Abstract P394: Pre-Existing Hypertension Intensifies Blood Brain Barrier Leakage But Not Astrogliosis Or Microgliosis After Traumatic Brain Injury In Mice

Abstract

The extent of brain damage accompanying traumatic brain injury (TBI) depends on the type and severity of insult and is modulated by age, sex, and comorbidities. Nearly half of all US adults suffer from hypertension. Not surprisingly, hypertension is the most common premorbid condition in people aged 50 or above hospitalized with a TBI. Hypertension has been linked to cerebrovascular damage, neuroinflammation and cognitive decline. Neurogenic hypertension is elevated blood pressure initiated by the local renin angiotensin system within the brain; often times involved in resistant hypertension (high blood pressure poorly responsive to common antihypertensives). Despite an overlap in several aspects of brain pathology induced by hypertension and triggered by TBI, little is understood about the impact of premorbid hypertension on outcomes following TBI. We hypothesize that hypertension induces mild blood-brain barrier leakiness and neuroinflammation, priming the brain for greater cerebrovascular damage after TBI. To test this hypothesis, mice were rendered hypertensive via subcutaneous infusion of 1000 ng/kg/min angiotensin-II (Ang-II) two weeks prior to and one week following induction of a moderate severity controlled cortical impact or sham injury. Vascular damage and astrocyte and microglia activation were examined using histology and immunohistochemistry. Quantification was performed using HALO image analysis software. Compared to injured normotensive mice, injured hypertensive mice exhibited significantly more IgG extravasation in the cortex denoting a potentiation of blood-brain barrier damage. Despite robust injury-induced astrogliosis and microgliosis, neither GFAP nor Iba1 immunostaining was further increased by hypertension. Microbleeds were observed more in the cortex and corpus callosum but much less in the hippocampi or thalami after injury and were equivalent in hypertensive and normotensive injured mice. This study contributes to laying the groundwork of identifying and characterizing hypertension as a significant premorbid risk factor for poor outcome after TBI and provides a logical basis for incorporation of pre-existing hypertension in preclinical models of TBI, increasing their clinical relevance and predictive validity.