Article Text

Download PDFPDF

Thrombolysis: newer thrombolytic agents and their role in clinical medicine
Free
  1. T K Nordt1,
  2. C Bode2
  1. 1Katherinenhospital, Stuttgart, Germany
  2. 2Department of Cardiology, University of Freiburg, Freiberg, Germany
  1. Correspondence to:
    PD Dr Thomas Nordt
    Katharinenhospital, Kriegsbergstrasse 60, 70174 Stuttgart, Germary; t.nordt{at}katharinenhospital.de

Statistics from Altmetric.com

Reperfusion treatment in acute myocardial infarction represents the main indication for thrombolytic therapy. The most common thrombolytic agents have been streptokinase (first generation thrombolytic agent) and alteplase (tissue type plasminogen activator, t-PA, second generation thrombolytic agent). In the meantime third generation thrombolytic agents have reached clinical practice. Many of them are derivatives of alteplase, the current gold standard for thombolytic therapy in acute coronary syndromes with ST segment elevation. The most prominent among them are reteplase, tenecteplase, and lanoteplase.

RETEPLASE

Reteplase (recombinant plasminogen activator, r-PA) is a single chain deletion mutant of alteplase that is expressed in Escherichia coli and, therefore, is expressed as an unglycosylated protein (table 1, figs 1 and 2). Reteplase includes 355 amino acids with a total molecular weight of 39 kDa. The molecule consists of cringle 2 and the protease domain of the alteplase molecule. Because of the deletion of the fibronectin finger region, the binding of reteplase to fibrin is significantly reduced in comparison with that of alteplase. Although kringle 2 (known to stimulate protease in the presence of fibrin) is part of the reteplase molecule, reteplase is stimulated in the presence of fibrin to a lower extent than alteplase, suggesting that the fibronectin finger is involved in the stimulation of the protease as well. Reteplase, in comparison with alteplase, is characterised by reduced fibrin selectivity. In the abscence of fibrin, reteplase and alteplase do not differ with respect to their activity as plasminogen activators, nor do they differ with respect to their inhibition by the plasminogen activator inhibitor type 1 (PAI-1).

View this table:
Table 1

Alteplase: structure of the molecule and function of its components

Figure 1

Alteplase.

Figure 2

Reteplase.

The elimination of reteplase from the circulating plasma predominantly occurs in the liver. Because of the deletion of the fibronectin finger region, the epidermal growth factor domain and kringle 1, as …

View Full Text

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Miscellanea
    BMJ Publishing Group Ltd and British Cardiovascular Society