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The Journal of Neuroscience, November 12, 2008, 28(46):12023-12031; doi:10.1523/JNEUROSCI.2435-08.2008

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Neurobiology of Disease
The HMGB1 Receptor RAGE Mediates Ischemic Brain Damage

Sajjad Muhammad,^1 * Waleed Barakat,^1 * Stoyan Stoyanov,² Sasidhar Murikinati,¹ Huan Yang,⁴ Kevin J. Tracey,⁴ Martin Bendszus,³ Grazisa Rossetti,⁵ Peter P. Nawroth,² Angelika Bierhaus,² and Markus Schwaninger¹

¹Pharmacological Institute, and Departments of ²Internal Medicine and ³Neuroradiology, University of Heidelberg, 69120 Heidelberg, Germany, ⁴Feinstein Institute for Medical Research, Manhasset, New York 11030, and ⁵HMGBiotech, 20133 Milan, Italy

Correspondence should be addressed to Dr. Markus Schwaninger, Pharmacological Institute, University of Heidelberg, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany. Email: markus.schwaninger{at}pharma.uni-heidelberg.de

In ischemic stroke, the necrotic core is surrounded by a zone of inflammation, in which delayed cell death aggravates the initial insult. Here, we provide evidence that the receptor for advanced glycation end products (RAGE) functions as a sensor of necrotic cell death and contributes to inflammation and ischemic brain damage. The RAGE ligand high mobility group box 1 (HMGB1) was elevated in serum of stroke patients and was released from ischemic brain tissue in a mouse model of cerebral ischemia. A neutralizing anti-HMGB1 antibody and HMGB1 box A, an antagonist of HMGB1 at the receptor RAGE, ameliorated ischemic brain damage. Interestingly, genetic RAGE deficiency and the decoy receptor soluble RAGE reduced the infarct size. In vitro, expression of RAGE in (micro)glial cells mediated the toxic effect of HMGB1. Addition of macrophages to neural cultures further enhanced the toxic effect of HMGB1. To test whether immigrant macrophages in the ischemic brain mediate the RAGE effect, we generated chimeric mice by transplanting RAGE^–/– bone marrow to wild-type mice. RAGE deficiency in bone marrow-derived cells significantly reduced the infarct size. Thus, HMGB1–RAGE signaling links necrosis with macrophage activation and may provide a target for anti-inflammatory therapy in stroke.

Key words: RAGE; HMGB1; microglia; cerebral ischemia; stroke; macrophage

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Received May 30, 2008; revised Sept. 8, 2008; accepted Sept. 29, 2008.

Correspondence should be addressed to Dr. Markus Schwaninger, Pharmacological Institute, University of Heidelberg, Im Neuenheimer Feld 366, 69120 Heidelberg, Germany. Email: markus.schwaninger{at}pharma.uni-heidelberg.de

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