Tissue-type plasminogen activator in the ischemic brain: more than a thrombolytic

Thrombolysis with tissue-type plasminogen activator (tPA) is used for the treatment of patients with acute ischemic stroke. However, a growing body of evidence indicates that, besides the unquestionable benefit from its thrombolytic activity, tPA also has a deleterious effect on the ischemic brain i...

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Published in:Trends in neurosciences (Regular ed.) Vol. 32; no. 1; pp. 48 - 55
Main Authors: Yepes, Manuel, Roussel, Benoit D., Ali, Carine, Vivien, Denis
Format: Journal Article
Language:English
Published: Amsterdam Elsevier Ltd 01.01.2009
Elsevier
Elsevier Sequoia S.A
Subjects:
Animals
Biological and medical sciences
Brain
Brain Ischemia - drug therapy
Fibrinolytic Agents - pharmacology
Fibrinolytic Agents - therapeutic use
Fundamental and applied biological sciences. Psychology
General aspects. Models. Methods
Humans
Life Sciences
Medical sciences
Neurology
Neurons
Neurons and Cognition
Neurosciences
Stroke
Tissue Plasminogen Activator - pharmacology
Tissue Plasminogen Activator - therapeutic use
Tissues
Vascular diseases and vascular malformations of the nervous system
Vertebrates: nervous system and sense organs
Human
Cerebral infarction
Nervous system diseases
Stroke
Central nervous system
Cardiovascular disease
Review
Permeability
Cerebral disorder
Encephalon
Vascular disease
Treatment
Central nervous system disease
Brain ischemia
Cerebral edema
Cerebrovascular disease
ISSN:0166-2236, 1878-108X
Online Access:Get full text
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Summary:Thrombolysis with tissue-type plasminogen activator (tPA) is used for the treatment of patients with acute ischemic stroke. However, a growing body of evidence indicates that, besides the unquestionable benefit from its thrombolytic activity, tPA also has a deleterious effect on the ischemic brain including cytotoxicity and increased permeability of the neurovascular unit with the development of cerebral edema. Because an increasing number of acute stroke patients are treated with tPA, it is important to know the mechanisms of harmful effects of tPA on the ischemic brain. Here, the best studied pathways of tPA neurotoxicity are discussed along with future directions for a safer use of tPA as a thrombolytic agent in the setting of acute ischemic stroke.
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ISSN:0166-2236
1878-108X
DOI:10.1016/j.tins.2008.09.006