Abstract: BACKGROUND: Acupuncture combined with rehabilitation training has significant clinical efficacy in the treatment of cerebral infarction and can promote the reconstruction of damaged neurological function in patients with cerebral infarction, but its specific mechanism is still unclear.
OBJECTIVE: To investigate the mechanism of acupuncture combined with rehabilitation training in promoting the reconstruction of damaged neurological function in rats with cerebral infarction.
METHODS: Sixty male Sprague-Dawley rats were divided into a sham operation group (15 rats) and an operation group (45 rats) by using the randomized numerical table method. In the sham operation group, only the right common carotid artery, internal carotid artery, external carotid artery and vagus nerve were isolated without intervention. In the operation group, the middle cerebral artery occlusion model was established. At 3 days after modeling, model rats were randomized into three groups with 15 rats in each group: a model group, a rehabilitation training group and an acupuncture combined with rehabilitation training group. The model group received no intervention. The rehabilitation training group performed rehabilitation training, including running training and balance training, once a day for 7 consecutive days. The acupuncture combined with rehabilitation training group performed acupuncture at Baihui, Shenting and Shuigou, once a day for 7 consecutive days, on the basis of the rehabilitation training group. The modified neurological severity scores were used to assess the degree of neurological deficits after intervention. Morris water maze was used to observe the spatial learning and memory ability. Hematoxylin-eosin staining was used to observe the pathological changes in the hippocampus. ELISA was used to detect the expression levels of Caspase-3 and Caspase-8 proteins in the cerebral cortex. Western blot was used to detect the expression levels of phosphatidylinositol 3-kinase (PI3K), protein kinase B (Akt) and mammalian target of rapamycin (mTOR) in the cerebral cortex.
RESULTS AND CONCLUSION: (1) Compared with the sham operation group, the modified neurological severity scores were increased (P < 0.01); spatial learning and memory ability were decreased; hippocampal damage was obvious, hippocampal neurons were arranged sparsely and disorderly with visible degeneration, and the number of glial cells was increased; the protein expression levels of Caspase-3 and Caspase-8 were increased (P < 0.01); the protein expression levels of PI3K, Akt and mTOR were decreased (P < 0.01) in the model group. (2) Compared with the model group, the modified neurological severity scores were decreased (P < 0.01); spatial learning and memory ability were increased; hippocampal damage was improved, hippocampal neurons were arranged orderly with degeneration decreased, and the number of glial cells was decreased; the protein expression levels of Caspase-3 and Caspase-8 were decreased (P < 0.01); the protein expression levels of PI3K, Akt and mTOR were increased (P < 0.01) in the rehabilitation training group and the acupuncture combined with rehabilitation training group. Moreover, the improvement of each index was more obvious in the acupuncture combined with rehabilitation training group compared with the rehabilitation training group. To conclude, acupuncture combined with rehabilitation training can promote the reconstruction of damaged neurological function in rats with cerebral infarction and exert neuroprotective effects via the activation of PI3K/Akt/mTOR signaling pathway.

Key words: acupuncture, rehabilitation training, acupuncture combined with rehabilitation training, cerebral infarction, neurological function reconstruction, PI3K/Akt/mTOR signaling pathway, Caspase-3, Caspase-8