Published Online
on December 29, 2004

A more recent version of this article appeared on February 1, 2005

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Submitted on June 11, 2004
Revised on October 22, 2004
Accepted on November 16, 2004

Aggravation of Focal Cerebral Ischemia by Tissue Plasminogen Activator Is Reversed by 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitor but Does Not Depend on Endothelial NO Synthase

Ertugrul Kilic PhD^*; Ülkan Kilic MD; Christian M. Matter MD; Thomas F. Lüscher MD; Claudio L. Bassetti MD; and Dirk M. Hermann MD

From the Department of Neurology (E.K, U.K., C.L.B., D.M.H.), University Hospital Zurich; and Cardiovascular Research (C.M.M., T.F.L.), Physiological Institute, University of Zurich, Switzerland.

^* To whom correspondence should be addressed. E-mail: ertugrul.kilic{at}usz.ch.

Background and Purpose--It has repeatedly been reported that the thrombolytic tissue plasminogen activator (tPA) may aggravate ischemic injury after stroke. The underlying mechanisms, however, remain unknown. We hypothesized that tPA induces an inhibition of endothelial NO synthase (eNOS) after focal ischemia that is responsible for ischemic damage and may be restored by 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors.

Methods--We examined the effects of tPA, administered either alone or in combination with rosuvastatin, on ischemic injury, on eNOS expression, and cell signaling after 90 minutes of intraluminal middle cerebral artery occlusion.

Results--In wild-type mice, tPA delivered immediately after ischemia significantly increased infarct volume 24 hours after reperfusion. Coadministration of rosuvastatin completely reversed the tPA-induced brain damage. Western blots of ischemic brain lysates showed that tPA markedly diminished eNOS levels, increased extracellular regulated kinase (ERK)-2, and decreased MAP kinase/p38 activity. Cotreatment with rosuvastatin prevented the decrease in eNOS, reduced ERK-1/-2 and normalized p38 levels. To elucidate the role of eNOS in tPA-induced ischemic injury, we also evaluated tPA effects in eNOS knockout mice. In eNOS knockout animals, tPA again significantly increased infarct size after transient focal ischemia.

Conclusions--In a mouse model of focal cerebral ischemia, tPA induces eNOS inhibition, ERK-2 activation, and p38 inhibition, possibly as part of a more complex signaling response exacerbating brain injury. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibition reverses the effects of tPA by a mechanism independent of eNOS.

Key words: hydroxymethylglutaryl-CoA reductase inhibitors • ischemia • stroke, acute • thrombolysis

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