Background-Urokinase-type plasminogen activator (uPA) has recently been implicated in the pathogenesis of ischemia-reperfusion (I/R) injury. The underlying mechanisms remain largely unclear. Methods and Results-Using in vivo microscopy on the mouse cremaster muscle, I/R-elicited firm adherence and transmigration of neutrophils were found to be significantly diminished in uPA-deficient mice and in mice treated with the uPA inhibitor WX-340, but not in uPA receptor (uPAR)-deficient mice. Interestingly, postischemic leukocyte responses were significantly reduced on blockade of the integrin CD11b/Mac-1, which also serves as uPAR receptor. Using a cell transfer technique, postischemic adherence and transmigration of wild-type leukocytes were significantly decreased in uPA-deficient animals, whereas uPA-deficient leukocytes exhibited a selectively reduced transmigration in wild-type animals. On I/R or stimulation with recombinant uPA, Ͼ90% of firmly adherent leukocytes colocalized with CD31-immunoreactive endothelial junctions as detected by in vivo fluorescence microscopy. In a model of hepatic I/R, treatment with WX-340 significantly attenuated postischemic neutrophil infiltration and tissue injury. Conclusions-Our data suggest that endothelial uPA promotes intravascular adherence, whereas leukocyte uPA facilitates the subsequent paracellular transmigration of neutrophils during I/R. This process is regulated via CD11b/Mac-1, and does not require uPAR. Pharmacological blockade of uPA interferes with these events and effectively attenuates postischemic tissue injury. (Circulation. 2011;124:1848-1859.)Key Words: ischemia Ⅲ leukocytes Ⅲ plasminogen activators Ⅲ reperfusion Ⅲ urokinase I schemia-reperfusion (I/R) injury is considered to be the most common cause of organ dysfunction and failure after myocardial infarction, hemorrhagic shock, and transplantation. Leukocyte infiltration of postischemic tissue is a key event in the pathogenesis of I/R injury. In this multistep cascade, a diversity of adhesion molecules, chemoattractants, and proteases are involved, regulating intravascular rolling and firm adherence as well as transendothelial migration of leukocytes to the reperfused tissue. [1][2][3][4]
Clinical Perspective on p 1859Urokinase-type plasminogen activator (uPA) is a serine protease that has been implicated in a variety of physiological and pathophysiological processes. In this context, uPA is known to activate extracellular matrix-degrading enzymes and, through interaction with the urokinase receptor (uPAR; CD87), uPA is thought to induce intracellular signaling pathways, ultimately regulating cell adhesion and migration. 5 Moreover, uPA mediates the conversion of plasminogen to plasmin, which, in addition to its fibrinolytic properties, is also able to degrade components of the ECM as well as to activate intracellular signaling mechanisms. 6 Plasminogen activators, such as recombinant uPA, are therapeutically used for the activation of the fibrinolytic system during thrombembolic events. 7 Interestingl...