Copyright © 1999 by the European Society of Cardiology.
Humoral and cellular immune responses up to 7·5 years after administration of streptokinase for acute myocardial infarction
Department of Medicine and Therapeutics, University of Leicester, Leicester, U.K.
Centre for the Mechanism of Human Toxicity, University of Leicester, Leicester, U.K.
Departments of Clinical Immunology, Western Infirmary, Glasgow, U.K.
Cardiology, Western Infirmary, Glasgow, U.K.
revised January 8, 1999; accepted January 15, 1999
Abstract
Aims Administration of streptokinase results in an immunological response which may lead to increased risk of anaphylactic reaction or reduced thrombolytic efficacy on repeat administration. For these reasons current recommendations suggest that streptokinase should not be given up to 1 year after first administration. We sought to define the profile of both the circulating antibody and T-cell response to streptokinase in patients who had received streptokinase up to 7·5 years previously following acute myocardial infarction.
Methods Neutralizing anti-streptokinase antibody and total anti-streptokinase IgG were measured in 219 patients who had suffered acute myocardial infarction between 12 and 90 months previously and had received streptokinase. T-cell response to streptokinase was assessed by in-vitro proliferation of peripheral blood mononuclear cells (n=234). Data on all parameters were available in 184 patients. Controls (n=22) had suffered acute myocardial infarction between 73 and 84 months previously but had not received thrombolytic therapy.
Results Compared to controls, anti-streptokinase antibodies were elevated at all time periods from 12 to 90 months after streptokinase treatment. Total anti-streptokinase titres showed the expected correlation with neutralizing anti-streptokinase antibodies (P<0·0001). Peripheral blood mononuclear cells showed a vigorous in-vitro proliferative response to streptokinase 6 days after treatment (P=0·05 vs pre-treatment), but this was not detectable at 6 weeks or subsequently.
Conclusion There is as yet no evidence of a time limit beyond which administration of streptokinase on a second occasion can be regarded as safe and likely to be effective. Measurement of neutralizing anti-streptokinase or total anti-streptokinase IgG titre appear to provide equivalent information regarding the antibody status of a population. Further studies are required regarding the apparent lack of peripheral blood mononuclear cells responsiveness in patients previously exposed to streptokinase.
Key Words: Streptokinase, myocardial infarction, immune response, anti-streptokinase antibodies
f1 Correspondence: Dr Iain Squire, University of Leicester, Department of Medicine and Therapeutics, Clinical Sciences Building, Leicester Royal Infirmary, Leicester LE2 7LX, U.K.
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