Xuesaitong May Protect Against Ischemic Stroke by Modulating Microglial Phenotypes and Inhibiting Neuronal Cell Apoptosis via the STAT3 Signaling Pathway

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Abstract

Background: Xuesaitong mainly comprises Panax notoginseng saponins and has shown a promising feature in an acute ischemic stroke model; however, its effect on long-term recovery following stroke, and the related mechanisms, are unknown.

Methods: The objective of this study was to investigate the long-term protective effects of xuesaitong against ischemic stroke and its effect on microglial polarization. Experimental cerebral ischemia was induced by middle cerebral artery occlusion (MCAO) for 45 min, and C57BL/6 mice were immediately injected with xuesaitong or vehicle through the caudal vein at the onset of cerebral reperfusion consecutively for 14 days. The animals were randomly divided into three groups: a sham-operated group, vehicle-treated group and xuesaitong-treated group at a dose of 15μg/g. Subsequently, 2,3,5-triphenyltetrazolium chloride staining was used to assess infarct volume, and adhesive removal tests and balance beam tests were used to evaluate neurological deficits at days 1, 3, 7 and 14 following ischemia. Reverse-transcriptase polymerase chain reaction and immunofluorescence staining for M1 markers (CD16, iNOS) and M2 markers (CD206, arginase-1) were performed to characterize phenotypic changes in microglia. Elisa was used to determine the release of pro-inflammatory and anti-inflammatory cytokines. TUNEL staining was conducted to detect neuronal cell apoptosis, and western blots were used to determine the activation of signal transducer and activator of transcription 3 (STAT3).

Results: Our results revealed that xuesaitong treatment, compared with vehicle treatment, significantly reduced cerebral infarct volume 1 and 3 days after MCAO and resulted in significant improvements in long-term neurological outcomes. Furthermore, xuesaitong treatment, compared with vehicle treatment, significantly reduced M1 markers and elevated M2 markers 7 and 14 days after MCAO at both the mRNA and protein level in ipsilateral brain tissue. This finding was also accompanied by a reduction in neuronal cell apoptosis and p-STAT3 transcription factor levels in the xuesaitong-treated group compared with the vehicle-treated group.

Conclusion: We demonstrated that xuesaitong has long-term neuroprotective effects against ischemic stroke, possibly by promoting the polarization of microglia to an M2 phenotype and by inhibiting neuronal cell death via down-regulation of the STAT3 signaling pathway, providing new evidence that xuesaitong might be a promising therapeutic strategy for ischemic stroke.

Keywords: Xuesaitong, microglia, polarization, cerebral ischemia, STAT3, phenotype.

Graphical Abstract

[1]
Mendis S, Davis S, Norrving B. Organizational update: The world health organization global status report on noncommunicable diseases 2014; one more landmark step in the combat against stroke and vascular disease. Stroke 2015; 46(5): e121-2.
[2]
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the american heart Association/American Stroke Association. Stroke 2018; 49(3): e46-e110.
[3]
Zanier ER, Fumagalli S, Perego C, Pischiutta F, De Simoni MG. Shape descriptors of the “never resting” microglia in three different acute brain injury models in mice. Intensive Care Med Exp 2015; 3(1): 39.
[4]
Xia CY, Zhang S, Gao Y, Wang ZZ, Chen NH. Selective modulation of microglia polarization to M2 phenotype for stroke treatment. Int Immunopharmacol 2015; 25(2): 377-82.
[5]
Boche D, Perry VH, Nicoll JA. Review: Activation patterns of microglia and their identification in the human brain. Neuropathol Appl Neurobiol 2013; 39(1): 3-18.
[6]
Perry VH, Nicoll JA, Holmes C. Microglia in neurodegenerative disease. Nat Rev Neurol 2010; 6(4): 193-201.
[7]
Torres-Platas SG, Comeau S, Rachalski A, et al. Morphometric characterization of microglial phenotypes in human cerebral cortex. J Neuroinflammation 2014; 11: 12.
[8]
David S, Kroner A. Repertoire of microglial and macrophage responses after spinal cord injury. Nat Rev Neurosci 2011; 12(7): 388-99.
[9]
Liu Z, Ran Y, Huang S, et al. Curcumin protects against ischemic stroke by titrating microglia/macrophage polarization. Front Aging Neurosci 2017; 9: 233.
[10]
Jiang X, Pu H, Hu X, et al. A post-stroke therapeutic regimen with omega-3 polyunsaturated fatty acids that promotes white matter integrity and beneficial microglial responses after cerebral ischemia. Transl Stroke Res 2016; 7(6): 548-61.
[11]
Qin C, Fan WH, Liu Q, et al. Fingolimod protects against ischemic white matter damage by modulating microglia toward m2 polarization via STAT3 pathway. Stroke 2017; 48(12): 3336-46.
[12]
Zhou N, Tang Y, Keep RF, Ma X, Xiang J. Antioxidative effects of Panax notoginseng saponins in brain cells. Phytomedicine 2014; 21(10): 1189-95.
[13]
Shi X, Yu W, Liu L, et al. Panax notoginseng saponins administration modulates pro- /anti-inflammatory factor expression and improves neurologic outcome following permanent MCAO in rats. Metab Brain Dis 2017; 32(1): 221-33.
[14]
Li H, Deng CQ, Chen BY, Zhang SP, Liang Y, Luo XG. Total saponins of Panax notoginseng modulate the expression of caspases and attenuate apoptosis in rats following focal cerebral Ischemia-reperfusion. J Ethnopharmacol 2009; 121(3): 412-8.
[15]
Hong Q, Wang S, Chen CX, et al. [Effects of Xuesaitong injection on inflammation induced by OGD/reoxygenation in BV2 microglia]. Zhongguo Zhongyao Zazhi 2017; 42(1): 140-5.
[16]
Liu X, Liu J, Zhao S, et al. Interleukin-4 is essential for microglia/macrophage M2 polarization and long-term recovery after cerebral ischemia. Stroke 2016; 47(2): 498-504.
[17]
Wang J, Zhao H, Fan Z, et al. Long Noncoding RNA H19 promotes neuroinflammation in Ischemic stroke by driving histone deacetylase 1-dependent m1 microglial polarization. Stroke 2017; 48(8): 2211-21.
[18]
Shen F, Degos V, Chu PL, et al. Endoglin deficiency impairs stroke recovery. Stroke 2014; 45(7): 2101-6.
[19]
Wang R, Li J, Duan Y, Tao Z, Zhao H, Luo Y. Effects of Erythropoietin on Gliogenesis during Cerebral Ischemic/Reperfusion Recovery in Adult Mice. Aging Dis 2017; 8(4): 410-9.
[20]
Zhao H, Wang R, Tao Z, et al. Ischemic postconditioning relieves cerebral ischemia and reperfusion injury through activating T-LAK cell-originated protein kinase/protein kinase B pathway in rats. Stroke 2014; 45(8): 2417-24.
[21]
He W, Xu XJ. Attenuation of brain inflammatory response after focal cerebral ischemia/reperfusion with Xuesaitong injection in rats. Chin J Integr Med 2006; 12(3): 203-6.
[22]
Ritzel RM, Patel AR, Grenier JM, et al. Functional differences between microglia and monocytes after ischemic stroke. J Neuroinflammation 2015; 12: 106.
[23]
Hu X, Leak RK, Shi Y, et al. Microglial and macrophage polarization-new prospects for brain repair. Nat Rev Neurol 2015; 11(1): 56-64.
[24]
Loane DJ, Byrnes KR. Role of microglia in neurotrauma. Neurotherapeutics 2010; 7(4): 366-77.
[25]
Qin H, Yeh WI, De Sarno P, et al. Signal transducer and activator of transcription-3/suppressor of cytokine signaling-3 (STAT3/ SOCS3) axis in myeloid cells regulates neuroinflammation. Proc Natl Acad Sci USA 2012; 109(13): 5004-9.
[26]
Wang L, Yu Y, Yang J, Zhao X, Li Z. Dissecting Xuesaitong’s mechanisms on preventing stroke based on the microarray and connectivity map. Mol Biosyst 2015; 11(11): 3033-9.
[27]
Wang G, Zhang J, Hu X, et al. Microglia/macrophage polarization dynamics in white matter after traumatic brain injury. J Cereb Blood Flow Metab 2013; 33(12): 1864-74.
[28]
Han L, Cai W, Mao L, et al. Rosiglitazone promotes white matter integrity and long-term functional recovery after focal cerebral ischemia. Stroke 2015; 46(9): 2628-36.
[29]
Zhang X, Wu J, Zhang B. Xuesaitong injection as one adjuvant treatment of acute cerebral infarction: a systematic review and meta-analysis. BMC Complement Altern Med 2015; 15: 36.
[30]
Ke L, Guo W, Xu J, Zhang G, Wang W, Huang W. Ginsenoside Rb1 attenuates activated microglia-induced neuronal damage. Neural Regen Res 2014; 9(3): 252-9.
[31]
Hu W, Lv J, Han M, et al. STAT3: The art of multi-tasking of metabolic and immune functions in obesity. Prog Lipid Res 2018; 70: 17-28.
[32]
Xin H, Wang M, Tang W, et al. Hydrogen sulfide attenuates inflammatory hepcidin by reducing il-6 secretion and promoting sirt1-mediated STAT3 deacetylation. Antioxid Redox Signal 2016; 24(2): 70-83.
[33]
Zhang Y, Liu J, Yang B, et al. Ginkgo biloba extract inhibits astrocytic lipocalin-2 expression and alleviates neuroinflammatory injury via the JAK2/STAT3 pathway after ischemic brain stroke. Front Pharmacol 2018; 9: 518.
[34]
Wang XL, Qiao CM, Liu JO, Li CY. Inhibition of the SOCS1-JAK2-STAT3 signaling pathway confers neuroprotection in rats with ischemic stroke. Cell Physiol Biochem 2017; 44(1): 85-98.
[35]
Meng HL, Li XX, Chen YT, et al. Neuronal soluble fas ligand drives m1-microglia polarization after cerebral ischemia. CNS Neurosci Ther 2016; 22(9): 771-81.