Synergistic stress exacerbation in hippocampal neurons: Evidence favoring the dual-hit hypothesis of neurodegeneration

Hippocampus. 2016 Aug;26(8):980-94. doi: 10.1002/hipo.22580. Epub 2016 Mar 29.


The dual-hit hypothesis of neurodegeneration states that severe stress sensitizes vulnerable cells to subsequent challenges so that the two hits are synergistic in their toxic effects. Although the hippocampus is vulnerable to a number of neurodegenerative disorders, there are no models of synergistic cell death in hippocampal neurons in response to combined proteotoxic and oxidative stressors, the two major characteristics of these diseases. Therefore, a relatively high-throughput dual-hit model of stress synergy was developed in primary hippocampal neurons. In order to increase the rigor of the study and strengthen the interpretations, three independent, unbiased viability assays were employed at multiple timepoints. Stress synergy was elicited when hippocampal neurons were treated with the proteasome inhibitor MG132 followed by exposure to the oxidative toxicant paraquat, but only after 48 h. MG132 and paraquat only elicited additive effects 24 h after the final hit and even loss of heat shock protein 70 activity and glutathione did not promote stress synergy at this early timepoint. Dual hits of MG132 elicited modest glutathione loss and slightly synergistic toxic effects 48 h after the second hit, but only at some concentrations and only according to two viability assays (metabolic fitness and cytoskeletal integrity). The thiol N-acetyl cysteine protected hippocampal neurons against dual MG132/MG132 hits but not dual MG132/paraquat hits. These findings support the view that proteotoxic and oxidative stress propel and propagate each other in hippocampal neurons, leading to synergistically toxic effects, but not as the default response and only after a delay. The neuronal stress synergy observed here lies in contrast to astrocytic responses to dual hits, because astrocytes that survive severe proteotoxic stress resist additional cell loss following second hits. In conclusion, a new model of hippocampal vulnerability was developed for the testing of therapies, because neuroprotective treatments that are effective against severe, synergistic stress are more likely to succeed in the clinic. © 2016 Wiley Periodicals, Inc.

Keywords: Alzheimer's disease; N-acetylcysteine; Parkinson's disease; dual hit; two hit.

MeSH terms

  • Acetylcysteine / pharmacology
  • Animals
  • Cell Survival / drug effects
  • Cells, Cultured
  • Glutathione / metabolism
  • HSP70 Heat-Shock Proteins / metabolism
  • Hippocampus / drug effects
  • Hippocampus / pathology
  • Hippocampus / physiopathology*
  • Leupeptins / toxicity
  • Microtubule-Associated Proteins / metabolism
  • Models, Neurological
  • Neurodegenerative Diseases / drug therapy
  • Neurodegenerative Diseases / pathology
  • Neurodegenerative Diseases / physiopathology
  • Neurons / drug effects
  • Neurons / pathology
  • Neurons / physiology*
  • Neuroprotective Agents / pharmacology
  • Oxidative Stress / physiology
  • Paraquat / toxicity
  • Proteasome Endopeptidase Complex / metabolism
  • Rats, Sprague-Dawley
  • Stress, Physiological / drug effects
  • Stress, Physiological / physiology*


  • HSP70 Heat-Shock Proteins
  • Leupeptins
  • MAP2 protein, rat
  • Microtubule-Associated Proteins
  • Neuroprotective Agents
  • Proteasome Endopeptidase Complex
  • Glutathione
  • Paraquat
  • benzyloxycarbonylleucyl-leucyl-leucine aldehyde
  • Acetylcysteine