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Katlowitz K, Gopinath S, Cruz Navarro J, Robertson C. HMG-CoA Reductase Inhibitors for Traumatic Brain Injury. Neurotherapeutics 2023; 20:1538-1545. [PMID: 37351829 PMCID: PMC10684840 DOI: 10.1007/s13311-023-01399-9] [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] [Accepted: 06/09/2023] [Indexed: 06/24/2023] Open
Abstract
Traumatic brain injuries (TBIs) are associated with high morbidity and mortality due to both the original insult as well as the destructive biological response that follows. Medical management aims to slow or even halt secondary neurological injury while simultaneously laying the groundwork for recovery. Statins are one class of medications that is showing increased promise in the management of TBI. Used extensively in cardiovascular disease, these drugs were originally developed as competitive inhibitors within the cholesterol production pipeline. They are now used in diverse disease states due to their pleiotropic effects on other biological processes such as inflammation and angiogenesis. Preclinical studies, retrospective reviews, and randomized clinical trials have shown a variety of benefits in the management of TBI, but to date, no large-scale randomized clinical trial has been performed. Despite this limitation, statins' early promise and well-tolerated side effect profile make them a promising new tool in the management of TBIs. More bench and clinical studies are needed to delineate proper treatment regimens as well as understand their true potential.
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Affiliation(s)
- Kalman Katlowitz
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, 77030, USA.
| | - Shankar Gopinath
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jovany Cruz Navarro
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Claudia Robertson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, 77030, USA
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2
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Zhong S, Liu T, Zhai Q, Zhang X, Jing H, Li K, Liu S, Liu G, Wang L, Li L, Tao S, Ren L, Shi X, Bao Y. Impacts of Statin Therapy Strategies on Incidence of Ischemic Cerebrovascular Events in Patients With Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Bayesian Network Meta-Analysis. Neurosurgery 2023; 93:24-32. [PMID: 36794961 DOI: 10.1227/neu.0000000000002392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 12/06/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The exacerbation of neurological outcomes often occurs in aneurysmal subarachnoid hemorrhage (aSAH). Statins have been commonly used for aSAH; however, there is lack of evidence of the pharmacological efficacy of different dosages and types of statins. OBJECTIVE To apply the Bayesian network meta-analysis to analyze the optimal dosage and type of statins for the amelioration of ischemic cerebrovascular events (ICEs) in patients with aSAH. METHODS We developed the Bayesian network meta-analysis and systemic review to analyze the effects of statins on functional prognosis and the impacts of optimal dosage and type of statins on ICEs in patients with aSAH. The outcome variables of the analysis were the incidence of ICEs and functional prognosis. RESULTS A total of 2569 patients with aSAH across 14 studies were included. Analysis of 6 randomized controlled trials showed that statin use significantly improved functional prognosis in patients with aSAH (risk ratio [RR], 0.73; 95% CI, 0.55-0.97). Statins significantly reduced the incidence of ICEs (RR, 0.78; 95% CI, 0.67-0.90). Pravastatin (40 mg/d) decreased the incidence ICEs compared with placebo (RR, 0.14; 95% CI, 0.03-0.65) and was ranked the most effective, presenting with a significantly lower rate of the incidence ICEs than the worst-ranked simvastatin (40 mg/d) (RR, 0.13; 95% CI, 0.02-0.79). CONCLUSION Statins could significantly diminish the incidence of ICEs and enhance functional prognosis in patients with aSAH. Various types and dosages of statins show distinct efficacies.
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Affiliation(s)
- Shiyu Zhong
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Tao Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Neurological Institute, Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education, Tianjin, China
| | - Qingqing Zhai
- School of Management, Shanghai University, Shanghai, China
| | - Xudong Zhang
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Huiquan Jing
- School of Public Health, Capital Medical University, Beijing, China
| | - Kunhang Li
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Shengyu Liu
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Guojun Liu
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Liang Wang
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Lishuai Li
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Shanwei Tao
- Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang, China
| | - Lijie Ren
- Neurology Department of Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University Health Science Center, Futian, Shenzhen, China
| | - Xin Shi
- School of Maths and Information Science, Shandong University of Technology and Business, Yantai, Shandong, China
- Business School, All Saints Campus, Manchester Metropolitan University, Manchester, United Kingdom
| | - Yijun Bao
- Department of Neurosurgery, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
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Clark AT, Abrahamson EE, Harper MM, Ikonomovic MD. Chronic effects of blast injury on the microvasculature in a transgenic mouse model of Alzheimer's disease related Aβ amyloidosis. Fluids Barriers CNS 2022; 19:5. [PMID: 35012589 PMCID: PMC8751260 DOI: 10.1186/s12987-021-00301-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/22/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Altered cerebrovascular function and accumulation of amyloid-β (Aβ) after traumatic brain injury (TBI) can contribute to chronic neuropathology and increase the risk for Alzheimer's disease (AD). TBI due to a blast-induced shock wave (bTBI) adversely affects the neurovascular unit (NVU) during the acute period after injury. However, the chronic effects of bTBI and Aβ on cellular components of the NVU and capillary network are not well understood. METHODS We exposed young adult (age range: 76-106 days) female transgenic (Tg) APP/PS1 mice, a model of AD-like Aβ amyloidosis, and wild type (Wt) mice to a single bTBI (~ 138 kPa or ~ 20 psi) or to a Sham procedure. At 3-months or 12-months survival after exposure, we quantified neocortical Aβ load in Tg mice, and percent contact area between aquaporin-4 (AQP4)-immunoreactive astrocytic end-feet and brain capillaries, numbers of PDGFRβ-immunoreactive pericytes, and capillary densities in both genotypes. RESULTS The astroglia AQP4-capillary contact area in the Tg-bTBI group was significantly lower than in the Tg-Sham group at 3-months survival. No significant changes in the AQP4-capillary contact area were observed in the Tg-bTBI group at 12-months survival or in the Wt groups. Capillary density in the Tg-bTBI group at 12-months survival was significantly higher compared to the Tg-Sham control and to the Tg-bTBI 3-months survival group. The Wt-bTBI group had significantly lower capillary density and pericyte numbers at 12-months survival compared to 3-months survival. When pericytes were quantified relative to capillary density, no significant differences were detected among the experimental groups, for both genotypes. CONCLUSION In conditions of high brain concentrations of human Aβ, bTBI exposure results in reduced AQP4 expression at the astroglia-microvascular interface, and in chronic capillary proliferation like what has been reported in AD. Long term microvascular changes after bTBI may contribute to the risk for developing chronic neurodegenerative disease later in life.
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Affiliation(s)
- Alexander T. Clark
- Department of Neurology, University of Pittsburgh School of Medicine, 3471 Fifth Ave, Pittsburgh, PA 15213 USA
| | - Eric E. Abrahamson
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240 USA
- Department of Neurology, University of Pittsburgh School of Medicine, 3471 Fifth Ave, Pittsburgh, PA 15213 USA
| | - Matthew M. Harper
- The Iowa City VA Center for the Prevention and Treatment of Visual Loss, 601 Hwy 6 West, Iowa City, IA 52246 USA
- Department of Ophthalmology and Visual Sciences and Biology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242 USA
| | - Milos D. Ikonomovic
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240 USA
- Department of Neurology, University of Pittsburgh School of Medicine, 3471 Fifth Ave, Pittsburgh, PA 15213 USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Thomas Detre Hall of the WPH, Room 1421, 3811 O’Hara Street, Pittsburgh, PA 15213-2593 USA
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4
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Hu Y, Tao W. Microenvironmental Variations After Blood-Brain Barrier Breakdown in Traumatic Brain Injury. Front Mol Neurosci 2021; 14:750810. [PMID: 34899180 PMCID: PMC8662751 DOI: 10.3389/fnmol.2021.750810] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury (TBI) is linked to several pathologies. The blood-brain barrier (BBB) breakdown is considered to be one of the initial changes. Further, the microenvironmental alteration following TBI-induced BBB breakdown can be multi-scaled, constant, and dramatic. The microenvironmental variations after disruption of BBB includes several pathological changes, such as cerebral blood flow (CBF) alteration, brain edema, cerebral metabolism imbalances, and accumulation of inflammatory molecules. The modulation of the microenvironment presents attractive targets for TBI recovery, such as reducing toxic substances, inhibiting inflammation, and promoting neurogenesis. Herein, we briefly review the pathological alterations of the microenvironmental changes following BBB breakdown and outline potential interventions for TBI recovery based on microenvironmental modulation.
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Affiliation(s)
- Yue Hu
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Weiwei Tao
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Nanjing University of Chinese Medicine, Nanjing, China
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Sultan W, Sapkota A, Khurshid H, Qureshi IA, Jahan N, Went TR, Dominic JL, Win M, Kannan A, Tara A, Ruo SW, Alfonso M. Statins' Effect on Cognitive Outcome After Traumatic Brain Injury: A Systematic Review. Cureus 2021; 13:e16953. [PMID: 34405076 PMCID: PMC8352842 DOI: 10.7759/cureus.16953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/06/2021] [Indexed: 11/05/2022] Open
Abstract
Traumatic brain injury (TBI), also known as the "Silent Epidemic," is a growing devastating global health problem estimated to affect millions of individuals yearly worldwide with little public recognition, leading to many individuals living with a TBI-related disability. TBI has been associated with up to five times increase in the risk of dementia among multiple neurologic complications compared with the general population. Several therapies, including statins, have been tried and showed promising benefits for TBI patients. In this systematic review, we evaluated the recent literature that tested the role of statins on neurological and cognitive outcomes such as Alzheimer's Disease and non-Alzheimer's dementia in survivors of TBI with various severities. We conducted a systematic search on PubMed, PubMed Central, MEDLINE, and Google Scholar. MeSH terms and keywords were used to search for full-text randomized clinical trials (RCTs), cross-sectional, case-control, cohort studies, systematic reviews, and animal studies published in English. Inclusion and exclusion criteria were applied, and the articles were subjected to quality appraisal by two reviewers. Our data search retrieved 4948 nonduplicate records. A total of 18 studies were included - nine human studies, and nine animal laboratory trials - after meeting inclusion, eligibility, and quality assessment criteria. Simvastatin was the most tested statin, and the oral route of administration was the most used. Eight human studies showed a significant neuroprotective effect and improvement in the cognitive outcomes, including dementia. Four randomized clinical trials with 296 patients showed that statins play a neuroprotective role and improve cognitive outcomes through different mechanisms, especially their anti-inflammatory effect; they were shown to lower tumor necrosis factor (TNF)-α and C-reactive protein (CRP) levels. Also, they decreased axonal injury and cortical thickness changes. In addition, four cohort studies compared a total of 867.953 patients. One study showed a decrease in mortality in statin-treated patients (p=0.05). Another study showed a reduction in the incidence of Alzheimer's disease and related dementias (RR, 0.77; 95% CI, 0.73-0.81), while one study showed a decreased risk of dementia after concussions by 6.13% (p=0.001). On the other hand, one cohort study showed no significant difference with the use of statins. In eight animal trials, statins showed a significant neuroprotective effect, improved cognitive outcomes, and neurological functions. Different molecular and cellular mechanisms were suggested, including anti-inflammatory effects, promoting angiogenesis, neurogenesis, increasing cerebral blood flow, neurite outgrowth, promoting the proliferation and differentiation of neural stem cells, and reducing axonal injury. On the contrary, one study showed no benefit and actual adverse effect on the cognitive outcome. Most of the studies showed promising neuroprotective effects of statins in TBI patients. Cognitive outcomes, especially dementia, were improved. However, the optimal therapeutic protocol is still unknown. Thus, statins are candidates for more advanced studies to test their efficacy in preventing cognitive decline in patients with TBI.
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Affiliation(s)
- Waleed Sultan
- Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Alisha Sapkota
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Hajra Khurshid
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Israa A Qureshi
- Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Nasrin Jahan
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Terry R Went
- Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Jerry Lorren Dominic
- General Surgery, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Myat Win
- General Surgery, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Amudhan Kannan
- General Surgery, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Anjli Tara
- General Surgery, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Sheila W Ruo
- General Surgery, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
| | - Michael Alfonso
- Medicine, California Institute of Behavioral Neurosciences & Psychology (CIBNP), Fairfield, USA
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6
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Baird A, Oelsner L, Fisher C, Witte M, Huynh M. A multiscale computational model of angiogenesis after traumatic brain injury, investigating the role location plays in volumetric recovery. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:3227-3257. [PMID: 34198383 DOI: 10.3934/mbe.2021161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Vascular endothelial growth factor (VEGF) is a key protein involved in the process of angiogenesis. VEGF is of particular interest after a traumatic brain injury (TBI), as it re-establishes the cerebral vascular network in effort to allow for proper cerebral blood flow and thereby oxygenation of damaged brain tissue. For this reason, angiogenesis is critical in the progression and recovery of TBI patients in the days and weeks post injury. Although well established experimental work has led to advances in our understanding of TBI and the progression of angiogenisis, many constraints still exist with existing methods, especially when considering patient progression in the days following injury. To better understand the healing process on the proposed time scales, we develop a computational model that quickly simulates vessel growth and recovery by coupling VEGF and its interactions with its associated receptors to a physiologically inspired fractal model of the microvascular re-growth. We use this model to clarify the role that diffusivity, receptor kinetics and location of the TBI play in overall blood volume restoration in the weeks post injury and show that proper therapeutic angiogenesis, or vasculogenic therapies, could speed recovery of the patient as a function of the location of injury.
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Affiliation(s)
- Austin Baird
- Applied Research Associates Inc., Advanced Modeling & Simulation Systems Directorate, 8537 Six Forks Rd, Raleigh, NC 27615, USA
| | - Laura Oelsner
- Varian Medical Systems, 3100 Hansen Way, Palo Alto, CA 94304, USA
| | - Charles Fisher
- Applied Research Associates Inc., Advanced Modeling & Simulation Systems Directorate, 8537 Six Forks Rd, Raleigh, NC 27615, USA
| | - Matt Witte
- Applied Research Associates Inc., Advanced Modeling & Simulation Systems Directorate, 8537 Six Forks Rd, Raleigh, NC 27615, USA
| | - My Huynh
- Applied Research Associates Inc., Advanced Modeling & Simulation Systems Directorate, 8537 Six Forks Rd, Raleigh, NC 27615, USA
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7
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Thalman SW, Powell DK, Lin AL. Novel Calibrated Short TR Recovery (CaSTRR) Method for Brain-Blood Partition Coefficient Correction Enhances Gray-White Matter Contrast in Blood Flow Measurements in Mice. Front Neurosci 2019; 13:308. [PMID: 31001077 PMCID: PMC6454029 DOI: 10.3389/fnins.2019.00308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/19/2019] [Indexed: 12/11/2022] Open
Abstract
The goal of the study was to develop a novel, rapid Calibrated Short TR Recovery (CaSTRR) method to measure the brain-blood partition coefficient (BBPC) in mice. The BBPC is necessary for quantifying cerebral blood flow (CBF) using tracer-based techniques like arterial spin labeling (ASL), but previous techniques required prohibitively long acquisition times so a constant BBPC equal to 0.9 mL/g is typically used regardless of studied species, condition, or disease. An accelerated method of BBPC correction could improve regional specificity in CBF maps particularly in white matter. Male C57Bl/6N mice (n = 8) were scanned at 7T using CaSTRR to measure BBPC determine regional variability. This technique employs phase-spoiled gradient echo acquisitions with varying repetition times (TRs) to estimate proton density in the brain and a blood sample. Proton density weighted images are then calibrated to a series of phantoms with known concentrations of deuterium to determine BBPC. Pseudo-continuous ASL was also acquired to quantify CBF with and without empirical BBPC correction. Using the CaSTRR technique we demonstrate that, in mice, white matter has a significantly lower BBPC (BBPCwhite = 0.93 ± 0.05 mL/g) than cortical gray matter (BBPCgray = 0.99 ± 0.04 mL/g, p = 0.03), and that when voxel-wise BBPC correction is performed on CBF maps the observed difference in perfusion between gray and white matter is improved by as much as 14%. Our results suggest that BBPC correction is feasible and could be particularly important in future studies of perfusion in white matter pathologies.
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Affiliation(s)
- Scott W Thalman
- F. Joseph Halcomb III, MD Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States.,Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, United States
| | - David K Powell
- F. Joseph Halcomb III, MD Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States.,Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, KY, United States
| | - Ai-Ling Lin
- F. Joseph Halcomb III, MD Department of Biomedical Engineering, University of Kentucky, Lexington, KY, United States.,Magnetic Resonance Imaging and Spectroscopy Center, University of Kentucky, Lexington, KY, United States.,Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States.,Department of Neuroscience, University of Kentucky, Lexington, KY, United States
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8
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Guo Y, Li X, Zhang M, Chen N, Wu S, Lei J, Wang Z, Wang R, Wang J, Liu H. Age‑ and brain region‑associated alterations of cerebral blood flow in early Alzheimer's disease assessed in AβPPSWE/PS1ΔE9 transgenic mice using arterial spin labeling. Mol Med Rep 2019; 19:3045-3052. [PMID: 30816468 PMCID: PMC6423566 DOI: 10.3892/mmr.2019.9950] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/06/2019] [Indexed: 02/07/2023] Open
Abstract
It has been suggested that cerebral blood flow (CBF) alterations may be involved in the pathogenesis of Alzheimer's disease (AD). However, how CBF changes with age has not been detailed in AD, particularly in its early stages. The objective of the present study was to evaluate CBF in four brain regions (the hippocampus, entorhinal cortex, frontoparietal cortex and thalamus) of mice in four age groups, to mimic the respective stages of AD in humans [2 months (pre-clinical), 3.5 months (sub-clinical), 5 months (early-clinical) and 8 months (mid-clinical)], to understand the age-associated changes in selected brain regions and to elucidate the underlying vascular mechanisms. CBF was measured using magnetic resonance imaging-arterial spin labelling (ASL) under identical conditions across the age groups of AβPPSWE/PS1ΔE9 (APP/PS1) transgenic mice with AD. The results indicated age- and brain region-associated changes in CBF were associated with early AD. More precisely, an age-dependent increase in CBF (in the pre- and sub-clinical AD groups) was observed in the frontoparietal cortex and thalamus. Conversely, increased CBF demonstrated an age-dependent decline (in the early- and mid-clinical AD groups) in all examined brain regions. Among the regions, the thalamus had the greatest increase in CBF in the 2 and 3.5 months age groups, which was substantially different compared with the age-matched controls. An extension of vessel area was also noted to be age- and brain region-dependent. In particular, correlation analysis revealed significant associations of CBF with vessel area in the frontoparietal cortex and thalamus of APP/PS1 mice at ages 2 and 3.5 months, indicating that CBF increase may arise from vessel extension. The results of the present study suggested that ASL can detect age- and brain region-associated changes in CBF in mice with AD, and that ASL-measured CBF increase may be a potential diagnostic biomarker for early AD. The observation that CBF increase resulted from vessel extension may aid in the understanding of the vascular role in age-associated development of AD pathology, and provide preclinical evidence for AD patient management.
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Affiliation(s)
- Yapei Guo
- Department of Neurology, The Fifth Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xueyuan Li
- Department of Neurosurgery, The First Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Min Zhang
- Department of Neurology, The Fifth Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Ningning Chen
- Department of Neurology, The Fifth Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Shitao Wu
- Department of Neurology, The Fifth Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Jianfeng Lei
- Center for Medical Experiments and Testing, Capital Medical University, Beijing 100069, P.R. China
| | - Zhanjing Wang
- Center for Medical Experiments and Testing, Capital Medical University, Beijing 100069, P.R. China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing 100052, P.R. China
| | - Jianping Wang
- Department of Neurology, The Fifth Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Hengfang Liu
- Department of Neurology, The Fifth Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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Abstract
Over 1.4 million people in the United States experience traumatic brain injury (TBI) each year and approximately 52,000 people die annually due to complications related to TBI. Traditionally, TBI has been viewed as a static injury with significant consequences for frontal lobe functioning that plateaus after some window of recovery, remaining relatively stable thereafter. However, over the past decade there has been growing consensus that the consequences of TBI are dynamic, with unique characteristics expressed at the individual level and over the life span. This chapter first discusses the pathophysiology of TBI in order to understand its dynamic process and then describes the behavioral changes that are the result of injury with focus on frontal lobe functions. It integrates a historical perspective on structural and functional brain-imaging approaches used to understand how TBI impacts the frontal lobes, as well as more recent approaches to examine large-scale network changes after TBI. The factors most useful for outcome prediction are surveyed, along with how the theoretical frameworks used to predict recovery have developed over time. In this chapter, the authors argue for the need to understand outcome after TBI as a dynamic process with individual trajectories, taking a network theory perspective to understand the consequences of disrupting frontal systems in TBI. Within this framework, understanding frontal lobe dysfunction within a larger coordinated neural network to study TBI may provide a novel perspective in outcome prediction and in developing individualized treatments.
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Affiliation(s)
- Rachel A Bernier
- Department of Psychology, Pennsylvania State University, University Park, State College, PA, United States
| | - Frank G Hillary
- Department of Psychology, Pennsylvania State University, University Park, State College, PA, United States.
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10
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Ikonomovic MD, Abrahamson EE, Carlson SW, Graham SH, Dixon CE. Novel therapies for combating chronic neuropathological sequelae of TBI. Neuropharmacology 2018; 145:160-176. [PMID: 29933008 DOI: 10.1016/j.neuropharm.2018.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/13/2018] [Accepted: 06/15/2018] [Indexed: 02/06/2023]
Abstract
Traumatic brain injury (TBI) is a risk factor for development of chronic neurodegenerative disorders later in life. This review summarizes the current knowledge and concepts regarding the connection between long-term consequences of TBI and aging-associated neurodegenerative disorders including Alzheimer's disease (AD), chronic traumatic encephalopathy (CTE), and Parkinsonism, with implications for novel therapy targets. Several aggregation-prone proteins such as the amyloid-beta (Aβ) peptides, tau proteins, and α-synuclein protein are involved in secondary pathogenic cascades initiated by a TBI and are also major building blocks of the hallmark pathological lesions in chronic human neurodegenerative diseases with dementia. Impaired metabolism and degradation pathways of aggregation-prone proteins are discussed as potentially critical links between the long-term aftermath of TBI and chronic neurodegeneration. Utility and limitations of previous and current preclinical TBI models designed to study the link between TBI and chronic neurodegeneration, and promising intervention pharmacotherapies and non-pharmacologic strategies to break this link, are also summarized. Complexity of long-term neuropathological consequences of TBI is discussed, with a goal of guiding future preclinical studies and accelerating implementation of promising therapeutics into clinical trials. This article is part of the Special Issue entitled "Novel Treatments for Traumatic Brain Injury".
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Affiliation(s)
- Milos D Ikonomovic
- Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Eric E Abrahamson
- Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shaun W Carlson
- Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, PA, USA; Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Steven H Graham
- Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - C Edward Dixon
- Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, PA, USA; Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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11
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Cheng WH, Stukas S, Martens KM, Namjoshi DR, Button EB, Wilkinson A, Bashir A, Robert J, Cripton PA, Wellington CL. Age at injury and genotype modify acute inflammatory and neurofilament-light responses to mild CHIMERA traumatic brain injury in wild-type and APP/PS1 mice. Exp Neurol 2017; 301:26-38. [PMID: 29269117 DOI: 10.1016/j.expneurol.2017.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/11/2017] [Accepted: 12/15/2017] [Indexed: 12/14/2022]
Abstract
Peak incidence of traumatic brain injury (TBI) occurs in both young and old individuals, and older age at injury is associated with worse outcome and poorer recovery. Moderate-severe TBI is a reported risk factor for dementia, including Alzheimer's disease (AD), but whether mild TBI (mTBI) alters AD pathogenesis is not clear. To delineate how age at injury and predisposition to amyloid formation affect the acute response to mTBI, we used the Closed Head Impact Model of Engineered Rotational Acceleration (CHIMERA) model of TBI to induce two mild injuries in wild-type (WT) and APP/PS1 mice at either 6 or 13months of age and assessed behavioural, histological and biochemical changes up to 14days post-injury. Age at injury did not alter acute behavioural responses to mTBI, including measures of neurological status, motor performance, spatial memory, fear, or anxiety, in either strain. Young APP/PS1 mice showed a subtle and transient increase in diffuse Aβ deposits after injury, whereas old APP/PS1 mice showed decreased amyloid deposits, without significant alterations in total soluble or insoluble Aβ levels at either age. Age at injury and genotype showed complex responses with respect to microglial and cytokine outcomes, where post-injury neuroinflammation is increased in old WT mice but attenuated in old APP/PS1 mice. Intriguingly, silver staining confirmed axonal damage in both strains and ages, yet only young WT and APP/PS1 mice showed neurofilament-positive axonal swellings after mTBI, as this response was almost entirely attenuated in old mice. Plasma neurofilament-light levels were significantly elevated after injury only in young APP/PS1 mice. This study suggests that mild TBI has minimal effects on Aβ metabolism, but that age and genotype can each modify acute outcomes related to white matter injury.
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Affiliation(s)
- Wai Hang Cheng
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Sophie Stukas
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Kris M Martens
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Dhananjay R Namjoshi
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Emily B Button
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Anna Wilkinson
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Asma Bashir
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Jerome Robert
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Peter A Cripton
- Department of Mechanical Engineering, International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
| | - Cheryl L Wellington
- Department of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 2215 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada.
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12
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Ma HR, Pan PL, Sheng LQ, Dai ZY, Wang GD, Luo R, Chen JH, Xiao PR, Zhong JG, Shi HC. Aberrant pattern of regional cerebral blood flow in Alzheimer's disease: a voxel-wise meta-analysis of arterial spin labeling MR imaging studies. Oncotarget 2017; 8:93196-93208. [PMID: 29190989 PMCID: PMC5696255 DOI: 10.18632/oncotarget.21475] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/20/2017] [Indexed: 12/20/2022] Open
Abstract
Many studies have applied arterial spin labeling (ASL) to characterize cerebral perfusion patterns of Alzheimer's disease (AD). However, findings across studies are not conclusive. A quantitatively voxel-wise meta-analysis to pool the resting-state ASL studies that measure regional cerebral blood flow (rCBF) alterations in AD was conducted to identify the most consistent and replicable perfusion pattern using seed-based d mapping. The meta-analysis, including 17 ASL studies encompassing 327 AD patients and 357 healthy controls, demonstrated that decreased rCBF in AD patients relative to healthy controls were consistently identified in the bilateral posterior cingulate cortices (PCC)/precuneus, bilateral inferior parietal lobules (IPLs), and left dorsolateral prefrontal cortex. The meta-regression analysis showed that more severe cognitive impairment in the AD samples correlated with greater decreases of rCBF in the bilateral PCC and left IPL. This study characterizes an aberrant ASL-rCBF perfusion pattern of AD involving the posterior default mode network and executive network, which are implicated in its pathophysiology and hold promise for developing imaging biomarkers.
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Affiliation(s)
- Hai Rong Ma
- Department of Neurology, Traditional Chinese Medicine Hospital of Kunshan, Kunshan, PR China
| | - Ping Lei Pan
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Li Qin Sheng
- Department of Neurology, Traditional Chinese Medicine Hospital of Kunshan, Kunshan, PR China
| | - Zhen Yu Dai
- Department of Radiology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Gen Di Wang
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Rong Luo
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Jia Hui Chen
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Pei Rong Xiao
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Jian Guo Zhong
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
| | - Hai Cun Shi
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, PR China
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13
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Disordered APP metabolism and neurovasculature in trauma and aging: Combined risks for chronic neurodegenerative disorders. Ageing Res Rev 2017; 34:51-63. [PMID: 27829172 DOI: 10.1016/j.arr.2016.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/20/2016] [Accepted: 11/04/2016] [Indexed: 11/20/2022]
Abstract
Traumatic brain injury (TBI), advanced age, and cerebral vascular disease are factors conferring increased risk for late onset Alzheimer's disease (AD). These conditions are also related pathologically through multiple interacting mechanisms. The hallmark pathology of AD consists of pathological aggregates of amyloid-β (Aβ) peptides and tau proteins. These molecules are also involved in neuropathology of several other chronic neurodegenerative diseases, and are under intense investigation in the aftermath of TBI as potential contributors to the risk for developing AD and chronic traumatic encephalopathy (CTE). The pathology of TBI is complex and dependent on injury severity, age-at-injury, and length of time between injury and neuropathological evaluation. In addition, the mechanisms influencing pathology and recovery after TBI likely involve genetic/epigenetic factors as well as additional disorders or comorbid states related to age and central and peripheral vascular health. In this regard, dysfunction of the aging neurovascular system could be an important link between TBI and chronic neurodegenerative diseases, either as a precipitating event or related to accumulation of AD-like pathology which is amplified in the context of aging. Thus with advanced age and vascular dysfunction, TBI can trigger self-propagating cycles of neuronal injury, pathological protein aggregation, and synaptic loss resulting in chronic neurodegenerative disease. In this review we discuss evidence supporting TBI and aging as dual, interacting risk factors for AD, and the role of Aβ and cerebral vascular dysfunction in this relationship. Evidence is discussed that Aβ is involved in cyto- and synapto-toxicity after severe TBI, and that its chronic effects are potentiated by aging and impaired cerebral vascular function. From a therapeutic perspective, we emphasize that in the fields of TBI- and aging-related neurodegeneration protective strategies should include preservation of neurovascular function.
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14
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Hamel E, Royea J, Ongali B, Tong XK. Neurovascular and Cognitive failure in Alzheimer’s Disease: Benefits of Cardiovascular Therapy. Cell Mol Neurobiol 2016; 36:219-32. [DOI: 10.1007/s10571-015-0285-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/06/2015] [Indexed: 12/19/2022]
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15
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Michels L, Warnock G, Buck A, Macauda G, Leh SE, Kaelin AM, Riese F, Meyer R, O'Gorman R, Hock C, Kollias S, Gietl AF. Arterial spin labeling imaging reveals widespread and Aβ-independent reductions in cerebral blood flow in elderly apolipoprotein epsilon-4 carriers. J Cereb Blood Flow Metab 2016; 36:581-95. [PMID: 26661143 PMCID: PMC4794091 DOI: 10.1177/0271678x15605847] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 10/07/2015] [Indexed: 12/11/2022]
Abstract
Changes in cerebral blood flow are an essential feature of Alzheimer's disease and have been linked to apolipoprotein E-genotype and cerebral amyloid-deposition. These factors could be interdependent or influence cerebral blood flow via different mechanisms. We examined apolipoprotein E-genotype, amyloid beta-deposition, and cerebral blood flow in amnestic mild cognitive impairment using pseudo-continuous arterial spin labeling MRI in 27 cognitively normal elderly and 16 amnestic mild cognitive impairment participants. Subjects underwent Pittsburgh Compound B (PiB) positron emission tomography and apolipoprotein E-genotyping. Global cerebral blood flow was lower in apolipoprotein E ɛ4-allele carriers (apolipoprotein E4+) than in apolipoprotein E4- across all subjects (including cognitively normal participants) and within the group of cognitively normal elderly. Global cerebral blood flow was lower in subjects with mild cognitive impairment compared with cognitively normal. Subjects with elevated cerebral amyloid-deposition (PiB+) showed a trend for lower global cerebral blood flow. Apolipoprotein E-status exerted the strongest effect on global cerebral blood flow. Regional analysis indicated that local cerebral blood flow reductions were more widespread for the contrasts apolipoprotein E4+ versus apolipoprotein E4- compared with the contrasts PiB+ versus PiB- or mild cognitive impairment versus cognitively normal. These findings suggest that apolipoprotein E-genotype exerts its impact on cerebral blood flow at least partly independently from amyloid beta-deposition, suggesting that apolipoprotein E also contributes to cerebral blood flow changes outside the context of Alzheimer's disease.
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Affiliation(s)
- Lars Michels
- Institute of Neuroradiology, University Hospital Zurich, Zurich, Switzerland Center of MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Geoffrey Warnock
- Clinic of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Alfred Buck
- Clinic of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Gianluca Macauda
- Institute of Neuroradiology, University Hospital Zurich, Zurich, Switzerland Neuropsychology Unit, Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Sandra E Leh
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Andrea M Kaelin
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Florian Riese
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Rafael Meyer
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Ruth O'Gorman
- Center of MR-Research, University Children's Hospital Zurich, Zurich, Switzerland
| | - Christoph Hock
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Spyros Kollias
- Institute of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Anton F Gietl
- Division of Psychiatry Research and Psychogeriatric Medicine, University of Zurich, Zurich, Switzerland
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16
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Badaut J, Bix GJ. Vascular neural network phenotypic transformation after traumatic injury: potential role in long-term sequelae. Transl Stroke Res 2013; 5:394-406. [PMID: 24323723 DOI: 10.1007/s12975-013-0304-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/23/2013] [Accepted: 10/24/2013] [Indexed: 01/11/2023]
Abstract
The classical neurovascular unit (NVU), composed primarily of endothelium, astrocytes, and neurons, could be expanded to include smooth muscle and perivascular nerves present in both the up- and downstream feeding blood vessels (arteries and veins). The extended NVU, which can be defined as the vascular neural network (VNN), may represent a new physiological unit to consider for therapeutic development in stroke, traumatic brain injury, and other brain disorders (Zhang et al., Nat Rev Neurol 8(12):711-716, 2012). This review is focused on traumatic brain injury and resultant post-traumatic changes in cerebral blood flow, smooth muscle cells, matrix, blood-brain barrier structures and function, and the association of these changes with cognitive outcomes as described in clinical and experimental reports. We suggest that studies characterizing TBI outcomes should increase their focus on changes to the VNN, as this may yield meaningful therapeutic targets to resolve posttraumatic dysfunction.
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Affiliation(s)
- J Badaut
- Department of Pediatrics, Loma Linda University School of Medicine, Coleman Pavilion, Room A1120, 11175 Campus Street, Loma Linda, CA, 92354, USA,
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