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Syvannarath V, Di Carlo S, Even G, Gachet B, Nicoletti A, Caligiuri G. P4618Lack of CD31 results in microvascular plugging and increased infarction size in an experimental model of myocardial ischemia-reperfusion injury. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The success of coronary recanalization therapy for the treatment of myocardial infarction can be hampered by microvascular plugging which prevents effective reperfusion of the ischemic tissue. Due to its constitutive expression in platelets, leukocytes, and endothelial cells and its peculiar tyrosine phosphatase cell detaching signaling properties, the trans-homophilic CD31 receptor may be important to modulate platelet and leukocyte aggregation in the microvasculature.
Objective
To investigate the impact of CD31 genetic deficiency on the infarct size, peri-infarction microvascular plugging and macrophage phenotype in a mouse model of heart ischemia/reperfusion.
Methods
Cardiac ischemia was induced in WT and CD31 KO mice (n=30, 15 females and 15 males in each group) by surgical ligation of the left anterior descending coronary artery (LAD) for 45 minutes followed by reperfusion for 72 hours. The area at risk (AAR) and necrotic zone (NZ) were assessed using ImageJ software on three consecutive 1 mm thick slices of the left ventricle (LV) by a combination of a blue dye and 2,3,5-triphenyltetrazolium chloride staining. Parallel sets of experiments served to evaluate by both fluorescence microscopy and cytometry the presence of microvascular plugs and leukocyte phenotype in the infarction area as compared to the peri-necrotic myocardium.
Results
The AAR was similar in WT and CD31 KO mice (41,7±3,5 vs 37±2,9% of LV, NS) whereas the size of myocardial infarction was significantly greater in CD31 KO as compared to WT mice (23,4±2 vs 17,8±1,7% of LV, p<0,05). Immunofluorescent microscopy showed a dramatic increase in microvascular platelets-rich plugs around the infarction in CD31 KO mice (Figure), confirmed by cytometry analysis (9749±573 vs 5976±376 platelet-leukocyte aggregates/mg of tissue, p<0.001). Furthermore, we found that the ratio between M1 and M2 type macrophages in the peri-infarction myocardium was significantly increased in CD31 KO mice (0,7±0.07) as compared to WT mice (0,4±0.06, p<0,01).
Conclusions
Our data suggest that CD31 is important for reducing the size of necrosis following coronary recanalization procedures by preventing the no-reflow phenomenon due to microvascular plugging and by promoting a reparative phenotype of peri-infarction macrophages.
Acknowledgement/Funding
Institut Servier - ANRT (CIFRE doctoral grant)
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Affiliation(s)
- V Syvannarath
- National Institute of Health and Medical Research (INSERM home), Paris, France
| | | | - G Even
- National Institute of Health and Medical Research (INSERM home), Paris, France
| | - B Gachet
- National Institute of Health and Medical Research (INSERM home), Paris, France
| | - A Nicoletti
- National Institute of Health and Medical Research (INSERM home), Paris, France
| | - G Caligiuri
- National Institute of Health and Medical Research (INSERM home), Paris, France
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Syvannarath V, Morvan M, Even G, Franck G, Deschildre C, Deschamps L, Nataf P, Michel JB, Nicoletti A, Caligiuri G. P125Lack of neuregulin-1 expression is associated with CD31 shedding on cardiac microvascular endothelial cells of patients suffering from post-ischemic heart failure. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - G Even
- INSERM, U1148, Paris, France
| | | | | | - L Deschamps
- Hospital Bichat-Claude Bernard, Patholgy, Paris, France
| | - P Nataf
- Hospital Bichat-Claude Bernard, Cardiac Surgery, Paris, France
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Syvannarath V, Delbosc S, Escoubet B, Le Borgne-Moynnier M, Laschet J, Morvan M, Even G, Journee C, Nicoletti A, Caligiuri G. Treatment with a CD31 agonist peptide improves the outcome of experimental heart failure with either reduced or preserved ejection fraction. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2018.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Syvannarath V, Delbosc S, Escoubet B, Le Borgne-Moynier M, Khallou-Laschet J, Morvan M, Even G, Journee C, Nicoletti A, Caligiuri G. P126The administration of a CD31 agonist peptide exerts a beneficial effect in experimental heart failure with both reduced and preserved ejection fraction. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - B Escoubet
- Hospital Bichat-Claude Bernard, Physiology, Paris, France
| | | | | | | | - G Even
- INSERM, U1148, Paris, France
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Desilles JP, Syvannarath V, Di Meglio L, Ducroux C, Boisseau W, Louedec L, Jandrot-Perrus M, Michel JB, Mazighi M, Ho-Tin-Noé B. Downstream Microvascular Thrombosis in Cortical Venules Is an Early Response to Proximal Cerebral Arterial Occlusion. J Am Heart Assoc 2018; 7:JAHA.117.007804. [PMID: 29496683 PMCID: PMC5866327 DOI: 10.1161/jaha.117.007804] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Previous experimental studies have shown that downstream microvascular thromboinflammation is involved in brain damage from acute ischemic stroke. Using intravital microscopy, we investigated and characterized the sequence of downstream microvascular thromboinflammation in an ischemia/reperfusion acute ischemic stroke model. Methods and Results Rats underwent transient monofilament middle cerebral artery (MCA) occlusion. Cerebral microcirculation in the MCA territory was exposed through a craniotomy and analyzed using real‐time intravital imaging coupled with laser Doppler interferometry. Leukocytes, platelets, fibrinogen, and blood–brain barrier permeability were analyzed by intravenous injection of fluorescent antibodies and bovine serum albumin. MCA occlusion induced a sudden and profound drop in downstream microvascular blood flow associated with leukocyte margination in the venous compartment. Leukocyte margination fostered fibrinogen deposition and thrombosis in postcapillary venules. Either in venules or arterioles, blood flow was not fully restored after MCA recanalization. Furthermore, venular thrombi persisted despite MCA recanalization, and leukocyte extravasation continued to develop in venules in association with blood–brain barrier disruption. Finally, microhemorrhages were occasionally observed, colocalizing with thrombosed venules characterized by marked leukocyte margination. Conclusions We showed that microvascular thrombosis in transient monofilament MCA occlusion and blood–brain barrier disruption are initiated immediately after occlusion and are propagated through the venous compartment in close association with marginating leukocytes. MCA occlusion–induced downstream microvascular thromboinflammation response was responsible for incomplete reperfusion after MCA recanalization and delayed microhemorrhages.
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Affiliation(s)
- Jean-Philippe Desilles
- Laboratory for Vascular Translational Science, Inserm Unit 1148, Sorbonne Paris Cite University Paris Diderot, Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Varouna Syvannarath
- Laboratory for Vascular Translational Science, Inserm Unit 1148, Sorbonne Paris Cite University Paris Diderot, Paris, France
| | - Lucas Di Meglio
- Laboratory for Vascular Translational Science, Inserm Unit 1148, Sorbonne Paris Cite University Paris Diderot, Paris, France
| | - Célina Ducroux
- Laboratory for Vascular Translational Science, Inserm Unit 1148, Sorbonne Paris Cite University Paris Diderot, Paris, France
| | - William Boisseau
- Laboratory for Vascular Translational Science, Inserm Unit 1148, Sorbonne Paris Cite University Paris Diderot, Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Liliane Louedec
- Laboratory for Vascular Translational Science, Inserm Unit 1148, Sorbonne Paris Cite University Paris Diderot, Paris, France
| | - Martine Jandrot-Perrus
- Laboratory for Vascular Translational Science, Inserm Unit 1148, Sorbonne Paris Cite University Paris Diderot, Paris, France
| | - Jean-Baptiste Michel
- Laboratory for Vascular Translational Science, Inserm Unit 1148, Sorbonne Paris Cite University Paris Diderot, Paris, France
| | - Mikael Mazighi
- Laboratory for Vascular Translational Science, Inserm Unit 1148, Sorbonne Paris Cite University Paris Diderot, Paris, France.,Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.,DHU NeuroVasc, Paris, France
| | - Benoît Ho-Tin-Noé
- Laboratory for Vascular Translational Science, Inserm Unit 1148, Sorbonne Paris Cite University Paris Diderot, Paris, France
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Desilles JP, Syvannarath V, Ollivier V, Journé C, Delbosc S, Ducroux C, Boisseau W, Louedec L, Di Meglio L, Loyau S, Jandrot-Perrus M, Potier L, Michel JB, Mazighi M, Ho-Tin-Noé B. Exacerbation of Thromboinflammation by Hyperglycemia Precipitates Cerebral Infarct Growth and Hemorrhagic Transformation. Stroke 2017; 48:1932-1940. [PMID: 28526762 DOI: 10.1161/strokeaha.117.017080] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/03/2017] [Accepted: 04/13/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Admission hyperglycemia is associated with a poor outcome in acute ischemic stroke. How hyperglycemia impacts the pathophysiology of acute ischemic stroke remains largely unknown. We investigated how preexisting hyperglycemia increases ischemia/reperfusion cerebral injury. METHODS Normoglycemic and streptozotocin-treated hyperglycemic rats were subjected to transient middle cerebral artery occlusion. Infarct growth and brain perfusion were assessed by magnetic resonance imaging. Markers of platelet, coagulation, and neutrophil activation were measured in brain homogenates and plasma. Downstream microvascular thromboinflammation (DMT) was investigated by intravital microscopy. RESULTS Hyperglycemic rats had an increased infarct volume with an increased blood-brain barrier disruption and hemorrhagic transformation rate compared with normoglycemic rats. Magnetic resonance imaging scans revealed that hyperglycemia enhanced and accelerated lesion growth and was associated with hemorrhagic transformation originating from territories that were still not completely reperfused at 1 hour after middle cerebral artery recanalization. Intravital microscopy and analysis of brain homogenates showed that DMT began immediately after middle cerebral artery occlusion and was exacerbated by hyperglycemia. Measurement of plasma serotonin and matrix metalloproteinase-9 indicated that platelets and neutrophils were preactivated in hyperglycemic rats. Neutrophils from hyperglycemic diabetic patients showed increased adhesion to endothelial cells as compared with neutrophils from normoglycemic donors in flow chamber experiments. CONCLUSIONS We show that hyperglycemia primes the thromboinflammatory cascade, thus, amplifying middle cerebral artery occlusion-induced DMT. DMT exacerbation in hyperglycemic rats impaired reperfusion and precipitated neurovascular damage, blood-brain barrier disruption, and hemorrhagic transformation. Our results designate DMT as a possible target for reduction of the deleterious impact of hyperglycemia in acute ischemic stroke.
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Affiliation(s)
- Jean-Philippe Desilles
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.).
| | - Varouna Syvannarath
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Véronique Ollivier
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Clément Journé
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Sandrine Delbosc
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Célina Ducroux
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - William Boisseau
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Liliane Louedec
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Lucas Di Meglio
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Stéphane Loyau
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Martine Jandrot-Perrus
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Louis Potier
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Jean-Baptiste Michel
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Mikael Mazighi
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
| | - Benoit Ho-Tin-Noé
- From the Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Univ Paris Diderot, Sorbonne Paris Cite, France (J.-P.D., V.S., V.O., C.J., S.D., C.D., W.B., L.L., L.D.M., S.L., M.J.-P., J.-B.M., M.M., B.H.-T.-N.); Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., W.B., M.M.); DHU NeuroVasc, Paris, France (J.-P.D., M.M.); FRIM-Paris 7 University, Paris, France (C.J.); and Department of Diabetology AP-HP, Bichat Hospital, Paris, France (L.P.)
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Desilles JP, Loyau S, Syvannarath V, Gonzalez-Valcarcel J, Cantier M, Louedec L, Lapergue B, Amarenco P, Ajzenberg N, Jandrot-Perrus M, Michel JB, Ho-Tin-Noe B, Mazighi M. Alteplase Reduces Downstream Microvascular Thrombosis and Improves the Benefit of Large Artery Recanalization in Stroke. Stroke 2015; 46:3241-8. [PMID: 26443832 DOI: 10.1161/strokeaha.115.010721] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Downstream microvascular thrombosis (DMT) is known to be a contributing factor to incomplete reperfusion in acute ischemic stroke. The aim of this study was to determine the timing of DMT with intravital imaging and to test the hypothesis that intravenous alteplase infusion could reduce DMT in a transient middle cerebral artery occlusion (MCAO) rat stroke model. METHODS Rats were subjected to 60-minute transient MCAO. Alteplase (10 mg/kg) was administered 30 minutes after the beginning of MCAO. Real-time intravital fluorescence microscopy through a dura-sparing craniotomy was used to visualize circulating blood cells and fibrinogen. Cerebral microvessel patency was quantitatively evaluated by fluorescein isothiocyanate-dextran perfusion. RESULTS Immediately after MCAO, platelet and leukocyte accumulation were observed mostly in the venous compartment. Within 30 minutes after MCAO, microthrombi and parietal fibrin deposits were detected in postcapillary microvessels. Alteplase treatment significantly (P=0.006) reduced infarct volume and increased the percentage of perfused vessels during MCAO (P=0.02) compared with saline. Plasma levels of fibrinogen from alteplase-treated rats showed a rapid and profound hypofibrinogenemia. In vitro platelet aggregation demonstrated that alteplase reduced platelet aggregation (P=0.0001) and facilitated platelet disaggregation (P=0.001). These effects were reversible in the presence of exogenous fibrinogen. CONCLUSIONS Our data demonstrate that DMT is an early phenomenon initiated before recanalization. We further show that alteplase-dependent maintenance of downstream perfusion during MCAO improves acute ischemic stroke outcome through a fibrinogen-dependent platelet aggregation reduction. Our results indicate that early targeting of DMT represents a therapeutic strategy to improve the benefit of large artery recanalization in acute ischemic stroke.
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Affiliation(s)
- Jean-Philippe Desilles
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.).
| | - Stephane Loyau
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Varouna Syvannarath
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Jaime Gonzalez-Valcarcel
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Marie Cantier
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Liliane Louedec
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Bertrand Lapergue
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Pierre Amarenco
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Nadine Ajzenberg
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Martine Jandrot-Perrus
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Jean-Baptiste Michel
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Benoit Ho-Tin-Noe
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Mikael Mazighi
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
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