Physiologic Variations in Blood Plasminogen Levels Affect Outcomes after Acute Cerebral Thromboembolism in Mice: A Pathophysiologic Role for Microvascular Thrombosis

Summary

Background and Objectives

Plasminogen appears to affect brain inflammation, cell movement, fibrinolysis, neuronal excitotoxicity and cell death. However, brain tissue and circulating blood plasminogen may have different roles and, there is large individual variation in blood plasminogen levels. The aim of this study was to determine the integrated effect of blood plasminogen levels on ischemic brain injury.

Methods

We examined thromboembolic stroke in mice with varying, experimentally-determined, blood plasminogen levels. Ischemic brain injury, blood-brain barrier breakdown, matrix metalloproteinase-9 expression and microvascular thrombosis were determined.

Results

Within the range of normal variation, plasminogen levels were strongly associated with ischemic brain injury (p<0.0001); higher blood plasminogen levels had dose-related, protective effects (p<0.0001). Higher plasminogen levels were associated with increased dissolution of the middle cerebral artery thrombus (p<0.0001). Higher plasminogen levels decreased blood-brain barrier breakdown (p<0.05), matrix metalloproteinase-9 expression (p<0.01) and reduced microvascular thrombosis (p<0.0001) in the ischemic brain. In plasminogen-deficient mice, selective restoration of blood plasminogen levels reversed the harmful effects of plasminogen deficiency on ischemic brain injury. Specific inhibition of thrombin also reversed the effect of plasminogen deficiency on ischemic injury by diminishing microvascular thrombosis, blood-brain barrier breakdown and matrix metalloproteinase-9 expression.

Conclusions

Variation in blood plasminogen levels, within the range seen in normal individuals, had marked effects on experimental ischemic brain injury. Higher plasminogen levels protected against ischemic brain injury, decreased blood-brain barrier breakdown, matrix metalloproteinase-9 expression and microvascular thrombosis. The protective effects of blood plasminogen appear to be mediated largely through reduction of microvascular thrombosis in the ischemic territory.