Hemorrhagic Transformation in Focal Cerebral Ischemia: Influence of Time to Artery Reopening and Tissue Plasminogen Activator

Author(s):  
Susan C. Fagan ◽  
Julio H. Garcia
Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Takayoshi Shimohata ◽  
Kunio Kawamura ◽  
Tetsuya Takahash ◽  
Masato Kanazawa ◽  
Masato Kanazawa ◽  
...  

An angiogenesis factor, angiopoietin-1 (Ang1), is known to participate in the survival of endothelial cells, vascular remodeling, and vascular stability. In addition, Ang1 has been reported to reduces postischemic vascular hyperpermeability. From the above findings, we hypothesized that Ang1 could attenuate hemorrhagic transformation and cerebral edema after tissue plasminogen activator (tPA) treatment by stabilizing blood vessels and inhibiting hyperpermeability. Sprague-Dawley rats subjected to thromboembolic focal cerebral ischemia were assigned to a permanent ischemia group and groups treated with tPA at 1 h or 4 h after ischemia. The cartilage oligomeric protein (COMP)-Ang1 protein or control protein (COMP protein) was administered immediately before tPA administration in the tPA 4 h group, because recombinant Ang1 protein is poorly soluble. At 24 h after ischemia, we evaluated the effects of the protein on the amount of cerebral hemorrhage, the cerebral edema volume, cerebral infarct volume, and the prognosis with a 6-point neurological score. Ang1 expression was observed in pericytes, astrocytes, and neuronal cells, in the healthy brain tissue of the sham group rats. It was decreased in the BBB when tPA treatment was performed after the therapeutic time window. Administering recombinant COMP-Ang1 to supplement this decrease could suppress hemorrhagic transformation as measured by hemoglobin content in a whole cerebral homogenate and cerebral edema due to BBB damage (Figure A, B). No significant differences were observed between groups for cerebral infarct volume and the neurological scale score (Figure C, D). In conclusion, Ang1 may be considered a promising target molecule for vasoprotective therapies in order to control the hemorrhagic transformation and cerebral edema that accompany tPA treatment.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saifudeen Ismael ◽  
Lexiao Li ◽  
Arum Yoo ◽  
Tauheed Ishrat

Background and Hypothesis: Acute hyperglycemia (AHG) worsens stroke outcome and increases the risk of intracerebral hemorrhage after tissue plasminogen activator (tPA) treatment, independent of preexisting diabetes. We have previously reported that genetic deletion of thioredoxin interacting protein exerts neuroprotection after experimental stroke. Here we tested the hypothesis that pharmacological inhibition of TXNIP, with verapamil protects against tPA-induced brain damage under AHG in a mouse model of focal cerebral ischemia. Methods: Transient focal cerebral ischemia was induced by a 60 min middle cerebral artery occlusion (MCAO) followed by 23 h reperfusion in mice. AHG was induced by administration of 20% glucose (ip), 15 minutes before MCAO. Verapamil (0.015 mg/kg, iv) and tPA (iv), or saline was administered at 1 h post-occlusion. After 24 h of I/R, mice were tested for neurobehavioral outcome and were evaluated for infarct size and expression inflammatory mediators, and blood brain barrier markers. Results: AHG aggravated brain edema, blood brain disruption and neuroinflammation. Treatment with verapamil significantly reduced in the infarct size (41%, p<0.05), hemorrhage (36%) and edema (36%, p<0.05) compared to saline treated controls. Furthermore, verapamil significantly inhibited the TXNIP mediated activation of NLRP3-inflammsome and ameliorated blood brain barrier leakage (Table 1). Conclusion: Taken together, these data indicate that inhibition of TXNIP with verapamil may have therapeutic implications on ischemic stroke in the acute hyperglycemic condition.


1998 ◽  
Vol 4 (2) ◽  
pp. 228-231 ◽  
Author(s):  
Yanming F. Wang ◽  
Stella E. Tsirka ◽  
Sidney Strickland ◽  
Philip E. Stieg ◽  
Sulpicio G. Soriano ◽  
...  

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