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Bohman LE, Riley J, Milovanova TN, Sanborn MR, Thom SR, Armstead WM. Microparticles Impair Hypotensive Cerebrovasodilation and Cause Hippocampal Neuronal Cell Injury after Traumatic Brain Injury. J Neurotrauma 2015; 33:168-74. [PMID: 26230045 DOI: 10.1089/neu.2015.3885] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Endothelin-1 (ET-1), tissue plasminogen activator (tPA), and extracellular signal-regulated kinases-mitogen activated protein kinase (ERK-MAPK) are mediators of impaired cerebral hemodynamics after fluid percussion brain injury (FPI) in piglets. Microparticles (MPs) are released into the circulation from a variety of cells during stress, are pro-thrombotic and pro-inflammatory, and may be lysed with polyethylene glycol telomere B (PEG-TB). We hypothesized that MPs released after traumatic brain injury impair hypotensive cerebrovasodilation and that PEG-TB protects the vascular response via MP lysis, and we investigated the relationship between MPs, tPA, ET-1, and ERK-MAPK in that process. FPI was induced in piglets equipped with a closed cranial window. Animals received PEG-TB or saline (vehicle) 30-minutes post-injury. Serum and cerebrospinal fluid (CSF) were sampled and pial arteries were measured pre- and post-injury. MPs were quantified by flow cytometry. CSF samples were analyzed with enzyme-linked immunosorbent assay. MP levels, vasodilatory responses, and CSF signaling assays were similar in all animals prior to injury and treatment. After injury, MP levels were elevated in the serum of vehicle but not in PEG-TB-treated animals. Pial artery dilation in response to hypotension was impaired after injury but protected in PEG-TB-treated animals. After injury, CSF levels of tPA, ET-1, and ERK-MAPK were all elevated, but not in PEG-TB-treated animals. PEG-TB-treated animals also showed reduction in neuronal injury in CA1 and CA3 hippocampus, compared with control animals. These results show that serum MP levels are elevated after FPI and lead to impaired hypotensive cerebrovasodilation via over-expression of tPA, ET-1, and ERK-MAPK. Treatment with PEG-TB after injury reduces MP levels and protects hypotensive cerebrovasodilation and limits hippocampal neuronal cell injury.
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Affiliation(s)
- Leif-Erik Bohman
- 1 Department of Neurosurgery, University of Pennsylvania , Philadelphia, Pennsylvania
| | - John Riley
- 2 Department of Anesthesiology and Critical Care, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Tatyana N Milovanova
- 3 Department of Emergency Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.,5 Institute for Environmental Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Matthew R Sanborn
- 1 Department of Neurosurgery, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Stephen R Thom
- 3 Department of Emergency Medicine, University of Pennsylvania , Philadelphia, Pennsylvania.,5 Institute for Environmental Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - William M Armstead
- 2 Department of Anesthesiology and Critical Care, University of Pennsylvania , Philadelphia, Pennsylvania.,4 Department of Pharmacology, University of Pennsylvania , Philadelphia, Pennsylvania
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When the brain tells the blood how to clot. Blood 2015; 125:2015-6. [PMID: 25814487 DOI: 10.1182/blood-2015-02-626515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this issue of Blood, Tian et al report that during traumatic brain injury, small membrane vesicles, called microparticles, disseminate procoagulant factors from the brain into the systemic circulation. The delivery appears to occur through the disrupted blood-brain barrier.
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Tian Y, Salsbery B, Wang M, Yuan H, Yang J, Zhao Z, Wu X, Zhang Y, Konkle BA, Thiagarajan P, Li M, Zhang J, Dong JF. Brain-derived microparticles induce systemic coagulation in a murine model of traumatic brain injury. Blood 2015; 125:2151-9. [PMID: 25628471 PMCID: PMC4375111 DOI: 10.1182/blood-2014-09-598805] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/12/2015] [Indexed: 12/14/2022] Open
Abstract
Traumatic brain injury (TBI) is associated with coagulopathy, although it often lacks 2 key risk factors: severe bleeding and significant fluid resuscitation associated with hemorrhagic shock. The pathogenesis of TBI-associated coagulopathy remains poorly understood. We tested the hypothesis that brain-derived microparticles (BDMPs) released from an injured brain induce a hypercoagulable state that rapidly turns into consumptive coagulopathy. Here, we report that mice subjected to fluid percussion injury (1.9 ± 0.1 atm) developed a BDMP-dependent hypercoagulable state, with peak levels of plasma glial cell and neuronal BDMPs reaching 17 496 ± 4833/μL and 18 388 ± 3657/μL 3 hours after TBI, respectively. Uninjured mice injected with BDMPs developed a dose-dependent hyper-turned hypocoagulable state measured by a progressively prolonged clotting time, fibrinogen depletion, and microvascular fibrin deposition in multiple organs. The BDMPs were 50 to 300 nm with intact membranes, expressing neuronal or glial cell markers and procoagulant phosphatidylserine and tissue factor. Their procoagulant activity was greater than platelet microparticles and was dose-dependently blocked by lactadherin. Microparticles were produced from injured hippocampal cells, transmigrated through the disrupted endothelial barrier in a platelet-dependent manner, and activated platelets. These data define a novel mechanism of TBI-associated coagulopathy in mice, identify early predictive markers, and provide alternative therapeutic targets.
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Affiliation(s)
- Ye Tian
- Tianjin Neurological Institute, Department of Neurosurgery, General Hospital, Tianjin Medical University, Tianjin, China; Puget Sound Blood Research Institute, Seattle, WA
| | | | - Min Wang
- Institute of Pathology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Hengjie Yuan
- Tianjin Neurological Institute, Department of Neurosurgery, General Hospital, Tianjin Medical University, Tianjin, China; Puget Sound Blood Research Institute, Seattle, WA
| | - Jing Yang
- Puget Sound Blood Research Institute, Seattle, WA
| | - Zilong Zhao
- Tianjin Neurological Institute, Department of Neurosurgery, General Hospital, Tianjin Medical University, Tianjin, China
| | - Xiaoping Wu
- Puget Sound Blood Research Institute, Seattle, WA
| | - Yanjun Zhang
- Tianjin Neurological Institute, Department of Neurosurgery, General Hospital, Tianjin Medical University, Tianjin, China
| | - Barbara A Konkle
- Puget Sound Blood Research Institute, Seattle, WA; Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Perumal Thiagarajan
- Departments of Pathology and Medicine, Baylor College of Medicine, Houston, TX; and Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Min Li
- Institute of Pathology, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jianning Zhang
- Tianjin Neurological Institute, Department of Neurosurgery, General Hospital, Tianjin Medical University, Tianjin, China
| | - Jing-Fei Dong
- Puget Sound Blood Research Institute, Seattle, WA; Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
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Midura EF, Jernigan PL, Kuethe JW, Friend LA, Veile R, Makley AT, Caldwell CC, Goodman MD. Microparticles impact coagulation after traumatic brain injury. J Surg Res 2015; 197:25-31. [PMID: 25846728 DOI: 10.1016/j.jss.2015.02.064] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/18/2015] [Accepted: 02/26/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND The pathophysiology that drives the subacute hypercoagulable state commonly seen after traumatic brain injury (TBI) is not well understood. Alterations caused by TBI in platelet and microparticle (MP) numbers and function have been suggested as possible causes; however, the contributions of platelets and MPs are currently unknown. MATERIALS AND METHODS A weight-drop technique of TBI using a murine model of moderate head injury was used. Blood was collected at intervals after injury. MP enumeration and characterization were performed using Nanoparticle Tracking Analysis, and platelet counts and coagulation parameters were determined using thromboelastometry. A MP procoagulant assay was used to compare activity between injured and sham mice. RESULTS At 24 h after injury, there were no changes in circulating platelet numbers. However, there was a decrease in platelet contribution to clot formation. In contrast, there was a decline in circulating total MP numbers. When MPs from sham mice were added to the blood from head-injured animals, there was a normalization of platelet contribution to clot formation. Conversely, when MPs from TBI mice were added to sham blood, there was a significant decrease in platelet contribution to clot formation. Notably, there was an increase in MP procoagulant activity in head-injured mice. CONCLUSIONS MPs generated after TBI likely contribute to altered coagulation after head injury and may play a key role in the development of a posttraumatic hypercoagulable state in TBI patients.
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Affiliation(s)
- Emily F Midura
- Division of Research, Department of Surgery and Institute for Military Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Peter L Jernigan
- Division of Research, Department of Surgery and Institute for Military Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Joshua W Kuethe
- Division of Research, Department of Surgery and Institute for Military Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Lou Ann Friend
- Division of Research, Department of Surgery and Institute for Military Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Rosalie Veile
- Division of Research, Department of Surgery and Institute for Military Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Amy T Makley
- Division of Research, Department of Surgery and Institute for Military Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Charles C Caldwell
- Division of Research, Department of Surgery and Institute for Military Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Michael D Goodman
- Division of Research, Department of Surgery and Institute for Military Medicine, University of Cincinnati, Cincinnati, Ohio.
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