Combination treatment with U0126 and rt-PA prevents adverse effects of the delayed rt-PA treatment after acute ischemic stroke

Sci Rep. 2021 Jun 7;11(1):11993. doi: 10.1038/s41598-021-91469-9.

Abstract

In acute ischemic stroke, the only FDA-approved drug; recombinant tissue plasminogen activator (rt-PA) is limited by restricted time-window due to an enhanced risk of hemorrhagic transformation which is thought to be caused by metalloproteinase (MMP). In experimental stroke inhibitors of the mitogen-activated protein kinase kinase extracellular signal-regulated kinase kinase (MEK) 1/2 pathways reduce the MMPs. This study evaluated whether a MEK1/2 inhibitor in combination with rt-PA can prevent the detrimental effects of delayed rt-PA therapy in stroke. Thromboembolic stroke was induced in C57 black/6J mice and the MEK1/2 inhibitor U0126 was administrated 3.5 h and rt-PA 4 h post stroke-onset. Treatment with rt-PA demonstrated enhanced MMP-9 protein levels and hemorrhagic transformation which was prevented when U0126 was given in conjunction with rt-PA. By blocking the MMP-9 with U0126 the safety of rt-PA administration was improved and demonstrates a promising adjuvant strategy to reduce the harmful effects of delayed rt-PA treatment in acute ischemic stroke.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Butadienes / pharmacokinetics*
  • Butadienes / therapeutic use
  • Disease Models, Animal
  • Drug Discovery
  • Drug Therapy, Combination
  • Drug-Related Side Effects and Adverse Reactions / prevention & control
  • Hemorrhage / prevention & control*
  • Humans
  • Ischemic Stroke / drug therapy*
  • Male
  • Matrix Metalloproteinase 9 / metabolism
  • Mice
  • Mitogen-Activated Protein Kinase Kinases / metabolism
  • Nitriles / pharmacokinetics*
  • Nitriles / therapeutic use
  • Signal Transduction
  • Tissue Plasminogen Activator / pharmacology*
  • Tissue Plasminogen Activator / therapeutic use
  • Treatment Outcome

Substances

  • Butadienes
  • Nitriles
  • U 0126
  • Mitogen-Activated Protein Kinase Kinases
  • Tissue Plasminogen Activator
  • Matrix Metalloproteinase 9