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Noguchi KK, Fuhler NA, Wang SH, Capuano S, Brunner KR, Larson S, Crosno K, Simmons HA, Mejia AF, Martin LD, Dissen GA, Brambrink A, Ikonomidou C. Brain pathology caused in the neonatal macaque by short and prolonged exposures to anticonvulsant drugs. Neurobiol Dis 2021; 149:105245. [PMID: 33385515 PMCID: PMC7856070 DOI: 10.1016/j.nbd.2020.105245] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/07/2020] [Accepted: 12/27/2020] [Indexed: 01/18/2023] Open
Abstract
Barbiturates and benzodiazepines are potent GABAA receptor agonists and strong anticonvulsants. In the developing brain they can cause neuronal and oligodendroglia apoptosis, impair synaptogenesis, inhibit neurogenesis and trigger long-term neurocognitive sequelae. In humans, the vulnerable period is projected to extend from the third trimester of pregnancy to the third year of life. Infants with seizures and epilepsies may receive barbiturates, benzodiazepines and their combinations for days, months or years. How exposure duration affects neuropathological sequelae is unknown. Here we investigated toxicity of phenobarbital/midazolam (Pb/M) combination in the developing nonhuman primate brain. Neonatal rhesus monkeys received phenobarbital intravenously, followed by infusion of midazolam over 5 (n = 4) or 24 h (n = 4). Animals were euthanized at 8 or 36 h and brains examined immunohistochemically and stereologically. Treatment was well tolerated, physiological parameters remained at optimal levels. Compared to naïve controls, Pb/M exposed brains displayed widespread apoptosis affecting neurons and oligodendrocytes. Pattern and severity of cell death differed depending on treatment-duration, with more extensive neurodegeneration following longer exposure. At 36 h, areas of the brain not affected at 8 h displayed neuronal apoptosis, while oligodendroglia death was most prominent at 8 h. A notable feature at 36 h was degeneration of neuronal tracts and trans-neuronal death of neurons, presumably following their disconnection from degenerated presynaptic partners. These findings demonstrate that brain toxicity of Pb/M in the neonatal primate brain becomes more severe with longer exposures and expands trans-synaptically. Impact of these sequelae on neurocognitive outcomes and the brain connectome will need to be explored.
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Affiliation(s)
- Kevin K Noguchi
- Department of Psychiatry, Washington University, School of Medicine, St Louis, USA
| | - Nicole A Fuhler
- Department of Psychiatry, Washington University, School of Medicine, St Louis, USA
| | - Sophie H Wang
- Department of Psychiatry, Washington University, School of Medicine, St Louis, USA
| | - Saverio Capuano
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kevin R Brunner
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Shreya Larson
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kristin Crosno
- Wisconsin National Primate Research Center, Madison, WI, USA
| | | | - Andres F Mejia
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Lauren D Martin
- Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Gregory A Dissen
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Ansgar Brambrink
- Department of Anesthesiology, Columbia University, New York Presbyterian Hospital, Irving Medical Center, New York, NY, USA
| | - Chrysanthy Ikonomidou
- Department of Neurology, University of Wisconsin, School of Medicine, Madison, WI, USA.
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Ikonomidou C, Kirvassilis G, Swiney BS, Wang SH, Huffman JN, Williams SL, Masuoka K, Capuano S, Brunner KR, Crosno K, Simmons HS, Mejia AF, Turski CA, Brambrink A, Noguchi KK. Mild hypothermia ameliorates anesthesia toxicity in the neonatal macaque brain. Neurobiol Dis 2019; 130:104489. [PMID: 31175984 PMCID: PMC6689440 DOI: 10.1016/j.nbd.2019.104489] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/13/2019] [Accepted: 06/04/2019] [Indexed: 01/18/2023] Open
Abstract
Sedatives and anesthetics can injure the developing brain. They cause apoptosis of neurons and oligodendrocytes, impair synaptic plasticity, inhibit neurogenesis and trigger long-term neurocognitive deficits. The projected vulnerable period in humans extends from the third trimester of pregnancy to the third year of life. Despite all concerns, there is no ethically and medically acceptable alternative to the use of sedatives and anesthetics for surgeries and painful interventions. Development of measures that prevent injury while allowing the medications to exert their desired actions has enormous translational value. Here we investigated protective potential of hypothermia against histological toxicity of the anesthetic sevoflurane in the developing nonhuman primate brain. Neonatal rhesus monkeys underwent sevoflurane anesthesia over 5 h. Body temperature was regulated in the normothermic (>36.5 °C), mild hypothermic (35-36.5 °C) and moderately hypothermic (<35 °C) range. Animals were euthanized at 8 h and brains examined immunohistochemically (activated caspase 3) and stereologically to quantify apoptotic neuronal and oligodendroglial death. Sevoflurane anesthesia was well tolerated at all temperatures, with oxygen saturations, end tidal CO2 and blood gases remaining at optimal levels. Compared to controls, sevoflurane exposed brains displayed significant apoptosis in gray and white matter affecting neurons and oligodendrocytes. Mild hypothermia (35-36.5 °C) conferred significant protection from apoptotic brain injury, whereas moderate hypothermia (<35 °C) did not. Hypothermia ameliorates anesthesia-induced apoptosis in the neonatal primate brain within a narrow temperature window (35-36.5 °C). Protection is lost at temperatures below 35 °C. Given the mild degree of cooling needed to achieve significant brain protection, application of our findings to humans should be explored further.
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Affiliation(s)
- Chrysanthy Ikonomidou
- Department of Neurology, School of Medicine, University of Wisconsin, Madison, WI, USA.
| | - George Kirvassilis
- Department of Anesthesiology, School of Medicine, University of Wisconsin, Madison, WI, USA
| | - Brant S Swiney
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Sophie H Wang
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Jacob N Huffman
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Sasha L Williams
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Kobe Masuoka
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
| | - Saverio Capuano
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kevin R Brunner
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Kristin Crosno
- Wisconsin National Primate Research Center, Madison, WI, USA
| | | | - Andres F Mejia
- Wisconsin National Primate Research Center, Madison, WI, USA
| | - Christopher A Turski
- Department of Neurology, School of Medicine, University of Wisconsin, Madison, WI, USA
| | - Ansgar Brambrink
- Department of Anesthesiology, Columbia University, New York Presbyterian Hospital, Irving Medical Center, New York, NY, USA
| | - Kevin K Noguchi
- Department of Psychiatry, School of Medicine, Washington University, St Louis, WA, USA
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Zhao G, Li K, Chen J, Li L. Protective Effect of Extract of Bletilla Striata on Isoflurane Induced Neuronal Injury By Altering PI3K/Akt Pathway. Transl Neurosci 2018; 9:183-189. [PMID: 30746281 PMCID: PMC6368668 DOI: 10.1515/tnsci-2018-0027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/17/2018] [Indexed: 01/03/2023] Open
Abstract
Background Present investigation evaluates the neuroprotective effect of Bletilla striata on isoflurane induced neuronal injury rat model. Methodology Neuronal injury was induced by exposing the pups (P7) isoflurane (0.75%) in oxygen (30%) for the period of 6 hr and rats were treated with Bletilla striata at a dose of 35, 70 and 140 mg/kg, p.o. for the period of 21 days. At the end of protocol neurological score was estimated and serum concentration of inflammatory cytokines was estimated. Isolated brains tissue was prepared to perform immunohistochemical analysis, TUNEL assay and western blot assay. Results Result of the study reveals that treatment with BS significantly (p<0.01) reduces the neurological score compared to negative control group. Level of inflammatory cytokines in the serum and the expression of p-Akt, Bcl-xL and Bad protein were significantly attenuated in BS treated group. Moreover the cleaved caspase-3 and TUNEL positive cell was significantly (p<0.01) reduced in BS treated group compared to negative control group of rats. Conclusion Present study concludes that ethanolic extract of Bletilla striata protects the neuronal injury by reducing apoptosis in isoflurane induced neuronal injury rats.
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Affiliation(s)
- Guoqing Zhao
- Department of anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China, 130033
| | - Kai Li
- Department of anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China, 130033
| | - Junyang Chen
- Department of anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China, 130033
| | - Longyun Li
- Department of anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China, 130033
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Liu F, Rainosek SW, Frisch-Daiello JL, Patterson TA, Paule MG, Slikker W, Wang C, Han X. Potential Adverse Effects of Prolonged Sevoflurane Exposure on Developing Monkey Brain: From Abnormal Lipid Metabolism to Neuronal Damage. Toxicol Sci 2015. [PMID: 26206149 DOI: 10.1093/toxsci/kfv150] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Sevoflurane is a volatile anesthetic that has been widely used in general anesthesia, yet its safety in pediatric use is a public concern. This study sought to evaluate whether prolonged exposure of infant monkeys to a clinically relevant concentration of sevoflurane is associated with any adverse effects on the developing brain. Infant monkeys were exposed to 2.5% sevoflurane for 9 h, and frontal cortical tissues were harvested for DNA microarray, lipidomics, Luminex protein, and histological assays. DNA microarray analysis showed that sevoflurane exposure resulted in a broad identification of differentially expressed genes (DEGs) in the monkey brain. In general, these genes were associated with nervous system development, function, and neural cell viability. Notably, a number of DEGs were closely related to lipid metabolism. Lipidomic analysis demonstrated that critical lipid components, (eg, phosphatidylethanolamine, phosphatidylserine, and phosphatidylglycerol) were significantly downregulated by prolonged exposure of sevoflurane. Luminex protein analysis indicated abnormal levels of cytokines in sevoflurane-exposed brains. Consistently, Fluoro-Jade C staining revealed more degenerating neurons after sevoflurane exposure. These data demonstrate that a clinically relevant concentration of sevoflurane (2.5%) is capable of inducing and maintaining an effective surgical plane of anesthesia in the developing nonhuman primate and that a prolonged exposure of 9 h resulted in profound changes in gene expression, cytokine levels, lipid metabolism, and subsequently, neuronal damage. Generally, sevoflurane-induced neuronal damage was also associated with changes in lipid content, composition, or both; and specific lipid changes could provide insights into the molecular mechanism(s) underlying anesthetic-induced neurotoxicity and may be sensitive biomarkers for the early detection of anesthetic-induced neuronal damage.
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Affiliation(s)
- Fang Liu
- *Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR 72079;
| | - Shuo W Rainosek
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Jessica L Frisch-Daiello
- Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Institute at Lake Nona, Orlando, FL 32827; and
| | - Tucker A Patterson
- *Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR 72079
| | - Merle G Paule
- *Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR 72079
| | - William Slikker
- Office of the Director, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR 72079
| | - Cheng Wang
- *Division of Neurotoxicology, National Center for Toxicological Research/Food and Drug Administration, Jefferson, AR 72079
| | - Xianlin Han
- Diabetes and Obesity Research Center, Sanford-Burnham Medical Research Institute at Lake Nona, Orlando, FL 32827; and
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