Abstract

Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is currently the only FDA-approved drug for acute ischemic stroke. However, its administration is still limited due to the associated increased risk of hemorrhagic transformation (HT). rt-PA may exacerbate blood-brain barrier (BBB) injury by several mechanisms that have not been fully elucidated. Caveolin-1 (Cav-1), a major structural protein of caveolae, has been linked to the endothelial barrier function. The effects of rt-PA on Cav-1 expression remain largely unknown. Here, Cav-1 protein expression after ischemic conditions, with or without rt-PA administration, was analyzed in a murine thromboembolic middle cerebral artery occlusion (MCAO) and in brain microvascular endothelial bEnd.3 cells subjected to oxygen/glucose deprivation (OGD). Our results show that Cav-1 is overexpressed in endothelial cells of infarcted area and in bEnd.3 cell line after ischemia but there is disagreement regarding rt-PA effects on Cav-1 expression between both experimental models. Delayed rt-PA administration significantly reduced Cav-1 total levels from 24 to 72 h after reoxygenation and increased pCav-1/Cav-1 at 72 h in the bEnd.3 cells while it did not modify Cav-1 immunoreactivity in the infarcted area at 24 h post-MCAO. Importantly, tissue Cav-1 positively correlated with Cav-1 serum levels at 24 h post-MCAO and negatively correlated with the volume of hemorrhage after infarction, the latter supporting a protective role of Cav-1 in cerebral ischemia. In addition, the negative association between baseline serum Cav-1 levels and hemorrhagic volume points to a potential usefulness of baseline serum Cav-1 levels to predict hemorrhagic volume, independently of rt-PA administration.

Highlights

  • Stroke is one of the leading causes of death and disability worldwide

  • A similar Cav-1 increase was detected in the infarcted area of middle cerebral artery occlusion (MCAO) + recombinant tissue plasminogen activator (rt-PA) group (p < .002 vs. sham; p = .211 vs. MCAO)

  • Our results show that tissue Cav-1 protein expression at 24 h post-MCAO: 1) increases in endothelial cells of the infarcted area, 2) positively correlates with Cav-1 serum levels at 24 h, 3) negatively correlates with the volume of hemorrhage after infarction and 4) it is not modified by rt-PA

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Summary

Introduction

Stroke is one of the leading causes of death and disability worldwide. Recombinant tissue plasminogen activator (rt-PA) is still the only FDA and EMA-approved fibrinolytic drug with a level I-A of evidence for the treatment of acute ischemic stroke [1]. Less than 10% of stroke patients receive this therapy [2]. This is due, among other reasons, to the increased associated risk of hemorrhagic transformation (HT) [3, 4] which occurs as a result of severe blood-brain barrier (BBB) disruption during reperfusion [4, 5]. The molecular mechanisms underlying rt-PA effects on the BBB disruption remained to be fully understood. In this context, the maintenance of BBB homeostasis represents an interesting target for neurovascular protection and for the development of thrombolytic adjuvant therapies aimed at decreasing the rt-PA-associated HT risk

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