251
|
Drieu A, Levard D, Vivien D, Rubio M. Anti-inflammatory treatments for stroke: from bench to bedside. Ther Adv Neurol Disord 2018; 11:1756286418789854. [PMID: 30083232 PMCID: PMC6066814 DOI: 10.1177/1756286418789854] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/19/2018] [Indexed: 12/11/2022] Open
Abstract
So far, intravenous tissue-type plasminogen activator (tPA) and mechanical
removal of arterial blood clot (thrombectomy) are the only available treatments
for acute ischemic stroke. However, the short therapeutic window and the lack of
specialized stroke unit care make the overall availability of both treatments
limited. Additional agents to combine with tPA administration or thrombectomy to
enhance efficacy and improve outcomes associated with stroke are needed.
Stroke-induced inflammatory processes are a response to the tissue damage due to
the absence of blood supply but have been proposed also as key contributors to
all the stages of the ischemic stroke pathophysiology. Despite promising results
in experimental studies, inflammation-modulating treatments have not yet been
translated successfully into the clinical setting. This review will (a) describe
the timing of the stroke immune pathophysiology; (b) detail the immune responses
to stroke sift-through cell type; and (c) discuss the pitfalls on the
translation from experimental studies to clinical trials testing the therapeutic
pertinence of immune modulators.
Collapse
Affiliation(s)
- Antoine Drieu
- Pathophysiology and Imaging of Neurological Disorders, Normandy University, Caen, France
| | - Damien Levard
- Pathophysiology and Imaging of Neurological Disorders, Normandy University, Caen, France
| | - Denis Vivien
- Pathophysiology and Imaging of Neurological Disorders, Normandy University, Caen, France Pathophysiology and Imaging of Neurological Disorders, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Marina Rubio
- Pathophysiology and Imaging of Neurological Disorders, Normandy University, Boulevard Henri Becquerel BP 5229, Caen Cedex, 14000, France
| |
Collapse
|
252
|
Aging alters the immunological response to ischemic stroke. Acta Neuropathol 2018; 136:89-110. [PMID: 29752550 PMCID: PMC6015099 DOI: 10.1007/s00401-018-1859-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/21/2018] [Accepted: 04/30/2018] [Indexed: 12/15/2022]
Abstract
The peripheral immune system plays a critical role in aging and in the response to brain injury. Emerging data suggest inflammatory responses are exacerbated in older animals following ischemic stroke; however, our understanding of these age-related changes is poor. In this work, we demonstrate marked differences in the composition of circulating and infiltrating leukocytes recruited to the ischemic brain of old male mice after stroke compared to young male mice. Blood neutrophilia and neutrophil invasion into the brain were increased in aged animals. Relative to infiltrating monocyte populations, brain-invading neutrophils had reduced phagocytic potential, and produced higher levels of reactive oxygen species and extracellular matrix-degrading enzymes (i.e., MMP-9), which were further exacerbated with age. Hemorrhagic transformation was more pronounced in aged versus young mice relative to infarct size. High numbers of myeloperoxidase-positive neutrophils were found in postmortem human brain samples of old (> 71 years) acute ischemic stroke subjects compared to non-ischemic controls. Many of these neutrophils were found in the brain parenchyma. A large proportion of these neutrophils expressed MMP-9 and positively correlated with hemorrhage and hyperemia. MMP-9 expression and hemorrhagic transformation after stroke increased with age. These changes in the myeloid response to stroke with age led us to hypothesize that the bone marrow response to stroke is altered with age, which could be important for the development of effective therapies targeting the immune response. We generated heterochronic bone marrow chimeras as a tool to determine the contribution of peripheral immune senescence to age- and stroke-induced inflammation. Old hosts that received young bone marrow (i.e., Young → Old) had attenuation of age-related reductions in bFGF and VEGF and showed improved locomotor activity and gait dynamics compared to isochronic (Old → Old) controls. Microglia in young heterochronic mice (Old → Young) developed a senescent-like phenotype. After stroke, aged animals reconstituted with young marrow had reduced behavioral deficits compared to isochronic controls, and had significantly fewer brain-infiltrating neutrophils. Increased rates of hemorrhagic transformation were seen in young mice reconstituted with aged bone marrow. This work suggests that age alters the immunological response to stroke, and that this can be reversed by manipulation of the peripheral immune cells in the bone marrow.
Collapse
|
253
|
Benakis C, Llovera G, Liesz A. The meningeal and choroidal infiltration routes for leukocytes in stroke. Ther Adv Neurol Disord 2018; 11:1756286418783708. [PMID: 29977343 PMCID: PMC6024265 DOI: 10.1177/1756286418783708] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/11/2018] [Indexed: 12/26/2022] Open
Abstract
Stroke is a major health burden as it is a leading cause of morbidity and mortality worldwide. Blood flow restoration, through thrombolysis or endovascular thrombectomy, is the only effective treatment but is restricted to a limited proportion of patients due to time window constraint and accessibility to technology. Over the past two decades, research has investigated the basic mechanisms that lead to neuronal death following cerebral ischemia. However, the use of neuroprotective paradigms in stroke has been marked by failure in translation from experimental research to clinical practice. In the past few years, much attention has focused on the immune response to acute cerebral ischemia as a major factor to the development of brain lesions and neurological deficits. Key inflammatory processes after stroke include the activation of resident glial cells as well as the invasion of circulating leukocytes. Recent research on anti-inflammatory strategies for stroke has focused on limiting the transendothelial migration of peripheral immune cells from the compromised vasculature into the brain parenchyma. However, recent trials testing the blockage of cerebral leukocyte infiltration in patients reported inconsistent results. This emphasizes the need to better scrutinize how immune cells are regulated at the blood-brain interface and enter the brain parenchyma, and particularly to also consider alternative cerebral infiltration routes for leukocytes, including the meninges and the choroid plexus. Understanding how immune cells migrate to the brain via these alternative pathways has the potential to develop more effective approaches for anti-inflammatory stroke therapies.
Collapse
Affiliation(s)
- Corinne Benakis
- Institute for Stroke and Dementia Research, University Medical Center Munich, Feodor-Lynen-Str. 17, Munich 81377, Germany
| | - Gemma Llovera
- Institute for Stroke and Dementia Research, University Medical Center Munich, Munich, Germany
| | - Arthur Liesz
- Institute for Stroke and Dementia Research, University Medical Center Munich, Munich, Germany Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| |
Collapse
|
254
|
Amantea D, Greco R, Micieli G, Bagetta G. Paradigm Shift to Neuroimmunomodulation for Translational Neuroprotection in Stroke. Front Neurosci 2018; 12:241. [PMID: 29692708 PMCID: PMC5903066 DOI: 10.3389/fnins.2018.00241] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022] Open
Abstract
The treatment of acute ischemic stroke is still an unresolved clinical problem since the only approved therapeutic intervention relies on early blood flow restoration through pharmacological thrombolysis, mechanical thrombus removal, or a combination of both strategies. Due to their numerous complications and to the narrow time-window for the intervention, only a minority of stroke patients can actually benefit from revascularization procedures, highlighting the urgent need of identifying novel strategies to prevent the progression of an irreversible damage in the ischemic penumbra. During the past three decades, the attempts to target the pathways implicated in the ischemic cascade (e.g., excitotoxicity, calcium channels overactivation, reactive oxygen species (ROS) production) have failed in the clinical setting. Based on a better understanding of the pathobiological mechanisms and on a critical reappraisal of most failed trials, numerous findings from animal studies have demonstrated that targeting the immune system may represent a promising approach to achieve neuroprotection in stroke. In particular, given the dualistic role of distinct components of both the innate and adaptive arms of the immune system, a strategic intervention should be aimed at establishing the right equilibrium between inflammatory and reparative mechanisms, taking into consideration their spatio-temporal recruitment after the ischemic insult. Thus, the application of immunomodulatory drugs and their ability to ameliorate outcomes deserve validation in patients with acute ischemic stroke.
Collapse
Affiliation(s)
- Diana Amantea
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Cosenza, Italy
| | - Rosaria Greco
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Micieli
- Department of Emergency Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Giacinto Bagetta
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Cosenza, Italy
| |
Collapse
|
255
|
Zinnhardt B, Wiesmann M, Honold L, Barca C, Schäfers M, Kiliaan AJ, Jacobs AH. In vivo imaging biomarkers of neuroinflammation in the development and assessment of stroke therapies - towards clinical translation. Theranostics 2018; 8:2603-2620. [PMID: 29774062 PMCID: PMC5956996 DOI: 10.7150/thno.24128] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/31/2018] [Indexed: 01/01/2023] Open
Abstract
Modulation of the inflammatory microenvironment after stroke opens a new avenue for the development of novel neurorestorative therapies in stroke. Understanding the spatio-temporal profile of (neuro-)inflammatory imaging biomarkers in detail thereby represents a crucial factor in the development and application of immunomodulatory therapies. The early integration of quantitative molecular imaging biomarkers in stroke drug development may provide key information about (i) early diagnosis and follow-up, (ii) spatio-temporal drug-target engagement (pharmacodynamic biomarker), (iii) differentiation of responders and non-responders in the patient cohort (inclusion/exclusion criteria; predictive biomarkers), and (iv) the mechanism of action. The use of targeted imaging biomarkers for may thus allow clinicians to decipher the profile of patient-specific inflammatory activity and the development of patient-tailored strategies for immunomodulatory and neuro-restorative therapies in stroke. Here, we highlight the recent developments in preclinical and clinical molecular imaging biomarkers of neuroinflammation (endothelial markers, microglia, MMPs, cell labeling, future developments) in stroke and outline how imaging biomarkers can be used in overcoming current translational roadblocks and attrition in order to advance new immunomodulatory compounds within the clinical pipeline.
Collapse
Affiliation(s)
- Bastian Zinnhardt
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms University Münster, Münster, Germany
- EU 7 th FP Programme “Imaging Inflammation in Neurodegenerative Diseases (INMiND)”
- Cells in Motion (CiM) Cluster of Excellence, University of Münster, Münster, Germany
- PET Imaging in Drug Design and Development (PET3D)
- Department of Nuclear Medicine, Universitätsklinikum Münster, Münster, Germany
| | - Maximilian Wiesmann
- Department of Anatomy, Radboud university medical center, Donders Institute for Brain, Cognition & Behaviour, Nijmegen, The Netherlands
| | - Lisa Honold
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms University Münster, Münster, Germany
| | - Cristina Barca
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms University Münster, Münster, Germany
- PET Imaging in Drug Design and Development (PET3D)
| | - Michael Schäfers
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms University Münster, Münster, Germany
- Cells in Motion (CiM) Cluster of Excellence, University of Münster, Münster, Germany
- Department of Nuclear Medicine, Universitätsklinikum Münster, Münster, Germany
| | - Amanda J Kiliaan
- Department of Anatomy, Radboud university medical center, Donders Institute for Brain, Cognition & Behaviour, Nijmegen, The Netherlands
| | - Andreas H Jacobs
- European Institute for Molecular Imaging (EIMI), Westfälische Wilhelms University Münster, Münster, Germany
- EU 7 th FP Programme “Imaging Inflammation in Neurodegenerative Diseases (INMiND)”
- Cells in Motion (CiM) Cluster of Excellence, University of Münster, Münster, Germany
- PET Imaging in Drug Design and Development (PET3D)
- Department of Geriatrics, Johanniter Hospital, Evangelische Kliniken, Bonn, Germany
| |
Collapse
|
256
|
Rayasam A, Hsu M, Kijak JA, Kissel L, Hernandez G, Sandor M, Fabry Z. Immune responses in stroke: how the immune system contributes to damage and healing after stroke and how this knowledge could be translated to better cures? Immunology 2018; 154:363-376. [PMID: 29494762 DOI: 10.1111/imm.12918] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/15/2022] Open
Abstract
Stroke is one of the leading causes of death and disability worldwide. The long-standing dogma that stroke is exclusively a vascular disease has been questioned by extensive clinical findings of immune factors that are associated mostly with inflammation after stroke. These have been confirmed in preclinical studies using experimental animal models. It is now accepted that inflammation and immune mediators are critical in acute and long-term neuronal tissue damage and healing following thrombotic and ischaemic stroke. Despite mounting information delineating the role of the immune system in stroke, the mechanisms of how inflammatory cells and their mediators are involved in stroke-induced neuroinflammation are still not fully understood. Currently, there is no available treatment for targeting the acute immune response that develops in the brain during cerebral ischaemia. No new treatment has been introduced to stroke therapy since the discovery of tissue plasminogen activator therapy in 1996. Here, we review current knowledge of the immunity of stroke and identify critical gaps that hinder current therapies. We will discuss advances in the understanding of the complex innate and adaptive immune responses in stroke; mechanisms of immune cell-mediated and factor-mediated vascular and tissue injury; immunity-induced tissue repair; and the importance of modulating immunity in stroke.
Collapse
Affiliation(s)
- Aditya Rayasam
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Martin Hsu
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Julie A Kijak
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Lee Kissel
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Gianna Hernandez
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Cellular and Molecular Pathology Graduate Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Matyas Sandor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Cellular and Molecular Pathology Graduate Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Zsuzsanna Fabry
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Cellular and Molecular Pathology Graduate Program, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
257
|
Thålin C, Daleskog M, Göransson SP, Schatzberg D, Lasselin J, Laska AC, Kallner A, Helleday T, Wallén H, Demers M. Validation of an enzyme-linked immunosorbent assay for the quantification of citrullinated histone H3 as a marker for neutrophil extracellular traps in human plasma. Immunol Res 2018; 65:706-712. [PMID: 28161762 PMCID: PMC5440486 DOI: 10.1007/s12026-017-8905-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There is an emerging interest in the diverse functions of neutrophil extracellular traps (NETs) in a variety of disease settings. However, data on circulating NETs rely largely upon surrogate NET markers such as cell-free DNA, nucleosomes, and NET-associated enzymes. Citrullination of histone H3 by peptidyl arginine deiminase 4 (PAD4) is central for NET formation, and citrullinated histone H3 (H3Cit) is considered a NET-specific biomarker. We therefore aimed to optimize and validate a new enzyme-linked immunosorbent assay (ELISA) to quantify the levels of H3Cit in human plasma. A standard curve made of in vitro PAD4-citrullinated histones H3 allows for the quantification of H3Cit in plasma using an anti-histone antibody as capture antibody and an anti-histone H3 citrulline antibody for detection. The assay was evaluated for linearity, stability, specificity, and precision on plasma samples obtained from a human model of inflammation before and after lipopolysaccharide injection. The results revealed linearity and high specificity demonstrated by the inability of detecting non-citrullinated histone H3. Coefficients of variation for intra- and inter-assay variability ranged from 2.1 to 5.1% and from 5.8 to 13.5%, respectively, allowing for a high precision. Furthermore, our results support an inflammatory induction of a systemic NET burden by showing, for the first time, clear intra-individual elevations of plasma H3Cit in a human model of lipopolysaccharide-induced inflammation. Taken together, our work demonstrates the development of a new method for the quantification of H3Cit by ELISA that can reliably be used for the detection of NETs in human plasma.
Collapse
Affiliation(s)
- Charlotte Thålin
- Department of Clinical Sciences, Danderyd Hospital, Division of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maud Daleskog
- Department of Clinical Sciences, Danderyd Hospital, Division of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sophie Paues Göransson
- Department of Clinical Sciences, Danderyd Hospital, Department of Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | | | - Julie Lasselin
- Stress Research Institute, Stockholm University, Stockholm, Sweden.,Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Ann-Charlotte Laska
- Department of Clinical Sciences, Danderyd Hospital, Division of Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Kallner
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
| | - Thomas Helleday
- Department of Medical Biochemistry and Biophysics, Division of Translational Medicine and Chemical Biology, Karolinska Institutet, Science for Life Laboratory, Stockholm, Sweden
| | - Håkan Wallén
- Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mélanie Demers
- Department of Clinical Sciences, Danderyd Hospital, Division of Internal Medicine, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
258
|
Hernandes MS, Lassègue B, Hilenski LL, Adams J, Gao N, Kuan CY, Sun YY, Cheng L, Kikuchi DS, Yepes M, Griendling KK. Polymerase delta-interacting protein 2 deficiency protects against blood-brain barrier permeability in the ischemic brain. J Neuroinflammation 2018; 15:45. [PMID: 29452577 PMCID: PMC5816395 DOI: 10.1186/s12974-017-1032-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 12/11/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Polymerase δ-interacting protein 2 (Poldip2) is a multifunctional protein that regulates vascular extracellular matrix composition and matrix metalloproteinase (MMP) activity. The blood-brain barrier (BBB) is a dynamic system assembled by endothelial cells, basal lamina, and perivascular astrocytes, raising the possibility that Poldip2 may be involved in maintaining its structure. We investigated the role of Poldip2 in the late BBB permeability induced by cerebral ischemia. METHODS Transient middle cerebral artery occlusion (tMCAO) was induced in Poldip2+/+ and Poldip2+/- mice. The volume of the ischemic lesion was measured in triphenyltetrazolium chloride-stained sections. BBB breakdown was evaluated by Evans blue dye extravasation. Poldip2 protein expression was evaluated by western blotting. RT-PCR, zymography, and ELISAs were used to measure mRNA levels, activity, and protein levels of cytokines and MMPs. Cultured astrocytes were transfected with Poldip2 siRNA, and mRNA levels of cytokines were evaluated as well as IκBα protein degradation. RESULTS Cerebral ischemia induced the expression of Poldip2. Compared to Poldip2+/+ mice, Poldip2+/- animals exhibited decreased Evans blue dye extravasation and improved survival 24 h following stroke. Poldip2 expression was upregulated in astrocytes exposed to oxygen and glucose deprivation (OGD) and siRNA-mediated downregulation of Poldip2 abrogated OGD-induced IL-6 and TNF-α expression. In addition, siRNA against Poldip2 inhibited TNF-α-induced IκBα degradation. TNF-α, IL-6, MCP-1, VEGF, and MMP expression induced by cerebral ischemia was abrogated in Poldip2+/- mice. The protective effect of Poldip2 depletion on the increased permeability of the BBB was partially reversed by systemic administration of TNF-α. CONCLUSIONS Poldip2 is upregulated following ischemic stroke and mediates the breakdown of the BBB by increasing cerebral cytokine production and MMP activation. Therefore, Poldip2 appears to be a promising novel target for the development of therapeutic strategies to prevent the development of cerebral edema in the ischemic brain.
Collapse
Affiliation(s)
- Marina S Hernandes
- Division of Cardiology, Department of Medicine, Emory University, 101 Woodruff Circle, 308 WMB, Atlanta, GA, 30322, USA
| | - Bernard Lassègue
- Division of Cardiology, Department of Medicine, Emory University, 101 Woodruff Circle, 308 WMB, Atlanta, GA, 30322, USA
| | - Lula L Hilenski
- Division of Cardiology, Department of Medicine, Emory University, 101 Woodruff Circle, 308 WMB, Atlanta, GA, 30322, USA
| | - Jonathan Adams
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Ning Gao
- Division of Neurology, Department of Pediatrics, Emory University, Atlanta, GA, 30322, USA
| | - Chia-Yi Kuan
- Division of Neurology, Department of Pediatrics, Emory University, Atlanta, GA, 30322, USA
| | - Yu-Yo Sun
- Division of Neurology, Department of Pediatrics, Emory University, Atlanta, GA, 30322, USA
| | - Lihong Cheng
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA
| | - Daniel S Kikuchi
- Division of Cardiology, Department of Medicine, Emory University, 101 Woodruff Circle, 308 WMB, Atlanta, GA, 30322, USA
| | - Manuel Yepes
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA
- Division of Neuroscience, Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30329, USA
| | - Kathy K Griendling
- Division of Cardiology, Department of Medicine, Emory University, 101 Woodruff Circle, 308 WMB, Atlanta, GA, 30322, USA.
| |
Collapse
|
259
|
Shi J, Peng H, You S, Liu Y, Xu J, Xu Y, Liu H, Shi R, Cao Y, Liu CF. Increase in neutrophils after recombinant tissue plasminogen activator thrombolysis predicts poor functional outcome of ischaemic stroke: a longitudinal study. Eur J Neurol 2018; 25:687-e45. [PMID: 29341345 DOI: 10.1111/ene.13575] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/11/2018] [Indexed: 12/30/2022]
Affiliation(s)
- J. Shi
- Department of Neurology; Second Affiliated Hospital of Soochow University; Suzhou China
| | - H. Peng
- Department of Epidemiology; School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases; Medical College of Soochow University; Suzhou China
| | - S. You
- Department of Neurology; Second Affiliated Hospital of Soochow University; Suzhou China
| | - Y. Liu
- Department of Electrocardiography; Suzhou Guangji Hospital; Suzhou China
| | - J. Xu
- Department of Neurology; Second Affiliated Hospital of Soochow University; Suzhou China
| | - Y. Xu
- Department of Neurology; Second Affiliated Hospital of Soochow University; Suzhou China
| | - H. Liu
- Department of Neurology; Second Affiliated Hospital of Soochow University; Suzhou China
| | - R. Shi
- Department of Neurology; Second Affiliated Hospital of Soochow University; Suzhou China
| | - Y. Cao
- Department of Neurology; Second Affiliated Hospital of Soochow University; Suzhou China
| | - C.-F. Liu
- Department of Neurology; Second Affiliated Hospital of Soochow University; Suzhou China
- Institute of Neuroscience; Soochow University; Suzhou China
| |
Collapse
|
260
|
Enzmann GU, Pavlidou S, Vaas M, Klohs J, Engelhardt B. ICAM-1 null C57BL/6 Mice Are Not Protected from Experimental Ischemic Stroke. Transl Stroke Res 2018; 9:608-621. [PMID: 29399739 DOI: 10.1007/s12975-018-0612-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/19/2018] [Accepted: 01/19/2018] [Indexed: 11/29/2022]
Abstract
Accumulation of neutrophils in the brain is a hallmark of cerebral ischemia and considered central in exacerbating tissue injury. Intercellular adhesion molecule (ICAM)-1 is upregulated on brain endothelial cells after ischemic stroke and considered pivotal in neutrophil recruitment as ICAM-1-deficient mouse lines were found protected from experimental stroke. Translation of therapeutic inhibition of ICAM-1 into the clinic however failed. This prompted us to investigate stroke pathogenesis in Icam1tm1Alb C57BL/6 mutants, a true ICAM-1null mouse line. Performing transient middle cerebral artery occlusion, we found that absence of ICAM-1 did not ameliorate stroke pathology at acute time points after reperfusion. Near-infrared imaging showed comparable accumulation of neutrophils in the ischemic hemispheres of ICAM-1null and wild type C57BL/6 mice. We also isolated equal numbers of neutrophils from the ischemic brains of ICAM-1null and wild type C57BL/6 mice. Immunostaining of the brains showed neutrophils to equally accumulate in the leptomeninges and brain parenchymal vessels of ICAM-1null and wild type C57BL/6 mice. In addition, the lesion size was comparable in ICAM-1null and wild type mice. Our study demonstrates that absence of ICAM-1 neither inhibits cerebral ischemia-induced accumulation of neutrophils in the brain nor provides protection from ischemic stroke.
Collapse
Affiliation(s)
- Gaby U Enzmann
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland
| | - Sofia Pavlidou
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland
| | - Markus Vaas
- Institute for Biomedical Engineering, ETH and University of Zurich, 8093, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Jan Klohs
- Institute for Biomedical Engineering, ETH and University of Zurich, 8093, Zurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Britta Engelhardt
- Theodor Kocher Institute, University of Bern, Freiestrasse 1, 3012, Bern, Switzerland.
| |
Collapse
|
261
|
Zrzavy T, Machado-Santos J, Christine S, Baumgartner C, Weiner HL, Butovsky O, Lassmann H. Dominant role of microglial and macrophage innate immune responses in human ischemic infarcts. Brain Pathol 2017; 28:791-805. [PMID: 29222823 PMCID: PMC6334527 DOI: 10.1111/bpa.12583] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/27/2017] [Indexed: 01/06/2023] Open
Abstract
Inflammatory mechanisms, involving granulocytes, T‐cells, B‐cells, macrophages and activated microglia, have been suggested to play a pathogenic role in experimental models of stroke and may be targets for therapeutic intervention. However, knowledge on the inflammatory response in human stroke lesions is limited. Here, we performed a quantitative study on the inflammatory reaction in human ischemic infarct lesions. We found increased numbers of T‐lymphocytes, mainly CD8+ cells, but not of B‐lymphocytes. Their number was very low in comparison to that seen in inflammatory diseases of the central nervous system and they did not show signs of activation. Polymorphonuclear leukocytes were present in meninges and less prominently in the perivascular space in early lesions, but their infiltration into the lesioned tissue was sparse with the exception of a single case. Microglia were lost in the necrotic core of fresh lesions, their number was increased in the surrounding penumbra, apparently due to proliferation. Using TMEM119 as a marker for the resident microglia pool, macrophages in lesions were in part derived from the original microglia pool, depending on the lesion stage. Most microglia and macrophages revealed a pro‐inflammatory activation pattern, expressing molecules involved in phagocytosis, oxidative injury, antigen presentation and iron metabolism and had partially lost the expression of P2RY12, an antigen expressed on homeostatic (“resting”) microglia in rodents. At later lesion stages, the majority of macrophages showed intermediate activation patterns, expressing pro‐inflammatory and anti‐inflammatory markers. Microglia in the normal white matter of controls and stroke patients were already partly activated toward a pro‐inflammatory phenotype. Our data suggest that the direct contribution of lymphocytes and granulocytes to active tissue injury in human ischemic infarct lesions is limited and that stroke therapy that targets pro‐inflammatory microglia and macrophage activation may be effective.
Collapse
Affiliation(s)
- Tobias Zrzavy
- Center for Brain Research, Medical University of Vienna, Austria
| | | | - Sheren Christine
- Center for Brain Research, Medical University of Vienna, Austria
| | - Christoph Baumgartner
- Department of Neurology, General Hospital Hietzing with Neurological Center Rosenhügel, Sigmund Freud University, Vienna, Austria
| | - Howard L Weiner
- Ann Romney Center for Neurological Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Evergrande Center for Immunologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Oleg Butovsky
- Ann Romney Center for Neurological Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Evergrande Center for Immunologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Austria
| |
Collapse
|
262
|
Zha A, Vahidy F, Randhawa J, Parsha K, Bui T, Aronowski J, Savitz SI. Association Between Splenic Contraction and the Systemic Inflammatory Response After Acute Ischemic Stroke Varies with Age and Race. Transl Stroke Res 2017; 9:484-492. [PMID: 29282627 DOI: 10.1007/s12975-017-0596-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 12/21/2022]
Abstract
Animal models have demonstrated the deleterious contribution of splenic immunocytes on secondary brain injury after stroke. While previous work has demonstrated splenic contraction (SC) in patients with acute ischemic stroke (AIS) and intracranial hemorrhage (ICH), no clinical studies have examined the relationship between the systemic inflammatory response syndrome (SIRS) with SC in stroke patients. This is a retrospective analysis of a previous prospective observational study where daily spleen sizes were evaluated in 178 acute stroke patients. Spleen contraction was based on previously established normograms of healthy volunteers from the same study. SC from the first 24 h of stroke onset was evaluated against criteria for SIRS for the first 5 days of admission after AIS. Ninety-one patients had verified AIS without concurrent infection at admission. SIRS was not associated with SC at admission. African-American patients with early SIRS had higher odds of having SC. Older patients with persistent SIRS at 72 h had lower odds of SC. At 48 h, there was significantly higher lymphocytosis and lower neutrophils present in patients with SC. Patients with SIRS at 72 h were more likely to have worse discharge mRS. This study provides evidence for an association among SC and SIRS in African-American patients suggesting that spleen changes could be a biomarker for detecting SIRS in this population. Our data also indicate a counter association between SC and a lack of SIRS in patients older than 75. Further studies are needed to ascertain how age affects this association.
Collapse
Affiliation(s)
- Alicia Zha
- Department of Neurology and The Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, UTHealth, Houston, TX, 77030, USA
| | - Farhaan Vahidy
- Department of Neurology and The Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, UTHealth, Houston, TX, 77030, USA
| | - Jaskaren Randhawa
- Department of Neurology and The Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, UTHealth, Houston, TX, 77030, USA
| | - Kaushik Parsha
- Department of Neurology and The Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, UTHealth, Houston, TX, 77030, USA
| | - Thanh Bui
- Department of Neurology and The Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, UTHealth, Houston, TX, 77030, USA
| | - Jaroslaw Aronowski
- Department of Neurology and The Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, UTHealth, Houston, TX, 77030, USA
| | - Sean I Savitz
- Department of Neurology and The Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, UTHealth, Houston, TX, 77030, USA.
| |
Collapse
|
263
|
Guo Z, Yu S, Chen X, Zheng P, Hu T, Duan Z, Liu X, Liu Q, Ye R, Zhu W, Liu X. Suppression of NLRP3 attenuates hemorrhagic transformation after delayed rtPA treatment in thromboembolic stroke rats: Involvement of neutrophil recruitment. Brain Res Bull 2017; 137:229-240. [PMID: 29258866 DOI: 10.1016/j.brainresbull.2017.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inflammation and neutrophils play pivotal roles in hemorrhagic transformation (HT) after recombinant tissue plasminogen activator (rtPA) treatment in stroke; however, the contribution of Nod-like receptor protein 3 (NLRP3), a key component of the innate immune system, is not yet known. This study aimed to explore the role of NLRP3 in the delayed rtPA-induced HT and its association with the neutrophil recruitment. METHODS Rats were subjected to thromboembolic focal cerebral ischemia and delayed rtPA treatment at 4 h after ischemia to mimic HT. NLRP3 short hairpin RNAs (shRNA) were administered 72 h before ischemia. Additionally, rabbit anti-rat neutrophil serum (inducing neutropenia) was administered before cerebral ischemia. The infarct volume, edema volume, neurological deficit, hemorrhages, blood-brain barrier (BBB) integrity and brain neutrophil recruitment were evaluated at 24 h after cerebral ischemia. RESULTS Our results demonstrated that delayed rtPA treatment at 4 h after ischemia promoted the expression of NLRP3 in neurons, microglia and endothelial cells, degradation of BBB components, and HT. NLRP3 knockdown significantly attenuated NLRP3 expression, BBB disruption, and HT. It also improved neurological functions and reduced neutrophil recruitment. Rabbit anti-rat neutrophil serum, like NLRP3 shRNA, reduced hemorrhage score and hemorrhage volumes after rtPA treatment. Furthermore, the anti-rat neutrophil serum combined with NLRP3 shRNA didn't further increase the protective effect on HT compared to rabbit anti-rat neutrophil serum used alone. CONCLUSIONS Together, our data suggest that NLRP3 inhibition can reduce neutrophil recruitment, which may contribute to the inhibitory effect on HT.
Collapse
Affiliation(s)
- Zhiliang Guo
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China; Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou 215004, China.
| | - Shuhong Yu
- Department of Encephalopathy, Suzhou Integrated Traditional and Western Medicine Hospital, Suzhou 215101, China.
| | - Xin Chen
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
| | - Ping Zheng
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia.
| | - Ting Hu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
| | - Zhenhui Duan
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
| | - Xiaoyun Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
| | - Qian Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
| | - Ruidong Ye
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
| | - Wusheng Zhu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
| |
Collapse
|
264
|
Gelderblom M, Gallizioli M, Ludewig P, Thom V, Arunachalam P, Rissiek B, Bernreuther C, Glatzel M, Korn T, Arumugam TV, Sedlacik J, Gerloff C, Tolosa E, Planas AM, Magnus T. IL-23 (Interleukin-23)-Producing Conventional Dendritic Cells Control the Detrimental IL-17 (Interleukin-17) Response in Stroke. Stroke 2017; 49:155-164. [PMID: 29212740 DOI: 10.1161/strokeaha.117.019101] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/27/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Inflammatory mechanisms can exacerbate ischemic tissue damage and worsen clinical outcome in patients with stroke. Both αβ and γδ T cells are established mediators of tissue damage in stroke, and the role of dendritic cells (DCs) in inducing the early events of T cell activation and differentiation in stroke is not well understood. METHODS In a murine model of experimental stroke, we defined the immune phenotype of infiltrating DC subsets based on flow cytometry of surface markers, the expression of ontogenetic markers, and cytokine levels. We used conditional DC depletion, bone marrow chimeric mice, and IL-23 (interleukin-23) receptor-deficient mice to further explore the functional role of DCs. RESULTS We show that the ischemic brain was rapidly infiltrated by IRF4+/CD172a+ conventional type 2 DCs and that conventional type 2 DCs were the most abundant subset in comparison with all other DC subsets. Twenty-four hours after ischemia onset, conventional type 2 DCs became the major source of IL-23, promoting neutrophil infiltration by induction of IL-17 (interleukin-17) in γδ T cells. Functionally, the depletion of CD11c+ cells or the genetic disruption of the IL-23 signaling abrogated both IL-17 production in γδ T cells and neutrophil infiltration. Interruption of the IL-23/IL-17 cascade decreased infarct size and improved neurological outcome after stroke. CONCLUSIONS Our results suggest a central role for interferon regulatory factor 4-positive IL-23-producing conventional DCs in the IL-17-dependent secondary tissue damage in stroke.
Collapse
Affiliation(s)
- Mathias Gelderblom
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.).
| | - Mattia Gallizioli
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Peter Ludewig
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Vivien Thom
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Priyadharshini Arunachalam
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Björn Rissiek
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Christian Bernreuther
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Markus Glatzel
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Thomas Korn
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Thiruma Valavan Arumugam
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Jan Sedlacik
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Christian Gerloff
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Eva Tolosa
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Anna M Planas
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.)
| | - Tim Magnus
- From the Department of Neurology (M. Gelderblom, P.L., V.T., P.A., B.R., C.G., T.M.), Institute of Neuropathology (C.B., M. Glatzel), Department for Neuroradiological Diagnosis and Intervention (J.S.), and Institute of Immunology (E.T.), University Medical Center Hamburg-Eppendorf, Germany; Department d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas, Spain (M. Gallizioli, A.M.P.); Department of Neurology, Technical University of Munich, Germany (T.K.); Munich Cluster for Systems Neurology (SyNergy), Germany (T.K.); and Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (T.V.A.).
| |
Collapse
|
265
|
Vallés J, Santos MT, Latorre AM, Tembl J, Salom J, Nieves C, Lago A, Moscardó A. Neutrophil extracellular traps are increased in patients with acute ischemic stroke: prognostic significance. Thromb Haemost 2017; 117:1919-1929. [DOI: 10.1160/th17-02-0130] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/16/2017] [Indexed: 12/14/2022]
Abstract
SummaryNeutrophil extracellular traps (NETs) are networks of DNA, histones, and proteolytic enzymes produced by activated neutrophils through different mechanisms. NET formation is promoted by activated platelets and can in turn activate platelets, thus favoring thrombotic processes. NETs have been detected in venous and arterial thrombosis, but data in stroke are scarce. The aim of this study was to evaluate NETs in the plasma of patients with acute ischemic stroke and their potential association with baseline clinical characteristics, stroke severity, and one-year clinical outcomes. The study included 243 patients with acute ischemic stroke. Clinical and demographic data and scores of stroke severity (NIHSS and mRs) at onset and discharge were recorded. Markers of NETs (cell-free DNA, nucleosomes, and citrullinated histone 3 (citH3)), were determined in plasma. Patients were followed-up for 12 months after the ischemic event. NETs were significantly elevated in the plasma of patients with acute ischemic stroke when compared to healthy subjects. NETs were increased in patients who were over 65 years of age and in those with a history of atrial fibrillation (AF), cardioembolic stroke, high glucose levels, and severe stroke scores at admission and discharge. In multivariate analysis, elevated levels of citH3, the most specific marker of NETs, at onset were independently associated with AF and all-cause mortality at oneyear follow-up. NETs play a role in the pathophysiology of stroke and are associated with severity and mortality. In conclusion, citH3 may constitute a useful prognostic marker and therapeutic target in patients with acute stroke.
Collapse
|
266
|
Shi YW, Zhang XC, Chen C, Tang M, Wang ZW, Liang XM, Ding F, Wang CP. Schisantherin A attenuates ischemia/reperfusion-induced neuronal injury in rats via regulation of TLR4 and C5aR1 signaling pathways. Brain Behav Immun 2017; 66:244-256. [PMID: 28690033 DOI: 10.1016/j.bbi.2017.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/25/2017] [Accepted: 07/05/2017] [Indexed: 01/24/2023] Open
Abstract
Toll-like receptor 4 (TLR4) and C5aR1 (CD88) have been recognized as potential therapeutic targets for the reduction of inflammation and secondary damage and improvement of outcome after ischemia and reperfusion (I/R). The inflammatory responses which induce cell apoptosis and necrosis after I/R brain injury lead to a limited process of neural repair. To further comprehend how these targets function in I/R state, we investigated the pathological changes and TLR4 and C5aR1 signaling pathways in vitro and in vivo models of I/R brain injury in this study. Meanwhile, we explored the roles of schisantherin A on I/R brain injury, and whether it exerted neuroprotective effects by regulating the TLR4 and C5aR1 signaling pathways or not. The results showed that schisantherin A significantly reduced the neuronal apoptosis induced by oxygen and glucose deprivation and reperfusion (OGD/R) injury in primary culture of rat cortical neurons. Also, schisantherin A alleviated neurological deficits, reduced infarct volume, attenuated oxidation stress, inflammation and apoptosis in ischemic parietal cortex of rats after middle cerebral artery occlusion and reperfusion (MCAO/R) injury. Moreover, the activated TLR4 and C5aR1 signaling pathways were inhibited by schisantherin A treatment. In conclusion, TLR4 and C5aR1 played a vital role during I/R brain injury in rats, and schisantherin A exhibited neuroprotective effects by TLR4 and C5aR1 signaling pathways. These findings also provided new insights that would aid in elucidating the effect of schisantherin A against cerebral I/R and support the development of schisantherin A as a potential treatment for ischemic stroke.
Collapse
Affiliation(s)
- Yun Wei Shi
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, No. 19, Qixiu Road, Nantong, Jiangsu 226001, PR China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, PR China
| | - Xiao Chuan Zhang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, No. 19, Qixiu Road, Nantong, Jiangsu 226001, PR China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, PR China
| | - Chen Chen
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, No. 19, Qixiu Road, Nantong, Jiangsu 226001, PR China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, PR China
| | - Miao Tang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, No. 19, Qixiu Road, Nantong, Jiangsu 226001, PR China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, PR China
| | - Zhi Wei Wang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, No. 19, Qixiu Road, Nantong, Jiangsu 226001, PR China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, PR China; Department of Pharmacology, University of California, Irvine, CA 92697, USA
| | - Xin Miao Liang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, No. 19, Qixiu Road, Nantong, Jiangsu 226001, PR China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, PR China; Dalian Institute of Chemical Physics, the Chinese Academy of Sciences, Dalian, Liaoning 116023, PR China.
| | - Fei Ding
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, No. 19, Qixiu Road, Nantong, Jiangsu 226001, PR China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, PR China.
| | - Cai Ping Wang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, No. 19, Qixiu Road, Nantong, Jiangsu 226001, PR China; Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu 226001, PR China.
| |
Collapse
|
267
|
Mizuma A, Yenari MA. Anti-Inflammatory Targets for the Treatment of Reperfusion Injury in Stroke. Front Neurol 2017; 8:467. [PMID: 28936196 PMCID: PMC5594066 DOI: 10.3389/fneur.2017.00467] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 08/23/2017] [Indexed: 12/20/2022] Open
Abstract
While the mainstay of acute stroke treatment includes revascularization via recombinant tissue plasminogen activator or mechanical thrombectomy, only a minority of stroke patients are eligible for treatment, as delayed treatment can lead to worsened outcome. This worsened outcome at the experimental level has been attributed to an entity known as reperfusion injury (R/I). R/I is occurred when revascularization is delayed after critical brain and vascular injury has occurred, so that when oxygenated blood is restored, ischemic damage is increased, rather than decreased. R/I can increase lesion size and also worsen blood barrier breakdown and lead to brain edema and hemorrhage. A major mechanism underlying R/I is that of poststroke inflammation. The poststroke immune response consists of the aberrant activation of glial cell, infiltration of peripheral leukocytes, and the release of damage-associated molecular pattern (DAMP) molecules elaborated by ischemic cells of the brain. Inflammatory mediators involved in this response include cytokines, chemokines, adhesion molecules, and several immune molecule effectors such as matrix metalloproteinases-9, inducible nitric oxide synthase, nitric oxide, and reactive oxygen species. Several experimental studies over the years have characterized these molecules and have shown that their inhibition improves neurological outcome. Yet, numerous clinical studies failed to demonstrate any positive outcomes in stroke patients. However, many of these clinical trials were carried out before the routine use of revascularization therapies. In this review, we cover mechanisms of inflammation involved in R/I, therapeutic targets, and relevant experimental and clinical studies, which might stimulate renewed interest in designing clinical trials to specifically target R/I. We propose that by targeting anti-inflammatory targets in R/I as a combined therapy, it may be possible to further improve outcomes from pharmacological thrombolysis or mechanical thrombectomy.
Collapse
Affiliation(s)
- Atsushi Mizuma
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Midori A Yenari
- Department of Neurology, University of California, San Francisco and Veterans Affairs Medical Center, San Francisco, CA, United States
| |
Collapse
|
268
|
Vaas M, Enzmann G, Perinat T, Siler U, Reichenbach J, Licha K, Kipar A, Rudin M, Engelhardt B, Klohs J. Non-invasive near-infrared fluorescence imaging of the neutrophil response in a mouse model of transient cerebral ischaemia. J Cereb Blood Flow Metab 2017; 37:2833-2847. [PMID: 27789786 PMCID: PMC5536255 DOI: 10.1177/0271678x16676825] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Near-infrared fluorescence (NIRF) imaging enables non-invasive monitoring of molecular and cellular processes in live animals. Here we demonstrate the suitability of NIRF imaging to investigate the neutrophil response in the brain after transient middle cerebral artery occlusion (tMCAO). We established procedures for ex vivo fluorescent labelling of neutrophils without affecting their activation status. Adoptive transfer of labelled neutrophils in C57BL/6 mice before surgery resulted in higher fluorescence intensities over the ischaemic hemisphere in tMCAO mice with NIRF imaging when compared with controls, corroborated by ex vivo detection of labelled neutrophils using fluorescence microscopy. NIRF imaging showed that neutrophils started to accumulate immediately after tMCAO, peaking at 18 h, and were still visible until 48 h after reperfusion. Our data revealed accumulation of neutrophils also in extracranial tissue, indicating damage in the external carotid artery territory in the tMCAO model. Antibody-mediated inhibition of α4-integrins did reduce fluorescence signals at 18 and 24, but not at 48 h after reperfusion, compared with control treatment animals. Antibody treatment reduced cerebral lesion volumes by 19%. In conclusion, the non-invasive nature of NIRF imaging allows studying the dynamics of neutrophil recruitment and its modulation by targeted interventions in the mouse brain after transient experimental cerebral ischaemia.
Collapse
Affiliation(s)
- Markus Vaas
- 1 Institute for Biomedical Engineering, ETH & University of Zurich, Zurich, Switzerland.,2 Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland
| | - Gaby Enzmann
- 3 Theodor Kocher Institute, University of Bern, Bern, Switzerland
| | - Therese Perinat
- 3 Theodor Kocher Institute, University of Bern, Bern, Switzerland
| | - Ulrich Siler
- 4 Division of Immunology, University Children's Hospital Zurich and Children's Research Centre, Zurich, Switzerland
| | - Janine Reichenbach
- 4 Division of Immunology, University Children's Hospital Zurich and Children's Research Centre, Zurich, Switzerland
| | - Kai Licha
- 5 Institute of Chemistry and Biochemistry, Freie Universität Berlin, Berlin, Germany
| | - Anja Kipar
- 6 Institute of Veterinary Pathology, University of Zurich, Zürich, Switzerland
| | - Markus Rudin
- 1 Institute for Biomedical Engineering, ETH & University of Zurich, Zurich, Switzerland.,2 Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland.,7 Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | | | - Jan Klohs
- 1 Institute for Biomedical Engineering, ETH & University of Zurich, Zurich, Switzerland.,2 Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland
| |
Collapse
|
269
|
Biswas A, French T, Düsedau HP, Mueller N, Riek-Burchardt M, Dudeck A, Bank U, Schüler T, Dunay IR. Behavior of Neutrophil Granulocytes during Toxoplasma gondii Infection in the Central Nervous System. Front Cell Infect Microbiol 2017; 7:259. [PMID: 28680853 PMCID: PMC5478696 DOI: 10.3389/fcimb.2017.00259] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/02/2017] [Indexed: 01/12/2023] Open
Abstract
Cerebral toxoplasmosis is characterized by activation of brain resident cells and recruitment of specific immune cell subsets from the periphery to the central nervous system (CNS). Our studies revealed that the rapidly invaded Ly6G+ neutrophil granulocytes are an early non-lymphoid source of interferon-gamma (IFN-γ), the cytokine known to be the major mediator of host resistance to Toxoplasma gondii (T. gondii). Upon selective depletion of Ly6G+ neutrophils, we detected reduced IFN-γ production and increased parasite burden in the CNS. Ablation of Ly6G+ cells resulted in diminished recruitment of Ly6Chi monocytes into the CNS, indicating a pronounced interplay. Additionally, we identified infiltrated Ly6G+ neutrophils to be a heterogeneous population. The Ly6G+CD62-LhiCXCR4+ subset released cathelicidin-related antimicrobial peptide (CRAMP), which can promote monocyte dynamics. On the other hand, the Ly6G+CD62-LloCXCR4+ subset produced IFN-γ to establish early inflammatory response. Collectively, our findings revealed that the recruited Ly6G+CXCR4+ neutrophil granulocytes display a heterogeneity in the CNS with a repertoire of effector functions crucial in parasite control and immune regulation upon experimental cerebral toxoplasmosis.
Collapse
Affiliation(s)
- Aindrila Biswas
- Institute of Inflammation and Neurodegeneration, Otto-von-Guericke University MagdeburgMagdeburg, Germany
| | - Timothy French
- Institute of Inflammation and Neurodegeneration, Otto-von-Guericke University MagdeburgMagdeburg, Germany
| | - Henning P Düsedau
- Institute of Inflammation and Neurodegeneration, Otto-von-Guericke University MagdeburgMagdeburg, Germany
| | - Nancy Mueller
- Institute of Inflammation and Neurodegeneration, Otto-von-Guericke University MagdeburgMagdeburg, Germany
| | - Monika Riek-Burchardt
- Institute for Molecular and Clinical Immunology, Otto-von-Guericke University MagdeburgMagdeburg, Germany
| | - Anne Dudeck
- Institute for Molecular and Clinical Immunology, Otto-von-Guericke University MagdeburgMagdeburg, Germany
| | - Ute Bank
- Institute for Molecular and Clinical Immunology, Otto-von-Guericke University MagdeburgMagdeburg, Germany
| | - Thomas Schüler
- Institute for Molecular and Clinical Immunology, Otto-von-Guericke University MagdeburgMagdeburg, Germany
| | - Ildiko Rita Dunay
- Institute of Inflammation and Neurodegeneration, Otto-von-Guericke University MagdeburgMagdeburg, Germany
| |
Collapse
|
270
|
Coles JA, Myburgh E, Brewer JM, McMenamin PG. Where are we? The anatomy of the murine cortical meninges revisited for intravital imaging, immunology, and clearance of waste from the brain. Prog Neurobiol 2017; 156:107-148. [PMID: 28552391 DOI: 10.1016/j.pneurobio.2017.05.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 04/25/2017] [Accepted: 05/08/2017] [Indexed: 12/15/2022]
Abstract
Rapid progress is being made in understanding the roles of the cerebral meninges in the maintenance of normal brain function, in immune surveillance, and as a site of disease. Most basic research on the meninges and the neural brain is now done on mice, major attractions being the availability of reporter mice with fluorescent cells, and of a huge range of antibodies useful for immunocytochemistry and the characterization of isolated cells. In addition, two-photon microscopy through the unperforated calvaria allows intravital imaging of the undisturbed meninges with sub-micron resolution. The anatomy of the dorsal meninges of the mouse (and, indeed, of all mammals) differs considerably from that shown in many published diagrams: over cortical convexities, the outer layer, the dura, is usually thicker than the inner layer, the leptomeninx, and both layers are richly vascularized and innervated, and communicate with the lymphatic system. A membrane barrier separates them and, in disease, inflammation can be localized to one layer or the other, so experimentalists must be able to identify the compartment they are studying. Here, we present current knowledge of the functional anatomy of the meninges, particularly as it appears in intravital imaging, and review their role as a gateway between the brain, blood, and lymphatics, drawing on information that is scattered among works on different pathologies.
Collapse
Affiliation(s)
- Jonathan A Coles
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, Sir Graeme Davis Building, University of Glasgow, Glasgow, G12 8TA, United Kingdom.
| | - Elmarie Myburgh
- Centre for Immunology and Infection Department of Biology, University of York, Wentworth Way, Heslington, York YO10 5DD, United Kingdom
| | - James M Brewer
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, Sir Graeme Davis Building, University of Glasgow, Glasgow, G12 8TA, United Kingdom
| | - Paul G McMenamin
- Department of Anatomy & Developmental Biology, School of Biomedical and Psychological Sciences and Monash Biomedical Discovery Institute, Faculty of Medicine, Nursing and Health Sciences, Monash University, 10 Chancellor's Walk, Clayton, Victoria, 3800, Australia
| |
Collapse
|
271
|
Khoshnam SE, Winlow W, Farzaneh M. The Interplay of MicroRNAs in the Inflammatory Mechanisms Following Ischemic Stroke. J Neuropathol Exp Neurol 2017; 76:548-561. [DOI: 10.1093/jnen/nlx036] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
272
|
Regulation of Human Brain Microvascular Endothelial Cell Adhesion and Barrier Functions by Memantine. J Mol Neurosci 2017; 62:123-129. [PMID: 28429235 DOI: 10.1007/s12031-017-0917-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 04/04/2017] [Indexed: 12/23/2022]
Abstract
Vascular risk factors have been linked to cognitive decline and dementia in the elderly. Microvascular inflammation, especially of the endothelium, may contribute to the progression of neurodegenerative events in Alzheimer's disease (AD). Memantine, an uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist, is a licensed drug used for the treatment of moderate to severe AD. However, little information is available regarding its anti-inflammatory effects on the endothelium. In this study, we investigated the effects of memantine on human brain microvascular endothelial dysfunction induced by the pro-inflammatory cytokine tumor necrosis factor-α (TNF-α). Our results show that memantine prevents the attachment of monocyte THP-1 cells to human brain microvascular endothelial cells (HBMVEs). An in vitro BBB model experiment displayed that memantine could rescue TNF-α-induced disruption of the in vitro BBB model. In addition, memantine also interferes with monocyte transmigration across the BBB model. Our results indicate that TNF-α significantly increased the expression of cell adhesion molecules, such as ICAM-1, VCAM-1, and E-selectin, which was prevented by pretreatment with memantine. Mechanistically, memantine reversed activation of the transcription factor NF-κB by preventing the phosphorylation and degradation of its inhibitor IκBα. Our data is the first to describe a novel anti-inflammatory mechanism driven by the endothelial cell-mediated neuroprotective effects of memantine.
Collapse
|
273
|
Thrombosis, Neuroinflammation, and Poststroke Infection: The Multifaceted Role of Neutrophils in Stroke. J Immunol Res 2017; 2017:5140679. [PMID: 28331857 PMCID: PMC5346374 DOI: 10.1155/2017/5140679] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 12/12/2022] Open
Abstract
Immune cells can significantly predict and affect the clinical outcome of stroke. In particular, the neutrophil-to-lymphocyte ratio was shown to predict hemorrhagic transformation and the clinical outcome of stroke; however, the immunological mechanisms underlying these effects are poorly understood. Neutrophils are the first cells to invade injured tissue following focal brain ischemia. In these conditions, their proinflammatory properties enhance tissue damage and may promote ischemic incidences by inducing thrombus formation. Therefore, they constitute a potential target for therapeutic approaches and prevention of stroke. Indeed, in animal models of focal brain ischemia, neutrophils have been targeted with successful results. However, even in brain lesions, neutrophils also exert beneficial effects, because they are involved in triggering immunological removal of cell debris. Furthermore, intact neutrophil function is essential for maintaining immunological defense against bacterial infections. Several studies have demonstrated that stroke-derived neutrophils displayed impaired bacterial defense capacity. Because infections are known to impair the clinical course of stroke, therapeutic interventions that target neutrophils should preserve or even restore their function outside the central nervous system (CNS). This complex situation requires well-tailored therapeutic approaches that can effectively tackle immune cell invasion in the brain but avoid increasing poststroke infections.
Collapse
|
274
|
Thomsen BB, Gredal H, Wirenfeldt M, Kristensen BW, Clausen BH, Larsen AE, Finsen B, Berendt M, Lambertsen KL. Spontaneous ischaemic stroke lesions in a dog brain: neuropathological characterisation and comparison to human ischaemic stroke. Acta Vet Scand 2017; 59:7. [PMID: 28086932 PMCID: PMC5237225 DOI: 10.1186/s13028-016-0275-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/31/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Dogs develop spontaneous ischaemic stroke with a clinical picture closely resembling human ischaemic stroke patients. Animal stroke models have been developed, but it has proved difficult to translate results obtained from such models into successful therapeutic strategies in human stroke patients. In order to face this apparent translational gap within stroke research, dogs with ischaemic stroke constitute an opportunity to study the neuropathology of ischaemic stroke in an animal species. CASE PRESENTATION A 7 years and 8 months old female neutered Rottweiler dog suffered a middle cerebral artery infarct and was euthanized 3 days after onset of neurological signs. The brain was subjected to histopathology and immunohistochemistry. Neuropathological changes were characterised by a pan-necrotic infarct surrounded by peri-infarct injured neurons and reactive microglia/macrophages and astrocytes. CONCLUSIONS The neuropathological changes reported in the present study were similar to findings in human patients with ischaemic stroke. The dog with spontaneous ischaemic stroke is of interest as a complementary spontaneous animal model for further neuropathological studies.
Collapse
|
275
|
Justicia C, Salas-Perdomo A, Pérez-de-Puig I, Deddens LH, van Tilborg GAF, Castellví C, Dijkhuizen RM, Chamorro Á, Planas AM. Uric Acid Is Protective After Cerebral Ischemia/Reperfusion in Hyperglycemic Mice. Transl Stroke Res 2016; 8:294-305. [PMID: 27981484 DOI: 10.1007/s12975-016-0515-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/03/2016] [Accepted: 12/06/2016] [Indexed: 12/20/2022]
Abstract
Hyperglycemia at stroke onset is associated with poor long-term clinical outcome in numerous studies. Hyperglycemia induces intracellular acidosis, lipid peroxidation, and peroxynitrite production resulting in the generation of oxidative and nitrosative stress in the ischemic tissue. Here, we studied the effects of acute hyperglycemia on in vivo intercellular adhesion molecule-1 (ICAM-1) expression, neutrophil recruitment, and brain damage after ischemia/reperfusion in mice and tested whether the natural antioxidant uric acid was protective. Hyperglycemia was induced by i.p. administration of dextrose 45 min before transient occlusion of the middle cerebral artery. Magnetic resonance imaging (MRI) was performed at 24 h to measure lesion volume. A group of normoglycemic and hyperglycemic mice received an i.v. injection of micron-sized particles of iron oxide (MPIOs), conjugated with either anti-ICAM-1 antibody or control IgG, followed by T2*w MRI. Neutrophil infiltration was studied by immunofluorescence and flow cytometry. A group of hyperglycemic mice received an i.v. infusion of uric acid (16 mg/kg) or the vehicle starting after 45 min of reperfusion. ICAM-1-targeted MPIOs induced significantly larger MRI contrast-enhancing effects in the ischemic brain of hyperglycemic mice, which also showed more infiltrating neutrophils and larger lesions than normoglycemic mice. Uric acid reduced infarct volume in hyperglycemic mice but it did not prevent vascular ICAM-1 upregulation and did not significantly reduce the number of neutrophils in the ischemic brain tissue. In conclusion, hyperglycemia enhances stroke-induced vascular ICAM-1 and neutrophil infiltration and exacerbates the brain lesion. Uric acid reduces the lesion size after ischemia/reperfusion in hyperglycemic mice.
Collapse
Affiliation(s)
- Carles Justicia
- Departament d'Isquemia Cerebral i Neurodegeneracio, Institut d'Investigacions Biomediques de Barcelona (IIBB), Consejo Superior de Investigaciones Cientificas (CSIC), Rossello 161, planta 6, 08036, Barcelona, Spain. .,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Rossello 161, planta 6, 08036, Barcelona, Spain.
| | - Angélica Salas-Perdomo
- Departament d'Isquemia Cerebral i Neurodegeneracio, Institut d'Investigacions Biomediques de Barcelona (IIBB), Consejo Superior de Investigaciones Cientificas (CSIC), Rossello 161, planta 6, 08036, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Rossello 161, planta 6, 08036, Barcelona, Spain
| | - Isabel Pérez-de-Puig
- Departament d'Isquemia Cerebral i Neurodegeneracio, Institut d'Investigacions Biomediques de Barcelona (IIBB), Consejo Superior de Investigaciones Cientificas (CSIC), Rossello 161, planta 6, 08036, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Rossello 161, planta 6, 08036, Barcelona, Spain
| | - Lisette H Deddens
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geralda A F van Tilborg
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Clara Castellví
- Departament d'Isquemia Cerebral i Neurodegeneracio, Institut d'Investigacions Biomediques de Barcelona (IIBB), Consejo Superior de Investigaciones Cientificas (CSIC), Rossello 161, planta 6, 08036, Barcelona, Spain
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ángel Chamorro
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Rossello 161, planta 6, 08036, Barcelona, Spain.,Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Anna M Planas
- Departament d'Isquemia Cerebral i Neurodegeneracio, Institut d'Investigacions Biomediques de Barcelona (IIBB), Consejo Superior de Investigaciones Cientificas (CSIC), Rossello 161, planta 6, 08036, Barcelona, Spain. .,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Rossello 161, planta 6, 08036, Barcelona, Spain.
| |
Collapse
|
276
|
Update on Inflammatory Biomarkers and Treatments in Ischemic Stroke. Int J Mol Sci 2016; 17:ijms17121967. [PMID: 27898011 PMCID: PMC5187767 DOI: 10.3390/ijms17121967] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 11/08/2016] [Accepted: 11/17/2016] [Indexed: 12/26/2022] Open
Abstract
After an acute ischemic stroke (AIS), inflammatory processes are able to concomitantly induce both beneficial and detrimental effects. In this narrative review, we updated evidence on the inflammatory pathways and mediators that are investigated as promising therapeutic targets. We searched for papers on PubMed and MEDLINE up to August 2016. The terms searched alone or in combination were: ischemic stroke, inflammation, oxidative stress, ischemia reperfusion, innate immunity, adaptive immunity, autoimmunity. Inflammation in AIS is characterized by a storm of cytokines, chemokines, and Damage-Associated Molecular Patterns (DAMPs) released by several cells contributing to exacerbate the tissue injury both in the acute and reparative phases. Interestingly, many biomarkers have been studied, but none of these reflected the complexity of systemic immune response. Reperfusion therapies showed a good efficacy in the recovery after an AIS. New therapies appear promising both in pre-clinical and clinical studies, but still need more detailed studies to be translated in the ordinary clinical practice. In spite of clinical progresses, no beneficial long-term interventions targeting inflammation are currently available. Our knowledge about cells, biomarkers, and inflammatory markers is growing and is hoped to better evaluate the impact of new treatments, such as monoclonal antibodies and cell-based therapies.
Collapse
|
277
|
Strecker JK, Schmidt A, Schäbitz WR, Minnerup J. Neutrophil granulocytes in cerebral ischemia - Evolution from killers to key players. Neurochem Int 2016; 107:117-126. [PMID: 27884770 DOI: 10.1016/j.neuint.2016.11.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 12/16/2022]
Abstract
Neutrophil granulocytes (or polymorphonuclear cells, PMNs) have long been considered as crude killing machines, particularly trained to attack bacterial or fungal pathogens in wounds or infected tissues. That perspective has fundamentally changed over the last decades, as PMNs have been shown to exert a livery exchange between other cells of the innate and adaptive immune system. PMNs do provide major immunomodulatory contribution during acute inflammation and subsequent clearance. Following sterile inflammation like cerebral ischemia, PMNs are among the first hematogenous cells attracted to the ischemic tissue. As inflammation is a crucial component within stroke pathophysiology, several studies regarding the role of PMNs following cerebral ischemia have been carried out. And indeed, recent research suggests a direct connection between PMNs' influx and brain damage severity. This review highlights the latest research regarding the close interconnection between PMNs and co-working cells following cerebral ischemia. We describe how PMNs are attracted to the site of injury and their tasks within the inflamed brain tissue and the periphery. We further report of new findings regarding the interaction of PMNs with resident microglia, immigrating macrophages and T cells after stroke. Finally, we discuss recent research results from experimental studies in the context with current clinical trials and point out potential new therapeutic applications that could emerge from this new knowledge on the action and interaction of PMNs following cerebral ischemia.
Collapse
Affiliation(s)
- Jan-Kolja Strecker
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
| | - Antje Schmidt
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| | | | - Jens Minnerup
- Department of Neurology, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany
| |
Collapse
|
278
|
Kazzaz NM, Sule G, Knight JS. Intercellular Interactions as Regulators of NETosis. Front Immunol 2016; 7:453. [PMID: 27895638 PMCID: PMC5107827 DOI: 10.3389/fimmu.2016.00453] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/11/2016] [Indexed: 12/12/2022] Open
Abstract
Neutrophil extracellular traps (NETs) are chromatin-derived webs extruded from neutrophils in response to either infection or sterile stimulation with chemicals, cytokines, or microbial products. The vast majority of studies have characterized NET release (also called NETosis) in pure neutrophil cultures in vitro. The situation is surely more complex in vivo as neutrophils constantly sample not only pathogens and soluble mediators but also signals from cellular partners, including platelets and endothelial cells. This complexity is beginning to be explored by studies utilizing in vitro co-culture, as well as animal models of sepsis, infective endocarditis, lung injury, and thrombosis. Indeed, various selectins, integrins, and surface glycoproteins have been implicated in platelet–neutrophil interactions that promote NETosis, albeit with disparate results across studies. NETosis can also clearly be regulated by soluble mediators derived from platelets, such as eicosanoids, chemokines, and alarmins. Beyond platelets, the role of the endothelium in modulating NETosis is being increasingly revealed, with adhesive interactions likely priming neutrophils toward NETosis. The fact that the same selectins and surface glycoproteins may be expressed by both platelets and endothelial cells complicates the interpretation of in vivo data. In summary, we suggest in this review that the engagement of neutrophils with activated cellular partners provides an important in vivo signal or “hit” toward NETosis. Studies should, therefore, increasingly consider the triumvirate of neutrophils, platelets, and the endothelium when exploring NETosis, especially in disease states.
Collapse
Affiliation(s)
- Nayef M Kazzaz
- Department of Internal Medicine, Division of Rheumatology, University of Michigan , Ann Arbor, MI , USA
| | - Gautam Sule
- Department of Internal Medicine, Division of Rheumatology, University of Michigan , Ann Arbor, MI , USA
| | - Jason S Knight
- Department of Internal Medicine, Division of Rheumatology, University of Michigan , Ann Arbor, MI , USA
| |
Collapse
|
279
|
Guo Z, Yu S, Xiao L, Chen X, Ye R, Zheng P, Dai Q, Sun W, Zhou C, Wang S, Zhu W, Liu X. Dynamic change of neutrophil to lymphocyte ratio and hemorrhagic transformation after thrombolysis in stroke. J Neuroinflammation 2016; 13:199. [PMID: 27561990 PMCID: PMC5000487 DOI: 10.1186/s12974-016-0680-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 08/18/2016] [Indexed: 01/02/2023] Open
Abstract
Background The neutrophil to lymphocyte ratio (NLR) has been shown to predict short- and long-term outcomes in ischemic stroke patients. We sought to explore the temporal profile of the plasma NLR in stroke patients treated with intravenous thrombolysis (IVT) and its relationship with intracranial bleeding complications after thrombolysis. Methods A total of 189 ischemic stroke patients were prospectively enrolled. Blood samples for leukocyte, neutrophil, and lymphocyte counts were obtained at admission and at 3–6, 12–18, and 36–48 h after IVT. Head CT was performed on admission and repeated after 36–48 h, and a CT scan was done immediately in case of clinical worsening. Hemorrhagic events were categorized as symptomatic intracranial hemorrhage (sICH) and parenchymal hematomas (PH) according to previously published criteria. Results An increasing trend in the NLR was observed after stroke, and the NLR was higher in patients who developed PH or sICH at 3–6, 12–18, and 36–48 h after IVT (P < 0.01) than in those without PH or sICH. The optimal cutoff value for the serum NLR as an indicator for auxiliary diagnosis of PH and sICH was 10.59 at 12–18 h. Furthermore, the NLR obtained at 12–18-h post-treatment was independently associated with PH (adjusted odds ratio [OR] 1.14) and sICH (adjusted OR 1.14). In addition, patients with a NLR ≥10.59 had an 8.50-fold greater risk for PH (95 % confidence interval [CI] 2.69–26.89) and a 7.93-fold greater risk for sICH (95 % CI 2.25–27.99) than patients with a NLR <10.59. Conclusions NLR is a dynamic variable, and its variation is associated with HT after thrombolysis in stroke patients. Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0680-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Zhiliang Guo
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China.,Department of Neurology, Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Shuhong Yu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China
| | - Lulu Xiao
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China
| | - Xin Chen
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China
| | - Ruidong Ye
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China
| | - Ping Zheng
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Qiliang Dai
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China
| | - Wen Sun
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China
| | - Changsheng Zhou
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Shuiping Wang
- Department of Neurology, PLA 123 Hospital, 1052 Yanshan Road, Yuhui District, Bengbu, 233000, China
| | - Wusheng Zhu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China.
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 E Zhongshan Rd, Nanjing, 210002, Jiangsu Province, China.
| |
Collapse
|
280
|
Simats A, García-Berrocoso T, Montaner J. Natalizumab: a new therapy for acute ischemic stroke? Expert Rev Neurother 2016; 16:1013-21. [PMID: 27476862 DOI: 10.1080/14737175.2016.1219252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Natalizumab, a well-characterized treatment for multiple sclerosis, is a humanized antibody against alpha-4 integrin (CD49d) that mitigates the transmigration of leukocytes across the endothelium. Although numerous experimental studies have evaluated the efficacy of anti-CD49d antibody treatment for ischemic stroke, discrepancies in their results have raised concerns about the benefits of this approach. AREAS COVERED This article reviews the main experimental studies on the blockage of CD49d and identifies the potential underlying causes for their inconclusive results. Despite these divergences and the difficulties in translation of experimental studies, a phase II clinical trial has recently been conducted to evaluate the efficacy of natalizumab in stroke patients (ACTION trial). Preliminary results of the trial are also discussed here, together with a general overview of the emerged importance of the neuroprotective strategies based on the mitigation of post-stroke neuroinflammation. Expert commentary: Despite natalizumab showing positive effects on functional outcome similar to what was found in experimental models, a better understanding of how this happens without reducing the infarct volume requires further research. Therefore, new clinical trials are needed to confirm its neuroprotectant role in ischemic stroke.
Collapse
Affiliation(s)
- Alba Simats
- a Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron (VHIR) , Universitat Autónoma de Barcelona , Barcelona , Spain
| | - Teresa García-Berrocoso
- a Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron (VHIR) , Universitat Autónoma de Barcelona , Barcelona , Spain
| | - Joan Montaner
- a Neurovascular Research Laboratory, Institut de Recerca, Hospital Universitari Vall d'Hebron (VHIR) , Universitat Autónoma de Barcelona , Barcelona , Spain.,b Stroke Programme , Institute of Biomedicine of Seville (IBiS) , Seville , Spain
| |
Collapse
|
281
|
Non-invasive evaluation of neuroprotective drug candidates for cerebral infarction by PET imaging of mitochondrial complex-I activity. Sci Rep 2016; 6:30127. [PMID: 27440054 PMCID: PMC4954989 DOI: 10.1038/srep30127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/22/2016] [Indexed: 01/12/2023] Open
Abstract
The development of a diagnostic technology that can accurately determine the pathological progression of ischemic stroke and evaluate the therapeutic effects of cerebroprotective agents has been desired. We previously developed a novel PET probe, 2-tert-butyl-4-chloro-5-{6-[2-(2-18F-fluoroethoxy)-ethoxy]-pyridin-3-ylmethoxy}-2H-pyridazin-3-one ([18F]BCPP-EF) for detecting activity of mitochondrial complex I (MC-I). This probe was shown to visualize neuronal damage in the living brain of rodent and primate models of neurodegenerative diseases. In the present study, [18F]BCPP-EF was applied to evaluate the therapeutic effects of a neuroprotectant, liposomal FK506 (FK506-liposomes), on cerebral ischemia/reperfusion (I/R) injury in transient middle cerebral artery occlusion rats. The PET imaging using [18F]BCPP-EF showed a prominent reduction in the MC-I activity in the ischemic brain hemisphere. Treatment with FK506-liposomes remarkably increased the uptake of [18F]BCPP-EF in the ischemic side corresponding to the improvement of blood flow disorders and motor function deficits throughout the 7 days after I/R. Additionally, the PET scan could diagnose the extent of the brain damage accurately and showed the neuroprotective effect of FK506-liposomes at Day 7, at which 2, 3, 5-triphenyltetrazolium chloride staining couldn’t visualize them. Our study demonstrated that the PET technology using [18F]BCPP-EF has a potent capacity to evaluate the therapeutic effect of drug candidates in living brain.
Collapse
|
282
|
Amantea D, Certo M, Petrelli F, Bagetta G. Neuroprotective Properties of a Macrolide Antibiotic in a Mouse Model of Middle Cerebral Artery Occlusion: Characterization of the Immunomodulatory Effects and Validation of the Efficacy of Intravenous Administration. Assay Drug Dev Technol 2016; 14:298-307. [PMID: 27392039 DOI: 10.1089/adt.2016.728] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Repurposing the macrolide antibiotic azithromycin has recently been suggested as a promising neuroprotective strategy for the acute treatment of ischemic stroke. Here, we aim at further characterizing the immunomodulatory properties of intraperitoneal (i.p.) administration of this drug and, more importantly, at assessing whether neuroprotection can also be achieved by the more clinically relevant intravenous (i.v.) route of administration in a mouse model of focal cerebral ischemia induced by transient (30-min) middle cerebral artery occlusion (MCAo). A single i.p. injection of azithromycin (150 mg/kg) upon reperfusion prevented ischemia-induced spleen contraction and increased the number of MAC-1-immunopositive microglia/macrophages in the ischemic hemisphere 48 h after the insult. This was paralleled by an elevation of alternatively activated phenotypes (i.e., Ym1-immunopositive M2-polarized cells) and by a reduced expression of the pro-inflammatory marker myeloperoxidase. More importantly, i.v. administration of azithromycin upon reperfusion reduced MCAo-induced infarct volume and cerebral edema to an extent comparable to that obtained via the i.p. route. Although the i.p. route is often used for research purposes, it is impractical in the clinical setting; however, i.v. administration can easily be used in ischemic stroke patients who usually have i.v. access already established on hospital admission. The neuroprotective efficacy of the clinically relevant i.v. administration of azithromycin, together with its beneficial immunomodulatory properties reported in mice subjected to transient MCAo, suggests that this macrolide antibiotic can be effectively repurposed for the acute treatment of ischemic stroke. To this end, further work is needed to validate the efficacy of azithromycin in the clinical setting.
Collapse
Affiliation(s)
- Diana Amantea
- 1 Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria , Rende (CS), Italy
| | - Michelangelo Certo
- 1 Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria , Rende (CS), Italy
| | - Francesco Petrelli
- 1 Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria , Rende (CS), Italy
| | - Giacinto Bagetta
- 1 Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria , Rende (CS), Italy .,2 University Consortium for Adaptive Disorders and Head Pain (UCADH), Section of Neuropharmacology of Normal and Pathological Neuronal Plasticity, University of Calabria , Rende, Italy
| |
Collapse
|
283
|
Platelet-to-White Blood Cell Ratio: A Prognostic Predictor for 90-Day Outcomes in Ischemic Stroke Patients with Intravenous Thrombolysis. J Stroke Cerebrovasc Dis 2016; 25:2430-8. [PMID: 27372596 DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/16/2016] [Accepted: 06/08/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study is aimed to investigate the relationship between platelet-to-white blood cell ratio (PWR) and 90-day outcomes in acute stroke patients with intravenous thrombolysis (IVT). MATERIALS AND METHODS A retrospective analysis was performed on 168 patients receiving IVT for acute ischemic stroke. Complete blood count evaluation was conducted at admission before IVT. A modified Rankin Scale (mRS) score of 3-6 at 90 days was considered an unfavorable outcome. RESULTS A total of 168 patients were included from 2013 to 2015. The mean age of the sample was 64.6 (±12.3) years, and 23.2% were women. The median baseline National Institutes of Health Stroke Scale score was 7.5 (interquartile range [IQR] 8.0) and the 90-day mRS score was 2 (IQR 2). In our multivariate logistic regression model, a PWR greater than 23.52 (odds ratio .454, 95% confidence interval: .212-.973, P < .050) was a predictor of 90-day outcomes. In addition, there was a significant difference in the PWR values of patients between favorable outcome and unfavorable outcome in the large-artery atherosclerosis subtype (28.241 ± 11.581 and 21.899 ± 9.107, respectively; P = .005). CONCLUSIONS The PWR at admission predicts 90-day outcomes in ischemic stroke patients with IVT. With the easy and routine use of hemogram analysis, the PWR should be investigated in further prospective randomized controlled trials of acute stroke.
Collapse
|
284
|
Commensal microbiota affects ischemic stroke outcome by regulating intestinal γδ T cells. Nat Med 2016; 22:516-23. [PMID: 27019327 PMCID: PMC4860105 DOI: 10.1038/nm.4068] [Citation(s) in RCA: 712] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/17/2016] [Indexed: 12/12/2022]
Abstract
Commensal gut bacteria impact the host immune system and can influence disease processes in several organs, including the brain. However, it remains unclear whether the microbiota has an impact on the outcome of acute brain injury. Here we show that antibiotic-induced alterations in the intestinal flora reduce ischemic brain injury in mice, an effect transmissible by fecal transplants. Intestinal dysbiosis alters immune homeostasis in the small intestine, leading to an increase in regulatory T cells and a reduction in interleukin (IL)-17-positive γδ T cells through altered dendritic cell activity. Dysbiosis suppresses trafficking of effector T cells from the gut to the leptomeninges after stroke. Additionally, IL-10 and IL-17 are required for the neuroprotection afforded by intestinal dysbiosis. The findings reveal a previously unrecognized gut-brain axis and an impact of the intestinal flora and meningeal IL-17(+) γδ T cells on ischemic injury.
Collapse
|
285
|
Immune cell trafficking across the barriers of the central nervous system in multiple sclerosis and stroke. Biochim Biophys Acta Mol Basis Dis 2016; 1862:461-71. [DOI: 10.1016/j.bbadis.2015.10.018] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/17/2015] [Accepted: 10/20/2015] [Indexed: 12/16/2022]
|
286
|
Miró-Mur F, Pérez-de-Puig I, Ferrer-Ferrer M, Urra X, Justicia C, Chamorro A, Planas AM. Immature monocytes recruited to the ischemic mouse brain differentiate into macrophages with features of alternative activation. Brain Behav Immun 2016; 53:18-33. [PMID: 26275369 DOI: 10.1016/j.bbi.2015.08.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/29/2015] [Accepted: 08/10/2015] [Indexed: 12/18/2022] Open
Abstract
Acute stroke induces a local inflammatory reaction causing leukocyte infiltration. Circulating monocytes are recruited to the ischemic brain and become tissue macrophages morphologically indistinguishable from reactive microglia. However, monocytes are a heterogeneous population of cells with different functions. Herein, we investigated the infiltration and fate of the monocyte subsets in a mouse model of focal brain ischemia by permanent occlusion of the distal portion of the middle cerebral artery. We separated two main subtypes of CD11b(hi) monocytes according to their expression of the surface markers Ly6C and CD43. Using adoptive transfer of reporter monocytes and monocyte depletion, we identified the pro-inflammatory Ly6C(hi)CD43(lo)CCR2(+) subset as the predominant monocytes recruited to the ischemic tissue. Monocytes were seen in the leptomeninges from where they entered the cortex along the penetrating arterioles. Four days post-ischemia, they had invaded the infarcted core, where they were often located adjacent to blood vessels. At this time, Iba-1(-) and Iba-1(+) cells in the ischemic tissue incorporated BrdU, but BrdU incorporation was rare in the reporter monocytes. The monocyte phenotype progressively changed by down-regulating Ly6C, up-regulating F4/80, expressing low or intermediate levels of Iba-1, and developing macrophage morphology. Moreover, monocytes progressively acquired the expression of typical markers of alternatively activated macrophages, like arginase-1 and YM-1. Collectively, the results show that stroke mobilized immature pro-inflammatory Ly6C(hi)CD43(lo) monocytes that acutely infiltrated the ischemic tissue reaching the core of the lesion. Monocytes differentiated to macrophages with features of alternative activation suggesting possible roles in tissue repair during the sub-acute phase of stroke.
Collapse
Affiliation(s)
- Francesc Miró-Mur
- Àrea de Neurociències, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Isabel Pérez-de-Puig
- Àrea de Neurociències, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Departament d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), 08036 Barcelona, Spain
| | - Maura Ferrer-Ferrer
- Àrea de Neurociències, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Departament d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), 08036 Barcelona, Spain
| | - Xabier Urra
- Àrea de Neurociències, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Functional Stroke Unit of Cerebrovascular Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Carles Justicia
- Àrea de Neurociències, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Departament d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), 08036 Barcelona, Spain
| | - Angel Chamorro
- Àrea de Neurociències, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Functional Stroke Unit of Cerebrovascular Diseases, Hospital Clínic, 08036 Barcelona, Spain
| | - Anna M Planas
- Àrea de Neurociències, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; Departament d'Isquèmia Cerebral i Neurodegeneració, Institut d'Investigacions Biomèdiques de Barcelona (IIBB), Consejo Superior de Investigaciones Científicas (CSIC), 08036 Barcelona, Spain.
| |
Collapse
|
287
|
Endothelial CD36 Contributes to Postischemic Brain Injury by Promoting Neutrophil Activation via CSF3. J Neurosci 2016; 35:14783-93. [PMID: 26538649 DOI: 10.1523/jneurosci.2980-15.2015] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
UNLABELLED The scavenger receptor CD36 is a critical factor initiating ischemic brain injury, but the cell type(s) expressing CD36 and responsible for its harmful effects remain unknown. Using bone marrow (BM) chimeras subjected to transient middle cerebral artery occlusion, we found that CD36(-/-) mice transplanted with wild-type (WT) BM (WT→CD36(-/-)) have smaller infarcts (-67%), comparable with those of mice lacking CD36 both in brain and hematogenous cells (CD36(-/-) →CD36(-/-); - 72%). Conversely, WT mice receiving CD36(-/-) BM (CD36(-/-) →WT) have infarcts similar to WT→WT mice, suggesting that CD36 in the host brain (i.e., in microglia and endothelial cells), and not in hematogenous cells is involved in the damage. As anticipated, postischemic neutrophil infiltration in CD36(-/-) →CD36(-/-) mice was attenuated. Surprisingly, however, in WT→CD36(-/-) mice, in which infarcts were small, neutrophil infiltration was large and similar to that of CD36(-/-) →WT mice, in which infarcts were not reduced. Postischemic neutrophil free radical production was attenuated in WT→CD36(-/-) mice compared with CD36(-/-) →WT mice, whereas expression of the neutrophil activator colony-stimulating factor 3 (CSF3) was suppressed in CD36(-/-) cerebral endothelial cells, but not microglia. In CD36(-/-) cerebral endothelial cultures exposed to extracts from stroke brains, the upregulation of CSF3, but not neutrophil attractant chemokines, was suppressed. Intracerebroventricular administration of CSF3, 24 h after stroke, reconstituted neutrophil radical production and increased infarct volume in WT→CD36(-/-) mice. The findings identify endothelial cells as a key player in the deleterious effects of CD36 in stroke, and unveil a novel role of endothelial CD36 in enabling neutrophil neurotoxicity through CSF3. SIGNIFICANCE STATEMENT Ischemic stroke is a leading cause of death and disability worldwide with limited therapeutic options. The inflammatory response initiated by cerebral ischemia-reperfusion contributes to ischemic brain injury and is a potential therapeutic target. Here we report that CD36, an innate immunity receptor involved in the initiation of postischemic inflammation, is a previously unrecognized regulator of neutrophil cytotoxicity. The effect is mediated by endothelial CD36 via upregulation of the neutrophil activator CSF3 in cerebral endothelial cells. Therefore, approaches to modulate cerebral endothelial CD36 signaling or to neutralize CSF3 may provide novel therapeutic opportunities to ameliorate postischemic inflammatory injury.
Collapse
|
288
|
Amantea D, Bagetta G. Drug repurposing for immune modulation in acute ischemic stroke. Curr Opin Pharmacol 2016; 26:124-30. [DOI: 10.1016/j.coph.2015.11.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/11/2015] [Accepted: 11/16/2015] [Indexed: 12/24/2022]
|
289
|
Wu F, Zou Q, Ding X, Shi D, Zhu X, Hu W, Liu L, Zhou H. Complement component C3a plays a critical role in endothelial activation and leukocyte recruitment into the brain. J Neuroinflammation 2016; 13:23. [PMID: 26822321 PMCID: PMC4731990 DOI: 10.1186/s12974-016-0485-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The complement system is becoming increasingly recognized as a key participant in many neurodegenerative diseases of the brain. Complement-deficient animals exhibit reduced neuroinflammation. METHODS In the present study, we administered intracerebroventricularly lipopolysaccharide (LPS) to mimic local infection of the brain and investigated the role of key complement component C3 in brain vasculature endothelial activation and leukocyte recruitment. The degree of neutrophil infiltration was determined by esterase staining. Leukocyte-endothelial interactions were measured using intravital microscopy. Cerebral endothelial activation was evaluated using real-time PCR and Western blotting. RESULTS Neutrophil infiltration into the brain cortex and hippocampus was significantly reduced in C3(-/-) mice and C3aR(-/-) mice but not in C6(-/-) mice. We detected markedly attenuated leukocyte-endothelial interactions in the brain microvasculature of C3(-/-) mice. Accordingly, in response to LPS administration, the brain microvasculature in these mice had decreased expression of P-selectin, E-selectin, intercellular cell adhesion molecule 1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1). Depletion of C3 from the circulation also caused reduction in VCAM-1 and E-selectin expression and leukocyte recruitment, suggesting that C3 in the circulation contributed to brain endothelial activation. Furthermore, C3(-/-) mice exhibited decreased leukocyte recruitment into the brain upon tumor necrosis factor-α (TNF-α) stimulation. C3a activated the phosphorylation of p38 mitogen-activated protein kinase (MAPK) and nuclear factor-κB (NF-κB) and induced the upregulation of VCAM-1 and ICAM-1 expression in murine primary cerebral endothelial cells in vitro. CONCLUSIONS Our study provides the first evidence that C3a plays a critical role in cerebral endothelial activation and leukocyte recruitment during inflammation in the brain.
Collapse
Affiliation(s)
- Fengjiao Wu
- Department of Immunology, Nanjing Medical University, 140 Hanzhong Road, Nanjing, JS, 210029, China.
| | - Qiang Zou
- Department of Immunology, Chengdu Medical College, Chengdu, 610083, Sichuan, China.
| | - Xiaodan Ding
- Department of Immunology, Nanjing Medical University, 140 Hanzhong Road, Nanjing, JS, 210029, China.
| | - Dongyan Shi
- Department of Immunology, Nanjing Medical University, 140 Hanzhong Road, Nanjing, JS, 210029, China.
| | - Xingxing Zhu
- Department of Immunology, Nanjing Medical University, 140 Hanzhong Road, Nanjing, JS, 210029, China.
| | - Weiguo Hu
- Shanghai Cancer Center and Institute of Biomedical Science, Shanghai Medical College, Shanghai Cancer Center, Fudan University, Shanghai, 200032, China.
| | - Lixin Liu
- Department of Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, S7N 5E5, Canada.
| | - Hong Zhou
- Department of Immunology, Nanjing Medical University, 140 Hanzhong Road, Nanjing, JS, 210029, China.
| |
Collapse
|
290
|
De Meyer SF, Denorme F, Langhauser F, Geuss E, Fluri F, Kleinschnitz C. Thromboinflammation in Stroke Brain Damage. Stroke 2016; 47:1165-72. [PMID: 26786115 DOI: 10.1161/strokeaha.115.011238] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/26/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Simon F De Meyer
- From the Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium (S.F.D.M., F.D.); and Department of Neurology, University Clinic of Würzburg, Würzburg, Germany (F.L., E.G., F.F., C.K.).
| | - Frederik Denorme
- From the Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium (S.F.D.M., F.D.); and Department of Neurology, University Clinic of Würzburg, Würzburg, Germany (F.L., E.G., F.F., C.K.)
| | - Friederike Langhauser
- From the Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium (S.F.D.M., F.D.); and Department of Neurology, University Clinic of Würzburg, Würzburg, Germany (F.L., E.G., F.F., C.K.)
| | - Eva Geuss
- From the Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium (S.F.D.M., F.D.); and Department of Neurology, University Clinic of Würzburg, Würzburg, Germany (F.L., E.G., F.F., C.K.)
| | - Felix Fluri
- From the Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium (S.F.D.M., F.D.); and Department of Neurology, University Clinic of Würzburg, Würzburg, Germany (F.L., E.G., F.F., C.K.)
| | - Christoph Kleinschnitz
- From the Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium (S.F.D.M., F.D.); and Department of Neurology, University Clinic of Würzburg, Würzburg, Germany (F.L., E.G., F.F., C.K.).
| |
Collapse
|
291
|
NETosis promotes cancer-associated arterial microthrombosis presenting as ischemic stroke with troponin elevation. Thromb Res 2016; 139:56-64. [PMID: 26916297 DOI: 10.1016/j.thromres.2016.01.009] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/23/2015] [Accepted: 01/10/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Large elevations of high sensitive Troponin T (hsTnT) in ischemic stroke patients is associated with a poor outcome. In a pilot study we found a high prevalence of malignancies among these patients. Since neutrophil extracellular traps (NETs) have been linked to cancer-associated thrombosis, we hypothesized that the concomitant cerebral and myocardial ischemia could be the result of a NET-induced hypercoagulable state. MATERIALS AND METHODS Clinical assessments, plasma analyses and autopsies with histopathology (in cases of in-hospital mortality) were performed on ischemic stroke patients with high elevations of hsTnT (N=12) and normal hsTnT (N=19). RESULTS Patients with hsTnT elevation had an unexpectedly higher prevalence of cancer (p=0.002), half of which were diagnosed post-mortem. Autopsies of these patients revealed widespread myocardial, cerebral and pulmonary microthrombosis with H3Cit in thrombi. A pro-coagulant state and an increase of the NET specific marker citrullinated histone H3 (H3Cit) was found in plasma of patients with elevated hsTnT compared to patients with normal levels (p<0.001). Plasma analyses in cancer patients showed even higher H3Cit levels (p<0.001), and an increase in granulocyte colony-stimulating factor, known to prime neutrophils towards NETosis. H3Cit correlated positively with thrombin-antithrombin complex (p=0.004) and soluble P-selectin (p<0.001), further linking NETosis to the pro-thrombotic state. CONCLUSIONS The high prevalence of known or occult cancer in our study suggests that cancer-associated arterial microthrombosis may be underestimated. By linking the thrombosis to NETs, we suggest markers of NETosis that could aid in revealing cancer in arterial microthrombosis as well as arterial microthrombosis in cancer.
Collapse
|
292
|
The Role of Spleen-Derived Immune Cells in Ischemic Brain Injury. SPRINGER SERIES IN TRANSLATIONAL STROKE RESEARCH 2016. [DOI: 10.1007/978-3-319-32337-4_10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
293
|
Detrimental role of the EP1 prostanoid receptor in blood-brain barrier damage following experimental ischemic stroke. Sci Rep 2015; 5:17956. [PMID: 26648273 PMCID: PMC4673693 DOI: 10.1038/srep17956] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/09/2015] [Indexed: 01/21/2023] Open
Abstract
Cyclooxygenase-2 (COX-2) is activated in response to ischemia and significantly contributes to the neuroinflammatory process. Accumulation of COX-2-derived prostaglandin E2 (PGE2) parallels the substantial increase in stroke-mediated blood-brain barrier (BBB) breakdown. Disruption of the BBB is a serious consequence of ischemic stroke, and is mainly mediated by matrix metalloproteinases (MMPs). This study aimed to investigate the role of PGE2 EP1 receptor in neurovascular injury in stroke. We hypothesized that pharmacological blockade or genetic deletion of EP1 protects against BBB damage and hemorrhagic transformation by decreasing the levels and activity of MMP-3 and MMP-9. We found that post-ischemic treatment with the EP1 antagonist, SC-51089, or EP1 genetic deletion results in a significant reduction in BBB disruption and reduced hemorrhagic transformation in an experimental model of transient focal cerebral ischemia. These neurovascular protective effects of EP1 inactivation are associated with a significant reduction in MMP-9/-3, less peripheral neutrophil infiltration, and a preservation of tight junction proteins (ZO-1 and occludin) composing the BBB. Our study identifies the EP1 signaling pathway as an important link between neuroinflammation and MMP-mediated BBB breakdown in ischemic stroke. Targeting the EP1 receptor could represent a novel approach to diminish the devastating consequences of stroke-induced neurovascular damage.
Collapse
|
294
|
Zhang T, Fang S, Wan C, Kong Q, Wang G, Wang S, Zhang H, Zou H, Sun B, Sun W, Zhang Y, Mu L, Wang J, Wang J, Zhang H, Wang D, Li H. Excess salt exacerbates blood-brain barrier disruption via a p38/MAPK/SGK1-dependent pathway in permanent cerebral ischemia. Sci Rep 2015; 5:16548. [PMID: 26549644 PMCID: PMC4637879 DOI: 10.1038/srep16548] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 10/15/2015] [Indexed: 12/16/2022] Open
Abstract
High salt diet (HSD) is one of the most important risk factors that contribute to many vascular diseases including ischemic stroke. One proposed mechanism underlying the disruption of blood-brain barrier (BBB) mediated by HSD is indirectly through enhancing blood pressure. The direct role of HSD on BBB integrity is unclear. Our purpose is to determine whether and how HSD might be involved in BBB breakdown during ischemia. To test that, we induced model of cerebral ischemia by permanent middle cerebral artery ligation (pMCAL) in either normal diet or HSD fed mice. We observed that HSD significantly enhanced ischemic brain damage which was associated with enhanced BBB disruption, increased leukocytes infiltration and loss of tight junction (TJ) proteins expression without apparently altering blood pressure. Our in vitro experiment also revealed that sodium chloride (NaCl) treatment down-regulated TJ protein expression by endothelial cells and substantially increased BBB permeability during starvation. Inhibition of p38/MAPK/SGK1 pathway eliminated the effect of NaCl on BBB permeability in vitro. In addition, we noticed a positive correlation between urinary sodium levels and ischemic lesion size in stroke patients. Together, our study demonstrates a hypertension-independent role of HSD during ischemia and provides rationale for post cerebral ischemic attack management.
Collapse
Affiliation(s)
- Tongshuai Zhang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Shaohong Fang
- The Key Laboratory of Myocardial Ischemia, The Second Affiliated Hospital of Harbin Medical University, Harbin, China 150081
| | - Cong Wan
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Qingfei Kong
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Guangyou Wang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Shuangshuang Wang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Haoqiang Zhang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Haifeng Zou
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Bo Sun
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Wei Sun
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China 150081
| | - Yao Zhang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Lili Mu
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Jinghua Wang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Jing Wang
- Department of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, China 150081
| | - Haiyu Zhang
- Department of Epidemiology and Biostatistics, Harbin Medical University, Harbin, China 150081
| | - Dandan Wang
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| | - Hulun Li
- Department of Neurobiology, Harbin Medical University, Harbin, China 150081
| |
Collapse
|
295
|
Amantea D, Certo M, Petrelli F, Tassorelli C, Micieli G, Corasaniti MT, Puccetti P, Fallarino F, Bagetta G. Azithromycin protects mice against ischemic stroke injury by promoting macrophage transition towards M2 phenotype. Exp Neurol 2015; 275 Pt 1:116-25. [PMID: 26518285 DOI: 10.1016/j.expneurol.2015.10.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/28/2015] [Accepted: 10/26/2015] [Indexed: 01/18/2023]
Abstract
To develop novel and effective treatments for ischemic stroke, we investigated the neuroprotective effects of the macrolide antibiotic azithromycin in a mouse model system of transient middle cerebral artery occlusion. Intraperitoneal administration of azithromycin significantly reduced blood-brain barrier damage and cerebral infiltration of myeloid cells, including neutrophils and inflammatory macrophages. These effects resulted in a dose-dependent reduction of cerebral ischemic damage, and in a remarkable amelioration of neurological deficits up to 7 days after the insult. Neuroprotection was associated with increased arginase activity in peritoneal exudate cells, which was followed by the detection of Ym1- and arginase I-immunopositive M2 macrophages in the ischemic area at 24-48 h of reperfusion. Pharmacological inhibition of peritoneal arginase activity counteracted azithromycin-induced neuroprotection, pointing to a major role for drug-induced polarization of migratory macrophages towards a protective, non-inflammatory M2 phenotype.
Collapse
Affiliation(s)
- Diana Amantea
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende (CS), Italy.
| | - Michelangelo Certo
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende (CS), Italy
| | - Francesco Petrelli
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende (CS), Italy
| | - Cristina Tassorelli
- C. Mondino National Neurological Institute, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | - Paolo Puccetti
- Department of Experimental Medicine, University of Perugia, Perugia, Italy
| | | | - Giacinto Bagetta
- Section of Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende (CS), Italy
| |
Collapse
|
296
|
Picascia A, Grimaldi V, Iannone C, Soricelli A, Napoli C. Innate and adaptive immune response in stroke: Focus on epigenetic regulation. J Neuroimmunol 2015; 289:111-20. [PMID: 26616880 DOI: 10.1016/j.jneuroim.2015.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/17/2015] [Accepted: 10/20/2015] [Indexed: 12/12/2022]
Abstract
Inflammation and immune response play a pivotal role in the pathophysiology of ischemic stroke giving their contribution to tissue damage and repair. Emerging evidence supports the involvement of epigenetic mechanisms such as methylation, histone modification and miRNAs in the pathogenesis of stroke. Interestingly, epigenetics can influence the molecular events involved in ischemic injury by controlling the switch from pro- to anti-inflammatory response, however, this is still a field to be fully explored. The knowledge of epigenetic processes could to allow for the discovery of more sensitive and specific biomarkers for risk, onset, and progression of disease as well as further novel tools to be used in both primary prevention and therapy of stroke. Indeed, studies performed in vitro and in small animal models seem to suggest a neuroprotective role of HDAC inhibitors (e.g. valproic acid) and antagomir (e.g. anti-miR-181a) in ischemic condition by modulation of both immune and inflammatory pathways. Thus, the clinical implications of altered epigenetic mechanisms for the prevention of stroke are very promising but clinical prospective studies and translational approaches are still warranted.
Collapse
Affiliation(s)
- Antonietta Picascia
- U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Department of Internal Medicine and Specialistics, Azienda Ospedaliera Universitaria (AOU), Second University of Naples, Naples, Italy
| | - Vincenzo Grimaldi
- U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Department of Internal Medicine and Specialistics, Azienda Ospedaliera Universitaria (AOU), Second University of Naples, Naples, Italy.
| | - Carmela Iannone
- U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Department of Internal Medicine and Specialistics, Azienda Ospedaliera Universitaria (AOU), Second University of Naples, Naples, Italy
| | - Andrea Soricelli
- IRCCS Research Institute SDN, Naples, Italy; Department of Studies of Institutions and Territorial Systems, University of Naples Parthenope, Naples, Italy
| | - Claudio Napoli
- U.O.C. Division of Immunohematology, Transfusion Medicine and Transplant Immunology [SIMT], Regional Reference Laboratory of Transplant Immunology [LIT], Department of Internal Medicine and Specialistics, Azienda Ospedaliera Universitaria (AOU), Second University of Naples, Naples, Italy; IRCCS Research Institute SDN, Naples, Italy
| |
Collapse
|
297
|
Herz J, Sabellek P, Lane TE, Gunzer M, Hermann DM, Doeppner TR. Role of Neutrophils in Exacerbation of Brain Injury After Focal Cerebral Ischemia in Hyperlipidemic Mice. Stroke 2015; 46:2916-25. [PMID: 26337969 DOI: 10.1161/strokeaha.115.010620] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 07/16/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Inflammation-related comorbidities contribute to stroke-induced immune responses and brain damage. We previously showed that hyperlipidemia exacerbates ischemic brain injury, which is associated with elevated peripheral and cerebral granulocyte numbers. Herein, we evaluate the contribution of neutrophils to the exacerbation of ischemic brain injury. METHODS Wild-type mice fed with a normal chow and ApoE knockout mice fed with a high cholesterol diet were exposed to middle cerebral artery occlusion. CXCR2 was blocked using the selective antagonist SB225002 (2 mg/kg) or neutralizing CXCR2 antiserum. Neutrophils were depleted using an anti-Ly6G antibody. At 72 hours post ischemia, immunohistochemistry, flow cytometry, and real-time polymerase chain reaction were performed to determine cerebral tissue injury and immunologic changes in the blood, bone marrow, and brain. Functional outcome was assessed by accelerated rota rod and tight rope tests at 4, 7, and 14 days post ischemia. RESULTS CXCR2 antagonization reduced neurological deficits and infarct volumes that were exacerbated in hyperlipidemic ApoE-/- mice. This effect was mimicked by neutrophil depletion. Cerebral neutrophil infiltration and peripheral neutrophilia, which were increased on ischemia in hyperlipidemia, were attenuated by CXCR2 antagonization. This downscaling of neutrophil responses was associated with increased neutrophil apoptosis and reduced levels of CXCR2, inducible nitric oxide synthase, and NADPH oxidase 2 expression on bone marrow neutrophils. CONCLUSIONS Our data demonstrate a role of neutrophils in the exacerbation of ischemic brain injury induced by hyperlipidemia. Accordingly, CXCR2 blockade, which prevents neutrophil recruitment into the brain, might be an effective option for stroke treatment in patients with hyperlipidemia.
Collapse
Affiliation(s)
- Josephine Herz
- From the Department of Neurology (J.H., P.S., D.M.H., T.R.D.), Department of Pediatrics I (J.H.), and Institute of Experimental Immunology and Imaging, University Duisburg-Essen (M.G.), University Hospital Essen, Essen, Germany; and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City (T.E.L.).
| | - Pascal Sabellek
- From the Department of Neurology (J.H., P.S., D.M.H., T.R.D.), Department of Pediatrics I (J.H.), and Institute of Experimental Immunology and Imaging, University Duisburg-Essen (M.G.), University Hospital Essen, Essen, Germany; and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City (T.E.L.)
| | - Thomas E Lane
- From the Department of Neurology (J.H., P.S., D.M.H., T.R.D.), Department of Pediatrics I (J.H.), and Institute of Experimental Immunology and Imaging, University Duisburg-Essen (M.G.), University Hospital Essen, Essen, Germany; and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City (T.E.L.)
| | - Matthias Gunzer
- From the Department of Neurology (J.H., P.S., D.M.H., T.R.D.), Department of Pediatrics I (J.H.), and Institute of Experimental Immunology and Imaging, University Duisburg-Essen (M.G.), University Hospital Essen, Essen, Germany; and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City (T.E.L.)
| | - Dirk M Hermann
- From the Department of Neurology (J.H., P.S., D.M.H., T.R.D.), Department of Pediatrics I (J.H.), and Institute of Experimental Immunology and Imaging, University Duisburg-Essen (M.G.), University Hospital Essen, Essen, Germany; and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City (T.E.L.)
| | - Thorsten R Doeppner
- From the Department of Neurology (J.H., P.S., D.M.H., T.R.D.), Department of Pediatrics I (J.H.), and Institute of Experimental Immunology and Imaging, University Duisburg-Essen (M.G.), University Hospital Essen, Essen, Germany; and Division of Microbiology and Immunology, Department of Pathology, University of Utah School of Medicine, Salt Lake City (T.E.L.)
| |
Collapse
|
298
|
Chang CY, Kao TK, Chen WY, Ou YC, Li JR, Liao SL, Raung SL, Chen CJ. Tetramethylpyrazine inhibits neutrophil activation following permanent cerebral ischemia in rats. Biochem Biophys Res Commun 2015; 463:421-7. [DOI: 10.1016/j.bbrc.2015.05.088] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 05/28/2015] [Indexed: 02/08/2023]
|
299
|
Lourbopoulos A, Ertürk A, Hellal F. Microglia in action: how aging and injury can change the brain's guardians. Front Cell Neurosci 2015; 9:54. [PMID: 25755635 PMCID: PMC4337366 DOI: 10.3389/fncel.2015.00054] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/03/2015] [Indexed: 01/03/2023] Open
Abstract
Neuroinflammation, the inflammatory response in the central nervous system (CNS), is a major determinant of neuronal function and survival during aging and disease progression. Microglia, as the resident tissue-macrophages of the brain, provide constant support to surrounding neurons in healthy brain. Upon any stress signal (such as trauma, ischemia, inflammation) they are one of the first cells to react. Local and/or peripheral signals determine microglia stress response, which can vary within a continuum of states from beneficial to detrimental for neuronal survival, and can be shaped by aging and previous insults. In this review, we discuss the roles of microglia upon an ischemic or traumatic injury, and give our perspective how aging may contribute to microglia behavior in the injured brain. We speculate that a deeper understanding of specific microglia identities will pave the way to develop more potent therapeutics to treat the diseases of aging brain.
Collapse
Affiliation(s)
- Athanasios Lourbopoulos
- Laboratory of Experimental Stroke Research, Institute for Stroke and Dementia Research (ISD), University of Munich Medical School Munich, Germany
| | - Ali Ertürk
- Laboratory of Acute Brain Injury, Institute for Stroke and Dementia Research (ISD), University of Munich Medical School Munich, Germany
| | - Farida Hellal
- Laboratory of Experimental Stroke Research, Institute for Stroke and Dementia Research (ISD), University of Munich Medical School Munich, Germany
| |
Collapse
|