Abstract:
Reperfusion therapy with intravenous tissue plasminogen activator (t‐PA) is the only FDA‐approved Medical therapy for acute ischemic stroke. Properly titrated use of t‐PA improves clinical outcomes. However, the near tenfold‐associated risk of intracerebral hemorrhage after t‐PA may keep this therapy from many acute stroke patients. Emerging data now suggest that some of the potentially neurotoxic side effects of t‐PA may be due to its signaling actions in the neurovascular unit. Besides its intended role in clot lysis, t‐PA is also an extracellular protease and signaling molecule in the brain. t‐PA mediates matrix remodeling during brain development and plasticity. By interacting with the NMDA‐type glutamate receptor, t‐PA may amplify potentially excitotoxic calcium currents. At selected concentrations, t‐PA may be vasoactive. Finally, by augmenting matrix metalloproteinase (MMP) dysregulation after stroke, t‐PA may degrade extracellular matrix integrity and increase risks of neurovascular cell death, blood–brain barrier leakage, edema, and hemorrhage. Understanding these pleiotropic actions of t‐PA may reveal new therapeutic opportunities for increasing the safety and efficacy of reperfusion strategies for stroke therapy.
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Abbreviations
- MMP:
-
Matrix metalloproteinase
- BBB:
-
blood brain barrier
- t‐PA:
-
tissue plasminogen activator
- rt‐PA:
-
recombinant tissue plasminogen activator
- NINDS:
-
National Institute of Neurological Disorders and Stroke
- ICH:
-
intracerebral haemorrhage
- HT:
-
Hemorrhagic transformation
- NVU:
-
neurovascular unit
- ECM:
-
extracellular matrix
- i.v.:
-
intravenous
- CNS:
-
central nervous system
- LTP:
-
long‐term potentiation
- LRP:
-
lipoprotein receptor‐related protein
- PKA:
-
protein kinase A
- MCAO:
-
middle cerebral artery occlusion
- NO:
-
nitric oxide
- NOS:
-
nitric oxide synthase
- TBI:
-
traumatic brain injury
- PMNL:
-
polymorphonuclear leukocytes
- MAP kinase:
-
mitogen‐activated protein kinase
- SOD:
-
superoxide dismutase
- MBP:
-
myelin basic protein
- ROS:
-
Reactive oxygen species
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Acknowledgment
We thank Dr Pei-Chen Ning, Dr Su Yu Xu, and Dr David McMullin for their insightful review and critique of this manuscript.
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Ning, M.M. et al. (2007). Matrix Metalloproteinases and Tissue Plasminogen Activator Reperfusion Therapy for Stroke. In: Lajtha, A., Chan, P.H. (eds) Handbook of Neurochemistry and Molecular Neurobiology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-30383-3_15
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