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Townsend A, Raju H, Serpa KA, Pruett R, Razi SS, Tarrazzi FA, Tami CM, Block MI. Tissue plasminogen activator with prolonged dwell time effectively evacuates pleural effusions. BMC Pulm Med 2022; 22:464. [PMID: 36471325 PMCID: PMC9724361 DOI: 10.1186/s12890-022-02261-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/24/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Fibrinolytic therapy can be effective for management of complex pleural effusions. Tissue plasminogen activator (tPA, 10 mg) and deoxyribonuclease (DNAse) every 12 h with a dwell time of one hour is a common strategy based on published data. We used a simpler protocol of tPA (4 mg) without DNAse but with a longer dwell time of 12 h, repeated daily. We reviewed our results. METHODS Charts were reviewed and demographics, clinical data and treatment information were abstracted. Outcomes were assessed based on radiographic findings and need for surgery. RESULTS Two hundred and fifteen effusions in 207 patients (8 bilateral) were identified. 85% were either infectious or malignant. Two hundred and forty nine chest tubes were used: 84% were 10 Fr or 12 Fr and 7% were PleurX®. Five hundred and thirty one doses of tPA were given. The median number of doses per effusion was 2 (range 1-10), and 84% of effusions were treated with three or fewer doses. There were no significant bleeding complications. Median time to chest tube removal was 6 days (range 1 to 98, IQR 4 to 10). Drainage was considered complete for 78% of effusions, while 6% required decortication. CONCLUSIONS Low dose tPA daily with a 12 h dwell time may be as effective as the standard regimen of tPA and DNAse twice daily with one hour dwell. For most patients only three doses were required, and small pigtail catheters were sufficient. This regimen uses less medication and is logistically much easier than the current standard.
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Affiliation(s)
- Alexandra Townsend
- grid.65456.340000 0001 2110 1845Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199 USA
| | - Harsha Raju
- grid.65456.340000 0001 2110 1845Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199 USA
| | - Krystina A. Serpa
- grid.489080.d0000 0004 0444 4637Division of Thoracic Surgery, Memorial Healthcare System, 1150 N. 35th Ave., Suite 660, Hollywood, FL 33026 USA
| | - Rachel Pruett
- grid.489080.d0000 0004 0444 4637Division of Thoracic Surgery, Memorial Healthcare System, 1150 N. 35th Ave., Suite 660, Hollywood, FL 33026 USA
| | - Syed S. Razi
- grid.489080.d0000 0004 0444 4637Division of Thoracic Surgery, Memorial Healthcare System, 1150 N. 35th Ave., Suite 660, Hollywood, FL 33026 USA
| | - Francisco A. Tarrazzi
- grid.489080.d0000 0004 0444 4637Division of Thoracic Surgery, Memorial Healthcare System, 1150 N. 35th Ave., Suite 660, Hollywood, FL 33026 USA
| | - Catherine M. Tami
- grid.489080.d0000 0004 0444 4637Division of Thoracic Surgery, Memorial Healthcare System, 1150 N. 35th Ave., Suite 660, Hollywood, FL 33026 USA
| | - Mark I. Block
- grid.489080.d0000 0004 0444 4637Division of Thoracic Surgery, Memorial Healthcare System, 1150 N. 35th Ave., Suite 660, Hollywood, FL 33026 USA
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Parveen A, Devika R. Fibrinolytic Enzyme - An Overview. Curr Pharm Biotechnol 2022; 23:1336-1345. [PMID: 34983344 DOI: 10.2174/1389201023666220104143113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/21/2021] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
Abstract
Cardiovascular diseases, like coronary heart disease or artery disorders (arteriosclerosis, including artery solidification), heart failure (myocardial infarction), arrhythmias, congestive heart condition, stroke, elevated vital signs (hypertension), rheumatic heart disorder, and other circulatory system dysfunctions are the most common causes of death worldwide. Cardiovascular disorders are treated with stenting, coronary bypass surgery grafting, anticoagulants, antiplatelet agents, and other pharmacological and surgical procedures; however, these have limitations due to their adverse effects. Fibrinolytic agents degrade fibrin through enzymatic and biochemical processes. There are various enzymes that are currently used as a treatment for CVDs, like Streptokinase, Nattokinase, Staphylokinase, Urokinase, etc. These enzymes are derived from various sources like bacteria, fungi, algae, marine organisms, plants, snakes, and other organisms. This review deals with the fibrinolytic enzymes, their mechanisms, sources, and their therapeutic potential.
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Affiliation(s)
- Parveen A
- Department of Biotechnology, Biotechnology, Aarupadai Institute of Technology, Vinayaka Missions University, Chennai, India
| | - Devika R
- Department of Biotechnology, Biotechnology, Aarupadai Institute of Technology, Vinayaka Missions University, Chennai, India
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Remmington A, Turner CE. The DNases of pathogenic Lancefield streptococci. MICROBIOLOGY (READING, ENGLAND) 2018; 164:242-250. [PMID: 29458565 DOI: 10.1099/mic.0.000612] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
DNases are abundant among the pathogenic streptococci, with most species harbouring genes for at least one. Despite their prevalence, however, the role for these extracellular enzymes is still relatively unclear. The DNases of the Lancefield group A Streptococcus, S. pyogenes are the best characterized, with a total of eight DNase genes identified so far. Six are known to be associated with integrated prophages. Two are chromosomally encoded, and one of these is cell-wall anchored. Homologues of both prophage-associated and chromosomally encoded S. pyogenes DNases have been identified in other streptococcal species, as well as other unique DNases. A major role identified for streptococcal DNases appears to be in the destruction of extracellular traps produced by immune cells, such as neutrophils, to ensnare bacteria and kill them. These traps are composed primarily of DNA which can be degraded by the secreted and cell-wall-anchored streptococcal DNases. DNases can also reduce TLR-9 signalling to dampen the immune response and produce cytotoxic deoxyadenosine to limit phagocytosis. Upper respiratory tract infection models of S. pyogenes have identified a role for DNases in potentiating infection and transmission, possibly by limiting the immune response or through some other unknown mechanism. Streptococcal DNases may also be involved in interacting with other microbial communities through communication, bacterial killing and disruption of competitive biofilms, or control of their own biofilm production. The contribution of DNases to pathogenesis may therefore be wide ranging and extend beyond direct interference with the host immune response.
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Affiliation(s)
- Alex Remmington
- Department of Molecular Biology and Biotechnology, The Florey Institute, University of Sheffield, Sheffield, UK
| | - Claire E Turner
- Department of Molecular Biology and Biotechnology, The Florey Institute, University of Sheffield, Sheffield, UK
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GESSERT CF, BAUMANN ES, SENTURIA BH. LXVIII The Action of Enzymes on Human Middle Ear Effusions. Ann Otol Rhinol Laryngol 2016; 69:936-55. [PMID: 13704817 DOI: 10.1177/000348946006900319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bhatnagar R, Maskell NA. Treatment of complicated pleural effusions in 2013. Clin Chest Med 2013; 34:47-62. [PMID: 23411056 DOI: 10.1016/j.ccm.2012.11.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The incidence of pleural infection seems to be increasing worldwide. Despite continued advances in the management of this condition, morbidity and mortality have essentially remained static over the past decade. This article summarizes the current evidence and opinions on the epidemiology, etiology, and management of complicated pleural effusions caused by infection, including empyema. Although many parallels may be drawn between children and adults in such cases, most trials, guidelines, and series regard pediatric patient groups and those more than 18 years of age as separate entities. This review focuses mainly on the treatment of adult disease.
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Affiliation(s)
- Rahul Bhatnagar
- Respiratory Research Unit, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, UK
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Palmer LJ, Chapple ILC, Wright HJ, Roberts A, Cooper PR. Extracellular deoxyribonuclease production by periodontal bacteria. J Periodontal Res 2011; 47:439-45. [PMID: 22150619 DOI: 10.1111/j.1600-0765.2011.01451.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Whilst certain bacteria have long been known to secrete extracellular deoxyribonuclease (DNase), the purpose in microbial physiology was unclear. Recently, however, this enzyme has been demonstrated to confer enhanced virulence, enabling bacteria to evade the host's immune defence of extruded DNA/chromatin filaments, termed neutrophil extracellular traps (NETs). As NETs have recently been identified in infected periodontal tissue, the aim of this study was to screen periodontal bacteria for extracellular DNase activity. MATERIAL AND METHODS To determine whether DNase activity was membrane bound or secreted, 34 periodontal bacteria were cultured in broth and on agar plates. Pelleted bacteria and supernatants from broth cultures were analysed for their ability to degrade DNA, with relative activity levels determined using an agarose gel electrophoresis assay. Following culture on DNA-supplemented agar, expression was determined by the presence of a zone of hydrolysis and DNase activity related to colony size. RESULTS Twenty-seven bacteria, including red and orange complex members Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, Parvimonas micra, Prevotella intermedia, Streptococcus constellatus, Campylobacter rectus and Prevotella nigrescens, were observed to express extracellular DNase activity. Differences in DNase activity were noted, however, when bacteria were assayed in different culture states. Analysis of the activity of secreted DNase from bacterial broth cultures confirmed their ability to degrade NETs. CONCLUSION The present study demonstrates, for the first time, that DNase activity is a relatively common property of bacteria associated with advanced periodontal disease. Further work is required to determine the importance of this bacterial DNase activity in the pathogenesis of periodontitis.
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Affiliation(s)
- L J Palmer
- Department of Periodontology, School of Dentistry, University of Birmingham, Birmingham, UK
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Sumby P, Barbian KD, Gardner DJ, Whitney AR, Welty DM, Long RD, Bailey JR, Parnell MJ, Hoe NP, Adams GG, Deleo FR, Musser JM. Extracellular deoxyribonuclease made by group A Streptococcus assists pathogenesis by enhancing evasion of the innate immune response. Proc Natl Acad Sci U S A 2005; 102:1679-84. [PMID: 15668390 PMCID: PMC547841 DOI: 10.1073/pnas.0406641102] [Citation(s) in RCA: 251] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Many pathogenic bacteria produce extracellular DNase, but the benefit of this enzymatic activity is not understood. For example, all strains of the human bacterial pathogen group A Streptococcus (GAS) produce at least one extracellular DNase, and most strains make several distinct enzymes. Despite six decades of study, it is not known whether production of DNase by GAS enhances virulence. To test the hypothesis that extracellular DNase is required for normal progression of GAS infection, we generated seven isogenic mutant strains in which the three chromosomal- and prophage-encoded DNases made by a contemporary serotype M1 GAS strain were inactivated. Compared to the wild-type parental strain, the isogenic triple-mutant strain was significantly less virulent in two mouse models of invasive infection. The triple-mutant strain was cleared from the skin injection site significantly faster than the wild-type strain. Preferential clearance of the mutant strain was related to the differential extracellular killing of the mutant and wild-type strains, possibly through degradation of neutrophil extracellular traps, innate immune structures composed of chromatin and granule proteins. The triple-mutant strain was also significantly compromised in its ability to cause experimental pharyngeal disease in cynomolgus macaques. Comparative analysis of the seven DNase mutant strains strongly suggested that the prophage-encoded SdaD2 enzyme is the major DNase that contributes to virulence in this clone. We conclude that extracellular DNase activity made by GAS contributes to disease progression, thereby resolving a long-standing question in bacterial pathogenesis research.
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Affiliation(s)
- Paul Sumby
- Center for Human Bacterial Pathogenesis Research, Department of Pathology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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SHERRY S, GOELLER JP. The extent of the enzymatic degradation of desoxyribonucleic acid (DNA) in purulent exudates by streptodornase. J Clin Invest 2004; 29:1588-94. [PMID: 14794787 PMCID: PMC436209 DOI: 10.1172/jci102400] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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JOHNSON AJ. Cytological studies in association with local injections of streptokinase-streptodornase into patients. J Clin Invest 2004; 29:1376-86. [PMID: 14778901 PMCID: PMC436181 DOI: 10.1172/jci102375] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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LIEBERMAN J, KURNICK NB. Influence of Deoxyribonucleic Acid Content on the Proteolysis of Sputum and Pus. Nature 1962; 196:988-90. [PMID: 13930541 DOI: 10.1038/196988a0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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JOHNSON AJ, AYVAZIAN JH, TILLETT WS. Crystalline pancreatic desoxyribonuclease as an adjunct to the treatment of pneumococcal meningitis. N Engl J Med 1959; 260:893-900. [PMID: 13657306 DOI: 10.1056/nejm195904302601801] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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STREITFELD MM, FIGGE FH, SCOTT JW. Enzymatic degradation of certain constituents of cervical mucus; a pilot study in mice of the congenital effect of intravaginal streptokinase-streptodornase. Fertil Steril 1957; 8:455-64. [PMID: 13461949 DOI: 10.1016/s0015-0282(16)32824-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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POLSON A. The isolation and purification of desoxyribonuclease by multi-membrane electrodecantation. BIOCHIMICA ET BIOPHYSICA ACTA 1956; 22:61-5. [PMID: 13373848 DOI: 10.1016/0006-3002(56)90223-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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LAWRENCE HS. The transfer in humans of delayed skin sensitivity to streptococcal M substance and to tuberculin with disrupted leucocytes. J Clin Invest 1955; 34:219-30. [PMID: 13233344 PMCID: PMC438618 DOI: 10.1172/jci103075] [Citation(s) in RCA: 251] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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JOHNSON AJ, GOGER PR, TILLETT WS. The intravenous injection of bovine crystalline pancreatic desoxyribonuclease into patients. J Clin Invest 1954; 33:1670-86. [PMID: 13211824 PMCID: PMC1072599 DOI: 10.1172/jci103048] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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SMILLIE JW. The effect of streptokinase on simulated hyphema; with a study of its toxicity to anterior chambers of rabbits. Am J Ophthalmol 1954; 37:911-7. [PMID: 13158489 DOI: 10.1016/0002-9394(54)91932-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Peschke J, Weber H. Über die fermentativ-enzymatische Behandlung intrathorakaler Eiterungen und Hämatome. Lung 1954. [DOI: 10.1007/bf02148088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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TAGNON HJ. Enzymes in clinical medicine; recent developments in the practical application of enzymes to clinical medicine. N Engl J Med 1953; 249:650-7. [PMID: 13099483 DOI: 10.1056/nejm195310152491604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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SONNTAG K. [The clinical effects of streptodornase and streptokinase in purulent exudation and their interpretation as the result of simple irritation]. J Mol Med (Berl) 1953; 31:423-6. [PMID: 13070505 DOI: 10.1007/bf01472497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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SHERRY S. The action of streptococcal desoxyribonuclease (streptodornase) on purulent exudates. TRANSACTIONS OF THE NEW YORK ACADEMY OF SCIENCES 1952; 14:138-40. [PMID: 14901440 DOI: 10.1111/j.2164-0947.1952.tb01080.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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HALSE T. Streptokinase, Wirkungsmechanismus und M�glichkeiten einer klinischen Anwendung. ACTA ACUST UNITED AC 1951; 29:406-9. [PMID: 14851659 DOI: 10.1007/bf01477412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sherry S, Tillett WS, Read CT. THE USE OF STREPTOKINASE-STREPTODORNASE IN THE TREATMENT OF HEMOTHORAX. ACTA ACUST UNITED AC 1950. [DOI: 10.1016/s0096-5588(20)31580-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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BLATTNER RJ. Streptococcal enzymatic débridement. J Pediatr 1950; 36:827-9. [PMID: 15422504 DOI: 10.1016/s0022-3476(50)80241-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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