|| Checking for direct PDF access through Ovid
Introduction: Diabetes increases the risk of occurrence and poor recovery of ischemic stroke injury. Activation of adaptive immune system and resulting inflammation contributes to neurovascular injury and deterioration of neurological functions post stroke in diabetes. We have shown that activation of TLR4, a key player in the innate immune system, decreases brain microvascular endothelial cell survival after hypoxic injury in diabetic conditions. Our previous work also demonstrated greater bleeding/edema and poor recovery after stroke in diabetes. Current study tested the hypothesis that activation of TLR4 contributes to worsened stroke injury in diabetes and its inhibition can improve functional outcomes.Methods: Low dose of Streptozotocin (30mg/kg) and high fat diet were used to induce type 2 diabetes in male Wistar rats. Middle cerebral artery occlusion for 60 mins was performed in 13 weeks old animals. Expression of TLR4 receptor in brain homogenates and cerebral microvasculature were assessed by immunoblotting (relative density). Another set of animals was treated with TLR4 inhibitor TAK242 (3mg/kg; i.p. after reperfusion, 24 and 48 hours). Neurobehavioral deficits were measured by composite score and adhesive removal test at baseline, day 1 and 3 post ischemic stroke.Results: Ischemic stroke increased the expression of TLR4 receptor in ischemic hemisphere (0.50±0.06 sham, 0.68±0.02 control and 1.24±2.0* diabetic; *p<0.05 vs sham) as well as in microvasculature (0.55±035 sham, 1.34±0.24 control and 9.49±2.5* diabetic; *p<0.05 vs sham) and this was significantly higher in diabetic animals. Diabetes worsened functional outcomes and inhibition of TLR4 significantly improved the deficits (Table).Conclusions: Our findings that TLR4 is highly upregulated in the microvasculature and that beneficial effects of TLR4 inhibition are more profound in diabetes suggest that vascular TLR4 holds a therapeutic potential for stroke recovery in diabetes.