Synergy of in vitro Thrombolytic Action of Combinations of Recombinant Staphylokinase and Single-Chain Urokinase-Type Plasminogen Activator

Kinetics of lysis of human plasma clots immersed in plasma were studied in vitro at 37°C under the influence of recombinant staphylokinase, single-chain urokinase-type plasminogen activator (scu-PA), and their simultaneous and consecutive combinations. Staphylokinase and scu-PA caused concentration- and time-dependent lysis of the clots; 32 nM staphylokinase and 75 nM scu-PA separately caused 50% lysis in 4 h. At these equally effective concentrations staphylokinase in 4 h induced a significantly lesser exhaustion of the plasma plasminogen, ₂-antiplasmin, and fibrinogen than scu-PA. Combinations of staphylokinase (<30 nM) and scu-PA (<75 nM) rendered synergic thrombolytic action on the clots. The synergy of thrombolytic action was more pronounced on the simultaneous addition of the two agents than on their consecutive addition, scu-PA 30 min after staphylokinase. In 4 h after the addition, staphylokinase (25 nM) or scu-PA (15 nM) induced 24% and 2% lysis, respectively, whereas the simultaneous and consecutive combination of the same concentrations of these agents induced 58% and 50% lysis, respectively. The simultaneous combination of 15 nM staphylokinase and 15 nM scu-PA resulted in maximal 3.8-fold increase in the thrombolytic effect as compared to the expected total effect of the individual agents. Synergic combinations of the two agents caused lesser exhaustion of plasma plasminogen, ₂-antiplasmin, and fibrinogen as compared with the expected total effect of these agents used separately. Thus, simultaneous and consecutive combinations of staphylokinase and scu-PA in a relatively narrow range of their concentrations possessed synergistic fibrinselective thrombolytic action on the plasma clot in vitro.     

Circadian rhythms may not influence the outcomes of thrombolysis in patients with ischemic stroke: A study from China

ABSTRACT

Circadian rhythms can affect physical or mental activities as well as the time of stroke onset. The impact of circadian rhythms on acute ischemic stroke (AIS) patients treated by recombinant alteplase (rt-PA) is still incongruent. This study aims to consider whether the outcomes of thrombolysis differ depending on stroke onset time and rt-PA infusion time in patients with AIS. A total of 447 AIS patients, who underwent rt-PA intravenous infusion within 4.5 hours after stroke onset, were enrolled in this study consecutively from June 2010 through December 2016. All of the patients were grouped based on the stroke onset time and rt-PA infusion time into two exact 12-hour intervals as daytime (06:01–18:00) and nighttime (18:01–06:00) and further divided into four subgroups at 6-hour time intervals (00:01–06:00, 06:01–12:00, 12:01–18:00 and 18:01–24:00). Major neurological improvement at 1 hour, 24 hours and 7 days, 7-day mortality rate and 24-hour hemorrhage transformation was recorded. The results showed that a total of 295 patients (66.4%) appeared with AIS and 252 (56.4%) were treated during daytime. Higher NIHSS at admission was observed when stroke occurred in nighttime, especially during 00:01–06:00. Patients with stroke onset in nighttime especially during 18:01–24:00 had a significant shorter onset-door time and onset-needle time. No differences of the major neurological improvement at 1 hour, 24 hours and 7 days, 24-hour hemorrhagic transformation and 7-day fatality rate were found among either 12-hour time frames or 6-hour time frames according to the time of stroke onset or rt-PA infusion. In conclusion, there was no evidence to predict that circadian rhythms could influence the outcomes of AIS patients treated with rt-PA in China, although stroke onset during nighttime might aggravate neurological impairment before treatment. Further, multicenter and prospective clinical trials with larger number of subjects are still needed to draw more reliable conclusions.     

叶下珠有效部位的溶栓作用及其对PAI-1和tPA活性的影响

采用改良的Charlton和Tomihisa等方法评价叶下珠植物(Phyllanthus urinaria)含corilagin的水溶性有效部位(代号PUW)对电刺激大鼠颈动脉血栓的溶栓作用;应用发色底物方法测定PUW在体内外对血浆tPA、血浆或血小板释放的PAl-1活性的影响。结果显示,5mg／kg的PUW,其再通率为50％,再栓率为60％;10mg／kg PUW的血管再通率为60％,其再栓率为33．3％,低于2万U／kg尿激酶42．9%的再栓率。再通后1h内,血管开放状态表现为,2万U／kg尿激酶组的血管开放状态与5mg／kg PUW组的相似;10mg／kg PUW组,其持续再通率高于2万U／kg的尿激酶组。PUW在体外或静脉注射均明显降低血浆PAI—1活性,同时提高血浆tPA的活性;PUW静注还明显抑制血小板释放的PA1-1活性。本实验结果提示,PUW静脉注射显著提高闭塞颈动脉的再通率,同时降低再通后颈动脉的再栓率;抑制PAI—1活性,同时提高tPA的活性可能是PUW具有较好溶栓作用的分子机制。     

Solitaire AB支架取栓联合动脉溶栓治疗急性缺血性脑卒中的临床疗效

目的:探讨Solitaire AB支架取栓联合动脉溶栓治疗急性缺血性脑卒中的临床疗效。方法:收集2014年8月至2016年8月我院收治的15例急性缺血性脑卒中患者,进行Solitaire AB支架取栓联合动脉溶栓治疗,通过评价患者治疗前后的美国国立卫生研究院卒中量表评分(NIHSS评分)比较治疗效果,通过评价患者随访期间的改良Rankin评分(m RS)和哥拉斯哥昏迷评分(GCS)比较预后情况。结果:15例患者通过动脉溶栓联合1~3次Solitaire AB取栓后,14例患者均达到部分或完全再通,1例患者因生命体征不稳而终止取栓手术,再通率为93.3%。患者出院时NIHSS评分为(4.33±1.45),显著低于术前的(12.93±4.25)(P0.05)。15例患者均通过3个月的术后随访,改良Rankin(m RS)评分均显示良好,其中2例为2分,5例为1分,8例为0分。所有患者均未发生血管再闭塞等相关并发症。结论:Solitaire AB支架取栓联合动脉溶栓治疗急性缺血性脑卒中的临床效果良好且安全性高。     

超选择性动脉溶栓治疗急性大脑中动脉脑梗死的疗效和安全性评价

目的:探讨超选择性动脉溶栓治疗急性大脑中动脉脑梗死的疗效和安全性。方法:收集我院就诊或住院治疗的120例急性大脑中动脉脑梗死患者,随机分为实验组和对照组,每组60例。两组患者入院后均给予相应的治疗措施,对照组患者给予静脉溶栓;实验组患者给予超选择动脉溶栓,观察并比较两组患者治疗前后神经功能缺损评分(NIHSS)以及患者治疗后临床疗效和并发症发生率。结果:与治疗前相比,两组患者治疗后的NIHSS水平均下显著降差异具有统计学意义(P0.05);与对照组相比,实验组患者的NIHSS水平、并发症的发生率和病死率较低而治疗有效率较高差异均具有统计学意义(P0.05)。结论:超选择性动脉溶栓治疗急性大脑中动脉脑梗死的临床疗效以及安全性较静脉溶栓更好。     

The extraction effect of ultrasound during plasma clot disruption

The products of the plasma clot destruction by the low-frequency ultrasound (US) were analyzed using the combination of SDS gel-electrophoresis, gel filtration chromatography and scanning electron microscopy. It was found that US (27 kHz) did not cause activation of the plasmin system or covalent bonds cleavage in the fibrin molecules. At US intensities less than 21.6 W/cm² there was extraction of blood serum proteins, which are located in the pores of the fibrin network. The increase in intensity of ultrasonic action resulted in protofibril dissociation, which was accompanied by further release into the solution of the blood serum proteins, located inside fibrin fibers. After US cavitation protein extracted from the plasma clot underwent aggregation. Interaction between free protofibrils resulted in formation of insoluble fibrin particles.     

Cardiovascular and Renal Outcomes With Sodium-Glucose Cotransporter-2 Inhibitors and Dipeptidyl Peptidase-4 Inhibitors Combination Therapy: A Meta-Analysis of Randomized Cardiovascular Outcome Trials

ObjectiveThe cardiovascular (CV) and renal benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in people with type 2 diabetes are well known. However, similar beneficial effects of SGLT2i in combination with dipeptidyl peptidase-4 inhibitors (DPP4i) are unknown. It is of interest to explore a trial-level meta-analysis to fill this knowledge gap.MethodsA literature search was conducted in the PubMed and Embase databases until January 31, 2023. All CV outcome trials (CVOTs) reporting the CV and renal outcomes of SGLT2i with or without background DPP4i therapy against the placebo were retrieved. A meta-analysis was subsequently conducted by applying the inverse variance-weighted averages of pooled logarithmic hazard ratio using primarily random-effects analysis.ResultsThis meta-analysis showed that the beneficial 3-point major adverse cardiovascular events composite (3 CVOTs; N = 32 418), the composite of CV death or heart failure hospitalization (hHF) (4 CVOTs; N = 37 687), hHF (3 CVOTs; N = 27 545), CV death (4 CVOTs; N = 34 565), and renal outcomes (2 CVOTs; N = 25 406) with SGLT2i were similar with or without background DPP4i therapy against the placebo (P_{heterogeneity} = .71, .07, .87, .72, and .25; respectively). However, against the placebo, the summary estimates for the 3-point major adverse cardiovascular events composite, hHF, and renal outcomes were stronger with SGLT2i alone, whereas the summary estimates for CV death or hHF composite were larger with SGLT2i with background DPP4i therapy.ConclusionBeneficial CV and renal effects of SGLT2i are similar against the placebo regardless of background DPP4i therapy.     

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.