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The Journal of Neuroscience, August 1, 2002, 22(15):6401-6407
Neuroprotection by Hypoxic Preconditioning Requires Sequential
Activation of Vascular Endothelial Growth Factor Receptor and Akt
Antje
Wick1,
Wolfgang
Wick2,
Johannes
Waltenberger3,
Michael
Weller2,
Johannes
Dichgans1, and
Jörg B.
Schulz1
Laboratories of 1 Neurodegeneration and
2 Neuro-Oncology, Department of Neurology, University of
Tübingen, 72076 Tübingen, Germany, and
3 Department of Internal Medicine II (Cardiology), Ulm
University Medical Center, 89081 Ulm, Germany
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ABSTRACT |
Hypoxic preconditioning provides protection against ischemic brain
lesions in animal models of cerebral ischemia-hypoxia. To analyze the
underlying molecular mechanisms, we developed an in
vitro model of hypoxic neuroprotection in cerebellar
granule neurons (CGN) by reducing the oxygen tension to 1-5% for
1-24 hr. Exposure to 5% O2 for 9 hr resulted in reduction
of cell death after potassium deprivation, treatment with 100 µM glutamate, or 500 µM 3-nitroproprioninc
acid (3-NP) by 46, 22, and 55%, respectively. Shorter (1 or 3 hr) or
longer (>12 hr) intervals or pretreatment with lower oxygen tension
failed to rescue CGN from death. In contrast, toxicity of four
different chemotherapeutic drugs
[1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea, cisplatine,
topotecane, and vincristine] was unaffected by hypoxic preconditioning. The induction of protective effects was dependent on
new protein synthesis. Protein levels of B-cell lymphoma
protein-2 (BCL-2), BCL-xL/S, heat shock protein
70/90, and BCL-2-associated death protein remained
unaltered. CGN incubated at 5% O2 for 9 hr showed
increased levels of the vascular endothelial growth factor (VEGF), the
VEGF receptor-2 (VEGFR-2), phosphorylated Akt/protein kinase B (PKB),
and extracellular signal-regulated kinase 1 (ERK1). Incubation with a
neutralizing anti-VEGF antibody, a monoclonal antibody to VEGFR-2,
wortmannin, or antisense-Akt/PKB, but not treatment with U0126, an
ERK-inhibitor, reverted the resistance acquired by hypoxic
preconditioning. Inhibition of VEGFR-2 blocked the activation of
Akt/PKB. Finally, pretreatment with recombinant VEGF resulted in a
hypoxia-resistant phenotype in the absence of hypoxic preconditioning.
Our data are indicating a sequential requirement for VEGF/VEGFR-2
activation and Akt/PKB phosphorylation for neuronal survival mediated
by hypoxic preconditioning and propose VEGF as a hypoxia-induced
neurotrophic factor.
Key words:
neuron; vascular endothelial growth factor; DC101; Akt; antisense oligonucleotide; glutamate; potassium; 3-nitropropionic
acid
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INTRODUCTION |
Preconditioning to ischemic
tolerance is a phenomenon in which brief episodes of a subtoxic insult
induce a robust protection against the deleterious effects of
subsequent, prolonged ischemia. Hypoxic-ischemic preconditioning
induces tolerance to focal ischemia (Miller et al., 2001 ), global
ischemia (Kitagawa et al., 1990 ), and neonatal hypoxia (Jones and
Bergeron, 2001 ). There are two temporally and mechanistically distinct
types of protection afforded by preconditioning stimuli, acute and
delayed preconditioning. Although they may share components of the
signaling pathway, they differ in their requirement of new protein
synthesis. The protective effects of acute preconditioning are protein
synthesis independent, mediated by post-translational protein
modifications, and are short lived. The effects of delayed
preconditioning require new protein synthesis and are sustained for
days and weeks (Nandagopal et al., 2001 ).
Descriptive studies have shown increased expression of heat shock
proteins (HSPs) (Sharp et al., 1999 ), B-cell lymphoma protein-2 (BCL-2)
(Shimazaki et al., 1994 ), and superoxide dismutase and decreased
expression of NMDA receptor NR2A and NR2B subunits (Shamloo et al.,
1999 ). NMDA receptor activation followed by nitric oxide (NO)-mediated activation of p21Ras
and nuclear factor- B (NF- B) appears to be a crucial step in the
generation of a signal transduction pathway resulting in hypoxic tolerance (Grabb and Choi, 1999 ; Gonzalez-Zulueta et al., 2000 ; Blondeau et al., 2001 ).
Recently, it became apparent that neurotrophic factors, such as nerve
growth factor, brain-derived neurotrophic factor (BDNF), and
insulin-like growth factor-1, protect cerebellar granule neurons (CGN),
motor neurons, or hippocampal neurons from excitotoxic and ischemic
insults (Segal and Greenberg, 1996 ; Han and Holtzman, 2000 ; Matsuzaki
et al., 2001 ). These factors activate intracellular signal transduction
pathways, including the phosphatidyl-inositol 3-kinase
(PI3-K)/Akt and mitogen-activated protein (MAP) kinase kinase
(MEK)/extracellular signal-regulated kinase (ERK) pathways (Segal and
Greenberg, 1996 ; Dudek et al., 1997 ). Vascular endothelial growth
factor (VEGF) is an angiogenic peptide that is released in response to
hypoxia in developing or neoplastic tissue; it acts on endothelial
cells to promote the sprouting of blood vessels (Neufeld et al., 1999 ).
The angiogenic action of VEGF involves an antiapoptotic effect that
promotes endothelial cell survival and is mediated through the VEGF
receptor-2 (VEGFR-2) and the PI3-K/Akt signaling pathway (Gerber et
al., 1998 ). Systemic treatment of an experimental intracerebral glioma
in mice with DC101, a monoclonal antibody to VEGFR-2, inhibited glioma
angiogenesis and growth (Kunkel et al., 2001 ). The role for VEGF in
neurons is less well defined. Deletion of the hypoxia-response element in the VEGF promoter in "knock-in" mice reduced the hypoxic VEGF expression in the spinal cord and caused motor neuron degeneration (Oosthuyse et al., 2001 ). In this study, it remained unclear whether VEGF was a survival factor for neurons through its effects on endothelial and/or neuronal cells. Others have demonstrated
neurotrophic activity for VEGF on Schwann cells and survival-promoting
effects on immortalized hippocampal neurons (Sondell et al., 1999 ; Jin et al., 2000 ).
These observations and the current interest in the therapeutic
potential of VEGF for stroke treatment led us to investigate whether preconditioning with moderate hypoxia resulted in the induction
of VEGF-dependent neuroprotective pathways. We used CGN to analyze the
effects of hypoxic preconditioning without glucose deprivation on
potassium deprivation-induced apoptosis, glutamate-induced
excitotoxicity, and inhibition of oxidative phosphorylation by
3-nitroproprioninc acid (3-NP), an irreversible inhibitor of succinate
dehydrogenase. Our results indicate that moderate hypoxia of 5%
O2 applied for 3-9 hr protects CGN against toxic
stimuli involving a pathway that sequentially requires the activation
of VEGFR-2, PI3-K, and Akt.
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MATERIALS AND METHODS |
Cell culture. Cerebellar granule neurons were
prepared from 7-d-old Sprague Dawley rats as described previously
(Weller et al., 1994 ). In brief, freshly dissected cerebella were
dissociated by mechanical disruption and by incubation at 37°C for 15 min in 0.3 mg/ml trypsin. Cells were plated in
poly-L-lysine-precoated 60 mm culture plates or
24-well plates and seeded at a density of 1 × 106 cells/cm2
in basal modified Eagle's medium supplemented with 10% fetal calf
serum, 2 mM glutamine, 20 µg/ml gentamicin, and
25 mM KCl (high K+).
Cytosine arabinoside was added at a concentration of 10 µM after 24 hr to prevent the growth of
non-neuronal cells. Contamination with glial cells was <5% (Schulz et
al., 1996 ).
Oxygen system. The standard oxygen level was defined as the
pO2 that exists in a standard, conventional,
humidified tissue culture incubator at 37°C (20%). The low (1-5%)
oxygen systems were established in a humidified environmental chamber
set at 37°C (C42; Labotect, Göttingen, Germany). This incubator
used an oxygen analyzer to monitor and maintain the selected chamber oxygen concentration. This oxygen concentration was maintained with a
calibrated gas mixture of 95% nitrogen and 5% carbon dioxide. The
cells were incubated on day 8 after preparation for 1-12 hr at 1-5%
pO2.
Treatment of cultures. In all experiments, neurons were
cultured for 7 d in 25 mM
K+ and 10% fetal calf serum before use.
For studies of K+ deprivation, medium was
replaced by serum-free basal modified Eagle's medium containing 5 mM potassium (low
K+) or 25 mM
potassium (high K+) and supplemented with
glutamine and gentamicin as indicated above. Glutamate
(Invitrogen, Beverly, MA), 3-NP (Sigma, St. Louis, MO),
1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) (Bristol, Munich,
Germany), cisplatine (Bristol), topotecane (GlaxoSmithKline Pharmaceuticals, Harlow, UK), or vincristine (Bristol) were added to
neurons cultured in high K+ and serum on
day 8 after preparation. Viability was measured at 24 hr after hypoxic
preconditioning. To investigate whether protein synthesis is relevant,
cycloheximide (CHX) (Sigma) was added to the cells. Wortmannin was
purchased from Sigma. LY924002 was obtained from Biomol (Plymouth
Meeting, PA), and U0126 (dissolved in DMSO from Sigma) was purchased
from Calbiochem (La Jolla, CA).
Determination of viability. Neurons plated in 24-well plates
were used for assessment of viability. Viability was measured by the
capability of the cells to diesterify and retain fluorescein diacetate
(FDA) in their cytoplasm. Medium was removed from neuronal cultures,
and cells were incubated at 37°C for 5 min with Locke's solution (in
mM: 154 NaCl, 5.6 KCl, 2.3 CaCl2, 1 MgCl2, 3.6 NaHCO3, 5 HEPES, and 20 glucose) containing 5 µg/ml FDA. Cultures were washed once with Locke's solution and
examined under fluorescent light microscopy. Cell numbers were
determined as described previously (Schulz et al., 1996 ). In brief,
three random fields were chosen from each well and digitized by a CCD
camera connected to an image processor (MCID-V; Imaging Research, St.
Catharines, Ontario, Canada). Images were filtered, and the total
number of stained cells was counted automatically by MCID-V computer software.
Immunoblot analysis. Blotting was performed essentially as
described previously (Schulz et al., 1996 ). CGN were seeded on 60 mm
dishes. After hypoxic preconditioning, medium was removed, and cultures
were washed once in cold PBS before the cells were lysed for 15 min on
ice in lysis buffer (1% Triton X-100 and 0.1% SDS with 10 µg/µl leupeptin and aprotinin). Cell debris was removed by
high-speed centrifugation at 4°C. Samples containing 20 µg of
protein were boiled in 1% SDS and 1% -mercaptoethanol for 5 min,
separated by 10-15% SDS-PAGE, and electrotransferred to a
nitrocellulose membrane. Filters were blocked for 1 hr in blocking solution (10 mM Tris-HCl, pH 7.5, 150 mM NaCl, 0.1% Tween 20, and 5% skim milk),
followed by incubation with primary antibodies overnight at 4°C and
secondary, horseradish peroxidase-linked antibodies. Bound antibody was
visualized using enhanced chemiluminescence (ECL kit; Amersham
Pharmacia Biotech, Braunschweig, Germany). The following primary
antibodies were used at a concentration of 2.5 µg/ml: rabbit
polyclonal phospho-Akt (Ser473) antibody (Cell Signaling Technology,
Beverly, MA); protein kinase B (PKB)/Akt antibody (Transduction
Laboratories, Lexington, KY); BCL-2-associated death protein (BAD)
antibody (catalog #9292; Cell Signaling Technology); -phospho-p44/42
MAP kinase antibody (E10 monoclonal; catalog #9106), VEGF
antibody (C-1; sc-7269), VEGF antibody (147; sc-507), VEGFR-1/Flt-1 antibody (A-3; sc-6251), VEGFR-2/Flk-1 (C-17; sc-316), HSP90 antibody (N-17; sc-1055), ERK1/2 antibody (1CK-23; sc-94), BCL-2 antibody (N-19; sc-492), and
BCL-xL/s antibody (S-18; sc-634) (all from
Santa Cruz Biotechnology, Santa Cruz, CA).
Akt antisense oligonucleotides. Transfection with an Akt
antisense oligonucleotide (sequence, gct ggt ggt cct ggc cat
ga; Interactiva Biotechnologie, Ulm, Germany) or a nonsense
oligonucleotide (sequence, gac caa gat ccg acg gga tc;
Interactiva Biotechnologie) at a DNA concentration of 1 µM was performed using Effectene transfection (Qiagen, Hilden, Germany).
DC101 antibody. The rat monoclonal antibody DC101 against
VEGFR-2 was provided by ImClone Systems (New York, NY) and used at 10 µg/ml. The rat control IgG (R & D Systems, Minneapolis, MN) was used
at 10 µg/ml.
Neutralizing VEGF antibody. The human neutralizing antibody
against VEGF (10 µg/ml) (R & D Systems) and the human control IgG (R
& D Systems) were applied at 10 µg/ml.
Recombinant VEGF. The rat protein was obtained from R & D
Systems and used at 100 ng/ml.
Statistical analysis. Data are expressed as mean ± SEM. Statistical significance was assessed by one-way ANOVA, followed
by Tukey's post hoc test. All experiments reported here
represent at least three independent replications performed in
triplicate. Values of p < 0.05 were considered significant.
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RESULTS |
Hypoxic preconditioning prevents apoptotic cell death in CGN
To establish an in vitro model of hypoxic
preconditioning with chronic nonlethal hypoxia, we exposed CGN at day
in vitro 8 for 1-24 hr to a reduced oxygen tension of
1-10%. After reincubation in the standard oxygen tension of 21% for
24 hr, CGN that had been exposed to O2
concentrations between 1 and 4% showed time-dependent cell death,
whereas CGN that had been exposed to 5% O2
remained fully viable (Fig. 1). We next
asked whether this lowest nonlethal oxygen concentration of 5% was
sufficient to alter the response of CGN to three established toxic
stimuli and tried to determine the optimal exposure for
preconditioning. We preexposed CGN to 5% O2 for
1, 3, 6, 9, 12, or 24 hr. Twenty-four hours after reexposure to 21%
O2, we challenged CGN with potassium deprivation,
with 100 µM glutamate, or with 500 µM 3-NP. Preconditioning by oxygen deprivation
for 9 hr resulted in a reduction of cell death induced by potassium
deprivation, glutamate, or 3-NP by 46, 22, and 55%, respectively (Fig.
2A). Shorter (1 or 3 hr) or longer (>12 hr) intervals of low oxygen preconditioning failed
to rescue the cells from death (data not shown). To determine whether
this protective effect was a general principle for toxic stress in
neurons, we challenged CGN with different chemotherapeutics (CCNU,
cisplatine, topotecane, and vincristine) after hypoxic preconditioning.
We showed recently that these chemotherapeutics induced apoptosis in
CGN (A. Wick, W. Wick, R. Dringen, M. Weller, and J. B. Schulz, unpublished observations). However, there were no differential toxicities of the chemotherapeutics in preconditioned versus normoxic CGN (data not shown). Caspase-3 activity was required for cell death
induced by potassium deprivation, glutamate, and 3-NP because caspase-3
was activated, and the panspecific caspase inhibitor zVAD-fmk
(for N-benzyloxycarbonyl-Val-Ala-Asp-fluoromethyl
ketone) inhibited cell death in these paradigms (data not shown). We
next analyzed whether increased neuronal survival after hypoxic
preconditioning was attributable to reduced caspase-3 activity
in the different models of neuronal cell death. Preexposure of
cerebellar granule neurons to 5% O2 for 9 hr
led to a reduction of caspase-3 activity as determined by DEVD-amc
(for
N-acetyl-Asp-Glu-Val-Asp-amino-4-methylcoumarin) hydrolysis after potassium deprivation and glutamate treatment (Fig.
2B). To determine whether the effect of hypoxic
preconditioning depended on new protein synthesis, we exposed CGN to
the protein synthesis inhibitor CHX during the 9 hr period of hypoxia
and for another 15 hr under normoxic conditions before switching to parallel conditioned sister medium. At this time, cells were switched to conditioned sister culture medium to reestablish optimal culture conditions. The cells were treated with potassium deprivation, glutamate, and 3-NP at 24 hr after reexposure to 21%
O2. Treatment with CHX abolished the death
inhibitory effects of hypoxia-induced preconditioning (Fig.
2C).

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Figure 1.
Oxygen deprivation-induced death of CGN. Neurons
were incubated at different oxygen concentrations (1%
O2, white bars; 5%
O2, black bars) for the indicated
intervals. Viability was determined 24 hr after transfer to normoxic
conditions. Data are expressed as mean ± SEM percentages of
viability (n = 3; *p < 0.05;
**p < 0.01; ANOVA, followed by Tukey's
post hoc test compared with normoxic controls).
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Figure 2.
Hypoxic preconditioning attenuates cytotoxicity
induced by potassium deprivation, glutamate, or 3-NP. A,
CGN were exposed to 5% O2 for 9 hr (black
bars) or not (white bars), reoxygenated for
subsequent 24 hr, and challenged with potassium deprivation, 100 µM glutamate (Glut), or 500 µM 3-NP for 24 hr. Viability was assessed by FDA
staining. B, CGN were treated as in A,
and caspase-3 activity was measured by the cleavage of DEVD-amc (12.5 µM) at 6 hr after potassium deprivation or exposure to
glutamate. Data are expressed as means ± SEM from three
independent experiments performed in triplicate (*p < 0.05; **p < 0.01 compared with normoxic
controls). C, CGN were treated according to the schedule
displayed in A (black bars and
white bars) or with CHX (10 µg/ml) in addition to
incubation for 9 hr at 5% O2 and for another 15 hr before
switching to regular parallel conditioned medium (dotted
bars). Data are expressed as means ± SEM from three
independent experiments performed in triplicate (*p < 0.05; **p < 0.01; ANOVA, followed by Tukey's
post hoc test compared with hypoxic but not with
CHX-treated controls). HK, High K+;
LK, low K+.
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Neither BCL-2 family proteins nor HSP90 are induced by hypoxic
preconditioning in CGN
Because induced expression of antiapoptotic proteins of the BCL-2
family has been described after hypoxia-reoxygenation treatment in
hippocampal neurons (Tamatani et al., 2000 ), we examined whether a
shift in the ratio of antiapoptotic and proapoptotic proteins of the
BCL-2 family correlated with the observed preconditioning phenomenon.
Protein levels of BAD, BCL-xL/S, or BCL-2 were
not altered in response to hypoxic preconditioning. Similarly, protein levels of HSP90 that is regulated in neurons in response to different cellular stresses remained stable 24 hr after hypoxic challenging (5%
O2) at different intervals (Fig.
3).

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Figure 3.
No induction of BCL-2,
BCL-xL/s, BAD, or HSP90 in hypoxic preconditioning.
CGN were cultured at 5% O2 for the indicated intervals.
The levels of BCL-2, BCL-xL/S, or HSP90 proteins
were assessed by immunoblot. Co, Control.
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Hypoxia-induced neuroprotection from death-inducing stimuli is
mediated by VEGFR-2
Recent studies provided first evidences that VEGF, which was
assumed to specifically affect endothelial cells, is a survival factor
for CNS neurons (Matsuzaki et al., 2001 ; Oosthuyse et al., 2001 ). Transient hypoxia results in an increased expression of VEGF and
its receptors (Marti and Risau, 1998 ). However, to date, a functional
role of VEGF in ischemic preconditioning has not been defined. In our
model, we found an increased expression of VEGF and VEGFR-1 and -2 after 1, 6, and 9 hr of 5% hypoxia (Fig. 4A). To prove that
induction of the VEGF/VEGFR system is indeed sufficient to protect from
toxic stimuli, we used recombinant VEGF and a VEGF antibody with
neutralizing function in CGN treated with potassium deprivation and
glutamate excitotoxicity. Interestingly, VEGF mimicked whereas a
neutralizing antibody against VEGF completely abolished the protective
effects of hypoxic preconditioning (Fig. 4B,C). To analyze the functional
significance of the induction of VEGFR-2, we used a monoclonal antibody
against VEGFR-2, DC101, that has been associated previously with
inhibition of tumor angiogenesis (Rockwell et al., 1995 ; Prewett et
al., 1999 ). DC101 alone was not toxic to control neurons. Treatment of
CGN with 10 µg/ml DC101 in parallel to exposure to 5% hypoxia
nullified the protective effects of hypoxic preconditioning against
cell death induced by potassium deprivation, glutamate (Fig.
5), or 3-NP (data not shown).

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Figure 4.
VEGF in hypoxia-induced neuroprotection.
A, CGN were cultured at 5% O2 for the
indicated intervals. VEGF (monomer at 21 kDa, dimer at 42 kDa;
nonspecific bands, ns), VEGFR-2, or VEGFR-1 were
assessed by immunoblot. B, CGN were exposed to 5%
O2 for 9 hr, reoxygenated for subsequent 24 hr, or
pretreated with recombinant VEGF (100 ng/ml) for 24 hr or left
untreated, and, subsequently, they were challenged as in Figure
2A. Viability was assessed by FDA staining. Data
are expressed as means ± SEM from three independent experiments
performed in triplicate (*p < 0.05, for the effect
of VEGF; ANOVA, followed by Tukey's post hoc test).
C, CGN were exposed to 5% O2 as detailed in
A, challenged with potassium deprivation, glutamate, or
3-NP as displayed in Figure 2A, and were
cotreated with an anti-human IgG control-antibody (10 µg/ml), or with
a human neutralizing VEGF-antibody (10 µg/ml)
(VEGF-Ab) as indicated. Viability was assessed by FDA
staining. Data are expressed as means ± SEM from three
independent experiments performed in triplicate (*p < 0.05, for the effect of the VEGF-antibody compared with the
control-antibody; ANOVA, followed by Tukey's post hoc
test). HK, High K+; LK, low
K+; Glut, glutamate.
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Figure 5.
Inhibition of VEGFR-2 abolishes hypoxia-induced
neuroprotection. CGN were treated as displayed in Figure
2A or with DC101 or a control rat IgG alone, or
cotreated with DC101 or rat IgG as labeled. Viability was assessed by
FDA staining. Data are expressed as means ± SEM from three
independent experiments performed in triplicate (*p < 0.05, for the effect of DC101 compared with rat IgG; ANOVA, followed
by Tukey's post hoc test). HK, High
K+; LK, low K+;
Glut, glutamate.
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Hypoxic preconditioning critically depends on Akt activation
The ERK and the PI3-K pathways have been implicated in paradigms
of rescue from apoptosis in neurons. Because the PI3-K pathway has been
implicated in VEGF-mediated protection (Gratton et al., 2001 ) and
because BDNF protects the neonatal brain of Sprague Dawley rats via
phosphorylation of ERK1/2 (Han and Holtzman, 2000 ), we investigated
whether either pathway was involved in the paradigm of hypoxic
preconditioning. Figure
6A shows an increase in
the phosphorylation of ERK, predominantly of the p44 form, 24 hr after exposure to a low oxygen tension of 5% for different time periods. To
analyze whether this ERK activation was functionally relevant for the
protective effects after hypoxic preconditioning, we treated CGN with
the MEK1/2 inhibitor U0126. There was no influence of U0126 at up to 50 µM on the protective effects induced by hypoxic preconditioning, although the hypoxia-induced ERK phosphorylation was
inhibited (data not shown). Similar to ERK, Akt phosphorylation, but
not protein expression, was induced by hypoxic preconditioning for 9 hr
(Fig. 6B). After exposure to the PI3-K inhibitor
wortmannin, the phosphorylation of the serine 473 was completely
blocked. In addition, both wortmannin (data not shown) and an Akt
antisense oligonucleotide prevented the protective effects of hypoxic
preconditioning on potassium deprivation and glutamate or 3-NP toxicity
(Fig. 6C). The next experiment aimed at defining whether Akt
is the key target for VEGF/VEGFR-2-controlled hypoxic neuroprotection in cerebellar granule neurons. Recombinant VEGF, similar to exposure to
5%O2 for 9 hr, lead to increased Akt
phosphorylation. The blocking VEGFR-2 antibody DC101 abrogated the
hypoxia-induced Akt phosphorylation (Fig. 6D),
confirming that the pathway from hypoxia to enhanced survival of CGN
involves VEGFR-2 and enhanced Akt activation.

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Figure 6.
Inhibition of the Akt pathway blocks
hypoxia-induced neuroprotection. A, B,
CGN were cultured at 5% O2 for the indicated intervals.
ERK, phospho-ERK, Akt/PKB, or phospho-Akt levels in neurons treated
with (+) or without ( ) wortmannin (WM) were
measured by immunoblot (nonspecific bands, ns).
C, CGN were treated as displayed in Figure
2A (white bars, normoxic neurons;
black bars, hypoxic neurons) or treated with Akt
antisense oligonucleotide or a nonsense control oligonucleotide in
parallel to the induction of hypoxia. Viability was assessed by
staining with FDA. Data are expressed as means ± SEM from three
independent experiments performed in triplicate (*p < 0.05, for the effect of the Akt antisense oligonucleotide compared
with nonsense controls; Student's t test). Immunoblot
analysis for Akt protein was performed at the indicated times after
addition of the Akt antisense (as) oligonucleotide, a
nonsense (ns) control or vehicle (Co).
D, The cells were cultured at 5% O2 for 9 hr. Phosphorylation of Akt at serine 473 in neurons treated with (+) or
without ( ) DC101 or VEGF (100 ng/ml) was assessed by immunoblot.
NS, No switch; HK, high K+;
LK, low K+; Glut,
glutamate.
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DISCUSSION |
Although VEGF was identified as an angiogenic and
vessel-permeability factor (Keck et al., 1989 ), recent studies have
shown neurotrophic and neuroprotective functions of VEGF, as well as induction of VEGF in pathological states of the CNS (Sondell et al.,
1999 ; Jin et al., 2000 ; Matsuzaki et al., 2001 ; Oosthuyse et al.,
2001 ). Our results document an additional intrinsic neuroprotective function of VEGF via VEGFR-2 and Akt.
Our data are consistent with previous reports of
preconditioning-induced tolerance in vivo or
in vitro but make several novel points: (1) the induction of
tolerance by moderate hypoxia of 5% O2 without
glucose deprivation; (2) the wide range of different toxic stimuli
attenuated by hypoxic preconditioning; and (3) the central role for
VEGF/VEGFR-2 in the hypoxia-induced neuronal protection.
VEGF is induced in vivo by exposing mice to systemic hypoxia
(Marti and Risau, 1998 ). VEGF induction was highest in the brain but
also occurred in kidney, testis, lung, liver, and heart. In the brain,
VEGF was expressed in neurons and in glial cells. Recent studies
demonstrated that VEGF expression was significantly induced in the
penumbra in cerebral ischemia (Leker et al., 2001 ). Although exogenous
VEGF protected immortalized hippocampal neurons from hypoxia and
glucose deprivation in vitro, VEGF, VEGFR-1 and VEGFR-2 expression were not induced in this paradigm (Jin et al., 2000 ). We
established a paradigm of hypoxic preconditioning without the necessity
of glucose deprivation or anoxia in CGN (Fig. 1). VEGF was induced by
moderate hypoxia of 5% O2 over 3-9 hr (Fig.
4A). These conditions did not result in immediate
cell death or delayed reduction of cell survival (Fig. 1). Shorter
periods of hypoxia did not lead to the induction of VEGF (data not
shown). Our model circumvents the necessity for the combination of
anoxia and glucose deprivation to induce hypoxic preconditioning,
allowing to study the effects of pure hypoxia. With regard to hypoxia,
our model may better reflect changes that occur in the penumbra. The
penumbra is defined as a region in which cells only suffer functional
but not structural impairments. The blood supply is decreased but not
completely blocked. In the initial phase, energy metabolism is normal
in the penumbra and deteriorates at a later phase (Hossmann, 1994 ).
Therefore, we established a model that circumvented the induction of
anoxia and complete glucose deprivation. Because CGN are the
predominant cell type in our cultures, accounting for 95% of all
cells, it appears likely that the VEGF that was detected was produced
by CGN. This suggests an autocrine or paracrine mechanism. However, we
cannot completely rule out that VEGF was derived from the 5% of
astrocytes (Sinor et al., 1998 ) or oligodendrocytes in our culture.
CGN preconditioned by sublethal exposure to a reduced oxygen
tension were rendered resistant to injuries induced by subsequent potassium deprivation or exposure to the excitotoxin glutamate or the
mitochondrial toxin 3-NP (Fig.
2A,B). In contrast, apoptosis induced by several chemotherapeutic drugs remained unaltered. Demonstration of such preconditioning-induced tolerance in
vitro supports the view that toxin tolerance in vivo
may be predominantly explained by intracellular alterations in neurons
rather than by alterations in blood flow or systemic responses to the
toxin. As in the initial gerbil studies (Kitagawa et al., 1990 ; Kato et
al., 1992 ), we observed that tolerance developed slowly over many hours
after the preconditioning episode, suggesting that changes in gene
expression are involved. Supporting the hypothesis that long-term
effects of ischemic preconditioning are depending on new protein
synthesis treatment with the protein synthesis inhibitor CHX blocked
the protective effects induced by 5% O2 (Fig.
2C). We excluded certain BCL-2 family members (BCL-2, BCL-x, and BAD) as candidates mediating the protective effects of hypoxic preconditioning (Fig. 3). In contrast to these findings in CGN, VEGF
has been demonstrated to induce BCL-2 expression in neoplastic cells
and to block apoptosis (Pidgeon et al., 2001 ).
In addition to the induction of VEGF, we also found an increase in
protein levels of VEGFR-1 and -2. VEGFR-1 apparently is primarily
involved in endothelial morphogenesis, at least during embryonic
development (Fong et al., 1995 ), but has no defined function in the
activation of cell protection pathways (Matsuzaki et al., 2001 ). It has
been shown that the VEGF-stimulated NO release is inhibited by blockade
of VEGFR-1. Additional VEGFR-1 negatively regulates VEGFR-2-mediated
proliferation via NO release and promotes the formation of capillary
networks in human umbilical vein endothelial cells (Bussolati et al.,
2001 ). The function of VEGFR-1 in neuronal cells, however, remains to
be elucidated. In contrast, our data support and extent the finding
that, in neurons, VEGFR-2 stimulation is linked to Akt activation and
neuronal protection (Matsuzaki et al., 2001 ).
How might endogenous VEGF act to prevent or limit neuronal injury after
hypoxic preconditioning? It has been suggested that VEGF signals
neuroprotection through the VEGFR-2 receptor in association with both
the PI3-K/Akt and the MEK/ERK pathways (Hetman et al., 1999 ; Matsuzaki
et al., 2001 ). ERKs are activated by growth factors and
G-protein-coupled receptors and are mostly involved in cell proliferation and survival. Both the stress activated and the ERK
members of the MAP kinase family are activated by oxidative stress. As
shown by increased phosphorylation of p44 (Fig. 6A), we detected ERK1 activation after hypoxic preconditioning. Because an
MEK1/2 inhibitor failed to attenuate hypoxic preconditioning, this
activation is unlikely to be of functional relevance in CGN. However,
we found a functional involvement of the PI3-K/Akt pathway that was
dependent on the activation of VEGFR-2. This result is in contrast to
findings in primary cortical cell cultures in which preconditioning by
oxygen-glucose deprivation requires the
p21Ras/ERK cascade but not the PI3-kinase
pathway (Gonzalez-Zulueta et al., 2000 ). The differences may be
explained by the different cell type used (cortical neurons vs CGN) and
by the different paradigm of hypoxic preconditioning (short but severe
oxygen-glucose deprivation vs pure but extended hypoxia). For CGN, the
PI3-K/Akt appears to be the predominant survival pathway (Datta et al., 1997 ; Dudek et al., 1997 ; Miller et al., 1997 ; Gleichmann et al., 2000 ). As shown by Hetman et al. (1999) , not only the cell type but
also the stress stimulus itself may determine the dominant signaling
pathway for cellular survival. Using primary cortical neurons, these
authors showed that BDNF-mediated protection against camptothecin
toxicity through the ERK pathway, whereas it mediated protection
against serum withdrawal through the PI3-K pathway. Crowder and Freeman
(1999) demonstrated that the survival of sympathetic neurons promoted
by potassium depolarization, but not by cAMP, required PI3-K and Akt.
Vice versa, our findings that potassium withdrawal, glutamate, and 3-NP
but not drug (CCNU, cisplatine, topotecan, and vincristine) toxicity
are ameliorated by hypoxic preconditioning stress the specificity of
the observed neuroprotection. Similarly, it has been shown for glioma
cells that protection against death ligands (CD95L) and irradiation but
not chemotherapeutics could be overcome by inhibition of PI3-K (Wick et
al., 1999 ).
PI3-K is thought to regulate cell death by activating the
serine-threonine protein kinase Akt, which enhances the activity of
antiapoptotic proteins through the transcription factor NF- B and
inhibits proapoptotic signaling by BAD, caspase-9, and other effectors
(Dudek et al., 1997 ). The serine 473 phosphorylation of Akt induced by
9 and 24 hr of hypoxia is prevented by the PI3-K inhibitor wortmannin.
These effect of wortmannin on neurons is not specific for the hypoxic
state but has been demonstrated to potentiate cell death in paradigms
of glutamate-induced apoptosis (Gary and Mattson, 2001 ). Total protein
levels of Akt were not affected (Fig. 6B). Both
wortmannin and an Akt antisense oligonucleotide reverted the protective
effects of hypoxic preconditioning (Fig. 6C). Treatment with
the VEGFR-2 antagonist DC101 inhibited hypoxia-induced serine 473 phosphorylation of Akt (Fig. 6D). The hypoxia-induced protective effects mediated by VEGFR-2 require the secretion and binding of its ligand VEGF, because a VEGF antibody blocks the protective effects. Furthermore, the protective effects are reproduced by exogenous addition of VEGF. In summary, we provide a framework for
the understanding of hypoxic preconditioning in CGN. The
hypoxia-induced neuroprotective effects sequentially require the
secretion of VEGF and the activation of VEGFR-2, PI3-K, and Akt.
 |
FOOTNOTES |
Received April 5, 2002; revised May 14, 2002; accepted May 17, 2002.
This work was supported by a grant from the German Research Foundation
(Sonderforschungsbereich 430, Teilprojekt B8) (J.B.S.).
Correspondence should be addressed to Dr. Jörg B. Schulz,
Department of Neurology, University of Tübingen, School of
Medicine, Hoppe-Seyler-Strasse 3, D-72076 Tübingen,
Germany. E-mail: joerg.b.schulz{at}uni-tuebingen.de.
 |
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