OBJECTIVE-There is evidence that insulin reduces brain injury evoked by ischemia/reperfusion (I/R). However, the molecular mechanisms underlying the protective effects of insulin remain unknown. Insulin is a well-known inhibitor of glycogen synthase kinase-3 (GSK-3). Here, we investigate the role of GSK-3 inhibition on I/R-induced cerebral injury in a rat model of insulinopenic diabetes.
RESEARCH DESIGN AND METHODS-Ratswith streptozotocin-induced diabetes were subjected to 30-min occlusion of common carotid arteries followed by 1 or 24 h of reperfusion. Insulin (2-12 IU/kg i.v.) or the selective GSK-3 inhibitor TDZD-8 (0.2-3 mg/kg i.v.) was administered during reperfusion.RESULTS-Insulin or TDZD-8 dramatically reduced infarct volume and levels of S100B protein, a marker of cerebral injury. Both drugs induced phosphorylation of the Ser9 residue, thereby inactivating GSK-3 in the rat hippocampus. Insulin, but not TDZD-8, lowered blood glucose. The hippocampi of the drugtreated animals displayed reduced oxidative stress at 1 h of reperfusion as shown by the decreased generation of reactive oxygen species and lipid peroxidation. I/R-induced activation of nuclear factor-B was attenuated by both drug treatments. At 24 h of reperfusion, TDZD-8 and insulin significantly reduced plasma levels of tumor necrosis factor-␣; neutrophil infiltration, measured as myeloperoxidase activity and intercellular-adhesion-molecule-1 expression; and cyclooxygenase-2 and inducible-NO-synthase expression.CONCLUSIONS-Acute administration of insulin or TDZD-8 reduced cerebral I/R injury in diabetic rats. We propose that the inhibitory effect on the activity of GSK-3 contributes to the protective effect of insulin independently of any effects on blood glucose. Diabetes 58:235-242, 2009 E pidemiological studies have shown that diabetes is a leading risk factor for ischemic cerebrovascular diseases (1). Animal and human studies demonstrate that insulin reduces brain damage evoked by ischemia/reperfusion (I/R) injury (2,3). Glycemic control by insulin may be involved in this protective effect, but the molecular mechanisms underlying the protective effects of insulin are debated and still poorly understood (4). One important pharmacological effect of insulin is its ability to inhibit the activity of the glycogen synthase kinase (GSK)-3, a serine/threonine kinase that was originally identified for its key role in glucose metabolism (5). More recently, GSK-3 has emerged as a key regulatory switch in the modulation of neurodegeneration and inflammation (6,7). There are two mammalian isoforms of GSK-3: GSK-3␣ and GSK-3. GSK-3 is highly expressed in the central nervous system (8). Unlike most kinases, GSK-3 is constitutively active in cells and can be inactivated by phosphorylation at Ser9 (9). Binding of insulin to its receptor activates phosphatidylinositol 3-kinase, leading to the subsequent activation of protein kinase B/Akt, and the inactivation of GSK-3 by phosphorylation on the regulatory Ser-9. This contributes to the insulin-induce...