Head-down position after reperfusion improves cerebral ischaemic injury in rat.

Background and aims: Preclinical and clinical studies found that head-down position (HDP) during ischaemic phase improved neurological function of acute ischaemic stroke, but the effect of HDP after reperfusion has never been investigated. This study aimed to investigate whether HDP after reperfusion can ameliorate cerebral ischaemic injury in rats.

Methods: The middle cerebral artery occlusion/reperfusion (MCAO/R) model was established in rats, and different HDP interventions were performed. Survival rate, haemorrhage transformation rate, neurological deficit scores, infarct volume, weight loss and brain oedema were measured at 24 hours after surgery to explore the cerebroprotective effect of HDP. Immunohistochemistry, ELISA and western blot were used to determine the possible mechanisms.

Results: Compared with MCAO/R group, HDP -20° immediately after reperfusion with 1 hour duration exerted a significant cerebroprotective effect including reducing brain infarction and oedema, and improving neurological impairment, with a favourable safety profile such as less haemorrhagic transformation and death. These protective effects were not observed under other HDP intervention conditions. Mechanistically, this HDP procedure may exert its effects by regulating microglial polarisation, inhibiting microglial activation and neuroinflammation, reducing brain oedema and blood-brain barrier (BBB) disruption, suppressing apoptosis and improving neurological function.

Conclusion: This is the first study to demonstrate the cerebroprotective effect of HDP -20° with 1 hour duration immediately after reperfusion in MCAO/R model rats, which involved inhibition of neuroinflammation and apoptosis as well as protection of BBB.