Pii: S1010-7940(01)00691-1

Objective: To determine whether cyclosporine A (CsA) or cycloheximide (CHX) can reduce neuronal apoptosis in the hippocampus in a chronic animal model of hypothermic circulatory arrest (HCA). Methods: Twenty-eight pigs (28±33 kg) underwent 90 min of HCA at 208C. In a blinded study, animals were randomized to placebo (n ˆ 12), 5 mg/kg CsA (n ˆ 8), or 1 mg/kg CHX (n ˆ 8). After elective sacri®ce 7 days postoperatively, brains were perfusion-®xed and the left hippocampus was examined for evidence of neuronal cell death. An in situ double-labeling method was used on cryosections to unequivocally identify apoptotic nuclei by the simultaneous visualization of DNA fragmentation and apoptotic chromatin condensation. Sections were also examined by immunocytochemistry for upregulation of the proapoptotic proteins Bax, activated caspase 3, and glyceraldehyde-3-phosphate dehydrogenase. Results: Apoptotic nuclear degradation was clearly present in the CA1, CA2 and CA3 subregions of the hippocampus after HCA. However, there was also morphological evidence for an accompanying necrotic-like cell death. There was no signi®cant difference between the number of apoptotic nuclei observed in CSA-treated animals, mean value 4.4 ^ 1.63 SEM or CHX-treated animals, mean value 4.0 ^ 1.92 SEM, and age-matched control HCA pigs, mean value 4.85 ^ 1.69 SEM, (P . 0:10).Conclusions: The data clearly demonstrate apoptotic cell death in pigs after HCA by simultaneously demonstrating in situ end labeling (TUNEL reaction) and apoptotic chromatin condensation using a nucleic acid-binding dye. Since CsA shows promising neuroprotective effects in behavioral studies, and since the peak of HCA-induced apoptosis occurs earlier than 7 days, further studies will be required to determine whether CsA can improve neuronal survival in the ®rst few days after HCA. CHX was not effective in reducing apoptosis in this model. q 2001 Elsevier Science B.V. All rights reserved.