Summary
Recombinant tissue-type plasminogen activator (tPA, trade name Alteplase), currently
the only drug approved by the US Food and Drug Administration and the European Medicines
Agency for the treatment of cerebral ischaemic stroke, has been implicated in a number
of adverse effects reportedly mediated by interactions with the low-density lipo-protein
(LDL) family receptors, including neuronal cell death and an increased risk of cerebral
haemorrhage. The tissue-type plasminogen activator is the principal initiator of thrombolysis
in human physiology, an effect that is mediated directly via localised activation
of the plasmin zymogen plasminogen at the surface of fibrin clots in the vascular
lumen. Here, we sought to identify a ligand to tPA capable of inhibiting the relevant
LDL family receptors without interfering with the fibrinolytic activity of tPA. Systematic
evolution of ligands by exponential enrichment (SELEX) was employed to isolate tPA-binding
RNA aptamers, which were characterised in biochemical assays of tPA association to
low density lipoprotein receptor-related protein-1 (LRP-1, an LDL receptor family
member); tPA-mediated in vitro and ex vivo clot lysis; and tPA-mediated plasminogen activation in the absence and presence of
a stimulating soluble fibrin fragment. Two aptamers, K18 and K32, had minimal effects
on clot lysis, but were able to efficiently inhibit tPA-LRP-1 association and LDL
receptor family-mediated endocytosis in human vascular endothelial cells and astrocytes.
These observations suggest that coadministration alongside tPA may be a viable strategy
to improve the safety of thrombolytic treatment of cerebral ischaemic stroke by restricting
tPA activity to the vascular lumen.
Keywords
Fibrin clot lysis time - low density lipoprotein receptor-related protein-1 - nucleic
acid aptamer - stroke - tissue-type plasminogen activator