目的：目前认为神经细胞凋亡在新生儿缺氧缺血性脑病(hypoxicischemicencephalopathy,HIE)的病理过程中起重要作用,细胞色素C(CytC)是重要的促凋亡蛋白因子之一。近年研究发现,肌苷对成年大鼠脑缺血损伤有保护作用,肌苷可降低CytCmRNA的表达从而抑制神经细胞凋亡。本实验通过观察肌苷对新生大鼠缺氧缺血性脑损伤(HIBD)后神经细胞凋亡和细胞色素C基因表达的影响,以初步探讨肌苷对HIBD新生大鼠脑保护作用和可能的机制。方法：健康7日龄SD大鼠140只被随机分为3组:正常对照组(n=40),肌苷治疗组(n=50)和HIBD组(n=50),其中肌苷治疗组和HIBD组分别再随机分为缺氧缺血(HI)后6h,12h,1d,3d,7d5个亚组(各亚组n=10)。通过分离、结扎左颈总动脉和8%低氧暴露制备HIBD动物模型。正常对照组不进行缺氧缺血处理,按肌苷治疗组和HIBD组各相同时间点随机分为5个亚组(各亚组n=8)。肌苷治疗组于模型制备后即刻开始腹腔注射肌苷注射液100mg/kg,每天2次,连续7d。以TUNEL法检测神经元凋亡情况,原位杂交技术测定CytCmRNA表达情况。结果：正常对照组皮质区和海马区可见少许凋亡细胞和CytC阳性细胞,HI后6hHIBD组皮质区和CA1区凋亡细胞和CytC阳性细胞即见增多,于HI后1d达高峰,之后逐渐下降,HI后7d凋亡细胞和CytC阳性细胞数仍明显高于正常对照组,各时间点与正常对照组相比较,差异有显著性意义(P0.05)。经肌苷治疗后凋亡细胞数和神经细胞CytCmRNA表达均减少,各时间点与HIBD组相应时间点比较,差异有显著性意义(P0.05)。直线相关分析显示HIBD后,凋亡细胞数与CytCmRNA表达呈显著正相关(r=0.88,P0.01)。结论：HI损伤后给予肌苷干预能减少HI导致的神经细胞凋亡,下调CytCmRNA表达。肌苷治疗后,新生HIBD大鼠的凋亡细胞数减少与CytCmRNA表达下调呈显著正相关,提示肌苷可能通过抑制CytCmRNA表达从而起到减少细胞凋亡、保护神经元的作用。

OBJECTIVE: It has been reported that neuronal apoptosis plays a critical role in pathology of hypoxic-ischemic encephalopathy (HIE). Cytochrome C (CytC) is an important apoptotic protease activating factor. Inosine might have a neuroprotective effect against cerebral ischemia reperfusion injury by inhibiting the neuronal apoptosis and the expression of CytC mRNA in adult rats. This study examined the effects of inosine on neuronal apoptosis and CytC mRNA expression following hypoxic-ischemic brain damage (HIBD) in order to investigate the neuroprotectivity of inosine against cerebral ischemia injury in neonatal rats and the possible mechanism. METHODS: A total of 140 healthy 7-day-old Sprague-Dawley rat pups were randomly assigned into Control (n=40), HIBD (n=50) and Inosine treatment groups (n=50). HIBD rat models were established by ligating the left common carotid artery, followed by 8%O_2 hypoxia exposure for 2 hrs in the HIBD and Inosine treatment groups. The Control group was not subjected to hypoxia-ischemia (HI). The Inosine treatment and the HIBD groups were randomly divided into 5 sub-groups sacrificed at 6 and 12 hrs, and 1, 3 and 7 days post- HI (n=10 each). The Control group rats were sacrificed at the corresponding time points (n=8 each). Inosine was administered to the Inosine treatment group by intraperitoneal injection immediately after HIBD at the dosage of 100 mg/kg twice daily for 7 days. TUNEL staining and in situ hybridization method was used to detect neuronal apoptosis and CytC mRNA expression respectively. RESULTS: Few apoptotic cells and CytC mRNA positive cells were found in brain tissues of the Control group. In the HIBD group, the number of apoptotic cells and the CytC mRNA expression in the cortical and hippocampal gyrum CA1 areas increased 6 hrs after HI, peaking at 1 day after HI and then decreased gradually. Until the 7th day, the number of apoptotic cells and the CytC mRNA expression in the cortical and hippocampal gyrum CA1 areas in the HIBD group remained significantly higher than in the Control group. Inosine treatment decreased the apoptotic cells and the CytC mRNA expression in both areas from 6 hrs to 7 days after HI compared with the HIBD group. The linear correlation analysis demonstrated that the number of apoptotic cells was positively correlated to the CytC mRNA expression in neonatal rats with HIBD (r=0.88, P﹤0.01) . CONCLUSIONS: Inosine can reduce the number of apoptotic cells and down-regulate the expression of CytC mRNA following HIBD in neonatal rats. The decreased number of apoptotic cells was positively correlated to the decreased CytC mRNA expression after inosine treatment, suggesting that inosine offered neuroprotectivity against HIBD possibly through inhibiting the CytC mRNA expression and resulting in a decrease of cell apoptosis.