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Kim T, Mehta SL, Morris-Blanco KC, Chokkalla AK, Chelluboina B, Lopez M, Sullivan R, Kim HT, Cook TD, Kim JY, Kim H, Kim C, Vemuganti R. The microRNA miR-7a-5p ameliorates ischemic brain damage by repressing α-synuclein. Sci Signal 2018; 11:eaat4285. [PMID: 30538177 PMCID: PMC7005928 DOI: 10.1126/scisignal.aat4285] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Ischemic stroke, which is caused by a clot that blocks blood flow to the brain, can be severely disabling and sometimes fatal. We previously showed that transient focal ischemia in a rat model induces extensive temporal changes in the expression of cerebral microRNAs, with a sustained decrease in the abundance of miR-7a-5p (miR-7). Here, we evaluated the therapeutic efficacy of a miR-7 mimic oligonucleotide after cerebral ischemia in rodents according to the Stroke Treatment Academic Industry Roundtable (STAIR) criteria. Rodents were injected locally or systemically with miR-7 mimic before or after transient middle cerebral artery occlusion. Decreased miR-7 expression was observed in both young and aged rats of both sexes after cerebral ischemia. Pre- or postischemic treatment with miR-7 mimic decreased the lesion volume in both sexes and ages studied. Furthermore, systemic injection of miR-7 mimic into mice at 30 min (but not 2 hours) after cerebral ischemia substantially decreased the lesion volume and improved motor and cognitive functional recovery with minimal peripheral toxicity. The miR-7 mimic treatment substantially reduced the postischemic induction of α-synuclein (α-Syn), a protein that induces mitochondrial fragmentation, oxidative stress, and autophagy that promote neuronal cell death. Deletion of the gene encoding α-Syn abolished miR-7 mimic-dependent neuroprotection and functional recovery in young male mice. Further analysis confirmed that the transcript encoding α-Syn was bound and repressed by miR-7. Our findings suggest that miR-7 mimics may therapeutically minimize stroke-induced brain damage and disability.
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Affiliation(s)
- TaeHee Kim
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Suresh L Mehta
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
| | | | - Anil K Chokkalla
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
- Cellular and Molecular Pathology Graduate Program, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Bharath Chelluboina
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Mary Lopez
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
- Cellular and Molecular Pathology Graduate Program, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Ruth Sullivan
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Hung Tae Kim
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Thomas D Cook
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, USA
| | - Joo Yong Kim
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - HwuiWon Kim
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Chanul Kim
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA.
- Cellular and Molecular Pathology Graduate Program, University of Wisconsin-Madison, Madison, WI 53792, USA
- Williams S. Middleton Veterans Administration Hospital Madison, Madison, WI 53705, USA
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Ma S, Zhao H, Ji X, Luo Y. Peripheral to central: Organ interactions in stroke pathophysiology. Exp Neurol 2015; 272:41-9. [PMID: 26054885 DOI: 10.1016/j.expneurol.2015.05.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/20/2015] [Accepted: 05/23/2015] [Indexed: 12/27/2022]
Abstract
Stroke is associated with a high risk of disability and mortality, and with the exception of recombinant tissue-type plasminogen activator for acute stroke, most treatments have proven ineffective. Clinical translation of promising experimental therapeutics is limited by inadequate stroke models and a lack of understanding of the mechanisms underlying acute stroke and how they affect outcome. Bidirectional communication between the ischemic brain and peripheral immune system modulates stroke progression and tissue repair, while epidemiological studies have provided evidence of an association between organ dysfunction and stroke risk. This crosstalk can determine the fate of stroke patients and must be taken into consideration when investigating the pathophysiological mechanisms and therapeutic options for stroke. This review summarizes the current evidence for interactions between the brain and other organs in stroke pathophysiology in basic and clinic studies, and discusses the role of these interactions in the progression and outcome of stroke and how they can direct the development of more effective treatment strategies.
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Affiliation(s)
- Shubei Ma
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Haiping Zhao
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China.
| | - Yumin Luo
- Cerebrovascular Diseases Research Institute, Xuanwu Hospital of Capital Medical University, Beijing 100053, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100053, China.
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Hameed AM, Lam VWT, Pleass HC. Significant elevations of serum lipase not caused by pancreatitis: a systematic review. HPB (Oxford) 2015; 17:99-112. [PMID: 24888393 PMCID: PMC4299384 DOI: 10.1111/hpb.12277] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 04/17/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many authors advocate lipase as the preferred serological test for the diagnosis of pancreatitis and a cut-off level of three or more times the upper limit of normal (ULN) is often quoted. The literature contains no systematic review that explores alternative causes of a lipase level over three times as high as the ULN. Such a review was therefore the objective of this study. METHODS The EMBASE and MEDLINE databases (1985 to August 2013) were searched for all eligible articles. Predetermined data were extracted and independently analysed by two reviewers. RESULTS In total, data from 58 studies were included in the final analysis. The following causes other than pancreatitis of lipase levels exceeding three times the ULN were found: reduced clearance of lipase caused by renal impairment or macrolipase formation; other hepatobiliary, gastroduodenal, intestinal and neoplastic causes; critical illness, including neurosurgical pathology; alternative pancreatic diagnoses, such as non-pathological pancreatic hyperenzymaemia, and miscellaneous causes such as diabetes, drugs and infections. CONCLUSIONS A series of differential diagnoses for significant serum lipase elevations (i.e. exceeding three times the ULN) has been provided by this study. Clinicians should utilize this knowledge in the interpretation and management of patients who have lipase levels over three times as high as the ULN, remaining vigilant for an alternative diagnosis to pancreatitis. The medical officer should be aware of the possibility of incorrect diagnosis in the asymptomatic patient.
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Affiliation(s)
- Ahmer M Hameed
- Department of Surgery, Westmead HospitalWestmead, NSW, Australia,Correspondence, Ahmer M. Hameed, Westmead Hospital, Cnr Darcy Road and Hawkesbury Road, Westmead, NSW 2145, Australia. Tel: + 61 2 9845 5555. Fax: + 61 2 989 374 40. E-mail: ,
| | - Vincent W T Lam
- Department of Surgery, Westmead HospitalWestmead, NSW, Australia,Discipline of Surgery, University of SydneySydney, NSW, Australia
| | - Henry C Pleass
- Department of Surgery, Westmead HospitalWestmead, NSW, Australia,Discipline of Surgery, University of SydneySydney, NSW, Australia
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Mitra B, Fitzgerald M, Raoofi M, Tan GA, Spencer JC, Atkin C. Serum lipase for assessment of pancreatic trauma. Eur J Trauma Emerg Surg 2013; 40:309-13. [PMID: 26816065 DOI: 10.1007/s00068-013-0341-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/30/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Pancreatic enzymes are routinely measured during reception of trauma patients to assess for pancreatic injury despite conflicting evidence on their utility. The aim of this study was to investigate the utility of routine initial serum lipase measurement for the diagnosis of acute pancreatic trauma. MATERIALS AND METHODS Lipase measurements were introduced as part of the trauma pathology panel and requested on all patients who presented to an adult major trauma service and met trauma call-out criteria. Clinical records of these patients were extracted from the trauma registry and retrospectively reviewed. The performance of an initial serum lipase level measured on presentation to detect pancreatic trauma was determined. RESULTS There were 2,580 patients included in the study, with 17 patients diagnosed with pancreatic trauma. An elevated lipase was recorded in 390 patients. Statistically significant associations were observed for elevated lipase in patients with pancreatic trauma, head injury, acute alcohol ingestion and massive blood transfusion. As a test for pancreatic trauma, an abnormal serum lipase result had a specificity of 85.3 % (95 % CI 83.8-86.6), sensitivity of 76.5 % (95 % CI 49.8-92.2), positive predictive value of 3.3 % (95 % CI 1.8-5.8) and negative predictive value of 99.8 % (95 % CI 99.4-99.9). Higher cut-offs of serum lipase did not result in better performance. CONCLUSIONS A normal serum lipase result can be a useful adjunct to exclude pancreatic injury. A positive lipase result, regardless of the cut-off used, was not reliably associated with pancreatic trauma, and should not be used to guide further assessment.
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Affiliation(s)
- B Mitra
- Emergency and Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. .,National Trauma Research Institute, Melbourne, Australia.
| | - M Fitzgerald
- Emergency and Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia.,National Trauma Research Institute, Melbourne, Australia.,Trauma Service, The Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - M Raoofi
- Trauma Service, The Alfred Hospital, Melbourne, Australia
| | - G A Tan
- Emergency and Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - J C Spencer
- Emergency and Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia
| | - C Atkin
- Trauma Service, The Alfred Hospital, Melbourne, Australia
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Abstract
PURPOSE OF REVIEW To learn about the prevalence, pathophysiology, and treatment of exocrine pancreatic involvement in critically ill patients. RECENT FINDINGS Elevations in the levels of pancreatic enzymes are observed in up to 80% of intensive care patients. Most of these patients do not develop clinically relevant pancreatitis. However, elevations in enzyme levels do represent pancreatic damage with a risk of complications. Different factors have been discussed, which may contribute to pancreatic damage in critically ill patients. These include splanchnic hypoperfusion during shock or major surgery, bacterial translocation, elevated triglyceride levels, development of biliary sluge, and biliary pancreatitis, as well as several drugs. Imaging procedures and inflammatory markers help to identify relevant disease. Several therapeutic options have been discussed recently with a focus on early enteral nutrition. SUMMARY Pancreatic damage is frequently observed in critically ill patients. Although in most of these patients, this is without major clinical consequences, some patients develop relevant pancreatitis, which contributes to morbidity and mortality. Risk factors have been identified and therapeutic strategies have been changed.
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Affiliation(s)
- Philip D Hardt
- University Hospital Giessen and Marburg, Giessen Site, Third Medical Department, Giessen, Germany.
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Denz C, Siegel L, Lehmann KJ, Dagorn JC, Fiedler F. Is hyperlipasemia in critically ill patients of clinical importance? An observational CT study. Intensive Care Med 2007; 33:1633-6. [PMID: 17497124 DOI: 10.1007/s00134-007-0668-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 04/12/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess morphological alterations of the pancreas by contrast-enhanced computed tomography (cCT) and subclinical cellular damage of the pancreas by measuring pancreatitis-associated protein (PAP) in critically ill patients without prior pancreatic disorder who presented with raised serum lipase levels. DESIGN Prospective, observational study SETTING Mixed surgical/neurosurgical intensive care unit of a German university hospital. PATIENTS One hundred and thirty consecutive critically ill patients without prior damage or disease of the pancreas and an expected length of stay of more than 5 days. INTERVENTIONS Daily serum lipase measurements and daily serum PAP measurements. Contrast-enhanced upper abdominal cCT study in patients with triple increase of serum lipase. MEASUREMENTS AND RESULTS Thirty-eight patients showed raised serum lipase levels and qualified for the cCT scan study. In 20 patients cCT scans were performed. Morphological alterations of the pancreas were found in 7 out these 20 patients while serum PAP levels were raised in all patients. CONCLUSION Hyperlipasemia is a common finding in critically ill patients without prior pancreatic disorder. While elevated serum PAP levels indicate pancreatic cellular stress morphological alterations of the pancreas are rare and of little clinical importance.
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Affiliation(s)
- Christof Denz
- University of Heidelberg, Clinic of Anesthesiology and Intensive Care Medicine, University Hospital Mannheim, Faculty of Clinical Medicine Mannheim, 68167 Mannheim, Germany.
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Abstract
Publications are reviewed to identify factors related to donor care that may optimize the function of pancreatic tissue (whole or segmental organ or islet cells) after transplantation. Short cold ischemia time, avoidance of hypotension, and treatment of donor hyperglycemia appear to be beneficial, although additional properly designed studies are needed to verify those findings.
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Affiliation(s)
- David J Powner
- Vivian L. Smith Center for Neurologic Research, University of Texas Health Science Center at Houston, TX, USA
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