7.4.1. Reactive astrogliosis and its role in ischemic brain injury
"Reactive astrogliosis" is a term used to describe cellular, functional, and molecular changes that astrocytes undergo following injury. The morphological changes range from hypertrophy of cell bodies and processes to alterations in protein profiles and/or proliferative activity [
187,
188]. The extent of their expression depends on the severity of the injury. Therefore, astrocytic reactivity can be characterized as mild, moderate, diffuse, or severe. This quantitative analysis is based on the degree of glial fibrillary acidic protein (GFAP) expression. The more pronounced the astrocytic transformation and consequently the severity of the injury, the stronger the intensity of GFAP expression [
188,
189]. Several intercellular and intracellular signaling molecules regulate this process. The effect can be both protective and exacerbating the damage. Reactive astrocytes provide neuroprotection in the acute stage of ischemic brain injury while simultaneously interacting with immune cells from the blood, endothelial cells, and microglia, leading to the development of brain edema and potentiation of the neuroinflammatory response. In the chronic stage, reactive astrocytes are responsible for the formation of a glial scar, which aims to limit the damage zone, tissue remodeling, and restoration of neuronal functions [
185,
186,
190].
Two subtypes of reactive astrocytes have been described: A1 and A2 reactive astrocytes. The proliferation of the A1 subtype is stimulated by secreted IL-1α, TNFα, and C1q from activated microglia, leading to neuronal and oligodendrocyte death. A2 reactive astrocytes have a neuroprotective effect and secrete trophic factors for neurons [
191]. Among the markers expressed in reactive astrocytes are Lcn2, GFAP, Vimentin, and Timp1. Transcriptional analysis of reactive astrocytes in experimental animals following ischemia confirms the claim that this cell type, similar to microglia, has both pro-inflammatory and neuroprotective functions [
192,
193].
High-tech imaging methods have been used to study the ischemic penumbra in the human cerebral cortex [
194]. Changes in astrocyte morphology can be described according to the stage of cerebral infarction. In the acute phase (1st to 4th day after ischemia), astrocytes exhibit increased proliferative activity and increased GFAP expression. In the subacute phase (4th to 8th day after ischemia), astrocytes with elongated processes and depolarized cell membranes are described, gradually forming a glial scar until the onset of the chronic stage (8th to 14th day after ischemia). Differences in astrocyte reactivity are associated with their sensitivity to ischemia, their location relative to the lesion core, and their subtypes [
195]. Some authors believe that the different reactivity is also due to differences in the protein profile [
196].
In ischemic brain injury, the lack of glucose is compensated by reactive astrocytes, which can initiate the process of glycolysis to produce lactate, serving as an energy source for neurons and transport it to them through specialized transporters. Data regarding this function of reactive astrocytes and their role in the survival or degeneration of neurons are contradictory [
197].
By establishing the connection between neurons and blood vessels within the neurovascular units in the central nervous system (CNS), astrocytes play a key role along with individual cells and pericytes in the aftermath of cerebral tissue infarction. Reactive astrocytes secrete VEGF and MMPs, which increase vascular permeability and exacerbate ischemic damage in the acute phase of the incident. In the chronic phase, when the process of neuroregeneration prevails, these same bioactive molecules stimulate angiogenesis and the restoration of the blood-brain barrier [
198,
199].
Excessive glutamate in the extracellular space of brain tissue has neurotoxic effects. This may be due to the inability of astrocytes to eliminate it through reuptake and convert it into glutamine. Therefore, by participating in the glutamate-glutamine cycle, reactive astrocytes have a protective effect on neurons [
66,
200]. Reactive astrocytes also secrete synaptic molecules such as cholesterol-associated apolipoprotein E (APOE) and thrombospondin [
201,
202].
Astrocytes exert their antioxidant action through the production of glutathione, which is important for limiting the damage during ischemia in the cerebral cortex [
203]. However, reactive astrocytes can also release reactive oxygen species (ROS) and nitric oxide, leading to oxidative stress [
170]. Recent studies have shown that astrocytes can produce extracellular vesicles containing proteins, lipids, nucleic acids, and thus interact with other cell types. There is evidence that under ischemic conditions, reactive astrocytes can increase the survival of neurons through such vesicular activity [
204,
205,
206]. However, studies on human astrocytes have demonstrated that these types of vesicles can be perceived by neurons and have adverse effects on their functioning and differentiation [
207].
The question of whether astrocytes in adult brain tissue can transfer mitochondria after ischemic injury, as observed in experimental studies in the mouse retina, remains a topic of interest [
208]. During ischemic brain injury, astrocytes exert neuroprotective and anti-inflammatory effects, attributed to the secretion of erythropoietin, VEGF (vascular endothelial growth factor), GDNF (glial cell line-derived neurotrophic factor), and estrogen (17β-estradiol), which limit neuronal damage [
209,
210,
211].
Gap junctions between astrocytes remain open during in vivo ischemia and in vitro hypoxia. This allows for the passage and rapid spread of pro-apoptotic factors, contributing to an increase in the size of the necrotic area. However, there is evidence from animal experiments suggesting that astrocytic gap junctions can limit the zone of necrosis. The exact role of these contacts is still contradictory, and further research is needed to clarify their significance [
199,
212].
There is a hypothesis that reactive astrocytes forming a scar are actually astrocyte-like NSCs (neural stem cells) that differentiate into astrocytes. This transformation is thought to be modulated by specific genes activated after ischemia. Reactive astrocytes isolated from the peri-infarct cortex following ischemia can de-differentiate into neural-sphere-producing cells (NSPCs), which are multipotent cells capable of self-renewal. However, when transplanted, these cells have been shown to differentiate into astrocytes and oligodendrocytes, but not neurons. Nevertheless, this demonstrates the high plasticity of reactive astrocytes. Recent studies indicate that reactive astrocytic glial cells after ischemia can be reprogrammed into functioning neurons, leading to a reduction in gliosis and restoration of synaptic contacts. There is also evidence that a combination of transcription factors can transform reactive astrocytes not only into neurons but also into neuroblasts. This highlights once again the unlimited plasticity of reactive glia and the potential for this property to find applications in targeted therapies following ischemic brain injury [
199,
213].
7.4.2. Role of Oligodendrocytes in Ischemic Brain Injury
Oligodendrocytes are highly susceptible to ischemia, and a significant number of them die within three hours of an acute incident [
214]. However, they play a crucial role in the chronic stage of ischemia as the main cellular population responsible for remyelinating affected axons [
215]. After ischemia, mature oligodendrocytes accumulate along the border of the infarct zone to participate in tissue recovery [
216].
It should be noted that oligodendrocytes do not have the capacity for self-renewal. In fact, ischemia stimulates the proliferation and differentiation of oligodendrocyte precursor cells (OPCs) into myelinating oligodendrocytes (OLs) [
217]. The number of OPCs increases in the penumbra (the surrounding region of the infarct) following ischemic brain injury but decreases in the center of the lesion. They undergo morphological transformation characterized by hypertrophy of cell bodies, as well as molecular and genetic changes that stimulate their migration, proliferation, and differentiation [
218,
219,
220,
221,
222].
During ischemic brain injury, OLs undergo apoptosis induced by the complement system and the toxic effects of released glutamate and ATP. Additionally, oligodendrocytes are influenced by inflammatory cytokines primarily released by microglia in the infarct area. For example, IFN-γ induces apoptosis, delays remyelination, and inhibits the proliferation and differentiation of OPCs. TNF-α also induces apoptosis and delays remyelination. IL-6, IL-11, and IL-17 have a beneficial effect by promoting the survival of oligodendrocytes. IL-1β has contradictory effects: it promotes the survival of oligodendrocytes on one hand and contributes to their necrotization on the other hand [
223]. Numerous studies indicate that interactions between microglia and oligodendrocytes can have both favorable and unfavorable effects, depending on the stage of oligodendrocyte development [
224].
7.4.3. Role of NG2-Glia in Ischemic Brain Injury
NG2-glia rapidly respond to ischemic damage in brain tissue. Together with macrophages, these glial cells are identified within the first day after the onset of injury [
187]. The observed changes in NG2-glia are morphological, including hypertrophy of the cell body, shortening and thickening of cellular processes, and increased intensity of NG2 expression [
225]. Their proliferative activity is also enhanced, and NG2+ cells migrate to the periphery of the ischemic lesion [
187]. After this stage, the number of NG2-glia gradually decreases, reaching optimal levels within 28 days after the injury. This suggests that these glial cells perform a regulatory function and maintain homeostatic balance following the injury [
153].
Experimental studies conducted on mouse brains after focal cerebral ischemia reveal the presence of cells containing genes characteristic of both NG2-glia and reactive astrocytes. Immunohistochemical analysis of their protein profile confirms these characteristics. Consequently, they are referred to as astrocyte-like NG2-glia cells. Their profile resembles that of astrocytes in the cortical gray matter. They are localized in the post-ischemic glial scar and are likely related to its formation following ischemia [
153,
226,
227]. Additionally, another study demonstrates the involvement of NG2-glia in the early stages of tissue recovery after brain injury [
228].