Abstract
Ischemia is defined as a reduction in blood flow to a level that is sufficient to alter normal cellular function. Brain tissue is highly sensitive to ischemia, such that even brief ischemic periods in neurons can initiate a complex sequence of events that may ultimately culminate in cell death. Stroke and cardiac arrest induce the cessation of cerebral blood flow, which can result in brain damage. The primary intervention to salvage the brain under such a pathological condition is to restore the cerebral blood flow to the ischemic region. However, paradoxically, restoration of blood flow can cause additional damage and exacerbate the neurocognitive deficits in patients who suffered a brain ischemic event, which is a phenomenon referred to as “reperfusion injury.” Transient brain ischemia following a stroke, cardiac arrest, hypoxia, head trauma, cerebral tumor, cerebrovascular disorder, and intracranial infection results from the complex interplay of multiple pathways including excitotoxicity, acidotoxicity, ionic imbalance, peri-infarct depolarization, oxidative and nitrative stress, inflammation, and apoptosis. Many lines of evidence have shown that mitochondria suffer severe damage in response to ischemic injury. Mitochondrial dysfunction based on the mitochondrial permeability transition (MPT) after reperfusion, particularly involving the calcineurin/immunophilin signal transduction pathway, appears to play a pivotal role in the induction of neuronal cell death. Here, we discuss the underlying pathophysiology of brain damage, which is a devastating pathological condition, and highlight the central signal transduction pathway involved in brain damage, which reveals potential targets for therapeutic intervention.
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Uchino H, Elmér E, Uchino K, Lindvall O, Siesjö BK (1995) Cyclosporin A dramatically ameliorates CA1 hippocampal damage following transient forebrain ischaemia in the rat. Acta Physiol Scand 155(4):469–471
Li PA, Uchino H, Elmer E, Siesjö BK (1997) Amelioration by cyclosporin A of brain damage following 5 or 10 min of ischemia in rats subjected to preischemic hyperglycemia. Brain Res 753(1):133–140
Siesjö BK, Elmer E, Janelidze S, Keep M, Kristian T, Ouyang YB et al (1999) Role and mechanisms of secondary mitochondrial failure. Acta Neurochir Suppl 73:7–13
Uchino H, Elmér E, Uchino K, Li PA, He QP, Smith ML et al (1998) Amelioration by cyclosporin A of brain damage in transient forebrain ischemia in the rat. Brain Res 812(1–2):216–226
Uchino H, Minamikawa-Tachino R, Kristian T, Perkins G, Narazaki M, Siesjö BK et al (2002) Differential neuroprotection by cyclosporin A and FK506 following ischemia corresponds with differing abilities to inhibit calcineurin and the mitochondrial permeability transition. Neurobiol Dis 10(3):219–233
Uchino H, Morota S, Takahashi T, Ikeda Y, Kudo Y, Ishii N et al (2006) A novel neuroprotective compound FR901459 with dual inhibition of calcineurin and cyclophilins. Acta Neurochir Suppl 96:157–162
Popp E, Bottiger BW (2006) Cerebral resuscitation: state of the art, experimental approaches and clinical perspectives. Neurol Clin 24(1):73–87 vi
Siesjö BK, Siesjö P (1996) Mechanisms of secondary brain injury. Eur J Anaesthesiol 13(3):247–268
Terasaki Y, Liu Y, Hayakawa K et al (2014) Mechanisms of neurovascular dysfunction in acute ischemic brain. Curr Med Chem 21(18):2035–2042
Povlishock JT, Katz DI (2005) Update of neuropathology and neurological recovery after traumatic brain injury. J Head Trauma Rehabil 20(1):76–94
Janardhan V, Biondi A, Riina HA, Sanelli PC, Stieg PE, Gobin YP (2006) Vasospasm in aneurysmal subarachnoid hemorrhage: diagnosis, prevention, and management. Neuroimaging Clin N Am 16(3):483–496, viii-ix
Wan H, AlHarbi BM, Macdonald RL (2014) Mechanisms, treatment and prevention of cellular injury and death from delayed events after aneurysmal subarachnoid hemorrhage. Expert Opin Pharmacother 15(2):231–243
Kaul M, Lipton SA (2006) Mechanisms of neuroimmunity and neurodegeneration associated with HIV-1 infection and AIDS. J Neuroimmune Pharmacol 1(2):138–151
Manuelidis L (1994) Dementias, neurodegeneration, and viral mechanisms of disease from the perspective of human transmissible encephalopathies. Ann N Y Acad Sci 724:259–281
Mori I, Kimura Y (2001) Neuropathogenesis of influenza virus infection in mice. Microbes Infect 3(6):475–479
Chen JW, Naylor DE, Wasterlain CG (2007) Advances in the pathophysiology of status epilepticus. Acta Neurol Scand 186:7–15
Henshall DC, Simon RP (2005) Epilepsy and apoptosis pathways. J Cereb Blood Flow Metab 25(12):1557–1572
Crompton M (1999) The mitochondrial permeability transition pore and its role in cell death. Biochem J 341(Pt 2):233–249
Friberg H, Wieloch T (2002) Mitochondrial permeability transition in acute neurodegeneration. Biochimie 84(2–3):241–250
Kroemer G (2003) The mitochondrial permeability transition pore complex as a pharmacological target. An introduction. Curr Med Chem 10(16):1469–1472
Wieloch T, Mattiasson G, Hansson M, Elmér E (2007) Mitochondrial permeability transition in the CNS – composition, regulation, and pathophysiological relevance. In: Gibson GE, Dienel GA (eds) Handbook of neurochemistry and molecular neurobiology brain energetics: integration of molecular and cellular processes, 3rd edn. Springer, Berlin/Heidelberg, pp 667–702
Meldrum BS (2000) Glutamate as a neurotransmitter in the brain: review of physiology and pathology. J Nutr 130(4S Suppl):1007S–1015S
Choi DW (1992) Excitotoxic cell death. J Neurobiol 23(9):1261–1276
Dirnagl U, Iadecola C, Moskowitz MA (1999) Pathobiology of ischaemic stroke: an integrated view. Trends Neurosci 22(9):391–397
Mattson MP (2003) Excitotoxic and excitoprotective mechanisms: abundant targets for the prevention and treatment of neurodegenerative disorders. Neuromol Med 3(2):65–94
Halestrap AP (1999) The mitochondrial permeability transition: its molecular mechanism and role in reperfusion injury. Biochem Soc Symp 66:181–203
Honda HM, Korge P, Weiss JN (2005) Mitochondria and ischemia/reperfusion injury. Ann NY Acad Sci 1047:248–258
Kim JS, He L, Lemasters JJ (2003) Mitochondrial permeability transition: a common pathway to necrosis and apoptosis. Biochem Biophys Res Commun 304(3):463–470
Halestrap AP, Clarke SJ, Javadov SA (2004) Mitochondrial permeability transition pore opening during myocardial reperfusion—a target for cardioprotection. Cardiovasc Res 61(3):372–385
Sullivan PG, Rabchevsky AG, Waldmeier PC, Springer JE (2005) Mitochondrial permeability transition in CNS trauma: cause or effect of neuronal cell death? J Neurosci Res 79(1–2):231–239
Schinzel AC, Takeuchi O, Huang Z, Fisher JK, Zhou Z, Rubens J et al (2005) Cyclophilin D is a component of mitochondrial permeability transition and mediates neuronal cell death after focal cerebral ischemia. Proc Natl Acad Sci U S A 102(34):12005–12010
Schneider MD (2005) Cyclophilin D: knocking on death’s door. Sci STKE 2005(287):pe26
Hansson MJ, Mansson R, Mattiasson G, Ohlsson J, Karlsson J, Keep MF et al (2004) Brain-derived respiring mitochondria exhibit homogeneous, complete and cyclosporin-sensitive permeability transition. J Neurochem 89(3):715–729
Hansson MJ, Mattiasson G, Mansson R, Karlsson J, Keep MF, Waldmeier P et al (2004) The nonimmunosuppressive cyclosporin analogs NIM811 and UNIL025 display nanomolar potencies on permeability transition in brain-derived mitochondria. J Bioenerg Biomembr 36(4):407–413
Hansson MJ, Persson T, Friberg H, Keep MF, Rees A, Wieloch T et al (2003) Powerful cyclosporin inhibition of calcium-induced permeability transition in brain mitochondria. Brain Res 960(1–2):99–111
Lloyde-Jones D, Adams RJ, Brown TM et al (2010) Heart disease and stroke statistics-2010 update: a report from the American Heart Association. Circulation 121(7):e46–e215
Krause GS, Kumar K, White BC et al (1986) Ischemia, resuscitation, and reperfusion: mechanisms of tissue injury and prospects for protection. Am Heart J 111(4):768–780
Vannucci RC (2000) hypoxic-ischemic encephalopathy. Am J Perinatol 17(3):113–120
Fraser PA (2011) The role of free radical generation in increasing cerebrovascular permeability. Free Radic Biol Med 51:967–977
Halestrap AP (2006) Calcium, mitochondria and reperfusion injury: a pore way to die. Biochem Soc Trans 34:232–237
Broughton BR, Reuter DC, Sobey CG (2009) Apoptotic mechanisms after cerebral ischemia. Stroke 40:e331–e339
Sanderson TH, Reynolds CA, Kumar R et al (2013) Molecular mechanisms of ischemia-reperfusion injury in brain: pivotal role of the mitochondrial membrane potential in reactive oxygen species generation. Mol Neurobiol 47(1):9–23
Chen Q, Vazquez EJ, Moghaddas S et al (2003) Production of reactive oxygen species by mitochondria: central role of complex III. J Biol Chem 278:36027–36031
Cali T, Ottolini D, Brini M (2012) Mitochondrial Ca2+ and neurodegeneration. Cell Calcium 52:73–85
Halestrap AP, Woodfield KY, Connern CP (1997) Oxidative stress, thiol reagents and membrane potential modulate the mitochondrial permeability transition by affecting nucleotide binding to the adenine nucleotide translocase. J Biol Chem 272:3346–3354
Ahmad M, Dar NJ, Bhat ZS et al (2014) Inflammation in ischemic stroke: mechanisms, consequences and possible drug targets. CNS Neurol Disord Drug Targets 13(8):1378–1396
Di FM, Chiasserini D, Tozzi A et al (2010) Mitochondria and the link between neuroinflammation and neurodegeneration? Mitochondrion 10:411–418
Knoll G, Brdiczka D (1983) Changes in freeze-fractured mitochondrial membranes correlated to their energetic state. Dynamic interactions of the boundary membranes. Biochim Biophys Acta 733(1):102–110
Crompton M, Barksby E, Johnson N, Capano M (2002) Mitochondrial intermembrane junctional complexes and their involvement in cell death. Biochimie 84(2–3):143–152
Baines CP, Kaiser RA, Purcell NH, Blair NS, Osinska H, Hambleton MA et al (2005) Loss of cyclophilin D reveals a critical role for mitochondrial permeability transition in cell death. Nature 434(7033):658–662
Gajavelli S, Sinha VK, Mazzeo AT et al (2014) Evidence to support mitochondrial neuroprotection, in severe traumatic brain injury. J Bioenerg Biomembr. [Epub ahead of print]
Hansson MJ, Morota S, Chen L et al (2011) Cyclophilin D-sensitive mitochondrial permeability transition in adult human brain and liver mitochondria. J Neurotrauma 28(1):143–153
Uchino H, Hatakeyama K, Morota S et al (2013) Cyclophilin-D inhibition in neuroprotection: dawn of a new era of mitochondrial medicine. Acta Neurochir Suppl 118:311–315
Vinogradov A, Scarpa A, Chance B (1972) Calcium and pyridine nucleotide interaction in mitochondrial membranes. Arch Biochem Biophys 152(2):646–654
Hunter DR, Haworth RA, Southard JH (1976) Relationship between configuration, function, and permeability in calcium-treated mitochondria. J Biol Chem 251(16):5069–5077
Wang JH, Desai R (1976) A brain protein and its effect on the Ca2+-and protein modulator-activated cyclic nucleotide phosphodiesterase. Biochem Biophys Res Commun 72(3):926–932
Yakel JL (1997) Calcineurin regulation of synaptic function: from ion channels to transmitter release and gene transcription. Trends Pharmacol Sci 18(4):124–134
Liu J, Farmer JD Jr, Lane WS, Friedman J, Weissman I, Schreiber SL (1991) Calcineurin is a common target of cyclophilin-cyclosporin A and FKBP-FK506 complexes. Cell 66(4):807–815
Morioka M, Hamada J, Ushio Y, Miyamoto E (1999) Potential role of calcineurin for brain ischemia and traumatic injury. Prog Neurobiol 58(1):1–30
Shibasaki F, Kondo E, Akagi T, McKeon F (1997) Suppression of signalling through transcription factor NF-AT by interactions between calcineurin and Bcl-2. Nature 386(6626):728–731
Wang HG, Pathan N, Ethell IM, Krajewski S, Yamaguchi Y, Shibasaki F et al (1999) Ca2+-induced apoptosis through calcineurin dephosphorylation of BAD. Science 284(5412):339–343
Sharkey J, Butcher SP (1994) Immunophilins mediate the neuroprotective effects of FK506 in focal cerebral ischaemia. Nature 371(6495):336–339
Waldmeier PC, Zimmermann K, Qian T, Tintelnot-Blomley M, Lemasters JJ (2003) Cyclophilin D as a drug target. Curr Med Chem 10(16):1485–1506
Shalbuyeva N, Brustovetsky T, Bolshakov A, Brustovetsky N (2006) Calcium-dependent spontaneously reversible remodeling of brain mitochondria. J Biol Chem 281(49):37547–37558
Mbye LH, Singh IN, Sullivan PG, Springer JE, Hall ED (2008) Attenuation of acute mitochondrial dysfunction after traumatic brain injury in mice by NIM811, a non-immunosuppressive cyclosporin A analog. Exp Neurol 209(1):243–253
Ravikumar R, McEwen ML, Springer JE (2007) Post-treatment with the cyclosporin derivative, NIM811, reduced indices of cell death and increased the volume of spared tissue in the acute period following spinal cord contusion. J Neurotrauma 24(10):1618–1630
McEwen ML, Sullivan PG, Springer JE (2007) Pretreatment with the cyclosporin derivative, NIM811, improves the function of synaptic mitochondria following spinal cord contusion in rats. J Neurotrauma 24(4):613–624
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Uchino, H., Chijiiwa, M., Ogihara, Y., Elmer, E. (2015). Molecular Mechanisms of Brain Ischemia and Its Protection. In: Uchino, H., Ushijima, K., Ikeda, Y. (eds) Neuroanesthesia and Cerebrospinal Protection. Springer, Tokyo. https://doi.org/10.1007/978-4-431-54490-6_4
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DOI: https://doi.org/10.1007/978-4-431-54490-6_4
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