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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Neurosci.</journal-id>
<journal-title>Frontiers in Neuroscience</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Neurosci.</abbrev-journal-title>
<issn pub-type="epub">1662-453X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fnins.2023.1243527</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Neuroscience</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Histochemical mapping of the duration of action of photobiomodulation on cytochrome c oxidase in the rat brain</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Wade</surname>
<given-names>Zachary S.</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Barrett</surname>
<given-names>Douglas W.</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Davis</surname>
<given-names>Roger E.</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Nguyen</surname>
<given-names>Adrian</given-names>
</name>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Venkat</surname>
<given-names>Sindhu</given-names>
</name>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Gonzalez-Lima</surname>
<given-names>F.</given-names>
</name>
<xref rid="c001" ref-type="corresp">
<sup>&#x002A;</sup>
</xref>
</contrib>
</contrib-group>
<aff><institution>Department of Psychology and Institute for Neuroscience, The University of Texas at Austin</institution>, <addr-line>Austin, TX</addr-line>, <country>United States</country></aff>
<author-notes>
<fn fn-type="edited-by" id="fn0001"><p>Edited by: Juanita J. Anders, Uniformed Services University of the Health Sciences, United States</p></fn>
<fn fn-type="edited-by" id="fn0002"><p>Reviewed by: Praveen Arany, University at Buffalo, United States; Jos&#x00E9; Luis Marcos, Vi&#x00F1;a del Mar University, Chile</p></fn>
<corresp id="c001">&#x002A;Correspondence: F. Gonzalez-Lima, <email>gonzalezlima@utexas.edu</email></corresp>
</author-notes>
<pub-date pub-type="epub">
<day>28</day>
<month>08</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="collection">
<year>2023</year>
</pub-date>
<volume>17</volume>
<elocation-id>1243527</elocation-id>
<history>
<date date-type="received">
<day>20</day>
<month>06</month>
<year>2023</year>
</date>
<date date-type="accepted">
<day>16</day>
<month>08</month>
<year>2023</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2023 Wade, Barrett, Davis, Nguyen, Venkat and Gonzalez-Lima.</copyright-statement>
<copyright-year>2023</copyright-year>
<copyright-holder>Wade, Barrett, Davis, Nguyen, Venkat and Gonzalez-Lima</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<sec id="sec1001">
<title>Introduction</title>
<p>This is the first study mapping the duration of action of <italic>in vivo</italic> photobiomodulation (PBM) on cytochrome-c-oxidase (CCO). In cellular bioenergetics, CCO is the terminal rate-limiting enzyme in the mitochondrial electron transport chain, which catalyzes oxygen utilization for aerobic energy production. PBM using transcranial infrared laser stimulation (TILS) is a promising intervention for non-invasively modulating CCO in the brain. TILS of the human prefrontal cortex directly causes CCO photo-oxidation, which is associated with increased cerebral oxygenation and improved cognition.</p>
</sec>
<sec id="sec2001">
<title>Methods</title>
<p>This experiment aimed to map the duration of action of <italic>in vivo</italic> PBM on CCO activity in discrete neuroanatomic locations within rat brains up to 4&#x2009;weeks after a single TILS session (50&#x2009;s, 1064&#x2009;nm CW, 250&#x2009;mW/cm<sup>2</sup>). Control brains from rats treated with a sham session without TILS (laser off) were compared to brains from TILS-treated rats that were collected 1&#x2009;day, 2&#x2009;weeks, or 4&#x2009;weeks post-TILS. Cryostat sections of the 36 collected brains were processed using quantitative enzyme histochemistry and digitally imaged. Densitometric readings of 28 regions of interest were recorded and converted to CCO activity units of oxygen utilization using calibration standards. Data analysis (ANCOVA) compared each laser-treated group to sham with whole-brain average as a covariate.</p>
</sec>
<sec id="sec3001">
<title>Results</title>
<p>The prefrontal infralimbic cortex showed the earliest significant increase in CCO activity between 1-day post-TILS and sham groups, which continued elevated for 2&#x2013;4&#x2009;weeks post-TILS. Significant differences in CCO activity between 2-weeks and sham groups were also found in the lateral septum, accumbens core, CA3 of the hippocampus, and the molecular layer of the hippocampus. The medial amygdala showed a significant decrease in CCO activity between 4-weeks and sham. Further analyses showed significant inter-regional CCO activity correlations among the brain regions as the result of TILS, with the most pronounced changes at 4-weeks post-stimulation.</p>
</sec>
<sec id="sec4001">
<title>Discussion</title>
<p>The time course of changes in CCO activity and network connectivity suggested that TILS caused different neuroplasticity types of bioenergetic changes at different time scales, depending on brain region and its depth from the cortex. In conclusion, this controlled CCO histochemical study demonstrated a long-lasting duration of action of PBM in the rat brain.</p>
</sec>
</abstract>
<kwd-group>
<kwd><italic>in vivo</italic> photobiomodulation</kwd>
<kwd>transcranial infrared laser stimulation</kwd>
<kwd>brain cytochrome c oxidase</kwd>
<kwd>hormesis</kwd>
<kwd>prefrontal cortex</kwd>
<kwd>neuroenergetics</kwd>
<kwd>enzyme histochemistry</kwd>
<kwd>low-level laser therapy</kwd>
</kwd-group>
<counts>
<fig-count count="9"/>
<table-count count="3"/>
<equation-count count="0"/>
<ref-count count="44"/>
<page-count count="12"/>
<word-count count="8042"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Neuroenergetics and Brain Health</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec sec-type="intro" id="sec1">
<title>Introduction</title>
<p>Cytochrome-c-oxidase (CCO) is a mitochondrial enzyme that reduces oxygen to water in the electron transport chain. This leads to increased oxidative phosphorylation of adenosine triphosphate (ATP) that promotes aerobic bioenergetic activity (<xref ref-type="bibr" rid="ref16">Hatefi, 1985</xref>). Cognitive performance is associated with aerobic bioenergetic activity in both animal and human studies (<xref ref-type="bibr" rid="ref22">Messier, 2004</xref>; <xref ref-type="bibr" rid="ref15">Hatchard et al., 2014</xref>). Neuronal bioenergetic activity is highly dependent on the activity of CCO (<xref ref-type="bibr" rid="ref43">Wong-Riley, 1989</xref>). CCO is the major intracellular acceptor of light in the red to near-infrared wavelengths (<xref ref-type="bibr" rid="ref20">Karu, 1999</xref>; <xref ref-type="bibr" rid="ref31">Rojas and Gonzalez-Lima, 2011</xref>). In rat models, photobiomodulation (PBM; <xref ref-type="bibr" rid="ref1">Anders et al., 2015</xref>) has been shown to improve oxygenation of the prefrontal cortex (<xref ref-type="bibr" rid="ref30">Rojas et al., 2012</xref>) as well as the whole brain (<xref ref-type="bibr" rid="ref33">Rojas et al., 2008</xref>). PBM increases ATP synthesis by mitochondria, promoting an increase in energy metabolism (<xref ref-type="bibr" rid="ref32">Rojas and Gonzalez-Lima, 2013</xref>; <xref ref-type="bibr" rid="ref10">Dole et al., 2023</xref>) and modifying multiple metabolic pathways revealed by molecular metabolomics of the rat brain (<xref ref-type="bibr" rid="ref11">Dos Santos Cardoso et al., 2021</xref>).</p>
<p>Transcranial infrared laser stimulation (TILS) is a type of <italic>in vivo</italic> PBM that involves the application of directional low-power and high-fluence monochromatic 1,064&#x2009;nm infrared light to the surface of the head. A portion of this light penetrates the skull and is absorbed by the chromophores in CCO, causing a direct photonic oxidation of CCO that is not mediated by a thermal effect (<xref ref-type="bibr" rid="ref40">Wang et al., 2022</xref>). For example, four recent sham-controlled studies have confirmed that <italic>in vivo</italic> oxidation of CCO is a direct photonic action of TILS administration to the human prefrontal cortex (<xref ref-type="bibr" rid="ref42">Wang et al., 2017</xref>, <xref ref-type="bibr" rid="ref41">2018</xref>; <xref ref-type="bibr" rid="ref27">Pruitt et al., 2020</xref>; <xref ref-type="bibr" rid="ref34">Saucedo et al., 2021</xref>). This supports the utility of a PBM method like TILS, which directly oxidizes CCO, in modifying brain bioenergetic capacity.</p>
<p>While many studies have investigated the ability of TILS to modulate CCO in the brain, the temporal duration of TILS effects on neural CCO activity is currently unknown. Studies on the effects of a single session of TILS in human subjects have revealed enhancement of cognitive function in the domains of processing speed, sustained attention, executive function, working memory and category learning (<xref ref-type="bibr" rid="ref3">Barrett and Gonzalez-Lima, 2013</xref>; <xref ref-type="bibr" rid="ref12">Gonzalez-Lima and Barrett, 2014</xref>; <xref ref-type="bibr" rid="ref4">Blanco et al., 2015</xref>, <xref ref-type="bibr" rid="ref5">2017</xref>). Notably, multiple weeks of TILS treatment in human subjects have further shown improvements in reaction time and working memory (<xref ref-type="bibr" rid="ref36">Vargas et al., 2017</xref>). In aged rat models, repeated TILS treatments produced beneficial brain bioenergetic effects by reversing the effects of aging on CCO activity (<xref ref-type="bibr" rid="ref9">Cardoso et al., 2022</xref>). Prior studies that examine the behavioral and neurophysiological effects of TILS have focused on the time period during or immediately following TILS treatment (<xref ref-type="bibr" rid="ref17">Holmes et al., 2019</xref>; <xref ref-type="bibr" rid="ref39">Wang et al., 2019</xref>). Because of this, the duration of action of a single administration of TILS is not known.</p>
<p>This study aims to histochemically quantify the duration of rat brain CCO activity in cortical and subcortical regions of interest (ROIs) over 4&#x2009;weeks following a single TILS administration. Based on published findings, we hypothesized that rats in groups that receive TILS would show modified levels of CCO activity when compared to rats that receive a sham procedure (<xref ref-type="bibr" rid="ref30">Rojas et al., 2012</xref>). We further hypothesized that CCO activity changes in key ROIs such as the prefrontal cortex would be found 1&#x2009;day after stimulation, with longer-lasting changes in CCO activity at 2 and 4&#x2009;weeks after TILS.</p>
</sec>
<sec sec-type="materials|methods" id="sec2">
<title>Materials and methods</title>
<sec id="sec3">
<title>Animals</title>
<p>The subjects of the present study were 47 male Sprague&#x2013;Dawley rats (sham <italic>n</italic>&#x2009;=&#x2009;9, TILS-treated <italic>n</italic>&#x2009;=&#x2009;27, homogenate paste <italic>n</italic>&#x2009;=&#x2009;10, light distribution <italic>n</italic>&#x2009;=&#x2009;1). Male rats were chosen to preclude the need for estrous cycle testing. An albino strain was used to eliminate pigmentation as a potential barrier to transcranial infrared light penetration. All rats were 8&#x2009;weeks old and weighed an average of 250 grams at the time of TILS or sham administration. Food was provided <italic>ad libitum</italic> throughout the experimental period. The animals were pair-housed at a temperature of 21&#x2009;&#x00B1;&#x2009;2&#x00B0;C with a 12&#x2009;h light/dark cycle. All procedures were approved by the Institutional Animal Care and Use Committee at the University of Texas at Austin. Frozen brain tissue was processed and analyzed at the University of Texas at Austin, following all institutional laboratory safety guidelines.</p>
</sec>
<sec id="sec4">
<title>Laser treatment</title>
<p>Beginning 1&#x2009;week before the TILS protocol, all subjects were handled daily to habituate them to the one-minute immobilization needed for laser stimulation. Each rat was assigned to one of three cohorts consisting of 12 rats. Three rats in each cohort were randomly assigned to the sham control condition; the remaining nine rats in each cohort were divided into three treatment groups, which determined when they were decapitated after treatment. All rats were manually immobilized without anesthesia for 1&#x2009;min, during which the rats in the treatment groups received 50&#x2009;s of stimulation from a laser diode with a measured power output of 3.4&#x2009;W, an irradiance of 250&#x2009;mW/cm<sup>2</sup>, a wavelength of 1,064&#x2009;nm, and an energy density of 12.5&#x2009;J/cm<sup>2</sup>. We used a continuous wave (CW) laser, and the irradiance (250&#x2009;mW/cm<sup>2</sup>) was the top-hat laser output measured at the head surface with a photometer (Newport model 1919-R power meter, Newport model 918D-SL photodiode detector). The same laser device, wavelength and irradiance used for our TILS studies in humans was used in the rats (HD Laser, Cell Gen Therapeutics, Dallas, Texas, USA). But a shorter exposure time period when compared to human subjects was warranted due to relatively small size of the rat brain as well as the thinner bones of the rat skull. Both of these factors increased the quantity of penetrating light from the TILS treatment. The laser diode was positioned posterior to the rats&#x2019; eyes to avoid unintentional eye damage. We chose a single irradiation point centered at the interaural line on the top of the rat head with an area of 1&#x2009;cm<sup>2</sup> (<xref rid="fig1" ref-type="fig">Figure 1</xref>) to target a majority of the brain. Rats in the sham control group did not receive laser stimulation, but were handled and restrained in the same way and for the same one-minute duration as the rats in the TILS treatment groups. All rats in the sham control group and the one-day group were decapitated 1&#x2009;day after the sham procedure/TILS treatment. All rats in the 2-weeks group were decapitated 2&#x2009;weeks after TILS treatment, and all rats in the four-weeks group were decapitated 4&#x2009;weeks after TILS treatment. After decapitation, all brains were quickly extracted and immediately frozen for subsequent cryostat sectioning.</p>
<fig position="float" id="fig1">
<label>Figure 1</label>
<caption>
<p>Diagram of laser irradiation point on the scalp centered between the ears.</p>
</caption>
<graphic xlink:href="fnins-17-1243527-g001.tif"/>
</fig>
</sec>
<sec id="sec5">
<title>Quantitative histochemistry of brain cytochrome c oxidase</title>
<p>Coronal sections of the brain (40&#x2009;&#x03BC;m thick) were obtained using a Reichert-Jung cryostat at &#x2212;20&#x00B0;C and processed for subsequent CCO enzyme histochemistry, following the quantitative method previously described in detail by <xref ref-type="bibr" rid="ref14">Gonzalez-Lima and Cada (1998)</xref>. All brains were processed in this way, with the exception of one brain from the four-week post-TILS decapitation group, which had significant tissue damage due to desiccation while in frozen storage. Calibration slides were prepared with frozen rat brain paste homogenate sectioned into 10, 20, 40, 60, and 80&#x2009;&#x03BC;m thick sections. Spectrophotometry of each paste homogenate served to quantify calibration standards of CCO activity units. Slides with these quantified brain paste homogenate sections were included with each CCO staining batch as calibration standards. The slides were fixed for 5&#x2009;min with 0.5% vol/vol glutaraldehyde and then were rinsed three times in 0.1&#x2009;M phosphate buffer with 10% wt/vol sucrose (pH 7.6). Slides were pre-incubated in a solution containing 275&#x2009;mg/L cobalt chloride, 10% wt/vol sucrose and 0.5% vol/vol dimethyl sulfoxide dissolved in Tris buffer (pH 7.6). For histochemical staining, slides were then incubated in the dark at 37&#x00B0;C for 1&#x2009;h in a continuously-stirred solution containing 350&#x2009;mg diaminobenzidine tetrahydrochloride, 35&#x2009;g sucrose, 52.5&#x2009;mg cytochrome c and 14&#x2009;mg catalase dissolved in 700&#x2009;ml of oxygen-saturated 0.1&#x2009;M phosphate buffer (pH 7.6). Immediately after incubation, the slides were dehydrated in a series of ethanol baths increasing from 30 to 100% vol/vol ethanol. Slides were then cleaned with xylene, and finally coverslips were applied using Permount.</p>
<p>High-resolution images of each section were captured using a high-precision, stable, and uniform illuminator, and digital camera (<xref ref-type="bibr" rid="ref9">Cardoso et al., 2022</xref>). The density of CCO histochemical staining of these brain section images were analyzed with the image analysis software ImageJ. Optical density (OD) readings were obtained from 28 brain ROIs (<xref rid="fig2" ref-type="fig">Figure 2</xref>) as defined in the rat brain atlas of <xref ref-type="bibr" rid="ref25">Paxinos and Watson (2006)</xref>: primary motor cortex (M1), secondary motor cortex (M2), cingulate cortex (CG1), prelimbic cortex, and infralimbic cortex at Bregma 2.2&#x2009;mm; striatum, lateral septum (LS), medial septum (MS), accumbens shell, and accumbens core at Bregma 0.7&#x2009;mm; posterior cingulate cortex, basolateral amygdala (AB), central amygdala (ACe), and medial amygdala (AMe) at Bregma &#x2212;2.12&#x2009;mm; field CA1 of the hippocampus, field CA3 of the hippocampus, molecular layer of the hippocampus, dentate gyrus (DG), posterior parietal cortex, perirhinal cortex (PRh), mediodorsal nucleus of the thalamus (MD), lateral habenula (LHb), and medial habenula (MHb) at Bregma &#x2212;2.80&#x2009;mm; periaqueductal gray (PAG), superior colliculus, medial geniculate nucleus (MG), Edinger-Westphal nucleus, and raphe nucleus at Bregma &#x2212;5.80&#x2009;mm. These ROIs were chosen to include a robust distribution of both anterior-to-posterior coordinates and cortical vs. subcortical regions throughout the entire rat brain.</p>
<fig position="float" id="fig2">
<label>Figure 2</label>
<caption>
<p>Rat brain ROIs from CCO-stained sections used in this study. Coronal sections at 5 Bregma levels distributed throughout the entire rat brain were histochemically stained for CCO enzymatic activity. Darker staining means greater CCO activity. Neuroanatomic ROIs are labeled. Anterior&#x2013;posterior coordinates from the Bregma landmark are noted at the top of each of the images. Selected sections exhibited high quality of tissue integrity after sectioning, staining, and image capture.</p>
</caption>
<graphic xlink:href="fnins-17-1243527-g002.tif"/>
</fig>
</sec>
<sec id="sec6">
<title>Correlation between histochemical staining and fresh brain tissue CCO activity measured biochemically</title>
<p>For the biochemical assay, we used fresh unfixed brain homogenate paste from 10 additional rats and measured CCO activity using spectrophotometry, as described in detail before (<xref ref-type="bibr" rid="ref14">Gonzalez-Lima and Cada, 1998</xref>). We made 10 batches of CCO staining that were correlated with the biochemical assay values. Each batch had 24 tissue sections with the spectrophotometrically measured CCO activity. The CCO activity correlation between the 240 fresh tissue samples and histochemically stained sections in the 10 batches yielded a mean regression coefficient of 0.97 (standard deviation 0.014, minimum 0.95, maximum 0.99). This served to confirm that the CCO activity measured by enzyme histochemistry after a 5-min fixation step with 0.5% glutaraldehyde was highly correlated with CCO activity measured by spectrophotometry in fresh unfixed tissue, as previously demonstrated (<xref ref-type="bibr" rid="ref14">Gonzalez-Lima and Cada, 1998</xref>).</p>
</sec>
<sec id="sec7">
<title>Statistical analysis</title>
<p>To account for potential variances in staining between brain sections of different staining batches, mean optical density (OD) of CCO-stained brain homogenate paste standards were recorded. Regression calibration curves were calculated for each batch between each homogenate brain paste standard section thickness and its spectrophotometrically-measured CCO enzymatic activity level. The mean OD measured histochemically in each ROI was converted to CCO enzymatic activity units (&#x03BC;mol of cytochrome c oxidized/min/g of wet tissue weight) using the regression curve calculated for each batch. Descriptive statistics were then calculated. All statistical analyses were performed using the jamovi open access statistical analysis software (<xref ref-type="bibr" rid="ref35">The jamovi project, 2022</xref>). Statistical significance was set at <italic>p</italic>&#x2009;&#x003C;&#x2009;0.05, two-tailed for all comparisons.</p>
<p>A series of analyses of covariance (ANCOVAs) compared CCO activity between treatment and sham groups in each brain ROI, using the whole brain average as a covariate. For each ROI, three ANCOVAs were performed, comparing 1-day to sham, 2-weeks to sham, and 4-weeks to sham. By averaging the CCO activity of all regions within each Bregma level, analyses of variance (ANOVAs) were used to examine group effects by Bregma level. Partial correlations of CCO activity between each ROI were computed for each group, controlling for whole brain mean, as previously described (<xref ref-type="bibr" rid="ref9">Cardoso et al., 2022</xref>). The number of significant partial correlations in each post-TILS group was compared to the number of significant partial correlations in the sham group.</p>
<p>Almost the entire dorsal surface of the rat brain was irradiated with light during TILS treatment. Amount of light absorbed from TILS varies between ROIs with differences in distance from the site of stimulation. To assess for any differential TILS effects on cortical and subcortical regions of the brain, each brain ROI was categorized as either cortical or subcortical. Separate ANOVAs were conducted to evaluate any significant group mean differences between cortical and subcortical regions. Brain regions of interest were categorized by the approximate dorsoventral depth of optical density readings, measured from the dorsal surface of the cortex (<xref ref-type="bibr" rid="ref25">Paxinos and Watson, 2006</xref>). Each ROI was categorized into one of 7 groups based on dorsoventral depth. Linear regression analysis with group and dorsoventral depth as factors assessed for any significant association between depth of brain ROIs and CCO activity. Dorsoventral depth and categorization of each brain ROI are presented in <xref rid="tab1" ref-type="table">Table 1</xref>.</p>
<table-wrap position="float" id="tab1">
<label>Table 1</label>
<caption>
<p>Categorization of each brain ROI by cortical or subcortical location and dorsoventral depth.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th/>
<th align="center" valign="top">Cortical or subcortical</th>
<th align="center" valign="top">Dorsoventral depth</th>
<th align="center" valign="top">Depth category</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="bottom">M1</td>
<td align="center" valign="bottom">Cortical</td>
<td align="center" valign="bottom">1.2&#x2009;mm</td>
<td align="center" valign="bottom">1&#x2013;1.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">M2</td>
<td align="center" valign="bottom">Cortical</td>
<td align="center" valign="bottom">1&#x2009;mm</td>
<td align="center" valign="bottom">1&#x2013;1.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">CG1</td>
<td align="center" valign="bottom">Cortical</td>
<td align="center" valign="bottom">2&#x2009;mm</td>
<td align="center" valign="bottom">2&#x2013;2.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Prelimbic</td>
<td align="center" valign="bottom">Cortical</td>
<td align="center" valign="bottom">3.2&#x2009;mm</td>
<td align="center" valign="bottom">3&#x2013;3.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Infralimbic</td>
<td align="center" valign="bottom">Cortical</td>
<td align="center" valign="bottom">4.3&#x2009;mm</td>
<td align="center" valign="bottom">4&#x2013;4.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Striatum</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">5&#x2009;mm</td>
<td align="center" valign="bottom">5&#x2013;5.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">LS</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">4.6&#x2009;mm</td>
<td align="center" valign="bottom">4&#x2013;4.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">MS</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">5.4&#x2009;mm</td>
<td align="center" valign="bottom">5&#x2013;5.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Accumbens shell</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">6.8&#x2009;mm</td>
<td align="center" valign="bottom">6&#x2013;6.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Accumbens core</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">6.9&#x2009;mm</td>
<td align="center" valign="bottom">6&#x2013;6.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Posterior cingulate</td>
<td align="center" valign="bottom">Cortical</td>
<td align="center" valign="bottom">1.4&#x2009;mm</td>
<td align="center" valign="bottom">1&#x2013;1.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">AB</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">7.8&#x2009;mm</td>
<td align="center" valign="bottom">7&#x2013;8.2&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">ACe</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">7.4&#x2009;mm</td>
<td align="center" valign="bottom">7&#x2013;8.2&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">AMe</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">8.2&#x2009;mm</td>
<td align="center" valign="bottom">7&#x2013;8.2&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">CA1</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">2.2&#x2009;mm</td>
<td align="center" valign="bottom">2&#x2013;2.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">CA3</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">3&#x2009;mm</td>
<td align="center" valign="bottom">3&#x2013;3.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Molecular layer</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">2.8&#x2009;mm</td>
<td align="center" valign="bottom">2&#x2013;2.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">DG</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">3.4&#x2009;mm</td>
<td align="center" valign="bottom">3&#x2013;3.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Posterior parietal</td>
<td align="center" valign="bottom">Cortical</td>
<td align="center" valign="bottom">1&#x2009;mm</td>
<td align="center" valign="bottom">1&#x2013;1.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">PRh</td>
<td align="center" valign="bottom">Cortical</td>
<td align="center" valign="bottom">6.8&#x2009;mm</td>
<td align="center" valign="bottom">6&#x2013;6.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">MD</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">5.2&#x2009;mm</td>
<td align="center" valign="bottom">5&#x2013;5.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">LHb</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">4.8&#x2009;mm</td>
<td align="center" valign="bottom">4&#x2013;4.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">MHb</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">4.7&#x2009;mm</td>
<td align="center" valign="bottom">4&#x2013;4.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">PAG</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">5&#x2009;mm</td>
<td align="center" valign="bottom">5&#x2013;5.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Superior colliculus</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">3.2&#x2009;mm</td>
<td align="center" valign="bottom">3&#x2013;3.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">MG</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">5.2&#x2009;mm</td>
<td align="center" valign="bottom">5&#x2013;5.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Edinger Westphal</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">6&#x2009;mm</td>
<td align="center" valign="bottom">6&#x2013;6.9&#x2009;mm</td>
</tr>
<tr>
<td align="left" valign="bottom">Raphe</td>
<td align="center" valign="bottom">Subcortical</td>
<td align="center" valign="bottom">6.2&#x2009;mm</td>
<td align="center" valign="bottom">6&#x2013;6.9&#x2009;mm</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p>Frequency of ROIs in each cortical or subcortical category: cortical (<italic>n</italic>&#x2009;=&#x2009;8), subcortical (<italic>n</italic>&#x2009;=&#x2009;20). Frequency of ROIs in each depth category: 1&#x2013;1.9&#x2009;mm (<italic>n</italic>&#x2009;=&#x2009;4), 2&#x2013;2.9&#x2009;mm (<italic>n</italic>&#x2009;=&#x2009;3), 3&#x2013;3.9&#x2009;mm (<italic>n</italic>&#x2009;=&#x2009;4), 4&#x2013;4.9&#x2009;mm (<italic>n</italic>&#x2009;=&#x2009;4), 5&#x2013;5.9&#x2009;mm (<italic>n</italic>&#x2009;=&#x2009;5), 6&#x2013;6.9&#x2009;mm (<italic>n</italic>&#x2009;=&#x2009;5), 7&#x2013;8.2&#x2009;mm (<italic>n</italic>&#x2009;=&#x2009;3).</p>
</table-wrap-foot>
</table-wrap>
</sec>
</sec>
<sec sec-type="results" id="sec8">
<title>Results</title>
<sec id="sec9">
<title>Whole brain CCO activity in the TILS groups versus sham</title>
<p>There were no significant differences in the whole brain CCO activity in the TILS groups versus the sham. Whole brain means of CCO activity units showed a small trend to increase as a function of time after TILS: group 1 (sham)&#x2009;=&#x2009;164, group 2 (1-day)&#x2009;=&#x2009;165, group 3 (2-weeks)&#x2009;=&#x2009;179, group 4 (4-weeks)&#x2009;=&#x2009;186. However, an ANOVA between the four groups did not show significant whole brain mean group differences (<italic>p</italic>&#x2009;=&#x2009;0.277). Similarly, individual group comparisons with ANOVA did not show any significant differences: group 1 vs. 2 (<italic>p</italic>&#x2009;=&#x2009;0.873), group 1 vs. 3 (<italic>p</italic>&#x2009;=&#x2009;0.301), group 1 vs. 4 (<italic>p</italic>&#x2009;=&#x2009;0.200).</p>
</sec>
<sec id="sec10">
<title>Duration of action of TILS on regional mean CCO activity</title>
<p>The group means and standard errors for each brain ROI are presented in <xref rid="tab2" ref-type="table">Table 2</xref>. Three ANCOVAs were conducted to compare regional mean CCO activity between each post-TILS group to the sham group for all ROIs, using the whole brain average as a covariate. Regions showing significant elevation in CCO activity are visualized in the top row of <xref rid="fig3" ref-type="fig">Figure 3</xref>, and regions showing significant reduction in CCO activity are visualized in the bottom row of <xref rid="fig3" ref-type="fig">Figure 3</xref>. In an ANCOVA comparing the 1-day post-TILS group to the sham group, the prefrontal infralimbic cortex showed a significant mean increase in CCO activity in the 1-day post-TILS group compared to sham (<italic>p</italic>&#x2009;=&#x2009;0.04). The infralimbic cortex also showed a significant mean increase in CCO activity in the 2-weeks post-TILS group compared to sham (<italic>p</italic>&#x2009;=&#x2009;0.023). Other ROIs that displayed a significant increase in CCO activity in the 2-weeks post-TILS group compared to the sham group included the LS (<italic>p</italic>&#x2009;=&#x2009;0.015) and the accumbens core (<italic>p</italic>&#x2009;=&#x2009;0.017). CCO activity in both CA3 (p&#x2009;=&#x2009;0.02), and the molecular layer of the hippocampus (<italic>p</italic>&#x2009;=&#x2009;0.009) were significantly reduced in the 2-weeks post-TILS group compared to sham. When comparing CCO activity in the four-weeks post-TILS group to sham, the AMe was the only ROI to demonstrate a significant change from the sham (<italic>p</italic>&#x2009;=&#x2009;0.036) with a significant decrease in CCO activity.</p>
<table-wrap position="float" id="tab2">
<label>Table 2</label>
<caption>
<p>Means and standard errors of cytochrome c oxidase activity (&#x03BC;mol of cytochrome c oxidized/min/g of wet tissue weight) of all ROIs from sham, 1-day, 2-weeks, and 4-weeks groups.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="center" valign="top" colspan="5">Mean&#x2009;&#x00B1;&#x2009;SE</th>
</tr>
<tr>
<th/>
<th align="center" valign="top">Sham (<italic>n</italic>&#x2009;=&#x2009;9)</th>
<th align="center" valign="top">1-day (<italic>n</italic>&#x2009;=&#x2009;9)</th>
<th align="center" valign="top">2-weeks (<italic>n</italic>&#x2009;=&#x2009;9)</th>
<th align="center" valign="top">4-weeks (<italic>n</italic>&#x2009;=&#x2009;8)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="bottom">M1</td>
<td align="center" valign="bottom">149&#x2009;&#x00B1;&#x2009;12.6</td>
<td align="center" valign="bottom">147&#x2009;&#x00B1;&#x2009;11.8</td>
<td align="center" valign="bottom">159&#x2009;&#x00B1;&#x2009;8.51</td>
<td align="center" valign="bottom">154&#x2009;&#x00B1;&#x2009;7.32</td>
</tr>
<tr>
<td align="left" valign="bottom">M2</td>
<td align="center" valign="bottom">144&#x2009;&#x00B1;&#x2009;12.8</td>
<td align="center" valign="bottom">140&#x2009;&#x00B1;&#x2009;8.36</td>
<td align="center" valign="bottom">156&#x2009;&#x00B1;&#x2009;8.45</td>
<td align="center" valign="bottom">141&#x2009;&#x00B1;&#x2009;11.0</td>
</tr>
<tr>
<td align="left" valign="bottom">CG1</td>
<td align="center" valign="bottom">145&#x2009;&#x00B1;&#x2009;12.4</td>
<td align="center" valign="bottom">145&#x2009;&#x00B1;&#x2009;7.59</td>
<td align="center" valign="bottom">152&#x2009;&#x00B1;&#x2009;4.03</td>
<td align="center" valign="bottom">159&#x2009;&#x00B1;&#x2009;8.80</td>
</tr>
<tr>
<td align="left" valign="bottom">Prelimbic</td>
<td align="center" valign="bottom">139&#x2009;&#x00B1;&#x2009;9.86</td>
<td align="center" valign="bottom">144&#x2009;&#x00B1;&#x2009;7.01</td>
<td align="center" valign="bottom">161&#x2009;&#x00B1;&#x2009;7.96</td>
<td align="center" valign="bottom">159&#x2009;&#x00B1;&#x2009;7.53</td>
</tr>
<tr>
<td align="left" valign="bottom">Infralimbic</td>
<td align="center" valign="bottom">127&#x2009;&#x00B1;&#x2009;8.90</td>
<td align="center" valign="bottom"><bold>138&#x2009;&#x00B1;&#x2009;7.50</bold></td>
<td align="center" valign="bottom"><bold>151&#x2009;&#x00B1;&#x2009;4.58</bold></td>
<td align="center" valign="bottom">151&#x2009;&#x00B1;&#x2009;8.69</td>
</tr>
<tr>
<td align="left" valign="bottom">Striatum</td>
<td align="center" valign="bottom">183&#x2009;&#x00B1;&#x2009;4.74</td>
<td align="center" valign="bottom">187&#x2009;&#x00B1;&#x2009;7.81</td>
<td align="center" valign="bottom">206&#x2009;&#x00B1;&#x2009;11.5</td>
<td align="center" valign="bottom">189&#x2009;&#x00B1;&#x2009;17.1</td>
</tr>
<tr>
<td align="left" valign="bottom">LS</td>
<td align="center" valign="bottom">156&#x2009;&#x00B1;&#x2009;7.82</td>
<td align="center" valign="bottom">170&#x2009;&#x00B1;&#x2009;8.20</td>
<td align="center" valign="bottom"><bold>185&#x2009;&#x00B1;&#x2009;7.88</bold></td>
<td align="center" valign="bottom">163&#x2009;&#x00B1;&#x2009;10.8</td>
</tr>
<tr>
<td align="left" valign="bottom">MS</td>
<td align="center" valign="bottom">123&#x2009;&#x00B1;&#x2009;4.86</td>
<td align="center" valign="bottom">120&#x2009;&#x00B1;&#x2009;7.95</td>
<td align="center" valign="bottom">150&#x2009;&#x00B1;&#x2009;11.1</td>
<td align="center" valign="bottom">123&#x2009;&#x00B1;&#x2009;7.66</td>
</tr>
<tr>
<td align="left" valign="bottom">Accumbens shell</td>
<td align="center" valign="bottom">169&#x2009;&#x00B1;&#x2009;11.1</td>
<td align="center" valign="bottom">187&#x2009;&#x00B1;&#x2009;12.2</td>
<td align="center" valign="bottom">193&#x2009;&#x00B1;&#x2009;8.94</td>
<td align="center" valign="bottom">175&#x2009;&#x00B1;&#x2009;12.5</td>
</tr>
<tr>
<td align="left" valign="bottom">Accumbens core</td>
<td align="center" valign="bottom">178&#x2009;&#x00B1;&#x2009;10.3</td>
<td align="center" valign="bottom">193&#x2009;&#x00B1;&#x2009;10.5</td>
<td align="center" valign="bottom"><bold>210&#x2009;&#x00B1;&#x2009;7.68</bold></td>
<td align="center" valign="bottom">197&#x2009;&#x00B1;&#x2009;19.0</td>
</tr>
<tr>
<td align="left" valign="bottom">Posterior cingulate</td>
<td align="center" valign="bottom">202&#x2009;&#x00B1;&#x2009;13.4</td>
<td align="center" valign="bottom">190&#x2009;&#x00B1;&#x2009;7.98</td>
<td align="center" valign="bottom">210&#x2009;&#x00B1;&#x2009;6.84</td>
<td align="center" valign="bottom">205&#x2009;&#x00B1;&#x2009;11.3</td>
</tr>
<tr>
<td align="left" valign="bottom">AB</td>
<td align="center" valign="bottom">159&#x2009;&#x00B1;&#x2009;12.6</td>
<td align="center" valign="bottom">168&#x2009;&#x00B1;&#x2009;4.97</td>
<td align="center" valign="bottom">166&#x2009;&#x00B1;&#x2009;8.14</td>
<td align="center" valign="bottom">186&#x2009;&#x00B1;&#x2009;9.56</td>
</tr>
<tr>
<td align="left" valign="bottom">ACe</td>
<td align="center" valign="bottom">143&#x2009;&#x00B1;&#x2009;9.51</td>
<td align="center" valign="bottom">141&#x2009;&#x00B1;&#x2009;5.29</td>
<td align="center" valign="bottom">146&#x2009;&#x00B1;&#x2009;7.12</td>
<td align="center" valign="bottom">158&#x2009;&#x00B1;&#x2009;9.89</td>
</tr>
<tr>
<td align="left" valign="bottom">AMe</td>
<td align="center" valign="bottom">141&#x2009;&#x00B1;&#x2009;9.86</td>
<td align="center" valign="bottom">145&#x2009;&#x00B1;&#x2009;7.94</td>
<td align="center" valign="bottom">145&#x2009;&#x00B1;&#x2009;4.02</td>
<td align="center" valign="bottom"><bold>127&#x2009;&#x00B1;&#x2009;7.63</bold></td>
</tr>
<tr>
<td align="left" valign="bottom">CA1</td>
<td align="center" valign="bottom">120&#x2009;&#x00B1;&#x2009;6.27</td>
<td align="center" valign="bottom">121&#x2009;&#x00B1;&#x2009;5.98</td>
<td align="center" valign="bottom">115&#x2009;&#x00B1;&#x2009;4.67</td>
<td align="center" valign="bottom">131&#x2009;&#x00B1;&#x2009;6.82</td>
</tr>
<tr>
<td align="left" valign="bottom">CA3</td>
<td align="center" valign="bottom">145&#x2009;&#x00B1;&#x2009;4.74</td>
<td align="center" valign="bottom">130&#x2009;&#x00B1;&#x2009;6.47</td>
<td align="center" valign="bottom"><bold>133&#x2009;&#x00B1;&#x2009;5.05</bold></td>
<td align="center" valign="bottom">152&#x2009;&#x00B1;&#x2009;7.35</td>
</tr>
<tr>
<td align="left" valign="bottom">Molecular layer</td>
<td align="center" valign="bottom">222&#x2009;&#x00B1;&#x2009;11.4</td>
<td align="center" valign="bottom">197&#x2009;&#x00B1;&#x2009;9.12</td>
<td align="center" valign="bottom"><bold>207&#x2009;&#x00B1;&#x2009;8.76</bold></td>
<td align="center" valign="bottom">220&#x2009;&#x00B1;&#x2009;13.5</td>
</tr>
<tr>
<td align="left" valign="bottom">DG</td>
<td align="center" valign="bottom">213&#x2009;&#x00B1;&#x2009;10.2</td>
<td align="center" valign="bottom">191&#x2009;&#x00B1;&#x2009;11.1</td>
<td align="center" valign="bottom">206&#x2009;&#x00B1;&#x2009;8.46</td>
<td align="center" valign="bottom">236&#x2009;&#x00B1;&#x2009;9.80</td>
</tr>
<tr>
<td align="left" valign="bottom">Posterior parietal</td>
<td align="center" valign="bottom">155&#x2009;&#x00B1;&#x2009;4.89</td>
<td align="center" valign="bottom">150&#x2009;&#x00B1;&#x2009;7.46</td>
<td align="center" valign="bottom">149&#x2009;&#x00B1;&#x2009;8.79</td>
<td align="center" valign="bottom">163&#x2009;&#x00B1;&#x2009;10.3</td>
</tr>
<tr>
<td align="left" valign="bottom">PRh</td>
<td align="center" valign="bottom">152&#x2009;&#x00B1;&#x2009;7.71</td>
<td align="center" valign="bottom">148&#x2009;&#x00B1;&#x2009;10.2</td>
<td align="center" valign="bottom">141&#x2009;&#x00B1;&#x2009;5.94</td>
<td align="center" valign="bottom">157&#x2009;&#x00B1;&#x2009;11.1</td>
</tr>
<tr>
<td align="left" valign="bottom">MD</td>
<td align="center" valign="bottom">157&#x2009;&#x00B1;&#x2009;10.9</td>
<td align="center" valign="bottom">156&#x2009;&#x00B1;&#x2009;8.29</td>
<td align="center" valign="bottom">148&#x2009;&#x00B1;&#x2009;6.70</td>
<td align="center" valign="bottom">160&#x2009;&#x00B1;&#x2009;6.10</td>
</tr>
<tr>
<td align="left" valign="bottom">LHb</td>
<td align="center" valign="bottom">182&#x2009;&#x00B1;&#x2009;10.1</td>
<td align="center" valign="bottom">178&#x2009;&#x00B1;&#x2009;15.0</td>
<td align="center" valign="bottom">191&#x2009;&#x00B1;&#x2009;6.54</td>
<td align="center" valign="bottom">207&#x2009;&#x00B1;&#x2009;10.3</td>
</tr>
<tr>
<td align="left" valign="bottom">MHb</td>
<td align="center" valign="bottom">207&#x2009;&#x00B1;&#x2009;11.0</td>
<td align="center" valign="bottom">198&#x2009;&#x00B1;&#x2009;14.5</td>
<td align="center" valign="bottom">222&#x2009;&#x00B1;&#x2009;15.9</td>
<td align="center" valign="bottom">230&#x2009;&#x00B1;&#x2009;10.6</td>
</tr>
<tr>
<td align="left" valign="bottom">PAG</td>
<td align="center" valign="bottom">167&#x2009;&#x00B1;&#x2009;12.1</td>
<td align="center" valign="bottom">159&#x2009;&#x00B1;&#x2009;6.51</td>
<td align="center" valign="bottom">193&#x2009;&#x00B1;&#x2009;17.8</td>
<td align="center" valign="bottom">219&#x2009;&#x00B1;&#x2009;22.3</td>
</tr>
<tr>
<td align="left" valign="bottom">Superior colliculus</td>
<td align="center" valign="bottom">204&#x2009;&#x00B1;&#x2009;13.9</td>
<td align="center" valign="bottom">193&#x2009;&#x00B1;&#x2009;5.79</td>
<td align="center" valign="bottom">226&#x2009;&#x00B1;&#x2009;22.5</td>
<td align="center" valign="bottom">259&#x2009;&#x00B1;&#x2009;25.5</td>
</tr>
<tr>
<td align="left" valign="bottom">MG</td>
<td align="center" valign="bottom">181&#x2009;&#x00B1;&#x2009;11.4</td>
<td align="center" valign="bottom">174&#x2009;&#x00B1;&#x2009;6.74</td>
<td align="center" valign="bottom">212&#x2009;&#x00B1;&#x2009;17.6</td>
<td align="center" valign="bottom">216&#x2009;&#x00B1;&#x2009;13.7</td>
</tr>
<tr>
<td align="left" valign="bottom">Edinger Westphal</td>
<td align="center" valign="bottom">198&#x2009;&#x00B1;&#x2009;12.7</td>
<td align="center" valign="bottom">184&#x2009;&#x00B1;&#x2009;15.1</td>
<td align="center" valign="bottom">210&#x2009;&#x00B1;&#x2009;29.4</td>
<td align="center" valign="bottom">249&#x2009;&#x00B1;&#x2009;23.7</td>
</tr>
<tr>
<td align="left" valign="bottom">Raphe</td>
<td align="center" valign="bottom">241&#x2009;&#x00B1;&#x2009;17.9</td>
<td align="center" valign="bottom">219&#x2009;&#x00B1;&#x2009;9.40</td>
<td align="center" valign="bottom">256&#x2009;&#x00B1;&#x2009;33.9</td>
<td align="center" valign="bottom">305&#x2009;&#x00B1;&#x2009;25.2</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p>Bold values denote ROIs with <italic>p</italic> value&#x2009;&#x2264;&#x2009;0.05 compared to sham in ANCOVA, using the whole brain average as a covariate.</p>
</table-wrap-foot>
</table-wrap>
<fig position="float" id="fig3">
<label>Figure 3</label>
<caption>
<p>Significant changes in CCO activity (&#x03BC;mol of cytochrome c oxidized/min/g of wet tissue weight) of 6 ROIs post-TILS treatment. Top row: significant increases; bottom row: significant decreases. CCO activity increases were noted in the infralimbic cortex of the 1-day post-TILS group compared to sham and from the 2-weeks post-TILS group to sham. Significant increases in CCO activity were also recorded in the lateral septum and accumbens core of the 2-weeks post-TILS group compared to sham. Decreases in CCO activity were recorded in the medial amygdala of the 4-weeks post-TILS group compared to sham. Significant decreases in CCO activity were also recorded in the CA3 and the molecular layer of the hippocampus of the 2-weeks post-TILS group compared to sham. &#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.05.</p>
</caption>
<graphic xlink:href="fnins-17-1243527-g003.tif"/>
</fig>
<p>An ANOVA comparing the between-group means of each Bregma level revealed a significant effect of group only in Bregma &#x2212;5.8 (<italic>p</italic>&#x2009;=&#x2009;0.029). ANOVAs that were conducted to assess for possible effects of group on cortical and subcortical CCO activity means revealed no significant effects, with a cortical <italic>p</italic>-value of 0.430 and a subcortical <italic>p</italic>-value of 0.329.</p>
</sec>
<sec id="sec11">
<title>Duration of action of TILS on inter-regional CCO activity correlations</title>
<p>Partial correlation matrices for the three post-TILS groups compared to sham assessed for any changes in the overall number of significant partial pairwise correlations between ROIs. Whole brain average was used as a covariate (<xref ref-type="bibr" rid="ref9">Cardoso et al., 2022</xref>). <xref rid="fig4" ref-type="fig">Figures 4</xref>&#x2013;<xref rid="fig7" ref-type="fig">7</xref> show heat color maps from each treatment condition, displaying Pearson&#x2019;s r values for each pairwise correlation between two ROIs. The red color indicates the presence of positive correlations, which increased as function of time after TILS (visualized as more red colors from <xref rid="fig4" ref-type="fig">Figures 4</xref> through <xref rid="fig7" ref-type="fig">7</xref>). Partial correlation analysis revealed 27 significant partial pairwise correlations between brain ROIs in the sham condition. When compared to sham, the 1-day post-TILS group displayed 31 significant pairwise partial correlations between ROIs that were not significant in the sham group. The 2-weeks post-TILS group displayed 23 significant pairwise partial correlations between ROIs that were not significant in the sham group. Finally, the 4-weeks post-TILS group exhibited 61 significant pairwise partial correlations between ROIs that were not significant in the sham group.</p>
<fig position="float" id="fig4">
<label>Figure 4</label>
<caption>
<p>Heat color map of Pearson&#x2019;s r values for each pairwise correlation between two ROIs in the sham group. Red indicates positive inter-regional correlations and blue indicates negative correlations. &#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.05. &#x002A;&#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.01. &#x002A;&#x002A;&#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.001.</p>
</caption>
<graphic xlink:href="fnins-17-1243527-g004.tif"/>
</fig>
<fig position="float" id="fig5">
<label>Figure 5</label>
<caption>
<p>Heat color map of Pearson&#x2019;s r values for each pairwise correlation between two ROIs in the 1-day group. Red indicates positive inter-regional correlations and blue indicates negative correlations. &#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;0.05. &#x002A;&#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.01. &#x002A;&#x002A;&#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.001. At 1-day post-TILS, there were 31 additional significant correlations that were not found in sham. Increased number of significant partial correlations over time post-stimulation suggests increased functional connectivity between brain ROIs.</p>
</caption>
<graphic xlink:href="fnins-17-1243527-g005.tif"/>
</fig>
<fig position="float" id="fig6">
<label>Figure 6</label>
<caption>
<p>Heat color map of Pearson&#x2019;s r values for each pairwise correlation between two ROIs in the 2-week group. Red indicates positive inter-regional correlations and blue indicates negative correlations. &#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.05. &#x002A;&#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.01. &#x002A;&#x002A;&#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.001. At 2-weeks post-TILS, there were 23 additional significant correlations that were not found in sham. Increased number of significant partial correlations over time post-stimulation suggests increased functional connectivity between brain ROIs.</p>
</caption>
<graphic xlink:href="fnins-17-1243527-g006.tif"/>
</fig>
<fig position="float" id="fig7">
<label>Figure 7</label>
<caption>
<p>Heat color map of Pearson&#x2019;s r values for each pairwise correlation between two ROIs in the 4-week group. Red indicates positive inter-regional correlations and blue indicates negative correlations. &#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.05. &#x002A;&#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.01. &#x002A;&#x002A;&#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.001. At 4-weeks post-TILS, there were 61 additional significant correlations that were not found in sham. Increased number of significant partial correlations over time post-stimulation suggests increased functional connectivity between brain ROIs.</p>
</caption>
<graphic xlink:href="fnins-17-1243527-g007.tif"/>
</fig>
</sec>
<sec id="sec12">
<title>Association between TILS and CCO activity depending on brain depth</title>
<p>The association between TILS effects on CCO activity and regional depth from the dorsal surface of the brain was assessed as a function of dorsoventral depth, treatment group classification, or both factors. Both Akaike information criterion (AIC) and Bayesian information criterion (BIC; <xref ref-type="bibr" rid="ref38">Vrieze, 2012</xref>) were used for each possible model. The best-fitting model, with the lowest AIC and BIC, was one containing both dorsoventral depth and group classification factors. The resulting linear regression using this best-fit model is in <xref rid="tab3" ref-type="table">Table 3</xref>. The estimated marginal means of each dorsoventral depth are represented in <xref rid="fig8" ref-type="fig">Figure 8</xref>. An R<sup>2</sup> of 0.919 and an overall model value of p of &#x003C;0.001 indicate that the variance in mean CCO activity at each dorsoventral depth can be explained by our explanatory variables, depth and treatment group. Comparisons of dorsoventral depth found no significant difference between 2 and 2.9&#x2009;mm below the dorsal surface of the brain and 1&#x2013;1.9&#x2009;mm below the dorsal surface (<italic>p</italic>&#x2009;=&#x2009;0.527). However, significant increases in CCO activity were found at 3&#x2013;3.9&#x2009;mm (<italic>p</italic>&#x2009;=&#x2009;0.002), 4&#x2013;4.9&#x2009;mm (<italic>p</italic>&#x2009;=&#x2009;0.002), and 6&#x2013;6.9&#x2009;mm (<italic>p</italic>&#x2009;&#x003C;&#x2009;0.001) below the dorsal surface of the brain, as well as a nonsignificant increase in activity at 5&#x2013;5.9&#x2009;mm below the surface (<italic>p</italic>&#x2009;=&#x2009;0.155). In contrast, there was a significant decrease in CCO activity at 7&#x2013;8.2&#x2009;mm below the dorsal surface (<italic>p</italic>&#x2009;=&#x2009;0.008).</p>
<table-wrap position="float" id="tab3">
<label>Table 3</label>
<caption>
<p>Linear regression of average cytochrome c oxidase activity (&#x03BC;mol of cytochrome c oxidized/min/g of wet tissue weight) with dorsoventral depth in mm and treatment group as factors.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="center" valign="top" colspan="7">Model fit measures</th>
</tr>
<tr>
<th colspan="3"></th>
<th align="center" valign="top" colspan="4">Overall model test</th>
</tr>
<tr>
<th align="left" valign="top">Model</th>
<th align="center" valign="top">R</th>
<th align="center" valign="top">R<sup>2</sup></th>
<th align="center" valign="top">F</th>
<th align="center" valign="top">df1</th>
<th align="center" valign="top">df2</th>
<th align="center" valign="top"><italic>p</italic></th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">1</td>
<td align="center" valign="top">0.959</td>
<td align="center" valign="top">0.919</td>
<td align="center" valign="top">22.8</td>
<td align="center" valign="top">9</td>
<td align="center" valign="top">18</td>
<td align="center" valign="top">&#x003C;&#x2009;0.001</td>
</tr>
</tbody>
</table>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top" colspan="5">Model Coefficients &#x2013; Mean CCO activity (&#x03BC;mol of cytochrome c oxidized/min/g of wet tissue weight)</th>
</tr>
<tr>
<th align="left" valign="top">Predictor</th>
<th align="center" valign="top">Estimate</th>
<th align="center" valign="top">SE</th>
<th align="center" valign="top"><italic>t</italic></th>
<th align="center" valign="top"><italic>p</italic></th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">Intercept<xref rid="tfn1" ref-type="table-fn"><sup>a</sup></xref></td>
<td align="center" valign="top">158.80</td>
<td align="center" valign="top">3.35</td>
<td align="center" valign="top">47.428</td>
<td align="center" valign="top">&#x003C;&#x2009;0.001</td>
</tr>
<tr>
<td align="left" valign="top" colspan="5">Depth in mm:</td>
</tr>
<tr>
<td align="left" valign="top">2&#x2013;2.9 &#x2013; 1&#x2013;1.9</td>
<td align="center" valign="top">&#x2212;2.56</td>
<td align="center" valign="top">3.96</td>
<td align="center" valign="top">&#x2212;0.645</td>
<td align="center" valign="top">0.527</td>
</tr>
<tr>
<td align="left" valign="top">3&#x2013;3.9 &#x2013; 1&#x2013;1.9</td>
<td align="center" valign="top">14.26</td>
<td align="center" valign="top">3.96</td>
<td align="center" valign="top">3.599</td>
<td align="center" valign="top">0.002</td>
</tr>
<tr>
<td align="left" valign="top">4&#x2013;4.9 &#x2013; 1&#x2013;1.9</td>
<td align="center" valign="top">14.17</td>
<td align="center" valign="top">3.96</td>
<td align="center" valign="top">3.576</td>
<td align="center" valign="top">0.002</td>
</tr>
<tr>
<td align="left" valign="top">5&#x2013;5.9 &#x2013; 1&#x2013;1.9</td>
<td align="center" valign="top">5.89</td>
<td align="center" valign="top">3.96</td>
<td align="center" valign="top">1.486</td>
<td align="center" valign="top">0.155</td>
</tr>
<tr>
<td align="left" valign="top">6&#x2013;6.9 &#x2013; 1&#x2013;1.9</td>
<td align="center" valign="top">32.87</td>
<td align="center" valign="top">3.96</td>
<td align="center" valign="top">8.296</td>
<td align="center" valign="top">&#x003C;&#x2009;0.001</td>
</tr>
<tr>
<td align="left" valign="top">7&#x2013;8.2 &#x2013; 1&#x2013;1.9</td>
<td align="center" valign="top">&#x2212;11.83</td>
<td align="center" valign="top">3.96</td>
<td align="center" valign="top">&#x2212;2.987</td>
<td align="center" valign="top">0.008</td>
</tr>
<tr>
<td align="left" valign="top" colspan="5">Group:</td>
</tr>
<tr>
<td align="left" valign="top">1&#x2009;day &#x2013; Sham</td>
<td align="center" valign="top">&#x2212;3.54</td>
<td align="center" valign="top">2.99</td>
<td align="center" valign="top">&#x2212;1.182</td>
<td align="center" valign="top">0.252</td>
</tr>
<tr>
<td align="left" valign="top">2&#x2009;weeks &#x2013; Sham</td>
<td align="center" valign="top">9.65</td>
<td align="center" valign="top">2.99</td>
<td align="center" valign="top">3.223</td>
<td align="center" valign="top">0.005</td>
</tr>
<tr>
<td align="left" valign="top">4&#x2009;weeks &#x2013; Sham</td>
<td align="center" valign="top">13.79</td>
<td align="center" valign="top">2.99</td>
<td align="center" valign="top">4.603</td>
<td align="center" valign="top">&#x003C;&#x2009;0.001</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn1"><label>a</label><p>Represents reference level.</p></fn>
</table-wrap-foot>
</table-wrap>
<fig position="float" id="fig8">
<label>Figure 8</label>
<caption><p>Biphasic hormetic trend in mean CCO activity: increasing CCO activity with increasing dorsoventral depths 1&#x2013;6.9&#x2009;mm, and decreasing CCO activity in dorsoventral depths greater than 7&#x2009;mm. Plot of estimated marginal means for dorsoventral depth from the dorsal surface of the brain (mm) from the linear regression versus mean cytochrome c oxidase activity (&#x03BC;mol of cytochrome c oxidized/min/g of wet tissue weight). &#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.05. &#x002A;&#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.01. &#x002A;&#x002A;&#x002A; indicates a <italic>p</italic>-value&#x2009;&#x003C;&#x2009;0.001. Error bars indicate 95% confidence intervals.</p>
</caption>
<graphic xlink:href="fnins-17-1243527-g008.tif"/>
</fig>
</sec>
<sec id="sec13">
<title>The dorsoventral biphasic CCO response to TILS does not parallel the decremental light distribution gradient in the brain</title><p>We measured in a freshly extracted brain from an additional rat that 8.5% of the irradiance applied at the dorsal brain surface reached the ventral surface. <xref rid="fig9" ref-type="fig">Figure 9</xref> shows a stereotaxic brain schematic to visualize that light distribution along the dorsoventral depth (mm) of the rat brain after TILS to the head surface (<xref rid="fig9" ref-type="fig">Figure 9A</xref>) is different than the corresponding CCO activity changes (<xref rid="fig9" ref-type="fig">Figure 9B</xref>). While ventral surfaces receive less light dose, the decremental light distribution gradient (<xref rid="fig9" ref-type="fig">Figure 9C</xref>) does not correspond to the biphasic CCO response to TILS (<xref rid="fig9" ref-type="fig">Figure 9D</xref>). The biphasic biological response consisted of opposite effects to high and low light doses. Following a characteristic hormetic dose&#x2013;response, CCO response increased as a function of decreasing light dose until reaching a peak response. After this point, a further decrease in light dose at the ventral surface caused CCO levels to drop below baseline (<xref rid="fig8" ref-type="fig">Figure 8</xref>). Therefore, these data are consistent with a true biological hormetic dose&#x2013;response of CCO activity to light dose, rather than simply a decreasing light distribution from the dorsal to the ventral surfaces of the brain.</p>
<fig position="float" id="fig9">
<label>Figure 9</label>
<caption><p>Schematic representation to visualize the light distribution and CCO activity through the dorsoventral depth (mm) of the brains of rats treated with TILS to the head surface. Our schematics are from a medial view of the rat brain (midsagittal plane) indicating the dorsoventral distance (depth from top brain surface) and anteroposterior distance (from the Bregma landmark on the skull) guided by coordinates verified with the stereotaxic atlas of <xref ref-type="bibr" rid="ref25">Paxinos and Watson (2006)</xref>. <bold>(A)</bold> Color gradient from red to white represents higher-to-lower level of light distribution. <bold>(B)</bold> Color gradient from red to white represents higher-to-lower CCO activity. <bold>(C)</bold> Linear function of light distribution along the dorsoventral depth. <bold>(D)</bold> Biphasic function of CCO activity changes in response to TILS. This figure illustrates that there is a biological hormetic dose&#x2013;response of CCO activity to TILS, rather than simply a decreasing effect of light distribution from the dorsal to the ventral surfaces of the brain.</p>
</caption>
<graphic xlink:href="fnins-17-1243527-g009.tif"/>
</fig>
</sec>
</sec>
<sec sec-type="discussions" id="sec14">
<title>Discussion</title><p>This sham-controlled study is the first to map the duration of action of <italic>in vivo</italic> PBM on cytochrome c oxidase (CCO). Our ANCOVA results demonstrated elevated CCO activity post-TILS in several brain ROIs. The infralimbic cortex displayed greater CCO activity at both 1-day and 2&#x2013;4&#x2009;weeks after TILS. This suggests a CCO upregulation in the infralimbic cortex after a single TILS treatment that appeared earlier than in other brain regions and that persisted for 2&#x2013;4&#x2009;weeks. Notably, the infralimbic cortex was the only cortical ROI to show a significant change in CCO activity after TILS, as well as the only ROI examined that exhibited a significant change 1&#x2009;day after TILS. Interestingly, the infralimbic cortex is the brain region with the greatest increase in CCO activity after associative learning, suggesting that it may have a higher capacity for metabolic neuroplasticity (<xref ref-type="bibr" rid="ref13">Gonzalez-Lima and Bruchey, 2004</xref>; <xref ref-type="bibr" rid="ref6">Bruchey and Gonzalez-Lima, 2008</xref>; <xref ref-type="bibr" rid="ref30">Rojas et al., 2012</xref>).</p>
<p>The neurobiological role of rat infralimbic cortex activity is of great behavioral significance for conditioned safety, as shown in many studies of fear extinction (<xref ref-type="bibr" rid="ref28">Quirk et al., 2006</xref>). In particular, <xref ref-type="bibr" rid="ref21">Kreutzmann et al. (2020)</xref> showed that temporary inactivation of the infralimbic cortex by muscimol during the behavioral fear expression test completely blocked the expression of conditioned safety. Furthermore, infralimbic cortex activity was required for the expression but not the acquisition of conditioned safety. This important study is consistent with our previous behavioral testing showing that improving CCO activity in the rat prefrontal cortex by photobiomodulation after fear extinction causes an improvement in the expression of conditioned safety tested 1&#x2009;day later (<xref ref-type="bibr" rid="ref30">Rojas et al., 2012</xref>). Furthermore, a single TILS session to the human prefrontal cortex causes significant reduction of fear in people with pathological fear (<xref ref-type="bibr" rid="ref44">Zaizar et al., 2023</xref>).</p>
<p>The rat infralimbic cortex is understood to be homologous to the human prefrontal cortex (<xref ref-type="bibr" rid="ref24">Ong&#x00FC;r and Price, 2000</xref>), which is the brain region typically targeted in TILS studies of human subjects (<xref ref-type="bibr" rid="ref3">Barrett and Gonzalez-Lima, 2013</xref>; <xref ref-type="bibr" rid="ref12">Gonzalez-Lima and Barrett, 2014</xref>; <xref ref-type="bibr" rid="ref4">Blanco et al., 2015</xref>, <xref ref-type="bibr" rid="ref5">2017</xref>; <xref ref-type="bibr" rid="ref36">Vargas et al., 2017</xref>; <xref ref-type="bibr" rid="ref42">Wang et al., 2017</xref>, <xref ref-type="bibr" rid="ref41">2018</xref>, <xref ref-type="bibr" rid="ref39">2019</xref>; <xref ref-type="bibr" rid="ref17">Holmes et al., 2019</xref>; <xref ref-type="bibr" rid="ref27">Pruitt et al., 2020</xref>; <xref ref-type="bibr" rid="ref34">Saucedo et al., 2021</xref>). This mapping study suggests that CCO activity in prefrontal cortex is more impacted by a single TILS treatment than other brain regions. The prefrontal cortex is also unique among all other brain regions in that it receives highly processed information from all major forebrain systems (<xref ref-type="bibr" rid="ref23">Miller et al., 2002</xref>).</p>
<p>Significant increases in CCO activity 2&#x2009;weeks after TILS were also found in other brain regions. The lateral septum (LS) and accumbens core displayed a non-significant elevation of CCO activity at 1&#x2009;day post-stimulation and a significant elevation in the 2-weeks post-TILS group. Since these two regions have subcortical neuroanatomic locations with greater dorsoventral depths compared to cortical regions, the LS and the accumbens core likely received somewhat less TILS light than cortical regions. Thus, it is possible that the LS and the accumbens core exhibited a delayed reaction to TILS. These regions are core components of the forebrain system associated with behaviorally rewarding functions, with major connections to the infralimbic cortex (<xref ref-type="bibr" rid="ref18">Hoover and Vertes, 2007</xref>; <xref ref-type="bibr" rid="ref26">Peters et al., 2009</xref>). Therefore, CCO increases in these regions may have followed in time as a result of the earlier metabolic neuroplasticity in the infralimbic cortex.</p>
<p>On the other hand, limbic regions in the hippocampus and amygdala showed opposite CCO effects to those seen in the forebrain reward system activated by TILS. Specifically, the CA3 sector and the molecular layer of the hippocampus exhibited a non-significant downward trend in CCO activity from sham in the 1-day post-TILS group. This CCO activity reduction demonstrated significance in the 2-weeks post-TILS group. The medial amygdala (AMe) showed a significant decrease in the 4-weeks group, but did not trend in either direction in the 1-day or 2-weeks post-TILS groups. These CCO decrements may also be related to the early TILS effect in the infralimbic cortex. There is consistent evidence in rat studies that increases in CCO and electrophysiological activity in the infralimbic cortex, such as after fear extinction learning, reduce the CCO and electrophysiological activity in the amygdala and hippocampus (<xref ref-type="bibr" rid="ref28">Quirk et al., 2006</xref>). Interestingly, we recently found that a single TILS administration that upregulates prefrontal CCO (<xref ref-type="bibr" rid="ref42">Wang et al., 2017</xref>) results in fear reduction in humans (<xref ref-type="bibr" rid="ref44">Zaizar et al., 2023</xref>). Together, the various regional changes in CCO activity suggest that TILS produced long-lasting effects in forebrain networks associated with the infralimbic cortex.</p>
<p>We previously conducted the first detailed brain mapping study of chronic laser effects on brain regional CCO activity (<xref ref-type="bibr" rid="ref9">Cardoso et al., 2022</xref>). Specifically, we used quantitative CCO histochemistry to map the differences in CCO activity of brain regions in healthy young (4&#x2009;months old) and aged (20&#x2009;months old) rats from control groups with sham stimulation and from treated groups with 58 consecutive days of transcranial laser PBM (810&#x2009;nm wavelength and 100&#x2009;mW power). We found that this daily PBM for nearly 2&#x2009;months predominantly decreased regional brain CCO activity in the young rats, whereas it increased CCO activity in the older rats. Since aging predominantly decreased regional brain CCO activity in control rats, the chronic laser stimulation was beneficial for the older treated rats because it reversed aging-related CCO deficits. Therefore, the physiopathological context of this chronic laser treatment was aging-dependent, with young rats showing mainly inhibitory effects and older rats showing mainly stimulatory effects on CCO activity.</p>
<p>We further investigated brain network neuroplasticity caused by TILS using inter-regional correlation matrices of changes in CCO activity. This is a well-validated analytical method for evaluating functional connectivity in the brain of rats (<xref ref-type="bibr" rid="ref29">Riha et al., 2011</xref>; <xref ref-type="bibr" rid="ref37">V&#x00E9;lez-Hern&#x00E1;ndez et al., 2014</xref>; <xref ref-type="bibr" rid="ref2">Auchter et al., 2020</xref>; <xref ref-type="bibr" rid="ref9">Cardoso et al., 2022</xref>). The most utility of this method is for evaluating overall patterns of modification in large brain networks rather than focusing on individual regions. The inter-regional correlation matrices revealed that the effects of laser stimulation at 1-day post-TILS resulted in 31 additional statistically significant pairwise partial correlations between ROIs as compared to the sham group. In these same ROIs, 23 significant partial correlations remained in the 2-weeks group compared to the sham group. Notably, 61 significant partial correlations were found in the 4-weeks group compared to the sham group. Generally, TILS increased the number of significant network correlations between brain ROIs as a function of time after administration. This suggests that TILS may augment functional connectivity between multiple networks in the brain. Changes in functional connectivity between some ROIs likely persist at least 4&#x2009;weeks after stimulation.</p>
<p>Increases in inter-regional functional connectivity are consistent with the previous findings of <xref ref-type="bibr" rid="ref9">Cardoso et al. (2022)</xref>, which histochemically examined CCO activity effects of 58 consecutive days of TILS in young and aged rats. They discovered that chronic TILS increased systems-level correlativity activity in aged rats, such that functional connectivity of aged rats receiving TILS rose to a level similar to young control rats. They also found an increase in functional connectivity after TILS, which is consistent with our results.</p>
<p>We also evaluated the association between TILS effects on CCO activity and regional depth from the dorsal surface of the brain. Linear regression analysis of dorsoventral depth and CCO activity showed significant increases in CCO activity at 2&#x2013;2.9&#x2009;mm, 3&#x2013;3.9&#x2009;mm, 4&#x2013;4.9&#x2009;mm, and 6&#x2013;6.9&#x2009;mm, as well as a nonsignificant increase in CCO activity at 5&#x2013;5.9&#x2009;mm. There was also a significant decrease in CCO activity at 7&#x2013;8.2&#x2009;mm. The medial amygdala (AMe), the central amygdala (ACe), and the basolateral amygdala (AB) are located at the 7&#x2013;8.2&#x2009;mm depth. Therefore, these regions may have been exposed to less light than more dorsally located regions. However, that simple explanation could not account for the fact that the most dorsal regions showed no changes in CCO activity. Alternatively, we speculate that the observed decrease in CCO activity at this deeper dorsoventral depth was likely contributed by the top-down inhibitory network effect of the infralimbic cortex discussed earlier. In addition, model coefficients and estimated marginal means (pictured in <xref rid="fig8" ref-type="fig">Figure 8</xref>) support a biphasic (hormetic) association (<xref ref-type="bibr" rid="ref7">Calabrese, 2008</xref>, <xref ref-type="bibr" rid="ref8">2015</xref>) of elevated mean CCO activity with increased depth from the dorsal surface of the brain, until a reduction at the 7&#x2013;8.2&#x2009;mm depth. Such opposite responses to lower and higher doses of PBM are characteristic of the hormetic dose&#x2013;response function found in PBM experiments, both <italic>in vitro</italic> and <italic>in vivo</italic> (<xref ref-type="bibr" rid="ref19">Huang et al., 2011</xref>). Our findings support the proposal of a biphasic, hormetic dose&#x2013;response to TILS (<xref ref-type="bibr" rid="ref9">Cardoso et al., 2022</xref>).</p>
<p>Our study reveals that a single administration of TILS appears to be sufficient to result in measurable changes in regional CCO activity and network functional connectivity. However, the main limitation of the present study is the small sample size, which may have prevented us from discovering more changes due to TILS. Due to the limited sample size, this study does not possess the statistical power to correct for multiple comparisons. A greater sample size would permit increased statistical power and could control for confounding variables. For example, desiccation of brain tissue as a result of prolonged freezing due to the COVID-19 pandemic damaged some brain sections, and one subject from the 4-weeks post-TILS group was excluded. Additionally, no measurements were recorded between 1&#x2009;day and 2 weeks post-TILS. Thus, it is possible that other significant effects of TILS in cortical regions receiving more direct stimulation may result between 1-day and 2-weeks post-TILS.</p>
<p>In conclusion, we found statistically significant changes in CCO activity of brain ROIs at 1-day, 2-weeks, and 4-weeks post-TILS. The most notable significant CCO activity change after TILS recorded at 1-day post-TILS was in the infralimbic cortex, suggesting its earlier capacity for metabolic neuroplasticity. Other subcortical regions associated with infralimbic networks showed the greatest significant CCO changes at 2-weeks and 4-weeks post-TILS. It is also possible that ventral brain regions with less penetrance of TILS may demonstrate a delayed reaction in CCO activity to TILS. Inter-regional correlation analyses also support greater functional connectivity between brain ROIs after TILS, with increased significant pairwise activity correlations persisting for 4-weeks post-stimulation. The time course of CCO changes in activity and functional coupling indicate that different types of neuroenergetic plasticity may occur at different time scales after TILS, depending on the brain region and its depth from the cortex. The overall results are the first to demonstrate the duration of action of a single TILS session on CCO activity in the brain.</p>
</sec>
<sec sec-type="data-availability" id="sec15">
<title>Data availability statement</title>
<p>The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.</p>
</sec>
<sec id="sec16">
<title>Ethics statement</title>
<p>The animal study was approved by The University of Texas at Austin, Institutional Animal Care and Use Committee. The study was conducted in accordance with the local legislation and institutional requirements.</p>
</sec>
<sec id="sec17">
<title>Author contributions</title>
<p>FG-L and DB designed the experiment and performed the TILS treatment. DB performed the live animal work, including handling, decapitation, brain extraction, and freezing the tissue. ZW sectioned the brains, histochemically stained the tissue, and gathered the brain metabolic data via optical densitometry, under supervision by FG-L and RD. ZW and DB performed the statistical analysis. FG-L, DB, and ZW interpreted the results and wrote the paper. RD, AN, and SV assisted in histochemical staining, sectioning, and optical densitometry. All authors contributed to the article and approved the submitted version.</p>
</sec>
<sec sec-type="COI-statement" id="sec18">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="sec100" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title><p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
<back>
<ack>
<p>The authors gratefully thank the Oskar Fischer Project Fund and Elhapa Foundation for their financial support.</p>
</ack>
<ref-list>
<title>References</title>
<ref id="ref1"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Anders</surname> <given-names>J. J.</given-names></name> <name><surname>Lanzafame</surname> <given-names>R. J.</given-names></name> <name><surname>Arany</surname> <given-names>P. R.</given-names></name></person-group> (<year>2015</year>). <article-title>Low-level light/laser therapy versus photobiomodulation therapy</article-title>. <source>Photomed. Laser Surg.</source> <volume>33</volume>, <fpage>183</fpage>&#x2013;<lpage>184</lpage>. doi: <pub-id pub-id-type="doi">10.1089/pho.2015.9848</pub-id>, PMID: <pub-id pub-id-type="pmid">25844681</pub-id></citation></ref>
<ref id="ref2"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Auchter</surname> <given-names>A. M.</given-names></name> <name><surname>Barrett</surname> <given-names>D. W.</given-names></name> <name><surname>Monfils</surname> <given-names>M. H.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2020</year>). <article-title>Methylene blue preserves cytochrome oxidase activity and prevents neurodegeneration and memory impairment in rats with chronic cerebral hypoperfusion</article-title>. <source>Front. Cell. Neurosci.</source> <volume>14</volume>:<fpage>130</fpage>. doi: <pub-id pub-id-type="doi">10.3389/fncel.2020.00130</pub-id>, PMID: <pub-id pub-id-type="pmid">32508596</pub-id></citation></ref>
<ref id="ref3"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Barrett</surname> <given-names>D. W.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2013</year>). <article-title>Transcranial infrared laser stimulation produces beneficial cognitive and emotional effects in humans</article-title>. <source>Neuroscience</source> <volume>230</volume>, <fpage>13</fpage>&#x2013;<lpage>23</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.neuroscience.2012.11.016</pub-id>, PMID: <pub-id pub-id-type="pmid">23200785</pub-id></citation></ref>
<ref id="ref4"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Blanco</surname> <given-names>N. J.</given-names></name> <name><surname>Maddox</surname> <given-names>T. W.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2015</year>). <article-title>Improving executive function using transcranial infrared laser stimulation</article-title>. <source>J. Neuropsychol.</source> <volume>11</volume>, <fpage>14</fpage>&#x2013;<lpage>25</lpage>. doi: <pub-id pub-id-type="doi">10.1111/jnp.12074</pub-id>, PMID: <pub-id pub-id-type="pmid">26017772</pub-id></citation></ref>
<ref id="ref5"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Blanco</surname> <given-names>N. J.</given-names></name> <name><surname>Saucedo</surname> <given-names>C. L.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2017</year>). <article-title>Transcranial infrared laser stimulation improves rule-based, but not information-integration, category learning in humans</article-title>. <source>Neurobiol. Learn. Mem.</source> <volume>139</volume>, <fpage>69</fpage>&#x2013;<lpage>75</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.nlm.2016.12.016</pub-id>, PMID: <pub-id pub-id-type="pmid">28039085</pub-id></citation></ref>
<ref id="ref6"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Bruchey</surname> <given-names>A. K.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2008</year>). <article-title>Enhanced metabolic capacity of the frontal cerebral cortex after Pavlovian conditioning</article-title>. <source>Neuroscience</source> <volume>152</volume>, <fpage>299</fpage>&#x2013;<lpage>307</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.neuroscience.2007.08.036</pub-id>, PMID: <pub-id pub-id-type="pmid">18291593</pub-id></citation></ref>
<ref id="ref7"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Calabrese</surname> <given-names>E. J.</given-names></name></person-group> (<year>2008</year>). <article-title>Hormesis: principles and applications for pharmacology and toxicology</article-title>. <source>Am. J. Pharmacol. Toxicol.</source> <volume>3</volume>, <fpage>59</fpage>&#x2013;<lpage>71</lpage>. doi: <pub-id pub-id-type="doi">10.3844/ajptsp.2008.59.71</pub-id></citation></ref>
<ref id="ref8"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Calabrese</surname> <given-names>E. J.</given-names></name></person-group> (<year>2015</year>). <article-title>Hormesis: principles and applications</article-title>. <source>Homeopathy</source> <volume>104</volume>, <fpage>69</fpage>&#x2013;<lpage>82</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.homp.2015.02.007</pub-id>, PMID: <pub-id pub-id-type="pmid">25869971</pub-id></citation></ref>
<ref id="ref9"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Cardoso</surname> <given-names>F. D. S.</given-names></name> <name><surname>Barrett</surname> <given-names>D. W.</given-names></name> <name><surname>Wade</surname> <given-names>Z.</given-names></name> <name><surname>Gomes da Silva</surname> <given-names>S.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2022</year>). <article-title>Photobiomodulation of cytochrome c oxidase by chronic transcranial laser in young and aged brains</article-title>. <source>Front. Neurosci.</source> <volume>16</volume>:<fpage>818005</fpage>. doi: <pub-id pub-id-type="doi">10.3389/fnins.2022.818005</pub-id>, PMID: <pub-id pub-id-type="pmid">35368252</pub-id></citation></ref>
<ref id="ref10"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Dole</surname> <given-names>M.</given-names></name> <name><surname>Auboiroux</surname> <given-names>V.</given-names></name> <name><surname>Langar</surname> <given-names>L.</given-names></name> <name><surname>Mitrofanis</surname> <given-names>J.</given-names></name></person-group> (<year>2023</year>). <article-title>A systematic review of the effects of transcranial photobiomodulation on brain activity in humans</article-title>. <source>Rev. Neurosci.</source> <volume>34</volume>, <fpage>671</fpage>&#x2013;<lpage>693</lpage>. doi: <pub-id pub-id-type="doi">10.1515/revneuro-2023-0003</pub-id>, PMID: <pub-id pub-id-type="pmid">36927734</pub-id></citation></ref>
<ref id="ref11"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Dos Santos Cardoso</surname> <given-names>F.</given-names></name> <name><surname>Dos Santos</surname> <given-names>J. C. C.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name> <name><surname>Ara&#x00FA;jo</surname> <given-names>B. H. S.</given-names></name> <name><surname>Lopes-Martins</surname> <given-names>R. A. B.</given-names></name> <name><surname>Gomes da Silva</surname> <given-names>S.</given-names></name></person-group> (<year>2021</year>). <article-title>Effects of chronic photobiomodulation with transcranial near-infrared laser on brain metabolomics of young and aged rats</article-title>. <source>Mol. Neurobiol.</source> <volume>58</volume>, <fpage>2256</fpage>&#x2013;<lpage>2268</lpage>. doi: <pub-id pub-id-type="doi">10.1007/s12035-020-02247-z</pub-id>, PMID: <pub-id pub-id-type="pmid">33417219</pub-id></citation></ref>
<ref id="ref12"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name> <name><surname>Barrett</surname> <given-names>D. W.</given-names></name></person-group> (<year>2014</year>). <article-title>Augmentation of cognitive brain functions with transcranial lasers</article-title>. <source>Front. Syst. Neurosci.</source> <volume>8</volume>:<fpage>36</fpage>. doi: <pub-id pub-id-type="doi">10.3389/fnsys.2014.00036</pub-id>, PMID: <pub-id pub-id-type="pmid">24672439</pub-id></citation></ref>
<ref id="ref13"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name> <name><surname>Bruchey</surname> <given-names>A. K.</given-names></name></person-group> (<year>2004</year>). <article-title>Extinction memory improvement by the metabolic enhancer methylene blue</article-title>. <source>Learn. Mem.</source> <volume>11</volume>, <fpage>633</fpage>&#x2013;<lpage>640</lpage>. doi: <pub-id pub-id-type="doi">10.1101/lm.82404</pub-id>, PMID: <pub-id pub-id-type="pmid">15466319</pub-id></citation></ref>
<ref id="ref14"><citation citation-type="book"><person-group person-group-type="author"><name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name> <name><surname>Cada</surname> <given-names>A.</given-names></name></person-group> (<year>1998</year>). &#x201C;<article-title>Quantitative histochemistry of cytochrome oxidase activity</article-title>&#x201D; in <source>Cytochrome oxidase in neuronal metabolism and Alzheimer&#x2019;s disease</source>. ed. <person-group person-group-type="editor"><name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<publisher-loc>New York, NY</publisher-loc>: <publisher-name>Plenum</publisher-name>), <fpage>55</fpage>&#x2013;<lpage>90</lpage>.</citation></ref>
<ref id="ref15"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hatchard</surname> <given-names>T.</given-names></name> <name><surname>Ting</surname> <given-names>J. J.</given-names></name> <name><surname>Messier</surname> <given-names>C.</given-names></name></person-group> (<year>2014</year>). <article-title>Translating the impact of exercise on cognition: methodological issues in animal research</article-title>. <source>Behav. Brain Res.</source> <volume>273</volume>, <fpage>177</fpage>&#x2013;<lpage>188</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.bbr.2014.06.043</pub-id>, PMID: <pub-id pub-id-type="pmid">25026095</pub-id></citation></ref>
<ref id="ref16"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hatefi</surname> <given-names>Y.</given-names></name></person-group> (<year>1985</year>). <article-title>The mitochondrial electron transport and oxidative phosphorylation system</article-title>. <source>Annu. Rev. Biochem.</source> <volume>54</volume>, <fpage>1015</fpage>&#x2013;<lpage>1069</lpage>. doi: <pub-id pub-id-type="doi">10.1146/annurev.bi.54.070185.005055</pub-id></citation></ref>
<ref id="ref17"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Holmes</surname> <given-names>E.</given-names></name> <name><surname>Barrett</surname> <given-names>D. W.</given-names></name> <name><surname>Saucedo</surname> <given-names>C. L.</given-names></name> <name><surname>O&#x2019;Connor</surname> <given-names>P.</given-names></name> <name><surname>Liu</surname> <given-names>H.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2019</year>). <article-title>Cognitive enhancement by transcranial photobiomodulation is associated with cerebrovascular oxygenation of the prefrontal cortex</article-title>. <source>Front. Neurosci.</source> <volume>13</volume>:<fpage>1129</fpage>. doi: <pub-id pub-id-type="doi">10.3389/fnins.2019.01129</pub-id>, PMID: <pub-id pub-id-type="pmid">31680847</pub-id></citation></ref>
<ref id="ref18"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Hoover</surname> <given-names>W. B.</given-names></name> <name><surname>Vertes</surname> <given-names>R. P.</given-names></name></person-group> (<year>2007</year>). <article-title>Anatomical analysis of afferent projections to the medial prefrontal cortex in the rat</article-title>. <source>Brain Struct. Funct.</source> <volume>212</volume>, <fpage>149</fpage>&#x2013;<lpage>179</lpage>. doi: <pub-id pub-id-type="doi">10.1007/s00429-007-0150-4</pub-id>, PMID: <pub-id pub-id-type="pmid">17717690</pub-id></citation></ref>
<ref id="ref19"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Huang</surname> <given-names>Y. Y.</given-names></name> <name><surname>Sharma</surname> <given-names>S. K.</given-names></name> <name><surname>Carroll</surname> <given-names>J.</given-names></name> <name><surname>Hamblin</surname> <given-names>M. R.</given-names></name></person-group> (<year>2011</year>). <article-title>Biphasic dose response in low level light therapy - an update</article-title>. <source>Dose-Response</source> <volume>9</volume>, <fpage>602</fpage>&#x2013;<lpage>618</lpage>. doi: <pub-id pub-id-type="doi">10.2203/dose-response.11-009.Hamblin</pub-id>, PMID: <pub-id pub-id-type="pmid">22461763</pub-id></citation></ref>
<ref id="ref20"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Karu</surname> <given-names>T.</given-names></name></person-group> (<year>1999</year>). <article-title>Primary and secondary mechanisms of action of visible to near-IR radiation on cells</article-title>. <source>J. Photochem. Photobiol. B</source> <volume>49</volume>, <fpage>1</fpage>&#x2013;<lpage>17</lpage>. doi: <pub-id pub-id-type="doi">10.1016/S1011-1344(98)00219-X</pub-id>, PMID: <pub-id pub-id-type="pmid">10365442</pub-id></citation></ref>
<ref id="ref21"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Kreutzmann</surname> <given-names>J. C.</given-names></name> <name><surname>Jovanovic</surname> <given-names>T.</given-names></name> <name><surname>Fendt</surname> <given-names>M.</given-names></name></person-group> (<year>2020</year>). <article-title>Infralimbic cortex activity is required for the expression but not the acquisition of conditioned safety</article-title>. <source>Psychopharmacology</source> <volume>237</volume>, <fpage>2161</fpage>&#x2013;<lpage>2172</lpage>. doi: <pub-id pub-id-type="doi">10.1007/s00213-020-05527-7</pub-id></citation></ref>
<ref id="ref22"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Messier</surname> <given-names>C.</given-names></name></person-group> (<year>2004</year>). <article-title>Glucose improvement of memory: a review</article-title>. <source>Eur. J. Pharmacol.</source> <volume>490</volume>, <fpage>33</fpage>&#x2013;<lpage>57</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.ejphar.2004.02.043</pub-id></citation></ref>
<ref id="ref23"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Miller</surname> <given-names>E. K.</given-names></name> <name><surname>Freedman</surname> <given-names>D. J.</given-names></name> <name><surname>Wallis</surname> <given-names>J. D.</given-names></name></person-group> (<year>2002</year>). <article-title>The prefrontal cortex: categories, concepts and cognition</article-title>. <source>Philos. Trans. R. Soc. Lond. Ser. B Biol. Sci.</source> <volume>357</volume>, <fpage>1123</fpage>&#x2013;<lpage>1136</lpage>. doi: <pub-id pub-id-type="doi">10.1098/rstb.2002.1099</pub-id>, PMID: <pub-id pub-id-type="pmid">12217179</pub-id></citation></ref>
<ref id="ref24"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Ong&#x00FC;r</surname> <given-names>D.</given-names></name> <name><surname>Price</surname> <given-names>J. L.</given-names></name></person-group> (<year>2000</year>). <article-title>The organization of networks within the orbital and medial prefrontal cortex of rats, monkeys and humans</article-title>. <source>Cereb. Cortex</source> <volume>10</volume>, <fpage>206</fpage>&#x2013;<lpage>219</lpage>. doi: <pub-id pub-id-type="doi">10.1093/cercor/10.3.206</pub-id>, PMID: <pub-id pub-id-type="pmid">10731217</pub-id></citation></ref>
<ref id="ref25"><citation citation-type="book"><person-group person-group-type="author"><name><surname>Paxinos</surname> <given-names>G.</given-names></name> <name><surname>Watson</surname> <given-names>C.</given-names></name></person-group> (<year>2006</year>). <source>The rat brain in stereotaxic coordinates: Hard cover edition</source>. <publisher-loc>Amsterdam</publisher-loc>: <publisher-name>Elsevier</publisher-name>.</citation></ref>
<ref id="ref26"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Peters</surname> <given-names>J.</given-names></name> <name><surname>Kalivas</surname> <given-names>P. W.</given-names></name> <name><surname>Quirk</surname> <given-names>G. J.</given-names></name></person-group> (<year>2009</year>). <article-title>Extinction circuits for fear and addiction overlap in prefrontal cortex</article-title>. <source>Learn. Mem.</source> <volume>16</volume>, <fpage>279</fpage>&#x2013;<lpage>288</lpage>. doi: <pub-id pub-id-type="doi">10.1101/lm.1041309</pub-id>, PMID: <pub-id pub-id-type="pmid">19380710</pub-id></citation></ref>
<ref id="ref27"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Pruitt</surname> <given-names>T.</given-names></name> <name><surname>Wang</surname> <given-names>X.</given-names></name> <name><surname>Wu</surname> <given-names>A.</given-names></name> <name><surname>Kallioniemi</surname> <given-names>E.</given-names></name> <name><surname>Husain</surname> <given-names>M. M.</given-names></name> <name><surname>Liu</surname> <given-names>H.</given-names></name></person-group> (<year>2020</year>). <article-title>Transcranial photobiomodulation (tPBM) with 1,064-nm laser to improve cerebral metabolism of the human brain in vivo</article-title>. <source>Lasers Surg. Med.</source> <volume>52</volume>, <fpage>807</fpage>&#x2013;<lpage>813</lpage>. doi: <pub-id pub-id-type="doi">10.1002/lsm.23232</pub-id>, PMID: <pub-id pub-id-type="pmid">32173886</pub-id></citation></ref>
<ref id="ref28"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Quirk</surname> <given-names>G. J.</given-names></name> <name><surname>Garcia</surname> <given-names>R.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2006</year>). <article-title>Prefrontal mechanisms in extinction of conditioned fear</article-title>. <source>Biol. Psychiatry</source> <volume>60</volume>, <fpage>337</fpage>&#x2013;<lpage>343</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.biopsych.2006.03.010</pub-id></citation></ref>
<ref id="ref29"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Riha</surname> <given-names>P. D.</given-names></name> <name><surname>Rojas</surname> <given-names>J. C.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2011</year>). <article-title>Beneficial network effects of methylene blue in an amnestic model</article-title>. <source>NeuroImage</source> <volume>54</volume>, <fpage>2623</fpage>&#x2013;<lpage>2634</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.neuroimage.2010.11.023</pub-id>, PMID: <pub-id pub-id-type="pmid">21087672</pub-id></citation></ref>
<ref id="ref30"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Rojas</surname> <given-names>J. C.</given-names></name> <name><surname>Bruchey</surname> <given-names>A. K.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2012</year>). <article-title>Low-level light therapy improves cortical metabolic capacity and memory retention</article-title>. <source>J. Alzheimers Dis.</source> <volume>32</volume>, <fpage>741</fpage>&#x2013;<lpage>752</lpage>. doi: <pub-id pub-id-type="doi">10.3233/JAD-2012-120817</pub-id>, PMID: <pub-id pub-id-type="pmid">22850314</pub-id></citation></ref>
<ref id="ref31"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Rojas</surname> <given-names>J. C.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2011</year>). <article-title>Low-level light therapy of the eye and brain</article-title>. <source>Eye Brain</source> <volume>3</volume>, <fpage>49</fpage>&#x2013;<lpage>67</lpage>. doi: <pub-id pub-id-type="doi">10.2147/EB.S21391</pub-id>, PMID: <pub-id pub-id-type="pmid">28539775</pub-id></citation></ref>
<ref id="ref32"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Rojas</surname> <given-names>J. C.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2013</year>). <article-title>Neurological and psychological applications of transcranial lasers and LEDs</article-title>. <source>Biochem. Pharmacol.</source> <volume>86</volume>, <fpage>447</fpage>&#x2013;<lpage>457</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.bcp.2013.06.012</pub-id>, PMID: <pub-id pub-id-type="pmid">23806754</pub-id></citation></ref>
<ref id="ref33"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Rojas</surname> <given-names>J. C.</given-names></name> <name><surname>Lee</surname> <given-names>J.</given-names></name> <name><surname>John</surname> <given-names>J. M.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name></person-group> (<year>2008</year>). <article-title>Neuroprotective effects of near-infrared light in an in vivo model of mitochondrial optic neuropathy</article-title>. <source>J. Neurosci.</source> <volume>28</volume>, <fpage>13511</fpage>&#x2013;<lpage>13521</lpage>. doi: <pub-id pub-id-type="doi">10.1523/JNEUROSCI.3457-08.2008</pub-id>, PMID: <pub-id pub-id-type="pmid">19074024</pub-id></citation></ref>
<ref id="ref34"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Saucedo</surname> <given-names>C. L.</given-names></name> <name><surname>Courtois</surname> <given-names>E. C.</given-names></name> <name><surname>Wade</surname> <given-names>Z. S.</given-names></name> <name><surname>Kelley</surname> <given-names>M. N.</given-names></name> <name><surname>Kheradbin</surname> <given-names>N.</given-names></name> <name><surname>Barrett</surname> <given-names>D. W.</given-names></name> <etal/></person-group>. (<year>2021</year>). <article-title>Transcranial laser stimulation: mitochondrial and cerebrovascular effects in younger and older healthy adults</article-title>. <source>Brain Stimul.</source> <volume>14</volume>, <fpage>440</fpage>&#x2013;<lpage>449</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.brs.2021.02.011</pub-id>, PMID: <pub-id pub-id-type="pmid">33636401</pub-id></citation></ref>
<ref id="ref35"><citation citation-type="other"><person-group person-group-type="author"><collab id="coll1">The jamovi project</collab></person-group> (<year>2022</year>). jamovi (Version 2.3) [Computer Software]. Available at: <ext-link ext-link-type="uri" xlink:href="https://www.jamovi.org">https://www.jamovi.org</ext-link> (Accessed November 14, 2022).</citation></ref>
<ref id="ref36"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Vargas</surname> <given-names>E.</given-names></name> <name><surname>Barrett</surname> <given-names>D. W.</given-names></name> <name><surname>Saucedo</surname> <given-names>C. L.</given-names></name> <name><surname>Huang</surname> <given-names>L. D.</given-names></name> <name><surname>Abraham</surname> <given-names>J. A.</given-names></name> <name><surname>Tanaka</surname> <given-names>H.</given-names></name> <etal/></person-group>. (<year>2017</year>). <article-title>Beneficial neurocognitive effects of transcranial laser in older adults</article-title>. <source>Lasers Med. Sci.</source> <volume>32</volume>, <fpage>1153</fpage>&#x2013;<lpage>1162</lpage>. doi: <pub-id pub-id-type="doi">10.1007/s10103-017-2221-y</pub-id>, PMID: <pub-id pub-id-type="pmid">28466195</pub-id></citation></ref>
<ref id="ref37"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>V&#x00E9;lez-Hern&#x00E1;ndez</surname> <given-names>M. E.</given-names></name> <name><surname>Padilla</surname> <given-names>E.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name> <name><surname>Jim&#x00E9;nez-Rivera</surname> <given-names>C. A.</given-names></name></person-group> (<year>2014</year>). <article-title>Cocaine reduces cytochrome oxidase activity in the prefrontal cortex and modifies its functional connectivity with brainstem nuclei</article-title>. <source>Brain Res.</source> <volume>1542</volume>, <fpage>56</fpage>&#x2013;<lpage>69</lpage>. doi: <pub-id pub-id-type="doi">10.1016/j.brainres.2013.10.017</pub-id>, PMID: <pub-id pub-id-type="pmid">24505625</pub-id></citation></ref>
<ref id="ref38"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Vrieze</surname> <given-names>S. I.</given-names></name></person-group> (<year>2012</year>). <article-title>Model selection and psychological theory: a discussion of the differences between the Akaike information criterion (AIC) and the Bayesian information criterion (BIC)</article-title>. <source>Psychol. Methods</source> <volume>17</volume>, <fpage>228</fpage>&#x2013;<lpage>243</lpage>. doi: <pub-id pub-id-type="doi">10.1037/a0027127</pub-id>, PMID: <pub-id pub-id-type="pmid">22309957</pub-id></citation></ref>
<ref id="ref39"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname> <given-names>X.</given-names></name> <name><surname>Dmochowski</surname> <given-names>J. P.</given-names></name> <name><surname>Zeng</surname> <given-names>L.</given-names></name> <name><surname>Kallioniemi</surname> <given-names>E.</given-names></name> <name><surname>Husain</surname> <given-names>M.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name> <etal/></person-group>. (<year>2019</year>). <article-title>Transcranial photobiomodulation with 1064-nm laser modulates brain electroencephalogram rhythms</article-title>. <source>Neurophotonics</source> <volume>6</volume>:<fpage>025013</fpage>:<fpage>1</fpage>. doi: <pub-id pub-id-type="doi">10.1117/1.NPh.6.2.025013</pub-id>, PMID: <pub-id pub-id-type="pmid">31259198</pub-id></citation></ref>
<ref id="ref40"><citation citation-type="book"><person-group person-group-type="author"><name><surname>Wang</surname> <given-names>X.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name> <name><surname>Liu</surname> <given-names>H.</given-names></name></person-group> (<year>2022</year>). &#x201C;<article-title>Transcranial infrared laser stimulation</article-title>&#x201D; in <source>Oxford handbook of transcranial stimulation</source>. eds. <person-group person-group-type="editor"><name><surname>Wassermann</surname> <given-names>E. M.</given-names></name> <name><surname>Peterchev</surname> <given-names>A. V.</given-names></name> <name><surname>Ziemann</surname> <given-names>U.</given-names></name> <name><surname>Lisanby</surname> <given-names>S. H.</given-names></name> <name><surname>Siebner</surname> <given-names>H. R.</given-names></name> <name><surname>Walsh</surname> <given-names>V.</given-names></name></person-group>. <edition>2nd</edition> ed (<publisher-loc>Oxford, UK</publisher-loc>: <publisher-name>Oxford University Press</publisher-name>) <comment>Chapter 10, C10.S1-C10.S19</comment></citation></ref>
<ref id="ref41"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname> <given-names>X.</given-names></name> <name><surname>Reddy</surname> <given-names>D. D.</given-names></name> <name><surname>Nalawade</surname> <given-names>S. S.</given-names></name> <name><surname>Pal</surname> <given-names>S.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name> <name><surname>Liu</surname> <given-names>H.</given-names></name></person-group> (<year>2018</year>). <article-title>Impact of heat on metabolic and hemodynamic changes in transcranial infrared laser stimulation measured by broadband near-infrared spectroscopy</article-title>. <source>Neurophotonics</source> <volume>5</volume>:<fpage>011004</fpage>:<fpage>1</fpage>. doi: <pub-id pub-id-type="doi">10.1117/1.NPh.5.1.011004</pub-id>, PMID: <pub-id pub-id-type="pmid">28948191</pub-id></citation></ref>
<ref id="ref42"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname> <given-names>X.</given-names></name> <name><surname>Tian</surname> <given-names>F.</given-names></name> <name><surname>Reddy</surname> <given-names>D. D.</given-names></name> <name><surname>Nalawade</surname> <given-names>S. S.</given-names></name> <name><surname>Barrett</surname> <given-names>D. W.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name> <etal/></person-group>. (<year>2017</year>). <article-title>Up-regulation of cerebral cytochrome-c-oxidase and hemodynamics by transcranial infrared laser stimulation: a broadband near-infrared spectroscopy study</article-title>. <source>J. Cereb. Blood Flow Metab.</source> <volume>37</volume>, <fpage>3789</fpage>&#x2013;<lpage>3802</lpage>. doi: <pub-id pub-id-type="doi">10.1177/0271678X17691783</pub-id>, PMID: <pub-id pub-id-type="pmid">28178891</pub-id></citation></ref>
<ref id="ref43"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Wong-Riley</surname> <given-names>M. T.</given-names></name></person-group> (<year>1989</year>). <article-title>Cytochrome oxidase: an endogenous metabolic marker for neuronal activity</article-title>. <source>Trends Neurosci.</source> <volume>12</volume>, <fpage>94</fpage>&#x2013;<lpage>101</lpage>. doi: <pub-id pub-id-type="doi">10.1016/0166-2236(89)90165-3</pub-id>, PMID: <pub-id pub-id-type="pmid">2469224</pub-id></citation></ref>
<ref id="ref44"><citation citation-type="journal"><person-group person-group-type="author"><name><surname>Zaizar</surname> <given-names>E. D.</given-names></name> <name><surname>Papini</surname> <given-names>S.</given-names></name> <name><surname>Gonzalez-Lima</surname> <given-names>F.</given-names></name> <name><surname>Telch</surname> <given-names>M. J.</given-names></name></person-group> (<year>2023</year>). <article-title>Singular and combined effects of transcranial infrared laser stimulation and exposure therapy on pathological fear: a randomized clinical trial</article-title>. <source>Psychol. Med.</source> <volume>53</volume>, <fpage>908</fpage>&#x2013;<lpage>917</lpage>. doi: <pub-id pub-id-type="doi">10.1017/S0033291721002270</pub-id>, PMID: <pub-id pub-id-type="pmid">34284836</pub-id></citation></ref>
</ref-list>
</back>
</article>