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Neutrophil extracellular traps regulate ischemic stroke brain injury
Frederik Denorme, … , Christian C. Yost, Robert A. Campbell
Frederik Denorme, … , Christian C. Yost, Robert A. Campbell
Published March 31, 2022
Citation Information: J Clin Invest. 2022;132(10):e154225. https://doi.org/10.1172/JCI154225.
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Research Article Hematology

Neutrophil extracellular traps regulate ischemic stroke brain injury

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Abstract

Ischemic stroke prompts a strong inflammatory response, which is associated with exacerbated outcomes. In this study, we investigated mechanistic regulators of neutrophil extracellular trap (NET) formation in stroke and whether they contribute to stroke outcomes. NET-forming neutrophils were found throughout brain tissue of ischemic stroke patients, and elevated plasma NET biomarkers correlated with worse stroke outcomes. Additionally, we observed increased plasma and platelet surface–expressed high-mobility group box 1 (HMGB1) in stroke patients. Mechanistically, platelets were identified as the critical source of HMGB1 that caused NETs in the acute phase of stroke. Depletion of platelets or platelet-specific knockout of HMGB1 significantly reduced plasma HMGB1 and NET levels after stroke, and greatly improved stroke outcomes. We subsequently investigated the therapeutic potential of neonatal NET-inhibitory factor (nNIF) in stroke. Mice treated with nNIF had smaller brain infarcts, improved long-term neurological and motor function, and enhanced survival after stroke. nNIF specifically blocked NET formation without affecting neutrophil recruitment after stroke. Importantly, nNIF also improved stroke outcomes in diabetic and aged mice and was still effective when given 1 hour after stroke onset. These results support a pathological role for NETs in ischemic stroke and warrant further investigation of nNIF for stroke therapy.

Authors

Frederik Denorme, Irina Portier, John L. Rustad, Mark J. Cody, Claudia V. de Araujo, Chieko Hoki, Matthew D. Alexander, Ramesh Grandhi, Mitchell R. Dyer, Matthew D. Neal, Jennifer J. Majersik, Christian C. Yost, Robert A. Campbell

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Figure 5

Platelets mediate HMGB1 release, contributing to detrimental NET formation in a mouse model of ischemic stroke.

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Platelets mediate HMGB1 release, contributing to detrimental NET formati...
Mice were subjected to 1 hour of tMCAO followed by 23 hours of reperfusion or sham surgery. Plasma was isolated and brains were analyzed for ischemic stroke brain damage by TTC staining 24 hours after stroke onset. Upon TTC staining, live brain tissue will stain red, while dead brain tissue will remain white (outlined with black dotted line). (A–D) Immediately after stroke onset, mice were injected with a platelet-depleting antibody or IgG control. Twenty-four hours later, plasma HMGB1 (A) and MPO-DNA complexes (B) were assessed as well as brain infarct volume (C and D). n = 6 for sham mice; n = 9 for groups subjected to stroke. (E–G) Immediately after stroke onset, mice were injected with a platelet-depleting antibody. One hour later, either recombinant HMGB1 (rHMGB1) or vehicle was administered. Twenty-four hours after stroke induction, plasma MPO-DNA complexes (E) were assessed as well as brain infarct volume (F and G). n = 7–9 per group. (H–K) Twenty-four hours before stroke induction, neutrophils were depleted by i.p. injection of neutrophil-depleting antibodies. Control mice were injected with an IgG control antibody. Twenty-four hours later, plasma HMGB1 (H) and MPO-DNA complexes (I) were assessed as well as brain infarct volume (J and K). n = 7–8 per group. (L–N) Twenty-four hours before stroke induction, neutrophils were depleted by i.p. injection of neutrophil-depleting antibodies. One hour after stroke onset, either rHMGB1 or vehicle was administered. Twenty-four hours after stroke induction, plasma MPO-DNA complexes (L) were assessed as well as brain infarct volume (M and N). n = 6–7 per group. Groups were compared by ordinary 1-way ANOVA (A, B, and D) or unpaired t test. *P < 0.05, **P < 0.01, ***P < 0.001.

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ISSN: 0021-9738 (print), 1558-8238 (online)

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