Patent Application
20230081922
The content of the following submission on ASCII text file is incorporated herein by reference in its entirety: a computer readable form (CRF) of the Sequence Listing (file name: 794922002400SEQLIST.TXT, date recorded: Aug. 5, 2022, size: 46,756 bytes).
The present application relates to a method for preventing or treating viral pneumonia, such as coronavirus-infected pneumonia and complications thereof, comprising administering an effective amount of a component of the plasminogen activation pathway or a related compound thereof (e.g., plasminogen) to a subject to alleviate lung inflammation, increase blood oxygen saturation, treat pneumonia and prevent related complications such as pulmonary fibrosis.
Coronavirus (CoV) is a positive single-stranded RNA virus with envelope, belonging to Coronaviridae family, and can be divided into four genera according to their genotypes: alpha coronavirus (α-CoV), beta coronavirus (β-CoV), gamma coronavirus (γ-CoV), delta coronavirus (δ-CoV); wherein α-CoV and β-CoV are more susceptible to mammals (CUI J, Li F, SHI Z L. Origin and evolution of pathogenic coronaviruses[J]. Naturereviews. Micorbiology, 2019, 17(3): 181-192).
Severe acute respiratory syndrome coronavirus (SARS-CoV), which outbroke in China in 2003 and caused severe acute respiratory syndrome (SARS) characterized by atypical pneumonia, belongs to β-CoV. A new human coronavirus (hCoVEMC/2012) similar to SARS-CoV appeared in the Middle East and South Korea in 2012, and caused middle east respiratory syndrome (MERS) in humans. In 2013, the World Health Organization named its pathogen as Middle East respiratory syndrome coronavirus (MERS-CoV). The disease is similar to SARS, but it is more likely to cause other complications, such as liver and kidney failure, thus the mortality rate of patients is higher.
SARS virus has extensive tissue tropism, invades various tissues and organs, and causes damage to various tissues and organs. A patient has the symptoms including pulmonary congestion, hemorrhage, edema and severe diffuse alveolar damage, hyaline membrane formation, alveolar epithelial hyperplasia, inflammatory infiltration of pulmonary interstitial mononuclear cells, shedding of interalveolar lung cells, and pulmonary interstitial fibrosis.
The 2019 novel coronavirus, which was first discovered in December 2019 in Wuhan, Hubei Province and spread rapidly in a short period of time. It was officially named 2019-nCoV by WHO on Jan. 12, 2020 (also referred to as COVID-19 in this application), belongs to β-genus coronavirus and its genetic characteristics are significantly different from SARS-CoV and MERS-CoV, and closer to the bat SARS-like coronavirus bat-SL-CoV ZC45 and bat-SL-CoV ZXC21 (CHEN Y, LIU Q, GUO D. Emerging coronaviruses: genome structure, replication, and pathogenesis [J]. Journal of medical virology, 2020).
2019-nCoV has high infectivity, and the population is generally susceptible to it, the main symptoms manifest as lower respiratory tract infection, such as dry cough, fever, dyspnea, etc. In severe cases, it can even cause acute respiratory distress syndrome (ARDS) and sepsis (Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance.28January 2020.WHO/nCoV/Clinical/2020.2).
Novel coronavirus pneumonia can be divided into three stages based on pathological staging: early stage, advanced stage and severe stage. At early stage, the disease is limited, and the symptoms manifest as single or multiple ground-glass opacity (GGO) nodules, patches or sheet shadows; in the advanced stage, the disease progresses, the lesions increase and expand in scope, GGO coexists with consolidation or strip shadows, partial consolidation or columnar thickening of the bronchi in structural distortion shadows; in severe stage, diffuse lesions in both lungs, extensive exudation and consolidation of lung parenchyma, mainly consolidation shadows, distorted lung structure, bronchiectasis, sub-segmental atelectasis, with “white lung” in severe cases are observed (SHI Heshui, HAN Xiaoyu, FAN Yanqing, LIANG Bo, YANG Fan, HAN Ping, ZHENG Chuansheng. Clinical features and imaging manifestations of pneumonia caused by novel coronavirus (2019-nCoV) infection. Journal of Clinical Radiology. https://doi.org/10.13437/j.cnki.jcr.20200206.002).
The present application finds that plasminogen can significantly alleviate pneumonia (including viral pneumonia, such as 2019-nCoV viral pneumonia) and improve lung ventilation function in patients with pulmonary fibrosis, increase blood oxygen saturation and improve symptoms of dyspnea, thereby treating pneumonia and pulmonary fibrosis -related diseases.
Particularly, the present application relates to the following items:
In one aspect, the present application relates to use of one or more compounds in the preparation of a medicament for preventing and treating pneumonia, wherein said one or more compounds are selected from the group consisting of: a component of plasminogen activation pathway, a compound directly activating plasminogen or indirectly activating plasminogen by activating an upstream component of plasminogen activation pathway, a compound mimicking the activity of plasminogen or plasmin, a compound upregulating the expression of plasminogen or an activator of plasminogen, an analog of plasminogen, an analog of plasmin, an analog of tPA or uPA, and an antagonist of fibrinolysis inhibitor.
In one aspect, the present application relates to use of one or more compounds in the prevention and treatment of pneumonia, wherein said one or more compounds are selected from the group consisting of: a component of plasminogen activation pathway, a compound directly activating plasminogen or indirectly activating plasminogen by activating an upstream component of plasminogen activation pathway, a compound mimicking the activity of plasminogen or plasmin, a compound upregulating the expression of plasminogen or an activator of plasminogen, an analog of plasminogen, an analog of plasmin, an analog of tPA or uPA, and an antagonist of fibrinolysis inhibitor.
In one aspect, the present application relates to a medicament for the prevention and treatment of pneumonia, which comprises one or more compounds selected from the group consisting of: a component of plasminogen activation pathway, a compound directly activating plasminogen or indirectly activating plasminogen by activating an upstream component of plasminogen activation pathway, a compound mimicking the activity of plasminogen or plasmin, a compound upregulating the expression of plasminogen or an activator of plasminogen, an analog of plasminogen, an analog of plasmin, an analog of tPA or uPA, and an antagonist of fibrinolysis inhibitor.
In some embodiments, the pneumonia is 2019-nCoV infectious pneumonia, and the plasminogen has one or more effects selected from the group consisting of: reducing lung tissue damage, reducing lung inflammation, reducing lung fibrin deposition, improving lung function, increasing blood oxygen saturation, reducing blood pressure, improving cardiac function, and improving general physical condition in the subject with 2019-nCoV pneumonia.
In any of the above embodiments of the application, the plasminogen may have at least 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98% or 99% sequence identity with SEQ ID NO: 2, 6, 8, 10 or 12, and still have plasminogen activity, e.g., proteolytic activity, lysine binding activity, or both proteolytic activity and lysine binding activity. In some embodiments, the plasminogen is a protein with addition, deletion and/or substitution of 1-100, 1-90, 1-80, 1-70, 1-60, 1-50, 1-45, 1-40, 1-35, 1-30, 1-25, 1-20, 1-15, 1-10, 1-5, 1-4, 1-3, 1-2, or 1 amino acid based on SEQ ID NO: 2, 6, 8, 10 or 12, and still has plasminogen activity.
In some embodiments, the plasminogen is a protein comprising an active fragment of plasminogen and still having plasminogen activity. In some embodiments, the plasminogen is selected from the group consisting of: Glu-plasminogen, Lys-plasminogen, mini-plasminogen, micro-plasminogen, delta-plasminogen, or variants thereof retaining plasminogen activity. In some embodiments, the plasminogen is natural or synthetic human plasminogen, or a variant or fragment thereof still retaining plasminogen activity. In some embodiments, the plasminogen is a human plasminogen ortholog from a primate or rodent, or a variant or fragment thereof still retaining plasminogen activity. In some embodiments, the amino acid sequence of the plasminogen is represented by SEQ ID NO: 2, 6, 8, 10 or 12. In some embodiments, the plasminogen is human natural plasminogen.
In some embodiments, the subject is a human In some embodiments, the subject is deficient or lacking in plasminogen. In some embodiments, the lack or deficiency of plasminogen is congenital, secondary and/or local.
In some embodiments, the pharmaceutical composition comprises a pharmaceutically acceptable carrier and plasminogen for use in the above methods. In some embodiments, the kit may be a prophylactic or therapeutic kit, comprising: (i) plasminogen for use in the above methods, and (ii) means for delivering the plasminogen to the subject. In some embodiments, the means is a syringe or a vial. In some embodiments, the kit further comprises a label or instructions for administrating the plasminogen to the subject to perform any of the above methods.
In some embodiments, the product comprises: a container comprising a label; and further comprises (i) plasminogen for use in the above method or a pharmaceutical composition comprising plasminogen, wherein the label instructs the administration of the plasminogen or composition to the subject to perform any of the above methods.
In some embodiments, the kit or product further comprises one or more additional means or containers containing other medicaments.
In some embodiments of the above methods, the plasminogen is administrated by systemic or topical administration for therapy, preferably by one or more routes or means selected from the group consisting of: nasal inhalation, aerosol inhalation, nasal drop, ear drop, eye drop, intravenous administration, intraperitoneal administration, subcutaneous administration, intracranial administration, intrathecal administration, intramuscular administration and intrarectal administration. In some embodiments of the above methods, the plasminogen is administrated in combination with a suitable polypeptide carrier or a stabilizer. In some embodiments of the above methods, the plasminogen is administrated per day at the amount of 0.0001-2000 mg/kg, 0.001-800 mg/kg, 0.01-600 mg/kg, 0.1-400 mg/kg, 1-200 mg/kg, 1-100 mg/kg, or 10-100mg/kg (by per kilogram of body weight); or 0.0001-2000 mg/cm2, 0.001-800 mg/cm2, 0.01-600 mg/cm2, 0.1-400 mg/cm2, 1-200 mg/cm2, 1-100 mg/cm2, or 10-100 mg/cm2 (by per square centimeter of body surface area), preferably repeating at least once, and preferably administrating at least daily.
The present application explicitly encompasses all the combinations of the technical features belonging to the embodiments of the present application, and these combined technical solutions have been explicitly disclosed in this application, just as the separately and explicitly disclosed above technical solutions. In addition, the present application also explicitly encompasses the combinations of each embodiment and its elements, and the combined technical solutions are explicitly disclosed herein.
Fibrinolytic system is a system consisting of a series of chemical substances involved in the process of fibrinolysis, mainly including plasminogen, plasmin, plasminogen activator, and fibrinolysis inhibitor. Plasminogen activators include tissue-type plasminogen activator (t-PA) and urokinase-type plasminogen activator (u-PA). t-PA is a serine protease that is synthesized by vascular endothelial cells. t-PA activates plasminogen, which is mainly carried out on fibrin; urokinase-type plasminogen activator (u-PA) is produced by renal tubular epithelial cells and vascular endothelial cells, and may directly activate plasminogen without the need for fibrin as a cofactor. Plasminogen (PLG) is synthesized by liver. When blood coagulates, a large amount of PLG is adsorbed on the fibrin network, and under the action of t-PA or u-PA it is activated into plasmin to promote fibrinolysis. Plasmin (PL) is a serine protease whose functions are as follows: degrading fibrin and fibrinogen; hydrolyzing various coagulation factors V, VIII, X, VII, XI, and II, etc.; converting plasminogen into plasmin; hydrolyzing complement, etc. Fibrinolysis inhibitors: including plasminogen activator inhibitor (PAI) and α2 antiplasmin (α2-AP). PAI mainly has two forms, PAI-1 and PAI-2, which may specifically bind to t-PA in a ratio of 1:1, thereby inactivating it and activating PLG at the same time. α2-AP is synthesized by liver, and binds to PL in a ratio of 1:1 to form a complex to inhibit the activity of PL; FXIII makes α2-AP covalently bound to fibrin, reducing the sensitivity of fibrin to PL. Substances that inhibit the activity of the fibrinolytic system in vivo: PAI-1, complement C1 inhibitor; α2 antiplasmin; α2 macroglobulin.
The term “component of plasminogen activation pathway” according to the present application encompasses:
“Variants” of the above plasminogen, plasmin, tPA and uPA include all naturally occurring human genetic variants as well as other mammalian forms of these proteins, as well as a protein obtained by addition, deletion and/or substitution of such as 1-100, 1-90, 1-80, 1-70, 1-60, 1-50, 1-45, 1-40, 1-35, 1-30, 1-25, 1-20, 1-15, 1-10, 1-5, 1-4, 1-3, 1-2, or 1 amino acid, and still retaining the activity of plasminogen, plasmin, tPA or uPA. For example, “variants” of plasminogen, plasmin, tPA and uPA include mutational variants of these proteins obtained by substitution of such as 1-100, 1-90, 1-80, 1-70, 1-60, 1-50, 1- 45, 1-40, 1-35, 1-30, 1-25, 1-20, 1-15, 1-10, 1-5, 1-4, 1-3, 1-2, or 1 conservative amino acid.
A “plasminogen variant” of the application encompasses a protein having at least 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98% or 99% sequence identity with SEQ ID NO: 2, 6, 8, 10 or 12, and still retaining plasminogen activity. For example, a “plasminogen variant” according to the present application may be a protein obtained by addition, deletion and/or substitution of 1-100, 1-90, 1-80, 1-70, 1-60, 1-50, 1-45, 1-40, 1-35, 1-30, 1-25, 1-20, 1-15, 1-10, 1-5, 1-4, 1-3, 1-2, or 1 amino acid on the basis of SEQ ID NO: 2, 6, 8, 10 or 12, and still retaining plasminogen activity. Particularly, the plasminogen variants according to the present application include all naturally occurring human genetic variants as well as other mammalian forms of these proteins, as well as mutational variants of these proteins obtained by substitution of such as 1-100, 1-90, 1-80, 1-70, 1-60, 1-50, 1-45, 1-40, 1-35, 1-30, 1-25, 1-20, 1-15, 1-10, 1-5, 1-4, 1-3, 1-2, or 1 conservative amino acid.
The plasminogen according to the present application may be a human plasminogen ortholog from a primate or rodent, or a variant thereof still retaining plasminogen activity, for example, a plasminogen represented by SEQ ID NO: 2, 6, 8, 10 or 12, such as a human natural plasminogen represented by SEQ ID NO: 2.
The “analogs” of the above plasminogen, plasmin, tPA, and uPA include compounds that respectively provide substantially similar effect to plasminogen, plasmin, tPA, or uPA.
The “variants” and “analogs” of above plasminogen, plasmin, tPA and uPA encompass “variants” and “analogs” of plasminogen, plasmin, tPA and uPA comprising one or more domains (e.g., one or more kringle domains and proteolytic domains). For example, “variants” and “analogs” of plasminogen encompass “variants” and “analogs” of plasminogen comprising one or more plasminogen domains (e.g., one or more kringle domains and proteolytic domains), such as mini-plasminogen. “Variants” and “analogs” of plasmin encompass “variants” and “analogs” of plasmin comprising one or more plasmin domains (e.g., one or more kringle domains and proteolytic domains), such as mini-plasmin, and delta-plasmin
Whether a “variant” or “analog” of the above plasminogen, plasmin, tPA or uPA respectively has the activity of plasminogen, plasmin, tPA or uPA, or whether the “variant” or “analog” provides substantially similar effect to plasminogen, plasmin, tPA or uPA, may be detected by methods known in the art, for example, it is measured by the level of activated plasmin activity based on enzymography, ELISA (enzyme-linked immunosorbent assay), and FACS (fluorescence-activated cell sorting method), for example, it is detected by referring to a method selected from the following documents: Ny, A., Leonardsson, G., Hagglund, A. C, Hagglof, P., Ploplis, V. A., Carmeliet, P. and Ny, T. (1999). Ovulation in plasminogen-deficient mice. Endocrinology 140, 5030-5035; Silverstein R L, Leung L L, Harpel P C, Nachman R L (November 1984). “Complex formation of platelet thrombospondin with plasminogen. Modulation of activation by tissue activator”. J. Clin. Invest. 74(5):1625-33; Gravanis I, Tsirka S E (February 2008). “Tissue-type plasminogen activator as a therapeutic target in stroke”. Expert Opinion on Therapeutic Targets. 12(2):159-70; Geiger M, Huber K, Wojta J, Stingl L, Espana F, Griffin J H, Binder B R (August 1989). “Complex formation between urokinase and plasma protein C inhibitor in vitro and in vivo”. Blood.74(2):722-8.
In some embodiments of the present application, the “component of plasminogen activation pathway” according to the present application is a plasminogen selected from the group consisting of: Glu-plasminogen, Lys-plasminogen, mini-plasminogen, micro-plasminogen, delta-plasminogen, or variants thereof retaining plasminogen activity. In some embodiments, the plasminogen is natural or synthetic human plasminogen, or a conservative mutant variant or fragment thereof still retaining plasminogen activity. In some embodiments, the plasminogen is a human plasminogen ortholog from a primate or rodent or a conservative mutant variant or fragment thereof still retaining plasminogen activity. In some embodiments, the amino acid sequence of the plasminogen is represented by SEQ ID NO: 2, 6, 8, 10 or 12. In some embodiments, the plasminogen is a human natural plasminogen. In some embodiments, the plasminogen is a human natural plasminogen represented by SEQ ID NO: 2.
“A compound capable of directly activating plasminogen, or indirectly activating plasminogen by activating an upstream component of plasminogen activation pathway”, refers to any compound capable of directly activating plasminogen, or indirectly activating plasminogen by activating an upstream component of plasminogen activation pathway, such as tPA, uPA, streptokinase, saruplase, alteplase, reteplase, tenecteplase, anistreplase, monteplase, lanoteplase, pamiteplase, staphylokinase.
The “antagonist of a fibrinolysis inhibitor” according to the present application is a compound that antagonizes, weakens, blocks, or prevents the action of a fibrinolysis inhibitor. Such fibrinolysis inhibitors are e.g., PAI-1, complement C1 inhibitor, α2 antiplasmin, and α2 macroglobulin. Such an antagonist is: e.g., an antibody of PAI-1, complement C1 inhibitor, α2 antiplasmin, or α2 macroglobulin; or an antisense RNA or small RNA blocking or downregulating the expression of such as PAI-1, complement C1 inhibitor, a2 antiplasmin or α2 macroglobulin; or a compound occupying the binding site of PAI-1, complement C1 inhibitor, α2 antiplasmin, or α2 macroglobulin but without the function of PAI-1, complement C1 inhibitor, α2 antiplasmin, or α2 macroglobulin; or a compound blocking the binding domains and/or active domains of PAI-1, complement C1 inhibitor, α2 antiplasmin, or α2 macroglobulin.
Plasmin is a key component of the plasminogen activation system (PA system). It is a broad-spectrum protease capable of hydrolyzing several components of the extracellular matrix (ECM), including fibrin, gelatin, fibronectin, laminin, and proteoglycans. In addition, plasmin may activate some metalloproteinase precursors (pro-MMPs) to form active metalloproteinases (MMPs). Therefore, plasmin is considered to be an important upstream regulator of extracellular proteolysis. Plasmin is formed by proteolysis of plasminogen by two physiological PAs: tissue-type plasminogen activator (tPA) or urokinase-type plasminogen activator (uPA). Due to the relatively high levels of plasminogen in plasma and other body fluids, it has traditionally been thought that the regulation of the PA system is mainly achieved through the synthesis and activity levels of PAs. The synthesis of components of PA system is strictly regulated by different factors, such as hormone, growth factor and cytokine. In addition, there are specific physiological inhibitors of plasmin and PAs. The main inhibitor of plasmin is α2-antiplasmin The activity of PAs is inhibited by plasminogen activator inhibitor-1 (PAI-1) of both uPA and tPA, and regulated by plasminogen activator inhibitor-2 (PAI-2) which mainly inhibits uPA. Certain cell surfaces have uPA-specific cell surface receptors (uPARs) with direct hydrolytic activity.
Plasminogen is a single-chain glycoprotein consisting of 791 amino acids with a molecular weight of approximately 92 kDa. Plasminogen is mainly synthesized in liver, and is abundantly present in the extracellular fluid. The content of plasminogen in plasma is approximately 2 μM. Plasminogen is thus a huge potential source of proteolytic activity in tissues and body fluids. Plasminogen exists in two molecular forms: glutamate-plasminogen (Glu-plasminogen) and lysine-plasminogen (Lys-plasminogen). The naturally secreted and uncleaved form of plasminogen has an amino-terminal (N-terminal) glutamate, and is therefore referred to as glutamate-plasminogen. However, in the presence of plasmin, glutamate-plasminogen is hydrolyzed at Lys76-Lys77 into lysine-plasminogen. Compared with glutamate-plasminogen, lysine-plasminogen has a higher affinity for fibrin, and may be activated by PAs at a higher rate. The Arg560-Val561 peptide bond of these two forms of plasminogen may be cleaved by either uPA or tPA, resulting in the formation of a two-chain protease plasmin linked by disulfide. The amino-terminal part of plasminogen comprises five homologous tri-cycles, i.e., so-called kringles, and the carboxy-terminal part comprises the protease domain. Some kringles comprise lysine-binding sites that mediate the specific interaction of plasminogen with fibrin and its inhibitor α2-AP. A recently found plasminogen is a 38 kDa fragment, including kringles 1-4, and it is a potent inhibitor of angiogenesis. This fragment is named as angiostatin, and is produced by the hydrolysis of plasminogen by several proteases.
The main substrate of plasmin is fibrin, and the dissolution of fibrin is the key to preventing pathological thrombosis. Plasmin also has substrate specificity for several components of the ECM, including laminin, fibronectin, proteoglycans, and gelatin, indicating that plasmin also plays an important role in ECM remodeling. Indirectly, plasmin may also degrade other components of the ECM, including MMP-1, MMP-2, MMP-3 and MMP-9, by converting certain protease precursors into active proteases. Therefore, it has been proposed that plasmin may be an important upstream regulator of extracellular proteolysis. In addition, plasmin has the ability to activate certain latent forms of growth factors. In vitro, plasmin also hydrolyzes components of the complement system, and releases chemotactic complement fragments.
“Plasmin” is a very important enzyme present in blood that hydrolyzes fibrin clots into fibrin degradation products and D-dimers.
“Plasminogen” is the zymogen form of plasmin. According to the sequence in swiss prot, it consists of 810 amino acids calculated by the natural human plasminogen amino acid sequence (SEQ ID NO: 4) containing the signal peptide, and the molecular weight is about 901(D, and it is a glycoprotein mainly synthesized in liver and capable of circulating in blood, the cDNA sequence encoding this amino acid sequence is represented by SEQ ID NO: 3. Full-length plasminogen contains seven domains: a C-terminal serine protease domain, an N-terminal Pan Apple (PAp) domain, and five Kringle domains (Kringlel-5). Referring to the sequence in swiss prot, its signal peptide comprises residues Met1-Gly19, PAp comprises residues Glu20-Val98, Kringlel comprises residues Cys103-Cys181, Kringle2 comprises residues Glu184-Cys262, Kringle3 comprises residues Cys275-Cys352, Kringle4 comprises residues Cys377-Cys454, and Kringle5 comprises residues Cys481-Cys560. According to NCBI data, the serine protease domain comprises residues Val581-Arg804.
Glu-plasminogen is a human natural full-length plasminogen, consisting of 791 amino acids (without a signal peptide of 19 amino acids); the cDNA sequence encoding this amino acid sequence is represented by SEQ ID NO: 1, and the amino acid sequence is represented by SEQ ID NO: 2. In vivo, there is also a Lys-plasminogen produced by the hydrolysis of the peptide bond between amino acids 76 and 77 of Glu-plasminogen, as represented by SEQ ID NO: 6; and the cDNA sequence encoding this amino acid sequence is represented by SEQ ID NO: 5. Delta-plasminogen (δ-plasminogen) is a fragment of full-length plasminogen that lacks the Kringle2-Kringle5 structure, and only contains Kringlel and a serine protease domain (also known as a protease domain (PD)). The amino acid sequence of delta-plasminogen (SEQ ID NO: 8) is reported in a literature, and the cDNA sequence encoding this amino acid sequence is represented by SEQ ID NO: 7. Mini-plasminogen consists of Kringle5 and a serine protease domain, and it is reported that it comprises residues Val443-Asn791 (with the Glu residue of the Glu-plasminogen sequence without the signal peptide as the starting amino acid), the amino acid sequence of the mini-plasminogen is represented by SEQ ID NO: 10, and the cDNA sequence encoding this amino acid sequence is represented by SEQ ID NO: 9. While micro-plasminogen comprises only a serine protease domain, and it is reported that its amino acid sequence comprises residues Ala543-Asn791 (with the Glu residue of the Glu-plasminogen sequence without the signal peptide as the starting amino acid); additionally, it is disclosed in patent document CN102154253A that its sequence comprises residues Lys531-Asn791 (with the Glu residue of the Glu-plasminogen sequence without the signal peptide as the starting amino acid); in the present patent application, the sequence of micro-plasminogen refers to the patent document CN102154253A, the amino acid sequence is represented by SEQ ID NO: 12, and the cDNA sequence encoding this amino acid sequence is represented by SEQ ID NO: 11.
The structure of the full-length plasminogen is also described in the article by Aisina et al. (Aisina RB, Mukhametova L I. Structure and function of plasminogen/plasmin system [J]. Russian Journal of Bioorganic Chemistry, 2014, 40(6):590-605). In this article, Aisina et al. describe that plasminogen comprises Kringle 1, 2, 3, 4, 5 domains and a serine protease domain (also called protease domain (PD))(i.e., lysine binding activity), wherein Kringles are responsible for binding of plasminogen to low or high molecular weight ligand, so that plasminogen transforms into a more open conformation that is more readily activated; the protease domain (PD) is residues Val562-Asn791; the Arg561-Val562 activating bond of plasminogen is specifically cleaved by tPA and uPA, thereby allowing plasminogen to change into plasmin; thus the protease domain (PD) is a region conferring the proteolytic activity of plasminogen.
In the present application, “plasmin” and “fibrinolytic enzyme” may be used interchangeably with the same meaning; “plasminogen” and “fibrinolytic zymogen” may be used interchangeably with the same meaning.
In the present application, “lack” of plasminogen or plasminogen activity means that the content of plasminogen in a subject is lower than that of a normal person, and is sufficiently low to affect the normal physiological function of the subject; “deficiency” of plasminogen or plasminogen activity means that the content of plasminogen in a subject is significantly lower than that of a normal person, and even the activity or expression is extremely low, and the normal physiological function may only be maintained by external supply of plasminogen.
Those skilled in the art may understand that, all technical solutions of plasminogen according to the present application are applicable to plasmin, thus the technical solutions described in the present application encompass plasminogen and plasmin During circulation, plasminogen is present in a closed, inactive conformation, but when bound to a thrombus or cell surface, it is converted into active plasmin with an open conformation after being mediated by plasminogen activator (PA). Active plasmin may further hydrolyze the fibrin clot into degradation products of fibrin and D-dimers, thereby dissolving the thrombus. The PAp domain of plasminogen comprises an important determinant for maintaining plasminogen in an inactive closed conformation, while the KR domain may bind to a lysine residue present on a receptor and substrate. A variety of enzymes are known to act as plasminogen activators, including: tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), kallikrein, and coagulation factor XII (Hageman factor) etc.
An “active fragment of plasminogen” refers to a fragment having the activity of binding to a lysine in the target sequence of a substrate (lysine-binding activity), or exerting the activity of a proteolytic function (proteolytic activity), or having a combination of proteolytic activity and lysine-binding activity. The technical solutions related to plasminogen according to the present application encompass the technical solutions of replacing plasminogen with an active fragment of plasminogen. In some embodiments, the active fragment of plasminogen according to the present application comprises or consists of a serine protease domain of plasminogen, preferably the active fragment of plasminogen according to the present application comprises or consists of SEQ ID NO: 14, or an amino acid sequence having at least 80%, 90%, 95%, 96%, 97%, 98%, 99% identity with SEQ ID NO: 14. In some embodiments, the active fragment of plasminogen according to the present application comprises or consists of one or more regions selected from the group consisting of: Kringle 1, Kringle 2, Kringle 3, Kringle 4, and Kringle 5. In some embodiments, the plasminogen according to the present application comprises a protein comprising the active fragment of plasminogen described above.
At present, the methods for measuring plasminogen and its activity in blood comprise: detection of tissue plasminogen activator activity (t-PAA), detection of plasma tissue plasminogen activator antigen (t-PAAg), detection of plasma tissue plasminogen activity (plgA), detection of plasma tissue plasminogen antigen (plgAg), detection of the activity of plasma tissue plasminogen activator inhibitor, detection of the antigen of plasma tissue plasminogen activator inhibitor, and detection of plasma plasmin-antiplasmin complex (PAP); wherein the most commonly used detection method is the chromogenic substrate method: adding streptokinase (SK) and a chromogenic substrate to the plasma to be detected, the PLG in the plasma to be detected is converted into PLM under the action of SK, and PLM acts on the chromogenic substrate; subsequently, the detection by spectrophotometer indicates that the increase in absorbance is proportional to plasminogen activity. In addition, the plasminogen activity in blood may also be detected by immunochemical method, gel electrophoresis, immunoturbidimetry, and radioimmunoassay.
“Ortholog or orthologs” refer to homologs between different species, including both protein homologs and DNA homologs, also known as orthologs and vertical homologs; particularly it refers to proteins or genes evolved from the same ancestral gene in different species. The plasminogen according to the present application includes human natural plasminogen, and also includes plasminogen ortholog or orthologs derived from different species and having plasminogen activity.
A “conservative substitution variant” refers to a variant in which a given amino acid residue is altered without changing the overall conformation and function of the protein or enzyme, including but not limited to those variants in which the amino acid(s) in the amino acid sequence of the parent protein are replaced by amino acid(s) with similar properties (e.g., acidic, basic, hydrophobic, etc.). Amino acids with similar properties are well known in the art. For example, arginine, histidine and lysine are hydrophilic basic amino acids and are interchangeable. Similarly, isoleucine is a hydrophobic amino acid, and may be replaced by leucine, methionine or valine. Therefore, the similarity of two proteins or amino acid sequences with similar functions may differ; for example, 70% to 99% similarity (identity) based on the MEGALIGN algorithm. “Conservative substitution variants” also include polypeptides or enzymes having not less than 60%, preferably not less than 75%, more preferably not less than 85%, or even most preferably not less than 90% amino acid identity determined by BLAST or FASTA algorithm, and having the same or substantially similar properties or functions as the natural or parent protein or enzyme.
“Isolated” plasminogen refers to a plasminogen protein isolated and/or recovered from its natural environment. In some embodiments, the plasminogen will be purified: (1) to more than 90%, more than 95%, or more than 98% purity (by weight), as determined by Lowry's method, e.g., more than 99% (by weight), (2) to a degree sufficient to obtain at least 15 residues of the N-terminal or internal amino acid sequence by using a spinning cup sequence analyzer, or (3) to homogeneity as determined by using Coomassie blue or silver staining through sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) under reducing or non-reducing conditions. Isolated plasminogen also includes plasminogen prepared from recombinant cells by bioengineering techniques and isolated by at least one purification step.
The terms “polypeptide”, “peptide” and “protein” are used interchangeably herein to refer to a polymeric form of amino acids of any length, which may include genetically encoded and non-genetically encoded amino acids, chemically or biochemically modified or derivatized amino acids, and polypeptides with modified peptide backbones. The terms include fusion proteins including, but not limited to, fusion proteins with heterologous amino acid sequences, fusions with heterologous and homologous leader sequences (with or without N-terminal methionine residues); and the like.
“Percent (%) of amino acid sequence identity” with respect to a reference polypeptide sequence is defined as, after introducing gaps as necessary to achieve maximum percent sequence identity, and no conservative substitutions are considered as part of the sequence identity, the percentage of amino acid residues in a candidate sequence that are identical to the amino acid residues in a reference polypeptide sequence. Alignment for purposes of determining percent amino acid sequence identity may be accomplished in a variety of ways within the technical scope in the art, e.g., by publicly available computer software, such as BLAST, BLAST-2, ALIGN or Megalign (DNASTAR) software. Those skilled in the art may determine the appropriate parameters for aligning sequences, including any algorithms needed to achieve maximal alignment over the full length of the sequences to be compared. However, for the purpose of the present application, the values of percent amino acid sequence identity are generated by using the computer program ALIGN-2 for sequence comparison.
Where ALIGN-2 is used to compare amino acid sequences, the percentage (%) of amino acid sequence identity of a given amino acid sequence A relative to a given amino acid sequence B (or may be expressed as a given amino acid sequence A having a certain percentage (%) of amino acid sequence identity relative to, with or with respective to a given amino acid sequence B) is calculated as follows:
Fraction X/Y times 100;
wherein X is the number of amino acid residues scored as identical matches during the alignment of sequences A and B by the sequence alignment program ALIGN-2, and wherein Y is the total number of amino acid residues in sequence B. It should be appreciated that, where the length of amino acid sequence A is not equal to that of amino acid sequence B, the percentage (%) of amino acid sequence identity of A with respect to B will not equal to the percentage (%) of amino acid sequence identity of B with respect to A. Unless expressly stated otherwise, all the values of percentage (%) of amino acid sequence identity used herein are obtained by using the ALIGN-2 computer program as described in the preceding paragraph.
As used herein, the terms “treatment/treating” refer to obtaining a desired pharmacological and/or physiological effect. The effect may be complete or partial prevention of the occurrence, or onset of the disease or symptoms thereof, partial or complete alleviation of the disease and/or symptoms thereof, and/or partial or complete cure of the disease and/or symptoms thereof; and includes: (a) preventing the occurrence or onset of the disease in a subject, who may have predisposition of the disease, but is not yet diagnosed as having the disease; (b) inhibiting the disease, i.e., blocking its development; and (c) alleviating the disease and/or symptoms thereof, i.e., causing regression or elimination of the disease and/or symptoms thereof.
The terms “individual”, “subject” and “patient” are used interchangeably herein to refer to mammals including, but not limited to, murine (rat, mouse), non-human primate, human, canine, feline, hoofed animals (e.g., horses, cattle, sheep, pigs, goats), etc.
A “therapeutically effective amount” or “effective amount” refers to an amount of a component of plasminogen activation pathway or a related compound thereof (e.g., plasminogen) sufficient to prevent and/or treat a disease when administrated to a mammal or other subject for treating the disease. A “therapeutically effective amount” will vary depending on the component of plasminogen activation pathway or a related compound thereof (e.g., plasminogen) in use, the severity of the disease and/or symptoms thereof in the subject to be treated, as well as the age, weight, and the like.
Plasminogen may be isolated from nature, and purified for further therapeutic use, or it may be synthesized by standard chemical peptide synthesis techniques. When the polypeptide is synthesized chemically, the synthesis may be carried out via liquid phase or solid phase. Solid-phase polypeptide synthesis (SPPS) (in which the C-terminal amino acid of the sequence is attached to an insoluble support, followed by the sequential addition of the retaining amino acids in the sequence) is a suitable method for chemical synthesis of plasminogen. Various forms of SPPS, such as Fmoc and Boc, may be used to synthesize plasminogen. Techniques for solid-phase synthesis are described in Barany and Solid-Phase Peptide Synthesis; pp.3-284 in The Peptides: Analysis, Synthesis, Biology. Vol. 2: Special Methods in Peptide Synthesis, Part A., Merrifield, et al. J. Am. Chem. Soc., 85:2149-2156 (1963); Stewart et al., Solid Phase Peptide Synthesis, 2nd ed. Pierce Chem. Co., Rockford, Ill. (1984); and Ganesan A. 2006 Mini Rev. Med Chem. 6:3-10, and Camarero JA et al. 2005, Protein Pept Lett. 12:723-8. Briefly, small insoluble porous beads are treated with functional units on which peptide chains are constructed; after repeated cycles of coupling/deprotection, the attached solid-phase free N-terminal amine is coupled to a single N-protected amino acid unit. This unit is then deprotected to reveal new N-terminal amines that may be attached to other amino acids. The peptide remains immobilized on the solid phase, subsequently it is cleaved off.
Plasminogen according to the present application may be produced by standard recombinant methods. For example, a nucleic acid encoding plasminogen is inserted into an expression vector to be operably linked to regulatory sequences in the expression vector. The regulatory sequences for expression include, but are not limited to, promoters (e.g., naturally associated or heterologous promoters), signal sequences, enhancer elements, and transcription termination sequences. Expression regulation may be a eukaryotic promoter system in a vector capable of transforming or transfecting a eukaryotic host cell (e.g., COS or CHO cell). Once the vector is incorporated into a suitable host, the host is maintained under conditions suitable for high-level expression of the nucleotide sequence and collection and purification of plasminogen.
A suitable expression vector is typically replicated in a host organism as an episome or as an integrated part of the host chromosomal DNA. Typically, an expression vector contains a selectable marker (e.g., ampicillin resistance, hygromycin resistance, tetracycline resistance, kanamycin resistance, or neomycin resistance marker) to facilitate the detection of those cells transformed with desired exogenous DNA sequence.
Escherichia coli is an example of a prokaryotic host cell that may be used to clone a subject antibody-encoding polynucleotide. Other microbial hosts suitable for use include bacilli such as Bacillus subtilis, and other enterobacteriaceae such as Salmonella, Serratia, and various Pseudomonas species. In these prokaryotic hosts, expression vectors may also be generated, which will typically contain an expression control sequence (e.g., origin of replication) that are compatible with the host cell. In addition, there are many well-known promoters, such as the lactose promoter system, the tryptophan (trp) promoter system, the beta-lactamase promoter system, or the promoter system from bacteriophage lambda. A promoter will typically control the expression, optionally in case of an operator gene sequence, and have ribosome binding site sequence, etc., to initiate and complete transcription and translation.
Other microorganisms, such as yeast, may also be used for expression. Yeast (e.g., S. cerevisiae) and Pichia are examples of suitable yeast host cells, and as required a suitable vector has an expression control sequence (e.g., promoter), origin of replication, termination sequence, etc. A typical promoter comprises 3-phosphoglycerate kinase and other saccharolytic enzymes. Particularly, inducible yeast promoters include promoters from ethanol dehydrogenase, isocytochrome C, and enzymes responsible for maltose and galactose utilization.
In addition to microorganisms, mammalian cells (e g , mammalian cells grown in in vitro cell culture) may also be used to express and produce the anti-Tau antibodies of the application (e.g., polynucleotides encoding the subject anti-Tau antibodies). See Winnacker, From Genes to Clones, VCH Publishers, N.Y., N.Y. (1987). Suitable mammalian host cells include CHO cell lines, various Cos cell lines, HeLa cells, myeloma cell lines, and transformed B cells or hybridomas. Expression vectors for use in these cells may comprise expression control sequences such as origin of replication, promoter and enhancer (Queen et al., Immunol. Rev. 89:49 (1986)), and necessary sites for processing information such as ribosome binding sites, RNA splicing sites, polyadenylation sites, and transcription terminator sequences. Examples of suitable expression control sequences are promoters derived from immunoglobulin gene, SV40, adenovirus, bovine papilloma virus, cytomegalovirus, and the like. See Co et al, J. Immunol. 148:1149 (1992).
Once synthesized (chemically or recombinantly), the plasminogen of the present application may be purified according to standard procedures in the art, including ammonium sulfate precipitation, affinity column, column chromatography, high performance liquid chromatography (HPLC), gel electrophoresis, and the like. The plasminogen is substantially pure, e.g., at least about 80-85% pure, at least about 85-90% pure, at least about 90-95% pure, or 98-99% pure or purer, e.g., free of contaminants such as cellular debris, macromolecules other than the target product, and the like.
A therapeutic formulation may be prepared by mixing the component of plasminogen activation pathway or a related compound thereof (e.g., plasminogen) of desired purity with an optional pharmaceutical carrier, excipient, or stabilizer (Remington's Pharmaceutical Sciences, 16th edition, Osol, A. ed. (1980)), to form a lyophilized formulation or an aqueous solution. An acceptable carrier, excipient, or stabilizer is non-toxic to a recipient at the employed dosage and concentration, including buffers such as phosphate, citrate and other organic acids; antioxidants such as ascorbic acid and methionine; preservatives (such as octadecyldimethylbenzylammonium chloride; hexanediamine chloride; benzalkonium chloride, benzethonium chloride; phenol, butanol or benzyl alcohol; alkyl parahydroxybenzoate such as methyl or propyl paraben; catechol; resorcinol; cyclohexanol; 3-pentanol; m-cresol); low molecular weight polypeptides (less than about 10 residues); proteins such as serum albumin, gelatin or immunoglobulins; hydrophilic polymers such as polyvinylpyrrolidone; amino acids such as glycine, glutamine, asparagine, histidine, arginine or lysine; monosaccharides, disaccharides and other carbohydrates such as glucose, mannose, or dextrin; chelating agents such as EDTA; carbohydrates such as sucrose, mannitol, fucose, or sorbitol; salt-forming counterions such as sodium; metal complexes (such as zinc-protein complexes); and/or nonionic surfactants such as TWENTM, PLURONICS™ or polyethylene glycol (PEG). Preferred lyophilized anti-VEGF antibody formulation is described in WO 97/04801, which is incorporated herein by reference.
The formulations according to the present application may also contain more than one active compound as required for the particular condition to be treated, preferably those compounds are complementary in activity and do not have side effects with each other.
The plasminogen according to the present application may be encapsulated in microcapsules prepared by techniques such as coacervation or interfacial polymerization, for example, the plasminogen may be placed in colloidal drug delivery systems (e.g., liposomes, albumin microspheres, microemulsions, nanoparticles and nanocapsules) or in hydroxymethyl cellulose or gel-microcapsules and poly-(methyl methacrylate) microcapsules in macroemulsions. These techniques are disclosed in Remington's Pharmaceutical Sciences 16th edition, Osol, A. Ed. (1980).
The component of plasminogen activation pathway or a related compound thereof (e.g., plasminogen) according to the present application for in vivo administration must be sterile. This may be easily achieved by filtration through sterilizing filters before or after lyophilization and reformulation.
The component of plasminogen activation pathway or a related compound thereof (e.g., plasminogen) according to the present application may be prepared as a sustained-release formulation. Suitable examples of sustained-release formulations include semipermeable matrices of solid hydrophobic polymers which have a certain shape and contain glycoprotein, for example, membranes or microcapsules. Examples of sustained-release matrices include polyesters, hydrogels such as poly(2-hydroxyethyl-methacrylate) (Langer et al., J. Biomed. Mater. Res., 15:167-277 (1981); Langer, Chem. Tech., 12:98-105 (1982)), or poly(vinyl alcohol), polylactide (U.S. Pat. No. 3,773,919, EP58,481), copolymers of L-glutamic acid and y-ethyl-L-glutamic acid (Sidman, et al., Biopolymers 22:547 (1983)), non-degradable ethylene-vinyl acetate (Langer, et al., supra), or degradable lactic acid-glycolic acid copolymers such as Lupron DepotTM (injectable microspheres consisting of lactic acid-glycolic acid copolymer and leuprolide acetate), and poly-D-(−)-3-hydroxybutyric acid. Polymers such as ethylene-vinyl acetate and lactic acid-glycolic acid may release molecules continuously for more than 100 days, while some hydrogels release proteins for shorter period of time. Rational strategies to stabilize proteins may be devised based on the relevant mechanisms. For example, if the mechanism of condensation is found to form intermolecular S-S bond through thiodisulfide interchange, then stabilization may be achieved by modifying sulfhydryl residues, lyophilizing from acidic solutions, controlling humidity, using suitable additives, and developing specific polymer matrix composition.
Administration of the pharmaceutical composition according to the present application may be accomplished by different means, e.g., nasal inhalation, aerosol inhalation, nasal or eye drop, intravenous administration, intraperitoneal administration, subcutaneous administration, intracranial administration, intrathecal administration, intraarteral administration (e.g., via the carotid artery), intramuscular administration, and rectal administration.
Preparations for parenteral administration include sterile aqueous or non-aqueous solutions, suspensions and emulsions. Examples of non-aqueous solvents are propylene glycol, polyethylene glycol, vegetable oils such as olive oil, and injectable organic esters such as ethyl oleate. Aqueous carriers include water, alcoholic/aqueous solutions, emulsions or suspensions, including saline and buffered media. Parenteral vehicles include sodium chloride solution, Ringer's dextrose, dextrose and sodium chloride, or fixed oils. Intravenous vehicles include fluid and nutritional supplements, electrolyte supplements, and the like. Preservatives and other additives may also be present, such as, for example, antimicrobials, antioxidants, chelating agents, and inert gases, etc.
Dosing regimens will be determined by medical personnel based on various clinical factors. As is well known in the medical field, the dosage for any patient depends on a variety of factors, including the patient's size, body surface area, age, the particular compound to be administrated, sex, number and route of administration, general health, and other concomitantly administrated medicaments. The dosage range of the pharmaceutical composition comprising the plasminogen according to the present application may be, for example, about 0.0001-2000 mg/kg, or about 0.001-500 mg/kg (e.g., 0.02 mg/kg, 0.25 mg/kg, 0.5 mg/kg, 0.75 mg/kg, 10 mg/kg, 50 mg/kg, etc.) body weight of the subject per day. For example, the dose may be 1 mg/kg body weight, or 50 mg/kg body weight, or in the range of 1-50 mg/kg, or at least 1 mg/kg. Dosages above or below this exemplary range are also contemplated, especially in view of the factors set forth above. Intermediate doses within the above ranges are also included within the scope of the present application. Subjects may be administrated such doses daily, every other day, weekly, or according to any other schedule determined by empirical analysis. An exemplary dosage schedule includes 0.01-100 mg/kg on consecutive days. Real-time evaluation of therapeutic efficacy and safety is required during the administration of the medicament of the present application.
One embodiment of the present application relates to a product or kit comprising a component of plasminogen activation pathway or a related compound thereof (e.g., plasminogen). The product preferably comprises a container, a label or package insert. Suitable containers are bottles, vials, syringes, etc. The container may be made of various materials such as glass or plastic. The container contains a composition which is effective for treatment of the disease or condition according to the present application and has a sterile access port (e.g., the container may be an intravenous solution pack or vial containing a stopper penetrable by a hypodermic needle). At least one active agent in the composition is a component of plasminogen activation pathway or a related compound thereof (e.g., plasminogen). The label on or attached to the container indicates that the composition is used for treatment of the diseases mentioned in the present application. The product may further comprise a second container containing a pharmaceutically acceptable buffer, such as phosphate buffered saline, Ringer's solution, and glucose solution. It may further contain other materials required from a commercial and user standpoint, including other buffers, diluents, filters, needles and syringes. In addition, the product comprises a package insert with instructions for use, including, for example, instructing the user of the composition to administrate the composition comprising a component of plasminogen activation pathway or a related compound thereof (e.g., plasminogen) to the patient along with other medicaments for treatment of concomitant diseases.
Human plasminogen used in the following examples is derived from plasma of a human donor, based on methods described in: Kenneth C Robbins, Louis Summaria, David Elwyn et al. Further Studies on the Purification and Characterization of Human Plasminogen and Plasmin. Journal of Biological Chemistry, 1965, 240(1): 541-550; Summaria L, Spitz F, Arzadon L et al. Isolation and characterization of the affinity chromatography forms of human Glu-and Lys-plasminogens and plasmins. J Biol Chem. 1976 Jun. 25; 251(12):3693-9; HAGAN J J, ABLONDI F B, DE RENZO E C. Purification and biochemical properties of human plasminogen. J Biol Chem. 1960 April; 235:1005-10, with process optimization, being purified from plasma of a human donor, with >98% human Lys-plasminogen and Glu-plasminogen.
Twelve 12-week-old C57 male mice are weighed, and their blood pressures are measured. According to their blood pressures, they are randomly divided into 2 groups; 4 mice in the blank control group, and 8 mice in the model group. The mice in the blank control group are injected with 100 μl of normal saline through the tail vein, and the mice in the model group are injected with 60 mg/kg/mouse of monocrotaline at a single injection through the tail vein, constructing the model for 3 days, and normally feeding the mice[3-4]. The blood pressure is measured 3 days later, and the mice in the model group are randomly divided into two groups according to the blood pressure; with 4 mice in each of the vehicle PBS control group and the plasminogen group. The mice in the plasminogen group are given plasminogen by tail vein injection at 1 mg/0.1 ml/mouse/day, and the mice in the vehicle PBS control group are given the same volume of PBS solution by tail vein injection for 28 consecutive days; the mice in the blank control group are not treated with plasminogen. The start of modeling and administration of plasminogen is set as day 1, and on day 29 the mice are sacrificed to collect the lungs and fix in 4% paraformaldehyde fix solution for 24 hours. The fixed lung tissues are dehydrated with ethanol gradient and cleared with xylene before being embedded in paraffin. The thickness of the tissue section is 3 μm. After the sections are dewaxed to water, washing once with water, staining with 0.1% Sirius red saturated picric acid for 30 min, rinsing with running water for 2 min; staining with hematoxylin for 1 min, rinsing with running water, differentiating with 1% hydrochloric acid in ethanol, and returning to blue in ammonia solution, rinsing with running water; then drying and sealing with neutral gum, and finally observing under a 200× optical microscope.
Monocrotaline is a pyrrolizidine alkaloid, which is converted by P450 mono-oxygenase in the liver and reaches the lungs through the blood circulation, causing irreversible damage to the pulmonary blood vessels. Pulmonary vascular endothelial cells are considered to be the target cells of monocrotaline, and endothelial cell injury plays a key role in the process of pulmonary vascular remodeling.
The results show that, there is basically no collagen deposition in the lungs of the mice in the blank control group (
Seventeen 12-week-old C57 male mice are randomly divided into two groups; with 11 in the vehicle PBS control group, and 6 in the plasminogen group. The day of the beginning of the experiment is recorded as day 0, and the mice are weighed to divide into groups. On day 1, the administration is started for modeling, the two groups of mice are injected subcutaneously with 0.1 mg/0.1 ml/mouse/day bleomycin to induce systemic sclerosis[5], and the administration of plasminogen or PBS is started and continued to construct the model for 21 days. The mice in the plasminogen group are injected with plasminogen at 1 mg/0.1 ml/mouse/day through the tail vein, and the mice in the vehicle PBS control group are given the same volume of PBS in the same way. On day 22, the mice are sacrificed to collect lung tissues and fix them in 4% paraformaldehyde fix solution for 24 hours. The fixed lung tissues are dehydrated with ethanol gradient and cleared with xylene before being embedded in paraffin. The thickness of the tissue section is 3 μm. After the sections are dewaxed to water, washing once with water, staining with 0.1% Sirius red saturated picric acid for 30 min, rinsing with running water for 2 min; staining with hematoxylin for 1 min, rinsing with running water, differentiating with 1% hydrochloric acid in ethanol, and returning to blue in ammonia solution, rinsing with running water; then drying and sealing with neutral gum, and finally observing under a 200× optical microscope.
The study finds that in the model mice of bleomycin-induced systemic sclerosis, the degree of collagen fibrosis [u2]in the PBS group (
Twelve 9-10-week-old C57 mice are randomly divided into two groups; with 6 mice in each of the vehicle PBS control group and the plasminogen group. The two groups of mice are administrated with plasminogen immediately after being given a single intraperitoneal injection of 15 mg/kg body weight of paraquat solution, recording as day 1[6]. The mice in the plasminogen group are injected with plasminogen through tail vein at 1 mg/0.1 mL/mouse/day, and the mice in the vehicle PBS control group are given the same volume of PBS in the same way. The dosing cycle is 14 days, on day 15 the mice are sacrificed to collect the lung tissues and fix them in 4% neutral formalin fix solution for 24 hours. The fixed lung tissues are dehydrated with ethanol gradient and cleared with xylene before being embedded in paraffin. The thickness of the tissue section is 3 μm. After the sections are dewaxed to water, washing once with water, staining with 0.1% Sirius red saturated picric acid for 60 min, rinsing with running water; staining with hematoxylin for 1 min, rinsing with running water, differentiating with 1% hydrochloric acid in ethanol, and returning to blue in ammonia solution, rinsing with running water; then drying and sealing, and finally observing under a 200× optical microscope.
Paraquat is a fast-killing herbicide that is extremely toxic to humans, and can damage the lungs, liver, and kidneys when it enters the human body. Lung injury manifests as early alveolar epithelial cell damage, intraalveolar hemorrhage and edema and other symptoms; at the late stage manifesting as intraalveolar and pulmonary interstitial fibrosis[6]. Currently, there is no treatment for paraquat poisoning, and the mortality rate is almost 100%.
The results of Sirius red staining show that, the collagen fibers deposition in the lungs of the mice in the plasminogen group (
Eighteen 6-8 week-old C57 mice are randomly divided into three groups according to body weight, i.e., blank control group, vehicle group, and plasminogen group; with 6 mice in each group. After the mice in the vehicle group and the plasminogen group are anesthetized with 2% isoflurane, 1.5 mg/ml of bacterial lipopolysaccharide (LPS) solution (purchased from Beijing Solarbio Technology Co., Ltd., Cat. No.: L8880) is instilled in the trachea according to 3 mg/kg body weight to construct a pneumonia model[7]. Two hours after administration of LPS, the mice in the plasminogen group are injected with plasminogen at 1 mg/0.1 ml/mouse/day through the tail vein, and the mice in the vehicle group are injected with the same volume of vehicle through the tail vein, the treatment is lasted for 14 consecutive days. On day 15, the mice are sacrificed to collect the lung tissues and fix them in 4% neutral formalin fix solution for 24 hours. The fixed lung tissues are dehydrated with ethanol gradient and cleared with xylene before being embedded in paraffin. The thickness of the tissue section is 3μm. After the sections are dewaxed to water, washing once with water, staining with 0.1% Sirius red saturated picric acid for 60 min, rinsing with running water; staining with hematoxylin for 1 min, rinsing with running water, differentiating with 1% hydrochloric acid in ethanol, and returning to blue in ammonia solution, rinsing with running water; then drying and sealing, and finally observing under a 200× optical microscope.
The results show that, the lung tissues of the blank control group (
Eighteen 6-8-week-old C57 mice are randomly divided into three groups according to body weight, i.e., blank control group, vehicle group, and plasminogen group; with 6 mice in each group. The mice in the plasminogen group are injected with plasminogen at 1 mg/0.1 ml/mouse/day through the tail vein, and the mice in the vehicle group are injected with the same volume of vehicle through the tail vein, the treatment is lasted for 3 consecutive days. On day 4, the mice in the vehicle group and the plasminogen group are anesthetized with 2% isoflurane, and 1.5 mg/ml of bacterial lipopolysaccharide (LPS) solution (purchased from Beijing Solarbio Technology Co., Ltd., Cat. No.: L8880) is instilled in the trachea according to 3 mg/kg body weight to construct a pneumonia model[7]. On day 9, the mice are sacrificed to collect the lung tissues and fix them in 4% neutral formalin fix solution for 24 hours. The fixed lung tissues are dehydrated with ethanol gradient and cleared with xylene before being embedded in paraffin. The thickness of the tissue section is 3 μm. After the sections are dewaxed to water, washing once with water, staining with 0.1% Sirius red saturated picric acid for 60 min, rinsing with running water; staining with hematoxylin for 1 min, rinsing with running water, differentiating with 1% hydrochloric acid in ethanol, and returning to blue in ammonia solution, rinsing with running water; then drying and sealing, and finally observing under a 200× optical microscope.
The results show that, the lung tissues of the blank control group (
Eighteen 6-8-week-old C57 mice are randomly divided into three groups according to body weight, i.e., blank control group, vehicle group, and plasminogen group; with 6 mice in each group. After the mice in the vehicle group and the plasminogen group are anesthetized with 2% isoflurane, 1.5 mg/ml of bacterial lipopolysaccharide (LPS) solution (purchased from Beijing Soloarbio Technology Co., Ltd., Catalog number: L8880) is instilled in the trachea according to 3 mg/kg body weight to construct a pneumonia model. Two hours after administration of LPS, the mice in the plasminogen group are injected with plasminogen at 1 mg/0.1 ml/mouse/day through the tail vein, and the mice in the vehicle group are injected with the same volume of vehicle through the tail vein, the treatment is lasted for 7 consecutive days. On day 8, all mice are sacrificed, and the lungs are dissected and weighed. The right lung bronchus is subjected to lavage with PBS twice continuously in a total of 0.7 ml. The liquid is collected and centrifuged at 700g at 4° C. for 10 min, collecting the supernatant to detect the total protein by Bicinchoninic acid (BCA) assay.
The results show that, there is a certain amount of total protein in the lung lavage fluid of the blank control group, and the total protein level in the lung lavage fluid of the vehicle group is significantly higher than that of the blank control group (*** means P<0.001), while the total protein level in the lung lavage fluid of the plasminogen group is significantly lower than that of the vehicle group, and the statistical difference is close to significance (P=0.052) (
Twelve 6-8-week-old C57 mice are randomly divided into two groups according to body weight, i.e., the vehicle group and the plasminogen group; with 6 mice in each group. After the mice in the vehicle group and the plasminogen group are anesthetized with 2% isoflurane, 1.5 mg/ml of bacterial lipopolysaccharide (LPS) solution (purchased from Beijing Soloarbio Technology Co., Ltd., Catalog number: L8880) is instilled in the trachea according to 3 mg/kg body weight to construct a pneumonia model[7]. Two hours after administration of LPS, the mice in the plasminogen group are injected with plasminogen at 1 mg/0.1 ml/mouse/day through the tail vein, and the mice in the vehicle group are injected with the same volume of vehicle through the tail vein, the treatment is lasted for 3 consecutive days. On day 4, the mice are sacrificed to collect the left lung and fix it in 4% neutral formalin fix solution for 24 hours. The fixed lung tissue samples are dehydrated with ethanol gradient and cleared with xylene before being embedded in paraffin. The thickness of the tissue section is 3 μm. After the tissue sections are dewaxed and rehydrated, washing them once with water, repairing with citric acid for 30 min, then cooling at room temperature for 10 min and rinsing gently with water. The tissue sections are incubated with 3% hydrogen peroxide for 15 min, circling the tissues with a PAP pen; blocking with 10% goat serum (Vector laboratories, Inc., USA) for 1 hour, the goat serum is discarded when the time is up. The tissue sections are incubated in rabbit-derived anti-Fibrin antibody (Abeam) overnight at 4° C., washing twice with PBS for 5 min each time; then incubating in goat anti-rabbit IgG (HRP) antibody (Abeam) secondary antibody at room temperature for 1 hour, and washing twice with PBS for 5 min each time. The color is developed according to the DAB kit (Vector laboratories, Inc., USA), after washing with water for 3 times, counterstaining with hematoxylin for 30 seconds, returning to blue under running water for 5 min, and then washing once with PBS. After gradient dehydration, the tissue sections are subjected to being cleared and sealed, finally observing under a 200× optical microscope.
Fibrin is the main component of the hyaline membrane of the lung in acute respiratory distress. The hyaline membrane hinders the gas exchange function of the alveoli, resulting in decreased blood oxygen saturation and dyspnea[8].
The results show that, the level of fibrin deposition in the lung tissues of the mice in the vehicle group (
The following examples further illustrate the practice of the application, but are not intended to limit the application.
All the following patients signed the informed consent forms and are voluntarily administrated plasminogen, and are approved by the hospital ethics committee.
The usage and dosage of plasminogen are adjusted according to the severity and course of the disease. The main modes of administration are aerosol inhalation and intravenous injection. The concentrations of human plasminogen purified from the above human donor blood, used in aerosol inhalation and intravenous injection are all 5 mg/ml, and normal saline is used as a vehicle.
The patient: a 77-year-old male, he has sequelae of cerebral infarction and pulmonary fibrosis. Before administration of plasminogen, he manifested as pneumonia, and the sputum was thick, yellow, viscous, and difficult to cough up; sputum suction was required, 25-26 times a day (24 hours), and a large amount of sputum was sucked out each time. He needed oxygen inhalation all the time (he almost could not live without oxygen inhalation), and the breath sounds were slightly rough. Laryngeal trachea incision was performed (being assisted with metal sleeve). He has been bedridden for nearly half a year, with poor sleep and poor mental state.
Therapeutic regimen: in the first 9 days, plasminogen is administrated by aerosol inhalation, 10 mg/time, 3 times/day; on day 10, aerosol inhalation, 10 mg/time, 2 times/day; on day 11, no administration of plasminogen; on day 12, aerosol inhalation once at a dose of 10 mg; on day 13, aerosol inhalation once at a dose of 10 mg, in combination with 10 mg of intravenous injection; on day 14, intravenous injection at a dose of 15 mg.
Therapeutic effects: on day 1 of administration of plasminogen: the symptoms are alleviated, manifesting as strong expectoration, spontaneous discharge from the trachea incision, and the times of sputum suctions reduce to 8 times (from 8:00 a.m. to 8:00 p.m.). On day 2 of administration of plasminogen: at the first time he can sit without oxygen inhalation for 20 min by being helped with armrest, the blood oxygen saturation is 94%, and the heart rate is 65; at the second time he can sit without oxygen inhalation for more than 10 min, the blood oxygen saturation is 98%, and the heart rate is 75; at the third time he can sit without oxygen inhalation for 20 min by being helped with armrest, the blood oxygen saturation is 94-98%, and the heart rate is about 78. The expectoration is stronger than the day before, and the suction is performed 6 times (from 8:00 a.m. to 8:00 p.m.). On day 14 of administration of plasminogen: the patient actively requests to give up oxygen inhalation; after giving up the oxygen inhalation, the blood oxygen saturation is 97%, and about 94% when falling asleep; and the time without oxygen inhalation in a whole day can reach more than 12 hours, basically he can live without oxygen inhalation; the sputum of the patient is changed from the yellow, thick, viscous state to white, thin and foamy state; and the patient changes from mainly excreting the sputum with the help of a sputum suction machine to excreting most of the sputum spontaneously.
The above results show that, plasminogen can effectively improve the symptoms of pneumonia in a patient, including strong expectoration, spontaneous expectoration, reduction of sputum suction times, prolonged time without oxygen inhalation, improvement of blood oxygen saturation, and improvement of sputum properties.
The patient: an 83-year-old female, she suffered from pulmonary tuberculosis when she was young. About 20 years ago, she was diagnosed with pulmonary fibrosis and asthma, which gradually worsened. Main manifestations: poor lung function, she basically could only support activities on bed, and could not get out of bed.
Therapeutic regimen: on day 1, administration of plasminogen is performed by aerosol inhalation, 10 mg/time, once a day; on day 2, aerosol inhalation, 10 mg/time, twice a day; on day 3, aerosol inhalation, 10 mg/time, 3 times a day.
Therapeutic effects: after administration of plasminogen, the patient can breathe smoothly, and she can support more activities after getting out of bed.
The above results show that, plasminogen can improve lung function in a patient with pulmonary fibrosis and asthma.
The patient: a 55-year-old male, he has stable vital signs and clear consciousness. Chief complaint: no history of hypertension, heart disease, and diabetes, etc. The patient had been taking trimetazidine and bayaspirin, ginkgo leaf capsules and deep-sea fish oil for a long time, and suffered from cerebral infarction 3 years ago. The patient complained of poor sleep quality, no other discomfort symptoms. The patient was observed for asthma after exercise.
Therapeutic regimen: the treatment consists of 14 doses of plasminogen over 22 days. In the first 6 days, plasminogen is administered once a day at a dose of 150 mg intravenous bolus injection each time; in the next 16 days, a dose of 150 mg intravenous bolus injection is administered once every two days.
Therapeutic effects: the treatment effects are assessed by scoring the patient's overall condition and post-exercise asthma symptoms. On day 1, the score of the patient's overall condition and post-exercise asthma symptoms without administration of plasminogen is set as 10 points, and after the administration the score of the patient's overall condition and post-exercise asthma symptoms of yesterday is set as 10 points. Particularly, 10 points is the most severe, and 1 point is the lightest.
On day 4 of administration of plasminogen, the overall condition score is 8 points, the post-exercise asthma symptom score is 8 points, the patient's mental state is better, and the sleep quality is improved. With the prolongation of administration time, various symptoms of the patient are further improved. On day 22 of administration of plasminogen, the overall condition score is 5 points, the post-exercise asthma symptom score is 3 points, the patient has no discomfort, the sleep quality is further improved, and the appetite is improved.
It can be seen from the above that, plasminogen can improve the symptoms of asthma patients, including general condition, post-exercise asthma symptoms, mental state, sleep quality, appetite, etc.
The patient: a 40-month-old female (3 years and 4 months), she was diagnosed with non-5q type SMA (spinal muscular atrophy). She developed SMA when she was 6 months old, and was diagnosed with SMA at 1.5 years old (18 months old). She had shallow breathing due to lung infection and difficulty in expelling sputum to block the respiratory tract. After intermittent use of the breathing machine, she gradually failed to take off the breathing machine, and continuously used the breathing machine for about 1.5 years. She lost language function and was unable to move, the muscle strength was basically grade 0. Symptoms: breathing machine is used until now, daily use of sputum excretion device, expectoration machine, sputum suction device, oxygen inhalation, aerosol inhalation (twice a day), and nasal feeding. Parameters of the breathing machine in use: pressure 20 cm H2O; tidal volume around 120 ml; almost no spontaneous breathing, oxygen flow 1-1.5 ml, sputum suction 15-20 times a day, irregular sputum suction at night (tracheal mucosa damage and bleeding had ever been caused by sputum suction). The blood oxygen detector shows that the blood oxygen saturation is above 95% under the condition of oxygen use (oxygen supply cannot be stopped), and the heart rate was 140 beats/min. The body temperature was above 37.5° C. for a long time.
The first course of treatment (2 weeks): aerosol inhalation, 10 mg/time, 3 times/day; in combination with 50-100 mg intravenous injection, once every three days.
After completion of the first course of treatment, an interval of 57 days is followed to start the second course of treatment.
The second to the fourth courses of treatment (there is a 2-week interval between adjacent courses): intravenous injection, 1 time/3 days, with a dose of 150-250 mg.
The first course of treatment: the parameters of the breathing machine remain unchanged, and the spontaneous breathing increases to about 20-30% (about 2-3 spontaneous breaths occur in 10 breaths). When the oxygen flow remains unchanged, after administration of plasminogen the blood oxygen saturation can reach 98-99%.
The second course of treatment: after 15 days of hospitalization, tracheotomy is performed, and the patient is discharged home for nursing care. The amount of sputum is too much to overflow from the trachea all the time, and it needs to be cleaned up in time by suction; the pressure of the breathing machine is reduced from 18 when discharged from the hospital to 16, the tidal volume is 130-140, and the spontaneous breathing recovers well; oxygen supply can be turned off, basically no oxygen is needed at night; the blood oxygen saturation is above 95%, heart rate is about 120 beats/min, sometimes better, and body temperature returns to normal.
The third course of treatment: the pressure of the breathing machine can be adjusted to 15 or 16, the tidal volume is 140-150, the trachea is more open, the patient maintains spontaneous breathing all the time, the times of oxygen inhalations is few, and oxygen inhalation is occasionally performed during sputum suction. Normal heart rate is 120 beats/min, after administration of plasminogen the oxygen supply may be stopped for 4-5 h, the heart rate is 100 beats/min, and the blood oxygen saturation is 99%. The patient's sputum volume is reduced, the trachea incision is basically free of sputum, and sputum suction is performed 5-6 times a day.
The fourth course of treatment: the parameters of the breathing machine and spontaneous breathing are the same as those in the third course of treatment, the blood oxygen saturation is 97-99% everyday, basically no oxygen supply is needed, and the times of sputum suctions is reduced, 2-3 times a day, and occasionally 5-6 times. Body temperature is normal.
The above results show that, plasminogen can improve lung function in SMA patients, including improvement of blood oxygen saturation; improvement of spontaneous breathing function, trachea patency, no oxygen inhalation or occasional oxygen inhalation; reduction of sputum volume.
The patient: an 18-month-old male, was diagnosed with type I SMA at 6 months. At the time of diagnosis, doctors informed that the average survival period of a patient with this type of disease is 2 years, and no treatment measure was taken by the family members. Pulmonary function symptoms: the blood oxygen is monitored for 24 hours in a whole day, blood oxygen saturation is 92-97%; chest heaves gently during breathing, and breathing is weak during sleep; sputum sounds, and the patient is unable to expectorate sputum spontaneously. Crying is weak with poor spirit.
Therapeutic regimen: aerosol inhalation (2-3 times/day) +intravenous injection (1 time/3 days), the treatment cycle is 5 courses of treatment (2 weeks as a course of treatment), and there is a 2-week interval between adjacent courses of treatment. The dose of aerosol inhalation is 5-10 mg/time; the dose of intravenous injection is 50 mg.
The first course of treatment: on day 2 of the treatment, the blood oxygen saturation reaches 97-98%, occasionally 95-96%. Blood oxygen saturation reaches normal, respiratory function improves, sputum expectoration can be achieved with assistance, and sputum volume is reduced.
The second course of treatment: the blood oxygen saturation remains normal, and the breathing is stronger.
The third course of treatment: sputum is excreted after administration of plasminogen by aerosol inhalation, there is a sputum sound in the morning, and the sputum sounds louder after crying, and the sputum can be excreted with assistance.
The fourth to the fifth courses of treatment: the effect is maintained, and the mental state is good, and there are no exacerbation conditions such as pulmonary infection and respiratory failure.
It can be seen from the above that, plasminogen can improve pulmonary function in a patient with type I SMA, including improving respiratory function and increasing blood oxygen saturation. After treatment, the blood oxygen saturation reaches the normal value; sputum can be excreted with assistance; the symptoms of the patient are improved, and there are no exacerbation conditions such as pulmonary infection and respiratory failure.
The patient: a 48-year-old male, he is diagnosed with severe novel coronavirus pneumonia (2019-nCoV). In the intensive care unit, the breathing machine and monitor have been used, the oxygen concentration is 100%, and the blood oxygen saturation is 80-90%. Vital signs: the heart rate is 92 beats/min, respiration rate is 41 times/min, and blood pressure is 128/84 mmHg
Therapeutic regimen: aerosol inhalation, 10 mg/time, two administrations of plasminogen with an interval of 5.5 h.
The first administration: before administration of plasminogen, the blood oxygen saturation is 84%, the heart rate is 92 beats/min, the respiration rate is 41 times/min, and the blood pressure is 128/84 mmHg; 1 hour after the administration, the blood oxygen saturation is 90%, the heart rate is 83 beats/min, the respiration rate is 37 times/min, and the blood pressure is 128/84 mmHg
The second administration: before administration of plasminogen, the blood oxygen saturation is 88%, the heart rate is 81 beats/min, the respiration rate is 39 times/min, and the blood pressure is 120/83 mmHg; 1 hour after the administration, the blood oxygen saturation is 91%, the heart rate is 70 beats/min, the respiration rate is 28/min, and the blood pressure 120/83 mmHg
There is no adverse reaction before and after the administration, and the patient reports feeling better.
It can be seen from the above that, plasminogen can effectively improve the blood oxygen saturation, slow down the respiratory rate, and improve the lung function in a critical patient with novel coronavirus pneumonia.
The patient: a 47-year-old male, he is diagnosed with severe novel coronavirus pneumonia (2019-nCoV). In the intensive care unit, the breathing machine and monitor have been used, the oxygen concentration is 100%, and the blood oxygen saturation is 80-90%. Vital signs: the body temperature is 37.5° C., heart rate is 110 beats/min, respiration rate is 37 times/min, and blood pressure is 139/94 mmHg
Therapeutic regimen: aerosol inhalation, 10 mg/time, two administrations of plasminogen with an interval of 4 hours and 50 min.
The first administration: before administration of plasminogen, the blood oxygen saturation is 81%; 3 hours after the administration, the blood oxygen saturation is 88-90%.
The second administration: before administration of plasminogen, the blood oxygen saturation is 89-92%, heart rate is 91 beats/min, respiration rate is 31 times/min, and blood pressure is 130/87 mmHg; 1 hour after the administration, the blood oxygen saturation is 91%, heart rate is 89 beats/min, respiration rate is 27 times/min, and blood pressure is 130/87mmHg
There is no adverse reaction before and after the administration, and the patient reports feeling better.
It can be seen from the above that, plasminogen can effectively increase the blood oxygen saturation, and improve the respiratory rate in a critical patient with novel coronavirus pneumonia.
The patient: a 46-year-old male with a blood oxygen saturation of 93% and a respiratory rate of 26 times/min, he is diagnosed with severe COVID-19 according to the clinical classification criteria of the Novel Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Version 6). The patient's blood pressure is 130/80 mmHg (systolic/diastolic) before treatment.
Human plasminogen lyophilized powder is dissolved in sterile water at a concentration of 5 mg/ml, and the solution is administered to the patient after being nebulized by a nebulizer; two administrations every day with a dose of 10mg each time.
After 6 doses of administrations, the patient's blood pressure decreases from the previous 130/80 mmHg to 116/69 mmHg It indicates that plasminogen can reduce blood pressure in a severe COVID-19 patient.
The patient: a 47-year-old male with a blood oxygen saturation of 93%, he is diagnosed with severe COVID-19 according to the clinical classification criteria of the Novel Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Version 6). The patient's respiratory rate is 45 times/min before treatment.
Human plasminogen lyophilized powder is dissolved in sterile water at a concentration of 5 mg/ml, and the solution is administered to the patient after being nebulized by a nebulizer; two administrations every day with a dose of 10mg each time.
After 2 doses of administrations, the patient's breathing rate decreases from previous 45 times/min to 37 times/min It indicates that plasminogen can reduce respiratory rate in a severe COVID-19 patient.
The patient: a 48-year-old male with a blood oxygen saturation of 79% and a respiratory rate of 41 times/min, he is diagnosed with critical COVID-19 according to the clinical classification criteria of the Novel Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Version 6). The patient's blood pressure is 128/84 mmHg (systolic/diastolic) before treatment.
Human plasminogen lyophilized powder is dissolved in sterile water at a concentration of 5 mg/ml, and the solution is administered to the patient after being nebulized by a nebulizer; two administrations every day with a dose of 10mg each time.
After 5 doses of administrations, the patient's blood pressure decreases from the previous 128/84 mmHg to 120/83 mmHg It indicates that plasminogen can reduce blood pressure in a critical COVID-19 patient.
The patient: a 47-year-old male with a blood oxygen saturation of 82% and a respiratory rate of 37 times/min, he is diagnosed with critical COVID-19 according to the clinical classification criteria of the Novel Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Version 6). The patient's blood pressure is 139/94 mmHg (systolic/diastolic) before treatment.
Plasminogen lyophilized powder is dissolved in sterile water at a concentration of 5 mg/ml, and the solution is administered to the patient after being nebulized by a nebulizer; two administrations every day with a dose of 10 mg each time.
After 2 doses of administrations, the patient's blood pressure decreases from the previous 139/94 mmHg to 120/83 mmHg, and the respiratory rate decreases from 37 times/min to 27 times/min. It indicates that plasminogen can reduce blood pressure and respiratory rate in a critical COVID-19 patient.
Thirteen 30-78 year-old COVID-19 patients are recruited in this experiment. According to the clinical classification criteria of the Novel Coronavirus Pneumonia Diagnosis and Treatment Program (Trial Version 6), these 13 patients include 5 ordinary patients, 6 severe patients, and 2 critical patients. The treatment is approved by the hospital ethics committee. All patients sign informed consent.
Human plasminogen lyophilized powder is dissolved in sterile water at a concentration of 5 mg/ml, and the solution is administered to the patients after being nebulized by a nebulizer. Different doses of plasminogen are administered according to the severity of the disease of the patients. Ordinary patients are administered once a day with a dose of 10 mg each time; severe and critical patients are administered twice a day with a dose of 10 mg each time. The basic circumstances of the patients and the frequency of administration are shown in Table 1. High-resolution chest CT (Neusoft, NeuViz 16Classic, China) is performed several days before administration or after the administration. The real-time blood oxygen saturation and heart rates are monitored by a monitor (Mindary, iPM5, China), and the blood oxygen saturation and heart rates are recorded 1 hour before aerosol inhalation of human plasminogen and several hours after the aerosol inhalation.
CT results show that, the bilateral lungs in 5 patients of common type show multiple patchy/punctate “ground glass” shadows with unclear boundary and uneven density before treatment, and the mediastinal window lesion regions show sparse spot-like shadows. Five patients received antibiotics and traditional Chinese medicine therapy before administration of human plasminogen, but the density and extent of the “ground glass” shadows in the lungs still increased over time, indicating aggravation of the disease. After 2-3 doses of human plasminogen administration, the number, extent and density of lung lesions in the 5 patients are reduced or even partially disappeared; patchy or punctate “ground glass” shadows are significantly reduced or absorbed (see
Result 2: plasminogen Increases Blood Oxygen Saturation in Severe and Critical COVID-19 Patients
During plasminogen administration, severe or critical COVID-19 patients are respectively infused with oxygen at a constant concentration of 80% or 100% through nasal cannula, and the blood oxygen saturation is monitored under oxygen infusion conditions.
The results show that, although blood oxygen saturation in severe patients is normal, after administration of human plasminogen, the blood oxygen saturation is still increased by 1-4% in 5 of the 6 severe patients. As for the 2 critical patients, only 1 hour after aerosol inhalation of human plasminogen, the blood oxygen saturation is increased from 79-82% before treatment to about 91%, and remained stable. After plasminogen is administered to one severe patient, the blood oxygen saturation is decreased from 91% before administration to 89% (Table 3). These data suggest that, plasminogen generally improves blood oxygen saturation levels in severe and critical COVID-19 patients, especially in patients with particularly low blood oxygen saturation.
The results of heart rate monitoring show that, after aerosol inhalation of human plasminogen, 8 of the 13 COVID-19 patients have their heart rate slowed down by approximately 26 beats per minute, 2 have an increased heart rate, and 3 have no significant change (Table 4). Statistical analysis shows that, after the administration of plasminogen, all the mean heart rates of the common, severe, and critical patients are decreased, and there is significant statistical difference in the comparison of the common patients before and after the administration of plasminogen (p<0.05) (
In addition, all patients report reduced chest tightness and smoother breathing after aerosol inhalation of human plasminogen.
In conclusion, aerosol inhalation of human plasminogen can reduce lung damage in COVID-19 patients, increase blood oxygen saturation, reduce heart rate, and improve respiratory function in patients.
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| Number | Date | Country | Kind |
|---|---|---|---|
| 202010086980.7 | Feb 2020 | CN | national |
This application is a national stage application under 35 U.S.C. § 371 of International Application No. PCT/CN2021/076035, filed Feb. 8, 2021, which claims priority to Chinese Application No. 202010086980.7, filed Feb. 11, 2020, the entire contents of each priority application are incorporated herein by reference.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/CN2021/076035 | 2/8/2021 | WO |
