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Panesar H, Pelz G, Mansour D. Intercostal artery aneurysm presenting as a spontaneous hemothorax in a patient with neurofibromatosis. J Surg Case Rep 2024; 2024:rjad725. [PMID: 38487396 PMCID: PMC10937254 DOI: 10.1093/jscr/rjad725] [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: 09/06/2023] [Revised: 12/17/2023] [Indexed: 03/17/2024] Open
Abstract
Beyond the commonly known clinical presentation of neurofibromatosis, vascular pathologies are increasingly becoming a known complication. We present a case of a 41-year-old adult with neurofibromatosis type 1 who came with a right-sided spontaneous hemothorax due to a ruptured 13-mm fusiform aneurysm of the right posterior T9 intercostal artery. Patient underwent a transcatheter angiographic embolization with subsequent video-assisted thoracic surgery (VATS) for a retained hemothorax. Patient was discharged home on Hospital Day 5, and follow-up imaging demonstrated a complete resolution of the hemothorax. This presented case contributes to literature by demonstrating intra-arterial embolization as a viable option to obtain hemostasis in fragile vessels. However, this may not always result in hemostasis, and VATS should be considered to achieve and ensure complete hemostasis.
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Affiliation(s)
- Harsimran Panesar
- Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
- Department of Surgery, Morristown Medical Center, Morristown, NJ 07960, United States
| | - Geoffrey Pelz
- Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
- Division of Thoracic Surgery, Hackensack University Medical Center, Hackensack, NJ 07601, United States
| | - Daniel Mansour
- Hackensack Meridian School of Medicine, Nutley, NJ 07110, United States
- Division of Thoracic Surgery, Hackensack University Medical Center, Hackensack, NJ 07601, United States
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2
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Fan Y, Zhao M, Hao F, Sun R, Chen J, Liu J. Neuroprotective role of FOXA1 in Parkinson's disease: Involvements of NF1 transcription activation and MAPK signaling pathway inhibition. Brain Res Bull 2024; 206:110860. [PMID: 38143008 DOI: 10.1016/j.brainresbull.2023.110860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/07/2023] [Accepted: 12/20/2023] [Indexed: 12/26/2023]
Abstract
Forkhead box A1 (FOXA1), a member of the forkhead family of transcription factors, plays a crucial role in the development of various organ systems and exhibits neuroprotective properties. This study aims to investigate the effect of FOXA1 on Parkinson's disease (PD) and unravel the underlying mechanism. Transcriptome analysis of PD was conducted using three GEO datasets to identify aberrantly expressed genes. A mouse model of PD was generated by injecting neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine hydrochloride (MPTP), resulting in reduced FOXA1 expression. FOXA1 decline was also observed in 1-methyl-4-phenylpyridinium-treated SH-SY5Y cells. Artificial upregulation of FOXA1 improved motor abilities of mice according to rotarod and pole tests, and it mitigated tissue damage, cell loss, and neuronal damage in the mouse substantia nigra or in vitro. FOXA1 was found to bind to the neurofibromin 1 (NF1) promoter, thereby inducing its transcription and inactivating the mitogen-activated protein kinase (MAPK) signaling pathway. Further experimentation revealed that silencing NF1 in mice or SH-SY5Y cells counteracted the neuroprotective effects of FOXA1. In conclusion, this research suggests that FOXA1 activates NF1 transcription and inactivates the MAPK signaling pathway, ultimately ameliorating neuronal damage and motor disability in PD. The findings may offer novel ideas in the field of PD management.
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Affiliation(s)
- Yu Fan
- Department of Neurology, The Baotou Central Hospital, Baotou 014040, Inner Mongolia, PR China
| | - Meili Zhao
- Department of Neurology, The Baotou Central Hospital, Baotou 014040, Inner Mongolia, PR China
| | - Fei Hao
- Department of Neurology, The Baotou Central Hospital, Baotou 014040, Inner Mongolia, PR China
| | - Ruyi Sun
- Department of Neurology, The Baotou Central Hospital, Baotou 014040, Inner Mongolia, PR China
| | - Jinyu Chen
- Department of Neurology, The Baotou Central Hospital, Baotou 014040, Inner Mongolia, PR China
| | - Jiahui Liu
- Department of Neurology, The Baotou Central Hospital, Baotou 014040, Inner Mongolia, PR China.
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Agouridis AP, Palli N, Karagiorga VE, Konsoula A, Markaki L, Spernovasilis N, Tsioutis C. Statins in Children with Neurofibromatosis Type 1: A Systematic Review of Randomized Controlled Trials. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1556. [PMID: 37761518 PMCID: PMC10528298 DOI: 10.3390/children10091556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/26/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Statins, apart from their plasma-cholesterol-lowering ability, exert several pleiotropic effects, making them a potential treatment for other diseases. Animal studies have showed that statins, through the inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase, can affect the Ras/MAPK pathway, thus providing impetus to examine the efficacy of statins in the pediatric population with neurofibromatosis type 1 (NF1). We aimed to systematically address all relevant evidence of statin treatment in children with NF1. METHODS We searched PubMed and Cochrane Library resources up to 2 June 2023 for randomized controlled trials (RCTs) written in English and evaluating statins versus placebo in children with NF1 (PROSPERO registration number: CRD42023439424). RESULTS Seven RCTs were suitable to be included in this qualitative synthesis, with a total participation of 336 children with NF1. The duration of the studies ranged from 12 to 52 weeks. The mean age of the pediatric population was 10.9 years old. Three studies investigated the role of simvastatin, while four studies examined lovastatin. According to our analysis, neither simvastatin nor lovastatin improved cognitive function, full-scale intelligence, school performance, attention problems, or internalizing behavioral problems when compared with placebo in children with NF1. Statins were well tolerated in all included RCTs. CONCLUSION Although safe, current evidence demonstrates that statins exert no beneficial effect in cognitive function and behavioral problems in children with NF1.
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Affiliation(s)
- Aris P. Agouridis
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus; (N.P.); (C.T.)
- Department of Internal Medicine, German Oncology Center, 4108 Limassol, Cyprus
| | - Nikoletta Palli
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus; (N.P.); (C.T.)
| | | | - Afroditi Konsoula
- Department of Pediatrics, General Hospital of Sitia, 72300 Sitia, Greece;
| | - Lamprini Markaki
- “Iliaktida” Pediatric & Adolescents Medical Center, 4001 Limassol, Cyprus;
| | | | - Constantinos Tsioutis
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus; (N.P.); (C.T.)
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Lu YT, Rejiepu B, Zhang D, Cai DC, Yang KQ, Tian T, Zhou XL, Fan P. Childhood-Onset Refractory Hypertension Results from Neurofibromatosis Type 1 Caused by a Splicing NF1 Mutation. Kidney Blood Press Res 2023; 48:568-577. [PMID: 37562365 PMCID: PMC10614435 DOI: 10.1159/000533144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Neurofibromatosis type 1 (NF-1) is caused by mutations in the NF1 gene that encodes neurofibromin, a negative regulator of RAS proto-oncogene. Approximately one-third of the reported pathogenic mutations in NF1 are splicing mutations, but most consequences are unclear. The objective of this study was to identify the pathogenicity of splicing mutation in a Chinese family with NF-1 and determine the effects of the pre-mRNA splicing mutation by in vitro functional analysis. METHODS Next-generation sequencing was used to screen candidate mutations. We performed a minigene splicing assay to determine the effect of the splicing mutation on NF1 expression, and three-dimensional structure models of neurofibromin were generated using SWISS-MODEL and PROCHECK methods, respectively. RESULTS A pathogenic splicing mutation c.479+1G>C in NF1 was found in the proband characterized by childhood-onset refractory hypertension. In vitro analysis demonstrated that c.479+1G>C mutation caused the skipping of exon 4, leading to a glutamine-to-valine substitution at position 97 in neurofibromin and an open reading frame shift terminating at codon 108. Protein modeling showed that several major domains were missing in the truncated neurofibromin protein. CONCLUSION The splicing mutation c.479+1G>C identified in a Chinese patient with NF-1 and childhood-onset refractory hypertension caused the skipping of exon 4 and a truncated protein. Our findings offer new evidence for the molecular diagnosis of NF-1.
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Affiliation(s)
- Yi-Ting Lu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Buweimairemu Rejiepu
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Di Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong-Cheng Cai
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kun-Qi Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Tian
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xian-Liang Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peng Fan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Quantitative OCT angiography of the retinal and choroidal vascular circulation in pediatric patients with neurofibromatosis type 1. J AAPOS 2022; 26:189.e1-189.e6. [PMID: 35850368 DOI: 10.1016/j.jaapos.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/24/2022] [Accepted: 05/10/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate retinal and choroidal microvascular changes in neurofibromatosis type 1 (NF1) pediatric patients using optical coherence tomography angiography (OCTA). METHODS This study was performed on 21 eyes of 21 NF1 patients and 30 eyes of 30 healthy subjects. Foveal avascular zone (FAZ) parameters, including area, perimeter, acircularity index, and foveal density, were measured using OCTA. Superficial (SCP) and deep (DCP) capillary plexus and radial peripapillary capillary (RPC) vessel densities and choriocapillaris flow were also evaluated. Choroidal nodules and thickness were detected using infrared reflectance and enhanced-depth imaging OCT. RESULTS No significant differences were observed for FAZ parameters or SCP and RPC vessel densities between groups. DCP vessel densities in the perifovea were significantly lower in the NF1 group than in the control group (P = 0.001). A significantly lower choriocapillaris flow area (P < 0.001) and increased subfoveal and nasal perifoveal choroidal thickness (P < 0.001) were observed in the NF1 group. Choriocapillaris flow area tended to be inversely related to the number of choroidal nodules in the NF1 group. CONCLUSIONS Perifoveal DCP vessel density and choriocapillaris flow significantly differed between NF1 patients and controls, suggesting that retinal and choroidal vascular microcirculation is affected in the former, potentially by choroidal nodules. Further longitudinal studies are required to determine the effects of these differences on circulation in the posterior segment of the eye.
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6
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Huguenard AL, Gupta VP, Braverman AC, Dacey RG. Genetic and heritable considerations in patients or families with both intracranial and extracranial aneurysms. J Neurosurg 2021; 134:1999-2006. [PMID: 33386011 DOI: 10.3171/2020.8.jns203234] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anna L Huguenard
- 1Department of Neurosurgery, Washington University in St. Louis; and
| | - Vivek P Gupta
- 1Department of Neurosurgery, Washington University in St. Louis; and
| | - Alan C Braverman
- 2Cardiovascular Division, Department of Medicine, Washington University in St. Louis, Missouri
| | - Ralph G Dacey
- 1Department of Neurosurgery, Washington University in St. Louis; and
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7
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Konig MF, Sathiyakumar V, Phan CM, Schulman SP, Gelber AC. Inside and Out. N Engl J Med 2021; 384:1753-1760. [PMID: 33951365 PMCID: PMC9055568 DOI: 10.1056/nejmcps2034360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Maximilian F Konig
- From the Department of Medicine (M.F.K., V.S., S.P.S., A.C.G.), the Division of Rheumatology (M.F.K., A.C.G.), the Division of Cardiology (V.S., S.P.S.), the Division of Dermatopathology (C.M.P.), and the Department of Dermatology (C.M.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Vasanth Sathiyakumar
- From the Department of Medicine (M.F.K., V.S., S.P.S., A.C.G.), the Division of Rheumatology (M.F.K., A.C.G.), the Division of Cardiology (V.S., S.P.S.), the Division of Dermatopathology (C.M.P.), and the Department of Dermatology (C.M.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Casey M Phan
- From the Department of Medicine (M.F.K., V.S., S.P.S., A.C.G.), the Division of Rheumatology (M.F.K., A.C.G.), the Division of Cardiology (V.S., S.P.S.), the Division of Dermatopathology (C.M.P.), and the Department of Dermatology (C.M.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Steven P Schulman
- From the Department of Medicine (M.F.K., V.S., S.P.S., A.C.G.), the Division of Rheumatology (M.F.K., A.C.G.), the Division of Cardiology (V.S., S.P.S.), the Division of Dermatopathology (C.M.P.), and the Department of Dermatology (C.M.P.), Johns Hopkins University School of Medicine, Baltimore
| | - Allan C Gelber
- From the Department of Medicine (M.F.K., V.S., S.P.S., A.C.G.), the Division of Rheumatology (M.F.K., A.C.G.), the Division of Cardiology (V.S., S.P.S.), the Division of Dermatopathology (C.M.P.), and the Department of Dermatology (C.M.P.), Johns Hopkins University School of Medicine, Baltimore
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8
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Tritz R, Benson T, Harris V, Hudson FZ, Mintz J, Zhang H, Kennard S, Chen W, Stepp DW, Csanyi G, Belin de Chantemèle EJ, Weintraub NL, Stansfield BK. Nf1 heterozygous mice recapitulate the anthropometric and metabolic features of human neurofibromatosis type 1. Transl Res 2021; 228:52-63. [PMID: 32781282 PMCID: PMC7779711 DOI: 10.1016/j.trsl.2020.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 12/26/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a heritable cancer predisposition syndrome resulting from mutations in the NF1 tumor suppressor gene. Genotype-phenotype correlations for NF1 are rare due to the large number of NF1 mutations and role of modifier genes in manifestations of NF1; however, emerging reports suggest that persons with NF1 display a distinct anthropometric and metabolic phenotype featuring short stature, low body mass index, increased insulin sensitivity, and protection from diabetes. Nf1 heterozygous (Nf1+/-) mice accurately reflect the dominant inheritance of NF1 and are regularly employed as a model of NF1. Here, we sought to identify whether Nf1+/- mice recapitulate the anthropometric and metabolic features identified in persons with NF1. Littermate 16-20 week-old male wildtype (WT) and Nf1+/- C57B/6J mice underwent nuclear magnetic resonance (NMR), indirect calorimetry, and glucose/insulin/pyruvate tolerance testing. In some experiments, tissues were harvested for NMR and histologic characterization. Nf1+/- mice are leaner with significantly reduced visceral and subcutaneous fat mass, which corresponds with an increased density of small adipocytes and reduced leptin levels. Additionally, Nf1+/- mice are highly reliant on carbohydrates as an energy substrate and display increased glucose clearance and insulin sensitivity, but normal response to pyruvate suggesting enhanced glucose utilization and preserved gluconeogenesis. Finally, WT and Nf1+/- mice subjected to high glucose diet were protected from diet-induced obesity and hyperglycemia. Our data suggest that Nf1+/- mice closely recapitulate the anthropometric and metabolic phenotype identified in persons with NF1, which will impact the interpretation of previous and future translational studies of NF1.
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Affiliation(s)
- Rebekah Tritz
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Tyler Benson
- Vascular Biology Center, Augusta University, Augusta, Georgia
| | - Valerie Harris
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Farlyn Z Hudson
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - James Mintz
- Vascular Biology Center, Augusta University, Augusta, Georgia
| | - Hanfang Zhang
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Simone Kennard
- Vascular Biology Center, Augusta University, Augusta, Georgia
| | - Weiqin Chen
- Vascular Biology Center, Augusta University, Augusta, Georgia
| | - David W Stepp
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Gabor Csanyi
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pharmacology and Toxicology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Eric J Belin de Chantemèle
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Neal L Weintraub
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Brian K Stansfield
- Vascular Biology Center, Augusta University, Augusta, Georgia; Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia.
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Le S, Zhang H, Huang X, Chen S, Wu J, Chen S, Ding X, Chen S, Zhao J, Xu H, Cui J, Zou Y, Yu J, Jiang L, Wu J, Ye P, Xia J. PKM2 Activator TEPP-46 Attenuates Thoracic Aortic Aneurysm and Dissection by Inhibiting NLRP3 Inflammasome-Mediated IL-1β Secretion. J Cardiovasc Pharmacol Ther 2020; 25:364-376. [PMID: 32323562 DOI: 10.1177/1074248420919966] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The development of thoracic aortic aneurysm and dissection (TAAD) is mediated by inflammasome activation, which exacerbates the secretion of pro-inflammatory cytokines, chemokines, matrix metalloproteinases (MMPs), and reactive oxygen species (ROS). The glycolytic enzyme pyruvate kinase M2 (PKM2) has shown a protective role against various disorders with an inflammatory basis, such as sepsis, tumorigenesis, and diabetic nephropathy. However, its potential role in TAAD has not been investigated so far. APPROACH AND RESULTS We analyzed aortic tissues from TAAD patients and the β-aminopropionitrile fumarate (BAPN)-induced mouse model of TAAD and observed elevated levels of PKM2 in the aortic lesions of both. Treatment with the PKM2 activator TEPP-46 markedly attenuated the progression of TAAD in the mouse model as demonstrated by decreased morbidity and luminal diameter of the aorta. In addition, the thoracic aortas of the BAPN-induced mice showed reduced monocytes and macrophages infiltration and lower levels of IL-1β, MMPs, and ROS when treated with TEPP-46. Furthermore, TEPP-46 treatment also suppressed the activation of the NOD-like receptor (NLR) family and pyrin domain-containing protein 3 (NLRP3) inflammasome by downregulating p-STAT3 and HIF1-α. CONCLUSION Pyruvate kinase M2 plays a protective role in TAAD development, and its activation is a promising therapeutic strategy against the progression of TAAD.
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Affiliation(s)
- Sheng Le
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,The authers Sheng Le and Hao Zhang contributed equally to this article as first authors
| | - Hao Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,The authers Sheng Le and Hao Zhang contributed equally to this article as first authors
| | - Xiaofan Huang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shu Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Wu
- Key Laboratory for Molecular Diagnosis of Hubei Province, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Chen
- Key Laboratory for Molecular Diagnosis of Hubei Province, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - XiangChao Ding
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Zhao
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Xu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jikai Cui
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanqiang Zou
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jizhang Yu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lang Jiang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Wu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Ye
- Department of Cardiology, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahong Xia
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Multiple Cerebral Aneurysms Associated With Neurofibromatosis Type 1. J Stroke Cerebrovasc Dis 2019; 28:e83-e91. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/25/2019] [Accepted: 04/14/2019] [Indexed: 11/21/2022] Open
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Loss of GTPase activating protein neurofibromin stimulates paracrine cell communication via macropinocytosis. Redox Biol 2019; 27:101224. [PMID: 31201114 PMCID: PMC6859534 DOI: 10.1016/j.redox.2019.101224] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/26/2019] [Accepted: 05/16/2019] [Indexed: 12/28/2022] Open
Abstract
Neurofibromin, the protein product of the neurofibromatosis type 1 (NF1) tumor suppressor gene, is a negative regulator of Ras signaling. Patients with mutations in NF1 have a strong predisposition for cardiovascular disease, which contributes to their early mortality. Nf1 heterozygous (Nf1+/-) bone marrow to wild type chimeras and mice with heterozygous recombination of Nf1 in myeloid cells recapitulate many of the vascular phenotypes observed in Nf1+/- mutants. Although these results suggest that macrophages play a central role in NF1 vasculopathy, the underlying mechanisms are currently unknown. In the present study, we employed macrophages isolated from either Nf1+/- or Lysm Cre+/Nf1f/f mice to test the hypothesis that loss of Nf1 stimulates macropinocytosis in macrophages. Scanning electron microscopy and flow cytometry analysis of FITC-dextran internalization demonstrated that loss of Nf1 in macrophages stimulates macropinocytosis. We next utilized various cellular and molecular approaches, pharmacological inhibitors and genetically modified mice to identify the signaling mechanisms mediating macropinocytosis in Nf1-deficient macrophages. Our results indicate that loss of Nf1 stimulates PKCδ-mediated p47phox phosphorylation via RAS activation, leading to increased NADPH oxidase 2 activity, reactive oxygen species generation, membrane ruffling and macropinocytosis. Interestingly, we also found that Nf1-deficient macrophages internalize exosomes derived from angiotensin II-treated endothelial cells via macropinocytosis in vitro and in the peritoneal cavity in vivo. As a result of exosome internalization, Nf1-deficient macrophages polarized toward an inflammatory M1 phenotype and secreted increased levels of proinflammatory cytokines compared to controls. In conclusion, the findings of the present study demonstrate that loss of Nf1 stimulates paracrine endothelial to myeloid cell communication via macropinocytosis, leading to proinflammatory changes in recipient macrophages.
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Herath H, Yogendranathan N, Kulatunga A. A patient with neurofibromatosis type 1 presenting with bilateral frontal lobe infarctions following anterior communicating artery aneurysm rupture. SAGE Open Med Case Rep 2019; 7:2050313X19841151. [PMID: 31057798 PMCID: PMC6452425 DOI: 10.1177/2050313x19841151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 03/08/2019] [Indexed: 11/22/2022] Open
Abstract
Neurofibromatosis is a neurocutaneous genetic condition with dysplasia of the
mesodermal and ectodermal tissues. Vascular abnormalities are well recognized in
neurofibromatosis and cerebral aneurysms are rarely reported in literature.
Here, we present a 20-year-old Sri Lankan female presented with headache,
altered personality, disinhibited behaviour, and urinary incontinence. On
imaging, she was found to have infarctions of both frontal lobes and evidence of
a ruptured anterior communicating artery aneurysm with a small subarachnoid
haemorrhage. Another small middle cerebral artery aneurysm was also seen in the
angiogram. She was managed conservatively and gradually recovered. Because
aneurysms in neurofibromatosis are usually asymptomatic and as rupture of such
an aneurysm is rare, regular vascular screening is not recommended to all
patients with neurofibromatosis. This is the first case report in literature in
which a patient with neurofibromatosis presented with infarctions of both
frontal lobes due to rupture of an anterior communicating artery aneurysm.
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Affiliation(s)
- Hmmtb Herath
- The National Hospital of Sri Lanka, Colombo, Sri Lanka
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13
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Zhang H, Hudson FZ, Xu Z, Tritz R, Rojas M, Patel C, Haigh SB, Bordán Z, Ingram DA, Fulton DJ, Weintraub NL, Caldwell RB, Stansfield BK. Neurofibromin Deficiency Induces Endothelial Cell Proliferation and Retinal Neovascularization. Invest Ophthalmol Vis Sci 2019; 59:2520-2528. [PMID: 29847659 PMCID: PMC5963003 DOI: 10.1167/iovs.17-22588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose Neurofibromatosis type 1 (NF1) is the result of inherited mutations in the NF1 tumor suppressor gene, which encodes the protein neurofibromin. Eye manifestations are common in NF1 with recent reports describing a vascular dysplasia in the retina and choroid. Common features of NF1 retinopathy include tortuous and dilated feeder vessels that terminate in capillary tufts, increased endothelial permeability, and neovascularization. Given the retinal vascular phenotype observed in persons with NF1, we hypothesize that preserving neurofibromin may be a novel strategy to control pathologic retinal neovascularization. Methods Nf1 expression in human endothelial cells (EC) was reduced using small hairpin (sh) RNA and EC proliferation, migration, and capacity to form vessel-like networks were assessed in response to VEGF and hypoxia. Wild-type (WT), Nf1 heterozygous (Nf1+/−), and Nf1flox/+;Tie2cre pups were subjected to hyperoxia/hypoxia using the oxygen-induced retinopathy model. Retinas were analyzed quantitatively for extent of retinal vessel dropout, neovascularization, and capillary branching. Results Neurofibromin expression was suppressed in response to VEGF, which corresponded with activation of Mek-Erk and PI3-K-Akt signaling. Neurofibromin-deficient EC exhibited enhanced proliferation and network formation in response to VEGF and hypoxia via an Akt-dependent mechanism. In response to hyperoxia/hypoxia, Nf1+/− retinas exhibited increased vessel dropout and neovascularization when compared with WT retinas. Neovascularization was similar between Nf1+/− and Nf1flox/+;Tie2cre retinas, but capillary drop out in Nf1flox/+;Tie2cre retinas was significantly reduced when compared with Nf1+/− retinas. Conclusions These data suggest that neurofibromin expression is essential for controlling endothelial cell proliferation and retinal neovascularization and therapies targeting neurofibromin-deficient EC may be beneficial.
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Affiliation(s)
- Hanfang Zhang
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, Georgia, United States.,Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Farlyn Z Hudson
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, Georgia, United States.,Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Zhimin Xu
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Rebekah Tritz
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, Georgia, United States.,Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Modesto Rojas
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States.,Department of Pharmacology and Toxicology, Augusta University, Augusta, Georgia, United States
| | - Chintan Patel
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Stephen B Haigh
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - Zsuzsanna Bordán
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States
| | - David A Ingram
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, Indiana, United States.,Department of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - David J Fulton
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States.,Department of Pharmacology and Toxicology, Augusta University, Augusta, Georgia, United States
| | - Neal L Weintraub
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States.,Department of Cardiology, Augusta University, Augusta, Georgia, United States
| | - Ruth B Caldwell
- Vascular Biology Center, Augusta University, Augusta, Georgia, United States.,Vision Discovery Institute, Augusta University, Augusta, Georgia, United States.,Department of Cellular Biology and Anatomy, Augusta University, Augusta, Georgia, United States.,Charlie Norwood VA Medical Center, Augusta, Georgia, United States
| | - Brian K Stansfield
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, Georgia, United States.,Vascular Biology Center, Augusta University, Augusta, Georgia, United States.,Vision Discovery Institute, Augusta University, Augusta, Georgia, United States
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14
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Wang J, Zhou Y, Wu S, Huang K, Thapa S, Tao L, Wang J, Shen Y, Wang J, Xue Y, Ji K. Astragaloside IV Attenuated 3,4-Benzopyrene-Induced Abdominal Aortic Aneurysm by Ameliorating Macrophage-Mediated Inflammation. Front Pharmacol 2018; 9:496. [PMID: 29872394 PMCID: PMC5972279 DOI: 10.3389/fphar.2018.00496] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 04/26/2018] [Indexed: 01/16/2023] Open
Abstract
Abdominal aortic aneurysm (AAA), characterized by macrophage infiltration-mediated inflammation and oxidative stress, is a potentially fatal disease. Astragaloside IV (AS-IV) has been acknowledged to exhibit antioxidant and anti-inflammatory properties. This study was designed to investigate the protective effect of AS-IV against AAA formation induced by 3,4-benzopyrene (Bap) and angiotensin II (Ang II), and to explore probable mechanisms. Results showed that AS-IV decreased AAA formation, and reduced macrophage infiltration and expression of matrix metalloproteinase. Furthermore, AS-IV abrogated Bap-/Ang II-induced NF-κB activation and oxidative stress. In vitro, AS-IV inhibition of macrophage activation and NF-κB was correlated with increased phosphorylation of phosphatidylinositol 3-kinase (PI3-K)/AKT. Together, our findings suggest that AS-IV has potential as an intervention in the formation of AAA.
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Affiliation(s)
- Jiaoni Wang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingying Zhou
- Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shaoze Wu
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kaiyu Huang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Saroj Thapa
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Luyuan Tao
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Wang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yigen Shen
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinsheng Wang
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yangjing Xue
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kangting Ji
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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15
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Takeshima Y, Ohmori Y, Nakagawa T, Kaku Y, Kuratsu JI, Yano S. Subarachnoid Hemorrhage Because of Distal Superior Cerebellar Artery Dissection in Neurofibromatosis Type 1. World Neurosurg 2017. [PMID: 28625904 DOI: 10.1016/j.wneu.2017.06.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is a rare disease with an incidence of 1 in every 3000 births. Numerous studies have focused on the main function of NF1 as a tumor suppressor, whereas few have examined the cerebrovascular abnormalities observed in patients with NF1. It is worth noting that intracranial aneurysms are uncommon in this condition. CASE DESCRIPTION We report a case of NF1 with a dissection of the distal segment of the superior cerebellar artery. A 36-year-old woman presented with a distal superior cerebellar artery (SCA) dissection causing subarachnoid hemorrhage. Subsequently, because of the rich collateral blood flow distal to the dissection, N-butyl cyanoacrylate (NBCA) glue embolization was unsuccessful. Therefore, direct trapping of the artery was necessary. The patient was discharged after an uneventful postoperative period, and has remained without complications. CONCLUSIONS In the treatment of subarachnoid hemorrhage because of a distal SCA dissection in patients with NF1, NBCA glue embolization may be a safer option than microsurgery or coil embolization, in the acute phase, considering the possible vulnerability of the vessel wall, accessibility, morphology of the lesions, and the risk of developing unpredictable infarcts in the case of parent artery occlusion. However, regular reevaluation of the blood flow is necessary to monitor recurrence, given the rich collateral circulation.
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Affiliation(s)
- Yuki Takeshima
- Department of Neurosurgery, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan.
| | - Yuki Ohmori
- Department of Neurosurgery, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Takashi Nakagawa
- Department of Neurosurgery, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Yasuyuki Kaku
- Department of Neurosurgery, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Jun-Ichi Kuratsu
- Department of Neurosurgery, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
| | - Shigetoshi Yano
- Department of Neurosurgery, Kumamoto University Graduate School of Medical Science, Kumamoto, Japan
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16
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Genetic and Epigenetic Regulation of Aortic Aneurysms. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7268521. [PMID: 28116311 PMCID: PMC5237727 DOI: 10.1155/2017/7268521] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/15/2016] [Indexed: 02/07/2023]
Abstract
Aneurysms are characterized by structural deterioration of the vascular wall leading to progressive dilatation and, potentially, rupture of the aorta. While aortic aneurysms often remain clinically silent, the morbidity and mortality associated with aneurysm expansion and rupture are considerable. Over 13,000 deaths annually in the United States are attributable to aortic aneurysm rupture with less than 1 in 3 persons with aortic aneurysm rupture surviving to surgical intervention. Environmental and epidemiologic risk factors including smoking, male gender, hypertension, older age, dyslipidemia, atherosclerosis, and family history are highly associated with abdominal aortic aneurysms, while heritable genetic mutations are commonly associated with aneurysms of the thoracic aorta. Similar to other forms of cardiovascular disease, family history, genetic variation, and heritable mutations modify the risk of aortic aneurysm formation and provide mechanistic insight into the pathogenesis of human aortic aneurysms. This review will examine the relationship between heritable genetic and epigenetic influences on thoracic and abdominal aortic aneurysm formation and rupture.
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17
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Bessler WK, Hudson FZ, Zhang H, Harris V, Wang Y, Mund JA, Downing B, Ingram DA, Case J, Fulton DJ, Stansfield BK. Neurofibromin is a novel regulator of Ras-induced reactive oxygen species production in mice and humans. Free Radic Biol Med 2016; 97:212-222. [PMID: 27266634 PMCID: PMC5765860 DOI: 10.1016/j.freeradbiomed.2016.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/25/2016] [Accepted: 06/02/2016] [Indexed: 12/22/2022]
Abstract
Neurofibromatosis type 1 (NF1) predisposes individuals to early and debilitating cardiovascular disease. Loss of function mutations in the NF1 tumor suppressor gene, which encodes the protein neurofibromin, leads to accelerated p21(Ras) activity and phosphorylation of multiple downstream kinases, including Erk and Akt. Nf1 heterozygous (Nf1(+/-)) mice develop a robust neointima that mimics human disease. Monocytes/macrophages play a central role in NF1 arterial stenosis as Nf1 mutations in myeloid cells alone are sufficient to reproduce the enhanced neointima observed in Nf1(+/-) mice. Though the molecular mechanisms underlying NF1 arterial stenosis remain elusive, macrophages are important producers of reactive oxygen species (ROS) and Ras activity directly regulates ROS production. Here, we use compound mutant and lineage-restricted mice to demonstrate that Nf1(+/-) macrophages produce excessive ROS, which enhance Nf1(+/-) smooth muscle cell proliferation in vitro and in vivo. Further, use of a specific NADPH oxidase-2 inhibitor to limit ROS production prevents neointima formation in Nf1(+/-) mice. Finally, mononuclear cells from asymptomatic NF1 patients have increased oxidative DNA damage, an indicator of chronic exposure to oxidative stress. These data provide genetic and pharmacologic evidence that excessive exposure to oxidant species underlie NF1 arterial stenosis and provide a platform for designing novels therapies and interventions.
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Affiliation(s)
- Waylan K Bessler
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis 46202, United States; Department of Pediatrics and Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis 46202, United States; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis 46202, United States
| | - Farlyn Z Hudson
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, GA 30912, United States; Vascular Biology Center, Augusta University, Augusta, GA 30912, United States
| | - Hanfang Zhang
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, GA 30912, United States; Vascular Biology Center, Augusta University, Augusta, GA 30912, United States
| | - Valerie Harris
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, GA 30912, United States; Vascular Biology Center, Augusta University, Augusta, GA 30912, United States
| | - Yusi Wang
- Vascular Biology Center, Augusta University, Augusta, GA 30912, United States; Department of Pharmacology and Toxicology, Augusta University, Augusta, GA 30912, United States
| | - Julie A Mund
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis 46202, United States; Department of Pediatrics and Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis 46202, United States; Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis 46202, United States
| | - Brandon Downing
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis 46202, United States; Department of Pediatrics and Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis 46202, United States
| | - David A Ingram
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis 46202, United States; Department of Pediatrics and Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis 46202, United States; Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis 46202, United States
| | - Jamie Case
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis 46202, United States; Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis 46202, United States; Scripps Clinic Medical Group, Center for Organ and Cell Transplantation, La Jolla, CA 92037, United States
| | - David J Fulton
- Vascular Biology Center, Augusta University, Augusta, GA 30912, United States; Department of Pharmacology and Toxicology, Augusta University, Augusta, GA 30912, United States
| | - Brian K Stansfield
- Department of Pediatrics and Neonatal-Perinatal Medicine, Augusta University, Augusta, GA 30912, United States; Vascular Biology Center, Augusta University, Augusta, GA 30912, United States.
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18
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Shibahara I, Watanabe T, Ezura M, Inoue T, Fujimura M, Kimura N, Inoue T, Suzuki I, Nishino A, Nishimura S, Uenohara H, Tominaga T. Clinical features of subarachnoid hemorrhage in patients with positive cancer history. J Neurooncol 2016; 128:129-136. [DOI: 10.1007/s11060-016-2085-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
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19
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Waheed W, Nathan MH, Allen GB, Borden NM, Babi MA, Tandan R. Neurofibromatosis 1-associated panhypopituitarism presenting as hypoglycaemic seizures and stroke-like symptoms. BMJ Case Rep 2015; 2015:bcr-2015-210816. [PMID: 26531733 DOI: 10.1136/bcr-2015-210816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 37-year-old man with a known history of neurofibromatosis 1 (NF1) presented within 2 days of diarrhoeal illness followed by encephalopathy, facial twitching, hypoglycaemia, hypotension, tachycardia and low-grade fever. Examination showed multiple café-au-lait spots and neurofibromas over the trunk, arms and legs and receptive aphasia with right homonymous hemianopia, which resolved. Workup for cardiac, inflammatory and infectious aetiologies was unrevealing. A brain MRI showed gyral swelling with increased T2 fluid-attenuated inversion recovery signal and diffusion restriction in the left cerebral cortex. Neuroendocrine findings suggested panhypopituitarism with centrally derived adrenal insufficiency. Supportive treatment, hormone supplementation, antibiotics, antivirals and levetiracetam yielded clinical improvement. A follow-up brain MRI showed focal left parieto-occipital atrophy with findings of cortical laminar necrosis. In conclusion, we describe a case of NF1-associated panhypopituitarism presenting as hypoglycaemic seizures and stroke-like findings, hitherto unreported manifestations of NF1. Prompt recognition and treatment of these associated conditions can prevent devastating complications.
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Affiliation(s)
- Waqar Waheed
- Department of Neurological sciences, University of Vermont, Burlington, Vermont, USA
| | - Muriel H Nathan
- Division of Endocrinology, Department of Medicine, University of Vermont College of Medicine, South Burlington, Vermont, USA
| | - Gilman B Allen
- Division of Pulmonary & Critical Care, Department of Medicine, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Neil M Borden
- Department of Radiology, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - M Ali Babi
- Department of Neurological sciences, University of Vermont, Burlington, Vermont, USA
| | - Rup Tandan
- Department of Neurological sciences, University of Vermont, Burlington, Vermont, USA
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20
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Wang KC, Li YH, Shi GY, Tsai HW, Luo CY, Cheng MH, Ma CY, Hsu YY, Cheng TL, Chang BI, Lai CH, Wu HL. Membrane-Bound Thrombomodulin Regulates Macrophage Inflammation in Abdominal Aortic Aneurysm. Arterioscler Thromb Vasc Biol 2015; 35:2412-22. [DOI: 10.1161/atvbaha.115.305529] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 08/18/2015] [Indexed: 01/30/2023]
Abstract
Objective—
Thrombomodulin (TM), a glycoprotein constitutively expressed in the endothelium, is well known for its anticoagulant and anti-inflammatory properties. Paradoxically, we recently found that monocytic membrane-bound TM (ie, endogenous TM expression in monocytes) triggers lipopolysaccharide- and gram-negative bacteria–induced inflammatory responses. However, the significance of membrane-bound TM in chronic sterile vascular inflammation and the development of abdominal aortic aneurysm (AAA) remains undetermined.
Approach and Results—
Implicating a potential role for membrane-bound TM in AAA, we found that TM signals were predominantly localized to macrophages and vascular smooth muscle cells in human aneurysm specimens. Characterization of the CaCl
2
-induced AAA in mice revealed that during aneurysm development, TM expression was mainly localized in infiltrating macrophages and vascular smooth muscle cells. To investigate the function of membrane-bound TM in vivo, transgenic mice with myeloid- (LysMcre/TM
flox/flox
) and vascular smooth muscle cell–specific (SM22-cre
tg
/TM
flox/flox
) TM ablation and their respective wild-type controls (TM
flox/flox
and SM22-cre
tg
/TM
+/+
) were generated. In the mouse CaCl
2
-induced AAA model, deficiency of myeloid TM, but not vascular smooth muscle cell TM, inhibited macrophage accumulation, attenuated proinflammatory cytokine and matrix metalloproteinase-9 production, and finally mitigated elastin destruction and aortic dilatation. In vitro TM-deficient monocytes/macrophages, versus TM wild-type counterparts, exhibited attenuation of proinflammatory mediator expression, adhesion to endothelial cells, and generation of reactive oxygen species. Consistently, myeloid TM–deficient hyperlipidemic mice (ApoE
−/−
/LysMcre/TM
flox/flox
) were resistant to AAA formation induced by angiotensin II infusion, along with reduced macrophage infiltration, suppressed matrix metalloproteinase activities, and diminished oxidative stress.
Conclusions—
Membrane-bound TM in macrophages plays an essential role in the development of AAA by enhancing proinflammatory mediator elaboration, macrophage recruitment, and oxidative stress.
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Affiliation(s)
- Kuan-Chieh Wang
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Yi-Heng Li
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Guey-Yueh Shi
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Hung-Wen Tsai
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Chawn-Yau Luo
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Min-Hua Cheng
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Chih-Yuan Ma
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Yun-Yan Hsu
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Tsung-Lin Cheng
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Bi-Ing Chang
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Chao-Han Lai
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
| | - Hua-Lin Wu
- From the Department of Biochemistry and Molecular Biology (K.-C.W., G.-Y.S., M.-H.C., C.-Y.M., Y.-Y.H., B.-I.C., H.-L.W.), Institute of Basic Medical Sciences (K.-C.W.), Cardiovascular Research Center (K.-C.W., Y.-H.L., G.-Y.S., C.-Y.L., C.-Y.M., Y.-Y.H., B.-I.C., C.-H.L., H.-L.W.), Department of Internal Medicine (Y.-H.L.), Department of Pathology (H.-W.T.), and Department of Surgery (C.-Y.L., C.-H.L.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University,
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Trachet B, Fraga-Silva RA, Jacquet PA, Stergiopulos N, Segers P. Incidence, severity, mortality, and confounding factors for dissecting AAA detection in angiotensin II-infused mice: a meta-analysis. Cardiovasc Res 2015; 108:159-70. [PMID: 26307626 DOI: 10.1093/cvr/cvv215] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/25/2015] [Indexed: 01/25/2023] Open
Abstract
AIMS While angiotensin II-infused mice are the most popular model for preclinical aneurysm research, representative data on incidence, severity, and mortality of dissecting abdominal aortic aneurysms (AAAs) have never been established, and the influence of confounding factors is unknown. METHODS AND RESULTS We performed a meta-analysis including 194 manuscripts representing 1679 saline-infused, 4729 non-treated angiotensin II-infused, and 4057 treated angiotensin II-infused mice. Incidence (60%) and mortality (20%) rates are reported overall as well as for grade I (22%), grade II (26%), grade III (29%), and grade IV (24%) aneurysms. Dissecting AAA incidence was significantly (P < 0.05) influenced by sex, age, genetic background, infusion time, and dose of angiotensin II. Mortality was influenced by sex, genetic background, and dose, but not by age or infusion time. Surprisingly, both incidence and mortality were significantly different (P < 0.05) when comparing angiotensin II-infused mice in descriptive studies (56% incidence and 19% mortality) with angiotensin II-infused mice that served as control animals in treatment studies designed to either enhance (35% incidence and 13% mortality) or reduce (73% incidence and 25% mortality) dissecting AAA formation. After stratification to account for confounding factors (selection bias), the observed effect was still present for incidence, but not for mortality. Possible underlying causes are detection bias (non-uniform definition for detection and quantification of dissecting AAA in mice) or publication bias (studies with negative results, related to incidence in the control group, not being published). CONCLUSIONS Our data provide a new meta-analysis-based reference for incidence and mortality of dissecting AAA in angiotensin II-infused mice, and indicate that treatment studies using this mouse model should be interpreted with caution.
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Affiliation(s)
- Bram Trachet
- IBiTech - bioMMeda, Ghent University-iMinds Medical IT, Ghent, Belgium Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Rodrigo A Fraga-Silva
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Philippe A Jacquet
- Bioinformatics and Biostatistics Core Facility, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Nikolaos Stergiopulos
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Patrick Segers
- IBiTech - bioMMeda, Ghent University-iMinds Medical IT, Ghent, Belgium
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Epstein JA, Ingram DA, Hirbe AC, Gutmann DH. A multidisciplinary approach in neurofibromatosis 1--authors' reply. Lancet Neurol 2015; 14:30-1. [PMID: 25496893 DOI: 10.1016/s1474-4422(14)70298-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Jonathan A Epstein
- Department of Cell and Developmental Biology, The Institute for Regenerative Medicine and the Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David A Ingram
- Department of Pediatrics and Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Angela C Hirbe
- Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA.
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Abstract
Neurofibromatosis type 1 is a relatively common inherited disorder. Patients have a high predisposition to develop both benign and malignant tumours. Although many manifestations of neurofibromatosis type 1 affect the nervous system, other organs and tissues can also be affected. Because of the varying features and clinical heterogeneity inherent to this disorder, patients can present to different medical and surgical specialists and, therefore, the association of clinical symptoms with neurofibromatosis type 1 might not be appreciated. Thus, for prompt diagnosis and to provide optimum care for patients with neurofibromatosis type 1, clinicians must be aware of the diverse clinical features of this disorder. We advocate a multidisciplinary approach to care, entailing a dedicated team of specialists throughout the lifetime of the patient. As our understanding of this disorder deepens through basic laboratory and clinical investigations, swift implementation of new effective treatments becomes feasible.
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Affiliation(s)
- Angela C Hirbe
- Department of Medicine, Washington University School of Medicine, St Louis, MO 63110, USA
| | - David H Gutmann
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA.
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