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Hyperglycemia-induced cerebral hematoma expansion is mediated by plasma kallikrein.

Nature medicine | 2011

Hyperglycemia is associated with greater hematoma expansion and poor clinical outcomes after intracerebral hemorrhage. We show that cerebral hematoma expansion triggered by intracerebral infusion of autologous blood is greater in diabetic rats and mice compared to nondiabetic controls and that this augmented expansion is ameliorated by plasma kallikrein (PK) inhibition or deficiency. Intracerebral injection of purified PK augmented hematoma expansion in both diabetic and acutely hyperglycemic rats, whereas injection of bradykinin, plasmin or tissue plasminogen activator did not elicit such a response. This response, which occurs rapidly, was prevented by co-injection of the glycoprotein VI agonist convulxin and was mimicked by glycoprotein VI inhibition or deficiency, implicating an effect of PK on inhibiting platelet aggregation. We show that PK inhibits collagen-induced platelet aggregation by binding collagen, a response enhanced by elevated glucose concentrations. The effect of hyperglycemia on hematoma expansion and PK-mediated inhibition of platelet aggregation could be mimicked by infusing mannitol. These findings suggest that hyperglycemia augments cerebral hematoma expansion by PK-mediated osmotic-sensitive inhibition of hemostasis.

Pubmed ID: 21258336 RIS Download

Associated grants

  • Agency: NHLBI NIH HHS, United States
    Id: P01 HL087203
  • Agency: NHLBI NIH HHS, United States
    Id: HL090132
  • Agency: NEI NIH HHS, United States
    Id: EY19029
  • Agency: NEI NIH HHS, United States
    Id: R01 EY019029
  • Agency: NHLBI NIH HHS, United States
    Id: HL87203
  • Agency: NEI NIH HHS, United States
    Id: R01 EY019029-03
  • Agency: NHLBI NIH HHS, United States
    Id: HL07917
  • Agency: NHLBI NIH HHS, United States
    Id: T32 HL007917
  • Agency: NIDDK NIH HHS, United States
    Id: DK36836
  • Agency: NIDDK NIH HHS, United States
    Id: P30 DK036836
  • Agency: NHLBI NIH HHS, United States
    Id: R43 HL090132

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