Subscribe to RSS
DOI: 10.1055/s-2002-35293
Pharmacology of Recombinant Hirudin
Publication History
Publication Date:
06 November 2002 (online)
ABSTRACT
Hirudin is the anticoagulative product of the salivary glands of the medical leech Hirudo medicinalis. It is characterized by a direct, bifunctional inhibition mechanism and a high, exclusive specificity and a strong ability to bind to thrombin (tight binding). Further characteristics are the organic-chemical structure of hirudin (peptide), which allows only parenteral administration; the missing metabolism in the organism; and the exclusive glomerular filtration of hirudin in kidneys as the effective elimination mechanism. Recombinant hirudin (r-hirudin) is a product of genetic engineering that is identical to the hirudin found in nature and has the same biochemical and pharmacological characteristics as natural hirudin.
KEYWORDS
r-hirudin - pharmacology - pharmacokinetics - ECT
REFERENCES
- 1 De la Llosa P, Tertrin C, Justisz M. Composition en acides aminés de l'hirudin. Identification du résidu N-terminal. Bulletin de la Societé de Chimie Biologique . 1963; 45 69-74
- 2 De la Llosa P, Tertrin C, Justisz M. L'enchainemant C-terminal de l'hirudin. Biochim Biophys Acta . 1964; 93 40-44
- 3 Dodt J, Müller H P, Seemüller U, Chang J Y. The complete amino acid sequence of hirudin, a thrombin specific inhibitor. FEBS Lett . 1984; 162 180-183
- 4 Johnson P, Sze P, Winant R, Payne P W, Lazar J B. Biochemistry and genetic engineering of hirudin. Semin Thromb Hemost . 1989; 15 302-315
- 5 Bagdy D, Barabas E, Graf L, Peterson T E, Magnusson S. Hirudin. In: Lorand L, ed. Methods in Enzymology: Proteolytic Enzymes, Vol 19. New York: Academic Press 1976: 924-932
- 6 Scharf M, Engels J, Tripier D. Primary structures of new ``iso-hirudins''. FEBS Lett . 1989; 225 105-110
- 7 Walsmann P, Markwardt F. Biochemische und pharmakologische Aspekte des Thrombininhibitors Hirudin. Pharmazie . 1981; 26 653-660
- 8 Rydel T J, Ravichandran K G, Tulinsky A. The structure of a complex of recombinant hirudin and human α-thrombin. Science . 1990; 249 277-280
- 9 Stone S, Hofsteenge J. The kinetics of the inhibition of thrombin by hirudin. Biochemistry . 1986; 25 4622-4628
- 10 Nowak G, Markwardt F, Fink E. Pharmacokinetic studies with recombinant hirudin in dogs. Folia Haematol Leipzig . 1988; 115 70-74
- 11 Markwardt F, Fink G, Kaiser B. Pharmacological survey of recombinant hirudin. Pharmazie . 1988; 43 202-207
- 12 Markwardt F, Hauptmann J, Nowak G, Klessen C, Walsmann P. Pharmacological studies on the antithrombotic action of hirudin in experimental animals. Thromb Haemost . 1982; 47 226-229
- 13 Markwardt F, Kaiser B, Nowak G. Studies on antithrombotic effects of recombinant hirudin. Thromb Res . 1989; 54 377-388
- 14 Lindhoff-Last E, Willeke A, Mosch G. Hirudin treatment in a breastfeeding woman. Lancet . 2000; 355 467-468
- 15 Markwardt F, Nowak G, Stürzebecher J, Vogel G. Clinico-pharmacological studies with recombinant hirudin. Thromb Res . 1988; 52 393-400
- 16 Markwardt F, Nowak G, Stürzebecher J. Pharmacokinetics and anticoagulant effect of hirudin in man. Thromb Haemost . 1984; 52 160-163
- 17 Nowak G, Bucha E, Gööck T, Prasa D, Thieler H. Pharmakokinetik von Hirudin bei gestörter Nierenfunktion. Hämostaseologie . 1991; 11 152-157
- 18 Nowak G, Bucha E, Gööck T, Thieler M, Markwardt F. Pharmacology of r-hirudin in renal impairment. Thromb Res . 1992; 66 707-715
- 19 Bucha E, Markwardt F, Nowak G. Hirudin in haemodialysis. Thromb Res . 1990; 60 445-455
- 20 Nowak G, Bucha E, Brauns I, Czerwinski R. Anticoagulation with r-hirudin in regular haemodialysis with heparin-induced thrombocytopenia (HIT II). Wien Klin Wochenschr . 1997; 109 354-358
- 21 Markwardt F, Nowak G, Bucha E. Hirudin as anticoagulant in experimental hemodialysis. Haemostasis . 1991; 21(Suppl 1) 149-155
- 22 Stringer K A, Lindenfield J. Hirudins: antithrombin anticoagulants. Ann Pharmacother . 1992; 26 1535-1540
- 23 Bucha E, Nowak G, Markwardt F. Prevention of experimental coronary thrombosis by hirudin. Folia Haematol . 1988; 115 52-58
- 24 Heras M, Chesebro J H, Webster M WI. Hirudin, heparin or placebo during deep arterial injury in the pig: the in vivo role of thrombin in platelet-mediated thrombosis. Circulation . 1990; 82 1476-1484
- 25 Markwardt F. Past, present and future of hirudin. Haemostasis . 1991; 21(Suppl 1) 11-26
- 26 Pötzsch B, Iversen S, Riess F C. Recombinant hirudin as an anticoagulant in open-heart surgery: a case report (Abst). Ann Hematol . 1993; 68(Suppl 2) A46
- 27 Pötzsch B, Madlener K, Seelig C. Monitoring of r-hirudin anticoagulation during cardiopulmonary bypass-assessment of the whole blood ecarin clotting time. Thromb Haemost . 1997; 77 920-925
- 28 Breddin H K, Radziwon P, Eschenfelder V, Müller-Peltzer H, Esslinger H U. PEG-hirudin and acetylsalicylic acid show a strong interaction on bleeding time (Abst). Ann Haematol . 1996; 72 53
- 29 Meyer B H, Luus H G, Müller F O, Badenhorst P N, Röthig H-J. The pharmacology of recombinant hirudin, a new anticoagulant. S Afr Med J . 1990; 78 268-270
- 30 Weitz J I, Hudoba M, Massel D, Maragonore J, Hirsh J. Clot-bound thrombin is protected from inhibition by heparin-antithrombin III but is susceptible to inactivation by antithrombin III-independent inhibitors. J Clin Invest . 1990; 86 385-391
- 31 Antman E M, for the TIMI 9B investigators. Hirudin in acute myocardial infarction. Thrombolysis and thrombin inhibition in myocardial infarction (TIMI) 9B trial. Circulation . 1996; 94 911-921
- 32 Canon C P, McCabe C H, Henry T D, for the TIMI-5 investigators. Hirudin reduces reocclusion compared to heparin following thrombolysis in acute myocardial infarction (Abst). J Am Coll Cardiol . 1993; 21 136a
- 33 Moia M, Schiele F, Walker M. Treatment of acute deep vein thrombosis (DVT) by subcutaneous r-hirudin (HBW 023): a multicenter study (Abst). Thromb Haemost . 1995; 73 1456
- 34 Parent F, Bridey F, Dreyfus M. Treatment of severe venous thrombo-embolism with intravenous hirudin (HBW-023). An open pilot study. Thromb Haemost . 1993; 70 386-388
- 35 Rupprecht H J, Terres W, Özbek C. Recombinant hirudin (HBW 023) prevents troponin release after coronary angioplasty in patients with unstable angina. J Am Coll Cardiol . 1995; 26 1637-1642
- 36 Hermann J PR, Kutryk M JV, Serruys P W. Clinical trials of direct thrombin inhibitors during invasive procedures. Thromb Haemost . 1997; 78 367-376
- 37 The Global Use of Strategies To Open occluded coronary arteries (GUSTO) IIb investigators. A comparison of recombinant hirudin with heparin for the treatment of acute coronary syndromes. N Engl J Med 1996 335: 775-782
- 38 Walenga J M, Pifarré R. Hirudin as an anticoagulant in cardiopulmonary bypass. In: Pifarré R, ed. New Anticoagulants for the Cardiovascular Patient Philadelphia, PA: Hanley & Belfus 1997: 175-186
- 39 Zeymer U, von Essen R, Tebbe U. Frequency of ``optimal anticoagulation'' for acute myocardial infarction after thrombolysis with front-load recombinant tissue-type plasminogen activator and conjunctive therapy with recombinant hirudin (HBW 023). Am J Cardiol . 1995; 76 997-1001
- 40 Zoldhelyi P, Webster M WI, Fuster V. Recombinant hirudin in patients with chronic, stable coronary artery disease. Safety, half-life, and effect on coagulation parameters. Circulation . 1993; 88 2015-2022
- 41 Greinacher A. Lepirudin for the treatment of heparin-induced thrombocytopenia: a prospective study (Abst). Blood . 1998; 92 1490
- 42 Schiele F, Vuillemenot A, Kramarz P. Use of recombinant hirudin as antithrombotic treatment in patients with heparin-induced thrombocytopenia. Am J Hematol . 1995; 50 20-25
- 43 Schmidt O H, Lang W. Heparin-induced thrombocytopenia with thromboembolic arterial occlusion treated with recombinant hirudin. N Engl J Med . 1997; 337 1389
- 44 Agnelli G, Snaglia F. Recombinant hirudin in the prevention of venous thromboembolism in patients undergoing elective hip surgery. Semin Thromb Hemost . 1997; 22 143-148
- 45 Eriksson B I, Ekman S, Kälebo P. Prevention of deep-vein thrombosis after total hip replacement: direct thrombin inhibition with recombinant hirudin, CGP 39393. Lancet . 1996; 347 635-639
- 46 Eriksson B, Kälebo P, Ekman S. Direct thrombin inhibition with Rec-hirudin CGP 39393 as prophylaxis of thromboembolic complications after total hip replacement. Thromb Haemost . 1994; 72 227-231
- 47 Buchwald A B, Sandrock D, Unterberg C A. Platelet and fibrin deposition on coronary stents in minipigs: effects of hirudin versus heparin. J Am Coll Cardiol . 1993; 21 249-254
- 48 Haskel E J, Prager N A, Sobel B E, Abenschein D R. Relative efficacy of antithrombin compared with antiplatelet agents in accelerating coronary thrombolysis and preventing early reocclusion. Circulation . 1991; 83 1048-1056
- 49 Bichler J, Gemmerli R, Fritz H. Studies for revealing a possible sensitization to hirudin after repeated intravenous injections in baboons. Thromb Res . 1991; 61 39-51
- 50 Eichler P, Friesen H J, Lubenow N, Jaeger B, Greinacher A. Antihirudin antibodies in patients with heparin-induced thrombocytopenia treated with lepirudin: incidence, effects on aPTT, and clinical relevance. Blood . 2000; 96 2373-2378
- 51 Brüggener E, Walsmann P, Markwardt F. Neutralization of hirudin anticoagulant action by DIP-thrombin. Pharmazie . 1989; 44 648-649
- 52 Tripodi A, Chantarangkul V, Arbini A A, Moia M, Manucci P M. Effects of hirudin on activated partial thromboplastin time determined with ten different reagents. Thromb Haemost . 1993; 70 286-288
- 53 Spinner S, Stöffler G, Fink E. Quantitative enzyme-linked immunosorbent assay (ELISA) for hirudin. J Immunol Methods . 1988; 87 79-83
- 54 Nowak G. Monitoring of the action of antithrombin agents by ecarin clotting time. In: Pifarré R, ed. New Anticoagulants for the Cardiovascular Patient Philadelphia, PA: Hanley & Belfus 1997: 530-550
- 55 Nowak G, Bucha E. Quantitative determination of hirudin in blood and body fluids. Semin Thromb Hemost . 1996; 22 197-202
- 56 Nowak G, Bucha E, Hoffmann J. Verfahren zur Bestimmung von Hirudin und synthetischen Thrombininhibitoren. DPA 4203980.0 Deutsches Patentamt 1992