The effect of protein-energy malnutrition on reactive gliosis following global ischemia

Protein-energy malnutrition (PEM) has been found in up to 16.3% of acute stroke patients upon admission to hospital. Our laboratory has previously shown that PEM impairs functional outcome in a gerbil model of global ischemia, but the mechanism has not been established. The purpose of the current study was to characterize the marked reactive gliosis apparent in a subset of these animals that could represent an increased inflammatory response. A second objective was to validate a screening protocol for assessing completeness of ischemia in this model. Male Mongolian gerbils, aged 11-12 weeks, were randomized to PEM (2% protein) or control diet (12.5% protein) for 28d. PEM animals lost 12.2% of their initial body weight, and feed intake and serum albumin concentration were 12.3% and 17.8% lower than controls, respectively. At day 28, animals underwent 5 min bilateral common carotid artery occlusion (ischemia) or sham surgery. Activity was monitored using infrared beam interruptions for 20h post-surgery to screen for complete ischemia on the basis of persistent hyperactivity. Brain sections were stained with hematoxylin & eosin, and viable hippocampal CA1 neurons were counted at 10d post-ischemia. Immunohistochemistry for glial-fibrillary acidic protein (GFAP) and ricinus communis agglutinin -120 (RCA-120), markers for astrocytes and microglia, respectively, and the inflammatory cytokine TNF-alpha was performed on brain sections at 6h, 24h, 3d and 10d post-surgery (Ischemic, n=8; Sham, n=3). The activity monitoring procedure for detecting complete ischemia validated against hippocampal CA1 neuronal loss at 10d demonstrated an accuracy of 84.6%. Temporal changes in GFAP and RCA-120 immunoreactivity characteristic of reactive gliosis were demonstrated following ischemia, but this was not exacerbated by PEM. TNF-alpha immunoreactivity following ischemia was also unaltered by PEM. Ischemia significantly reduced surviving CA1 neurons at 10 days post-ischemia (two-way ANOVA;