The fibrinolytic enzyme CA-7 (derived from Aspergillus oryzae)1, 2 was shown, in the dog, to have strong thrombolytic activity.3-7 Its systemic or regional effectiveness, however, was limited by circulating inhibitors whose concentrations vary greatly between species as well as between individuals. 3-10 It was shown that these inhibitors can be estimated by various techniques,3,5, 7-10 of which the protease resistance test3> ~ 5 proved to be the quickest and most practical. An individual systemic dose can be predicted from the pretreatment protease resistance value, to be administered by intravenous injection. 3-5 Excellent thrombolytic results were obtained in the dog with single doses of CA-7 that lowered the protease resistance value to about 30 TTR (test tube requirement) units3, 5 from a mean normal (pretreatment) of 80 TTR units (range = 50 to 120 TTR units). The toxicity resulting from the proteolytic activity of the enzyme at this dose level was considered to be acceptable if weighed against the excellent therapeutic results. However, the frequent observation of distinct side effects during therapy made it desirable to lower the individual dose to nontoxic levels and to continue treatments with frequently repeated injections until such time as thrombolysis might occur.The nontoxic dose of the enzyme was found to be that amount which lowered the protease resistance to 40 TTR units (instead of 30 TTR units). Thrombolysis could not be achieved with a single dose of that size, but it was induced by repeated treatments over a period of 3 days.4 4 The objective toxic effects of the enzyme that were observed when protease resistance was depressed below 40 TTR units, and that are regarded to be of clinical significance, are: transient reversible coagulation disorders ;3,6, 7, 8, 11 transient reversible hypotension, notably at the approach of thrombolytic dose levels;3> 8 reversible hemoconcentration;3 reversible elevations of serum transaminase ;3 and varying degrees of extravasation found at autopsy after sacrifice.3, 4, 7~ s It was shown that the appearance of all of these effects was directly related to the degree to which protease inhibitors were reduced. The complete disappearance of inhibitors, indicated by protease resistance levels below 20 TTR units, usually produced severe general proteolysis with loss of the animal.Since it was found that, in single-dose treatments, the optimal thrombolytically effective dose was that amount of enzyme which reduced the protease resistance to under 40 TTR units but not lower that 20 TTR units, the target of 30 TTR units was adopted for dose prediction .3, 5 Excessive dosage with at Bobst Library, New York University on April 12, 2015 ang.sagepub.com Downloaded from