Effects of α2-adrenoceptor agonists on perinatal excitotoxic brain injury -: Comparison of clonidine and dexmedetomidine

Background: A growing number of children have severe neurologic impairment related to very premature birth. Experimental data suggest that overstimulation of cerebral N-methyl-D-aspartate (NMDA) receptors caused by excessive glutamate release may be involved in the genesis of perinatal hypoxic-ischemic brain injury. alpha(2)-Adrenoceptor agonists are protective in models of brain ischemia in adults. The authors sought to determine whether they prevent perinatal excitotoxic neuronal damage. Methods: Five-day-old mice were allocated at random to clonidine (4-400 mug/kg), dexmedetomidine (1-30 mug/kg), or saline injected intraperitoneally before an intracerebral stereotactic injection of the NMDA receptor agonist ibotenate; cortical and white matter lesions were quantified 5 days later by histopathologic examination. Cortical neuron cultures exposed to 300 mum NMDA were used to evaluate the effects of clonidine or dexmedetomidine on neuronal death assessed by counting the number of pycnotic nuclei after fluorescent chromatin staining. Results: In vivo, both clonidine and dexmedetomidine induced significant concentration-dependent reductions in the size of ibotenate-induced lesions in the cortex and White matter. lit vitro, the number of neurons damaged by NMDA exposure was significantly decreased by both dexmedetomidine (-28+/-12% at 10 muM; P<0.01) and clonidine (-37 +/- 19% at 100 mu M; P<0.01) as compared with controls. in both models, the selective alpha(2)-adrenoceptor antagonist yohimbine abolished the neuroprotective effect of clonidine and dexmedetomidine. Conclusions: Clonidine and dexmedetomidine are potent neuroprotectors that act by stimulating the alpha(2)-adrenoceptors. These results obtained in a murine model of perinatal excitotoxic injury may be relevant to some forms of neonatal brain damage in humans.