White Matter Protection in Cerebral Ischemia

描述（由申请人提供）：脑白质对脑缺血非常脆弱，脑白质损伤（WMI）是脑卒中中功能性残疾的主要原因，是美国第三大死亡原因和永久性残疾的主要原因。因此，针对WMI的干预措施可能会显著改善脑卒中后的生活质量，这是一个研究相对不足和理解不足的领域。烟酰胺磷酸核糖基转移酶（NAMPT）主要定位于细胞质中，是生物合成烟酰胺腺嘌呤二核苷酸（NAD）14的限速酶。NAMPT对脑缺血具有神经保护作用15,16。在非中枢系统中，NAMPT可在细胞外间隙（eNAMPT）中发现，并在血液中全身循环。中枢神经系统是否也有eNAMPT及其作用尚不清楚。在我们的前期研究中，我们首先检测到神经细胞将NAMPT分泌到细胞外空间，并且在缺血后，eNAMPT而不是其细胞内对应物（iNAMPT）被选择性地诱导，这意味着细胞外NAMPT可能在缺血中发挥作用。神经元特异性转基因小鼠缺血后，细胞外空间和白质中NAMPT水平升高。最重要的是，除了灰质保护外，我们发现NAMPT转基因过表达对缺血后的WMI有保护作用。这些发现使我们推测细胞外NAMPT可能介导缺血后的白质保护。与此一致，我们发现重组NAMPT蛋白可以保护少突胶质细胞免受氧葡萄糖剥夺（OGD）和AMPA毒性引起的缺血样损伤。更重要的是，我们发现外源性给药的NAMPT蛋白可以穿过血脑屏障，在体内保护缺血性WMI。进一步研究发现，重组NAMPT蛋白对缺血诱导的少突胶质细胞及其祖细胞（OPCs）细胞死亡具有保护作用，并促进OPCs向成熟少突胶质细胞的分化。这些发现表明NAMPT可能通过抑制少突胶质细胞死亡和促进OPCs成熟来直接预防WMI。我们发现NAMPT还能增强小胶质细胞髓磷脂的吞噬。这一点很重要，因为受损的髓磷脂被认为会抑制OPCs的成熟，并在许多病理条件下导致脱髓鞘。因此，NAMPT可能通过调节小胶质髓鞘吞噬作用间接促进少突胶质形成。本项目旨在进一步检测NAMPT对脑缺血后脑白质的保护作用及其机制，为脑缺血后脑白质保护提供一种新的、具有临床意义的治疗途径。待验证的中心假设是NAMPT通过增强少突胶质细胞保护/再生和小胶质细胞介导的髓磷脂吞噬来预防WMI。本研究提出以下具体目的：目的1：验证全身给药NAMPT蛋白对局灶性脑缺血所致WMI的保护作用。本研究将检验NAMPT在治疗局灶性脑缺血所致脑损伤中的潜在翻译价值。通过小鼠腹腔注射NAMPT重组蛋白，定量评价NAMPT对缺血性脑损伤的影响。评估终点包括梗死面积、WMI和神经学预后。目的2：验证NAMPT通过抑制脑缺血后少突胶质细胞死亡和促进少突胶质细胞形成来预防脑缺血的假设。该研究将测试全身给药NAMPT蛋白是否能减少局灶性缺血后少突胶质细胞死亡。我们还将测试NAMPT是否刺激缺血后少突胶质细胞的再生。目的3：验证NAMPT通过增强小胶质髓鞘吞噬来保护WMI的假设。两种方法将用于提高NAMPT水平：系统给药NAMPT蛋白和通过小胶质/巨噬细胞特异性F4/80启动子驱动的AAV9载体靶向小胶质靶向NAMPT过表达。NAMPT对缺血后小胶质髓鞘吞噬、少突胶质形成、WMI和功能结局的影响将被评估。小灵通398/2590 （Rev. 06/09）页延续格式页

DESCRIPTION (provided by applicant): Cerebral white matter is highly vulnerable to cerebral ischemia13 and white matter injury (WMI) is a major cause of functional disability in stroke, the nation's third leading cause of death and the leading cause of permanent disability. Thus, interventions targeted at WMI, an area that remains relatively understudied and poorly understood, may significantly improve post-stroke quality of life. Nicotinamide phosphoribosyltransferase (NAMPT) primarily localizes in the cytosol and functions as the rate-limiting enzyme for the biosynthesis of nicotinamide adenine dinucleotide (NAD)14. NAMPT is neuroprotective against cerebral ischemia15,16. In non-CNS systems, NAMPT can be found in the extracellular space (eNAMPT) and circulates systemically in the blood. Whether the CNS also has eNAMPT and the role of this eNAMPT remains unknown. In our pilot studies, we first detected that neural cells secrete NAMPT into the extracellular space and that eNAMPT, but not its intracellular counterpart (iNAMPT), is selectively induced after ischemia, implying that extracellular NAMPT may play a role in ischemia. Increased NAMPT levels are present in the extracellular space and in white matter after ischemia in neuron-specific transgenic mice. Most importantly, in addition to gray matter protection, we found that NAMPT transgenic overexpression protects against WMI after ischemia. These findings lead us to speculate that extracellular NAMPT may mediate white matter protection after ischemia. In line with this, we found that recombinant NAMPT protein protects oligodendrocytes against ischemia-like injury induced by oxygen glucose deprivation (OGD) and AMPA toxicity. More importantly, we found that exogenously administered NAMPT protein can cross the blood brain barrier and protect against ischemic WMI in vivo. Further studies found that recombinant NAMPT protein protects against cell death of oligodendrocytes and its progenitor cells (OPCs) induced by ischemia, and enhances the differentiation of OPCs into mature oligodendrocytes. These findings suggest that NAMPT may directly protect against WMI via inhibiting oligodendrocyte death and enhancing the maturation of OPCs. We found that NAMPT also enhances microglial myelin phagocytosis. This is important because damaged myelin is believed to suppress the maturation of OPCs and cause demyelination in many pathological conditions. Thus NAMPT may indirectly enhance oligodendrogenesis via modulating microglial myelin phagocytosis. The objective of this project is to further test the white matter protective effect of NAMPT and its underlying mechanisms, and to develop a novel and clinically relevant therapeutic approach for white matter protection after cerebral ischemia. The central hypothesis to be tested is that NAMPT protects against WMI via enhancing oligodendrocytic protection/ regeneration and microglia-mediated myelin phagocytosis. Focal ischemia will be induced in mice by middle cerebral artery occlusion (MCAO) The following Specific Aims are proposed: Aim 1: Test the hypothesis that systemic administration of NAMPT protein protects against WMI induced by focal ischemia. The proposed study will test the potential translational value of NAMPT in treating WMI induced by focal cerebral ischemia. NAMPT recombinant protein will be administrated intraperitoneally to mice and the effect of NAMPT on ischemic brain injury will be quantitatively evaluated. The endpoints for assessment include infarct volume, WMI, and neurological outcomes. Aim 2: Test the hypothesis that NAMPT protects against WMI by inhibiting oligodendrocytic death and enhancing oligodendrogenesis after cerebral ischemia. The proposed study will test whether systemic administration of NAMPT protein reduces oligodendrocyte death after focal ischemia. We will also test whether NAMPT stimulates the regeneration of oligodendrocytes after ischemia. Aim 3: Test the hypothesis that NAMPT protects against WMI by enhancing microglial myelin phagocytosis. Two approaches will be used to elevate NAMPT levels: systemic administration of NAMPT protein and microglia-targeted NAMPT overexpression via an AAV9 vector driven by microglia/macrophage specific F4/80 promoter. The effect of NAMPT on microglial myelin phagocytosis, oligodendrogenesis, WMI, and functional outcomes after ischemia will be evaluated. PHS 398/2590 (Rev. 06/09) Page Continuation Format Page