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tPA-NMDAR Signaling Blockade Reduces the Incidence of Intracerebral Aneurysms. Transl Stroke Res 2022; 13:1005-1016. [DOI: 10.1007/s12975-022-01004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
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Peng C, Liu J, He W, Qin W, Yuan T, Kan Y, Wang K, Wang S, Shi Y. Numerical simulation in the abdominal aorta and the visceral arteries with or without stenosis based on 2D PCMRI. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3569. [PMID: 34967124 DOI: 10.1002/cnm.3569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/10/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Abstract
It is important to obtain accurate boundary conditions (BCs) in hemodynamic simulations. This article aimed to improve the accuracy of BCs in computational fluid dynamics (CFD) simulation and analyze the differences in hemodynamics between healthy volunteers and patients with visceral arterial stenosis (VAS). The geometric models of seven cases were reconstructed using the magnetic resonance angiogram (MRA) or computed tomography angiogram (CTA) imaging data. The physiological flow waveforms obtained from 2D Phase Contrast Magnetic Resonance Imaging (PCMRI) were imposed on the aortic inlet and the visceral arteries' outlets. The individualized RCR values of the three-element Windkessel model were imposed on the aortic outlet. CFD simulations were run in the open-source software: svSolver. Two specific time points were selected to compare the hemodynamics of healthy volunteers and patients with VAS. The results suggested that blood in the stenotic visceral arteries flowed at high speed throughout the cardiac cycle. The low pressure is distributed at stenotic lesions. The wall shear stress (WSS) reached 4 Pa near stenotic locations. The low time average wall shear stress (TAWSS), high oscillatory shear index (OSI), and high relative residence time (RRT) concentrated in the abdominal aorta. Besides, the ratios of the areas with low TAWSS, high OSI, and high RRT to the computational domain were higher in patients with VAS than which in the healthy volunteers. The individualized BCs were used for hemodynamic simulations and results suggest that patients with stenosis have a higher risk of blood retention and atherosclerosis formation in the abdominal aorta.
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Affiliation(s)
- Chen Peng
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Junzhen Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei He
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wang Qin
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Tong Yuan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanqing Kan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Keqiang Wang
- Institute of Panvascular Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
- Institute of Biomedical Engineering Technology, Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Yun Shi
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Fréneau M, Baron-Menguy C, Vion AC, Loirand G. Why Are Women Predisposed to Intracranial Aneurysm? Front Cardiovasc Med 2022; 9:815668. [PMID: 35224050 PMCID: PMC8866977 DOI: 10.3389/fcvm.2022.815668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/11/2022] [Indexed: 12/21/2022] Open
Abstract
Intracranial aneurysm (IA) is a frequent and generally asymptomatic cerebrovascular abnormality characterized as a localized dilation and wall thinning of intracranial arteries that preferentially arises at the arterial bifurcations of the circle of Willis. The devastating complication of IA is its rupture, which results in subarachnoid hemorrhage that can lead to severe disability and death. IA affects about 3% of the general population with an average age for detection of rupture around 50 years. IAs, whether ruptured or unruptured, are more common in women than in men by about 60% overall, and more especially after the menopause where the risk is double-compared to men. Although these data support a protective role of estrogen, differences in the location and number of IAs observed in women and men under the age of 50 suggest that other underlying mechanisms participate to the greater IA prevalence in women. The aim of this review is to provide a comprehensive overview of the current data from both clinical and basic research and a synthesis of the proposed mechanisms that may explain why women are more prone to develop IA.
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Zhu H, Tan J, Zhao Y, Wang Z, Wu Z, Li M. Potential Role of the Chemotaxis System in Formation and Progression of Intracranial Aneurysms Through Weighted Gene Co-Expression Network Analysis. Int J Gen Med 2022; 15:2217-2231. [PMID: 35250300 PMCID: PMC8893157 DOI: 10.2147/ijgm.s347420] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/22/2022] [Indexed: 12/21/2022] Open
Abstract
Background Intracranial aneurysm (IA) is the most common and is the main cause of spontaneous subarachnoid hemorrhage (SAH). The underlying molecular mechanisms for preventing IA progression have not been fully identified. Our research aimed to identify the key genes and critical pathways of IA through gene co-expression networks. Methods Gene Expression Omnibus (GEO) datasets GSE13353, GSE54083 and GSE75436 were used in the study. The genetic data were analyzed by weighted gene co-expression network analysis (WGCNA). Then the clinically significant modules were identified and the differentially expressed genes (DEGs) with the genes were intersected in these modules. GO (gene ontology) and KEGG (Kyoto Gene and Genomic Encyclopedia) were used for gene enrichment analysis to determine the function or pathway. In addition, the composition of immune cells was analyzed by CIBERSORT algorithm. Finally, the hub genes and key genes were identified by GSE122897. Results A total of 266 DEGs and two modules with clinical significance were identified. The inflammatory response and immune response were identified by GO and KEGG. CCR5, CCL4, CCL20, and FPR3 were the key genes in the module correlated with IA. The proportions of infiltrating immune cells in IA and normal tissues were different, especially in terms of macrophages and mast cells. Conclusion The chemotactic system has been identified as a key pathway of IA, and interacting macrophages may regulate this pathological process.
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Affiliation(s)
- Huaxin Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Jiacong Tan
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Yeyu Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Zhihua Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Zhiwu Wu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
| | - Meihua Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, People’s Republic of China
- Correspondence: Meihua Li, Email
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105
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Wang H, Uhlmann K, Vedula V, Balzani D, Varnik F. Fluid-structure interaction simulation of tissue degradation and its effects on intra-aneurysm hemodynamics. Biomech Model Mechanobiol 2022; 21:671-683. [PMID: 35025011 PMCID: PMC8940862 DOI: 10.1007/s10237-022-01556-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/04/2022] [Indexed: 12/03/2022]
Abstract
Tissue degradation plays a crucial role in vascular diseases such as atherosclerosis and aneurysms. Computational modeling of vascular hemodynamics incorporating both arterial wall mechanics and tissue degradation has been a challenging task. In this study, we propose a novel finite element method-based approach to model the microscopic degradation of arterial walls and its interaction with blood flow. The model is applied to study the combined effects of pulsatile flow and tissue degradation on the deformation and intra-aneurysm hemodynamics. Our computational analysis reveals that tissue degradation leads to a weakening of the aneurysmal wall, which manifests itself in a larger deformation and a smaller von Mises stress. Moreover, simulation results for different heart rates, blood pressures and aneurysm geometries indicate consistently that, upon tissue degradation, wall shear stress increases near the flow-impingement region and decreases away from it. These findings are discussed in the context of recent reports regarding the role of both high and low wall shear stress for the progression and rupture of aneurysms.
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Abstract
In 2001, the concept of the neurovascular unit was introduced at the Stroke Progress Review Group meeting. The neurovascular unit is an important element of the health and disease status of blood vessels and nerves in the central nervous system. Since then, the neurovascular unit has attracted increasing interest from research teams, who have contributed greatly to the prevention, treatment, and prognosis of stroke and neurodegenerative diseases. However, additional research is needed to establish an efficient, low-cost, and low-energy in vitro model of the neurovascular unit, as well as enable noninvasive observation of neurovascular units in vivo and in vitro. In this review, we first summarize the composition of neurovascular units, then investigate the efficacy of different types of stem cells and cell culture methods in the construction of neurovascular unit models, and finally assess the progress of imaging methods used to observe neurovascular units in recent years and their positive role in the monitoring and investigation of the mechanisms of a variety of central nervous system diseases.
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Affiliation(s)
- Taiwei Dong
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Min Li
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Feng Gao
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Peifeng Wei
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Jian Wang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Provinve, China
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Wu CH, Tsai HP, Su YF, Tsai CY, Lu YY, Lin CL. 2-PMAP Ameliorates Cerebral Vasospasm and Brain Injury after Subarachnoid Hemorrhage by Regulating Neuro-Inflammation in Rats. Cells 2022; 11:242. [PMID: 35053358 PMCID: PMC8773560 DOI: 10.3390/cells11020242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 02/01/2023] Open
Abstract
A subarachnoid hemorrhage (SAH), leading to severe disability and high fatality in survivors, is a devastating disease. Neuro-inflammation, a critical mechanism of cerebral vasospasm and brain injury from SAH, is tightly related to prognoses. Interestingly, studies indicate that 2-[(pyridine-2-ylmethyl)-amino]-phenol (2-PMAP) crosses the blood-brain barrier easily. Here, we investigated whether the vasodilatory and neuroprotective roles of 2-PMAP were observed in SAH rats. Rats were assigned to three groups: sham, SAH and SAH+2-PMAP. SAHs were induced by a cisterna magna injection. In the SAH+2-PMAP group, 5 mg/kg 2-PMAP was injected into the subarachnoid space before SAH induction. The administration of 2-PMAP markedly ameliorated cerebral vasospasm and decreased endothelial apoptosis 48 h after SAH. Meanwhile, 2-PMAP decreased the severity of neurological impairments and neuronal apoptosis after SAH. Furthermore, 2-PMAP decreased the activation of microglia and astrocytes, expressions of TLR-4 and p-NF-κB, inflammatory markers (TNF-α, IL-1β and IL-6) and reactive oxygen species. This study is the first to confirm that 2-PMAP has vasodilatory and neuroprotective effects in a rat model of SAH. Taken together, the experimental results indicate that 2-PMAP treatment attenuates neuro-inflammation, oxidative stress and cerebral vasospasm, in addition to ameliorating neurological deficits, and that these attenuating and ameliorating effects are conferred through the TLR-4/NF-κB pathway.
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Affiliation(s)
- Chieh-Hsin Wu
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (H.-P.T.); (Y.-F.S.); (C.-Y.T.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Hung-Pei Tsai
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (H.-P.T.); (Y.-F.S.); (C.-Y.T.)
| | - Yu-Feng Su
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (H.-P.T.); (Y.-F.S.); (C.-Y.T.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Cheng-Yu Tsai
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (H.-P.T.); (Y.-F.S.); (C.-Y.T.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Department of Health and Beauty, Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
| | - Chih-Lung Lin
- Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-H.W.); (H.-P.T.); (Y.-F.S.); (C.-Y.T.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
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108
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Epithelial-mesenchymal transition related genes in unruptured aneurysms identified through weighted gene coexpression network analysis. Sci Rep 2022; 12:225. [PMID: 34997174 PMCID: PMC8741966 DOI: 10.1038/s41598-021-04390-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/21/2021] [Indexed: 11/08/2022] Open
Abstract
Intracranial aneurysm (IA) can cause fatal subarachnoid hemorrhage (SAH) after rupture, and identifying patients with unruptured IAs is essential for reducing SAH fatalities. The epithelial-mesenchymal transition (EMT) may be vital to IA progression. Here, identified key EMT-related genes in aneurysms and their pathogenic mechanisms via bioinformatic analysis. The GSE13353, GSE75436, and GSE54083 datasets from Gene Expression Omnibus were analyzed with limma to identify differentially expressed genes (DEGs) among unruptured aneurysms, ruptured aneurysms, and healthy samples. The results revealed that three EMT-related DEGs (ADIPOQ, WNT11, and CCL21) were shared among all groups. Coexpression modules and hub genes were identified via weighted gene co-expression network analysis, revealing two significant modules (red and green) and 14 EMT-related genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses suggested that cytokine interactions were closely related. Gene set enrichment analysis revealed that unruptured aneurysms were enriched for the terms "inflammatory response" and "vascular endothelial growth". Protein-protein interaction analysis identified seven key genes, which were evaluated with the GSE54083 dataset to determine their sensitivity and specificity. In the external validation set, we verified the differential expression of seven genes in unruptured aneurysms and normal samples. Together, these findings indicate that FN1, and SPARC may help distinguish normal patients from patients with asymptomatic IAs.
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109
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Fuentes AM, Stone McGuire L, Amin-Hanjani S. Sex Differences in Cerebral Aneurysms and Subarachnoid Hemorrhage. Stroke 2022; 53:624-633. [PMID: 34983239 DOI: 10.1161/strokeaha.121.037147] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sex differences in cerebral aneurysm occurrence and characteristics have been well described. Although sex differences in outcomes following ischemic stroke have been identified, the effect of sex on outcomes following hemorrhagic stroke, and in particular, aneurysm treatment has been less studied. We describe the current state of knowledge regarding the impact of sex on treatment and outcomes of cerebral aneurysms. Although prior studies suggest that aneurysm prevalence and progression may be related to sex, we did not find clear evidence that outcomes following subarachnoid hemorrhage vary based on sex. Last, we identify areas for future research that could enhance understanding of the role sex plays in this context.
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110
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Wang Q, Qi Y, Li Y, Yan Z, Wang X, Ma Q, Tang C, Liu X, Wei M, Zhang H. Psychiatric traits and intracerebral hemorrhage: A Mendelian randomization study. Front Psychiatry 2022; 13:1049432. [PMID: 36684013 PMCID: PMC9850495 DOI: 10.3389/fpsyt.2022.1049432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Psychiatric traits have been associated with intracerebral hemorrhage (ICH) in observational studies, although their causal relationships remain uncertain. We used Mendelian randomization analyses to infer causality between psychiatric traits and ICH. METHODS We collected data from genome-wide association studies of ICH (n = 361,194) and eight psychiatric traits among Europeans, including mood swings (n = 451,619), major depressive disorder (n = 480,359), attention-deficit/hyperactivity disorder (n = 53,293), anxiety (n = 459,560), insomnia (n = 462,341), schizophrenia (n = 77,096), neuroticism (n = 374,323), and bipolar disorder (n = 51,710). We performed a series of bidirectional two-sample Mendelian randomization and related sensitivity analyses. A Bonferroni corrected threshold of p < 0.00625 (0.05/8) was considered to be significant, and p < 0.05 was considered suggestive of evidence for a potential association. RESULTS Mendelian randomization analyses revealed suggestive positive causality of mood swings on ICH (odds ratio = 1.006, 95% confidence interval = 1.001-1.012, p = 0.046), and the result was consistent after sensitivity analysis. However, major depressive disorder (p = 0.415), attention-deficit/hyperactivity disorder (p = 0.456), anxiety (p = 0.664), insomnia (p = 0.699), schizophrenia (p = 0.799), neuroticism (p = 0.140), and bipolar disorder (p = 0.443) are not significantly associated with the incidence of ICH. In the reverse Mendelian randomization analyses, no causal effects of ICH on mood swings (p = 0.565), major depressive disorder (p = 0.630), attention-deficit/hyperactivity disorder (p = 0.346), anxiety (p = 0.266), insomnia (p = 0.102), schizophrenia (p = 0.463), neuroticism (p = 0.261), or bipolar disorder (p = 0.985) were found. CONCLUSION Our study revealed that mood swings are suggestively causal of ICH and increase the risk of ICH. These results suggest the clinical significance of controlling mood swings for ICH prevention.
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Affiliation(s)
- Qingduo Wang
- Department of Neurosurgery, The Yangzhou School of Clinical Medicine of Dalian Medical University, Dalian, China
| | - Yajie Qi
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Yuping Li
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Zhengcun Yan
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiaodong Wang
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Qiang Ma
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Can Tang
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiaoguang Liu
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Min Wei
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hengzhu Zhang
- Department of Neurosurgery, Clinical Medical College, Yangzhou University, Yangzhou, China
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111
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Wen D, Chen R, Li H, Zheng J, Fu W, Shi Z, You C, Yang M, Ma L. Reduced M2 macrophages and adventitia collagen dampen the structural integrity of blood blister-like aneurysms and induce preoperative rerupture. Cell Prolif 2021; 55:e13175. [PMID: 34970805 PMCID: PMC8828257 DOI: 10.1111/cpr.13175] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/11/2021] [Accepted: 12/07/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Blood blister–like aneurysms (BBAs) are extremely rare aneurysms. They are predisposed to preoperative rerupture with a high case‐fatality rate. Here, we attempt to interrogate the distinct clinicopathology and the histological basis underlying its clinical rerupture. Methods Three middle meningeal arteries, 11 BBA (5 reruptured, 6 non‐rerupture) and 19 saccular aneurysm samples were obtained for histopathological investigation. Three reruptured BBAs, 3 non‐reruptured BBAs and 6 saccular (3 ruptured, 3 unruptured) aneurysms were obtained for quantitative flow cytometry analysis. Results Compared with true saccular aneurysms, the BBA aneurysm wall lacks arterial stroma cells including CD31+ endothelial cells and α‐SMA + smooth muscle cells. Only fibroblasts and adventitial collagen were observed in the BBA aneurysm wall. Meanwhile, BBAs were enriched with infiltrated inflammatory cells, especially polarized macrophages. Based on the rerupture status, those reruptured BBAs showed drastically reduced fibroblasts and adventitia collagen. Moreover, M2‐polarized macrophages were observed dominant in BBAs and exhibit repairing cellular functions based on their interplays with arterial fibroblasts. Reduced M2 macrophages and arterial tissue repairing modulation may be responsible for the decreasing collagen synthesis and fibrosis repairment, which potentially dampens the aneurysm integrity and induces BBA aneurysm reruputre. Conclusions BBAs poses histopathological features of occult pseudoaneurysms or dissecting aneurysms. Reduced M2 macrophages and adventitia collagen may dampen the structural integrity of BBAs and induce preoperative rerupture.
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Affiliation(s)
- Dingke Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruiqi Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei Fu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mu Yang
- Translational Centre for Oncoimmunology, Sichuan Cancer Hospital & Institute, University of Electronic and Science Technology of China, Chengdu, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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112
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Galloy AE, Raghuram A, Nino MA, Varon Miller A, Sabotin R, Osorno-Cruz C, Samaniego EA, Raghavan SML, Hasan D. Analysis of Cerebral Aneurysm Wall Tension and Enhancement Using Finite Element Analysis and High-Resolution Vessel Wall Imaging. Front Neurol 2021; 12:764063. [PMID: 34956050 PMCID: PMC8702555 DOI: 10.3389/fneur.2021.764063] [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: 08/24/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
Biomechanical computational simulation of intracranial aneurysms has become a promising method for predicting features of instability leading to aneurysm growth and rupture. Hemodynamic analysis of aneurysm behavior has helped investigate the complex relationship between features of aneurysm shape, morphology, flow patterns, and the proliferation or degradation of the aneurysm wall. Finite element analysis paired with high-resolution vessel wall imaging can provide more insight into how exactly aneurysm morphology relates to wall behavior, and whether wall enhancement can describe this phenomenon. In a retrospective analysis of 23 unruptured aneurysms, finite element analysis was conducted using an isotropic, homogenous third order polynomial material model. Aneurysm wall enhancement was quantified on 2D multiplanar views, with 14 aneurysms classified as enhancing (CRstalk≥0.6) and nine classified as non-enhancing. Enhancing aneurysms had a significantly higher 95th percentile wall tension (μ = 0.77 N/cm) compared to non-enhancing aneurysms (μ = 0.42 N/cm, p < 0.001). Wall enhancement remained a significant predictor of wall tension while accounting for the effects of aneurysm size (p = 0.046). In a qualitative comparison, low wall tension areas concentrated around aneurysm blebs. Aneurysms with irregular morphologies may show increased areas of low wall tension. The biological implications of finite element analysis in intracranial aneurysms are still unclear but may provide further insights into the complex process of bleb formation and aneurysm rupture.
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Affiliation(s)
- Adam E Galloy
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
| | - Ashrita Raghuram
- Department of Neurology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
| | - Marco A Nino
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
| | - Alberto Varon Miller
- Department of Neurology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
| | - Ryan Sabotin
- Department of Neurology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
| | - Carlos Osorno-Cruz
- Department of Neurosurgery, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
| | - Edgar A Samaniego
- Department of Neurology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States.,Department of Neurosurgery, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States.,Department of Radiology, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
| | - Suresh M L Raghavan
- Roy J. Carver Department of Biomedical Engineering, University of Iowa, Iowa City, IA, United States
| | - David Hasan
- Department of Neurosurgery, The University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, IA, United States
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Ogawa Y, Watanabe M, Tominaga T. Pituitary Adenomas Associated with Intracranial Aneurysms: the Clinical Characteristics, Therapeutic Strategies, and Possible Effects of Vascular Remodeling Factors. J Neurol Surg A Cent Eur Neurosurg 2021; 83:555-560. [DOI: 10.1055/s-0041-1739232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Background Pituitary adenoma coexists with intracranial aneurysms in 2.3 to 3.6% of cases, and intracranial aneurysms are thought to be incidental. On the other hand, older age and cavernous sinus invasion are reported to increase the rate of coexistence, so these two diseases may be related.
Methods Ten males and 14 females with the coexistence of pituitary adenomas and intracranial aneurysms were retrospectively investigated among 923 patients (2.6%). Patients were subdivided into two groups: those with direct attachment of cerebral aneurysms to the pituitary adenomas and those without direct attachment. The clinical characteristics, therapeutic strategies, and possible effects of vascular remodeling factors were investigated.
Results Twelve patients had functioning pituitary adenomas, and cavernous sinus invasion was identified in 7 of 24 patients. Five of these 7 patients were treated with priority for the cerebral aneurysm until 2007, whereas 14 of 17 patients without involvement of the aneurysm tip in the tumor were treated with priority for the pituitary adenoma in the later period. Among vascular remodeling factors, strong expression of vascular endothelial growth factor (VEGF) was significantly associated with the coexistence of pituitary adenoma and cerebral aneurysm (p < 0.05).
Conclusion Intracranial aneurysms were found to coexist in 2.6% of cases of surgically treated pituitary adenomas. VEGF-induced arterial wall remodeling may be part of the mechanism of association between pituitary adenomas and cerebral aneurysms, suggesting possible causative mechanism.
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Affiliation(s)
- Yoshikazu Ogawa
- Department of Neurosurgery, Kohnan Hospital, Taihaku-ku, Sendai, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Hospital, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Acosta JM, Cayron AF, Dupuy N, Pelli G, Foglia B, Haemmerli J, Allémann E, Bijlenga P, Kwak BR, Morel S. Effect of Aneurysm and Patient Characteristics on Intracranial Aneurysm Wall Thickness. Front Cardiovasc Med 2021; 8:775307. [PMID: 34957259 PMCID: PMC8692777 DOI: 10.3389/fcvm.2021.775307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The circle of Willis is a network of arteries allowing blood supply to the brain. Bulging of these arteries leads to formation of intracranial aneurysm (IA). Subarachnoid hemorrhage (SAH) due to IA rupture is among the leading causes of disability in the western world. The formation and rupture of IAs is a complex pathological process not completely understood. In the present study, we have precisely measured aneurysmal wall thickness and its uniformity on histological sections and investigated for associations between IA wall thickness/uniformity and commonly admitted risk factors for IA rupture. Methods: Fifty-five aneurysm domes were obtained at the Geneva University Hospitals during microsurgery after clipping of the IA neck. Samples were embedded in paraffin, sectioned and stained with hematoxylin-eosin to measure IA wall thickness. The mean, minimum, and maximum wall thickness as well as thickness uniformity was measured for each IA. Clinical data related to IA characteristics (ruptured or unruptured, vascular location, maximum dome diameter, neck size, bottleneck factor, aspect and morphology), and patient characteristics [age, smoking, hypertension, sex, ethnicity, previous SAH, positive family history for IA/SAH, presence of multiple IAs and diagnosis of polycystic kidney disease (PKD)] were collected. Results: We found positive correlations between maximum dome diameter or neck size and IA wall thickness and thickness uniformity. PKD patients had thinner IA walls. No associations were found between smoking, hypertension, sex, IA multiplicity, rupture status or vascular location, and IA wall thickness. No correlation was found between patient age and IA wall thickness. The group of IAs with non-uniform wall thickness contained more ruptured IAs, women and patients harboring multiple IAs. Finally, PHASES and ELAPSS scores were positively correlated with higher IA wall heterogeneity. Conclusion: Among our patient and aneurysm characteristics of interest, maximum dome diameter, neck size and PKD were the three factors having the most significant impact on IA wall thickness and thickness uniformity. Moreover, wall thickness heterogeneity was more observed in ruptured IAs, in women and in patients with multiple IAs. Advanced medical imaging allowing in vivo measurement of IA wall thickness would certainly improve personalized management of the disease and patient care.
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Affiliation(s)
- Jason M. Acosta
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anne F. Cayron
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Nicolas Dupuy
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Graziano Pelli
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bernard Foglia
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julien Haemmerli
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Eric Allémann
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Brenda R. Kwak
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- *Correspondence: Sandrine Morel
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115
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Niemann A, Talagini A, Kandapagari P, Preim B, Saalfeld S. Tissue segmentation in histologic images of intracranial aneurysm wall. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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116
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Wu S, Lu W, Cheng G, Wu J, Liao S, Hu Q, Li X, Jiang B. DAPK1 may be a potential biomarker for arterial aneurysm in clinical treatment and activated inflammation levels in arterial aneurysm through NLRP3 inflammasome by Beclin1. Hum Exp Toxicol 2021; 40:S563-S572. [PMID: 34796763 DOI: 10.1177/09603271211041667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Death-associated protein kinase (DAPK1) is one of the positive regulators of apoptosis, and it is widely involved in apoptosis induced by multiple pathways. We examined that the function of DAPK1 in Clinical treatment of arterial aneurysm and its underlying mechanisms. Arterial aneurysm is a common cerebrovascular disease with high disability and fatality rate. OBJECTIVES Male C57BL/6 mice or DAPK1-/- mice were injected with 50 mg/kg pentobarbital sodium and then were injected with angiotensin II (AngII) infusion for vivo model. hASMCs (Human artery smooth muscle cell) were treated with murine recombinant IL-6 (20 ng ml-1; Cell Signaling) for vitro model. RESULTS DAPK1 gene, mRNA expression, and protein expression were induced in mice of arterial aneurysm. DAPK1 mRNA expression was increased and Area Under Curve was 0.9075 in patients with arterial aneurysm. Knockout of DAPK1 decreased inflammation and vascular injury in mice model of arterial aneurysm. Beclin1/NLRP3 (NACHT, LRR, and PYD domains-containing protein 3) signal pathway is a critical downstream effector of DAPK1 by TAP production. The regulation of Beclin1 participated in the effects of DAPK1 on inflammation of arterial aneurysm by ATP-dependent NLRP3 inflammasome. The regulation of NLRP3 participated in the effects of DAPK1 on inflammation of arterial aneurysm. CONCLUSION Collectively, our data indicated that DAPK1 may be a potential biomarker for arterial aneurysm in clinical treatment and activated inflammation levels in arterial aneurysm through NLRP3 inflammasome by Beclin1. DAPK1 might be a key pathogenic event underlying excess inflammation of arterial aneurysm.
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Affiliation(s)
- Senyan Wu
- Department of Vascular Surgery, 91619The Quzhou Affiliated Hospital of Wenzhou Medical University , Quzhou People's Hospital, Quzhou, PR China
| | - Wei Lu
- Department of Vascular Surgery, 91619The Quzhou Affiliated Hospital of Wenzhou Medical University , Quzhou People's Hospital, Quzhou, PR China
| | - Guobing Cheng
- Department of Vascular Surgery, 91619The Quzhou Affiliated Hospital of Wenzhou Medical University , Quzhou People's Hospital, Quzhou, PR China
| | - Jiawen Wu
- Department of Vascular Surgery, 91619The Quzhou Affiliated Hospital of Wenzhou Medical University , Quzhou People's Hospital, Quzhou, PR China
| | - Sheng Liao
- Department of Vascular Surgery, 91619The Quzhou Affiliated Hospital of Wenzhou Medical University , Quzhou People's Hospital, Quzhou, PR China
| | - Qiang Hu
- Department of Vascular Surgery, 91619The Quzhou Affiliated Hospital of Wenzhou Medical University , Quzhou People's Hospital, Quzhou, PR China
| | - Xiaoyang Li
- Department of Vascular Surgery, 91619The Quzhou Affiliated Hospital of Wenzhou Medical University , Quzhou People's Hospital, Quzhou, PR China
| | - Buping Jiang
- Department of Vascular Surgery, 91619The Quzhou Affiliated Hospital of Wenzhou Medical University , Quzhou People's Hospital, Quzhou, PR China
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Morel S, Schilling S, Diagbouga MR, Delucchi M, Bochaton-Piallat ML, Lemeille S, Hirsch S, Kwak BR. Effects of Low and High Aneurysmal Wall Shear Stress on Endothelial Cell Behavior: Differences and Similarities. Front Physiol 2021; 12:727338. [PMID: 34721060 PMCID: PMC8551710 DOI: 10.3389/fphys.2021.727338] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/21/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Intracranial aneurysms (IAs) result from abnormal enlargement of the arterial lumen. IAs are mostly quiescent and asymptomatic, but their rupture leads to severe brain damage or death. As the evolution of IAs is hard to predict and intricates medical decision, it is essential to improve our understanding of their pathophysiology. Wall shear stress (WSS) is proposed to influence IA growth and rupture. In this study, we investigated the effects of low and supra-high aneurysmal WSS on endothelial cells (ECs). Methods: Porcine arterial ECs were exposed for 48 h to defined levels of shear stress (2, 30, or 80 dyne/cm2) using an Ibidi flow apparatus. Immunostaining for CD31 or γ-cytoplasmic actin was performed to outline cell borders or to determine cell architecture. Geometry measurements (cell orientation, area, circularity and aspect ratio) were performed on confocal microscopy images. mRNA was extracted for RNAseq analysis. Results: ECs exposed to low or supra-high aneurysmal WSS were more circular and had a lower aspect ratio than cells exposed to physiological flow. Furthermore, they lost the alignment in the direction of flow observed under physiological conditions. The effects of low WSS on differential gene expression were stronger than those of supra-high WSS. Gene set enrichment analysis highlighted that extracellular matrix proteins, cytoskeletal proteins and more particularly the actin protein family were among the protein classes the most affected by shear stress. Interestingly, most genes showed an opposite regulation under both types of aneurysmal WSS. Immunostainings for γ-cytoplasmic actin suggested a different organization of this cytoskeletal protein between ECs exposed to physiological and both types of aneurysmal WSS. Conclusion: Under both aneurysmal low and supra-high WSS the typical arterial EC morphology molds to a more spherical shape. Whereas low WSS down-regulates the expression of cytoskeletal-related proteins and up-regulates extracellular matrix proteins, supra-high WSS induces opposite changes in gene expression of these protein classes. The differential regulation in EC gene expression observed under various WSS translate into a different organization of the ECs’ architecture. This adaptation of ECs to different aneurysmal WSS conditions may affect vascular remodeling in IAs.
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Affiliation(s)
- Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sabine Schilling
- Institute of Applied Simulation, Zurich University of Applied Sciences, Wädenswil, Switzerland.,Institute of Tourism and Mobility, Lucerne School of Business, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland
| | - Mannekomba R Diagbouga
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Matteo Delucchi
- Institute of Applied Simulation, Zurich University of Applied Sciences, Wädenswil, Switzerland
| | | | - Sylvain Lemeille
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sven Hirsch
- Institute of Applied Simulation, Zurich University of Applied Sciences, Wädenswil, Switzerland
| | - Brenda R Kwak
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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118
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Youwakim J, Girouard H. Inflammation: A Mediator Between Hypertension and Neurodegenerative Diseases. Am J Hypertens 2021; 34:1014-1030. [PMID: 34136907 DOI: 10.1093/ajh/hpab094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/03/2021] [Accepted: 06/15/2021] [Indexed: 12/14/2022] Open
Abstract
Hypertension is the most prevalent and modifiable risk factor for stroke, vascular cognitive impairment, and Alzheimer's disease. However, the mechanistic link between hypertension and neurodegenerative diseases remains to be understood. Recent evidence indicates that inflammation is a common pathophysiological trait for both hypertension and neurodegenerative diseases. Low-grade chronic inflammation at the systemic and central nervous system levels is now recognized to contribute to the physiopathology of hypertension. This review speculates that inflammation represents a mediator between hypertension and neurodegenerative diseases, either by a decrease in cerebral blood flow or a disruption of the blood-brain barrier which will, in turn, let inflammatory cells and neurotoxic molecules enter the brain parenchyma. This may impact brain functions including cognition and contribute to neurodegenerative diseases. This review will thus discuss the relationship between hypertension, systemic inflammation, cerebrovascular functions, neuroinflammation, and brain dysfunctions. The potential clinical future of immunotherapies against hypertension and associated cerebrovascular risks will also be presented.
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Affiliation(s)
- Jessica Youwakim
- Département de Pharmacologie et Physiologie, Université de Montréal, Montreal, QC, Canada
- Centre interdisciplinaire de recherche sur le cerveau et l’apprentissage (CIRCA); Montreal, QC, Canada
- Groupe de Recherche sur le Système Nerveux Central, Montreal, QC, Canada
| | - Hélène Girouard
- Département de Pharmacologie et Physiologie, Université de Montréal, Montreal, QC, Canada
- Centre interdisciplinaire de recherche sur le cerveau et l’apprentissage (CIRCA); Montreal, QC, Canada
- Groupe de Recherche sur le Système Nerveux Central, Montreal, QC, Canada
- Centre de recherche de l’Institut Universitaire de Gériaterie de Montréal, Montreal, QC, Canada
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Prediction of atherosclerotic changes in cavernous carotid aneurysms based on computational fluid dynamics analysis: a proof-of-concept study. Neuroradiology 2021; 64:575-585. [PMID: 34505180 DOI: 10.1007/s00234-021-02803-x] [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: 05/03/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Recent computational fluid dynamics (CFD) studies have demonstrated the concurrence of atherosclerotic changes in regions exposed to prolonged blood residence. In this proof-of-concept study, we investigated a small but homogeneous cohort of large, cavernous carotid aneurysms (CCAs) to establish the clinical feasibility of CFD analysis in treatment planning, based on the association between pathophysiology and hemodynamics. METHODS This study included 15 patients with individual large CCAs. We identified calcifications, which indicated atherosclerotic changes, using the masking data of digital subtraction angiography. We conducted a CFD simulation under patient-specific inlet flow rates measured using magnetic resonance (MR) velocimetry. In the post-CFD analysis, we calculated the blood residence time ([Formula: see text]) and segmented the surface exposed to blood residence time over 1 s ([Formula: see text]). We measured the decrease in volume after flow diversion using the original time-of-flight MR angiography data. RESULTS Calcifications were observed in the region with [Formula: see text]. In addition, the ratio of [Formula: see text] to the surface of the aneurysmal domain exhibited a negative relationship with the rate of volume reduction at the 6- and 12-month follow-ups. Post-CFD visualization demonstrated that intra-aneurysmal swirling flow prolonged blood residence time under the condition of a small inlet flow rate, when compared to the aneurysmal volume. CONCLUSION The results of this study suggest the usefulness of CFD analysis for the diagnosis of atherosclerotic changes in large CCAs that may affect the therapeutic response after flow diversion.
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120
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Association of Periodontal Disease with the Occurrence of Unruptured Cerebral Aneurysm among Adults in Korea: A Nationwide Population-Based Cohort Study TRANSLATE with x EnglishArabicHebrewPolishBulgarianHindiPortugueseCatalanHmong DawRomanianChinese SimplifiedHungarianRussianChinese TraditionalIndonesianSlovakCzechItalianSlovenianDanishJapaneseSpanishDutchKlingonSwedishEnglishKoreanThaiEstonianLatvianTurkishFinnishLithuanianUkrainianFrenchMalayUrduGermanMalteseVietnameseGreekNorwegianWelshHaitian CreolePersian// TRANSLATE with COPY THE URL BELOW Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster PortalBack//. MEDICINA-LITHUANIA 2021; 57:medicina57090910. [PMID: 34577833 PMCID: PMC8465273 DOI: 10.3390/medicina57090910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Cerebral aneurysms can cause disability or death during rupture, but information on the etiology of cerebral aneurysms is currently lacking. Periodontal disease causes both systemic inflammation and local inflammation of the oral cavity. Systemic inflammation is a major cause of cerebral aneurysms. The aim of our study was to determine whether the presence of periodontal disease is related to the occurrence of unruptured cerebral aneurysms in a nationwide population-based cohort. Materials and Methods: We analyzed data on demographics, previous medical history, and laboratory test results of 209,620 participants from the Korean National Health Insurance System-Health Screening Cohort. The presence of periodontal disease and oral hygiene parameters, including the number of lost teeth, tooth brushing frequency per day, dental visits for any reason, and expert teeth scaling, were investigated. The occurrences of unruptured cerebral aneurysms (I67.1) were defined according to the International Statistical Classification of Diseases Related Health Problems-10. Results: The mean age of the participants was 53.7 ± 8.7 years, and 59.4% were male. Periodontal disease was found in 20.9% of the participants. A total of 2160 (1.0%) cases of unruptured cerebral aneurysms developed after 10.3 years of median follow up. In multivariate analysis, the presence of periodontal disease was significantly associated with an increased risk of unruptured cerebral aneurysms (hazard ratio: 1.21, 95% confidence interval: 1.09–1.34, p < 0.001). Conclusion: The presence of periodontal disease could be associated with the occurrence of unruptured cerebral aneurysms. It should be noted that when periodontal diseases are present, the risk of aneurysms is increased in the future.
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121
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Rabelo NN, Samaia da Silva Coelho AC, Telles JPM, Coelho G, de Souza CS, Tozetto-Mendoza TR, Galvani de Oliveira NP, Braz-Silva PH, Teixeira MJ, Figueiredo EG. Human herpesvirus DNA occurrence in intracranial aneurysmal wall: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21301. [PMID: 35855086 PMCID: PMC9265188 DOI: 10.3171/case21301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Subarachnoid hemorrhages secondary to intracranial aneurysms (IAs) are events of high mortality. These neurological vascular diseases arise from local and systemic inflammation that culminates in vessel wall changes. They may also have a possible relationship with chronic viral infections, such as human herpesvirus (HHV), and especially Epstein–Barr virus (EBV), which causes several medical conditions. This is the first description of the presence of HHV deoxyribonucleic acid (DNA) in a patient with IA. OBSERVATIONS A 61-year-old woman with a downgraded level of consciousness underwent radiological examinations that identified a 10-mm ruptured aneurysm in the anterior communicating artery. A microsurgery clip was performed to definitively treat the aneurysm and occurred without surgical complications. Molecular analysis of the material obtained revealed the presence of EBV DNA in the aneurysm wall. The patient died 21 days after admission due to clinical complications and brain swelling. LESSONS This is the first description of the presence of herpesvirus DNA in a patient with IA, presented in 2.8% of our data. These findings highlight that viral infection may contribute to the pathophysiology and is an additional risk factor for IA formation, progression, and rupture by modulating vessel wall inflammation and structural changes in chronic infections.
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Affiliation(s)
| | | | | | | | - Caio Santos de Souza
- Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, and
| | | | | | - Paulo Henrique Braz-Silva
- Laboratory of Virology (LIM-52), Institute of Tropical Medicine of São Paulo, School of Medicine, and
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Identification of intima-to-media signals for flow-induced vascular remodeling using correlative gene expression analysis. Sci Rep 2021; 11:16142. [PMID: 34373496 PMCID: PMC8352890 DOI: 10.1038/s41598-021-95403-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Changes in blood flow can induce arterial remodeling. Intimal cells sense flow and send signals to the media to initiate remodeling. However, the nature of such intima-media signaling is not fully understood. To identify potential signals, New Zealand white rabbits underwent bilateral carotid ligation to increase flow in the basilar artery or sham surgery (n = 2 ligated, n = 2 sham). Flow was measured by transcranial Doppler ultrasonography, vessel geometry was determined by 3D angiography, and hemodynamics were quantified by computational fluid dynamics. 24 h post-surgery, the basilar artery and terminus were embedded for sectioning. Intima and media were separately microdissected from the sections, and whole transcriptomes were obtained by RNA-seq. Correlation analysis of expression across all possible intima-media gene pairs revealed potential remodeling signals. Carotid ligation increased flow in the basilar artery and terminus and caused differential expression of 194 intimal genes and 529 medial genes. 29,777 intima-media gene pairs exhibited correlated expression. 18 intimal genes had > 200 medial correlates and coded for extracellular products. Gene ontology of the medial correlates showed enrichment of organonitrogen metabolism, leukocyte activation/immune response, and secretion/exocytosis processes. This demonstrates correlative expression analysis of intimal and medial genes can reveal novel signals that may regulate flow-induced arterial remodeling.
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123
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Hallikainen J, Pyysalo M, Keränen S, Kellokoski J, Koivisto T, Suominen AL, Pussinen P, Pessi T, Frösen J. Systemic immune response against the oral pathogens Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans is associated with the formation and rupture of intracranial aneurysms. Eur J Neurol 2021; 28:3089-3099. [PMID: 34145948 DOI: 10.1111/ene.14986] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Periodontal infections are associated with the formation and rupture of intracranial aneurysms (IAs). This study investigated the role of two key periodontal pathogens, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. METHODS Immunoglobulin A (IgA) and IgG antibodies against P. gingivalis and A. actinomycetemcomitans were measured with enzyme immune assay from the serum of 227 IA patients, of whom 64 also underwent clinical oral examination. As a control group, 1096 participants in a cross-sectional health survey, Health 2000, underwent serological studies and oral examination. Logistic regression was used for multivariate analysis. Immunohistochemistry was performed to demonstrate bacteria-derived epitopes in the IA wall. RESULTS Widespread gingivitis and severe periodontitis were more common in IA patients than in controls (2× and 1.5×, respectively). IgA antibodies against P. gingivalis and A. actinomycetemcomitans were 1.5× and 3-3.4× higher, respectively, in both unruptured and ruptured IA patients compared to controls (p ≤ 0.003). IgG antibodies against P. gingivalis were 1.8× lower in unruptured IA patients (p < 0.001). In multivariate analysis, high IgA, but low IgG, antibody levels against P. gingivalis (odds ratio [OR] = 1.4, 95% confidence interval [Cl] = 1.1-1.8 and OR = 1.5, 95% Cl = 1.1-1.9; OR = 0.6, 95% Cl = 0.4-0.7 and OR = 0.5, 95% Cl = 0.4-0.7) and against A. actinomycetemcomitans (OR = 2.3, 95% Cl = 1.7-3.1 and OR = 2.1, 95% Cl = 1.5-2.9; OR = 0.6, 95% Cl = 0.4-0.8 and OR = 0.6, 95% Cl = 0.5-0.9) were associated with the risk of IA formation and rupture. Immunohistochemistry showed P. gingivalis epitopes in the IA wall. CONCLUSIONS Exposure to the periodontal pathogens P. gingivalis and A. actinomycetemcomitans and dysfunctional acquired immune response against them may increase the risk of IA formation and IA rupture.
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Affiliation(s)
- Joona Hallikainen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Mikko Pyysalo
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Sara Keränen
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.,A. I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Jari Kellokoski
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pirkko Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tanja Pessi
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.,Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
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Shimizu K, Kataoka H, Imai H, Yamamoto Y, Yamada T, Miyata H, Koseki H, Abekura Y, Oka M, Kushamae M, Ono I, Miyamoto S, Nakamura M, Aoki T. Hemodynamic Force as a Potential Regulator of Inflammation-Mediated Focal Growth of Saccular Aneurysms in a Rat Model. J Neuropathol Exp Neurol 2021; 80:79-88. [PMID: 33212493 DOI: 10.1093/jnen/nlaa131] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Past studies have elucidated the crucial role of macrophage-mediated inflammation in the growth of intracranial aneurysms (IAs), but the contributions of hemodynamics are unclear. Considering the size of the arteries, we induced de novo aneurysms at the bifurcations created by end-to-side anastomoses with the bilateral common carotid arteries in rats. Sequential morphological data of induced aneurysms were acquired by magnetic resonance angiography. Computational fluid dynamics analyses and macrophage imaging by ferumoxytol were performed. Using this model, we found that de novo saccular aneurysms with a median size of 3.2 mm were induced in 20/45 (44%) of animals. These aneurysms mimicked human IAs both in morphology and pathology. We detected the focal growth of induced aneurysms between the 10th and 17th day after the anastomosis. The regional maps of hemodynamic parameters demonstrated the area exposed to low wall shear stress (WSS) and high oscillatory shear index (OSI) colocalized with the regions of growth. WSS values were significantly lower in the growing regions than in ones without growth. Macrophage imaging showed colocalization of macrophage infiltration with the growing regions. This experimental model demonstrates the potential contribution of low WSS and high OSI to the macrophage-mediated growth of saccular aneurysms.
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Affiliation(s)
- Kampei Shimizu
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Suita.,Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto.,Core Research for Evolutional Science and Technology (CREST) from Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Suita
| | - Hiroharu Kataoka
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
| | - Hirohiko Imai
- Department of Systems Science, Graduate School of Informatics, Kyoto University, Kyoto
| | - Yuto Yamamoto
- Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Tomohiro Yamada
- Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Haruka Miyata
- Core Research for Evolutional Science and Technology (CREST) from Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Suita
| | - Hirokazu Koseki
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Suita.,Core Research for Evolutional Science and Technology (CREST) from Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Suita
| | - Yu Abekura
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Suita.,Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto.,Core Research for Evolutional Science and Technology (CREST) from Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Suita
| | - Mieko Oka
- Core Research for Evolutional Science and Technology (CREST) from Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Suita
| | - Mika Kushamae
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Suita.,Core Research for Evolutional Science and Technology (CREST) from Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Suita
| | - Isao Ono
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Suita.,Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto.,Core Research for Evolutional Science and Technology (CREST) from Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Suita
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
| | - Masanori Nakamura
- Department of Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Tomohiro Aoki
- From the Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Suita.,Core Research for Evolutional Science and Technology (CREST) from Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Suita
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125
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Weiland J, Beez A, Westermaier T, Kunze E, Sirén AL, Lilla N. Neuroprotective Strategies in Aneurysmal Subarachnoid Hemorrhage (aSAH). Int J Mol Sci 2021; 22:5442. [PMID: 34064048 PMCID: PMC8196706 DOI: 10.3390/ijms22115442] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 12/19/2022] Open
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) remains a disease with high mortality and morbidity. Since treating vasospasm has not inevitably led to an improvement in outcome, the actual emphasis is on finding neuroprotective therapies in the early phase following aSAH to prevent secondary brain injury in the later phase of disease. Within the early phase, neuroinflammation, thromboinflammation, disturbances in brain metabolism and early neuroprotective therapies directed against delayed cerebral ischemia (DCI) came into focus. Herein, the role of neuroinflammation, thromboinflammation and metabolism in aSAH is depicted. Potential neuroprotective strategies regarding neuroinflammation target microglia activation, metalloproteases, autophagy and the pathway via Toll-like receptor 4 (TLR4), high mobility group box 1 (HMGB1), NF-κB and finally the release of cytokines like TNFα or IL-1. Following the link to thromboinflammation, potential neuroprotective therapies try to target microthrombus formation, platelets and platelet receptors as well as clot clearance and immune cell infiltration. Potential neuroprotective strategies regarding metabolism try to re-balance the mismatch of energy need and supply following aSAH, for example, in restoring fuel to the TCA cycle or bypassing distinct energy pathways. Overall, this review addresses current neuroprotective strategies in aSAH, hopefully leading to future translational therapy options to prevent secondary brain injury.
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Affiliation(s)
- Judith Weiland
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider Str. 11, 97080 Würzburg, Germany; (A.B.); (T.W.); (E.K.); (A.-L.S.)
| | - Alexandra Beez
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider Str. 11, 97080 Würzburg, Germany; (A.B.); (T.W.); (E.K.); (A.-L.S.)
| | - Thomas Westermaier
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider Str. 11, 97080 Würzburg, Germany; (A.B.); (T.W.); (E.K.); (A.-L.S.)
- Department of Neurosurgery, Helios-Amper Klinikum Dachau, Krankenhausstr. 15, 85221 Dachau, Germany
| | - Ekkehard Kunze
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider Str. 11, 97080 Würzburg, Germany; (A.B.); (T.W.); (E.K.); (A.-L.S.)
| | - Anna-Leena Sirén
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider Str. 11, 97080 Würzburg, Germany; (A.B.); (T.W.); (E.K.); (A.-L.S.)
| | - Nadine Lilla
- Department of Neurosurgery, University Hospital Würzburg, Josef-Schneider Str. 11, 97080 Würzburg, Germany; (A.B.); (T.W.); (E.K.); (A.-L.S.)
- Department of Neurosurgery, University Hospital Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany
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126
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Rikhtegar R, Mosimann PJ, Rothaupt J, Mirza-Aghazadeh-Attari M, Hallaj S, Yousefi M, Amiri A, Farashi E, Kheyrollahiyan A, Dolati S. Non-coding RNAs role in intracranial aneurysm: General principles with focus on inflammation. Life Sci 2021; 278:119617. [PMID: 34004250 DOI: 10.1016/j.lfs.2021.119617] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/30/2021] [Accepted: 05/09/2021] [Indexed: 02/07/2023]
Abstract
Intracranial aneurysm (IA) is one of the most challenging vascular lesions in the brain for clinicians. It was reported that 1%-6% of the world's population is affected by IAs. Owing to serious complications arising from these lesions, much attention has been paid to better understand their pathophysiology. Non-coding RNAs including short non-coding RNAs and long non-coding RNAs, have critical roles in modulating physiologic and pathological processes. These RNAs are emerging as new fundamental regulators of gene expression, are related with the progression of IA. Non-coding RNAs act via multiple mechanisms and be involved in vascular development, growth and remodeling. Furthermore, these molecules are involved in the regulation of inflammation, a key process in the formation and rupture of IA. Studying non-coding RNAs can yield a hypothetical mechanism for better understanding IA. The present study aims to focus on the role of these non-coding RNAs in the pathogenesis of IA.
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Affiliation(s)
- Reza Rikhtegar
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Pascal J Mosimann
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | - Jan Rothaupt
- Department of Intracranial Endovascular Therapy, Alfried Krupp Krankenhaus Essen, Essen, Germany
| | | | - Shahin Hallaj
- Burn and Regenerative Medicine Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehdi Yousefi
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh Amiri
- Department of Cardiology, Marien Marl Hospital, Marl, Germany
| | - Ebrahim Farashi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Sanam Dolati
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
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127
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The association between hemodynamics and wall characteristics in human intracranial aneurysms: a review. Neurosurg Rev 2021; 45:49-61. [PMID: 33913050 DOI: 10.1007/s10143-021-01554-w] [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: 02/17/2021] [Revised: 04/02/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
Hemodynamics plays a key role in the natural history of intracranial aneurysms (IAs). However, studies exploring the association between aneurysmal hemodynamics and the biological and mechanical characteristics of the IA wall in humans are sparse. In this review, we survey the current body of literature, summarize the studies' methodologies and findings, and assess the degree of consensus among them. We used PubMed to perform a systematic review of studies that explored the association between hemodynamics and human IA wall features using different sources. We identified 28 publications characterizing aneurysmal flow and the IA wall: 4 using resected tissues, 17 using intraoperative images, and 7 using vessel wall magnetic resonance imaging (MRI). Based on correlation to IA tissue, higher flow conditions, such as high wall shear stress (WSS) with complex pattern and elevated pressure, were associated with degenerated walls and collagens with unphysiological orientation and faster synthesis. MRI studies strongly supported that low flow, characterized by low WSS and high blood residence time, was associated with thicker walls and post-contrast enhancement. While significant discrepancies were found among those utilized intraoperative images, they generally supported that thicker walls coexist at regions with prolonged residence time and that thinner regions are mainly exposed to higher pressure with complex WSS patterns. The current body of literature supports a theory of two general hemodynamic-biologic mechanisms for IA development. One, where low flow conditions are associated with thickening and atherosclerotic-like remodeling, and the other where high and impinging flow conditions are related to wall degeneration, thinning, and collagen remodeling.
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128
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Kim JJ, Yang H, Kim YB, Oh JH, Cho KC. The quantitative comparison between high wall shear stress and high strain in the formation of paraclinoid aneurysms. Sci Rep 2021; 11:7947. [PMID: 33846487 PMCID: PMC8041878 DOI: 10.1038/s41598-021-87126-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/24/2021] [Indexed: 11/12/2022] Open
Abstract
In the hemodynamic study, computational fluid dynamics (CFD) analysis has shown that high wall shear stress (WSS) is an important parameter in cerebral aneurysm formation. However, CFD analysis is not more realistic than fluid–structure interaction (FSI) analysis given its lack of considering the involvement of vascular structures. To investigate the relationship between the hemodynamic parameters and the aneurysm formation, the locations of high WSS and high strain were extracted from the CFD and FSI analyses, respectively. Then the distances between the aneurysm formation site and the locations of high WSS or high strain were calculated. A total of 37 intracranial paraclinoid aneurysms were enrolled for quantitative comparison. Additionally, the dura mater was modeled to facilitate realistic results in FSI analysis. The average distance from the location of the aneurysm formation site to the high strain (1.74 mm \documentclass[12pt]{minimal}
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\begin{document}$$\pm $$\end{document}± 1.04 mm) was smaller than the average distance to the high WSS (3.33 mm \documentclass[12pt]{minimal}
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\begin{document}$$\pm $$\end{document}± 1.18 mm). The presence of dura mater also influenced the findings in the aneurysm formation site. High strain extracted by FSI analysis is an important hemodynamic factor related to the formation of cerebral aneurysms. Strain parameter could help to predict the formation of aneurysms and elucidate the appropriate treatment.
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Affiliation(s)
- Jung-Jae Kim
- Department of Neurosurgery, College of Medicine, Ewha Womans University, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Hyeondong Yang
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, 15588, Gyeonggi-do, Korea
| | - Yong Bae Kim
- Department of Neurosurgery, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
| | - Je Hoon Oh
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, 15588, Gyeonggi-do, Korea.
| | - Kwang-Chun Cho
- Department of Neurosurgery, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Simgokro 100gil 25, Seo-gu, Incheon, Korea.
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129
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Wang TY, Chang MM, Li YSJ, Huang TC, Chien S, Wu CC. Maintenance of HDACs and H3K9me3 Prevents Arterial Flow-Induced Venous Endothelial Damage. Front Cell Dev Biol 2021; 9:642150. [PMID: 33898431 PMCID: PMC8063156 DOI: 10.3389/fcell.2021.642150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/09/2021] [Indexed: 01/11/2023] Open
Abstract
The transition of flow microenvironments from veins to arteries in vein graft surgery induces “peel-off” of venous endothelial cells (vECs) and results in restenosis. Recently, arterial laminar shear stress (ALS) and oscillatory shear stress (OS) have been shown to affect the cell cycle and inflammation through epigenetic controls such as histone deacetylation by histone deacetylases (HDACs) and trimethylation on lysine 9 of histone 3 (H3K9me3) in arterial ECs. However, the roles of H3K9me3 and HDAC in vEC damage under ALS are not known. We hypothesized that the different responses of HDACs and H3K9me3 might cause vEC damage under the transition of venous flow to arterial flow. We found that arterial ECs showed high expression of H3K9me3 protein and were retained in the G0 phase of the cell cycle after being subjected to ALS. vECs became round under ALS with a decrease in the expression of H3K9me3, HDAC3, and HDAC5, and an increase in the expression of vascular cell adhesion molecule 1 (VCAM-1). Inhibition of HDACs activity by a specific inhibitor, phenylbutyrate, in arterial ECs caused similar ALS-induced inflammation and cell loss as observed in vECs. Activation of HDACs and H3K9me3 by ITSA-1, an HDAC activator, could prevent ALS-induced peel-off and reduced VCAM-1 expression in vECs. Moreover, shear stress modulates EC morphology by the regulation of focal adhesion kinase (FAK) expression. ITSA-1 or EGF could increase phosphorylated (p)-FAK expression in vECs under ALS. We found that perturbation of the activity of p-FAK and increase in p-FAK expression restored ALS-induced H3K9me3 expression in vECs. Hence, the abnormal mechanoresponses of H3K9me3 and HDAC in vECs after being subjected to ALS could be reversed by ITSA-1 or EGF treatment: this offers a strategy to prevent vein graft failure.
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Affiliation(s)
- Ting-Yun Wang
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Min Chang
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Shuan Julie Li
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Tzu-Chieh Huang
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shu Chien
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States.,Institute of Engineering in Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Chia-Ching Wu
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
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130
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Suzuki T, Hasegawa H, Ando K, Shibuya K, Takahashi H, Saito S, On J, Oishi M, Fujii Y. Hemodynamic features of an intracranial aneurysm rupture predicted by perianeurysmal edema: A case report. Surg Neurol Int 2021; 12:49. [PMID: 33654552 PMCID: PMC7911146 DOI: 10.25259/sni_780_2020] [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: 11/01/2020] [Accepted: 01/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Perianeurysmal edema (PAE) has been suggested as an indicator of potential aneurysm rupture; however, the hemodynamic features of these aneurysms are still unknown. A computational fluid dynamic (CFD) analysis was performed to evaluate the hemodynamic features of a very rare case of a ruptured middle cerebral artery (MCA) aneurysm with PAE. Case Description: A 65-year-old woman presented with disturbed consciousness. A subarachnoid hemorrhage due to an azygos anterior cerebral artery (ACA) aneurysm rupture was suspected. An unruptured MCA aneurysm with PAE was identified in the left temporal lobe. Although the ACA aneurysm was clipped to prevent re-bleeding, the MCA aneurysm subsequently ruptured 6 days later. Clipping of the MCA aneurysm was performed, and hemosiderin deposits suggestive of sentinel bleeding were found on the surface of the aneurysm dome. CFD analysis revealed unstable hemodynamic stress at the expanded bleb area after rupture, localized to the rupture site. Moreover, this analysis revealed flow impingement with pressure elevation and low wall shear stress, which indicated increased inflammation and aneurysm wall thinning that likely led to rupture. Conclusion: Hemosiderin deposits at the aneurysm wall and PAE indicates leakage from a cerebral aneurysm. Hemodynamic stress at the aneurysm may promote an inflammatory response and lead to wall weakening accompanied by PAE. Based on our findings, we recommend that surgical intervention should be considered as the first line of treatment for such aneurysms to prevent rupture.
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Affiliation(s)
- Tomoaki Suzuki
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Kazuhiro Ando
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Kohei Shibuya
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Haruhiko Takahashi
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Shoji Saito
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Jotaro On
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Makoto Oishi
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
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131
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Roa JA, Zanaty M, Osorno-Cruz C, Ishii D, Bathla G, Ortega-Gutierrez S, Hasan DM, Samaniego EA. Objective quantification of contrast enhancement of unruptured intracranial aneurysms: a high-resolution vessel wall imaging validation study. J Neurosurg 2021; 134:862-869. [PMID: 32032948 PMCID: PMC7415549 DOI: 10.3171/2019.12.jns192746] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/05/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE High-resolution vessel wall imaging (HR-VWI) has emerged as a valuable tool in assessing unruptured intracranial aneurysms (UIAs). There is no standardized method to quantify contrast enhancement of the aneurysm wall. Contrast enhancement can be objectively measured as signal intensity (SI) or subjectively adjudicated. In this study, the authors compared the different methods to quantify wall enhancement of UIAs and determined the sensitivity and specificity of each method as a surrogate of aneurysm instability. They also compared SI quantification between scanners from different manufacturers. METHODS The University of Iowa HR-VWI Project database was analyzed. This database compiles patients with UIAs who prospectively underwent HR-VWI using a 3T MRI scanner. The mean and maximal SI values of the aneurysm wall, pituitary stalk, and genu of the corpus callosum were used to compare 3 different measurement methods: 1) aneurysm enhancement ratio AER = (SIwall post - SIwall pre)/SIwall pre; 2) aneurysm-to-pituitary stalk contrast ratio CRstalk = SIwall post/SIstalk post; and 3) aneurysm enhancement index AEI = ([SIwall post/SIbrain post] - [SIwall pre/SIbrain pre])/(SIwall pre/SIbrain pre) (where "pre" indicates precontrast images and "post" indicates postcontrast images). Size ≥ 7 mm was used as a surrogate of aneurysm instability for receiver operating characteristic (ROC) curve analysis. To determine if the objective quantification of SI varies among scanners from different manufacturers, 9 UIAs underwent the same HR-VWI protocol using a 3T General Electric (GE) scanner and a 3T Siemens scanner. Three UIAs also underwent a third scanning procedure on a unit with a different magnet strength (7T GE). RESULTS Eighty patients with 102 UIAs were included in the study. The mean age was 64.5 ± 12.2 years, and 64 (80%) patients were women. UIAs ≥ 7 mm had significantly higher SIs than smaller UIAs (< 7 mm): AER = 0.82 vs 0.49, p < 0.001; CRstalk = 0.84 vs 0.61, p < 0.001; and AEI = 0.81 vs 0.48, p < 0.001. ROC curves demonstrated optimal sensitivity of 81.5% for CRstalk ≥ 0.60, 75.9% for AEI ≥ 0.50, and 74.1% for AER ≥ 0.49. Intermanufacturer correlation between 3T GE and 3T Siemens MRI scanners for CRstalk using mean and maximal SI values was excellent (Pearson coefficients > 0.80, p < 0.001). A similar correlation was identified among the 3 UIAs that underwent 7T imaging. CONCLUSIONS CRstalk using maximal SI values was the most reliable objective method to quantify enhancement of UIAs on HR-VWI. The same ratios were obtained between different manufacturers and on scans obtained using magnets of different strengths.
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Affiliation(s)
- Jorge A. Roa
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Mario Zanaty
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Carlos Osorno-Cruz
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daizo Ishii
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Girish Bathla
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - David M. Hasan
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Edgar A. Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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132
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Perrelli A, Fatehbasharzad P, Benedetti V, Ferraris C, Fontanella M, De Luca E, Moglianetti M, Battaglia L, Retta SF. Towards precision nanomedicine for cerebrovascular diseases with emphasis on Cerebral Cavernous Malformation (CCM). Expert Opin Drug Deliv 2021; 18:849-876. [PMID: 33406376 DOI: 10.1080/17425247.2021.1873273] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Cerebrovascular diseases encompass various disorders of the brain vasculature, such as ischemic/hemorrhagic strokes, aneurysms, and vascular malformations, also affecting the central nervous system leading to a large variety of transient or permanent neurological disorders. They represent major causes of mortality and long-term disability worldwide, and some of them can be inherited, including Cerebral Cavernous Malformation (CCM), an autosomal dominant cerebrovascular disease linked to mutations in CCM1/KRIT1, CCM2, or CCM3/PDCD10 genes.Areas covered: Besides marked clinical and etiological heterogeneity, some commonalities are emerging among distinct cerebrovascular diseases, including key pathogenetic roles of oxidative stress and inflammation, which are increasingly recognized as major disease hallmarks and therapeutic targets. This review provides a comprehensive overview of the different clinical features and common pathogenetic determinants of cerebrovascular diseases, highlighting major challenges, including the pressing need for new diagnostic and therapeutic strategies, and focusing on emerging innovative features and promising benefits of nanomedicine strategies for early detection and targeted treatment of such diseases.Expert opinion: Specifically, we describe and discuss the multiple physico-chemical features and unique biological advantages of nanosystems, including nanodiagnostics, nanotherapeutics, and nanotheranostics, that may help improving diagnosis and treatment of cerebrovascular diseases and neurological comorbidities, with an emphasis on CCM disease.
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Affiliation(s)
- Andrea Perrelli
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino Italy.,CCM Italia Research Network, National Coordination Center at the Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino Italy
| | - Parisa Fatehbasharzad
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino Italy.,CCM Italia Research Network, National Coordination Center at the Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino Italy
| | - Valerio Benedetti
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino Italy.,CCM Italia Research Network, National Coordination Center at the Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino Italy
| | - Chiara Ferraris
- Department of Drug Science and Technology, University of Torino, Torino, Italy.,Nanostructured Interfaces and Surfaces (NIS) Interdepartmental Centre, University of Torino, Torino, Italy
| | - Marco Fontanella
- CCM Italia Research Network, National Coordination Center at the Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino Italy.,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Elisa De Luca
- Nanobiointeractions & Nanodiagnostics, Center for Biomolecular Nanotechnologies, Arnesano, Lecce, Italy.,Institute for Microelectronics and Microsystems (IMM), CNR, Lecce, Italy
| | - Mauro Moglianetti
- Nanobiointeractions & Nanodiagnostics, Center for Biomolecular Nanotechnologies, Arnesano, Lecce, Italy.,Istituto Italiano Di Tecnologia, Nanobiointeractions & Nanodiagnostics, Genova, Italy
| | - Luigi Battaglia
- Department of Drug Science and Technology, University of Torino, Torino, Italy.,Nanostructured Interfaces and Surfaces (NIS) Interdepartmental Centre, University of Torino, Torino, Italy
| | - Saverio Francesco Retta
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino Italy.,CCM Italia Research Network, National Coordination Center at the Department of Clinical and Biological Sciences, University of Torino, Orbassano, Torino Italy
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133
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Salimi Ashkezari SF, Mut F, Chung BJ, Robertson AM, Frösen J, Cebral JR. Analysis of hemodynamic changes from aneurysm inception to large sizes. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3415. [PMID: 33205887 PMCID: PMC8991439 DOI: 10.1002/cnm.3415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 06/11/2023]
Abstract
While previous studies have identified many risk factors for the progression and rupture of cerebral aneurysms, the changes in aneurysm flow characteristics during its evolution are not fully understood. This work analyzes the changes in the aneurysm hemodynamic environment from its initial development to later stages when the aneurysm has substantially enlarged. A total of 88 aneurysms at four locations were studied with image based computational fluid dynamics (CFD). Two synthetic sequences representing the aneurysm geometry at three earlier stages were generated by shrinking the aneurysm sac while keeping the neck fixed or shrinking the neck simultaneously. The flow conditions were then quantitatively compared between these two modes of evolution. As aneurysms enlarged, the inflow rate increased in growing neck sequences, but decreased in fixed neck sequences. The inflow jet became more concentrated in both sequences. The mean aneurysm flow velocity and wall shear stress decreased in both sequences, but they decreased faster in enlarging aneurysms if the neck was fixed. Additionally, the intra-aneurysmal flows became more complex and more unstable, wall shear stress distribution became more oscillatory, and the area under low wall shear stress increased for both sequences. The evolution of flow characteristics of aneurysms with fixed and growing necks are different. The observed trends suggest that fixed neck aneurysms may evolve towards a flow environment characteristic of stable aneurysms faster than aneurysms with growing necks, which could also evolve towards a more disfavorable environment.
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Affiliation(s)
| | - Fernando Mut
- Bioengineering Department, George Mason University, Fairfax, Virginia, USA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, Montclair, New Jersey, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Juan R Cebral
- Bioengineering Department, George Mason University, Fairfax, Virginia, USA
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134
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Keränen S, Suutarinen S, Mallick R, Laakkonen JP, Guo D, Pawlikowska L, Jahromi BR, Rauramaa T, Ylä-Herttuala S, Marchuk D, Krings T, Koivisto T, Lawton M, Radovanovic I, Kim H, Faughnan ME, Frösen J. Cyclo-oxygenase 2, a putative mediator of vessel remodeling, is expressed in the brain AVM vessels and associates with inflammation. Acta Neurochir (Wien) 2021; 163:2503-2514. [PMID: 34185176 PMCID: PMC8357659 DOI: 10.1007/s00701-021-04895-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Brain arteriovenous malformations (bAVM) may rupture causing disability or death. BAVM vessels are characterized by abnormally high flow that in general triggers expansive vessel remodeling mediated by cyclo-oxygenase-2 (COX2), the target of non-steroidal anti-inflammatory drugs. We investigated whether COX2 is expressed in bAVMs and whether it associates with inflammation and haemorrhage in these lesions. METHODS Tissue was obtained from surgery of 139 bAVMs and 21 normal Circle of Willis samples. The samples were studied with immunohistochemistry and real-time quantitative polymerase chain reaction (RT-PCR). Clinical data was collected from patient records. RESULTS COX2 expression was found in 78% (109/139) of the bAVMs and localized to the vessels' lumen or medial layer in 70% (95/135) of the bAVMs. Receptors for prostaglandin E2, a COX2-derived mediator of vascular remodeling, were found in the endothelial and smooth muscle cells and perivascular inflammatory cells of bAVMs. COX2 was expressed by infiltrating inflammatory cells and correlated with the extent of inflammation (r = .231, p = .007, Spearman rank correlation). COX2 expression did not associate with haemorrhage. CONCLUSION COX2 is induced in bAVMs, and possibly participates in the regulation of vessel wall remodelling and ongoing inflammation. Role of COX2 signalling in the pathobiology and clinical course of bAVMs merits further studies.
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Affiliation(s)
- Sara Keränen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Santeri Suutarinen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Rahul Mallick
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Johanna P Laakkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Diana Guo
- Center for Cerebrovascular Research, Dept of Anesthesiology and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Ludmila Pawlikowska
- Center for Cerebrovascular Research, Dept of Anesthesiology and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Behnam Rezai Jahromi
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Tuomas Rauramaa
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Department of Pathology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Doug Marchuk
- Division of Human Genetics, Duke University School of Medicine, Durham, NC, USA
| | - Timo Krings
- Department of Neuroradiology, University Hospital Network Toronto, Toronto, Canada
| | - Timo Koivisto
- Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Michael Lawton
- Department of Neurosurgery, Barrow Brain and Spine Institute, Phoenix, AZ, USA
| | - Ivan Radovanovic
- Department of Neurosurgery, University Hospital Network Toronto, Toronto, Canada
| | - Helen Kim
- Center for Cerebrovascular Research, Dept of Anesthesiology and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Marie E Faughnan
- Toronto HHT Centre, St. Michael's Hospital and Li Ka Shing Knowledge Institute, Toronto, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland.
- Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Elämänaukio 2, PoBox 33521, Tampere, Finland.
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135
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Fortunato RN, Robertson AM, Sang C, Duan X, Maiti S. Effect of macro-calcification on the failure mechanics of intracranial aneurysmal wall tissue. EXPERIMENTAL MECHANICS 2021; 61:5-18. [PMID: 33776069 PMCID: PMC7992055 DOI: 10.1007/s11340-020-00657-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/16/2020] [Accepted: 08/05/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Calcification was recently found to be present in the majority of cerebral aneurysms, though how calcification and the presence or absence of co-localized lipid pools affect failure properties is still unknown. OBJECTIVE The primary objective is to quantify the biomechanical effect of a macro-calcification with surrounding Near-Calcification Region (NCR) of varying mechanical properties on tissue failure behavior. METHODS We utilized a structurally informed finite element model to simulate pre-failure and failure behavior of a human cerebral tissue specimen modeled as a composite containing a macro-calcification and surrounding NCR, embedded in a fiber matrix composite. Data from multiple imaging modalities was combined to quantify the collagen organization and calcification geometry. An idealized parametric model utilizing the calibrated model was used to explore the impact of NCR properties on tissue failure. RESULTS Compared to tissue without calcification, peak stress was reduced by 82% and 49% for low modulus (representing lipid pool) and high modulus (simulating increase in calcification size) of the NCR, respectively. Failure process strongly depended on NCR properties with lipid pools blunting the onset of complete failure. When the NCR was calcified, the sample was able to sustain larger overall stress, however the failure process was abrupt with nearly simultaneous failure of the loaded fibers. CONCLUSIONS Failure of calcified vascular tissue is strongly influenced by the ultrastructure in the vicinity of the calcification. Computational modeling of failure in fibrous soft tissues can be used to understand how pathological changes impact the tissue failure process, with potentially important clinical implications.
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Affiliation(s)
- R. N. Fortunato
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh Pittsburgh, USA
| | - A. M. Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh Pittsburgh, USA
- Department of Bioengineering, University of Pittsburgh Pittsburgh, USA
| | - C. Sang
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh Pittsburgh, USA
| | - X. Duan
- Intelligent Automation Group, PNC Bank, University of Pittsburgh Pittsburgh, USA
| | - S. Maiti
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh Pittsburgh, USA
- Department of Bioengineering, University of Pittsburgh Pittsburgh, USA
- Department of Chemical and Petroleum Engineering, University of Pittsburgh Pittsburgh, USA
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136
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Hadad S, Mut F, Chung BJ, Roa JA, Robertson AM, Hasan DM, Samaniego EA, Cebral JR. Regional Aneurysm Wall Enhancement is Affected by Local Hemodynamics: A 7T MRI Study. AJNR Am J Neuroradiol 2020; 42:464-470. [PMID: 33361379 DOI: 10.3174/ajnr.a6927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/30/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysm wall enhancement has been proposed as a biomarker for inflammation and instability. However, the mechanisms of aneurysm wall enhancement remain unclear. We used 7T MR imaging to determine the effect of flow in different regions of the wall. MATERIALS AND METHODS Twenty-three intracranial aneurysms imaged with 7T MR imaging and 3D angiography were studied with computational fluid dynamics. Local flow conditions were compared between aneurysm wall enhancement and nonenhanced regions. Aneurysm wall enhancement regions were subdivided according to their location on the aneurysm and relative to the inflow and were further compared. RESULTS On average, wall shear stress was lower in enhanced than in nonenhanced regions (P = .05). Aneurysm wall enhancement regions at the neck had higher wall shear stress gradients (P = .05) with lower oscillations (P = .05) than nonenhanced regions. In contrast, aneurysm wall enhancement regions at the aneurysm body had lower wall shear stress (P = .01) and wall shear stress gradients (P = .008) than nonenhanced regions. Aneurysm wall enhancement regions far from the inflow had lower wall shear stress (P = .006) than nonenhanced regions, while aneurysm wall enhancement regions close to the inflow tended to have higher wall shear stress than the nonenhanced regions, but this association was not significant. CONCLUSIONS Aneurysm wall enhancement regions tend to have lower wall shear stress than nonenhanced regions of the same aneurysm. Moreover, the association between flow conditions and aneurysm wall enhancement seems to depend on the location of the region on the aneurysm sac. Regions at the neck and close to the inflow tend to be exposed to higher wall shear stress and wall shear stress gradients. Regions at the body, dome, or far from the inflow tend to be exposed to uniformly low wall shear stress and have more aneurysm wall enhancement.
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Affiliation(s)
- S Hadad
- From the Departments of Bioengineering and Mechanical Engineering (S.H., F.M., J.R.C.), George Mason University, Fairfax, Virginia
| | - F Mut
- From the Departments of Bioengineering and Mechanical Engineering (S.H., F.M., J.R.C.), George Mason University, Fairfax, Virginia
| | - B J Chung
- Department of Applied Mathematics and Statistics (B.J.C.), Mountclair State University, Mountclair, New Jersey
| | - J A Roa
- Departments of Neurology, Neurosurgery, and Radiology (J.A.R., E.A.S.)
| | - A M Robertson
- Department of Mechanical Engineering and Material Science (A.M.R.), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - D M Hasan
- Neurosurgery (D.M.H.), University of Iowa, Iowa City, Iowa
| | - E A Samaniego
- Departments of Neurology, Neurosurgery, and Radiology (J.A.R., E.A.S.)
| | - J R Cebral
- From the Departments of Bioengineering and Mechanical Engineering (S.H., F.M., J.R.C.), George Mason University, Fairfax, Virginia
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137
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Chehaitly A, Vessieres E, Guihot AL, Henrion D. Flow-mediated outward arterial remodeling in aging. Mech Ageing Dev 2020; 194:111416. [PMID: 33333130 DOI: 10.1016/j.mad.2020.111416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022]
Abstract
The present review focuses on the effect of aging on flow-mediated outward remodeling (FMR) via alterations in estrogen metabolism, oxidative stress and inflammation. In ischemic disorders, the ability of the vasculature to adapt or remodel determines the quality of the recovery. FMR, which has a key role in revascularization, is a complex phenomenon that recruits endothelial and smooth muscle cells as well as the immune system. FMR becomes progressively less with age as a result of an increase in inflammation and oxidative stress, in part of mitochondrial origin. The alteration in FMR is greater in older individuals with risk factors and thus the therapy cannot merely amount to exercise with or without a mild vasodilating drug. Interestingly, the reduction in FMR occurs later in females. Estrogen and its alpha receptor (ERα) play a key role in FMR through the control of dilatory pathways including the angiotensin II type 2 receptor, thus providing possible tools to activate FMR in older subjects although only experimental data is available. Indeed, the main issue is the reversibility of the vascular damage induced over time, and to date promoting prevention and limiting exposure to the risk factors remain the best options in this regard.
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Affiliation(s)
- Ahmad Chehaitly
- MITOVASC Laboratory and CARFI Facility, INSERM U1083, CNRS UMR 6015, University of Angers, Angers, France
| | - Emilie Vessieres
- MITOVASC Laboratory and CARFI Facility, INSERM U1083, CNRS UMR 6015, University of Angers, Angers, France
| | - Anne-Laure Guihot
- MITOVASC Laboratory and CARFI Facility, INSERM U1083, CNRS UMR 6015, University of Angers, Angers, France
| | - Daniel Henrion
- MITOVASC Laboratory and CARFI Facility, INSERM U1083, CNRS UMR 6015, University of Angers, Angers, France.
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138
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Teixeira FS, Neufeld E, Kuster N, Watton PN. Modeling intracranial aneurysm stability and growth: an integrative mechanobiological framework for clinical cases. Biomech Model Mechanobiol 2020; 19:2413-2431. [PMID: 32533497 PMCID: PMC7603456 DOI: 10.1007/s10237-020-01351-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Abstract
We present a novel patient-specific fluid-solid-growth framework to model the mechanobiological state of clinically detected intracranial aneurysms (IAs) and their evolution. The artery and IA sac are modeled as thick-walled, non-linear elastic fiber-reinforced composites. We represent the undulation distribution of collagen fibers: the adventitia of the healthy artery is modeled as a protective sheath whereas the aneurysm sac is modeled to bear load within physiological range of pressures. Initially, we assume the detected IA is stable and then consider two flow-related mechanisms to drive enlargement: (1) low wall shear stress; (2) dysfunctional endothelium which is associated with regions of high oscillatory flow. Localized collagen degradation and remodelling gives rise to formation of secondary blebs on the aneurysm dome. Restabilization of blebs is achieved by remodelling of the homeostatic collagen fiber stretch distribution. This integrative mechanobiological modelling workflow provides a step towards a personalized risk-assessment and treatment of clinically detected IAs.
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Affiliation(s)
| | - Esra Neufeld
- IT’IS Foundation & ETH Zürich, Zürich, Switzerland
| | - Niels Kuster
- IT’IS Foundation & ETH Zürich, Zürich, Switzerland
| | - Paul N. Watton
- Department of Computer Science, Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, USA
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139
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Rodemerk J, Jabbarli R, Wrede KH. Response by Rodemerk et al to Letter Regarding Article, "Pathophysiology of Intracranial Aneurysms: COX-2 Expression, Iron Deposition in Aneurysm Wall, and Correlation With Magnetic Resonance Imaging". Stroke 2020; 51:e369-e370. [PMID: 33226922 DOI: 10.1161/strokeaha.120.032514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jan Rodemerk
- Department of Neurosurgery, University Hospital Essen, Germany
| | | | - Karsten H Wrede
- Department of Neurosurgery, University Hospital Essen, Germany
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140
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Fenrich M, Habjanovic K, Kajan J, Heffer M. The circle of Willis revisited: Forebrain dehydration sensing facilitated by the anterior communicating artery: How hemodynamic properties facilitate more efficient dehydration sensing in amniotes. Bioessays 2020; 43:e2000115. [PMID: 33191609 DOI: 10.1002/bies.202000115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/10/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022]
Abstract
We hypothesize that threat of dehydration provided selection pressure for the evolutionary emergence and persistence of the anterior communicating artery (ACoA - the inter-arterial connection that completes the Circle of Willis) in early amniotes. The ACoA is a hemodynamically insignificant artery, but, as we argue in this paper, its privileged position outside the blood-brain barrier gives it a crucial sensing function for the osmolarity of the blood against the background of the rest of the brain, which efficiently protects itself from dehydration. Till now, the questions of why the ACoA evolved, and what its physiological function is, have remained unsatisfactorily answered. The traditional view-that the ACoA serves as a collateral source of vascularization in case of arterial stenosis-is anthropocentric, and not in accordance with principles of natural selection that apply more generally. Diseases underlying arterial stenosis are associated with aging and the human lifestyle, so this cannot explain why the ACoA formed hundreds of millions of years ago and persisted in amniotes to this day. The peculiar hemodynamic properties of the ACoA could be selected traits that allowed for more efficient forebrain detection of dehydration and complex behavioral responses to water loss, a major advantage in the survival of early amniotes. This hypothesis also explains insufficient hydration often seen in elderly humans.
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Affiliation(s)
- Matija Fenrich
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Karlo Habjanovic
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Josip Kajan
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
| | - Marija Heffer
- Laboratory of Neurobiology, Faculty of Medicine, J. J. Strossmayer University of Osijek, Osijek, Croatia
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141
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Kadomoto S, Muraoka Y, Uji A, Tamiya R, Ooto S, Murakami T, Oritani Y, Kawai K, Tsujikawa A. Ultrastructure and hemodynamics of microaneurysms in retinal vein occlusion examined by an offset pinhole adaptive optics scanning light ophthalmoscope. BIOMEDICAL OPTICS EXPRESS 2020; 11:6078-6092. [PMID: 33282476 PMCID: PMC7687975 DOI: 10.1364/boe.402331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 05/06/2023]
Abstract
Retinal microaneurysms (MAs) associated with retinal vein occlusions often cause macular edema due to vascular leakage from the MAs, which can lead to severe vision loss. However, studies using conventional imaging modalities have not shown a significant association between MAs and retinal functional changes. The recent technological advancements to the adaptive optics scanning light ophthalmoscope (AOSLO) have enabled real-time observation of the human retinal microvasculature. Additionally, offsetting the confocal aperture in the AOSLO enables the blocking of specular reflection from the inner retina and the enhancement of the image contrast of the retinal capillaries. This study investigated the ultrastructure and hemodynamics of MAs examined by structural images and perfusion maps of the offset pinhole AOSLO and evaluated their associations with vascular leakage on fluorescein angiography. Our results show the diverse configurations of the MAs, some of which are occasionally accompanied by a cap structure on the aneurysmal surface. Moreover, the morphological and hemodynamic changes were significantly associated with vascular leakage.
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142
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Zhang J, Can A, Lai PMR, Mukundan S, Castro VM, Dligach D, Finan S, Gainer VS, Shadick NA, Savova G, Murphy SN, Cai T, Weiss ST, Du R. Surrounding vascular geometry associated with basilar tip aneurysm formation. Sci Rep 2020; 10:17928. [PMID: 33087795 PMCID: PMC7578056 DOI: 10.1038/s41598-020-74266-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/17/2020] [Indexed: 01/18/2023] Open
Abstract
Hemodynamic stress is thought to play an important role in the formation of intracranial aneurysms, which is conditioned by the geometry of the surrounding vasculature. Our goal was to identify image-based morphological parameters that were associated with basilar artery tip aneurysms (BTA) in a location-specific manner. Three-dimensional morphological parameters obtained from CT-angiography (CTA) or digital subtraction angiography (DSA) from 207 patients with BTAs and a control group of 106 patients with aneurysms elsewhere to control for non-morphological factors, who were diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016, were evaluated. We examined the presence of hypoplastic, aplastic or fetal PCoAs, vertebral dominance, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. Sensitivity analyses with small (≤ 3 mm) aneurysms only and with angles excluded, were also performed. In multivariable analysis, daughter-daughter angle was directly, and parent artery diameter and diameter size ratio were inversely associated with BTAs. These results remained significant in the subgroup analysis of small aneurysms (width ≤ 3 mm) and when angles were excluded. These easily measurable and robust parameters that are unlikely to be affected by aneurysm formation could aid in risk stratification for the formation of BTAs in high-risk patients.
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Affiliation(s)
- Jian Zhang
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Victor M Castro
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
| | - Dmitriy Dligach
- Boston Children's Hospital Informatics Program, Boston, MA, USA
- Department of Computer Science, Loyola University, Chicago, IL, USA
| | - Sean Finan
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Vivian S Gainer
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
| | - Nancy A Shadick
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Guergana Savova
- Boston Children's Hospital Informatics Program, Boston, MA, USA
| | - Shawn N Murphy
- Research Information Systems and Computing, Massachusetts General Brigham, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tianxi Cai
- Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Scott T Weiss
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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143
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Weng JC, Wang J, Du X, Li H, Jiao YM, Fu WL, Huo R, Yan ZH, Xu HY, Wang S, Cao Y, Zhao JZ. Safety of Aspirin Use in Patients With Stroke and Small Unruptured Aneurysms. Neurology 2020; 96:e19-e29. [PMID: 33055274 DOI: 10.1212/wnl.0000000000010997] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE We initiated a multicenter, prospective cohort study to test the hypothesis that aspirin is safe for patients with ischemic cerebrovascular disease (ICVD) harboring unruptured intracranial aneurysms (UIAs) <7 mm. METHODS This prospective, multicenter cohort study consecutively enrolled 1,866 eligible patients with ICVD harboring UIAs <7 mm in diameter from 4 hospitals between January 2016 and August 2019. Baseline and follow-up patient information, including the use of aspirin, was recorded. The primary endpoint was aneurysm rupture. RESULTS After a total of 4,411.4 person-years, 643 (37.2%) patients continuously received aspirin treatment. Of all included patients, rupture occurred in 12 (0.7%). The incidence rate for rupture (IRR) was 0.27 (95% confidence interval [CI] 0.15-0.48) per 100 person-years. The IRRs were 0.39 (95% CI 0.21-0.72) and 0.06 (95% CI 0.010-0.45) per 100 person-years for the nonaspirin and aspirin groups, respectively. In the multivariate analysis, uncontrolled hypertension and UIAs 5 to <7 mm were associated with a high rate of aneurysm rupture, whereas aspirin use was associated with a low rate of aneurysm rupture. Compared with other groups, the high-risk group (UIAs 5 to <7 mm with concurrent uncontrolled hypertension) without aspirin had higher IRRs. CONCLUSION Aspirin is a safe treatment for patients with concurrent small UIAs and ICVD. Patients who are not taking aspirin in the high-risk group warrant intensive surveillance. CLINICALTRIALSGOV IDENTIFIER NCT02846259. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for patients harboring UIAs <7 mm with ICVD, aspirin does not increase the risk of aneurysm rupture.
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Affiliation(s)
- Jian-Cong Weng
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
| | - Jie Wang
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
| | - Xin Du
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
| | - Hao Li
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
| | - Yu-Ming Jiao
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
| | - Wei-Lun Fu
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
| | - Ran Huo
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
| | - Zi-Han Yan
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
| | - Hong-Yuan Xu
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
| | - Shuo Wang
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
| | - Yong Cao
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China.
| | - Ji-Zong Zhao
- From the Department of Neurosurgery (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.); Department of Cardiology (X.D.), Beijing Anzhen Hospital, Capital Medical University; and Department of Cardiology (X.D.), Health Research Center, Beijing, People's Republic of China
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Salimi Ashkezari SF, Mut F, Chung BJ, Yu AK, Stapleton CJ, See AP, Amin-Hanjani S, Charbel FT, Rezai Jahromi B, Niemelä M, Frösen J, Maiti S, Robertson AM, Cebral JR. Hemodynamics in aneurysm blebs with different wall characteristics. J Neurointerv Surg 2020; 13:642-646. [PMID: 33020208 PMCID: PMC8294199 DOI: 10.1136/neurintsurg-2020-016601] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Blebs are important secondary structures of intracranial aneurysms associated with increased rupture risk and can affect local wall stress and hemodynamics. Mechanisms of bleb development and evolution are not clearly understood. We investigate the relationship between blebs with different wall characteristics and local hemodynamics and rupture sites. METHODS Blebs with different wall appearances in intra-operative videos were analyzed with image-based computational fluid dynamics. Thin red blebs were compared against thick atherosclerotic/hyperplastic white/yellow blebs. Rupture points were identified in videos of ruptured aneurysms harboring blebs. RESULTS Thin blebs tended to be closer to the inflow than atherosclerotic blebs of the same aneurysm (P=0.0234). Blebs near the inflow had higher velocity (P=0.0213), vorticity (P=0.0057), shear strain rate (P=0.0084), wall shear stress (WSS) (P=0.0085), and WSS gradient (P=0.0151) than blebs far from the inflow. In a subset of 12 ruptured aneurysms harboring blebs, rupture points were associated with thin blebs in 42% of aneurysms, atherosclerotic blebs in 25%, and were away from blebs in the remaining 33%. CONCLUSIONS Not all blebs are equal; some have thin translucent walls while others have thick atherosclerotic walls. Thin blebs tend to be located closer to the inflow than atherosclerotic blebs. Blebs near the inflow are exposed to stronger flows with higher and spatially variable WSS than blebs far from the inflow which tend to have uniformly lower WSS. Aneurysms can rupture at thin blebs, atherosclerotic blebs, and even away from blebs. Further study of wall failure in aneurysms with different bleb types is needed.
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Affiliation(s)
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, Montclair, New Jersey, USA
| | - Alexander K Yu
- Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - Alfred P See
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Behnam Rezai Jahromi
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
| | - Juhana Frösen
- Department of Neurosurgery, University of Tampere, Tampere, Finland.,Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Spandan Maiti
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA.,Department of Mechanical Engineering, George Mason University, Fairfax, Virginia, USA
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145
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Presence of vasa vasorum in human intracranial aneurysms. Acta Neurochir (Wien) 2020; 162:2283-2293. [PMID: 32696328 DOI: 10.1007/s00701-020-04502-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/15/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Vasa vasorum is associated with the pathogenesis of various cerebrovascular diseases, but its presence in intracranial aneurysms (IA) and its ability to act as a predicting factor of IA rupture remain unrevealed. METHODS Histological investigation was performed for 3 middle meningeal arteries and 25 human IAs that were sequentially collected from 2017 to 2019. Relevant medical information was collected from the hospital information and imaging system. Fisher's exact tests and Student's t tests were performed to identify the histological and clinical differences between aneurysms with and without vasa vasorum. RESULTS Vasa vasorum were present in 14/25 (56%) aneurysm samples. They were detected at a similar frequency in male patients (4/9, 44.4%) and (10/16, 62.5%) female patients. Patients with vasa vasorum present aneurysms (47.07 ± 3.668 years, n = 14) or vasa vasorum absent aneurysms (50.27 ± 2.289 years, n = 11) did not differ in age (p = 0.49). True aneurysms and pseudoaneurysms also shared a similar rate of vasa vasorum presence (10/16, 62.5% in true aneurysms vs 4/9, 44.4% in pseudoaneurysms). The average size of aneurysms with vasa vasorum varied from 21.70 to 3.00 mm, and no statistical difference in size was detected when comparing aneurysms with and without vasa vasorum (p = 0.71). The vasa vasorum in almost all IAs had uniform vascular trajectory with occasional exceptions. The presence of vasa vasorum appears to be tightly associated with important histopathological changes of myointimal hyperplasia and increased immune cell infiltration in IAs (both p value < 0.05), though it does not appear to be indicative of IA rupture or other rupture-related histological degenerations (all p values > 0.05). CONCLUSIONS The presence of vasa vasorum is common in IAs. While it is associated with aneurysm wall remodeling and robust inflammatory cell infiltration, our results indicate that it is not a single specific marker of rupture-prone aneurysms.
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146
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Salimi Ashkezari SF, Mut F, Chung BJ, Robertson AM, Cebral JR. Hemodynamic conditions that favor bleb formation in cerebral aneurysms. J Neurointerv Surg 2020; 13:231-236. [PMID: 32680874 PMCID: PMC8294198 DOI: 10.1136/neurintsurg-2020-016369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although it is generally believed that blebs represent weaker spots in the walls of intracranial aneurysms (IAs), it is largely unknown which aneurysm characteristics favor their development. OBJECTIVE To investigate possible associations between aneurysm hemodynamic and geometric characteristics and the development of blebs in intracranial aneurysms. METHODS A total of 270 IAs in 199 patients selected for surgical clipping were studied. Blebs were visually identified and interactively marked on patient-specific vascular models constructed from presurgical images. Blebs were then deleted from the vascular reconstruction to approximate the aneurysm before bleb formation. Computational fluid dynamics studies were performed in these models and in cases without blebs. Hemodynamic and geometric characteristics of aneurysms with and without blebs were compared. RESULTS A total of 173 aneurysms had no blebs, while 97 aneurysms had a total of 122 blebs. Aneurysms favoring bleb formation had stronger (p<0.0001) and more concentrated inflow jets (p<0.0001), higher flow velocity (p=0.0061), more complex (p<0.0001) and unstable (p=0.0157) flow patterns, larger maximum wall shear stress (WSS; p<0.0001), more concentrated (p=0.0005) and oscillatory (p=0.0004) WSS distribution, and a more heterogeneous WSS field (p<0.0001), than aneurysms without blebs. They were also larger (p<0.0001), more elongated (p<0.0001), had wider necks (p=0.0002), and more distorted and irregular shapes (p<0.0001). CONCLUSIONS Strong and concentrated inflow jets, high-speed, complex, and unstable flow patterns, and concentrated, oscillatory, and heterogeneous WSS patterns favor the formation of blebs in IAs. Blebs are more likely to form in large, elongated, and irregularly shaped aneurysms. These adverse characteristics could be considered signs of aneurysm instability when evaluating aneurysms for conservative observation or treatment.
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Affiliation(s)
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, Montclair, New Jersey, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA.,Department of Mechanical Engineering, George Mason University, Fairfax, Virginia, USA
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147
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Järvelin P, Wright R, Pekonen H, Keränen S, Rauramaa T, Frösen J. Histopathology of brain AVMs part I: microhemorrhages and changes in the nidal vessels. Acta Neurochir (Wien) 2020; 162:1735-1740. [PMID: 32399691 PMCID: PMC7295831 DOI: 10.1007/s00701-020-04391-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/30/2020] [Indexed: 02/04/2023]
Abstract
Background Arteriovenous malformations of the brain (bAVM) may rupture from aneurysms or ectasias of the feeding, draining, or nidal vessels. Moreover, they may rupture from the immature, fragile nidal vessels that are characteristic to bAVMs. How the histopathological changes of the nidal vessels associate with clinical presentation and hemorrhage of the lesion is not well known. Materials and methods We investigated tissue samples from surgically treated bAVMs (n = 85) using standard histological and immunohistochemical stainings. Histological features were compared with the clinical presentation of the patient. Results Microhemorrhages from nidal vessels were found both in bAVMs with a history of clinically evident rupture and in bAVMs considered unruptured. These microhemorrhages were associated with presence of immature, pathological nidal vessels (p = 0.010) and perivascular inflammation of these vessels (p = 0.001), especially with adhesion of neutrophils (p < 0.001). In multivariate analysis, perivascular inflammation (OR = 19, 95% CI 1.6 to 230), neutrophil infiltration of the vessel wall (OR = 13, 95% CI 1.9 to 94), and rupture status (OR = 0.13, 95% CI 0.017 to 0.92) were significantly associated with microhemorrhages. Conclusions Clinically silent microhemorrhages from nidal vessels seem to be very common in bAVMs, and associate with perivascular inflammation and neutrophil infiltration. Further studies on the role of perivascular inflammation in the clinical course of bAVMs are indicated. Electronic supplementary material The online version of this article (10.1007/s00701-020-04391-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrik Järvelin
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Roosa Wright
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Henri Pekonen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Sara Keränen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Dept of Molecular Medicine, AIV-Institute, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Rauramaa
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Dept of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
- Dept of Molecular Medicine, AIV-Institute, University of Eastern Finland, Kuopio, Finland.
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.
- Dept of Neurosurgery, Tampere University Hospital, Teiskontie 35, PO Box 33521, Tampere, Finland.
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148
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Kataoka H, Yagi T, Ikedo T, Imai H, Kawamura K, Yoshida K, Nakamura M, Aoki T, Miyamoto S. Hemodynamic and Histopathological Changes in the Early Phase of the Development of an Intracranial Aneurysm. Neurol Med Chir (Tokyo) 2020; 60:319-328. [PMID: 32536660 PMCID: PMC7358784 DOI: 10.2176/nmc.st.2020-0072] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Hemodynamic stress and chronic inflammation are closely associated with the
pathogenesis of intracranial aneurysms (IAs). However, the hemodynamic and
biological mechanisms triggering IA formation remain to be elucidated. To
clarify them, computational fluid dynamics (CFD) and histopathological analyses
in the early phase of IA development using an experimentally induced IA model in
rats were conducted. Histological changes in the early phase of IA development
were observed under a scanning electron microscope (SEM) and a transmission
electron microscope (TEM). Using data from 7-T magnetic resonance angiography
(7T-MRA), CFD analyses were performed to determine wall shear stress (WSS) and
wall pressure (WP) at the prospective site of IA. A bump-like protrusion named
an “intimal pad” was located in the anterior cerebral artery (ACA)
immediately distal to the apex of the bifurcation. TEM showed the degeneration
of the internal elastic lamina (IEL) and longitudinally elongated smooth muscle
cells (SMCs) that switched from the contractile to the proliferative phenotype
and penetrated between two divided layers of the degenerated IEL in the
prospective site of the IA. However, no inflammatory cells were observed. CFD
analyses showed no particular pattern of WSS and WP at the prospective IA site.
IEL degeneration and the phenotypic change and longitudinal elongation of SMCs
were identified as the early events in IA development. CFD analyses and TEM data
suggest that these biological events may be derived from increased
circumferential wall stress due to increased blood pressure and increased
longitudinal wall strain due to the existence of the intimal pad.
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Affiliation(s)
- Hiroharu Kataoka
- Department of Neurosurgery, Kyoto University, Graduate School of Medicine
| | - Takanobu Yagi
- Center for Advanced Biomedical Science, Waseda University
| | - Taichi Ikedo
- Department of Neurosurgery, Kyoto University, Graduate School of Medicine
| | - Hirohiko Imai
- Department of Systems Science, Graduate School of Informatics, Kyoto University
| | | | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University, Graduate School of Medicine
| | - Masanori Nakamura
- Department of Mechanical Engineering, Nagoya Institute of Technology
| | - Tomohiro Aoki
- Department of molecular pharmacology, National Cerebral and Cardiovascular Center
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University, Graduate School of Medicine
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149
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The Bilateral Ovariectomy in a Female Animal Exacerbates the Pathogenesis of an Intracranial Aneurysm. Brain Sci 2020; 10:brainsci10060335. [PMID: 32486339 PMCID: PMC7349062 DOI: 10.3390/brainsci10060335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/23/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022] Open
Abstract
Considering the poor outcome of subarachnoid hemorrhage (SAH) due to the rupture of intracranial aneurysms (IA), mechanisms underlying the pathogenesis of IAs, especially the rupture of lesions, should be clarified. In the present study, a rat model of IAs in which induced lesions spontaneously ruptured resulting in SAH was used. In this model, the combination of the female sex and the bilateral ovariectomy increased the incidence of SAH, similar to epidemiological evidence in human cases. Importantly, unruptured IA lesions induced in female animals with bilateral ovariectomy were histopathologically similar to ruptured ones in the presence of vasa vasorum and the accumulation of abundant inflammatory cells, suggesting the exacerbation of the disease. The post-stenotic dilatation of the carotid artery was disturbed by the bilateral ovariectomy in female rats, which was restored by hormone replacement therapy. The in vivo study thus suggested the protective effect of estrogen from the ovary on endothelial cells loaded by wall shear stress. β-estradiol or dihydrotestosterone also suppressed the lipopolysaccharide-induced expression of pro-inflammatory genes in cultured macrophages and neutrophils. The results of the present study have thus provided new insights about the process regulating the progression of the disease.
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150
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Oka M, Shimo S, Ohno N, Imai H, Abekura Y, Koseki H, Miyata H, Shimizu K, Kushamae M, Ono I, Nozaki K, Kawashima A, Kawamata T, Aoki T. Dedifferentiation of smooth muscle cells in intracranial aneurysms and its potential contribution to the pathogenesis. Sci Rep 2020; 10:8330. [PMID: 32433495 PMCID: PMC7239886 DOI: 10.1038/s41598-020-65361-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 05/04/2020] [Indexed: 12/18/2022] Open
Abstract
Smooth muscle cells (SMCs) are the major type of cells constituting arterial walls and play a role to maintain stiffness via producing extracellular matrix. Here, the loss and degenerative changes of SMCs become the major histopathological features of an intracranial aneurysm (IA), a major cause of subarachnoid hemorrhage. Considering the important role of SMCs and the loss of this type of cells in IA lesions, we in the present study subjected rats to IA models and examined how SMCs behave during disease progression. We found that, at the neck portion of IAs, SMCs accumulated underneath the internal elastic lamina according to disease progression and formed the intimal hyperplasia. As these SMCs were positive for a dedifferentiation marker, myosin heavy chain 10, and contained abundant mitochondria and rough endoplasmic reticulum, SMCs at the intimal hyperplasia were dedifferentiated and activated. Furthermore, dedifferentiated SMCs expressed some pro-inflammatory factors, suggesting the role in the formation of inflammatory microenvironment to promote the disease. Intriguingly, some SMCs at the intimal hyperplasia were positive for CD68 and contained lipid depositions, indicating similarity with atherosclerosis. We next examined a potential factor mediating dedifferentiation and recruitment of SMCs. Platelet derived growth factor (PDGF)-BB was expressed in endothelial cells at the neck portion of lesions where high wall shear stress (WSS) was loaded. PDGF-BB facilitated migration of SMCs across matrigel-coated pores in a transwell system, promoted dedifferentiation of SMCs and induced expression of pro-inflammatory genes in these cells in vitro. Because, in a stenosis model of rats, PDGF-BB expression was expressed in endothelial cells loaded in high WSS regions, and SMCs present nearby were dedifferentiated, hence a correlation existed between high WSS, PDGFB and dedifferentiation in vivo. In conclusion, dedifferentiated SMCs presumably by PDGF-BB produced from high WSS-loaded endothelial cells accumulate in the intimal hyperplasia to form inflammatory microenvironment leading to the progression of the disease.
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Affiliation(s)
- Mieko Oka
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Core Research for Evolutional Science and Technology from Japan Agency for Medical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawata-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Satoshi Shimo
- Department of Occupational Therapy, Health Science University, 7181 Kodachi, Minamitsurugun Fujikawaguchikomachi, Yamanashi, 401-0380, Japan
| | - Nobuhiko Ohno
- Division of Histology and Cell Biology, Department of Anatomy, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.,Division of Ultrastructural Research, National Institute for Physiological Sciences, 38 Saigonaka, Meidaiji-cho, Okazaki City, Aichi, 444-8787, Japan
| | - Hirohiko Imai
- Department of Systems Science, Graduate School of Informatics, Kyoto University, 36-1 Yoshidahomachi Saikyo-ku, Kyoto City, Kyoto, 606-8317, Japan
| | - Yu Abekura
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Core Research for Evolutional Science and Technology from Japan Agency for Medical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hirokazu Koseki
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Core Research for Evolutional Science and Technology from Japan Agency for Medical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Department of Neurosurgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Haruka Miyata
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Core Research for Evolutional Science and Technology from Japan Agency for Medical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Department of Neurosurgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City, Shiga, 520-2192, Japan
| | - Kampei Shimizu
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Core Research for Evolutional Science and Technology from Japan Agency for Medical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Mika Kushamae
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Core Research for Evolutional Science and Technology from Japan Agency for Medical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Department of Neurosurgery, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Isao Ono
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Core Research for Evolutional Science and Technology from Japan Agency for Medical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.,Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City, Shiga, 520-2192, Japan
| | - Akitsugu Kawashima
- Department of Neurosurgery, Tokyo Women's Medical University Yachiyo Medical Center, 477-96 Oowadashinden, Yachiyo City, Chiba, 276-8524, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawata-cho, Shinjyuku-ku, Tokyo, 162-8666, Japan
| | - Tomohiro Aoki
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan. .,Core Research for Evolutional Science and Technology from Japan Agency for Medical Research and Development, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita City, Osaka, 564-8565, Japan.
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