Objective-Prompt post-hypoxia-ischemia (HI) revascularization has been suggested to improve outcome in adults and newborn subjects. Other than hypoxia-inducible factor, sensors of metabolic demand remain largely unknown. During HI, anaerobic respiration is arrested resulting in accumulation of carbohydrate metabolic intermediates. As such succinate readily increases, exerting its biological effects via a specific receptor, G-protein-coupled receptor (GPR) 91. We postulate that succinate/GPR91 enhances post-HI vascularization and reduces infarct size in a model of newborn HI brain injury. Approach and Results-The Rice-Vannucci model of neonatal HI was used. Succinate was measured by mass spectrometry, and microvascular density was evaluated by quantification of lectin-stained cryosection. Gene expression was evaluated by real-time polymerase chain reaction. Succinate levels rapidly increased in the penumbral region of brain infarcts. GPR91 was foremost localized not only in neurons but also in astrocytes. Microvascular density increased at 96 hours after injury in wild-type animals; it was diminished in GPR91-null mice leading to an increased infarct size. Stimulation with succinate led to an increase in growth factors implicated in angiogenesis only in wild-type mice. To explain the mode of action of succinate/GPR91, we investigated the role of prostaglandin E 2 -prostaglandin E receptor 4, previously proposed in neural angiogenesis. Succinate-induced vascular endothelial growth factor expression was abrogated by a cyclooxygenase inhibitor and a selective prostaglandin E receptor 4 antagonist. This antagonist also abolished succinate-induced neovascularization. Conclusions-We uncover a dominant metabolic sensor responsible for post-HI neurovascular adaptation, notably succinate/ GPR91, acting via prostaglandin E 2 -prostaglandin E receptor 4 to govern expression of major angiogenic factors. We propose that pharmacological intervention targeting GPR91 could improve post-HI brain recovery. [20][21][22] Yet, their mode of action has generally remained inexplicable, until membrane-bound receptors that are specifically activated by these metabolites have been identified. 23 In this context, succinate has been shown to contribute to the developmental and possibly aberrant retinal neovascularization presumably through actions on G-protein-coupled receptor (GPR) 91 independent of hypoxia-inducible factor activation 24 ; accordingly, siRNAand shRNA-GPR91 interfere with developmental angiogenesis and partly with abnormal preretinal neovascularization.
Nonstandard Abbreviations and Acronyms
EP4prostaglandin E receptor 4 GPR G-protein-coupled receptor HI hypoxia-ischemia VEGF Vascular endothelial growth factor Figure 1. Succinate accumulates in the penumbral region after cerebral hypoxia-ischemia (HI) where G-protein-coupled receptor (GPR) 91 is expressed in neurons and astrocytes. A, GPR91 colocalizes with NeuN (i) and glial fibrillary acidic protein (GFAP) (ii) in the rat cerebral cortex. Rabbit anti-GPR91 was used to l...