101
|
Petrovic-Djergovic D, Goonewardena SN, Pinsky DJ. Inflammatory Disequilibrium in Stroke. Circ Res 2017; 119:142-58. [PMID: 27340273 DOI: 10.1161/circresaha.116.308022] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 05/25/2016] [Indexed: 01/01/2023]
Abstract
Over the past several decades, there have been substantial advances in our knowledge of the pathophysiology of stroke. Understanding the benefits of timely reperfusion has led to the development of thrombolytic therapy as the cornerstone of current management of ischemic stroke, but there remains much to be learned about mechanisms of neuronal ischemic and reperfusion injury and associated inflammation. For ischemic stroke, novel therapeutic targets have continued to remain elusive. When considering modern molecular biological techniques, advanced translational stroke models, and clinical studies, a consistent pattern emerges, implicating perturbation of the immune equilibrium by stroke in both central nervous system injury and repair responses. Stroke triggers activation of the neuroimmune axis, comprised of multiple cellular constituents of the immune system resident within the parenchyma of the brain, leptomeninges, and vascular beds, as well as through secretion of biological response modifiers and recruitment of immune effector cells. This neuroimmune activation can directly impact the initiation, propagation, and resolution phases of ischemic brain injury. To leverage a potential opportunity to modulate local and systemic immune responses to favorably affect the stroke disease curve, it is necessary to expand our mechanistic understanding of the neuroimmune axis in ischemic stroke. This review explores the frontiers of current knowledge of innate and adaptive immune responses in the brain and how these responses together shape the course of ischemic stroke.
Collapse
Affiliation(s)
- Danica Petrovic-Djergovic
- From the Departments of Internal Medicine (D.P.-D., S.N.G., D.J.P.) and Molecular and Integrative Physiology (D.J.P.), University of Michigan, Ann Arbor
| | - Sascha N Goonewardena
- From the Departments of Internal Medicine (D.P.-D., S.N.G., D.J.P.) and Molecular and Integrative Physiology (D.J.P.), University of Michigan, Ann Arbor
| | - David J Pinsky
- From the Departments of Internal Medicine (D.P.-D., S.N.G., D.J.P.) and Molecular and Integrative Physiology (D.J.P.), University of Michigan, Ann Arbor.
| |
Collapse
|
102
|
Bivard A, Lincz LF, Maquire J, Parsons M, Levi C. Platelet microparticles: a biomarker for recanalization in rtPA-treated ischemic stroke patients. Ann Clin Transl Neurol 2017; 4:175-179. [PMID: 28275651 PMCID: PMC5338157 DOI: 10.1002/acn3.392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 11/27/2016] [Accepted: 12/17/2016] [Indexed: 01/05/2023] Open
Abstract
Objectives Identification of a biomarker for acute recanalization could have significant clinical impact. Methods We prospectively collected baseline, 24‐h, and 90‐day clinical and imaging data from consecutive ischemic stroke patients who fulfilled standard clinical eligibility criteria for treatment with intravenous recombinant tissue plasminogen activator (rtPA). Computed tomography angiography was acquired at 24 h and assessed using the thrombolysis is myocardial infarction (TIMI) scale with a score of 2b/3 indicating recanalization. Blood samples collected at 24 h after stroke symptom onset were used to measure the inflammatory biomarkers of glycoprotein IIb (CD41) expressing microparticles (MP), C‐reactive protein (CRP), COX 2, APOE, and Angiopoietin 1. Analysis was performed using linear regression and Pearson's correlation coefficient. Results A total of 57 patients met study eligibility criteria and had sufficient data and sample quality to be analyzed. Circulating levels of platelet derived CD41 + MP were significantly related to reperfusion (Pearson correlation, PC: 0.554, P < 0.001) and recanalization (PC: 0.495, P < 0.001) as well as related with 3‐month modified Rankin Score (PC: 0.483, P < 0.001). CRP was significantly negatively correlated with recanalization on 24 h CTA (PC: −0.292, P = 0.041). Backward logistic regression with CRP and CD41 + MP increased the association with reperfusion (r2 = 0.357 P < 0.001). Interpretation There is a significant relationship between the inflammatory biomarkers CD41 + MP and CRP and recanalization.
Collapse
Affiliation(s)
- Andrew Bivard
- Departments of Neurology John Hunter Hospital University of Newcastle Newcastle Australia
| | - Lisa F Lincz
- Hunter Haematology Research Group Calvary Mater Newcastle hospital Waratah Australia
| | - Jane Maquire
- Departments of Neurology John Hunter Hospital University of Newcastle Newcastle Australia
| | - Mark Parsons
- Departments of Neurology John Hunter Hospital University of Newcastle Newcastle Australia
| | - Christopher Levi
- Departments of Neurology John Hunter Hospital University of Newcastle Newcastle Australia
| |
Collapse
|
103
|
Hu X, De Silva TM, Chen J, Faraci FM. Cerebral Vascular Disease and Neurovascular Injury in Ischemic Stroke. Circ Res 2017; 120:449-471. [PMID: 28154097 PMCID: PMC5313039 DOI: 10.1161/circresaha.116.308427] [Citation(s) in RCA: 256] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/13/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
The consequences of cerebrovascular disease are among the leading health issues worldwide. Large and small cerebral vessel disease can trigger stroke and contribute to the vascular component of other forms of neurological dysfunction and degeneration. Both forms of vascular disease are driven by diverse risk factors, with hypertension as the leading contributor. Despite the importance of neurovascular disease and subsequent injury after ischemic events, fundamental knowledge in these areas lag behind our current understanding of neuroprotection and vascular biology in general. The goal of this review is to address select key structural and functional changes in the vasculature that promote hypoperfusion and ischemia, while also affecting the extent of injury and effectiveness of therapy. In addition, as damage to the blood-brain barrier is one of the major consequences of ischemia, we discuss cellular and molecular mechanisms underlying ischemia-induced changes in blood-brain barrier integrity and function, including alterations in endothelial cells and the contribution of pericytes, immune cells, and matrix metalloproteinases. Identification of cell types, pathways, and molecules that control vascular changes before and after ischemia may result in novel approaches to slow the progression of cerebrovascular disease and lessen both the frequency and impact of ischemic events.
Collapse
Affiliation(s)
- Xiaoming Hu
- Center of Cerebrovascular Disease Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
| | - T. Michael De Silva
- Biomedicine Discovery Institute, Department of Pharmacology, 9 Ancora Imparo Way, Monash University, Clayton, Vic, Australia
| | - Jun Chen
- Center of Cerebrovascular Disease Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
| | - Frank M. Faraci
- Departments of Internal Medicine and Pharmacology, Carver College of Medicine, University of Iowa, Iowa City Veterans Affairs Healthcare System, Iowa City, IA, USA
| |
Collapse
|
104
|
Lee SH, Nah HW, Kim BJ, Ahn SH, Kim JS, Kang DW, Kwon SU. Role of Perfusion-Weighted Imaging in a Diffusion-Weighted-Imaging-Negative Transient Ischemic Attack. J Clin Neurol 2017; 13:129-137. [PMID: 28176500 PMCID: PMC5392454 DOI: 10.3988/jcn.2017.13.2.129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/08/2016] [Accepted: 10/10/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The absence of acute ischemic lesions in diffusion-weighted imaging (DWI) in transient ischemic attack (TIA) patients makes it difficult to diagnose the true vascular etiologies. Among patients with DWI-negative TIA, we investigated whether the presence of a perfusion-weighted imaging (PWI) abnormality implied a true vascular event by identifying new acute ischemic lesions in follow-up magnetic resonance imaging (MRI) in areas corresponding to the initial PWI abnormality. METHODS The included patients underwent DWI and PWI within 72 hours of TIA and also follow-up DWI at 3 days after the initial MRI. These patients had visited the emergency room between July 2009 and May 2015. Patients who demonstrated initial DWI lesions were excluded. The initial PWI abnormalities in the corresponding vascular territory were visually classified into three patterns: no abnormality, focal abnormality, and territorial abnormality. RESULTS No DWI lesions were evident in initial MRI in 345 of the 443 TIA patients. Follow-up DWI was applied to 87 of these 345 DWI-negative TIA patients. Initial PWI abnormalities were significantly associated with follow-up DWI abnormalities: 8 of 43 patients with no PWI abnormalities (18.6%) had new ischemic lesions, whereas 13 of 16 patients with focal perfusion abnormalities (81.2%) had new ischemic lesions in the areas of initial PWI abnormalities [odds ratio (OR)=15.1, 95% confidence interval (CI)=3.6-62.9], and 14 of 28 patients with territorial perfusion abnormalities (50%) had new lesions (OR=3.7, 95% CI=1.2-11.5). CONCLUSIONS PWI is useful in defining whether or not the transient neurological symptoms in DWI-negative TIA are true vascular events, and will help to improve the understanding of the pathomechanism of TIA.
Collapse
Affiliation(s)
- Sang Hun Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Wook Nah
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Ho Ahn
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
105
|
Escobar-Peso A, Chioua M, Frezza V, Martínez-Alonso E, Marco-Contelles J, Alcázar A. Nitrones, Old Fellows for New Therapies in Ischemic Stroke. SPRINGER SERIES IN TRANSLATIONAL STROKE RESEARCH 2017. [DOI: 10.1007/978-3-319-45345-3_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
106
|
Abstract
The immune response to acute cerebral ischemia is a major factor in stroke pathobiology and outcome. While the immune response starts locally in occluded and hypoperfused vessels and the ischemic brain parenchyma, inflammatory mediators generated in situ propagate through the organism as a whole. This "spillover" leads to a systemic inflammatory response first, followed by immunosuppression aimed at dampening the potentially harmful proinflammatory milieu. In this overview we will outline the inflammatory cascade from its starting point in the vasculature of the ischemic brain to the systemic immune response elicited by brain ischemia. Potential immunomodulatory therapeutic approaches, including preconditioning and immune cell therapy will also be discussed.
Collapse
Affiliation(s)
- Josef Anrather
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
107
|
Jancsó G, Arató E, Hardi P, Nagy T, Pintér Ö, Fazekas G, Gasz B, Takacs I, Menyhei G, Kollar L, Sínay L. Controlled reperfusion decreased reperfusion induced oxidative stress and evoked inflammatory response in experimental aortic-clamping animal model. Clin Hemorheol Microcirc 2016; 63:217-34. [DOI: 10.3233/ch-152038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G. Jancsó
- Department of Vascular Surgery, University of Pécs, Faculty of Medicine, Pécs, Hungary
- Department of Surgical Research and Techniques, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - E. Arató
- Department of Vascular Surgery, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - P. Hardi
- Department of Surgical Research and Techniques, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - T. Nagy
- Department of Surgical Research and Techniques, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - Ö. Pintér
- Department of Surgical Research and Techniques, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - G. Fazekas
- Department of Vascular Surgery, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - B. Gasz
- Department of Surgical Research and Techniques, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - I. Takacs
- Department of Surgical Research and Techniques, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - G. Menyhei
- Department of Vascular Surgery, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - L. Kollar
- Department of Vascular Surgery, University of Pécs, Faculty of Medicine, Pécs, Hungary
| | - L. Sínay
- Department of Vascular Surgery, University of Pécs, Faculty of Medicine, Pécs, Hungary
| |
Collapse
|
108
|
Anti-Inflammation of Natural Components from Medicinal Plants at Low Concentrations in Brain via Inhibiting Neutrophil Infiltration after Stroke. Mediators Inflamm 2016; 2016:9537901. [PMID: 27688603 PMCID: PMC5027307 DOI: 10.1155/2016/9537901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/27/2016] [Accepted: 06/14/2016] [Indexed: 12/17/2022] Open
Abstract
Inflammation after stroke consists of activation of microglia/astrocytes in situ and infiltration of blood-borne leukocytes, resulting in brain damage and neurological deficits. Mounting data demonstrated that most natural components from medicinal plants had anti-inflammatory effects after ischemic stroke through inhibiting activation of resident microglia/astrocytes within ischemic area. However, it is speculated that this classical activity cannot account for the anti-inflammatory function of these natural components in the cerebral parenchyma, where they are detected at very low concentrations due to their poor membrane permeability and slight leakage of BBB. Could these drugs exert anti-inflammatory effects peripherally without being delivered across the BBB? Factually, ameliorating blood-borne neutrophil recruitment in peripheral circulatory system has been proved to reduce ischemic damage and improve outcomes. Thus, it is concluded that if drugs could achieve effective concentrations in the cerebral parenchyma, they can function via crippling resident microglia/astrocytes activation and inhibiting neutrophil infiltration, whereas the latter will be dominating when these drugs localize in the brain at a low concentration. In this review, the availability of some natural components crossing the BBB in stroke will be discussed, and how these drugs lead to improvements in stroke through inhibition of neutrophil rolling, adhesion, and transmigration will be illustrated.
Collapse
|
109
|
Prasongsukarn K, Borger MA. Reducing Cerebral Emboli During Cardiopulmonary Bypass. Semin Cardiothorac Vasc Anesth 2016; 9:153-8. [PMID: 15920641 DOI: 10.1177/108925320500900209] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neurologic injury is a common complication of cardiac surgery and is associated with significant morbidity, mortality, and resource utilization. The incidence varies widely according to the definition used, patient age, and complexity of surgery. The manifestations of neurologic injury are broad, ranging from subtle neurocognitive dysfunction to frank stroke. An increasing amount of evidence points to cerebral embolization during cardiopulmonary bypass (CPB) as the principal etiologic factor of these neurologic complications. Cerebral emboli may be composed of atherosclerotic debris, calcium, air, fat, platelet thrombi, or CPB tubing. Advancements in perfusion technology, CPB techniques and surgical strategies may lead to a reduction in neurologic injury during cardiac surgery. In the current paper, we discuss the pathophysiology of neurologic injury after cardiac surgery and methods of reducing cerebral embolization. Reducing emboli and neurologic injury during CPB requires a multidisciplinary approach that includes several simple diagnostic and therapeutic strategies. Reducing cerebral emboli should be a major goal for future research in the fields of cardiac anesthesia, surgery and perfusion.
Collapse
Affiliation(s)
- Kriengchai Prasongsukarn
- Division of Cardiovascular Surgery, Toronto General Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
110
|
Linfante I, Cipolla MJ. Improving Reperfusion Therapies in the Era of Mechanical Thrombectomy. Transl Stroke Res 2016; 7:294-302. [PMID: 27221511 PMCID: PMC4929023 DOI: 10.1007/s12975-016-0469-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 05/08/2016] [Accepted: 05/10/2016] [Indexed: 12/27/2022]
Abstract
Recent positive clinical trials using mechanical thrombectomy proved that endovascular recanalization is an effective treatment for patients with acute stroke secondary to large vessel occlusions. The trials offer definite evidence that in acute ischemia recanalization is a powerful predictor of good outcome. However, even in the era of rapid and effective recanalization using endovascular approaches, the percentage of patients with good outcomes varies between 33 and 71 %. In addition, the number of patients who are eligible for endovascular thrombectomy is small and usually based on having salvageable tissue on imaging. There is therefore room for improvement to both enhance the effectiveness of current practice and expand treatment to a larger subset of stroke patients. In this review, we highlight some of the most promising approaches to improve endovascular therapy by combining with strategies to enhance collateral perfusion and vascular protection.
Collapse
Affiliation(s)
- Italo Linfante
- Miami Cardiac and Vascular Institute and Neuroscience Center, Baptist Hospital, Miami, FL, USA
| | - Marilyn J Cipolla
- Department of Neurological Sciences and Pharmacology, University of Vermont College of Medicine, 149 Beaumont Ave.; HSRF 416A, Burlington, VT, 05405, USA.
| |
Collapse
|
111
|
Murkin JM. Adverse Central Nervous System Outcomes After Cardiopulmonary Bypass: A Beneficial Effect of Aprotinin? Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/seva.2001.28175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This review considers the evidence for potential central nervous system benefits associated with use of anti- protease therapy for patients undergoing procedures involving cardiopulmonary bypass. Unfortunately, few randomized, controlled clinical trials have assessed the lysine analogue class of antifibrinolytics (ie, ∈-amino caproic acid, tranexamic acid) compared with the num ber investigating the efficacy of the enzyme-inactivator class of antifibrinolytic typified by the nonspecific serine protease inhibitors aprotinin and nafamostat.
Collapse
|
112
|
Taylor ZJ, Hui ES, Watson AN, Nie X, Deardorff RL, Jensen JH, Helpern JA, Shih AY. Microvascular basis for growth of small infarcts following occlusion of single penetrating arterioles in mouse cortex. J Cereb Blood Flow Metab 2016; 36:1357-73. [PMID: 26661182 PMCID: PMC4976746 DOI: 10.1177/0271678x15608388] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 07/02/2015] [Indexed: 01/08/2023]
Abstract
Small cerebral infarcts, i.e. microinfarcts, are common in the aging brain and linked to vascular cognitive impairment. However, little is known about the acute growth of these minute lesions and their effect on blood flow in surrounding tissues. We modeled microinfarcts in the mouse cortex by inducing photothrombotic clots in single penetrating arterioles. The resultant hemodynamic changes in tissues surrounding the occluded vessel were then studied using in vivo two-photon microscopy. We were able to generate a spectrum of infarct volumes by occluding arterioles that carried a range of blood fluxes. Those resulting from occlusion of high-flux penetrating arterioles (flux of 2 nL/s or higher) exhibited a radial outgrowth that encompassed unusually large tissue volumes. The gradual expansion of these infarcts was propagated by an evolving insufficiency in capillary flow that encroached on territories of neighboring penetrating arterioles, leading to the stagnation and recruitment of their perfusion domains into the final infarct volume. Our results suggest that local collapse of microvascular function contributes to tissue damage incurred by single penetrating arteriole occlusions in mice, and that a similar mechanism may add to pathophysiology induced by microinfarcts of the human brain.
Collapse
Affiliation(s)
- Zachary J Taylor
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Edward S Hui
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
| | - Ashley N Watson
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA
| | - Xingju Nie
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Rachael L Deardorff
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Jens H Jensen
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Joseph A Helpern
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| | - Andy Y Shih
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA Center for Biomedical Imaging, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
113
|
Chamorro Á, Dirnagl U, Urra X, Planas AM. Neuroprotection in acute stroke: targeting excitotoxicity, oxidative and nitrosative stress, and inflammation. Lancet Neurol 2016; 15:869-881. [DOI: 10.1016/s1474-4422(16)00114-9] [Citation(s) in RCA: 556] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/15/2016] [Accepted: 03/03/2016] [Indexed: 01/04/2023]
|
114
|
Kurisu K, Abumiya T, Nakamura H, Shimbo D, Shichinohe H, Nakayama N, Kazumata K, Shimizu H, Houkin K. Transarterial Regional Brain Hypothermia Inhibits Acute Aquaporin-4 Surge and Sequential Microvascular Events in Ischemia/Reperfusion Injury. Neurosurgery 2016; 79:125-34. [DOI: 10.1227/neu.0000000000001088] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
115
|
Abstract
Despite more than 30 years of aggressive neuroprotective research by many investigators, neuropsychological deficit after cardiac surgery remains an important cause of postoperative morbidity. Although the neurological outcome is a result of a multifactorial etiology, many physicians world-wide have recognized the importance of this problem, and extensive efforts have been made in attempting to minimize the incidence of neurological and neurocognitive dysfunction. Pharmacological intervention is one of the important potential methods of neuroprotection during cardiac surgery. In vitro studies have identified drugs that are effective protectants against focal cerebral ischemia, hemorrhage, and global ischemia. However, at present there is no solid agreement on the need for prophylactic neuroprotectants in cardiac surgery. Researchers and clinicians must become more cognizant of the pitfalls and paradoxes that have arisen in attempting to translate the results of animal studies into clinical trial, with regard to neuroprotective therapy during cardiac surgery. There is an extensive need for new pharmacological approaches directed at reducing neurologic and neurocognitive injury during cardiac surgery. This article reviews past and present neuroprotective efforts and interventions during cardiac surgery.
Collapse
Affiliation(s)
- Yuji Kadoi
- Department of Anesthesiology, Gunma University, Graduate School of Medicine, Gunma, Japan.
| |
Collapse
|
116
|
Takeishi N, Imai Y, Ishida S, Omori T, Kamm RD, Ishikawa T. Cell adhesion during bullet motion in capillaries. Am J Physiol Heart Circ Physiol 2016; 311:H395-403. [PMID: 27261363 DOI: 10.1152/ajpheart.00241.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/31/2016] [Indexed: 01/13/2023]
Abstract
A numerical analysis is presented of cell adhesion in capillaries whose diameter is comparable to or smaller than that of the cell. In contrast to a large number of previous efforts on leukocyte and tumor cell rolling, much is still unknown about cell motion in capillaries. The solid and fluid mechanics of a cell in flow was coupled with a slip bond model of ligand-receptor interactions. When the size of a capillary was reduced, the cell always transitioned to "bullet-like" motion, with a consequent decrease in the velocity of the cell. A state diagram was obtained for various values of capillary diameter and receptor density. We found that bullet motion enables firm adhesion of a cell to the capillary wall even for a weak ligand-receptor binding. We also quantified effects of various parameters, including the dissociation rate constant, the spring constant, and the reactive compliance on the characteristics of cell motion. Our results suggest that even under the interaction between P-selectin glycoprotein ligand-1 (PSGL-1) and P-selectin, which is mainly responsible for leukocyte rolling, a cell is able to show firm adhesion in a small capillary. These findings may help in understanding such phenomena as leukocyte plugging and cancer metastasis.
Collapse
Affiliation(s)
- Naoki Takeishi
- Graduate School of Biomedical Engineering, Tohoku University, Aoba, Sendai, Japan
| | - Yohsuke Imai
- School of Engineering, Tohoku University, Aoba, Sendai, Japan;
| | - Shunichi Ishida
- Graduate School of Biomedical Engineering, Tohoku University, Aoba, Sendai, Japan
| | - Toshihiro Omori
- School of Engineering, Tohoku University, Aoba, Sendai, Japan
| | - Roger D Kamm
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts; and Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Takuji Ishikawa
- Graduate School of Biomedical Engineering, Tohoku University, Aoba, Sendai, Japan; School of Engineering, Tohoku University, Aoba, Sendai, Japan
| |
Collapse
|
117
|
Leukocyte plugging and cortical capillary flow after subarachnoid hemorrhage. Acta Neurochir (Wien) 2016; 158:1057-67. [PMID: 27040552 DOI: 10.1007/s00701-016-2792-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND It is believed that increased intracranial pressure immediately after subarachnoid hemorrhage (SAH) causes extensive brain ischemia and results in worsening clinical status. Arterial flow to the cerebral surfaces is clinically well maintained during clipping surgery regardless of the severity of the World Federation of Neurological Societies grade after SAH. To explore what kinds of changes occur in the cortical microcirculation, not at the cerebral surface, we examined cortical microcirculation after SAH using two-photon laser scanning microscopy (TPLSM). METHODS SAH was induced in mice with an endovascular perforation model. Following continuous injection of rhodamine 6G, velocities of labeled platelets and leukocytes and unlabeled red blood cells (RBCs) were measured in the cortical capillaries 60 min after SAH with a line-scan method using TPLSM, and the data were compared to a sham group and P-selectin monoclonal antibody-treated group. RESULTS Velocities of leukocytes, platelets, and RBCs in capillaries decreased significantly 60 min after SAH. Rolling and adherent leukocytes suddenly prevented other blood cells from flowing in the capillaries. Flowing blood cells also decreased significantly in each capillary after SAH. This no-reflow phenomenon induced by plugging leukocytes was often observed in the SAH group but not in the sham group. The decreased velocities of blood cells were reversed by pretreatment with the monoclonal antibody of P-selection, an adhesion molecule expressed on the surfaces of both endothelial cells and platelets. CONCLUSIONS SAH caused sudden worsening of cortical microcirculation at the onset. Leukocyte plugging in capillaries is one of the reasons why cortical microcirculation is aggravated after SAH.
Collapse
|
118
|
Ahnstedt H, Sweet J, Cruden P, Bishop N, Cipolla MJ. Effects of Early Post-Ischemic Reperfusion and tPA on Cerebrovascular Function and Nitrosative Stress in Female Rats. Transl Stroke Res 2016; 7:228-38. [PMID: 27125535 DOI: 10.1007/s12975-016-0468-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/11/2016] [Accepted: 04/19/2016] [Indexed: 01/13/2023]
Abstract
Stroke is a major health issue in women. Our previous studies in male rats showed decreased myogenic tone in middle cerebral arteries (MCAs) after ischemia and reperfusion (I/R), while tone in parenchymal arterioles (PAs) was increased. This vascular response may aggravate stroke damage in males by limiting reperfusion; however, the effect in females is not known. The current study investigated the effect of I/R and tissue plasminogen activator (tPA) on myogenic tone and reactivity of MCAs and PAs in female rats. Nitrosative stress by peroxynitrite and recruitment of inflammatory neutrophils to the microvasculature were also studied. Female rats were subjected to 2-h MCA filament occlusion (n = 16) or sham surgery (n = 17) and given tPA (1 mg/kg, i.v) or vehicle followed by 30-min reperfusion. Myogenic tone and reactivity were measured in isolated and pressurized MCAs and PAs from the same animals. Cerebrovascular F-actin, 3-nitrotyrosine (3-NT, peroxynitrite marker), and intravascular neutrophils were quantified. Myogenic tone and constriction to the nitric oxide synthase inhibitor Nω-nitro-L-arginine were decreased in MCAs but unchanged in PAs after I/R with no effect of tPA. F-actin and 3-NT expression were unaffected by I/R or tPA. Our study showed that MCAs from females, similar to what has been seen in males, are dilated after I/R and have decreased myogenic tone while tone in PAs was unchanged. Increased small vessel resistance may contribute to decreased reperfusion and worse outcome after stroke.
Collapse
Affiliation(s)
- Hilda Ahnstedt
- Department of Neurological Sciences, University of Vermont College of Medicine, HSRF 416A, 149 Beaumont Avenue, Burlington, VT, 05405, USA
| | - Julie Sweet
- Department of Neurological Sciences, University of Vermont College of Medicine, HSRF 416A, 149 Beaumont Avenue, Burlington, VT, 05405, USA
| | - Patrick Cruden
- Department of Neurological Sciences, University of Vermont College of Medicine, HSRF 416A, 149 Beaumont Avenue, Burlington, VT, 05405, USA
| | - Nicole Bishop
- Department of Neurological Sciences, University of Vermont College of Medicine, HSRF 416A, 149 Beaumont Avenue, Burlington, VT, 05405, USA
| | - Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont College of Medicine, HSRF 416A, 149 Beaumont Avenue, Burlington, VT, 05405, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA.
| |
Collapse
|
119
|
Burrows F, Haley MJ, Scott E, Coutts G, Lawrence CB, Allan SM, Schiessl I. Systemic inflammation affects reperfusion following transient cerebral ischaemia. Exp Neurol 2016; 277:252-260. [PMID: 26795089 PMCID: PMC4767324 DOI: 10.1016/j.expneurol.2016.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/13/2016] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
Reperfusion after stroke is critical for improved patient survival and recovery and can be achieved clinically through pharmacological (recombinant tissue plasminogen activator) or physical (endovascular intervention) means. Yet these approaches remain confined to a small percentage of stroke patients, often with incomplete reperfusion, and therefore there is an urgent need to learn more about the mechanisms underlying the no-reflow phenomenon that prevents restoration of adequate microvascular perfusion. Recent evidence suggests systemic inflammation as an important contributor to no-reflow and to further investigate this here we inject interleukin 1 (IL-1) i.p. 30 min prior to an ischaemic challenge using a remote filament to occlude the middle cerebral artery (MCA) in mice. Before, during and after the injection of IL-1 and occlusion we use two-dimensional optical imaging spectroscopy to record the spatial and temporal dynamics of oxyhaemoglobin concentration in the cortical areas supplied by the MCA. Our results reveal that systemic inflammation significantly reduces oxyhaemoglobin reperfusion as early as 3h after filament removal compared to vehicle injected animals. CD41 immunohistochemistry shows a significant increase of hyper-coagulated platelets within the microvessels in the stroked cortex of the IL-1 group compared to vehicle. We also observed an increase of pathophysiological biomarkers of ischaemic damage including elevated microglial activation co-localized with interleukin 1α (IL-1α), increased blood brain barrier breakdown as shown by IgG infiltration and increased pyknotic morphological changes of cresyl violet stained neurons. These data confirm systemic inflammation as an underlying cause of no-reflow in the post-ischaemic brain and that appropriate anti-inflammatory approaches could be beneficial in treating ischaemic stroke.
Collapse
Affiliation(s)
- F Burrows
- Faculty of Life Sciences, The University of Manchester, Stopford Building, Oxford Road, M13 9PT Manchester, UK
| | - M J Haley
- Faculty of Life Sciences, The University of Manchester, Stopford Building, Oxford Road, M13 9PT Manchester, UK
| | - E Scott
- Faculty of Life Sciences, The University of Manchester, Stopford Building, Oxford Road, M13 9PT Manchester, UK
| | - G Coutts
- Faculty of Life Sciences, The University of Manchester, Stopford Building, Oxford Road, M13 9PT Manchester, UK
| | - C B Lawrence
- Faculty of Life Sciences, The University of Manchester, Stopford Building, Oxford Road, M13 9PT Manchester, UK
| | - S M Allan
- Faculty of Life Sciences, The University of Manchester, Stopford Building, Oxford Road, M13 9PT Manchester, UK
| | - I Schiessl
- Faculty of Life Sciences, The University of Manchester, Stopford Building, Oxford Road, M13 9PT Manchester, UK.
| |
Collapse
|
120
|
Boyajian RA, Sobel DF, DeLaria GA, Otis SM. Embolic Stroke As a Sequela of Cardiopulmonary Bypass. J Neuroimaging 2016; 3:1-5. [DOI: 10.1111/jon1993311] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
121
|
del Zoppo GJ, Moskowitz M, Nedergaard M. The Neurovascular Unit and Responses to Ischemia. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
122
|
Mechanisms of Cerebral Hemorrhage. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
123
|
Anrather J, Iadecola C, Hallenbeck J. Inflammation and Immune Response. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
124
|
Amantea D, Certo M, Petrelli F, Tassorelli C, Micieli G, Corasaniti MT, Puccetti P, Fallarino F, Bagetta G. Azithromycin protects mice against ischemic stroke injury by promoting macrophage transition towards M2 phenotype. Exp Neurol 2015; 275 Pt 1:116-25. [PMID: 26518285 DOI: 10.1016/j.expneurol.2015.10.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/28/2015] [Accepted: 10/26/2015] [Indexed: 01/18/2023]
Abstract
To develop novel and effective treatments for ischemic stroke, we investigated the neuroprotective effects of the macrolide antibiotic azithromycin in a mouse model system of transient middle cerebral artery occlusion. Intraperitoneal administration of azithromycin significantly reduced blood-brain barrier damage and cerebral infiltration of myeloid cells, including neutrophils and inflammatory macrophages. These effects resulted in a dose-dependent reduction of cerebral ischemic damage, and in a remarkable amelioration of neurological deficits up to 7 days after the insult. Neuroprotection was associated with increased arginase activity in peritoneal exudate cells, which was followed by the detection of Ym1- and arginase I-immunopositive M2 macrophages in the ischemic area at 24-48 h of reperfusion. Pharmacological inhibition of peritoneal arginase activity counteracted azithromycin-induced neuroprotection, pointing to a major role for drug-induced polarization of migratory macrophages towards a protective, non-inflammatory M2 phenotype.
Collapse
Affiliation(s)
- Diana Amantea
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende (CS), Italy.
| | - Michelangelo Certo
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende (CS), Italy
| | - Francesco Petrelli
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende (CS), Italy
| | - Cristina Tassorelli
- C. Mondino National Neurological Institute, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Paolo Puccetti
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Giacinto Bagetta
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende (CS), Italy
| |
Collapse
|
125
|
Peplow PV. Neuroimmunomodulatory effects of transcranial laser therapy combined with intravenous tPA administration for acute cerebral ischemic injury. Neural Regen Res 2015; 10:1186-90. [PMID: 26487831 PMCID: PMC4590216 DOI: 10.4103/1673-5374.162687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
At present, the only FDA approved treatment for ischemic strokes is intravenous administration of tissue plasminogen activator within 4.5 hours of stroke onset. Owing to this brief window only a small percentage of patients receive tissue plasminogen activator. Transcranial laser therapy has been shown to be effective in animal models of acute ischemic stroke, resulting in significant improvement in neurological score and function. NEST-1 and NEST-2 clinical trials in human patients have demonstrated the safety and positive trends in efficacy of transcranial laser therapy for the treatment of ischemic stroke when initiated close to the time of stroke onset. Combining intravenous tissue plasminogen activator treatment with transcranial laser therapy may provide better functional outcomes. Statins given within 4 weeks of stroke onset improve stroke outcomes at 90 days compared to patients not given statins, and giving statins following transcranial laser therapy may provide an effective treatment for patients not able to be given tissue plasminogen activator due to time constraints.
Collapse
Affiliation(s)
- Philip V Peplow
- Department of Anatomy, University of Otago, Dunedin, New Zealand
| |
Collapse
|
126
|
Granger DN, Kvietys PR. Reperfusion injury and reactive oxygen species: The evolution of a concept. Redox Biol 2015; 6:524-551. [PMID: 26484802 PMCID: PMC4625011 DOI: 10.1016/j.redox.2015.08.020] [Citation(s) in RCA: 936] [Impact Index Per Article: 104.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 12/11/2022] Open
Abstract
Reperfusion injury, the paradoxical tissue response that is manifested by blood flow-deprived and oxygen-starved organs following the restoration of blood flow and tissue oxygenation, has been a focus of basic and clinical research for over 4-decades. While a variety of molecular mechanisms have been proposed to explain this phenomenon, excess production of reactive oxygen species (ROS) continues to receive much attention as a critical factor in the genesis of reperfusion injury. As a consequence, considerable effort has been devoted to identifying the dominant cellular and enzymatic sources of excess ROS production following ischemia-reperfusion (I/R). Of the potential ROS sources described to date, xanthine oxidase, NADPH oxidase (Nox), mitochondria, and uncoupled nitric oxide synthase have gained a status as the most likely contributors to reperfusion-induced oxidative stress and represent priority targets for therapeutic intervention against reperfusion-induced organ dysfunction and tissue damage. Although all four enzymatic sources are present in most tissues and are likely to play some role in reperfusion injury, priority and emphasis has been given to specific ROS sources that are enriched in certain tissues, such as xanthine oxidase in the gastrointestinal tract and mitochondria in the metabolically active heart and brain. The possibility that multiple ROS sources contribute to reperfusion injury in most tissues is supported by evidence demonstrating that redox-signaling enables ROS produced by one enzymatic source (e.g., Nox) to activate and enhance ROS production by a second source (e.g., mitochondria). This review provides a synopsis of the evidence implicating ROS in reperfusion injury, the clinical implications of this phenomenon, and summarizes current understanding of the four most frequently invoked enzymatic sources of ROS production in post-ischemic tissue. Reperfusion injury is implicated in a variety of human diseases and disorders. Evidence implicating ROS in reperfusion injury continues to grow. Several enzymes are candidate sources of ROS in post-ischemic tissue. Inter-enzymatic ROS-dependent signaling enhances the oxidative stress caused by I/R. .
Collapse
Affiliation(s)
- D Neil Granger
- Department of Molecular & Cellular Physiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130-3932, United States.
| | - Peter R Kvietys
- Department of Physiological Sciences, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
127
|
Desilles JP, Loyau S, Syvannarath V, Gonzalez-Valcarcel J, Cantier M, Louedec L, Lapergue B, Amarenco P, Ajzenberg N, Jandrot-Perrus M, Michel JB, Ho-Tin-Noe B, Mazighi M. Alteplase Reduces Downstream Microvascular Thrombosis and Improves the Benefit of Large Artery Recanalization in Stroke. Stroke 2015; 46:3241-8. [PMID: 26443832 DOI: 10.1161/strokeaha.115.010721] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Downstream microvascular thrombosis (DMT) is known to be a contributing factor to incomplete reperfusion in acute ischemic stroke. The aim of this study was to determine the timing of DMT with intravital imaging and to test the hypothesis that intravenous alteplase infusion could reduce DMT in a transient middle cerebral artery occlusion (MCAO) rat stroke model. METHODS Rats were subjected to 60-minute transient MCAO. Alteplase (10 mg/kg) was administered 30 minutes after the beginning of MCAO. Real-time intravital fluorescence microscopy through a dura-sparing craniotomy was used to visualize circulating blood cells and fibrinogen. Cerebral microvessel patency was quantitatively evaluated by fluorescein isothiocyanate-dextran perfusion. RESULTS Immediately after MCAO, platelet and leukocyte accumulation were observed mostly in the venous compartment. Within 30 minutes after MCAO, microthrombi and parietal fibrin deposits were detected in postcapillary microvessels. Alteplase treatment significantly (P=0.006) reduced infarct volume and increased the percentage of perfused vessels during MCAO (P=0.02) compared with saline. Plasma levels of fibrinogen from alteplase-treated rats showed a rapid and profound hypofibrinogenemia. In vitro platelet aggregation demonstrated that alteplase reduced platelet aggregation (P=0.0001) and facilitated platelet disaggregation (P=0.001). These effects were reversible in the presence of exogenous fibrinogen. CONCLUSIONS Our data demonstrate that DMT is an early phenomenon initiated before recanalization. We further show that alteplase-dependent maintenance of downstream perfusion during MCAO improves acute ischemic stroke outcome through a fibrinogen-dependent platelet aggregation reduction. Our results indicate that early targeting of DMT represents a therapeutic strategy to improve the benefit of large artery recanalization in acute ischemic stroke.
Collapse
Affiliation(s)
- Jean-Philippe Desilles
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.).
| | - Stephane Loyau
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Varouna Syvannarath
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Jaime Gonzalez-Valcarcel
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Marie Cantier
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Liliane Louedec
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Bertrand Lapergue
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Pierre Amarenco
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Nadine Ajzenberg
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Martine Jandrot-Perrus
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Jean-Baptiste Michel
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Benoit Ho-Tin-Noe
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| | - Mikael Mazighi
- From the Univ Paris Diderot, Sorbonne Paris Cite, Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France (J.-P.D., S.L., V.S., J.G.-V., M.C., L.L., P.A., N.A., M.J.-P., J.-B.M., B.H.-T.-N., M.M.); Division of Neurology, Stroke Center, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Paris, France (B.L.); Departments of Neurology and Stroke Center (P.A.) and Hematology (N.A.), AP-HP, Bichat Hospital, Paris, France; and Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, DHU Neurovasc, Paris, France (M.M.)
| |
Collapse
|
128
|
Dalkara T, Alarcon-Martinez L. Cerebral microvascular pericytes and neurogliovascular signaling in health and disease. Brain Res 2015; 1623:3-17. [DOI: 10.1016/j.brainres.2015.03.047] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/10/2015] [Accepted: 03/27/2015] [Indexed: 02/07/2023]
|
129
|
Fluri F, Schuhmann MK, Kleinschnitz C. Animal models of ischemic stroke and their application in clinical research. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:3445-54. [PMID: 26170628 PMCID: PMC4494187 DOI: 10.2147/dddt.s56071] [Citation(s) in RCA: 242] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review outlines the most frequently used rodent stroke models and discusses their strengths and shortcomings. Mimicking all aspects of human stroke in one animal model is not feasible because ischemic stroke in humans is a heterogeneous disorder with a complex pathophysiology. The transient or permanent middle cerebral artery occlusion (MCAo) model is one of the models that most closely simulate human ischemic stroke. Furthermore, this model is characterized by reliable and well-reproducible infarcts. Therefore, the MCAo model has been involved in the majority of studies that address pathophysiological processes or neuroprotective agents. Another model uses thromboembolic clots and thus is more convenient for investigating thrombolytic agents and pathophysiological processes after thrombolysis. However, for many reasons, preclinical stroke research has a low translational success rate. One factor might be the choice of stroke model. Whereas the therapeutic responsiveness of permanent focal stroke in humans declines significantly within 3 hours after stroke onset, the therapeutic window in animal models with prompt reperfusion is up to 12 hours, resulting in a much longer action time of the investigated agent. Another major problem of animal stroke models is that studies are mostly conducted in young animals without any comorbidity. These models differ from human stroke, which particularly affects elderly people who have various cerebrovascular risk factors. Choosing the most appropriate stroke model and optimizing the study design of preclinical trials might increase the translational potential of animal stroke models.
Collapse
Affiliation(s)
- Felix Fluri
- Department of Neurology, University Clinic Wuerzburg, Wuerzburg, Germany
| | | | | |
Collapse
|
130
|
Hill RA, Tong L, Yuan P, Murikinati S, Gupta S, Grutzendler J. Regional Blood Flow in the Normal and Ischemic Brain Is Controlled by Arteriolar Smooth Muscle Cell Contractility and Not by Capillary Pericytes. Neuron 2015; 87:95-110. [PMID: 26119027 PMCID: PMC4487786 DOI: 10.1016/j.neuron.2015.06.001] [Citation(s) in RCA: 489] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/24/2015] [Accepted: 05/22/2015] [Indexed: 01/25/2023]
Abstract
The precise regulation of cerebral blood flow is critical for normal brain function, and its disruption underlies many neuropathologies. The extent to which smooth muscle-covered arterioles or pericyte-covered capillaries control vasomotion during neurovascular coupling remains controversial. We found that capillary pericytes in mice and humans do not express smooth muscle actin and are morphologically and functionally distinct from adjacent precapillary smooth muscle cells (SMCs). Using optical imaging we investigated blood flow regulation at various sites on the vascular tree in living mice. Optogenetic, whisker stimulation, or cortical spreading depolarization caused microvascular diameter or flow changes in SMC but not pericyte-covered microvessels. During early stages of brain ischemia, transient SMC but not pericyte constrictions were a major cause of hypoperfusion leading to thrombosis and distal microvascular occlusions. Thus, capillary pericytes are not contractile, and regulation of cerebral blood flow in physiological and pathological conditions is mediated by arteriolar SMCs.
Collapse
Affiliation(s)
- Robert A Hill
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA; Department of Neurobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Lei Tong
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA; Department of Neurobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Peng Yuan
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA; Department of Neurobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Sasidhar Murikinati
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA; Department of Neurobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Shobhana Gupta
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA; Department of Neurobiology, Yale School of Medicine, New Haven, CT 06510, USA
| | - Jaime Grutzendler
- Department of Neurology, Yale School of Medicine, New Haven, CT 06510, USA; Department of Neurobiology, Yale School of Medicine, New Haven, CT 06510, USA.
| |
Collapse
|
131
|
Hawkins BT, Gu YH, Izawa Y, del Zoppo GJ. Dabigatran abrogates brain endothelial cell permeability in response to thrombin. J Cereb Blood Flow Metab 2015; 35:985-92. [PMID: 25669912 PMCID: PMC4640263 DOI: 10.1038/jcbfm.2015.9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/07/2014] [Accepted: 12/09/2014] [Indexed: 12/21/2022]
Abstract
Atrial fibrillation (AF) increases the risk and severity of thromboembolic stroke. Generally, antithrombotic agents increase the hemorrhagic risk of thromboembolic stroke. However, significant reductions in thromboembolism and intracerebral hemorrhage have been shown with the antithrombin dabigatran compared with warfarin. As thrombin has been implicated in microvessel injury during cerebral ischemia, we hypothesized that dabigatran decreases the risk of intracerebral hemorrhage by direct inhibition of the thrombin-mediated increase in cerebral endothelial cell permeability. Primary murine brain endothelial cells (mBECs) were exposed to murine thrombin before measuring permeability to 4-kDa fluorescein isothiocyanate-dextran. Thrombin increased mBEC permeability in a concentration-dependent manner, without significant endothelial cell death. Pretreatment of mBECs with dabigatran completely abrogated the effect of thrombin on permeability. Neither the expressions of the endothelial cell β1-integrins nor the tight junction protein claudin-5 were affected by thrombin exposure. Oxygen-glucose deprivation (OGD) also increased permeability; this effect was abrogated by treatment with dabigatran, as was the additive effect of thrombin and OGD on permeability. Taken together, these results indicate that dabigatran could contribute to a lower risk of intracerebral hemorrhage during embolism-associated ischemia from AF by protection of the microvessel permeability barrier from local thrombin challenge.
Collapse
Affiliation(s)
- Brian Thomas Hawkins
- Department of Medicine (Hematology), Division of Hematology, Seattle, Washington, USA
| | - Yu-Huan Gu
- Department of Medicine (Hematology), Division of Hematology, Seattle, Washington, USA
| | - Yoshikane Izawa
- Department of Medicine (Hematology), Division of Hematology, Seattle, Washington, USA
| | - Gregory John del Zoppo
- 1] Department of Medicine (Hematology), Division of Hematology, Seattle, Washington, USA [2] Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
132
|
Amantea D, Micieli G, Tassorelli C, Cuartero MI, Ballesteros I, Certo M, Moro MA, Lizasoain I, Bagetta G. Rational modulation of the innate immune system for neuroprotection in ischemic stroke. Front Neurosci 2015; 9:147. [PMID: 25972779 PMCID: PMC4413676 DOI: 10.3389/fnins.2015.00147] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/09/2015] [Indexed: 01/08/2023] Open
Abstract
The innate immune system plays a dualistic role in the evolution of ischemic brain damage and has also been implicated in ischemic tolerance produced by different conditioning stimuli. Early after ischemia, perivascular astrocytes release cytokines and activate metalloproteases (MMPs) that contribute to blood–brain barrier (BBB) disruption and vasogenic oedema; whereas at later stages, they provide extracellular glutamate uptake, BBB regeneration and neurotrophic factors release. Similarly, early activation of microglia contributes to ischemic brain injury via the production of inflammatory cytokines, including tumor necrosis factor (TNF) and interleukin (IL)-1, reactive oxygen and nitrogen species and proteases. Nevertheless, microglia also contributes to the resolution of inflammation, by releasing IL-10 and tumor growth factor (TGF)-β, and to the late reparative processes by phagocytic activity and growth factors production. Indeed, after ischemia, microglia/macrophages differentiate toward several phenotypes: the M1 pro-inflammatory phenotype is classically activated via toll-like receptors or interferon-γ, whereas M2 phenotypes are alternatively activated by regulatory mediators, such as ILs 4, 10, 13, or TGF-β. Thus, immune cells exert a dualistic role on the evolution of ischemic brain damage, since the classic phenotypes promote injury, whereas alternatively activated M2 macrophages or N2 neutrophils prompt tissue remodeling and repair. Moreover, a subdued activation of the immune system has been involved in ischemic tolerance, since different preconditioning stimuli act via modulation of inflammatory mediators, including toll-like receptors and cytokine signaling pathways. This further underscores that the immuno-modulatory approach for the treatment of ischemic stroke should be aimed at blocking the detrimental effects, while promoting the beneficial responses of the immune reaction.
Collapse
Affiliation(s)
- Diana Amantea
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria Rende, Italy
| | | | - Cristina Tassorelli
- C. Mondino National Neurological Institute Pavia, Italy ; Department of Brain and Behavioral Sciences, University of Pavia Pavia, Italy
| | - María I Cuartero
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid and Instituto de Investigación Hospital 12 de Octubre Madrid, Spain
| | - Iván Ballesteros
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid and Instituto de Investigación Hospital 12 de Octubre Madrid, Spain
| | - Michelangelo Certo
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria Rende, Italy
| | - María A Moro
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid and Instituto de Investigación Hospital 12 de Octubre Madrid, Spain
| | - Ignacio Lizasoain
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid and Instituto de Investigación Hospital 12 de Octubre Madrid, Spain
| | - Giacinto Bagetta
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria Rende, Italy ; Section of Neuropharmacology of Normal and Pathological Neuronal Plasticity, University Consortium for Adaptive Disorders and Head Pain, University of Calabria Rende, Italy
| |
Collapse
|
133
|
Crocetin downregulates the proinflammatory cytokines in methylcholanthrene-induced rodent tumor model and inhibits COX-2 expression in cervical cancer cells. BIOMED RESEARCH INTERNATIONAL 2015; 2015:829513. [PMID: 25874230 PMCID: PMC4385625 DOI: 10.1155/2015/829513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 09/11/2014] [Indexed: 11/17/2022]
Abstract
The effect of crocetin (C20H24O4) on methylcholanthrene- (MCA-) induced uterine cervical cancer in mice was studied in this paper. After the mice were treated orally with crocetin, maleic dialdehyde (MDA), polymorphonuclear cells (PMN), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were examined by ELISA or immunohistochemistry. The inducible nitric oxide synthase (iNOS) activation in HeLa cells was analyzed using fluorescence microscopy for light microscopic examination. The MCA mice showed a significant increase in plasma MDA, PMN, IL-1β, TNF-α, and nitrates levels. At the same time, the mRNA level of COX-2 in HeLa cells was also significantly increased. These changes were attenuated by crocetin supplementation in the MCA mice. Crocetin supplementation in the MCA mice also showed protection against cervical cancer. These results suggest that crocetin may act as a chemopreventive and an anti-inflammatory agent.
Collapse
|
134
|
Zhang DW, Wang ZL, Qi W, Lei W, Zhao GY. Cordycepin (3'-deoxyadenosine) down-regulates the proinflammatory cytokines in inflammation-induced osteoporosis model. Inflammation 2015; 37:1044-9. [PMID: 24493324 DOI: 10.1007/s10753-014-9827-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The effect of cordycepin (3'-deoxyadenosine) on inflammation-induced osteoporosis (IMO) was studied in this paper. After the rats were treated orally with cordycepin (20 mg/kg), serum osteocalcin (OC), homocysteine (HCY), C-terminal cross-linked telopeptides of collagen type I (CTX), maleic dialdehyde (MDA), polymorphonuclear cells (PMN), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α), they were examined by ELISA or immunohistochemistry. The specimens from the liver were also processed for light microscopic examination. The IMO rats showed a significant increase in plasma CTX, MDA, PMN, IL-1β, TNF-α, and nitrate levels as well as a significant decrease in plasma OC. These changes were attenuated by cordycepin (20 mg/kg) supplementation in the IMO rats. Examination of the liver specimens revealed mononuclear cell infiltration in the portal areas in the IMO rats which was not detected in the cordycepin (20 mg/kg) rats. These results suggest that cordycepin may act as an anti-inflammatory agent in magnesium silicate-induced inflammation in osteoporosis.
Collapse
Affiliation(s)
- Da-wei Zhang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | | | | | | | | |
Collapse
|
135
|
Mohamed Mokhtarudin MJ, Payne SJ. Mathematical model of the effect of ischemia-reperfusion on brain capillary collapse and tissue swelling. Math Biosci 2015; 263:111-20. [PMID: 25749185 DOI: 10.1016/j.mbs.2015.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/05/2015] [Accepted: 02/25/2015] [Indexed: 11/19/2022]
Abstract
Restoration of an adequate cerebral blood supply after an ischemic attack is a primary clinical goal. However, the blood-brain barrier may break down after a prolonged ischemia causing the fluid in the blood plasma to filtrate and accumulate into the cerebral tissue interstitial space. Accumulation of this filtration fluid causes the cerebral tissue to swell, a condition known as vasogenic oedema. Tissue swelling causes the cerebral microvessels to be compressed, which may further obstruct the blood flow into the tissue, thus leading to the no-reflow phenomenon or a secondary ischemic stroke. The actual mechanism of this however is still not fully understood. A new model is developed here to study the effect of reperfusion on the formation of vasogenic oedema and cerebral microvessel collapse. The formation of vasogenic oedema is modelled using the capillary filtration equation while vessel collapse is modelled using the tube law of microvessel. Tissue swelling is quantified in terms of displacement, which is modelled using poroelastic theory. The results show that there is an increase in tissue displacement and interstitial pressure after reperfusion. In addition, the results also show that vessel collapse can occur at high value of reperfusion pressure, low blood osmotic pressure, high cerebral capillary permeability and low cerebral capillary stiffness. This model provides insight on the formation of ischemia-reperfusion injury by tissue swelling and vessel collapse.
Collapse
Affiliation(s)
- M J Mohamed Mokhtarudin
- Institute of Biomedical Engineering, Department of Engineering Science, Old Road Campus Research Building, University of Oxford, Headington, Oxford OX3 7DQ, UK; Faculty of Mechanical Engineering, University Malaysia Pahang, 26600 Pekan, Pahang, Malaysia.
| | - S J Payne
- Institute of Biomedical Engineering, Department of Engineering Science, Old Road Campus Research Building, University of Oxford, Headington, Oxford OX3 7DQ, UK
| |
Collapse
|
136
|
Murray KN, Parry-Jones AR, Allan SM. Interleukin-1 and acute brain injury. Front Cell Neurosci 2015; 9:18. [PMID: 25705177 PMCID: PMC4319479 DOI: 10.3389/fncel.2015.00018] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/12/2015] [Indexed: 01/05/2023] Open
Abstract
Inflammation is the key host-defense response to infection and injury, yet also a major contributor to a diverse range of diseases, both peripheral and central in origin. Brain injury as a result of stroke or trauma is a leading cause of death and disability worldwide, yet there are no effective treatments, resulting in enormous social and economic costs. Increasing evidence, both preclinical and clinical, highlights inflammation as an important factor in stroke, both in determining outcome and as a contributor to risk. A number of inflammatory mediators have been proposed as key targets for intervention to reduce the burden of stroke, several reaching clinical trial, but as yet yielding no success. Many factors could explain these failures, including the lack of robust preclinical evidence and poorly designed clinical trials, in addition to the complex nature of the clinical condition. Lack of consideration in preclinical studies of associated co-morbidities prevalent in the clinical stroke population is now seen as an important omission in previous work. These co-morbidities (atherosclerosis, hypertension, diabetes, infection) have a strong inflammatory component, supporting the need for greater understanding of how inflammation contributes to acute brain injury. Interleukin (IL)-1 is the prototypical pro-inflammatory cytokine, first identified many years ago as the endogenous pyrogen. Research over the last 20 years or so reveals that IL-1 is an important mediator of neuronal injury and blocking the actions of IL-1 is beneficial in a number of experimental models of brain damage. Mechanisms underlying the actions of IL-1 in brain injury remain unclear, though increasing evidence indicates the cerebrovasculature as a key target. Recent literature supporting this and other aspects of how IL-1 and systemic inflammation in general contribute to acute brain injury are discussed in this review.
Collapse
Affiliation(s)
- Katie N Murray
- Faculty of Life Sciences, University of Manchester Manchester, UK
| | | | - Stuart M Allan
- Faculty of Life Sciences, University of Manchester Manchester, UK
| |
Collapse
|
137
|
Neutrophil recruitment to the brain in mouse and human ischemic stroke. Acta Neuropathol 2015; 129:239-57. [PMID: 25548073 DOI: 10.1007/s00401-014-1381-0] [Citation(s) in RCA: 302] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 12/20/2014] [Accepted: 12/21/2014] [Indexed: 12/15/2022]
Abstract
Neutrophils are rapidly recruited in response to local tissue infection or inflammation. Stroke triggers a strong inflammatory reaction but the relevance of neutrophils in the ischemic brain is not fully understood, particularly in the absence of reperfusion. We investigated brain neutrophil recruitment in two murine models of permanent ischemia induced by either cauterization of the distal portion of the middle cerebral artery (c-MCAo) or intraluminal MCA occlusion (il-MCAo), and three fatal cases of human ischemic stroke. Flow cytometry analyses revealed progressive neutrophil recruitment after c-MCAo, lesser neutrophil recruitment following il-MCAo, and absence of neutrophils after sham operation. Confocal microscopy identified neutrophils in the leptomeninges from 6 h after the occlusion, in the cortical basal lamina and cortical Virchow-Robin spaces from 15 h, and also in the cortical brain parenchyma at 24 h. Neutrophils showed signs of activation including histone-3 citrullination, chromatin decondensation, and extracellular projection of DNA and histones suggestive of extracellular trap formation. Perivascular neutrophils were identified within the entire cortical infarction following c-MCAo. After il-MCAo, neutrophils prevailed in the margins but not the center of the cortical infarct, and were intraluminal and less abundant in the striatum. The lack of collaterals to the striatum and a collapsed pial anastomotic network due to brain edema in large hemispheric infarctions could impair neutrophil trafficking in this model. Neutrophil extravasation at the leptomeninges was also detected in the human tissue. We concluded that neutrophils extravasate from the leptomeningeal vessels and can eventually reach the brain in experimental animal models and humans with prolonged arterial occlusion.
Collapse
|
138
|
Bai J, Lyden PD. Revisiting Cerebral Postischemic Reperfusion Injury: New Insights in Understanding Reperfusion Failure, Hemorrhage, and Edema. Int J Stroke 2015; 10:143-52. [DOI: 10.1111/ijs.12434] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/14/2014] [Indexed: 01/11/2023]
Abstract
Cerebral postischemic reperfusion injury is defined as deterioration of ischemic brain tissue that parallels and antagonizes the benefits of restoring cerebral circulation after therapeutic thrombolysis for acute ischemic stroke. To understand the paradox of injury caused by treatment, we first emphasize the phenomenon in which recanalization of an occluded artery does not lead to tissue reperfusion. Additionally, no-reflow after recanalization may be due to injury of the neurovascular unit, distal microthrombosis, or both, and certainly worsens outcome. We examine the mechanism of molecular and sub-cellular damage in the neurovascular unit, notably oxidative stress, mitochondrial dysfunction, and apoptosis. At the level of the neurovascular unit, which mediates crosstalk between the damaged brain and systemic responses in blood, we summarize emerging evidence demonstrating that individual cell components play unique and cumulative roles that lead to damage of the blood–brain barrier and neurons. Furthermore, we review the latest developments in establishing a link between the immune system and microvascular dysfunction during ischemic reperfusion. Progress in assessing reperfusion injury has also been made, and we review imaging studies using various magnetic resonance imaging modalities. Lastly, we explore potential treatment approaches, including ischemic preconditioning, postconditioning, pharmacologic agents, and hypothermia.
Collapse
Affiliation(s)
- Jilin Bai
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Patrick D. Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
139
|
Gonzalez LM, Moeser AJ, Blikslager AT. Animal models of ischemia-reperfusion-induced intestinal injury: progress and promise for translational research. Am J Physiol Gastrointest Liver Physiol 2015; 308:G63-75. [PMID: 25414098 PMCID: PMC4297854 DOI: 10.1152/ajpgi.00112.2013] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Research in the field of ischemia-reperfusion injury continues to be plagued by the inability to translate research findings to clinically useful therapies. This may in part relate to the complexity of disease processes that result in intestinal ischemia but may also result from inappropriate research model selection. Research animal models have been integral to the study of ischemia-reperfusion-induced intestinal injury. However, the clinical conditions that compromise intestinal blood flow in clinical patients ranges widely from primary intestinal disease to processes secondary to distant organ failure and generalized systemic disease. Thus models that closely resemble human pathology in clinical conditions as disparate as volvulus, shock, and necrotizing enterocolitis are likely to give the greatest opportunity to understand mechanisms of ischemia that may ultimately translate to patient care. Furthermore, conditions that result in varying levels of ischemia may be further complicated by the reperfusion of blood to tissues that, in some cases, further exacerbates injury. This review assesses animal models of ischemia-reperfusion injury as well as the knowledge that has been derived from each to aid selection of appropriate research models. In addition, a discussion of the future of intestinal ischemia-reperfusion research is provided to place some context on the areas likely to provide the greatest benefit from continued research of ischemia-reperfusion injury.
Collapse
Affiliation(s)
- Liara M. Gonzalez
- 1Department of Clinical Sciences, Center for Comparative Medicine and Translational Research, North Carolina State University, Raleigh, North Carolina; and
| | - Adam J. Moeser
- 2Department of Population Health and Pathobiology, Center for Comparative Medicine and Translational Research, North Carolina State University, Raleigh, North Carolina
| | - Anthony T. Blikslager
- 1Department of Clinical Sciences, Center for Comparative Medicine and Translational Research, North Carolina State University, Raleigh, North Carolina; and
| |
Collapse
|
140
|
Yata K, Nishimura Y, Unekawa M, Tomita Y, Suzuki N, Tanaka T, Mizoguchi A, Tomimoto H. In Vivo Imaging of the Mouse Neurovascular Unit Under Chronic Cerebral Hypoperfusion. Stroke 2014; 45:3698-703. [DOI: 10.1161/strokeaha.114.005891] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background and Purpose—
Proper brain function is maintained by an integrated system called the neurovascular unit (NVU) comprised cellular and acellular elements. Although the individual features of specific neurovascular components are understood, it is unknown how they respond to ischemic stress as a functional unit. Therefore, we established an in vivo imaging method and clarified the NVU response to chronic cerebral hypoperfusion.
Methods—
Green mice (b-act-EGFP) with SR101 plasma labeling were used in this experiment. A closed cranial window was made over the left somatosensory cortex. To mimic chronic cerebral hypoperfusion, mice were subjected to bilateral common carotid artery stenosis operations using microcoils. In vivo real-time imaging was performed using 2-photon laser-scanning microscopy during the preoperative period, and after 1 day and 1 and 2 weeks of bilateral common carotid artery stenosis or sham operations.
Results—
Our method allowed 3-dimensional observation of most of the components of the NVU, as well as dynamic capillary microcirculation. Under chronic cerebral hypoperfusion, we did not detect any structural changes of each cellular component in the NVU; however, impairment of microcirculation was detected over a prolonged period. In the pial small arteries and veins, rolling and adhesion of leukocyte were detected, more prominently in the latter. In the deep cortical capillaries, flow stagnation because of leukocyte plugging was frequently observed.
Conclusions—
We established an in vivo imaging method for real-time visualization of the NVU. It seems that under chronic cerebral hypoperfusion, leukocyte activation has a critical role in microcirculation disturbance.
Collapse
Affiliation(s)
- Kenichiro Yata
- From the Department of Neurology (K.Y., H.T.), Department of Molecular and Cellular Pharmacology, Pharmacogenomics and Pharmacoinformatics (Y.N., T.T.), and Department of Neural Regeneration and Cell Communication (A.M.), Mie University Graduate School of Medicine, Tsu, Mie, Japan; and Department of Neurology, Keio University School of Medicine, Shinjuku, Tokyo, Japan (M.U., Y.T., N.S.)
| | - Yuhei Nishimura
- From the Department of Neurology (K.Y., H.T.), Department of Molecular and Cellular Pharmacology, Pharmacogenomics and Pharmacoinformatics (Y.N., T.T.), and Department of Neural Regeneration and Cell Communication (A.M.), Mie University Graduate School of Medicine, Tsu, Mie, Japan; and Department of Neurology, Keio University School of Medicine, Shinjuku, Tokyo, Japan (M.U., Y.T., N.S.)
| | - Miyuki Unekawa
- From the Department of Neurology (K.Y., H.T.), Department of Molecular and Cellular Pharmacology, Pharmacogenomics and Pharmacoinformatics (Y.N., T.T.), and Department of Neural Regeneration and Cell Communication (A.M.), Mie University Graduate School of Medicine, Tsu, Mie, Japan; and Department of Neurology, Keio University School of Medicine, Shinjuku, Tokyo, Japan (M.U., Y.T., N.S.)
| | - Yutaka Tomita
- From the Department of Neurology (K.Y., H.T.), Department of Molecular and Cellular Pharmacology, Pharmacogenomics and Pharmacoinformatics (Y.N., T.T.), and Department of Neural Regeneration and Cell Communication (A.M.), Mie University Graduate School of Medicine, Tsu, Mie, Japan; and Department of Neurology, Keio University School of Medicine, Shinjuku, Tokyo, Japan (M.U., Y.T., N.S.)
| | - Norihiro Suzuki
- From the Department of Neurology (K.Y., H.T.), Department of Molecular and Cellular Pharmacology, Pharmacogenomics and Pharmacoinformatics (Y.N., T.T.), and Department of Neural Regeneration and Cell Communication (A.M.), Mie University Graduate School of Medicine, Tsu, Mie, Japan; and Department of Neurology, Keio University School of Medicine, Shinjuku, Tokyo, Japan (M.U., Y.T., N.S.)
| | - Toshio Tanaka
- From the Department of Neurology (K.Y., H.T.), Department of Molecular and Cellular Pharmacology, Pharmacogenomics and Pharmacoinformatics (Y.N., T.T.), and Department of Neural Regeneration and Cell Communication (A.M.), Mie University Graduate School of Medicine, Tsu, Mie, Japan; and Department of Neurology, Keio University School of Medicine, Shinjuku, Tokyo, Japan (M.U., Y.T., N.S.)
| | - Akira Mizoguchi
- From the Department of Neurology (K.Y., H.T.), Department of Molecular and Cellular Pharmacology, Pharmacogenomics and Pharmacoinformatics (Y.N., T.T.), and Department of Neural Regeneration and Cell Communication (A.M.), Mie University Graduate School of Medicine, Tsu, Mie, Japan; and Department of Neurology, Keio University School of Medicine, Shinjuku, Tokyo, Japan (M.U., Y.T., N.S.)
| | - Hidekazu Tomimoto
- From the Department of Neurology (K.Y., H.T.), Department of Molecular and Cellular Pharmacology, Pharmacogenomics and Pharmacoinformatics (Y.N., T.T.), and Department of Neural Regeneration and Cell Communication (A.M.), Mie University Graduate School of Medicine, Tsu, Mie, Japan; and Department of Neurology, Keio University School of Medicine, Shinjuku, Tokyo, Japan (M.U., Y.T., N.S.)
| |
Collapse
|
141
|
Moon KC, Han SK, Lee YN, Jeong SH, Dhong ES, Kim WK. Effect of normobaric hyperoxic therapy on tissue oxygenation in diabetic feet: A pilot study. J Plast Reconstr Aesthet Surg 2014; 67:1580-6. [DOI: 10.1016/j.bjps.2014.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 05/20/2014] [Accepted: 07/06/2014] [Indexed: 11/16/2022]
|
142
|
Chen J, Fredrickson V, Ding Y, Jiang L, Luo Y, Ji X. The effect of a microcatheter-based selective intra-arterial hypothermia on hemodynamic changes following transient cerebral ischemia. Neurol Res 2014; 37:263-8. [PMID: 25310355 DOI: 10.1179/1743132814y.0000000451] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES We investigated the effect of a microcatheter-based selectively induced intra-arterial hypothermia on hemodynamic changes following transient cerebral ischemia in rats. METHODS Stroke was induced in male Sprague-Dawley rats by a two-hour middle cerebral artery occlusion (MCAO) using a microcatheter. After the two-hour MCAO, 0·9% cold saline (0°C) was selectively infused through a microcatheter. Cerebral blood flow (CBF) in the ischemic brain region was continuously monitored by Laser-Doppler flowmetry (LDF) during the procedure. Following ischemia/reperfusion, serial functional neurologic testing was performed, and cerebral infarct volume was evaluated after 48 hours. RESULTS The local cold saline infusion, via a microcatheter, achieved a rapid induction of brain hypothermia (cerebral cortex from 37·1 ± 0·3 to 30·7 ± 0·4°C; striatum from 37·5 ± 0·3 to 30·9 ± 0·5°C). When compared to the non-treatment group, the local cold saline infusion treatment reduced both post-ischemic hyperperfusion (about 40%, P < 0·01) and delayed post-ischemic hypoperfusion (P < 0·01), improved functional neurological testing (P < 0·01), and reduced both cerebral infarction volume (40·6 ± 5·3 vs. 61·7 ± 8·6%, P < 0·01) and cerebral edema (7·8 ± 2·6 vs.15·4 ± 3·2%, P < 0·01). CONCLUSION Cold saline, when infused directly into the ischemic brain region, can confer robust neuroprotection by reducing immediate post-ischemic hyperperfusion and delayed post-ischemic hypoperfusion.
Collapse
|
143
|
Famakin BM. The Immune Response to Acute Focal Cerebral Ischemia and Associated Post-stroke Immunodepression: A Focused Review. Aging Dis 2014; 5:307-26. [PMID: 25276490 DOI: 10.14336/ad.2014.0500307] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 12/20/2022] Open
Abstract
It is currently well established that the immune system is activated in response to transient or focal cerebral ischemia. This acute immune activation occurs in response to damage, and injury, to components of the neurovascular unit and is mediated by the innate and adaptive arms of the immune response. The initial immune activation is rapid, occurs via the innate immune response and leads to inflammation. The inflammatory mediators produced during the innate immune response in turn lead to recruitment of inflammatory cells and the production of more inflammatory mediators that result in activation of the adaptive immune response. Under ideal conditions, this inflammation gives way to tissue repair and attempts at regeneration. However, for reasons that are just being understood, immunosuppression occurs following acute stroke leading to post-stroke immunodepression. This review focuses on the current state of knowledge regarding innate and adaptive immune activation in response to focal cerebral ischemia as well as the immunodepression that can occur following stroke. A better understanding of the intricate and complex events that take place following immune response activation, to acute cerebral ischemia, is imperative for the development of effective novel immunomodulatory therapies for the treatment of acute stroke.
Collapse
Affiliation(s)
- Bolanle M Famakin
- National Institutes of Health, National Institute of Neurological Diseases and Stroke, Stroke Branch, Branch, Bethesda, MD, 20892, USA
| |
Collapse
|
144
|
Garcia-Bonilla L, Moore JM, Racchumi G, Zhou P, Butler JM, Iadecola C, Anrather J. Inducible nitric oxide synthase in neutrophils and endothelium contributes to ischemic brain injury in mice. THE JOURNAL OF IMMUNOLOGY 2014; 193:2531-7. [PMID: 25038255 DOI: 10.4049/jimmunol.1400918] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
NO produced by inducible NO synthase (iNOS) contributes to ischemic brain injury, but the cell types expressing iNOS and mediating tissue damage have not been elucidated. To examine the relative contribution of iNOS in resident brain cells and peripheral leukocytes infiltrating the ischemic brain, we used bone marrow (BM) chimeric mice in which the middle cerebral artery was occluded and infarct volume was determined 3 d later. iNOS(-/-) mice engrafted with iNOS(+/+) BM exhibited larger infarcts (44 ± 2 mm(3); n = 13; mean ± SE) compared with autologous transplanted iNOS(-/-) mice (24 ± 3 mm(3); n = 10; p < 0.01), implicating blood-borne leukocytes in the damage. Furthermore, iNOS(+/+) mice transplanted with iNOS(-/-) BM had large infarcts (39 ± 6 mm(3); n = 13), similar to those of autologous transplanted iNOS(+/+) mice (39 ± 4 mm(3); n = 14), indicating the resident brain cells also play a role. Flow cytometry and cell sorting revealed that iNOS is highly expressed in neutrophils and endothelium but not microglia. Surprisingly, postischemic iNOS expression was enhanced in the endothelium of iNOS(+/+) mice transplanted with iNOS(-/-) BM and in leukocytes of iNOS(-/-) mice with iNOS(+/+) BM, suggesting that endothelial iNOS suppresses iNOS expression in leukocytes and vice versa. To provide independent evidence that neutrophils mediate brain injury, neutrophils were isolated and transferred to mice 24 h after stroke. Consistent with the result in chimeric mice, transfer of iNOS(+/+), but not iNOS(-/-), neutrophils into iNOS(-/-) mice increased infarct volume. The findings establish that iNOS in both neutrophils and endothelium mediates tissue damage and identify these cell types as putative therapeutic targets for stroke injury.
Collapse
Affiliation(s)
- Lidia Garcia-Bonilla
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10021; and
| | - Jamie M Moore
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10021; and
| | - Gianfranco Racchumi
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10021; and
| | - Ping Zhou
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10021; and
| | - Jason M Butler
- Department of Genetic Medicine, Weill Cornell Medical College, New York, NY 10021
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10021; and
| | - Josef Anrather
- Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY 10021; and
| |
Collapse
|
145
|
Oxidative Stress and the Use of Antioxidants in Stroke. Antioxidants (Basel) 2014; 3:472-501. [PMID: 26785066 PMCID: PMC4665418 DOI: 10.3390/antiox3030472] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/08/2014] [Accepted: 05/14/2014] [Indexed: 12/12/2022] Open
Abstract
Transient or permanent interruption of cerebral blood flow by occlusion of a cerebral artery gives rise to an ischaemic stroke leading to irreversible damage or dysfunction to the cells within the affected tissue along with permanent or reversible neurological deficit. Extensive research has identified excitotoxicity, oxidative stress, inflammation and cell death as key contributory pathways underlying lesion progression. The cornerstone of treatment for acute ischaemic stroke remains reperfusion therapy with recombinant tissue plasminogen activator (rt-PA). The downstream sequelae of events resulting from spontaneous or pharmacological reperfusion lead to an imbalance in the production of harmful reactive oxygen species (ROS) over endogenous anti-oxidant protection strategies. As such, anti-oxidant therapy has long been investigated as a means to reduce the extent of injury resulting from ischaemic stroke with varying degrees of success. Here we discuss the production and source of these ROS and the various strategies employed to modulate levels. These strategies broadly attempt to inhibit ROS production or increase scavenging or degradation of ROS. While early clinical studies have failed to translate success from bench to bedside, the combination of anti-oxidants with existing thrombolytics or novel neuroprotectants may represent an avenue worthy of clinical investigation. Clearly, there is a pressing need to identify new therapeutic alternatives for the vast majority of patients who are not eligible to receive rt-PA for this debilitating and devastating disease.
Collapse
|
146
|
Cipolla MJ, Chan SL, Sweet J, Tavares MJ, Gokina N, Brayden JE. Postischemic reperfusion causes smooth muscle calcium sensitization and vasoconstriction of parenchymal arterioles. Stroke 2014; 45:2425-30. [PMID: 24968928 DOI: 10.1161/strokeaha.114.005888] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Parenchymal arterioles (PAs) are high-resistance vessels in the brain that connect pial vessels to the microcirculation. We previously showed that PAs have increased vasoconstriction after ischemia and reperfusion that could increase perfusion deficit. Here, we investigated underlying mechanisms by which early postischemic reperfusion causes increased vasoconstriction of PAs. METHODS Isolated and pressurized PAs from within the middle cerebral artery territory were studied in male Wistar rats that were either nonischemic control (n=34) or after exposure to transient middle cerebral artery occlusion (MCAO) by filament occlusion for 2 hours with 30 minutes of reperfusion (MCAO; n=38). The relationships among pressure-induced tone, smooth muscle calcium (using Fura 2), and membrane potential were determined. Sensitivity of the contractile apparatus to calcium was measured in permeabilized arterioles using Staphylococcus aureus α-toxin. Reactivity to inhibition of transient receptor potential melastanin receptor type 4 (9-phenanthrol), Rho kinase (Y27632), and protein kinase C (Gö6976) was also measured. RESULTS After MCAO, PAs had increased myogenic tone compared with controls (47±2% versus 35±2% at 40 mm Hg; P<0.01), without an increase in smooth muscle calcium (177±21 versus 201±16 nmol/L; P>0.05) or membrane depolarization (-38±4 versus -36±1 mV; P>0.05). In α-toxin-permeabilized vessels, MCAO caused increased sensitivity of the contractile apparatus to calcium. MCAO did not affect dilation to transient receptor potential melastanin receptor type 4 or protein kinase C inhibition but diminished dilation to Rho kinase inhibition. CONCLUSIONS The increased vasoconstriction of PAs during early postischemic reperfusion seems to be due to calcium sensitization of smooth muscle and could contribute to infarct expansion and limit neuroprotective agents from reaching their target tissue.
Collapse
Affiliation(s)
- Marilyn J Cipolla
- From the Department of Neurological Sciences (M.J.C., S.-L.C., J.S.), Department of Pharmacology (M.J.C., M.J.T., J.E.B.), and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington (M.J.C., N.G.).
| | - Siu-Lung Chan
- From the Department of Neurological Sciences (M.J.C., S.-L.C., J.S.), Department of Pharmacology (M.J.C., M.J.T., J.E.B.), and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington (M.J.C., N.G.)
| | - Julie Sweet
- From the Department of Neurological Sciences (M.J.C., S.-L.C., J.S.), Department of Pharmacology (M.J.C., M.J.T., J.E.B.), and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington (M.J.C., N.G.)
| | - Matthew J Tavares
- From the Department of Neurological Sciences (M.J.C., S.-L.C., J.S.), Department of Pharmacology (M.J.C., M.J.T., J.E.B.), and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington (M.J.C., N.G.)
| | - Natalia Gokina
- From the Department of Neurological Sciences (M.J.C., S.-L.C., J.S.), Department of Pharmacology (M.J.C., M.J.T., J.E.B.), and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington (M.J.C., N.G.)
| | - Joseph E Brayden
- From the Department of Neurological Sciences (M.J.C., S.-L.C., J.S.), Department of Pharmacology (M.J.C., M.J.T., J.E.B.), and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont, Burlington (M.J.C., N.G.)
| |
Collapse
|
147
|
Polymorphonuclear neutrophil in brain parenchyma after experimental intracerebral hemorrhage. Transl Stroke Res 2014; 5:554-61. [PMID: 24696130 DOI: 10.1007/s12975-014-0341-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 01/08/2023]
Abstract
Polymorphonuclear neutrophils (PMNs) infiltration into brain parenchyma after cerebrovascular accidents is viewed as a key component of secondary brain injury. Interestingly, a recent study of ischemic stroke suggests that after ischemic stroke, PMNs do not enter brain parenchyma and as such may cause no harm to the brain. Thus, the present study was designed to determine PMNs' behavior after intracerebral hemorrhage (ICH). Using the autologous blood injection model of ICH in rats and immunohistochemistry for PMNs and vascular components, we evaluated the temporal and spatial PMNs distribution in the ICH-affected brain. We found that, similar to ischemia, there is a robust increase in presence of PMNs in the ICH-injured tissue that lasts for at least 1 to 2 weeks. However, in contrast to what was suggested for ischemia, besides PMNs that stay in association with the vasculature, after ICH, we found abundance of intraparenchymal PMNs (with no obvious association with vessels) in the ICH core and hematoma border, especially between 1 and 7 days after the ictus. Interestingly, the increased presence of intraparenchymal PMNs after ICH coincided with the massive loss of microvascular integrity, suggesting vascular disruption as a potential cause of PMNs presence in the brain parenchyma. Our study indicates that in contrast to ischemic stroke, after ICH, PMNs target not only vascular compartment but also brain parenchyma in the affected brain. As such, it is possible that the pathogenic role and therapeutic implications of targeting PMNs after ICH could be different from these after ischemic stroke. Our work suggests the needs for more studies addressing the role of PMNs in ICH.
Collapse
|
148
|
Sladojevic N, Stamatovic SM, Keep RF, Grailer JJ, Sarma JV, Ward PA, Andjelkovic AV. Inhibition of junctional adhesion molecule-A/LFA interaction attenuates leukocyte trafficking and inflammation in brain ischemia/reperfusion injury. Neurobiol Dis 2014; 67:57-70. [PMID: 24657919 DOI: 10.1016/j.nbd.2014.03.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 02/27/2014] [Accepted: 03/13/2014] [Indexed: 11/15/2022] Open
Abstract
Proinflammatory mediators trigger intensive postischemic inflammatory remodeling of the blood-brain barrier (BBB) including extensive brain endothelial cell surface and junctional complex changes. Junctional adhesion molecule-A (JAM-A) is a component of the brain endothelial junctional complex with dual roles: paracellular route occlusion and regulating leukocyte docking and migration. The current study examined the contribution of JAM-A to the regulation of leukocyte (neutrophils and monocytes/macrophages) infiltration and the postischemic inflammatory response in brain ischemia/reperfusion (I/R injury). Brain I/R injury was induced by transient middle cerebral artery occlusion (MCAO) for 30min in mice followed by reperfusion for 0-5days, during which time JAM-A antagonist peptide (JAM-Ap) was administered. The peptide, which inhibits JAM-A/leukocyte interaction by blocking the interaction of the C2 domain of JAM-A with LFA on neutrophils and monocytes/macrophages, attenuated I/R-induced neutrophil and monocyte infiltration into brain parenchyma. Consequently, mice treated with JAM-A peptide during reperfusion had reduced expression (~3-fold) of inflammatory mediators in the ischemic penumbra, reduced infarct size (94±39 vs 211±38mm3) and significantly improved neurological score. BBB hyperpermeability was also reduced. Collectively, these results indicate that JAM-A has a prominent role in regulating leukocyte infiltration after brain I/R injury and could be a new target in limiting post-ischemic inflammation.
Collapse
Affiliation(s)
- Nikola Sladojevic
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Svetlana M Stamatovic
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Jamison J Grailer
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - J Vidya Sarma
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Peter A Ward
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Anuska V Andjelkovic
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| |
Collapse
|
149
|
Gu Y, Chen J, Shen J. Herbal medicines for ischemic stroke: combating inflammation as therapeutic targets. J Neuroimmune Pharmacol 2014; 9:313-39. [PMID: 24562591 DOI: 10.1007/s11481-014-9525-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/27/2014] [Indexed: 12/23/2022]
Abstract
Stroke is a debilitating disease for which limited therapeutic approaches are available currently. Thus, there is an urgent need for developing novel therapies for stroke. Astrocytes, endothelial cells and pericytes constitute a neurovascular network for metabolic requirement of neurons. During ischemic stroke, these cells contribute to post-ischemic inflammation at multiple stages of ischemic cascades. Upon ischemia onset, activated resident microglia and astrocytes, and infiltrated immune cells release multiple inflammation factors including cytokines, chemokines, enzymes, free radicals and other small molecules, not only inducing brain damage but affecting brain repair. Recent progress indicates that anti-inflammation is an important therapeutic strategy for stroke. Given a long history with direct experience in the treatment of human subjects, Traditional Chinese Medicine and its related natural compounds are recognized as important sources for drug discovery. Last decade, a great progress has been made to identify active compounds from herbal medicines with the properties of modulating post-ischemic inflammation for neuroprotection. Herein, we discuss the inflammatory pathway in early stage and secondary response to injured tissues after stroke from initial artery occlusion to brain repair, and review the active ingredients from natural products with anti-inflammation and neuroprotection effects as therapeutic agents for ischemic stroke. Further studies on the post-ischemic inflammatory mechanisms and corresponding drug candidates from herbal medicine may lead to the development of novel therapeutic strategies in stroke treatment.
Collapse
Affiliation(s)
- Yong Gu
- School of Chinese Medicine, LKS Faculty of Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong, SAR, China
| | | | | |
Collapse
|
150
|
Easton AS. Neutrophils and stroke – Can neutrophils mitigate disease in the central nervous system? Int Immunopharmacol 2013; 17:1218-25. [DOI: 10.1016/j.intimp.2013.06.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 02/15/2013] [Accepted: 06/09/2013] [Indexed: 12/19/2022]
|