1
|
Santana RDS, Mendes FDS, Paula da Silva BJ, Lima ES, Nascimento TP, Carneiro da Cunha MN, Porto ALF, Teixeira MFS, Carvalho RP, Gomes WR. Recovery and partial purification of fibrinolytic protease from Pleurotus ostreatus and P. eryngii and cytotoxic and antioxidant activity of their extracts. Prep Biochem Biotechnol 2024; 54:545-552. [PMID: 37667995 DOI: 10.1080/10826068.2023.2253466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
Mushrooms are a source of primary and secondary metabolites. Little is known about the most suitable conditions for production of mushrooms by submerged fermentation. This article reports antioxidant and cytotoxic assays, in addition to quantitatively evaluating the content of proteases with fibrinolytic action in the crude extracts of two species of edible mushrooms produced in different formulations, as well as evaluating the recovery of these enzymes by aqueous two-phase systems (ATPS). The mushrooms Pleurotus ostreatus and Pleurotus eryngii, at concentration of 100 µg/mL, displayed inhibition of DPPH and ABTS radicals below 50%. In the cytotoxicity test, the cells human fibroblast cell lines (MRC-5) showed cell viability greater than 80%. Concerning fibrinolytic activity, P. eryngii presented 226.47 ± 7.26 U/mL, therefore being more efficient than P. ostreatus (71.5 ± 0.56 U/mL). In the recovery of the P. eryngii extract by ATPS, the fibrinolytic protease was partitioned in the salt phase (30.25 U/mL). The molecular mass of the proteases was between 75 and 100 kDa. These results prove the low cytotoxicity of the extracts produced and that fermentation in supplemented malt broth favored the excretion of fibrinolytic proteases compared to the other evaluated media.
Collapse
Affiliation(s)
- Romário da S Santana
- Postgraduate Program in Biotechnology, Federal University of Amazonas, Manaus, Brazil
| | - Felipe de S Mendes
- Postgraduate Program in Biotechnology, Federal University of Amazonas, Manaus, Brazil
| | | | - Emerson S Lima
- Faculty of Pharmaceutical Sciences, Federal University of Amazonas (UFAM), Manaus, Brazil
| | - Thiago P Nascimento
- Campus Professora Cinobelina Elvas, Federal University of Piaui, Bom Jesus, Brazil
| | | | - Ana Lúcia F Porto
- Department of Animal Morphology and Physiology, Rural Federal University of Pernambuco, Recife, Brazil
| | | | - Rosany P Carvalho
- Department of Physiological Sciences, Federal University of Amazonas, Manaus, Brazil
| | - Waldireny R Gomes
- Faculty of Pharmaceutical Sciences, Federal University of Amazonas (UFAM), Manaus, Brazil
| |
Collapse
|
2
|
Quintal Martínez JP, Quintal Ortiz IG, Alonso Salomón LG, García-Sosa K, Peña Rodríguez LM, Guerrero Analco JA, Monribot Villanueva JL, Vidal Limón AM, Segura Campos MR. Bioassay-guided identification of antithrombotic compounds from Cnidoscolus aconitifolius (Mill.) I. M. Jhonst.: molecular docking, bioavailability, and toxicity prediction. J Biomol Struct Dyn 2024; 42:1692-1710. [PMID: 37232450 DOI: 10.1080/07391102.2023.2214214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/05/2023] [Indexed: 05/27/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading cause of death worldwide. Conventional antithrombotic therapy has reported hemorrhagic accidents. Ethnobotanical and scientific reports point to Cnidoscolus aconitifolius as an antithrombotic adjuvant. Previously, C. aconitifolius leaves ethanolic extract displayed antiplatelet, anticoagulant, and fibrinolytic activities. This work aimed to identify compounds from C. aconitifolius with in vitro antithrombotic activity through a bioassay-guided study. Antiplatelet, anticoagulant, and fibrinolytic tests guided the fractionation. Ethanolic extract was subjected to a liquid-liquid partitioning, followed by vacuum liquid, and size exclusion chromatography to obtain the bioactive JP10B fraction. The compounds were identified through UHPLC-QTOF-MS, and their molecular docking, bioavailability, and toxicological parameters were determined computationally. Kaempferol-3-O-glucorhamnoside and 15(S)-HPETE were identified; both showed affinity for antithrombotic targets, low absorption, and safety for human consumption. Further in vitro and in vivo evaluations will better understand their antithrombotic mechanism. This bioassay-guided fractionation demonstrated that C. aconitifolius ethanolic extract has antithrombotic compounds.Communicated by Ramaswamy H. Sarma.
Collapse
Affiliation(s)
| | | | | | - Karlina García-Sosa
- Organic Chemistry Group, Biotechnology Unit, Yucatan Scientific Research Center, Merida, Yucatan, Mexico
| | - Luis Manuel Peña Rodríguez
- Organic Chemistry Group, Biotechnology Unit, Yucatan Scientific Research Center, Merida, Yucatan, Mexico
| | - José Antonio Guerrero Analco
- Chemistry of Natural Products Laboratory, Network of Advanced Molecular Studies, Institute of Ecology AC, BioMimic® Scientific and Technological Cluster, Xalapa, Veracruz, Mexico
| | - Juan Luis Monribot Villanueva
- Chemistry of Natural Products Laboratory, Network of Advanced Molecular Studies, Institute of Ecology AC, BioMimic® Scientific and Technological Cluster, Xalapa, Veracruz, Mexico
| | - Abraham Marcelino Vidal Limón
- Chemistry of Natural Products Laboratory, Network of Advanced Molecular Studies, Institute of Ecology AC, BioMimic® Scientific and Technological Cluster, Xalapa, Veracruz, Mexico
| | | |
Collapse
|
3
|
Faber S, McLean‐Tooke A, Kuok YJ, Lee YCG. Intrapleural therapy for pleural infection from bronchopleural fistula in an adult with hyper-IgE syndrome. Respirol Case Rep 2023; 11:e01156. [PMID: 37151367 PMCID: PMC10160851 DOI: 10.1002/rcr2.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023] Open
Abstract
We presented the case of an adult patient with hyper-IgE syndrome (HIES) who was admitted acutely with a large hydropneumothorax from lung consolidation, a bronchopleural fistula and pleural infection. He has had recurrent pulmonary and skin infections since childhood and longstanding pneumatoceles. He was treated with systemic antibiotics and chest tube drainage. Administration of two doses of low-dose intrapleural therapy (1 mg tissue plasminogen activator and 5 mg deoxyribonuclease) allowed complete evacuation of his residual loculated pleural fluid, aided resolution of his infection without provoking a significant air leak and avoided the need for surgery.
Collapse
Affiliation(s)
- Sam Faber
- Respiratory DepartmentSir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - Andrew McLean‐Tooke
- Department of Clinical ImmunologySir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - Yi Jin Kuok
- Department of RadiologySir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - Y. C. Gary Lee
- Respiratory DepartmentSir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
- Pleural Medicine UnitInstitute for Respiratory HealthNedlandsWestern AustraliaAustralia
- Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
| |
Collapse
|
4
|
Yorioka N, Namisaki T, Shibamoto A, Suzuki J, Kubo T, Iwai S, Tomooka F, Tanaka M, Takeda S, Fujimoto Y, Enomoto M, Muarata K, Inoue T, Tsuji Y, Fujinaga Y, Nishimura N, Kitagawa K, Takaya H, Kaji K, Kawaratani H, Akahane T, Mitoro A, Yamazaki M, Yoshiji H. Changes in Coagulation and Fibrinolytic Factors in Patients With Cirrhotic Refractory Ascites Undergoing Cell-free and Concentrated Ascites Reinfusion Therapy: A Retrospective Observational Study in Japan. In Vivo 2023; 37:1226-1235. [PMID: 37103093 DOI: 10.21873/invivo.13199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND/AIM The management of refractory ascites is critical for the treatment of patients with decompensated cirrhosis. This study aimed to evaluate the feasibility and safety of cell-free and concentrated ascites reinfusion therapy (CART) in patients with cirrhosis and refractory ascites, with a focus on changes in coagulation and fibrinolytic factors in ascitic fluid following CART. PATIENTS AND METHODS This was a retrospective cohort study including 23 patients with refractory ascites undergoing CART. Serum endotoxin activity (EA) before and after CART and the levels of coagulation and fibrinolytic factors and proinflammatory cytokines in original and processed ascitic fluid were measured. The Ascites Symptom Inventory-7 (ASI-7) scale was used for subjective symptom assessment before and after CART. RESULTS Body weight and waist circumference significantly decreased after CART, whereas serum EA did not significantly change after CART. Similar to the previous reports, ascitic fluid concentrations of total protein, albumin, high-density lipoprotein cholesterol, γ-globulin, and immunoglobulin G levels were significantly increased after CART; mild elevations in body temperature and interleukin 6 and tumor necrosis factor-alpha levels in ascitic fluid were also observed. Importantly, the levels of antithrombin-III, factor VII, and X, which are useful for patients with decompensated cirrhosis, were markedly increased in the reinfused fluid during CART. Finally, the total ASI-7 score was significantly lower following CART, compared with the pre-CART score. CONCLUSION CART is an effective and safe approach for the treatment of refractory ascites that allows the intravenous reinfusion of coagulation and fibrinolytic factors in the filtered and concentrated ascites.
Collapse
Affiliation(s)
- Nobuyuki Yorioka
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Tadashi Namisaki
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan;
| | - Akihiko Shibamoto
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Junya Suzuki
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Takahiro Kubo
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Satoshi Iwai
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Fumimasa Tomooka
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Misako Tanaka
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Soichi Takeda
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Yuki Fujimoto
- Division of Endoscopy, Nara Medical University, Kashihara, Japan
| | - Masahide Enomoto
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Koji Muarata
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Takashi Inoue
- Department of Evidence-Based Medicine, Nara Medical University Hospital, Kashihara, Japan
| | - Yuki Tsuji
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Yukihisa Fujinaga
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Norihisa Nishimura
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Koh Kitagawa
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Hiroaki Takaya
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Kosuke Kaji
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Takemi Akahane
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| | - Akira Mitoro
- Division of Endoscopy, Nara Medical University, Kashihara, Japan
| | - Masaharu Yamazaki
- Central Clinical Laboratory, Nara Medical University Hospital, Kashihara, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Kashihara, Japan
| |
Collapse
|
5
|
Quintal Martínez JP, Segura Campos MR. Flavonoids as a therapeutical option for the treatment of thrombotic complications associated with COVID-19. Phytother Res 2023; 37:1092-1114. [PMID: 36480428 PMCID: PMC9878134 DOI: 10.1002/ptr.7700] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/18/2022] [Accepted: 11/19/2022] [Indexed: 12/13/2022]
Abstract
The SARS-CoV-2 outbreak has been one of the largest public health crises globally, while thrombotic complications have emerged as an important factor contributing to mortality. Therefore, compounds that regulate the processes involved in thrombosis could represent a dietary strategy to prevent thrombotic complications involved in COVID-19. In August 2022, various databases were consulted using the keywords "flavonoids", "antiplatelet", "anticoagulant", "fibrinolytic", and "nitric oxide". Studies conducted between 2019 and 2022 were chosen. Flavonoids, at concentrations mainly between 2 and 300 μM, are capable of regulating platelet aggregation, blood coagulation, fibrinolysis, and nitric oxide production due to their action on multiple receptors and enzymes. Most of the studies have been carried out through in vitro and in silico models, and limited studies have reported the in vivo and clinical effect of flavonoids. Currently, quercetin has been the only flavonoid evaluated clinically in patients with COVID-19 for its effect on D-dimer levels. Therefore, clinical studies in COVID-19 patients analyzing the effect on platelet, coagulant, fibrinolytic, and nitric oxide parameters are required. In addition, further high-quality studies that consider cytotoxic safety and bioavailability are required to firmly propose flavonoids as a treatment for the thrombotic complications implicated in COVID-19.
Collapse
|
6
|
Chen J, Wang Z, Jia X, Li R, Chen J, Liu X, Song B, Zhong S, Qi Y. Anticoagulant and Fibrinolytic Properties of Two Heparinoid Compounds Prepared from Shrimp Waste. Foods 2022; 12. [PMID: 36613282 DOI: 10.3390/foods12010066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022] Open
Abstract
Heparinoid, a type of compound that has structures similar to heparin, has been found in marine organisms such as shrimp head. This shrimp waste products were used to prepare, characterize, and evaluate the antithrombotic effect of heparinoid. Two heparinoid compounds were obtained from shrimp head, and the main fraction F1 was →4)-GlcA-(1→3)-GalNAc-(1→ with Ara, while the minor fraction F2 composed mainly of the backbone as →4)-β-D-GlcA (or IdoA)-(1→4)-β-D-GlcN (or GlcNAc)-(1→. Both F1 and F2 could extend activated partial thromboplastin time and thrombin time concentration-dependently, and F2 has stronger activity than F1 at the same concentration. The potential anticoagulant mechanism of F1 and F2 may relate to their combination with more antithrombin III, which binds to and potentiates the action of antithrombin as well as inhibiting coagulation factors Xa and IIa, preventing blood clot formation. Furthermore, heparinoid F1 and F2 were found to have high fibrinolytic capability in vitro and in vivo via activating the self-fibrinolytic system. In conclusion, heparinoids (F1 and F2) derived from shrimp head wastes could be used as candidate compounds to prevent thrombosis while posing a lower hemorrhagic risk.
Collapse
|
7
|
Nair SR, C SD. Serratiopeptidase: An integrated View of Multifaceted Therapeutic Enzyme. Biomolecules 2022; 12:1468. [PMID: 36291677 PMCID: PMC9599151 DOI: 10.3390/biom12101468] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2023] Open
Abstract
Microbial products have been used for the treatment of different diseases for many centuries. The serratiopeptidase enzyme provides a new hope for COVID-19-infected patients. Nowadays, anti-inflammatory drugs are easy to obtain at minimal expenditure from microbial sources. Serratia sp. is identified as one of the most efficient bacteria produced from serratiopeptidase. Screening for new and efficient bacterial strains from different sources has been of interest in recent years. Serratiopeptidase remains the most well-known anti-inflammatory drug of choice. Serratiopeptidase is a cheaper and safer anti-inflammatory drug alternative to NSAIDs. The multifaceted properties of serratiopeptidase may lead towards arthritis, diabetes, cancer and thrombolytic treatments. Existing serratiopeptidase treatments in combination with antibiotics are popular in the treatment of postoperative swelling. Although an exclusive number of serratiopeptidase-producing strains have been derived, there is an urge for new recombinant strains to enhance the production of the enzyme. This review explores the properties of serratiopeptidase, different therapeutic aspects, industrial production, and various analytical techniques used in enzyme recovery. In addition, the review highlights the therapeutic and clinical aspects of the serratiopeptidase enzyme to combat COVID-19-induced respiratory syndrome.
Collapse
Affiliation(s)
| | - Subathra Devi. C
- Department of Biotechnology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore 632014, India
| |
Collapse
|
8
|
Hang S, Chen H, Wu W, Wang S, Fang Y, Sheng R, Tu Q, Guo R. Progress in Isoindolone Alkaloid Derivatives from Marine Microorganism: Pharmacology, Preparation, and Mechanism. Mar Drugs 2022; 20:md20060405. [PMID: 35736208 PMCID: PMC9227046 DOI: 10.3390/md20060405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/11/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022] Open
Abstract
Compound 1 (SMTP-7, also FGFC1), an isoindolone alkaloid from marine fungi Starchbotrys longispora FG216 and fungi Stachybotrys microspora IFO 30018, possessed diverse bioactivities such as thrombolysis, anti-inflammatory and anti-oxidative properties, and so on. It may be widely used for the treatment of various diseases, including cerebral infarction, stroke, ischemia/reperfusion damage, acute kidney injury, etc. Especially in cerebral infarction, compound 1 could reduce hemorrhagic transformation along with thrombolytic therapy, as the traditional therapies are accompanied with bleeding risks. In the latest studies, compound 1 selectively inhibited the growth of NSCLC cells with EGFR mutation, thus demonstrating its excellent anti-cancer activity. Herein, we summarized pharmacological activities, preparation of staplabin congeners—especially compound 1—and the mechanism of compound 1, with potential therapeutic applications.
Collapse
Affiliation(s)
- Sijin Hang
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China; (S.H.); (W.W.)
| | - Hui Chen
- Shanghai Engineering Center of Hadal Science and Technology, College of Marine Sciences, Shanghai Ocean University, Shanghai 201306, China;
| | - Wenhui Wu
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China; (S.H.); (W.W.)
| | - Shiyi Wang
- AIEN Institute, Shanghai Ocean University, Shanghai 201306, China;
| | - Yiwen Fang
- Department of Chemistry, College of Science, Shantou University, Shantou 515063, China;
| | - Ruilong Sheng
- CQM-Centro de Química da Madeira, Campus da Penteada, Universidade da Madeira, 9000-390 Funchal, Portugal;
| | - Qidong Tu
- Jiangxi Provincial Key Laboratory of Drug Design and Evaluation, School of Pharmacy, Jiangxi Science & Technology Normal University, Nanchang 330013, China
- Correspondence: (Q.T.); (R.G.)
| | - Ruihua Guo
- College of Food Science and Technology, Shanghai Ocean University, Shanghai 201306, China; (S.H.); (W.W.)
- Shanghai Engineering Research Center of Aquatic-Product Processing & Preservation, Shanghai 201306, China
- Laboratory of Quality and Safety Risk Assessment for Aquatic Products on Storage and Preservation (Shanghai), Ministry of Agriculture, Shanghai 201306, China
- Correspondence: (Q.T.); (R.G.)
| |
Collapse
|
9
|
Takada E, Adachi S, Horibe Y, Shimizu M. Intramuscular Bleeding Triggered by Disseminated Intravascular Coagulation with Enhanced Fibrinolysis in a Patient with Prostate Cancer. Intern Med 2022; 61:1411-1413. [PMID: 34645757 PMCID: PMC9152864 DOI: 10.2169/internalmedicine.7697-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
Disseminated intravascular coagulation (DIC) is the most frequent coagulation disorder associated with solid tumors, including prostate cancer. We herein report a 76-year-old man who suffered from intramuscular bleeding of the right gluteus maximus. Laboratory data showed a pattern of DICwith enhanced fibrinolysis, and a general examination led to the diagnosis of advanced prostate cancer with multiple bone metastases. To our knowledge, this is the first report describing intramuscular bleeding as an initial manifestation of prostate cancer with DIC with enhanced fibrinolysis.
Collapse
Affiliation(s)
- Eri Takada
- Department of Internal Medicine, Gifu-Seino Medical Center, Gihoku Kosei Hospital, Japan
| | - Seiji Adachi
- Department of Internal Medicine, Gifu-Seino Medical Center, Gihoku Kosei Hospital, Japan
| | - Yohei Horibe
- Department of Internal Medicine, Gifu-Seino Medical Center, Gihoku Kosei Hospital, Japan
| | - Masahito Shimizu
- First Department of Internal Medicine, Gifu University Graduate School of Medicine, Japan
| |
Collapse
|
10
|
Mosconi MG, Paciaroni M, Ageno W. Investigational drugs for ischemic stroke: what's in the clinical development pipeline for acute phase and prevention? Expert Opin Investig Drugs 2022; 31:645-667. [PMID: 35486110 DOI: 10.1080/13543784.2022.2072725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Stroke is a leading cause of disability and mortality and its burden expected to increase. The only approved drug for acute ischemic stroke is the intravenous thrombolytic alteplase. The risk of bleeding complications is one of the reasons for the undertreatment of eligible patients. Numerous drugs are currently being developed to improve safety-efficacy. AREAS COVERED We reviewed literature from January 1st, 2000, to 15th January 2022 for the development and testing of novel drugs with the aim of targeting treatment at prevention of ischemic stroke: PubMed, MEDLINE, Google Scholar, and ClinicalTrial.gov. EXPERT OPINION The pathophysiology of ischemic stroke involves multiple pathways causing cerebral artery obstruction and brain tissue ischemia. Data suggest that tenecteplase is a more promising fibrinolytic agent with a superior efficacy-safety profile, compared to the currently approved alteplase. Current guidelines consider a short-term cycle of mannitol or hypertonic saline to be advisable in patients with space-occupying hemispheric infarction. Regarding primary and secondary prevention, research is primarily focused on identifying mechanisms to improve the safety-efficacy profile using a "hemostasis-sparing" approach. Further evaluation on those agents that have already shown promise for their risk/benefit profiles, would benefit greatly a neurologist's capacity to successfully prevent and treat ischemic stroke patients.
Collapse
Affiliation(s)
- Maria Giulia Mosconi
- Emergency and vascular medicine Stroke Unit University of Perugia, Perugia, Italy
| | - Maurizio Paciaroni
- Emergency and vascular medicine Stroke Unit University of Perugia, Perugia, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| |
Collapse
|
11
|
Sutton B, Long Mays E, McLaughlin C. Case Report: Successful Reperfusion of Pulmonary Thromboembolism Using tPA in a Cat. Front Vet Sci 2022; 9:851106. [PMID: 35518636 PMCID: PMC9067301 DOI: 10.3389/fvets.2022.851106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Pulmonary thromboembolism is a potentially life threatening condition that is uncommonly recognized in cats. Thrombolytic agents have been described as a treatment for this condition in human and canine patients, particularly in cases where hemodynamic instability is persistent despite supportive care. This report describes the clinical course, echocardiographic diagnosis, and successful thrombolysis of a cat with pulmonary thromboembolism. Despite confirmed reperfusion, the cat succumbed to thromboembolic disease highlighting the dearth of knowledge about optimal treatment of this disease process in small animals, particularly in cats.
Collapse
Affiliation(s)
- Blake Sutton
- Veterinary Specialty Services, St. Louis, MO, United States
| | - Erin Long Mays
- Veterinary Specialty Services, St. Louis, MO, United States
| | - Chris McLaughlin
- Department of Cardiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
| |
Collapse
|
12
|
Janowak CF, Becker BR, Philpott CD, Makley AT, Mueller EW, Droege CA, Droege ME. Retrospective Evaluation of Intrapleural Tissue Plasminogen Activator With or Without Dornase Alfa for the Treatment of Traumatic Retained Hemothorax: A 6-Year Experience. Ann Pharmacother 2022; 56:10600280221077383. [PMID: 35184602 DOI: 10.1177/10600280221077383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intrapleural fibrinolytic instillation is second-line treatment for retained hemothorax. Dornase alfa (DNase) has demonstrated efficacy in parapneumonic effusion, but the lack of deoxyribonucleoproteins limits direct extrapolation to traumatic retained hemothorax treatment. OBJECTIVE This study evaluated the effectiveness of intrapleural tissue plasminogen activator (tPA) with and without DNase in the treatment of retained traumatic hemothorax. METHODS This retrospective cohort study included patients aged 16 years and older admitted to a level 1 trauma center from January 2013 through July 2019 with retained hemothorax and one or more intrapleural tPA instillations. Exclusion criteria were tPA for other indications or concomitant empyema. The primary endpoint was treatment failure defined as the need for operative intervention. RESULTS Fifty patients were included (tPA alone: 28; tPA with DNase: 22). Baseline characteristics were similar between groups, including time to diagnosis (6.5 [interquartile range (IQR), 4-15.5] days vs 6 [IQR, 6.3-10.8] days, P = 0.52). Median tPA dose per treatment (6 [IQR, 6-6.4] mg vs 10 [IQR, 8.4-10] mg, P < 0.001) and cumulative tPA (18 [IQR, 6.5-24] mg vs 30 [IQR, 29.5-40], P < 0.001) dose were significantly lower in the tPA alone group. Treatment failure was similar between groups. Chest tube output, retained hemothorax reduction, and bleeding incidences were similar between groups. Multivariate logistic regression demonstrated no significant risk factors for treatment failure. CONCLUSIONS AND RELEVANCE Dornase alfa added to tPA may not reduce the need for operation to treat retained hemothorax. Further studies should be directed at optimal tPA dose determination and economic impact of inappropriate DNase use.
Collapse
Affiliation(s)
- Christopher Francis Janowak
- Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bradley Robert Becker
- IngenioRX, Inc, Morristown, NJ, USA
- Univeristy of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
| | - Carolyn Dosen Philpott
- Univeristy of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- UC Health - University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Amy Teres Makley
- Section of General Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Eric William Mueller
- Univeristy of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- UC Health - University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Christopher Allen Droege
- Univeristy of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- UC Health - University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Molly Elizabeth Droege
- Univeristy of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, OH, USA
- UC Health - University of Cincinnati Medical Center, Cincinnati, OH, USA
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Frias J, Toubarro D, Fraga A, Botelho C, Teixeira J, Pedrosa J, Simões N. Purification and Characterization of a Thrombolytic Enzyme Produced by a New Strain of Bacillus subtil. J Microbiol Biotechnol 2021; 31:327-337. [PMID: 33148943 PMCID: PMC9705946 DOI: 10.4014/jmb.2008.08010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/30/2020] [Accepted: 11/02/2020] [Indexed: 12/15/2022]
Abstract
Fibrinolytic enzymes with a direct mechanism of action and safer properties are currently requested for thrombolytic therapy. This paper reports on a new enzyme capable of degrading blood clots directly without impairing blood coagulation. This enzyme is also non-cytotoxic and constitutes an alternative to other thrombolytic enzymes known to cause undesired side effects. Twenty-four Bacillus isolates were screened for production of fibrinolytic enzymes using a fibrin agar plate. Based on produced activity, isolate S127e was selected and identified as B. subtilis using the 16S rDNA gene sequence. This strain is of biotechnological interest for producing high fibrinolytic yield and consequently has potential in the industrial field. The purified fibrinolytic enzyme has a molecular mass of 27.3 kDa, a predicted pI of 6.6, and a maximal affinity for Ala-Ala-Pro-Phe. This enzyme was almost completely inhibited by chymostatin with optimal activity at 48°C and pH 7. Specific subtilisin features were found in the gene sequence, indicating that this enzyme belongs to the BPN group of the S8 subtilisin family and was assigned as AprE127. This subtilisin increased thromboplastin time by 3.7% (37.6 to 39 s) and prothrombin time by 3.2% (12.6 to 13 s), both within normal ranges. In a whole blood euglobulin assay, this enzyme did not impair coagulation but reduced lysis time significantly. Moreover, in an in vitro assay, AprE127 completely dissolved a thrombus of about 1 cc within 50 min and, in vivo, reduced a thrombus prompted in a rat tail by 11.4% in 24 h compared to non-treated animals.
Collapse
Affiliation(s)
- Jorge Frias
- CBA – Biotechnology Centre of Azores, Faculty of Sciences and Technology, University of Azores, 9500-32 Ponta Delgada, Açores. Portugal,Corresponding author Phone: +351919687431 E-mail:
| | - Duarte Toubarro
- CBA – Biotechnology Centre of Azores, Faculty of Sciences and Technology, University of Azores, 9500-32 Ponta Delgada, Açores. Portugal
| | - Alexandra Fraga
- ICVS - Life and Health Research Institute, University of Minho, 4710-07 Braga, Portugal
| | - Claudia Botelho
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal,CBMA – Centre of Molecular and Environmental Biology, University of Minho, 4710-057 Braga, Portugal,INL - International Iberian Nanotechnology Laboratory, 715-330 Braga, Portugal
| | - José Teixeira
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal
| | - Jorge Pedrosa
- ICVS - Life and Health Research Institute, University of Minho, 4710-07 Braga, Portugal
| | - Nelson Simões
- CBA – Biotechnology Centre of Azores, Faculty of Sciences and Technology, University of Azores, 9500-32 Ponta Delgada, Açores. Portugal
| |
Collapse
|
15
|
Ozgur S, Aksay E, Kacar AA. A rare complication of extracorporeal membrane oxygenation and thrombolytic treatment in a patient with massive pulmonary embolism: Intraperitoneal hemorrhage. Turk J Emerg Med 2021; 21:34-37. [PMID: 33575514 PMCID: PMC7864125 DOI: 10.4103/2452-2473.301916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/14/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022] Open
Abstract
Massive pulmonary embolism (PE) is one of the important emergencies that needs aggressive treatment for decreasing the risk of death. Extracorporeal membrane oxygenation (ECMO) and fibrinolysis should be considered in patients with failure in oxygenation and perfusion despite invasive mechanical ventilation and vasopressor treatment. We present the case of a 22-year-old male who underwent ECMO, systemic fibrinolysis, and cardiopulmonary resuscitation because of massive PE and subsequently developed intraperitoneal bleeding.
Collapse
Affiliation(s)
- Sefer Ozgur
- Department of Emergency Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ersin Aksay
- Department of Emergency Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Aysen Aydın Kacar
- Department of Emergency Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| |
Collapse
|
16
|
Mishra EK, Clive AO, Wills GH, Davies HE, Stanton AE, Al-Aloul M, Hart-Thomas A, Pepperell J, Evison M, Saba T, Harrison RN, Guhan A, Callister ME, Sathyamurthy R, Rehal S, Corcoran JP, Hallifax R, Psallidas I, Russell N, Shaw R, Dobson M, Wrightson JM, West A, Lee YCG, Nunn AJ, Miller RF, Maskell NA, Rahman NM. Randomized Controlled Trial of Urokinase versus Placebo for Nondraining Malignant Pleural Effusion. Am J Respir Crit Care Med 2019; 197:502-508. [PMID: 28926296 DOI: 10.1164/rccm.201704-0809oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Patients with malignant pleural effusion experience breathlessness, which is treated by drainage and pleurodesis. Incomplete drainage results in residual dyspnea and pleurodesis failure. Intrapleural fibrinolytics lyse septations within pleural fluid, improving drainage. OBJECTIVES To assess the effects of intrapleural urokinase on dyspnea and pleurodesis success in patients with nondraining malignant effusion. METHODS We conducted a prospective, double-blind, randomized trial. Patients with nondraining effusion were randomly allocated in a 1:1 ratio to intrapleural urokinase (100,000 IU, three doses, 12-hourly) or matched placebo. MEASUREMENTS AND MAIN RESULTS Co-primary outcome measures were dyspnea (average daily 100-mm visual analog scale scores over 28 d) and time to pleurodesis failure to 12 months. Secondary outcomes were survival, hospital length of stay, and radiographic change. A total of 71 subjects were randomized (36 received urokinase, 35 placebo) from 12 U.K. centers. The baseline characteristics were similar between the groups. There was no difference in mean dyspnea between groups (mean difference, 3.8 mm; 95% confidence interval [CI], -12 to 4.4 mm; P = 0.36). Pleurodesis failure rates were similar (urokinase, 13 of 35 [37%]; placebo, 11 of 34 [32%]; adjusted hazard ratio, 1.2; P = 0.65). Urokinase was associated with decreased effusion size visualized by chest radiography (adjusted relative improvement, -19%; 95% CI, -28 to -11%; P < 0.001), reduced hospital stay (1.6 d; 95% CI, 1.0 to 2.6; P = 0.049), and improved survival (69 vs. 48 d; P = 0.026). CONCLUSIONS Use of intrapleural urokinase does not reduce dyspnea or improve pleurodesis success compared with placebo and cannot be recommended as an adjunct to pleurodesis. Other palliative treatments should be used. Improvements in hospital stay, radiographic appearance, and survival associated with urokinase require further evaluation. Clinical trial registered with ISRCTN (12852177) and EudraCT (2008-000586-26).
Collapse
Affiliation(s)
- Eleanor K Mishra
- 1 Norfolk and Norwich Pleural Unit, Norfolk and Norwich University Hospital NHS Foundation Trust, Norfolk, United Kingdom
| | - Amelia O Clive
- 2 Academic Respiratory Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, United Kingdom
| | | | - Helen E Davies
- 4 Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | | | - Mohamed Al-Aloul
- 6 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Alan Hart-Thomas
- 7 Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
| | - Justin Pepperell
- 8 Somerset Lung Centre, Musgrove Park Hospital, Taunton, United Kingdom
| | - Matthew Evison
- 6 University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | - Tarek Saba
- 9 Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Richard Neil Harrison
- 10 North Tees and Hartlepool Hospitals NHS Foundation Trust, North Tees, United Kingdom
| | - Anur Guhan
- 11 University Hospital Ayr, Ayr, United Kingdom
| | | | | | - Sunita Rehal
- 3 Medical Research Council Clinical Trials Unit and
| | - John P Corcoran
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Robert Hallifax
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Ioannis Psallidas
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Nicky Russell
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Rachel Shaw
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Melissa Dobson
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - John M Wrightson
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom
| | - Alex West
- 15 Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Y C Gary Lee
- 16 School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; and
| | | | - Robert F Miller
- 17 Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom
| | - Nick A Maskell
- 2 Academic Respiratory Unit, School of Clinical Sciences, Southmead Hospital, University of Bristol, Bristol, United Kingdom
| | - Najib M Rahman
- 14 Oxford Respiratory Trials Unit and Oxford Pleural Diseases Unit, Churchill Hospital, Oxford, United Kingdom.,18 National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
17
|
Hart JA, Badiei A, Lee YCG. Successful management of pleural infection with very low dose intrapleural tissue plasminogen activator/deoxyribonuclease regime. Respirol Case Rep 2019; 7:e00408. [PMID: 30805192 PMCID: PMC6373170 DOI: 10.1002/rcr2.408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 11/24/2022] Open
Abstract
Pleural infection managed with intrapleural therapy using a combination of 10 mg of tissue plasminogen activator (tPA) and 5 mg of deoxyribonuclease (DNase) has been shown in randomized and open-label studies to successfully treat >90% of patients without resorting to surgery. Potential bleeding risks, although low, and costs associated with tPA remain important concerns. No phase I studies exist for intrapleural tPA therapy and the lowest effective dose has not been established. In patients with high bleeding risks, lower doses may present a safer alternative. We report a case of a complex parapneumonic effusion in a patient with coagulopathy that was successfully treated with a very low dose tPA (1 mg) and DNase (5 mg) regime.
Collapse
Affiliation(s)
- Jodi Andrea Hart
- Department of Respiratory MedicineSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | - Arash Badiei
- Department of Respiratory MedicineSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | - Y C Gary Lee
- Department of Respiratory MedicineSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
- Pleural Medicine UnitInstitute for Respiratory HealthPerthWestern AustraliaAustralia
- Centre for Respiratory HealthUniversity of Western AustraliaPerthWestern AustraliaAustralia
| |
Collapse
|
18
|
Mihalko E, Huang K, Sproul E, Cheng K, Brown AC. Targeted Treatment of Ischemic and Fibrotic Complications of Myocardial Infarction Using a Dual-Delivery Microgel Therapeutic. ACS Nano 2018; 12:7826-7837. [PMID: 30016078 DOI: 10.1021/acsnano.8b01977] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Myocardial infarction (MI), commonly known as a heart attack, affects millions of people worldwide and results in significant death and disabilities. A major cause of MI is fibrin-rich thrombus formation that occludes the coronary arteries, blocking blood flow to the heart and causing fibrin deposition. In treating MI, re-establishing blood flow is critical. However, ischemia reperfusion (I/R) injury itself can also occur and contributes to cardiac fibrosis. Fibrin-specific poly( N-isopropylacrylamide) nanogels (FSNs) comprised of a core-shell colloidal hydrogel architecture are utilized in this study to design a dual-delivery system that simultaneously addresses the need to (1) re-establish blood flow and (2) inhibit cardiac fibrosis following I/R injury. These therapeutic needs are met by controlling the release of a fibrinolytic protein, tissue plasminogen activator (tPA), and a small molecule cell contractility inhibitor (Y-27632). In vitro, tPA and Y-27632-loaded FSNs rapidly degrade fibrin and decrease cardiac cell stress fiber formation and connective tissue growth factor expression, which are both upregulated in cardiac fibrosis. In vivo, FSNs localize to fibrin in injured heart tissue and, when loaded with tPA and Y-27632, showed significant improvement in left ventricular ejection fraction 2 and 4 weeks post-I/R as well as significantly decreased infarct size, α-smooth muscle actin expression, and connective tissue growth factor expression 4 weeks post-I/R. Together, these data demonstrate the feasibility of this targeted therapeutic strategy to improve cardiac function following MI.
Collapse
|
19
|
Gayatri A, Nafrialdi N, Setiabudy RD, Tjandrawinata RR, Rachman A, Louisa M. A Clinical Trial on Biological Half Life of Bioactive Protein from Lumbricus rubellus, DLBS1033 in Healthy Volunteers. Acta Med Indones 2018; 50:208-214. [PMID: 30333270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND DLBS1033 is a bioactive protein fraction extracted from Lumbricus rubellus, with fibrinogenolytic, fibrinolytic and anti-aggregation activities reported in an in vitro study. Plasma half-life is an important parameter to calculate its dose. This study was conducted to evaluate the biological half-life of DLBS1033 by measuring serial plasmin-antiplasmin (PAP) complex. PAP complex is a stable and inactive compound as a result of fibrinolysis process. METHODS this was an open-label clinical trial in healthy adult subjects. Subjects were divided into two groups to receive single dose drugs (received 3 x 490 mg) or repeated administration until steady state conditions (3 x 490 mg/day for 3 days). Blood samples for PAP complex measurement were collected at time 0 (before drug administration for single dose group), then at 0.5, 1, 1.5, 2, 3, 6, 8, 10, 12, and 24 hours after drug administration. Safety parameters used in this study were creatinine, prothrombin time (PT), activated partial thromboplastin time (aPTT), SGOT, and SGPT. RESULTS the biological half-life of DLBS1033 was calculated based on the mean of PAP complex concentration on each time sampling. In single dose group, the highest mean of PAP complex concentration was reached before drug administration. Our result showed that the activity of DLBS1033 could not be determined after single dose administration. In steady state condition, the PAP complex concentration increase in 2 hours after last drug administration. The biological half-life of DLBS1033 was 8.6 hours. There were no significant safety findings on all laboratory parameters and no serious adverse events. CONCLUSION it is concluded that the fibrinolytic effects of DLBS1033 can be measured in steady state condition. The biological half-life of DLBS1033 in steady state condition was 8.6 hours. There were no serious adverse events on two groups of subjects.
Collapse
Affiliation(s)
- Anggi Gayatri
- Department of Pharmacology and Therapeutic, Medical Faculty Universitas Indonesia, Jakarta, Indonesia.
| | | | | | | | | | | |
Collapse
|
20
|
Eberle H, Lyn R, Knight T, Hodge E, Daley M. Clinical update on thrombolytic use in pulmonary embolism: A focus on intermediate-risk patients. Am J Health Syst Pharm 2018; 75:1275-1285. [PMID: 29895520 DOI: 10.2146/ajhp170357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Current literature on clinical controversies surrounding the use of thrombolytic agents in patients with intermediate-risk pulmonary embolism (PE) is reviewed. SUMMARY PE is a major cause of morbidity and mortality. When used in conjunction with anticoagulation, thrombolysis has been shown to reduce hemodynamic decompensation in select patients, but thrombolytic therapy is associated with high risks of bleeding and intracranial hemorrhage and its role in treating patients with intermediate-risk PE remains controversial. In the PEITHO study, the largest trial to date involving only patients with intermediate-risk PE (n = 1,006), patients receiving the thrombolytic agent tenecteplase were significantly (p = 0.02) less likely than those receiving unfractionated heparin to develop the primary outcome, a composite of death from any cause and hemodynamic decompensation or collapse within 7 days. However, a meta-analysis of data from clinical trials of systemic thrombolytic therapy in intermediate-risk PE generally showed a lack of benefit in terms of all-cause mortality and long-term complications. Novel strategies for treatment of intermediate-risk PE, including low-dose thrombolysis and catheter-directed thrombolysis, are being investigated in an attempt to identify strategies that provide therapeutic outcomes equivalent to those provided by traditional thrombolytic modalities but with a decreased risk of bleeding. CONCLUSION The use of thrombolysis in the treatment of intermediate-risk PE is complicated by high rates of bleeding and should be limited to patients who clinically deteriorate rather than given as a standard-of-care treatment in this population. Data for low-dose thrombolysis remain limited.
Collapse
Affiliation(s)
- Hannah Eberle
- Department of Pharmacy, Dell Seton Medical Center, Austin, TX
| | - Raquel Lyn
- Department of Medicine, Dell Seton Medical Center, Austin, TX
| | | | - Emily Hodge
- Department of Pharmacy, Dell Seton Medical Center, Austin, TX
| | - Mitchell Daley
- Department of Pharmacy, Dell Seton Medical Center, Austin, TX
| |
Collapse
|
21
|
Iqbal O, Jeske W, Fareed J. Reversal of new oral anticoagulants and personalized medicine. Per Med 2017; 14:5-7. [PMID: 29749823 DOI: 10.2217/pme-2016-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Omer Iqbal
- Department Pathology & Ophthalmology, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Walter Jeske
- Department of Thoracic & Cardiovascular Surgery & Pathology, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Jawed Fareed
- Department Pathology & Pharmacology, Loyola University Medical Center, Maywood, IL 60153, USA
| |
Collapse
|
22
|
Kini RM, Koh CY. Metalloproteases Affecting Blood Coagulation, Fibrinolysis and Platelet Aggregation from Snake Venoms: Definition and Nomenclature of Interaction Sites. Toxins (Basel) 2016; 8:E284. [PMID: 27690102 DOI: 10.3390/toxins8100284] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 09/21/2016] [Accepted: 09/22/2016] [Indexed: 01/08/2023] Open
Abstract
Snake venom metalloproteases, in addition to their contribution to the digestion of the prey, affect various physiological functions by cleaving specific proteins. They exhibit their activities through activation of zymogens of coagulation factors, and precursors of integrins or receptors. Based on their structure–function relationships and mechanism of action, we have defined classification and nomenclature of functional sites of proteases. These metalloproteases are useful as research tools and in diagnosis and treatment of various thrombotic and hemostatic conditions. They also contribute to our understanding of molecular details in the activation of specific factors involved in coagulation, platelet aggregation and matrix biology. This review provides a ready reference for metalloproteases that interfere in blood coagulation, fibrinolysis and platelet aggregation.
Collapse
|
23
|
Chu F, Wang X, Sun Q, Liang H, Wang S, An D, Cui C, Chai Y, Li S, Song S, Ji A. Purification and characterization of a novel fibrinolytic enzyme from Whitmania pigra Whitman. Clin Exp Hypertens 2016; 38:594-601. [PMID: 27668456 DOI: 10.3109/10641963.2016.1174254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A fibrinolytic enzyme was purified from the dry body of Whitmania pigra Whitman. The fibrinolytic enzyme was purified to homogeneity with a yield of 0.003% and a purification of 630.7 fold. The molecular weight of the enzyme was estimated to be 26.7 kDa by reduced sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The enzyme was tested by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS) and it showed that the enzyme was a novel fibrinolytic enzyme. The optimal pH and temperature of the enzyme were 8.5 and 55°C, respectively. Enzyme activity was enhanced by Na+, Mg2+, and K+. On the contrary, the proteolytic activity was significantly inhibited by Mn2+, Fe2+, Fe3+, ethylenediaminetetraacetic acid (EDTA), and ethylenebis(oxyethylenenitrilo)tetraacetic acid (EGTA). Fibrinolytic and fibrinogenolytic assays showed that the enzyme preferentially hydrolyzed fibrinogen Aα-chains, followed by Bβ- and γ-chains. The α-, β-, and γ-γ-chains of fibrin were also degraded by the enzyme.
Collapse
Affiliation(s)
- Fulong Chu
- a Marine College, Shandong University , Weihai , China.,b Weihai International Biotechnology Research and Development Center, Shandong University , Weihai , China
| | - Xiaochen Wang
- a Marine College, Shandong University , Weihai , China.,b Weihai International Biotechnology Research and Development Center, Shandong University , Weihai , China
| | - Qianqian Sun
- a Marine College, Shandong University , Weihai , China.,b Weihai International Biotechnology Research and Development Center, Shandong University , Weihai , China
| | - Hao Liang
- a Marine College, Shandong University , Weihai , China.,b Weihai International Biotechnology Research and Development Center, Shandong University , Weihai , China
| | - Sijian Wang
- d Zaozhuang Mining Group Central Hospital , Zaozhuang , China
| | - Dengkun An
- a Marine College, Shandong University , Weihai , China.,b Weihai International Biotechnology Research and Development Center, Shandong University , Weihai , China
| | - Chao Cui
- a Marine College, Shandong University , Weihai , China.,b Weihai International Biotechnology Research and Development Center, Shandong University , Weihai , China
| | - Yuchao Chai
- a Marine College, Shandong University , Weihai , China.,b Weihai International Biotechnology Research and Development Center, Shandong University , Weihai , China
| | - Shuaishuai Li
- a Marine College, Shandong University , Weihai , China.,b Weihai International Biotechnology Research and Development Center, Shandong University , Weihai , China
| | - Shuliang Song
- a Marine College, Shandong University , Weihai , China.,b Weihai International Biotechnology Research and Development Center, Shandong University , Weihai , China
| | - Aiguo Ji
- a Marine College, Shandong University , Weihai , China.,b Weihai International Biotechnology Research and Development Center, Shandong University , Weihai , China.,c School of Pharmaceutical Sciences, Shandong University , Jinan , China
| |
Collapse
|
24
|
Kaymaz C, Öztürk S, Akbal Ö, Tanboğa IH, Yılmaz F, Poçi N, Türkday S, Hakgör A, Yildiz C, Aktemur T, Özdemir N, Konstantinides S. Ultrasound-Assisted Catheter-Directed Thrombolysis in High-Risk and Intermediate-High-Risk Pulmonary Embolism: Results From a Single-Center Cohort. Angiology 2016; 68:433-440. [PMID: 27485362 DOI: 10.1177/0003319716661446] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present our single-center results on ultrasound-assisted thrombolysis (USAT) in patients with pulmonary embolism (PE) at intermediate high risk (IHR) and high risk (HR). Our study consisted of 75 patients with PE who underwent USAT (60 at IHR and 15 at HR). The median time delay from symptoms to USAT was 5 days. Ultrasound-assisted thrombolysis resulted in improvements in tricuspid annular plane systolic excursion; pulmonary artery (PA) systolic and mean pressures; Qanadli score; right to left ventricle diameter ratio and right to left atrial diameter ratio; and diameters of main, right, and left PA regardless of the baseline risk status ( P < .0001 for all). Death was documented in 4 patients, and major and minor bleeding were noted in 2 and 5 of the patients, respectively. No PE-related event was noted during postdischarge follow-up period of median 310 days. Our study revealed that USAT facilitates the resolution of PA thrombotic burden, recovery of pulmonary hemodynamics, and right heart functions with acceptable rates of procedure-related complications in patients with PE, irrespective of the IHR or HR status.
Collapse
Affiliation(s)
- Cihangir Kaymaz
- 1 Department of Cardiology, Koşuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Selçuk Öztürk
- 1 Department of Cardiology, Koşuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Özgür Akbal
- 1 Department of Cardiology, Koşuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim Halil Tanboğa
- 2 Department of Cardiology, Ataturk University Medical School, Erzurum, Turkey.,3 Department of Biostatistics, Ataturk University Medical School, Erzurum, Turkey
| | - Fatih Yılmaz
- 1 Department of Cardiology, Koşuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Nertila Poçi
- 1 Department of Cardiology, Koşuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Sevim Türkday
- 1 Department of Cardiology, Koşuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Aykun Hakgör
- 1 Department of Cardiology, Koşuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Canan Yildiz
- 1 Department of Cardiology, Koşuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Tugba Aktemur
- 1 Department of Cardiology, Koşuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Nihal Özdemir
- 1 Department of Cardiology, Koşuyolu Heart Education and Research Hospital, Istanbul, Turkey
| | - Stavros Konstantinides
- 4 Department of Cardiology, Democritus University Medical School, Thrace, Greece.,5 Centre for Thrombosis and Hemostasis, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany
| |
Collapse
|
25
|
Cha LMJ, Choi S, Kim T, Yoon SW. Intrapleural urokinase therapy in a neonate with pleural empyema. Pediatr Int 2016; 58:616-9. [PMID: 27460398 DOI: 10.1111/ped.12906] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/05/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
Abstract
Pleural empyema is rare in neonates, and treatment with systemic antibiotics and tube drainage may fail because of the thick viscous fluid, bacterial products with fibrin deposition, and multiple loculations. Intrapleural fibrinolytic therapy with urokinase is an effective and non-invasive treatment option that avoids surgical intervention, although its use in neonates has not been studied extensively. In this report, we describe the case of a 13-day-old male neonate with Escherichia coli sepsis and pneumonia, which rapidly progressed to parapneumonic effusion and pleural empyema. After inadequate response to i.v. antibiotics and chest tube drainage, the patient was successfully treated with intrapleural urokinase.
Collapse
Affiliation(s)
- Lily Myung-Jin Cha
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sunha Choi
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Taehwan Kim
- Department of Diagnostic Radiology, National Health Insurance Medical Center, Ilsan Hospital, Goyang, South Korea
| | - Shin Won Yoon
- Department of Pediatrics, National Health Insurance Medical Center, Ilsan Hospital, Goyang, South Korea
| |
Collapse
|
26
|
Solhpour A, Chang KW, Arain SA, Balan P, Zhao Y, Loghin C, McCarthy JJ, Vernon Anderson H, Smalling RW. Comparison of 30-day mortality and myocardial scar indices for patients treated with prehospital reduced dose fibrinolytic followed by percutaneous coronary intervention versus percutaneous coronary intervention alone for treatment of ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2016; 88:709-715. [PMID: 27028120 DOI: 10.1002/ccd.26523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/06/2016] [Accepted: 02/27/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We investigated whether prehospital, reduced dose fibrinolysis coupled with urgent percutaneous coronary intervention (FAST-PCI) reduces mortality and cardiac magnetic resonance (CMR) measures of infarct size, compared with primary percutaneous coronary intervention (PPCI), in patients with ST-elevation myocardial infarction (STEMI). BACKGROUND Current standard therapy for STEMI is PPCI. However, FAST-PCI may shorten ischemic time (IT) and improve outcomes. METHODS Eligible STEMI patients received prehospital, reduced dose fibrinolysis along with standard therapy, and were transported for urgent percutaneous coronary intervention, or else they received usual treatment without prehospital fibrinolysis. Patients were divided retrospectively into four groups based on IT (<120, 120-179, 180-239 min, ≥240) for a mortality analysis cohort, and into three groups (<120, 120-179, ≥180 min) for a CMR analysis cohort. Within each IT group, patients were compared by FAST-PCI vs. PPCI strategy. RESULTS Between 1/2007 and 2/2014, 1,112 STEMI patients were treated. FAST-PCI was employed in 551 and PPCI in 561. Of these, 357 (32.1%) underwent CMR. The treatment groups were well matched. In STEMI patients with short IT (<120 and 120-179 min groups), those treated by FAST-PCI had lower 30-day mortality and myocardial scar sizes compared with PPCI treatment. For IT ≥180 min, the mortalities and myocardial scar sizes were equivalent for both groups. CONCLUSIONS In STEMI patients with IT <180 min, FAST-PCI may reduce 30-day mortality and myocardial scar size compared with PPCI. This suggests that infarct interventions must be instituted within 3 hr of symptom onset in order to detect an optimal beneficial effect both clinically and by CMR measurement. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Amirreza Solhpour
- Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas
| | - Kay-Won Chang
- Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas
| | - Salman A Arain
- Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas
| | - Prakash Balan
- Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas
| | - Yelin Zhao
- Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas
| | - Catalin Loghin
- Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas
| | - James J McCarthy
- Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas
| | - H Vernon Anderson
- Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas
| | - Richard W Smalling
- Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas
| |
Collapse
|
27
|
Piccolo F, Pitman N, Bhatnagar R, Popowicz N, Smith NA, Brockway B, Nickels R, Burke AJ, Wong CA, McCartney R, Choo-Kang B, Blyth KG, Maskell NA, Lee YC. Intrapleural tissue plasminogen activator and deoxyribonuclease for pleural infection. An effective and safe alternative to surgery. Ann Am Thorac Soc 2014; 11:1419-25. [PMID: 25296241 DOI: 10.1513/AnnalsATS.201407-329OC] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Intrapleural tissue plasminogen activator (tPA)/deoxyribonuclease (DNase) therapy for pleural infection given at the time of diagnosis has been shown to significantly improve radiological outcomes. Published cases are limited to only a single randomized controlled trial and a few case reports. OBJECTIVES Multinational observation series to evaluate the pragmatic "real-life" application of tPA/DNase treatment for pleural infection in a large cohort of unselected patients. METHODS All patients from eight centers who received intrapleural tPA/DNase for pleural infection between January 2010 and September 2013 were included. Measured outcomes included treatment success at 30 days, volume of pleural fluid drained, improvement in radiographic pleural opacity and inflammatory markers, need for surgery, and adverse events. MEASUREMENTS AND MAIN RESULTS Of 107 patients treated, the majority (92.3%) were successfully managed without the need for surgical intervention. No patients died as a result of pleural infection. Most patients (84%) received tPA/DNase more than 24 hours after failing to respond to initial conservative management with antibiotics and thoracostomy. tPA/DNase increased fluid drained from a median of 250 ml (interquartile range [IQR], 100-654) in the 24 hours preceding commencement of intrapleural therapy to 2,475 ml (IQR 1,800-3,585) in the 72 hours following treatment initiation (P < 0.05). We observed a corresponding clearance of pleural opacity on chest radiographs from a median of 35% (IQR 25-31) to 14% (7-28) of the hemithorax (P < 0.001), as well as significant reduction in C-reactive protein (P < 0.05). Pain necessitating escalation of analgesia occurred in 19.6% patients, and nonfatal bleeding occurred in 1.8%. CONCLUSIONS This large series of patients who received intrapleural tPA/DNase therapy provides important evidence that the treatment is effective and safe, especially as a "rescue therapy" in patients who do not initially respond to antibiotics and thoracostomy drainage.
Collapse
|
28
|
Abstract
Acute pulmonary embolism is a frequent cause of hospitalization and is associated with a wide range of symptom severity. Anticoagulants are the mainstay of treatment for acute pulmonary embolism; however, in patients with massive or submassive pulmonary embolism, advanced therapy with thrombolytics may be considered. The decision to use thrombolytic therapy for acute pulmonary embolism should be based on careful risk-benefit analysis for each patient, including risk of morbidity and mortality associated with the embolism and risk of bleeding associated with the thrombolytic. Alteplase is currently the thrombolytic agent most studied and with the most clinical experience for this indication, although the most appropriate dose remains controversial, especially in patients with low body weight. When considering thrombolysis, unfractionated heparin is the preferred initial anticoagulant due to its short duration of action and its reversibility should bleeding occur.
Collapse
Affiliation(s)
- Billie Bartel
- Avera McKennan Hospital and University Health Center , Sioux Falls, SD , USA
| |
Collapse
|
29
|
Zhang W, Sun YL, Chen DH. Effects of chitin and sepia ink hybrid hemostatic sponge on the blood parameters of mice. Mar Drugs 2014; 12:2269-81. [PMID: 24727395 PMCID: PMC4012435 DOI: 10.3390/md12042269] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 03/18/2014] [Accepted: 03/25/2014] [Indexed: 11/23/2022] Open
Abstract
Chitin and sepia ink hybrid hemostatic sponge (CTSH sponge), a new biomedical material, was extensively studied for its beneficial biological properties of hemostasis and stimulation of healing. However, studies examining the safety of CTSH sponge in the blood system are lacking. This experiment aimed to examine whether CTSH sponge has negative effect on blood systems of mice, which were treated with a dosage of CTSH sponge (135 mg/kg) through a laparotomy. CTSH sponge was implanted into the abdominal subcutaneous and a laparotomy was used for blood sampling from abdominal aortic. Several kinds of blood parameters were detected at different time points, which were reflected by coagulation parameters including thrombin time (TT), prothrombin time (PT), activated partial thromboplatin time (APTT), fibrinogen (FIB) and platelet factor 4 (PF4); anticoagulation parameter including antithrombin III (AT-III); fibrinolytic parameters including plasminogen (PLG), fibrin degradation product (FDP) and D-dimer; hemorheology parameters including blood viscosity (BV) and plasma viscosity (PV). Results showed that CTSH sponge has no significant effect on the blood parameters of mice. The data suggested that CTSH sponge can be applied in the field of biomedical materials and has potential possibility to be developed into clinical drugs of hemostatic agents.
Collapse
Affiliation(s)
- Wei Zhang
- Zhanjiang Normal University, Round Beibu Gulf Institute for the Protection and Utilization of Marine Animals in Medicine, Zhanjiang 524048, China.
| | - Yu-Lin Sun
- Zhanjiang Normal University, Round Beibu Gulf Institute for the Protection and Utilization of Marine Animals in Medicine, Zhanjiang 524048, China.
| | - Dao-Hai Chen
- Zhanjiang Normal University, Round Beibu Gulf Institute for the Protection and Utilization of Marine Animals in Medicine, Zhanjiang 524048, China.
| |
Collapse
|
30
|
Zeraati F, Homayounfar S, Esna-Ashari F, Khalili M. Fibrinolytic Therapy in CCU Instead of Emergency Ward: How It Affects Door to Needle Time? Int J Prev Med 2014; 5:308-12. [PMID: 24829715 PMCID: PMC4018640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/11/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The door-to-needle-time (DNT) is considered a standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit (CCU). METHODS A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU. RESULTS The mean time interval between arrival at the hospital and electrocardiogram (ECG) assessment was 6.30 min, taking ECG and patient's admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 ± 53.00 min ranged 30-325 min that was significantly more than standard DNT (P <0.01). Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospital (P <0.01). CONCLUSIONS The DNT is higher than the standard level and higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU.
Collapse
Affiliation(s)
- Fatemeh Zeraati
- Department of Pharmacology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran,Correspondence to: Dr. Fatemeh Zeraati, Department of Pharmacology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran. E-mail:
| | - Shahram Homayounfar
- Department of Cardiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farzaneh Esna-Ashari
- Department of Community Medicine, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marzieh Khalili
- Graduated Student of Medicine, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
31
|
Abstract
Background Intrapleural fibrinolytics have been used successfully worldwide for the management of complicated pleural effusions and empyema. Bleeding complications are usually mentioned as rare side effects, but there is no clear information in the literature addressing the alarming outcome that might result following the use of alteplase as a fibrinolytic in the management of complicated parapneumonic effusions. We present a rare, if not unique, case of intrapleural hemorrhage requiring transfusion after alteplase use as a fibrinolytic in a 6-year-old male with complicated parapneumonic effusion. Methods A search of the PubMed database was carried out, using a combination of the following terms: alteplase, fibrinolytic, intrapleural hemorrhage, and side effects. Results The majority of studies found in the search concentrated on the efficacy of intrapleural fibrinolytics in the management of pleural effusion, but very few of the reports addressed the bleeding complications which may be caused by the treatment. Conclusion Although intrapleural and systemic hemorrhage are rare side effects of intrapleural fibrinolytic use, the health care provider must be watchful for these potentially life-threatening complications. Further studies are needed to understand not only the efficacy of fibrinolytics but also their safety, especially in children.
Collapse
|
32
|
Gautam PL, Katyal S, Yamin M, Singh A. Effect of tranexamic acid on blood loss and transfusion requirement in total knee replacement in the Indian population: A case series. Indian J Anaesth 2013; 55:590-3. [PMID: 22223903 PMCID: PMC3249866 DOI: 10.4103/0019-5049.90614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Total knee replacement (TKR) is often carried out using a tourniquet to minimize intraoperative blood loss. However, its application enhances local fibrinolysis, resulting in excessive blood loss during the post-operative period. Fibrinolytic profile varies in different regions and races. Tranexamic acid has been shown to reduce post-operative blood loss and the need for transfusion in TKR. However, there is paucity of literature from the Indian population and the efficacy of the agent has not been tested in Indian patients undergoing TKR. AIMS Effect of tranexamic acid on blood loss in TKR surgery in the Indian population. SETTING AND DESIGN In this double-blinded study, 40 patients undergoing unilateral TKR were randomly divided into two groups. METHODS All patients were conducted under spinal anaesthesia using injection bupivacaine 0.5% heavy 12-15 mg. The treatment group received 10 mg/kg tranexamic acid, intravenous (IV), half an hour before deflation of the tourniquet, with a second dose of 2 mg/kg administered 3 hours after the first dose. The exact protocol was followed for the placebo group, except that normal saline was used instead of tranexamic acid. Blood loss, blood transfusion details and change in haemoglobin levels were noted. STATISTICAL ANALYSIS Student's paired 't' test was used in statistical analysis. RESULTS The mean post-operative blood loss in the tranexamic acid group was 272.5±122.5 ml (mean±SD), and 685±118.2 ml in the placebo group (P<0.001). The total blood loss was lower in the tranexamic acid group than in the placebo group (427.6 ml vs. 911.6 ml; P<0.001). The absolute number of blood transfusions and the number of patients who required transfusions were lower in the tranexamic acid group than in the placebo group. None of the patients had any side or adverse effect. CONCLUSIONS Tranexamic acid significantly decreases post-operative blood loss and reduces the need for blood transfusion in patients undergoing TKR.
Collapse
Affiliation(s)
- Parshotam Lal Gautam
- Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | | | | | | |
Collapse
|
33
|
Satish A, Sairam S, Ahmed F, Urooj A. Moringa oleifera Lam.: Protease activity against blood coagulation cascade. Pharmacognosy Res 2012; 4:44-9. [PMID: 22224061 PMCID: PMC3250039 DOI: 10.4103/0974-8490.91034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 09/04/2011] [Accepted: 12/22/2011] [Indexed: 12/25/2022] Open
Abstract
Background: The present study evaluated the protease activity of aqueous extracts of Moringa oleifera (Moringaceae) leaf (MOL) and root (MOR). Materials and Methods: Protease activity was assayed using casein, human plasma clot and human fibrinogen as substrates. Results: Caseinolytic activity of MOL was significantly higher (P ≤ 0.05) than that of MOR. Similar observations were found in case of human plasma clot hydrolyzing activity, wherein MOL caused significantly higher (P ≤ 0.05) plasma clot hydrolysis than MOR. Zymographic techniques were used to detect proteolytic enzymes following electrophoretic separation in gels. Further, both the extracts exhibited significant procoagulant activity as reflected by a significant decrease (P ≤ 0.05) in recalcification time, accompanied by fibrinogenolytic and fibrinolytic activities; clotting time was decreased from 180 ± 10 sec to 119 ± 8 sec and 143 ± 10 sec by MOL and MOR, respectively, at a concentration of 2.5 mg/mL. Fibrinogenolytic (human fibrinogen) and fibrinolytic activity (human plasma clot) was determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), plate method and colorimetric method. Zymographic profile indicated that both the extracts exerted their procoagulant activity by selectively hydrolyzing Aα and Bβ subunits of fibrinogen to form fibrin clot, thereby exhibiting fibrinogenolytic activity. However, prolonged incubation resulted in degradation of the formed fibrin clot, suggesting fibrinolytic like activity. Conclusions: These findings support the traditional usage of M. oleifera extracts for wound healing.
Collapse
Affiliation(s)
- A Satish
- Department of Studies in Food Science and Nutrition, University of Mysore, Mysore, Karnataka, India
| | | | | | | |
Collapse
|
34
|
Abstract
For many decades, intravenous (IV) thrombolytics have been delivered to treat acute thrombosis. Although these medications were originally effective for coronary thrombosis, their mechanisms have proven beneficial for many other disease processes, including ischemic stroke. Treatment paradigms for acute ischemic stroke have largely followed those of cardiology. Specifically, the aim has been to recanalize the occluded artery and to restore perfusion to the brain that remains salvageable. To that end, rapid clot lysis was sought using thrombolytic medicines already proven effective in the coronary arteries. IV-thrombolysis for ischemic stroke began its widespread adoption in the late 1990s after the publication of the National Institute of Neurological Disorders and Stroke study. Since that time, other promising IV-thrombolytics have been developed and tested in human trials, but as of yet, none have been proven better than a placebo. Adjunctive treatments are also being evaluated. The challenge remains balancing reperfusion and salvaging brain tissue with the potential risks of brain hemorrhage.
Collapse
Affiliation(s)
- Andrew D Barreto
- Department of Neurology, Stroke Division, Neurosonology Laboratory, University of Texas-Houston Medical School, Houston, TX 77030, USA.
| |
Collapse
|