Blockade of VCAM1 or VLA4 preserves cerebrovasculature and prevents cognitive decline late after stroke

Infarct-induced neurodegeneration increases dementia risk for at least a decade in humans. It can be modeled in wildtype mice, where a cortical stroke results in chronic lymphocytic infiltration into the infarct and delayed cognitive decline. Vascular cell adhesion molecule 1 (VCAM1) on endothelial cells is increased by stroke and facilitates immune cell diapedesis by binding very late antigen 4 (VLA4) on immune cells. We report here that after stroke, chronic but not acute treatment with an anti-VCAM1 blocking antibody reduces B and T lymphocyte infiltration and prevents chronic cognitive dysfunction in wildtype male and female mice. Preservation of cognitive function was also seen with chronic anti-VLA4 treatment despite anti-VLA4’s lack of effect on lymphocyte infiltration. High-depth single-cell RNA sequencing of the chronic infarct and peri-infarct cortex revealed a pronounced decrease in expression of blood vessel growth and maturation genes in endothelial cells that was reversed by both anti-VLA4 and anti-VCAM1. Plasma proteomics also support a vasculoprotective mechanism of anti-VCAM1. Finally, immunostaining demonstrated that both antibodies improve pericyte coverage of the vasculature and prevent extravascular fibrinogen leakage. Together, our findings indicate that vascular structure and function remain abnormal long after stroke and that the VLA4/VCAM1 axis is a promising treatment target for infarct-induced neurodegeneration as blockade restores cerebrovasculature and prevents cognitive decline.