On the mechanism of fibrin-specific plasminogen activation by staphylokinase

The mechanism of plasminogen activation by recombinant staphylokinase was studied both in the absence and in the presence of fibrin, in purified systems, and in human plasma. Staphylokinase, like streptokinase, forms a stoichiometric complex with plasminogen that activates plasminogen following Michaelis-Menten kinetics with Km = 7.0 microM and k2 = 1.5 s-1. In purified systems, alpha 2-antiplasmin inhibits the plasminogen-staphylokinase complex with k1(app) = 2.7 +/- 0.30 x 10(6) M-1 s-1 (mean +/- S.D., n = 12), but not the plasminogen-streptokinase complex. Addition of 6-aminohexanoic acid induces a concentration-dependent reduction of k1(app) to 2.0 +/- 0.17 x 10(4) M-1 s-1 (mean +/- S.D., n = 5) at concentrations greater than or equal to 30 mM, with a 50% reduction at a 6-aminohexanoic acid concentration of 60 microM. Staphylokinase does not bind to fibrin, and fibrin stimulates the initial rate of plasminogen activation by staphylokinase only 4-fold. Staphylokinase induces a dose-dependent lysis of a 0.12-ml 125I-fibrin-labeled human plasma clot submersed in 0.5 ml of citrated human plasma; 50% lysis in 2 h is obtained with 17 nM staphylokinase and is associated with only 5% plasma fibrinogen degradation. Corresponding values for streptokinase are 68 nM and more than 90% fibrinogen degradation. In the absence of a fibrin clot, 50% fibrinogen degradation in human plasma in 2 h requires 790 nM staphylokinase, but only 4.4 nM streptokinase. These results suggest the following mechanism for relatively fibrin-specific clot lysis with staphylokinase in a plasma milieu. In plasma in the absence of fibrin, the plasminogen-staphylokinase complex is rapidly neutralized by alpha 2-antiplasmin, thus preventing systemic plasminogen activation. In the presence of fibrin, the lysine-binding sites of the plasminogen-staphylokinase complex are occupied and inhibition by alpha 2-antiplasmin is retarded, thus allowing preferential plasminogen activation at the fibrin surface.     

Treatment of Deep Vein Thrombosis. A Trial of Heparin,Streptokinase, and Arvin

Thirty patients with deep vein thrombosis of the legs of less than four days'' duration were allocated at random to treatment with heparin, streptokinase, or Arvin under laboratory control. When the fate of the thrombi was assessed by objective techniques—phlebography and the ¹²⁵I-labelled fibrinogen test—the incidence of complete thrombolysis was greatest in the streptokinase group. Complications arose during treatment in each group but were least with Arvin. The natural history of the disease favours clinical but not always anatomical recovery.     

Action of streptokinase on the hemostatic indices of rabbits with a toxic lesion of the liver due to carbon tetrachloride

The rabbits with CCl4-induced hepatic failure have revealed changes in hemostasis responses to streptokinase administration. The main distinction of hepatic dystrophy was the depression of plasma fibrinolytic activity accompanying the decrease in fibrinogen and antiplasmin concentrations. Streptokinase administration to rabbits with productive inflammatory liver disorders produced changes in hemostasis identical to those observed in intact rabbits, fibrinogen levels, however, remained unchanged. The common feature of all the toxic liver disorders is the increase of antithrombin III levels after streptokinase administration, whereas the antithrombin levels in the control animals were decreased.     

Thrombolysis with tissue plasminogen activator in patients with acute myocardial infarction

Thrombolytic agents are being employed clinically in increasing numbers of patients in the attempt to eliminate occlusive coronary thrombi in patients with evolving myocardial infarction. When administered by the intracoronary route, streptokinase lyses is successful in coronary thrombi in more than two-thirds of patients, but when administered intravenously is successful in only one-third. Since streptokinase is a nonselective plasminogen activator, it induces fibrinogenolysis when administered selectively or systematically with an attendant marked reduction in plasma fibrinogen levels and significant bleeding complications. In contrast, the action of tissue plasminogen activator (t-Pa) is relatively selective for fibrinolysis (as opposed to fibrinogenolysis). It induces coronary thrombolysis in at least 60% of patients when administered either into a coronary ostium or a peripheral vein without producing substantial reductions in circulating fibrinogen. Bleeding complications are modest and usually related to high administered doses and concomitant heparinization, and occur primarily at sites of vascular access. Thus, t-Pa appears to be a promising agent for thrombolytic treatment of patients with evolving acute myocardial infarction.     

Treatment of deep vein thrombosis with streptokinase.

From September 1962 to May 1972 145 patients with acute or subacute deep vein thrombosis confirmed by phlebography were treated with streptokinase. During the same period 42 patients considered unfit for thrombolytic therapy were treated with herapin and oral anticoagulants. The results, assessed by repeat phlebography, in 93 of the patients treated with streptokinase were compared with those in 42 patients treated with heparin. The age, sex, and severity of occlusion were roughly similar in both groups. Streptokinase treatment was successful in 42 per cent, partially successful in 25 per cent, and unsuccessful in 32 per cent of the 93 patients compared with none, 10 per cent, and 88 percent respectively in the 42 patients treated with heparin. Streptokinase was more effective when the thrombus was in proximal rather than calf veins. Thrombi of more than six days old were readily lysed. Plasma fibrinogen levels were below 0-8 g/1 (80 mg/100 ml) in nearly all patients successfully treated. The incidence of pulmonary embolism was no greater with streptokinase than with heparin treatment. Only prolonged follow-up would show whether thrombolytic treatment would be effective in preventing late complications of deep vein thrombosis such as chronic venous insufficiency.     

Short-term lysis of venous thrombosis with ultra-high streptokinase doses

11 patients with deep pelvic and leg vein thrombosis were treated with ultra-high streptokinase infusion, 1.5. 10(6) IE streptokinase per hour over a six hour period. Opening of the vein occlusion was achieved in four cases completely and in five cases partially. The frequency of complications was lower at short-time thrombolysis with ultra-high streptokinase infusion in contrast to long-time thrombolysis. Bleedings did not occur. Because of the slight side effects ultra-high streptokinase infusion is an alternative in the fibrinolytic treatment of risk patients with pelvic and leg vein thrombosis.     

重组葡激酶对小型猪冠脉血栓的溶栓作用研究*

目的: 评价重组葡激酶的溶栓效力,并与相同作用方式的重组链激酶进行比较。方法: 30只中国实验小型猪分成5组,分别为溶剂对照组、阳性药对照组和三个重组葡激酶组,每组6只,采用麻醉动物、手术开胸、直流电刺激形成冠脉血栓;在冠脉血栓形成30 min后开始静脉给药,采用先推注、再蠕动泵恒速输注的方式给药;溶剂对照组静脉推注对照液,阳性药对照组静脉给予重组链激酶4 mg·kg^-1,三个重组葡激酶组分别静脉给予4 mg·kg^-1、2 mg·kg^-1、1 mg·kg^-1重组葡激酶,静脉推注体积为5 ml,1 min内注毕,输注速度为0.5 ml·min^-1,60 min内输毕,120 min后放血处死动物。于给药前及给药后30、60、120 min取静脉血,实验结束后取血栓形成部位的冠脉血管段,分别检测优球蛋白溶解时间(ELT)、血纤维蛋白原含量(Fbg)、纤维蛋白(原)降解产物(FDP)和伤口出血量,检测冠脉血栓溶解率、心肌缺血程度及缺血范围。结果: 与溶剂对照组相比,试验组ELT明显缩短(P＜0.05或P＜0.01),FDP 明显升高(P＜0.05或P＜0.01),较少量实验动物Fbg降解超过20%,对小型猪血压及心率无明显影响。与对照组相比,试验组高、中2个剂量组,最大血栓面积分别减少34.3%、15.4%(P＜0.05)。与等剂量的重组链激酶相比,重组葡激酶对电刺激引起的冠脉血栓具有更强的溶栓作用(P＜0.05或P＜0.01),引起的出血副反应少。结论: 重组葡激酶对小型猪冠脉血栓有较好的溶栓作用,相比重组链激酶,溶栓速度快、具有更高的纤维蛋白专一性,出血副反应较少。综合比较, 2 mg·kg^-1重组葡激酶具有较好的临床疗效和安全性保障。     

Engineering and production of streptokinase in a Bacillus subtilis expression-secretion system.

Streptokinase is one of the major blood-clot-dissolving agents used in many medical treatments. With the cloned streptokinase gene (skc) available, production of the secreted streptokinase from various Bacillus subtilis strains was studied. The use of the six-extracellular-protease-deficient strain, WB600, greatly improved the production yield of the secreted streptokinase. A modified skc which has the original skc promoter and signal sequence replaced with the B. subtilis levansucrase promoter and signal sequence was also constructed. B. subtilis carrying either the wild-type or the modified skc produces streptokinase at a comparable level. Even with WB600 as the expression host, a C-terminally-processed streptokinase was also observed. Through region-specific combinatorial mutagenesis around the C-terminal processing sites, streptokinase derivatives resistant to C-terminal degradation were engineered. One of the derivatives showed a 2.5-fold increase in specific activity and would potentially be a better thrombolytic agent.     

Streptokinase and Deep Vein Thrombosis

Five patients with deep vein thrombosis were given streptokinase. Five others with similar phlebograms were given anticoagulants, and the results assessed by examining changes in the iliac, femoral, and calf segments of the phlebograms when repeated 7-10 days later. Those of the anticoagulant group were unchanged. Four of the five given streptokinase had a reduction in the size and extent of their thrombosis. Fresh thrombus surrounded by flowing blood was lysed. Thrombus completely blocking a vein was not lysed.The indications for the use of streptokinase in deep vein thrombosis are reviewed.     

Diagnosis of Deep Vein Thrombosis with 99mTc-streptokinase: A Clinical Comparison with Phlebography

Nineteen patients with signs of deep vein thrombosis in the legs were investigated with a new technique using ^{9 9m}Tc-streptokinase. This compound is probably superior to iodine-labelled fibrinogen in detecting established thrombi. The ratio between the activity in the leg with suspected thrombosis and the other leg was calculated. The results were compared with those obtained with phlebography. A pathologically high activity ratio was found in 11 out of 13 patients in whom phlebography showed a thrombus, while the ratio was normal in the remaining six patients who showed no thrombus on phlebography. No negative correlation was found between the activity ratio and the titrated initial dose of streptokinase. The activity ratio as well as diagnosing the presence of a thrombus may also provide a guide for therapy.     

The degradation of nascent fibrinogen chains is mediated by the ubiquitin proteasome pathway.

Recent studies have shown that ubiquitin-dependent proteolysis by proteasomes plays an essential role in the degradation of ER-retained proteins. We investigated the degradation of individual fibrinogen chains in transfected COS cells which express but do not secrete single chains. In transfected COS cells, the degradation of fibrinogen Bbeta and gamma chain was markedly inhibited by the proteasome inhibitors lactacystin and MG132. These specific proteasome inhibitors also partially affected the degradation of Aalpha chain. In HepG2 cells, which synthesize and secrete fibrinogen, the degradation of intracellular free gamma chain was also inhibited by MG132. We also detected high molecular weight polyubiquitinated forms of fibrinogen chains in transfected COS cells and in HepG2 cells by sequential immunoprecipitation. These results implicate proteasomes in the degradation of fibrinogen chains. In COS cells, gamma chains have a longer half-life than Bbeta chains and Aalpha chains, suggesting that the presence of surplus gamma chains in fibrinogen-producing cells is due to the unequal degradation rate of fibrinogen chains. These results indicate that the ubiquitin-proteasome pathway may be a major system for the degradation of unassembled fibrinogen chains.     

Preeclampsia-associated decrease of potential collagenolytic and gelatinolytic activities in the wall of the umbilical cord vein.

Preeclampsia is the most common pathological syndrome associated with pregnancy. It is accompanied by remodelling of the extracellular matrix of the umbilical cord. A decrease of collagen content in the umbilical cord vein was described. This decrease may result from reduced collagen biosynthesis or enhanced collagen degradation. It was decided to evaluate whether or not this phenomenon is associated with alterations in the activities of collagenolytic, gelatinolytic and non-specific proteolytic enzymes that may be involved in collagen degradation, as well as the activity of prolidase which provides proline as a substrate for collagen biosynthesis. Studies were performed on the umbilical cord veins of newborns delivered by healthy mothers and those with preeclampsia. The control vein extract, activated with trypsin, degraded reconstituted collagen fibres (64.4+/-2.9 nmol Hyp x mg(-1) protein), whereas the preeclamptic material demonstrated only a trace activity. The venous wall extract contained a latent form of gelatinase that might have been activated by trypsin and 4-aminophenylmercuric acetate. A decrease in the gelatinolytic and proteolytic activities of preeclamptic vein extract at neutral pH was found. Prolidase activity was almost 3-fold lower in the preeclamptic extract (240.6+/-29.3 nmol Pro x min(-1) x mg(-1) protein) in comparison to the control (608.2+/-63.7 nmol Pro x min(-1) x mg(-1)protein). It was concluded that the umbilical cord vein contains a latent form of gelatinase A. The decrease in prolidase activity may reduce collagen biosynthesis, resulting in a decrease of this protein in the preeclamptic umbilical cord vein.     

Conformational changes in human fibrinogen after in vitro phosphorylation and their relation to fibrinogen behaviour

The far-ultraviolet circular dichroism spectra of fibrinogens phosphorylated by protein kinase C or casein kinase II indicated a conformational change corresponding to an increase in ordered secondary structure. The spectra of protein kinase A- or casein kinase I-phosphorylated fibrinogens did not differ substantially from the control. Fluorescence studies indicated changes in the tertiary structure around tryptophan residues for protein kinase A- or C-phosphorylated fibrinogens, but failed to show any such change for fibrinogen phosphorylated by either of the casein kinases. This latter result was also confirmed by circular dichroism measurements in the near-ultraviolet region. The apparent increase in ordered structure was proposed as an explanation for the slower rate of plasmin degradation seen in fibrinogens after phosphorylation by protein kinase C [6], and casein kinase II, especially as both spectral changes and plasmin degradation rate were unaffected by alkaline phosphatase.     

A new plasminogen activator isolated from the saliva of Rhapactor biparticeps (Heteroptera, Reduviidae): biological and physicochemical properties

A new plasminogen activator has been isolated from the saliva of Rhapactor biparticeps. This product is 5% of salivary proteins and acts at an optimal pH of 7.8.P.D.F which results from its action on human fibrinogen are similar to those which are obtained with streptokinase. The modalities of action of this plasminogen activator on the fibrinogen are discussed.     

Comparative evaluation of fibrinogen and fibrin hydrolysis with plasmin

A high-sensitive method is developed for determining the degree of plasmin-catalyzed fibrinogen hydrolysis by the released amino groups stained with trinitrobenzene sulphoacid. The method permits determining 0.02-0.08 casein units of plasmin. The method made it possible to establish that after streptokinase activation plasmin hydrolyzes equally fibrinogen and fibrin in solution and as gel. When a tissue activator is used, fibrin intensifies significantly the plasminogen activation. Inhibition of plasmin by an inhibitor produced from soya is considerably slowed down in fibrin gel.     

Effect of streptokinase on prostacyclin synthesis and phospholipase activity in cultured pulmonary artery endothelial cells

In this study, we examined the effects of streptokinase on arachidonic acid release and prostacyclin biosynthesis in cultured bovine pulmonary artery endothelial cells. When intact cells were incubated with streptokinase, a significant stimulatory effect on prostacyclin biosynthetic activity in cells was evident without any cellular damage at all concentrations used (1-10,000 units/ml). Streptokinase also caused a marked release of arachidonic acid. It induced rapid phospholipid hydrolysis, resulting in the release of up to 15% of incorporated [3H]arachidonic acid into the medium. After the addition of streptokinase, degradation of phosphatidylcholine and phosphatidylethanolamine was observed and lysophosphatidylcholine and lysophosphatidylethanolamine were produced. We also observed a transient rise in diacylglycerol after the addition of streptokinase. To test for phospholipase C activity, the release of incorporated [3H]choline, [3H]inositol and [3H]ethanolamine into the culture medium was determined. The level of radioactive inositol showed an increase, but the changes in choline and ethanolamine were comparatively small. An increase in inositol was detectable within 1 min after streptokinase addition and peaked after 15 min. Inositol phosphate and inositol trisphosphate were released, and these releases were suppressed by the addition of neomycin (50 microM). These results suggest that streptokinase stimulates phospholipase A2 and C activity, and that prostacyclin biosynthesis is subsequently increased in cultured endothelial cells.     

The interaction of streptokinase.plasminogen activator complex, tissue-type plasminogen activator, urokinase and their acylated derivatives with fibrin and cyanogen bromide digest of fibrinogen. Relationship to fibrinolytic potency in vitro.

The effects of purified soluble fibrin and of fibrinogen fragments (fibrin mimic) on the activation of Lys-plasminogen (i.e. plasminogen residues 77-790) to plasmin by streptokinase.plasminogen activator complex and by tissue-type plasminogen activator were studied. Dissociation constants of both activators were estimated to lie in the range 90-160 nM (fibrin) and 16-60 nM (CNBr-cleavage fragments of fibrinogen). The kinetic mechanism for both types of activator comprised non-essential enzyme activation via a Rapid Equilibrium Ordered Bireactant sequence. In order to relate the fibrin affinity of plasminogen activators to their fibrinolytic potency, the rate of lysis of supported human plasma clots formed in the presence of unmodified or active-centre-acylated precursors of plasminogen activators was studied as a function of the concentration of enzyme derivative. The concentrations of unmodified enzyme giving 50% lysis/h in this assay were 0.9, 2.0 and 11.0 nM for tissue-type plasminogen activator, streptokinase.plasmin(ogen) and urokinase respectively. However, the potencies of active-centre-acylated derivatives of these enzymes suggested that acylated-tissue plasminogen activator and streptokinase.plasminogen complexes of comparable hydrolytic stability were of comparable potency. Both types of acyl-enzyme were significantly more potent than acyl-urokinases.     

Stimulation of fibrinogen synthesis in cultured rat hepatocytes by fibrinogen fragment E

Because of the inherent difficulties of experimentation in intact animals, we used primary monolayer cultures of non-proliferating adult rat hepatocytes to study the effects of fibrinogen degradation products on fibrinogen biosynthesis. The freshly isolated hepatocytes obtained by collagenase perfusion of the liver in situ were cultured in a chemically defined serum-free medium. The rate of fibrinogen synthesis in control cultures was $\text{40–50}\text{pmol}\text{2.5·10}{}^6$ cells per 24 h. Additions of 20, 60 or 100 μg of homologous stage I fibrinogen degradation products had no effect on fibrinogen synthesis. In contrast, addition of the same amounts of homologous or heterologous (human) stage III fibrinogen degradation products resulted in a concentration-dependent increase in fibrinogen biosynthesis without affecting the rate of synthesis of albumin. When purified stage III fibrinogen degradation products D and E (human) were tested in 10, 30 or 50 μg/3 ml medium only fragment E showed a significant increase in fibrinogen biosynthesis (1.9-, 2.8- and 5.6-fold, respectively, over the control cultures). The presence of excess fibrinogen had no effect. These results suggest that fibrinogen fragment E may be a specific stimulator of fibrinogen biosynthesis which may play an important role in maintaining normal levels of plasma fibrinogen.     

Interference of active site specific reagents in plasminogen-streptokinase active site formation

We have recently observed slow, non-Michaelis-Menten kinetics of activation of native cat plasminogen by catalytic concentrations of streptokinase. In order to understand the reasons for this phenomenon, we undertook to study the formation of the plasminogen-streptokinase activator complex under the same plasminogen activation conditions. The results obtained in this study show that the potential active site in both cat and human plasminogen is capable of binding strongly the specific substrates (S) p-nitrophenyl p-guanidinobenzoate (NPGB) and H-D-valyl-L-leucyl-L-lysyl-p-nitroanilide, through the active site is incapable of hydrolyzing these substrates. Binding studies support these and the following conclusions. Streptokinase binds to this zymogen-substrate complex to create the ternary plasminogen-S-streptokinase complex, which then slowly converts to an acylated plasminogen-streptokinase form. This acylation reaction is 550 times slower than acylation of the preformed plasminogen-streptokinase complex by NPGB. The same reaction also occurs with human plasminogen, though the acylation reaction is 10 times faster than when the cat zymogen is used. NPGB binds specifically to plasminogen but not to streptokinase. These studies proved that inhibition of cat plasminogen activation by streptokinase occurs at the level of activator complex formation. We conclude from our studies that streptokinase binding to both cat and human plasminogen occurs at the potential active site of the zymogen. Consequently, it is probable that plasminogen activation in vivo is inhibited by binding of active site specific inhibitors to plasminogen.     

Enzymatic degradation of protein mixtures.

The rate of protein enzymatic degradation in a mixture is slower than that of single proteins. In a mixture of haemoglobin or casein with protamine, the release of tyrosine by trypsin and chymotrypsin A is slower. A slower rate in the release of arginine from protamine occurs only in mixtures with haemoglobin. The inhibition of enzymatic degradation of proteins in a mixture is due to formation of intermolecular associations and to changes in their spacial structure.