Neurochemical effects of exercise and neuromuscular electrical stimulation on brain after stroke: a microdialysis study using rat model

The role of stem cell factor and granulocyte-colony stimulating factor in treatment of stroke

Stroke is a serious cerebrovascular disease that causes high mortality and persistent disability in adults worldwide. Stroke is also an enormous public health problem and a heavy public financial burden in the United States. Treatment for stroke is very limited. Thrombolytic therapy by tissue plasminogen activator (tPA) is the only approved treatment for acute stroke, and no effective treatment is available for chronic stroke. Developing new therapeutic strategies, therefore, is a critical need for stroke treatment. This article summarizes the discovery of new routes of treatment for acute and chronic stroke using two hematopoietic growth factors, stem cell factor (SCF) and granulocyte-colony stimulating factor (G-CSF). In a study of acute stroke, SCF and G-CSF alone or in combination displays neuroprotective effects in an animal model of stroke. SCF appears to be the optimal treatment for acute stroke as the functional outcome is superior to G-CSF alone or in combination (SCF+G-CSF); however, SCF+G-CSF does show better functional recovery than G-CSF. In a chronic stroke study, the therapeutic effects of SCF and G-CSF alone or in combination appear differently as compared with their effects on the acute stroke. SCF+G-CSF induces stable and long-lasting functional improvement; SCF alone also improves functional outcome but its effectiveness is less than SCF+G-CSF, whereas G-CSF shows no therapeutic effects. Although the mechanism by which SCF+G-CSF repairs the brain in chronic stroke remains poorly understood, our recent findings suggest that the SCF+G-CSF-induced functional improvement in chronic stroke is associated with a contribution to increasing angiogenesis and neurogenesis through bone marrow-derived cells and the direct effects on stimulating neurons to form new neuronal networks. These findings would assist in developing new treatment for stroke. The article presents some promising patents on role of stem cell factor and granulocyte-colony stimulating factor in treatment of stroke.

Beneficial effects of antecedent exercise training on limb motor function and calpain expression in a rat model of stroke

[Purpose] In the present study, we investigated the effects of antecedent exercise on functional recovery and calpain protein expression following focal cerebral ischemia injury. [Subjects and Methods] The rat middle cerebral artery occlusion model was employed. Adult male Sprague-Dawley rats were randomly divided into 4 groups. Group I comprised untreated normal rats (n=10); Group II comprised untreated rats with focal cerebral ischemia (n=10); Group III comprised rats that performed treadmill exercise (20 m/min) training after focal cerebral ischemia (n=10); and Group IV comprised rats that performed antecedent treadmill exercise (20 m/min) training before focal cerebral ischemia (n=10). At different time points (1, 7, 14, and 21 days), limb placement test score and the levels of calpain protein in the hippocampus were examined. [Results] In the antecedent exercise group, improvements in the motor behavior index (limb placement test) were observed and hippocampal calpain protein levels were decreased. [Conclusion] These results indicated that antecedent treadmill exercise prior to focal cerebral ischemia exerted neuroprotective effects against ischemic brain injury by improving motor performance and decreasing the levels of calpain expression. Furthermore, these results suggest that antecedent treadmill exercise of an appropriate intensity is critical for post-stroke rehabilitation.

The Effect of Synchronized Forced Running with Chronic Stress on Short, Mid and Long- term Memory in Rats

PURPOSE

Impairment of learning and memory processes has been demonstrated by many studies using different stressors. Other reports suggested that exercise has a powerful behavioral intervention to improve cognitive function and brain health. In this research, we investigated protective effects of treadmill running on chronic stress-induced memory deficit in rats.

METHODS

Fifty male Wistar rats were randomly divided into five groups (n=10) as follows: Control (Co), Sham (Sh), Stress (St), Exercise (Ex) and Stress and Exercise (St & Ex) groups. Chronic restraint stress was applied by 6h/day/21days and also treadmill running at a speed 20-21m/min for 1h/day/21days. Memory function was evaluated by the passive avoidance test in different intervals (1, 7 and 21 days) after foot shock.

RESULTS

OUR RESULTS SHOWED THAT: 1) Although exercise alone showed beneficial effects especially on short and mid-term memory (P<0.05) in comparison with control group, but synchronized exercise with stress had not significantly improved short, mid and long-term memory deficit in stressed rats. 2) Short and mid-term memory deficit was significantly (P<0.05) observed in synchronized exercise with stress and stress groups with respect to normal rats. 3) Memory deficit in synchronized exercise with stress group was nearly similar to stressed rats. 4) Helpful effects of exercise were less than harmful effects of stress when they were associated together.

CONCLUSION

The data correspond to the possibility that although treadmill running alone has helpful effects on learning and memory consolidation, but when it is synchronized with stress there is no significant benefit and protective effects in improvement of memory deficit induced by chronic stress. However, it is has a better effect than no training on memory deficit in stressed rats.

The effects of voluntary, involuntary, and forced exercises on motor recovery in a stroke rat model

Stroke rehabilitation with different exercise paradigms has been investigated, but a comparison study on motor recovery after voluntary, involuntary, and forced exercises is limited. The current study used a rat brain ischemia model to investigate the effects of voluntary wheel running, involuntary muscle movement caused by functional electrical stimulation (FES), and forced treadmill exercise on motor recovery and brain BDNF changes. The results showed that voluntary exercise is the most effective intervention in upregulating the hippocampal BDNF level, and facilitating motor recovery after brain ischemia.

Short-term, moderate exercise is capable of inducing structural, BDNF-independent hippocampal plasticity

Exercise is known to improve cognitive functions and to induce neuroprotection. In this study we used a short-term, moderate intensity treadmill exercise protocol to investigate the effects of exercise on usual markers of hippocampal synaptic and structural plasticity, such as synapsin I (SYN), synaptophysin (SYP), neurofilaments (NF), microtubule-associated protein 2 (MAP2), glutamate receptor subunits GluR1 and GluR2/3, brain-derived neurotrophic factor (BDNF) and glial fibrillary acidic protein (GFAP). Immunohistochemistry, Western blotting and real-time PCR were used. We also evaluated the number of cells positive for the proliferation marker 5-bromo-2-deoxyuridine (BrdU), the neurogenesis marker doublecortin (DCX) and the plasma corticosterone levels. Adult male Wistar rats were adapted to a treadmill and divided into 4 groups: sedentary (SED), 3-day exercise (EX3), 7-day exercise (EX7) and 15-day exercise (EX15). The protein changes detected were increased levels of NF68 and MAP2 at EX3, of SYN at EX7 and of GFAP at EX15, accompanied by a decreased level of GluR1 at EX3. Immunohistochemical findings revealed a similar pattern of changes. The real-time PCR analysis disclosed only an increase of MAP2 mRNA at EX7. We also observed an increased number of BrdU-positive cells and DCX-positive cells in the subgranular zone of the dentate gyrus at all time points and increased corticosterone levels at EX3 and EX7. These results reveal a positive effect of short-term, moderate treadmill exercise on hippocampal plasticity. This effect was in general independent of transcriptional processes and of BDNF upregulation, and occurred even in the presence of increased corticosterone levels.

Effects of treadmill exercise on the expression of netrin-1 and its receptors in rat brain after cerebral ischemia

Recent evidence suggests that exercise improves functional outcome in animal models of cerebral ischemia. Since netrin-1 and its receptors, deleted in colorectal cancer (DCC) and uncoordinated gene 5B (Unc5B), act as important regulators in neural and vascular activities, we sought to determine whether netrin-1 and DCC and Unc5B are involved in the neuroprotective effects of exercise on rats with induced cerebral ischemia. A total of 108 rats were randomly distributed into three groups: sham-operated group (n = 12), middle cerebral artery occlusion (MCAO) group (n = 48), MCAO+treadmill exercise group (n = 48). Behavioral testing indicated that treadmill exercise could significantly improve neurologic deficits of rats with cerebral ischemia at day 14 and 28 after MCAO (n = 12, P<0.05 and P<0.01), but there was no significant difference at day 4 and 7. Quantitative reverse transcription polymerase chain reaction (qPCR) and Western blot analysis revealed that treadmill exercise enhanced netrin-1 and DCC expression, while it suppressed Unc5B expression in rat peri-ischemic brain area, especially at day 14 and 28 after MCAO (n = 4, P<0.05 or P<0.01). Immunofluorescence analysis showed that in the peri-ischemic area, netrin-1 was expressed in neuronal perikarya, DCC, however, was expressed in neural processes and peri-vascular astrocytes, while Unc5B was expressed mostly in neuronal perikarya and some processes. These results suggest that netrin-1 and its receptors DCC and Unc5B may engage in exercise-induced neural circuit remodeling in the peri-ischemic area, and exercise may promote survival of neurons in this area by regulating netrin-1-Unc5B signaling. Additionally, netrin-1 may also play a role in brain-blood barrier via DCC-immunoreactive peri-vascular astrocytes. In conclusion, we demonstrate that treadmill exercise has beneficial effects that may be attributed, at least in part, to the involvement of netrin-1 and its receptors DCC and Unc5B in the neuronal and vascular activities in brain-ischemic rats.

Effect of different exercise protocols on histone acetyltransferases and histone deacetylases activities in rat hippocampus

Regular and moderate exercise has been considered an interesting neuroprotective strategy. Although the mechanisms by which physical exercise alters brain function are not clear, it appears that neuroprotective properties of exercise could be related to chromatin remodeling, specifically the induction of histone acetylation through modulation of histone deacetylases (HDAC) and histone acetyltransferases (HAT) activities. The aim of the present work was to investigate the effect of exercise on HDAC and HAT activities in rat whole hippocampus at different times after treadmill. Adult male Wistar rats were assigned to non-exercised (sedentary) and exercised groups on different protocols: a single session of treadmill exercise (running for 20 min) and a chronic treadmill protocol (running once daily for 20 min, for 2 weeks). The effects of exercise on HDAC and HAT activities were measured immediately, 1 h and 18 h after the single session or the last training session of chronic treadmill exercise using specific assay kits. The single session of treadmill exercise reduced HDAC activity, increased HAT activity and increased the HAT/HDAC balance in rat hippocampus immediately and 1 h after exercise, an indicative of histone hyperacetylation status. The acetylation balance was also influenced by the circadian rhythm, since the HAT/HDAC ratio was significantly decreased in the early morning in all groups when compared to the afternoon. These data support the hypothesis that exercise neuroprotective effects may be related, at least in part, to acetylation levels through modulation of HAT and HDAC activities. We also demonstrated circadian changes in the HAT and HDAC activities and, consequently, in the acetylation levels.

The effects of voluntary, involuntary, and forced exercises on brain-derived neurotrophic factor and motor function recovery: a rat brain ischemia model

Background

Stroke rehabilitation with different exercise paradigms has been investigated, but which one is more effective in facilitating motor recovery and up-regulating brain neurotrophic factor (BDNF) after brain ischemia would be interesting to clinicians and patients. Voluntary exercise, forced exercise, and involuntary muscle movement caused by functional electrical stimulation (FES) have been individually demonstrated effective as stroke rehabilitation intervention. The aim of this study was to investigate the effects of these three common interventions on brain BDNF changes and motor recovery levels using a rat ischemic stroke model.

Methodology/Principal Findings

One hundred and seventeen Sprague-Dawley rats were randomly distributed into four groups: Control (Con), Voluntary exercise of wheel running (V-Ex), Forced exercise of treadmill running (F-Ex), and Involuntary exercise of FES (I-Ex) with implanted electrodes placed in two hind limb muscles on the affected side to mimic gait-like walking pattern during stimulation. Ischemic stroke was induced in all rats with the middle cerebral artery occlusion/reperfusion model and fifty-seven rats had motor deficits after stroke. Twenty-four hours after reperfusion, rats were arranged to their intervention programs. De Ryck's behavioral test was conducted daily during the 7-day intervention as an evaluation tool of motor recovery. Serum corticosterone concentration and BDNF levels in the hippocampus, striatum, and cortex were measured after the rats were sacrificed. V-Ex had significantly better motor recovery in the behavioral test. V-Ex also had significantly higher hippocampal BDNF concentration than F-Ex and Con. F-Ex had significantly higher serum corticosterone level than other groups.

Conclusion/Significance

Voluntary exercise is the most effective intervention in upregulating the hippocampal BDNF level, and facilitating motor recovery. Rats that exercised voluntarily also showed less corticosterone stress response than other groups. The results also suggested that the forced exercise group was the least preferred intervention with high stress, low brain BDNF levels and less motor recovery.

Muscle activation changes during body weight support treadmill training after focal cortical ischemia: A rat hindlimb model

The study used a focal ischemia rat hindlimb model to investigate muscle activity changes during a 10-day body weight support (BWS) treadmill training program. The changes being studied included fatigue effects, EMG burst duration in the gait cycle, and the symmetry of muscle activation between affected and unaffected sides. Intramuscular EMG of medial gastrocnemius (MG) and tibialis anterior (TA) muscles in male Sprague Dawley rats at affected side (n=10) and unaffected side (n=10) were recorded during the treadmill running before a middle cerebral artery occlusion/reperfusion (MCAo/r) surgery and poststroke recovery stage. Behavioral test score and bodyweight were recorded at a daily basis after stroke. The mean power frequency (MPF) of the EMG, EMG burst duration in the gait cycle, and symmetry index between two sides were used for analysis. The drop rate of MPF of MG at the unaffected side increased (P<0.05) at poststroke day 2 and it generally decreased along the poststroke training days and almost returned to baseline value at poststroke day 6. Symmetry index of MG and TA showed a large imbalance right after stroke and tended to return to normal. Our findings of the MPF drop after stroke might indicate fatigue effects due to the compensation loading share of the ipsilateral side muscle and the increase of the symmetry index reflects abnormal gait pattern after the onset of stroke. The recovery rate after stroke could be investigated with EMG parameters together with the behavioral score, and both were improved during and after the BWS treadmill training.

Exercise-induced plasticity of AMPA-type glutamate receptor subunits in the rat brain

The aim of this study was to analyze the plastic effects of moderate exercise upon the motor cortex (M1 and M2 areas), cerebellum (Cb), and striatum (CPu) of the rat brain. This assessment was made by verifying the expression of AMPA-type glutamate receptor subunits (GluR1 and GluR2/3). We used adult Wistar rats, divided into 5 groups based on duration of exercise training, namely 3 days (EX3), 7 days (EX7), 15 days (EX15), 30 days (EX30), and sedentary (S). The exercised animals were subjected to a treadmill exercise protocol at the speed of the 10 meters/min for 40 min. After exercise, the brains were subjected to immunohistochemistry and immunoblotting to analyze changes of GluR1 and GluR2/3, and plasma corticosterone was measured by ELISA in order to verify potential stress induced by physical training. Overall, the results of immunohistochemistry and immunoblotting were similar and revealed that GluR subunits show distinct responses over the exercise periods and for the different structures analyzed. In general, there was increased expression of GluR subunits after longer exercise periods (such as EX30), although some opposite effects were seen after short periods of exercise (EX3). In a few cases, biphasic patterns with decreases and subsequent increases of GluR expression were seen and may represent the outcome of exercise-dependent, complex regulatory processes. The data show that the protocol used was able to promote plastic GluR changes during exercise, suggesting a specific involvement of these receptors in exercise-induced plasticity processes in the brain areas tested.

Evaluation of cerebral blood flow changes in focal cerebral ischemia rats by using transcranial Doppler ultrasonography

Ischemic stroke is typically characterized by the disruption of cerebral blood flow. This study aimed to consecutively evaluate the cerebral blood flow changes in a focal ischemia rat model during the occlusion-reperfusion procedure and along the recovery stage after stroke. In 12 Sprague Dawley (SD) rats, a middle cerebral artery occlusion/reperfusion (MCAo/r) surgery was conducted, which combines a permanent occlusion of the right common carotid artery (CCA), external carotid artery (ECA) and a transient occlusion of the right internal carotid artery (ICA) and middle cerebral artery (MCA) with a monofilament introduced from the proximal ICA towards the distal right ICA then removed after 90 min. Blood flow velocity (BFV) from the concerned arteries were measured using ultrasonography (13-4 MHz) at the basal stage before the surgery, after the reperfusion stage and during the post-stroke status. At reperfusion stage and after, BFV increased significantly in the left ICA and in the basilar artery (BA) (starting from post-24 h, p < 0.05 vs. basal). Moreover, BFV were reversed in the distal right ICA and reflow was recorded in the right MCA. Time-average maximum BFV in the right MCA at reperfusion and post-stroke 24-96 h was decreased significantly (p < 0.05 vs. basal). The reversed flow in the right ICA was enabled by the settlement of the collateral supply through the circle of Willis which consisted in higher BFV in the opposite ICA and in the BA still 24 h, although the proximal right ICA remain occluded. Ultrasound measurement of BFV helps to provide information on the redistribution of the blood flow supply after the onset of stroke.

Muscle activation improvement during treadmill training at ischemia rat

This study is aimed to investigate the muscle activity changes, including fatigue effects and the symmetry of muscle activation between affected and unaffected sides during a 10-day body weight support treadmill training program using a focal ischemia rat hindlimb model. Our findings of the MPF drop after stroke might indicate fatigue effects due to the compensation loading share of the ipsilateral side muscle during locomotion and the increase of the symmetry index reflects abnormal coactivation synergies after the onset of stroke. The EMG parameters could provide information on the muscle activation pattern and fatigue. The recovery rate after stroke could be investigated with EMG parameters together with the behavioral score, and both were improved during and after the treadmill training.

Cortical effect and functional recovery by the electromyography-triggered neuromuscular stimulation in chronic stroke patients

We investigated the effect of electromyography (EMG)-triggered neuromuscular electrical stimulation (NMES; EMG-stim) on functional recovery of the hemiparetic hand and the related cortical activation pattern in chronic stroke patients. We enrolled 14 stroke patients, who were randomly assigned to the EMG-stim (n=7) or the control groups (n=7). The EMG-stim was applied to the wrist extensor of the EMG-stim group for two sessions (30 min/session) a day, five times per week for 10 weeks. Four functional tests (box and block, strength, the accuracy index, and the on/offset time of muscle contraction) and functional MRI (fMRI) were performed before and after treatment. fMRI was measured at 1.5 T in parallel with timed finger flexion-extension movements at a fixed rate. Following treatment, the EMG-stim group showed a significant improvement in all functional tests. The main cortical activation change with such functional improvement was shifted from the ipsilateral sensorimotor cortex (SMC) to the contralateral SMC. We demonstrated that 10-week EMG-stim can induce functional recovery and change of cortical activation pattern in the hemiparetic hand of chronic stroke patients.

Nitric oxide signaling participates in norepinephrine-induced activity of neuronal intracellular survival pathways

Much evidence has gathered that nitric oxide (NO) signaling, via cGMP-dependent mechanisms, may activate pro-survival pathways in hippocampal neurons and inhibit apoptosis. Past research has revealed that the enhancement of monoaminergic neurotransmission via exercise or treatment with antidepressant medications leads to an enhanced expression of brain-derived neurotrophic factor (BDNF). In isolated hippocampal neurons, norepinephrine (NE) application also increases the immunoreactivity of BDNF and several pro-survival signaling molecules. The data herein support the possibility that NO signaling plays an important role in enhancing neurotrophin expression and activation of the pro-survival phosphatidylinositol 3' kinase (PI-3K) pathway stimulated by NE. In isolated hippocampal neurons, the NO donor, sodium nitroprusside, increases BDNF, PI-3K, and phospho-ERK1 immunoreactivity. Specific inhibitors of the NO system suggest that NE-induced increases in hippocampal BDNF and the PI-3K pathway, but not stimulation of the MAPK pathway, depend upon NO signaling. In addition, inhibiting cGMP suggest that the effects of NE on BDNF immunoreactivity and Akt phosphorylation are also cGMP-dependent. Finally, the application of l-NAME to hippocampal neurons increases cell death. This is the first study of its kind demonstrating the involvement of NE-induced pro-survival signaling in three distinct signaling pathways: PI-3K, MAPK, and NO/cGMP. Possible mechanisms are discussed in light of the results.