Aplicación tópica de ácido tranexámico en urología: ¿Una alternativa de manejo? / Topical Application of Tranexamic Acid in Urology: An Alternative Management?

Los agentes antifibrinolíticos, como el ácido tranexámico, por medio de su administración endovenosa se usan en distintos procedimientos quirúrgicos para prevenir la pérdida de sangrado perioperatorio.[1] Este medicamento es un derivado sintético análogo de la lisina que bloquea los sititos de unión de la lisina en el plasminógeno, inhibiendo su conversión a plasmina e interfiriendo en la fibrinólisis.[2] La aplicación del ácido tranexámico para disminuir el riesgo de sangrado ha sido utilizado en procedimientos urológicos como la resección transuretral prostática (RTUP), prostatectomía radical y nefrolitotomía percutánea (NLP),[3] [4] [5] también se emplea para disminuir las hematurias persistentes en pacientes con poliquistosis renal y en otras hematurias macroscópicas de origen urológico.

Antifibrinolytic agents, such as tranexamic acid, by intravenous administration are used in various surgical procedures to prevent perioperative bleeding loss.[1] This drug is a synthetic lysine analog derivative that blocks the lysine binding sites on plasminogen, inhibiting its conversion to plasmin and interfering with fibrinolysis.[2] The application of tranexamic acid to reduce the risk of bleeding has been used in urological procedures such as transurethral resection of the prostate (TURP), radical prostatectomy and nephrolithotomy. The application of tranexamic acid to reduce the risk of bleeding has been used in urological procedures such as transurethral resection of the prostate (TURP), radical prostatectomy and percutaneous nephrolithotomy (PNL),[3] [4] [5] it is also used to reduce persistent hematuria in patients with polycystic kidney disease and other macroscopic hematuria of urological origin.

Uso y Administración del rtPA (activador tisular del plasminógeno): cuidados de enfermería / Use and Administration of rtPA (tissue plasminogen activator): nursing care

Si bien el uso rtPA está indicado para diversas patologías como el tratamiento trombolítico en los infartos agudos de miocardio, el tromboembolismo pulmonar agudo con inestabilidad hemodinamica y el tratamiento trombolítico del accidente cerebrovascular isquémico agudo conforme a la disposición DI­2018-495-APN-ANMAT#MSYDS el uso del mismo en Argentina y conforme a consenso (consenso sobre accidente cerebrovascular isquémico agudo). La administración oportuna del rtPA, a pacientes apropiadamente seleccionados constituye el principal tratamiento de forma temprana en el ACV (1-8). Por lo que el rol que cumple enfermería es fundamental en la valoración de riesgos previa a la administración, preparación, administración del fármaco y valoración continua post administración del mismo[AU]

Although the use of rtPA is indicated for various pathologies such as thrombolytic treatment in acute myocardial infarctions, acute pulmonary thromboembolism with hemodynamic instability, and thrombolytic treatment of acute ischemic stroke according to the DI-2018-495-APN-ANMAT provision. #MSYDS the use of thesame in Argentina and accordingtoconsensus (consensus on accident cerebrovascular ischemico acute). Timely administration of rtPAto appropriately selected patients constitutes the main treat mentearly in stroke (1,8). Therefore, the role play edby nursingis fundamental in the risk ass essment prior to the administration, preparation, administration of the drug, and continuous post-administration assessment[AU]

Embora o uso de rtPA seja indicado para várias patologias, como tratamento trombolítico em infartos agudos do miocárdio, tromboembolismo pulmonar agudo com instabilidade hemodinâmica e tratamento trombolítico de acidente vascular cerebral isquêmico agudo de acordo com a disposição DI- 2018-495-APN-ANMAT. #MSYDS a uso do mesmona Argentina e de acordocom o consenso (consensus on accident cerebrovascular ischemico agute). A administração oportuna de rtPA a pacientes adequadamente selecionados constitui o principal tratamento no início do AVC (1,8). Por tanto, o papel da enfermagem é fundamental na avaliação do risco antes da administração, preparo, administração do medicamento e avaliação pós-administração contínua[AU]

Study of angiopoietin and plasminogen genes in hereditary angioedema

SUMMARY OBJECTIVE To investigate the presence of the Angiopoietin 1 (ANGPT1) and Plasminogen (PLG) mutations in patients with Hereditary Angioedema (HAE) and normal C1 esterase inhibitor (C1-INH) levels, who do not harbor the F12 gene mutation. METHODS Patients clinically diagnosed with HAE but without C1-INH deficiency or dysfunction and F12 gene mutation were evaluated. DNA extraction, quantification, and dilution were performed at a concentration of 100 ng/µL, followed by a DNA amplification (PCR) for molecular evaluation of exon 2 of the ANGPT1 gene and exon 9 of the PLG gene for identification of mutations c.807G>T / p.A119S and c.988A>G / p.K330E, respectively. The PCR product was evaluated in 1% agarose gel electrophoresis. Sequencing was performed using the Sanger method. The electropherograms were analyzed using the FASTA® program. RESULTS DNA samples from 15 women were sequenced. Their ages ranged from 10 to 60 years and the normal C1 esterase and C4 inhibitor serum levels ranged from 22 to 39 mg/dL and from 10 to 40 mg/dL, respectively. No mutations were detected in the analyzed exons of ANGPT1 and PLG. However, a single-nucleotide polymorphism (SNP) was detected in two homozygotic and five heterozygotic patients. CONCLUSION Further studies are needed to evaluate these SNPs and scrutinize their potential for use as molecular markers of HAE and as novel therapeutic targets.

RESUMO OBJETIVO Investigar a presença das mutações no gene Angiopoietina (ANGPT1) e gene Plasminogênio (PLG) em pacientes com Angioedema Hereditário (AEH) com inibidor C1 esterase (C1-INH) normal e negativos para mutação do gene F12. MÉTODOS Foram avaliados pacientes com diagnóstico clínico de AEH sem deficiência ou disfunção de C1-INH e negativos para mutação do gene F12. Realizou-se extração, quantificação e diluição do DNA a uma concentração de 100 ng/uL, em seguida amplificação do DNA (PCR) para avaliação molecular do exon 2 do gene ANGPT1 e do exon 9 do gene PLG para identificação das mutações c.807G>T.p.A119S e c.988A>G p.K330E, respectivamente. O produto da PCR foi avaliado em eletroforese em gel de agarose 1%. Foi realizado o sequenciamento pelo método de Sanger. As análises dos eletroferogramas foram realizadas pelo programa FASTA®. RESULTADOS Foram sequenciadas amostras de 15 mulheres, idade entre 10 e 60 anos, com níveis séricos de inibidor de C1 esterase e C4 normais variando de 22 a 39mg/dL e 10 a 40mg/dL, respectivamente. Não foram identificadas mutações nos éxons analisados dos genes ANGPT1 e PLG. Entretanto no gene PLG foram encontrados polimorfismo de nucleotídeo único (SNP), em duas pacientes homozigotas e cinco heterozigotas. CONCLUSÃO Mais estudos sobre SNP são necessários para esclarecer estes achados pois eles podem ser utilizados como marcadores moleculares do AEH e alvo para novos tratamentos.

Subproteome of Lachesis muta rhombeata venom and preliminary studies on LmrSP-4, a novel snake venom serine proteinase

Lachesis muta rhombeata is one of the venomous snakes of medical importance in Brazil whose envenoming is characterized by local and systemic effects which may produce even shock and death. Its venom is mainly comprised of serine and metalloproteinases, phospholipases A2 and bradykinin-potentiating peptides. Based on a previously reported fractionation of L. m. rhombeata venom (LmrV), we decided to perform a subproteome analysis of its major fraction and investigated a novel component present in this venom. Methods: LmrV was fractionated through molecular exclusion chromatography and the main fraction (S5) was submitted to fibrinogenolytic activity assay and fractionated by reversed-phase chromatography. The N-terminal sequences of the subfractions eluted from reversed-phase chromatography were determined by automated Edman degradation. Enzyme activity of LmrSP-4 was evaluated upon chromogenic substrates for thrombin (S-2238), plasma kallikrein (S-2302), plasmin and streptokinase-activated plasminogen (S-2251) and Factor Xa (S-2222) and upon fibrinogen. All assays were carried out in the presence or absence of possible inhibitors. The fluorescence resonance energy transfer substrate Abz-KLRSSKQ-EDDnp was used to determine the optimal conditions for LmrSP-4 activity. Molecular mass of LmrSP-4 was determined by MALDI-TOF and digested peptides after trypsin and Glu-C treatments were analyzed by high resolution MS/MS using different fragmentation modes. Results: Fraction S5 showed strong proteolytic activity upon fibrinogen. Its fractionation by reversed-phase chromatography gave rise to 6 main fractions (S5C1-S5C6). S5C1-S5C5 fractions correspond to serine proteinases whereas S5C6 represents a C-type lectin. S5C4 (named LmrSP-4) had its N-terminal determined by Edman degradation up to the 53rd amino acid residue and was chosen for characterization studies. LmrSP-4 is a fibrinogenolytic serine proteinase with high activity against S-2302, being inhibited by PMSF and benzamidine, but not by 1,10-phenantroline. In addition, this enzyme exhibited maximum activity within the pH range from neutral to basic and between 40 and 50 °C. About 68% of the LmrSP-4 primary structure was covered, and its molecular mass is 28,190 Da. Conclusions: Novel serine proteinase isoforms and a lectin were identified in LmrV. Additionally, a kallikrein-like serine proteinase that might be useful as molecular tool for investigating bradykinin-involving process was isolated and partially characterized.(AU)

Treatment of ligneous conjunctivitis with heterologous serum / Tratamento de conjuntivite lenhosa com soro heterólogo

ABSTRACT Ligneous conjunctivitis is a rare form of chronic and recurrent bilateral conjunctivitis, in which thick membranes develop on the tarsal conjunctiva and on other mucosae. We report the case of a 55-year old female patient with bilateral ligneous conjunctivitis who was successfully treated with 50% heterologous serum. There was no recurrence or side effects after one-year follow-up. We suggest the use of 50% heterologous serum should be further studied to better determine its efficacy as a treatment option for ligneous conjunctivitis.

RESUMO A conjuntivite lenhosa é uma forma rara de conjuntivite bilateral crônica e recorrente, na qual há formação de membranas espessas na conjuntiva tarsal e em outras mucosas. Relatamos o caso de uma paciente de 55 anos com conjuntivite lenhosa bilateral, que obteve sucesso no tratamento com soro heterólogo em concentração de 50%. Não houve recorrência após um ano de seguimento e nem efeitos colaterais ao tratamento. Dessa forma, o uso de soro heterólogo a 50% poderia ser mais estudado para melhor avaliação de sua eficácia como opção de tratamento para a conjuntivite lenhosa.

Identification of the alpha-enolase P46 in the extracellular membrane vesicles of Bacteroides fragilis

BACKGROUND Members of the Bacteroides fragilis group are the most important components of the normal human gut microbiome, but are also major opportunistic pathogens that are responsible for significant mortality, especially in the case of bacteraemia and other severe infections, such as intra-abdominal abscesses. Up to now, several virulence factors have been described that might explain the involvement of B. fragilis in these infections. The secretion of extracellular membrane vesicles (EMVs) has been proposed to play a role in pathogenesis and symbiosis in gram-negative bacteria, by releasing soluble proteins and other molecules. In B. fragilis, these vesicles are known to have haemagglutination and sialidosis activities, and also contain a capsular polysaccharide (PSA), although their involvement in virulence is still not clear. OBJECTIVE The aim of this study was to identify proteins in the EMV of the 638R B. fragilis strain by mass spectrometry, and also to assess for the presence of Bfp60, a surface plasminogen (Plg) activator, previously shown in B. fragilis to be responsible for the conversion of inactive Plg to active plasmin, which can also bind to laminin-1. METHODS B. fragilis was cultured in a minimum defined media and EMVs were obtained by differential centrifugation, ultracentrifugation, and filtration. The purified EMVs were observed by both transmission electron microscopy (TEM) and immunoelectron microscopy (IM). To identify EMV constituent proteins, EMVs were separated by 1D SDS-PAGE and proteomic analysis of proteins sized 35 kDa to approximately 65 kDa was performed using mass spectrometry (MALDI-TOF MS). FINDINGS TEM micrographs proved the presence of spherical vesicles and IM confirmed the presence of Bfp60 protein on their surface. Mass spectrometry identified 23 proteins with high confidence. One of the proteins from the B. fragilis EMVs was identified as an enolase P46 with a possible lyase activity. MAIN CONCLUSIONS Although the Bfp60 protein was not detected by proteomics, α-enolase P46 was found to be present in the EMVs of B. fragilis. The P46 protein has been previously described to be present in the outer membrane of B. fragilis as an iron-regulated protein.

Plasminogenemia asociada a conjuntivitis leñosa / Plasminogen Deficiency and Ligneous Conjunctivitis

El artículo presenta el caso clínico de un joven de 18 años de edad sin antecedente familiares de enfermedad crónica o hereditaria, nacido a término, sin complicaciones, quien desde los dos días de vida presentó una lesión tipo masa en la conjuntiva tarsal. Inicialmente, recibió tratamiento farmacológico tópico y seguimiento por oftalmología, por conjuntivitis bilateral persistente, masas tarsales recidivantes y cataratas en ambos ojos, por lo que requirió siete intervenciones con pobre respuesta al manejo farmacológico y quirúrgico. A los seis meses de vida se le diagnosticó hidrocefalia, que requirió manejo con derivación del ventrículo peritoneal. Dada la persistencia de la sintomatología y la refractariedad al tratamiento, se ampliaron los estudios y en una junta médica se sugirió el diagnóstico de conjuntivitis leñosa asociada a alteración del plasminógeno. Este diagnóstico fue confirmado por laboratorio clínico, que mostró sus bajas concentraciones de plasminógeno en muestras tomadas con intervalos de dos meses en tres ocasiones: 16,9%, 11,1%, 18,6% (valores de referencia: 70-150%). Se le indicó heparina de bajo peso molecular antes de procedimientos quirúrgicos mayores y triamcinolona tópica según síntomas oculares.

We present a case of an 18-year-old patient without a family history of ocular disease, born full term without complications, within his first 2 days a mass in the tarsal conjunctiva appeared. Initially he received topical treatment and follow-up by the ophthalmology department with a diagnosis of persistent bilateral conjunctivitis, relapsing tarsal masses and cataracts in both eyes requiring a total of 7 surgical interventions with a poor response. At the age of 6 months he was diagnosed with hydrocephalus and required a ventricular-peritoneal shunt. Giren the persistence of the symptoms, further studies were made and a medical board made the diagnosis of ligneous conjunctivitis associated to low levels of plasminogen. The diagnosis was confirmed by decreased levels of plasminogen in serum measured three times with 2 months intervals: 16.9%, 11.1%, 18.6% (reference valúes 70'150%). Low molecular weight heparin was ordered before surgical procedures, and topical triamcinolone applied according to ocular symptoms.

Terapia nutricional proposta para conjuntivite lenhosa: estudo de caso e revisão de literatura / Nutritional treatment for leagnous conjuntivitis: case report and literature review and case report

RESUMO A conjuntivite lenhosa é resultante de um raro distúrbio autossômico recessivo hereditário, a deficiência de plasminogênio. Esta apresenta sintomas crônicos, como lesões conjuntivais membranosas características, inicialmente finas e com a persistência da inflamação evoluem se tornando esbranquiçadas, espessas e enrijecidas, lacrimejamento, secreção mucosa e hiperemia ocular acompanhados de espessas pseudomembranas lenhosa (PL) que recobrem a parte interior da conjuntiva tarsal. A literatura apresenta alguns tratamentos, entretanto nenhum deles alcançou a cura da doença. A terapia nutricional abordada neste estudo trata-se da combinação de nutrientes dentro dos limites estabelecidos para ingestão diária, baseada na nutrição ortomolecular, visando ao aumento da taxa de plasminogênio funcional, e a consequente redução dos sintomas associados à sua deficiência. Notou-se o desaparecimento de sintomas associados e redução do crescimento da PL, e também um aumento de 25% do plasminogênio funcional. Um aumento de 25% na dosagem de plasminogênio pode não ser altamente significativo, mas abre um respaldo para maiores estudos, pois já apresentou minimização dos sintomas da paciente.

ABSTRACT Ligneous conjunctivitis is the result of a rare inherited autosomal recessive disorder, the plasminogen deficiency. This presents chronic symptoms such as growth spongiosa meat, tearing, mucous discharge and ocular reddening accompanied by ligenous pseudomembranes (PL) coat the inside of the tarsal conjunctiva. The literature presents some treatments, but none of them reached a cure. The nutritional therapy addressed in this study is a combination of nutrients within the limits of daily intake, based on orthomolecular nutrition, aimed at increasing functional plasminogen rate, and the consequent reduction of symptoms associated with their disability. It was noted disappearance of the symptoms associated and a 25% increase in the functional plasminogen. A 25% increase in plasminogen dosage may not be highly significant, but it opens up a support for further study, as already presented reduction of symptoms of the patient.

Successful treatment of ligneous conjunctivitis with topical fresh frozen plasma in an infant / Sucesso do tratamento da conjuntivite lenhosa com uso tópico de plasma fresco congelado em uma criança

ABSTRACTA 6-month-old female infant presented to our clinic with bilateral eyelid swelling, yellowish-white membranes under both lids, and mucoid ocular discharge. Her aunt had similar ocular problems that were undiagnosed. The conjunctival membranes were excised and histopathological investigation of these membranes showed ligneous conjunctivitis. Further, laboratory examination revealed plasminogen deficiency. A good response was observed to topical fresh frozen plasma (FFP) treatment without systemic therapy, and the membranes did not recur during the treatment. Topical FFP treatment may facilitate rapid rehabilitation and prevent recurrence in patients with ligneous conjunctivitis.

RESUMOUma criança feminina com seis meses de idade se apresentou à nossa clínica com edema palpebral bilateral, membranas brancas amareladas sob as pálpebras de ambos os olhos e descarga mucosa. Sua tia já havia apresentado problemas oculares semelhantes que não foram diagnosticados. As membranas conjuntivais foram excisadas e a investigação histopatológica das membranas demonstraram conjuntivite lenhosa. O diagnóstico de deficiência de plasminogênio foi obtido a partir de um exame laboratorial. Tratamento tópico com plasma fresco congelado (FFP) sem qualquer terapia sistêmica mostrou boa resposta. Não foram observadas recorrências das membranas. O tratamento tópico com FFP pode ajudar a reabilitação rápida e prevenir a recorrência em pacientes com conjuntivite lenhosa.

Plasmin degradation of the alpha chain of fibrinogen/fibrin: improved activation constant and activity determination in assays for tissue plasminogen activator / Degradación por la plasmina de la cadena alfa del fibrinógeno/fibrina: mejoría de la constante de activación y determinación de la actividad en ensayos para el activador del plasminógeno tisular

Objectives. The aim of this investigation was to increase the efficiency of ternary complex formation (fibrin-plasminogen-tissue-plasminogen activator) in the degradation process of the three-dimensional soluble fibrin monomer. Materials and methods. Fibrinogen was purified from human plasma by repeating precipitation six times, using different concentrations of cold ethanol. Fibrinogen was converted to DesAAfibrinogen by degradation with bathroxobin. Human plasminogen was purified by affinity and ion-exchange chromatography, and activated to plasmin by incubation with urokinase. Digested DesAAfibrinogen was prepared by controlled digestion with plasmin. Results. This study demonstrates that the α-chains of DesAAfibrinogen sterically hinder the formation of the ternary complex and are first degraded by plasmin. The degradation of fibrin(ogen) facilitates the in vitro determination of tissue plasminogen activator activity. Finally, release of fibrinopeptide A from bathroxobin-cleaved fibrinogen was confirmed, optimized and evaluated by various methods. Conclusions. Use of digested desAAfibrinogen with plasmin yielded a more stable activation constant of the ternary complex than that of undigested DesAAfibrinogen.

Objetivos. El propósito de la presente investigación fue incrementar la eficacia de la formación del complejo terciario (fibrina-plasminógeno-activador tisular del plasminógeno) en el proceso de degradación de la estructura tridimensional del monómero de fibrina soluble. Materiales y métodos. El fibrinógeno fue purificado de plasma humano, por seis precipitaciones repetidas, con diferentes concentraciones de etanol frío. El fibrinógeno fue convertido a desAAfibrinógeno por degradación con batroxobina. El plasminógeno humano fue purificado por cromatografías de afinidad e intercambio iónico y activado a plasmina con uroquinasa. El desAAfibrinogeno digerido fue preparado por digestión controlada con plasmina. Resultados. Este estudio demuestra que la cadena α del desAAfibrinógeno, dificulta la formación del complejo terciario, por impedimentos estéricos, por lo cual la cadena α se sometió a hidrólisis controlada con plasmina, facilitando así la determinación in vitro de la actividad del activador tisular del plasminógeno. Finalmente, la liberación del fibrinopéptido A por hidrólisis del fibrinógeno con batroxobina, fue confirmada, optimizada y evaluada por varios métodos. Conclusiones. El uso de desAAfibrinogeno digerido con plasmina da una constante de activación más estable en la formación del complejo terciario que el desAAfibrinógeno no digerido (fibrina-plasminogeno- activador tisular del plasminógeno).

Determinación de los parámetros cinéticos de la plasmina porcina y comparación con la humana / Porcine plasmin: determination of kinetic parameters and comparison with human plasmin

El plasminógeno es el zimógeno de la plasmina, enzima relacionada con la disolución del coágulo sanguíneo. Estudios con plasminas de diferentes especies animales han demostrado mayor afinidad que la plasmina humana por sustratos análogos hechos exclusivamente para ella. Así lo confirman la activación y cinética del sistema plasminógeno/plasmina porcino, que hasta el presente no se habían determinado ni comparado con el humano. En este trabajo se utilizaron, para la purificación del plasminógeno, cromatografía de afinidad y cambio iónico; se utilizó urocinasa para la activación del plasminógeno a plasmina y se determinaron los parámetros cinéticos con el sustrato cromógeno S-2251. Los terminales-N se determinaron por el método de degradación de Edman. La plasmina porcina demostró mayor afinidad (Km) por el sustrato que la plasmina humana, 1,55 y 5,3 mM respectivamente, mientras que la plasmina humana mostró mayor velocidad de conversión del sustrato a producto (0,1 UA/ seg) que la porcina (0,033 UA/seg). Los terminales-N se diferenciaron en los aminoácidos 1 y 3, DPPDDY (porcino) y EPLDDY (humano).

Plasminogen is the zymogen of plasmin, enzyme that is responsible for dissolving blood clots. Studies with plasmins from different animals have demonstrated higher affinity than human plasmin for substrate analogs made exclusively for the latter. This has been confirmed by the activation and kinetics of the porcine plasminogen/plasmin system, which had so far not been determined or compared with the human system. The methods used in this study for purification of plasminogen were affinity and ion exchange chromatographies. Urokinase was used for the activation of plasminogen to plasmin and kinetic parameters were determined with the chromogenic substrate S-2251. The N-terminals were determined by the Edman degradation method. Porcine plasmin showed higher affinity (Km) than human plasmin for the chromogenic substrate, 1.55 mM and 5.3 mM, respectively; contrariwise, human plasmin demonstrated higher velocity in the substrate to product conversion: 0.1 UA/seg) vs. 0.033 UA/seg. The N-terminals differed in the amino acids 1 and 3: DPPDDY (for porcine) and EPLDDY (for human).

Plasminogen and fibrinogen plasma levels in coronary artery disease

OBJECTIVE: The formation of thrombi at the site of atherosclerotic lesions plays a central role in atherothrombosis. Impaired fibrinolysis may exacerbate pre-existing coronary artery disease and potentiate its evolution. While the fibrinogen plasma level has been strongly associated with the severity of coronary artery disease, its relevance in the evaluation of plasminogen in coronary artery disease patients remains unclear. This study evaluated fibrinogen and plasminogen levels in subjects with coronary artery disease as diagnosed by angiography. METHODS: This is a cross-sectional study. Blood samples obtained from 17 subjects with angiographically normal coronary arteries (controls), 12 with mild/moderate atheromatosis and 28 with severe atheromatosis were evaluated. Plasma plasminogen and fibrinogen levels were measured by chromogenic and coagulometric methods, respectively. RESULTS: Fibrinogen levels were significantly higher in the severe atheromatosis group compared to the other groups(p-value < 0.0001). A significant positive correlation was observed between the severity of coronary artery diseaseand increasing fibrinogen levels (r = 0.50; p-value < 0.0001) and between fibrinogen and plasminogen levels (r =0.46; p-value < 0.0001). There were no significant differences in the plasminogen levels between groups. CONCLUSION: Plasma fibrinogen, but not plasminogen levels were higher in patients with coronary artery disease compared to angiographically normal subjects. The plasma fibrinogen levels also appear to be associated with the severity of the disease. The results of this study provide no evidence of a significant correlation between plasma plasminogen levels and the progress of coronary stenosis in the study population.

Surface-expressed enolases of Plasmodium and other pathogens

Enolase is the eighth enzyme in the glycolytic pathway, a reaction that generates ATP from phosphoenol pyruvate in cytosolic compartments. Enolase is essential, especially for organisms devoid of the Krebs cycle that depend solely on glycolysis for energy. Interestingly, enolase appears to serve a separate function in some organisms, in that it is also exported to the cell surface via a poorly understood mechanism. In these organisms, surface enolase assists in the invasion of their host cells by binding plasminogen, an abundant plasma protease precursor. Binding is mediated by the interaction between a lysine motif of enolase with Kringle domains of plasminogen. The bound plasminogen is then cleaved by specific proteases to generate active plasmin. Plasmin is a potent serine protease that is thought to function in the degradation of the extracellular matrix surrounding the targeted host cell, thereby facilitating pathogen invasion. Recent work revealed that the malaria parasite Plasmodium also expresses surface enolase, and that this feature may be essential for completion of its life cycle. The therapeutic potential of targeting surface enolases of pathogens is discussed.

Purificación y activación de los plasminógenos caprino y canino: comparación con el plasminógeno humano / Purification and activation of caprine and canine plasminogens: Comparison with human plasminogen

Objective: To unify the purification and activation of plasminogens from three different species, namely: human, caprine and canine. Materials and methods: Lysine-Sepharose 4B and sephacel DEAE were used, for affinity and ion-exchange chromatography, respectively. The N-terminal sequence was determined for both the intact and degraded plasminogens. Results:Bands of 92 kDa corresponding to native plasminogens were identified in the three species. Their N-terminal sequences were found to be EPLDDY, DPLDDY and XXLDDY for human, caprine and canine plasminogen, respectively. Furthermore, the degraded in vivo circulating plasminogens from the three species were purified and their N-terminal sequences were KVYLSE, RITLL and RIYLS for the human, caprine and canine, in that order. Conclusion: Activation of the three plasminogens confirmed the formation of the typical electrophoretic bands for human plasmin corresponding to the heavy A and the light B chains which were also identified in the caprine and canine plasmins. This new purification methodology facilitates the comparison and further elucidation of the fibrinolytic systems in mammals.

Objetivo: unificar la purificación y activación de los plasminógenos de tres especies diferentes, a saber: humana, caprina y canina. Materiales y métodos: se usaron Lysina-Sefarosa 4B y Sefacel DEAE para las cromatografías de afinidad y de intercambio iónico, respectivamente. Se determinó la secuencia terminal-N tanto de los plasminógenos intactos como de los degradados. Resultados: en las tres especies se identificaron bandas de 92 kDa correspondientes a los plasminógenos nativos. Se halló que sus secuencias terminales-N eran EPLDDY, DPLDDY y XXLDDY para los plasminógenos humano, caprino y canino, respectivamente. Además, se purificaron los plasminógenos degradados circulantes, cuyas secuencias terminales-N fueron, en el mismo orden, KVYLSE, RITLL Y RIYSL. Conclusión: la activación de los tres plasminógenos confirmó la formación de las bandas electroforéticas típicas de la plasmina humana correspondientes a las cadenas pesada A y liviana B, que también se identificaron en las plasminas caprina y canina. Este nuevo método de purificación facilita la comparación y el esclarecimiento de los sistemas fibrinolíticos de los mamíferos.

Efecto de los anticuerpos antifosfolipídicos en la formación y degradación de la malla de fibrina en pacientes con aborto recurrente / Effect of antiphospholipid antibodies on the formation and lysis of fibrin network in patients with recurrent miscarriage

En el presente trabajo se estudió el proceso de formación y disolución de la malla de fibrina y la generación de plasmina en un grupo de pacientes con aborto recurrente (AR) debido a la presencia de anticuerpos antifosfolipídicos (N= 10), mujeres con AR sin el síndrome antifosfolipídico (SAF) (N= 6) y se comparó con un grupo de mujeres sanas (N= 8). Del grupo de pacientes estudiadas con SAF, nueve fueron positivas para anticuerpos anticardiolipina (aCL), cinco para la anti-b2-glicoproteína I (anti-b2GPI), cuatro para ambos anticuerpos, una para anticuerpos antiprotrombina (aPT) y anticoagulante lúpico (AL). El proceso de formación de la fibrina y su disolución fue estudiado por turbidimetría y la generación de plasmina mediante sustrato cromogénico S2251. Las curvas de polimerización de la(s) paciente(s) con AR sin SAF y AL presentaron un incremento en la pendiente y turbidez final, comparado con las del grupo control de mujeres sanas. La velocidad de disolución del coágulo fue mayor en la paciente con AL (21 ± 0) 10-4 DDO/seg y en las AR sin SAF (19,6 ± 5,7) 10-4 DDO/seg, comparado con el grupo control (14,5 ± 2,8) 10-4 DDO/seg. La generación de plasmina estuvo incrementada solamente en las AR sin SAF (85 ± 24%) comparado con 52 ± 3% en el grupo control, p= 0,005. Los cambios observados en el proceso de polimerización y fibrinólisis de la(s) paciente(s) con AR sin SAF y AL pudieran estar relacionados con el incremento en los niveles de fibrinógeno, mientras que los de la generación de plasmina con la entidad mórbida.

The present work was intended to study the process of fibrin formation and lysis and plasmin generation in a group of patients with recurrent miscarriage (RM), due to the presence of antiphospholipid antibodies (N= 10); as well as in women with RM without the antiphospholipid syndrome (APS) (N= 6), compared with those of a group of healthy women (N= 8). In the group of patients with APS, nine were positive for antibodies against cardiolipin (aCL), five for anti-b2-glycoprotein I (anti-b2GPI), four for both antibodies, and one for antibodies against prothrombin (aPT) and lupus anticoagulant (LA). Fibrin formation and lysis was followed by turbidity and plasmin generation using chromogenic substrate S2251. The polymerization curves from RM patients without APS and the LA patient showed an increased slope and maximum turbidity compared to those of the control group. The speed of lysis was higher in the LA patient (21 ± 0) 10-4 DOD/seg and the RM patients without APS (19.6 ± 5.7) 10-4 DDO/seg, compared to that of the control group (14.5 ± 2.8) 10-4 DDO/seg. Plasmin generation increased only in RM patients without APS (85 ± 24%) against the control group (52 ± 3%), p= 0.005. The changes observed in the fibrin polymerization and lysis process of women with RM without APS and LA seem to be related to their higher fibrinogen levels, while the increased plasmin generation was related to the patients´ morbidity.

Comparación de la activación y la cinética de laplasmina bufalina con la humana / Ativação e cinética comparativa da plasmina bufalina e a humana / Comparative activation and kinetic of plasmin bufaline with the human one

El plasminógeno es el zimógeno de la plasmina, enzima activada a nivel fisiológico por el activadortisular del plasminógeno y la urokinasa, la plasmina es la enzima encargada de disolver el coágulosanguíneo. En este estudio se compararon la plasmina humana con la bufalina en su forma de activación dezimógeno a enzima y en la afinidad hacia el sustrato cromogénico. Los plasminógenos fueron purificadospor el mismo método de cromatografías de afinidad y cambio iónico. De igual manera las activaciones sehicieron utilizando urokinasa humana en ambos casos. La plasmina bufalina demostró mayor activacióny afinidad (1.35mM) que la plasmina humana (2.16 mM), siendo la bufalina 1.5 veces mas afin al sustratocromogénico que la humana. Este estudio demuestra que el método de purificación de los plasminógenospuede ser el mismo para muchas especies, se demuestra una vez más que las plasminas animales al parecerson más eficientes en la disolución del coágulo o degradación de sustratos, que la plasmina humana.Este estudio indica que la plasmina bufalina puede ser utilizada en los parámetros que se determinanclínicamente en pacientes con problemas cardiovasculares, reduciendo el tiempo de determinación de estosparámetros fibrinolíticos, que pueden dar al médico un margen de tiempo superior para actuar.

The Plasminogen is the zymogene of the Plasmin, enzyme which physiologically is activated by twodifferent enzymes, the tissue plasminogen activator and the urokinase, the plasmin is the enzyme that dissolves blood clots. In this study the human plasmin was compared to the bufaline plasmin, in theactivation from the zymogene to the enzyme form as well as in the affinity to the chromogenic substrate.The two plasminogens were purified by the same chromatographies methods: affinity and ion-exchange.Furthermore, both plasminogens were activated by human urokinase. The bufaline plasmin showed moreactivation and affinity (1.35 mM) that the human plasmin (2.16 mM), in addition, the bufaline plasmindemonstrated a 1.5 times more affinity to the chromogenic substrate that the human plasmin. This studydemonstrated that the plasminogens of several species can be purified by this method. Besides, one moretime the animal’s plasmins probably to be more efficient in the dissolution of blood clots or degradation ofsubstrates than the human plasmin. More over this study indicated that the bufaline plasmin can be usedin clinical determinations of patients with cardiovascular diseases. This also reduces the determinationtime of fibrinolytic parameters that physicians can give, having more time to take appropriate treatment.

O plasminogênio é o zymogen da plasmina, enzima ativada a nivel fisiológico pelo ativador tissulardo plasminogênio e uroquinase, plasmina é a enzima responsável de dissolver o coágulo de sanguíneo.neste estudo foi comparada a plasmina humana com a plasmina búbalina em seu modo de ativaçãode zymogen a enzima e na afinidade substrato cromogênico. Os plasminogênio foram purificados como mesmo método de cromatografia de afinidade e de troca iônica, e as ativações foram feitas usandouroquinase humana nos dois casos. A Búfalo plasmina mostrou maior ativação e afinidade (1.35 mM)que a plasmina humana (2.16 mM), sendo a bufalina 1.5 vezes mais afim ao substrato Cromogênico quea humana. Este estudo mostrou que o método de purificação do plasminogênios pode ser o mesmo paramuitas espécies, alem disso, que as plasminas animais são mais eficientes na dissolução do coáguloo degradação de substratos que a plasmina humana. Este estudo indicou que a plasmina búfalo podeser utilizada nos parâmetros determinados clínicamente em pacientes com problemas cardiovasculares,diminuindo o tempo de determinação destes parâmetros fibrinolíticos, que podem dar ao médico umintervalo de maior tempo para atuar.

Trombolisis intravenosa con rtPA en el Stroke Isquémico Agudo. Eficacia y seguridad del programa instalado en el Hospital Universitario de la Fundación Favaloro / Intravenous thrombolysis with recombinant tissue plasminogen activator in the acute ischemic stroke

The study of the National Institute of Neurological Disorders and Stroke (NINDS) proved that the use of the recombinant tissue plasminogen activator (rtPA) within the first 3 hours since the beginning of the symptomatology of the acute ischemis stroke (AIS) is as well safe as effective...These preliminary data reported in our study show that a strict protocol of thrombolysis IV with rtPA in AIS is feasible to be carried on with good results in a high complexity Center.

Fibrosis Hepática: El papel de las metaloproteinasas y de TGF-β / Hepatic fibrosis: Role of matrix Metallopoteases and TGF-β

La fibrosis hepática involucra múltiples eventos celulares y moleculares que inducen un excesivo depósito de proteínas de matriz extracelular que distorsionan la arquitectura del parénquima hepático, cuya etapa final es conocida como cirrosis. El daño proviene de una variedad de causas como abuso de drogas y enfermedades virales, autoinmunes, metabólicas y colestásicas. La degradación de estas proteínas de matriz ocurre predominantemente como una consecuencia de la acción de metalopro teinasas (MMPs) que degradan sustratos colágenos y no colágenos. La degradación de la matriz en el hígado se lleva a cabo principalmente por la acción de cuatro de estas enzimas: MMP-1, MMP-2, MMP-3 y MMP-9. En el sistema fibrinolítico, las MMPs pueden ser activadas a través de un corte proteolítico por acción del activador de plasminógeno tipo urocinasa y un segundo mecanismo de activación es realizado por las mismas MMPs. La regulación para restringir la actividad puede ser a diferentes niveles; en el sistema fibrinolítico el principal regulador es el PAI- 1, molécula que bloquea la conversión de plasminógeno a plasmina y la MMP no puede ser activada. Un segundo nivel de inhibición es posible a través del TIMP, que inhibe la actividad proteolítica aun cuando las MMPs hayan sido activadas vía plasmina. Durante condiciones patológicas la sobreexpresión de estos inhibidores es dirigida por el factor de crecimiento transformante β, el cual en un padecimiento fibrótico actúa como el más importante factor adverso.

Liver fibrosis and cirrhosis involve multiple cellular and molecular events that lead to deposition of an excess of extracellular matrix proteins and increase the distortion of normal liver architecture. Etiologies include chronic viral hepatitis, alcohol abuse and drug toxicity. Degradation of these matrix proteins occurs predominantly as a result of a family of enzymes called metalloproteinases (MMPs) that specifically degrade collagenous and non collagenous substrates. Matrix degradation in the liver is due to the action of at least four of these enzymes: MMP-1, MMP-2, MMP 3 and MMP 9. In the fibrinolytic system, MMPs can be activated through proteolytic cleavage by the action of urokinase plasminogen activator; a second mechanism includes the same metalloproteinases. This activity is regulated at many levels in the fibrinolytic system. The main regulator is the PAI- 1. This molecule blocks the conversion of plasminogen into plasmin, and the MMP cannot be activated. At a second level, the inhibition is possible by binding to inhibitors called TIMP that can inhibit the proteolytic activity even when the MMPs had been previously activated by plasmin. During abnormal conditions, overexpression of these inhibitors is directed by the transforming growth factor-β that in a fibrotic disease acts as an extremely important adverse factor.