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SURVIVIN EXPRESSION AFTER TRAUMATIC BRAIN INJURY: POTENTIAL
ROLES IN NEUROPROTECTION
ERIK ANDREW JOHNSON
A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
Erik Andrew Johnson
This document is dedicated to my wife, Karie, for her loving and unwavering support
during this process.
I would first and foremost like to thank my wife, Karie, for her undying support
and patience during these long years. No matter what the situation, she is always waiting
there with a smile and she has helped me more than she will ever know. I would also like
to thank my parents, Arlen and Patricia Johnson, for their love, dedication and fantastic
parenting skills. Without these, I would not be the person I am today and I would never
have been able to pursue this level of education.
I would like to thank Dr. Ronald Hayes for the opportunity to pursue this novel
research and for the opportunity to contribute to the scientific community. I would also
like to thank past and present committee members, Dr. Douglas Anderson, Dr. William
Dunn, Dr. Gerry Shaw and Dr. Brian Pike for their invaluable input and guidance. I
would especially like to thank Dr. Stanislav Svetlov, whose understanding, patience and
dedication to my educational growth have not gone unappreciated or unnoticed.
Additionally, I would also like to thank Dr. S. Michelle DeFord and Dr. Jose Pineda for
their help and guidance in completing these studies.
Lastly, I would like to thank all the members of Dr. Hayes' laboratory for their
assistance and friendship throughout the years. I would like to especially thank Jeremy
Flint, Barbara Osteen, Dr. Rebecca Ellis, Dr. Stephen Lamer, Dr. Claire Ringger, Jada
Aikman, and Shannon Janssen for their effort and support.
TABLE OF CONTENTS
A C K N O W L E D G M E N T S ................................................................................................. iv
LIST OF FIGURE S ......... ..................................... ........... vii
ABSTRACT .............. .......................................... ix
1 IN TR OD U CTION ............................................... .. ......................... ..
Traum atic Brain Injury Dem ographics..................................................... ..............1
Traumatic Brain Injury Pathophysiology ........................ ........... .... .........2
Traumatic Brain Injury, Apoptosis and Caspase-3 Activation.................................
A poptosis Inhibition Follow ing TBI ........................................ ........................ 6
Cellular Proliferation Follow ing TB I ........................................ ........ ............... 7
Survivin: M itosis and A nti-apoptosis Protein.................................... .....................9
Survivin Protein Structure ................................................. ............................... 9
Survivin Expression and M itosis .......................... ............ ................. 10
Survivin and Apoptosis Inhibition................................... ........... ..... .......... 11
Potential Role for Survivin in TBI Pathology .................................... ............... 13
2 M E T H O D O L O G Y ........................................................................ .......................15
Induction of Controlled Cortical Impact Brain Injury ...............................................15
Quantitative Reverse Transcriptase Polymerase Chain Reaction (Q-PCR) ..............15
Rat-Specific Survivin Polyclonal Antibody Production...........................................17
Survivin Polyclonal Antibody Characterization .. ............... .. ............... ................... 18
W western B lot A nalyses ... ......... ... .. .......... .... ........................ ........... ....... .... 18
Preparation and Sectioning of Tissue for Immunohistochemistry (IHC) .................20
Dual Label Fluorescent Immunohistochemistry (IHC)...........................................21
Dual Label Fluorescent IHC for Same-Species Antibodies ....................................22
Experim ental Group Sizes ..................................... .......................................22
Cell Quantification and Statistical Analysis.................................... ............... 23
3 SURVIVIN EXPRESSION FOLLOWING TRAUMATIC BRAIN INJURY..........25
Induction of Survivin Expression After TBI................................... .................25
PCN A Expression After TBI. ............................................. ............................. 26
Co-Expression of Survivin and PCNA Following TBI.................. ..................28
Survivin and PCNA are Expressed in Astrocytes After TBI........................... 30
Survivin and PCNA are Expressed in a Sub-Set of Neurons After TBI ....................34
Survivin is Not Expressed in Microglia and Oligodendrocytes ..............................35
D discussion of Chapter 3 .................. ........................... .... .... .. ........ .... 36
4 SURVIVING AND APOPTOSIS INHIBITION FOLLOWING TRAUMATIC
B R A IN IN JU R Y ............ ..................................................................... ........ .. ....... .. 40
Caspase-3 is Activated in the Same Brain Regions as Survivin Following TBI........40
Survivin Expression Correlates with Decreased TUNEL Labeling but not Active
Caspase-3 Expression. ..... ............. .................... .... .. ......... ..... ................ 40
Astrocytes and Neurons Demonstrate Cell Specific Differences in
Active Caspase-3 and TUNEL Labeling .................................... ............... 44
D iscu ssion of C chapter 4 ...................................................................... .................. 46
5 CONCLUSIONS AND FUTURE DIRECTIONS ............................................. 53
C o n c lu sio n s.................................................... .................. 5 3
F future D directions .......................................................................58
LIST OF REFEREN CES ..................................................................... ............... 60
BIO GRAPH ICAL SK ETCH .................................................. ............................... 77
LIST OF FIGURES
1-1 Intrinsic and extrinsic apoptosis pathways..... .......... ....................................... 5
1-2 Survivin protein structure ........................................................................... ... .... 12
2-1 IHC characterization of the rat-specific survivin antibody .............. ...................19
2-2 Control section for biotin/streptavidin same-species dual labeling IHC..................23
3-1 Survivin mRNA induction in rat brain after TBI. .................................................26
3-2 Expression of survivin protein after TBI in rats.....................................................27
3-3 Expression of PCNA after TBI in rats ........................................... ...............29
3-4 Immunohistochemistry of survivin and PCNA.....................................................30
3-5 Co-localization of survivin and GFAP in brain tissue after TBI.............................31
3-6 Co-localization of PCNA and GFAP in brain tissue after TBI.............................32
3-7 A sub-set of NeuN-positive neurons express survivin and PCNA after TBI........... 33
3-8 No survivin expression is found in oligodendrocytes or microglia following
T B I in rats. ............................................................................35
4-1 Caspase-3 Activation in rat brain after traumatic brain injury..............................41
4-2 Co-expression of survivin and apoptosis markers following TBI in rats ...............42
4-3 Survivin expression decreases the accumulation of TUNEL but not
active caspase-3 ................................................. .... ........ ........... 43
4-4 Astrocytes express active caspase-3 and label with TUNEL following TBI
in rats ................... ...................................... ............................46
4-5 Neurons express active caspase-3 and label with TUNEL following TBI in rats....47
4-6 TUNEL labeling is cell specific following TBI in rats. ................ ............... 48
4-7 Putative mechanism of apoptosis inhibition by survivin following TBI .................49
Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy
SURVIVIN EXPRESSION AFTER TRAUMATIC BRAIN INJURY: POTENTIAL
ROLES IN NEUROPROTECTION
Erik Andrew Johnson
Chair: Ronald L. Hayes
Major Department: Neuroscience
In these studies,the expression profile and cellular localization of survivin, a novel
anti-apoptotic and mitosis protein, following traumatic brain injury (TBI) in rats was
examined. Specifically, survivin co-localization with the cell cycle protein PCNA, the
apoptosis protease active caspase-3, and the DNA fragmentation label TUNEL was
determined to reveal potential role of survivin in neuroprotection and to elucidate anti-
apoptotic mechanisms. Levels of survivin mRNA and protein were increased in the
ipsilateral, but not contralateral, cortex and hippocampus of rats after TBI, peaking at five
days post injury. Similar temporal and spatial patterns of PCNA were also significantly
enhanced in these brain regions. Immunohistochemistry revealed that survivin and
PCNA were co-expressed in the same cells and had a focal distribution within the injured
brain. Further analysis revealed a frequent co-localization of survivin and GFAP, an
astrocytic marker, in both ipsilateral brain regions, while a much smaller subset of cells
showed co-localization of survivin and NeuN, a mature neuronal marker. PCNA protein
expression was detected in both astrocytes and neurons of the ipsilateral cortex and
hippocampus after TBI.
Western blot analysis revealed significant increases in the accumulation of active
caspase-3 between five and fourteen days post injury. The percentage of survivin-
positive and negative cells labeled with active caspase-3 at five or seven days post-injury
was not significantly different. However, survivin-negative cells exhibited a significantly
greater labeling with TUNEL compared to survivin-positive cells, thereby suggesting that
expression of survivin may attenuate DNA cleavage and progression of apoptosis.
Although a higher percentage of astrocytes accumulated active caspase-3 compared to
neurons, these neurons showed significantly higher frequency of TUNEL labeling.
These novel data demonstrate that survivin is abundantly expressed in brain cortex
and hippocampus of adult rats following TBI. Survivin accumulation occurs primarily in
astrocytes and a sub-set of neurons. The occasional co-expression of survivin and PCNA
coupled with the low frequency of TUNEL labeling in survivin expressing cells may
suggest that survivin is primarily involved in attenuating apoptotic cell death and
secondarily may play a role in regulation of neural cell proliferative responses after TBI.
Traumatic Brain Injury Demographics
Traumatic brain injury (TBI) is the leading cause of death and permanent disability
for children and young adults in the United States. Currently, there are more than 5.3
million Americans, approximately 2% of the current U.S. population, living with TBI-
related disabilities (Thurman et al., 1999a) with an estimated 1.5 million additional TBIs
occurring each year (Sosin et al., 1996). Approximately 230,000 cases are severe enough
that the victims require transport and hospitalization (Thurman et al., 1999b). Of these,
approximately 50,000 victims die from their injuries, accounting for 33% of all injury-
related deaths (Sosin et al., 1995). Of those severely injured survivors, 90,000 TBI
victims must live with long-term disabilities (Thurman et al., 1999b). The U.S. economy
loses an estimated $56.3 billion a year through the direct and indirect costs associated
with TBI (Thurman et al., 1999b).
Currently, most traumatic brain injuries result from motor vehicle accidents
(48.9%) followed by falls (25.8%) and firearms/ assaults (19.2%) (Thurman et al.,
1999b). Young males, ages 15 to 24, are the most "at-risk" demographic, a statistic that
likely reflects lifestyle choices (Jennett, 1996; Thurman et al., 1999b). The magnitude of
this problem led to the passing of Public Law 104-166, better known as the Traumatic
Brain Injury Act of 1996, a bill designed to help prevent TBI and educate the public
about the health consequences of this injury (Thurman et al., 1999b). While these
educational efforts have decreased TBI-related deaths by an estimated 22% since 1980
(Sosin et al., 1995), the number of people living with TBI-related disabilities has risen
(Thurman et al., 1999b).
To date, few pharmacological or treatment options are available to reduce these
TBI-induced disabilities. Prevention remains the only effective "cure." True advances in
clinical treatment depend on understanding the underlying pathophysiology mechanisms
that regulate both cell death and cell survival following TBI.
Traumatic Brain Injury Pathophysiology
Traumatic brain injury is a complex injury that is comprised of an immediate
primary injury and a progressive secondary injury cascade (Graham et al., 2000). The
primary mechanical injury can be contusive or concussive and involves tearing and
stretching of the neural tissues. Neurons and white matter tracts seem particularly
vulnerable to the mechanical injury (Baldwin et al., 1997; Maxwell et al., 1997;
McCullers et al., 2002; Grady et al., 2003). The secondary injury cascade is initiated by
the primary mechanical injury and is defined by unrestrained biochemical and
inflammatory reactions (Gennarelli, 1993). Though the brain is remarkably adaptive,
damage sustained as the result of secondary injury prevents the brain from regaining pre-
While many of the biochemical processes seen after TBI occur under normal
homeostasis, their collective dysregulation acts in a synergistic manner to contribute to
the pathology associated with secondary injury. Some of the more prominent events
include perturbations in blood flow (Graham et al., 1995; McIntosh et al., 1998;
Raghupathi et al., 2000), ischemia (Lee et al., 1999; Passineau et al., 2000), excitotoxicity
(Choi and Rothman, 1990; Gennarelli, 1993), calcium deregulation (Graham et al., 1995),
free radical production (Kontos, 1989; Beckman et al., 1990; Maier and Chan, 2002),
inflammation (Povlishock and Kontos, 1985; Giulian, 1991; Morganti-Kossmann et al.,
2001), edema (Choi, 1988; Bullock et al., 1991) and protease activation (Pike et al., 1998;
Clark et al., 2000; Eldadah and Faden, 2000; Raghupathi et al., 2000; Knoblach et al.,
2002; Larner et al., 2004). Ultimately, activation of these processes disrupts fragile
homeostatic states and creates an inhospitable environment for neural cell survival.
Traumatic Brain Injury, Apoptosis and Caspase-3 Activation
Cell death following TBI is distinguished by necrotic and apoptotic processes
(Conti et al., 1998; Clark et al., 2000; Yakovlev and Faden, 2001). Necrosis and
apoptosis lie on a continuum (Nicotera et al., 1999) wherein the mode of cell death is
dictated by several factors including ATP availability (Green and Reed, 1998), calpain
activity (Wang, 2000), intracellular calcium levels (Gwag et al., 1999; Zipfel et al.,
2000), presence of anti-apoptotic factors (Raghupathi et al., 2000) and the presence of
activated caspases (Denecker et al., 2001). Within hours of a TBI, neural cells around the
contusion area exhibit classic signs of necrosis including cytotoxic edema, mitochondrial
swelling, nuclear pyknosis, ruptured plasma membranes, organelle breakdown and
vacuolated cytoplasm (Sutton et al., 1993; Dietrich, 1994; Denecker et al., 2001).
However, as time progresses, many cells including neurons, astrocytes and
oligodendrocytes begin to exhibit characteristics of apoptosis including chromatin
condensation, cell shrinkage, apoptotic body formation and DNA laddering (Conti et al.,
1998; Newcomb et al., 1999). It is well documented that apoptotic cell death continues
for many months following injury, thereby making it a chronic contributor to post-TBI
pathology (Cervos-Navarro and Lafuente, 1991).
Apoptosis has been well characterized following traumatic brain injury (Pike et
al., 1998; Beer et al., 2000; Clark et al., 2000) and utilizes both the intrinsic and extrinsic
apoptotic pathways (Fig. 1-1). Each pathway involves a unique set of upstream and
downstream cysteine specific proteases called caspases that cleave a variety of
intracellular substrates and drive apoptosis. Synthesized as inactive zymogens, caspases
require the cleavage of a pro-domain to become active. Caspase activation is achieved in
multiple manners including proximity-induced autoproteolysis or cleavage by another
caspase (Stennicke and Salvesen, 1999; Van de Craen et al., 1999). Both the intrinsic
and extrinsic pathways lead to cleavage and activation of caspase-3, the most abundant
executioner caspase in the brain (Chan and Mattson, 1999; Slee et al., 2001).
Among the numerous structural and regulatory protein targets of active caspase-3
are stress response proteins (e.g., PARP, Rb and p21), signal transduction proteins (e.g.,
phospholipase A2, NFKB and PKC), structural proteins (e.g., a-II-spectrin, actin and
vimentin), nuclear matrix proteins (e.g., lamins A, B and C) and mitochondrial proteins
(e.g., Bcl-2, Bcl-xl and Bid) (Cohen, 1997; Chan and Mattson, 1999; Earnshaw et al.,
1999; Wang, 2000). Cleavage of proteins such as iCAD/DFF45 (Enari et al., 1998; Liu
et al., 1998b; Sakahira et al., 1998), poly (ADP-ribose) polymerase (PARP) (Ferrer and
Planas, 2003), DNA-dependent protein kinase (DNA-PK) (Lazebnik et al., 1994) and
acinus (Sahara et al., 1999) prevents DNA repair and promotes DNA condensation and
fragmentation (Woo et al., 1998). When unregulated, even moderate activation of
caspase-3 can rapidly lead to cell death. Therefore, nature has developed various
mechanisms to temper the deleterious effects of caspase-3 over-activity and counter the
progression of apoptosis.
pa-!X. \;e-s 0 1
Rb T 5 & 'a a ^ ^
Actin DNA Fragmentation
Lamins A, B1 & C
i Cell Death
Figure 1-1: Intrinsic and extrinsic apoptosis pathways. Apoptosis progresses primarily
through the extrinsic and intrinsic apoptosis pathways. The extrinsic pathway
is mediated by ligand binding to membrane bound death receptors and
caspase-8 activation. Activation of this pathway can promote cell death by
intrinsic pathway activation or apoptosis prevention by up-regulation of
apoptosis inhibitors. The intrinsic pathway is mediated by mitochondrial
stress. Caspase-9 is activated in the apoptosome complex. Both pathways
promote caspase-3 activation. Active caspase-3 can cleave several
intracellular proteins. Cleavage of proteins such as iCAD (DFF45), PARP
and acinus can lead to DNA fragmentation and cell death.
Death i eeptol llsaind
Apoptosis Inhibition Following TBI
While many pro-apoptotic proteins are expressed following TBI, there is a
concomitant increase in pro-survival factors (Nowak and Jacewicz, 1994; Iwata et al.,
1997; Buytaert et al., 2001; Hermann et al., 2001; Sanz et al., 2001; Alzheimer and
Werner, 2002; Maroni et al., 2003). Of these pro-survival factors, a family of proteins
known as inhibitor of apoptosis proteins (IAPs) can attenuate apoptotic cell death by
directly binding to the active site of activated caspases such as caspase-3 (Tamm et al.,
1998; Conway et al., 2000; Shin et al., 2001). The IAP family contains eight known
members including survivin (Li, 2003). The proteins are highly conserved across species
(LaCasse et al., 1998) and the expression of each IAP appears to be cell type specific.
Each IAP has one to three baculovirus IAP repeat (BIR) domains that possess the ability
to bind and directly inhibit active caspase-3 (Tamm et al., 1998; Conway et al., 2000;
Shin et al., 2001), caspase-7 (Tamm et al., 1998; Shin et al., 2001) and caspase-9
(LaCasse et al., 1998; Deveraux and Reed, 1999). Mutation studies have demonstrated
that the BIR domain is responsible for caspase interaction and is therefore necessary for
anti-apoptotic action of the IAPs (Roy et al., 1997; Takahashi et al., 1998; Vucic et al.,
1998; Muchmore et al., 2000).Although few IAPs have been extensively characterized in
the context of TBI pathophysiology, increases in XIAP (Keane et al., 2001; Lotocki et al.,
2003), NAIP (Xu et al., 1997; Hutchison et al., 2001; Thompson et al., 2004), clAP-1
(Keane et al., 2001; Belluardo et al., 2002) and cIAP-2 (Keane et al., 2001) have been
reported in neurons following brain injury. The potential role of survivin following TBI
has not been investigated.
Cellular Proliferation Following TBI
In addition to pro-survival factors, new cell production plays a pivotal role in the
brain following injury. Large pools of neural progenitor cells have recently been
identified in the germinal centers of the dentate gyms subgranular zone (SGZ) and
subventricular zones (SVG) of the adult brain (Gage et al., 1998; Magavi et al., 2000;
Gage, 2002; Sanai et al., 2004). Following both ischemia and TBI, these neural
progenitor cells proliferate (Gould and Tanapat, 1997; Yagita et al., 2001) and
differentiate into mature neurons (Gage et al., 1998; Doetsch et al., 1999; Magavi et al.,
2000; Cameron and McKay, 2001; Dash et al., 2001; Kemie et al., 2001; Yagita et al.,
2001; Peterson, 2002), astrocytes (Dash et al., 2001; Gould et al., 2001; Chirumamilla et
al., 2002; Chen et al., 2003) and oligodendrocytes (Gould et al., 2001). Consistent with
these findings, many cell cycle proteins (e.g., cyclins A, B and Dl, cdk4 and PCNA) are
also up-regulated after brain injury (Miyake et al., 1992; Kaya et al., 1999a; Chen et al.,
2003; McPherson et al., 2003).
Cellular proliferation following TBI can have both beneficial and detrimental
consequences to the recovery of the damaged brain. These consequences can also vary
by cell type. Neuronal progenitor cells have been shown to proliferate following brain
injury (Parent, 1997; Hill-Felberg et al., 1999; Dash et al., 2001; Kernie et al., 2001;
Yagita et al., 2001; Chirumamilla et al., 2002; Rice et al., 2003) but the functional
viability and therefore significance of these newly formed neurons is not clear. New
neurons appear to migrate away from the germinal centers of the subventricular zone
(SVZ) and subgranular zones of the dentate gyms (SGZ) but not towards areas of injury
(Rice et al., 2003). Additionally, as many as 80% of all newly formed neurons undergo
apoptosis within two weeks of their formation in normal conditions (Morshead and van
der Kooy, 1992; Morshead et al., 1994). The proliferation of neurons following TBI may
be advantageous but their inability to survive and contribute to recovery requires
Glial cell proliferation, specifically astrocytes and oligodendrocytes, can serve to
both support and inhibit natural recovery processes. Adult oligodendrocyte precursor
cells (OPC) can develop into both astrocytes and oligodendrocytes following injury.
Furthermore, their distribution in the adult brain is not as restricted as the neuronal
precursor populations (Dawson et al., 2000). An increase in both the astrocyte and
oligodendrocyte population may contribute positively to the post-injury milieu.
Astrocytes metabolize extracellular glutamate, neutralize free radicals, modulate the
immunological response by production of cytokines and modulating nitric oxide activity
(Gabryel and Trzeciak, 2001; Bambrick et al., 2004; Heales et al., 2004). Similarly,
oligodendrocytes can help re-myelinate damaged axons. Furthermore, glial cell
proliferation may contribute to formation of the glial scar. This barrier can act to protect
non-damaged brain regions from advancing secondary injury processes (Ridet et al.,
1997; Bush et al., 1999; Smith et al., 2001). However, the glial scar also produces
chondroitin sulfate proteoglycans which may then act to form an impermissible
environment for axonal growth (Fawcett and Asher, 1999; Chen et al., 2002).
With developmental origins as hematopoietic cells, microglia are one of the few
mature neural cell types that retain the ability to divide (Simard and Rivest, 2004). After
various types of brain injury, microglia proliferate rapidly (Liu et al., 1998a; Csuka et al.,
2000; Liu et al., 2000; Grady et al., 2003) to remove cellular debris, protect injured
neurons and promote functional recovery (Giulian, 1991). However, microglia have been
documented as a major source of proteases and inflammatory cytokines following various
CNS injuries (Nakajima and Kohsaka, 1993; Streit and Kincaid-Colton, 1995; Streit,
1996; Aldskogius et al., 1999; Fawcett and Asher, 1999; Gong et al., 2000).
Functional replacement of injured and dying cells may contribute to more complete
recovery following TBI. Because the neural environment becomes hostile for new cells
to survive during the injury state, the identification of proteins that promote both cellular
proliferation and survival in compromised cellular environments may prove useful in
treating the injured brain. A very delicate balance between proliferation and cell death
inhibition is desired. Survivin is a protein that has recently been identified as having
roles in both mitosis regulation and apoptosis inhibition in other non-central nervous
system (CNS) pathological conditions and may contribute to this balance following TBI.
Survivin: Mitosis and Anti-apoptosis Protein
Survivin was discovered in 1997 as a protein expressed only by rapidly dividing
cells during development (Ambrosini et al., 1997). As its expression is prominent in
apoptosis-resistant tumor cells, survivin became an intensely studied protein in cancer
research. These studies demonstrated that survivin functioned to inhibit apoptosis and
was essential for the proper completion of mitosis. Because it has an integral role in
cellular proliferation and apoptotic cell death, both of which contribute to the
pathophysiology of TBI, survivin may have an important role in the secondary injury
Survivin Protein Structure
The survivin protein is composed of 142 amino acids with a molecular weight of 17
kDa per monomer (Ambrosini et al., 1997). Cellular survivin exists as a homodimer
bound together by an intermolecular Zn atom giving the complex a "bow-tie "
appearance and is the only IAP known to homodimerize in solution (Chantalat et al.,
2000; Muchmore et al., 2000; Verdecia et al., 2000) (Fig. 1-2). Survivin is the smallest
IAP to have anti-apoptotic properties, containing only a single BIR domain and
microtubule-binding coiled coil domain (Ambrosini et al., 1997).
A distinct subcellular pool of survivin exists in the cytoplasm and nucleus of the
cell (Conway et al., 2000; Li, 2003; Badran et al., 2004) with a ratio of 6:1, respectively
(Fortugno et al., 2002). Recent evidence suggests that the subcellular localization of
survivin may designate its role. The nuclear pool appears to be associated with cellular
proliferation while cytoplasmic survivin appears to be more predictive of caspase
inhibition (Moon and Tarnawski, 2003). Survivin is a relatively short-lived protein with
a half-life of approximately 30 minutes (Zhao et al., 2000), though phosphorylation may
enhance its stability (O'Connor et al., 2000a; O'Connor et al., 2002). Survivin is removed
from the cell by polyubiquitination and proteasomal destruction (Zhao et al., 2000).
Survivin Expression and Mitosis
As a protein found almost exclusively in apoptosis-regulated embryonic and fetal
tissue (Adida et al., 1998; Kobayashi et al., 1999), survivin is not normally found in
differentiated adult tissues. However, it is present at very low levels in adult cells with a
high mitotic index (Ambrosini et al., 1997). The function of survivin during mitosis is
intimately related to its ability to bind microtubules. Survivin is required for the
assembly of a bipolar mitotic apparatus by controlling microtubule stability (Altieri,
2001, 2003b). Homozygous deletion of the survivin gene causes defects in microtubule
assembly, mitotic spindle formation and cell division resulting in multi-nucleation and
total lethality of the organism by E3.5-4.5 in knockout mice (Uren et al., 2000).
Beyond development, survivin is prominently expressed in many cancers and is
linked to poor survival prognosis, higher rates of cancer reoccurrence and elevated
mortality rates (Altieri, 2003a). Many neural derived cancer cell lines have been shown
to over-express survivin including astrocytes gliomaa), neurons neuroblastomaa) and
oligodendrocytes (oligodendroglioma) (Shankar et al., 2001; Borriello et al., 2002; Sasaki
et al., 2002; Kajiwara et al., 2003; Kleinschmidt-DeMasters et al., 2003; Jiao et al.,
2004), indicating that mature, albeit abnormal, neural cells retain the ability to express
survivin beyond differentiation. Additionally, proliferating neural stem cells express
mitosis proteins after brain injury (Cameron and McKay, 1998; Doetsch et al., 1999;
Cameron and McKay, 2001; Song et al., 2002) indicating that non-transformed neural
cells may also express survivin following TBI.
Survivin and Apoptosis Inhibition
The ability of survivin to inhibit apoptosis is known to occur in conjunction with
the cell cycle but also has been shown to be independent of mitosis. For example, many
tumor cells express survivin when not actively dividing and can inhibit apoptosis caused
by chemotherapeutic agents (Li et al., 1998). Beyond cancer, survivin expression has
been reported in non-proliferating, non-tumor cells after ischemic brain injury without
activating mitosis and with the ability to inhibit cell death (Blanc-Brude et al., 2002; Tran
et al., 2002; Conway et al., 2003). Therefore, survivin expression may occur without
activation of the cell cycle.
It has been demonstrated repeatedly that survivin over-expression can inhibit
apoptosis in cancer cells (Ambrosini et al., 1998; Grossman et al., 1999; Muchmore et al.,
2000; Shin et al., 2001; Kim et al., 2004). Survivin expressing gastric and esophageal
squamous cell cancers exhibit significantly lower rates of apoptosis compared to
1 14 BIR 8o 9s Coiled coil 140142 Su
Coiled Coil 142
Figure 1-2: Survivin protein structure. Survivin is a 142 amino acid (17 kDa) protein that
contains a single baculovirus IAP repeat (BIR) domain (red) and a C-terminus
a-helical coiled coil domain (orange). In solution, survivin homodimerizes
and is held together by a zinc ion interaction. The survivin BIR domain has
been shown to bind activated caspase-3 and inhibit apoptosis induced by
many factors. The coiled coil domain can bind and stabilize microtubules
during assembly of the bipolar mitotic apparatus and keep it in close
proximity to caspase activity as mitosis progresses. 3-D survivin structure
adapted from Verdecia et al 2000.
survivin-negative cancer cells (Lu et al., 1998). Molecular antagonists of survivin (e.g.,
siRNA, antisense, dominant negative mutants) cause caspase-dependent cell death and
magnify the effects of other pro-apoptotic signals in vitro and in vivo (Li et al., 1999;
Kanwar et al., 2001; Kasof and Gomes, 2001; Shankar et al., 2001; Xia et al., 2002a;
Zhou et al., 2002; Choi et al., 2003). In addition, survivin has been shown to protect cells
from a variety of apoptotic stimuli including IL-3 withdrawal (Ambrosini et al., 1997),
Fas stimulation (Tamm et al., 1998; Jiang et al., 2001), anoikis (Papapetropoulos et al.,
2000), cytochrome c administration (Takahashi et al., 1998; Tamm et al., 1998), Bax
over-expression (Deveraux et al., 1997; Tamm et al., 1998), active caspase-3 (Tamm et
al., 1998), active caspase-7 (Tamm et al., 1998; Jiang et al., 2001), Taxol (Li et al., 1998),
and etoposide (Tamm et al., 1998; Jiang et al., 2001).
In these models, survivin appears to exert its anti-apoptotic effects by directly
binding to active caspase-3 (Tamm et al., 1998; Kobayashi et al., 1999). It is possible,
however, that survivin may also act at other, less clearly defined points in the apoptotic
cascade (Suzuki et al., 2000; Grossman and Altieri, 2001; Grossman et al., 2001a;
Fortugno et al., 2003) or outside of apoptotic caspase activation to prevent cell death
(Shankar et al., 2001; Chakravarti et al., 2004).
Potential Role for Survivin in TBI Pathology
There are currently no comprehensive studies of survivin in neural cells following
CNS injury. Moreover, the potential involvement of survivin in TBI pathophysiology is
unknown. The role of survivin in apoptosis inhibition and cellular proliferation in
various in vitro and in vivo models supports the hypothesis that survivin may also
contribute to the pathophysiology of TBI. Both apoptosis and cellular proliferation occur
following traumatic brain injury and create an environment where survivin expression
may be important in balancing two contrasting yet related processes. From the literature,
it is clear that survivin is ubiquitously expressed by all cells early in development and
that this expression may be restored in certain mature cells following CNS injury.
Therefore, based on the existing data described above from the areas of cancer,
mitosis and apoptosis, a thorough investigation of survivin following TBI was warranted.
Thus, the main goal of this work is to reveal and characterize potential roles for survivin
in neural cell responses following traumatic brain injury. The general hypothesis of the
study is that survivin is up-regulated following TBI and plays a role in anti-apoptotic and
cell cycle activation mechanisms to oppose TBI pathogenesis. Specifically, I propose that
(i) survivin up-regulation inhibits caspase-3 mediated DNA fragmentation in a cell-
specific manner following TBI, and (ii) survivin plays a role in cell cycle progression
Induction of Controlled Cortical Impact Brain Injury
The surgical and cortical impact injury procedures were conducted as previously
described (Dixon et al., 1991; Pike et al., 1998). Briefly, adult male Sprague-Dawley rats
(250-300 g) were anesthetized with 4% isoflurane (Halocarbon Laboratories; River Edge,
NJ) in 1:1 O2/ N20 for 4 minutes and maintained during surgery with 2.5% isoflurane.
Core body temperature was continuously monitored using a rectal thermistor probe and
maintained at 36.5-37.5 C using an adjustable heating pad. A unilateral craniotomy
(ipsilateral to injury) was performed over the right cortex between the sagittal suture,
bregma and lambda while leaving the dura intact. Traumatic insult was generated by
impacting the exposed cortex with a 5 mm diameter aluminum tip at a velocity of 4
m/sec, a 150ms dwell time and 1.6 mm compression. Craniotomy control animals
received the craniotomy but not the impact injury. All procedures were performed
according to guidelines established by the University of Florida Institutional Animal Care
and Use Committee (IACUC) and the National Institutes of Health (NIH). In the
following studies, "ipsilateral" refers to the same side as the impact injury whereas
"contralateral" refers to the opposite side of the injury. "Craniotomy control" refers to
animals that received the craniotomy but did not receive the impact injury.
Quantitative Reverse Transcriptase Polymerase Chain Reaction (Q-PCR)
Survivin primers were generated using GeneBank locus AF 276775: forward
primer 5' TAAGC CACTT GTCCC AGCTT 3', and reverse primer 5' AGGAT GGTAC
CCCAT TACCT 3'. GAPDH: forward primer 5' GGCTG CCTTC TCTTG TGAC 3'
and the reverse primer 5' CACCA CTTCG TCCGC CGG 3'. Cortical and hippocampal
tissues from the ipsilateral and contralateral hemispheres were rapidly excised at either 1
day, 2 days, 3 days, 5 days, 7 days or 14 days and 'snap-frozen' with liquid nitrogen.
Total RNA was isolated from the samples using TRIzol reagent (Invitrogen, Carlsbad,
CA, USA) according to the manufacturer's instructions. Final RNA concentrations were
determined via spectrophotometry and were stored at -200 C in diethyl pyrocarbonate
(DEPC) water for future cDNA preparation.
cDNA synthesis was performed using 1 |jg of total RNA with the SuperScriptTM
First-Strand Synthesis System for RT-PCR kit (Invitrogen/Life Technologies, Carlsbad,
CA) according to the manufacturer's instructions. Any DNA contamination was detected
in the RNA samples by "no reverse transcriptase" reactions that were performed in
conjunction with the cDNA synthesis reaction.
Q-PCR was performed as previously described (Tolentino et al., 2002) using the
LightCycler-FastStart DNA Master SYBR Green I reaction mix (Roche Diagnostics,
Indianapolis, IN) in combination with 0.5 [LM primers, 2.5 mM MgC12 in the Light
Cycler rapid thermal cycler system (Roche Diagnostics, Indianapolis, IN). Briefly, the
products were amplified then continuously quantified by online monitoring. Each PCR
reaction has its kinetics represented by an amplification curve. Each amplification curve
(fluorescence vs. cycle number) is assigned a crossing point value (CPV), which is the
exact time point at which the logarithmic linear phase could be distinguished from the
background. A lower CPV indicates a more rapid increase in the level of fluorescence
indicative of a higher concentration of specific message present in the sample. Therefore,
those samples with a lower CPV have more amplified message than those with a higher
The survivin primer sets were subjected to serial dilution and linear regression
analysis of the logarithm of the dilution factor vs. the CPV generated a standard curve for
each transcript-specific template. The specificity of the amplified products were
confirmed using melting curve analysis and gel electrophoresis. The relative amounts of
RNA from the unknown samples were extrapolated from its calculated CVP in relation to
the generated standard curve. Results are presented as percentage of craniotomy control.
Data were analyzed by ANOVA with a post-hoc Bonferroni-test and are given as mean +
SEM. Differences were considered significant at the level of p < 0.05.
Rat-Specific Survivin Polyclonal Antibody Production
Commercially available survivin antibodies were not adequate to label survivin in
tissue sections. Therefore, a new rat-specific antibody was developed for use in
fluorescent immunohistochemistry. Two rat-specific survivin sequence peptides were
synthesized using the protein sequence from GeneBank, accession number AF276775
(Swissprot Q9JHY7), for antibody production. The two peptides corresponded to regions
in the conserved BIR domain (CPTENEPDLAQC) and from the C-terminus coiled coil
domain (CFKELEGWEPDDNPIEE). The peptides used to develop the survivin antibody
(R51) are specific to survivin and do not recognize other IAP family proteins according
to SDSC Biology Workbench BLASTP (2.2.2) (Altschul et al., 1997) and CLUSTAL W
(1.81) analysis (Higgins et al., 1992; Thompson et al., 1994) resulting in the survivin
antibody's specificity. Alignment scores for CLUSTALW (1.81) were computed with
the following multiple alignment parameters: Matrix: Gonnet, Gap Open Penalty: 10.00,
% Identity for Delay: 30, Penalize End Gaps: on, Gap Separation Distance: 0, Negative
Matrix?: no, Gap Extension Penalty: 0.20, Residue-Specific Gap Penalties: on,
Hydrophilic Gap Penalties: on, Hydrophilic Residues: GPSNDQEKR.
Rabbits were immunized with these peptides, allowed to produce antibodies to the
peptides and finally serum was extracted from the immunized rabbits. The rat specific
survivin antibodies were removed and affinity purified using a SulfoLink kit (Pierce Inc;
Rockford, IL) as per the manufacturers instructions.
Survivin Polyclonal Antibody Characterization
The specificity of the survivin antibody (R51; Dr. G. Shaw) was compared to other
commercially available survivin antibodies (Chemicon; Temecula, CA and Novus
Biologicals; Littleton, CO) on western blots and in cell culture. On western blots using
dividing cell culture lysates (HeLa and SY5Y) and injured tissue lysates, R51 and the
Novus survivin antibody show a similar labeling pattern and recognized the 17 kDa
monomer of survivin. For IHC, R51 showed characteristic staining of the cleavage
furrow between dividing HeLa and SY5Y cells consistent with other reports (Li et al.,
1998; Li et al., 1999; Uren et al., 2000) (Figure 2-1). In addition, dual-labeling in
dividing cell cultures of both HeLa and SY5Y cells with R51 and the Chemicon survivin
antibody showed co-localization at the cleavage furrow.
Western Blot Analyses
The cortex and hippocampus from each set of brain tissues was excised, rinsed with
cold PBS, snap frozen in liquid nitrogen and homogenized in ice-cold triple detergent
lysis buffer containing a CompleteTM protease inhibitor cocktail (Roche Biochemicals,
Indianapolis, IN). Protein concentration was determined by bicinchoninic acid (BCA)
Figure 2-1: IHC characterization of the rat-specific survivin antibody. The survivin
antibody (R51) reveals a characteristic and previously described labeling
pattern on western blot (A) and in IHC (B). Western blot analysis revealed a
classic 17 kDa band in cell culture lysates (lanes 1-3) and in injured rat tissue
lysates (lanes 6-7) but not in un-injured rat tissue lysates (lanes 4-5). IHC
using the survivin antibody revealed a well-characterized survivin (green)
staining pattern around the nuclei (DAPI, blue) of proliferating SY5Y cells in
various stages of mitosis including G2/M, interphase (I), pro-metaphase (PM),
anaphase (A) and telophase (T).
micro protein assays (Pierce, Inc., Rockford, IL). Forty micrograms of protein per well
was loaded and separated by SDS-PAGE, transferred to PVDF membranes and probed
with either goat-anti-rabbit survivin antibody (Novus Biologicals; Littleton, CO; 1:1000)
or goat-anti-rabbit active caspase-3 (Cell Signaling; 9661L; 1:100). After incubation
with goat anti-rabbit HRP-labeled secondary antibody (Biorad, Hercules, CA), the
membranes were developed using Enhanced Chemiluminescence Plus reagents (ECL
Plus; Amersham, Arlington Heights, IL). For further PCNA analysis, developed PVDF
membranes were incubated in stripping buffer, rinsed twice in TBST and incubated with
PCNA (Santa Cruz Biotech; Santa Cruz, CA; 1:1000) antibody with goat-anti-mouse
HRP conjugated secondary antibody. Semi-quantitative, densitometric analysis was
performed using the AlphalmagerTM 2000 Digital Imaging System (San Leandro, CA).
The blots were not labeled with an antibody, such as actin or GAPDH, to act as an
internal standard because our previous studies found that many "stable" proteins are the
targets of proteolytic cleavage and thus could not act as a proper internal control.
Transformed data (experimental densitometry value/ craniotomy control densitometry
value x 100) was evaluated by ANOVA and a post-hoc Dunnet-test. Values were
expressed as percentage of craniotomy controls and are reported as mean + SEM.
Differences were considered significant at the level of p 0.05.
Preparation and Sectioning of Tissue for Immunohistochemistry (IHC)
Tissue was prepared and sectioned for vibratome and cryostat sectioning. For
vibratome sectioning, animals were transcardially perfused with 2% Heparin (Elkins-
Sinn, Inc.; Cherry Hill, NJ) in 0.9% saline solution (pH 7.4) followed by 4%
paraformaldehyde in 0.1M phosphate buffer (pH 7.4). The brains were post-fixed in 4%
paraformaldehyde and stored in 0.1M PBS or cryobuffer. Sections were cut on a Series
1000 vibratome (Ted Pella; Redding, CA) at forty microns. For cryostat sectioning,
animals were anesthetized with 4% isoflurane (Halocarbon Laboratories; River Edge, NJ)
in 1:1 02/ N20 for 4 minutes, then the head was removed. The brains were blocked in
O.C.T. (Ted Pella; Redding, CA), snap frozen in liquid nitrogen and cut on a Leica
CM3050 cryostat. Five micron sections were attached to Fropen (Ted Pella; Redding,
CA)-treated coverslips, fixed in cold methanol for 20 minutes at -200 C.
Dual Label Fluorescent Immunohistochemistry (IHC)
Sections were fluorescent immunolabeled with two primary antibodies in the
following experiments: survivin (1:500)/GFAP for astrocytes (Sternberger; Lutherville,
MD; 1:1000), survivin/NeuN for mature neurons (Chemicon; Temecula, CA; 1:1000),
survivin/PCNA (Santa Cruz Biotech; Santa Cruz, CA; 1:200), PCNA/GFAP,
PCNA/NeuN, active caspase-3 (1:100)/GFAP, active caspase-3 /NeuN and active
caspase-3 /survivin (G. Shaw; 1:250). In addition, sections were labeled with the
Apoptag Cell Death Labeling kit (terminal deoxynucleotidyl transferase-mediated
biotinylated dUTP nick-end labeling or TUNEL) to mark double stranded DNA breaks as
per the manufacturer's instructions. This kit was used in conjunction with the following
antibodies: TUNEL/GFAP, TUNEL/NeuN and TUNEL/survivin. The nuclear dye DAPI
(in Vectashield; H-1200; Vector Laboratories; Burlingame, CA) was used to label the
nuclei in all sections. The first primary antibody was incubated at 4 C for 24- 48 h in a
2% goat serum/ 2% horse serum/ 0.2% Triton-X 100 in 0.1 M PBS (block) solution
followed by the second primary antibody at 4 C for 1 h in block solution. Fluorescent-
tagged secondary antibody (Molecular Probes; Eugene, OR) was used for visualization.
Sections were viewed and digitally captured with a Zeiss Axioplan 2 microscope
equipped with a SPOT Real Time Slider high-resolution color CCD digital camera
(Diagnostic Instruments, Inc., Sterling Heights, MI). A Bio-Rad 1024 ES confocal
microscope was used to confirm single cell localization of the label pairings. The
settings for these images were as follows: power = 100%; for the red field: iris = 2.7 -
5.2, gain = 1400, Blev = -3; for the green field: iris = 3.0 5.7, gain = 1400, Blev = -3.
The number of animals used for each label pairing for dual-labeling IHC was four (n=4).
Dual Label Fluorescent IHC for Same-Species Antibodies
Two systems were used for dual-labeling using same species antibodies; the
tyramide signal amplification (TSA) kit (PerkinElmer Life Sciences, Boston, MA) and a
biotin/streptavidin antibody protocol. Both techniques rely on steric hindrance to block
same-species binding sites. Control sections showed the secondary/tertiary complex was
sufficient for steric hindrance of same species sites for both protocols (Figure 2-2).
Tyramide signal amplification (TSA) was accomplished using the TSA kit
(PerkinElmer Life Sciences, Boston, MA) according to the manufacturer's instructions
and as previously described (Stone et al., 2002). Biotin/streptavidin same species dual-
labeling begins with an endogenous biotin blocking step (Vector Laboratories;
Burlingame, CA) followed by incubation of the first primary antibody as described above
followed sequentially by a biotin-conjugated secondary antibody and fluorescent-labeled
streptavidin (Molecular Probes; Eugene, OR), both steps at room temperature for 1 h in
block solution. The second antigen was then labeled as described above.
Experimental Group Sizes
The number of animals used for western blot analysis is as follows (per time point):
survivin = 6, PCNA = 6, active caspase-3 = 6. The number of animals used for dual-
labeling IHC is as follows (presented as 5 days post injury or both 5 / 7 days post injury):
survivin x PCNA = 4, survivin x GFAP = 6, survivin x NeuN = 4, PCNA x GFAP = 4,
PCNA x NeuN = 4, active caspase-3 x survivin = 4/4, active caspase-3 x GFAP = 4/4,
active caspase-3 x NeuN = 4/4, TUNEL x GFAP = 4/4, TUNEL x NeuN = 4/4 & TUNEL
x survivin = 4/4.
Figure 2-2: Control section for biotin/streptavidin same-species dual labeling IHC.
Biotin/streptavidin same-species dual labeling IHC is a technique based on
steric hindrance of same species binding sites to prevent the second
fluorescent-labeled secondary from binding to the first primary antibody. To
ensure that this process was sufficient, mouse antibodies for astrocytes
(GFAP, green) and neurons (NeuN, red) were used to label a section of brain.
These two protein targets were chosen because of their abundance and distinct
labeling patterns in adult rat brain. On the left (30 Control), neurons were
labeled with only the primary and biotin secondary with no fluorescent
streptavidin tertiary antibody while astrocytes were labeled with a primary and
fluorescent-tagged secondary antibody. On the right (Complete), neurons
were labeled with a primary, the biotin conjugated secondary and a
fluorescent-tagged streptavidin tertiary while astrocytes were labeled as
described previously. The absence of red fluorescent labeling in the picture
on the left indicates that the biotin secondary antibody was sufficiently large
to prevent the green fluorescent-labeled secondary antibody to bind to it thus
confirming steric hindrance of NeuN binding sites.
Cell Quantification and Statistical Analysis
Cell counts were obtained by comparing the number of dual-labeled cells to total single-
labeled cells in the following groups: survivin/NeuN positive cells to total NeuN positive
cells, survivin/PCNA positive cells to total PCNA positive cells, PCNA/NeuN positive
cells to total NeuN positive cells, survivin/GFAP positive cells to total GFAP positive
cells, active caspase-3/NeuN positive cells to total NeuN positive cells, active caspase-
3/survivin positive cells to total survivin positive cells, active caspase-3/GFAP positive
cells to total GFAP positive cells, TUNEL/NeuN positive cells to total NeuN positive
cells, TUNEL/survivin positive cells to total survivin positive cells and TUNEL/GFAP
positive cells to total GFAP positive cells. Percentages were calculated by dividing the
number of dual-labeled cells with the total number of single-labeled cells. For each
group, representative photomicrographs were selected and counted. Cells were counted
in a total area of 188,000 am2 for each label pairing in both cortical and hippocampal
regions. These numbers were then transformed into percentage of either total cells or
total cell type. Individual comparisons between groups were made using an unpaired
Student t-test. Results were considered significant at p<0.05. Two additional blinded
observers were used to count representative samples. Inter-rater reliability was calculated
using the inter-rater reliability formula created by R.L. Ebel (Ebel, 1951). The intra-class
correlation (ICC) value achieved was 0.97 indicating little variation between raters.
SURVIVING EXPRESSION FOLLOWING TRAUMATIC BRAIN INJURY
Induction of Survivin Expression After TBI
Q-PCR analysis revealed an initial increase in survivin mRNA at 2 days post injury
in the ipsilateral cortex and hippocampus. These transcripts remained elevated in both
regions, reached maximum levels at day 5 post-injury and declined at 7 days in the cortex
and at 14 days in the hippocampus. All experimental animals remained alive and
exhibited slightly impaired motor and cognitive impairments (data not shown). Cortical
mRNA levels reached a maximum of 448 10.0%, whereas hippocampal mRNAs
attained 606 10.0% compared to craniotomy control values (Figure 3-1). To determine
if the induction of survivin mRNA resulted in corresponding increases in survivin
protein, western blot analysis was performed. Survivin (17 kDa protein) was readily
detectable in the ipsilateral cortex and hippocampus of TBI rats, while it was negligible
in contralateral cortex and hippocampus (Figure 3-2A). Survivin was expressed in a time-
dependant manner with a maximum increase at 5 days after injury followed by a gradual
decline by 14 days. Specifically, the levels of survivin in cortical tissue were at 616
257% at 3 days and at 839 339% at 5 days compared to craniotomy controls (Figure 3-
2B). Similar increases of survivin protein in the ipsilateral hippocampus were detected at
3 days and 5 days post injury: 464 196% and 545 102% compared to craniotomy
control, respectively (Figure 3-2C).
I ipsilateral cortex
S00 ipsilateral hippocampus
0 500** ** *
E 400 o
cr~a y 1 2 3 5 7 14
Time After Injury (Days)
Figure 3-1: Survivin mRNA induction in rat brain after TBI. Rats were subjected to
craniotomy followed by controlled cortical impact brain injury. Total RNA
was isolated from injured (ipsilateral) cortex (ic) and hippocampus (ih) at
indicated post-injury times. cDNA was synthesized, and quantitative PCR
using survivin primers was performed as described in detail under Materials
and Methods. Data are given as percent of survivin expression over
craniotomy controls; each time point represents mean + SEM of 4
independent measurements in craniotomy control or TBI group. ** p<0.01
versus craniotomy control (one-way ANOVA test with post hoc Bonferroni
PCNA Expression After TBI.
For detection of proliferating cell nuclear antigen (PCNA), PVDF membranes
immunostained for survivin were stripped and re-probed using a PCNA-specific
antibody. PCNA (36 kDa protein) was significantly detectable in the ipsilateral cortex
and hippocampus of TBI rats, but only negligible amounts were observed in the
contralateral cortex and hippocampus (Figure 3-3A). The temporal patterns exhibited by
PCNA protein were similar to that of survivin protein. Namely, PCNA expressed in a
time-dependant fashion with a maximum increase at 5 days after injury followed by a
~ 0 ps~ilteraI
Crawm"o~o~ Id 2d
I_ --o-I17 l
After Injury (Days)
CrIi&oWrny 14 W 5d 74 i4.
CoT A Iroi
Time After Injury iDai''i
Figure 3-2: Expression of survivin protein after TBI in rats. Brain tissue homogenate
proteins (40 [pg) were separated using SDS-PAGE, immunoblotted with
survivin antibody and visualized as described in detail under Materials and
Methods. A-Representative western blot of survivin (17 kDa protein) in
ipsilateral cortex (ic) and hippocampus (ih), contralateral cortex (cc) and
hippocampus (ch) obtained from injured rats, and from craniotomy control
rats without cortical impact (craniotomy control.). Densitometry analysis
representation of survivin-positive bands in ipsilateral (ic) and contralateral
(cc) cortex (B) and ipsilateral (ih) and contralateral (ch) hippocampus (C)
after TBI is shown as percent of craniotomy control values. Each data point
represents the mean + SEM of 4 to 6 independent experiments. *p<0.05, **
p< 0.001 versus craniotomy control (one-way ANOVA test with post hoc
gradual decline by 14 days. The levels of PCNA in ipsilateral cortical tissue were raised
over craniotomy control by 919+ 459% at 3 days, 2263 333% at 5 days, and 1035
356% at 7 days post injury (Figure 3-3B). Similar increases of PCNA protein in
ipsilateral hippocampus were detected at 5 days post injury with a maximum of 1006 +
229% compared to craniotomy controls (Figure 3-3C). No significant increase was found
in the contralateral regions when compared to craniotomy controls (Figure 3-3A).
Co-Expression of Survivin and PCNA Following TBI
To examine spatial co-localization of survivin and PCNA, dual-label
immunohistochemistry was performed on five-day post injury brain tissue sections, when
peak expression of these proteins was observed.
Survivin and PCNA immunoreactivity was found in the ipsilateral cortex (Figure 3-
4A) and ipsilateral hippocampus (Figure 3-4B) consistent with data obtained using
Western blot analyses. Within both regions, focal co-expression patterns of survivin and
PCNA in single cells were detected, which was demonstrated by both separate
fluorescent visualization of individual proteins and by merging the images of dual-stained
slides (Figure 3-4C-E). However, the dual expression of survivin and PCNA occurred
infrequently as survivin and PCNA immunoreactivity could readily be found separately
(Figure 3-4C-E). Approximately 12% of the total number of PCNA-positive cells also
labeled with survivin. The nuclear morphology of dual survivin and PCNA-positive cells
was ambiguous as indicated by DAPI staining (Figure 3-4F). Therefore, DAPI staining
was simply used for cell identification in all subsequent experiments.
- 38 kDa
Cranioonry id 2d 3d d 7d 14d
Time After Injury (Days)
Craniotmy id 2d Sd 6d 7d 14d
Time After injuryy (Days)
Figure 3-3: Expression of PCNA after TBI in rats. PVDF membranes visualized for
survivin were stripped and re-probed with PCNA antibody as described in
Materials and Methods. Representative western blots showing PCNA (36
kDa) (A) and densitometry analysis of PCNA-positive bands (B, C) are
presented. Experimental conditions, sample size and abbreviations are
identical to those in Fig. 3-2. *p<0.05, ** p< 0.01 versus craniotomy control
(one-way ANOVA test with post hoc Bonferroni analysis). Values are mean
+ SEM with n=6.
Figure 3-4: Immunohistochemistry of survivin and PCNA. Dual-label fluorescent
immunostaining for survivin (red) and PCNA (green) was performed in the
ipsilateral cortex (A) and hippocampus (B) at 5 day post-injury as described in
detail under Materials and Methods. Survivin is expressed in the cytoplasm
(C, red) while PCNA is expressed in the nucleus (D, green). The white arrow
indicates the typical focal co-expression of survivin and PCNA as shown in
merged survivin and PCNA images (E). PCNA expression was co-incident
with DAPI staining (F, blue, white arrow). Magnification: 200x, scale bar 50
[tm (A and B); 400x, scale bar 20 [tm (C-F).
Survivin and PCNA are Expressed in Astrocytes After TBI
To determine the cell types expressing survivin and PCNA, dual-label
immunohistochemistry for these proteins and GFAP, a marker of astrocytes, was
performed in five-day post injury tissue. In accordance with western blot data, survivin-
positive immunoreactivity was observed in the ipsilateral cortex and hippocampus
proximal to the injury cavity (Figure 3-5A & G, green) but not in the contralateral areas
(Figure 3-5B & H). Survivin was co-localized with GFAP in the cells of injured cortex
and hippocampus, which strongly suggested primary accumulation of survivin in cells of
Figure 3-5: Co-localization of survivin and GFAP in brain tissue after TBI. Fluorescent
immunohistochemistry for survivin (green) and GFAP (red) was performed in
the ipsilateral and contralateral cortex (A, B) and in the CA1 and dentate
gyms regions of the hippocampus (G, H) at 5 day post-injury as described in
Materials and Methods. The injury has completely destroyed the cortex in G
leaving only the hippocampus in this picture. Survivin was expressed in the
cytoplasm (D, J, green) of GFAP-positive astrocytes (C, I, red) of the
ipsilateral cortex and hippocampus and was found to co-localize to these cells
as shown in merged C/D and I/J images (E, K, respectively, yellow). White
arrows indicate typical survivin-positive astrocytes. Nuclei are shown using
DAPI (F, L, blue). Magnification: 100x, scale bar 50 tm (A, B, G, H); 400x,
scale bar 20 tm (C F, and I L).
astrocytic lineage (Figure 3-5C-E, I-L). It was further observed that survivin was
uniformly distributed in the cytoplasm and processes of astrocytes in both cortex and
hippocampus (Figure 3-5D & J). DAPI staining is shown in Figures 3-5F & L.
Approximately 88% of the total number of GFAP-positive cells also labeled with
PCNA-positive immunoreactivity staining was observed in the ipsilateral cortex
(Figure 3-6A, green) and hippocampus (Figure 3-6G, green) of injured brain, while
contralateral cortex and hippocampus exhibited negligible PCNA immunoreactivity
Figure 3-6: Co-localization of PCNA and GFAP in brain tissue after TBI. Dual-label
immunostaining for PCNA (green) and GFAP (red) was performed in the
ipsilateral and contralateral cortex (A, B) and the CA1 and dentate gyms
regions of the hippocampus (G, H) at 5 day post-injury. PCNA is present in
GFAP positive cells of ipsilateral cortex (C, D) and, to a lesser extent
hippocampus (I, J). E and K depict merged C/D and I/J, respectively. White
arrows indicate typical PCNA-positive astrocytes. PCNA expression was co-
incident with DAPI staining (F, L, blue). Magnification: 100x, scale bar 50
tm (A, B, G, H); 400x, scale bar 20 tm (C F, and I L).
(Figure 3-6B & H). PCNA (Figures 3-6C & I) was partially co-localized with GFAP
(Figures 3-6D & J, red) in both regions, and was characteristically distributed in the
nucleus of the cells in both cortex and hippocampus (Figures 3-6E & K). DAPI staining
is shown in Figures 3-6F & L.
Taken together, dual-label immunohistochemistry data provides evidence that both
survivin and PCNA can be detected in GFAP-positive astrocytes following traumatic
insult. Since survivin and PCNA immunoreactivity was not exclusively localized in
GFAP-positive cells, other cell types must also express survivin.
NeuN PCNA Co-localized DAPI
Figure 3-7: A sub-set of NeuN-positive neurons express survivin and PCNA after TBI.
Dual-label fluorescent immunohistochemistry for survivin (green) and NeuN
(red) in the ipsilateral cortex (A & B) and the CA1 pyramidal layer of the
contralateral hippocampus (E & F) was performed as described in Materials
and Methods. Survivin is expressed in the cytoplasm and, to a limited extent,
in the processes of NeuN-positive neurons (merged images C & G). Dual
staining for PCNA (green) and NeuN (red) is shown in the ipsilateral cortex (I
& J) and the CA1 pyramidal layer of the ipsilateral hippocampus (M & N).
The nuclei are shown using DAPI staining (D & H, blue). PCNA is expressed
in the nucleus of NeuN-positive neurons (merged images K & O). PCNA
expression was co-incident with DAPI staining in these examples (L & P,
blue). White arrows indicate focal co-localization of survivin/NeuN and
PCNA/NeuN. Survivin/NeuN co-localization of survivin (green) and NeuN
(red) was seen only in TBI rats as opposed to either hemisphere of craniotomy
control (Q & R). (Magnification of A-P = 400x, scale bar = 20 atm;
magnification of Q & R 50x, scale bar = 100,000 atm).
Survivin and PCNA are Expressed in a Sub-Set of Neurons After TBI
As can be seen in Figure 3-7, survivin and PCNA were each co-expressed with NeuN, a
marker of mature neurons. NeuN-positive cells were found to express survivin in the
ipsilateral cortex distal to the injury cavity (Figure 3-7A-D) and in the contralateral
hippocampus (Figure 3-7E-H). It should be noted, however, that NeuN-positive cells that
also expressed survivin occurred infrequently. For example, the number of dual
survivin/NeuN positive cells was estimated at 0.1% to 1.5% of the total number of NeuN-
positive cells in these regions. Survivin immunoreactivity was negligible in either
hemisphere of craniotomy control brains (Figures 3-7Q & R). No co-localization of
survivin and NeuN was observed in ipsilateral hippocampus (data not shown). As can be
seen in Figures 3-7B & F, survivin was predominantly localized to the cytoplasm and
axons of NeuN-positive neurons. DAPI staining is shown in Figures 3-7D & H.
PCNA-positive neurons were found in the ipsilateral cortex (Figures 3-7I-L) and
hippocampus after TBI (Figure 3-7M-P), whereas craniotomy control tissue exhibited
only trace amounts of PCNA (data not shown). Similar to the survivin/NeuN co-
localization data, dual PCNA/ NeuN immunostaining was a rare event accounting for
approximately 4% of the total number of NeuN positive cells. PCNA was distributed in
the nuclei of these neurons (Figures 3-7K & O) although the nuclear morphology of these
cells was not clearly resolved by DAPI staining (Figures 3-7L & P).
Figure 3-8: Survivin expression is absent in oligodendrocytes and microglia following
TBI in rats. Dual-label fluorescent immunohistochemistry for survivin
(green), CNPase (red, A) and OX42 (red, B) in the ipsilateral cortex and
hippocampus was performed as described in Materials and Methods.
Negligible co-localization was seen with survivin, CNPase and OX42 in the
ipsilateral cortex (A, B respectively) and hippocampus (data not shown).
Higher magnification photomicrographs (inset, A and B) show survivin-
positive cells (white arrowheads) surrounded by oligodendrocytes (white
arrows, A) and microglia (white arrows, B) that do not show co-localization.
(Magnification of A and B = 400x, scale bar = 20 tm).
Survivin is Not Expressed in Microglia and Oligodendrocytes
To further determine the neural cell types expressing survivin, dual-label
immunohistochemistry for survivin, OX42, a marker of microglia, and CNPase, a marker
for oligodendrocytes, was performed in five-day post injury tissue sections. No co-
localization with survivin and either CNPase (Figure 3-8A) or OX-42 (Figure 3-8B) is
observed following traumatic brain injury. In addition, attempts were made to localize
survivin with the neuronal progenitor cell markers nestin, doublecortin, a-internexin and
P-III-tubulin. However, these antibodies did not prove to be of acceptable quality to use
in western blot and IHC analyses in this model leaving proliferating progenitors
/ SU( B~
Discussion of Chapter 3
Traumatic brain injury (TBI) initiates various biochemical cascades that induce
neural tissue injury and cell death. To counteract these cascades, several proteins
expressed in neural cells after TBI are directed to resist cell death and promote recovery
in the injured CNS (Ridet et al., 1997; Chen and Swanson, 2003). Survivin is a multi-
functional protein that inhibits apoptosis and is also required for the proper completion of
mitosis. Anti-apoptotic and pro-mitogenic roles for survivin have been documented in
proliferating cells of neural origin in vitro, such as in neuroblastoma and glioma cells
(LaCasse et al., 1998; Tamm et al., 1998; Deveraux and Reed, 1999; Conway et al., 2000;
Shin et al., 2001; Sasaki et al., 2002). However, no studies have investigated the
potential role of survivin in the adult brain after TBI, when a sub-population of CNS cells
may initiate a cell cycle-related process in response to injury.
These data demonstrate the induction of survivin expression in rat brain subjected
to TBI. The expression of survivin was time-dependent, cell-specific and was present in
astrocytes and, to a much lesser extent, in neurons in ipsilateral cortex and hippocampus.
Induction of survivin in these cells was accompanied by occasional expression of PCNA,
a cell cycle protein involved in mitotic G1/S progression. These data are the first to show
that survivin mRNA and protein are significantly up-regulated after TBI in rats. PCNA
expression after TBI has been described previously (Miyake et al., 1992; Chen et al.,
2003), suggesting its role in mechanisms of brain recovery after injury. The concurrent
up-regulation of survivin with a similar temporal profile as PCNA shown herein further
suggests that survivin may play a role in cellular proliferation after TBI.
Brain injury evoked the expression of survivin and PCNA in a time-dependent
manner (Figures 3-2 & 3-3). Western blot analysis revealed maximal co-expression of
both survivin and PCNA at five days post injury. Immunohistochemistry demonstrated
co-localization of these proteins (Figure 3-4), although most cells were labeled separately
with PCNA and survivin. In fact, only 12 % of the total number of PCNA-positive cells
were also survivin positive. It has been reported that PCNA is expressed predominantly
in G1/S (Bravo et al., 1987), while survivin is found at the G2/M phase of the cell cycle
(Bravo et al., 1987; Otaki et al., 2000). Hence, a lack of strict co-localization of survivin
and PCNA in this study may be explained by their expression at different points in the
cell cycle. To determine if the differing expression patterns of survivin and PCNA
contributed to lower incidence of co-localization, other cell cycle proteins were
investigated including cdk4 (G1), cyclin B (G2), cyclin D (G1) and AIM-1 (M). Only
PCNA provided clear results in both western blot and IHC analyses.
Survivin-positive and PCNA-positive astrocytes were observed in the proximal
area of the injury and in the ipsilateral hippocampus. Proliferation of astrocytes is well
documented after TBI as shown by cell labeling with BrdU as well as expression of
PCNA (Latov et al., 1979; Dunn-Meynell and Levin, 1997; Carbonell and Grady, 1999;
Norton, 1999; Csuka et al., 2000; Kernie et al., 2001; Chen et al., 2003). Because
survivin and PCNA were expressed in astrocytes following TBI (Figures 3-5 & 3-6), it is
possible that survivin plays an important role linking astrocyte survival and proliferation
after traumatic insult. Astrocyte proliferation has been implicated in the formation of the
glial scar observed after injury (Latov et al., 1979) and creates a non-permissive
environment for repair (Sykova et al., 1999). However, glial proliferation may also
enhance neuronal survival (Smith et al., 2001; Wei et al., 2001).
Of particular interest is a sub-set of NeuN-positive neurons found to express
survivin only after TBI (Figure 3-7). These cells were much less abundant than survivin-
positive astrocytes and their functional significance is currently unknown. However, both
neurons and astrocytes have been documented previously to express cell cycle proteins
after various insults such as exposure to P-amyloid activated microglia (Wu et al., 2000),
TBI (Kaya et al., 1999a; Kaya et al., 1999b), chlorin e6 toxicity, (Magavi et al., 2000) or
as a consequence of Alzheimer's Disease (Yang et al., 2001). The ramifications of cell
cycle protein expression in mature neurons is still controversial and may be a marker of
cell death rather than cell proliferation (Herrup and Busser, 1995; Li et al., 1997; Kaya et
al., 1999a; Kaya et al., 1999b; Wu et al., 2000; Yang et al., 2001). These papers
underscore the significant controversy that exists regarding the function of cell cycle
proteins such as PCNA in neurons after different types of injury.
It should be noted that dual staining of survivin and PCNA could not be directly
attributed to a specific cell type due to the technical difficulties of triple labeling
antibody-based IHC. Therefore, other cell types, such as endothelial (Conway et al 2003),
inflammatory cells (Hill-Felberg et al., 1999) or neural progenitor cells (Ignatova et al.,
2002), may also contribute to survivin and PCNA expression after TBI. The appearance
of survivin and PCNA separately in neurons (NeuN-positive) and astrocytes (GFAP-
positive) along with co-localization of survivin with PCNA in the same cells provide
correlative data to suggest an activation of cell cycle-like program in astrocytes and
possibly in a small subtype of neurons after TBI. In these experiments, survivin co-
localization with PCNA does suggest that survivin may be associated with a pro-mitotic
process. In an attempt to clarify these protein's roles after TBI, the nuclear morphology
of survivin-positive cells was analyzed to define the apoptotic or mitotic architecture of
nuclei. DAPI staining proved too ambiguous in identifying apoptotic versus mitotic
phenotypes likely due to the thickness of the brain sections (40 atm). Further studies using
direct markers of mitosis such as BrdU incorporation as well as simultaneous labeling
with cell death related proteins is required to delineate anti-apoptotic and pro-mitotic
activities of survivin and PCNA in these cells.
To summarize, an induction of survivin was found in rat brain cortex and
hippocampus after TBI in a time-dependent fashion. Expression of survivin occurred
predominantly in astrocytes and a sub-set of neurons but not in oligodendrocytes or
microglia, and was occasionally accompanied by expression of PCNA. However,
survivin expression is only found in 12% of PCNA positive cells, which suggests that the
primary role of survivin after traumatic brain injury is not related to the cell cycle but
rather to apoptosis inhibition. Thus, the next specific aim of this study was to examine the
link between survivin, active caspase-3 and downstream DNA fragmentation following
traumatic brain injury in rats.
SURVIVIN AND APOPTOSIS INHIBITION FOLLOWING TRAUMATIC BRAIN
Caspase-3 is Activated in the Same Brain Regions as Survivin Following TBI
To determine the temporal and regional profile of caspase-3 activation, western blot
analysis was performed on cortical and hippocampal TBI samples. Active caspase-3 (19
kDa protein) was readily detectable in the ipsilateral cortex and hippocampus of rats
subjected to TBI (Figure 4-1A). Caspase-3 activation occurred in a time-dependant
manner in the ipsilateral cortex and hippocampus with prominent activation occurring
between five and fourteen days post-injury, with peak accumulation occurring at seven
days post-injury. In the ipsilateral cortex, significant increases in active caspase-3 levels
reached 3468 1088% at five days, 4019 1291% at seven days and 2984 1058%
fourteen days post-injury, compared with craniotomy controls. Similar increases in
caspase-3 activation were detected in the ipsilateral hippocampus with increases of 671 +
257% at five days, 2662 738% at seven days and 1487 405% at fourteen days post-
injury, compared with craniotomy controls (Figure 4-1B).
Survivin Expression Correlates with Decreased TUNEL Labeling but not Active
Immunohistochemistry (IHC) was performed on brain sections at five days post
injury to investigate the expression of active caspase-3 and TUNEL labeling at peak
survivin expression (Johnson et al., 2004). IHC revealed moderate co-localization of
survivin with active caspase-3 and TUNEL in the ipsilateral cortex (Figure 4-2A,F) and
s ^* a e I
-- .IO -a- 19 kODa
00 I Ig ipslateral hippocampus
cranitomy id 2d 3d 5d 7d 14d
Time After Injury (Days)
Figure 4-1: Caspase-3 Activation in rat brain after traumatic brain injury. Rats were
subjected to craniotomy followed by controlled cortical impact brain injury.
Brain tissue homogenate proteins (40 tg) were separated using SDS-PAGE,
immunoblotted with antibody specific for active caspase-3 and visualized as
described in detail under Materials and Methods. Representative western
blots of active caspase-3 (19 kDa) in ipsilateral cortex and hippocampus
obtained from injured rats and from craniotomy control rats without cortical
impact revealed the accumulation of active caspase-3 after TBI (A).
Densitometry analysis of the active caspase-3 bands in ipsilateral cortex and
hippocampus after TBI show significant increases in a time dependent manner
(B). Data are given as percent of the active fragment of caspase-3 related to
craniotomy controls; each time point represents mean + SEM of 6
independent measurements in craniotomy control or TBI group. p<0.05, **
p<0.01 versus craniotomy control (one-way ANOVA test with post hoc
ipsilateral hippocampus (Figure 4-2B,G) of injured animals. These data are summarized
in Table 1 (pg 45). Survivin was found primarily in the cytoplasm and to a lesser extent
in the nucleus of the ipsilateral cortex (Figure 4-2C,H). A similar pattern was seen in the
Survivin/ Active Caspase-3 Survivin/ TUNEL
Figure 4-2: Co-expression of survivin and apoptosis markers following TBI in rats.
Dual-label fluorescent immunostaining for survivin (red) and active caspase-3
(green, A-E) or TUNEL (green, F-J) was performed in the ipsilateral cortex
(A, F) and hippocampus (B, G) at 5 day post-injury as described in detail
under Materials and Methods. Survivin is expressed in both the cytoplasm
and in the nucleus (C & H, red) while active caspase-3 (D, green) and TUNEL
(I, green) label predominantly the nucleus. The white arrow indicates the
typical focal co-localization of survivin and active caspase-3 (E) and TUNEL
(J) as shown in the merged images. Magnification: 200x, scale bar 50 [m (A,
B, F, G); 200x, scale bar 10 [m (C-E, H-J).
ipsilateral hippocampus (data not shown). Active caspase-3 (Figure 4-2D) and TUNEL
(Figure 4-21) labeling were both found in the nucleus in both regions. Survivin co-
localization with active caspase-3 and TUNEL is shown at high magnification in Figure
4-2E and Figure 4-2J, respectively. Confocal microscopy was used to assure single cell
co-localization of survivin, active caspase-3 and TUNEL (data not shown).
Quantitative analysis revealed no significant difference in the accumulation of
active caspase-3 in survivin-positive cells compared to survivin-negative cells at five
days post injury in either the cortex or hippocampus (Figure 4-3A,B). However,
significantly higher percentage of TUNEL labeling was observed in survivin-negative
Survivin (+) Survivin (-)
Active Caspase-3 Positive
o TUNEL Positive
[ TUNEL Negative
Figure 4-3: Survivin expression decreases the accumulation of TUNEL but not active
caspase-3. Cells were quantified and visualized as described in detail under
Materials and Methods. The percentage of cells expressing active caspase-3
and labeling with TUNEL was compared in two cell populations, survivin-
positive and survivin-negative, in the ipsilateral cortex (A) and hippocampus
(B). No differences were found in the percentage of survivin-positive and
survivin-negative cells expressing active caspase-3 in either the cortex (A,
black bars) or hippocampus (B, black bars). Significantly more survivin-
negative cells were TUNEL-positive compared to survivin-positive cells in
both the cortex (p<0.01, A, white bars) and hippocampus (p<0.001, B, white
bars). No differences were found in the percentage of TUNEL-positive (C,
white bars) or TUNEL-negative cells (C, gray bars) that also labeled with
active caspase-3. Each bar represents mean + SEM of 4 (A, cortex) or 3 (B,
hippocampus) independent measurements using an unpaired Student t-test for
Survivin (+) Survivin (-)
potive negL ve
cells as compared to survivin-positive cells in both regions (p<0.01) (Figure 4-3A,B,
Table 1A). At seven days post injury, there was no significant difference in the
accumulation of both active caspase-3 and TUNEL labeling in survivin-positive cells
compared to survivin-negative cells in either the cortex or hippocampus (Table 1B).
To verify that caspase-3 activation does not necessarily result in irreversible cell
death, possibly due to survivin inhibition, quantification data was gathered on cells that
accumulate active caspase-3 and are TUNEL label-positive and compared to active
caspase-3-positive cells that do not label with TUNEL. Indeed, we found that the number
of dual-labeled active caspase-3 and TUNEL cells was not statistically different from
those cells labeled with active caspase-3 only (Figure 4-3C). This finding further
supports the notion that several counteractive factors, including survivin, may inhibit
active caspase-3 and diminish cell death following TBI.
Astrocytes and Neurons Demonstrate Cell Specific Differences in Active Caspase-3
and TUNEL Labeling
To determine cell types that express active caspase-3 or labeled with TUNEL, dual
immunohistochemistry of these apoptosis markers was performed with GFAP, a marker
of astrocytes, and NeuN, a marker of mature neurons. Co-localization of GFAP was
observed with both active caspase-3 and TUNEL labeling in the ipsilateral cortex (Figure
4-4A,F respectively) and ipsilateral hippocampus (Figure 4-4B,G respectively). Higher
magnification photomicrographs show a typical astrocyte expressing active caspase-3
(Figure 4-4C-E) or labeling with TUNEL (Figure 4-4H-J).
NeuN-positive cells exhibited modest accumulation of active caspase-3 and
considerable labeling with TUNEL in the ipsilateral cortex (Figure 4-5A,F) and
ipsilateral hippocampus (Figure 4-5B,G). These data are summarized in Table 1.
Table 1 Cell Quantification Data for Immunohistochemistry Labeling Pairs This table
summarizes the results from all cell count experiments investigating survivin,
cell type and the apoptosis markers. The numbers given are percentages
calculated as described in the Materials and Methods. Each percentage
represents the mean + SEM of 4 (cortex) or 3 (hippocampus) independent
measurements at either five days post-injury (A) or seven days post-injury
(B). ** p<0.01 versus survivin-negative cells, ## p<0.01, ### p<0.001 versus
NeuN-positive cells, $$ p<0.01 versus TUNEL-negative cells (unpaired
A Survivin (+) Stuvivin (-) GFAP (+) NeuN (+) TUNEL (+) TUNEL (-)
Active coitex 37 2 26 6 50 7" 7 1 51 6 49 6
(+) Hippocanipus 21 5 22 3 29 4 15 2 45 11 55 11
EL otex 252** 49 5 11 2 46 2
() Hippocanpus 30 4** 55 3 19 0.2" 60 3
B Stuvivin (+) Su-vivin (-) GFAP (+) NeuN (+) TUNEL (+) TUNEL (-)
Active Cortex 36 2 39 11 36 3" 11 1 484 524
(+) Hippocanpus 37 2 22 6 31 3" 15 3 625" 385
205 2510 19+1"" 74 5
+) Hippocmnpus 20 3 31 10 28 7* 80 2
Specifically, both active caspase-3 (Figure 4-5D) and TUNEL (Figure 4-51) were present
in neuronal nuclei (Figure 4-5C,H), which was indicated by co-localization with NeuN
(Figure 4-5E, J). Confocal microscopy was used to assure single cell co-localization of
NeuN and GFAP with active caspase-3 and TUNEL (data not shown).
Quantitative analysis revealed a substantially different expression profile of active
caspase-3 and TUNEL in neurons and astrocytes. A significantly higher number of
astrocytes accumulated active caspase-3 as compared to neurons in the cortex, but not the
hippocampus (p<0.001) (Table 1). Conversely, a significantly greater number of neurons
were labeled with TUNEL compared to astrocytes in both the cortex and hippocampus
(p<0.001) (Figure 4-6, Table 1A). A similar expression profile of active caspase-3 and
GFAP/ Active CasDase-3
Figure 4-4: Astrocytes express active caspase-3 and label with TUNEL following TBI in
rats. Dual-label fluorescent immunostaining for GFAP (red) and active
caspase-3 (green, A-E) or TUNEL (green, F-J) was performed in the
ipsilateral cortex (A, F) and hippocampus (B, G) at 5 day post-injury as
described in detail under Materials and Methods. GFAP is expressed in the
cytoplasm (C & H, red) while active caspase-3 (D, green) and TUNEL (I,
green) are expressed in the nucleus. The white arrow indicates the typical
focal co-expression of GFAP and active caspase-3 (E) and TUNEL (J) as
shown in the merged images. Magnification: 200x, scale bar 50 tm (A, B, F,
G); 200x, scale bar 10 tm (C-E, H-J).
TUNEL was observed in astrocytes and neurons seven days post injury (Table 1B).
Discussion of Chapter 4
Caspase-3 activation is a prominent feature of apoptosis and its role in DNA
fragmentation after TBI has been well documented (Nicholson et al., 1995; Tewari et al.,
1995; Pike et al., 1998; Tang and Kidd, 1998; Wolf et al., 1999; Beer et al., 2000; Buki et
al., 2000; Clark et al., 2000). Survivin is an inhibitor of apoptosis protein (IAP), which
can inhibit active caspase-3 and thereby moderate cell death in various tissues, including
CNS (Shankar et al., 2001; Sasaki et al., 2002; Van Haren et al., 2004). However, no
NeuN/ Active Caspase-3 NeuN/ TUNEL
Figure 4-5: Neurons express active caspase-3 and label with TUNEL following TBI in
rats. Dual fluorescent immunostaining for NeuN (red) and active caspase-3
(green, A-E) or TUNEL (green, F-J) was performed in the ipsilateral cortex
(A, F) and hippocampus (B, G) at 5 day post-injury as described in detail
under Materials and Methods. NeuN is expressed primarily in the nucleus but
also in the cytoplasm (C & H, red) while active caspase-3 (D, green) and
TUNEL (I, green) are found in the nucleus. The white arrow indicates the
typical focal co-localization of NeuN and active caspase-3 (E) and TUNEL (J)
as shown in the merged images. Magnification: 200x, scale bar 50 tm (A, B,
F, G); 200x, scale bar 10 tm (C-E, H-J).
studies have investigated the potential anti-apoptotic role of survivin in the adult brain
These data characterize the relationship between survivin expression and two
apoptosis events: the accumulation of active caspase-3 and downstream DNA
fragmentation (as shown by TUNEL labeling) in rat brain subjected to TBI. The use of
TUNEL labeling in conjunction with active caspase-3 is considered a reliable tool to
assess apoptosis progression (Lei et al., 2004; Marciano et al., 2004; Nakase et al., 2004).
The appearance of active caspase-3 was time-dependent and region specific (Figure 4-1)
loo -Cortex Hippocampus
S80 p 'p<0.001
Neurons Astrocytes Neurons Astrocytes
t I ,
TUNEL ) UNEL(+)
Figure 4-6: TUNEL labeling is cell specific following TBI in rats. Cells were quantified
and visualized as described in detail under Materials and Methods. The
percentage of cells labeling with TUNEL was compared in astrocytes (black
bars) and neurons (gray bars) in the ipsilateral cortex and hippocampus.
Significantly more TUNEL labeling was seen in neurons than in astrocytes in
both the cortex and hippocampus (p<0.001). Each bar represents mean +
SEM of 4 (cortex) or 3 (hippocampus) independent measurements using an
unpaired Student t-test for statistical analysis.
with a pattern similar to survivin expression after TBI which suggests that survivin may
inhibit caspase-3 activity to diminish the deleterious consequences of proteolysis after
TBI (Tamm et al., 1998; Kobayashi et al., 1999; O'Connor et al., 2000b; Shin et al.,
2001). Other IAPs are up-regulated in concert with activation of caspases after brain
injury (Keane et al., 2001). In addition, survivin expression is up-regulated by the pro-
survival PI3-kinase/Akt pathway which is activated after TBI (Kitagawa et al., 1999; Xia
et al., 2002b; Kim et al., 2004).
Survivin-positive cells expressed active caspase-3 and were labeled with TUNEL
(Figure 4-2) though survivin-positive cells showed no significant difference in
accumulation of active caspase-3 compared to survivin-negative cells (Figure 4-3).
DNA Cleavage (TUNEL)
Figure 4-7: Putative mechanism of apoptosis inhibition by survivin following TBI.
Traumatic brain injury induces activation of upstream caspases-8 and 9 that
can process pro-caspase-3 to its active form. Once activated, caspase-3 can
cleave several intracellular substrates and activate restrictases that may lead to
DNA fragmentation. Concomitant survivin expression is up-regulated in
response to the same TBI signals. Survivin has the ability to inhibit the
activity of active caspase-3, which results in the attenuation of DNA
These data are in accordance with the ability of survivin (Tamm et al., 1998) and other
IAPs (Shankar et al., 2001; Maier et al., 2002) to inhibit the activity but not the activation
of caspase-3. In contrast, fewer survivin-positive cells exhibited DNA fragmentation
(TUNEL labeling) compared to survivin-negative cells at five days post injury (Figure 4-
3). These data suggest that survivin expression may attenuate the apoptotic cascade by
inhibiting the cleavage of caspase-3 specific substrates that result in DNA fragmentation.
Furthermore, the finding that active caspase-3 accumulation led to positive TUNEL
Traumatic --- --
labeling in 51% of all active caspase-3-positive cells (Figure 4-3) is consistent with the
observation that endogenous factors, including survivin, may inhibit active caspase-3 and
attenuate DNA fragmentation following TBI. In an attempt to more directly investigate
whether survivin could inhibit active caspase-3 activity, survivin was co-localized with
markers of caspase-3 activity including the cleaved species of PARP, DFF45/iCAD and
a-II-spectrin (120 kDa). Unfortunately, these markers proved to be of unacceptable
quality to use in western blot and IHC analyses in this model. Therefore, it remains
unknown whether survivin correlates with a decrease in active caspase-3 activity as
measured by caspase-3-specific breakdown products. The ability of survivin to inhibit
DNA fragmentation has been shown in gastric cancer cells (Lu et al., 1998). In addition,
survivin antisense treatment increases DNA fragmentation in neuroblastoma and
oligodendroglioma (Shankar et al., 2001). Taken together, these findings suggest that
survivin likely inhibits the proteolytic activity of caspase-3 after TBI to attenuate DNA
The labeling patterns of active caspase-3 and TUNEL in astrocytes and neurons
were investigated. Data described in Chapter 3 showed that a large majority of astrocytes
but few neurons express survivin after TBI. These data show that both astrocytes and
neurons expressed active caspase-3 and label with TUNEL post-injury but the prevalence
of this labeling was drastically different (Figures 4-4, 4-5). A higher percentage of
astrocytes accumulate active caspase-3 but fewer astrocytes label with TUNEL compared
to neurons (Figure 4-6). It is unclear at present why these experiments revealed few
neurons labeling with active caspase-3 (Table 1). Some active caspase-3-positive
neurons may not have been detected due to caspase-3 mediated loss ofNeuN antigenicity
(Unal-Cevik et al., 2004). Other groups have found prominent caspase-3 activation in
apoptotic neurons after TBI (Beer et al., 2000). In addition, caspase-independent necrosis
may also be a major contributor of neuronal cell death after TBI (Newcomb et al., 1999;
Wennersten et al., 2003).
Cell specific survivin expression may contribute to the lower incidence of TUNEL
labeling in astrocytes as compared to neurons (Table 1). Cell type specific expression of
IAPs after TBI has been previously shown. For example, XIAP is expressed primarily by
neurons (Lotocki et al., 2003) and a subset of oligodendrocytes (Keane et al., 2001)
following brain injury. NAIP is expressed in neurons after ischemia (Xu et al., 1997) and
TBI (Hutchison et al., 2001). Lastly, RIAP-2 is abundantly expressed in neurons as
opposed to astrocytes after kainic acid treatment in rats (Belluardo et al., 2002). Figure
4-7 shows a putative mechanism for apoptosis inhibition by survivin. Following
upstream caspase activation and cleavage of procaspase-3 to active caspase-3, survivin
acts to attenuate the apoptotic cascade and finally DNA cleavage and cell death by
inhibiting caspase-3 activity.
Taken together, data from Chapter 4 demonstrate that the activation of caspase-3 in
the rat brain after TBI follows the same timeframe, regions and cell type expression
patterns as survivin. Quantitative correlative analysis reveals that significantly fewer
cells expressing survivin undergo final stage of apoptosis and cell death. These data
suggest that DNA cleavage may be attenuated via inhibition of active caspase-3 by
survivin after traumatic brain injury in a cell-specific fashion. Namely, astrocytes have
significantly lower TUNEL labeling than neurons suggesting a more robust anti-apoptotic
role for survivin in astrocytes. Collectively, these results suggest that survivin plays a
role in diminishing apoptosis and DNA fragmentation following traumatic brain injury in
CONCLUSIONS AND FUTURE DIRECTIONS
Traumatic brain injury (TBI) remains a major health care and economic issue in the
United States to this date. Despite continued education and improved first responder
care, the Centers for Disease Control estimate that there are more than 5.3 million
Americans living with disabilities from TBI with another 1.5 million new TBIs sustained
in the U.S each year. Cognitive and memory deficits resulting from TBI are especially
difficult to cure and no effective treatment options are available.
TBI is a complex injury that induces both apoptotic cell death and neural cell
proliferation. Apoptosis is opposed by up-regulation of inhibitor of apoptosis proteins
(IAPs) that attenuate apoptosis through direct inhibition of active caspases. Neural cell
proliferation may contribute to neural tissue healing by repopulating damaged regions
with new, functional cells but may also prevent normal recovery of the injured brain by
forming impermissible barriers for axonal growth.
The recently discovered protein, survivin, may play a significant role in these
processes following TBI. Survivin is a protein that is both integral for mitosis and is an
IAP with anti-apoptotic properties. Though not normally found in quiescent adult tissues,
survivin can be induced in certain mature, non-neural cells after CNS insult or cancer
transformation to resist apoptosis. Furthermore, brain injury can induce stem cell
proliferation, a process that likely requires the survivin protein for proper completion.
However, no study to date had investigated the temporal, regional and neural cell
expression patterns of this unique protein following TBI.
Chapter 3 of this dissertation critically examined the transcriptional and
translational expression of survivin following TBI in rats. This dissertation is the first to
demonstrate that survivin mRNA and protein are expressed in neural cells following TBI
and that this expression is cell type specific. QPCR analysis confirmed elevated levels of
survivin following TBI that peaked at five days post-injury in the ipsilateral cortex and
hippocampus. Immunoblot analysis confirmed survivin translation with peak expression
at five days post-injury in both regions. Survivin localization at this time point was
observed in approximately 88% of the astrocytes in the ipsilateral cortex and
hippocampus. Survivin expression was also observed in a much smaller sub-set of
neurons, where no more than 1.5% of neurons expressed survivin. Survivin expression
was not observed in microglia and oligodendrocytes. Like other IAP proteins, expression
of survivin appears to be cell type specific following TBI. In contrast to the IAPs XIAP,
NAIP, cIAP-1 and cIAP-2 which are predominantly expressed in neurons following brain
insult, survivin is expressed primarily in astrocytes. Attempts were made to localize
survivin with the neuronal progenitor cell markers nestin, doublecortin, a-internexin and
P-III-tubulin. However, these antibodies did not prove to be of acceptable quality to use
in western blot and IHC analyses in this model leaving proliferating progenitors
Survivin has two biochemically distinct functions, that of apoptosis inhibition and
to properly separate DNA during mitosis. To reveal the relationship between survivin
and cellular proliferation, several cell cycle proteins were investigated including cdk4,
cyclin B, cyclin D, AIM-1 and PCNA. Only PCNA provided clear results in both
western blot and IHC analyses. Therefore, the regional, temporal and cell specific
protein expression of the previously characterized cell cycle protein, PCNA and its co-
localization with survivin was investigated. PCNA protein accumulated in the ipsilateral
cortex and hippocampus peaking at five days post-injury. In addition, astrocytes and a
small subset of neurons expressed PCNA in a pattern similar to survivin. However, only
12% of PCNA-positive cells also expressed survivin. The cellular identity of these dual-
labeled cells remains unknown due to difficulties with triple-label IHC. Therefore, the
ramifications of cell cycle protein expression in individual cell types remains unclear.
However, these data seem to indicate that the primary function of survivin following TBI
is not cellular proliferation. A more complete picture of survivin's role in cellular
proliferation following brain insult would require co-localization with other cell cycle
related proteins. Thus far, additional investigations with proteins such as AIM-1, cdk4,
cyclin D and cyclin B have been inconclusive. Further studies will be required to
determine the extent to which survivin acts as an indicator of cellular proliferation and
the cell types that may be actively proliferating following TBI.
Chapter 4 revealed the relationship between survivin and apoptosis inhibition by
investigating the accumulation of active caspase-3, the main executioner caspase in
apoptosis, and the appearance of DNA fragmentation (TUNEL) following TBI.
Immunoblot studies revealed that active caspase-3 did accumulate following TBI with
significant accumulation at five, seven and fourteen days post-injury in the ipsilateral
cortex and at seven and fourteen days post-injury in the ipsilateral hippocampus.
Because survivin and active caspase-3 levels peaked on different post-injury days, IHC
was performed at the peak expression times of five days (survivin) and seven days (active
caspase-3) post-injury. IHC analysis revealed that survivin and both active caspase-3 and
TUNEL did co-localize to the same cells at these time points. Attempts were made to co-
localize survivin with markers of caspase-3 activity to correlate the presence of survivin
to an absence in caspase-3 specific breakdown products. Antibodies for the caspase-3-
specific cleaved species ofPARP, DFF45/iCAD and a-II-spectrin (120 kDa) proved to be
of unacceptable quality to use in western blot and IHC analyses in this model leaving
markers of caspase-3 activity undetected.
Quantitative analysis revealed no significant difference in the accumulation of
active caspase-3 in survivin-positive cells compared to survivin-negative cells at five
days post injury in either the cortex (37 2% v. 26 6%) or hippocampus (21 5% v. 22
3%). Conversely, a significantly higher percentage of TUNEL labeling was observed
in survivin-negative cells as compared to survivin-positive cells in ipsilateral cortex (49 +
5% v. 25 2%) and hippocampus (55 3% v. 30 4%). These data are consistent with
my hypothesis that survivin expression may attenuate the apoptotic cascade by inhibiting
the cleavage of caspase-3 substrates. However, by seven days post injury, there was no
significant difference in the accumulation of either active caspase-3 or TUNEL labeling
in survivin-positive cells compared to survivin-negative cells. It is unclear why this
pattern was observed. In particular, the sharp decrease in survivin-negative, TUNEL-
positive cells from five days to seven days post-injury was unexpected. This decrease in
DNA fragmentation may be explained by death and removal of TUNEL-positive cells
between five and seven days as evidenced by progressive increases in cavity size seen
after brain injury (data not shown). The turnover from healthy to TUNEL-positive in the
survivin-negative cell population may not be steady, as indicated by the biphasic
fluctuations of cell death indicators after brain injury (Holmin and Mathiesen, 1995;
Domanska-Janik, 1996; Kampfl et al., 1996; Baskaya et al., 1997). Again because of the
difficulty of triple-label IHC, the cell type of survivin dual-labeled cells could not be
Because survivin is expressed in astrocytes and neurons, the accumulation of active
caspase-3 and TUNEL-labeling in these cells was investigated. Both cell types
accumulated active caspase-3 and labeled with TUNEL following TBI. Quantification
studies revealed a significantly greater percentage of neurons labeled with TUNEL
compared to astrocytes in both the cortex and hippocampus at both five and seven days
post injury. Taken with the observation that a majority of astrocytes express survivin
after TBI, it is possible that survivin expression contributes to the low DNA
fragmentation observed in these cells despite prominent caspase-3 activation. The
opposite appears to be the case with neurons. Few neurons express survivin following
TBI and many of these cells show prominent DNA fragmentation. Neurons are
particularly vulnerable to apoptosis signals following brain injury and absence of survivin
expression may contribute to this vulnerability. Therefore the hypothesis does not seem
to support an anti-apoptosis role for survivin in the majority of neurons following TBI.
Collectively, these data indicate that survivin, a developmental protein normally
absent in adult tissues, is up-regulated at both the transcriptional and translational level
following traumatic brain injury. Survivin is expressed predominantly by astrocytes and
a small sub-set of neurons. In addition, this is the first study to provide indirect evidence
that survivin functions as both an apoptosis inhibitor and as a cell cycle protein following
brain trauma. These data suggest that further studies are necessary to show the overall
ramifications of survivin expression on the secondary injury cascade following TBI.
Additional studies of survivin expression and function must be completed before
survivin may be considered a potential therapeutic agent/target for brain injury treatment.
First, survivin activities following TBI in the intact animal must be inhibited to observe
the histological and behavioral changes associated with its expression. Of interest are
heterozygous survivin knockout mice strains that appear to be particularly vulnerable to
even mild apoptotic stimuli (Conway et al., 2002). TBI experiments comparing the
histological and behavioral differences between heterozygous survivin knockouts and
their wild type littermates would give more direct evidence of survivin function following
brain insults. Additionally, a host of new techniques to inhibit survivin expression in the
whole animal are currently being developed for cancer treatment and can be readily
applied to a TBI model. Of practical interest to this model is "molecular antagonism"
and pharmacological inhibition. "Molecular antagonism" using siRNA, antisense and
dominant-negative survivin mutants are effective in vivo at interfering with survivin
expression and function (Grossman et al., 2001b; Kanwar et al., 2001; Yamamoto et al.,
2002; Williams et al., 2003). Pharmacological inhibition by flavopiridol (Zhai et al.,
2002) or Purv.A (Gray et al., 1998) can increase survivin turnover and reduce its
effectiveness as an apoptosis inhibitor by reducing the phosphorylation state of survivin
(O'Connor et al., 2000a; Grossman et al., 2001b). Based on the findings in this
dissertation, inhibition of survivin following TBI will likely increase apoptotic cell death,
cavity size and have a negative impact on behavioral recovery.
Second, the activities of survivin must be enhanced to see if increased survivin has
a beneficial role to the overall recovery of the organism. Both pharmacological and gene
transfection can be used to accomplish this task. Gene transfection has been successfully
used to temporarily up-regulate proteins of interest in the adult brain (Yenari and
Sapolsky, 2004) and may be used to increase survivin expression following TBI. A more
flexible approach may include pharmacological agents because they can be used in
established wild-type animal models. Compounds that enhance Cdk phosphorylation
activity such as PD0166285 (Li et al., 2002) may inhibit survivin turnover and promote
cell survival by increasing the phosphorylation state of survivin. Based on the findings
from this dissertation and work by other groups, enhancing survivin activity in the brain
following TBI will likely decrease cell death, reduce cavity size and enhance behavioral
recovery compared to untreated animals.
This set of proposed experiments will reveal the functional consequences of
endogenous survivin expression in injured brain tissues. With this knowledge, it can be
determined whether survivin is indeed a viable therapeutic agent for brain injury
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Erik Andrew Johnson was born in Louisville, KY, and raised in Kansas City, MO.
He graduated high school from Lincoln College Preparatory Academy (Kansas City,
MO) in 1994. He attended Macalester College (St. Paul, MN) where he received a
Bachelor of Arts degree in 1998 with majors in biology, psychology and neuroscience.
After a year of graduate study at the University of Texas-Houston, he transferred to the
Interdisciplinary Program in Biological Sciences at the University of Florida
(Gainesville, FL) to complete his doctorate in the laboratory of Dr. Ronald Hayes. Erik
has been awarded top honors at the National and International Neurotrauma Society
Student Poster Competition in 2001. In addition, Erik has twice been awarded the B.W.
Robinson Research Endowment Grant-in-Aid Achievement Award in 2003 and 2004.
Erik finished his doctoral work with two peer reviewed first author papers and five total
papers to his credit.