Electroacupuncture Pretreatment as a Novel Avenue to Protect Brain against Ischemia and Reperfusion Injury

Abstract

Electroacupuncture (EA) pretreatment is a recent observation which has been shown to induce ischemic tolerance mimicking the ischemic pretreatment, suggesting that EA pretreatment may be a promising preventive strategy for the patients with high risk of acute ischemia/reperfusion injury. It was first described in the brain, then in the heart where EA stimulation at acupoint prior to ischemia led to neuroprotection and myocardial protection and induced rapid and delayed ischemic tolerance. Then the optimal parameters and acupoint specificity of EA pretreatment to induce protective effect were proved. Many studies have shown that protective mechanisms of EA pretreatment may involve a series of regulatory molecular pathways including activity enhancement of antioxidant, regulation of the endocannabinoid system, involvement of beta-adrenergic receptor, and postreceptor signaling pathway, inhibition of apoptosis. Recently, the neuroprotective and cardioprotective effect of EA pretreatment had been demonstrated in patients undergoing craniocerebral tumor resection or heart valve replacement surgery. Thus, the purpose of this paper is to collect the evidence for the neuroprotective effect of EA pretreatment, to summarize the proposed protective mechanisms of EA pretreatment, and to discuss the possibility of EA pretreatment as a new preventive strategy for patients with high risk of ischemia in clinic.

Non-pharmaceutical therapies for stroke: Mechanisms and clinical implications

“…Intravenous injection of Naltrindole reversed the EA-induced protection (Zhou et al , 2013b). Dr. Xiong and his colleagues also demonstrated that DOR is involved in the EA-induced brain tolerance to cerebral ischemic injury (Xiong, et al , 2007; Li, et al , 2012). Intraperitoneal administration of Naltrindole abolished EA-induced protection against ischemic injury, while nor -BNI, a kappa-opioid receptor antagonist, did not significantly affect EA neuroprotection (Xiong, et al , 2007), demonstrating the specific role of DOR in brain protection against ischemic injury.…”

“…There is substantial evidence showing that either EA, which stimulates specific acupoints for an appropriate period of time with suitable current parameters, or manual acupuncture, can generate beneficial signals to the brain through peripheral nerve pathways (Guo et al , 2010; Xia et al , 2010; Xia et al , 2012). These signals lead to the regulation of cerebral blood flow and modulate the balance between survival and death signals at both cellular and molecular levels (Zhao et al , 2002; Tian et al , 2008; Zhou et al , 2008; Guo et al , 2010; Zhou et al , 2010; Zhou et al , 2011b; Xu et al , 2012; Li et al , 2012; Zhou et al ., 2013a; Zhou et al ., 2013b). In a side by side comparative study using the MCAO model, EA compared favorably to several pharmacological agents and Chinese herb medicines, such as taurine, “ Salvia miltiorrhizae injection, ” “Qingkailing injection,” and “Xingnaojing injection” in terms of protective effects against ischemic injury (Zhao et al , 2008).…”

“…Instances of acute ischemic stroke result in heterogeneous changes in CBF (cerebral blood flow) and brain metabolism in the affected region. The human brain and its meshwork of roughly 100 billion interwoven neurons receives close to 15% of the body’s resting cardiac output while expending 20% of its oxygen, rendering the organ especially sensitive to such cases of hypoxic or ischemic insult (Clarke and Sokoloff, 1999; Fisher et al , 2009; Chao and Xia, 2010; Arai et al , 2011; Ding et al , 2012; Li et al , 2012a; Albert-Weißenberger et al , 2013; He et al , 2013). As the brain is extremely sensitive to hypoxia or ischemia, protecting brain tissue from injury, simplified as “neuroprotection”, has therefore been a long sought after strategy in quelling physiological damage following stroke onset.…”

Electroacupuncture and Brain Protection against Cerebral Ischemia: Specific Effects of Acupoints

“…Indeed, several ancient TCM books, for example, Huangdi Nei Jing ( Huangdi's Internal Classic ) and “Handbook of Prescriptions for Emergencies” ( Zhou Hou Fang ), both contain descriptions of acupuncture therapy for stroke-like disorders. In recent years, a substantial amount of the literature has appeared on the use of manual acupuncture or EA for the brain protection against ischemic injury in both human subjects and animal models [5–15]. However, there are still controversies in terms of the clinical outcome [16–18].…”

Electro-acupuncture up-regulates astrocytic MCT1 expression to improve neurological deficit in middle cerebral artery occlusion rats

“…Our results on the profound effects of EA treatment in enhancing the astrocytic expression of lactate transporter suggested that EA could provide instant protection to the neurons by transferring energy in early ischemia. Previous studies have reported that in the later stage of ischemia in rat, EA treatment reduced the release of glutamate and alleviated brain edema [7]. Taken together, it's thought that EA treatment has multifaceted effects through a comprehensive mechanism.…”