Cyclosporine A as a potential neuroprotective agent: a study of prolonged hypothermic circulatory arrest in a chronic porcine model

Objective: To assess whether Cyclosporine A (CsA) or cycloheximide (CHX) can reduce ischemia-induced neurological damage by blocking apoptotic pathways, we assessed their effects on cerebral recovery in a chronic animal model of hypothermic circulatory arrest (HCA). Methods: Twenty-eight pigs (28-33 kg) underwent 90 min of HCA at 20 degreesC. In this blinded study, animals were randomized to placebo (n = 12), 5 mg/kg CsA (n = 8), given intravenously before and subcutaneously for 7 days after HCA, or a single dose of 1 mg/kg CHX (n = 8), given after weaning from cardiopulmonary bypass. Hemodynamics, intracranial pressure (ICP) and neurophysiological data (EEG, SSEP) were assessed for 3 h after HCA; early behavioral recovery was scored, and neurological/behavioral evaluation (9 = normal) was carried out daily until elective sacrifice on postoperative day (POD) 7. Brains were selectively perfused and evaluated histopathologically fur apoptosis. Results: Basic hemodynamic data revealed no differences between CsA or CHX and control groups. ICP was significantly lower throughout rewarming (P = 0.009) and reperfusion (P = 0.05) in the CsA group. EEG recovery 3 h after NCA was observed in four of eight CsA animals but in only 1 of 12 controls (P = 0.11) and one of eight CHX animals; cortical SSEP recovery also seemed faster in CsA animals, but failed to reach significance. Some early recovery scores were significantly better in the CsA group, and daily behavioral scores were consistently and significantly higher in the CsA-treated animals from POD 1 through POD4. Conclusions: The data indicate that treatment with Cyclosporine A but not cycloheximide has a positive effect on cerebral recovery following HCA. Whether CsA results in inhibition of neuronal apoptosis. and/or inhibits release of cytokines and thereby reduces postischemic cerebral edema remains to be elucidated. The neuroprotective effect of CsA, if confirmed in further studies, would make its clinical application conceivable. (C) 2001 Elsevier Science B.V. All rights reserved.