Kraft Peter, Schuhmann Michael K, Fluri Felix, Lorenz Kristina, Zernecke Alma, Stoll Guido, Nieswandt Bernhard, Kleinschnitz Christoph
From the Department of Neurology (P.K, M.K.S., F.F., G.S., C.K.) and Institute of Clinical Biochemistry and Pathobiochemistry (A.Z.), University Clinics Würzburg, Würzburg, Germany; and Institute of Pharmacology and Toxicology (K.L) and the Rudolf Virchow Center, Deutsche Forschungsgemeinschaft Research Center for Experimental Biomedicine (B.N.), University of Würzburg, Würzburg, Germany.
Stroke. 2015 Dec;46(12):3502-6. doi: 10.1161/STROKEAHA.115.011114. Epub 2015 Oct 20.
Despite the medical and socioeconomic effect of ischemic stroke and extensive preclinical research, treatment options for ischemic stroke are limited. We recently identified and characterized essential steps of thrombus formation in stroke and demonstrated that inhibition of the platelet glycoprotein (GP) receptors Ib and VI, but not IIb/IIIa, protects young and healthy mice from ischemic neurodegeneration. Whether these findings translate to the clinic remains unclear. Considering that the typical stroke patient is elderly with comorbidity, we aimed to analyze the efficacy and safety of novel preclinical antithrombotics in adult and comorbid mice with acute experimental stroke.
We subjected adult, healthy, atherosclerotic (Ldlr(-/-)), diabetic (streptozotocin treated), and hypertensive (RenTgMK) mice to a 60-minute transient middle cerebral artery occlusion. Animals were pretreated with anti-GPVI antibodies or treated 1 hour after stroke induction with anti-GPIb or anti-GPIIb/IIIa antigen-binding fragments, respectively. Isotype treatment served as control. Twenty-four hours after transient middle cerebral artery occlusion, we visually assessed the intracerebral hemorrhage rate and measured infarct volumes (using 2,3,5-triphenyltetrazolium chloride-stained brain slices) and functional outcome (using Bederson and grip-test scores).
GPIb and GPVI inhibition protected the mice from ischemic stroke without increasing bleeding complications. In contrast, GPIIb/IIIa inhibition was not protective but increased the intracerebral hemorrhage rate.
Inhibition of early steps of thrombus formation protects adult and comorbid mice from ischemic stroke. The use of clinically meaningful mouse strains might improve the translation of preclinical stroke research to the clinic.
尽管缺血性卒中具有医学和社会经济影响,且有广泛的临床前研究,但缺血性卒中的治疗选择仍然有限。我们最近确定并描述了卒中血栓形成的关键步骤,并证明抑制血小板糖蛋白(GP)受体Ib和VI而非IIb/IIIa,可保护年轻健康小鼠免受缺血性神经变性。这些发现能否转化到临床仍不清楚。考虑到典型的卒中患者是患有合并症的老年人,我们旨在分析新型临床前抗栓药物在患有急性实验性卒中的成年合并症小鼠中的疗效和安全性。
我们对成年健康、动脉粥样硬化(Ldlr(-/-))、糖尿病(链脲佐菌素处理)和高血压(RenTgMK)小鼠进行60分钟的短暂大脑中动脉闭塞。动物分别用抗GPVI抗体预处理,或在卒中诱导后1小时用抗GPIb或抗GPIIb/IIIa抗原结合片段处理。同型处理作为对照。在短暂大脑中动脉闭塞24小时后,我们目视评估脑出血率,测量梗死体积(使用2,3,5-三苯基四氮唑氯化物染色的脑切片)和功能结局(使用贝德森评分和握力测试评分)。
抑制GPIb和GPVI可保护小鼠免受缺血性卒中,且不增加出血并发症。相比之下,抑制GPIIb/IIIa没有保护作用,但增加了脑出血率。
抑制血栓形成的早期步骤可保护成年合并症小鼠免受缺血性卒中。使用具有临床意义的小鼠品系可能会改善临床前卒中研究向临床的转化。