Preconditioning Provides Neuroprotection in Models of CNS Disease: Paradigms and Clinical Significance.

Progress in Neurobiology (Impact Factor: 10.3). 01/2014; 114. DOI: 10.1016/j.pneurobio.2013.11.005
Source: PubMed

ABSTRACT Preconditioning is a phenomenon in which brief episodes of a sublethal insult induce robust protection against subsequent lethal injuries. Preconditioning has been observed in multiple organisms and can occur in the brain as well as other tissues. Extensive animal studies suggest that the brain can be preconditioned to resist acute injuries, such as ischemic stroke, neonatal hypoxia/ischemia, trauma, and agents that are used in models of neurodegenerative diseases, such as Parkinson's disease and Alzheimer's disease. Effective preconditioning stimuli are numerous and diverse, ranging from transient ischemia, hypoxia, hyperbaric oxygen, hypothermia and hyperthermia, to exposure to neurotoxins and pharmacological agents. The phenomenon of "cross-tolerance," in which a sublethal stress protects against a different type of injury, suggests that different preconditioning stimuli may confer protection against a wide range of injuries. Research conducted over the past few decades indicates that brain preconditioning is complex, involving multiple effectors such as metabolic inhibition, activation of extra- and intracellular defense mechanisms, a shift in the neuronal excitatory/inhibitory balance, and reduction in inflammatory sequelae. An improved understanding of brain preconditioning should help us identify innovative therapeutic strategies that prevent or at least reduce neuronal damage in susceptible patients. In this review, we focus on the experimental evidence of preconditioning in the brain and systematically survey the models used to develop paradigms for neuroprotection, and then discuss the clinical potential of brain preconditioning. In a subsequent components of this two-part series, we will discuss the cellular and molecular events that are likely to underlie these phenomena.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Significant reductions in the extent of acute injury in the CNS can be achieved by exposure to different preconditioning stimuli, but the duration of the induced protective phenotype is typically short-lasting, and thus is deemed as limiting its clinical applicability. Extending the period over which such adaptive epigenetic changes persist - in effect, expanding conditioning's "therapeutic window" - would significantly broaden the potential applications of such a treatment approach in patients. The frequency of the conditioning stimulus may hold the key. While transient (1-3 days) protection against CNS ischemic injury is well established preclinically following a single preconditioning stimulus, repetitively presenting preconditioning stimuli extends the duration of ischemic tolerance by many weeks. Moreover, repetitive intermittent postconditioning enhances post-ischemic recovery metrics and improves long-term survival. Intermittent conditioning is also efficacious for preventing or delaying injury in preclinical models of chronic neurodegenerative disease, and for promoting long-lasting functional improvements in a number of other pathologies as well. Although the detailed mechanisms underlying these protracted kinds of neuroplasticity remain largely unstudied, accumulating empirical evidence supports the contention that all of these adaptive phenotypes are epigenetically mediated. Going forward, additional preclinical demonstrations of the ability to induce sustained beneficial phenotypes that reduce the burden of acute and chronic neurodegeneration, and experimental interrogations of the regulatory constructs responsible for these epigenetic responses, will accelerate the identification of not only efficacious but also practical, adaptive epigenetics-based treatments for individuals with neurological disease.
    Frontiers in Neurology 03/2015; 6:42. DOI:10.3389/fneur.2015.00042
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: a r t i c l e i n f o Hypothermia is potently neuroprotective but poor mechanistic understanding has restricted its clinical use. Rodent studies indicate that hypothermia can elicit preconditioning, wherein a subtoxic cellular stress confers resistance to an otherwise lethal injury. The molecular basis of this preconditioning remains obscure. Here we explore molecular effects of cooling using functional cortical neurons differentiated from human pluripotent stem cells (hCNs). Mild-to-moderate hypothermia (28–32 °C) induces cold-shock protein expression and mild endoplasmic reticulum (ER) stress in hCNs, with full activation of the unfolded protein response (UPR). Chemical block of a principal UPR pathway mitigates the protective effect of cooling against oxidative stress, whilst pre-cooling neurons abrogates the toxic injury produced by the ER stressor tunicamycin. Cold-stress thus preconditions neurons by upregulating adaptive chaperone-driven pathways of the UPR in a manner that precipitates ER-hormesis. Our findings establish a novel arm of neurocryobiology that could reveal multiple therapeutic targets for acute and chronic neuronal injury.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Low birth weight (LBW) is common in humans and has been found to cause lasting cognitive and developmental deficits later in life. It is thought that the primary cause is intra-uterine growth restriction (IUGR) due to a shortage of oxygen and supply of nutrients to the fetus. Pigs appear to be a good model animal to investigate long-term cognitive effects of LBW, as LBW is common in commercially farmed breeds of pigs. Moreover, pigs are developmentally similar to humans and can be trained to perform complex tasks. In this study, we trained ten very low birth weight (vLBW) piglets and their ten normal birth weight (NBW) siblings in a spatial cognitive holeboard task in order to investigate long-term cognitive effects of LBW. In this task, four out of sixteen holes contain a hidden food reward, which allows measuring working memory (WM) (short-term memory) and reference memory (RM) (long-term memory) in parallel. Piglets were trained for 46-54 trials during the acquisition phase, followed by a 20-trial reversal phase in which a different set of four holes was baited. Both groups acquired the task and improved their performance over time. A mixed model repeated measures ANOVA revealed that vLBW piglets showed better RM performance than NBW piglets in both the acquisition and reversal phase. Additionally, WM scores in the vLBW were less disrupted than in the NBW animals when switched to the reversal phase. These findings are contrary to findings in humans. Moreover, vLBW pigs had lower hair cortisol concentrations (HCCs) than NBW pigs in flank hair at 12 weeks of age. These results could indicate that restricted intra-uterine growth causes compensatory mechanisms to arise in early development that result in beneficial effects for vLBW piglets, increasing their low survival chances in early-life competition.
    Frontiers in Behavioral Neuroscience 02/2015; 9:43. DOI:10.3389/fnbeh.2015.00043 · 4.16 Impact Factor