The molecular mechanism of Ngb has not been clearly elucidated. When Ngb was first discovered, it was believed to act as an oxygen transporter or buffer supplying oxygen during anoxia, similar to hemoglobin.
43,46 However, this has been found to be unlikely due to its low concentration in the brain and its relatively low oxygen affinity.
6,46 Studies have demonstrated that Ngb binds to cytochrome c (Cyt c) and membrane bound G-protein coupled receptor (GPCR) and thus the proposed mechanisms of action are closely related to these proteins.
46 –48 One possible mechanism of action is the role of Ngb in a redox reaction with Cyt c.
46,49 During oxidative stress, Cyt c is released and triggers apoptosis through activation of proapoptotic caspase 3. This proposed redox interaction between Cyt c and Ngb suggests that Cyt c in converted by Ngb to a reduced ferrous form that is now unable to trigger apoptosis.
46,49 Furthermore, in vitro studies have demonstrated that oxidative stress only occurs in neuroglobin overexpressing transgenic cells when the level of exogenous Cyt c is elevated beyond the usual level required to induce apoptosis.
46 These findings suggest that Ngb resets the trigger level for apoptosis. Other studies, however, reveal that Ngb maintains the mitochondrial membrane potential and mitochondrial function during oxidative stress through activation of phosphatidylinositol 3-kinases (PI3) and anti-apoptotic AKT pathways.
43,46,50,51 Neuroglobin is also believed to couple with the membrane-bound GPCR.
43,46 This binding leads to the suppression of elevated calcium levels through the inositol trisphosphate (IP3) pathway and prevents apoptosis.
2,46,52 Putting these theories together, it may be postulated that during retinal ischemia, Ngb binds to the released cytochrome c during the initial mitochondrial oxidative stress. This leads to the inactivation of cytochrome c and the prevention of apoptosis as we found in our Ngb-Tg mice with ischemia. Moreover, the prevention of further mitochondrial oxidative damage in retinal ischemia after the initial release of Cyt c may be explained by the coupling of Ngb with GPCR. During retinal ischemia, there is an increase in calcium levels that lead to apoptosis and neuronal cell death.
14,53 Studies have demonstrated that Ngb is associated with decreased calcium levels and it can be postulated that by activating the IP3 pathway through GPCR, this rise in calcium levels during retinal ischemia is suppressed and thus preventing further mitochondrial oxidative stress and apoptosis.
10,53 In addition, Ngb may prevent further mitochondrial oxidative stress by coupling with GPCR to activate PI3 and trigger antiapoptotic events through AKT. However, further studies will be necessary to confirm our postulation and confirm the definitive molecular mechanisms behind this neuroprotection in retinal ischemia.