Myocardial infarction (MI) is the death of myocardial cells because of prolonged ischemia (
1). Thrombolytic therapy is an important form of treatment for acute MI (
2). In this regard, different fibrinolytic agents and plasminogen activators (PAs) have been developed (
2). Streptokinase and urokinase (as the first generation agents); alteplase (as the second generation agent); and reteplase, tenecteplase, lanatoplase, and staphylokinase (as the third generation agents) are three types of PAs in the market (
3). It has been shown that immediate intravenous infusion of alteplase is associated with an improved mortality compared with intravenous administration of streptokinase or the combination of streptokinase and t-PA (
2).
Tissue plasminogen activatoris a 527 amino acids glycoprotein with a molecular weight of 67 kDa, which causes conversion of plasminogen to plasmin in the presence of fibrin. The protein molecule contains five structural domains: finger domain (F), a growth factor domain (EGF), the N-terminal region, and two kringle 1 (K1) and kringle 2 (K2) domains. Kringle 2 domain is the serine protease domain with the catalytic site at the C terminus. Binding of both finger and kringle 2 domains to fibrin accelerates the activation of t-PA on plasminogen (
4).
However, full t-PA has several disadvantages such as the rapid clearance from plasma by the liver as the structural elements on first three N-terminal domains are recognized by certain hepatic receptors (
5-
7), and difficult prokaryotic production and refolding process (
8). Therefore, smaller active molecules such as reteplase and lanatoplase have been synthesized and are commercially available (
3). Reteplase is a mutant version of t-PA with prolonged half-life in which the F, EGF, and K1 region of the wild-type t-PA molecule have been deleted. Finger domain is the responsible domain for fibrin affinity. Therefore, reteplase has weaker affinity for fibrin and causes more fibrinogen depletion than full length forms (
2,
9). Furthermore, reteplase can be used within 3 hours of stroke, while streptokinase is not indicated for treatment of stroke (
10).