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.     

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。     

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。     

Anticoagulant and antithrombotic activities of a chemically sulfated galactoglucomannan obtained from the lichen Cladonia ibitipocae

A galactoglucomannan (GGM), isolated from the lichen Cladonia ibitipocae, consisted of a (1-->6)-linked main chain of alpha-mannopyranose units, substituted by alpha- and beta-D-galacto (alpha- and beta-D-Galp)-, beta-D-gluco (beta-D-Glcp)- and alpha-D-mannopyranosyl (alpha-D-Manp) groups, and was sulfated giving a sulfated polysaccharide (GGM-SO4) with 42.2% sulfate corresponding to a degree of substitution of 1.29. NMR studies indicated that after sulfation, the OH-6 groups of galactopyranosyl and mannopyranosyl units were preferentially substituted. GGM-SO4 was investigated in terms of its in vitro anticoagulant and in vivo antithrombotic properties. Those of the former were evaluated by its activated partial thromboplastin (APTT) and thrombin time (TT), using pooled normal human plasma, and compared with that of 140 USP units mg(-1) for a porcine intestinal mucosa heparin. Anticoagulant activity was detected in GGM-SO4, but not in GGM. The in vivo antithrombotic properties of GGM-SO4 were evaluated using a stasis thrombosis model in Wistar rats, intravenous administration of 2 mg kg(-1) body weight totally inhibiting thrombus formation. It caused dose-dependent increases in tail transection bleeding time. The results obtained showed that this sulfated polysaccharides is a promising anticoagulant and antithrombotic agent.     

Antithrombotic effect of preparations from the leeches Hirudo medicinalis

Antithrombotic effect of leech salivary gland secretion was maximal after intravenous administration into rats and was slightly decreased in cases of peroral administration. Blood from leech intestinal tract and leech homogenate exhibited less distinct antithrombotic action. Effect of these preparations was maintained after peroral administration. The antithrombotic effect of the leech preparations did not depend on their antithrombic activity caused by hirudin. These leech preparations appear to elongate a period of blood plasma recalcification caused by kallikrein inhibitor as well as apparently due to their capacity to inhibit aggregation of the thrombocytes.     

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.     

Low-molecular-weight heparin (dalteparin) effectively prevents thrombosis in a rat model of deep arterial injury

Unfractionated heparin is often used to prevent thrombosis in microvascular surgery, but a major drawback of heparin therapy is increased bleeding. Low-molecular-weight heparins prevent venous thrombosis as effectively as heparin and have better bioavailability and a longer plasma half-life, which explains the increased use of low-molecular-weight heparins as substitutes for heparin in clinical practice. However, the ability of low-molecular-weight heparins to prevent arterial thrombosis has been debated. In this study, the authors compared the antithrombotic and antihemostatic effects of heparin and the low-molecular-weight heparin dalteparin in a rat model of arterial thrombosis. A segment of the left common carotid artery was isolated between vascular clamps and opened longitudinally. An endarterectomy was performed and the arteriotomy was closed with a running suture. The antithrombotic effect (vascular patency 31 minutes after reperfusion) and the surgical bleeding were measured. Groups of 10 rats were treated in a blind, random fashion with intravenous injection of one of the following substances 1 minute before clamp release. Three groups received a bolus of heparin (20, 60, or 180 IU anti-factor Xa/kg), three groups received dalteparin (60, 180, or 540 IU anti-factor Xa/kg), and one group was treated with vehicle (saline). Heparin 180 IU/kg produced a distinct antithrombotic effect compared with the control group (p = 0.03), but it also significantly increased the surgical bleeding to 2.0 g compared with 1.5 g in the control group (medians, p = 0.01). Dalteparin 180 and 540 IU/kg also produced a powerful antithrombotic effect (p = 0.01 and p = 0.03, respectively). In contrast to heparin, 180 IU/kg dalteparin did not increase the surgical bleeding (median, 1.5 g; p = 0.37 versus controls). Dalteparin 540 IU/kg increased the median surgical bleeding to 2.6 g (p = 0.06 versus controls). The nonsignificant difference may be explained by the great interindividual variation of surgical bleeding in the high-dose dalteparin group. Dalteparin prevented arterial thrombosis as effectively as unfractionated heparin. In contrast to heparin, dalteparin did not increase the surgical bleeding, which indicates that dalteparin instead of heparin can be used to prevent thrombosis in microvascular surgery.     

白藜芦醇苷对血栓形成及血浆TXB2和6-keto-PGF1α水平的影响

研究了白藜芦醇苷(polydatim,PD)的抗血栓形成作用及其作用机制。采用小鼠尾静脉注射花生四烯酸(arachidonicacid,AA)、电刺激大鼠颈动脉血栓形成方法评价PD的抗血栓形成作用;运用放射免疫法测定polydatin对兔血浆血栓素B2(thromboxaneB2,TXB2)及6酮前列腺素F1α(6ketoprostaglandinF1α,6ketoPGF1α)水平的影响。结果显示PD对AA、电刺激大鼠颈动脉引起的血栓形成具有明显的对抗作用;PD亦能降低兔血浆TXB2含量并升高6KetoPGF1α水平。本实验提示PD有明显的抗血栓形成作用,其机制可能与其降低血浆TXB2含量及升高6KetoPGF1α水平密切相关。     

Ent-16β,17-dihydroxy-kauran-19-oic acid,a kaurane diterpene acid from Siegesbeckia pubescens,presents antiplatelet and antithrombotic effects in rats

The antiplatelet and antithrombotic effects of ent-16β,17-dihydroxy-kauran-19-oic acid (DDKA) isolated from Siegesbeckia pubescens were investigated with different methods both in vitro and in vivo. We tested the antithrombotic activity of DDKA in arterio-venous shunt model. The effects of DDKA on adenosine diphosphate (ADP)-, Thrombin-, Arachidonic acid-induced rat platelets aggregation were tested in vitro. We also assessed its bleeding side effect by measuring coagulation parameters after intravenous administration for 5 days and investigated the potential mechanisms underlying such activities. In vivo, DDKA significantly reduced thrombus weight in the model of arterio-venous shunt. Meanwhile, DDKA increased plasma cAMP level determined by radioimmunoassay in the same model. Notably, DDKA prolonged PT and APTT in rats after intravenous administration DDKA for successive 5 days. In vitro, pretreatment with DDKA on washed rat platelets significantly inhibited various agonists stimulated platelet aggregation and caused an increase in cAMP level in platelets activated by ADP. These findings support our hypothesis that DDKA possesses antiplatelet and antithrombotic activities. The mechanisms underlying such activities may involve the anticoagulatory effect and cAMP induction.     

An ethanol extract of Ramulus mori improves blood circulation by inhibiting platelet aggregation

Inappropriate platelet aggregation can cause blood coagulation and thrombosis. In this study, the effect of an ethanol extract of Ramulus mori (ERM) on blood circulation was investigated. The antithrombotic activity of ERM on rat carotid arterial thrombosis was evaluated in vivo, and the effect of ERM on platelet aggregation and blood coagulation time was evaluated ex vivo. To evaluate the safety of ERM, its cytotoxicity to platelets and its effect on tail bleeding time were assessed; ERM was not toxic to rat platelets and did not prolong bleeding time. Moreover, administering ERM to rats had a significant preventive effect on carotid arterial thrombosis in vivo, and significantly inhibited adenosine diphosphate- and collagen-induced platelet aggregation ex vivo, whereas it did not prolong coagulation periods, such as prothrombin time and activated partial thromboplastin time. The results suggest that ERM is effective in improving blood circulation via antiplatelet activity rather than anticoagulation activity.     

The influence of Annexin32, a new Ca2+-dependent phospholipid-binding protein, on coagulation time and thrombosis

The pharmacodynamics of Annexin32, a new Ca2+-dependent phospholipid-binding protein, was studied by measuring coagulation time in rabbits and venous thrombosis in rabbits and rats. Rabbits and rats were given Annexin32 by intravenous administration. Then Kaolin partial thromboplastin time (KPTT), thrombosis in vitro and in vivo were assayed. The results showed that KPTT of rabbits was prolonged (p < 0.01), and the length and weight of thrombus in vitro were reduced (p < 0.01) after administration of Annexin32 at 1 mg/kg. It also inhibited thrombosis in vivo and reduced the weight of venous thrombus significantly in rats (p < 0.01). All these results suggested that Annexin32 possesses the characteristic of antithrombotic effect and fewer side effects on coagulation time.     

N-methylnicotinamide inhibits arterial thrombosis in hypertensive rats.

There are few findings indicating that nicotinamide may potentially influence intravascular thrombosis. Interestingly, N-methylnicotinamide, one of the metabolites of nicotinamide - could be more potent than its parent compound. In the present study we have investigated the influence of N-methylnicotinamide on arterial thrombosis in normotensive and renovascular hypertensive rats. The contribution of platelets, coagulation and fibrinolytic systems in the mode of N-methylnicotinamide action was also determined. Furthermore, we examined the role of nitric oxide/prostacyclin in the mechanisms of N-methylnicotinamide action. N-methylnicotinamide, but not nicotinamide, administered intravenously into renovascular hypertensive rats developing electrically induced arterial thrombosis caused dose-dependent decrease of thrombus weight, collagen-induced platelet aggregation and plasma antigen/activity of plasminogen activator inhibitor - 1, without changing of occlusion time, routine coagulation parameters and plasma activity of tissue plasminogen activator. Indomethacin - an inhibitor of prostacyclin synthesis, completely abolished the antithrombotic and antiplatelet effect of N-methylnicotinamide, and the plasma level of 6-keto-PGF(1alpha) , prostacyclin metabolite, increased simultaneously with the inhibition of thrombus formation. Our study shows that N-methylnicotinamide via production/release of prostacyclin inhibits arterial thrombosis development. The antithrombotic effect of N-methylnicotinamide is accompanied by platelet inhibition and enhanced fibrinolysis, due to the decrease production of plasminogen activator inhibitor - 1.     

Antithrombotic effect of tissue and plasma type angiotensin converting enzyme inhibitors in experimental thrombosis in rats.

This study compared the antithrombotic effect of plasma angiotensin converting enzyme inhibitors (ACE-Is): captopril (CAP), enalapril (ENA) and tissue ACE-Is: perindopril (PER), quinapril (QUIN) in experimental venous and arterial thrombosis. Normotensive Wistar rats were treated p.o. with CAP (75 mg/kg), ENA (20 mg/kg), PER (2 mg/kg) and QUIN (3 mg/kg) for 10 days. The influence of ACE-Is on coagulation and fibrinolytic systems as well as platelet function was evaluated. The hypotensive effect of ACE-Is was equal in all groups. QUIN maintained the final carotid blood flow at the highest value in comparison to PER and plasma ACE-Is. The arterial thrombus weight was reduced in PER and QUIN groups while venous thrombus weight was also reduced after CAP. Tissue and plasma ACE-Is caused the inhibition of platelet adhesion and aggregation. A reduction of fibrin generation, prolongation of prothrombin time (PT), activated partial thromboplastin time (APTT) and shortening of euglobulin clot lysis time (ECLT) were observed after PER and QUIN treatment. In conclusion, given in equipotent hypotensive doses, tissue ACE-Is exerted more pronounced antithrombotic effect than plasma ACE-Is in experimental thrombosis. The differences between tissue and plasma ACE-Is in terms of their more pronounced inhibition of experimental thrombosis may be related to the intensified activation of fibrinolysis and inhibition of coagulation.     

The influence of Annexin32, a new Ca2+-dependent phospholipid-binding protein, on coagulation time and thrombosis

The pharmacodynamics of Annexin32, a new Ca2+-dependent phospholipid-binding protein, was studied by measuring coagulation time in rabbits and venous thrombosis in rabbits and rats. Rabbits and rats were given Annexin32 by intravenous administration. Then Kaolin partial thromboplastin time (KPTT), thrombosis in vitro and in vivo were assayed. The results showed that KPTT of rabbits was prolonged (p < 0.01), and the length and weight of thrombus in vitro were reduced (p < 0.01) after administration of Annexin32 at 1 mg/kg. It also inhibited thrombosis in vivo and reduced the weight of venous thrombus significantly in rats (p < 0.01). All these results suggested that Annexin32 possesses the characteristic of antithrombotic effect and fewer side effects on coagulation time.     

改善血栓形成新的药物组合物及其分子机制

目的：研究α1受体阻断药与山莨菪碱（Ani）形成的药物组合物改善血栓形成的作用及其分子机制。方法：离体大鼠尾动脉血管模型研究α1受体阻断药及其与山莨菪碱的药物组合物的扩血管效应,角又菜胶诱发小鼠尾部血栓模型研究组合物对抗血栓形成的作用及其机制。结果：α1受体阻断药中哌唑嗪（Pra）对血管环舒张率最大,达（82．6±8．9）％,作用强度最强,Ec50值为O．44μmol/L;山莨菪碱和哌唑嗪分别以不同剂量配伍组成组合物,能使角叉菜胶诱发的鼠尾血栓长度（啪）由24．6±4．6缩短到6．94-2．7,成栓率由86．6％下降到50．0％。上述新药物组合物能显著延长血栓小鼠血浆凝血酶原时间（er）,对活化部分凝血活酶时间（APTT）无影响;能抑制血栓小鼠血浆中组织型纤溶酶原激活剂（t-PA）、6-酮一前列腺素F1a（6．Keto．PGF1α）含量的降低和组织纤溶酶原激活剂抑制物-1（PAI-1）、血栓烷B2（TXB2）的增多;并不在于扩血管作用的进一步增强上。结论：山莨菪碱和哌唑嗪组成的药物组合物具有舒张外周血管和改善血栓形成的作用,其抗血栓形成机制分别与影响外源性凝血途径、抑制血小板的活化功能以及促进纤溶功能有关。     

Engineering of a staphylokinase-based fibrinolytic agent with antithrombotic activity and targeting capability toward thrombin-rich fibrin and plasma clots

Current clinically approved thrombolytic agents have significant drawbacks including reocclusion and bleeding complications. To address these problems, a staphylokinase-based thrombolytic agent equipped with antithrombotic activity from hirudin was engineered. Because the N termini for both staphylokinase and hirudin are required for their activities, a Y-shaped molecule is generated using engineered coiled-coil sequences as the heterodimerization domain. This agent, designated HE-SAKK, was produced and assembled from Bacillus subtilis via secretion using an optimized co-cultivation approach. After a simple in vitro treatment to reshuffle the disulfide bonds of hirudin, both staphylokinase and hirudin in HE-SAKK showed biological activities comparable with their parent molecules. This agent was capable of targeting thrombin-rich fibrin clots and inhibiting clot-bound thrombin activity. The time required for lysing 50% of fibrin clot in the absence or presence of fibrinogen was shortened 21 and 30%, respectively, with HE-SAKK in comparison with staphylokinase. In plasma clot studies, the HE-SAKK concentration required to achieve a comparable 50% clot lysis time was at least 12 times less than that of staphylokinase. Therefore, HE-SAKK is a promising thrombolytic agent with the capability to target thrombin-rich fibrin clots and to minimize clot reformation during fibrinolysis.     

The comeback of hirudin--an old-established anticoagulant agent

Early studies dating back to 1884 revealed that extracts from medicinal leeches contain a substance which is able to prevent blood from clotting. Since our successful isolation of hirudin, the pure anticoagulant substance, in the late 1950s and its characterization as a selective thrombin inhibitor with polypeptide structure, hirudin preparations have been employed for diagnostic and scientific uses in haemostaseology. As early as 25 years ago we have shown in experimental pharmacotoxicological studies that hirudin is an anticoagulant of high quality. The antithrombotic effect of hirudin was demonstrated in several thrombosis models. But the clinical use of hirudin remained limited since it was not available in adequate amounts for therapeutic purposes. One hundred years after its discovery there is a renewed interest in this naturally occurring thrombin inhibitor. Advanced methods of peptide isolation and genetic engineering are about to provide sufficient quantities of hirudin in purified form. This prompted us to resume our investigations in hirudin and to represent new experimental and clinical pharmacological studies with natural hirudin prepared from medicinal leeches and genetically engineered recombinant hirudin, thus appreciating the comeback of hirudin into the focus of interest.     

Design and synthesis of glycolic and mandelic acid derivatives as factor Xa inhibitors

A series of glycolic and mandelic acid derivatives was synthesized and investigated for their factor Xa inhibitory activity. These analogues are highly potent and selective inhibitors against fXa. In a rabbit deep vein thrombosis model, compound 26 showed significant antithrombotic effects (81% inhibition of thrombus formation) at 1.1 microM plasma concentration following intravenous administration.     

Synthesis and evaluation of 1,4-diphenylbutadiene derivatives as inhibitors of plasminogen activator inhibitor-1 (PAI-1) production

Butadiene-imide 1 (T-686) derivatives were synthesized and evaluated for their inhibitory activity against PAI-1 production and their ADMET (DMPK and toxicology) profiles. Among these derivatives, compound 15k (T-2639) showed good antithrombotic activity in two rat thrombosis models without affecting bleeding time, indicating reduction of haemorrhagic risk. We also describe in this report a practical synthesis of 15k suitable for scale-up using Z,E-selective Stobbe condensation.     

hVEGF165 和嵌合水蛭肽融合基因的构建、表达和活性检测

根据抗 PTCA 或支架后再狭窄的基因治疗需要多基因治疗的特点,用基因重组技术构建了 hVEGF165 和嵌合水蛭肽 (fused hirudin , FH) 融合基因,并克隆到真核表达载体 pcDNA3.0 中,通过脂质体介导将 pcDNA3.0/hVEGF165 - FH 转染到人内皮细胞株 (ECV304) 中, RT-PCR 及蛋白质印迹证明融合基因 hVEGF165 - FH 在 ECV304 细胞中得到表达 ( 分子质量为 24 ku 左右 ). 通过体外活性检测——— MTT 法检测 hVEGF165 - FH 对 ECV304 细胞增殖的影响,通过体外血管生成分析 hVEGF165 - FH 对内皮细胞株 ECV304 增殖的影响 . 通过体外抗栓活性检测,表明表达产物具有促进内皮细胞株增殖及加快血管生成的作用,同时显著抑制了 ADP 诱导的血小板聚集率 (P < 0.05) 并显著延长 APTT 和 TT (P < 0.05) . 实验结果表明,融合基因在内皮细胞株中得到表达,表达的融合蛋白具有 hVEGF165 和嵌合水蛭肽 (FH) 的双重活性,这为以后的融合基因治疗再狭窄的动物实验打下了良好基础 .