Department of Radiology (K.S., P.F., T.T., T.Q., C.A.), Massachusetts General Hospital, Harvard Medical School, Boston.
Department of Neurosurgery, Yamaguchi University School of Medicine, Japan (K.S.).
Stroke. 2024 Oct;55(10):2502-2509. doi: 10.1161/STROKEAHA.124.048032. Epub 2024 Sep 5.
Functional activation of the focal ischemic brain has been reported to improve outcomes by augmenting collateral blood flow. However, functional activation also increases metabolic demand and might thereby worsen outcomes. Indeed, preclinical and clinical reports have been conflicting. Here, we tested the effect of functional activation during acute ischemic stroke using distal middle cerebral artery occlusion in anesthetized mice.
Using transgenic mice expressing channelrhodopsin-2 in neurons, we delivered functional activation using physiological levels of transcranial optogenetic stimulation of the moderately ischemic cortex (ie, penumbra), identified using real-time full-field laser speckle perfusion imaging during a 1-hour distal microvascular clip of the middle cerebral artery. Neuronal activation was confirmed using evoked field potentials, and infarct volumes were measured in tissue slices 48 hours later.
Optogenetic stimulation of the penumbra was associated with more than 2-fold larger infarcts than stimulation of the contralateral homotopic region and the sham stimulation group (n=10, 7, and 9; 11.0±5.6 versus 5.1±4.3 versus 4.1±3.7 mm; =0.008, 1-way ANOVA). Identical stimulation in wild-type mice that do not express channelrhodopsin-2 did not have an effect. Optogenetic stimulation was associated with a small increase in penumbral perfusion that did not explain enlarged infarcts.
Our data suggest that increased neuronal activity during acute focal arterial occlusions can be detrimental, presumably due to increased metabolic demand, and may have implications for the clinical management of hyperacute stroke patients.
已有研究报道,通过增加侧支血流,对局部缺血性大脑进行功能激活可改善预后。然而,功能激活也会增加代谢需求,从而可能使结果恶化。事实上,临床前和临床报告存在矛盾。在此,我们使用麻醉小鼠的大脑中动脉远端闭塞模型,检测了急性缺血性卒中期间的功能激活对预后的影响。
使用在神经元中表达通道视紫红质-2 的转基因小鼠,我们通过实时全视野激光散斑灌注成像,在大脑中动脉的 1 小时远端微血管夹闭期间,对中度缺血皮质(即半影区)进行生理水平的经颅光遗传学刺激,以实现功能激活。使用诱发场电位确认神经元激活,在 48 小时后在组织切片上测量梗死体积。
与对侧同源区和假刺激组相比,光遗传学刺激半影区导致的梗死体积增加了 2 倍以上(n=10、7 和 9;11.0±5.6 比 5.1±4.3 比 4.1±3.7mm;=0.008,单因素方差分析)。在不表达通道视紫红质-2 的野生型小鼠中进行相同的刺激没有效果。光遗传学刺激与半影区灌注的轻微增加相关,但不能解释梗死体积的增大。
我们的数据表明,在急性局灶性动脉闭塞期间增加神经元活动可能有害,推测是由于代谢需求增加所致,这可能对超急性卒中患者的临床管理产生影响。