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Wider JM, Gruley E, Morse PT, Wan J, Lee I, Anzell AR, Fogo GM, Mathieu J, Hish G, O'Neil B, Neumar RW, Przyklenk K, Hüttemann M, Sanderson TH. Modulation of mitochondrial function with near-infrared light reduces brain injury in a translational model of cardiac arrest. Crit Care 2023; 27:491. [PMID: 38098060 PMCID: PMC10720207 DOI: 10.1186/s13054-023-04745-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Brain injury is a leading cause of morbidity and mortality in patients resuscitated from cardiac arrest. Mitochondrial dysfunction contributes to brain injury following cardiac arrest; therefore, therapies that limit mitochondrial dysfunction have the potential to improve neurological outcomes. Generation of reactive oxygen species (ROS) during ischemia-reperfusion injury in the brain is a critical component of mitochondrial injury and is dependent on hyperactivation of mitochondria following resuscitation. Our previous studies have provided evidence that modulating mitochondrial function with specific near-infrared light (NIR) wavelengths can reduce post-ischemic mitochondrial hyperactivity, thereby reducing brain injury during reperfusion in multiple small animal models. METHODS Isolated porcine brain cytochrome c oxidase (COX) was used to investigate the mechanism of NIR-induced mitochondrial modulation. Cultured primary neurons from mice expressing mitoQC were utilized to explore the mitochondrial mechanisms related to protection with NIR following ischemia-reperfusion. Anesthetized pigs were used to optimize the delivery of NIR to the brain by measuring the penetration depth of NIR to deep brain structures and tissue heating. Finally, a model of out-of-hospital cardiac arrest with CPR in adult pigs was used to evaluate the translational potential of NIR as a noninvasive therapeutic approach to protect the brain after resuscitation. RESULTS Molecular evaluation of enzyme activity during NIR irradiation demonstrated COX function was reduced in an intensity-dependent manner with a threshold of enzyme inhibition leading to a moderate reduction in activity without complete inhibition. Mechanistic interrogation in neurons demonstrated that mitochondrial swelling and upregulation of mitophagy were reduced with NIR treatment. NIR therapy in large animals is feasible, as NIR penetrates deep into the brain without substantial tissue heating. In a translational porcine model of CA/CPR, transcranial NIR treatment for two hours at the onset of return of spontaneous circulation (ROSC) demonstrated significantly improved neurological deficit scores and reduced histologic evidence of brain injury after resuscitation from cardiac arrest. CONCLUSIONS NIR modulates mitochondrial function which improves mitochondrial dynamics and quality control following ischemia/reperfusion. Noninvasive modulation of mitochondria, achieved by transcranial treatment of the brain with NIR, mitigates post-cardiac arrest brain injury and improves neurologic functional outcomes.
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Affiliation(s)
- Joseph M Wider
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5014, USA
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, B10-103A, NCRC 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Department of Molecular and Integrative Physiology, University of Michigan, 7744 MS II, 1137 E. Catherine St., Ann Arbor, MI, 48109-5622, USA
| | - Erin Gruley
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5014, USA
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, B10-103A, NCRC 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Paul T Morse
- Center for Molecular Medicine and Genetics, Wayne State University, 3214 Scott Hall, 540 E. Canfield Ave., Detroit, MI, 48201, USA
| | - Junmei Wan
- Center for Molecular Medicine and Genetics, Wayne State University, 3214 Scott Hall, 540 E. Canfield Ave., Detroit, MI, 48201, USA
| | - Icksoo Lee
- College of Medicine, Dankook University, Cheonan-Si, Chungcheongnam-Do, 31116, Republic of Korea
| | - Anthony R Anzell
- Department of Human Genetics, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Garrett M Fogo
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5014, USA
- Neuroscience Graduate Program, University of Michigan, 204 Washtenaw Ave, Ann Arbor, MI, 48109, USA
| | - Jennifer Mathieu
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5014, USA
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, B10-103A, NCRC 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
- Department of Molecular and Integrative Physiology, University of Michigan, 7744 MS II, 1137 E. Catherine St., Ann Arbor, MI, 48109-5622, USA
| | - Gerald Hish
- Unit for Laboratory Animal Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Ann Arbor, MI, 48109, USA
| | - Brian O'Neil
- Department of Emergency Medicine, Wayne State University, 4201 St. Antoine St., University Health Center - 6G, Detroit, MI, 48201, USA
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5014, USA
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, B10-103A, NCRC 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Karin Przyklenk
- Clinical Research Institute, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, USA
- Department of Pediatrics, Central Michigan University, 1280 S. East Campus Drive, Mount Pleasant, MI, 48859, USA
| | - Maik Hüttemann
- Center for Molecular Medicine and Genetics, Wayne State University, 3214 Scott Hall, 540 E. Canfield Ave., Detroit, MI, 48201, USA
| | - Thomas H Sanderson
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5014, USA.
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, B10-103A, NCRC 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
- Department of Molecular and Integrative Physiology, University of Michigan, 7744 MS II, 1137 E. Catherine St., Ann Arbor, MI, 48109-5622, USA.
- Neuroscience Graduate Program, University of Michigan, 204 Washtenaw Ave, Ann Arbor, MI, 48109, USA.
- Department of Emergency Medicine, Wayne State University, 4201 St. Antoine St., University Health Center - 6G, Detroit, MI, 48201, USA.
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Morse PT, Tuck S, Kerns M, Goebel DJ, Wan J, Waddell T, Wider JM, Hüttemann CL, Malek MH, Lee I, Sanderson TH, Hüttemann M. Non-invasive treatment of ischemia/reperfusion injury: Effective transmission of therapeutic near-infrared light into the human brain through soft skin-conforming silicone waveguides. Bioeng Transl Med 2023; 8:e10496. [PMID: 37206207 PMCID: PMC10189478 DOI: 10.1002/btm2.10496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/02/2023] [Accepted: 01/13/2023] [Indexed: 02/10/2023] Open
Abstract
Noninvasive delivery of near-infrared light (IRL) to human tissues has been researched as a treatment for several acute and chronic disease conditions. We recently showed that use of specific IRL wavelengths, which inhibit the mitochondrial enzyme cytochrome c oxidase (COX), leads to robust neuroprotection in animal models of focal and global brain ischemia/reperfusion injury. These life-threatening conditions can be caused by an ischemic stroke or cardiac arrest, respectively, two leading causes of death. To translate IRL therapy into the clinic an effective technology must be developed that allows efficient delivery of IRL to the brain while addressing potential safety concerns. Here, we introduce IRL delivery waveguides (IDWs) which meet these demands. We employ a low-durometer silicone that comfortably conforms to the shape of the head, avoiding pressure points. Furthermore, instead of using focal IRL delivery points via fiberoptic cables, lasers, or light-emitting diodes, the distribution of the IRL across the entire area of the IDW allows uniform IRL delivery through the skin and into the brain, preventing "hot spots" and thus skin burns. The IRL delivery waveguides have unique design features, including optimized IRL extraction step numbers and angles and a protective housing. The design can be scaled to fit various treatment areas, providing a novel IRL delivery interface platform. Using fresh (unfixed) human cadavers and isolated cadaver tissues, we tested transmission of IRL via IDWs in comparison to laser beam application with fiberoptic cables. Using the same IRL output energies IDWs performed superior in comparison to the fiberoptic delivery, leading to an up to 95% and 81% increased IRL transmission for 750 and 940 nm IRL, respectively, analyzed at a depth of 4 cm into the human head. We discuss the unique safety features and potential further improvements of the IDWs for future clinical implementation.
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Affiliation(s)
- Paul T. Morse
- Center for Molecular Medicine and GeneticsWayne State University School of MedicineDetroitMichiganUSA
| | - Samuel Tuck
- Center for Molecular Medicine and GeneticsWayne State University School of MedicineDetroitMichiganUSA
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | - Dennis J. Goebel
- Department of Ophthalmology, Visual and Anatomical SciencesWayne State University School of MedicineDetroitMichiganUSA
| | - Junmei Wan
- Center for Molecular Medicine and GeneticsWayne State University School of MedicineDetroitMichiganUSA
| | - Tom Waddell
- Mitovation, Inc.Innovation Partnerships Startup Incubator University of Michigan North Campus Research ComplexAnn ArborMichiganUSA
| | - Joseph M. Wider
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Charlotte L. Hüttemann
- Center for Molecular Medicine and GeneticsWayne State University School of MedicineDetroitMichiganUSA
| | - Moh H. Malek
- Department of Health Care SciencesEugene Applebaum College of Pharmacy & Health Sciences, Wayne State UniversityDetroitMichiganUSA
| | - Icksoo Lee
- College of MedicineDankook UniversityCheonan‐siChungcheongnam‐doRepublic of Korea
| | - Thomas H. Sanderson
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Maik Hüttemann
- Center for Molecular Medicine and GeneticsWayne State University School of MedicineDetroitMichiganUSA
- Department of Biochemistry, Microbiology and ImmunologyWayne State UniversityDetroitMichiganUSA
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Morse PT, Wan J, Bell J, Lee I, Goebel DJ, Malek MH, Sanderson TH, Hüttemann M. Sometimes less is more: inhibitory infrared light during early reperfusion calms hyperactive mitochondria and suppresses reperfusion injury. Biochem Soc Trans 2022; 50:1377-1388. [PMID: 36066188 PMCID: PMC10121102 DOI: 10.1042/bst20220446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022]
Abstract
Ischemic stroke affects over 77 million people annually around the globe. Due to the blockage of a blood vessel caused by a stroke, brain tissue becomes ischemic. While prompt restoration of blood flow is necessary to save brain tissue, it also causes reperfusion injury. Mitochondria play a crucial role in early ischemia-reperfusion injury due to the generation of reactive oxygen species (ROS). During ischemia, mitochondria sense energy depletion and futilely attempt to up-regulate energy production. When reperfusion occurs, mitochondria become hyperactive and produce large amounts of ROS which damages neuronal tissue. This ROS burst damages mitochondria and the cell, which results in an eventual decrease in mitochondrial activity and pushes the fate of the cell toward death. This review covers the relationship between the mitochondrial membrane potential (ΔΨm) and ROS production. We also discuss physiological mechanisms that couple mitochondrial energy production to cellular energy demand, focusing on serine 47 dephosphorylation of cytochrome c (Cytc) in the brain during ischemia, which contributes to ischemia-reperfusion injury. Finally, we discuss the use of near infrared light (IRL) to treat stroke. IRL can both stimulate or inhibit mitochondrial activity depending on the wavelength. We emphasize that the use of the correct wavelength is crucial for outcome: inhibitory IRL, applied early during reperfusion, can prevent the ROS burst from occurring, thus preserving neurological tissue.
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Affiliation(s)
- Paul T. Morse
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI 48201, USA
| | - Junmei Wan
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI 48201, USA
| | - Jamie Bell
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI 48201, USA
- Division of Pediatric Critical Care, Children’s Hospital of Michigan, Central Michigan University, Detroit, MI 48201, USA
| | - Icksoo Lee
- College of Medicine, Dankook University, Cheonan-si, Chungcheongnam-do 31116, Republic of Korea
| | - Dennis J. Goebel
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Moh H. Malek
- Department of Health Care Sciences, Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University, Detroit, MI 48201, USA
| | - Thomas H. Sanderson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Maik Hüttemann
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI 48201, USA
- Department of Biochemistry, Microbiology, and Immunology, Wayne State University, Detroit, MI 48201, USA
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Nizamutdinov D, Ezeudu C, Wu E, Huang JH, Yi SS. Transcranial near-infrared light in treatment of neurodegenerative diseases. Front Pharmacol 2022; 13:965788. [PMID: 36034819 PMCID: PMC9400541 DOI: 10.3389/fphar.2022.965788] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Light is a natural agent consisting of a range of visible and invisible electromagnetic spectrum travels in waves. Near-infrared (NIR) light refers to wavelengths from 800 to 2,500 nm. It is an invisible spectrum to naked eyes and can penetrate through soft and hard tissues into deep structures of the human body at specific wavelengths. NIR light may carry different energy levels depending on the intensity of emitted light and therapeutic spectrum (wavelength). Stimulation with NIR light can activate intracellular cascades of biochemical reactions with local short- and long-term positive effects. These properties of NIR light are employed in photobiomodulation (PBM) therapy, have been linked to treating several brain pathologies, and are attracting more scientific attention in biomedicine. Transcranial brain stimulations with NIR light PBM in recent animal and human studies revealed a positive impact of treatment on the progression and improvement of neurodegenerative processes, management of brain energy metabolism, and regulation of chronic brain inflammation associated with various conditions, including traumatic brain injury. This scientific overview incorporates the most recent cellular and functional findings in PBM with NIR light in treating neurodegenerative diseases, presents the discussion of the proposed mechanisms of action, and describes the benefits of this treatment in neuroprotection, cell preservation/detoxification, anti-inflammatory properties, and regulation of brain energy metabolism. This review will also discuss the novel aspects and pathophysiological role of the glymphatic and brain lymphatics system in treating neurodegenerative diseases with NIR light stimulations. Scientific evidence presented in this overview will support a combined effort in the scientific community to increase attention to the understudied NIR light area of research as a natural agent in the treatment of neurodegenerative diseases to promote more research and raise awareness of PBM in the treatment of brain disorders.
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Affiliation(s)
- Damir Nizamutdinov
- Baylor Scott and White Health, Neuroscience Institute, Neurosurgery, TX, United States
- Texas A&M University, College of Medicine, Neurosurgery, TX, United States
| | - Chibueze Ezeudu
- Texas A&M University, College of Medicine, Neurosurgery, TX, United States
| | - Erxi Wu
- Baylor Scott and White Health, Neuroscience Institute, Neurosurgery, TX, United States
- Texas A&M University, College of Medicine, Neurosurgery, TX, United States
- Texas A&M University, School of Pharmacy, Pharmaceutical Sciences, TX, United States
- Department of Oncology, Dell Medical School, The University of Texas at Austin, TX, United States
| | - Jason H. Huang
- Baylor Scott and White Health, Neuroscience Institute, Neurosurgery, TX, United States
- Texas A&M University, College of Medicine, Neurosurgery, TX, United States
- *Correspondence: S. Stephen Yi, ; Jason H. Huang,
| | - S. Stephen Yi
- Department of Oncology, Dell Medical School, The University of Texas at Austin, TX, United States
- *Correspondence: S. Stephen Yi, ; Jason H. Huang,
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