Glucocorticoid activation of two types of adrenocorticosteroid receptors (ACRs), themineralocorticoid receptor (MR) and the glucocorticoid receptor (GR), influences hippocampalneuron vulnerability to injury. Excessive activation of GR may compromise hippocampalneuron survival after several types of challenge including ischemic, metabolic, and excitotoxicinsults. In contrast, MR prevents adrenalectomy-induced loss of granule neurons in the dentategyrus. The present thesis addresses the respective roles of MR and GR in modulating neuronalsurvival following two forms of neuronal injury, excitotoxicity and traumatic brain injury. MaleSprague-Dawley rats were pretreated with MR antagonist spironolactone or GR antagonistmifepristone (RU486) and subsequently injected with kainic acid, an excitotoxic glutamateanalog, or injured with a controlled cortical impact. Twenty-four hours following injury,hippocampal neuron survival was measured to test the hypotheses that MR blockade wouldendanger and GR blockade would protect hippocampal neurons following injury. MessengerRNA levels of viability-related genes including bcl-2, bax, p53, BDNF, and NT-3 were alsomeasured to test the hypothesis that ACR regulation of these genes wouldcorrelate with neuronal survival. In addition, ACR mRNA levels were measured followingreceptor blockade and injury to test the hypothesis that glucocorticoid signaling is alteredfollowing neuronal injury via regulation of ACR expression.Mineralocorticoid receptor blockade with spironolactone increased neuronal vulnerability toexcitotoxic insult in hippocampal field CA3, and GR blockade with RU486 prevented neuronalloss after traumatic brain injury in field CA1. These results are consistent with the hypothesesthat MR protects and GR endangers hippocampal neurons. Adrenocorticosteroid receptorblockade decreased mRNA levels of the anti-apoptotic gene bcl-2 in select regions of uninjuredhippocampus, yet ACR regulation of bcl-2 did not consistently correspond with measures ofneuronal survival after injury. Kainic acid decreased MR mRNA levels in CA1 and CA3, whileboth kainic acid and controlled cortical impact dramatically decreased GR mRNA levels indentate gyrus. These data suggest that injury modulation of glucocorticoid signaling throughregulation of ACR expression may influence hippocampal neuron viability following injury.

Traumatic brain injury (TBI) is becoming a national epidemic, as it accounts for 1.5 million cases each year. This disorder affects primarily the young population and elderly. Currently, there is no treatment for TBI, which means that ~2% of the U.S. population is currently living with prolonged neurological damage and dysfunction. Recently, there have been many studies showing that TBI negatively impacts mitochondrial function. It has been proposed that in order to save the cell from destruction mitochondrial function must be preserved. The ketogenic diet, originally designed to mimic fasting physiology, is effective in treating epilepsy. Therefore, we have used fasting as a post injury treatment and attempted to elucidate its underlying mechanism. 24 hours of fasting after a moderate TBI increased tissue sparing, cognitive recovery, improved mitochondrial function, and decreased mitochondrial biomarkers of injury. Fasting results in hypoglycemia, the production of ketones, and the upregulation of free fatty acids (FFA). As such, we investigated the neuroprotective effect of hypoglycemia in the absence of fasting through insulin administration. Insulin administration was not neuroprotective and increased mortality in some treatment groups. However, ketone administration resulted in increased tissue sparing. Also, reduced reactive oxygen species (ROS) production, increased the efficiency of NADH utilization, and increased respiratory function. FFAs and uncoupling proteins (UCP) have been implicated in an endogenously regulated anti-ROS mechanism. FFAs of various chain lengths and saturation were screened for their ability to activate UCP mediated mitochondrial respiration and attenuate ROS production. We also measured FFA levels in serum, brain, and CSF after a 24 hour fast. We also used UCP2 transgenic overexpressing and knockout mice in our CCI injury model, which showed UCP2 overexpression increased tissue sparing, however UCP2 deficient mice did not show a decrease in tissue sparing, compared with their wild type littermates. Together our results indicate that post injury initiated fasting is neuroprotective and that this treatment is able to preserve mitochondrial function. Our work also indicates ketones and UCPs may be working together to preserve mitochondrial and cellular function in a concerted mechanism, and that this cooperative system is the underlying mechanism of fasting induced neuroprotection.

In the hours and days following acute CNS injury, a secondary wave of events is initiated that exacerbate spinal tissue damage and neuronal cell death. A potential mechanism driving these secondary events is opening of the mitochondrial permeability transition pore (mPTP) and subsequent release of several cell death proteins. Previous studies have shown that inhibition of cyclophilin D(CypD), the key regulating component in mPTP opening, was protective against insults that induce necrotic cell death. We therefore hypothesized that CypD-null mice would show improved functional and pathological outcomes following spinal cord injury (SCI) and traumatic brain injury (TBI). Moderate and severe spinal contusion was produced in wild-type (WT) and CypD-null mice at the T-10 level using the Infinite Horizon impactor. Changes in locomotor function were evaluated using the Basso Mouse Scale (BMS) at 3 days post-injury followed by weekly testing for 4 weeks. Histological assessment of tissue sparing and lesion volume was performed 4 weeks post SCI. Calpain activity, measured by calpain-mediated spectrin degradation, was assessed in moderate injury only by western blot 24 hours post SCI. Results showed that following moderate SCI, CypD-null mice had no significant improvement in locomotor recovery or tissue sparing compared to wild-type mice. Following severe SCI, CypD-null mice showed significantly lower locomotor recovery and decreased tissue sparing compared to WT mice. Calpain-mediated spectrin degradation was not significantly reduced in CypD-null mice compared to WT mice 24h post moderate SCI. The lack of protective effects in CypD-null mice suggests that more dominant mechanisms are involved in the pathology of SCI. In addition, CypD may have a pro survival role that is dependent on the severity of the spinal cord injury.

Traumatic brain injury (TBI) is a leading cause of death and long-term disability worldwide, and survivors are often left with cognitive deficits and significant problems with day to day tasks. To date, therapeutic pharmacological treatments of TBI remain elusive despite numerous clinical trials. An improved understanding of the molecular and cellular response to injury may help guide future treatment strategies. One promising marker for brain injury is the translocator protein (TSPO), which is normally expressed at a low level, but is highly expressed following brain damage and is associated with neuroinflammation. The isoquinoline carboxamide PK11195 binds selectively to the TSPO in many species, and has therefore become the most-studied TSPO ligand. To characterize the time-course of TSPO expression in the controlled cortical injury (CCI) model of TBI we subjected Sprague-Dawley rats to CCI and euthanatized them after 30 minutes, 12 hours, 1, 2, 4, or 6 days. Autoradiography with radiolabelled PK11195 was used to assess the time-course of TSPO binding following CCI. Autoradiographs were compared to adjacent tissue slices stained with the microglia/macrophage marker ED-1, with which a moderate positive correlation was discovered. PK11195 autoradiography was used as a tool with which to assess neuroinflammation following CCI and the administration of an α7 nAChR antagonist, methyllycaconitine (MLA). We hypothesized that blocking the calcium permeable α7 nAChR after brain injury would have a neuroprotective effect by attenuating excitotoxicity in the shortterm. Our study revealed clear dose-dependent tissue sparing in rats administered MLA after trauma and a modest improvement in functional outcome. The relatively modest recovery of function with MLA, which could be due to prolonged α7 nAChR blockade or downregulation lead us to explore the potential of α7 nAChR partial agonists in treating TBI. The α7 nAChR partial agonists tropisetron, ondansetron, and DMXB-A produced a moderate attenuation of cognitive deficits, but did not have a neuroprotective effect on tissue sparing. These studies show that following TBI, α7 nAChR modulation can have neuroprotective effects and attenuate cognitive deficits. Whether this modulation is best achieved through partial agonist treatment alone or a combination antagonist/agonist treatment remains to be determined.

Older individuals sustaining traumatic brain injury (TBI) experience a much higher incidence of morbidity and mortality. This age-related exacerbated response to neurological insult has been demonstrated experimentally in aged animals, which can serve as a model to combat this devastating clinical problem. The reasons for this worse initial response are unknown but may be related to age-related changes in mitochondrial respiration. Evidence is shown that mitochondrial dysfunction occurs early following traumatic brain injury (TBI), persists long after the initial insult, and is severitydependent. Synaptic and extrasynaptic mitochondrial fractions display distinct respiration capacities, stressing the importance to analyze these fractions separately. Sprague- Dawley and Fischer 344 rats, two commonly used strains used in TBI and aging research, were found to show very similar respiration profiles, indicating respiration data are not strain dependent. Neither synaptic nor extrasynaptic mitochondrial respiration significantly declined with age in naïve animals. Only the synaptic fraction displayed significant age-related increases in oxidative damage, measured by 3-nitrotyrosine (3- NT), 4-hydroxynonenal (4-HNE), and protein carbonyls (PC). Alterations in respiration with age appear to be more subtle than previously thought. Subtle declines in respiration and elevated levels of oxidative damage may not to be sufficient to produce detectable deficits until the system is challenged. Following TBI, synaptic mitochondria exhibit dysfunction that increased significantly with age at injury, evident in lower respiratory control ratio (RCR) values and declines in ATP production rates. Furthermore, synaptic mitochondria displayed increased levels of oxidative damage with age and injury, while extrasynaptic mitochondria only displayed significant elevations following the insult. Age-related synaptic mitochondrial dysfunction following TBI may contribute to an exacerbated response in the elderly population.

The purpose of this project is to examine how the factors of gender, placement status, type of treatment, the number of different types of trauma experienced, and a child’s age at the start of treatment may influence end of treatment symptom severity scores for children ages 2-12 years who received trauma-informed evidence-based treatment for trauma. Method: Caregivers and children receiving outpatient services (N=134) completed the Child Behavioral Checklist, Trauma Symptom Checklist for Young Children, and the Trauma Symptom Checklist for Children-Alternate Version at baseline and end of treatment. Hypotheses were tested with a series of ANCOVA analyses, Independent t-Tests, and a Paired Samples t-Test. Results: While statistically significant improvements were found between baseline and termination outcome scores regardless of treatment type, TF-CBT was found to more successfully reduce externalizing and total problem scores at termination compared to PCIT. Despite the relatively young age of this sample, significant differences in externalizing and total problem scores on the CBCL were found for older children at the end of treatment. No significant differences were found between pre-and post-test internalizing and externalizing scale scores for either TF-CBT or PCIT. Additionally, examination of caregiver and child daily functioning scale scores indicated improved ratings of daily functioning from baseline to the end of treatment. Implications: Behavior problems stemming from traumatic exposure may resolve differently from behaviors that result from environmental factors apart from trauma. Trauma recovery is dependent upon successful matching of client characteristics and need to treatment type. Practitioners are encouraged to be mindful of the specialized needs of older children who are seeking treatment. Research that focuses on clarifying the factors that differentiate symptom resolution can inform treatment selection decisions. Social work educators are encouraged to design curriculum that is trauma-informed with an emphasis on helping students learn how to think critically about a child’s needs and to integrate this knowledge into treatment decisions. The development of policies that incentivize agencies to provide evidence-based care can increase the availability of research-supported care for trauma exposed youth.

Traumatic brain injury (TBI) is a prevalent CNS neurodegenerative condition that results in lasting neurological dysfunction, including potentially debilitating cognitive impairments. Despite the advancements in understanding the complex damage that can culminate in cellular dysfunction and loss, no therapeutic treatment has been effective in clinical trials, highlighting that new approaches are desperately needed. A therapy that limits cell death while simultaneously promoting reparative mechanisms, including post-traumatic neurogenesis, in the injured brain may have maximum effectiveness in improving recovery of function after TBI. Insulin-like growth factor-1 (IGF-1) is a potent growth factor that has previously been shown to promote recovery of function after TBI, but no studies have evaluated the efficacy of IGF-1 to promote cell survival and modulate neurogenesis following brain injury. Systemic infusion of IGF-1 resulted in undetectable levels of IGF-1 in the brain, but did promote increased cortical activation of Akt, a pro-survival downstream mediator of IGF-1 signaling, in mice subjected to controlled cortical impact (CCI), a well-established model of contusion TBI. However, systemic infusion of IGF-1 did not promote recovery of motor function in mice after CCI. A one week central infusion of IGF-1 elevated brain levels of IGF-1, increased Akt activation and improved motor and cognitive function after CCI. Central infusion of IGF-1 also significantly increased immature neuron density at 7 d post-injury for a range of doses and when administered with a clinically relevant delayed onset of 6 hr post-injury. To mitigate potential side effects of central infusion, an alternative conditional astrocyte-specific IGF-1 overexpressing mouse model was utilized to evaluate the efficacy of IGF-1 to promote post-traumatic neurogenesis. Overexpression of IGF-1 did not protect against acute immature neuron loss, but did increase immature neuron density above uninjured levels at 10 d post-injury. The increase in immature neuron density appeared to be driven by enhanced neuronal differentiation. In wildtype mice, immature neurons exhibited injury-induced reductions in dendritic arbor complexity following severe CCI, a previously unknown pathological phenomenon. Overexpression of IGF-1 in brain-injured mice promoted the restoration of dendritic arbor complexity to the dendritic morphology observed in uninjured mice. Together, these findings provide strong evidence that treatment with IGF-1 promotes the recovery of neurobehavioral function and enhances post-traumatic neurogenesis in a mouse model of contusion TBI.

Brain trauma occurs frequently in children and its consequences cause significant health and financial burden to the patients, their carers and society. This thesis assessed the modulating effects of physiological, genetic, and biochemical factors on the sequelae of childhood brain trauma. Primary brain injury from the mechanical forces of trauma and secondary brain insults consequent on the primary injury are determinants of brain trauma outcome. The most important secondary insults recognised are reduced cerebral perfusion pressure (CPP) and raised intracranial pressure (ICP). CPP is governed by the mean arterial blood pressure and the ICP. During childhood these physiological measures change with age. With continuous physiological recordings, ‘critical’ age-related minimum CPP thresholds for children aged 2-6, 7-10 and 11-15 years were defined as 48, 54 and 58mmHg respectively. Utilising these thresholds and a novel cumulative pressure-time index (PTIc), we have demonstrated that CPP insult still remains a feature in 80% of the severe brain trauma patients and significantly relates to global outcome. Brain trauma and cerebral ischaemia are stimuli to the inflammatory cascade leading to further brain damage. Serum adhesion molecule levels after brain trauma indicate injury severity and predict outcome better than brain specific proteins. Predictability is improved using more than one serum biomarker level. Neuro-inflammatory pathways involving adhesion molecules may have a strong modulating effect on brain trauma outcome but warrants further investigations in relation to CPP insult. Genetic factors such as Apolipoprotein E (APO E) genetic polymorphisms may additionally influence outcome, but it was not known whether genetic factors lessen the quantity of CPP insult or the cellular response to it. We demonstrated that the e4 carriers who had unfavourable outcome had 22 times less CPP insult than the non-e4 carriers, while the e3 homozygous who had good recovery had 26 times more CPP insult than the non-e3 homozygous. This suggests that APO E polymorphisms may affect the patient’s cerebral ischaemic tolerance differently, indicating especially the need to prevent CPP insult among e4 carriers. Cerebral ischaemia may, therefore, be a common pathway through which physiological and genetic factors modulate outcome after brain trauma.

The aims of the thesis were to examine i) whether the endogenous opioid system (EOS) is lateralized in human brain areas involved in processing of emotions and pain; ii) whether EOS responses to unilateral brain injury depend on side of lesion, and iii) whether in human alcoholics, this system is involved in molecular adaptations in brain areas relevant for cognitive control of addictive behavior and habit formation. The main findings were that (1) opioid peptides but not opioid receptors and classic neurotransmitters are markedly lateralized in the anterior cingulate cortex involved in processing of  positive and negative emotions and affective component of pain. The region-specific lateralization of neuronal networks expressing opioid peptides may underlie in part lateralization of higher functions in the human brain including emotions and pain. (2) Analysis of the effects of traumatic brain injury (TBI) demonstrated predominant alteration of dynorphin levels in the hippocampus ipsilateral to the injury, while injury to the right hemisphere affected dynorphin levels in the striatum and frontal cortex to a greater extent than that to the left hemisphere. Thus, trauma reveals a lateralization in the mechanisms mediating the response of dynorphin expressing neuronal networks in the brain. These networks may differentially mediate effects of left or right brain injury on lateralized brain functions. (3) In human alcoholics, the enkephalin and dynorphin systems were found to be downregulated in the caudate nucleus and / or putamen that may underlie in part changes in goal directed behavior and formation of a compulsive habit in alcoholics. In contrast to downregulation in these areas, PDYN mRNA and dynorphins in dorsolateral prefrontal cortex, k-opioid receptor mRNA in orbitofrontal cortex, and dynorphins in hippocampus were upregulated in alcoholics. Activation of the k-opioid receptor by upregulated dynorphins may underlie in part neurocognitive dysfunctions relevant for addiction and disrupted inhibitory control. We conclude that the EOS exhibits region-specific lateralization in human brain and brain-area specific lateralized response after unilateral TBI in mice; and that the EOS is involved in adaptive processes associated with specific aspects of alcohol dependence.

Magistro teoriniame darbe yra nagrinėjama post-traumatinė teritorina esanti Libano sostinėje Beirute. Atliktų analizių išvados nurodo tolimesnę praktinio darbo eigą. / This Master thesis project analyzes post-traumatic area situated in Beirut, Lebanon. Conclusions taken from analysis are used to elevate the practical part of MA project.