According to the results in the present study, trehalose caused a) improved motor behavior and reduced apomorphine-induced rotations, b) reduced dopaminergic cell apoptosis of substantia nigra neurons caused by the 6-OHDA neurotoxin and, consequently, increased DA and DOPAC c) induced autophagy (increased LC3II/LC3I ratio), d) increased expression of p62 protein, e) elevated the Nrf2 transcription factor and its degredation inhibition and thus translocation into the cell nucleus f) increased expression of downstream antioxidant transcription factors, such as GR, GPx, and CAT and thus decreased ROS level. The behavioral and pathological tissue changes suggested the successful induction of the PD model. This unilateral PD induction is the most common pre-clinical model and the effects of this model on the dopaminergic system of the nigrostriatal pathway are well known (
13-
25). The 6-OHDA model renders molecular variations in the substantia nigra, which has the most similarity to the human PD (
26). It is believed that 6-OHDA oxidized in the extracellular space produces the oxidative factors in the cell, induces oxidative stress in the cell, and eventually leads to mitochondrial electron transport chain dysfunction (
24). As the 6-OHDA was injected to the left side of the brain, the asymmetrical damage to the dopaminergic neurons of substantia nigra was evaluated by the apomorphine-induced behavioral test (
27). Apomorphine is a dopamine agonist and causes the contralateral rotation of the mouse towards the opposite side of the affected area as we assessed in the current study (
24). In this study, the trehalose improved the motor function of the animals by reducing motor asymmetry and reducing rotations (28). The trehalose also prevented the reduction of DA and DOPAC levels, which could justify a decrease in motor symmetry in the treatment group in comparison with the lesion group. This finding is in agreement with the results of other researchers that DA and DOPAC contents are reduced by 6-OHDA neurotoxin. On the other hand, one of the important pathogenic factors in inducing the PD production is the oxidative stress. It occurs as the imbalance between the production and detoxification of free radicals in the cytoplasm is perturbed. The elevation in free radical levels leads to dysfunction and death of post-mitotic cells, such as neurons. Under the normal cellular circumstances, intracellular antioxidant defense system causes the removal of oxidative agents (
29). The GPx and CAT detoxify dopaminergic cells from overproduced H
2O
2. Previous studies have demonstrated that the damage caused by 6-OHDA reduces the levels of antioxidant enzymes (
30). In line with other studies, the ROS level was increased and GR, CAT and also GPx, DA and DOPAC levels were reduced in the lesion group, suggesting 6-OHDA-induced impairment in the antioxidant system. 6-OHDA also results in a consistent, significant decrease in the total GPx (
Figure 4a) and GR activity (
Figure 4b). Administration of trehalose can potently inhibit all of these pro-oxidative stress effects. These results imply that trehalose may be able to prevent oxidative damage in the SN after 6-OHDA exposure. Nrf2 activates expression of GPx and SOD enzymes which detoxifies ROS productions. We observed that trehalose increased the expression of Nrf2 that shows its regulatory effect at the translational level as well. Nrf2 activation neutralizes the neurotoxic agents in dopaminergic neurons such as the one that is related to 6-OHDA (
31). We showed that the nigral Nrf2 level decreased in the lesion group and its levels increased with trehalose pretreatments. Considering the negative effects of 6-OHDA on Nrf2 expression, it is possible that trehalose prevents the 6-OHDA-induced oxidative stress by activating Nrf2. In the current study, trehalose treatment through antioxidant system enhancement prevented these reductions in levels or activities in the dopaminergic neurons and consequently improved the motor functions as seen in the apomorphine-behavioral tests (
31). It has been well accepted that, Nrf2 is a master transcription factor responsible for gene expression of a series of anti-oxidant proteins and detoxifying enzymes in two ways known as canonical and non-canonical pathways. In the canonical pathway, Keap1, an adaptor protein of Cullin-3 ubiquitin ligase, senses electrophilic or oxidative stresses and then arrests ubiquitination of Nrf2 and inhibiting its degradation by the proteasome, leading to Nrf2 translocation and targeted gene expressions containing ARE in their sequence. Importantly, in addition to this canonical pathway, in a non-canonical mechanism of action, p62 competitively with Nrf2 to bind to Keap1 and p62 attachment to Keap1 releases Nrf2 from the Keap1 and hence, it translocates to the dopaminergic cell nucleus. Interestingly, this non-canonical pathway is hyper-activated in autophagy-deficient cells and tissues highlighting the p62-dependent of non-canonical antioxidant defense pathway (
32,
33). Thus, the p62/SQSTM1-Keap1-Nrf2 axis may be linked to trehalose actions on increasing the cell survival as trehalose treatments increase p62 levels in the substantia nigra cells. Moreover, our results show that trehalose activates autophagy as well, as it increased the LC3II/LC3I ratio, indicating the activation of autophagy by the trehalose. In the autophagy, p62 acts as a link between LC3 and ubiquitinated substrates, which is degraded in autolysosome by autophagy, thus, autophagy activation decreases p62 levels in the dopaminergic cells and activating the autophagy and non-canonical Nrf2 pathway is simultaneously possible only under high levels of p62 gene expressions. Interestingly, the protein quantification results confirm that trehalose treatments increased p62 levels in the dopaminergic cells as high as to be effective in both of the processes,
i.e. autophagy and non-canonical Nrf2 pathways which renders them be both active simultaneously in the cells. Recently, stem cell therapy approach, small molecules as drugs and epigenetic aspects are considered to find an effective way for the treatment of neurodegenerative disease (
13,
34-
43); however, investigations are continued to find more neurodegenerative-specific drugs.