Inhibition of tPA-induced hemorrhagic transformation involves adenosine A2b receptor activation after cerebral ischemia.

Inhibition of tPA-induced hemorrhagic transformation involves adenosine A2b receptor activation after cerebral ischemia.
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DOI:
10.1016/j.nbd.2017.08.011
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发表时间:
2017-12
影响因子:
6.1
通讯作者:
Wang J
Wang J
中科院分区:
医学1区
文献类型:
--
作者:
Li Q;Han X;Lan X;Hong X;Li Q;Gao Y;Luo T;Yang Q;Koehler RC;Zhai Y;Zhou J;Wang J

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组织纤溶酶原激活剂(tPA)在缺血性卒中后使用,以溶解血管内凝块,但其使用可导致出血性转化(HT)。减少tPA出血并发症的治疗策略可能对卒中患者有益。腺苷A2 b受体(AdenosineA 2breceptor,A2 bR)在外周器官血管保护中起重要作用。本研究探讨了A2 bR激动剂BAY 60-6583是否可降低tPA使用后的出血风险。使用大鼠短暂性大脑中动脉闭塞模型,我们发现,A2 bR的mRNA和蛋白质表达增加到更大的程度比其他三个腺苷受体(A1,A2 a和A3)的表达缺血再灌注后。tPA给药降低缺血脑微血管中A2 bR的表达。在再灌注开始时用BAY 60-6583(1 mg/kg)进行后处理在不存在或存在tPA(10 mg/kg)的情况下减小了病变体积,并且在24小时时减弱了脑肿胀、血脑屏障破坏和tPA加重的HT。此外,BAY 60-6583减轻了存在tPA时的感觉运动缺陷。BAY 60-6583抑制tPA增强的基质金属蛋白酶-9活化,可能是通过提高基质金属蛋白酶-1表达的组织抑制剂,从而减少紧密连接蛋白的降解。这些作用可能会保护脑血管的完整性。A2 bR激动剂作为tPA的辅助治疗可能是降低缺血性卒中治疗期间HT风险的一种有前景的策略。
Tissue plasminogen activator (tPA) is administered after ischemic stroke to dissolve intravascular clots, but its use can lead to hemorrhagic transformation (HT). Therapeutic strategies to reduce hemorrhagic complications of tPA might be of benefit for stroke patients. Adenosine A2b receptor (A2bR) plays pivotal roles in regulating vascular protection in peripheral organs. This study explored whether A2bR agonist BAY 60-6583 reduces hemorrhage risk after tPA usage. Using a rat transient middle cerebral artery occlusion model, we showed that mRNA and protein expression of A2bR increased to a greater extent after ischemia-reperfusion than did expression of the other three adenosine receptors (A1, A2a, and A3). tPA administration reduced A2bR expression in ischemic brain microvessels. Post-treatment with BAY 60-6583 (1 mg/kg) at the start of reperfusion reduced lesion volume in the absence or presence of tPA (10 mg/kg) and attenuated brain swelling, blood-brain barrier disruption, and tPA-exacerbated HT at 24 h. Additionally, BAY 60-6583 mitigated sensorimotor deficits in the presence of tPA. BAY 60-6583 inhibited tPA-enhanced matrix metalloprotease-9 activation, probably through elevation of tissue inhibitor of matrix metalloproteinases-1 expression, and thereby reduced degradation of tight junction proteins. These effects would likely protect cerebrovascular integrity. A2bR agonists as an adjuvant to tPA could be a promising strategy for decreasing the risk of HT during treatment for ischemic stroke.
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