Apolipoprotein A-I breakdown is induced by thrombolysis in coronary patients.
BACKGROUND
The outcome of percutaneous coronary intervention (PCI) is apparently worse in patients receiving a prior thrombolytic therapy ('facilitated PCI'). Recombinant tissue-type plasminogen activator (rt-PA) can degrade circulating high-density lipoproteins (HDL) bound apolipoprotein A-I (apoA-I), thus possibly reducing the vascular protective activity. There have never been reports of the detection of apolipoprotein breakdown products in the circulation.


OBJECTIVE
We studied the potential interactions between the protein components of HDL and tenecteplase, infused as thrombolytic therapy.


METHODS
Sera from a total of 40 patients with acute myocardial infarction (AMI), unstable angina (UA), and dilative cardiomyopathy (controls) were investigated. AMI patients underwent either immediate PCI or were treated with tenecteplase thrombolysis.


RESULTS
Products of extensive proteolysis of apoA-I were found in many acute coronary patients treated with tenecteplase, and in some AMI patients before starting the treatment (time 0). These were not detected in controls, UA patients as well as AMI patients undergoing immediate PCI. Small pre-beta-HDLs were selectively degraded.


CONCLUSIONS
Significant apoA-I degradation occurs in AMI patients after thrombolytic treatment. This finding may provide a potential mechanism for the apparent reduction of benefit of facilitated versus nonfacilitated PCI.
Eberini
Ivano
I
Proteomics and Protein Structure Study Group, University of Milan, Milan, Italy.
Gianazza
Elisabetta
E
Breghi
Loranni
L
Klugmann
Silvio
S
Calabresi
Laura
L
Gomaraschi
Monica
M
Mombelli
Giuliana
G
Brusoni
Bruno
B
Wait
Robin
R
Sirtori
Cesare R
CR
D000368:Aged; D000789:Angina, Unstable / Q000378:metabolism / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D016632:Apolipoprotein A-I / Q000187:drug effects* / Q000378:metabolism; D002311:Cardiomyopathy, Dilated / Q000378:metabolism / Q000628:therapy; D016022:Case-Control Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism / Q000628:therapy; D000077785:Tenecteplase; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000494:pharmacology*
D016632:Apolipoprotein A-I; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase