Abstract

Perinatal asphyxia represents one of the major causes of neonatal morbidity and mortality. Hypothermia is currently the only established treatment for hypoxic-ischemic encephalopathy (HIE), but additional pharmacological strategies are being explored to further reduce the damage after perinatal asphyxia. The aim of this study was to evaluate whether 2-iminobiotin (2-IB) superimposed on hypothermia has the potential to attenuate hypoxia-induced injury of neuronal cells. In vitro hypoxia was induced for 7 h in neuronal IMR-32 cell cultures. Afterwards, all cultures were subjected to 25 h of hypothermia (33.5°C), and incubated with vehicle or 2-IB (10, 30, 50, 100, and 300 ng/ml). Cell morphology was evaluated by brightfield microscopy. Cell damage was analyzed by LDH assays. Production of reactive oxygen species (ROS) was measured using fluorometric assays. Western blotting for PARP, Caspase-3, and the phosphorylated forms of akt and erk1/2 was conducted. To evaluate early apoptotic events and signaling, cell protein was isolated 4 h post-hypoxia and human apoptosis proteome profiler arrays were performed. Twenty-five hour after the hypoxic insult, clear morphological signs of cell damage were visible and significant LDH release as well as ROS production were observed even under hypothermic conditions. Post-hypoxic application of 2-IB (10 and 30 ng/ml) reduced the hypoxia-induced LDH release but not ROS production. Phosphorylation of erk1/2 was significantly increased after hypoxia, while phosphorylation of akt, protein expression of Caspase-3 and cleavage of PARP were only slightly increased. Addition of 2-IB did not affect any of the investigated proteins. Apoptosis proteome profiler arrays performed with cellular protein obtained 4 h after hypoxia revealed that post-hypoxic application of 2-IB resulted in a ≥ 25% down regulation of 10/35 apoptosis-related proteins: Bad, Bax, Bcl-2, cleaved Caspase-3, TRAILR1, TRAILR2, PON2, p21, p27, and phospho Rad17. In summary, addition of 2-IB during hypothermia is able to attenuate hypoxia-induced neuronal cell damage in vitro. Combination treatment of hypothermia with 2-IB could be a promising strategy to reduce hypoxia-induced neuronal cell damage and should be considered in further animal and clinical studies.

Highlights

  • Hypoxic-ischemic encephalopathy (HIE) is a major reason for neonatal death and long-term disabilities

  • We have demonstrated that 2-IB, when administered after hypoxia-ischemia is able to reduce neuronal cell damage in an in vitro neuronal cell model of hypoxia-ischemia during normothermia (Zitta et al, 2016)

  • About 45% of infants continue to have an adverse outcome despite this treatment (Bel, 2016) and adjunct therapies on top of hypothermia are urgently needed to reduce the harmful effects of hypoxic-ischemic encephalopathy (HIE)

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Summary

Introduction

Hypoxic-ischemic encephalopathy (HIE) is a major reason for neonatal death and long-term disabilities. It is the second largest cause of the neonatal global burden of disease and accounts for 2.0% of total disability-adjusted life years After years of research on cooling, therapeutic hypothermia (33.5◦C) became as currently standard of care for newborn infants presenting HIE (Higgins et al, 2011). About 45% of infants still continue to have an adverse outcome despite this treatment (Bel, 2016). It is a major challenge to develop adjunct therapies on top of hypothermia that will help to reduce the adverse effects of HIE (Martinello et al, 2017)

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