Stroke is a leading cause of disability worldwide1. A stroke happens when blood flow to the brain is disrupted. This can occur either through a hemorrhagic stroke (~15% of cases), where a blood vessel in the brain bursts, or through an ischemic stroke, where blood flow to the brain is blocked1. Ischemic strokes are most prevalent and account for ~85% of stroke cases1. A stroke reduces the delivery of glucose and oxygen to the brain, leading to swift neuronal cell death and impaired neural function.
Ischemic stroke leads to the loss of cells within minutes in the core of the lesion through mechanisms of excitotoxicity, oxidative and nitrosative stress, calcium dysregulation, cortical spreading depolarization, edema, disruption of the blood-brain barrier (BBB), and inflammation2,3. Cells in the peri-infarct regions undergo apoptotic cell death within hours, and for days, post-stroke4. The peri-infarct environment is exposed to pro- and anti-inflammatory signals that lead to the activation of microglia and astrocytes ("reactive" astrocytes), that play diverse roles after injury5,6,7,8. Reactive astrocytes undergo a number of phenotypic changes that include the upregulation of glial fibrillary acidic protein (GFAP), and the formation of a border around the lesion within days post-stroke that helps to limit the extent of the lesion as well as impacts neuroplasticity within the injured tissue8,9,10.
Direct cellular reprogramming allows for the conversion of one mature cell type into a different mature cell type without going through a pluripotent state11. Turning resident brain cells into new neurons to substitute those lost to injury presents an appealing avenue for brain restoration. Stroke is an ideal target for cell-based treatments, given the necessity for therapeutic methods to replace lost neurons, broaden the therapeutic timeframe, and ultimately facilitate functional recovery. To this end, there have been many papers demonstrating astrocyte to neuron (AtN) reprogramming in vitro and in vivo, using a variety of basic- helix-loop-helix (bHLH) neurogenic transcription factors, including Ascl1, Neurog2, Neurod1 and more recently, mutated versions of Ascl1 (Ascl1-SA6) which demonstrated improved reprogramming efficacy11,12,13,14. Important to consider are the many experimental design factors that can impact outcomes, interpretation, and comparisons between studies. Ghazale et al. demonstrated that AtN reprogramming efficiency varied between different mouse strains, AAV serotypes, and promoters when using the same bHLH transcription factor14. Other considerations, such as the injury model, brain region, viral dosing, timing of gene delivery, the reprogramming factor, and the mode of delivery, will impact the outcomes. Recent reports have demonstrated that pre-existing transduced neurons have been misinterpreted as reprogrammed neurons15,16. While the reports do not necessarily negate that AtN conversion occurs, these studies have highlighted the importance of well-controlled experiments, and several papers have put forth recommendations for the next steps in the field15,17,18,19. What is apparent from the literature is that the ectopic expression of bHLH transcription factors can improve functional outcomes in a variety of animal models of neurodegenerative disease/injury13,20,21,22,23,24.
Herein, this protocol Neurod1, a transcription factor of interest, is ectopically expressed in transduced cells13,22. The well-established endothelin-1 (ET-1) model of ischemic stroke to the sensorimotor cortex in adult mice is used. Injection of ET-1 leads to local vasoconstriction mimicking the pathophysiology of ischemic stroke, including functional impairment22,23,25. The commonly employed short-GFAP promoter (gfaABC(1)D) is used to drive the ectopic expression of Neurod1 at the injury site and perilesional region using two viral strategies: (1) AAV5-CAG-Flex::GFP+AAV5-GFAP-Neurod1-Cre delivery in wild-type mice and (2) AAV5-GFAP-Neurod1-Cre delivery in tdTom-Cre reporter mice. To further understand the potential for ectopic expression of Neurod1 in the stroke-injured brain, AAVs were delivered in the subacute phase (7 days), or in the chronic phase (21 days), post-stroke. In both paradigms, significantly more labeled neurons were found within weeks following ectopic Neurod1 expression.