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Recombinant ADAMTS13 reduces tissue plasminogen activator‐induced hemorrhage after stroke in mice
Author(s) -
Wang Lixiang,
Fan Wenying,
Cai Ping,
Fan Mengchen,
Zhu Ximin,
Dai Yiqin,
Sun Chungang,
Cheng Yannan,
Zheng Ping,
Zhao BingQiao
Publication year - 2013
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.23762
Subject(s) - von willebrand factor , tissue plasminogen activator , medicine , adamts13 , t plasminogen activator , plasminogen activator , stroke (engine) , blood–brain barrier , downregulation and upregulation , pharmacology , platelet , chemistry , central nervous system , biochemistry , mechanical engineering , engineering , gene
Objective Tissue plasminogen activator (tPA) is approved for treatment of acute ischemic stroke, but it increases the risk of cerebral hemorrhage. Accumulating evidence suggests that von Willebrand factor (VWF) plays a pivotal role in thrombus formation and microcirculatory disturbances after ischemic stroke. By cleaving VWF, ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) protects mice from stroke. Therefore, we hypothesized that recombinant ADAMTS13 (rADAMTS13) could increase the safety of tPA thrombolysis in stroke. Methods We examined blood–brain barrier (BBB) permeability after intraventricular injection of tPA, VWF, and rADAMTS13 in nonischemic mice. We investigated the role of rADAMTS13 on reducing tPA‐induced BBB dysfunction and cerebral hemorrhage in a mouse stroke model. Results Intraventricular injection of tPA or VWF under nonischemic conditions resulted in a significant increase in BBB permeability. In contrast, rADAMTS13 blocked both tPA‐ and VWF‐induced BBB opening. BBB disruption following stroke was exacerbated by intravenous administration of tPA, but this was attenuated by injection of rADAMTS13. Correspondingly, tPA‐associated hemorrhage after stroke was significantly reduced by rADAMTS13. The antihemorrhagic effect of rADAMTS13 was reversed by injection of recombinant VWF. We also showed that rADAMTS13 inhibited tPA‐mediated upregulation of vascular endothelial growth factor (VEGF) in vascular endothelium after stroke. The upregulation of VEGF was suppressed by either an Akt inhibitor wortmannin or a Rho kinase inhibitor fasudil. Furthermore, rADAMTS13 downregulated tPA‐induced phosphorylation of Akt and activation of RhoA. Interpretation These findings demonstrate that the VWF‐cleaving protease rADAMTS13 reduced tPA‐induced hemorrhage by regulating BBB integrity, and suggest that this effect may occur through the Akt/RhoA‐mediated VEGF pathways. ANN NEUROL 2013;73:189–198