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Ballestero M, Dias C, Gomes ICN, Grisi LS, Cardoso RAM, Júnior ELZ, de Oliveira RS. Can a new noninvasive method for assessment of intracranial pressure predict intracranial hypertension and prognosis? Acta Neurochir (Wien) 2023; 165:1495-1503. [PMID: 37061612 PMCID: PMC10105611 DOI: 10.1007/s00701-023-05580-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/04/2023] [Indexed: 04/17/2023]
Abstract
PURPOSE Individuals with TBI are at risk of intracranial hypertension (ICH), and monitoring of intracranial pressure (ICP) is usually indicated. However, despite many new noninvasive devices, none is sufficiently accurate and effective for application in clinical practice, particularly in the management of TBIs. This study aimed to compare the noninvasive Brain4Care system (nICP) with invasive ICP (iICP) curve parameters in their ability to predict ICH and functional prognosis in severe TBI. METHODS Observational, descriptive-analytical, and prospective study of 22 patients between 2018 and 2021, simultaneously monitored with nICP and iICP. The independent variables evaluated were the presence of ICH and functional prognoses. The dependent variables were the P2/P1 pressure ratio metrics, time to peak (TTP), and TTP × P2/P1. RESULTS We found a good nonlinear correlation between iICP and nICP waveforms, despite a moderate Pearson's linear correlation. The noninvasive parameters of P2/P1, P2/P1 × TTP, and TTP were not associated with outcomes or ICH. The nICP P2/P1 ratio showed sensitivity/specificity/accuracy (%) of 100/0/56.3, respectively for 1-month outcomes and 77.8/22.2/50 for 6-month outcomes. The nICP TTP ratio had values of 100/0/56.3 for 1-month and 99.9/42.9/72.2 for 6-month outcomes. The nICP P2/P1 × TTP values were 100/0/56.3 for 1-month outcomes and 81.8/28.6/61.1 for 6-month outcomes. CONCLUSION Brain4Care's noninvasive method showed low specificity and accuracy and cannot be used as the sole means of monitoring ICP in patients with severe TBI. Future studies with a larger sample of patients with P2 > P1 and new nICP curve parameters are warranted.
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Affiliation(s)
- Matheus Ballestero
- Department of Medicine, Federal University of São Carlos, São Carlos, Brazil.
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
| | - Celeste Dias
- Hospital São João, University of Porto, Porto, Portugal
| | | | - Luca Soares Grisi
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Milanez MIO, Nishi EE, Mendes R, Rocha AA, Bergamaschi CT, Campos RR. Renal sympathetic activation triggered by the rostral ventrolateral medulla is dependent of spinal cord AT1 receptors in Goldblatt hypertensive rats. Peptides 2021; 146:170660. [PMID: 34571055 DOI: 10.1016/j.peptides.2021.170660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/30/2021] [Accepted: 09/22/2021] [Indexed: 11/20/2022]
Abstract
Spinal cord neurons contribute to elevated sympathetic vasomotor activity in renovascular hypertension (2K1C), particularly, increased actions of angiotensin II. However, the origin of these spinal angiotensinergic inputs remains unclear. The present study aimed to investigate the role of spinal angiotensin II type 1 receptor (AT1) receptors in the sympathoexcitatory responses evoked by the activation of the rostral ventrolateral medulla (RVLM) in control and 2K1C Goldblatt rats. Hypertension was induced by clipping of the left renal artery. After 6 weeks, a catheter (PE-10) filled with losartan was inserted into the subarachnoid space and advanced to the T10-11 vertebral level in urethane-anesthetized rats. The effects of glutamate microinjection into the RVLM on blood pressure (BP), heart rate (HR), and renal and splanchnic sympathetic nerve activity (rSNA and sSNA, respectively) were evaluated in the presence or absence of spinal AT1 blockade. Tachycardic, pressor, and renal sympathoexcitatory effects caused by RVLM activation were significantly blunted by losartan in 2K1C rats, but not in control rats. However, no differences were found in the gene expression of angiotensin-converting enzyme, angiotensinogen, and renin in the spinal cord segments between the groups. In conclusion, acute sympathoexcitation induced by RVLM activation is dependent on the spinal AT1 receptor in Goldblatt, but not in control, rats. The involvement of other central cardiovascular nuclei in spinal angiotensinergic actions, as well as the source of angiotensin II, remains to be determined in the Goldblatt model.
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Affiliation(s)
- Maycon I O Milanez
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Erika E Nishi
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Rodrigo Mendes
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Antônio A Rocha
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Cássia T Bergamaschi
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Ruy R Campos
- Cardiovascular Division, Department of Physiology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
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Mowry FE, Peaden SC, Stern JE, Biancardi VC. TLR4 and AT1R mediate blood-brain barrier disruption, neuroinflammation, and autonomic dysfunction in spontaneously hypertensive rats. Pharmacol Res 2021; 174:105877. [PMID: 34610452 PMCID: PMC8648989 DOI: 10.1016/j.phrs.2021.105877] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 01/23/2023]
Abstract
Angiotensin II (AngII) is implicated in neuroinflammation, blood-brain barrier (BBB) disruption, and autonomic dysfunction in hypertension. We have previously shown that exogenous AngII stimulates Toll-like receptor 4 (TLR4) via AngII type 1 receptor (AT1R), inducing activation of hypothalamic microglia ex vivo, and that AngII-AT1R signaling is necessary for the loss of BBB integrity in spontaneously hypertensive rats (SHRs). Herein, we hypothesized that microglial TLR4 and AT1R signaling interactions represent a crucial mechanistic link between AngII-mediated neuroinflammation and BBB disruption, thereby contributing to sympathoexcitation in SHRs. Male SHRs were treated with TAK-242 (TLR4 inhibitor; 2 weeks), Losartan (AT1R inhibitor; 4 weeks), or vehicle, and age-matched to control Wistar Kyoto rats (WKYs). TLR4 and AT1R inhibitions normalized increased TLR4, interleukin-6, and tumor necrosis factor-α protein densities in SHR cardioregulatory nuclei (hypothalamic paraventricular nucleus [PVN], rostral ventrolateral medulla [RVLM], and nucleus tractus solitarius [NTS]), and abolished enhanced microglial activation. PVN, RVLM, and NTS BBB permeability analyses revealed complete restoration after TAK-242 treatment, whereas SHRs presented with elevated dye leakage. Mean arterial pressure was normalized in Losartan-treated SHRs, and attenuated with TLR4 inhibition. In conscious assessments, TLR4 blockade rescued SHR baroreflex sensitivity to vasoactive drugs, and reduced the SHR pressor response to ganglionic blockade to normal levels. These data suggest that TLR4 activation plays a substantial role in mediating a feed-forward pro-hypertensive cycle involving BBB disruption, neuroinflammation, and autonomic dysfunction, and that TLR4-specific therapeutic interventions may represent viable alternatives in the treatment of hypertension.
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Affiliation(s)
- Francesca E Mowry
- Department of Anatomy, Physiology & Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA; Center for Neurosciences Initiative, Auburn University, Auburn, AL, USA
| | - Sarah C Peaden
- Department of Anatomy, Physiology & Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA
| | - Javier E Stern
- Center for Neuroinflammation, Georgia State University, Atlanta, GA, USA
| | - Vinicia C Biancardi
- Department of Anatomy, Physiology & Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, USA; Center for Neurosciences Initiative, Auburn University, Auburn, AL, USA.
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Losartan and Traumatic Brain Injury: Why Is a Retrospective Study Urgent? World Neurosurg 2021; 154:167-168. [PMID: 34583471 DOI: 10.1016/j.wneu.2021.07.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brasil S, Taccone FS, Wayhs SY, Tomazini BM, Annoni F, Fonseca S, Bassi E, Lucena B, Nogueira RDC, De-Lima-Oliveira M, Bor-Seng-Shu E, Paiva W, Turgeon AF, Jacobsen Teixeira M, Malbouisson LMS. Cerebral Hemodynamics and Intracranial Compliance Impairment in Critically Ill COVID-19 Patients: A Pilot Study. Brain Sci 2021; 11:874. [PMID: 34208937 PMCID: PMC8301789 DOI: 10.3390/brainsci11070874] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: One of the possible mechanisms by which the new coronavirus (SARS-Cov2) could induce brain damage is the impairment of cerebrovascular hemodynamics (CVH) and intracranial compliance (ICC) due to the elevation of intracranial pressure (ICP). The main objective of this study was to assess the presence of CVH and ICC alterations in patients with COVID-19 and evaluate their association with short-term clinical outcomes. Methods: Fifty consecutive critically ill COVID-19 patients were studied with transcranial Doppler (TCD) and non-invasive monitoring of ICC. Subjects were included upon ICU admission; CVH was evaluated using mean flow velocities in the middle cerebral arteries (mCBFV), pulsatility index (PI), and estimated cerebral perfusion pressure (eCPP), while ICC was assessed by using the P2/P1 ratio of the non-invasive ICP curve. A CVH/ICC score was computed using all these variables. The primary composite outcome was unsuccessful in weaning from respiratory support or death on day 7 (defined as UO). Results: At the first assessment (n = 50), only the P2/P1 ratio (median 1.20 [IQRs 1.00-1.28] vs. 1.00 [0.88-1.16]; p = 0.03) and eICP (14 [11-25] vs. 11 [7-15] mmHg; p = 0.01) were significantly higher among patients with an unfavorable outcome (UO) than others. Patients with UO had a significantly higher CVH/ICC score (9 [8-12] vs. 6 [5-7]; p < 0.001) than those with a favorable outcome; the area under the receiver operating curve (AUROC) for CVH/ICC score to predict UO was 0.86 (95% CIs 0.75-0.97); a score > 8.5 had 63 (46-77)% sensitivity and 87 (62-97)% specificity to predict UO. For those patients undergoing a second assessment (n = 29), after a median of 11 (5-31) days, all measured variables were similar between the two time-points. No differences in the measured variables between ICU non-survivors (n = 30) and survivors were observed. Conclusions: ICC impairment and CVH disturbances are often present in COVID-19 severe illness and could accurately predict an early poor outcome.
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Affiliation(s)
- Sérgio Brasil
- Division of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (S.Y.W.); (R.D.C.N.); (M.D.-L.-O.); (E.B.-S.-S.); (W.P.); (M.J.T.)
| | - Fabio Silvio Taccone
- Department of Intensive Care, Universitè Libre de Bruxelles, 1000 Brussels, Belgium; (F.S.T.); (F.A.)
| | - Sâmia Yasin Wayhs
- Division of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (S.Y.W.); (R.D.C.N.); (M.D.-L.-O.); (E.B.-S.-S.); (W.P.); (M.J.T.)
| | - Bruno Martins Tomazini
- Department of Intensive Care, Universidade de São Paulo, São Paulo 05403-000, Brazil; (B.M.T.); (S.F.); (E.B.); (B.L.); (L.M.S.M.)
| | - Filippo Annoni
- Department of Intensive Care, Universitè Libre de Bruxelles, 1000 Brussels, Belgium; (F.S.T.); (F.A.)
| | - Sérgio Fonseca
- Department of Intensive Care, Universidade de São Paulo, São Paulo 05403-000, Brazil; (B.M.T.); (S.F.); (E.B.); (B.L.); (L.M.S.M.)
| | - Estevão Bassi
- Department of Intensive Care, Universidade de São Paulo, São Paulo 05403-000, Brazil; (B.M.T.); (S.F.); (E.B.); (B.L.); (L.M.S.M.)
| | - Bruno Lucena
- Department of Intensive Care, Universidade de São Paulo, São Paulo 05403-000, Brazil; (B.M.T.); (S.F.); (E.B.); (B.L.); (L.M.S.M.)
| | - Ricardo De Carvalho Nogueira
- Division of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (S.Y.W.); (R.D.C.N.); (M.D.-L.-O.); (E.B.-S.-S.); (W.P.); (M.J.T.)
| | - Marcelo De-Lima-Oliveira
- Division of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (S.Y.W.); (R.D.C.N.); (M.D.-L.-O.); (E.B.-S.-S.); (W.P.); (M.J.T.)
| | - Edson Bor-Seng-Shu
- Division of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (S.Y.W.); (R.D.C.N.); (M.D.-L.-O.); (E.B.-S.-S.); (W.P.); (M.J.T.)
| | - Wellingson Paiva
- Division of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (S.Y.W.); (R.D.C.N.); (M.D.-L.-O.); (E.B.-S.-S.); (W.P.); (M.J.T.)
| | - Alexis Fournier Turgeon
- Division of Critical Care Medicine and the Department of Anesthesiology, Université Laval, Québec City, QC G1V 0A6, Canada;
| | - Manoel Jacobsen Teixeira
- Division of Neurosurgery, Department of Neurology, Universidade de São Paulo, São Paulo 05403-000, Brazil; (S.Y.W.); (R.D.C.N.); (M.D.-L.-O.); (E.B.-S.-S.); (W.P.); (M.J.T.)
| | - Luiz Marcelo Sá Malbouisson
- Department of Intensive Care, Universidade de São Paulo, São Paulo 05403-000, Brazil; (B.M.T.); (S.F.); (E.B.); (B.L.); (L.M.S.M.)
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Lucera GM, Menani JV, Colombari E, Colombari DSA. ANG II and Aldosterone Acting Centrally Participate in the Enhanced Sodium Intake in Water-Deprived Renovascular Hypertensive Rats. Front Pharmacol 2021; 12:679985. [PMID: 34113255 PMCID: PMC8186501 DOI: 10.3389/fphar.2021.679985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022] Open
Abstract
Renovascular hypertension is a type of secondary hypertension caused by renal artery stenosis, leading to an increase in the renin–angiotensin–aldosterone system (RAAS). Two-kidney, 1-clip (2K1C) is a model of renovascular hypertension in which rats have an increased sodium intake induced by water deprivation (WD), a common situation found in the nature. In addition, a high-sodium diet in 2K1C rats induces glomerular lesion. Therefore, the purpose of this study was to investigate whether angiotensin II (ANG II) and/or aldosterone participates in the increased sodium intake in 2K1C rats under WD. In addition, we also verified if central AT1 and mineralocorticoid receptor blockade would change the high levels of arterial pressure in water-replete (WR) and WD 2K1C rats, because blood pressure changes can facilitate or inhibit water and sodium intake. Finally, possible central areas activated during WD or WD followed by partial rehydration (PR) in 2K1C rats were also investigated. Male Holtzman rats (150–180 g) received a silver clip around the left renal artery to induce renovascular hypertension. Six weeks after renal surgery, a stainless-steel cannula was implanted in the lateral ventricle, followed by 5–7 days of recovery before starting tests. Losartan (AT1 receptor antagonist) injected intracerebroventricularly attenuated water intake during the thirst test. Either icv losartan or RU28318 (mineralocorticoid receptor antagonist) reduced 0.3 M NaCl intake, whereas the combination of losartan and RU28318 icv totally blocked 0.3 M NaCl intake induced by WD in 2K1C rats. Losartan and RU28318 icv did not change hypertension levels of normohydrated 2K1C rats, but reduced the increase in mean arterial pressure (MAP) produced by WD. c-Fos expression increased in the lamina terminalis and in the NTS in WD condition, and increased even more after WD-PR. These results suggest the participation of ANG II and aldosterone acting centrally in the enhanced sodium intake in WD 2K1C rats, and not in the maintenance of hypertension in satiated and fluid-replete 2K1C rats.
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Affiliation(s)
- Gabriela Maria Lucera
- Department of Physiology and Pathology, School of Dentistry, Sao Paulo State University, Araraquara, Brazil
| | - José Vanderlei Menani
- Department of Physiology and Pathology, School of Dentistry, Sao Paulo State University, Araraquara, Brazil
| | - Eduardo Colombari
- Department of Physiology and Pathology, School of Dentistry, Sao Paulo State University, Araraquara, Brazil
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