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Quetiapine protects the blood-brain barrier in traumatic brain injury

Robinson, Bobby Darnell, MD; Isbell, Claire Larson, MD; Anasooya Shaji, Chinchusha; Kurek, Stanley Jr, DO; Regner, Justin L., MD; Tharakan, Binu, PhD

Journal of Trauma and Acute Care Surgery: November 2018 - Volume 85 - Issue 5 - p 968–976
doi: 10.1097/TA.0000000000002011
2018 WTA PODIUM PAPER
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BACKGROUND The integrity of the blood-brain barrier (BBB) is paramount in limiting vasogenic edema following traumatic brain injury (TBI). The purpose of this study was to ascertain if quetiapine, an atypical antipsychotic commonly used in trauma/critical care for delirium, protects the BBB and attenuates hyperpermeability in TBI.

METHODS The effect of quetiapine on hyperpermeability was examined through molecular modeling, cellular models in vitro and small animal models in vivo. Molecular docking was performed with AutoDock Vina to matrix metalloproteinase-9. Rat brain microvascular endothelial cells (BMECs) were pretreated with quetiapine (20 μM; 1 hour) followed by an inflammatory activator (20 μg/mL chitosan; 2 hours) and compared to controls. Immunofluorescence localization for tight junction proteins zonula occludens-1 and adherens junction protein β-catenin was performed. Human BMECs were grown as a monolayer and pretreated with quetiapine (20 μM; 1 hour) followed by chitosan (20 μg/mL; 2 hours), and transendothelial electrical resistance was measured. C57BL/6 mice (n = 5/group) underwent mild to moderate TBI (controlled cortical impactor) or sham craniotomy. The treatment group was given 10 mg/kg quetiapine intravenously 10 minutes after TBI. The difference in fluorescence intensity between intravascular and interstitium (ΔI) represented BBB hyperpermeability. A matrix metalloproteinase-9 activity assay was performed in brain tissue from animals in the experimental groups ex vivo.

RESULTS In silico studies showed quetiapine thermodynamically favorable binding to MMP-9. Junctional localization of zonula occludens-1 and β-catenin showed retained integrity in quetiapine-treated cells as compared with the chitosan group in rat BMECs. Quetiapine attenuated monolayer permeability compared with chitosan group (p < 0.05) in human BMECs. In the animal studies, there was a significant decrease in BBB hyperpermeability and MMP-9 activity when compared between the TBI and TBI plus quetiapine groups (p < 0.05).

CONCLUSION Quetiapine treatment may have novel anti-inflammatory properties to provide protection to the BBB by preserving tight junction integrity.

LEVEL OF EVIDENCE level IV.

From the Department of Surgery, Scott and White Medical Center and Texas A&M University Health Science Center College of Medicine

Submitted: January 15, 2018, Revised: April 26, 2018, Accepted: May 14, 2018, Published online: July 6, 2018.

Address for reprints: Binu Tharakan, PhD, Department of Surgery Texas A&M University Health Science Center College of Medicine &Baylor Scott and White Health 702 SW HK Dodgen Loop, Temple, TX 76504; email: Binu.Tharakan@BSWHealth.org.

This work was presented at the 2018 Western Trauma Association Annual Meeting as a finalist for the Earl Young Award and awarded 2nd place to Bobby D. Robinson.

© 2018 Lippincott Williams & Wilkins, Inc.