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The Journal of Neuroscience, 2001, 21:RC195:1-6
RAPID COMMUNICATION
Prenatal Choline Supplementation Protects against Postnatal
Neurotoxicity
Shirley X.
Guo-Ross1, 3,
Suzanne
Clark1, 2,
Daniel A. C.
Montoya1, 3,
Katherine H.
Jones1, 2,
Jennifer
Obernier6,
Ashok K.
Shetty1, 4,
Aaron M.
White1, 3,
Jan Krzysztof
Blusztajn7,
Wilkie A.
Wilson1, 2, and
H. Scott
Swartzwelder1, 3, 5
1 Neurobiology Research Laboratory, Veterans Affairs
Medical Center, Durham, North Carolina 27705, Departments of
2 Pharmacology, 3 Psychiatry, and
4 Surgery, Duke University Medical Center, Durham, North
Carolina 27710, 5 Department of Psychology, Duke
University, Durham, North Carolina 27710, 6 Center for
Alcohol Studies, University of North Carolina School of Medicine,
Chapel Hill, North Carolina 27514, and 7 Department of
Pathology and Laboratory Medicine, Boston University School of
Medicine, Boston, Massachusetts 02118
 |
ABSTRACT |
Choline, a dietary compound present in many foods, has recently
been classified as an essential nutrient for humans. There is evidence
from animal models that the availability of choline during the prenatal
period influences neural and cognitive development. Here we report that
choline supplementation during a 6 d gestational period protects
against neurodegeneration in the posterior cingulate and retrosplenial
cortices of female adolescent rats produced by peripheral
administration of the NMDA receptor antagonist dizocilpine (MK-801).
These data show that availability of a single nutrient, choline, during
a brief period of prenatal development diminishes vulnerability to
neurotoxicity in adolescent offspring.
Key words:
choline; neurotoxicity; cingulate; NMDA; MK-801; supplementation
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INTRODUCTION |
Poor
nutrition early in life, as well as perinatal insults such as exposure
to alcohol or other neurotoxins, have been linked to a variety of
abnormalities in brain development and behavior. Thus, there is much
interest in ensuring that pregnant and lactating women consume a diet
that is rich in nutrients necessary for the proper physical and
cognitive development of children. An example is the recent public
health policy initiative in the United States designed to reduce the
incidence of neural tube defects in newborns by supplementing all grain
products with folic acid to ensure high folate consumption by American women.
Choline, although less well studied than folate, is also an essential
nutrient. In recognition of its key role during development, the
recommended daily intake of this compound is higher during pregnancy
and lactation (Zeisel and Blusztajn, 1994 ; Blusztajn, 1998 ). Although
choline is available in many foods, the normal dietary sources may
prove to be insufficient during times of heightened need, such as
pregnancy and lactation (Zeisel and Blusztajn, 1994 ). Because choline
is particularly important during fetal development, dietary
supplementation during this time could provide long-lasting benefits.
Recent studies in animal models have indicated that prenatal choline
supplementation does indeed produce enduring enhancements of CNS
function. For example, prenatal choline supplementation has been shown
to increase phospholipase-D activity in the hippocampus of adult
offspring (Holler et al., 1996 ) and to decrease acetylcholine esterase activity in the hippocampus of juvenile offspring
(Cermak et al., 1999 ). These changes are consistent with the
improvements in spatial (Meck et al., 1988 ; Williams et al., 1998 ) and
temporal (Meck and Williams, 1997 ) memory observed in adult offspring
after prenatal choline supplementation, as well as with enhancement of
NMDA receptor-mediated neurotransmission (Montoya and
Swartzwelder, 2000 ) and long-term potentiation (Pyapali et al.,
1998 ) in hippocampal slices from prenatally choline-supplemented rats.
Prenatal choline supplementation has also been shown to protect against
the memory deficits that occur after severe pilocarpine-induced seizures (Yang et al., 2000 ). This finding suggests that prenatal choline supplementation may provide protection against postnatal neurotoxicity. Because of our interest in neurotoxicity from drugs of
abuse, we were interested in whether this supplementation could protect
against the neurotoxicity in the cingulate gyrus produced by NMDA
receptor antagonists, several of which are drugs of abuse, including
ethanol, ketamine, and phencyclidine. To test this hypothesis, we
provided dietary choline supplementation to pregnant rat dams during a
6 d period and then measured the neurotoxic effect of the NMDA
receptor antagonist dizocilpine (MK-801) on the offspring during adolescence.
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MATERIALS AND METHODS |
Prenatal choline treatment. Pregnant Sprague Dawley
rats were obtained from Charles River (Raleigh, NC) at day 9 of
gestation [embryonic day 9 (E9)] and housed individually in clear
polycarbonate cages (27.9 × 27.9 × 17.8 cm3) on a 12 hr light/dark cycle at the
Durham Veterans Affairs Medical Center vivarium. From the day of
arrival, dams were given tap water and purified Dyets formula AIN-76A
(Dyets Inc., Bethlehem, PA) containing the standard amount of
choline (7.9 mmol/kg choline chloride) ad libitum.
This provided an average daily choline intake of ~1.3 mmol/kg. During
E12-E17, choline chloride (25 mM)-supplemented drinking
water was given to one group of dams ("supplemented"). The other
group was given water with no added choline ("nonsupplemented"). The average total water intake across days E12-E17 was 158 gm for
control dams and 149 gm for those receiving choline supplementation. This resulted in an average daily choline intake of 4.6 mmol/kg for the
supplemented group, whereas the nonsupplemented group continued to
receive the standard amount (1.3 mmol · kg 1 ·
d 1). In both groups, saccharine (50 mM) was
used to neutralize the bitter taste of choline in the water and to
equalize intake among dams in the treatment groups. The E12-E17 time
frame was chosen because it is a critical period during which
manipulation of dietary choline results in both behavioral (Meck et
al., 1988 ; Meck and Williams, 1997 ; Williams et al., 1998 ) and
electrophysiological (Pyapali et al., 1998 ; Montoya and Swartzwelder,
2000 ) changes in offspring.
After E17, all dams were placed back on regular tap water (i.e.,
without choline or saccharine) and continued on the normal AIN-76A diet. Within 24 hr after birth, the pups were
cross-fostered between the dams to litters of equal size
(n = 12-14/litter). Pups were weaned at postnatal day
22 (P22), housed four to a cage, and provided the AIN-76A diet (i.e.,
with a standard choline level) and water ad libitum.
Drug treatment. A total of 16 male and 16 female offspring
from a total of five litters were used for this study. One-half of the
rats of each gender were given MK-801 (5 mg/kg, at 1 ml/kg injection
volume, i.p.; RBI-Sigma, St. Louis, MO) on P39, and the other one-half
were administered MK-801 on P42. At the time of MK-801 injection, the
average body weights (in grams) were 190 (±4 SEM, male, control), 180 (±3.2 SEM, male, supplemented), 141 (±6.2 SEM, female, control), and
137 (±3.7 SEM, female, supplemented). This dose of MK-801 has been
shown to produce neurotoxicity in young rats (Olney et al., 1991 ; Fix
et al., 1995 ; Corso et al., 1997 ). Saline-injected controls were not
used, because previous studies have shown that positive neurons are
almost never seen with Fluoro-Jade (FJ) staining in saline-injected
rats (Schmued et al., 1997 ). This was demonstrated clearly in a similar
study designed to study the effects of agents that were protective
against NMDA receptor antagonist-induced neurotoxicity (Olney et al., 1991 ).
Histology. At 3 days after MK-801 injection, the rats were
weighed, anesthetized with Halothane, and perfused transcardially with
150 ml of heparinized saline followed by 250 ml of 4%
paraformaldehyde. The brains were removed and post-fixed in 4%
paraformaldehyde overnight, transferred to 0.1 M
phosphate buffer (PB) for 1 d, and then soaked in 30% sucrose in
0.1 M PB for 3-5 d until sinking. Cryostat
sections (40 µm) were cut and stored in 0.1 M
PB at 4°C.
The sections were processed for staining with FJ-B or with the older,
related fluorochrome, FJ. Sections from all of the animals were
stained with FJ-B, and the cell numbers from these sections were used
for all statistical analyses. Alternating sections from one-half of the
animals from each treatment group were stained with FJ as an internal
comparison of the methods and for purposes of illustration. The
staining methods were as described previously (Schmued et al., 1997 ;
Schmued and Hopkins, 2000 ). Both FJ and FJ-B provided similar staining
patterns with respect to the anatomical regions stained, the number of
positive neurons per region, and agreement between the individuals
doing the counting. FJ provided better staining of neuronal processes,
and so was used for photographic images (Fig.
1). FJ-B showed less background staining
(and positive neurons stood out more clearly, facilitating counting),
and so was used for quantitative measures. Twelve serial sections
(approximately every seventh section) from each animal were selected in
a rostral-to-caudal orientation and comprised 3.5 mm along the
anteroposterior axis of the cingulate cortex (CC) and retrosplenial
cortex (RSC) ( 0.3 to 3.8 mm from bregma; see Fig. 3A,B).
Sections were mounted from distilled water onto 0.5% gelatin-coated
slides and air-dried at room temperature overnight. Slides were then
processed in the following solutions: 100% ethanol (3 min), 70%
ethanol (1 min), distilled water (1 min), 0.06% potassium permanganate
(7 min with slow shaking), distilled water (1 min), 0.01% FJ or
0.004% FJ-B (Histo-Chem Inc., Jefferson, AR) (in 0.1% acetic acid)
for 30 min (FJ) or 20 min (FJ-B) with slow shaking in the dark, and
distilled water (three times for 1 min). Slides were then
air-dried in the dark for at least 2 hr (but not >2 d); dehydrated in
70, 95, and 100% ethanol; placed in xylene; and then
coverslipped with distyrene plasticizer xylene (Electron
Microscopy Sciences, Washington, PA).

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Figure 1.
Fluoro-Jade staining of sections from
MK-801-treated nonsupplemented (A) and
choline-supplemented (B) female rats.
A1 and
B1 show a low-magnification view (10×
magnification). Scale bar, 200 µm. Boxes in
A1 and
B1 indicate areas enlarged in
A2 and
B2 (40× magnification). Scale bar, 50 µm. C, Fluoro-Jade-positive stained neurons
(C1) counterstained with H&E
(C2): (100× magnification). Scale
bar, 20 µm. Arrowheads show degenerating neurons.
Sections were taken from between approximately 2.00 and 2.25 mm
relative to bregma.
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The stained sections were examined with a Nikon (Tokyo, Japan)
epifluorescence microscope using a FITC filter. Neurotoxicity was
assessed by an individual who was blind to the treatment condition of
the animals from which sections were taken. In the CC-RSC region, bilateral FJ-positive cell counts were made from 12 serial sections (see Fig. 3).
Some FJ-stained sections (four each from supplemented and
nonsupplemented animals) were counterstained with hematoxylin and eosin
(H&E) using standard methods (Fig. 1). Three measures of neurodegeneration were qualitatively assessed by visual inspection: nuclear size, condensation, and an eosinophilic cell body. Four sections per animal in both supplemented and nonsupplemented groups were also stained for neurodegeneration using a silver staining kit (FD
NeuroTechnologies, Ellicott City, MD). Degenerating neurons were
assessed under a light microscope (by visual inspection).
Statistical analysis. The data from FJ-positive cell counts
were analyzed using a two-way ANOVA with dietary treatment
condition and day of MK-801 administration as between-subjects factors
and histological section as the within-subjects factor. Comparisons of
particular histological sections across dietary treatment groups were
made using parametric post hoc tests where appropriate and secondary to the overall ANOVA.
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RESULTS |
Consistent with previous findings, administration of MK-801 caused
degeneration of neurons in the CC-RSC (Olney et al., 1989 ; 1991 ), as
evidenced by FJ staining (Fig. 1A,B) (Schmued
and Hopkins, 2000 ), and varied across the rostral-to-caudal sections
that were analyzed (Fix et al., 1995 ; Corso et al., 1997 ).
As reported previously, females were more sensitive than males to NMDA
receptor antagonist-induced neurotoxicity (Hönack and
Löscher, 1993 ; Fix et al., 1995 ). Very little neuronal damage was
observed in male offspring of either age. Of a total of 16 male rats
tested, only 3 rats showed any FJ-positive stained neurons, and in
those rats, the maximum number of stained neurons in any section was
eight. The average number of positively stained neurons per section was
0.16 (±0.09 SEM) in sections from control males, and 0.3 (±0.11 SEM)
in sections from prenatally choline-supplemented animals. This minimal
amount of positive staining in sections from males precluded any
statistical comparisons between control and choline-supplemented males.
Therefore, all subsequent analyses were performed on females.
In FJ-stained sections, degenerating neurons have a bright
yellowish-green soma against a dark green background. Some neurons were
clearly pyramidal in shape, and in some neurons proximal processes were
also stained. In the sections from control animals, 80% (SD = 2)
of the FJ-positive neurons were pyramidal; in sections from prenatally
choline-supplemented animals, 83% (SD = 4.5) were pyramidal. This
difference was not statistically significant
(t(8) = 1.462; p = 0.18). Neurodegeneration was most prominent in deep cortical layers,
consistent with typical NMDA receptor antagonist-induced neurotoxicity,
in which cortical layers III and IV are the most affected (Olney et
al., 1989 , 1991 ). To further confirm that FJ-positive neurons were
indeed degenerating, we stained representative sections from
supplemented and nonsupplemented female rats with two other widely used
methods to assess neurodegeneration: H&E and silver. Some FJ-stained
sections were also counterstained with H&E (FJ plus H&E). In these
sections, all FJ-positive neurons showed degeneration characterized by
eosinophilic staining of the soma and proximal dendrites. Figure
1C shows a FJ plus H&E counterstained section in two views
(Fig.1C1, FJ; Fig.
1C2, H&E). As shown in Figure 2, silver staining revealed
neurodegeneration in the same layers as FJ staining.

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Figure 2.
Illustration of silver staining of sections from
MK-801-treated nonsupplemented (A) and
choline-supplemented (B) female rats.
(A1 and
B1: 40× magnification). Scale bar, 50 µm. Arrowheads in A1
and B1 show the same degenerating
neurons magnified in A2 and
B2 (100× magnification). Scale bar,
20 µm. Sections were taken from between approximately 2.00 and
2.25 mm relative to bregma.
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Prenatal choline supplementation provided significant protection
against MK-801-mediated neurotoxicity in female rats. Figure 3C shows the number of FJ-B-positive neurons in sections
from choline-supplemented and nonsupplemented female animals that were treated with MK-801 on P39 (Fig. 3C, left) or P42
(Fig. 3C, right). The ANOVA revealed significant
main effects for both dietary choline treatment
(F(1,12) = 17.33; p = 0.001) and day of MK-801 treatment (F(1,12) = 5.35; p = 0.039). In addition, the number of FJ-B-positive neurons varied
significantly across the 12 sections analyzed
(F(11) = 34.32; p < 0.0009). There was a significant interaction between this effect and
the main effect of dietary treatment
(F(11) = 6.98; p < 0.0009), indicating that the effect of choline treatment varied with
the rostrocaudal depth of the sections analyzed.
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DISCUSSION |
Dietary choline supplementation during gestation
protected against MK-801-induced neurotoxicity in adolescent offspring.
This finding is striking because it indicates that moderate dietary supplementation with an essential nutrient during a brief period of
prenatal development produces an enduring neuroprotective effect on the
offspring. This result is quite unique because most studies of prenatal
dietary manipulations have focused on the negative outcomes of
nutritional deficiency rather than on positive outcomes of supplementation.
The mechanisms underlying NMDA receptor antagonist-induced toxicity are
not well understood. However, there is evidence from in vivo
(Olney et al., 1991 ; Sharp et al., 1994 , 2001 ; Tomitaka et al., 2000 )
and in vitro (Li et al., 2000 ) studies that inhibitory processes may be involved. Based on those findings, it has been proposed that NMDA receptor antagonists cause neurodegeneration by
blocking NMDA receptor-mediated excitatory inputs onto inhibitory interneurons, and this could create a state of disinhibition sufficient to render the principle neurons vulnerable to
excitotoxicity.

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Figure 3.
Protective effects of prenatal choline
supplementation against MK-801-induced neurodegeneration in female
offspring. A, Outline of a coronal
section of the rat brain at the level of the optic chiasm
(corresponding to 0.3 mm posterior to bregma). This is the
anterior-most part of the CC at which counting of
Fluoro-Jade-positive cells commenced. AC, Anterior
commissure; cc, corpus callosum; OC,
optic chiasm; ST, striatum. B,
Outline of a coronal section of the rat brain at the
level of the posterior-most part of the dorsal hippocampus
(corresponding to 3.8 mm posterior to bregma). This is the
posterior-most part of the cingulate cortex (the RSC) at which counting
of Fluoro-Jade-positive cells ended. DG, Dentate gyrus;
3V, third ventricle; IC, internal capsule.
C, Graphs show the number of Fluoro-Jade-B-positive
(FJ-B+) neurons in the CC-RSC per section from female
offspring treated with MK-801 on P39 (left) and P42
(right). Asterisks indicate a significant
difference (p < 0.05; SPSS Inc., Chicago,
IL) between equivalent rostral-to-caudal sections from supplemented and
nonsupplemented offspring. x-axis, Approximate
coordinates relative to bregma (36); y-axis, mean FJ-B+
neurons (bilaterally) in the CC-RSC, per section (±SEM).
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We do not know whether choline supplementation provides protection by
directly opposing excitotoxicity or by indirectly interacting with
modulatory processes. One possibility is that it does so through a
cholinergic mechanism. Previous studies have shown that prenatal
choline supplementation causes increased release of acetylcholine in
offspring (Cermak et al., 1998 ), and stimulation of nicotinic cholinergic receptors is known to be neuroprotective against some neurotoxic processes (Belluardo et al., 2000 ). Perhaps supplemented animals activate more nicotinic receptors and are therefore protected against NMDA receptor antagonist toxicity. However, other
studies have shown that NMDA receptor antagonist toxicity is reduced by muscarinic cholinergic antagonists. This would suggest that muscarinic receptors somehow mediate a toxic process. Prenatal choline
supplementation could also act through more general mechanisms. For
example, acetylcholine has morphogenetic actions during brain
development (Lauder and Schambra, 1999 ), and thus could influence a
number of processes that could prove to be neuroprotective. Clearly
more studies are needed to adequately test these hypotheses.
The ability of prenatal choline supplementation to enhance CNS function
and decrease vulnerability to neurotoxicity may have wide-ranging
implications. For example, the age at which we first treated animals in
this study (P39) is shortly after the onset of vulnerability to
MK-801-induced neurotoxicity (Farber et al., 1995 ; Auer, 1996 ), and
also is within the periadolescent period of development in rats (Odell,
1990 ; Witt, 1994 ). Thus, the present results have implications for
adolescent health, in that it is during adolescence that many
individuals initiate recreational use of a variety of psychoactive
compounds, including NMDA receptor antagonists such as
phencyclidine, ketamine, and alcohol. We also observed that the
protective effect of prenatal choline supplementation was greater when
MK-801 treatment was delayed several days later into adolescent
development (P42). This is consistent with previous studies that have
shown that the neurotoxicity of MK-801 increases with age into
adulthood (Farber et al., 1995 ; Auer, 1996 ). It is not known whether
the neuroprotective effect of prenatal choline supplementation persists
into adulthood, but studies are currently underway in our laboratory to
assess that possibility.
In addition to recreational use, NMDA receptor antagonists have been
used clinically, although their use in humans has been curtailed
because of unacceptable behavioral side effects. The present results
suggest a possible approach toward enhancing resistance to NMDA
receptor antagonist toxicity that could lead to strategies that would
allow the safe therapeutic use of these compounds.
Perhaps even more intriguing is the possibility that prenatal dietary
choline manipulation could decrease the vulnerability to some
psychiatric illnesses. Converging lines of evidence suggest that the
type of neuronal injury that occurs after exposure to NMDA receptor
antagonists may be related to the onset or acute manifestation of
psychosis (Ellison, 1995 ; Farber et al., 1995 ). Developmentally, the
onset of psychotic schizophrenic symptoms in humans generally does not
occur until adolescence or early adulthood (Rapoport et al., 1997 ), a
developmental onset that is consistent with the onset of toxic
liability to NMDA receptor antagonists in rats (Farber et al., 1995 ;
Auer, 1996 ). In addition, abnormalities in both the cingulate gyrus
(Shergill et al., 2000 ; Tamminga et al., 2000 ) and thalamic nuclei that
modulate cingulate activity (Shergill et al., 2000 ; Sharp et al., 2001 )
have been implicated in the etiology of psychosis. Finally, drugs that
ameliorate or prevent psychotic symptoms, such as haloperidol and
olanzapine, also attenuate NMDA receptor antagonist-induced
neurotoxicity (Sharp et al., 1994 ; Farber et al., 1996 ). Thus, prenatal
choline supplementation, as a treatment that protects against NMDA
receptor antagonist-induced neurotoxicity, could potentially diminish
the likelihood of psychosis in adolescents or young adults.
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FOOTNOTES |
Received July 11, 2001; revised Sept. 21, 2001; accepted Oct. 9, 2001.
This research was supported in part by National Institute on
Aging Grant P01-AG09525 to H.S.S. and by Senior Veterans Affairs Research Career Scientist Awards to H.S.S. and W.A.W. We extend our
thanks to Dr. Vandana Zaman for her expertise and advice with respect
to histological methods.
Correspondence should be addressed to Dr. H. Scott Swartzwelder,
Veterans Affairs Medical Center, 508 Fulton Street, Building 16, Room
24 (151E), Durham, NC 27705. E-mail: hss{at}duke.edu.
This article is published in
The Journal of Neuroscience, Rapid Communications Section,
which publishes brief, peer-reviewed papers online, not in print. Rapid
Communications are posted online approximately one month earlier than
they would appear if printed. They are listed in the Table of Contents
of the next open issue of JNeurosci. Cite this article as:
JNeurosci, 2001, 21:RC195 (1-6). The
publication date is the date of posting online at
www.jneurosci.org.
 |
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