Background and Purpose-Glucocorticoids potently stabilize the blood-brain barrier and ameliorate tissue edema in certain neoplastic and inflammatory disorders of the central nervous system, but they are largely ineffective in patients with acute ischemic stroke. The reasons for this discrepancy are unresolved. Methods-To address the molecular basis for the paradox unresponsiveness of the blood-brain barrier during hypoxia, we used murine brain microvascular endothelial cells exposed to O 2 /glucose deprivation as an in vitro model. In an in vivo approach, mice were subjected to transient middle cerebral artery occlusion to induce brain infarctions. Blood-brain barrier damage and edema formation were chosen as surrogate markers of glucocorticoid sensitivity in the presence or absence of proteasome inhibitors. Results-O 2 /glucose deprivation reduced the expression of tight junction proteins and transendothelial resistance in murine brain microvascular endothelial cells in vitro. Dexamethasone treatment failed to reverse these effects during hypoxia. Proteasome-dependent degradation of the glucocorticoid receptor impaired glucocorticoid receptor transactivation thereby preventing physiological glucocorticoid activity. Inhibition of the proteasome, however, fully restored the blood-brain barrier stabilizing properties of glucocorticoid during O 2 /glucose deprivation. Importantly, mice treated with the proteasome inhibitor Bortezomib in combination with steroids several hours after stroke developed significantly less brain edema and functional deficits, whereas respective monotherapies were ineffective. Conclusions-We for the first time show that inhibition of the proteasome can overcome glucocorticoid resistance at the hypoxic blood-brain barrier. Hence, combined treatment strategies may help to combat stroke-induced brain edema formation in the future and prevent secondary clinical deterioration. (Stroke. 2011;42:1081-1089.)Key Words: blood-brain barrier Ⅲ proteasome Ⅲ nuclear receptor Ⅲ steroids Ⅲ stroke D isruption of the blood-brain barrier (BBB) and successive edema formation are pathological hallmarks of various disorders of the central nervous system and can dramatically deteriorate neurological symptoms especially in patients with stroke. Glucocorticoids (GCs) are frequently applied to fight BBB leakage in different central nervous system disorders, but GC efficacy is highly variable. Although GCs diminish edema formation in neuroinflammatory diseases such as acute multiple sclerosis lesions, and in certain brain tumors, this substance class is ineffective or even harmful in acute ischemic stroke. [1][2][3][4][5] This is unfortunate because excessive edema formation is a frequent cause of secondary infarct growth and successive death in patients with stroke. 6 The mechanisms underlying this discrepant GC efficacy are largely unknown and their revelation could help to develop novel antiedematous strategies in many neurological diseases.The biological effects of GC are mediated by the glucocorticoid recepto...