Neuronal death in brain infarcts in man

The mechanism of neuronal death in brain ischaemia remains unclear. Morphology, terminal transferase‐mediated dUTP‐digoxigenin nick end‐labelling (TUNEL) and immunohistochemistry for the pro‐apoptotic enzyme caspase‐3 (CASP3), for its substrates poly(ADP‐ribose) polymerase (PARP) and the DNA‐dependent protein kinase catalytic subunit (DNA–PKCS) and for poly(ADP‐ribose) (PAR), an end‐product of PARP activity, were used to investigate neuronal death in brain infarcts from 15 men and 20 women, aged 46–95 years. The infarcts varied in age from 18 h to several months. Neuronal death was characterized morphologically by cell shrinkage, cytoplasmic hypereosinophilia and moderate nuclear pyknosis with later chromatin dispersal and disintegration, but not features of apoptosis. Occasional apoptotic bodies were seen but these appeared to be related to inflammatory cells, endothelial cells and occasional glia, including satellite cells. Neurones within infarcts showed strong nuclear and cytoplasmic labelling for CASP3 during the first 2 days after infarction. Neuronal DNA–PKCS, PARP and poly(ADP‐ribose) immunoreactivity was demonstrable in scattered neurones in and adjacent to infarcts for 18–24 h but thereafter declined to below detectable levels in most cases. TUNEL labelled cells towards the edge of the infarcts, particularly at 2–4 days, but most of the labelling could be prevented by preincubation of the sections in diethyl pyrocarbonate to inactivate endogenous nucleases. Between 3 days and 3 weeks, CASP3 and DNA–PKCS were detected in proliferating capillaries and CASP3, PARP and poly(ADP‐ribose) in infiltrating macrophages. Our findings indicate that neuronal death in human brain infarcts has some of the early biochemical features of programmed cell death, with upregulation of CASP3 and rapid disappearance of DNA–PKCS and PARP. However, the morphological changes are not those of apoptosis, the DNA cleavage occurs relatively late, and some of the TUNEL is probably mediated by the release of endogenous endonucleases during protease or microwave pretreatment of the damaged tissue.