Non-Invasive Mitochondrial Modulation
Mechanistic Foundation
Recent studies from the Sanderson and Hüttemann laboratories led to the development of a novel, non-invasive therapeutic strategy to target ischemic brain injury. The foundation of our technology is based on our research discovery that discrete near infrared (NIR) light wavelengths directly modulate mitochondrial function in the brain by changing the activity of the mitochondrial enzyme Cytochrome c Oxidase (COX).
(A) Isolated regulatory-competent bovine COX separated into its subunits on a high-resolution urea/SDS-PAGE Coomassie-stained gel. Subunits are indicated in roman numerals. (B) Representative scan of wavelength-dependent COX activity identifying the 750 nm and 950 nm wavelength as inhibitory regions. (C) Effect of NIR emitted by LED diodes confirms that 750 nm and 950 nm NIR inhibit COX in vitro while 810 nm NIR activates the enzyme. Data were obtained over a 3-min interval of irradiation and normalized to non-irradiated samples (n=4; *p<0.05). (D) NIR irradiation modulates oxygen consumption rate (OCR) in a wavelength specific manner. 750 nm and 950 nm NIR reduce OCR below the basal respiration rate whereas 810 nm NIR increases mitochondrial OCR (n=4; *p<0.05).
First Evidence: Inhibitory NIR Wavelengths are Neuroprotective
The neuroprotective effect of NIR was first tested in our adult rat model of global brain ischemia (bilateral carotid-occlusion + systemic hypotension). Following transient global brain ischemia in rats, hippocampal CA1 neurons are particularly sensitive, and a near-complete loss is observed at 3-7 days after reperfusion . Our studies defined the neuroprotective effect of NIR in terms of its ability to prevent degeneration of CA1 neurons (A & B) and to preserve hippocampal function. Non-invasive irradiation of the brain was performed by direct illumination through the scalp and skull applied at the onset of reperfusion and maintained for 2h. All wavelengths or wavelength combinations identified in vitro to reduce COX activity were evaluated for neuroprotection using a randomized and blinded study design. After 14 days, brain sections were stained for neuron counting, together with immuno-fluorescence to detect neurons, microglia, and astrocytes (A & B). Untreated animals subjected to I/R showed an 86% loss of neurons in the CA1 hippocampal region. In contrast, in rats treated with 950 nm or 750 nm NIR, neuronal death was profoundly attenuated: 83% of hippocampal neurons remained viable with 950 nm NIR vs 14% in untreated controls (B) . For the inhibitory NIR-treated groups, % viable neurons ranged from 83% to 65% depending on the wavelength(s) that were applied. We identified: (i) two wavelength/combinations that show maximum and statistically equivalent neuroprotection: 950 nm, and 750/950 nm (83%±10% and 77%±15% viable neurons, respectively); and (ii) one wavelength (810 nm) that provided no protection. Importantly, the protection in NIR treated rats coincided with improved spatial learning (Sanderson et al, Sci Rep, 2018).
NIR Treatment for Focal Ischemia/Reperfusion Injury
To investigate the efficacy of this treatment following ischemic stroke, we evaluated the efficacy of NIR in the rat middle cerebral artery occlusion (MCAO) model. One hour into ischemia, perfusion weighted imaging (PWI) sequences were obtained to quantify the ischemic territory, or area at risk. After 90 min, the filament was withdrawn and NIR treatment immediately initiated for 2 h or 4 h applied directly to the scalp. Animals were treated with combined COX-inhibitory wavelengths of 750 nm and 950 nm as was shown to be most effective by our previous work. Control animals underwent the same procedure but were not treated with NIR. Animals underwent PWI and diffusion weighted imaging (DWI) immediately following treatment. DWI was again taken at 24 h of reperfusion, then on days 7 and 14 the animals were imaged to document infarct volume with T2 weighted imaging (T2WI). Importantly, NIR treatment for 2 h resulted in a 22% reduction in infarct volume at 14 days of reperfusion and NIR treatment for 4 h resulted in an infarct reduction of 50% (Strubakos et al, 2019 JCBFM). Infarct volume reduction was independent of area at risk, demonstrating NIR can reduce infarct volume in a wide range of injury severities (c).
NIR Treatment for Traumatic Brain Injury
Similar to ischemia/reperfusion injury, mitochondria are important contributors to the pathophysiology of brain injury caused by trauma. TBIs are heterogenous injuries that can vary according to the cause, severity, anatomical location and many other complicating factors. Furthermore, the molecular pathways that cause cellular injury are multifaceted and redundant. Despite the complexity of the injury, mitochondria appear to be a common component in the cellular pathways of neurological injury. Mitochondrial dysfunction, caused largely by excitotoxicity, causes accumulation of reactive oxygen species, a well-established driver of brain damage. The Sanderson Lab is evaluating inhibitory NIR to reduce oxidative stress and provide neuroprotection in preclinical and translational models of TBI.
Clinical Translation
Clinical translation of this technology is ongoing at our company, Mitovation, Inc. Please visit https://mitovation.com for details on our translational and commercialization efforts.
Relevant Publications:
Wider JM, Gruley E, Morse PT, Wan J, Lee I, Anzell AR, Fogo GM, Mathieu J, Hish G, O'Neil B, Neumar RW, Przyklenk K, Hüttemann M, Sanderson TH. (2023). Modulation of mitochondrial function with near-infrared light reduces brain injury in a translational model of cardiac arrest. Critical Care. 27: 491. https://doi.org/10.1186/s13054-023-04745-7
Morse PT, Tuck S, Kerns M, Goebel DJ, Wan J, Waddell T, Wider JM, Hüttemann CL, Malek MH, Lee I, Sanderson TH, Hüttemann M. Non-invasive treatment of ischemia/reperfusion injury: Effective transmission of therapeutic near-infrared light into the human brain through soft skin-conforming silicone waveguides. Bioeng Transl Med. 8(3):e10496. doi: 10.1002/btm2.10496.
Strubakos CD, Malik M, Wider JM, Lee I, Reynolds CA, Mitsias P, Przyklenk K, Hüttemann M, Sanderson TH. (2020). Non-invasive treatment with near-infrared light: A novel mechanisms-based strategy that evokes sustained reduction in brain injury after stroke. J Cereb Blood Flow Metab. 40(4): 833-844.
Morse PT, Goebel DJ, Wan J, Tuck S, Hakim L, Hüttemann CL, Malek MH, Lee I, Sanderson TH, Hüttemann M. (2020). Cytochrome c oxidase-modulatory near-infrared light penetration into the human brain: Implications for the noninvasive treatment of ischemia/reperfusion injury. IUBMB Life. Online ahead of print.
Sanderson TH, Wider JM, Lee I, Reynolds CA, Liu J, Lepore B, Tousignant R, Bukowski MJ, Johnston H, Fite A, Raghunayakula S, Kamholz J, Grossman LI, Przyklenk K, Hüttemann M. (2018). Inhibitory modulation of cytochrome c oxidase activity with specific near-infrared light wavelengths attenuates brain ischemia/reperfusion injury. Sci Rep. 8(1): 3481.
For a complete listing of publications: click here