1
|
Wu L, Liu Y, Zhu L, Li T, Wang L, Zhang Y, Zhou Z, Xing Y, Wang M, Gao B. MRI arterial spin labeling in evaluating hemorrhagic transformation following endovascular recanalization of subacute ischemic stroke. Front Neurosci 2023; 17:1105816. [PMID: 36937682 PMCID: PMC10020198 DOI: 10.3389/fnins.2023.1105816] [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: 11/23/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Objective To investigate the value of the MRI arterial spin labeling (ASL) in evaluating the blood-brain barrier permeability of anterior circulation ischemic lesions in subacute ischemic stroke (SIS) and the risk of hemorrhage transformation (HT) after endovascular recanalization. Materials and methods Patients with anterior circulation SIS treated with endovascular recanalization were prospectively enrolled. The imaging presentations in the MRI ASL sequences, dynamic contrast-enhanced (DCE) sequence, and Xper CT were studied. The relative cerebral blood flow (rCBF), volume transfer constant (Ktrans), and the weighted Kappa coefficient (rKtrans) were analyzed. Results Among 27 eligible patients, HT occurred in 7 patients (25.92%). Patients with HT had significantly higher rCBF value (1.56 ± 0.16 vs. 1.16 ± 0.16), Ktrans, (0.08 ± 0.03 min vs. 0.03 ± 0.01 min) and rKtrans (3.02 ± 0.89 vs. 1.89 ± 0.56). The ASL imaging sequence had a high consistency with the DCE sequence and Xper CT with a high weighted Kappa coefficient of 0.91 for the DCE sequence and 0.70 for the Xper CT imaging. The DCE sequence was also highly consistent with the Xper CT in imaging classification with a high weighted Kappa coefficient of 0.78. The rCBF value in the 21 patients with the subcortical and basal ganglia infarction was significantly lower than that in the other 6 patients with the cortical infarction (1.222 ± 0.221 vs. 1.413 ± 0.259, t = 1.795, P = 0.004). Conclusion The MRI ASL sequence has an important role in evaluating the blood-brain barrier permeability and the risk of hemorrhagic transformation of anterior circulation SIS following endovascular recanalization.
Collapse
Affiliation(s)
- Liheng Wu
- Department of Cerebrovascular Diseases, National Advanced Stroke Center, Henan Provincial People’s Hospital, People’s Hospital of Henan University, Zhengzhou, China
| | - Yanghui Liu
- Department of Cerebrovascular Diseases, National Advanced Stroke Center, Henan Provincial People’s Hospital, People’s Hospital of Henan University, Zhengzhou, China
| | - Liangfu Zhu
- Department of Cerebrovascular Diseases, National Advanced Stroke Center, Henan Provincial People’s Hospital, People’s Hospital of Henan University, Zhengzhou, China
- *Correspondence: Liangfu Zhu,
| | - Tianxiao Li
- Department of Cerebrovascular Diseases, National Advanced Stroke Center, Henan Provincial People’s Hospital, People’s Hospital of Henan University, Zhengzhou, China
| | - Li’na Wang
- Department of Cerebrovascular Diseases, National Advanced Stroke Center, Henan Provincial People’s Hospital, People’s Hospital of Henan University, Zhengzhou, China
| | - Yang Zhang
- Department of Cerebrovascular Diseases, National Advanced Stroke Center, Henan Provincial People’s Hospital, People’s Hospital of Henan University, Zhengzhou, China
| | - Zhilong Zhou
- Department of Cerebrovascular Diseases, National Advanced Stroke Center, Henan Provincial People’s Hospital, People’s Hospital of Henan University, Zhengzhou, China
| | - Ying Xing
- Department of Cerebrovascular Diseases, National Advanced Stroke Center, Henan Provincial People’s Hospital, People’s Hospital of Henan University, Zhengzhou, China
| | - Meiyun Wang
- Department of Imaging, Henan Provincial People’s Hospital, People’s Hospital of Henan University, Zhengzhou, China
| | - Bulang Gao
- Department of Cerebrovascular Diseases, National Advanced Stroke Center, Henan Provincial People’s Hospital, People’s Hospital of Henan University, Zhengzhou, China
| |
Collapse
|
2
|
Lu J, Mei Q, Hou X, Manaenko A, Zhou L, Liebeskind DS, Zhang JH, Li Y, Hu Q. Imaging Acute Stroke: From One-Size-Fit-All to Biomarkers. Front Neurol 2021; 12:697779. [PMID: 34630278 PMCID: PMC8497192 DOI: 10.3389/fneur.2021.697779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/30/2021] [Indexed: 12/27/2022] Open
Abstract
In acute stroke management, time window has been rigidly used as a guide for decades and the reperfusion treatment is only available in the first few limited hours. Recently, imaging-based selection of patients has successfully expanded the treatment window out to 16 and even 24 h in the DEFUSE 3 and DAWN trials, respectively. Recent guidelines recommend the use of imaging techniques to guide therapeutic decision-making and expanded eligibility in acute ischemic stroke. A tissue window is proposed to replace the time window and serve as the surrogate marker for potentially salvageable tissue. This article reviews the evolution of time window, addresses the advantage of a tissue window in precision medicine for ischemic stroke, and discusses both the established and emerging techniques of neuroimaging and their roles in defining a tissue window. We also emphasize the metabolic imaging and molecular imaging of brain pathophysiology, and highlight its potential in patient selection and treatment response prediction in ischemic stroke.
Collapse
Affiliation(s)
- Jianfei Lu
- Central Laboratory, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiyong Mei
- Department of Neurosurgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Xianhua Hou
- Department of Neurology, Southwest Hospital, Army Medical University, Chongqing, China
| | - Anatol Manaenko
- National Health Commission Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lili Zhou
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core and University of California Los Angeles Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - John H Zhang
- Department of Anesthesiology, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Yao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qin Hu
- Central Laboratory, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Bernardo-Castro S, Donato H, Ferreira L, Sargento-Freitas J. Permeability of the blood-brain barrier through the phases of ischaemic stroke and relation with clinical outcome: protocol for a systematic review. BMJ Open 2020; 10:e039280. [PMID: 32948573 PMCID: PMC7511624 DOI: 10.1136/bmjopen-2020-039280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Ischaemic stroke is the most prevalent type of stroke and is characterised by a myriad of pathological events triggered by a vascular arterial occlusion. Disruption of the blood-brain barrier (BBB) is a key pathological event that may lead to fatal outcomes. However, it seems to follow a multiphasic pattern that has been associated with distinct biological substrates and possibly contrasting outcomes. Addressing the BBB permeability (BBBP) along the different phases of stroke through imaging techniques could lead to a better understanding of the disease, improved patient selection for specific treatments and development of new therapeutic modalities and delivery methods. This systematic review will aim to comprehensively summarise the existing evidence regarding the evolution of the BBBP values during the different phases of an acute ischaemic stroke and correlate this event with the clinical outcome of the patient. METHODS AND ANALYSIS We will conduct a computerised search on Medline, EMBASE, Cochrane Central Register of Controlled Trials, Scopus and Web of Science. In addition, grey literature and ClinicalTrials.gov will be scanned. We will include randomised controlled trials, cohort, cross-sectional and case-controlled studies on humans that quantitatively assess the BBBP in stroke. Retrieved studies will be independently reviewed by two authors and any discrepancies will be resolved by consensus or with a third reviewer. Reviewers will extract the data and assess the risk of bias of the selected studies. If possible, data will be combined in a quantitative meta-analysis following the guidelines provided by Cochrane Handbook for Systematic Reviews of Interventions. We will assess cumulative evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION Ethical approval is not needed. All data used for this work are publicly available. The result obtained from this work will be published in a peer-reviewed journal and disseminated in relevant conferences. PROSPERO REGISTRATION NUMBER CRD42019147314.
Collapse
Affiliation(s)
- Sara Bernardo-Castro
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Helena Donato
- Documentation Service, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Lino Ferreira
- Center for Neurosciences and Cell Biology, Universidade de Coimbra, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - João Sargento-Freitas
- Stroke Unit, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
- Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| |
Collapse
|
4
|
Huang WY, Wu G, Guo SX, Geng DY, Li JJ, Yang K. Multi-parameters of Magnetic Resonance Imaging to Estimate Ischemia-Reperfusion Injury after Stroke in Hyperglycemic Rats. Sci Rep 2019; 9:2852. [PMID: 30814576 PMCID: PMC6393533 DOI: 10.1038/s41598-019-39263-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/17/2019] [Indexed: 01/12/2023] Open
Abstract
The aim of the study is to verify the effect of hyperglycemia on ischemia-reperfusion injury and to explore the feasibility of noninvasive observation of ischemic-reperfusion injury in hyperglycemic ischemic stroke by MRI technique. According to the duration of ischemia and blood glucose levels, 40 rats were divided into hyperglycemic ischemic 2-hr (H-I2h), hyperglycemic ischemic 6-hr (H-I6h), non- hyperglycemic ischemic 2-hr (NH-I2h), and non- hyperglycemic ischemic 6-hr (NH-I6h) groups. T2W imaging, DW imaging, T2 mapping, T2* mapping, DCE, and T1 mapping after enhancement sequences were acquired before reperfusion and approximately 3-hr after reperfusion. ADC, T1, T2, T2*, and Ktrans values of ischemic lesion were obtained in different groups. After reperfusion, the variation of ADC values showed no significant difference between groups with diabetes and groups without diabetes and between different recanalization time-points (2-hr vs 6-hr). After reperfusion, T2, T2*, and Ktrans values increased in different degrees in all four groups. Only the T1 value decreased in all groups. The change of all parameters in groups with hyperglycemia was more obvious than that in groups without hyperglycemia and was more obvious in groups with H-I6h versus those with H-I2h. This study confirms that hyperglycemia aggravates ischemia-reperfusion injury and may be an important risk factor for the prognosis of ischemic stroke. The Ktrans values should be noninvasive imaging indicators to monitor blood brain barrier permeability and ischemic-reperfusion injury in ischemic stroke.
Collapse
Affiliation(s)
- Wei-Yuan Huang
- Department of Radiology, Hainan General Hospital, Haikou, 570311, China
| | - Gang Wu
- Department of Radiotherapy, Hainan General Hospital, Haikou, 570311, China
| | - Shan-Xi Guo
- Department of Radiology, Hainan General Hospital, Haikou, 570311, China
| | - Dao-Ying Geng
- Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jian-Jun Li
- Department of Radiology, Hainan General Hospital, Haikou, 570311, China.
| | - Kai Yang
- Department of Radiology, Hainan General Hospital, Haikou, 570311, China.
| |
Collapse
|
5
|
Eser Ocak P, Ocak U, Sherchan P, Zhang JH, Tang J. Insights into major facilitator superfamily domain-containing protein-2a (Mfsd2a) in physiology and pathophysiology. What do we know so far? J Neurosci Res 2018; 98:29-41. [PMID: 30345547 DOI: 10.1002/jnr.24327] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/20/2018] [Accepted: 08/28/2018] [Indexed: 01/02/2023]
Abstract
Major facilitator superfamily domain-containing protein-2a (Mfsd2a) which was considered as an orphan transporter has recently gained attention for its regulatory role in the maintenance of proper functioning of the blood-brain barrier. Besides the major role of Mfsd2a in maintaining the barrier function, increasing evidence has emerged with regard to the contributions of Mfsd2a to various biological processes such as transport, cell fusion, cell cycle, inflammation and regeneration, managing tumor growth, functioning of other organs with barrier functions or responses to injury. The purpose of this article is to review the different roles of Mfsd2a and its involvement in the physiological and pathophysiological processes primarily in the central nervous system and throughout the mammalian body under the lights of the current literature.
Collapse
Affiliation(s)
- Pinar Eser Ocak
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Umut Ocak
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Prativa Sherchan
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - John H Zhang
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| | - Jiping Tang
- Department of Physiology and Pharmacology, School of Medicine, Loma Linda University, Loma Linda, California
| |
Collapse
|
6
|
Okuyama S, Yamamoto K, Mori H, Sawamoto A, Amakura Y, Yoshimura M, Tamanaha A, Ohkubo Y, Sugawara K, Sudo M, Nakajima M, Furukawa Y. Neuroprotective effect of Citrus kawachiensis (Kawachi Bankan) peels, a rich source of naringin, against global cerebral ischemia/reperfusion injury in mice. Biosci Biotechnol Biochem 2018; 82:1216-1224. [DOI: 10.1080/09168451.2018.1456320] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Abstract
Cerebral ischemia/reperfusion is known to induce the generation of reactive oxygen species and inflammatory responses. Numerous studies have demonstrated that naringin (NGIN) has anti-oxidant and anti-inflammatory properties. We previously reported that Citrus kawachiensis contains a large quantity of NGIN in its peel. In the present study, we orally (p.o.) administered dried peel powder of C. kawachiensis to mice of a transient global ischemia model and found in the hippocampus region that it 1) suppressed neuronal cell death, 2) reversed the reduction in the level of phosphorylated calcium-calmodulin-dependent protein kinase II, 3) had the tendency to reverse the reduction in the level of glutathione, and 4) blocked excessive activation of microglia and astrocytes. These results suggested that the dried peel powder of C. kawachiensis had a neuroprotective effect against ischemic brain via anti-oxidative and anti-inflammatory effects. We also showed that these effects of the dried peel powder were more powerful than those obtained with a comparable amount of NGIN alone.
Collapse
Affiliation(s)
- Satoshi Okuyama
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University , Matsuyama, Japan
| | - Kana Yamamoto
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University , Matsuyama, Japan
| | - Hirotomo Mori
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University , Matsuyama, Japan
| | - Atsushi Sawamoto
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University , Matsuyama, Japan
| | - Yoshiaki Amakura
- Department of Pharmacognosy, College of Pharmaceutical Sciences, Matsuyama University , Matsuyama, Japan
| | - Morio Yoshimura
- Department of Pharmacognosy, College of Pharmaceutical Sciences, Matsuyama University , Matsuyama, Japan
| | - Arisa Tamanaha
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University , Matsuyama, Japan
| | - Yuu Ohkubo
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University , Matsuyama, Japan
| | - Kuniaki Sugawara
- Department of Planning and Development, Ehime Beverage Inc. , Matsuyama, Japan
| | - Masahiko Sudo
- Department of Planning and Development, Ehime Beverage Inc. , Matsuyama, Japan
| | - Mitsunari Nakajima
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University , Matsuyama, Japan
| | - Yoshiko Furukawa
- Department of Pharmaceutical Pharmacology, College of Pharmaceutical Sciences, Matsuyama University , Matsuyama, Japan
| |
Collapse
|
7
|
Li Y, Xia Y, Chen H, Liu N, Jackson A, Wintermark M, Zhang Y, Hu J, Wu B, Zhang W, Tu J, Su Z, Zhu G. Focal Low and Global High Permeability Predict the Possibility, Risk, and Location of Hemorrhagic Transformation following Intra-Arterial Thrombolysis Therapy in Acute Stroke. AJNR Am J Neuroradiol 2017; 38:1730-1736. [PMID: 28705822 DOI: 10.3174/ajnr.a5287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 05/06/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The contrast volume transfer coefficient (Ktrans), which reflects blood-brain barrier permeability, is influenced by circulation and measurement conditions. We hypothesized that focal low BBB permeability values can predict the spatial distribution of hemorrhagic transformation and global high BBB permeability values can predict the likelihood of hemorrhagic transformation. MATERIALS AND METHODS We retrospectively enrolled 106 patients with hemispheric stroke who received intra-arterial thrombolytic treatment. Ktrans maps were obtained with first-pass perfusion CT data. The Ktrans values at the region level, obtained with the Alberta Stroke Program Early CT Score system, were compared to determine the differences between the hemorrhagic transformation and nonhemorrhagic transformation regions. The Ktrans values of the whole ischemic region based on baseline perfusion CT were obtained as a variable to hemorrhagic transformation possibility at the global level. RESULTS Forty-eight (45.3%) patients had hemorrhagic transformation, and 21 (19.8%) had symptomatic intracranial hemorrhage. At the region level, there were 82 ROIs with hemorrhagic transformation and parenchymal hemorrhage with a mean Ktrans, 0.5 ± 0.5/min, which was significantly lower than that in the nonhemorrhagic transformation regions (P < .01). The mean Ktrans value of 615 nonhemorrhagic transformation ROIs was 0.7 ± 0.6/min. At the global level, there was a significant difference (P = .01) between the mean Ktrans values of patients with symptomatic intracranial hemorrhage (1.3 ± 0.9) and those without symptomatic intracranial hemorrhage (0.8 ± 0.4). Only a high Ktrans value at the global level could predict the occurrence of symptomatic intracranial hemorrhage (P < .01; OR = 5.04; 95% CI, 2.01-12.65). CONCLUSIONS Global high Ktrans values can predict the likelihood of hemorrhagic transformation or symptomatic intracranial hemorrhage at the patient level, whereas focal low Ktrans values can predict the spatial distributions of hemorrhagic transformation at the region level.
Collapse
Affiliation(s)
- Y Li
- From the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
- Department of Radiology (Y.L., M.W.), Neuroradiology Section, Stanford University, Stanford, California
| | - Y Xia
- Department of Critical Care Medicine (Y.X.), Yantai Yuhuangding Hospital, Shandong, China
| | - H Chen
- From the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
| | - N Liu
- From the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
| | - A Jackson
- Wolfson Molecular Imaging Centre (A.J.), University of Manchester, Manchester, UK
| | - M Wintermark
- Department of Radiology (Y.L., M.W.), Neuroradiology Section, Stanford University, Stanford, California
| | - Y Zhang
- Department of Neurology (Y.Z.), Changhai Hospital, Second Military Medical University, Shanghai, China
| | - J Hu
- Department of Neurology (J.H., G.Z.), Southwest Hospital, Third Military Medical University, Chongqing, China
| | - B Wu
- Department of Radiology (B.W.), PLA Army General Hospital, Beijing, China
| | - W Zhang
- From the Department of Neurology (Y.L., H.C., N.L., W.Z.), PLA Army General Hospital, Beijing, China
| | - J Tu
- Outpatient Department (J.T.), PLA 61889 Army, Beijing, China
| | - Z Su
- GE Healthcare (Z.S.), Beijing, China.
| | - G Zhu
- Department of Neurology (J.H., G.Z.), Southwest Hospital, Third Military Medical University, Chongqing, China
| |
Collapse
|
8
|
Shiraishi K, Wang Z, Kokuryo D, Aoki I, Yokoyama M. A polymeric micelle magnetic resonance imaging (MRI) contrast agent reveals blood–brain barrier (BBB) permeability for macromolecules in cerebral ischemia-reperfusion injury. J Control Release 2017; 253:165-171. [DOI: 10.1016/j.jconrel.2017.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/17/2017] [Accepted: 03/11/2017] [Indexed: 01/10/2023]
|
9
|
Pan R, Yu K, Weatherwax T, Zheng H, Liu W, Liu KJ. Blood Occludin Level as a Potential Biomarker for Early Blood Brain Barrier Damage Following Ischemic Stroke. Sci Rep 2017; 7:40331. [PMID: 28079139 PMCID: PMC5228160 DOI: 10.1038/srep40331] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/05/2016] [Indexed: 11/09/2022] Open
Abstract
Concern about intracerebral hemorrhage (ICH) is the primary reason for withholding tPA therapy from patients with ischemic stroke. Early blood brain barrier (BBB) damage is the major risk factor for fatal post-thrombolysis ICH, but rapidly assessing BBB damage before tPA administration is highly challenging. We recently reported that ischemia induced rapid degradation of tight junction protein occludin in cerebromicrovessels. The present study investigates whether the cleaved occludin is released into the blood stream and how blood occludin levels correlate to the extent of BBB damage using a rat model of ischemic stroke. Cerebral ischemia induced a time-dependent increase of blood occludin with a sharp increase at 4.5-hour post-ischemia onset, which concurrently occurred with the loss of occludin from ischemic cerebral microvessels and a massive BBB leakage at 4.5-hour post-ischemia. Two major occludin fragments were identified in the blood during cerebral ischemia. Furthermore, blood occludin levels remained significantly higher than its basal level within the first 24 hours after ischemia onset. Our findings demonstrate that blood occludin levels correlate well with the extent of BBB damage and thus may serve as a clinically relevant biomarker for evaluating the risk of ICH before tPA administration.
Collapse
Affiliation(s)
- Rong Pan
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Kewei Yu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Theodore Weatherwax
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Handong Zheng
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| | - Wenlan Liu
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA.,The Central Laboratory, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, Shenzhen University 1st Affiliated Hospital, Shenzhen, Guangdong, 518035, China
| | - Ke Jian Liu
- Department of Pharmaceutical Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM 87131, USA
| |
Collapse
|
10
|
Chen H, Liu N, Li Y, Wintermark M, Jackson A, Wu B, Su Z, Chen F, Hu J, Zhang Y, Zhu G. Mismatch of Low Perfusion and High Permeability Predicts Hemorrhagic Transformation Region in Acute Ischemic Stroke Patients Treated with Intra-arterial Thrombolysis. Sci Rep 2016; 6:27950. [PMID: 27302077 PMCID: PMC4908417 DOI: 10.1038/srep27950] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/27/2016] [Indexed: 01/20/2023] Open
Abstract
This study sought to determine whether the permeability related parameter K(trans), derived from computed tomography perfusion (CTP) imaging, can predict hemorrhagic transformation (HT) in patients with acute ischemic stroke who receive intra-arterial thrombolysis. Data from patients meeting the criterion were examined. CTP was performed and K(trans) maps were used to assess the permeability values in HT and non-HT regions. A receiver operating characteristic (ROC) curve was calculated, showing the sensitivity and specificity of K(trans) for predicting HT risk. Composite images were produced to illustrate the spatial correlations among perfusion, permeability changes and HT. This study examined 41 patients. Twenty-six patients had hemorrhagic infarction and 15 had parenchymal hemorrhage. The mean K(trans) value in HT regions was significantly lower than that in the non-HT regions (0.26 ± 0.21/min vs. 0.78 ± 0.64/min; P < 0.001). The ROC curve analysis identified an optimal cutoff value of 0.334/min for K(trans) to predict HT risk. Composite images suggested ischemic regions with low permeability, or the mismatch area of low perfusion and high permeability, more likely have HT. HT regions after intra-arterial thrombolysis had lower permeability values on K(trans) maps. The mismatch area of lower perfusion and higher permeability are more likely to develop HT.
Collapse
Affiliation(s)
- Hui Chen
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| | - Nan Liu
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| | - Ying Li
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| | - Max Wintermark
- Stanford University, Department of Radiology, Neuroradiology Section, Stanford, CA, USA
| | - Alan Jackson
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Bing Wu
- Department of Radiology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| | | | - Fei Chen
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| | - Jun Hu
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Yongwei Zhang
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Guangming Zhu
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing, 100700, China
| |
Collapse
|
11
|
Huang CH, Shih YYI, Siow TY, Hsu YH, Chen CCV, Lin TN, Jaw FS, Chang C. Temporal assessment of vascular reactivity and functionality using MRI during postischemic proangiogenenic vascular remodeling. Magn Reson Imaging 2015; 33:903-10. [PMID: 25944092 DOI: 10.1016/j.mri.2015.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 03/13/2015] [Accepted: 04/26/2015] [Indexed: 11/18/2022]
Abstract
Postischemic angiogenesis is an important recovery mechanism. Both arteries and veins are upregulated during angiogenesis, but eventually there are more angiogenic veins than arteries in terms of number and length. It is critical to understand how the veins are modulated after ischemia and then transitioned into angiogenic vessels during the proangiogenic stage to finally serve as a restorative strength to the injured area. Using a rat model of transient focal cerebral ischemia, the hypercapnic blood oxygen level-dependent (BOLD) response was used to evaluate vascular reactivity, while the hyperoxic BOLD and tissue oxygen level-dependent (TOLD) responses were used to evaluate the vascular functionality at 1, 3, and 7days after ischemia. Vessel-like venous signals appeared on R2* maps on days 3 and 7, but not on day 1. The large hypercapnic BOLD responses on days 3 and 7 indicated that these areas have high vascular reactivity. The temporal correlation between vascular reactivity and the immunoreactivity to desmin and VEGF further indicates that the integrity of vascular reactivity is associated with the pericyte coverage as regulated by the VEGF level. Vascular functionality remained low on days 1, 3, and 7, as reflected by the small hyperoxic BOLD and large hyperoxic TOLD responses, indicating the low oxygen consumption of the ischemic tissues. These functional changes in proangiogenic veins may be critical for angiogenesis.
Collapse
Affiliation(s)
- Chien-Hsiang Huang
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan; Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan
| | - Yen-Yu Ian Shih
- Experimental Neuroimaging Laboratory, Department of Neurology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Tiing-Yee Siow
- Department of Medical Imaging and Intervention, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Hua Hsu
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan
| | - Chiao-Chi V Chen
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan
| | - Teng-Nan Lin
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan
| | - Fu-Shan Jaw
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.
| | - Chen Chang
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan.
| |
Collapse
|
12
|
Prediction of Reperfusion-Associated Hemorrhagic Transformation Using Dynamic Contrast-Enhanced Imaging in a Rat Stroke Model. J Comput Assist Tomogr 2015. [DOI: 10.1097/rct.0000000000000283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Combination approaches to attenuate hemorrhagic transformation after tPA thrombolytic therapy in patients with poststroke hyperglycemia/diabetes. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2014; 71:391-410. [PMID: 25307224 DOI: 10.1016/bs.apha.2014.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To date, tissue type plasminogen activator (tPA)-based thrombolytic stroke therapy is the only FDA-approved treatment for achieving vascular reperfusion and clinical benefit, but this agent is given to only about 5% of stroke patients in the USA. This may be related, in part, to the elevated risk of symptomatic intracranial hemorrhage, and consequently limited therapeutic time window. Clinical investigations demonstrate that poststroke hyperglycemia is one of the most important risk factors that cause intracerebral hemorrhage and worsen neurological outcomes. There is a knowledge gap in understanding the underlying molecular mechanisms, and lack of effective therapeutics targeting the severe complication. This short review summarizes clinical observations and experimental investigations in preclinical stroke models of the field. The data strongly suggest that interactions of multiple pathogenic factors including hyperglycemia-mediated vascular oxidative stress and inflammation, ischemic insult, and tPA neurovascular toxicity in concert contribute to the BBB damage-intracerebral hemorrhagic transformation process. Development of combination approaches targeting the multiple pathological cascades may help to attenuate the hemorrhagic complication.
Collapse
|
14
|
Gao X, Qian J, Zheng S, Changyi Y, Zhang J, Ju S, Zhu J, Li C. Overcoming the blood-brain barrier for delivering drugs into the brain by using adenosine receptor nanoagonist. ACS NANO 2014; 8:3678-89. [PMID: 24673594 DOI: 10.1021/nn5003375] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The extremely low permeability of the blood-brain barrier (BBB) poses the greatest impediment in the treatment of central nervous system (CNS) diseases. Recent work indicated that BBB permeability can be up-regulated by activating A2A adenosine receptor (AR), which temporarily increases intercellular spaces between the brain capillary endothelial cells. However, due to transient circulation lifetime of adenosine-based agonists, their capability to enhance brain delivery of drugs, especially macromolecular drugs, is limited. In this work, a series of nanoagonists (NAs) were developed by labeling different copies of A2A AR activating ligands on dendrimers. In vitro transendothelial electrical resistance measurements demonstrated that the NAs increased permeability of the endothelial cell monolayer by compromising the tightness of tight junctions, the key structure that restricts the entry of blood-borne molecules into the brain. In vivo imaging studies indicated the remarkably up-regulated brain uptake of a macromolecular model drug (45 kDa) after intravenous injection of NAs. Autoradiographic imaging showed that the BBB opening time-window can be tuned in a range of 0.5-2.0 h by the NAs labeled with different numbers of AR-activating ligands. By choosing a suitable NA, it is possible to maximize brain drug delivery and minimize the uncontrollable BBB leakage by matching the BBB opening time-window with the pharmacokinetics of a therapeutic agent. The NA-mediated brain drug delivery strategy holds promise for the treatment of CNS diseases with improved therapeutic efficiency and reduced side-effects.
Collapse
Affiliation(s)
- Xihui Gao
- Key Laboratory of Smart Drug Delivery, Ministry of Education, School of Pharmacy, Fudan University , 826 Zhangheng Road, Shanghai 201203, China
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Flores JJ, Zhang Y, Klebe DW, Lekic T, Fu W, Zhang JH. Small molecule inhibitors in the treatment of cerebral ischemia. Expert Opin Pharmacother 2014; 15:659-80. [PMID: 24491068 DOI: 10.1517/14656566.2014.884560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Stroke is the world's second leading cause of death. Although recombinant tissue plasminogen activator is an effective treatment for cerebral ischemia, its limitations and ischemic stroke's complex pathophysiology dictate an increased need for the development of new therapeutic interventions. Small molecule inhibitors (SMIs) have the potential to be used as novel therapeutic modalities for stroke, since many preclinical and clinical trials have established their neuroprotective capabilities. AREAS COVERED This paper provides a summary of the pathophysiology of stroke as well as clinical and preclinical evaluations of SMIs as therapeutic interventions for cerebral ischemia. Cerebral ischemia is broken down into four mechanisms in this article: thrombosis, ischemic insult, mitochondrial injury and immune response. Insight is provided into preclinical and current clinical assessments of SMIs targeting each mechanism as well as a summary of reported results. EXPERT OPINION Many studies demonstrated that pre- or post-treatment with certain SMIs significantly ameliorated adverse effects from stroke. Although some of these promising SMIs moved on to clinical trials, they generally failed, possibly due to the poor translation of preclinical to clinical experiments. Yet, there are many steps being taken to improve the quality of experimental research and translation to clinical trials.
Collapse
Affiliation(s)
- Jerry J Flores
- Loma Linda University School of Medicine, Department of Physiology and Pharmacology , Risley Hall, Room 223, Loma Linda, CA 92354 , USA
| | | | | | | | | | | |
Collapse
|
16
|
Duong TQ. Recent MRI advances in experimental stroke. Transl Stroke Res 2012; 3:1-3. [PMID: 24323749 PMCID: PMC4758113 DOI: 10.1007/s12975-012-0144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 01/11/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy Q Duong
- Research Imaging Institute, UT Health Science Center San Antonio, San Antonio, TX, USA,
| |
Collapse
|