Abciximab combined with half-dose reteplase has beneficial effects on inflammatory myocardial response in patients with myocardial infarction.
In patients with ST-segment elevation myocardial infarction (STEMI), myocardial reperfusion is associated with an inflammatory response leading to adverse effects on further myocardial damage. Therefore, we investigated the effects of the thrombolytic regimen with half-dose reteplase (r-PA) combined with abciximab on different cytokines involved in the local and systemic inflammatory scenario in STEMI patients. Thirty-eight STEMI patients were enrolled in this study. We investigated the effects of the regimen with half-dose r-PA plus abciximab versus full-dose r-PA on interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), MCP-1 and tumor necrosis factor-alpha (TNF-alpha) up to 48 h after the start of therapy. The full-dose r-PA group had a significant IL-6 increase after 48 h compared with the combination group. Furthermore, the full-dose r-PA group showed a marked increase of IL-10 (up to 3 h after) compared with a 41% IL-10 decrease in the combination group. MCP-1 decreased significantly after 3 h in the combination group compared with patients on r-PA therapy only. The combination group showed a nonsignificant increase in IL-8 within the first 6 h. There were no differences in TNF-alpha levels between the two infarct groups. In vivo, the investigated combined thrombolytic regimen consisting of half-dose r-PA plus abciximab causes less of an IL-6 increase and marked decreases in IL-10 and MCP-1 in STEMI patients compared with the pure r-PA thrombolytic regimen. This observation suggests that besides the known beneficial effects on systemic coagulation and leukocyte-platelet aggregates, this regimen may exert a favorable influence on myocardial tissue damage and thus on cardiac repair following myocardial infarction.
Department of Internal Medicine II, Klinik für Kardiologie, Städtisches Klinikum, Gotenstrasse 1, Solingen, Germany. KrisztinaSzb@aol.com
Sebastian
S
Szabo
Diana
D
Etzel
Thomas
T
Walter
Silke
S
Kazmaier
Thomas
T
Oikonomopoulos
Roger
R
Marx
Hans Martin
HM
Hoffmeister
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D000925:Anticoagulants / Q000008:administration & dosage*; D016207:Cytokines / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007249:Inflammation / Q000097:blood / Q000188:drug therapy; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000008:administration & dosage; D012038:Regeneration / Q000187:drug effects*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D016207:Cytokines; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D018836:Inflammation Mediators; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator; D000077284:Abciximab