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Study of the pharmacokinetics of non-immunogenic staphylokinase in patients with acute myocardial infarction and acute ischemic stroke

https://doi.org/10.19163/2307-9266-2025-13-5-415-428

Abstract

The aim. To investigate the pharmacokinetic parameters of non-immunogenic staphylokinase (Fortelyzin®, SuperGene LLC, Russia) in patients with acute myocardial infarction with ST-segment elevation (STEMI) on the electrocardiogram and in patients with ischemic stroke.

Materials and methods. The clinical study was conducted in 50 patients with STEMI after a single intravenous administration of non-immunogenic staphylokinase at a dose of 15 mg and in 50 patients with ischemic stroke after a single intravenous administration of the drug at a dose of 10 mg. The main pharmacokinetic parameters were determined: half-life, initial concentration, volume of distribution, clearance, and area under the pharmacokinetic curve.

Results. As a result of the study of the pharmacokinetics of non-immunogenic staphylokinase, it was found that after a single intravenous administration of the drug at a dose of 15 mg, the initial concentration was 7.1 ± 2.7 μg/mL, the half-life was 5.77 ± 0.72 min, the clearance was 0.33 ± 0.04 l/min, and the area under the pharmacokinetic curve (AUC0-t) was 42.9 ± 3.2 μg/mL*min. After administration of the drug at a dose of 10 mg, the initial concentration was 2.8 ± 0.3 μg/ml, the half-life was 5.11 ± 0.56 min, the clearance was 0.35 ± 0.06 l/min, and the area under the pharmacokinetic curve (AUC0-t) was 28.5 ± 3.6 μg/mL*min. The terminal half-life was 32 min in both dosage regimens.

Conclusion. It was found that non-immunogenic staphylokinase is characterized by a short half-life and high clearance, which ensures the safety of the drug in clinical practice. The peculiarities of the pharmacodynamics of non-immunogenic staphylokinase, associated with its interaction with plasmin in the thrombus and subsequent recirculation of released drug molecules, allow it to be used in low doses, regardless of the patient’s body weight, despite the short half-life.

About the Authors

S. V. Ivanov
1. Orekhovich Scientific Research Institute of Biomedical Chemistry. 2. SuperGene Limited Liability Company.
Russian Federation

Candidate of Sciences (Biology), Senior Researcher of the Orekhovich Scientific Research Institute of Biomedical Chemistry. 

1. 10 Pogodinskaya Str., bldg. 8, Moscow, Russia, 119435.

2. 6 Luzhnetskaya Emb., bldg. 1, Moscow, Russia, 119270.



I. P. Beletsky
Institute of Theoretical and Experimental Biophysics.
Russian Federation

Doctor of Sciences (Biology), department professor, director of Institute of Theoretical and Experimental Biophysics.

3 Institutskaya Str., Pushchino, Russia, 142290.



M. V. Zakharova
Skryabin Institute of Biochemistry and Physiology of Microorganisms.
Russian Federation

Candidate of Sciences (Biology), leading researcher Skryabin Institute of Biochemistry and Physiology of Microorganisms of Russian Academy of Sciences. 

5 Nauki Ave., Pushchino, Russia, 142290



E. A. Ponomarev
1. City Clinical Emergency Hospital No. 25. 2. Volgograd State Medical University.
Russian Federation

Doctor of Sciences (Medicine), Professor of the Department of Hospital Surgery of the Volgograd State Medical University, Deputy Chief Physician for Surgical Care of the City Clinical Emergency Hospital No. 25 (Volgograd, Russia). 

1. 74 Zemlyachki Str., Volgograd, Russia, 400138.

2. 1 Pavshikh Bortsov Sq., Volgograd, Russia, 400066.



Zh. Yu. Chefranova
Belgorod State National Research University.
Russian Federation

Doctor of Sciences (Medicine), nProfessor of the Department of Nervous Diseases and Restorative Medicine of the Medical Institute, Belgorod State National Research University. 

85 Pobedy Str., Belgorod, Russia, 308015.



S. L. Konstantinov
Belgorod Regional Clinical Hospital of St. Joasaph.
Russian Federation

Head of the Cardiology Department No. 2 of the Belgorod Regional Clinical Hospital of St. Joasaph. 

8/9 Nekrasova Str., Belgorod, Russia, 308007.



G. I. Stryabkova
Belgorod Regional Clinical Hospital of St. Joasaph.
Russian Federation

cardiologist of the Belgorod Regional Clinical Hospital of St. Joasaph. 

8/9 Nekrasova Str., Belgorod, Russia, 308007.



Yu. A. Lykov
Belgorod Regional Clinical Hospital of St. Joasaph.
Russian Federation

neurologist of the Belgorod Regional Clinical Hospital of St. Joasaph. 

8/9 Nekrasova Str., Belgorod, Russia, 308007.



U. A. Yelemanov
Kaluga Regional Clinical Hospital.
Russian Federation

Head of the Neurological Department for Patients with Cerebral Circulatory Disorders of the Kaluga Regional Clinical Hospital (Kaluga, Russia). 

1 Vishnevsky Str., Kaluga, Russia, 248007.



S. E. Chuprina
Voronezh Regional Clinical Hospital No. 1.
Russian Federation

Candidate of Sciences (Medicine), Head of the Neurological Department for Patients with Cerebral Circulatory Disorders, Voronezh Regional Clinical Hospital No. 1 (Voronezh, Russia). 

151 Moskovsky Ave., Voronezh, Russia, 394066.



S. S. Markin
1. Orekhovich Scientific Research Institute of Biomedical Chemistry. 2. SuperGene Limited Liability Company.
Russian Federation

Doctor of Sciences (Medicine), Professor, senior research associate of the Orekhovich Scientific Research Institute of Biomedical Chemistry. 

1. 10 Pogodinskaya Str., bldg. 8, Moscow, Russia, 119435.

2. 6 Luzhnetskaya Emb., bldg. 1, Moscow, Russia, 119270.



References

1. Hasdai D., Behar S., Wallentin L., Danchin N., Gitt A.K., Boersma E., Fioretti P.M., Simoons M.L., Battler A. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). Eur Heart J. 2002;23(15):1190–1201. DOI: 10.1053/euhj.2002.3193

2. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI). Lancet. 1986;1(8478):397–402.

3. Fox KA, Goodman SG, Klein W, Brieger D, Steg PG, Dabbous O, Avezum A. Management of acute coronary syndromes. Variations in practice and outcome; findings from the Global Registry of Acute Coronary Events (GRACE). Eur Heart J. 2002;23(15):1177–89. DOI: 10.1053/euhj.2001.3081

4. Chazov EI, Andreenko GV. The first experience of thrombosis therapy with domestic fibrinolysin // Cardiology. 1962;(4):59–63. Russian

5. Collen D. Staphylokinase: a potent, uniquely fibrin-selective thrombolytic agent. Nat Med. 1998;4(3):279–84. DOI: 10.1038/nm0398-279

6. Verstraete M. Third-generation thrombolytic drugs. Am J Med. 2000;109(1):52–8. DOI: 10.1016/s0002-9343(00)00380-6

7. Kirienko AI, Leontyev SG, Yarovaya EB, Konstantinov SI, Orlov BB, Meray I, Duplyakov DV, Oleynikov VE, Vasilyeva EYu, Ponomarev EA, Pribylov SA, Komarova AG, Bobkov VV, Rabinovich RM, Klein GV, Shogenov ZS, Karabach YuV, Zolkin VN, Kulabukhov VV, Kashtalap VV, Linev KA, Stryabkova GI, Yasnopolskaya NV, Tolmacheva VYu, Chefranova ZhYu, Lykov YuA, Panina ES, Solovieva NV, Rybin EV, Furman NV, Kulibaba EV, Makukhin VV, Koledinsky AG, Mullova IS, Cherepanova NA, Pavlova TV, Savvinova PP, Libov IA, Igoshin AS, Bogomazov IYu, Pecherina TB, Lyudnev LO, Vlasov PN, Avdeeva IV, Maksimov DB, Komissarova EV, Ivanov VS, Vyazova NL, Vyshlov EV, Kurtasov DS, Kutsenko VA, Ivlev OE, Soplenkova AG, Tereshchenko SN, Yavelov IS, Shakhnovich RM, Erlikh AD, Talibov OB, Semenov AM, Semenov MP, Ivanov SV, Romashova YuA, Beregovykh VV, Archakov AI, Markin SS. Non-immunogenic staphylokinase — a thrombolytic agent in the treatment of massive pulmonary embolism: results of the FORPE clinical trial. Russian Journal of Cardiology. 2024;29(11):6157. DOI: 10.15829/1560-4071-2024-6157

8. Christner RB, Boyle MD. Role of staphylokinase in the acquisition of plasmin(ogen)-dependent enzymatic activity by staphylococci. J Infect Dis. 1996;173(1):104–12. DOI: 10.1093/infdis/173.1.104

9. Toul M., Nikitin D., Marek M., Damborsky J., Prokop Z. Extended mechanism of the plasminogen activator staphylokinase revealed by global kinetic analysis: 1000-fold higher catalytic activity than that of clinically used alteplase. ACS Catalysis. 2022;12:3807–14. DOI: 10.1021/acscatal.1c05042

10. Markin SS, Ivanov SV, Beletsky IP, Zakharova MV, Ponomarev EA, Arzamascev EV. Assessment of the allergenic and immunotoxic properties of the recombinant non-immunogenic staphylokinase in preclinical and clinical trials. Pharmacy & Pharmacology. 2025;13(1):31–44. DOI: 10.19163/2307-9266-2025-13-1-31-44

11. Markin SS, Semenov AM, Markov VA, Nizov AA, Ponomarev EA, Lebedev PA. Clinical trial of fibrinselective thrombolytic pharmaceutical agent «FORTELYZIN®» (III Phase). RUDN Journal of Medicine. 2012;(1):105–110. EDN: OPPLCH

12. Markov VA, Duplyakov DV, Konstantinov SL, Klein GV, Aksentev SB, Platonov DYu, Vyshlov EV, Ponomarev EA, Rabinovich RM, Makarov EL, Kulibaba EV, Yunevich DS, Kritskaia OV, Baranov EA, Talibov OB, Gerasimets EA. Fortelyzin® in comparison with Metalyse® for ST-elevated myocardial infarction: one-year results and clinical outcomes of a multicenter randomized study FRIDOM1. Russian Journal of Cardiology. 2018;(11):110–116. DOI: 10.15829/1560-4071-2018-11-110-116

13. Markov VA, Duplyakov DV, Konstantinov SL, Klein GV, Aksentiev SB, Platonov DYu, Vyshlov EV, Ponomarev ЕA, Rabinovich RM, Makarov EL, Kulibaba EV, Yunevich DS, Kritskaya OV, Baranov EA, Talibov OB, Kutsenko VA, Orlovsky AA, Vyazova NL, Koledinsky AG, Semenov AM, Semenov MP, Yarovaya EB, Uskach TM, Shakhnovich RM, Tereshchenko SN, Markin SS. Advanced results of Fortelyzin® use in the FRIDOM1 study and real clinical practice. Russian Journal of Cardiology. 2022;27(8):5178. DOI: 10.15829/1560-4071-2022-5178

14. Collen D, De Cock F, Demarsin E, Jenné S, Lasters I, Laroche Y, Warmerdam P, Jespers L. Recombinant staphylokinase variants with altered immunoreactivity. III: Species variability of antibody binding patterns. Circulation. 1997;95(2):455–62. DOI: 10.1161/01.cir.95.2.455

15. Gusev EI, Martynov MY, Nikonov AA, Shamalov NA, Semenov MP, Gerasimets EA, Yarovaya EB, Semenov AM, Archakov AI, Markin SS; FRIDA Study Group. Non-immunogenic recombinant staphylokinase versus alteplase for patients with acute ischaemic stroke 4·5 h after symptom onset in Russia (FRIDA): a randomised, open label, multicentre, parallel-group, non-inferiority trial. Lancet Neurol. 2021;20(9):721–8. DOI: 10.1016/S1474-4422(21)00210-6

16. Gusev EI, Martynov MYu, Shamalov NA, Yarovaya EB, Semenov MP, Semenov AM, Orlovsky AA, Kutsenko VA, Nikonov AA, Aksentiev SB, Yunevich DS, Alasheev AM, Androfagina OV, Bobkov VV, Choroshavina KV, Gorbachev VI, Korobeynikov IV, Greshnova IV, Dobrovolskiy AV, Elemanov UA, Zhukovskaya NV, Zakharov SA, Chirkov AN, Korsunskaya LL, Nesterova VN, Nikonova AA, Nizov AA, Girivenko AI, Ponomarev EA, Popov DV, Pribylov SA, Semikhin AS, Timchenko LV, Jadan ON, Fedyanin SA, Chefranova ZhYu, Lykov YuA, Chuprina SE, Vorobev AA, Archakov AI, Markin SS. Nonimmunogenic staphylokinase in the treatment of acute ischemic stroke (FRIDA trial results). S.S. Korsakov Journal of Neurology and Psychiatry. 2022;122(7):56–65. DOI: 10.17116/jnevro202212207156

17. Collen D, Stockx L, Lacroix H, Suy R, Vanderschueren S. Recombinant staphylokinase variants with altered immunoreactivity. IV: Identification of variants with reduced antibody induction but intact potency. Circulation. 1997;95(2):463–72. DOI: 10.1161/01.cir.95.2.463

18. Cannon CP, Gibson CM, McCabe CH, Adgey AA, Schweiger MJ, Sequeira RF, Grollier G, Giugliano RP, Frey M, Mueller HS, Steingart RM, Weaver WD, Van de Werf F, Braunwald E. TNK-tissue plasminogen activator compared with front-loaded alteplase in acute myocardial infarction: results of the TIMI 10B trial. Thrombolysis in Myocardial Infarction (TIMI) 10B Investigators. Circulation. 1998;98(25):2805–14. DOI: 10.1161/01.cir.98.25.2805

19. Modi NB, Fox NL, Clow FW, Tanswell P, Cannon CP, Van de Werf F, Braunwald E. Pharmacokinetics and pharmacodynamics of tenecteplase: results from a phase II study in patients with acute myocardial infarction. J Clin Pharmacol. 2000;40(5):508–15. DOI: 10.1177/00912700022009125

20. Wahlgren N, Ahmed N ,, Eriksson N, Aichner F, Bluhmki E, Dávalos A, Erilä T, Ford GA, Grond M, Hacke W, Hennerici MG, Kaste M, Köhrmann M, Larrue V, Lees K R, Machnig T, Roine R, Toni D, Vanhooren G; Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy Investigators. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials: Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy (SITS-MOST). Stroke. 2008;39(12):3316–22. DOI: 10.1161/STROKEAHA.107.510768

21. Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, Larrue V, Bluhmki E, Davis S, Donnan G, Schneider D, Diez-Tejedor E, Trouillas P. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998;352(9136):1245–51. DOI: 10.1016/s0140-6736(98)08020-9

22. Clark WM, Wissman S, Albers G W, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999;282(21):2019–26. DOI: 10.1001/jama.282.21.2019

23. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke // The New England Journal of Medicine. 2008;359(13):1317–29. DOI: 10.1056/NEJMoa0804656

24. Collen D, Van de Werf F. Coronary thrombolysis with recombinant staphylokinase in patients with evolving myocardial infarction. Circulation. 1993;87(6):1850–3. DOI: 10.1161/01.cir.87.6.1850

25. Tanswell P, Modi N, Combs D, Danays T. Pharmacokinetics and pharmacodynamics of tenecteplase in fibrinolytic therapy of acute myocardial infarction. Clinical Pharmacokinetics. 2002;41(15):1229–45. DOI: 10.2165/00003088-200241150-00001

26. Boytsov SA, Shakhnovich RM, Tereschenko SN, Erlikh AD, Pevsner DV, Gulyan RG, Rytova YuK, Dmitrieva NYu, Voznyuk YaM, Musikhina NA, Nazarova OA, Pogorelova NA, Sanabasova GK, Sviridova AV, Sukhareva IV, Filinova AS, Shylko YuV, Shirikova GA. Features of the Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction According to the Russian Registry of Acute Myocardial Infarction – REGION-IM. Kardiologiia. 2024;64(2):3–17. DOI: 10.18087/cardio.2024.2.n2601

27. Stone GW, Selker HP, Thiele H, Patel MR, Udelson JE, Ohman EM, Maehara A, Eitel I, Granger CB, Jenkins PL, Nichols M, Ben-Yehuda O. Relationship between infarct size and outcomes following primary PCI: patient-level analysis from 10 randomized trials // Journal of American College of Cardiology. – 2016. – Vol. 67, No. 14. – P. 1674–1683. DOI: 10.1016/j.jacc.2016.01.069

28. Tereshchenko SN, Bagnenko SF, Markov VA, Miroshnichenko AG, Serebrennikov II, Krylov SO, Lishchenko AN, Gorbacheva SM, Kuznetsov VV, Ostroumova LA, Ikhaev AB, Duplyakov DV, Chefranova ZhYu, Konstantinov SL, Vyshlov EV, Ponomarev EA, Rabinovich RM, Petrushin MA, Kutsenko VA, Koledinsky AG, Vyazova NL, Stryabkova GI, Uskach TM, Minnullin IP, Gaponova NI, Trukhanova IG, Prokhasko LV, Mukhin SI, Kostylev VV, Krause OV, Belova LP, Lesnikov EV, Zhukov GP, Pribylov SA, Farsiyants AV, Zhirov AV, Shtegman OA, Ivanov VB, Timoshchenko ES, Makarov EL, Tolstoy OA, Sachkov DYu, Karamova IM, Rakhmatullin AR, Kostogryz VB, Volkov ES, Rukosuev EV, Yurkin EP, Shakhnovich RM, Yavelov IS, Erlikh AD, Ivanov SV, Semenov AM, Semenov MP, Yarovaya EB, Markin SS. Safety of prehospital thrombolysis with non-immunogenic staphylokinase in 51021 patients with ST-elevation myocardial infarction: data from the FRIDOM-registry. Russian Journal of Cardiology. 2025;30(6):6355. DOI: 10.15829/1560-4071-2025-6355

29. Kirienko AI, Leontyev SG, Tereschenko SH, Yavelov IS, Shakhnovich RM, Erlikh AD, Talibov OB, Yarovaya EB, Semenov AM, Semenov MP, Ivanov SV, Beregovykh VV, Archakov AI, Markin SS; FORPE study group. Non-immunogenic recombinant staphylokinase versus alteplase for patients with massive pulmonary embolism: a randomised open-label, multicenter, parallel-group, non-inferiority trial FORPE. Journal of Thrombosis and Haemostasis. 2025;23(2):657–67. DOI: 10.1016/j.jtha.2024.09.035

30. Tereshchenko SN, Yarovaya EB, Leontiev SG, Yavelov IS, Shakhnovich RM, Erlikh AD, Uskach TM, Duplyakov DV, Kutsenko VA, Ivlev OE, Soplenkova AG, Semenov AM, Semenov MP, Ivanov SV, Markin SS. Non-immunogenic staphylokinase in patients with massive intermediate-high risk pulmonary embolism: protocol of the FORPE-2 multicenter, double-blind, randomized, placebo-controlled trial. Russian Journal of Cardiology. 2025;30(2):6291. DOI: 10.15829/1560-4071-2025-6291

31. Zatevakhin II, Chupin AV, Karpenko AA, Savello AV, Zolkin VN, Yarovaya EB, Kutsenko VA, Ivanov SV, Semenov MP, Semenov AM, Markin SS. Intraarterial intrathrombus thrombolysis with non-immunogenic staphylokinase vs surgery in patients with acute limb ischemia: protocol of a multicenter, open-label, randomized clinical trial FORAT. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2025;31(2):33–41. DOI: 10.33029/1027-6661-2025-31-2-33-41


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For citations:


Ivanov S.V., Beletsky I.P., Zakharova M.V., Ponomarev E.A., Chefranova Zh.Yu., Konstantinov S.L., Stryabkova G.I., Lykov Yu.A., Yelemanov U.A., Chuprina S.E., Markin S.S. Study of the pharmacokinetics of non-immunogenic staphylokinase in patients with acute myocardial infarction and acute ischemic stroke. Pharmacy & Pharmacology. 2025;13(5):415-428. (In Russ.) https://doi.org/10.19163/2307-9266-2025-13-5-415-428

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