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Sivagurunathan N, Calivarathan L. SARS-CoV-2 Infection to Premature Neuronal Aging and Neurodegenerative Diseases: Is there any Connection with Hypoxia? CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:431-448. [PMID: 37073650 DOI: 10.2174/1871527322666230418114446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 01/28/2023] [Accepted: 02/09/2023] [Indexed: 04/20/2023]
Abstract
The pandemic of coronavirus disease-2019 (COVID-19), caused by SARS-CoV-2, has become a global concern as it leads to a spectrum of mild to severe symptoms and increases death tolls around the world. Severe COVID-19 results in acute respiratory distress syndrome, hypoxia, and multi- organ dysfunction. However, the long-term effects of post-COVID-19 infection are still unknown. Based on the emerging evidence, there is a high possibility that COVID-19 infection accelerates premature neuronal aging and increases the risk of age-related neurodegenerative diseases in mild to severely infected patients during the post-COVID period. Several studies correlate COVID-19 infection with neuronal effects, though the mechanism through which they contribute to the aggravation of neuroinflammation and neurodegeneration is still under investigation. SARS-CoV-2 predominantly targets pulmonary tissues and interferes with gas exchange, leading to systemic hypoxia. The neurons in the brain require a constant supply of oxygen for their proper functioning, suggesting that they are more vulnerable to any alteration in oxygen saturation level that results in neuronal injury with or without neuroinflammation. We hypothesize that hypoxia is one of the major clinical manifestations of severe SARS-CoV-2 infection; it directly or indirectly contributes to premature neuronal aging, neuroinflammation, and neurodegeneration by altering the expression of various genes responsible for the survival of the cells. This review focuses on the interplay between COVID-19 infection, hypoxia, premature neuronal aging, and neurodegenerative diseases and provides a novel insight into the molecular mechanisms of neurodegeneration.
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Affiliation(s)
- Narmadhaa Sivagurunathan
- Molecular Pharmacology & Toxicology Laboratory, Department of Life Sciences, School of Life Sciences, Central University of Tamil Nadu, Thiruvarur - 610005, Tamil Nadu, India
| | - Latchoumycandane Calivarathan
- Molecular Pharmacology & Toxicology Laboratory, Department of Life Sciences, School of Life Sciences, Central University of Tamil Nadu, Thiruvarur - 610005, Tamil Nadu, India
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Wang ZX, Su R, Li H, Dang P, Zeng TA, Chen DM, Wu JG, Zhang DL, Ma HL. Changes in Hippocampus and Amygdala Volume with Hypoxic Stress Related to Cardiorespiratory Fitness under a High-Altitude Environment. Brain Sci 2022; 12:brainsci12030359. [PMID: 35326315 PMCID: PMC8946638 DOI: 10.3390/brainsci12030359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 02/05/2023] Open
Abstract
The morphology of the hippocampus and amygdala can be significantly affected by a long-term hypoxia-induced inflammatory response. Cardiorespiratory fitness (CRF) has a significant effect on the neuroplasticity of the hippocampus and amygdala by countering inflammation. However, the role of CRF is still largely unclear at high altitudes. Here, we investigated brain limbic volumes in participants who had experienced long-term hypoxia exposure in Tibet (3680 m), utilizing high-resolution structural images to allow the segmentation of the hippocampus and amygdala into their constituent substructures. We recruited a total of 48 participants (48 males; aged = 20.92 ± 1.03 years) to undergo a structural 3T MRI, and the levels of maximal oxygen uptake (VO2max) were measured using a cardiorespiratory function test. Inflammatory biomarkers were also collected. The participants were divided into two groups according to the levels of median VO2max, and the analysis showed that the morphological indexes of subfields of the hippocampus and amygdala of the lower CRF group were decreased when compared with the higher CRF group. Furthermore, the multiple linear regression analysis showed that there was a higher association with inflammatory factors in the lower CRF group than that in the higher CRF group. This study suggested a significant association of CRF with hippocampus and amygdala volume, which may be related to hypoxic stress in high-altitude environments. A better CRF reduced physiological stress and a decrease in the inflammatory response was observed, which may be related to the increased oxygen transport capacity of the body.
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Affiliation(s)
- Zhi-Xin Wang
- Plateau Brain Science Research Center, Tibet University/South China Normal University, Lhasa 850012, China; (Z.-X.W.); (R.S.); (H.L.); (P.D.); (T.-A.Z.); (D.-M.C.)
| | - Rui Su
- Plateau Brain Science Research Center, Tibet University/South China Normal University, Lhasa 850012, China; (Z.-X.W.); (R.S.); (H.L.); (P.D.); (T.-A.Z.); (D.-M.C.)
| | - Hao Li
- Plateau Brain Science Research Center, Tibet University/South China Normal University, Lhasa 850012, China; (Z.-X.W.); (R.S.); (H.L.); (P.D.); (T.-A.Z.); (D.-M.C.)
| | - Peng Dang
- Plateau Brain Science Research Center, Tibet University/South China Normal University, Lhasa 850012, China; (Z.-X.W.); (R.S.); (H.L.); (P.D.); (T.-A.Z.); (D.-M.C.)
| | - Tong-Ao Zeng
- Plateau Brain Science Research Center, Tibet University/South China Normal University, Lhasa 850012, China; (Z.-X.W.); (R.S.); (H.L.); (P.D.); (T.-A.Z.); (D.-M.C.)
| | - Dong-Mei Chen
- Plateau Brain Science Research Center, Tibet University/South China Normal University, Lhasa 850012, China; (Z.-X.W.); (R.S.); (H.L.); (P.D.); (T.-A.Z.); (D.-M.C.)
| | - Jian-Guo Wu
- Management Department, Tibet Police College, Lhasa 850012, China;
| | - De-Long Zhang
- Plateau Brain Science Research Center, Tibet University/South China Normal University, Lhasa 850012, China; (Z.-X.W.); (R.S.); (H.L.); (P.D.); (T.-A.Z.); (D.-M.C.)
- Key Laboratory of Brain, Cognition and Education Sciences, Center for Studies of Psychological Application, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education, School of Psychology, South China Normal University, Guangzhou 510631, China
- Correspondence: (D.-L.Z.); (H.-L.M.)
| | - Hai-Lin Ma
- Plateau Brain Science Research Center, Tibet University/South China Normal University, Lhasa 850012, China; (Z.-X.W.); (R.S.); (H.L.); (P.D.); (T.-A.Z.); (D.-M.C.)
- Correspondence: (D.-L.Z.); (H.-L.M.)
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Chen WL, Nishita Y, Nakamura A, Kato T, Nakagawa T, Zhang S, Shimokata H, Otsuka R, Su KP, Arai H. Hemoglobin Concentration is Associated with the Hippocampal Volume in Community-Dwelling Adults. Arch Gerontol Geriatr 2022; 101:104668. [DOI: 10.1016/j.archger.2022.104668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/02/2022]
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Ma RN, He YX, Bai FP, Song ZP, Chen MS, Li M. Machine Learning Model for Predicting Acute Respiratory Failure in Individuals With Moderate-to-Severe Traumatic Brain Injury. Front Med (Lausanne) 2022; 8:793230. [PMID: 35004766 PMCID: PMC8739486 DOI: 10.3389/fmed.2021.793230] [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: 10/11/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background: There is a high incidence of acute respiratory failure (ARF) in moderate or severe traumatic brain injury (M-STBI), worsening outcomes. This study aimed to design a predictive model for ARF. Methods: Adult patients with M-STBI [3 ≤ Glasgow Coma Scale (GCS) ≤ 12] with a definite history of brain trauma and abnormal head on CT images, obtained from September 2015 to May 2017, were included. Patients with age >80 years or <18 years, multiple injuries with TBI upon admission, or pregnancy (in women) were excluded. Two models based on machine learning extreme gradient boosting (XGBoost) or logistic regression, respectively, were developed for predicting ARF within 48 h upon admission. These models were evaluated by out-of-sample validation. The samples were assigned to the training and test sets at a ratio of 3:1. Results: In total, 312 patients were analyzed including 132 (42.3%) patients who had ARF. The GCS and the Marshall CT score, procalcitonin (PCT), and C-reactive protein (CRP) on admission significantly predicted ARF. The novel machine learning XGBoost model was superior to logistic regression model in predicting ARF [area under the receiver operating characteristic (AUROC) = 0.903, 95% CI, 0.834–0.966 vs. AUROC = 0.798, 95% CI, 0.697–0.899; p < 0.05]. Conclusion: The XGBoost model could better predict ARF in comparison with logistic regression-based model. Therefore, machine learning methods could help to develop and validate novel predictive models.
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Affiliation(s)
- Rui Na Ma
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospitals of Fourth Military Medical University, Xi'an, China
| | - Yi Xuan He
- Neurocritical Care Unit, Department of Neurosurgery, The Second Affiliated Hospitals of Fourth Military Medical University, Xi'an, China
| | - Fu Ping Bai
- Department of Neurosurgery, Lin Fen Center Hospital, Lin Fen, China
| | - Zhi Peng Song
- Neurocritical Care Unit, Department of Neurosurgery, The Second Affiliated Hospitals of Fourth Military Medical University, Xi'an, China
| | - Ming Sheng Chen
- Neurocritical Care Unit, Department of Neurosurgery, The Second Affiliated Hospitals of Fourth Military Medical University, Xi'an, China
| | - Min Li
- Neurocritical Care Unit, Department of Neurosurgery, The Second Affiliated Hospitals of Fourth Military Medical University, Xi'an, China
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Li C, Shah KA, Powell K, Wu YC, Chaung W, Sonti AN, White TG, Doobay M, Yang WL, Wang P, Becker LB, Narayan RK. CBF oscillations induced by trigeminal nerve stimulation protect the pericontusional penumbra in traumatic brain injury complicated by hemorrhagic shock. Sci Rep 2021; 11:19652. [PMID: 34608241 PMCID: PMC8490389 DOI: 10.1038/s41598-021-99234-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/16/2021] [Indexed: 02/08/2023] Open
Abstract
Traumatic peri-contusional penumbra represents crucial targets for therapeutic interventions after traumatic brain injury (TBI). Current resuscitative approaches may not adequately alleviate impaired cerebral microcirculation and, hence, compromise oxygen delivery to peri-contusional areas. Low-frequency oscillations in cerebral blood flow (CBF) may improve cerebral oxygenation in the setting of oxygen deprivation. However, no method has been reported to induce controllable oscillations in CBF and it hasn't been applied as a therapeutic strategy. Electrical stimulation of the trigeminal nerve (TNS) plays a pivotal role in modulating cerebrovascular tone and cerebral perfusion. We hypothesized that TNS can modulate CBF at the targeted frequency band via the trigemino-cerebrovascular network, and TNS-induced CBF oscillations would improve cerebral oxygenation in peri-contusional areas. In a rat model of TBI complicated by hemorrhagic shock, TNS-induced CBF oscillations conferred significant preservation of peri-contusional tissues leading to reduced lesion volume, attenuated hypoxic injury and neuroinflammation, increased eNOS expression, improved neurological recovery and better 10-day survival rate, despite not significantly increasing CBF as compared with those in immediate and delayed resuscitation animals. Our findings indicate that low-frequency CBF oscillations enhance cerebral oxygenation in peri-contusional areas, and play a more significant protective role than improvements in non-oscillatory cerebral perfusion or volume expansion alone.
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Affiliation(s)
- Chunyan Li
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA. .,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| | - Kevin A Shah
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Keren Powell
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Yi-Chen Wu
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Wayne Chaung
- Center for Immunology and Inflammation, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Anup N Sonti
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Timothy G White
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Mohini Doobay
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA
| | - Weng-Lang Yang
- Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ping Wang
- Center for Immunology and Inflammation, The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Lance B Becker
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Raj K Narayan
- Translational Brain Research Laboratory, The Feinstein Institutes for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Stem Cell-Engineered Nanovesicles Exert Proangiogenic and Neuroprotective Effects. MATERIALS 2021; 14:ma14051078. [PMID: 33669122 PMCID: PMC7956182 DOI: 10.3390/ma14051078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/20/2021] [Accepted: 02/22/2021] [Indexed: 02/06/2023]
Abstract
As a tissue regeneration strategy, the utilization of mesenchymal stem cells (MSCs) has drawn considerable attention. Comprehensive research using MSCs has led to significant preclinical or clinical outcomes; however, improving the survival rate, engraftment efficacy, and immunogenicity of implanted MSCs remains challenging. Although MSC-derived exosomes were recently introduced and reported to have great potential to replace conventional MSC-based therapeutics, the poor production yield and heterogeneity of exosomes are critical hurdles for their further applications. Herein, we report the fabrication of exosome-mimetic MSC-engineered nanovesicles (MSC-NVs) by subjecting cells to serial extrusion through filters. The fabricated MSC-NVs exhibit a hydrodynamic size of ~120 nm, which is considerably smaller than the size of MSCs (~30 μm). MSC-NVs contain both MSC markers and exosome markers. Importantly, various therapeutic growth factors originating from parent MSCs are encapsulated in the MSC-NVs. The MSC-NVs exerted various therapeutic effects comparable to those of MSCs. They also significantly induced the angiogenesis of endothelial cells and showed neuroprotective effects in damaged neuronal cells. The results collectively demonstrate that the fabricated MSC-NVs can serve as a nanosized therapeutic agent for tissue regeneration.
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Ondek K, Brevnova O, Jimenez-Ornelas C, Vergara A, Zwienenberg M, Gurkoff G. A new model of repeat mTBI in adolescent rats. Exp Neurol 2020; 331:113360. [PMID: 32442552 DOI: 10.1016/j.expneurol.2020.113360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 05/02/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022]
Abstract
Sports-related injury is frequently associated with repeated diffuse and mild traumatic brain injury (mTBI). We combined two existing models for inducing TBI in rats, the Impact Acceleration and Controlled Cortical Impact models, to create a new method relevant to the study of cognitive sequelae of repeat mTBI in adolescent athletes. Repeated mTBI, such as those incurred in sports, can result in a wide range of outcomes, with many individuals experiencing no chronic sequela while others develop profound cognitive and behavioral impairments, typically in the absence of lasting motor symptoms or gross tissue loss appreciable antemortem. It is critical to develop models of mTBI and repeat mTBI that have the flexibility to assess multiple parameters related to injury (e.g. number and magnitude of impacts, inter-injury interval, etc) that are associated with brain vulnerability compared to normal recovery. We designed a 3D-printed plastic implant to permanently secure a metal disc to the skull of adolescent rats in order to induce multiple injuries without performing multiple survival surgeries and also to minimize pre-injury anesthesia time. Rats were randomly assigned to sham injury (n = 12), single injury (n = 12; injury on P41), or repeat injury (n = 14; injuries on P35, P38, and P41) groups. Compared to single injury and sham injury, repeat injuries caused increased toe pinch reflex latency (F(2,34) = 4.126, p < .05) and diminished weight gain (F(2, 34) = 4.767, p < .05). Spatial navigation was tested using Morris water maze, beginning one week after the final injury (P48). While there were no differences between groups during acquisition, both single and repeat injuries resulted in deficits on probe trial performance (p < .01 and p < .05 respectively). Single injury animals also exhibited a deficit in working memory deficit across three days of testing (p < .05). Neither injury group had neuronal loss in the hilus or CA3, according to stereological quantification of NeuN. Therefore, by implanting a helmet we have created a relevant model of sports-related injury and repeated mTBI that results in subtle but significant changes in cognitive outcome in the absence of significant hippocampal cell death.
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Affiliation(s)
- Katelynn Ondek
- Department of Neurological Surgery, University of California, Davis School of Medicine, 4800 Y St Suite 3740, Sacramento, CA 95817, United States of America; Center for Neuroscience, University of California, Davis, 1544 Newton Ct, Davis, CA 95818, United States of America.
| | - Olga Brevnova
- Department of Neurological Surgery, University of California, Davis School of Medicine, 4800 Y St Suite 3740, Sacramento, CA 95817, United States of America.
| | - Consuelo Jimenez-Ornelas
- Department of Neurological Surgery, University of California, Davis School of Medicine, 4800 Y St Suite 3740, Sacramento, CA 95817, United States of America.
| | - Audrey Vergara
- Department of Neurological Surgery, University of California, Davis School of Medicine, 4800 Y St Suite 3740, Sacramento, CA 95817, United States of America.
| | - Marike Zwienenberg
- Department of Neurological Surgery, University of California, Davis School of Medicine, 4800 Y St Suite 3740, Sacramento, CA 95817, United States of America.
| | - Gene Gurkoff
- Department of Neurological Surgery, University of California, Davis School of Medicine, 4800 Y St Suite 3740, Sacramento, CA 95817, United States of America; Center for Neuroscience, University of California, Davis, 1544 Newton Ct, Davis, CA 95818, United States of America.
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Vibration Does Not Affect Short Term Outcomes Following Traumatic Brain Injury in a Porcine Model. Mil Med 2020. [DOI: 10.1093/milmed/usz346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Traumatic brain injury (TBI) has become increasingly prevalent among the injuries sustained in the military. Many wounded warriors require emergency medical evacuation via helicopter and subsequently fixed wing transport. During aeromedical evacuation, both pilots and patients experience whole body vibration due to engine, rotor, and propeller rotation. The impact of posttraumatic vibration and hypoxia exposure characteristic of the aeromedical evacuation environment on TBI is currently unknown.
Methods
A swine TBI model of controlled cortical impact was utilized. The pigs first underwent TBI or sham injury and were subsequently exposed to vibration or no vibration and hypoxia or normoxia for 2 hours. They were monitored for an additional 4 hours following vibration/hypoxia and blood was drawn at hourly intervals for cytokine and serum biomarker analysis. Continuous physiologic and neurologic monitoring were utilized. Prior to the conclusion of the experiment, the animals underwent brain magnetic resonance imaging. At the end of the study, the brain was extracted for histologic analysis.
Results
Physiologic parameters except for peripheral capillary oxygen saturation (SpO2) were similar between all groups. The hypoxia groups demonstrated the expected decrease in SpO2 and pO2 during the hypoxic period, and this was sustained throughout the study period. The pH, pCO2 and electrolytes were similar among all groups. Neuron specific enolase was increased over time in the TBI group, however it was similar to the sham TBI group at all time points. There were no differences in IL-1β, IL-6, IL-8, TNFα, GFAP, HIF1α, syndecan-1, or S100β serum levels between groups. The mean ICP during cortical impact in the TBI group was 279.8 ± 56.2 mmHg. However, the postinjury ICP was not different between groups at any subsequent time point. Brain tissue oxygenation and perfusion were similar between all groups.
Conclusion
In this novel study evaluating the effect of vibration on short-term outcomes following TBI, we demonstrate that the moderate vibration and hypoxia simulating aeromedical evacuation do not impact short term outcomes following TBI.
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Oxygenation extremes after traumatic brain injury transiently affect coagulation. Thromb Res 2020; 186:58-63. [DOI: 10.1016/j.thromres.2019.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/09/2019] [Accepted: 12/19/2019] [Indexed: 01/06/2023]
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Griemert E, Schwarzmaier SM, Hummel R, Gölz C, Yang D, Neuhaus W, Burek M, Förster CY, Petkovic I, Trabold R, Plesnila N, Engelhard K, Schäfer MK, Thal SC. Plasminogen activator inhibitor-1 augments damage by impairing fibrinolysis after traumatic brain injury. Ann Neurol 2019; 85:667-680. [PMID: 30843275 PMCID: PMC6593843 DOI: 10.1002/ana.25458] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/18/2019] [Accepted: 03/03/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Plasminogen activator inhibitor-1 (PAI-1) is the key endogenous inhibitor of fibrinolysis, and enhances clot formation after injury. In traumatic brain injury, dysregulation of fibrinolysis may lead to sustained microthrombosis and accelerated lesion expansion. In the present study, we hypothesized that PAI-1 mediates post-traumatic malfunction of coagulation, with inhibition or genetic depletion of PAI-1 attenuating clot formation and lesion expansion after brain trauma. METHODS We evaluated PAI-1 as a possible new target in a mouse controlled cortical impact (CCI) model of traumatic brain injury. We performed the pharmacological inhibition of PAI-1 with PAI-039 and stimulation by tranexamic acid, and we confirmed our results in PAI-1-deficient animals. RESULTS PAI-1 mRNA was time-dependently upregulated, with a 305-fold peak 12 hours after CCI, which effectively counteracted the 2- to 3-fold increase in cerebral tissue-type/urokinase plasminogen activator expression. PAI-039 reduced brain lesion volume by 26% at 24 hours and 43% at 5 days after insult. This treatment also attenuated neuronal apoptosis and improved neurofunctional outcome. Moreover, intravital microscopy demonstrated reduced post-traumatic thrombus formation in the pericontusional cortical microvasculature. In PAI-1-deficient mice, the therapeutic effect of PAI-039 was absent. These mice also displayed 13% reduced brain damage compared with wild type. In contrast, inhibition of fibrinolysis with tranexamic acid increased lesion volume by 25% compared with vehicle. INTERPRETATION This study identifies impaired fibrinolysis as a critical process in post-traumatic secondary brain damage and suggests that PAI-1 may be a central endogenous inhibitor of the fibrinolytic pathway, promoting a procoagulatory state and clot formation in the cerebral microvasculature. Ann Neurol 2019;85:667-680.
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Affiliation(s)
- Eva‐Verena Griemert
- Department of AnesthesiologyUniversity Medical Center of Johannes‐Gutenberg‐University MainzMainzGermany
| | - Susanne M. Schwarzmaier
- Department of AnesthesiologyLudwig‐Maximilians‐University (LMU) Munich Medical CenterMunichGermany
| | - Regina Hummel
- Department of AnesthesiologyUniversity Medical Center of Johannes‐Gutenberg‐University MainzMainzGermany
| | - Christina Gölz
- Department of AnesthesiologyUniversity Medical Center of Johannes‐Gutenberg‐University MainzMainzGermany
| | - Dong Yang
- Department of AnesthesiologyUniversity Medical Center of Johannes‐Gutenberg‐University MainzMainzGermany
| | - Winfried Neuhaus
- Austrian Institute of Technology, Department Health and EnvironmentMolecular DiagnosticsViennaAustria
| | - Malgorzata Burek
- Department of Anesthesia and Critical CareUniversity of WürzburgWürzburgGermany
| | - Carola Y. Förster
- Department of Anesthesia and Critical CareUniversity of WürzburgWürzburgGermany
| | - Ivan Petkovic
- Department of AnesthesiologyUniversity Medical Center of Johannes‐Gutenberg‐University MainzMainzGermany
| | - Raimund Trabold
- Institute for Surgical Research at the Walter Brendel Center of Experimental MedicineUniversity of Munich Medical CenterMunichGermany
| | - Nikolaus Plesnila
- Institute for Stroke and Dementia Research (ISD)Ludwig‐Maximilians‐University (LMU) Munich Medical Center, Munich, Germany and Munich Cluster for Systems Neurology (Synergy)MunichGermany
| | - Kristin Engelhard
- Department of AnesthesiologyUniversity Medical Center of Johannes‐Gutenberg‐University MainzMainzGermany
| | - Michael K. Schäfer
- Department of AnesthesiologyUniversity Medical Center of Johannes‐Gutenberg‐University MainzMainzGermany
- Focus Program Translational NeuroscienceUniversity Medical Center of Johannes‐Gutenberg‐University MainzMainzGermany
| | - Serge C. Thal
- Department of AnesthesiologyUniversity Medical Center of Johannes‐Gutenberg‐University MainzMainzGermany
- Focus Program Translational NeuroscienceUniversity Medical Center of Johannes‐Gutenberg‐University MainzMainzGermany
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Vukovic AA, Hanson HR, Murphy SL, Mercurio D, Sheedy CA, Arnold DH. Apneic oxygenation reduces hypoxemia during endotracheal intubation in the pediatric emergency department. Am J Emerg Med 2018; 37:27-32. [PMID: 29699900 DOI: 10.1016/j.ajem.2018.04.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Apneic oxygenation (AO) has been evaluated in adult patients as a means of reducing hypoxemia during endotracheal intubation (ETI). While less studied in pediatric patients, its practice has been largely adopted. OBJECTIVE Determine association between AO and hypoxemia in pediatric patients undergoing ETI. METHODS Observational study at an urban, tertiary children's hospital emergency department. Pediatric patients undergoing ETI were examined during eras without (January 2011-June 2011) and with (August 2014-March 2017) apneic oxygenation. The primary outcome was hypoxemia, defined as pulse oximetry (SpO2) < 90%. The χ2 and Wilcoxon rank-sum tests examined differences between cohorts. Multivariable regression models examined adjusted associations between covariates and hypoxemia. RESULTS 149 patients were included. Cohorts were similar except for greater incidence of altered mental status in those receiving AO (26% vs. 7%, p = 0.03). Nearly 50% of the pre-AO cohort experienced hypoxemia during ETI, versus <25% in the AO cohort. Median [IQR] lowest SpO2 during ETI was 93 (69, 99) for pre-AO and 100 [95, 100] for the AO cohort (p < 0.001). In a multivariable logistic regression model, hypoxemia during ETI was associated with AO (aOR 0.3, 95% confidence interval [CI] 0.1-0.8), increased age (for 1 year, aOR 0.8, 95% CI 0.7-1.0), lowest SpO2 before ETI (for 1% increase, aOR 0.9, 95% CI 0.8-1.0), and each additional intubation attempt (aOR 4.0, 95% CI 2.2-7.2). CONCLUSIONS Apneic oxygenation is an easily-applied intervention associated with decreases in hypoxemia during pediatric ETI. Nearly 50% of children not receiving AO experienced hypoxemia.
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Affiliation(s)
- Adam A Vukovic
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA.
| | - Holly R Hanson
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA
| | - Shelley L Murphy
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA
| | - Danielle Mercurio
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA
| | - Craig A Sheedy
- Department of Emergency Medicine, Vanderbilt University Medical Center, 1313 21st Avenue South, 703 Oxford House, Nashville, TN 37232, USA
| | - Donald H Arnold
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA; Department of Pediatrics, Division of Pulmonary Medicine and the Center for Asthma Research Vanderbilt University School of Medicine, 2200 Children's Way, Nashville, TN 37232, USA
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12
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Davies M, Jacobs A, Brody DL, Friess SH. Delayed Hypoxemia after Traumatic Brain Injury Exacerbates Long-Term Behavioral Deficits. J Neurotrauma 2018; 35:790-801. [PMID: 29149808 PMCID: PMC5831743 DOI: 10.1089/neu.2017.5354] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hypoxemia during initial stabilization of patients with severe traumatic brain injury (TBI) has been associated with poorer outcomes. However, the effects of delayed hypoxemia occurring during intensive care post-TBI on outcome is unclear. Pre-clinical models of TBI have rarely shown cognitive or behavioral deficits beyond 6 weeks post-injury and commonly have not included modeling of secondary insults. We have previously developed a murine model of TBI followed by delayed hypoxemia to model the secondary insult of hypoxemia and brain hypoxia occurring in the intensive care setting. Understanding long-term effects of delayed hypoxemia post-TBI in our murine model is critical for future testing of candidate therapeutics targeting secondary brain hypoxia. For this study, forty 5-week-old male mice were randomized to controlled cortical impact (CCI; N = 24) or sham surgery (N = 16). One day later, awake animals were randomized to 60 min of hypoxemia or normoxemia. Six months after initial injury, animals underwent behavior testing (Morris water maze, social interaction, and tail suspension) before euthanasia for immunohistochemistry (IHC) assessments. At 6 months post-injury, mice experiencing CCI and hypoxemia (CCI+H) had longer swim distances to the hidden platform (51 cm) compared to CCI alone (26 cm) or sham animals (22 cm). During social interaction assessments, CCI + H mice spent less time interacting with novel stimulus mice (79 sec) than CCI alone (101 sec) or sham animals (139 sec). CCI + H had larger lesion volumes compared to CCI alone (14.0% vs. 9.9%; p < 0.003). Glial fibrillary acidic protein IHC at 6 months post-injury demonstrated increased astrogliosis in the ipsilateral white matter of CCI + H compared to CCI alone. To summarize, this clinically relevant model of delayed hypoxia post-TBI resulted in long-term behavioral deficits and evidence of exacerbated structural injury.
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Affiliation(s)
- McKenzie Davies
- Department of Pediatrics, Washington University in St. Louis School of Medicine, Saint Louis, Missouri
| | - Addison Jacobs
- Department of Pediatrics, Washington University in St. Louis School of Medicine, Saint Louis, Missouri
| | - David L. Brody
- Department of Neurology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri
| | - Stuart H. Friess
- Department of Pediatrics, Washington University in St. Louis School of Medicine, Saint Louis, Missouri
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13
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Garling RJ, Watts LT, Sprague S, Digicaylioglu M. Progesterone modulates mTOR in the hippocampus of mice after traumatic brain injury. Neural Regen Res 2018; 13:434-439. [PMID: 29623927 PMCID: PMC5900505 DOI: 10.4103/1673-5374.228725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The mechanistic target of rapamycin (mTOR) is an intracellular protein kinase that functions as an energy and nutrient sensor in the cellular microenvironment of neurons. Modulation of mTOR is vital when nutrient and energy sources become limited. Hypoxia, traumatic brain injury, cellular energy states, and growth factors all regulate the phosphorylation and total levels of mTOR in cells. Alterations in the microenvironment induce transduction of signals to downstream proteins by mTOR allowing for cells to make the necessary adjustments to counteract stressors and survive. Progesterone, a hydrophobic steroid hormone, has been shown in studies of non-neural tissue to be a suppressor of mTOR and modulator of mTOR phosphorylation. Our study tested the effects of progesterone on mTOR expression following traumatic brain injury. C57BL/6 mice were treated with progesterone (8 mg/kg) at 1 (intraperitoneal), 6 (subcutaneous), 24 (subcutaneous), and 48 (subcutaneous) hours post closed skull traumatic brain injury. The hippocampus was then harvested 72 hours post injury and prepared for western blot analysis. We found that progesterone significantly decreased total mTOR levels in all groups compared to sham treated with vehicle. This was further confirmed by immunostaining showing decreased cytoplasmic mTOR levels compared to sham. Our study shows progesterone is a significant modulator of mTOR levels in the hippocampus of mice following traumatic brain injury.
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Affiliation(s)
- Richard Justin Garling
- Department of Neurosurgery, Wayne State University, Detroit, MI; School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Lora Talley Watts
- School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Shane Sprague
- Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Murat Digicaylioglu
- Department of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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14
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Feng JF, Liu J, Zhang L, Jiang JY, Russell M, Lyeth BG, Nolta JA, Zhao M. Electrical Guidance of Human Stem Cells in the Rat Brain. Stem Cell Reports 2017; 9:177-189. [PMID: 28669601 PMCID: PMC5511115 DOI: 10.1016/j.stemcr.2017.05.035] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 12/13/2022] Open
Abstract
Limited migration of neural stem cells in adult brain is a roadblock for the use of stem cell therapies to treat brain diseases and injuries. Here, we report a strategy that mobilizes and guides migration of stem cells in the brain in vivo. We developed a safe stimulation paradigm to deliver directional currents in the brain. Tracking cells expressing GFP demonstrated electrical mobilization and guidance of migration of human neural stem cells, even against co-existing intrinsic cues in the rostral migration stream. Transplanted cells were observed at 3 weeks and 4 months after stimulation in areas guided by the stimulation currents, and with indications of differentiation. Electrical stimulation thus may provide a potential approach to facilitate brain stem cell therapies. Developed a technology and device delivering electric current to the brain in vivo Achieved stable delivery of currents to brain with monitoring and safety concerns Exhibited effective guidance of migration of transplanted human NSCs in live brain Demonstrated enhanced motility, survival, and differentiation of the guided hNSCs
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Affiliation(s)
- Jun-Feng Feng
- Departments of Dermatology and Ophthalmology, Institute for Regenerative Cures, University of California Davis, 2921 Stockton Boulevard, Sacramento, CA 95817, USA; Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People's Republic of China; Shanghai Institute of Head Trauma, Shanghai 200127, People's Republic of China
| | - Jing Liu
- Stem Cell Program and Institute for Regenerative Cures, University of California Davis, Sacramento, CA 95817, USA
| | - Lei Zhang
- Departments of Dermatology and Ophthalmology, Institute for Regenerative Cures, University of California Davis, 2921 Stockton Boulevard, Sacramento, CA 95817, USA
| | - Ji-Yao Jiang
- Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People's Republic of China; Shanghai Institute of Head Trauma, Shanghai 200127, People's Republic of China
| | | | - Bruce G Lyeth
- Department of Neurological Surgery, University of California Davis, Davis, CA 95616, USA
| | - Jan A Nolta
- Stem Cell Program and Institute for Regenerative Cures, University of California Davis, Sacramento, CA 95817, USA
| | - Min Zhao
- Departments of Dermatology and Ophthalmology, Institute for Regenerative Cures, University of California Davis, 2921 Stockton Boulevard, Sacramento, CA 95817, USA.
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15
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Nyanzu M, Siaw-Debrah F, Ni H, Xu Z, Wang H, Lin X, Zhuge Q, Huang L. Improving on Laboratory Traumatic Brain Injury Models to Achieve Better Results. Int J Med Sci 2017; 14:494-505. [PMID: 28539826 PMCID: PMC5441042 DOI: 10.7150/ijms.18075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/31/2017] [Indexed: 11/30/2022] Open
Abstract
Experimental modeling of traumatic brain injury (TBI) in animals has identified several potential means and interventions that might have beneficial applications for treating traumatic brain injury clinically. Several of these interventions have been applied and tried with humans that are at different phases of testing (completed, prematurely terminated and others in progress). The promising results achieved in the laboratory with animal models have not been replicated with human trails as expected. This review will highlight some insights and significance attained via laboratory animal modeling of TBI as well as factors that require incorporation into the experimental studies that could help in translating results from laboratory to the bedside. Major progress has been made due to laboratory studies; in explaining the mechanisms as well as pathophysiological features of brain damage after TBI. Attempts to intervene in the cascade of events occurring after TBI all rely heavily on the knowledge from basic laboratory investigations. In looking to discover treatment, this review will endeavor to sight and state some central discrepancies between laboratory models and clinical scenarios.
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Affiliation(s)
- Mark Nyanzu
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.,Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Felix Siaw-Debrah
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.,Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Haoqi Ni
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.,Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Zhu Xu
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.,Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Hua Wang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.,Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiao Lin
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.,Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Qichuan Zhuge
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.,Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Lijie Huang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.,Department of Neurosurgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
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16
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Parikh U, Williams M, Jacobs A, Pineda JA, Brody DL, Friess SH. Delayed Hypoxemia Following Traumatic Brain Injury Exacerbates White Matter Injury. J Neuropathol Exp Neurol 2016; 75:731-747. [PMID: 27288907 PMCID: PMC7299434 DOI: 10.1093/jnen/nlw045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Indexed: 12/04/2022] Open
Abstract
Hypoxemia immediately following traumatic brain injury (TBI) has been observed to exacerbate injury. However, it remains unclear whether delayed hypoxemia beyond the immediate postinjury period influences white matter injury. In a retrospective clinical cohort of children aged 4-16 years admitted with severe TBI, 28/74 (35%) patients were found to experience delayed normocarbic hypoxemia within 7 days of admission. Based on these clinical findings, we developed a clinically relevant mouse model of TBI with delayed hypoxemia by exposing 5-week old (adolescent) mice to hypoxic conditions for 30 minutes starting 24 hours after moderate controlled cortical impact (CCI). Injured mice with hypoxemia had increased axonal injury using both β-amyloid precursor protein and NF200 immunostaining in peri-contusional white matter compared with CCI alone. Furthermore, we detected increased peri-contusional white matter tissue hypoxia with pimonidazole and augmented astrogliosis with anti-glial fibrillary acidic protein staining in CCI + delayed hypoxemia compared with CCI alone or sham surgery + delayed hypoxemia. Microglial activation as evidenced by Iba1 staining was not significantly altered by delayed hypoxemia. These clinical and experimental data indicate the prevention or amelioration of delayed hypoxemia effects following TBI may provide a unique opportunity for the development of therapeutic interventions to reduce axonal injury and improve clinical outcomes.
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Affiliation(s)
- Umang Parikh
- From the Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri (UP, MW, AJ, JAP, SHF)Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (DLB)
| | - Melissa Williams
- From the Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri (UP, MW, AJ, JAP, SHF)Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (DLB)
| | - Addison Jacobs
- From the Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri (UP, MW, AJ, JAP, SHF)Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (DLB)
| | - Jose A Pineda
- From the Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri (UP, MW, AJ, JAP, SHF)Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (DLB)
| | - David L Brody
- From the Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri (UP, MW, AJ, JAP, SHF)Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (DLB)
| | - Stuart H Friess
- From the Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri (UP, MW, AJ, JAP, SHF)Department of Neurology, Washington University School of Medicine, St. Louis, Missouri (DLB).
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17
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Mrozek S, Luzi A, Gonzalez L, Kerhuel L, Fourcade O, Geeraerts T. Cerebral and extracerebral vulnerability to hypoxic insults after diffuse traumatic brain injury in rats. Brain Res 2016; 1646:334-341. [PMID: 27302136 DOI: 10.1016/j.brainres.2016.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 11/30/2022]
Abstract
The post-traumatic brain vulnerability suggests that after traumatic brain injury (TBI), the brain may be more susceptible to posttraumatic hypoxic insults. This concept could be extended to 'peripheral' organs, as non-neurologic organ failure is common after TBI. This study aims to characterize and quantify cerebral and extracerebral tissue hypoxia with pimonidazole resulting from a standardized hypoxia-hypotension (HH) phase occurring after a diffuse experimental TBI in rats. Rats were allocated to Sham (n=5), TBI (n=7), HH (n=7) and TBI+HH (n=7) groups. Then, pimonidazole was injected and brain, liver, heart and kidneys were analysed. In the cerebral cortex, post-treatment hypoxia was higher in TBI+HH group than Sham group (p=0.003), HH group (p=0.003) and TBI group (p=0.002). Large trends in thalamus, hippocampus and striatum for the TBI+HH group compared to the other groups were observed. For the heart and liver, the 4 groups were comparable. For the kidneys, post-treatment hypoxia was higher in the TBI group compared to the Sham and HH groups, but not more than TBI+HH group. This study reveals that a posttraumatic hypoxic insult occurring after a severe TBI has major hypoxic consequences on brain structures. However, TBI by itself appears to induce renal hypoxia that is not enhanced by posttraumatic hypoxic insult.
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Affiliation(s)
- Ségolène Mrozek
- Equipe d'accueil' Modélisation de l'aggression tissulaire et nociceptive', University Toulouse 3 Paul Sabatier, Toulouse, France; Departement of Anesthesiology and Critical Care, University Hospital of Toulouse, Toulouse, France.
| | - Aymeric Luzi
- Equipe d'accueil' Modélisation de l'aggression tissulaire et nociceptive', University Toulouse 3 Paul Sabatier, Toulouse, France; Departement of Anesthesiology and Critical Care, University Hospital of Toulouse, Toulouse, France.
| | - Leslie Gonzalez
- Equipe d'accueil' Modélisation de l'aggression tissulaire et nociceptive', University Toulouse 3 Paul Sabatier, Toulouse, France; Departement of Anesthesiology and Critical Care, University Hospital of Toulouse, Toulouse, France.
| | - Lionel Kerhuel
- Equipe d'accueil' Modélisation de l'aggression tissulaire et nociceptive', University Toulouse 3 Paul Sabatier, Toulouse, France; Departement of Anesthesiology and Critical Care, University Hospital of Toulouse, Toulouse, France.
| | - Olivier Fourcade
- Equipe d'accueil' Modélisation de l'aggression tissulaire et nociceptive', University Toulouse 3 Paul Sabatier, Toulouse, France; Departement of Anesthesiology and Critical Care, University Hospital of Toulouse, Toulouse, France.
| | - Thomas Geeraerts
- Equipe d'accueil' Modélisation de l'aggression tissulaire et nociceptive', University Toulouse 3 Paul Sabatier, Toulouse, France; Departement of Anesthesiology and Critical Care, University Hospital of Toulouse, Toulouse, France.
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18
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Traumatic Brain Injury and Polytrauma in Theaters of Combat: The Case for Neurotrauma Resuscitation? Shock 2016; 44 Suppl 1:17-26. [PMID: 25895144 DOI: 10.1097/shk.0000000000000380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Polytrauma associated with traumatic brain injury (TBI) is defined as a concurrent injury to the brain and one or more body areas or organ systems that results in physical, cognitive, and psychosocial impairments. Consequently, polytrauma accompanied by TBI presents a unique challenge for emergency medicine, in particular, to those associated with the austere environments encountered in military theaters of operation and the logistics of en-route care. Here, we attempt to put needed focus on this medical emergency, specifically addressing the problem of an exsanguinating polytrauma requiring fluid resuscitation complicated by TBI. Critical questions to consider are the following: (1) What is the optimal resuscitation fluid for these patients? (2) In defining the resuscitation fluid, what considerations must be given with regard to the very specific logistics of military operations? and (3) Can treatment of the brain injury be initiated in parallel with resuscitation practices. Recognizing the immense clinical and experimental complexity of this problem, our goal was to encourage research that embraces with high-fidelity 'combined' animal models of polytrauma and TBI with an objective toward elucidating safe and effective neurotherapeutic resuscitation protocols.
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19
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Combined hypoxemic and hypotensive insults altered physiological responses and neurofunction in a severity-dependent manner following penetrating ballistic-like brain injury in rats. J Trauma Acute Care Surg 2016; 79:S130-8. [PMID: 26406425 DOI: 10.1097/ta.0000000000000785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic brain injury often occurs with concomitant hypoxemia (HX) and hemorrhagic shock (HS), leading to poor outcomes. This study characterized the acute physiology and subacute behavioral consequences of these additional insults in a model of penetrating ballistic-like brain injury (PBBI). METHODS Rats were randomly assigned into sham control, HX + HS (HH), 5% PBBI alone, 5% PBBI + HH, 10% PBBI alone, and 10% PBBI + HH groups. Mean arterial pressure, heart rate, and breathing rate were monitored continuously. In the combined injury groups, animals were subjected to 30-minute HX (Pao2, 30-40 mm Hg) and then 30-min HS (mean arterial pressure, 40 mm Hg) followed by fluid resuscitation with lactated Ringer's solution after PBBI or sham PBBI. Motor function was assessed using the rotarod task at 7 days and 14 days after injury. Cognitive function was assessed in the Morris water maze task from 13 days to 17 days after injury. RESULTS Combined HH caused acute bradycardia that was reversed by fluid resuscitation. During HX phase, tachypnea was observed in all HH groups. Persistent bradypnea was detected in 10% PBBI + HH group during the resuscitation phase. PBBI produced significant decrements in motor performance (vs. sham and HH groups). Additional insults significantly worsened motor deficits following 5% PBBI but not 10% PBBI. Both 5% PBBI and 10% PBBI produced significant cognitive deficits in the Morris water maze task with worsened deficits evident following the more severe injury (i.e., 10% PBBI). Alternatively, rats subjected to 5% PBBI + HH exhibited cognitive impairment that was significantly worse compared with 5% PBBI alone, whereas this worsening effect was not detected in the 10% PBBI groups. CONCLUSION This study characterized the physiological responses and neurobehavioral profiles following combined PBBI and HH. Ten percent PBBI produces motor and cognitive deficits, which may exceed a sensitivity threshold capacity. In contrast, 5% PBBI produces a lower, albeit significant, magnitude of deficits and thus provides a more sensitive screen for evaluating the cumulative effects of additional insults, which were indeed demonstrated to significantly worsen outcome.
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20
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Abstract
Fluid percussion was first conceptualized in the 1940s and has evolved into one of the leading laboratory methods for studying experimental traumatic brain injury (TBI). Over the decades, fluid percussion has been used in numerous species and today is predominantly applied to the rat. The fluid percussion technique rapidly injects a small volume of fluid, such as isotonic saline, through a circular craniotomy onto the intact dura overlying the brain cortex. In brief, the methods involve surgical production of a circular craniotomy, attachment of a fluid-filled conduit between the dura overlying the cortex and the outlet port of the fluid percussion device. A fluid pulse is then generated by the free-fall of a pendulum striking a piston on the fluid-filled cylinder of the device. The fluid enters the cranium, producing a compression and displacement of the brain parenchyma resulting in a sharp, high magnitude elevation of intracranial pressure that is propagated diffusely through the brain. This results in an immediate and transient period of traumatic unconsciousness as well as a combination of focal and diffuse damage to the brain, which is evident upon histological and behavioral analysis. Numerous studies have demonstrated that the rat fluid percussion model reproduces a wide range of pathological features associated with human TBI.
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Affiliation(s)
- Ken C Van
- Department of Neurological Surgery, University of California at Davis, 1515 Newton Court, One Shields Avenue, Davis, CA, 95616-8797, USA
| | - Bruce G Lyeth
- Department of Neurological Surgery, University of California at Davis, 1515 Newton Court, One Shields Avenue, Davis, CA, 95616-8797, USA.
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21
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Abstract
Traumatic brain injury (TBI) has been named the most complex disease in the most complex organ of the body. It is the most common cause of death and disability in the Western world in people <40 years old and survivors commonly suffer from persisting cognitive deficits, impaired motor function, depression and personality changes. TBI may vary in severity from uniformly fatal to mild injuries with rapidly resolving symptoms and without doubt, it is a markedly heterogeneous disease. Its different subtypes differs in their pathophysiology, treatment options and long-term consequences and to date, there are no pharmacological treatments with proven clinical benefit available to TBI patients. To enable development of novel treatment options for TBI, clinically relevant animal models are needed. Due to their availability and low costs, numerous rodent models have been developed which have substantially contributed to our current understanding of the pathophysiology of TBI. The most common animal models used in laboratories worldwide are likely the controlled cortical impact (CCI) model, the central and lateral fluid percussion injury (FPI) models, and weight drop/impact acceleration (I/A) models. Each of these models has inherent advantages and disadvantages; these need to be thoroughly considered when selecting the rodent TBI model according to the hypothesis and design of the study. Since TBI is not one disease, refined animal models must take into account the clinical features and complexity of human TBI. To enhance the possibility of establishing preclinical efficacy of a novel treatment, the preclinical use of several different experimental models is encouraged as well as varying the species, gender, and age of the animal. In this chapter, the methods, limitations, and challenges of the CCI and FPI models of TBI used in rodents are described.
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Affiliation(s)
- Niklas Marklund
- Division of Neurosurgery, Department of Neuroscience, Uppsala University Hospital, Uppsala University, Uppsala, 751 85, Sweden.
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22
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Miyazaki H, Miyawaki H, Satoh Y, Saiki T, Kawauchi S, Sato S, Saitoh D. Thoracic shock wave injury causes behavioral abnormalities in mice. Acta Neurochir (Wien) 2015; 157:2111-20; discussion 2120. [PMID: 26489739 DOI: 10.1007/s00701-015-2613-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is caused by complex mechanisms of systemic, local and cerebral responses to blast exposure. However, the molecular mechanisms of cognitive impairment after exposure to blast waves are not clearly known. We tested the hypothesis that thoracic injury induced functional and morphological impairment in the brain, leading to behavioral abnormalities. METHODS Mice were exposed to laser-induced shock waves (LISWs) impacting the thorax and assessed for behavioral outcome at 7 and 28 days post injury. Hippocampus and lung were collected for histopathological analysis and gene expression profiling after injury. RESULTS Thoracic injury transiently decreased the heart rate, blood pressure, peripheral oxyhemoglobin saturation and cerebral blood flow immediately after LISW exposure. Although LISWs exposure caused pulmonary contusions, hemorrhage was not apparent in the brain. At 7 and 28 days after, the injured mice exhibited impaired short-term memory and depression-like behavior compared with controls. Histological assessments showed an increase in neuronal cell death after shock wave exposure, especially in the CA3 region of the hippocampus. Moreover, shock wave exposure altered the expression of functionally relevant genes in the hippocampus at 1 h and 1 day post injury. CONCLUSIONS Our findings indicate that the LISW-induced thoracic injury with no direct impact on the brain affected the hippocampal gene expression and led to morphological alterations, resulting in behavioral abnormalities. Therefore, body protection may be extremely important in the effective prevention against blast-induced alterations in brain function.
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Affiliation(s)
- Hiromi Miyazaki
- Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Hiroki Miyawaki
- Department of Traumatology and Critical Care Medicine, National Defense Medical College Hospital, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Yasushi Satoh
- Department of Anesthesiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Takami Saiki
- Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Satoko Kawauchi
- Division of Biomedical Information Sciences, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Shunichi Sato
- Division of Biomedical Information Sciences, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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23
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Determination of Serum Lost Goodwill Target Proteome in Patients with Severe Traumatic Brain Injury. BIOMED RESEARCH INTERNATIONAL 2015; 2015:183821. [PMID: 26491659 PMCID: PMC4600481 DOI: 10.1155/2015/183821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/26/2015] [Accepted: 07/28/2015] [Indexed: 11/24/2022]
Abstract
This study investigates the biokinetics of LGT proteome, a potential biomarker of severe TBI, in serum of severe TBI patients. The LGT proteome presents in the serum of severe TBI patients. The abundance diversity of LGT proteome is closely associated with pathologic condition of TBI patients. Serum LGT proteome may be used as a promising marker for evaluating severity of severe TBI.
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Gibb SL, Zhao Y, Potter D, Hylin MJ, Bruhn R, Baimukanova G, Zhao J, Xue H, Abdel-Mohsen M, Pillai SK, Moore AN, Johnson EM, Cox CS, Dash PK, Pati S. TIMP3 Attenuates the Loss of Neural Stem Cells, Mature Neurons and Neurocognitive Dysfunction in Traumatic Brain Injury. Stem Cells 2015; 33:3530-44. [PMID: 26299440 DOI: 10.1002/stem.2189] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/30/2015] [Accepted: 08/07/2015] [Indexed: 12/19/2022]
Abstract
Mesenchymal stem cells (MSCs) have been shown to have potent therapeutic effects in a number of disorders including traumatic brain injury (TBI). However, the molecular mechanism(s) underlying these protective effects are largely unknown. Herein we demonstrate that tissue inhibitor of matrix metalloproteinase-3 (TIMP3), a soluble protein released by MSCs, is neuroprotective and enhances neuronal survival and neurite outgrowth in vitro. In vivo in a murine model of TBI, intravenous recombinant TIMP3 enhances dendritic outgrowth and abrogates loss of hippocampal neural stem cells and mature neurons. Mechanistically we demonstrate in vitro and in vivo that TIMP3-mediated neuroprotection is critically dependent on activation of the Akt-mTORC1 pathway. In support of the neuroprotective effect of TIMP3, we find that intravenous delivery of recombinant TIMP3 attenuates deficits in hippocampal-dependent neurocognition. Taken together, our data strongly suggest that TIMP3 has direct neuroprotective effects that can mitigate the deleterious effects associated with TBI, an area with few if any therapeutic options.
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Affiliation(s)
- Stuart L Gibb
- Blood Systems Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Yuhai Zhao
- Department of Neurobiology and Anatomy, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Daniel Potter
- Blood Systems Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Michael J Hylin
- Department of Neurobiology and Anatomy, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Roberta Bruhn
- Blood Systems Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gyulnar Baimukanova
- Blood Systems Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jing Zhao
- Department of Neurobiology and Anatomy, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Hasen Xue
- Department of Pediatric Surgery and Institute for Molecular Medicine, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Mohamed Abdel-Mohsen
- Blood Systems Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Satish K Pillai
- Blood Systems Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Anthony N Moore
- Department of Neurobiology and Anatomy, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Evan M Johnson
- Department of Neurobiology and Anatomy, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Charles S Cox
- Department of Pediatric Surgery and Institute for Molecular Medicine, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Pramod K Dash
- Department of Neurobiology and Anatomy, The University of Texas Health Sciences Center at Houston, Houston, Texas, USA
| | - Shibani Pati
- Blood Systems Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
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25
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Kerrey BT, Mittiga MR, Rinderknecht AS, Varadarajan KR, Dyas JR, Geis GL, Luria JW, Frey ME, Jablonski TE, Iyer SB. Reducing the incidence of oxyhaemoglobin desaturation during rapid sequence intubation in a paediatric emergency department. BMJ Qual Saf 2015; 24:709-17. [DOI: 10.1136/bmjqs-2014-003713] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 07/05/2015] [Indexed: 11/03/2022]
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26
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Wang HC, Sun CF, Chen H, Chen MS, Shen G, Ma YB, Wang BD. Where are we in the modelling of traumatic brain injury? Models complicated by secondary brain insults. Brain Inj 2014; 28:1491-503. [PMID: 25111457 DOI: 10.3109/02699052.2014.943288] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hong-Cai Wang
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo
NingboPR China
| | - Cheng-Feng Sun
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo
NingboPR China
| | - Hai Chen
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo
NingboPR China
| | - Mao-Song Chen
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo
NingboPR China
| | - Gang Shen
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo
NingboPR China
| | - Yan-Bin Ma
- Department of Neurosurgery, NO.3 People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
ShanghaiPR China
| | - Bo-Ding Wang
- Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo
NingboPR China
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27
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Interleukin 6 mediates neuroinflammation and motor coordination deficits after mild traumatic brain injury and brief hypoxia in mice. Shock 2014; 40:471-5. [PMID: 24088994 DOI: 10.1097/shk.0000000000000037] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Traumatic brain injury (TBI) is a leading cause of mortality and disability. Acute postinjury insults after TBI, such as hypoxia, contribute to secondary brain injury and worse clinical outcomes. The functional and neuroinflammatory effects of brief episodes of hypoxia experienced following TBI have not been evaluated. Our previous studies have identified interleukin 6 (IL-6) as a potential mediator of mild TBI-induced pathology. In the present study, we sought to determine the effects of brief hypoxia on mild TBI and whether IL-6 played a role in the neuroinflammatory and functional deficits after injury. A murine model of mild TBI was induced by a weight drop (500 g from 1.5 cm). After injury, mice were exposed to immediate hypoxia (FIO2 = 15.1%) or normoxia (FIO2 = 21%) for 30 min. Serum and brain samples were analyzed for inflammatory cytokines 24 h after TBI. Neuron-specific enolase was measured as a serum biomarker of brain injury. Evaluation of motor coordination was performed for 5 days after TBI using a rotarod device. In some animals, anti-IL-6 was administered following TBI and hypoxia to neutralize systemic IL-6. Mice undergoing TBI had significant increases in brain injury. Exposure to brief hypoxia after TBI resulted in a more than 5-fold increase in serum neuron-specific enolase. This increase was associated with increases in serum and brain cytokine expression, suggesting that brief hypoxia exacerbates systemic and brain inflammation. Neutralization of IL-6 suppressed postinjury neuroinflammation and neuronal injury. In addition, TBI and hypoxia induced significant motor coordination deficits that were completely abrogated by IL-6 blockade. Exposure to hypoxia after TBI induces neuroinflammation and brain injury. These changes can be mitigated by neutralization of systemic IL-6. Interleukin 6 blockade also corrected the TBI-induced deficit in motor coordination. These data suggest that systemic IL-6 modulates the degree of neuroinflammation and contributes to reduced motor coordination after mild TBI.
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28
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Traumatic brain injury precipitates cognitive impairment and extracellular Aβ aggregation in Alzheimer's disease transgenic mice. PLoS One 2013; 8:e78851. [PMID: 24223856 PMCID: PMC3817089 DOI: 10.1371/journal.pone.0078851] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/24/2013] [Indexed: 02/03/2023] Open
Abstract
Traumatic brain injury (TBI) has become a signature wound of the wars in Iraq and Afghanistan. Many American soldiers, even those undiagnosed but likely suffering from mild TBI, display Alzheimer's disease (AD)-like cognitive impairments, suggesting a pathological overlap between TBI and AD. This study examined the cognitive and neurohistological effects of TBI in presymptomatic APP/PS1 AD-transgenic mice. AD mice and non-transgenic (NT) mice received an experimental TBI on the right parietal cortex using the controlled cortical impact model. Animals were trained in a water maze task for spatial memory before TBI, and then reevaluated in the same task at two and six weeks post-TBI. The results showed that AD mice with TBI made significantly more errors in the task than AD mice without TBI and NT mice regardless of TBI. A separate group of AD mice and NT mice were evaluated neurohistologically at six weeks after TBI. The number of extracellular beta-amyloid (Aβ)-deposits significantly increased by at least one fold in the cortex of AD mice that received TBI compared to the NT mice that received TBI or the AD and NT mice that underwent sham surgery. A significant decrease in MAP2 positive cells, indicating neuronal loss, was observed in the cortex of both the AD and NT mice that received TBI compared to the AD and NT mice subjected to sham surgery. Similar changes in extracellular Aβ deposits and MAP2 positive cells were also seen in the hippocampus. These results demonstrate for the first time that TBI precipitates cognitive impairment in presymptomatic AD mice, while also confirming extracellular Aβ deposits following TBI. The recognition of this pathological link between TBI and AD should aid in developing novel treatments directed at abrogating cellular injury and extracellular Aβ deposition in the brain.
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29
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Guo RB, Sun PL, Zhao AP, Gu J, Ding X, Qi J, Sun XL, Hu G. Chronic asthma results in cognitive dysfunction in immature mice. Exp Neurol 2013; 247:209-17. [PMID: 23639832 DOI: 10.1016/j.expneurol.2013.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/09/2013] [Accepted: 04/15/2013] [Indexed: 01/24/2023]
Abstract
Asthma is the most common chronic childhood illness today. However, little attention is paid for the impacts of chronic asthma-induced hypoxia on cognitive function in children. The present study used immature mice to establish ovalbumin-induced chronic asthma model, and found that chronic asthma impaired learning and memory ability in Morris Water Maze test. Further study revealed that chronic asthma destroyed synaptic structure, impaired long-term potentiation (LTP) maintaining in the CA1 region of mouse hippocampal slices. We found that intermittent hypoxia during chronic asthma resulted in down-regulation of c-fos, Arc and neurogenesis, which was responsible for the impairment of learning and memory in immature mice. Moreover, our results showed that budesonide treatment alone was inadequate for attenuating chronic asthma-induced cognitive impairment. Therefore, our findings indicate that chronic asthma might result in cognitive dysfunction in children, and more attention should be paid for chronic asthma-induced brain damage in the clinical therapy.
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Affiliation(s)
- Ruo-Bing Guo
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, 140 Hanzhong Road, Nanjing, Jiangsu 210029, China
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30
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Gurkoff GG, Feng JF, Van KC, Izadi A, Ghiasvand R, Shahlaie K, Song M, Lowe DA, Zhou J, Lyeth BG. NAAG peptidase inhibitor improves motor function and reduces cognitive dysfunction in a model of TBI with secondary hypoxia. Brain Res 2013; 1515:98-107. [PMID: 23562458 DOI: 10.1016/j.brainres.2013.03.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/22/2013] [Accepted: 03/27/2013] [Indexed: 10/27/2022]
Abstract
Immediately following traumatic brain injury (TBI) and TBI with hypoxia, there is a rapid and pathophysiological increase in extracellular glutamate, subsequent neuronal damage and ultimately diminished motor and cognitive function. N-acetyl-aspartyl glutamate (NAAG), a prevalent neuropeptide in the CNS, is co-released with glutamate, binds to the presynaptic group II metabotropic glutamate receptor subtype 3 (mGluR3) and suppresses glutamate release. However, the catalytic enzyme glutamate carboxypeptidase II (GCP II) rapidly hydrolyzes NAAG into NAA and glutamate. Inhibition of the GCP II enzyme with NAAG peptidase inhibitors reduces the concentration of glutamate both by increasing the duration of NAAG activity on mGluR3 and by reducing degradation into NAA and glutamate resulting in reduced cell death in models of TBI and TBI with hypoxia. In the following study, rats were administered the NAAG peptidase inhibitor PGI-02776 (10mg/kg) 30 min following TBI combined with a hypoxic second insult. Over the two weeks following injury, PGI-02776-treated rats had significantly improved motor function as measured by increased duration on the rota-rod and a trend toward improved performance on the beam walk. Furthermore, two weeks post-injury, PGI-02776-treated animals had a significant decrease in latency to find the target platform in the Morris water maze as compared to vehicle-treated animals. These findings demonstrate that the application of NAAG peptidase inhibitors can reduce the deleterious motor and cognitive effects of TBI combined with a second hypoxic insult in the weeks following injury.
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Affiliation(s)
- Gene G Gurkoff
- Department of Neurological Surgery, University of California at Davis, One Shields Avenue, Davis, CA 95616, USA
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31
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Dapul HR, Park J, Zhang J, Lee C, DanEshmand A, Lok J, Ayata C, Gray T, Scalzo A, Qiu J, Lo EH, Whalen MJ. Concussive injury before or after controlled cortical impact exacerbates histopathology and functional outcome in a mixed traumatic brain injury model in mice. J Neurotrauma 2013; 30:382-91. [PMID: 23153355 DOI: 10.1089/neu.2012.2536] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Traumatic brain injury (TBI) may involve diverse injury mechanisms (e.g., focal impact vs. diffuse impact loading). Putative therapies developed in TBI models featuring a single injury mechanism may fail in clinical trials if the model does not fully replicate multiple injury subtypes, which may occur concomitantly in a given patient. We report development and characterization of a mixed contusion/concussion TBI model in mice using controlled cortical impact (CCI; 0.6 mm depth, 6 m/sec) and a closed head injury (CHI) model at one of two levels of injury (53 vs. 83 g weight drop from 66 in). Compared with CCI or CHI alone, sequential CCI-CHI produced additive effects on loss of consciousness (p<0.001), acute cell death (p<0.05), and 12-day lesion size (p<0.05) but not brain edema or 48-h contusion volume. Additive effects of CHI and CCI on post-injury motor (p<0.05) and cognitive (p<0.005) impairment were observed with sequential CCI-CHI (83 g). The data suggest that concussive forces, which in isolation do not induce histopathological damage, exacerbate histopathology and functional outcome after cerebral contusion. Sequential CHI-CCI may model complex injury mechanisms that occur in some patients with TBI and may prove useful for testing putative therapies.
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Affiliation(s)
- Heda R Dapul
- Neuroscience Center , Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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32
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Agoston DV, Elsayed M. Serum-based protein biomarkers in blast-induced traumatic brain injury spectrum disorder. Front Neurol 2012; 3:107. [PMID: 22783223 PMCID: PMC3390892 DOI: 10.3389/fneur.2012.00107] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 06/12/2012] [Indexed: 11/16/2022] Open
Abstract
The biological consequences of exposure to explosive blast are extremely complex. Serum protein biomarkers in blast-induced traumatic brain injury (bTBI) can aid in determining injury severity, monitoring progress, and predicting outcome. Exposure to blast results in varying degrees of physical injury. Explosive blast can also induce psychological stress that can contribute to or amplify the extent of physical damage. Given the complexity, scale of injury, and variety of symptoms, bTBI may be best described as a spectrum disorder. In this focused review, we summarize the status of serum protein biomarkers in bTBI in the context of the classification and pathological changes of other forms of TBI. Finally, we recommend specific and easily implementable measures to accelerate serum protein biomarker discovery and validation in bTBI.
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Affiliation(s)
- Denes V Agoston
- Department of Anatomy, Physiology and Genetics, Uniformed Services University Bethesda, MD, USA
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33
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Feng JF, Gurkoff GG, Van KC, Song M, Lowe DA, Zhou J, Lyeth BG. NAAG peptidase inhibitor reduces cellular damage in a model of TBI with secondary hypoxia. Brain Res 2012; 1469:144-52. [PMID: 22750589 DOI: 10.1016/j.brainres.2012.06.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 06/11/2012] [Accepted: 06/15/2012] [Indexed: 11/26/2022]
Abstract
Traumatic brain injury (TBI) leads to a rapid and excessive glutamate elevation in the extracellular milieu, resulting in neuronal degeneration and astrocyte damage. Posttraumatic hypoxia is a clinically relevant secondary insult that increases the magnitude and duration of glutamate release following TBI. N-acetyl-aspartyl glutamate (NAAG), a prevalent neuropeptide in the CNS, suppresses presynaptic glutamate release by its action at the mGluR3 (a group II metabotropic glutamate receptor). However, extracellular NAAG is rapidly converted into NAA and glutamate by the catalytic enzyme glutamate carboxypeptidase II (GCPII) reducing presynaptic inhibition. We previously reported that the GCPII inhibitor ZJ-43 and its prodrug di-ester PGI-02776 reduce the deleterious effects of excessive extracellular glutamate when injected systemically within the first 30 min following injury. We now report that PGI-02776 (10mg/kg) is neuroprotective when administered 30 min post-injury in a model of TBI plus 30 min of hypoxia (FiO(2)=11%). 24h following TBI with hypoxia, significant increases in neuronal cell death in the CA1, CA2/3, CA3c, hilus and dentate gyrus were observed in the ipsilateral hippocampus. Additionally, there was a significant reduction in the number of astrocytes in the ipsilateral CA1, CA2/3 and in the CA3c/hilus/dentate gyrus. Administration of PGI-02776 immediately following the cessation of hypoxia significantly reduced neuronal and astrocytic cell death across all regions of the hippocampus. These findings indicate that NAAG peptidase inhibitors administered post-injury can significantly reduce the deleterious effects of TBI combined with a secondary hypoxic insult.
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Affiliation(s)
- Jun-Feng Feng
- Department of Neurological Surgery, University of California at Davis, One Shields Ave., Davis, CA 95616, USA
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