Sex differences in the therapeutic effects of anti-PDL2 neutralizing antibody on stroke

  • Hilary A. SeifertEmail author
  • Wenbin Zhu
  • Arthur A. Vandenbark
  • Nabil J. Alkayed
  • Halina Offner
Original Article


Inflammation involving migration of immune cells across the damaged blood–brain barrier (BBB), activation of resident innate microglia and production of inflammatory humoral mediators such as cytokines and chemokines play a critical role in the pathogenesis of ischemic stroke. Cell-cell signaling involved in the process also includes checkpoint interaction between programmed death receptor (PD1) and programmed death ligands, PDL1 and PDL2. Based on our previous studies showing reduced MCAO infarct volumes in PDL2 deficient mice, we evaluated the ability of anti-PDL2 mAb to treat MCAO in male and female C57BL/6 mice. We found that anti-PDL2 neutralizing antibody treatment of MCAO significantly reduced infarct volumes in male mice but had no protective effects in female mice even at a 5-fold increased dose of anti-PDL2 mAb. The protection in male mice was likely mediated by reduced percentages in the spleen of PDL2+CD19+ B cells, PDL1+CD4+ T cells and CD86+CD11b+ macrophages in concert with reduced expression of PDL1 and TNFα and continued expression of CD206, in the injured ipsilateral brain hemisphere. The lack of a therapeutic benefit of anti-PDL2 on stroke-induced infarct volumes in female mice was reflected by no detectable reduction in expressed PDL2 or PDL1 and an increased frequency of Th1 and Th17 pro-inflammatory T cell subsets in the spleen, an effect not seen in PDL2 mAb treated males. This result potentially limits the utility of anti-PDL2 mAb therapy in stroke to males but underscores the importance of meeting the STAIR requirements for development of new stroke therapies for both sexes.


MCAO Anti-PDL2 mAb Checkpoint regulation Sex differences 



This work was funded by the American Heart Association grant 17GRNT33220001 (HO) and the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Senior Research Career Scientist Award 1IK6BX004209 (AAV). The contents do not represent the views of the Department of Veterans Affairs or the United States Government. The authors would like to acknowledge the following individuals for their contributions towards the completion of this manuscript: Dr. Gil Benedek, Gail Kent, Grant Gerstner, and Ha Nguyen.


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply [YEAR] 2019

Authors and Affiliations

  1. 1.Department of NeurologyOregon Health & Science UniversityPortlandUSA
  2. 2.Neuroimmunology ResearchVeterans Affairs Portland Health Care SystemPortlandUSA
  3. 3.Department of Anesthesiology & Perioperative MedicineOregon Health & Science UniversityPortlandUSA
  4. 4.Department of Molecular Microbiology & ImmunologyOregon Health & Science UniversityPortlandUSA
  5. 5.The Knight Cardiovacular InstituteOregon Health & Science UniversityPortlandUSA

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