Global brain inflammation in stroke

Epigenetic regulation of the inflammatory response in stroke

Stroke is classified as ischemic or hemorrhagic, and there are few effective treatments for either type. Immunologic mechanisms play a critical role in secondary brain injury following a stroke, which manifests as cytokine release, blood-brain barrier disruption, neuronal cell death, and ultimately behavioral impairment. Suppressing the inflammatory response has been shown to mitigate this cascade of events in experimental stroke models. However, in clinical trials of anti-inflammatory agents, long-term immunosuppression has not demonstrated significant clinical benefits for patients. This may be attributable to the dichotomous roles of inflammation in both tissue injury and repair, as well as the complex pathophysiologic inflammatory processes in stroke. Inhibiting acute harmful inflammatory responses or inducing a phenotypic shift from a pro-inflammatory to an anti-inflammatory state at specific time points after a stroke are alternative and promising therapeutic strategies. Identifying agents that can modulate inflammation requires a detailed understanding of the inflammatory processes of stroke. Furthermore, epigenetic reprogramming plays a crucial role in modulating post-stroke inflammation and can potentially be exploited for stroke management. In this review, we summarize current findings on the epigenetic regulation of the inflammatory response in stroke, focusing on key signaling pathways including nuclear factor-kappa B, Janus kinase/signal transducer and activator of transcription, and mitogen-activated protein kinase as well as inflammasome activation. We also discuss promising molecular targets for stroke treatment. The evidence to date indicates that therapeutic targeting of the epigenetic regulation of inflammation can shift the balance from inflammation-induced tissue injury to repair following stroke, leading to improved post-stroke outcomes.

Targeting CDK1 inhibits Golgi apparatus stress-mediated neuroinflammation and neuronal apoptosis after intracerebral hemorrhage by modulating GRASP55 phosphorylation

Cyclin-dependent kinase 1 (CDK1) has been found to be associated with neuronal apoptosis. However, the role of CDK1 in intracerebral hemorrhage (ICH) remains unclear. The aim of this study was to investigate the role of CDK1 in mediating neuroinflammation and neuronal apoptosis through the modulation of Golgi apparatus stress (GAS) in ICH. In this study, rats received collagenase IV injections to induce ICH, while primary neurons and PC-12 cells were stimulated with Hemin to establish ICH models. We observed that CDK1 expression was upregulated and GAS levels increased after ICH. Downregulation of CDK1 significantly attenuated neuronal damage and GAS levels after ICH. In addition, CDK1 downregulation reduced inflammatory cytokine levels in both in vitro and in vivo models of ICH. Interestingly, the phosphorylation of Golgi reassembly-stacking protein 55 (GRASP55) was significantly increased after ICH. However, CDK1 downregulation was able to reverse this change. Our data show that CDK1 phosphorylates GRASP55 through the T225 site. Lastly, mutating the GRASP55 T225 phosphorylation site abolished the CDK1-mediated exacerbation of GAS, neuronal apoptosis, and inflammatory responses in vitro. In summary, targeted inhibition of CDK1 suppresses GAS-mediated neuroinflammation and neuronal apoptosis after ICH by regulating GRASP55 phosphorylation. Research on CDK1 may offer clinicians new insights into the treatment of patients with ICH.

Deciphering spatiotemporal molecular pattern of traumatic brain injury by resveratrol-engineered two-dimensional-material-based field-effect-transistor biopatch

Traumatic Brain Injury (TBI) is a severe neurological disorder with an incomplete understanding of its underlying mechanisms, primarily due to the lack of effective strategy for in situ spatiotemporal analysis. Biomarkers associated with TBI, such as glial fibrillary acidic protein (GFAP), are typically detected in vitro rather than in situ, with a notable absence of spatiotemporal dynamics analysis. Herein, we developed a resveratrol-functionalized silver nanowires-doped MXene-based field-effect transistor biopatch (Res-Ag-MFETs) for in-situ spatiotemporal GFAP analysis, aiming to elucidate the TBI's biomolecular mechanisms. We employed silver nanowires (AgNWs)-doped two-dimensional MXene as the FET's semiconductor and validated the favorable capability of MXene@AgNWs via morphological, elemental characterization, and DFT simulations. Res-Ag-MFETs demonstrated a favorable capability to suppress neuronal damage and inflammation, as evidenced by histological staining and bioactivity tests. Additionally, Res-Ag-MFETs demonstrated remarkable reproducibility (RSD = 2.12%), stability, and sensitivity for GFAP quantification, achieving a detection limit as low as 0.47 pg/mL. Ultimately, Res-Ag-MFETs enabled efficient in-situ spatiotemporal analysis of GFAP in a Sprague Dawley (SD) rat with TBI, revealing a progressive diffusion of GFAP from the centre to the periphery over time. This advancement provides a novel platform for spatiotemporal dynamics analysis of biochemical markers in brain disorders, potentially laying the groundwork for further exploration of underlying pathogenic mechanisms.

Inhibition of the cGAS-STING pathway: contributing to the treatment of cerebral ischemia-reperfusion injury

The cGAS-STING pathway plays an important role in ischemia-reperfusion injury in the heart, liver, brain, and kidney, but its role and mechanisms in cerebral ischemia-reperfusion injury have not been systematically reviewed. Here, we outline the components of the cGAS-STING pathway and then analyze its role in autophagy, ferroptosis, cellular pyroptosis, disequilibrium of calcium homeostasis, inflammatory responses, disruption of the blood-brain barrier, microglia transformation, and complement system activation following cerebral ischemia-reperfusion injury. We further analyze the value of cGAS-STING pathway inhibitors in the treatment of cerebral ischemia-reperfusion injury and conclude that the pathway can regulate cerebral ischemia-reperfusion injury through multiple mechanisms. Inhibition of the cGAS-STING pathway may be helpful in the treatment of cerebral ischemia-reperfusion injury.

Intermittent theta burst stimulation regulates microglial polarization through Cry1 to enhance neuroplasticity for stroke recovery

BACKGROUND

Neuroplasticity is crucial for functional recovery after stroke, with modulation of microglial polarization enhancing this process. Intermittent theta burst stimulation (iTBS), as a neuromodulation technique, can simultaneously generate electric and magnetic fields to act on the central nervous system. Neurons can induce electrochemical signal transduction as excitable cells. Meanwhile, iTBS can regulate microglial inflammatory polarization post-stroke. However, how iTBS exerts its effect on microglia remains unclear. The magnetoreceptive protein Cryptochrome (Cry) can respond to the magnetic effect and is known to regulate macrophage-mediated inflammatory responses. However, whether iTBS modulates microglial polarization through Cry1 is unknown.

OBJECTIVE

To explore the magnetic effects of iTBS on microglial polarization through Cry1, thereby enhancing neuroplasticity and stroke recovery, and also elucidate the role of the Cry1-NF-κB pathway in iTBS-mediated regulation of microglial polarization.

METHODS

A mouse model was established using photothrombosis (PT), followed by 7-day iTBS intervention. BV2 cells and primary neurons were subjected to oxygen-glucose deprivation/reperfusion (OGD/R) respectively, followed by once-daily iTBS treatment for two days. Brain damage and functional recovery were assessed using Map-2 staining and behavioral tests. RT-PCR, western blot, immunofluorescence and transwell co-culture experiments were employed to evaluate the effects of iTBS on microglial polarization and neuroplasticity. Cry1 knockdown via siRNA transfection was used to explore the Cry1-NF-κB signaling pathway.

RESULTS

iTBS ameliorated neuronal damage induced by ischemic injury, reduced pro-inflammatory microglial activation, and promoted anti-inflammatory polarization. Cry1 expression was upregulated in BV2 cells in response to iTBS, while Cry1 knockdown increased CD16 expression, decreased CD206 expression and further alleviate the inhibition of NF-κB activation. In primary neurons, anti-inflammatory microglia induced by iTBS could enhance neuroplasticity.

CONCLUSION

This study demonstrates that post-stroke iTBS promotes neuroplasticity and functional recovery by regulating microglial polarization via the Cry1-NF-κB pathway.

Methyl isoeugenol suppresses NLRP3 inflammasome-mediated pyroptosis via activation of Nrf2/NQO1/HO-1 signaling in cerebral ischemia-reperfusion injury

Microglial neuroinflammation is considered to be a vital injury factor aggravating ischemia-reperfusion (I/R) injury on the progression of cerebral ischemic stroke. Mounting evidences have verified the effect of pyroptosis mediated by NLRP3 inflammasome on modulating microglial phenotype, and maintaining the microglial M1/M2 phenotype balance could be a novel target to ameliorate cerebral I/R injury. Herein, we focused on the anti-neuroinflammatory effect of methyl isoeugenol, a bioactive compound isolated from Acorus tatarinowii Schott, on nuclear factor erythroid 2-related factor 2 (Nrf2)-mediated NLRP3 inflammasome in vivo or in vitro. The results showed that methyl isoeugenol reduced cerebral infarct volume, modulated microglia M1/M2 phenotypes, and protected against NLRP3 inflammasome-primed pyroptosis. Mechanistically, methyl isoeugenol increased the nuclear translocation of Nrf2 and decreased that of NF-κB, and consequently, upregulated cellular antioxidants (HO-1 and NQO1), with the increased expression of antioxidant enzymes SOD and the decreased expression of lipid peroxidation MDA. These findings suggest that Nrf2 may serve as a vital target for the protective effect of methyl isoeugenol, making methyl isoeugenol as a promising anti-neuroinflammatory agent for NLRP3 inflammasome mediated microglial neuroinflammation in I/R injury.

Artesunate demonstrates neuroprotective effect through activation of lysosomal function and inhibition of cGAS-STING pathway

Artesunate, a derivative of artemisinin, has a variety of pharmacological effects. Its potential application in ischemic brain injury still largely unknown. This study investigated the therapeutic effect and pharmacological mechanism of artesunate in neuronal injury following cerebral ischemia, and explore the potential role of lysosomal function and cGAS-STING signaling pathway in ischemia injury and artesunate treatment. Studies in rat models have revealed that artesunate can ameliorate neuronal injury and improve learning and memory function following ischemic insults. Furthermore, both in vivo and in vitro studies have confirmed that artesunate can protect neural cells from ischemic injury-induced cell death. Mechanistically, artesunate appears to exert its neuroprotective actions by activating lysosomal function and inhibiting the cGAS-STING pathway-mediated inflammatory response. Our findings provide valuable insights into the therapeutic effects of artesunate exerting a neuroprotective role in chronic ischemic brain injury by activating lysosomal function, inhibiting the cGAS-STING pathway, and regulating the inflammatory response. This study offers a potential therapeutic strategy by regulating lysosome for the treatment of stroke and related neurological disorders.

Identification of cytochrome P450 2E1 as a novel target in neuroinflammation and development of its inhibitor Q11 as a treatment strategy

Neuroinflammation is implicated in nearly all pathological processes of central nervous system (CNS) diseases. However, no medications specifically targeting neuroinflammation are clinically available, and conventional anti-inflammatory drugs exhibit limited efficacy. Here, we identified cytochrome P450 2E1 (CYP2E1) as a novel therapeutic target in neuroinflammation. Elevated CYP2E1 levels were observed in hippocampal tissues of mouse and rat neuroinflammation models, as well as in LPS-stimulated primary microglia. Genetic ablation of Cyp2e1 improved spatial learning and memory in neuroinflammatory rats and reduced pro-inflammatory cytokine levels in Cyp2e1-deficient microglia. Furthermore, Q11 (1-(4-methyl-5-thiazolyl) ethanone), a novel CYP2E1 inhibitor developed and synthesized in our laboratory, effectively ameliorated Alzheimer's disease-related spatial learning and memory functions and depression-related anxiety-like behaviors in mice/rats. Mechanistically, Q11 attenuated microglial activation, neuronal damage, oxidative stress, and neuroinflammation by suppressing the PI3K/Akt, STAT1/3, and NF-κB signaling pathways. These findings establish CYP2E1 as a druggable target for neuroinflammation and propose Q11 as a promising candidate for treating neuroinflammation-related diseases.

The roles of ROCK2/CBS-H2S pathway in the cerebral ischemia/reperfusion injury

The purpose of present study was to demonstrate the effects and relationship of ROCK2 knockdown and cystathionine β-synthase (CBS)/H2S in the neuronal injury and astrocytic function following cerebral ischemia/reperfusion (I/R). Wild type and ROCK2 knockdown mice were used to establish cerebral I/R model, and CBS knockdown astrocytes were used to establish the model of oxygen glucose deprivation/re‑oxygenation (OGD/R). We revealed that ROCK2 knockdown protects against cerebral I/R injury, as evidenced by reduced deficiency of exploratory behavior and decreased impairment of spatial memory, and suggested by reduced neuronal injury. Besides, ROCK2 knockdown improves the CBS expression and promotes H2S release. Importantly, ROCK2 knockdown inhibits the proliferation of neurotoxic astrocytes and promotes the transformation of neuroprotective astrocytes. Furthermore, we found in the OGD/R model of astrocytes that down-regulation of CBS expression promotes the expressions of ROCK1 and ROCK2 and improves the astrocytic injury, which can be inhibited by H2S supplement. Additionally, down-regulation of CBS expression improves the proliferation of neurotoxic astrocytes. While supplement with H2S can promote the transformation of neuroprotective astrocytes. In conclusion, inhibition of ROCK2 can reduce the cerebral I/R injury via retaining neuroprotective function of astrocytes via promoting CBS/H2S release, which in turn further inhibits the ROCKs expression.

Unveiling the Hidden Impact: Hematoma Volumes Unravel Circuit Disruptions in Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) imposes a significant burden on patients, and the volume of hematoma plays a crucial role in determining the severity and prognosis of ICH. Although significant recent progress has been made in understanding the cellular and molecular mechanisms of surrounding brain tissue in ICH, our current knowledge regarding the precise impact of hematoma volumes on neural circuit damage remains limited. Here, using a viral tracing technique in a mouse model of striatum ICH, two distinct patterns of injury response were observed in upstream connectivity, characterized by both linear and nonlinear trends in specific brain areas. Notably, even low-volume hematomas had a substantial impact on downstream connectivity. Neurons in the striatum-ICH region exhibited heightened excitability, evidenced by electrophysiological measurements and changes in metabolic markers. Furthermore, a strong linear relationship (R2 = 0.91) was observed between hematoma volumes and NFL damage, suggesting a novel biochemical index for evaluating changes in neural injury. RNA sequencing analysis revealed the activation of the MAPK signaling pathway following hematoma, and the addition of MAPK inhibitor revealed a decrease in neuronal circuit damage, leading to alleviation of motor dysfunction in mice. Taken together, our study highlights the crucial role of hematoma size as a determinant of circuit injury in ICH. These findings have important implications for clinical evaluations and treatment strategies, offering opportunities for precise therapeutic approaches to mitigate the detrimental effects of ICH and improve patient outcomes.

Association between post-stroke cognitive impairment and gut microbiota in patients with ischemic stroke

More than half of stroke survivors have post-stroke cognitive impairment (PSCI). The role of gut microbiota, which can communicate with the brain through the gut-brain axis and affect inflammation, has been receiving increased attention. This cross-sectional study aimed to investigate the association of PSCI, gut microbiota, and inflammatory markers. Patients with first ischemic stroke and complete 3-month and 1-year follow-up data were included and divided into PSCI and non-PSCI groups according to the Montreal Cognitive Assessment (MoCA) score at the above time points. PSCI was defined as having a MoCA less than 23 at either 3 months or 1 year, or a decrease of more than 2 points at both time points. Gut microbiota was assessed by 16 S rRNA gene sequencing and Next Generation Sequencing analysis. The inflammatory markers included interleukins (ILs), eotaxin, G-CSF, TNF-α, IFNγ, sCD40L, and MCP-1. There were 95 ischemic stroke patients (mean age, 60.5 ± 12.1 years; male, 68.4%), including 30 with PSCI and 65 with non-PSCI. In gut microbiota analysis, the PSCI group had a higher abundance of Bacteroidaceae and Clostridiaceae, and the non-PSCI group had a higher abundance of Prevotellaceae, Ruminococcaceae, Oscillibacter, and Faecalibacterium. Ruminococcaceae family under the Oscillospirales order remains significantly different in the two groups in logistic regression model adjusting confounding variables (p = 0.044). In an analysis of inflammatory markers, the plasma levels of eotaxin (p = 0.041) and IL-12p40 (p = 0.031) were significantly higher in the PSCI group than those in the non-PSCI group, and the plasma level of eotaxin was significantly positively correlated with the amount of Clostridiaceae (rho = 0.389, p = 0.045). The study found that PSCI was associated with certain gut microbiota, and these gut microbiotas correlated with the pro-inflammatory marker eotaxin. This suggests that gut microbiota might play a role in the development of cognitive impairment after ischemic stroke.

Neuroprotective Effects of Urolithin A in a Mouse Model of Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) accounts for 10-15% of all stroke cases and is associated with high mortality and morbidity. Brain injury caused by ICH includes primary and secondary brain injury. Neuroinflammation and apoptosis play important roles in the pathological process of secondary brain injury after ICH. Urolithin A (UroA) is a metabolite derived from ellagic acid and has been confirmed to be anti-inflammatory, anti-oxidant and anti-apoptotic. The aim of this study was to investigate the effects of UroA on neuroinflammation and neuronal apoptosis in a mouse model of ICH induced by collagenase. Compared with ICH mice given vehicle, intraperitoneal injection of UroA (2.5 mg/kg) significantly reduced neurological impairment and brain water content 3 days after ICH. UroA reduced Evans Blue exudation and the loss of zonula occludens-1 and Occludin. Western blot showed that UroA significantly decreased the concentration of matrix metalloproteinases-9 (MMP-9). UroA treatment significantly attenuated the density of activated microglia and infiltrated neutrophils after 3 days of ICH. Finally, UroA inhibited cell death around the hematoma, attenuated ipsilateral brain injury, and improved neurological function in mice with ICH. UroA plays a neuroprotective role in ICH by inhibiting the expression of MMP-9 and reducing neuroinflammation, blood-brain barrier destruction, brain cell death and brain injury.

European Stroke Organisation (ESO) and European Association of Neurosurgical Societies (EANS) guideline on stroke due to spontaneous intracerebral haemorrhage

Spontaneous (non-traumatic) intracerebral haemorrhage (ICH) affects ~3.4 million people worldwide each year, causing ~2.8 million deaths. Many randomised controlled trials and high-quality observational studies have added to the evidence base for the management of people with ICH since the last European Stroke Organisation (ESO) guidelines for the management of spontaneous ICH were published in 2014, so we updated the ESO guideline. This guideline update was guided by the European Stroke Organisation (ESO) standard operating procedures for guidelines and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, in collaboration with the European Association of Neurosurgical Societies (EANS). We identified 37 Population, Intervention, Comparator, Outcome (PICO) questions and prioritised clinical outcomes. We conducted systematic literature searches, tailored to each PICO, seeking randomised controlled trials (RCT) - or observational studies when RCTs were not appropriate, or not available - that investigated interventions to improve clinical outcomes. A group of co-authors allocated to each PICO screened titles, abstracts, and full texts and extracted data from included studies. A methodologist conducted study-level meta-analyses and created summaries of findings tables. The same group of co-authors graded the quality of evidence, and drafted recommendations that were reviewed, revised and approved by the entire group. When there was insufficient evidence to make a recommendation, each group of co-authors drafted an expert consensus statement, which was reviewed, revised and voted on by the entire group. The systematic literature search revealed 115,647 articles. We included 208 studies. We found strong evidence for treatment of people with ICH on organised stroke units, and secondary prevention of stroke with blood pressure lowering. We found weak evidence for scores for predicting macrovascular causes underlying ICH; acute blood pressure lowering; open surgery via craniotomy for supratentorial ICH; minimally invasive surgery for supratentorial ICH; decompressive surgery for deep supratentorial ICH; evacuation of cerebellar ICH > 15 mL; external ventricular drainage with intraventricular thrombolysis for intraventricular extension; minimally invasive surgical evacuation of intraventricular blood; intermittent pneumatic compression to prevent proximal deep vein thrombosis; antiplatelet therapy for a licensed indication for secondary prevention; and applying a care bundle. We found strong evidence against anti-inflammatory drug use outside of clinical trials. We found weak evidence against routine use of rFVIIa, platelet transfusions for antiplatelet-associated ICH, general policies that limit treatment within 24 h of ICH onset, temperature and glucose management as single measures (outside of care bundles), prophylactic anti-seizures medicines, and prophylactic use of temperature-lowering measures, prokinetic anti-emetics, and/or antibiotics. New evidence about the management of ICH has emerged since 2014, enabling this update of the ESO guideline to provide new recommendations and consensus statements. Although we made strong recommendations for and against a few interventions, we were only able to make weak recommendations for and against many others, or produce consensus statements where the evidence was insufficient to guide clinical decisions. Although progress has been made, many interventions still require definitive, high-quality evidence, underpinning the need for embedding clinical trials in routine clinical practice for ICH.

Neuroprotective Mechanisms of Baicalin in Ischemia Stroke

Ischemic stroke (IS) remains one of the leading global causes of mortality and disability, imposing a substantial socioeconomic burden on families and healthcare systems. Despite recognition as a critical global health challenge, therapeutic interventions for cerebral ischemia remain severely limited. The current standard treatment for acute ischemic stroke is intravenous thrombolysis using a tissue plasminogen activator (tPA). However, its narrow therapeutic window and elevated risk of hemorrhagic complications restrict thrombolytic therapy to a minority of eligible patients. Baicalin, a bioactive flavonoid derived from Scutellaria baicalensis roots, exhibits neuroprotective properties across diverse neurological conditions, including ischemic and hemorrhagic brain injury. Its neuroprotective mechanisms are multifactorial, encompassing antioxidant activity, antiapoptotic, and antiinflammatory effects, upregulation of neurotrophic factors, mitochondrial protection, and vasodilation of peripheral vasculature. The breadth of baicalin's neuroprotective actions highlights its potential as a promising therapeutic candidate for ischemic stroke. This review synthesizes current evidence on baicalin's neuroprotective effects and molecular mechanisms in ischemic stroke, emphasizing its potential as a novel therapeutic strategy.

Advances in cerebral edema research and targeted drug delivery systems

Cerebral edema, marked by excessive brain fluid accumulation, hinders stroke recovery and impacts survival, highlighting the need for effective therapies. This review examines the glymphatic system's role in post-stroke edema pathogenesis, explores edema formation mechanisms, and identifies therapeutic targets. While small molecule drugs show promise, their limited solubility and brain targeting necessitate advanced delivery approaches. Nanodrug delivery systems, capable of crossing the blood-brain barrier (BBB) and targeting cells via ligands, offer a compelling solution. We discuss the application of novel nanodrugs to enhance post-stroke edema treatment, aiming to improve survival and neurological recovery. This review seeks to guide future research in post-stroke edema management.

Circulatory factors in stroke protection and recovery

Over the past decade, the management of acute ischemic stroke has undergone a paradigm shift, especially a longer time-window and a wider indication for endovascular treatments. However, many patients still have long-term dysfunction despite the best medical care at present. Based on findings from innovative proteomic and transcriptomic technologies, researchers have identified an array of novel or previously underappreciated circulatory factors that play pivotal roles in mediating post-injuries brain communication. Thus, the previous concept of the brain as a privileged compartment isolated from the rest of the body has been replaced by the novel consensus that brain bidirectionally interacts with the other organs after brain diseases. In this review, we make a summary of several axes that connect the brain with the rest of the body after stroke. More importantly, we summarize several circulatory factors that play pivotal roles in fostering post-stroke functional recovery in the chronic stage. Special attention is given to the instrumental role of circulatory signals, positing them as significant contributors to the complex process of brain function recovery and as translational therapeutic targets for ischemic stroke in future studies.

Repurposing of modafinil as an anti-inflammatory drug: a systematic review of experimental studies

Previous studies suggested the anti-inflammatory properties of modafinil. This study aimed to review the current literature to provide a comprehensive insight into the anti-inflammatory uses of modafinil in experimental studies. We conducted a systematic search using Medline (via PubMed), Web of Science, Scopus, and Embase databases from their commencement until 10 October 2022. All original articles focusing on modafinil anti-inflammatory effects were included. Our initial search yielded 1398 articles. Fourteen publications were included in our systematic review. Recent studies attempted to provide evidence for repurposing modafinil for several diseases, including autoimmune encephalomyelitis, nonalcoholic liver disease, gastric mucosal injury, neuropathic pain, atherosclerosis, intestinal ischemia, pulmonary hypertension, pancreatitis, ischemic stroke, testicular torsion, and lithium-pilocarpine-induced status epilepticus. Current evidence supports that modafinil can modulate inflammation, suppress the immune response, and improve disease severity partly by inhibiting NF-κB, NOS, Kca3.1, Kca2.3, and COX-2. By reviewing recent findings from experimental studies, we discussed the beneficial effects of modafinil on several inflammatory diseases, with a particular focus on the underlying mechanisms.

Lycium barbarum glycopeptide attenuates intracerebral hemorrhage-induced inflammation and oxidative stress via activation of the Sirt3 signaling pathway

BACKGROUND

Intracerebral hemorrhage (ICH) is a severe neurological condition characterized by high morbidity and mortality rates, with no effective treatment currently available. Lycium barbarum glycopeptide (LbGP), derived from the further purification of Lycium barbarum polysaccharides (LBP), has demonstrated anti-inflammatory effects, suggesting its potential as a therapeutic agent for ICH. However, the role and mechanisms of LbGP in ICH remain unclear. This study aimed to investigate the effects of LbGP on ICH and its underlying mechanisms.

METHODS

A collagenase injection-induced mouse model of ICH was used to evaluate the therapeutic effects of LbGP. Mice were treated with varying doses of LbGP, and outcomes were assessed based on hemorrhage volume, neurological function, inflammation, and oxidative stress markers. Apoptosis was analyzed using TUNEL staining. Mechanistic studies focused on mitochondrial acetylation homeostasis and the expression of Sirt3, a mitochondrial deacetylase. Statistical analyses were performed using one-way ANOVA with Tukey's post hoc tests.

RESULTS

LbGP administration reduced hemorrhage volume and improved neurological function in a dose-dependent manner. It significantly decreased pro-inflammatory cytokines (IL-18, TNF-α, IL-1β) and oxidative stress markers (malondialdehyde and reactive oxygen species) while increasing superoxide dismutase activity and total antioxidant capacity. LbGP treatment also mitigated apoptosis and promoted mitochondrial acetylation homeostasis. Mechanistically, LbGP upregulated mitochondrial Sirt3 expression, and blocking Sirt3 disrupted mitochondrial acetylation homeostasis, resulting in increased inflammation and oxidative stress.

CONCLUSIONS

LbGP alleviates inflammation and oxidative stress in hemorrhagic brain injury by activating Sirt3 and maintaining mitochondrial acetylation homeostasis. These findings highlight the therapeutic potential of LbGP in treating ICH, providing a foundation for further clinical applications.

Exploring OLR1-mediated inflammatory mechanisms in the hematoma microenvironment of acute intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is a devastating form of stroke with high mortality and limited therapeutic options. The current study investigates the role of oxidative low-density lipoprotein receptor 1 (OLR1) within the hematoma microenvironment, focusing on its impact on immune responses and disease progression in ICH patients. Through comprehensive bioinformatics analyses of datasets from the Gene Expression Omnibus (GEO), including peripheral blood, brain tissue, and hematoma samples, we identified significant upregulation of OLR1, particularly in hematoma regions. This upregulation was strongly correlated with increased monocyte and macrophage activity, exacerbating neuroinflammation and contributing to poor clinical outcomes. Single-cell RNA sequencing (scRNA-seq) further elucidated the involvement of OLR1 in monocyte-driven immune responses, suggesting its critical role in the pathophysiology of ICH. Validation through quantitative real-time PCR (qRT-PCR) confirmed that OLR1 expression was significantly higher in hematoma samples than in peripheral blood, with the most notable elevation observed in patients with poor prognoses. Our findings suggest that OLR1 could serve as a promising biomarker and therapeutic target for modulating immune responses in ICH. Targeted therapies to regulate OLR1 expression could potentially mitigate neuroinflammation and improve recovery outcomes. This study not only enhances the understanding of the molecular mechanisms underlying ICH but also provides a foundation for developing novel therapeutic strategies that focus on the hematoma microenvironment and immune modulation.

Accelerated Molecular Transportation in the Brain Extracellular Space with 755-nm Light Attenuates Post-Stroke Cognitive Impairment in Rats

Ischemic stroke exacts a heavy toll in death and disability worldwide. After ischemic stroke, the accumulation of pathobiomolecules in the brain extracellular space (ECS) will exacerbate neurological damage and cognitive impairment. Photobiomodulation (PBM) has been demonstrated to improve cognitive function in Alzheimer's disease mouse models by accelerating molecular transportation in the brain ECS. This suggests that PBM may have a potential role in the accumulation of pathobiomolecules in the brain ECS following ischemic stroke. In this study, we developed a PBM therapy apparatus with custom parameters. By evaluating the treatment effect, we identified that 755 nm was the optimal light wavelength for ischemic stroke in rats with transient middle cerebral artery occlusion/reperfusion. Extracellular diffusion and interstitial fluid (ISF) drainage were measured using a tracer-based magnetic resonance imaging method. Our results showed that PBM accelerated molecular transportation in the brain ECS and ISF drainage, promoting the clearance of pro-inflammatory cytokines and reducing the deposition of pathological proteins. Consequently, the infarct volume decreased and neurological cognitive function was improved. Besides, the acceleration of ISF drainage was achieved by reducing expression and restoring polarization of aquaporin 4 (AQP4) in the peri-infarct area. In summary, we demonstrated that PBM could alleviate ischemia-reperfusion injury and prevent post-stroke cognitive impairment by accelerating molecular transportation in the brain ECS, paving a pathway for ischemic stroke treatment via the light-ECS interaction.

NLRP3 Inflammasome in Vascular Dementia: Regulatory Mechanisms, Functions, and Therapeutic Implications: A Comprehensive Review

BACKGROUND

Vascular dementia, the second most common type of dementia globally after Alzheimer's disease, is associated with neuroinflammation. Activation of the NLRP3 inflammasome, an important pattern recognition receptor in human innate immunity, plays a key role in the pathogenesis of vascular dementia.

RESULTS

The NLRP3 inflammasome pathway destroys neuronal cells primarily through the production of IL-18 and IL-1β. Moreover, it exacerbates vascular dementia by producing IL-18, IL-1β, and the N-terminal fragment of GSDMD, which also contributes to neuronal cell death. Thus, blocking the NLRP3 inflammasome pathway presents a new therapeutic strategy for treating vascular dementia, thereby delaying or curing the disease more effectively and mitigating adverse effects.

CONCLUSIONS

This review explores the role and mechanisms of the NLRP3 inflammasome in vascular dementia, summarizing current research and therapeutic strategies. Investigating the activation of the NLRP3 inflammasome can reveal the pathogenesis of vascular dementia from a new perspective and propose innovative preventive and treatment strategies.

Analysis of Prognostic Risk Factors in Patients with Complete Revascularization After Thrombectomy for Acute Anterior Circulation Large Vessel Occlusion

OBJECTIVE

Prognostic risk factors were analyzed for patients with acute anterior circulation large vessel occlusion stroke who achieved modified Treatment in Cerebral Ischemia (mTICI) 3 grade by endovascular treatment.

METHODS

Patients with Acute ischemic stroke with mTICI=3 grade after endovascular treatment from June 2019 to September 2024, at the Eighth Clinical College of Guangzhou University of Traditional Chinese Medicine, were retrospectively analyzed. Data related to patients' baseline data, risk factors, test data, and surgical data were collected, and the primary endpoint was 90-day poor functional outcome, defined as patients' modified Rankin score >2 at 90 days after surgery. The predictive effect was evaluated using receiver operating characteristic curve analysis, and multivariate logistic regression analysis was used to explore the independent correlation between inflammatory markers and prognosis.

RESULTS

A total of 103 eligible patients were included. Multivariate logistic regression analysis showed that the neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 1.10, 95% confidence interval [CI]: 1.01∼1.20, P = 0.021) at 24 hours after surgery, 7-day National Institute of Health stroke scale (NIHSS) score: (OR = 1.15, 95% CI: 1.07∼1.23, P < 0.001), diabetes history: (OR = 9.60, 95% CI: 2.41∼38.26, P = 0.001), was independently associated with poor prognosis in patients with mTICI = grade 3 after endovascular therapy. Receiver operating characteristic curve analysis: NLR (area under the curve [AUC] = 0.687, 95% CI: 0.584∼0.790) at 24 hours after surgery, NIHSS (AUC = 0.826, 95% CI: 0.746∼0.906), and diabetes history (AUC = 0.667, 95% CI: 0.563∼0.771). Three-marker combined predictive indicators (AUC = 0.889, 95%CI: 0.829∼0.949) CONCLUSIONS: In patients with acute anterior large vascular occlusive stroke with mTICI = grade 3 after endovascular therapy, NIHSS score at 7 days after surgery, NLR within 24 hours after surgery, and history of diabetes were independent influencing factors for poor prognosis. Patients with a history of diabetes who had a NLR ≥6.7 within 24 hours and a NIHSS score ≥4.5 at 7 days after surgery were more likely to have a poor prognosis.

Radiologic and Blood Markers Predicting Long-Term Neurologic Outcome Following Decompressive Craniectomy for Malignant Ischemic Stroke: A Preliminary Single-Center Study

BACKGROUND

 Malignant ischemic stroke (MIS) is defined by progressive cerebral edema leading to increased intracranial pressure (ICP), compression of neural structures, and, eventually, death. Decompressive craniectomy (DC) has been advocated as a lifesaving procedure in the management of patients with MIS. This study aims to identify pre- and postoperative predictive variables of neurologic outcomes in patients undergoing DC for MIS.

METHODS

 We conducted a retrospective study of patients undergoing DC in a single center from April 2016 to April 2020. Preoperative workup included baseline clinical status, laboratory data, and brain computed tomography (CT). The primary outcome was the 6-month modified Rankin score (mRS). The secondary outcome was the 30-day mortality.

RESULTS

 During data capture, a total of 58 patients fulfilled the criteria for MIS, of which 22 underwent DC for medically refractory increased ICP and were included in the present analysis. The overall median age was 58.5 years. An immediate (24 hour) postoperative extended Glasgow Outcome Scale (GOSE) score ≥5 was associated with a good 6-month mRS (1-3; p = 0.004). Similarly, low postoperative neutrophils (p = 0.002), low lymphocytes (p = 0.004), decreased neutrophil-to-lymphocyte ratio (NLR; p = 0.02), and decreased platelet-to-lymphocytes ratio (PLR; p = 0.03) were associated with good neurologic outcomes. Preoperative variables independently associated with worsened 6-month mRS were the following: increased age (odds ratio [OR]: 1.10; 95% confidence interval [CI]: 1.01-1.20; p = 0.02), increased National Institutes of Health Stroke Scale (NIHSS) score (OR: 7.8; 95% CI: 2.5-12.5; p = 0.035), Glasgow Coma Scale (GCS) score less than 8 at the time of neurosurgical referral (OR: 21.63; 95% CI: 1.42-328; p = 0.02), and increased partial thromboplastin time (PTT) before surgery (OR: 2.11; 95% CI: 1.11-4; p = 0.02). Decreased postoperative lymphocytes confirmed a protective role against worsened functional outcomes (OR: 0.01; 95% CI: 0.01-0.4; p = 0.02). Decreased postoperative lymphocyte count was associated with a protective role against increased mRS (OR: 0.01; 95% CI: 0.01-0.4; p = 0.02). The occurrence of hydrocephalus at the postoperative CT scan was associated with 30-day mortality (p = 0.005), while the persistence of postoperative compression of the ambient and crural cistern showed a trend towards higher mortality (p = 0.07).

CONCLUSIONS

 This study reports that patients undergoing DC for MIS showing decreased postoperative blood inflammatory markers achieved better 6-month neurologic outcomes than patients with increased inflammatory markers. Similarly, poor NIHSS score, poor GCS score, increased age, and larger PTT values at the time of surgery were independent predictors of poor outcomes. Moreover, the persistence of postoperative compression of basal cisterns and the occurrence of hydrocephalus are associated with 30-day mortality.

A bibliometric analysis of electroencephalogram research in stroke: current trends and future directions

Background

Electroencephalography (EEG) has become an indispensable tool in stroke research for real-time monitoring of neural activity, prognosis prediction, and rehabilitation support. In recent decades, EEG applications in stroke research have expanded, particularly in areas like brain-computer interfaces (BCI) and neurofeedback for motor recovery. However, a comprehensive analysis of research trends in this domain is currently unavailable.

Methods

The study collected data from the Web of Science Core Collection database, selecting publications related to stroke and EEG from 2005 to 2024. Visual analysis tools such as VOSviewer and CiteSpace were utilized to build knowledge maps of the research field, analyzing the distribution of publications, authors, institutions, journals, and collaboration networks. Additionally, co-occurrence, clustering, and burst detection of keywords were analyzed in detail.

Results

A total of 2,931 publications were identified, indicating a consistent increase in EEG research in stroke, with significant growth post-2017. The United States, China, and Germany emerged as the leading contributors, with high collaboration networks among Western institutions. Key research areas included signal processing advancements, EEG applications in seizure risk and consciousness disorder assessment, and EEG-driven rehabilitation techniques. Notably, recent studies have focused on integrating EEG with machine learning and multimodal data for more precise functional evaluations.

Conclusion

The findings reveal that EEG has evolved from a diagnostic tool to a therapeutic support platform in the context of stroke care. The advent of deep learning and multimodal integration has positioned EEG for expanded applications in personalized rehabilitation. It is recommended that future studies prioritize interdisciplinary collaboration and standardized EEG methodologies in order to facilitate clinical adoption and enhance translational potential in stroke management.

Association of immunonutritional indicators with all-cause mortality in adult stroke patients

The study aimed to evaluate the relationship between immunonutritional indicators such as the systemic immune-inflammation index (SII), the Naples prognostic score (NPS), nutritional risk index (NRI), serum albumin (ALB), total cholesterol (TC) and all-cause mortality in adult stroke patients. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) databases for 2005-2018. To determine mortality outcomes, participants were matched with National Death Index records until December 31, 2019. Spearman's correlation analysis and the random survival forest (RSF) were employed to assess the relationships among NPS, NRI, SII, ALB, and TC, and to determine the most predictive indicator for all-cause mortality in stroke patients. For the selected prognostic indicator, Kaplan-Meier survival analysis and Cox proportional hazards regression models were subsequently utilized to evaluate their associations with all-cause mortality in stroke patients. The study included 1076 stroke patients, with a median (IQR) age of 67 (56, 77) years. During a median follow-up of 67 months, a total of 372 (weighted 31%) stroke participants died from all causes. Among the immunonutritional indicators evaluated, NPS had the strongest predictive power for all-cause mortality in stroke patients. The Kaplan-Meier curve and Log-rank test showed that all-cause mortality was higher in the higher NPS group (3-4) compared to the lower NPS group (0-2) (P < 0.001). After adjusting for multiple potential confounders, the Cox regression model indicated that the higher NPS (3-4) group remained an independent predictor for higher all-cause mortality risk (HR = 1.89, 95% CI 1.44-2.47, P < 0.001). As a comprehensive evaluation index of inflammation and nutrition, NPS is a powerful predictor of all-cause mortality in stroke patients.

CD4+ T cells in ischemic stroke: effects and therapeutic targets

Ischemic stroke (IS) is a significant contributor to disability and death worldwide, with limited treatments beyond early intervention. The importance of CD4+ T cells in the advancement of IS has been highlighted by recent studies, providing new insights into immunomodulatory strategies. This review describes the spatiotemporal dynamics of CD4+ T cells and their subsets at different stages of IS. The signaling pathways activated by IS regulate the distribution of CD4+ T cells and their subsets, which further influences the inflammatory response and disease progression. In the acute and subacute stages, CD4+ T cells exacerbate neuronal damage. In contrast, CD4+ T cells, which are predominantly composed of Treg cells (Tregs), promote tissue repair and neurological recovery in the chronic stage. In light of recent findings that challenge traditional views, we analyze the underlying mechanisms and potential explanations for these discrepancies. In addition, we summarize the potential of targeting CD4+ T cells as a therapeutic strategy for IS. Although no drugs specifically targeting CD4+ T cells have been developed, certain drugs that modulate CD4+ T cells show potential for IS treatment. Moreover, multitarget drugs integrated with nanomaterials are currently undergoing preclinical investigation. We further explore the challenges in the clinical translation of CD4+ T-cell-targeted therapies and discuss potential strategies to address these challenges. In conclusion, a deeper comprehension of the complex effects of CD4+ T cells and their subsets on IS will contribute to disease management and drug development, thereby improving the quality of life for IS patients.

St3gal5-mediated sialylation of glyco-CD177 on neutrophils restricts neuroinflammation following CNS injury

Neutrophils are the most abundant circulating leukocyte population that play critical roles in neuroinflammation following central nervous system (CNS) injury. CD177, a glycoprotein on neutrophils, is emerging as an important immune regulator which can fundamentally affect multiple human inflammatory diseases. However, the role and regulatory mechanism of CD177 glycobiology of neutrophils in neuroinflammation remain elusive. Here, we show that CD177+ neutrophils expand significantly and infiltrate the injured brain following CNS injury both in the human and mouse. Using single-cell RNA sequencing and genetic approaches, we find CD177+ neutrophils as an anti-inflammatory subset that is critical for modulating neuroinflammation after CNS injury. We further identify St3gal5, a sialyltransferase (ST), that can mediate the sialylation and cell surface presentation of glyco-CD177 on neutrophils. Glycoproteomics reveal downregulated sialylation levels in St3gal5-deficient neutrophils. Neutrophil-specific depletion of St3gal5 prevents the cell surface presentation of CD177 on brain-infiltrated neutrophils and exacerbates neuroinflammation. Administration of the FDA-approved anticonvulsant valproic acid (VPA), an St3gal5 upregulator, promotes the glycosylation of neutrophils and attenuates neuroinflammation following CNS injury. Our study reveals a glycoimmuno-regulatory effect of neutrophils and suggests VPA as a neutrophil glycobiology targeting approach to combat neuroinflammation following CNS injury.

Circulating Neutrophil-to-Lymphocyte Ratio Predicts Stroke-Associated Infection and Poststroke Fatigue Affecting Long-Term Neurological Outcomes in Stroke Patients

Background: Since peripheral leukocytes may contribute to the pathophysiology of stroke, the aim of this study was to elucidate the relationship between leukocytes and stroke outcomes and identify which leukocyte subtypes most accurately predict functional outcomes and poststroke fatigue (PSF) in stroke patients. Methods: A total of 788 ischemic stroke patients within 72 h of onset of disease were admitted in our study. Stroke-associated infection (SAI) and PSF were evaluated according to diagnosis standards by a special neurologist. Analyses were performed using SPSS 23.0 and GraphPad Prism 10.0. Results: Neutrophil-to-lymphocyte ratio (NLR) has discriminative power in predicting stroke outcome, and the area under the curve (AUC) of NLR to distinguish stroke outcomes was 0.689 (95% confidence interval, 0.646-0.732). Positive correlation was found between NLR levels and NIHSS score on admission (r = 0.2786, p < 0.001). Risk model for predicting stroke outcome was constructed using age, NIHSS, previous stroke history, triglycerides, glucose and hemoglobin levels, thrombolysis treatment, and NLR, with an AUC of 0.865. Patients who developed SAI and PSF both had significantly higher NLR levels at admission than those patients not diagnosed with SAI and PSF (p < 0.0001). A risk model was constructed to predict PSF based on parameters including age, NIHSS score, lipoprotein(a) and NLR, and an AUC of 0.751. Conclusions: Higher NLR levels in the acute phase of stroke might indicate a higher incidence of SAI and PSF. Therefore, higher NLR is associated with a poor stroke prognosis.

Inhalable Ce Nanozyme-Backpacked Phage Aims at Ischemic Cerebral Injury by M1-Microglia Hitchhiking

There is a desperate need for precise nanomedications to treat ischemic cerebral injury. Yet, the drawbacks of poor delivery efficiency and off-target toxicity in pathologic parenchyma for traditional antioxidants against ischemic stroke result in inadequate brain accumulation. M13 bacteriophages are highly phagocytosed by M1-polarized microglia and can be carried toward the neuroinflammatory sites. Here, a bio-active, inhalable, Ce0.9Zr0.1O2-backpacked-M13 phage (abbreviated as CZM) is developed and demonstrates how M13 bacteriophages are taken up by different phenotypes' microglia. With the M1 microglia's proliferating and migrating, CZM can be extensively and specifically delivered to the site of the ischemic core and penumbra, where the surviving nerve cells need to be shielded from secondary oxidative stress and inflammatory cascade initiated by reactive oxygen species (ROS). With non-invasive administration, CZM effectively alleviates oxidative damage and apoptosis of neurons by eliminating ROS generated by hyperactive M1-polarized microglia. Here, a secure and effective strategy for the targeted therapy of neuroinflammatory maladies is offered by this research.

Flavonoids in the regulation of microglial-mediated neuroinflammation; focus on fisetin, rutin, and quercetin

Neuroinflammation is a critical mechanism in central nervous system (CNS) inflammatory disorders, encompassing conditions such as Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), multiple sclerosis (MS), traumatic brain injury (TBI), encephalitis, spinal cord injury (SCI), and cerebral stroke. Neuroinflammation is characterized by increased blood vessel permeability, leukocyte infiltration, glial cell activation, and elevated production of inflammatory mediators, such as chemokines and cytokines. Microglia act as the resident macrophages of the central nervous system, serving as the principal defense mechanism in brain tissue. After CNS injury, microglia modify their morphology and downregulate genes that promote homeostatic functions. Despite comprehensive transcriptome analyses revealing specific gene modifications in "pathological" microglia, microglia's precise protective or harmful functions in neurological disorders remain insufficiently comprehended. Accumulating data suggests that the polarization of microglia into the M1 proinflammatory phenotype or the M2 antiinflammatory phenotype may serve as a sensible therapeutic strategy for neuroinflammation. Flavonoids, including rutin, fisetin, and quercetin, function as crucial chemical reservoirs with unique structures and diverse actions and are extensively used to modulate microglial polarization in treating neuroinflammation. This paper highlights the detrimental effects of neuroinflammation seen in neurological disorders such as stroke. Furthermore, we investigate their therapeutic benefits in alleviating neuroinflammation via the modulation of macrophage polarization.

Shuxuetong injection inhibits pyroptosis in acute ischemic stroke via CD44/NLRP3/GSDMD signal

ETHNOPHARMACOLOGICAL RELEVANCE

Acute ischemic stroke (AIS) is an important cause of death and disability in the world. Based on the blood stasis syndrome of stroke, Shuxuetong Injection (SXT) is a representative prescription for the treatment of AIS, which extracted by modern technology from Whitmania pigra Whitman (Shuizhi) and Pheretima aspergillum E.Perrier (Dilong).

AIM OF THE STUDY

This study is in order to examine whether SXT regulates pyroptosis in AIS via Cluster of Differentiation 44 (CD44)/NOD-like receptor thermal protein domain associated protein 3 (NLRP3)/gasdermin D (GSDMD) signal.

MATERIALS AND METHODS

The rats were randomly divided into sham group, model (transient middle cerebral artery occlusion, 24 h) group, SXT low-dose group (0.27 mL/kg), SXT medium-dose group (0.54 mL/kg), SXT high-dose group (1.08 mL/kg) and positive drug group (edaravone injection, 1.35 mL/kg). Transient middle cerebral artery occlusion (tMCAO, 24 h) model of rats was set up. Neurological deficit score, tetrazolium red staining, hematoxylin-eosin staining, and Nissl staining were used to observe and screen out the optimal dosage for improving AIS. Mechanism research indicators included transmission electron microscopy and Western blot. Adeno-associated virus (AAV)-CD44 and small interfering RNA (siRNA) of CD44 were used for knocking down the CD44 expression level to verify whether SXT could resist pyroptosis through CD44. The oxygen and glucose deprivation/re-oxygenation (OGD/R, 24 h) model of PC12 cells was used for in vitro pharmacological validation. Molecular docking, cellular thermal shift assay and drug affinity responsive target stability were employed to assess the binding affinity of critical components for the CD44 protein.

RESULTS

SXT conspicuously mitigated the neurological function scores and cerebral infarct volume in tMCAO rats, thereby safeguarding nerve cells. In vitro, SXT not only enhanced the viability of PC12 cells subjected to OGD/R but also mitigated cellular swelling and inflammatory infiltration. The optimal dose was 1.08 mL/kg (rats) or 72.56 mg/mL (PC12 cells). SXT reduced pyroptosis and inflammation in tMCAO rats and OGD/R cells by decreasing the expression levels of GSDMD-N, NLRP3 and CD44. In addition, after knocking down the expression level of CD44 by using AAV-CD44 and siRNA-CD44, it was found that the pyroptosis of AIS intervened by SXT was closely related to the CD44/NLRP3/GSDMD signal. The pivotal constituent of SXT, xanthine, exhibited pronounced binding affinity towards the CD44 protein, thereby demonstrating the capacity to stabilize this molecular target.

CONCLUSION

This study demonstrates that Shuxuetong Injection inhibits pyroptosis in acute ischemic stroke via CD44/NLRP3/GSDMD signal.

Association of neutrophil-to-lymphocyte ratio with stroke morbidity and mortality: evidence from the NHANES 1999-2020

Background

Stroke is closely linked to inflammation, with the neutrophil-to-lymphocyte ratio (NLR) emerging as a promising inflammatory marker. This study aims to investigate the association between NLR and both morbidity and mortality in stroke patients.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2020 were analyzed, including adults with complete neutrophil and lymphocyte count records. Multivariate logistic regression was used to examine the relationship between NLR and both stroke morbidity and all-cause mortality. Restricted cubic spline regression was employed to assess potential nonlinearity in these associations. Subgroup analyses were performed to identify influencing factors.

Results

After adjusting for confounders, the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for stroke in the higher NLR quartiles, compared to the lowest quartile, were 1.28 (1.07-1.52) and 1.36 (1.12-1.65), respectively. The restricted cubic spline curve indicated a nonlinear positive association between NLR and stroke risk. Additionally, an elevated NLR was positively associated with an increased risk of all-cause mortality.

Conclusion

The findings underscore the potential use of NLR in stratifying and predicting mortality risk in stroke patients, suggesting its relevance in clinical practice.

The Kidney-Immune-Brain Axis: The Role of Inflammation in the Pathogenesis and Treatment of Stroke in Chronic Kidney Disease

Cardiovascular diseases such as stroke are a major cause of morbidity and mortality for patients with chronic kidney disease (CKD). The underlying mechanisms connecting CKD and cardiovascular disease are yet to be fully elucidated, but inflammation is proposed to play an important role based on genetic association studies, studies of inflammatory biomarkers, and clinical trials of anti-inflammatory drug targets. There are multiple sources of both endogenous and exogenous inflammation in CKD, including increased production and decreased clearance of proinflammatory cytokines, oxidative stress, metabolic acidosis, chronic and recurrent infections, dialysis access, changes in adipose tissue metabolism, and disruptions in intestinal microbiota. This review focuses on the mechanisms of inflammation in CKD, dialysis and associated therapies, its proposed impact on stroke pathogenesis and prognosis, and the potential role of anti-inflammatory agents in the prevention and treatment of stroke in patients with CKD.

NLRP3 inflammasome in neuroinflammation and central nervous system diseases

Neuroinflammation plays an important role in the pathogenesis of various central nervous system (CNS) diseases. The NLRP3 inflammasome is an important intracellular multiprotein complex composed of the innate immune receptor NLRP3, the adaptor protein ASC, and the protease caspase-1. The activation of the NLRP3 inflammasome can induce pyroptosis and the release of the proinflammatory cytokines IL-1β and IL-18, thus playing a central role in immune and inflammatory responses. Recent studies have revealed that the NLRP3 inflammasome is activated in the brain to induce neuroinflammation, leading to further neuronal damage and functional impairment, and contributes to the pathological process of various neurological diseases, such as multiple sclerosis, Parkinson's disease, Alzheimer's disease, and stroke. In this review, we summarize the important role of the NLRP3 inflammasome in the pathogenesis of neuroinflammation and the pathological course of CNS diseases and discuss potential approaches to target the NLRP3 inflammasome for the treatment of CNS diseases.

Siegesbeckia orientalis ethanol extract impedes RAGE-CD11b interaction driven by HMGB1 to alleviate neutrophil-involved neuronal injury poststroke

BACKGROUND

Ischemic stroke is a life-threatening cerebrovascular disease with limited therapeutic options. During the progression of acute ischemic stroke (AIS), neutrophil-involved inflammation mediated by high mobility group box 1 (HMGB1) considerably contributes to intensification of neuronal injury. Siegesbeckia orientalis L. (SO), one of the primary sources of Sigesbeckiae Herba, is promising in anti-neuroinflammation and neutrophil function modulation. Consequently, it is supposed that SO could fight against neuronal inflammatory injury following AIS.

PURPOSE

The current study struggles to explore the ameliorative effects of ethanol extract of SO (EESO) on neuronal inflammatory injury following AIS, and dissect the related mechanisms focusing on HMGB1-driven neutrophil recruitment and neutrophil extracellular traps (NETs) generation.

METHODS

Murine photothrombotic stroke model was established to evaluate the ameliorative effects of EESO administration against AIS. Histopathological examination and immunofluorescence staining were conducted for the observation of cerebral neuronal injury, neutrophil infiltration and NETs generation. Additionally, inflammatory indexes and serum HMGB1 levels were also detected through qPCR and ELISA, respectively. In vitro, the effects of EESO-containing serum administration on neutrophil migration and NETs generation were also assessed. HMGB1-overexpressed mimic transfection, cellular thermal shift assay and coimmunoprecipitation were employed to investigate whether the compounds from EESO-containing serum targeted HMGB1 to block the receptor for advanced glycation end products (RAGE)-CD11b interaction. Furthermore, potential active compounds of EESO targeting HMGB1 were screened and verified.

RESULTS

EESO administration alleviated photochemically induced murine AIS as revealed by remarkably reducing infract volume as well as improving cerebral blood flow and neurological functions. Moreover, EESO administration prominently mitigated secondary neuronal injury, restrained neutrophil infiltration and NETs generation, as well as lowered the levels of serum pro-inflammatory mediators and HMGB1. In vitro, the compounds in EESO-containing serum directly interacted with neuron-derived HMGB1. HMGB1-driven neutrophil migration and NETs generation through the RAGE-CD11b interaction were also reversed by EESO-containing serum administration. Additionally, isoimperatorin, 4,7-dimethyltetral-1-one, perillartine and darutigenol, as the active components, contributed to the suppressive effects of EESO on neutrophil migration and NETs generation driven by HMGB1.

CONCLUSION

In the present study, it was demonstrated that HMGB1 promoted interaction between CD11b and RAGE to drive NETs generation for the first time. Furthermore, EESO was proved to target neuron-derived HMGB1 to inhibit neutrophil infiltration and NETs generation against neuronal inflammatory injury poststroke, which was attributed to the components absorbed in the blood including isoimperatorin, 4,7-dimethyltetral-1-one, perillartine and darutigenol.

Mitochondrial Transplantation via Magnetically Responsive Artificial Cells Promotes Intracerebral Hemorrhage Recovery by Supporting Microglia Immunological Homeostasis

The immune-inflammatory responses in the brain represent a key therapeutic target to ameliorate brain injury following intracerebral hemorrhage (ICH), where pro-inflammatory microglia and its mitochondrial dysfunction plays a pivotal role. Mitochondrial transplantation is a promising strategy to improve the cellular mitochondrial function and thus modulate their immune properties. However, the transplantation of naked mitochondria into the brain has been constrained by the peripheral clearance and the difficulty in achieving selective access to the brain. Here, a novel strategy for mitochondrial transplantation via intravenous injection of magnetically responsive artificial cells (ACs) are proposed. ACs can protect the loaded mitochondria and selectively accumulate around the lesion under an external magnetic field (EMF). In this study, mitochondria released from ACs can effectively improve microglial mitochondrial function, attenuate their pro-inflammatory attributes, and elevate the proportion of immunosuppressive microglia. In this way, microglia immune homeostasis in the brain is reestablished, and inflammation is attenuated, ultimately promoting functional recovery. This study presents an effective approach to transplant mitochondria into the brain, offering a promising alternative to modulate the immune-inflammatory cascade in the brain following ICH.

Advances in brain ischemia mechanisms and treatment approaches: Recent insights and inflammation-driven risks

The application of existing radical treatments for stroke is limited to a small number of cases, with current practices predominantly focusing on conservative therapy. This review examines the pathophysiology of excitotoxicity, oxidative stress, and inflammation during brain ischemia caused by stroke, highlighting insights into each pathology and reporting the latest therapeutic developments that are expected to serve as new treatment options. Finally, we outline the recent attention given to the relationship between periodontal disease and stroke. We propose addressing the limitations of existing treatments for stroke and suggest novel therapeutic approaches while also presenting the potential contribution of periodontal disease treatment to the prevention of stroke.

miRNA506 Activates Sphk1 Binding with Sirt1 to Inhibit Brain Injury After Intracerebral Hemorrhage via PI3K/AKT Signaling Pathway

Intracerebral hemorrhage (ICH) is an acute neurological disorder characterized by high mortality and disability rates. Previous studies have shown that 75% of patients who survive ICH experience varying degrees of neurological deficits. Sphk1 has been implicated in a multitude of phylogenetic processes, including innate immunity and cell proliferation. An in vivo rat model of ICH and an in vitro model of neuronal oxyhemoglobin (OxyHb) were constructed. The expression level of Sphk1 was assessed using western blotting and immunofluorescence, whereas cell death following ICH was evaluated using fluoro-Jade B and terminal deoxynucleotidyl transferase dUTP nick end labeling staining. Immunofluorescence facilitated the examination of microglial phenotypic alterations, while enzyme-linked immunosorbent assays were used to determine the concentrations of inflammatory markers. Behavioral assays were employed to assess the overall behavioral modifications of animals. Neuronal Sphk1/Sirt1 protein levels gradually increased following the induction of ICH. Elevated Sphk1 expression resulted in increased levels of anti-inflammatory microglia and reduced levels of pro-inflammatory factors. In contrast, suppression of Sphk1 expression resulted in an increased number of dead cells, thereby exacerbating neurological deficits. In vitro findings indicated that the levels of phosphorylated PI3K and AKT proteins increased in conjunction with Sphk1 expression. This study established that after ICH, Sphk1 interacts with Sirt1 to mitigate neuroinflammation, cell death, oxidative stress, and brain edema via the PI3K/AKT signaling pathway. Augmenting expression of Sphk1 significantly can ameliorate neurological impairments induced by ICH, offering novel targets and perspectives for therapeutic interventions in ICH treatment.

Single-Cell Transcriptomes of Immune Cells from Multiple Compartments Redefine the Ontology of Myeloid Subtypes Post-Stroke

The activation and infiltration of immune cells are hallmarks of ischemic stroke. However, the precise origins and the molecular alterations of these infiltrating cells post-stroke remain poorly characterized. Here, a murine model of stroke (permanent middle cerebral artery occlusion [p-MCAO]) is utilized to profile single-cell transcriptomes of immune cells in the brain and their potential origins, including the calvarial bone marrow (CBM), femur bone marrow (FBM), and peripheral blood mononuclear cells (PBMCs). This analysis reveals transcriptomically distinct populations of cerebral myeloid cells and brain-resident immune cells after stroke. These include a novel CD14+ neutrophil subpopulation that transcriptomically resembles CBM neutrophils. Moreover, the sequential activation of transcription factor regulatory networks in neutrophils during stroke progression is delineated, many of which are unique to the CD14+ population and underlie their acquisition of chemotaxis and granule release capacities. Two distinct origins of post-stroke disease-related immune cell subtypes are also identified: disease inflammatory macrophages, likely deriving from circulating monocytes in the skull, and transcriptionally immature disease-associated microglia, possibly arising from pre-existing homeostatic microglia. Together, a comprehensive molecular survey of post-stroke immune responses is performed, encompassing both local and distant bone marrow sites and peripheral blood.

Mild hypercapnia before reperfusion reduces ischemia-reperfusion injury in hyperacute ischemic stroke rat model

Endovascular thrombectomy has a recanalization rate over 80%; however, approximately 50% of ischemic stroke patients still experience dependency or mortality. Recently, clinical trials demonstrated the benefits of administering neuroprotective agents prior to endovascular thrombectomy. Additionally, recent studies showed neuroprotective effects of mild hypercapnia in patients resuscitated after cardiac arrest. However, its efficacy in ischemic stroke remains unclear. We aimed to investigate whether carbon dioxide (CO2) per-conditioning has neuroprotective effects in rat models with middle cerebral artery occlusion (MCAO). Rat models received intermittent inhalation of mixed gas during the MCAO period. After surgery, behavioral assessments, infarct size measurement, immunohistochemistry, and western blot analysis were performed. We found CO2 per-conditioning reduced infarct size and neurological deficit. The number of 8-hydroxy-2-deoxyguanosine (8-OHdG) positive cells and matrix metalloproteinase 9 (MMP-9)/platelet derived growth factor receptor beta (PDGFRβ) double positive cells were significantly decreased after CO2 per-conditioning. The expressions of tight junction protein and pericytes survival were preserved. This study underscores mild hypercapnia before reperfusion not only reduces neurologic deficit and infarct size, but also maintains the integrity of the blood-brain barrier and neurovascular unit, alongside mitigating oxidative stress in hyperacute stroke rat models. Therapeutic mild hypercapnia before reperfusion is promising and requires further clinical application.

SERPINA3 predicts long-term neurological outcomes and mortality in patients with intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is a severe stroke subtype with high mortality and disability rates, and long-term outcomes among survivors remain unpredictable due to the lack of reliable biomarkers. In this study, spatial transcriptomics was used to analyze molecular profiles in autopsy brain tissues from chronic ICH patients, revealing distinct transcriptomic features in the thalamus and cortex, with common inflammatory characteristics such as gliosis, apoptosis, and immune activation. Serine proteinase inhibitor NA3 (SERPINA3) was significantly upregulated in both regions and co-expressed with astrocytes in the thalamus. Pathological studies in postmortem human tissues and mouse models confirmed elevated SERPINA3 expression, with murine Serpina3n showing a similar pattern in mice. Plasma analysis of 250 ICH patients and 250 healthy controls revealed significantly higher SERPINA3 levels in ICH patients, correlating with hemorrhage severity, National Institutes of Health Stroke Scale (NIHSS), and Glasgow Coma Scale (GCS) scores, and long-term functional outcomes. Higher SERPINA3 levels within 72 hours of hemorrhage onset were independently associated with worse functional recovery (mRS ≥ 3) and increased all-cause mortality at 6 and 12 months. Additionally, SERPINA3 levels at 7 days post-ictus correlated with white matter hyperintensities and poor cognitive performance at 6 months. These findings highlight SERPINA3 as a potential prognostic biomarker for ICH, warranting further investigation into its role in long-term neurological dysfunction and validation in larger prospective cohorts.

Extracellular Vesicles as a Potential Therapy for Stroke

Although thrombolytic therapy has enjoyed relative success, limitations remain, such as a narrow therapeutic window and inconsistent efficacy. Consequently, there is a pressing need to develop novel therapeutic approaches. In recent years, extracellular vesicles (EVs) have garnered increasing attention as a potential alternative to stem cell therapy. Because of their ability to cross the blood-brain barrier and exert neuroprotective effects in cerebral ischemia and hemorrhage, the exploration of EVs for clinical application in stroke treatment is expanding. EVs are characterized by high heterogeneity, with their composition closely mirroring that of their parent cells. This property enables EVs to distinguish between cerebral ischemia and hemorrhage, thus facilitating a more rapid and accurate diagnosis. Additionally, EVs can be engineered to carry specific molecules, such as miRNAs, targeting them to specific cells, potentially enhancing the therapeutic outcome and improving stroke prognosis. In this review, we will also explore the methodologies for the isolation and extraction of EVs, critically evaluating the advantages and disadvantages of various commonly employed separation techniques. Furthermore, we will briefly address current EV preservation and administration methods, providing a comprehensive overview of the state of EV-based therapies in stroke treatment.

Hydroxysafflower yellow A alleviates the inflammatory response in astrocytes following cerebral ischemia by inhibiting the LCN2/STAT3 feedback loop

Lipocalin-2 (LCN2), an acute phase protein mainly expressed in astrocytes (Ast), is closely related to the production of inflammatory cytokines following ischemic stroke. During the pathophysiological process of ischemic stroke, the Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway is activated. Despite evidence suggesting some link between the two, the relationship between the JAK2/STAT3 signaling pathway and the LCN2 expression in Ast following brain ischemia is incompletely understood. Hydroxysafflower yellow A (HSYA), an active ingredient found in Carthamus tinctorius L flowers, has been demonstrated to effectively mitigate cerebral ischemia via its anti-inflammatory effect. However, whether HSYA mitigates the neuroinflammatory damage after ischemic stroke by disrupting the interaction between the JAK2/STAT3 signaling pathway and LCN2 in Ast is unknown. Focusing on these two scientific questions, we established an in vivo middle cerebral artery occlusion/reperfusion (MCAO/R) rat model and in vitro primary astrocyte oxygen glucose deprivation/reperfusion (OGD/R) model. In vivo results showed that HSYA treatment alleviated nerve damage and inhibited the expression of LCN2 and inflammatory factors in Ast. In vitro results showed after OGD/R the expression of LCN2 and inflammatory cytokines increased and the JAK2/STAT3 was activated in Ast. Meanwhile, after OGD/R the JAK2/STAT3 activation in Ast increased LCN2 expression, and the inhibition of LCN2 expression by HSYA decreased the JAK2/STAT3 activation in Ast. These findings suggest that there is an interaction between the LCN2 and JAK2/STAT3 in Ast after ischemic stroke, which can enhance the inflammatory factors and exacerbate neuroinflammatory injury. Therefore, we conclude that HSYA may inhibit the LCN2/STAT3 loop in Ast, thereby mitigating neuroinflammation after cerebral ischemia.

Stroke with White Matter Lesions: Potential Pathophysiology and Therapeutic Targets

Stroke is one of the most common causes of morbidity and mortality among adults globally. Significant advancements have been made in elucidating its pathophysiology, with stroke categorized into pathological subtypes, such as ischemic stroke (IS) and hemorrhagic stroke. White matter lesions (WMLs) identified on magnetic resonance imaging rank as a hallmark of cerebral small vessel disease and are associated with vascular risk factors. They are linked to adverse outcomes like dementia, depression, and an increased risk of both first-ever and recurrent strokes, independent of other risk factors. Despite the evidence indicating the close link between WMLs and stroke, their underlying pathophysiological relationship remains unclear. This study aims to provide an overview of the current knowledge and recent advances in epidemiology, risk factors, and pathophysiological mechanisms of WMLs and stroke, focusing on their interconnection and emerging therapeutic targets.

Rationale and Study Design to Assess the Efficacy and Safety of Minocycline in Patients with Moderate to Severe Acute Ischaemic Stroke (EMPHASIS)

BACKGROUND

Inflammation and blood-brain barrier disruption may contribute to the pathogenesis of ischaemic stroke. Minocycline was shown to exert anti-inflammatory effects by attenuating microglial activation and protecting blood-brain barrier in preclinical studies. Previous small-scale clinical studies have suggested that minocycline may have a potential beneficial effect on prognosis in acute ischaemic stroke. However, the efficacy and safety of minocycline in patients with acute ischaemic stroke need to be further confirmed.

STUDY AIMS

We designed the study, Efficacy and Safety of Minocycline in Patients with Moderate to Severe Acute Ischaemic Stroke (EMPHASIS), to evaluate the effect of minocycline in improving the functional outcome and the drug safety in patients with acute ischaemic stroke.

METHODS

The EMPHASIS study is a multicentre, randomised, double-blind, placebo-controlled trial aiming to recruit patients with acute ischaemic stroke. Patients who had ischaemic stroke within 72 hours of onset, a National Institutes of Health Stroke Scale score between 4 and 25 and Ia≤1 (moderate-to-severe) will be randomly allocated to either minocycline or placebo groups in a 1:1 ratio. Patients will receive minocycline (or placebo) with a loading dose of 200 mg, and subsequent 100 mg every 12 hours for 4 days. All patients will receive routine guideline-based treatment. The primary efficacy outcome is an excellent functional outcome assessed by the proportion of modified Rankin Scale score of 0-1 at 90±7 days. The main safety outcomes include the number of symptomatic intracranial haemorrhage at 24±2 hours and 6±1 days.

DISCUSSION

The EMPHASIS trial is the first phase III trial to investigate whether minocycline is effective and safe in improving functional outcome at 90 days in patients with moderate-to-severe acute ischaemic stroke. The data generated may provide valuable evidence of a potential anti-inflammation treatment for ischaemic stroke.

Cardio-cerebral infarction: a narrative review of pathophysiology, treatment challenges, and prognostic implications

Cardio-cerebral infarction (CCI) is a rare clinical syndrome characterized by the simultaneous or sequential occurrence of acute myocardial infarction (AMI) and acute ischemic stroke (AIS). Despite its complex pathogenesis and more severe prognosis compared to isolated AMI or AIS, no consensus has been established regarding its definition, classification, epidemiology, treatment protocols, or prognostic management. Current research is largely confined to case reports or small case series, and there are no unified diagnostic or treatment guidelines, nor any expert consensus. Consequently, clinicians often rely on single-disease guidelines for AMI or AIS, or personal experience, when managing CCI cases. This approach complicates treatment decisions and may result in missed opportunities for optimal interventions, thereby adversely affecting long-term patient outcomes. This narrative review aimed to systematically summarize the definition, classification, epidemiological features, pathogenesis and therapeutic strategies, and prognostic aspects of CCI while thoroughly examining the progress and limitations of existing studies to guide future research and clinical practice. By offering a detailed analysis of reperfusion strategies, antiplatelet therapy, and anticoagulation in CCI patients, this review highlights the safety and efficacy differences among current treatments and explores methods for optimizing individualized management to improve clinical outcomes. Furthermore, this article aimed to enhance clinicians' understanding of CCI, provide evidence-based recommendations for patient care, and outline directions for future research. Ultimately, by refining diagnostic and therapeutic strategies, we aimed to reduce CCI-related mortality and improve long-term prognoses for affected patients.

The Role of IL-6 in Ischemic Stroke

The pathophysiology of a stroke is a complex process involving oxidative stress and inflammation. As a result of the actions of reactive oxygen species (ROS), not only does vascular damage occur, but the brain tissue is also damaged. It is a dynamic process, induced by a cellular-molecular immune response, focused on the development of an immediate reaction. During ischemia, inflammatory mediators are released, among which IL-6 plays a particularly important role in the acute phase of a stroke. Recently, a lot of attention has been devoted to this pleiotropic pro-inflammatory cytokine, which enhances the migration of leukocytes and is controlled by chemokines and the expression of adhesion handlers. The impact of IL-6 on the severity of neurological treatment and on patient prognosis in AIS is of interest to many researchers. More and more data indicate that it may be a reliable prognostic factor in strokes.

Comparison of the Predictive Value of Neutrophil Percentage-to-Albumin Ratio and Modified Glasgow Prognostic Score for the Risk of Stroke-Associated Pneumonia Among Stroke Patients

Objective

To assess the predicting value of neutrophil percentage-to-albumin ratio (NPAR) and modified Glasgow Prognostic Score (mGPS) for Stroke-Associated Pneumonia (SAP) occurrence among stroke patients.

Methods

We recruited stroke patients (aged 18 years) hospitalized at Tianjin First Central Hospital from January 2022 to February 2023 for this retrospective cohort study. NPAR was categorized into four groups by considering the quartiles: Q1 (<1.38), Q2 (≥1.38 and <1.62), Q3 (≥1.62 and <1.87), Q4 (≥1.87). SAP incident was the primary outcome in this study. Univariate and multivariate logistic regression models were employed to explore the association between NPAR, mGPS and SAP occurrence among individuals with stroke. Besides, we compared the predicting value of NPAR and mGPS for SAP occurrence by the receiver operating characteristic (ROC) curve.

Results

Our study encompassed 851 patients with stroke. One hundred and forty-seven patients (17.27%) developed SAP. After accounting for confounding factors, we observed significant positive association of high NPAR with SAP occurrence [(for the third quartile: odds ratio (OR)=2.35, 95% confidence interval (CI): 1.01-5.47; for the fourth quartile: OR=3.35, 95% CI: 1.44-7.77)]. Additionally, the results also indicated that mGPS 1 (OR=2.26, 95% CI: 1.25-4.08) and mGPS 2 (OR=7.37, 95% CI: 2.63-20.70) were related to the increased probability of SAP, respectively. ROC analysis demonstrated that both the NPAR [area under the curve (AUC)=0.729, 95% CI: 0.687-0.771] and mGPS (AUC=0.671, 95% CI: 0.627-0.716) exhibited good predictive power for SAP occurrence. Based on the DeLong test, the predictive value of NPAR for SAP may be significantly superior to that of mGPS (P<0.05).

Conclusion

Our findings suggest that both NPAR and mGPS serve as reliable biomarker for assessing SAP risk in stroke patients, with NPAR demonstrating superior predictive value for SAP compared to mGPS.

Lipid droplets deposition in perihematoma tissue is associated with neurological dysfunction after intracerebral hemorrhage

Secondary brain injury following intracerebral hemorrhage (ICH) significantly reduces patients' quality of life due to impaired neurological function. Lipid droplets are implicated in secondary brain injury in various central nervous system diseases. Thus, the role and mechanisms of lipid droplets in secondary brain injury post-ICH require further investigation. We analyzed the changes of genes related to lipid metabolism in brain tissue of ICH mice. Lipid droplets around the hematoma were detected by BODIPY staining. Mice received intraperitoneal injections of Triacsin C (10 mg/kg, once daily) after ICH. Subsequently, neuronal damage was evaluated using TUNEL and Nissl staining, and ethological tests assessed sensorimotor function. After ICH, notable changes occurred in lipid metabolism pathways and genes (Plin2, Ucp2, Apoe), and a large number of lipid droplets accumulated around the hematoma. Triacsin C significantly reduced lipid droplets deposition, decreased neuronal damage, and improved sensory and motor functions. Peripheral administration to prevent lipid droplets formation can greatly reduce nerve damage and enhance nerve function. Our findings indicate that targeting lipid droplets could be a promising treatment for ICH.