Pharmacokinetics and hepatic catabolism of tissue-type plasminogen activator.

Recombinant tissue-type plasminogen activator (rt-PA, alteplase, Actilyse, Activase; CAS 105857-23-6) is the most effective agent currently available for thrombolytic therapy of life-threatening diseases such as acute myocardial infarction. It acts by rapid, clot-specific lysis of pathological thrombi, with only limited effects on systemic hemostasis. Pharmacokinetics of rt-PA have been extensively characterized in animal species and man, and can be generally described by a 3-compartment model. Preferred analytical methods for rt-PA in plasma are ELISA and chromogenic activity assays. The dominant plasma half-life of rt-PA in myocardial infarction patients is short (3.6 min), which allows excellent control of plasma levels during therapy. Steady-state plasma concentrations effecting coronary thrombolysis using the current dosage regimen are 2.2 micrograms/ml. A deep compartment results in elevated rt-PA concentrations several hours after termination of infusions, which may contribute to short-term maintenance of patency of reperfused blood vessels. Clearance of rt-PA can be saturated in animals at very high plasma concentrations (Km = 12-15 micrograms/ml), however, pharmacokinetics in clinical settings are linear. Clearance occurs via hepatic receptor mediated endocytosis and intracellular degradation in liver parenchymal, endothelial and Kupffer cells. The catabolism involves coated pits, coated vesicles, endosomes, and finally degradation in lysosomes. Current evidence supports the existence of hepatic receptors recognizing carbohydrate as well as polypeptide determinants in rt-PA. In conclusion, increasing knowledge of rt-PA pharmacokinetics will contribute to the optimization of new clinical dosage regimens, such as front-loaded infusions and boluses, and to the identification of novel molecular targets for pharmacologic control of rt-PA catabolism and of circulating fibrinolytic activity.