Grandjean Cynthia, McMullen Patricia C, Newschwander Gregg
School of Nursing, The Catholic University of America, Washington, DC 20064, USA.
J Cardiovasc Nurs. 2004 Nov-Dec;19(6):417-20. doi: 10.1097/00005082-200411000-00014.
While tissue-type plasminogen activator (tPA) is currently the standard "clot-busting" drug used to treat patients with acute ischemic stroke, another new option for treatment is now under clinical study. Desmodus rotundus plasminogen activator (DSPA), an enzyme found in the saliva of vampire bats, may offer another therapeutic option instead of tPA, a current therapy for stroke. Animal research indicates that tPA may mediate neuronal death as well as increase systemic plasminogen consumption and fibrinogenolysis. Conversely, DSPA's activity is dependent on the presence of fibrin and therefore has not been associated with the systemic plasminogen consumption and fibrinogenolysis that potentially may occur in those receiving tPA. In animal studies, tPA was found to exhibit "inherent neurotoxic properties" not seen with DSPA. In addition, DSPA may be administered up to 9 hours after the onset of symptoms, unlike tPA, which cannot be given after 3 hours without potential risk of additional brain injury. Phase II clinical trials have demonstrated a positive result in human subjects. Phase III trials are currently under way in stroke populations.
虽然组织型纤溶酶原激活剂(tPA)目前是用于治疗急性缺血性中风患者的标准“溶栓”药物,但现在另一种新的治疗选择正在进行临床研究。圆叶吸血蝠纤溶酶原激活剂(DSPA)是在吸血蝙蝠唾液中发现的一种酶,它可能提供一种替代tPA(目前的中风治疗方法)的治疗选择。动物研究表明,tPA可能介导神经元死亡,并增加全身纤溶酶原消耗和纤维蛋白溶解。相反,DSPA的活性依赖于纤维蛋白的存在,因此与接受tPA治疗的患者可能发生的全身纤溶酶原消耗和纤维蛋白溶解无关。在动物研究中,发现tPA表现出DSPA所没有的“内在神经毒性特性”。此外,与tPA不同,DSPA可在症状出现后长达9小时给药,而tPA在3小时后给药会有导致额外脑损伤的潜在风险。II期临床试验已在人体受试者中取得了阳性结果。目前正在中风人群中进行III期试验。