Clearance of albumin following ultrasound-induced blood–brain barrier opening is mediated by glial but not neuronal cells

Ultrasound-mediated opening of the blood–brain barrier (BBB) in the presence of gas-filled microbubbles is a potential strategy for drug delivery across the blood–brain barrier to promote regeneration after ischemic stroke. However, related bioeffects and potential side-effects that could limit a translation into clinical application are poorly understood so far. We therefore examined the clearance of extravasated albumin following ultrasound-mediated BBB opening. Autofluorescence of albumin-bound Evans Blue dye indicated cellular albumin uptake as soon as 30 min after insonation (2 ± 0.72 cells/optical field). Cellular albumin uptake increased constantly over 24 h (22 ± 3.33 cells/optical field, p < 0.05). Initially, the majority of albumin-positive cells were located in the periphery of brain capillaries. Most albumin phagocyting cells stained positive for CD163 and Iba-1, identifying them as activated microglia. Further, a small fraction of albumin-positive cells stained positive for the astroglial markers GFAP/S100B. Some perivascular cells with intracellular albumin were shown to express the endothelial marker protein EN4. Albumin uptaking cells stained negative for the neuronal TubulinIII. Thus, ultrasound-induced BBB opening leads to albumin extravasation which is phagocytized predominantly by activated microglia, astrocytes and endothelial cells. As albumin uptake into neurons has been shown to be neurotoxic, rapid albumin clearance by microglia might prevent neuronal cell death.

► Ultrasound together with microbubbles can transiently open the blood–brain barrier.
► Extravasating albumin might be neurotoxic.
► We examine the processing of extravasated albumin in a rat model.
► Albumin is rapidly cleared by microglia, astrocytes and endothelial cells.
► Neurons do not contribute to albumin clearance.