The calpain–cathepsin hypothesis
posits a key role for elevated
calpain-1 and cathepsin-B activity in the neurodegeneration underlying
neurotrauma and multiple disorders including Alzheimer’s disease
(AD). AD clinical trials were recently halted on alicapistat, a selective
calpain-1 inhibitor, because of insufficient exposure of neurons to
the drug. In contrast to neuroprotection, the ability of calpain-1
and cathepsin-B inhibitors to protect the blood–brain barrier
(BBB), is understudied. Since cerebrovascular dysfunction underlies
vascular dementia, is caused by ischemic stroke, and is emerging as
an early feature in the progression of AD, we studied protection of
brain endothelial cells (BECs) by selective and nonselective calpain-1
and cathepsin-B inhibitors. We show these inhibitors protect both
neurons and murine BECs from ischemia–reperfusion injury. Cultures
of primary BECs from ALDH2
–/–
mice that manifest enhanced oxidative
stress were sensitive to ischemia, leading to reduced cell viability
and loss of tight junction proteins; this damage was rescued by calpain-1
and cathepsin-B inhibitors. In ALDH2
–/–
mice 24 h after
mild traumatic brain injury (mTBI), BBB damage was reflected by significantly
increased fluorescein extravasation and perturbation of tight junction
proteins, eNOS, MMP-9, and GFAP. Both calpain and cathepsin-B inhibitors
alleviated BBB dysfunction caused by mTBI. No clear advantage was
shown by selective versus nonselective calpain inhibitors in these
studies. The lack of recognition of the ability of calpain inhibitors
to protect the BBB may have led to the premature abandonment of this
therapeutic approach in AD clinical trials and requires further mechanistic
studies of cerebrovascular protection by calpain-1 inhibitors.