Abstract

Development of vasogenic brain edema is a key event contributing to mortality after subarachnoid hemorrhage (SAH). The precise underlying mechanisms at the neurovascular level that lead to disruption of the blood-brain barrier (BBB) are still unknown. Activation of myosin light chain kinases (MLCK) may result in change of endothelial cell shape and opening of the intercellular gap with subsequent vascular leakage. Male C57Bl6 mice were subjected to endovascular perforation. Brain water content was determined by wet-dry ratio and BBB integrity by Evans-Blue extravasation. The specific MLCK inhibitor ML-7 was administered to the mice to determine the role of the contractile apparatus of the neurovascular unit in determining brain water content, BBB integrity, neurofunctional outcome, brain damage, and survival at 7 days after SAH. Inhibition of MLCK significantly reduced BBB permeability (Evans Blue extravasation − 28%) and significantly decreased edema formation in comparison with controls (− 2%). MLCK-treated mice showed reduced intracranial pressure (− 53%), improved neurological outcome at 24 h and 48 h after SAH, and reduced 7-day mortality. Tight junction proteins claudin-5 and zonula occludens-1 levels were not influenced by ML-7 at 24 h after insult. The effect of ML-7 on pMLC was confirmed in brain endothelial cell culture (bEnd.3 cells) subjected to 4-h oxygen-glucose deprivation. The present study indicates that MLCK contributes to blood-brain barrier dysfunction after SAH by a mechanism that does not involve modulation of tight junction protein levels, but via activation of the contractile apparatus of the endothelial cell skeleton. This underlying mechanism may be a promising target for the treatment of SAH.

Highlights

  • A critical factor for the 35% mortality rate in patients suffering from subarachnoid hemorrhage (SAH) is the development of severe global cerebral edema [1]

  • SAH resulted in a cerebral blood flow (CBF) decrease to 20–30% of baseline followed by gradual recovery over 15 min to 90% of baseline

  • The mechanisms by which vascular cells contribute to the breakdown of the blood-brain barrier (BBB) in SAH remain elusive

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Summary

Introduction

A critical factor for the 35% mortality rate in patients suffering from subarachnoid hemorrhage (SAH) is the development of severe global cerebral edema [1]. Brain edema formation correlates with ischemic damage, cognitive deficits, and mortality [1, 2]. Post-hemorrhagic brain edema is mostly of vasogenic origin and results from the disruption of bloodbrain-barrier (BBB) integrity [3]. The precise underlying mechanisms leading to BBB breakdown at the neurovascular level and the significance of the endothelial cells for the development of vasogenic brain edema after SAH are still unknown. Recent in vitro studies suggest that the activation of the contractile apparatus of endothelial cells may contribute to the disruption of the BBB in pathologic conditions [4,5,6]. Data from mechanical brain lesions indicate increased activity of myosin light chain kinase

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