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Reger RM, Meinicke A, Härtig W, Knüpfer M, Thome U, Schob S, Krause M. Changes in CSF Surface Tension in Relation to Surfactant Proteins in Children with Intraventricular Hemorrhage. Brain Sci 2022; 12:brainsci12111440. [PMID: 36358367 PMCID: PMC9688901 DOI: 10.3390/brainsci12111440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/20/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022] Open
Abstract
The regulation of surface tension (ST) by surfactants plays an important role in the human respiratory system but is largely unexplored in brain homeostasis. The aim of this study was to evaluate changes in ST in relation to surfactant proteins (SPs) in children with intraventricular hemorrhage (IVH). CSF samples from 93 patients were analyzed for ST with a force tensiometer and SP-A-D and -G with ELISA assays. Patients belonged to six groups: (i) IVH before primary intervention (PI), (ii) IVH 4−28 days after PI, (iii) IVH 44−357 days after PI, (iv) hydrocephalus, (v) sepsis and (vi) controls. We found indirect correlations and significant differences in ST and SPs (all p < 0.001; except for SP-C, p = 0.007). Post hoc analyses showed significantly decreased ST in IVH patients before PI compared with patients with hydrocephalus, sepsis or controls (p < 0.001), but it increased in IVH patients over time. All SPs were significantly elevated when comparing IVH patients before PI with controls (all p < 0.001; except for SP-C, p = 0.003). Children suffering from IVH displayed an increase in SPs and a decrease in ST as coping mechanisms to preserve CSF flow. The increase in ST over time could serve as prognostic marker for the healing process.
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Affiliation(s)
- Rieka M. Reger
- Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Anton Meinicke
- Paul Flechsig Institute for Brain Research, Leipzig University, 04103 Leipzig, Germany
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, Leipzig University, 04103 Leipzig, Germany
| | - Matthias Knüpfer
- Department of Neonatology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Ulrich Thome
- Department of Neonatology, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Stefan Schob
- Department of Neuroradiology, University Hospital Halle, 06120 Halle (Saale), Germany
| | - Matthias Krause
- Department of Neurosurgery, University Hospital Leipzig, 04103 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-9717500
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Michalski D, Reimann W, Spielvogel E, Mages B, Biedermann B, Barthel H, Nitzsche B, Schob S, Härtig W. Regionally Altered Immunosignals of Surfactant Protein-G, Vascular and Non-Vascular Elements of the Neurovascular Unit after Experimental Focal Cerebral Ischemia in Mice, Rats, and Sheep. Int J Mol Sci 2022; 23:ijms23115875. [PMID: 35682557 PMCID: PMC9180438 DOI: 10.3390/ijms23115875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/14/2022] [Accepted: 05/19/2022] [Indexed: 01/12/2023] Open
Abstract
The surfactant protein-G (SP-G) has recently been discovered in the brain and linked to fluid balance regulations. Stroke is characterized by impaired vessel integrity, promoting water influx and edema formation. The neurovascular unit concept (NVU) has been generated to cover not only ischemic affections of neurons or vessels but also other regionally associated cells. This study provides the first spatio-temporal characterization of SP-G and NVU elements after experimental stroke. Immunofluorescence labeling was applied to explore SP-G, vascular and cellular markers in mice (4, 24, and 72 h of ischemia), rats (24 h of ischemia), and sheep (two weeks of ischemia). Extravasated albumin indicated vascular damage within ischemic areas. Quantifications revealed decreasing SP-G signals in the ischemia-affected neocortex and subcortex. Inverse immunosignals of SP-G and vascular elements existed throughout all models. Despite local associations between SP-G and the vasculature, a definite co-localization was not seen. Along with a decreased SP-G-immunoreactivity in ischemic areas, signals originating from neurons, glial elements, and the extracellular matrix exhibited morphological alterations or changed intensities. Collectively, this study revealed regional alterations of SP-G, vascular, and non-vascular NVU elements after ischemia, and may thus stimulate the discussion about the role of SP-G during stroke.
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Affiliation(s)
- Dominik Michalski
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (W.R.); (E.S.)
- Correspondence: ; Tel.: +49-341-9724339
| | - Willi Reimann
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (W.R.); (E.S.)
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (B.B.); (W.H.)
| | - Emma Spielvogel
- Department of Neurology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany; (W.R.); (E.S.)
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (B.B.); (W.H.)
| | - Bianca Mages
- Institute of Anatomy, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany;
| | - Bernd Biedermann
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (B.B.); (W.H.)
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Stephanstr. 11, 04103 Leipzig, Germany; (H.B.); (B.N.)
| | - Björn Nitzsche
- Department of Nuclear Medicine, University of Leipzig, Stephanstr. 11, 04103 Leipzig, Germany; (H.B.); (B.N.)
- Institute of Anatomy, Histology, and Embryology, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 43, 04103 Leipzig, Germany
| | - Stefan Schob
- Department of Neuroradiology, University of Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany;
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (B.B.); (W.H.)
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Meinicke A, Härtig W, Winter K, Puchta J, Mages B, Michalski D, Emmer A, Otto M, Hoffmann KT, Reimann W, Krause M, Schob S. Surfactant Protein-G in Wildtype and 3xTg-AD Mice: Localization in the Forebrain, Age-Dependent Hippocampal Dot-like Deposits and Brain Content. Biomolecules 2022; 12:biom12010096. [PMID: 35053244 PMCID: PMC8773979 DOI: 10.3390/biom12010096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
The classic surfactant proteins (SPs) A, B, C, and D were discovered in the lungs, where they contribute to host defense and regulate the alveolar surface tension during breathing. Their additional importance for brain physiology was discovered decades later. SP-G, a novel amphiphilic SP, was then identified in the lungs and is mostly linked to inflammation. In the brain, it is also present and significantly elevated after hemorrhage in premature infants and in distinct conditions affecting the cerebrospinal fluid circulation of adults. However, current knowledge on SP-G-expression is limited to ependymal cells and some neurons in the subventricular and superficial cortex. Therefore, we primarily focused on the distribution of SP-G-immunoreactivity (ir) and its spatial relationships with components of the neurovascular unit in murine forebrains. Triple fluorescence labeling elucidated SP-G-co-expressing neurons in the habenula, infundibulum, and hypothalamus. Exploring whether SP-G might play a role in Alzheimer’s disease (AD), 3xTg-AD mice were investigated and displayed age-dependent hippocampal deposits of β-amyloid and hyperphosphorylated tau separately from clustered, SP-G-containing dots with additional Reelin-ir—which was used as established marker for disease progression in this specific context. Semi-quantification of those dots, together with immunoassay-based quantification of intra- and extracellular SP-G, revealed a significant elevation in old 3xTg mice when compared to age-matched wildtype animals. This suggests a role of SP-G for the pathophysiology of AD, but a confirmation with human samples is required.
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Affiliation(s)
- Anton Meinicke
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (A.M.); (W.H.); (J.P.); (W.R.)
- Institute of Neuroradiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (A.M.); (W.H.); (J.P.); (W.R.)
| | - Karsten Winter
- Institute of Anatomy, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany; (K.W.); (B.M.)
| | - Joana Puchta
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (A.M.); (W.H.); (J.P.); (W.R.)
- Institute of Neuroradiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Bianca Mages
- Institute of Anatomy, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany; (K.W.); (B.M.)
| | - Dominik Michalski
- Department of Neurology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Alexander Emmer
- Department of Neurology, University Hospital Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (A.E.); (M.O.)
| | - Markus Otto
- Department of Neurology, University Hospital Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany; (A.E.); (M.O.)
| | - Karl-Titus Hoffmann
- Institute of Neuroradiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Willi Reimann
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr. 19, 04103 Leipzig, Germany; (A.M.); (W.H.); (J.P.); (W.R.)
- Institute of Neuroradiology, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Matthias Krause
- Department of Neurosurgery, University Hospital Leipzig, Liebigstr. 20, 04103 Leipzig, Germany;
| | - Stefan Schob
- Department of Neuroradiology, Clinic and Policlinic of Radiology, University Hospital Halle, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
- Correspondence: ; Tel.: +49-345-557-2432
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Schob S, Puchta J, Winter K, Michalski D, Mages B, Martens H, Emmer A, Hoffmann KT, Gaunitz F, Meinicke A, Krause M, Härtig W. Surfactant protein C is associated with perineuronal nets and shows age-dependent changes of brain content and hippocampal deposits in wildtype and 3xTg mice. J Chem Neuroanat 2021; 118:102036. [PMID: 34626771 DOI: 10.1016/j.jchemneu.2021.102036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/24/2021] [Accepted: 09/24/2021] [Indexed: 01/15/2023]
Abstract
Surfactant protein C (SP-C) modulates cerebrospinal fluid (CSF) rheology. During ageing, its declining levels are accompanied by an increased burden of white matter lesions. Pulmonary SP-C intermediates harbouring the BRICHOS-domain prevent protein misfolding in the lungs. Thus, cerebral SP-C intermediates may counteract cerebral β-amyloidosis, a hallmark of Alzheimer's disease (AD). However, data on the molecular neuroanatomy of SP-C and its alterations in wildtype and triple transgenic (3xTg) mice, featuring essential elements of AD-neuropathology, are lacking. Therefore, this study investigated SP-C-containing structures in murine forebrains and their spatial relationships with vascular, glial and neuronal components of the neurovascular unit. Fluorescence labelling demonstrated neuronal SP-C in the medial habenula, the indusium griseum and the hippocampus. Glial counterstaining elucidated astrocytes in the corpus callosum co-expressing SP-C and S100β. Notably, perineuronal nets were associated with SP-C in the nucleus reticularis thalami, the lateral hypothalamus and the retrosplenial cortex. In the hippocampus of aged 3xTg mice, an increased number of dot-like depositions containing SP-C and Reelin, but devoid of BRICHOS-immunoreactivity were observed apart from AD-like lesions. Wildtype and 3xTg mice revealed an age-dependent increase of such deposits markedly pronounced in about 24-month-old 3xTg mice. SP-C levels of the intracellular and extracellular compartments in each group revealed an inverse correlation of SP-C and Reelin, with reduced SP-C and increased Reelin in an age-dependent fashion especially in 3xTg mice. Taken together, extracellular SP-C, as modulator of glymphatic clearance and potential ligand of PNs, declines in 3xTg mice, which show an accumulation of extracellular Reelin depositions during ageing.
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Affiliation(s)
- Stefan Schob
- Department of Neuroradiology, Clinic and Policlinic of Radiology, University Hospital Halle, Ernst-Grube-Str. 40, 06120 Halle/Saale, Germany.
| | - Joana Puchta
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr.19, 04103 Leipzig, Germany; Institute of Neuroradiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Karsten Winter
- Institute for Anatomy, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany
| | - Dominik Michalski
- Department of Neurology, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany
| | - Bianca Mages
- Institute for Anatomy, University of Leipzig, Liebigstr. 13, 04103 Leipzig, Germany
| | - Henrik Martens
- Synaptic Systems GmbH, Rudolf-Wissell-Str. 28a, 37079 Göttingen, Germany
| | - Alexander Emmer
- Department of Neurology, Martin Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle/Saale, Germany
| | - Karl-Titus Hoffmann
- Institute of Neuroradiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Frank Gaunitz
- Department of Neurosurgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Anton Meinicke
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr.19, 04103 Leipzig, Germany; Institute of Neuroradiology, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Matthias Krause
- Department of Neurosurgery, University of Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, Liebigstr.19, 04103 Leipzig, Germany
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Liang X, Peng J, Chen D, Tang L, Liu A, Fu Z, Shi L, Wang K, Shao C. Identification of novel hub genes and lncRNAs related to the prognosis and progression of pancreatic cancer by microarray and integrated bioinformatics analysis. Gland Surg 2021; 10:1104-1117. [PMID: 33842254 PMCID: PMC8033078 DOI: 10.21037/gs-21-151] [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: 01/27/2021] [Accepted: 03/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pancreatic cancer (PC) is one of the most invasive and metastatic neoplasms among the fatal malignancies of the digestive system. Abnormal expression of genes and long non-coding RNAs (lncRNAs) are reportedly linked to multiple cancers. However, the lncRNA-mRNA expression profiles and their molecular mechanisms in PC progression are poorly known. This study aimed to map the hub genes and lncRNAs which might play core roles in the development of PC. METHODS This study used microarray expression analysis to screen for both differentially expressed genes (DEGs) and differentially expressed lncRNAs (DElncRNAs) between PC and matched adjacent non-tumor (AN) tissues. In order to clarify the functional classification of DEGs, we conducted GO and KEGG pathway enrichment analyses via the Enrichr database. LncRNA-mRNA co-expressed networks were also constructed to explore the probable core regulating DEGs and DElncRNAs. Subsequently, the hub genes and lncRNAs were validated via the ONCOMINE and GEPIA databases and the co-expressed networks. RESULTS By analyzing an mRNA-lncRNA microarray, we identified 943 mRNAs and 1,138 lncRNAs differentially expressed in PC tumors compared with the matched AN tissues. GO analysis confirmed that both up-regulated and down-regulated DEGs were enriched in multiple terms. The KEGG pathways enrichment analyses revealed that DEGs were mostly enriched in the focal adhesion and glutathione metabolism pathways, amongst others. Co-expressed networks were established to reveal the differential interactions between DEGs and DElncRNAs, and to indicate the core regulatory factors located at the core nodes of the co-expressed networks. The expression levels of potential core-regulating DEGs were validated by the GEPIA and ONCOMINE databases, and the relationship between overall survival and tumor stage and the potential core-regulating DEGs was analyzed using the GEPIA database. As a result, five genes and sixteen lncRNAs were finally considered as the hub transcripts in PC. CONCLUSIONS This study identified DEGs and DElncRNAs between PC tumors and matched AN tissues, and these transcripts were connected with malignant phenotypes in PC through different BPs and signaling pathways. Furthermore, five hub genes and sixteen lncRNAs were identified, which are expected to represent candidate diagnostic biomarkers or potential therapeutic targets for PC.
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Affiliation(s)
- Xing Liang
- Department of Pancreatic-biliary Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Junfeng Peng
- Department of Pancreatic-biliary Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Danlei Chen
- Department of Pancreatic-biliary Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Liang Tang
- Department of Pancreatic-biliary Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Anan Liu
- Department of Pancreatic-biliary Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhiping Fu
- Department of Pancreatic-biliary Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ligang Shi
- Department of Pancreatic-biliary Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Keqi Wang
- Department of Gastroenterology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chenghao Shao
- Department of Pancreatic-biliary Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Lolansen SD, Rostgaard N, Oernbo EK, Juhler M, Simonsen AH, MacAulay N. Inflammatory Markers in Cerebrospinal Fluid from Patients with Hydrocephalus: A Systematic Literature Review. DISEASE MARKERS 2021; 2021:8834822. [PMID: 33613789 PMCID: PMC7875647 DOI: 10.1155/2021/8834822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this systematic review was to evaluate existing literature on inflammatory markers in CSF from patients with hydrocephalus and identify potential markers capable of promoting hydrocephalus development and progression. METHODS Relevant studies published before December 3rd 2020 were identified from PubMed, Embase, and reference lists. Studies were screened for eligibility using the predefined inclusion and exclusion criteria. Data from eligible studies were extracted, and sources of bias were evaluated. We included articles written in English investigating inflammatory markers in CSF from patients with hydrocephalus and control subjects. The review was conducted according to the PRISMA guidelines by three independent reviewers. RESULTS Twenty-two studies analyzed CSF from 311 patients with idiopathic normal pressure hydrocephalus (iNPH), 178 with posthemorrhagic hydrocephalus (PHH), 151 with other hydrocephalus diagnoses, and 394 control subjects. Fifty-eight inflammatory markers were investigated. The CSF of iNPH patients had increased CSF levels of IL-6, IL-1β, and LRG compared with control subjects, whereas the CSF of PHH patients had increased levels of IL-6, IL-18, and VEGF. CSF from patients with "other hydrocephalus diagnoses" had elevated IFN-γ compared to control subjects, and VEGF was increased in congenital hydrocephalus, spina bifida, and hydrocephalus associated with tuberculous meningitis compared with controls. CONCLUSION IL-6, IL-1β, LRG, IL-18, VEGF, and IFN-γ are elevated in CSF from patients with hydrocephalus and may be involved in promotion of hydrocephalus development and progression. They may serve as novel disease biomarkers, and their signaling pathways may represent targets for pharmacological management of hydrocephalus.
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Affiliation(s)
| | - Nina Rostgaard
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Eva Kjer Oernbo
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Anja Hviid Simonsen
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
| | - Nanna MacAulay
- Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
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Krause M, Härtig W, Mahr CV, Richter C, Schob J, Puchta J, Hoffmann KT, Nestler U, Thome U, Knüpfer M, Gebauer C, Schob S. CSF Surfactant Protein Changes in Preterm Infants After Intraventricular Hemorrhage. Front Pediatr 2020; 8:572851. [PMID: 33102410 PMCID: PMC7546901 DOI: 10.3389/fped.2020.572851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Surfactant proteins (SP) have been shown to be inherent proteins of the human CNS and are altered during acute and chronic disturbances of CSF circulation. Aim of the study was to examine the changes of surfactant protein concentrations in CSF of preterm babies suffering from intraventricular hemorrhage. Patients and Methods: Consecutive CSF samples of 21 preterm infants with intraventricular hemorrhages (IVH) and posthemorrhagic hydrocephalus (PHHC) were collected at primary intervention, after 5-10 days and at time of shunt insertion ~50 days after hemorrhage. Samples were analyzed for surfactant proteins A, B, C, and G by ELISA assays and the results were compared to 35 hydrocephalus patients (HC) without hemorrhage and 6 newborn control patients. Results and Discussion: Premature patients with IVH showed a significant elevation of surfactant proteins SP-A, C, and G compared to HC and control groups: mean values for the respective groups were SP-A 4.19 vs. 1.08 vs. 0.38 ng/ml. Mean SP-C 3.63 vs. 1.47 vs. 0.48 ng/ml. Mean SP-G 3.86 vs. 0.17 vs. 0.2 ng/ml. SP-A and G concentrations were slowly falling over time without reaching normal values. SP-C levels declined faster following neurosurgical interventions and reached levels comparable to those of hydrocephalus patients without hemorrhage. Conclusion: Intraventricular hemorrhages of premature infants cause posthemorrhagic CSF flow disturbance and are associated with highly significant elevations of surfactant proteins A, C, and G independent of total CSF protein concentrations.
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Affiliation(s)
- Matthias Krause
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, Medical Faculty of University Leipzig, Leipzig, Germany.,Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Cindy Richter
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Julia Schob
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | - Joana Puchta
- Paul Flechsig Institute for Brain Research, Medical Faculty of University Leipzig, Leipzig, Germany.,Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Ulf Nestler
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Ulrich Thome
- Department of Neonatology, University Hospital Leipzig, Leipzig, Germany
| | - Matthias Knüpfer
- Department of Neonatology, University Hospital Leipzig, Leipzig, Germany
| | - Corinna Gebauer
- Department of Neonatology, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Schob
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
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Weiß A, Krause M, Stockert A, Richter C, Puchta J, Bhogal P, Hoffmann KT, Emmer A, Quäschling U, Scherlach C, Härtig W, Schob S. Rheologically Essential Surfactant Proteins of the CSF Interacting with Periventricular White Matter Changes in Hydrocephalus Patients - Implications for CSF Dynamics and the Glymphatic System. Mol Neurobiol 2019; 56:7863-7871. [PMID: 31127529 DOI: 10.1007/s12035-019-01648-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
Surfactant proteins (SP) are multi-systemic proteins playing crucial roles in the regulation of rheological properties of physiological fluids, host defense, and the clearance of potentially harmful metabolites. Hydrocephalus patients suffer from disturbed central nervous system (CNS) fluid homeostasis and exhibit remarkably altered SP concentrations within the cerebrospinal fluid (CSF). A connection between CSF-SPs, CSF flow, and ventricular dilatation, a morphological hallmark of hydrocephalus, has been reported previously. However, currently there are no studies investigating the link between rheologically active SPs and periventricular white matter changes caused by impaired CSF microcirculation in hydrocephalic conditions. Thus, the aim of this study was to assess their possible relationships. The present study included 47 individuals (27 healthy subjects and 20 hydrocephalus patients). CSF specimens were analyzed for concentrations of SP-A, SP-C, and SP-D by using enzyme-linked immunosorbent assays (ELISAs). Axial T2w turbo inversion recovery magnitude (TIRM) magnetic resonance imaging was employed in all cases. Using a custom-made MATLAB-based tool for quantification of magnetic resonance signal intensities in the brain, parameters related to disturbed deep white matter CSF microcirculation were estimated (TIRM signal intensity (SI)-mean, minimum, maximum, median, mode, standard deviation, and percentiles, p10th, p25th, p75th, p90th, as well as kurtosis, skewness, and entropy of the SI distribution). Subsequently, statistical analysis was performed (IBM SPSS 24™) to identify differences between hydrocephalic patients and healthy individuals and to further investigate the connections between CSF-SP changes and deep white matter signal intensities. SP-A (0.38 ± 0.23 vs. 0.76 ± 0.49 ng/ml) and SP-C (0.54 ± 0.28 vs. 1.27 ± 1.09 ng/ml) differed between healthy controls and hydrocephalus patients in a statistically significant manner. Also, corresponding quantification of white matter signal intensities revealed statistically significant differences between hydrocephalus patients and healthy individuals: SImean (370.41 ± 188.15 vs. 222.27 ± 99.86, p = 0.001), SImax (1115.30 ± 700.12 vs. 617.00 ± 459.34, p = 0.005), SImedian (321.40 ± 153.17 vs. 209.52 ± 84.86, p = 0.001), SImode (276.55 ± 125.63 vs. 197.26 ± 78.51, p = 0.011), SIstd (157.09 ± 110.07 vs. 81.71 ± 64.94, p = 0.005), SIp10 (229.10 ± 104.22 vs. 140.00 ± 63.12, p = 0.001), SIp25 (266.95 ± 122.62 vs. 175.63 ± 71.42, p = 0.002), SIp75 (428.80 ± 226.88 vs. 252.19 ± 110.91, p = 0.001), SIp90 (596.47 ± 345.61 vs. 322.06 ± 176.00, p = 0.001), skewness (1.19 ± 0.68 vs. 0.43 ± 1.19, p = 0.014), and entropy (5.36 ± 0.37 vs. 4.92 ± 0.51, p = 0.002). There were no differences regarding SP-D levels in hydrocephalus patients vs. healthy controls. In the acute hydrocephalic subgroup, correlations were as follows: SP-A showed a statistically significant correlation with SImax (r = 0.670, p = 0.024), SIstd (r = 0.697, p = 0.017), SIp90 (r = 0.621, p = 0.041), and inverse correlation with entropy (r = - 0.700, p = 0.016). SP-C correlated inversely with entropy (r = - 0.686, p = 0.020). For the chronic hydrocephalus subgroup, the following correlations were identified: SP-A correlated with kurtosis of the TIRM histogram (r = - 0.746, p = 0.021). SP-C correlated with SImean (r = - 0.688, p = 0.041), SImax (r = - 0.741, p = 0.022), SImedian (r = - 0.716, p = 0.030), SImode (r = - 0.765, p = 0.016), SIstd (r = - 0.671, p = 0.048), SIp25 (r = - 0.740, p = 0.023), SIp75 (r = - 0.672, p = 0.048), and SIp90 (r = - 0.667, p = 0.050). SP-D apparently does not play a major role in CSF fluid physiology. SP-A and SP-C are involved in different aspects of CNS fluid physiology. SP-A appears to play an essential compensatory role in acute hydrocephalus and seems less involved in chronic hydrocephalus. In contrary, SP-C profile and white matter changes are remarkably connected in CSF of chronic hydrocephalus patients. Considering the association between CSF flow phenomena, white matter changes, and SP-C profiles, the latter may especially contribute to the regulation of paravascular glymphatic physiology.
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Affiliation(s)
- Alexander Weiß
- Department of Neuroradiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Matthias Krause
- Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany
| | - Anika Stockert
- Department of Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Cindy Richter
- Department of Neuroradiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Joana Puchta
- Department of Neuroradiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.,Paul Flechsig Institute for Brain Research, University Leipzig, Leipzig, Germany
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, Royal London Hospital, London, UK
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Alexander Emmer
- Department for Neurology, University Hospital Halle-Wittenberg, Halle, Germany
| | - Ulf Quäschling
- Department of Neuroradiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Cordula Scherlach
- Department of Neuroradiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University Leipzig, Leipzig, Germany
| | - Stefan Schob
- Department of Neuroradiology, University Hospital Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
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