一氧化氮合酶在脑缺血再灌注中的双重作用

目的 探讨短暂脑缺血再灌注后大鼠脑内3型一氧化氮合酶(nitric oxide synthase，NOS)的表达及作用，为脑缺血治疗提供理论依据。方法 采用免疫组织化学方法，用3型NOS的多克隆抗体检测大鼠局灶性脑缺血2h再灌注15min及22h NOS在脑内的表达情况。结果 大鼠脑缺血2h再灌注15min，在脑缺血边缘区的血管壁及神经细胞出现内皮型一氧化氮合酶(endothelial nitric oxide synthase，eNOS)上调表达；脑缺血2h再灌注22h，在脑梗死区内表达神经元型一氧化氮合酶(neuronal mitric oxide synthase，nNOS)的神经细胞减少，并出现表达诱导型一氧化氮合酶(inducible nitric oxide synthase，iNOS)的胶质细胞，同时梗死边缘区血管及神经细胞出现eNOS及iNOS的上调表达。结论 在短暂脑缺血再灌注早期，缺血区周围可能有eNOS相关的保护机制；亚急性期eNOS及iNOS的保护及损伤机制并存；因此，在短暂脑缺血早期恢复灌注后予选择性iNOS抑制剂及促进eNOS活性有可能减少迟发性神经损伤。     

一氧化氮合酶与脑缺血早期神经损伤关系研究

目的:探讨大鼠脑缺血早期脑内3种亚型一氧化氮合酶(nitric oxide synthase,NOS)的表达及作用。方法:采用免疫组织化学方法,用三型NOS的多克隆抗体检测大鼠局灶性脑缺血15、30min及1、2、3、6 h NOS在脑内的表达情况。结果:局灶性脑缺血1 h内缺血侧基底节区内神经元型NOS(nNOS)表达上调;脑缺血1 h内在缺血区小血管壁及3 h时在缺血边缘区小血管壁出现内皮型NOS(eNOS)两次上调。局灶性脑缺血6 h内神经组织中未见诱生型NOS(iNOS)表达。结论:在脑缺血的超早期出现结构型NOS(nNOS及eNOS)的上调表达,此时可能同时存在nNOS的神经损伤作用及eNOS的神经保护作用。     

一氧化氮合酶及其抑制剂与脑缺血

一氧化氮合酶(NOS)在脑缺血中具有双重作用,nNOS介导缺血早期神经元损伤,iNOS介导缺血晚期神经元损伤,eNOS则介导神经保护作用。对NOS抑制剂,尤其是选择性nNOS和iNOS抑制剂的研究,无疑将为缺血性脑损伤的治疗提供新途径。     

人工合成E-选择素对大鼠局灶性脑缺血再灌注损伤后脑组织一氧化氮合酶表达的影响

目的 探讨人工合成E-选择素对大鼠局灶性脑缺血/再灌注（I/R）损伤后脑组织一氧化氮合酶（NOS）及血清一氧化氮（NO）含量的影响.方法 采用改良的Zea Longa法建立脑I/R损伤模型.66只雄性SD大鼠随机分为对照组、模型组和人工合成E-选择素治疗组（治疗组）.治疗组大鼠采用股静脉注射人工合成E-选择素10 mg·kg-1.应用硝酸盐还原法测定血清中NO含量和免疫组化法检测缺血区脑组织神经型一氧化氮合酶（nNOS）、诱导型一氧化氮合酶（iNOS）阳性细胞数.结果 ①NO：以对照组NO含量为正常生理数据,模型组脑缺血2h/再灌注2～24h NO含量呈上升趋势,24 h时达高峰,72 h有所降低但仍高于对照组,各时间点与对照组比较明显增高（P＜0.01）;治疗组NO变化趋势同模型组,NO含量较模型组减少（P＜0.05）,较对照组增多（P＜0.01）.②NOS：以对照组nNOS、iNOS阳性细胞数为正常生理数据,模型组nNOS阳性细胞在脑缺血2h/再灌注2h后开始表达,12h达高峰,至24h开始降低,各时间点与对照组比较明显增高（P＜0.01）;模型组iNOS阳性细胞在脑缺血2h/再灌注2h开始出现,并持续增多,随时间延长呈上升趋势,24h达高峰,至72 h出现下降,各时间点与对照组比较明显增多（P＜0.01）;治疗组各时间点nNOS、iNOS阳性细胞变化趋势同模型组,但较模型组减少（P＜0.05）,较对照组增多（P＜0.01）.结论 大鼠脑I/R损伤后脑组织NOS活性表达增多,NO浓度升高导致脑组织损伤;人工合成E-选择素通过降低NOS表达,减少NO释放、减轻炎症反应和脑I/R损伤,起脑保护作用.     

脑缺血再灌注损伤后一氧化氮合酶表达变化及知母总皂苷对其影响

目的观察脑缺血再灌注损伤后3型—氧化氮合酶(NOS)在脑内表达的变化,了解知母总皂苷(SAaB)对它们表达的影响。方法大鼠灌胃给药7d,采用线栓法制作大鼠局灶性脑缺血再灌注损伤模型,观察大鼠神经功能损害,利用免疫组织化学法观察脑组织中3型NOS表达。结果缺血再灌注组大鼠表现出明显神经功能障碍,神经元型NOS(nNOS)含量明显升高,内皮型NOS (eNOS)仅轻度升高。SAaB低、高剂量治疗组大鼠神经功能障碍较轻,同时脑组织中nNOS表达明显降低,而eNOS的表达增强,经图像分析比较后显示各组表达强度差异具有统计学意义(P＜0．05)。结论各型NOS的表达变化在脑缺血再灌注损伤的机制中起着重要作用,推测SAaB因其减低nNOS表达同时增加eNOS表达的作用,而表现出一定的神经保护作用。     

局灶脑缺血后早,晚期一氧化氮合成酶的活性变化

一氧化氮(NO)在脑缺血中起重要作用,一氧化氮合成酶(NOS)作为NO合成的关键酶,其活性变化直接调节NO的生成量及生物学效应。本文在建立兔MCAO局灶脑缺血模型基础上,测定缺血后不同时间缺血区和正常脑组织的NOS活性。结果显示,脑缺血早期(1h内)NOS活性突然升高,随之下降;脑缺血后24h NOS活性又升高,至48h、96h明显升高。     

氯美噻唑对大鼠脑出血周边组织一氧化氮含量、一氧化氮合酶活性及细胞凋亡的干预作用

目的 研究氯美噻唑对大鼠脑出血周边组织一氧化氮(NO)含量、一氧化氮合酶(NOS)活性及细胞凋亡的影响.方法 Wistar大鼠112只,随机分为脑出血组和脑出血+氯美噻唑(CMZ)组,两组各分为(出血前和出血后4h、6h、12h、24h、72h、7d)7个时间点.利用化学方法测定大鼠脑出血周边组织NO含量、NOS活性;利用原位末端标记法测定出血周边组织中神经细胞的凋亡情况.结果 大鼠脑出血周边组织NO含量、诱导型一氧化氮合酶(iNOS)、一氧化氮合酶(NOS)4h开始升高(P<0.05),24h到7d显著升高(P<0.01),大约72h左右NO、iNOS、NOS达峰值.大鼠脑出血周边组织6h出现凋亡细胞,12h上升显著(P<0.01),3d凋亡细胞达峰值,与NO、iNOS、NOS峰值对应,7d时仍存在较多凋亡细胞.氯美噻唑干预后,NO含量、iNOS和NOS活性及凋亡细胞数量与脑出血组对应时间点比较显著下降(P<0.01).结论 大鼠脑出血周边组织NO含量增高,iNOS、NOS活性增强,脑出血周边组织神经细胞存在长时间凋亡,NO、iNOS可以促进其凋亡;氯美噻唑干预后NO含量降低,iNOS、NOS活性下降,减少大鼠脑出血周边组织神经细胞凋亡.     

依达拉奉预处理对小鼠脑缺血再灌注损伤后皮质一氧化氮合酶表达的影响

目的探讨依达拉奉预处理对小鼠脑缺血再灌注(IR)损伤后皮质一氧化氮合酶(NOS)表达的影响。方法 48只健康ICR小鼠被分为假手术组、对照组和依达拉奉组。依达拉奉组和对照组分别给予依达拉奉3 mg/(kg.d)和同等体积的生理盐水腹腔注射共7 d,然后建立小鼠IR模型;缺血1 h、再灌注24 h时应用2,3,5-氯化三苯基四氮唑(TTC)染色法测量各组脑梗死体积,应用免疫组化法检测各组小鼠皮质神经元型、、诱导型和内皮型NOS(nNOS、iNOS、eNOS)阳性细胞数。结果与假手术组比较,对照组小鼠皮质nNOS、iNOS和eNOS阳性细胞数明显增多(均P<0.05);与对照组比较,依达拉奉组脑梗死体积明显缩小,皮质nNOS和iNOS阳性细胞数明显减少,eNOS阳性细胞数明显增多(均P<0.05)。结论依达拉奉预处理可以影响IR小鼠皮质nNOS、iNOS和eNOS的表达,发挥神经保护作用。     

一氧化氮合酶抑制剂对脊髓损伤后运动功能的影响

目的观察诱导型和神经型一氧化氮合酶(iNOS,nNOS)抑制剂对大鼠脊髓损伤(SCI)后运动功能的影响和机理。方法大鼠脊髓压迫伤后分别给予iNOS和nNOS抑制剂—氨基胍(AG)和7-硝基吲唑(7-NI)进行治疗,24h后用分光光度法测定组织中一氧化氮(NO)含量和一氧化氮合酶(NOS)活性,72h后用流式细胞仪检测神经细胞凋亡情况,4周后用电生理和动物行为学等指标评价运动功能的恢复情况。结果AG和7-NI均可以抑制组织中的NO含量,并使NOS活性下降,同时降低神经细胞的凋亡比率,对运动功能的恢复前者优于后者。结论脊髓损伤后应用NOS抑制剂可以使伤后运动功能得到改善,AG的作用似乎更明显,提示iNOS活性变化可能对脊髓损伤的恢复更具决定作用。     

颅脑损伤后局部组织一氧化氮合酶表达的实验研究

目的研究一氧化氮合酶(nitricoxidesynthase,NOS)基因在实验性大鼠颅脑创伤后局部组织中表达.方法应用免疫组化技术和高清晰度彩色病理图像分析系统,对大鼠脑组织神经细胞中诱导型一氧化氮合酶(iNOS)的表达进行了检测.结果颅脑创伤后大鼠局部及周围神经细胞中有NOS阳性产物表达并具时程特点,伤后2h平均积分光密度(ODI)较0.5h升高不显著(P0.05),伤后6h、12h、24hODI较0.5h升高非常显著(P<0.01).结论在急性脑损伤后的病理过程中,脑组织中诱导型一氧化氮合酶被大量合成,可能是造成机体一氧化氮(Nitricoxide,NO)升高的直接原因.     

Remote ischemic conditioning approach for the treatment of ischemic stroke

Stroke is the leading cause of disability and death in North America.There has been growing interest in identifying neuroprotective strategies to reduce ischemic burden in patients with acute ischemic stroke.However,despite extensive clinical trials,no neuroprotective agent has been found for prevention of ischemic damage.Remote ischemic preconditioning(RIC)is a promising non-invasive strategy that has been proven to provide renal and cardioprotection and has recently found to have a potential broad application in the treatment of neurovascular disease,which has bee linked to its possible effects on the release and activation of endogenous neuroprotective substances against the ischemia/reperfusion injuries in experimental studies.This endogenous neuroprotection might vaccinate neural tissues against effects of acute IR following primary infarction insult.Regardless of the method of RIC administration,through manual or automated blood pressure cuff,RIC procedure is inexpensive and easy to use.Based on the experimental and clinical data,application of RIC avoids possible adverse effects and interactions associated with chemical pharmacological agents.In previous clinical studies RIC was safe and associated with only minor transient adverse effects in few cases,including petechia and minor limb pain,which were mostly resolved shortly after completing the treatment.     

Neuroprotection targeting ischemic penumbra and beyond for the treatment of ischemic stroke

Neuroprotection to attenuate or block the ischemic cascade and salvage neuronal damage has been extensively explored for the treatment of ischemic stroke. In the last two decades, neuroprotective strategy has been evolving from targeting a signal pathway in neurons to protecting all neurovascular components and improving cell-cell and cell-extracellular matrix interaction that ultimately benefits the brain recovery after ischemic stroke. The progression from potentially reversible to irreversible injury in the ischemic penumbra has provided the opportunity to develop therapies to attenuate the ischemic stroke damage. Thus, the ischemic penumbra has been the main target for the current neuroprotective intervention. However, despite our increasing knowledge of the physiologic, mechanistic, and imaging characterizations of the ischemic penumbra, no effective neuroprotective therapy has been found so far for the treatment of ischemic stroke. The current acute neuroprotective approach focusing on the damaging mechanisms at the ischemic penumbra is greatly limited by the rapid evolution of the deleterious cascades in the ischemic penumbra. Neuroprotective intervention attempts to promote endogenous repairing in the transition zone of the penumbra for the therapeutic purposes may overcome the unrealistic therapeutic windows under the current neuroprotective strategy. In addition, increasing evidence has indicated ischemic stroke could induce long-lasing cellular and hemodynamic changes beyond the ischemic territory. It is unclear whether and how the global responses induced by the ischemic cascade contribute to the progression of cognitive impairment after ischemic stroke. The prolonged pathophysiological cascades induced by ischemic stroke beyond the ischemic penumbra might provide novel therapeutic opportunities for the neuroprotective intervention, which could prevent or slow down the progression of vascular dementia after ischemic stroke.     

Potassium homeostasis in the ischemic brain

Extracellular [K+] can range within 2.5-3.5 mM under normal conditions to 50-80 mM under ischemic and spreading depression events. Sustained exposure to elevated [K+]o has been shown to cause significant neuronal death even under conditions of abundant glucose supply. Astrocytes are well equipped to buffer this initial insult of elevated [K] through extensive gap junctional coupling, Na+/K+ pump activity (with associated glycogen and glycolytic potential), and endfoot siphoning capability. Their abundant energy availability and alkalinizing mechanisms help sustain Na+/K+ ATPase activity under ischemic conditions. Furthermore, passive K+ uptake mechanisms and water flux mediated through aquaporin-4 channels in endfoot processes are important energy-independent mechanisms. Unfortunately, as the length of ischemic episode is prolonged, these mechanisms increase to a point where they begin to have repercussions on other important cellular functions. Alkalinizing mechanisms induce an elevation of [Na+]i, increasing the energy demand of Na+/K+ ATPase and leading to eventual detrimental reversal of the Na+/glutamate- cotransporter and excitotoxic damage. Prolonged ischemia also results in cell swelling and activates volume regulatory processes that release excessive excitatory amino acids, further exacerbating excitotoxic injury. In the days following ischemic injury, reactive astrocytes demonstrate increased cell size and process thickness, leading to improved spatial buffering capacity in regions outside the lesion core where there is better neuronal survival. There is a substantial heterogeneity among reactive astrocytes, with some close to the lesion showing decreased buffering capacity. However, it appears that both Na+/K+ ATPase activity (along with energy production processes) as well as passive K+ uptake mechanisms are upregulated in gliotic tissue outside the lesion to enhance the above-mentioned homeostatic mechanisms.     

Brain ischemic lesions of the newborn

Ischemia is the most frequent pathogenetic mechanism of brain lesions in infancy. The authors give a brief report on the recent advances achieved in knowledge of the underlying neuropathology, clinical manifestations, strategies of management and outcome of ischemic brain lesions in the newborn. A better knowledge of pathophysiological mechanisms is necessary so that prevention can be made more effective and outcomes improved. As far the vulnerability to ischemic insults in term and preterm infants is concerned, the different types of brain damage cause various neurological consequences at different gestational ages. Thus, the authors deal separately with white matter lesions, which are typical of infants born prematurely, and cortical brain ischemic lesions, which are found in full-term newborns.     

短暂性脑缺血发作与脑缺血耐受研究进展

脑缺血耐受是近年来的研究热点。短暂性脑缺血发作虽然使缺血性卒中危险增加,但同时可诱导神经细胞对再次缺血产生耐受。耐受的机制涉及血管因素、腺苷、兴奋性氨基酸、热休克蛋白、低氧诱导因子-1、促红细胞生成素、KATP通道等。临床观察显示,TIA的持续时间、发作频度、脑梗死间隔时间以及脑梗死体积等均与耐受的发生有关。     

Experimental model for repetitive ischemic attacks in the gerbil: the cumulative effect of repeated ischemic insults

An experimental model for repeated ischemic attacks, which allows easy induction of cerebral ischemia of any desired duration and frequency, has been developed in the gerbil. With this procedure, a pronounced cumulative effect on development of edema and tissue injury was observed using 3 separate, 5-min bilateral occlusions of the common carotid arteries spaced at various time intervals. This effect was most evident when the occlusions were carried out at 1-h intervals, i.e., during the period of marked postischemic hypoperfusion. Such animals, killed after 24 h of recirculation, showed significantly more severe edema and brain tissue injury in the areas exposed to ischemia than was observed in animals killed 24 h after single 5- or 15-min occlusions. The changes of regional CBF, assayed with a [3H]nicotine method, indicated a relatively rapid onset of hypoperfusion of similar degree after each release of arterial occlusion. The hypoperfusion recovered significantly within 6 h of recirculation following either single or multiple occlusions, and no residual hypoperfusion was observed in animals which, when killed at 24 h, showed severe edema and brain tissue injury. This model should prove useful in elucidating the pathophysiological mechanisms operative in repetitive cerebral ischemia.