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Babenko VA, Yakupova EI, Pevzner IB, Bocharnikov AD, Zorova LD, Fedulova KS, Grebenchikov OA, Kuzovlev AN, Grechko AV, Silachev DN, Rahimi-Moghaddam P, Plotnikov EY. Effects of Lithium Ions on tPA-Induced Hemorrhagic Transformation under Stroke. Biomedicines 2024; 12:1325. [PMID: 38927532 PMCID: PMC11201972 DOI: 10.3390/biomedicines12061325] [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: 05/18/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Thrombolytic therapy with the tissue plasminogen activator (tPA) is a therapeutic option for acute ischemic stroke. However, this approach is subject to several limitations, particularly the increased risk of hemorrhagic transformation (HT). Lithium salts show neuroprotective effects in stroke, but their effects on HT mechanisms are still unknown. In our study, we use the models of photothrombosis (PT)-induced brain ischemia and oxygen-glucose deprivation (OGD) to investigate the effect of Li+ on tPA-induced changes in brain and endothelial cell cultures. We found that tPA did not affect lesion volume or exacerbate neurological deficits but disrupted the blood-brain barrier. We demonstrate that poststroke treatment with Li+ improves neurological status and increases blood-brain barrier integrity after thrombolytic therapy. Under conditions of OGD, tPA treatment increased MMP-2/9 levels in endothelial cells, and preincubation with LiCl abolished this MMP activation. Moreover, we observed the effect of Li+ on glycolysis in tPA-treated endothelial cells, which we hypothesized to have an effect on MMP expression.
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Affiliation(s)
- Valentina A. Babenko
- A.N. Belozersky Research Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.B.); (E.I.Y.); (I.B.P.); (A.D.B.); (L.D.Z.); (K.S.F.); (D.N.S.)
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Elmira I. Yakupova
- A.N. Belozersky Research Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.B.); (E.I.Y.); (I.B.P.); (A.D.B.); (L.D.Z.); (K.S.F.); (D.N.S.)
| | - Irina B. Pevzner
- A.N. Belozersky Research Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.B.); (E.I.Y.); (I.B.P.); (A.D.B.); (L.D.Z.); (K.S.F.); (D.N.S.)
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Alexey D. Bocharnikov
- A.N. Belozersky Research Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.B.); (E.I.Y.); (I.B.P.); (A.D.B.); (L.D.Z.); (K.S.F.); (D.N.S.)
- Advanced Engineering School “Intelligent Theranostics Systems”, Sechenov First Moscow State Medical University, 119992 Moscow, Russia
| | - Ljubava D. Zorova
- A.N. Belozersky Research Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.B.); (E.I.Y.); (I.B.P.); (A.D.B.); (L.D.Z.); (K.S.F.); (D.N.S.)
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Kseniya S. Fedulova
- A.N. Belozersky Research Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.B.); (E.I.Y.); (I.B.P.); (A.D.B.); (L.D.Z.); (K.S.F.); (D.N.S.)
| | - Oleg A. Grebenchikov
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (O.A.G.); (A.N.K.); (A.V.G.)
| | - Artem N. Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (O.A.G.); (A.N.K.); (A.V.G.)
| | - Andrey V. Grechko
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 107031 Moscow, Russia; (O.A.G.); (A.N.K.); (A.V.G.)
| | - Denis N. Silachev
- A.N. Belozersky Research Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.B.); (E.I.Y.); (I.B.P.); (A.D.B.); (L.D.Z.); (K.S.F.); (D.N.S.)
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
| | - Parvaneh Rahimi-Moghaddam
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran 14496-14535, Iran;
| | - Egor Y. Plotnikov
- A.N. Belozersky Research Institute of Physico-Chemical Biology, Lomonosov Moscow State University, 119991 Moscow, Russia; (V.A.B.); (E.I.Y.); (I.B.P.); (A.D.B.); (L.D.Z.); (K.S.F.); (D.N.S.)
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, 117997 Moscow, Russia
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Aziz YN, Vagal V, Mehta TV, Siegler JE, Mistry AM, Yaghi S, Khatri P, Mistry EA. Higher blood glucose is associated with the severity of hemorrhagic transformation after endovascular therapy for stroke. J Stroke Cerebrovasc Dis 2024; 33:107823. [PMID: 38880367 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 06/09/2024] [Accepted: 06/13/2024] [Indexed: 06/18/2024] Open
Abstract
OBJECTIVES Hyperglycemia is associated with poor outcome in large vessel occlusion (LVO) stroke, with mechanism for this effect unknown. MATERIALS AND METHODS We used our prospective, multicenter, observational study, Blood Pressure After Endovascular Stroke Therapy (BEST), of anterior circulation LVO stroke undergoing endovascular therapy (EVT) from 11/2017-7/2018 to determine association between increasing blood glucose (BG) and intracerebral hemorrhage (ICH). Our primary outcome was degree of ICH, classified as none, asymptomatic ICH, or symptomatic ICH (≥4-point increase in National Institutes of Health Stroke Scale [NIHSS] at 24 h with any hemorrhage on imaging). Secondary outcomes included 24 h NIHSS, early neurologic recovery (ENR, NIHSS 0-1 or NIHSS reduction by ≥8 within 24 h), and 90-day modified Rankin Scale (mRS) using univariate and multivariable regression. RESULTS Of 485 enrolled patients, increasing BG was associated with increasing severity of ICH (adjusted OR, aOR 1.06, 95 % CI 1.02-1.1, p < 0.001), higher 24 h NIHSS (aOR 1.22, 95 % CI 1.11-1.34, p < 0.001), ENR (aOR 0.90, 95 % CI 0.82-1.00, p < 0.002), and 90-day mRS (aOR 1.06, 95 % CI 1.03-1.09, p < 0.001) when adjusted for age, presenting NIHSS, ASPECTS, 24-hour peak systolic blood pressure, time from last known well, and successful recanalization. CONCLUSIONS In the BEST study, increasing BG was associated with greater odds of increasing ICH severity. Further study is warranted to determine whether treatment of will decrease ICH severity following EVT.
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Affiliation(s)
- Yasmin N Aziz
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States.
| | - Vaibhav Vagal
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States.
| | | | - James E Siegler
- Department of Neurology, University of Chicago, Chicago, IL, United States.
| | - Akshitkumar M Mistry
- Department of Neurosurgery, University of Louisville, Louisville, KY, United States.
| | - Shadi Yaghi
- Brown University, Division of Biology and Medicine, Providence, RI, United States.
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States.
| | - Eva A Mistry
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, United States.
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Abdalkader M, Nguyen TN, Sahoo A, Qureshi MM, Ong CJ, Klein P, Miller MI, Mian AZ, Kaesmacher J, Mujanovic A, Hu W, Chen HS, Setty BN. Contrast Staining in Noninfarcted Tissue after Endovascular Treatment of Acute Ischemic Stroke. AJNR Am J Neuroradiol 2024; 45:701-707. [PMID: 38697792 PMCID: PMC11288587 DOI: 10.3174/ajnr.a8222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/03/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND PURPOSE Contrast staining is a common finding after endovascular treatment of acute ischemic stroke. It typically occurs in infarcted tissue and is considered an indicator of irreversible brain damage. Contrast staining in noninfarcted tissue has not been systematically investigated. We sought to assess the incidence, risk factors, and clinical significance of contrast staining in noninfarcted tissue after endovascular treatment. MATERIALS AND METHODS We conducted a retrospective review of consecutive patients who underwent endovascular treatment for anterior circulation large-vessel occlusion acute ischemic stroke. Contrast staining, defined as new hyperdensity on CT after endovascular treatment, was categorized as either contrast staining in infarcted tissue if the stained region demonstrated restricted diffusion on follow-up MR imaging or contrast staining in noninfarcted tissue if the stained region demonstrated no restricted diffusion. Baseline differences between patients with and without contrast staining in noninfarcted tissue were compared. Logistic regression was used to identify independent associations for contrast staining in noninfarcted tissue after endovascular treatment. RESULTS Among 194 patients who underwent endovascular treatment for large-vessel occlusion acute ischemic stroke and met the inclusion criteria, contrast staining in infarcted tissue was noted in 52/194 (26.8%) patients; contrast staining in noninfarcted tissue, in 26 (13.4%) patients. Both contrast staining in infarcted tissue and contrast staining in noninfarcted tissue were noted in 5.6% (11/194). Patients with contrast staining in noninfarcted tissue were found to have a higher likelihood of having an ASPECTS of 8-10, to be associated with contrast staining in infarcted tissue, and to achieve successful reperfusion compared with those without contrast staining in noninfarcted tissue. In contrast staining in noninfarcted tissue regions, the average attenuation was 40 HU, significantly lower than the contrast staining in infarcted tissue regions (53 HU). None of the patients with contrast staining in noninfarcted tissue had clinical worsening during their hospital stay. The median discharge mRS was significantly lower in patients with contrast staining in noninfarcted tissue than in those without (3 versus 4; P = .018). No independent predictors of contrast staining in noninfarcted tissue were found. CONCLUSIONS Contrast staining can be seen outside the infarcted tissue after endovascular treatment of acute ischemic stroke, likely attributable to the reversible disruption of the BBB in ischemic but not infarcted tissue. While generally benign, understanding its characteristics is important because it may mimic pathologic conditions such as infarcted tissue and cerebral edema.
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Affiliation(s)
- Mohamad Abdalkader
- From the Department of Radiology (M.A., T.N.N., A.S., M.M.Q., P.K., A.Z.M., B.N.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Thanh N Nguyen
- From the Department of Radiology (M.A., T.N.N., A.S., M.M.Q., P.K., A.Z.M., B.N.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology (T.N.N., C.J.O.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Anurag Sahoo
- From the Department of Radiology (M.A., T.N.N., A.S., M.M.Q., P.K., A.Z.M., B.N.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Muhammad M Qureshi
- From the Department of Radiology (M.A., T.N.N., A.S., M.M.Q., P.K., A.Z.M., B.N.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Charlene J Ong
- Department of Neurology (T.N.N., C.J.O.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Department of Neurology (C.J.O.), Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Piers Klein
- From the Department of Radiology (M.A., T.N.N., A.S., M.M.Q., P.K., A.Z.M., B.N.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Matthew I Miller
- Department of Medicine (M.I.M.), Cambridge Health Alliance, Cambridge, Massachusetts
| | - Asim Z Mian
- From the Department of Radiology (M.A., T.N.N., A.S., M.M.Q., P.K., A.Z.M., B.N.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology (J.K., A.M.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Adnan Mujanovic
- Institute of Diagnostic and Interventional Neuroradiology, Institute of Diagnostic, Interventional and Pediatric Radiology and Department of Neurology (J.K., A.M.), Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Wei Hu
- Department of Neurology and Stroke Center (W.H.), Division of Life Sciences and Medicine, The First Affiliated Hospital of the University of Science and Technology of China, Hefei, Anhui, China
| | - Hui Sheng Chen
- Department of Neurology (H.S.C.), General Hospital of Northern Theater Command, Shenyang, China
| | - Bindu N Setty
- From the Department of Radiology (M.A., T.N.N., A.S., M.M.Q., P.K., A.Z.M., B.N.S.), Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Chen H, Guo S, Li R, Yang L, Wang R, Jiang Y, Hao Y. YTHDF2-regulated matrilin-3 mitigates post-reperfusion hemorrhagic transformation in ischemic stroke via the PI3K/AKT pathway. J Neuropathol Exp Neurol 2024; 83:194-204. [PMID: 38230623 PMCID: PMC10880072 DOI: 10.1093/jnen/nlad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024] Open
Abstract
Hemorrhagic transformation can complicate ischemic strokes after recanalization treatment within a time window that requires early intervention. To determine potential therapeutic effects of matrilin-3, rat cerebral ischemia-reperfusion was produced using transient middle cerebral artery occlusion (tMCAO); intracranial hemorrhage and infarct volumes were assayed through hemoglobin determination and 2,3,5-triphenyltetrazoliumchloride (TTC) staining, respectively. Oxygen-glucose deprivation (OGD) modeling of ischemia was performed on C8-D1A cells. Interactions between matrilin-3 and YTH N6-methyladenosine RNA binding protein F2 (YTHDF2) were determined using RNA immunoprecipitation assay and actinomycin D treatment. Reperfusion after tMCAO modeling increased hemorrhage, hemoglobin content, and infarct volumes; these were alleviated by matrilin treatment. Matrilin-3 was expressed at low levels and YTHDF2 was expressed at high levels in ischemic brains. In OGD-induced cells, matrilin-3 was negatively regulated by YTHDF2. Matrilin-3 overexpression downregulated p-PI3K/PI3K, p-AKT/AKT, ZO-1, VE-cadherin and occludin, and upregulated p-JNK/JNK in ischemic rat brains; these effects were reversed by LY294002 (a PI3K inhibitor). YTHDF2 knockdown inactivated the PI3K/AKT pathway, inhibited inflammation and decreased blood-brain barrier-related protein levels in cells; these effects were reversed by matrilin-3 deficiency. These results indicate that YTHDF2-regulated matrilin-3 protected ischemic rats against post-reperfusion hemorrhagic transformation via the PI3K/AKT pathway and that matrilin may have therapeutic potential in ischemic stroke.
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Affiliation(s)
- Hanze Chen
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Siping Guo
- Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou City, Jiangsu Province, China
| | - Runnan Li
- Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou City, Jiangsu Province, China
| | - Lihui Yang
- Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou City, Jiangsu Province, China
| | - Rui Wang
- Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou City, Jiangsu Province, China
| | - Yasi Jiang
- Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou City, Jiangsu Province, China
| | - Yonggang Hao
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
- Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou City, Jiangsu Province, China
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5
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Gu YH, Hawkins BT, Izawa Y, Yoshikawa Y, Koziol JA, Del Zoppo GJ. Intracerebral hemorrhage and thrombin-induced alterations in cerebral microvessel matrix. J Cereb Blood Flow Metab 2022; 42:1732-1747. [PMID: 35510668 PMCID: PMC9441730 DOI: 10.1177/0271678x221099092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Four phase III clinical trials of oral direct factor Xa or thrombin inhibitors demonstrated significantly lower intracranial hemorrhage compared to warfarin in patients with nonvalvular-atrial fibrillation. This is counter-intuitive to the principle that inhibiting thrombosis should increase hemorrhagic risk. We tested the novel hypothesis that anti-thrombin activity decreases the risk of intracerebral hemorrhage by directly inhibiting thrombin-mediated degradation of cerebral microvessel basal lamina matrix, responsible for preventing hemorrhage. Collagen IV, laminin, and perlecan each contain one or more copies of the unique α-thrombin cleavage site consensus sequence. In blinded controlled experiments, α-thrombin significantly degraded each matrix protein in vitro and in vivo in a concentration-dependent fashion. In vivo stereotaxic injection of α-thrombin significantly increased permeability, local IgG extravasation, and hemoglobin (Hgb) deposition together with microvessel matrix degradation in a mouse model. In all formats the direct anti-thrombin dabigatran completely inhibited matrix degradation by α-thrombin. Fourteen-day oral exposure to dabigatran etexilate-containing chow completely inhibited matrix degradation, the permeability to large molecules, and cerebral hemorrhage associated with α-thrombin. These experiments demonstrate that thrombin can degrade microvessel matrix, leading to hemorrhage, and that inhibition of microvessel matrix degradation by α-thrombin decreases cerebral hemorrhage. Implications for focal ischemia and other conditions are discussed.
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Affiliation(s)
- Yu-Huan Gu
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Brian T Hawkins
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Duke University Center for WaSH-AID, Department of Eklectrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Yoshikane Izawa
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Yoji Yoshikawa
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - James A Koziol
- Department of Molecular Medicine, Scripps Research Institute, La Jolla, CA, USA
| | - Gregory J Del Zoppo
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
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Branyan TE, Selvamani A, Park MJ, Korula KE, Kosel KF, Srinivasan R, Sohrabji F. Functional Assessment of Stroke-Induced Regulation of miR-20a-3p and Its Role as a Neuroprotectant. Transl Stroke Res 2022; 13:432-448. [PMID: 34570349 PMCID: PMC9046320 DOI: 10.1007/s12975-021-00945-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/12/2021] [Accepted: 09/07/2021] [Indexed: 12/14/2022]
Abstract
MicroRNAs have gained popularity as a potential treatment for many diseases, including stroke. This study identifies and characterizes a specific member of the miR-17-92 cluster, miR-20a-3p, as a possible stroke therapeutic. A comprehensive microRNA screening showed that miR-20a-3p was significantly upregulated in astrocytes of adult female rats, which typically have better stroke outcomes, while it was profoundly downregulated in astrocytes of middle-aged females and adult and middle-aged males, groups that typically have more severe stroke outcomes. Assays using primary human astrocytes and neurons show that miR-20a-3p treatment alters mitochondrial dynamics in both cell types. To assess whether stroke outcomes could be improved by elevating astrocytic miR-20a-3p, we created a tetracycline (Tet)-induced recombinant adeno-associated virus (rAAV) construct where miR-20a-3p was located downstream a glial fibrillary acidic protein promoter. Treatment with doxycycline induced miR-20-3p expression in astrocytes, reducing mortality and modestly improving sensory motor behavior. A second Tet-induced rAAV construct was created in which miR-20a-3p was located downstream of a neuron-specific enolase (NSE) promoter. These experiments demonstrate that neuronal expression of miR-20a-3p is vastly more neuroprotective than astrocytic expression, with animals receiving the miR-20a-3p vector showing reduced infarction and sensory motor improvement. Intravenous injections, which are a therapeutically tractable treatment route, with miR-20a-3p mimic 4 h after middle cerebral artery occlusion (MCAo) significantly improved stroke outcomes including infarct volume and sensory motor performance. Improvement was not observed when miR-20a-3p was given immediately or 24 h after MCAo, identifying a unique delayed therapeutic window. Overall, this study identifies a novel neuroprotective microRNA and characterizes several key pathways by which it can improve stroke outcomes.
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Affiliation(s)
- Taylor E Branyan
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, 77807, USA
- Texas A&M Institute for Neuroscience, College Station, TX, 77840, USA
| | - Amutha Selvamani
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, 77807, USA
| | - Min Jung Park
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, 77807, USA
| | - Kriti E Korula
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, 77807, USA
| | - Kelby F Kosel
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, 77807, USA
| | - Rahul Srinivasan
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, 77807, USA
- Texas A&M Institute for Neuroscience, College Station, TX, 77840, USA
| | - Farida Sohrabji
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, 77807, USA.
- Texas A&M Institute for Neuroscience, College Station, TX, 77840, USA.
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, 8447 Riverside Pkwy, Bryan, TX, 77807, USA.
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7
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del Zoppo GJ, Moskowitz MA, Nedergaard M. The Neurovascular Unit and Responses to Ischemia. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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Mechanisms of Thrombosis and Thrombolysis. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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9
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Baek JH, Kim BM, Heo JH, Kim DJ, Nam HS, Kim YD, Choi HS, Kim JH, Kim JW. Association between flat-panel computed tomography hyperattenuation and clinical outcome after successful recanalization by endovascular treatment. J Neurosurg 2021; 135:704-711. [PMID: 33361477 DOI: 10.3171/2020.7.jns193214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 07/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hyperattenuation on CT scanning performed immediately after endovascular treatment (EVT) is known to be associated with the final infarct. As flat-panel CT (FPCT) scanning is readily accessible within their angiography suite, the authors evaluated the ability of the extent of hyperattenuation on FPCT to predict clinical outcomes after EVT. METHODS Patients with successful recanalization (modified Thrombolysis in Cerebral Infarction grade 2b or 3) were reviewed retrospectively. The extent of hyperattenuation was assessed by the Alberta Stroke Program Early CT Score on FPCT (FPCT-ASPECTS). FPCT-ASPECTS findings were compared according to functional outcome and malignant infarction. The predictive power of the FPCT-ASPECTS with initial CT images before EVT (CT-ASPECTS) and follow-up diffusion-weighted images (MR-ASPECTS) was also compared. RESULTS A total of 235 patients were included. All patients were treated with mechanical thrombectomy, and 45.5% of the patients received intravenous tissue plasminogen activator. The mean (± SD) time from stroke onset to recanalization was 383 ± 290 minutes. The FPCT-ASPECTS was significantly different between patients with a favorable outcome and those without (mean 9.3 ± 0.9 vs 6.7 ± 2.6) and between patients with malignant infarction and those without (3.4 ± 2.9 vs 8.8 ± 1.4). The FPCT-ASPECTS was an independent factor for a favorable outcome (adjusted OR 3.28, 95% CI 2.12-5.01) and malignant infarction (adjusted OR 0.42, 95% CI 0.31-0.57). The area under the curve (AUC) of the FPCT-ASPECTS for a favorable outcome (0.862, cutoff ≥ 8) was significantly greater than that of the CT-ASPECTS (0.637) (p < 0.001) and comparable to that of the MR-ASPECTS (0.853) (p = 0.983). For malignant infarction, the FPCT-ASPECTS was also more predictive than the CT-ASPECTS (AUC 0.906 vs 0.552; p = 0.001) with a cutoff of ≤ 5. CONCLUSIONS The FPCT-ASPECTS was highly predictive of clinical outcomes in patients with successful recanalization. FPCT could be a practical method to immediately predict clinical outcomes and thereby aid in acute management after EVT.
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Affiliation(s)
- Jang-Hyun Baek
- 1Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul
- 2Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Byung Moon Kim
- 3Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, and Department of Radiology, Yonsei University College of Medicine, Seoul; and
| | - Ji Hoe Heo
- 2Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Dong Joon Kim
- 3Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, and Department of Radiology, Yonsei University College of Medicine, Seoul; and
| | - Hyo Suk Nam
- 2Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Young Dae Kim
- 2Department of Neurology, Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Hyun Seok Choi
- 3Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, and Department of Radiology, Yonsei University College of Medicine, Seoul; and
| | - Jun-Hwee Kim
- 3Interventional Neuroradiology, Severance Stroke Center, Severance Hospital, and Department of Radiology, Yonsei University College of Medicine, Seoul; and
| | - Jin Woo Kim
- 4Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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10
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Kim HJ, Lee E, Nam M, Chung JK, Joo S, Nam Y, Sun W. Contribution of Extracellular Matrix Component Landscapes in the Adult Subventricular Zone to the Positioning of Neural Stem/Progenitor Cells. Exp Neurobiol 2021; 30:275-284. [PMID: 34483142 PMCID: PMC8424380 DOI: 10.5607/en21012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/11/2021] [Accepted: 08/28/2021] [Indexed: 01/01/2023] Open
Abstract
Neurogenesis persists in restricted regions of the adult brain, including the subventricular zone (SVZ). Adult neural stem cells (NSCs) in the SVZ proliferate and give rise to new neurons and glial cells depending on intrinsic and environmental cues. Among the multiple factors that contribute to the chemical, physical, and mechanical components of the neurogenic niche, we focused on the composition of the extracellular matrix (ECM) of vasculature and fractones in the SVZ. The SVZ consists of ECM-rich blood vessels and fractones during development and adulthood, and adult neural stem/progenitor cells (NS/PCs) preferentially attach to the laminin-rich basal lamina. To examine the ECM preference of adult NS/PCs, we designed a competition assay using cell micropatterning. Although both laminin and collagen type IV, which are the main components of basal lamina, act as physical scaffolds, adult NS/PCs preferred to adhere to laminin over collagen type IV. Interestingly, the ECM preference of adult NS/PCs could be manipulated by chemokines such as stromal-derived factor 1 (SDF1) and α6 integrin. As SDF1 re-routes NSCs and their progenitors toward the injury site after brain damage, these results suggest that the alteration in ECM preferences may provide a molecular basis for context-dependent NS/PC positioning.
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Affiliation(s)
- Hyun Jung Kim
- Department of Anatomy, College of Medicine, Korea University, Seoul 02841, Korea.,Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejon 34141, Korea
| | - Eunsoo Lee
- Department of Anatomy, College of Medicine, Korea University, Seoul 02841, Korea.,Fluorescence Core Imaging Center, Ewha Womans University, Seoul 03760, Korea
| | - Myungwoo Nam
- Department of Anatomy, College of Medicine, Korea University, Seoul 02841, Korea
| | - Jae Kwon Chung
- Department of Anatomy, College of Medicine, Korea University, Seoul 02841, Korea
| | - Sunghoon Joo
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea
| | - Yoonkey Nam
- Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34141, Korea
| | - Woong Sun
- Department of Anatomy, College of Medicine, Korea University, Seoul 02841, Korea
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11
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Bernsen MLE, Veendrick PB, Martens JM, Pijl MEJ, Hofmeijer J, van Gorp MJ. Initial experience with dual-layer detector spectral CT for diagnosis of blood or contrast after endovascular treatment for ischemic stroke. Neuroradiology 2021; 64:69-76. [PMID: 34046731 DOI: 10.1007/s00234-021-02736-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether spectral detector CT (SDCT) with a plain non-enhanced monochromatic CT, a water-weighted image after iodine removal, an iodine map, and Mono energetic images changes the diagnosis and classification of intracranial hemorrhage based on single energy CT after endovascular treatment (EVT) for ischemic stroke. METHODS Two readers evaluated single energy and SD CT data collected from 63 patients within one week after EVT. They diagnosed ICH or contrast staining, and graded ICH according to the Heidelberg and Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) classification. Differences in diagnosis between single energy and SD CT were tested with Pearson's chi-squared test. Diagnostic values of single energy CT were calculated. Interrater agreement was based on Cohen's Kappa. RESULTS When spectral data were added to single energy CT, the diagnosis of ICH changed in 8 CT scans (13%): in 4, the diagnosis of ICH was rejected and in 4, initially undetected ICH was diagnosed. In an additional 3 patients, the ICH grade was modified. CT alone had 88% sensitivity, 87% specificity, 88% positive diagnostic value, 87% negative diagnostic value, and 87% overall accuracy for ICH compared to SDCT. Interreader agreement on the presence of ICH was 0.84 (95% CI 0.51-0.86) for spectral CT and 0.84 (95% CI 0.73-0.97) for single energy CT. CONCLUSION SD CT after endovascular treatment contributes to the distinction between intracranial hemorrhage and contrast staining.
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Affiliation(s)
- Marie Louise E Bernsen
- Department of Radiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands.
| | - Peter B Veendrick
- Department of Radiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Jasper M Martens
- Department of Radiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Milan E J Pijl
- Department of Radiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - Jeannette Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands.,Clinical Neurophysiology, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Maarten J van Gorp
- Department of Radiology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
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12
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Heller GJ, Marshall MS, Issa Y, Marshall JN, Nguyen D, Rue E, Pathmasiri KC, Domowicz MS, van Breemen RB, Tai LM, Cologna SM, Crocker SJ, Givogri MI, Sands MS, Bongarzone ER. Waning efficacy in a long-term AAV-mediated gene therapy study in the murine model of Krabbe disease. Mol Ther 2021; 29:1883-1902. [PMID: 33508430 PMCID: PMC8116612 DOI: 10.1016/j.ymthe.2021.01.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
Neonatal AAV9-gene therapy of the lysosomal enzyme galactosylceramidase (GALC) significantly ameliorates central and peripheral neuropathology, prolongs survival, and largely normalizes motor deficits in Twitcher mice. Despite these therapeutic milestones, new observations identified the presence of multiple small focal demyelinating areas in the brain after 6-8 months. These lesions are in stark contrast to the diffuse, global demyelination that affects the brain of naive Twitcher mice. Late-onset lesions exhibited lysosomal alterations with reduced expression of GALC and increased psychosine levels. Furthermore, we found that lesions were closely associated with the extravasation of plasma fibrinogen and activation of the fibrinogen-BMP-SMAD-GFAP gliotic response. Extravasation of fibrinogen correlated with tight junction disruptions of the vasculature within the lesioned areas. The lesions were surrounded by normal appearing white matter. Our study shows that the dysregulation of therapeutic GALC was likely driven by the exhaustion of therapeutic AAV episomal DNA within the lesions, paralleling the presence of proliferating oligodendrocyte progenitors and glia. We believe that this is the first demonstration of diminishing expression in vivo from an AAV gene therapy vector with detrimental effects in the brain of a lysosomal storage disease animal model. The development of this phenotype linking localized loss of GALC activity with relapsing neuropathology in the adult brain of neonatally AAV-gene therapy-treated Twitcher mice identifies and alerts to possible late-onset reductions of AAV efficacy, with implications to other genetic leukodystrophies.
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Affiliation(s)
- Gregory J Heller
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Michael S Marshall
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
| | - Yazan Issa
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Jeffrey N Marshall
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Duc Nguyen
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Emily Rue
- Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, USA
| | | | - Miriam S Domowicz
- Department of Pediatrics, University of Chicago, Chicago, IL 60612, USA
| | | | - Leon M Tai
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Stephanie M Cologna
- Department of Chemistry, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Stephen J Crocker
- Department of Neuroscience, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Maria I Givogri
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Mark S Sands
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Ernesto R Bongarzone
- Department of Anatomy and Cell Biology, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
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13
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Wang L, Deng L, Yuan R, Liu J, Li Y, Liu M. Association of Matrix Metalloproteinase 9 and Cellular Fibronectin and Outcome in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:523506. [PMID: 33329294 PMCID: PMC7732454 DOI: 10.3389/fneur.2020.523506] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction: The role of matrix metalloproteinase 9 (MMP-9) and cellular fibronectin (c-Fn) in acute ischemic stroke is controversial. We systematically reviewed the literature to investigate the association of circulating MMP-9 and c-Fn levels and MMP-9 rs3918242 polymorphism with the risk of three outcome measures after stroke. Methods: We searched English and Chinese databases to identify eligible studies. Outcomes included severe brain edema, hemorrhagic transformation, and poor outcome (modified Rankin scale score ≥3). We estimated standardized mean differences (SMDs) and pooled odds ratios (ORs) with 95% confidence intervals (CIs). Results: Totally, 28 studies involving 7,239 patients were included in the analysis of circulating MMP-9 and c-Fn levels. Meta-analysis indicated higher levels of MMP-9 in patients with severe brain edema (SMD, 0.76; 95% CI, 0.18–1.35; four studies, 419 patients) and hemorrhagic transformation (SMD, 1.00; 95% CI, 0.41–1.59; 11 studies, 1,709 patients) but not poor outcome (SMD, 0.30; 95% CI, −0.12 to 0.72; four studies, 759 patients). Circulating c-Fn levels were also significantly higher in patients with severe brain edema (SMD, 1.55; 95% CI, 1.18–1.93; four studies, 419 patients), hemorrhagic transformation (SMD, 1.75; 95% CI, 0.72–2.78; four studies, 458 patients), and poor outcome (SMD, 0.46; 95% CI, 0.16–0.76; two studies, 210 patients). Meta-analysis of three studies indicated that the MMP-9 rs3918242 polymorphism may be associated with hemorrhagic transformation susceptibility under the dominant model (TT + CT vs. CC: OR, 0.621; 95% CI, 0.424–0.908; P = 0.014). No studies reported the association between MMP-9 rs3918242 polymorphism and brain edema or functional outcome after acute stroke. Conclusion: Our meta-analysis showed that higher MMP-9 levels were seen in stroke patients with severe brain edema and hemorrhagic transformation but not poor outcome. Circulating c-Fn levels appear to be associated with all three outcomes including severe brain edema, hemorrhagic transformation, and poor functional outcome. The C-to-T transition at the MMP-9 rs3918242 gene appears to reduce the risk of hemorrhagic transformation.
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Affiliation(s)
- Lu Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.,Center of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Deng
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ruozhen Yuan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxiao Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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14
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Portela de Oliveira E, Chakraborty S, Patel M, Finitsis S, Iancu D. Value of high-density sign on CT images after mechanical thrombectomy for large vessel occlusion in predicting hemorrhage and unfavorable outcome. Neuroradiol J 2020; 34:120-127. [PMID: 33283627 DOI: 10.1177/1971400920975259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Cerebral hyperdensities can appear on head computed tomography (CT) images performed early after endovascular treatment (EVT) in patients with acute ischemic stroke and may be secondary to contrast staining or hemorrhagic transformation. The aim of this study was to determine how the high-density sign on CT affects mortality and clinical outcome and whether CT parameters predict hemorrhagic conversion or unfavorable outcome. METHODS We retrospectively reviewed a database of patients who underwent EVT with mechanical thrombectomy for acute ischemic stroke over 7 years. Included were acute stroke patients with a CT examination within 24 h post-EVT with mechanical thrombectomy, demonstrating areas of hyperdensity. We evaluated morphologic characteristics of these lesions, location, CT Hounsfield units and largest area, as well as patient demographics, EVT methods and patient outcome. RESULTS A total of 29 patients met the strict inclusion criteria. Complete recanalization was achieved in 58.6% (17/29). Seventeen (58.6%) cases of post-intervention cerebral hyperdensities were related to contrast staining and 12 (41.4%) cases to contrast staining and hemorrhage. Patient mortality was significantly higher in the hemorrhagic group (50.0% versus 5.9%, p = 0.003). The increased density on CT was associated with higher hemorrhagic risk (odds ratio 1.05, p = 0.036). CONCLUSION Patients with the high-density sign on CT images after mechanical thrombectomy for acute ischemic stroke demonstrated increased mortality and worse clinical outcome, primarily when these hyperdensities were related to hemorrhage. CT imaging parameters as higher density areas can help in the differentiation of hemorrhage from contrast staining.
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Affiliation(s)
| | - Santanu Chakraborty
- Department of Radiology, University of Ottawa; Medical Imaging Division, The Ottawa Hospital, Canada
| | - Mihilkumar Patel
- Department of Radiology, University of Ottawa; Medical Imaging Division, The Ottawa Hospital, Canada
| | - Stefanos Finitsis
- Department of Radiology, Aristotle University of Thessaloniki, Greece
| | - Daniela Iancu
- Department of Radiology, University of Montreal, Canada
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15
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Semiquantitative assessment of iodine extravasation in acute ischemic stroke after mechanical thrombectomy. Chin Med J (Engl) 2020; 134:469-471. [PMID: 33617186 PMCID: PMC7909472 DOI: 10.1097/cm9.0000000000001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Qian J, Fan L, Zhang W, Wang J, Qiu J, Wang Y. A meta-analysis of collateral status and outcomes of mechanical thrombectomy. Acta Neurol Scand 2020; 142:191-199. [PMID: 32342996 DOI: 10.1111/ane.13255] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To perform a systematic review and meta-analysis to investigate pretreatment collaterals and outcomes of mechanical thrombectomy in patients with acute ischemic stroke of large-vessel occlusion in anterior circulation. METHODS We systematically searched Embase, PubMed, and the Cochrane Library from their dates of inception to March 5, 2020, and also manually searched reference lists of relevant articles. Pooled relative risk with 95% confidence interval on the association between good collaterals and functional independence (in terms of mRS 0-2), symptomatic intracranial hemorrhage, mortality, and successful reperfusion were synthesized using a random-effects model. RESULTS Thirty-four studies enrolling 5768 patients were included in analysis. Good collaterals were significantly associated with functional independence (RR 1.93, 95%CI 1.64-2.27, P < .0001), successful reperfusion (RR 1.23, 95%CI 1.12-1.35, P < .0001), decreased rate of symptomatic intracranial hemorrhage (RR 0.68, 95%CI 0.47-0.97, P = .032), and mortality (RR 0.37, 95%CI 0.27-0.52, P < .0001). The results were consistent in sensitivity analysis. The associations between good collaterals and reperfusion remained stable after adjusting for publication bias. CONCLUSIONS Good pretreatment collaterals were associated with functional independence, successful reperfusion, and decreased rate of sICH and mortality after receiving mechanical thrombectomy in patients with acute ischemic stroke of large-vessel occlusion.
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Affiliation(s)
- Jiacheng Qian
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
- China Medical University Shenyang China
| | - Lu Fan
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
- Dalian Medical University Dalian China
| | - Weiqing Zhang
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
- Dalian Medical University Dalian China
| | - Jian Wang
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
| | - Jianting Qiu
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
| | - Yujie Wang
- Department of Neurology Cerebrovascular Disease Center People's HospitalChina Medical University Shenyang China
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17
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Morgan CA, Mesquita M, Ashioti M, Beech JS, Williams SCR, Irving E, Cash D. Late changes in blood-brain barrier permeability in a rat tMCAO model of stroke detected by gadolinium-enhanced MRI. Neurol Res 2020; 42:844-852. [PMID: 32600164 DOI: 10.1080/01616412.2020.1786637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES After cerebral ischaemia the blood-brain barrier (BBB) may be compromised and this has been observed in both clinical and preclinical studies. The timing of BBB disruption after ischaemia has long been considered to be biphasic, however some groups contest this view. Therefore, the purpose of this study was to characterize the BBB permeability timecourse in a rat model at both acute and chronic time points. METHODS Unilateral transient middle cerebral artery occlusion (tMCAO) was performed in 15 male Sprague Dawley rats. Change in T1-weighted MR signal before and after an injection of gadolinium-based contrast agent was calculated voxelwise to derive a BBB permeability index (BBBPI) at both early (6 h, 12 h, and 24 h) and late (7 and 14 days) time points. RESULTS As expected, BBBPI in the non-lesioned ROI was not significantly different from pre-occlusion baseline at any time point. However, BBBPI in the ipsilateral (lesioned) ROI was statistically different to baseline at day 7 (p < 0.001) and day 14 (p < 0.01) post-tMCAO. There was a small, but not-significant increase in BBBPI in the earlier phase (at 6 hours). DISCUSSION Our results indicate a significant late opening of the BBB. This is important as the majority of previous studies have only characterised an early acute BBB permeability in ischemia. However, the later period of increased permeability may indicate an optimal time for drug delivery across the BBB, when it is especially suited to drugs targeting delayed processes.
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Affiliation(s)
- Catherine A Morgan
- School of Psychology and Centre for Brain Research, The University of Auckland , Auckland, New Zealand.,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London , London, UK
| | - Michel Mesquita
- School of Psychology and Centre for Brain Research, The University of Auckland , Auckland, New Zealand
| | - Maria Ashioti
- School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster , London, UK
| | - John S Beech
- School of Psychology and Centre for Brain Research, The University of Auckland , Auckland, New Zealand
| | - Steve C R Williams
- School of Psychology and Centre for Brain Research, The University of Auckland , Auckland, New Zealand
| | - Elaine Irving
- Value Evidence & Outcomes, GlaxoSmithKline R&D Ltd , Stevenage, UK
| | - Diana Cash
- School of Psychology and Centre for Brain Research, The University of Auckland , Auckland, New Zealand
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18
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Gautam J, Xu L, Nirwane A, Nguyen B, Yao Y. Loss of mural cell-derived laminin aggravates hemorrhagic brain injury. J Neuroinflammation 2020; 17:103. [PMID: 32252790 PMCID: PMC7133020 DOI: 10.1186/s12974-020-01788-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/25/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mural cells synthesize and deposit laminin to the basement membrane. To investigate the function of mural cell-derived laminin, we generated a mutant mouse line lacking mural cell-derived laminin (termed PKO). In a previous study, we showed that the PKO mice were grossly normal under homeostatic condition, but developed blood-brain barrier (BBB) breakdown with advanced age (> 8 months), suggesting that these mutants are intrinsically weak. Based on these findings, we hypothesized that PKO mice have exacerbated injuries in pathological conditions. METHODS Using collagenase-induced intracerebral hemorrhage (ICH) as an injury model, we examined various stroke outcomes, including hematoma volume, neurological function, neuronal death, BBB integrity, paracellular/transcellular transport, inflammatory cell infiltration, and brain water content, in PKO mice and their wildtype littermates at young age (6-8 weeks). In addition, transmission electron microscopy (TEM) analysis and an in vitro ICH model were used to investigate the underlying molecular mechanisms. RESULTS Compared to age-matched wildtype littermates, PKO mice display aggravated stroke outcomes, including larger hematoma size, worse neurological function, increased neuronal cell death, enhanced BBB permeability, increased transcytosis, and elevated inflammatory cell infiltration. These mutants also exhibit high baseline brain water content independent of aquaporin-4 (AQP4). In addition, mural cell-derived laminin significantly reduced caveolin-1 without affecting tight junction proteins in the in vitro ICH model. CONCLUSIONS These results suggest that mural cell-derived laminin attenuates BBB damage in ICH via decreasing caveolin-1 and thus transcytosis, regulates brain water homeostasis, and plays a beneficial role in ICH.
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Affiliation(s)
- Jyoti Gautam
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, 240 W Green Street, Athens, GA, 30602, USA
| | - Lingling Xu
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, 240 W Green Street, Athens, GA, 30602, USA
| | - Abhijit Nirwane
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, 240 W Green Street, Athens, GA, 30602, USA
| | - Benjamin Nguyen
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, 240 W Green Street, Athens, GA, 30602, USA
| | - Yao Yao
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, 240 W Green Street, Athens, GA, 30602, USA.
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19
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Effects of nicorandil on neurobehavioral function, BBB integrity, edema and stereological parameters of the brain in the sub-acute phase of stroke in a rat model. J Biosci 2020. [DOI: 10.1007/s12038-020-0021-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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20
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Neuroprotection for ischemic stroke in the endovascular era: A brief report on the future of intra-arterial therapy. J Clin Neurosci 2019; 69:289-291. [DOI: 10.1016/j.jocn.2019.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/05/2019] [Indexed: 01/05/2023]
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21
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Nirwane A, Yao Y. Laminins and their receptors in the CNS. Biol Rev Camb Philos Soc 2019; 94:283-306. [PMID: 30073746 DOI: 10.1111/brv.12454] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 01/24/2023]
Abstract
Laminin, an extracellular matrix protein, is widely expressed in the central nervous system (CNS). By interacting with integrin and non-integrin receptors, laminin exerts a large variety of important functions in the CNS in both physiological and pathological conditions. Due to the existence of many laminin isoforms and their differential expression in various cell types in the CNS, the exact functions of each individual laminin molecule in CNS development and homeostasis remain largely unclear. In this review, we first briefly introduce the structure and biochemistry of laminins and their receptors. Next, the dynamic expression of laminins and their receptors in the CNS during both development and in adulthood is summarized in a cell-type-specific manner, which allows appreciation of their functional redundancy/compensation. Furthermore, we discuss the biological functions of laminins and their receptors in CNS development, blood-brain barrier (BBB) maintenance, neurodegeneration, stroke, and neuroinflammation. Last, key challenges and potential future research directions are summarized and discussed. Our goals are to provide a synthetic review to stimulate future studies and promote the formation of new ideas/hypotheses and new lines of research in this field.
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Affiliation(s)
- Abhijit Nirwane
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, 240 W Green Street, Athens, GA 30602, U.S.A
| | - Yao Yao
- Department of Pharmaceutical and Biomedical Sciences, University of Georgia, 240 W Green Street, Athens, GA 30602, U.S.A
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22
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Abstract
Located at the interface of the circulation system and the CNS, the basement membrane (BM) is well positioned to regulate blood-brain barrier (BBB) integrity. Given the important roles of BBB in the development and progression of various neurological disorders, the BM has been hypothesized to contribute to the pathogenesis of these diseases. After stroke, a cerebrovascular disease caused by rupture (hemorrhagic) or occlusion (ischemic) of cerebral blood vessels, the BM undergoes constant remodeling to modulate disease progression. Although an association between BM dissolution and stroke is observed, how each individual BM component changes after stroke and how these components contribute to stroke pathogenesis are mostly unclear. In this review, I first briefly introduce the composition of the BM in the brain. Next, the functions of the BM and its major components in BBB maintenance under homeostatic conditions are summarized. Furthermore, the roles of the BM and its major components in the pathogenesis of hemorrhagic and ischemic stroke are discussed. Last, unsolved questions and potential future directions are described. This review aims to provide a comprehensive reference for future studies, stimulate the formation of new ideas, and promote the generation of new genetic tools in the field of BM/stroke research.
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Affiliation(s)
- Yao Yao
- Yao Yao, Department of Pharmaceutical and Biomedical Sciences, University of Georgia, 340 Pharmacy South Building, 250 West Green Street, Athens, GA 30602, USA.
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23
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Antiplatelet Drugs in the Management of Cerebral Ischemia. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00057-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Subacute Elevation of Plasma Level of Caspase-Cleaved Cytokeratin-18 is Associated with Hemorrhagic Transformation and Functional Outcome in Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 28:719-727. [PMID: 30528602 DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/17/2018] [Accepted: 11/08/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Caspase-cleaved cytokeratin-18 (CCCK-18) is an apoptosis marker. Here, we analyzed the relationship between plasma level of CCCK-18 in the acute and subacute stage of ischemic stroke and early and late functional outcome. Besides, correlation among CCCK-18 and complications, such as hemorrhagic transformation (HT) were also explored. METHODS Plasma concentration of CCCK-18 was investigated in 54 patients at admission and poststroke 72 hours. HT was evaluated by CT scans on 24 poststroke hours. Outcome measures were assessed by modified Rankin scale at hospital discharge and 6-month later. Receiver operating characteristics (ROC) analysis was used to determine the best cut-off values of CCCK-18 as a predictor of unfavorable functional outcome. RESULTS Significantly elevated CCCK-18 level was observed at 72 hours after onset of stroke, in nonsurviving compared to surviving patients (331 ± 191 ng/L versus 251 ± 164 ng/L, P = .01). Based on ROC analysis, the cut-off value of plasma CCCK-18 levels >223 ng/L at 72 poststroke hours predicted 6-month unfavorable stroke outcome with a sensitivity of 84.4% and a specificity of 77.3% (area under the curve: .851, 95% confidence interval = .745-.955, P < .001). The rate of complications such as HT and in-hospital infection was significantly higher in patients presented with a plasma CCCK-18 level above the cut-off value. CONCLUSIONS The association between high serum CCCK-18 levels and unfavorable early and late stroke outcome in an unselected study population was first described here. Besides, the apoptosis marker CCCK-18 might be a predictor of further complication such as HT and in-hospital infection.
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Sayeed I, Turan N, Stein DG, Wali B. Vitamin D deficiency increases blood-brain barrier dysfunction after ischemic stroke in male rats. Exp Neurol 2018; 312:63-71. [PMID: 30502340 DOI: 10.1016/j.expneurol.2018.11.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/05/2018] [Accepted: 11/22/2018] [Indexed: 12/18/2022]
Abstract
Because vitamin D hormone deficiency (VDHdef) can worsen severity and outcome for ischemic stroke, we examined the role of VDH in maintaining blood-brain-barrier (BBB integrity) in a rat model of stroke. In most types of stroke, the BBB is markedly compromised, potentially leading to a cascade of injury processes and functional deficits, so we examined a number of biomarkers associated with BBB disruption to determine whether VDH deficiency would further compromise the BBB following a stroke. Male Wistar rats were randomly assigned to one of two diet cohorts, VDH-sufficient (VDHsuf) and VDHdef. The VDHsuf group was fed standard rat chow and the VDHdef group got a VDH-null version of the same diet for 8 weeks. Animals from both cohorts were subjected to transient middle cerebral artery occlusion (tMCAO) surgery, killed at 72 h post-stroke, and their brains evaluated for BBB permeability and injury severity using expression of immunoglobulin (IgG), matrix metalloproteinase-9 (MMP-9) activity and alteration of tight junction (TJ) proteins as markers of BBB disruption. We also evaluated modulation of glucose transporter-1 (GLUT1), osteopontin (OPN), β-catenin and vitamin D receptor (VDR) expression in VDHsuf and VDHdef subjects. At the time of MCAO, rats on the VDHdef diet had circulating VDH levels one-fourth that of rats fed control chow. IgG extravasation after MCAO, indicating more severe BBB injury, was significantly higher in the MCAO+VDHdef than the MCAO+VDHsuf rats. Following MCAO, expression of MMP-9, GLUT1, VDR and OPN increased and the TJ proteins occludin and claudin-5 decreased significantly in the VDHdef compared to the VDHsuf group. We also observed significantly lower expression of β-catenin in the MCAO group of both VDHsuf and VDHdef rats. Under these conditions, VDH deficiency itself can compromise the BBB. We think that low serum VDH levels are likely to complicate stroke severity and its chronic consequences.
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Affiliation(s)
- Iqbal Sayeed
- Department of Emergency Medicine, Brain Research Laboratory, Emory University, Atlanta, GA 30322, USA
| | - Nefize Turan
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Donald G Stein
- Department of Emergency Medicine, Brain Research Laboratory, Emory University, Atlanta, GA 30322, USA
| | - Bushra Wali
- Department of Emergency Medicine, Brain Research Laboratory, Emory University, Atlanta, GA 30322, USA.
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Chen H, Zhu G, Liu N, Li Y, Xia Y. Applications and development of permeability imaging in ischemic stroke. Exp Ther Med 2018; 16:2203-2207. [PMID: 30186459 DOI: 10.3892/etm.2018.6454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/06/2017] [Indexed: 12/17/2022] Open
Abstract
Brain permeability imaging techniques are specific for the assessment of blood-brain barrier integrity. The present review article primarily focuses on the application of permeability imaging in cases of ischemic stroke. The permeability maps may be used to predict future hemorrhagic transformation in patients following acute ischemic stroke, that have been treated with tissue plasminogen activator (tPA) or recanalization therapy. The permeability imaging would help make the clinical decision to administer tPA following acute ischemic stroke or not, which is not only due to the current 3-4.5 h time window. Additionally, permeability imaging may also be used to evaluate the collateral circulation in the perfusion and permeability of the ischemic area of the brain.
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Affiliation(s)
- Hui Chen
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing 100700, P.R. China
| | - Guangming Zhu
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing 100700, P.R. China
| | - Nan Liu
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing 100700, P.R. China
| | - Ying Li
- Department of Neurology, Military General Hospital of Beijing PLA, Beijing 100700, P.R. China
| | - Yonghong Xia
- Department of Critical Care Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
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Castellanos M, van Eendenburg C, Gubern C, Kádár E, Huguet G, Puig J, Sobrino T, Blasco G, Serena J, Sánchez JM. Low Levels of Caveolin-1 Predict Symptomatic Bleeding After Thrombolytic Therapy in Patients With Acute Ischemic Stroke. Stroke 2018; 49:1525-1527. [DOI: 10.1161/strokeaha.118.020683] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/19/2018] [Accepted: 03/23/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Mar Castellanos
- From the Department of Neurology, A Coruña University Hospital/Biomedical Research Institute (INIBIC), Spain (M.C.)
| | | | | | - Elisabet Kádár
- Department of Biology, University of Girona, Spain (E.K., G.H.)
| | - Gemma Huguet
- Department of Biology, University of Girona, Spain (E.K., G.H.)
| | - Josep Puig
- Diagnostic Imaging Institute Research Unit (J.P., G.B.), University Hospital Dr. Josep Trueta/Girona Biomedical Research Institute, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, University Hospital and Research Institute of Santiago de Compostela, Spain (T.S.)
| | - Gerard Blasco
- Diagnostic Imaging Institute Research Unit (J.P., G.B.), University Hospital Dr. Josep Trueta/Girona Biomedical Research Institute, Spain
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Izawa Y, Gu YH, Osada T, Kanazawa M, Hawkins BT, Koziol JA, Papayannopoulou T, Spatz M, Del Zoppo GJ. β1-integrin-matrix interactions modulate cerebral microvessel endothelial cell tight junction expression and permeability. J Cereb Blood Flow Metab 2018; 38:641-658. [PMID: 28787238 PMCID: PMC5888854 DOI: 10.1177/0271678x17722108] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Acutely following focal cerebral ischemia disruption of the microvessel blood-brain barrier allows transit of plasma proteins into the neuropil as edema formation that coincides with loss of microvessel endothelial β1-integrins. We extend previous findings to show that interference with endothelial β1-integrin-matrix adhesion by the monoclonal IgM Ha2/5 increases the permeability of primary cerebral microvascular endothelial cell monolayers through reorganization of claudin-5, occludin, and zonula occludens-1 (ZO-1) from inter-endothelial borders. Interference with β1-integrin-matrix adhesion initiates F-actin conformational changes that coincide with claudin-5 redistribution. β1-integrin-matrix interference simultaneously increases phosphorylation of myosin light chain (MLC), while inhibition of MLC kinase (MLCK) and Rho kinase (ROCK) abolishes the Ha2/5-dependent increased endothelial permeability by 6 h after β1-integrin-matrix interference. These observations are supported by concordant observations in the cortex of a high-quality murine conditional β1-integrin deletion construct. Together they support the hypothesis that detachment of β1-integrins from abluminal matrix ligands increases vascular endothelial permeability through reorganization of tight junction (TJ) proteins via altered F-actin conformation, and indicate that the β1-integrin-MLC signaling pathway is engaged when β1-integrin detachment occurs. These findings provide a novel approach to the research and treatment of cerebral disorders where the breakdown of the blood-brain barrier accounts for their progression and complication.
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Affiliation(s)
- Yoshikane Izawa
- 1 Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,2 Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Yu-Huan Gu
- 1 Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Takashi Osada
- 1 Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,2 Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Masato Kanazawa
- 1 Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,3 Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Brian T Hawkins
- 1 Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,4 Discovery, Science, & Technology, RTI International, Research Triangle Park, NC, USA
| | - James A Koziol
- 5 Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
| | - Thalia Papayannopoulou
- 1 Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Maria Spatz
- 6 Stroke Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Gregory J Del Zoppo
- 1 Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.,7 Department of Neurology, University of Washington School of Medicine, Seattle, WA, USA
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Bonatti M, Lombardo F, Zamboni GA, Vittadello F, Currò Dossi R, Bonetti B, Pozzi Mucelli R, Bonatti G. Iodine Extravasation Quantification on Dual-Energy CT of the Brain Performed after Mechanical Thrombectomy for Acute Ischemic Stroke Can Predict Hemorrhagic Complications. AJNR Am J Neuroradiol 2018; 39:441-447. [PMID: 29348131 DOI: 10.3174/ajnr.a5513] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/05/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage represents a potentially severe complication of revascularization of acute ischemic stroke. The aim of our study was to assess the capability of iodine extravasation quantification on dual-energy CT performed immediately after mechanical thrombectomy to predict hemorrhagic complications. MATERIALS AND METHODS Because this was a retrospective study, the need for informed consent was waived. Eighty-five consecutive patients who underwent brain dual-energy CT immediately after mechanical thrombectomy for acute ischemic stroke between August 2013 and January 2017 were included. Two radiologists independently evaluated dual-energy CT images for the presence of parenchymal hyperdensity, iodine extravasation, and hemorrhage. Maximum iodine concentration was measured. Follow-up CT examinations performed until patient discharge were reviewed for intracerebral hemorrhage development. The correlation between dual-energy CT parameters and intracerebral hemorrhage development was analyzed by the Mann-Whitney U test and Fisher exact test. Receiver operating characteristic curves were generated for continuous variables. RESULTS Thirteen of 85 patients (15.3%) developed hemorrhage. On postoperative dual-energy CT, parenchymal hyperdensities and iodine extravasation were present in 100% of the patients who developed intracerebral hemorrhage and in 56.3% of the patients who did not (P = .002 for both). Signs of bleeding were present in 35.7% of the patients who developed intracerebral hemorrhage and in none of the patients who did not (P < .001). Median maximum iodine concentration was 2.63 mg/mL in the patients who developed intracerebral hemorrhage and 1.4 mg/mL in the patients who did not (P < .001). Maximum iodine concentration showed an area under the curve of 0.89 for identifying patients developing intracerebral hemorrhage. CONCLUSIONS The presence of parenchymal hyperdensity with a maximum iodine concentration of >1.35 mg/mL may identify patients developing intracerebral hemorrhage with 100% sensitivity and 67.6% specificity.
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Affiliation(s)
- M Bonatti
- From the Departments of Radiology (M.B., F.L., G.B.)
| | - F Lombardo
- From the Departments of Radiology (M.B., F.L., G.B.)
| | - G A Zamboni
- Department of Radiology (G.A.Z., R.P.M.), University of Verona, Verona, Italy
| | - F Vittadello
- Explora-Research and Statistical Analysis (F.V.), Vigodarzere, Italy
| | - R Currò Dossi
- Neurology (R.C.D., B.B.), Bolzano Central Hospital, Bolzano, Italy
| | - B Bonetti
- Neurology (R.C.D., B.B.), Bolzano Central Hospital, Bolzano, Italy
| | - R Pozzi Mucelli
- Department of Radiology (G.A.Z., R.P.M.), University of Verona, Verona, Italy
| | - G Bonatti
- From the Departments of Radiology (M.B., F.L., G.B.)
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Vascular expression of angiopoietin1, α5β1 integrin and tight junction proteins is tightly regulated during vascular remodeling in the post-ischemic brain. Neuroscience 2017; 362:248-256. [DOI: 10.1016/j.neuroscience.2017.08.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/20/2017] [Accepted: 08/20/2017] [Indexed: 02/05/2023]
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31
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Kwon I, An S, Kim J, Yang SH, Yoo J, Baek JH, Nam HS, Kim YD, Lee HS, Choi HJ, Heo JH. Hemorrhagic Transformation After Large Cerebral Infarction in Rats Pretreated With Dabigatran or Warfarin. Stroke 2017; 48:2865-2871. [DOI: 10.1161/strokeaha.117.017751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Il Kwon
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Sunho An
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Jayoung Kim
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Hee Yang
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Joonsang Yoo
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Jang-Hyun Baek
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Jung Choi
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- From the Department of Neurology (I.K., S.A., J.K., S.-H.Y., J.Y., J.-H.B., H.S.N., Y.D.K., J.H.H.), Severance Biomedical Science Institute (I.K., J.H.H.), Severance Integrative Research Institute for Cerebral and Cardiovascular Diseases (I.K., S.A., J.K., S.-H.Y., H.S.N., Y.D.K., H.-J.C., J.H.H.), and Department of Biostatistics (H.S.L.), Yonsei University College of Medicine, Seoul, Korea
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Lee EJ, Han JC, Kee C. A novel hypothesis for the pathogenesis of glaucomatous disc hemorrhage. Prog Retin Eye Res 2017; 60:20-43. [DOI: 10.1016/j.preteyeres.2017.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/08/2017] [Accepted: 08/28/2017] [Indexed: 01/16/2023]
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Wolcott Z, Batra A, Bevers MB, Sastre C, Khoury J, Sperling M, Meyer BC, Walsh KB, Adeoye O, Broderick JP, Kimberly WT. Soluble ST2 predicts outcome and hemorrhagic transformation after acute stroke. Ann Clin Transl Neurol 2017; 4:553-563. [PMID: 28812045 PMCID: PMC5553222 DOI: 10.1002/acn3.435] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/15/2017] [Indexed: 11/19/2022] Open
Abstract
Objective ST2 is a member of the toll‐like receptor superfamily that can alter inflammatory signaling of helper T‐cells. We investigated whether soluble ST2 (sST2) could independently predict outcome and hemorrhagic transformation (HT) in the setting of stroke. Methods We measured sST2 in patients enrolled in the Specialized Program of Translational Research in Acute Stroke (SPOTRIAS) network biomarker study. 646 patients had plasma samples collected at the time of hospital admission and 210 patients had a second sample collected 48 h after stroke onset. Functional outcome was assessed using the modified Rankin Scale (mRS), with good and poor outcomes defined as mRS 0‐2 and 3‐6, respectively. HT was classified using ECASS criteria. The relationships between sST2, outcome, and HT were evaluated using multivariable logistic regression, Kaplan–Meier survival analysis and receiver operating characteristic curves. Results 646 patients were included in the analysis (mean age 69 years; 44% women), with a median NIHSS of 5 [IQR: 2–12]. The median sST2 level on hospital admission was 35.0 ng/mL [IQR: 25.7–49.8 ng/mL] and at 48 h it was 37.4 ng/mL [IQR 27.9–55.6 ng/mL]. sST2 was independently associated with poor outcome (OR: 2.77, 95% CI: 1.54–5.06; P = 0.003) and mortality (OR: 3.56, 95% CI: 1.58–8.38, P = 0.001) after multivariable adjustment. Plasma sST2 was also associated with hemorrhagic transformation after adjustment for traditional risk factors (OR: 5.58, 95% CI: 1.40–37.44, P = 0.039). Interpretation Soluble ST2 may serve as a prognostic biomarker for outcome and hemorrhagic transformation in patients with acute stroke. ST2 may link neuroinflammation and secondary injury after stroke.
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Affiliation(s)
- Zoe Wolcott
- Department of Neurology and Center for Genomic Medicine Massachusetts General Hospital Boston Massachusetts
| | - Ayush Batra
- Department of Neurology and Center for Genomic Medicine Massachusetts General Hospital Boston Massachusetts
| | - Matthew B Bevers
- Department of Neurology Brigham and Women's Hospital Boston Massachusetts
| | - Cristina Sastre
- Department of Neurology and Center for Genomic Medicine Massachusetts General Hospital Boston Massachusetts
| | - Jane Khoury
- Division of Biostatistics and Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio
| | - Matthew Sperling
- Department of Emergency Medicine University of Cincinnati Cincinnati Ohio
| | - Brett C Meyer
- Department of Neurosciences University of California San Diego San Diego California
| | - Kyle B Walsh
- Department of Emergency Medicine University of Cincinnati Cincinnati Ohio
| | - Opeolu Adeoye
- Department of Emergency Medicine University of Cincinnati Cincinnati Ohio
| | | | - W Taylor Kimberly
- Department of Neurology and Center for Genomic Medicine Massachusetts General Hospital Boston Massachusetts
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Neuroprotective Effect of the Ginsenoside Rg1 on Cerebral Ischemic Injury In Vivo and In Vitro Is Mediated by PPAR γ-Regulated Antioxidative and Anti-Inflammatory Pathways. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:7842082. [PMID: 28656054 PMCID: PMC5471560 DOI: 10.1155/2017/7842082] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/29/2017] [Accepted: 05/09/2017] [Indexed: 01/26/2023]
Abstract
The ginsenoside Rg1 exerts a neuroprotective effect during cerebral ischemia/reperfusion injury. Rg1 has been previously reported to improve PPARγ expression and signaling, consequently enhancing its regulatory processes. Due to PPARγ's role in the suppression of oxidative stress and inflammation, Rg1's PPARγ-normalizing capacity may play a role in the observed neuroprotective action of Rg1 during ischemic brain injury. We utilized a middle cerebral artery ischemia/reperfusion injury model in rats in addition to an oxygen glucose deprivation model in cortical neurons to elucidate the mechanisms underlying the neuroprotective effects of Rg1. We found that Rg1 significantly increased PPARγ expression and reduced multiple indicators of oxidative stress and inflammation. Ultimately, Rg1 treatment improved neurological function and diminished brain edema, indicating that Rg1 may exert its neuroprotective action on cerebral ischemia/reperfusion injury through the activation of PPARγ signaling. In addition, the present findings suggested that Rg1 was a potent PPARγ agonist in that it upregulated PPARγ expression and was inhibited by GW9662, a selective PPARγ antagonist. These findings expand our previous understanding of the molecular basis of the therapeutic action of Rg1 in cerebral ischemic injury, laying the ground work for expanded study and clinical optimization of the compound.
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35
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Cipolla MJ, Sweet JG, Chan SL. Effect of hypertension and peroxynitrite decomposition with FeTMPyP on CBF and stroke outcome. J Cereb Blood Flow Metab 2017; 37:1276-1285. [PMID: 27317653 PMCID: PMC5453450 DOI: 10.1177/0271678x16654158] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We investigated the effect of peroxynitrite decomposition catalyst FeTMPyP treatment on perfusion deficit, vascular function and stroke outcome in Wistar ( n = 26) and spontaneously hypertensive rats stroke-prone (SHRSP; n = 26) that underwent tMCAO for 2 h or Sham operation. Peri-infarct CBF was measured by hydrogen clearance in the absence or presence of FeTMPyP (10 mg/kg, i.v.) or vehicle 10 min before reperfusion. Myogenic tone of parenchymal arterioles (PAs) was measured as an indication of small vessel resistance (SVR). Baseline CBF was similar between Wistar and SHRSP (114 ± 12 vs. 132 ± 9 mL/100 g/min); however, MCAO caused greater perfusion deficit in SHRSP (24 ± 6 vs. 7 ± 1 mL/100 g/min; p < 0.05) and increased infarct volume by TTC (12 ± 6 vs. 32 ± 2%; p < 0.05). Reperfusion CBF was decreased from baseline in both SHRSP and Wistar (54 ± 16 and 46 ± 19 mL/100 g/min; p < 0.05), suggesting increased infarction in SHRSP was related to greater perfusion deficit. PAs from SHRSP had increased tone vs. Wistar that was enhanced after tMCAO. FeTMPyP treatment did not affect CBF during ischemia or reperfusion, or tone of PAs, but decreased the incidence of hemorrhage in SHRSP by 50%. Thus, increased tone in PAs from SHRSP could increase perfusion deficit during MCAO that was not alleviated by FeTMPyP.
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Affiliation(s)
- Marilyn J Cipolla
- Departments of Neurological Sciences, Obstetrics, Gynecology & Reproductive Sciences, and Pharmacology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Julie G Sweet
- Departments of Neurological Sciences, Obstetrics, Gynecology & Reproductive Sciences, and Pharmacology, University of Vermont College of Medicine, Burlington, VT, USA
| | - Siu-Lung Chan
- Departments of Neurological Sciences, Obstetrics, Gynecology & Reproductive Sciences, and Pharmacology, University of Vermont College of Medicine, Burlington, VT, USA
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Renú A, Laredo C, Tudela R, Urra X, Lopez-Rueda A, Llull L, Oleaga L, Amaro S, Chamorro Á. Brain hemorrhage after endovascular reperfusion therapy of ischemic stroke: a threshold-finding whole-brain perfusion CT study. J Cereb Blood Flow Metab 2017; 37:153-165. [PMID: 26661254 PMCID: PMC5363740 DOI: 10.1177/0271678x15621704] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 11/17/2022]
Abstract
Endovascular reperfusion therapy is increasingly used for acute ischemic stroke treatment. The occurrence of parenchymal hemorrhage is clinically relevant and increases with reperfusion therapies. Herein we aimed to examine the optimal perfusion CT-derived parameters and the impact of the duration of brain ischemia for the prediction of parenchymal hemorrhage after endovascular therapy. A cohort of 146 consecutive patients with anterior circulation occlusions and treated with endovascular reperfusion therapy was analyzed. Recanalization was assessed at the end of reperfusion treatment, and the rate of parenchymal hemorrhage at follow-up neuroimaging. In regression analyses, cerebral blood volume and cerebral blood flow performed better than Delay Time maps for the prediction of parenchymal hemorrhage. The most informative thresholds (receiver operating curves) for relative cerebral blood volume and relative cerebral blood flow were values lower than 2.5% of normal brain. In binary regression analyses, the volume of regions with reduced relative cerebral blood volume and/or relative cerebral blood flow was significantly associated with an increased risk of parenchymal hemorrhage, as well as delayed vessel recanalization. These results highlight the relevance of the severity and duration of ischemia as drivers of blood-brain barrier disruption in acute ischemic stroke and support the role of perfusion CT for the prediction of parenchymal hemorrhage.
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Affiliation(s)
- Arturo Renú
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carlos Laredo
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Raúl Tudela
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Group of Biomedical Imaging of the University of Barcelona, Barcelona, Spain
| | - Xabier Urra
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Laura Llull
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laura Oleaga
- Radiology Department, Hospital Clinic, Barcelona, Spain
| | - Sergio Amaro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Ángel Chamorro
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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The Potential Therapeutic Effects of Artesunate on Stroke and Other Central Nervous System Diseases. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1489050. [PMID: 28116289 PMCID: PMC5223005 DOI: 10.1155/2016/1489050] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/20/2016] [Indexed: 12/31/2022]
Abstract
Artesunate is an important agent for cerebral malaria and all kinds of other severe malaria because it is highly efficient, lowly toxic, and well-tolerated. Loads of research pointed out that it had widespread pharmacological activities such as antiparasites, antitumor, anti-inflammation, antimicrobes activities. As we know, the occurrence and development of neurological disorders usually refer to intricate pathophysiologic mechanisms and multiple etiopathogenesis. Recent progress has also demonstrated that drugs with single mechanism and serious side-effects are not likely the candidates for treatment of the neurological disorders. Therefore, the pluripotent action of artesunate may result in it playing an important role in the prevention and treatment of these neurological disorders. This review provides an overview of primary pharmacological mechanism of artesunate and its potential therapeutic effects on neurological disorders. Meanwhile, we also briefly summarize the primary mechanisms of artemisinin and its derivatives. We hope that, with the evidence presented in this review, the effect of artesunate in prevention and curing for neurological disorders can be further explored and studied in the foreseeable future.
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Abstract
Numerous preclinical studies indicate that sustained endothelial activation significantly contributes to tissue edema, perpetuates the inflammatory response, and exacerbates tissue injury ultimately resulting in organ failure. However, no specific therapies aimed at restoring endothelial function are available as yet. Sphingosine-1-phosphate (S1P) is emerging as a potent modulator of endothelial function and endothelial responses to injury. Recent studies indicate that S1PR are attractive targets to treat not only disorders of the arterial endothelium but also microvascular dysfunction caused by ischemic or inflammatory injury. In this article, we will review the current knowledge of the role of S1P and its receptors in endothelial function in health and disease, and we will discuss the therapeutic potential of targeting S1PR not only for disorders of the arterial endothelium but also the microvasculature. The therapeutic targeting of S1PR in the endothelium could help to bridge the gap between biomedical research in vascular biology and clinical practice.
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Affiliation(s)
- Teresa Sanchez
- Department of Pathology and Laboratory Medicine, Center for Vascular Biology, Weill Cornell Medical College, 1300 York Ave, Room A607B/Box 69, New York, NY, 10065, USA.
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Correction of T1 Effects in Calculation of Relative Recirculation in Ischemic Stroke Patients. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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40
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del Zoppo GJ, Moskowitz M, Nedergaard M. The Neurovascular Unit and Responses to Ischemia. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Mechanisms of Thrombosis and Thrombolysis. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cathepsin L acutely alters microvessel integrity within the neurovascular unit during focal cerebral ischemia. J Cereb Blood Flow Metab 2015. [PMID: 26198177 PMCID: PMC4635247 DOI: 10.1038/jcbfm.2015.170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
During focal cerebral ischemia, the degradation of microvessel basal lamina matrix occurs acutely and is associated with edema formation and microhemorrhage. These events have been attributed to matrix metalloproteinases (MMPs). However, both known protease generation and ligand specificities suggest other participants. Using cerebral tissues from a non-human primate focal ischemia model and primary murine brain endothelial cells, astrocytes, and microglia in culture, the effects of active cathepsin L have been defined. Within 2 hours of ischemia onset cathepsin L, but not cathepsin B, activity appears in the ischemic core, around microvessels, within regions of neuron injury and cathepsin L expression. In in vitro studies, cathepsin L activity is generated during experimental ischemia in microglia, but not astrocytes or endothelial cells. In the acidic ischemic core, cathepsin L release is significantly increased with time. A novel ex vivo assay showed that cathepsin L released from microglia during ischemia degrades microvessel matrix, and interacts with MMP activity. Hence, the loss of microvessel matrix during ischemia is explained by microglial cathepsin L release in the acidic core during injury evolution. The roles of cathepsin L and its interactions with specific MMP activities during ischemia are relevant to strategies to reduce microvessel injury and hemorrhage.
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Tan Z, Lucke-Wold BP, Logsdon AF, Turner RC, Tan C, Li X, Hongpaison J, Alkon DL, Simpkins JW, Rosen CL, Huber JD. Bryostatin extends tPA time window to 6 h following middle cerebral artery occlusion in aged female rats. Eur J Pharmacol 2015; 764:404-412. [PMID: 26189021 PMCID: PMC4698807 DOI: 10.1016/j.ejphar.2015.07.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 02/08/2023]
Abstract
Blood-brain barrier (BBB) disruption and hemorrhagic transformation (HT) following ischemic/reperfusion injury contributes to post-stroke morbidity and mortality. Bryostatin, a potent protein kinase C (PKC) modulator, has shown promise in treating neurological injury. In the present study, we tested the hypothesis that administration of bryostatin would reduce BBB disruption and HT following acute ischemic stroke; thus, prolonging the time window for administering recombinant tissue plasminogen activator (r-tPA). Acute cerebral ischemia was produced by reversible occlusion of the right middle cerebral artery (MCAO) in 18-20-month-old female rats using an autologous blood clot with delayed r-tPA reperfusion. Bryostatin (or vehicle) was administered at 2 h post-MCAO and r-tPA was administered at 6 h post-MCAO. Functional assessment, lesion volume, and hemispheric swelling measurements were performed at 24 h post-MCAO. Assessment of BBB permeability, measurement of hemoglobin, assessment of matrix metalloproteinase (MMP) levels by gel zymography, and measurement of PKCε, PKCα, PKCδ expression by western blot were conducted at 24 h post-MCAO. Rats treated with bryostatin prior to r-tPA administration had decreased mortality and hemispheric swelling when compared with rats treated with r-tPA alone. Administration of bryostatin also limited BBB disruption and HT and down-regulated MMP-9 expression while up-regulating PKCε expression at 24 h post-MCAO. Bryostatin administration ameliorates BBB disruption and reduces the risk of HT by down-regulating MMP-9 activation and up-regulating PKCε. In this proof-of-concept study, bryostatin treatment lengthened the time-to-treatment window and enhanced the efficacy and safety of thrombolytic therapy.
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Affiliation(s)
- Zhenjun Tan
- Department of Neurosurgery, School of Medicine, United States
| | | | - Aric F Logsdon
- Department of Basic Pharmaceutical Science, School of Pharmacy, United States
| | - Ryan C Turner
- Department of Neurosurgery, School of Medicine, United States
| | - Cong Tan
- Department of Physiology and Pharmacology, School of Medicine, United States
| | - Xinlan Li
- Department of Neurosurgery, School of Medicine, United States
| | - Jarin Hongpaison
- Blanchette Rockfeller Neuroscience Institute, West Virginia University, United States
| | - Daniel L Alkon
- Blanchette Rockfeller Neuroscience Institute, West Virginia University, United States
| | - James W Simpkins
- Department of Physiology and Pharmacology, School of Medicine, United States
| | - Charles L Rosen
- Department of Neurosurgery, School of Medicine, United States
| | - Jason D Huber
- Department of Basic Pharmaceutical Science, School of Pharmacy, United States.
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Critical role of sphingosine-1-phosphate receptor-2 in the disruption of cerebrovascular integrity in experimental stroke. Nat Commun 2015; 6:7893. [PMID: 26243335 PMCID: PMC4587559 DOI: 10.1038/ncomms8893] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 06/23/2015] [Indexed: 12/13/2022] Open
Abstract
The use and effectiveness of current stroke reperfusion therapies are limited by the complications of reperfusion injury, which include increased cerebrovascular permeability and haemorrhagic transformation. Sphingosine-1-phosphate (S1P) is emerging as a potent modulator of vascular integrity via its receptors (S1PR). By using genetic approaches and a S1PR2 antagonist (JTE013), here we show that S1PR2 plays a critical role in the induction of cerebrovascular permeability, development of intracerebral haemorrhage and neurovascular injury in experimental stroke. In addition, inhibition of S1PR2 results in decreased matrix metalloproteinase (MMP)-9 activity in vivo and lower gelatinase activity in cerebral microvessels. S1PR2 immunopositivity is detected only in the ischemic microvessels of wild-type mice and in the cerebrovascular endothelium of human brain autopsy samples. In vitro, S1PR2 potently regulates the responses of the brain endothelium to ischaemic and inflammatory injury. Therapeutic targeting of this novel pathway could have important translational relevance to stroke patients.
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45
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Jin X, Sun Y, Xu J, Liu W. Caveolin-1 mediates tissue plasminogen activator-induced MMP-9 up-regulation in cultured brain microvascular endothelial cells. J Neurochem 2015; 132:724-30. [PMID: 25683686 DOI: 10.1111/jnc.13065] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/03/2015] [Accepted: 02/09/2015] [Indexed: 12/01/2022]
Abstract
Thrombolysis with tissue plasminogen activator (tPA) increases matrix metalloproteinase-9 (MMP-9) activity in the ischemic brain, which exacerbates blood-brain barrier injury and increases the risk of symptomatic cerebral hemorrhage. The mechanism through which tPA enhances MMP-9 activity is not well understood. Here we report an important role of caveolin-1 in mediating tPA-induced MMP-9 synthesis. Brain microvascular endothelial cell line bEnd3 cells were incubated with 5 or 20 μg/ml tPA for 24 hrs before analyzing MMP-9 levels in the conditioned media and cellular extracts by gelatin zymography. tPA at a dose of 20 μg/mL tPA, but not 5 μg/mL, significantly increased MMP-9 level in cultured media while decreasing it in cellular extracts. Concurrently, tPA treatment induced a 2.3-fold increase of caveolin-1 protein levels in endothelial cells. Interestingly, knockdown of Cav-1 with siRNA inhibited tPA-induced MMP-9 mRNA up-regulation and MMP-9 increase in the conditioned media, but did not affect MMP-9 decrease in cellular extracts. These results suggest that caveolin-1 critically contributes to tPA-mediated MMP-9 up-regulation, but may not facilitate MMP-9 secretion in endothelial cells. Thrombolysis with tissue plasminogen activator (tPA) increases matrix metalloproteinase-9 (MMP-9) activity in the ischemic brain, which exacerbates ischemic blood brain barrier (BBB) injury and increases the risk of symptomatic cerebral hemorrhage. Our results suggest a novel mechanism underlying this tPA-MMP 9 axis. In response to tPA treatment, caveolin-1 protein levels increased in endothelial cells, which mediate MMP-9 mRNA up-regulation and its secretion into extracellular space. Caveolin-1 may, however, not facilitate MMP-9 secretion in endothelial cells. Our data suggest caveolin-1 as a novel therapeutic target for protecting the BBB against ischemic damage. The schematic outlines tPA-induced MMP-9 upreguation.
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Affiliation(s)
- Xinchun Jin
- Jiangsu Key Laboratory of Translational Research and Therapy for Neuro-Psycho-Diseases and Institute of Neuroscience, The Second Affiliated Hospital of Soochow University, Soochow University, Suzhou, China
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Lee NY, Park HYL, Park SH, Park CK. The Association of Nailfold Capillaroscopy with Systemic Matrix Metalloproteinase-9 Concentration in Normal-Tension Glaucoma. Curr Eye Res 2015; 40:1001-7. [PMID: 25658690 DOI: 10.3109/02713683.2014.971937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To investigate the association of nailfold capillaroscopy, heart rate variability (HRV), and clinical characteristics of glaucoma with the plasma matrix metalloproteinase-9 (MMP-9) level in normal-tension glaucoma (NTG). MATERIALS AND METHODS We conducted a prospective, cross-sectional study on 25 patients with NTG. Subjects with systemic diseases were excluded. The patients underwent a complete ophthalmic examination and were referred to the Rheumatology Department, where nailfold capillaroscopy and HRV assessment were performed. The patients were assigned to the lowest and highest HRV groups according to the standard deviation value of the qualified normal-to-normal intervals of the HRV assessment. Blood samples from all the subjects were assayed for MMP-9 concentrations. RESULTS The systemic MMP-9 level was significantly associated with the nailfold capillaroscopy result (ρ = 0.439, p = 0.032). Of the 25 patients, seven had optic disc hemorrhage (ODH). The mean MMP-9 concentration was 4375.6 ± 2923.2 pg/ml in ODH patients and 5932.1 ± 1265.4 pg/ml in patients without ODH. However, there was no significant association of HRV parameters or disc hemorrhage with the systemic MMP-9 level. CONCLUSIONS The systemic MMP-9 level was associated with the nailfold capillaroscopy results in patients with NTG but had no direct association with ODH.
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Affiliation(s)
- Na Young Lee
- a College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea .,b Department of Ophthalmology , Incheon St. Mary's Hospital , Seoul , Republic of Korea
| | - Hae-Young Lopilly Park
- a College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea .,c Department of Ophthalmology , Seoul St. Mary's Hospital , Seoul , Republic of Korea , and
| | - Sung-Hwan Park
- a College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea .,d Division of Rheumatology, Department of Internal Medicine , Seoul St. Mary's Hospital , Seoul , Republic of Korea
| | - Chan Kee Park
- a College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea .,c Department of Ophthalmology , Seoul St. Mary's Hospital , Seoul , Republic of Korea , and
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Renú A, Amaro S, Laredo C, Román LS, Llull L, Lopez A, Urra X, Blasco J, Oleaga L, Chamorro Á. Relevance of blood-brain barrier disruption after endovascular treatment of ischemic stroke: dual-energy computed tomographic study. Stroke 2015; 46:673-9. [PMID: 25657188 DOI: 10.1161/strokeaha.114.008147] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Computed tomographic (CT) high attenuation (HA) areas after endovascular therapy for acute ischemic stroke are a common finding indicative of blood-brain barrier disruption. Dual-energy CT allows an accurate differentiation between HA areas related to contrast staining (CS) or to brain hemorrhage (BH). We sought to evaluate the prognostic significance of the presence of CS and BH after endovascular therapy. METHODS A prospective cohort of 132 patients treated with endovascular therapy was analyzed. According to dual-energy CT findings, patients were classified into 3 groups: no HA areas (n=53), CS (n=32), and BH (n=47). The rate of new hemorrhagic transformations was recorded at follow-up neuroimaging. Clinical outcome was evaluated at 90 days with the modified Rankin Scale (poor outcome, 3-6). RESULTS Poor outcome was associated with the presence of CS (odds ratio [OR], 11.3; 95% confidence interval, 3.34-38.95) and BH (OR, 10.4; 95% confidence interval, 3.42-31.68). The rate of poor outcome despite complete recanalization was also significantly higher in CS (OR, 9.7; 95% confidence interval, 2.55-37.18) and BH (OR, 15.1; 95% confidence interval, 3.85-59.35) groups, compared with the no-HA group. Patients with CS disclosed a higher incidence of delayed hemorrhagic transformation at follow-up (OR, 4.5; 95% confidence interval, 1.22-16.37) compared with no-HA patients. CONCLUSIONS Blood-brain barrier disruption, defined as CS and BH on dual-energy CT, was associated with poor clinical outcomes in patients with stroke treated with endovascular therapies. Moreover, isolated CS was associated with delayed hemorrhagic transformation. These results support the clinical relevance of blood-brain barrier disruption in acute stroke.
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Affiliation(s)
- Arturo Renú
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.)
| | - Sergio Amaro
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.)
| | - Carlos Laredo
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.)
| | - Luis San Román
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.)
| | - Laura Llull
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.)
| | - Antonio Lopez
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.)
| | - Xabier Urra
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.)
| | - Jordi Blasco
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.)
| | - Laura Oleaga
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.)
| | - Ángel Chamorro
- From the Department of Neuroscience, Comprehensive Stroke Center, Hospital Clinic, University of Barcelona, August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain (A.R., S.A., C.L., L.L., X.U., Á.C.); and Radiology Department, Hospital Clinic, Barcelona, Spain (L.S.R., A.L., J.B., L.O.).
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Mouchtouris N, Jabbour PM, Starke RM, Hasan DM, Zanaty M, Theofanis T, Ding D, Tjoumakaris SI, Dumont AS, Ghobrial GM, Kung D, Rosenwasser RH, Chalouhi N. Biology of cerebral arteriovenous malformations with a focus on inflammation. J Cereb Blood Flow Metab 2015; 35:167-75. [PMID: 25407267 PMCID: PMC4426734 DOI: 10.1038/jcbfm.2014.179] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 09/05/2014] [Accepted: 09/22/2014] [Indexed: 01/01/2023]
Abstract
Cerebral arteriovenous malformations (AVMs) entail a significant risk of intracerebral hemorrhage owing to the direct shunting of arterial blood into the venous vasculature without the dissipation of the arterial blood pressure. The mechanisms involved in the growth, progression and rupture of AVMs are not clearly understood, but a number of studies point to inflammation as a major contributor to their pathogenesis. The upregulation of proinflammatory cytokines induces the overexpression of cell adhesion molecules in AVM endothelial cells, resulting in enhanced recruitment of leukocytes. The increased leukocyte-derived release of metalloproteinase-9 is known to damage AVM walls and lead to rupture. Inflammation is also involved in altering the AVM angioarchitecture via the upregulation of angiogenic factors that affect endothelial cell proliferation, migration and apoptosis. The effects of inflammation on AVM pathogenesis are potentiated by certain single-nucleotide polymorphisms in the genes of proinflammatory cytokines, increasing their protein levels in the AVM tissue. Furthermore, studies on metalloproteinase-9 inhibitors and on the involvement of Notch signaling in AVMs provide promising data for a potential basis for pharmacological treatment of AVMs. Potential therapeutic targets and areas requiring further investigation are highlighted.
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Affiliation(s)
- Nikolaos Mouchtouris
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Pascal M Jabbour
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - David M Hasan
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Mario Zanaty
- 1] Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA [2] Department of Neurosurgery, University of Iowa, Iowa City, Iowa, USA
| | - Thana Theofanis
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Dale Ding
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Stavropoula I Tjoumakaris
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Aaron S Dumont
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - George M Ghobrial
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - David Kung
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Division of Neurovascular Surgery and Endovascular Neurosurgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
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von Kummer R, Dzialowski I, Gerber J. Therapeutic efficacy of brain imaging in acute ischemic stroke patients. J Neuroradiol 2015; 42:47-54. [DOI: 10.1016/j.neurad.2014.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/10/2014] [Indexed: 10/24/2022]
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Yin KJ, Hamblin M, Chen YE. Angiogenesis-regulating microRNAs and Ischemic Stroke. Curr Vasc Pharmacol 2015; 13:352-65. [PMID: 26156265 PMCID: PMC4079753 DOI: 10.2174/15701611113119990016] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 11/12/2012] [Accepted: 11/15/2012] [Indexed: 12/19/2022]
Abstract
Stroke is a leading cause of death and disability worldwide. Ischemic stroke is the dominant subtype of stroke and results from focal cerebral ischemia due to occlusion of major cerebral arteries. Thus, the restoration or improvement of reduced regional cerebral blood supply in a timely manner is very critical for improving stroke outcomes and poststroke functional recovery. The recovery from ischemic stroke largely relies on appropriate restoration of blood flow via angiogenesis. Newly formed vessels would allow increased cerebral blood flow, thus increasing the amount of oxygen and nutrients delivered to affected brain tissue. Angiogenesis is strictly controlled by many key angiogenic factors in the central nervous system, and these molecules have been well-documented to play an important role in the development of angiogenesis in response to various pathological conditions. Promoting angiogenesis via various approaches that target angiogenic factors appears to be a useful treatment for experimental ischemic stroke. Most recently, microRNAs (miRs) have been identified as negative regulators of gene expression in a post-transcriptional manner. Accumulating studies have demonstrated that miRs are essential determinants of vascular endothelial cell biology/angiogenesis as well as contributors to stroke pathogenesis. In this review, we summarize the knowledge of stroke-associated angiogenic modulators, as well as the role and molecular mechanisms of stroke-associated miRs with a focus on angiogenesis-regulating miRs. Moreover, we further discuss their potential impact on miR-based therapeutics in stroke through targeting and enhancing post-ischemic angiogenesis.
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Affiliation(s)
- Ke-Jie Yin
- Cardiovascular Center, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
| | - Milton Hamblin
- Department of Pharmacology, Tulane University School of Medicine, 1430 Tulane Avenue SL83, New Orleans, Louisiana 70112, USA
| | - Y. Eugene Chen
- Cardiovascular Center, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
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