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Crane A, Shanahan RM, Hudson JS, Nowicki KW, Gersey ZC, Agarwal P, Jacobs RC, Lang MJ, Gross B. Pharmaceutical Modulation of Intracranial Aneurysm Development and Rupture. J Clin Med 2024; 13:3324. [PMID: 38893035 PMCID: PMC11173282 DOI: 10.3390/jcm13113324] [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: 04/17/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Management of intracranial aneurysms (IAs) is determined by patient age, risk of rupture, and comorbid conditions. While endovascular and microsurgical interventions offer solutions to mitigate the risk of rupture, pharmacological management strategies may complement these approaches or serve as alternatives in appropriate cases. The pathophysiology of IAs allows for the targeting of inflammation to prevent the development and rupture of IAs. The aim of this review is to provide an updated summary of different pharmaceutical management strategies for IAs. Acetylsalicylic acid and renin-angiotensin-aldosterone system (RAAS) inhibitor antihypertensives have some evidence supporting their protective effect. Studies of selective cyclooxygenase-2 (COX-2) inhibitors, statins, ADP inhibitors, and other metabolism-affecting drugs have demonstrated inconclusive findings regarding their association with aneurysm growth or rupture. In this manuscript, we highlight the evidence supporting each drug's effectiveness.
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Affiliation(s)
- Alex Crane
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Regan M. Shanahan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Joseph S. Hudson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Kamil W. Nowicki
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Zachary C. Gersey
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Prateek Agarwal
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Rachel C. Jacobs
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Michael J. Lang
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Bradley Gross
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
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Lapusan R, Borlan R, Focsan M. Advancing MRI with magnetic nanoparticles: a comprehensive review of translational research and clinical trials. NANOSCALE ADVANCES 2024; 6:2234-2259. [PMID: 38694462 PMCID: PMC11059564 DOI: 10.1039/d3na01064c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/01/2024] [Indexed: 05/04/2024]
Abstract
The nexus of advanced technology and medical therapeutics has ushered in a transformative epoch in contemporary medicine. Within this arena, Magnetic Resonance Imaging (MRI) emerges as a paramount tool, intertwining the advancements of technology with the art of healing. MRI's pivotal role is evident in its broad applicability, spanning from neurological diseases, soft-tissue and tumour characterization, to many more applications. Though already foundational, aspirations remain to further enhance MRI's capabilities. A significant avenue under exploration is the incorporation of innovative nanotechnological contrast agents. Forefront among these are Superparamagnetic Iron Oxide Nanoparticles (SPIONs), recognized for their adaptability and safety profile. SPION's intrinsic malleability allows them to be tailored for improved biocompatibility, while their functionality is further broadened when equipped with specific targeting molecules. Yet, the path to optimization is not devoid of challenges, from renal clearance concerns to potential side effects stemming from iron overload. This review endeavors to map the intricate journey of SPIONs as MRI contrast agents, offering a chronological perspective of their evolution and deployment. We provide an in-depth current outline of the most representative and impactful pre-clinical and clinical studies centered on the integration of SPIONs in MRI, tracing their trajectory from foundational research to contemporary applications.
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Affiliation(s)
- Radu Lapusan
- Biomolecular Physics Department, Faculty of Physics, Babes-Bolyai University Cluj-Napoca Romania
- Nanobiophotonics and Laser Microspectroscopy Centre, Interdisciplinary Research Institute on Bio-Nano-Sciences, Babes-Bolyai University Cluj-Napoca Romania
| | - Raluca Borlan
- Nanobiophotonics and Laser Microspectroscopy Centre, Interdisciplinary Research Institute on Bio-Nano-Sciences, Babes-Bolyai University Cluj-Napoca Romania
| | - Monica Focsan
- Biomolecular Physics Department, Faculty of Physics, Babes-Bolyai University Cluj-Napoca Romania
- Nanobiophotonics and Laser Microspectroscopy Centre, Interdisciplinary Research Institute on Bio-Nano-Sciences, Babes-Bolyai University Cluj-Napoca Romania
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Feng Y, Zhang H, Dai S, Li X. Aspirin treatment for unruptured intracranial aneurysms: Focusing on its anti-inflammatory role. Heliyon 2024; 10:e29119. [PMID: 38617958 PMCID: PMC11015424 DOI: 10.1016/j.heliyon.2024.e29119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024] Open
Abstract
Intracranial aneurysms (IAs), as a common cerebrovascular disease, claims a worldwide morbidity rate of 3.2%. Inflammation, pivotal in the pathogenesis of IAs, influences their formation, growth, and rupture. This review investigates aspirin's modulation of inflammatory pathways within this context. With IAs carrying significant morbidity and mortality upon IAs rupture and current interventions limited to surgical clipping and endovascular coiling, the quest for pharmacological options is imperative. Aspirin's role in cardiovascular prevention, due to its anti-inflammatory effects, presents a potential therapeutic avenue for IAs. In this review, we examine aspirin's efficacy in experimental models and clinical settings, highlighting its impact on the progression and rupture risks of unruptured IAs. The underlying mechanisms of aspirin's impact on IAs are explored, with its ability examined to attenuate endothelial dysfunction and vascular injury. This review may provide a theoretical basis for the use of aspirin, suggesting a promising strategy for IAs management. However, the optimal dosing, safety, and long-term efficacy remain to be established. The implications of aspirin therapy are significant in light of current surgical and endovascular treatments. Further research is encouraged to refine aspirin's clinical application in the management of unruptured IAs, with the ultimate aim of reducing the incidence of aneurysms rupture.
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Affiliation(s)
- Yuan Feng
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongchen Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shuhui Dai
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Xia Li
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Ji H, Li Y, Sun H, Chen R, Zhou R, Yang Y, Wang R, You C, Xiao A, Yi L. Decoding the Cell Atlas and Inflammatory Features of Human Intracranial Aneurysm Wall by Single-Cell RNA Sequencing. J Am Heart Assoc 2024; 13:e032456. [PMID: 38390814 PMCID: PMC10944067 DOI: 10.1161/jaha.123.032456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Intracranial aneurysm (IA) is common and occasionally results in life-threatening hemorrhagic strokes. However, the cell architecture and inflammation in the IA dome remain less understood. METHODS AND RESULTS Single-cell RNA sequencing was performed on ruptured and unruptured human IA domes for delineating the cell atlas, gene expression perturbations, and inflammation features. Two external bulk mRNA sequencing-based data sets and serological results of 126 patients were collected for validation. As a result, a total of 21 332 qualified cells were captured. Vascular cells, including endothelial cells, smooth muscle cells, fibroblasts, and pericytes, were assigned in extremely sparse numbers (4.84%), and were confirmed by immunofluorescence staining. Pericytes, characterized by ABCC9 and HIGD1B, were identified in the IA dome for the first time. Abundant immune cells were identified, with the proportion of monocytes/macrophages and neutrophils being remarkably higher in ruptured IA. The lymphocyte compartment was also thoroughly categorized. By leveraging external data sets and machine learning algorithms, macrophages were robustly associated with IA rupture, irrespective of their polarization status. The single nucleotide polymorphism rs2280543, which is identified in East Asian populations, was associated with macrophage metabolic reprogramming through regulating TALDO1 expression. CONCLUSIONS This study provides insights into the cellular architecture and inflammatory features in the IA dome and may enlighten novel therapeutics for unruptured IA.
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Affiliation(s)
- Hang Ji
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Yue Li
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Haogeng Sun
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Ruiqi Chen
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Ran Zhou
- Department of Neurosurgery, State Key Laboratory of Biotherapy and Cancer Center, West China HospitalSichuan UniversityChengduChina
| | - Yongbo Yang
- Department of Neurosurgery, Nanjing Drum Tower HospitalThe Affiliated Hospital of Nanjing University Medical SchoolNanjingChina
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Chao You
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Anqi Xiao
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Liu Yi
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
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Lauzier DC, Srienc AI, Vellimana AK, Dacey Jr RG, Zipfel GJ. Peripheral macrophages in the development and progression of structural cerebrovascular pathologies. J Cereb Blood Flow Metab 2024; 44:169-191. [PMID: 38000039 PMCID: PMC10993883 DOI: 10.1177/0271678x231217001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 11/26/2023]
Abstract
The human cerebrovascular system is responsible for maintaining neural function through oxygenation, nutrient supply, filtration of toxins, and additional specialized tasks. While the cerebrovascular system has resilience imparted by elaborate redundant collateral circulation from supportive tertiary structures, it is not infallible, and is susceptible to developing structural vascular abnormalities. The causes of this class of structural cerebrovascular diseases can be broadly categorized as 1) intrinsic developmental diseases resulting from genetic or other underlying aberrations (arteriovenous malformations and cavernous malformations) or 2) extrinsic acquired diseases that cause compensatory mechanisms to drive vascular remodeling (aneurysms and arteriovenous fistulae). Cerebrovascular diseases of both types pose significant risks to patients, in some cases leading to death or disability. The drivers of such diseases are extensive, yet inflammation is intimately tied to all of their progressions. Central to this inflammatory hypothesis is the role of peripheral macrophages; targeting this critical cell type may lead to diagnostic and therapeutic advancement in this area. Here, we comprehensively review the role that peripheral macrophages play in cerebrovascular pathogenesis, provide a schema through which macrophage behavior can be understood in cerebrovascular pathologies, and describe emerging diagnostic and therapeutic avenues in this area.
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Affiliation(s)
- David C Lauzier
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Anja I Srienc
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ananth K Vellimana
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ralph G Dacey Jr
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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Wiart M, Tavakoli C, Hubert V, Hristovska I, Dumot C, Parola S, Lerouge F, Chauveau F, Canet-Soulas E, Pascual O, Cormode DP, Brun E, Elleaume H. Use of metal-based contrast agents for in vivo MR and CT imaging of phagocytic cells in neurological pathologies. J Neurosci Methods 2023; 383:109729. [PMID: 36272462 DOI: 10.1016/j.jneumeth.2022.109729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/30/2022]
Abstract
The activation of phagocytic cells is a hallmark of many neurological diseases. Imaging them in their 3-dimensional cerebral environment over time is crucial to better understand their role in disease pathogenesis and to monitor their potential therapeutic effects. Phagocytic cells have the ability to internalize metal-based contrast agents both in vitro and in vivo and can thus be tracked by magnetic resonance imaging (MRI) or computed tomography (CT). In this review article, we summarize the different labelling strategies, contrast agents, and in vivo imaging modalities that can be used to monitor cells with phagocytic activity in the central nervous system using MRI and CT, with a focus on clinical applications. Metal-based nanoparticle contrast agents such as gadolinium, gold and iron are ideal candidates for these applications as they have favourable magnetic and/or radiopaque properties and can be fine-tuned for optimal uptake by phagocytic cells. However, they also come with downsides due to their potential toxicity, especially in the brain where they might accumulate. We therefore conclude our review by discussing the pitfalls, safety and potential for clinical translation of these metal-based neuroimaging techniques. Early results in patients with neuropathologies such as multiple sclerosis, stroke, trauma, cerebral aneurysm and glioblastoma are promising. If the challenges represented by safety issues are overcome, phagocytic cells imaging will be a very valuable tool for studying and understanding the inflammatory response and evaluating treatments that aim at mitigating this response in patients with neurological diseases.
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Affiliation(s)
- Marlène Wiart
- Univ. Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69003 Lyon, France; CNRS, Lyon, France.
| | - Clément Tavakoli
- Univ. Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69003 Lyon, France; Univ. Grenoble Alpes, INSERM UA7 STROBE, 38000 Grenoble, France
| | - Violaine Hubert
- Univ. Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | | | - Chloé Dumot
- Univ. Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69003 Lyon, France; Hospices Civils de Lyon, Lyon, France
| | - Stéphane Parola
- Université de Lyon, Ecole Normale Supérieure de Lyon, CNRS UMR 5182, Université Lyon 1, Laboratoire de Chimie, 46 allée d'Italie, 69364 Lyon, France
| | - Frédéric Lerouge
- Université de Lyon, Ecole Normale Supérieure de Lyon, CNRS UMR 5182, Université Lyon 1, Laboratoire de Chimie, 46 allée d'Italie, 69364 Lyon, France
| | - Fabien Chauveau
- CNRS, Lyon, France; Univ. Lyon, Lyon Neurosciences Research Center, CNRS UMR5292, INSERM U1028, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | - Emmanuelle Canet-Soulas
- Univ. Lyon, CarMeN Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69003 Lyon, France
| | | | - David P Cormode
- Department of Radiology, University of Pennsylvania, Pennsylvania, United States
| | - Emmanuel Brun
- Univ. Grenoble Alpes, INSERM UA7 STROBE, 38000 Grenoble, France
| | - Hélène Elleaume
- Univ. Grenoble Alpes, INSERM UA7 STROBE, 38000 Grenoble, France
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Kiru L, Zlitni A, Tousley AM, Dalton GN, Wu W, Lafortune F, Liu A, Cunanan KM, Nejadnik H, Sulchek T, Moseley ME, Majzner RG, Daldrup-Link HE. In vivo imaging of nanoparticle-labeled CAR T cells. Proc Natl Acad Sci U S A 2022; 119:e2102363119. [PMID: 35101971 PMCID: PMC8832996 DOI: 10.1073/pnas.2102363119] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 12/10/2021] [Indexed: 01/20/2023] Open
Abstract
Metastatic osteosarcoma has a poor prognosis with a 2-y, event-free survival rate of ∼15 to 20%, highlighting the need for the advancement of efficacious therapeutics. Chimeric antigen receptor (CAR) T-cell therapy is a potent strategy for eliminating tumors by harnessing the immune system. However, clinical trials with CAR T cells in solid tumors have encountered significant challenges and have not yet demonstrated convincing evidence of efficacy for a large number of patients. A major bottleneck for the success of CAR T-cell therapy is our inability to monitor the accumulation of the CAR T cells in the tumor with clinical-imaging techniques. To address this, we developed a clinically translatable approach for labeling CAR T cells with iron oxide nanoparticles, which enabled the noninvasive detection of the iron-labeled T cells with magnetic resonance imaging (MRI), photoacoustic imaging (PAT), and magnetic particle imaging (MPI). Using a custom-made microfluidics device for T-cell labeling by mechanoporation, we achieved significant nanoparticle uptake in the CAR T cells, while preserving T-cell proliferation, viability, and function. Multimodal MRI, PAT, and MPI demonstrated homing of the T cells to osteosarcomas and off-target sites in animals administered with T cells labeled with the iron oxide nanoparticles, while T cells were not visualized in animals infused with unlabeled cells. This study details the successful labeling of CAR T cells with ferumoxytol, thereby paving the way for monitoring CAR T cells in solid tumors.
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Affiliation(s)
- Louise Kiru
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305
| | - Aimen Zlitni
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305
| | | | | | - Wei Wu
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305
| | - Famyrah Lafortune
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305
| | - Anna Liu
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332
| | - Kristen May Cunanan
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305
| | - Hossein Nejadnik
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104
| | - Todd Sulchek
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332
| | - Michael Eugene Moseley
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305
| | - Robbie G Majzner
- Department of Pediatrics, Stanford University, Stanford, CA 94305
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305
| | - Heike Elisabeth Daldrup-Link
- Department of Radiology, Molecular Imaging Program at Stanford, Stanford University, Stanford, CA 94305;
- Department of Pediatrics, Stanford University, Stanford, CA 94305
- Stanford Cancer Institute, Stanford University, Stanford, CA 94305
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Wanderer S, Grüter BE, Strange F, Boillat G, Sivanrupan S, Rey J, von Gunten M, Remonda L, Widmer HR, Casoni D, Andereggen L, Fandino J, Marbacher S. Aspirin treatment prevents inflammation in experimental bifurcation aneurysms in New Zealand White rabbits. J Neurointerv Surg 2022; 14:189-195. [PMID: 33785639 PMCID: PMC8785064 DOI: 10.1136/neurintsurg-2020-017261] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Aneurysm wall degeneration is linked to growth and rupture. To address the effect of aspirin (ASA) on aneurysm formation under various wall conditions, this issue was analyzed in a novel rabbit bifurcation model. METHODS Bifurcation aneurysms created in 45 New Zealand White rabbits were randomized to vital (n=15), decellularized (n=13), or elastase-degraded (n=17) wall groups; each group was assigned to a study arm with or without ASA. At follow-up 28 days later, aneurysms were evaluated for patency, growth, and wall inflammation at macroscopic and histological levels. RESULTS 36 rabbits survived to follow-up at the end of the trial. None of the aneurysms had ruptured. Patency was visualized in all aneurysms by intraoperative fluorescence angiography and confirmed in 33 (92%) of 36 aneurysms by MRI/MRA. Aneurysm size was significantly increased in the vital (without ASA) and elastase-degraded (with and without ASA) groups. Aneurysm thrombosis was considered complete in three (50%) of six decellularized aneurysms without ASA by MRI/MRA. Locoregional inflammation of the aneurysm complex was significantly reduced in histological analysis among all groups treated with ASA. CONCLUSION ASA intake prevented inflammation of both the periadventitial tissue and aneurysm wall, irrespective of initial wall condition. Although ASA prevented significant growth in aneurysms with vital walls, this preventive effect did not have an important role in elastase-degraded pouches. In possible translation to the clinical situation, ASA might exert a potential preventive effect during early phases of aneurysm formation in patients with healthy vessels but not in those with highly degenerative aneurysm walls.
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Affiliation(s)
- Stefan Wanderer
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Basil Erwin Grüter
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Fabio Strange
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Gwendoline Boillat
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Sivani Sivanrupan
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Jeannine Rey
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | | | - Luca Remonda
- Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau AG, Aarau, Aargau, Switzerland
| | | | - Daniela Casoni
- Faculty of Medicine, University of Bern, Experimental Surgery Facility, Bern, Switzerland
| | - Lukas Andereggen
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Javier Fandino
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
| | - Serge Marbacher
- Neurosurgery, Kantonsspital Aarau AG, Aarau, Switzerland
- Department for BioMedical Research, University of Bern, Cerebrovascular Research Group, Bern, Switzerland
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Huang Y, Hsu JC, Koo H, Cormode DP. Repurposing ferumoxytol: Diagnostic and therapeutic applications of an FDA-approved nanoparticle. Am J Cancer Res 2022; 12:796-816. [PMID: 34976214 PMCID: PMC8692919 DOI: 10.7150/thno.67375] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
Ferumoxytol is an intravenous iron oxide nanoparticle formulation that has been approved by the U.S. Food and Drug Administration (FDA) for treating anemia in patients with chronic kidney disease. In recent years, ferumoxytol has also been demonstrated to have potential for many additional biomedical applications due to its excellent inherent physical properties, such as superparamagnetism, biocatalytic activity, and immunomodulatory behavior. With good safety and clearance profiles, ferumoxytol has been extensively utilized in both preclinical and clinical studies. Here, we first introduce the medical needs and the value of current iron oxide nanoparticle formulations in the market. We then focus on ferumoxytol nanoparticles and their physicochemical, diagnostic, and therapeutic properties. We include examples describing their use in various biomedical applications, including magnetic resonance imaging (MRI), multimodality imaging, iron deficiency treatment, immunotherapy, microbial biofilm treatment and drug delivery. Finally, we provide a brief conclusion and offer our perspectives on the current limitations and emerging applications of ferumoxytol in biomedicine. Overall, this review provides a comprehensive summary of the developments of ferumoxytol as an agent with diagnostic, therapeutic, and theranostic functionalities.
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Guo Y, Guo XM, Zhao K, Yang MF. Aspirin and growth, rupture of unruptured intracranial aneurysms: A systematic review and meta-analysis. Clin Neurol Neurosurg 2021; 209:106949. [PMID: 34562772 DOI: 10.1016/j.clineuro.2021.106949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Aspirin has been suggested as a potential therapeutic strategy to prevent the growth and rupture of unruptured intracranial aneurysms (UIAs), but there is still controversy. The aim of this systematic review and meta-analysis is to determine the association between aspirin use and growth, rupture of UIAs. METHODS We performed a systematic literature search of electronic databases to identify cohort and case-control studies investigating the relationship between aspirin use and growth or rupture of UIAs. Pooled odds ratio (OR) with corresponding 95% confidence interval (CI) were calculated using a random effects model. Heterogeneity among studies was quantified using the I2 statistic, and potential publication bias was assessed using funnel plots. Sensitivity analysis was performed to verify the robustness of the intention-to-treat results. Subgroup analysis was conducted according to the frequency of aspirin use. RESULTS We identified 8 studies comprising 10,518 participants. The risk of bias was low to moderate. The pooled estimate showed that aspirin use was associated with a lower likelihood of growth of UIAs (OR = 0.25, 95% CI = 0.11-0.55; p = 0.0005) without statistical heterogeneity (p for Cochran Q statistic = 0.62, I2 = 0%). Likewise, aspirin intake also significant decreased 58% risk of intracranial aneurysms rupture (OR = 0.42, 95% CI = 0.29-0.60; p < 0.00001) with moderate heterogeneity (p for Cochran Q statistic = 0.005, I2 = 66%). Similar results were observed in the sensitivity analysis. Pooled OR of aspirin frequency subgroup analysis for less than or equal to 2 times per week was 0.82 (95%CI = 0.40-1.72; I2 = 0%), for at least 3 times per week to daily was 0.25 (95%CI = 0.12-053; I2 = 0%), for daily was 0.59 (95%CI: 0.47-0.74; I2 = 0%), and for unknown was 0.26 (95%CI: 0.15-0.45; I2 = 51%). CONCLUSIONS The results of this systematic review and meta-analysis indicates a beneficial effect of aspirin on growth and rupture of UIAs.
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Affiliation(s)
- Yu Guo
- Graduate School, Qinghai University, Xining, Qinghai, China
| | - Xin-Mei Guo
- Biomedical Engineering Research Center, Kunming Medical University, Kunming, Yunnan, China
| | - Kai Zhao
- Graduate School, Qinghai University, Xining, Qinghai, China
| | - Ming-Fei Yang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai, China.
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Muhammad S, Chaudhry SR, Dobreva G, Lawton MT, Niemelä M, Hänggi D. Vascular Macrophages as Therapeutic Targets to Treat Intracranial Aneurysms. Front Immunol 2021; 12:630381. [PMID: 33763073 PMCID: PMC7982735 DOI: 10.3389/fimmu.2021.630381] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/11/2021] [Indexed: 01/08/2023] Open
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a highly fatal and morbid type of hemorrhagic strokes. Intracranial aneurysms (ICAs) rupture cause subarachnoid hemorrhage. ICAs formation, growth and rupture involves cellular and molecular inflammation. Macrophages orchestrate inflammation in the wall of ICAs. Macrophages generally polarize either into classical inflammatory (M1) or alternatively-activated anti-inflammatory (M2)-phenotype. Macrophage infiltration and polarization toward M1-phenotype increases the risk of aneurysm rupture. Strategies that deplete, inhibit infiltration, ameliorate macrophage inflammation or polarize to M2-type protect against ICAs rupture. However, clinical translational data is still lacking. This review summarizes the contribution of macrophage led inflammation in the aneurysm wall and discuss pharmacological strategies to modulate the macrophageal response during ICAs formation and rupture.
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Affiliation(s)
- Sajjad Muhammad
- Department of Neurosurgery, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany.,Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Anatomy and Developmental Biology, Medical Faculty Mannheim and European Center for Angioscience (ECAS), University of Heidelberg, Mannheim, Germany
| | - Shafqat Rasul Chaudhry
- Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Gergana Dobreva
- Department of Anatomy and Developmental Biology, Medical Faculty Mannheim and European Center for Angioscience (ECAS), University of Heidelberg, Mannheim, Germany
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Brain and Spine, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Daniel Hänggi
- Department of Neurosurgery, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
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12
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Fu Q, Wang Y, Zhang Y, Zhang Y, Guo X, Xu H, Yao Z, Wang M, Levitt MR, Mossa-Basha M, Zhu J, Cheng J, Guan S, Zhu C. Qualitative and Quantitative Wall Enhancement on Magnetic Resonance Imaging Is Associated With Symptoms of Unruptured Intracranial Aneurysms. Stroke 2021; 52:213-222. [PMID: 33349014 PMCID: PMC7770055 DOI: 10.1161/strokeaha.120.029685] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysmal wall enhancement (AWE) on vessel wall magnetic resonance imaging (VW-MRI) has been described as a new imaging biomarker of unstable unruptured intracranial aneurysms (UIAs). Previous studies of symptomatic UIAs are limited due to small sample sizes and lack of AWE quantification. Our study aims to investigate whether qualitative and quantitative assessment of AWE can differentiate symptomatic and asymptomatic UIAs. METHODS Consecutive patients with UIAs were prospectively recruited for vessel wall magnetic resonance imaging at 3T from October 2014 to October 2019. UIAs were categorized as symptomatic if presenting with sentinel headache or oculomotor nerve palsy directly related to the aneurysm. Evaluation of wall enhancement included enhancement pattern (0=none, 1=focal, and 2=circumferential) and quantitative wall enhancement index (WEI). Univariate and multivariate analyses were used to identify the parameters associated with symptoms. RESULTS Two hundred sixty-seven patients with 341 UIAs (93 symptomatic and 248 asymptomatic) were included in this study. Symptomatic UIAs more frequently showed circumferential AWE than asymptomatic UIAs (66.7% versus 17.3%, P<0.001), as well as higher WEI (median [interquartile range], 1.3 [1.0-1.9] versus 0.3 [0.1-0.9], P<0.001). In multivariate analysis, both AWE pattern and WEI were independent factors associated with symptoms (odds ratio=2.03 across AWE patterns [95% CI, 1.21-3.39], P=0.01; odds ratio=3.32 for WEI [95% CI, 1.51-7.26], P=0.003). The combination of AWE pattern and WEI had an area under the curve of 0.91 to identify symptomatic UIAs, with a sensitivity of 95.7% and a specificity of 73.4%. CONCLUSIONS In a large cohort of UIAs with vessel wall magnetic resonance imaging, both AWE pattern and WEI were independently associated with aneurysm-related symptoms. The qualitative and quantitative features of AWE can potentially be used to identify unstable intracranial aneurysms.
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Affiliation(s)
- Qichang Fu
- Department of Magnetic Resonance, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuting Wang
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Zhang
- Department of Magnetic Resonance, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinbin Guo
- Department of Interventional Neuroradiology, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haowen Xu
- Department of Interventional Neuroradiology, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhiqiang Yao
- Department of Interventional Neuroradiology, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Wang
- Department of Neurological Surgery, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Michael R. Levitt
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
- Department of Radiology, University of Washington, Seattle, WA, USA
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | | | - Jinxia Zhu
- MR Collaboration, Siemens Healthcare Ltd., Beijing, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sheng Guan
- Department of Interventional Neuroradiology, The first Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chengcheng Zhu
- Department of Radiology, University of Washington, Seattle, WA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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13
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Wang J, Wei L, Lu H, Zhu Y. Roles of inflammation in the natural history of intracranial saccular aneurysms. J Neurol Sci 2020; 424:117294. [PMID: 33799211 DOI: 10.1016/j.jns.2020.117294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 12/18/2022]
Abstract
Aneurysmal subarachnoid hemorrhage is caused by intracranial aneurysm (IA) rupture and results in high rates of mortality and morbidity. Factors contributing to IA generation, growth and rupture can involve genetics, injury, hemodynamics, environmental factors, and inflammation, in which inflammatory factors are believed to play central roles in the whole natural history. Inflammatory reactions that contribute to IA development may involve synthesis of many functional proteins and expression of genes induced by changes of blood flow, external stimuli such as smoking, internal balance such as hormonal status changes, and blood pressure. Meanwhile, inflammatory reactions itself can evoke inflammatory cytokines release and aggregation such as MMPs, MCP-1, TNF-α and ZO-1, directly or indirectly promoting aneurysm growth and rupture. However, the details of these inflammatory reactions and their action on inflammatory chemokines are still unknown. Moreover, some agents with the function of anti-inflammation, lipid-lowering, antihypertension or inflammatory factor inhibition may have the potential benefit to reduce the risk of aneurysm development or rupture in a group of population despite the underlying mechanism remains unclear. Consequently, we reviewed the potential inflammatory responses and their mechanisms contributing to aneurysm development and rupture and sought intervention targets that may prevent IA rupture or generation.
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Affiliation(s)
- Jienan Wang
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China
| | - Liming Wei
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China
| | - Haitao Lu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China.
| | - Yueqi Zhu
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600, Yishan Road; Shanghai 200233, China.
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14
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Abstract
Unruptured intracranial aneurysms measuring <7 mm in diameter have become increasingly prevalent due to advances in diagnostic imaging. The most feared complication is aneurysm rupture leading to a subarachnoid hemorrhage. Based on the current literature, the 3 main treatments for an unruptured intracranial aneurysm are conservative management with follow-up imaging, endovascular coiling, or surgical clipping. However, there remains no consensus on the best treatment approach. The natural history of the aneurysm and risk factors for aneurysm rupture must be considered to individualize treatment. Models including population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from a prior aneurysm, site of aneurysm score, Unruptured Intracranial Aneurysm Treatment Score, and advanced neuroimaging can assist physicians in assessing the risk of aneurysm rupture. Macrophages and other inflammatory modulators have been elucidated as playing a role in intracranial aneurysm progression and eventual rupture. Further studies need to be conducted to explore the effects of therapeutic drugs targeting inflammatory modulators.
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15
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Weng JC, Wang J, Li H, Jiao YM, Fu WL, Huo R, Yan ZH, Xu HY, Zhan J, Wang S, Du X, Cao Y, Zhao JZ. Aspirin and Growth of Small Unruptured Intracranial Aneurysm. Stroke 2020; 51:3045-3054. [DOI: 10.1161/strokeaha.120.029967] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
The role of aspirin in unruptured intracranial aneurysm (UIA) growth remains largely unknown. We aim to identify whether aspirin is associated with a lower rate of UIA growth in patients with UIA <7 mm.
Methods:
This prospective cohort study consecutively enrolled patients with UIAs <7 mm with ischemic cerebrovascular disease between January 2016 and December 2019. Baseline and follow-up patient information, including the use of aspirin and blood pressure level, were recorded. Patients were considered aspirin users if they took aspirin, including standard- and low-dose aspirin, ≥3× per week. The primary end point was aneurysm growth in any direction or an indisputable change in aneurysm shape.
Results:
Among the 315 enrolled patients, 272 patients (86.3%) underwent imaging examinations during follow-up (mean follow-up time, 19.6±12.7 months). A total of 113 patients were continuously treated with aspirin. UIA growth occurred in 31 (11.4%) patients. In the multivariate Cox analysis, specific aneurysm locations (anterior communicating artery, posterior communicating artery, or middle cerebral artery; hazard ratio, 2.89 [95% CI, 1.22–6.88];
P
=0.016) and a UIA size of 5 to <7 mm (hazard ratio, 7.61 [95% CI, 3.02–19.22];
P
<0.001) were associated with a high risk of UIA growth, whereas aspirin and well-controlled blood pressure were associated with a low risk of UIA growth (hazard ratio, 0.29 [95% CI, 0.11–0.77];
P
=0.013 and hazard ratio, 0.25 [95% CI, 0.10–0.66];
P
=0.005, respectively). The cumulative annual growth rates were as high as 40.0 and 53.3 per 100 person-years in the high-risk patients (>1 risk factor) with and without aspirin, respectively.
Conclusions:
Aspirin therapy and well-controlled blood pressure are associated with a low risk of UIA growth; the incidence of UIA growth in high-risk patients in the first year is high, warranting intensive surveillance in this patient group.
Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02846259.
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Affiliation(s)
- Jian-Cong Weng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
| | - Jie Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
| | - Hao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
| | - Yu-Ming Jiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
| | - Wei-Lun Fu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
| | - Ran Huo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
| | - Zi-Han Yan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
| | - Hong-Yuan Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
| | - Jiong Zhan
- Neuroscience Imaging Center, Beijing Tiantan Hospital, Capital Medical University, People’s Republic of China (J.Z.)
| | - Shuo Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, People's Republic of China (X.D.)
- Department of Cardiology, Health Research Center, Beijing, People’s Republic of China (X.D.)
| | - Yong Cao
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
| | - Ji-Zong Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China (J.-C.W., J.W., H.L., Y.-M.J., W.-L.F., R.H., Z.-H.Y., H.-Y.X., S.W., Y.C., J.-Z.Z.)
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16
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Yodsanit N, Wang B, Zhao Y, Guo LW, Kent KC, Gong S. Recent progress on nanoparticles for targeted aneurysm treatment and imaging. Biomaterials 2020; 265:120406. [PMID: 32979792 DOI: 10.1016/j.biomaterials.2020.120406] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
An abdominal aortic aneurysm (AAA) is a localized dilatation of the aorta that plagues millions. Its rupture incurs high mortality rates (~80-90%), pressing an urgent need for therapeutic methods to prevent this deadly outcome. Judiciously designed nanoparticles (NPs) have displayed a unique potential to fulfill this need. Aneurysms feature excessive inflammation and extracellular matrix (ECM) degradation. As such, typically inflammatory cells and exposed ECM proteins have been targeted with NPs for therapeutic, diagnostic, or theranostic purposes in experimental models. NPs have been used not only for encapsulation and delivery of drugs and biomolecules in preclinical tests, but also for enhanced imaging to monitor aneurysm progression in patients. Moreover, they can be readily modified with various molecules to improve lesion targeting, detectability, biocompatibility, and circulation time. This review updates on the progress, limitations, and prospects of NP applications in the context of AAA.
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Affiliation(s)
- Nisakorn Yodsanit
- Department of Biomedical Engineering, And Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Bowen Wang
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22903, USA
| | - Yi Zhao
- Department of Biomedical Engineering, And Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Lian-Wang Guo
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22903, USA.
| | - K Craig Kent
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22903, USA.
| | - Shaoqin Gong
- Department of Biomedical Engineering, And Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA; Department of Material Science and Engineering and Department of Chemistry, University of Wisconsin-Madison, Madison, WI, 53715, USA.
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17
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Abstract
OBJECTIVES The aim of this study was to determine the relaxation properties of ferumoxytol, an off-label alternative to gadolinium-based contrast agents, under physiological conditions at 1.5 T and 3.0 T. MATERIALS AND METHODS Ferumoxytol was diluted in gradually increasing concentrations (0.26-4.2 mM) in saline, human plasma, and human whole blood. Magnetic resonance relaxometry was performed at 37°C at 1.5 T and 3.0 T. Longitudinal and transverse relaxation rate constants (R1, R2, R2*) were measured as a function of ferumoxytol concentration, and relaxivities (r1, r2, r2*) were calculated. RESULTS A linear dependence of R1, R2, and R2* on ferumoxytol concentration was found in saline and plasma with lower R1 values at 3.0 T and similar R2 and R2* values at 1.5 T and 3.0 T (1.5 T: r1saline = 19.9 ± 2.3 smM; r1plasma = 19.0 ± 1.7 smM; r2saline = 60.8 ± 3.8 smM; r2plasma = 64.9 ± 1.8 smM; r2*saline = 60.4 ± 4.7 smM; r2*plasma = 64.4 ± 2.5 smM; 3.0 T: r1saline = 10.0 ± 0.3 smM; r1plasma = 9.5 ± 0.2 smM; r2saline = 62.3 ± 3.7 smM; r2plasma = 65.2 ± 1.8 smM; r2*saline = 57.0 ± 4.7 smM; r2*plasma = 55.7 ± 4.4 smM). The dependence of relaxation rates on concentration in blood was nonlinear. Formulas from second-order polynomial fittings of the relaxation rates were calculated to characterize the relationship between R1blood and R2 blood with ferumoxytol. CONCLUSIONS Ferumoxytol demonstrates strong longitudinal and transverse relaxivities. Awareness of the nonlinear relaxation behavior of ferumoxytol in blood is important for ferumoxytol-enhanced magnetic resonance imaging applications and for protocol optimization.
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Barrow JW, Turan N, Wangmo P, Roy AK, Pradilla G. The role of inflammation and potential use of sex steroids in intracranial aneurysms and subarachnoid hemorrhage. Surg Neurol Int 2018; 9:150. [PMID: 30105144 PMCID: PMC6080146 DOI: 10.4103/sni.sni_88_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background Aneurysmal subarachnoid hemorrhage (aSAH) continues to be a devastating neurological condition with a high risk of associated morbidity and mortality. Inflammation has been shown to increase the risk of complications associated with aSAH such as vasospasm and brain injury in animal models and humans. The goal of this review is to discuss the inflammatory mechanisms of aneurysm formation, rupture and vasospasm and explore the role of sex hormones in the inflammatory response to aSAH. Methods A literature review was performed using PubMed using the following search terms: "intracranial aneurysm," "cerebral aneurysm," "dihydroepiandrosterone sulfate" "estrogen," "hormone replacement therapy," "inflammation," "oral contraceptive," "progesterone," "sex steroids," "sex hormones" "subarachnoid hemorrhage," "testosterone." Only studies published in English language were included in the review. Results Studies have shown that administration of sex hormones such as progesterone and estrogen at early stages in the inflammatory cascade can lower the risk and magnitude of subsequent complications. The exact mechanism by which these hormones act on the brain, as well as their role in the inflammatory cascade is not fully understood. Moreover, conflicting results have been published on the effect of hormone replacement therapy in humans. This review will scrutinize the variations in these studies to provide a more detailed understanding of sex hormones as potential therapeutic agents for intracranial aneurysms and aSAH. Conclusion Inflammation may play a role in the pathogenesis of intracranial aneurysm formation and subarachnoid hemorrhage, and administration of sex hormones as anti-inflammatory agents has been associated with improved functional outcome in experimental models. Further studies are needed to determine the therapeutic role of these hormones in the intracranial aneurysms and aSAH.
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Affiliation(s)
- Jack W Barrow
- Cerebrovascular Research Laboratory, Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA.,Mercer University School of Medicine, Savannah, Georgia, USA
| | - Nefize Turan
- Cerebrovascular Research Laboratory, Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Pasang Wangmo
- Cerebrovascular Research Laboratory, Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anil K Roy
- Cerebrovascular Research Laboratory, Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gustavo Pradilla
- Cerebrovascular Research Laboratory, Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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19
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Abstract
Unruptured intracranial aneurysms often have a relatively benign clinical course. Frequently, they are found incidentally during workup for an underlying, possibly related or unrelated, symptom or condition. Overall, brain aneurysms are considered to have a relatively low annual risk of rupture. However, should it occur, aneurysmal subarachnoid hemorrhage can lead to significant morbidity and mortality. Our understanding of the natural history and treatment outcomes of cerebral aneurysms has significantly increased over the last few decades, but choosing the optimal management for each patient requires the careful consideration of numerous medical, clinical and anatomic factors. The purpose of this review is to help physicians and caregivers, who may participate in the diagnosis, counseling and triage of patients with brain aneurysms, understand the basic elements of decision making. We discuss natural history, risk factors, screening, presentation, diagnosis, and their implications on aneurysm management and long-term follow-up. We also provide an overview of the risks and benefits of currently available treatment options.
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Affiliation(s)
- Gabor Toth
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
| | - Russell Cerejo
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
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20
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Macrophage Polarization in Cerebral Aneurysm: Perspectives and Potential Targets. J Immunol Res 2017; 2017:8160589. [PMID: 29445758 PMCID: PMC5763122 DOI: 10.1155/2017/8160589] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/20/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022] Open
Abstract
Cerebral aneurysms (CAs) have become a health burden not only because their rupture is life threatening, but for a series of devastating complications left in survivors. It is well accepted that sustained chronic inflammation plays a crucial role in the pathology of cerebral aneurysms. In particular, macrophages have been identified as critical effector cells orchestrating inflammation in CAs. In recent years, dysregulated M1/M2 polarization has been proposed to participate in the progression of CAs. Although the pathological mechanisms of M1/M2 imbalance in CAs remain largely unknown, recent advances have been made in the understanding of the molecular basis and other immune cells involving in this sophisticated network. We provide a concise overview of the mechanisms associated with macrophage plasticity and the emerging molecular targets.
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21
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Abstract
Unruptured intracranial aneurysms (UIA) occur in approximately 2-3 % of the population. Most of these lesions are incidentally found, asymptomatic and typically carry a benign course. Although the risk of aneurysmal subarachnoid hemorrhage is low, this complication can result in significant morbidity and mortality, making assessment of this risk the cornerstone of UIA management. This article reviews important factors to consider when managing unruptured intracranial aneurysms including patient demographics, comorbidities, family history, symptom status, and aneurysm characteristics. It also addresses screening, monitoring, medical management and current surgical and endovascular therapies.
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22
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Chalouhi N, Atallah E, Jabbour P, Patel PD, Starke RM, Hasan D. Aspirin for the Prevention of Intracranial Aneurysm Rupture. Neurosurgery 2017; 64:114-118. [DOI: 10.1093/neuros/nyx299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/01/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Elias Atallah
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Purvee D. Patel
- Department of Neuro-logical Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers Univer-sity, New Brunswick, New Jersey
| | - Robert M. Starke
- Depart-ment of Neurosurgery, Miami Miller School of Medicine, Miami University Hospital, Miami, Florida
| | - David Hasan
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
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Phan K, Moore JM, Griessenauer CJ, Ogilvy CS, Thomas AJ. Aspirin and Risk of Subarachnoid Hemorrhage. Stroke 2017; 48:1210-1217. [DOI: 10.1161/strokeaha.116.015674] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/15/2017] [Accepted: 02/01/2017] [Indexed: 01/07/2023]
Abstract
Background and Purpose—
Recent studies have suggested that the use of low-dose aspirin may reduce the risk of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to evaluate any association between aspirin use and risk of aSAH based on the literature, and whether this is influenced by duration or frequency of aspirin use.
Methods—
A search of electronic databases was done from inception to September 2016. For each study, data on risk of aSAH in aspirin versus nonaspirin users were used to generate odds ratios and 95% confidence intervals, and combined using inverse variance–weighted averages of logarithmic odds ratios in a random-effects models.
Results—
From 7 included studies, no significant difference was noted between aspirin use of any duration or frequency and nonaspirin users (odds ratio, 1.00; 95% confidence interval, 0.81–1.24;
P
=0.99). We found a significant association between short-term use of aspirin (<3 months) and the risk of aSAH (odds ratio, 1.61; 95% confidence interval, 1.20–2.18;
P
=0.002). No significant difference was found in terms of risk of aSAH for 3 to 12 months, 1 to 3 years, and >3 years of durations of use. No significant association was found between infrequent aspirin use (≤2× per week) or frequent use (≥3× per week) with risk of aSAH.
Conclusions—
Current evidence suggests that short-term (<3 months) use of aspirin is associated with increased risk of aSAH. Limitations include substantial heterogenity of the included studies. The role of long-term aspirin in reducing risk of aSAH remains unclear and ideally should be addressed by an appropriately designed randomized controlled trial.
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Affiliation(s)
- Kevin Phan
- From the NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia (K.P.); Sydney Medical School, University of Sydney, New South Wales, Australia (K.P.); Department of Neurosurgery, Stanford University School of Medicine, CA (J.M.M.); and Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.M.M., C.J.G., C.S.O., A.J.T.)
| | - Justin M. Moore
- From the NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia (K.P.); Sydney Medical School, University of Sydney, New South Wales, Australia (K.P.); Department of Neurosurgery, Stanford University School of Medicine, CA (J.M.M.); and Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.M.M., C.J.G., C.S.O., A.J.T.)
| | - Christoph J. Griessenauer
- From the NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia (K.P.); Sydney Medical School, University of Sydney, New South Wales, Australia (K.P.); Department of Neurosurgery, Stanford University School of Medicine, CA (J.M.M.); and Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.M.M., C.J.G., C.S.O., A.J.T.)
| | - Christopher S. Ogilvy
- From the NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia (K.P.); Sydney Medical School, University of Sydney, New South Wales, Australia (K.P.); Department of Neurosurgery, Stanford University School of Medicine, CA (J.M.M.); and Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.M.M., C.J.G., C.S.O., A.J.T.)
| | - Ajith J. Thomas
- From the NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, New South Wales, Australia (K.P.); Sydney Medical School, University of Sydney, New South Wales, Australia (K.P.); Department of Neurosurgery, Stanford University School of Medicine, CA (J.M.M.); and Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.M.M., C.J.G., C.S.O., A.J.T.)
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Wáng YXJ, Idée JM. A comprehensive literatures update of clinical researches of superparamagnetic resonance iron oxide nanoparticles for magnetic resonance imaging. Quant Imaging Med Surg 2017; 7:88-122. [PMID: 28275562 DOI: 10.21037/qims.2017.02.09] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This paper aims to update the clinical researches using superparamagnetic iron oxide (SPIO) nanoparticles as magnetic resonance imaging (MRI) contrast agent published during the past five years. PubMed database was used for literature search, and the search terms were (SPIO OR superparamagnetic iron oxide OR Resovist OR Ferumoxytol OR Ferumoxtran-10) AND (MRI OR magnetic resonance imaging). The literature search results show clinical research on SPIO remains robust, particularly fuelled by the approval of ferumoxytol for intravenously administration. SPIOs have been tested on MR angiography, sentinel lymph node detection, lymph node metastasis evaluation; inflammation evaluation; blood volume measurement; as well as liver imaging. Two experimental SPIOs with unique potentials are also discussed in this review. A curcumin-conjugated SPIO can penetrate brain blood barrier (BBB) and bind to amyloid plaques in Alzheime's disease transgenic mice brain, and thereafter detectable by MRI. Another SPIO was fabricated with a core of Fe3O4 nanoparticle and a shell coating of concentrated hydrophilic polymer brushes and are almost not taken by peripheral macrophages as well as by mononuclear phagocytes and reticuloendothelial system (RES) due to the suppression of non-specific protein binding caused by their stealthy ''brush-afforded'' structure. This SPIO may offer potentials for the applications such as drug targeting and tissue or organ imaging other than liver and lymph nodes.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong SAR, China
| | - Jean-Marc Idée
- Guerbet, Research and Innovation Division, Roissy-Charles de Gaulle, France
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25
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Intracranial vessel wall imaging for evaluation of steno-occlusive diseases and intracranial aneurysms. J Neuroradiol 2016; 44:123-134. [PMID: 27836652 DOI: 10.1016/j.neurad.2016.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/18/2016] [Accepted: 10/04/2016] [Indexed: 01/23/2023]
Abstract
Cerebrovascular diseases have traditionally been classified, diagnosed and managed based on their luminal characteristics. However, over the past several years, several advancements in MRI techniques have ushered in high-resolution vessel wall imaging (HR-VWI), enabling evaluation of intracranial vessel wall pathology. These advancements now allow us to differentiate diseases which have a common angiographic appearance but vastly different natural histories (i.e. moyamoya versus atherosclerosis, reversible cerebral vasoconstriction syndrome versus vasculitis, stable versus unstable intracranial aneurysms). In this review, we detail the anatomical, histopathological and imaging characteristics of various intracranial steno-occlusive diseases and types of intracranial aneurysms and describe the role that HR-VWI can play in diagnosis, risk stratification and treatment.
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26
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Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol 2016; 12:699-713. [DOI: 10.1038/nrneurol.2016.150] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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27
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Zhang C, Li P, Xi G, Gemmete JJ, Chaudhary N, Thompson BG, Pandey AS. Aspirin and Clopidogrel Inhibit Aneurysm Healing after HydroCoil Implantation in External Carotid Artery Aneurysm Model. J Stroke Cerebrovasc Dis 2016; 25:2610-2618. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022] Open
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28
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Achrol AS, Steinberg GK. Personalized Medicine in Cerebrovascular Neurosurgery: Precision Neurosurgical Management of Cerebral Aneurysms and Subarachnoid Hemorrhage. Front Surg 2016; 3:34. [PMID: 27446925 PMCID: PMC4916172 DOI: 10.3389/fsurg.2016.00034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/26/2016] [Indexed: 11/13/2022] Open
Abstract
Cerebral aneurysms are common vascular lesions. Little is known about the pathogenesis of these lesions and the process by which they destabilize and progress to rupture. Treatment decisions are motivated by a desire to prevent rupture and the devastating morbidity and mortality associated with resulting subarachnoid hemorrhage (SAH). For patients presenting with SAH, urgent intervention is required to stabilize the lesion and prevent re-rupture. Those patients fortunate enough to survive a presenting SAH and subsequent securing of their aneurysm must still face a spectrum of secondary sequelae, which can include cerebral vasospasm, delayed ischemia, seizures, cerebral edema, hydrocephalus, and endocrinologic and catecholamine-induced systemic dysfunction in cardiac, pulmonary, and renal systems. Increased focus on understanding the pathophysiology and molecular characteristics of these secondary processes will enable the development of targeted therapeutics and novel diagnostics for improved patient selection in personalized medicine trials for SAH. In unruptured cerebral aneurysms, treatment decisions are less clear and currently based solely on treating larger lesions, using rigid aneurysm size cutoffs generalized from recent studies that are the subject of ongoing controversy. Further compounding this controversy is the fact that the vast majority of aneurysms that come to clinical attention at the time of a hemorrhagic presentation are of smaller size, suggesting that small aneurysms are indeed not benign lesions. As such, patient-specific biomarkers that better predict which aneurysms represent high-risk lesions that warrant clinical intervention are of vital importance. Recent advancements in genomic and proteomic technologies have enabled the identification of molecular characteristics that may prove useful in tracking aneurysm growth and progression and identifying targets for prophylactic therapeutic interventions. Novel quantitative neuroimaging technologies have also recently emerged, capable of non-invasive characterization of hemodynamic factors, inflammation, and structural changes in aneurysmal walls. The combined use of these quantitative neuroimaging and molecular-based approaches, called Radiogenomics, is a technique that holds great promise in better characterizing individual aneurysms. In the near future, these radiogenomic techniques may help improve quality of life and patient outcomes via patient-specific approaches to the treatment of unruptured cerebral aneurysms and personalized medical management of secondary processes following aneurysmal SAH.
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Affiliation(s)
- Achal Singh Achrol
- Department of Neurosurgery, Stanford University School of Medicine , Stanford, CA , USA
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine , Stanford, CA , USA
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29
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Vasanawala SS, Nguyen KL, Hope MD, Bridges MD, Hope TA, Reeder SB, Bashir MR. Safety and technique of ferumoxytol administration for MRI. Magn Reson Med 2016; 75:2107-11. [PMID: 26890830 DOI: 10.1002/mrm.26151] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 01/10/2016] [Accepted: 01/15/2016] [Indexed: 12/12/2022]
Abstract
Ferumoxytol is an ultrasmall superparamagnetic iron oxide agent marketed for the treatment of anemia. There has been increasing interest in its properties as an MRI contrast agent as well as greater awareness of its adverse event profile. This mini-review summarizes the current state of knowledge of the risks of ferumoxytol and methods of administration.
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Affiliation(s)
| | - Kim-Lien Nguyen
- Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles
| | - Michael D Hope
- Department of Radiology, University of California, San Francisco
| | | | - Thomas A Hope
- Department of Radiology, University of California, San Francisco
| | - Scott B Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, and Emergency Medicine, University of Wisconsin, Madison, WI
| | - Mustafa R Bashir
- Center for Advanced Magnetic Resonance Development and Department of Radiology, Duke University, Durham, NC
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30
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Perrone RD, Malek AM, Watnick T. Vascular complications in autosomal dominant polycystic kidney disease. Nat Rev Nephrol 2015; 11:589-98. [PMID: 26260542 PMCID: PMC4904833 DOI: 10.1038/nrneph.2015.128] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disease. Relentless cyst growth substantially enlarges both kidneys and culminates in renal failure. Patients with ADPKD also have vascular abnormalities; intracranial aneurysms (IAs) are found in ∼10% of asymptomatic patients during screening and in up to 25% of those with a family history of IA or subarachnoid haemorrhage. As the genes responsible for ADPKD—PKD1 and PKD2—have complex integrative roles in mechanotransduction and intracellular calcium signalling, the molecular basis of IA formation might involve focal haemodynamic conditions exacerbated by hypertension and altered flow sensing. IA rupture results in substantial mortality, morbidity and poor long-term outcomes. In this Review, we focus mainly on strategies for screening, diagnosis and treatment of IAs in patients with ADPKD. Other vascular aneurysms and anomalies—including aneurysms of the aorta and coronary arteries, cervicocephalic and thoracic aortic dissections, aortic root dilatation and cerebral dolichoectasia—are less common in this population, and the available data are insufficient to recommend screening strategies. Treatment decisions should be made with expert consultation and be based on a risk-benefit analysis that takes into account aneurysm location and morphology as well as patient age and comorbidities.
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Affiliation(s)
- Ronald D Perrone
- Department of Medicine, Division of Nephrology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Adel M Malek
- Department of Neurosurgery, Cerebrovascular and Endovascular Division, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Terry Watnick
- Department of Medicine, Division of Nephrology, University of Maryland, 720 Rutland Avenue, Baltimore, MD 21205, USA
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31
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Gounis MJ, van der Marel K, Marosfoi M, Mazzanti ML, Clarençon F, Chueh JY, Puri AS, Bogdanov AA. Imaging Inflammation in Cerebrovascular Disease. Stroke 2015; 46:2991-7. [PMID: 26351362 DOI: 10.1161/strokeaha.115.008229] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/07/2015] [Indexed: 02/01/2023]
Abstract
Imaging inflammation in large intracranial artery pathology may play an important role in the diagnosis of and risk stratification for a variety of cerebrovascular diseases. Looking beyond the lumen has already generated widespread excitement in the stroke community, and the potential to unveil molecular processes in the vessel wall is a natural evolution to develop a more comprehensive understanding of the pathogenesis of diseases, such as ICAD and brain aneurysms.
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Affiliation(s)
- Matthew J Gounis
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester.
| | - Kajo van der Marel
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Miklos Marosfoi
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Mary L Mazzanti
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Frédéric Clarençon
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Ju-Yu Chueh
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Ajit S Puri
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Alexei A Bogdanov
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
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32
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Hasan DM, Hindman BJ, Todd MM. Pressure Changes Within the Sac of Human Cerebral Aneurysms in Response to Artificially Induced Transient Increases in Systemic Blood Pressure. Hypertension 2015; 66:324-31. [DOI: 10.1161/hypertensionaha.115.05500] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/19/2015] [Indexed: 12/26/2022]
Abstract
Formation and rupture of cerebral aneurysms have been associated with chronic hypertension. The effect of transient increase in blood pressure and its effect on intra-aneurysmal hemodynamics have not been studied. We examined the effects of controlled increases in blood pressure on different pressure parameters inside the sac of human cerebral aneurysms and corresponding parent arteries using invasive technology. Twelve patients (10 female, 2 male, age 54±15 years) with unruptured cerebral aneurysms undergoing endovascular coiling were recruited. Dual-sensor microwires with the capacity to simultaneously measure flow velocity and pressure were used to measure systolic, diastolic, and mean pressure inside the aneurysm sac and to measure both pressures and flow velocities in the feeder vessel just outside the aneurysm. These pressures were recorded simultaneously with pressures from a radial arterial catheter. Measurements were taken at baseline and then during a gradual increase in systemic systolic blood pressure to a target value of ≈25 mm Hg above baseline, using a phenylephrine infusion. The dose needed to achieve the required increase in radial arterial systolic blood pressure was 0.8±0.2 μg/kg/min. There was a clear linear relationship between changes in radial and aneurysmal pressures with substantial patient-by-patient variation in the slopes of those relationships. The overall increases in systolic and mean pressures in both radial artery and in the aneurysms were similar. Pressures in the aneurysm and in the parent vessels were similar. Peak and mean flow velocities in the parent arteries did not change significantly with phenylephrine infusion, nor did vessel diameters as measured angiographically.
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Affiliation(s)
- David M. Hasan
- From the Department of Neurosurgery (D.M.H) and Department of Anesthesia (B.J.H., M.M.T.), University of Iowa Carver College of Medicine, Iowa City
| | - Bradley J. Hindman
- From the Department of Neurosurgery (D.M.H) and Department of Anesthesia (B.J.H., M.M.T.), University of Iowa Carver College of Medicine, Iowa City
| | - Michael M. Todd
- From the Department of Neurosurgery (D.M.H) and Department of Anesthesia (B.J.H., M.M.T.), University of Iowa Carver College of Medicine, Iowa City
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Starke RM, Chalouhi N, Ding D, Hasan DM. Potential role of aspirin in the prevention of aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis 2015; 39:332-42. [PMID: 25967073 DOI: 10.1159/000381137] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 02/18/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Inflammation is a key element behind the pathophysiology of cerebral aneurysm formation and rupture. Aspirin is a potent inhibitor of cyclooxygenase-2 (COX), which plays a critical role in the expression of immune modulators known to contribute to cerebral aneurysm formation and rupture. Currently, there are no pharmacological therapies for patients with cerebral aneurysms. Both endovascular and microsurgical interventions may be associated with significant morbidity and mortality. Potentially, a medical alternative that prevents aneurysm progression and rupture may be a beneficial therapy for a significant number of patients. SUMMARY In animal models, treatment with aspirin and genetic inactivation of COX-2 decreases aneurysm formation and rupture. Selective inhibition of COX-1 did not decrease aneurysm rupture, suggesting that selection inhibition of COX-2 may be critical in thwarting aneurysm progression. Walls of ruptured human intracranial aneurysms have higher levels of COX-2 and microsomal prostaglandin E2 synthase 1 (mPGES-1), both of which are known to be inhibited by aspirin. In a pilot study, patients undergoing microsurgical clipping had attenuated expression of COX-2, mPGES-1, and macrophages in aneurysm walls after 3 months of aspirin therapy versus those that did not receive aspirin. Additionally, in patients undergoing endovascular therapy, local circulating expression of chemokines and COX-2 were increased in blood samples taken from within aneurysm domes as compared to peripheral blood sample controls. Treatment with aspirin also resulted in decreased expression of COX-2 within leukocytes within aneurysms as compared to peripheral blood samples. Novel molecular imaging with ferumoxytol-enhanced MRI may help in the identification of patients at increased risk for aneurysm rupture and assessment of a response to aspirin therapy. Key Messages: Aspirin has been found to be a safe in patients harboring cerebral aneurysms and clinical studies provide evidence that it may decrease the overall rate of rupture. Furthermore, aspirin is an accessible and inexpensive medicine for patients who may not have access to endovascular or microsurgical treatment or for patients who are deemed low risk of aneurysm rupture, high risk for intervention, or both. Future clinical trials are indicated to determine the overall effect of aspirin on aneurysm progression and rupture. This review provides an update on the potential mechanisms and benefits of aspirin in the treatment of cerebral aneurysms.
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Affiliation(s)
- Robert M Starke
- Department of Neurological Surgery, University of Virginia, Charlottesville, Va., USA
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34
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Iron-based superparamagnetic nanoparticle contrast agents for MRI of infection and inflammation. AJR Am J Roentgenol 2015; 204:W302-13. [PMID: 25714316 DOI: 10.2214/ajr.14.12733] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE. In this article, we summarize the progress to date on the use of superparamagnetic iron oxide nanoparticles (SPIONs) as contrast agents for MRI of inflammatory processes. CONCLUSION. Phagocytosis by macrophages of injected SPIONs results in a prolonged shortening of both T2 and T2* leading to hypointensity of macrophage-infiltrated tissues in contrast-enhanced MR images. SPIONs as contrast agents are therefore useful for the in vivo MRI detection of macrophage infiltration, and there is substantial research and clinical interest in the use of SPION-based contrast agents for MRI of infection and inflammation. This technique has been used to identify active infection in patients with septic arthritis and osteomyelitis; importantly, the MRI signal intensity of the tissue has been found to return to its unenhanced value on successful treatment of the infection. In SPION contrast-enhanced MRI of vascular inflammation, animal studies have shown decreased macrophage uptake in atherosclerotic plaques after treatment with statin drugs. Human studies have shown that both coronary and carotid plaques that take up SPIONs are more prone to rupture and that abdominal aneurysms with increased SPION uptake are more likely to grow. Studies of patients with multiple sclerosis suggest that MRI using SPIONs may have increased sensitivity over gadolinium for plaque detection. Finally, SPIONs have enabled the tracking and imaging of transplanted stem cells in a recipient host.
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35
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Sim KJ, Yan B, Dowling RJ, Mitchell PJ. Intracranial aneurysms with perianeurysmal edema: Long-term outcomes post-endovascular treatment. J Neuroradiol 2015; 42:72-9. [DOI: 10.1016/j.neurad.2014.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 05/06/2014] [Accepted: 05/11/2014] [Indexed: 11/30/2022]
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36
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Bourcier R, Redon R, Desal H. Genetic investigations on intracranial aneurysm: update and perspectives. J Neuroradiol 2015; 42:67-71. [PMID: 25676693 DOI: 10.1016/j.neurad.2015.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/26/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Abstract
Detection of an intracranial aneurysm (IA) is a common finding in MRI practice. Nowadays, the incidence of unruptured IA seems to be increasing with the continuous evolution of imaging techniques. Important modifiable risk factors for SAH are well defined, but familial history of IA is the best risk marker for the presence of IA. Numerous heritable conditions are associated with IA formation but these syndromes account for less than 1% of all IAs in the population. No diagnostic test based on genetic knowledge is currently available to identify theses mutations and patients who are at higher risk for developing IAs. In the longer term, a more comprehensive understanding of independent and interdependent molecular pathways germane to IA formation and rupture may guide the physician in developing targeted therapies and optimizing prognostic risk assessment.
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Affiliation(s)
- Romain Bourcier
- Department of neuroradiology, CHU Nantes, boulevard J.-Monod, 44000 Nantes, France; 1087 Inserm unit, institut du thorax, 44000 Nantes, France.
| | - Richard Redon
- 1087 Inserm unit, institut du thorax, 44000 Nantes, France
| | - Hubert Desal
- Department of neuroradiology, CHU Nantes, boulevard J.-Monod, 44000 Nantes, France; 1087 Inserm unit, institut du thorax, 44000 Nantes, France
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37
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Peña-Silva RA, Chalouhi N, Wegman-Points L, Ali M, Mitchell I, Pierce GL, Chu Y, Ballas ZK, Heistad D, Hasan D. Novel role for endogenous hepatocyte growth factor in the pathogenesis of intracranial aneurysms. Hypertension 2014; 65:587-93. [PMID: 25510828 DOI: 10.1161/hypertensionaha.114.04681] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Inflammation plays a key role in formation and rupture of intracranial aneurysms. Because hepatocyte growth factor (HGF) protects against vascular inflammation, we sought to assess the role of endogenous HGF in the pathogenesis of intracranial aneurysms. Circulating HGF concentrations in blood samples drawn from the lumen of human intracranial aneurysms or femoral arteries were compared in 16 patients. Tissue from superficial temporal arteries and ruptured or unruptured intracranial aneurysms collected from patients undergoing clipping (n=10) were immunostained with antibodies to HGF and its receptor c-Met. Intracranial aneurysms were induced in mice treated with PF-04217903 (a c-Met antagonist) or vehicle. Expression of inflammatory molecules was also measured in cultured human endothelial, smooth muscle cells and monocytes treated with lipopolysaccharides in presence or absence of HGF and PF-04217903. We found that HGF concentrations were significantly higher in blood collected from human intracranial aneurysms (1076±656 pg/mL) than in femoral arteries (196±436 pg/mL; P<0.001). HGF and c-Met were detected by immunostaining in superficial temporal arteries and in both ruptured and unruptured human intracranial aneurysms. A c-Met antagonist did not alter the formation of intracranial aneurysms (P>0.05), but significantly increased the prevalence of subarachnoid hemorrhage and decreased survival in mice (P<0.05). HGF attenuated expression of vascular cell adhesion molecule-1 (P<0.05) and E-Selectin (P<0.05) in human aortic endothelial cells. In conclusion, plasma HGF concentrations are elevated in intracranial aneurysms. HGF and c-Met are expressed in superficial temporal arteries and in intracranial aneurysms. HGF signaling through c-Met may decrease inflammation in endothelial cells and protect against intracranial aneurysm rupture.
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Affiliation(s)
- Ricardo A Peña-Silva
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Nohra Chalouhi
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Lauren Wegman-Points
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Muhammad Ali
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Ian Mitchell
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Gary L Pierce
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Yi Chu
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Zuhair K Ballas
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - Donald Heistad
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.)
| | - David Hasan
- From the Departments of Pharmacology and Neurosurgery, Medical School, Universidad de los Andes, Bogotá, Colombia (R.A.P.-S.); Department of Neurosurgery, Thomas Jefferson University School of Medicine, Philadelphia, PA (N.C.); Department of Health and Human Physiology, University of Iowa, Iowa City (L.W.-P., G.L.P.); Departments of Neurosurgery (M.A., I.M., Y.C., D. Hasan) and Medicine (Y.C., Z.K.B., D. Heistad), University of Iowa Carver College of Medicine, Iowa City; and Department of Medicine, VA Medical Center, Iowa City, IA (Z.K.B.).
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Inflammation, vasospasm, and brain injury after subarachnoid hemorrhage. BIOMED RESEARCH INTERNATIONAL 2014; 2014:384342. [PMID: 25105123 PMCID: PMC4106062 DOI: 10.1155/2014/384342] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/14/2014] [Accepted: 05/26/2014] [Indexed: 12/15/2022]
Abstract
Subarachnoid hemorrhage (SAH) can lead to devastating neurological outcomes, and there are few pharmacologic treatments available for treating this condition. Both animal and human studies provide evidence of inflammation being a driving force behind the pathology of SAH, leading to both direct brain injury and vasospasm, which in turn leads to ischemic brain injury. Several inflammatory mediators that are elevated after SAH have been studied in detail. While there is promising data indicating that blocking these factors might benefit patients after SAH, there has been little success in clinical trials. One of the key factors that complicates clinical trials of SAH is the variability of the initial injury and subsequent inflammatory response. It is likely that both genetic and environmental factors contribute to the variability of patients' post-SAH inflammatory response and that this confounds trials of anti-inflammatory therapies. Additionally, systemic inflammation from other conditions that affect patients with SAH could contribute to brain injury and vasospasm after SAH. Continuing work on biomarkers of inflammation after SAH may lead to development of patient-specific anti-inflammatory therapies to improve outcome after SAH.
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Bashir MR, Bhatti L, Marin D, Nelson RC. Emerging applications for ferumoxytol as a contrast agent in MRI. J Magn Reson Imaging 2014; 41:884-98. [PMID: 24974785 DOI: 10.1002/jmri.24691] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 06/18/2014] [Indexed: 12/12/2022] Open
Abstract
Ferumoxytol is an ultrasmall superparamagnetic iron oxide (USPIO) agent initially approved by the Food and Drug Administration (FDA) as an iron replacement therapy for patients with anemia due to chronic renal failure. Recently, ferumoxytol has been investigated extensively as an intravenous contrast agent in magnetic resonance imaging (MRI). Since it causes regional T1 and T2 * shortening in vivo, conventional pulse sequences can be used following ferumoxytol administration to demonstrate signal enhancement or loss. Ferumoxytol can be administered as a rapid bolus and has a long intravascular half-life on the order of 14-15 hours, making it a potentially useful agent for vascular and perfusion-weighted MRI. In comparison to other USPIOs, ferumoxytol is less limited by allergic and idiosyncratic reactions. Furthermore, since ferumoxytol is an iron-based agent with no potential for causing nephrogenic systemic fibrosis, it may be useful as an alternative to gadolinium-based contrast agents in patients with compromised renal function. Ferumoxytol is ultimately taken up by macrophages/the reticuloendothelial system in the liver, spleen, and lymph nodes, and this uptake mechanism is being explored as a novel imaging technique for vascular lesions, tumors, and lymph nodes. This article reviews the properties of ferumoxytol relevant to MRI as well as many of the uses for the agent currently under investigation.
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Affiliation(s)
- Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
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40
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Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms. Neuroradiology 2014; 56:487-95. [DOI: 10.1007/s00234-014-1355-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 03/19/2014] [Indexed: 11/30/2022]
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41
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Accurate prediction of nodal status in preoperative patients with pancreatic ductal adenocarcinoma using next-gen nanoparticle. Transl Oncol 2013; 6:670-5. [PMID: 24466369 DOI: 10.1593/tlo.13400] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/21/2013] [Accepted: 08/23/2013] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The objective of this study is to assess lymphotropic nanoparticle-enhanced magnetic resonance imaging (LNMRI) in identifying malignant nodal involvement in patients with pancreatic ductal adenocarcinoma. METHODS Magnetic resonance imaging was performed in 13 patients with known or high index of suspicion of pancreatic cancer and who were scheduled for surgical resection. Protocols included T2*-weighted imaging before and after administration of Ferumoxytol (Feraheme) for the evaluation of lymph node involvement. Eleven of the 13 patients underwent a Whipple procedure and lymph node dissection. Nodes that lacked contrast uptake were deemed malignant, and those that demonstrated homogeneous uptake were deemed benign. RESULTS A total of 264 lymph nodes were resection, of which 17 were malignant. The sensitivity and specificity of LNMRI was 76.5% and 98.4% at a nodal level and 83.3% and 80% at a patient level. CONCLUSION LNMRI demonstrated high sensitivity and specificity in patients with pancreatic ductal adenocarcinoma.
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42
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Hudson JS, Hoyne DS, Hasan DM. Inflammation and human cerebral aneurysms: current and future treatment prospects. FUTURE NEUROLOGY 2013; 8. [PMID: 24376373 DOI: 10.2217/fnl.13.40] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The formation of cerebral aneurysms and their rupture propensity is of immediate clinical importance. Current management includes observation with expectant management, microsurgical clipping and/or endovascular coiling. The surgical options are invasive and are not without increased risk despite the technological advances. Recent human and animal studies have shown that inflammation plays a critical role in aneurysm formation and progression to rupture. Modulating this inflammatory process may prove to be clinically significant. This review will discuss cerebral aneurysm pathogenesis with a focus on current and future research of potential use of pharmaceutical agents that attenuate inflammation in the aneurysm wall leading to decreased risk of aneurysm rupture.
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Affiliation(s)
| | - Danielle S Hoyne
- Department of Otolaryngology University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - David M Hasan
- Department of Neurosurgery, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52240, USA
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43
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Chalouhi N, Jabbour P, Magnotta V, Hasan D. Molecular imaging of cerebrovascular lesions. Transl Stroke Res 2013; 5:260-8. [PMID: 24323714 DOI: 10.1007/s12975-013-0291-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/23/2013] [Accepted: 09/26/2013] [Indexed: 01/19/2023]
Abstract
Inflammation is a key component in the pathogenesis of cerebrovascular lesions. Two agents have emerged as promising possibilities for imaging cerebrovascular lesions. These agents are ferumoxytol and myeloperoxidase (MPO)-specific paramagnetic magnetic resonance (MR) contrast agent. Ferumoxytol is an iron oxide nanoparticle coated by a carbohydrate shell that is used in MRI studies as an inflammatory marker as it is cleared by macrophages. Ferumoxytol-enhanced MRI allows noninvasive assessment of the inflammatory status of cerebral aneurysms and arteriovenous malformations and, possibly, may differentiate "unstable" lesions that require early intervention from "stable" lesions that can be safely observed. Several pilot studies have also suggested that MPO-specific paramagnetic MR contrast agent, di-5-hydroxytryptamide of gadopentetate dimeglumine, may allow imaging of inflammation in the wall of saccular aneurysms in animal models. However, studies in human subjects have yet to be performed. In this paper, we review current data regarding ferumoxytol-enhanced MRI and MPO-specific paramagnetic MR contrast agent and discuss current and future applications.
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Affiliation(s)
- Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA
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44
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Affiliation(s)
- Nohra Chalouhi
- From the Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA (N.C.); Jefferson Hospital for Neuroscience, Philadelphia, PA (N.C.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); and Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City (D.H.)
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45
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Vascular smooth muscle cells in cerebral aneurysm pathogenesis. Transl Stroke Res 2013; 5:338-46. [PMID: 24323713 DOI: 10.1007/s12975-013-0290-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
Vascular smooth muscle cells (SMC) maintain significant plasticity. Following environmental stimulation, SMC can alter their phenotype from one primarily concerned with contraction to a pro-inflammatory and matrix remodeling phenotype. This is a critical process behind peripheral vascular disease and atherosclerosis, a key element of cerebral aneurysm pathology. Evolving evidence demonstrates that SMCs and phenotypic modulation play a significant role in cerebral aneurysm formation and rupture. Pharmacological alteration of smooth muscle cell function and phenotypic modulation could provide a promising medical therapy to inhibit cerebral aneurysm progression. This study reviews vascular SMC function and its contribution to cerebral aneurysm pathophysiology.
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46
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Chalouhi N, Jabbour P, Magnotta V, Hasan D. The emerging role of ferumoxytol-enhanced MRI in the management of cerebrovascular lesions. Molecules 2013; 18:9670-83. [PMID: 23945642 PMCID: PMC6270297 DOI: 10.3390/molecules18089670] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 08/08/2013] [Indexed: 12/22/2022] Open
Abstract
Inflammation is increasingly being understood to be a key component to the pathophysiology of cerebrovascular lesions. Ferumoxytol, an iron oxide nanoparticle coated by a carbohydrate shell, has been used in MRI studies as an inflammatory marker because it is cleared by macrophages. Ferumoxytol-enhanced MRI has emerged as an important tool for noninvasive assessment of the inflammatory status of cerebrovascular lesions, namely aneurysms and arteriovenous malformations. Moreover, preliminary evidence suggests that ferumoxytol-enhanced MRI could be applied as a non-invasive tool to differentiate “unstable” lesions that require early intervention from “stable” lesions in which observation may be safe. Assessment of the effects of anti-inflammatory pharmacological interventions on cerebrovascular lesions is also a potentially crucial application of the technique. Future improvements in technique and MRI signal quantification will certainly pave the way for widespread and efficient use of ferumoxytol-enhanced MRI in clinical practice. In this paper, we review current data regarding ferumoxytol-enhanced MRI and discuss its current/potential applications and future perspectives.
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Affiliation(s)
- Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA 19107, USA; E-Mails: (N.C.); (P.J.)
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA 19107, USA; E-Mails: (N.C.); (P.J.)
| | - Vincent Magnotta
- Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA; E-Mail:
| | - David Hasan
- Department of Neurosurgery, University of Iowa, Iowa City, IA 52242, USA; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-319-384-8669; Fax: +1-319-356-2237
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