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Nebulised alteplase (recombinant tissue-plasminogen activator, rt-PA) is an investigational nebulised formulation of the thrombolytic enzyme alteplase. Developed by University College London (UCL), it is administered via inhalation directly into the lungs to target fibrin clots and microthrombi in the alveolar compartment. By converting plasminogen to plasmin, it facilitates localized thrombolysis, aiming to improve oxygenation and reduce alveolar clotting. This formulation was evaluated in the Phase II PACA (Plasminogen Activator COVID-19 ARDS) pilot trial for the treatment of patients with COVID-19-induced acute respiratory distress syndrome (ARDS).
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