Circadian variation of fibrinolytic activity in blood.

Approximately 35 years ago, it was discovered that spontaneous fibrinolytic activity in blood showed a sinusoidal variation with a period of 24 h; it increased severalfold during the day, reaching a peak at 6:00 p.m. and then dropped to trough levels at 3:00-4:00 a.m. The range of the fluctuation and the 24-h mean levels were highly reproducible within an individual; moreover, the timing of the oscillation was remarkably consistent among individuals, with a fixed phase relationship to external clock time. The biorhythm could not be accounted for simply by variations in physical activity, body posture, or sleep/wake schedule. Gender, ethnic origin, meals, or resting levels of blood fibrinolytic activity also did not influence the basic features of the rhythm. Older subjects, compared to younger ones, showed a blunted diurnal increase in fibrinolytic activity in blood. Recent studies have established that, of the known components of the fibrinolytic system, only tissue-type plasminogen activator (tPA) and its fast-acting inhibitor, plasminogen activator inhibitor-1 (PAI-1), show a marked circadian variation in plasma. In contrast, levels of plasminogen, alpha 2-antiplasmin, urinary-type plasminogen activator, and a reversible tPA inhibitor vary little or none during the 24 h. Quenching antibodies to tPA have shown that the circadian rhythm of fibrinolytic activity in blood is due exclusively to changes in tPA activity. However, the 24-h fluctuation of plasma tPA activity is phase shifted in relation to the rhythm of immunoreactive tPA, but shows a precise phase inversion with respect to the 24-h variation of PAI-1 activity and antigen. Therefore, plasma tPA activity, as currently measured in vitro, is tightly and inversely related to the levels of PAI-1 throughout the 24-h cycle. The factors controlling the rhythmicity of plasma PAI-1 are not fully elucidated but probably involve a humoral mechanism; changes in endothelial function, circulating platelet release products, corticosteroids, catecholamines, insulin, activated protein C, or hepatic clearance do not appear to be responsible. Shift workers on weekly shift rotations show a disrupted 24-h rhythm of plasma tPA and PAI-1. In acute and chronic diseases, the circadian rhythmicity of fibrinolytic activity may show a variety of alterations, affecting the 24-h mean, the amplitude, or the timing of the fluctuation. It is advisable, therefore to define the 24-h pattern of plasma tPA and PAI-1 in patient groups, before levels based on a single blood sampling time are compared to those of a control population.(ABSTRACT TRUNCATED AT 400 WORDS)     

Fibrinolytic effect of a particular glycosaminoglycan (endoglycan) per os on normals and in patients with chronic artery disease.

Endoglycan, a heparan-dermatan sulphate association, is a highly purified heparinoid extracted from porcine intestinal mucosa. The aim of our study was to investigate the fibrinolytic system in a group of healthy controls and vascular disease patients, before and after endoglycan administration "per os". All the patients had a reduced basal fibrinolytic activity. The tests carried out were PT, PTT, FDP, Euglobulin Lysis Time (ELT), fibrinogen, plasminogen, alpha 2-antiplasmin, alpha 2-macroglobulin and t-PA activity assayed with a chromogenic method. After endoglycan administration, we have shown a significant shortening of ELT with complete normalization during the treatment. A fibrinogen decrease and either plasminogen or alpha 2-antiplasmin increase was seen. This was shown in normals too, however to a lesser extent. During therapy most of the healthy subjects, but only some patients, showed increased t-PA levels. Before and during treatment, significantly higher t-PA levels were seen in the control group as compared to the patients group. Reduced t-PA release was seen in our vascular disease patients. In conclusion, endoglycan "per os" appears to exert a stimulatory effect on the fibrinolytic system.     

Seasonal and individual characteristics of the response of the fibrinolytic system of blood to physical exercise

The response of the fibrinolytic system of the blood of 33 untrained subjects (16 males and 17 females 18 years old) to a single 20-min bicycle-ergometric large-capacity load (N _male = 2.66 W/kg, N _female = 2.3 W/kg) was studied for 1 year. It is known that the blood fibrinolytic activity at rest has seasonal characteristics: it is relatively high in autumn and spring and low in winter and summer. On average, physical activity in winter and summer stimulates the blood clot lysis, whereas in autumn and spring this stimulation is not observed. The direction and intensity of the response of the fibrinolytic system to exercise have individual features: in autumn and spring they depend on its initial state (increase when the blood FA is low and decrease when it is high) and fluctuate widely, whereas in winter and summer this dependence is not observed. According to the direction of response to the load and its persistence, three types of responses can be distinguished: (a) hyperfibrinolytic, which is characterized by an increase in FA during exercise throughout the year, with a constantly low initial level of fibrinolytic activity at rest; (b) hypofibrinolytic, which is characterized by a stable suppression of fibrinolysis after exercise regardless of the season and the initial level of fibrinolytic activity, with a high fibrinolytic activity at rest in autumn and spring and a low fibrinolytic activity in winter and summer; and (c) unstable, in which the direction of the response of the fibrinolytic system to exercise varies. It is concluded that the development of thromboembolic complications after exercise can be expected with the highest and lowest probability in the subjects with the hypofibrinolytic and hyperfibrinolytic response, respectively.     

Circadian Variation of Fibrinolytic Activity in Blood

Approximately 35 years ago, it was discovered that spontaneous fibrinolytic activity in blood showed a sinusoidal variation with a period of 24 h; it increased severalfold during the day, reaching a peak at 6:OO p.m. and then dropped to trough levels at 3:00–4:00 a.m. The range of the fluctuation and the 24-h mean levels were highly reproducible within an individual; moreover, the timing of the oscillation was remarkably consistent among individuals, with a fixed phase relationship to external clock time. The biorhythm could not be accounted for simply by variations in physical activity, body posture, or sleepfwake schedule. Gender, ethnic origin, meals, or resting levels of blood fibrinolytic activity also did not influence the basic features of the rhythm. Older subjects, compared to younger ones, showed a blunted diurnal increase in fibrinolytic activity in blood. Recent studies have established that, of the known components of the fibrinolytic system, only tissue-type plasminogen activator (tPA) and its fast-acting inhibitor, plasminogen activator inhibitor- 1 (PAL l), show a marked circadian variation in plasma. In contrast, levels of plasminogen, α₂-antiplasmin, urinarytype plasminogen activator, and a reversible tPA inhibitor vary little or none during the 24 h. Quenching antibodies to tPA have shown that the circadian rhythm of fibrinolytic activity in blood is due exclusively to changes in tPA activity. However, the 24-h fluctuation of plasma tPA activity is phase shifted in relation to the rhythm of immunoreactive tPA, but shows a precise phase inversion with respect to the 24-h variation of PAL 1 activity and antigen. Therefore, plasma tPA activity, as currently measured in vitro, is tightly and inversely related to the levels of PAL 1 throughout the 24-h cycle. The factors controlling the rhythmicity of plasma PAI-1 are not fully elucidated but probably involve a humoral mechanism; changes in endothelial function, circulating platelet release. products, corticosteroids, catecholamines, insulin, activated protein C, or hepatic clearance do not appear to be responsible. Shift workers on weekly shift rotations show a disrupted 24-h rhythm of plasma tPA and PAL 1. In acute and chronic diseases, the circadian rhythmicity of fibrinolytic activity may show a variety of alterations, affecting the 24-h mean, the amplitude, or the timing of the fluctuation. It is advisable, therefore, to define the 24-h pattern of plasma tPA and PAI- 1 in patient groups, before levels based on a single blood sampling time are compared to those of a control population. In normal conditions, the 24-h variation of plasma tPA and PAI- 1 is not associated with parallel circadian changes in effective fibrinolysis, assessed as plasma D-dimer concentrations, presumably because fibrin generation in the circulation is low. In diseases in which fibrin formation is increased, however, the physiological drop of fibrinolytic activity in the morning hours may favour thrombus development at this time of day, in agreement with the reported higher morning frequency of acute thrombotic events.     

Sexual maturity and physical exercise alter fibrinolytic activity in birds (chickens)

1. Sexual maturity in the domestic hen is accompanied by hyperlipidaemia. This study examined effects of hyperlipidaemia on fibrinolytic activity at rest and following prolonged treadmill exercise. 2. In immature hens the mean pooled-plasma fibrinolytic activity was 50 mm2 and following 90 min continuous exercise this rose to 114 mm2. In contrast, fibrinolytic activity in mature hens was undetectable but rose to 51 mm2 after exercise. 3. The fibrinolytic response of mature and immature cocks was comparable to that of the immature hens. 4. The resting plasma triglyceride concentration in mature hens was approximately seven times that of the immature hens, immature and mature cocks. Exercise induced significant increases in plasma non-esterified fatty acid concentrations but had no significant effect on triglyceride or cholesterol levels. 5. The results demonstrate that prolonged exercise in birds, as in man, evokes hyperfibrinolysis. However, the response is impaired in mature females and this may be associated with increased blood lipid levels.     

Haemostatic variables, serum lipid abnormalities and vascular complications in diabetes mellitus: a 5 year follow-up study

The relationship among blood lipids, haemostatic and fibrinolytic parameters have been evaluated, during a follow-up study, in 27 non-insulin dependent (type II) diabetic patients. Upon recruitment, and in periodical controls, we observed that plasma triglycerides and VLDL levels correlated inversely, and HDL directly, with the fibrinolytic activity of plasma and euglobulin precipitate. Furthermore triglycerides and VLDL correlated directly with Factor VIII antigen (vWFAg). After 5 years in the study, 12 patients (44%) had macroangiopathic complications, and 9 of these subjects showed persistently high levels of triglycerides (above 2.36 mmol/l). These haemostatic and lipid components, however, do not influence the progression of diabetic retinopathy and nephropathy. The alterations of lipid, haemostatic and fibrinolytic parameters and their possible relationships seem to play an important role in the occurrence of diabetic macroangiopathy.     

Blood and vein-wall fibrinolytic activity in health and vascular disease.

The resting blood fibrinolytic activity of 120 normal subjects and 294 patients with various forms of vascular disease was assessed by measuring the dilute blood clot lysis time and fibrin plate lysis area before and after 10 minutes of venous congestion. The tissue fibrinolytic activity of several of these subjects was assessed in vein biopsy specimens. The results suggested that there was a correlation between blood and tissue fibrinolytic activity and that certain venous diseases, particularly recurrent superficial thrombophlebitis and venous liposclerosis, were associated with a deficiency of blood and tissue fibrinolytic activity.     

Effect of physical exercise on fibrinolytic properties of erythrocytes

The fibrinolytic properties of blood and erythrocytes were studied before and after physical exercise in male volunteers. Their fibrinolytic responses were of two distinct types. In type 1 response, fibrinolytic activities of blood and erythrocytes increased; the plasminogen activator and active plasmin contents in erythrocytes also increased, whereas the profibrinolysin content correspondingly decreased. In addition, physical exercise increased the erythrocyte adsorption properties for plasma activators of fibrinolysis. Type 2 response was characterized by a decrease in the fibrinolytic activity of blood; neither fibrinolytic activity nor adsorption properties of erythrocytes increased. The type of blood and erythrocyte response to muscular activity was determined by the pre-exercise level of red blood cell fibrinolytic activity. It was low in type 1 response due to a lesser content of plasmin activators and greater content of antiplasmin. In type 2 response, the initially high lytic capacity is connected with a greater reserve of activators and lesser reserve of inhibitors of the fibrinolytic system. A conclusion was made that individual differences in fibrinolytic responses to physical exercise were largely accounted for by the properties of erythrocytes.     

Effect of exercise and oral contraceptive agents on fibrinolytic potential in trained females

It has been shown that physical exercise increases blood fibrinolytic potential, primarily by inducing a release of extrinsic plasminogen activator from the vessel wall. Synthetic estrogens have also been reported to influence fibrinolytic activity. The effect of exercise and the possible additional effect of oral contraceptive agents (OCA) on the fibronolytic system were studied in 20 competitive female rowers. Ten females used OCA (users), and 10 others did not (nonusers). All participants were subjected to standardized exhaustive exercise. Preexercise data revealed higher factor XII, total plasminogen, and free plasminogen levels together with a significantly lower C1-inactivator level in the group of users. No differences were observed in prekallikrein, high-molecular-weight kininogen, alpha 2-antiplasmin, alpha 2-macroglobulin, antithrombin III, and histidine-rich glycoprotein plasma levels. The factor XII-dependent fibrinolytic activator activity and the extrinsic (tissue-type) plasminogen activator were significantly higher; however, the urokinase-like fibrinolytic activator activity was significantly lower. These observations suggest a greater susceptibility to activation of the fibrinolytic pathways during OCA medication. Exercise resulted in a decrease of all factors under study but an increase in all fibrinolytic activities. No differences were observed between the two groups in the percentages of change that occurred with exercise.     

Erythrocyte Aggregation in Athletes

Erythrocyte aggregation (examined microscopically in diluted blood), lipid and protein plasma profiles, and fibrinolytic activity were studied in endurance athletes. Division of the athletes into two subgroups by cluster analysis showed that a higher level of fitness was associated with a lower plasminogen activity; enhanced fibrinolysis; increased blood fluidity; lower fibrinogen, cholesterol, and triglyceride levels; a relatively low erythrocyte aggregation index; and high suspension stability of the blood. Fibrinogen was the key plasma factor determining erythrocyte aggregation. Its level was closely correlated with plasminogen activity. Discriminant analysis showed that most differences between groups of athletes were connected with plasminogen activity, the von Willebrand factor, and fibrinolytic activity.     

Changes in the fibrinolytic system associated with physical conditioning

The effects of physical conditioning on plasma fibrinolytic activity were studied in two groups of subjects. Volunteers not engaged in any sport were compared with individuals having been subjected to aerobic conditioning (middle-distance runners, defined as men running more than 80 km per week). Plasma concentrations of the different components of the fibrinolytic system were evaluated before and immediately after a maximal effort treadmill protocol. Comparison of the resting parameters revealed that under basal conditions for plasma concentrations of plasminogen, fibrinogen, alpha 2-antiplasmin, protein C and protein S there were no differences between the two groups. Concentrations of the fibrin degradation products (FbDP) and fibrinogen degradation products (FgDP) were significantly higher in the runners than in the control group, indicating an increased fibrinolytic potential that seemed to be a consequence of the reduced formation of tissue plasminogen activator-plasminogen activator inhibitor (t-PA-PAI) complexes. Acute maximal exercise resulted in pronounced fibrinolysis, evidenced by the elevation of FbDP and FgDP concentrations, in both groups of subjects. The acceleration of the fibrinolytic activity was larger in conditioned individuals, which could be accounted for by a higher t-PA release and reduced formation of t-PA-PAI complexes when compared to the untrained subjects.     

The mechanism of aldosterone response to furosemide test in patients with Shy-Drager syndrome

We examined the renin-angiotensin-aldosterone system in seven patients with Shy-Drager syndrome by studying their response to the stimulation of 1 mg/kg furosemide injection followed by sitting for 1 hour. Six of the seven patients showed a low response of plasma renin activity to the stimulation. However, in five of the low responders, the plasma aldosterone levels after stimulation were observed to be similar to those of the control subjects; in addition, an increment in the plasma cortisol level appeared although no such increment was observed in normal subjects. Next, we studied the aldosterone response to angiotensin II. The five patients who showed a low plasma renin activity response and a normal aldosterone response to furosemide administration also showed low plasma aldosterone response to angiotensin II. Furthermore, in the patients who demonstrated a low plasma renin activity response and a normal aldosterone response to furosemide administration, the pretreatment with 2 mg dexamethasone for 2 days caused a marked inhibition of aldosterone response to the stimulation. These findings suggested that in most patients with Shy-Drager syndrome, the plasma aldosterone response to the stimulation of furosemide injection followed by sitting for 1 hour might be controlled by ACTH but not by plasma renin activity.     

Urokinase plasminogen receptor and the fibrinolytic complex play a role in nerve repair after nerve crush in mice, and in human neuropathies

Remodeling of extracellular matrix (ECM) is a critical step in peripheral nerve regeneration. In fact, in human neuropathies, endoneurial ECM enriched in fibrin and vitronectin associates with poor regeneration and worse clinical prognosis. Accordingly in animal models, modification of the fibrinolytic complex activity has profound effects on nerve regeneration: high fibrinolytic activity and low levels of fibrin correlate with better nerve regeneration. The urokinase plasminogen receptor (uPAR) is a major component of the fibrinolytic complex, and binding to urokinase plasminogen activator (uPA) promotes fibrinolysis and cell movement. uPAR is expressed in peripheral nerves, however, little is known on its potential function on nerve development and regeneration. Thus, we investigated uPAR null mice and observed that uPAR is dispensable for nerve development, whereas, loss of uPAR affects nerve regeneration. uPAR null mice showed reduced nerve repair after sciatic nerve crush. This was a consequence of reduced fibrinolytic activity and increased deposition of endoneurial fibrin and vitronectin. Exogenous fibrinolysis in uPAR null mice rescued nerve repair after sciatic nerve crush. Finally, we measured the fibrinolytic activity in sural nerve biopsies from patients with peripheral neuropathies. We showed that neuropathies with defective regeneration had reduced fibrinolytic activity. On the contrary, neuropathies with signs of active regeneration displayed higher fibrinolytic activity. Overall, our results suggest that enforced fibrinolysis may facilitate regeneration and outcome of peripheral neuropathies.     

Lack of correlation between fibrinolysis and the transformed state of cultured mammalian cells

Transformed cells in culture have been reported by others to exhibit high levels of extracellular proteolytic (fibrinolytic) activity due to plasminogen activation, compared to low levels from nontransformed cells. Enhanced fibrinolysis was accordingly proposed to be a reliable and general enzymatic change associated with cell transformation.In the present study, ten different types of serially cultured, growing cells were examined for their extracellular fibrinolytic activity. The level of the fibrinolytic activity was found not to correlate with the transformed or nontransformed state of these cells.     

White coat hypertension and haemostatic/fibrinolytic balance disorders

White coat hypertension (WCH) or isolated clinic hypertension is generally accepted to be a benign condition, although some reports have suggested that it may be associated with an increased cardiovascular event rate or other cardiovascular alterations. It has been previously shown that essential hypertension (EH) is associated with abnormalities in haemostatic/fibrinolytic balance and endothelial function. The aim of our study was to assess the impact of WCH on fibrinolytic balance and endothelial function by measuring plasma levels of plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator antigen (tPA), fibrinogen, and thrombomodulin. These markers were determined in 71 patients with EH, 26 with WCH and 87 normotensive healthy control subjects. The three groups were not different with respect to age, gender, smoking habits, BMI and blood lipids. Subjects with WCH were found to have increased plasma levels of PAI-1, tPA, fibrinogen and thrombomodulin compared to controls, but less compared to hypertensive ones. Our results suggest that WCH may be associated with decreased fibrinolytic potential and endothelial dysfunction, indicating that WCH may not be a completely harmless trait.     

一株产纤溶酶菌株的分离鉴定及其纤溶组分分析

【目的】筛选性能良好的产纤溶酶菌株,对菌株进行多项分类鉴定,分析其纤溶酶系的组成特征及纤溶能力。【方法】通过酪蛋白培养基初筛,琼脂-纤维蛋白双层平板复筛,从海泥、土壤等环境中筛选纤维蛋白降解菌,以尿激酶为标准测定纤溶酶活性。通过形态学、生理生化特征研究,结合16S rDNA基因序列分析菌株种类及系统分类地位。通过SDS-PAGE和纤维蛋白酶谱法分析胞外纤溶酶系的组成特征。【结果】筛选到一株能降解纤维蛋白的细菌CNY16,鉴定其为沙福芽孢杆菌(Bacillus safensis)。该酶为胞外酶,SDS-PAGE和纤维蛋白酶谱结果表明该纤溶酶系有至少两种分子量大小不同的纤溶酶,分别约33 kD和23 kD。能有效溶解血块中纤维蛋白,并且对红细胞无降解作用。【结论】细菌CNY16是一株新的纤溶酶产生菌,纤溶酶活性及稳定性较好,具有潜在开发价值。为获取新型纤溶酶提供了一种新的菌源。     

Leupeptin-sensitive proteases involved in cell survival after X-ray irradiation in human RSa cells

Proteases have received attention as important cellular components responsible for stress response in human cells. However, little is known about the role of proteases in the early steps of cell response after X-ray irradiation. In the present study, we first searched for proteases whose activity levels are changed soon after X-ray irradiation in human RSa cells with a high sensitivity to X-ray cell-killing. RSa cells showed an increased level of fibrinolytic protease activity within 10 min after irradiation with X-ray (up to 3 Gy). The induced protease activity was proved to be inhibited by leupeptin. We next examined whether this protease inducibility is related to the X-ray susceptibility of cells. Treatment of RSa cells with leupeptin prior to X-ray irradiation resulted in lowered colony survival and an increased ratio of G(2)/M-arrested cells and apoptotic cells. These results suggest that leupeptin-sensitive proteases are involved in the resistance of human RSa cells to X-ray cell-killing.     

The major fibrinolytic proteases of human leukocytes

The major fibrinolytic enzymes present in leukocyte granules and active at physiological pH have been identified. The fibrinolytic activity in extracts of leukocyte granules was bound to fibrinogen-Sepharose and eluted with 8.0 M urea. Two distinct zones of fibrinolytic activity were detected upon electrophoresis of leukocyte extracts on fibrinogen polyacrylamide gels, and both were qualitatively recovered in the 8.0 M urea eluate. Quantitatively, greater than 95% of the fibrinolytic activity was recovered in the urea eluate. Two major leukocyte proteases, elastase (EC 3.4.21.11) and cathepsin G (EC 3.4.21.-), were quantitatively recovered in the urea eluate. Both enzymes, when purified separately by affinity chromatography, were shown to: (a) possess fibrinolytic activity; (b) coincide in mobility and generate the two zones of fibrinolytic activity on fibrinogen polyacrylamide gels; and (c) quantitatively reconstitute the fibrinolytic activity of the leukocyte granules when combined at activity levels present in granular extracts. A highly significant correlation (r = 0.98) was found between the fibrinolytic activity and the sum of elastase and cathepsin G activity in leukocytes from five donors. Thus, elastase and cathepsin G are the major enzymes of the leukocyte fibrinolytic pathway, and fibrinogen-Sepharose chromatography may be used to obtain these enzymes.     

Fibrinolytic activity is not dependent upon exercise mode in post-myocardial infarction patients

In this study we investigated possible differences in fibrinolytic activity in cardiac patients while they performed treadmill and cycle ergometry. Thirteen post-myocardial infarction patients completed two maximal exercise tests on treadmill and cycle ergometers. Blood was collected before and after each exercise test and was analyzed for the fibrinolytic variables, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) activity, and lactate. Maximal oxygen uptake, heart rate, and ventilation were greater (P < 0.05) on the treadmill than during cycle ergometry, however, blood lactate was similar between modes. t-PA activity significantly increased with exercise (P < 0.05) and there was a trend toward a reduction in PAI-1 activity with exercise, but this did not reach statistical significance. The fibrinolytic responses to maximal exercise did not differ between the two modes of exercise studied. Therefore, exercise intensity, but not the mode of exercise, appeared to be the primary determinant of the fibrinolytic response to acute exercise in these patients. Accepted: 29 January 1998     

Clinical and Laboratory Double-blind Investigation on Effect of Fibrinolytic Therapy in Patients with Cutaneous Vasculitis

The effects of phenformin and ethyloestrenol and phenformin and stanozolol on the clinical state, plasma fibrinolytic activity, and fibrinogen-fibrin-related antigen (F.R.-antigen) were compared with placebo in 13 patients with cutaneous vasculitis. Eight patients showed considerable clinical improvement when taking phenformin and an anabolic steroid; an impaired fibrinolytic activity before treatment favoured clinical improvement.