1
|
Hoogenboom WS, Rubin TG, Ambadipudi K, Cui MH, Ye K, Foster H, Elkouby E, Liu J, Branch CA, Lipton ML. Evolving brain and behaviour changes in rats following repetitive subconcussive head impacts. Brain Commun 2023; 5:fcad316. [PMID: 38046094 PMCID: PMC10691880 DOI: 10.1093/braincomms/fcad316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 09/26/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023] Open
Abstract
There is growing concern that repetitive subconcussive head impacts, independent of concussion, alter brain structure and function, and may disproportionately affect the developing brain. Animal studies of repetitive subconcussive head impacts are needed to begin to characterize the pathological basis and mechanisms underlying imaging and functional effects of repetitive subconcussive head impacts seen in humans. Since repetitive subconcussive head impacts have been largely unexplored in animals, we aimed to characterize the evolution of imaging, behavioural and pathological effects of repetitive subconcussive head impacts in awake adolescent rodents. Awake male and female Sprague Dawley rats (postnatal Day 35) received 140 closed-head impacts over the course of a week. Impacted and sham-impacted animals were restrained in a plastic cone, and unrestrained control animals were included to account for effects of restraint and normal development. Animals (n = 43) underwent repeated diffusion tensor imaging prior to and over 1 month following the final impact. A separate cohort (n = 53) was assessed behaviourally for fine motor control, emotional-affective behaviour and memory at acute and chronic time points. Histological and immunohistochemical analyses, which were exploratory in nature due to smaller sample sizes, were completed at 1 month following the final impact. All animals tolerated the protocol with no overt changes in behaviour or stigmata of traumatic brain injury, such as alteration of consciousness, intracranial haemorrhage or skull fracture. We detected longitudinal, sex-dependent diffusion tensor imaging changes (fractional anisotropy and axial diffusivity decline) in corpus callosum and external capsule of repetitive subconcussive head impact animals, which diverged from both sham and control. Compared to sham animals, repetitive subconcussive head impact animals exhibited acute but transient mild motor deficits. Repetitive subconcussive head impact animals also exhibited chronic anxiety and spatial memory impairment that differed from the control animals, but these effects were not different from those seen in the sham condition. We observed trends in the data for thinning of the corpus callosum as well as regions with elevated Iba-1 in the corpus callosum and cerebral white matter among repetitive subconcussive head impact animals. While replication with larger study samples is needed, our findings suggest that subconcussive head impacts cause microstructural tissue changes in the developing rat brain, which are detectable with diffusion tensor imaging, with suggestion of correlates in tissue pathology and behaviour. The results point to potential mechanisms underpinning consequences of subconcussive head impacts that have been described in humans. The congruence of our imaging findings with human subconcussive head impacts suggests that neuroimaging could serve as a translational bridge to advance study of injury mechanisms and development of interventions.
Collapse
Affiliation(s)
- Wouter S Hoogenboom
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA
- Department of Clinical Investigation, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Todd G Rubin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, NewYork, NY 10029, USA
| | - Kamalakar Ambadipudi
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Min-Hui Cui
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Kenny Ye
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Henry Foster
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA
| | - Esther Elkouby
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA
| | - Jinyuan Liu
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA
| | - Craig A Branch
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
- Department of Physiology and Biophysics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA
| | - Michael L Lipton
- Department of Radiology, Columbia University Irving Medical Center, NewYork, NY 10032, USA
- Department of Biomedical Engineering, Columbia University, NewYork, NY 10032, USA
| |
Collapse
|
2
|
McNerney MW, Gurkoff GG, Beard C, Berryhill ME. The Rehabilitation Potential of Neurostimulation for Mild Traumatic Brain Injury in Animal and Human Studies. Brain Sci 2023; 13:1402. [PMID: 37891771 PMCID: PMC10605899 DOI: 10.3390/brainsci13101402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Neurostimulation carries high therapeutic potential, accompanied by an excellent safety profile. In this review, we argue that an arena in which these tools could provide breakthrough benefits is traumatic brain injury (TBI). TBI is a major health problem worldwide, with the majority of cases identified as mild TBI (mTBI). MTBI is of concern because it is a modifiable risk factor for dementia. A major challenge in studying mTBI is its inherent heterogeneity across a large feature space (e.g., etiology, age of injury, sex, treatment, initial health status, etc.). Parallel lines of research in human and rodent mTBI can be collated to take advantage of the full suite of neuroscience tools, from neuroimaging (electroencephalography: EEG; functional magnetic resonance imaging: fMRI; diffusion tensor imaging: DTI) to biochemical assays. Despite these attractive components and the need for effective treatments, there are at least two major challenges to implementation. First, there is insufficient understanding of how neurostimulation alters neural mechanisms. Second, there is insufficient understanding of how mTBI alters neural function. The goal of this review is to assemble interrelated but disparate areas of research to identify important gaps in knowledge impeding the implementation of neurostimulation.
Collapse
Affiliation(s)
- M. Windy McNerney
- Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA; (M.W.M.); (C.B.)
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gene G. Gurkoff
- Department of Neurological Surgery, and Center for Neuroscience, University of California, Davis, Sacramento, CA 95817, USA;
- Department of Veterans Affairs, VA Northern California Health Care System, Martinez, CA 94553, USA
| | - Charlotte Beard
- Mental Illness Research Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA; (M.W.M.); (C.B.)
- Program in Neuroscience and Behavioral Biology, Emory University, Atlanta, GA 30322, USA
| | - Marian E. Berryhill
- Programs in Cognitive and Brain Sciences, and Integrative Neuroscience, Department of Psychology, University of Nevada, Reno, NV 89557, USA
| |
Collapse
|
3
|
Fronczak KM, Roberts A, Svirsky S, Parry M, Holets E, Henchir J, Dixon CE, Carlson SW. Assessment of behavioral, neuroinflammatory, and histological responses in a model of rat repetitive mild fluid percussion injury at 2 weeks post-injury. Front Neurol 2022; 13:945735. [PMID: 36341117 PMCID: PMC9630846 DOI: 10.3389/fneur.2022.945735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/26/2022] [Indexed: 11/23/2022] Open
Abstract
Repetitive mild traumatic brain injury (rmTBI) is a prominent public health concern, with linkage to debilitating chronic sequelae. Developing reliable and well-characterized preclinical models of rmTBI is imperative in the investigation of the underlying pathophysiological mechanisms, as models can have varying parameters, affecting the overall pathology of the resulting injury. The lateral fluid percussion injury (FPI) model is a reliable and frequently used method of TBI replication in rodent subjects, though it is currently relatively underutilized in rmTBI research. In this study, we have performed a novel description of a variation of the lateral repetitive mild FPI (rmFPI) model, showing the graded acute behavioral impairment and histopathology occurring in response to one, two or four mild FPI (1.25 atm) or sham surgeries, implemented 24h apart. Beam walking performance revealed significant motor impairment in injured animals, with dysfunction increasing with additional injury. Based upon behavioral responses and histological observations, we further investigated the subacute pathophysiological outcomes of the dual FPI (dFPI). Immunoreactivity assessments showed that dFPI led to regionally-specific reductions in the post-synaptic protein neurogranin and increased subcortical white matter staining of the presynaptic protein synaptophysin at 2 weeks following dFPI. Immunohistochemical assessments of the microglial marker Iba-1 showed a striking increase in in several brain regions, and assessment of the astrocytic marker GFAP showed significantly increased immunoreactivity in the subcortical white matter and thalamus. With this study, we have provided a novel account of the subacute post injury outcomes occurring in response to a rmFPI utilizing these injury and frequency parameters, and thereby also demonstrating the reliability of the lateral FPI model in rmTBI replication.
Collapse
Affiliation(s)
| | - Andrea Roberts
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarah Svirsky
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Madison Parry
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Erik Holets
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jeremy Henchir
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - C. Edward Dixon
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
- VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Shaun W. Carlson
- Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| |
Collapse
|
4
|
Nwafor DC, Brichacek AL, Foster CH, Lucke-Wold BP, Ali A, Colantonio MA, Brown CM, Qaiser R. Pediatric Traumatic Brain Injury: An Update on Preclinical Models, Clinical Biomarkers, and the Implications of Cerebrovascular Dysfunction. J Cent Nerv Syst Dis 2022; 14:11795735221098125. [PMID: 35620529 PMCID: PMC9127876 DOI: 10.1177/11795735221098125] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 04/14/2022] [Indexed: 11/15/2022] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of pediatric morbidity and mortality. Recent studies suggest that children and adolescents have worse post-TBI outcomes and take longer to recover than adults. However, the pathophysiology and progression of TBI in the pediatric population are studied to a far lesser extent compared to the adult population. Common causes of TBI in children are falls, sports/recreation-related injuries, non-accidental trauma, and motor vehicle-related injuries. A fundamental understanding of TBI pathophysiology is crucial in preventing long-term brain injury sequelae. Animal models of TBI have played an essential role in addressing the knowledge gaps relating to pTBI pathophysiology. Moreover, a better understanding of clinical biomarkers is crucial to diagnose pTBI and accurately predict long-term outcomes. This review examines the current preclinical models of pTBI, the implications of pTBI on the brain’s vasculature, and clinical pTBI biomarkers. Finally, we conclude the review by speculating on the emerging role of the gut-brain axis in pTBI pathophysiology.
Collapse
Affiliation(s)
- Divine C. Nwafor
- Department of Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
- West Virginia University School of Medicine, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Allison L. Brichacek
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Chase H. Foster
- Department of Neurosurgery, George Washington University Hospital, Washington D.C., USA
| | | | - Ahsan Ali
- Department of Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
| | | | - Candice M. Brown
- Department of Neuroscience, West Virginia University School of Medicine, Morgantown, WV, USA
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Rabia Qaiser
- Department of Neurosurgery, Baylor Scott and White, Temple, TX, USA
| |
Collapse
|
5
|
Psycho-affective health, cognition, and neurophysiological functioning following sports-related concussion in symptomatic and asymptomatic athletes, and control athletes. Sci Rep 2021; 11:13838. [PMID: 34226626 PMCID: PMC8257649 DOI: 10.1038/s41598-021-93218-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/31/2021] [Indexed: 11/08/2022] Open
Abstract
Little is known about the neuropsychiatric and neurophysiological differences that characterize abnormal recovery following a concussion. The present study aimed to investigate the psycho-affective, cognitive, and neurophysiological profiles of symptomatic, slow-to-recover, concussed athletes, asymptomatic concussed athletes, and control athletes. Seventy-eight athletes (26 symptomatic, 26 asymptomatic, 26 control) completed the Beck Depression Inventory-II, Profile of Mood States, and 2-Back task. Additionally, event-related brain potentials were recorded during an experimental three-stimulus visual Oddball paradigm. Compared to asymptomatic and control groups, the symptomatic group reported greater depression symptoms and negatively altered mood states. Symptomatic athletes also exhibited poorer cognitive performance on the 2-Back task, indicated by more errors and slower reaction time. ERP analyses indicated prolonged P3b latency for both symptomatic and asymptomatic groups, but symptomatic athletes also exhibited reduced P3b amplitude compared to both asymptomatic and control groups. For the asymptomatic group, correlations were observed between time since last concussion and functioning, but no relations were observed within the symptomatic group for any measure. The current findings provide valuable information regarding the psycho-affective, cognitive, and neurophysiological profiles of athletes with and without persistent symptoms following a concussion and highlight the need to assess and treat symptomatic, slow-to-recover athletes from a multidimensional and integrative perspective.
Collapse
|
6
|
Vita SM, Redell JB, Maynard ME, Zhao J, Grill RJ, Dash PK, Grayson BE. P-glycoprotein Expression Is Upregulated in a Pre-Clinical Model of Traumatic Brain Injury. Neurotrauma Rep 2020; 1:207-217. [PMID: 33274346 PMCID: PMC7703495 DOI: 10.1089/neur.2020.0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Athletes participating in contact sports are at risk for sustaining repeat mild traumatic brain injury (rmTBI). Unfortunately, no pharmacological treatment to lessen the pathophysiology of brain injury has received U.S. Food and Drug Administration (FDA) approval. One hurdle to overcome for potential candidate agents to reach effective therapeutic concentrations in the brain is the blood-brain barrier (BBB). Adenosine triphosphate (ATP)-binding cassette (ABC) transporters, such as P-glycoprotein (Pgp), line the luminal membrane of the brain capillary endothelium facing the vascular space. Although these transporters serve to protect the central nervous system (CNS) from damage by effluxing neurotoxicants before they can reach the brain, they may also limit the accumulation of therapeutic drugs in the brain parenchyma. Thus, increased Pgp expression following brain injury may result in reduced brain availability of therapeutic agents. We therefore questioned if repeat concussive injury increases Pgp expression in the brain. To answer this question, we used a rodent model of repeat mild closed head injury (rmCHI) and examined the messenger RNA (mRN) and protein expression of both isoforms of rodent Pgp (Abcb1a and Abcb1b). Compared with sham-operated controls (n = 5), the mRNA levels of both Abcb1a and Abcb1b were found to be increased in the hippocampus at day 1 (n = 5) and at day 5 (n = 5) post-injury. Using a validated antibody, we show increased immunolabeling for Pgp in the dorsal cortex at day 5 and in the hippocampus at day 1 (n = 5) and at day 5 (n = 5) post-injury compared with sham controls (n = 6). Taken together, these results suggest that increased expression of Pgp after rmCHI may reduce the brain accumulation of therapeutic drugs that are Pgp substrates. It is plausible that including a Pgp inhibitor with a candidate therapeutic agent may be an effective approach to treat the pathophysiology of rmCHI.
Collapse
Affiliation(s)
- Sydney M Vita
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - John B Redell
- Department of Neurobiology and Anatomy, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Mark E Maynard
- Department of Neurobiology and Anatomy, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Jing Zhao
- Department of Neurobiology and Anatomy, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Raymond J Grill
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Pramod K Dash
- Department of Neurobiology and Anatomy, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Bernadette E Grayson
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| |
Collapse
|
7
|
Honig MG, Dorian CC, Worthen JD, Micetich AC, Mulder IA, Sanchez KB, Pierce WF, Del Mar NA, Reiner A. Progressive long-term spatial memory loss following repeat concussive and subconcussive brain injury in mice, associated with dorsal hippocampal neuron loss, microglial phenotype shift, and vascular abnormalities. Eur J Neurosci 2020; 54:5844-5879. [PMID: 32090401 PMCID: PMC7483557 DOI: 10.1111/ejn.14711] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/14/2022]
Abstract
There is considerable concern about the long‐term deleterious effects of repeat head trauma on cognition, but little is known about underlying mechanisms and pathology. To examine this, we delivered four air blasts to the left side of the mouse cranium, a week apart, with an intensity that causes deficits when delivered singly and considered “concussive,” or an intensity that does not yield significant deficits when delivered singly and considered “subconcussive.” Neither repeat concussive nor subconcussive blast produced spatial memory deficits at 4 months, but both yielded deficits at 14 months, and dorsal hippocampal neuron loss. Hierarchical cluster analysis of dorsal hippocampal microglia across the three groups based on morphology and expression of MHCII, CX3CR1, CD68 and IBA1 revealed five distinct phenotypes. Types 1A and 1B microglia were more common in sham mice, linked to better neuron survival and memory, and appeared mildly activated. By contrast, 2B and 2C microglia were more common in repeat concussive and subconcussive mice, linked to poorer neuron survival and memory, and characterized by low expression levels and attenuated processes, suggesting they were de‐activated and dysfunctional. In addition, endothelial cells in repeat concussive mice exhibited reduced CD31 and eNOS expression, which was correlated with the prevalence of type 2B and 2C microglia. Our findings suggest that both repeat concussive and subconcussive head injury engender progressive pathogenic processes, possibly through sustained effects on microglia that over time lead to increased prevalence of dysfunctional microglia, adversely affecting neurons and blood vessels, and thereby driving neurodegeneration and memory decline.
Collapse
Affiliation(s)
- Marcia G Honig
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Conor C Dorian
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - John D Worthen
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anthony C Micetich
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Isabelle A Mulder
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katelyn B Sanchez
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - William F Pierce
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nobel A Del Mar
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anton Reiner
- Department of Anatomy and Neurobiology, The University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Ophthalmology, The University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
8
|
Harper MM, Woll AW, Evans LP, Delcau M, Akurathi A, Hedberg-Buenz A, Soukup DA, Boehme N, Hefti MM, Dutca LM, Anderson MG, Bassuk AG. Blast Preconditioning Protects Retinal Ganglion Cells and Reveals Targets for Prevention of Neurodegeneration Following Blast-Mediated Traumatic Brian Injury. Invest Ophthalmol Vis Sci 2019; 60:4159-4170. [PMID: 31598627 PMCID: PMC6785841 DOI: 10.1167/iovs.19-27565] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The purpose of this study was to examine the effect of multiple blast exposures and blast preconditioning on the structure and function of retinal ganglion cells (RGCs), to identify molecular pathways that contribute to RGC loss, and to evaluate the role of kynurenine-3-monooxygenase (KMO) inhibition on RGC structure and function. Methods Mice were subjected to sham blast injury, one single blast injury, or three blast injuries separated by either 1 hour or 1 week, using a blast intensity of 20 PSI. To examine the effect of blast preconditioning, mice were subjected to sham blast injury, one single 20-PSI injury, or three blast injuries separated by 1 week (5 PSI, 5 PSI, 20 PSI and 5 PSI, 5 PSI, 5 PSI). RGC structure was analyzed by optical coherence tomography (OCT) and function was analyzed by the pattern electroretinogram (PERG). BRN3A-positive cells were quantified to determine RGC density. RNA-seq analysis was used to identify transcriptional changes between groups. Results Analysis of mice with multiple blast exposures of 20 PSI revealed no significant differences compared to one 20-pounds per square inch (PSI) exposure using OCT, PERG, or BRN3A cell counts. Analysis of mice exposed to two preconditioning 5-PSI blasts prior to one 20-PSI blast showed preservation of RGC structure and function. RNA-seq analysis of the retina identified multiple transcriptomic changes between conditions. Pharmacologic inhibition of KMO preserved RGC responses compared to vehicle-treated mice. Conclusions Preconditioning protects RGC from blast injury. Protective effects appear to involve changes in KMO activity, whose inhibition is also protective.
Collapse
Affiliation(s)
- Matthew M. Harper
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Addison W. Woll
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Lucy P. Evans
- Medical Scientist Training Program, University of Iowa, Iowa City, Iowa, United States
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
| | - Michael Delcau
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Abhigna Akurathi
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa
| | - Adam Hedberg-Buenz
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, United States
| | - Dana A. Soukup
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, United States
| | - Nickolas Boehme
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Marco M. Hefti
- Department of Pathology, University of Iowa, Iowa City, Iowa, United States
| | - Laura M. Dutca
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
| | - Michael G. Anderson
- The Iowa City Department of Veterans Affairs Medical Center, Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa, United States
| | - Alexander G. Bassuk
- Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States
- Department of Neurology, University of Iowa, Iowa City, Iowa, United States
| |
Collapse
|
9
|
Abstract
The underlying mechanisms that result in neurophysiological changes and cognitive sequelae in the context of repetitive mild traumatic brain injury (rmTBI) remain poorly understood. Animal models provide a unique opportunity to examine cellular and molecular responses using histological assessment, which can give important insights on the neurophysiological changes associated with the evolution of brain injury. To better understand the potential cumulative effects of multiple concussions, the focus of animal models is shifting from single to repetitive head impacts. With a growing body of literature on this subject, a review and discussion of current findings is valuable to better understand the neuropathology associated with rmTBI, to evaluate the current state of the field, and to guide future research efforts. Despite variability in experimental settings, existing animal models of rmTBI have contributed to our understanding of the underlying mechanisms following repeat concussion. However, how to reconcile the various impact methods remains one of the major challenges in the field today.
Collapse
Affiliation(s)
- Wouter S Hoogenboom
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Clinical Investigation, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA.
| | - Craig A Branch
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Physiology and Biophysics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
| | - Michael L Lipton
- The Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10641, USA; Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; Departments of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA; The Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, USA.
| |
Collapse
|
10
|
Tucker LB, Velosky AG, Fu AH, McCabe JT. Chronic Neurobehavioral Sex Differences in a Murine Model of Repetitive Concussive Brain Injury. Front Neurol 2019; 10:509. [PMID: 31178814 PMCID: PMC6538769 DOI: 10.3389/fneur.2019.00509] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/29/2019] [Indexed: 01/29/2023] Open
Abstract
Traumatic brain injury (TBI) resulting from repeated head trauma is frequently characterized by diffuse axonal injury and long-term motor, cognitive and neuropsychiatric symptoms. Given the delay, often decades, between repeated head traumas and the presentation of symptoms in TBI patients, animal models of repeated injuries should be studied longitudinally to properly assess the longer-term effects of multiple concussive injuries on functional outcomes. In this study, male and cycling female C57BL/6J mice underwent repeated (three) concussive brain injuries (rCBI) delivered via a Leica ImpactOne cortical impact device and were assessed chronically on motor (open field and rotarod), cognitive (y-maze and active place avoidance), and neuropsychiatric (marble-burying, elevated zero maze and tail suspension) tests. Motor deficits were significant on the rotarod on the day following the injuries, and slight impairment remained for up to 6 months. All mice that sustained rCBI had significant cognitive deficits on the active place avoidance test and showed greater agitation (less immobility) in the tail suspension test. Only injured male mice were significantly hyperactive in the open field, and had increased time spent in the open quadrants of the elevated zero maze. One year after the injuries, mice of both sexes exhibited persistent pathological changes by the presence of Prussian blue staining (indication of prior microbleeds), primarily in the cortex at the site of the injury, and increased GFAP staining in the perilesional cortex and axonal tracts (corpus callosum and optic tracts). These data demonstrate that a pathological phenotype with motor, cognitive, and neuropsychiatric symptoms can be observed in an animal model of rCBI for at least one year post-injury, providing a pre-clinical setting for the study of the link between multiple brain injuries and neurodegenerative disorders. Furthermore, this is the first study to include both sexes in a pre-clinical long-term rCBI model, and female mice are less impaired functionally than males.
Collapse
Affiliation(s)
- Laura B Tucker
- Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.,Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Alexander G Velosky
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Amanda H Fu
- Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.,Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Joseph T McCabe
- Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.,Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| |
Collapse
|
11
|
Fehily B, Bartlett CA, Lydiard S, Archer M, Milbourn H, Majimbi M, Hemmi JM, Dunlop SA, Yates NJ, Fitzgerald M. Differential responses to increasing numbers of mild traumatic brain injury in a rodent closed-head injury model. J Neurochem 2019; 149:660-678. [PMID: 30702755 DOI: 10.1111/jnc.14673] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/20/2018] [Accepted: 01/14/2019] [Indexed: 01/13/2023]
Abstract
Following mild traumatic brain injury (mTBI), further mild impacts can exacerbate negative outcomes. To compare chronic damage and deficits following increasing numbers of repeated mTBIs, a closed-head weight-drop model of repeated mTBI was used to deliver 1, 2 or 3 mTBIs to adult female rats at 24 h intervals. Outcomes were assessed at 3 months following the first mTBI. No gross motor, sensory or reflex deficits were identified (p > 0.05), consistent with current literature. Cognitive function assessed using a Morris water maze revealed chronic memory deficits following 1 and 2, but not 3 mTBI compared to shams (p ≤ 0.05). Oxidative damage to DNA was assessed immunohistochemically in the dentate hilus of the hippocampus and splenium of the corpus callosum; no changes were observed. IBA1-positive microglia were increased in size in the cortex following 1 mTBI and in the corpus callosum following 2 mTBI compared to shams (p ≤ 0.05); no changes were observed in the dentate hilus. Glial fibrillary acidic protein (GFAP)-positive astrocyte immunoreactivity was assessed in all three brain regions and no chronic changes were observed. Integrity of myelin ultrastructure in the corpus callosum was assessed using transmission electron microscopy. G ratio was decreased following 2 mTBIs compared to shams (p ≤ 0.05) at post hoc level only. The changing patterns of damage and deficits following increasing numbers of mTBI may reflect dynamic responses to small numbers of mTBIs or a conditioning effect such that increasing numbers of mTBIs do not necessarily result in worsening pathology. OPEN SCIENCE BADGES: This article has received a badge for *Open Materials* because it provided all relevant information to reproduce the study in the manuscript. The complete Open Science Disclosure form for this article can be found at the end of the article. More information about the Open Practices badges can be found at https://cos.io/our-services/open-science-badges/. Cover Image for this issue: doi: 10.1111/jnc.14508.
Collapse
Affiliation(s)
- Brooke Fehily
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
- School of Human Sciences, The University of Western Australia, Nedlands, WA, Australia
| | - Carole A Bartlett
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Stephen Lydiard
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Michael Archer
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Hannah Milbourn
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Maimuna Majimbi
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Bentley, WA, Australia
| | - Jan M Hemmi
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Sarah A Dunlop
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
| | - Nathanael J Yates
- School of Human Sciences, The University of Western Australia, Nedlands, WA, Australia
| | - Melinda Fitzgerald
- Experimental and Regenerative Neurosciences, School of Biological Sciences, Crawley, WA, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Bentley, WA, Australia
- The Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute Building, Nedlands, WA, Australia
| |
Collapse
|
12
|
Adams C, Bazzigaluppi P, Beckett TL, Bishay J, Weisspapir I, Dorr A, Mester JR, Steinman J, Hirschler L, Warnking JM, Barbier EL, McLaurin J, Sled JG, Stefanovic B. Neurogliovascular dysfunction in a model of repeated traumatic brain injury. Am J Cancer Res 2018; 8:4824-4836. [PMID: 30279740 PMCID: PMC6160760 DOI: 10.7150/thno.24747] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/02/2018] [Indexed: 12/13/2022] Open
Abstract
Traumatic brain injury (TBI) research has focused on moderate to severe injuries as their outcomes are significantly worse than those of a mild TBI (mTBI). However, recent epidemiological evidence has indicated that a series of even mild TBIs greatly increases the risk of neurodegenerative and psychiatric disorders. Neuropathological studies of repeated TBI have identified changes in neuronal ionic concentrations, axonal injury, and cytoskeletal damage as important determinants of later life neurological and mood compromise; yet, there is a paucity of data on the contribution of neurogliovascular dysfunction to the progression of repeated TBI and alterations of brain function in the intervening period. Methods: Here, we established a mouse model of repeated TBI induced via three electromagnetically actuated impacts delivered to the intact skull at three-day intervals and determined the long-term deficits in neurogliovascular functioning in Thy1-ChR2 mice. Two weeks post the third impact, cerebral blood flow and cerebrovascular reactivity were measured with arterial spin labelling magnetic resonance imaging. Neuronal function was investigated through bilateral intracranial electrophysiological responses to optogenetic photostimulation. Vascular density of the site of impacts was measured with in vivo two photon fluorescence microscopy. Pathological analysis of neuronal survival and astrogliosis was performed via NeuN and GFAP immunofluorescence. Results: Cerebral blood flow and cerebrovascular reactivity were decreased by 50±16% and 70±20%, respectively, in the TBI cohort relative to sham-treated animals. Concomitantly, electrophysiological recordings revealed a 97±1% attenuation in peri-contusional neuronal reactivity relative to sham. Peri-contusional vascular volume was increased by 33±2% relative to sham-treated mice. Pathological analysis of the peri-contusional cortex demonstrated astrogliosis, but no changes in neuronal survival. Conclusion: This work provides the first in-situ characterization of the long-term deficits of the neurogliovascular unit following repeated TBI. The findings will help guide the development of diagnostic markers as well as therapeutics targeting neurogliovascular dysfunction.
Collapse
|
13
|
Abstract
Mild traumatic brain injury (mTBI) represents a significant public healthcare concern, accounting for the majority of all head injuries. While symptoms are generally transient, some patients go on to experience long-term cognitive impairments and additional mild impacts can result in exacerbated and persisting negative outcomes. To date, studies using a range of experimental models have reported chronic behavioral deficits in the presence of axonal injury and inflammation following repeated mTBI; assessments of oxidative stress and myelin pathology have thus far been limited. However, some models employed induced acute focal damage more suggestive of moderate–severe brain injury and are therefore not relevant to repeated mTBI. Given that the nature of mechanical loading in TBI is implicated in downstream pathophysiological changes, the mechanisms of damage and chronic consequences of single and repeated closed-head mTBI remain to be fully elucidated. This review covers literature on potential mechanisms of damage following repeated mTBI, integrating known mechanisms of pathology underlying moderate–severe TBIs, with recent studies on adult rodent models relevant to direct impact injuries rather than blast-induced damage. Pathology associated with excitotoxicity and cerebral blood flow-metabolism uncoupling, oxidative stress, cell death, blood-brain barrier dysfunction, astrocyte reactivity, microglial activation, diffuse axonal injury, and dysmyelination is discussed, followed by a summary of functional deficits and preclinical assessments of therapeutic strategies. Comprehensive characterization of the pathology underlying delayed and persisting deficits following repeated mTBI is likely to facilitate further development of therapeutic strategies to limit long-term sequelae.
Collapse
Affiliation(s)
- Brooke Fehily
- 1 Experimental and Regenerative Neurosciences, School of Biological sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Melinda Fitzgerald
- 1 Experimental and Regenerative Neurosciences, School of Biological sciences, The University of Western Australia, Perth, Western Australia, Australia.,2 Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia.,3 Perron Institute for Neurological and Translational Science, Sarich Neuroscience Research Institute, Nedlands, Western Australia, Australia
| |
Collapse
|
14
|
Tucker LB, Velosky AG, McCabe JT. Applications of the Morris water maze in translational traumatic brain injury research. Neurosci Biobehav Rev 2018; 88:187-200. [PMID: 29545166 DOI: 10.1016/j.neubiorev.2018.03.010] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/09/2018] [Accepted: 03/09/2018] [Indexed: 12/21/2022]
Abstract
Acquired traumatic brain injury (TBI) is frequently accompanied by persistent cognitive symptoms, including executive function disruptions and memory deficits. The Morris Water Maze (MWM) is the most widely-employed laboratory behavioral test for assessing cognitive deficits in rodents after experimental TBI. Numerous protocols exist for performing the test, which has shown great robustness in detecting learning and memory deficits in rodents after infliction of TBI. We review applications of the MWM for the study of cognitive deficits following TBI in pre-clinical studies, describing multiple ways in which the test can be employed to examine specific aspects of learning and memory. Emphasis is placed on dependent measures that are available and important controls that must be considered in the context of TBI. Finally, caution is given regarding interpretation of deficits as being indicative of dysfunction of a single brain region (hippocampus), as experimental models of TBI most often result in more diffuse damage that disrupts multiple neural pathways and larger functional networks that participate in complex behaviors required in MWM performance.
Collapse
Affiliation(s)
- Laura B Tucker
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA; Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301, Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - Alexander G Velosky
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - Joseph T McCabe
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA; Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301, Jones Bridge Road, Bethesda, MD, 20814, USA.
| |
Collapse
|
15
|
Sangobowale MA, Grin'kina NM, Whitney K, Nikulina E, St Laurent-Ariot K, Ho JS, Bayzan N, Bergold PJ. Minocycline plus N-Acetylcysteine Reduce Behavioral Deficits and Improve Histology with a Clinically Useful Time Window. J Neurotrauma 2018; 35:907-917. [PMID: 29187031 DOI: 10.1089/neu.2017.5348] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
There are no drugs to manage traumatic brain injury (TBI) presently. A major problem in developing therapeutics is that drugs to manage TBI lack sufficient potency when dosed within a clinically relevant time window. Previous studies have shown that minocycline (MINO, 45 mg/kg) plus N-acetylcysteine (NAC, 150 mg/kg) synergistically improved cognition and memory, modulated inflammation, and prevented loss of oligodendrocytes that remyelinated damaged white matter when first dosed 1 h after controlled cortical impact (CCI) in rats. We show that MINO (45 mg/kg) plus NAC (150 mg/kg) also prevent brain injury in a mouse closed head injury (CHI) TBI model. Using the CHI model, the concentrations of MINO and NAC were titrated to determine that MINO (22.5 mg/kg) plus NAC (75 mg/kg) was more potent than the original formulation. MINO (22.5 mg/kg) plus NAC (75 mg/kg) also limited injury in the rat CCI model. The therapeutic time window of MINO plus NAC was then tested in the CHI and CCI models. Mice and rats could acquire an active place avoidance task when MINO plus NAC was first dosed at 12 h post-injury. A first dose at 12 h also limited gray matter injury in the hippocampus and preserved myelin in multiple white matter tracts. Mice and rats acquired Barnes maze when MINO plus NAC was first dosed at 24 h post-injury. These data suggest that MINO (22.5 mg/kg) plus NAC (75 mg/kg) remain potent when dosed at clinically useful time windows. Both MINO and NAC are drugs approved by the Food and Drug Administration and have been administered safely to patients in clinical trials at the doses in the new formulation. This suggests that the drug combination of MINO plus NAC may be effective in treating patients with TBI.
Collapse
Affiliation(s)
| | - Natalia M Grin'kina
- Department of Physiology and Pharmacology, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Kristen Whitney
- School of Graduate Studies, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Elena Nikulina
- Department of Physiology and Pharmacology, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Karrah St Laurent-Ariot
- Department of Physiology and Pharmacology, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Johnson S Ho
- Department of Physiology and Pharmacology, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Narek Bayzan
- Department of Physiology and Pharmacology, SUNY-Downstate Medical Center, Brooklyn, New York
| | - Peter J Bergold
- Department of Physiology and Pharmacology, SUNY-Downstate Medical Center, Brooklyn, New York.,Robert F. Furchgott Center for Neural and Behavioral Science, SUNY-Downstate Medical Center, Brooklyn, New York
| |
Collapse
|
16
|
Velosky AG, Tucker LB, Fu AH, Liu J, McCabe JT. Cognitive performance of male and female C57BL/6J mice after repetitive concussive brain injuries. Behav Brain Res 2017; 324:115-124. [PMID: 28214540 DOI: 10.1016/j.bbr.2017.02.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/24/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
In contact sports, repetitive concussive brain injury (rCBI) is the prevalent form of head injury seen in athletes. The need for effective treatment is urgent as rCBI has been associated with a host of cognitive, behavioral and neurological complaints. There has been a growing trend in the use of female animals in pre-clinical research, but few studies have investigated possible sex differences following rCBI. The goal of the current study was to determine any differences between male and female C57BL/6J mice on assessments of learning and memory after repetitive concussive injury. Following rCBI by impact to the scalp, male mice exhibited longer righting reflexes during acute recovery. In both sexes, there were no evident histopathological changes observed in the underlying cerebral cortex or hippocampus. Reactive astrogliosis was elevated in the corpus callosum and optic tract, and astrogliosis was slightly less in the optic tract of female mice. rCBI mice exhibited impairment during the learning phase of the Morris water maze (MWM), but female mice, in comparison to male mice, were observed to have superior spatial memory during standard MWM probe trials. Female mice were overall more active, evidenced by greater distances traveled in the y-maze and greater swim speeds in the MWM. The results of this study demonstrate sex differences in cognitive performance following rCBI and support previous research suggesting the neuroprotective role of sex in brain injury.
Collapse
Affiliation(s)
- Alexander G Velosky
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States
| | - Laura B Tucker
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States; Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States
| | - Amanda H Fu
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States; Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States
| | - Jiong Liu
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States
| | - Joseph T McCabe
- Department of Anatomy, Physiology & Genetics, F.E. Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, United States; Pre-Clinical Studies Core, Center for Neuroscience and Regenerative Medicine, Bethesda, MD, United States.
| |
Collapse
|
17
|
Zhang HB, Cheng SX, Tu Y, Zhang S, Hou SK, Yang Z. Protective effect of mild-induced hypothermia against moderate traumatic brain injury in rats involved in necroptotic and apoptotic pathways. Brain Inj 2017; 31:406-415. [PMID: 28140659 DOI: 10.1080/02699052.2016.1225984] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM To investigate the protective effect of hypothermia (HT) on brain injury in moderate traumatic brain injury (TBI) rat models and the potential mechanisms, especially the involvement of RIPK1 in apoptosis and necroptosis. METHODS Adult Sprague-Dawley rats were randomized to four groups: sham+normothermia (sham+NT), sham+hypothermia (sham+HT), moderate TBI+normothermia (TBI+NT) and moderate TBI+hypothermia (TBI+HT). The sham+HT and TBI+HT groups were submitted to 32°C for 6 hours. The regional cerebral blood flow (rCBF) was assessed 24 hours after TBI; 24 and 48 hours after TBI, the modified neurological severity score (mNSS) was assessed. Immediately after behavioural tests, rats were sacrificed to harvest the brain tissues. RESULTS mNSS scores were lower in the TBI+HT group compared with the TBI+NT group (p < 0.01) and cerebral blood flow was better (p < 0.01). H&E staining of the cortex and ipsilateral hippocampus showed pyknotic and irregularly shaped neurons in TBI+NT rats, which were less frequent in TBI+HT rats. The TBI+NT and TBI+HT groups showed higher TNF-α, TRAIL, FasL, FADD, caspase-3, caspase-8, PARP-1, RIPK-1 and RIPK-3 levels than the sham+NT group (all p < 0.05), but the levels of these proteins were all lower in the TBI+HT group compared with the TBI+NT group (all p < 0.01). CONCLUSION HT treatment significantly reduced RIPK-1 upregulation, which may inhibit necroptosis and apoptosis pathways after moderate TBI.
Collapse
Affiliation(s)
- Hai-Bo Zhang
- a Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience of Chinese People's Armed Police Forces (PAP) , Neurosurgical and Neurological Hospital of PAP , Tianjin , PR China
| | - Shi-Xiang Cheng
- a Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience of Chinese People's Armed Police Forces (PAP) , Neurosurgical and Neurological Hospital of PAP , Tianjin , PR China
| | - Yue Tu
- a Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience of Chinese People's Armed Police Forces (PAP) , Neurosurgical and Neurological Hospital of PAP , Tianjin , PR China
| | - Sai Zhang
- a Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience of Chinese People's Armed Police Forces (PAP) , Neurosurgical and Neurological Hospital of PAP , Tianjin , PR China
| | - Shi-Ke Hou
- a Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience of Chinese People's Armed Police Forces (PAP) , Neurosurgical and Neurological Hospital of PAP , Tianjin , PR China
| | - Zhen Yang
- a Tianjin Key Laboratory of Neurotrauma Repair, Institute of Traumatic Brain Injury and Neuroscience of Chinese People's Armed Police Forces (PAP) , Neurosurgical and Neurological Hospital of PAP , Tianjin , PR China
| |
Collapse
|
18
|
Jamnia N, Urban JH, Stutzmann GE, Chiren SG, Reisenbigler E, Marr R, Peterson DA, Kozlowski DA. A Clinically Relevant Closed-Head Model of Single and Repeat Concussive Injury in the Adult Rat Using a Controlled Cortical Impact Device. J Neurotrauma 2016; 34:1351-1363. [PMID: 27762651 DOI: 10.1089/neu.2016.4517] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Repeat concussions (RC) can result in significant long-term neurological consequences and increased risk for neurodegenerative disease compared with single concussion (SC). Mechanisms underlying this difference are poorly understood and best elucidated using an animal model. To the best of our knowledge, there is no closed-head model in the adult rat using a commercially available device. We developed a novel and clinically relevant closed-head injury (CHI) model of both SC and RC in the adult rat using a controlled cortical impact (CCI) device. Adult rats received either a single or repeat CHI (three injuries, 48 h apart), and acute deficits in sensorimotor and locomotor function (foot fault; open field), memory (novel object), and anxiety (open field; corticosterone [CORT]) were measured. Assessment of cellular pathology was also conducted. Within the first week post-CHI, rats with SC or RC showed similar deficits in motor coordination, decreased locomotion, and higher resting CORT levels. Rats with an SC had memory deficits post-injury day (PID) 3 that recovered to sham levels by PID 7; however, rats with RC continued to show memory deficits. No obvious gross pathology was observed on the cortical surface or in coronal sections. Further examination showed thinning of the cortex and corpus callosum in RC animals compared with shams and increased axonal pathology in the corpus callosum of both SC and RC animals. Our data present a model of CHI that results in clinically relevant markers of concussion and an early differentiation between SC and RC.
Collapse
Affiliation(s)
- Naseem Jamnia
- 1 Department of Biological Sciences, DePaul University , Chicago, Illinois
| | - Janice H Urban
- 2 Department of Physiology & Biophysics, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
| | - Grace E Stutzmann
- 3 Center for Stem Cell & Regenerative Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
- 4 Department of Neuroscience, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
| | - Sarah G Chiren
- 3 Center for Stem Cell & Regenerative Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
- 4 Department of Neuroscience, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
| | - Emily Reisenbigler
- 3 Center for Stem Cell & Regenerative Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
- 4 Department of Neuroscience, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
| | - Robert Marr
- 3 Center for Stem Cell & Regenerative Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
- 4 Department of Neuroscience, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
| | - Daniel A Peterson
- 3 Center for Stem Cell & Regenerative Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
- 4 Department of Neuroscience, Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago, Illinois
| | | |
Collapse
|
19
|
Grin’kina NM, Li Y, Haber M, Sangobowale M, Nikulina E, Le’Pre C, El Sehamy AM, Dugue R, Ho JS, Bergold PJ. Righting Reflex Predicts Long-Term Histological and Behavioral Outcomes in a Closed Head Model of Traumatic Brain Injury. PLoS One 2016; 11:e0161053. [PMID: 27657499 PMCID: PMC5033343 DOI: 10.1371/journal.pone.0161053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 07/30/2016] [Indexed: 12/22/2022] Open
Abstract
Blunt impact produces a heterogeneous brain injury in people and in animal models of traumatic brain injury. We report that a single closed head impact to adult C57/BL6 mice produced two injury syndromes (CHI-1 and CHI-2). CHI-1 mice spontaneously reinitiated breathing after injury while CHI-2 mice had prolonged apnea and regained breathing only after cardiopulmonary resuscitation and supplementation of 100% O2. The CHI-1 group significantly regained righting reflex more rapidly than the CHI-2 group. At 7 days post-injury, CHI-1, but not CHI-2 mice, acquired but had no long-term retention of an active place avoidance task. The behavioral deficits of CHI-1 and CHI-2 mice were retained one-month after the injury. CHI-1 mice had loss of hippocampal neurons and localized white matter injury at one month after injury. CHI-2 had a larger loss of hippocampal neurons and more widespread loss of myelin and axons. High-speed videos made during the injury were followed by assessment of breathing and righting reflex. These videos show that CHI-2 mice experienced a larger vertical g-force than CHI-1 mice. Time to regain righting reflex in CHI-2 mice significantly correlated with vertical g-force. Thus, physiological responses occurring immediately after injury can be valuable surrogate markers of subsequent behavioral and histological deficits.
Collapse
Affiliation(s)
- Natalia M. Grin’kina
- Robert F. Furchgott Center for Neural Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
- Department of Physiology and Pharmacology SUNY-Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, United States of America
| | - Yang Li
- Robert F. Furchgott Center for Neural Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
| | - Margalit Haber
- Program in Neural and Behavioral Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
- Robert F. Furchgott Center for Neural Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
| | - Michael Sangobowale
- Program in Neural and Behavioral Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
| | - Elena Nikulina
- Robert F. Furchgott Center for Neural Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
- Department of Physiology and Pharmacology SUNY-Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, United States of America
| | - Charm Le’Pre
- Program in Neural and Behavioral Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
| | - Alexander M. El Sehamy
- Robert F. Furchgott Center for Neural Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
| | - Rachelle Dugue
- Program in Neural and Behavioral Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
| | - Johnson S. Ho
- Robert F. Furchgott Center for Neural Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
| | - Peter J. Bergold
- Program in Neural and Behavioral Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
- Robert F. Furchgott Center for Neural Science, SUNY-Downstate Medical Center, Brooklyn, NY, United States of America
- Department of Physiology and Pharmacology SUNY-Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, United States of America
- * E-mail:
| |
Collapse
|
20
|
Shultz SR, McDonald SJ, Vonder Haar C, Meconi A, Vink R, van Donkelaar P, Taneja C, Iverson GL, Christie BR. The potential for animal models to provide insight into mild traumatic brain injury: Translational challenges and strategies. Neurosci Biobehav Rev 2016; 76:396-414. [PMID: 27659125 DOI: 10.1016/j.neubiorev.2016.09.014] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 09/07/2016] [Accepted: 09/16/2016] [Indexed: 12/14/2022]
Abstract
Mild traumatic brain injury (mTBI) is a common health problem. There is tremendous variability and heterogeneity in human mTBI, including mechanisms of injury, biomechanical forces, injury severity, spatial and temporal pathophysiology, genetic factors, pre-injury vulnerability and resilience factors, and clinical outcomes. Animal models greatly reduce this variability and heterogeneity, and provide a means to study mTBI in a rigorous, controlled, and efficient manner. Rodent models, in particular, are time- and cost-efficient, and they allow researchers to measure morphological, cellular, molecular, and behavioral variables in a single study. However, inter-species differences in anatomy, morphology, metabolism, neurobiology, and lifespan create translational challenges. Although the term "mild" TBI is used often in the pre-clinical literature, clearly defined criteria for mild, moderate, and severe TBI in animal models have not been agreed upon. In this review, we introduce current issues facing the mTBI field, summarize the available research methodologies and previous studies in mTBI animal models, and discuss how a translational research approach may be useful in advancing our understanding and management of mTBI.
Collapse
Affiliation(s)
- Sandy R Shultz
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.
| | - Stuart J McDonald
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Melbourne, VIC, Australia
| | - Cole Vonder Haar
- Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Alicia Meconi
- Division of Medical Sciences, The University of Victoria, Victoria, BC, Canada
| | - Robert Vink
- Division of Health Sciences, The University of South Australia, Adelaide, SA, Australia
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, The University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Chand Taneja
- Division of Medical Sciences, The University of Victoria, Victoria, BC, Canada
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, and MassGeneral Hospital for Children™ Sports Concussion Program, Boston, MA, USA
| | - Brian R Christie
- Division of Medical Sciences, The University of Victoria, Victoria, BC, Canada
| |
Collapse
|
21
|
Laker SR, Meron A, Greher MR, Wilson J. Retirement and Activity Restrictions Following Concussion. Phys Med Rehabil Clin N Am 2016; 27:487-501. [PMID: 27154858 DOI: 10.1016/j.pmr.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sport-related concussion is prevalent at all levels of play. Increased attention from sports media and scientific and medical communities has prompted players and physicians to explore the long-term effects of concussion and ask the questions of when and how players should begin to mitigate their concussion risk. The authors evaluate their risks from the perspective of epidemiology, symptomatology, neuropsychological performance, and biomechanics. The authors propose that there is not a set number of concussions that necessitates retirement in athletes and, aside from a few absolute contraindications to return to collision sport, return to play should be an individualized process.
Collapse
Affiliation(s)
- Scott R Laker
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, CO 80045, USA.
| | - Adele Meron
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Denver, CO 80045, USA
| | - Michael R Greher
- University of Colorado School of Medicine, Department of Neurosurgery, Academic Office One, 12631 E. 17th Avenue, Suite 5001, Aurora, CO 80045, USA
| | | |
Collapse
|
22
|
Sabbagh JJ, Fontaine SN, Shelton LB, Blair LJ, Hunt JB, Zhang B, Gutmann JM, Lee DC, Lloyd JD, Dickey CA. Noncontact Rotational Head Injury Produces Transient Cognitive Deficits but Lasting Neuropathological Changes. J Neurotrauma 2016; 33:1751-1760. [PMID: 26739819 DOI: 10.1089/neu.2015.4288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) caused by improvised explosive devices (IEDs) is a growing problem in military settings, but modeling this disease in rodents to pre-clinically evaluate potential therapeutics has been challenging because of inconsistency between models. Although the effects of primary blast wave injury have been extensively studied, little is known regarding the effects of noncontact rotational TBIs independent of the blast wave. To model this type of injury, we generated an air cannon system that does not produce a blast wave, but generates enough air pressure to cause rotational TBI. Mice exposed to this type of injury showed deficits in cognitive and motor task acquisition within 1-2 weeks post-injury, but mice tested 7-8 weeks post-injury did not retain any deficits. This suggests that the effects of a single, noncontact rotational TBI are not long lasting. Despite the transient nature of the behavioral deficits, increased levels of phosphorylated tau were observed at 2 and 8 weeks post-injury; however, this tau did not adopt typical pathological structures that have been observed in other TBI models that incorporate blast waves. This was possibly attributed to the fact that this injury was insufficient to induce changes in microglial activation, which was not affected at 2 or 8 weeks post-injury. Taken together, these data suggest that exposure to noncontact, rotational head injury only produces transient cognitive anomalies, but elicits some minor lasting neuropathological changes.
Collapse
Affiliation(s)
- Jonathan J Sabbagh
- 1 Byrd Alzheimer's Institute, University of South Florida , Tampa, Florida.,3 James A. Haley Veteran's Hospital , Tampa, Florida
| | - Sarah N Fontaine
- 1 Byrd Alzheimer's Institute, University of South Florida , Tampa, Florida.,3 James A. Haley Veteran's Hospital , Tampa, Florida
| | - Lindsey B Shelton
- 1 Byrd Alzheimer's Institute, University of South Florida , Tampa, Florida.,3 James A. Haley Veteran's Hospital , Tampa, Florida
| | - Laura J Blair
- 1 Byrd Alzheimer's Institute, University of South Florida , Tampa, Florida.,3 James A. Haley Veteran's Hospital , Tampa, Florida
| | - Jerry B Hunt
- 1 Byrd Alzheimer's Institute, University of South Florida , Tampa, Florida
| | - Bo Zhang
- 1 Byrd Alzheimer's Institute, University of South Florida , Tampa, Florida
| | - Joseph M Gutmann
- 1 Byrd Alzheimer's Institute, University of South Florida , Tampa, Florida.,3 James A. Haley Veteran's Hospital , Tampa, Florida
| | - Daniel C Lee
- 1 Byrd Alzheimer's Institute, University of South Florida , Tampa, Florida
| | - John D Lloyd
- 2 Department of Chemical and Biomedical Engineering, College of Engineering, University of South Florida , Tampa, Florida.,3 James A. Haley Veteran's Hospital , Tampa, Florida
| | - Chad A Dickey
- 1 Byrd Alzheimer's Institute, University of South Florida , Tampa, Florida.,3 James A. Haley Veteran's Hospital , Tampa, Florida
| |
Collapse
|
23
|
Bang SA, Song YS, Moon BS, Lee BC, Lee HY, Kim JM, Kim SE. Neuropsychological, Metabolic, and GABAA Receptor Studies in Subjects with Repetitive Traumatic Brain Injury. J Neurotrauma 2015; 33:1005-14. [PMID: 26414498 DOI: 10.1089/neu.2015.4051] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Repetitive traumatic brain injury (rTBI) occurs as a result of mild and accumulative brain damage. A prototype of rTBI is chronic traumatic encephalopathy (CTE), which is a degenerative disease that occurs in patients with histories of multiple concussions or head injuries. Boxers have been the most commonly studied patient group because they may experience thousands of subconcussive hits over the course of a career. This study examined the consequences of rTBI with structural brain imaging and biomolecular imaging and investigated whether the neuropsychological features of rTBI were related to the findings of the imaging studies. Five retired professional boxers (mean age, 46.8 ± 3.19 years) and four age-matched controls (mean age, 48.5 ± 3.32 years) were studied. Cognitive-motor related functional impairment was assessed, and all subjects underwent neuropsychological evaluation and behavioral tasks, as well as structural brain imaging and functional-molecular imaging. In neuropsychological tests, boxers showed deficits in delayed retrieval of visuospatial memory and motor coordination, which had a meaningful relationship with biomolecular imaging results indicative of neuronal injury. Morphometric abnormalities were not found in professional boxers by structural magnetic resonance imaging (MRI). Glucose metabolism was impaired in frontal areas associated with cognitive dysfunction, similar to findings in Alzheimer's disease. Low binding potential (BP) of (18)F-flumazenil (FMZ) was found in the angular gyrus and temporal cortical regions, revealing neuronal deficits. These results suggested that cognitive impairment and motor dysfunction reflect chronic damage to neurons in professional boxers with rTBI.
Collapse
Affiliation(s)
- Seong Ae Bang
- 1 Department of Neuroscience, Seoul National University College of Medicine , Seoul, Republic of Korea.,2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Yoo Sung Song
- 2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Byung Seok Moon
- 2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Byung Chul Lee
- 2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,4 Center for Nanomolecular Imaging and Innovative Drug Development, Advanced Institutes of Convergence Technology , Suwon, Republic of Korea
| | - Ho-Young Lee
- 2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Jong-Min Kim
- 5 Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea
| | - Sang Eun Kim
- 1 Department of Neuroscience, Seoul National University College of Medicine , Seoul, Republic of Korea.,2 Department of Nuclear Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.,3 Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University , Seoul, Republic of Korea.,4 Center for Nanomolecular Imaging and Innovative Drug Development, Advanced Institutes of Convergence Technology , Suwon, Republic of Korea
| |
Collapse
|
24
|
Smith DH, Hicks RR, Johnson VE, Bergstrom DA, Cummings DM, Noble LJ, Hovda D, Whalen M, Ahlers ST, LaPlaca M, Tortella FC, Duhaime AC, Dixon CE. Pre-Clinical Traumatic Brain Injury Common Data Elements: Toward a Common Language Across Laboratories. J Neurotrauma 2015; 32:1725-35. [PMID: 26058402 DOI: 10.1089/neu.2014.3861] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Traumatic brain injury (TBI) is a major public health issue exacting a substantial personal and economic burden globally. With the advent of "big data" approaches to understanding complex systems, there is the potential to greatly accelerate knowledge about mechanisms of injury and how to detect and modify them to improve patient outcomes. High quality, well-defined data are critical to the success of bioinformatics platforms, and a data dictionary of "common data elements" (CDEs), as well as "unique data elements" has been created for clinical TBI research. There is no data dictionary, however, for preclinical TBI research despite similar opportunities to accelerate knowledge. To address this gap, a committee of experts was tasked with creating a defined set of data elements to further collaboration across laboratories and enable the merging of data for meta-analysis. The CDEs were subdivided into a Core module for data elements relevant to most, if not all, studies, and Injury-Model-Specific modules for non-generalizable data elements. The purpose of this article is to provide both an overview of TBI models and the CDEs pertinent to these models to facilitate a common language for preclinical TBI research.
Collapse
Affiliation(s)
- Douglas H Smith
- 1 Department of Neurosurgery, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Ramona R Hicks
- 2 One Mind, Seattle, Washington.,3 National Institutes of Health, National Institute of Neurological Disorders and Stroke , Bethesda, Maryland
| | - Victoria E Johnson
- 1 Department of Neurosurgery, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Debra A Bergstrom
- 3 National Institutes of Health, National Institute of Neurological Disorders and Stroke , Bethesda, Maryland
| | - Diana M Cummings
- 3 National Institutes of Health, National Institute of Neurological Disorders and Stroke , Bethesda, Maryland
| | - Linda J Noble
- 4 Department of Neurological Surgery, University of California , San Francisco, San Francisco, California
| | - David Hovda
- 5 Department of Neurosurgery, University of California Los Angeles , Los Angeles, California
| | - Michael Whalen
- 6 Department of Pediatrics, Neuroscience Center at Massachusetts General Hospital , Charlestown, Massachusetts
| | - Stephen T Ahlers
- 7 Operational & Undersea Medicine Directorate, Naval Medical Research Center , Silver Spring, Maryland
| | - Michelle LaPlaca
- 8 Department of Biomedical Engineering, Georgia Tech and Emory University , Atlanta, Georgia
| | - Frank C Tortella
- 9 Walter Reed Army Institute of Research , Silver Spring, Maryland
| | | | - C Edward Dixon
- 11 Department of Neurological Surgery, University of Pittsburgh , Pittsburgh, Pennsyvania
| |
Collapse
|
25
|
Semple BD, Lee S, Sadjadi R, Fritz N, Carlson J, Griep C, Ho V, Jang P, Lamb A, Popolizio B, Saini S, Bazarian JJ, Prins ML, Ferriero DM, Basso DM, Noble-Haeusslein LJ. Repetitive concussions in adolescent athletes - translating clinical and experimental research into perspectives on rehabilitation strategies. Front Neurol 2015; 6:69. [PMID: 25883586 PMCID: PMC4382966 DOI: 10.3389/fneur.2015.00069] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/13/2015] [Indexed: 12/23/2022] Open
Abstract
Sports-related concussions are particularly common during adolescence, a time when even mild brain injuries may disrupt ongoing brain maturation and result in long-term complications. A recent focus on the consequences of repetitive concussions among professional athletes has prompted the development of several new experimental models in rodents, as well as the revision of guidelines for best management of sports concussions. Here, we consider the utility of rodent models to understand the functional consequences and pathobiology of concussions in the developing brain, identifying the unique behavioral and pathological signatures of concussive brain injuries. The impact of repetitive concussions on behavioral consequences and injury progression is also addressed. In particular, we focus on the epidemiological, clinical, and experimental evidence underlying current recommendations for physical and cognitive rest after concussion, and highlight key areas in which further research is needed. Lastly, we consider how best to promote recovery after injury, recognizing that optimally timed, activity-based rehabilitative strategies may hold promise for the adolescent athlete who has sustained single or repetitive concussions. The purpose of this review is to inform the clinical research community as it strives to develop and optimize evidence-based guidelines for the concussed adolescent, in terms of both acute and long-term management.
Collapse
Affiliation(s)
- Bridgette D. Semple
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Sangmi Lee
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Raha Sadjadi
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Nora Fritz
- Kennedy Krieger Institute, John Hopkins University, Baltimore, MD, USA
| | - Jaclyn Carlson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Carrie Griep
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Vanessa Ho
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Patrice Jang
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Annick Lamb
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Beth Popolizio
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Sonia Saini
- San Francisco State University Graduate Program in Physical Therapy, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey J. Bazarian
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY, USA
| | - Mayumi L. Prins
- Department of Neurosurgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - Donna M. Ferriero
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - D. Michele Basso
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, USA
| | - Linda J. Noble-Haeusslein
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
- Department of Physical Therapy and Rehabilitation Sciences, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
26
|
Johnson VE, Meaney DF, Cullen DK, Smith DH. Animal models of traumatic brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2015; 127:115-28. [PMID: 25702213 DOI: 10.1016/b978-0-444-52892-6.00008-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Traumatic brain injury (TBI) is a major health issue comprising a heterogeneous and complex array of pathologies. Over the last several decades, numerous animal models have been developed to address the diverse nature of human TBI. The clinical relevance of these models has been a major point of reflection given the poor translation of pharmacologic TBI interventions to the clinic. While previously characterized broadly as either focal or diffuse, this classification is falling out of favor with increased awareness of the overlap in pathologic outcomes between models and an emerging consensus that no one model is sufficient. Moreover, an appreciation of injury biomechanics is essential in recapitulating and interpreting the spectrum of TBI neuropathology observed in various established models of dynamic closed-head TBI. While these models have replicated many specific features of human TBI, an enhanced context with clinical relevancy will facilitate the further elucidation of the mechanisms and treatment of injury.
Collapse
Affiliation(s)
- Victoria E Johnson
- Penn Center for Brain Injury and Repair and Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - David F Meaney
- Departments of Bioengineering and Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - D Kacy Cullen
- Penn Center for Brain Injury and Repair and Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas H Smith
- Penn Center for Brain Injury and Repair and Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
27
|
Cheng JS, Craft R, Yu GQ, Ho K, Wang X, Mohan G, Mangnitsky S, Ponnusamy R, Mucke L. Tau reduction diminishes spatial learning and memory deficits after mild repetitive traumatic brain injury in mice. PLoS One 2014; 9:e115765. [PMID: 25551452 PMCID: PMC4281043 DOI: 10.1371/journal.pone.0115765] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/01/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Because reduction of the microtubule-associated protein Tau has beneficial effects in mouse models of Alzheimer's disease and epilepsy, we wanted to determine whether this strategy can also improve the outcome of mild traumatic brain injury (TBI). METHODS We adapted a mild frontal impact model of TBI for wildtype C57Bl/6J mice and characterized the behavioral deficits it causes in these animals. The Barnes maze, Y maze, contextual and cued fear conditioning, elevated plus maze, open field, balance beam, and forced swim test were used to assess different behavioral functions. Magnetic resonance imaging (MRI, 7 Tesla) and histological analysis of brain sections were used to look for neuropathological alterations. We also compared the functional effects of this TBI model and of controlled cortical impact in mice with two, one or no Tau alleles. RESULTS Repeated (2-hit), but not single (1-hit), mild frontal impact impaired spatial learning and memory in wildtype mice as determined by testing of mice in the Barnes maze one month after the injury. Locomotor activity, anxiety, depression and fear related behaviors did not differ between injured and sham-injured mice. MRI imaging did not reveal focal injury or mass lesions shortly after the injury. Complete ablation or partial reduction of tau prevented deficits in spatial learning and memory after repeated mild frontal impact. Complete tau ablation also showed a trend towards protection after a single controlled cortical impact. Complete or partial reduction of tau also reduced the level of axonopathy in the corpus callosum after repeated mild frontal impact. INTERPRETATION Tau promotes or enables the development of learning and memory deficits and of axonopathy after mild TBI, and tau reduction counteracts these adverse effects.
Collapse
Affiliation(s)
- Jason S. Cheng
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States of America
| | - Ryan Craft
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
| | - Gui-Qiu Yu
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
| | - Kaitlyn Ho
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
| | - Xin Wang
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
| | - Geetha Mohan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Sergey Mangnitsky
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, United States of America
| | - Ravikumar Ponnusamy
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
| | - Lennart Mucke
- Gladstone Institute of Neurological Disease, San Francisco, California, United States of America
- Department of Neurology, University of California San Francisco, California, United States of America
| |
Collapse
|
28
|
Rozas NS, Redell JB, Hill JL, McKenna J, Moore AN, Gambello MJ, Dash PK. Genetic activation of mTORC1 signaling worsens neurocognitive outcome after traumatic brain injury. J Neurotrauma 2014; 32:149-58. [PMID: 25025304 DOI: 10.1089/neu.2014.3469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Although the mechanisms that contribute to the development of traumatic brain injury (TBI)-related deficits are not fully understood, it has been proposed that altered energy utilization may be a contributing factor. The tuberous sclerosis complex, a heterodimer composed of hamartin/Tsc-1 and tuberin/Tsc-2, is a critical regulatory node that integrates nutritional and growth signals to govern energy using processes by regulating the activity of mechanistic Target of Rapamycin complex 1 (mTORC1). mTORC1 activation results in enhanced protein synthesis, an energy consuming process. We show that mice that have a heterozygous deletion of Tsc2 exhibit elevated basal mTORC1 activity in the cortex and the hippocampus while still exhibiting normal motor and neurocognitive functions. In addition, a mild closed head injury (mCHI) that did not activate mTORC1 in wild-type mice resulted in a further increase in mTORC1 activity in Tsc2(+/KO) mice above the level of activity observed in uninjured Tsc2(+/KO) mice. This enhanced level of increased mTORC1 activity was associated with worsened cognitive function as assessed using the Morris water maze and context discrimination tasks. These results suggest that there is a threshold of increased mTORC1 activity after a TBI that is detrimental to neurobehavioral performance, and interventions to inhibit excessive mTORC1 activation may be beneficial to neurocognitive outcome.
Collapse
Affiliation(s)
- Natalia S Rozas
- 1 Department of Neurobiology and Anatomy, the University of Texas Medical School , Houston, Texas
| | | | | | | | | | | | | |
Collapse
|
29
|
Mannix R, Berglass J, Berkner J, Moleus P, Qiu J, Andrews N, Gunner G, Berglass L, Jantzie LL, Robinson S, Meehan WP. Chronic gliosis and behavioral deficits in mice following repetitive mild traumatic brain injury. J Neurosurg 2014; 121:1342-50. [PMID: 25267088 DOI: 10.3171/2014.7.jns14272] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECT With the recent increasing interest in outcomes after repetitive mild traumatic brain injury (rmTBI; e.g., sports concussions), several models of rmTBI have been established. Characterizing these models in terms of behavioral and histopathological outcomes is vital to assess their clinical translatability. The purpose of this study is to provide an in-depth behavioral and histopathological phenotype of a clinically relevant model of rmTBI. METHODS The authors used a previously published weight-drop model of rmTBI (7 injuries in 9 days) in 2- to 3-month-old mice that produces cognitive deficits without persistent loss of consciousness, seizures, gross structural imaging findings, or microscopic evidence of structural brain damage. Injured and sham-injured (anesthesia only) mice were subjected to a battery of behavioral testing, including tests of balance (rotarod), spatial memory (Morris water maze), anxiety (open field plus maze), and exploratory behavior (hole-board test). After behavioral testing, brains were assessed for histopathological outcomes, including brain volume and microglial and astrocyte immunolabeling. RESULTS Compared with sham-injured mice, mice subjected to rmTBI showed increased exploratory behavior and had impaired balance and worse spatial memory that persisted up to 3 months after injury. Long-term behavioral deficits were associated with chronic increased astrocytosis and microgliosis but no volume changes. CONCLUSIONS The authors demonstrate that their rmTBI model results in a characteristic behavioral phenotype that correlates with the clinical syndrome of concussion and repetitive concussion. This model offers a platform from which to study therapeutic interventions for rmTBI.
Collapse
|
30
|
Mouzon BC, Bachmeier C, Ferro A, Ojo JO, Crynen G, Acker CM, Davies P, Mullan M, Stewart W, Crawford F. Chronic neuropathological and neurobehavioral changes in a repetitive mild traumatic brain injury model. Ann Neurol 2014; 75:241-54. [DOI: 10.1002/ana.24064] [Citation(s) in RCA: 221] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/11/2013] [Accepted: 10/10/2013] [Indexed: 12/14/2022]
Affiliation(s)
- Benoit C. Mouzon
- Roskamp Institute; Sarasota FL
- James A. Haley Veterans Administration Medical Center; Tampa FL
- Department of Life Sciences; Open University; Milton Keynes United Kingdom
| | - Corbin Bachmeier
- Roskamp Institute; Sarasota FL
- Department of Life Sciences; Open University; Milton Keynes United Kingdom
| | | | | | - Gogce Crynen
- Roskamp Institute; Sarasota FL
- Department of Life Sciences; Open University; Milton Keynes United Kingdom
| | - Christopher M. Acker
- Litwin-Zucker Center for Research in Alzheimer's Disease; Feinstein Institute for Medical Research, North Shore/LIJ Health System; Manhasset NY
| | - Peter Davies
- Litwin-Zucker Center for Research in Alzheimer's Disease; Feinstein Institute for Medical Research, North Shore/LIJ Health System; Manhasset NY
| | - Michael Mullan
- Roskamp Institute; Sarasota FL
- James A. Haley Veterans Administration Medical Center; Tampa FL
- Department of Life Sciences; Open University; Milton Keynes United Kingdom
| | - William Stewart
- Department of Neuropathology; Southern General Hospital; Glasgow United Kingdom
- University of Glasgow; Glasgow United Kingdom
| | - Fiona Crawford
- Roskamp Institute; Sarasota FL
- James A. Haley Veterans Administration Medical Center; Tampa FL
- Department of Life Sciences; Open University; Milton Keynes United Kingdom
| |
Collapse
|
31
|
Miyauchi T, Wei EP, Povlishock JT. Evidence for the therapeutic efficacy of either mild hypothermia or oxygen radical scavengers after repetitive mild traumatic brain injury. J Neurotrauma 2014; 31:773-81. [PMID: 24341607 DOI: 10.1089/neu.2013.3181] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Repetitive brain injury, particularly that occurring with sporting-related injuries, has recently garnered increased attention in both the clinical and public settings. In the laboratory, we have demonstrated the adverse axonal and vascular consequences of repetitive brain injury and have demonstrated that moderate hypothermia and/or FK506 exerted protective effects after repetitive mild traumatic brain injury (mTBI) when administered within a specific time frame, suggesting a range of therapeutic modalities to prevent a dramatic exacerbation. In this communication, we revisit the utility of targeted therapeutic intervention to seek the minimal level of hypothermia needed to achieve protection while probing the role of oxygen radicals and their therapeutic targeting. Male Sprague-Dawley rats were subjected to repetitive mTBI by impact acceleration injury. Mild hypothermia (35 °C, group 2), superoxide dismutase (group 3), and Tempol (group 4) were employed as therapeutic interventions administered 1 h after the repetitive mTBI. To assess vascular function, cerebral vascular reactivity to acetylcholine was evaluated 3 and 4 h after the repetitive mTBI, whereas to detect the burden of axonal damage, amyloid precursor protein (APP) density in the medullospinal junction was measured. Whereas complete impairment of vascular reactivity was observed in group 1 (without intervention), significant preservation of vascular reactivity was found in the other groups. Similarly, whereas remarkable increase in the APP-positive axon was observed in group 1, there were no significant increases in the other groups. Collectively, these findings indicate that even mild hypothermia or the blunting free radical damage, even when performed in a delayed period, is protective in repetitive mTBI.
Collapse
Affiliation(s)
- Takashi Miyauchi
- 1 Department of Anatomy and Neurobiology, Virginia Commonwealth University Medical Center , Richmond, Virginia
| | | | | |
Collapse
|
32
|
Zhang YP, Cai J, Shields LBE, Liu N, Xu XM, Shields CB. Traumatic brain injury using mouse models. Transl Stroke Res 2014; 5:454-71. [PMID: 24493632 DOI: 10.1007/s12975-014-0327-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 12/09/2013] [Accepted: 01/05/2014] [Indexed: 12/14/2022]
Abstract
The use of mouse models in traumatic brain injury (TBI) has several advantages compared to other animal models including low cost of breeding, easy maintenance, and innovative technology to create genetically modified strains. Studies using knockout and transgenic mice demonstrating functional gain or loss of molecules provide insight into basic mechanisms of TBI. Mouse models provide powerful tools to screen for putative therapeutic targets in TBI. This article reviews currently available mouse models that replicate several clinical features of TBI such as closed head injuries (CHI), penetrating head injuries, and a combination of both. CHI may be caused by direct trauma creating cerebral concussion or contusion. Sudden acceleration-deceleration injuries of the head without direct trauma may also cause intracranial injury by the transmission of shock waves to the brain. Recapitulation of temporary cavities that are induced by high-velocity penetrating objects in the mouse brain are difficult to produce, but slow brain penetration injuries in mice are reviewed. Synergistic damaging effects on the brain following systemic complications are also described. Advantages and disadvantages of CHI mouse models induced by weight drop, fluid percussion, and controlled cortical impact injuries are compared. Differences in the anatomy, biomechanics, and behavioral evaluations between mice and humans are discussed. Although the use of mouse models for TBI research is promising, further development of these techniques is warranted.
Collapse
Affiliation(s)
- Yi Ping Zhang
- Norton Neuroscience Institute, Norton Healthcare, 210 East Gray Street, Suite 1102, Louisville, KY, 40202, USA,
| | | | | | | | | | | |
Collapse
|