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Wang L, Hao M, Wu N, Wu S, Fisher M, Xiong Y. Comprehensive Review of Tenecteplase for Thrombolysis in Acute Ischemic Stroke. J Am Heart Assoc 2024; 13:e031692. [PMID: 38686848 PMCID: PMC11179942 DOI: 10.1161/jaha.123.031692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/20/2024] [Indexed: 05/02/2024]
Abstract
Although intravenous thrombolysis with alteplase remains the primary treatment for acute ischemic stroke, tenecteplase has shown potential advantages over alteplase. Animal studies have demonstrated the favorable pharmacokinetics and pharmacodynamics of tenecteplase. Moreover, it is easier to administer. Clinical trials have demonstrated that tenecteplase is not inferior to alteplase and may even be superior in cases of acute ischemic stroke with large vessel occlusion. Current evidence supports the time and cost benefits of tenecteplase, suggesting that it could potentially replace alteplase as the main option for thrombolytic therapy, especially in patients with large vessel occlusion.
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Affiliation(s)
- Liyuan Wang
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Manjun Hao
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Na Wu
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
| | - Shuangzhe Wu
- Chinese Institute for Brain Research Beijing China
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA USA
| | - Yunyun Xiong
- Department of Neurology, Beijing Tiantan Hospital Capital Medical University Beijing China
- Chinese Institute for Brain Research Beijing China
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Rossetto A, Torres T, Platton S, Vulliamy P, Curry N, Davenport R. A new global fibrinolysis capacity assay for the sensitive detection of hyperfibrinolysis and hypofibrinogenemia in trauma patients. J Thromb Haemost 2023; 21:2759-2770. [PMID: 37207863 DOI: 10.1016/j.jtha.2023.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/14/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Conventional clotting tests are not expeditious enough to allow timely targeted interventions in trauma, and current point-of-care analyzers, such as rotational thromboelastometry (ROTEM), have limited sensitivity for hyperfibrinolysis and hypofibrinogenemia. OBJECTIVES To evaluate the performance of a recently developed global fibrinolysis capacity (GFC) assay in identifying fibrinolysis and hypofibrinogenemia in trauma patients. METHODS Exploratory analysis of a prospective cohort of adult trauma patients admitted to a single UK major trauma center and of commercially available healthy donor samples was performed. Lysis time (LT) was measured in plasma according to the GFC manufacturer's protocol, and a novel fibrinogen-related parameter (percentage reduction in GFC optical density from baseline at 1 minute) was derived from the GFC curve. Hyperfibrinolysis was defined as a tissue factor-activated ROTEM maximum lysis of >15% or LT of ≤30 minutes. RESULTS Compared to healthy donors (n = 19), non-tranexamic acid-treated trauma patients (n = 82) showed shortened LT, indicative of hyperfibrinolysis (29 minutes [16-35] vs 43 minutes [40-47]; p < .001). Of the 63 patients without overt ROTEM-hyperfibrinolysis, 31 (49%) had LT of ≤30 minutes, with 26% (8 of 31) of them requiring major transfusions. LT showed increased accuracy compared to maximum lysis in predicting 28-day mortality (area under the receiver operating characteristic curve, 0.96 [0.92-1.00] vs 0.65 [0.49-0.81]; p = .001). Percentage reduction in GFC optical density from baseline at 1 minute showed comparable specificity (76% vs 79%) to ROTEM clot amplitude at 5 minutes from tissue factor-activated ROTEM with cytochalasin D in detecting hypofibrinogenemia but correctly reclassified >50% of the patients with false negative results, leading to higher sensitivity (90% vs 77%). CONCLUSION Severe trauma patients are characterized by a hyperfibrinolytic profile upon admission to the emergency department. The GFC assay is more sensitive than ROTEM in capturing hyperfibrinolysis and hypofibrinogenemia but requires further development and automation.
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Affiliation(s)
- Andrea Rossetto
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK.
| | - Tracy Torres
- Barts Health National Health Service Trust, London, UK
| | - Sean Platton
- Barts Health National Health Service Trust, London, UK
| | - Paul Vulliamy
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK
| | - Nicola Curry
- Oxford Haemophilia & Thrombosis Centre, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Ross Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK
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Lotfy MA, Salman SA. Evaluation of efficacy and safety of intraoperative tranexamic acid: prospective placebo-controlled comparative study. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2113703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- Mohamed A. Lotfy
- Department of Anesthesia, Pain & ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Samar A. Salman
- Department of Anesthesia, Pain & ICU, Faculty of Medicine, Cairo University, Giza, Egypt
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Napolitano F, Montuori N. Role of Plasminogen Activation System in Platelet Pathophysiology: Emerging Concepts for Translational Applications. Int J Mol Sci 2022; 23:ijms23116065. [PMID: 35682744 PMCID: PMC9181697 DOI: 10.3390/ijms23116065] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 12/13/2022] Open
Abstract
Traditionally, platelets have been exclusively considered for their procoagulant and antifibrinolytic effects during normal activation of hemostasis. Effectively, activated platelets secrete coagulation factors, expose phosphatidylserine, and promote thrombin and fibrin production. In addition to procoagulant activities, platelets confer resistance of thrombi to fibrinolysis by inducing clot retraction of the fibrin network and release of huge amounts of plasminogen activator inhibitor-1, which is the major physiologic inhibitor of the fibrinolytic cascade. However, the discovery of multiple relations with the fibrinolytic system, also termed Plasminogen Activation System (PAS), has introduced new perspectives on the platelet role in fibrinolysis. Indeed, the activated membrane surface of platelets provides binding sites on which fibrinolytic enzymes can be activated. This review discusses the evidence of the profibrinolytic properties of platelets through the description of PAS components and related proteins that are contained in or bind to platelets. Our analyses of literature data lead to the conclusion that in the initial phase of the hemostatic process, antifibrinolytic effects prevail over profibrinolytic activity, but at later stages, platelets might enhance fibrinolysis through the engagement of PAS components. A better understanding of spatial and temporal characteristics of platelet-mediated fibrinolysis during normal hemostasis could improve therapeutic options for bleeding and thrombotic disorders.
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Dorgalaleh A, Favaloro EJ, Bahraini M, Rad F. Standardization of Prothrombin Time/International Normalized Ratio (PT/INR). Int J Lab Hematol 2020; 43:21-28. [PMID: 32979036 DOI: 10.1111/ijlh.13349] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 01/02/2023]
Abstract
The prothrombin time (PT) represents the most commonly used coagulation test in clinical laboratories. The PT is mathematically converted to the international normalized ratio (INR) for use in monitoring anticoagulant therapy with vitamin K antagonists such as warfarin in order to provide test results that are adjusted for thromboplastin and instrument used. The INR is created using two major PT 'correction factors', namely the mean normal PT (MNPT) and the international sensitivity index (ISI). Manufacturers of reagents and coagulometers have made some efforts to harmonizing INRs, for example, by tailoring reagents to specific coagulometers and provide associated ISI values. Thus, two types of ISIs may be generated, with one being a 'general' or 'generic' ISI and others being reagent/coagulometer-specific ISI values. Although these play a crucial role in improving INR results between laboratories, these laboratories reported INR values are known to still differ, even when laboratories use the same thromboplastin reagent and coagulometer. Moreover, ISI values for a specific thromboplastin can vary among different models of coagulometers from a manufacturer using the same method for clot identification. All these factors can be sources of error for INR reporting, which in turn can significantly affect patient management. In this narrative review, we provide some guidance to appropriate ISI verification/validation, which may help decrease the variability in cross laboratory reporting of INRs.
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Affiliation(s)
- Akbar Dorgalaleh
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Emmanuel J Favaloro
- Department of Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, NSW, Australia
| | - Mehran Bahraini
- Department of Hematology and Blood Transfusion, School of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Rad
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.,Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
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Liquid Platelet-Rich Fibrin and Heat-Coagulated Albumin Gel: Bioassays for TGF-β Activity. MATERIALS 2020; 13:ma13163466. [PMID: 32781631 PMCID: PMC7475845 DOI: 10.3390/ma13163466] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023]
Abstract
Liquid platelet-rich fibrin (PRF) can be prepared by high centrifugation forces separating the blood into a platelet-poor plasma (PPP) layer and a cell-rich buffy coat layer, termed concentrated PRF (C-PRF). Heating the liquid PPP was recently introduced to prepare an albumin gel (Alb-gel) that is later mixed back with the concentrated liquid C-PRF to generate Alb-PRF. PRF is a rich source of TGF-β activity; however, the overall TGF-β activity in the PPP and the impact of heating the upper plasma layer remains unknown. Here, we investigated for the first time the in vitro TGF-β activity of all fractions of Alb-PRF. We report that exposure of oral fibroblasts with lysates of PPP and the buffy coat layer, but not with heated PPP, provoked a robust increase in the TGF-β target genes interleukin 11 and NADPH oxidase 4 by RT-PCR, and for IL11 by immunoassay. Consistent with the activation of TGF-β signaling, expression changes were blocked in the presence of the TGF-β receptor type I kinase inhibitor SB431542. Immunofluorescence and Western blot further confirmed that lysates of PPP and the buffy coat layer, but not heated PPP, induced the nuclear translocation of Smad2/3 and increased phosphorylation of Smad3. The immunoassay further revealed that PPP and particularly BC are rich in active TGF-β compared to heated PPP. These results strengthen the evidence that not only the cell-rich C-PRF but also PPP comprise a TGF-β activity that is, however, heat sensitive. It thus seems relevant to mix the heated PPP with the buffy coat C-PRF layer to regain TGF-β activity, as proposed during the preparation of Alb-PRF.
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Cheng S, Qi F, Jiang Z, Peng B, Hou W, Wang Y, Xiao J, Guo H, Wang Z. Knockdown of Clock gene induces thrombotic potential reduction by inhibiting α1-antitrypsin with promotion of fibronectin. BIOL RHYTHM RES 2020. [DOI: 10.1080/09291016.2020.1712782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Shuting Cheng
- Health Ministry Key Laboratory of Chronobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, P.R. China
| | - Fang Qi
- Health Ministry Key Laboratory of Chronobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, P.R. China
| | - Zhou Jiang
- Health Ministry Key Laboratory of Chronobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, P.R. China
| | - Bo Peng
- Health Ministry Key Laboratory of Chronobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, P.R. China
| | - Wang Hou
- Health Ministry Key Laboratory of Chronobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, P.R. China
| | - Yuhui Wang
- Health Ministry Key Laboratory of Chronobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, P.R. China
| | - Jing Xiao
- Health Ministry Key Laboratory of Chronobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, P.R. China
| | - Huiling Guo
- Health Ministry Key Laboratory of Chronobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, P.R. China
| | - Zhengrong Wang
- Health Ministry Key Laboratory of Chronobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, P.R. China
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Kolodziejczyk-Czepas J, Pasiński B, Ponczek MB, Moniuszko-Szajwaj B, Kowalczyk M, Pecio Ł, Nowak P, Stochmal A. Bufadienolides from Kalanchoe daigremontiana modulate the enzymatic activity of plasmin - In vitro and in silico analyses. Int J Biol Macromol 2018; 120:1591-1600. [PMID: 30261260 DOI: 10.1016/j.ijbiomac.2018.09.143] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/07/2018] [Accepted: 09/23/2018] [Indexed: 01/23/2023]
Abstract
Plasmin (EC 3.4.21.7) is a key enzyme of the fibrinolytic system, responsible for the degradation of fibrin clot and maintaining blood fluidity. Hence, alterations of the fibrinolytic capacity of blood plasma may contribute to thrombotic or bleeding complications. The aim of this study was to determine effects of a bufadienolide-rich fraction, isolated from roots of Kalanchoe daigremontiana (0.05-50 μg/ml) on enzymatic properties of plasmin. Hydrolysis of a synthetic substrate S-2251 (H-D-Valyl-l-leucyl-l-lysine-p-nitroaniline dihydrochloride) by plasmin revealed that the bufadienolide-rich fraction had a diverse effect on this enzyme, dependently on the concentration range. While the lower concentrations of the examined fraction (0.05-2.5 μg/ml) significantly enhanced the amidolytic activity of plasmin, at 25-50 μg/ml concentrations, the enzyme was evidently inhibited (by about 60%). The Lineweaver-Burk plot indicated on an uncompetitive inhibition of plasmin. Inhibitory effects (up to 80%) were also found in the streptokinase-induced plasminogen activation to plasmin. Docking results suggest that only some of compounds (mostly bersaldegenin 1-acetate (10), bryotoxin (13) and hovetrichoside C (17)) were bound to plasminogen/plasmin, depending on the presence or absence of the substrate in the active site. The obtained findings suggest allosteric regulation of plasminogen activation and plasmin activity by components of the examined fraction.
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Affiliation(s)
- Joanna Kolodziejczyk-Czepas
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland.
| | - Bartłomiej Pasiński
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Michal B Ponczek
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Barbara Moniuszko-Szajwaj
- Department of Biochemistry, Institute of Soil Science and Plant Cultivation, State Research Institute, Czartoryskich 8, 24-100 Pulawy, Poland
| | - Mariusz Kowalczyk
- Department of Biochemistry, Institute of Soil Science and Plant Cultivation, State Research Institute, Czartoryskich 8, 24-100 Pulawy, Poland
| | - Łukasz Pecio
- Department of Biochemistry, Institute of Soil Science and Plant Cultivation, State Research Institute, Czartoryskich 8, 24-100 Pulawy, Poland
| | - Pawel Nowak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Anna Stochmal
- Department of Biochemistry, Institute of Soil Science and Plant Cultivation, State Research Institute, Czartoryskich 8, 24-100 Pulawy, Poland
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10
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Assumpção TC, Mizurini DM, Ma D, Monteiro RQ, Ahlstedt S, Reyes M, Kotsyfakis M, Mather TN, Andersen JF, Lukszo J, Ribeiro JMC, Francischetti IMB. Ixonnexin from Tick Saliva Promotes Fibrinolysis by Interacting with Plasminogen and Tissue-Type Plasminogen Activator, and Prevents Arterial Thrombosis. Sci Rep 2018; 8:4806. [PMID: 29555911 PMCID: PMC5859130 DOI: 10.1038/s41598-018-22780-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/22/2018] [Indexed: 12/11/2022] Open
Abstract
Tick saliva is a rich source of modulators of vascular biology. We have characterized Ixonnexin, a member of the "Basic-tail" family of salivary proteins from the tick Ixodes scapularis. Ixonnexin is a 104 residues (11.8 KDa), non-enzymatic basic protein which contains 3 disulfide bonds and a C-terminal rich in lysine. It is homologous to SALP14, a tick salivary FXa anticoagulant. Ixonnexin was produced by ligation of synthesized fragments (51-104) and (1-50) followed by folding. Ixonnexin, like SALP14, interacts with FXa. Notably, Ixonnexin also modulates fibrinolysis in vitro by a unique salivary mechanism. Accordingly, it accelerates plasminogen activation by tissue-type plasminogen activator (t-PA) with Km 100 nM; however, it does not affect urokinase-mediated fibrinolysis. Additionally, lysine analogue ε-aminocaproic acid inhibits Ixonnexin-mediated plasmin generation implying that lysine-binding sites of Kringle domain(s) of plasminogen or t-PA are involved in this process. Moreover, surface plasmon resonance experiments shows that Ixonnexin binds t-PA, and plasminogen (KD 10 nM), but not urokinase. These results imply that Ixonnexin promotes fibrinolysis by supporting the interaction of plasminogen with t-PA through formation of an enzymatically productive ternary complex. Finally, in vivo experiments demonstrates that Ixonnexin inhibits FeCl3-induced thrombosis in mice. Ixonnexin emerges as novel modulator of fibrinolysis which may also affect parasite-vector-host interactions.
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Affiliation(s)
- Teresa C Assumpção
- Laboratory of Malaria and Vector Research, NIAID, National Institutes of Health, Bethesda, USA
| | - Daniella M Mizurini
- Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dongying Ma
- Laboratory of Malaria and Vector Research, NIAID, National Institutes of Health, Bethesda, USA
| | - Robson Q Monteiro
- Institute of Medical Biochemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sydney Ahlstedt
- Department of Pathology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
| | - Morayma Reyes
- Department of Pathology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
| | - Michail Kotsyfakis
- Institute of Parasitology, Biology Center, Czech Academy of Sciences, České Budějovice, Czech Republic
| | - Thomas N Mather
- Rhode Island Center for Vector-Borne Disease, University of Rhode Island, Kingston, Rhode Island, USA
| | - John F Andersen
- Laboratory of Malaria and Vector Research, NIAID, National Institutes of Health, Bethesda, USA
| | - Jan Lukszo
- Laboratory of Malaria and Vector Research, NIAID, National Institutes of Health, Bethesda, USA
| | - José M C Ribeiro
- Laboratory of Malaria and Vector Research, NIAID, National Institutes of Health, Bethesda, USA
| | - Ivo M B Francischetti
- Laboratory of Malaria and Vector Research, NIAID, National Institutes of Health, Bethesda, USA.
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