Abstract: Objective To explore the effect of acupuncture-rehabilitation therapy on apoptosis and the expression of X-linked inhibitor of apoptosis protein (XIAP) and cleaved-caspase-9 in ischemic penumbra of rats with cerebral ischemia. Methods A total of 180 male Sprague-Dawley rats were randomly divided into sham operation group, model group, acupuncture group, rehabilitation group and acupuncture-rehabilitation therapy group. Each group was divided into three days, seven days and 14 days subgroups (n=12). The model was established with the modified Longa suture method. The model group and the sham operation group received no treatment. The acupuncture group received cluster needling of scalp acupuncture, the rehabilitation group received treadmill training, and the acupuncture-rehabilitation therapy group received both acupuncture and treadmill training. On the third, seventh and 14th days after modeling, the neurological function was assessed with modified Neurological Severity Score (mNSS). The apoptosis was observed by TUNEL staining and the expression of XIAP and cleaved-caspase-9 protein was determined by Western blotting in cerebral ischemic penumbra, respectively. Results Compared with the model group, the mNSS scores decreased, the rate of apoptosis decreased, the expression of XIAP protein increased, and the expression of cleaved-caspase-9 decreased in each treatment group at each time point (P<0.05). Compared with the other two treatment groups, the rate of apoptosis further decreased at each time points (P<0.05), the expression of XIAP protein further increased at each time points (P<0.05), the mNSS score further decreased (P<0.05) and the expression of cleaved-caspase-9 protein further decreased (P<0.05) seven days and 14 days after modeling in the acupuncture-rehabilitation therapy group. Conclusion Acupuncture and rehabilitation therapy could reduce the neurological deficit in rats with cerebral ischemia, which was superior to the simple acupuncture treatment and rehabilitation training. The mechanism may be related to th reduction of apoptosis by promoting XIAP protein expression and inhibiting caspase-9 protein activation.

Key words: cerebral ischemia, neurological function, acupuncture-rehabilitation therapy, apoptosis, X-linked apoptosis inhibitory protein, cleaved-caspase-9, rats