Within the framework of ours studies on blood clotting inhibitors from blood sucking animals, 1 we succeeded in isolating the anticoagulant agent from medicinal leeches (Hirudo medicinalis) in the late 1950s. [2][3][4] It was characterized as a specific thrombin inhibitor with polypeptide structure and was named hirudin. 5,6 Since our successful isolation and analysis of the naturally occurring thrombin inhibitor, hirudin preparations have been employed for diagnostic and scientific use in hemostaseology. 7,8 Pharmacologic studies have shown that due to its pronounced and specific anticoagulant effect, hirudin is an antithrombotic agent of high quality. 9 But the clinical use of hirudin has remained limited, since this substance is not available in adequate amounts for therapeutic purposes.Today, there is renewed interest in the naturally occurring thrombin inhibitor. Advanced methods of peptide isolation and genetic engineering are now able to provide sufficient quantities of the anticoagulant as a recombinant-type hirudin. The latter is currently being profiled in clinical settings to evaluate its efficacy. This development prompted us to resume our investigation of native hirudin and to present new experimental and clinical pharmacologic studies on recombinant hirudin, revealing the true potential of this anticoagulant agent.
NATIVE HIRUDINRecombinant hirudin was developed on the basis of our knowledge of native hirudin. The biochemical and pharmacologic characteristics of native hirudin are outlined below.
BiochemistryHirudin is produced by the peripharyngeal glands of medicinal leeches. The substance is extracted from the homogenized head parts of the animal and enriched by precipitation procedures followed by ion exchange chromatography and gel filtration. Recently, affinity chromatography on matrix-bound thrombin was used to obtain highly purified hirudin. 9 The pure substance obtained in this way is a one-chain carbohydrate-free polypeptide containing three intramolecular disulfide bridges and a sulfated tyrosine residue. 10-14 Preliminary establishment of the primary structure showed that the polypeptide chain contains 65 amino acids from which a molecular weight of about 7000 was calculated. 4,15,16 The amino acid composition of hirudin is characterized by a remarkably high content of dicarboxylic amino acids as well as by the absence of arginine, methionine, and tryptophan. In studies of the amino acid sequence of highly purified hirudin preparations, variants (isoinhibitor forms) were found with different N-terminal amino acids (Val-Val or Ile-Thr-hirudin) and certain differences in the amino acid sequence 16-21 (Fig. 1). Conflicting reports on the amino acid composition, which were reviewed by us, 8 can now be explained as being due to isolation of multiple forms of hirudin. The analysis of the anticoagulant effect