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Acosta I, Hofer M, Hilton-Jones D, Squier W, Brady S. Treatment resistance in inclusion body myositis: the role of mast cells. Neuromuscul Disord 2024; 41:20-23. [PMID: 38865916 DOI: 10.1016/j.nmd.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/29/2024] [Accepted: 05/02/2024] [Indexed: 06/14/2024]
Abstract
Inclusion body myositis is the commonest acquired myopathy in those over 50 years of age. Although it is classified as an idiopathic inflammatory myopathy and the most frequent finding on muscle biopsy in inclusion body myositis is an endomysial inflammatory infiltrate, it is clinically distinct from other myositis, including a lack of response to immunosuppressive medication. Neurogenic changes are commonly reported in inclusion body myositis and inflammatory changes are observed in muscle following neurogenic injury. The objective of our study was to explore whether neurogenic inflammation plays a role in the pathogenesis of inclusion body myositis, possibly explaining its resistance to immunosuppression. The number of mast cells and presence of neuropeptides, substance P and calcitonin gene-related peptide, were assessed in 48 cases of inclusion body myositis, 11 cases of steroid responsive myositis, two cases of focal myositis associated with neurogenic injury, and ten normal controls. The number of mast cells in inclusion body myositis focal and myositis associated to neurogenic injury were significantly greater than that observed in steroid responsive myositis. Our findings suggest that neurogenic inflammation mediated through mast cells may play a role in the pathogenesis of inclusion body myositis, and focal myositis associated to neurogenic injury, and thus, explain in some part its lack of response to immunosuppressive treatments.
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Affiliation(s)
- I Acosta
- Neuropathology Department, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford OX3 9DU. United Kingdom; Translational neurology and neurophysiology laboratory (NODO lab), Advance clinical research centre (CICA). School of Medicine, Universidad de Chile, Providencia 7500787, Santiago Chile; Neurology and Psychiatry Department, Clínica Alemana Santiago, Vitacura, Santiago 7650568, Santiago Chile.
| | - M Hofer
- Neuropathology Department, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford OX3 9DU. United Kingdom
| | - D Hilton-Jones
- Oxford Muscle Service, Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford OX3 9DU, United Kingdom
| | - W Squier
- Neuropathology Department, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford OX3 9DU. United Kingdom
| | - S Brady
- Oxford Muscle Service, Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford OX3 9DU, United Kingdom
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2
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Chen Z, Liu P, Xia X, Wang L, Li X. Living on the border of the CNS: Dural immune cells in health and disease. Cell Immunol 2022; 377:104545. [DOI: 10.1016/j.cellimm.2022.104545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/26/2022] [Accepted: 05/09/2022] [Indexed: 12/31/2022]
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3
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Koroleva KS, Svitko SO, Nurmieva DA, Gafurov OS, Buglinina AD, Sitdikova GF. Effects of Nitric Oxide on the Electrical Activity of the Rat Trigeminal Nerve and Mast Cell Morphology. J EVOL BIOCHEM PHYS+ 2022. [DOI: 10.1134/s0022093022030243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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4
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Rosas EP, Paz ST, Costa RF, da Silva AA, da Silva RL, da Silva APF, da Silva SRS, de Medeiros PL, de Freitas MFL, Valença MM. Histomorphometry of mast cells in the convexity of human intracranial dura mater. J Anat 2022; 240:724-734. [PMID: 34816423 PMCID: PMC8930819 DOI: 10.1111/joa.13585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/30/2022] Open
Abstract
Mast cells, known as pro-inflammatory effector cells, are immunocytes present in the meninges and may be involved in the pathophysiology of migraine. This study aims to evaluate the histomorphometric parameters of mast cells located in the convexity of the human intracranial dura mater. For this, samples of intracranial dura mater from eight human fresh cadavers were collected between 8- and 24-h post-mortem. The whole samples were fixed and, subsequently, two fragments of 1.5 cm² each were cut from four different areas of the dura mater convexity, containing a segment of the middle meningeal artery, totaling 64 fragments. After histological processing, the fragments were submitted to microtomy (5 and 10 µm), stained with toluidine blue (0.1%), or immunohistochemically labeled for tryptase, and analyzed using optical microscopy. The following histomorphometric parameters were evaluated: distance from mast cells to vessels, the density of mast cells, and percentage of mast cells with degranulation. Histomorphometric analyzes showed a higher density of mast cells in the vicinity of blood vessels (arterial and venous), with distances around 0-150 µm. A greater number of mast cells was detected near venous vessels in the periosteal layer (17.0 ± 10.1 cells/mm²) than in the meningeal layer (14.1 ± 7.0 cells/mm²) (p < 0.05). Mast cells from the region close to the superior sagittal sinus were found in greater quantity close to the venous vessels (16.7 ± 10.1 cells/mm²) than to the arterial vessels (11.2 ± 7.5 cells/mm²) (p < 0.05). In short, in the convexity of the human intracranial dura mater, mast cells are located close to blood vessels, with a greater number of cells next to the venous vessels of the periosteal layer and in the proximal region of the superior sagittal sinus.
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Affiliation(s)
- Emanuela P. Rosas
- Postgraduate Program in Biology applied to Health (PPGBAS)Keizo Asami Immunopathology Laboratory (LIKA)Federal University of Pernambuco (UFPE)RecifeBrazil
| | | | - Raisa F. Costa
- Postgraduate Program in Biological Sciences (PPGCB)UFPERecifeBrazil
| | | | | | - Ana P. F. da Silva
- Postgraduate Program in Biology applied to Health (PPGBAS)Keizo Asami Immunopathology Laboratory (LIKA)Federal University of Pernambuco (UFPE)RecifeBrazil
| | - Sabrina R. S. da Silva
- Postgraduate Program in Animal Bioscience (PPGBA)Federal Rural University of Pernambuco (UFRPE)RecifeBrazil
| | | | | | - Marcelo M. Valença
- Postgraduate Program in Biology applied to Health (PPGBAS)Keizo Asami Immunopathology Laboratory (LIKA)Federal University of Pernambuco (UFPE)RecifeBrazil
- Postgraduate Program in Biological Sciences (PPGCB)UFPERecifeBrazil
- Neurosurgery UnitFederal University of PernambucoRecifeBrazil
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Nasr IW, Chun Y, Kannan S. Neuroimmune responses in the developing brain following traumatic brain injury. Exp Neurol 2019; 320:112957. [PMID: 31108085 DOI: 10.1016/j.expneurol.2019.112957] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/26/2022]
Abstract
Traumatic brain injury (TBI) is one of the leading causes of both acute and long-term morbidity in the pediatric population, leading to a substantial, long-term socioeconomic burden. Despite the increase in the amount of pre-clinical and clinical research, treatment options for TBI rely heavily on supportive care with very limited targeted interventions that improve the acute and chronic sequelae of TBI. Other than injury prevention, not much can be done to limit the primary injury, which consists of tissue damage and cellular destruction. Secondary injury is the result of the ongoing complex inflammatory pathways that further exacerbate tissue damage, resulting in the devastating chronic outcomes of TBI. On the other hand, some level of inflammation is essential for neuronal regeneration and tissue repair. In this review article we discuss the various stages of the neuroimmune response in the immature, pediatric brain in the context of normal maturation and development of the immune system. The developing brain has unique features that distinguish it from the adult brain, and the immune system plays an integral role in CNS development. Those features could potentially make the developing brain more susceptible to worse outcomes, both acutely and in the long-term. The neuroinflammatory reaction which is triggered by TBI can be described as a highly intricate interaction between the cells of the innate and the adaptive immune systems. The innate immune system is triggered by non-specific danger signals that are released from damaged cells and tissues, which in turn leads to neutrophil infiltration, activation of microglia and astrocytes, complement release, as well as histamine release by mast cells. The adaptive immune response is subsequently activated leading to the more chronic effects of neuroinflammation. We will also discuss current attempts at modulating the TBI-induced neuroinflammatory response. A better understanding of the role of the immune system in normal brain development and how immune function changes with age is crucial for designing therapies to appropriately target the immune responses following TBI in order to enhance repair and plasticity.
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Affiliation(s)
- Isam W Nasr
- Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States of America
| | - Young Chun
- Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States of America
| | - Sujatha Kannan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, United States of America.
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Koyuncu Irmak D, Kilinc E, Tore F. Shared Fate of Meningeal Mast Cells and Sensory Neurons in Migraine. Front Cell Neurosci 2019; 13:136. [PMID: 31024263 PMCID: PMC6460506 DOI: 10.3389/fncel.2019.00136] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/20/2019] [Indexed: 12/24/2022] Open
Abstract
Migraine is a primary headache disorder which has complex neurogenic pathophysiological mechanisms still requiring full elucidation. The sensory nerves and meningeal mast cell couplings in the migraine target tissue are very effective interfaces between the central nervous system and the immune system. These couplings fall into three categories: intimacy, cross-talk and a shared fate. Acting as the immediate call-center of the neuroimmune system, mast cells play fundamental roles in migraine pathophysiology. Considerable evidence shows that neuroinflammation in the meninges is the key element resulting in the sensitization of trigeminal nociceptors. The successive events such as neuropeptide release, vasodilation, plasma protein extravasation, and mast cell degranulation that form the basic characteristics of the inflammation are believed to occur in this persistent pain state. In this regard, mast cells and sensory neurons represent both the target and source of the neuropeptides that play autocrine, paracrine, and neuro-endocrine roles during this inflammatory process. This review intends to contribute to a better understanding of the meningeal mast cell and sensory neuron bi-directional interactions from molecular, cellular, functional points of view. Considering the fact that mast cells play a sine qua non role in expanding the opportunities for targeted new migraine therapies, it is of crucial importance to explore these multi-faceted interactions.
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Affiliation(s)
- Duygu Koyuncu Irmak
- Department of Histology and Embryology, School of Medicine, Biruni University, Istanbul, Turkey
| | - Erkan Kilinc
- Department of Physiology, School of Medicine, Bolu Abant İzzet Baysal University, Bolu, Turkey
| | - Fatma Tore
- Department of Physiology, School of Medicine, Biruni University, Istanbul, Turkey
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Arac A, Grimbaldeston MA, Galli SJ, Bliss TM, Steinberg GK. Meningeal Mast Cells as Key Effectors of Stroke Pathology. Front Cell Neurosci 2019; 13:126. [PMID: 31001088 PMCID: PMC6457367 DOI: 10.3389/fncel.2019.00126] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/13/2019] [Indexed: 01/14/2023] Open
Abstract
Stroke is the leading cause of adult disability in the United States. Because post-stroke inflammation is a critical determinant of damage and recovery after stroke, understanding the interplay between the immune system and the brain after stroke holds much promise for therapeutic intervention. An understudied, but important aspect of this interplay is the role of meninges that surround the brain. All blood vessels travel through the meningeal space before entering the brain parenchyma, making the meninges ideally located to act as an immune gatekeeper for the underlying parenchyma. Emerging evidence suggests that the actions of immune cells resident in the meninges are essential for executing this gatekeeper function. Mast cells (MCs), best known as proinflammatory effector cells, are one of the long-term resident immune cells in the meninges. Here, we discuss recent findings in the literature regarding the role of MCs located in the meningeal space and stroke pathology. We review the latest advances in mouse models to investigate the roles of MCs and MC-derived products in vivo, and the importance of using these mouse models. We examine the concept of the meninges playing a critical role in brain and immune interactions, reevaluate the perspectives on the key effectors of stroke pathology, and discuss the opportunities and challenges for therapeutic development.
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Affiliation(s)
- Ahmet Arac
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Stephen J. Galli
- Department of Pathology, School of Medicine, Stanford University, Stanford, CA, United States
- Department of Microbiology and Immunology, School of Medicine, Stanford University, Stanford, CA, United States
| | - Tonya M. Bliss
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, CA, United States
- Stanford Stroke Center, School of Medicine, Stanford University, Stanford, CA, United States
| | - Gary K. Steinberg
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, CA, United States
- Stanford Stroke Center, School of Medicine, Stanford University, Stanford, CA, United States
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8
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Levy D, Labastida-Ramirez A, MaassenVanDenBrink A. Current understanding of meningeal and cerebral vascular function underlying migraine headache. Cephalalgia 2018; 39:1606-1622. [PMID: 29929378 DOI: 10.1177/0333102418771350] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The exact mechanisms underlying the onset of a migraine attack are not completely understood. It is, however, now well accepted that the onset of the excruciating throbbing headache of migraine is mediated by the activation and increased mechanosensitivity (i.e. sensitization) of trigeminal nociceptive afferents that innervate the cranial meninges and their related large blood vessels. OBJECTIVES To provide a critical summary of current understanding of the role that the cranial meninges, their associated vasculature, and immune cells play in meningeal nociception and the ensuing migraine headache. METHODS We discuss the anatomy of the cranial meninges, their associated vasculature, innervation and immune cell population. We then debate the meningeal neurogenic inflammation hypothesis of migraine and its putative contribution to migraine pain. Finally, we provide insights into potential sources of meningeal inflammation and nociception beyond neurogenic inflammation, and their potential contribution to migraine headache.
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Affiliation(s)
- Dan Levy
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Alejandro Labastida-Ramirez
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Antoinette MaassenVanDenBrink
- Department of Internal Medicine, Division of Vascular Medicine and Pharmacology, Erasmus University Medical Center, Rotterdam, The Netherlands
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9
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Squier W, Mack J, Jansen AC. Infants dying suddenly and unexpectedly share demographic features with infants who die with retinal and dural bleeding: a review of neural mechanisms. Dev Med Child Neurol 2016; 58:1223-1234. [PMID: 27435495 DOI: 10.1111/dmcn.13202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 01/01/2023]
Abstract
The cause of death in infants who die suddenly and unexpectedly (sudden unexpected death in infancy [SUDI]) remains a diagnostic challenge. Some infants have identified diseases (explained SUDI); those without explanation are called sudden infant death syndrome (SIDS). Demographic data indicate subgroups among SUDI and SIDS cases, such as unsafe sleeping and apparent life-threatening events. Infants dying suddenly with retinal and dural bleeding are often classified as abused, but in many there is no evidence of trauma. Demographic features suggest that they may represent a further subgroup of SUDI. This review examines the neuropathological hypotheses to explain SIDS and highlights the interaction of infant oxygen-conserving reflexes with the brainstem networks considered responsible for SIDS. We consider sex- and age-specific vulnerabilities related to dural bleeding and how sensitization of the dural innervation by bleeding may influence these reflexes, potentially leading to collapse or even death after otherwise trivial insults.
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Affiliation(s)
- Waney Squier
- Formerly Department of Neuropathology, Oxford University John Radcliffe Hospital, Oxford, UK
| | - Julie Mack
- Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Anna C Jansen
- Paediatric Neurology Unit, Department of Paediatrics, UZ Brussel, Brussels, Belgium.,Neurogenetics Research Unit, Vrije Universiteit Brussel, Brussels, Belgium
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Aich A, Afrin LB, Gupta K. Mast Cell-Mediated Mechanisms of Nociception. Int J Mol Sci 2015; 16:29069-92. [PMID: 26690128 PMCID: PMC4691098 DOI: 10.3390/ijms161226151] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/28/2015] [Accepted: 12/01/2015] [Indexed: 12/12/2022] Open
Abstract
Mast cells are tissue-resident immune cells that release immuno-modulators, chemo-attractants, vasoactive compounds, neuropeptides and growth factors in response to allergens and pathogens constituting a first line of host defense. The neuroimmune interface of immune cells modulating synaptic responses has been of increasing interest, and mast cells have been proposed as key players in orchestrating inflammation-associated pain pathobiology due to their proximity to both vasculature and nerve fibers. Molecular underpinnings of mast cell-mediated pain can be disease-specific. Understanding such mechanisms is critical for developing disease-specific targeted therapeutics to improve analgesic outcomes. We review molecular mechanisms that may contribute to nociception in a disease-specific manner.
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Affiliation(s)
- Anupam Aich
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Lawrence B Afrin
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Kalpna Gupta
- Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
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Arac A, Grimbaldeston MA, Nepomuceno ARB, Olayiwola O, Pereira MP, Nishiyama Y, Tsykin A, Goodall GJ, Schlecht U, Vogel H, Tsai M, Galli SJ, Bliss TM, Steinberg GK. Evidence that meningeal mast cells can worsen stroke pathology in mice. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 184:2493-504. [PMID: 25134760 DOI: 10.1016/j.ajpath.2014.06.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/27/2014] [Accepted: 06/04/2014] [Indexed: 01/07/2023]
Abstract
Stroke is the leading cause of adult disability and the fourth most common cause of death in the United States. Inflammation is thought to play an important role in stroke pathology, but the factors that promote inflammation in this setting remain to be fully defined. An understudied but important factor is the role of meningeal-located immune cells in modulating brain pathology. Although different immune cells traffic through meningeal vessels en route to the brain, mature mast cells do not circulate but are resident in the meninges. With the use of genetic and cell transfer approaches in mice, we identified evidence that meningeal mast cells can importantly contribute to the key features of stroke pathology, including infiltration of granulocytes and activated macrophages, brain swelling, and infarct size. We also obtained evidence that two mast cell-derived products, interleukin-6 and, to a lesser extent, chemokine (C-C motif) ligand 7, can contribute to stroke pathology. These findings indicate a novel role for mast cells in the meninges, the membranes that envelop the brain, as potential gatekeepers for modulating brain inflammation and pathology after stroke.
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Affiliation(s)
- Ahmet Arac
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, California; Stanford Stroke Center, School of Medicine, Stanford University, Stanford, California; Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California
| | - Michele A Grimbaldeston
- Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California; Division of Human Immunology, Center for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia; School of Molecular & Biomedical Science, University of Adelaide, Adelaide, South Australia, Australia.
| | - Andrew R B Nepomuceno
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, California; Stanford Stroke Center, School of Medicine, Stanford University, Stanford, California; Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California
| | - Oluwatobi Olayiwola
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, California; Stanford Stroke Center, School of Medicine, Stanford University, Stanford, California; Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California
| | - Marta P Pereira
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, California; Stanford Stroke Center, School of Medicine, Stanford University, Stanford, California; Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California; Department of Molecular Biology and Center of Molecular Biology "Severo Ochoa", Universidad Autonoma de Madrid, Madrid, Spain
| | - Yasuhiro Nishiyama
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, California; Stanford Stroke Center, School of Medicine, Stanford University, Stanford, California; Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California
| | - Anna Tsykin
- Division of Human Immunology, Center for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia; School of Molecular & Biomedical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Gregory J Goodall
- Division of Human Immunology, Center for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia; School of Molecular & Biomedical Science, University of Adelaide, Adelaide, South Australia, Australia
| | - Ulrich Schlecht
- Department of Biochemistry, School of Medicine, Stanford University, Stanford, California
| | - Hannes Vogel
- Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California; Department of Pathology, School of Medicine, Stanford University, Stanford, California
| | - Mindy Tsai
- Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California; Department of Pathology, School of Medicine, Stanford University, Stanford, California
| | - Stephen J Galli
- Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California; Department of Pathology, School of Medicine, Stanford University, Stanford, California; Department of Microbiology and Immunology, School of Medicine, Stanford University, Stanford, California.
| | - Tonya M Bliss
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, California; Stanford Stroke Center, School of Medicine, Stanford University, Stanford, California; Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California.
| | - Gary K Steinberg
- Department of Neurosurgery, School of Medicine, Stanford University, Stanford, California; Stanford Stroke Center, School of Medicine, Stanford University, Stanford, California; Stanford Institute for Neuro-Innovation and Translational Neurosciences, School of Medicine, Stanford University, Stanford, California.
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Pedersen SH, Ramachandran R, Amrutkar DV, Petersen S, Olesen J, Jansen-Olesen I. Mechanisms of glyceryl trinitrate provoked mast cell degranulation. Cephalalgia 2015; 35:1287-97. [PMID: 25724914 DOI: 10.1177/0333102415574846] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Migraine patients develop attacks several hours after intravenous infusion of glyceryl trinitrate. Due to the short half-life of nitric oxide, this delayed migraine cannot be caused by a direct action of nitric oxide derived from glyceryl trinitrate. The involvement of meningeal inflammation and dural mast cell degranulation is supported by the effectiveness of prednisolone on glyceryl trinitrate-induced delayed headache. METHODS Using a newly developed rat model mimicking the human glyceryl trinitrate headache model, we have investigated the occurrence of dural mast cell degranulation after a clinically relevant dose of glyceryl trinitrate. RESULTS A 6-fold increase in degranulation was observed starting at 2 hours after glyceryl trinitrate infusion. Interestingly, pre-treatment with the effective anti-migraine substances L-nitro-arginine methyl ester and sumatriptan prevented glyceryl trinitrate-induced mast cell degranulation whereas the calcitonin gene-related peptide-receptor antagonist olcegepant and the substance P receptor antagonist L-733,060 did not affect mast cell degranulation. However, topical application of two different nitric oxide donors did not cause mast cell degranulation ex vivo. CONCLUSIONS Direct application of an exogenous nitric oxide donor on dural mast cells does not cause mast cell degranulation ex vivo. In vivo application of the nitric oxide donor glyceryl trinitrate leads to a prominent level of degranulation via a yet unknown mechanism. This effect can be completely blocked by inhibition of the endogenous nitric oxide production and by 5-HT1B/1D receptor agonists but is unaffected by calcitonin gene-related peptide and substance P receptor antagonists.
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Affiliation(s)
- Sara Hougaard Pedersen
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Glostrup Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Roshni Ramachandran
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Glostrup Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Dipak Vasantrao Amrutkar
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Glostrup Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Steffen Petersen
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Glostrup Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Glostrup Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Inger Jansen-Olesen
- Danish Headache Center, Department of Neurology, Glostrup Research Institute, Glostrup Hospital and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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14
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Mast cells in the human dura: effects of age and dural bleeding. Childs Nerv Syst 2013; 29:1967-8. [PMID: 24013215 PMCID: PMC3821528 DOI: 10.1007/s00381-013-2275-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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15
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Squier W, Mack J, Green A, Aziz T. The pathophysiology of brain swelling associated with subdural hemorrhage: the role of the trigeminovascular system. Childs Nerv Syst 2012; 28:2005-15. [PMID: 22885686 DOI: 10.1007/s00381-012-1870-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 07/18/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This paper reviews the evidence in support of the hypothesis that the trigeminal system mediates brain swelling associated with subdural bleeding. The trigeminovascular system has been extensively studied in migraine; it may play an important but under-recognized role in the response to head trauma. Nerve fibers originating in trigeminal ganglion cells are the primary sensors of head trauma and, through their collateral innervation of the intracranial and dural blood vessels, are capable of inciting a cascade of vascular responses and brain swelling. The extensive trigeminal representation in the brainstem initiates and augments autonomic responses. Blood and tissue injury in the dura incite neurogenic inflammatory responses capable of sensitizing dural nerves and potentiating the response to trauma. DISCUSSION The trigeminal system may provide the anatomo-physiological link between small-volume, thin subdural bleeds and swelling of the underlying brain. This physiology may help to explain the poorly understood phenomena of "second-impact syndrome," the infant response to subdural bleeding (the "big black brain"), as well as post-traumatic subdural effusions. Considerable age-specific differences in the density of dural innervation exist; age-specific responses of this innervation may explain differences in the brain's response to trauma in the young. An understanding of this pathophysiology is crucial to the development of intervention and treatment of these conditions. Antagonists to specific neuropeptides of the trigeminal system modify brain swelling after trauma and should be further explored as potential therapy in brain trauma and subdural bleeding.
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Affiliation(s)
- Waney Squier
- Neuropathology, John Radcliffe Hospital, Oxford, UK.
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Davidson JR, Mack J, Gutnikova A, Varatharaj A, Darby S, Squier W. Developmental changes in human dural innervation. Childs Nerv Syst 2012; 28:665-71. [PMID: 22395537 DOI: 10.1007/s00381-012-1727-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 02/13/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is limited published work on the abundant innervation of the human dura mater, its role and responses to injury in humans. The dura not only provides mechanical support for the brain but may also have other functions, including control of the outflow of venous blood from the brain via the dural sinuses. The trigeminal nerve supplies sensory fibres to the dura as well as the leptomeninges, intracranial blood vessels, face, nose and mouth. Its relatively large size in embryonic life suggests an importance in development; the earliest fetal reflexes, mediated by the trigeminal, are seen by 8 weeks. Trigeminal functions vital to the fetus include the coordination of sucking and swallowing and the protective oxygen-conserving reflexes. Like other parts of the nervous system, the trigeminal undergoes pruning and remodelling throughout development. METHODS We have investigated changes in the innervation of the human dura with age in 27 individuals aged between 31 weeks of gestation and 60 years of postnatal life. Using immunocytochemistry with antibodies to neurofilament, we have found significant changes in the density of dural innervation with age RESULTS The density of innervation increased between 31 and 40 weeks of gestation, peaking at term and decreasing in the subsequent 3 months, remaining low until the sixth decade. CONCLUSIONS Our observations are consistent with animal studies but are, to our knowledge, the first to show age-related changes in the density of innervation in the human dura. They provide new insights into the functions of the human dura during development.
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Affiliation(s)
- J R Davidson
- Department of Neuropathology, John Radcliffe Hospital, Oxford, UK
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