Risk area and infarct area relations in the hypertensive stroke-prone rat

Is the spontaneously hypertensive stroke prone rat a pertinent model of sub cortical ischemic stroke? A systematic review

The spontaneously hypertensive stroke prone rat is best known as an inducible model of large artery stroke. Spontaneous strokes and stroke propensity in the spontaneously hypertensive stroke prone rat are less well characterized; however, could be relevant to human lacunar stroke. We systematically reviewed the literature to assess the brain tissue and small vessel pathology underlying the spontaneous strokes of the spontaneously hypertensive stroke prone rat. We searched systematically three online databases from 1970 to May 2010; excluded duplicates, reviews, and articles describing the consequences of induced middle cerebral artery occlusion or noncerebral pathology; and recorded data describing brain region and the vessels examined, number of animals, age, dietary salt intake, vascular and tissue abnormalities. Among 102 relevant studies, animals sacrificed after developing stroke-like symptoms displayed arteriolar wall thickening, subcortical lesions, enlarged perivascular spaces and cortical infarcts and hemorrhages. Histopathology, proteomics and imaging studies suggested that the changes not due simply to hypertension. There may be susceptibility to endothelial permeability increase that precedes arteriolar wall thickening, degeneration and perivascular tissue changes; systemic inflammation may also precede cerebrovascular changes. There were very few data on venules or tissue changes before hypertension. The spontaneously hypertensive stroke prone rat shows similar features to human lacunar stroke and may be a good spontaneous model of this complex human disorder. Further studies should focus on structural changes at early ages and genetics to identify factors that predispose to vascular and brain damage.

Topological basis for the robust distribution of blood to rodent neocortex

The maintenance of robust blood flow to the brain is crucial to the health of brain tissue. We examined the pial network of the middle cerebral artery, which distributes blood from the cerebral arteries to the penetrating arterioles that source neocortical microvasculature, to characterize how vascular topology may support such robustness. For both mice and rats, two features dominate the topology. First, interconnected loops span the entire territory sourced by the middle cerebral artery. Although the loops comprise <10% of all branches, they maintain the overall connectivity of the network after multiple breaks. Second, >80% of offshoots from the loops are stubs that end in a single penetrating arteriole, as opposed to trees with multiple penetrating arterioles. We hypothesize that the loops and stubs protect blood flow to the parenchyma from an occlusion in a surface vessel. To test this, we assayed the viability of tissue that was sourced by an individual penetrating arteriole following occlusion of a proximal branch in the surface loop. We observed that neurons remained healthy, even when occlusion led to a reduction in the local blood flow. In contrast, direct blockage of a single penetrating arteriole invariably led to neuronal death and formation of a cyst. Our results show that the surface vasculature functions as a grid for the robust allocation of blood in the event of vascular dysfunction. The combined results of the present and prior studies imply that the pial network reallocates blood in response to changing metabolic needs.

Do in vivo experimental models reflect human cerebral small vessel disease? A systematic review

Cerebral small vessel disease (SVD) is a major cause of stroke and dementia. Pathologically, three lesions are seen: small vessel arteriopathy, lacunar infarction, and diffuse white matter injury (leukoaraiosis). Appropriate experimental models would aid in understanding these pathologic states and also in preclinical testing of therapies. The objective was to perform a systematic review of animal models of SVD and determine whether these resemble four key clinicopathologic features: (1) small, discrete infarcts; (2) small vessel arteriopathy; (3) diffuse white matter damage; (4) cognitive impairment. Fifteen different models were included, under four categories: (1) embolic injuries (injected blood clot, photochemical, detergent-evoked); (2) hypoperfusion/ischaemic injury (bilateral common carotid occlusion/stenosis, striatal endothelin-1 injection, striatal mitotoxin 3-NPA); (3) hypertension-based injuries (surgical narrowing of the aorta, or genetic mutations, usually in the renin-angiotensin system); (4) blood vessel damage (injected proteases, endothelium-targeting viral infection, or genetic mutations affecting vessel walls). Chronic hypertensive models resembled most key features of SVD, and shared the major risk factors of hypertension and age with human SVD. The most-used model was the stroke-prone spontaneously hypertensive rat (SHR-SP). No model described all features of the human disease. The optimal choice of model depends on the aspect of pathophysiology being studied.

Intact female stroke-prone hypertensive rats lack responsiveness to mineralocorticoid receptor antagonists

Data from the Framingham Heart Study suggest that women may be more sensitive to the deleterious cardiovascular remodeling effects of aldosterone. Previous studies from our laboratory have shown that chronic treatment with spironolactone, a mineralocorticoid receptor (MR) antagonist, decreases ischemic cerebral infarct size and prevents remodeling of the middle cerebral artery (MCA) in male spontaneously hypertensive stroke-prone rats (SHRSP). Therefore, we hypothesized that MR antagonism would reduce ischemic infarct size and prevent MCA remodeling in female SHRSP. Six-week-old female SHRSP were treated for 6 wk with spironolactone (25 or 50 mg.kg(-1).day(-1)) or eplerenone (100 mg.kg(-1).day(-1)) and compared with untreated controls. At 12 wk, cerebral ischemia was induced for 18 h using the intraluminal suture occlusion technique, or the MCA was isolated for analysis of passive structure using a pressurized arteriograph. MR antagonism had no effect on infarct size or passive MCA structure in female SHRSP. To study the potential effects of estrogen, the above experiments were repeated in bilaterally ovariectomized (OVX) female SHRSP treated with spironolactone (25 mg.kg(-1).day(-1)). Infarct size and vessel structure in OVX SHRSP were not different from control SHRSP. Spironolactone had no effect on infarct size in OVX SHRSP. However, MCA lumen and outer diameters were increased in spironolactone-treated OVX SHRSP, suggesting an effect of estrogen. Cerebral artery MR expression, assessed by Western blotting, was increased in female, compared with male, SHRSP. These studies highlight an apparent sexual dimorphism of MR expression and activity in the cerebral vasculature from hypertensive rats.

Spironolactone improves structure and increases tone in the cerebral vasculature of male spontaneously hypertensive stroke-prone rats

BACKGROUND

Previous studies show that ischemic cerebral infarct size is related to cerebral vessel structure. Spironolactone, a mineralocorticoid receptor antagonist, decreases ischemic cerebral infarct size in male spontaneously hypertensive stroke-prone rats (SHRSP). Therefore, we hypothesized that chronic spironolactone treatment would improve cerebral artery structure in the SHRSP.

METHODS

Six-week-old male SHRSP were treated with spironolactone (2.5 mg/day) for 6 weeks and were compared to untreated control SHRSP and normotensive Wistar Kyoto (WKY) rats. Using a pressurized arteriograph, structural measurements of the middle cerebral artery (MCA) were taken under passive (calcium-free), zero-flow conditions. Myogenic tone was calculated from active and passive measurements taken at 75 and 125 mmHg. Mean arterial pressure was measured using radiotelemetry.

RESULTS

Myogenic tone was increased only at 75 mmHg in the spironolactone-treated SHRSP compared to control rats. The MCA lumen and outer diameters were increased in the spironolactone-treated SHRSP compared to control SHRSP, but were not different from WKY rats, indicating a decrease in vascular remodeling. There was no effect of spironolactone on blood pressure, suggesting that this is a blood pressure-independent effect.

CONCLUSION

Increased myogenic tone and lumen diameter in the spironolactone-treated SHRSP may be responsible for the protective role of spironolactone in ischemic stroke.

The role of the renin–angiotensin system in malignant vascular injury affecting the systemic and cerebral circulations

Malignant hypertension is a rare but serious syndrome complicating 1% of essential hypertension and causing neurological, renal and cardiac complications. Despite improved anti-hypertensive medication, the incidence of this condition fails to decline. In the first part of this review, we discuss transgenic rat models of malignant hypertension, generated by over-expressing renin, to illustrate the role of the renin-angiotensin system in the development of systemic hypertensive vascular remodelling and hypertension. In the second part, we focus on the cerebrovascular response to hypertension and discuss new data using a conditional, transgenic model of malignant hypertension, the inducible hypertensive rat (IHR). Cerebral infarction associates strongly with hypertension in man and the mechanisms by which hypertension predisposes to different types of stroke remains poorly understood. Rats have similar cerebrovascular anatomy and structure to humans and as such provide a good experimental tool. To date, such models lack controllability and blood-pressure matched controls. Using the IHR, we have manipulated dietary salt and water intake to generate a novel, controllable stroke phenotype. Hypertensive small-vessel stroke develops over a predictable time period, permitting the study of developing cerebrovascular lesions. Systemic end-organ injury and hypertension are not affected. Dissociation of the systemic and central vascular responses in this way, will allow for comparative study of animals with equivalent hypertension, genetic background and systemic features of hypertension with or without stroke.

Why are strokes related to hypertension? Classic studies and hypotheses revisited

Although it seems obvious that excessive intravascular pressure is the cause of spontaneous intracerebral haemorrhage, the available evidence instead suggests that haemorrhage arises from previous ischaemic damage to the walls of small blood vessels. This interpretation unifies the aetiology of cerebral infarction and intracerebral haemorrhage. It is supported by much pathological evidence and also fits with observations on spontaneous stroke-prone hypertensive rats, which have smaller cerebral arteries than Wistar-Kyoto rats. Ischaemic damage to the brain probably occurs during spontaneous dips in aortic pressure in the presence of atheromatous arterial lesions and arteriolar narrowing by lipohyaline deposits. It may also follow long-lasting arterial spasm provoked by sudden pressure elevations. Local factors, especially unevenness of cerebral perfusion, probably determine the site of an infarct and whether it becomes haemorrhagic or not. In the long term, hypotensive drugs will lessen atheroma deposition. In the short term, they may act by reducing or preventing damaging arteriolar spasm.

Oxotremorine-induced cerebral hyperemia does not predict infarction volume in spontaneously hypertensive or stroke-prone rats

OBJECTIVES

We tested the following hypotheses: a) spontaneously hypertensive stroke-prone rats (SHR-SP) have more brain injury than spontaneously hypertensive rats (SHR) and normotensive controls (Wistar-Kyoto rats [WKY]) when exposed to transient focal ischemia; b) infarction size is not correlated with baseline blood pressure; and c) infarction size is inversely related to the cerebral hyperemic response to oxotremorine, a muscarinic agonist that increases cerebral blood flow (CBF) by stimulating endothelial nitric oxide synthase.

DESIGN

In vivo study.

SETTING

Animal laboratory in a university teaching hospital.

SUBJECTS

Adult age-matched male WKY, SHR, and SHR-SP.

INTERVENTIONS

Rats were instrumented under halothane anesthesia. Transient focal cerebral ischemia was produced for 2 hrs with the intravascular suture technique. Cerebral perfusion, estimated with laser Doppler flowmetry (LD-CBF), in response to intravenous oxotremorine, was measured in one cohort of rats to estimate endothelial nitric oxide synthase function. Infarction volume was measured at 22 hrs of reperfusion with 2,3,5-triphenyltetrazolium chloride staining.

MEASUREMENTS AND MAIN RESULTS

Infarction volume in the striatum of SHR-SP (42+/-4 mm3) was greater than in SHR (29+/-6 mm3) or WKY (1+/-1 mm3) (n = 9 rats/strain). Resting (unanesthetized) mean arterial blood pressure was similar in SHR-SP (177+/-5 mm Hg) and SHR (170+/-5 mm Hg) despite a greater infarction volume in SHR-SP (n = 4) compared with SHR (n = 5). The percentage increase in LD-CBF signal in response to oxotremorine was similar for both groups (SHR, 64%+/-22% [n = 10]; SHR-SP, 69%+/-22% [n = 8]). However, in this cohort, cortical infarction volume was less in SHR (30%+/-4% of ipsilateral cortex) than in SHR-SP (49%+/-2% of ipsilateral cortex).

CONCLUSIONS

Although SHR-SP have greater infarction volume than SHR, the mechanism of injury does not appear to be related to a difference in unanesthetized baseline mean arterial blood pressure or to an alteration in endothelium-produced nitric oxide.

Larger anastomoses in angiotensinogen-knockout mice attenuate early metabolic disturbances after middle cerebral artery occlusion

Abnormalities in the homeostasis of the renin-angiotensin system have been implicated in the pathogenesis of vascular disorders, including stroke. The authors investigated whether angiotensinogen (AGN) knockout mice exhibit differences in brain susceptibility to focal ischemia, and whether such differences can be related to special features of the collateral circulation. Wild-type and AGN-knockout mice were submitted to permanent suture occlusion of the middle cerebral artery (MCA). The collateral vascular system was visualized by systemic latex infusion, and the ischemic lesions were identified by cresyl-violet staining. The core and penumbra of the evolving infarct were differentiated by bioluminescence and autoradiographic imaging of ATP and protein biosynthesis, respectively. In wild-type mice, mean arterial blood pressure was 95.0 +/- 8.6 mm Hg, and the diameter of fully relaxed anastomotic vessels between the peripheral branches of the anterior and middle cerebral arteries 26.6 +/- 4.0 microm. In AGN knockouts, mean arterial blood pressure was significantly lower, 71.5 +/- 8.5 mm Hg (P < .01), and the anastomotic vessels were significantly larger, 29.4 +/- 4.6 microm (P < .01). One hour after MCA occlusion, AGN-knockout mice exhibited a smaller ischemic core (defined as the region of ATP depletion) but a larger penumbra (the area of disturbed protein synthesis with preserved ATP). At 24 hours after MCA occlusion, this difference disappeared, and histologically visible lesions were of similar size in both strains. The observations show that in AGN-knockout mice the more efficient collateral blood supply delays ischemic injury despite the lower blood pressure. Pharmacologic suppression of angiotensin formation may prolong the therapeutic window for treatment of infarcts.

The determinants of long-term blood pressure stability: control of trough blood pressure during sleep

Long-term blood pressure stability in humans is not affected by prolonged hypotensive drug therapy. After withdrawal of long-term hypotensive therapy from essential hypertensives, their blood pressures soon return to pre-treatment levels. Since the well-studied stabilizing systems all adapt to prevailing blood pressure levels, they cannot account for long-term stability of blood pressure. There is a parallel between trough blood pressure and the lower limit of cerebral autoregulation. Blood pressure goes down to a trough level once sleep has been established. This level is maintained for 3-4 h, with minor perturbations. For normal and hypertensive humans and rats, the level is almost the same as the lower limit of cerebral autoregulation. In essential hypertension the nocturnal fall of blood pressure and the lower limit for cerebral autoregulation could be set by atheromatous narrowing or occlusion of large cerebral arteries, especially those supplying the brain stem, from which the Cushing response is initiated. Constriction and maldevelopment of smaller cerebral arteries are probably the main causes of increased cerebrovascular resistance in spontaneously hypertensive rats (SHR). The structural difference between the two situations might explain the failure of prolonged hypotensive therapy to reduce the lower limit of cerebral autoregulation in humans, which it is able to achieve in young SHR. If trough blood pressure stability were the anchor which prevents casual blood pressures from drifting, a primary increase of cerebrovascular resistance would be a plausible explanation for essential hypertension. It could also make a major causal neurogenic contribution to hypertension in rat models, especially SHR and stroke-prone SHR.

Differences in the cerebrovascular anatomy of C57black/6 and SV129 mice

The vascular architecture of the brain of C57Black/6 and SV129 mice was studied following microvascular injection of carbon black stained latex. The dorsal brain surface was photographed to determine the number, diameter, and position of pial anastomotic vessels between the middle and anterior cerebral arteries. The mean number and diameter of anastomoses were not significantly different, but the line of anastomoses interconnecting the half way points of anastomotic vessels was located significantly closer to the midline in C57Black/6 mice, demonstrating that the middle cerebral artery had a larger vascular supplying territory than in SV129 mice. This explains the larger infarct volume previously reported in C57Black/6 mice, and raises concerns about the use of C57Black/6 and SV129 mice as parent strains for genetically modified animals in stroke research.

Rat strain and vendor differences in collateral anastomoses

Recently we observed inter- and intrastrain differences in cortical infarct volumes after middle cerebral artery (MCA) occlusion. Variations in the anastomoses providing collateral blood supply could account for different lesion sizes. Our objectives were to compare number and internal diameters of the MCA-anterior cerebral artery (MCA-ACA) anastomoses and to determine if the lesion extended beyond branches of the MCA territory into the field of the ACA in the rat strains/lines. Sprague-Dawley rats and Wistar rats from Simonsen Laboratories (SLSD and SLWIS) and Sprague-Dawley rats from Taconic Laboratories (TLSD) and Charles River Laboratories (CRSD) were anesthetized and injected with papaverine and Vultex (white latex) for arterial visualization. Some rats were also subjected to MCA occlusion. Significantly fewer anastomoses were present in SLSD and SLWIS than in CRSD and TLSD (p < 0.05). The mean internal diameters of the anastomoses were not significantly different between the strains/lines (p < 0.05). After MCA occlusion, significantly more (p < 0.05) TLSD and CRSD than SLSD had lesions extending from the MCA field beneath the anastomoses and into the region supplied by the ACA. Neither the number, luminal diameter, nor density of MCA-ACA anastomoses appears to be the limiting factor that differentiates lesion size following MCA occlusion in these particular rat strains/lines. Therefore, factors other than anatomical variations probably account for different lesion sizes.

Infarct volume varies with rat strain and vendor in focal cerebral ischemia induced by transcranial middle cerebral artery occlusion

We recently reported that the outcome of focal cerebral ischemia induced by intraluminal middle cerebral artery occlusion may differ depending upon a rat's strain and/or vendor. Sprague-Dawley rats originating from Taconic Laboratories and Charles River Laboratories had infarct volumes several fold larger than Sprague-Dawley rats originating from Simonsen Laboratories. The present study sought to determine whether these differences were restricted to an intraluminal technique or whether strain and vendor dependent differences will also exist in rats subjected to a transcranial method of focal cerebral ischemia. Accordingly, we permanently coagulated the middle cerebral artery via a transcranial approach in Sprague-Dawley rats originating from Simonsen Laboratories and Taconic Laboratories and in Simonsen Laboratories Fischer-344 rats. The cortical infarct volume significantly differed in the following order: Simonsen Laboratories Sprague-Dawley rats < Simonsen Laboratories Fischer-344 rats < Taconic Laboratories Sprague-Dawley rats. The subcortical infarct volume differed statistically in the following order: Simonsen Laboratories Sprague-Dawley rats < Taconic Laboratories Sprague-Dawley rats < Simonsen Laboratories Fischer-344 rats. These results along with our previous findings demonstrate that strain and vendor differences in the outcome of focal cerebral ischemia are independent of the technique applied.

Identification of collaterally perfused areas following focal cerebral ischemia in the rat by comparison of gradient echo and diffusion-weighted MRI

Diffusion-weighted (DW) and gradient echo (GE) magnetic resonance images were acquired before and after occlusion of the middle cerebral artery (MCA) in the rat. Upon occlusion, an increase in DW imaging signal intensity was observed in a core area within the MCA territory, most likely reflecting cytotoxic edema. The signal from GE images, which is sensitive to changes in the absolute amount of deoxyhemoglobin, decreased following ischemia within a region that extended beyond the core area observed with DW imaging. This hypointensity is attributed to increases in blood volume and/or oxygen extraction fraction, which result from a decrease in perfusion pressure in the collaterally perfused area. The evolution of the GE imaging signal intensity from different regions was studied for 3.5 h following the occlusion. In the core area, the GE imaging signal returned towards baseline values after approximately 1-2 h, while it remained stable in the surrounding area. This feature may reflect a decrease in hematocrit due to microcirculatory defect and/or a decrease in the oxygen extraction fraction due to ongoing infarction of the tissue and may indicate that tissue recovery is severely compromised. The combined use of DW and GE imaging offers great promise for the noninvasive identification of specific pathological events with high spatial resolution.