Mechanisms of brain injury after global cerebral ischemia

Cerebral ischemia results in a rapid depletion of energy stores that triggers a complex cascade of cellular events such as cellular depolarization and Ca2+ influx, resulting in excitotoxic cell death. The critical determinant of severity of brain injury is the duration and severity of the ischemic insult and early restoration of CBF. Induced therapeutic hypothermia following CA is the only strategy that has demonstrated improvement in outcomes in prospective, randomized clinical trials. Although pharmacologic neuro-protection has been disappointing thus far in a variety of experimental animal models, further research efforts are directed at using some agents that demonstrate marginal or moderate efficacy in combination with hypothermia. Although the signal transduction pathways and intracellular molecular events during cerebral ischemia and reperfusion are complex, potential therapeutic neuroprotective strategies hold promise for the future.     

Matrix metalloproteinase 2 gene knockout has no effect on acute brain injury after focal ischemia

Matrix metalloproteinases (MMPs) may contribute to tissue damage after cerebral ischemia. In this study, wildtype and MMP-2 knockout mice were subjected to permanent and transient (2 h) occlusions of the middle cerebral artery. Gelatin zymography showed that MMP-9 levels were increased in all brains after ischemia. MMP-2 levels did not show a significant increase in wildtype mice, and were not detectable in knockout mice. Laser doppler flowmetry demonstrated equivalent ischemic reductions in perfusion in wildtype and knockout mice. In both permanent and transient occlusion paradigms, there were no statistically significant differences between wildtype and knockout mice in terms of 24 h ischemic lesion volumes. These data suggest that MMP-2 does not contribute to acute tissue damage in this model of focal ischemia.     

Caspase inhibitors reduce neuronal injury after focal but not global cerebral ischemia in rats

BACKGROUND AND PURPOSE: Studies show that blocking the activation of caspases by the caspase inhibitors z-VAD.FMK and z-DEVD.FMK can reduce ischemic neuronal injury after cerebral ischemia. Because the severity of ischemia was mild in some studies, we tested the efficacy of these caspase inhibitors on moderately severe but transient forebrain and focal ischemic insults in the rat. METHODS: Various regimens of z-VAD, z-DEVD, and control DMSO were given to rats subjected to either 4-vessel occlusion ischemia (4-VO, 10-minute occlusion, 7-day survival) or distal middle cerebral artery occlusion (MCAo, 90-minute occlusion, 22.5-hour survival). In global ischemia, treatments were given immediately after ischemia (experiment 1) or as preischemic and postischemic treatments (experiment 2). Three focal ischemia experiments were done. Injection times were 60 minutes into ischemia (experiment 1) and 60 minutes into ischemia plus 30 and 120 minutes after ischemia (experiment 2). Experiment 3 was identical to experiment 2 except that a 30-minute preischemia treatment was instituted. Core normothermia was maintained in all experiments during ischemia. However, in the last focal and global experiments, core and brain temperatures, respectively, were also measured after ischemia with telemetry probes. Because hyperthermia accompanied z-DEVD treatment, an extra z-DEVD-treated group (MCAo) was included with temperature clamped at normothermia. RESULTS: Neither z-VAD nor z-DEVD significantly reduced CA1 injury after global ischemia. In focal ischemia, both drugs significantly reduced infarction, but only in the third experiment, and the prevention of hyperthermia that accompanied z-DEVD treatment did not alter this. CONCLUSIONS: These results suggest a detrimental role of caspases in moderately severe focal but not global cerebral ischemia.     

东菱克栓酶对全脑缺血再灌流损伤脑保护作用的实验研究

本文采用Ｐｕｌｌｓｉｎｅｌｌｉ的４ＶＯ方法制作了大鼠全脑缺血再灌流动动物模型，采用ＴＢＡ法、ＤＴＮＢ直接法测定全脑缺血１０ｍｉｎ再灌流后４８ｈ海马区的过氧化脂质（ＬＰＯ）和谷光甘肽过氧化物酶（ＧＳＨ－Ｐｘ）含量变化，计量病理和电子显微镜观察病理变化及东菱精纯克栓酶对其含量变化和病理改变的影响。结果显示：（１）东菱克栓酶可降低海马区ＬＰＯ含量（Ｐ〈０．０１），使ＧＳＨ－Ｐｘ活性上升（Ｐ〈０．０１）。     

Ziprasidone attenuates brain injury after focal cerebral ischemia induced by middle cerebral artery occlusion in rats

Ziprasidone is an atypical antipsychotic drug used for the treatment of schizophrenia. Recent studies have reported that atypical antipsychotics have neuroprotective effects against brain injury. In the present study, the effect of ziprasidone on ischemic brain injury was investigated. Focal cerebral ischemia was induced by middle cerebral artery occlusion (MCAO) in rats. All the animals experienced ischemia for 1h and then underwent reperfusion. The infarct size induced by MCAO was significantly reduced in the animals that received acute treatment with 5mg/kg ziprasidone and subchronic treatment with 2.5mg/kg ziprasidone for 7 days compared with that in the vehicle-treated animals. The acute treatment with ziprasidone significantly improved neurological functions, as measured by the modified neurological severity score, in a dose-dependent manner. The subchronic treatment produced more rapid recovery from functional deficits than the vehicle treatment. The immunohistochemical investigation revealed that the subchronic treatment prevented severe loss of neuronal marker intensity and attenuated the increased in microglial marker intensity in the infarcted cortical area. These results suggest that ziprasidone has neuroprotective effects in a rat model of ischemic stroke and provide new insight for its clinical applications.     

c—fos反义寡聚核苷酸对脑缺血性损伤和电针抗损伤作用的影响

用c-fos反义寡聚核苷酸脑内微量注射、TTC染色、c-Fos免疫组织化学和电针等技术和方法,探讨即早反应基因c-fos在大鼠局灶性脑缺血（MCAO）模型的脑损伤中和电针抗局灶性脑缺血脑损伤中所起的作用。实验结果表明,局灶性脑缺血可引起c-fos在缺血侧皮质的大量表达,电针能部分抑制这种表达,使脑缺血梗死灶体积减小。在缺血中心区注射c-fos反义寡聚核苷酸后,脑内c-fos的表达基本上被完全阻断,导致脑梗死灶的体积明显增大,电针抗脑缺血脑损伤的作用也被取消,提示脑缺血后,脑内的c-fos适度表达可能对脑损伤有一定的保护作用。电针可能部分抑制了脑内c-fos表达,调整了缺血后的c-fos表达的程度,对脑缺血损伤起一定的保护作用。     

Ischemic axonal injury and its recovery after focal cerebral ischemia

After focal cerebral infarction by occluding the middle cerebral artery (MCA) of the rat, the neuronal death occurred in the ipsilateral thalamic neurons, because axons of the thalamic neurons were injured by infarction and retrograde degeneration occurred in the thalamic neurons. However, cortical neurons adjacent to the infarction survived despite their axons injured by ischemia. We employed immunohistochemical staining for 200 kilodalton (kD) neurofilament (NF), in order to study those responses of cortical and thalamic neurons against axonal injury caused by focal cerebral infarction. In the sham operated rats the immunoreactivity to the anti-200 kD NF antibody was only detected in the axon but not in the cell bodies and dendrites. At 3 days after MCA occlusion, axonal swelling proximal to the site of ischemic injury was found in the caudoputamen and internal capsule of the ipsilateral side. At 7 days after occlusion, cell bodies and dendrites of the neurons in the ipsilateral cortex and thalamus were strongly stained with anti-NF antibodies. At 2 weeks after occlusion these responses disappeared in the cortex, but lasted in the thalamus. These phenomena are caused by stasis of the slow axonal transport, because the NF is transported by slow axonal transport. In the cortical neurons impairment of slow axonal transport recovered in the early phase after injury, but in the thalamic neurons the impairment prolonged up to 3 weeks after occlusion. The early recovery of axonal transport from ischemia seemed to be essential for survival of neurons after ischemic axonal injury.     

大鼠局灶性脑缺血后神经营养因子表达的自然变化

目的 观察大鼠局灶性脑缺血后大鼠神经行为、梗死体积、组织形态及缺血半暗带神经生长因子(NGF)、脑源性神经营养因子(BDNF)的表达水平变化。方法 将健康雄性SD大鼠24只随机分为2组,Ⅰ组(假手术组); Ⅱ组(脑缺血组)。用线栓法建立动物模型,不给予再灌注,各组在术后48h断头取脑,处死前行神经功能评分,用氯化三苯基四氮唑(TTC)染色计算脑梗死体积,用HE染色观察组织学形态,用免疫组织化学染色观察NGF、BDNF的表达水平。结果 Ⅰ组在神经功能评分、梗死体积、组织形态及大脑皮层相应部位NGF、BDNF阳性细胞数均正常。与Ⅰ组比较,Ⅱ组的神经功能评分和梗死体积均严重受损; 光镜下Ⅱ组缺血性病理改变较重,与Ⅰ组比较,Ⅱ组缺血半暗带NGF、BDNF阳性神经元数增加(P<0.05)。结论 脑缺血本身可上调缺血半暗带NGF、BDNF的表达水平。     

Evolution of brain infarction after transient focal cerebral ischemia in mice.

The evolution of brain infarction after transient focal cerebral ischemia was studied in mice using multiparametric imaging techniques. One-hour focal cerebral ischemia was induced by occluding the middle cerebral artery using the intraluminal filament technique. Cerebral protein synthesis (CPS) and the regional tissue content of adenosine triphosphate (ATP) were measured after recirculation times from 0 hours to 3 days. The observed changes were correlated with the expression of the mRNAs of hsp-70, c-fos, and junB, as well as the distribution of DNA double-strand breaks, visualized by TUNEL. At the end of 1 hour of ischemia, protein synthesis was suppressed in a larger tissue volume than ATP in accordance with the biochemical differentiation between core and penumbra. Hsp70 mRNA was selectively expressed in the cortical penumbra, whereas c-fos and junB mRNAs were increased both in the lateral part of the penumbra and in the ipsilateral cingulate cortex with normal metabolism. During reperfusion after withdrawal of the intraluminal filament, suppression of CPS persisted except in the most peripheral parts of the middle cerebral artery territory, in which it recovered between 6 hours and 3 days. ATP, in contrast, returned to normal levels within 1 hour but secondarily deteriorated from 3 hours on until, between 1 and 3 days, the ATP-depleted area merged with that of suppressed protein synthesis leading to delayed brain infarction. Hsp70 mRNA, but not c-fos and junB, was strongly expressed during reperfusion, peaking at 3 hours after reperfusion. TUNEL-positive cells were detected from 3 hours on, mainly in areas with secondary ATP depletion. These results stress the importance of an early recovery of CPS for the prevention of ischemic injury and suggest that TUNEL is an unspecific response of delayed brain infarction.     

胰岛素对局灶性脑缺血再灌注损伤的作用

目的　观察胰岛素对脑缺血再灌注损伤的治疗作用。方法　制备易卒中型肾血管性高血压大鼠（ Ｒ Ｈ Ｒ Ｓ Ｐ） ,用线栓法复制大脑中动脉阻塞（ Ｍ Ｃ Ａ Ｏ） ,造成缺血６ ｈ 再灌注１８ ｈ ,术后立即及６ 小时后即时使用胰岛素,测定神经功能障碍评分及脑梗死体积的变化。结果　胰岛素可使神经功能障碍评分显著减低,梗死灶体积及其占全大脑体积比值,两半球体积差值显著减小。结论　胰岛素能减轻脑缺血再灌注损伤,早期用药效果更好。     

A phenothiazine derivative reduces rat brain damage after global or focal ischemia.

BACKGROUND AND PURPOSE: We previously reported that 2-(10H-phenothiazin-2-yloxy)-N,N-dimethylethanamine hydrochloride is a potent inhibitor of iron-dependent lipid peroxidation in vitro and can protect primary cultures of rat hippocampal neurons from hydrogen peroxide-induced toxicity. Because oxidants may play an important role in mediating postischemic tissue injury, we evaluated this agent in two rat models of transient cerebral ischemia. METHODS: In a model of global forebrain ischemia, 23 male Wistar rats were subjected to 10 minutes of four-vessel occlusion followed by 72 hours of reperfusion. The rats received three intraperitoneal injections of either vehicle (2% aqueous acacia) or test agent (40 mg/kg). In a model of focal stroke, 19 spontaneously hypertensive rats were subjected to 2 hours of tandem middle cerebral and ipsilateral common carotid artery occlusion followed by 24 hours of reperfusion. The rats received three intraperitoneal injections of either vehicle (2% aqueous acacia) or test agent (40 mg/kg). RESULTS: In the global model, the phenothiazine significantly protected the CA1 layer of the hippocampus, with a reduction in mean damage score from 2.1 +/- 0.3 for control rats to 1.0 +/- 0.4 for treated rats (p less than 0.05). In the transient focal stroke model, the compound reduced cortical infarct volume from 130.1 +/- 10.3 mm3 for control rats to 95.2 +/- 24.5 mm3 for treated rats (p less than 0.02). CONCLUSIONS: Although the primary mechanism responsible for the protective effect is unclear at the present time, our study is consistent with the hypothesis that oxidant-mediated lipid peroxidation may be involved in the pathophysiology of postischemic brain injury.     

Risperidone attenuates brain damage after focal cerebral ischemia in vivo

Since their introduction, atypical neuroleptic agents have been discovered to have some beneficial effects beyond their effectiveness as neuroleptic drugs. Among these initially unexpected effects are their potential effects as mood stabilizers in bipolar disorder and their efficacy in improving long-term outcome in schizophrenia. These effects recently raised the question whether these drugs may also have some neuroprotective effect in the brain. To examine this matter, in this study we evaluated the neuroprotective effect of risperidone after permanent focal cerebral ischemia. Anaesthetized male C57BL/6j mice were submitted to permanent thread occlusion of the middle cerebral artery (MCA). Risperidone (0.1, 1 or 10 mg/kg) or vehicle was applied intraperitoneally just after permanent ischemia. Twenty-four hours after permanent ischemia, brain injury was evaluated by triphenyltetrazolium chloride staining (TTC). Risperidone (0.1, 1 and 10 mg/kg) showed significant neuroprotection after permanent focal cerebral ischemia.     

Olanzapine attenuates brain damage after focal cerebral ischemia in vivo

Atypical antipsychotic drugs are widely used in the treatment of schizophrenia. These agents are discovered to have some additional beneficial effects beyond their effectiveness as antipsychotic drugs. Among these initially unexpected effects are their potential effects as mood stabilizers in bipolar disorder and their efficacy in improving long-term outcome in schizophrenia. These effects recently raised the question whether these drugs may also have some neuroprotective effect in the brain. To examine this matter, in this study we evaluated the neuroprotective effect of olanzapine after permanent focal cerebral ischemia. Anaesthetized male C57BL/6j mice were submitted to permanent thread occlusion of the middle cerebral artery (MCA). Olanzapine (0.1 and 1 mg/kg) or vehicle was applied intraperitoneally just after permanent ischemia. Twenty-four hours after permanent ischemia, brain injury was evaluated by triphenyltetrazolium chloride staining (TTC). Olanzapine (0.1 and 1 mg/kg) showed significant neuroprotection after permanent focal cerebral ischemia.     

局灶性脑缺血后脑内髓过氧化物酶活性观察

目的　探讨局灶性脑缺血后脑组织髓过氧化物酶（ＭＰＯ） 活性的测定方法,以及与缺血性损害的关系。方法　采用新型小鼠大脑中动脉线栓模型,检测不同缺血时间组梗塞体积及ＭＰＯ活性。结果　缺血１ ｈ 后再灌注２３ ｈ 组（ｔＭＣＡＯ）缺血灶体积明显小于缺血２４ ｈ 组（ｐＭＣＡＯ）;ＭＰＯ活性在各缺血组缺血侧明显高于对照侧和对照组（ Ｐ＜ ０－０５）,ｐＭＣＡＯ 组缺血侧基底节区ＭＰＯ 活性显著高于ｔＭＣＡＯ 组（ Ｐ＜ ０－０５） ,而两组缺血皮质区ＭＰＯ 活性则无显著差异。结论　本研究建立了局灶性脑缺血的ＭＰＯ活性测定方法,证明ＭＰＯ活性与缺血损伤间具有一定关系。     

亚低温对大鼠脑缺血再灌注损伤的保护研究

目的观察亚低温对大鼠全脑缺血再灌注后海马CAI区神经元凋亡的影响,探讨亚低温对缺血再灌注脑损伤的保护作用。方法SD大鼠30只随机分为对照组（n=10）,常温缺血组（n=10）,亚低温组（n=10）,采用改良的Pulsinelli-Brierley4血管法建立全脑缺血再灌注动物模型,缺血30min后再灌注72h,尼氏体染色观察海马区存活锥体细胞数,TUNEL法检测缺血后海马CAI区神经元凋亡情况,电镜下观察神经细胞形态学改变。结果与对照组比较,常温缺血组的海马CAI区存活的锥体细胞数目减少（P〈0.01）;与常温缺血组比较,亚低温组海马CAI存活的锥体细胞数目明显增多（P〈0.01）。对照组、亚低温组的海马CAI区神经元凋亡数目和凋亡指数明显低于常温缺血组。在电镜下观察亚低温能明显减轻缺血后脑组织病理形态学的损害程度。结论亚低温可以抑制脑缺血再灌注后的神经细胞凋亡,对神经细胞有保护作用。     

局灶性脑低温处理对大鼠创伤性脑损伤模型的保护作用

目的探讨局灶性低温处理对SD大鼠创伤性脑损伤（TBI）模型的保护作用并探讨其相关机制。 方法将15只雄性SD大鼠随机平均分成假手术组（sham）,非冷却组（non-cooling）和冷却组（cooling）。Non-cooling组和cooling组制作TBI模型,3组实验同步进行,创伤后低温处理3 h,复温3 h,过程中检测大鼠血气、皮层脑电。复温结束处死大鼠后,对脑组织进行TTC和HE染色以评价脑死亡和脑水肿情况,Western blot检测相关机制蛋白表达情况。 结果Sham组和non-cooling组受外部刺激脑组织代谢升高,cooling组较其他组脑组织代谢低,TTC和HE染色显示cooling组脑死亡的面积和细胞死亡数量均少于non-cooling组,差异均具有统计学意义（P<0.05）。大鼠TBI后局灶性低温处理能显著降低大脑皮层的癫痫样棘波,在回温时这种不完全抑制持续存在,且低温处理降低了GABA_B1R蛋白的表达,差异均具有统计学意义（P<0.05）。Cooling组的脑水肿情况较non-cooling组轻,且cooling组AQP4蛋白表达降低,差异均具有统计学意义（P<0.05）。 结论局灶性低温处理对TBI大鼠具有保护作用,能显著减轻TBI引起的脑水肿,抑制大脑皮层的癫痫样棘波,具体机制可能分别与GABA_B1R和AQP4相关。为临床治疗TBI提供了一种更加安全、简单有效的方法。     

大鼠局灶性脑缺血再灌注后bcl-2蛋白在大脑皮质的表达

目的观察bcl-2蛋白在大鼠局灶性脑缺血再灌注(FCIR)后表达的变化。方法大脑中动脉内线栓法(MCAO)建立缺血再灌注(IR)模型,用免疫组化(SP)法观察bcl-2蛋白不同时间的表达。HE染色观察各个时间点细胞形态学变化。结果脑缺血2h再灌注2hbcl-2表达升高(P<0.01),IR6h达到高峰,IR12h开始下降。结论随着脑缺血再灌注时间延长脑损伤加重,bcl-2蛋白表达减少,bcl-2蛋白表达增加对细胞存亡有重要意义。