E very year, ischemic stroke accounts for ≈10% of global deaths, leaving 5 million patients permanently disabled, not only in high-income, but also in less-developed countries. 1 Besides the primary hypoxic damage and secondary processes, such as excitotoxicity, recruitment of inflammatory cells following restoration of cerebral perfusion contributes to ischemic brain injury.2,3 Especially, inflammatory events occurring at the blood-brain barrier (BBB) during cerebral ischemia are critical for the pathogenesis of tissue damage in ischemic stroke. Cell adhesion molecules (eg, intercellular adhesion molecule 1 4 and the selectins) 5 are involved in the development of postischemic brain inflammation by promoting cell adhesion, migration, and activation of leukocytes. Although genetic deficiency or antibody blocking of cellular adhesion molecules, such as intercellular adhesion molecule 1 and platelet selectin, demonstrated attenuated cerebral damage in mice, [5][6][7] links between early BBB breakdown and the innate immune response are still not fully understood. Neutrophils are an essential component of the innate immune system and among the first cells to adhere to the cerebral endothelium and infiltrate the ischemic brain. 8 This postischemic inflammation leads to impairment of BBB function and neuronal damage by release of matrix metalloproteinases (MMPs), for example MMP-9 and proinflammatory cytokines, including interleukin (IL)-1β, as well as reactive oxygen species. Objective: We sought to identify and characterize the relevance of CEACAM1-expressing inflammatory cells in BBB breakdown and outcome after ischemic stroke in Ceacam1 −/− and wild-type mice.
Methods and Results:Focal ischemia was induced by temporary occlusion of the middle cerebral artery with a microfilament. Using MRI and Evans blue permeability assays, we observed increased stroke volumes, BBB breakdown and edema formation, reduction of cerebral perfusion, and brain atrophy in Ceacam1 −/− mice. This translated into poor performance in neurological scoring and high poststroke-associated mortality. Elevated neutrophil influx, hyperproduction, and release of neutrophil-related matrix metalloproteinase-9 in Ceacam1 −/− mice were confirmed by immune fluorescence, flow cytometry, zymography, and stimulation of neutrophils. Importantly, neutralization of matrix metalloproteinase-9 activity in Ceacam1 −/− mice was sufficient to alleviate stroke sizes and improve survival to the level of CEACAM1-competent animals. Immune histochemistry of murine and human poststroke autoptic brains congruently identified abundance of CEACAM1 + matrix metalloproteinase-9 + neutrophils in the ischemic hemispheres.
Conclusions: CEACAM1 controls matrix metalloproteinase-9 secretion by neutrophils in postischemic inflammationat the BBB after stroke. We propose CEACAM1 as an important inhibitory regulator of neutrophil-mediated tissue damage and BBB breakdown in focal cerebral ischemia. Thus, understanding the regulation of neutrophils at the ischemic BBB will provide nov...