Prevention of experimental coronary thrombosis by hirudin

The antithrombotic activity of hirudin was studied in a rat coronary thrombosis model. The thrombus formation was induced by external application of silver nitrate solution onto the left anterior descending coronary artery. Following subcutaneous injection, hirudin in doses of 0.25, 0.5 and 1.0 mg/kg reduced the development of coronary thrombosis in a dose-dependent manner. The most pronounced antithrombotic effect of hirudin in the described model was related with plasma concentrations between 0.20 and 0.35 microgram hirudin/ml.     

Thrombin mediates the extraintestinal thrombosis associated with experimental colitis

Recent evidence implicating tissue factor and the protein C pathway in the hypercoagulable state associated with intestinal inflammation suggests that thrombin is likely to contribute to this response. The objective of this study was to assess the role of thrombin in the extraintestinal thrombosis associated with experimental colitis. Thrombus formation was quantified in microvessels of the cremaster muscle in mice with dextran sodium sulfate (DSS)-induced colonic inflammation. The light/dye endothelial injury model was used to elicit thrombus formation in DSS colitic mice treated with either hirudin, heparin, or antithrombin III. The initiation and propagation/stabilization phases of thrombus formation were quantified using the time of onset of the thrombus and time to blood flow cessation, respectively. Thrombus formation was accelerated in arterioles of DSS colitic mice, as exhibited by significant reductions in the time of thrombus initiation and propagation/stabilization. Colitic mice treated with hirudin, heparin, or antithrombin III did not exhibit a significant change in the time of onset of the thrombus compared with untreated colitic mice. However, all three antithrombin agents largely prevented the DSS-induced reduction in the time to flow cessation following light/dye injury, with hirudin offering complete protection. These findings indicate that thrombin plays a major role in the extraintestinal thrombus formation associated with experimental colitis. Thrombin appears to contribute to the propagation/stabilization, rather than initiation, phase of the colitis-associated thrombogenesis at the distant vascular site. The results support the therapeutic use of antithrombin agents for reducing the risk of thromboembolism in patients with inflammatory bowel disease.     

新型水蛭素嵌合抗栓剂的构建表达与功能研究

水蛭素（Hirudin,HV）作为新一代抗凝剂,它是目前已知最强的天然凝血酶抑制剂,并有望在临床上完全取代肝素。虽然水蛭素有许多优点,但出血倾向是其在临床应用上的主要副作用。目前尚没有好的解决办法。针对水蛭素在临床应用中所出现的这个问题,依据血栓形成的生理生化机制,构建出了含FXa识别序列水蛭素嵌合抗栓剂,来降低水蛭素在非血栓部位的活性从而减小出血的危险。小鼠尾部血栓模型实验表明：此新型嵌合抗栓剂能在不减少水蛭素抗凝血活性的同时,又能大幅度地降低出血副作用。具有非常重要的临床意义。     

Electrolytic inferior vena cava model (EIM) of venous thrombosis

Animal models serve a vital role in deep venous thrombosis (DVT) research in order to study thrombus formation, thrombus resolution and to test potential therapeutic compounds. New compounds to be utilized in the treatment and prevention of DVT are currently being developed. The delivery of potential therapeutic antagonist compounds to an affected thrombosed vein has been problematic. In the context of therapeutic applications, a model that uses partial stasis and consistently generates thrombi within a major vein has been recently established. The Electrolytic Inferior vena cava Model (EIM) is mouse model of DVT that permits thrombus formation in the presence of continuous blood flow. This model allows therapeutic agents to be in contact with the thrombus in a dynamic fashion, and is more sensitive than other models of DVT. In addition, this thrombosis model closely simulates clinical situations of thrombus formation and is ideal to study venous endothelial cell activation, leukocyte migration, venous thrombogenesis, and to test therapeutic applications. The EIM model is technically simple, easily reproducible, creates consistent thrombi sizes and allows for a large sample (i.e. thrombus and vein wall) which is required for analytical purposes.     

人组织型纤溶酶原激活剂-水蛭素融合基因的构建及其在毕赤酵母中的表达

构建并表达兼有溶栓和抗凝活性、减少出血副作用的人组织型纤溶酶原激活剂(t-PA)和水蛭素(HV2)的融合蛋白。通过提取总RNA和RT-PCR获得t-PA基因,与HV2基因通过活化凝血因子X(Fxa)识别序列（IEGR）的对应碱基序列连接构成融合蛋白基因,融合蛋白基因经pGEM-T、pIC9克隆至表达载体pIC9K上,电转导入毕赤酵母（Pichia pastoris）GS115。转化子摇瓶内甲醇诱导表达。纤维蛋白平板溶圈法和纤维蛋白凝块法分别检测溶栓和抗凝活性。琼脂糖凝胶电泳结果显示克隆的t-PA基因片段大小为1700bp,序列测定结果表明其35位氨基酸由文献报道的精氨酸突变为色氨酸。限制性酶切和PCR鉴定结果均表明融合蛋白基因已克隆入表达载体和宿主菌。甲醇利用实验、G418抗性筛选获得多拷贝甲醇利用快型克隆。甲醇诱导表达产物具有纤溶活性并可被抗t-PA抗体抑制。完整融合蛋白无抗凝活性,但以Fxa裂解后可释放抗凝活性。同时,融合蛋白以单链和双链两种形式存在。融合蛋白在血栓部位特有的Fxa作用下靶向释放抗凝活性,具有溶栓抗凝双功能,有望降低临床出血副作用。     

血栓弹力图指导食管癌患者临床输血的价值及其与常规凝血实验检测指标的相关性分析

目的:探讨血栓弹力图(TEG)指导食管癌患者临床输血的价值及其与常规凝血实验检测指标的相关性。方法:选取2017年1月-2019年3月在我院收治的食管癌手术治疗需输血的99例患者作为研究对象,将99例患者随机分为常规凝血功能检测组和TEG组,常规凝血功能检测组采用常规凝血实验检查结果指导输血,TEG组采用TEG检查结果指导输血,对比两组输血前后的常规凝血实验检测指标以及临床用血量,对比TEG组输血前后的TEG指标,分析TEG指标与常规凝血实验检测指标的相关性。结果:两组患者输血前凝血四项和血小板计数(PLT)差异无统计学意义(P>0.05),输血后两组活化凝血酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)均有不同程度的改善(P<0.05),TEG组PT、TT较常规凝血功能检测组低(P<0.05);输血后,TEG组患者凝血反应时间(R值)、血凝块形成时间(K值)较输血前降低,最大血凝块强度(MA值)、凝血综合指数(CI值)升高,凝血形成速率(Angle角)增大,差异有统计学意义(P<0.05);Pearson相关性分析结果显示,R值与APTT呈正相关(P<0.05),K值与PLT呈负相关,与FIB呈正相关(P<0.05),Angle角、MA值、CI值与FIB、PLT呈正相关(P<0.05);TEG组新鲜冰冻血浆、冷沉淀输注量少于常规凝血功能检测组,差异有统计学意义(P<0.05)。结论:TEG能更好地指导食管癌手术患者各种血液成分的合理输注,有效改善凝血异常情况,减少输血用量,TEG指标与常规凝血实验检测指标存在一定的相关性。     

重组水蛭素的抗血栓形成作用及其机制

目的：研究重组水蛭素抗血栓形成的作用及机制。方法：将60只雄性昆明小鼠随机分为对照组、模型组、阿司匹林组和重组水蛭素低、中、高剂量组（n=10）。除对照组外,其余各组小鼠分别腹腔注射角叉菜胶2.5 mg/kg,诱发小鼠尾部血栓形成。注射角叉菜胶前24 h、0.5 h和注射后24 h,阿司匹林组小鼠分别腹腔注射阿司匹林25 mg/kg,重组水蛭素低、中、高剂量组小鼠分别腹腔注射0.05、0.1、0.2 mg/kg重组水蛭素,对照组和模型组小鼠分别腹腔注射等体积生理盐水。注射角叉菜胶后48 h,观察小鼠黑尾长度并计算黑尾发生率;检测血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、组织型纤溶酶原激活剂（t-PA）、纤溶酶原激活物抑制因子-1（PAI-1）、6-酮-前列腺素F1α（6-keto-PGF1α）、血栓恶烷B2（TXB2）水平。结果：与对照组比较,模型组小鼠尾部形成血栓;血浆PT明显缩短（P<0.01）,PAI-1、TXB2水平明显升高（P<0.01）,t-PA、6-keto-PGF1α水平明显降低（P<0.01）。与模型组比较,重组水蛭素低、中、高剂量组和阿司匹林组小鼠尾部血栓长度明显缩短（P<0.05或P<0.01）,PT明显延长（P<0.01）,PAI-1、TXB2水平明显降低（P<0.01）,t-PA、6-keto-PGF1α水平明显升高（P<0.01）。与阿司匹林组比较,重组水蛭素低剂量组小鼠尾部血栓长度明显增加（P<0.05）,PT明显缩短（P<0.01）,PAI-1、TXB2水平明显升高（P<0.01）;重组水蛭素低、中剂量组6-keto-PGF1α水平明显降低（P<0.01,P<0.05）;重组水蛭素中剂量组PAI-1、TXB2水平明显升高（P<0.01,P<0.05）。结论：重组水蛭素有明显抗血栓形成作用,其机制可能与影响外源性凝血系统、促进纤溶功能有关。     

重组水蛭素的突变及突变体部分性质研究

以基因突变结合动力学分析的方法研究了水蛭素空间结构及其与凝血酶的相互作用．采用基因定点突变和随机突变的方法得到两个重组水蛭素突变体,并从抗酰胺水解活性,抗凝血酶活力和稳定性三个方面,比较研究了重组水蛭素ｒＨＶ２中４７位和１１位两个氨基酸残基对其稳定性和抑制能力的影响．将ｒＨＶ２中Ｇｌｎ１１和Ａｓｎ４７分别突变为Ｈｉｓ１１和Ｌｙｓ４７后,ｒＨＶ２－Ｈ１１生物活力降低３０％,ｒＨＶ２－Ｋ４７生物活力提高６１％．测定抑制常数Ｋｉ表明,ｒＨＶ２－Ｈ１１突变体Ｋｉ值升高１４倍,ｒＨＶ２－Ｋ４７突变体Ｋｉ值降低１４倍,两个突变体的热稳定性均有所增强,ｒＨＶ２－Ｈ１１在酸性和碱性条件的稳定性降低．分析实验结果,可以认为：①４７位的Ｌｙｓ可能是通过氢键和静电两种作用力同时影响着水蛭素的三维结构和其与凝血酶的结合．②１１位氨基酸可能是水蛭素分子中另一个重要位点．     

Interaction of site specific hirudin variants with alpha-thrombin

The kinetics of complex formation between recombinant hirudin or recombinant hirudin mutants with thrombin were analyzed. In order to elucidate the inhibitor's reactive site peptide bond predetermined amino acid substitutions were introduced at positions of basic amino acid residues by means of site-directed mutagenesis of a hirudin gene. In comparison to recombinant hirudin (Ki = 19 pM) only those mutant inhibitors which were modified at amino acid position Lys47 showed a higher Ki value for their complexes with thrombin. The observed effects are mainly due to increased koff rate constants.     

重组葡激酶和水蛭素融合蛋白的血栓靶向性机制

为解释以凝血因子Xa(FXa)的识别序列为连接肽的葡激酶和水蛭素的融合蛋白(命名为SFH)在体内的强溶栓和低出血的特征,研究分析了SFH的两个血栓靶向性作用机理.首先采用ELISA和免疫组化的方法在体外分析了由水蛭素游离的C末端赋予的SFH对血栓的靶向性,结果显示SFH对凝血酶和富含凝血酶的血栓具有更高的亲和力.为阐明SFH抗凝活性在血栓部位的靶向性释放,构建表达了仅在水蛭素N末端连接FXa识别序列的水蛭素衍生物(命名为FH).体外试验结果表明完整的FH无抗凝活性,在体内FH可以发挥抗栓作用,且出血副作用较低,这些结果说明FXa的识别序列可以封闭水蛭素的抗凝活性,在体内FH可以由于FXa的成功裂解而释放其抗凝活性,且其抗凝活性可能仅局限于血栓局部.这就间接说明了SFH的抗凝活性可以在血栓局部进行靶向性释放.以上两个血栓靶向性作用机理是SFH在体内发挥更高溶栓效率和降低出血副作用的重要机制.     

Analysis of the secondary structure of hirudin and the mechanism of its interaction with thrombin

Highly purified hirudin with a specific activity of 13,950 antithrombin units/mg was isolated from a commercial preparation by reversed-phase chromatography. The circular dichroism (CD) spectrum of hirudin was investigated and it was found that the spectrum cannot be accounted for solely in terms of the traditional three components of peptide backbone. It was also found that the CD spectrum of the thrombin-hirudin complex was not additive with respect to the individual spectra of thrombin and hirudin. This deviation from additivity was significant between 210 and 225 nm, indicating alterations in the secondary structures of the proteins during complex formation. When thrombin was titrated with hirudin, the spectral deviation from additivity was sigmoidal, suggesting the cooperative nature of the binding process. Gel filtration of the thrombin-hirudin mixture showed no molecular species greater than a 1:1 complex (Mr 45,500), but gel filtration of free hirudin showed a multimeric form (Mr 51,300) under the same experimental conditions. It is concluded that the cooperative nature of the binding process is due to the binding of thrombin molecules to the multimeric form of hirudin. This initial binding occurs with little or no change in the CD spectrum. In the second step, the multiple complex dissociates to form 1:1 complexes, resulting in larger conformational changes and a considerable increase in binding affinity.     

Pharmacologic influence on secondary generalized fibrinolysis

Secondary generalized hyperfibrinolysis was induced by thrombin infusion or batroxobin injection in rats. To follow intravascular fibrinolysis quantitatively, an electroimmuno-assay was used for determination of the fibrin degradation products formed. Anticoagulants (heparin, hirudin), antifibrinolytics (EACA, PAMBA, AMCA), and synthetic (APPA) and naturally occurring (aprotinin) protease inhibitors were studied with regard to their influence on secondary fibrinolysis. The potency and duration of action of the antifibrinolytics tested correspond to their antifibrinolytic activity measured in vitro and to their pharmacokinetics. Formation of degradation products is initiated after the appearance of fibrin monomer or fibrin, respectively. Due to their antithrombin action heparin, hirudin, and APPA prevent the thrombin-induced fibrin formation and thus the induction of secondary fibrinolysis. In contrast, formation of fibrin monomers caused by batroxobin is not influenced by thrombin inhibitors so that in this case formation of degradation products is not prevented.     

The C-terminal binding domain of hirullin P18. Antithrombin activity and comparison to hirudin peptides

Hirullin P18 is a 61-amino acid hirudin-related protein having potent antithrombin activity. Similar to hirudin, it contains a highly acidic C-terminus, but has a significantly different sequence from any other known hirudin variant. The present study demonstrates that the C-terminal fragment acetyl-hirullin P18(41-62) [corrected] possesses an antithrombin potency similar to that of acetyl-desulfatohirudin(45-65). Additionally, like the hirudin fragment analog, it inhibits fibrin-clot formation by binding to a non-catalytic site on thrombin. Sequential shortening of the hirullin P18 C-terminal fragment demonstrates the critical nature of Phe51, which corresponds to the important Phe56 residue of hirudin. Although the sequences of hirullin P18(54-61) and hirudin(59-65) have substantial differences, the C-terminal functional domain represented by hirullin P18(50-61) appears to be comparable to hirudin(55-65) in terms of its functional role in antithrombin activity.     

The centriolar cycle in polykaryons containing prematurely condensed chromosomes or telophase-like nuclei]

In fused interphase-mitotic cells, either interphase nuclei are induced to premature chromosome condensation (PCC) or mitotic chromosomes are induced to telophase-like nuclei (TLN) formation. This study concerns structural and functional changes in centrioles of fused cells in which PCC or TLN are induced. Embryonic pig kidney cells were fused using a modified PEG-DMSO-serum method. Cell cycle period of the nuclei was determined before cell fusion using double-labeling autoradiography. Polykaryons containing desirable type of PCC or interphase nuclear combination in TLN were selected on the basis of isotope labeling after being embedded in epon. Selected cells were cut into serial sections and studied under electron microscope. The data obtained showed that centrioles at every interphase period undergo mitotic activation when their nuclei are induced to PCC. They acquire fibrillar halo and form half-spindles. Daughter centrioles at G1, S and G2 periods are also capable of mitotic activation when separated from their mother centriole. Inert centrioles were found in some cells with G1-PCC. When mitotic nuclei are induced to TLN formation, their centrioles also become inactivated. They lose fibrillar halo and mitotic spindles break down. Some mitotic centrioles develop features characteristic of interphase period such as satellites and vacuoles. Induced nuclear and centriolar changes are simultaneous and may be controlled by the same factor. Mitotic factor of mitotic cell partner which induces PCC may also induce interphase centrioles to mitotic activation. Degradation of the mitotic factor leading to TLN formation may also cause the loss of the mitotic activity of centrioles and disorganization of mitotic spindles.     

Vascular Pattern Analysis for the Prediction of Clinical Behaviour in Pheochromocytomas and Paragangliomas

Pheochromocytomas (PCCs) are neuroendocrine tumors arising from chromaffin cells of the adrenal medulla. Related tumors that arise from the paraganglia outside the adrenal medulla are called paragangliomas (PGLs). PCC/PGLs are usually benign, but approximately 17% of these tumors are malignant, as defined by the development of metastases. Currently, there are no generally accepted markers for identifying a primary PCC or PGL as malignant. In 2002, Favier et al. described the use of vascular architecture for the distinction between benign and malignant primary PCC/PGLs. The aim of this study was to validate the use of vascular pattern analysis as a test for malignancy in a large series of primary PCC/PGLs. Six independent observers scored a series of 184 genetically well-characterized PCCs and PGLs for the CD34 immunolabeled vascular pattern and these findings were correlated to the clinical outcome. Tumors were scored as malignant if an irregular vascular pattern was observed, including vascular arcs, parallels and networks, while tumors with a regular pattern of short straight capillaries were scored as benign. Mean sensitivity and specificity of vascular architecture, as a predictor of malignancy was 59.7% and 72.9%, respectively. There was significant agreement between the 6 observers (mean κ = 0.796). Mean sensitivity of vascular pattern analysis was higher in tumors >5 cm (63.2%) and in genotype cluster 2 tumors (100%). In conclusion, vascular pattern analysis cannot be used in a stand-alone manner as a prognostic tool for the distinction between benign and malignant PCC, but could be used as an indicator of malignancy and might be a useful tool in combination with other morphological characteristics.     

Experimental studies on the antithrombotic and haemorrhagic effects of heparin and a low molecular weight heparin derivative

Antithrombotic, haemorrhagic and anticoagulant effects of unfractionated heparin (UH) and the low molecular weight heparin fragment KABI 2165 were studied in rats. In stasis-induced venous thrombosis of the jugular vein intravenous injection of both, UH and KABI 2165, either reduced significantly the size of thrombi or completely prevented thrombus formation in a dose-dependent manner. The dose of KABI 2165 required for prevention of thrombus formation showed a marked anticoagulant activity measured by APTT which was in the same range as that of the equieffective dose of UH. After administration of antithrombotically effective doses only UH caused a significant prolongation of bleeding time after standardized incision of the tail. KABI 2165 produced haemorrhagic effects at about 4-fold higher doses only than those required for the antithrombotic action.     

Characterization of the interactions of a bifunctional inhibitor with alpha-thrombin by molecular modelling and peptide synthesis.

A potent thrombin inhibitor, [D-Phe45, Arg47] hirudin 45-65, that contains an active site-directed sequence D-Phe-Pro-Arg-Pro, an exosite specific fragment hirudin 55-65 (H55-65) and a linker portion hirudin 49-54, was designed based on the hirudin sequence [DiMaio et al. (1990) J. Biol. Chem., 265, 21698-21798]. A three-dimensional model of the complex between the B-chain of human thrombin and the inhibitor [D-Phe45, Arg47] hirudin 45-65 was constructed using molecular modelling starting from the X-ray C alpha coordinates of the thrombin-hirudin complex and the NMR-derived structure of the thrombin-bound hirudin 55-65. The contribution of the H49-54 fragment to the thrombin-inhibitor interaction was deduced by examining a series of analogs containing single glycine substitution and analogs with reduced number of residues within the linker. The results were consistent with the molecular modelling observations i.e. the H49-54 fragment serves the role of a spacer in the binding interaction and could be replaced by four glycine residues. The studies on the interaction of the exosite-directed portion of the inhibitor with thrombin using a series of synthetic H55-65 analogs demonstrated that residues AspH55 to ProH60 play a major role in binding to human thrombin where the side chains of PheH56, IleH59 and GluH57 showed critical contributions. Molecular modelling suggested that these side chains may contribute to inter- and intramolecular hydrophobic and electrostatic interactions, respectively.     

Identification of regions of alpha-thrombin involved in its interaction with hirudin

The contributions of various regions of human alpha-thrombin to the formation of the tight complex with hirudin have been assessed by using derivatives of thrombin. alpha-Thrombin in which the active-site serine was modified with diisopropyl fluorophosphate was able to bind hirudin, but its affinity for hirudin was decreased by 10(3)-fold compared to unmodified alpha-thrombin. Modification of the active-site histidine with D-Phe-Pro-Arg-CH2Cl resulted in a form of thrombin with a 10(6)-fold reduced affinity for hirudin. gamma-Thrombin is produced by proteolytic cleavage of alpha-thrombin in two surface loops corresponding to residues 65-83 and 146-150 in alpha-chymotrypsin [Berliner, L. J. (1984) Mol. Cell. Biochem. 61, 159-172; Birktoft, J. J., & Blow, D. M. (1972) J. Mol. Biol. 68, 187-240]. The gamma-thrombin-hirudin complex had a dissociation constant that was 10(6)-fold higher than that of alpha-thrombin. Treatment of alpha-thrombin with pancreatic elastase resulted in a form of thrombin only cleaved in the loop corresponding to residues 146-150 in alpha-chymotrypsin, and this form of thrombin had only a slightly reduced affinity for hirudin. By using limited proteolysis with trypsin, it was possible to isolate beta-thrombin which contained a single cleavage in the loop corresponding to residues 65-83 in alpha-chymotrypsin. This form of thrombin had a 100-fold decrease in affinity for hirudin. Kinetic analysis of the binding of hirudin to beta-thrombin indicated that the 100-fold decrease in affinity was predominantly due to a decrease in the rate of association of the two molecules.(ABSTRACT TRUNCATED AT 250 WORDS)     

From Cerius² based stereoview to mouse and enzyme: the model systems for discovery of novel urokinase inhibitors

Antifibrinolytic therapy during major complex surgery could reduce blood loss and allogeneic transfusion. Novel antagonists of the plasminogen activator and the corresponding model system are of clinical importance. In this paper (1S,2'S,3S)-1-[2-(S)-carboxylindolemethylenemethineaminoeth-1-yl]-2,3,4,5-tetrahydropyrolo[1,2:1,6]pyrazino[3,4:2,3]-1,2,3,4-tetrahydrocarboline-2,5-dione (CIPPC) was presented as a novel antagonist of plasminogen activator, and its blood coagulation and action mechanism were investigated by using a model system which consisted of a mouse-tail bleeding assay, in vitro and in vivo fibrinolysis inhibition assays, a thrombus formation assay and a plasminogen (PLG) electrophoresis assay.     

Mechanism of the inhibition of alpha-thrombin by hirudin-derived fragments hirudin(1-47) and hirudin(45-65)

The kinetic mechanism of the inhibition of alpha-thrombin by hirudin was analyzed using the hirudin-derived fragments hirudin(1-47) and hirudin(45-65). Previously, these fragments have been shown to interact with alpha-thrombin at distinct sites inhibiting thrombin-mediated clot formation. Binding to the active site the N-terminal fragment hirudin(1-47) competitively inhibits hydrolysis of the substrates Tos-Gly-Pro-Arg-NH-Mec (Tos, tosyl; NH-Mec, 4-methylcoumaryl-7-amide) and fibrinogen with Ki values of 420 +/- 18 nM and 460 +/- 25 nM, respectively. Interacting with the anion-binding site of alpha-thrombin the C-terminal fragment competitively inhibits the hydrolysis of fibrinogen with a Ki of 760 +/- 40 nM. It was found, however, that this fragment acts as a hyperbolic uncompetitive inhibitor with respect to the hydrolysis of the peptide-NH-Mec substrate. According to the Botts-Morales scheme for enzyme inhibition, the parameters Ki = 710 +/- 38 nM, K'i = 348 +/- 22 nM, as well as alpha = beta = 0.49 of thrombin inhibition by the C-terminal fragment hirudin(45-65), were obtained. The results are discussed in terms of the interaction of hirudin and thrombin.