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Introduction: Ischemic preconditioning (IPC) protects the brain against subsequent ischemic injuries. However, its protective mechanisms and long-term impact on stroke outcomes are unknown. IPC requires mild oxidative stress and may activate nuclear factor (erythroid-derived 2)-like 2 (Nrf2). Endogenous lipid electrophiles serve as robust Nrf2 activators. This study tests long-term effects of IPC and explores the mechanisms of IPC-mediated ischemic tolerance, focusing on lipid electrophiles and Nrf2 pathway. Methods: Wildtype (WT) and Nrf2 knockout (KO) mice were subjected to 60-min middle cerebral artery occlusion (MCAO) 3 d after IPC (12-min MCAO). Tissue loss, blood-brain barrier (BBB) damage, and neurobehavioral outcomes were assessed up to 35 d post stroke. The molecular mechanisms were explored by primary endothelial cell (EC) cultures with plasmid transfection and molecular biological approaches. Results: IPC reduced sensorimotor and cognitive deficits and tissue loss up to 35 d post stroke in WT mice, while Nrf2 KO abolished IPC-mediated protection. IPC led to mild oxidative stress, lipid electrophile generation and Nrf2 pathway activation. Prominent Nrf2 activation was seen in ECs and a selected group of astrocytes in tight association with microvessels, both of which are BBB components. As expected, IPC reduced BBB leakage 48 h post stroke and increased expressions of junctional proteins Claudin-5 and VE-Cadherin. Moreover, Nrf2 directly regulated Claudin-5 and VE-Cadherin promoter activities. Finally, a novel mechanism for electrophiles to activate Nrf2 was identified-through direct inhibition of glycogen synthase kinase 3β (GSK3β) activity via GSK3β-C199 residue. Conclusions: IPC preserves the BBB and provides long-term neuroprotection against stroke. Mechanistically, mild oxidative stress in IPC generates a pool of electrophiles, which then activates Nrf2 pathway through direct inhibition GSK3β-dependent Nrf2 degradation.

Background: Inflammasome in microglia are critical to elicit inflammatory cascades in ischemic stroke. Histone deacetylases 3 (HDAC3) regulate acetylation states of histone and non-histone proteins and could be a powerful regulator of inflammatory process in stroke. Methods: Primary microglia, BV2 cells subjected to oxygen glucose deprivation (OGD) or LPS stimulation were applied to mimic inflammatory response in vitro . Middle cerebral artery occlusion (MCAO) model were applied to mimic acute stroke in vivo . Ischemic infarct volume and neurological functions were evaluated through 2,3,5-triphenyltetrazolium chloride (TTC) staining and Neurological Severity Scores (NSS) respectively. Expression of HDAC3, AIM2 inflammasome were detected by western blotting, PCR. Immunofluorescence was used to detect M1/M2 polarization. Luciferase activity of absent in melanoma 2 (AIM2) reporter promoter constructs was measured by fluorospectrophotometer. AIM2 knockdown and over-expression leti-virus were constructed to decrease or increase AIM2 expression. HDAC3 inhibitor RGFP966 was used to inhibit acetylation activity of HDAC3. Results: HDAC3 is widely distributed in cerebral cortex, lateral ventricular , hippocampus, cerebellar cortex ; HDAC3 and AIM2 expression were enhanced in LPS stimulated-microglia and MCAO model. A marked stimulatory effect of RGFP966 on H3K9Ac was observed in nuclear extracts form BV2 cells at the dosage of 15 uM. Treatment of RGFP966 increased both IL-4-stimulated expression of Ym-1 and CD206 at 4 h, 10 h, 24 h, 48 h. AIM2, NLRP-1 and NLRP3 significantly increased in MCAO+Vehicle group compared to sham group, but decreased in MCAO+RGFP966 group. RGFP966 inhibited the elevation of circulatory IL-18 and IL-1β induced by stroke. RGFP966 decreased infracted size and alleviated neurological deficit. Conclusions: HDAC3i alleviated ischemic stroke injury through modulating AIM2 inflammasome and microglia polarization. Selective HDAC3 inhibitor-RGFP966 could be a potential medication for combating ischemic brain injury.

Background: The crosstalk between T lymphocyte and microglia plays an important role in ischemia reperfusion injury. The FasL mutation Gld mice had emerged the advantages in neuroprotection after MCAO. Double negative (DN) CD4(-)CD8(-) T lymphocytes were accumulated in peripheral blood and spleen of Gld mice. The objectives of this study were to explore the crosstalk between DN T cells and microglia in Gld mice after ischemic stroke. Method: The subtypes of T lymphocytes and microglia in brain tissue after cerebral ischemia were measured by flow cytometry and immunofluorescence. In vitro, different subtypes of T lymphocyte were co-cultured with primary microglia undergoing different treatments. ELISA and Real-time PCR were used to quantify the cytokines and chemokines. Results: DN T lymphocytes were obviously accumulated in ischemic regions in Gld mice after MCAO 3 days, the percentage of CD4+ or CD 8+ T lymphocyte were lightly decreased in Gld mice, compared with wild type B6 mice. Meanwhile, the activation of microglia in ischemic tissue was alleviated in Gld mice. Compared to wild type mice, a shift to alternative activated microglia (M2) rather than classical activated microglia (M1) was observed in Gld mice. In vitro, different T lymphocyte subtypes isolated from spleen in Gld mice showed various effect on primary microglia. Primary microglia underwent a shift to M2 microglia when co-cultured with CD4+ T lymphocytes and DN T lymphocytes, while switched a shift to M1 microglia when co-cultured with CD8+ T lymphocytes. Besides, pro-inflammation cytokines like IL-1β, TNF-α and MCP-1 secreted by microglia and T lymphocytes were decreased, anti-inflammation cytokines such as IL-4, IL-10 and TGF-βwere increased when primary microglia were co-cultured with CD4+ T lymphocytes and DN T lymphocytes. Conclusion: It’s showed that DN T lymphocytes were accumulated in ischemic brain tissue in Gld mice,which improved the outcome of stroke in Gld mice. The neuroprotective mechanism may be referred to the immunoregulation of DN T lymphocytes on microglia via promoting switching to alternative activated microglia and alleviating inflammation. The new understanding on DN T lymphocyte may provide additional views on post-stroke immune regulation.

Background and Purpose— Little research regarding genotypes and clopidogrel response related to acute ischemic stroke has been published. This study was conducted to investigate whether the polymorphisms of receptors or enzymes involved in the metabolic process of clopidogrel affect clopidogrel response and prognosis related to acute stroke. Methods— A total of 259 patients with acute ischemic stroke were enrolled in this study; all received follow-up evaluations 3 and 6 months after clopidogrel treatment. CYP2C19, CYP3A4, and P2Y12 were screened. The adenosine diphosphate-induced platelet aggregation test, the National Institutes of Health Stroke Scale (NIHSS), and the modified Rankin Scale (mRS) were used, and blood vascular events were evaluated. Results— The difference before and after clopidogrel treatment on adenosine diphosphate-induced platelet aggregation was significantly smaller in patients carrying 1 or 2 CYP2C19 loss-of-function alleles (*2, *3) compared with patients carrying none. Patients with none had better outcomes than patients with CYP2C19 loss-of-function alleles, as demonstrated by NIHSS and mRS scores at 3 and 6 months after treatment. Regression analysis showed that CYP2C19 was an independent predictor of clopidogrel resistance. Conclusions— CYP2C19 genotypes had significant impact on clopidogrel response and prognosis of patients with stroke. Clinical Trial Registration Information— URL: http://www.chictr.org/ . Unique Identifier: ChiCTR-OCH-12002681.

We thank Jia et al for their valuable comments regarding our recently published article.1 This prospective study enrolled 259 patients with acute ischemic stroke and found that CYP2C19 (cytochrome P450, family 2, subfamily C, polypeptide 19) genotypes had significant impact on clopidogrel response and prognosis of patients with stroke. We have to clarify that the National Institutes of Health Stroke Scale and modified Rankin Scale score in our study were used to evaluate the therapeutic effect of clopidogrel at 3 and 6 months after treatment. In addition to coagulation, platelets also release abundant proinflammatory cytokines that aggravate the pathogenic progress of ischemic injury. Substantial evidence demonstrated that clopidogrel application diminished inflammatory mediators, including C-reactive protein.2 …

Brain ischemia is a devastating disorder without effective therapies. One of the most promising approaches to attenuate ischemic brain injury is mild hypothermia. Recent studies show that adenosine nucleotides can induce hypothermia in mice. The purpose of the present study was to test the hypothesis that ATP, a common form of energy currency, induces mild hypothermia in rats and reduces brain injury following focal cerebral ischemia. ATP solution was dissolved in water and intraperitoneally injected; and focal stroke was induced by a suture model of middle cerebral artery occlusion and ischemic outcomes were evaluated within 24 hr. We found that injections of ATP lowered core body temperature in a dose-dependent manner; the dose appropriate for subsequent experiments was 2 g/kg as it reduced temperature to the range of mild hypothermia for approximately 7 hours. While intravenous injection of ATP was less effective in lowering body temperature. However, when ATP-induced hypothermia was applied to stroke, a neuroprotective effect was not observed. In contrast, the infarct volume grew even larger in ATP-treated rats. Not surprisingly, this was accompanied by an increased rate of seizure events, hemorrhagic transformation, and higher mortality. Continuous monitoring of physiological parameters revealed that ATP severely reduced heartbeat rate and blood pressure. ATP also raised blood glucose to dangerous levels and this was accompanied by severe acidosis and hypocalcemia. Western blotting showed that ATP treatment decreased levels of both phospho-Akt and total-Akt in the ischemic cortex. Our results reveal that, despite inducing hypothermia, ATP is not appropriate for protecting the brain against stroke, as it is associated with exaggerated ischemic outcomes and dangerous systemic side effects.

Background and Purpose— Heme oxygenase-1 (HO-1) is an inducible Phase 2 enzyme that degrades toxic heme; its role in cerebral ischemia is not fully understood. We hypothesize that chemically induced HO-1 upregulation with the novel triterpenoid CDDO-Im (2-cyano-3,12 dioxooleana-1,9 dien-28-oyl imidazoline), a robust inducer of Phase 2 genes, protects neurons against ischemic injury. Methods— Using 3 different models of ischemia, including oxygen–glucose deprivation in neuronal cultures, global ischemia in rats, and focal ischemia in mice, we determined (1) whether CDDO-Im induces HO-1 expression and protects against ischemic injury; and (2) whether HO-1 inhibition disrupts the neuroprotective effect of CDDO-Im. Results— CDDO-Im treatment (50–300 nmol/L) resulted in 8-fold HO-1 upregulation in cultured neurons and protected against oxygen–glucose deprivation. The protection was abolished when the cultures were transfected with nuclear factor (erythroid-derived 2) like-2–shRNA or coincubated with tin protoporphyrin IX, a specific HO-1 inhibitor. In the rat model of global ischemia, intracerebroventricular infusion of CDDO-Im (0.5–1.5 μg) augmented HO-1 expression in hippocampal neurons and resulted in significant increases in CA1 neuronal survival after global ischemia. To further strengthen the clinical relevance of the CDDO-Im treatment, we tested its effects in the mouse model of temporary focal ischemia (60 minutes). Postischemic intraperitoneal injection of CDDO-Im (10–100 μg) enhanced HO-1 expression and significantly reduced neurological dysfunction and infarct volume. Intracerebroventricular infusion of tin protoporphyrin IX reduced the neuroprotective effect of CDDO-Im against global and focal ischemia. Conclusions— CDDO-Im confers neuroprotection against ischemic injury by upregulating HO-1, suggesting that enhance of HO-1 expression may be a legitimate strategy for therapeutic intervention of stroke.