Background: We have previously demonstrated thrombolytic efficacy of tissue plasminogen activator (tPA)-loaded echogenic liposomes (TELIP), a directed therapeutic construct that features exposed tPA fibrin-binding sites, in a rabbit abdominal aorta thrombosis model. The most relevant animal model for evaluation of directed thrombolytic therapy for ischemic stroke is the rabbit thrombotic stroke model previously used to validate recombinant tPA (rtPA; Alteplase). The ability to precisely monitor tPA-mediated thrombus dissolution in vivo is important for quantitative assessment of directed TELIP efficacy. Hypothesis: A gas-free ultrasound contrast agent can be incorporated into blood clots at a concentration that does not affect the tPA-mediated clot dissolution rate, while enabling quantitative assessment of the clot dissolution rate. Methods: In 1.5-ml Eppendorf tubes, 0.2-ml clots were formed from a mixture of whole rabbit blood, 1 M calcium chloride, human thrombin and various amounts of microcrystalline cellulose. At 0-time, 50 μg rtPA in 0.5 ml porcine plasma was added to each tube. Washed clots in tubes were weighed with an analytical balance at 30, 60 and 90 minutes. Clot echogenicity at each time point was assessed with a Philips HDI 5000 ultrasound system using an L12-5 linear array probe positioned laterally to tubes placed in an anechoic chamber. Recorded Images were subjected to videodensitometric analysis that converted image reflectivity to mean gray scale values (MGSV). Results: We found that 1.12 mg/ml of microcrystalline cellulose in rabbit blood clots (0.2 ml) provided optimal echogenicity without affecting the clot dissolution rates (0.3-0.6 mg/min.) caused by 100 μg/ml of rtPA. The clot dissolution rate measured by videodensitometric analysis of serial sonograms of the echogenic clots agreed well with that determined by mass loss measurements (0.28% 0-time value/minute). Conclusions: We have developed a method for monitoring rtPA-mediated clot mass loss by ultrasound imaging techniques and validated it in vitro. This method will be important for demonstrating the enhanced efficacy and decreased hemorrhagic effects provided by directed tPA vehicles relative to systemic administration of the free thrombolytic.
Read full abstract