Tissue-type plasminogen activator (tPA) is an extracellular protease that converts plasminogen into plasmin. For tPA to generate plasmin under biologic conditions, a cofactor must first bring tPA and plasminogen into physical proximity. Fibrin provides this cofactor for tPAmediated plasmin generation in blood. Despite being naturally devoid of fibrin(ogen), tPA-mediated plasmin formation also occurs in the brain. The fibrin-like cofactor(s) that facilitates plasmin formation in the injured brain has remained unknown. Here we show that protein aggregates formed during neuronal injury provide a macromolecular, nonfibrin cofactor that promotes tPA-mediated plasmin formation and subsequent cell breakdown. The binding of plasminogen and tPA to these protein aggregates occurs via distinct mechanisms. Importantly, nonneuronal cell types also exhibit this cofactor effect upon injury, indicating a general phenomenon. This novel cofactor identified in nonviable cells has ramifications for ischemic stroke where tPA is used clinically and where plasmin activity within the injured brain is unwanted. A means of selectively inhibiting the binding of tPA to nonviable cells while preserving its association with fibrin may be of benefit for the treatment of ischemic stroke. (Blood. 2009;114:1937-1946
IntroductionTissue-type plasminogen activator (tPA) is a multidomain 70-kDa extracellular glycoprotein that converts inactive plasminogen into the broad-acting protease plasmin. 1,2 For tPA to generate plasmin optimally in the blood, both tPA and plasminogen must first bind to fibrin. 2,3 The physical colocalization of tPA and plasminogen on the fibrin surface significantly facilitates tPA-mediated plasmin generation and subsequent fibrinolysis. 2,4 Hence, fibrin acts as both a cofactor for tPA-mediated plasmin formation and as a substrate for plasmin. 3 In contrast to the blood, the brain is devoid of fibrin. 5-7 Nevertheless, tPA-mediated plasmin generation is also important for brain function and dysfunction. 8,9 Indeed, tPA-mediated plasmin formation in the brain has been shown to be neurotoxic. [10][11][12][13] For instance, it was shown that hippocampal neurons of tPA Ϫ/Ϫ and plasminogen Ϫ/Ϫ mice were resistant to excitotoxic cell death, whereas administration of exogenous tPA restored sensitivity to excitotoxic injury in tPA Ϫ/Ϫ but not plasminogen Ϫ/Ϫ mice. [14][15][16] Furthermore, fibrinogen Ϫ/Ϫ mice were found to be as vulnerable to intrahippocampal excitotoxicity as wild-type mice, although genetic ablation of plasminogen on either background conferred equal protection from excitotoxic injury. 15 Hence, fibrinindependent tPA-mediated plasmin generation sensitizes neurons to excitotoxicity-an insult that contributes to infarction during stroke, 17 traumatic brain injury, 18 and numerous other neurodegenerative paradigms. Whereas -amyloid and NG2 are likely cofactors for plasmin generation during Alzheimer disease 19 and spinal cord injury, 20 respectively, the "fibrin-like" cofactor that promotes tPA-mediated plasmin for...