[Use of andekalin in treating diabetic microangiopathies]

A combined study of the state of the blood kinin, coagulation and fibrinolytic systems and microcirculation in the peripheral microvessels of 19 patients with diabetic microangiopathies has shown a diverse nature of disorders of kininogenesis (the enhancement or weakening of the process) and corresponding to it hypo- and hypertonic stages of changes of microcirculation in the microvessels of the eyeball and I toe nail matrix. Activation of blood coagulation, Phase I, revealed both in weakened and enhanced kininogenesis, was more noticeable in the phase of hypokininemia. The administration of andekalin at a single dose of 0.6 units per 1 kg of body mass against a background of sugar reducing therapy in both types of disorders of the activity of the kinin system was accompanied by an insignificant increase in the activity of plasma callicrein but resulted in a marked increase in the initially lowered kinin destroying blood enzymes. The improvement of some indices of microcirculation was noted but in patients with microangiopathies against a background of the weakening of kininogenesis. The administration of andekalin with an enhanced process resulted in some cases in the deterioration of the condition and development of perivascular edema. Insufficient therapeutic efficacy of commonly used doses of andekalin was determined by the presence of andekalin agents in commercial samples and admixtures of a considerable amount of kininases of tissue origin. Proceeding from the earlier experiments and ongoing clinical trials it was proposed that andekalin should be administered to patients with suppressed activity of the blood kinin system only at doses which would not practically contain kininases and would correspond to 0.004-0.005 units per 1 kg of body mass a day.