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Maroofi A, Moro T, Agrimi J, Safari F. Cognitive decline in heart failure: Biomolecular mechanisms and benefits of exercise. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166511. [PMID: 35932891 DOI: 10.1016/j.bbadis.2022.166511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 11/24/2022]
Abstract
By definition, heart failure (HF) is a human pathological condition affecting the structure and function of all organs in the body, and the brain is not an exception to that. Failure of the heart to pump enough blood centrally and peripherally is at the foundation of HF patients' inability to attend even the most ordinary daily activities and progressive deterioration of their cognitive capacity. What is more, between heart and brain exists a bidirectional relationship that goes well beyond hemodynamics and concerns bioelectric and endocrine signaling. This increasingly consolidated evidence makes the scenario even more complex. Studies have mainly chased how HF impairs cognition without focusing much on preventive measures, notably cardio-cerebral health proxies. Here, we aim to provide a brief account of known and hypothetical factors that may explain how exercise can help obviate cognitive dysfunction associated with HF in its different forms. As we shall see, there is a stringent need for a deeper grasp of such mechanisms. Indeed, gaining this new knowledge will automatically shed new light on the inner workings of HF itself, thus resulting in more effective prevention and treatment of this escalating syndrome.
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Affiliation(s)
- Abdulbaset Maroofi
- Department of Exercise Physiology, Faculty of Physical Education & Sport Sciences, University of Guilan, Rasht, Iran
| | - Tatiana Moro
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy
| | - Jacopo Agrimi
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy.
| | - Fatemeh Safari
- Department of Physiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Kim KJ, Diaz JR, Presa JL, Muller PR, Brands MW, Khan MB, Hess DC, Althammer F, Stern JE, Filosa JA. Decreased parenchymal arteriolar tone uncouples vessel-to-neuronal communication in a mouse model of vascular cognitive impairment. GeroScience 2021; 43:1405-1422. [PMID: 33410092 PMCID: PMC8190257 DOI: 10.1007/s11357-020-00305-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/22/2020] [Indexed: 01/18/2023] Open
Abstract
Chronic hypoperfusion is a key contributor to cognitive decline and neurodegenerative conditions, but the cellular mechanisms remain ill-defined. Using a multidisciplinary approach, we sought to elucidate chronic hypoperfusion-evoked functional changes at the neurovascular unit. We used bilateral common carotid artery stenosis (BCAS), a well-established model of vascular cognitive impairment, combined with an ex vivo preparation that allows pressurization of parenchymal arterioles in a brain slice. Our results demonstrate that mild (~ 30%), chronic hypoperfusion significantly altered the functional integrity of the cortical neurovascular unit. Although pial cerebral perfusion recovered over time, parenchymal arterioles progressively lost tone, exhibiting significant reductions by day 28 post-surgery. We provide supportive evidence for reduced adenosine 1 receptor-mediated vasoconstriction as a potential mechanism in the adaptive response underlying the reduced baseline tone in parenchymal arterioles. In addition, we show that in response to the neuromodulator adenosine, the action potential frequency of cortical pyramidal neurons was significantly reduced in all groups. However, a significant decrease in adenosine-induced hyperpolarization was observed in BCAS 14 days. At the microvascular level, constriction-induced inhibition of pyramidal neurons was significantly compromised in BCAS mice. Collectively, these results suggest that BCAS uncouples vessel-to-neuron communication-vasculo-neuronal coupling-a potential early event in cognitive decline.
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Affiliation(s)
- Ki Jung Kim
- Department of Physiology, Augusta University, Augusta, GA, 30912, USA
| | - Juan Ramiro Diaz
- Department of Physiology, Augusta University, Augusta, GA, 30912, USA
| | - Jessica L Presa
- Department of Physiology, Augusta University, Augusta, GA, 30912, USA
| | - P Robinson Muller
- Department of Physiology, Augusta University, Augusta, GA, 30912, USA
| | - Michael W Brands
- Department of Physiology, Augusta University, Augusta, GA, 30912, USA
| | - Mohammad B Khan
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - David C Hess
- Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Javier E Stern
- Neuroscience Institute, Georgia State University, Atlanta, GA, USA
| | - Jessica A Filosa
- Department of Physiology, Augusta University, Augusta, GA, 30912, USA.
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3
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Revuelta JM, Zamarrón Á, Fortes J, Rodríguez-Boto G, Vaquero J, Gutiérrez-González R. Experimental rat model of chronic cerebral hypoperfusion-reperfusion mimicking normal perfusion pressure breakthrough phenomenon. Neurocirugia (Astur) 2020; 31:209-215. [PMID: 31948841 DOI: 10.1016/j.neucir.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Normal perfusion pressure breakthrough (NPPB) phenomenon is a major life-threatening complication that restricts the treatment of complex intracranial arteriovenous malformations. The aim of the study it to develop a rat model mimicking NPPB phenomenon that enables the evaluation of any therapy to prevent such complication. METHODS Twenty Wistar male rats were randomly assigned to either a study or a control group. Study animals underwent an end-to-side left external jugular vein-common carotid artery anastomosis and ligation of bilateral external carotid arteries. Control animals only underwent ligation of bilateral external carotid arteries. All animals were sacrificed sixty days after the procedure. Hemodynamic parameters [mean arterial pressure (MAP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP)], blood-brain barrier (BBB) permeability (measured by fluorescein staining) and histological features were then compared between both groups. RESULTS A significant decrease in MAP and CPP was confirmed in the study group. An increase in ICP was also observed. A significant decrease in MAP and CPP was also present in the study group when comparing preoperative values with those recorded on days 0 (postoperative), 7 and 60. Fluorescein staining findings were consistent with signs of BBB disruption in study animals. Histological analysis demonstrated an increased number of pyknotic neurons in the ipsilateral hemisphere of rat brains included in the study group. CONCLUSION These results confirm that this model mimics a vascular steal state with chronic cerebral hypoperfusion comparable to patients with AVMs behavior and disruption of the BBB after fistula closure comparable to NPPB phenomenon disorders.
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Affiliation(s)
- Juan Manuel Revuelta
- Department of Neurosurgery, Puerta de Hierro University Hospital, Manuel de Falla 1, 28222 Majadahonda-Madrid, Spain
| | - Álvaro Zamarrón
- Department of Neurosurgery, La Paz University Hospital, P° Castellana 261, 28046 Madrid, Spain
| | - José Fortes
- Health Research Institute-Fundación Jiménez Díaz (IIS-FJD), Avda Reyes Católicos 2, 28040 Madrid, Spain
| | - Gregorio Rodríguez-Boto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Manuel de Falla 1, 28222 Majadahonda-Madrid, Spain
| | - Jesús Vaquero
- Department of Neurosurgery, Puerta de Hierro University Hospital, Manuel de Falla 1, 28222 Majadahonda-Madrid, Spain
| | - Raquel Gutiérrez-González
- Department of Neurosurgery, Puerta de Hierro University Hospital, Manuel de Falla 1, 28222 Majadahonda-Madrid, Spain; Health Research Institute-Fundación Jiménez Díaz (IIS-FJD), Avda Reyes Católicos 2, 28040 Madrid, Spain.
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Bhogal P, Yeo LL, Henkes H, Krings T, Söderman M. The role of angiogenesis in dural arteriovenous fistulae: the story so far. Interv Neuroradiol 2018; 24:450-454. [PMID: 29562862 DOI: 10.1177/1591019918764090] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intracranial dural arteriovenous fistulae are a commonly encountered pathology that can present with a variety of different clinical symptoms. Although there is a significant body of work relating to the natural history and treatment of dural arteriovenous fistulae the exact underlying pathogenesis remains elusive. Various different pathogenetic models have been put forward but there is now a growing body of evidence implicating angiogenesis and the involvement of angiogenetic factors. In this review we attempt to show how the various animal and human studies performed over the past two decades have contributed to the proposed hypothesis on the development of dural arteriovenous fistulae.
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Affiliation(s)
- Pervinder Bhogal
- 1 Neuroradiological Clinic, Klinikum Stuttgart, Stuttgart, Germany.,2 Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Leonard L Yeo
- 2 Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.,3 Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hans Henkes
- 1 Neuroradiological Clinic, Klinikum Stuttgart, Stuttgart, Germany
| | - Timo Krings
- 4 Department of Neuroradiology, Toronto Western Hospital and University Health Network, Toronto, Canada
| | - Michael Söderman
- 2 Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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Animal Models in Studying Cerebral Arteriovenous Malformation. BIOMED RESEARCH INTERNATIONAL 2015; 2015:178407. [PMID: 26649296 PMCID: PMC4663287 DOI: 10.1155/2015/178407] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/11/2015] [Accepted: 10/25/2015] [Indexed: 12/13/2022]
Abstract
Brain arteriovenous malformation (AVM) is an important cause of hemorrhagic stroke. The etiology is largely unknown and the therapeutics are controversial. A review of AVM-associated animal models may be helpful in order to understand the up-to-date knowledge and promote further research about the disease. We searched PubMed till December 31, 2014, with the term “arteriovenous malformation,” limiting results to animals and English language. Publications that described creations of AVM animal models or investigated AVM-related mechanisms and treatments using these models were reviewed. More than 100 articles fulfilling our inclusion criteria were identified, and from them eight different types of the original models were summarized. The backgrounds and procedures of these models, their applications, and research findings were demonstrated. Animal models are useful in studying the pathogenesis of AVM formation, growth, and rupture, as well as in developing and testing new treatments. Creations of preferable models are expected.
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Gutiérrez-González R, Pérez-Zamarron A, Rodríguez-Boto G. Normal perfusion pressure breakthrough phenomenon: experimental models. Neurosurg Rev 2014; 37:559-67. [PMID: 24777643 DOI: 10.1007/s10143-014-0549-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 08/25/2013] [Accepted: 02/08/2014] [Indexed: 11/28/2022]
Abstract
One of the most life-threatening complications after the obliteration of intracranial arteriovenous malformations is the development of oedema and/or multifocal haemorrhage. Two main theories have been postulated so far in order to explain this situation. On one hand, "normal perfusion pressure breakthrough phenomenon" is based on the loss of cerebral vessel autoregulation due to the chronic vasodilation of perinidal microcirculation. On the other hand, the "occlusive hyperaemia" deals with thrombotic and venous obstruction phenomena that may also generate such manifestations. The aim of this study is to resume the main concepts of the "normal perfusion pressure breakthrough phenomenon" theory as well as the related animal models described up to date, their advantages and disadvantages, and the main conclusions obtained as a result of the experimental research.
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Affiliation(s)
- Raquel Gutiérrez-González
- Department of Neurosurgery, Fundación Jiménez Díaz (IIS-FJD), Avda Reyes Católicos 2, 28040, Madrid, Spain,
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Melo MCSC, Gadelha D, Mascena GV, Oliveira TKB, Brandt CT. Translational realistic expectations of chronic cerebral hypoxemia in rat model after bilateral commom carotid artery ligation. Neurocognitive aspects. Acta Cir Bras 2014; 29:53-8. [DOI: 10.1590/s0102-86502014000100008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 12/16/2013] [Indexed: 11/21/2022] Open
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Bhattacharjee AK, White L, Chang L, Ma K, Harry GJ, Deutsch J, Rapoport SI. Bilateral common carotid artery ligation transiently changes brain lipid metabolism in rats. Neurochem Res 2012; 37:1490-8. [PMID: 22422289 PMCID: PMC3478069 DOI: 10.1007/s11064-012-0740-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 01/04/2012] [Accepted: 02/20/2012] [Indexed: 10/28/2022]
Abstract
Brain lipid metabolism was studied in rats following permanent bilateral common carotid artery ligation (BCCL), a model for chronic cerebral hypoperfusion. Unesterified (free) fatty acids (uFA) and acyl-CoA concentrations were measured 6 h, 24 h, and 7 days after BCCL or sham surgery, in high energy-microwaved brain. In BCCL compared to sham rats, cytosolic phospholipase A(2) (cPLA(2)) immunoreactivity in piriform cortex, and concentrations of total uFA and arachidonoyl-CoA, an intermediate for arachidonic acid reincorporation into phospholipids, were increased only at 6 h. At 24 h, immunoreactivity for secretory phospholipase A(2) (sPLA(2)), which may regulate blood flow, was increased near cortical and hippocampal blood vessels. BCCL did not affect levels of brain IB(4)+ microglia, glial fibrillary acidic protein (GFAP)+ astrocytes, cyclooxygenase-2 (COX-2) immunoreactivity at any time, but increased cPLA(2) immunoreactivity in one region at 6 h. Thus, BCCL affected brain lipid metabolism transiently, likely because of compensatory sPLA(2)-mediated vasodilation, without producing evidence of neuroinflammation.
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Affiliation(s)
- Abesh Kumar Bhattacharjee
- Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Laura White
- Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Chang
- Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Kaizong Ma
- Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - G. Jean Harry
- Neurotoxicology Group, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Joseph Deutsch
- Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
- The Hebrew University of Jerusalem, School of Pharmacy, Jerusalem, Israel
| | - Stanley I. Rapoport
- Brain Physiology and Metabolism Section, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
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Alexander MD, Connolly ES, Meyers PM. Revisiting normal perfusion pressure breakthrough in light of hemorrhage-induced vasospasm. World J Radiol 2010; 2:230-2. [PMID: 21160635 PMCID: PMC2999324 DOI: 10.4329/wjr.v2.i6.230] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Revised: 06/02/2010] [Accepted: 06/28/2010] [Indexed: 02/06/2023] Open
Abstract
Cerebral arteriovenous malformations (AVMs) have abnormally enlarged arteries and veins prone to spontaneous hemorrhage. Immediately following surgical excision of a cerebral AVM, even normal brain tissue surrounding the lesion is subject to hemorrhage, a phenomenon termed normal perfusion pressure breakthrough (NPPB) syndrome. According to this theory, arteries supplying cerebral AVMs become dilated and lose their capacity to dilate or constrict to autoregulate pressure. Acutely after removal of a cerebral AVM, excessive blood pressure in these arterial feeders can cause normal brain tissue to bleed. However, this theory remains controversial. We present a patient with a cerebral AVM that demonstrated cerebrovascular reactivity and argues against an assumption underlying the theory of NPPB syndrome.
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Kennedy KM, Rodrigue KM, Land SJ, Raz N. BDNF Val66Met polymorphism influences age differences in microstructure of the Corpus Callosum. Front Hum Neurosci 2009; 3:19. [PMID: 19738930 PMCID: PMC2737488 DOI: 10.3389/neuro.09.019.2009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 07/31/2009] [Indexed: 12/25/2022] Open
Abstract
Brain-derived neurotrophic factor (BDNF) plays an important role in neuroplasticity and promotes axonal growth, but its secretion, regulated by a BDNF gene, declines with age. The low-activity (met) allele of common polymorphism BDNF val66met is associated with reduced production of BDNF. We examined whether age-related reduction in the integrity of cerebral white matter (WM) depends on the BDNF val66met genotype. Forty-one middle-aged and older adults participated in the study. Regional WM integrity was assessed by fractional anisotropy (FA) computed from manually drawn regions of interest in the genu and splenium of the corpus callosum on diffusion tensor imaging scans. After controlling for effects of sex and hypertension, we found that only the BDNF 66met carriers displayed age-related declines in the splenium FA, whereas no age-related declines were shown by BDNF val homozygotes. No genotype-related differences were observed in the genu of the corpus callosum. This finding is consistent with a view that genetic risk for reduced BDNF affects posterior regions that otherwise are considered relatively insensitive to normal aging. Those individuals with a genetic predisposition for decreased BDNF expression may not be able to fully benefit from BDNF-based plasticity and repair mechanisms.
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Affiliation(s)
- Kristen M Kennedy
- Center for Brain Health, School of Behavioral and Brain Sciences, The University of Texas at Dallas Dallas, TX, USA
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Parrilla G, Zamarro J, De Rueda ME, Lüttich A, Morales A, Lopez M, Moreno A. Brain Edema after Carotid Revascularization: Benign Syndrome or Prelude to Hemorrhage? Neuroradiol J 2009; 22:464-70. [DOI: 10.1177/197140090902200418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 06/10/2009] [Indexed: 11/15/2022] Open
Abstract
Brain edema (BE) post carotid revascularization (CR) is considered a benign presentation of the hyperperfusion syndrome. Its physiopathology has been related to production of vasogenic edema that tends to progressive spontaneous resolution. Its relation with post-CR hemorrhage remains unclear. Three cases of BE post-CR are described and compared to controls. Clinical evolution, medical management, and plain-CT and perfusion-CT (PCT) results are analysed. Two cases of BE had a benign course, with a progressive resolution of edema and disappearance of neurologic deficits. Effective blood pressure control was achieved in these patients. The third case suffered massive hemorrhage 24h after initial BE and died. This patient reached peak systolic levels of 220 mmHg before conversion to hemorrhage. Plain-CT and PCT findings were similar in the three patients with BE. CT showed signs of hemispheric brain swelling ipsilateral to CR. PCT showed low MTT and high CBF values on the hemisphere ipsilateral to CR compared to the contralateral hemisphere, with symmetric CBV values. Plain-CT and PCT in controls showed no abnormalities. BE post CR can be reversible but may also herald a hemorrhagic complication. A common physiopathology of post-CR BE and hemorrhage is suggested by PCT findings, related to failure of autoregulation and secondary blood-brain-barrier dysfunction. Spontaneous resolution of BE post-CR should not be routinely expected in clinical practice. Conversion to hemorrhage might be related with deficient blood pressure control and secondary rupture of the already damaged vessel wall.
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Affiliation(s)
- G. Parrilla
- Departments of Neurology, Hospital Universitario Virgen de la Arrixaca; Murcia, Spain
| | - J. Zamarro
- Departments of Radiology, Section of Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca; Murcia, Spain
| | - M. Espinosa De Rueda
- Departments of Radiology, Section of Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca; Murcia, Spain
| | - A. Lüttich
- Departments of Radiology, Section of Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca; Murcia, Spain
| | - A. Morales
- Departments of Neurology, Hospital Universitario Virgen de la Arrixaca; Murcia, Spain
| | - M. Lopez
- Departments of Neurology, Hospital Universitario Virgen de la Arrixaca; Murcia, Spain
| | - A. Moreno
- Departments of Radiology, Section of Interventional Neuroradiology, Hospital Universitario Virgen de la Arrixaca; Murcia, Spain
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Raz N, Rodrigue KM, Kennedy KM, Land S. Genetic and vascular modifiers of age-sensitive cognitive skills: effects of COMT, BDNF, ApoE, and hypertension. Neuropsychology 2009; 23:105-116. [PMID: 19210038 DOI: 10.1037/a0013487] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Several single nucleotide polymorphisms have been linked to neural and cognitive variation in healthy adults. We examined contribution of three polymorphisms frequently associated with individual differences in cognition (Catechol-O-Methyl-Transferase Val158Met, Brain-Derived-Neurotrophic-Factor Val66Met, and Apolipoprotein E epsilon4) and a vascular risk factor (hypertension) in a sample of 189 volunteers (age 18-82). Genotypes were determined from buccal culture samples, and cognitive performance was assessed in 4 age-sensitive domains?fluid intelligence, executive function (inhibition), associative memory, and processing speed. We found that younger age and COMT Met/Met genotype, associated with low COMT activity and higher prefrontal dopamine content, were independently linked to better performance in most of the tested domains. Homozygotes for Val allele of BDNF polymorphism exhibited better associative memory and faster speed of processing than the Met allele carriers, with greater effect for women and persons with hypertension. Carriers of ApoE epsilon4 allele evidenced steeper age-related increase in costs of Stroop color interference, but showed no negative effects on memory. The findings indicate that age-related cognitive performance is differentially affected by distinct genetic factors and their interactions with vascular health status.
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Shin Y, Nakase H, Nakamura M, Shimada K, Konishi N, Sakaki T. Expression of angiogenic growth factor in the rat DAVF model. Neurol Res 2008; 29:727-33. [PMID: 17588308 DOI: 10.1179/016164107x208077] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The precise mechanisms responsible for the development and growth of dural arteriovenous fistula (DAVF) remain unclear, but it has been hypothesized that vascular endothelial growth factor (VEGF) might be involved in the pathogenesis. The aim of this study was to examine the expression of VEGF in the rat DAVF model. METHODS Forty-five Sprague-Dawley rats were used in two experiments. In Experiment 1 (n = 20, including sham-operated controls), VEGF expression was analysed by Western blots in three different rat DAVF models: model I: common carotid artery-external jugular vein (CCA-EJV) anastomosis (n = 5); model II: sagittal sinus thrombosis and bipolar coagulation of the vein draining the transverse sinus (n = 5); model III: CCA-EJV anastomosis and bipolar coagulation of the vein draining the transverse sinus and sagittal sinus thrombosis to induce venous hypertension (n = 5). Based on the results of Experiment 1, Western blots were performed at weekly intervals 1, 2 and 3 weeks in Experiment 2 following induction of venous hypertension in model III (n = 5 at each time point and n = 5 sham controls); in addition, VEGF expression was immunohistochemically examined in the dura and the brain near the occluded sinus in five model III animals after 1 week. RESULTS In Experiment 1, Western blot analysis showed barely detectable bands with molecular weights of 45 kD, corresponding to VEGF, in the sham group, but the highest level of VEGF was induced in model III, followed by models I and II (model III>model I>model II). In Experiment 2, the expression of VEGF peaked 1 week after induction of venous hypertension in model III, decreasing in a linear fashion over 2 and 3 weeks (week 1>weeks 2 and 3). The expression of immunoreactive VEGF was restricted in the connective tissue and the endothelial layer of the dura matter, cerebral cortical tissue and neurons of the basal ganglia. CONCLUSION Our results strongly suggest a possible contribution of an angiogenic factor to the growth of DAVF. Venous ischemia by venous hypertension might be a mechanism for inducing up-regulation of angiogenic factor expression.
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Affiliation(s)
- Yasushi Shin
- Department of Neurosurgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan
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Comati A, Beck H, Halliday W, Snipes GJ, Plate KH, Acker T. Upregulation of Hypoxia-Inducible Factor (HIF)-1α and HIF-2α in Leptomeningeal Vascular Malformations of Sturge-Weber Syndrome. J Neuropathol Exp Neurol 2007; 66:86-97. [PMID: 17204940 DOI: 10.1097/nen.0b013e31802d9011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cutaneous and leptomeningeal vascular malformations are hallmarks of the Sturge-Weber Syndrome (SWS), resulting in chronic ischemic tissue damage. The mechanisms underlying the pathobiology of these progressive lesions are unknown. Aberrant expression of angiogenic factors has been implicated in the genesis and maintenance of vascular malformations. To assess the role of angiogenesis in SWS vascular lesions we determined the expression of key angiogenic factors by immunohistochemistry and in situ hybridization in 8 SWS patients (age: 8 months to 18 years). We observed increased expression of vascular endothelial growth factor (VEGF), its cognate receptors VEGFR-1, VEGFR-2, and neuropilin (NP)-1 as well as Tie2 in leptomeningeal SWS blood vessels. Intriguingly, these factors are known to be transcriptionally induced by hypoxia-inducible factor (HIF). The HIF system has emerged as the key regulatory system of responses to hypoxia. Immunohistochemical analysis demonstrated markedly elevated nuclear HIF-1alpha and HIF-2alpha protein levels in SWS vessels. Concomitantly, SWS vessels revealed signs of enhanced endothelial cell (EC) turnover as evidenced by increased EC proliferation and apoptosis. Thus, in terms of angiogenesis, vascular malformations in SWS are not static lesions but constitute dynamic structures. Our observation of a dysregulated HIF-alpha expression in SWS vessels are in agreement with recent findings that EC-specific HIF activation provides a setting which supports and sustains angiogenesis and could be of potential use for developing therapeutic strategies to treat these currently incurable lesions.
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Lee TH, Yang JT, Kato H, Wu JH. Hypertension downregulates the expression of brain-derived neurotrophic factor in the ischemia-vulnerable hippocampal CA1 and cortical areas after carotid artery occlusion. Brain Res 2006; 1116:31-8. [PMID: 16962081 DOI: 10.1016/j.brainres.2006.07.117] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 07/17/2006] [Accepted: 07/29/2006] [Indexed: 12/23/2022]
Abstract
We studied the effect of hypertension on brain damage and brain-derived neurotrophic factor (BDNF) expression in the hippocampal formation and cerebral cortex after permanent occlusion of bilateral common carotid arteries (CCA). Two groups of rats were used, including normotensive Wistar-Kyoto (WKY) rat and spontaneous hypertensive rat (SHR). Each group contained sham operation, 1 week and 4 weeks after bilateral CCA occlusion (n=5-10 in each time point). The blood pressure showed a significant elevation in WKY rats from 1 h after operation to 4 weeks before sacrifice (P<0.05), but was not changed in SHR (P>0.05). However, rectal temperature showed no significant change after operation in WKY rat and SHR (P>0.05) and showed no significant difference at any time point between WKY rat and SHR (P>0.05). Hematoxylin and eosin staining showed SHR had a significantly larger necrotic volume than WKY rats (n=10 in each group, 6044+/-6895 microm(3) vs. 144+/-174 microm(3), P<0.05) at 4 weeks after ischemia. In SHR, BDNF immunoreactivity and mRNA decreased significantly from 1 week to 4 weeks in both the hippocampal CA1 and cortical areas (P<0.01) but decreased transiently in dentate gyrus. However, in WKY rats, BDNF immunoreactivity and mRNA decreased transiently at 1 week (P<0.05) and recovered at 4 weeks after cerebral ischemia. Our study demonstrates that after bilateral CCA occlusion, preexisting hypertension may aggravate the brain injury and downregulate the expression of BDNF immunoreactivity and mRNA in the ischemia-vulnerable hippocampal CA1 and cortical areas but not in ischemia-resistant dentate gyrus.
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Affiliation(s)
- Tsong-Hai Lee
- Stroke Section, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University, 5 Fu-Hsing St., Kuei-Shan, Tao-Yuan, 33333 Taiwan.
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16
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Krivoshapkin AL, Melidy EG. Microsurgery for cerebral arteriovenous malformation management: a Siberian experience. Neurosurg Rev 2005; 28:124-30. [PMID: 15690217 DOI: 10.1007/s10143-004-0375-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2004] [Accepted: 11/13/2004] [Indexed: 10/25/2022]
Abstract
Cerebral vascular malformations remain among the most difficult neurosurgical entities to treat. We report a retrospective study of the outcome in 95 consecutive patients with angiographically revealed arteriovenous malformations (AVMs). Fifty-four patients underwent microsurgical total AVM removal (group I). Forty-one patients who refused open surgery (group II) were managed either by endovascular embolisation (16 cases), radiosurgery (three) or followed up with medical treatment for their symptoms. In the first group pretreatment with the non-selective beta-blocker propranolol before surgery, the current neuronavigation techniques, intraoperative embolisation and AVM nidus colouring in high flow AVM were used for total microsurgical excision of the lesions. All AVM patients but one survived microsurgery. The mortality rate was 1.8% for group I. Six patients with grade IV-V AVM developed new temporal neurological symptoms following surgery. Four of them recovered completely in 3-6 weeks; two patients remained with mild persistent monoparesis and with homonymous hemianopsia postoperatively. In ten of 13 epileptic patients surgery produced a cure. No patient re-bled following surgery. No postoperative normal perfusion pressure breakthrough occurred. In the second group ten patients (24%) developed intracerebral haemorrhages, six of ten patients demonstrated progressive seizures. The mortality rate in group II totalled 17% over 6 years. Microsurgical management approaches must consider preoperative correction of impaired cerebral autoregulation, neuronavigation for preoperative planning and intraoperative orientation, intraoperative embolisation and dying of the nidus for large high-flow AVMs.
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Affiliation(s)
- Alexei L Krivoshapkin
- Research Institute of Traumatology, Novosibirsk Neurosurgical Centre, Railway Hospital, Novosibirsk Medical University, Russia,
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17
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Hai J, Lin Q, Li ST, Pan QG. Chronic cerebral hypoperfusion and reperfusion injury of restoration of normal perfusion pressure contributes to the neuropathological changes in rat brain. ACTA ACUST UNITED AC 2004; 126:137-45. [PMID: 15249137 DOI: 10.1016/j.molbrainres.2004.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2004] [Indexed: 10/26/2022]
Abstract
Restoration of normal perfusion pressure after resection of cerebral arteriovenous malformations (AVMs) is sometimes complicated by unexplained postoperative brain swelling and/or intracranial hemorrhage, which has been termed normal perfusion pressure breakthrough (NPPB). The precise mechanism of NPPB is still unclear. In this study, we investigated the time courses of blood-brain barrier (BBB) disruption, water content, neuronal apoptosis, myeloperoxidase (MPO) activity and superoxide dismutase (SOD) activity in the brain during restoration of normal perfusion pressure in a new rat model of chronic cerebral hypoperfusion associated with AVMs. Male Sprague-Dawley rats were randomly divided into either a sham-operated group, a control group, or a model group with reperfusion assessed at 1, 12, 24 and 72 h after restoration of normal perfusion pressure. BBB disruption was judged by extravasation of Evans blue (EB) dye. We observed that EB and water content in rat brains of the model group with reperfusion were significantly increased compared with the other groups. The most predominant increase occurred at 1 h after reperfusion, and the next at 24 h after reperfusion, representing biphasic changes which are similar to the pathological processes of acute cerebral ischemia/reperfusion injury. There was no difference of the percentage of apoptotic cells in rat brains between the sham-operated group and the control group using flow cytometry. No prominent apoptotic cells were found in the model group with reperfusion at 1 h. However, the percentage of apoptotic cells increased significantly in rat brains of the model group with reperfusion at 12 h, peaked at 24 h, and decreased at 72 h after reperfusion. Apoptotic cells were confirmed with electron microscopy and terminal deoxynuleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL). A significant enhancement of MPO activity in combination with reduction of SOD activity was seen at 12, 24 and 72 h in rat brains of the model group with reperfusion. Our data indicates that reperfusion after restoration of normal perfusion pressure with chronic cerebral hypoperfusion lead to secondary neuronal damage which may associate with cerebral ischemia/reperfusion injury.
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Affiliation(s)
- Jian Hai
- Department of Neurosurgery, Tongji Hospital, Tongji University, 389 XinCun Rd., Shanghai 200065, China.
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18
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Abstract
Sturge-Weber syndrome is a neurocutaneous disorder classically presenting with a facial port-wine stain, vascular eye abnormalities, and an ipsilateral occipital leptomeningeal angioma. Children with Sturge-Weber syndrome often develop progressive neurologic problems. Data on the pathophysiology of Sturge-Weber syndrome are briefly reviewed. The embryologic, genetic, and pathologic considerations are discussed, as are theories regarding the mechanisms of the degenerative brain changes. Sturge-Weber syndrome likely results from an early embryologic malformation of vascular development affecting the development of the nearby skin, eye, and brain structures. Studies suggest that complex molecular interactions contribute to the abnormal development and function of blood vessels in Sturge-Weber syndrome. Neurologic deterioration in Sturge-Weber syndrome is likely secondary to impaired blood flow to the brain and is worsened by the presence of seizures. Insights from related areas are discussed, and future research studies are suggested.
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Affiliation(s)
- Anne M Comi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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19
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Bay-Hansen R, Ma XD, Hauerberg J, Larsen EH, Juhler M. Effects of cerebrospinal fluid acidity on cerebral blood flow and autoregulation in rats. J Neurosurg Anesthesiol 2003; 15:110-8. [PMID: 12657996 DOI: 10.1097/00008506-200304000-00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Using a ventriculocisternal perfusion method, the effects of cerebrospinal fluid (CSF) acidity of nonrespiratory origin on cerebral blood flow (CBF) and autoregulation of CBF were investigated. Three groups (six rats each) were studied: one group of sham operated rats, one control group with ventriculocisternal perfusion at normal pH (mean inflow pH +/- SD, 7.42 +/- 0.02), and one experimental group with ventriculocisternal perfusion at low pH (mean inflow pH +/- SD, 6.81 +/- 0.01). CBF was measured by the intracarotid xenon 133 method. Autoregulation was studied by repetitive measurements of CBF during an initial increase and then stepwise reduction of mean arterial blood pressure (MABP). No difference in CBF was found between sham operated and control rats with unperturbed pH (mean cisternal outflow pH +/- SD, 7.42 +/- 0.03) of CSF), and autoregulation was intact in both groups. In the experimental group, the mean CBF +/- SD was increased by 58%, from 127 +/- 33 mL/(100 g.min) before ventriculocisternal perfusion to 201 +/- 54 mL/(100 g.min) (P <.00001) during perfusion with acid CSF (mean cisternal outflow pH +/- SD, 7.23 +/- 0.04). In this group, the relationship between CBF and MABP was linear, thus indicating disrupted autoregulation. In conclusion, CSF acidity significantly increases CBF and impairs autoregulation of CBF.
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Affiliation(s)
- Rikke Bay-Hansen
- Department of Neurosurgery and the Neurobiology Research Unit, Rigshospitalet, Denmark
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20
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Meyer B, Stoffel M, Stuer C, Schaller C, Muhlbauer B, Schramm J. Norepinephrine in the Rat Cortex before and after Occlusion of Chronic Arteriovenous Fistulae: A Microdialysis Study in an Animal Model of Cerebral Arteriovenous Malformations. Neurosurgery 2002. [DOI: 10.1227/00006123-200209000-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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21
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Norepinephrine in the Rat Cortex before and after Occlusion of Chronic Arteriovenous Fistulae: A Microdialysis Study in an Animal Model of Cerebral Arteriovenous Malformations. Neurosurgery 2002. [DOI: 10.1097/00006123-200209000-00028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Morgan M, Winder M. Haemodynamics of arteriovenous malformations of the brain and consequences of resection: a review. J Clin Neurosci 2001; 8:216-24. [PMID: 11386794 DOI: 10.1054/jocn.2000.0795] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The physiological manifestations of arteriovenous fistulae in humans have been studied since the 18th century. However, confusion regarding concepts of cerebral 'steal', 'normal perfusion breakthrough', and 'congestive hyperaemia' continue. Although the advent of more accurate monitoring of pressures and flows within the brain has provided useful information to help understand some of these proposed pathological hypotheses, disagreement still exists. The purpose of this review is to examine the current physiological data in attempt to explain the clinicopathological manifestations of arteriovenous malformations of the brain and the consequences of their removal.
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Affiliation(s)
- M Morgan
- North and West Cerebrovascular Unit, Department of Surgery, The University of Sydney, Australia
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Gao E, Young WL, Pile-Spellman J, Ornstein E, Ma Q. Mathematical considerations for modeling cerebral blood flow autoregulation to systemic arterial pressure. THE AMERICAN JOURNAL OF PHYSIOLOGY 1998; 274:H1023-31. [PMID: 9530217 DOI: 10.1152/ajpheart.1998.274.3.h1023] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The shape of the autoregulation curve for cerebral blood flow (CBF) vs. pressure is depicted in a variety of ways to fit experimentally derived data. However, there is no general empirical description to reproduce CBF changes resulting from systemic arterial pressure variations that is consistent with the reported data. We analyzed previously reported experimental data used to construct autoregulation curves. To improve on existing portrayals of the fitting of the observed data, a compartmental model was developed for synthesis of the autoregulation curve. The resistive arterial and arteriolar network was simplified as an autoregulation device (ARD), which consists of four compartments in series controlling CBF. Each compartment consists of a group of identical vessels in parallel. The response of each vessel category to changes in perfusion pressure was simulated using reported experimental data. The CBF-pressure curve was calculated from the resistance of the ARD. The predicted autoregulation curve was consistent with reported experimental data. The lower and upper limits of autoregulation (LLA and ULA) were predicted as 69 and 153 mmHg, respectively. The average value of the slope of the CBF-pressure curve below LLA and beyond ULA was predicted as 1.3 and 3.3% change in CBF per mmHg, respectively. Our four-compartment ARD model, which simulated small arteries and arterioles, predicted an autoregulation function similar to experimental data with respect to the LLA, ULA, and average slopes of the autoregulation curve below LLA and above ULA.
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Affiliation(s)
- E Gao
- Department of Electrical Engineering, Columbia University, New York, New York 10032, USA
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