Epha4/Tie2 Crosstalk Regulates Leptomeningeal Collateral Remodeling Following Ischemic Stroke

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Epha4/Tie2 Crosstalk Regulates Leptomeningeal Collateral Remodeling Following Ischemic Stroke EphA4/Tie2 crosstalk regulates leptomeningeal collateral remodeling following ischemic stroke Benjamin Okyere, … , John B. Matson, Michelle H. Theus J Clin Invest. 2019. https://doi.org/10.1172/JCI131493. Research In-Press Preview Neuroscience Vascular biology Leptomeningeal anastomoses or pial collateral vessels play a critical role in cerebral blood flow (CBF) restoration following ischemic stroke. The magnitude of this adaptive response is postulated to be controlled by the endothelium, although the underlying molecular mechanisms remain under investigation. Here we demonstrated that endothelial genetic deletion, using EphA4f/f/Tie2-Cre and EphA4f/f/VeCahderin-CreERT2 mice and vessel painting strategies, implicated EphA4 receptor tyrosine kinase as a major suppressor of pial collateral remodeling, CBF and functional recovery following permanent middle cerebral artery occlusion. Pial collateral remodeling is limited by the cross talk between EphA4-Tie2 signaling in vascular endothelial cells, which is mediated through p-Akt regulation. Furthermore, peptide inhibition of EphA4 resulted in acceleration of the pial arteriogenic response. Our findings demonstrate EphA4 is a negative regulator of Tie2 receptor signaling which limits pial collateral arteriogenesis following cerebrovascular occlusion. Therapeutic targeting of EphA4 and/or Tie2 represents an attractive new strategy for improving collateral function, neural tissue health and functional recovery following ischemic stroke. Find the latest version: https://jci.me/131493/pdf 1 EphA4/Tie2 Crosstalk Regulates Leptomeningeal Collateral Remodeling Following Ischemic Stroke 2 3 Benjamin Okyere1, William A. Mills III4, Xia Wang1, Michael Chen1, Jiang Chen1, Amanda Hazy1, Yun Qian3,6, John B. 4 Matson2,6 and Michelle H. Theus*1,4,5 5 6 1Department of Biomedical Sciences and Pathobiology, Virginia Tech, Blacksburg, VA 24061, USA 7 2Department of Chemistry, Virginia Tech, Blacksburg, VA 24061, USA 8 3Department of Mechanical Engineering, Virginia Tech, Blacksburg VA 24061, USA 9 4School of Neuroscience, Virginia Tech, Blacksburg VA 24061, USA 10 5Center for Regenerative Medicine, VT College of Veterinary Medicine, Blacksburg, Virginia, 24061, USA 11 6Center for Drug Discovery, Virginia Tech, Blacksburg, Virginia, 24061, USA 12 7Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA 24061 13 14 Running Title: EphA4 negatively regulates collateral remodeling after stroke 15 Keywords: vessel painting, neuroprotection, KYL, angiopoietin-2, tie2 receptor, cerebral blood flow, p-Akt 16 Corresponding author: 17 Michelle H. Theus, Ph.D. 18 Associate Professor 19 Department of Biomedical Sciences and Pathobiology 20 College of Veterinary Medicine, Virginia Tech 21 970 Washington Street SW (MC0910) 22 Blacksburg, VA 24061 23 Tel. 540-231-0909; Fax 540-231-7425; E-mail: [email protected] 24 25 Key words: ischemia, vascular biology, angiopoietin, Tie2 26 27 Abbreviations: VP, vessel painting; pMCAO, permanent middle cerebral artery occlusion; KYL, 28 KYLPYWPVLSSL 29 30 31 Conflict of interest statement: The authors have declared that no conflict of interest exists. 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 1 1 Abstract 2 3 Leptomeningeal anastomoses or pial collateral vessels play a critical role in cerebral blood flow (CBF) restoration 4 following ischemic stroke. The magnitude of this adaptive response is postulated to be controlled by the 5 endothelium, although the underlying molecular mechanisms remain under investigation. Here we demonstrated 6 that endothelial genetic deletion, using EphA4f/f/Tie2-Cre and EphA4f/f/VeCahderin-CreERT2 mice and vessel 7 painting strategies, implicated EphA4 receptor tyrosine kinase as a major suppressor of pial collateral remodeling, 8 CBF and functional recovery following permanent middle cerebral artery occlusion. Pial collateral remodeling 9 is limited by the cross talk between EphA4-Tie2 signaling in vascular endothelial cells, which is mediated through 10 p-Akt regulation. Furthermore, peptide inhibition of EphA4 resulted in acceleration of the pial arteriogenic 11 response. Our findings demonstrate EphA4 is a negative regulator of Tie2 receptor signaling which limits pial 12 collateral arteriogenesis following cerebrovascular occlusion. Therapeutic targeting of EphA4 and/or Tie2 13 represents an attractive new strategy for improving collateral function, neural tissue health and functional 14 recovery following ischemic stroke. 15 16 2 17 Introduction 18 Ischemic stroke results in significant cerebral blood flow (CBF) loss to brain regions predominately served 19 by the middle cerebral artery, leading to cell death and neural tissue dysfunction. However, restoration of CBF 20 may occur through developmentally regulated adaptations to the vascular network called, leptomeningeal 21 anastomoses or pial collateral vessels which provide retrograde reperfusion to vulnerable tissue regions. This 22 phenomenon is essential for preventing or reducing the consequences of an ischemic attack, however, the 23 molecular mechanism(s) regulating the patient-specific pial collateral response remains understudied. While 24 tissue plasminogen activator (tPA) and/or Alteplase remains the gold standard for stroke therapy it is not effective 25 in large vessel occlusions (LVO) or when treatment is started prior to 4.5 hours post-ischemic attack (1, 2) or 9 26 hours in select patients (3). Recently, the use of endovascular thrombectomy has improved outcomes and extended 27 the therapeutic window (4-7). In fact, it has been reported that endovascular thrombectomy has extended the 28 treatment window up to at least 24 hours (8). Extension of this window due to pial collateral-mediated reperfusion 29 enables CBF to maintain tissue protection in the penumbra region. Thus, improving our basic understanding of 30 how collateral vessels remodel will allow us to better diagnose and treat patients with divergent responses. 31 The extent of collateral-mediated reperfusion has a major impact on preserving the penumbra and often 32 dictates stroke outcome (9-13). Several studies have demonstrated that the outcome after thrombolysis and 33 thrombectomy therapy is highly dependent on patient collateral scoring (14-19). Patients with high collateral 34 function also have higher reperfusion rates after rtPA therapy and a lower risk for symptomatic bleeding after 35 reperfusion therapy (20). Pharmacological targeting of the pial collateral network therefore represents a viable 36 therapeutic option to improve outcomes following embolic stroke by sustaining penumbral blood flow and 37 preserving neural tissue health. The middle cerebral arteries (MCA), anterior cerebral arteries (ACA) and 38 posterior cerebral arteries (PCA) anastomose at their distal ends to form the MCA-ACA and MCA-PCA collateral 39 vessels (21). Collateral vessels do not show a proximal-to-distal axis with respect to blood flow rather they 40 connect two arterial branches with opposing flow. Therefore, collateral blood flow is bi-directional along the 41 collateral vessel wall (22). Following an obstruction, collateral vessels undergo immense vascular restructuring 3 42 and remodeling (enlargement), also called arteriogenesis, to allow for uni-directional retrograde blood reperfusion 43 into the area of an occluded arterial branch (22, 23). 44 Although the benefits of targeting the collateral system are evident, further research is essential to 45 elucidate the mechanism(s) underlying this remarkable tissue saving adaptation. Collateral remodeling is initiated 46 when mechanoreceptors on endothelial cells (ECs) detect fluid shear stress after an occlusion (24-26). Thus, the 47 endothelial cells comprised within the collateral niche may perform essential duties during the active remodeling 48 process. Recently, we implicated EphA4 receptor tyrosine kinase in limiting collateral formation and recovery 49 from hindlimb ischemia following femoral artery ligation (FAL) (27). The current study demonstrates that ECs 50 are central to pial collateral remodeling after ischemic stroke and the presence of EphA4 suppresses their growth 51 properties in vitro and in vivo by acting as an inhibitor of the Akt/Tie2 receptor-signaling pathway. These findings 52 greatly improve our understanding of the cellular and molecular mechanism(s) involved in pial collateral 53 remodeling following vascular obstruction. 54 55 Results 56 EphA4f/f/Tie2-Cre knockout (KO) mice show improved CBF, neural tissue and behavioral recovery 57 following pMCAO 58 In the current study, we used EphA4f/f/Tie2-Cre knockout (KO) mice to evaluate changes in cerebral blood flow 59 (CBF) following acute ischemic stroke and subsequent outcomes compared to EphA4f/f wild type (WT) mice. 60 Vascular recombination was confirmed using Tie2-Cre/ROSAmTmG reporter mice (supplemental Fig. 1) and as 61 previously described (27). CBF was measured by Laser Doppler prior to and at 5 minutes (m), 1-4 days (d) post- 62 pMCAO in the ipsilateral hemisphere and the perfusion units quantified and represented relative to baseline pre- 63 injury CBF (Fig. 1A-1B). No significant difference in CBF was observed at 5m post-pMCAO between WT and 64 KO mice (relative PFUs: 0.532 ± 0.026 vs 0.502 ± 0.034). However, we observed a significantly increase in CBF 65 at 1d (0.87 ± 0.05 vs 0.69 ± 0.05), 2d (0.94 ± 0.06 vs 0.73 ± 0.05), 3d (0.95 ± 0.05 vs 0.79 ± 0.06) and 4d (0.97 ± 66 0.04 vs 0.82 ± 0.04) in KO compared to WT mice. These findings correlated
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