Beneficial Effects of Theta-Burst Transcranial Magnetic Stimulation on Stroke Injury via Improving Neuronal Microenvironment and Mitochondrial Integrity

  • Xuemei Zong
  • Yan Dong
  • Yuyu Li
  • Luodan Yang
  • Yong Li
  • Baocheng Yang
  • Lorelei Tucker
  • Ningjun Zhao
  • Darrell W. Brann
  • Xianliang Yan
  • Shuqun HuEmail author
  • Quanguang ZhangEmail author
Original Article


Recent work suggests that repetitive transcranial magnetic stimulation (rTMS) may beneficially alter the pathological status of several neurological disorders, although the mechanism remains unclear. The current study was designed to investigate the effects of rTMS on behavioral deficits and potential underlying mechanisms in a rat photothrombotic (PT) stroke model. From day 0 (3 h) to day 5 after the establishment of PT stroke, 5-min daily continuous theta-burst rTMS (3 pulses of 50 Hz repeated every 200 ms, intensity at 200 G) was applied on the infarct hemisphere. We report that rTMS significantly attenuated behavioral deficits and infarct volume after PT stroke. Further investigation demonstrated that rTMS remarkably reduced synaptic loss and neuronal degeneration in the peri-infarct cortical region. Mechanistic studies displayed that beneficial effects of rTMS were associated with robust suppression of reactive micro/astrogliosis and the overproduction of pro-inflammatory cytokines, as well as oxidative stress and oxidative neuronal damage especially at the late stage following PT stroke. Intriguingly, rTMS could effectively induce a shift in microglial M1/M2 phenotype activation and an A1 to A2 switch in astrocytic phenotypes. In addition, the release of anti-inflammatory cytokines and mitochondrial MnSOD in peri-infarct regions were elevated following rTMS treatment. Finally, rTMS treatment efficaciously preserved mitochondrial membrane integrity and suppressed the intrinsic mitochondrial caspase-9/3 apoptotic pathway within the peri-infarct cortex. Our novel findings indicate that rTMS treatment exerted robust neuroprotection when applied at least 3 h after ischemic stroke. The underlying mechanisms are partially associated with improvement of the local neuronal microenvironment by altering inflammatory and oxidative status and preserving mitochondrial integrity in the peri-infarct zone. These findings provide strong support for the promising therapeutic effect of rTMS against ischemic neuronal injury and functional deficits following stroke.


Ischemic stroke Functional recovery Neuroprotection Neuroinflammation Oxidative stress Apoptosis 



We would like to thank Yujiao Lu for technical support with biochemical analyses.

Funding Information

This study was supported by an American Heart Association Innovative Project Award 18IPA34170148 (to QZ); a Scientific Research Project of Jiangsu Provincial Commission of Health and Family Planning(Z2017016 to XZ); an Open Project Program of Jiangsu Key Laboratory of Anesthesiology (KJS1704 to XZ); and a Key Research and Development Plan of Xuzhou Science and Technology Bureau (KCI7161 to XZ).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that there is no conflict of interest.

Ethical Approval

All procedures in studies involving animals were approved and performed in accordance with the guidelines of the Institutional Animal Care and Use Committee of the local institutes.


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Authors and Affiliations

  1. 1.Jiangsu Provincial Institute of Health EmergencyXuzhou Medical University; the Emergency Center of the Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
  2. 2.Department of Neuroscience and Regenerative Medicine, Medical College of GeorgiaAugusta UniversityAugustaUSA

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