Anti-apoptotic and neuroprotective effects of Tetramethylpyrazine following spinal cord ischemia in rabbits
© Fan et al; licensee BioMed Central Ltd. 2006
Received: 02 March 2006
Accepted: 14 June 2006
Published: 14 June 2006
Tetramethylpyrazine (TMP) is one of the most important active ingredients of a Chinese herb Ligusticum wallichii Franchat, which is widely used in many ischemia disorders treatments. However, the exact mechanism by which TMP protects the spinal cord ischemia/reperfusion (I/R) injury is still unknown. For this purpose, rabbits were randomly divided into sham group, control group and TMP group. After the evaluation of neurologic function, the spinal cords were immediately removed for biochemical and histopathological analysis. Apoptosis was measured quantitatively by the terminal transferase UTP nick end-labeling (TUNEL) method and confirmed by electron microscopic examination, the expression of Bax and Bcl-2 was immunohistochemically evaluated and quantified by Western blot analysis.
Neurologic outcomes in the TMP-group were significantly better than those in the control group (P < 0.05). TMP decreased spinal cord malondialdehyde (MDA) levels and ameliorated the down regulation of spinal cord superoxide dismutase (SOD) activity. TMP significantly reduced the loss of motoneurons and TUNEL-positive rate. Greater Bcl-2 and attenuated Bax expression was found in the TMP treating rabbits.
These findings suggest that TMP has protective effects against spinal cord I/R injury by reducing apoptosis through regulating Bcl-2 and Bax expression.
Spinal cord ischemia/reperfusion (I/R) injury may present immediate or delayed paraplegia that occurs 4% to 33% of patients undergoing surgery on the thoracic aorta . Therefore, In attempt to prevent this complication, various methods of spinal cord protection have been suggested, including temporary shunts or partial bypass, hypothermia, drainage of cerebrospinal fluid, and pharmacologic measures [2–4]. Despite their use, paraplegia remains a persistent complication.
Although the exact mechanism of I/R injury is not fully understood, it is believed that Oxidative stress plays a pivotal role in triggering lipid peroxidation, DNA damage and specific gene expression . In addition, blood-brain-barrier disruption, mediated by oxygen free radicals, results in spinal cord edema. Oxidative stress resulting from reactive oxygen species (ROS) production is also implicated in apoptosis. Although ischemic neuronal cell death had been traditionally interpreted by necrotic mechanisms, the role of apoptotic mechanisms has been recently proposed in neuronal cell death following spinal cord I/R injury . Several studies have suggested that apoptotic mechanisms were initiated at the molecular level in I/R neural cells[9, 10].
In traditional Oriental medicine, Ligusticum wallichii Franchat (Chuan Xiong) is applied in the treatment of neurovascular and cardiovascular diseases. Tetramethylpyrazine (TMP), a purified and chemically identified component of Chuan Xiong, has strong effects to scavenge oxygen free radicals . It has been shown that TMP can alleviate kidney and brain damage induced by I/R via scavenging free radicals[12, 13]. However it remains uncertain whether the protective effects of TMP on spinal cord I/R injury are related to scavenging free radicals and suppressing apoptotic pathways.
In this study, the authors investigated the effect of TMP on the neurologic function, biochemical and histopathological changes and studied its impact on expression of pro- and anti-apoptotic proteins as well as the numbers of apoptotic cells following spinal cord I/R injury in rabbits.
All experimental protocols were approved by our Institutional Committee on Animal Research, and were carried out in accordance with the National Institutes of Health guidelines for animal use and care (National Institutes of Health publication no. 96- 23, revised 1996). Experiments were performed on 36 adult male New Zealand White rabbits (provided by Experimental Animal Center of the Xi'an Jiaotong University) weighing 2.5 to 3.0 kg. The animals were initially anaesthetised with pentobarbital sodium (30 mg/kg IV, sigma, USA, NO: 20030709), followed by a half-dose as required during surgical procedure. No animals received hemodynamic or ventilatory support. The left ear vein was cannulated with a 24-gauge catheter for intravenous drug administration. The right femoral artery was catheterized for blood pressure and heart rate monitoring (Spacelab, USA, model 90206A). Arterial blood was sampled for determination of blood gases (AVL-2, Switzerland) and blood glucose (One Touch II, USA). The rectal body temperature was maintained close to 38°C with the aid of a heating pad during the study.
Experimental groups and Animal models
Rabbits were randomly assigned to 3 groups (n = 12 each). In the TMP group, TMP (30 mg/kg) (Changzhou Pharmacological Co., China, NO: 99091401) was injected via ear vein 30 min before aortic clamping and at the onset of reperfusion. Control animals underwent standard aortic occlusion and intravenous injection of 0.9% sodium chloride under conditions identical to the TMP injection. Sham operated animals subjected to operative dissections without aortic occlusion.
Each group of animals was divided into four experimental subgroups: group A for Biochemical analysis (n = 3), group B for hematoxylin and eosin staining (H&E), Terminal Deoxynucleotidyltransferase-Mediated dUTP Nick End-Labeling (TUNEL) staining and immunohistochemistry (n = 3), group C for electron microscopy (n = 2), group D for Western blot assay (n = 4). The rabbit model of spinal cord I/R injury was established according to Savas'discription . Briefly, after sterile preparation, a 10-cm midline incision was performed. Following anticoagulation with 400 unit's heparin, the abdominal aorta was cross-clamped at the level just inferior to the origin of the left renal artery and at the level of aortic bifurcation for 30 min. Reperfusion was initiated by removal of the occlusion and lasted 48 h. The abdomen was then closed.
Neurological function was observed at the 24th and 48th hour after reperfusion according to Johnson's score.
0: Hind-limb paralysis;
1: Severe paraparesis;
2: Functionalmovement, no hop;
3: Ataxia, disconjugate hop;
4: Minimal ataxia;
5: Normal function.
Two individuals without knowledge of the treatment graded neurological function independently.
The animals were euthanized by intravenous administration of a high concentration of pentobarbital at the 48th hour and the spinal cords were quickly removed. The spinal cords were immersed in 4% paraformaldehyde in 0.1 mol/l phosphate buffer and stored at 4°C for 2 weeks. The specimens for microscopy were prepared by obtaining spinal cord cross sections from the L2 or L3 vertebra. The specimens were then embedded in paraffin, cut into sections of 5μm thickness, stained with hematoxylin-eosin (H&E). The specimens were examined under the light microscope by a neuropathologist who was blinded to the study.
Preparation for electron microscopic examination of excised cords
The specimens were fixed in 2.5% glutaraldehyde for 6 h, washed in phosphate buffer (pH 7.4), postfixed in 1% osmium tetroxide in phosphate buffer (pH 7.4), and dehydrated in increasing concentrations of alcohol. Then the tissues were immersed in propylene oxide and embedded in epoxy resin embedding media. Ultrathin sections (thickness 60 nm) were cut and stained with uranyl acetate and lead citrate, and examined with a ZEISS-EM902 transmission electron microscope (Carl Zeiss, Thornwood, NY).
Spinal cord tissues were washed two times with cold saline solution and stored in a deep freeze kept at -30°C until analysis. Tissue MDA levels were determined by the method described by Wasowicz. Briefly, MDA was reacted with thiobarbituric acid by incubating for 1 h at 95–100°C. Following the reaction, fluorescence intensity was measured in the n-butanol phase with a fluorescence spectrophotometry(Hitachi, Model F-4010, Japan), by comparing with a standard solution of 1,1,3,3 tetramethoxypropane. Results were expressed in terms of nmol/g wet tissue. Total (Cu-Zn and Mn) SOD activity was measured by reduction of nitrobluetetrazolium (NBT) by xanthine-xanthine oxidase system. Enzyme activity leading to 50% inhibition was accepted as one unit. Results were expressed as U/mg protein . Protein concentrations were determined according to Lowry's method .
TUNEL staining and immunohistochemistry
TUNEL staining was performed on paraffin sections using an in situ cell death detection kit (Rochev, Germany) according to the manufacturer's instructions. Sections were counterstained with hematoxylin. A negative control was similarly performed except for omitting TUNEL reaction mixture. Only cells showing nuclear condensation/fragmentation and apoptotic bodies in the absence of cytoplasmic TUNEL reactivity were considered apoptotic. For immunohistochemistry, sections, blocked using 2% normal goat serum in PBS, were incubated for overnight at 4°C with mouse monoclonal antibody against Bcl-2/Bax at a dilution of 1:50 (Maxim Biotech Inc, China) followed by followed by a biotinylated sheep anti-mouse antibody and avidin-biotin complex (Vector Laboratories, Burlingame, CA, USA.) for 2 h. The slices were colorized with DAB/H2O2 solution, and then cell nucleuses were counterstained with hematoxylin. Each procedure was followed by several rinses in PBS. Blank staining was carried out in the same way as the above, except for eliminating the primary antibodies. Brown color of nuclei was taken as the positive staining of apoptotic neuronal cells and Brown color of cytoplasm was taken as the positive staining of Bcl-2/Bax. For quantitative analysis, 10 microscopic fields were taken, and all neurons, including neurons with TUNEL staining were counted. The mean values of the percentage of neurons with TUNEL positive staining were taken for further processing.
Western blot assay of Bcl-2 and Bax proteins
Spinal cord tissue was placed in lysis buffer containing inhibitors(leupeptin, pepstatin A, and aprotinin), homogenized, and then centrifuged(12,000 × g). After determining concentration of protein in each sample using a protein assay (Bio-Rad, Hercules, CA, USA), Samples were loaded (50 mg of protein/lane), electrophoresed on a 15% SDS-polyacrylamide gel electrophoresis (SDS-PAGE) gel and blotted to a nylon filter. Blots were probed with mouse monoclonal antibody against Bcl-2/Bax at a dilution of 1:200 (Maxim Biotech Inc, China) and visualized with horseradish peroxidase-conjugated secondary antibodies by enhanced chemiluminescence detection reagents (Amersham). Bcl-2 and Bax proteins were detected as 26 and 21 kDa bands, respectively, using molecular weight marker bands. The filter was scanned by FluorImager 595 (Amersham) and quantified with NIH Image J.
Statistical analysis was performed using SPSS 10.0. An unpaired t-test was used for comparisons in physiological parameters, MDA levels, SOD activity, TUNEL-positive rate and Bcl-2/Bax expression between the groups. Neurological scores were analyzed with nonparametric method (Kruskal-Wallis test) followed by the Mann-Whitney U test with Bonferroni correction. Data were expressed as mean ± S.D. and statistical significance was set at P <0.05.
Physiological variables were within normal limits at any evaluating time points, and showed no statistically significant differences between the groups [see Additional file 1].
Neurologic function evaluation
Changes in neurologic outcome at the 24 th and 48th hour reperfusion
Average motor score
4.92 ± 0.29
2.67 ± 0.78 *
1.75 ± 0.75 *,***
3.42 ± 0.79*, **
3.25 ± 0.75*, **
The biochemical analysis of oxidant stress markers in spinal cord
TUNEL staining and immunohistochemistry for Bax and Bcl-2
Expression in Bcl-2 and Bax proteins
Neuroprotective effects of TMP
This study demonstrates a considerable neuropotective effect of TMP, an active ingredient of the Chinese herb Ligusticum wallichii Franchat, on neurological, biochemical and histopathological status of spinal cord I/R in rabbits. There is increasing evidence that free radicals are generated by I/R and they contribute to tissue injury . ROS attack a variety of critical biological molecules, including membrane lipids, essential cellular proteins, and DNA. We studied the effect of TMP on lipid peroxidation, which was measured in terms of MDA. TMP reversed the increase in MDA levels to a considerable extent, thereby confirming its antioxidant role in I/R. Furthermore, we showed that SOD levels increased following TMP treatment. The SOD is the first line of defense against free radical generation. It has been reported that total SOD is down-regulated following spinal cord I/R . Decreased SOD renders a tissue susceptible to oxidant injury. Therefore, the elevated SOD levels induced by TMP may contribute to reduce superoxide radicals following spinal cord I/R.
In our study, the histology of the spinal cords confirms the clinical observations. In general, severity of injury correlated well with the degree of neuronal damage. In animals that had significant impairment of motor function, evidence of both necrosis and apoptosis was apparent. However, TMP increased the proportion of animals that had normal motor function, and in these animals, necrosis was decreased and more normal motoneurons were preserved. This improvement of neurologic function and the histopathological findings reveal the protective effect of TMP on spinal tissue against I/R injury.
Bax/Bcl-2 dependent anti-apoptotic effects of TMP
The principal finding of this work is that TMP increased Bcl-2 expression together with significant decrease in Bax expression in spinal cord. In addition, TMP significantly reduced the number of TUNEL-positive cells in anterior horn of the spinal cord, and the Bax/Bcl-2 expression appeared to correlate with the anti-apoptotic effect.
It has been suggested that neuronal apoptosis occurs concurrently with necrosis following spinal cord I/R and may contribute predominantly to delayed onset of neuronal cell death [22, 23]. The major mechanism of I/R induced apoptosis is attributed to the ROS release. ROS induces apoptosis by causing DNA damage, oxidation of lipid membranes, and activation of the proteins responsible for apoptosis[24, 25]. Among these apoptosis regulatory proteins, the Bcl-2 family consists of both cell death promoters and cell death preventers. The ratio of anti- to pro-apoptotic molecules such as Bcl-2/Bax determines the response to a death signal. Indeed, the role of the Bcl-2 family in regulating apoptosis has been characterized in CNS ischemia[26, 27]. In addition, over-expression of Bcl-2 may play a protective role in neuropathological sequelae after CNS insults .
Recent studies have revealed that antioxidants attenuated ischemic neuronal apoptosis through Bcl-2 up-regulation parallel to Bax down-regulation . TMP has been reported to attenuate oxidative damage and apoptosis both in vitro and in vivo [30, 31]. In the present study, treatment with TMP is related to an up-regulated level of the anti-apoptotic protein Bcl-2 and a down-regulated pro-apoptotic protein Bax, suggesting that TMP exhibit an inhibitory effect on apoptotic cell death due to spinal cord I/R through modulation of Bcl-2 family.
TMP shows a potent protection against spinal cord I/R injury in rabbit model, and reduces apoptotic cell death through Bcl-2 up-regulation parallel to Bax down-regulation.
The support of Xi'an Jiao Tong University is acknowledged. We thank Prof. Kun-Zheng Wang for the generous supply of Tetramethylpyrazine.
- Svensson LG, Von Ritter CM, Groeneveld HT, Rickards ES, Hunter SJ, Robinson MF, Hinder RA: Cross-clamping of the thoracic aorta. Influence of aortic shunts, laminectomy, papaverine, calcium channel blocker, allopurinol, and superoxide dismutase on spinal cord blood flow and paraplegia in baboons. Ann Surg. 1986, 204: 38-47.PubMed CentralView ArticlePubMedGoogle Scholar
- Svensson LG, Crawford ES, Hess KR, Coselli JS, Safi HJ: Experience with 1509 patients undergoing thoracoabdominal aortic operations. J Vasc Surg. 1993, 17: 357-368. 10.1067/mva.1993.42297.View ArticlePubMedGoogle Scholar
- Tabayashi K, Niibori K, Konno H, Mohri H: Protection from postischemic spinal cord injury by perfusion cooling of the epidural space. Ann Thorac Surg. 1993, 56: 494-498.View ArticlePubMedGoogle Scholar
- McCullough JL, Hollier LH, Nugent M: Paraplegia after thoracic aortic occlusion: influence of cerebrospinal fluid drainage. Experimental and early clinical results. J Vasc Surg. 1988, 7: 153-160. 10.1067/mva.1988.avs0070153.View ArticlePubMedGoogle Scholar
- Zvara DA: Thoracoabdominal aneurysm surgery and the risk of paraplegia: contemporary practice and future directions. J Extra Corpor Technol. 2002, 34: 11-17.PubMedGoogle Scholar
- Chan PH: Role of oxidants in ischemic brain damage. Stroke. 1996, 27: 1124-1129.View ArticlePubMedGoogle Scholar
- Orendacova J, Marsala M, Marsala J: The blood-brain barrier permeability in graded postischemic spinal cord reoxygenation in rabbits. Neurosci Lett. 1991, 128: 143-146. 10.1016/0304-3940(91)90247-Q.View ArticlePubMedGoogle Scholar
- Lin R, Roseborough G, Dong Y, Williams GM, Wei C: DNA damage and repair system in spinal cord ischemia. J Vasc Surg. 2003, 37: 847-858. 10.1067/mva.2003.150.View ArticlePubMedGoogle Scholar
- Sakurai M, Nagata T, Abe K, Horinouchi T, Itoyama Y, Tabayashi K: Survival and death-promoting events after transient spinal cord ischemia in rabbits: induction of Akt and caspase3 in motor neurons. J Thorac Cardiovasc Surg. 2003, 125: 370-377. 10.1067/mtc.2003.112.View ArticlePubMedGoogle Scholar
- Sakurai M, Takahashi G, Abe K, Horinouchi T, Itoyama Y, Tabayashi K: Endoplasmic reticulum stress induced in motor neurons by transient spinal cord ischemia in rabbits. J Thorac Cardiovasc Surg. 2005, 130: 640-645. 10.1038/sj.cr.7290306.View ArticlePubMedGoogle Scholar
- Zhang ZH, Yu SZ, Wang ZT, Zhao BL, Hou JW, Yang FJ, Xin WJ: Scavenging effects of tetramethylpyrazine on active oxygen free radicals. Zhongguo Yao Li Xue Bao. 1994, 15: 229-231.PubMedGoogle Scholar
- Feng L, Xiong Y, Cheng F, Zhang L, Li S, Li Y: Effect of ligustrazine on ischemia-reperfusion injury in murine kidney. Transplant Proc. 2004, 36: 1949-1951. 10.1016/j.transproceed.2004.07.050.View ArticlePubMedGoogle Scholar
- Liao SL, Kao TK, Chen WY, Lin YS, Chen SY, Raung SL, Wu CW, Lu HC, Chen CJ: Tetramethylpyrazine reduces ischemic brain injury in rats. Neurosci Lett. 2004, 372: 40-45. 10.1016/j.neulet.2004.09.013.View ArticlePubMedGoogle Scholar
- Savas S, Delibas N, Savas C, Sutcu R, Cindas A: Pentoxifylline reduces biochemical markers of ischemia-reperfusion induced spinal cord injury in rabbits. Spinal Cord. 2002, 40: 224-229. 10.1038/sj.sc.3101281.View ArticlePubMedGoogle Scholar
- Johnson SH, Kraimer JM, Graeber GM: Effects of flunarizine on neurological recovery and spinal cord blood flow in experimental spinal cord ischemia in rabbits. Stroke. 1993, 24: 1547-1553.View ArticlePubMedGoogle Scholar
- Wasowicz W, Neve J, Peretz A: Optimized steps in fluorometric determination of thiobarbituric acid-reactive substances in serum: importance of extraction pH and influence of sample preservation and storage. Clin Chem. 1993, 39: 2522-2526.PubMedGoogle Scholar
- Sun Y, Oberley LW, Li Y: A simple method for clinical assay of superoxide dismutase. Clin Chem. 1988, 34: 497-500.PubMedGoogle Scholar
- Lowry OH, Rosebrough NJ, Farr AL, Randall RJ: Protein measurement with the Folin phenol reagent. J Biol Chem. 1951, 193: 265-275.PubMedGoogle Scholar
- Agee JM, Flanagan T, Blackbourne LH, Kron IL, Tribble CG: Reducing postischemic paraplegia using conjugated superoxide dismutase. Ann Thorac Surg. 1991, 51: 911-914.View ArticlePubMedGoogle Scholar
- Kempski OS: Neuroprotection. Models and basic principles. Anaesthesist. 1994, 25-33. Suppl 2Google Scholar
- Erten SF, Kocak A, Ozdemir I, Aydemir S, Colak A, Reeder BS: Protective effect of melatonin on experimental spinal cord ischemia. Spinal Cord. 2003, 41: 533-538. 10.1038/sj.sc.3101508.View ArticlePubMedGoogle Scholar
- Sakurai M, Hayashi T, Abe K, Sadahiro M, Tabayashi K: Delayed selective motor neuron death and fas antigen induction after spinal cord ischemia in rabbits. Brain Res. 1998, 797: 23-28. 10.1016/S0006-8993(98)00290-X.View ArticlePubMedGoogle Scholar
- Hayashi T, Sakurai M, Abe K, Sadahiro M, Tabayashi K, Itoyama Y: Apoptosis of motor neurons with induction of caspases in the spinal cord after ischemia. Stroke. 1998, 29: 1007-1012.View ArticlePubMedGoogle Scholar
- Kroemer G: The proto-oncogene Bcl-2 and its role in regulating apoptosis. Nat Med. 1997, 3: 614-620. 10.1038/nm0697-614.View ArticlePubMedGoogle Scholar
- Galang N, Sasaki H, Maulik N: Apoptotic cell death during ischemia/reperfusion and its attenuation by antioxidant therapy. Toxicology. 2000, 148: 111-118. 10.1016/S0300-483X(00)00201-8.View ArticlePubMedGoogle Scholar
- Schabitz WR, Sommer C, Zoder W, Kiessling M, Schwaninger M, Schwab S: Intravenous brain-derived neurotrophic factor reduces infarct size and counterregulates Bax and Bcl-2 expression after temporary focal cerebral ischemia. Stroke. 2000, 31: 2212-2217.View ArticlePubMedGoogle Scholar
- Wang LM, Yan Y, Zou LJ, Jing NH, Xu ZY: Moderate hypothermia prevents neural cell apoptosis following spinal cord ischemia in rabbits. Cell Res. 2005, 15: 387-393. 10.1038/sj.cr.7290306.View ArticlePubMedGoogle Scholar
- Zhao H, Yenari MA, Cheng D, Sapolsky RM, Steinberg GK: Bcl-2 overexpression protects against neuron loss within the ischemic margin following experimental stroke and inhibits cytochrome c translocation and caspase-3 activity. J Neurochem. 2003, 85: 1026-1036.View ArticlePubMedGoogle Scholar
- Amemiya S, Kamiya T, Nito C, Inaba T, Kato K, Ueda M, Shimazaki K, Katayama Y: Anti-apoptotic and neuroprotective effects of edaravone following transient focal ischemia in rats. Eur J Pharmacol. 2005, 516: 125-130. 10.1016/j.ejphar.2005.04.036.View ArticlePubMedGoogle Scholar
- Zhang Z, Wei T, Hou J, Li G, Yu S, Xin W: Iron-induced oxidative damage and apoptosis in cerebellar granule cells: attenuation by tetramethylpyrazine and ferulic acid. Eur J Pharmacol. 2003, 467: 41-47. 10.1016/S0014-2999(03)01597-8.View ArticlePubMedGoogle Scholar
- Kao TK, Ou YC, Kuo JS, Chen WY, Liao SL, Wu CW, Chen CJ, Ling NN, Zhang YH, Peng WH: Neuroprotection by tetramethylpyrazine against ischemic brain injury in rats. Neurochem Int. 2006, 48: 166-176. 10.1016/j.neuint.2005.10.008.View ArticlePubMedGoogle Scholar
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