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For personal use only. 1992 79: 1213-1217 Thrombolytic properties of Desmodus rotundus (vampire bat) salivary plasminogen activator in experimental pulmonary embolism in rats W Witt, B Baldus, P Bringmann, L Cashion, P Donner and WD Schleuning Updated information and services can be found at: http://www.bloodjournal.org/content/79/5/1213.full.html Articles on similar topics can be found in the following Blood collections Information about reproducing this article in parts or in its entirety may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#repub_requests Information about ordering reprints may be found online at: http://www.bloodjournal.org/site/misc/rights.xhtml#reprints Information about subscriptions and ASH membership may be found online at: http://www.bloodjournal.org/site/subscriptions/index.xhtml Blood (print ISSN 0006-4971, online ISSN 1528-0020), is published weekly by the American Society of Hematology, 2021 L St, NW, Suite 900, Washington DC 20036. Copyright 2011 by The American Society of Hematology; all rights reserved. From www.bloodjournal.org by guest on November 7, 2014. For personal use only. Thrombolytic Properties of Desmodus rotundus (vampire bat) Salivary Plasminogen Activator in Experimental Pulmonary Embolism in Rats By Werner Witt, Berthold Baldus, Peter Bringmann, Linda Cashion, Peter Donner, and Wolf-Dieter Schleuning * rDSPA,, (recombinant Desmodus salivary plasminogen activator al)is a recombinant protein corresponding to a natural plasminogen activator from the vampire bat Desmodusrotundus. The thrombolytic properties of rDSPA-, and tissue-type plasminogen activator (SPA) were compared in a rat model of pulmonary embolism. Whole blood clots, produced in vitro and labeled with '%fibrinogen, were embolized into the lungs of anesthetized rats. Thrombolysis was calculated from the difference between initial clot radioactivityand that remaining in the lungs at 60 minutes. Blood was sampled for gamma counting, measurement of hemostatic factors, and plasminogen activator antigen levels. Thrombolysis at 3,10, 30,and 100 nmol/kg intravenously (10% bolus, 90% over 60 minutes) amounted to 30% 2%. 51% f 4%, 85% 2 4%. 98% f 0% for rDSPAa,and 30% f 3%. 41% f 3%. 57% f 6%, 93% -e 2% for t-PA (controls: 29% -C 2%; mean f SEM, n 2 6).t-PA at 100 nmol/kg significantly decreased fibrinogen, plasminogen, and q-antiplasmin levels by 33% f 7%. 38% 2 8%. and 61% 2 9%. whereas rDSPA,, at 100 nmol/kg only lowered q-antiplasmin significantly (by 29% f 6%). T nary embolism in rats. rDSPA,, is more potent and more fibrin-specific in vivo than t-PA at doses that achieve full thrombolytic efficacy. There is also evidence that rDSPA,, may lyse blood clots faster and more completely in vivo than t-PA. The in vivo results reported here confirm the in vitro data previously obtained by other investigators (see Discussion) and exhibit some additional interesting features that may further improve the profile of this new thrombolytic agent. HE INITIAL anticipation that the safety of thrombolytic therapy would improve with the introduction of human tissue-type plasminogen activator (t-PA) has not been fulfilled in clinical trials.' The expectation that bleeding episodes might be reduced with t-PA was based on early in vitro and experimental animal work which suggested that t-PA, unlike other clinically available thrombolytics, would not deplete coagulation factors in effective thrombolytic doses.*-4These experimental findings were interpreted as the result of the enhancement of t-PA-mediated plasminogen activation in the presence of fibrin: Unfortunately, a strict fibrin-specific (clot-specific) plasminogen activation is limited to low doses (low plasma levels) of t-PA in vivo. However, at higher plasma levels that are necessary to achieve satisfactory clinical results in patients with myocardial infarction, the limitation of plasmin formation to the presence of fibrin on the clot surface is lost and systemic plasminogen activation occurs that leads to plasminemia and subsequent degradation of coagulation factors like fibrinogen.' The lack of a strict fibrin specificity under clinically relevant conditions may explain the failure of t-PA to reduce bleeding. Furthermore, it has been suggested that all fibrinolytic agents, which reduce systemic plasminogen levels, may also show a reduced thrombolytic efficacy.6 The intensive search for new and safer plasminogen activators with increased clot specificity has shown no major breakthrough until recently, when a series of reports described the isolation, cloning, and characterization of a new class of plasminogen activators derived from saliva of the vampire bat Desmodus rotund~s.'-'~ A family of four Desmodus plasminogen activators encoded by four distinct genes has been discovered." Although there is striking structural homology of these bat plasminogen activators to human t-PA, their fibrin specificity is greatly increased in comparison with t-PA. Most interesting, the increased fibrin dependence of bat plasminogen activators does not correlate with fibrin binding because the two smaller forms of the family actually have no fibrin affinity.' In this study we demonstrate that rDSP&,, the recombinant protein corresponding to one of the two larger natural plasminogen activator forms ( a l ,a2)from Desmodus, is an effective thrombolytic agent in vivo in experimental pulmoBlood, Vol79, No 5 (March I),1992: pp 1213-1217 Compared with t-PA, rDSPk, is the more potent and more clot selective (fibrin specific) thrombolytic agent. These results suggest that rDSPA,, may be safer and more efficacious than currently used thrombolytics. o 1992 by The American Society of Hematology. MATERIALS AND METHODS Animal model. The method is based on that described by Clozel et al.'* Normotensive male Wistar rats (320 to 400 g) were anesthetized with 90 mg/kg i.p. pentobarbitone sodium. Blood was withdrawn from a carotid artery catheter and anticoagulated with 3.18% sodium citrate solution (9 + 1 vol + vol). One milliliter of citrated whole blood + 40 FL (about 1.5 x lo5 Bq) radiolabeled fibrinogen (3.4 MBq/mg '*'I-fibrinogen; Amersham, Buckinghamshire, England) was then clotted by the addition of 20 p,L (500 mmol/L) calcium and 30 FL thromboplastin (Thromborel; Behring, Marburg, Germany) in a silicone catheter (0.058 in. ID). The clot was then aged for 2 hours at 37°C including the time for withdrawal from the catheter and careful washing in warm saline to remove '"I-fibrinogen not bound to the clot. Thereafter, 12-mm pieces of the clot (about 3 x lo3 Bq) were counted in a gamma counter, aspirated into the tip of a polyethylene catheter (PE205), and injected into the left external jugular vein. The clot was flushed into the venous circulation with 0.5 mL warm saline. Embolization into the lungs was successfully achieved in all but three animals, which did not show radioactivity in the lungs nor in blood at any time and were therefore excluded. Immediately after clot injection thrombolytic treatment was started and continued for 1 hour, From the Research Laboratories of ScheringAG, Berlin, Germany; and Berlex Biosciences, Brisbane, CA. Submitted July 23, 1991; accepted October 23, 1991. Address reprint requests to Wemer Witt, PhD, Laboratory for Thrombosis Research, CardiovascularPharmacology, Schering AG, Miillerstr. 170-178, lo00 Berlin 65, Germany. The publication costs of this article were defrayed in pari by page charge payment. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. section 1734 solely to indicate this fact. 0 I992 by The American Society of Hematology. 0006-497119217905-0025$3.00/0 1213 From www.bloodjournal.org by guest on November 7, 2014. For personal use only. WlTT ET AL 1214 during which blood samples for radioactivity measurement were withdrawn (0, 10, 20, 40, and 60 minutes). Before the treatment period and at the end (60 minutes) blood samples were taken to obtain plasma for determination of hemostasis factors and plasminogen activator antigen levels (see below). The heart and lungs were then removed and residual radioactivity was counted. Thrombolysis was determined as the remaining radioactivity in the lungs divided by that injected with the clot. Whole blood samples (200 pL) were used for gamma counting of radioactivity. Plasma was obtained from 400 pL of whole blood to which 40 p L of 3.16% sodium citrate and 50 pL of 10 pmol/L PPACK (Calbiochem, La Jolla, CA) were added to stabilize the plasma against proteolytic degradation. All plasma samples were stored frozen at -80°C. Hemostasis factors. Plasma fibrinogen was measured as clottable protein according to the method of Clauss.'' Plasminogen and %-antiplasmin were determined on microtiter plates using the chromogenic substrate S-2251 (KabiVitrum, Munich, Germany) and expressed as percentage of that in normal pooled rat plasma. For comparisons among groups, the percent changes from initial values were calculated from the original data. Plasminogen activator antigen determinations. r D S P 4 , antigen levels in rat plasma were determined using a sandwich enzymelinked immunosorbent assay (ELISA) employing biotinylated rabbit anti-rDSPAal antibodies. This assay had a linear range expanding from 2 ng/mL to 100 ng/mL with a lower detection limit of 1 ng/mL. t-PA antigen concentrations in rat plasma were also determined by ELISA using a commercially available kit (Biopool, Umea, Sweden). Plasminogen activators. Each dose of plasminogen activator was administered in 2 mL of isotonic saline. Ten percent of the total volume was injected as an intravenous (IV) bolus followed by the remaining 1.8 mL infused over 1hour. r D S P 4 , was produced by heterologous expression of its cDNA in CHO cells. The entire cDNA clone was subcloned into the expression plasmid pSVLRI." Transfection of dhfr-CHO cells was performed according to Chen and 0 k a ~ a m a . Transfectants l~ were screened for producers by fibrin plate assay and immediately subcloned in a MEM (minimum essential medium) containing increasing amounts of methotrexate. Methotrexate treatment led to substantial amplification of expression levels and one clone was grown in a small bioreactor for fermentation. Purification of the recombinant protein was achieved by affinity chromatography on immobilized Erythrina trypsin inhibitor followed by ion exchange chromatography on a Mono S resin. The purity of isolated rDSPA,, was determined by RP-HPLC, gel electrophoresis, and N-terminal sequence identity. Its apparent molecular weight was assessed to be 52,000 Kd. Bioactivity was measured on fibrin plates and expressed as t-PA units by comparison to the activity of the international standard preparation of t-PA (86/670). Specific activity was estimated as 330,000 U/mg protein using amino acid composition for determination of mass. A commercial recombinant t-PA preparation registered for clinical use (Actilyse) was purchased from Thomae (Biberach, Germany). Its specific activity on fibrin plates was determined as 1,000,000 U/mg. Statistics. All data were presented as means ? SEM. For comparisons of single doses versus control and equimolar doses of the two plasminogen activators, multiple t-tests (two-tailed, a = .05 per comparison) were used. A comparison of the dose-response relationships (thrombolytic effects, lung radioactivity) was performed by means of linear regression and analysis of covariance. To get linear logdose-response relationships logarithms of percent lysis values (see below) were taken and the highest dose of rDSP4, was excluded. Parallel lines fitted did not show a deviation from the hypothesis of parallelism (a= .05) and their distance differed significantlyfrom zero (a = .05). RESULTS Thrombolysis (lung radioactivity). rDSP&, and t-PA at 3 to 100 nmol/kg IV diminished thrombus radioactivity in a dose-dependent manner achieving significance over controls at total doses 2 10 nmol/kg (Fig 1,Table 1). Spontaneous thrombolysis in controls amounted to 28.5% 2 1.5% (n = 13). At 10 and 30 nmol/kg rDSPA,, was significantly more effective than equimolar doses of t-PA, achieving 50.7% ? 3.7% and 85.0% f 3.8% lysis for rDSP&, and 40.7% 2 3.0% and 56.7% 2 6.1% for t-PA, respectively (n = 6 to 8). Regression analysis (see above) showed that rDSPAmlwas significantly more potent than t-PA, 2 times on a molar and 2.5 times on a weight basis. Time course of blood radioactivig. Mean peak levels of whole blood radioactivity increased in a dose-dependent manner for rDSPA, and t-PA (Fig 2, Table 1). Usually in controls, as well as at doses up to 30 nmol/kg, the blood radioactivity increased to a maximum at 60 minutes after the start of (plasminogen activator) infusion. However, with 100 nmol/kg t-PA or rDSP4, the maxima of mean blood radioactivity were already reached at 40 or 20 minutes, respectively (Fig 2). In six of six animals receiving 100 nmol/kg rDSPA, the early maximum in blood radioactivity was followed by a decrease, whereas for the same dose of t-PA this was seen in only three of eight rats, namely the three animals that showed the highest lytic efficacy. Although the extent of thrombolysis measured by lung radioactivity was slightly higher with 100 nmol/kg rDSPA,, compared with the equimolar dose of t-PA, peak blood counts were more than 50% lower in the case of rDSPA,. Estimated from peak blood counts at 100 nmol/kg and assuming a total blood volume of 50 ml/kg in rats, about 21% of the initial clot radioactivity was recovered in the blood with rDSP&,, 43% with t-PA. O * 3 10 PA-doae 30 100 [nmol/kg i.v.1 Fig 1. Thrombolytic effects of 3,10,30, and 100 nmol/kg IV (10% bolus, 90%/ 60 min) rDSP4, and t-PA in pulmonary embolism in rats. Percentagethrombolysis was calculated from the difference between initial radioactivityof the thrombus and that remaining in the lungs at 60 minutes. Asterisks refer to significance versus control (a= .05, multiple t-test; mean ? SEM,n = 6 to 8, control n = 13). From www.bloodjournal.org by guest on November 7, 2014. For personal use only. THROMBOLYTIC PROPERTIES OF rOSPA,, 1215 Table 1. Plasma Levels, Thrombolysis, and Peak Blood Radioactivitv Levels Control rDSPA,, t-PA Dose (nmollkg) Plasma Level 3 10 30 100 3 10 0.3 ? 0 0.8 ? 0.1 3.7 f 0.2 9.7 f 0.6 0.2 2 0.1 0.3 f 0 1.2 f 0.1 7.5 f 2.1 (wlmL) 0 30 100 r' + rD@PAal 0 Thrombolysis Peak Levels of (lung radioactivity) Blood Radioactivity (04 (cf" 28.5 2 1.5 29.8 f 2.4 50.7 f 3.7*t 85.0 ? 3.8't 98.4 f 0.2' 29.9 f 2.9 40.7 2 3.0* 56.7 2 6.1' 92.5 f 1.5* I t-PA o Control loot 65 ? 3 80 f 10 103 f 9 180 2 18*t 245 f 34*t 72 f 6 97 2 11 121 2 17' 539 f 36' O Values represent mean 2 SEM of n = 6 to 8 (control n = 13) animals per group; blood radioactivity reflects mean of individual peaks (Fig 2 shows means at a given time). 'Significant versus control. tsignificant versus equimolar dose of t-PA (LT= .05 per comparison, multiple t-test). 0 100 1000 10000 PA - pleama l e v e l a t 6 0 min [ng/ml] Fig 3. Thrombolytic effects of 3, 10,30, and 100 nmol/kg IV (10% bolus, 90%/60 min) rDSPk, and t-PA in pulmonary embolism in rats. Percentagethrombolysis was calculated from the difference between initial radioactivityof the thrombus and that remaining in the lungs at 60 minutes. Instead of dose, like in Fig 1, abscissa shows (mean) plasma levels (mean 2 SEM, n = 6 to 8, control n = 13). Plasminogen activator antigen levels. The plasma levels of both rDSPA,, and t-PA measured at 60 minutes increased in a dose-dependent manner up to means of 9.7 Fg/mL and 7.5 pg/mL for 100 nmol/kg rDSPA,, and t-PA, respectively (Table 1). The dose-response curves of thrombolysis (lung radioactivity) versus mean plasma levels (instead of total dose as in Fig 1) at 60 minutes show both plasminogen activators to be approximately equipotent (Fig 3). At equimolar doses mean plasma levels were 1.5, 2.7, 3.1, and 1.3 times higher for rDSPA,, at 3, 10, 30, and 100 nmol/kg, respectively. Hemostasis factors. qAntiplasmin levels measured at the end of the treatment period (60 minutes) decreased significantly at 100 nmol/kg of either rDSPAm,or t-PA (Table 2). In contrast, neither plasma fibrinogen nor plasminogen concentrations changed significantly with r D S P 4 , up to 100 nmol/kg, while the same dose of t-PA depleted fibrinogen and plasminogen levels significantly by 33% 2 7% and 38% 2 8%, respectively (n 2 6). agent in vivo. r D S P 4 , is 2.5 times more potent than t-PA (by mass). However, at equal antigen plasma levels both plasminogen activators have a comparable thrombolytic potency, ie, their specific activity in vivo (thrombolytic activity/plasma level) is about equal. The higher plasma levels for rDSPA,, compared with t-PA at 60 minutes indicate different pharmacokinetic profiles of the two plasminogen activators. Indeed, preliminary pharmacokinetic studies in rats and dogs show that rDSPA,, has a longer @-eliminationhalf-life and a slower clearance than t-PA (unpublished results). Hence, infusion of rDSPA,, could lead to higher steady-state plasma levels, which would then account for the observed differences in effectiveness of equimolar doses of rDSPA,, and t-PA. The pulmonary lung embolism model in rats described here is highly reproducible. Therefore, even the small difference in potency between t-PA and rDSPA,, becomes significant. The rate of spontaneous thrombolysis in controls, which is stable and acceptably low, has been shown to be due to release of endogenous t-PA in the lungs." A specific advantage of this model is that full effectiveness of t-PA is only achieved at doses where clot specificity is lost, DISCUSSION Desmodus rotundus plasminogen activator rDSPA,, has previously been shown to be a potent plasminogen activator in vitro with a markedly higher fibrin specificity than t-PA.'' We now report that rDSPA,, is a very effective thrombolytic rD@PAa1 t-PA - 500 V 400 v I 2 V I v 5 300 " 0 .( 3 nmol/kg 10 nmol/kg 30 nmol/kg 100 nmol/kg 0 3 nmol/kg 10 nmol/kg 30 nmol/kg 100 nmol/kg 200 Fig 2. Time course of blood radioactivity during thrombolysis with 3 to 100 nmol/kg IV (10% bolus, 90%/60 min) rDSPA,, and t-PA in rats with radiolabeled pulmonary emboli. Ordinate gives radioactivity in 200 CL whole blood (cpm = counts per minute; mean f SEM, n = 6 to 8, control n = 13). L -8 W 100 m n o IO 20 30 min 40 50 60 a io 20 30 min 40 50 60 From www.bloodjournal.org by guest on November 7, 2014. For personal use only. 1216 WlTT ET AL Table 2. Decrease in HemostasisParameters Control rDSPA,, t-PA Dose (nmollkg) Fibrinogen Plasminogen (Oh) W) 30 100 823 15 1 2* 924 332 7t 723 30 100 225 324 9 2 6’ 9-t5 38 -t 8t a,-Antiplasmin (Oh) -5 13 12 2 5 29 2 6*t 615 61 2 9 t Values represent percentage decrease (at 60 minutes) from initial values of hemostasis parameters; mean 2 SEM of n = 6 to 8 (control n = 13)animals per group. *Significant versus equimolar dose of t-PA (a= 0.05 per comparison, multiple t-test). tsignificant versus control. and systemic plasminogen activation and consumption of coagulation factors (fibrinogenolysis) are induced. This is very similar to the clinical usage of t-PA in patients with myocardial infarction, although fibrinogenolysis in humans appears to occur at lower plasma levels than in rats.’.’’ In contrast to t-PA, rDSPA,, seems to activate clot-bound plasminogen only because it neither depletes circulating plasminogen nor induces fibrinogenolysis in the dose range tested. The observed decrease in %-antiplasmin levels probably reflects inhibition of clot-bound plasmin or plasmin liberated from the clot during thrombolysis. Therefore, these results confirm in vivo the higher fibrin specificity of rDSPA,, observed in vitro. The elevation of blood radioactivity during thrombolysis indicates release of fibrin degradatiotl products (FbDP) from the radiolabeled clot. Up to doses of 30 nmol/kg, ie, in the suboptimal dose range, peak radioactivity levels in the blood are consistently attained at the end of the treatment period (60 minutes) for both rDSPA*, and t-PA. Using 100 nmol/kg of both agents, nearly complete thrombolysis was achieved in most animals. When clot lysis is complete, clearance of FbDP from the blood should eventually exceed liberation, leading to a decrease of blood radioactivity. Indeed, this was observed in all animals treated with 100 nmol/kg rDSPA,,, but only in three of eight animals receiving an equimolar dose of t-PA. These differences clearly indicate a more rapid thrombolysis with rDSPA,,. Furthermore, although 100nmol/kg of r D S P 4 , is slightly more effective than the equimolar dose of t-PA, blood radioactivity levels in the rDSPA,, group were always lower. This indicates that FbDP released from the clot by rDSPA,, induced lysis are more rapidly cleared from the blood than those liberated with t-PA. Because plasmin is the ultimate effector of clot degradation for both plasminogen activators, this puzzling observation seems to suggest a qualitatively different (acting) plasmin to be generated by rDSPAa,. Another possible explanation could be that t-PA complexes with FbDP are formed that may have a reduced liver clearance. Most significantly, higher levels of circulating FbDP could be one explanation for the lower clot specificity of t-PA, because FbDP have been shown to stimulate (systemic) plasminogen activation by t-PA.16 rDSPAa, is an effective thrombolytic agent in experimental pulmonary embolism in rats. Compared with t-PA, rDSPA,, is the more potent thrombolytic agent, it may also achieve lysis more rapidly and more completely and, because of its improved clot (fibrin) specificity, rDSPA,, may also be the safer agent, reducing the risk of bleeding, which is still the predominant side effect of all thrombolytics. ACKNOWLEDGMENT We thank Gabi Gehrmann, Petra Kolsch, Thomas Kuhles, and Petra Scheu for expert technical assistance; Thomas Petri for the cell culture work which will be published in detail elsewhere; Jean-Paul Clozel (Basel) for valuable remarks on his animal model; and Karola Hohlmann for her assistance in the statistical apalysis of the data. REFERENCES 1. Rao AK, Pratt C, Berke A, Jaffe A, Ockene I, Schreiber TL, Bell WR, Knatterud G, Robertson TL, Terrin ML, for the TIMI Investigators: Thrombolysis in myocardial infarction (TIMI) trialPhase I: Hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol11:1, 1988 2. Rijken DC, Hoylaerts M, Collen D: Comparison of the relative fibrinogenolytic, fibrinolytic and thrombolytic properties of tissue plasminogen activator and urokinase in vitro. Thromb Haemost 45:225,1981 3. Matsuo 0, Rijken DC, Collen D: Thrombolysis by human tissue plasminogen activator and urokinase in rabbits with experimental pulmonary embolus. Nature 291:590,1981 4. Collen D, Stassen JM, Verstraete M: Thrombolysis with human extrinsic (tissue-type) plasminogen activator in rabbits with experimental jugular vein thrombosis. J Clin Invest 71:368,1983 5. Hoylaerts M, Rijken DC, Lijnen HR, Collen D: Kinetics of the activation of plasminogen by human tissue plasminogen activator. Role of fibrin. J Biol Chem 257:2912,1982 6. Sobel BA, Nachowiak DA, Fly ETA, Bergmann SR, Torr SR: Paradoxical attenuation of fibrinolysis attributable to “plasmino- gen steal” and its implications for coronary thrombolysis. Coronary Artery Dis 1:111,1990 7. Gardell SJ, Duong LT, Diehl RT, York JD, Hare TR, Register RB, Jacobs JW, Dixon RAF, Friedman PA: Isolation, characterization, and cDNA cloning of a vampire bat salivary plasminogen activator. J Biol Chem 264:17947,1989 8. Gardell SJ, Hare TR, Bergum PW, Cuca GC, O’NeillPalladino L, Zavodny SM: Vampire bat salivary plasminogen activator is quiescent in human plasma in the absence of fibrin unlike human tissue plasminogen activator. Blood 76:2560,1990 9. Haendler B, Kratzschmar J, Langer G, Boidol W, Alagon A, Schleuning WD: Cloning and expression of salivary plasminogen activators from the vampire bat Desmodus rotundus. Fibrinolysis 4:97,1990 (abstr) 10. Bringmann P, Donner P, Baldus B, Alagon A, Schleuning WD: Isolation and characterization of plasminogen activators of the vampire bat Desmodus rotundus. Fibrinolysis 4:97, 1990 (abstr) 11. Kratzschmar J, Haendler B, Langer G, Boidol W, Bringmann P, Alagon A, Donner P, Schleuning WD: The plasminogen activator family from the salivary gland of the vampire bat Desmodus rotundus: Molecular cloning and expression. Gene 105:229,1991 From www.bloodjournal.org by guest on November 7, 2014. For personal use only. THROMBOLYTIC PROPERTIES OF rDSPA-, 12. Clozel JP, Holvoet P, Tschopp T Experimental pulmonary embolus in the rat: A new in vivo model to test thrombolytic drugs. J Cardiovasc Pharmacol12520,1988 13. Clauss V A Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogeds. Acta Haematol17:237,1957 14. Chen CA, Okayama H: Calcium phosphate-mediated gene transfer: A highly efficient transfection system for stably transforming cell with plasmid DNA. BioTechniques 6:632,1988 1217 15. Collen D, Bounameaux H, De Cock F, Lijnen HR, Verstraete M: Analysis of coagulation and fibrinolysis during intravenous infusion of recombinant human tissue-type plasminogen activator in patients with acute myocardial infarction. Circulation 73511,1986 16. Weitz JI, Leslie B, Ginsberg S: Soluble fibrin degradation products potentiate tissue plasminogen activator fibrinogen proteolysis. J Clin Invest 87:1082, 1991
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