The neurotoxicity of tissue plasminogen activator?

J Cereb Blood Flow Metab. 2004 Sep;24(9):945-63. doi: 10.1097/01.WCB.0000137868.50767.E8.


Tissue plasminogen activator (tPA), a fibrin specific activator for the conversion of plasminogen to plasmin, stimulates thrombolysis and rescues ischemic brain by restoring blood flow. However, emerging data suggests that under some conditions, both tPA and plasmin, which are broad spectrum protease enzymes, are potentially neurotoxic if they reach the extracellular space. Animal models suggest that in severe ischemia with injury to the blood brain barrier (BBB) there is injury attributed to the protease effects of this exogenous tPA. Besides clot lysis per se, tPA may have pleiotropic actions in the brain, including direct vasoactivity, cleaveage of the N-methyl-D-aspartate (NMDA) NR1 subunit, amplification of intracellular Ca++ conductance, and activation of other extracellular proteases from the matrix metalloproteinase (MMP) family, e.g. MMP-9. These effects may increase excitotoxicity, further damage the BBB, and worsen edema and cerebral hemorrhage. If tPA is effective and reverses ischemia promptly, the BBB remains intact and exogenous tPA remains within the vascular space. If tPA is ineffective and ischemia is prolonged, there is the risk that exogenous tPA will injure both the neurovascular unit and the brain. Methods of neuroprotection, which prevent tPA toxicity or additional mechanical means to open cerebral vessels, are now needed.

Publication types

  • Review

MeSH terms

  • Animals
  • Blood-Brain Barrier / drug effects*
  • Blood-Brain Barrier / pathology
  • Brain / drug effects*
  • Brain / pathology
  • Extracellular Space / drug effects
  • Fibrinolysin / adverse effects
  • Humans
  • Neuroprotective Agents / adverse effects*
  • Stroke / drug therapy
  • Tissue Plasminogen Activator / adverse effects*


  • Neuroprotective Agents
  • Tissue Plasminogen Activator
  • Fibrinolysin