جستجوی مقالات مرتبط با کلیدواژه « tenecteplase » در نشریات گروه « پزشکی »
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Journal of Advances in Medical and Biomedical Research, Volume:32 Issue: 151, Mar-Apr 2024, PP 119 -126Background & Objective
Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) has been considered as primary therapy in ischemic stroke patients. Alteplase is prescripted as the thrombolytic therapy for more than two decades. Tenecteplase is a new type of tPA that is reported to have beneficial effects in recent years. The present research focused on the effectiveness and the side effects of tenecteplase in the ischemic stroke.
Materials & MethodsHere we administrated 0.25 mg/kg tenecteplase in 36 individuals with acute ischemic stroke in the first 4.5 hours of stroke occurrence. The NIHSS in baseline, 24 hours, 7 days after and the modified Rankin scale (mRS) at 90 days were assessed. The primary efficacy outcome was reduction of at least 4 points in the NIHSS during 7 days and the secondary efficacy outcome was defined as mRS 0 and 1 at 90 days. The safety outcome was evaluated based on the symptomatic intracranial hemorrhage (ICH) and death occurance during 90 days.
ResultsThe mean NIHSS at baseline was 12.7±4.6, and the mean NIHSS corresponding to 24 hours after admission was 9.6±4.8. The mean 7-day NIHSS was 7.6±4.4. The primary and secondary efficacy outcomes were met in 18 (50%) and 22 (61.1 %) of the patients respectively. Symptomatic ICH was observed in one patient with lung cancer who died of respiratory failure.
ConclusionThis study confirmed the efficacy and safety of tenecteplase in thrombolysis for acute ischemic stroke treatment. Tenecteplase appears to be an appropriate therapy as thrombolytic agent against ischemic stroke.
Keywords: Tenecteplase, Ischemic Stroke, Thrombolysis, Alteplase, Tissue Plasminogen Activator} -
Therapeutic Tenecteplase (TNKase) is a recombinant and site directed mutant version of human tissue plasminogen activator (TPA) with clinical advantages over TPA. Due to specific glycosylation, TNKase is preferred to over-express in mammalian cell lines such as Chinese Hamster Ovarian (CHO) Cells. The production and purification of this protein need huge efforts and costs, which directly increase the end product price and limits its medical applications in developing countries despite its benefits. In the current study, we compared two purification methods in order to minimize purification steps as well as purification costs. In the first method, DMEM medium containing CHO-C111 cells expressed recombinant TNKase was purified by a three columns protocol including Sephadex® G-10, HiPrepTM CM FF and L-lysine HyperD®. In the second method, because of its properties, only L-lysine HyperD® column was applied for purification of protein molecules with the lysine binding site, including TNKase. Our results showed that in the second method, higher purification fold and purification yield (1.14 and 1.25 times, respectively) have achieved compared to the first method. This finding in addition to reduction in purification steps, purification cost and time, make it possible to use this method for purification of TNKase. In addition, we suggest overexpressing this protein in serum-free cell lines such as CHO-DG44 in order to minimize impurities and make purification procedure easier.Keywords: Tenecteplase, Purification, human tissue plasminogen activator}
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BackgroundAcute myocardial infarction (AMI) is the leading cause of death throughout the world. One of the standard approaches to treatment of AMI is fibrinolysis. The study was conducted to evaluate the clinical efficacy of tenecteplase versus reteplase through network meta-analysis for AMI.MethodsRandomized trials were comprehensively searched in PubMed, Scopus, Cochrane library, and Web of Science using appropriate strategies. Quality assessment was done for the papers. The primary and secondary end-points were mortality, TIMI grade 3 flow at 90 minutes, death or non-fatal stroke, infarction, total stroke and major bleeding. Odds ratios (OR) were computed (95% confidence intervals).ResultsAfter screening 27325 records, eight articles were included with total patients of 49875 to the meta-analysis. Indirect comparison of tenecteplase vs. reteplase showed no significant differences in the risk of mortality (OR= 0.98, p>0.05), TIMI grade 3 flow at 90 minutes (OR= 0.77, p>0.05), death or non-fatal stroke (OR= 1.04, p>0.05), infarction (OR= 1.11, p>0.05), total stroke (OR=2.71, p>0.05), and major bleeding (OR= 0.81, p>0.05) (all p>0.05).ConclusionsIndirect comparison suggests similar efficacy and safety of tenecteplase and reteplase. Hence, the use of each one of the two medicines depends on price, facility, and accessibility of the medicine.Keywords: tenecteplase, Reteplase, alteplase, systematic review, Meta-Analysis, Efficacy, Safety}
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BackgroundThe expression of bio-therapeutic proteins in mammalian cells, such as CHO, attains high homogeneity related to post-translational modifications. Although CHO remains the most popular cell line for bestselling biotherapeutic proteins on the market, there are still drawbacks such as expensive culture media, long time line, and high drug cost. Recently, researches on a novel Leishmania protozoan system have confirmed that this low level eukaryote could represent a competitive alternative to the mammalian cell lines.MethodsThe full length of coding sequence of modified tPA TNKase tenecteplase) was synthesized and cloned into an inducible expression vector of L. tarentolae T7-TR cells.ResultsThe expression of the construct was driven by a Tet-inducible promoter. A Leishmania secretory signal sequence was also added to the expression cassette to facilitate the release of the recombinant protein into the medium. The secretory recombinant protein was analyzed and confirmed by SDS-PAGE and Western blot analyses. The expression level of TNKase in this novel system of L. tarentolae was 810 IU/mL after induction, which means that the percentage of expression increases two times compared to previous models in L. tarentolae. The TNKase activity was comparable with Activase.ConclusionOur results suggested that expressed TNK (modified tPA) is functionally compatible with Activase regarding their effect on fibrinolysis. Given the post-translational modification similarities between mammalian and L. tarentolae, it is speculated that this system is capable of producing complex proteins such as tPA similar to mammalian system, with easier manipulation and non-expensive method.Keywords: Leishmania tarentolae, Tenecteplase, Tissue plasminogen activator}
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مقدمهبا توجه به نبود شواهدی مبنی بر اینکه کدام یک از داروهای ترومبولیتیک در درمان انفارکتوس حاد میوکارد با صعود قطعه اس - تی هزینه اثربخش تر هست، این مطالعه با هدف ارزیابی هزینه اثربخشی داروی جدیدتر تنکتپلاز در مقابل رتپلاز در درمان بیماران مبتلا به انفارکتوس حاد میوکارد با صعود قطعه اس- تی در ایران انجام پذیرفت.روش بررسیاین مطالعه از نوع مطالعات ارزیابی فناوری سلامت بود. استراتژی جستجو با استفاده از کلیدواژه های مرتبط در پایگاه های داده ای Medline، Cochrane library، PubMed Central، Web of Science، Embase در فاصله سال های 1980 تا مارس 2017 به منظور پیدا کردن مطالعات اثربخشی، ایمنی و اقتصادی جستجو شدند. ارزیابی کیفیت مطالعات توسط دو نفر به صورت مستقل با استفاده از چک لیست استروب انجام گرفت و داده ها با استفاده از فرم استخراج داده های کاکرین استخراج شدند.یافته هاسه مطالعه شرایط لازم را برای ورود به مطالعه داشته و هر سه دارای کیفیت بالا بودند. مرگ و میر در سه گزارش بین تنکتپلاز و رتپلاز مقایسه شده بود که نتایج دو مطالعه با 781 نمونه، اثربخشی یکسان دو داروی تنکتپلاز و رتپلاز را در میزان مرگ و میر نشان داد. نتایج حاصل از تحلیل هزینه اثربخشی نشان داد که داروی رتپلاز داروی هزینه اثربخش تری نسبت به داروی تنکتپلاز بود (هزینه 10500000 ریال در برابر 22574820 ریال).بحث و نتیجه گیریداروی رتپلاز در مقایسه با داروی تنکتپلاز به دلیل هزینه پایین تر و همچنین ایمنی و اثربخشی یکسان، ارجح بود و با توجه به وضعیت اقتصادی کشور توصیه می شود از این دارو استفاده شود. واژگان کلیدی: ارزیابی فناوری سلامت ، رتپلاز ، تنکتپلاز، آنفارکتوس حاد میوکارد ، ارزشیابی اقتصادی ارجاع: باش زر سلمان، تورانی سوگند، نیکفر شکوفه، رواقی حمید، حبیبی مریم. ارزیابی فناوری سلامت داروی تنکتپلاز در مقایسه با رتپلاز در درمان بیماران مبتلا به آنفارکتوس حاد میوکارد در ایران. مجله پژوهش های سلامت محور 1397؛ 4(1): 62-51.کلید واژگان: ارزیابی فناوری سلامت, رتپلاز, تنکتپلاز, آنفارکتوس حاد میوکارد, ارزشیابی اقتصادی}ObjectivesDue to the lack of evidence about the most cost-effective thrombolytic drug in the treatment of acute myocardial infarction with the ascension of the ST segment, this study was conducted to evaluate the cost effectiveness of tenecteplase, as a new medicine, versus Reteplase in the treatment of acute myocardial infarction patients with the ascension of the ST segment in Iran.MethodsThis study was a type of health technology assessment study. We searched the MEDLINE, Cochrane Library (DARE-EED-HTA, Web of Science and EMBASE databases (from March1980 to March 2017) by using related keywords for finding cost-effectiveness, safety and economic studies. The qualities of studies were independently assessed by STROBE checklist and data were extracted using Cochrane data extraction form.ResultsThree studies were eligible for inclusion and all three were of high quality. Mortality had been compared between Tenecteplase and Reteplase. The results of two studies with 781 samples had showed the same efficacy for Tenecteplase and Reteplase in regard to mortality rate. According to the cost-effectiveness analysis, Reteplase is more cost effective than TNK-ase (250 $ versus 537.49 $).ConclusionReteplase, due to the same safety and effictiveness but lower cost, is preferred to Tenecteplase and considering the current economic conditions of Iran, it is recommended to be used in the treatment of acute myocardial infarction patients with the ascension of the ST segment. Key words: Health Technology Assessment, Acute Myocardial Infarction, Tenecteplase, Reteplase, Economic evaluation Citation: Bashzar S, Tourani S, Nikfar S, Ravaghi H, Habibi M. Health Technology Assessment of TNK-ase vs. Reteplase in the Treatment of Acute Myocardial Infarction in Iran. Journal of Health Based Research 2018; 4(1): 51-62.Keywords: Health Technology Assessment, Acute Myocardial Infarction, Tenecteplase, Reteplase, Economic evaluation}
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BackgroundAlthough primary percutaneous intervention (PCI) is the preferred reperfusion strategy in patients with STEMI, not all patients are good candidates for PCImainly because of a delay in requesting medical care and longer 1st medical contact to balloon time. The objective of this study was to compare the efficacy and side effects of 2 known fibrinolytic therapies, streptokinase (SK) and tenecteplase (TNK).MethodsThis descriptive, analytic cross-sectional study recruited patients not amenable to primary PCI. a total of 142 patients recruited, 88 patients received SK and the other 54 patients received TNK. Thereafter, the efficacy of the agents, their side effects, territory of the culprit vessel, minor and major bleeding, relation to diabetes mellitus, and mortality in the index hospitalization were compared.ResultsPatients who were administered SK showed a 2.09-mm ST elevation after the drug administration as opposed to 1.95 mm in the TNK group (P=0.340). Minor bleeding was reported in 22.7% of the SK group and 24.1% in the TNK group. Major bleeding in the SK and TNK groups was 11.1% and 5.7%, respectively, with no significant difference. In the patients index admission, death due to STEMI occurred in 10 (11.4%) patients in the SK group and 8 (14%) patients in the TNK group; the difference did not constitute statistical significance.ConclusionsThe results of our study showed that SK and TNK were similar in terms of major complications, mortality rates, and efficacy. Thus, if TNK is not available, SK would be a reasonable choice.Keywords: ST elevation MI, Primary PCI, Fibrinolytic therapy, Streptokinase, Tenecteplase}
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