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Mechanisms of Median Nerve Electrical Stimulation

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Mechanisms of Median Nerve Electrical Stimulation NEURAL REGENERATION RESEARCH April 2015,Volume 10,Issue 4 www.nrronline.org RESEARCH ARTICLE Resuscitation therapy for traumatic brain injury- induced coma in rats: mechanisms of median nerve electrical stimulation *, Zhen Feng #, Ying-jun Zhong#, Liang Wang, Tian-qi Wei Department of Rehabilitation Medicine, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China Abstract *Correspondence to: In this study, rats were put into traumatic brain injury-induced coma and treated with median Zhen Feng, M.D., [email protected]. nerve electrical stimulation. We explored the wake-promoting effect, and possible mechanisms, of median nerve electrical stimulation. Electrical stimulation upregulated the expression levels of #These authors contributed to this work orexin-A and its receptor OX1R in the rat prefrontal cortex. Orexin-A expression gradually in- equally. creased with increasing stimulation, while OX1R expression reached a peak at 12 hours and then decreased. In addition, after the OX1R antagonist, SB334867, was injected into the brain of rats doi:10.4103/1673-5374.155433 after traumatic brain injury, fewer rats were restored to consciousness, and orexin-A and OXIR http://www.nrronline.org/ expression in the prefrontal cortex was downregulated. Our findings indicate that median nerve electrical stimulation induced an up-regulation of orexin-A and OX1R expression in the pre- Accepted: 2014-11-22 frontal cortex of traumatic brain injury-induced coma rats, which may be a potential mechanism involved in the wake-promoting effects of median nerve electrical stimulation. Key Words: nerve regeneration; traumatic brain injury; coma; median nerve electrical stimulation; wake-promoting; orexin-A; OX1R; NSFC grants; neural regeneration Funding: This study was funded by grants from the National Natural Science Foundation of China, No. 81260295, and the Natural Science Foundation of Jiangxi Province of China, No. 20132BAB205063. Feng Z, Zhong YJ, Wang L, Wei TQ (2015) Resuscitation therapy for traumatic brain injury-induced coma in rats: mechanisms of median nerve electrical stimulation. Neural Regen Res 10(4):594-598. Introduction aimed to verify this hypothesis. The incidence of traumatic brain injury is increasing rapidly in China. Recent progress in traumatic brain injury treat- Materials and Methods ment technology has resulted in a sharp decrease in traumat- Establishment of traumatic brain injury-induced coma ic brain injury patient’s mortality. However, approximately model 14% of traumatic brain injury patients remain in long-term A total of 120 male/female adult Sprague-Dawley rats, of coma or a vegetative state after rescue, and this percentage is specific pathogen free grade, weighing 250−300 g, were used gradually increasing (Harvey, 2013). Preliminary research has in this study. Rats were obtained from the Institute of Labo- shown that median nerve electrical stimulation is associated ratory Animals of Nanchang University (Nanchang, Jiangxi with an arousal-promoting effect in comatose humans (Coo- Province, China). All rats were housed in the Laboratory per et al., 1999), but the exact mechanisms remain unclear. Animal Center of the First Affiliated Hospital of Nanchang Orexin-A is a hypothalamic neuropeptide, which is in- University (Nanchang, Jiangxi Province, China). All rats volved in a number of physiological functions such as feed- were maintained in an air-conditioned room with a 12-hour ing, energy homeostasis, and wakefulness (Gao and Wang, light/dark cycle, standard diet and water were available ad 2010). Orexin receptor-1 (OX1R) is expressed in many brain libitum. Ethical approval for this study was obtained from regions, including the prefrontal cortex, cerebral cortex, the Ethics Committee of Nanchang University (Nanchang, ventromedial hypothalamus nucleus, and locus coeruleus Jiangxi Province, China). Animals were divided into four (Sakurai and Mieda, 2011). Orexin-A is one of the most im- groups: control, model, stimulated, and antagonist groups. portant neurotransmitters in the ascending reticular activat- Each group comprised 30 rats. ing system, and contributes to awareness and/or the sleep- Rats in the model, stimulated, and antagonist groups wake cycle (Feeney et al., 1981; Sakurai and Mieda, 2011). were anesthetized using diethyl ether inhalation and al- Thus, we hypothesized that orexin-A and OX1R play an lowed to breathe air spontaneously. After anesthesia, the essential role in the mechanism of the wake-enhancing effect skull was exposed via a 5 mm vertical incision using con- of median nerve electrical stimulation. The present study ventional surgical techniques. A cross hit point was marked 594 Feng Z, et al. / Neural Regeneration Research. 2015;10(4):594-598. by a syringe needle at 2 mm adjacent to the left midline and with 10% chloral hydrate at 6, 12, and 24 hours after median 1 mm anterior to the coronal suture. A cylindrical impact nerve electrical stimulation, respectively, along with a corre- hammer weighing 400 g was dropped at a vertical height of sponding control and traumatic brain injury-induced coma 40−44 cm along a vertical metal bar to hit the plastic spacer rat simultaneously. Next, prefrontal cortex tissues (within on the hit-point marked previously, resulting in a concave the frontal lobe) were extracted (Yeterian et al., 2012), and fracture of the skull (Feeney et al., 1981). After injury, the in- expression of orexin-A and OX1R was detected using immu- cision was closed, and animals were disinfected and removed nohistochemistry, western blot analysis, and enzyme-linked to a cage. 1 hour later, we classified consciousness into I−VI immunosorbent assay. degrees according to sensory and motor functions (Stephens and Levy, 1994). Degree I: Normal activity freely engaged in Western blot assay cages; degree II: decreased activity; degree III: decreased ac- The tissue samples obtained were homogenized using a tivity with motor incoordination; degree IV: righting reflex Tissue Protein Extraction Kit (CW0891, Beijing Kangwei could be elicited; animals could stand up; degree V: righting Biotechnology Co., Ltd., Beijing, China). Homogenates were reflex disappeared; animals could react to pain; degree VI: centrifuged at 12,000 × g for 10 minutes at 4°C. Superna- animals have no reaction to pain. We defined rats in degrees tants were divided into small aliquots and stored at −80°C. V and VI, which lasted at least 30 minutes, as rats in a coma The amount of total protein in each sample was determined state and suitable for the following procedures. using the Bio-Rad DC protein assay (Bio-Rad, Hercules, CA, USA). Homogenated samples containing equal amounts Intracerebroventricular injection of OX1R antagonist of protein and loading buffer were boiled for 5 minutes in SB334867 water and run on a 10% sodium dodecyl sulfate/polyacryl- Under sterile conditions, an injection catheter was inserted amide gel. After electrophoresis, the proteins were trans- into the left cerebral ventricle of rats in the antagonist group. ferred to polyvinylidene difluoride membranes. Membranes One hour before surgery, each rat received pre-treatment were blocked for 2 hours at room temperature with TBS-T with gentamicin (0.1 mL/100 g, intramuscular injection), and buffer (150 mM NaCl, 20 mM Tris HCl, pH 7.4, 0.1% Tween was anesthetized with 10% chloral hydrate (0.3 mL/100 g, 20) containing 5% milk. The blots were incubated overnight intraperitoneal injection). Rats were positioned in a stereo- with rabbit anti-OX1R polyclonal antibody (1:200; ab68718, taxic frame (ZS-B/S, Beijing Zhongshi Dichuang Science and Abcam, New Territories, HK Co., Ltd., China) and rabbit an- Technology Development Co., Ltd., Beijing, China), and the ti-rat β-actin monoclonal antibody (1:400; CW0096, Beijing co-ordinates used to map the guide cannula were as follows: Kangwei, Beijing, China) at 4°C overnight. After incubation, 1.0 mm posterior to bregma, 1.5 mm lateral to the midline, the membranes were washed three times with TBS-T and in- and 4.5 mm ventral to the skull surface, with the incisor bar cubated for 2 hours with horseradish peroxidase-conjugated 3.2 mm below the interauricular line. Following surgery, goat anti-rabbit IgG (H+L) (ZB-2301, Beijing Zhongshan rats received an injection of SB334867 (Tocris Bioscience, Golden Bridge Biotechnology Co., Ltd., Beijing, China) Ellisville, MO, USA), 10 mg/kg dissolved in 5 μL of 60:40 di- diluted 1:3,000 in TBS-T containing 5% milk at room tem- methyl sulfoxide solution. After rats awoke from anesthesia, perature for 1 hour. The concentration of proteins was de- they were prepared for median nerve electrical stimulation treatment. tected using the bicinchoninic acid protein assay. To monitor loading of gel lanes, the blots were stripped by incubation Median nerve electrical stimulation for 30 minutes at 70°C with a solution containing 2% sodi- Rats in the stimulated and antagonist groups were treated um dodecyl sulfate, 100 mM β-mercaptoethanol in 62.5 mM with median nerve electrical stimulation following traumat- Tris-HCl, pH 6.8, and re-probed using rabbit anti-β-actin ic brain injury, after evaluation of consciousness, using a low monoclonal antibody (CW0096, Beijing Kangwei). Then, frequency electrical stimulator (ES-420, ITO Physiotherapy blots were incubated with a chemiluminescence substrate & Rehabilitation, Tokyo, Japan). An acupuncture needle was (32109, ECL Plus, Amersham Biosciences, NJ, USA) and inserted (depth: 1 mm, angle: 45°) 5 mm lateral
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