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The Journal of Neuroscience, July 15, 1998, 18(14):5112-5123
Neuroprotective Actions of Dipyridamole on Cultured CNS
Neurons
Stephen E.
Farinelli1,
Lloyd A.
Greene1, and
Wilma
J.
Friedman1, 2
1 Department of Pathology and Center for Neurobiology
and Behavior and 2 Taub Center for Alzheimer's Disease
Research, Columbia University, College of Physicians and Surgeons, New
York, New York 10032
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ABSTRACT |
We report that dipyridamole is neuroprotective for a variety of rat
embryonic CNS neurons cultured in serum-free basal medium lacking
trophic factors or other additives. We also describe the mechanism
underlying this action. Neurons died rapidly in basal medium but were
rescued in large measure by 10 µM dipyridamole. The
protective action of dipyridamole seems to be attributable to its
antioxidant property. Vitamin E and N-acetylcysteine
provided comparable neuroprotection in basal medium, whereas an array
of compounds that mimic other actions of dipyridamole (inhibition of
phosphodiesterases, blockade of nucleoside and chloride transport, interference with the multidrug resistance protein, and enhancement of
prostacyclin synthesis) failed to promote survival. Thus, a major cause
of neuronal death in this system seems to be oxidative stress that is
relieved by dipyridamole. Iron plays a significant role in generation
of such stress, as indicated by the observations that addition of
apotransferrin or iron chelators to basal medium or use of iron-free
medium also afforded protection. Although oxidative stress was a major
determinant of neuronal death, it was not the only factor. Dipyridamole
or other antioxidant measures did not provide sustained
neuroprotection. However, provision of insulin, which was not
protective alone in basal medium, along with dipyridamole significantly
enhanced long-term neuronal survival. Hence, optimal protection
requires both trophic support and relief from oxidative stress. These
findings lend credence to the potential use of dipyridamole or its
derivatives in prevention and/or treatment of CNS injuries and
degenerative disorders in which oxidative stress is a significant
component.
Key words:
dipyridamole; transferrin; iron; oxidative stress; neuronal death; trophic factors
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INTRODUCTION |
Survival of neurons is affected by
multiple variables including the presence of appropriate neurotrophic
agents, the supply of required nutrients, and protection from
potentially toxic conditions such as oxidative stress. One strategy to
identify both natural and synthetic products that are neuroprotective
is to culture neurons in a nonsupportive basal medium and to supplement
this with potential survival-promoting agents (Skaper et al., 1979 , 1982 ; Bottenstein et al., 1980 ; Huck, 1983 ). This approach has led to
the development of a widely used defined medium for culturing and
maintaining CNS neurons that consists of basal medium (often a 1:1
mixture of Ham's F12 medium and Minimal Essential Medium) supplemented
with insulin, transferrin, progesterone, selenium, and putrescine
(Bottenstein and Sato, 1979 ; Bottenstein et al., 1980 ; di Porzio et
al., 1980 ). The use of this and other defined basal media has permitted
the identification and study of a variety of neurotrophic and
neuroprotective agents (Barbin et al., 1984 ; Varon et al., 1984 ;
Friedman et al., 1993 ).
In addition to primary neurons, cell lines such as the rat
pheochromocytoma line PC12 have proved useful for evaluation of potential neuroprotective agents. Among the substances that have been
found to prevent death of PC12 cells in serum-free RPMI 1640 medium are
permeant derivatives of cAMP and cGMP (Rukenstein et al., 1991 ;
Farinelli et al., 1996a ). Moreover, nitric oxide (NO) generators and
natriuretic peptides promote PC12 cell survival under such conditions
by raising intracellular levels of cGMP (Farinelli et al., 1996a ,b ). We
noted that coaddition of the drug dipyridamole markedly potentiated and
prolonged the neuroprotective activity of NO and natriuretic peptides
on PC12 cells. Although dipyridamole has diverse pharmacological
targets, its actions in this case presumably were caused by its
capacity to inhibit phosphodiesterase-mediated hydrolysis of cGMP
(Thompson, 1991 ).
The potentiating actions of dipyridamole in serum-free PC12 cell
cultures led us to explore the potential survival-promoting actions of
this drug on CNS neurons. To do so, we used a system in which neurons
from various regions of embryonic rat brain were plated in
unsupplemented basal medium. In this report, we describe the
neuroprotective effects of dipyridamole on CNS neurons and delineate
the mechanism by which these occur.
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MATERIALS AND METHODS |
Materials. Minimal essential medium (MEM), catalog
#11095-080, and Ham's F12 nutrient mixture, catalog #11765-054, were
obtained from Gibco, and all tissue culture plastic ware was from
Becton Dickinson (Rutherford, NJ). All pharmacological and common
tissue culture reagents were obtained from Sigma (St. Louis, MO) with the following exceptions.
S-Nitroso-N-acetylpenicillamine (SNAP), diethylenetriamine nitric oxide adduct (DETA-NO), 7-nitroindazole, and
MK-801 were from Research Biochemicals (Natick, MA); milrinone and
trequinsin were from Calbiochem (La Jolla, CA);
8-(4-chlorophenylthio)-cAMP (8-CPT-cAMP) was from Boehringer Mannheim
(Indianapolis, IN); iloprost was generously provided by Dr. Stephen
Feinmark, Columbia University; and flavopiridol was graciously provided
by Dr. David Park, Columbia University. Timed-pregnant Sprague Dawley
rats were obtained from Zivic-Miller Labs or Taconic (Germantown, NY). Dipyridamole was made up in dimethylsulfoxide as a 20 mM
stock, protected from light, and stored frozen at 20°C until use
for up to 1 month. Cyanogen bromide-activated Sepharose was purchased from Sigma and was coupled to deferoxamine by the method of Feng et al.
(1992) . After coupling, the beads were washed extensively to remove
unbound deferoxamine.
Preparation of neuronal cultures. Primary neuronal cultures
from embryonic day 16 (E16) and E18 rats were prepared as described previously (Friedman et al., 1993 ) and maintained in serum-free conditions throughout the course of the investigations. After dissection, brain tissue was dissociated by mechanical trituration, and
the cells were resuspended in MEM. The cell suspension was diluted to
200,000 cells/ml and then plated in 24-well
poly-L-lysine-coated tissue culture dishes at a density of
100,000 cells per well in a final volume of 1 ml. The final
experimental culture conditions were arrived at by adding 0.5 ml of the
cell suspension in MEM to each well that contained 0.5 ml of tissue
culture medium (Ham's F12 or MEM) plus a twofold concentration of
serum-free supplements and/or pharmacological agents when indicated.
Thus, this 1:2 dilution resulted in the concentrations of agents
reported in the Results. The standard culture conditions that served as
the experimental control consisted of MEM/Ham's F12 (1:1) containing
insulin (25 µg/ml), glucose (6 mg/ml), transferrin (100 µg/ml),
progesterone (20 nM), putrescine (60 µM), and
selenium (30 nM) and is referred to as complete serum-free
medium (SFM) (di Porzio et al., 1980 ). MEM/Ham's F12 that did not
include these supplements is referred to as basal medium. Cultures were
maintained at 37°C in a humidified atmosphere of 95% air/5%
CO2, and the medium was not changed during the
course of the experiment unless otherwise indicated.
FeSO4 and H2O2
toxicity. Neurons were plated and maintained in 0.5 ml of complete
SFM for 3 d. On the third day, 0.5 ml of complete SFM containing
twice the stated concentrations of FeSO4, H2O2, and any indicated pharmacological
agents was added to experimental wells. Cultures were not pretreated
with the protective agents before the addition of FeSO4 or
H2O2. One day later, the cells were assessed
for survival. In this paradigm, the control cultures received an
additional 0.5 ml of complete SFM. In the experiments in which the
cultures were plated in MEM alone, the medium was supplemented with 0.5 mM pyruvate, a nutrient that has been shown to be critical
for neuronal survival (Selak et al., 1985 ). The mixture of MEM/F12
contains 0.5 mM pyruvate.
Thiobarbituric acid reactive substances assay. Neurons were
dissected from E18 fetuses and plated in complete SFM, basal medium, or
basal medium with 10 µM dipyridamole. After 5-6 hr,
cells were washed twice in PBS and harvested in 300 µl of PBS. A
volume of 0.5 ml of thiobarbituric acid reactive substances (TBARS)
stock reagent was then added to the harvested material. The stock
reagent consisted of 15% trichloroacetic acid, 0.375%
2-thiobarbituric acid, and 0.25N HCl (Buege and Aust, 1978 ).
The cell suspensions were incubated in boiling water for 15 min and
centrifuged at 14,000 rpm for 10 min, and fluorescence was measured at
553 nm with excitation at 515 nm (Keller et al., 1998 ).
Medium replacement experiment. Neurons were plated in 1 ml
of complete SFM or basal medium containing 10 µM
dipyridamole. One day later, 0.8 ml of the medium was carefully removed
from the well and replaced with 0.8 ml of the fresh medium containing the indicated additives. This partial removal and the readdition were
necessary because it was determined that complete removal of the medium
resulted in decreased viability of the neurons. The residual 20% of
dipyridamole or serum-free supplements had no impact on the outcome of
this experiment because these levels were unable to promote survival.
The following day, the cells were assessed for survival.
Assay for neuronal survival. Neuronal survival was assayed
by a method routinely used to assess PC12 cell viability and described previously (Batistatou and Greene, 1991 ; Rukenstein et al., 1991 ). After removal of the culture medium, the neurons were lysed at daily
intervals, and intact nuclei were counted using a hemacytometer (Soto
and Sonnenschein, 1985 ). In this assay, nuclei of dead cells generally
disintegrate or, if in the process of dying, appear pyknotic and
irregularly shaped. In contrast, nuclei of living cells are phase
bright and have clearly defined limiting membranes. Cell counts were
performed on triplicate wells. The data are expressed as a percentage
of the number of neurons alive in complete SFM 1 d after plating.
All data shown are representative experiments of at least three
replicate experiments.
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RESULTS |
Dipyridamole rescues multiple neuronal populations from death in
basal medium
One of our primary aims was to use a simple model system for
testing potential agents that are neuroprotective for CNS neurons. To
do so, we used a system in which freshly dissociated embryonic rat CNS
neurons were plated in medium with no trophic factors or other
additives. We predicted that neuronal survival in this minimal medium
would be poor and, therefore, that the effect of exogenously supplied
protective agents would be readily apparent. When E18 hippocampal
neurons were plated in complete serum-free medium with a high level of
insulin and other serum-free additives (complete SFM) (di Porzio et
al., 1980 ), neuronal survival at 24 hr was excellent, as judged by
morphological criteria, and the cells attached to the substrate and
began to elaborate neuritic processes (Fig.
1A). When the same
neurons were plated in wells containing unsupplemented, basal medium,
the cells failed to survive beyond 16 hr, and virtually all were dead
by 24 hr. There were very few intact cell bodies and no cells with
visible neuritic processes (Fig. 1B). When 10 µM dipyridamole was added at the time of plating, there
was substantial rescue of the hippocampal neurons with 70-80%
survival after 24 hr. The neurons surviving in basal medium with
dipyridamole were nearly indistinguishable from the neurons grown in
complete SFM (Fig. 1C).

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Figure 1.
Phase contrast micrographs of E18 hippocampal
neurons maintained in complete SFM for 24 hr (A),
no additives (B), 10 µM
dipyridamole (C), or 100 µg/ml (230 µM) vitamin E (D).
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Dipyridamole prevented neuronal death in a concentration-dependent
manner with the maximal effect in the range of 10-20 µM (Fig. 2A). The
dose-response curve is very steep as concentrations 1
µM had no effect on neuronal survival. Concentrations of
dipyridamole that were >20 µM seemed toxic to neurons
because viability was significantly less than that in cultures treated
with 10 µM dipyridamole. To confirm the viability of the
neurons maintained by dipyridamole, we plated cultures in basal medium
with dipyridamole and then 1 d later switched a portion to either
complete SFM or basal medium, in each case without dipyridamole.
The cultures were scored for viability the next day. Under these
conditions, the cells that had been treated for 1 d with
dipyridamole and then exposed to complete SFM were still alive on day
2, whereas those cultures that were switched to basal medium had almost
no surviving cells (Fig. 2B). These observations
confirm that the neurons judged to be maintained by dipyridamole were
alive and not irreversibly committed to death.

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Figure 2.
Dipyridamole promotes survival of primary CNS
neurons in basal medium. A, Dose-response relationship
for the effect of dipyridamole on survival of E18 hippocampal neurons
in basal medium (1 d). Survival data are expressed relative to the
number of neurons alive in complete SFM 1 d after plating
(arbitrarily set at 100). B, Viability of
dipyridamole-supported cells confirmed by responsiveness to complete
SFM. Cells were cultured for 24 hr in basal medium with or without 10 µM dipyridamole or complete SFM, and the culture medium
was then replaced as indicated. Cells maintained continuously in
complete SFM or in basal medium containing 10 µM
dipyridamole are shown for reference. Cell numbers were quantified
2 d after plating and expressed relative to the number of neurons
in replicate cultures maintained continuously in complete SFM.
C, Protection of neurons from several different brain
regions by dipyridamole. Survival data are expressed relative to the
number of neurons from the indicated brain region alive in complete SFM
1 d after plating. D, Time course. E18 hippocampal
neurons were plated in the indicated media, and replicate cultures were
assessed for surviving neurons at various times. No subsequent addition
of dipyridamole was given. Data are the mean ± SEM of three
samples. In this and subsequent figures, the apparent absence of error
bars indicates that the error was smaller than the
symbol used. DP,
Dipyridamole.
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We extended our model system to test whether dipyridamole could promote
survival of neurons from regions of the CNS in addition to the
hippocampus. We assessed several brain regions including the cerebral
cortex, basal forebrain, ventral mesencephalon, spinal cord, and
striatum. In every brain region tested, dipyridamole significantly
increased neuronal survival in comparison with that in cultures in
basal medium. Dipyridamole was most effective on cultures taken from
E18 hippocampus and cortex, rescuing 70-80% of the neurons relative
to cultures in complete SFM. For neurons taken from the other brain
regions on E16, the optimal age for culturing basal forebrain and
ventral mesencephalon (Friedman et al., 1993 ), dipyridamole rescued
50-60% of the neurons (Fig. 2C).
Figure 2D shows a time course for
dipyridamole-promoted survival of hippocampal neurons in basal medium.
Dipyridamole rescued ~50% of the neurons after 3 d in culture,
25% after 5 d, and <10% by day 7. Thus dipyridamole, unlike
complete SFM, does not confer long-term survival. When dipyridamole was
added to complete SFM, there was no increase in neuronal viability
compared with that in cultures maintained in complete SFM alone (Fig.
2D). Readdition of dipyridamole on days 1-5 did not
prolong neuronal survival beyond that observed when the drug was added
just once at the time of plating (data not shown). The time course of
dipyridamole-mediated survival in basal medium was similar regardless
of the brain region from which the neurons were cultured (data not
shown).
Mechanism of the neuroprotective action of dipyridamole
We next studied the mechanism by which dipyridamole rescues
neurons from death. Because dipyridamole is a compound with multiple pharmacological actions, we tested whether we could protect CNS neurons
by mimicking any of these known activities by other means. We initially
focused on the well established ability of dipyridamole to inhibit
phosphodiesterases (Thompson, 1991 ) because it was this property that
led to the potentiation of NO and natriuretic peptides on the survival
of PC12 cells (Farinelli et al., 1996a ,b ) and also because elevated
cAMP can rescue neurons from trophic factor deprivation (Rydel and
Greene, 1988 ; Chang et al., 1996 ; Miller et al., 1997 ). However a
number of different phosphodiesterase inhibitors as well as permeant
cAMP and cGMP analogs failed to prevent neuronal death (Table
1). Nitric oxide generators and nitric
oxide synthase (NOS) inhibitors were also without effect. In addition
to its actions on phosphodiesterases, dipyridamole has been shown to
block nucleoside uptake (Zhang and Fredholm, 1994 ; Thorn and Jarvis,
1996 ), inhibit the multidrug resistance protein (Ayesh et al., 1996 ),
block chloride transport (Garcia and Lodish, 1989 ), and increase
prostacyclin synthesis (Jackson et al., 1982 ). None of the variety of
agents tested that mimic these as well as several other activities
promoted survival of CNS neurons in basal medium (Table 1). Transfer to
a basal, serum-free medium lacking growth factors has also been used to
probe survival and death mechanisms of PC12 cells. In the latter
system, rescue from death is conferred by cyclin-dependent kinase
inhibitors (Park et al., 1996 ) and blockers of RNA synthesis (Mesner et
al., 1992 ). In contrast, these were ineffective on CNS neurons in basal medium. Conversely, dipyridamole did not rescue PC12 cells or sympathetic neurons deprived of trophic support (Farinelli et al.,
1996a ).
The failure of all these different agents to mimic the protective
actions of dipyridamole on CNS neurons led us to examine one of its
lesser-studied properties, namely its role as an antioxidant. Dipyridamole has been shown to inhibit lipid peroxidation and to
scavenge superoxide and hydroxyl radicals (Iuliano et al., 1989 , 1995 ).
We therefore tested whether the antioxidants vitamin E and
N-acetylcysteine (NAC) might also prevent neuronal death in
basal medium. Both vitamin E, a free-radical scavenger, and NAC, an
antioxidant that increases intracellular glutathione levels, prevented
neuronal death in a concentration-dependent manner (Fig. 3A,B).
A vitamin E-treated culture is shown in Figure 1D.
Vitamin E was maximally effective at a concentration of 100 µg/ml
(230 µM), and NAC was maximally effective at 100-300
µM; both saved ~80% of the hippocampal neurons after
24 hr relative to cultures maintained in complete SFM. The time course
of survival in the presence of vitamin E more closely resembled that
observed with dipyridamole treatment than it did that after NAC
treatment (Fig. 3C). After 3 d, survival in the
presence of NAC was no different than that in the cultures maintained
in basal medium alone. In contrast, vitamin E afforded significant
protection after 5 d, similar to dipyridamole. Readdition of NAC
or vitamin E did not prolong survival beyond that observed when either
was added only once at the time of plating (data not shown). As
observed with dipyridamole, addition of vitamin E or NAC to complete
SFM did not increase neuronal survival compared with that seen in
cultures maintained in complete SFM alone (Fig. 3D) The
protective effects of the three antioxidants were not additive. When
dipyridamole, vitamin E, and NAC were combined, the combination was no
more effective than each of them alone, suggesting a shared mechanism of action (Fig. 3E).

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Figure 3.
The antioxidants vitamin E and NAC promote
survival of primary CNS neurons in basal medium. A,
B, Dose-response relationships for the effect of
vitamin E (A) and NAC (B)
on promotion of survival of E18 hippocampal neurons in basal medium (1 d) are shown. The open circle represents survival
mediated by 10 µM dipyridamole. Survival data are
expressed relative to the number of neurons alive in complete SFM
1 d after plating (arbitrarily set at 100). C, Time
course is shown. E18 hippocampal neurons were plated in either complete
SFM or basal medium in the presence of the indicated additives. No
subsequent addition of these agents was given. D,
Antioxidants do not afford additional protection beyond that provided
by complete SFM alone. E, Antioxidant effects on
survival in basal medium are not additive and fail to increase
dipyridamole-promoted survival. All survival data are expressed
relative to the number of neurons alive in complete SFM 1 d after
plating.
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Dipyridamole protects neurons from oxidative stress
In view of the above data, we had reason to suspect that
death in our neuronal cultures in basal medium was primarily
attributable to oxidative stress rather than to loss of trophic
support, at least during the first several days in vitro. We
tested this hypothesis by placing healthy neurons cultured in complete
SFM under conditions known to cause oxidative stress, namely, exposure
to FeSO4 or H2O2 (Zhang et al.,
1993 ), and then we assessed whether dipyridamole could mimic the
effects of other antioxidants and be protective under these
circumstances. For example, Chow et al. (1994) reported that Trolox, a
vitamin E analog, protects cultured cortical neurons from exposure to
iron salts, and thus the iron toxicity model seemed to be a good test
system in which to determine whether the antioxidant property of
dipyridamole was sufficient to confer protection. One day after
treatment with either 10 µM FeSO4 or 30 µM H2O2 in complete SFM, ~80%
of the neurons died compared with the effects seen in untreated
controls (Fig.
4A,B).
When added at the time of exposure to FeSO4,
dipyridamole, vitamin E, or NAC afforded very good protection from the
oxidative insult (Figs. 4A,
5). Pretreatment of the cultures with the
antioxidants before addition of FeSO4 was not required for
protection. Dipyridamole provided complete protection, whereas NAC and
vitamin E protected 75-80% of the neurons. These agents were less
effective against H2O2 toxicity, but all
provided protection compared with untreated cultures (Fig.
4B). NAC was the most effective at protecting against H2O2 toxicity, rescuing ~70% of the neurons
at 1 d.

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Figure 4.
Dipyridamole, vitamin E, and NAC provide
protection to E18 hippocampal neurons under conditions of oxidative
stress. Neurons were plated in complete SFM and allowed to become
established for 3 d. On the third day, cultures were treated with
10 µM FeSO4 (A) or 30 µM H2O2 (B)
in complete SFM with the indicated additions. Cultures were not
pretreated with the agents before addition of FeSO4 or
H2O2. Cultures were assessed for survival 24 hr
later. All survival data are expressed relative to the number of
neurons in untreated control cultures.
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Figure 5.
Phase contrast micrographs of E18 hippocampal
neurons maintained in complete SFM for 3 d followed by a 1 d
treatment with no additives (complete SFM control)
(A), 10 µM FeSO4
(B), or 10 µM FeSO4
plus 10 µM dipyridamole (C).
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Neurons cultured in basal medium are under oxidative stress, and
this is reduced by dipyridamole
The above findings suggested that dipyridamole protects neurons
not by mimicking or replacing required neurotrophic support but rather
by protecting them from oxidative stress. To determine whether the
neurons cultured in basal medium were, in fact, under oxidative stress,
we used the TBARS assay to measure membrane lipid peroxidation in
cultures maintained under various conditions for 5-6 hr after plating.
At this time, the cultures do not yet show overt signs of neuronal
degeneration. The levels of TBARS in neurons cultured in basal medium
were considerably higher than that for neurons cultured in SFM
(176 ± 6% of the levels in SFM controls; n = 4),
indicating a greater level of oxidative stress. When present in basal
medium, dipyridamole substantially decreased the level of lipid
peroxidation measured by the TBARS assay (119 ± 6% of the levels
in SFM controls; n = 4). Similar results were obtained in two independent experiments. Comparable findings were achieved with cultures grown in complete SFM for 4-5 d and then challenged with 3-10 µM FeSO4 in the
presence or absence of dipyridamole.
Iron as a major contributor to oxidative stress in
basal medium
We next proceeded to investigate the potential source of oxidative
stress in neurons cultured in basal medium. An important clue in this
direction was furnished by testing the individual components of the
normal supplements that are included in complete medium. None of these
agents was able to protect hippocampal neurons in basal medium
except apotransferrin (Table 1; Fig. 6).
Addition of 100 µg/ml apotransferrin, the concentration that is
present in complete SFM, protected ~70% of the neurons after 1 d (Fig. 6). Based on the protective actions of the transferrin and the antioxidants, it seemed possible that such agents and dipyridamole protect the neurons from components of the MEM/F12 mixture that constitute basal medium and, in particular, from the pro-oxidant actions of iron. Examination of the components of basal medium revealed
the presence of 1.5 µM FeSO4. We therefore
assessed the hypothesis that, in the absence of supplements to the
basal medium, iron-catalyzed production of free radicals is toxic to
the neurons and that dipyridamole is protective because it inhibits
this process. If this hypothesis were correct, one would predict that
iron chelators should protect neurons in basal medium and that medium
formulated without FeSO4 would not be as toxic to neurons
as basal medium.

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Figure 6.
Transferrin promotes survival of primary
hippocampal neurons in basal medium. Survival data are expressed
relative to the number of neurons alive in complete SFM 1 d after
plating (arbitrarily set at 100). Tf,
Transferrin.
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We tested the first prediction by plating neurons in basal medium
supplemented with the iron chelators deferoxamine or mimosine (Hashiguchi and Takahashi, 1977 ; Ganeshaguru et al., 1980 ). Both deferoxamine and mimosine partially blocked neuronal death in a
concentration-dependent manner. Both agents were maximally effective at
a concentration of 30 µM, rescuing ~70% of the neurons
after 24 hr relative to cultures plated in complete SFM (Fig.
7). This level of survival, although not
complete, is comparable with that promoted by dipyridamole, vitamin E,
or NAC. To exclude the possibility that the chelators might rescue
neurons by a mechanism unrelated to their chelating properties as well
as to ensure that the 30% death (relative to SFM) that occurs with
dipyridamole and the chelators was not caused by iron bound to the
chelators but still present in the medium, we incubated basal MEM/F12
with deferoxamine coupled to Sepharose beads. The medium was then
centrifuged to remove the beads and bound iron. Neuronal survival in
this iron-depleted medium was similar to survival in medium
supplemented with the iron chelators (Figs. 7,
8B). To assess the
second prediction, we tested whether neurons plated in unsupplemented
MEM (without F12), a formulation that does not contain iron, had any
survival advantage over neurons plated in basal medium. Compared with
neurons plated in complete SFM, there was ~65-75% survival after 24 hr when neurons were plated in unsupplemented MEM, whereas in contrast, nearly all the neurons plated in unsupplemented MEM/F12 were dead (Fig.
8A). There was little, if any, further enhancement of
survival with addition of dipyridamole. Thus, removal of iron by
chelators or culture in iron-free medium confers a significant degree
of neuronal protection.

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Figure 7.
The iron chelators deferoxamine and mimosine
promote survival of primary CNS neurons in basal medium. Dose-response
relationships for the effects of deferoxamine and mimosine on survival
of E18 hippocampal neurons in basal medium (1 d) are shown. The
closed circle represents survival mediated by 10 µM dipyridamole. The open circle indicates
survival in basal medium depleted of iron by immobilized deferoxamine
(DF). All survival data are expressed relative to
the number of neurons in complete SFM 1 d after
plating.
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Figure 8.
Death of neurons is enhanced in basal medium
(MEM/F12), compared with MEM, a culture medium lacking
FeSO4. E18 hippocampal neurons were plated in the indicated
medium and assessed for survival at daily intervals. A,
Survival is enhanced in iron-free MEM compared with that in
iron-containing basal medium and is diminished by the addition of
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We next determined whether the presence of iron is sufficient to cause
neuronal death. Various concentrations of FeSO4 were added
to neurons plated in iron-free MEM medium. At 1.5 µM, the same concentration that is in basal medium, there was a significant decrease in viability relative to neurons cultured in MEM alone (Fig.
8A). However, even when FeSO4 was added
to reach concentrations as high as 10 µM, the degree of
neuronal death was not as great as that observed in cultures plated in
basal MEM/F12 (Fig. 8A). This suggests that although
iron is a major factor in generation of oxidative stress in the
cultures, there may be other contributing factors as well. To assess
this possibility, we maintained neuronal cultures for 3 d in
iron-free MEM or in MEM/F12 depleted of iron by the
deferoxamine-coupled beads and with or without dipyridamole. Additionally, to ensure that the MEM did not contain trace amounts of
iron that contributed to neuronal death over time, we also incubated
this medium with deferoxamine-coupled beads. Under these conditions,
neuronal death at 3 d of culture continued in MEM alone,
deferoxamine-treated MEM, and deferoxamine-treated MEM/F12 but was
significantly arrested in the presence of dipyridamole in all three
media (Fig. 8B). Moreover, the presence of vitamin E
in deferoxamine-treated MEM or deferoxamine-treated MEM/F12 also
rescued ~50% of the neurons at 3 d (Fig. 8B).
Thus, even in the absence of iron, there seems to be a source of
oxidative stress that is alleviated by dipyridamole or vitamin E.
Contribution of trophic factors to acute and longer-term
neuronal survival
Although dipyridamole conferred protection from death, the level
of rescue achieved with this drug never reached >75-80% of that
attained with complete SFM. This raised the possibility that neurotrophic support, which is present in complete SFM in the form of
high concentrations of insulin, may be an additional factor in
survival. We therefore assessed the effects of supplying insulin (but
not other additives to complete medium) with or without dipyridamole. As shown in Figure 8C, insulin did not substantially enhance
survival when added alone to basal medium. However, when added together with dipyridamole, the rescue was comparable with that in complete SFM.
This finding suggests that although insulin alone cannot protect the
neurons from oxidative stress, it can rescue an additional population
when oxidative stress is effectively suppressed. This is corroborated
by the observation that addition of insulin to iron-free MEM also
brings the relative level of survival to 100% (Fig.
8C).
As noted above, in contrast to complete SFM, dipyridamole provided
neuroprotection for only a limited length of time in basal medium. One
possible explanation for this is that neurons require both protection
from oxidative stress and neurotrophic support and that provision of
either alone is insufficient for long-term survival. To test this, we
plated hippocampal neurons in basal medium supplemented with either
dipyridamole, insulin, or dipyridamole plus insulin and assessed the
survival of these neurons at 1 week. As anticipated, there was no
survival with insulin alone and poor long-term survival with
dipyridamole alone. However, a substantial proportion of the cells
remained viable at 1 week in the presence of both dipyridamole and
insulin (Fig. 9).

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|
Figure 9.
Trophic factors contribute to longer-term neuronal
survival. E16 hippocampal neurons were plated in basal medium
supplemented with either dipyridamole, insulin, or dipyridamole plus
insulin and assessed for survival at 1 week. The survival data are
expressed relative to the number of neurons alive in complete SFM
1 d after plating.
|
|
 |
DISCUSSION |
The reductionist approach has proved to be a powerful strategy for
defining the variables that affect neuronal survival as well as for
uncovering and characterizing drugs with neuroprotective activity. This
has highlighted the importance of nutrients, antioxidants, and trophic
factors. In the present study we used a serum-free basal medium to test
the potential neuroprotective role of the drug dipyridamole. We report
that although a wide variety of CNS neurons cannot survive in a
standard basal medium, they are acutely supported under such conditions
by dipyridamole. Moreover, dipyridamole permits prolonged survival in
basal medium when supplied in conjunction with insulin.
Dipyridamole has multiple pharmacological actions that could
potentially account for its neuroprotective effects. It was especially important to establish whether the survival-promoting actions of
dipyridamole were attributable to mimicry of neurotrophic activity. For
instance, the capacity of dipyridamole to inhibit phosphodiesterase activity was of particular interest in that elevated levels of cAMP or
cGMP protect certain neurons from loss of trophic support. The
ineffectiveness of other phosphodiesterase inhibitors in our system
both eliminates a mechanism involving cyclic nucleotides and suggests
an action other than exertion of trophic factor-like effects. Another
means by which dipyridamole might have protected neurons was its
inhibition of nucleoside transport that could have resulted in enhanced
levels of extracellular adenosine that in turn might have promoted
survival by promoting receptor-mediated elevation of intracellular cAMP
and thereby providing trophic support. However, here
again other inhibitors of this action were not neuroprotective.
Additional evidence against a mechanism whereby dipyridamole exerts
trophic factor-like actions includes the inability of high levels of
insulin alone to inhibit death in basal medium and the ineffectiveness
of dipyridamole as well as of vitamin E or 100 µM NAC to
block neuronal death in other systems caused by withdrawal of trophic
support (Ferrari et al., 1995 ). NAC has been found to protect neurons
from loss of trophic support, but in these cases, much higher
concentrations (20-60 mM) were required, and protection
did not correlate with antioxidant activity (Ferrari et al., 1995 ; Yan
et al., 1995 ). An array of additional agents that provide protection
from withdrawal of neurotrophic factors also failed to rescue neurons
in the present paradigm.
Positive evidence regarding the mechanism of dipyridamole was provided
by the observations that its neuroprotective actions on neurons
cultured in basal medium were effectively mimicked by the antioxidants
vitamin E and NAC (100 µM) and that dipyridamole, like
vitamin E and NAC, protected neurons from oxidative stress evoked by
exposure to ferrous iron or peroxide. It has been demonstrated that
dipyridamole, like vitamin E, is an effective free radical-scavenging agent (Iuliano et al., 1995 ) and that it is effective at inhibiting FeSO4-induced lipid peroxidation in experimental systems
including rat lens and lung (De la Cruz et al., 1994 , 1996 ). We show
here that dipyridamole also substantially reduces the formation of TBARS in cultures grown in basal medium or in complete medium supplemented with 3-10 µM iron. Taken together, these
findings reveal that a major reason neurons rapidly die in basal medium is that they are under oxidative stress and that this is alleviated by
dipyridamole.
Our studies indicate that a major generator of oxidative stress for
neurons in basal medium is iron. It has been well established that iron
can cause oxidative stress by promoting lipid peroxidation as well as
DNA and protein damage by catalyzing the formation of hydroxyl radicals
(Halliwell and Gutteridge, 1986a ,b ). Moreover, a number of studies have
shown that ferrous iron is toxic to cultured neurons (Brewer et al.,
1993 ; Zhang et al., 1993 ; Chow et al., 1994 ). Our findings reinforce
the potentially harmful effects of iron salts on cultured neurons, even
when present at relatively low levels (1.5 µM in this
case). The most likely mechanism by which dipyridamole protects neurons
from iron seems to be by virtue of its capacity to scavenge free
radicals. There is no evidence that dipyridamole directly interacts
with iron, and the structure of dipyridamole does not suggest
iron-chelating activity.
Among the evidence pointing to the possibility that FeSO4
in basal medium might be responsible for oxidative stress and cell death was the observation that addition of apotransferrin alone provides protection similar to that conferred by dipyridamole. It was
originally conceived that the role of transferrin in defined medium
would be to provide a source of iron transport into cells (Bottenstein
and Sato, 1979 ; Aizenman et al., 1986 ). However, transferrin binds iron
and as such prevents its participation in formation of the hydroxyl
radical and lipid peroxidation (Gutteridge et al., 1979 , 1981 ). Thus,
apotransferrin also seems to play an important neuroprotective role in
defined medium by preventing iron-mediated oxidative stress.
Another piece of evidence implicating FeSO4 as a source of
oxidative stress in our cultures was the observation that the iron chelators deferoxamine and mimosine are neuroprotective in basal medium. It was established previously that these agents protect PC12
cells and sympathetic neurons from trophic factor withdrawal (Farinelli
and Greene, 1996 ). However, this effect occurs only at 10-100-fold
higher concentrations than that required here to protect CNS neurons.
This suggests differences in the mechanisms of death as well as in the
actions of the iron chelators in the two systems. In the trophic factor
deprivation system, iron was not present in the medium, and it was
postulated that the neuroprotective effects of mimosine and
deferoxamine were attributable to their known actions as cell cycle
blockers at the G1/S transition rather than to protection from
oxidative stress. In contrast, for the current studies, the low
concentrations of the chelators were likely protective because they
bound iron present in the basal medium. This is corroborated by our
observation that incubating basal medium with immobilized deferoxamine
was equally effective in preventing death.
Our observations indicate that iron alone is not the sole source of the
oxidative stress on cultured neurons. Although addition of
FeSO4 to MEM produced substantial levels of death, the
effect was not as great as that observed in basal medium. Moreover,
neurons did not show longer-term survival in iron-free MEM unless
dipyridamole was present. The source of such stress is presently
unclear but may reflect both the composition of the culture medium as
well as the status of intracellular antioxidant mechanisms.
Even though oxidative stress was a major factor in the death of
neurons, it was not the only contributory element. Exposure to
dipyridamole or other antioxidants or the use of iron-free medium did
not support the same level of acute survival as that obtained with
complete SFM. Moreover, suppression of oxidative stress by vitamin E or
dipyridamole was not in itself sufficient to maintain long-term support
of neurons. Survival of embryonic neurons both in vivo and
in vitro requires an adequate supply of trophic factors. We
observed that provision of insulin in addition to dipyridamole resulted
in undiminished acute survival (relative to complete SFM) as well as
longer-term maintenance. Insulin and insulin-like growth factors (whose
receptors are activated by the high concentrations of insulin used
here) have been shown to possess widespread trophic actions on neurons
(Snyder and Kim, 1979 ; Skaper et al., 1982 ; Huck, 1983 ). It therefore
seems likely that the incomplete survival of dipyridamole-treated
neurons on day 1 in culture as well as their subsequent loss over time
reflects the absence of required trophic support and that this is
provided, at least in part, by insulin. Optimal neuronal survival in
culture was thus achieved when the neurons received both protection
from oxidative stress and a source of trophic activity. Such findings substantiate the points that oxidative stress and trophic factor deprivation evoke death by means of distinct pathways and that trophic
factors and antioxidants promote survival by different mechanisms.
The present studies support the potential use of dipyridamole or its
analogs as effective agents for protection of neurons from oxidative
stress. In contrast to vitamin E, which acts only at the cell membrane,
dipyridamole is an effective scavenger in both the aqueous and lipid
phases (Iuliano et al., 1995 ). It is also notable that dipyridamole was
optimally active in our experiments at 10 µM, whereas
comparable efficacy of vitamin E and NAC required concentrations of
approximately an order of magnitude higher. In an animal model of
induced stroke, an analog of dipyridamole that passes the blood-brain
barrier provided significant levels of protection (De la Cruz, 1992 ).
Given the suggested role of free radicals in neuronal death after
ischemia or trauma (Halliwell, 1992 ) or in neurodegenerative disorders
(Gerlach et al., 1994 ) as well as the recent report that vitamin E
administration significantly delays progression of Alzheimer's disease
(Sano et al., 1997 ), our in vitro findings lend credence to
the potential use of dipyridamole or its derivatives in prevention
and/or treatment of certain injuries and diseases of the nervous
system.
 |
FOOTNOTES |
Received Feb. 10, 1998; revised April 7, 1998; accepted April 24, 1998.
This work was supported in part by National Institutes of
Health-National Institute of Neurological Disorders and Stroke (NINDS) Grants 31357 (W.J.F.) and 33689 (L.A.G.) and by grants from the Amyotrophic Lateral Sclerosis Foundation and the Blanchette Rockefeller Foundation. S.E.F. was supported in part by a National Research Service
Award from the NINDS. We thank Dania Alarcon-Vargas for her excellent
technical assistance.
Correspondence should be addressed to Dr. Lloyd A. Greene, Department
of Pathology and Center for Neurobiology and Behavior, Columbia
University, College of Physicians and Surgeons, 630 West 168th Street,
New York, NY 10032.
 |
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L. Stefanis, D. S. Park, W. J. Friedman, and L. A. Greene
Caspase-Dependent and -Independent Death of Camptothecin-Treated Embryonic Cortical Neurons
J. Neurosci.,
August 1, 1999;
19(15):
6235 - 6247.
[Abstract]
[Full Text]
[PDF]
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