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Sarkislali K, Kobayashi K, Sarić N, Maeda T, Henmi S, Somaa FA, Bansal A, Tu SC, Leonetti C, Hsu CH, Li J, Vyas P, Kawasawa YI, Tu TW, Wang PC, Hanley PJ, Hashimoto-Torii K, Frank JA, Jonas RA, Ishibashi N. Mesenchymal Stromal Cell Delivery Via Cardiopulmonary Bypass Provides Neuroprotection in a Juvenile Porcine Model. JACC Basic Transl Sci 2023; 8:1521-1535. [PMID: 38205346 PMCID: PMC10774600 DOI: 10.1016/j.jacbts.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/13/2023] [Accepted: 07/05/2023] [Indexed: 01/12/2024]
Abstract
Oxidative/inflammatory stresses due to cardiopulmonary bypass (CPB) cause prolonged microglia activation and cortical dysmaturation, thereby contributing to neurodevelopmental impairments in children with congenital heart disease (CHD). This study found that delivery of mesenchymal stromal cells (MSCs) via CPB minimizes microglial activation and neuronal apoptosis, with subsequent improvement of cortical dysmaturation and behavioral alteration after neonatal cardiac surgery. Furthermore, transcriptomic analyses suggest that exosome-derived miRNAs may be the key drivers of suppressed apoptosis and STAT3-mediated microglial activation. Our findings demonstrate that MSC treatment during cardiac surgery has significant translational potential for improving cortical dysmaturation and neurological impairment in children with CHD.
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Affiliation(s)
- Kamil Sarkislali
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
| | - Kei Kobayashi
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC, USA
| | - Nemanja Sarić
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
| | - Takuya Maeda
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
| | - Soichiro Henmi
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC, USA
| | - Fahad A. Somaa
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
| | - Ankush Bansal
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
| | - Shao Ching Tu
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
| | - Camille Leonetti
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
| | - Chao-Hsiung Hsu
- Molecular Imaging Laboratory, Department of Radiology, Howard University, Washington, DC, USA
| | - Jingang Li
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
| | - Pranav Vyas
- Department of Radiology, Children’s National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Yuka Imamura Kawasawa
- Departments of Pharmacology and Biochemistry and Molecular Biology, Institute for Personalized Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Tsang-Wei Tu
- Molecular Imaging Laboratory, Department of Radiology, Howard University, Washington, DC, USA
| | - Paul C. Wang
- Molecular Imaging Laboratory, Department of Radiology, Howard University, Washington, DC, USA
- Department of Electrical Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Patrick J. Hanley
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Program for Cell Enhancement and Technologies for Immunotherapy, Division of Blood and Marrow Transplantation, Center for Cancer and Immunology Research, Children’s National Hospital, Washington, DC, USA
| | - Kazue Hashimoto-Torii
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Pharmacology and Physiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Joseph A. Frank
- Frank Laboratory, Radiology and Imaging Sciences, National Institutes of Health; Bethesda, Maryland, USA
- National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland, USA
| | - Richard A. Jonas
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Nobuyuki Ishibashi
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Pharmacology and Physiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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2
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Morton PD, Korotcova L, Lewis BK, Bhuvanendran S, Ramachandra SD, Zurakowski D, Zhang J, Mori S, Frank JA, Jonas RA, Gallo V, Ishibashi N. Abnormal neurogenesis and cortical growth in congenital heart disease. Sci Transl Med 2018; 9:9/374/eaah7029. [PMID: 28123074 DOI: 10.1126/scitranslmed.aah7029] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 08/04/2016] [Accepted: 10/05/2016] [Indexed: 12/21/2022]
Abstract
Long-term neurological deficits due to immature cortical development are emerging as a major challenge in congenital heart disease (CHD). However, cellular mechanisms underlying dysregulation of perinatal corticogenesis in CHD remain elusive. The subventricular zone (SVZ) represents the largest postnatal niche of neural stem/progenitor cells (NSPCs). We show that the piglet SVZ resembles its human counterpart and displays robust postnatal neurogenesis. We present evidence that SVZ NSPCs migrate to the frontal cortex and differentiate into interneurons in a region-specific manner. Hypoxic exposure of the gyrencephalic piglet brain recapitulates CHD-induced impaired cortical development. Hypoxia reduces proliferation and neurogenesis in the SVZ, which is accompanied by reduced cortical growth. We demonstrate a similar reduction in neuroblasts within the SVZ of human infants born with CHD. Our findings demonstrate that SVZ NSPCs contribute to perinatal corticogenesis and suggest that restoration of SVZ NSPCs' neurogenic potential is a candidate therapeutic target for improving cortical growth in CHD.
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Affiliation(s)
- Paul D Morton
- Center for Neuroscience Research, Children's National Health System, Washington, DC 20010, USA.,Children's National Heart Institute, Children's National Health System, Washington, DC 20010, USA
| | - Ludmila Korotcova
- Center for Neuroscience Research, Children's National Health System, Washington, DC 20010, USA.,Children's National Heart Institute, Children's National Health System, Washington, DC 20010, USA
| | - Bobbi K Lewis
- Frank Laboratory and Laboratory of Diagnostic Radiology Research, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA
| | - Shivaprasad Bhuvanendran
- Center for Genetic Medicine Research, Children's National Health System, Washington, DC 20010, USA
| | - Shruti D Ramachandra
- Center for Neuroscience Research, Children's National Health System, Washington, DC 20010, USA.,Children's National Heart Institute, Children's National Health System, Washington, DC 20010, USA
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
| | - Jiangyang Zhang
- Department of Biomedical Engineering and The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Susumu Mori
- Department of Biomedical Engineering and The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Joseph A Frank
- Frank Laboratory and Laboratory of Diagnostic Radiology Research, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA.,Intramural Research Program, National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD 20892, USA
| | - Richard A Jonas
- Center for Neuroscience Research, Children's National Health System, Washington, DC 20010, USA. .,Children's National Heart Institute, Children's National Health System, Washington, DC 20010, USA
| | - Vittorio Gallo
- Center for Neuroscience Research, Children's National Health System, Washington, DC 20010, USA.
| | - Nobuyuki Ishibashi
- Center for Neuroscience Research, Children's National Health System, Washington, DC 20010, USA. .,Children's National Heart Institute, Children's National Health System, Washington, DC 20010, USA
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3
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Stinnett GR, Lin S, Korotcov AV, Korotcova L, Morton PD, Ramachandra SD, Pham A, Kumar S, Agematsu K, Zurakowski D, Wang PC, Jonas RA, Ishibashi N. Microstructural Alterations and Oligodendrocyte Dysmaturation in White Matter After Cardiopulmonary Bypass in a Juvenile Porcine Model. J Am Heart Assoc 2017; 6:JAHA.117.005997. [PMID: 28862938 PMCID: PMC5586442 DOI: 10.1161/jaha.117.005997] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Newly developed white matter (WM) injury is common after cardiopulmonary bypass (CPB) in severe/complex congenital heart disease. Fractional anisotropy (FA) allows measurement of macroscopic organization of WM pathology but has rarely been applied after CPB. The aims of our animal study were to define CPB‐induced FA alterations and to determine correlations between these changes and cellular events after congenital heart disease surgery. Methods and Results Normal porcine WM development was first assessed between 3 and 7 weeks of age: 3‐week‐old piglets were randomly assigned to 1 of 3 CPB‐induced insults. FA was analyzed in 31 WM structures. WM oligodendrocytes, astrocytes, and microglia were assessed immunohistologically. Normal porcine WM development resembles human WM development in early infancy. We found region‐specific WM vulnerability to insults associated with CPB. FA changes after CPB were also insult dependent. Within various WM areas, WM within the frontal cortex was susceptible, suggesting that FA in the frontal cortex should be a biomarker for WM injury after CPB. FA increases occur parallel to cellular processes of WM maturation during normal development; however, they are altered following surgery. CPB‐induced oligodendrocyte dysmaturation, astrogliosis, and microglial expansion affect these changes. FA enabled capturing CPB‐induced cellular events 4 weeks postoperatively. Regions most resilient to CPB‐induced FA reduction were those that maintained mature oligodendrocytes. Conclusions Reducing alterations of oligodendrocyte development in the frontal cortex can be both a metric and a goal to improve neurodevelopmental impairment in the congenital heart disease population. Studies using this model can provide important data needed to better interpret human imaging studies.
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Affiliation(s)
- Gary R Stinnett
- Children's National Heart Institute, Children's National Health System, Washington, DC.,Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - Stephen Lin
- Department of Radiology, Howard University, Washington, DC
| | - Alexandru V Korotcov
- Department of Radiology, Howard University, Washington, DC.,Center for Neuroscience and Regenerative Medicine, Uniformed Services University, Bethesda, MD
| | - Ludmila Korotcova
- Children's National Heart Institute, Children's National Health System, Washington, DC.,Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - Paul D Morton
- Children's National Heart Institute, Children's National Health System, Washington, DC.,Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - Shruti D Ramachandra
- Children's National Heart Institute, Children's National Health System, Washington, DC.,Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - Angeline Pham
- George Washington University School of Medicine and Health Science, Washington, DC
| | - Sonali Kumar
- George Washington University School of Medicine and Health Science, Washington, DC
| | - Kota Agematsu
- Children's National Heart Institute, Children's National Health System, Washington, DC.,Center for Neuroscience Research, Children's National Health System, Washington, DC
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Paul C Wang
- Department of Radiology, Howard University, Washington, DC.,College of Science and Engineering, Fu Jen Catholic University, Taipei, Taiwan
| | - Richard A Jonas
- Children's National Heart Institute, Children's National Health System, Washington, DC .,Center for Neuroscience Research, Children's National Health System, Washington, DC.,George Washington University School of Medicine and Health Science, Washington, DC
| | - Nobuyuki Ishibashi
- Children's National Heart Institute, Children's National Health System, Washington, DC .,Center for Neuroscience Research, Children's National Health System, Washington, DC.,George Washington University School of Medicine and Health Science, Washington, DC
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4
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Neurocardiology: Cardiovascular Changes and Specific Brain Region Infarcts. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5646348. [PMID: 28758117 PMCID: PMC5512017 DOI: 10.1155/2017/5646348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/15/2017] [Indexed: 11/18/2022]
Abstract
There are complex and dynamic reflex control networks between the heart and the brain, including cardiac and intrathoracic ganglia, spinal cord, brainstem, and central nucleus. Recent literature based on animal model and clinical trials indicates a close link between cardiac function and nervous systems. It is noteworthy that the autonomic nervous-based therapeutics has shown great potential in the management of atrial fibrillation, ventricular arrhythmia, and myocardial remodeling. However, the potential mechanisms of postoperative brain injury and cardiovascular changes, particularly heart rate variability and the presence of arrhythmias, are not understood. In this chapter, we will describe mechanisms of brain damage undergoing cardiac surgery and focus on the interaction between cardiovascular changes and damage to specific brain regions.
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Tsygan NV, Odinak MM, Khubulava GG, Tsygan VN, Peleshok AS, Andreev RV, Kurasov ES, Litvinenko IV. [Postoperative cerebral dysfunction]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:34-39. [PMID: 28617376 DOI: 10.17116/jnevro20171174134-39] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study the structure, risk factors and methods of prevention of postoperative brain dysfunction on the example of coronary artery bypass surgery with cardiopulmonary bypass. MATERIAL AND METHODS The study included 77 patients who undergone elective coronary artery bypass surgery at the beating heart (22 patients) or with cardiopulmonary bypass (55 patients, including 24 patients, who received cerebroprotective treatment with cytoflavin in the preoperative period). All patients underwent dynamic (pre- and postoperative) neurological, neuropsychological, instrumental examinations. RESULTS The postoperative cerebral dysfunction was diagnosed in 34 (44,2%) patients. The frequency of the clinical types of postoperative cerebral dysfunction significantly differed: perioperative stroke - 3 (3,9%) cases, symptomatic delirium of the early postoperative period - 11 (14,3%) cases, delayed cognitive impairment - 28 (36,4%) cases. The risk factors of postoperative cerebral dysfunction after the coronary artery bypass surgery with cardiopulmonary bypass were identified. Preventive preoperative use of the neuroprotective drug cytoflavin reduces the severity of delayed cognitive impairment after the coronary artery bypass surgery with cardiopulmonary bypass and has a good safety profile. CONCLUSION An analysis of the literature data and the results of our own studies show that postoperative cerebral dysfunction is the nosological entity with various etiological factors, pathogenetic mechanisms and the characteristic clinical types, which has an effect on the outcome of surgical treatment.
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Affiliation(s)
- N V Tsygan
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | - M M Odinak
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | - G G Khubulava
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | - V N Tsygan
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | - A S Peleshok
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | - R V Andreev
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | - E S Kurasov
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | - I V Litvinenko
- Kirov Military Medical Academy, Saint Petersburg, Russia
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6
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Agematsu K, Korotcova L, Scafidi J, Gallo V, Jonas RA, Ishibashi N. Effects of preoperative hypoxia on white matter injury associated with cardiopulmonary bypass in a rodent hypoxic and brain slice model. Pediatr Res 2014; 75:618-25. [PMID: 24488087 PMCID: PMC3992169 DOI: 10.1038/pr.2014.9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/22/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND White matter (WM) injury is common after cardiopulmonary bypass or deep hypothermic circulatory arrest in neonates who have cerebral immaturity secondary to in utero hypoxia. The mechanism remains unknown. We investigated effects of preoperative hypoxia on deep hypothermic circulatory arrest-induced WM injury using a combined experimental paradigm in rodents. METHODS Mice were exposed to hypoxia (prehypoxia). Oxygen-glucose deprivation was performed under three temperatures to simulate brain conditions of deep hypothermic circulatory arrest including ischemia-reperfusion/reoxygenation under hypothermia. RESULTS WM injury in prenormoxia was identified after 35 °C-oxygen-glucose deprivation. In prehypoxia, injury was displayed in all groups. Among oligodendrocyte stages, the preoligodendrocyte was the most susceptible, while the oligodendrocyte progenitor was resistant to insult. When effects of prehypoxia were assessed, injury of mature oligodendrocytes and oligodendrocyte progenitors in prehypoxia significantly increased as compared with prenormoxia, indicating that mature oligodendrocytes and progenitors that had developed under hypoxia had greater vulnerability. Conversely, damage of oligodendrocyte progenitors in prehypoxia were not identified after 15 °C-oxygen-glucose deprivation, suggesting that susceptible oligodendrocytes exposed to hypoxia are protected by deep hypothermia. CONCLUSION Developmental alterations due to hypoxia result in an increased WM susceptibility to injury. Promoting WM regeneration by oligodendrocyte progenitors after earlier surgery using deep hypothermia is the most promising approach for successful WM development in congenital heart disease patients.
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Affiliation(s)
- Kota Agematsu
- Children’s National Heart Institute, Children’s National Medical Center, Washington, DC,Center for Neuroscience Research, Children’s National Medical Center, Washington, DC
| | - Ludmila Korotcova
- Children’s National Heart Institute, Children’s National Medical Center, Washington, DC,Center for Neuroscience Research, Children’s National Medical Center, Washington, DC
| | - Joseph Scafidi
- Center for Neuroscience Research, Children’s National Medical Center, Washington, DC
| | - Vittorio Gallo
- Center for Neuroscience Research, Children’s National Medical Center, Washington, DC
| | - Richard A. Jonas
- Children’s National Heart Institute, Children’s National Medical Center, Washington, DC,Center for Neuroscience Research, Children’s National Medical Center, Washington, DC
| | - Nobuyuki Ishibashi
- Children’s National Heart Institute, Children’s National Medical Center, Washington, DC,Center for Neuroscience Research, Children’s National Medical Center, Washington, DC,Correspondence: Nobuyuki Ishibashi, MD, Children’s National Heart Institute and Center for Neuroscience Research, Children’s National Medical Center, 111 Michigan Avenue, N.W., Washington, DC, 20010-2970. Tel: 202-476-2388, Fax: 202-476-5572,
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Murata A, Agematsu K, Korotcova L, Gallo V, Jonas RA, Ishibashi N. Rodent brain slice model for the study of white matter injury. J Thorac Cardiovasc Surg 2013; 146:1526-1533.e1. [PMID: 23540655 DOI: 10.1016/j.jtcvs.2013.02.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 02/13/2013] [Accepted: 02/28/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Cerebral white matter (WM) injury is common after cardiac surgery in neonates and young infants who have brain immaturity and genetic abnormalities. To understand better the mechanisms associated with WM injury, we tested the adequacy of a novel ex vivo brain slice model, with a particular focus on how the maturational stage modulates the injury. METHODS To replicate conditions of cardiopulmonary bypass, we transferred living brain slices to a closed chamber perfused by artificial cerebrospinal fluid under controlled temperature and oxygenation. Oxygen-glucose deprivation (OGD) simulated circulatory arrest. The effects of maturation were investigated in 7- and 21-day-old mice (P7, P21) that are equivalent in maturation stage to the human fetus and young adult. RESULTS There were no morphologic changes in axons after 60 minutes of OGD at 15°C in both P7 WM and P21 WM. Higher temperature and longer duration of OGD were associated with significantly greater WM axonal damage, suggesting that the model replicates the injury seen after hypothermic circulatory arrest. The axonal damage at P7 was significantly less than at P21, demonstrating that immature axons are more resistant than mature axons. Conversely, a significant increase in caspase3(+) oligodendrocytes in P7 mice was identified relative to P21, indicating that oligodendrocytes in immature WM are more vulnerable than oligodendrocytes in mature WM. CONCLUSIONS Neuroprotective strategies for immature WM may need to focus on reducing oligodendrocyte injury. The brain slice model will be helpful in understanding the effects of cardiac surgery on the immature brain and the brain with genetic abnormalities.
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Affiliation(s)
- Akira Murata
- Children's National Heart Institute, Children's National Medical Center, Washington, DC; Center for Neuroscience Research, Children's National Medical Center, Washington, DC
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Ishibashi N, Scafidi J, Murata A, Korotcova L, Zurakowski D, Gallo V, Jonas RA. White matter protection in congenital heart surgery. Circulation 2012; 125:859-71. [PMID: 22247493 DOI: 10.1161/circulationaha.111.048215] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurodevelopmental delays in motor skills and white matter (WM) injury have been documented in congenital heart disease and after pediatric cardiac surgery. The lack of a suitable animal model has hampered our understanding of the cellular mechanisms underlying WM injury in these patients. Our aim is to identify an optimal surgical strategy for WM protection to reduce neurological injury in congenital heart disease patients. METHODS AND RESULTS We developed a porcine cardiopulmonary bypass model that displays area-dependent WM maturation. In this model, WM injury was identified after cardiopulmonary bypass-induced ischemia-reperfusion injury. The degree of injury was inversely correlated with the maturation stage, which indicates maturation-dependent vulnerability of WM. Within different oligodendrocyte developmental stages, we show selective vulnerability of O4+ preoligodendrocytes, whereas oligodendrocyte progenitor cells were resistant to insults. This indicates that immature WM is vulnerable to cardiopulmonary bypass-induced injury but has an intrinsic potential for recovery mediated by endogenous oligodendrocyte progenitor cells. Oligodendrocyte progenitor cell number decreased with age, which suggests that earlier repair allows successful WM development. Oligodendrocyte progenitor cell proliferation was observed within a few days after cardiopulmonary bypass-induced ischemia-reperfusion injury; however, by 4 weeks, arrested oligodendrocyte maturation and delayed myelination were detected. Logistic model confirmed that maintenance of higher oxygenation and reduction of inflammation were effective in minimizing the risk of injury at immature stages of WM development. CONCLUSIONS Primary repair in neonates and young infants potentially provides successful WM development in congenital heart disease patients. Cardiac surgery during this susceptible period should avoid ischemia-reperfusion injury and minimize inflammation to prevent long-term WM-related neurological impairment.
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Affiliation(s)
- Nobuyuki Ishibashi
- Children's National Medical Center, 111 Michigan Ave NW, Washington, DC 20010-2970, USA
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