Traumatic brain injury (TBI) is a leading cause of death and functional disability in western countries, affecting mostly young patients. Despite intense and sustained efforts deployed for the development of new therapeutic strategies, no clinical benefit has been shown by any of the investigated compounds. Increasing attention has been drawn during the past two decades to the neuroprotective effects of estrogens, although most of the available data relate to ischemic brain injury. The purpose of the present study was to investigate the potential neuroprotective value of estrogens in TBI as a therapeutic modality. For this purpose, a contusion was created in the parietal cortex by dynamic cortical deformation in two groups of 10 Sprague-Dawley male rats. Following the injury, treated animals received conjugated estrogens for 3 days, using a subcutaneously implanted osmotic pump. Animals were then sacrificed, and TUNEL, anti-active Caspase 3, bcl-2, and bax labeling were performed in paraffin-embedded brain sections, allowing for comparative and quantitative analysis. In estrogen-treated animals, there was a marked and significant reduction of apoptosis in comparison with non-treated animals. The reduction in TUNEL and active Caspase 3 staining was similar and close to 50%. Optical analysis of histological slides prepared by bcl-2 labeling showed a significant increase in bcl-2 expression in estrogen-treated animals compared to non-treated animals. On the contrary, bax expression was not influenced by hormonal treatment, and no difference could be noticed between the two groups. These results support the potential therapeutic value of estrogens in TBI and further clarify their mode of action.

Neuropathic pain remains one of the leading causes of global disability. The mechanism of neuropathic pain development and maintenance involves mitochondrial dysfunction-induced neuronal apoptosis of peripheral and central nociceptive pathways. Transient receptor potential vanilloid 1 (TRPV1) is a non-selective cation channel, which has a high Ca2+ permeability, playing an essential role in neuronal apoptosis in the spinal cord following peripheral nerve injury. However, the mechanism of how TRPV1 activation in the spinal cord induces mitochondrial dysfunction-mediate neuronal apoptosis, resulting in allodynia is unknown. Here, we found that activating the TRPV1 channel in the spinal cord using capsaicin, a TRPV1 agonist, results in mechanical and thermal hypersensitivity that were found to be mediated by neuroinflammation, an elevated level of apoptosis, and reduced transcription of the mitochondrial complexes in the spinal cord and dorsal root ganglion (DRG). Moreover, during the early activation of TRPV1 (1 h, 24 h, 48 h following the capsaicin injection into the spinal cord) we observed a robust reduction in mitochondrial oxygen consumption in the non-phosphorylated state, ATP-linked respiration, maximal respiration and electron transfer capacity (ETC). A more advanced experiment, wherein we controlled capsaicin, Ca2+ concentration and exposure time in isolated spinal cord tissue (lumbar, L1–L6), unveiled that TRPV1 activation impaired mitochondrial function in terms of oxygen consumption, collapsed the mitochondrial membrane potential (Ψm) and induction of the mitochondrial permeability transition pore (mPTP), which were reversed by the mPTP inhibitor-Cyclosporin A (CsA) during challenging the mitochondria with Ca2+ in a dose-dependent manner. More critically, injection of the TRPV1 antagonist, AMG9810, into the spinal cord following sciatic nerve crush reversed mechanical allodynia and modulated thermal hypersensitivity. In addition, the presence of the TRPV1 antagonist AMG9810 along with capsaicin and Ca2+ during challenging the spinal cord tissue completely prevents early mPTP induction, and the reduction in oxygen consumption. In conclusion, our findings suggest that TRPV1 activation induces neuronal apoptosis, neuroinflammation and mitochondrial dysfunction in the spinal cord, reflected in mechanical and thermal allodynia. Notably, the mitochondrial dysfunction following TRPV1 activation in the spinal cord includes crucial elements that contribute to neuronal death, including mPTP induction, reduction in Ψm and oxygen consumption. Strikingly, regulating TRPV1 following sciatic nerve injury reverses hypersensitivity probably via protection of the mitochondria, suggesting a fundamental role for the TRPV1 pathway in mitochondrial dysfunction-mediated pain development.

The opening of the mitochondrial permeability transition pore (mPTP) has emerged as a pivotal event following traumatic brain injury (TBI). Evidence showing the impact of the translocator protein (TSPO) over mPTP activity has prompted several studies exploring the effect of TSPO ligands, including etifoxine, on the outcome of traumatic brain injury (TBI). Mitochondrial respiration was assessed by respirometry in isolated rat brain mitochondria (RBM) by measurements of oxidative phosphorylation capacity (OXPHOS). The addition of calcium to RBM was used to induce mitochondrial injury and resulted in significant OXPHOS reduction that could be reversed by preincubation of RBM with etifoxine. Sensorimotor and cognitive functions were assessed following controlled cortical impact and compared in vehicle and etifoxine-treated animals. There was no difference between the vehicle and etifoxine groups for sensorimotor functions as assessed by rotarod. In contrast, etifoxine resulted in a significant improvement of cognitive functions expressed by faster recovery in Morris water maze testing. The present findings show a significant neuroprotective effect of etifoxine in TBI through restoration of oxidative phosphorylation capacity associated with improved behavioral and cognitive outcomes. Since etifoxine is a registered drug used in common clinical practice, implementation in a phase II study may represent a reasonable step forward.

Experimental studies have shown that ligands of the 18 kDa translocator protein can reduce neuronal damage induced by traumatic brain injury by protecting mitochondria and preventing metabolic crisis. Etifoxine, an anxiolytic drug and 18 kDa translocator protein ligand, has shown beneficial effects in the models of peripheral nerve neuropathy. The present study investigates the potential effect of etifoxine as a neuroprotective agent in traumatic brain injury (TBI). For this purpose, the effect of etifoxine on lesion volume and modified neurological severity score at 4 weeks was tested in Sprague–Dawley adult male rats submitted to cortical impact contusion. Effects of etifoxine treatment on neuronal survival and apoptosis were also assessed by immune stains in the perilesional area. Etifoxine induced a significant reduction in the lesion volume compared to nontreated animals in a dose-dependent fashion with a similar effect on neurological outcome at four weeks that correlated with enhanced neuron survival and reduced apoptotic activity. These results are consistent with the neuroprotective effect of etifoxine in TBI that may justify further translational research.