Acupuncture Alleviates Blood–Brain Barrier Damage After Delayed rtPA Thrombolysis for Acute Ischemic Stroke by Regulating Ferroptosis

ABSTRACT Background Acute ischemic stroke (AIS) is the second leading cause of death and disability worldwide. Recombinant tissue plasminogen activator (rtPA) was the first FDA‐approved thrombolytic drug for AIS. However, delayed administration of rtPA exacerbates brain injury and increases the risk...

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Main Authors: Zheng Huang, Tianliang Lu, Xinyu Liu, Zhihui Zhang, Yangyang Song, Yiyang Li, Wentao Xu, Xinchang Zhang, Guangxia Ni
Format: Article
Language:English
Published: Wiley 2025-07-01
Series:Brain and Behavior
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Online Access:https://doi.org/10.1002/brb3.70644
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author Zheng Huang
Tianliang Lu
Xinyu Liu
Zhihui Zhang
Yangyang Song
Yiyang Li
Wentao Xu
Xinchang Zhang
Guangxia Ni
author_facet Zheng Huang
Tianliang Lu
Xinyu Liu
Zhihui Zhang
Yangyang Song
Yiyang Li
Wentao Xu
Xinchang Zhang
Guangxia Ni
author_sort Zheng Huang
collection DOAJ
description ABSTRACT Background Acute ischemic stroke (AIS) is the second leading cause of death and disability worldwide. Recombinant tissue plasminogen activator (rtPA) was the first FDA‐approved thrombolytic drug for AIS. However, delayed administration of rtPA exacerbates brain injury and increases the risk of hemorrhagic transformation (HT) and mortality. Ferroptosis, an iron‐dependent form of cell death, is closely associated with the pathological process of AIS. Acupuncture, a vital component of traditional Chinese medicine, has been widely used in clinical practice for AIS treatment. This study aims to investigate the protective effects of acupuncture on rats subjected to delayed rtPA thrombolysis in cerebral infarction and its relationship with ferroptosis. Methods Adult male Sprague‐Dawley rats were used to establish a thromboembolic stroke model and were randomly assigned to different treatment groups. Xingnao Kaiqiao (XNKQ) acupuncture (at Neiguan and Shuigou acupoints) or sham acupuncture was administered in combination with rtPA thrombolysis. Outcome measures included neurological scores, infarct volume, brain water content, blood–brain barrier (BBB) permeability, expression of iron metabolism‐related proteins, lipid peroxidation levels, and mitochondrial ultrastructural changes. Results XNKQ acupuncture significantly improved neurological deficits following delayed rtPA thrombolysis, reduced infarct volume and brain water content, and decreased the incidence of HT and brain edema. By modulating iron metabolism, inhibiting lipid peroxidation, and preserving mitochondrial integrity, acupuncture attenuated neuronal damage and BBB disruption mediated by ferroptosis. Conclusion XNKQ acupuncture inhibits neuronal ferroptosis by improving iron metabolism disorders, lipid peroxidation accumulation, and mitochondrial structure, thereby alleviating neuronal damage and BBB disruption, and exerting a protective effect on brain tissue after delayed rtPA thrombolysis.
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publishDate 2025-07-01
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spelling doaj-art-91c18b0115d94059aa1753d37f043df42025-08-20T02:48:43ZengWileyBrain and Behavior2162-32792025-07-01157n/an/a10.1002/brb3.70644Acupuncture Alleviates Blood–Brain Barrier Damage After Delayed rtPA Thrombolysis for Acute Ischemic Stroke by Regulating FerroptosisZheng Huang0Tianliang Lu1Xinyu Liu2Zhihui Zhang3Yangyang Song4Yiyang Li5Wentao Xu6Xinchang Zhang7Guangxia Ni8College of Acupuncture‐Moxibustion and Tuina Nanjing University of Chinese Medicine Nanjing ChinaCollege of Acupuncture‐Moxibustion and Tuina Nanjing University of Chinese Medicine Nanjing ChinaCollege of Acupuncture‐Moxibustion and Tuina Nanjing University of Chinese Medicine Nanjing ChinaCollege of Acupuncture‐Moxibustion and Tuina Nanjing University of Chinese Medicine Nanjing ChinaCollege of Acupuncture‐Moxibustion and Tuina Nanjing University of Chinese Medicine Nanjing ChinaCollege of Acupuncture‐Moxibustion and Tuina Nanjing University of Chinese Medicine Nanjing ChinaCollege of Acupuncture‐Moxibustion and Tuina Nanjing University of Chinese Medicine Nanjing ChinaCollege of Acupuncture‐Moxibustion and Tuina Nanjing University of Chinese Medicine Nanjing ChinaCollege of Acupuncture‐Moxibustion and Tuina Nanjing University of Chinese Medicine Nanjing ChinaABSTRACT Background Acute ischemic stroke (AIS) is the second leading cause of death and disability worldwide. Recombinant tissue plasminogen activator (rtPA) was the first FDA‐approved thrombolytic drug for AIS. However, delayed administration of rtPA exacerbates brain injury and increases the risk of hemorrhagic transformation (HT) and mortality. Ferroptosis, an iron‐dependent form of cell death, is closely associated with the pathological process of AIS. Acupuncture, a vital component of traditional Chinese medicine, has been widely used in clinical practice for AIS treatment. This study aims to investigate the protective effects of acupuncture on rats subjected to delayed rtPA thrombolysis in cerebral infarction and its relationship with ferroptosis. Methods Adult male Sprague‐Dawley rats were used to establish a thromboembolic stroke model and were randomly assigned to different treatment groups. Xingnao Kaiqiao (XNKQ) acupuncture (at Neiguan and Shuigou acupoints) or sham acupuncture was administered in combination with rtPA thrombolysis. Outcome measures included neurological scores, infarct volume, brain water content, blood–brain barrier (BBB) permeability, expression of iron metabolism‐related proteins, lipid peroxidation levels, and mitochondrial ultrastructural changes. Results XNKQ acupuncture significantly improved neurological deficits following delayed rtPA thrombolysis, reduced infarct volume and brain water content, and decreased the incidence of HT and brain edema. By modulating iron metabolism, inhibiting lipid peroxidation, and preserving mitochondrial integrity, acupuncture attenuated neuronal damage and BBB disruption mediated by ferroptosis. Conclusion XNKQ acupuncture inhibits neuronal ferroptosis by improving iron metabolism disorders, lipid peroxidation accumulation, and mitochondrial structure, thereby alleviating neuronal damage and BBB disruption, and exerting a protective effect on brain tissue after delayed rtPA thrombolysis.https://doi.org/10.1002/brb3.70644acupunctureacute ischemic strokeblood–brain barriercerebral infarctionferroptosisneuron
spellingShingle Zheng Huang
Tianliang Lu
Xinyu Liu
Zhihui Zhang
Yangyang Song
Yiyang Li
Wentao Xu
Xinchang Zhang
Guangxia Ni
Acupuncture Alleviates Blood–Brain Barrier Damage After Delayed rtPA Thrombolysis for Acute Ischemic Stroke by Regulating Ferroptosis
Brain and Behavior
acupuncture
acute ischemic stroke
blood–brain barrier
cerebral infarction
ferroptosis
neuron
title Acupuncture Alleviates Blood–Brain Barrier Damage After Delayed rtPA Thrombolysis for Acute Ischemic Stroke by Regulating Ferroptosis
title_full Acupuncture Alleviates Blood–Brain Barrier Damage After Delayed rtPA Thrombolysis for Acute Ischemic Stroke by Regulating Ferroptosis
title_fullStr Acupuncture Alleviates Blood–Brain Barrier Damage After Delayed rtPA Thrombolysis for Acute Ischemic Stroke by Regulating Ferroptosis
title_full_unstemmed Acupuncture Alleviates Blood–Brain Barrier Damage After Delayed rtPA Thrombolysis for Acute Ischemic Stroke by Regulating Ferroptosis
title_short Acupuncture Alleviates Blood–Brain Barrier Damage After Delayed rtPA Thrombolysis for Acute Ischemic Stroke by Regulating Ferroptosis
title_sort acupuncture alleviates blood brain barrier damage after delayed rtpa thrombolysis for acute ischemic stroke by regulating ferroptosis
topic acupuncture
acute ischemic stroke
blood–brain barrier
cerebral infarction
ferroptosis
neuron
url https://doi.org/10.1002/brb3.70644
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