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Submitted on November 7, 2001
Revised on February 26, 2002
Accepted on February 26, 2002
From the Vascular Research Laboratory (J.-N.L., Z.S., V.G.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; the Institute of Molecular Medicine (J.-N.L., J.-X.L., B.L., Z.S., P.Z., J.Z., Y.C.), Nanjing University, Nanjing, China; and Suzhou Medical College (J.-X.L., J.-L.Z.), Suzhou, China.
* To whom correspondence should be addressed. E-mail: jnliu{at}prodigy.net.
Prourokinase (proUK) is a zymogenic plasminogen activator that at pharmacological doses is prone to nonspecific activation to urokinase. This has handicapped therapeutic exploitation of its fibrin-specific physiological properties. To attenuate this susceptibility without compromising specific activation of proUK on a fibrin clot, a Lys300
His mutation (M5) was developed. M5 had a lower intrinsic activity and, therefore, remained stable in plasma at a 4-fold higher concentration than did proUK. M5 had a higher 2-chain activity and induced more rapid plasminogen activation and fibrin-specific clot lysis in vitro. Sixteen dogs embolized with radiolabeled clots were infused with saline, proUK, tissue plasminogen activator, or M5. The lower intrinsic activity allowed a higher infusion rate with M5, which induced the most rapid and efficient clot lysis (50% clot lysis by
600 µg/kg M5 versus
1200 µg/kg proUK). In association with this, M5 caused neither a significant increase in the primary bleeding time nor secondary bleeding (total blood loss). By contrast, these measurements increased 4-fold and 5-fold, respectively, with proUK and >5-fold and 8-fold, respectively, with tissue plasminogen activator. Clot lysis by M5 and hemostasis were further evaluated in 6 rhesus monkeys. M5 again induced rapid clot lysis without a significant increase in the primary bleeding time, and secondary bleeding did not occur. In conclusion, a site-directed mutation designed to improve the stability of proUK in blood at therapeutic concentrations induced superior clot lysis in vitro and in vivo without causing significant interference with hemostasis.
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