Limb Remote Postconditioning Alleviates Cerebral Reperfusion Injury Through Reactive Oxygen Species-Mediated Inhibition of Delta Protein Kinase C in Rats

BACKGROUND: Remote ischemic postconditioning (RPostC) is an emerging concept for cerebral infarction protection, and its potential protective mechanisms have not been well established. We attempted to investigate the implications of reactive oxygen species (ROS) and delta protein kinase C (delta PKC) in neuroprotection induced by RPostC in a rat model of focal cerebral ischemia, and also to explore a possible relationship between ROS and epsilon PKC. METHODS: Focal cerebral ischemia was induced by middle cerebral artery occlusion using the intraluminal filament technique in male rats. RPostC was generated by 3 10-minute cycles of femoral artery occlusion/reperfusion on the right limb at the onset of middle cerebral artery reperfusion. RPostC was performed alone or with pretreatment of N-acetylcysteine, a ROS scavenger. In separate group, TAT-delta V1-1, a delta PKC-selective peptide inhibitor, was administered at the onset of reperfusion. Brain ischemic injury was evaluated by neurologic scores, infarction volumes, and TUNEL staining. Moreover, the activation of delta PKC in the ischemic penumbra was investigated by Western blot after reperfusion. RESULTS: RPostC improved neurologic outcome, reduced infarct size, and inhibited neuronal apoptosis as well as suppressed the activation of delta PKC after reperfusion. Moreover, systemic delivery of TAT-delta V1-1 conferred neuroprotection against cerebral reperfusion injury at the onset of reperfusion. Pretreatment with N-acetylcysteine not only completely prevented all aspects of RPostC-induced neuroprotection, but also reversed RPostC-induced inhibition of delta PKC activation after reperfusion. CONCLUSION: These findings suggested that RPostC performed in one limb alleviated reperfusion injury after focal cerebral ischemia through ROS-mediated inhibition of endogenous delta PKC activation signaling cascade in an in vivo rat model of focal cerebral ischemia. (Anesth Analg 2011; 113: 1180-7)