- Email: [email protected]
Assessment of coagulation and fibrinolytic levels in patients with cancer and disseminated intravascular coagulation
WS2-B2-1-08 THE EFFECTS OF INTRAARTICULAR HYALURONATE ON PLASMINOGEN ACTIVATOR AND ITS INHIBITOR IN SYNOVIAL FLUID FROM PATIENTS WITH OSTEOARTHRITIS. Kikuchi H, Nonaka T, Shimada W, Tanaka S. Dept.of Orthopaedic Surgery,Kinki University School of Medicine,Osaka,Japan.
During the progress of the joint destruction, many proteinases may contribute actively to the pathogenetic mechanism. In particular, urokinase type plasminogen activator(u-PA) derived from synovial fluid(SF) are important in enhancing matrix metalloproteases, causing joint destruction. Recent "advances have demonstrated that PA inhibitor-I (PAl-l) can inhibit u-PA activity in joint cavity.In orthopaedic surgery, intraarticular hyaluronate(HA) injection which may protect for chondrolysis and depress to inflammation, is common therapy for osteoarthritis(OA). The present investigation was undertaken to examine the pathophysiological role of u-PA and PAI-1 in the SF of OA with HA treatment. In 42 OA patients, the SF was obtained 3ml before 25mg of HA injection. For 3 hours later, every residual SF volume was obtained. Samples were u~ed for analysis of u-PA and PAI-1. Assay of u-PA and PAl-1 activities were performed by electrophoretic enzymography and their antigens were performed by ELISA-kit(Technoclone). In this OASF, 3 molecular weight PAs were detected in every euglobrin fractioned sample. The 110 ~90KD high molecular weight(HMW) PA was u-PA • PAI-1 complex form and the other 55 and 33KD PAs were u-PA, immunologically. In the follow up studied cases, total PA activities were decreased gradually by enzymography.The levels of the u-PA antigen and the PAl-1 antigen were 6~60(28.4)mlU and 17.7~42.9(28.8)mlU before HA treatment, and 4~300(41.8)mlU and 18.9~63.6(37.2)mlU after HA treatment respectively.Effects of HA on OASF can indicate the increases for both u-PA and PAI-I antigens and u-PA • PAl-1 complex formation. The 31 out of 42 joints got the effective results clinically, loss of pain, decrease of ballottement, enlarged range of motion and improvement of activities of daily living. But 11 joints were unchanged. In this 31 joints, the ratio of PAl- I/u-PA antigen was increased in 29 joints(93.5c/~), while in the other 11 joints, it was increased in only two joints(18.2%). Complications are none in this study. The results suggests that one of the HA function for chondroprotection may contribute the decrease of fibrinolysis in the OA joint cavity.
WS2-B2-2-01 ASSESSMENT OF COAGULATION AND FIBRINOLYTIC LEVELS IN PATIENTS WITH CANCER AND I)ISSEM1NATEI) INTRAVASCULAR COAGULATION K. Nakagawa, H. Tsuji, H. Masuda, H. Kitanmra, Y. Ogasahara, Y. Nakahara, S. Komatsu, H. Nishimura, T. Kasahara, R. Yamashita, T. Sato, A. Toratani, Shohei Sawada and Masao Nakagawa. Second Department of Medicine, Kyoto Prefectural University of Medicine, Kawaramachi Hirokji, Kamigo-ku, Kyolo 602, Japan. Comect assessnlent of coagulation and fibrinolytic state iu cancer patients is indispensable for following two reasons; one of tile most critical complications of cancer is disseminated intravascular coagulation (DIC), and the valnerability to which is primarily evaluated from the sequential data of coagulation parameters. Second is lhat the plasminogen-plamin system is reported to serve an inlportaut role in tumor invasion and metastasis. Thus, we have analysed both the coagulation and fibrinolytic states in cancer palieuls using several molecular markers which are specifically designed to assess each steps in coagulation and fibrinolytic cascade. Citrated plasma was obtained from patients with leukemia (n=17); tell males and seven females (age 55.2-*4.5, mean-*SE, total 48 samples), and cancer (n=10); six males and four females (age 68.6±2.3, total 43 samples). Thrombin-antithrombinlll complex (TAT: Enzygnost TAT, Boehringwerke AG, Germauy) and l'roihrombiu fragment fl+2 (Fl+2:Enzygnost FI+2, Boehringwerke AG, Germany), soluble fibrin (SF) (Elisa Fibrin: Boehringer Manuheinl, Germany), and soluble fibriu mooonler complex (SFMC) (FM-test: Boehringer Mannheim, Gemlany) were measured as coagulation markers almlg with prothrombin time (PT) and activated partial thromboplastin time (aPTT), and fibrinogen, hi order to assess the fibriuolylic activities, we have measured fibrin degradation products (FDP) (LPIA.FDP:Teikoku Zoki Pharma., Japan), plasminogen activator inhibitor-1 (PAl-l) (Imulyse PAl-l: Biopool AlL Sweden),tissue plasminogen activator (tPA) (lmulyse tPA:Biopool Data of c a n c e r patients AB, Sweden), and tPA/PAI-1 complex (t-PA/PAI-1 Complex ELISA Kit, Thechnoclone GMBH, Austria). Tile diagnosis of DIC 120 y=3.01 +0.18x 600 was made according to "The DIC Scoring Guideline" proposed r=0.88 by the DIC Working Party under the Ministry of Public Welfare, • ~100 n=43 ~. f f 2 d " Japan, io 1988. 80 p
13oo! 0'3
143
S
e Ibe
During the progress of the joint destruction, many proteinases may contribute actively to the pathogenetic mechanism. In particular, urokinase type plasminogen activator(u-PA) derived from synovial fluid(SF) are important in enhancing matrix metalloproteases, causing joint destruction. Recent "advances have demonstrated that PA inhibitor-I (PAl-l) can inhibit u-PA activity in joint cavity.In orthopaedic surgery, intraarticular hyaluronate(HA) injection which may protect for chondrolysis and depress to inflammation, is common therapy for osteoarthritis(OA). The present investigation was undertaken to examine the pathophysiological role of u-PA and PAI-1 in the SF of OA with HA treatment. In 42 OA patients, the SF was obtained 3ml before 25mg of HA injection. For 3 hours later, every residual SF volume was obtained. Samples were u~ed for analysis of u-PA and PAI-1. Assay of u-PA and PAl-1 activities were performed by electrophoretic enzymography and their antigens were performed by ELISA-kit(Technoclone). In this OASF, 3 molecular weight PAs were detected in every euglobrin fractioned sample. The 110 ~90KD high molecular weight(HMW) PA was u-PA • PAI-1 complex form and the other 55 and 33KD PAs were u-PA, immunologically. In the follow up studied cases, total PA activities were decreased gradually by enzymography.The levels of the u-PA antigen and the PAl-1 antigen were 6~60(28.4)mlU and 17.7~42.9(28.8)mlU before HA treatment, and 4~300(41.8)mlU and 18.9~63.6(37.2)mlU after HA treatment respectively.Effects of HA on OASF can indicate the increases for both u-PA and PAI-I antigens and u-PA • PAl-1 complex formation. The 31 out of 42 joints got the effective results clinically, loss of pain, decrease of ballottement, enlarged range of motion and improvement of activities of daily living. But 11 joints were unchanged. In this 31 joints, the ratio of PAl- I/u-PA antigen was increased in 29 joints(93.5c/~), while in the other 11 joints, it was increased in only two joints(18.2%). Complications are none in this study. The results suggests that one of the HA function for chondroprotection may contribute the decrease of fibrinolysis in the OA joint cavity.
WS2-B2-2-01 ASSESSMENT OF COAGULATION AND FIBRINOLYTIC LEVELS IN PATIENTS WITH CANCER AND I)ISSEM1NATEI) INTRAVASCULAR COAGULATION K. Nakagawa, H. Tsuji, H. Masuda, H. Kitanmra, Y. Ogasahara, Y. Nakahara, S. Komatsu, H. Nishimura, T. Kasahara, R. Yamashita, T. Sato, A. Toratani, Shohei Sawada and Masao Nakagawa. Second Department of Medicine, Kyoto Prefectural University of Medicine, Kawaramachi Hirokji, Kamigo-ku, Kyolo 602, Japan. Comect assessnlent of coagulation and fibrinolytic state iu cancer patients is indispensable for following two reasons; one of tile most critical complications of cancer is disseminated intravascular coagulation (DIC), and the valnerability to which is primarily evaluated from the sequential data of coagulation parameters. Second is lhat the plasminogen-plamin system is reported to serve an inlportaut role in tumor invasion and metastasis. Thus, we have analysed both the coagulation and fibrinolytic states in cancer palieuls using several molecular markers which are specifically designed to assess each steps in coagulation and fibrinolytic cascade. Citrated plasma was obtained from patients with leukemia (n=17); tell males and seven females (age 55.2-*4.5, mean-*SE, total 48 samples), and cancer (n=10); six males and four females (age 68.6±2.3, total 43 samples). Thrombin-antithrombinlll complex (TAT: Enzygnost TAT, Boehringwerke AG, Germauy) and l'roihrombiu fragment fl+2 (Fl+2:Enzygnost FI+2, Boehringwerke AG, Germany), soluble fibrin (SF) (Elisa Fibrin: Boehringer Manuheinl, Germany), and soluble fibriu mooonler complex (SFMC) (FM-test: Boehringer Mannheim, Gemlany) were measured as coagulation markers almlg with prothrombin time (PT) and activated partial thromboplastin time (aPTT), and fibrinogen, hi order to assess the fibriuolylic activities, we have measured fibrin degradation products (FDP) (LPIA.FDP:Teikoku Zoki Pharma., Japan), plasminogen activator inhibitor-1 (PAl-l) (Imulyse PAl-l: Biopool AlL Sweden),tissue plasminogen activator (tPA) (lmulyse tPA:Biopool Data of c a n c e r patients AB, Sweden), and tPA/PAI-1 complex (t-PA/PAI-1 Complex
13oo! 0'3
143
S
e Ibe