Optimized tPA: A non-neurotoxic fibrinolytic agent for the drainage of intracerebral hemorrhages.

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Goulay R, Naveau M, Gaberel T, Vivien D, Parcq J

Optimized tPA: A non-neurotoxic fibrinolytic agent for the drainage of intracerebral hemorrhages.

J Cereb Blood Flow Metab. 2018 Jul;38(7):1180-1189. doi: 10.1177/0271678X17719180. Epub 2017 Jul 25.

PubMed ID
28741405 [ View in PubMed
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Abstract

Intracerebral hemorrhage (ICH) is the most severe form of stroke. Catheter-delivered thrombolysis with recombinant tissue-type plasminogen activator (rtPA) for the drainage of ICH is currently under evaluation in a phase III clinical trial (MISTIE III). However, in a pig model of ICH, in situ fibrinolysis with rtPA was reported to increase peri-lesional edema by promoting N-methyl-D-aspartate (NMDA)-dependent excitotoxicity. In the present study, we engineered a non-neurotoxic tPA variant, OptPA, and investigated its safety and efficacy for in situ fibrinolysis in a rat model of ICH. Magnetic resonance imaging analyses of hematoma and edema volumes, behavioral tasks and histological analyses were performed to measure the effects of treatments. In vitro, OptPA was equally fibrinolytic as rtPA without promoting NMDA-dependent neurotoxicity. In vivo, in situ fibrinolysis using OptPA reduced hematoma volume, like rtPA, but it also reduced the evolution of peri-hematomal neuronal death and subsequent edema progression. Overall, this preclinical study demonstrates beneficial effects of OptPA compared to rtPA for the drainage of ICH.

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