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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 7

Prophylactic treatment with nNIF protects mice from ischemic stroke brain injury.

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Prophylactic treatment with nNIF protects mice from ischemic stroke brai...
Mice were subjected to 1 hour of tMCAO followed by 23 hours of reperfusion. Mice were treated with nNIF or SCR 1 hour before and 1 hour after stroke onset (10 mg/kg). Open circles, females; filled circles, males. (A) Brain sections were stained with TTC. Red areas indicate healthy brain tissue; white areas show infarcted brain tissue (outlined with black dotted line). (B) Quantification of brain infarct volumes 24 hours after stroke. (C) Bederson’s test was used to assess neurological outcome 24 hours after stroke. (D) Twenty-four hours after stroke, motor function was measured using the grip test. n = 14 per group. (E) In a separate experiment, mice were followed for up to 7 days after stroke; survival was monitored. n = 9 for SCR; n = 10 for nNIF. (F–H) NETs in brain tissue were identified by staining for MPO (red), H3cit (green), and DNA (DAPI; blue). The percentage of NET-forming neutrophils was quantified by counting of H3cit+ neutrophils. n = 5 per group. Scale bar: 50 μm. (I) Plasma NETs were measured 24 hours after stroke using MPO-DNA complex ELISA. n = 7–9 per group. (J–L) Brain sections were stained for apoptosis by labeling of DNA strand breaks with TUNEL (green). TUNEL+ cells were counted in the striatum and cortex. n = 5 per group. Scale bar: 100 μm. (M–O) Flow cytometric analysis of single-cell suspensions of ipsilesional brain hemispheres. CD45+CD11b+Ly6G+ cells were counted in nNIF- and SCR-treated animals. n = 5–7 per group. (P) Quantification of neutrophil staining with Ly6G in brain sections 24 hours after stroke. n = 5 per group. Groups were compared by unpaired t test (B, H, I, O, and P), Mann-Whitney test (C and D), ordinary 1-way ANOVA (L), or log-rank test (E). *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001.

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