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      Isoflurane Increases Neuronal Cell Death Vulnerability by Downregulating miR-214

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          Abstract

          Since accumulating evidence suggests the application of anesthetics may increase the risk of Alzheimer’s disease (AD), we investigated the cytotoxicity of inhaled general anesthesia in neurons and its underlying mechanism. Using primary cultured rat hippocampal neurons as the study model, here we show that isoflurane increases vulnerability to intracellular or extracellular amyloid β with or without serum deprivation. This isoflurane-induced effect is mediated by the downregulation of miR-214 level that lead to an elevated expression of Bax, a prominent target for miR-214. We conclude that isoflurane increases cell death in the presence of amyloid β by increasing Bax level through downregulating miR-214. Our data provide a new insight for inhaled anesthetics toxicity and indicate a possible mechanistic link between anesthetic application and neurodegenration in AD.

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          Most cited references46

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          Early exposure to common anesthetic agents causes widespread neurodegeneration in the developing rat brain and persistent learning deficits.

          Recently it was demonstrated that exposure of the developing brain during the period of synaptogenesis to drugs that block NMDA glutamate receptors or drugs that potentiate GABA(A) receptors can trigger widespread apoptotic neurodegeneration. All currently used general anesthetic agents have either NMDA receptor-blocking or GABA(A) receptor-enhancing properties. To induce or maintain a surgical plane of anesthesia, it is common practice in pediatric or obstetrical medicine to use agents from these two classes in combination. Therefore, the question arises whether this practice entails significant risk of inducing apoptotic neurodegeneration in the developing human brain. To begin to address this problem, we have administered to 7-d-old infant rats a combination of drugs commonly used in pediatric anesthesia (midazolam, nitrous oxide, and isoflurane) in doses sufficient to maintain a surgical plane of anesthesia for 6 hr, and have observed that this causes widespread apoptotic neurodegeneration in the developing brain, deficits in hippocampal synaptic function, and persistent memory/learning impairments.
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            Anesthesia leads to tau hyperphosphorylation through inhibition of phosphatase activity by hypothermia.

            Postoperative cognitive dysfunction, confusion, and delirium are common after general anesthesia in the elderly, with symptoms persisting for months or years in some patients. Even middle-aged patients are likely to have postoperative cognitive dysfunction for months after surgery, and Alzheimer's disease (AD) patients appear to be particularly at risk of deterioration after anesthesia. Several investigators have thus examined whether general anesthesia is associated with AD, with some studies suggesting that exposure to anesthetics may increase the risk of AD. However, little is known on the biochemical consequences of anesthesia on pathogenic pathways in vivo. Here, we investigated the effect of anesthesia on tau phosphorylation and amyloid precursor protein (APP) metabolism in mouse brain. We found that, regardless of the anesthetic used, anesthesia induced rapid and massive hyperphosphorylation of tau, rapid and prolonged hypothermia, inhibition of Ser/Thr PP2A (protein phosphatase 2A), but no changes in APP metabolism or Abeta (beta-amyloid peptide) accumulation. Reestablishing normothermia during anesthesia completely rescued tau phosphorylation to normal levels. Our results indicate that changes in tau phosphorylation were not a result of anesthesia per se, but a consequence of anesthesia-induced hypothermia, which led to inhibition of phosphatase activity and subsequent hyperphosphorylation of tau. These findings call for careful monitoring of core temperature during anesthesia in laboratory animals to avoid artifactual elevation of protein phosphorylation. Furthermore, a thorough examination of the effect of anesthesia-induced hypothermia on the risk and progression of AD is warranted.
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              Consensus recommendations for the postmortem diagnosis of Alzheimer disease from the National Institute on Aging and the Reagan Institute Working Group on diagnostic criteria for the neuropathological assessment of Alzheimer disease.

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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2013
                8 February 2013
                : 8
                : 2
                : e55276
                Affiliations
                [1 ]State Key Laboratory of Biomembrane and Membrane Biotechnology, College of Life Sciences, Peking University, Beijing, China
                [2 ]Department of Pharmacology, Physiology and Neuroscience, Sophie Davis School of Biomedical Education/City University of New York Medical School, New York, New York, United States of America
                [3 ]Beijing No.4 High School, Beijing, China
                [4 ]Department of Urology, Peking University People’s Hospital, Beijing, China
                Massachusetts General Hospital, United States of America
                Author notes

                Competing Interests: All the authors and the commercial funder of the study Roche play no role in employment, consultancy, patents, products in development or marketed products. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

                Conceived and designed the experiments: YZ. Performed the experiments: HY TX KL HZ. Analyzed the data: HY YZ. Contributed reagents/materials/analysis tools: TX HW. Wrote the paper: YZ HW.

                Article
                PONE-D-12-29053
                10.1371/journal.pone.0055276
                3568119
                23408966
                4f2c6868-6c94-4d6d-8699-802ec9ba35f1
                Copyright @ 2013

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 September 2012
                : 30 December 2012
                Page count
                Pages: 10
                Funding
                This work was supported by the National Program of Basic Research sponsored by the Ministry of Science and Technology of China (2009CB941301), National Science Foundation of China (NSFC) Major Research Grant (91132718) and Roche research grant. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Biology
                Biochemistry
                Proteins
                Serum Amyloid P Component
                Genetics
                Gene Expression
                RNA interference
                Model Organisms
                Animal Models
                Rat
                Molecular Cell Biology
                Gene Expression
                RNA interference
                Signal Transduction
                Signaling Cascades
                Apoptotic Signaling Cascade
                Signaling in Cellular Processes
                Apoptotic Signaling
                Neuroscience
                Behavioral Neuroscience
                Learning and Memory
                Neurobiology of Disease and Regeneration
                Medicine
                Neurology
                Dementia
                Alzheimer Disease

                Uncategorized
                Uncategorized

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