either streptokinase, urokinase-type plasminogen activator (u-PA), or a Porphyromonas gingivalis culture supernatant. In the case of the P. gingivalis culture supernatant, a cysteine protease was likely involved in the activation. The plasmin activity generated on the cell surface of F. nucleatum subsp. nucleatum could be inhibited by aprotinin. Activation of plasminogen by u-PA was greatly enhanced when plasminogen was bound to bacteria rather than in a free soluble form. u-PA-activated plasminogen-coated F. nucleatum subsp. nucleatum was found to degrade fibronectin, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Tissue inhibitor of metalloproteinase-1 was also degraded by the plasmin activity generated on the bacterial cells. This study suggests a possible role for plasminogen, which is present in affected periodontal sites, in promoting tissue destruction and invasion by nonproteolytic bacteria such as F. nucleatum subsp. nucleatum.