Visualization of thrombi in pulmonary arteries with radiolabeled, enzymatically inactivated tissue-type plasminogen activator.

BACKGROUND: Despite the high frequency of pulmonary thromboembolism and its significant morbidity and mortality, diagnosis remains suboptimal. We have been developing a method for prompt detection with the use of radiolabeled, inactivated tissue-type plasminogen activator (TPA) and performed the present study to determine whether its use permits rapid scintigraphic visualization of pulmonary thrombi in vivo. METHODS AND RESULTS: The thrombolytic, but not fibrin-binding, property of TPA was inactivated with a tripeptide chloromethyl ketone (YPACK) that had already been iodinated with 123I to radiolabel the TPA. Pulmonary arterial thrombosis was induced in nine dogs with the use of guide wires modified to provide thrombogenic tips. 123I-YPACK-TPA (1.1 to 7.8 mCi, 0.5 to 7.8 mg) was infused for 5 minutes into either the systemic or the pulmonary circulation. Clearance of radioactivity from the blood was rapid and indistinguishable from that of unlabeled, thrombolytically active TPA, with only 6.7 +/- 1.0% (mean +/- SEM) of peak radioactivity remaining after 60 minutes and minimal release of labeled fragments from the liver during this interval. Thrombi were visualized with single photon emission computed tomography and/or planar imaging 40 to 120 minutes after infusion of tracer in all seven animals given at least 3.7 mCi of 123I-YPACK-TPA. Ratios of radioactivity in thrombus (wet mass, 610 +/- 64 mg) to blood were high (14 +/- 3:1). CONCLUSIONS: The use of radiolabeled TPA in which thrombolytic activity is inactivated permits prompt scintigraphic detection of thrombi in pulmonary arteries in vivo.

Scintigraphic visualization of pulmonary thrombi with 123I-YPACK-TNK-tPA.

BACKGROUND: We have previously demonstrated that radiolabeled tissue-type plasminogen activation (tPA) in which the plasminogen-activating catalytic site has been inactivated binds avidly to thrombi and can be used for scintigraphic detection of pulmonary thrombi in vivo. The present study was performed to overcome identified limitations of the initially developed approach and to determine whether a tracer made with a molecular variant of tPA, TNK-tPA, would provide superior images of pulmonary thrombi and hence facilitate differential diagnosis of pulmonary embolism from acute myocardial infarction. It was thought that TNK-tPA may be superior in view of its longer biological half-life and less avid uptake by macrophages that would otherwise contribute to high background because of non-clot-selective uptake of the tracer. METHODS: 123I-tyrosylprolylarginyl chloromethyl ketone (123I-YPACK-TNK-tPA) was infused into the systemic circulation of dogs with either pulmonary or right ventricular thrombi induced with thrombogenic tips of modified guide wires. Planar and single-photon emission computed tomography (SPECT) scintigraphic data were obtained, and blood and tissue samples were acquired for analysis of the distribution of the radiotracer over time. RESULTS: Tracer cleared from blood with an alpha phase half-life of 10 +/- 1 min, paralleling the clearance of unlabeled TNK-tPA. Only minimal release of labeled fragments from liver into blood occurred during the entire time course of the imaging studies. Pulmonary thrombi were visualized with SPECT within 30-120 min in all dogs. Images were superior to those obtained after infusion of labeled wild-type tPA, primarily because of diminished background radioactivity and consequently increased scintigraphic contrast. In one dog which had a right ventricular thrombus, the thrombus was readily detectable in both planar and SPECT images. CONCLUSIONS: Radiolabeled TNK-tPA in which plasminogen-activating activity has been inhibited biochemically is an excellent radiopharmaceutical for prompt scintigraphic detection of pulmonary and ventricular thrombi in vivo, and an attractive candidate for rapid, sensitive and non-invasive diagnosis of pulmonary thromboembolic disease in patients.

Effect of acute hypertension in the coronary circulation: role of mechanical factors and oxygen radicals.

OBJECTIVE: In previous studies severe, acute hypertension damaged the endothelium in proximal coronary arteries and selectively potentiated constriction of the artery to serotonin. In the present study we investigated the role of several mechanical factors and of oxygen radicals in this response. DESIGN: To test the role of mechanical factors in the response to acute hypertension, the effect of different magnitudes of elevation of perfusion pressure and the rate of the rise in perfusion pressure were studied. Pharmacologically induced increases in blood pressure were produced by infusion of angiotensin II or phenylephrine. The role of oxygen radicals was tested by measuring responses to serotonin before and after increases in perfusion pressure in dogs treated with a combination of superoxide dismutase and catalase or with deferoxamine. METHODS: In open-chest anesthetized dogs the diameter of the left anterior descending coronary artery (LADCA) was measured using sonomicrometer crystals, and the LADCA was perfused at a constant pressure of 80 mmHg from a reservoir. Responses to serotonin were measured at this perfusion pressure before and after an abrupt increase in perfusion pressure. RESULTS: Intracoronary serotonin (5 or 50 micrograms/min) produced a dose-dependent constriction of the LADCA while increasing coronary flow. Abruptly increasing the coronary perfusion pressure from 80 to 120, 150 or 200 mmHg augmented the constriction to serotonin twofold, whereas increases in perfusion pressure to 100 mmHg had no effect. Increasing coronary pressure slowly (over a 4-min period) from 80 to 200 mmHg augmented constriction to serotonin. Inducing acute hypertension (coronary pressure 200 mmHg) pharmacologically with angiotensin II also augmented constriction to serotonin, whereas phenylephrine-induced hypertension did not. Superoxide dismutase, a scavenger of superoxide anions and catalase, a scavenger of hydrogen peroxide, prevented the augmented constriction to serotonin following a pressure increase. Deferoxamine, which prevents generation of hydroxyl radicals from superoxide anions and hydrogen peroxide, also prevented the enhanced constriction to serotonin following an acute pressure increase. CONCLUSIONS: Moderate physiological increases in pressure, induced either mechanically or pharmacologically, can augment the responses to serotonin. Oxygen-derived free radicals, particularly hydroxyl radicals, might be involved in the abnormal response to serotonin following an abrupt increase in coronary pressure.

Effects of norepinephrine on endothelium-dependent vasodilation of forearm resistance vessels.

BACKGROUND: Endothelium-dependent dilatation of forearm resistance vessels is attenuated in patients with heart failure. Activation of the sympathetic nervous system could cause this abnormality by way of vasoconstriction and chemical inactivation of nitric oxide. METHODS AND RESULTS: The effects of concurrent intra-arterial norepinephrine infusions (25, 50 and 100 ng/min) on forearm blood flow responses to equipotent doses of an endothelium-dependent vasodilator, methacholine (0.3 and 1.5 micrograms/min), and an endothelium-independent vasodilator, nitroprusside (1 and 5 micrograms/min), were studied in 12 normal subjects. Norepinephrine infusions increased the mean plasma norepinephrine from 255 pg/ml at baseline to 460, 629, and 1089 pg/ml, respectively. Basal forearm blood flow was reduced from 2.9 to 1.6 ml/min/100 ml of forearm volume at the highest dose (p < 0.01). The average response to the lowest dose of methacholine (4.5 ml/min/100 ml) was not significantly reduced by concurrent infusion of norepinephrine (4.4, 4.2, and 4.3 ml/min/100 ml, respectively), whereas the response to the higher dose of methacholine (8.9 ml/min/100 ml) tended to be lower (7.2, 6.7, and 7.4 ml/min/100 ml, respectively) but did not attain statistical significance. Methacholine induced vasodilation was not more sensitive to norepinephrine than nitroprusside responses. Lower body negative pressure (-20 mm Hg) also significantly reduced baseline forearm flow and increased plasma norepinephrine but did not effect either methacholine or nitroprusside induced vasodilation. CONCLUSION: Sympathetic stimulation induced by infusion of norepinephrine or lower body negative pressure is not a potent antagonist to endothelium-dependent vasodilation of the forearm vasculature. These data suggest that sympathetic activation does not completely explain the abnormal endothelium-dependent vasodilation seen in patients with heart failure.