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Chronotherapy to reinforce circadian rhythms improves poststroke outcomes and glymphatic function in mice
Emma Waight, Yuxi Zhu, Ashley Caudell, Velia S. Vizcarra, Evan Newbold, Michael J. Giannetto, Evalien Duyvestyn, Estephanie Balbuena, Wei Song, Tanzil M. Arefin, Yuki Mori, Maiken Nedergaard, Lauren M. Hablitz
Emma Waight, Yuxi Zhu, Ashley Caudell, Velia S. Vizcarra, Evan Newbold, Michael J. Giannetto, Evalien Duyvestyn, Estephanie Balbuena, Wei Song, Tanzil M. Arefin, Yuki Mori, Maiken Nedergaard, Lauren M. Hablitz
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Research Article Cell biology Neuroscience

Chronotherapy to reinforce circadian rhythms improves poststroke outcomes and glymphatic function in mice

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Abstract

Stroke remains a leading cause of morbidity and mortality worldwide, with few effective interventions to promote recovery. Targeting circadian timing and glymphatic function may represent viable therapeutic strategies. Here, we show that the small-molecule clock modulator, KL001; high-dose melatonin; acute light pulses; and active-phase time-restricted feeding were each sufficient to enhance glymphatic function in mice. Moreover, initiating treatment with either KL001 or active-phase time-restricted feeding 3 days after preclinical models of stroke improved motor outcomes, reduced lesion volume, increased glymphatic flow, and lowered poststroke brain cytokine burden. These findings suggest that reinforcing normal daily rhythmicity after stroke can markedly enhance neurological recovery, even when interventions are initiated several days after stroke onset.

Authors

Emma Waight, Yuxi Zhu, Ashley Caudell, Velia S. Vizcarra, Evan Newbold, Michael J. Giannetto, Evalien Duyvestyn, Estephanie Balbuena, Wei Song, Tanzil M. Arefin, Yuki Mori, Maiken Nedergaard, Lauren M. Hablitz

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Figure 2

Ischemic stroke disrupts circadian behavior and glymphatic flow.

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Ischemic stroke disrupts circadian behavior and glymphatic flow.
(A) Rep...
(A) Representative double-plotted actograms of double-housed mice that received no surgery (None, dark gray), sham surgery (light gray), or photothrombotic stroke (blue). Tan indicates lights on; white represents lights off; black tic marks denote wheel-running activity. (B) Box plot of χ2 periodogram calculated rhythmicity amplitude at 24 hours. (C) Average activity counts after stroke over 24 hours. Thick lines indicate means, and shading indicates SEM. (D) Representative coronal sections of glymphatic tracer influx. Lighter colors/white are increased fluorescent tracer. Area within yellow boxes is shown at ×3 magnification to the right, with yellow arrows indicating perivascular influx of CSF tracer. (E) Box plot of MPI of glymphatic influx after sham and stroke. (F–H) Cartoon representative of the behavior tests: box plots of wire walk (F), rotarod (G), and velocity in open field (H) for sham (gray) and stroke (blue) mice. (I) Representative coronal immunohistochemistry (IHC) sections for mice 1 day, 3 days, and 11 days after photothrombotic stroke. MAP2 (magenta) was used to identify the stroke site. GFAP (yellow) and DAPI (cyan) were used for slice visualization. Scale bar: 1 mm. (J) Schematics of anterior-to-posterior coronal sections (white) with individual mouse stroke sites indicated in transparent red at 1, 3, and 11 days after stroke. The darker the red, the more stroke sites overlapped between mice. (K) Minimum/maximum box plot of stroke volume in mice 1, 3, and 11 days after stroke. In all box plots, minimum and maximum values are shown, center lines indicate the medians, quartiles are shown by box-and-whisker plots, individual mice are shown as colored dots. *P < 0.05, **P < 0.01, ***P < 0.001, ****P < 0.0001. B: 1-way ANOVA test with Tukey’s HSD post hoc analysis. F–H: unpaired t tests. E: unpaired t test with Welch’s correction. K: Welch’s ANOVA test with Dunnett’s T3 multiple comparisons test. All statistics are shown in Supplemental Table 1.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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