Remote ischemic conditioning mitigates diffuse traumatic brain injury via specialized pro-resolving mediators

Research project


Project Summary Awkward body positions lead to an arm or leg ?falling asleep.? Upon repositioning, blood rushes back into thelimb, with nerves spontaneously regaining function after being deprived of oxygen and electrolytes. While asleep,cellular and molecular processes within the ischemic limb may produce bioactive restorative and regenerativecompounds that are released intravenously upon reperfusion. The method of intentional, intermittent restrictionof blood flow to a limb is called Remote Ischemic Conditioning (RIC), which can be achieved by simple and cost-effective application of a tourniquet to a limb for several cycles of pre-determined duration. RIC can protect thebrain and other organs from ischemic, surgical, and traumatic events, whether administered prior to or followingthe event. In fact, our team has demonstrated that RIC reduced biomarkers of acute damage in traumatic braininjury (TBI) patients. In pre-clinical cardiac arrest and cerebral ischemia, RIC preserves histopathology andimproves functional outcome, using either pre-injury or post-injury RIC. To date, the mechanisms underlying RICefficacy are unknown, with a dozen conflicting mechanisms proposed. TBI and other acquired neurologicalinjuries share secondary injury processes, including inflammation and oxidative stress, which have beenrepeated targets of neuroprotective strategies. We propose a class of endogenous lipids derived from fatty acids,called Specialized Pro-Resolving Mediators (SPMs), as the molecular mechanism for RIC efficacy. SPMs,including the molecular families of resolvins, lipoxins, and protectins, are released from lipid bilayers afterischemia, actively resolve inflammation, and are neuroprotective in diffuse TBI, with the assumed biostability totravel in blood to the brain and the lipid structure for blood-brain barrier permeability. In this proposal, wehypothesize that RIC preserves neurological function following experimental diffuse TBI by producingSPMs, which mitigate injury-induced inflammation. To test the hypothesis, we apply RIC sequences to thehind limb of adult mice, first before and then after diffuse TBI induced by midline fluid percussion injury. Aim 1will evaluate the efficacy of RIC sequences on preserving neurological, cognitive, and affective function over a21 day time course post-injury. Aim 2, using the most effective sequence of RIC identified in Aim 1, willdemonstrate that RIC attenuates microglial activation as an index of inflammation and produces SPMs asmeasured in plasma by liquid chromatography-coupled tandem mass spectrometry and commercial ELISA.Results from these aims will identify the RIC sequence necessary to improve neurological outcome from diffuseTBI. Further, we explore the production of SPMs as the molecular mechanism that targets microglial activation.Direct evidence is necessary to support the efficacy of RIC as a therapeutic approach to treat the estimated 1.7million TBIs that occur in the United States. Ultimately, RIC could serve as a cost-effective and feasible therapyfor delivering endogenous restorative and reparative compounds, such as SPMs, to improve outcome from TBI.
Effective start/end date8/15/167/31/18


  • National Institutes of Health: $252,572.00


Diffuse Brain Injury
Conditioning (Psychology)
Traumatic Brain Injury
Wounds and Injuries
Costs and Cost Analysis
CD59 Antigens
Lipid Bilayers
Tandem Mass Spectrometry
Heart Arrest
Brain Ischemia
Blood-Brain Barrier
Liquid Chromatography