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The Journal of Neuroscience, July 15, 1999, 19(14):5910-5918
Neuronal Nitric Oxide Synthase Activation and Peroxynitrite
Formation in Ischemic Stroke Linked to Neural Damage
Mikael J. L.
Eliasson1, 2,
Zhihong
Huang4,
Robert J.
Ferrante5, 6,
Masao
Sasamata4,
Mark E.
Molliver2,
Solomon H.
Snyder1, 2, 3, and
Michael A.
Moskowitz4
Departments of 1 Pharmacology and Molecular Science,
2 Neuroscience, and 3 Psychiatry, Johns Hopkins
University School of Medicine, Baltimore, Maryland 21205, 4 Stroke and Neurovascular Regulation Laboratory, Neurology
and Neurosurgery Services Massachusetts General Hospital, Charlestown,
Massachusetts 02129, 5 Departments of Neurology, Pathology,
and Psychiatry, Boston University School of Medicine, Boston,
Massachusetts 02118, and 6 Bedford Veterans Administration
Medical Center, GRECC Unit 182B, Bedford, Massachusetts 01730
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ABSTRACT |
Nitric oxide (NO) is a new intercellular messenger that occurs
naturally in the brain without causing overt toxicity. Yet, NO has been
implicated as a mediator of cell death in cell death. One explanation
is that ischemia causes overproduction of NO, allowing it to react with
superoxide to form the potent oxidant peroxynitrite. To address this
question, we used immunohistochemistry for citrulline, a marker for NO
synthase activity, and 3-nitrotyrosine, a marker for peroxynitrite
formation, in mice subjected to reversible middle cerebral artery
occlusion. We show that ischemia triggers a marked augmentation in
citrulline immunoreactivity but more so in the peri-infarct than the
infarcted tissue. This increase is attributable to the
activation of a large population (~80%) of the neuronal isoform of
NO synthase (nNOS) that is catalytically inactive during basal
conditions, indicating a tight regulation of physiological NO
production in the brain. In contrast, 3-nitrotyrosine immunoreactivity
is restricted to the infarcted tissue and is not present in the
peri-infarct tissue. In nNOS / mice, known to
be protected against ischemia, no 3-nitrotyrosine immunoreactivity is
detected. Our findings provide a cellular localization for nNOS
activation in association with ischemic stroke and establish that NO is
not likely a direct neurotoxin, whereas its conversion to peroxynitrite
is associated with cell death.
Key words:
citrulline; ischemial; peroxynitrite; 3-nitrotyrosine; nitric oxide; nitric oxide synthase; peroxynitrite
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INTRODUCTION |
Nitric oxide (NO) is a putative
neurotransmitter in the brain and peripheral nervous system (Holscher,
1997 ). It is formed by the enzyme NO synthase (NOS), which generates NO
from the guanidine nitrogen of arginine giving rise to NO and
stoichiometric amounts of citrulline. NO functions in blood vessels in
which it accounts for endothelial-derived relaxing factor activity
(Moncada, 1994 ), in macrophages in which it accounts for the ability of
activated macrophages to kill tumor cells and bacteria (MacMicking et
al., 1997 ), and in neurons. For these three functions and
localizations, NO is formed by three different types of NOS derived
from three distinct genes referred to, respectively, as neuronal NOS
(nNOS; NOS-1), macrophage or inducible NOS (iNOS; NOS-2), and
endothelial NOS (eNOS; NOS-3) (Moncada et al., 1997 ). nNOS is localized
to discrete populations of neurons in the brain and the peripheral nervous system, as well as to some forms of skeletal muscle and certain
epithelial tissues (Yun et al., 1996 ). In the brain, iNOS can occur in
astrocytes and microglia but usually not in neurons (Jaffrey and
Snyder, 1995 ). There is some evidence that eNOS can occur in certain
neuronal populations (Dinerman et al., 1994 ; O'Dell et al., 1994 ;
Doyle and Slater, 1997 ), but this is controversial (Vincent and Kimura,
1992 ; Stanarius et al., 1997 ) so that it is likely that the
predominant, if not sole, form of NOS in neurons in the brain is nNOS.
Initial evidence for a specific function of NO in the brain came from
the demonstration that glutamate, acting through NMDA receptors,
stimulates the conversion of arginine to citrulline with a
concentration-response relationship similar to its stimulation of
cGMP formation and that NOS inhibitors block both NOS activity and cGMP formation (Bredt and Snyder, 1989 ; Garthwaite et al., 1989 ).
Thus, under presumed physiological conditions, NMDA transmission activates NO formation in the brain.
Excessive glutamate release can be toxic, because exposure of cortical
cultures to glutamate or NMDA results in the delayed killing of
neuronal cells (Choi, 1988 ). NO appears to be involved in mediating
NMDA neurotoxicity in cortical cultures. Thus, NMDA neurotoxicity is
markedly reduced after treatment with NOS inhibitors (Dawson et al.,
1993 ) and in cultures from mice with targeted deletion of nNOS
(nNOS / ) (Dawson et al., 1996 ). Although NMDA
activates NOS, the NOS-containing neurons resist toxic effects of NMDA
and form NO that is released to kill adjacent non-NOS neurons (Dawson
et al., 1993 ). The unique resistance of NOS neurons to NMDA toxicity
appears to be associated with their very high content of manganese
superoxide dismutase, which presumably prevents interactions of NO with
superoxide to form the potent oxidant peroxynitrite (Gonzalez-Zulueta
et al., 1998 ).
Glutamate neurotoxicity acting via NMDA receptors has been implicated
in neural damage after ischemic stroke (Choi, 1988 ; Yun et al., 1996 ).
Focal ischemia associated with middle cerebral artery occlusion (MCAo)
leads to massive neuronal release of glutamate. Evidence that this
glutamate accounts for neural damage comes from studies showing that
NMDA antagonists block neural damage in a variety of stroke models
(Choi, 1994 ). Because NO mediates NMDA neurotoxicity in brain cultures,
NO may mediate glutamate neurotoxicity in ischemic stroke. Supporting
evidence includes the demonstration that relatively specific nNOS
inhibitors reduce stroke damage (Iadecola, 1997 ) and that such damage
is also diminished in nNOS / mice (Huang et
al., 1994 ). Although several reports of increased NO production after
ischemia have been published (Malinski et al., 1993 ; Iadecola, 1997 ),
little evidence exists regarding the source responsible for this
increased production. This has precluded definitive conclusions
regarding the role of NO in the pathogenesis of stroke damage. Indeed,
in certain circumstances, NO confers protection against stroke because
mice deficient in eNOS suffer greater damage than control mice after
reversible ischemia (Huang et al., 1996 ). One explanation is that NO is
not toxic in itself but becomes toxic only when it reacts with
superoxide and is converted to peroxynitrite (Beckman and Koppenol,
1996 ) and that the likelihood that this will occur is dependent on
where NO is being produced.
Because of difficulties in measuring and localizing NO itself, we
focused on citrulline. Citrulline immunoreactivity (cit-IR) is
localized exclusively to nNOS-containing neurons and is abolished after
treatment with NOS inhibitors (Pasqualotto et al., 1991 ; Demas et al.,
1997 ; Eliasson et al., 1997 ). Moreover, no other enzyme capable of
synthesizing citrulline has been found in the brain (Pasqualotto et
al., 1991 ; Eliasson et al., 1997 ). Thus, staining for citrulline
provides a useful approach to evaluating NO turnover. In the present
study, we have examined citrulline formation associated with MCAo. We
demonstrate that citrulline levels are markedly augmented after
ischemia but more so in the peri-infarct rather than the infarcted
tissue. In contrast, 3-nitrotyrosine immunoreactivity (3NT-IR), which
reflects the formation of peroxynitrite, is restricted to the infarcted
area and is not present in the peri-infarct tissue. Our findings
provide the first cellular localization of NOS activation in
association with ischemic stroke and establish that NO is not likely a
direct neurotoxin, whereas its conversion to peroxynitrite leads to
cell death.
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MATERIALS AND METHODS |
Ischemic model. Wild-type mice (129/Sv and
C57BL/6NcrlBR) and nNOS / mice (Huang et al.,
1993 ) (20-25 gm) were housed under diurnal lighting conditions and
allowed access to food and water ad libitum. For surgery,
mice were anesthetized with 2% halothane for induction and maintained
on 1% halothane in 70:30% nitrous oxide/oxygen by mask. Rectal
temperature was maintained between 36.5 and 37.5°C with a
homeothermic blanket system (YSI, Yellow Springs, OH). Focal cerebral
ischemia was induced by unilateral MCAo (right side) using the
intraluminal filament technique (Longa et al., 1989 ; Huang et al.,
1994 ). Through a ventral midline incision, the right common and
external carotid arteries were isolated and ligated. A microvascular
clip (Zen temporary clip; Ohwa Tsusho, Tokyo, Japan) was
temporarily placed on the internal carotid artery and the
pterygopalatine artery. An 8-0 nylon monofilament (Ethicon, Somerville, NJ) coated with silicone was introduced into the internal carotid artery through a small incision in the external carotid artery
and advanced 10 mm distal to the carotid bifurcation to occlude the
MCA. The wound was sutured, and the animal was returned to its cage. At
the indicated durations of MCAo, animals were anesthetized deeply with
an overdose of pentobarbital, the filament was removed, and the common
carotid artery was reopened. Reperfusion into the previously ischemic
brain was allowed for 1 min, after which the animals were perfused for
immunohistochemistry through the left ventricle.
NMDA administration. NMDA was administered by either
intrastriatal perfusion or intraperitoneal injections. Either
application caused similar increases in cit-IR, as determined by
quantification of cit-IR perikarya. For intrastriatal NMDA perfusion,
wild-type 129/Sv mice (20-27 gm) were anesthetized with 1.5%
halothane in 2:1 air and oxygen. Mice were placed into a
custom-designed stereotactic frame (David Kopf, Tujunga, CA),
and microdialysis probes (CMA10; 1 mm membrane length, 0.5 mm
diameter) were placed in the cerebral cortex. Stereotactic coordinates
from bregma were as follows: 0.5 mm anterior, 2 mm lateral, and 1 mm
deep from the brain surface (Sidman et al., 1971 ). Microdialysis probes
were perfused with artificial CSF [containing
(mM): NaCl 125, KCl 2.5, CaCl2 1.2, NaH2PO4·H2O 0.5, Na2HPO4 5, MgCl2·6H2O
1, and ascorbic acids 0.2, pH 7.4] at a flow rate of 2 µl/min using
a microinfusion pump. After implantation, stabilization of the tissue
was allowed by waiting for 1 hr, during which aCSF was superfused. A 30 min baseline control was obtained with aCSF superfusion, followed by 10 min of 1 mM NMDA superfusion. Six minutes later, the
animals were perfused for immunohistochemistry. For intraperitoneal
NMDA injections, mice were given 75 mg/kg NMDA dissolved in 0.9% NaCl.
Mice were perfused for immunohistochemistry 30 min after administration.
3-Nitrotyrosine immunohistochemistry. Mice were deeply
anesthetized and transcardially perfused with cold (4°C) saline,
followed by 0.1 M sodium phosphate buffer, pH 7.4, containing a 4% paraformaldehyde solution. Brains were removed
directly after perfusion, post-fixed for 2 hr, washed in 0.1 M sodium phosphate buffer, and cryoprotected in increasing
concentrations of 10 and 20% glycerol-2% DMSO solution. Frozen
serial coronal sections of the entire brain were made at 50 µm
intervals. Sections were subsequently stained for Nissl substance using
cresyl violet to identify the lesioned locus and for
immunohistochemical localization of 3-nitrotyrosine (monoclonal antibody; 1:500 dilution; Upstate Biotechnology, Lake Placid, NY) using
a previously reported conjugated secondary antibody method (Ferrante et
al., 1993 ). Tissue sections were preincubated in absolute
methanol-0.3% hydrogen peroxide solution for 30 min, washed (three
times) in PBS, pH 7.4, 10 min each, placed in 10% normal goat serum
(Life Technologies, Gaithersburg, MD) for 1 hr, incubated free floating
in primary antiserum at room temperature for 12-18 hr (all dilutions
of primary antisera above included 0.3% Triton X-100 and 10% normal
goat serum), washed (three times) in PBS for 10 min each, incubated
with peroxidase-conjugated goat anti-rabbit IgG (1:300 in PBS;
Boehringer Mannheim, Mannheim, Germany), washed (three times) in PBS 10 min each, and reacted with 3,3'-diaminobenzidine-HCl (1 mg/ml) in
Tris-HCl buffer with 0.005% hydrogen peroxide. Specificity of antibody
binding was established by preincubation of tissue sections for
3-nitrotyrosine immunohistochemistry for 6 hr at room temperature with
either 20 mM nitrotyrosine or 1 mg/ml nitrated BSA
containing ~30 µM nitrotyrosine. For the data in Figure
6, glutaraldehyde-fixed tissue was used to allow comparison between
cit-IR and 3NT-IR in adjacent sections. Glutaraldehyde-fixed tissue was
reduced with 0.5% NaBH4 to increase permeability and
affinity of the citrulline immunohistochemistry (Campistron et al.,
1986 ). This raises the possibility that nitrotyrosine would be reduced
to aminotyrosine and not recognized by the monoclonal antibody. In our
experiment on glutaraldehyde-fixed tissue, the staining was comparable
in distribution with that seen in paraformaldehyde-fixed tissue using the same dilution of the antisera. Specificity of antibody binding in
glutaraldehyde-fixed tissue was established by omission of the primary
antibody and preincubation of tissue sections for 3-nitrotyrosine
immunohistochemistry for 4 hr at room temperature with 1 mg/ml nitrated
BSA containing ~30 µM nitrotyrosine. This supports the
preservation of the high-affinity epitope recognized by the monoclonal
antibody after glutaraldehyde fixation and NaBH4 treatment.
Citrulline and NOS immunohistochemistry. Citrulline as a
free amino acid is not immunogenic. By cross-linking citrulline with glutaraldehyde, highly specific and sensitive antisera can be raised
and used for immunohistochemistry (Eliasson et al., 1997 ). However, the
use of glutaraldehyde has limitations because it gives rise to strong
autofluorescence and precludes the observation of specific
immunofluorescence staining necessary for double-labeling experiments
using immunofluorescent antibodies. Previous studies by others
(Pasqualotto et al., 1991 ) and us (Eliasson et al., 1997 ) have tried to
overcome this limitation either by combining immunohistochemistry with
NADPH diaphorase histochemistry or denaturing the antibody complex to
allow multiple immunoenzyme staining. The former method is unreliable
because NADPH staining is unsuitable as a marker for NOS in
glutaraldehyde-fixed tissue (see Discussion). In the latter method, the
use of two chromogens enabled reliable distinction between cells
containing only citrulline (yellow), and nNOS/citrulline (dark blue),
but made it difficult to distinguish between cells containing
nNOS/citrulline (dark blue), and cells containing only nNOS (blue).
The citrulline antiserum has been characterized previously (Eliasson et
al., 1997 ) and was used at a 1:12,000 dilution of purified crude
antiserum. Animals were perfused through the left ventricle with 37°C
oxygenated Krebs'-Henseleit buffer, followed by 250 ml of 37°C 5%
glutaraldehyde-0.5% paraformaldehyde containing 0.2%
Na2S2O5 in 0.1 M sodium
phosphate, pH 7.4. Glutaraldehyde fixation is necessary because
the citrulline antiserum is specific for glutaraldehyde-linked
citrulline and does not detect free citrulline (Eliasson et al., 1997 ).
Brains were post-fixed in the same buffer for 2 hr at room temperature
and cryoprotected for 2 d at 4°C in 50 mM sodium
phosphate, pH 7.4, 0.1 M NaCl, 20% (vol/vol) glycerol.
Brain sections (40 µm) were cut on a sliding microtome. Free-floating
brain sections were reduced for 20 min with 0.5% NaBH4 and
0.2% Na2S2O5 in PBS (10 mM, pH 7.4, and 0.19 M NaCl) to reduce
background staining caused by the glutaraldehyde fixation. After
washing for 45 min at room temperature in PBS containing 0.2%
Na2S2O5, sections were
blocked with 4% normal goat serum for 1 hr in the presence of 0.2%
Triton X-100 and incubated overnight at 4°C with the primary
antiserum diluted in PBS containing 2% goat serum and 0.1% Triton
X-100. Immunoreactivity was visualized with the Vectastain ABC Elite
kit (Vector Laboratories, Burlingame, CA) using
3,3'-diaminobenzidine-HCl as chromogen. The specificity of the antisera
and the detection assay were tested by preabsorption with the antigen
and omission of the primary antibody, respectively. The distribution of
cit-IR neurons in immunostained sections was mapped using a
computer-microscope mapping system equipped with video frame grabber,
microscope stage digitizer, and software designed for quantitative
analysis of labeled cells. This system (Wilson and Molliver, 1991 ) uses
digitized video images and tracks microscope stage coordinates to
create digital brain maps that maintain the location of labeled cells.
Cit-IR neurons were mapped in coronal sections of the forebrain at the
level of the decussation of the anterior commissure, and the density of
labeled cells was determined in defined areas. A polyclonal antiserum
to the C-terminal region of human nNOS (residues 1419-1433) was kindly
provided by Jeffrey Spangenberg (IncStar, Stillwater, MN) and used at a 1:15,000 dilution of crude serum. Antiserum for iNOS (1 mg/ml to 10 µg/ml) (Transduction Laboratories, Lexington, KY) did not show any
specific immunoreactivity of brain sections. Specificity of iNOS
antibody binding was examined by omission of the primary antibody.
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RESULTS |
Cit-IR is stimulated by ischemia
Mice were subjected to MCAo and killed at a variety of time
points, and their brains were stained for citrulline or nNOS. Both
wild-type and nNOS / mice were used. Focal
ischemia markedly enhances cit-IR (Fig. 1). One hour after MCAo, examination at
low magnification reveals markedly increased cit-IR in the areas
supplied by the occluded MCA, including the corpus striatum, basal
forebrain, and cerebral cortex. At 1 hr, cit-IR is also augmented in
the contralateral cerebral cortex (Fig. 1b,
arrow), whereas at 3 hr it has declined (Fig.
1c,d). Presumably, the contralateral staining
reflects a transient increase in global cortical firing.

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Figure 1.
Low-power inverted photomicrographs of cit-IR in
representative coronal sections after no ischemia
(a), 1 hr of unilateral MCAo
(n = 3) (b), 3 hr
(n = 4) (c), 3 hr with
intense IR in the peri-infarct tissue (n = 5)
(d), 3 hr nNOS / mouse
(n = 3) (e), and 6 hr
wild-type mouse (n = 3)
(f). The circled X
indicates infarcted hemisphere. The increase in cit-IR ipsilateral to
the occlusion is readily apparent in all wild-type brains subjected to
MCAo for 30 min to 6 hr (n = 58). Increased cit-IR
is not restricted to the infarct, because staining of either equal
(b, c) or higher (d,
f) intensity is always seen in peri-infarct areas
(arrowheads). One hour of cerebral ischemia also elicits
increased cit-IR in the contralateral cerebral cortex
(n = 3) (b, arrow).
This is transient, because a similar increase is not apparent in any
brain subjected to >1 hr of MCAo (n = 28). For
nNOS / mice, an ipsilateral increase in cit-IR
is only seen after 3 hr ischemia (n = 3) but not
for 2 hr (n = 9) or 30 min (n = 4). All sections in this figure were processed identically for
immunohistochemistry and photographic reproduction to enable comparison
of IR. Rectangles in a indicate area of
photomicrographs shown in Figure 2.
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At 3 hr, cit-IR augmentation in the infarcted hemisphere is nonuniform.
In 60% of the brains, the medial striatum and basal forebrain stain
much more intensely than lateral areas, with a clear demarcation
between the two areas (Fig. 1d). In the remaining brains,
the medial and lateral areas show similar staining (Fig. 1c). This medial area receives blood supply from the
anterior cerebral artery, whereas the MCA supplies the lateral area.
Thus, the medial areas represent nonischemic, peri-infarct tissue,
although the more lateral areas are infarcted (Lo et al., 1996 ). This
suggests that sustained citrulline production is restricted to areas
that are still receiving blood supply and are fully viable, whereas ischemic areas, supplied by the occluded MCA, have diminished citrulline production.
Higher magnification confirms the augmented cit-IR after focal ischemia
and shows that it involves both neuronal perikarya and neuropil (Fig.
2). At 30 min, increases in perikaryal
and neuropil cit-IR are evident in the ischemic areas, in contrast to
much less staining in contralateral areas (Fig.
2a,b). At 1 hr, staining is further increased in
the ischemic areas (Fig. 2c). In contrast, at 3 hr,
peri-infarct tissue stains much more intensely than ischemic tissue
(Fig. 2d). This differentiation in cit-IR between
peri-infarct and infarcted tissue staining is also evident in the
striatum (Fig. 2g).

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Figure 2.
High-power photomicrographs of cit-IR neurons from
coronal sections shown in Figure 1. a-d, cit-IR in
basal forebrain of wild-type mice after unilateral MCAo. In the
peri-infarct zone (P), the longer the duration of
ischemia, the more pronounced the IR (b-d). After 3 hr,
a subset of wild-type mice (5 of 9) exhibits much more intense IR in
the peri-infarct than the infarct zone (I)
(d). In the infarct zone, IR increases in
intensity initially but is diminished at 3 hr
(d). In the striatum, the same pattern holds true
(g). In nNOS / mice,
after 3 hr of ischemia, IR is evident in both the basal forebrain
(e) and striatum (h). The
IR cells exhibit neuronal morphology (i), are
most abundant in the peri-infarct tissue (P), and
are blocked by incubating the citrulline antiserum with 200 µM soluble antigen (f).
nNOS-IR cells are also seen in the nNOS / mice
(i). Images are from typical immunohistochemistry
that were replicated at least three times for each duration of
occlusion. BF, Basal forebrain; St,
striatum; ip, ipsilateral; co,
contralateral. Scale bar (in i), 25 µm.
a-h, Bright-field, 200×; i, phase
contrast. Locations of areas magnified are indicated in Figure
1a.
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Cit-IR is stimulated by ischemia to a substantially lesser extent
in nNOS / mice
Augmented cit-IR is evident in nNOS / mice
after MCAo but to a substantially lesser extent than wild-type animals
(Fig. 1e). Higher magnification examination in the basal
forebrain and striatum at 3 hr reveals more cit-IR in the peri-infarct
than infarcted tissue (Fig. 2e,h). This staining
is blocked by preabsorption of the antiserum with the citrulline
antigen (Fig. 2f). In nNOS /
mice, both nNOS and cit-IR involve neurons with well defined perikarya
and processes (Fig. 2i). For occlusions <3 hr, no cit-IR is
detected in the nNOS / mice (n = 6; data not shown). To ascertain a potential role of iNOS
after focal ischemia, we conducted iNOS staining but detected no
iNOS-IR in brains of wild-type or nNOS / mice
after 3 hr of MCAo (n = 5; data not shown).
Ischemia causes a fourfold increase in the number of
cit-IR perikarya
To quantify the neuronal responses in greater detail, we counted
cit-IR perikarya (Fig. 3). We conducted
cell counting in the corpus striatum and basal forebrain in brains
subjected to 30 min of unilateral MCAo, a time point at which cit-IR is
increased but cell loss as a result of necrosis is minimal. The
striatum was differentiated into an area with a large amount of
infarction (designated A), the striatal peri-infarct area (designated
B), and the basal forebrain area (designated C) (Fig. 3b).
Increased numbers of cit-IR perikarya are most apparent in the
peri-infarct striatum with a substantially lesser augmentation in the
infarcted area (Fig. 3a, histogram). The increase in the
basal forebrain is similar to the augmentation in the peri-infarct
striatum. Contralateral to MCAo, no increase in cit-IR compared with
control is evident in any of the examined areas. We did not conduct
cell counting in the cerebral cortex because the increased cit-IR in
the cortex primarily reflects staining of neuropil, consistent with
localization of cortical nNOS primarily in processes rather than in
perikarya (Aoki et al., 1993 ).

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Figure 3.
Ischemia increases the number of cit-IR perikarya.
a, A representative coronal section showing the
distribution of cit-IR perikarya after 30 min of MCAo in a wild-type
mouse. +, Cit-IR perikaryon; X, infarcted hemisphere.
b, Three areas were selected for quantification:
striatum, A; medial striatum, B; and basal forebrain, C. The histogram
shows the number of cit-IR perikarya per square millimeter for each
area. Unilateral MCAo increases the density of cit-IR cells in all
areas examined ipsilateral (MCAo-Ipsi) but not
contralateral (MCAo-Contra). This includes the medial
striatum (area B), an area devoid of major necrosis after MCAo. Data
are presented as means ± SEM. Untreated, n = 8; ipsilateral MCAo, n = 4; contralateral MCAo,
n = 4. Significance was determined by
comparing untreated or contralateral MCAo with ipsilateral MCAo by
using one-way ANOVA with Fisher's post hoc test.
p < 0.05; p < 0.001. There was no statistically significant difference between untreated and
contralateral MCAo in either area. c, A representative
cit-IR neuron ipsilateral to MCAo displays extensive cit-IR of
perikaryon and processes, whereas a representative neuron contralateral
to MCAo displays much less extensive IR (d). This
shows that quantification by counting cit-IR perikarya underestimates
the overall increase in citrulline production. The adjacent endothelium
is devoid of cit-IR, presumably because eNOS is not activated.
c, d, Bright-field, 400×.
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The fourfold increase in the number of cit-IR cells triggered by
ischemia is less striking than the more dramatic overall enhancement of
cit-IR in ischemic areas observed at low magnification (Fig. 1). This
discrepancy reflects the greater increase of citrulline in neuronal
processes than perikarya. Low-magnification staining of cit-IR reveals
citrulline in neuronal processes, as well as perikarya. Higher
magnification examination reveals substantial cit-IR in extensively
branched processes in addition to perikaryal staining ipsilateral to
MCAo, whereas contralateral staining is both of lesser intensity and
extent (Fig. 3c,d). Some cit-IR occurs in neurons
that overlay blood vessels, but staining is confined to the neurons
with no endothelial staining (Fig. 3c). We see only
occasional cit-IR in the endothelium with little difference between
ischemic and nonischemic tissue.
Only a minority of nNOS cells stain for citrulline: evidence for
"quiescent" nNOS
To clarify the relationship between cells that express citrulline
and nNOS, we stained contiguous sections for nNOS and citrulline and
quantified nNOS-IR and cit-IR in contiguous coronal sections (Fig.
4). In untreated brains, the
density of cit-IR neurons in the striatum is only 23% of the density
of nNOS-positive neurons, similar to previous observations (Pasqualotto
et al., 1991 ; Eliasson et al., 1997 ). This suggests that, under basal
conditions, most nNOS neurons are not actively synthesizing citrulline
at detectable levels. To evaluate whether they retain the capacity to
form citrulline, we administered NMDA into the striatum by
microdialysis (Fig. 4). NMDA administration, which activates nNOS by
stimulating calcium entry (Bredt and Snyder, 1990 ), augments the number
of cit-IR perikarya to levels comparable with the number of nNOS-IR
perikarya. Ischemia also augments the number of cit-IR perikarya to
levels comparable with those of nNOS-IR perikarya. In contrast, cit-IR contralateral to MCAo is similar to the levels observed under basal
conditions.

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Figure 4.
Photomicrographs illustrating the presence of
quiescent nNOS in mice. The density of cit-IR neurons in the striatum
(a) is less than the density of nNOS-IR in a
contiguous section (b). NMDA administration
markedly increases cit-IR (c) to levels
comparable with nNOS-IR. Similarly, in the striatum of mice subjected
to 30 min of unilateral MCAo, contralateral cit-IR density
(d) is less than nNOS-IR
(e), although ipsilateral
(f), they are comparable.
Cit, Citrulline; ip, ipsilateral;
co, contralateral; / , mouse deficient in nNOS
expression; ctrl, control. a-e,
Bright-field, 100×. Data are from typical immunohistochemistry that
was repeated at least three times for each condition. g,
Quantification of citrulline and nNOS-IR in the striatum demonstrates
the presence of a large pool of quiescent nNOS neurons that can be
activated by either NMDA application or 30 min of MCAo. Each data point
is mean ± SEM. Control, n = 8; NMDA,
n = 3; ipsilateral MCAo, n = 6;
contralateral MCAo, n = 6. p < 0.001 for either NMDA or ipsilateral MCAo compared with either control
or contralateral MCAo using one-way ANOVA with Bonferroni's
post hoc test; there is no statistically significant
difference between either control and contralateral, or NMDA and
ipsilateral.
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The enhancement of nNOS activity after focal ischemia could be caused
by increased enzymatic activity in all nNOS neurons, stimulation of
previously inactive nNOS cells, or to stimulation of NOS activity in
cells other than nNOS neurons. The intensity of cit-IR appears
approximately the same in the minority of nNOS neurons displaying
cit-IR under basal conditions as in neurons after NMDA treatment or
focal ischemia. Thus, the mechanism of increased NO formation in
ischemic stroke seems to primarily involve activation of previously
"quiescent" nNOS neurons.

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Figure 5.
3-Nitrotyrosine immunoreactivity in the
ischemic lesion. Nissl staining (a, b)
and 3NT-IR (c, d) of ischemic lesions of
the right hemisphere in wild-type (wt) and
nNOS / ( / ) mice at the level of the
decussation of the anterior commissure. Nissl staining delineates the
ischemic lesion of the wild-type mouse by staining pallor. Note the
marked swelling of the right hemisphere with a gross shift to the left
side. In comparison, except for pallor in the MCA territory on Nissl
stain, little gross damage is evident in the
nNOS / brains. There is a marked increase of
3NT-IR in a contiguous tissue section within the wild-type mouse in
relation to the zone of cortical and subcortical damage observed in the
Nissl section. No such increase is found in a serial cut
tissue section from the nNOS / mouse. Although
the contralateral hemisphere of the wild-type mouse appears darker than
the nNOS / mouse, that staining was not
specific. Photomicrographs of 3-nitrotyrosine immunohistochemistry
in the cerebral cortex (e,
f) and striatum (g,
h) of wild-type and nNOS /
mouse, respectively, from the coronal sections shown above. There is a
significant increase in 3NT-IR within cortical and striatal neurons and
neuropil from tissue sections of wild-type mice compared with
nNOS / mice. e-h,
Bright-field, 200×.
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|
Different localizations of 3-nitrotyrosine and citrulline
A variety of evidence indicates that NO itself does not elicit
cell death. Rather, the rapid reaction between NO and superoxide to
form peroxynitrite, a powerful reactive oxygen species, is thought to
mediate NO-triggered cell death (Beckman and Koppenol, 1996 ).
Peroxynitrite mediates nitration of tyrosine to form
3-nitrotyrosine, which has been used as a biochemical marker for
peroxynitrite formation. Although other chemical species can nitrate
tyrosine, in vivo peroxynitrite is the major source,
particularly in the absence of neutrophils (Beckman and Koppenol,
1996 ). Because of these considerations, one might expect 3NT to
predominantly label infarcted tissue. To examine this possibility, we
compared 3NT-IR and cit-IR after MCAo (Fig. 5). After 3 hr of MCAo, we observed a marked increase in 3NT-IR restricted to the
ischemic infarcted area in wild-type mice (Fig. 5). IR occurs in
neurons, the surrounding neuropil, and vascular endothelium in the
striatum and the cerebral cortex. In nNOS /
mice, the ischemic lesion is reduced, as reported previously (Huang et
al., 1994 ; Hara et al., 1996a ), and devoid of enhanced 3NT-IR.
In contiguous sections, we compared cit-IR and 3NT-IR (Fig. 6). Whereas
3NT-IR is restricted to the infarcted area, cit-IR extends more
medially into the peri-infarcted zone.

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|
Figure 6.
Comparison of 3NT-IR and cit-IR in relation to the
ischemic lesion determined by delineating pallor in Nissl staining in
contiguous tissue sections after 3 hr of MCAo. Whereas 3NT-IR is
restricted to the ischemic lesion, cit-IR is high in other areas as
well (arrowhead). CC, Cerebral cortex;
St, striatum; / , nNOS /
mouse. Data are from a typical experiment that was replicated three
times.
|
|
 |
DISCUSSION |
One of the main findings of the present study is that nNOS is
selectively activated in specific brain areas associated with focal
ischemia. Abundant evidence has implicated excess release of NO in the
etiology of ischemic brain damage (Malinski et al., 1993 ; Iadecola,
1997 ), which is substantially reduced in nNOS /
mice (Huang et al., 1994 ) and after treatment with NOS inhibitors (Dawson and Dawson, 1997 ). However, the poor spatial resolution in
these studies has limited conclusions regarding sources of NO
production after focal cerebral ischemia. Our study shows selective patterns of nNOS activation that clarify mechanisms whereby NO elicits
ischemic damage.
Thus, one of our notable findings is that, after initial cit-IR
increases in both the peri-infarcted and infarcted area, cit-IR, in
most animals, is prominent only in the peri-infarct area, which continues to be supplied by branches of the anterior cerebral artery.
Transient depolarizations associated with spreading depression could be
responsible for the increased cit-IR in peri-infarct tissue. These
depolarizations are known to occur in peri-infarct tissue, triggered by
extracellular release of potassium and excitatory amino acids in the
infarcted tissue (Hossmann, 1996 ). The triggering of the spreading
depolarization by ischemia is variable, as a recent study in mice
eliciting focal ischemia by the same procedure used here, revealed such
events only in a subset of animals (Zaharchuk et al., 1997 ).
Presumably, spreading depolarization is triggered in animals in which
the medial peri-infarct zones stain intensely for citrulline.
The continued viability of tissue in an area associated with the most
prominent augmentation of cit-IR indicates that NO itself is not
sufficient to elicit neuronal death. Instead, it is likely that the
combination of NO with superoxide, formed by hypoxic mitochondria,
leads to the formation of peroxynitrite, which most likely kills cells
by direct reaction with cellular targets (Beckman and Koppenol, 1996 ).
The absence of 3NT-IR in nNOS / mice, which
coincides with the protection against stroke damage in these animals,
and the selective localization of 3NT-IR to areas of infarcted tissue
in wild-type mice further substantiates the conclusion that
peroxynitrite rather than NO itself is responsible for cell death.
3NT-IR is also selectively augmented in neurodegenerative diseases,
such as amyotrophic lateral sclerosis and Parkinson's disease (Schulz
et al., 1995 ; Beal et al., 1997 ; Ferrante et al., 1997 ), suggesting a
prominent role for peroxynitrite in neurotoxicity. The lack of any
3NT-IR in the nNOS / mice most likely is
attributable to insufficient production of NO to compete with
superoxide dismutase for superoxide. It is estimated that micromolar
concentrations of NO are necessary to generate peroxynitrite. Whereas
micromolar levels of NO have been recorded after ischemia (Malinski et
al., 1993 ), physiological concentrations of NO in wild-type mice are in
the nanomolar range. In nNOS / mice brains,
Ca2+-dependent NOS activity and
[3H]L-NG-nitro-arginine
autoradiography are reduced by 95% compared with wild type (Huang et
al., 1993 ; Hara et al., 1996b , 1997 ). The residual 5% NOS
activity may not generate enough 3-nitrotyrosine for detection by immunohistochemistry.
Cit-IR was present in nNOS / mice brains,
although at lower levels than wild-type brains, and was augmented after
focal ischemia. This persistent cit-IR is unlikely to be attributable
to eNOS. We (Dinerman et al., 1994 ; O'Dell et al., 1994 ) and others
(Doyle and Slater, 1997 ) initially reported evidence for eNOS staining by immunohistochemistry and NADPH diaphorase in neurons, although studies by others only identified eNOS in blood vessels in the brain
(Seidel et al., 1997 ; Stanarius et al., 1997 ; Topel et al., 1998 ). One
limitation of immunohistochemistry involves the possibility of eNOS
antibodies recognizing nonspecific antigens. NADPH diaphorase staining
reflects oxidative enzyme activity using NADPH as an electron donor and
so can involve enzymes other than NOS. This is supported by
observations that changes in fixation protocols alter the distribution
of NADPH diaphorase staining (Dinerman et al., 1994 ; Buwalda et al.,
1995 ). In situ hybridization using appropriate probes and
high-stringency conditions can be highly specific. In a recent study
using a cRNA probe for eNOS, we failed to detect any eNOS in neuronal
populations (G. E. Demas, L. J. Kriegsfeld, S. Blackshaw, P. Huang, S. C. Gammie, R. J. Nelson, and S. H. Snyder,
unpublished observations). Furthermore, we failed to detect any
increase in cit-IR in the endothelium after ischemia in both wild-type
and nNOS / mice, suggesting that there is no
accumulation of citrulline in the endothelium after ischemia. Thus,
eNOS does not contribute substantially to the increase in cit-IR
observed in post-ischemic wild-type and nNOS / brains.
iNOS has also been implicated in focal ischemia but only at >24 hr
after onset of ischemia (Iadecola, 1997 ). No iNOS activity was detected
by calcium-independent conversion of
L-[3H]arginine to
L-[3H]citrulline in normal or ischemic
mice brains 0-4 d after MCAo (Yoshida et al., 1995 ). In this study,
using immunohistochemistry for iNOS, no labeling of neuronal
populations in either wild-type or nNOS / mice
was observed 22 hr after MCAo. Thus, iNOS is not responsible for the
augmented cit-IR in the post-ischemic wild-type and
nNOS / brains.
Because there are nNOS-positive neurons in the
nNOS / mice (Fig. 2i), the
persistent cit-IR presumably reflects alternatively spliced forms of
nNOS, designated nNOS and nNOS , which do not use exon 2 for
transcription (Brenman et al., 1996 ). Because the nNOS / mice were created by inserting a stop
codon in exon 2 (Huang et al., 1993 ), nNOS and nNOS persist in
these mice. Brenman et al. (1996) observed catalytic activity with
nNOS but not with nNOS , whereas Marsden and colleagues (Wang et
al., 1997 ) have detected some catalytic activity in nNOS cloned
independently from the testes. Whether nNOS and nNOS contribute
in intact organisms to NO formation has not been clear. Previously, we
showed by in situ hybridization that nNOS mRNA is
prominent in areas of the brain displaying residual NOS catalytic
activity in nNOS / mice and that modest levels
of cit-IR are retained in the mutant mice (Eliasson et al., 1997 ). Our
present findings establish more definitively that the alternatively
spliced residual forms of nNOS are catalytically active and capable of
stimulation after focal ischemia. However, the level of NOS activity is
substantially less than in wild-type animals, and no 3NT-IR is
detectable, explaining the marked protection of
nNOS / mice from stroke damage.
Our comparisons of proportions of cells staining for citrulline and
nNOS reveal a pattern for activation of neurotransmitter formation that
differs markedly from classical transmitters. Most neurotransmitters
are stored in synaptic vesicles, and their effects are elicited after
exocytosis. In contrast, NO, because of its lipid solubility (Yun et
al., 1996 ), cannot be stored in vesicles, and transmitter release
directly follows activation of nNOS (Jaffrey and Snyder, 1995 ). Under
basal conditions, we find that only 20% of nNOS neurons stain for
citrulline and hence are actively synthesizing NO. NMDA treatment or
focal ischemia augments the proportion of cit-IR cells markedly. This
activation of at baseline quiescent nNOS fits with abundant
other evidence supporting a tight regulation of NOS activity necessary
to enable NO to function as a neurotransmitter (Yun et al., 1996 ).
 |
FOOTNOTES |
Received Jan. 22, 1999; revised April 7, 1999; accepted May 6, 1999.
This work was supported by a Gustavus and Louise Pfeiffer Scholarship
(M.J.L.E.), the Veterans Administration, National Institutes of Health
Awards NS37102, NS35255, and AG12992 (R.J.F.), Interdepartmental Stroke
Program Project P50 NS10828 (M.A.M.), United States Public Health
Service Grant MH18501 (S.H.S), and Research Scientist Award DA-00074
(S.H.S.). We thank Eng H. Lo for help with intrastriatal NMDA
perfusion, Paul L. Huang for assistance with the
nNOS / mice, and Michael J. Schell for helpful advice.
Correspondence should be addressed to Dr. Solomon H. Snyder, Department
of Neuroscience, Johns Hopkins University School of Medicine, 725 North
Wolfe Street/813 Wood Basic Science Building, Baltimore, MD 21205.
 |
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D. S. Warner, H. Sheng, and I. Batinic-Haberle
Oxidants, antioxidants and the ischemic brain
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G. A. Rameau, L.-Y. Chiu, and E. B. Ziff
Bidirectional Regulation of Neuronal Nitric-oxide Synthase Phosphorylation at Serine 847 by the N-Methyl-D-aspartate Receptor
J. Biol. Chem.,
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T. Altay, E. R. Gonzales, T. S. Park, and J. M. Gidday
Cerebrovascular inflammation after brief episodic hypoxia: modulation by neuronal and endothelial nitric oxide synthase
J Appl Physiol,
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B. R. Jarabek, R. P. Yasuda, and B. B. Wolfe
Regulation of proteins affecting NMDA receptor-induced excitotoxicity in a Huntington's mouse model
Brain,
March 1, 2004;
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505 - 516.
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G. Takahashi, M. Sakurai, K. Abe, Y. Itoyama, and K. Tabayashi
MCI-186 prevents spinal cord damage and affects enzyme levels of nitric oxide synthase and Cu/Zn superoxide dismutase after transient ischemia in rabbits
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P. M. Klinge, A. Samii, A. Muhlendyck, K. Visnyei, G.-J. Meyer, G. F. Walter, G. D. Silverberg, and T. Brinker
Cerebral Hypoperfusion and Delayed Hippocampal Response After Induction of Adult Kaolin Hydrocephalus
Stroke,
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A.A. Mongin, H. Bolay, and T. Dalkara
Nitric Oxide May Contribute to the Long-Term Impairment of Synaptic Transmission After Transient Ischemia
Stroke,
October 1, 2002;
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K.-j. Yin, S.-D. Chen, J.-M. Lee, J. Xu, and C. Y. Hsu
ATM Gene Regulates Oxygen-Glucose Deprivation-Induced Nuclear Factor-{kappa}B DNA-Binding Activity and Downstream Apoptotic Cascade in Mouse Cerebrovascular Endothelial Cells
Stroke,
October 1, 2002;
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2471 - 2477.
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H. S. Han, Y. Qiao, M. Karabiyikoglu, R. G. Giffard, and M. A. Yenari
Influence of Mild Hypothermia on Inducible Nitric Oxide Synthase Expression and Reactive Nitrogen Production in Experimental Stroke and Inflammation
J. Neurosci.,
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E. Paxinou, Q. Chen, M. Weisse, B. I. Giasson, E. H. Norris, S. M. Rueter, J. Q. Trojanowski, V. M.-Y. Lee, and H. Ischiropoulos
Induction of {alpha}-Synuclein Aggregation by Intracellular Nitrative Insult
J. Neurosci.,
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G.-W. Lu and H.-Y. Liu
Downregulation of nitric oxide in the brain of mice during their hypoxic preconditioning
J Appl Physiol,
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G. DENG, N. D. VAZIRI, B. JABBARI, Z. NI, and X.-X. YAN
Increased Tyrosine Nitration of the Brain in Chronic Renal Insufficiency: Reversal by Antioxidant Therapy and Angiotensin-Converting Enzyme Inhibition
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A. Wagle and J. P. Singh
Fibroblast Growth Factor Protects Nitric Oxide-Induced Apoptosis in Neuronal SHSY-5Y Cells
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Y.-W. E. Chang, R. Jakobi, A. McGinty, M. Foschi, M. J. Dunn, and A. Sorokin
Cyclooxygenase 2 Promotes Cell Survival by Stimulation of Dynein Light Chain Expression and Inhibition of Neuronal Nitric Oxide Synthase Activity
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K. Sampei, A. S. Mandir, Y. Asano, P. C. Wong, R. J. Traystman, V. L. Dawson, T. M. Dawson, P. D. Hurn, and C. Y. Hsu
Stroke Outcome in Double-Mutant Antioxidant Transgenic Mice Editorial Comment
Stroke,
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Y. Gursoy-Ozdemir, H. Bolay, O. Saribas, T. Dalkara, and J. S. Beckman
Role of Endothelial Nitric Oxide Generation and Peroxynitrite Formation in Reperfusion Injury After Focal Cerebral Ischemia Editorial Comment
Stroke,
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A. J. Gow, Q. Chen, M. Gole, M. Themistocleous, V. M.-Y. Lee, and H. Ischiropoulos
Two distinct mechanisms of nitric oxide-mediated neuronal cell death show thiol dependency
Am J Physiol Cell Physiol,
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J. CUI, E. H. HOLMES, T. G. GREENE, and P. K. LIU
Oxidative DNA damage precedes DNA fragmentation after experimental stroke in rat brain
FASEB J,
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R. Golser, A. C. F. Gorren, A. Leber, P. Andrew, H.-J. Habisch, E. R. Werner, K. Schmidt, R. C. Venema, and B. Mayer
Interaction of Endothelial and Neuronal Nitric-oxide Synthases with the Bradykinin B2 Receptor. BINDING OF AN INHIBITORY PEPTIDE TO THE OXYGENASE DOMAIN BLOCKS UNCOUPLED NADPH OXIDATION
J. Biol. Chem.,
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V. L. Dawson
Potent neuroprotectants linked to bifunctional inhibition
PNAS,
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C. Quijano, D. Hernandez-Saavedra, L. Castro, J. M. McCord, B. A. Freeman, and R. Radi
Reaction of Peroxynitrite with Mn-Superoxide Dismutase. ROLE OF THE METAL CENTER IN DECOMPOSITION KINETICS AND NITRATION
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