Impact of menopause-associated frailty on traumatic brain injury

Navigating menopause involves traversing a complex terrain of hormonal changes that extend far beyond reproductive consequences. Menopausal transition is characterized by a decrease in estradiol-17β (E2), and the impact of menopause resonates not only in the reproductive system but also through the central nervous system, musculoskeletal, and gastrointestinal domains. As women undergo menopausal transition, they become more susceptible to frailty, amplifying the risk and severity of injuries, including traumatic brain injury (TBI). Menopause triggers a cascade of changes leading to a decline in muscle mass, accompanied by diminished tone and excitability, thereby restricting the availability of irisin, a crucial hormone derived from muscles. Concurrently, bone mass undergoes reduction, culminating in the onset of osteoporosis and altering the dynamics of osteocalcin, a hormone originating from bones. The diminishing levels of E2 during menopause extend their influence on the gut microbiota, resulting in a reduction in the availability of tyrosine, tryptophan, and serotonin metabolites, affecting neurotransmitter synthesis and function. Understanding the interplay between menopause, frailty, E2 decline, and the intricate metabolisms of bone, gut, and muscle is imperative when unraveling the nuances of TBI after menopause. The current review underscores the significance of accounting for menopause-associated frailty in the incidence and consequences of TBI. The review also explores potential mechanisms to enhance gut, bone, and muscle health in menopausal women, aiming to mitigate frailty and improve TBI outcomes.

Electronic Cigarette Vape Exposure Exacerbates Post-Ischemic Outcomes in Female but Not in Male Rats

BACKGROUND

Nicotine-containing electronic cigarette (EC) vaping has become popular worldwide, and our understanding of the effects of vaping on stroke outcomes is elusive. Using a rat model of transient middle cerebral artery occlusion, the current exploratory study aims to evaluate the sex-dependent effects of EC exposure on brain energy metabolism and stroke outcomes.

METHODS

Adult Sprague-Dawley rats of both sexes were randomly assigned to air/EC vapor (5% nicotine Juul pods) exposure for 16 nights, followed by randomization into 3 cohorts. The first cohort underwent exposure to air/EC preceding randomization to transient middle cerebral artery occlusion (90 minutes) or sham surgery, followed by survival for 21 days. During the survival period, rats underwent sensorimotor and Morris water maze testing. Subsequently, brains were collected for histopathology. A second cohort was exposed to air/EC after which brains were collected for unbiased metabolomics analysis. The third cohort of animals was exposed to air/EC and received transient middle cerebral artery occlusion/sham surgery, and brain tissue was collected 24 hours later for biochemical analysis.

RESULTS

In females, EC significantly increased (P<0.05) infarct volumes by 94% as compared with air-exposed rats, 165±50 mm3 in EC-exposed rats, and 85±29 mm3 in air-exposed rats, respectively, while in males such a difference was not apparent. Morris water maze data showed significant deficits in spatial learning and working memory in the EC sham or transient middle cerebral artery occlusion groups compared with the respective air groups in rats of both sexes (P<0.05). Thirty-two metabolites of carbohydrate, glycolysis, tricarboxylic acid cycle, and lipid metabolism were significantly altered (P≤0.05) due to EC, 23 of which were specific for females. Steady-state protein levels of hexokinase significantly decreased (P<0.05) in EC-exposed females; however, these changes were not seen in males.

CONCLUSIONS

Even brief EC exposure over 2 weeks impacts brain energy metabolism, exacerbates infarction, and worsens poststroke cognitive deficits in working memory more in female than male rats.

A Perspective on Hormonal Contraception Usage in Central Nervous System Injury

Naturally occurring life stages in women are associated with changes in the milieu of endogenous ovarian hormones. Women of childbearing age may be exposed to exogenous ovarian hormone(s) because of their use of varying combinations of estrogen and progesterone hormones-containing oral contraceptives (OC; also known as "the pill"). If women have central nervous system (CNS) injury such as spinal cord injury (SCI) and traumatic brain injury (TBI) during their childbearing age, they are likely to retain their reproductive capabilities and may use OC. Many deleterious side effects of long-term OC use have been reported, such as aberrant blood clotting and endothelial dysfunction that consequently increase the risk of myocardial infarction, venous thromboembolism, and ischemic brain injury. Although controversial, studies have suggested that OC use is associated with neuropsychiatric ramifications, including uncontrollable mood swings and poorer cognitive performance. Our understanding about how the combination of endogenous hormones and OC-conferred exogenous hormones affect outcomes after CNS injuries remains limited. Therefore, understanding the impact of OC use on CNS injury outcomes needs further investigation to reveal underlying mechanisms, promote reporting in clinical or epidemiological studies, and raise awareness of possible compounded consequences. The goal of the current review is to discuss the impacts of CNS injury on endogenous ovarian hormones and vice-versa, as well as the putative consequences of exogenous ovarian hormones (OC) on the CNS to identify potential gaps in our knowledge to consider for future laboratory, epidemiological, and clinical studies.

Resveratrol Preconditioning Mitigates Ischemia-Induced Septal Cholinergic Cell Loss and Memory Impairments

BACKGROUND

Cholinergic cells originating from the nuclei of the basal forebrain (BF) are critical for supporting various memory processes, yet BF cholinergic cell viability has not been explored in the context of focal cerebral ischemia. In the present study, we examined cell survival within several BF nuclei in rodents following transient middle cerebral artery occlusion. We tested the hypothesis that a previously established neuroprotective therapy-resveratrol preconditioning-would rescue BF cell loss, deficits in cholinergic-related memory performance, and hippocampal synaptic dysfunction after focal cerebral ischemia.

METHODS

Adult (2-3-month old) male Sprague-Dawley rats or wild-type C57Bl/6J mice were injected intraperitoneally with a single dose of resveratrol or vehicle and subjected to transient middle cerebral artery occlusion using the intraluminal suture method 2 days later. Histopathological, behavioral, and electrophysiological outcomes were measured 1-week post-reperfusion. Animals with reduction in cerebral blood flow <30% of baseline were excluded.

RESULTS

Cholinergic cell loss was observed in the medial septal nucleus and diagonal band of Broca following transient middle cerebral artery occlusion. This effect was prevented by resveratrol preconditioning, which also ameliorated transient middle cerebral artery occlusion-induced deficits in cognitive performance and hippocampal long-term potentiation.

CONCLUSIONS

We demonstrate for the first time that focal cerebral ischemia induces cholinergic cell death within memory-relevant nuclei of the BF. The preservation of cholinergic cell viability may provide a mechanism by which resveratrol preconditioning improves memory performance and preserves functionality of memory-processing brain structures after focal cerebral ischemia.

Post-stroke periodic estrogen receptor-beta agonist improves cognition in aged female rats

Women have a higher risk of having an ischemic stroke and increased cognitive decline after stroke as compared to men. The female sex hormone 17β-estradiol (E2) is a potent neuro- and cognitive-protective agent. Periodic E2 or estrogen receptor subtype-beta (ER-β) agonist pre-treatments every 48 h before an ischemic episode ameliorated ischemic brain damage in young ovariectomized or reproductively senescent (RS) aged female rats. The current study aims to investigate the efficacy of post-stroke ER-β agonist treatments in reducing ischemic brain damage and cognitive deficits in RS female rats. Retired breeder (9-10 months) Sprague-Dawley female rats were considered RS after remaining in constant diestrus phase for more than a month. The RS rats were exposed to transient middle cerebral artery occlusion (tMCAO) for 90 min and treated with either ER-β agonist (beta 2, 3-bis(4-hydroxyphenyl) propionitrile; DPN; 1 mg/kg; s.c.) or DMSO vehicle at 4.5 h after induction of tMCAO. Subsequently, rats were treated with either ER-β agonist or DMSO vehicle every 48 h for ten injections. Forty-eight hours after the last treatment, animals were tested for contextual fear conditioning to measure post-stroke cognitive outcome. Neurobehavioral testing, infarct volume quantification, and hippocampal neuronal survival were employed to determine severity of stroke. Periodic post-stroke ER-β agonist treatment reduced infarct volume, improved recovery of cognitive capacity by increasing freezing in contextual fear conditioning, and decreased hippocampal neuronal death in RS female rats. These data suggest that periodic post-stroke ER-β agonist treatment to reduce stroke severity and improve post-stroke cognitive outcome in menopausal women has potential for future clinical investigation.

Abstract TMP111: Electronic Cigarette Exposure Exacerbates Ischemic Stroke Outcome Via Altered Neurotransmitter Metabolism In Rats Of Both Sexes

Introduction: Smoking is a preventable risk factor for stroke and battery-operated nicotine delivery systems known as electronic cigarettes (EC) are popular. EC vapes aerosolize a mix of nicotine and chemicals forming harmful toxicants such as formaldehyde hemiacetal. Our understanding about effects of EC vaping on stroke outcome is limited. This study investigated effects of EC on global metabolic signature and stroke outcome in animals of both sexes.

Methods: Sprague-Dawley rats (2-3 months old; n=8) of both sexes were randomly assigned either to air or EC vapor (5% nicotine Juul pods) exposure using the EcigAero-TM Aerosol Exposure Apparatus. Rats were exposed to air/EC for 16 nights. Per night, rats were exposed to 16 episodes of EC vapor. Each episode consisted of 2 seconds of Juul puffs followed by 8 seconds of air over the period of 8 minutes. After 16 days, the rats were divided into two cohorts. The first cohort of rats exposed to EC/Air was tested for cognitive capacities using the Morris water maze (WM) followed by brain collection for unbiased metabolomic (Metabolon Inc.) or Western blot analysis. The second cohort of rats exposed to EC/Air was subjected to transient middle cerebral artery occlusion (tMCAO; 90 min) or sham surgery and survived for 15-21 days. During the post-tMCAO survival, rats were tested for cognition using WM followed by brain collection for histopathological analysis.

Results: Metabolomic analysis indicated that EC exposure resulted in significant increases (p≤0.05) in phenylalanine and tryptophan metabolites, and both increases (p≤0.05) and decreases (p≤0.05) in histamine and tyrosine metabolites in the brains of female and male rats. Western blotting of rate-limiting enzymes in respective NT pathways corroborated the metabolomic data. Behavioral testing indicated worsened cognitive outcome in EC groups compared to air groups in rats of both sexes.

Conclusion: EC vape exposure, even for as short as 2 weeks, impacts the metabolism of NT, induces cognitive deficits and worsens stroke outcomes in young male and female rats. Future studies investigating the impact of EC withdrawal on NT metabolism are needed to understand how long the deleterious effects of EC vaping persist in the brain.

Abstract TP129: Increased Levels Of Matrix Metalloproteinases-induced BBB Dysfunction May Be Responsible For Increased Post-sich Hematoma Growth In Nicotine-exposed Rats

Spontaneous intracerebral hemorrhage (sICH) is the deadliest type of stroke, accounting for as high as 28% of all strokes. Tobacco use is one of the major risk factors of sICH, and it also worsens outcomes following sICH. In our earlier study, we observed that nicotine exposure increases TNFα levels in brain vessels, impairs BBB integrity, and increases post-sICH hematoma volume in a TNFα-dependent manner compared to saline-exposed controls. Earlier studies have demonstrated interactions between MMPs and TNFα. Increased levels of matrix metalloproteinases (MMPs) have been found in sICH patients and nicotine-exposed individuals. MMPs are involved in BBB breakdown, edema formation, hematoma expansion, and neuronal loss that follow hematoma development after sICH. In the present study, we tested the hypothesis that nicotine exposure-induced increase in TNFα is responsible for increased post-sICH hematoma volume in a MMP-dependent manner. To test our hypothesis, young male and female rats were exposed to chronic nicotine treatment for 2-3 weeks using osmotic pumps containing either saline or nicotine (4.5 mg/kg/day). Levels of MMPs (2, 3, 9, and 12) and GAPDH were evaluated in brain homogenates using Western blot. Nicotine-treated female rats showed a 37% (100±7 vs. 137±10, p<0.05), 144% (100±18 vs. 244±16, p<0.01), 29% (100±7 vs. 129±9, p<0.05), 22% (100±6 vs. 122±6, p<0.05), and 24% (100±6 vs. 124±7, p<0.05) increase in levels of pro and cleaved forms of MMP-3, cleaved form of MMP-9, pro and cleaved forms of MMP-12, respectively, compared to saline-treated female rats. We are in the process of evaluating levels of MMPs in male samples. Considering the role of MMP-9 in BBB integrity, using both TNFα and MMP-9 inhibitors, we are also in the process of evaluating if TNFα increases post-sICH hematoma growth in nicotine-exposed rats via increased levels of MMP-9. The results so far imply that increased TNFα levels in nicotine-exposed rats may be responsible for increased post-sICH hematoma growth in a MMP-dependent manner. Support: James Esther King Biomedical Research Grant 9JK08 and PK is a recipient of the Lois Pope Neuroscience Summer Research Fellowship.

Abstract WP213: The Effect Of Nicotine Withdrawal On Stroke Outcome In Female Rats

Significance: Smoking-derived nicotine (N) is known to synergistically magnify the risk and severity of cerebral ischemia in females. Most importantly, smoking is the one preventable risk factor and giving up smoking reduces the risk for cerebral ischemia. However, how long the harmful effects of N on the brain persist after women stop smoking is unknown. In a laboratory study using an animal model of cerebral ischemia, we demonstrated that N alters brain energy metabolism and thus exacerbates ischemic brain damage. Therefore, the current study aims to investigate how long after N withdrawal (NW) N toxicity on brain energy metabolism persists and its impact on stroke outcomes in female rats.

Methods: Female Sprague-Dawley rats (n=8/group) were randomly exposed to either saline or N (4.5 mg/kg) for 16-21 days after which point, they were withdrawn from N exposure and able to recover for 0, 15, or 30 days. These rats were then randomly assigned to either have their cortical tissue collected for global metabolomic (Metabolon Inc) and Western blot analysis or undergo a sham surgery or transient middle-cerebral artery occlusion (tMCAO; 90 min). Post-stroke cognition was tested with contextual fear conditioning at month following tMCAO, subsequently the brains were collected for infarct quantification.

Results: Analysis of the metabolomics data revealed an increase in carbohydrate metabolites in the 30-day NW group when compared to the N-exposed group, suggesting persistence of N toxicity in the brain. Furthermore, fear conditioning data revealed a significantly lower freezing time in all NW groups when compared to the saline group implying that spatial memory deficits persist even after 30 days of NW. Lastly, the observed infarct volume was 26%(p<0.05), 25%(p<0.05), and 16%(p<0.05) higher in the 0, 15, and 30 day NW groups respectively, when compared to the saline group.

Conclusion: Even after 30 days of NW, N-induced global metabolomic changes in the brain persist and may be responsible for increased ischemic brain damage as well as cognitive deficits in female rats.

The Impact of Nicotine along with Oral Contraceptive Exposure on Brain Fatty Acid Metabolism in Female Rats

Smoking-derived nicotine (N) and oral contraceptive (OC) synergistically exacerbate ischemic brain damage in females, and the underlying mechanisms remain elusive. In a previous study, we showed that N + OC exposure altered brain glucose metabolism in females. Since lipid metabolism complements glycolysis, the current study aims to examine the metabolic fingerprint of fatty acids in the brain of female rats exposed to N+/-OC. Adolescent and adult Sprague-Dawley female rats were randomly (n = 8 per group) exposed to either saline or N (4.5 mg/kg) +/-OC (combined OC or placebo delivered via oral gavage) for 16-21 days. Following exposure, brain tissue was harvested for unbiased metabolomic analysis (performed by Metabolon Inc., Morrisville, NC, USA) and the metabolomic profile changes were complemented with Western blot analysis of key enzymes in the lipid pathway. Metabolomic data showed significant accumulation of fatty acids and phosphatidylcholine (PC) metabolites in the brain. Adolescent, more so than adult females, exposed to N + OC showed significant increases in carnitine-conjugated fatty acid metabolites compared to saline control animals. These changes in fatty acyl carnitines were accompanied by an increase in a subset of free fatty acids, suggesting elevated fatty acid β-oxidation in the mitochondria to meet energy demand. In support, β-hydroxybutyrate was significantly lower in N + OC exposure groups in adolescent animals, implying a complete shunting of acetyl CoA for energy production via the TCA cycle. The reported changes in fatty acids and PC metabolism due to N + OC could inhibit post-translational palmitoylation of membrane proteins and synaptic vesicle formation, respectively, thus exacerbating ischemic brain damage in female rats.

Oral contraceptives and stroke: Foes or friends

Incidents of strokes are increased in young women relative to young men, suggesting that oral contraceptive (OC) use is one of the causes of stroke among young women. Long-term exposures to the varying combinations of estrogen and progestogen found in OCs affect blood clotting, lipid and lipoprotein metabolism, endothelial function, and de novo synthesis of neurosteroids, especially brain-derived 17β-estradiol. The latter is essential for neuroprotection, memory, sexual differentiation, synaptic transmission, and behavior. Deleterious effects of OCs may be exacerbated due to comorbidities like polycystic ovary syndrome, sickle cell anemia, COVID-19, exposures to endocrine disrupting chemicals, and conventional or electronic cigarette smoking. The goal of the current review is to revisit the available literature regarding the impact of OC use on stroke, to explain possible underlying mechanisms, and to identify gaps in our understanding to promote future research to reduce and cure stroke in OC users.

Post-stroke low-frequency whole-body vibration improves cognition in middle-aged rats of both sexes

Low-frequency whole-body vibration (WBV; 40 Hz), a low impact form of exercise, intervention for a month following moderate transient middle-cerebral artery occlusion (tMCAO) reduces infarct volume and improves motor function in reproductively senescent, middle-aged female rats. Since post-stroke cognitive decline remains a significant problem, the current study aims to investigate the efficacy of WBV in ameliorating post-tMCAO cognitive deficits and to determine the underlying putative mechanism(s) conferring benefits of WBV in middle-aged rats. Middle-aged rats of both sexes were randomly assigned to tMCAO (90 min) or sham surgery followed by exposure to either WBV (twice a day for 15 min each for 5 days a week over a month) or no WBV treatment groups. Following the last WBV treatment, rats were tested for hippocampus-dependent learning and memory using a water maze followed by harvesting brain and blood samples for histopathological and inflammatory marker analyses, respectively. Results show that post-tMCAO WBV significantly lessens cognitive deficits in rats of both sexes. Post-tMCAO WBV significantly decreased circulating pro-inflammatory cytokines and increased serum levels of irisin, a muscle-derived hormone that may play a role in brain metabolism and inflammation regulation, which suggests putative beneficial mechanisms of WBV.

Abstract TP126: The Therapeutic Window Of Red Cell Microparticles In Limiting Intracerebral Hemorrhage-induced Hematoma Growth In Nicotine-exposed Rats

Spontaneous intracerebral hemorrhage (sICH) is a subtype of hemorrhagic stroke with enormous mortality and morbidity, and tobacco use is one of the major risk factors for sICH. We have shown that red cell microparticle (RMP) treatment limits hematoma growth following sICH in nicotine-exposed rats. Presently, we determined the therapeutic time window of RMP efficacy. RMPs were generated from RBCs using high pressure extrusion. Rats were treated for a period of 2-3 weeks with nicotine (4.5 mg / kg b.w./ day, s.c.) using osmotic pumps. sICH was induced using intra-striatal collagenase administration. Rats of either sex were randomized between saline (vehicle) or RMP treatment groups (n=10 each for 4.5 h and 6 h RMP treatment time points, n=15 each for pooled vehicle time points). Males treated at 4.5 h and females treated at both timepoints received ~1.34х10 11 particles/ kg b.w., i.v. over 2 h period. While males treated at 6 h received ~ 1.58х10 11 particles/ kg b.w., i.v. over 2 h duration. After ~24 hours, functional deficit was assessed using neurological scores, and hematoma volume was measured in a blinded manner. The hematoma volume of male rats treated with RMPs 4.5 h post-sICH (94±3 mm 3 ) was significantly lower (p<0.05) than the controls (119±7 mm 3 ). Moreover, the neurological score of male rats treated with RMPs 4.5 h post-sICH (8.9±0.5) was significantly lower (p<0.005) than the controls (10.9±0.2). However, the hematoma volume (103±12 mm 3 ) and neurological score (10.1±0.6) of the 6 h post-sICH RMP treatment male group were not different from the controls. The hematoma volume observed in female rats treated with RMPs 4.5 h post-sICH (60±6 mm 3 ) was significantly lower (p<0.01) than the controls (99±2 mm 3 ). Further, neurological score of the rats treated with RMPs 4.5 h post-sICH (7.7±0.6) was significantly lower (p<0.001) than the controls (10.1±0.2). However, the hematoma volume (96±8 mm 3 ) and neurological score (10.4±0.3) in female rats treated with RMPs 6 h post-sICH were not different from the controls. Our results show that RMPs limit hematoma growth in nicotine-exposed rats when administrated 4.5 h post-sICH induction. Thus, RMPs may lower hematoma growth in sICH patients following tobacco use. Support: James Esther King Biomedical Research Grant 9JK08.

Abstract TP231: Irisin, Elicited By Low Frequency Whole Body Vibration Or Exogenously, Improves Post-Stroke Cognition And Reduces Infarct Volume In Middle-Aged Rats

Significance: Low frequency whole body vibration (LFV) at 40 Hz, a low impact form of exercise, for a month following mild transient middle-cerebral artery occlusion (tMCAO) reduces infarct volume and improves motor function in reproductively senescent, middle-aged female rats (1). In humans, LFV was shown to increase circulating levels of irisin, a skeletal muscle-derived hormone. Irisin has also been shown to play a crucial role in preserving mitochondrial function, preventing oxidative stress, and elevating expression of BDNF, among other neuroprotective measures. The current study aims to investigate the efficacy of LFV in ameliorating post-tMCAO cognitive deficits and to determine the putative role of irisin in conferring the benefits of LFV in middle-aged rats.

Methods: Middle-aged rats of both sexes (5-8) were randomly assigned to tMCAO (90 min), or sham surgery followed by exposure to either LFV (twice a day for 15 min each for 5 days a week over a month) or no LFV treatment groups. Following the last LFV treatment, rats were tested for hippocampus-dependent learning and memory using a water maze followed harvesting brain and blood samples for histopathological and inflammatory marker analyses, respectively. In a parallel experiment in the absence of LFV, middle-aged female rats were randomly assigned to either saline or irisin treatment following tMCAO. Recombinant irisin was purchased from PeproTech (Rocky Hill, NJ). Rats were treated with irisin (0.2 μg/g BW; IP) or saline for a month followed by their brains were assessed by histopathology.

Results: Post-tMCAO LFV significantly lessens cognitive deficits in rats of both sexes. It also significantly decreased circulating pro-inflammatory cytokines and increased serum levels of native irisin. Quantification of infarct volume irisin-treated rats demonstrated that, compared to saline, infarct volume was significantly reduced. Saline treatment resulted in 234 ± 30 mm 3 , while irisin treatment yielded 128 ± 34 mm 3 (p<0.05) of infarct volume.

Conclusion: Irisin, either as elicited by LFV or administered exogenously without LFV, regulates brain metabolism and inflammation and its beneficial effects can be stimulated by LFV.Reference: 1. Raval, A.P., et al., Int J Mol Sci, 2018. 19 (9).

Traumatic brain injury in women across lifespan

Traumatic brain injury (TBI) is a leading cause of death and disability and a global public health challenge. Every year more than 50 million people suffer a TBI, and it is estimated that 50% of the global population will experience at least one TBI in their lifetime. TBI affects both men and women of all ages, however there is a male bias in TBI research as women have frequently been left out of the literature despite irrefutable evidence of male and female dimorphism in several posttraumatic measures. Women uniquely experience distinct life stages marked by levels of endogenous circulating sex hormones, as well as by physiological changes that are nonexistent in men. In addition to generalized sex-specific differences, a woman's susceptibility, neurological outcomes, and treatment success may vary considerably depending upon when in her lifespan she incurred a traumatic insult. How women impacted by TBI might differ from other women as a factor of age and physiology is not well understood. Furthermore, there is a gap in the knowledge of what happens when TBI occurs in the presence of certain sex-specific and sex-nonspecific variables, such as during pregnancy, with oral contraceptive use, in athletics, in cases of addiction and nicotine consumption, during perimenopause, postmenopause, in frailty, among others. Parsing out how hormone-dependent and hormone-independent lifespan variables may influence physiological, neurodegenerative, and functional outcomes will greatly contribute to future investigative studies and direct therapeutic strategies. The goal of this review is to aggregate the knowledge of prevalence, prognosis, comorbid risk, and response of women incurring TBI at differing phases of lifespan. We strive to illuminate commonalities and disparities among female populations, and to pose important questions to highlight gaps in the field in order to further the endeavor of targeted treatment interventions in a patient-specific manner.

Xenoestrogens impact brain estrogen receptor signaling during the female lifespan: A precursor to neurological disease?

Xenoestrogens, foreign synthetic chemicals mimicking estrogens, are lurking in our surroundings. Climate change may alter their toxicity and bioavailability. Since xenoestrogens have extremely high lipid solubility and are structurally similar to natural endogenous estrogens, they can bind to estrogen receptors (ERs) -alpha (ER-α) and -beta (ER-β). Scientific evidence accumulated over the past decades have suggested that natural 17β-estradiol (E2; a potent estrogen), via activation of its receptors, plays a pivotal role in regulation of brain development, differentiation, metabolism, synaptic plasticity, neuroprotection, cognition, anxiety, body temperature, feeding and sexual behavior. In the brain, ER-β is predominantly expressed in the various regions, including cerebral cortex and hippocampus, that have been shown to play a key role in cognition. Therefore, disturbances in function of ER-β mediated E2 signaling by xenoestrogens can lead to deleterious effects that potentiate a variety of neurological diseases starting from prenatal to post-menopause in women. The goal of this review is to identify the possible neurological effects of xenoestrogens that can alter estrogen receptor-mediated signaling in the brain during different stages of the female lifespan.

Irisin-Associated Neuroprotective and Rehabilitative Strategies for Stroke

Irisin, a newly discovered protein hormone that is secreted in response to low frequency whole body vibration (LFV), could be a promising post-stroke rehabilitation therapy for patients who are frail and cannot comply with regular rehabilitation therapy. Irisin is generated from a membrane-bound precursor protein fibronectin type III domain-containing protein 5 (FNDC5). Aside from being highly expressed in muscle, FNDC5 is highly expressed in the brain. The cleaved form of FNDC5 was found in the cerebrospinal fluid as well as in various regions of the brain. Numerous studies suggest that irisin plays a key role in brain metabolism and inflammation regulation. Both the metabolism and inflammation govern stroke outcome, and in a published study, we demonstrated that LFV therapy following middle cerebral artery occlusion significantly reduced innate immune response, improved motor function and infarct volume in reproductively senescent female rats. The observed effect of LFV therapy could be working via irisin, therefore, the current review focuses to understand various aspects of irisin including its mechanism of action on the brain.

Simultaneous nicotine and oral contraceptive exposure alters brain energy metabolism and exacerbates ischemic stroke injury in female rats

Smoking-derived nicotine (N) and oral contraceptives (OC) synergistically exacerbate ischemic brain damage in the females and underlying mechanisms remain elusive. Our published study showed that N toxicity is exacerbated by OC via altered mitochondrial function owing to a defect in the activity of cytochrome c oxidase. Here, we investigated the global metabolomic profile of brains of adolescent female Sprague-Dawley rats exposed to N ± OC. Rats were randomly exposed to saline or N + /-OC for 16-21 days followed by random allocation into two cohorts. One cohort underwent transient middle cerebral artery occlusion and histopathology was performed 30 days later. From the second cohort, cortical tissues were collected for an unbiased global metabolomic profile. Pathway enrichment analysis showed significant decrease in glucose, glucose 6-phosphate and fructose-6-phosphate, along with a significant increase in pyruvate in the N + /-OC exposed groups when compared to saline (p < 0.05), suggesting alterations in the glycolytic pathway which were confirmed by Western blot analyses of glycolytic enzymes. Infarct volume quantification showed a significant increase following N alone or N + OC as compared to saline control. Because glucose metabolism is critical for brain physiology, altered glycolysis deteriorates neural function, thus exacerbating ischemic brain damage.

Abstract P764: Single versus Dual Dose of Intra-Arterial Stem Cell Therapy for Stroke

Introduction: Pre-clinical studies have shown great promise in the use of cell-based therapies for stroke. Intra-arterial (IA) delivery directs the cells to the injured brain, is minimally invasive and widely available, making it attractive for clinical translation. Our group and others have shown the safety and efficacy of IA Mesenchymal Stem Cell (MSC) treatment in a rodent stroke model at 24 hours post-reperfusion. The optimal timing of a single dose of IA MSC is unknown. Also, whether an additional dose will lead to greater benefit and the optimal timing of the second dose need to be determined for successful translation of IA MSC to clinic. The objective of this study is to determine if dual dose IA-MSC treatment is superior to single dose and find the optimal timing for the second dose.

Methods: We used a reversible middle cerebral artery occlusion (rMCAO) model for stroke in rats. IA-MSCs were administered using a PE-10 catheter at 1, 2 and 4 day after stroke as single dose. Based on the results of the first experiment, dual doses were given at 1-4, 1-6 and 1-15 day. Behavioral analysis of rotarod, neurological deficit scoring and stroke volume were determined at 30 days after treatment.

Results: Single dose IA-MSC at 1day was superior (p=0.02, 0.01, 0.04) to single dose given on day 2 and no benefit was seen when given on day 4. Among the dual dose groups, 1-6 day after stroke showed significant improvement in neurodeficit score and stroke volume (p=0.007, p=0.03). However, the percentage increase in improvement in 1-6day (dual) was much higher than that observed in 1day (single) group (Fig 1). Detailed results will be presented at the meeting.

Conclusion: The results of our study indicate that 1day after stroke is optimal for single dose of IA-MSC. An additional dose at 6days after stroke enhances the effect of IA-MSC in aiding symptomatic recovery and stroke lesion reduction. In summary, our findings contribute to understanding of the benefit of dual dose of IA MSC for translation to the clinic.

Abstract P799: Nicotine Along With Oral Contraceptive Exposure Alters Brain Lipid Metabolism and Exacerbates Ischemic Injury in Female Rats

Background: Smoking-derived nicotine (N) and oral contraceptives (OC) synergistically exacerbate both global and focal ischemic brain damage in females. While the underlying mechanisms remain elusive, our published study showed that OC exacerbate N toxicity via altered mitochondrial electron transport chain function. Because mitochondria play a central role in cellular metabolism, we examined the metabolic fingerprint of adolescent and adult female rat brains exposed to N +/- OC.

Methods: Adolescent (6 weeks old) and adult (12 weeks old) Sprague-Dawley female rats were randomly (n = 8/group) exposed to either saline, N (4.5 mg/kg) +/- OC for 16-21 days. Following treatment, brain tissue was harvested for unbias metabolomic analysis (performed by Metabolon Inc.). The metabolomic profile was complemented with western blot analysis and enzyme activity measurements.

Results: Pathway enrichment analysis showed significant alterations in lipid metabolism. Adolescent but not adult females treated with N, OC and N+OC compared to saline showed significant increases in carnitine conjugated fatty acid metabolites such as arachidonoylcarnitine (C20:4), docosahexaenoylcarnitine (C22:6) and stearoylcarnitine (C18). These changes in fatty acyl carnitines were accompanied by an increase in a subset of free fatty acids, suggesting elevated fatty acid β-oxidation in the mitochondria to meet energy demand. In support, 3-hydroxybutyrate (BHBA) was significantly lower in OC and N+OC treatment group in adolescent animals, implying a complete shunting of acetyl CoA for energy production via TCA cycle. BHBA is a ketone body that increases in concentration as lipid oxidation rates increase with acetyl CoA accumulation. Reduced BHBA levels may also suggest mitochondrial dysfunction in response to OC and N+OC treatment.

Conclusion: The observed changes in the metabolic fingerprint and fatty acid metabolism reflect a general alteration in energy metabolism with nicotine treatment exclusively in young animals and these changes are enhanced by N+OC treatment. Discerning the exact effects of N +/- OC on overall brain metabolism and the molecular mechanisms affecting mitochondrial function at different ages will open a new window for future therapeutic intervention.

Abstract P422: Chronic Nicotine Exposure Increases Hematoma Growth Following Intracerebral Hemorrhage in Young Rats of Both Sexes

Spontaneous intracerebral hemorrhage (sICH) is the deadliest stroke subtype. There is strong evidence that tobacco use / smoking increases the risk of sICH, and some epidemiological studies have observed sex differences in sICH outcomes. However, systematic controlled studies on the effect of tobacco / smoking on post-sICH outcomes in both sexes are lacking. Therefore, we determined the effect of nicotine exposure on outcomes following collagenase-induced sICH both sexes. Young animals of both sexes were randomly divided into nicotine (4.5 mg / kg / day b.w.) and vehicle (saline) treatment groups (using osmotic pumps for two to three weeks). sICH in females was induced during the diestrous stage of estrous cycle. sICH was induced by collagenase injection into the right striatum and ~24 hours later, neurological scores were evaluated, rats were euthanized, and brains were sectioned to measure hematoma volume. Hematoma volumes for male rats was 42% higher (p<0.01) in the nicotine-treated group (139 ± 9 mm 3 , n=10) versus vehicle-treated group (98 ± 9 mm 3 , n=10). Hematoma volumes for female rats was 48% higher (p<0.01) in the nicotine-treated group (134 ± 11 mm 3 , n=10) versus vehicle-treated group (90 ± 7 mm 3 , n=10). Hematoma volumes for the vehicle and nicotine-treated male groups were not different from their respective female groups. The neurological score for the nicotine-treated male group (9.3 ± 0.6) was significantly higher (p<0.05) when compared to vehicle group (7.4 ± 0.6). The neurological score for the nicotine-treated female group (10.7 ± 0.2) was significantly higher (p<0.001) than the vehicle group (7.7 ± 0.7). The neurological score for the vehicle-treated male group was not different from its respective female group. However, the neurological score for the nicotine-treated male group was significantly lower than the female group. Our results show that chronic nicotine exposure increases hematoma volume post-sICH in animals of both sexes. Future studies into the mechanism of nicotine-induced increase in hematoma growth following sICH are required. Support: James and Esther King Biomedical Research Grant 9JK08

New Mechanistic Insights, Novel Treatment Paradigms, and Clinical Progress in Cerebrovascular Diseases

The past decade has brought tremendous progress in diagnostic and therapeutic options for cerebrovascular diseases as exemplified by the advent of thrombectomy in ischemic stroke, benefitting a steeply increasing number of stroke patients and potentially paving the way for a renaissance of neuroprotectants. Progress in basic science has been equally impressive. Based on a deeper understanding of pathomechanisms underlying cerebrovascular diseases, new therapeutic targets have been identified and novel treatment strategies such as pre- and post-conditioning methods were developed. Moreover, translationally relevant aspects are increasingly recognized in basic science studies, which is believed to increase their predictive value and the relevance of obtained findings for clinical application.This review reports key results from some of the most remarkable and encouraging achievements in neurovascular research that have been reported at the 10th International Symposium on Neuroprotection and Neurorepair. Basic science topics discussed herein focus on aspects such as neuroinflammation, extracellular vesicles, and the role of sex and age on stroke recovery. Translational reports highlighted endovascular techniques and targeted delivery methods, neurorehabilitation, advanced functional testing approaches for experimental studies, pre-and post-conditioning approaches as well as novel imaging and treatment strategies. Beyond ischemic stroke, particular emphasis was given on activities in the fields of traumatic brain injury and cerebral hemorrhage in which promising preclinical and clinical results have been reported. Although the number of neutral outcomes in clinical trials is still remarkably high when targeting cerebrovascular diseases, we begin to evidence stepwise but continuous progress towards novel treatment options. Advances in preclinical and translational research as reported herein are believed to have formed a solid foundation for this progress.

The peri-menopause in a woman's life: a systemic inflammatory phase that enables later neurodegenerative disease

The peri-menopause or menopausal transition—the time period that surrounds the final years of a woman’s reproductive life—is associated with profound reproductive and hormonal changes in a woman’s body and exponentially increases a woman’s risk of cerebral ischemia and Alzheimer’s disease. Although our understanding of the exact timeline or definition of peri-menopause is limited, it is clear that there are two stages to the peri-menopause. These are the early menopausal transition, where menstrual cycles are mostly regular, with relatively few interruptions, and the late transition, where amenorrhea becomes more prolonged and lasts for at least 60 days, up to the final menstrual period. Emerging evidence is showing that peri-menopause is pro-inflammatory and disrupts estrogen-regulated neurological systems. Estrogen is a master regulator that functions through a network of estrogen receptors subtypes alpha (ER-α) and beta (ER-β). Estrogen receptor-beta has been shown to regulate a key component of the innate immune response known as the inflammasome, and it also is involved in regulation of neuronal mitochondrial function. This review will present an overview of the menopausal transition as an inflammatory event, with associated systemic and central nervous system inflammation, plus regulation of the innate immune response by ER-β-mediated mechanisms.

Osteocalcin, ovarian senescence, and brain health

Menopause, an inevitable event in a woman's life, significantly increases risk of bone resorption and diseases such as Alzheimer's, vascular dementia, cardiac arrest, and stroke. The sole role of bones, as traditionally regarded, is to provide structural support for skeletal muscles and allow for ambulation, however this concept is becoming quickly outdated. New literature has emerged that suggests the bone cell-derived hormone osteocalcin (OCN) plays a pivotal role in cognition. OCN levels are correlated with bone mass density and bone turnover, and thus are strongly influenced by the changes associated with menopause. The goal of the current review is to discuss potential gaps in our knowledge of OCN and cognition, discrepancies in methods of OCN quantification, and therapies to enhance circulating OCN. A discussion on implementing exercise or low frequency vibration interventions at the menopausal transition to reduce risk and severity of neurological diseases and associated cognitive decline is included.

Abstract WP153: Post-Stroke Physical Exercise Improves Cognition in Middle-Aged Female Rats

Background: A woman’s risk of a stroke increases exponentially following the onset of menopause, andpost-stroke cognitive decline is a significant consequence of stroke survivors. Our earlier study demonstrated that physical exercise (PE) reduced post-stroke brain injury and improved cognitive functions in male rats. The focus of our study is on the improvement of post-stroke cognitive function in female rats.

Methods: Reproductively senescent Sprague-Dawley female rats were exposed to transient middle cerebral artery occlusion (tMCAO; 90 min) and randomly assigned to either PE or sham-PE groups. After 3-5 days, rats underwent sham-PE (0m/min speed) or PE (15m/min speed) for 30 mins either every day (continuous) or alternate day for five times on treadmill. The rats that underwent the alternate day paradigm were treated with ER-β agonist (DPN; 1mg/kg) or vehicle-DMSO immediately following PE/sham-PE sessions to determine the synergistic effect. Twenty-one days after the last PE/sham-PE, rats were tested for hippocampal-dependent contextual fear conditioning and freeze time was measured. Rat brains were processed for histology and infarct area was measured with MCID software. From a separate cohort of rat subjected to PE or sham-PE, brain tissue was harvested for various biochemical assays and mitochondrial enzyme activity measurements.

Results: Post-tMCAO continuous PE did not reduce ischemic damage. However, alternate PE regimen with or without ER-β agonist reduced infract volume by 20% (p < 0.05) and 23% (p < 0.05), respectively as compared to no-PE. Similarly, alternate PE showed increased freezing on the second day of fear conditioning by 15% (p < 0.05), indicating improved spatial memory. Individual mitochondrial complex I, II, III and IV enzyme activity measurements demonstrated significant improvement in complex III-IV enzyme activities in the alternate PE treated group as compared to sham-PE.

Conclusion: An alternate day PE paradigm and ER-β activation improves post-stroke mitochondrial enzyme activities and cognition in reproductively senescent female rats. Future studies delineating underlying mechanism could help identify therapies to prevent/reduce cognitive decline in menopausal female stroke patients.

Sexually dimorphic microglia and ischemic stroke

Ischemic stroke kills more women compared with men thus emphasizing a significant sexual dimorphism in ischemic pathophysiological outcomes. However, the mechanisms behind this sexual dimorphism are yet to be fully understood. It is well established that cerebral ischemia activates a variety of inflammatory cascades and that microglia are the primary immune cells of the brain. After ischemic injury, microglia are activated and play a crucial role in progression and resolution of the neuroinflammatory response. In recent years, research has focused on the role that microglia play in this sexual dimorphism that exists in the response to central nervous system (CNS) injury. Evidence suggests that the molecular mechanisms leading to microglial activation and polarization of phenotypes may be influenced by sex, therefore causing a difference in the pro/anti‐inflammatory responses after CNS injury. Here, we review advances highlighting that sex differences in microglia are an important factor in the inflammatory responses that are seen after ischemic injury. We discuss the main differences between microglia in the healthy and diseased developing, adult, and aging brain. We also focus on the dimorphism that exists between males and females in microglial‐induced inflammation and energy metabolism after CNS injury. Finally, we describe how all of the current research and literature regarding sex differences in microglia contribute to the differences in poststroke responses between males and females.

Sex-Dependent Differences in Physical Exercise-Mediated Cognitive Recovery Following Middle Cerebral Artery Occlusion in Aged Rats

Stroke remains a leading cause of death and disability in the United States. No current treatments exist to promote cognitive recovery in survivors of stroke. A previous study from our laboratory determined that an acute bout of forced treadmill exercise was able to promote cognitive recovery in 3 month old male rats after middle cerebral artery occlusion (MCAo). In this study, we tested the hypothesis that 6 days of intense acute bout of forced treadmill exercise (physical exercise – PE) promotes cognitive recovery in 11–14 month old male rats. We determined that PE was able to ameliorate cognitive deficits as determined by contextual fear conditioning. Additionally, we also tested the hypothesis that PE promotes cognitive recovery in 11–13 month old reproductive senescent female rats. In contrast to males, the same intensity of exercise that decrease cognitive deficits in males was not able to promote cognitive recovery in female rats. Additionally, we determined that exercise did not lessen infarct volume in both male and female rats. There are many factors that contribute to higher stroke mortality and morbidities in women and thus, future studies will investigate the effects of PE in aged female rats to identify sex differences.

Estrogen preconditioning: A promising strategy to reduce inflammation in the ischemic brain

During the premenopausal phase of a woman's life, estrogen naturally protects against ischemic brain damage and its debilitating consequence of cognitive decline. However, the decline in estrogen at menopause exponentially increases a women's risk for cerebral ischemia and its severity. Supplementation of estrogen during menopause is the most logical solution to abate this increased risk for cerebral ischemia; however, continuous therapy has proven to be contraindicative. Studies from our laboratory over the past decade have shown that a single bolus or long-term periodic 17β-estradiol treatment(s) two days prior to ischemia mimics ischemic preconditioning-conferred protection of the brain in ovariectomized or reproductively senescent female rats. These studies also demonstrated that 17β-estradiol-induced preconditioning (EPC) requires estrogen receptor (ER)-subtype beta (ER-β) activation. ER-β is expressed throughout the brain, including in the hippocampus, which plays a key role in learning and memory. Because periodic activation of ER-β mitigates post-ischemic cognitive decline in ovariectomized female rats, it can be surmised that EPC has the potential to reduce post-ischemic damage and cognitive decline in females. Estrogens are key anti-inflammatory agents; therefore this review discusses the effects of EPC on the inflammasome. Furthermore, as we now clearly know, the brain acts differently in males and females. Indeed, neurodegenerative diseases, including cerebral ischemia, and pharmacological drugs affect males and females in different ways. Thus, inasmuch as the National Institutes of Health and the Stroke Treatment Academic Industry Roundtable (STAIR) consortium mandate inclusion of female experimental animals, this review also discusses the need to close the gap in our knowledge in future studies of EPC in female animal models of cerebral ischemia.

Abstract TP124: Nicotine Alters Brain Energy Metabolism and Exacerbates Ischemic Brain Damage

Background: Smoking-derived nicotine (N) and oral contraceptives (OC) are known to synergistically magnify the risk and severity of cerebral ischemia in females. The underlying pathological mechanism remains elusive. Our studies have shown that N toxicity is exacerbated by OC via altered mitochondrial function, which involved a defect in activity of cytochrome c oxidase, the terminal enzyme of the electron transport chain. However, the effects of impaired mitochondrial function on brain metabolism remain to be investigated. To understand the impact in brain metabolisms, in the current study we investigated the global metabolomic profile of brains of adolescent and adult female rats exposed to N +/- OC.

Methods: Six and twelve weeks old Sprague-Dawley female rats were randomly (n = 8/group) exposed to either saline, N (4.5 mg/kg) +/- OC for 16-21 days. At the end of the treatment, brain tissue was harvested for metabolomic analysis (performed by Metabolon Inc.) The metabolomic profile was complemented with western blot analysis and enzyme activity measurements.

Results: Pathway enrichment analysis showed significant changes in energy metabolism (glycolysis and TCA cycle) and neurotransmitters in both adolescent and adult rats exposed to N, OC and N+OC in relation to saline treatment. The changes were more pronounced in adolescent rats with a significant decrease in glucose, glucose 6-phosphate, fructose-6-phosphate along with a significant increase in pyruvate in N and N+OC exposed groups when compared to saline (p<0.05), suggesting alterations in the glycolytic pathway. Western blot analyses of glycolytic enzymes support the observed metabolic changes.

Conclusion: Nicotine and N+OC exposure increased brain glycolysis in an age-dependent manner. Since glucose metabolism is critical for brain physiology, altered glycolysis deteriorates neural function thus exacerbating ischemic brain damage. Moreover, significant decrease in the neuroactive peptide GABA was observed in young female rats treated with N+OC when compared to saline group. Discerning the exact effects of N +/- OC on overall brain metabolism and the molecular mechanisms affecting mitochondrial function at different ages will open a new window for future therapeutic intervention.

Abstract TP118: Post-Stroke Whole Body Vibration Reduces Frailty in Nicotine Exposed Female Rats

Background: Stroke disproportionately kills more women than men and the risk of stroke remains high even at a young age among women smokers. Smoking prior to stroke is associated with increased post-stroke frailty. Frailty is characterized by an increased vulnerability to acute stressors and the reduced capacity of various bodily systems due to age-associated physiological deterioration. Such age related physiological deterioration of bone in laboratory animals and humans has shown to reverse after therapeutic intervention of whole body vibration (WBV). In the current study we aim to test the efficacy of WBV in reducing post-ischemic frailty and improving physical activity and cognition using a rat model of smoking attributed nicotine.

Methods: Nicotine or saline exposed adult female rats underwent transient middle cerebral artery occlusion (tMCAO; 90 min) / sham-surgery and randomly assigned (n = 6-8 per group) to either WBV or control groups. Animals placed in the WBV (40 Hz) group underwent 30 days of WBV treatment performed twice daily for 15 min each session for 5 days each week. We monitored the frailty index (FI) prior to and 1 month after tMCAO alone or in combination with WBV. The FI was composed of the following criteria: 1) activity levels, 2) blood pressure (BP), 3) basic metabolic status, and 4) cognitive performance of rats. Animals were sacrificed on the 30th day of WBV treatment, and brain tissue was harvested for histopathological analysis.

Results: Post-tMCAO WBV did not change activity levels or BP in nicotine or saline treated rats. Post-tMCAO WBV cognitive performance improved in saline group as compared to nicotine exposed rats. Sensorimotor function was also improved in tMCAO WBV saline group compared to nicotine-exposed rats. We observed 56% reduction in infarct volume of WBV treated rats as compared to control (p < 0.05). This difference was not seen in nicotine treated groups.

Conclusions: The post-ischemic WBV intervention had no detrimental effects on the frailty parameters, decreased brain damage, and reduced frailty in control female rats, but not in the nicotine-exposed group. This suggests that WBV may be a potential therapy for non-smokers to reduce post-ischemic frailty and improve functional and cognitive outcomes after stroke.

Preconditioning with CpG-ODN1826 reduces ischemic brain injury in young male mice: a replication study

Earlier studies established that ischemic tolerance can be induced in the brain using various strategies. An earlier study demonstrated that preconditioning with the toll-like receptor 9 ligand, CpG oligodeoxynucleotides (ODN), protects the brain against ischemic damage. To increase the potential translational value of the previous study, the goal of the present study was to replicate this earlier finding in a different animal cohort at a different site. In addition to these replication studies, following the Stroke Treatment Academic Industry Roundtable (STAIR) guidelines, we also conducted studies to evaluate the protective effect of CpG-ODN 1826 preconditioning on cerebral ischemic damage in ovariectomized (Ovx) female animals. Young male and female mice were treated with CpG-ODN 1826 or control ligand 3 days prior to the induction of transient (60 min) cerebral ischemia using a middle cerebral artery occlusion (MCAO) model. Infarct size was evaluated at ~24 h post-MCAO. We were able to replicate earlier findings that preconditioning with a low dose (20 μg/mouse) of CpG-ODN 1826 was able to lower cerebral ischemic damage in young male mice. However, we did not see any protective effect of low dose CpG-ODN 1826 preconditioning against cerebral ischemic damage in young Ovx female mice. Our study independently confirms the protective effect of CpG-ODN 1826 in inducing cerebral ischemia tolerance in male but not in Ovx female mice. Our study also demonstrates the feasibility of conducting such replication studies in rodent models of transient stroke.

Sexual dimorphism in inflammasome-containing extracellular vesicles and the regulation of innate immunity in the brain of reproductive senescent females

A woman's risk for stroke increases exponentially following the onset of menopause; however, the underlying mechanisms responsible for the increased risk remain unknown. The depletion of endogenous estrogen at menopause is known to activate the inflammatory response. Therefore, in this study we have used reproductively senescent (RS) rats to test the hypotheses that (1) inflammasome activation is significantly higher in the brain of RS females (RSF) as compared to their younger counterparts and age-matched senescent male rats, and that (2) RS triggers an innate immune response mediated in part by inflammasome-containing extracellular vesicles (EV) that originate in the female reproductive organs and then spreads to the brain. We tested these hypotheses using male and female Sprague-Dawley rats (Young: 6-7 months and RS: 9-13 months). Hippocampus, gonads and serum were collected. Additionally, cerebrospinal fluid (CSF) of pre- and post-menopausal women (ages 23 to 37 and 52 to 68) was purchased and extracellular vesicles (EV) were isolated from serum and CSF. The Inflammasome proteins caspase-1, apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) and IL-1β were then resolved by immunoblotting. We found that inflammasome protein expression increased significantly in the analyzed tissues in RSF as compared to young females (YF), such difference was not present in age-matched male rat brains. Interestingly, we found that Nik-related kinase (NRK), which is present in female reproductive organs was present in the CSF and serum-derived EV, suggesting that the source of the EV seen in the brain during RS/menopause originate, in part, in the female reproductive organs. Thus, this study shows for the first time an involvement of the inflammasome originating in the female reproductive system as a contributor to inflammation in the brain that makes the peri-menopausal women's brain more susceptible to neurodegenerative diseases such as stroke.

Nicotine Alters Estrogen Receptor-Beta-Regulated Inflammasome Activity and Exacerbates Ischemic Brain Damage in Female Rats

Smoking is a preventable risk factor for stroke and smoking-derived nicotine exacerbates post-ischemic damage via inhibition of estrogen receptor beta (ER-β) signaling in the brain of female rats. ER-β regulates inflammasome activation in the brain. Therefore, we hypothesized that chronic nicotine exposure activates the inflammasome in the brain, thus exacerbating ischemic brain damage in female rats. To test this hypothesis, adult female Sprague-Dawley rats (6–7 months old) were exposed to nicotine (4.5 mg/kg/day) or saline for 16 days. Subsequently, brain tissue was collected for immunoblot analysis. In addition, another set of rats underwent transient middle cerebral artery occlusion (tMCAO; 90 min) with or without nicotine exposure. One month after tMCAO, histopathological analysis revealed a significant increase in infarct volume in the nicotine-treated group (64.24 ± 7.3 mm³; mean ± SEM; n = 6) compared to the saline-treated group (37.12 ± 7.37 mm³; n = 7, p < 0.05). Immunoblot analysis indicated that nicotine increased cortical protein levels of caspase-1, apoptosis-associated speck-like protein containing a CARD (ASC) and pro-inflammatory cytokines interleukin (IL)-1β by 88% (p < 0.05), 48% (p < 0.05) and 149% (p < 0.05), respectively, when compared to the saline-treated group. Next, using an in vitro model of ischemia in organotypic slice cultures, we tested the hypothesis that inhibition of nicotine-induced inflammasome activation improves post-ischemic neuronal survival. Accordingly, slices were exposed to nicotine (100 ng/mL; 14–16 days) or saline, followed by treatment with the inflammasome inhibitor isoliquiritigenin (ILG; 24 h) prior to oxygen-glucose deprivation (OGD; 45 min). Quantification of neuronal death demonstrated that inflammasome inhibition significantly decreased nicotine-induced ischemic neuronal death. Overall, this study shows that chronic nicotine exposure exacerbates ischemic brain damage via activation of the inflammasome in the brain of female rats.

Cognitive Deficits after Cerebral Ischemia and Underlying Dysfunctional Plasticity: Potential Targets for Recovery of Cognition

Cerebral ischemia affects millions of people worldwide and survivors suffer from long-term functional and cognitive deficits. While stroke and cardiac arrest are typically considered when discussing ischemic brain injuries, there is much evidence that smaller ischemic insults underlie neurodegenerative diseases, including Alzheimer's disease. The "regenerative" capacity of the brain relies on several aspects of plasticity that are crucial for normal functioning; less affected brain areas may take over function previously performed by irreversibly damaged tissue. To harness the endogenous plasticity mechanisms of the brain to provide recovery of cognitive function, we must first understand how these mechanisms are altered after damage, such as cerebral ischemia. In this review, we discuss the long-term cognitive changes that result after cerebral ischemia and how ischemia alters several plasticity processes. We conclude with a discussion of how current and prospective therapies may restore brain plasticity and allow for recovery of cognitive function, which may be applicable to several disorders that have a disruption of cognitive processing, including traumatic brain injury and Alzheimer's disease.

Abstract TP91: Multiple Intra-arterial Dosing of the Mesenchymal Stem Cells Reduces Ischemic Brain Injury in a Rat Stroke Model

Background: Cell therapy is emerging as a promising novel treatment for ischemic stroke. Intra-arterial (IA) mesenchymal stem cells (MSCs) delivery in ischemic stroke has a high potential for clinical translation. Recently, we demonstrated the safety and efficacy of IA delivery of MSCs at 24h in a reversible middle cerebral artery occlusion (rMCAo) rodent model. Given the trophic mechanism of action of cell therapy in stroke, a second dose of cells may be beneficial. However, it is unclear if a second IA-MSCs administration is safe and efficacious. Therefore, we aimed to evaluate administration of two doses of IA-MSCs in the rodent stroke model.

Methods: Female ovariectomized Sprague–Dawley rats were exposed to MCAo for 90 min. Rats were treated with IA-MSCs (1x10 5 cells) or phosphate-buffered saline (PBS) at 1 and 6 days (1D-6D) after MCAo. To test neurological and motor function, the standardized neurobehavioral test battery and the rotarod test were performed. The mean duration (in seconds) on the device was recorded from 3 rotarod measurements. The rats were tested at 7, 15 and 30 days after MCAo. Rats were sacrificed at 30 days for infarct volume measurement using histology.

Results: There were no neurological worsening or mortality seen in either treatment group. We observed significant reduction in infarct volume in 1D-6D MSCs group (21 ± 15mm 3 ; n=5) compared to the PBS-treated group (86 ± 19 mm 3 ; n=8, p<0.05). The 1D-6D MSCs group also showed improvement in rotarod test results (16.8 ± 5.8% vs 7.9 ± 3.4%, p=0.075) at 30 days and neurological scores (5.6 ± 1.2 vs 7.75 ± 0.6, p=0.15) at 15 days.

Conclusions: Double dose IA-MSCs at 1D-6D post rMCAo is safe and reduces ischemic brain injury in female rats, with a trend towards functional improvement.

Abstract WP96: Whole Body Vibration After Ischemia Reduces Inflammation in the Brain of Reproductively Senescent Female Rats

Introduction: A woman’s risk of stroke increases exponentially after menopause, and even a mild ischemic episode can result in increased frailty. Studies performed in laboratory animals and humans support the hypothesis that whole body vibration (WBV) reduces or reverses pathological remodeling of bone and lessens frailty-related physiological deterioration. Using a rodent model of stroke, we have examined whether WBV reduces inflammation and post-ischemic damage and improves motor function in reproductively senescent (RS) female rats.

Methods: The estrous cycles of retired breeder Sprague–Dawley female rats (9–12 months; n = 4-6) were monitored for 14-20 days by daily vaginal smears. Rats that remained in constant diestrous were considered RS, exposed to transient middle cerebral artery occlusion (tMCAO; 60 min) and randomly assigned to either WBV or control groups. Animals placed in the WBV (40 Hz) group underwent 30 days of WBV treatment performed twice daily for 15 min each session for 5 days each week. During the treatment period, we tested motor function using a rotarod test intermittently after tMCAO. Animals were sacrificed on 30th day of WBV treatment and brain tissue was harvested for histopathological and inflammasome protein analysis performed by western blotting.

Results: WBV decreased protein levels of caspase-1, ASC and IL-1 β by 88% (p < 0.05), 57% (p < 0.05) and 148% (p < 0.05) in the peri-infarct area as compared to control-treated group. The rotarod test scores from the WBV treatment group were significantly higher than the control group on day 30 (p < 0.05), suggesting a significant improvement in functional activity of the WBV group. The histopathological assessment demonstrated a significant reduction in infarct volume in a mild-stroke model following WBV treatment as compared to control rats. We observed 56% reduction in infarct volume of WBV treated rats as compared to control. In parallel, we also monitored neurological deficit of rats that were exposed to WBV/control treatment after tMCAO.

Conclusion: The post-ischemic WBV intervention reduces brain damage and frailty in RS female rats, suggesting that WBV may be a potential therapy to reduce post-ischemic frailty and improve functional and cognitive outcomes after stroke in women.

Large animal canine endovascular ischemic stroke models: A review

BACKGROUND

Stroke is one of the leading causes of death and long-term disability worldwide. Recent exciting developments in the field with endovascular treatments have shown excellent outcomes in acute ischemic stroke. Prior to translating these treatments to human populations, a large-animal ischemic stroke model is needed. With the advent of new technologies in digital subtraction angiography, less invasive endovascular stroke models have been developed. Canines have gyrencephalic brain similar to human brain and accessible neurovascular anatomy for stroke model creation. Canine stroke model can be widely utilized to understand the disease process of stroke and to develop novel treatment. Less invasive endovascular internal carotid emboli injection and coil embolization methods can be used to simulate transient or permanent middle cerebral artery occlusion. Major restriction includes the extensive collateral circulation of canine cerebral arteries that can limit the stroke size. Transient internal carotid artery occlusion can decrease collateral circulation and increase stroke size to some degree. Additional method of manipulating the extent of collateral circulation needs to be studied. Other types of canine stroke models, including vertebral artery occlusion and basilar artery occlusion, can also be accomplished by endovascular thrombi injection.

CONCLUSIONS

We extensively review the literature on endovascular technique of creating canine ischemic stroke models and their application in finding new therapies for ischemic stroke.

Estrogen receptor beta signaling alters cellular inflammasomes activity after global cerebral ischemia in reproductively senescence female rats

Periodic treatments with estrogen receptor subtype-β (ER-β) agonist reduce post-ischemic hippocampal injury in ovariectomized rats. However, the underlying mechanism of how ER-β agonists protect the brain remains unknown. Global cerebral ischemia activates the innate immune response, and a key component of the innate immune response is the inflammasome. This study tests the hypothesis that ER-β regulates inflammasome activation in the hippocampus, thus reducing ischemic hippocampal damage in reproductively senescent female rats that received periodic ER-β agonist treatments. First, we determined the effect of hippocampal ER-β silencing on the expression of the inflammasome proteins caspase 1, apoptosis-associated speck-like protein containing a CARD (ASC), and interleukin (IL)-1β. Silencing of ER-β attenuated 17β-estradiol mediated decrease in caspase 1, ASC, and IL-1β. Next, we tested the hypothesis that periodic ER-β agonist treatment reduces inflammasome activation and ischemic damage in reproductively senescent female rats. Periodic ER-β agonist treatments significantly decreased inflammasome activation and increased post-ischemic live neuronal counts by 32% (p < 0.05) as compared to the vehicle-treated, reproductively senescent rats. Current findings demonstrated that ER-β activation regulates inflammasome activation and protects the brain from global ischemic damage in reproductively senescent female rats. Further investigation on the role of a periodic ER-β agonist regimen to reduce the innate immune response in the brain could help reduce the incidence and the impact of global cerebral ischemia in post-menopausal women. We propose that estrogen receptor subtype-β (ER-β) activation regulates inflammasome activation and protects the brain from global ischemic damage in reproductively senescent female rats.

Abstract 168: Intra-arterial Stem Cell Treatment Reduces Ischemic Brain Injury In Reproductively Senescent Female Rats

Background: Cell therapy is emerging as a promising treatment for stroke. We recently we demonstrated the efficacy of intra-arterial delivery of MSCs (IA MSCs) at 24h after a reversible middle cerebral artery occlusion (MCAo). Our study also identified a maximum tolerated dose of MSCs that could be delivered IA without compromising middle cerebral artery flow. The IA approach avoids first-pass trapping of MSCs in the lungs and liver as seen with intravenous delivery. Intra-arterial treatment is also minimally invasive and widely available in clinical practice and thus appealing for clinical translation. Since majority of ischemic strokes in women occur after onset of menopause it is crucial that we test the efficacy of IA MSCs in reproductively senescent females consistent with STAIR recommendations. We aimed to validate the efficacy of IA MSCs in reproductively senescent female rats. Methods: Retired breeder female (9-11 months; 280-350 g) Sprague-Dawley rats showing estrous acyclicity were exposed to MCAo (90 min). A day later, rats were treated with IA MSCs (1x10^5 cells) or phosphate-buffered saline (PBS). MSCs or PBS treated rats were sacrificed at 28-30 days for infarct volume measurement using histology. To test motor function, the rotarod test was performed. Rats were trained for 3 consecutive days for the rotarod test before undergoing the MCAo procedure. The mean duration (in seconds) on the device was recorded from 3 rotarod measurements 1 day before surgery. The rats were tested at 1, 7, 15 and 28-30 days after MCAo. Results: We observed significantly lower mean infarct volume in the MSC-treated group (12 ± 3 mm3; n=6) compared to the PBS-treated group (29 ± 7 mm3; Mean ± SEM; n=4, p<0.05). Treatment at 1 day after MCAO with MSCs significantly improved functional recovery, as evidenced by improved rotarod test results and neurological scores at 7, 15 and 30 days (P<0.05) compared with the PBS-treated group. Conclusions: Intra-arterial stem cell treatment reduces ischemic brain injury and improves functional outcomes in reproductively senescent female rats. Validating the efficacy of IA MSC treatment using a reproductively senescent animal stroke model suggests high potential for future clinical translation in a population at high risk for stroke.

Effect of sugar beet tubers as a partial replacer to green fodder on production performance and economics of lactating Surti buffaloes in lean period

Aim:

The objective of this study was to evaluate the effects of sugar beet tubers as a replacer to green fodder on production performance and economics of lactating Surti buffaloes.

Materials and Methods:

This trial was conducted at the Livestock Research Station, Navsari Agricultural University, Navsari. Twenty lactating Surti buffaloes in a changeover experimental design were selected to assess the effects of replacing green fodder with sugar beet (Beta vulgaris L.) tubers on production performance, economics of feeding sugar beet and blood biochemical profile. Half (50%) of the hybrid Napier was replaced with sliced sugar beet tubers in the ration of experimental animals.

Results:

Partial replacement of hybrid Napier with that of sugar beet tubers numerically improved dry matter intake, milk yield, 4% fat corrected milk and milk composition parameters such as fat, solid non-fat, protein and lactose, but not significantly. The blood parameters were in normal range and non-significant except that of glucose and triglycerides, which were increased in the sugar beet group. Replacing sugar beet tubers also proved to be cost-effective with improved net profit around Rs. 6.63/day.

Conclusion:

It can be concluded that 50% hybrid Napier fodder can be replaced with sugar beet tubers without any adverse effect on animal production performance, milk composition blood biochemical profile and economics of feeding.

Increased BDNF protein expression after ischemic or PKC epsilon preconditioning promotes electrophysiologic changes that lead to neuroprotection

Ischemic preconditioning (IPC) via protein kinase C epsilon (PKCɛ) activation induces neuroprotection against lethal ischemia. Brain-derived neurotrophic factor (BDNF) is a pro-survival signaling molecule that modulates synaptic plasticity and neurogenesis. Interestingly, BDNF mRNA expression increases after IPC. In this study, we investigated whether IPC or pharmacological preconditioning (PKCɛ activation) promoted BDNF-induced neuroprotection, if neuroprotection by IPC or PKCɛ activation altered neuronal excitability, and whether these changes were BDNF-mediated. We used both in vitro (hippocampal organotypic cultures and cortical neuronal-glial cocultures) and in vivo (acute hippocampal slices 48 hours after preconditioning) models of IPC or PKCɛ activation. BDNF protein expression increased 24 to 48 hours after preconditioning, where inhibition of the BDNF Trk receptors abolished neuroprotection against oxygen and glucose deprivation (OGD) in vitro. In addition, there was a significant decrease in neuronal firing frequency and increase in threshold potential 48 hours after preconditioning in vivo, where this threshold modulation was dependent on BDNF activation of Trk receptors in excitatory cortical neurons. In addition, 48 hours after PKCɛ activation in vivo, the onset of anoxic depolarization during OGD was significantly delayed in hippocampal slices. Overall, these results suggest that after IPC or PKCɛ activation, there are BDNF-dependent electrophysiologic modifications that lead to neuroprotection.

Efficacy and dose-dependent safety of intra-arterial delivery of mesenchymal stem cells in a rodent stroke model

Intra-arterial (IA) delivery of mesenchymal stem cells (MSCs) for acute ischemic stroke is attractive for clinical translation. However, studies using rat model of stroke have demonstrated that IA MSCs delivery can decrease middle cerebral artery (MCA) flow, which may limit its clinical translation. The goal of this study is to identify a dose of IA MSCs (maximum tolerated dose; MTD) that does not compromise MCA flow and evaluate its efficacy and optimal timing in a rat model of reversible middle cerebral artery occlusion (rMCAo). We sought to determine if there is a difference in efficacy of acute (1 h) versus sub-acute (24 h) IA MSCs treatment after rMCAo. Adult female Sprague-Dawley rats underwent rMCAo (90 min) and an hour later a single dose of MSCs (at de-escalating doses 1 × 10(6), 5 × 10(5), 2 × 10(5), 1 × 10(5) and 5 × 10(4)) was given using IA route. MSCs were suspended in phosphate buffered saline (PBS) and PBS alone was used for control experiments. We measured the percent change in mean laser Doppler flow signal over the ipsilateral MCA in de-escalating doses groups to determine MTD. The results demonstrated that the lowering of IA MSC dose to 1 × 10(5) and below did not compromise MCA flow and hence an IA MSC dose of 1 × 10(5) considered as MTD. Subsequently, 1 h and 24 h after rMCAo, rats were treated with IA MSCs or PBS. The 24 h delivery of IA MSCs significantly improved neurodeficit score and reduced the mean infarct volume at one month as compared to control, but not the 1 h delivery. Overall, this study suggests that the IA delivery of MSCs can be performed safely and efficaciously at the MTD of 1 × 10(5) delivered at 24 hours in rodent model of stroke.

Periodic 17β-estradiol pretreatment protects rat brain from cerebral ischemic damage via estrogen receptor-β

Although chronic 17β-estradiol (E2) has been shown to be a cognition-preserving and neuroprotective agent in animal brain injury models, concern regarding its safety was raised by the failed translation of this phenomenon to the clinic. Previously, we demonstrated that a single bolus of E2 48 hr prior to ischemia protected the hippocampus from damage in ovariectomized rats via phosphorylation of cyclic-AMP response element binding protein, which requires activation of estrogen receptor subtype beta (ER-β). The current study tests the hypothesis that long-term periodic E2-treatment improves cognition and reduces post-ischemic hippocampal injury by means of ER-β activation. Ovariectomized rats were given ten injections of E2 at 48 hr intervals for 21 days. Hippocampal-dependent learning, memory and ischemic neuronal loss were monitored. Results demonstrated that periodic E2 treatments improved spatial learning, memory and ischemic neuronal survival in ovariectomized rats. Additionally, periodic ER-β agonist treatments every 48 hr improved post-ischemic cognition. Silencing of hippocampal ER-β attenuated E2-mediated ischemic protection suggesting that ER-β plays a key role in mediating the beneficial effects of periodic E2 treatments. This study emphasizes the need to investigate a periodic estrogen replacement regimen to reduce cognitive decline and cerebral ischemia incidents/impact in post-menopausal women.

Oral contraceptives and nicotine synergistically exacerbate cerebral ischemic injury in the female brain

Oral contraceptives (OC) and smoking-derived nicotine (N) are known to synergistically increase the risk and severity of cerebral ischemia in women. Although it has been known for some time that long-term use of OC and nicotine will have an increased risk of peripheral thrombus formation, little is known about how the combination of OC and nicotine increases severity of brain ischemia. Recent laboratory studies simulating the conditions of nicotine exposure produced by cigarette smoking and OC regimen of women in female rats confirms that the severity of ischemic hippocampal damage is far greater in female rats simultaneously exposed to OC than to nicotine alone. These studies also demonstrated that the concurrent exposure of OC and nicotine reduces endogenous 17β-estradiol levels and inhibits estrogen signaling in the brain of female rats. The endogenous 17β-estradiol plays a key role in cerebrovascular protection in women during their pre-menopausal life and loss of circulating estrogen at reproductive senescence increases both the incidence and severity of cerebrovascular diseases. Therefore, OC and nicotine induced severe post-ischemic damage might be a consequence of lack of estrogen signaling in the brain. In the present review we highlight possible mechanisms by which OC and nicotine inhibits estrogen signaling that could be responsible for severe ischemic damage in females.

Nitrite therapy is neuroprotective and safe in cardiac arrest survivors

Cardiac arrest results in significant mortality after initial resuscitation due in most cases to ischemia-reperfusion induced brain injury and to a lesser degree myocardial dysfunction. Nitrite has previously been shown to protect against reperfusion injury in animal models of focal cerebral and heart ischemia. Nitrite therapy after murine cardiac arrest improved 22 h survival through improvements in myocardial contractility. These improvements accompanied transient mitochondrial inhibition which reduced oxidative injury to the heart. Based on preliminary evidence that nitrite may also protect against ischemic brain injury, we sought to test this hypothesis in a rat model of asphyxia cardiac arrest with prolonged survival (7d). Cardiac arrest resulted in hippocampal CA1 delayed neuronal death well characterized in this and other cardiac arrest models. Nitrite therapy did not alter post-arrest hemodynamics but did result in significant (75%) increases in CA1 neuron survival. This was associated with increases in hippocampal nitrite and S-nitrosothiol levels but not cGMP shortly after therapy. Mitochondrial function 1h after resuscitation trended towards improvement with nitrite therapy. Based on promising preclinical data, the first ever phase I trial of nitrite infusions in human cardiac arrest survivors has been undertaken. We present preliminary data showing low dose nitrite infusion did not result in hypotension or cause methemoglobinemia. Nitrite thus appears safe and effective for clinical translation as a promising therapy against cardiac arrest mediated heart and brain injury.

Abstract 3671: Intra-Carotid Mesenchymal Stem Cell Therapy is Superior to Intravenous delivery in Rat Model of Cerebral Ischemia

INTRODUCTION: There are multiple pre-clinical studies showing significant neurological functional benefit of Mesenchymal Stem Cells (MSCs) in cerebral ischemia. MSCs are adult bone marrow derived cells that have a high potential for clinical translation. The optimal route of MSC delivery has not been established. Intra-carotid (IC) delivery via catheters has several attributes attractive for clinical application & may be superior to intravenous (IV) delivery as it circumvents systemic trapping of cells and allows more cells to reach the target lesion. In our previous study using the rat rMCAo model, we found the maximum tolerated dose (MTD) of IC MSCs to be 1 x 10^5 HYPOTHESIS: We tested the hypothesis that the MTD of IC mesenchymal stem cells (MSCs) is more efficacious as compared to IV MSCs and IC control. We further hypothesized that the MTD of IC MSCs given at 24 hours is more efficacious as compared to IC MSCs at 60 minutes. METHODS: 34 female Sprague-Dawley rats underwent 90 minutes reversible middle cerebral artery occlusion (rMCAo). At 60 minutes or 24 hours post rMCAo, rats were assigned to receive: allogeneic IC MSCs at a dose of 1x 10^5 or IC phosphate buffered saline (PBS) 0.5ml or allogeneic intravenous (IV) MSCs 1 x 10^6 & rMCAo with no treatment (sham). Primary outcome measures were blinded neurodeficit score and infarct volume at 4 weeks.

RESULTS: At 24 hours post rMCAo, there was no significant difference in the neurodeficit score (NDS) amongst the groups. At four weeks post treatment, the IC MSC group showed a significantly lower NDS (7%_3.3) as compared to IV MSCs (10.2%_1.5, p=0.042); In subgroup analysis, IC MSCs given at 60 minutes showed no significant difference compared to other groups, but IC MSC given at 24 hours showed a significantly lower neurodeficit score (5.8 %_2.6) as compared to IC PBS (10.8%_1.2, p=0.003), IV MSCs (10.2 %_1.5, p=0.005) and Sham (10%_ 3.4, p=0.018) ( Fig1 .). The mean infarct volume of the group treated with IC MSCs was significantly lower as compared to IC PBS (18cc%_ 8 vs. 50cc%_17, p=0.043). On infarct topography frequency map comparison, we found a significantly decreased volume of infarction in the cortical regions in IC MSC group as compared to IC PBS group.

CONCLUSIONS: Treatment with maximum tolerated IC MSC dose of 1 x 10^5 post rMCAO results in superior functional outcome when compared with IV MSC 1 x 10^6, IC PBS and sham rats. Additionally, IC MSC at 24 hours is more efficacious than IC MSC at 60 minutes. There is also a significant decrease in infarct volume in IC MSC treated rats when compared with IC PBS. The IC MSCs may ameliorate injury in the cortex surrounding the core.

Abstract 2818: Safety, Feasibility and Signal of Activity of Intra-carotid Allogenic Mesenchymal Stem Cell therapy in a Large Animal Stoke Model

INTRODUCTION: Promising pre-clinical data shows benefits of intra-carotid allogenic mesenchymal stem cell (MSCs) therapy in ischemic stroke (IS) in small animal stroke models. Intra-carotid (IC) delivery of MSCs may be superior to intravenous (IV) delivery. However, due to the large size (15-50 microns) of MSCs, there is a concern that they may cause microvascular occlusion during IC administration. There is a need for large animal experiments to confirm positive results in small animal models as has been recommended by STAIR and STEPS consortia.

HYPOTHESIS: We tested the hypothesis that IC administration of allogeneic mesenchymal stem cells (MSCs) is feasible and safe in a large animal (canine) stroke model..

METHODS: We performed 1-3 hrs of reversible middle cerebral artery occlusion (rMCAo), in10 female mongrel dogs weighing 40-60 lbs, using an endovascular retrievable coil occlusion of the MCA with a transfemoral arterial approach. At 1 - 72 hrs after rMCAo, animals were assigned to the following treatment groups: A. IC saline placebo (saline) or B. IC allogeneic MSCs or C. IV allogeneic MSCs. Primary outcome measures were: development of angiographic occlusion post-IC MSC or saline infusion, change in MRI infarct volume or new ischemic lesions, and neurological deficit score (NDS) at 4 weeks. Dosing of MSCs was based on extrapolated maximum tolerated dose calculated in a rat study of IC MSCs in our laboratory.

RESULTS: Successful IC administration of MSCs was possible in all animals assigned to the treatment group. Animals receiving IC MSCs at 1× 10^6 or 10 × 10^6 (n=6) there were no clinical adverse events or neurological worsening during or 4 weeks post treatment. There were no angiographic decreases in flow or occlusions during or after IC MSC delivery. In the two animals with additional TCD monitoring during IC MSC delivery there were no changes in flow velocity or HITS signals indicating emboli. There was no worsening in MRI infarct volume ( Fig 1 .) amongst the IC MSC groups. A dramatic decrease in infarct volume was noted, in 2 animals in the IC MSC group with minimal infarct related atrophy at one month. None of the animals in the IV MSC or IC saline groups (n=2 in each group) showed a significant change in MRI infarct volume, and major infarct related atrophy was noted.

CONCLUSION: IC MSC administration in a large animal rMCAo model is feasible & safe. Fig1 : In vivo coronal MRI FLAIR sequences in IC delivery of MSCs in canine stroke model. There is a signal of biologic activity seen with IC MSC delivery. A. Baseline infarct at 48 hours after rMCAo. B. Infarct evolution at 29 days after IC administration of 10×10^6 MSCs.

Recurrent hypoglycemia increases oxygen glucose deprivation-induced damage in hippocampal organotypic slices

More than 65% of mortality among diabetics is due to stroke and heart disease. The major side effect of intensive therapy in both type 1 and type 2 diabetics is recurrent hypoglycemic episodes (RH). Our previous study in a rat model of insulin-requiring diabetes indicated that RH exacerbates cerebral ischemic damage. Studies related to RH in hypoglycemia unawareness suggest that RH may be deleterious to outcome following cerebral ischemia owing to systemic effects, since hormonal response to hypoglycemia is impaired following RH. The goal of the present study was to determine if RH increases oxygen-glucose deprivation (OGD)-induced damage in hippocampal organotypic slices, which are devoid of systemic influence. Hippocampal slices cultured in ex vivo conditions for 9-10 days were exposed to ten 30-min episodes of "hypoglucose" (to mimic the hypoglycemic condition) medium (1.06 mM) twice a day. Slices were exposed to OGD 12h after the last hypo/normo-glucose exposure. OGD in control slices resulted in 60% neuronal death. The percentage of cell death in RH-treated slices was significantly higher by 24% than in control slices. The results demonstrate that RH can affect brain cells in the absence of humoral influence. In conclusion, the previous exposure of hippocampal slices to RH exacerbates OGD-induced damage. Understanding the mechanism by which RH increases ischemic damage in diabetics will help improve outcome following stroke.