Haemoglobin causes neuronal damage in vivo which is preventable by haptoglobin

Patrick Garland, Matthew J Morton, William Haskins, Ardalan Zolnourian, Andrew Durnford, Ben Gaastra, Jamie Toombs, Amanda J Heslegrave, John More, Azubuike I Okemefuna, Jessica L Teeling, Jonas H Graversen, Henrik Zetterberg, Soren K Moestrup, Diederik O Bulters, Ian Galea

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After subarachnoid haemorrhage, prolonged exposure to toxic extracellular haemoglobin occurs in the brain. Here, we investigate the role of haemoglobin neurotoxicity in vivo and its prevention. In humans after subarachnoid haemorrhage, haemoglobin in cerebrospinal fluid was associated with neurofilament light chain, a marker of neuronal damage. Most haemoglobin was not complexed with haptoglobin, an endogenous haemoglobin scavenger present at very low concentration in the brain. Exogenously added haptoglobin bound most uncomplexed haemoglobin, in the first 2 weeks after human subarachnoid haemorrhage, indicating a wide therapeutic window. In mice, the behavioural, vascular, cellular and molecular changes seen after human subarachnoid haemorrhage were recapitulated by modelling a single aspect of subarachnoid haemorrhage: prolonged intrathecal exposure to haemoglobin. Haemoglobin-induced behavioural deficits and astrocytic, microglial and synaptic changes were attenuated by haptoglobin. Haptoglobin treatment did not attenuate large-vessel vasospasm, yet improved clinical outcome by restricting diffusion of haemoglobin into the parenchyma and reducing small-vessel vasospasm. In summary, haemoglobin toxicity is of clinical importance and preventable by haptoglobin, independent of large-vessel vasospasm.

Original languageEnglish
Article numberfcz053
JournalBrain Communications
Issue number1
Number of pages17
Publication statusPublished - 3. Jan 2020


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