Platelet-activating factor (PAF) is a lipid derived from breakdown of cell membranes that is postulated to be a mediator of cerebral ischemic injury. PAF regulates CNS gene transcription via intracellular binding sites. To test the hypothesis that PAF mediates CNS injury in part by modulating gene transcription, we evaluated the neuroprotective efficacy of the drug BN 50730, an antagonist of the intracellular (microsomal) CNS PAF binding site, in the neonatal rat model of unilateral cerebral hypoxiaischemia. Seven-day-old rats underwent right carotid ligation followed by a 2.5-h exposure to 8% O 2 , and were then treated with BN 50730 (2.5 or 25 mg/kg per dose) or vehicle, at 0 and 2 h after the end of hypoxia. Ipsilateral cortical, striatal, and hippocampal damage was quantitated either 5 d later, or at 5 wk after the insult. Treatment with BN 50730 resulted in approximately 60 -80% reduction in ipsilateral tissue loss at both times. Learning and memory were evaluated 5 wk after insult using the Morris Watermaze place navigation task. Severity of cortical and striatal damage correlated significantly with learning and memory deficits. These results support the hypothesis that PAF is a pathogenetic mediator of hypoxic-ischemic damage in the immature brain. Accumulating evidence suggests that PAF mediates its deleterious effects in the immature CNS via multiple mechanisms. PAF (1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine) is a potent phospholipid mediator with distinct systemic and CNS actions. In the CNS, PAF is synthesized in neurons and microglia (1, 2), and PAF receptors are expressed predominantly in neurons and microglia and, to a lesser extent, on astrocytes and CNS endothelium (3-5). PAF has distinct neuronal actions, as a synaptic messenger, a transcriptional activator, and a critical determinant of normal brain development (6, 7). In addition to these CNS effects, PAF has potent proinflammatory systemic effects (8). PAF accumulates in ischemic CNS tissue in mature and immature animals (9 -12). In mature animals, most reports indicate that PAF receptor antagonist treatment attenuates cerebral ischemic damage (13-16). Several recent studies implicate PAF as a mediator of ischemic injury in the neonatal brain (12, 17).Brain PAF concentrations rise acutely after neonatal cerebral hypoxia-ischemia (12), most likely as a result of breakdown of membrane phospholipids. Treatment with the PAF receptor antagonist BN 52021 (ginkgolide B), beginning either before or immediately after hypoxia exposure, reduced hypoxicischemic brain injury in postnatal d 7 rats (17). Pretreatment with a Ginkgo biloba extract, which includes BN 52021, attenuated posthypoxic-ischemic PAF accumulation (12). These results suggest that PAF contributes to the pathogenesis of neonatal cerebral hypoxic-ischemic injury.PAF could mediate cerebral hypoxic-ischemic injury via either of two distinct neuronal PAF binding sites. Studies in adult rat cerebral cortex subcellular membrane fractions delineate distinct populations of neuronal PAF bind...