Improvement of in vitro thrombolysis employing magnetically-guided microspheres.

Significant shortcomings in clinical thrombolysis efficiencies and arterial recanalization rates still exist to date necessitating the development of additional thrombolysis-enhancing technologies. For example, to improve tPA-induced systemic clot lysis several supplementary treatment methods have been proposed, among them ultrasound-enhanced tissue plasminogen activator (tPA) thrombolysis which has already found some clinical applicability. The rationale of this study was to investigate whether biodegradable, magnetic spheres can be a useful adjuvant to currently existing tPA-induced thrombolysis and further enhance clot lysis results. Based on an envisioned, novel thrombolysis technology--magnetically-guided, tPA-loaded nanocarriers with triggered release of the shielded drug at an intravascular target site--we evaluated the lysis efficiencies of magnetically-guided, non-medicated magnetic spheres in various combinations with tPA and ultrasound. When tPA was used in conjunction with magnetic spheres and a magnetic field, the lysis efficiency under static, no-flow conditions improved by 1.7 and 2.7 fold for red and white clots, respectively. In dynamic lysis studies, the addition of ultrasound and magnetically-guided spheres to lytic tPA dosages resulted in both maximum clot lysis efficiency and shortest reperfusion time corresponding to a 2-fold increase in lysis and 7-fold reduction in recanalization time, respectively. Serial microscopic evaluations on histochemical sections reconfirmed that tPA penetration into and fragmentation of the clot increased with escalating exposure time to tPA and magnetic spheres/field. These results delineate the effectiveness of magnetic spheres as an adjuvant to tPA therapy accelerating in vitro lysis efficiencies beyond values found for tPA with and without ultrasound. We demonstrated that the supplementary use of magnetically-guided, non-medicated magnetic spheres significantly enhances in vitro static and dynamic lysis of red and white blood clots.

[1]  V. Larrue,et al.  Enhancement of enzymatic fibrinolysis with 2‐MHz ultrasound and microbubbles , 2004, Journal of thrombosis and haemostasis : JTH.

[2]  S. Diamond,et al.  Transport Phenomena and Clot Dissolving Therapy: An Experimental Investigation of Diffusion-Controlled and Permeation-Enhanced Fibrinolysis , 1994, Thrombosis and Haemostasis.

[3]  G Trübestein,et al.  Thrombolysis by ultrasound. , 1976, Clinical science and molecular medicine. Supplement.

[4]  P. F. Fisher,et al.  Magnetically responsive microparticles for targeted drug and radionuclide delivery. , 2004 .

[5]  M. Hennerici,et al.  Ultrasound in the treatment of ischaemic stroke , 2003, The Lancet Neurology.

[6]  C. Molina,et al.  Tandem Internal Carotid Artery/Middle Cerebral Artery Occlusion: An Independent Predictor of Poor Outcome After Systemic Thrombolysis , 2006, Stroke.

[7]  E. Antman,et al.  Angiographic and clinical outcomes associated with direct versus conventional stenting among patients treated with fibrinolytic therapy for ST-elevation acute myocardial infarction. , 2005, The American journal of cardiology.

[8]  R S Meltzer,et al.  Ultrasound accelerates urokinase-induced thrombolysis and reperfusion. , 1994, American heart journal.

[9]  A. Alexandrov Ultrasound Identification and Lysis of Clots , 2004, Stroke.

[10]  S M Moghimi,et al.  Long-circulating and target-specific nanoparticles: theory to practice. , 2001, Pharmacological reviews.

[11]  C. L. Morfey Dictionary of Acoustics , 2000 .

[12]  C. Francis Ultrasound‐Enhanced Thrombolysis , 2001, Echocardiography.

[13]  P. Roberson,et al.  Intracranial Clot Lysis With Intravenous Microbubbles and Transcranial Ultrasound in Swine , 2004, Stroke.

[14]  Terry Matsunaga,et al.  Effectiveness of lipid microbubbles and ultrasound in declotting thrombosis. , 2005, Ultrasound in medicine & biology.

[15]  P. T. Onundarson,et al.  Enhancement of fibrinolysis in vitro by ultrasound. , 1992, The Journal of clinical investigation.

[16]  H. Lee,et al.  Synthesis of Pegylated Immunonanoparticles , 2002, Pharmaceutical Research.

[17]  C. Francis,et al.  Enhancement of fibrinolysis with 40-kHz ultrasound. , 1998, Circulation.

[18]  J. Baron,et al.  Stroke Attributable to a Calcific Embolus From the Brachiocephalic Trunk , 2006, Stroke.

[19]  C. Francis,et al.  Ultrasound accelerates transport of recombinant tissue plasminogen activator into clots. , 1995, Ultrasound in medicine & biology.

[20]  M. Skalej,et al.  Early Outcome of Carotid Angioplasty and Stenting versus Carotid Endarterectomy in a Single Academic Center , 2003, Cerebrovascular Diseases.

[21]  Michael D. Kaminski,et al.  Magnetically guided plasminogen activator-loaded designer spheres for acutestroke lysis. , 2007 .

[22]  Michael D Hill,et al.  Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. , 2004, The New England journal of medicine.

[23]  R. Müller,et al.  'Stealth' corona-core nanoparticles surface modified by polyethylene glycol (PEG): influences of the corona (PEG chain length and surface density) and of the core composition on phagocytic uptake and plasma protein adsorption. , 2000, Colloids and surfaces. B, Biointerfaces.

[24]  K. Ohmori,et al.  Enhancement of ultrasound-accelerated thrombolysis by echo contrast agents: dependence on microbubble structure. , 1999, Ultrasound in medicine & biology.

[25]  James P. Blue,et al.  Impedance measurements of ex vivo rat lung at different volumes of inflation. , 2003, The Journal of the Acoustical Society of America.

[26]  S. Smye,et al.  A mathematical model of post-canalization thrombolysis. , 2002, Physics in medicine and biology.

[27]  J. Weber,et al.  Blood-Brain Barrier Disruption By Low-Frequency Ultrasound , 2006, Stroke.

[28]  Peter Grolimund Transmission of Ultrasound Through the Temporal Bone , 1986 .

[29]  C. Francis,et al.  Flow through clots determines the rate and pattern of fibrinolysis. , 1994, Thrombosis and haemostasis.

[30]  S. Diamond,et al.  Engineering design of optimal strategies for blood clot dissolution. , 1999, Annual review of biomedical engineering.

[31]  H. Furuhata,et al.  Evaluation of the thrombolytic effect of tissue-type plasminogen activator with ultrasonic irradiation: in vitro experiment involving assay of the fibrin degradation products from the clot. , 1994, Biological & pharmaceutical bulletin.

[32]  J. Arenillas,et al.  Differential Pattern of Tissue Plasminogen Activator–Induced Proximal Middle Cerebral Artery Recanalization Among Stroke Subtypes , 2004, Stroke.

[33]  E. Tschachler,et al.  Ultrasound affects distribution of plasminogen and tissuetype plasminogen activator in whole blood clots in vitro , 2004, Thrombosis and Haemostasis.

[34]  R. Hamdy Drug Facts and Comparisons: 57th Edition: , 2003 .

[35]  M. Hennerici,et al.  Low-frequency, low-intensity ultrasound accelerates thrombolysis through the skull. , 1999, Ultrasound in medicine & biology.

[36]  L. Frizzell,et al.  Threshold estimates and superthreshold behavior of ultrasound-induced lung hemorrhage in adult rats: role of pulse duration. , 2003, Ultrasound in medicine & biology.

[37]  M. Kaps,et al.  Brain Edema and Intracerebral Necrosis Caused by Transcranial Low-Frequency 20-kHz Ultrasound: A Safety Study in Rats , 2006, Stroke.

[38]  S L Diamond,et al.  Inner clot diffusion and permeation during fibrinolysis. , 1993, Biophysical journal.

[39]  W. Hacke,et al.  Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke , 1992, Annals of neurology.

[40]  Rune Aaslid,et al.  Transcranial Doppler Sonography , 1986, Springer Vienna.

[41]  K. Sartor,et al.  New Method of Embolus Preparation for Standardized Embolic Stroke in Rabbits , 2002, Stroke.

[42]  E. Benes,et al.  In vitro thrombolysis enhanced by standing and travelling ultrasound wave fields. , 2002, Ultrasound in medicine & biology.

[43]  K. Tachibana,et al.  Albumin microbubble echo-contrast material as an enhancer for ultrasound accelerated thrombolysis. , 1995, Circulation.

[44]  C. Francis,et al.  Binding of tissue-plasminogen activator to fibrin: effect of ultrasound. , 1998, Blood.

[45]  H. Hopf,et al.  Low‐Frequency Ultrasound Induces Nonenzymatic Thrombolysis In Vitro , 2002, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[46]  Achim Gass,et al.  Transcranial Low-Frequency Ultrasound-Mediated Thrombolysis in Brain Ischemia: Increased Risk of Hemorrhage With Combined Ultrasound and Tissue Plasminogen Activator Results of a Phase II Clinical Trial , 2005, Stroke.

[47]  I. Schwartz,et al.  Calcification of the mitral annulus fibrosus with systemic embolization. A clinicopathologic study of 16 cases. , 1987, Archives of pathology & laboratory medicine.

[48]  F. Demsar,et al.  Lysing Patterns of Retracted Blood Clots with Diffusion or Bulk Flow Transport of Plasma with Urokinase into Clots – a Magnetic Resonance Imaging Study In Vitro , 1992, Thrombosis and Haemostasis.

[49]  Raquel Delgado-Mederos,et al.  Microbubble administration accelerates clot lysis during continuous 2-MHz ultrasound monitoring in stroke patients treated with intravenous tissue plasminogen activator. , 2006, Stroke.

[50]  A. Alexandrov,et al.  Ultrasound‐Enhanced Thrombolysis for Acute Ischemic Stroke: Phase I. Findings of the CLOTBUST Trial , 2004, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[51]  C. Francis,et al.  Ultrasound enhancement of fibrinolysis at frequencies of 27 to 100 kHz. , 2002, Ultrasound in medicine & biology.

[52]  P. A. Dijkmansa,et al.  Microbubbles and ultrasound : from diagnosis to therapy , 2004 .

[53]  Michael D. Kaminski,et al.  Preparation and characterization of hydrophobic superparamagnetic magnetite gel , 2006 .