title: Iron and carbon monoxide attenuate Crotalus atrox venom-enhanced tissue-type plasminogen activator-initiated fibrinolysis.
abstract: In addition to degrading fibrinogen as a source of consumptive coagulopathy, rattlesnake venom has also been demonstrated to enhance fibrinolysis and degrade alpha-2-antiplasmin. The goals of this investigation was to characterize the kinetic fibrinolytic profile of Crotalus atrox venom in the absence and presence of tissue-type plasminogen activator (tPA), and to also ascertain if iron and carbon monoxide (CO, a positive modulator of alpha-2-antiplasmin) could attenuate venom-enhanced fibrinolysis. Utilizing thrombelastographic methods, the coagulation and fibrinolytic kinetic profiles of human plasma exposed to C. atrox venom (0-2 μg/ml) were determined in the absence or presence of tPA (0-100 IU/ml). Then, either separately or in combination, plasma was exposed to iron (ferric chloride, 10 μmol/l) or CO (carbon monoxide-releasing molecule-2, 100 μmol/l) prior to incubation with venom; the plasma sample was subsequently subjected to thrombelastographic analysis with addition of tPA. Venom exposure in the absence of tPA did not result in detectable fibrinolysis. In the presence of tPA, venom markedly enhanced fibrinolysis. Iron and CO, markedly attenuated venom enhancement of fibrinolysis. C. atrox venom enhances tPA-mediated fibrinolysis, and interventions that enhance/protect alpha-2-antiplasmin activity significantly attenuate venom-enhanced fibrinolysis. Future preclinical investigation is required to determine if iron and CO can attenuate venom-mediated degradation of alpha-2-antiplasmin-dependent fibrinolytic resistance.
authors.affiliation: aDepartment of Anesthesiology bVIPER Institute, the University of Arizona College of Medicine, Tucson, Arizona, USA.
authors.forename: Vance G
authors.initials: VG
authors.lastname: Nielsen
authors.forename: Leslie V
authors.initials: LV
authors.lastname: Boyer
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Matika
authors.forename: Quinlan
authors.initials: Q
authors.lastname: Amos
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Redford
mesh_terms: D000818:Animals; D002248:Carbon Monoxide / Q000737:chemistry / Q000494:pharmacology*; D002712:Chlorides / Q000494:pharmacology*; D003435:Crotalid Venoms / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D017839:Crotalus / Q000378:metabolism; D005290:Ferric Compounds / Q000494:pharmacology*; D063285:Fibrin Clot Lysis Time; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects*; D005343:Fibrinolytic Agents / Q000494:pharmacology*; D006490:Hemostatics / Q000494:pharmacology*; D006801:Humans; D009942:Organometallic Compounds / Q000737:chemistry / Q000494:pharmacology; D013916:Thrombelastography; D010959:Tissue Plasminogen Activator / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D000979:alpha-2-Antiplasmin / Q000378:metabolism / Q000494:pharmacology
chemical_list: D002712:Chlorides; D003435:Crotalid Venoms; D005290:Ferric Compounds; D005343:Fibrinolytic Agents; D006490:Hemostatics; D009942:Organometallic Compounds; D000979:alpha-2-Antiplasmin; C447082:tricarbonyldichlororuthenium (II) dimer; D002248:Carbon Monoxide; D005340:Fibrinogen; D010959:Tissue Plasminogen Activator; C024555:ferric chloride