Background and Purpose
The effects of lytic stroke therapy in patients with sickle cell anemia (SCA) are unknown, although a recent study suggested that co-existent SCA does not increase the risk of cerebral hemorrhage. This finding calls for systemic analysis of the effects of thrombolytic stroke therapy, first in humanized sickle mice, then in patients. There is also a need for additional predictive markers of SCA-associated vasculopathy.
Methods
We used Doppler ultrasound to examine the carotid artery of Townes sickle mice tested their responses to repetitive-mild hypoxia-ischemia (rmHI) and transient hypoxia-ischemia (tHI)-induced stroke at three or six months of age, respectively. We also examined the effects of tissue-plasminogen activator (tPA) treatment in tHI-injured sickle mice.
Results
Three-month-old SS mice showed elevated resistive index (RI) in the carotid artery and higher sensitivity to rmHI-induced cerebral infarct. Six-month-old SS mice showed greater RI and increased flow velocity without obstructive vasculopathy in the carotid artery. Instead, the cerebral vascular wall in SS mice showed ectopic expression of Plasminogen Activator Inhibitor-1 (PAI-1) and P-Selectin, suggesting a pro-adhesive and pro-thrombotic propensity. Indeed, SS mice showed enhanced leukocyte and platelet adherence to the cerebral vascular wall, broader fibrin deposition, and higher mortality after tHI. Yet, post-tHI treatment with tPA reduced thrombosis and mortality in SS mice.
Conclusions
Sickle mice are sensitive to hypoxia/ischemia-induced cerebral infarct, but benefit from thrombolytic treatment. An increased resistive index in carotid arteries may be an early marker of sickle cell vasculopathy.