(Circulation. 1995;92:3032-3040.)
© 1995 American Heart Association, Inc.
Articles |
New Variant of Human Tissue Plasminogen Activator (TPA) With Enhanced Efficacy and Lower Incidence of Bleeding Compared With Recombinant Human TPA
From the Division of Cardiology (C.R.B., R.P.), Department of Internal Medicine, University of Texas Health Science Center, Houston, and the Department of Cardiovascular Research at Genentech, Inc, South San Francisco, Calif.
Correspondence to C.R. Benedict, MD, Department of Internal Medicine, Division of Cardiology, University of Texas Medical School, 6431 Fannin MSB 6.039, Houston, TX 77030.
Background The thrombolytic properties of a new variant of tissue plasminogen activator (TPA) (T103N, N117Q, KHRR 296-299 AAAA, or TNK-TPA) with longer plasma half-life, greater fibrin specificity, and increased resistance to inhibition by plasminogen activator inhibitor (PAI-1) were investigated in a rabbit thrombosed carotid artery model.
Methods and Results After 60 minutes of arterial
occlusion, TPA (1.5, 3.0, 6.0, or 9.0 mg/kg as a front-loaded IV
infusion for 90 minutes; n=22) or TNK-TPA (0.38, 0.75, or 1.5 mg/kg as
IV bolus; n=16) was administered. Blood flow through the artery was
monitored for an additional 120 minutes. Bleeding was assessed by
weighing the amount of blood absorbed in a gauze pad placed in a
subcutaneous muscular incision. Recanalization
rates and duration of recanalization were dose
dependent. The doses that produced >80%
recanalization rates with the longest duration of
recanalization were 9.0 mg/kg for TPA and 1.5 mg/kg
for TNK-TPA. At these doses, time to reperfusion (mean±SEM) was
significantly faster (11±2 versus 23±7 minutes) and duration of
recanalization longer (77±9 versus 51±18 minutes)
for TNK-TPA compared with TPA (P<.025). Weights of the
residual thrombi of the TPA group were greater than those of the
TNK-TPA group (P=.004). Concentrations of fibrinogen,
plasminogen, and 
2-antiplasmin at 120
minutes were significantly higher for TNK-TPA–treated animals compared
with TPA-treated animals (P<.001). ANOVA of the blood loss
data determined that there were significant differences between
thrombolytic agents but not between doses. After correction
for saline controls, total blood loss for pooled doses of TPA and
TNK-TPA was 82±6 mg and 40±4 mg, respectively
(P<.01).
Conclusions From these data, we conclude that TNK-TPA, given as a bolus, produces faster and more complete recanalization of occluded arteries in a rabbit experimental model compared with TPA, without increasing systemic plasmin generation or peripheral bleeding. In addition, we observed that TNK-TPA, unlike TPA, did not potentiate collagen-induced aggregation of platelets obtained from human plasma. This lack of effect on platelet aggregation by TNK-TPA potentially could be associated with a decreased risk of reocclusion after successful thrombolysis.
Key Words: thrombolysis • plasminogen activators • occlusion • blood flow
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