101
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Histological reinterpretation of paraphysis cerebri in Ambystoma mexicanum. Acta Histochem 2022; 124:151915. [PMID: 35738026 DOI: 10.1016/j.acthis.2022.151915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
Abstract
Intraventricular and extraventricular choroid plexuses are neuroepithelial folds which arise from the roof of the diencephalon. We describe the circumventricular structure of the diencephalon roof (paraphysis cerebri) during the various development stages of Ambystoma mexicanum. The parasagittal sections of the larvae epithalamus exhibit the presence, in addition to the epiphysis, of two dorsal primordia in nearby areas, which appear to be extraventricular saccular evaginations of different origin that give rise to two structures we define as the anterior extraventricular choroid plexus (AEP) and posterior extraventricular choroid plexus (PEP). During larvae development, the primordia arise perpendicular to each other, grow and show luminal folds and invaginations. Later, the two extraventricular evaginations, which are separate units, become interrelated. As the PEP grows, it covers the AEP dorsally, but it is difficult to define the borders of these organs. AEP is formed by alveolar-acinar epithelial aggregates with evidence of secretion-like content. PEP structure is like a choroid plexus, but its position is extraventricular and dorsal to the AEP. The PEP is always between the AEP and the meninges and can be small or large in size. This means that in A. mexicanum, the paraphysis cerebri is made up of two adjacent organs, which arise almost simultaneously from two different primordia (the AEP and the PEP) and as the posterior one grows, it overlaps the anterior one and masks itself. In conclusion, we suggest that AEP and PEP are homologous to paraphysis cerebri and the dorsal sac, respectively.
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102
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Targeting choroid plexus epithelium as a novel therapeutic strategy for hydrocephalus. J Neuroinflammation 2022; 19:156. [PMID: 35715859 PMCID: PMC9205094 DOI: 10.1186/s12974-022-02500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
The choroid plexus is a tissue located in the lateral ventricles of the brain and is composed mainly of choroid plexus epithelium cells. The main function is currently thought to be the secretion of cerebrospinal fluid and the regulation of its pH, and more functions are gradually being demonstrated. Assistance in the removal of metabolic waste and participation in the apoptotic pathway are also the functions of choroid plexus. Besides, it helps to repair the brain by regulating the secretion of neuropeptides and the delivery of drugs. It is involved in the immune response to assist in the clearance of infections in the central nervous system. It is now believed that the choroid plexus is in an inflammatory state after damage to the brain. This state, along with changes in the cilia, is thought to be an abnormal physiological state of the choroid plexus, which in turn leads to abnormal conditions in cerebrospinal fluid and triggers hydrocephalus. This review describes the pathophysiological mechanism of hydrocephalus following choroid plexus epithelium cell abnormalities based on the normal physiological functions of choroid plexus epithelium cells, and analyzes the attempts and future developments of using choroid plexus epithelium cells as a therapeutic target for hydrocephalus.
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103
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Pardridge WM. A Historical Review of Brain Drug Delivery. Pharmaceutics 2022; 14:1283. [PMID: 35745855 PMCID: PMC9229021 DOI: 10.3390/pharmaceutics14061283] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 12/13/2022] Open
Abstract
The history of brain drug delivery is reviewed beginning with the first demonstration, in 1914, that a drug for syphilis, salvarsan, did not enter the brain, due to the presence of a blood-brain barrier (BBB). Owing to restricted transport across the BBB, FDA-approved drugs for the CNS have been generally limited to lipid-soluble small molecules. Drugs that do not cross the BBB can be re-engineered for transport on endogenous BBB carrier-mediated transport and receptor-mediated transport systems, which were identified during the 1970s-1980s. By the 1990s, a multitude of brain drug delivery technologies emerged, including trans-cranial delivery, CSF delivery, BBB disruption, lipid carriers, prodrugs, stem cells, exosomes, nanoparticles, gene therapy, and biologics. The advantages and limitations of each of these brain drug delivery technologies are critically reviewed.
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Affiliation(s)
- William M Pardridge
- Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
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104
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Xuan X, Zhou G, Chen C, Shao A, Zhou Y, Li X, Zhou J. Glymphatic System: Emerging Therapeutic Target for Neurological Diseases. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:6189170. [PMID: 35726332 PMCID: PMC9206554 DOI: 10.1155/2022/6189170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Abstract
The newly discovered glymphatic system acts as pseudolymphatic vessels subserving brain waste clearance and is functionally dependent on astrocytic aquaporin-4 channels. The glymphatic system primarily functions during sleep as an interchange between cerebrospinal fluid and interstitial fluid, with cerebrospinal fluid flowing into the parenchyma via the perivascular spaces and then exchanging with interstitial fluid. The discovery of meningeal lymphatics helps refine the conceptual framework of glymphatic pathway, as certain waste products collected alongside perivascular spaces ultimately drain into the cervical lymph nodes via meningeal lymphatics, whose function regulates the functioning of the glymphatic system. The glymphatic and meningeal lymphatic systems are critical for the homeostasis of central nervous system, and their malfunctions complicate cerebral dysfunction and diseases. The present review will shed light on the structure, regulation, functions, and interrelationships of the glymphatic system and meningeal lymphatics. We will also expound on their impairments and corresponding targeted intervention in neurodegenerative diseases, traumatic brain injury, stroke, and infectious/autoimmune diseases, offering valuable references for future research.
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Affiliation(s)
- Xianjun Xuan
- Department of Neurology, Hangzhou Ninth People's Hospital, Hangzhou, China
| | - Guoyi Zhou
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Caihong Chen
- Department of Neurology, Hangzhou Ninth People's Hospital, Hangzhou, China
| | - Anwen Shao
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunxiang Zhou
- Department of Surgical Oncology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaobo Li
- Department of Neurology, Hangzhou Ninth People's Hospital, Hangzhou, China
| | - Jiaqi Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, China
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105
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Tuță S. Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension-From Physiopathology to Treatment. Life (Basel) 2022; 12:854. [PMID: 35743885 PMCID: PMC9224858 DOI: 10.3390/life12060854] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 12/23/2022] Open
Abstract
In this review, we provide an update on the pathogenesis, diagnosis, and management of adults with idiopathic intracranial hypertension (IIH) and implications of the cerebral venous system, highlighting the progress made during the past decade with regard to mechanisms of the venous outflow pathway and its connection with the cerebral glymphatic and lymphatic network in genesis of IIH. Early diagnosis and treatment are crucial for favorable visual outcomes and to avoid vision loss, but there is also a risk of overdiagnosis and misdiagnosis in many patients with IIH. We also present details about treatment of intracranial hypertension, which is possible in most cases with a combination of weight loss and drug treatments, but also in selected cases with surgical interventions such as optic nerve sheath fenestration, cerebral spinal fluid (CSF) diversion, or dural venous sinus stenting for some patients with cerebral venous sinus stenosis, after careful analysis of mechanisms of intracranial hypertension, patient clinical profile, and method risks.
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Affiliation(s)
- Sorin Tuță
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, 050471 Bucharest, Romania;
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases, 041914 Bucharest, Romania
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106
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Xu H, Miyajima M, Nakajima M, Ogino I, Kawamura K, Akiba C, Kamohara C, Sakamoto K, Karagiozov K, Nakamura E, Tada N, Arai H, Kondo A. Ptpn20 deletion in H-Tx rats enhances phosphorylation of the NKCC1 cotransporter in the choroid plexus: an evidence of genetic risk for hydrocephalus in an experimental study. Fluids Barriers CNS 2022; 19:39. [PMID: 35658898 PMCID: PMC9164390 DOI: 10.1186/s12987-022-00341-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital hydrocephalus occurs with some inheritable characteristics, but the mechanisms of its development remain poorly understood. Animal models provide the opportunity to identify potential genetic causes in this condition. The Hydrocephalus-Texas (H-Tx) rat strain is one of the most studied animal models for investigating the causative genetic alterations and analyzing downstream pathogenetic mechanisms of congenital hydrocephalus. METHODS Comparative genomic hybridization (CGH) array on non-hydrocephalic and hydrocephalic H-Tx rats was used to identify causative genes of hydrocephalus. Targeted gene knockout mice were generated by CRISPR/Cas9 to study the role of this gene in hydrocephalus. RESULTS CGH array revealed a copy number loss in chromosome 16p16 region in hydrocephalic H-Tx rats at 18 days gestation, encompassing the protein tyrosine phosphatase non-receptor type 20 (Ptpn20), a non-receptor tyrosine phosphatase, without change in most non-hydrocephalic H-Tx rats. Ptpn20-knockout (Ptpn20-/-) mice were generated and found to develop ventriculomegaly at 8 weeks. Furthermore, high expression of phosphorylated Na-K-Cl cotransporter 1 (pNKCC1) was identified in the choroid plexus (CP) epithelium of mice lacking Ptpn20 from 8 weeks until 72 weeks. CONCLUSIONS This study determined the chromosomal location of the hydrocephalus-associated Ptpn20 gene in hydrocephalic H-Tx rats. The high level of pNKCC1 mediated by Ptpn20 deletion in CP epithelium may cause overproduction of cerebrospinal fluid and contribute to the formation of hydrocephalus in Ptpn20-/- mice. Ptpn20 may be a potential therapeutic target in the treatment of hydrocephalus.
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Affiliation(s)
- Hanbing Xu
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan.
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ikuko Ogino
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kaito Kawamura
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Chihiro Akiba
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Chihiro Kamohara
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Koichiro Sakamoto
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Eri Nakamura
- Department of Genetic Analysis Model Laboratory, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Nobuhiro Tada
- Department of Genetic Analysis Model Laboratory, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
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107
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Liu S, Shah DK. Mathematical Models to Characterize the Absorption, Distribution, Metabolism, and Excretion of Protein Therapeutics. Drug Metab Dispos 2022; 50:867-878. [PMID: 35197311 PMCID: PMC11022906 DOI: 10.1124/dmd.121.000460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 01/31/2022] [Indexed: 11/22/2022] Open
Abstract
Therapeutic proteins (TPs) have ranked among the most important and fastest-growing classes of drugs in the clinic, yet the development of successful TPs is often limited by unsatisfactory efficacy. Understanding pharmacokinetic (PK) characteristics of TPs is key to achieving sufficient and prolonged exposure at the site of action, which is a prerequisite for eliciting desired pharmacological effects. PK modeling represents a powerful tool to investigate factors governing in vivo disposition of TPs. In this mini-review, we discuss many state-of-the-art models that recapitulate critical processes in each of the absorption, distribution, metabolism/catabolism, and excretion pathways of TPs, which can be integrated into the physiologically-based pharmacokinetic framework. Additionally, we provide our perspectives on current opportunities and challenges for evolving the PK models to accelerate the discovery and development of safe and efficacious TPs. SIGNIFICANCE STATEMENT: This minireview provides an overview of mechanistic pharmacokinetic (PK) models developed to characterize absorption, distribution, metabolism, and elimination (ADME) properties of therapeutic proteins (TPs), which can support model-informed discovery and development of TPs. As the next-generation of TPs with diverse physicochemical properties and mechanism-of-action are being developed rapidly, there is an urgent need to better understand the determinants for the ADME of TPs and evolve existing platform PK models to facilitate successful bench-to-bedside translation of these promising drug molecules.
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Affiliation(s)
- Shufang Liu
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, New York
| | - Dhaval K Shah
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, The State University of New York at Buffalo, Buffalo, New York
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108
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Insights into the Critical Role of Exosomes in the Brain; from Neuronal Activity to Therapeutic Effects. Mol Neurobiol 2022; 59:4453-4465. [DOI: 10.1007/s12035-022-02853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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109
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Atchley TJ, Vukic B, Vukic M, Walters BC. Review of Cerebrospinal Fluid Physiology and Dynamics: A Call for Medical Education Reform. Neurosurgery 2022; 91:1-7. [PMID: 35522666 DOI: 10.1227/neu.0000000000002000] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The flow of cerebrospinal fluid (CSF) has been described as a unidirectional system with the choroid plexus serving as the primary secretor of CSF and the arachnoid granulations as primary reabsorption site. This theory of neurosurgical forefathers has been universally adopted and taught as dogma. Many neuroscientists have found difficulty reconciling this theory with common pathologies, and recent studies have found that this "classic" hypothesis may not represent the full picture. OBJECTIVE To review modern CSF dynamic theories and to call for medical education reform. METHODS We reviewed the literature from January 1990 to December 2020. We searched the PubMed database using key terms "cerebrospinal fluid circulation," "cerebrospinal fluid dynamics," "cerebrospinal fluid physiology," "glymphatic system," and "glymphatic pathway." We selected articles with a primary aim to discuss either CSF dynamics and/or the glymphatic system. RESULTS The Bulat-Klarica-Orešković hypothesis purports that CSF is secreted and reabsorbed throughout the craniospinal axis. CSF demonstrates similar physiology to that of water elsewhere in the body. CSF "circulates" throughout the subarachnoid space in a pulsatile to-and-fro fashion. Osmolarity plays a critical role in CSF dynamics. Aquaporin-4 and the glymphatic system contribute to CSF volume and flow by establishing osmolarity gradients and facilitating CSF movement. Multiple studies demonstrate that the choroid plexus does not play any significant role in CSF circulation. CONCLUSION We have highlighted major studies to illustrate modern principles of CSF dynamics. Despite these, the medical education system has been slow to reform curricula and update learning resources.
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Affiliation(s)
- Travis J Atchley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Barbara Vukic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Miroslav Vukic
- Department of Neurosurgery, Sisters of Mercy University Hospital, Zagreb, Croatia
| | - Beverly C Walters
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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110
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Juhler M, Hansen TS, Novrup HVG, MacAulay N, Munch TN. Hydrocephalus Study Design: Testing New Hypotheses in Clinical Studies and Bench-to-Bedside Research. World Neurosurg 2022; 161:424-431. [PMID: 35505563 DOI: 10.1016/j.wneu.2021.12.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 10/18/2022]
Abstract
In this article, we aimed to describe some of the currently most challenging problems in neurosurgical management of hydrocephalus and how these can be reasons for inspiration for and development of research. We chose 4 areas of focus: 2 dedicated to improvement of current treatments (shunt implant surgery and endoscopic hydrocephalus surgery) and 2 dedicated to emerging future treatment principles (molecular mechanisms of cerebrospinal fluid secretion and hydrocephalus genetics).
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Affiliation(s)
- Marianne Juhler
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | | | - Hans V G Novrup
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Nanna MacAulay
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Tina Nørgaard Munch
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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111
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Maloveská M, Humeník F, Vikartovská Z, Hudáková N, Almášiová V, Krešáková L, Čížková D. Brain Fluid Channels for Metabolite Removal. Physiol Res 2022; 71:199-208. [DOI: 10.33549/physiolres.934802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The adult human brain represents only 2 % of the body's total weight, however it is one of the most metabolically active organs in the mammalian body. Its high metabolic activity necessitates an efficacious waste clearance system. Besides the blood, there are two fluids closely linked to the brain and spinal cord drainage system: interstitial fluid (ISF) and cerebrospinal fluid (CSF). The aim of this review is to summarize the latest research clarifying the channels of metabolite removal by fluids from brain tissue, subarachnoid space (SAS) and brain dura (BD). Special attention is focused on lymphatic vascular structures in the brain dura, their localizations within the meninges, morphological properties and topographic anatomy. The review ends with an account of the consequences of brain lymphatic drainage failure. Knowledge of the physiological state of the clearance system is crucial in order to understand the changes related to impaired brain drainage.
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Affiliation(s)
| | | | | | | | | | | | - D Čížková
- Centre of Experimental and Clinical Regenerative Medicine, University of Veterinary Medicine and Pharmacy in Kosice, Slovak Republic.
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112
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Role of Tissue Hydraulic Permeability in Convection-Enhanced Delivery of Nanoparticle-Encapsulated Chemotherapy Drugs to Brain Tumour. Pharm Res 2022; 39:877-892. [PMID: 35474156 PMCID: PMC9160122 DOI: 10.1007/s11095-022-03261-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/07/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Tissue hydraulic permeability of brain tumours can vary considerably depending on the tissue microstructure, compositions in interstitium and tumour cells. Its effects on drug transport and accumulation remain poorly understood. METHODS Mathematical modelling is applied to predict the drug delivery outcomes in tumours with different tissue permeability upon convection-enhanced delivery. The modelling is based on a 3-D realistic tumour model that is extracted from patient magnetic resonance images. RESULTS Modelling results show that infusing drugs into a permeable tumour can facilitate a more favourable hydraulic environment for drug transport. The infused drugs will exhibit a relatively uniform distribution and cover a larger tumour volume for effective cell killing. Cross-comparisons show the delivery outcomes are more sensitive to the changes in tissue hydraulic permeability and blood pressure than the fluid flow from the brain ventricle. Quantitative analyses demonstrate that increasing the fluid gain from both the blood and brain ventricle can further improve the interstitial fluid flow, and thereby enhance the delivery outcomes. Furthermore, similar responses to the changes in tissue hydraulic permeability can be found for different types of drugs. CONCLUSIONS Tissue hydraulic permeability as an intrinsic property can influence drug accumulation and distribution. Results from this study can deepen the understanding of the interplays between drug and tissues that are involved in the drug delivery processes in chemotherapy.
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113
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Eide PK, Lashkarivand A, Hagen-Kersten ÅA, Gjertsen Ø, Nedregaard B, Sletteberg R, Løvland G, Vatnehol SAS, Pripp AH, Valnes LM, Ringstad G. Intrathecal Contrast-Enhanced Magnetic Resonance Imaging of Cerebrospinal Fluid Dynamics and Glymphatic Enhancement in Idiopathic Normal Pressure Hydrocephalus. Front Neurol 2022; 13:857328. [PMID: 35463139 PMCID: PMC9019061 DOI: 10.3389/fneur.2022.857328] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/10/2022] [Indexed: 01/09/2023] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease, characterized by cerebrospinal fluid (CSF) flow disturbance. Today, the only available treatment is CSF diversion surgery (shunt surgery). While traditional imaging biomarkers typically assess CSF space anatomy, recently introduced imaging biomarkers of CSF dynamics and glymphatic enhancement, provide imaging of CSF dynamics and thereby more specifically reveal elements of the underlying pathophysiology. The biomarkers address CSF ventricular reflux grade as well as glymphatic enhancement and derive from intrathecal contrast-enhanced MRI. However, the contrast agent serving as CSF tracer is administered off-label. In medicine, the introduction of new diagnostic or therapeutic methods must consider the balance between risk and benefit. To this end, we performed a prospective observational study of 95 patients with iNPH, comparing different intrathecal doses of the MRI contrast agent gadobutrol (0.10, 0.25, and 0.50 mmol, respectively), aiming at the lowest reasonable dose needed to retrieve diagnostic information about the novel MRI biomarkers. The present observations disclosed a dose-dependent enrichment of subarachnoid CSF spaces (cisterna magna, vertex, and velum interpositum) with dose-dependent ventricular reflux of tracer in iNPH, as well as dose-dependent glymphatic tracer enrichment. The association between tracer enrichment in CSF and parenchymal compartments were as well dose-related. Intrathecal gadobutrol in a dose of 0.25 mmol, but not 0.10 mmol, was at 1.5T MRI considered sufficient for imaging altered CSF dynamics and glymphatic enhancement in iNPH, even though 3T MRI provided better sensitivity. Tracer enrichment in CSF at the vertex and within the cerebral cortex and subcortical white matter was deemed too low for maintaining diagnostic information from a dose of 0.10 mmol. We conclude that reducing the intrathecal dose of gadobutrol from 0.50 to 0.25 mmol gadobutrol improves the safety margin while maintaining the necessary diagnostic information about disturbed CSF homeostasis and glymphatic failure in iNPH.
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Affiliation(s)
- Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aslan Lashkarivand
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Øivind Gjertsen
- Department of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Bård Nedregaard
- Department of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Ruth Sletteberg
- Department of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Grethe Løvland
- The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Svein Are Sirirud Vatnehol
- The Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway.,Institute of Optometry Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South Eastern Norway, Drammen, Norway
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Lars Magnus Valnes
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Geir Ringstad
- Department of Radiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway.,Department of Geriatrics and Internal Medicine, Sorlandet Hospital, Arendal, Norway
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114
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Solár P, Zamani A, Lakatosová K, Joukal M. The blood-brain barrier and the neurovascular unit in subarachnoid hemorrhage: molecular events and potential treatments. Fluids Barriers CNS 2022; 19:29. [PMID: 35410231 PMCID: PMC8996682 DOI: 10.1186/s12987-022-00312-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/24/2022] [Indexed: 12/12/2022] Open
Abstract
The response of the blood-brain barrier (BBB) following a stroke, including subarachnoid hemorrhage (SAH), has been studied extensively. The main components of this reaction are endothelial cells, pericytes, and astrocytes that affect microglia, neurons, and vascular smooth muscle cells. SAH induces alterations in individual BBB cells, leading to brain homeostasis disruption. Recent experiments have uncovered many pathophysiological cascades affecting the BBB following SAH. Targeting some of these pathways is important for restoring brain function following SAH. BBB injury occurs immediately after SAH and has long-lasting consequences, but most changes in the pathophysiological cascades occur in the first few days following SAH. These changes determine the development of early brain injury as well as delayed cerebral ischemia. SAH-induced neuroprotection also plays an important role and weakens the negative impact of SAH. Supporting some of these beneficial cascades while attenuating the major pathophysiological pathways might be decisive in inhibiting the negative impact of bleeding in the subarachnoid space. In this review, we attempt a comprehensive overview of the current knowledge on the molecular and cellular changes in the BBB following SAH and their possible modulation by various drugs and substances.
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Affiliation(s)
- Peter Solár
- Department of Anatomy, Cellular and Molecular Neurobiology Research Group, Faculty of Medicine, Masaryk University, 625 00, Brno, Czech Republic
- Department of Neurosurgery, Faculty of Medicine, Masaryk University and St. Anne's University Hospital Brno, Pekařská 53, 656 91, Brno, Czech Republic
| | - Alemeh Zamani
- Department of Anatomy, Cellular and Molecular Neurobiology Research Group, Faculty of Medicine, Masaryk University, 625 00, Brno, Czech Republic
| | - Klaudia Lakatosová
- Department of Anatomy, Cellular and Molecular Neurobiology Research Group, Faculty of Medicine, Masaryk University, 625 00, Brno, Czech Republic
| | - Marek Joukal
- Department of Anatomy, Cellular and Molecular Neurobiology Research Group, Faculty of Medicine, Masaryk University, 625 00, Brno, Czech Republic.
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115
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Quarleri J, Delpino MV. SARS-CoV-2 interacts with renin-angiotensin system: impact on the central nervous system in elderly patients. GeroScience 2022; 44:547-565. [PMID: 35157210 PMCID: PMC8853071 DOI: 10.1007/s11357-022-00528-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/08/2022] [Indexed: 01/18/2023] Open
Abstract
SARS-CoV-2 is a recently identified coronavirus that causes the current pandemic disease known as COVID-19. SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as a receptor, suggesting that the initial steps of SARS-CoV-2 infection may have an impact on the renin-angiotensin system (RAS). Several processes are influenced by RAS in the brain. The neurological symptoms observed in COVID-19 patients, including reduced olfaction, meningitis, ischemic stroke, cerebral thrombosis, and delirium, could be associated with RAS imbalance. In this review, we focus on the potential role of disturbances in the RAS as a cause for central nervous system sequelae of SARS-CoV-2 infection in elderly patients.
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Affiliation(s)
- Jorge Quarleri
- Instituto de Investigaciones Biomédicas en Retrovirus Y Sida (INBIRS), Universidad de Buenos Aires-CONICET, Paraguay 2155-Piso 11 (1121), Buenos Aires, Argentina.
| | - M Victoria Delpino
- Instituto de Investigaciones Biomédicas en Retrovirus Y Sida (INBIRS), Universidad de Buenos Aires-CONICET, Paraguay 2155-Piso 11 (1121), Buenos Aires, Argentina.
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116
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Abstract
The brain harbors a unique ability to, figuratively speaking, shift its gears. During wakefulness, the brain is geared fully toward processing information and behaving, while homeostatic functions predominate during sleep. The blood-brain barrier establishes a stable environment that is optimal for neuronal function, yet the barrier imposes a physiological problem; transcapillary filtration that forms extracellular fluid in other organs is reduced to a minimum in brain. Consequently, the brain depends on a special fluid [the cerebrospinal fluid (CSF)] that is flushed into brain along the unique perivascular spaces created by astrocytic vascular endfeet. We describe this pathway, coined the term glymphatic system, based on its dependency on astrocytic vascular endfeet and their adluminal expression of aquaporin-4 water channels facing toward CSF-filled perivascular spaces. Glymphatic clearance of potentially harmful metabolic or protein waste products, such as amyloid-β, is primarily active during sleep, when its physiological drivers, the cardiac cycle, respiration, and slow vasomotion, together efficiently propel CSF inflow along periarterial spaces. The brain's extracellular space contains an abundance of proteoglycans and hyaluronan, which provide a low-resistance hydraulic conduit that rapidly can expand and shrink during the sleep-wake cycle. We describe this unique fluid system of the brain, which meets the brain's requisites to maintain homeostasis similar to peripheral organs, considering the blood-brain-barrier and the paths for formation and egress of the CSF.
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Affiliation(s)
- Martin Kaag Rasmussen
- Center for Translational Neuromedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Humberto Mestre
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, New York
| | - Maiken Nedergaard
- Center for Translational Neuromedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, New York
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117
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Bramall AN, Anton ES, Kahle KT, Fecci PE. Navigating the ventricles: Novel insights into the pathogenesis of hydrocephalus. EBioMedicine 2022; 78:103931. [PMID: 35306341 PMCID: PMC8933686 DOI: 10.1016/j.ebiom.2022.103931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/14/2022] Open
Abstract
Congenital hydrocephalus occurs in one in 500-1000 babies born in the United States and acquired hydrocephalus may occur as the consequence of stroke, intraventricular and subarachnoid hemorrhage, traumatic brain injuries, brain tumors, craniectomy or may be idiopathic, as in the case of normal pressure hydrocephalus. Irrespective of its prevalence and significant impact on quality of life, neurosurgeons still rely on invasive cerebrospinal fluid shunt systems for the treatment of hydrocephalus that are exceptionally prone to failure and/or infection. Further understanding of this process at a molecular level, therefore, may have profound implications for improving treatment and quality of life for millions of individuals worldwide. The purpose of this article is to review the current research landscape on hydrocephalus with a focus on recent advances in our understanding of cerebrospinal fluid pathways from an evolutionary, genetics and molecular perspective.
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Affiliation(s)
- Alexa N Bramall
- Department of Neurosurgery, Duke University Hospital, 2301 Erwin Rd., Durham, NC 27710, United States.
| | - E S Anton
- UNC Neuroscience Center and the Department of Cell Biology and Physiology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Kristopher T Kahle
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
| | - Peter E Fecci
- Department of Neurosurgery, Duke University Hospital, 2301 Erwin Rd., Durham, NC 27710, United States
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118
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Fang Y, Huang L, Wang X, Si X, Lenahan C, Shi H, Shao A, Tang J, Chen S, Zhang J, Zhang JH. A new perspective on cerebrospinal fluid dynamics after subarachnoid hemorrhage: From normal physiology to pathophysiological changes. J Cereb Blood Flow Metab 2022; 42:543-558. [PMID: 34806932 PMCID: PMC9051143 DOI: 10.1177/0271678x211045748] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Knowledge about the dynamic metabolism and function of cerebrospinal fluid (CSF) physiology has rapidly progressed in recent decades. It has traditionally been suggested that CSF is produced by the choroid plexus and drains to the arachnoid villi. However, recent findings have revealed that the brain parenchyma produces a large portion of CSF and drains through the perivascular glymphatic system and meningeal lymphatic vessels into the blood. The primary function of CSF is not limited to maintaining physiological CNS homeostasis but also participates in clearing waste products resulting from neurodegenerative diseases and acute brain injury. Aneurysmal subarachnoid hemorrhage (SAH), a disastrous subtype of acute brain injury, is associated with high mortality and morbidity. Post-SAH complications contribute to the poor outcomes associated with SAH. Recently, abnormal CSF flow was suggested to play an essential role in the post-SAH pathophysiological changes, such as increased intracerebral pressure, brain edema formation, hydrocephalus, and delayed blood clearance. An in-depth understanding of CSF dynamics in post-SAH events would shed light on potential development of SAH treatment options. This review summarizes and updates the latest physiological characteristics of CSF dynamics and discusses potential pathophysiological changes and therapeutic targets after SAH.
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Affiliation(s)
- Yuanjian Fang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lei Huang
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA.,Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, USA
| | - Xiaoyu Wang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoli Si
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cameron Lenahan
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA.,Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Hui Shi
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA.,Department of Neurosurgery, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Anwen Shao
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiping Tang
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA.,Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, USA.,Department of Anesthesiology, Loma Linda University, Loma Linda, CA, USA
| | - Sheng Chen
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - John H Zhang
- Department of Neurosurgery, Loma Linda University, Loma Linda, CA, USA.,Department of Physiology and Pharmacology, Loma Linda University, Loma Linda, CA, USA.,Department of Anesthesiology, Loma Linda University, Loma Linda, CA, USA
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119
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Cellular Distribution of Brain Aquaporins and Their Contribution to Cerebrospinal Fluid Homeostasis and Hydrocephalus. Biomolecules 2022; 12:biom12040530. [PMID: 35454119 PMCID: PMC9025855 DOI: 10.3390/biom12040530] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 01/19/2023] Open
Abstract
Brain aquaporins facilitate the movement of water between the four water compartments: blood, cerebrospinal fluid, interstitial fluid, and intracellular fluid. This work analyzes the expression of the four most abundant aquaporins (AQPs) (AQP1, AQP4, AQP9, and AQP11) in the brains of mice and discuss their contribution to hydrocephalus. We analyzed available data from single-cell RNA sequencing of the central nervous system of mice to describe the expression of aquaporins and compare their distribution with that based on qPCR, western blot, and immunohistochemistry assays. Expression of AQP1 in the apical cell membrane of choroid plexus epithelial cells and of AQP4 in ependymal cells, glia limitans, and astrocyte processes in the pericapillary end foot is consistent with the involvement of both proteins in cerebrospinal fluid homeostasis. The expression of both aquaporins compensates for experimentally induced hydrocephalus in the animals. Recent data demonstrate that hypoxia in aged animals alters AQP4 expression in the choroidal plexus and cortex, increasing the ventricle size and intraventricular pressure. Cerebral distensibility is reduced in parallel with a reduction in cerebrospinal fluid drainage and cognitive deterioration. We propose that aged mice chronically exposed to hypoxia represent an excellent experimental model for studying the pathophysiological characteristics of idiopathic normal pressure hydrocephalus and roles for AQPs in such disease.
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120
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Trimmel NE, Podgoršak A, Oertel MF, Jucker S, Arras M, Schmid Daners M, Weisskopf M. The Sheep as a Comprehensive Animal Model to Investigate Interdependent Physiological Pressure Propagation and Multiparameter Influence on Cerebrospinal Fluid Dynamics. Front Neurosci 2022; 16:868567. [PMID: 35431780 PMCID: PMC9008349 DOI: 10.3389/fnins.2022.868567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
The present study aims to develop a suitable animal model for evaluating the physiological interactions between cerebrospinal fluid (CSF) dynamics, hemodynamics, and abdominal compartment pressures. We seek to contribute to the enhanced recognition of the pathophysiology of CSF-dependent neurological disorders like hydrocephalus and the improvement of available treatment options. To date, no comprehensive animal model of CSF dynamics exists, and establishing an accurate model will advance our understanding of complex CSF physiology. Persisting knowledge gaps surrounding the communication and pressure propagation between the cerebrospinal space and adjacent anatomical compartments exacerbate the development of novel therapies for neurological diseases. Hence, the need for further investigation of the interactions of vascular, craniospinal, and abdominal pressures remains beyond dispute. Moreover, the results of this animal study support the optimization of in vitro test benches for medical device development, e.g., ventriculoperitoneal shunts. Six female white alpine sheep were surgically equipped with pressure sensors to investigate the physiological values of intracranial, intrathecal, arterial, central venous, jugular venous, vesical pressure, and four differently located abdominal pressures. These values were measured simultaneously during the acute animal trial with sheep under general anesthesia. Both carotid and femoral arterial blood pressure indicate a reliable and comparable representation of the systematic blood pressure. However, the jugular venous pressure and the central venous pressure in sheep in dorsal recumbency do not correlate well under general anesthesia. Furthermore, there is a trend for possible comparability of lateral intraventricular and lumbar intrathecal pressure. Nevertheless, animal body position during measurements must be considered since different body constitutions can alter the horizontal line between the cerebral ventricles and the lumbar subarachnoid space. While intra-abdominal pressure measurement in the four different abdominal quadrants yielded greater inter-individual variability, intra-vesical pressure measurements in our setting delivered comparable values for all sheep. We established a novel and comprehensive ovine animal model to investigate interdependent physiologic pressure propagation and multiparameter influences on CSF dynamics. The results of this study will contribute to further in vitro bench testing, the derivation of novel quantitative models, and the development of a pathologic ovine hydrocephalus model.
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Affiliation(s)
- Nina Eva Trimmel
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anthony Podgoršak
- Department of Mechanical and Process Engineering, ETH Zürich, Zurich, Switzerland
| | - Markus Florian Oertel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Simone Jucker
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Margarete Arras
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Miriam Weisskopf
- Center for Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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121
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Dunlap T, Cao Y. Physiological Considerations for Modeling in vivo Antibody-Target Interactions. Front Pharmacol 2022; 13:856961. [PMID: 35281913 PMCID: PMC8912916 DOI: 10.3389/fphar.2022.856961] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
The number of therapeutic antibodies in development pipelines is increasing rapidly. Despite superior success rates relative to small molecules, therapeutic antibodies still face many unique development challenges. There is often a translational gap from their high target affinity and specificity to the therapeutic effects. Tissue microenvironment and physiology critically influence antibody-target interactions contributing to apparent affinity alterations and dynamic target engagement. The full potential of therapeutic antibodies will be further realized by contextualizing antibody-target interactions under physiological conditions. Here we review how local physiology such as physical stress, biological fluid, and membrane characteristics could influence antibody-target association, dissociation, and apparent affinity. These physiological factors in the early development of therapeutic antibodies are valuable toward rational antibody engineering, preclinical candidate selection, and lead optimization.
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Affiliation(s)
- Tyler Dunlap
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Yanguang Cao
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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122
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Blomqvist KJ, Skogster MOB, Kurkela MJ, Rosenholm MP, Ahlström FHG, Airavaara MT, Backman JT, Rauhala PV, Kalso EA, Lilius TO. Systemic hypertonic saline enhances glymphatic spinal cord delivery of lumbar intrathecal morphine. J Control Release 2022; 344:214-224. [PMID: 35301056 DOI: 10.1016/j.jconrel.2022.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 12/13/2022]
Abstract
The blood-brain barrier significantly limits effective drug delivery to central nervous system (CNS) targets. The recently characterized glymphatic system offers a perivascular highway for intrathecally (i.t.) administered drugs to reach deep brain structures. Although periarterial cerebrospinal fluid (CSF) influx and concomitant brain drug delivery can be enhanced by pharmacological or hyperosmotic interventions, their effects on drug delivery to the spinal cord, an important target for many drugs, have not been addressed. Hence, we studied in rats whether enhancement of periarterial flow by systemic hypertonic solution might be utilized to enhance spinal delivery and efficacy of i.t. morphine. We also studied whether the hyperosmolar intervention affects brain or cerebrospinal fluid drug concentrations after systemic administration. Periarterial CSF influx was enhanced by intraperitoneal injection of hypertonic saline (HTS, 5.8%, 20 ml/kg, 40 mOsm/kg). The antinociceptive effects of morphine were characterized, using tail flick, hot plate and paw pressure tests. Drug concentrations in serum, tissue and microdialysis samples were determined by liquid chromatography-tandem mass spectrometry. Compared with isotonic solution, HTS increased concentrations of spinal i.t. administered morphine by 240% at the administration level (T13-L1) at 60 min and increased the antinociceptive effect of morphine in tail flick, hot plate, and paw pressure tests. HTS also independently increased hot plate and paw pressure latencies but had no effect in the tail flick test. HTS transiently increased the penetration of intravenous morphine into the lateral ventricle, but not into the hippocampus. In conclusion, acute systemic hyperosmolality is a promising intervention for enhanced spinal delivery of i.t. administered morphine. The relevance of this intervention should be expanded to other i.t. drugs and brought to clinical trials.
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Affiliation(s)
- Kim J Blomqvist
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Moritz O B Skogster
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mika J Kurkela
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Clinical Pharmacology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marko P Rosenholm
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Center for Translational Neuromedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik H G Ahlström
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mikko T Airavaara
- Faculty of Pharmacy and Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Janne T Backman
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Clinical Pharmacology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka V Rauhala
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eija A Kalso
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Finland; SleepWell Research Programme, Faculty of Medicine, University of Helsinki, Finland
| | - Tuomas O Lilius
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Center for Translational Neuromedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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123
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Li Y, Rusinek H, Butler T, Glodzik L, Pirraglia E, Babich J, Mozley PD, Nehmeh S, Pahlajani S, Wang X, Tanzi EB, Zhou L, Strauss S, Carare RO, Theise N, Okamura N, de Leon MJ. Decreased CSF clearance and increased brain amyloid in Alzheimer's disease. Fluids Barriers CNS 2022; 19:21. [PMID: 35287702 PMCID: PMC8919541 DOI: 10.1186/s12987-022-00318-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/21/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In sporadic Alzheimer's disease (AD), brain amyloid-beta (Aβ) deposition is believed to be a consequence of impaired Aβ clearance, but this relationship is not well established in living humans. CSF clearance, a major feature of brain glymphatic clearance (BGC), has been shown to be abnormal in AD murine models. MRI phase contrast and intrathecally delivered contrast studies have reported reduced CSF flow in AD. Using PET and tau tracer 18F-THK5117, we previously reported that the ventricular CSF clearance of the PET tracer was reduced in AD and associated with elevated brain Aβ levels. METHODS In the present study, we use two PET tracers, 18F-THK5351 and 11C-PiB to estimate CSF clearance calculated from early dynamic PET frames in 9 normal controls and 15 AD participants. RESULTS we observed that the ventricular CSF clearance measures were correlated (r = 0.66, p < 0.01), with reductions in AD of 18 and 27%, respectively. We also replicated a significant relationship between ventricular CSF clearance (18F-THK5351) and brain Aβ load (r = - 0.64, n = 24, p < 0.01). With a larger sample size, we extended our observations to show that reduced CSF clearance is associated with reductions in cortical thickness and cognitive performance. CONCLUSIONS Overall, the findings support the hypothesis that failed CSF clearance is a feature of AD that is related to Aβ deposition and to the pathology of AD. Longitudinal studies are needed to determine whether failed CSF clearance is a predictor of progressive amyloidosis or its consequence.
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Affiliation(s)
- Yi Li
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA.
| | - Henry Rusinek
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Tracy Butler
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Lidia Glodzik
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Elizabeth Pirraglia
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - John Babich
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - P David Mozley
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Sadek Nehmeh
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Silky Pahlajani
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Xiuyuan Wang
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Emily B Tanzi
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Liangdong Zhou
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Sara Strauss
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA
| | - Roxana O Carare
- Department of Clinical Neuroanatomy, University of Southampton, Southampton, UK
| | - Neil Theise
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Nobuyuki Okamura
- Division of Pharmacology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Mony J de Leon
- Department of Radiology, Weill Cornell Medicine, Cornell University, Brain Health Imaging Institute, 407 East 61 Street, New York, NY, 10021, USA.
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Tobar LE, Farnsworth RH, Stacker SA. Brain Vascular Microenvironments in Cancer Metastasis. Biomolecules 2022; 12:biom12030401. [PMID: 35327593 PMCID: PMC8945804 DOI: 10.3390/biom12030401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 01/27/2023] Open
Abstract
Primary tumours, particularly from major solid organs, are able to disseminate into the blood and lymphatic system and spread to distant sites. These secondary metastases to other major organs are the most lethal aspect of cancer, accounting for the majority of cancer deaths. The brain is a frequent site of metastasis, and brain metastases are often fatal due to the critical role of the nervous system and the limited options for treatment, including surgery. This creates a need to further understand the complex cell and molecular biology associated with the establishment of brain metastasis, including the changes to the environment of the brain to enable the arrival and growth of tumour cells. Local changes in the vascular network, immune system and stromal components all have the potential to recruit and foster metastatic tumour cells. This review summarises our current understanding of brain vascular microenvironments, fluid circulation and drainage in the context of brain metastases, as well as commenting on current cutting-edge experimental approaches used to investigate changes in vascular environments and alterations in specialised subsets of blood and lymphatic vessel cells during cancer spread to the brain.
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Affiliation(s)
- Lucas E. Tobar
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (L.E.T.); (R.H.F.)
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Rae H. Farnsworth
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (L.E.T.); (R.H.F.)
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Steven A. Stacker
- Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; (L.E.T.); (R.H.F.)
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3050, Australia
- Correspondence: ; Tel.: +61-3-8559-7106
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Abstract
Brain disease remains a significant health, social, and economic burden with a high failure rate of translation of therapeutics to the clinic. Nanotherapeutics have represented a promising area of technology investment to improve drug bioavailability and delivery to the brain, with several successes for nanotherapeutic use for central nervous system disease that are currently in the clinic. However, renewed and continued research on the treatment of neurological disorders is critically needed. We explore the challenges of drug delivery to the brain and the ways in which nanotherapeutics can overcome these challenges. We provide a summary and overview of general design principles that can be applied to nanotherapeutics for uptake and penetration in the brain. We next highlight remaining questions that limit the translational potential of nanotherapeutics for application in the clinic. Lastly, we provide recommendations for ongoing preclinical research to improve the overall success of nanotherapeutics against neurological disease. Expected final online publication date for the Annual Review of Chemical and Biomolecular Engineering, Volume 13 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Andrea Joseph
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Elizabeth Nance
- Department of Chemical Engineering, University of Washington, Seattle, Washington, USA;
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Yatsushiro S, Sunohara S, Matsumae M, Atsumi H, Horie T, Kajihara N, Kuroda K. Evaluation of Cardiac- and Respiratory-driven Cerebrospinal Fluid Motions by Applying the S-transform to Steady-state Free Precession Phase Contrast Imaging. Magn Reson Med Sci 2022; 21:372-379. [PMID: 35173115 DOI: 10.2463/mrms.mp.2021-0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To extract the status of hydrocephalus and other cerebrospinal fluid (CSF)-related diseases, a technique to characterize the cardiac- and respiratory-driven CSF motions separately under free breathing was developed. This technique is based on steady-state free precession phase contrast (SSFP-PC) imaging in combination with a Stockwell transform (S-transform). METHODS 2D SSFP-PC at 3 T was applied to measure the CSF velocity in the caudal-cranial direction within a sagittal slice at the midline (N = 3) under 6-, 10-, and 16-s respiratory cycles and free breathing. The frequency-dependent window width of the S-transform was controlled by a particular scaling factor, which then converted the CSF velocity waveform into a spectrogram. Based on the frequency bands of the cardiac pulsation and respiration, as determined by the electrocardiogram (ECG) and respirator pressure sensors, Gaussian bandpass filters were applied to the CSF spectrogram to extract the time-domain cardiac- and respiratory-driven waveforms. RESULTS The cardiac-driven CSF velocity component appeared in the spectrogram clearly under all respiratory conditions. The respiratory-driven velocity under the controlled respiratory cycles was observed as constant frequency signals, compared to a time-varying frequency signal under free breathing. When the widow width was optimized using the scale factor, the temporal change in the respiratory-driven CSF component was even more apparent under free breathing. CONCLUSION Velocity amplitude variations and transient frequency changes of both cardiac- and respiratory-driven components were successfully characterized. These findings indicated that the proposed technique is useful for evaluating CSF motions driven by different cyclic forces.
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Affiliation(s)
- Satoshi Yatsushiro
- Department of Human and Information Science, School of Information Science and Technology, Tokai University.,BioView, Inc
| | | | | | - Hideki Atsumi
- Department of Neurosurgery, School of Medicine, Tokai University
| | - Tomohiko Horie
- Department of Radiological Technology, Tokai University Hospital
| | - Nao Kajihara
- Department of Radiological Technology, Tokai University Hospital
| | - Kagayaki Kuroda
- Department of Human and Information Science, School of Information Science and Technology, Tokai University
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127
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Blood GFAP as an emerging biomarker in brain and spinal cord disorders. Nat Rev Neurol 2022; 18:158-172. [PMID: 35115728 DOI: 10.1038/s41582-021-00616-3] [Citation(s) in RCA: 232] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 12/14/2022]
Abstract
Blood-derived biomarkers for brain and spinal cord diseases are urgently needed. The introduction of highly sensitive immunoassays led to a rapid increase in the number of potential blood-derived biomarkers for diagnosis and monitoring of neurological disorders. In 2018, the FDA authorized a blood test for clinical use in the evaluation of mild traumatic brain injury (TBI). The test measures levels of the astrocytic intermediate filament glial fibrillary acidic protein (GFAP) and neuroaxonal marker ubiquitin carboxy-terminal hydrolase L1. In TBI, blood GFAP levels are correlated with clinical severity and extent of intracranial pathology. Evidence also indicates that blood GFAP levels hold the potential to reflect, and might enable prediction of, worsening of disability in individuals with progressive multiple sclerosis. A growing body of evidence suggests that blood GFAP levels can be used to detect even subtle injury to the CNS. Most importantly, the successful completion of the ongoing validation of point-of-care platforms for blood GFAP might ameliorate the decision algorithms for acute neurological diseases, such as TBI and stroke, with important economic implications. In this Review, we provide a systematic overview of the evidence regarding the utility of blood GFAP as a biomarker in neurological diseases. We propose a model for GFAP concentration dynamics in different conditions and discuss the limitations that hamper the widespread use of GFAP in the clinical setting. In our opinion, the clinical use of blood GFAP measurements has the potential to contribute to accelerated diagnosis and improved prognostication, and represents an important step forward in the era of precision medicine.
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128
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Lu S, Brusic A, Gaillard F. Arachnoid Membranes: Crawling Back into Radiologic Consciousness. AJNR Am J Neuroradiol 2022; 43:167-175. [PMID: 34711549 PMCID: PMC8985673 DOI: 10.3174/ajnr.a7309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 07/29/2021] [Indexed: 02/03/2023]
Abstract
The arachnoid membranes are projections of connective tissue in the subarachnoid space that connect the arachnoid mater to the pia mater. These are underappreciated and largely unrecognized by most neuroradiologists despite being found to be increasingly important in the pathogenesis, imaging, and treatment of communicating hydrocephalus. This review aims to provide neuroradiologists with an overview of the history, embryology, histology, anatomy, and normal imaging appearance of these membranes, as well as some examples of their clinical importance.
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Affiliation(s)
- S. Lu
- From the Department of Radiology (S.L., A.B., F.G.), Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - A. Brusic
- From the Department of Radiology (S.L., A.B., F.G.), Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - F. Gaillard
- From the Department of Radiology (S.L., A.B., F.G.), Royal Melbourne Hospital, Parkville, Victoria, Australia,Faculty of Medicine, Dentistry, and Health Sciences (F.G.), University of Melbourne, Parkville, Victoria, Australia
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129
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Deng P, Halmai JANM, Beitnere U, Cameron D, Martinez ML, Lee CC, Waldo JJ, Thongphanh K, Adhikari A, Copping N, Petkova SP, Lee RD, Lock S, Palomares M, O’Geen H, Carter J, Gonzalez CE, Buchanan FKB, Anderson JD, Fierro FA, Nolta JA, Tarantal AF, Silverman JL, Segal DJ, Fink KD. An in vivo Cell-Based Delivery Platform for Zinc Finger Artificial Transcription Factors in Pre-clinical Animal Models. Front Mol Neurosci 2022; 14:789913. [PMID: 35153670 PMCID: PMC8829036 DOI: 10.3389/fnmol.2021.789913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022] Open
Abstract
Zinc finger (ZF), transcription activator-like effectors (TALE), and CRISPR/Cas9 therapies to regulate gene expression are becoming viable strategies to treat genetic disorders, although effective in vivo delivery systems for these proteins remain a major translational hurdle. We describe the use of a mesenchymal stem/stromal cell (MSC)-based delivery system for the secretion of a ZF protein (ZF-MSC) in transgenic mouse models and young rhesus monkeys. Secreted ZF protein from mouse ZF-MSC was detectable within the hippocampus 1 week following intracranial or cisterna magna (CM) injection. Secreted ZF activated the imprinted paternal Ube3a in a transgenic reporter mouse and ameliorated motor deficits in a Ube3a deletion Angelman Syndrome (AS) mouse. Intrathecally administered autologous rhesus MSCs were well-tolerated for 3 weeks following administration and secreted ZF protein was detectable within the cerebrospinal fluid (CSF), midbrain, and spinal cord. This approach is less invasive when compared to direct intracranial injection which requires a surgical procedure.
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Affiliation(s)
- Peter Deng
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, United States,Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States,Department of Biochemistry and Molecular Medicine, Genome Center, University of California, Davis, Davis, CA, United States,Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Julian A. N. M. Halmai
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, United States,Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States,Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Ulrika Beitnere
- Department of Biochemistry and Molecular Medicine, Genome Center, University of California, Davis, Davis, CA, United States
| | - David Cameron
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, United States,Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States,Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Michele L. Martinez
- Departments of Pediatrics and Cell Biology and Human Anatomy, School of Medicine, Gene Therapy Center, and California National Primate Research Center, University of California, Davis, Davis, CA, United States
| | - Charles C. Lee
- Departments of Pediatrics and Cell Biology and Human Anatomy, School of Medicine, Gene Therapy Center, and California National Primate Research Center, University of California, Davis, Davis, CA, United States
| | - Jennifer J. Waldo
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, United States,Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States,Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Krista Thongphanh
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, United States,Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States
| | - Anna Adhikari
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Nycole Copping
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Stela P. Petkova
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Ruth D. Lee
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Samantha Lock
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, United States,Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States,Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Miranda Palomares
- Department of Biochemistry and Molecular Medicine, Genome Center, University of California, Davis, Davis, CA, United States
| | - Henriette O’Geen
- Department of Biochemistry and Molecular Medicine, Genome Center, University of California, Davis, Davis, CA, United States
| | - Jasmine Carter
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, United States,Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States,Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Casiana E. Gonzalez
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, United States,Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States,Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Fiona K. B. Buchanan
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, United States,Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States,Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Johnathan D. Anderson
- Department of Otolaryngology, University of California, Davis, Davis, CA, United States
| | - Fernando A. Fierro
- Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States
| | - Jan A. Nolta
- Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States
| | - Alice F. Tarantal
- Departments of Pediatrics and Cell Biology and Human Anatomy, School of Medicine, Gene Therapy Center, and California National Primate Research Center, University of California, Davis, Davis, CA, United States
| | - Jill L. Silverman
- Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States
| | - David J. Segal
- Department of Biochemistry and Molecular Medicine, Genome Center, University of California, Davis, Davis, CA, United States
| | - Kyle D. Fink
- Department of Neurology, University of California Davis School of Medicine, Sacramento, CA, United States,Stem Cell Program and Gene Therapy Center, University of California, Davis, Sacramento, CA, United States,Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California Davis School of Medicine, Sacramento, CA, United States,*Correspondence: Kyle D. Fink,
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Wan J, Zhou S, Mea HJ, Guo Y, Ku H, Urbina BM. Emerging Roles of Microfluidics in Brain Research: From Cerebral Fluids Manipulation to Brain-on-a-Chip and Neuroelectronic Devices Engineering. Chem Rev 2022; 122:7142-7181. [PMID: 35080375 DOI: 10.1021/acs.chemrev.1c00480] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Remarkable progress made in the past few decades in brain research enables the manipulation of neuronal activity in single neurons and neural circuits and thus allows the decipherment of relations between nervous systems and behavior. The discovery of glymphatic and lymphatic systems in the brain and the recently unveiled tight relations between the gastrointestinal (GI) tract and the central nervous system (CNS) further revolutionize our understanding of brain structures and functions. Fundamental questions about how neurons conduct two-way communications with the gut to establish the gut-brain axis (GBA) and interact with essential brain components such as glial cells and blood vessels to regulate cerebral blood flow (CBF) and cerebrospinal fluid (CSF) in health and disease, however, remain. Microfluidics with unparalleled advantages in the control of fluids at microscale has emerged recently as an effective approach to address these critical questions in brain research. The dynamics of cerebral fluids (i.e., blood and CSF) and novel in vitro brain-on-a-chip models and microfluidic-integrated multifunctional neuroelectronic devices, for example, have been investigated. This review starts with a critical discussion of the current understanding of several key topics in brain research such as neurovascular coupling (NVC), glymphatic pathway, and GBA and then interrogates a wide range of microfluidic-based approaches that have been developed or can be improved to advance our fundamental understanding of brain functions. Last, emerging technologies for structuring microfluidic devices and their implications and future directions in brain research are discussed.
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Affiliation(s)
- Jiandi Wan
- Department of Chemical Engineering, University of California, Davis, California 95616, United States
| | - Sitong Zhou
- Department of Chemical Engineering, University of California, Davis, California 95616, United States
| | - Hing Jii Mea
- Department of Chemical Engineering, University of California, Davis, California 95616, United States
| | - Yaojun Guo
- Department of Electrical and Computer Engineering, University of California, Davis, California 95616, United States
| | - Hansol Ku
- Department of Electrical and Computer Engineering, University of California, Davis, California 95616, United States
| | - Brianna M Urbina
- Biochemistry, Molecular, Cellular and Developmental Biology Program, University of California, Davis, California 95616, United States
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131
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Wagner K, Unger L, Salman MM, Kitchen P, Bill RM, Yool AJ. Signaling Mechanisms and Pharmacological Modulators Governing Diverse Aquaporin Functions in Human Health and Disease. Int J Mol Sci 2022; 23:1388. [PMID: 35163313 PMCID: PMC8836214 DOI: 10.3390/ijms23031388] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 02/07/2023] Open
Abstract
The aquaporins (AQPs) are a family of small integral membrane proteins that facilitate the bidirectional transport of water across biological membranes in response to osmotic pressure gradients as well as enable the transmembrane diffusion of small neutral solutes (such as urea, glycerol, and hydrogen peroxide) and ions. AQPs are expressed throughout the human body. Here, we review their key roles in fluid homeostasis, glandular secretions, signal transduction and sensation, barrier function, immunity and inflammation, cell migration, and angiogenesis. Evidence from a wide variety of studies now supports a view of the functions of AQPs being much more complex than simply mediating the passive flow of water across biological membranes. The discovery and development of small-molecule AQP inhibitors for research use and therapeutic development will lead to new insights into the basic biology of and novel treatments for the wide range of AQP-associated disorders.
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Affiliation(s)
- Kim Wagner
- School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia;
| | - Lucas Unger
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK; (L.U.); (P.K.)
| | - Mootaz M. Salman
- Department of Physiology Anatomy and Genetics, University of Oxford, Oxford OX1 3QX, UK;
- Oxford Parkinson’s Disease Centre, University of Oxford, South Parks Road, Oxford OX1 3QX, UK
| | - Philip Kitchen
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK; (L.U.); (P.K.)
| | - Roslyn M. Bill
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK; (L.U.); (P.K.)
| | - Andrea J. Yool
- School of Biomedicine, University of Adelaide, Adelaide, SA 5005, Australia;
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Muñoz-Montecinos C, Romero A, Sepúlveda V, Vira MÁ, Fehrmann-Cartes K, Marcellini S, Aguilera F, Caprile T, Fuentes R. Turning the Curve Into Straight: Phenogenetics of the Spine Morphology and Coordinate Maintenance in the Zebrafish. Front Cell Dev Biol 2022; 9:801652. [PMID: 35155449 PMCID: PMC8826430 DOI: 10.3389/fcell.2021.801652] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/31/2021] [Indexed: 12/13/2022] Open
Abstract
The vertebral column, or spine, provides mechanical support and determines body axis posture and motion. The most common malformation altering spine morphology and function is adolescent idiopathic scoliosis (AIS), a three-dimensional spinal deformity that affects approximately 4% of the population worldwide. Due to AIS genetic heterogenicity and the lack of suitable animal models for its study, the etiology of this condition remains unclear, thus limiting treatment options. We here review current advances in zebrafish phenogenetics concerning AIS-like models and highlight the recently discovered biological processes leading to spine malformations. First, we focus on gene functions and phenotypes controlling critical aspects of postembryonic aspects that prime in spine architecture development and straightening. Second, we summarize how primary cilia assembly and biomechanical stimulus transduction, cerebrospinal fluid components and flow driven by motile cilia have been implicated in the pathogenesis of AIS-like phenotypes. Third, we highlight the inflammatory responses associated with scoliosis. We finally discuss recent innovations and methodologies for morphometrically characterize and analyze the zebrafish spine. Ongoing phenotyping projects are expected to identify novel and unprecedented postembryonic gene functions controlling spine morphology and mutant models of AIS. Importantly, imaging and gene editing technologies are allowing deep phenotyping studies in the zebrafish, opening new experimental paradigms in the morphometric and three-dimensional assessment of spinal malformations. In the future, fully elucidating the phenogenetic underpinnings of AIS etiology in zebrafish and humans will undoubtedly lead to innovative pharmacological treatments against spinal deformities.
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Affiliation(s)
- Carlos Muñoz-Montecinos
- Departamento de Biología Celular, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
- Grupo de Procesos en Biología del Desarrollo (GDeP), Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Adrián Romero
- Departamento de Biología Celular, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
- Grupo de Procesos en Biología del Desarrollo (GDeP), Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Vania Sepúlveda
- Departamento de Biología Celular, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
- Grupo de Procesos en Biología del Desarrollo (GDeP), Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - María Ángela Vira
- Departamento de Biología Celular, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
- Grupo de Procesos en Biología del Desarrollo (GDeP), Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Karen Fehrmann-Cartes
- Núcleo de Investigaciones Aplicadas en Ciencias Veterinarias y Agronómicas, Universidad de las Américas, Concepción, Chile
| | - Sylvain Marcellini
- Departamento de Biología Celular, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
- Grupo de Procesos en Biología del Desarrollo (GDeP), Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Felipe Aguilera
- Grupo de Procesos en Biología del Desarrollo (GDeP), Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
- Departamento de Bioquímica y Biología Molecular, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Teresa Caprile
- Departamento de Biología Celular, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
- Grupo de Procesos en Biología del Desarrollo (GDeP), Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
| | - Ricardo Fuentes
- Departamento de Biología Celular, Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
- Grupo de Procesos en Biología del Desarrollo (GDeP), Facultad de Ciencias Biológicas, Universidad de Concepción, Concepción, Chile
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133
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Sadekar SS, Bowen M, Cai H, Jamalian S, Rafidi H, Shatz‐Binder W, Lafrance‐Vanasse J, Chan P, Meilandt WJ, Oldendorp A, Sreedhara A, Daugherty A, Crowell S, Wildsmith KR, Atwal J, Fuji RN, Horvath J. Translational approaches for brain delivery of biologics via cerebrospinal fluid. Clin Pharmacol Ther 2022; 111:826-834. [PMID: 35064573 PMCID: PMC9305158 DOI: 10.1002/cpt.2531] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/04/2022] [Indexed: 11/14/2022]
Abstract
Delivery of biologics via cerebrospinal fluid (CSF) has demonstrated potential to access the tissues of the central nervous system (CNS) by circumventing the blood‐brain barrier and blood‐CSF barrier. Developing an effective CSF drug delivery strategy requires optimization of multiple parameters, including choice of CSF access point, delivery device technology, and delivery kinetics to achieve effective therapeutic concentrations in the target brain region, whereas also considering the biologic modality, mechanism of action, disease indication, and patient population. This review discusses key preclinical and clinical examples of CSF delivery for different biologic modalities (antibodies, nucleic acid‐based therapeutics, and gene therapy) to the brain via CSF or CNS access routes (intracerebroventricular, intrathecal‐cisterna magna, intrathecal‐lumbar, intraparenchymal, and intranasal), including the use of novel device technologies. This review also discusses quantitative models of CSF flow that provide insight into the effect of fluid dynamics in CSF on drug delivery and CNS distribution. Such models can facilitate delivery device design and pharmacokinetic/pharmacodynamic translation from preclinical species to humans in order to optimize CSF drug delivery to brain regions of interest.
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Affiliation(s)
- Shraddha S Sadekar
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Mayumi Bowen
- Pharma Technical Development. Genentech, Inc, a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Hao Cai
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Samira Jamalian
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Hanine Rafidi
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Whitney Shatz‐Binder
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Julien Lafrance‐Vanasse
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Pamela Chan
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - William J. Meilandt
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Amy Oldendorp
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Alavattam Sreedhara
- Pharma Technical Development. Genentech, Inc, a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Ann Daugherty
- Pharma Technical Development. Genentech, Inc, a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Susan Crowell
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Kristin R. Wildsmith
- Clinical pharmacology and translational medicine Neurology business Eisai, Nutley NJ 07110 USA
| | - Jasvinder Atwal
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Reina N. Fuji
- Genentech Research and Early Development Genentech, Inc., a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
| | - Josh Horvath
- Pharma Technical Development. Genentech, Inc, a member of the Roche Group 1 DNA Way South San Francisco CA 94080 USA
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Albayram MS, Smith G, Tufan F, Tuna IS, Bostancıklıoğlu M, Zile M, Albayram O. Non-invasive MR imaging of human brain lymphatic networks with connections to cervical lymph nodes. Nat Commun 2022; 13:203. [PMID: 35017525 PMCID: PMC8752739 DOI: 10.1038/s41467-021-27887-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
Meningeal lymphatic vessels have been described in animal studies, but limited comparable data is available in human studies. Here we show dural lymphatic structures along the dural venous sinuses in dorsal regions and along cranial nerves in the ventral regions in the human brain. 3D T2-Fluid Attenuated Inversion Recovery magnetic resonance imaging relies on internal signals of protein rich lymphatic fluid rather than contrast media and is used in the present study to visualize the major human dural lymphatic structures. Moreover we detect direct connections between lymphatic fluid channels along the cranial nerves and vascular structures and the cervical lymph nodes. We also identify age-related cervical lymph node atrophy and thickening of lymphatics channels in both dorsal and ventral regions, findings which reflect the reduced lymphatic output of the aged brain.
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Affiliation(s)
- Mehmet Sait Albayram
- Department of Radiology, University of Florida, College of Medicine, Gainesville, FL, 32610, USA.
| | - Garrett Smith
- Department of Radiology, University of Florida, College of Medicine, Gainesville, FL, 32610, USA
| | - Fatih Tufan
- Geriatrician (PP), Silivrikapi Mh. Hisaralti Cd, Istanbul, 34093, Turkey
| | - Ibrahim Sacit Tuna
- Department of Radiology, University of Florida, College of Medicine, Gainesville, FL, 32610, USA
| | | | - Michael Zile
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
- Division of Cardiology, Department of Medicine, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, 29425, USA
| | - Onder Albayram
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, 29425, USA
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Podgoršak A, Trimmel NE, Oertel MF, Qvarlander S, Arras M, Eklund A, Weisskopf M, Schmid Daners M. Intercompartmental communication between the cerebrospinal and adjacent spaces during intrathecal infusions in an acute ovine in-vivo model. Fluids Barriers CNS 2022; 19:2. [PMID: 34983575 PMCID: PMC8725268 DOI: 10.1186/s12987-021-00300-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/19/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction The treatment of hydrocephalus has been a topic of intense research ever since the first clinically successful use of a valved cerebrospinal fluid shunt 72 years ago. While ample studies elucidating different phenomena impacting this treatment exist, there are still gaps to be filled. Specifically, how intracranial, intrathecal, arterial, and venous pressures react and communicate with each other simultaneously. Methods An in-vivo sheep trial (n = 6) was conducted to evaluate and quantify the communication existing within the cranio-spinal, arterial, and venous systems (1 kHz sampling frequency). Standardized intrathecal infusion testing was performed using an automated infusion apparatus, including bolus and constant pressure infusions. Bolus infusions entailed six lumbar intrathecal infusions of 2 mL Ringer’s solution. Constant pressure infusions were comprised of six regulated pressure steps of 3.75 mmHg for periods of 7 min each. Mean pressure reactions, pulse amplitude reactions, and outflow resistance were calculated. Results All sheep showed intracranial pressure reactions to acute increases of intrathecal pressure, with four of six sheep showing clear cranio-spinal communication. During bolus infusions, the increases of mean pressure for intrathecal, intracranial, arterial, and venous pressure were 16.6 ± 0.9, 15.4 ± 0.8, 3.9 ± 0.8, and 0.1 ± 0.2 mmHg with corresponding pulse amplitude increases of 2.4 ± 0.3, 1.3 ± 0.3, 1.3 ± 0.3, and 0.2 ± 0.1 mmHg, respectively. During constant pressure infusions, mean increases from baseline were 14.6 ± 3.8, 15.5 ± 4.2, 4.2 ± 8.2, and 3.2 ± 2.4 mmHg with the corresponding pulse amplitude increases of 2.5 ± 3.6, 2.5 ± 3.0, 7.7 ± 4.3, and 0.7 ± 2.0 mmHg for intrathecal, intracranial, arterial, and venous pulse amplitude, respectively. Outflow resistances were calculated as 51.6 ± 7.8 and 77.8 ± 14.5 mmHg/mL/min for the bolus and constant pressure infusion methods, respectively—showing deviations between the two estimation methods. Conclusions Standardized infusion tests with multi-compartmental pressure recordings in sheep have helped capture distinct reactions between the intrathecal, intracranial, arterial, and venous systems. Volumetric pressure changes in the intrathecal space have been shown to propagate to the intraventricular and arterial systems in our sample, and to the venous side in individual cases. These results represent an important step into achieving a more complete quantitative understanding of how an acute rise in intrathecal pressure can propagate and influence other systems.
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Affiliation(s)
- Anthony Podgoršak
- Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Nina Eva Trimmel
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Markus Florian Oertel
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sara Qvarlander
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umea University, Umeå, Sweden
| | - Margarete Arras
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anders Eklund
- Department of Radiation Sciences, Radiation Physics, Biomedical Engineering, Umea University, Umeå, Sweden
| | - Miriam Weisskopf
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Mehta NH, Sherbansky J, Kamer AR, Carare RO, Butler T, Rusinek H, Chiang GC, Li Y, Strauss S, Saint-Louis LA, Theise ND, Suss RA, Blennow K, Kaplitt M, de Leon MJ. The Brain-Nose Interface: A Potential Cerebrospinal Fluid Clearance Site in Humans. Front Physiol 2022; 12:769948. [PMID: 35058794 PMCID: PMC8764168 DOI: 10.3389/fphys.2021.769948] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/26/2021] [Indexed: 12/17/2022] Open
Abstract
The human brain functions at the center of a network of systems aimed at providing a structural and immunological layer of protection. The cerebrospinal fluid (CSF) maintains a physiological homeostasis that is of paramount importance to proper neurological activity. CSF is largely produced in the choroid plexus where it is continuous with the brain extracellular fluid and circulates through the ventricles. CSF movement through the central nervous system has been extensively explored. Across numerous animal species, the involvement of various drainage pathways in CSF, including arachnoid granulations, cranial nerves, perivascular pathways, and meningeal lymphatics, has been studied. Among these, there is a proposed CSF clearance route spanning the olfactory nerve and exiting the brain at the cribriform plate and entering lymphatics. While this pathway has been demonstrated in multiple animal species, evidence of a similar CSF egress mechanism involving the nasal cavity in humans remains poorly consolidated. This review will synthesize contemporary evidence surrounding CSF clearance at the nose-brain interface, examining across species this anatomical pathway, and its possible significance to human neurodegenerative disease. Our discussion of a bidirectional nasal pathway includes examination of the immune surveillance in the olfactory region protecting the brain. Overall, we expect that an expanded discussion of the brain-nose pathway and interactions with the environment will contribute to an improved understanding of neurodegenerative and infectious diseases, and potentially to novel prevention and treatment considerations.
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Affiliation(s)
- Neel H. Mehta
- Undergraduate Department of Biology, Cornell University, Ithaca, NY, United States
| | | | - Angela R. Kamer
- Department of Periodontology and Implant Dentistry, NYU College of Dentistry, New York, NY, United States
| | - Roxana O. Carare
- Department of Medicine, University of Southampton, Southampton, United Kingdom
| | - Tracy Butler
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, New York, NY, United States
| | - Henry Rusinek
- Department of Radiology, NYU Langone Health, New York, NY, United States
| | - Gloria C. Chiang
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Yi Li
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, New York, NY, United States
| | - Sara Strauss
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - L. A. Saint-Louis
- Department of Radiology, NYU Langone Health, New York, NY, United States
| | - Neil D. Theise
- Department of Pathology, NYU Grossman School of Medicine, New York, NY, United States
| | - Richard A. Suss
- Division of Neuroradiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kaj Blennow
- Clinical Neurochemistry Lab, Inst. of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Michael Kaplitt
- Laboratory of Molecular Neurosurgery, Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Mony J. de Leon
- Department of Radiology, Brain Health Imaging Institute, Weill Cornell Medicine, New York, NY, United States
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137
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Dawes W. Secondary Brain Injury Following Neonatal Intraventricular Hemorrhage: The Role of the Ciliated Ependyma. Front Pediatr 2022; 10:887606. [PMID: 35844746 PMCID: PMC9280684 DOI: 10.3389/fped.2022.887606] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Intraventricular hemorrhage is recognized as a leading cause of hydrocephalus in the developed world and a key determinant of neurodevelopmental outcome following premature birth. Even in the absence of haemorrhagic infarction or posthaemorrhagic hydrocephalus, there is increasing evidence of neuropsychiatric and neurodevelopmental sequelae. The pathophysiology underlying this injury is thought to be due to a primary destructive and secondary developmental insult, but the exact mechanisms remain elusive and this has resulted in a paucity of therapeutic interventions. The presence of blood within the cerebrospinal fluid results in the loss of the delicate neurohumoral gradient within the developing brain, adversely impacting on the tightly regulated temporal and spatial control of cell proliferation and migration of the neural stem progenitor cells within the subventricular zone. In addition, haemolysis of the erythrocytes, associated with the release of clotting factors and leucocytes into the cerebrospinal (CSF), results in a toxic and inflammatory CSF microenvironment which is harmful to the periventricular tissues, resulting in damage and denudation of the multiciliated ependymal cells which line the choroid plexus and ventricular system. The ependyma plays a critical role in the developing brain and beyond, acting as both a protector and gatekeeper to the underlying parenchyma, controlling influx and efflux across the CSF to brain interstitial fluid interface. In this review I explore the hypothesis that damage and denudation of the ependymal layer at this critical juncture in the developing brain, seen following IVH, may adversely impact on the brain microenvironment, exposing the underlying periventricular tissues to toxic and inflammatory CSF, further exacerbating disordered activity within the subventricular zone (SVZ). By understanding the impact that intraventricular hemorrhage has on the microenvironment within the CSF, and the consequences that this has on the multiciliated ependymal cells which line the neuraxis, we can begin to develop and test novel therapeutic interventions to mitigate damage and reduce the associated morbidity.
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Affiliation(s)
- William Dawes
- Alder Hey Children's Hospital, Liverpool, United Kingdom.,NIHR Great Ormond Street Hospital BRC, London, United Kingdom
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138
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Otun A, Morales DM, Garcia-Bonilla M, Goldberg S, Castaneyra-Ruiz L, Yan Y, Isaacs AM, Strahle JM, McAllister JP, Limbrick DD. Biochemical profile of human infant cerebrospinal fluid in intraventricular hemorrhage and post-hemorrhagic hydrocephalus of prematurity. Fluids Barriers CNS 2021; 18:62. [PMID: 34952604 PMCID: PMC8710025 DOI: 10.1186/s12987-021-00295-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
Background Intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) have a complex pathophysiology involving inflammatory response, ventricular zone and cell–cell junction disruption, and choroid-plexus (ChP) hypersecretion. Increased cerebrospinal fluid (CSF) cytokines, extracellular matrix proteins, and blood metabolites have been noted in IVH/PHH, but osmolality and electrolyte disturbances have not been evaluated in human infants with these conditions. We hypothesized that CSF total protein, osmolality, electrolytes, and immune cells increase in PHH. Methods CSF samples were obtained from lumbar punctures of control infants and infants with IVH prior to the development of PHH and any neurosurgical intervention. Osmolality, total protein, and electrolytes were measured in 52 infants (18 controls, 10 low grade (LG) IVH, 13 high grade (HG) IVH, and 11 PHH). Serum electrolyte concentrations, and CSF and serum cell counts within 1-day of clinical sampling were obtained from clinical charts. Frontal occipital horn ratio (FOR) was measured for estimating the degree of ventriculomegaly. Dunn or Tukey’s post-test ANOVA analysis were used for pair-wise comparisons. Results CSF osmolality, sodium, potassium, and chloride were elevated in PHH compared to control (p = 0.012 − < 0.0001), LGIVH (p = 0.023 − < 0.0001), and HGIVH (p = 0.015 − 0.0003), while magnesium and calcium levels were higher compared to control (p = 0.031) and LGIVH (p = 0.041). CSF total protein was higher in both HGIVH and PHH compared to control (p = 0.0009 and 0.0006 respectively) and LGIVH (p = 0.034 and 0.028 respectively). These differences were not reflected in serum electrolyte concentrations nor calculated osmolality across the groups. However, quantitatively, CSF sodium and chloride contributed 86% of CSF osmolality change between control and PHH; and CSF osmolality positively correlated with CSF sodium (r, p = 0.55,0.0015), potassium (r, p = 0.51,0.0041), chloride (r, p = 0.60,0.0004), but not total protein across the entire patient cohort. CSF total cells (p = 0.012), total nucleated cells (p = 0.0005), and percent monocyte (p = 0.016) were elevated in PHH compared to control. Serum white blood cell count increased in PHH compared to control (p = 0.042) but there were no differences in serum cell differential across groups. CSF total nucleated cells also positively correlated with CSF osmolality, sodium, potassium, and total protein (p = 0.025 − 0.0008) in the whole cohort. Conclusions CSF osmolality increased in PHH, largely driven by electrolyte changes rather than protein levels. However, serum electrolytes levels were unchanged across groups. CSF osmolality and electrolyte changes were correlated with CSF total nucleated cells which were also increased in PHH, further suggesting PHH is a neuro-inflammatory condition. Supplementary Information The online version contains supplementary material available at 10.1186/s12987-021-00295-8.
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Affiliation(s)
- Ayodamola Otun
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Diego M Morales
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Seth Goldberg
- Department of Nephrology, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | | | - Yan Yan
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Albert M Isaacs
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, T2N 2T9, Canada
| | - Jennifer M Strahle
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
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139
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Kuroda T, Honma M, Mori Y, Futamura A, Sugimoto A, Kasai H, Yano S, Hieda S, Kasuga K, Ikeuchi T, Ono K. White Matter Lesions May Aid in Differentiating Idiopathic Normal Pressure Hydrocephalus and Alzheimer's Disease. J Alzheimers Dis 2021; 85:851-862. [PMID: 34864676 DOI: 10.3233/jad-215187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Idiopathic normal pressure hydrocephalus (iNPH) is often misdiagnosed as Alzheimer's disease (AD) due to overlapping pathophysiology and similar imaging characteristics, including ventricular enlargement and increased white matter lesions (WMLs). OBJECTIVE To compare the extent and distribution of WMLs directly between iNPH and AD and examine the association with underlying pathophysiology. METHODS Twelve patients with iNPH (mean age: 78.08 years; 5 females), 20 with AD (mean age: 75.40 years; 13 females), and 10 normal cognition (NC) participants (mean age: 76.60 years; 7 females) were recruited. The extent and distribution of WMLs and the lateral ventricular volume (LV-V) were evaluated on MRI using voxel-based morphometry analysis. Concentrations of cerebrospinal fluid biomarkers, such as amyloid-β protein (Aβ)42, Aβ 40, Aβ 38, and tau species, were also measured. Risk factors for small vessel disease (SVD) were assessed by blood examination and medical records. RESULTS The periventricular WML volume (PWML-V) and deep WML volume (DWML-V) were significantly larger in iNPH than in AD and NC. The DWML-V was dominant in iNPH, while the PWML-V was dominant in AD and NC. GM-V was significantly smaller in AD than in iNPH and NC. The LV-V positively correlated with WML-V in all participants. There was a significant negative correlation between LV-V and Aβ 38 in iNPH. Furthermore, there was no significant difference in SVD risk factors between the groups. CONCLUSION The differences in the extent and distribution of WMLs between iNPH and AD, especially predominance of DWML-V over PWML-V in iNPH, may reflect decreased fluid and Aβ clearance.
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Affiliation(s)
- Takeshi Kuroda
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Motoyasu Honma
- Department of Physiology, Showa University School of Medicine, Tokyo, Japan
| | - Yukiko Mori
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Akinori Futamura
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Azusa Sugimoto
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Hideyo Kasai
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Yano
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Sotaro Hieda
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kensaku Kasuga
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Chuo-ku, Niigata, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Chuo-ku, Niigata, Japan
| | - Kenjiro Ono
- Division of Neurology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.,Department of Neurology and Neurobiology of Aging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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140
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Alselisly AMA, Ashry AH, Mahmoud AT. Hydrocephalus with lateral ventricular lesions: case series and review of literature. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00283-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lateral ventricular lesions associated with hydrocephalus are considered a challenge to neurosurgeons. Hydrocephalus after surgery of such lesions and its pathogenesis and how to deal with it is a big question facing neurosurgeons.
Objectives
In this study, we tried to discuss the pathogenesis and different forms of presentation of hydrocephalus in lateral ventricular lesions and how to deal with it.
Methods
Eleven patients with lateral ventricular lesions associated with hydrocephalus either preoperative or postoperative presenting to our hospital were managed by excision of the lesion. A prospective study was done for these cases including their clinical data, radiological data, the presence, or absence of hydrocephalus either preoperative or postoperative and how we managed it.
Results
This study included 11 cases. The mean patient age at surgery was 25 years old. Nine cases were presented with radiological signs of hydrocephalus preoperatively. Two cases developed new onset hydrocephalus after lesion excision. Six cases ended with permanent CSF diversion.
Conclusion
Management of cases with lateral ventricular lesions does not stand on only excision of the lesion. Hydrocephalus should be kept into consideration perioperatively. We should try to avoid events that could lead to ventriculitis. Prolonged follow-up of the patients postoperative is very important as hydrocephalus may develop later after surgery.
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141
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Yatsushiro S, Sunohara S, Tokushima T, Takizawa K, Matsumae M, Atsumi H, Horie T, Kajihara N, Kuroda K. Characterization of Cardiac- and Respiratory-driven Cerebrospinal Fluid Motions Using a Correlation Mapping Technique Based on Asynchronous Two-dimensional Phase Contrast MR Imaging. Magn Reson Med Sci 2021; 20:385-395. [PMID: 33551384 PMCID: PMC8922357 DOI: 10.2463/mrms.mp.2020-0085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The cardiac- and respiratory-driven components of cerebrospinal fluid (CSF) motion characteristics and bulk flow are not yet completely understood. Therefore, the present study aimed to characterize cardiac- and respiratory-driven CSF motions in the intracranial space using delay time, CSF velocity waveform correlation, and displacement. METHODS Asynchronous two-dimensional phase-contrast at 3T was applied to measure the CSF velocity in the inferior-superior direction in a sagittal slice at the midline (N = 12) and an axial slice at the foramen magnum (N = 8). Volunteers were instructed to engage in six-second respiratory cycles. The calculated delay time and correlation coefficients of the cardiac- and respiratory-driven velocity waveforms, separated in the frequency domain, were applied to evaluate the propagation of the CSF motion. The cardiac- and respiratory-driven components of the CSF displacement and motion volume were calculated during diastole and systole, and during inhalation and exhalation, respectively. The cardiac- and respiratory-driven components of the velocity, correlation, displacement, and motion volume were compared using an independent two-sample t-test. RESULTS The ratio of the cardiac-driven CSF velocity to the sum of the cardiac- and respiratory-driven CSF velocities was higher than the equivalent respiratory-driven ratio for all cases (P < 0.01). Delay time and correlation maps demonstrated that the cardiac-driven CSF motion propagated more extensively than the respiratory-driven CSF motion. The correlation coefficient of the cardiac-driven motion was significantly higher in the prepontine (P < 0.01), the aqueduct, and the fourth ventricle (P < 0.05). The respiratory-driven displacement and motion volume were significantly greater than the cardiac-driven equivalents for all observations (P < 0.01). CONCLUSION The correlation mapping technique characterized the cardiac- and respiratory-driven CSF velocities and their propagation properties in the intracranial space. Based on these findings, cardiac-driven CSF velocity is greater than respiratory-induced velocity, but the respiratory-driven velocity might displace farther.
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Affiliation(s)
- Satoshi Yatsushiro
- Department of Human and Information Science, School of Information Science and Technology, Tokai University.,BioView, Inc
| | | | - Tetsuya Tokushima
- Course of Electrical and Electronic Engineering, Graduate School of Engineering, Tokai University
| | - Ken Takizawa
- Department of Neurosurgery, School of Medicine, Tokai University
| | | | - Hideki Atsumi
- Department of Neurosurgery, School of Medicine, Tokai University
| | - Tomohiko Horie
- Department of Radiological Technology, Tokai University Hospital
| | - Nao Kajihara
- Department of Radiological Technology, Tokai University Hospital
| | - Kagayaki Kuroda
- Department of Human and Information Science, School of Information Science and Technology, Tokai University.,Course of Electrical and Electronic Engineering, Graduate School of Engineering, Tokai University
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Blinkouskaya Y, Caçoilo A, Gollamudi T, Jalalian S, Weickenmeier J. Brain aging mechanisms with mechanical manifestations. Mech Ageing Dev 2021; 200:111575. [PMID: 34600936 PMCID: PMC8627478 DOI: 10.1016/j.mad.2021.111575] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/09/2021] [Accepted: 09/22/2021] [Indexed: 12/14/2022]
Abstract
Brain aging is a complex process that affects everything from the subcellular to the organ level, begins early in life, and accelerates with age. Morphologically, brain aging is primarily characterized by brain volume loss, cortical thinning, white matter degradation, loss of gyrification, and ventricular enlargement. Pathophysiologically, brain aging is associated with neuron cell shrinking, dendritic degeneration, demyelination, small vessel disease, metabolic slowing, microglial activation, and the formation of white matter lesions. In recent years, the mechanics community has demonstrated increasing interest in modeling the brain's (bio)mechanical behavior and uses constitutive modeling to predict shape changes of anatomically accurate finite element brain models in health and disease. Here, we pursue two objectives. First, we review existing imaging-based data on white and gray matter atrophy rates and organ-level aging patterns. This data is required to calibrate and validate constitutive brain models. Second, we review the most critical cell- and tissue-level aging mechanisms that drive white and gray matter changes. We focuse on aging mechanisms that ultimately manifest as organ-level shape changes based on the idea that the integration of imaging and mechanical modeling may help identify the tipping point when normal aging ends and pathological neurodegeneration begins.
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Affiliation(s)
- Yana Blinkouskaya
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States
| | - Andreia Caçoilo
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States
| | - Trisha Gollamudi
- Department of Biomedical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States
| | - Shima Jalalian
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States
| | - Johannes Weickenmeier
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ 07030, United States.
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Interplay between vascular hemodynamics and the glymphatic system in the pathogenesis of idiopathic normal pressure hydrocephalus, exploring novel neuroimaging diagnostics. Neurosurg Rev 2021; 45:1255-1261. [PMID: 34773535 DOI: 10.1007/s10143-021-01690-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/15/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
As the aging population continues to grow, so will the incidence of age-related conditions, including idiopathic normal pressure hydrocephalus (iNPH). The pathogenesis of iNPH remains elusive, and this is due in part to the poor characterization of cerebral spinal fluid (CSF) dynamics within the brain. Advancements in technology and imaging techniques have enabled new breakthroughs in understanding CSF physiology, and therefore iNPH pathogenesis. This includes understanding the hemodynamic and microvascular components involved in CSF influx and flow. Namely, the glymphatic system appears to be the great mediator, facilitating perivascular CSF flow via astrocytic aquaporin channels located along the endothelium of the pial vasculature. The interplay between glymphatics and both arterial pulsatilty and venous compliance has also been recently demonstrated. It appears then that CSF flow, and therefore glymphatic function, are highly dependent on cardiocirculatory and vascular factors. Impairment in any one component, whether it be related to arterial pulsatility, microvascular changes, reduced venous drainage, or astrogliosis, contributes greatly to iNPH, although it is likely a combination thereof. The strong interplay between vascular hemodynamics and CSF flow suggests perfusion imaging and cerebral blood flow quantification may be a useful diagnostic tool in characterizing iNPH. In addition, studies detecting glymphatic flow with magnetic resonance imaging have also emerged. These imaging tools may serve to both diagnose iNPH and help delineate it from other similarly presenting disease processes. With a better understanding of the vascular and glymphatic factors related to iNPH pathogenesis, physicians are better able to select the best candidates for treatment.
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144
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Monzio-Compagnoni N, Romani F, Mondino MG, Rampoldi AG, Trimarchi S, Tolva VS. Oxygen Partial Pressure in Cerebrospinal Fluid as a Potential Parameter to Identify Spinal Cord Ischaemia. Eur J Vasc Endovasc Surg 2021; 63:352-353. [PMID: 34774374 DOI: 10.1016/j.ejvs.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/01/2021] [Accepted: 09/18/2021] [Indexed: 11/25/2022]
Affiliation(s)
| | - Federico Romani
- Vascular Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michele G Mondino
- Cardiovascular Intensive Care Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio G Rampoldi
- Interventional Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valerio S Tolva
- Vascular Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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145
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Haddad G, Alam R, Atweh LA, Hourani M. What provokes a disappearing arachnoid cyst? - Case study and literature review. Clin Imaging 2021; 82:193-197. [PMID: 34875551 DOI: 10.1016/j.clinimag.2021.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Intracranial Arachnoid cysts (AC) are stable cerebral spinal fluid (CSF)-filled sacs that can rarely undergo progressive shrinkage or disappearance throughout life. In this manuscript, we present a case of post-traumatic complete resolution of an AC, review the possible triggers of this phenomenon, and discuss the pathophysiological mechanisms behind them. METHODS After presenting our case, we performed a literature review using the PubMed Database of all the reported cases of AC reduction or resolution (last updated in February 2021). Spontaneous cases were excluded. An analysis of the remaining cases (1985-2021) according to their inciting event, demographical, and clinical characteristics was then presented. RESULTS 58 patients were identified, 33 of which spontaneously resolved. The remaining 25 were included in the survey in addition to the case we presented. The mean age was 20.2 years, average time to resolution was 25.3 months, with only two third of the cases showing complete disappearance of the AC. A central nervous system infection was the inciting cause of resolution in one infant (4%), a history of head trauma in 16 (62%) patients and an intracranial procedure in 9 (35%) patients. DISCUSSION AC disappearance is a rare phenomenon that can occur spontaneously or after an inciting event. The cyst wall rupture and CSF flow perturbation theories seem to be the most applicable pathophysiological mechanisms in triggered AC resolution.
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Affiliation(s)
- Gaelle Haddad
- Diagnostic Radiology Department, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon.
| | - Raquelle Alam
- Diagnostic Radiology Department, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon.
| | - Lamya Ann Atweh
- Diagnostic Radiology Department, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon.
| | - Mukbil Hourani
- Diagnostic Radiology Department, American University of Beirut Medical Center, Riad El-Solh, Beirut, Lebanon.
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Skripka A, Mendez-Gonzalez D, Marin R, Ximendes E, Del Rosal B, Jaque D, Rodríguez-Sevilla P. Near infrared bioimaging and biosensing with semiconductor and rare-earth nanoparticles: recent developments in multifunctional nanomaterials. NANOSCALE ADVANCES 2021; 3:6310-6329. [PMID: 36133487 PMCID: PMC9417871 DOI: 10.1039/d1na00502b] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/03/2021] [Indexed: 05/17/2023]
Abstract
Research in novel materials has been extremely active over the past few decades, wherein a major area of interest has been nanoparticles with special optical properties. These structures can overcome some of the intrinsic limitations of contrast agents routinely used in medical practice, while offering additional functionalities. Materials that absorb or scatter near infrared light, to which biological tissues are partially transparent, have attracted significant attention and demonstrated their potential in preclinical research. In this review, we provide an at-a-glance overview of the most recent developments in near infrared nanoparticles that could have far-reaching applications in the life sciences. We focus on materials that offer additional functionalities besides diagnosis based on optical contrast: multiple imaging modalities (multimodal imaging), sensing of physical and chemical cues (multivariate diagnosis), or therapeutic activity (theranostics). Besides presenting relevant case studies for each class of optically active materials, we discuss their design and safety considerations, detailing the potential hurdles that may complicate their clinical translation. While multifunctional nanomaterials have shown promise in preclinical research, the field is still in its infancy; there is plenty of room to maximize its impact in preclinical studies as well as to deliver it to the clinics.
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Affiliation(s)
- Artiom Skripka
- Nanomaterials for Bioimaging Group, Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid Madrid 28049 Spain
- The Molecular Foundry, Lawrence Berkeley National Laboratory Berkeley California 94720 USA
| | - Diego Mendez-Gonzalez
- Nanomaterials for Bioimaging Group, Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid Madrid 28049 Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Ctra. Colmenar km. 9.100 Madrid 28034 Spain
| | - Riccardo Marin
- Nanomaterials for Bioimaging Group, Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid Madrid 28049 Spain
| | - Erving Ximendes
- Nanomaterials for Bioimaging Group, Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid Madrid 28049 Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Ctra. Colmenar km. 9.100 Madrid 28034 Spain
| | - Blanca Del Rosal
- ARC Centre of Excellence for Nanoscale BioPhotonics, School of Science, RMIT University 124 La Trobe St Melbourne VIC 3000 Australia
| | - Daniel Jaque
- Nanomaterials for Bioimaging Group, Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid Madrid 28049 Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Ctra. Colmenar km. 9.100 Madrid 28034 Spain
| | - Paloma Rodríguez-Sevilla
- Nanomaterials for Bioimaging Group, Departamento de Física de Materiales, Facultad de Ciencias, Universidad Autónoma de Madrid Madrid 28049 Spain
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Cai X, Harding IC, Sadaka AH, Colarusso B, Kulkarni P, Ebong E, Qiao J, O'Hare NR, Ferris CF. Mild repetitive head impacts alter perivascular flow in the midbrain dopaminergic system in awake rats. Brain Commun 2021; 3:fcab265. [PMID: 34806002 PMCID: PMC8600963 DOI: 10.1093/braincomms/fcab265] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022] Open
Abstract
Head injury is a known risk factor for Parkinson's disease. Disruption in the perivascular clearance of metabolic waste and unwanted proteins is thought to be a contributing factor to disease progression. We hypothesized that repetitive mild head impacts, without evidence of structural brain damage, would increase microgliosis and AQP4 expression and depolarization and alter perivascular flow in the midbrain dopaminergic system. Adult male rats were subjected to sham, or two mild head impacts separated by 48 h. Three weeks later, fully awake rats were imaged using dynamic, contrast-enhanced MRI to follow the distribution of intraventricular gadobenate dimeglumine contrast agent. Images were registered to and analysed using a 3D MRI rat atlas providing site-specific data on 171 different brain areas. Following imaging, rats were tested for cognitive function using the Barnes maze assay. Histological analyses of tyrosine hydroxylase, microglia activation and AQP4 expression and polarization were performed on a parallel cohort of head impacted rats at 20 days post insult to coordinate with the time of imaging. There was no change in the global flux of contrast agent between sham and head impacted rats. The midbrain dopaminergic system showed a significant decrease in the influx of contrast agent as compared to sham controls together with a significant increase in microgliosis, AQP4 expression and depolarization. There were no deficits in cognitive function. The histology showed a significant level of neuroinflammation in the midbrain dopaminergic system 3 weeks post mild repetitive head impact but no loss in tyrosine hydroxylase. MRI revealed no structural brain damage emphasizing the potential serious consequences of mild head impacts on sustained brain neuroinflammation in this area critical to the pathophysiology of Parkinson's.
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Affiliation(s)
- Xuezhu Cai
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
| | - Ian C Harding
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
| | - Aymen H Sadaka
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
| | - Bradley Colarusso
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
| | - Praveen Kulkarni
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
| | - Eno Ebong
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA
- Department of Neuroscience, Albert Einstein College of Medicine, New York, NY 10461, USA
| | - Ju Qiao
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
| | - Nick R O'Hare
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
| | - Craig F Ferris
- Department of Psychology, Center for Translational NeuroImaging, Northeastern University, Boston, MA 02115, USA
- Department of Psychology, Northeastern University, Boston, MA 02115, USA
- Department of Pharmaceutical Sciences, Northeastern University, Boston, MA 02115, USA
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Abstract
Reparative inflammation is an important protective response that eliminates foreign organisms, damaged cells, and physical irritants. However, inappropriately triggered or sustained inflammation can respectively initiate, propagate, or prolong disease. Post-hemorrhagic (PHH) and post-infectious hydrocephalus (PIH) are the most common forms of hydrocephalus worldwide. They are treated using neurosurgical cerebrospinal fluid (CSF) diversion techniques with high complication and failure rates. Despite their distinct etiologies, clinical studies in human patients have shown PHH and PIH share similar CSF cytokine and immune cell profiles. Here, in light of recent work in model systems, we discuss the concept of "inflammatory hydrocephalus" to emphasize potential shared mechanisms and potential therapeutic vulnerabilities of these disorders. We propose that this change of emphasis could shift our thinking of PHH and PIH from a framework of life-long neurosurgical disorders to that of preventable conditions amenable to immunomodulation.
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Bilateral hyperplasia of choroid plexus with severe CSF production: a case report and review of the glymphatic system. Childs Nerv Syst 2021; 37:3521-3529. [PMID: 34410450 DOI: 10.1007/s00381-021-05325-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND An important feature of hydrocephalus is the alteration of the cerebral spinal fluid (CSF) homeostasis. New insights in the understanding of production, secretion, and absorption of CSF, along with the discovery of the glymphatic system (GS), can be useful for a better understanding and treatment of hydrocephalus in disorders with CSF overproduction. CASE DESCRIPTION A 1-year-old patient was diagnosed with communicating hydrocephalus; ventricle peritoneal shunt (VPS) is installed and ascites developed. VPS is exposed, yielding volumes of 1000-1200ml/day CSF per day. MRI is performed showing generalized choroidal plexus hyperplasia. Bilateral endoscopic coagulation of thechoroid plexus was performed in 2 stages (CPC) however the high rate of CSF production persisted, needing a bilateral plexectomy through septostomy, which finally decreased the CSF outflow. DISCUSSION New knowledge about the CSF physiology will help to propose better treatment depending on the cause of the hydrocephalus. The GS is becoming an additional reason to better study and develop new therapies focused of the modulation of alternative CSF reabsorption. CONCLUSION Despite the current knowledge about hydrocephalus, we remain without a complete understanding of the pathophysiology of this condition. GS could be more important than conventional concept of reabsorption of CSF in the arachnoid villi, therefore GS could be a new key point, which will guide future investigations.
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Garcia-Bonilla M, McAllister JP, Limbrick DD. Genetics and Molecular Pathogenesis of Human Hydrocephalus. Neurol India 2021; 69:S268-S274. [PMID: 35102976 DOI: 10.4103/0028-3886.332249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hydrocephalus is a neurological disorder with an incidence of 80-125 per 100,000 live births in the United States. The molecular pathogenesis of this multidimensional disorder is complex and has both genetic and environmental influences. This review aims to discuss the genetic and molecular alterations described in human hydrocephalus, from well-characterized, heritable forms of hydrocephalus (e.g., X-linked hydrocephalus from L1CAM variants) to those affecting cilia motility and other complex pathologies such as neural tube defects and Dandy-Walker syndrome. Ventricular zone disruption is one key pattern among congenital and acquired forms of hydrocephalus, with abnormalities in cadherins, which mediate neuroepithelium/ependymal cell junctions and contribute to the pathogenesis and severity of the disease. Given the relationship between hydrocephalus pathogenesis and neurodevelopment, future research should elucidate the genetic and molecular mechanisms that regulate ventricular zone integrity and stem cell biology.
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Affiliation(s)
- Maria Garcia-Bonilla
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - James P McAllister
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - David D Limbrick
- Department of Neurosurgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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