Brn3b基因对视神经损伤条件下视网膜神经节细胞的保护作用

目的　探讨Brn3b过表达对视神经损伤条件下视网膜神经节细胞（retinal ganglion cells,RGCs）的保护作用。方法　选取雄性健康成年BALB/c小鼠60只,用微型视神经夹将小鼠右眼球后视神经夹持损伤,按视神经损伤后的天数依次分为第1、3、5、7、14天组,小鼠左侧正常眼作为空白组,明确视神经损伤天数条件。选取雄性健康成年BALB/c小鼠40只,用微量进样器以小鼠右眼玻璃体内注射的方法将腺相关病毒载体转染小鼠视网膜,建立Brn3b过表达模型并分组:Brn3b过表达组［转染Brn3b过表达腺相关病毒载体（Brn3b overexpressed adeno-associated viral vector,AAV-CMV-Brn3b）］和阴性对照组［转染空白腺相关病毒载体（blank adeno-associated viral vector,AAV-CMV-GFP）阴性对照物］,每组20只;之后,取Brn3b过表达组和阴性对照组各10只,用微型视神经夹将小鼠右眼球后视神经夹持损伤,构建模拟小鼠视神经损伤（controlled optic nerve crush,CONC）模型并分组:CONC-Brn3b过表达组和CONC-阴性对照组。利用视网膜铺片和切片免疫荧光标记相关蛋白表达量,检测Brn3b过表达对视神经损伤条件下RGCs、Brn3b和Caspase3蛋白表达的影响,并对其共定位情况做出统计分析。结果　与阴性对照组相比,Brn3b过表达组小鼠视网膜Brn3b的表达水平明显增加。在小鼠CONC模型制作后的第7天RGCs的总凋亡数量达到65%,第14天RGCs的凋亡数量未见进一步改变。免疫荧光标记的蛋白表达量及其共定位分析显示,在视神经损伤条件下,与CONC-阴性对照组相比,CONC-Brn3b过表达组小鼠RGCs的凋亡量以及凋亡因子Caspase3的表达量均明显减少,差异均有统计学意义（均为P＜0.001）。结论　Brn3b基因对视神经损伤条件下RGC具有明确的保护作用,Brn3b基因对凋亡因子Caspase3的表达可能具有一定的抑制作用。     

Mechanism of retinal ganglion cells death in secondary degeneration of the optic nerve

In central nervous system injury, the secondary degeneration process is known to play a major role in determining the final extent of impairment. Here, we investigated the mechanism of retinal ganglion cell (RGC) death in secondary degeneration of the optic nerve using a unique model that allows morphological separation between primary and secondary degeneration. A partial transection model was applied unilaterally in 110 Wistar rat eyes. The rate of apoptosis was evaluated in primary and secondary degeneration over a period of 6 months using the Hoechst staining technique. The involvement of caspase 3 and members of the Bcl-2 family (Bax, Bad, Bcl-2 and Bcl-xl) was evaluated at multiple time points for 6 months after the injury by immunohistochemistry and RT-PCR. We found that in secondary degeneration of the optic nerve, RGCs died by apoptosis from day 3-6 months following the injury, peaking at 3 months (16.3% ± 2.5% apoptotic cells, p < 0.01). Both primary and secondary degeneration of the optic nerve resulted in caspase 3 activation, which was longer and more intense in the former. Similarly, both primary and secondary degeneration led to significant (p < 0.05) downregulation of the pro-survival genes Bcl-2 and Bcl-x-L and up-regulation of the pro-apoptotic genes Bax and Bad (p < 0.05), with a suggested delay in secondary degeneration. Thus, secondary degeneration of the optic nerve leads to RGC apoptosis over long periods in a similar mechanism as in primary degeneration.     

Axonal degeneration, regeneration and ganglion cell death in a rodent model of anterior ischemic optic neuropathy (rAION)

Using laser-induced photoactivation of intravenously administered rose Bengal in rats, we generated an ischemic infarction of the intrascleral portion of the optic nerve (ON) comparable to that which occurs in humans to investigate optic nerve axon degenerative events following optic nerve infarct and the potential for axon re-growth. Animals were euthanized at different times post infarct. Axon degeneration was evaluated with SMI312 immunolabeling, and GAP-43 immunostaining was used to identify axon regeneration. Terminal dUTP nick end labeling (TUNEL) was used to evaluate retinal ganglion cell (RGC) death. There was significant axon structural disruptinot ion at the anterior intrascleral portion of the ON by 3d post-infarct, extending to the posterior ON by 7d post-stroke. Destruction of normal axon structure and massive loss of axon fibers occurred by 2 weeks. GAP-43 immunoreactivity occurred in the anterior ON by 7d post-infarct, lasting 3-4 weeks, without extension past the primary ischemic lesion.TUNEL-positive cells in the RGC layer appeared by 7d post-insult. These results indicate that following induction of ischemic optic neuropathy, significant axon damage occurs by 3d post-infarct, with later neuronal death. Post-stroke adult rat retinal ganglion cells attempt to regenerate their axons, but this effort is restricted to the unmyelinated region of the anterior ON. These responses are important in understanding pathologic process that underlies human non-arteritic anterior ischemic optic neuropathy (NAION) and may guide both the appropriate treatment of NAION and the window of opportunity for such treatment.     

Mouse models of retinal ganglion cell death and glaucoma

Once considered too difficult to use for glaucoma studies, mice are now becoming a powerful tool in the research of the molecular and pathological events associated with this disease. Often adapting technologies first developed in rats, ganglion cell death in mice can be induced using acute models and chronic models of experimental glaucoma. Similarly, elevated IOP has been reported in transgenic animals carrying defects in targeted genes. Also, one group of mice, from the DBA/2 line of inbred animals, develops a spontaneous optic neuropathy with many features of human glaucoma that is associated with IOP elevation caused by an anterior chamber pigmentary disease. The advent of mice for glaucoma research is already having a significant impact on our understanding of this disease, principally because of the access to genetic manipulation technology and genetics already well established for these animals.     

The effect of ginkgo biloba on the rat retinal ganglion cell survival in the optic nerve crush model

Purpose: To investigate the effect of ginkgo biloba on the retinal ganglion cell survival in a rat optic nerve crush model. Methods: Twenty‐four Sprague–Dawley rats were divided randomly into a study group of 12 animals receiving intraperitoneal injections of ginkgo biloba and a control group of 12 animals receiving intraperitoneal saline injections. All injections were performed 1 hr before the optic nerve crush and daily afterwards. For each animal, the right optic nerve was crushed closely behind the globe for 60 seconds using a microclip with 40 g power. The left optic nerve was kept intact. At 23 days after the optic nerve crush, the retinal ganglion cells were labelled retrogradely by injecting 3% fluorogold into both sides of the superior colliculus of the brain. At 4 weeks after the optic nerve crush, the animals were killed. Photographs taken from retinal flat mounts were assessed for the number and density of the retinal ganglion cells. Results: The survival rate, defined as the ratio of the retinal ganglion cell density in the right eye with the optic nerve crush divided by the retinal ganglion cell density in left eye without an optic nerve trauma, was significantly (p = 0.035) higher in the study group with ginkgo biloba than in the control group (60.0 ± 6.0% versus 53.5 ± 8.0%). Conclusion: The results suggest that intraperitoneal injections of a ginkgo biloba extract given prior to and daily after an experimental and standardized optic nerve crush in rats were associated with a higher survival rate of retinal ganglion cells.     

Ocular hypertension impairs optic nerve axonal transport leading to progressive retinal ganglion cell degeneration

Ocular hypertension (OHT) is the main risk factor of glaucoma, a neuropathy leading to blindness. Here we have investigated the effects of laser photocoagulation (LP)-induced OHT, on the survival and retrograde axonal transport (RAT) of adult rat retinal ganglion cells (RGC) from 1 to 12 wks. Active RAT was examined with fluorogold (FG) applied to both superior colliculi (SCi) 1 wk before processing and passive axonal diffusion with dextran tetramethylrhodamine (DTMR) applied to the optic nerve (ON) 2 d prior to sacrifice. Surviving RGCs were identified with FG applied 1 wk pre-LP or by Brn3a immunodetection. The ON and retinal nerve fiber layer were examined by RT97-neurofibrillar staining. RGCs were counted automatically and color-coded density maps were generated. OHT retinas showed absence of FG⁺ or DTMR⁺RGCs in focal, pie-shaped and diffuse regions of the retina which, by two weeks, amounted to, approximately, an 80% of RGC loss without further increase. At this time, there was a discrepancy between the total number of surviving FG-prelabelled RGCs and of DMTR⁺RGCs, suggesting that a large proportion of RGCs had their RAT impaired. This was further confirmed identifying surviving RGCs by their Brn3a expression. From 3 weeks onwards, there was a close correspondence of DTMR⁺RGCs and FG⁺RGCs in the same retinal regions, suggesting axonal constriction at the ON head. Neurofibrillar staining revealed, in ONs, focal degeneration of axonal bundles and, in the retinal areas lacking backlabeled RGCs, aberrant staining of RT97 characteristic of axotomy. LP-induced OHT results in a crush-like injury to ON axons leading to the anterograde and protracted retrograde degeneration of the intraocular axons and RGCs.     

Retinal ganglion cell numbers and delayed retinal ganglion cell death in the P23H rat retina

The P23H-1 rat strain carries a rhodopsin mutation frequently found in retinitis pigmentosa patients. We investigated the progressive degeneration of the inner retina in this strain, focussing on retinal ganglion cells (RGCs) fate. Our data show that photoreceptor death commences in the ventral retina, spreading to the whole retina as the rat ages. Quantification of the total number of RGCs identified by Fluorogold tracing and Brn3a expression, disclosed that the population of RGCs in young P23H rats is significantly smaller than in its homologous SD strain. In the mutant strain, there is also RGC loss with age: RGCs show their first symptoms of degeneration at P180, as revealed by an abnormal expression of cytoskeletal proteins which, at P365, translates into a significant loss of RGCs, that may ultimately be caused by displaced inner retinal vessels that drag and strangulate their axons. RGC axonal compression begins also in the ventral retina and spreads from there causing RGC loss through the whole retinal surface. These decaying processes are common to several models of photoreceptor loss, but show some differences between inherited and light-induced photoreceptor degeneration and should therefore be studied to a better understanding of photoreceptor degeneration and when developing therapies for these diseases.     

Citicoline and lithium rescue retinal ganglion cells following partial optic nerve crush in the rat

Citicoline and lithium (Li(-)) have been shown to support retinal ganglion cell (RGC) survival and axon regeneration in vitro. Optic nerve crush (ONC) is a model of both brain axonal injury and certain aspects of the glaucomatous degeneration of RGC. We have used this model to quantify protection offered to RGC by these drugs and to determine whether their effects are mediated by enhanced expression of the antiapoptotic protein Bcl-2. Adult rats (6-12 per group) were subjected to ONC accompanied by a contralateral sham operation. Animals were treated intraperitoneally with either vehicle, citicoline sodium (1g/kg daily for up to 7 days and 300 mg/kg daily afterwards), lithium chloride (30 mg/kg daily), or both drugs combined. Fluorogold was injected bilaterally into superior colliculi 1, 5 or 19 days after ONC. Labeled cells were counted under a fluorescence microscope 2 days after tracer injection. In a separate set of experiments the effects of treatments on expression of Bcl-2 in retinas were evaluated by immunohistochemistry. In vehicle-treated animals there was a progressive decrease of RGC density after crush. This decrease was attenuated in citicoline-treated animals 1 week and 3 weeks after the crush. In the lithium-treated group protection was even more pronounced. In animals treated with both drugs RGC protection was similar to that achieved by lithium alone. Bcl-2 immunoreactivity was seen predominantly in retinal ganglion cells. Its increase was recorded in the lithium and citicoline group as well as in animals treated with the combination of both drugs. Both citicoline and lithium protect RGC and their axons in vivo against delayed degeneration triggered by the ONC. Retinoprotective action of both drugs may involve an increase in Bcl-2 expression.     

大鼠视神经部分切断模型的建立和重复性评价

 目的 应用自行设计的模具制作大鼠视神经部分切断模型,并评价大鼠视神经部分切断模型的可重复性。 设计 实验研究。研究对象  15只Wistar大鼠。方法  利用模具将大鼠视神经部分切断,术后对13只大鼠行荧光金逆行标记及全视网膜拼图,使用Ret-camⅡ眼底照相观察视网膜血供情况。主要指标  观察视网膜神经节细胞（RGC）形态及分布变异。结果 视神经部分切断直接影响的视网膜与周围正常视网膜有明确分界线,标记荧光金视网膜面积比例变异系数最大值为1.85%,平均变异系数为0.67%±0.44%。Ret-camⅡ眼底照相显示视神经部分切断后,未引起视网膜供血障碍。 结论 利用新型模具器械可成功建立易于量化的重复性高的RGC继发性损伤模型。（眼科,2013,22：34-37）     

大鼠视神经夹挫伤视网膜视神经病理学动态观察及功能检测

目的 :动态观察视神经夹挫伤后视网膜、视神经形态学和视功能变化 ,揭示其病理过程的内在规律 ,为视神经保护研究提供依据。方法 :应用光镜、电镜观察正常及视神经夹挫伤 2 4、4 8、72小时 ,1、2、4周大鼠的视神经和视网膜形态学改变 ,闪光视觉诱发电位检测正常及视神经损伤后 1小时、4周大鼠的视功能状况。结果 :视神经部分损伤诱导视网膜神经节细胞 (RGCs)严重下降 ,损伤后的前 2周RGCs快速减少 ,2周以后缓慢减少 ;电镜下可见RGCs染色质明显聚集 ,胞体皱缩 ,核膜、胞膜完整 ;也可见核膜溶解 ,细胞器水肿、崩解 ;视神经纤维在损伤过程交错存在着轴突空泡样变 ,髓鞘崩解、消失 ,胶质细胞增生 ;视神经急性损伤F VEP波形较正常变得低而宽 ,损伤 4周波形消失。结论 :神经元继发性损伤是视功能进行性下降的重要原因 ,保护神经元免受继发性损伤是视神经保护的重要方面 ,对改善视功能有极其重要的意义     

细胞因子信号转导抑制因子3(SOCS3)对视神经损伤大鼠视网膜神经节细胞存活的影响

目的 研究细胞因子信号转导抑制因子3(suppressor of cytokine signaling 3,SOCS3)对视神经损伤大鼠视网膜神经节细胞(retinal ganglion cells,RGCs)存活的影响,并探讨其潜在的分子机制.方法 采用视神经横断手术构建大鼠视神经损伤模型,术后分离RGCs.实验分为视神经损伤组(optic nerve transection,ONT组)和假手术组.采用Western blot和RT-PCR检测SOCS3在两组细胞中的表达.随后将SOCS3 siRNA分别转染假手术组和ONT组RGCs,实验进一步分为空白对照组、阴性对照组和SOCS3沉默组.CCK8和MTT法检测细胞存活,Hoechst 33342荧光染色法和流式细胞技术检测细胞凋亡.进一步将mTOR siRNA和SOCS3 siRNA共转染RGCs,检测细胞存活和细胞凋亡.结果 视神经损伤3d后,ONT组SOCS3表达水平显著高于假手术组(P =0.049),且随损伤时间延长而升高.与空白对照组相比,SOCS3沉默可显著提高视神经损伤后RGCs的存活率[空白对照组与SOCS3沉默组分别为(49.47±7.35)％和(73.24±8.70)％],降低细胞凋亡率[2组分别为(27.25±0.75)％和(10.96±1.07)％]和细胞生长抑制率[2组分别为(23.06±1.43)％和(10.65±1.77)％].Hoechst染色也表明SOCS3沉默可改善视神经损伤诱导的细胞凋亡.同时,SOCS3沉默可显著提高视神经损伤后2周mTOR活性标志蛋白pS6的表达;且与单独沉默SOCS3相比,共同沉默mTOR和SOCS3可降低细胞存活率,提高细胞生长抑制率和细胞凋亡率.结论 SOCS3沉默可以通过上调损伤后期mTOR的活性而促进损伤RGCs的存活并抑制其凋亡.     

NLRP3 and autophagy in retinal ganglion cell inflammation in age-related macular degeneration: potential therapeutic implications

Retinal degenerative diseases were a large group of diseases characterized by the primary death of retinal ganglion cells (RGCs). Recent studies had shown an interaction between autophagy and nucleotide-binding oligomerization domain-like receptor 3 (NLRP3) inflammasomes, which may affect RGCs in retinal degenerative diseases. The NLRP3 inflammasome was a protein complex that, upon activation, produces caspase-1, mediating the apoptosis of retinal cells and promoting the occurrence and development of retinal degenerative diseases. Upregulated autophagy could inhibit NLRP3 inflammasome activation, while inhibited autophagy can promote NLRP3 inflammasome activation, which leaded to the accelerated emergence of drusen and lipofuscin deposition under the neurosensory retina. The activated NLRP3 inflammasome could further inhibit autophagy, thus forming a vicious cycle that accelerated the damage and death of RGCs. This review discussed the relationship between NLRP3 inflammasome and autophagy and its effects on RGCs in age-related macular degeneration, providing a new perspective and direction for the treatment of retinal diseases.     

杞贞胶囊对视网膜神经节细胞保护作用及其作用机制的实验研究

目的 探索杞贞胶囊对大鼠视神经夹伤模型视网膜神经节细胞的保护作用及其作用机制。设计 实验研究。研究对象 SPF级SD大鼠72只。方法 72只SD大鼠随机分为2组：用药组36只;对照组36只。两组大鼠右眼行视神经夹伤,于球后2 mm处用40 g微型视神经夹夹伤视神经60 s。左眼作为正常对照。夹伤后2小时及此后每日予以灌胃给药一次。用药组给予20%杞贞溶液2.5 ml/kg,对照组给予生理盐水2.5 ml/kg。给药第28天取眼球标本,用药组和对照组各取24只行HE染色﹑Tunel试剂盒染色﹑Caspase-3免疫组化染色;剩余每组12只分离视网膜提取mRNA,测定Bax和Bcl-2基因的表达量。主要指标 视网膜厚度﹑Bax和Bcl-2基因表达量。结果 用药组视网膜厚度平均为（109.0±4.4）μm;对照组视网膜厚度为（101.8±7.6）μm（F=29.497,P=0.028）。两组间Bax基因表达差异具有统计学意义（t=1.089,P=0.028）;Bcl-2基因表达差异未见统计学意义（t=0.553,P=0.692）。结论 杞贞胶囊对大鼠视神经夹伤后的视网膜神经节细胞具有保护作用,可能通过下调Bax基因表达和抑制Caspase蛋白活性从而减少视网膜神经节细胞凋亡。     

Axonal regeneration induced by repetitive electrical stimulation of crushed optic nerve in adult rats

Purpose  To investigate whether electrical stimulation promoted axonal regeneration of retinal ganglion cells (RGCs) after optic nerve (ON) crush in adult rats. Methods  Transcorneal electrical stimulation (TES), which stimulates the retina with current from a corneal contact lens electrode, was used to stimulate the eye. TES was applied for 1 h immediately after ON crush. Axonal regeneration was determined by anterograde labeling of RGC axons. To examine whether the axonal regeneration was mediated by insulin-like growth factor 1 (IGF-1) receptors, an IGF-1 receptor antagonist, JB3, was injected intraperitoneally before each TES application. Immunostaining for IGF-1 was performed to examine the effects of TES. To test the survival-promoting effects of TES applied daily, the mean density of retrogradely labeled RGCs was determined on day 12 after ON crush. Results  Compared with sham stimulation, the mean number of regenerating axons significantly increased at 250 μm distal from the lesion and increased IGF-1 immunoreactivity was observed in retinas treated daily with TES. Preinjection of an IGF-1 receptor antagonist significantly blocked axonal regeneration by TES applied daily. TES applied daily also markedly enhanced the survival of RGCs 12 days after ON crush. Conclusion  TES applied daily promotes both axonal regeneration and survival of RGCs after ON crush.     

沉默信息调节因子1 调控胆固醇合成对大鼠视神经损伤后RGCs修复的作用机制

目的：探讨沉默信息调节因子1( silent information regulator 1, SIRT1)调控胆固醇合成在视神经损伤修复中的作用机制。
　　方法：制备视神经损伤的大鼠模型,随机数字法将70只大鼠分为正常组10只,白黎芦醇治疗组(实验组)30只和PBS缓冲液对照组(对照组)30只;再将实验组和对照组分别分为三组,每组各10只;将白黎芦醇或PBS分别注射实验组和对照组大鼠,观察视神经损伤后第7,14,21 d处死大鼠。分离视网膜,观察各组大鼠视网膜神经节细胞( retinal ganglion cell ,RGCs)的存活数量。分离术眼视神经,检测其胆固醇含量;RT-PCR法检测SIRT1、SREBP2和HMGCR的mRNA表达水平;Western blot法检测SIRT1、SREBP2和HMGCR蛋白表达水平。
　　结果：损伤模型大鼠的视网膜RGCs的存活数量以及视神经胆固醇含量均明显减少( P<0.01);SIRT1、SREBP2和HMGCR的mRNA和蛋白表达水平均下降( P<0.05),并呈时间依赖关系。三组分三个时间点,随时间延长损伤均加重,而治疗组损伤程度较对照组明显减弱。而白黎芦醇治疗组的视神经胆固醇含量以及SIRT1、SREBP2、HMGCR的mRNA和蛋白表达水平,RGCs存活数量均明显回升(P<0.01),且呈时间依赖关系。
　　结论：白黎芦醇通过上调SIRT1、SREBP-2及其下游调控基因HMGCR的表达,从而进一步促进神经元细胞的胆固醇合成以及视网膜神经节细胞的损伤后修复过程。     

Neuroprotective effects of BDNF and GDNF in intravitreally transplanted mesenchymal stem cells after optic nerve crush in mice

AIM: To assess the neuro-protective effect of bone marrow mesenchymal stem cells (BMSCs) on retinal ganglion cells (RGCs) following optic nerve crush in mice. METHODS: C56BL/6J mice were treated with intravitreal injection of PBS, BMSCs, BDNF-interference BMSCs (BIM), and GDNF-interference BMSCs (GIM) following optic nerve crush, respectively. The number of surviving RGCs was determined by whole-mount retinas and frozen sections, while certain mRNA or protein was detected by q-PCR or ELISA, respectively. RESULTS: The density (cell number/mm2) of RGCs was 410.77±56.70 in the retina 21d after optic nerve crush without any treatment, compared to 1351.39±195.97 in the normal control (P<0.05). RGCs in BMSCs treated eyes was 625.07±89.64/mm2, significantly higher than that of no or PBS treatment (P<0.05). While RGCs was even less in the retina with intravitreal injection of BIM (354.07+39.77) and GIM (326.67+33.37) than that without treatment (P<0.05). BMSCs injection improved the internal BDNF expression in retinas. CONCLUSION: Optic nerve crush caused rust loss of RGCs and intravitreally transplanted BMSCs at some extent protected RGCs from death. The effect of BMSCs and level of BDNF in retinas are both related to BDNF and GDNF expression in BMSCs.     

Neuroprotective effects of tempol on retinal ganglion cells in a partial optic nerve crush rat model with and without iron load

Iron overload can contribute to oxidative stress in many tissues. We studied the effects of pretreatment with iron dextran on RGC loss in a calibrated partial optic nerve crush (PONC) model in rats, along with the protection offered by tempol (4-hydroxy-2,2,6,6-tetramethylpiperidinyl-1-oxyl, a membrane-permeable superoxide dismutase mimetic and free-radical scavenger), in the same experimental paradigm. A total of 40 rats in 6 groups of 5-8 animals each underwent PONC in one eye and sham crush in the other. Animals were pretreated with a single iron dextran load 24 h prior to PONC, and treated with tempol 6 h before and then once daily after PONC. Control animals were treated with PBS. RGC were retrogradely labeled with a fluorescent marker; all data are expressed in percent of the RGC count in the respective sham-treated eye. Immunohistochemistry was performed to visualize 3-nitrotyrosine, a marker of nitroxidative stress. PONC without iron pretreatment resulted in the survival of only 31.4% of labeled RGC after 7 days. Even fewer RGC (12.7%) survived after PONC with iron pretreatment. However, tempol in doses of 20 mg/kg of body weight (BW) significantly attenuated this effect when given as described above; in the group without iron pretreatment the number of surviving RGC doubled from 31.4% to 62.1%. In the group with iron pretreatment the survival rate of RGC increased even more pronouncedly, from 12.7% without tempol to 46.2% with tempol. Tempol in doses of 1 mg/kg BW and 5 mg/kg BW showed no significant rescue of RGC. Immunostaining showed nitrotyrosine-positive RGCs in PONC but not in sham-treated eyes and an increase in positive cells after iron load. Tempol treatment reduced nitrotyrosine staining in both the iron and non-iron groups. Our results demonstrate that PONC results in significantly greater RGC damage when iron pretreatment is performed, and that the compound tempol may provide additional protection for RGC in cases of neuronal damage both with and without prior iron treatment.