Neuropathological hallmarks during the chronic phase of ischemic stroke in mice and humans

BackgroundImprovements in acute stroke treatment, including endovascular thrombectomy and critical care management, have increased survival rates post-stroke. However, stroke remains a leading cause of long-term disability and many survivors have significant neurological and cognitive deficits. Despite this, the chronic neurological sequelae and underlying secondary injury mechanisms induced by ischemic stroke remain understudied. MethodsThis study examined long-term neurobehavioral recovery and neuropathology at 2- and 6- months post-stroke in young (12-week-old) male C57Bl/6 mice after a 60-minute transient middle cerebral artery occlusion (MCAO) or sham surgery. Behavioral testing included the open field test (OFT), novel object recognition test (NORT), fear conditioning (FC), nesting activity, and tail suspension. Post-mortem brain samples from patients with chronic ischemic stroke were also assessed. Immunohistochemistry (IHC) was performed to assess demyelination (MBP), neuronal apoptosis (TUNEL), and A{beta}42 in human brains. Flow cytometric analysis was performed to assess microglial phenotypes, the chronic neuroimmune landscape, and to evaluate senescent-like phenotypes (SA-{beta}Gal and lipofuscin). Transcriptomic profiling was performed using RNA isolated from the ipsilateral hemisphere in stroke mice. ResultsExperimental stroke caused progressive cognitive and motor decline up to 6 months post-MCAO. IHC and flow cytometric analyses revealed a significant increase in TUNEL-positive neurons, cortical and hippocampal gliosis, white matter degradation, senescent cell accumulation, and altered microglial function. IHC analysis of postmortem human brains shows significantly increased levels of microgliosis, senescent cells and amyloid burden. Transcriptomic analysis revealed that pathways involving apoptosis, microglial activation and the complement pathway were chronically upregulated after stroke. ConclusionOur findings demonstrate that ischemic stroke induces a non-resolving microglial response and accelerated inflamm-aging in the brain, evidenced by premature senescence and elevated production of cytokines within the chronic infarct microenvironment. Senescent-like phenotypes and chronic neurodegenerative disease signatures may contribute to the progressive worsening of cognitive function post-stroke. These results suggest that chronic, ongoing neurodegeneration occurs late after stroke, even in younger mice. Mitigating these detrimental changes may offer viable targets for delayed treatment strategies for stroke.