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Devalckeneer A, Lu T, Bourgeois P, Maurage CA, Loiez C, Grolez GP, Morales O, Menovsky T, Aboukaïs R, Delhem N. Oral bacterial genic expression detection in aneurysm wall of a French population sample - preliminary monocentric study. Neurosurg Rev 2024; 47:325. [PMID: 39001998 DOI: 10.1007/s10143-024-02548-0] [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: 05/14/2024] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
INTRODUCTION The etiology of brain aneurysms remains poorly understood. Finnish research suggests that oral bacteria might contribute to the development and rupture of brain aneurysms. Previous studies by our team have not confirmed these findings, likely due to methodological differences. We aimed to replicate the Finnish study with a French population, using the same primers and comparing the results to internal controls. METHODS We used RT-qPCR to retrospectively analyze the expression of oral bacterial genes in eight patients. During surgical procedures, four tissue types were consistently sampled from each patient: the aneurysmal wall, the superficial temporal artery (STA), the middle meningeal artery (MMA), and the dura mater (DM). Results were expressed as fold differences employing the 2-∆∆Ct method, and statistical analyses were performed accordingly. RESULTS Our cohort included eight patients, evenly split into ruptured and unruptured groups. The sex distribution was balanced (4 females, 4 males). We observed DNA expression from oral bacteria in all sampled tissues; however, there were no significant differences between the ruptured and unruptured groups. CONCLUSION We detected oral bacterial gene expression in the aneurysmal wall, STA, MMA, and DM in a sample of French patients. Although limited by the small sample size, our results suggest a potential role for bacterial involvement in vascular invasiveness related to bacteremia. These findings do not definitively link oral bacteria to the pathogenesis of aneurysm development and rupture.
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Affiliation(s)
- Antoine Devalckeneer
- Department of Neurosurgery, Lille University Hospital, Rue E. Laine, Hôpital Nord, Lille cedex, 59037, France.
- Lille University, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France.
| | - Tuong Lu
- Department of Neurosurgery, Lille University Hospital, Rue E. Laine, Hôpital Nord, Lille cedex, 59037, France
| | - Philippe Bourgeois
- Department of Neurosurgery, Lille University Hospital, Rue E. Laine, Hôpital Nord, Lille cedex, 59037, France
| | | | - Caroline Loiez
- Department of Microbiology, Lille University Hospital, Hôpital Nord, France
| | - Guillaume Paul Grolez
- Lille University, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France
| | - Olivier Morales
- Lille University, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France
- University Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille, F-59000, France
| | - Thomas Menovsky
- Department of Microbiology, Lille University Hospital, Hôpital Nord, France
- Department of Neurosurgery, Antwerpen University Hospital, Antwerp, Belgium
| | - Rabih Aboukaïs
- Department of Neurosurgery, Lille University Hospital, Rue E. Laine, Hôpital Nord, Lille cedex, 59037, France
- Lille University, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France
| | - Nadira Delhem
- Lille University, INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for Oncology, Lille, F-59000, France
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Abdullah AN, Al-Habib OAM, Mohammed SA. Salivary microbial shifting in hypertensive patients with chronic periodontitis after scaling and root surface debridement. Mol Biol Rep 2024; 51:758. [PMID: 38874801 DOI: 10.1007/s11033-024-09687-z] [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: 03/25/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES This study aimed to evaluate the impact of scaling and root surface debridement (SRP) on salivary bacterial counts and systolic and diastolic blood pressure in hypertensive patients with chronic periodontitis, with a focus on clinical significance. METHODS An observational trial included 24 chronic periodontitis patients, eleven of them were hypertensive patients. Non-surgical periodontal treatment was administered to all patients, with clinical parameters including gingival index (GI), plaque index (PI), and probing pocket depth (PPD) recorded. Saliva samples were collected before and after SRP to quantify total bacterial counts and specific bacterial counts. RESULTS Two months following SRP, PI and PPD in every subject under study demonstrated good responses. In hypertension patients, the salivary bacterial count was significantly higher following SRP (P = 0.0221). The incidence of Porphyromonas gingivalis in hypertension patients significantly decreased after treatment (P = 0.0386). Despite this, there was no discernible decrease in blood pressure following treatment. CONCLUSIONS SRP alone was ineffective in reducing overall bacterial counts, but P. gingivalis levels responded favorably. Regular periodontal assessment is crucial for hypertensive individuals to mitigate cardiovascular risk. CLINICAL SIGNIFICANCE Periodontal therapy in hypertensive patients may improve oral health but might not significantly impact blood pressure. Regular periodontal evaluation is essential for managing cardiovascular risk in hypertension.
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Affiliation(s)
- Ahed Najimelddin Abdullah
- Department of Dental Basic Sciences, College of Dentistry, University of Duhok, Duhok, Kurdistan Region, Iraq
| | | | - Saeed Ali Mohammed
- Periodontics Department, College of Dentistry, University of Duhok, Duhok, Kurdistan Region, Iraq
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Chen Y, Huang JH, Kang YB, Yao ZJ, Song JH. Bioinformatics analysis revealed the potential crosstalk genes and molecular mechanisms between intracranial aneurysms and periodontitis. BMC Med Genomics 2024; 17:114. [PMID: 38685029 PMCID: PMC11059758 DOI: 10.1186/s12920-024-01864-0] [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: 09/28/2023] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES The risk of intracranial aneurysms (IAs) development and rupture is significantly higher in patients with periodontitis (PD), suggesting an association between the two. However, the specific mechanisms of association between these two diseases have not been fully investigated. MATERIALS AND METHODS In this study, we downloaded IAs and PD data from the Gene Expression Omnibus. Differentially expressed genes (DEGs) were identified, and functional enrichment analysis was performed. The protein-protein interaction (PPI) network and weighted gene co-expression network analysis (WGCNA) was performed to identified key modules and key crosstalk genes. In addition, the immune cell landscape was assessed and the correlation of key crosstalk genes with each immune cell was calculated. Finally, transcription factors (TFs) regulating key crosstalk genes were explored. RESULTS 127 overlapping DEGs were identified and functional enrichment analysis highlighted the important role of immune reflection in the pathogenesis of IAs and PD. We identified ITGAX and COL4A2 as key crosstalk genes. In addition, the expression of multiple immune cells was significantly elevated in PDs and IAs compared to controls, and both key crosstalk genes were significantly negatively associated with Macrophages M2. Finally, GATA2 was identified as a potential key transcription factor (TF), which regulates two key crosstalk gene. CONCLUSIONS The present study identifies key crosstalk genes and TF in PD and IAs, providing new insights for further study of the co-pathogenesis of PD and IAs from an immune and inflammatory perspective. Also, this is the first study to report the above findings.
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Affiliation(s)
- Yao Chen
- Department of Neurosurgery, Affiliated Hospital of Putian University, Putian, Fujian Province, China
| | - Jian-Huang Huang
- Department of Neurosurgery, Affiliated Hospital of Putian University, Putian, Fujian Province, China.
| | - Yuan-Bao Kang
- Department of Neurosurgery, Affiliated Hospital of Putian University, Putian, Fujian Province, China
| | - Zheng-Jian Yao
- Department of Neurosurgery, Affiliated Hospital of Putian University, Putian, Fujian Province, China
| | - Jian-Hua Song
- Department of Neurosurgery, Affiliated Hospital of Putian University, Putian, Fujian Province, China
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Leira Y, Vivancos J, Diz P, Martín Á, Carasol M, Frank A. The association between periodontitis and cerebrovascular disease, and dementia. Scientific report of the working group of the Spanish Society of Periodontology and the Spanish Society of Neurology. Neurologia 2024; 39:302-311. [PMID: 38224833 DOI: 10.1016/j.nrleng.2024.01.002] [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: 09/23/2023] [Accepted: 11/03/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE This article reviews the scientific evidence on the relationship between periodontitis and neurological disease, and particularly cerebrovascular disease and dementia. We also issue a series of recommendations regarding the prevention and management of periodontitis and these neurological diseases at dental clinics and neurology units. DEVELOPMENT In response to a series of questions proposed by the SEPA-SEN working group, a literature search was performed, with no restrictions on study design, to identify the most relevant articles on the association between periodontitis and cerebrovascular disease and dementia from the perspectives of epidemiology, treatment, and the biological mechanisms involved in these associations. CONCLUSIONS Periodontitis increases the risk of ischaemic stroke and Alzheimer dementia. Recurrent bacterial infections and increased low-grade systemic inflammation seem to be possible biological mechanisms underlying this association. Limited evidence suggests that various oral health interventions can reduce the future risk of cerebrovascular disease and dementia.
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Affiliation(s)
- Y Leira
- Unidad de Periodoncia, Facultad de Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Grupo de Investigación en Neuroenvejecimiento, Laboratorio de Investigación en Neurociencias Clínicas (LINC), Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain.
| | - J Vivancos
- Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain; Servicio de Neurología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - P Diz
- Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain; Unidad de Pacientes Especiales, Facultad de Odontología, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Á Martín
- Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain; Servicio de Neurología, Hospital Universitario de La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Carasol
- Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain; Grupo de Investigación en Etiología y Terapéutica de Enfermedades Periodontales y Periimplantarias, Universidad Complutense de Madrid, Madrid, Spain
| | - A Frank
- Grupo de Trabajo de la Sociedad Española de Periodoncia (SEPA) y Sociedad Española de Neurología (SEN), Madrid, Spain; Servicio de Neurología, Hospital Universitario de La Paz, Universidad Autónoma de Madrid, Madrid, Spain
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Joerger AK, Albrecht C, Rothhammer V, Neuhaus K, Wagner A, Meyer B, Wostrack M. The Role of Gut and Oral Microbiota in the Formation and Rupture of Intracranial Aneurysms: A Literature Review. Int J Mol Sci 2023; 25:48. [PMID: 38203219 PMCID: PMC10779325 DOI: 10.3390/ijms25010048] [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: 11/12/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
In recent years, there has been a growing interest in the role of the microbiome in cardiovascular and cerebrovascular diseases. Emerging research highlights the potential role of the microbiome in intracranial aneurysm (IA) formation and rupture, particularly in relation to inflammation. In this review, we aim to explore the existing literature regarding the influence of the gut and oral microbiome on IA formation and rupture. In the first section, we provide background information, elucidating the connection between inflammation and aneurysm formation and presenting potential mechanisms of gut-brain interaction. Additionally, we explain the methods for microbiome analysis. The second section reviews existing studies that investigate the relationship between the gut and oral microbiome and IAs. We conclude with a prospective overview, highlighting the extent to which the microbiome is already therapeutically utilized in other fields. Furthermore, we address the challenges associated with the context of IAs that still need to be overcome.
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Affiliation(s)
- Ann-Kathrin Joerger
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany; (A.-K.J.); (B.M.)
| | - Carolin Albrecht
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany; (A.-K.J.); (B.M.)
| | - Veit Rothhammer
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen Nuremberg, 91054 Erlangen, Germany;
| | - Klaus Neuhaus
- Core Facility Microbiom, ZIEL Institute for Food & Health, Technical University of Munich, 85354 Freising, Germany;
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany; (A.-K.J.); (B.M.)
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany; (A.-K.J.); (B.M.)
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany; (A.-K.J.); (B.M.)
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Wu Y, Zhao Z, Kang S, Zhang L, Lv F. Potential application of peripheral blood biomarkers in intracranial aneurysms. Front Neurol 2023; 14:1273341. [PMID: 37928138 PMCID: PMC10620808 DOI: 10.3389/fneur.2023.1273341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Intracranial aneurysm (IA) counts are increasing yearly, with a high mortality and disability after rupture. Current diagnosis and treatment rely on costly equipment, lacking effective indicators for progression prediction and specific drugs for treatment. Recently, peripheral blood biomarkers, as common clinical test samples, reflecting the immune and inflammatory state of the body in real-time, have shown promise in providing additional information for risk stratification and treatment in IA patients, which may improve their outcomes after aneurysm rupture through anti-inflammatory therapy. Therefore, this paper reviewed the progress of potential biomarkers of IAs, including inflammatory blood indicators, cytokines, and blood lipids, aiming to aid individual management and therapy of aneurysms in clinical practices.
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Affiliation(s)
- Yangying Wu
- Department of Radiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ziya Zhao
- Department of Radiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Shaolei Kang
- Department of Radiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
- The Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lijuan Zhang
- Department of Radiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Rabelo NN, Yoshikawa MH, Telles JPM, Coelho G, de Souza CS, de Oliveira NPG, Mendoza TRT, Braz-Silva PH, Boechat AL, Teixeira MJ, Figueiredo EG. Torque Teno virus DNA is found in the intracranial aneurysm wall-Is there a causative role? Front Med (Lausanne) 2023; 10:1047310. [PMID: 36744144 PMCID: PMC9894622 DOI: 10.3389/fmed.2023.1047310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Objective Torque Teno virus (TTV) is a recently discovered virus with high prevalence worldwide, that has been associated with vascular diseases. The aim of this study is to investigate the prevalence of TTV molecular DNA in the intracranial aneurysm (IA) artery walls. Method Samples of IA walls were collected after microsurgical clipping from 35 patients with IA (22 ruptured/13 unruptured cases). The samples were submitted to molecular DNA extraction using the EasyMag automatized extractor and performed with Qiagen DNA extraction Minikit 250. The samples underwent PCR examination with primers for β-globin as internal control using the Nanodrop ® 2000 spectrophotometer. A quantitative (real-time) PCR with TTV-specific primers was performed. Clinical and radiological data of patients included was collected. Results TTV was detected in 15 (42.85%) cases, being 10 (45.4%) ruptured and 5 (38.4%) unruptured (p = 0.732) lesions. Multiple IAs accounted for 14 (40%) cases. Five cases (17.2%) had TTV+ and multiple aneurysms (p = 0.73). Association between presence of virus and aneurysm rupture was not statistically significant (p = 0.96). Conclusion This study demonstrated a relatively high prevalence of viral DNA in the walls of IAs. This is the first study to identify the presence of TTV DNA in IA's samples, which was found more often in ruptured lesions. This is an exploratory study, therefore, larger studies are required to clarify the relationships between inflammation, viral infection, IA formation and rupture.
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Affiliation(s)
- Nícollas Nunes Rabelo
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil,*Correspondence: Nícollas Nunes Rabelo,
| | | | | | - Giselle Coelho
- Department of Neurosurgery, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Paulo Henrique Braz-Silva
- Laboratory of Virology (LIM-52), University of São Paulo, São Paulo, SP, Brazil,Department of Stomatology, University of São Paulo, São Paulo, SP, Brazil
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Hallikainen J, Pessi T, Vehkalahti M, Suominen AL, Pyysalo M, Frösen J. Unlike severe periodontitis, caries does not associate with intracranial aneurysms or aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2023; 165:169-175. [PMID: 36416942 PMCID: PMC9840572 DOI: 10.1007/s00701-022-05406-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Periodontal diseases and caries are common oral diseases that predispose to tooth loss if untreated. In this study, we investigated whether loss of teeth or caries associate with intracranial aneurysm (IA) pathology similar to periodontal diseases. METHODS A total of 166 patients with either IA or aneurysmal subarachnoid hemorrhage (aSAH) underwent oral examination in Kuopio University Hospital and Tampere University Hospital. Findings were compared to geographically matched controls acquired from cross-sectional Health2000 survey. This study consisted of three sequential steps. First, we compared the number of missing teeth and prevalence of caries in IA and aSAH patients and geographically matched control population, second step was a multivariate analysis including other risk factors, and third step was a 13-year follow-up of the Health2000 survey participants with missing teeth or caries at baseline. RESULTS Loss of teeth did not significantly differ between IA patients and controls. In logistic regression model adjusted for known risk factors and demographic data, 1-4 caries lesions (OR: 0.40 95%Cl 0.2-0.9, p = 0.031) was associated with lack of IAs, while age (OR: 1.03 95%Cl 1.01.1 p = 0.024), current smoking (OR: 2.7 95%Cl 1.4-5.1, p = 0.003), and severe periodontitis (OR: 5.99 95%Cl 2.6-13.8, p < 0.001) associated to IA formation. In the cox-regression, severe periodontitis at baseline increased the risk of aSAH (HR: 14.3, 95%Cl 1.5-135.9, p = 0.020) during a 13-year follow-up, while caries or missing teeth did not. CONCLUSION Unlike severe periodontitis, caries does not increase the risk of IAs and aSAHs. However, cariogenic bacteria may participate to IA pathology by disseminating to circulation via inflamed gingival tissue.
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Affiliation(s)
- Joona Hallikainen
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.
- Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.
- Oral and Maxillofacial Diseases, Central Finland Central Hospital, Helsinki, Finland.
| | - Tanja Pessi
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Miira Vehkalahti
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Anna Liisa Suominen
- Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Mikko Pyysalo
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
- Oral Health Services, City of Tampere, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
- Neurosurgery, Tampere University Hospital, Tampere, Finland
- Department of Neurosurgery, Tampere University, Tampere, Finland
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Porphyromonas gingivalis-Derived Lipopolysaccharide Promotes Glioma Cell Proliferation and Migration via Activating Akt Signaling Pathways. Cells 2022; 11:cells11244088. [PMID: 36552854 PMCID: PMC9777333 DOI: 10.3390/cells11244088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/11/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Periodontitis is significantly associated with the risk of cancers in the lung and the digestive system. Emerging evidence shows a plausible link between periodontitis and several types of brain diseases. However, the association between periodontal infection and glioma remains unclear. In the cultured GL261 glioma cells, P. gingivalis lipopolysaccharide (LPS) significantly promoted cell proliferation at concentrations ranging from 10 to 1000 ng/mL. It promoted cell migration at a higher concentration (100 and 1000 ng/mL). Additionally, exposure to 100 ng/mL P. gingivalis LPS induced a significant increase in the expression of TNF-α, TGF-β, MMP2, and MMP9, as well as the phosphorylation level of Akt at Ser473. These changes induced by P. gingivalis LPS were significantly antagonized by the Akt inhibitor. Furthermore, a total of 48 patients with brain tumors were enrolled to investigate their periodontal status before receiving tumor management. Poor periodontal status [probing depth (PD) ≥ 6 mm and attachment loss (AL) >5 mm] was found in 42.9% (9/21) of patients with glioma, which was significantly higher than that in patients with benign tumors and the relevant data in the 4th National Oral Health Survey in China. The glioma patients with both AL > 5 mm and PD ≥ 6 mm had a higher ki-67 labeling index than those with AL ≤ 5 mm or PD < 6 mm. These findings support the association between periodontal infection and glioma progression.
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Van Der Veken J, Huang H, Lai LT. Aneurysmal subarachnoid haemorrhage in Indigenous and non-Indigenous Australians: A retrospective study assessing patient characteristics and outcome. J Clin Neurosci 2022; 101:144-149. [PMID: 35597062 DOI: 10.1016/j.jocn.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Smoking and hypertension are prevalent among Indigenous Australians (Aboriginal and Torres Strait Islanders). We investigated if these risk factors suggest a greater rate of aneurysmal subarachnoid haemorrhage in Indigenous Australians (IA) compared to non-IA. MATERIALS AND METHODS A retrospective cross-sectional study was performed on data retrieved from the Nationwide Hospital Morbidity Database for all aSAH cases in Australia between 2012 and 2018. Patient characteristics, radiological findings, aneurysm characteristics, treatment characteristics and discharge outcomes were assessed. Crude and age-adjusted incidences, trends of aSAH and case fatality rate over time were calculated. RESULTS A total of 12,286 patients were included (285 IA, 12,001 non-IA). Indigenous aSAH patients were significantly younger than non-IA, with 89.8 percent of IA younger than 65 years old (p < 0.001). Crude annual incidences were similar between the 2 cohorts, however age-adjusted incidence shows a RR = 1.4 at 45-59 years in IA patients, compared with their non-IA counterparts. 30-day mortality was similar between the two groups, at 25.3 and 26.9% for IA and non-IA groups, respectively. CONCLUSION This 10 year nationwide retrospective study highlights a disparity between the crude and age-adjusted incidence of aSAH in IA compared to non-IA.
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Affiliation(s)
- Jorn Van Der Veken
- Department of Neurosurgery, Flinders Medical Centre, Flinders Dr, Bedford Park 5042, Australia.
| | - Helen Huang
- Department of Neurosurgery, Monash Health, Level 5, Block D, 246 Clayton Road, Clayton, Victoria 3168, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Level 5, Block D, 246 Clayton Road, Clayton, Victoria 3168, Australia; Department of Surgery, Monash Medical Centre, Level 5, Block E, 246 Clayton Road, Clayton, Victoria 3168, Australia
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Morel S, Bijlenga P, Kwak BR. Intracranial aneurysm wall (in)stability-current state of knowledge and clinical perspectives. Neurosurg Rev 2021; 45:1233-1253. [PMID: 34743248 PMCID: PMC8976821 DOI: 10.1007/s10143-021-01672-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/15/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022]
Abstract
Intracranial aneurysm (IA), a local outpouching of cerebral arteries, is present in 3 to 5% of the population. Once formed, an IA can remain stable, grow, or rupture. Determining the evolution of IAs is almost impossible. Rupture of an IA leads to subarachnoid hemorrhage and affects mostly young people with heavy consequences in terms of death, disabilities, and socioeconomic burden. Even if the large majority of IAs will never rupture, it is critical to determine which IA might be at risk of rupture. IA (in)stability is dependent on the composition of its wall and on its ability to repair. The biology of the IA wall is complex and not completely understood. Nowadays, the risk of rupture of an IA is estimated in clinics by using scores based on the characteristics of the IA itself and on the anamnesis of the patient. Classification and prediction using these scores are not satisfying and decisions whether a patient should be observed or treated need to be better informed by more reliable biomarkers. In the present review, the effects of known risk factors for rupture, as well as the effects of biomechanical forces on the IA wall composition, will be summarized. Moreover, recent advances in high-resolution vessel wall magnetic resonance imaging, which are promising tools to discriminate between stable and unstable IAs, will be described. Common data elements recently defined to improve IA disease knowledge and disease management will be presented. Finally, recent findings in genetics will be introduced and future directions in the field of IA will be exposed.
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Affiliation(s)
- Sandrine Morel
- Department of Pathology and Immunology, Faculty of Medicine, Centre Medical Universitaire, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland. .,Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Philippe Bijlenga
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Brenda R Kwak
- Department of Pathology and Immunology, Faculty of Medicine, Centre Medical Universitaire, University of Geneva, Rue Michel-Servet 1, 1211, Geneva, Switzerland
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Association of Periodontal Disease with the Occurrence of Unruptured Cerebral Aneurysm among Adults in Korea: A Nationwide Population-Based Cohort Study TRANSLATE with x EnglishArabicHebrewPolishBulgarianHindiPortugueseCatalanHmong DawRomanianChinese SimplifiedHungarianRussianChinese TraditionalIndonesianSlovakCzechItalianSlovenianDanishJapaneseSpanishDutchKlingonSwedishEnglishKoreanThaiEstonianLatvianTurkishFinnishLithuanianUkrainianFrenchMalayUrduGermanMalteseVietnameseGreekNorwegianWelshHaitian CreolePersian// TRANSLATE with COPY THE URL BELOW Back EMBED THE SNIPPET BELOW IN YOUR SITE Enable collaborative features and customize widget: Bing Webmaster PortalBack//. MEDICINA-LITHUANIA 2021; 57:medicina57090910. [PMID: 34577833 PMCID: PMC8465273 DOI: 10.3390/medicina57090910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/22/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Cerebral aneurysms can cause disability or death during rupture, but information on the etiology of cerebral aneurysms is currently lacking. Periodontal disease causes both systemic inflammation and local inflammation of the oral cavity. Systemic inflammation is a major cause of cerebral aneurysms. The aim of our study was to determine whether the presence of periodontal disease is related to the occurrence of unruptured cerebral aneurysms in a nationwide population-based cohort. Materials and Methods: We analyzed data on demographics, previous medical history, and laboratory test results of 209,620 participants from the Korean National Health Insurance System-Health Screening Cohort. The presence of periodontal disease and oral hygiene parameters, including the number of lost teeth, tooth brushing frequency per day, dental visits for any reason, and expert teeth scaling, were investigated. The occurrences of unruptured cerebral aneurysms (I67.1) were defined according to the International Statistical Classification of Diseases Related Health Problems-10. Results: The mean age of the participants was 53.7 ± 8.7 years, and 59.4% were male. Periodontal disease was found in 20.9% of the participants. A total of 2160 (1.0%) cases of unruptured cerebral aneurysms developed after 10.3 years of median follow up. In multivariate analysis, the presence of periodontal disease was significantly associated with an increased risk of unruptured cerebral aneurysms (hazard ratio: 1.21, 95% confidence interval: 1.09–1.34, p < 0.001). Conclusion: The presence of periodontal disease could be associated with the occurrence of unruptured cerebral aneurysms. It should be noted that when periodontal diseases are present, the risk of aneurysms is increased in the future.
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Hallikainen J, Pyysalo M, Keränen S, Kellokoski J, Koivisto T, Suominen AL, Pussinen P, Pessi T, Frösen J. Systemic immune response against the oral pathogens Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans is associated with the formation and rupture of intracranial aneurysms. Eur J Neurol 2021; 28:3089-3099. [PMID: 34145948 DOI: 10.1111/ene.14986] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Periodontal infections are associated with the formation and rupture of intracranial aneurysms (IAs). This study investigated the role of two key periodontal pathogens, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. METHODS Immunoglobulin A (IgA) and IgG antibodies against P. gingivalis and A. actinomycetemcomitans were measured with enzyme immune assay from the serum of 227 IA patients, of whom 64 also underwent clinical oral examination. As a control group, 1096 participants in a cross-sectional health survey, Health 2000, underwent serological studies and oral examination. Logistic regression was used for multivariate analysis. Immunohistochemistry was performed to demonstrate bacteria-derived epitopes in the IA wall. RESULTS Widespread gingivitis and severe periodontitis were more common in IA patients than in controls (2× and 1.5×, respectively). IgA antibodies against P. gingivalis and A. actinomycetemcomitans were 1.5× and 3-3.4× higher, respectively, in both unruptured and ruptured IA patients compared to controls (p ≤ 0.003). IgG antibodies against P. gingivalis were 1.8× lower in unruptured IA patients (p < 0.001). In multivariate analysis, high IgA, but low IgG, antibody levels against P. gingivalis (odds ratio [OR] = 1.4, 95% confidence interval [Cl] = 1.1-1.8 and OR = 1.5, 95% Cl = 1.1-1.9; OR = 0.6, 95% Cl = 0.4-0.7 and OR = 0.5, 95% Cl = 0.4-0.7) and against A. actinomycetemcomitans (OR = 2.3, 95% Cl = 1.7-3.1 and OR = 2.1, 95% Cl = 1.5-2.9; OR = 0.6, 95% Cl = 0.4-0.8 and OR = 0.6, 95% Cl = 0.5-0.9) were associated with the risk of IA formation and rupture. Immunohistochemistry showed P. gingivalis epitopes in the IA wall. CONCLUSIONS Exposure to the periodontal pathogens P. gingivalis and A. actinomycetemcomitans and dysfunctional acquired immune response against them may increase the risk of IA formation and IA rupture.
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Affiliation(s)
- Joona Hallikainen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Mikko Pyysalo
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Sara Keränen
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.,A. I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Jari Kellokoski
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pirkko Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tanja Pessi
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.,Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
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Liu K, Sun J, Shao L, He H, Liu Q, Li Y, Ge H. Correlation of periodontal diseases with intracranial aneurysm formation: novel predictive indicators. Chin Neurosurg J 2021; 7:31. [PMID: 34092261 PMCID: PMC8182916 DOI: 10.1186/s41016-021-00249-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 05/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background We investigated whether periodontal diseases, specifically, periodontitis and gingivitis, could be risk factors of the incidence of intracranial aneurysms (IAs). Methods We performed a case–control study to compare the differences in the periodontal disease parameters of 281 cases that were divided into the IAs group and non-IAs group. All cases underwent complete radiographic examination for IAs and examination for periodontal health. Results Comparing with those in the non-IAs group, the cases in the IAs group were older (53.95 ± 8.56 vs 47.79 ± 12.33, p < 0.001) and had a higher incidence of hypertension (76 vs 34, p = 0.006). Univariate logistic regression analysis revealed that age (> 50 years) and hypertension were predictive risk factors of aneurysm formation (odds ratio [OR] 1.047, 95% confidence interval [95% CI] 1.022–1.073, p < 0.001 and OR 2.047, 95% CI 1.232–3.401, p = 0.006). In addition, univariate and multivariate logistic regression analyses showed that the parameters of periodontal diseases, including gingival index, plaque index, clinical attachment loss, and alveolar bone loss, were significantly associated with the occurrence of IAs (all p < 0.05). For further statistical investigation, the parameters of periodontal diseases were divided into four layers based on the quartered data. Poorer periodontal health condition (especially gingival index > 1.1 and plaque index > 1.5) had the correlation with IAs formation (p = 0.007 and p < 0.001). Conclusion Severe gingivitis or periodontitis, combining with hypertension, is significantly associated with the incidence of IAs.
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Affiliation(s)
- Keyun Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai, Beijing, 100070, People's Republic of China
| | - Jia Sun
- Department of Stomatology, Tianjin Stomatological Hospital, Hospital of Stomatology, Nankai University, Tianjin, 300041, People's Republic of China
| | - Lingling Shao
- Department of Tuberculosis, Beijing Tuberculosis and Thoracic Tumor Institute, Beijing Chest Hospital, Capital Medical University, Beijing, 101149, People's Republic of China
| | - Hongwei He
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai, Beijing, 100070, People's Republic of China
| | - Qinglin Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai, Beijing, 100070, People's Republic of China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai, Beijing, 100070, People's Republic of China.
| | - Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 119, West Road of South Fourth Ring, Fengtai, Beijing, 100070, People's Republic of China.
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Hujoel PP, Kato T, Hujoel IA, Hujoel MLA. Bleeding tendency and ascorbic acid requirements: systematic review and meta-analysis of clinical trials. Nutr Rev 2021; 79:964-975. [PMID: 33517432 DOI: 10.1093/nutrit/nuaa115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
CONTEXT The World Health Organization set the recommended daily vitamin C intake, henceforth referred to as ascorbic acid (AA), on the basis of scurvy prevention. Double-blind AA depletion-repletion studies suggest that this recommended AA dose may be too low to prevent microvascular fragility. OBJECTIVES (1) To conduct a systematic review and meta-analysis of controlled clinical trials on whether AA supplementation leads to a reduced gingival bleeding tendency, a manifestation of microvascular fragility; and (2) to relate AA plasma levels to retinal hemorrhaging, another manifestation of microvascular fragility. DATA SOURCES Data were reviewed from 15 trials conducted in 6 countries with 1140 predominantly healthy participants with measures of gingival bleeding tendency, and from the National Health and Nutrition Examination Survey (NHANES) III of 8210 US residents with measures of retinal hemorrhaging. RESULTS In clinical trials, AA supplementation reduced gingival bleeding tendency when estimated baseline AA plasma levels were < 28 μmol/L (standardized mean difference [SMD], -0.83; 95%CI, -1.16 to -0.49; P < 0.002). Supplementation with AA did not unequivocally reduce gingival bleeding tendency when baseline estimated AA plasma levels were >48 μmol/L or unknown (respective standardized mean differences: -0.23, 95%CI, -0.45 to -0.01, P < 0.05; and -0.56; 95%CI: -1.19 to 0.06, P < 0.08). In NHANES III, prevalence of both retinal hemorrhaging and gingival bleeding tendency increased when AA plasma levels were within the range that protects against scurvy (11-28 μmol/L; respective prevalence ratios adjusted for age and sex: 1.47; 95%CI: 1.22-1.77; and 1.64; 95%CI: 1.32-2.03; P < 0.001 for both). CONCLUSION Consistent evidence from controlled clinical trials indicates that setting human AA requirements based on scurvy prevention leads to AA plasma levels that may be too low to prevent an increased gingival bleeding tendency. Gingival bleeding tendency and retinal hemorrhaging coincide with low AA plasma levels and thus may be reflective of a systemic microvascular pathology that is reversible with an increased daily AA intake.
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Affiliation(s)
- Philippe P Hujoel
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.,Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Tomotaka Kato
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Isabel A Hujoel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Margaux L A Hujoel
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Frösen J, Cebral J, Robertson AM, Aoki T. Flow-induced, inflammation-mediated arterial wall remodeling in the formation and progression of intracranial aneurysms. Neurosurg Focus 2020; 47:E21. [PMID: 31261126 DOI: 10.3171/2019.5.focus19234] [Citation(s) in RCA: 147] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/01/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Unruptured intracranial aneurysms (UIAs) are relatively common lesions that may cause devastating intracranial hemorrhage, thus producing considerable suffering and anxiety in those affected by the disease or an increased likelihood of developing it. Advances in the knowledge of the pathobiology behind intracranial aneurysm (IA) formation, progression, and rupture have led to preclinical testing of drug therapies that would prevent IA formation or progression. In parallel, novel biologically based diagnostic tools to estimate rupture risk are approaching clinical use. Arterial wall remodeling, triggered by flow and intramural stresses and mediated by inflammation, is relevant to both. METHODS This review discusses the basis of flow-driven vessel remodeling and translates that knowledge to the observations made on the mechanisms of IA initiation and progression on studies using animal models of induced IA formation, study of human IA tissue samples, and study of patient-derived computational fluid dynamics models. RESULTS Blood flow conditions leading to high wall shear stress (WSS) activate proinflammatory signaling in endothelial cells that recruits macrophages to the site exposed to high WSS, especially through macrophage chemoattractant protein 1 (MCP1). This macrophage infiltration leads to protease expression, which disrupts the internal elastic lamina and collagen matrix, leading to focal outward bulging of the wall and IA initiation. For the IA to grow, collagen remodeling and smooth muscle cell (SMC) proliferation are essential, because the fact that collagen does not distend much prevents the passive dilation of a focal weakness to a sizable IA. Chronic macrophage infiltration of the IA wall promotes this SMC-mediated growth and is a potential target for drug therapy. Once the IA wall grows, it is subjected to changes in wall tension and flow conditions as a result of the change in geometry and has to remodel accordingly to avoid rupture. Flow affects this remodeling process. CONCLUSIONS Flow triggers an inflammatory reaction that predisposes the arterial wall to IA initiation and growth and affects the associated remodeling of the UIA wall. This chronic inflammation is a putative target for drug therapy that would stabilize UIAs or prevent UIA formation. Moreover, once this coupling between IA wall remodeling and flow is understood, data from patient-specific flow models can be gathered as part of the diagnostic workup and utilized to improve risk assessment for UIA initiation, progression, and eventual rupture.
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Affiliation(s)
- Juhana Frösen
- 1Department of Neurosurgery, and.,2Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
| | - Juan Cebral
- 3Bioengineering Department, Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - Anne M Robertson
- 4Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Tomohiro Aoki
- 5Department of Molecular Pharmacology, Research Institute, and.,6Core Research for Evolutional Science and Technology (CREST) from Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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17
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Salimi Ashkezari SF, Detmer FJ, Mut F, Chung BJ, Yu AK, Stapleton CJ, See AP, Amin-Hanjani S, Charbel FT, Rezai Jahromi B, Niemelä M, Frösen J, Zhou J, Maiti S, Robertson AM, Cebral JR. Blebs in intracranial aneurysms: prevalence and general characteristics. J Neurointerv Surg 2020; 13:226-230. [PMID: 32680877 PMCID: PMC8294207 DOI: 10.1136/neurintsurg-2020-016274] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Blebs are rupture risk factors in intracranial aneurysms (IAs), but their prevalence, distribution, and associations with clinical factors as well as their causes and effects on aneurysm vulnerability remain unclear. METHODS A total of 122 blebs in 270 IAs selected for surgery were studied using patient-specific vascular reconstructions from 3D angiographic images. Bleb geometry, location on the aneurysm, and frequency of occurrence in aneurysms at different locations were analyzed. Associations between gender, age, smoking, hypertension, hormone therapy, dental infection, and presence of blebs were investigated. RESULTS Of all aneurysms with blebs, 77% had a single bleb and 23% had multiple blebs. Only 6% of blebs were at the neck, while 46% were in the body and 48% in the dome. Aneurysms with blebs were larger (p<0.0001), more elongated (p=0.0002), and with wider necks than aneurysms without blebs. Bleb presence was associated with dental infection (p=0.0426) and negatively associated with hormone therapy (p=0.0426) in women. Anterior and posterior communicating arteries had larger percentages of aneurysms with blebs than internal carotid arteries. Patients with a history of hypertension tended to have a larger percentage of aneurysms with blebs. However, these trends did not reach significance in this sample. CONCLUSIONS Blebs are common in IAs, and most aneurysms harboring blebs have a single bleb. Blebs in the aneurysm neck are rare, but they are equally common in the body and dome. The presence of blebs in IAs was associated with dental infection, and negatively associated with hormone replacement therapy.
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Affiliation(s)
| | - Felicitas J Detmer
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, Montclair, New Jersey, USA
| | - Alexander K Yu
- Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - Alfred P See
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Behnam Rezai Jahromi
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Juhana Frösen
- Department of Neurosurgery, University of Tampere, Tampere, Pirkanmaa, Finland.,Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Ji Zhou
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Spandan Maiti
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA.,Department of Mechanical Engineering, George Mason University, Fairfax, Virginia, USA
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Periodontitis and Hypertension: Is the Association Causal? High Blood Press Cardiovasc Prev 2020; 27:281-289. [PMID: 32500479 DOI: 10.1007/s40292-020-00392-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/30/2020] [Indexed: 02/07/2023] Open
Abstract
High blood pressure (BP) and periodontitis are two highly prevalent conditions worldwide with a significant impact on cardiovascular disease (CVD) complications. Poor periodontal health is associated with increased prevalence of hypertension and may have an influence on BP control. Risk factors such as older age, male gender, non-Caucasian ethnicity, smoking, overweight/obesity, diabetes, low socioeconomic status, and poor education have been considered the common denominators underpinning this relationship. However, recent evidence indicates that the association between periodontitis and hypertension is independent of common risk factors and may in fact be causal in nature. Low-grade systemic inflammation and redox imbalance, in particular, represent the major underlying mechanisms in this relationship. Neutrophil dysfunction, imbalance in T cell subtypes, oral-gut dysbiosis, hyperexpression of proinflammatory genes, and increased sympathetic outflow are some of the pathogenetic events involved. In addition, novel findings indicate that common genetic bases might shape the immune profile towards this clinical phenotype, offering a rationale for potential therapeutic and prevention strategies of public health interest. This review summarizes recent advances, knowledge gaps and possible future directions in the field.
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Jabbarli R, Rauschenbach L, Dinger TF, Darkwah Oppong M, Rodemerk J, Pierscianek D, Dammann P, Junker A, Sure U, Wrede KH. In the wall lies the truth: a systematic review of diagnostic markers in intracranial aneurysms. Brain Pathol 2020; 30:437-445. [PMID: 32068920 PMCID: PMC8017992 DOI: 10.1111/bpa.12828] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/20/2020] [Accepted: 02/10/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Despite recent advances in molecular biology and genetics, the development of intracranial aneurysms (IA) is still poorly understood. Elucidation of the processes occurring in the IA wall is essential for a better understanding of IA pathophysiology. We sought to analyze the current evidence from histological, molecular and genetic studies of IA. METHODS We systematically searched PubMed, Scopus, Web of Science and Cochrane Library for articles published before Mar 1, 2019 reporting on different diagnostic markers in human IA specimens. Expression of the markers in IA wall (vs. healthy arterial wall) and association with the rupture status were analyzed. The quality of the included studies and the level of the evidence for the markers were incorporated into the final data assessment. RESULTS We included 123 studies reporting on analyses of 3476 IA (median 19 IA/study) published between 1966 and 2018. Based on microscopic, biochemical, genetic and biomechanical analyses, data on 358 diagnostic targets in the IA wall were collected. We developed a scale to distribute the diagnostic markers according to their specificity for IA or healthy arterial wall, as well as for ruptured or unruptured IA. We identified different functional pathways, which might reflect the intrinsic and extrinsic processes underlying IA pathophysiology. CONCLUSIONS Multiple histological and molecular markers and the related functional pathways contributing to the development of IA might present promising targets for future therapeutic interventions. Because of small numbers of IA samples in each study, 89% of the analyzed diagnostic markers presented with the lowest level of evidence. This underlines the need for the initiation of a multi-centric prospective histological IA register for pooled data analysis.
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Affiliation(s)
- Ramazan Jabbarli
- Department of NeurosurgeryUniversity Hospital of EssenEssenGermany
| | | | | | | | - Jan Rodemerk
- Department of NeurosurgeryUniversity Hospital of EssenEssenGermany
| | | | - Philipp Dammann
- Department of NeurosurgeryUniversity Hospital of EssenEssenGermany
| | - Andreas Junker
- Clinic for NeuropathologyUniversity Hospital of EssenEssenGermany
| | - Ulrich Sure
- Department of NeurosurgeryUniversity Hospital of EssenEssenGermany
| | - Karsten H. Wrede
- Department of NeurosurgeryUniversity Hospital of EssenEssenGermany
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Role of oral pathogens in the pathogenesis of intracranial aneurysm: review of existing evidence and potential mechanisms. Neurosurg Rev 2020; 44:239-247. [PMID: 32034564 PMCID: PMC7850994 DOI: 10.1007/s10143-020-01253-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/12/2020] [Accepted: 01/27/2020] [Indexed: 12/13/2022]
Abstract
Degeneration of intracranial aneurysm wall is under active research and recent studies indicate an increased risk of rupture of intracranial aneurysm among patients with periodontal diseases. In addition, oral bacterial DNA has been identified from wall samples of ruptured and unruptured aneurysms. These novel findings led us to evaluate if oral diseases could predispose to pathological changes seen on intracranial aneurysm walls eventually leading to subarachnoid hemorrhage. The aim of this review is to consider mechanisms on the relationship between periodontitis and aneurysm rupture, focusing on recent evidence.
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Hashimoto T, Sato H, Shikata F, Lawton MT. Response by Hashimoto et al to Letter Regarding Article "Potential Influences of Gut Microbiota on the Formation of Intracranial Aneurysm". Hypertension 2019; 74:e2-e3. [PMID: 31055953 PMCID: PMC6953982 DOI: 10.1161/hypertensionaha.119.12980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Tomoki Hashimoto
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, AZ
| | - Hiroki Sato
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, AZ
| | - Fumiaki Shikata
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, AZ
| | - Michael T. Lawton
- Barrow Aneurysm and AVM Research Center, Barrow Neurological Institute, Phoenix, AZ
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