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Yang MF, Ren DX, Pan X, Li CX, Xu SY. The Role of Astrocytes in Migraine with Cortical Spreading Depression: Protagonists or Bystanders? A Narrative Review. Pain Ther 2024:10.1007/s40122-024-00610-9. [PMID: 38743247 DOI: 10.1007/s40122-024-00610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 05/01/2024] [Indexed: 05/16/2024] Open
Abstract
Cortical spreading depression (CSD) is a slow wave of cortical depolarization closely associated with migraines with an aura. Previously, it was thought that CSD depolarization was mainly driven by neurons, with characteristic changes in neuronal swelling and increased extracellular potassium (K+) and glutamate. However, the role of astrocytes, a member of the neurovascular unit, in migraine with CSD has recently received increasing attention. In the early stages of CSD, astrocytes provide neurons with energy support and clear K+ and glutamate from synaptic gaps. However, in the late stages of CSD, astrocytes release large amounts of lactic acid to exacerbate hypoxia when the energy demand exceeds the astrocytes' compensatory capacity. Astrocyte endfoot swelling is a characteristic of CSD, and neurons are not similarly altered. It is primarily due to K+ influx and abnormally active calcium (Ca2+) signaling. Aquaporin 4 (AQP-4) only mediates K+ influx and has little role as an aquaporin. Astrocytes endfoot swelling causes perivascular space closure, slowing the glymphatic system flow and exacerbating neuroinflammation, leading to persistent CSD. Astrocytes are double-edged swords in migraine with CSD and may be potential targets for CSD interventions.
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Affiliation(s)
- Meng-Fan Yang
- Department of Neurology, Headache Center, The First Hospital of Shanxi Medical University, Jiefangnan 85 Road, Taiyuan,, 030001, Shanxi, China
| | - Dong-Xue Ren
- Department of Neurology, Headache Center, The First Hospital of Shanxi Medical University, Jiefangnan 85 Road, Taiyuan,, 030001, Shanxi, China
| | - Xue Pan
- Department of Neurology, Headache Center, The First Hospital of Shanxi Medical University, Jiefangnan 85 Road, Taiyuan,, 030001, Shanxi, China
| | - Chang-Xin Li
- Department of Neurology, Headache Center, The First Hospital of Shanxi Medical University, Jiefangnan 85 Road, Taiyuan,, 030001, Shanxi, China
| | - Sui-Yi Xu
- Department of Neurology, Headache Center, The First Hospital of Shanxi Medical University, Jiefangnan 85 Road, Taiyuan,, 030001, Shanxi, China.
- Research Center for Neurological Diseases, Center for Cerebrovascular Diseases Research, Shanxi Medical University, Taiyuan, China.
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Vittorini MG, Sahin A, Trojan A, Yusifli S, Alashvili T, Bonifácio GV, Paposhvili K, Tischler V, Lampl C, Sacco S. The glymphatic system in migraine and other headaches. J Headache Pain 2024; 25:34. [PMID: 38462633 PMCID: PMC10926631 DOI: 10.1186/s10194-024-01741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024] Open
Abstract
Glymphatic system is an emerging pathway of removing metabolic waste products and toxic solutes from the brain tissue. It is made of a network of perivascular spaces, filled in cerebrospinal and interstitial fluid, encompassing penetrating and pial vessels and communicating with the subarachnoid space. It is separated from vessels by the blood brain barrier and from brain tissue by the endfeet of the astrocytes rich in aquaporin 4, a membrane protein which controls the water flow along the perivascular space. Animal models and magnetic resonance (MR) studies allowed to characterize the glymphatic system function and determine how its impairment could lead to numerous neurological disorders (e.g. Alzheimer's disease, stroke, sleep disturbances, migraine, idiopathic normal pressure hydrocephalus). This review aims to summarize the role of the glymphatic system in the pathophysiology of migraine in order to provide new ways of approaching to this disease and to its therapy.
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Affiliation(s)
- Maria Grazia Vittorini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Aysenur Sahin
- Faculty of Medicine-Acibadem Mehmet, Ali Aydinlar University, Istanbul, Turkey
| | - Antonin Trojan
- Department of Neurology, Strakonice Hospital, Strakonice, Czechia
| | - Sevil Yusifli
- Faculty of Medicine-Istanbul University, Istanbul, Turkey
| | - Tamta Alashvili
- Department of Internal Medicine, New Vision University Hospital, Tbilisi, Georgia
| | | | - Ketevan Paposhvili
- Department of Neurology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Viktoria Tischler
- Department of Neurology, Konventhospital Barmherzige Brüder Linz, Linz, Austria
| | - Christian Lampl
- Department of Neurology, Konventhospital Barmherzige Brüder Linz, Linz, Austria.
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Yaghoobi Z, Seyed Bagher Nazeri SS, Asadi A, Derafsh E, Talebi Taheri A, Tamtaji Z, Dadgostar E, Rahmati-Dehkordi F, Aschner M, Mirzaei H, Tamtaji OR, Nabavizadeh F. Non-coding RNAs and Aquaporin 4: Their Role in the Pathogenesis of Neurological Disorders. Neurochem Res 2024; 49:583-596. [PMID: 38114727 DOI: 10.1007/s11064-023-04067-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023]
Abstract
Neurological disorders are a major group of non-communicable diseases affecting quality of life. Non-Coding RNAs (ncRNAs) have an important role in the etiology of neurological disorders. In studies on the genesis of neurological diseases, aquaporin 4 (AQP4) expression and activity have both been linked to ncRNAs. The upregulation or downregulation of several ncRNAs leads to neurological disorder progression by targeting AQP4. The role of ncRNAs and AQP4 in neurological disorders is discussed in this review.
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Affiliation(s)
- Zahra Yaghoobi
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, I.R. of Iran
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. of Iran
| | | | - Amir Asadi
- Psychiatry and Behavioral Sciences Research Center, School of Medicine, Addiction Institute, and Department of Psychiatry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ehsan Derafsh
- Windsor University School of Medicine, Cayon, St Kitts and Nevis
| | - Abdolkarim Talebi Taheri
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Tamtaji
- Student Research Committee, Kashan University of Medical Sciences, Kashan, I.R. of Iran
| | - Ehsan Dadgostar
- Behavioral Sciences Research Center, Isfahan University of Medical Sciences, Isfahan, I.R. of Iran
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, I.R. of Iran
| | - Fatemeh Rahmati-Dehkordi
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, I.R. of Iran
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. of Iran
| | - Michael Aschner
- Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R. of Iran.
| | - Omid Reza Tamtaji
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, I.R. of Iran.
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. of Iran.
| | - Fatemeh Nabavizadeh
- Electrophysiology Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, I.R. of Iran.
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, I.R. of Iran.
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Wu CH, Chang FC, Wang YF, Lirng JF, Wu HM, Pan LLH, Wang SJ, Chen SP. Impaired Glymphatic and Meningeal Lymphatic Functions in Patients with Chronic Migraine. Ann Neurol 2024; 95:583-595. [PMID: 38055324 DOI: 10.1002/ana.26842] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE This study was undertaken to investigate migraine glymphatic and meningeal lymphatic vessel (mLV) functions. METHODS Migraine patients and healthy controls (HCs) were prospectively recruited between 2020 and 2023. Diffusion tensor image analysis along the perivascular space (DTI-ALPS) index for glymphatics and dynamic contrast-enhanced magnetic resonance imaging parameters (time to peak [TTP]/enhancement integral [EI]/mean time to enhance [MTE]) for para-superior sagittal (paraSSS)-mLV or paratransverse sinus (paraTS)-mLV in episodic migraine (EM), chronic migraine (CM), and CM with and without medication-overuse headache (MOH) were analyzed. DTI-ALPS correlations with clinical parameters (migraine severity [numeric rating scale]/disability [Migraine Disability Assessment (MIDAS)]/bodily pain [Widespread Pain Index]/sleep quality [Pittsburgh Sleep Quality Index (PSQI)]) were examined. RESULTS In total, 175 subjects (112 migraine + 63 HCs) were investigated. DTI-ALPS values were lower in CM (median [interquartile range] = 0.64 [0.12]) than in EM (0.71 [0.13], p = 0.005) and HCs (0.71 [0.09], p = 0.004). CM with MOH (0.63 [0.07]) had lower DTI-ALPS values than CM without MOH (0.73 [0.12], p < 0.001). Furthermore, CM had longer TTP (paraSSS-mLV: 55.8 [12.9] vs 40.0 [7.6], p < 0.001; paraTS-mLV: 51.2 [8.1] vs 44.0 [3.3], p = 0.002), EI (paraSSS-mLV: 45.5 [42.0] vs 16.1 [9.2], p < 0.001), and MTE (paraSSS-mLV: 253.7 [6.7] vs 248.4 [13.8], p < 0.001; paraTS-mLV: 252.0 [6.2] vs 249.7 [1.2], p < 0.001) than EM patients. The MIDAS (p = 0.002) and PSQI (p = 0.002) were negatively correlated with DTI-ALPS index after Bonferroni corrections (p < q = 0.01). INTERPRETATION CM patients, particularly those with MOH, have glymphatic and meningeal lymphatic dysfunctions, which are highly clinically relevant and may implicate pathogenesis for migraine chronification. ANN NEUROL 2024;95:583-595.
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Grants
- MOHW 108-TDU-B-211-133001 Ministry of Health and Welfare, Taiwan
- MOHW107-TDU-B-211-123001 Ministry of Health and Welfare, Taiwan
- MOHW112-TDU-B-211-144001 Ministry of Health and Welfare, Taiwan
- N/A Professor Tsuen CHANG's Scholarship Program from Medical Scholarship Foundation In Memory Of Professor Albert Ly-Young Shen
- V109B-009 Taipei Veterans General Hospital
- V110C-102 Taipei Veterans General Hospital
- V111B-032 Taipei Veterans General Hospital
- V112B-007 Taipei Veterans General Hospital
- V112C-053 Taipei Veterans General Hospital
- V112C-059 Taipei Veterans General Hospital
- V112C-113 Taipei Veterans General Hospital
- V112D67-001-MY3-1 Taipei Veterans General Hospital
- V112D67-002-MY3-1 Taipei Veterans General Hospital
- V112E-004-1 Taipei Veterans General Hospital
- VGH-111-C-158 Taipei Veterans General Hospital
- The Brain Research Center, National Yang Ming Chiao Tung University from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan
- 110-2314-B-075-005 The National Science and Technology Council, Taiwan
- 110-2314-B-075-032 The National Science and Technology Council, Taiwan
- 110-2321-B-010-005- The National Science and Technology Council, Taiwan
- 110-2326-B-A49A-501-MY3 The National Science and Technology Council, Taiwan
- 111-2314-B-075 -086-MY3 The National Science and Technology Council, Taiwan
- 111-2314-B-075-025 -MY3 The National Science and Technology Council, Taiwan
- 111-2314-B-A49-069-MY3 The National Science and Technology Council, Taiwan
- 111-2321-B-A49-004 The National Science and Technology Council, Taiwan
- 111-2321-B-A49-011 The National Science and Technology Council, Taiwan
- 112-2314-B-075-066- The National Science and Technology Council, Taiwan
- 112-2314-B-A49-037 -MY3 The National Science and Technology Council, Taiwan
- 112-2321-B-075-007 The National Science and Technology Council, Taiwan
- NSTC 108-2314-B-010-022 -MY3 The National Science and Technology Council, Taiwan
- 109V1-5-2 Veterans General Hospitals and University System of Taiwan Joint Research Program
- 110-G1-5-2 Veterans General Hospitals and University System of Taiwan Joint Research Program
- VGHUST-112-G1-2-1 Veterans General Hospitals and University System of Taiwan Joint Research Program
- Vivian W. Yen Neurological Foundation
- CI-109-3 Yen Tjing Ling Medical Foundation
- CI-111-2 Yen Tjing Ling Medical Foundation
- CI-112-2 Yen Tjing Ling Medical Foundation
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Affiliation(s)
- Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Feng Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Ling Hope Pan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Pin Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
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Wu CH, Kuo Y, Ling YH, Wang YF, Fuh JL, Lirng JF, Wu HM, Wang SJ, Chen SP. Dynamic changes in glymphatic function in reversible cerebral vasoconstriction syndrome. J Headache Pain 2024; 25:17. [PMID: 38317074 PMCID: PMC10840154 DOI: 10.1186/s10194-024-01726-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/26/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The pathophysiology of the reversible cerebral vasoconstriction syndrome (RCVS) remains enigmatic and the role of glymphatics in RCVS pathophysiology has not been evaluated. We aimed to investigate RCVS glymphatic dynamics and its clinical correlates. METHODS We prospectively evaluated the glymphatic function in RCVS patients, with RCVS subjects and healthy controls (HCs) recruited between August 2020 and November 2023, by calculating diffusion-tensor imaging along the perivascular space (DTI-ALPS) index under a 3-T MRI. Clinical and vascular (transcranial color-coded duplex sonography) investigations were conducted in RCVS subjects. RCVS participants were separated into acute (≤ 30 days) and remission (≥ 90 days) groups by disease onset to MRI interval. The time-trend, acute stage and longitudinal analyses of the DTI-ALPS index were conducted. Correlations between DTI-ALPS index and vascular and clinical parameters were performed. Bonferroni correction was applied to vascular investigations (q = 0.05/11). RESULTS A total of 138 RCVS patients (mean age, 46.8 years ± 11.8; 128 women) and 42 HCs (mean age, 46.0 years ± 4.5; 35 women) were evaluated. Acute RCVS demonstrated lower DTI-ALPS index than HCs (p < 0.001) and remission RCVS (p < 0.001). A continuously increasing DTI-ALPS trend after disease onset was demonstrated. The DTI-ALPS was lower when the internal carotid arteries resistance index and six-item Headache Impact test scores were higher. In contrast, during 50-100 days after disease onset, the DTI-ALPS index was higher when the middle cerebral artery flow velocity was higher. CONCLUSIONS Glymphatic function in patients with RCVS exhibited a unique dynamic evolution that was temporally coupled to different vascular indices and headache-related disabilities along the disease course. These findings may provide novel insights into the complex interactions between glymphatic transport, vasomotor control and pain modulation.
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Grants
- V112C-113 & V112E-004-1 (to SJW); V110C-102, VGH-111-C-158, V112C-053 & V112D67-001-MY3-1 (to SPC); V112B-007, V111B-032, V109B-009 (to CHW) Taipei Veterans General Hospital
- V112C-113 & V112E-004-1 (to SJW); V110C-102, VGH-111-C-158, V112C-053 & V112D67-001-MY3-1 (to SPC); V112B-007, V111B-032, V109B-009 (to CHW) Taipei Veterans General Hospital
- V112C-113 & V112E-004-1 (to SJW); V110C-102, VGH-111-C-158, V112C-053 & V112D67-001-MY3-1 (to SPC); V112B-007, V111B-032, V109B-009 (to CHW) Taipei Veterans General Hospital
- CI-112-2, CI-111-2, CI-109-3 (to CHW) Yen Tjing Ling Medical Foundation
- NSTC 108-2314-B-010-022 -MY3, 110-2326-B-A49A-501-MY3 & 112-2314-B-A49 -037 -MY3 (to SPC); 110-2321-B-010-005-, 111-2321-B-A49-004, 111-2321-B-A49-011, 111-2314-B-A49-069-MY3, 111-2314-B-075 -086-MY3 & 112-2321-B-075-007 (to SJW); 111-2314-B-075 -025 -MY3 & 110-2314-B-075-005 (to CHW) National Science and Technology Council
- NSTC 108-2314-B-010-022 -MY3, 110-2326-B-A49A-501-MY3 & 112-2314-B-A49 -037 -MY3 (to SPC); 110-2321-B-010-005-, 111-2321-B-A49-004, 111-2321-B-A49-011, 111-2314-B-A49-069-MY3, 111-2314-B-075 -086-MY3 & 112-2321-B-075-007 (to SJW); 111-2314-B-075 -025 -MY3 & 110-2314-B-075-005 (to CHW) National Science and Technology Council
- NSTC 108-2314-B-010-022 -MY3, 110-2326-B-A49A-501-MY3 & 112-2314-B-A49 -037 -MY3 (to SPC); 110-2321-B-010-005-, 111-2321-B-A49-004, 111-2321-B-A49-011, 111-2314-B-A49-069-MY3, 111-2314-B-075 -086-MY3 & 112-2321-B-075-007 (to SJW); 111-2314-B-075 -025 -MY3 & 110-2314-B-075-005 (to CHW) National Science and Technology Council
- MOHW107-TDU-B-211-123001, MOHW 108-TDU-B-211-133001 and MOHW112-TDU-B-211-144001 (to SJW) Ministry of Health and Welfare
- VGHUST-112-G1-2-1 (to SJW) Veterans General Hospitals and University System of Taiwan Joint Research Program
- Professor Tsuen CHANG’s Scholarship Program from Medical Scholarship Foundation In Memory Of Professor Albert Ly-Young Shen
- Vivian W. Yen Neurological Foundation
- Brain Research Center, National Yang Ming Chiao Tung University from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan
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Affiliation(s)
- Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St, Taipei, Taiwan
| | - Yu Kuo
- Department of Radiology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St, Taipei, Taiwan
- Department of Nuclear Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan
| | - Yu-Hsiang Ling
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan
| | - Yen-Feng Wang
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Taipei, Taiwan
| | - Jong-Ling Fuh
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St, Taipei, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Taipei, Taiwan
| | - Jiing-Feng Lirng
- Department of Radiology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St, Taipei, Taiwan
| | - Hsiu-Mei Wu
- Department of Radiology, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St, Taipei, Taiwan
| | - Shuu-Jiun Wang
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St, Taipei, Taiwan.
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Taipei, Taiwan.
| | - Shih-Pin Chen
- School of Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St, Taipei, Taiwan.
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Taipei, Taiwan.
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong St., Taipei, Taiwan.
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Taipei, Taiwan.
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