PT  - JOURNAL ARTICLE
AU  - Patrick Reeson
AU  - Kelly A. Tennant
AU  - Kim Gerrow
AU  - Josh Wang
AU  - Sammy Weiser Novak
AU  - Kelsey Thompson
AU  - Krista-Linn Lockhart
AU  - Andrew Holmes
AU  - Patrick C. Nahirney
AU  - Craig E. Brown
TI  - Delayed Inhibition of VEGF Signaling after Stroke Attenuates Blood–Brain Barrier Breakdown and Improves Functional Recovery in a Comorbidity-Dependent Manner
AID  - 10.1523/JNEUROSCI.2810-14.2015
DP  - 2015 Apr 01
TA  - The Journal of Neuroscience
PG  - 5128--5143
VI  - 35
IP  - 13
4099  - http://www.jneurosci.org/content/35/13/5128.short
4100  - http://www.jneurosci.org/content/35/13/5128.full
SO  - J. Neurosci.2015 Apr 01; 35
AB  - Diabetes is a common comorbidity in stroke patients and a strong predictor of poor functional outcome. To provide a more mechanistic understanding of this clinically relevant problem, we focused on how diabetes affects blood–brain barrier (BBB) function after stroke. Because the BBB can be compromised for days after stroke and thus further exacerbate ischemic injury, manipulating its function presents a unique opportunity for enhancing stroke recovery long after the window for thrombolytics has passed. Using a mouse model of Type 1 diabetes, we discovered that ischemic stroke leads to an abnormal and persistent increase in vascular endothelial growth factor receptor 2 (VEGF-R2) expression in peri-infarct vascular networks. Correlating with this, BBB permeability was markedly increased in diabetic mice, which could not be prevented with insulin treatment after stroke. Imaging of capillary ultrastructure revealed that BBB permeability was associated with an increase in endothelial transcytosis rather than a loss of tight junctions. Pharmacological inhibition (initiated 2.5 d after stroke) or vascular-specific knockdown of VEGF-R2 after stroke attenuated BBB permeability, loss of synaptic structure in peri-infarct regions, and improved recovery of forepaw function. However, the beneficial effects of VEGF-R2 inhibition on stroke recovery were restricted to diabetic mice and appeared to worsen BBB permeability in nondiabetic mice. Collectively, these results suggest that aberrant VEGF signaling and BBB dysfunction after stroke plays a crucial role in limiting functional recovery in an experimental model of diabetes. Furthermore, our data highlight the need to develop more personalized stroke treatments for a heterogeneous clinical population.